Loading...
HomeMy WebLinkAbout0373 WEST MAIN STREET i Town ®f Barnstable Building Department Brian Flownw, CBO Building CoHMsslomr 200 Main Stroot,Hymffls,MA 02601 www.town.bamstable.mam Pre-application for Business Certificate Map QZ(10 p4mol Applicant Information ApPiio44t§Nye - — -------- ' AppiimU Addmgo of—y _ Business Information 'Nov� o�io�s? ____ ------------ Y�� No ig a roBigtorod eorpoffltion? _________________ No If yog Ndm@ of Corporation , Don§Ngioeg®oporoto uod@r tho rogi®tmd oorpo oto#4m@? Yo@ No h tho bmium a goio propri@tofft of hofflo 0o911pA004? _______=_ Yoe N® If yog thn 4 Now®mPtion fopigtrAW i§rogoirod_Soo ft1diog Divbioo SWff Nam of Booir#al 3 73 W��� :� s j���ed C , C��9 ck BuRdIng MMISS10mr®fry Us@ OW Condition l L Sp Building Commissioner Ckrk®#flE@ Us@ only Assessor's office(1st Floor): Assessor's map and lot number 11 C7 of t"E to Conservation(4th Floor): Board of Health(3rd floor)' ' _ o � f , t ssa�sr►nr, Sewage Permit number �� 02, o y rua ,�y� o Engineering Department(3rd floor):;' " / ' ; o,�va 9.6`�d° House number ' 7 0 oar Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30;9:30 A.M.rand 1:00-2.00 P.M.only TOWN OF BARNSTABLE 'BUILDING INSPECTOR APPLICATION FOR PERMIT TO %t TYPE OF CONSTRUCTION19 e , TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 3 23 GvsST' rn AyA,` S — Zz2� IAII f. Proposed Use &'7A70� /�C/f�i✓ Zoning District A/ D • Fire District �tiNlS Name of Owner 1q• Address 1 U 6:�eO64f 5 f a Name of Builder c7 0 H N F / G P-s Address Name of Architect fel Y j #AAA-,IV) Number of Rooms Foundation /;o n�C/L 67z:— Exterior k�� F r Roofing 5 y�I�zT S1f//y Floors Interior S/ 7' &,o ClC f SiAIA✓L,-TS HeatingA /2 Plumbing —' Fireplace Approximate Costi"' 44 n Or--p Area /S % ��p r Diagram of Lot and Building with Dimensions Fee 0 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .Tf7�}1✓ 1>� C,, Construction Supervisor's License o® ! / (o .w DiPRETE, HENRY A. No Permit For BUILD ADDITION Commercial - Location 373 West Street ; Hyannis Owner' Henry A. DiPrete Type of Construction Frame Plot Lot Permit'Granted February 28,19 94 Date of Inspection: Frame 19 Insulation 19? Fire I ce 19 Dateo�n9i1 ted 19 R s „ t o ._. 1 . /e 7 .3.5 Al SO SS u/ 9S 93 fn ,La-7 1 S+K ,CD T S � •r �4 1 R� 7 i J 40.3 Wc+fK__ J 1 � . GEORGE LANIDES No. 2V23 P: fcrsita G /Grotc�'�u S170�//7 Cij Y�iiS ib/aij .-.s rlol` /n � fI00C( /fxt3A/rf •4rc4 f'vL Corl/n1G�n/`r J'anc/'�?Saoc!-nO�D B C o n�o r/rIE� 7o 745 Zcn/�9 to ws o �5 c ?-o► I) o� $arnsfa6/c When co�s�Wec cc(, P� o7 : :PzA /v 373 W,Zsr ,411A v.'JT •'f� ' f- COMMONWTA.I.TH OF i sAC $ _ c F Jr�fir:T:YJ�'T OS I�'DUST}*1A4,,A IDFNT- jamcs- Ga-none+ i30STO N• MJLSSACH US3 3-S 03111 c—n:ss•one• wORK£RS'OOMPENSATION INSURANCE AF.FIDAvIT Qiccnscdpertnittcc) with a principal plzcc ofbusincssh-csidmoc2c - (GryISt3ccJZip) do hcrcby ccrti . undcr the sins and nskia of 'u • tha� P !x Pu! �� r. j) I am 2n cmplovcr providing ncc following workcrs'compcnsazion covcragc for my cmployccs Korking on job. Insur2ncc Comp2ny Policy Numbcr. 2m 2 sole proprietor and have no one working for me j) 12m a sole proprietor,gcncr.-J eontraor or homeowner (earde one)end hive hired the eontraaors listed beloY.- who have the followiagworkcn`aompcnsauon insu=cc polities: F=mc of Conrmccor Insu=cc CompanylPolicr?lumber -2mc ofConzmcror Insurancc Company/Policy Numbcr X-imc ofConz=aor Ins=ncc Company/Policy?dumber Q I 2m a homcok ncr performing all the work mysd£ � ?�OT� Pkasc be aM_-tc L:t�•t7<feo<o•�crsv3o employpctsoa:to 20 ta:ieteasoec„eoortrtset:000ftcpait�wticon a 2.•01ins of not more tLtm Lrc<t:aiu is:.-L-i6 ti<bor>co-,zcr also r<sidcs ce oa the Ervcrads:pputuazat dc(<to aac Dot EcocrzU)' «ns:dcrcd 10 be"-ploy<Is%=&r Corrpcasatioa Act(GL C 152.sect.. 1(5)).appliutioc by a 6mco-Mee for a Ti«as< or perrnit r-._y cvi2ccc< Cc 1<tz1 s;at:s c!:-cr_-Ioycr uo�cr t1c Worltcrs'Giorapcosatioo/act_ i uaccrst:nc tn:c a copy of tru st:t<rn<rr 16—a:dce to u,< D<pa::::cnt of lndustriJ Acdd<nu'Orrc<of hsu::nu for.cnvc—;C �•crific:tion sd th_t f=i1ur<to.1-ut<co.•trz9c r<Su;rcd ur.,Jcr&ction 54 of MGL]52 c:.n k24d to tic irrpos;6on oluininal pcnJu<s eonsisons of a fine of vp to 51500.00 a-.&cr i-rrisomm=t of vp to on<xvu and e;Q penalties in the form ef:Stop Wcck Order and'= I frn<of S 100.0o a day against mc. Si;ncd thi c�2yof oI . lg Liccn:cc1Pcrmirtcc Licensor/Pcrm;aor • COMMONWEALTH DEPARTMENT OF PUBLIC SAFETY OF ONE ASHBORTON PLACE r, MASSACHUSETTS BOSTON,MA 02108 r L_ +. %I is ft EXPIRATION DATE CAUTION 171CTi{. aL,PERVISOR _ ry � / '2 , 9 ` 41 Sol- ` EFFECTIVE DATE LIC-NO. FOR PROTECTION AGAINST ( `RESTRICTIONS THEFT, PUT RIGHT THUMB t� tiE T 06/30/1993 009765 PRINT IN APPROPRIATE o J C H w E FIELDS BOX ON LICENSE. S # 19 7—3 8-6 8 09 LIq C 4� A R N M E 0 2 ° BLASTJNG.OPERATORS Z I� 3RPi1 02b68 m m MUSINCLU PHOTO. PHOTO(BLASTING OPR ONLY) F `�t r. NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT: ''• STAMPED-OR-SIGNATURE OF THE COMMISSIONER DOB:- I. 0,/02/1948 /"- THIS DOCUMENT MUST BE CARRIEDON THE PERSON OF IGNATURE OF LICENSEE SIGN NAME IN FULL ABOVE SIGNATURE LINE THE HOLDER WHEN EN- OTHERS-RIGHT THUMB PRINT GAGEDIt1 THISOCCUPATION. �`p,t• �^' :+'='mew COMMISSIONER _ t BMW � fie Ua�;►�r�Ioou�sea�� o��G��czc��e� HOME IMPROVEMENT CONTRACTORS REGISTRATION u<:>di C GT CU uiilg Regulations and Staridarus One P iace Room ll'3( 1 11 --ssachiu- L ., 0_1C723 lt'1PFRO',JCME NT CGNT FACTOR �Xp1'i'_, _i0n HOME IMPROVtM`:Ni LON?RAliOR Registration I_3260 ii) ;i'? __ IF? i D. iype - INDIVIDUAL J0 1i'`1 L_ . i _LLLLU Expiration 40 MAGGT-I: I_At. ri-ni�_��._:�� ri 0 c, _ .i l?N Lin JUrIN E. t 1L Ut v ADMINISTRATOR BARvti n6L . i'ir. '32668 .... .:?.. ....ttt:..ttttt...: .....:........ }.... ::..:.t:::...t::.........: ": ;:B ............. :.t?t ;i. ..4 titi';:>.;:{+i+•v.�:n{L>.~::}Ltii:i4:i}>.i:..v iiii::.tttt•::.t•.:•::.t•}.t{t,::ii:::.•:ti{::::}t}+:::••:•::;•::..>}`?•:?:??::::::::y.tt>}}::}:•}?:•.;.}}?}}}}}}}}};{.tt; .v::::::::::;}}:;+.{•:4:ti•:iL:iiv:{{viiti8?i:•:,i{iG�}:{+;:{{.}?:L..iv:{{.:i{.:iL?:•.vv?:w}:{�:•:J:{•:v.+.{.:{t{{ii.:{{iL:v{titii{S:ivi•: •:i:{ '•'•" i•\�+r :?��••:f.:::i.,> • •t•.vt••y:h..�2tiitiji;:}�i�r:,:���i2ti�itii<'vivtti titi$fv:titi ii:k'v :tiAvv :�iti :nit};: :;:y.•'. •:i .....vwnv:::nw::u: •.v::::.. vxtvv:•:nv :•}:L•:tiitit,ii;`.lvt.;`.ni;;:;:t;?`?`}� .};}}iy,`.`i :xv. vnv,:•n •v:•.tv?:vvv:4nv.�:L {i; . w.x ••:.»::•• i•?:tvv�:xxyxw: ...«v:vv:v}t:•:v..v..n .v:vnvvx:.xvvxw:.xvx:vrvt •}::v:•x: •:•v.}v}:y}vvv:v}}•.}•.w.t;.......,v...t:::};Lv{{•?.}n....v...v;;...v.vxt{IX•.vv::::. ::....:.. ::.t::v.::•.w:.vxxvw:nvvtty''•' ,.;..:aitii i•.;:{v::vw::.v::::::u:.va ..xxw.xxv:::v:v:nvwn•..:h::{{:•:x.v.:..vvvvv:..v nv»v.w::. :. KSt tt. i......v..tt:..tt..........:ttt:ti.:.tt.........t. }:{.>}:::::::::::ii..t::..:::..ti.?.{.>'{{{tv.:t ,..:.tt.::.tty. ........:. x ... f.... ..........tt.t,....:..... ..?:?... .......... t.:::.tt.v::::::.�:::::.:..tv:.t....t......:t..:.:.t...:tt.....vt...t. t.......ttt.:...ttt.tt.:::::::. ::.�:.t..tt.::::::.tt.::..�:::{{.>:;>.: �f�.• :•>W. MAIN STREET iANNIS iti};;;;{tiff IV '•'}tiiii Y :..t::..:..:..t. .> <><«< ................ttt....,...............:tt.:........t.....:..:..::.::.::.�.t.::.�:.tt:.::::.:� .::t?ttt:.::.t..t.:.. . NEIGHBOR }. > `i ... :. ; ON ' }:.>:.};:.>?ti>:.i}}.}}}:.?:.?}}}::?::»::».;::;.i}}:.?>}:>'ii«>:'>::::;>:::::�}};}:.}:.}::.}:<>:::>::::A>:::::.: ....�.�:�{.�. tti:;i'L'tt2�i'\tiiiitititii2`•`.itikiiiii+:>:; xw:::xx titriri:, x':itivvw:::.v:::w:.v'v'v t .vv{ii}:.;:ti;�:Li.}:LLB{{{:::?:ii>.•vr,::{ >::::;. .. ....................... ..: .....:..... KKI O UCT NEON SIGNS IN WINDOWS. :;:tij4i;:�i::v::;:.y:}}vw:iiii i:ititiii;iititiiititititiit::::tiii:iiiiiii:Ci'iti�tiiiiivv:::iiiii:iiiiii''i>i tiii viiL::<v�iivit• ttvv::v:::...:.:.:.::•h{•}:{{{8:v:•n24;{r{::::n:y:};,;......tx......t........................t.......... `.:;iiii•':::tititi22}.';titi:ktititi%`y,`v}�.ti>r;:�iy } :.::w:.v:::;}.,.;;Y•v:J::uvxw::.w:nvttiv::ntvtv:::::::•vvvx:v.vx:v:.vt n; .vw:.::vxvv»vt,{{..J:v:vvw.w:.vv.xvv:wnvv xnxw"i{i`tititi ti itiitiii;:ivii; v..ivvnt tvt»•.:w:.vv ::::::::vv..v.vxvw.:v:.tw:::nw:::::::.w:.vv..vvv'v'vv''vtt xv:.vxv..vms:.vv.:::.v..:v..w:::.\::::.v:. ":.:..tx::..».v..v»vtv.vw:.:v........ ........:.....}..:::::}:v'r'•}'•}????.......4 ...... *} CALLED-ASKED CALLED-ASKED THEM TO REMOVE-IF .` N DONE BYM ONDAY-31 WI LL TA A T RT <:TIC KETS.TS ?ti:4ti:' i;i;; :i'•P':itiyyi,i��$$ ::::.w:::.:v:nvtv.v:nv::::::::::::::.w:.:vvt:vw::.v:::::•. ::.w::::•.,•.vv::•:.xv::•:nxw::ntw::nx•.x:::::::::::w:.0.::nw.v::::::.v:n:::::•::::ry•. :.w.w.vw•tv::• nvx:::::.w::•.vvw.::t:vnvxw.v: :::::::::.::v::. n}}}i:•iQ:•iiii}i?i?i}ik{i}:{}}}??:{•:•? ..�dici::ii+}:: r::tii;:ii:'{^::;{yu:4M1yi::iir::;:::Sr+i<r%:? i'r:':.:ivii;{ri:`•J {:}j<{i:;jiiiyiiy;;':.';iv::'}�$::•:::}:+:ti:i{':::i{:i::::i;`•L$•:{y}:it}t':i:•; .:.::.::::`:::':::.�......... •......!�t�•.......t ::::.:.:.::.t.:.:.:.:.::t:::.•;.,{{.?:i•:.:;:::;.<�?.tt.;{.: »{.}r}i.:{.}:{{.:>.??:{i•;:::•:i{{;i•.•::•::{ti.><:{..«.>:{:.ii:i>:i::{.::i>{<. { 9 O �O I , f lo L5 II Q I I ,. ' w II II Z! a a xIISL S 3 3 LI jj . . II j II v 3 r 11. (� 3 Z Q �a-o^ f'I-v"i�Va�^w- r — ��ETNE Tows ® V F1, BAR.NSTABLE BAMYgT"L Office of the Building Inspector y MA86. p� p 1639 �y 8, Date December 30, 1986 ............................................ Fee ......$50..............00................................ Permit No. .....8 4..................... PERMIT TO ERECT SIGN IS HEREBY GRANTED TO ............3..3...w.......main...Street...Care.............................. .................................................. D/B/A .............................. ack' s LOCATION ..................3,73 ie:st mAin S� Eet ........................................... Hyannis, Massachusetts 02641 .............................................................................................................................................. ANY VIOLATION OF THE SIGN LAW WILL CAUSE IMMEDIATE REVOCATION OF THIS PERMIT r Building Inspector TOWN OF -BARNSTAB,LE 'f = BUILDING DEPARTMENT — TOWN OFFICE BUILDING 7 •Yl �r r►�a `� HY.ANNIS, MASS. 02601 ,APPLICATION FOR SIGN PERMIT DATE •i,V Application is hereby made for a sign permit in accordance with,the description and for the purposes hereinafter set forth. This application is made subject to- all Rules and Regulations of the .Town of Bor'nstable ,now in force or that may hereafter be enacted affecting or regulating thereto and which are hereby agreed to by the undersigned applicant and which shall be deemed a condition entering into the exercise of this permit. INSTRUCTIONS 1. This application must be filled out completely. 2 A drawing, in duplicate, showing the shape and dimensions of the sign, lettering on same, height, method of securing to building, or if freestanding, method of erection. Drawing must show sizes of structural supports, and size and depth of foundation. SIGN LOCATION , � -.Owner %3� 41, ft fi) -�� �'�'P D�/✓ � c1wco Street- Rd. Zoning District Fire District OWNER OF PROPERTY Name ��ln� //< .Y/ c Address / 0 CTC�-Q ]T City 4A St. Zip Tel No.( Ares Code SIGN CONTRACTOR .Name—MaJAM 14 . Sew Address JJ4 Scpp. 1 City St. _ MA Zip 6 4 V1 Tel No.(6/�) yir 4 �1/- Type of Construction � Area ode YP Free Standing or Attached DESCRIPTION L 'DIAGRAM OF LOT SHOWING LOCATION OF BUILDINGS AND EXISTING ��� e V" . SIGNS WITH DIMENSIONS LOCATION AND SIZE OF THE NEW SIGN TO BE DRAWN ON THE REVERSE SIDE OF THIS APPLICATION. Is there any electrical wiring required for this sign? Yes No If "Yes." who is the electrical contractor Lo ' �10 a FOR OFFICE USE ONLY Area Permit Pee J DEPT. ROUTE DATE DATE DATE y' RECEIVED APPROVED REJECTED INITIALS PLANNING Mail permit to: & ZONING ELECTRICAL INSPECTOR BUILDING INSPECTION I I hereby certify that I am the owner or that I have the authority of the owner to make application, that the informatio- given is correct and that the use and construction shall conform to all the Rules and Regulations o e Town of Barns?c which are imposed on the property. Phone Signatur of sign owner!suthoriicd agent 51dcs 'Opal J/off" ram. o4.53Felr�. 'G deR f�- l -r/&V pv-OZV r i�Y J i, r f - - - yL - - �- _ �- ,d;,��°'-"`ma's. ,�, �",� w ��" �.��}»•'���,�� �—�=��,' �„t 3�-s ,�� �('d "'-1 E�'' t � `�'3'2 �1 4•f � t���ms.� �t``' -'l�Sr- .� i I DA- �'- r�'x` e.4f k � 7 z+cr •i. '�`c;� y�a�'�, '�-'-v',� -�; � ,eta � •.�..,�-;�"_ �� a 3` ZIA--ela Town of Barnstable *Permit# Y ��FTHE TgyH Expires 6 months from issue date 60 Regulatory Services ere oZ S• 61 d y�xrrsr�st�� aanss. $ Thomas F. Geller,Director 59. Building Division Torn Perry, Building Commissioner 'ScIT 200 Main Street,-Hyannis,MA 02601 X-P R , ;; Office: 508-862-4.038 MAR 2 .1 2004 Fax: 508 790-6230 EXPRESS PER APPLICATION = RESIDENTIAL ONLY Not Valid without Redxpressimprint TC ilN ®t= W-1,I-STASi-E Map/parcel Number `— Address � Property �. Value of Work Residential Owner's Name&Address a . Telephone Number y�-K Contractor's Name Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) &orkman's Compensation Insurance Check one: 1 I am a sole proprietor MI am the Homeowner I have Worker's Compensation Insurance Insurance Company Name l ? workman's Comp.Policy# � �2g i Permit Request(check box) Re-roof(stripping old shingles) All construction debris will, Re-roof(not stripping• Going over existing layers of Re-side ula ions and Standards e lacementWindows. U-Value_______ (maul aC - Room 1301 R p ) ,, Usetts 02108 * ro uixed: Issuance of this permit does not exempt compiia=with d tr where 4 a_Ctor Registration 0 must si 0'YUel x opertY • , Registration: 112536 II pro ent tcacto icense is�.a._,;... „w f, Type: DBA L . Expiration: 3/23/2005 Signature � � f� ; • _.f i t Q:Forms:expmSrg :..� ,'�°•; Rwica115�QQ3 �� ti'� Il Fraser Construction Roofing & Siding Specialists. Possible Extra-Any rotted or otherwise deteriorated trim boards, 1 ood P 3'v' sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$40.00 per hour, plus materials, plus 20% overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the shingles and labor for 10 years. FRASER CONSTRUCTION Warranties the shingles against Blow-Offs.for 10 years. CERTAINTEED Warranties the shingles and labor 100%for the first 5 years, and then on a pro rated basis for 30 years total if the shingles become defective. CERTAINTEED Warranties the shingles to be ALGAE resistant for a full 10 years. Any deviation.or alteration from above specification.will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: SUBMITTED BY: Homeowner ras t ion L - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map `' Parcel Application # �® : [ 6 �� Health Division ' Date Issued �° L4 Conservation Division Application FeeI CP Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address 323 Village Owner —Address ,2:? Telephone y 15'�O,_f -7 ' ^,;2 Permit Request u Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay a Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other 4 0 Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood%coal stogie: ❑ s ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: D;existing0 nevi, size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ u a Commercial ❑Yes ❑ No If yes, site plan review# Current Use V Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �( /Gaol/ /�� Telephone Number 70 l Address 6 G- License # (2 15 Z� [� =i Home Improvement Contractor# 49 742e) Worker's Compensation # L ' GAG't�0/ 06'0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �` DATE �G �� FOR OFFICIAL USE ONLY f- APPLICATION# DATE ISSUED _.MAP%PARCEL N0,-_: s� ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION, FRAME INSULATION. ` i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL s ` GAS: : ROUGH rl �� FINAL fr <tiFCNAL BUI'LDING�t F DATE CLOSED OUT . ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Deparfinent of Ltdustrial,4ccidents Office of Investigations . 600 Washington Street " Boston, MA 02111 lvww.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ise ibl Name (13usiness/Organiza6on/Individual): Address: /�� - .• ' City/State/Zip: Phone.#: —� Are you an employer? Check the appropriate bor: Type of project(required): 4 I am general contractor and f 1.❑ I am a employer with . m 6. ❑New construction have hired the stib-contractors employees(full and/or part-airn.c).* listed on th 2.El I am a sole proprietor or'partfter-' e attached sheet 7..,Q Remodeling ship and have no employees These sub-contractors have g. 'Q Demolition worldn for me in an capacity. employees and have workers' g .Y p ts'• 9. .0 Building addition [No workers'.comp.•insurance comp, insurance.$ required] S. [] We arc 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, §l(4), and we have no employees. [No workers' 13"0 Other comp.insurance required-] ''Any applicant•thatehecks box#1 must also fiii 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. rContractors 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-conh-actors have employees,they must providb 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 info rmafiorc Insurance Company Name: t� �,� G/ / C�i4 ci cT d/ — Policy#or Self-ins.Lic. #:� ���G, Zvi Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page (showing the policy number and expiration'date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of crimirial 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. B e advised that a copy of this statement may be forwarded to the'Of5cc of Investigations of the DIA for insurance coverage verification. I do hereby certify under he ns and penalties of perjury that the information provided above is,,true and correct . Date: l Si ature; �t� — Phone #: Official use only. Do not write in this area, to be completed by city or town offtclat city or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other . r t ion and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as every person in,the service of another under any contract of hire, express or implied,oral or written." Am employer is defined as "an individual,partnership, association, corporation or other legal entity; or any two or more -of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or tiustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house purtenant thereto shall not because of such employment be deemed to be an employei. or on the grounds or building ap " MGL chapter 152,§25C(6) also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any �`. applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25CO 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 Rath 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-contcactor(s)narne(s),•ad&css(rs) and u. phone nmber(s) along with their certificates)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required, Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials .Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the pernut/license number which will be used as a reference number. fn addition, an applicant that must submit multiple permiV4cense applications in Iany,given year, need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"fhe applicant should write "all locations in (city or town),".A copy of the affidavit that has been officially stamped or ma-rkcd by the city or town may be provided to the t be filled out each applicant as proof that a valid affidavit is on file for future permits or liccrses. .A new affidavit mus year..Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (Le. 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 Ma ssarhusekts Depar4ulmt of Industrial Accidents Office of Tn�esfigat�oz�s 600 Washington Street Boston, MA 02111 Te1. # 617-727-4900 ex '406 or 1-877-NIAS-SAFE Fax # 617-72777749 Zevised I 1-22-06 www.ma.ss.gov/dia FroM:Erlca Barrett Faxia.CYLOE,.CAPE COD INSURA Page 2 of 2 Gate:4,2012011 12:C2 PNI Page.2 of 2 I i OP ID: EB ACCei2D` DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE I 04120/11 THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS-'NO RIGHTS UPON THE CERTIFICATE.`HOLDER. THIS CERTIFICATE DOES 1NOT 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 policV(les)must 6e endorsed. If:SUBROGATION 15 WAIVED, subject to the terms and conditions of the policy,certain policles may require an endorsement A.statemerlf,ori''this certificate does not confer rights to the certificate holder in lieu of such endorsement's - PRODUCER 508-771-3300. raAMeA�. Olde Cape Cod Insurance -- ---- -- Martha Findlay 508.775.3821 F'CONE Fxt1. —F e.No): -- 296 Winter Street f11Ai>- '- -- --- -- Hyannis,MA07.801 ADDRESS:PRoouCER_--_---_-- ------------ Martha Findlay cUSTOMERlo#VILLA-1 --- _ _—_- ! INSURER, )A=FO_R_QIN_G CO_V_E_RAGE .NSURED Villani Construction Inc — P.O.Box S92 �INSURER A:Scottsdale Insurance Company I INsuRERB:Safettlnsurance Co _ ...___.-----------...__i39454- - West Hyannispert,NIA 02672 INSURERc:Granite State Ir4suranre Co. — ----- . l.INSURER E_. --.— ----- --- INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED,NAMED•ABOVE FOR THE POLICY PERIOD .INDICATED. NOTW(THFAN DING ANY REOUiREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT'NYITH RESPECT TO WHICH.HIS. CERTIFICATE MAY ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCR(BED,HEREIN IS-SUBJECT TO ALL THE TERMS; EXCIUJSIONS AND CONDITIONS OF=SUCH POLICIES.LLavirrS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSIJRAr10E IPOLICY NUMBER IN POLICiXP MM)DWY .(;IL—EFMFE;_"=•..'F;-_D';y.F rE`.—Nr.e_rii,_.�!—+!:EFry-n—n:I(e SO,i�LIMITS GENERAL LIABILITY R FNI. --—li-00- 0,o0 0 rdcPCICLGEP ? _ tILITY �CP136668A X 5 04t12111 04122 5 .00 C_AIMF-IA✓DEII x 0:3C_R S,pO 1;000100JUR dJ_k�, A••;r;r.'E'ATE 2;000,00 -S P:'L 4�Ct R'cG,kTE L i K-H-IEi P7?: I i I � _r 1,000,000 fr-- - ....----------- ------------'--=- POLICY PG�_� I �I LCIC AUTOMOB!LELJ0.ELL.ITYr"IAP�nCD•Si:;LELIMIT CGd.nl�S Ica .I¢ _.Ar-:Y AUTO I 13150275 j Datum I OBi09i11. I.a a_.,,--F > r•a _,�i—- 250,00 --AL_0WNE.DA_T0$1 ! I I I 506,000 P;�a.,fon I B X S_N uIJLEL e.UTC-� H REo a*Os I. I I (Fore 400 OOO •�OIJ-C'•.9'NELtA„TC� I I I ._ r ---- .------ I UMBRELLA LIAB I ti=C_R EXCESS LIAB CLAWS rM.iJE i I :PE—PTE t D°DUCTIHLt I i -------- --{- R?TE,-ON S - WORKERS COMPENSATlPr1ANDEMPLOYERS'LIABIIJITY YIN IT_Jr-I�:'LI_Ilif__I" AM,'=Ri PRIETORlFARTPiER£XECUT'7E r--I I IWC 001-66-0670 01/08/11 OV08112 kF .�::c�+Acc;DEN. ¢ 100,000 OFFICERWIDV35R EXCLUCEDi U IPI/A — - (MendatoWinNHl I I IcL CiSFASE-E,:..Ef-<F.:'!=E :{ iDO.OO It Se=.des;ibe undp.r --.___..----._.._._..---------- ---------- ------ CESCRFT:)N O-rP=RFT IONS balrn I I . E,...DcEASE-Pr,)L.0 Y'LI'd IT I¢ r•D0,000 I I 1 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,It more space is rec,ulrad) I I i I I CERTIFICATE HOLDE14 CANCELLATION TOWN-05 - -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN Town Of Dennis ACCORDANCE WITH THE POLICY PROVISIONS. Building Department 465 Main Sf reef AU'HORIZZEDDREPRESENTATIVE�—_ Dennispol MA 02639 ,r,w111,1uLgIS F I O 198E-2009 ACORD CORPORATION. All.rlghts reserved. . ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD i i I i I VILLANI CONSTRUCTION INC. Roofing& Siding Specialists PO Box 692 West Hyannis Port,MA 02672 508-778-2495 1-888-766-3043 Member of the Better Business Bureau—Insured—Licensed—Free Estimate Grace Horton July 13, 2011 Jack's Lounge 373 W. Main st , Hyannis Ma. DESCRIPTION Furnish and install the following, labor and materials to re-roof building at Jack's Lounge Ma. as follows: 1. Remove existing roof shingles. 2. Check all boarding and nail where necessary. 3. Remove existing drip edge and soil pipe flashings. 4. Install new aluminum drip edge. 5. Install new aluminum and neoprene soil pipe flashing. 6. Install#15 felt paper. 7. Install ice&water barrier to eves, valley and penetration. 8. Install 30yr architectural algae resisting roof shingles. Certaindeed 9. Install ridge vent. 10.Remove debris from job site. Note: Replace 4ft.x 8ft%" cdx plywood$50.00 per sheet. -Dump fees for removal are included in this quote. -Villaui Construction,Inc.guarantees labor for 10 years. We propose hereby to furnish labor&materials complete in accordance with above specification for the sum of: TWO THOUSAND SIX HUNDRED Dollars.-$2,600.00 Payments to be made as follows: DUE ON COMPLETION All materials are guaranteed by manufacturer. All work to be completed in a substantial workmanlike manner according to specifications submitted,per standard practices. Any alteration or deviation from above specifications involving extra costs will be executed only upon verbal request and will become an extra charge over and above the estimate. All agreements contingent upon weather, accidents, or delays beyond our control. Owners to carry fire, tornado, and other necessary insurance. This proposal maybe withdrawn if not accepted within 30 days. ACCEPTANCE OF PROPOSAL— The ve prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to cified. Payments wile made as outlined above. Signature l� Signature Date.2 ��`�� -+�- [Milssachusctts - Departlnent of Public Safeo j Board of• Building Regulations :utd Standards III Construction Supervisor License License: CS 74360 RICHARD VILLANI PO BOX 692 W HYANNISPORT MA 02672 i 4 �=::f- Expiration`. 6/23/2012 ('unnnissioncr Tr#: 1239 'IKESign .- TOWN ,OF BARNSTABLE Permit B.AlWn)YBLE, MASS. 9� s6 ArF0 A� Permit Number. Application Ref: 201001061 20070424 Issue Date: 03/12/10 ,* Applicant: DIPRETE, HENRY A&ANNE,I Proposed Use: : RESTAURANT & CLUB Permit Type. SIGN PERMIT Y Permit Fee $ 50.00 Location 373 WEST MAIN STREET Map Parcel 269099 Town HYANNIS Zoning-District` HB Contractor PROPERTY OWNER Remarks 4 REPAINT EXISTING-22 SQ FREESTANDING SIGN JACK'S Owner: ' N DIPRETE, HENRY A & ANNE 1 Address: 2022 MICANOPY TRAIL ' NOKOMIS FL 34275 • Issued By: PC POST THIS CARD SO THAT IS VISIBLE:FROM THE STREET I� , t ski t LY t� �p THE 1p� Town of Barnstable TOW I OF BARI IST BLE Regulatory Services 25 B'`R''ASS.� Thomas F. Geiler,Director �� �3 9�A1639. � �fntA Building Division Tom Perry, Building Commissioner m 200 Main Street, Hyannis,MA 02601 a Als��� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# \ Building Official approving- t�N ----------- Application ' U for Sign Permit Applicant:----��-(h' - - d G ___-- -- - _--_C�s- Assessors No:__2-�a Doing Business As: g _____________________Telephone No._s��_rl O(4 t Iz--- Sign Location Street/Road:____ �_ _l�_st _ Zoning District:_________Old Kings Highway? Yes No�Hyannis Historic District? Yes/No Property Owner Name:_ ---- _ ( -----==---Teleplhone:__ �(/-.`f_4`5 Address:------------ ----- - --- --- -�-----------Village:-------------- - - -- � � - - - - cx Sign Contractor Name:-Rf ET 1-l'L= -- ��' c-'�Z��'_----Telephone:2�� -_`���-70_ Mailing Address: �_ _ � c Description' Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is die sign to be electrified? Ye4No (Note:If yes, a wiring permit is required) Width of building face_ _ft. is 10=Aac)---x .10 ___LL©.__ S E- Check one Reface existing sign V-1,"or New-----Total Sq. Ft. of proposed sign (s) _ _ Z Z If you have additional signs please aaach a slieetlisting eac1i one with dimensions If refacing an existing sign please provide a picture of the existing'sign with dimensions. I Hereby certify that I am the owner or.that I have die authority of die owner to make this application,. that the information is correct and that the use and construction shall conform to the provisions of §240-59 through §240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: �_'��'''t_" "`'___-_ Date-------___ SIGNS/SIGNREQU revised103009 y 3� a y •sjM a• �N J �x, • ' 9 3 r �tS ''""� ��.11er - y .. ,3 "�f"�� _�,. p� {� '� ✓ t i _ €a � �c 4 �.� `^" it.t,,� E�� � � . �; s F� a �,sr �"".Y1 � �y �'7.,;.1'_'� F � "M r $ �� !` �p � '+ ,,� ,�,+,.'n7�, i• y _ 6 r r yw fi r,.. �.•i �` �� k,�,�, '� n 3•' w » ,9r ''i F '� t { v� ;f f ;P' ;t. �_ .. I ( t�=" iM e lei" 5 V..,):`.�� .,.$' •� P A ? �f Y �.; � 7� '+�':.M f„ � 'A x..-y� y{.., � III Al ea+ - + r r Is ;Fh'ryh, � x' a � =. s' $� „i' xt N � "�1ly��' " ,�5. �.•.