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0855 WEST MAIN STREET (2)
�'ss w. �rta,�v .ef t --- - - - -- �- -- � �I' 1 f TOWN bF BARNSTAB a;!: 'BUILDING DIVISI® -aD - a&3 200MAIN ST, HYANNIS, M`A Town of Barnstable Certificate of Zoning Compliance Certificate No. 2020-11 Map 249 Parcel 031-OOW Owner Name as of 1/1/20: Address 855 West Main Street#22 Village Hyannis DEGRACE, RUTH F ESTATE OF 855 WEST MAIN STREET#22 Zone (SPLIT)Highway Business HYANNIS, MA 02601 RB Single-family Overlay Water Protection (WP) Year Constructed 1973 Property,Use: Residential/ Condo Unit Lot Size N/A condo Cert of Occupancy Issued: Unknown Setbacks: Front Yard 60' Date Permit Side Yard 30' Rear 20' Open Permits: None Code Violations: None on file The Building Division does not receive or maintain information regarding municipal liens. Liens - Tax Office 508-8624054 Property Description: Currently located in a split zoning district,the structures are predominately located within the HB district. Although no zoning decision was found in the street file, it is recommended that the Planning Dept. be consulted to confirm the status due to the age of the original development._ The subject property was developed in 1973. A permit on file (#15148) dated June 20, 1972 identifies the application as construction for a two story building containing 10 apartments, no.other permits are on file for construction or alterations. A comprehensive permit history is unavailable as the construction pre-dates our record retention. Reviewed by Title Date: Robin C. Anderson Code Compliance Manager 05/18/20.20 I u P E M C 0 L I M I T E D g0111-DING DEPT. MAY 11 2020 PEMCO-Limited 3131 South Vaughn Way,Suite 428 TOWN OF BARNS►ABLE Aurora, CO 80014 `Town of Barnstable Attn: Robin Anderson 200 Main Sf Hyannis, MA 026 Date: ,4/27 020 RE: Code Violations Search Dear Code Enforcement Please see attached check for the $75.00 search fee required by your city. PEMCO-Limited represents Fannie Mae,the owner of record of the property located at: ,8SS WEST MAIN STREET#22,HYANNIS, MA 02601 We would like to request copies of the following: 1) Copies of open code violations and summons(if applicable)attached to the property. 2) If there are open invoices pertaining to the code violation or past due liens, please send copies along with the fee breakdown. Thank you for your time! Nicholaus Rice Property Specialist Direct: (770)609-6832 nick.rice@pemco-limited.com PEMCO-Limited,4600 S.ULSTER ST,STE 530,DENVER,CO 80237 From: foiadirect(@townforms.com To: Nick Rice Cc: quirk.ann(5town.barnstable.ma.us:;Brian.florenceCaltown.barnstable.ma.us;ann.auirk( town.barnstable.ma.us Subject: Request#2020-0128:Estimated Cost for your Request for payment Date: Friday,April 24,2020 1:15:52 PM Town of Barnstable,MA Public Record Request Number:2020-0128 Requester:Nicholaus Rice Request Date: Friday,April 17,2020 10:26:52 AM Response Due Date:Monday,May 4,2020 Hello Nicholaus Rice: T Based on your request,we have estimated the effort involved to comply with your request. As this is more than minimum effort by public records law,we have created an estimated effort and related cost which is shown below: Estimated Printing Cost: Department Estimated. Rate Per Estimated Printing Copies Unit Cost Building 3 $25.00. $75.00 Department Total Estimated Printing Cost $75.00 Total Estimated Response cost:$75.00 Please arrange to send us the payment for the Total Amount. If check payment is used, check shall be payable to Town of Barnstable and mail to the following address: Town of Barnstable 367 Main Street Hyannis, MA02601 Note the Request Number on the check Until we have received the payment, your request status has been put on hold. We will start the process of creating the response as soon as we receive the payment in full. Please note that the actual cost of complying with your request might vary once the Town begins preparing. In such event;the'Town will charge for your any additional costs prior to providing a response to your request; or refund you if the actual costs were less than the original estimate. If you have any questions regarding this matter,please do not hesitate to contact us by email at the following address. Thank you, Brian Florence,Department RAO Building Department Department Town of Barnstable 367 Main Street Hyannis, MA 02601 Tel: (508)-862-4030 Email: Brian.florence@town.barnstable.ma.us • 1 •• 11 ',1 ',1 ',1 le •:: '.� eee ',/ ',e '.e '.� lee •: ',� 11/ ',1 ',1 '.1 ',� ell •:. ',� eel ',1 '.1 ',/ ',� eee ,71 Ppi 4 � Se r ��-INS �'" � x ,f 4t ✓rw..•+1' c' � ,�4'i J :� r ¢� .alp <' gam. p�'"(�'$�• 6�-+A"4j +{� �• 03l05/2010rkt yOFTNET0�1 TOWN OF BARNSTABLE • 8AHB9TADLS, i 9° NAM ,,� BUILD.IN INSPECTOR APPLICATION FOR PERMIT TO ..... C�. ...... .... ........ . ...... ..... ............ ..... ............................................. TYPE OF CONSTRUCTION9/7 ....... . . .(�.................1.�..0.R.. ............................................................................... .............................. ..............� v TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accordin to the following information: location ......... S.5.....< .:.. .. ..�Q� ..V. .............. ........................................ n ProposedUse ....... ` .................................................................................................................................. Zoning District -.... .......................... ................... ...... ......•..Fire District ....... .. . ,,K- 17 Name of Owner AUej.. .. 1.....L• '••`•• .``•• .Address 6..��. '!I �..11�2e...Gib..:...................... Nameof Builder .........:..........................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................. ............. .................................. Number of Rooms z.....................................................Foundation 12 4� Exterior ...(��... .........:. Roofing ... ` '7........................... Floors .InteriorA CV. v� .......................................................... Heating ....... .�... ...............Plumbing ........ ........ Y.....,F�.!r� ✓............................... Fireplace ...,!.? Z .................................................................Approximate Cost .....1� ... /....................... ........ Definitive Plan Approved by Planning Board ---------------____-----------19________. `rD0 0 , Diagram of Lot and Building with Dimensions / �e SUBJECT TO APPROVAL OF BOARD OF HEALTH J Lil Od J W U_ U) m 'r z � � CC 1y7 � � M < '� n. � 00 O OcWnd� �' ►-. D. W OC -I W-. J J Cl_ odd zz Q OLt LU Q LU Q � e 1 QQ ;� ¢ a 7 i• �4 I hereby agree to conform to all the Rules aril_Regulations of the Town of Barnstable regarding the above construction. YName ............................................ ...... Investments of Cape Cod, Inc, f i No ....1�`.':8.. Permit for .......10,unit............. 3 story apartment building i . ............................................................................... Location .........$55. ..Wes. .t..Main. ..Street........... .... .. .... . .. ...... .. ............. ........................Hyannis....................................... Owner Invest.ments. ... ... ... ... of Cape Cod, Inc. ............. ........ . .... ........ ....... Type of Construction ...........frame ............................... ................................................................................ Plot ............................ Lot ................................ Permit Granted ........At1A..zQ................19 72 Date of Inspection 19 Date Completed ......................................19 PERMIT REFUSED . ........ .............. 19 .. .............. e. �.. �. . 7 s_....... e APerov ed ..,......... .. ......... . .. .. 9 Efficient Buildings, LLC., f October 31, 2011 n • I Town of Barnstable Attn: Thomas Perry, CBO 200 Main Street Hyannis, MA 02601 re: 855 West Main Street, Hyannis, MA 02601 Dear Mr. Perry: This affidavit is to certify that all work completed at 855 West Main Street, Hyannis, MA 02601, has been inspected by a certified Building Performance Institute (BPI) inspector. Work included air sealing, weatherstripping and 660 sq. ft. of R-38 cellulose blown in attic. All work performed meets or exceeds Federal and State requirements. Sincerely, cle Steve C. White A 7e. Owner/Managing Member `I Efficient Buildings, LLC ,C 8,Jan Sebastian Drive, Unit 10, Sandwich, MA 02563 Tel: 508-888=1110 Fax: 508-888-1109 Town of Barnstable Building Department Services Brian Florence,CBO Building Commissioner i # uansrnaLL 200 Main Street Hyannis,MA 02601 v n>nss. $ 1639. wHw.town.barnstable.ma.us ArED fV1A�A Office: 508-862-4038 Fax 508-790-6230 Approved: /?/ . Fee: S� Permit#: HOME OCCUPATION REGISTRATION Date: Name:_ J 0 21JVA � , ,pmo U-1 Phone#:-509 3 GO - 3 G Address:%S-1J � .o y► Village: 6( 91In'V.-C-S Name of Business: �l`\ —��DVVI� 1Y q y-o� :4_ C� Type of Business: L Map/Lov _;�qq 00l� 1LNTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation uithin 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 visua alteration to the premises which would suggest anything other than a residential use: no increase in traffic above norma 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: 1/0 The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. b,4 Such use occupies no more than 400 square feet of space, ,4 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. y 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. 1.the undersigned,have read and agree with the above restrictions for my home occupation I am registering. :1,ppl icant: QADate: ' 9 Homcoc.doc Rcv.0620/1r MUST CM PLY WITH HOME OCCUPATIO N RULES ''J0 �REGULA.TIONS. FAILURE TO COMPL' 10t-,4 RE- ULT IN FINES, MUST _-?O,\�,PLY WITH NONE OCC UIPATf .� ;,,�a P GULATIONS. FPIr URE TQ�'own of Barnstable RULE Building Department COMPLY' ;GRAY R �1�T IN F�NE Brian Florence,CBC: Building Commissioner 00 Main Street,Hyannis,MA 02601 `•�',ti%P..CC?',;.gl.�:anicin�la.ri%1.!i� _ Pre-application for Business Certificate Date .2019 Mai Parcel U /_ �? � 1 Applicant Information Applicants Name s:T(Oa� �, �ar"W"ems ! D ?1A Applicants Address gsrj- 13< l�> . rna1n Email'AddresshiQ`�'►(�agl� W1Ca26{'� Telephone Number 56$_aw 7$to Listed 1 i Unlisted Business Information New Business? ________________________________________ Yes Nc Business is a registered corporation? ____--------------------- Yes No If ves Name of Corporation Does business operate under the registered corporate naive? Yes No Is the business a sole proprietorship or hone occupation? ________ Yes No If yes then arrHo(me Occupation Registration is required See Building Division Staff Name of Business G( I j r�VQ.771 7$ Q4i�ref o.1 Business Address ` - �55 � 13 �. W1at n �_}�1vw�¢ � . MFJ D Zoo d J Type of Business. �80 L j dQ //��en�r►u ildina Co fissionex Office,ITs Onl3,, b Condit] is l" ,�� Mt; tohm -94 "1 Bull g Commiss- e "� bate I Clerk Office Use Only Town of Barnstable Building Department Services �oFt►+e r° Brian Florence,CBO hP �" -Building Commissioner BARNSTABM 206 Main'Street,Hyannis,MA 02601 9 MASS - - 1639• www.town.ba rnsta ble.ma.its ATED A�A Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee Permit#: HOME OCCUPATION REGISTRATION Date:'J a.!'t �20 (� Name: :3-0 , ,a41 LorLe-1 Phone#:SQR toy 6 Address:q,9 -1J �,L•1�w Village: Idpt-�- ' Name of Business:,Ll p-�, 4'0 M.42_ Type of Business: v" Map/Lot: l 0a WENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation kvithin 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 dwellina: there shall be no increase in noise or odor:no visua alteration to the premises which would suggest anything other than a residential use;no increase in traffic above norms; 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 y ,here is no outside evidence of such use. ✓• No traffic will be generated in excess of normal residential volumes. ,y 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 oftoxiIC 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_ I-tome Occupation,and not within the required front yard. ✓• T here 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 on;- pickck_� k 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. Z"• No sign shall be displayed indicating the Customary Home Occupation. f If the Customary Home Occupation is listed or advertised as a business_the street address shall not be, included. r ' No person shall be employed in the Customary Home Occupation who is not a permanent resident of the swelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation i am registering. Applicant: Date: ! Homcoc.doc Rcv.06/20/16 MUST COMPLY WITH HOME OCCUPATION RULES A ':'0 -EGULA,TIONS, FAILURE TO COMPLY" l/;/i.Y RESULT IN FINIPS. Town of Barnstable ]Building Department Services Brian Florence,CBO Building Commissioner � r BAMSTABLL 200 Main Street,Hyannis,MA 02601 MASS. v� s639. ��� ww�v.town.barnstable.ma.us CFO MA'S A Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: -?,,20 l� Name: �Y6 33(\ Phone#:56R V Cp0 J 3?�o Address:-D'LJ u5•yy\aJn a Village: 'd 1 {y%-C.5 Name of Business: \p —�'o{�/L� l-QAqV 1f�`"Co Type of Business: 19 Map/l.ot- �Ol LNTENT: 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. u,,P- 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 auantities. 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 pickcktruck 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. �e No sign shall be displayed indicating the Customary Home Occupation. r A- If the Customary_ Home Occupation is listed or advertised as a business._the street address shall not bee included. No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. 1,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. ?applicant: 0Date: Homcoc.dac Rev.o6i2o/i MUST COMPLY WITH HOME OCCUPATION RULES A .D REGULATIONS. FAILURE TO COMPLY" MAY RESULT IN FINES. a '==✓ �IP Application n Pp umber.....X.l....HE f. ......f. a e o� Date Issued................... �.l..Z�.. ..... .................. aARNMBI.E �p muss, 9. ®0 T0'�� 4A ' Building Inspectors Initials.......... / 24 ?® Ma P Nq O 031 p/ arcel.....-Z... ..................................:_:.............. TOWN OF VARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: -4-1 NUMBER STREET VILLAGE Owner's Name: an,'eI CriY,a /'� Phone Number 5tom-771-,2, 3 r- Email Address: ,,rP:l,o-� e Cell Phone Number Project cost$—�a (g°I — Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 Civ1R Owner Signature: 5 e cll\a Date: TYPE OF WORK Siding ►9 Windows (no header change)# LI El Insulation/Weatherization Doors (no header change)# Commercial Doors require an inspector's review C7J Roof(not applying more than 1 layer of shingles) I n Construction Debris will be going to GJasfe-Ira4a P.yIP� - _�ry,►'t�� i�f' t Z CONTRACTOR'S INFORMATION Contractor's name A2,.J ��s��v,� 1111-n cow S Home Improvement Contractors Registration(if applicable)# 17 3 2_ .� (attach copy) Construction Supervisor's License# Z S 7 07 (attach copy) Email of Contractor Q SLJee�9 qS& • C e,cn Phone number q01 Z Z R -1900 ALL PROPERTIES THAT HAVE STRUCTURES VER 75 YEARS OLD OR W 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. 1 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 If food is being served at your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3:30 pia-4:30pm. Commercial events may require Fire Department approval. *WOOD/CGAL/PELLET STOVES x Manufacturer# Model/I.D. ' I Fuel Type Testing Lab Offsets from combustibles: front back left side right side i HOLED ER'S LICENSE EXEMPTION � Homeowner's Name: Telephone Number Cell or Work number k I understand my responsibilities under the rules and regulations for Licensed Constr6ction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures, specific inspections and documentation required by 980 CAM and the Town of Barnstable. Signature Date i 'PLICANT9 S SIGNATURE � Date Signature All permit applications are subject to a building official's approval prior to issuance. Renewal : Agreement Document and Payment Terms Andersen. dba:Renewal By Andersen of Southern New England daniel.Camaia M.ILA.MIM Legal Name:Southern New England Windows LLC855 West Main Street RI#36079, MA#173245,CT#0634555,Lead Firm#1237. -'Hyannis,MA_02601 10 Reservoir Rd I Smithfield,RI 02917 H:(508)771-2636 Phone:866-563-2235 1 Fax:401-633-6602 1 sales®renewalsne.com Buyer(s) Name: daniel Camara Contract Date: 03/28/19 . Buyer(s)Street Address: 855 West Main Street, Hyannis, MA 02601 Primary Telephone Number: (508)771-2636 Secondary.Telephone Number: Primary Email: Shureshot@comcast.net Secondary Email: Buyer(s)hereby jointly and,severally agrees to.purchase the products and/or services of Southern New England Windows,LLC d/b/a Renewal B Andersen of Southern New En land "Contractor' in accordance with the terms n y g ( )> t e e . s And conditions described m this Agreement Document and Payment Terms,any,documents listed in the Table of Contents,and any other document attached to.thi.s Agreement Document, the terms of which are all agreed to by the parties and incorporated herein by reference,(collectively, this"Agreement"). . Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work urider.this Agreement. Total Job Amount: $8,789' By signing this Agreement;you acknowledge that the,Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,,or cash. Deposit Received: $0 Balance Due: $8,189 Estimated Start: Estimated Completion:, .6-9 weeks 6=9 weeks Amount Financed: - $8,189 Method of Payment: Financing We schedule installations based on,the date:of the signed contract and secondarily on the date in which we complete the technical measurements.The installation date that we are providing aithis time is.only an estimate.We will communicate an official date and time at a later date: Rain and extreme weather are the most common causes for delay. Notes: 50%DEP 50% ON COMP TXS PD IN HYANNIS MA Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understandings changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,:written consent of both the Buyer(s) and Contractor. Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement, understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the.two attached Notices of Cancellation,,on the date first written-above and 2)was'orally informed of Buyer's right to cancel,this Agreement-. NOTICE TO BUYER: Do not sign this contract if blank.You are entitled to a copy of the.contract at the time you sign. YOU,THE BUYER,.MAY CANCEL THIS TRANSACTION AT ANY TIME NOT.LATER THAN MIDNIGHT OF 04/01/2019 OR.THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION,' WHICHEVER DATE IS LATER:SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN . EXPLANATION OF THIS RIGHT. Legal Name:Southern New England Windows,LLC dba:Renewal By Andersen Southern New England Buyer(s) .� Signature of Sales Person Signature. Signature Eric Woods daniel Camara Print Name of Sales Person Print Name: Print Name UPDATED:.03/28/19 Page.2 / 10 (� 'r Office of Consumer affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration i Type: Supplement Card 173245 SOUTHERN NEW ENGLAND WINDOWS, LLC Registration:10 RESERVOIR ROAD Expiration: 09/18/2/18/2020 SMITHFIELD, RI 02917 Update Address and Return Card. SCA 2010-05:,' - Office of Consumer Affairs&Business Regulation i HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Suoolement Card 'before the expiration date. If found return to: Registration Expiration Office of Consumer Affairs and Business Reguiation 173245 09/18/2020 1000 Washington Street-Suite 710 SOUTHERN NEW ENGLAND WINDOWS.LLC Boston,MA 0211 BRIAN DENNISON 10 RESERVOIR ROAD SMITHFIELD. RI 02917 Iwo van Without Signature Undersecretary 1' f Commonwealth or- Nlassachus.ets Division o9 Professional L1Cen5U3 Board of Building Reg ilaflons and Mannar � �-,onstruc r- n S°ti pe 1'S011, i kr..'P'S-0957 07 tYpires : 09/08/2020 ,. 'BRIAN ® DENNISON 7- 8 LACKELLr®RIVE s e� CHARLTON A:=®1507 _ _ I Commissioner 1 i The Cotnitaonwealdi ofMassaehusetts Department oflndustrialAceidents I Congress Street, Suite 100 a Boston MA 07114-2017 www.mms.;ovl&a 11-orkers' Compensation Insurance Affidavit:Buhldens/Contractors/Electricians/Plumbe rs. TO BE FILED WITH THE PE1L%f TLYG AUTHORITY. Applicant Information Please Print Leeibly Name(Business/Organimlion/Individual): &- her e a) Address: /USA UDt IZe� . City/State/Zip:S fq,-HiA e-l ( ,I?! 02'-9 17 Phone#: 40/-ZZ R- c/ ff-06 A�yaa employer'Check the appropriate bos: Type of project(required): a employer with A� mployees(full and/or part-time).• 7. New construction 2.0 I an a sole proprietor or partnership and have no employees working for me in 8: Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'camp.insurance required.]t 9. ❑Demolition 4.rl I am a homeowner and will be hiring contractors to conduct all work on my Property. [will 10 Q Building addition ensure that all contractors either have workers'compensation insurance or are sole l I.[]Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions i.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.* 13.❑Roof repairs 6Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.other 6v iir QI/Z /✓ 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Arty applicant that checks box#I 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 pratriding workers'compensation insurance for my employees Below is thepolicy and job site information /� Insurance Company Name:'Fjre.&A-5 ()rswaA _ W - ON Policy#or Self-ins.Lic.#:2A _3 l!E� g-]Z.G Z Expiration Date: 2.0 L.O Job Site Address: S S' 4/6-s i"la,n S 2 City/State/Zip: ,,,I _ Attach a Copy of the workers'compensation policy declaration page(showing the policy num6ber and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprl'sbnment,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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. f do hereby certi under the p ' d penalties of perjury that the information provided above is true and correct a:Mynature: ' Date:Mp Phone Official use only. Do not write in this area,to be completed by city or town offrciaL 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#: ' 7 DATE(MM/DD/YYYY) ' ,�CCW"'� CERTIFICATE OF LIABILITY INSURANCE �✓�. 12/28/2018 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terns and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder,in lieu of such endorsement(s). PRODUCER CONTACT CoBiz Insurance, Inc.- CO NAME: 1401 Lawrence St., Ste. 1200 PHCN o Ext: 303-988-0446 FAX No:303-988-0804 IL Denver CO 80202 ADDRESS: COMail@cobizinsurance.com INSURE S AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED ESLERCO-01 INSURER B:FlremenS Insurance Company of WA,D.C. 21784 Southern New England VTindows, LLC. dba Renewal by Andersen of Southern New England INSURER C:Homeland Insurance Company of New York 34452 10 Reservior Rd INSURERD: Smithfield RI 02917 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:787175890 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER . POLICY EFF POLICY EXP LTR POLICY NUMBER MMIOD/YYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CPA3158728 111/2019 1/112020 EACH OCCURRENCE $1.000,000 CLAIMS-MADE a OCCUR A D PREMISES Ea occurrence $300,000 MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,00g000 X JECT POLICY PRO. LOC PRODUCTS-COMP/OP AGG $2,000,000 OTHER: $ A AUTOMOBILE LIABILITY CPA3158728 1/1/2019 1/1/2020 COMBINED SINGLE LIMIT Ea accident $1 000000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS S AUTOS BODILY BODILY INJURY(Per accident) $ X HIRED AUTOSX NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ A X UMBRELLA LIAB XI OCCUR CPA3158728 1/1/2019 1/1/2020 EACH OCCURRENCE $15,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $15,000,000 DED I X I RETENTION$ $ B WORKERS COMPENSATION WCA315872924 1/l/2019' 1/112020 X I STATUTE I I ERi AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑N NIA E.L.EACH ACCIDENT $1,000.000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 Ifyes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 C Pollution Liability 7930073340000 1/1/2019 1/1/2020 Each Occurrence $2,000,000 Gaims-Made Policy Aggregate $2,000,000 Retroactive Date 06/20/2013 Deductible $25,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED'POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD R andy@asweetandco.com From: Mike bedard <mike@permitservicesne.com> Sent: Tuesday,April 23, 2019 10:53 AM To: 'Asweet and Company' Subject: FW: FW: Camara of Fisherman's Village in Hyannis From: Paul Baron<baronPm.11c@gmail.com> Sent: Monday,April 22,2019 10:06 AM To: Kim Catallozzi<kcatallozzi@renewalsne.com> Subject: Re: FW: Camara of Fisherman's Village Hi Kim, Thank you for reaching out to us regarding the replacement of the windows.There is no specific written approval needed, but we require that the window be the same design and as close to the original color as possible. If you need approval, please accept this email as one. Regards Paul Paul A.Baron President Baron Property Management,LLC PO Box 1682 East Dennis,MA 02641 Email:baronpm.11c@smail.com Office:508-38S-9499 Fax:508-385-7565 Cell:508-360-1SS7 On Fri,Apr 19, 2019 at 10:44 AM Kim Catallozzi<kcatallozzi@renewalsne.com>.wrote: Good Morning, Our company is seeking approval of a 4 window project for Daniel Camara of 855 West Main Street Apt 2. If you p Y g PP ( ) P 1 p could please let me know what is required to gain said approval, it would be greatly appreciated. Thank you. Kim Catallozzi Permit Administrator Renewal by Andersen of Southern New England 10 Reservoir Rd. 1 ti Hello! Jorgen and I had Home Depot come out for new windows on the cottage-#24. Any issues? Probably 6-8 weeks before installation. Let us know. Melissa and Jorgen <1-K4PRT33_Customer Specification Sheet_taylor.pdf> Sent from my Whone The information in this Internet Email is confidential and may be legally privileged.It is intended solely for the addressee.Access to this Email by anyone else is unauthorized.If you are not the intended recipient,any disclosure,copying,distribution or any action taken or omitted to be taken in reliance on it,is prohibited and may be unlawful.When addressed to our clients any opinions or advice contained in this Email are subject to the terms and conditions expressed in any applicable governing The Home Depot terms of business or client engagement letter.The Home Depot disclaims all responsibility and liability for the accuracy and content of this attachment and for any damages or losses arising from any inaccuracies,errors,viruses,e.g.,worms,trojan horses,etc.,or other items of a destructive nature,which may be contained in this attachment and shall not be liable for direct,indirect,consequential or special damages in connection with this e-mail message or its attachment. 2 Smithfield, RI 02917 w: 401-450-0708 Renewal ByAndersen.com Renewal by Andersen sells,installs,and services energy- efficient replacement windows and patio doors resulting in beautiful homes and delighted homeowners. Our Company Mantra: Renewal. m.P., &fiw-tv ear: , ft lIF111911 l Shea, Sally From: Shea, Sally Sent: Wednesday,January 23, 2019 1:44 PM' To: 'boniejoanie1 @comcast.net' Subject: Home Occupation Registration/Business Certificate Pre-Applicaiton Hi Joan, We are in receipt of your request for a Home Occupation Registration along with the Pre-application for the Business Certificate. There is a $35 fee required to register your Home Occupation. This is a one -time fee. The Business Certificate form once signed must then be taken to the Town Hall building to obtain your Business Certificate. We are open Monday— Friday 8-4:30. We accept cash, or check. Thank you. Sally Shea Town of Barnstable Assistant Zoning Admin/Lead Permit Tech. 508-862-4031 i Any individual,partnership or corporation doing business under a.name. other than their owr� name or incorporated name,must file a Business Certificate. Any individual.,partnership or corporation doing business under a name, other than their own name or incorporated name,must file a Business Certificate. The certificate fee is$40.00 and is valid for 4 years. The Business Certificate form is must be submitted to the Building Division for review and signoff by the Building Commissioner. The form is then submitted to the Town Clerk's Office for processing. Town Clerk Building Commissioner Barnstable Town Hall Town.Offices 367 Main St,Hyannis 200 Main.St,Hyannis 508.862.4044 508.862.4038 Under the provisions of Chapter 337 of the Acts of 1985 and Chapter 110, Section 5 of the Mass. General Laws; business certificates shall be in effect for four years from the date of issue and shall be renewed each four years thereafter. A statement under oath must be filed with.the Town Clerk upon discontinuance or withdrawing from such business or partnership. Copies of such certificates shall be available at the address such business is conducted and shall be furnished upon request during regular business hours to any person who has purchased goods or services from such business. Violations are subject to a fine of not more than three hundred.dollars, ($300.00)for each month during which such violation occurs. ' he issuance of a Business Certificate does not imply that all relevant licenses required to ,egally operate this business have been obtained or are current. This certificate only records that a business is being conducted. a,55,t3 W. � r . P �^ ,Q I I O wr1 0 lVe -n�S l - - - -——-- - Ago 2,00 .st 1 11 1 11111111 11 111111 11111 11 1 11 1 11 1111 1 \ T - R Town of Barnstable Building . - LPg,7. "r..::lAl'*'N3'T¢IT3CA�t t►l�r:.,+°":..".. i$s'.Card�5o That tt is'�U�s�bl:e.'%F'r�om'/x the Stree t-A P'n1'ro ved"'P.lan's M ust t�"b.e.Retain:e,'d on��;Job� �n'Ssd� this�Ca�r:=.,zdt �M usxt,. be Ke pt eljj t _ Permit NO. B-17-762 Applicant Name:. . .0& F REMODELING Approvals Date Issued: 04/10/2017 r Current Use: —" Structure Permit Type: Building-Demolition-Accessory Expiration Date: 10/10/2017, Foundation: Location: 855 UNIT 1 WEST MAIN STREET,HYANNIS Map/Lot 249 031 OOB Zoning District: .SPLIT Sheathing: Owner on Record: PAPPAS,MARIANNA E Contractor Name C&F REMODELING Framing: 1 Address: PO BOX 188 Contractor License 153792 2 �i a m.. ._. .,u. a� CENTERVILLE, MA 02632 f Est Protect Cost: $3,000.00 Chimney: Description: To fill in a swimming r P g Permit Fee: $50.00 Insulation: Project Review Req: To fill in a swimming e, Fee P�d`' $50.00 Date 4/10/2017 Final: ... ...... "y t Plumbing/Gas m bing/Gas: Rough Plumbing: r Building Official Final Plumbing:, This permit shall be deemed abandoned and invalid unless the work a homed y this permit is commenced within s mo'ths after,"issuance. .; Rough Gas: All work authorized by this permit shall conform to the approved"application and the approved construction documents,for which his permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zon ng by laws and codes: Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public mspec•tition for the entire duration of the w work until the completion ofthe same. 2 01 Electrical The Certificate of Occupancy will not be issued until all applicable signatures bythe I3u�ldmg and Fire Officials are:provided onthls permit. Service: Minimum of Five Call Inspections Required for All Construction Work 1.Foundation or Footing3 r Rough 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed priorto Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map d 1 Parcel D��� Application #"'P' ' —7 V Health Division Date Issued O'y /o /7 /erg Conservation Division Application Fee Planning Dept. Permit Fee S-50 ' UO Date Definitive Plan Approved by Planning Board — Historic - OKH _ Preservation/Hyannis Project Street Address ?55 Village YMNN6.9 Owner FI-M KMANS 1111144C &nDQ 45SOG• Address 5AmF Telephone 50 S•3$5• g4 Rq Permit Request TO F r L L 0Q S W IMH'N& PD o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 3.000, ®D Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# Lfagjt�aLDING®EP-'. Age of Existing Structure 0 + W-9 Historic House: ❑Yes ❑ No On,�ld.I iiyVfghway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other N►AK J G n�N OF Basement Finished Area(sq.ft.) Basement Unfinisha" 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: Y//existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� (.(ems Telephone Number Of0 J v- Address 71) rAV:&�',�, LLI- -1 C-S d2- License# D y l o Home Improvement Contractor# ��- Email C+lFt6-Cf:i Vi-I&A J000. OPMA-16� .Worker's Compensation # A LUG.yO-703d ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO n.-a SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE I .. OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING it DATE CLOSED OUT ASSOCIATION PLAN NO. i 27M Commo7nveah*of Massadrmeft DePartmentofradushitAccidezzir 41. - Office 00M.. gafiew. f 600 Washington street -- Boston,MA 02HIT -Fvr mmasxgavfdia Warkers CompensafionIusuranceAffidaviL dex �;antract�rsJElecErtcianslF hers �ImUcant Informafign Please Frin y Address: 20 cttet �-VAA phoneiv:,-_ rare you an employer?Check the appropriate bay I.❑ I am a 1 v&h 4. El am a general confractor and I Type of project{requir edj': �P employees(full andforpart-time.* trovehiredthie sub-contractors 6. ❑New consbu�on. . 7.(M I am a sole proprietor orpartaw- Tisted on the attached sheet 7. ❑Remodeling ship and have no employees. These sub-corifractars have 8. Demolition ,wa lying far me.many rapacity`. employees and lire wogs' JNo wddJEIS'CAmp.iravtranre COLIIp.En¢Terartc• $ 9. ❑Building addition ! required-] : 5. 0 We are a oorparation and its 1 El Electrical repairs or additions 3.❑ I ama 11 aeawmer doing all wank officers have:exExdsed their 11_❑Plumbingrepairs or additions mp'set€[No workm'comp- rigb#of exemption per MM v fizuranrerequire&]i c.152',§1(4handwehaFveno 12 El Roofrepairs employees.(No WQt-kem, 13-❑other conq_kmraflw require&] r 'Ampapprica fatchefsbosffil— also M=ttheswflcmb9awshuvdnZthekwales'comp easatinupaIicgiafo�saon 1 F€ameoamerswlm submit ids sFSdark b&=tMg they ass dGMg RU WC*MM&&M bfM out a cvnbxct zmst mbmit a new affidaeft indicaiino su`fh fCautcacta6$st d�eclr tlgs bear mast attadse�as additi-st sheet sbouiiag then—of the sob-canvscarrrs and state whethet orxm those enktieshav empiayees.Ifthe ib-c�sbare empioFe?_%dLeYmmstFrni&&ir stem,C 'P.raker um beL lam an eTnipla r Heat ie pratritiittg markers'eaet�rertsrde'art utsrurre�ca jar my elrrp eex Befoav is flte pvHgy and jab site in,formadom Insurance Co .Nt ame: mpaay . 'Policy lt'or Self-ins.Lie. �lC�® 0 3� `C a���� (14 l 1~xpiaatiouDate= - � �'�3 0 �i k Job Me Address Cy S � S',L Citg/Stafef�.tp ,v[ Attach a copy of the workers'con.pensationpoRcy declaration page(showing the poficy nmiber and expiration date). Failure to secmm coverage as required under Sm ibn 2 5A of MGL c.157 can lead to the imposition of criminal penalises of a tine up to$UQa OQ aarlfor one-yearimprisogmeat,as well as civil penalties is the fora.of a STOP WORK ORDERaud a fine of up to$250.00 a day a, ainst the violator. Be adiised that a copy of this sbhment maybe fxwarded to the Office of Imresdgati,ons of''the DIA for imsutmee coverage verification_ Ida hemzt r cW#JY W Pa s and psnaMes°fp ry thattJre informaawiptbtudeda.bmv is true and correct. Simmtgre- s Date- ® 3 J l ` f Phone Qowai we wild. Da nat wrke in fiefs area,&be CaMpIdesd by dY or town official � City or Toww Perm hTkense# I L ing Authe►ritp(tacle one): oard of Health 2.IIuTrmg Departm.�eat 3.#�Town Clerk 4 Electrical inspector S.Plug Inspector ther actIlerson: phow#. i L � orm anon. and Mstructions L&ssaahasetjs Ge�=Zal LaWs chapter 152 rcqairm all employers to prOvtde WOIIMs'cnIIlpenSafiOn fur their en3pI0yee9. pmsua�tn Ibis sf ,331 MMplayee is defimed as¢-evMy pra M M the service of another Mder M331 cMxact of bae, express or implied oral or " An enrplQym'is defined as ran individual,partnersb�p,associaf cm,corporation or Oilier Iegal entity,or any two or more of the f)egoing is a joint eoterpase,and mcbrag the legal of a deceased employer,or the receiver or trustee of an indiv13u2l,pMShip,association or other Iegal emtify,employing emPlnye - However t$e owner of a.dwelling horse having not more than three apartments and who resides therein,or the occ¢gant ofthe - dwelling house of mother WWhO empIDYS p=S=tn.do mahtmance,consUncticyn or repair wo&on such dpreIImg hayse or on ds the groun or building appu rteumitthe rcb shallnotbecanse of such employment be deeme dto be an employer." MGL chapter 152,§25C(6)also sizzs that"every sfa:tn or local licensing agency,shall wifhhold$ie issuance ar renewal of a license or permit to operate a bvskess or to construct buildings In the commoawealti for any a-PPILc=twho has not prod-acedacceptable evidence of compliance with the insurance.coYe)mge regnirecl-" Additionally.M(H_chapter 152,§25CM states fiTeiiher the nor ray ofits poIifical Subdivisions Shall anf r mtD any c oat md for the p an ce 0fpnblic WDIk 11 tiI acceptable evidence of complia nce Wlth$ie insar�mce. reqIi3_rraentS of this chapter have been.presence to the eo—nf,actirig aathomty-" Applicarrt_s Please fill obt the Workers'compensation affidavit completely,by checking the boxes that apply to Your srb atEon and,if necessary,supply sab_mnt mctor(s)name(s), address(es)and phone n mbe_r(s)along with their certtCic2t`--CS)of insurance. L=itrdLiabffity Compa>aes(LLC)or Limit LiebfiityParta=hs ps.(LLP)withno employees otheriianlhe members or partners,are not rbquaed to cagy Workers' compensation insa ance_ If an LLC or LLP does have employees,apolicy is required. Be advised that this af&dayitmaybe s�idnd try the Depar[ment of Industrial Accidents for conformation of insm-mce coverage_ Also Be sure to sign and date he affidavit. The affidavit should be retOmed to Ihe city or town that the application for the pemit or license is being requested,not the D epailmr of rT rim ai A=de nt?, Should you have any question regar�g$ie law or if you are regnraed to obtain a Workers' compemsationpoliey,please call theDepadmentat the-n=bMIistsdbelow Self-kscnedcompaniesShonldenZrtheir s elf_h u ce fi e number On the approgriafe Ifim City or Town Oft xxcials f Please be sore that the affidavit is complete and prided legibly. The Departmenthas provided a space at,tiie bot bom of the affidavit for you to fM out in the event the Office ofInv has to comet youregardingthe applicant Please b e sure to fill in the pea>nhllice nse number which Will be used as a ret�nce number. In addition,an applicant that must submit m uhiple pennit(liceose applicafions in any given yea,need only submit one affidavit indicatmg cuo ent policy information.of nwzssaiy)and under°Job�e Address"tie applicatit shoT�Id W>D"all locations n ( ' town)--A copy of the�affitdavit that has been officially stamped Or marked by th a city or town may be provided to ilia ' applicant as proofthat a valid affidavit is on file for futrne.pesmi!S or Iiceuses. Anew affidavitmzjst be filled oiit each year.'Whew a home owner or citizen is obtaining a license or permit not related to any business or commercial Tautru (Lo. a dog license or permit to bum leaves eta.)said person is NOT required to complete this affidavit T1ie Office ofTny to youthadvance for your cooperation and s. shouldyanhave any please do not hesitate to give us a MIL i The Depar rn mfs address,telephone and fax mimbe�r: CG a of ns Depazfimmt cf lnd Aocidants Bastrzn,MA(2111 D,1 . 61 - -4- Mft406(rI477MA&gAFE Fax#617 727 7M Revised 4-24--07 gagITa Town of Barnstable' - ,, , :;, Regulatory Services � r3' s MAB& ` Richard V.Scali,Director s a�nes. Building Division Paul Roma,Building Commissioner, 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma-us Office: 508-862-4038 f:. Fax: 508-790-6230 kj k Property Owner .Must ` `Complete and Sign This Sectori If Using A Builder . 4, *.-r- -musim I, n DA SIM— k . ,as c of the subject property hereby authorize r. 17 R�K01)Qrh 8A to act on my behalf in all matters relative to work authorized by this building permit application for. 896 w ST.. Oais 7 sl (Address of Job) 'k*Pool fences acid alarms'are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final, . inspections are performed and accepted. CM L497 f Signature of Ova er Signature o Applicant Print Name Print Name Da flee , Q:FORM&OWNERPERMMSIONPOOLS Town of Barnstable Regulatory Services ' dF Richard V.Scab, Director Building Division � Paul Roma,Building Commissioner i6s9� `�� 200 Main Street, Hyannis,MA 02601 Ep www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION DATE: �aO (,) Please Print JOB LOCATION: SSS CST MAIAN �IAN I S number street village "HMlEOWNERn:VI*Grt*4k kh the 508'385--R'�'q�1 name Q^ �t home phone# work phone# CURRENT MAILING.ADDRESS: P0. fox 16 a EAST D&-W i 15 MI R qk 14-1 crty/tovw state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual,for hire who does not possess a license,provided that the owner acts as supervisor. ' DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such,use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for.compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. ^` I The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Sign f own i Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required . shall be exempt from the-provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires,unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. FISHERMAN'S VILLAGE CONDOMQNIUMS 855 West Main Street Hyannis, MA 02601 March 20, 2017 The Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 To Whom It May Concern Re: Pool Closure Please be advised that the Board of Trustees of the Fisherman's Village Condominiums.have authorized Carlos IFigueiroa dba CNF Remodeling to act as general contractor for the work required to fill in the association's pool. Please contact the management company at 508-385-9499 should you have any questions regarding this matter. Sincerely, i Linda M. Stevens, Trustee Do -: 1 F 156 r 227 12-21=-2010 1 :00 i ARNSTA LE LAND COURT REGISTRY FISHERMAN'S VILLAGE CONDOMINIUMS CERTIFICATE OF BOARD MEMBERS AND ADDRESSES" PURSUANT TO MASSACHUSETTS GENERAL LAWS—CHAPTER 183A I, 416 , ereby certify that I am the Secretary of the Fisherman's Village Co ominium Trust (Declaration of Trust recorded in the Barnstable County Registry of Deeds, Document No. 163081,Master Deed recorded in the Barnstable County Registry of Deeds,Document No. 168536,as amended on 7/26/72). . I hereby acknowledge and attest that the following individuals have been duly elected and presently serve as,Trustees of Fisherman's Village Condominium Trust. Linda Stevens,855 W.Main St. Unit#19,Hyannis,MA Dennis Marchant, PO Box 442,Barnstable,MA 02630 Marianna Pappas,PO Box 16387, High Point,NC 27261 I hereby attest that our legal mailing address is: Fisherman Village Condominiums P. O.Box 1682 East Dennis,MA 02641 I hereby attest that Fisherman's Village Condominium Trust, having duly contracted with Paul A. Baron,Baron Property Management,its Managing Agent, is authorized to execute Certificates of Lien (6D) and to both receive and send notices of a legal nature, regarding Fisherman's Village Condominium Trust. Any current Trustee has also been empowered to execute Certificates of Lien (6D). Witness my hand and sea this ' day of_ h e c ew 6 e r ,2010. s Secretary and Trustee COMMONWEALTH OF MASSACHUSETTS Barnstable s.s b e c e-i be r /3 , 2010 u Then personally appeared before the above named, Acknowledged the foregoing instrument, by her hand subscribed,to be her free act and deed as Secretary, before me. My commission expires Notary Publi,-/" �BARNSTABLE COUNT)( �— REGISTRY OF DEEDS MICHAEL J SHOEMAKER A.TRUE COPY,ATTEST � Notary Public 1 Davidson County N12 A DE R� pis; R North Carolina - My Commission Expires Jun 25, 2011 AARNSTABLE REGISTRY OF DEEDS MICHAEL CASHEN ELECTRICIAN 1553 ORLEANS RD HARWICH, MA 02645 LIC#1342213 To Whom It May Concern: A on site inspection of the pool at 855 West Main ST. Hyannis was completed on 12/22/16. All electrical wiring for pool was disconnected and removed. Michael Cashen 774-212-1852 nationalgriaw March 29,`2017 855 W.Main St Hyannis,MA To Whom It May Concern RE: 855 W.Main St,HYA This letter is to confirm tha1.t National Grid has verified there are no natural gas services at the address above. I can be reached directly at 508460-7484 should there be'any further questions. Patti Weldon nationalgrid Sr.Sales Rep mComplex Gas Connections 127 White's Path S.Yarmouth,MA. 02664 508-760-7484 desk 508400-5051 cell 508-394-1109 fax patricia.weldona,nattonalgrid.com 4.z THONUS NORTH PLUMBING,(HEATING&AIR InvoiceCONDITIONING, INC. Lic.#15520 35 Cottonwood Road Harwich, MA 02645 508-430-1150 thonusnorth@hotmail.com http://www.thonusnorth.com Paul Baron Baron Property Management 55 Lady Slipper Dr. East Dennis, MA 02641 ''-iNvOICE# DATE w TOTAL DUE DUE DATES TERMS `}ENCLOSED 4104 03/31/2017 $0.00 04/30/2017C.O.D DATE SERVICED AC(IVITY ' x K"„ QTY HATE ' = AIv10UNT 03/29/2017 'Labor:Plumbing repairs 1 0.00 0.00: 855 West Main St O Hyannis Inspect property for gas line to peing, molished. -Checked pool area, adjacent urrounding areas for gas service lines. - Did not find any gas service lines or equipment above ground anywhere or inside the pool house. - It is always recommended that a mark out be done before excavating.R BALANCE DUE $0.00 i Construction Supervisor Restricted to: Unrestricted,-Buildings of any use group which contain' i less than 35,000 cubic feet(991 cubic meters)of enclosed " space. i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: VVVVW.MASS.GOV/DPS. \ i . A (] aOX N r o n =�0 C N � fD C. N O c D O m . . . . . . AZT O fA— W O O 'C rnI O N cn a as ;eu6is}noq lm plan'o ti aj�asjapui D ' o v %a�RZO t1W`43nowjek g ;-_ _ _ � f' ,, .__ •�"�� ;�'`-:-I 'pd��aAoN ule;de0 OZ rw ... m ! lei Ei 4lNt�'M 3aOW3a'�'8.0 a ' NIL... O 1. 9LLZ0 VW uotso �.._�r. N O ; I OLLS a1InS-Bzeld Ted 01. 6LOVLO/40 m uollein6ad ssaulsnq PUB site++y jawnsuo uolle� x a ' O+o ao!;+O 3 ol3e�fsl a r a :ol uin3aj puno;+l 'elep uol;endxe ayf aao aq "rn (Iuo asn IBnP!niPu!Jo+PllBn uol;eJ;s!6a 0dA uO-aVsN031N3 O:l W mkr�_ w auisng 3o W+eOHiDY- Y - - — — oP;7aaa��vrr..vn���oam2oouvecoop� a� Town of Barnstable OF THE Regulatory Services Thomas F.Geller,Director s Building Division + RARNL`I`ARi.F • Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 'I www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: - 4--D Permit#• HOME OCCUPATION REGISTRATION Date: (-a Name: esl C Phone#: hay Address: 0 - ; Village: f Name of Businness: l rK k2UnG7 I C Me—mal d-- Type of Business: �I Pi�I I�Y�CI ICIQ Map/Lot: INTENT: It is the intent of this section to allow the residents of the Tollm of Barnstable to operate a home occupation_ xazdhin single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the acdvIty shall not be discernible from outside die dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anyding other than a residential use;no uicrease in traffic above normal residential volumes; and no increase in air or grotmdxaater 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 11ithin that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to die 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 die Customary Home Occupation,.and not xxit in tie 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 tie Customary Home Occupation is listed or advertised as a business,die street address shall not be included. • No person shall be emplo ed in tie Customary Home Occupation xvho is not a permanent resident of the dxve �rag nit 1,tie undersigned h ve r d n agree With die above restrictions for my home occupation I am registering. Applicant: Dater Homeoc.doc Rev.01 0 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 MO 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: 7-/ 4t � ' ,. Fill in please: ..: .... c APPLICANT'S YOUR NAME/S: �R BU IN SS YOUR HOME ADDRESS: y� �.. 4. CR g •, ' '�' TELEPHONE # Home Telephone Number 44111 .NAME fJF CORPORATION . ; ... . . . NAME OF NEW BUSINE5S e ✓T1 / TYP.E OF BUSINESS — IS 71 IIS A HOME OCCURA�I N? YES IVU ACIDRESS OF BUSI ESSe,' hl... . C�:: t' MAP/PARCEL NUMBER o�4 . ('�.' L�UL[Assessing) When starting a new business there are several things you most 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 CO ISSIO ER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individ al h s for an RULES AND REGULATIONS. FAILURE TO . In y per it requir ents that pertain to this type of busines�OMPLY MAY RESULT IN FINES. Au orize ig atur * COMMENT l' S Qn S 2. BOARD OF H LTH This individual he e inform d f the par it req 'rements that pertain to this type.of business. Authorized Sig ature* 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 BUILDING PERMIT APPLICATION :-,'ApplicationSl Map Parcel Health Division 'Date Issued Z Conservation Division Application Fee ;(co Planning Dept. '!Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH - Preservation / Hyannis Project Street Address 9-5S all Mhlilv SQL k Village Owner 1 6}''0-e/t/ -ed Address tk�. �, 11W sli -Olt' Telephone S O-72( - E/T D 1Permit Request ZV S l TA0 0 '� �i� /'✓'� . P Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation e �0 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 I new_' C Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor Roo'n'lCount Z w Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other t -,: µ Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 13 Yes1,2U No r`7, Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) l / Name D set) Telephone Number E0 2 Address r�l License # 7c-0 2 Z t ,/, L bvyl 0 � 7 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS ES ING FROM THIS PROJECT W�LL BE TAKEN TO v SIGNATURE DATE r 7J1 i 7 . FOR OFFICIAL USE ONLY APPLICATION# -DATE.ISSUED ' - K _ MAP/PARGEL N0,_ r � . t a ADDRESS. VILLAGE OWNER DATE OF INSPECTION: FOUNDATION , a FRAME INSULATION- 2 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS 2 ; _"" ROUGH: :t ;' FINAL s FINAL BUILDING r,,_. 4 S f_DATE,CLOSED OUT ASSOCIATION PLAN NO. 6 ri 'y The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations w° 600 Washington Street F Boston, MA 02111 www.mass.gov/dia Worker's compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): , _ �oS �✓. Address: . ��/�jG'�✓1/ �_� City/State/Zip: /'�� G�� •/' l�• Qe �NC Phone#: S09✓ Are you n employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4.❑ I am a general contractor and I have 6. Vemodeling construction employees(full and/or part-time).* hired the sub-contractors listed on '7. the attached sheet.$ 2. ❑ I am a sole proprietor or partnership These sub-contractors have 8• ❑ Demolition and have no employees working for employees and have workers' comp. 9. ❑ Building addition me in any capacity. [No workers' insurance.$ 10. Electrical repairs or additions comp insurance required.] 5.❑ We are a corporation and its officers have exercised their right of 11. Plumbing repairs or additions 3• ❑ I am a homeowner doing all work exemption per MGL c. 152§ (4),and 12. ❑ Roof repairs myself. [No workers' comp. we have no employees. [No workers' 13. ❑ Other insurance required.] 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 hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attach 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: LTfY "y Policy#or Self-ins.Lic.#: C 3 J 9 . 206 y00,xpiration Date: f Job Site Address: 13EJ W- ' ' 4 - "W/ k City/State/Zip: `✓ S• r v � 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 stateme ay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb ce fy under a pa' s a nalties ofp u that the information provided above is tru nd correct. Signature: Date: Phone#: Official use only.Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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) 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 compliance with the commonwealth for any applicant who has not produced acceptable evidence of com p insurance.coverage required.'.'Additionally,M.G.L. 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 applies 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 Site Address"the applicant should write"all locations in (city or town)." A copy of the affidavit that has been officially stamped marked b the city or town may be provided to the applicant as roof that a valid affidavit is on file for future or Y Y Y P PP P 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 burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # (617) 727-4900 ext. 406 or 1-877-MASSAFE Revised 11-22-06 Fax# 617-727-7749 Revised 12-14-06 www.mass.gov/dia 4/26/2012t8:30:17 V4 PST (G-MT—e) FROM: 100005-T : 15087102086 Page: 2 of 2 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND COMERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT SETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CER71RCATE HOLDER. ;i IMPORTANT: If the certHicete hoder is an ADDITIONAL INSURED,the policy(les)must be endorsed. It SUBROGATION IS W NED,subject to j the terms and conditions of the policy,certain policies way require an endorsement. A statemeat on this certificate does not confer rights to the certificate holder in Lou of such endorserne s. PROMN-ER PAUL 0 SULLIVAN INS AGCY INC CWTAM 1467 S MAIN ST FALL RIVER,MA 02724 AFF N)"COVetAGE Nw 40 14URM A J SEPH DUARTE&JOHN DALEY "s` DBA J&J REMODELING "SURM c: 15 WILSON WAY ers a: MIDDLEBOROUGH.MA 02346 E Rf COVERAGES CERTIFICATE NUMBER: 12951222 REVISION OVER: 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 WHCH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY ThE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND COWITIONS OF SUCH POUCFES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LOUTS LTR Tr►E of rsSYRAacE L POL�r Nta CENERALLWaRITr t:ACLiDGCt)RiENNCP S COIrUdM AL GENERAL LIABILITY CLArdS44F OCCUR i I 6ED EXP An one peraoa) I; 'i PERSOWAL 8 ADV 19JURY S ! GENFRAL AJ tGREGATE f GEM AGGREGA1*L(Wr APPLIES M: PRODUCTS-COAPtOP AM S POLICY PRO COG CWT AUTOMOBLLE LlAaiTTY s s S RNY AUTO somLY NJURt(Par panwi f , ALL OWNED scmwLEC i_ BODILY NJURY(Par aCci�f) AUTOS AUTOS ALITOR AUTQ W !11 I g i I S FJUNiaRKLAUAR .ODOUR EACHOc f MEBa NAe i AGGREGATE S ClAMt4MA0E ! 1 f A woes mS cavPer+B^Tlow WC5 I FBI, 31 S-384800-012 2t212012 2/2/2013 f wL A Auo&WLoreRS•UA5IWY v r N E L.EAc1+AccmENlr O S r1009r, ANY PROPRIETOPRARw0KxECVTNf F f AGE WbAEMBEF E]LCA.UDED? Te 1 A EA.plSf.EA EMPLOYE S 1 (NhlnOslory io NH) ll rres,daswAe under E.L.CESEASE.POLICY LOOT S SDODO OESCR PTION OF OPERATIONS w 1 I >1 OESCRV"ONOFOVERATIONSILOCA—SIVEKCLEe WWII`ACdICA40'at*.d*anudwsdwdWggmmeap'"b+*quire* Workers compensmtion insurance coverage applies 0*to Me workers conVensalion laws of the state of MA. NO PARTNERS ARE GOvERED 8Y THE WORKERS'COMPENSATION POLICY. ; TI ATIE HER E SHOULD ANY OF THE ABOVE DESCRIBED pout;WS W CAMML D BEFORE TOWN OF BARNSTABLE THE EXMATIOW DATE TNt�f, NOTICE WILL BE DELA(CAM Of 200 MAIN STREET ACCORDN CEWITHTHEPOLICY➢RtI1It MS. HYANNIS MA 02601 AUTTaRIMwAVRRSWATW ,- Jiff Eke e 019>l8,2010 ACORD CORPORATION- All rights reserved. ACORD 25(201 OM5) Ttw ACORD name and logo are Registered marks of ACORD tAas cnrCrficnCaZ2Lncels andreuplrseQesr ALL pzeviouSl%r issueGa ceztillcatess� Fn9a i of l •�+ �� I�C+"'�Y�'FPE`5'Eh. � �gip./ !� f o¢fIGe of Consumer Aff airs andusinesS RC',gall tion 10 Farm.Plaza - Suite 51 (} Boston, Massachusetts 0211.6 Home improvement Cta tractor Rdp-istratiatl Rpoistration. 132348 Type: Partnership Expiration: 1I11/2013 Tr# 207392 J & J Remodeling - Joseph Duarte -- 15 Fail St. Wareham, ma 02571 Update Address and return card.Mark reason for change Address D Renewal 0 Employtuent [j Lost Card �Ps•Cni 0 Sohn-04roo-0101216 a rs ,�sine�s';'Regu a on License or registration valid for individul use only Office o oosu before the expiration date. If found return to: Vem SOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: ., 132349 ' 10 park Plaza-Suite 5110 Expiratlon: :�ltiJ2013 Partnership Boston,MA 02116 Tye odeling;. 6. E Joseph Duarte �.'1���("� 15 fall St. — ' of V d without signature Wareham,m8 02571'. Undersecretary �l:to<:►chu:Mto- l)cl►.t,n►ler►(of Puhtic'Nafcq 1 Sr)urd of Bui4ttin'2 lit?'ulatiut►s autl`(a,tdard� Construction Supervisor License License: CS 70077 J0SEPH C DUARTE 15 FALL ST WAK AM,MA 02571 s , • _ �, Expiration: ty3012p12 `_ Tr#: 70 - - - _ Z9LGSGZ ES:TZ TZ@Z/Z0/t0 I6 3r9Vd FISHERMAN'S VILLAGE CONDOMINIUMS 855 West Main Street Hyannis, MA 02601 4 May 7,2012 Town of Barnstable Regulatory Services Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 Dear Mr. Perry, , RE: Fisherman's Village Condo Association:,, Erik Groeneveld-Unit 16 On behalf of the Board of Trustees, please be,advised that.permission has been granted to the unit , owner, Mr.Groeneveld of Unit 16,to install 2 patio doors and 3 windows at Unit 16.The window! and' doors will be the same in style,size,and color; Please also be advised that permission has been granted to Home Depot and Mr.Joe Duarte of J&J Remodeling,the contractor,to.install the windows and doors for Mr.Groeneveld., Should you have any questions; please feel free,to contact my management company at 508-385-9499. Si I , Paul A. aeon R , PropertyManager- HOIMkt JMyWVWAE NT CoNTVACr t PLEASK RM TMR Sold.FitttUAW aed bomW by. srmv na�a Rtartte Ihtu ! THD A14km=Stllvleest Im. dWs The promo Depa At-Uww Ser Amo 3d5A Qtaa wmd Street,Uoit 2.Waroeecm'.MA 01607 Beaaei Nember:31 TNI Feoe(sm)657-sum ):.(St)f))7.%-w23 Fadetd M 49 75-2151)841110;ME Ut#C 02499;itl that,U016427 CT uC 0 m5m 3dA Kama Cooaactor Ba.11126891 InubdIation Address: _$. (.t,1.. . i.a�16 a cry stad 4 Ld w�a): 18moe Cdfl6w+e: C�Q v r at f 1 11271170z6704 tbWeAddteal: _ _ _ (If ddkmt$nM bNa►lation Addrew) City $uw Z;p 16-10 l Addraw(lo MCeiw prujaat aomm ftivmimm and w(mw D"t npdwLt„ 100 NOT wish W receive arty anrketing entalls fivm The Rome Depot feet lof®o+aoe: uadmlivwd("Cstataawl,the owm t uf the pnvLny ltltcrtea at the dean inmitation address,agmu co buy. and THD At-Motet$avkes.lm.C'M nome Dotal AFeee t0 tmiffi,"vw and a m"V far the im tallstmm(1nft&v&e).of aq mW9rials described as rho below and oo slte rd=nced Spec Sboa(s).AN tit whkA am h unlwytM htto this(earner q min t f Vie,Haim*with any applicable State Svppleoum and Paymmi Sudiamy atuchw hrnm oral any 0tsngo Otdefa(cdkdvdy. Jab A:samat.tate.en $ COP61 • n.e ed Acmam,f ltmofing[194,46 Win4owc Immtttaaa �L l lls� oc lC~DFAIr7 Doan a 6 D 3 Roorms 031wits U Windows EYINIVIAAm „E OGuaw f Gown prutry Uoors p Dlkoor w LISiding❑Wimb,wn Q Inwhaiun _. •,� �QOumn f Cwvm Cheney Dour❑ Y . t.1�61Yt(�IdmR 0 Windo+va�ironfaioo .__ . poutwsfcu m buyD%n D S hthramm napt�tdC..dsnalAm®mdocup(mtexwo,dm,afeftewian. potatt�atsanAattltme !uncttiamwtet�maac�aimorce,.ntwodd,dormcu�aurecat $ �D Ctultneer spree.tbsr.Itamediulely"pm Completion of the wrack fw each Pmdun.Customu win tam-uk a tau wed m Cagifims (oae for enO Product as delimad by an individmil spec Sheet)and pay any bmatuc,tee. Ant qVficalit.. eal,b LUMMK Under d16 Coatrut agrees to be JW Wly sad stv=Uy obbDted and liable 6eremAder. The Home Daps reserves the right to Issue a O mme Order or tet111inafe this Coauaet tar say imtividml PftaksQs)ioduded harola,at its dimetloN If The Now Depot or ib n%Wmiaed suvicc peevlder anarulirtes that it caM prMma its(,W)p6uos due to a tttfumral peobleru with the home,gavlroWneetal hazards such as mold asbestos or lead grunt,Aura%*. ty ta,ut711a,TWdog exom or became wMk tbattirod rm cawflets the jab w.nm Irtclurled in/Om Caaww% . Pavrromt Saaeaaav: The Payment Somataey R 67-T�i 0�� ,)edttded an part or Ihia c;sa ,.m.smell V..toter Contract amour and payments fqu M for the depotja and float payments by ptodaa(as Vokahle).ppr� NOTIM.TO CUSTOMER Yw are mlitlsd to a swat eet Illled-ie copy of lAr(oatrs[!a the linen Yar a"t)g1.I)v t�6M a Ctretpl oom Ctattlittatt(Lek: there la ww t ttmpttdlea(act state for cram dated rrndUca as dtMW by mid'ni L Stlee A-M)bob..work on that ptodw la eotnpit:le. In the t weM of kFMkIIOM d ddS Ctlrfl Uk Ctn{aetet' ass to pay The IldnteDew ales todnarmaderiak labor,expaw and xervkas provided by The home Depot or Ao Sergi Ptovldcr t ttttldt 9re done 4d tecmineuaa amer amo= R�mb get forth in this Agr"meat or allowed aster be law. TNi3 ffo"r DRp(vr MAY VYrI MOMS OW1s"A TO TF N Dwp(y' vat)M '11HE D1F�SAy.vA NT OR OTHKK rAYMWM KAIW,WrMUT 1.INIfl7N4-THE MOMM UWOTPS 07M REMEDIES FOR RECOVERY OY SUCH AbtOUN'tS MeAcce tttr and AathO Customer GPMand votlemeds that tlds Agrowamt u the e4m tlB sit between t wAmu:r he IMIM Dcrowt I&M nega d to the Prodmcm mad iatlallarion services and mrpersedea altpamr discussions and oral or"flim,rC)tliva to said PMdwfs and iestaUstiod•This A,ytuetileet cannot be aLgmd or samaded C a a�wrwal L ed b Custorow aml 71a Kinte h'v m C tti�7lb y t)eprA t'.uslaltter ackrtowtedgts teed agseec that t]I.stoaoer bat react,mlderttaad.,volsatl,nty accsQte t8e tertmt lif ant ha.n=ivod a copy of this AAmearent. Accepted by: (Subset by: t C 7'a S' ro >Yal R■lcs naaltent'x SiBttdate two TelcPhim;No. Cuamater'a Sigrattwe OaaL Sales(:0WVhaat Liaato No. WCELIATIM: t.'t111TOMEIR MAY CANCEL 1121 twasotica6lel AGRPJ MIiNY WITHOUT PENALTY OR 05I•)GAMN NY DELIVERING WRITTEN N017CP TO THE ITOME term(), BY MEW4GfHT ON Tt4R THIRD BUNLNES.R.4 DAY AVM 9ICNIAIC TAMS AGREEMV*T TNY. STATE SUPPI,KMWF AT'rgCE;) HS,It1tTt? COPtTAINS A TORM TO USR IF ONE IS SPE=CALLY PROO ED BY I.A w IN - (•'Ii�TOHgTt'SSTATK NO'DCatADLtMK4LTKNORAMCONOai 11ft ARE RTAtMONTIhRwewieR=AND ARIIRMAppIIIDtCtkn*At'r rta®w G9C Ob-Btr OF05 venma-CmbW PJ*-9>Iaatlanaalmt Z/Z d « 76G>L56QOS 3N0N4•810d)(3Z1.4d 65:2 80-SO-NOZ " 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, 1st FI., 367 Main St., Hyannis, MA 02601 (town Hall) and get the Business Certificate that is required by law. DATE: a081? i°' Fill in please: tm3 1', APPLICANT'S YOUR NAME/S: /LL. rs �r SIN SS �./ Y HOME A DRESS: ' '� TELEPHONE # H eTele hone Plumber 7— / NAME,;OF CORPORATION t i NAME.OF NEW BUSINESS y TYPE OF BUSINESS :' 7S.THIS A HOME.00CUPATI ADDRESS'OF'BUSINESS i' S'7 l/t MAP/PARCEL NUMBE ""� /� (Assessin 9) ���� When starting a new business there are several thin you must ddn order to be in 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 CO ISSIO R'S OFF This individ al h s e ir5far ed any rm' requirements that pertain to this type of � tOMPLY WITH HOME OCCUPATION Auth riz i at RULES AND REGULATIONS. FAILURE TO: COMM -Aw (cd r,J�k cjr) .11� IV : COMPLY MAY RESULT IN:FINES. Or -Aja ` 4c Cf 2. BOARD OF HEALTH This individual has een rme the permit requirements that pertain to this type of business. Authorized.Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) `vim This individual has been informed of the licensing requirements that pertain to this type of business.' Authorized Signature* COMMENTS: . . Town of:Barnstable of s"e ram, Regulatory Services_ 1% Thomas F.Geiler,Director Building Division y MASS, Tom Perry,Building Commissioner s63q �m °ram act s 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 APProved@ Fee: �� Permit#: HOME OCCUPATION REGISTRATION i Date: Name: Phone �J Address: �� `°> e r Name of Business: Type of Business: �/ Map/Lot:—G� ��3I INTENT: It is the intent of this section to allow the residents of the To«Zi of Barnstable to operate a home occupation ,wi2thin single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discennible from outside die d«felling: 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; �1~ and no increase in air or groundwater pollution. Or After registration Hfith the Buildirig 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 dwellirng unit,located mm2thin 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 nornn.al 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 sliall be met on the same lot containing the Customary Home Occupation,and not witlmin 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 trifler 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 pers m shall be employed in the tomary Home Occupation who is not a permanent resident of the, dwe g unit. I,the unders' d,ha r d and -ee ve ref my home occupation I am regfste Q Applic, Date: (� Hon eoc.doc Rei%01/3/08 , v �1 f �� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION , Map Parcel 123 / Application # 2�COZX¢`�7 Health Division Date Issued k 2 `.� 3 \)V Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address '00 WEST /V/f//V J7 OiV/7`5 Village dI%CNN/, S Owner^ K/W_ 1,5 /yf CH,4iV, ALES7,6E Address A 85-5 AA57 1AA1S7 ;,ys�iyit//5 Telephone J641 &6 D Permit Request ST" LX/,57/A/G /yQQ r Shy1A1&ZZF:5 DFF 11A/!ZS 1/1//7ff 3a- Y,P. • ARC#/7EC7///1i4� cat/NGGES - CD Lo,E /A TCfY �T/fE.2 �/A//7,5 IAI CDMP�X - /7 sQ. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay roject Valuatior�7 0 ® Construction Type i Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure &/L7 RM Historic House: ❑Yes XNo On Old King's Highway 4 - ❑Yes XNo � . `.a Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing -•new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing 0 new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use z���/bE'NT1AL_ 601V DO Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) r � �L S� -�36PI Name /Vkre.K /VIC,���.SD/V Telephone Number Address 1a Oie License # /o/ /,•L5- a- ON( ag7Z, Home Improvement Contractor# /33,15/ oxzzL ft'/US At+ 1WS-3 Worker's Compensation # byc,2\-345-36)ff?-D/D ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO LAY/,52s A66 YCt/I✓6- 60• ArC a3 6rlbb A- RD- 1!2Z�,4/vs 144 SIGNATURE /Zq1/b { ' FOR OFFICIAL USE ONLY f 1 APPLICATION# DATE ISSUED .s MAP/PARCEL NO. S c ADDRESS VILLAGE OWNER DATE OF INSPECTION: _ FOUNDATION.' =' ' FRAME 5 INSULATION': FIREPLACE r t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL { N GAS: ROUGH ; _ FINAL ; , r } , : :FINAL BUILDING -'" S DATE CLOSED OUT ASSOCIATION PLAN NO. �_ , The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): /v/c.�Ek�SON 4ME 1,W,e6l/E/"IEN7 Address: /a (.bMMEkCE Zk /5 0• ZI X o?-//76 City/State/Zip: aeLE�iVS /V9 0,US3 Phone #: 501?' o�`7�0 -c308•/ Are you an employer? Check the appropriate box: Type of project(required): 1.CK I am a employer with 6 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑'Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their 11.❑ Plumbing 3.El I am a homeowner doing all work g repairs or additions myself [No workers' comp. right of exemption per MGL 12.Zl Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.[:1 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. lContractors 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: /�jE/Z,7y �(/T(�/li-L CTieDLJj� Policy#or Self-ins. Lic.#: AW-,3/s- 36Q 9&'9-Q/D Expiration Date: 311 Z// Job Site Address: City/State/Zip: 11Y,4A//V1,5 M1 ilWa >/ Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: _ Date. /`Aa Mo Phone#: Jim/ 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#: ACC> CERTIFICATE OF LIABILITY INSURANCE °ATE'M�D°"YYY' `,� 10 2010 PRODUCER ROGERS&GRAY INS AGCY INC - _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 434 RTE 134 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE SOUTH DENNIS, MA 02664 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (508)398-7963 INSURERS AFFORDING COVERAGE NAIC# INSURED MCAS LLC - INSURER Liberty Mutual Group s DBA NICKERSON HOME IMPROVEMENT INSURERS: PO BOX 2476 INSURER C: ORLEANS MA 02653 INSURER D: INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONLTR TYPE OF INSURANCE DATE(MMIDDfYYYY1 DATE tMMIDDfYYYYI LIMITS _ GENERAL LIABILITY EACH OCCURRENCE $ - 7MERCIAL GENERAL LIABILITY PREM SES EREec currence $ CLAIMS MADE M OCCUR _ - - MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GENT.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- MJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO - - '(Ea accident) $ ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO _ - - - OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WC2-31S-360989-010 3/1/2010 3/1/2011 �/ NCSTATU.RY - oTH- AND EMPLOYERS'LIABILITY ` ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N - - E.L.EACH ACCIDENT $ 100000 OFFICERIMEMBER EXCLUDED? ❑Y (Mandatory in NH) E.L.DISEASE EA EMPLOYE $ 100000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500000 OTHER - DESCRIPTION OF OPERATIONS I LOCATIONS!'VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Workers Compensation Insurance:Part One of the policy applies only to the Workers Compensation Law of the State of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION BARNSTABLE/BLDG DEPT DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 200 MAIN STREET NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL HYANNIS MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - - Jeff Eldridge w ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. CERT NO.: 6993491 CLIENT CODE: 1228681 Deb Derochemont 3/10/2010'7:20:51 AM Page 1 of 1 1 w j ! r•lassachusetts-Department of Public S"lctw; 1 Board of,Br ildin keiiulations.>nd'Standard5 Construction Supervisor Specialty License License: CS SC 101185' Restricted to: RF,WS,DM a j . MARK NICKERSON 321 RED TOP ROAD 1t �� } BREWSTER, MA02631 IL Expiration: 10/26/2011_ " t'��nm�is inner Tr#: 101155- j .. I , - i L 'I i I Office of ConasameZ r Affa�rr�s& usr� R ul� �� S g License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: ,133851 - 10 Park Plaza-Suite 5170 Expiration _8/17/2011 Tr# 287107 Type 4Pn a e o poration Boston,MA 02116 NICKERSON HOME IMPROVEMENT MARK NICKERSON `= (=j 12 COMMERE DPoVz ORLEANS,MA 02653 ,% Undersecretary Not valid without signature j ,I k r HOME IMPROVEMEIffs C. PROPOSAL .. NICKERSON Rty4FlNG *SCREEN PORCHES HOME P.O.BOX 247E SIDING -SECOND STORIES DECKS *RENOVATIONS 50$-2S&SI07 FAX HYANNIS,MA 026W, ADDITIONS *INTERIORIEXTERIOR PAINTING www.nickersonhomeimprovement.com SKYLIGHTS -WINDOWSIDOORS E Mai1 mark12026630yahoo.com GARAGES • KITCHEN & WH REMODELING PMCNC fa irE TO: Paul Baron -1.17912010 Baron Property Management .toll NAMC,LOcn„KM P.U. Box 1682 855 West Main Street East Dennis MA 02641 Hyannis dca NUMBER Joe PHONE, No hereby submit speciticaiiorts and ecMrnates for - .•...�.v,. Roof Evi imatc Strip shingles off Units l i and 12, front and back,complete RL-nail all loose sheathing Install white aluminum drip edge on all lower edges Install 36" Ice and Water barrier on all lower edges around openings Install 15-pound black underlayment felt paper on rernaining stripped areas Install new flanges around all soil pipes . Install landmark Wcxrdsc;ape 30 year Algae Resistant roof shingles on stripped area hurricane-nailed Supply all labor. materials and debris removal at$5700 OPTTQnS:To install ridge vent at$7.00 per lineal foot(approximately 41 feet) We PrOpase horcby to furnish material and iabnr—complete in accorowcowlth.iha above spocifications,forlhe sure of: dollars is ). Payment to be mado as follows: $100O deposit requested with accepted proposal Balance due upon completion AO malarial is guaranteed to be os spoactort,An work to be completed in a pmlessional namor a=rding to standard practicus.Any suo►bon or dowatton from abowspecificotions Amwized invoMng oft costs w01 be a mmsed only upon wriftn oxw%and YAO oocoma an extra *nature dvaMo owx opt&Ww the eWmte.AU egawnents eantingWA upon 01M.aaidents or delays beyond our conM Ownttr to c wy rue.tonndo%and other neoug*y Ifl$fI uvo.Our Note:This prooml may be . workers are My cowroo oy woremn t anpercsatm w ance. wehdrarwn by us If not accopted wirldtin �V' Acceptance of Proposal -The above prices,specitieaborw and conditions aro satisfictory mid are hereby accupta d.You ato mAwnzed to do the work as specified_Paymentwiff bo muck as outlfnod above SgAatury Sagture M#e of AccWwc-e_ �-d LO7 9_99Z_809 ucaua)p!N )PeW e179:60 0 8Z PO 11/23/2010 12:37 FAX 5083859499 BARON PROPERTY NGHT 001 FISHERMAN'S VILLAGE CONDOMINIUMS 855 West Main Street Hyannis,MA 02601 November 23,2010 Mr.Paul Roma,Building Inspector Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Dear Mr.Roma RE: Nickerson Home Improvement Inc. Please be advised that the Board of Trustees give permission to Nickerson Home Improvement Inc.to re-shingle the roof at Units 11&12. The Unit owners are as follows: Unit 11-Anita Zetland Unit 12-Robert Hayes Please do not hesitate to contact the property manager at 508-360-1557 should you have any questions or require additional information. Sincerely Dennis Marchant President Board of Trustees FVC .r TOWN OF BARNSTABLE.BUILDING PERMIT APPLICATION Map 4 Parcel- 03 1 00 Application Health Division o1_007'31 Date Issued Conservation Division Application Fe �' Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board `r Historic - OKH _ Preservation/Hyannis Project Street Address SIXZFI�77, Un T Village gm NIV is Owner elf Z A&C,� PE'b/ 60&" 60'fN,JS Address 95 0/?V Fib (I /Erf11 Telephone 7�) 33 5- A�/ Permit Request RC&CC &S0,47-1071 Agni'411 /�Vp PSG Square feet: 1 st floor: existing ZOX proposed 2nd floor: existing proposed / Total new ROZ Zoning District Flood Plain Groundwater Overlay Project Valuation ,3500• Construction Type Lot Size 0 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family I( Two Family ❑ Multi-Family (# units) Age of Existing Structure 145 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout VOther 5 LA 6 - -? Basement Finished Area(sq.ft.) O Basement Unfinished Area(sq'ft) O. Number of Baths: Full: existing new Half: existing r= new c Number of Bedrooms: 1. existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil UPElectric ❑ Other t ` Central Air: ❑Yes E(No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing 0 new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name �*I r, �S t€y Telephone Number Address b7 E7nt&-� LSE- License# C$ gsll q Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 9*w le hgyn F! DATE SIGNATURE b �� 1 r_ FOR OFFICIAL USE ONLY ,4PPLICATION# ` DATE ISSUED �_„MAP-/PARCEL NO. ADDRESS VILLAGE OWNER S • DATE OF INSPECTION: ` 4 < 'FQUNDATION_[...:r:` ; FRAME t INSULATION.:_ FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS y r -ROUGH FINAL ti 1 �ti-_-ZATE.CLOSED__OUT t. ASSOCIATION PLAN NO. The Commonwealth of Massachusetts .Department of Industrial Accidents. Office of Investigations 600 Washington Street c - Boston, MA 02111, yy www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeEibly Name (Business/Organization/Individual): Address: ,� � Ci1Zr City/State/Zip: Phone Are you an employer?-Check the appropriate box,: Type of project(required): 4. I am a general contractor and I 1.❑ ]New construction N have`hired the sub-contractors., ployee 'asole propr_etor-or partner s(full and/of'part-time). - -- . _... . - listed the attached sheet. 7; ❑ Remodeling 2. " I am ship and have no employees j These sub-contractors have . g, 0 Demolition employees and have workers' working for me in any capacity. 9. 0 Building addition [No workers'coup. insurance comp. insurance.1 5. 0 We.area corporation and its 10.❑ Electrical repairs or additions . required.] 3.❑ I am a homeowner doing all work officers have exercised their 1 l.[] Plumbing repairs or additions myself. [No workers comp. right of exemption per,MGL 12.[] Roof repairs uired. t c. 152, §1(4), and we have no insurance required]] 13.❑ Other employees. [No workers': comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional shcet,showing the name of the sub-contractors and state whether or not those cnti.tics 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._#: Expiration Dater Job Site Address: City/State/Zip: Attach a copy of the workers' compensatiori policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL c. 152 can lead to the imposition of criminal penalties of a fine 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 c rti under the pains and penalties fp rjury that the information provided ab ve is true and correct. _. 14 U,/A Signature: ate41 Phone#: Official its' only. Do not write in this area,to be completed by city.or town of xiaL r City or Town:; Perini t/Licen se.#.;. 'Issuing Authority (circle on 1.Board of Health 2. Building Dep2rtrnent.3. City/Town Clerk 4. Electrical Inspector,{5. Plumbing Inspector 6. Other f m Contact Person: Phone#: Information and. tnstructzORS Massachusetts General Laws chapter 152 requires all employers toiprthe)dservioce kof ersa'noth com P underon for their any contract �lhirees. Pursuant to this statute, an employee is defined as `.,.every person express or implied, oral or written. thcr o or mord An employer is defined as "an individual, partnership, association, ]e, al corporation of aedeceased employer,gal cbtitY, Or any or Lhc of the foregoing engaged in ajoint enterprise, and including g r or trustee of an individual,.partnership, association'or other legal entity, employing employees. However the receive resideswho owner of a dwelling house having not more than three apartments e onstnictionor repa o a ir work on such house dwelling house of another who employs persons to do m or on the grounds or building appurtenant thereto shall not because ofsuch employment be deemed to be an employer.' also slates that"every state or local licensing agency shall ivithl�old the issuance or MGL chapter 152, §25C(6) renewal of a license or permit to operate a business or to construct buildings in the common}vealte form" applicant tvho has not produced acceptable evidence of compliance with the insurance coverage divisi.ed." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth le nor any e of compliance litil wisubdivisions h'lh�,insurance enter into any contract for the peiforriiance of pubhcwork untilp requirements of this chapter have been presented to the contracting authority." Applicants Please.fll out:the workers' compensation affidavit completely;by checking the boxes that apply to your situation and, if ` with their cerlificate(s) of necessary,supply sub-conlractor(s)name(s), address(es) and phone numbers)along 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 belsubamidttdd to the ahe I Dcpart it nt of odustvit)should Accidents for confirmation of insurance coverage. Also be sure to sign be returned to the city or town thatlthe application for the pennit or license is.being requested,not the Department of n a,,workcrs' industrial Accidents. Should you have any questions regarding the law if you� ,�ns required red companies should enter their compensation policy,please call the Department at the number listed below, 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.piovided a space.at the bottom of the affidavit for you to fill out i-n the event the Office.of Investigations has to contact you regarding the applicant. Please be sure to fill in the,permiUhcense 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"a]1 locations in (city or town)."A copy of the affidavit that has been officially stamped or marked b A new affidavil C)t or town nmuay s berfill provided out each applicant as proof that a valid affidavit is on file for future permits or licenses.. 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 of permit to burn leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigat1ons WOUIT11kC to th n"UU a � i� r�DOPPrati\n 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 Indus tTial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 4.06 or 1-877-MASSAFE Fax # 617427-7749 Revised 4-24-07 www.lnass'.gov/dia ^ Bill Inquiry - MUNIS [TOWN OF BARNSTABLE] y File 'Edit• Tools Help -- -- -Year/Type/Bill No. ---- _.. ,. Customer account information- --............. ........... 2009 R E R 22479 2945 7 m_ His F i PRICE, EST OF SHIRLEY TR Detail ! Property information - C/O GRIFFON,ELIZABETH 0rig Bill Parcel ID 249 031-OOF 63 GARFIELD AVE WEYMOUTH,MA 02188 ' Effective Date Alt Parc --- w- - _ Prop Loc 855 WEST MAIN STREET Lien/Sale 400 #- ;IS Special Conditions/Notes Scan Bill Quick Entry I Int Dt Billed Abt/Adj Pmt/Crd Interest Unpaid bal _ 08/02108 230.69 00 230.69 OOr 00 UtilityAcct "� 11104l08 230.67 00 230.67 .00 .00 02I03I09 43 81 6 00 43 81 00 .00 Customer 6 j - I 05l02109 643.79 00 f 611 91 f 416 36 04 Name ..-.. . ..__._ ,._.. ,w ...1 _ ; } Fees/Pen .00 5.00 5.00 00 .00 Parcel Totals 1,748 96 5.00 1 722 08 4.16 f 36.041 Prop Code Notes/Alerts - - Due 08/06/2010 36.04 Billing Dates Per Diem 01 JAN 1 Owner: PRICE, EST OF SHIRL Bill Audit I nt Paid 35.25 Reprint _..__. _ ......_ i_.�3Viev"prior unpaid bill.. . Preferences Diagnostics _ _ __ egn DISH ® �E►fir, ' U0 06pnox ° � TOWN OF SARNSTA Display transaction history for the current bill. J* bii� room Mas y v _ A k. c 1. . b drao _ 4 C _ ARC s c F wq-11 S ro N9D 13E W sUld-710. 08/05/2010 14:48 FAX 781 281 1111 EASTERN INSURANCE NORWEL fa 002/002 08/06/2010 15:40 FA-1 6083859499 BARON PROP73M 11Qu IA002 Town of Barnstable _ . . . Regmlatory Services i Thous V.0*00r,10Ixaator Building Divblon Tam Parry,Building Cott rWujoncr 200 Main Street,Hymai ,MA 02601 Tr*wAuwn.bjtM1Ub1v,ma.u3 Ofiicc: 508.862-4038 Fax: 508-790-6230 Property Ocher Must Complete and Sign This Section If Us' , .A Builder . I, J 1' b' c�` ,as Owwr of the sut m e _ •1 lc, hembyauthot6 DAVTJS A914LCI --_ _to act ou my 66If in AU z AUM re116M to Verb authodzed by This b uUing permit appL'caxiou for. g55 WaSr Mhiw s , NN is _ (Addmss of job) of Owner Iaa Ptinr :..�.,.... _ ... __... ._. if�ri er r is a��1Y for�e nut please complete.the 'Homeo=wners License Exemption Form on'the reverie side. Q:F�lR►riBsOWNEf'LPBtt1,S1S�N - FISHERMAN'S VILLAGE CONDOMINIUMS 855 West Main Street Hyannis, MA 02601 .August 5, 2010 Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Dear Mr. Perry, Re: Fisherman's Village Condo Assoc—Unit 5 Please be advised that the Board of Trustees give permission to Mr. David Ashley to perform the necessary repair work to Unit 5. Should you have any questions regarding this matter, please contact the management company at 508- 385-9499. Sincerely, Board of Trustees Fisherman's Village Condominium Association Dennis Marchant—President 1 illassachusett.s- Department o#'Puhlic.Safcty . 8oaicl of Bul Regsulations and Standards G,onstruefion Supervisor License License:'cs. 95114 z�. Restricted,to: 00 , DAVID ASHLEYwa?ti 69 EMERAL:DjLANE s a 4: 4" MARSTON<MILLS''MA 02648 w Expiration: 3/7/2012 ('tnnmissii'mer 2 Tr#: 199� 2 9 -- — -- ✓lie -C�ommoouaea�,� ✓�/aaczctivaelta Office of Consumer Affairs&B smess Regulation License or registration valid for individul use only HOME IMPROVEMENT CONYAACTOR before the expiration date. If found return to: Registration: ,136164/ Type: Office of Consumer Affairs and Business Regulation Expiration: li/19l2012 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 D D,V.,THLES'� DAVID ASHLEY ��kn — 69 EMERALD LN 19L� MARSTON MILLS, M4p2648 Undersecretary Not valid without signature /77 4 - 0 k t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a Parcel. Application # S 0 5 1p Health Division Date Issued 6/� /I Conservation Division Application Fee D Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ��-- Historic - OKH Preservation/Hyannis Project Street,Address �� �S"ta �`� L�IrL `� J O Village��V� Owner TC1V36=�C, 115q,06 Address ' kj v R_ Telephone — `t 9 - 2-041 _2 Permit Request Q���a��rv� t��'�n ��z�'�►®v� c�a_ iaV-e-S IkAex"cyq n YL V31or Square feet: 1 st floor: existing proposed 2nd floor: existing �&Q proposed Total new C Zoning District Flood Plain Groundwater Overlay Project Valuation 499 Z D G Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ C> r Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed UseGm APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �"�"� 1,�G,�-�"-�- Telephone Number s -aLao - q(2 9 Address �` 5 �04 LS X-- License# tra _� CU Z Home Improvement Contractor# �S Worker's Compensation # �� 2S� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Trz�v�s l SIGNATURE DATE CQAI`/� r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ~ MAP/PARCEL NO. ` ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION ` FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. s .'e k ' The Corlirnonwec ltlT of Massachusetts , Department of Industrial Accidents Y - Office of Investigations 600 Washington Street _ t . Boston, MA 02111 y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print I�/e�ibly Name(Business/Organizatiord1ndividual): (3—tAo'eir �e36« Address: City/State/Zip: hone Are y 6u an employer?.Chect the appropriate box: Type of project(required): 1.[9`l am a employer with—�— 4 C] I am a general contractor and I'' 6: ❑New construction * have hired the sub-contractors employees(fiili and/orpart-time). - --- -. _ ..... . .... . .. _ . .. 2.❑ I am a sole proprietor or partner- listed on.the attached sheet. 7. ❑,Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition _ employees and have workers' working for me in any capacity. 9. '❑ Building addition [No.workers' comp. insurance comp. insurance.f . Electrical repairs or additions 3a❑ I am a,boineowner'doing'all work t`officers have exercised their :11..❑ Plumbing repairs or additions right of exemption per MGL` l2 ❑'Roof repairs myself. [No workers .comp. 0�� � _nn insurance required.] t c. 152, §1(4), and we have no 13. Otber t,aAteit-m�L�� employees.[No workers' comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they.arc doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp:policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information P Insurance Company Name:, - Policy#or Self-ins.Lie.#: W� (�1 �LS 4 - Expiratton'Date:' .. � Job Site Address: �SS W' City/State/Zip: S4t' 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 certi c j der the pains and penalties of perjury that the information provided above is true and correct Si nature: Date: !' O Phone 08' d Official use only. Do not write in this area, to completed by city or town offreral 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 { Phone#: Contact Person: . information. and str, uctxOns their em loyees.. all Employers to e workers' compensation for P Laws chapter 152 requiresP Massachusetts General Lrovid p q statute, an em to )ee is defined as "...every person in.the service of another under any contract of hire, Pursuant to this st p ) express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal entity, m 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 nts and who resides therein, the ant of the owner of a dwelling house having not more than three apartme or e occupant dwelling house of another who employs persons to do maintenance, constriction 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 slates 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 conunonwealth nor any of its political subdivisions shall enter into any contract for the performance of public-work until acceptable evidence of compliance with the ins�uance 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 certificates) of insurance, Limited Liability Companies (LLC)or Limited Li.ability 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 lodustrial 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 applical'. 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 ou y Dt Policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in 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 or commercial venture year. Where a home owner or citizen is obtaining a license or permit not related to any business (i,e. a dog license or permit to burn leaves etc.) said person.is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions; please do not hesitate to give us a call. The Department's'address, telephone and fax number: The.Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax 4 617-727-7749 Revised 4-24-07 www.inass.gov/dia , . . . FISHERMAN'S VILLAGE CONDOMINIUMS 8B West Main Street Hyannis, MA 02601 June Zl20lU ' Steve White � Caliber Building Q Remodeling LL{ � l47 Ridgewood Ave Hyannis, k8A026Ul Dear Mr.White, Re: Unit lO— Fisherman's Village Condo Assoc. Please be advised that permission is granted to Your company to perform the necessary weatherization work to the above mentioned unit outlined by the HuudoQAssistanceCorp. | We have received your certificate of liability insurance so you can now schedule the work at anytime, Should You have any questions or require additional information, please do not hesitate to contact me at5U8']D5'9499(uKice)or508'36O'l557(ceU). Since�ly�, � | / Paul Baron propertynxanage/ FVC / � - ` U h QYh O. 4 S , as owner(s) of the subject property at: % hereby authorize Steve White of Caliber Building And Remodeling, LLC (contractor) to i act on my behalf in all matters relative to the building permit application. signature of o ner d e I j signature of owner date I F i e 4 7 , . Massachusetts- Department of Public Safety Board of Building- Regulations and Standards Construction Supervisor License License: CS 95038 Restricted to: 00 STEVEN WHITE 147 RIDGEWOOD AVENUE HYANNIS, MA 02601 Expiration: 2/28/2012 ('nnmi�si rocr Tr=: 19311IZX ; ' ✓tie �azxmaruuea�o�✓�aaaacfuc� Board of Biiilding Regulation§and Standards i HOW IMPROVEMENT CONTRACTOR Reg tratfan~,,,154359 ' . 228/2011 Tr# 280764 Lt(i,'L1ability,:Gorporation f. CALIBER BUILDINGAMiiDELING;LLC. S STEVEN WHITE } 147 RIDGEWOOD HYANNIS,MA 02601 Administrator License or registration valid;for mdividdl use only before the expiration date. 1f found return to: i Board of.Build%ng Regulations and Standards One Ashburton Plaee Rm'1301 Boston,Mai 02108 . Not valid without signature '�. Massachusetts- Department of Public $afet% Board of Building Regulations and Standards Construction Supervisor License License: CS 95038 Restricted to: 00 STEVEN WHITE 147 RIDGEWOOD AVENUE HYANNIS, MA 02601 Expiration: 2l2&2012 ('mnni.�incr Tr:-`: 19311 Board of Building Regulation and`Standards HOME IMPROVEMENT CONTRACTOR Registraln :154359 Expiralli-ow M/2011 Tr# 280764 7-T Ltd,trability:Corpbration CALIBERBUILDMAW:R ELING,LLC. STEVEN WHITE s 147RIDGEW061)A�E° ` �. •� HYANNIS,MA 02601 Administrator x, - - - License or egrstration.valid for individtl'use only before the expiration•date. If found return to: -Board Of,Buildyng-Regulations and Standards One Ashburton-Place RM 1301 : Boston,Ma:0210$i AiNlidw thout signature • ACORD M CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/30/2010 PRODUCER 508.945.0393 FAX 508.945.4048 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION! Eldredge & Lumpkin Ins. Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 697 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Chatham, MA 02633 INSURERS AFFORDING COVERAGE NAIC# INSURED Caliber Building and Remodeling LLC INSURERA: National Grange Mutual Ins Co 4788 INSURERS: Commerce Group CIG001 147 Ridgewood Ave INSURERc: Granite State.Ins. Co.-ARWC 13102 Hyannis, MA 02601 INSURER D: INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITH ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY B'E ISSUE MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITION: POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD', TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTNE POLICY EXPIRATION LTR NSR DATE MM/DDIYYYY DATE MWDD/YYYY LIMITS GENERAL LIABILITY MP027360 09/15/2009 09/15/2010 EACH OCCURRENCE $ 500.000 X COMMERCIAL GENERAL LIABILITY DAMAGE T77717rff- PREMISES Ea occurrence $ 500 CLAIMS MADE M OCCUR MED EXP(Any one person) S 10,00( A PERSONAL&ADV INJURY $ 500 GENERAL AGGREGATE $ I 0OO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO- LOC JECT AUTOMOBILE LIABILITY BBNVCS 02/16/2010 02/16/2011 COMBINED SINGLE LIMIT ANY AUTO (Ea acddent) $ ALL OWNED AUTOS BODILY INJURY $ B X SCHEDULED AUTOS (Per person) 250 HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (Per accident) $ 500.000 PROPERTY DAMAGE $ (Per accident) 100.000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION YIN WC7425405 03/02/2010 03/02/2011 ORY LIMITS OER ANY PROPRIETOR/PARTNER/EXECUTIVE Q E.L.EACH ACCIDENT $ 1()0,00( C OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,desaibe under 10O SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of Barnstable IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Att: Bldg Dept. REPRESENTATIVES. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 Alan R. Long, President ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENERGY CONSERVATION APPLICATION FORM FOR ENERGY EFFICICIENCY FOR ONE- AND TWO-FAMILY DETACHED RESIDENTIAL CONSTRUCTION (780 CMR 61.00) Site.Address: Q{-- Applicant Name: prhll Town: Applicant Phone: 6 Applicant Signature: Date of Application:. a3 a NEW CONSTRUCTION: (choose,ONE of the following two options) 780 CMR TABLE 61.07.1 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA FOR 4 NEW ONE- AND TWO-FAMILY BUILDINGS I MAXIMUM MINIMUM Ceiling or Basement Slab Option 1: Fenestration exposed Wall Floor Perimeter Wall AFUE HSPF SEER U-factor floors R-Value R-Value R-Value R-Value R-Value and Depth National Appliance Energy R-10, Conservation Act(NAECA)of .35 R-38 R-19 R-19 R-10 4 ft. 1987 as amended,minimums or eater as applicaWe Note: This form is not required if you choose either of the two versions of REScheck as listed,below.. REScheck Version 4.1.2 or later variant software analysis must be completed Option 2: I (780 CMR 6107:3.2 REScheck—Web which can—be accessed at http•//www.energycodes.gov/rescheck/ . ADDITIONS, ORAL-TERATIONS TO EXISTING BUILDINGS.OVER:5 YEARS OLD* *Buildings under 5 years old must use option#1 or#2 in New Construction section above:' { Complete the following formula to detennine-the % of glazing: (a) Gross Wall & Ceiling Area equals Formula: (100 x b_ a) 4 SF 100 x _ %o of glazing b a. . , (b) Glazing area equals. SF If glazing is.<40% use the chart below. If glazing is > 40.%' proceed to "SUNROOM" section 780 CMR TABLE 6101.3 PRESCRIPTIVE ENVELOPE COMPONENT CRITERIA ADDITIONS TO EXISTING LOW-RISE RESIDENTIAL BUILDINGS MAXIMUM MINIMUM Ceiling and Slab Perimeter El Fenestration Exposed floors Wall Floor Basement Wall R-Value U-factor R-Value R-value R-Value and Depth R-Value .39 R=3 7 a '. R-13 R-19 R-10 R-10, 4 feet a R-30 ceiling insulation may be used in place of R-37 if the insulation achieves the full R-value over the entire ceiling Area(i.e.not compressed over exterior walls, and including any access openings). SUNROOM—An addition of alteration to an existing building/dwelling unit where,the total' El glazing area of said addition exceeds 40%'of the combined gross wall and ceiling area of the addition. Note: Owner to fill out Consumer Information Form (found in Appendix 120.P)� TOWN OF BARNSTABLE,BUILDING PERMIT APPLICATION f Map Parcel . t Application Health°Divis±ion Date Issued Conservation Division - Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address Village Owner_M,2W,ZX SXZff�_ Address Telephone 22(5_J j:c� Permit Request y�,G2�t���1 D'l4rz ZZ60F A&P_I UJ- Lyz72Y Square feet: 1'st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �1A3 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 0 Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: 0 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' C=3 N Number of Baths: Full: existing new Half: existing IT—ew Number of Bedrooms: existing _new ry Total Room Count (not including baths): existing new First Floor o m Court Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Zr Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wo coal spe: Yes ❑ No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: existing ❑ e size_ Attached garage: ❑ existing 0 new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 0 No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) i'Name, ���,������� Telephone Number 7 AVress �; QR,, ZX License # Home Improvement Contractor# Worker's Compensation # l/.E'. Z-7— 21 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE F FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ' MAP/PARCEL NO. ADDRESS ' VILLAGE OWNER i DATE OF INSPECTION: ' FOUNDATION FRAME i INSULATION Y FIREPLACE s ELECTRICAL: ROUGH FINAL PLUMBING:. ROUGH FINAL GAS: ROUGH ; FINAL FINAL BUILDING , f DATE CLOSED OUT ASSOCIATION PLAN NO. 4 . Y l 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Ledbly Name(Business/Organimflongndividual): Address: City/State/Zip:-�1/ Xxx� z�U 22,/--�8 Phone.#: 7-2 5�&6 Are you an employer? Check the appropriate bog: Type of project(required): ti® 1. I am a employer with V 4. I am a general contractor and I ❑ employees(full and/or part time). * have hired the sub-contractors' 6. New construction 2.El I am a"sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling • ship and have no employees These sub-contractors have g, �]Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.-insurance comp.iusurance.t required] 5. 0 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. myselL[No workers' comp. right of exemption per MGL 12.VRoof 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 infomration. t Homeowners who submit this affidavit indicating they are doing all work and then hive 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-conbactors have employees,they must providb their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL a 152 can lead to the imposition of crimifial penalties of a fine tip to$1,500.00 and/or one-year,imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un r the pains•and penalties of perjury that the information provided above is true and correct Date: Signature: Phone#- Official use only. Do not write in.this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 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 hiie, 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 fori the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested.,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permittlicense 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 (Le. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone-and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Wwhington Street Boston,MA 02111 Tel. #617-727-4940 ext 406 or 1-977-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia "E JL-21-2008 03:24P FROM: 15085400441 TO:15087906230 P.1 ACDRD,: CERTIFICATE OF LIABILITY INSURANCE OP ID oATE(MM/oo/Y DAVIn-a o7/al/08oe ODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Northwood ins. Agency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 805 West Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Hyannis MA 02601 Phone: 508-771-1632 Fax:508-393-2955 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Insurance Co. INSURER 81 Trtaysler• xnaurenoo ccm%"ny David Cox, Inc. INSURER C: P. O. BOX 401 INSURER D: 6 Yarmouth MA 02664 INSURER E. COVERAGES THE POLICIES OF INSURANCE LISTED LOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITI N OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,W INSUKENCE AFFOR ED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE L[fdUS SHOWN AY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSRE -LTYPE OnNSURANC POLICY NUMBER DATE MMIDDIYY DATE MWDDIYY LIMITS GENERAL LIABIL�PY EACH OCCURRENCE $ 1000000 A Cp MERCI-GENEFRALLII/l�11ITY 680-148IM796 03/14/08 03/14/09 PREMISES Eaoavrence $ 50000 `DCLAIMS-MADE ❑j:GGGGCUR MED EXP(Any one person) $ 5000 X Busines% OWne B PERSONAL BADVINJURY $1000000 GENERAL AGGREGATE $ 2000000 GEWLA(GREGA �LIMIT APPLI€SPER: PRODUCTS-COMP/OP AGO $ 2000000 PO i�Y. VPE� LOC CSL 2000000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per occldont) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S. ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGO $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ - WORKERS COMPENSATION AND TORY LIMITS ER B EMPLOYERS'LIABILITY GKUB91OX742207 07/1S/07 07/15/08 E-L.EACH ACCIDENT $100000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? 6KUB91OX742208 07/15/08 07/15/09 E.L.DISEASE-EA EMPLOYE $100000 I(yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 50 000 0 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION TOWNHAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN TOWN OF BARNSTABLE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL Building Dept. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 367 MAIN STREET HYANNIS MA 02601 REPRESENTATIVES. AUTOO D RESEW 5� ACORD 25(2001/08) ©ACORD CORPORATION 1988 _Town of Barnstable Regulatory Services BARNSTvMAS&"B ; Thomas F.Geiler,Director 4i'OrFn,3,a�t6. Building Division Tom,Perry, Building Commissioner -200 Main Street, Hyannis, MA 02601 www.town.barnstable.rna.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf,. in all,matters relative to work authorized by this building permit application for: Z�) :/ " XZZ-) (Address of Job) 7 // Signature of Owner ate Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. r Town of Barnstable mop SHE tp�� Regulatory Services Thomas F.Geiler,Director BARNSTABLE, ' Fqj 6 MASS. Building Division PrED �A Tom Perry,Building Commissioner . 200 Main Street, Hyannis,MA 02601 www.town.barnsiable.ma.us Office: 508-862-4038 Fax: 5-08-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s) who owns a parcel of land on'which he/she resides or intends to reside, on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed.under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations; The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be.required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.,1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly he homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed personas,it would with a licensed when the homeown caner actin as Supervisor is ultimate] responsible. Supervisor. The homeowner Y P P g R To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that helshe understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a fomi/certification for use in Your community. r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION• Map �,, Parcel V r �� _ ';Application#_� � Health Division Date Issued* 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 F<63' Village /i7y Z! X/dz' Owner it7At?/22jj1 /xl e�o�K — Address Telephone Permit Request / o 7-0 s 610 Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District / Flood Plain Groundwater Overlay Project Valuation G �® Construction Type i Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting I ocumertalion. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) /Z C7 Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Hrgh`way: ❑'Yes 7 No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Others. �n Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) r? cn 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: Zonin Board of Appeals Authorization ❑_ Appeal# _r :_Recorded 0_ Commercial ❑Yes ❑No If yes, site plan review# ` Current Use Proposed Use BUILDER INFORMATION Name 5�it'I�JI� �,�xJ l� Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1�iCIrP/�1� 7" /jJ�I SIGNATURE DATE R FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. T' ADDRESS VILLAGE OWNER . DATE OF INSPECTION: , FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL k GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT i ASSOCIATION PLAN NO. •s= The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,M4 02111 www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):. 1/ ,Q • •Address: �9���✓����1_�� City/State/Zip: Z/ Z��.4225Z ()24 ?Phone.#: Z2_6 3� AFOu an employer? Check the appropriate box: Type of project(required):. I am a employer with 4. ❑ I am a general contractor and I employees(full and/or.* have hired the sub-contractors 6. ❑New construction . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition won for me in an capacity. employees and have workers' � y P �'• $- 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their M❑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 worker;'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is Ike policy and job site information. Insurance Company Name: , Policy#or Self-ins.Lic.#: Expiration Date: Q Job Site Address: a25" ,) zf&y�6�I f��'l�jV//�/-5'City/State/Zip:� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprison==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 DU for insurance coverage verification. I do hereby certify and the pains-and penalties of perjury that the information provided above is true and correct: Simature: Date: f. Phone#• Official use only. Do not write in this area,to he 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 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()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 infante 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-conti-actor(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 Departmeirt 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"lob 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 burn leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Commonwealth of Massachusetts Department of Indus6al Accidents Office of Investigaflons 600 Washingtcai Street Boston,MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.go-v/dia Jul. 26 07 09: 19p MRRIRNNR PRPPAS 508 770 9369 p. 2 FISHERMAN'S VILLAGE CONDOMINIUMS 855 WEST MAIN STREET HYANNIS, MA.02601. JULY 26,2007 ` I,MARIANNA PAPPAS';MANAGER OF THE ABOVE CONDOMINIUM,ALONGiMTH THE APPROVAL OF THE BOARD OF TRUSTEES, DO HEREBY HIRE AND GIVE PERMISSION TO MR. DAVID COX AND HIS CREW TO RE?LACE/REPAIR ANY ROOFS LOCATED AT FISHHERMANS VILLAGE CONDOMINIUMS. THANK YOU _ MARIANNA PAPPAS, MANAGER Date:7/27/2007 09:27 AM Sender's Fax ID:Northwood Insurance Page 2 of 2 ACORD CERTIFICATE OF LIABILITY INSURANCE K DATE(MM/DD/ 0 DAVIDVID-2 07/27/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Northwood Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 805 West Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-771-1632 Fax:508-393-2955 INSURERS AFFORDING COVERAGE NAIC# INSURED ; INSURER A: The Norfolk & Dedham Group INSURER B: Travelers Insurance Company David Cox, Inc. INSURER C: P. 0. BOX 401 INSURER D: S Yarmouth MA 02664 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) - LIMITS GENERAL LIABILITY EACH OCCURRENCE $ $1,0 0 0,000 COMMERCIAL GENERAL LIABILITY .PREMISES(Ea occurenca) $ $50,000 CLAIMS MADE OCCUR MED EXP(Any one person) $ $5,0 0 0 A X Business Owners R00309545 03/14/07 03/14/08 PERSONAL&ADV INJURY $ $1,000,000 GENERAL AGGREGATE $ $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ $2,000,000 POLICY jE0. LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY .$ SCHEDULED AUTOS (Per person) HIREDAUTOS BODILY INJURY $ NON-OWNED AUTOS I (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY ALTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND _ TORY LIMITS ER EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE 6KUB91OX742207 07/15/07 07/15/08 E.L.EACH ACCIDENT $ $100,000 OFFICERIMEMBEREXCLUDED? E.L,DISEASE-EA EMPLOYEE $ $100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ $500,000 OTHER N C �t —r DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS C= '[Y � 1 CERTIFICATE HOLDER CANCELLATION TOWNBAR SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN ELLED BEFORE THE€XPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO AIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL TOWN OF BARNSTABLE IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 367 MAIN STREET HYANNIS MA 02601 REPRESENTATIVES. AUTHO D R PRESEf�TAT�xF/ ACORD 25(2001/08) ��J 0 ACORD CORPORATION 1988 �. �' ,., +. ,�' r yr. s-'' y �. .y. -. •�1+. t .. ,� ..., �„�a ,�•_ �xr,;�-� i4��►tea "s--�".�,. ,a � F. �! � �� � , To:Building Department of Town of Barnstable attn.Dave Mattos 200 Main Street Hyannis MA 02601 From: Boris Levin 121 Tremont St.Apt 322 Boston,MA 02135 617-254-8998,Cell: 617-347-5362 ' I have a second house at 855 West Main-Street apt.#3,Hyannis,MA. I and my wife are both senior citizens.In April of 2001,a squirrel jumped in my chimney cap from the roof and damaged my apartment.This happened because the management company did not complete the necessary preventative management measures such as cutting branches from the trees and changing of the rust on the chimney caps. In 2002, after many discussions and letters,the damaged chimney cap was replaced by a new one. When the chimney company was conducting a chimney inspection in April 2,2002,to evaluate my house before replacing the chimney the cap,they accidentally broke the damper of my fireplace.After they changed the chimney cap,I noticed that the newly installed chimney caps were inadequate in height.As you can tell from the included photo,the chimney caps for units 2 and 4 are taller in height than my chimney cap for unit 3 that is in between them. This means that the gas flow from the two higher chimney caps reverses itself to my chimney line. On 6/11/2003,the chimney company repaired the chimney caps and was.paid$880 dollars for this service by check number 2870.The invoice says that chimneys of units 1,2,4,10,11,13,and 14 were evaluated for cleaning while chimneys from units 3,,5,6,7,8,9,15,16,18,19,20,and 21 were evaluated as well as cleaned and repaired.I have also seen no convincing indication that any of the repair work on chimneys was actually done.I conclude this from the fact that no work was done on my unit.In Unit 3 where I live,I am absolutely certain that no cleaning work on the chimneys could have been done because there were no notices asking for the owners to stay home while the workers come and clean the chimneys.Another reason why I am sure that no work was done is because the damper in the chimney was not opened since previous repairs in 2002. That means that the chimney could not have been cleaned.Also,the damper could not have been opened to do the cleaning because the chain has been missing since the repairs in'2002 that were done by the management company. On the 6/26/04 annual meeting when I raised the question about the repair of my chimney cap and damper,the, member of the Board of Trustees Linda Stevens instructed the management company to make the needed repairs. But since then,no repairs have been done.I have had trouble making the management company pay attention to the problems in my unit. Starting from 2001 until today,I contacted the management company and trustees many times about the chimney caps and the damper.For four years,they ignored my requests to make repairs of the damper and the chimney in my unit. Their refusal violates the laws that are written in the Declaration of Trust and by-Laws. The specific law violates Article 7 of the Declaration of Trust and by Laws, section A. Sincerely, 1 o ZIVIA/ 6M/ Boris Levin P.S.Documents and Photos included n BARTLETT ASSOCIATES P.O. BOX 646 WEST YARMOUTH, MA 02673 50B-780-181 2 R p - April 2, 2002 TO: Owner's Fisherman's Village RE: Chimney,Inspections All fireplaces and chimneys will be inspected on Friday, April 5, 2002 starting at about 8 AM. We will need access to your unit. If you will not be home please make arrangements with me or a neighbor to make your unit available_ to the inspectors. Thanks. Pe6rge H. Bartlett Manager. T G:Bartlett managment co. P.G.646 West Yarmouth,MA ,02673 cc:Wil Crocker,secretary and ail members of Trustee,Fisherman"s village condominium. From:Boris Levin, owner unit#3,Fisherman"s village, 855West main street,Hyannis JMA 02106. I still would like out following issues: {i) In regard to repair my chemney cap. I have sent you several letters: {9i 13,9%29,11 i08,1 1 i28i01)and i have same conversation with you about this issue. For more then 12 month only chemney inspection was done . Nobody knows when will be done necessary repairs. This is a violation of Declaration of Trust and by-LAWS. Article 7-by-LAWS,sec A and sec.A#3 "The Trustee will be responsible for proper maintenance,pepair and w replacement Common area." I would like to give you my suggestens: {a}GO to" HOME DEPOT" and buy chemney cap for about$25.00 each. . Insraction sheet for installation chemney cap enclosed. {b}Cut tree branches near the bulding and squirrels will never rich foof of the buiding,and destroy the chemney caps. f f TO.OWNER-Fisherman"s village I have bought my unit in the year 1985. During the last seventen years my apartment twice was destroed. First time, they did not installed cutter and water from apartment above destroy celling in living room. Second time,they did not cut tree branches, replacement chemney cap and squirrels get inside the living room and destroy all apartment. All this problem and many others becouse Chairman of Trustee and Managment co. not quarantee professional service and not respect unit owners. More information about Trustee and Managment co.in the letter dated 6/01/02 inclosed: Sincerely Boris Levin. 6/03/02. F r BARTLETT ASSOCIATES P.O. BOX 64B WEST YARMOUTH, MA 02673 , 50B-790-1 B 12 r June 12, 2002 Boris Levin c/o Galina 121 Tremont Street, Apt 322 Boston, MA 02135 Boris, In regards to the chimney repairs, I agree that it has taken awhile to get things going. Have you ever tried to get a busy contractor on Cape Cod to be prompt? The work necessary is more complicated than.just-adding a$25.00 cap as you suggest. We have received an evaluation of all chimneys, what is required to fix the problems and a cost estimate for the work. This work should start in the near future once the Trustees approve the expenditure. BARTLETT ASSOCIATES P.O. BOX 646 WEST YARMOUTH, MA 02673 508-790-1812 , rx January 28, 2002 Boris Levin c/o Galina 121 Tremont Street, Apt 322 Boston, MA 02135 Boris, I had Rwt �e done. If you have questions, please contact me. I will be glad to 'sit down with you to discuss what is going on. Sinc 1 yours, G rge H. Bard , Manager BARTLETT ASSOCIATES P.O. BOX B46 WEST YARMOUTH, MA 02873 508-790-1 B 12 November 8 2001 Boris Levin 121 Tremont Street, Apt 322, Boston,MA 02135 Boris, - Second, in regard to your chimney cap, it has been straightened. I have been waiting for a chimney company to give me information about the needs for all chimneys. To date I have not received that information. r 9/2 111cc��.CL co We o✓z 2�SCi C, A-as�t� o e- A. 6,4 i i TI-u i'i �� ���, �;�> �2 ���5 �+► r�,c 4 ; 0 Z-i 3-> t611=2s�-,Y99S 01� u j W:,.-! �i�a r�C i c c:.rl i/�k� c.� « e�o i^►'L i t� i �-wv4 L.V, I + vl .� �, cl i2 0 l Gl C. C 2 I c G ✓e o v/ v1/l 1 a loe- `gin ,eaC �� e-&3 ��r.SL K. 1sf Assessor's office(1st Floor): , /�? Assessor's map and lot number � �" all --Conservation' ' - 3 Y 3 `�P w •w--Board of Health(3rd fbor)/' t DAHd7T�DLt: J Sewage Permit numbery /V � rua Engineering Department(3rd floor): p� n�f`` - ? o639- \�d� House number O � J Definitive Plan Approved by Planning Board n}g APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only f r TOWN OF. " ,.BARNSTABLE �3 BUILDING . G INSPECTOR APPLICATION FOR PERMIT TO o 2 ,I- 7 Oy f 7-7 d U f TYPE OF CONSTRUCTION _ Q©d Pj!✓4f -O 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies(for a permit according to the following information: ��// ,( Location �i S h t'_r fruL It V,a&5ie✓ gS� (,l� , M�+itJ 7�1� /T �1/+U' , �� U oZ(�0 / Proposed Use i--- t Te- f,V Zoning District 1Y 13 Fire District '110AN�t5 Name of Owner r-1111 l y --p 4 y 64 Address (Ir-,4T m fe Name of Builder r) Address r' Name of Architect � � Address 4 rwoaD WAY Number of Rooms Foundation A� sr �l� �v�' Exterior +1 "'r7 Roofing Floors. Interior Heating �- L G+f� G Plumbing Fireplace ✓ p Approximate Cost Area zVo 'I p o Diagram of Lot and Building with Dimensions Fee &�JJ 7 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License V F DAYBRE, EMILY No 35932 Permit For REMODEL INTERIOR CONDO UNIT r Location Unit #14, 855 West Main Street Hyannis - • r Owner - Emily Daybre Type of Construction Frame Plot _ Lot Permit Granted June ' 81 19 93 - M Date of InspectionO! f3-19'.' - s i q Date Completed /� 19, t r. 1 t PS9Z0 tlW sueaj10 liolvaSININOV t' XOa Od A?h POOMIV allIlm 0 uosl9m3-•'d PaeyOtb £'S9Z0 dW sup=aL.!.r�l u0s lam 3 PIPVTt C/V xoe Od APM pooM�d aTjjTi�i i+7 I uos!9w-3 ' d pa1�?'-P7y b6/SO/80 aijucdx3 u0saalu-4 ltl(1GIAIGNh' adAl r j 199101. uo?�el}st.6aa 8013tl�1N03103ACadWI309., — I I�'t10Ir�I(IN I 'O' rnarn��mr�i1?/�o Iva iiuoui�uoo.a�� 16 f c^ U O T 4 e.l T d x L `� G i i -- �JOl:Dd>J1N00 1N21rl_:Ir1J'`3&1 . t30ZZ0 sjjasng3e8SeW'l ' UO4S02 TOOT Cl0' � r u suor"�> jn�ay t5uTpjin;.� 4 p sp.lepu��� p - I N0I1ddlGT93'd Sboj--)VbiN07 1N3W3A0bdWI 3WON 37, lu �`• - h`,1, L bPAR TMENT OF PUBLC SAF COMNWEAMO K1010 COMMONWEALTH AVE. ETY rJ �* . .. ! 5 OF ti BOSTON,MASS.02215 r DER MASSACHLISETTS r NCLOSE CHECK OR MONEY OR ( LICENSE I FOR REQUIRED FEE, i C0NST,R. SUPER.V.ISOR ' i EXPIRATION DATE - �® .�1 �� ' MADE PAYABLE TO 1993 t 06/30/ ,I .: ,. t 1 EFFECTIVE DATE LIC NO. A. RESTRICTIONS 6/3O./1991 O31 SO4, t, rCOMMISSIONER OF PUBLIC SAFET NONE t a1 I , (DO NOT SEND CASH). R.ICHARD P EMERSON ~r T 1 35 :OLD UALLE.Y RD . PO BO FE IN ASE SS •� 01.3-52. 7 75, BIZEWSTER - MA 02631. NO� T PHOTO(BLASTING OPP ONLY( FEE: ` E � C T I d E F E E: 1 198 S I .'100 00' r 1 - ' I 'NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY 'J 7 1 '7 � HEIGHT: STAMPED OR•SIGNATURE OF THE COMMISSIONER DOB: . r ( E Si $r 06/22%195 ,u/%./�'?A//s eA D NO, ETA'FLa0V=uR�'LI " s—�"�� SI 9W IN L'IN'1 ' THIS DOCUMENT MV9T! T; SIGNATURE OF LICENSEE - T/ CARRIED ON THE PERSON k -t - '! 1ti THE HQLDER WHEN ENG �}j�' COMMISSIONER a • 'I r,11 OTHERS RIGHT THUMB PRINT EO IN •THI$ OCCUPA,11 rV �' 200-A.2-87.8142� 00 G r ax6 ��►��N9 �"��s��8���,y��� pooR y ®Ay&eg Owl, �oorA ;W �o JB��R►I� G,Ns � ��� FPO i N 1 c� sb 3 P R� ax6c�►i,N9 3 yu `.. 000 R Utirf iy yy4 yivrS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map io Parcel f Permit# 2 a 7 S Health Division C. Date Issued l� Conservation Division Application FeeY. ` Tax Collector Permit Fee 'Treasurer Planning Dept. Itp%SYSTEM MUST B n ImSTALLED IN Date Definitive Plan Approved by Planning Board VM TITLE 5 ENVIRONMENTAL CODE ANt Historic-OKH Preservation/Hyannis -r0%%qJ REGULATIONS Project Street Address ,Z6� Village Owner '�" ` Address ' Telephone _ ;�J D ! i 3 '��` /O �P5— [ � Permit Request ���� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation�/,'7 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 qNo 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 0 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 Cl new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O Commercial ❑Yes ❑No If yes, site plan review# __Current Use Proposed Use BUILDER INFORMATION Name i4 a��•0 ✓ i,�'�/.1 Telephone Number Address License# O 7/ 7 3' Home Improvement Contractor# 4Z.0 0/15 7 Worker's Compensation# C- 1 I,21121 R S-p ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /d S - FOR OFFICIAL USE ONLY k _ PERMIT NO. - DATE ISSUED MAP/PARCEL NO. 4 ADDRESS VILLAGE OWNER ' "r ► DATE OF INSPECTION: E FOUNDATION FRAME } INSULATION " FIREPLACE f ELECTRICAL: ROUGH FINAL t ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. y . The Commonweai'th of Massachusetts - - - Department of Industrial Accidents Office OIIOYeslf a f00s ` 600 Washington Street Boston,Mass. 02111 ' Workers' Compensation Insurance Affidavit i name: location jooe ci hone# r42 2 ❑ I afn a homeowner performing all work myself. ❑ I am a sole rietor and have no one worlds in capacity I am an em lover roviding workers' compensation for my employees.working on P ?............................ . ..:.:.:..,..:...:.::.::.:..........................:::::.::.:.....................,................................. :.:::....:............ ................ . ........ :::.::... :::::::::::. ::::::::v.., n.....�+t•:.vT:::w:•v`rf:i•T::;?:::•.v.v:::::::::.vr w.v:i,.,.•:.:. ::::::... .......... ....... .......................................................:::.:....:C:?•T}}':•:T}:.:-+:;•}::•::.v..•.::n.......:::::::::::::::::::::::::r:::::....... •v:nv�•:•: 'tity::4;ri•t:^:;:j;}: .......... .... .. ... .. .n..... ... ....... .....v......v.... ..«::T:v}}:^:•:•:L4:?4:::.•:•y:??•4:v:•:v;9`:i•.;??•}:•}:•}:}'•:}}:•}:•:{•:}}}•.} vt>,+.R:}v{}}:{:(i':}i}:i�'•i?:•i:•:?•:S: ;� :...., ... ... .........:::::::.::fix{; ::::::::;:;�;:%::;T:;•>:•}T::.T .. :,....:...................... •T: ,•:LL;:{:«;:;;!T `.- }k't;;:;r.6.:err.+.'.,''}'•}::r:::::9`•:"-'?%:L�<5:?:?{::?<?}:;i ';v;:'••:i:;:;:;: :!;ii:siii:iiiT:•}:4:4}}:•?i::i::is::'riiS.';:i::'�'•':??,'-}....;.? 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Ol! ..........................:... ..:...........:............... .................................................. ..... ...........:.....:::::::::::::::::::.�?<:;.T}iT:�::.TTT:.:{.};TTT:.>}:.}:�}}:•}:•}:?.}:•}:.i}:.}T'•}>TT:�T>:;?{.}'?.>:.T:;?;•}i:.i::.T:.}:.:{.ii.;;:•>T-?.-<:>:::«:>}::•:>:<::.: :•ii'ry'fj;:;:5;;}. }i}{:;v:,i:::ii:i::i'j:ii;:;isii:<?�`::isC:is:iv::i±'r,:::iii::::{i:tij::;:{ri;:�j'.;:;:::ii}:}.i;{:;:i:ii}%;::; :;:i�i: ;:ti?:i!{::: :j :<s .....n{?:;}:»:::::.:,::•:.::::::•::.:,•::.i:�•:+:4}?•T:'::;:•}::iT:;:'x::•T>::t::<:>:•:{•;:�k::::�:::i:::: s:::«:srs::;;•TTi:c::s:::•:{•:;�>T >•::::•::.�}••:;• ;•}:.:._?.:::•::::•.,:;. 11]IIra4@�:LO:.}:.}};T:;.}:?•T;:•:•':;}:x•:;:.;�.�.::.}::;::r,•T:;;�•::.�::.:.:•::•»T::;•!:•}:•}:<•:;•:•}:;�•:•TT:?•T:•x•:;•:�:•:;;;•;:•}:.:;:;:•:;•::<.T:•:>:•�.:.:?•::::.:::;. 0 i Faibae to aecvre coverage as required under Section 35A of MGL 152 can lead to the imposittion otcrmm�al pertaltie�of a fine to SI,S00.00 and/or i ons years+imprltonment ss weIl as dvfi penalties in the form of a STOP WORK ORDER and a Sae o[S100.00 a day agaitut me: I miderstand that a copy o[this statement may be fornarded to the Office of Investigations of the DIA for coverage verification, 1 do hereby certify under the p ' and allies of perjury that the information provided above is tru<and correct Signature Date Print name 1�i4�//� iC/ti/!/�// .s i�-- Phone# Y /-Z f ------------------- official use only do not write in this area to be completed by city or town official city or town: perndt/liceme# ❑Building Department [I Licensing Board ❑check if immediate response is required ❑Selectmen's Office oHealth Department contactpetson• phone#; _ ❑Other_. O viud 9/95 PJA) y y t' 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 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 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 and `Kd supplying company names,'address and phone numbers along with a certificate of.insurance as all affidavits may be :€ q cidents for confirmation of insurance coverage. Also be sure to sign and submitted to the Department of Industrial Ac V. affidavit. The affidavit should be retumed to the city or town that the application for the permit or license is date the 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. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the peimitllicense number which will be used as a reference number. The affidavits may be retumed'io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of ImlestigaUuns 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 r °FTHET° Town of Barnstable °� Regulatory Services Thomas F.Geiler,Director y Mnss. $ . Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cost Address of Work: s Owner's Name: L- Date of Application:_ Ill I hereby certify that: Registration is not required for the following reason(s): FWork excluded by law ❑Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the o r: ,,p —elf Date Date Contractor Name Registration No. OR Date Owner's Name QIorms:homeaffidav r P�oFTHGE r Town of Barnstable . Regulatory Services MASS9� i639. ,0� Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject l property hereby authorize ��I� �1�.� l �i��l'.i l� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Si aueOer Date Print Name ll.T/�DT1.TC.l1R7fTCD Di7D�dTCCTl1T�T • BOARD OF BUILDING REGULATIONS )i License: CONSTRUCTION SUPERVISOR �+ Numfi 071507 gir�hdat� b8f1l1.968 i f ==w!r _ t�6. tI /,2005 Tr.no: 3481 �qt _ ,, DAVID J LINNEL Ir p w _ 59 FREEBOARD YARMOU7 HPORT,`iYIIA � 675 Administrator dWA6 � Board ot$ul�driug g pVEMEN GOM RA"C OR 3 r H'OME I��\ g Regl120659 ExP�Fan � /04 i rt LhNt�tiLL ENTERP��� x ryy DAVpD LINNELL 59 FREE BOARD LAIC Adtrator ,. YARM'O�IJTHPORT MA 02�6?5-��� r i r a. GENERAL INVESTMENT COMPA 80 ENTERPRISE ROAD • HYANNIS, MASS. 02601 • (617) 771-0122 BUILDING SYSTEMS OF CAPE COD • INVESTMENTS OF CAPE COD INC. • EDMOND J. LA FLEUR. REALTOR BUILDING SPECIFICATIONS FISHERMAN'S VILLAGE Buildings 3 , 4 & 5 West`#ki i 1treet Hyanrii�sMass; 1. Foundation - 10" concrete wall 716" high on footing 12" x 20" 2. Fiberglass sill sealer 3. Sill - 2 - 2x6 4. Floor - cellar - 3" concrete lst - 2.-x 12 Irk 16 o.c. 5/8 underlay 2nd - 2 x 12 Spruce 16 o,c, 5/8 underlay 5. Exterior Walls - 2 x 4 frame, 16" o.c, covered with 1/2 x 4' x 8' plyscord with brick veneer, 6. Interior Partitions 2 x 4 16" o,c, common walls to be 8" cement block with 2" Celotex Sound Board panels and 3" fiberglass insulation. 7. Roof 16" o.c, 2 x 10 spruce , 5/8 CD Exterior ply. , 8. Roof shingles textured timberline by GAF or similar, Class C underwriters spec;. approve, 9. Exterior Doors - steel insulated (Pease ) Interior Doors - Bi-fold louvered on closet and Pease entrance doors and six panel interior. 10. Interior trim - core mouldings, drywall to Windows, wood sills. Windows - extruded aluminum sliding units with insulated glass 6 ' insulated sliding. glass units. 11. Fireplace - Prefabricated steel with prefabricated chimney per underwriters ' specs. Heatolator Mark 1231 Slate or similar hearth, 12. Interior Walls and Ceiling - %" sheet rock painted, 13. Floors - Wall to wall carpet, kitchen and bath inlaid linoleum. 14. Bathroom - walls 2" sheet rock painted. Tubs moulded fiberglass. Colored fixtures. Vanities with formica tops. a 2 s Kitchen - factory built oak with formica tops and backsplash. Stainless steel sink. Top grade Formica cabinetry w/plywood base. No particle or chip board. 15. Electrical - 100 amp circuit breakers per code. 16. Heat - forced hot water by gas; engineered to maintain 70 degrees interior at 0 degree exterior. 17. Insulation - 331-2" walls - 3%" ceilings. No poly - alum 18. Hot water - glass lined 40 gallon tanks, gas in cellar 19. Decks - 2 x 8 frame , 2 x 6 decking, 2 x 4 rail 20. Landscaping - as per plans of landscape architect D. S. Lawrence Associates. Arnica Mutual Insurance Company SOUTHEASTERN MASSACHUSETTS OFFICE Arnica Life Insurance Company 596 Paramount Drive t Arnica General Agency,Inc. Raynham,Massachusetts02767-5172 i Mail: PO Box 529,East Taunton,MA 0271870529 AUTO HOME LIFE 5 : , } April 41 2002 Town of Hyannis Attn: Building Inspector Hyannis, MA 02632 File Number: F12200202695D Date of Loss: April 1, 2002 Owner/Insured: Faye E. Pratt Street: .F.isherman' s Village, '\ 855 West Main ST. , #17 Town: 'Hyannis Type of Loss: Smoke To Whom It May Concern: Please be advised that we insure the above named individual(s) . A claim has been made for Damage to Real Property , and. as the insurer, we are presently in the process of 'adjuqginc-a the loss. We are mandated to comply with 'Massachusetts General Lis`, Chapter 139 and as such, if there are any present lie on qe, u:, .1 above property, please notify us within 10 days of receipt of T$ this letter. If we do not hear from you, we will be t er n3 obligation to pay you any portion of this claim. � rn Very truly yours /2, William N. 'Lamb Jr. Claims Department Amica Mutual Insurance Company wlamb@am'ica.com-'- *AR T. t Toll Free:i-800-59-AMICA(1-800-592-6422),Web Site:www.amica.com Claims Fax: (5o8)824-5927,Production Fax: (5o8)821-5525