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0775 WEST MAIN STREET
�l 7� t.�e�}- rna� h s� . �,� �� �� - � �� _-_ YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00.for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you . t give ou permission too operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. must do b M.G.L.-it does not y p P . m y • Hyannis, MA 02601.(Town Hall) and get the Business Certificate that is he Town Clerk's Office 1st FI., 367 Main St, y - , Take the compl eted form tot - required by law. DATE: .2 2 C f Fill in please: . _ G G P o S l� `�°'i.'�t�r, '�'�'• `I ' APPLICANT'S � YOUR NAME/S: i� BUSINESS YOUR HOME ADDRESS �'a-S tu1EST �,t Fl iM5"r F1PT• a6 N,4N+V S 042 ��`!'yc'�,J TELEPHONE # Home pTelephone Number ;�i'Hsu t�r4atl 5SN or E I N 1.49 MAII i KE o_G I,00- NAME OF CORPORATION:. l NAME OF-NEW BUSINESS 5 I A) TYPE OF BUSINESS ` Q . '! IS THIS A HOME OCCUPATION? `� YES NO 1. �Q �(� 020 �' ADDRESS OF BUSINESS.415 - ST 1u A 'm T. AP-r.A6 � i4NN%S - MAP/PARCEL NUMBER ` [Assessing] When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth ' Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S /Iz CE -MUST COMPLY WITH HOME OCCUPATION This individual has bee limed of a?- ermit requirements that pertain to this type of business.RULES AND REGULATIONS.. FAILURE TO 4 horized Signature * 4 COMPl Y.MAY RESULT IN FIN€& COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS [LICENSING AUTHORITY] This individual has been informed of the licensing requirements that pertain to this type=of business Authorized Signature** COMMENTS: 4� i own opt uarnstable �OF-THE ray Regulatory.Services o Richard V. Scab;Director . Building Division AARrtsT,uart 1659. `0$ Tom Perry,Building Commissioner jDreo►eat" 200 Main Street,Hyannis,MA 02601 f www.town.barnstable.ma.us Office: 508-862-4038 Fax:'508-790-6230 Approved: Fee: Permit#: . HOME OCCUPATION REGISTRATION Date: 04126 /20.,(6 , Name: Ci 61 W 8 (2A C A IU D b k,4 Phone M 500 _ 3 6 O 90 4 Z j . Address:_ !q q-5 WEST A)A i V 51 0 PT. �6 village: 44A RJ iV i 6 Name of Business: AQ t S T f.N A S CG ERN I N G /N C Type of Business: (i 6p a_n i n i0 or-or INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor,no visual.alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject-to the following conditions: • The activity is carried on by the permaaent'resident of a single family residential dwelling unit;located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess.of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. , • Any need for parking generated by such'use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard • There is no exterior storage or display of materials or equipment • There are no commercial vehicles related to the Customary Home Occupation,other than one van br one pickup truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length,and not to exceed 4 tires,parked on the same lofcontaming the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. •. No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: 4s&U CeRl HO Date:_ Ok 116 /O 0/r6 Homeoc.doc Rev.103113 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map Lei-I , Parcel �, 2� J, y Application#,;;aV 741174,�2 y Health Division Date Issued 1 b(.01 in I I f Conservation Division Application Fee Tax Collector Permit Fee ` Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 7 75 ma it) 4�f4l%5 23 � _ Village Owner L26&7"14211' Address L—yL/ �`� i�i��- Telephone Q508 7 7 lam // Permit Request mo�.,P T Q e/a,2 S`cw o s��1--c 4/5cr. A: e Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new.` Zoning District Flood Plain Groundwater Overlay ' ' '; Project Valuation /6,O aa_ Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting doc Mentation.R .r n1 ` (,,11 Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family,(#units) Age of Existing Structure 30 Historic House: ❑Yes >i No On Old King's Highway: ❑Yes No Basement Type: )d Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) � Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes .❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name /c/ Telephone Number Address, �'� \ClZoe-J ✓ .5 nc- License# 7� Home Improvement Contractor# Worker's Compensation# �C G b gC1 ` 3 O ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE 1l` 70 `C7` r e _ i k FOR OFFICIAL USE ONLY k APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE r , 'i OWNER DATE OF INSPECTION: ' x' FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ,per 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 Le bbly Name(Business/Organization/Individual): � / �- e C Address: �.�,1kc r If1 ��-rL City/State/Zip:_ 6_11 1 ��.�� . �a 432.Phone.#:�t,'d� Are you an employer?Check the appropriate bog: .'Type of project(required):, 1,0 I am a employer with Z. 4• ❑ I am a general contractor and I have hired the sub-contractors 6• ❑New construction . employees(full and/or part-time),* . Remode 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet ?• ❑ ship and have no employees These sub-contractors have g• ❑Demolition d have workers'e$loye an working for me in any capacity. emp 9• []Building addition [No workers'comp,insurance comp.insurance.$' 5. [] We are a corporation and its 10.❑Blectrical repairs or additions required.] officers have exercised their ME]Plumbing repairs or additions 3.❑ I am a homeowner doing all work . myself,[No workers'comp. right of exemption per MGL 12•[]Roof repairs insurance.req?tired.]t c. 152, §1(4), and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowaers.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 ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Jam an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site, information. Insurance Company Name: „/ -7 — Policy#or Self-ins.Lie.#: 1O h b 0 Expiration Date: 0 U Job Site Address: /7S_ �- 041 P��'' City/State/Zip: %l t9l�'7hV 5 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 maybe forwarded to the Office of Investi ations of the DIA for insurance covera a verification. I do hereby certify under the pains•and penalties of perjury that the information providedJabove is true and correct. Signatures/� Date Phone# 1!50 73 - LY F_? Official use only. Do not wrtte in this area, tb 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#: 4 . � I..•t-� 5(I.__✓� V/O4Jl/1➢LOIZU/ N�✓(�LClQ6df�Ll[GGG{a F 4 Board of Building)3egulatio i ns and Standards . .:Construction Supervisor.Ucense ram! f License CS 56340 Birthdate 0/29/1954 EgE ira lon 1= 12912008_ O Rest%tct�o,�00 3 C WILLIAM L SCHULN-- PO BOX 288 Vl� AlCENTERVILLE 'MA %1 Commissioner Town of Barnstable. Regulatory Services �• Thomas F. Geiler,Director - �b'°rF ���� Building Division Tom Terry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www-town.barnstable.maxs office: 5 08-862-403 8 Fax: 508-790-62.3 0 Property Owner Must _ Complete and Sign.This Section If UsingABuilder I as Owner of the subject property hereby authorize ���/�� h„i .r to act on my behalf, in all matters relative to work authorized by this building permita plication for • ��f�(��-f �. Wit..( ram-`. 6 �(p a � I (Address of Job) 4�naturNf Owner . Date 19�c1 (-(. L . print Name a--2 Q:FoP MS:0WNFrRPERMISS I0N • • • • MIA= •• THE INSURANCE COMPANY OF THE STATE OF PENNSYLVANIA 75190-0000 WC 683-89730 13889 -- -----------------=013-82-0507-00 PENNSYLVANIA SCHULZX 288 BUILDING COMPANY LLC P 0 BOX �� Member Companies of 'CENTERVI LLE, MA 02632-0000 American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 ' I.D# •. PMC INS AGENCY INC WORKERS COMPENSATION AND EMPLOYERS 50 CABOT STREET LIABILITY POLICY INFORMATION PAGE PO BOX 920179 N ED A 024 2-0002 INSURED IS PREVIOUS POLICY NUMBER LIMITED LIABILITY COMPANY RENEWAL 008940748 OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - wc9go610 REM 2 POLICY PERIOD 12:01 A.M.standard time at the Insured's mailing address FROM 05/1 1/07 TO 05/1 1/08 REM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA 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 $ 500,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ Soo 1 000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed hero; AK AL AR AZ CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME MI MN MOMS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI REM 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. Estimated Total Rate Per Estimated Remuneraflon Premium Classifications Code Number ❑ ❑ muneral on X Annual 3 Year N Annual 3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES = $562 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $284 MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $1 3,82 3 It Indicated_below, interim adjustments of premium shall be made: Semi-Annually Quarterly Monthly DEPOSIT PREMIUM ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 03/24/07 PARSIPPANY 82 Issue Date Issuing Office Authorized Represent ive WC 00 00 01 M967 INSURED'S COPY GeJ�iG L s f�x`1 / -/,'sT �,'-14--1G fl ; UIV17- . ro PADs - rour, 0 Vil CahWdn-„ram/14Y�'1 f t Application number.... b 9 Date Issued.....1. II .�.1.0.1a.......................................... saxwsra ts.s AS& `e�' Building Inspectors Initials.... ........................... Map/ParceLZ y.4.d�..l........................................ TOWN OF BA STABLE EXPEDITED PERMIT APPLICATION: ' ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 77r Wn<t MgmSt an If 14 5 NUMBER STREET VIL AGE Owner's Name: Phone Number ,S0 8--77to 3 6 2 7 Email Address: - Cell Phone Number Project cost$ �o�q Check one Residential - Commercial OWNER'S AUTHORIZATION 0 As owner of the above property I hereby authorize C to make application for a building permit in accordance with 780 CMR o f � � Q Date: o z Owner Signature: �- v� �o m TYPE GE WORK n � Siding Windows (no header change)# ' Insulation/Weat1i zation Doors(no header change)# Commercial Doors require aq�inspelor'kieview f shingles) � not applying more than 1 layer o gl ) Roof ( Construction Debris will be going to Sle ,► .�,p s CONTRACTOR'S INFORMATION Contractor's name � 'd�P�1 ( Mn O 1' S IMP �n-�"� L L"C Home Improvement Contractors Registration(if applicable)'# 114&5 8 (attach copy) Construction Supervisor's License# 1 l O—7 (attach copy) Email of Contractor Phone number i_s o o_3,/j._L L 1 I ALL PROPERTIES THAT HAVE STRUCTURES OVE 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATIONNUMBER............................................................ *For Tents Only. * Date Tent(s)will be erected Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one:this event is a:for profit non-profit event Check one:Food served Yes No Flame Spread Sheet of each tent must be attached.Provide a site plan with the location(s) of each tent I,food is being served at your event please obtain a Health Department approval between the hoops of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles:front back - left side right side HOMEOWNEWS LICENSE EXENTTION Homeowner's Name: Telephone Number Cell or Work number I understand easy responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 C R the Massachusetts State Building Code. I understand M the construction.inspection procedures,specific inspections and documentation required by780 CMR and the Town of Barnstable. y, Signature Date 1AP�DL��,A T'S SIGNATURE Date �� G Signature All pe It applications are subject to a building official's approval prior to issuance Page 2 of 12 MA Reg#146589 ' CT Reg#0605216 . 'A f �4 n Federal ID# 20-2625129 Window %Door Contract Customer Information Roger Green (508) 776-3627 O Date: 09/27/2019 775 West Main Street Unit 14 roger4g2@comcast.net Rep: Jason Santos Hyannis MA 02601 Office# 800-242-9974 Location Agreement NEWPRO hereby agrees that it will, for the consideration hereinafter mentioned, furnish all labor and material necessary to install the goods purchased,by Owner in,accordance with the terms described on the following pages of this agreement (collectively, this "Agreement") at the premises located at: 775 West Main Street Unit 14 Hyannis MA 02601 Windows Being Installed: 1 Doors Being Installed: 1 Window Details - Location: Master Bedroom Series: Ecomax Double Hung Interior Color: White Screen Type: 1/2 Exterior Color: White Grid Pattern: None Hardware Finish: White Grid Type: None Additional Labor: (Conversion) Glass Options: None Endure 6512 Endure 2-Lite Patio Door ` -Standard Size:72"x 80" 'l -Unit Size:70 7/8"x 79 1/2" Quantity -Left Hand Operable-Left Door Active (OSLI) l f -Euro White Inside/Outside i -Aeris/Endure White Multi-Point Mortised Handle l with Keylock -Assign a Random Key Number �_ # -Top Hung Screen with BetterVue Screen Mesh -Fully Assembled Unit 5745425 -Accuvent Multi-Venting System (White) -Snow Mist White Poplar Colonial 2 1/2"Casing. -'Glass for Entire Unit:.- ComforTech TLA Inside View Outside View. -Double Strength Glass (Tempered) Door Location 4« -� Office /Bedroom Window Capping Type Standard Capping Capping Texture PVC Capping Color Aspen White 27243 Additional Details Newpro will remove any demoed or installation debris from the property in relation to this contract. All promotions were applied at the time of purchase and can not be combined with any future offers. Discounts 0 ZZZZZZZ 4 Z Z Zhis-sp lly left blank LeapToDigitalxom 1.5.0 w { Page Senior Discount Applied Payment ' Total Price: $6,659 Deposit $0 Due Upon Completion ,$6,659 Payment Method finance Estimated Start&Completion Dates Estimated Start Date 11/28/2019 Estimated Completion.Date 11/29/2019 Customer understands that these are estimated dates andwill be contacted to schedule actual date. hisspace�intenfiona ty lef.�4blank • I LeapToDigital.com 1.5.0 ' Page 12 of 12 Terms and Conditions Owner has read and agrees to the terms and conditions of this Agreement. Owner specifically agrees to the (1) Total Cash Price; (2) work being performed; and (3) work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two (2) copies of a cancellation form explaining this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. YOU THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY OF THIS TRANSACTION. SEE THE ACCOMPANYING NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. The undersigned gives NEWPRO permission to debit their checking/savings account, or process a credit card transaction, for the deposit amount indicated on or after the contract date. Subsequent payments, such as start payments, or completion payments will remain in effect until I cancel it in writing, and agree to notify NEWPRO of alternate payment intentions. If the above noted payment dates fall on a weekend or holiday, 1 understand that the payments may be executed on the next business day. For ACH debits to my checking/savings account, I understand that because these are electronic transactions, these funds may be withdrawn from my account as soon as the above noted periodic transaction dates. In the case of an ACH Transaction being rejected for Non Sufficient Funds (NSF) I understand that NEWPRO may at its discretion attempt to process the charge again within 30 days. I acknowledge that the origination of ACH transactions to my account must comply with the provisions of U.S. law. I certify that I am an authorized user of this credit card/bank account and will not dispute the scheduled transactions with my bank or credit card company; provided the transactions correspond to the terms indicated in this authorization form. a Roger Green 09/27/2019 Date r f r Jason Santos 09/27/2019 ' Date - , i his s ace 'ntent-ional:y left.. `Iank LeapToDigital.com 1.5.0 t i 4 u mein =1 1,644 �s ;. :!` c 4 xMi t{-� �. r- .��� Ala. a a x G s ' tl s p r THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINALS) I M ^C&L DATA A f ne,- p j! L i 71 -Sarrl58 �S ij Jme im,rico Ra' Type:., _S;s.pcierni_p, ::-aCc, -agist rn iion: 148589 Elcpirwirin: '-D-5,10d,"2102 1 25 CEDAR ST. INOGURN, MA U-301 'Jodate Addrass and 73rurn—ird. 77' Office of Consumer Affairs 3 ausiness Regulation HCIVIE IMPROVEMENT CONTRACTOR Registration;valid tGr individual use only TYPE.--SUOviernent Card before the expiration-date. If found return to: RealsMa6ort Expiration Office of gonsumer Affairs and 3usiness Regulation 05004/2921 lQ00'#A,,-*ington Street • Suite Ill ftstdn,�. A 42113 q ,,EFFIREY CONISIORS�___ 26CEDAP. ST. 'tV:)I3(j-RN.MA 801 Undersecmrar/ #iot valid without Signaturs Departuntent of Public Saf2ry Sciard of Building Pcgularions and Standards License: CS-110763 JEFFREY CONNORS - 64 OLD FIELDS ROAD SOUTH BERWICK ME 03908 05105/2020 Jr .i_ -a.. �'�.r�4-'('1L�,�+n. ♦ .. Fes' - i ��1 r�'i l 1-. �y edl� � 3r � v 1 WIM kk lr• rive S, f �lN G T ? . si .1 a ✓'�, n"2���'�.�4?��yy'' 1�}t' i fit. _ _ �-L 5'�y�ii -f5•?f ".r'p�7h�{{7r r f�.Ca�f Nr�1/'� �f r - r i rerl`rrfb5 4 1�,i: • f I r _� L t `., I S >Tr' _ _ r �°c'��_�J s-++.��'r+`r /''%�•��:;��, %^=-off. _+ a' r 'i. -5,...! ` � I 't''- ,:iti�E" > c t�✓r� / , si. - ��r;'' rc, - <9X •S-e- .;r.-�"��-�,ssti�.._'r.� l � Ss--.. ��pa;':;s...�. �_- r,� M ,'1 y. r ! ��f ?,�_-j[^•r• ,, fii'�s wry .�hr �'� Fl�' f K �` `.k,i-- 7Y r�� s. J!' Il i C Y��r f•ly. Y CC '( ',r t 'R� - t . ,�, r f ._� t 4� ,4� r a ?� 'dr „tis,;}7 r,'—.! t A�_�r r,.. ,..3 �.�- •r' }. f.. 1 S S`t.zl "l{ .1'r+ J -' {cC"T•+.f�J� �' 1 �' i r' �G1 1 c _a'�'.3� j�.�,','�,'''� r � ,�{. �r :�{�r �.- ..7 . _ iN 1 i fir,.r5`/' •• -r. k The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,PM 02114-2017 www.mass.gov/dia lVorkers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Ak, r®r0 e�et^at n (_L Address: . r City/State/Zip: 0 �,� /✓� D l 0 [ Phone #:_ /—&0 & -3 L4 - 2 2- Are you n employer?Check the appropriate box: F7TNew oject(required):1. [am a employerwithZ. 'employees(full and/or part-time).' construction2.❑I am a sole proprietor or partnership and have no employees workingfor me inany capacity.[No workers'comp.insurance required.] Remodeling3.a I am a homeowner doing all work myself.[No workers'camp.insurance required.]} • ❑Demolition 4. I am a homeowner and will be hiring contractors to conduct all work on m roe I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs ar additions proprietors with no employees. 5.0[am a general contractor and I have hired the sub-contractors listed on the attached sheet. •12. Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.- 13.❑Roof repairssf��-�'' 1 J 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 1`.W Otherwf jl f W $ door 1 52.E$1(4),and we have no employees.[No workers'comp_insurance required.] � }Any applicant that checks box 91 must also filI out the section below showing their workers'compensation policy information. 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'cos nation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: L)EIri02?` 7 -7 Expiration Dater ! Z� Job Site Address: 776- 1 0, 1 q �jVl�" 1 / City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy a tuber and expiratiotl'date). Failure to secure coverage as required ugder MOM c. 152,§25A is a criminal violation punishable by a fine up to S 1,500.00 and/or one-year impriso ment,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 viol r.A y of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificatio . I do hereby certify[nd t pains and penalties ofperjury that the information provided ab ve is true and correct. Sienature: Date: d/ Phone#- —g q q- 2 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#: �oA = a� 1 11, ` 0 _I SU� F ) I U, AA_ IE , nu00r^r,^rl 11121, THIS CE,RTIFIC.=LT_IS ISSUL=:7 AS'A NLATTER OF INFOR(VIrATION ONLY AMD COAia_,RS •10 RIGHTS UPON-i HE CEIBTIFIC;ITE HOLDER.THIS I C_RTIFIC,AT_DOES MOT.A FI R0j)ATIVELY OR PIEGATIVELV AiCIEND, EXTEND OR,AL TcR THE COVERAGE AFFORDED 3`(THE POLICIES BELOW. THIS CERTIFICATC OF INSUFLAi ICE DOES NOT CONSTITUTE A CD-'AT-.-PACT 3ET7ll1•_==;1I THE ISSUING IIAISURER(S),.AUTHORIZED I + REPRESEN IATIV'E OR?RODUC2R,AiUD THE CERTIFICATE MOLDER. iIMPOrRTANT: 11 the certificate holder is an ADDITiOhIAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or 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 ce;-tificate does not comer right3 to the certificate holder in lieu of such andol'sement(3). PRODUCER NAME Nlellssa Pflug blackintire Insurance Agency Inc H NN Ext: (508)366-8161 ac,No: (508)366-5202 11 West lMain Street g00RIESs: melissap@macl(intire.com INSURERIS)AFFORDING COVERAGE NAIC II Westborough MA 01581-1931 INSURERA: Sentry Insurance INSURED INSURERS: Middlesex Insurance CO Newpro Operating LLC INSURER c: Guard Insurance Group 26 Cedar St. INSURER 0: Colony Insurance Co INSURER E: Woburn MA 01801 INSURER F: COVERAGES CERTIFICATE NUMBER: 19-20 (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. I�TR TYPE OF INSURANCE INSD WVD POLICY NUMBER M jAUULjbUdKj MIIOODYIYYFYY MMIOD/YYYY LIMITS x COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 1,000,000 CLAIMS.MADE OCCUR .. , PREMISES(Ea occurrence - 500,000 MED EXP(Any one person) 3 15,000 A I A0092403003 12/31/2018 12/31i2019 PERSONAL 3AOVINJURY 5 1.000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 3,000,000 POLICY jRa 17 LOC I PRODUCTS-CCMPICPAGG 5 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 5 1.000,000 Ea accident ANY AUTO BODILY INJURY(Per person) S g OWNED SCHEDULED A0092403004 12131/201a 12/31/2019 BODILY INJURY(Per accident) S AUTOS ON .AUTOS H HIRED �/ NON-OWNED PROPERTY DAMAGE AUTOS ONLY X .AUTOS ONLY Per accident) Uninsured motorist BI is 250.000 X UMBRELLA LIAR OCCUR EACH OCCURRENCE S 5,000.000 A EXCESS UAB HCLAIMS-MADE A0092403006 12/31/2018 12/31/2019 AGGREGATE I is 5.000,000 OED X RETENTIONS 0 S WORKERS COMPENSATION PER CRH- AND EMPLOYERS'LIABILITY - TATUTE R C YIN ANY PR /MEMBER EXCLUDED.ECUTIVE ❑ NIA NEWCO28778 05/01/2019 05/01/2020 E.L EACH ACCIDENT 3 500,000 OFF (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE 5 SOO,OOD It yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT a" Limit $1,000.000 Pollution Liability D CSP304242 12131/2018 12/31/2019 Aggregate $2,000,000 DED $5,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Addltlonal Remarks Schedule,rray be attached It more space Is required) , CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE'MILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE MA 01504 ry j//ri ©1988-2015 ACORD CORPORATION. ,All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of;ACORD TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Maps_ Y9/1 y4,� Parcel j/h iT d- Application# 260 Health Division Conservation Division Permit# Tax Collector Date Issued 42 (� Treasurer Application Fee w Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board P Historic-OKH Preservation/Hyannis Project Street Address 60. A4 4X Village A�XAAt IPJ Owner "0QE it) A-6 O ell C Address Telephone Permit Request "0,6&T-e Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation I + Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new I Number of Bedrooms: existing new f ,, 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 tove: ��Yes O No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑ex' t C-ing ❑new ye v p.. Attached garage:❑existing Elnew size Shed:❑existing ❑new size Other: �'► Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use - - - BUILDER INFORMATION r Name �I"> Clk G i'J l��s Vy� Telephone Number 5-o U ~, r� q 1 Address/e g Wa- r O m License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO ^6 SIGNATURE DATE 442p �� a 2 i FOR OFFICIAL USE ONLY f PERMIT NO. DATE ISSUED s , 3 MAP/PARCEL NO. P a - ADDRESS VILLAGE OWNER r DATE OF INSPECTION: 4 FOUNDATION i FRAME INSULATION I FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department f Industrial Accidents o _ Office of Investigations a d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insuralnce.Affdavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): //z Address: 16 1,00 Oh 1 ' City/State/Zi /✓/ Phone.#:moo 7!!9/y - Are you employer? Check the appropriate box: Type of project(required):. 1.Uiof am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction . . employees (full and/or part-time).* have hired the sub-contractors 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' Y P tY• �' word.] ,9. ❑Building addition [No workers' comp.insurance comp.insurance. re .] 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 MG 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: ��� Policy#or Self-ins.Lic.#: LUC- ��`��`C2 0� O 1f 1 Expiration Date: Job Site Address: 7� �?/!, /!?cS / ' City/State/Zip: 7IV4 /�,G 4d �ti1 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi ander the pains d penalti s of perjury that the information provided above is true and correct t ` Si mature: Phone#:. dO 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#: I Information and Instructions g 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 impl ied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the' dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §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, §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 insinlrance 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-contractor(s)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 sure.to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all-locations 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 to any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Commonwealth of Massachusetts Deparbnent of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel.#617-727-4900 ext 4.06 or 1-877-MASSAFE Revised 11-22-06 Fax 4 617-727-7749 www.mass.go-v/dia I"E +a• 'Town of Barnstable Regulatory Services '$ Thomas F.CTeiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstzble.ma.us Office: 508-862-4038 Tax: 50.8-790-62.3 0 Property Owner Must Complete and Sign.This Section If Using A Builder I, /?/1�✓��lz'� ��D��i c. ,as Owner of the subject property hereby authorize ���,�- p to act on my behalf, is all matters relati7e to work authorized bythis building permit application for. , (Address of Job) Signature of Owner Date .;rk)pV;P,- 4 A6v`r- Print Name OFORi`�IS:0 vTN-�RPbRMI55I0N ' I 05-i1-0 003:4 pm rrcm-AIG +073 331 9509 T-392 P 001/002 F-e49 � Y -. ___�..�q.•-"-Ord---.+.o-.--- � ' P oc ul m` m , THIS CERTIFICAT€. IS -� I E --- _ I ( loSJ�C�AS A SAT TER GF fhtiF(3R�M ION I ONLY AND CONFERS I CJ RIGHTS UPON THE CERTIFICATE Clde Cape Cod ins Agcy Inc I HOLDER. THIS CERTIFICATE DOES NOT/OMEhIE? FStT N 296 WIrder Stroot j ALTER THE COVERAGE AFFORDED BY TH4 POLiCtES BELOW I�Iyannis,%%02801 { coAAPANIES AFFORD—lN (csIURANCE ' 1N51JREp— " --------.o___ _ COMPANY,A GRANITE STATE INSURANCE COMPANY i� Villani Conslimction Inc + I Hyannisport, MA0.2b,2- 0UU TNIS IS TO CERTIFY-rH;AT LICIES OF INSURAN..E LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASOVE FOR THE POLICY PERW INDICATEC?,NOT WITHSTANDING MY REOUIREME NT,TERM OR(:ONDITII?N Of ANY CC3NTRNCT OR i7THER I UaCUMEPVT 4M1t1TH REdi)ec T TO WHICh!'PHIS rEFtTIFICATE wky BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE I POLICIES DFSCRf6FD hFRE!N 15 SUBJECT TO ALL THE TERMS,EXC! ISIONS AND CONDITIONS OF SUCH POLICIESI LIMITS SHOWN I MAY HAVE,4FeN REDUCE[)BY PAID CLAIMS. LTR f TYPE OF IN iutlµtlCE cy'NUNfle rPbIIC Y 'f.FFECTIVE LATE anal IwY�xPiw,aTIGN naTF A Of kERSC MPEN9.4T'IOk -- _..____�_ _,_jaLIV,.«._._. NO Ennl"!_OYERB'LV LOLTY7-7 I —��,�,--- . + C PROPRICTOA! I I LIMITS �CIFFIC06 ARE.; PAHTNLfZuiExE'CUTNE �----�- ---""'"��----T- I�__ I r cL o EXCL a 235a620 4101/2007 �1f:1120Ca TATuroRv Lmr5 _. +Ccveraga AapUec it N1R Gpera!ICne Dmy_ -�-��_---"` { EACH ACCIDENT �HISC.lGEPOLICYLU IT :iDii,0001 IEiE:SGrlli`TIO U bI✓OFE::I AIIOM1IStvEHICLESISPEc1Al�!fEIUdS _ -- al>r�+s�,�rq�H ElnplovsE �_�__._ _ $100 00 I i CEFlT'IFICATE FIOLCEFt _ ;CANCELLATION TOWN 0',z DIVISI OiNj E SHOULD ANY OF THE ABOVE OrsCRIBEO POLICIEB U!CnNCELLEI fjFf7a I:THE BUILDING I�I1/ISI�Iv UPRATION DATE THE(a,"F,Y1E ISSUING COMPANY V.11'L 6?JD AYDw TO NIM.1S 20n MAIN 5T I DAYS WR!TT$!d ygQY!CE-rU THE C`<PTIFIGATF HOLDER NAME(]TO THE'ILF_FT,NUT HYANNIS, MA 02581 FAILURE 10 MAIL 61CH N:7TICE$HA!_J tMF'GSE'40llKI0IxrIQN OR LIABILITY OF: ANY KIND UPON THI:COMPANY,I'r q AQEHT S OR REPRESENTATIVE8. AUTHoR,1ZED REPRESENTATIVE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map y�C)�/gL�l Parcel yi7 rT' 6'4&7 e Application# e;?W7G 35q Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ,� ��� li� S'7_7 Village ��Y���✓� Owner 6/2 e e,, Address Telephone Permit Request Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Z ✓"� 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 Hight ay: ❑ s ]No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) j Number of Baths: Full:existing new Half:existing new, Number of Bedrooms: existing new c� Total Room Count(not including baths):existing new First Floor Room ount Heat Type and Fuel: ❑1 Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If,yes, site plan review# Current Use Proposed Use BUILDER INFORMATION n Named Gf a'cl //���, Telephone Number `�� ' J `Address Ala G 4, • License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO v u SIGNATURE v DATE s 3 ' FOR OFFICIAL USE ONLY , y i PERMIT NO. DATE ISSUED i MAP/PARCEL NO. 5 S j}j 1 4 ' ' ADDRESS VILLAGE OWNER a DATE OF INSPECTION: FOUNDATION 7 FRAME f INSULATION FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ` DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents _ Office of Investigations ' d "• 600 Washington Street Boston,MA 02111 ' ov/dia www.mass. � M V g Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lebbly Name(Business/Organizationflndividual): Z I Zza 4 h S Address: Gor g �7 4l �' cS •L �- City/State/Zip: Phone 3_0 Are you employer? Check the appropriate bog: Type of project(required):. 1. ' am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction . employees (full and/or part-time).* have hired the sub-contractors 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' Y P t5'• �• 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 l l.❑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: Policy#or Self-ins.Lic.#: UIC ��3,S� lo� t��l Expiration Date: Job Site Address: 5- OyL- City/State/Zip: A d, cr l xlb( 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/nndd penalties of perjury that the information provided above is true and correct Signature: Phone#: LOther only. Do not write in this area,to be completed by city or town o�cciai n: Permit/License# hority(circle one): Elealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector I I son: Phone#: Information 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." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two.or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §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, §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-contiactoi(s)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 sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all-locations 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 to any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The,Commonwealth ofMassaohusetts Department of Infttrial Moidents .?fee of Investigations 600 Washington Street Boston, MA 02111 Tel. 4 617-727-4900 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia p.` Town of Barnstable. Regulatory Services 9BAMSTABLE,$ Thomas F.Geller,Director �ArE%9. A, Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 .. Fax: 508-790-62-30 Property Owner Must Complete and Sign This Section If Using A Builder L , as Owner of the subject property hereby authorize �/11b",i 6 o 1 to act on my behalf, in all matters relative to work authorized by this building permit application for: . (Address of Job) Signature of Owner Date Print Name i Q FO RM S:O WNERP ERM IS S ION 05-H-07 03:43pm rrcm-AIG +973 331 $599 T-362 P.001/002 F-04.9 77 7— PhOOL'CER —�-- Tp�iS CgEARryryT#FICATE iS ASS C�A A rU}A�TEQ GF Ih1FC RMATI NV I GNLY AN6i IJ 1 ~ �' 1 � . �7IVFE OPde Cape God Ins A c Inc � RS NL)F�6LaH.S llPlCid TN-,E CEQ�'3"lFICATE 9 FCaLPER. TF11S CEI:TIFIIwATE C}C0E•S 296 Winter Stral�t NOT AMEND, EXTEND�lR I ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW I Hyannis,IlOA tJ2B01 — COMPANIE AFFORD IN6 tPQS4:N_'OaN E COMPANY A GRANITE;:STATE INSURANCE COMPANY INSURED Villarll ConsIsuction Inc Po Box a92 Hyannisport,MAb'28.2•n,00U I PHIS f5 TO'Ci:FiTIFY THAT THE POLICIES OF INSURANCE RISTED BELOW HAVE BEEN MSUED TO THE INSURED NAMED ABOVE FOR I THE POLICY PER=INDICATEC?,NOT WITHSTANDING ANY REQUIREMENT,TERM OR CONDITION Or ANY CONTRACT OR OTHER i DOCUME:N'r WITH RMSPE..r, TO m llChl'PHIS CERY-IFICATE MAY BE ISSUED OFF MAY PERTAIN,THE INSURANCE AFFORDED THE I i POLICIES DESCRIE F-D HEREIN iS SUBJECT TO ALL THE TF-kms,EXCLUSIONS AND CONDIflONS OF S-UC61 POLICIES',Umn SI-IoWN I MAY HAVE BEEN REDUC'E0 BY PAI0 CLAIMS. LTR TVR!OF IN su}�ANCE POt.It,Y NUMbe PODGY f3FFE0Tiy6 CATS PgCpUY ExfllR.isY10N � - _J A ORz;ER5 c3MP R8,ai•IOt; I __— _ ,.._ __�.m� --"®-EX . NO ENIRLOYERS'LA010Y NO PROPRILTOat i LNAflN�°,3' f PARTrd1_R6,SXECUTNF. f — - ---r ICFFICER&ARE; --- I NK-L 0 E�,c�a 235 62I: ! lLl'1i2r b l r�1(; 7ATidTORV 63tA7Ts j il—Eft t covap AppIW 4c MA Gpara ons Onry. — CAGH Af=Q6N'T $ I Ut1,13001 1ISE GE POLICY CIIAIT I CERT'QFICAT�ATF ate= . OLDER �CANCELLATIONd -- " I TOWN)OF BARNSTABLE i SHOULD We OF THE AOt7VE Or_5C,91BED PULICIGli£1E:CANCE'LI,CD BEFORE THE BUILDING DIVISION GYPIRATION DATE THERkOF,TKE ISSUING COMPANY wi-,I_a 4D6 WOR TO MAr,an, 20f3 MAIN ST [PAYS WRITTpN illor ETO T4E CETiTIFICATF li"DER NAma TO THE LEF"r,WT W rAheNIS IViA 02601 FAILURE TO MAIL SUCH NOTICE SHA;L IMPOSE NO QRLIOATIM4'OR LlRBILITY OF .3MY KING L1P[tN THE CQNiPANY,I`:t Au'1dNT3 OFt'HePREBCrdTATIVES.— AUTHORIZED REPRESENTATIVE i YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: O Lj Fill i please: p APPLICANT'S YOUR NAME/S: Gv BUSINESS -YOUR HOME ADDRESS: ,O V- w. jo`b—Sa 1- Sl Ir A A 1. Ale TELEPHONE # Home Telephone Number - - NAME-OF CORPORATION. NAME;OF VIEW BUSINESS`.L t L k� S. "u0i ". TYPE OF BUSINESS o .o it CEJ IS'THIS:A HOME OCCUPATION? NO C7. ,. ADDRESS OF`BUSINESS` MAP/PARCEL NUMBE (Assessing) w M fil u S7-#4 ftyi1 w.v►5 ,M When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the.Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM ISSIO ER'S OF ICE This individu I_ n infor d f a y p rmit requirements that pertain to this type of busines MUST COMPLY WITH HOME OCCUPATION `Ayt orize i ** RULES AND REGULATIONS. FAILURE TO COMMENT COMPLY MAY RESULT IN FINES. S► 2. BOARD O HEALTH This individual has been informed of the permit requirements that pertain.to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature COMMENTS: Town of Barnstable THE Regulatory Services �,,, o Richard V.Scali,Director Building Division MAM $ Tom Perry,Building Commissioner 1639. 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: D HOME OCCUPATION REGISTRATION -------- Date:-Name: Z U(-1 AVA L14-(/�- Phone#: SD3 F-O,p- -7 7/-- Address: M B r iU S 1 # Village: ti��/til Name of Business: L 1 -FrL& t&! 5TU 191-0 Type of Business: %t1/1 CC-5 Map/Lot:cl?I l \ 1 � 1 . INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution.. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic'will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. , • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included: • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant:aLez X Date: ©,f- a 3- ^ y Homeoc.doc Rev.103113 TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL`'ID 249 049 20A CEOBASE ID 1573E ADDRESS 775 WEST MAIN STREET PHONE HYANNIS ZIP LOT UNIT 1 BLOCK LOT SIZE I' DBA DEVELOPMENT DISTRICT HY PERMIT. { 36531 DESCRIPTION OCCUPANCY FOR DECKS #65396 PERMIT TYPE BCOCAD TITLE OCCUPANCY/COMMERCIAL ADD. cONTRACTORs Department of ARCHITECT Regulatory Services TOTAL FEES: $75.00 BONS? $o 00 pU� CONSTRUCTION COSH'S $.00 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE 0 * BnMSTABLE, 039. QED MP'� BUILDING DIVIr IO' , BY o DATE ISSUED 08/29/2005 EXPIRATION DATE 4 THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- J CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ly ALLEY 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 CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE a 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- PERMITS ARE REQUIRED FOR (READY TO LATH). PANCY IS REQUIRED, SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS E 2 2 2 s 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL `I WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. BUILD. ING PERMIT Jui 07 05 09:27a Rimington (5C8) 428-7167 p.1 Rainey Alex Ranney (508)733-4683 & Rmi ington Patrick Rimington (508)290-7074 Custom Carpentry P.O. Box 816, Marstons Mills, Ma 02648 i License#CS-088595 Workmen's Compensation#WC-828-16-40 Home Improvement Registration# 144752 Fax too Barnstable BuildingDepartment Attn: Sherry (508) 790-6230 From: Alex Ranney Fax (508) 428-7167 t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � raycl Ma Parcel p Application# Health Division Conservation Division Permit# Tax Collector Date Issued d r0 Treasurer Application Fee Do Planning Dept. Permit Fee gel Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis ` Project Street Address 775 W 5���1 Village Owner rrTne-e Kx O r 1 e Ccwp D4 4sc— Address Telephone Permit Request R e n°1oJQ 9f e. p DACE- O fJ e rr ! Fo o- D E56 ,J Q I tDENTiLAL 512E t ,,-T�eL.Ir. AS 0P-11a1 MAL_ DF-c-k SSt2JILE 5 f O-+fL C:o and- U nl 1 s . Peck ID b�_, coua&,AgLn oe RrATfD k6 . Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation + 101000. Construction Type ?T* l/Joo ij RA We- Lot Size Grandfathered: ❑Yes ❑No If yes,attach supporting documentation. Dwelling Type: Single Family ❑ Two.Family ❑ Multi-Family(#units) S Age of Existing Structure 2 > enR S Historic House: ❑Yes $No On Old King's Highway: ❑Yes %54 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 mew ' d Number of Bedrooms: existing new CI) _Z Total Room Count(not including baths):existing new First Floor m Coug' Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wo /coal stove: CRes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use 6�i t"J 0 Proposed Use COO)DO BUILDER INFORMATION Name Wit-4-119 m :Sc��U 12 L Telephone Number Address ��J (_' 2cxtEg ::�2 T91�_'&77 — License# 03 3 L4 Home Improvement Contractor# Worker's Compensation# 4) G 6 77 0 - 3V ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO CynTTc-�,I UE. Jt C .SIGNATURE DATE I D Z 2--0 FOR OFFICIAL USE ONLY i o PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE r OWNER A � r DATE OF INSPECTION: s FOUNDATION FRAME °�—C!Fv P �_ h F' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 3• k PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT t . ASSOCIATION PLAN NO. ' k } t r - The Commonwealth of Massachusetts Department of Industrial Accidents .>1 Office of Investigations 600 Washington Street Boston,MA 02111 rr www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): %A L l✓(el I L b 1 Q(; ��d Address: 6:� C fZCk.,eEF. -"5TR,t=r City/State/Zip: V1F�/JTFAJ1LLr Phone #: ` 8� �'J7 � - �ElJIt Are you an employer?Check the appropriate box: Type of project(required): 1.:Z I am a employer with 2- 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 1 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑Plumbing repairs or additions . myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.JZ Other 9$ R. �-t�. 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 hue 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Ame,e-16Aq 41 h-►.e_ ��Ljr�yl G Lr Policy#or Self-ins.Lic.#: �j�o ` 3 ` q g Expiration Date: LJ Job Site Address: 7 -7 S_ p). V1'11411J l rl onkm"3 City/State/Zip: O Leo 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. Sim ature: -7W'0 Date: 10 2-2- 06, Phone#: 77 C - 8604 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 i Contact Person: Phone#: Information and Instructions ' n Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §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, §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 ti Please be sure that the affidavit is complete and printed legibly. The Department has provided a ipace at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need'only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations 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 to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts . Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-$.7 MASSAFE Fax 4 617-727-7749 Revised 5-26-05 xnass.gov/dia F AMERICAN HOME ASSURANCE COMPANY 75190-0000 WC 894-07-48 13781 ------------------ -------------------------- 013-82-05o6-oo NEW YORK 11 a SCHULZE BUILDING COMPANY LLC P 0 BOX 288 Member Companies of CENTERVI LLE, MA 02632-0000 rim American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I.D# MA I PMC INSURANCE AGENCY INC. WORKERS COMPENSATION AND EMPLOYERS 50 CABOT STREET LIABILITY POLICY INFORMATION PAGE PO BOX 920179 NEEDHAM MA 024 2-0002 INSURED IS I PREVIOUS POLICY NUMBER LIMITED LIABILITY COMPANY IRENEWAL 006701398 OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - wc9go6i0 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the Insured's mailing address FROM 05/1 1/06 TO 05/1 1/07 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA 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: a h Bodily Injury by Accident $ 500,000 each accident Bodily Injury by Disease $ SOO.000 policy limit Bodily Injury by Disease $ 1300,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: AK AL AR AZ CO CT DC DE FL GA, HI IA ID. IL IN KS KY LA MD ME MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN 'TX UT VA. VT WI 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. Estimated Total Rate Per Estimated Remuneration Premium Classifications Code Number $100 OF Re- Annual ❑3 Year muneration Annual ❑3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 TAXES/ASSESSMENTS/SURCHARGES 5590 EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $284 MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $1 3,9 7 If indicated below,interim adjustments of premium shall.be made: Semi-Annually 11 Quarterly El Monthly DEPOSIT PREMIUM ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE .- WC990612 1 i [:05/01/06 PARSIPPANY 82 Date Issuing Office Authorized Representative WC 00 00 01 INSURED'© f ;!f� ,�;_ ✓die�arrr!nza7eurea�c p�,/�aaaac, ��-,� s BOARD OF BUIL6I14'C4RECULA�TI�(�t�^ 11{ c. License CONfiSTRUCTI,ON SUPERUt 8N "1' Numbed CS 056340 Bi a 1-954 tl / EfxOi2 A0;6 Tr.no 3725.Q; �Ri` Qd—etlrw j.I j WILLIAML SCH 51,, f` PO Box 2a-8 r 9T i CENT.EIkVILLE, MA 0363 - Commissiortei �.__. Board of Building Regulations and Standards HOME IMfPROVEMENT CONTRACTOR Registratron 12049A rr�,PSPLra--! E-�19/2007 r TYP BRA SCHULZE BUIL N" = WILLIAM SCHUL'-EE efJ YY\k J PO BOX 288/65 CRf�ir4� S-1' CENTERVI'LLE. MA 02632 Administrator °Ft► ►o,;ti Town of Barnstable Regulatory Services B"NSMBM + o MAN, Thomas F. Geiler,Director �A i6;9. �f ru►'�p Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 :e: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �C)"Q UtL-jLA , as Owner of the subject property, hereby authorize (it_)l LG 1 A)vI j,4 to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) 9 ignature of Owner Date J0 V) Print Name QTORMSDVVNMRPERMISSION _ I or i e . C Wd 'i "[Iltt �j�/r./N�7 - _ Q� o one t ( 13�T .cc1v UVI S T lip? )y 1.171 1*1 r.,fu ysg �sTiv�, - - _ aps mat- OOL, � --.-__--- __--- ------.------------.._----�--__._ -_. 7 reer /,"1114 E'1 L1 Ll li. s ro `jl /3C-7c,✓CCN UN/TS . i Gy Vil paa5 `ournwT 7 7 S f-rat,.�rr�is, /1//4 21F weer bpi�e� C�ah�l�n�irll1 i knl 4 R f + � ( f C F 4 g i•' C { _ 4 f� 0 Y. ' - 0 �_\ tide.. "�;� `'F•�f \.. � ti w: �� i :,, ,�� , t. }. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Permit# _ Health Division `7 Z u �ti.�, lever Date Issued _ Conservation Division �J ( Fee Tax Collector Application Fee Treasurer KID Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board A3 r AMNT Historic-OKH Preservation/Hyannis Project Street Address 775� Ldefr MAlt( C1 Village =5 Owner Address 3oX oo mp Telephone (SOB) O?/07 Permit Request 4wve TW6 T�sT O6 WAf P-6f LAW, w' V-xAeA- COP"r- VP ID opq c Square feed' 1 st floor: existi'g proposed 2nd floor: existing proposed 0 Total new D Valuation 000 1.= Zoning District Flood Plain Na Groundwater Overlay A Construction'Type�o R-Z ®0 Lot Size �` �Q,:11 3•F. Grandfathered: ❑Yes ONo If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family 'D Multi-Family(#units) , Age of Existing Structure 2-3 V1, Historic House: ❑Yes 0k o On Old King's Highway: ❑Yes T(No Basement Type: iFull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 61 Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing 0 new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes QlNo If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name ROK/ E,iL Tn(ti� CuS t� _ ?33 ���3 'r' F cA Telephone Number Address License# &S'0 51 S Home Improvement Contractor# 1 yj 7,57z Worker's Compensation# W C- ALL CONSTRUCTION.DEBRIS RESULTINGFROM THIS PROJECT WILL BE TAKEN TO >VAPMf-- �J� oPR-sS Y7 SIGNATURE DATE >ti=Y 5 • FOR OFFICIAL USE ONLY l E r PERMIT NO. DATE ISSUED t MAP/PARCEL NO. ADDRESS VILLAGE OWNER a� DATE OF INSPECTION: FOUNDATION a FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL v PLUMBING: ROUGH FINAL 1 GAS: ROUGH 4.{ FINAL . f . ^ FINAL BUILDING t� .DATE CLOSED OUT ASSOCIATION PLAN NO. /: �. The Commonwealth of Massachusetts • -- - ( Department of Industrial Accidents y — 0�pgfl�sd�sd�s 600 Washington Street Boston,Mass. 02111 Workers' Co ensa on Insurance Affidavit-General Businesses ru r iii name _address: ®� city hill 5 i �-5 state• ' zip' (449 vh0ne# 7 3 3 y 6�3 work site location(full address): ❑ I am a sole proprietor and have no one Business Type: El Retail❑Restaurant/Bar/Eating Establishment orking in any capacity, ❑ ffice❑ Sales(including Real Estate,Autos etc.) [ I am an empto er with etn loyees(full& art time). U Other Co9V 1-z N`�ui+�5 am an employer p/rjo�vi�d�ing WER NEW 1011 viorkt s' co`nmp easaio�n��wformmyy�e((mplony`eAes w(orlQn/}g/po�n{�this job,a�(/ r • (4 .':•r�f1111 ' .... :. J.��M� •_"- \ V�/V a�� a .•W.�r{ 1 = j companv'name t , bone P. city: �TV' : ': S ,;. D.. �••��. _. .v-: a lnstissince.ebs•= , olio.'•# 1 '•••. I am a sole proprietor and have hired the independent contractors listed below who have the following workers' compensation polices: c6ifipany name: hone.#A insurance co. - // / com"en. riatiie:••:: � .,� •. , address :. Cl .r .. hone# s i. :,• iristirence co:011 12,40 NMI ' r' PJUMINAWE Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of eriminalpnaaltie+of a tine to$1,500.00 and/or one yearn'imprisonment as wen 25 chr9penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day againstme.I understand that p copy of this statement may be forwarded to the Office of Investigations of the DIAfor coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true an tort ct Date Signature ( Q S �ti�hC{�•(D�� Phone 73 361 3 Print name . r0frlCiRl we only do not write in this area to be completed by city or town official r town: permit(licease# ❑Building Department OLicensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department , contactperson: phone#; ❑Other 'e (revised 3egt 20M) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the.service;of another under any contract of hire,express or implied, oral or written An employer is defi&d as an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership, association or other legal entity,.employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of . another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or budding appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until- acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name, address andphone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industnal 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 listedbelow. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please Beense number which will'be used as a reference number. The affidavits maybe returned to be sure to fill in the pernn't( . the Departrnent by mail or FAX unless other arrangements have been made.- The Office of Investigations would like to thank you in advance for you coop eration and should you have any questions, please do not hesitate to give us a call. 1011 s The Department's address,telephone and fax number: The Commonwealth Of Massachusetts. Department of Industrial Accidents On of Imsagauens 600 Washington Street Boston,Ma. 02111 fax.#: (617)727-7749 phone#: (617) 727-4900 ext.406 E Town of Barnstable . � Regulatory Services WNSUBLA Thomas F.Geller,Director � Building Division Tom Perry, Building Commissioner 200 Main Street, 11yannis,MA 02601 www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section- If Using A Builder / 2 r0 G ,as @*cr of the subject property hereby authorize cayN e-.C., . to act on mybehalf, in all matters relative to work authorized bythis building permit application for: -71 S W C,S`T M pfi4) 5-179 _ 4YAA k (Address of Job) WIgnatL re of f 1 Date Print Name n.cnotdR•f1WNFRPF.RMTfiSTON Jul 07 05 09:27a Rimington (508) 428-7167 p.2 ✓�:e�n��a�uueca� o`'✓��teosuc/uae,G:: BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number CS 088595 ,.r:. Birthdate: 04/16/1971 Expires:04/16=08 Tr.no: 88595 Restricted: (A ALEXANOER M RANNEY 267 IIAEIGGS-BACKUS RO SANDWICH, MA 02563 Commissioner . ,� �1<u Pa•�ri�,w��ueus/.C>l ��..���vs:wro/ru:�et3 Board of Building Regulations and Standards HOME iMPROVEMENT CONTRACTOR Registration: 144752 Expiration: 11/212006 Type: DBA RANNEY&RIMINGTON CUSTOM 9C85 NLTE RANNEY:. 267 MEIGGS BACKUS Ra SANDWICH,MA 02563 Administrator Results Page 1 of 1 Licensed Contractor Look Up Select the search method: I License ` Maximum number of matches: 25 Enter Search terms separated by spaces. 88595 Select Search type �' AND C OR Search ' Search Results City/Town Name Type Lic. # Restriction Expiration Street State Zip RANNEY' M 267 267 SANDWICH ALEXANDER CS 88595 00 04/16/2008 EIGGS MA 02563 M BACKUS RD Total of 1 Records matched. Back to Home Page BBRS Privacy Statement I http://db.state.ma.usibbrs/contract.p1 7/7/2005 I� .I TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY 1 PARCEL-ID 249 049 20A GEOBASE ID 15786 ADDRESS 775 WEST MAIN STREET PHONE . HYANNIS ZIP - LOT UNIT 1 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 86531 DESCRIPTION OCCUPANCY FOR DECKS #85395 ; PERMIT TYPE BCOCAD TITLE OCCUPANCY/COMMERCIAL ADD. CONTRACTORS:ARCHITECTS: Department of Regulatory Services TOTAL FEES: $75.00 BOND $.00 �tNE CONSTRUCTION COSTS $.00 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE I .0-. * BARNSTABLE, • MASS. 039. FD MAC 'I 010)7 BUILDING DIV] BY V DATE ISSUED 08/29/2005 EXPIRATION DATE i TOWN OF 134 NSTABLE PAa-"EIS ID _249 049 20A GEOBASE ID 15786 ADDRESS 775 WEST MAIN STREET PHONE HYANNIS ZIP — r LOT UNIT 1 BLOCK LOT SIZE DBA � DEVELOPMENT DISTRICT HY PERMIT 85395 DESCRIPTION REPLACE 2 EXISTING DECK WkITH SAME PERMIT TYPE BREMODC TITLE COMMERCIAL ALT/CONY CONTRACTORS: RANNEY ALEXANDER M Department of ARCHITECTS: Regulatory Services TOTAL FEES: $197.20 BOND CONSTRUCTION COSTS $12,000.00 tNE 437 NONRES./NONHSKP ADD/CONY 1 PRIVATE MAM 1639. 1� { FD MPl a BUILDLNG DIsV�ISION BY DATE IS$pgt) 07/13/2005 EXPIRATION DATE `-"'~ R '� 'Q]TW�NI 03 y JByA NSSyT{ABLE PAROEA_� ID' 249 049 20A '' O��(3BASE ID 15786 ADDRESS' 775 WEST MAIN STREET" PHONE HYANNXS LIP LOT UNIT 1 BLOCK., LOT S I Z'E DBA _ °DE zAPMENT DISTRICT THY. PERMIT 85395 DESCRIPTION REPLACE 2 EXISTING DECK W ITI "SAME PERMIT -TYPE BREMODC TITLE; COMMERCIAL ALT/CONY CONTRACTORS RANNEY ALEXANDER M,. � Department of ARCHITECTS: „ Regulatory Services.' TOTAL FEES: $197A01; ' BOND $.00 ` CONSTRUCTION COSTS $12,000.00 1 `437 NONRES./NONHSKP ADD/CONS': 1 PRIVATE, W BMWSTABLE, * 1 ' 16 MASS. A1� . I BUILDIO D" ISION ;. BY ri DATE I SStJE , O'7/13/2005 EXP I RAT ION DATE ' THIS PERMIT CONVEYS NO FIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- I CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY.THE JURISDICTION.STREET OR I ALLEY 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 CONSTRUCTION WORK: APPROVED PLANS MUST-BE•RETAINED'ON.JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS.CARD KEPT-POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS,BEEN'MADE.WHERE.A.CERTIFICATE OF OCCU I (READY TO LATH). ELECTRICAL,PLUMBING AND MECH- PANCY IS REQUIRED,�SUCH'BUIL-DING_-SHALL NOT BE I ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. I BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS Li 2 2 ' 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD-OF HEALTH I I OTHER: SITE PLAN REVIEW APPROVAL I I' WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON.THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. i I+ I� 1 `I i YM li Ili Ass'essor's_map and lot number ........ ................ Yf Sewage Permit. number. - SEPTIC SYSTEM IM r k . I NSULLED IN CO LE, iRFYI House number ......775.................................i........:............... i " iTH TiTL w,,� 639• ENVIRONMENTAL av®D. 1M x TOWN OF BARNSTAE ���i� BU1 DING INSPECTOR h APPLICATION FOR PERMIT TO .........:1 ! S??.... 0 � .......................................................... TYPE OF CONSTRUCTION 1�bC_L� �. � ................................. � ....�. .............. r TO THE INSPECTOR OF BUILDINGS: The and rsigned hereby applies for a/permit according to the/following information: Location ..... . ... ............ ........... ��-S-7 �%/,"A/V..5 ... �I��ii/�.5./......... ... ... ....... ..... C� .V T S ProposedUse �..�......��,►���.�:)......!.....�''ts.........L�.�..................`.............�............................................................ ... :`e'`�'J."'.�.. ................................................ Zoning District ............., �..`�................, ............. ............... ox 0 Cen ill• � 02632 ....Fire District � G EiVBRIER P �, `� 7 NSA Name of Owner i .........................TIVIII ���`�`(� WM �' M I � dO �J1 �j"I p►�'►3 5 ......................Address ............................ .................................................... Y Nameof Builder ............... .�.�.......................................Address ...�.�.�..`.. ........................................................ C- .........................Address �'4 e.T...................................................... Name of Architect�4.......!..!A. ....IC- �.... 7(.... Numberof Rooms ..................................................................Foundation ...........................1................................................. Exterior c-t . t9GSC...8--j:e.4Hf :Roofing--:T- cam. P/ 4(-T- Floors .............�................... .......................................Interior .......:..........................1./................................................ ��. -rieating- '�..... ........ .. .� .... 'v .... ......... .........Plumbing .. ..............................................................� ........ ... Fireplace .. �" ................Approximate Cost N............................................. 1 :.?--......................-�- ......... D�Definitive Plan Approved by Planning Board ________________________________19________ . Area ........... Diagram of Lot and Building with Dimensions Fee ��� SUBJECT TO APPROVAL OF BOARD OF HEALTH e4mP�111111r�v llgo, I hereby agree to conform to all the Rules and Regulations oft Town of Barns t le reg ing th a construction. Name .... ...... ... .. �. ... ....... ,GREENBRIER CORP . t n�i24591... Permit for ...BUILD.................... -t Cohdominiums (16 Units) . Location .....775 West Main Street a' Hyannis Owner ' Greenbrier Corp. �' 1 F. . ............................................................. }' ` Frame Type of Construction. ` ` .......... ................................................................ Plot ....... ............ Lot_ r November 29, 82 =� 'Permit,Granted ........................................19 k' • Date.of•,Inspection Date Completed ... :,e.,/A)4,r................190 r s Ile '. PERMIT REFUSED • t �F ; - ....................................................r ...... 19 _ �? �i ,f• f . ............ .. .......................................................... Approved ............................................... 19 )A.' � T ................... ............................................................ ...........`.......................... . ,A _ r R t -'j Assessor's map and lot number ...... .....� .......... -"� . : � CF?NE TO w Sewage Permit number���?e� .. - ?! .....: �;,••5. ,':^- �,'� �� r.......Y Z MARNSTADLE, i House number ......77�?.. ........................_................:...., V Mb 9 - m ,sue 3 \0� / t. 'F11 MAY p TOWNS OF BARNSTABLE m' , -BU11DING INSPECTOR APPLICATION FOR PERMIT TO � ? ?��.I V . ..................................................... TYPE OF CONSTRUCTION � a � ` ...... ...................................................... . �, E ....�r..................�9.b' TO THE INSPECTOR OF BUILDINGS: 1 The under g�d hereby applies for a permit according to the following information: Location ..................................... .. ../........................................ ��57,.r ✓ /.0 S� �!/,�it/it/i.s.. ....... Proposed Use �) � a, ......................................'........ �MN.�. ........ A ZoningDistrict ... ��:5............................. ...................Fire District ...� .:...,.;..,............,.......r.................. .. .................. If3.%. P 4?_ti3? Name of Owner ...... � r. ?T �L ICEsI�IL�f�( gddress ` ..1.,.!. !C�ltn �-v111 �. ..r .U '.:. .... M !�h �0 Name of Builder .............................................. ...................Address ..l.............................................r....... C =.Address J� �U y Name of Architect�:L4+ :........).k. CAy.,.. ...................... . ... :...... v�C. Q Numberof Rooms ..................................................................Foundation ............................... ................................ S �' — C T—, i �LGC.. ............... .....Exter ............, :..........Rfg .. . ............. .. Floors .......................................Interior .. ...C•?� �� r;...............L...... TC....:............ Heating.— •; .�f � �'r Plumbing .......� ... �D� t�l�............................................................ —L- Fire lace. ................... ...................Approximate Cost �:. ..................................... Definitive Plan Approved by Planning Board ______ ___,_____________________19-------- Area Area <.:..! .. ?..7.........`.:1...... Diagram of Lot and Building with Dimensions �� }`'' Fee ......................................... r SUBJECT TO APPROVAL OF BOARD OF' HEALTH' / 1 I ' i I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above, construction. Name .... ... ,/ �. . �' '�.�!:. :�.. .. fir ....... `w. ,Y '- Y k .. q!b GREENBRIER CORP . A=24 -49 �24591 BUILD No ......... Permit for ...................... ............. Sondominlr-ums......(.�5.hit.................................... . .... ................ D A 2..4 9 U j t /n ....... ............. S t Location ...7.7.5 W�est Main S eet . ... ................. Hylan s ............. ... ................................ . ...................... Owner .....G.re.4b.r.i.e,I; ' Corp. .......... . .. ......................... Type of Construction Frame I , - ..1........................ ........... ............. ..............I........................................ Plot ........ .......... Lot ................................ November 29, 82 Permit Grant d .....i 01.............................19 Date of Insp ction . ..................................19 Date Compl ted ... I..............................19 V. PERMIT REFUSED ................................................................ 19 rt�jcom� ......................................................).................... Q4- ,........ .........I. ..............!-.1,...... ... ..... ......... ............................................................................... ............................................................................... Approved ................................................ 19 ...................... ......................................................... ................ ............................................................. 1, 1 -D 2 � AAA r-a - - - - �t" t r ll,� TOWNS OF BARNSTABLE 'hermit No __.____243 _' Building:Inspector s.ua s « Cash - ------ ------ PERMIT Bond , ` - ` OCCUPAI�ICY _ x-- 7f Issued to ��'10E?t1DY1C'Y..CCr)^*�}, A Addressn '�Cs'�, � � �E:2�eY?J11� Buildine B Uii L 9 775 'West Main Sheet. Tivanni.5° I' iring Inspectors . i�` --� Inspection Gate 'W Plumbing Inspector / / , ~ - Inspection date (ems f. c- '-: Gas Inspect orfA , � -- Inspection date ., `Engineering Department' /".r_ �Z : : ✓ Inspection date /�?,,ru-•Fit.._....., :,.�= _� ._� �-Board--of-Heaitlf _L L, £,_�, 5 Inspection date �� /g J THIS PERMIT .WILL NOT BE VALID, AND�THE BUILDING SHALL. NOT BE OCCUPIED UNTIL SIGNED 'BY THE •BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH. TOWN REQUIREMENTS AND IN' ACCORDANCE. WITH SECTION 119.0 OF THE.MASSACHUSETTS'STAGE BUILDING"CODE. �f ^. • ' .. / �, ��. '✓ V• ''Building Inspector • TOWN OF BARNSTABLE Permit No. -------1' Q7---______ t ; Building Inspector cash ------------------------ OCCUPANCY PERMIT Bond _X_______---__-___ Issued to Greenbrier Corp, Address Buildine B Unit I 1 775 WPRt M'qi" gf-eami- ��ts�i}xTa f Wiring Inspector C / �� G� Inspection date Plumbing Inspector Inspection date F Gas Inspector N/A Inspection date Engineering Department `' /� ,-r ti - Inspection date �Bd-"oaf Health_ f � , � __ Inspection date,, A?3 THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. U Building Inspector TOWN OF BARNSTABLE Permit No. 24591 n ----------- t � Building Inspector SUA�YL Cash -------------------- e�a i° OCCUPANCY PERMIT Bond ---_-------------------�___ Issued to Greenbrier Corp. Address Box 510, Centerville Rsti 1 rT;r.er R TTM;t- I M 779 TJAgi• Mni i Strpr-+fi Iiyatmi n Wiring Inspector ,� `—. � Inspection date Plumbing Inspector f /%e 4 /` Inspection date Gas Inspector N/A Inspection date Engineering Department d,,, `jam y __L Inspection date eB d of—Health Inspection date el-2119-3 THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. µ .. .. G Building•Inspector i o� TOWN OF BARNSTABLE Permit No. _-__2�+��� Building Inspector I IMITAU : cash -------------—- -- 163 ` X OCCUPANCY PERMIT Bond -------------- Issued to Greenbrier Corp. Address Box 510, Centerville Building B Unit 15 775 Nest Main Street, HyaImis, Wiring Inspector J �, . f� _ Inspection date41 — 15;;, Plumbing Inspectors t Inspection date Gas Inspector N/A ` Inspection date Engineering Department (, i.�:_ j }F Inspection date aLBoard o�f`H th f`� � Y Inspection date Ar THIS :PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE _BUILDING CODE. ................................. 19_ __ F. Building Inspector TOWN OF BARNSTABLE Permit No. 24591 _----------------------------- 1 nwIT I Building Inspector ; . wa Cash ----------------------- 16)a x OCCUPANCY PERMIT Bond Issued to Greenbrier Corp. Address Box 510, Centerville Building B Unit 12 775 West lain Street) HyB.nnis Wiring Inspector �� � � Inspection date,,/ Plumbing Inspector �i �y, (--,;- Inspection date Gas Inspector N/A Inspection date Engineering Department Inspection date Board_of Health. Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE .WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ,.. .. uildingnspector r....... B I _..... . . TOWN OF B.ARNSTABLE 2459i Permit No. -------------------------- n ; Building Inspector cash ----------------- rr� �S63 , x OCCUPANCY PERMIT Bond ----------------------__--_- Issued to Greenbrier Corp. Address Box 510, Centerville BIB i. .di.xtP B Unit 1. 775 West Main Street, Hyannis Wiring Inspector /�.. �� � .t' Inspection date Plumbing Inspector . Inspection date Gas Inspector Y N/A L 1 Inspection date Engineering Department rf�-�� 1j f;�z� ,. .� Inspection date ,1Boa d-of Health. % ' Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. _. .... ....... ............ .:....... ,,..... Building Inspector TOWN OF BABNSTABLE 2459� Permit No- ------------------------------- Building Inspector Cash rua ------------- ------------- 1639. X "gal'` OCCUPANCY PERMIT Bond Issued to Greenbrier Corp. Address Box 510, Centerville Building B Unit 14 775 West Main Street, Hyannis Wiring Inspector , �/� �� �� Inspection date(:�-- w-7�. Plumbing Inspector Inspection date r r Gas Inspector Y NSA Inspection date Engineering Department i Inspection date 7-li and-o� �. Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALT, NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. I /,caGa ..z.................. it3 .f....................... -�7,�_ (� Building Inspector e• TOWN OF BARNSTABLIE Permit No. 24591. = Building Inspector N�� cash --------------- ,e�a OCCUPANCY PERMIT Bond ---_--_--------------------- Issued to Greenbrier Corp, Address building #lA Unit 8 775 West Alain Street, ilyannis Wiring Inspector C� i� �, -- Inspection date Plumbing Inspector _,,!:; ,,_., Inspection date Gas Inspector Inspection date Engineering Department , Inspection date Board of Health Inspection date r r THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. Building'Inspector .�}i,_• TOWN OF BARNSTABLE Permit No. 24591 _---------------------------- Building Inspector saasssm Cash +era OCCUPANCY PERMIT Bond ---_--------------------_----- Issued to Greenbrier Corp. Address Box 510, Centerville Building #1h unit 7 775 West Main Street, Hyannis Wiring Inspector �/ � Inspection date Plumbing Inspector * Inspection date Vp Gas Inspector Inspection date Engineering Departments ' Inspection date Board of Health _. t � Inspection date 'r17,Pi 3 THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING/CODE. ......... 19 c 5 .,/�Ir ,. 1:® / o.., �:.............._..........Building.`Inspector........_.............._.,..�- „t TOWN OF BARNSTABLE Permit No. -_---------24591--..--- I Building Inspector Cash -------------------------- WL �e�a OCCUPANCY PERMIT Bond ---------------- Greenbrier x 510 Centerville issued to 're�E=X'i xl@r Corp.�Ol"j)' Address � Building #1A Unit 6 775 west Wain Street, gyami.s f Wiring Inspector rf ,. � Inspection date Plumbing Inspectors-, Inspection date Gas Inspector � � Inspection date t � F / Engineering Department A �J Inspection date/- - Board of Health �� s Zs?/L � d� .n Inspection date x— -4 .; THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. V Building Inspector TOWN OF BARNSTABLE 24591 Permit No. - ------------ - 1 SAWnA Building Inspector NMIL Cash --------------------- •r.Y OCCUPANCY PERMIT Bond Issued to Greenbrier Corp. Address Box 510, Ce;_lterville Building; #3A unit 5 775 crest 114.in Street, fiyannis Wiring Inspector �/ � - Inspection date Plumbing Inspector �Y^ Inspection date v -� Gras Inspector / , 7 Inspection date Engineering Department ;f_ Inspection date y _ Board of Healthi� ..dtii.A/K ���f ►. Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ,. Building Inspector TOWN OF .BARNSTABLE 24591 PermitNo- --------------------------------- Building Inspector Cash --------------=------- � wa +ya � OCCUPANCY PERMIT Bond --- ---------------------__--_ Issued to Greenbrier Corp. Address Building #1A Unit 4 775 West Hain Street, Hyarmis Wiring Inspector �/ � Inspection date Plumbing Inspector/ l Inspection date Gas Inspectorf �� 1 A Inspection date Engineering Department " Inspection date Board of Health Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDIN/Gf CODE. _ .. Building"Inspector ' TOWN OF BARNSTABLB 2459 • Permit No. --------------------------- Building Inspector usa Cash ---------------- OCCUPANCY PERMIT Bond ---------_- Issued to Greenbrier Q-orp. Address Boy. 510, Centerville Building #IA Unit 3 775 hest Main Street, Hyannis 'Wiring Inspector Inspection date Plumbing Inspectoyr —� Inspection date Gas Inspector / Inspection date Engineering Department ' A � ® � Inspection date &I Board of Health �r, Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. r............ ........... .... .p V Building InspectorIns ector •� TOWN OF BARNSTABLE 2459� Permit No. _---------------------------- e �..n� = Building Inspector cash .... ----------------------- +ya OCCUPANCY PERMIT Bond --_-----------------_---_-.---- Issued to Greenbrier Corp. Address Box 510, Centerville Building #A Unit 2 775 6t Main Street, Hyannis Wiring Inspector �� �� Inspection date Plumbing Inspector�� � _ v Inspection date Gas Inspector � � �r Inspection date Engineering Department _' Inspection date f� % Board of Health Inspection date r THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUI/LjDIN,GG CODE. .�... r...... _............. ...... Building Inspector i . TOWN OF BARNSTABLE 245-1 e Permit No. ---- --------------------- Building Inspector waCash ------------------------ a�a x Y OCCUPANCY PERMIT Bond ------------------------- Issued to Gi:eenhrier Cbrv. Address 'Brix 510, Centerville 'Bui.leting IN. tini.t 1 771 Nest 3,Tain Street:, Fwarni.s Wiring Inspector ` ///� Inspection date Plumbing Inspector •� rf � �T Inspection date Gas Inspector /fi i f% Inspection date Engineering Department y , j j1 Inspection date '-ems-- ---- - Board of Health ��1"21-t,, fQ�'_-� ,fL Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. AA ^. ......................................................» Building Inspector ((( e TOWN OF BARNSTABLE Permit No. `459] ---------------------------- -- Building Inspector • Cash �.,. OCCUPANCY PERMIT Bond ________________x_________ Issued to Greenbrier Corp. Address . Box 510, Centerville Building B Unit 16 775 hest plain Street, Hyannis Wiring Inspector 11 •w Inspection date���• 4y Plumbing Inspector Inspection date Gas Inspector N11 Inspection date Engineering Department } �. Inspection date Inspection dated/may/e.3 THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON ,SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. , �. Building Ins e'dor I :I t : : _ I I t : _.. . , _ j— Lit 4 _. . , LS _i 1 , I , l ` 0$0 I l E - 1 i f " pp t � 1 I -• t !nth t$ , , i t r I t ; I ; i I i � :, I, •. �� I t .�. i 1 !' I ELKS '� 'i +' , - O _ , i 1 , 1 I S mil' , i. , cam- . , , t� • L-V , t 1_... .-! 1 It r r 6 , SO bol ilk 14 1 6t J : I 1 • -j _,-1L.._..i-� I ; � � ; � _ � .. _ 1 'I-- 4, I I I -1'. . 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'�'r ns � P� - j 0 �� o-� �9 s c _ A to J . lP`��fl� ylc NPR Ir TH/S•PLAN /S BASEO ON A PLAN AY a YAI�TCR S NYE/NC.DATED APR/L/3, +gs ., r. /9B/RGco:tOBO/N PLAN goOK JS3 /L`ERT/^YTNAT TN/SPLAN NAS 4 IbAGE34- BL4lN'o,t_PARQO/N CoNpo TMA NCS . TO THE JAN.1,/976 qaL--,-V ANa , /7e.G(/(�T/ON1 OF THE 0ARN$TABL6' COUNTY RL-/STeRS Of OEL7OJ- PA7V- y z�a3 A. Alo-reL.A : S/TB PLAN ALL MFASUIiEMENTS ARE >o GR�c^(8R/ER Col"70M/N/UM RLWSTERL!O LAA/O tIR✓L>YOAt THE CONCRETE CORNERS OF MA S5. BIl/LO/NG POI/NPATIONS' NYAIVN/S BA RN STAB LE GREENER/ER DEVELOPMENT CORK • V - _ "pa /HERL'QY rwY THAT YMd PROPMTY ZJNEJ _ /GLRT/FY THAT THIS/OLAH.PMLLY ANO AC- dm+ sHow,y qp T ,PLAN ARL TNL L/NF9 OIV/- CUl(ATCLy OGPICTS TN--LOGT/ON ANP - DRAWN OYA.A.M. EXISTI�"OWNLRSN/PS,Aevp THGL/NLJ DATE= oL`C.2�,I9B2 t°01Y O/MLNS/DNS OF THE QU/LD/NGS AS Bd/LT cllccxra OyR�.t- �+•'�goem s� Of TNt STREB%S AN yWA YS SNO H/N ARE ANO P//LLY L/STJ THE LINIT3 CONTA/NBo epuce SCA LB: //N. n 30 FT, ESDAFD.. { N = TMOSc Ot'Pf/C�C.OR PR/{M TEST No0R V•4Y9 a _ - ALRtAPY LL/$NGO,ANP OWNER- s�P oa • L/Na'S/OR /J/ONOP I.ST/NG nn suc+ SHIPJ OR fd ,V--,W YAPS ARL SHOWN. �i�• /�///� � _ FLDRED6E EKGINEER/NG COS INC. 4 c+ ... '„ - pATB: 'Y 27 63 � RGG.C/V/L CNG/NEARS S SUR YEYOR+" p .h + -_L/ RCR/9TERLP L4 N0 Sl/RYEYOR7/2 MAIN Sr N Cl ZZV O y RLB iANO SURYLYOR ' LOCUS MAP It SCALG: I/N. - 2000 P'T• NAP 249 LOT 99 `#� ' O v'b 6�29 A35',"O" p � a G 4 �s c eo G P JI L07' /1 �'/• 11 ' 'l l N/T S PL 3J3 P4.3I covJ 1 D4 p V ftj th 2NE RLC �---•�_ .. 61�� LI SUN/T/4� `3(op �•04 a 9 v 11 ZOO —0 Ole 0 N I ' larA EvrgU V►'y P co P(L Rf f� SIN' /CERT/P'Y THAT TN/S PLAN NA S BEGN PRGPARly/N CONRORMAIVC'6 A 1 NOT, TO THE J7OA,I /976 RULGJ ANO THIS PLAN/S BAStO ON A PLAN By R!!G(/LA7'YON1 Or THE aARNSTABLB C+OONTY RG1rA/STBRS O/.OHBOS• ` 0,4X7'--R B IVYE/NC.OA7,C-b APR/L/9, PA TE; f/27 B3 - /98/RGCOR:b60/N PLAN BOOk 3S,y IOAGE 34• i RE4/STERGo/.ANO (/R✓EYOAt - ALL MEASUREMENTS ARE To THE CONCRETE CORNERS 0,- S/TE PLAN 1 Bt//Lo/NG 0-04VwoA770,VS. GREENBR/ER CONOOM/N/UM o- /HERrQYrrRnP'YTNATTMGPROPgeTy L/NE9 r� NY,4,v-/S BARNSTABLE MASS. SHOWN ON TH/S PLAN ARG THJ'L/NFS PIVI- - 1 POR O/NO BX/ST/NO OWNBRSH/PS/WOTF/GL1NG9 /CERTIFY THAT THIS PLAN FULLY AMP AC- GREE,NBR/ER DEVELOPMENT CORD Or Me STREGTS ANOIVAYS SHOI'V,V AR£ C!/RATEGY OGPICTS THB LOCATION A,VO z _- THOSG O.-AVa"C ORPRiw TESTROETS OR i•VA yS �� DIMCNS/ONS OF THE BU/GOINGS AS BUILT PR.wN OYA.A.Iy, ALRGIOY ESTAQL/SHGO,ANO THAT NO NG/V ANO FULLY L/STJ THE UNIT! G•ONTAINEO DATE: DEC.2�/9B2 a r TNGRE/N. - C/IKKro ac. +�)"L/NGS rOR D/Y/SION 4 4xt sr/NG OWNE,e, ' e ` SH/P.T OR FOR NGW WAYS ARQ SHOWN. �� SCALE: //N. 30 FT• ,Q eWBERT .ucc e 3e' DATG: Y 27 B3 2 PATC: �/ 7 83 Ar -� ELDRE06E ENG/NEER/NCr CO•I C. 4xn SU RE6/STPRGP'LANO StIR/�E'YO/� F RGq/STERGO LAND SURVEYOR RG•G.C/V/L G/VG/VEERS B St/R VEyoRs P� 712 MAIN sr. Y HyAAWAY, MASS. Ng 82200 : j 1 I I I f x 1 I I • _,_I I i 1 1 i 1 I : 1 F , , I I _ : _ I r 3 I i ' ST�ire.� � 'pow :� !_ �._ ..� __�__ , 17 1 , I_ 1 I -t ' i j � j ' (. ( � 1 � rrk a fi � �•;. q��t�w;m. �? 'f, I 1. I � I j �r� , I , , , .... .-...,,. .: j I .. .-:.1,. � _.: '•adf. "''�w. j""b+'7. _ _ _ ��,p,,;— _ _ � . - ! _is (( ff Iv VT t i , , E I I • , - I 3 � I 6 i I I if 11 a _ _._ N 6' i I ! !, I AWL i, � �n g arm i ) s-� ANa 2N� F400S� "0ccKs ._ I !I i , 1 6 i , I I , I 1 1 f ED 'TyH .�,_.�. : I i • : I i I kF`IPrP�:MS r! rMO� nz w► _ _ _ �_ {. ; �xy �T Po Ts; yTo II j L • �� �•� i ����= i I I , � ' I i� ! I + reff j I ! k,; O 1 '- I L... - I{{I 111 �. TO a'': Pt- �t,NAA'mbt4 ! I ' I I I - 1 I I I s } I I i I I i I I 1 I , ff t , p � I • I I } I I I r51 ,- 1 4 TO AV M ` I ' MT y {r 47,0 1 I + I ( 1 4 ' I - _ I - - -- - _ - -- - _ ( il v n, � � I � I i I { t : i I r } ' p I I f ZX 1 Z R+• S R-�l�I�e�' r_ � I i �p� � �. _.a � :. .I. ___.L. r I . I I , i - I I } I + pn ! Q{I s 'p►N!D Z.ND %o0f� D Kr V _(- i i i t �. ! ( r:� iY1�'TRt TffD 1"16 ✓� b C.►CZ11& 15E I PT. I _ NFyPrMN IS I �A ozbat i I i i q;} Li E �T ; ebsts-' .TO B L#�*mD! j I iGx FIV I I ( / I I I 1 M I �z sus it - vs , I I , �� L Dfprxs' TO I LAc(§l.a Td1 1 _-M'�r �u4s46 sway i w{ /Q go��'S I t VS� ExtsT�!►lG PgDS } FOB. I. N I -PArA.l � ` f a _ 1 ^! LO C vs sCAJ : //N. - 2000 Pr. MAP 20! LOT 99 r VE °p"YJ - ' Aa. �r/�o�N p3.f3 0 'AR iO ¢9 ,� o `\ �A°N � t - • M peo u UN?q 0 w Z UNIT ,�2vN J.4 H N 107 S. PL.BK.J"P4.34 /J 40 th Zj oli s, N. �+ b o %K II 1 200. _ �� S9 of 1/'! N �59+E m C[� �8 Ze►. a �t,os M f fly o v��ylA k° nly' 0. NPRRf �� m�gC /CGRW.-Y THAT 7-W15 PLAN NA 9 S q:, NO7W OCEN PRrPARfo/At CONPORMANCL =' R TO THE JAM.;/976 RULCS ANO 4 TN/S PLAN/T BASEv ON A PLAN BY RR6!/LA7►04V9 O/TNO 49ARN97ABLB 1 BAXTGR .6/VYE/NG OWTBO APR/L/3 G1°DNTYRM/JTERs oPOrr09• /99/RCCOmOB.O/N PLAN QOOr$S3 PATY((l�, 4' 7•�BQ3J/f�� !� -AGC J-0. R�!'G/ TrRr�.VO IIRYPYOA2 I • A/oTE . ALL.MEAB(/RCMENTS ARE TO S/TE PLAN THE CONCRETE cORNEJes of GREENER/ER CONDOMINIUM Bl//GO/N6 PO UNOAT70N3. �' NYANN/9 BARJVSTABLE MA9s. /H2RGQY Q7RT/PY TihGVT YNOPR°Pl9CTY L/NE.7 BHoWN ON T/V/9 PLAN qRC TN!'L/Ni3 O/V/- POR '' _ 40/1V4 rx/sr/Nv OWlVERSN/PS,ANOTHGL1Nr3 /CaariPY rYAT TN/s PLAN FULLY ANO AC- QRLTE+NB/7/ER DE✓EL.OPMENT CORK Or TNO-Vr TL TS ANPIVAYS SHOWN AR£ C//RATGLy OGP/CTS TNO LOCATION ANO 77/OSa do-PvSL/CORPR/IMr7ESTRG@T3OR WAYS O/MCNS/ON3 OF THE L(/ILD/NBS As BUILT PRAw�v sYw.A./y,AL OArE: peC.2Z/902 �•u RG40Y e3'rAQL/3XAW,ANO THAT NO/YE/y ANO/SULLY IJSTJ TNC 1/N/T3 ooNTA/Neo CNKxro iYR.4s. L/NBS POR PW1ff1OIV OP E{C/ST/N6 OIYNER- TNtRE/N. SCALe:///y, a 3 O 0 P7: +i �.uc y%• SNIPS OR iAR NGIV WAYS ARe SHOWN I' DATG: //27 B3 �1GL fi PATG: Y 27 8 3 ��L�� �__- — ELDRBL76'E EKGINEER/NCO CO.,INC. 4yo's�`,"•+o� RCO/.9TERB0 LAND SaOWAWaM RED•C/✓/L CNO/NEGRS I S(/R✓rYOR9 REB/.9T?.tCPLfINOS!/RI�ByO/t NYANN-'-*, MASS. N!2 B22QO