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Home My WebLink About0320 STEVENS STREET (6) f � 320 STEVENS STREET • p \ \ N Y nN�➢��n I)EXISTING VTILITIEB WHERE SHOWN IN ME ORA EI ARE APPRO%INANE.LOCATIONS AND ELEVATIONS Cl THEIR ARWND Y OR T ARE TMTL FAOM RECORD PLANS THE ENGINEER DOES / NOT GURTHE C MEW ACCURACY OR THAT ALL UTILITIES MT 41185OCXHN STRUCTURES ARE // 2 �' \ - CIO V A A THE EWPR ME LONMACTON SHALL 6E RP CON—CHON Y—CIEE FOR PROP-1FE LOCATING AND COGDINATINIE �MAINTAINING ME EXISTING UT TY BYSTEMS IN BERNCE.OR`—6yALL BEE APPIUCABLE UNOTIFITY fD PERS THE STALE ON YASSAGMUSETT9 STANIE LXARIER e2,SEGRON AOB AL TEL19e436e�22J.LTHE CONTRACTOR SHALL VERIFT SIZE LOCATION AND NPERTB OF UTILITIE5 AND BYR—RES AS REOURTED PNON TH E E START W CONSTRUCTION. i ryy / H \ \ N 2)PROPOSED CM.WATER AND ELECMD CONNECTIONS VOW ME SCHEMATIC ONLY.R AI umTY DESIGN BY BE DETERMINED BY ME APPROPRIATE UTILITY COMPANY.WATER LINE NSYN—ON PER TMwN OF BARNSTABLE WATER CEPARTNENT RULES AND—CATIONS '% It 3)—MANHOLES AND FRAMES AND COVERS TO BE H-20 LOADW0. )SEE PLANB ENTITLED'SITE PLANS.TOO MAW STREET'PREPAR ED BY BSC GROUP.INC.FGI W SE R INFORMATION TO MAIN STREET. —————— IX \yam g PROFESSIONAL ENGINEER DiiE SITE PLAN 350 STEVENS STREET HYANNIS MASSACHUSETTS mN �\ / f �' S � � � � � •_\ b \\ (BARNSTABLE COUNT'/) J / o� UTILITY o�, � x z / \ \\ PLAN I'aii�:"Ia ° 'a . DECEMBER 12,2005 g . AI ER , ' - • "i0 •nn I RE,BvoNS: Rd __ NO. DATE TE DESC. w l ✓IN L +` 1 12/21/05 REV.PER TOWN COMN£NE N 0T•2 22•E / W W W . Ya sy L IM DIP Br I"-------ll n �yI'L --S'--r- A co z n ➢ mvw�Aw: ye 11 m e A _ o N Z N GINSBERC ABSET MANAGEMENT LLC h '0 N-N r• m P.O.BOX 901 'O tNn W.BARNS7ABLE,MA n BSC GROUP P I a ? 657 MRID Sveet(Rout.28) West V.rm.um.Massachusetts 02673 _ 508 778 8919 I 'It i 548,6C PROM. I.. YO.: O y SO W— • I •—• Q M—.—. —W—v . -MAN . a W fIELD: D.W.LO.J.NCCMIIN STEVENS STREET iT.` aD✓°swDI Y.oBB OMYM: M.OIBB G"E`N`RG"I"I"A1' —®.———— a„=wN-u. Nwa+—— a..—w.—I.. aN•—o-M—wrv— nLE: ABeeB-unuTr.Dwo owc.NO: *k' SN[EI a of e ee,e.oD it 3 i .Ni".7`-. ' .DVANTA 4/r E v CONTRACTOR FINAL AFFIDAVIT i Wednesday,November 30,2011 PROJECT: CONTRACT FOR: General Construction Flagship Condos Phase II ;E.CONTRACT DATE: March 01,2011 320 Stcvens Street] Hyannis,MA OWNER: GENERAL CONTRACTOR: Flagship Estates Hyannis,LLC Advantage Construction Two Adams Place,Suite 100 Two Adams Place,Suite 100 Quincy,MA,02169 Quincy,MA,02169 PROJECT OR PORTION OF THE PROJECT DESIGNATED FOR USE SHALL INCLUDE: Five(5)residential units in the"G"Building T G-1 permit#201105027 G-2 permit#201105028 G-3 permit#201105030. ° G-4 permit#201105029 G-5 permit#201105031 The Work performed under this Contract has been reviewed and found to be in accordance with the 8s'Edition MSBC to the Design Builder's best knowledge,information and belief,to be substantially complete. Substantial Completion is.the stage in the progress of the Work when the Work or designated portion is sufficiently complete in accordance with the Contract Documents so that the , Owner can occupy or utilize the Work for its intended use. The date of Substantial Completion of the Project or portion designated above is the date of issuance established by this Certificate,which is also the date of commencement of applicable warranties required by the Contract Document,except as stated below: WARRANTY: One Calendar Year from Date f Commencement ' BY: oC.Kelly 4,,hiden t tA vantage Construction,Inc. Two Adams Place Suite-100 Quincy,MA 02169 RKfug; Project Name: Flagship Estates—Building G" Project 1040 Project Location: 350 Stevens Street Date: Nov. 3ta, 2011 Hyannis,MA Project Description Interior Fit-Out Residential Condominium Project Permit# G-1 201105027 G-2 201105028 G-3 201105030 G-4 201105029 G-5 201105031 To the building commissioner of the city/town of Hyannis, in accordance with The International Building Code—2009 Edition, I,Wayne E. Benson Jr, Registration No. 10731, being a registered Professional engineer/architect in the following discipline: ARCHITECTURAL ® STRUCTURAL ❑ MECHANICAL 171 FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER ❑ For the above named project and hereby certify that the following services were carried out by me,or by a representative directly supervised by me: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit,and approval for s conformance to the design concept. 2. Review of the quality procedures for all code-required controlled materials. B 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards. To the best of my Knowledge, information and belief the work has been completed in accordan Vkh the documents approved-for the building permit. ® \ ED ARCyl Therefore, I request a Certificate of Occupancy be issued for the above address. �k�' 0SON rFo y p No. 10731 g, NORTH EASTON, C . GNAT E Seal: 0ti� MA G�Ty OF MPS SS: On this 318t day of November, 2011 AD before me, the undersigned notary public personally appeared Wayne E. Benson,Jr., proven to me through satisfactory evidence of identification,which were MA State Driver's License, to be the person whose name is signed on the preceding or attached j document in my presence. (Notary Public) ' My ission expires: l U/l/�1, �( '• /2011.11.31 Final Affidavit.docx QAViO DIEH$NER - MY�Ga�one i i _ .. x b n ,n a k .x� sy ` - is .1 i k t f .+' y a.r 4 •. , 1 / - t � D _4.1 Q., . _ ,_.. , __ _ .,,�_. —, I , � + }.. Yr < Y L K a Structural. "Engineering ' x - e. fib: ' ' a m _ r - III STRUCTURAL FINAL AFFEDA�IT FOR CONS'I`RUCTION�CONTROL , - 3 y*= S, c - E y A r F F x TO Donald O'Aleill yt �/` r t w xv i iw` F`^ j - s F^wr i- Advantage Construction Two Adams Place, Suite 1.00 ` y - Quincy,MA 02169 `{ i t v N 1 y �- s: k< '.� ._., .�. f - y RE Hyannis Condominiums w �, h � i� BuRding=G 1 _ 700 N1ain.Street T ` kiyann�s,N1A , PROJECTNO FC#0569 ' v. _ �: DATE: November 28 2011 a o w ,.. 9 ? F F _ . _ _ - a: + - - '...' - _. - 3 To the Building'Commssiori"er - f In accordance with Section llG 0 of the`Massachus, State Buald�ng Code,this letter shalt serve as a Frnal Affidavit for the above-referenced building and;that toahe best of my knowiedge;.the provisions of the build'ng code have been complied with and the area of jwork meets the requirements of the construction documents > r; 4 - ` s — 7 y nc Y Y zy �F ea 1'S �' K h - �.. - S {A� f i ` - ftoon , = % Lic..#42868 N0`�� 9' ORIG SIGNAT rucrt, _ URE MAS'S REG NO f - ,, StacyR Flobd, PE' 3 _ , ; r. - t pt t � fi __ 5. 3 t*_.h > k �� i �{ i .,{ 1 L ,, ., _x T r �i K _ A s s 56 Laurel Drive Hudson MA 01149 TEL (978) 562`6499 FAX (978) 562 6246 h A s j �• r 5` n NEW ENGLAND FIRE SYSTEMS, [ ., Mvemler:29,2011 . :.; PROJECT; FLAGSHIP CONDOMINIUMS BLDG"G" LETTER OF-COMPLIANCE/AFFIDAVIT Our work consisted.of installing a new wet pipe sprinkler system.to meet new dpcument`s<7 hoc:' . document confirms that the work has-been installed per all applicable codes 6hl'A13e),rules; s laws,regulations,plans,manufacturer's specifications including:tit not lunited.to5780 CMR,527 CM.R and MGL 148..This shalt document appropriate testing of the sprinkler supervisory and .alarm devices to the fire alarm panel and subsequent appropriate transmittal to.the cegtral station:::* company occurred and.all valves and alarms have been:left in service and.in a fully operational and compliant condition as November 29,201.1:. " t Ifany other information is needed please contact our office s, n;ly, x y -j coat Dwyer `Y .508-962-2487 :' t C Ujj tauaac�UJpti4tw3' * ,� k� I lip NEW ENGLAND FINAL AFFIDAVIT permit:No: To the Commissioner,Inspectional Services Department Re: FLAGSHIP CONDOMINIUMS,BLDG.'T."HYANNIS,NIA. I certify to the Best of my knowledge,information;and belief,.the plans and computations accompanying the attached application concerning the locus at Are in accordance with the requirements of the Massachusetts State Building Code and all other pertinent laws and.ordinances. The work is in accordance with the documents approved for the budding permit and shall be responsible for the following as specified in Section 116.22 1. Review.of shop drawings,samples and ot01 her sub uittat;of the.contractor.. as required by the construction documents as sulim�ttei for the building permit,and approval for conformance to'the11 design concept.. 2. Review and approval of the quality control procedures or:all.code- required controlled materials , " 3. Special engineering professional anspectiori`of critical construction components requiring controlled mate'riA or construction specified:in the aceepted:engineering practice standards listed in Appendix B, Pursuant to Section 11.6,I shall submit periodically a progress report, together with pertinent comments,tothe Building Commissioner.Upon completion.and readiness of the pr6ject for occupancy 4. All systems have been tested @ 2,00psi'for'2hrs. +P 13 Name of Engineer.: - Signature: Oat- Stamp: e. I— ,SON N RE PROT10t ION F i 0 { L Contractor's Material and Test Certificate for Abovegro,nd Piping PROCEDURE • 'croon completion of work,inspection and tests shalt be made by the.Contractor's representative and witnessed by an owner's representative.,All defects shall be corrected and system left in service before contractors personnel finally leave the job. 5r A certificate shall be filled out and signed by both representatives.Coples shall be prepared for approving authorities,owners,and contractor;it is understood the owner's representative's signature in noway prejudices"any claim against contractor for faulty material,poor'workmanship,or failure to. comply with approving authority's requirements or local"ordinances: PROPERTY NAME FLAGSHIP CONDOMINIUMS BUILDING"G DATE 14 28-41 PROPERTY ADDRESS STEVENS ST.HYANNIS,MA ACCEPTED BY APPROVING AUTHORITIES-i(NAMES)HYANNIS FIRE DEPT ADDRESS HYANNIS MA" PLANS INSTALLATION CONFORMS TO ACCEPTED PLANS. Z YES 0 NO EQUIPMENT USED.IS APR ROVED "YES :[I NO IF NO,EXPLAIN DEVIATIONS HAS PERSON IN CHARGE OF FIRE:EQUIPMENT BEEN,INSTRUCTED AS TO LOCATION- 0 YES:, Q"-NO OF CONTROL VALVES AND CARE AND MAINTENANCE OF°THEIS NEW;EQUIPMENT� IF NO,EXPLAIN ' - INSTRUCTIONS HAVE COPIES OF THE FOLLOWING BEEN LEFT ON THEPREMISES "' ®YES ""❑ NO 1. SYSTEM COMPONENTS INSTRUCTIONS ®:YES [I'NO 2: CARE AND MAINTENANCE INSTRUCTIONS, ®YES.._,[I .NO - 3. NFPA 25 (]YES .CI`NO. • S YEAR OF ORIFICE ».. TEMPERATURE MAKE MODEL MANUFACTURE -SIZE QUANTITY. RATING. SPRINKLERS VICTAULIC RES 2011; 4.2K ` 128. 155 4 PIPE AND TYPE OF,PIPE FITTINGS TYPE OF'FITTINGS.- MAXIMUM TIME TO OPERATE ALARM VALVE ALARM DEVICE: THROUGH TEST CONNECTION,G .OR TYPE I. MODEL MIN _ SEC. FLOW FLOWSWITCH ,-Sy' T M:SEN OR` INDICATOR _. MAKE ..MODEL.. 'SERIAL NO. MAKE= MODE"".SERIAL NO. TIME:TO TRIP TIME WATER •; ALARM DRY PIPE THROUGH TEST. WATER` AIR TRIP POINT REACHED OPERATED OPERATING CONNECTION'. _ PRESSURE -.PR S URE• .IR PRESSURE• TEST OUTLET' PROPERLY TEST MIN' SEC_ PSI' ' PSI P 1. MIN`. SEC YES. NO WITH ,O.D. ` K r ti W/O Q.O.D. iF NO,EXPLAIJ3t. y OPERATION ❑PNEUMATIC - Q ELECTRIC " '❑HYDRAULIC PIPING SUPERVISED YES. ❑NO DETECTING MEDIA SUPERVISED ❑YES ❑NO DOES THE VALVE OPERATE.FROM THE MANUALTRIP AND/OR REMOTE DELUGE& CONTROL STATIONS Cl:YES NO ' PRERCTION IS THERE AN ACCESSIBLE FACILITY IN EACH CIRCUIT. IF NO,EXPLAIN ` VALVES" FOR TESTING? ❑YES= NO. DOES EACH CIRCUIT OPERATE ` DOES EACH CIRCUITMAXIMUM TIME TO MAKE MODEJ SUPERVISION LOSS ALARM OPERATE AtVE RELEASE 'OPERATE RELEASE w YES NO, YES NO MIN SEC i _ PRESSURE LQCATION MAKE Ili SETTING STAT,C PRESSURE RESIDUAL PRESSURE FLOW RATE REDUCING &FLOOR MODEL (FLOWING). VALVE TEST INLET(_PSI) OUTLET(PSI) INLET(PSI) OUTLET(PSI) FLOW(GPM) W ' ... .. - ... .- .....- .ter...,. - ..✓ r, „ ... S t.. .... 4A'-w .s HYDROSTATIC:Hydrostatic tests shall be made at.not less than 200 psis 03.6 bars)for twoaiours or 50 psi(3.4 bars)abovestatic TEST pressure in excess of 150 psi(10.2 bars)for two hours.Differential dry=pipe valve-clappers shall`be:left open during test to prevent DESCRIPTION damage.All aboveground piping leakage shall be stopped. PNEUMATIC:Establish 40 i .2.7 bars air re r s uean s d me Ps (. ) P measure drop,which shall no p, _ not 1./psi(0;1 bars)in 24houis.Test. N ressure tanks at normal water level and air ssure-and measure ir pressure dro which shall not exceed 1 si in 24 hours.. ALL PIPING HYDROSTATICALLY TESTED AT 200 FOR 2 HOURS IF NO,STATE REASON DRY PIPING PNEUMATICALLY TESTED ®YES —ONO EQUIPMENT OPERATES.PROPERLY 6d YES ❑NO DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR THAT ADDITIVES AND CORROSIVE CHEMICALS,SODIUM SILICATE OR DERIVATIVES OF SODIUM SILICATE,BRINE,OR OTHER CORROSIVE CHEMICALS WERE NOT USED FOR TESTING SYSTEMS OR STOPPING LEAKS? 6ZI YES n NO DRAIN READING OF GAGE LOCATED NEAR,WATER RESIDUAL PRESSURE WITH.VALVE IN.TEST TESTS TEST SUPPLY TEST CONNECTION PSI CONNECTION OPEN WIDE PSI UNDERGROUND MAIN$AND LEAD-IN CONNECTIONS TO SYSTEM RISERS FLUSHED BEFORE CONNECTION MADE.TO"SPRINKLER PIPING, VERIFIED BY COPY OF.THE U FORM NO:`858 ,D YES ❑NO OTHER . EXPLAIN FLUSHED BY INSTALLER OF UNDERGROUND SPRINKER PIPING C7 YES C7N0 IF POWDER DRIVEN FASTENERS:ARE USED IN CONCRETE IF NO,EXPLAIN, HAS REPRESENTATIVE SAMPLE.TESTING BEEN COMPLETED? El YES NO BLANK TEST NUMBER USED. LOCATIONS NUMBER'REMOVED GASKETS NONE WELDED PIPING O YES ONO IF YES... DO YOU CERTIFY AS THE SPRINKLER CONTRACTOR.THAT WELDING PROCEDURES COMPLY WITH THE REQUIREMENTS OF AT LEAST AWS D10.9.LEVEL AR 37 0 YES Q NO DO YOU CERTIFY THAT THE WELDING WAS PERFORMED 13Y WELDERS QUALIFIED IN COMPLIANCE WELDING WITH THE REQUIREMENTS OF AT LEAST AWS:D10.9.LEVEL AR 3? ❑YES 0 NO DO YOU CERTIFY THAT'WELDING WAS CARRIED OUT IN COMPLIANCE WITH A-DOCUMENTED. QUALITY CONTROL PROCEDURE TO INSURE THAT ALL DISCS ARE RETRIEVED,THAT OPENINGS IN PIPING ARE SMOOTH;THAT SLAG AND OTHER WELDING RESIDUE ARE REMOVED,AND THAT THE INTERNALDIAMETERS OF PIPING ARE NOT PENETRATED YES NO CUTOUTS DO YOU CERTIFY THAT YOU HAVE A CONTROL FEATURE TO ENSURE THAT ALL CUTOUTS(DISCS) DISCS ARE RETRIEVED? R YES rl NO HYDRAULIC NAMEPLATE PROVIDED IF NO,EXPLAIN DATA ®YES ❑NO NAMEPLATE DATE LEFT IN SERVICE WITH.ALL CONTROL VALVES OPEN.. REMARKS 11-24-11 NAME OF SPRINKER CONTRACTOR: NEW ENGL AND FIRESYSTEMS.INC... SIGNATURES TESTS WITNESSED BY FOR P E TY OWNER'(SIGNED) TITLE DATE OR TIT p ADDITIONAL EXP Y • � ` , t �'f O S9��L�C't'M south�Shore Era � O&W- �. `eaihn �Into: ��... AFF Ic hanica! c�c�Iwrica xt ine r Name of>rc,ject. Plakshxp kstatis Unit 01. Project Loeatt,rt 320 Stevens Street trn,,e tvtA Permit Number B201 t 2032 NnIlt of pipitit RVAC im#iallaiiut) . Ica the building gnurussiancr of th€c,ry ,t F3�usxnls IV1A, ii:necard ih.M smeh*tts St ise'�txi[ding dads,1,Juares P Strakct Itegstratrn . cr..ZOgti$�beinb are istered;pxcifesssiait l cngin c reraots111e;fir t>xeFpTlca�+?ixa :d,seiplure{}: °rIz1 PR , CT:: ARCHITECTURAL C3HV- AC FIRE At ' 1'C t7M13tiyC � In cecardamo with ivilmichu4crt�Slue Aux i n 1#3s fcs p Strtat.c .hart by ttitb:Baal an. be}a!f�f Cditr It!tin orr li Vf1C,fine.,the d rgwbal d cr,ra an c1 inspectetl: dtr Hdv txrl allon for tilt#xrb e namc�'prpject- 't :file h ;r l my kmb+clGctry ,rrt t rtt a ran belief£the con, ,clitiri,gf the Clcr C t been . emptcted.to t empty ttt.#halati latrsta Stutc:tiuxlt3iaa¢: ade; epixrb en,nrir pied and sj a � nEahi nt errtluse and crafrirP} �luthdnredcepres?rttrixyC : fnut#t` hnrgrnriril`earrif`lac lxt�cburnpreseni. it'tli eni, trvctxun ,ta#0 rft tennirtC t1,at t i'v nark,v e�rropl #ext irr:ricc4rd n.ce with thts dctcuareWs€, prs yr d for n the ,ailding'L c3rrtal - - ►aa[A- S1CNA' 'T-tJSTAOX O. 726 Wrt.=h�npian 5treei;Hanover;N1A 0233��'Phonc:.7tt1-331<+1�G0 t fax:�$l Q� }g05: ' 1 .., , FINAL CO NSTR�ucho South.Shore p� neer�n e�na�� 1`'-othanicnl &Electr cat.Engineer�c. Name Qfi T' t�jtct' Flagship I SIki1cS Unit�2 � 'M ect Location: �320 Stevens.Sheet,Hyntwis AN Permit Nundfxr_- B20112032 Mature.of Project 1;,�ACiitStit118ta0aa. fiu the t uilzT ng conimtss,oner oC the.4ity p. 1)`fitly S l►3A tt}AGt�td9(aCe tkttl a'�fn,�achiycet%� State 13taild,tig Code;1;jarnes P.Strk*4e RWsltat od Tea,2066i,being a t is ercd p ifessienial cng,ncti' amporu4ible fort llnrvin d,�ct linets�.- l i�°1 R .1?.OJW- r Q. ARCNrC'E�°f{Jlt�►1,. Q. PT t�aNWNG € 1vcr>r>♦AIz Q 1~ t'xlt .:v ' Gt nccrinttet7t4tisehutt Statc t3ttNingd0x Thanc.0 Strobe,hcielzy stnt+~_thai Q,t izelaalt QtCott�oJWkWH-VAC luc,thdesig�bualdconrncttaroFrecnrd,l hovevitzzsed n :inspected' the HVA�itallatidflnr th ;nttuue.'ntiriicxl prAjcc 1 Tn Elie Test s`i ttty lend;uled ge anform3tton ttti i6elle,the c�tns�trttetenl,-0 she OVA ha been � ,r Pleted tt'titatnlyith tltc;apphrblerov,'.sttttt oi3tlle Mns•��cht,ses Scan t3uildingoc1e A6oelatalzle engE teeratag praotica�adnppUeable WN and prdinAn�es tear thegtv�p%��d use rind 4gcupanoy, Ir Attritsn d.a resent tov6set!'Sautta5hdi6Xrljtnccrrn} Tcam}latc ha bcaaa z rattsn't#ic. ctanstmctat�n s,te tta da terttxute want iris work atiss ci irtl�tcted to ilcs�►cdntice�u,dt the dcat tittitnt,ujt aartved tttt ' ihb at,l 'w— Per it t t, 1. seal Sj�r7VA. - JAl,ti< ate*..I Ixr_ Oil c r tST �v,� S + s 7 41tstashing€0e S1r2et Harpver.MIA 02339-1"We i8t-33t46%t FAI:141-8"4406 _ ■p��yg N'.{gN1lW aid .vim.-'T 8 .+ 4mY TRUC.0. 1fN fg .J. rogtneig Inc Mechanical .kcO cal line tzf Fzrtjecti,rIt Estztteti Unik 3' Project Locition - 320 Star trc tz H" nn� !'cttinit Nurrib� ��t l�t33� , • �•a; ,�tsturre cfrcject HVe�G rfrswll;ru#tt, 7 .etc buildn„t oririirzasitttti c�E thezrf .u�ects Sttftl3ui]din+NadisrMairok 7estratin err 2A0n to are istr>vtt rfssirtt cn ftttl. . . ' re�ptansibte CcfzA ctac fc��lc�r�n�;:lcrpl�t�s�: ' - �., .. CT RVAd r kf€;c� tt3t ilcttldacc+�t tt J ►r P.T.stet tEfat crtt bel t c�! cat r-ft n na7Nt1 �7i �,t s ti r o kftnid: ffta ict r±sF rd,:7-tr =e a>r Zoo ttuc3:inv o ttztlfrtir#ttr th ; tvve tttn€tst�: �g {t t fc best sEaf kri wlW— Infoob4 n eetfrrtup7c . uaftzracl� �fIre1�etu � � er et t too. Cgt , cte: t 7 A t g 0041 .11 1 i c . r � sztfc� r rttc�usra;s�Cruuite�alfn�nPzetctm tof tt.3.'.t�e�rmrrirfz tih�t thtf �qrukr titv c ca± tiSt t' ,vsv b.Cecfrnt err ttre t:fd , zl ttedo i +r cds c ct x . z a . : �t■/��t �.� ' C� '.. e - 3.aMia��• 3F�i�� 'Yff`� �', _ 97,,,f. Joe Batt: w mbcr,� ` (t :l fl ; �2Q VJ�Sfsfngi,9r$ff�xf hfana ar~.;MA Q23��Y�'h4ite 7�t��66�4(fa�c 7'81 f��9xP13'. . l CoNt South ShoKe Eng eer ng Tea: , Luc: Mechanical & Vtectric ,t4 gineerIs AI}! l,lt�tlVi'1` Name of Project; miv ti,n stia es Clnit<G4'. Project4.oc46o 320Stevcn.;$trect,.11 nruais,�9 `h�itiliiC.Plttmber:. E320I'1,2ij�2 _ ..-._ _ stature of project. HV��inatdllattnt To tkic build ng a oulmtmsionerr qt dae.city taf>r),yan�nls;:I4j 1,in ece�rdtance w%itt.vfza clattsert l, OhB62)$tAt 4uldli C9de,1dAn1s en t mg Isarr ponciblefor"the foloiv3 Ei`f'CIR j'Ft.Q1 C,t' Q AItCM.T.��"1'URAL. fiCRL': Q. El*EC'Cl2.C.CsI: [� ln.aecprdznee w nh ti7 n;t3ulld nt,Code g C,j;rnies P_Stroke, tl,e . . , hebct 't}� h e bucnrcrg ,vh nd tbes ifoCpiti4Qhns nHVl Inc$ ed iVA e na " s d np coc ftot � I 1 s To thei st of nay knrJctiledge to,ormation zrndd:b ltei the tofl UvctRenoftlae RVAQhay been: co!0*14 to Oinply icFrth the apphcAble p �i,seons t�f rise,JVfns.�chltktts StntcBuildu,g:Code 'cccp}-ably ea, ireerinrrer trCe '>nnd npplible:lacy;and e?rdusnasccs for ttapraud ir,�e fled tteiaparaoy. AWhnrayed OPr"sC41; t�04 ats uth ChOrC l�+r mccrin `tcarra,xnc tZa4 been y� scr ii ba'thz c6nstvWe}n 1.s td t9 t�Ofe�,,,,etau;hint the8"' A: ass eaonapl�tedia acc Ordiko wi h tiie.docuratcnt�a��r��cd 9'or t the auileltn�,.F'eraaatt,.' t qq-}ArAA SIGNA' Seal. MtS JA STROKE V - y+'. ll �s q 72tt:'IV�shingidri 3uac1,I�a�ver,A!A p2�3�t @none 79 ,3�t�fitft)t��ac 7�1-8�.9-+t?xp�. _ . . �t D � � g South Shore weer g leap= helb cN�r c [ ch id C1 ctr�. n Ctrs Name of Project: hiptacY-s<rtnc` 5_ Project Location 320 Steven.'$trcct liyannrs-,k4T. Peemit Number:; 13 0 l 12Q32 Nature ec of.Pro 7 t F IYAG installation t . a t a fht bwltln caitimr�S�an. r of thti city of lartnt n1lA,ae atcardanv►ttMatchtisr:tt State Buildittg t ode;'L Jraitics P Strok. ittggi, t'rtr#fl.:N10 xA�►tiS,ttetib rep to pre fe ionttl�n�iifr'iw te5pansiblc Far the.T'r56it�wislt�rFipline�5j: t , t 37'TRF>7'TUJt `x } PLUMB TG 0! k1 VAG T?TR �LAY2i �' :> GGTRICAL ; OTHM In tsectardance th vltassaclfusett State Flu ld ng C�Ocle,1, c T' Stioke,hereFry strict that on l�hnitof�piit lalrnsott T�VA�,Tnc�,rle dest�t-burttl��}ntraciar q(`rcc�rci,f hn4 a x�zttt:�:�ed ttrtd u�°pect��t;:; i the HVAG to tnllatt+n t 414,- Ve.ri'i+med{artlect; .. ... aHI. To the beet tt iti .#ttia�z)cdg .tnfarxtta'irurt rtrid:btliCf,alit catttttrGtitin ae TlV,4C lta§berti completed.'to comply tlrthe applicrrlileprav scans f ltc l� itchtaliot Scat t�rtdi�t CQcict3 sccepwb'1 ent3 nQeritrg practte pnd s plioablz laws and 0rdinai cc for the rr§Ta�ticd trse ttad r�cupaneyi ` ilutharizrrl r p setttiirrs�cs 4f'South;5hota.r ,rteerriy 't'cam,.Tnck h � n Pr e .: c4n5tttrGti9n site to drMtemin `titat the w accgid age ivi€h the drnc�nistpprove r_ the tirilditi Pt;.rtnir: ' . :j ST ._ 1 U11w �lATvi> S 72t}V++at.ttirrgto�Street,Hanover.k!A f#�3J91 Pbiane 7�1.3�1.4666[F`mx 76�-�2�-4»#t3a „i'4 FIRE ALARM SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. 1. Protected Property Information Name of property:. Address: Description of property: _--- � � -" ——---------- — -------- Occupancytype: .._._._...._................:............... .__.- Name of property representative: _...... _ ...._._. __. . ..._..._.__..-_._. _.-.......__._..._---._---------- Address: ............................_..._._.........__......_......._...._.... -- -......._ Phone: Fax: E-mail: Authority having jurisdiction over this property: ...._..........._-------__._....__..._.._.._..___.__.._.....-......__....__.__-...._..._............__........... Phone: Fax:. E-mail: 2. Fire Alarm System Installation,Service,and Testing Information - Installation contractor for this equipment: ....._......._.._....... .._.._.....- -..._......._ Address: ........mot[ .......... .2 E,.... Phone: '-- �--� Fax: 1i�� E-mail: -----......._........_.._...._....._......_.._..........__.._.........._....__...._.. __....._.............. Service organization for this equipment: Address: Phone: -- Fax: E-mail: Location of as-built drawings: 3 Location f Historical Test Reports: �._.._. ___._... 4 P Location of system operation'and maintenance manuals. A contract for test and inspection in accordance with NFPA standards is in effect as of .. Contracted testing company: _._...._....__........ _._..........__._......__._.._...__._..____.......... _..._..... Address: _... ._..._...._....._.__.._.._._.....__._......_--...._......----........._........__...........__..... Phone: Fax: E-mail: . ......-..............---._.___._.__.._...........__.....__.-.____..._......_..____._._. Contract expires:. .......,_......... Contract number: Frequency of routine inspections: 3. Type of Fire Alarm System or Service NFPA 72® Chapter Reference of System Type: ..........._..-_....__-------....._..._............._._-..........................._........__............................_.._.._.. Name of organizations receiving alarm signals with phone numbers(if applicable): Alarm: - __._. r._• ......._.....004 c� ._. ..._ .__... --"-" --. Phone: 1 Supervisory: Phone:- Trouble: Phone: Entity to which alarms are retransmitted: Phone: ._................_....._.__. _...._................................................._.._.................._ . Method of retransmission of alarms to that organization or location: NFPA 72, Fig.4.5.2.1 (p.1 of 5) Copyright 0 2009 National Fire Protection Assoaation.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. If Chapter 8,note the means of transmission from the protected premises to the central station: ❑Digital alarm communicator ❑McCulloh ❑Multiplex ❑2-way radio (] I-way radio ❑N/A 11 If Chapter 9,note the type of connection: ©Local energy ❑Shunt Q N/A 3.1 System Software Operating system(executive)software revision level: P Revision completed by; Site-specific software revision date: 4. Signaling Une Circuits� Characteristics of signaling line circuits connected to this system(see NFPA 72®, Table 6.6.1): Quantity -_._..._.........._.. ��........_.._....... - - Style: _........__... .._......_................_.......... Class: S. Alarm-Initiating Devices and Circuits Characteristics of initiating device circuits connected to this system(see NFPA 72® Table 6.5): Quantity: ..._.__..:.--_------.___? Style:___-._-__ ty Class 5.1 Manual Initiating Devices. 5.1.1 Manual Pull Stations Number of manual pull stations: Type of devices: 0 Addressable ❑Conventional j❑Coded 0 Transmitter ZW11A 5.2 Automatic Initiating Devices 5.2.1 Area.Smoke Detectors Number of smoke detectors: // ......................_......_.............._:.__._.._.__..._........._........._._._...._.....................................__......_.................__ Type of coverage: []Complete area ❑Partial area ❑Nonrequired partial area ❑N/A Type of devices: 13 Addressable ❑Conventional 0 Coded ❑Transmitter ❑N/A ' Type of smoke detector sensing technology: ❑Ionization (3 Photoelectric 5.2.2 Duct Smoke Detectors Number of duct smoke detectors: Type of coverage: ...................--........._—..—_.�.._._._... - _._._......_...._......_.__.... ......_...._.._._......._._._..._...._.._....._._... ....... ..----- --- _............. ........... Type of devices: :0 Addressable ❑Conventional El Coded ❑Transmitter [;KIA Type of smoke detector sensing technology: 0 Ionization ❑Photoelectric 5.2.3 Heat Detectors Number of heat detectors: Type of coverage: 0 Complete area M Partial area ❑Nonrequired partial area /A Type of devices: 0 Addressable 0 Conventional ❑Coded 0 Transmitter ❑N/A 5.2.4 Sprinkler Waterflow Detectors Number of waterflow detectors: O Type of devices: Addressable ❑Conventional ❑Coded 0 Transmitter N/A 5.2.5 Alarm Verification Number of devices subject to alarm verification: _ ---... ._....... ._...._._..__...._..._.._._...._....-.__.......__.... ..._.... Alarm verification on this system is: Enabled 0 Disabled ❑Set for seconds 6. Supervisory Signal-Initiating Devices and Circuits 6.1 Sprinkler System Number of valve supervisory switches: _._.._.,__.._....._............_.__................_._.._...._...__.............._...... ._...-...._._.. _ Type of devices: Addressable ❑Conventional 0 Coded .[]Transmitter ❑NIA NFPA 72, Fig.4.5.2.1 (p.2 of 5) Copyright®2009 National fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. • 6.2 Fire Pump Type of fire pump: -❑Electric ❑Diesel Type of fire pump supervisory devices: ❑Addressable Q Conventional ❑Coded ❑Transmitter W.taiA Fire Pump Functions Supervised ❑Fire pump power ❑Fire pump running ❑Fire pump phase reversal ❑Selector switch not in auto ❑Engine or control panel trouble [I Low fuel Other: 6.3 Engine-Driven lGenerator Type of generator supervisory devices: [ Addressable ❑Conventional ❑Coded [:]Transmitter /A ❑Engine or control panel trouble ❑Generator running ❑Selector switch not in auto, ❑Low fuel Other: 7. Annunciators 7.1 Annunciator 1 ❑Local ❑Remote Type:Q Addressable ❑Directory ❑Graphic /A Location: ..F 7.2 Annunciator 2 ❑Local ❑Remote; Type:❑Addressable ❑Directory ❑Graphic LEA Location: r 7.3 Annunciator 3 ❑Local ❑Remote Type:o Addressable ❑Directory ❑Graphic /A Location: 8. Alarm Notification Devices and Circuits 8.1 Emergency Voice Alarm Service Number of single voice alarm channels: I Number of multiple voice alarm channels: . Number of speakers: Number of speaker zones: 8.2 Telephone Jacks Number of telephone jacks installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑Electrically powered ❑Sound powered ❑N/A 8.3 Nonvoice Audible System Characteristics of notification device circuits connected to this system(see NFPA 72' Table 6.5): Quantity: ..............._--.__._...............:._. . .... Style: . ............_.._...__._. ......._...:__... _...__._: Class: 8.4 Types and Quantities of Nonvoice Notification Appliances Installed Bells: ' With visual device: Horns:, With visual device: Chimes: With visual device: Bells: With visual device: Visual devices without audible devices: Other(describe): NFPA 72, Fig. 4.5.2.1 (p.3 of 5) Copyright 02009 National Fire Protection Association. is form may be copied for individual use other than for resale.It may not be copied for commereia[sate or distribution. t 9. Emergency Control Functions Activated ❑Hold-open door releasing devices ❑Smoke management or smoke control ❑Door unlocking ❑Elevator recall ❑Other 10.System Power Supply 10.1 Primary Power Nominal voltage: - _ ..._....._r�c�s.�._.__.5__._:- - _.:._.._.._ Amps: ..........._........_............_........_.._......._._.__................... Overcurrent protection: Type: _.......__..__.._...._-.............._._.. Amps: Location(of primary supply panelboard): Disconnecting means location: 10.2 Secondary Power Location: Type: —_ — Nominal voltage: Current rating: _....._.__...._._._._ .............._......... _.._._......_.... Number of standby batteries: Amp hour rating: Location of emergency generator: _......_.............................._........................_.........._..._..__......._............--_._..._.:_._..... Location of fuel storage: _....................._.............__........._..__...._...___................._.........__...................... Calculated capacity of secondary power to drive the system In standby mode: In alarm mode: 11.Record of System Installation t Fill out.after all installation is complete-and wiring has been checked for opens,shorts,ground faults,and improper branching,but before conducting operational acceptance tests. The system has been installed in accordance with the following NFPA'tandards:(Note any or all that apply.) [�� TNFPA 72 El NFPA 70®,Article 760 I-Manufacturer's published instructions ❑Other(please specify): __........___..__...................._..._.. ._._..._.............._.... _-.........._............................_.,.__ System deviations,from referenced NFPA standards: Signed: -- - �j Date': _.....__......... Printed name:_.._.__......_.._._.._... -- _. _.._. z" _.._.. .. Organization: Title �— Phone: 12. Record of System Operation -All operational features and functions of this system were tested by or in the presence of the signer shown below,on the date shown below,and were found to be operating properly in accordance with the requirements of: E't/vFPA 720 ❑NFPA 700, Article 760 -E Manufacturer's published instructions ❑Other leasespecify): (P ......................_._......_._.__..._....._..._............___..............._.__.-........... . ❑Documentation in accordance with Inspection and Testing Form(Figure 10.6.2.3 of NFPA72�)is attached Signed: Printed name: /� _.__._._.... ......_. ._.._................................... :.... Date: .........1�:....Z��'� Organization: Title: Phone: NFPA 72, Fig.4.5.2.1 (p.4 of 5) Copyright®2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution 13.Certifications and Approvals .. J1►F . 13.1 System Installation Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: __....._._._._� Printed nazne: / Date: // t - .._....� _..._.....l...l-.__...._._ ` Organization: Title: Phone: 13.2 System Service Contractor This system as specified herein has been installed and tested according to all NFPA standards cited herein. Signed: ...._..............I Printed name:_...... .................._.._....... ...................._... Date: Organization: Title: ,.... _ .. .. : Phone: � 133 Central Station This system e ' led h ein will be onitored according to all NFPA standards cited herein. Signed: _._ Printed name:� •f .omG� Dater Organization. �'� L f � le; �'. �Pn?!'1 !!...5 ......_........ -- Phone: ems!✓ r B 13.4 Property Representative I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: ......._..._.........._.. Printed name:_........_........_.. _.-............._.. Date: Organization: Title: Phone: 13.5 Authority Having Jurisdiction I have witnessed a satisfactory acceptance test of this system and find it to be installed'and operating properly in accordance with its approved plans and specifications,its approved sequence of operations,and with all NFPA standards cited herein. Signed: ------ ___..----__.__._.__.._....._._._..__...__...__._-. Printed name: Date: _-- _ Organization: Title: Phone: NFPA 72: Fig.4,5.2.1 (p.5 of 5) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. �IHE y To wn of Barnstable *: Building Department - 200 Main Street fARNSTABLE. * Hyannis, MA 02601 9 MASS. ate (508) 862-4038 D MA't C e ccu rtif in' te of 0 ancY p n Application Number:"201105027 CO Number: • 20110178 Parcel 10: 30800400Y 3: -CO Issue Date: 11130111 a Location: 320 S.TEVENS STREET G1 Zoning Classification OFFICEIMULTI'FAMILY RESIDENTIA.- Proposed Use Village: HYANNIS _ Gen. Gontractor. .,k°" _ 'ADVANTAGE.CONSTRUCTION Permlt;Type. ,z "R G00 CERTIFICATE OFOCCUPANCY RES" Comments: { " Building Department Signature \ Date Signed TOWN OF BARNSTABLE BUild IHETn.-� r _ _t Ing 201110-5027-1 * BARNSTABLE, * Issue Date: 09/20/11 `� Permit 9 MASS. �p 1639• p, Applicant: ADVANTAGE CONSTRUCTION Permit Number: B 20112032 Argo�� Proposed Use: Expiration Date: 03/19/12 Location 320 STEVENS STREET Gl Zoning District OM Permit Type: SP PROJ RES ADD/ALT Map Parcel 30800400Y Permit Fee$ 606.23 Contractor ADVANTAGE CONSTRUCTION Village HYANNIS App Fee$ 50.00 License Num 019925 Est Construction Cost$ 118,867 i Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND TENANT FIT OUT FOR CONDO GI THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: FLAGSHIP ESTATES HYANNIS LLC BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: TWO ADAMS PL INSPECTION HAS BEEN MADE. QUINCY,MA 02169 Application Entered by: PR Building Permit Issued By: THIS PE64TT'CONVFY.S NO RIGHT TOOCCUPY ANY STREET ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER•TEMPORARILY-OB;PERMANENTLY ENCROACHMENTS ON PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE'BUICDING CODE;MUST 6FAPPROVED BY THE]URISDICTION c STREET OR ALLEY GRADES�AS WELL AS•DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THi DEPAR TMENT�OF PUBLIC'WORKS THE ISSUANCE OP THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS: , MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5. INSULATION. 6.'.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). E&110 y BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS r its 3 lam , / /_ r 1 Heating Inspection Approvals Engineering Dept Fire Dept '�r ,� 2 Boa• o ealth INN Town of Barnstable , Building Department - 200 Main Street * STABLE. • Hyannis, MA 02601 9 MASS. ib39- (508) 862-4038 Certificate of occu anc p Y Application Number: 201105028 CO Number: 20110177 Parcel ID: 3080040OZ CO Issue Date: 11130111 Location: 320 STEVENS STREET G2 Zoning Classification: OFFICEIMULTI-FAMILY RESIDENTIA Proposed Use: Village: HYANNIS Gen Contractor: ADVANTAGE CONSTRUCTION Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: Building Department Signature Date Signed TOWN OF BARNSTABLEn g ■ ■ ' 2011 Oa-N& : m BARNSTABLE, Issue Date: 09/20/11 Permit MASS 1639• $ Applicant: ADVANTAGE CONSTRUCTION ArF� .1 s Permit Number': B 20112031 Proposed Use: Expiration Date: 03/19/12 Location 320 STEVENS STREET G2 Zoning District OM Permit Type: SP PROJ RES ADD/ALT Map Parcel 3080040OZ Permit Fee$ 606.33 Contractor ADVANTAGE CONSTRUCTION Village. HYANNIS App Fee$ 50.00 License Num 019925 Est Construction Cost$ 118,887 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND -UNIT G2 TENANT FIT OUT FOR THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A' CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: FLAGSHIP ESTATES HYANNIS LLC BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: TWO ADAMS PL INSPECTION HAS BEEN MADE. QUINCY,MA 02169 Application Entered by: PR Building Permit Issued By: (� THIS PERMIT CONVEYS NO RIGHT TO OCCUPY'ANY STREET ALLEY OR SIDEWALK R AN�ART THEREOF EITHER TEMPORARILY ORAPERMANENTLY ENCROACHMENTS ON PUBLIC PRO PERTY,:NO , SPECfFICALLY PERMITTED UNDER THE BUILDING CODE;MUST BE APPROVED BY THE,NRISDICTION=4 STREET OR ALLEY GRADES AS`WELL AS DEPTH ANb iL&TION OF-PUBLIC,SEW,ERS""MAY BE OBTAINED Pkd&4,tH, DSPARTMENT.OF,P.UBLIC WORKS,.THEYSSUANCE OF THIS°PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS: ' F; MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). NO BUILDING INSPECTION.APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS rf r 3 � I _ r l 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 ar of ealth �.,` Town of Barnstable Building Department - 200 Main Street BARNSTABLE. * Hyannis, MA 02601 - 9 MASS. 16�q. (508) 862-4038 .w r rFD MA'S a ., Certificate of occu anc Y p Application Number: 201105030 CO Number: 20110180 Parcel ID: 3080040AA CO Issue Date: 11130111 Location: 320 STEVENS STREET G3 Zoning Classification: OFFICE/MULTI-FAMILY RESIDENTIA Proposed Use: Village: HYANNIS Gen Contractor: ADVANTAGE CONSTRUCTION Permit Type: R000 :CERTIFICATE OF OCCUPANCY RES Comments: hr) Building Department Signature Date Signed TOWN OFBARNSTABLE ■,� �' 2011 Gfw_p3 p { BARNSTABLE, Issue Date: 09/20/11 Permit 9 MASS. �A 1639. a� Applicant: ADVANTAGE CONSTRUCTION Permit Number: B 20112030 rFD MA'1 Proposed Use: Expiration Date: 03/19/12 [Location 320 STEVENS STREET G3 Zoning District OM Permit Type: SP PROJ RES ADD/ALT Map Parcel 3080040AA Permit.Fee$ 606.33 Contractor ADVANTAGE CONSTRUCTION Village HYANNIS App Fee$ 50.00 License Num 019925 Est Construction Cost$ 118,887 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND TENANT FIT OUT FOR INTERIOR FINISH-UNIT G3 THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: FLAGSHIP ESTATES HYANNIS LLC BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: TWO ADAMS PL INSPECTION HAS BEEN MADE. QUINCY,MA 02169 Application Entered by: PR Building Permit Issued By: �� THIS'PERIvIIT CONVEYS`NO RIGHT TO OCCUPY;ANY"STREET ALLEY OR SIDEWALK OR ANY PART THEREOF EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON,PUBLIC PROPERTY;=NO # : , r �SPEGIFICALLY PERMITTED UNDER THE BUH.DING CODE;MUST BE APPROVED Y THE JURISDICTTON' TREETOR ALLEY'GRADES;AS WELL-AS<DEPTR ANDLOCRTION,;OF PUBLICtSEWERS°IvIAY BE .. . , ., a OBTAINED FROM THE,,DEPARTMENT OF PUBLIC N'ORRS THE ISSUANCE OF THIS.PERMIT DOES NOT RELEAS771 LICAMP OM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). i16, UNA IN A mwlg BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2rOv 3 f _ ( + 1 Heating Inspection Approvals Engineering Dept A`� Fire Dept U f 2 B rd ealth G/w Town of. Barnstable Building Department - 200 Main Street SARNSTABLE. * Hyannis, MA 02601 MASS. (508) 1639. 862-4038 RFD MA'S A ' fiOccupancyCerti cate of Application Number: 201105029 CO Number: 20110179 Parcel ID: 3080040AB CO Issue Date: 11130111 Location: 320 STEVENS STREET G4 Zoning Classification: OFFICEIMULTI-FAMILY RESIDENTIA Proposed Use: Village: HYANNIS Gen Contractor: ADVANTAGE CONSTRUCTION Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: [1301r ( Building Department Signature Date Signed TOWN OF BARNSTABLE Building ENE � Tp� _ _ - _ � 20110-5- -0219---3 BARNSTABLE, * Issue Date: 09/20/11 Permit y MASS. �A i639• Applicant: ADVANTAGE CONSTRUCTION Permit Number: B 20112028 rFD MA'l A Proposed Use: Expiration Date: 03/19/12 [Location 320 STEVENS STREET G4 Zoning District OM Permit Type: SP PROJ RES ADD/ALT Map Parcel 3080040AB Permit Fee$ 606.33 Contractor ADVANTAGE CONSTRUCTION Village HYANNIS App Fee$ 50.00 License Num 019925 Est Construction Cost$ 118,887 Remarks _ APPROVED PLANS MUST BE RETAINED ON JOB AND TENANT FIT OUT FOR UNI_TT G4`� THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: FLAGSHIP ESTATES HYANNIS LLC BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: TWO ADAMS PL INSPECTION HAS BEEN MADE. QUINCY,MA 02169 �) Application Entered by: PR Building Permit Issued By: THIS PERMIT CONVEY S NO RIGHT TO OCCUPY ANY STREET,ALLEY'OR.SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTSAN.PUBLICPROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION:. STREET OR ALLEY GRADES AS WELL AS DEPTH AND.LOCATION OF PUBLIC SEWERS MAYBE. OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES Not RELEASETHE APPLICANT FROM THE:CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. - - - MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). -5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS b 0/// 2 ( ASV j� j"� 2 �n,( 2 , t. 3 1 Heatin nspection Approvals Engineering Dept 4 Fire Dept l/ 2 ��S, f/ f��,�j� B f ealth l / I �t"E' ti Town of Barnstable Building Department - 200 Main Street Hyannis, MA 02601 E 63 a.� (508) 862-4038 CeftIf icate of Occupancy Application Number: 201105031 CO Number: 20110181 Parcel ID: 3080040AC CO Issue Date: 11/30/11 Location: 320 STEVENS STREET G5 Zonin'g Classification: OFFICE/MULTI.-FAMILY RESIDENTIA Proposed Use: Village:. HYANNJS Gen Contractor: ADVANTAGE CONSTRUCTION Permit Type: RC00 CERTIFICATE OF OCCUPANCY RES Comments: r� Building Department Signature, Date Signed r TOWN OF BARNSTABLE �tWE, — Building 2 0110-5:03 1--- ,�r * BARNSTABLE, * Issue Date: 09/20/11 P.-■ ■ ■m■ f t MASS. qj Ar 039• Applicant: ADVANTAGE CONSTRUCTION A Permit Number: B 20112029 FO MA'1 Proposed Use: Expiration Date: 03/19/12 Location 320 STEVENS STREET G5 Zoning District OM Permit Type: SP PROJ RES ADD/ALT Map Parcel 3080040AC Permit Fee$ 606.33 Contractor ADVANTAGE CONSTRUCTION Village HYANNIS App Fee$ 50.00 License Num 019925 `Est Construction Cost$ 118,8.87 Remarks eI APPROVED PLANS MUST BE RETAINED ON JOB AND TENANT FIT OUT FOR UNIT G5� THIS CARD MUST BE KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: FLAGSHIP ESTATES HYANNIS LLC BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: TWO ADAMS PL INSPECTION HAS BEEN MADE. QUINCY,MA 02169 Application Entered by: PR Building Permit Issued By: THIS+PERMrT CONVEYS NO RIGHT.TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY;PART THEREOF EITHER TEMPORARILY.OR'PERMANENTLY ENCROACHMENTS"ON PUBLIC'PROPERTY,NO SPECIFICALLY PERMITTED UNDER•THE BUILDING CODE,MUST BE`APPROVED BY THE JURISDICTION ,.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATIONfOF PUBLICS SEWERS-MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC wORKS.'THE'ISSUANCE OF THIS PERMIT,DOES NOT RELEASE T.HE APP,LIGANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRTCTIONS:- MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT-THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). 41 e a `�"t��'•`znF � 3,�,. �E .. ,� �� ,,,, �� ..,...»arm.. .. ;% '•.,� ,, :,;• 1 .v ,+ ; ». '' ��: : BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS �v l� c P G>� 3 I'J 1 Heating Inspecti royals Engineering Dept Fire Dept 2 rd of lth � ON 02-- ��tTti Town of Barnstable. Building Department 200 Mai Street BARNSTABLE, * Hyannis,.M A 02601 MASS. 9�A i639- . (508) 862-4038 rF0 Mp`t s r ifiOccupancyC e t cate of. Application Number: 201005612 CO Number: 20110182 Parcel ID: . 308004 CO Issue Date: 11/30111 Location: 320 STEVENS STREET Zoni ng.Classification: SPLIT ZONING Proposed Use: CONDOMINIUM - Village: HYANNIS Gen Contractor: ADVANTAGE CONSTRUCTION Permit Type: SC00 CERT OF.000 SPECIAL PROD. CM Comments: BUILDING G SHELL PERMIT Building Department Signature Date Signed 320 STEVENS STREET FEES PAID FEES CHARGED OVER PD BUILDING A 7,202.50 3,682.47 BUILDING B 5,453.11 3,378.05 BUILDING C 3,406.85 1,981.83 BUILDING D 3,331.85 2,056.83 BUILDING E 100.00 4,503.17 BUILDING F 4,557.24 2,446.91 BUILDING G 7,872.18 6,422.14 TOTAL 31,923.73 23,471.40 8,452.33 BUILDING G C/O 125.00 8,327.33 0 THE FOLLOWING IS/ARE THE BEST IMAGES FROM ',.P.O,OR , QUALITY ORIGINALS) I m DATA . 000 r: 0 ° 0 0 i50 ° 00 2 9 2'18 ° '1 ':5 000 - 000 75 ° 00 ! 0 " 00 0 - 00 000 50 UU 25'1 24 i 000 Q QQ 50 UU 04 UU 3- 2 51 4r 1 0 0 . 0 0 -� 50 ° 00 000 50 •• 00 251 ° 24 0 ° 00 009 OQ o ° 3 40,6 - 85 1 000 50 ° OQ 0 - 00 606 - 23 i 50 ° (j0 s 000 i 606.° 25 • -� 0 QQ , r,�ir ' 2a - i O'o - 00 s 50 ° U0 s cF65 0f;'I ° x i 50 00 s 606'm 55 50 00 r 1S. ��0 0 U 4- Q� i 5 0 ° U 0 s 000 4 , 55'? �'24 \. 606 33 s 01 6 t 0 - 0U. f I. 000 I 9 V f( 37 ,1 9 i fir) 5 .0 0 5 ts.2 2 . 1.4 uk 002 EIS r j 1 oQQ 5` ,7 I,-( i . 150 ° 00 50 ° 0l) e 5 U 0 0' F 0 U-(� , 251 24 s 5-0 ° 0 0 + 000 25i 24 0 UU 008 1 �, r 3 9 5 5 i 85 n 9�r 4 f3 r ).0 U „0 01 i I 0 0 0 . 0 O:U 000 .;� 0 .(J0 0 . 00 000 ® 000 0 . 0 Q QO. 004 13921 87 r 002 6.65 .081 ° c 290.2 - 8'7 0 ° 004I [ 1 7 U U �vv) 002 qS 6 �5 CA O i NIA_` 000 U 0 0 : . 000 0 .r..._ U UU ` .Uo� U Uu} 000 ! 000 00 r 50 , UC) t U - pO IUt1 0 r l(� z i 50 UO U(1U i U0 0( `( Z "t I U�1 0U t w 2 It. t UUO �i� > �, 75�� t tU UU 0 . 00 251 ° 2u. 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Conservation Division Permit# Tax Collector Date Issued Treasurer ��] ,,-Yq Application Fee Planning Dept. �� Permit Fee ` Z Date Definitive Plan Approved by Planning Board l i�- Historic-OKH Preservation/Hyannis Project Street Address Village Owner s Gf S f.J CAddress A140 I-OZ-5 � �� cJ ., /00 Telephone — ycf— , Permit Request Square feet: 1 st floor:existing i proposed 2nd floor:existing proposed YS�; Total new IAI& Zoning District Flood Plain Groundwater Overlay Project Valuation611^2 Construction Type Lot Size 7 ,Grandfathered: ❑Yes 210 If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) (_r Age of Existing Structure Historic House: ❑Yes A<oo On Old King's Highway: ❑Yes 01T0___" Basement Type: ❑ Full ❑Crawl ❑Walkout' ❑'Other �S" G 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 L Heat Type and Fuel: 06aas ❑Oil ❑ Electric ❑Other Central Air: ®'Yes ❑No Fireplaces:.Existing New Existing wood/coal stove: _❑Yes -ff No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exist ng ❑ntR sizes Mm Attached garage:❑existing 0r5ew size�� :❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ -� 77, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map� _Parcel Application# 7e 2,TY - ;.-_Health Division Conservation Division Permit# Tax Collector Date Issued j 1,Treasurer Application Fee 60 Planning Dept. Permit ,0(� Fee i Date Definitive Plan Approved by Planning Board b� Historic-OKH Preservation/Hyannis Project Street Address Village Owner Address Telephone — e7 e fi ;Permit Request S t p�/ Aleftl Square feet: 1st floor:existing proposed 2nd floor:, "7 proposed Total new _01 Zoning District Flood Plain Groundwater Overlay Project Valuation 61,o2 Construction Type Lot Size �/d, z�� Grandfathered: ❑Yes a'IVo, If yes, attach supporting documentation. a Dwelling Type: Single Family O Two Family ❑ Multi-Family(#units) .. Age of Structure Historic Houses O Yes 3<oo On Old King's Highway: ❑Yes 2'1Tb__ Basement Type: ❑ Full ❑Crawl ❑Walkout ra ther Basement Finished Area(sq.ft.) Basement U mished 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: CkYes m Detached garage:❑existing ❑new size Pool:0 existing ❑new size Barn:❑eing ❑new s'i co Attached garage:O existing ew size._,2?/� Shed:0 existing ❑new size Other.- Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ r: r�_3 r OW F BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 5 M1'`, W Application# G �5 � pp Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application e Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ,T Village AZ�lOwner Q E'S s ��Address z' Telephone IV-7 l J-�f "&r7 7 Permit Request 4Z Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District 157,1611 Flood Plain Groundwater Overlay Project Valuation Construction Type o -, _ Lot Size aK fw 7 Grandf thered: ❑Yes ❑ No If yes, attach supporting dUumentation. cr Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) «� Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: O;Yes -L)No Basement Type: ❑Full ❑Crawl ❑Walkout D4ther J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Parcel p bQC Application# Health Division Conservation Division Permit# Tax Collector Date Issued as Treasurer Application Fee Planning Dept. Permit Fee n� Date Definitive Plan Approved by Planning Board1 Historic-OKH Preservation/Hyannis "eV 3 Project Street Address Village f Owner S /� ��:s '«Address Telephone _76r —fel . Permit Request lL-✓ d�� orii �'siG! ` Square feet: 1 st floor:existing proposed 2nd floor: existing proposed /62�/ Total neW9??J_7 Zoning District �/ Flood Plain - r Groundwater Overlay = Project Valuation �� 77 Construction Type Alayl_ — Lot Size Z/X, �,� Grandfathered: ❑Yes O'I�lo If yes, attach supporting documentation. r Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) r o�cSG Age of Existing Structure Historic House: ❑Yes gi<o On Old K•ing's Highway: ❑YE s _ Basement Type: ❑ Full q Crawl q Walkout er i- civ O� Basement Finished Area(sq.ft.) — Basement Unfinis ed Area(sq.ft) Number of Baths: Full:existing new Half:existing _ new Number of Bedrooms: existing f new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: 6Gas ❑Oil ❑ Electric . ❑Other Central Air: Orles ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes a 0 Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing yew size ,2O 5hed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded 0 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# 7k�l Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer 0-0 Application Fee Planning Dept. tq-Permit Fee Ob ; Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis' & (� Project Street Address-�s, i�C� PJ �/'ri L� s Village Owner L5 � Address Telephone 1i' 7 Permit Request z Square feet: 1st floor:existing proposed qy4 2nd floor:existing proposed Total new Zoning District /.1 Flood Plain Groundwater Overlay Project Valuation �� 77 Construction Typed Lot Size `/ 7 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) a Age of Existing Structure Historic House: ❑Yes a'No On Old King's Highway: ❑Yes Z<0 Basement Type: ❑Full ❑Crawl ❑Walkout Q-Orher 1.,,7 7,-7 /4 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: 2Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑.existing ❑neWztize Attached garage:❑existing enew size qZb hed:❑existing ❑new size Other` Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ � r I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 306 Parcel FW Application# Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application e /0 Planning Dept. Permit 0 Date Definitive Plan Approved by Planning Board I .� Historic-OKH Preservation/H annis - Y Project Street Address ?D V �' C° U,'/�� /�r�� s , ;17 Village Owner S s' �i S Address Telephone T t f 7�7 Permit Request_ Square feet 1 st floor:existing proposed W 2nd floor.existing —" proposed,1?2q Tot6w,"e ZZO Zoning Distr tL-ill Flood Plain Groundwater Overlay Project Valuation !� Construction Type a �, Lot Size + /� � Grandfathered: ❑Yes ❑ No If yes, attach supporting docume tation.�41 Dwelling Type, Single Family ❑ Two Family ❑ Multi-Family(#units) O Age ofwExisting Structure Historic House: Cl Yes a 0 On Old King's Highway: ❑Yes �IVo Basement!Tpe ❑Full ❑Crawl ❑Walkout OO(her Basement Figished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths Full:existing �- .�P ;Y '.. s�� ti ' s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map— Parcel 00 1C Application# L9 Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Applicat �D JJA , Planning Dept. Permit Fbe 5 � Date Definitive Plan Approved by Planning Board PP- Historic-OKH Preservation/Hyannis Project Street Address Village Owner Z6�� i Telephone Z / — 7.j:;�7 Permit Request ��SC J Square feet: 1 st floor:existing proposed re:;, 2nd floor: existing — proposed d Total new;' Zoning District Flood Plain Groundwater Overlay _ Project Valuation � 7� Construction Typero Y~4� Lot Size e , 6 Grandfathered: ❑Yes No If yes, attach supporting d cumentation. {- Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) � Age of Existing Structure Historic House: ❑Yes 21< On Old King's Highway: 0 Yes il No Ba sement Type: ❑Full ❑Crawl ❑Walkout ❑Other RAY LAPIERRE PHONE:774-259-4885 AS D® CT- RAY@MASSDUCTBLASTERS.COM BLASTERS Www.MASSDUCTBLASTERS.COM IEC 2009 & MA Stretch Energy Code Duct Tightness Verification (P:DASi / FAIL ' Date: ./ Permit No: Street Address: Total Conditioned Floor Area: /P17 C"7 r- r� Ll rM HE_tS Raier: Certification Number: / / %gnat U�re:;� 4J Builder: �v �w c�r��5 Builder Contact: . _ l ;fi �✓�-r>� ors� HVAC Contractor: 6,:C #)4�' :50 AJ30 � 9 2009 IECC- New Construction Post-Construction test ® Total Leakage-1 2 cfm/100ft2 maximum allowed ® Leakage to outdoors-89 cfm/100ft2 maximum allowed ' Testing Results: cfm/100ft2 Rough-in Test Total' akage.' Yes-6 cfm/100ft2 maximum allowed ' Ll No 4 cfm/100ft2 maximum allowed Testing Results: cfm/100ft2 MA Stretch Energy Code-401.3 Prescriptive Option for Residential Additions ` Applies to all systems except those in which.the air handier and all ducts are located within conditioned space. ® Leakage to outdoors-4 cfm/100ft2 maximum allowed Testing Results: cfm/100ft2 MASSDUCTBLASTERS 2011 sfi ,a ? RAY LAPIERRE PHONE:774-259-4885 MASS DUCT RAY@MASSDUCTBLASTERS.COM �� ERS www.MASSDUCTBLASTERS.COM IEC 2009 & MA Stretch Energy Code Duct Tightness Verification (PLA! / FAIL. Dater Permit No: 13 C� / pro Street Address: 51E_t� As 5 7- 6_7 q Total Conditioned Floor.Area: y f= HERS Rater: L.: Cei fication Number: CC - �CG� � Sig6iture: r,, C 5Build•..er: V 7Alq C'C n Builder Contact:am ) (�C` lcl d� 7 6k—I a HVAC Contractor: (f& 20091ECC- New Construction Post-Construction test ® Total'Leakage'-12 cfm/100ft2 maximum allowed ® Leakage to outdoors-89 cfm/100ft2 maximum allowed Testing Results: cfm/100ft2 Rough-in Test ' . rYes akage 6 cfm/100ft2 maximum allowed ` ® No-4 cfm/100ft2 maximum allowed Testing Results: ry � cfm/100ft2 MA Stretch Energy Code-401.3 Prescriptive Option for Residential'Additions Applies to all systems except those in which the air handler and all ducts are located within conditioned space. ® Leakage to outdoors-4 cfm/100ft2 maximum allowed Testing Results: cfm/100ft2 MASSDUCTBLASTERS 2011 .;� RAY LAPIERRE PHONE:774-259-4885 MASS DUCT RAY@MASSDUCTBLASTERS.COM LA �� WWW.MASSDUCTBLASTERS.COM IEC 2009 & MA Stretch Energy Code Duct Tightness Verification � FAIL Date: Permit No: 01 Uc) Gf Street Address: �� t 1 �r 3a0 5 A:-_V0?5 51"r Total Conditioned Floor Area: HERS Rater: Certifi ation Number: - Zz- ,�,$ignature. <!Builde'r: 6�s C:¢uilder Contact , i(�� C'/l� q'"od(li �r��/ HVAC Contractor: CCi / �U�� '✓ v� 1p2 2009 IECC- New Construction Post-Construction test Total Leakage-12 cfm/100ft2 maximum allowed ® Leakage to outdoors-89 cfm/100ft2 maximum allowed Testing Results: cfm/100ft2 Rough-in Test Total Leakage U Yes-6 cfm/100ft2 maximum allowed `No-4 cfm/100ft2 maximum allowed Testing Results: cfm/100ft2 MA Stretch Energy Code-401.3'Prescriptive Option for Residential"Additions Applies to all systems except those in which the air handler and all ducts are located within conditioned space. ® Leakage to outdoors-4 cfm/100ft2 maximum allowed Testing Results: cfm/100ft2 MASSDUCTBLASTERS 2011 i RAY LAPIERRE . PHONE:774-259-4885. ("ASS DUCT RAY@MASSDUCTBLASTERS.COM BLASTERS WWW.MASSDUCTBLASTERS.COM' IEC 2009 & MA Stretch Energy Code Duct Tightness Verification A ./ FAIL Date: Permit No: Street Address: Total Conditioned Floor Area: 13r_� Ll HERS Rater: CeFtification Number: l 5 CM Signature: rn djvilder-- Bt�ildertContact: r p rK_ HVAC Contractor: % U f� �C�+✓ V �� 2009 IECC - New Construction Post-Construction test ® Total Leakage'-12 cfm/100ft2 maximum allowed ® Leakage to outdoors-89 cfm/100ft2 maximum allowed Testing Results: cfm/100ft2 Rough-in Test. Total Leakage 6J Yes-6 cfm/100ft2 maximum allowed ® No-4 cfm/100ft2 maximum allowed Testing`Results: �/ cfm/100ft2 MA Stretch Energy Code-'401.3 Prescriptive Option for Residential Additions Applies to all systems except those in which the air handier and all ducts are located within conditioned space. LILeakage to outdoors-4 cfm/100ft2 maximum allowed Testing Results: cfm/100ft2 MASSDUCTBLASTERS 2011 RAY LAPIERRE - PHONE:774-259-4885 MASS DUCT RAY@MASSDUCTBLASTERS.COM BLASTERS WWW.MASSDUCTBLASTERS.COM IEC 2009 & MA Stretch Ener Y Code Duct Tightness Verification LPAI�P/ FA e Date: Permit No: Street Address: YO Total Conditioned Floor Area: IERS Rater: Certification Nu M ber: • pgnat" e: CID Builder ju J/ � 1 Builder Contact: j� ell�G" . [HVAC Contractor: �(/hf°(f jG, 6'� U 33 3 2•-9— f d% 2009 IECC- New Construction Post-Construction test ® Total Leakage-12 cfm/100ft2 maximum allowed ® Leakage to outdoors-89 cfm/100ft2 maximum allowed Testing Results: cfm/100ft2 Rough-in Test Total Leakage ®Yes-6 cfm/100ft2 maximum allowed L.No-4 cfm/100ft2 maximum allowed e Testing Results: cfm/100ft2 MA Stretch Energy Code-401.3 Prescriptive Option for Residential Additions Applies to all systems except those in which the air handler and all ducts are located within conditioned space. ® Leakage to outdoors-4 cfm/100ft2 maximum allowed Testing Results: cfm/100ft2 MASSDUCTBLASTERS 2011 4 i Town of Barnstable Regulatory Services r BARNSfABLE, 9 MASS. - �, Thomas F. Geiler, Director �A s639. �0 rF0,39 Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 MEMO TO: Joseph Lambalot FROM: Debi Barrows DATE: September 12, 2007 RE: 350 Stevens Street, Hyannis The following applications 200700489,200700490 and 200700486 were entered as commercial instead of residential. In order to correct this error the following applications 200704737, 200704739 and 200704740 fees have been adjusted to reflect over charge. See below. Fees Over I'd 200700486 200700489 200700490 Application 50 50 50 Permit 1875 1875 1125 Cert. Occupancy 75 75 75 2,000 2,000 1,250 200704740 200704737 200704739 Permit Fees 1,921.88 1,921.88 1,153.13 Balance 78.12 78.12 .96.87 f OE PROJECT ADDRESS4 1;0 PERMIT# PERMIT DATE: Zp M/p: II LARGE ROLLED T-LANS ARE IN: BOX (� SLOT Data entered in MAPS,, on: . vv� BY: , V TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map,36F, Parcel (50 L-lu`! .'Application" Application # �j Health Division Date Issued Conservation Division Y Application Fee lLA Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 15 Sme oeA.WW 31 Hye Village P Owner I R g s ,��s °re S l�. Address �'l J f 4 Telephone 's 0 1 Tr /40. a Permit Request AjTO1i Rean., , c Geu- 6IG Qu�,,dC Square feet: 1 st floor: existing proposed nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation .0 Sbc Construction Type Lot Size �gJ� an CJ Thz I Grandfathered: ❑Yes ❑ No If yes, attach sup orting documentation. Dwelling Type: Single Family �1 Two Family ❑ Multi-Family (# units) UIVIT3 TBIM Age of Existing Structure Historic House: ❑Yes ❑ N On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other A.) Basement Finished Area(sq.ft.) �� Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Z Half: existing new c-Z Number of Bedrooms: existing z new Total Room Count (not including baths): existing new 7 First Floor F�bm County Heat Type and Fuel: gGas ❑ Oil ❑ Electric ❑ Other , Central Air: Yes ❑ No • Fireplaces: Existing NewN Existing wood/coal stove: 44es ❑ No Detached garage: ❑ existing ❑ new size_PAJ. xisting ❑ new size _ Barn: ❑lexisting-,L) ne size_ Attached garage: ❑existing new size _Shed: ❑ existing ❑ new size _ Other: s C CO M Zoning Board of Appeals Authorization ❑ Appeal #_ Recorded ❑ Commercial El Yes No If yes, site plan review #R Current Use -C,S o e de _Proposed_Use______ t9ejjioj.dCv.l - -- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name L/bT'T) 1-°'r"°�`"felephone Number 96/- Address 9b CP�cJ S%, License # eaAARw i MA, o a W Home Improvement Contractor# Worker's Compensation # fd,)C. CAI V 9, /ki ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO DATE SIGNATURE - -�--s ��'<� z FOR OFFICIAL USE ONLY APPLICATION# `I DATE ISSUED ' MAP/PARCEL NO. ADDRESS i VILLAGE OWNER j DATE OF INSPECTION: ell i FOUNDATION~ FRAME "i � . ,r INSULATION #, , ' FIREPLACE F ELECTRICAL: ROUGH FINAL _ PLUMBING: ROUGH a F FINALt 0 j ,GAS: ROUGH FINAL I FINAL BUILDING' r L DATE CLOSED OUT ' ASSOCIATION PLAN NO. n The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 t s The Commonwealth of Massachusetts William Francis Galvin y � Secretary of the Commonwealth,Corporations Division One Ashburton Place, 17th floor Boston,MA 02108-1512 Telephone: (617)727-9640 FLAGSHIP ESTATES HYANNIS, LLC Summary Screen Help with this form '; FRequest a Certificate��,�.a„ The exact name of the Domestic Limited Liability Company(LLC): FLAGSHIP ESTATES HYANNIS,LLC Entity Type: Domestic Limited Liabilily Company(LLC) Identification Number: 000922231 Date of Organization in Massachusetts: 04/20/2006 The location of its principal office: No. and Street: 2 ADAMS PLACE, STE. 100 City or Town: QUINCY State:MA Zip: 02169 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: ~ Name: JEFFREY C. O'NEILL No. and Street: 2 ADAMS PLACE, STE. 100 City or Town: QUINCY State: MA Zip: 02169 Country: USA The name and business address of each manager: Title Individual Name Address (no Po Box) First,Middle,Last,Suffix Address,City or Town;State,Zip Code MANAGER JOHN KELLY 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA MANAGER DONALD O'NEILL 2 ADAMS PLACE,STE.100. QUINCY,MA 02169 USA MANAGER JEFFREY C.O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA The name and business address of the person in addition to the manager,who is authorized to execute documents to be filed with the Corporations Division: Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY JOHN KELLY 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA SOC SIGNATORY JEFFREY C.O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA SOC SIGNATORY DONALD O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 8/18/2011 The Commonwealth of Massachusetts William Francis Galvin - Public Browse and Search Page 2 of 2 The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no Po Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY DONALD F.O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA REAL PROPERTY JOHN KELLY 2 ADAMS PLACE,STE.160 QUINCY,MA 02169 USA REAL PROPERTY JEFFREY C.O'NEILL . 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA Consent Manufacturer _ Confidential Data Does Not Require Annual Report Partnership _ Resident Agent _ For Profit _ Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS J J Annual Report Ix Annual Report-Professional ' Articles of Entity Conversion Certificate of Amendment W d Mew Filing ', New Sea.ch � Comments O 2001-2011 Commonwealth of Massachusetts All Rights Reserved Help i http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 8/18/2011 r. v ' d+ G� E ,e+ . - Cc�3M.MON�1.�EALTI� O�' 4Vie�k.� 'Ar.aeL3e,�'�J'�T9.i7 - SHEET METAL WORKERS 'AS`A MASTER-UNRESTRICTED ISSUES THE ABOVE LICENSE TO: KEVIN L MAIN 816 WINTER STREET = m • I HANS0N. MA 02341 1131 1.25.61 07/28/12 85:58: COMM0NWEALTH vE MASSACl-IUSETTS ;�oMft I MI:I AL VV99RMM AS=A BUSINESS ISSUES THE ABOVE LICENSE TO. 'KEVLN'..L MAIN ; COTTI 'J:O'HNSON 'HVAC INC 80" GEDAR ST � CANTON '' MA 02021-080.0 35.5 05/09/13 9984 . KEVIN MAIN VICE PRESIDENT/OWNER - ' �./. KMAIN@C OTT IJ0HNS0N.00M (617) 799-OB60 CELL JOHNSON 1;�1WAF.9 QMCo ' SINCE 1948 80 CEDAR STREET, CANTON, MA 02021 (781) 821-1511 PHONE (781 ) 82 1-1599 FAx WWW.COTTIJOHNSONHVAC.COM 300arb of Regi5t ation Of mt.. et F �� u� � tip c�� trje re�utreil�eltt� of: � cYjtx ett� (bencrat lad ter 112, ectiou 237 tfjrougrj 251 tt A;,V, {i r; Yjerebp grauteb 005 certf f f cate 110. 355 a,5 0i ence to taractic.e a. a ee Oil tYjis TJ bap of ,RRp 20.11 Jn �e�tintottp VYjereof, i.5 YjeLettuto afffxeb the ttante of tbe, (ff,xeetttfbe 0lrector of trje 3Boarb OII�IVlON�1f Ede[1"81 OF IVIASSACFIOSETTS a . . g WPM f AS-A BUSINESS TO ISSUES THE ABOVE LICENSE Y 4V c �VIN L> MAIN400 ri �"OTTI :JOHNSON HVAC IhIC cD °CEDAR ST r= � � 7}e t,ANTON MA 02021 00D 355 ,t 05/09/13 0984 The Commonwealth of Massachusetts Department of Industrial Accidents Office ofInvestigations- a 600 Washington Street ` Boston,MA 02111. www.mass.gov/dia ` Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �CI. �/1— T j,�©� V .Thr- 0 ce-Li. I 1 " Address: City/State/Zip: Ca h1oh, MA 0 Q Phone Are you an employer?Check the appropriate box:` Type of project(required): 1.X I am a employer with_ s4/ 4. Q I am general`contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no employees a These sub-contractors have 8. E]Demolition working for me in any capacity. employees and have workers' [No workers' comp:insurance comp.,msurance.t 9. ❑Building addition required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work` . officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof.repairs t insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.0 Oiher w comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this liox 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 Nam e: Policy#or Self-ins. Lic.#: (1)1Q Expiration Date:y 0 Q Job Site Address: 320. �IQIM/1JOA cST. City/State/Zip: �YaAni MA a2bb� 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 crirninal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form.of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised.that a copy of this statement may be forwarded.to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature �i�•t�� ' Date Phone#: Official use:only. Do not write in this'area,to be completed by city or town official City or Town: .". Permit/License# . Issuing Authority(circle one): y 1.Board of Health 2.Building Department 3. City/Tbwn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• 1 .11C DATE(MM/DD/YY) CERTIFICATE OF LIABILITY INSURANCE , 06/17/11 �i -THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I` CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED I 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 Aon Risk Services,Inc of Florida Aon Risk Services,Inc of Florida NAME: - 1001 Brickell Bay Drive,Suite#1100 PHONE 800-743-8130 FAX 800-522-7514 A/C No.Ext: A/C,No): Miami,FL 33131-4937 E-MAIL ADP COI Center@Aon.com . ADDRESS: - - PRODUCER 10762287 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:New Hampshire Ins Co 23841 ADP TotalSource MI XXX,Inc. INSURER B: 10200 Sunset Drive Miami,FL 33173 INSURER C: ALTERNATE EMPLOYER INSURER D: Cotti-Johnson HVAC,Inc. 80 Cedar St - INSURER E: Canton,MA 02021 INSURER F: COVERAGES CERTIFICATE NUMBER: 308176 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LI111't'S SHOWN ARE AS RE(JUESTED, INSR ADD L SUER POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE INS R WVD POLICY NUMBER DATE(MM/ODNYYY) DATE(MMIDD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ ' O COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ + O CLAIMS MADE 13 OCCUR PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY "$. GEN'L AGGREGATE LIMIT APPLIES PER: � ❑POLICY ❑PROJECT ❑ LOC - GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ . ❑ANY AUTO + - (Ea accident) ❑ALL OWNED AUTOS BODILY INJURY $ ❑SCHEDULED AUTOS (Per person) - ❑HIRED AUTOS - BODILY INJURY ❑NON OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) ❑UMBRELLA LIAB OCCUR EACH OCCURRENCE $ f ❑EXCESS LIAB CLAIMS-MADE r GA $• - AGGREGATE ❑ DEDUCTIBLE $ ❑ RETENTION b - $ y A WORKERS'COMPENSATION AND WC 012438946 MA 07/01/11 07/01/12 0 WC STATu ❑ OTHER EMPLOYERS'LIABILITY TORYLIMITs ANY PROPRIETOR/PARTNER/EXECUTIVE _ OFFICER/MEMBER EXCLUDED? NIA ❑ E.L.EACH ACCIDENT $ 2,000,000 1. (Mandamry in NH) _If yes,descdbe under E.L DISEASE-EA EMPLOYEE $ 2,000,000 : DESCRIPTION OF OPERATIONS below . E.L.DISEASE—POLICY LIMIT, ' $ 2,000,000 E- t t DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - { All worksite employees working for the above named client company,paid under ADP TOTALSOURCE,INC.'s payroll,are covered under the above stated policy. The above named client is an alternate employer under this policy. �c jt 'f t a� CANCELLATIOPf.. COTTt-JOHNSON HVAC,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 80 CEDAR ST '',' THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. f. CANTON,MA 02021 AUTHORIZED REPRESENTATIVE I, (7147a �6K- ezvieal, gate o f L-�lozida }}� ACORD 25,(2009/09 OORAON:,"Alr tghfs_, eserve8 ORUR The ACORD name and logo are registered marks of ACORD is Ij Town of.B arn'stabie Regulatory Services MASI �* Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder . , as Owner of the subject property hereby authorize e07- / to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) tore of Date 0 Print ame If Propedy Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM3:O WNER.P ERMIS310N �4oF Y�ray Town of Barnstable Regulatory Services Thomas F. Geiler,Director W Ass. Building Division orFD { Tom Perry,B nil.dfng Commissioner 200 Maid.Street;_Uyannis,MA.02601 Rrww.town.barnstable.ma us Office: 508-862-403 8 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": . name, home phone# work phone# CURRENT MAILING ADDRESS: city/tovm state zip code T c 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. y DEFWMON OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who coast mcts more than one home in a two-year period shall not be considered a bomeowner. Such "homeowner'shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responstNE:for all such work performed under the"building tiermit:i'(Section 109:1'.'!) l The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department min mum inspection procedures and requirements and that he/she will comply with said procedures and requirements. " Signature of Homeowner Approval of Building Official ' Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner performing work for which a building porn it is required shag be exempt from the provisions Of this sec6on_(Secd6n 1 D9.1.1-Li=nsing of construction Supervisors);provided that if the homeowner rngages a persons)for hire to do such work,that such Homeownrs shall act as supervisor." 4any homeowners who use this rxcmption are unaware that they are assurning the responsibilities of a supervisor(set Appendix Q, Rules&Regulations for Licauing Construction Supervisors,Section 2.15) This lack of awarzness often results in serious problems,particularly when the homeowner hires unlicensed persons. In.this case,our Board cannot proceed against the unlicensed person as it would with a liernsed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the hamcowner is fully aware of his/her responm'bilitics,many communities require,as part of the permit application, that the homcowncr certify that hdshe 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 forn/ccrtification for use in your cotranunity. Q:forrns:homccxcmpt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 O Parcel_ CEO v Application # C Health Division -' Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 70 Date Definitive Plan Approved by Planning Board Historic.- OKH _ Preservation / Hyannis //7/ir Project Street Address es STUeASeak (010-3 Village ' 4�q 0.nni S _ Owner \aes h%o Gs 1m-n L L L Address a JgJ-CL_5 Su i 1Z- /00 Telephone Permit Request � 4 nS �� c i 'sP, c e y/ Aen i Square feet: 1 st floor: existing propose 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay a w� o Project Valuation 600 Construction Type Ne y" Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family* ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure ALA*L,'-) Historic House: ❑Ye Ll No On Old King's Higflway: ❑Yes 01No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other i A+ Basement Finished Area(sq.ft.) /l��l� Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new _ it Half: existing new Number of Bedrooms: existing.3 new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: XYes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new siz ol: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing new size _Shed: ❑ existing ❑ new size _ Other: E Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes )�No If yes, site plan review# Current Use &sideATf o✓l Proposed Use APPLICANT INFORMATION (,,BUILDER OR HOMEOWNER) Name 6T I �A1611 L 1h41ri Telephone Number ��' � 7� — Id y 8 Nli Address - W Cedcxr License# y a O2 Home Improvement Contractor#' Worker's Compensation # W� 154 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i SIGNATURE T T DATE r' i FOR OFFICIAL USE ONLY . r APPLICATION# DATE ISSUED - r MAP/PARCEL NO. , ADDRESS VILLAGE OWNER DATE OF INSPECTION: , y D - FOUNDATION- FRAME INSULATION t FIREPLACE p ELECTRICAL: ROUGH FINAL s • r PLUMBING: ROUGH FINAL F ;GAS: "• ROUGH,,, FINAL . .FINAL BUILDING f DATE CLOSED OUT ASSOCIATION PLAN NO. 4 The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 _ www.mass.gov/dia . Workers' Compensation Insurance Affidavit: Builders/Contraciors/Electricians/Plumbers . Applicant Information Please Print Legibly Name (Business/Organization/Individual): �¢,C — T�hsah ��, � Address: 9 0 CeJcg ` R City/State/Zip: 40A, ® Phone#: Are you an employer?Check the appropriate boxy Ty a of project(required): .' 1.!mil I am a employer with e1�y $'�� 4• E] I.am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. A New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g,.0 Demolition working for me in any capacity, employees and have workers' - com insurance.$ 9. Building addition [No workers' comp.insurance P• required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c.'152, §1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required:] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. •-{-' Insurance Company Name: Ah Kikk eFVISCS,�S h O f fi/pl^I�A Policy#or Self-ins.Lic.#: j , � MA Expiration Date: - 0 01 Job Site Address: 3Z O ST9_,ieAjC341 67• City/State/Zip: n;,S /► 4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form.of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: `' Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other , Contact Person: Phone#• .. '; .k«• 1 { a i a CERTIFICATE OF LIABILITY-''i�la7`9®®/�pp'g��a DATE(/17111 YY) �3K£3P69'' N C E 'f x , 06/17/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY,THE POLICIES ' BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),`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 1S 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 : i' the certificate holder in lieu of such endorsement(s). ' PRODUCER -CONTACT Aon Risk Se vices,Inc of Florida NAME; Aon Risk Services,Inc of Florida PHONE FAX 1001 Brickell BayDrive,Suite#1100 800-743-8130 800 522-7514 A1C No.Ext:• e. " A/C`No: , Miami,FL 33131-4937 E-MAIL' ADP_COI_Center@Aon com 'ADDRESS: - PRODUCER 10762287' CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIL# INSURED * INSURER A:New Hampshire Ins Co 23841 .. ADP TotalSource MLXXX,Inc. INSURER B. •. . .' �;", ,. -� :. 10200 Sunset Drive µ ' Miami,FL 33173 INSURER C: .'•,.s a . ALTERNATE EMPLOYER y "' • - -INSURER D. '`r - Cotti-Johnson HVAC,Inc. 80 Cedar St INSURER E: y Canton,MA 02021 INSURER F:Y COVERAGES' CERTIFICATE NUMBER: 308116` ,. �°. _REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LIS 7 ED 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: : L143i"GS tif)r)4:1:.•.1tt lS RLr K LS(Ei?J: r a I ` INSR ADDL SUBR '- POLICY fFFECTIVE.POLICY EXPIRATION ¢- TYPE OF INSURANCE x POLICY NUMBER ' LIMITS'- LTR INSR WVD DATE(MMIDDNYYY) DATE(MMIDDNYYY) GENERAL LIABILITY - •' `; •• .= EACH OCCURRENCE ` ❑COMMERCIAL GENERAL LIABILITY ! - -DAMAGE TO RENTED O CLAIMS MADE ❑OCCUR - - PREMISES(Ea occurrence) .t $ MED EXP(Anyone person) - $ GEN'L AGGREGATE LIMIT APPLIES PER.:;. r` r •; .�V.', ;A PERSONAL&ADV INJURY;7 $ GENERAL AGGREGATE - $ ❑POLICY O PROJECT ❑ LOO e � 'i,.'�-,q' � ' I PRODUCTS COMP/OP AGG $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ❑ANY AUTO (Ea accident) ' $ + - _-. ❑ALL OWNED AUTOS- _ •�-',ei BODILY INJURY; ❑SCHEDULED AUTOS - _ ` (Per person) °$ - O HIRED AUTOS Aq, e. BODILY INJURY (Per accident) ..F. -$ - `* ❑NON OWNED AUTOS - •. PROPERTY DAMAGE $ + - " "v (Per accident) •i ❑ UMBRELLA LIAB' OCCUR ` $ r EACH OCCURRENCE $,.._ ❑ EXCESS LIAR CLAIMS-MADE h AGGREGATE ❑ DEDUCTIBLE ., Y• $ RETENTION S I y_ i r A WORKERS'COMPENSATION AND WC 012438946 MA ` 07/01/11 07/01/12 . "®we STATU- ❑ OTHER t p• i EMPLOYERS'LIABILITY - >:, -TORY LIMITS - _ ANY PROPRIETORiPARTNERtFXECUTIVE E.L.EACH ACCIDENT `';�_ $ 2,000,000, j OFFICER/RdEMSER EXCLUDED? NIA ❑ f' .�`~}_ 1, (Mandatory in NH) .- ;v E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes,describe under w DESCRIPTION OF OPERATIONS below• ` a• '9 yI 'sh:. °�" . E.L.DISEASE—POLICY LIMIT. $ '^ .2,000,000 ' DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101'Additional Remarks Schedule,if more space is required) All workslte employees working for the above named client'Coin pa, ,hy,paid under ADP TOTALSOURCE,INC.'s payroll are covered under the above stated policy. The above named client is an alternate employer under this policy. + COTTI•JOHNSON HVAC,INC. ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 80 CEDAR ST THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS., I -- (: CANTON,MA 02021 AUTHORIZED REPRESENTATIVE,, •1. � ,p , ACDRp 25'(20Q9109) „ g, 019i38 2009 ACt?RG1 CORPORATION:,All,,rtghts fesenied The.ACORD name and logo are registered marks of ACORD ! ' . ,.... , .- ...:�_."+.. _._ z .s_...y.,.:..a�.-'��.3.;v.-- .Y..�:.� .,>:""M c.W.��.. ix^>r r .�,�- - - °'eta..,.e-w,.•.��+•�.;:e- DRIVER'S LICENSE NUMBER - - S08865802DOB c ' 07 05:201'2 07 05 1967 f.; •� CLASS i BEST HGT 1 SE)( DM ,:' 6-02 M i. MAIM` KEVINL Mr z(a I jrsa,�Jj r 816 WINTER ST 4': HANSON,MA..,.; �' �• r, _..:�I 02341.1131 1, 07 0-i967 r COMMONWEALTH OF lMASSAC'HUSE 3_�S, SHEET METAL WORKERS AS A MASTER-UNRESTRICTED F !SSUES THE ABOVE LICENSE To: KEVIN.,:.L•.-MAIFJ 816 WINTER STREET > A I HAN SON-'` MA 0234171131`°' ti 125.61 07/28/12 8558 L - COMMONWEALTH OF MASSACHUSE:TTS P 0 �0 % s - AS 'A BUSINESS ISSUES THE ABOVE LICENSE TO: KEVIN L' MAIN " COT.TI.-J:OHNSON HVAC INC , 80' .CEDAR ST \: CANTON '. MA '02U?1_000 t 355 05/09/13 9984 •KEVIN MAIN VICE PRESIDENT/OWNER KMAIN@COTTIJOHNSON.COM } �� ➢o (617) 799-0860 CELL �1J(F41�y �tl�3 F1mo - SINCE 1948 ` 80 CEDAR STREET, CANTON, MA 02021 (781) 821-151 1 PHONE (781 ) 821-1 599 FAX WWW.COTTIJOHNSONHVAC.COM Regt.5tfattou of �j�e_tr etacY or erg abtng 5 tidieb the requfremo t. of �� crjuatt. �eriei�AY ab� Cbapter 1: l2, *ection 237tjjrougb.251 Aosur s oth 0 u U . y r t� fjere p, gran.teb tlji�, certificate," 355 ei� beitce t 'practice . ry . v bap of �p Fk 20,1e i Te!tiluollp Mjereof,_io. Yjerettitto affixeb tYje bate of tYje (executibe Tl rectbe oftYje oar"b COIVIIVI®14WEALTH of nn�4ss�4cwu:sE-t�5 #: AS."A BUSINESS . 'ISSUES THE ABOVE LICENSE x. �VIN L. MAIN q.- - W/ T..3 OTTI,-JOHNSON HVAC ZINC f r � D C;E.DAR ST _ Mate ANTON MA 02021 000 , � 355 05/09/13 9984' I of THE r TOW�- n of.Barnstable Regulatory Services t �arrs-rtac.E, �* Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Dff ce: 508-962-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, (z O �`� _ t'i/ as Owner of the subject.property - J P PertY hereb authorize �' �U to act on my behalf, . k in all=tters relative to work authorized by this building permit application foi: '301v (Address of Job) f Date Print Name If Property Owner is applying for pen-nit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:0 VJNERPER.MISS)ON Y� Town of Barnstable ray - ti� o Regulatory Services a&XNsrABLr_ Thomas F. Geiler,Director MAB-4 i6.59. ,�� Building Division PlfD MAC h Tom Perry,Building Commissioner. 200 Main-Stme t jlyannis,MA 02601 Fww.to wn.b zrnstabl e_m2_us Office: 508-962-403 8 Fax: 508-790-6230 ]10KEO"ER LICMMSE EXEMPTTON Please Print DATE JOB LOCATION: number street village "HOMEOWNER": name homc phone# work phone# CURRENT MAILING ADDRESS: city town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. . DEFIAMON 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 constrticts more than one home in a two-year period shall not be considered a bomeowner. Such "homeowner"shall submit to the Building Official on.a.form acceptable to the Budding Official, that he/she shall be responsible for all such work perfaimed°tinder the building pefmit:'(Section 109:1`1)� The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that.be/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMMOWNER'S EXEMPTIbN The Code statrs that: "Any homeowner performing work for which a building permit is rcquircd shall be exempt from the provisions of this section_(Sectian ID9.1.1 -Licensing of construction Supenvsors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor," Many homeowners who use this exemption are unaware that they are assuring the responsibilities of a supdvisor(see Appendix Q, Rulers&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In.this case,our Board cannot proceed against the unlicensed person as it wou)d with a licensed Supervisar. The-hom'Towner acting as Supervisor is ultiarate)y responsrb)e. To ensure that the homeowner is fully aware of his/her responsibilitics,many communities require,as part of the permit application, that the homeowner certify that hdshe understands the respomsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/acrtification for use in your community. Q:forms:homccxcmpt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel OCR `' 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 3 a o. S7eve/iAr CS_/ AAA S Village n Owner'Oq qSk io CST<1I-J L c- Address Z 4d 4?M j iOl SU/%E/o� Telephone .f Permit Request wV qAJ -T nS IVOl — L &!q(w a A eA., i o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new i 7q2 Zoning District Flood Plan Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 1 Two Family ❑ Multi-Family(# units) j Y Age of Existing Structure Historic H use: ❑Yes ❑ No On Old King's ighway:==0 Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ all Other w M Basement Finished Area (sq.ft.) 14 Basement Unfinished Area (sq.ft) 7 -i Number of Baths: Full: existing new Half: existing _ new a,D Number of Bedrooms: existing + new Total Room Count (not including baths): existing new First Floor Room;Count Z Heat Type and Fuel: X Gas • ❑Oil ❑ Electric ❑ Other Central Air: 1 Yes ❑ No Fireplaces: Existing New Existing wood/co&l stove:f�p YeFrQ No Detached garage: ❑existing 0 new �'4: ❑ 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 Re S I�Pn-'i C'( Proposed Use &S i eat d e- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name dC)TT7' 40-J i�Qvm L M'4'1 Telephone Number � �" S 1W la Ve Address a r cS 1 • License # QC✓1 TZ),,-) MA , d a Ool ) Home Improvement Contractor# Worker's Compensation # we oa t y ??V4 4V ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. " ADDRESS VILLAGE ,. OWNER DATE OF INSPECTION: FOUNDATION`,,:% :J r F�AME ` „_INSULATION s FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL s GAS; :w-• ROUGH j FINAL 'F:INAL BUILDING DAT_EYCLOSED.OUT ASSOCIATION PLAN NO. r COMMONWEALTH,0E 2VIASSACA, E I TS o Y ao- SHEET METAL WORKERS AS 'A MASTER-UNRESTRICTED ' ISSUES THE ABOVE LICENSE TO: ' KEVIN L MAIN 816 WINTER STREET 7 N I HA'NSON .: MA 02341'=1131 125.61 -07/28/12 8558 'CONVIONWEALTH OFF MASSAC-IUcSE:o i'S I METAL AS'.A BUSINESS ISSUES THE ABOVE LICENSE TO: KEVI-N L MAIN CO;TTI-JOHNSON HVAC' INC 80` C.EDAR ST 1... CANTON` MA 020 2 1`="000 355 05/09/13 9984 KEVIN MAIN ` pP VICE PRESIDENT/OWNER KMAIN@C OTT IJ O H N S O N.C O M. � �- ®4t ➢� r. „ - - � • (617) 799-0860 CELL NvAc, HHC. SINCE 1948, 80 CEDAR STREET, CANTON,'MA 02021 ,� (781) 821-1511 •PHO_NE (781) 821-1599 FAX f WWW.COTTIJOHNSONHVAC.COM 38barb of 'RegultattD t of "6bec ' .0leta Vorhcr,5r m �)a biug atfidieb tYje rcQutrcm'cnt� of aaarljtzgettq 0encrar la . ja ter4 Pctto u t jrougj251. , _ t t t t be'rebp granteb 4biq;-certificate 010: 355 a.5-ebibeuce to pratfice a!6 a i �eu eet etc _ _otttrjkF 911) �ba DfJa 20 i`. p r p _ it_�e�tiiuoitprjereof, t Yjerettuto AfftYeb tYje iYan�e of trje �xecutie, irector 'of trje 38oarb COIVIMOlVWEALTH OF MASSACFiUSETI'S= [y +' r r n .. AS`A BUSINESS ' ,; [j ik f _ ISSUES THE;ABOVE LICENSE TO 4 t a LVIN L MAIN.. r OTT.T JOHNSON _HVAC 0 CEDAR. ST Mite E " A ANT.ON MA 02021 0'00 7 . Y 355 05/09/13 99$4 f �'THE rp Town of.Barnstable ♦� Regulatory Services i f . f �K�A$ury i M.tav g Thomas F. Geiler,Director 4�`TED 16 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder as Owner of the subject ro e P P nY hereby authorize k IT'i to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) r Date Print 1TWme If Prove Owneris app1 rn for penni t ple ase complete the Homeowners License Exemption Form on the reverse side. Q:FORMS.O WNERPERMISSION 4 t of YHE ram, Town of Barnstable ` Regulatory Services H _ � Thomas F. Geiler,Director i�xxsrwste, � Building Division rED { Tom Perry,Building Commissioner 200 Main-Street, Ayannis,MA 02601 www.town.barnstable.ma us Office: 508-962-403 8 Fax: 509-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number strcot village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town statz ip 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 supervise DEFIRTI'ION OF HOMEOWNER P erson(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 constr gcts more than one home in a two-year period shall not be considered a homeowner, Such "homeowner"shall submit to the Building Of.5cial on a form acceptable to the Building.'Official, that he/she shall be responsible for all such work performed under the buildint?'_neimit.'(gection 109.1:1)'' The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. ' The undersigned"homeowner"certifies that.he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that.he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEmmbN .The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section.(Scction 1D9.1.1 -Licensing of emit urtion Supervisors);provided that if the homeor�,ner engages a parson(s)for hire to do such work,that such Homeowner shall act as supervisor." 4any homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In.this case,our Board cannot proceed against the unlicensed person as it would with a liecnscd Supervisor. The hom:Towner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responnbilitics,many communities require,as part of the permit application, that the homeowner certify that hdshe understands the responnbilitics 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 community. i . Q:forms:homecxcmpt The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �C3 ¢/— T It hsah1 M VIAC 11 C, Address: _ ed�H S ' City/State/Zip: h1oho AA O Q Phone#: 90 Are you an employer?Check the appropriate box: Type of project(required): 1.D<I am a employer with 4/- 4. ❑ 1.am a general contractor and I �( employees(full and/or part-time).* have hired the sub-contractors 6. JM New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling`., ship and have no employees These sub-contractors have 8. ❑Demolition working for me in,any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.'insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10:❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and.we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my,employees. Below is thepolicy and job site information. r Insurance Company Name:_ IDS eFVI o CGS;The a f ___or Policy#or Self-ins.Lic.#: PVC q4� ��._ Expiration Date: V Q Job Site Address: 3610 5TeU&bQXA1 IS—IT a-0—r— City/State/Zip: Q,)M s IVIA. 0d.L01 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL.c 152 can lead to the imposition of criminal penalties of a. fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above iss/true and correct. Signature: - Date: Phone#: Official use only. Do not write in this area,to be completed by city or townrofficial City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: k DATE(MM/DD/YY) -T CERTIFICATE OF LIABILITY INSURANCE 06/17/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to l; the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Aon Risk Services,Inc of Florida I: Aon Risk Services,Inc of Florida NAME: - 1001 Brickell Bay Drive,Suite#1100 PHONE 800-743-8130 FAX 800-522-7514 A/C No.Ext: A/C,No): Miami,FL 33131-4937 E-MAIL • ' ADP COI_Center@Aon.com ADDRESS: — PRODUCER 10762287 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE , NAIC# INSURED - INSURER A:New Hampshire Ins Co - - 23841. ADP TotalSource MI XXX,Inc. INSURER B: 10200 Sunset Drive Miami,FL 33173 INSURER C: ALTERNATE EMPLOYER INSURER D: Cotti-Johnson HVAC,Inc. INSURER E: ~ 80 Cedar St Canton,MA 02021 INSURER F; COVERAGES CERTIFICATE NUMBER: 308176 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIM[I'S SHOWN ARE,AS REiiAliGSTEi). ' INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION -LIMITS - LTR INSR WVD DATE(MM/DD/YYYY) DATE(MM/DD/YYYY) - GENERAL LIABILITY - EACH OCCURRENCE $ ' O COMMERCIAL GENERAL LIABILITY a DAMAGE TO RENTED $ - ❑CLAIMS MADE 0 OCCUR •r PREMISES(Ea occurrence) r MED EXP(Any one person) $ , • GEN'L AGGREGATE LIMIT APPLIES PER: . PERSONAL&ADV INJURY $ ' ❑POLICY ❑PROJECT ❑ LOC GENERAL AGGREGATE $ PRODUCTS—COMP/OP AGG $ 1 $ AUTOMOBILE LIABILITY - • COMBINED SINGLE LIMIT $ ❑ANY AUTO (Ea accident) ❑ALL OWNED AUTOS BODILY INJURY $ ❑SCHEDULED AUTOS _ (Per person) j r ❑HIRED AUTOS BODILY INJURY $ ❑NON OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) 0 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ I ❑ EXCESS LIAB CLAIMS-MADE AGGREGATE $ - ❑ DEDUCTIBLE P " $ ❑ RETENTION S - $ k A WORKERS'COMPENSATION AND WC 012438946 MA 07/01/11 07/01/12 We STATU-. ❑ OTHER EMPLOYERS'LIABILITY TORY LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ E.L.EACH ACCIDENT $ 2 OOO,OOO f OFFICER/MEMBER EXCLUDED? N/A (Mend-wry In NH) E.L.DISEASE—EA EMPLOYEE $ 2,000,000 f If yes.describe under i� DESCRIPTION of OPERATIONS bemw E.L.DISEASE—POLICY LIMIT $ 2,000,000 - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) All worksite employees working for the above named client company,paid under ADP TOTALSOURCE,INC's payroll,are covered under the above stated policy.The above named client is an alternate employer under this policy. I i€ CERTIFICATE`HOLDER .,.. t, • , CANCELLATION . .. .. COTTI-JOHNSON HVAC,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 80 CEDAR ST _ ;' THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CANTON,MA 02021 AUTHORIZED REPRESENTATIVE 1` {? ooxra�Ce�vies, r�ca '€irla ACORp 25'(2009/09) , •�,.. ' u 1988 2009 AGORA CORPORAT g iION:AIl,fi .hts reserroem . � L; The ACORD name and logo are registered marks of ACORD l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map O Parcel 00 t; Application #6?0, Health-Division r " Date Issued l Conservation Division Application F ` Planning Dept. w Permit Fee o Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis 41! 11 Project Street Address S e L)&1 S cS 1 Village 4\4 0.nM S _ Owner a �S"R°►'rt LL C Address Telephone iJd'1 Permit Request Ply �.r' �1 Nei < A��- 24J��N►v�"rI _ - Square feet: 1 st floor: existing—proposed 2nd floor: existing proposed Tota4µraew ° Zoning District Flood Plain Groundwater Overlay ? ; Project Valuation Construction Type Ne LO e0 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure AA0 His014 tori House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Other Basement Finished Area (sq.ft.) N Y1 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 Z Heat Type and Fuel: X Gas ❑ Oil ❑ Electric ❑ Other Central Air: Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new siA_) ool: ❑ 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name e6TT; A/Ij Lyevfr- LY4141N Telephone Number - ��' Jr 7 f — )a y0 Address 8Q Cela r License o4N i�� \A, Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# `J i DATE ISSUED MAP/PARCEL NO. ADDRESS - VILLAGE , OWNER r DATE OF INSPECTION: '* ' _FOUNDATION - i ` -FRAME f 's INSULATION' FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH - FINALZlol Q GAS: ROUGH :�, FINAL FINAL BUILDING _,-d r .DATE CLOSED OUT ASSOCIATION PLAN NO. f � " The Commonwealth of Massachusetts Department of Industrial Accidents' Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly t 1 T � Name (Business/Organization/Individual): co ¢/- 'T�ti��ay 1�JC• Address: 0 (f4w V ' City/State/Zip: cc,h o L Q Phone#: 411518 11518 Are you an employer?Check the appropriate box: Type of project(required): 1.IAl I am a employer with S4/ 4. •❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. New construction 2.❑ 1 am a sole proprietor,or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition _ working for me in any capacity:. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9.'❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]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' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing'all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether- '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 thepolicy and job,site information ,( Insurance Company Name: k ( 1.� fu-yl 1 eS,T Tile-, d C F�phl�0t c / Policy#or Self-ins. Lic.#: _ �= Expiration Date: 07101422 Job Site Address: 3olo . 57,eL)eA'_(0, S I. City/State/Zip: 4\1a A11l Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date): " Failure to secure coverage as required'under Section 25A of MGL c. 152 can lead to the imposition of.criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civil'penalties in the form.of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be,forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: ' `' Date Phone#: Official use only. Do not write in this area,to be completed by city or town official .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: " '' Phone# "" ' ' (MM/DD/YY) CERTIFICATE ®F LIABILITY, INSURANCE- TDATE 06/17/11. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS !` CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED f' 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 Aon Risk Services,Inc of Florida Aon Risk Services,Inc of Florida NAME: r 1001 Brickell BayDrive,Suite#1100 PHONE 800-743-8130 FAX 800-522-7514 . A/C No.Ext: A/C,No): Miami,FL 33131-4937 E-MAIL ADP_COI_Center@Aon.com ADDRESS: PRODUCER 10762287 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED' ' INSURER A:New Hampshire Ins Co 23841 ADP TotalSOurce MI XXX,Inc. INSURER 8: - - 10200 Sunset Drive INSURER C: ' Miami,FL 33173 ALTERNATE EMPLOYER INSURER D: Cotti-Johnson HVAC,Inc. 80 Cedar St INSURER E: Canton,MA 02021 y INSURER F: ; COVERAGES CERTIFICATE NUMBER: 308176 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIMITS SHOW.\)ARL AS RErtt'ESTIA). INSR ADOL SUBR POLICYEFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS LTR INSR WYD - DATE(MM/DDIYYYY) DATE(MM/DDIYYYY) GENERAL LIABILITY - EACH OCCURRENCE $ ❑COMMERCIAL GENERAL LIABILITY - DAMAGE TO RENTED •$ O CLAIMS MADE ❑OCCUR '' .. PREMISES(Ea occurrence) v MED EXP(Any one person) $ ` GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ ❑POLICY ❑PROJECT ❑ LOc GENERAL AGGREGATE $ a PRODUCTS-COMP/OPAGG $ $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ 1 ❑ANY AUTO - _ (Ea accident) .•. i • I ❑ALL OWNED AUTOS BODILY INJURY $ } ❑SCHEDULED AUTOS - (Per person) - ❑HIREDAUTOS - BODILY INJURY i ❑NON oWNED auro5' $ (Per accident) - - PROPERTY DAMAGE $ I (Per accident). O UMBRELLA LIAB OCCUR et EACH OCCURRENCE $ _ ❑ EXCESS LIAR CLAIMS-MADE • AGGREGATE $ ❑ DEDUCTIBLE ., ' - $ ❑ RETENTION S A WORKERS'COMPENSATION AND WC 012438946 MA 07/01/11 07/01/12 0 WC STATU- ❑ OTHER , t i EMPLOYERS'LIABILITY - TORY LIMITS - .,•T _; .' ANY PROPRIETORMARTNER/EXECUTIVE' ❑ .� E.L.EACH ACCIDENT $ t 2,000,000 ^ OFFICER/MEMBER EXCLUDED? NIA l (Mendamry In NH) .r E.L.DISEASE-EA EMPLOYEE $ 2,000,000 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT $ - 2,000,000 s E p DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - { All worksite employees working for the above named client company,paid under ADP TOTALSOURCE,INC.'s payroll,are covered under the above stated policy. The above named client is an alternate employer under this policy. ;f f: CERTIFiCATE:;HOLDER:' `x CANCELLATION COTTI-JOHNSON HVAC,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 80 CEDAR ST -„; THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ;(. li CANTON,MA 02021 AUTHORIZED REPRESENTATIVE !{ I a 2009'ACOR.D COitPORATfON;,AII ndhts,�esenied•, ` The ACORD name and logo are registered marks of ACORD (}+: THEri Town of Barnstable o Regulatory Services a,�trxsr�s[.E, MAM g Thomas F. Geiler,Director -Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.b'arnstable.ma,us Off ce: S09-862-4038 Fax: 508-790-6230 Property Owner Must: Complete and Sign This Section If Using A Builder P as Owner of the subject.property hereby authorize 9,677'. to act on my behalf, i.n.ail matters relative to work authorized by this building permit application for. 3)y s t e d,, �s i. (Address of Job) 4S, 400er Date / � / Prin ame If Property Owner is`applying for permit please complete the Homeowners License Exemption Form on 'the reverse side. Q:F0 RMS:OWNERP ERM IS510N TRE ray Town of Barnstable yam. o Regulatory Services Thomas F. Geiler,Director MASS. sbsp- .�� Building Division PrED � Tom Perry,Building Commissioner 200 Mairi.Sireet, fyannis,MA.02601 www.town.barnstable.ma us w Office: 509-862-403 8 Fax: 508-790-6230 EIOIN EOVYNER LICENSE EXEMPTION Pleare Print DATE: JOB LOCAMN: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: eity/town state zip code nc current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOW F,0V 1N'ER 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 constrgcts more than one home in a two-year period shall not be considered a homeowner, Such "homeowner"shall submit to the Building Of5cial 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"ccrtifics 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 Nota: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION .The Code states that: "Any bomeowner performing work for which a building permit is rcquimd shaD be excrrrpt from the provisions of this section_(Section ID9.1.1 -Licensing of umstruction Supcnvsors);provided that if the homeowner engages a persons)for hilt to do such work,that such Homeowner shall act as supervisor. h any homcowncrs who use this rxcmption are unaware that they are assuring the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Constriction 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 procccd against the unlicensed person as it Would with a iiccnscd Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities mquire,as part of the permit application, that the homeowner certify that hdshe understands the rcsponnbilitics of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homccxcmpt The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search. Page 1 of 2 The Commonwealth of Massachusetts t f;. William Francis Galvin Secretary of the Commonwealth, Corporations Division Y 'I` One Ashburton Place, 17th floor t' Boston,MA 02108-1512 Telephone: (617)727-9640 1 FLAGSHIP ESTATES HYANNIS, LLC Summary Screen Help with this form r_ sRgquesta,Certdlcafe�� The exact name of the Domestic Limited Liability Company(LLC): FLAGSHIP ESTATES HYANNIS, LLC Entity Type: Domestic Limited Liability Company (LLC) Identification Number: 000922231 Date of Organization in Massachusetts: 04/20/2006 The location of its principal office: No. and Street: 2 ADAMS PLACE, STE. 100 City or Town: QUINCY State: MA Zip: 02169 Country:USA If the business entity is organized wholly-to do business outside Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country: . The name and address.of the Resident Agent: Name: JEFFREY C. O'NEILL No. and Street: 2 ADAMS PLACE, STE. 100 City or Town: QUINCY State:MA Zip: 021.69 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First,Middle,Last,,Suffix Address,City or Town,State,Zip Code MANAGER JOHN KELLY 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA MANAGER DONALD O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA MANAGER JEFFREY C.O'NEILL 7ADAMS PLACE,STE.100 QUINCY,MA 02169 USA The name and business address of the person in addition to the manager,who is authorized to execute documents to be filed with the Corporations Division. Title Individual Name Address (no Po Box) First,Middle;Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY JOHN KELLY. 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA , SOC SIGNATORY JEFFREY C.O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA SOC SIGNATORY DONALD O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 8/18/2011 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 2 of 2 u • The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address(no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY DONALD F.O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA REAL PROPERTY JOHN KELLY 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA REAL PROPERTY JEFFREY C.O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA Consent _ Manufacturer Confidential Data _ Does Not Require Annual Report Partnership Resident Agent For Profit Merger Allowed. Select a type of filing from below to view this business entity filings: ALL FILINGS Annual Report fog Annual Report-Professional Articles of Entity Conversion Certificate of Amendment tUlewFtlings., , j ;NewSearch '1 YQ Comments ©2001-2011 Commonwealth of Massachusetts L t All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 8/18/2011 �VL45SACHUSE7TS DRIVE_R'S LICENSE NUMBER f x S08865802 r h EXP V � • CLASS 'REST NOT :SEX i 1 t #u�I'-5N'+'F • DM 6 02;M MAIN KEVIN L "; Mr S� 7rsaa 816'WINTER ST HANSON MA 02341.1131 » ` r 07-054967 C.°OSilIM09!JVi�EALT OF i1f1ASSA.CHUSETTS ; SHEET METAL WORKERS AS:A MASTER-UNRESTRICTED' ISSUES THE ABOVE LICENSE TO: KEVIN', L • MAIN 816 WINTER STREET HA'NS'ON: MA ' 0234171131 .1.25.61 07/28/12 8558 F COMMONWEALTH OFF MASSAC HUSE..ATS AS A BUSINESS 'ISSUES THE ABOVE LICENSE TO: KEVI;W t: MAIN u COTT.I-JOHNSON' HVAC INC 80CEDAR ST. CANTON` ' MA 02021-00:0 35.5 05/09/13 9984 ok - +Y. KEVIN,MAIN ° VICE PRESIDENT/OWNER KMAIN@C0TTIJ0HNS0N.COM z �a�4�➢o, (617) 799-0860 CELL SINCE 1948 80 CEDAR STREET, CANTON, MA 02621 (781) 821-1511-PHONE (781 ) 821-1599 FAX WWW.COTTIJOHNSONHVAC.COM - 1, roH: 1 a v v w - 36 gib ofReg '.5trat 'On Of *btct Act" t orkfto, • abtrtgttfie� tYje reutt�en�ertt ofacYjuett� .�erterAratro Cbapter 1121 6ectton 237 ttjrougb 251th 4 w rM t , ;b tq;-I)a6p-{ grdnteb. tljf!9, certfftcat , no. 355 M6 ebtbence to ,practice a!6 a t r t7.,A t �e . :e r x r. - ou t t 9t bap.of_�•ap `201�1 . T Mir �e�tin�oiipYjereof,°°ig Yjereuito Affiteb tY f tYjeoa1Dr 1 COMMONWEAL.TH OF MASSACHU:SETTSw HEET MET r AS'A BUSINESS ISSUES THE ABOVE LICENSE TO LVI;N L MAIN y x pTT:I UGHNSON HV.AC CEDAR ST ' b ,m } 7tttC ANTON AMA 0202: 3 9 9.84 355' 05/09/13 ; . I : sy fig: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3 V' Parcel 00 q Application #Z Health Division Date Issued Conservation Division Application RaW Planning Dept. w° Permit Fee Date Definitive Plan Approved by Planning Board P Historic - OKH _ Preservation/ Hyannis CPO Project Street Address ' S Village 7 GIA4J Owner Cis I�7�1 (.(, � Address-_ <7Q 6'Aalr^.S PI`l (a- Sy�� Telephone �J c Permit Request 50 OD l rv)S►A tl Hec,r ¢ Ar e - Square feet: 1 st floor: existing proposed 2nd floor: existing proposed f Toad new 1 j 41-44 Or. Zoning District Flood Plain Groundwater Overlay Project Valuation o 0 Construction Type. co 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 ❑ alkout ❑ Other_ Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new _1 Half: existing new Number of Bedrooms: existing , new Total Room Count (not including baths): existing new First Floor Room Count Z Heat Type and Fuel: 0 Gas ❑ Oil ❑ Electric ❑ Other Central Air: X Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new sizeI: ❑ 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 ICPNtci,� Proposed Use S1101ck APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name r�arn d ion "j`" Z' �h Telephone Number 7V- S r7t /.I Address 80 Cel a-r License # MA, pa��j Home Improvement Contractor# Worker's Compensation # wL Cd l yZN6 MA ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I _ _ SIGNATURE_ DATE ��/D —p FOR OFFICIAL USE ONLY APPLICATION# v DATE ISSUED - MAP/PARCEL N0. . _ a t ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION r � FRAME a N INSULATIO r -- FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL r GAS: z._t=-. ROUGH 13 - FINAL - FINAL QUILDING.o - DATE CLOSED OUT ` ASSOCIATION PLAN NO. x The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations fi 600 Washington StreetIvy ' Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors_/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �O. ¢/�— 101fiSajt /'/ VAC. ha, Address: 9 City/State/Zip: Cd k o Q Phone#: 166- V�_ ��/ Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer_with �$'� 4. ❑ lam a general contractor and I * have hired the sub-contractors 6. New construction employees (full and/or part-time). , • 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7:; ❑Remodeling shipand have no employees These sub-contractors have U 8. ❑Demolition working for mein any capacity." employees.and have workers' [No workers' comp. insurance comp. insurance. 9. ❑ Building addition' required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their -• 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other ' IN, insurance required.] *Any applicant that checks box#1 must also fill out.the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such; TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees: If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. . Insurance Company Name: � IDS e)-ViCeS,f h , J rIJ4 Policy#or Self-ins:Lic:# {V .Expiration Date: 0 Q Job Site Address: 3010 cS 1 C.UQV1h3A . City/State/Zip: /)i1 i �'►�/� Attach a copy of the workers',compensation policy�declaration page.(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the-form.of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. 'Be.advised that,a copy of this statement.may be forwarded to the Office of. Investigations of the DIA for insurance coverage verification. ` I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: ' - `' Date Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town:r Permit/License# Issuing Authority(circle one): 1.Board of Health 2,Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other v. Contact Person: Phone#: � DATE(MM/DD/YY) i`�O CERTIFICATE OF LIABILITY INSURANCE" y`„�`R 06/17/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED I 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 i; the certificate holder in lieu of such endorsement(s). _ PRODUCER CONTACT Aon Risk Services,Inc of Florida NAME: Aon Risk Services,Inc of Florida PHONE 800-743r8130 FAX 800-522-7514 1001 Brickell Bay Drive,Suite#1100 A/C No.Ext: A/C,No Miami,FL 33131-4937 E-MAIL ADP COI—Center@Aon.com ADDRESS: — — PRODUCER 10762287 CUSTOMER ID#: s INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:New Hampshire Ins Cc 23841 ADP TotalSource MI XXX,Inc. INSURER B: 10200 Sunset Drive Miami,FL 33173 INSURER C: ALTERNATE EMPLOYER INSURER D: Cotti-Johnson HVAC,Inc. INSURER E:. 80 Cedar St Canton,MA 02021 INSURER F: COVERAGES CERTIFICATE NUMBER: 308176 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD. INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS -+ CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L€MI"I'S SHOWN ARE AS REQUESTED. INSR TYPE OF INSURANCE ADDL SUBR - POLICY NUMBER S POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR INSR WVD DATE(MMIDDIYYYY) DATE(MMIDDIYYYY) - _ GENERAL LIABILITY - EACH OCCURRENCE $ ❑COMMERCIAL GENERAL LIABILITY _ DAMAGE TO RENTED $ , ❑CLAIMS MADE ❑OCCUR - ° PREMISES(Ea occurrence) MED EXP(Any one person) $ GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL 8 ADV INJURY $ _ ❑POLICY ❑PROJECT 13 LOc GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ 1 $ f AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ I ❑ANY AUTO _ .. [ (Eaaccident)• O ALL OWNED AUTOS BODILY INJURY $. ❑SCHEDULED AUTOS (Per person) ' ❑HIRED AUTOS BODILY INJURY• ❑NON OWNED AUTOS (Per accident) - $ PROPERTY DAMAGE (Per accident) ' $ { ❑UMBRELLA LIAB OCCUR - EACH OCCURRENCE $ ❑ EXCESS LIAB CLAIMS-MADE - AGGREGATE $ ❑ DEDUCTIBLE $ ❑ RETENTION $ - $ L A WORKERS'COMPENSATION AND WC 012438946 MA 07/01/11 07/01/12 ®WC STATU- ❑ OTHER I Ka EMPLOYERS'LIABILITY TORY LIMITS - , ANY PROPRIETOR/PARTNER/EXECUTIVE - OFFICERIMEMBER EXCLUDED? N/A ❑ - E.L.EACH ACCIDENT $ 2,000,000 I (Mandatary in NH) - E.L DISEASE—.EA EMPLOYEE $ - 2,000,000 ' If yes,describe ender _ f DESCRIPTION OF OPERATIONS below _ E.L.DISEASE-POLICY LIMIT $ 2,000,000 I e b DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required), {; All worksite employees working for the above named client company,paid under ADP TOTALSOURCE,INC.'s payroll,are covered under the above stated policy. The e above named client is an alternate employer under this policy. I„ II, CERTIFICATEHOLDER CANCELLATION [f COTTI-JOHNSON HVAC,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE , 80 CEDAR ST %"'`=` THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. (Fi CANTON,MA 02021 lea AUTHORIZED REPRESENTATIVE a ( O2Lh SrGItCE� fiEL 4D$L ' A�QRQ"25(2009/09), . ;K s t# i=. " Q ACORD CORPORATION All!righ ts?reserve'ii,' The ACORD name and logo are registered marks of ACORD 12 Ia; IF< �► r � Town of Barnstable Regulatory Services t�xsrAst.E. p MAM �* Thomas F. Geiler,Director 16�� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property O Tier Mus t Complete and Sign This Section If Using A Builder as Owner of the subject.property hereby authorize (.,D�f) to act on guy behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) SW of r Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverseside. Q:F0RM5:O.WNERPERMIS3ION` Town of Barnstable yam- o Regulatory Services akxKsrA Lr_ Thomas F. Geiler,Director MASS. g. - �bs� .� Building Division PIEDy Tom Perry,Building Commissioner 200 Mairi.Street,_Hyannis,MA 02601 www.town.b arnstabl e.ma.us Office: 509-862-403 8 Fax: 508-790-6230 I YMMOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number stroot village "HO1vIFAWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of•six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFWMON OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constrticts more than one home in a two-year period shall not be considered a bomeowner. Such "homeowner" shall submit to the Building Official on.a form acceptable.,to the Budding:Official, that he/she shall be responsible for all such work performed under the building permit:`(Section 109.1.I .. The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. f The undersigned"homeowner"certifies that.he/she understands thew Ton of Barnstable Budding Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 1 t Signatim of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that: "Any bameowner performing work for which a building permit is required shaD be cxompt from the provisions of this section(Section I D9.1.1-Uccnsing of construction Supervisors);provided that if the homeowner engages a persons)for hire to do such work,that such Homeowner shall act as supervisor. 14any homeowners who use this exemption are unaware that they are assurning the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In.this case,our Board cannot proceed against the unlicrosed person as it would with a licensed Supervisar. The homeowner acting as Supervisor is ultimately responsible. To enure that the homeowner is fully aware of hislha responsibilities,many communities require,as part of the permit application, that the homeowner certify that bt/she understands the responsibilities of a Supervisor. On the last page of this issue is s farm currently used by several towns. You may care t amend and adopt such a formi/certifieation for use in your community, Q:forms:homccxcmpt The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 a-=s The Commonwealth of Massachusetts }� William Francis Galvin rs4 Secretary of the Commonwealth,Corporations Division One Ashburton Place, 17th floor Boston,MA 02108-1512 , t Telephone: (617)727-9640 FLAGSHIP ESTATES HYANNIS, LLC Summary Screen. Help with this form Request a�Certificate ;'.� The exact name of the Domestic Limited Liability Company(LLC): FLAGSHIP ESTATES HYANNIS.LLC Entity Type: Domestic Limited Liabilily Company(LLC) Identification Number: 000922231 Date of Organization in Massachusetts: 04/20/2006 The location of its principal office: No. and Street: 2 ADAMS PLACE, STE. 100 City or Town: QUINCY State: MA Zip: 02169 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: JEFFREY C. O'NEILL No. and Street: 2 ADAMS PLACE, STE. 100 City or Town: QUINCY State:MA Zip: 02169, Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER JOHN KELLY 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA MANAGER DONALD O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA MANAGER JEFFREY C.O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA The name and business address of the person in addition to the manager,who is authorized to execute documents to be filed with the Corporations Division, Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY JOHN KELLY_ 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA SOC SIGNATORY JEFFREY C.O'NEILL 2 ADAMS PLACE,STE.100 i QUINCY,MA 02169 USA SOC SIGNATORY DONALD O'NEILL 2 ADAMS PLACE,STE.too QUINCY,MA 02169 USA http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 8/18/2011 The Commonwealth of Massachusetts William Francis Galvin-' Public Browse and Search Page 2 of 2 The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no Po Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY DONALD F.O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA REAL PROPERTY JOHN KELLY 2 ADAMS PLACE,STE,100 QUINCY,MA 02169 USA REAL PROPERTY JEFFREY C.O'NEILL 2 ADAMS PLACE,STE.100 QUINCY,MA 02169 USA Consent Manufacturer Confidential Data _ Does Not Require Annual Report Partnership _ Resident Agent For Profit Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS Annual Report I Annual Report-Professional Articles of Entity Conversion 's Certificate of Amendment F� llmgs sa r New Se rch .' Comments O 2001-2011 Commonwealth of Massachusetts l J All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 8/18/2011 COMMONWEALTH OF MASSACMUSETT SHEET METAL WORKERS AS-A MASTER-UNRESTRICTED ISSUES THE ABOVE LICENSE TO. K.EVI'N `L MAIN 816 7WINTER STREET N HA NSON MA. 02341 1131 + 12561 07/28/12 85.58 COMMONWEALTH `OMiM EIIfVASS�-aC►f�9SE.o.TS - 3 '. B G ® ii "9 H rya 7 •;'1 H •16p B _ �. AS_`A BUSINESS ISSUES THE ABOVE LICENSE TO: . F "KE-VIN L,.MAIN C0TT1 JOHNS0.N '-HVAC INC r 1 m CANTON 'MA 02021-000 355 05/09/13 9984' � KEVIN MAIN VICE PRESIDENT/OWNER �r. KMAIN@COTTIJOHNSON.COM crn (61.7) 799-0860 CELL SINCE1948 80'CEDAR STREET, CANTON, MA 02021: (781) 821-15M PHONE (781) 821-1 599 FAX , WWW.COTTIJOHNSONHVAC.COM - — — -- 380arb of Regl5tr tton. of )Or' r ��ifu� ti�fieb tYje re u rellic1 t6 of A,5�' - � �• r�cY tt�ett�; Q�el telFCr �.. .. (CYjar ter- 112, *ection 237 tf rott Y jj 25-1 ' (f,_QW0,10th, S � !Sur 1 ! • jerebp gr ttteb tiji! certificate' no; 353 a.5 ebibOice to practice ash a ue -Obeet,_ fnetat f Oil 9th bap ofp 2011 �111 �e�tilltolrp Yjereof, Ig YjEL'EulYtD rxffrlEb tl)C 1Yf11tE Of tljE (ExerlltibE Mitector of tr)e 39oarb {( COMMONWEALTH OF MASSACHUSETTSLAIR PAP ' k Y A$:A BUSINESS F " � 3 ISSUES THE ABOVE LICENSE TO yri w0VIN.: L MAIPJ ;OTTI-JOHNSON HVAC IhlC N� .�0 CEDAR ST ON C ANT MA 020"1-'000 3- '' jr X' fY'"tiv+•'�i'SC°7l 1+ " M1 y�'+t .7 rV 355 05/09/13 9984 :c. ci� -6 . PROJECT NAME: l�-� �'�- ✓�'� - LD C� ADDRESS: Jam • Vt�n tS PERMIT# 2Q (. PERMIT DATE:. : J IZIS It-, M/P Q y LARGE ROLLED PLANS ARE IN: 'BOX SLOT Data entered in MAPS .program on: BY: q/wpfiles/archive TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION - Map ParceX, /a 2 b Application# Health Division n Conservation Division Permit# Tax Collector Date Issued (a Treasurer Application Fee Planning Dept. Permit Pan q q-( ' S Date Definitive Plan Approved b Planning Board pp Y 9 Historic-OKH Preservation/Hyannis i,,, 7;--- Project Street Address its lee- Village . ��S,4a, Owner Address Telephone Permit Request C � G Square feet: 1 st floor:existing proposed 2nd floor:existing proposed X// Total new�6_7 7 Zoning District Flood Plain Groundwater Overlay Co Project Valuation �. Construction Type Lot Size , 7 Grandfathered: ❑Yes f yes, attach supporting documentation. 1r,11a41Xe_5- Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) U !! 2W/7 Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Hi`,hway: Yes -❑No Basement Type: ❑Full ❑Crawl ❑Walkout 1115ther Basement Finished Area(sq.ft.) Basement Unfinished A a(sq.ft) q,i t Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new A:2 Total Room Count(not including baths):existing new First Floor Room Co nt , �rn Heat Type and Fuel: Zas ❑Oil ❑Electric ❑Other Central Air: es ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ego_ Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size 2?, d:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑rt Appeal# Recorded❑ Commercial ❑Yes ff<O If yes, site plan review# Current'lJse '�Gl e r Proposed Use � B,ILDER INFORMATION Name -1 Telephone Number 7� Address / rov License# ali —2 Home Improvement Contractor# �J-e �� Worker's Compensation# fiG 24Op�,? 797- ALL CONSTRUCTION DEBR S RES2.? //G FRO2�1, PROJECT WILL PE TAKEN TO 21 / CSiGNATURE� C. DATE �� FOR OFFICIAL USE ONLY . ' PERMIT'NO. , 1 DATE ISSUED , ' '• MAP/PARCEL NO. • - - I l 3 ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' FOUNDATION FRAME ' INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL FINAL BUILDING " DATE CLOSED OUT ' ASSOCIATION PLAN NO. , � J 1 Q. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insur nce ;<davit; oil ers/ ontractors/Electricians/Plumbers Applicant Information Please Print Lelzibl Name (Business/Organizationdndividual): . Address: gW NAU City/State/Zip: Qfi Phone.#: , ArA�yon employer? Check appropriate boa: -Type of project(required):. 4. I am a eneral contractor and Ia employer with ❑ g employees(full and/or.part-time).* have hired the sub-contractors 6. New construction . 2.❑ I am a•sole proprietor or partner- listed on the4 attached sheet. — 7. Q Remodeling ,shi and have no em to ees These sub-contractors have g, p p y ❑Demolition working for mein any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.t ' , required.] ' ' 5• ❑ We are a corporation and its 10.❑Electrical repairs or additions .3.❑ I am a homeowner doing all work I officers have exercised their 11.❑Plumbing repairs or additions myself. o workers' com right of exemption per MGL y � p: 12.❑Roof repairs - insurance required.]t c. 152, §1(4), and we have no employees.>[No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees: If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees, Below is.the policy and job site information, /1 Insurance Company Name.- Policy#or Self-ins.Lic.#: � ��-�� Expiration Date:, �iJ ^ Job Site.Address: City/State/Zip: � Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c..152 can lead to the imposition of criminal penalties of a fine 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 maybe forwarded to the Office of Investi s of the 1AA for insurance covera e verification. I do her ce ify un er a pains and penalties of per*qlae�6� that th information pro ' ed above is true and.correct. Si afore: (j Date: a-- _ Phone#: LOther only; Do not write.in this area, to be completed by city or town official n: Permit/License# hority(circle one): .-I. Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector rson: Phone#: J Information and. Instructi®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 =eceiy .r nr trustee-of an individualpartnership, 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." IvmGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewat of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for;the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or.license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sane to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has.been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related 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 Depu meat of Industrial Accidents Office of Investigations 600 Washingtaii Street Boston,MA 02111 Tel.# 617-727-4900 ext 406 or 1-977-NiASSAFE Fax:g 617-727-7749 . Revised 11-22-06 www.mass.gov/dia Town of Barnstable. h Regulatory Services BARNS TABLE, Thomas F.Geiler,Director • �'prFo;a�a1 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must P Complete and Sign This Section If Using A Builder subject bj as Owner of the suproperty � J hereby authorize to act on my behalf, in all matters relative to.work authorized by this building permit application for: . (Address of Job) i tore of e 7� Date CO 4y,�- We Print Name Q:FORMS:O W NERP ERM IS S ION ,t ✓fie �o%mmzarccaea� o�✓�aoeac�ivael.�O _...._.. ..._ ._._.... ......_..- BOARD OF BUILDING REGULATIONS Licenser CONSTRUCTION SUPERVISOR :... n,.:.. _ ... ._...:..., E<O ARt}4 F E3 3EE 1.E G E E EfiLA NS 1. E: tit b rt 00722 f.. fE1l T 48 Tr.no: 2w CathmlSS+c3tt�'r ;J ,i A ORD_ CERTIFICATE OF LIABILITY INSURANCE 6/19/2oo Y) PRODUCER (781)681-6656, Fax(781)681-6686 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION The Driscoll Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 93 Longwater Circle ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 9120 Norwell MA 02061 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Travelers Indemnity Co. Advantage Construction, Inc. INSURER 13:Travelers Property INSURER C: Two Adams Place, Suite 100 INSURERD: Quincy MA 02169 INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING AN REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AG RE ATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER PD 6 MMIDD/YYE PDATE MM/DDm N T LIMITS GENERAL LIABILITY DTC0464D1464-IND07 06/20/2007 06/20/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAPRE M MISES Ea occurrence AGES( RENTED 300,000 $ A CLAIMS MADE FXI OCCUR MEDEXP(Any oneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X JECT 7 LOC AUTOMOBILE LIABILITY DTAO810464D1476-TIL07 06/20/2007 06/20/2008 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 B ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA AUTO ONLY: AGG $ EXCESS/UMBRELLA DTSCUP464D1488-TIL07 06/20/2007 06/20/2007EACHOCCURRENCE $ 15,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 15,000,000 B DEDUCTIBLE $ RETENTION A WORKERS COMPENSATION AND DTEUB4641D14140-07 06/20/2007 06/20/2008 y[ T RYTAMIT OR EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE$ 1,000,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER K DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: Harry's Bar & Grill, 700 Main Street and Flagship Estates, 350 Stevens Street, Hyannis Evidence of insurance for work performed within the Insureds scope of normal business operations. Notice of Cancellation provision is 30 days except 10 days applies for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Town of Barnstable EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 368 Main Street 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT Hyannis, MA 02601 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _ B. Driscoll/KAD ACORD 25(2001108) ©ACORD CORPORATION 1988 I IdCM4 m�nv�nv., P.—1 of 7 IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) INS025(0108).08a Page 2 of 2 COMMENTS/REMARKS CIP Hyannis, LLC and Flagship Estates Hyannis, LLC, TD Banknorth, $SC Group, DHS Design and Advantage Construction, Inc. are included as Additional Insureds for General Liability and Excess (Umbrella) Liability as required by a signed written contract or agreement with the Named Insured. CIP Hyannis, LLC and Flagship Estates Hyannis, LLC, TD Banknorth, BSC Group, DHS Design and Advantage Construction, Inc. are included as insured for Automobile Liability on a Primary Basis for the conduct of the (Named) Insured, but only to the extent of that liability. OFREMARK COPYRIGHT 2000, AMS SERVICES INC. i s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION,., Mapes Parc I4 ;'Application # C ;.. t Health Division Date IssuedAt Conservation Division 5��3_ V c'q PCu�1� ' _~:Application Fee L o Planning:Dept; �a � � Permit Fee Date Definitive Plan,Approved by I n 01 06 481A Historic OKH Preservation / Hyannis a Project Street Address a , Village WVI Owner'' Addresses ZVt M -""' J Telephone Permit R uest 4�. 4" pVj U y Square feet: 1 st floor: existing proposed 4�wnd floor: existing proposed MT Total new t Zoning District 0 M Flood Plain ( Groundwater Overlay Project Valuation Construction Type_ + Lot Size 119Rai Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ;,0 Two Family ❑ Multi-Family(# units)�s Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout X Other s5k6 CIA Gkjc Basement Finished Area(sq.ft.): Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new ID Half: existing new Number of Bedrooms: existing lonew Total Room Count (not including baths): existing new 1� FursVFloorURoorn Count 4s" Heat Type and Fuel: 'UGas ❑Oil ❑ Electric ❑ Other ��,' REC"D Central Air: "*Yes ❑ No Fireplaces: Existing New E Wng wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size Barn. r_n=0-exi g ❑ new size_ ay Attached garage: ❑ existing '§(new size _Shed: 0 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 df�,Y4 C �( 0 Telephone Number 1 p �, 1 • ,l r Ao ss License# uw1V1,L`I . DZ li Home Improvement Contractor# Worker's Compensation # �' y ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO G.I.., Ncnllnc�► a G SIGNATURE 4/w/1 e n DATE C;c�� (I T e � � 0� F i FOR OFFICIAL USE ONLY APPLICATION# ` DATE ISSUED MAP/PARCEL N0. ADDRESS VILLAGE - H OWNER t - E DATE OF INSPECTION: € FOUNDATION K FRAME - - INSULATION s FIREPLACE ' ELECTRICAL: ROUGH, FINAL ' PLUMBING: ROUGH FINAL f _GAS: - ROUGH - FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN,NO. 1 o�.IME A Town of Barnstable P ° 200 Main Street, f[yannts,Massachusetts 0260'1 ,ann.+ssrwBiE. Growth Managernent l3eparfinent Thomas A: Broadr>ck;AICP 367 Main Street,Hyarinis,Massachusetts 02601 Director of I2egrilatory Review Phone(S08)862-4785 Fax•(508)862-4725 w�vw,ibwn.bumstable.ma.us June 0 2006, Ginlsburg Assets Management LLC C/O.-barrel Adarns. P. 0..Box.901 West.:Barnstable,MA.-02:668 RE- Stte I?lar3 RevrEw {)73 05 Ginsburg—350 'teveris>Streetl lyanriis . Map 308,Parcel 004 Deq,,Mr. :dams:, The Site Plan Review Committee has reviewod"the above proposal and fhe$uildin Corr Usione.r has determined that, e plans could be administrdtively�approved:subject to the following conditions. 'Plans dated December 12, 2005,revised December 21 2005 and Marcli.l42006 Sheets.l=8,:prepared by BSCCrroup;Weast;Yarmoutli,MA will need to be finalized and'rev7sed to incorporate the:condations`of this letter. Said co nprehensive revised plan will need ter.be"submitted for administrative approval by the Building, Commissioner.'prior to the issuance of"a b ilding permit: All construction shall'b&in eornpliance with this.final approved site plan. ® The number of bedrooms rv>ll.need to,be added to the Zoning'Campliarice Table on the Title Sheet,of the revised plan. ® A:letter:,of con plraiice'=with the Town's`Design and Tnfrastruc#ure Plan will need tp.be obtained.from the.Growth Management Department: indoor pakinb.space dimensions'Mll need to reflect a 19 ft._length on the°revised plan,instead of 118"ft. length,as currently shown. The:g9agl6 parkint;spaces mould depict a t"p cal..car size on the revised plan,and.sliall demonstrate adequate vehic filar access within the garage.of at least fourteen(14) feet ® The water main constructro t_sh411 e in:compliance with the revised,.approved; signed plans bye Mark Dibb,PE dated 2113I06,which plan is the basis for the<approval letter:. from.Hans Keijser, Water:Supply Division Department of Public Works, as he states that plan,incarpvrates and adciresses.all issues lncluded,in his memo tv the'applicant dated 02109106 'v The Hyrarirus Fife De artthent must review and approve a plan showin 'th .main t eat Stevens Street and MainStreet;and tF e tie"at Stevens Street and;No"rth Stree€. ® The cross;pitch of the sidewalk needs to.indicate drainage toward the roads as'shown in: the`°corierete sidewalk:detail"oii'sheet 7 of-8 of'the"referenced.plans A'11:permits, licenses andapprovals required will..need to;be obtained, - Upon completion of all work; a registered engineer or land siirveyor•shall submit a . letter of certification,,made upon kriowled'ge acid`belief in accordance with professional standards that all work.has been clone in-substantial compliance with. he aoproved:s te, plan(Section 240405(G). This document'shall be,submitted prior to the issuance;of the final certificate of occupancy. 'a No occupancy,permits shall be issued.for any"of the 29 units until Such tin e as the developer.executes a.monitoring agreement And.deed restrictions in a form approved by the Town Attorney i i which the developer agrees to sell three of the twenty-nine "units-to a governmental agency,or non-profit who shall offer said.units;for sale or lease to a qualified affordable purchaser or tenani whose income is at 65°/a of the area: ri eclian income based upon Household size;.'l'he initial selling prices'foi each unit shall be:basedupon a formula,under,.which'monthly.housing,costs, including-mortgage payments,'taxes;insurance, and'.condoinm um association fees shall not exceed 30%0 of 65%of;the area"median ii cbirie based upon household size.The affordable a nits;" shall be=integrated with the.development and shall be compatible.in i esigri construct on and quality of material-.with the other,units,and otherwise comply with ;the: provisions of Sectioii:9 of the Code of the Town:of Barnstable., Siich:units"shall be depicted on.-the:revised plan'show'ing the location and mix of units proposed; No occtipaneypermits shall be issued for any ofthe 29 units.until the developer eitY er l.) I posits$"50,OQQ with the;Towri Treasurer for ceimpletion of the sidewalkbr 2)_ constructs to the_satisfaction:of the Town 1ingineer a concrete sidewalk 5.5 feet.wide: with granite curbing in:the area along Stevens Street from Main Street;to North Street. T his,letter is<issued for the:applicant to proceed:directly to abuildng permit appl"ication tivith lie` Biiilciing Comiriissoner or toward Regulatory Agreement 2O:Q6 Ql'as scheduled with:the PIanri rig Board June 2642006. Sincerely, f P,llen M Swiniarski. Sec.;to:Planning Rd.,-and SPR Coord. cc Planning Board File Thomas Perry,Building Coinrriissiorer; Site Plan Review l"ile The Commonwealth of Massachusetts ' Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 2VIYu" Address: ``) �E �V � GC4 � City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): I.ElI am a employer with 4. 0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. employees and have workers' Y9. ❑ Building addition [No workers' comp. insurance comp, insurance.$ required.] 5. ['We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp..insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.=Below is the policy and job site- information. Insurance Company Name:\_J� tv� , FRS , ® %�,-\z Policy#or Self-ins.Lic.#: � j Expiration Date.:. �� Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy del ration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A.of MGL c. 152 can.lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here cce*rtiunde he ins and penalties of perjury that the information provided above is true and correct. Siiznature: Date: Phone#: CX N�4 Official use only. Do not write in.this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk .4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: L9=2010 14:44 CONDYNE LLC 781 848 3774. P.01 ADVAl TAGS Construction, Inc.. October 19,,2010 na,. Tom Perry Town of Barnstable gy 368 Main'Street Hyannis, MA'02601' Re: Flagship Estates Building G, 320 Stevens Street, Hyannis, MA Dear Tom Perry: , Please accept this=letter of notification that William G. Kelly,',an employee of Advantage Construction, Inc., has been appointed to be our full time Superintendent for the project listed above, Y. If you have any question, please feel free to contact our office at(617)237.1829 Sincerely Advantage Construction,;Inc. Eileen Harkins :a Human Resources ADVANTAGE CONSTRUCTION. INC. Two Adams Place, Suite 1 OD, Quincy, MA 02169 Telephone 781.848.e787 Fax 761.840.3774 www.advantaQeconstructioninc.com TOTAL P.01 f I CONSTRUCTION CONTROL AFFIDAVIT OR% K o) Project Name: Flagship Estates—Building "G" . Project#: 1040 Project Location: 300 Stevens Street Date: Aug. 30, 2010 Hyannis, MA Project Description Residential Condominium Project To the building commissioner of the city/town of Hyannis, in accordance with The Massachusetts State Building Code I,Wayne E Benson,Jr., Registration No. 10731, being a registered professional engineer/architect in the following discipline: ARCHITECTURAL ® STRUCTURAL ❑ MECHANICAL ❑ FIRE PROTECTION 0 ELECTRICAL ❑ OTHER ❑ Hereby,certify.that I have prepared or directly.supervised the preparation of all base building E Architectural Plans,Computations and Specifications for the above named project. O s To the best of my knowledge, information and belief,such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, acceptable engineering practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance w with the documents approved for the Building Permit. I shall submit periodically,a progress report Q together with pertinent data to the Building Commissioner. Upon Completion of the work I shall submit a Final Report as to the satisfactory completion and readiness of the project for occupancy. co fi Therefore, I request a Building Permit be issued for the above address. • \'Co ARC, pSON R ip o No. 10731 ti t E NORTH EASTON, $ Seal: O MA J C SIGNAT RE OF VA SS: On this 30th day of August, 201 OAD before me,the undersigned notary public pe n�a1 y a appeared Wayne E. Benson,Jr., proven to me through satisfactory evidence of identification,which were MA State Drivers License,to be.the person whose name is signed on the preceding or attached document in my presence. U G N r (Notary Public) H r U My Commission expires: ?hy m Y 2010 0830 C..Affidavit docx January 28,2010 Town of Barnstable - Building Department 200 Main Street Hyannis, MA 02601 RE; 320 Stevens Street Flagship Estates Hyannis, MA 02601 Dear Building Inspector: ' C &A has performed a review of the site location and.its proximity to coastal mean high water. . and the nearest applicable coastline. C&A has determined that the project site is not within the 1- mile Wind Borne Debris area, 0 If you have any questions please call me at 617-237-1828. Sincerely, V, ' Mark D. Dibb,P.E, Civil Engineer i C &. A Architectural Design & Engineerin g: LLC Two Adams Place, Suite too, Quincy. MA D2169 Telephone 781.848.8787 Fax 781.848.3774 www.condyne.com r ACORDTM CERTIFICATE OF LIABILITY INSURANCE °A/201014:52 "' 10/07/2010 14:52 PRODUCER (800)225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C.Church,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 41 Wellman Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lowell,MA 01851 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 800-225-1865 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Charter Oak Fire Ins.Co. Advantage Construction,Inc. INSURER B: National Union Fire Insurance Company of Pittsburgh Two Adams Place,Suite 100 Quincy,MA 02169 INSURER C: Everest National Insurance Company INSURER D:_Navigators Insurance Company INSURER E: Travelers Casualty Insurance Company of America COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICY EFFECTIVE POLICY EXPIRATION R TYPE OF INSURANCE POLICY NUMBER DATE fMM/DD1YY1E MM DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $11000,000 C DAMAGE TO RENTED OM PREMISES LIABILITY PREMISES Ea oocurence $300,000 CLAIMS MADE Pq OCCUR : MED EXP(Any one person) $5,000 A 464D1464 6/20/2010 6/20/2011 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY M PRO-JECT F7 LOC . AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) E X 8104779L224 6/20/2010 6/20/2011 HIRED AUTOS - - - BODILY INJURY X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ , (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLALIABILITY EACH OCCURRENCE $ $5,000,000 X OCCUR FICLAIMS MADE - .AGGREGATE $.$5,000,000 C 71 C 1000148101 6/20/2010 6/20/2011 $ DEDUCTIBLE $ X RETENTION $O $ WORKERS COMPENSATION AND - WC STATU- OTH- EMPLOYERS'LIABILITY Y LI ER B ANY PROPRIETOR/PARTNER/EXECUTIVE 006430048 6/20/2010 6/20/2011 E.L.EACH ACCIDENT. $1,000,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEEI$ 1,000,000 If yes,describe under 1,000,000 SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT $ OTHER D Umbrella NYIOEXC711193IV 6/20/2010 6/20/2011 $10,000,000 X of$$,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Certificate is issued as evidence of coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION own of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1200 PhlririeyS Lane IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. yanllis,MA 02601 AUTHORIZEDREPRESENTATNE ACORD 25(2001/08) Client# 1AAAn Mst# 10-11 GL,Auto,WC, Cert# ©ACORD CORPORATION 1988 Umb IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)., 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively_amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2001/08) oFjHEI Town of Barnstable ti °. Regulatory Services 9 an NSTABLK MASS. $ Thomas F.Geiler,Director �A 039. ♦Q' lfn r�u.+A Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA U601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize Lto act on my behalf, in all matters relative to work authorized by this building permit application for: Otr1A1<1 (Address of Job) Sig re `er Da } e Print Name i If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION Town of Barnstable FTHE T �.p pllti Regulatory Services � BARNSTABLE, Thomas F.Geiler,Director 9 MASS. �A 16.3 _..Building Division lED MA't A Toni Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state Zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supensor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/cettifrcation for use in your community. Q:forrns:homeexempt COMcheck Software'Version 3.8.0 Envelope. Compliance Certificate'.`' 2009 IECC Section 1: Project Information Project Type: New Construction 4 Project Title: Flagship Estates-Buidling G Construction Site: Owner/Agent. "t Designer/Contractor: . 40 Stevens St. , .rr Advantage Construction RKB Architects,Inc. Hyannis,MA- 2 Adams Place,Suite 100 5 Zero Campanelli Drive T Quincy;MA 02169 Braintree,MA 02184 Section 2 General Information Building Location(for weather data): Hyannis,Massachusetts - L ' Climate Zone: 5a Vertical Glazing/Wall Area Pct.: 24% k Skylight Glazing/Roof Area Pct.: 0% Activity Type(s) Floor Area Multifamily 8752 Section 3: Requirements Checklist Climate-Specific Requirements:. s Component Name/Description Gross Cavity Cont. Proposed Budget ` �,. R. w " Area or R-Value R-Value U-Factor U•Factor(a) Perimeter ' Roof:Attic Roof with Wood Joists 4087 38.0 0.0 0.027 0.027 Skylight'H':Vinyl Frame:Double Pane with Low-E,Clear,SHGC .7 --- 0.440,' - '0,600 0.24 ,,, k ' Exterior Wall-Front:Wood-Framed, 16"o.c. Y -1333- . -13.0 3.8 6.064' 0.051 Windows:Wood Frame:Double Pane with Low-E,Clear,SHGC 0.31 217 0.300 0.350 Doors Ent Glass >50% lazin Metal Frame,Entrance Door, 105 --- -= 0.350, 0.800(Entry): ( 9 9)� SHGC 0.35 f Exterior Wall-Side Right:Wood-Framed, 16"o.c. "718 13.0 3.8 0.064, 0.051 Windows:Wood Frame:Double Pane with Low-E,Clear,SHGC 0.31 67 ,p, 0.300 0.350 Exterior Wall-Rear:Wood-Framed, 16"ox - - 2144 13.0 3.8 0.064 0.051 Windows:Wood Frame:Double Pane with Low-E,Clear,SHGC 0.31 525 0.300 0.350. Doors-Rear Slider:Glass(>50%glazing):Metal Frame,.Entrance 210 --= • =- 0.350 Door,SHGC 0.35 Exterior Wall-Side Right:Wood-Framed, 16"o.c. 718 13.0 3:8 0.064. 0.051 Windows:Wood Frame:Double Pane with Low-E,Clear,SHGC 0.31 - ~ `4,51 0.300 0.350 • . Floor-Slab on Grade:Slab-On-Grade:Unheated,Vertical 2 ft. 414 - _ r 10.0 --- (a)Budget U-factors are used for software baseline calculations ONLY,and.are not code requirements. , Airteakage, Component Certification,and`Vapor Retarder Requirements: ; b 1. All joints and penetrations are caulked,gasketed or covered with a moisture vapor-permeable wrapping material installed in accordance with the manufacturer's installation instructions. 2. Windows,doors,and skylights certified as meeting leakage requirements. Q 3. Component R-values&U-factors labeled as certified. Project Title: Flagship Estates-Buidling G Report date: 08/27/10 Data filename:P:\1040 Flagship Estates-Hyanis,MA\Building G\ComCheck\1040_Bldg G-ComCheck.cck Page 1 of 2 r 4. No roof insulation is installed on a suspended ceiling with removable Ceiling panels. 5. 'Other'components have supporting documentation for proposed U-Factors. . 6. Insulation installed according to manufacturer's instructions,insubstantial contact with the surface being insulated,and in a manner that. achieves the rated R-value without compressing the insulation. °' 0 7. Stair,elevator shaft vents,and other outdoor air intake and exhaust openings in the building envelope are equipped with motorized dampers. ' 8. Cargo doors and loading dock doors are weather sealed: 9. Recessed lighting fixtures installed in the building envelope are Type IC rated as meeting ASTM E283,are sealed with gasket or caulk. 10.Building entrance doors have a vestibule equipped with closing devices. Exceptions: LJ Building entrances with revolving doors. Doors that open directly from a space less than 3000 sq.ft.in area. Section 4: Compliance Statement Compliance Statement: The proposed envelope design represented in this document is consistent with the building plans,specifications and other calculations submitted with this permit application.The proposed envelope system has been designed to meet the 2009 IECC requirements in COMcheck Version 3.8.0 and to comply with the mandatory requirements in the Requirements Checklist. Name-Title 'Signature Date y f S Project Title: Flagship Estates-Buidling G Report date: 08/27/10 Data filename:P:\1040 Flagship Estates-Hyanis,MA\Building G\ComCheck\1040_Bldg G-ComCheck.cck Page 2 of 2 4 .}_ N(assitchusetts- Departiitent of Public Sufetj Board of Boildin!� Reaulations and Standards Construction Supervisor License License: cs 19925 Restricted to: 00 S: WILLIAM G KELLY PO BOX,395 S DENNIS, MA 02660 --- Expiration: 6/13/2012 ('onuuisi u�rr Tr#: 27030 - K ofINE �, TOWN OF BARNSTABLEBuilding ti Application Ref: 200704737 - Permit r t EMNSTABLEI I Issue Date: 09/06/07 9 MASS. �j 1639. 1e Applicant; LAMBALOT,JOSEPH E. Permit Number: B 20072145 Ar�D �A Proposed Use: RESTUARANT&CLUB ` Expiration Date: 03/05/08 Location 350 STEVENS STREET Zoning District SPLTPermit Type: SP PROJ THREE OR FOUR FAMILY Map Parcel 308004 Permit Fee$ 1,921.88 Contractor LAMBALOT,JOSEPH E. Village HYANNIS App Fee$ 100.00 License Num 048722 Est Construction Cost$ 468,750 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND SHELL PERMIT BUILDING 7TH BLDG):HARRY'S THIS CARD MUST BE KEPT POSTED UNTIL FINAL FLAGSHIP ESTATES INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record:.GINSBERG ASSET MANAGEMENT LLC BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: TWO ADAMS PLACE ST 100 INSPECTION HAS BEEN MADE. QUINCY,MA 02169 Application Entered by: PR Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY. ENCROACHEMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. .2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED"OVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). RE Pk e BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3 1 Heating Inspection Approvals Engineering Dept a Fire Dept 2 Board.of Health ~ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map - Parc Application # Health Division Date Issued Conservation Division Application Fe Planning Dept. Permit Fee �� ► � Date Definitive Plan Approved by Planning Board �- Historic - OKH _ Preservation /Hyannis Q. ` ,w Project Street Address .Village ��O-ny—\ Owner Fs a-fit-Aa n—is LLC Address Telephone `1 u 4s`1 59-1 Permit Request �� lill'td J, t % _ 0 I/T; 1/7_0 Tr �7 Square feet: 1 st floor: existing proposed 2nd floor: existing_'�' proposed Total new /a3Z3 Zoning District Flood Plain Groundwater Overlay _ - ^ Project Valuation At Construction Type Lot Size Grandfathered: ❑Yes 3- 0 If yes, attach supporting docume"r►Q, ation. ,ZX dZ �. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure e�) Historic House: ❑Yes U-11 On Old King's Highway: Zf Yes"=Flo Basement Type: ❑ Full ❑ Crawl ❑WalkoutOther I role Basement Finished Area (sq.ft.) - Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: .1A___ existing new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: lKa-s ❑ Oil ❑ Electric ❑ Other Central Air: ad'1'es ❑ No Fireplaces: Existing •-- New Existing wood/coal stove: ❑Yes 31No 0 Detached garage: ❑ size-Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑� size Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes aKo If yes, site plan review# - -Current Use ��A�� Proposed Use nd -- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name N'Mjc gx cp��\,�-060 Inc Telephone Number Address C� `� owes 'V\0_(A i0i,-) License # `) Home Improvement Contractor# J_I Worker's Compensation # CC3jyX)1AV) ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO CA_ 0 SIGNATURE DATE �� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION E FRAME S `} INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING `3 'Y DATE CLOSED OUT ! ASSOCIATION PLAN NO. �t c 4 SEP-16-2011 11:30 CONDYNE LLC 781 848 3774 P.04 The Commonwealth of Massachusetts PrintF,'orr�lti Department Of IndustrialAccidents.. Office of Investigations I Congress Street, Suite 100 Boston,MA 02114--2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Blectricians/Plumbers A licant Information Please Print Le ibl Name (Business/Organization/Individual):. Address: City/State/Zip: \r% C- Phone #: Are you an employer?Check the appropriate box: 1.9-1—am a employer with �'� 4. ❑ I am a general contract7aindTie of project(required): employees (full and/or p�.* have hired the subcon 6•`E `��'�'construction 2.❑ I am a sole proprietor or partner- listed on the attached s 7. 0 Remodeling ship and have no employees These sub-contractors have g El Demolition working for mein any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.1 9• F] Building addition required.] S. 13 We are a corporation and its 10.[l Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL I I.❑ Plumbing repairs or additions insurance required.]t c. 152, §1(4), and we have no 12.❑Roof repairs employees. [No workers' 13.[1 Other comp. insurance required.] *Any applicgnt that checks box ill must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affdbvit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entides 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 information. for my employees. Below is the policy and joh site Insurance Company Name: -Policy#or Self-ins. Lic.# _ \� �Olp�3C�0� Expiration Date: Job Site Address: n� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy slumber and expiration date). Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine tip to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP of up to $250.00 a day against the violator. Be advised that a copy of this Grp ORDER and a fine statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi p#n r.the yajns andpenalties-o er'ur that the information provided above iS true and correct Si ature: Date: q 1 � Phone#: 6� Official use ly. Do not write in this area, to be completed by city or town official - City or Town-, Permit/License# Issuing Authority(circle one): I.Board of Health 2. Building Department 3. City/Town Clerk 4.Elect 6, Other rical Inspector 5.Plumbing Inspector Contact Person: Phone#: �OFTHErp��" Town of:Barnstable Regulatory Services T &A.MSrABLE +` MASS. $ Thomas F.Geiler,Director:" 16y a. Building.Division,. : Tom Perry,Building Commissioner 200.Main Street, Hyannis;MA 02601' www.town.ba'rnstable.ma.us: Office: 508-862-4038 - -. Fax: 508 790 6230 w Property Owner. 1�ust 4y . Complete and SignThis'Section If Us ing A B{ 3 n wilder- "as Owner of the subject property hereby authorize - / \ M1'V-� to act on my behalf, in all matters relative to work authorized bytl is building permit appkatiori for, . '(Address of Job) } z ,.a nature o er ate Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:F0RMS:0 WNERPERMISSION ti Town of Barnstable 4opTtie roly� y�� o Regulatory Services = SARNSTASLE; n Thomas F.Geiler,Director Y MASS.. g. g,A 16.59. Building Division T A fp 't MA Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601, www.to-wn.barnstable.ma:us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION - Please Print DATE: JOB LOCATION:- number street village "HOMEOWNER': name . home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption foi•"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. _ DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed.under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he./she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOAfEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor. Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ul.6matelyresponsfble. 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 forrh/certification for use in your community. ;aco CERTIFICATE OF LIABILITY INSURANCE °AT °"YYY) 9/12/20 v20.11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Diane Shaw - Fred C.Church,Inc. NAME: 41 Wellman Street PHONE 978 3227272 FAX (978)454-1865 Lowell,MA 01851 .. A/C No Ext: A/C,No): (800)225-1865 _ E-MAIL dshaw@fredcchurch.com - ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# - INSURER A: Chants Property Casualty Company 19402 INSURED INSURER B.: Charter Oak Fire Ins.Co. 25615 Advantage Construction,Inc. - INSURER C: Navigators Insurance Company 42307 Two Adams Place,Suite 100 Travelers Casualty Insurance Company of America - 19046' Quincy,MA 02169 INSURER D INSURER E: Starr Indemnity&Liability Company 38318__ INSURER F COVERAGES CERTIFICATE NUMBER. 18537 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR - POLICY EFF POLICY EXP LTR S D POLICY NUMBER - MWDD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY _ EACH OCCURRENCE $'1,000,000 X COMMERCIAL GENERAL LIABILITY - DAMAGE TO RENTED - 300,000 PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5.000 - B 464D1464 `6/20/2011 "6/20/2012 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO X - F LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1.000,000 Ea accident $ ANY AUTO BODILY INJURY(Per person) $ D ALL OWNED SCHEDULED 810464DI476 6/20/2011 6/20/2012 AUTOS AUTOS BODILY INJURY(Per accident) $ - _ X HIRED AUTOS X NON-OWNED - + PROPERTY DAMAGE $ _ AUTOS s Per accident $ X UMBRELLA LAB X, OCCUR EACH OCCURRENCE $ $5,000,000 E EXCESS LIAB CLAIMS-MADE SISCCCLO1523811 6/20/2011 6/20/2012 AGGREGATE $ $5,000,000 DED I X I RETENTION$0 ' $ WORKERS COMPENSATION - WC STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNEWEXECUTIVE Y/N 1,000,000 OFFICER/MEMBER EXCLUDED? N/A 006430048 6/20/2011 6/2012012 q - - - E.L.EACH ACCIDENT $ � (Mandatory in NH) E.L.DISEASE-EA EMPLOYE '$ 1,000,000 If yes,describe under - 1,000,000 DESCRIPTION OF OPERATIONS below. - E.L.DISEASE-POLICY LIMIT $ $10,000,000 X of$5,000,000 - C Umbrella NY11EXC7111931V 6/20/2011 -6/20/2012 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate is issued as evidence of coverage. CERTIFICATE HOLDER CANCELLATION own of Barnstable - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1200 Phinneys Lane THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE Client k 36440 Mst# 18537Cert Holder# ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Y EMBEEM NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. 0090063-00 WC 004-32-1274 13072 --------------------------------------------- 013-82-0611-oo N Y V ADVANTAGE CONSTRUCTION, INC. C H A R T I S TWO ADAMS PLAZA SUITE 100 QUINCY, MA 0210-7456 A Chartis company EXECUTIVE OFFICES:. SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 175 Water Street s. New York, NY 10638 KEATING GROUP OF MA LLC WORKERS COMPENSATION AND EMPLOYERS, 144'TURNP I KE ROAD LIABILITY POLICY INFORMATION PAGE SUITE 150 f SOUTHBOROUGH MA 01 2-0000 INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL 006430048 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address FROM 06/20/11 TO 06/20/12 • ' ITEM 3 A. Workers Compensation Insurance:.Part One of the policy applies to the Workers Compensation Law of the states listed here: MA NH RI B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two.are:. Bodily Injury by Accident $ 1 ,000,000` each accident Bodily Injury by Disease $ 1 .000,000 policy limit Bodily Injury by Disease $ 1 .000,002 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CA CO CT DC DE FL GA HI IA ,ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE _NJ , NM NV NY OK OR PA SC SD TN UT,VA VT,WI WV D. This policy includes these endorsements and schedules: SEE EXTENSION OF ITEM 3.D.•OF THE INFORMATION PAGE - WC990612' ITEM The premium for this policy will be determined by:our,Manuals-of-Rules;.Classifications, Rates and.Rating Plans. All information required below is subject to verification and change:by audit. Premium Basis Rate Per Estimated " aassifications Code Number Total Remuneration $100 OF Re, Premium Annual❑3 Year m"n,ration Annual ❑3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE -'WC7754 TAXES/ASSESSMENTS/SURCHARGES $9,616.. EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) 3338 MA - MINIMUM PREMIUM $750 NH_. TOTAL ESTIMATED ANNUAL PREMIUM�1 4 8 If indicated below,interim adjustments of premium shall be made: ' ❑ Semi-Annually ❑ Quarterly ,❑ Monthly - 'DEPOSIT PREMIUM 06/29/11 PARS I PPANY 82 -- Issue Date - Issuing Office Authorized Representative WC 00 00 01A _ - 39967(Rev'd 04/08) ��.�,fit �: $ �.. ...E .. g � 3 4 3 t# �€ e_! � •� 5 ['F_ s �r e r� x �r Y ( (( t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r _ ' - 'A <li ation # �� oa� Ma Parcel. c p pP Health'. ealth Division Date Issued 'Lc� Conservation Division ;. Application Fee, Planning Dept. Permit.Fee Date Definitive Plan Approved by.Planning Board U /`--- Historic - OKH _ Preservation / Hyannis �© Project Street Address Village Owner �_-, Address`7C, _�IVAc Qk,\n Telephone Permit Request 141n1li-i4 T %; i i" 0VT_ Igl7 �,',v,'SyvS Square feet: 1 st floor:"existing proposed �7 2nd floor: existing proposed N14 Total new �n3' Zoning'District Flood Plain Groundwater Overlay, Project Valuation Construction Type �iJvv �l Lot Size. � •Grandfathered: ❑Yes Flo If es attach supporting doc mentation. o S e. Y pp9 g ."vu 7 Dwelling Type: Single Family,..❑ Two Family ❑ Multi-Family (#units) ` Age of Existing Structure '— Historic House: ❑Yes WrIlo On Old Kings Highway: U'Yes ~ o Y ._ Basement Type: ❑ Full ❑ Crawl ❑Walkout &66her �o,-7 Basement Finished Area(sq.ft.)_ Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Z Half' existing nevus Number of Bedrooms: _ existing new Total Room Count (not including baths): existing new y� First Floor Room Count Heat Type and Fuel: u'Uas ❑ Oil ❑ Electric ❑ Other Central Air: Q<es- ❑ No Fireplaces: Existing -- New Existing wood/coal stove: ❑Yes U-NIO Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing Ctiew size,,?-' ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization 0 Appeal # Recorded ❑ Commercial ❑Yes o If yes, site plan review# Current-Use- Gcr"7Z ./ --_ —. --.----Proposed Use i",17 141,oKcf= APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ! \( , v1 - (e rc on �,U Telephone Number Address T\G c g License# 1CIA,3 � c - Home Improvement Contractor# Worker's Compensation # a3iUZ�CXSPC ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE . i s FOR OFFICIAL USE ONLY s F=APPLICATION# DATE ISSUED 4 . MAP/PARCEL NO. j . ADDRESS VILLAGE a '.� OWNER E DATE OF INSPECTION: -FOUNDATION . FRAME INSULATION f FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ROUGH = FINAL 4 _ _ .-,,F.INAL BUILDING. _ R DATE CLOSED OUT ASSOCIATION PLAN NO. SEP-16-2011 11:31 CONDYNE LLC 781 848 3774 P.05 .� .c roe t ummonwealtit of Massachusetts Pririt Forme',';; t y Department of Industrial Accidents - Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/OrganirAtion/Individual): Address: j City/State/Zip; �,rt C u�� Phlone #: Are you an employer?Check the appropriate box: ].Qt am a employer with %, 4. ❑ I am a general contractor and I TYPe of project(required); employees (full and/or part-time).* have hired the sub-contractors 6.`�ew construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp, insurance-: 9• ❑ Building addition required.] 5_ ❑ We are a corporation and its 10.El Electrical repairs or additions 3,❑ I am a homeowner doing all work officers have exercised their 1 l.d Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL insurance required.]t c. 152, §](4),and we have no 12.❑ Roof repairs employees, [No workers' 13.❑ Other comp.insurance required.j *Any applicant that checks box Itl mast also fill out the section below showing their workers'compensation policy information. t ldemeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContraaors that check this boa must attached an additional sheet showing the name of the sub-contractors and state whether or not thosc entities have employees. If 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: Policy#or Self-ins. Lic.#: Q��py Z��ayr6 Expiration Date; Job Site Address: I-)LO `z_�,�eoet\5 !_�A _City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500,00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and of up to$250.00 a day against the violator_ Be advised that a copy of this a fine statement may be forwarded to the Office of Investigations ofthe DIA for insurance coverage.verification, J'do hereby certi n r the asns and enalties o eriur that the information provided above is true and correct Si ature: Date: 1 Phone Official use 1y. Do not write Lin this area, to be completed by city or town of,-cial City or Town: Permit/License# I ssuinghority(circle one): I. FIealth 2,Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector son; Phone#: oFZHEr Town of Barnstable Regulatory Services as MASS. E Thomas F. Geiler,Director 16yq' Building.Division Tom Perry,Building Commissioner 200.Main Street,Hyannis,MA 0260.1 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 15� as Owner.of the subject property hereby authorize' \ ." : Y-\ 'to act on my behalf, , in all matters relative to work authorized;bythis building permit application for: (Address of Job) ignature of er ate Print Name x if Property Owner is applying for permit please complete the Homeowners License ExemptionTorm on-the reverse.side " Q:FORMS:OWNERPERMISSION A. 4 Town of Barnstable �40. y� o Regulatory Services BARNSTABLE; Thomas F. Geiler,Director . 9 MASS... 163¢. Building Division rfo Mai a , Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.to A,n.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number _>_ street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"-was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. . DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit.'(Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. r The.undersigned"homeowner"certifies that he/she understands the-Town of Barnstable Building Department minimum inspection procedures and requirements'and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State.Building Code Section 127.0 Construction Control. HOATEOWNER'S EXEMPTION The Code states that: "Any,homeowner performing work for which a building Permit is required shall be exempt from the provisions of this section(Section 109.1.1 Licensing of construction Superv�isors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the Homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is.a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. DATE ACC) CERTIFICATE OF LIABILITY INSURANCE 9/12/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A'CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). ; PRODUCER CONTACT - Diane_iane Shaw • ` - " Fred C.Church,Inc. 41 Wellman Street PHONE 978 3227272 FAX (978)454-1865 Lowell,MA 01851 AIC No EXt: A/C,No): (800)225-1865 - E-MAIL ,. dshaw@fredcchurch.com , ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: •Chartis Property Casualty Company - ` -' ", 19402 INSURED INSURER B: Charter Oak Fire Ins.Co. 25615 Advantage Construction,Inc. INSURER C: Navigators Insurance Company - 42307 - ' � - Two Adams Place,Suite 100 - Travelers Casualty Insurance Company of America 19046 Quincy,MA 02169 - INSURER D INSURER E: Starr Indemnity&Liability Company - 38318 • - INSURER F: - - COVERAGES CERTIFICATE NUMBER: 18537 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS "CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR - POLICY EFF POLICY EXP f LTR g POLICY NUMBER MM/DD/YYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X DAMAGE TO.RENTED COMMERCIAL GENERAL LIABILITY - 300,000 PREMISES Ea occurrence $ CLAIMS-MADE..00CUR - - MED EXP(Any one person) $ 5,000 B - 464D1464. 6/20/2011 6/20/2012 PERSONAL&ADV INJURY $ 1;000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO- LOC $ - AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT' 1,000,000 - Ea accident $ ANY AUTO BODILY INJURY(Per person) $ D ALL OWNED SCHEDULED 810464DI476 6/20/2011 6/20/2012 BODILY INJURY(Per acci dent) $ AUTOS AUTOS - ( ) X HIRED AUTOS X NON-OWNED - PROPERTY DAMAGE '$ AUTOS - c - Per accident X UMBRELLA LIAR X I OCCUR EACH OCCURRENCE $ $5,000,000 E EXCESS LAB CLAIMS-MADE - SISCCCLO1523811 6/20/2011. 6/20/2012 AGGREGATE - $ $5,000,000. DED I X I RETENTIONS 0 $ - - WORKERS COMPENSATION - - WC STATU- - OTH- - - AND EMPLOYERS'LIABILITY Y/N , l ER ANY PROPRIETORIPARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? ❑ N/A 006430048 6/20/2011 6/20/2012 (Mandatory in NH) - - E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under - 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ " $10,000,000'X of$5,000,000 - C Umbrella NY11EXC7111931V 6/2 012 0 1 1 '• 6/20/2012 , DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - Certificate is issued as evidence of coverage. CERTIFICATE HOLDER CANCELLATION Town of Barnstable - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1200 Phinneys Lane THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE Clientk Mst* 18537 29035 Cert Holder# - ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD iry •• .,may • • • • CEMEEM •� CMEEMMO NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. 6090063-00 WC 004-32-1274 13072 ------------------ -------------------------- 013-82-o611-oo ADVANTAGE CONSTRUCTION, INC. C'H A R T I S ` TWO ADAMS PLAZA SUITE 100 QUINCY, MA 0210-7456 A,Chartis company EXECUTIVE OFFICES: . SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 1.75 Water Street New York, NY 10038 I.D# 911597713 PRODUCERS NAME AND ;ADDRESS 7EAG GROUP OF MA LLC.,, WORKERS COMPENSATION AND EMPLOYERSRNPIKE ROADLIABILITY POLICY INFORMATION PAGE 1500 OUGH - MA 01 2-0000 INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL 006430048 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE WC990610 _ ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insure7d's mailing address FROM 06/20/11 .To • 06/20/12 ITEM A. Workers Compensation lnsurance:,Part One of the policy applies to the Workers Compensation Law of the states listed here: MA NH RI B. Employers Liability Insurance: Part Two of the policy applies to the work in each state"listed in item 3.A: - The limits of our liability under Part Two are: ` Bodily Injury by Accident $ 1.,000,000 each accident Bodily Injury by Disease $ 1 ,.o00,D00 policy limit Bodily Injury by Disease $ 1_.000.000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL- INKS-'KY LA MD ME 'MI MN MOMS MT. NC NE NJ NM NV NY OK OR PA SC SD TN UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC990612 ITEM 4 The premium for this policy will be. determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. , Premium Basis Rate Per Estimated Oassifications Code Number Total Remuneration •$100 OF Re- Premium Annual❑3 Year muneration Annual E]3 Year SEE EXTENSION OF ITEM-4. OF THE INFORMATION PAGE,' WC7754 TAXES/ASSESSMENTS/SURCHARGES $9,616 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) - $338 MA MINIMUM PREMIUM $750 NH r° TOTAL ESTIMATED ANNUAL PREMIUM $14 8 - If indicated below,interim adjustments of premium shall be made: .;, Semi-Annually Quarterly, �. Monthly DEPOSIT PREMIUM 06/29/11 PARS I PPANY 82 Issue Date Issuing"Office _ Authorized Representative WC 00 00 01A ' 39967(Rev'd 04/08) 3 .6 .2i r E MA WN 6 l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel y Application # o '" - Health Division " Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board. / Historic - OKH Preservation/ Hyannis Project Street Address Village Owner ddress i n 11'114 Telephone_ �l�s Ss LA SE - Tc1tS-1 Permit Request ��m4l Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new o?av' Zoning District � Flood Plain Groundwater Overlay Project Valuation Construction Type �✓�0v Lot Size L/ . Grandfathered: •❑Yes LIR16�lf yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family ((## units) Age of Existing Structure Historic House:. ❑ 11N Yes o On Old King's Highway: ❑Yes 0'tqo--, Basement Type: ❑ Full ❑ Crawl `-0 Walkout 0106ther bllc,? CD Basement Finished Area(sq.ft.) Basement Unfinished Area (sgrft) _ Number of Baths: Full: existing new Half: existing neyv Number of Bedrooms: existing new t Total Room Count (not including baths): existing new First Floor Room Counter Heat Type and Fuel: ®'Gas ❑Oil ❑ Electric ❑ Other C-D M Central Air: Ohs ❑ No Fireplaces: Existing — New Existing wood/coal stove: ❑Yes allo Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing [B'11'ew siz&��hed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes If yes,.site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �-non Telephone Number Address _ \AG_u OW icense# C.0 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO n CX)�C n \ \ DATE SIGNATURE Z�� 1 •.j FOR OFFICIAL USE ONLY ,,APPLICATION# DATE ISSUED > _c r MAP/PARCEL NO. _- x ADDRESS VILLAGE y OWNER i DATE OF INSPECTION: R ' F ' t FOUNDATION n FRAME R f INSULATION' k FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: .: ROUGH-_- , • r FINAL i-FINAL BUILDING`;_ DATE CLOSED OUT t , ASSOCIATION PLAN NO. r SEP-16-2011 11:31 CONDYNE LLC 781 848 3774 P.05 .� Arie --ummon Wealth of MassaChusetts Print Forme•`,';; Department of IndustrialAccidents TW Office of Investigations 1 Congress Street, Suite.100 Boston, MA 02114-2017 www-mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Inforlmation Please Print I,e ibl Name (Business/Grgani�.aWon/dndividual): Address. ��{ City/State/Zip; �,� Phone Are you an employer?Check the appropriate box: ]•�t am a employer with �'� 4. [] I am a general contractor and I T7. EI roject(required): employees (full and/or part-time).* have hired the sub-contractors construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet odeling ship and have no employees These sub-contractors have working for me in any capacity, employees and have workers' 8' ❑ Demolition [No workers' comp. insurance comp, insurance.: 9• ❑ Building addition 3,❑ required.] 5. ❑ We a a corporation and its 10.El Electrical repairs or.additions re I am a homeowner doing all work officers have exercised their myself � 1 L❑ Plumbing repairs or additions Y [No workers comp. right of exemption per MGL insurance required.]t c. 152, §](4),and we have no 12.❑ Roof repairs employees, [No workers' 13.❑ Other comp.insurance required.] 'Any applicant that checks box#1 mast also fill out the section below shohdng their workors'compensation policy information. t!•iomeowncrs who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Conitraaors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not[host 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 poticy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: OQ�y - �6 Expiration Date; Job Site Address: SAeoe City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage.veTification. I do hereby certi rz r the 401s and Penalties Of e6u that the information provided above is true and correct; Si ature: JDate: Phone Official use ly. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2,Building Department'3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person; ------------ Phone#: �OpTHE T° 'Town of Barnstable Regulatory Services RARNSTv ASS. "E$ Thomas F. Geiler,Director . ... .16.39. Building.Division 1 Tom Perry,Building Commissioner 200.Main;Street,Hyannis,MA 02601 www.town.barnstable;ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section . If Using A Builder I We'51 lj` ,,as Owner.of the subject property hereby authorized to act on my behalf, in all matters relative to work authorized by this-building permit application for: (Address of job) Signature q�f er . Dat _ ti Print Name pe If Property Owner is applying for rmit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION . Town of Barnstable P of 1He r�2 ` Regulatory Services ` BARNSTASLE; Thomas F. Geiler,Director .� MASS... $. .. w39• .� Building Division prfD �n Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 1101 IaOPYNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION:, number street village ..HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners','was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. r DEFINITION OF HOMEOWNER Person(s).who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance_ with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned "homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official = Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control: HOMEOWNER'S EXEMPTION . The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are rassuming the responsibilities of a Supervisor(see Appendix Q, Rules&Regulations for Licensing Constriction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it-wouldwith a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. ' r Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 9/12/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Diane Shaw Fred C.Church,Inc. PHONE 41 Wellman Streel (A/C No Ex[:.978 3227272 A/C NoIFAX : (978)454-1865 Lowell.MA 01851 - E-MAIL dshaw@fredcchurch.conn (800)225-1865 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA; ChartisPropertyCasualtyCompany - - 19402 INSURED a INSURER 8: Charter Oak Fire Ins.Co. - 25615 Advantage Construction,Inc. _ INSURER C: Navigators Insurance Company 42307 Two Adams Place,Suite 100 Quincy,MA 02169 INSURER D Travelers Casualty Insurance Company of America 19046 - INSURER E: Starr Indemnity&Liability Company 38318 R INSURER F COVERAGES CERTIFICATE NUMBER: 18537 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY -.PREMISES Ea occurrence) $ 300,000 CLAIMS-MADE Fi-I OCCUR MED EXP(Any one person) S 5,000 B 464D1464 6/20/2011 6/20/2012 PERSONAL&ADV INJURY $ 1,000,000 ' GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY X PRO - J - LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ ANY AUTO - BODILY INJURY(Per person) $ D ALL OWNED SCHEDULED 810464D1476, - 6/20/2011 6/20/2012 �B (Per accident) 'BODILY Pi $ AUTOS AUTOS - _ ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LAB X -OCCUR EACH OCCURRENCE $ $5,000,000 E EXCESS LIAB CLAIMS-MADE SISCCCLO1523811 6/20/2011 6/20/2012 AGGREGATE $ $5,000,000 _ DIED I X J RETENTION$0 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N I S1 ER A ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED' a NIA 006430048 6/20/2011 6/20/2012. , _ (Mandatory in NH) -E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under •i - 1,000,000 DESCRIPTION OF OPERATIONS below - E.L. POLICY DISEASE- LIMIT $ $10.000.000 X of$5,000,000 C Umbrella NY11EXC7111931V 6/20/2011 6/20/2012 - DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate is issued as evidence of coverage., CERTIFICATE HOLDER CANCELLATION own of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1200 Phinneys Lane THE EXPIRATION DATE THEREOF, NOTICE WILL -BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ' Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE - I ' Client x 36440Mist x 18537 Cert Holder# 29035 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. , 0090063-00 WC 004-32-1274 13072 ---------------------=----------------------- 01-3-82-o611-oo 111019111111 ADVANTAGE CONSTRUCTION, INC. C: -1 A R T L S TWO ADAMS PLAZA SUITE 100 QUINCY, MA 0210-7456 r , A Chartis company EXECUTIVE OFFICES: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 175 Water Street New York, NY 10038- I.D# 911597713 PRODUCERSADDRESS WORKERS COMPENSATION AND EMPLOYERS KEATING GROUP OF MA LLC144 TURNPIKE ROAD LIABILITY POLICY INFORMATION PAGE SUITE 150 SOUTHBOROUGH MA 01 2-0000 INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL 006430048 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address FROM 06/20/11" TO 06/20/12 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA NH RI B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $' 1,000,000_ each accident Bodily Injury by Disease $' 1 .000,000 policy limit s Bodily Injury by Disease $ 1 .000.000- each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CA CO CT DC DE FL GA HI IA 1D IL IN KS KY 'LA MD ME .MI MN MO MS MT NC NE NJ NM NV NY OK OR PA SC SD TN UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC990612 ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rate Per Estimated Cassifications Code Number Total Remuneration $100 OF Re- Premium ❑ Annual❑3 Year muneration ❑Annual ❑3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE WC7754 TAXES/ASSESSMENTS/SURCHARGES $9,616 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $338 MA MINIMUM PREMIUM $750 NH TOTAL ESTIMATED ANNUAL PREMIUM• $143,835 If indicated below,interim adjustments of premium shall be made: Semi-Annually ❑ Quarterly ❑ Monthly DEPOSIT PREMIUM - - r 06/29/11 PARS I PPANY 82 Issue Date Issuing Office Authorized Representative WC 00 00 01A 39967(Rev'd 04/08) a.; r r 3 ' i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 04 0 J 7�-L") ApplicationMap Parce Health'bivision Date Issued t� Conservation Division Application Fee i Planning Dept. Permit Fee b O ('e r Date Definitive Plan Approved by Planning Board 76/�— Historic - OKH _Preservatiion / Hyannis Project Street Address -� - ��-- --� Village Owner L Address Telephone_ `s'�l - �`� e ` �8-1 WA cawq Permit Request 1vAlA k ? i % % /)OF •I fi 'f`�r�/I iE'S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed 72,&" Total new /TWO Zoning District Flood Playn Groundwater Overlay a ``' •Project Valuation / Construction Type��%� E Lot Size �l 8'�7 Grandfathered: ❑Yes Colo If yes, attach supporting documeTti�ation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ® 1'I�o On Old King's Highway: El Yes noo Basement Type: ❑ Full ❑ Crawl ❑Walkout 9105her j o�P Basement Finished Area (sq.ft.) �^ Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new CZ Half: existing new Number of Bedrooms: existing new Total Room Count (not including baths):existing new First Floor Room Count Heat Type and Fuel: &(.-�-a's ❑ Oil ❑ Electric ❑ Other Central Air: U-Ye"s_ ❑ 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 knew sizeZ�2hed: ❑ existing ❑ new size _ Other: Zoning Board of Appeal;l��izatio n ❑ Appeal # Recorded ❑ Commercial ❑Yes No If es site Ian review# Y p Current Use Proposed Use- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name MNITelephone Number �1 ,� � �� Address \W License # SCR ram Qom,\ -UA VYNA Home Improvement Contractor# Worker's Compensation # u �Y�u ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO CA- SIGNATURE DATE �.� O Y FOR OFFICIAL USE ONLY ' APPLICATION# DATE ISSUED r' MAP PARCEL NO. } t ADDRESS VILLAGE S OWNER ` t DATE OF INSPECTION: FOUNDATION 4 4 FRAME r INSULATION:. FIREPLACE ELECTRICAL: ROUGH FINAL a � F ti PLUMBING: ROUGH FINAL t GAS:;—; -. ROUGH ..< :FINAL {� ,FINAL BU;ILDING.�i a- - r DATE.CLOSED OUT F ASSOCIATION PLAN NO. i SEP-16-2011 11:30 CONDYNE LLC 781 848 3774 P.04 The Commonwealth of MasSaChusetts Print".F;orrp ' r. Department oflndustrial Accidents Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/B lectricians/Plumbers ARPlicant Information Please Print Legibly Name (Business/Organization/Individual): A.ddress.n City/State/Zip: 1. Phone Are you an employer?Check the appropriate box: 1•Q—i am a employer with �� 4. Type of project(required): D I am a general contractor and i employees (full and/or part-time),* have hired the sub-contractors 6•`ETIq_eN'construction 2.❑ I am a sole proprietor or partner- listed on,the attached sheet 7. 0 Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for mein any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.t 9• [] Building addition required.) S• We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL " insurance required,]t C. 152, §1(4), and we have no 12.0 Roof repairs employees. [No workers' 13.❑ Other comp. insurance required,] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance_for my employees, Below is the policy and job site information. Insurance Company Name: -Policy#-or Self ins. Lic.# � OOtp�3Cg0'�r6 Expiration Date: Job Site Address: �v to CTty/State/Zlp: Attach a copy of tine wrke orspensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 acid/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to $250.00 a day against the violator,"Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi p jzn r the a' and enaLties of2criury that the information provided above is true and correct S i azure: I Date] Phone#: Offlcial use ly. Do not write in this area, to be completed by city or town official - City or Town; Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical I 6, Other nspector 5.Plumbing Inspector Contact Person: Phone#: �°FTHET Town of Barnstable Regulatory Services] anxwsTasr..E, y MASS. �, Thomas F. Geiler,Director 1639. ♦� . plFo � Building'Divisi_on Tom Perry,Building-Commissioner 2GO.Main Street, Hyannis;-MA 0201 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508=790-6230 Property Owner Must . .. Complete and Sign`This Section If Using ABuilder 43. -5 /2 as Owner of the subject property .Y hereby authorize." / \ to-act oa my behalf, r. in all matters relative to work authorized bythis-building p ermit application for: (Address of Job) zo/% Si a e o Owner Date r. Print acne F .. If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the`reverse side. b . Q:FORMS:0WNERPERMISSI0N j :' • Town of Barnstable �O'�THE 1p�� Regulatory Services BARNSTABLE; w Thomas F. Geiler,Director MASS.._ $. g, 1659• Building Division ArfD '�a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.tovc,n.b arnstab l e.ma.us Office: 508-862-4038 ' Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION:_- number street village "HOMEOWNER name home phone#.. work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which 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 homeowricr. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned "homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings.containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOATEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permitis required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. ' To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may caret amend and adopt such a form/certification for use in your community. Aco CERTIFICATE OF LIABILITY INSURANCE °AT12/20°�YYY' 9/12/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT-BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Diane Shaw - "- Fred C.Church,Inc. NAME: _. 41 Wellman Street - - PHONE 0 978 3227272 ° FAX (978)454-1865 _ Lowell,MA 01851 A/C No Ext: AIC,No Lowell, A 018 E-MAIL dshaw@fredcchurch.com ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# INSURER A: Chartis Property Casualty Company ,19402 INSURED INSURER B: Charter Oak Fire Ins.Co. - 25615 Advantage Construction,Inc. Navigators Insurance:Company 42307 „ INSURER C Two Adams Place,Suite 100 -Quincy,MA 02169 INSURER D: Travelers Casualty Insurance Company of America 19046 � ' _... - INSURER E: Starr Indemnity 8 Liability Company 38318 INSURER F: COVERAGES CERTIFICATE NUMBER: 18537REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED'HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rypE OF INSURANCE ADDL SUBR - POLICY EFF POLICY EXP a LTR S POLICY NUMBER MMIDD/YYY MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X •COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 300,000 PREMISES.Ea occurrence .$ CLAIMS-MADE OCCUR ? MED EXP(Any one person) $ 5,000 - B 464D1464 6/20/2011 6/20/2012 PERSONAL 8 ADV INJURY $ 1,000,000 r ` GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 ' POLICY X PRO- LOC - $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ ANY AUTO BODILY INJURY(Per person) $ D ALL OWNED SCHEDULED 810464DI476 6/20/2011 6/20/2012 ,BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED - PROPERTY DAMAGE $ AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ $5,000,000 E EXCESS LIAB CLAIMS-MADE SISCCCLO1523811 - 6/20/2011 6/20/2012 AGGREGATE $ $5,000,000 DIED I X I RETENTIONS 0 $,. WORKERS COMPENSATION - WC STATU- OTH- AND EMPLOYERS'LIABILITY - - ' A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A 006430048 6/20/2011 6/20l2012 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 570,000,000 X of$5,000,000 - C Umbrella - , - NY11EXC7111931V - 6/20/2011 6/20/2012 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101;Additional Remarks Schedule,if more space is required) Certificate is issued as evidence of coverage. - a CERTIFICATE HOLDER CANCELLATION own of Barnstable 4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1200 Phinneys Lane THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 'ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 - AUTHORIZED REPRESENTATIVE - client# Mst# 18537 Cert Holder# 29035 ©1888-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA. 0090063'-OO WC 004-32-1274 13072 ---------------- =--------------------------- 013-82-0611-00 NOR U1110RI2410TRIA I ADVANTAGE CONSTRUCTION, INC. C "�A R T S TWO ADAMS PLAZA SUITE 100 QUINCY, MA 0210-7456 A Chartis company EXECUTIVE OFFICES: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 17.5 Water Street New York, NY 10038 I.D# 911597713 •.. ADDRESS KEATING GROUP OF MA LLC WORKERS COMPENSATION AND EMPLOYERS 144 TURNPIKE ROAD LIABILITY POLICY INFORMATION PAGE SUITE 150 SOUTHBOROUGH MA 01 2-0000 INSURED IS PREVIOUS POLICY NUMBER CORPORATION RENEWAL 006430048 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE WC990610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address • FROM 06/20/11 TO 06/20/12 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA NH RI B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by-Accident $ 1 ,000,000 each,accident Bodily Injury by Disease $ 1 .000,000 policy limit Bodily Injury by Disease $ 1 .000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI MN MO MS MT NC NE NJ NM NV NY OK OR PA SC SD TN UT VA VT WI WV D. This policy includes these endorsements and schedules: d SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC990612 ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications,Rates and Rating Plans.All information required below is subject to verification and change by audit. Premium Basis Rate Per Estimated, • Classifications - Code Number Total Remuneration $100 OF Re- Premium mAnnual ❑3 Year mun,r,tion ❑X Annual ❑3 Year ' t SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES $9,616 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) - $338..MA ' MINIMUM PREMIUM $750 NH TOTAL ESTIMATED ANNUAL PREMIUM $143,835 If indicated below,interim adjustments of premium shall be made: ❑ Semi-Annually ❑ Quarterly .•❑-Monthly DEPOSITPREMIUM - r 06/29/11 PARS I PPANY $2 Issue Date - Issuing Office Authorized Representative WC 00 00 01A 39967(Rev'd 04/08) ; z s p e 3 x pp r dam„ € g . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Par 15- - Application # 031 Health Division Date•Issued Conservation Division Application Fee ' Planning Dept. Permit Fee _ ® 10, Date Definitive Plan Approved by Planning Board Historic.- OKH _ Preservation/ Hyannis 21ek Project Street Address �'�•��` Village Owner _U -C Address �a rn�} Telephone Permit Requesto t/7w f �? �i2 Square feet: 1 st floor: existing proposed �2nd floor: existing — _proposedTotal new Z� Zoning District Flood Plain Groundwater Overlay --� Project Valuation A`, Construction Type Lot Size Grandfathered: ❑Yes U-P�o If yes, attach supporting d cumitation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) (_S�_ IP % ? Age of Existing Structure Historic House: ❑Yes 4J<o On Old King's Highway: Q_Yes 0'o Basement Type: ❑ Full ❑ Crawl ,.O-Walkout &CR-h-er �s��P� �i do c Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing ' new, vZ Half: existing new Number of Bedrooms: existing, new Total Room Count (not including baths): existing new �2— First Floor Room Count Heat Type and Fuel: &G�as ❑ Oil ❑ Electric ❑ Other Central Air: U-'Ire's ❑ 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 6'6ew size `Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes,site plan,review # Current Use �� Ate, ,f�'ld./ Proposed Use .APPLICANT INFORMATION -(BUILDER OR HOMEOWNER) Name n Telephone Number Address ��yr� �A c p ,, License # v\Ot Home Improvement Contractor# Worker's Compensation # ALL-CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOcv�c� SIGNATURE DATE zo/� i FOR OFFICIAL USE ONLY f 'APPLICATION# ti DATE ISSUED + MAP lPARCEL NO. `4 ADDRESS VILLAGE OWNER DATE OF INSPECTION: + FOUNDATIONS `. FRAME INSULATION.. FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH ~fi FINAL f :GAS;: ROUGH.—; e FINAL ;,FINAL BUILDING f r DATE CLOSED OUT, *, ASSOCIATION PLAN NO. SEP-16-2011 11:30 CONDYNE LLC 781 848 3774 P.04 The Commonwealth ofMassachusetts Prinf.F;oir�h Department oflndustrialAccidknts V Office of Investigations I Congress Street, Suite 100 Boston,MA 02114-2017 www-mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Blectrieians/Plumbers A licant Information Please Print Legibly Name (Business/Organization/individual): Address: C� A, City/State/Zip; Phone#: Z);,n FQ2E] you an employer? Check the appropriate box: 'am a employer with � 4• d 1 am a general contractor and I Type of project(required)-,employees (full and/or part-time).* have hired the sub-contractors 6•`� `��'construction I am a sole proprietor or partner- listed on the attached sheet 7. .EJ Remodeling ship and have no employees These sub-contractors have g, Demolition working for me in any capacity, employees and have workers' [No workers' comp. insurance comp, insurance.x 9• ❑ Building addition required-] S, We are a corporation and its 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their myself. I I.El Plumbing repairs or additions y [No workers comp, right of exemption per MGL insurance required.] I C. 152, §1(4), and we have no 12.❑Roof repairs employees. [No workers' 13•❑ Other I—omp. insurance required.] *Any aPPlimt 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 aE�idavit indicating such. =Contractors that,eheck 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 providrng workers'compensation insurance.for my employees, Below is the policy and job site information. Insurance Company Name: _-Policy-#or Self-ins. Lie,.# pp�j�3ooq<r ------- - - Expiration bate: Job Site Address: �v ��(� n City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of fine up to $.1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, I do hereby certr p n r the pains and en!E, o er'ur that the information provided above is true and correct ~— S i ature: Date: `� ! to Phone#: ( Of�'Zcial�usely. Do not write in this area, to.be completed by city or town official - City or Town-, Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6, Other Contact Person: Phone#: �oFSNer Town of Barnstable ' - Regulatory Services saxM SS. i Thomas F.Geiler,Director� Mass. , rEO N9. A. Building.Division Tom Perry,Building Commissioner 200 Main Street, Hyannis;MA 0260.1 wivw.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property.Owner Mus t Complete and Sign This Section If Us in A B uilde r as Owner.of the subject property hereby authorize' \ to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address,of Job) r k 1 n' tore of er Date No Name If Pro eity Owner is applying for permit please com"ple'te the Homeowners License Exemption Fort- on the revene side. Q:FORMS:O WNERPERMISSION THE Town of Barnstable t�� Regulatory Services y T w BARNSTABLE; Thomas F. Geiler,Director .9 MASS.. - �,, 1659. Building Division .Tom Perry,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.toWn.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HONfEOPYNER LICENSE EXEMPTION ` Please Print DATE: JOB LOCATION:.. number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less;and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. . DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall-submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned "homeowner"certifies that he/she understands the Town ofBamstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State.Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor:" Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2,15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. ACC>R o® CERTIFICATE OF LIABILITY INSURANCE F 'ATE(MM/,YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). r PRODUCER CONTANAME:C. , Diane Shaw Fred C.Church,Inc. 41 Wellman Street PHONE 9783227272 - FAX (978)454-1865 Lowell,MA 01851 AIC No Ext: A/C,No): E-MAIL dshaw@fredechurch.com (800)225-1865 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Chartis Property Casualty Company - - 19402 - INSURED - INSURERS: Charter Oak Fire Ins.Co. - 25615 Advantage Construction,Inc. - INSURER C: Navigators Insurance Company 42307 Two Adams Place.Suite 100 - Travelers Casualty Insurance Company of America 19046 Quincy,MA 02169 INSURER D: INSURER E; Starr Indemnity&Liability Company 38318.. INSURER F: COVERAGES CERTIFICATE NUMBER: 18537 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. tNSRLTR TYPE OF INSURANCE - ADDL SUBR - POLICY EFF POLICY EXP LTR SR WVD POLICY NUMBER MWDD MWDD/YYYY LIMITS - - GENERAL LIABILITY ' - - EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED - COMMERCIAL GENERAL LIABILITY, - 14 � � 300,000 PREMISES Ea occurrence $L CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 B 464D1464. 6/20/2011 6/20/2012 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 - POLICY MPRO- JECT _ LOC $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT 1.000,000 Ea accident $ ANY AUTO BODILY INJURY(Per person) $ D ALL OWNED SCHEDULED - 810464DI476 6/20/2011 6/20/2012 BODILY INJURY(Per accident) $ AUTOS AUTOS - - - X HIRED AUTOS X NON-OWNED - PROPERTY DAMAGE ,. $ - .AUTOS - Per accident $ X UMBRELLA LIAB X I OCCUR - EACH OCCURRENCE $ $5,000,000 E EXCESS LIAB I CLAIMS-MADE SISCCCLO1523811 6/20/2011 6/20/2012 AGGREGATE $ $5,000,000 DED I X RETENTION S 0. _ $ - e WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY M" YIN 1 IY LIMITS ER_ - A ANY PROPRIETOR/PARTNER/EXECUTIVE .E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? '- ❑ NIA 006430048 6/20/2011 6/20/2012 (Mandatory in NH) _ E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $10,000,000 X.of$5,000.000 C Umbrella - NYIIEXC7111931V 6/20/2011 6/20/2012 - DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more.space is required)- Certificate is issued as evidence of coverage. �- CERTIFICATE HOLDER CANCELLATION'' Town of Barnstable - - - - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1200 Phinneys Lane THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE Client# 364411 Mst# 18537 Cert Holder# ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ® ••®� NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH; .PA. 0090063-00 WC 004-32-1274 13072 ----------------- ---82-0611-oo pI 6=1. ki it 12 161il I Lai • ADVANTAGE CONSTRUCTION, INC. C TWO ADAMS PLAZA SUITE 100 -, - . CHART. ++ A T I S QUINCY, MA 0216§-7456 A Chartis company,, - • w EXECUTIVE OFFICES: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE WC990610 175 Water Street New York, NY 10038 I.o# 911597713 girs]. Owl 11 KEATING GROUP OF MA LLC WORKERS COMPENSATION AND EMPLOYERS 144 TURNPIKE ROAD ' LIABILITY POLICY INFORMATION PAGE SUITE 150 SOUTHBOROUGH MA 01 2-0600 - INSURED IS-- PREVIOUS POLICY NUMBER CORPORATION RENEWAL 006430048 OTHER WORKPLACES NOT SHOWN ABOVE: SEE EXTENSION OF ITEM 1. OF THE INFORMATION PAGE - WC990610 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the insured's mailing address FROM 06/20/1 1 TO o6/20/1 2 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law-of the states listed - here: MA NH RI B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 1 000,000 each accident Bodily,Injury by Disease $ 1 .000,000 policy limit v Bodily Injury by Disease $ 1 :000.000 each employee C. Other States Insurance: Part Three of the policy_applies to the states, if any, listed here: AK AL AR AZ CA CO CT DC DE FL GA HI 'IA ID IL IN KS XY LA MD ME MI MN 'MO MS MT NC NE `NJ NM NV NY .OK OR PA SC. SD TN UT VA VT WI WV D. This policy includes these endorsements and-schedules: SEE EXTENSION OF ITEM 3.D. OF THE INFORMATION PAGE - WC990612 ITEM 4 The premium for this policy will.be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. s Premium Basis Rate Per Estimated aassifications Code Number `Total Remuneration gtoo of Re- Premium`. t Annual❑3 Year ,muneration Annual ❑3 Year SEE EXTENSION OF ITEM 4. OF THE INFORMATION PAGE - WC7754 ' TAXES/ASSESSMENTS/SURCHARGES $9+,616 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE,BY STATE) $338 MA - MINIMUMPREMIUM $750 - NH TOTAL ESTIMATED ANNUAL PREMIUM .__$1431835 If indicated below,interim adjustments of premium shall be made: i.. ❑ Semi-Annually ❑ Quarterly ❑ Monthly, - - DEPOSIT PREMIUM 06/29/11 PARS I PPANY 82 --,��' "~-' Issue Date , Issuing Office - 'Authorized Representative WC 00 00 01A 39967(RaVd 04/08) z g g� g� as {{� p( �gi ✓ -+'te ` :F, ;,i�lal Nf5.4�! y `..3 ` & .,. .. t .qy pp pia g S :. ''S :> :i n €tom, i-� ;°B }} a a i d s s. Icecyp ni,i�,,s- ce 4i a � 2:•-. :'yam -. Y :} Y r t r , wt U. x. :4 '•` t __ i �R ! Y r4 A. b t 8 q r z: „r f s � a z a. s g t 4 J