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0080 YARMOUTH ROAD
A o inghouse,Pc OF • STABS`E :P.O.Box 182 . ; - 1y5e Mashpee,MA 02649 1' C Phone: 508221-2980 =' 19 ���� 'ELF structural design Email: jensen@inghouse.net ingenuity Web: wii w.inghouse.net June 21" 2019 inghouse project ID: ING19037 Bass River Properties Attn: Jodi Daley 2 Lynxholm Court Hyannis, MA RE: 5-year egress evaluation of Multi-Family Residence Building located,at 80 Yarmouth Road,Hyannis, MA Dear Mrs. Daley: INGHOUSE has performed the final structural review of the existing; exterior egress stairs and walkways at the properties of the multi family residence building at the project address on July 20`h,2019,and as required by the Massachusetts State Building Code, 780 CMR, 9th Edition, Section 1001.3.2 Testing and Certification(MA Amendments). We have found that the exterior egress systems are in adequate..structural condition and meet the requirements for a renewed 5-Year Structural Egress Certification. OF M1�S Very truly yours, 02 LARSJENSEN INGHOUSE 0STRUCTURAL No.50602 Lars Jensen,P.E., S.E. FG/ST �� 06/21/201y r Town of Barnstable Building Department Services Brian Florence, CBO Building Commissioner BASTABLE 200 Main Street Hyannis, MA 02601 M0.NSRd t4J639-2014Nrt•YAHMl �j nw^exs ie:s•a^cawe.iscieser,-,au _ ) y 7 1639-2014 - www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code.Violation(s) and Order to Cease, Desist and Abate: Our Child Realty Trust 80 Yarmouth Road,Hyannis,MA and all persons having notice of this order: As property owner or tenant of the property located at 80 Yarmouth Road,Hyannis,MA.02601 Assessors Map 328 Parcel 185 and known as residential structure,you are hereby notified that you are in violation of 780 CMR,the Massachusetts State Building Code Chapter 1 Section 110.7,and are ORDERED this date 4/22/2019 to: CEASE AND DESIST all functions associated with the following violation(s)on or at the above mentioned premises: Summary of Violation: On 4/2/2019 I observed a violation of 780 CMR the Massachusetts State Building Code Chapter-1 Section'110.7 Specifically, after having received first and second notices to complete an application for a periodic inspection, pay the requisite fee and request an inspection of the premises you have failed to do so. It is unlawful to occupy a structure without a valid Certificate of-Inspection. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence within 14 days upon receipt of this notice the following action: Come to the building division, complete the application for a Certificate of Inspection,pay the requisite fee and schedule an . appointment for an inspection. And, if aggrieved by this notice and order;to show cause as to why you should not be required . abate the violation in this notice,you may file a Notice of Appeal specifying the grounds thereof with the State Building Code Appeals Board within forty-five(45)days of this notice in accordance with MGL 143 c. 100 and 780 CMR. If, at the expiration of the time allowed,action to abate this violation has not commenced,further action as the law requires may be taken. By Order, Robert McKechnie Local Inspector i l.t._ ti.. TO\41N CI [4t °A� .�1 a(at(S!lf[abIfIllffif-dIli! # is f":t'.t a U.S.P OSTAGE>>PITNEY BOWES WILDING DEPARTMENT SERVICES 00 MAIN STREET rI`fANNIS,MA 02601 a. =':I :.� +�4, . ZIP 02601 $ 006.80' 02 4NV 00003.36455APR. 02. 2019. 7017 1000 0000 6757 2904 Robert Bourgeois. 150 Route 28 West.Denni., Nl.x�E a 81s ;°E 1 0 0:c��,;,�ea /.�,s T0. ��; 1,DE NOT 0ELIVE.� AB. L`E AS .A DR.ESS:ED U:N A8 L E TO FORWARD G�_ 7 C-�_.h sA C?d"1^B A•1 7;® _ 1'J T G ®-r^ C11,11 4.0 a'9 RSA l�aa14a6�a � ��iaaea�:aaalteaaea�aad3a$ aaataas" a� i� '31$e��9 __ s ..,rt. c c eats s .t ... e , L ar^.'C i'�. - f ilt 1 1 e Complete items 1,2,and 3. V7Sign7.tur. e Print your name and address on the reverse ❑Agent I so that we can return the card to you. ❑Addressee I ! ■ Attach this Card to the back of the mailpiece, B. Received by(Printed Name) C. Date of Delivery I or on the front if space permits. I 1. Article Addressed to: D. Is delivery-address different from item 1? ❑Yes I If YES,enter delivery address below: - ❑No I I tL).—De Yl I I ' II I II�III IIII III I III I III I II I I I II II I II I II II I�II 3. Service Type 0 Priority Mail Express® ❑Adult Signature ❑Registered MailTM I i ❑Adult Signature Restricted Delivery ❑Registered Mail Restricted I 9590 9402 3630 7305 4666 41 Certified Mail® Delivery !' Certified Mail Restricted Dellvery Retum Recelpt for I, El Collect on Delivery 'Merchandise ! 2. Article Number(Transfer from_service label) 11 Collect on Delivery Restricted Delivery ❑Signature ConfirmationTm I ❑Signature Confirmation ! 7'017 ,10 0 0 0 0.0 0.:6 7 5 7 2904 Restricted Delivery Restricted Delivery l PS Form 3811,July 2015 PSN 7530-02-000-9053 Domestic Return Receipt ? • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION —rA A t teA Map Parcel ,2�b4 Application ,2&I Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee `) Date Definitive Plan Approved by Planning Board Historic OKH _ Preservation/ Hyannis Project Street Address lc) Nac r-r1ex A Village ,H yMnn l S 1a1 (5 2-1S®f Owner �;��$ Trc3no r-4 e g Address Telephone -60%- 39!4® 9 Permit Request 'r C_ � f .C'1' `,�5 r e , illf 1� comeij-T CAS nee e T.2.Sli k It V C • J A --V1n l 3 ;,a ceJ k3 1 b ''o I-�/I�, L/r' ! '/ �r W 11 i lia `s lCtl it ck,4 6 M1, F-) I(.e-+11M(gent°.. 48rd t-�dl�C�ii"�� quare f�et: 1 t floor: existing proposed 2nd floor: existing proposed Tota new Zoning District Flood Plain Groundwater Overlay Project Valuation kj01 -Q 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .W 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 UILLDING DEPT. Basement Finished Area(sq.ft.) Basement Uninis�ied Area (sq.ft) Number of Baths: Full: existing new Half: EMOV614 2016 new Number of Bedrooms: existing _new TOWN OF BARNSTABLE Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �e ��e��s,b `,� Telephone Number "7 4 70 Address,q� G r f, s-&- License # �o�ll Rom'; MC>1 Home Improvement Contractor# ISO 9'7 Email o-cd-n Cbs Aig,1 fcAe?_5cxkje- fU Worker's Compensation # xt of 5, tt ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �� �� R4 Fly ku �� tz2-721 SIGNATURE DATE�! I N lit FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED ' MAP/ PARCEL NO. ti 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. C� ♦ a THERMAL Work Order 'FACILITY:,80 Yarmouth Rd Apartments. ADDRESS:80'Yarmouth'Rd. Hyannis,IVIA 02601 NUMBER`OF UNITS IN.FACILITY:.B CONTACT:iodi.McDonald with Bass River Properties at:508-394=4446z4 or maintenance super: Erroll_ at 518=210-7842 RISE Contact: Doug Brown at 508-769-9469: SITE DESCRIPTION: This is a 2-story home built circa 1920 housing income-eligible residents: Heated area is:1800 s.f. Heat and hot water system is a gas-fired boiler with an indirect,tank. Roof,.sidewal'I, and windows are all-new in the past 1-2 years.The interior has been renovated within"15 years. Enter driveway.off:Crocker St: Y f d :d SCOPE OF WOR K COMBUSTION SAFETY TEST Perform combustion safety tests for gas-fired space heating/domestic. hot water devices. Work below will not be performed for any units where system(s)fail, until. corrections are arranged by owner and system(s) pass. ATTIC/`KNEEWA. LL ACCESS OPENINGS • Create an attic-to-attic sheathing access into north dormer from main attic: 1.@$31.31 x ! 3 • Create temporary kneewall access openings in unit 8:2 0$74.19.per • Install finished kneewall access doors in existing openings;rear hallway:2('see pix be ow) @$120.00 per ?_A0 -00 •_ Insulate the overhead hatch with R-28 Thermax and compression weatherstripping..1 I'I { tr} w`(r :A Overhead attic Fallen batts in Kneewall KNEEWALL RAFTER INSULATION • Install R-19 un-faced fiberglass to 100 sq.ft.eof missing kneewall rafters. @$1:69 • Install 2 inch FSK faced compressed fiberglass board over the surface of the rafters. Tape all seams with FSK tape and seal the base with one-part foam:`465 sq.ft. @$3.31 15 • 1 KN'EEWALL FLOOR INSULATION Install densely packed cellulose insulation in the 8"joist cavities beneath present.flooring at the band joist areas: 182 sq.ft.'@$2.00 CRAWLSPACE Install a 6-mil polyethylene ground cover over 256 s.f.of earthen floor in the front 8'x 32' section. @$.65 SKETCH f F a 4b NiY f � x5��Cd Yd'fyyx2 . . .. .. l , KW acc.behind unit 7(24 x 51 R.O.) KW acc.behind N(29:511 w X 22.5l Ii R.O.+triangle) AMSEALING Seal attic, kneewall and basement sill electrical and plumbing penetrations,.partition top plates and other leakage points to reduce heat loss through air infiltration. Includes time to re-fast en.approx. 100 s.f.of hanging f/g batts in rafters and combustion safety testing. EstimitOd.Air Sealing Time:13 hours @$80.00 10- y C7 ATTIC VENTILATION Install 4"x16"white, aluminum soffit vents: 3 @$28.91 - G(o.-7 3 BATHROOM FLAPPERS F 8'•�00 Install black, roof-mounted.flapper vents with insulated hoses to existing fans:4 @$87AS ATTIC INSULATION Furnish and install blown cellulose insulation, including ventilation chutes,wind-wash baffles and damming as necessary. Insulation measuring sticks must be installed. An accurate bag count must be recorded and reported. Distance from truck location to furthest corner of the attic is-75 feet. • Install 12" over 400 sq.ft.of open attic area. @$1.46 -,, 9 kt,..pO • Install 6" over 80 sq.ft. of open attic area. @$1.20 C1to 00 LM fq, It dj }g} �} d t 33 2—. j I ^` 3 Ai.". �g:� 3 # * f L _ F t i sit It Rod SW ! ! 1 by # f € ; ,�,� � ! _ty,�.b•, i." "'{,.�.�W—•5--- .�:,i a.. y. �,•,� y�, � r (- '�'^ Kra,^- r �.:., a fIT AN c 24 OW ij } } _ - 1 - 4 t �'• { - { f _ AC40Rf> CERTIFICATE OF LIABILITY INSURANCE °"'�`�"'°°'"�'"' 12/9/15 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 COVERAGEAFFOFtDED BY THE POLICIES BELOW. THIS CERTIFICATE-OF.INSURANCE-.DOES:NOT CONSTITUTIE A CONTRACT BETWEEM THE.ISSUING INSURE_..(S);AUTHORIZED REPRESENTATIVE OR PRODUCER,"AND THE,CERnFICATE.HOLDER.: IMPORTANT: If the certificate holderis an ADDITIONAL INSURED,the pohcy(es) must be endorsed. If,SUBROGATION IS WAIVED,subject to the terms and conditions of.,the:policy,certain policies.`may'require an endorsement A statement on this certificate does not confer rights to the .certificate holder in lieu-of such elldorsemenf(s);. PRODUCER CONTACT NAME: ._ Anthony F. Cordeiro- Insurance PHONE -- FAX 1 • 1508) 677-0407 No: (508) 677-0409 171 Pleasant Street E-MAIL ADDRESS: hsouza0cordeiroinsurance.com Fall River, MA 02721 INSURE S AFFORDING COVERAGE _ NAIC# INSURERA:LibertV Mutual Insurance INSURED INSURER B. i Insulate 2 iSave, Inc. INSURERC: 410 Grove St. INSURERD: Fall. River,; MA 02720 INsuRERE,: NSU RER F: COVERAGES i CERTIFICATE.NUMBER: REVISION NUMBER: THIS ISTO CERTIFY THAT THE POLICESOF 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 —.__._.._..,------_^.,-- ADDLSUBR ----------.--_. __...._. PO'LICYfFF POLICY.EXP. - LTR TYPE OF INSURANCE POLICY NUMBER M/DD/Y.. MM/DDfYY.YY LIMIT'S A GENERALLIABILITY i Y Y. BKS 5.6418741 12/10/15 12/10/16 EACH OCCURRENCE _ $ 1,000,000 X COMMERCIAL GENE RALLUIBILI.TY DAMAGETORENTEDPREMISES(Ea 0=rremW $ 306000 . CLO IMS LADE a OCCUR ME EXP(Any one person) $ 5,000 _. PERSONALBADV INJURY $ 1 00`0 .000 _ GENERAL AGGREGATE $ 2 000 000 H'LAGGREGATELIMITAPPLIESPER PRODUCTS-OOMP/OPAGG $ . 2 000:, 000 MOT- y LOC. — $ A Al1TUMOBICE'LIABIUTY' 1 y Y BAA 564.187.41 12/10/15 12/10/16„CaNaB�INrOHSINGI LIMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ X. NON-OWNED PROPS RTY.DAMA GE HIRED AUTOS X AUTOS .,..Gdenl $ A X UMBRELLALIAB X OCCUR y y USO 564187.41 12/10/15 .12/10/16 EACH OCCURRENCE $ 2,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE, -- - $ 10,000- DED. RETENTION$ - $ A YQRKERSCOMPENSATION. XHj$. :c�64.18741 12/.10/15 12/10/16 X WGSTATU- OTH- AND EMPLOYERS'LUU31L1TY YIN N -- ANY PROPRIETOR/PARTNER/EXECUTNE E.L.EACH ACCJOENf $ . 560,000 OFFICERMIEMBER EXCL LID ED? = N/A (Mandatixyvn NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 Ryyes d�scribeunder DESG�RIPTIONOFOPERATIONS.below• E.L.DISEASE-POLICY11MIT. $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AUachACORD 101,Additional Rerrorks Schedule,ifnwre,space is regr red) Proof of Insurance CERTIFICATE;HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE;DES CRIB_ED POLICIES BE CANCELLED.BEFORE j THE EXPIRATION DATE THE REOE,::NOTICE .WILL BE DELJVERED IN Town Of Franklin ACCORDANCE:WITH THE POLICY PROVISIONS. 55 East Central Street Franklin, MA 0203:8 AUTHORIZED REPRESENTATIVE ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(20.10/05) The ACORD name and logo are registered marks ofACORD Phone: Fax: E-Mail: f -'� The Commonwealth of AVlassachusetts ; J, Department of lnditstrialAccidents jn 1 Congress Street,Suite 100 l7� Boston, MA'02114-2t117' �. www mass.gov%ilia Jt+ N orkers'Compensation Insurance Affidavit:Builders/Contiactors/Electricians/Plumbers: TO BE.FiLED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Insulate2Save/Roland Lange.vin Address:410 Grove Street City/State/Zip:Fall River MA 02720 P}ione#:508-567-6706 Are you an employer?Check the appropriate box: Type of project:(required): 1��✓ f am a employer with 20 employees(full'and/or part-tune),* 7, New C(7t]`St-uction 2.[]1 am a sole proprietor or partnership and have no'employees ivorkine.f©r-rne in 8, �_Reined ling any capacity.[No workers'comp.insurance required.] 3.Q lain a homeowner doing all work myself:[No workers'comp,insunace required.]' 9. 0 Dernolitiotl. 10 Q 13uildine addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'cgtnpensation insurance or are sole 1 I EI Electrical repairs or additions prop rs 5. lamratton<nitco contr no actor . ' 12. Plumbing xe.arrs_oraddtlons 0 g p g or acid I have'hired the�sub-contractors listed on the attached sheet. 11.0 IZUof repairs, rS; These sub-contractors have,en$ployees and have workers'comp.insurance:*` b.o GVe are a corporation and its officers'have exercised their right iif exemption per MG L.c. 14. Otherinsulafion 152,,�1(4),and we have no employees.(No workers'comp:insurance required.] Any applicant that cheeks boxl rnust also fill oui the:section below:showing their workers'compensation policy information. Homeowners who submit this affidavit indicating,they are doing all work and then hire outside contractors ritust submit a new affidavit-indicating such. -Contractors that check this box must attached an Aiditional,Acet showing the name of the sub-contractors and stale N hetlior.or not'lhose entities have; einployces. If the sub-contractors have einployee ,_.bey must,providethcir wurkcrs'comp:policy numbers I am an employer that is providing workers'evnipensatiort.in.sueatice fvr n{y e»rnlr�yces. fieIota is t/repolicy and job site irrforntation. Insurance Company Name.-Liberty Mutual Insurance Po,liev k or Scif=ins.tic,#f XWS 56,418741 Gxpira[ion Datc;1'2/10/1,6' Attach co ty of the workers coin ensation policy declaration page shovr�tt iryiStafe/Gip:Job Site c P. p p. y p g ( g the policy number 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 ilnprisornnent,as well as civil penalties in the form of a STOP WORK ORDER.and a firie of up to$250:00 a day against the violator.A copy of this statement lay be forwarded to the Office of fnifestigations of the UlA for insurance coverage verification. I do:hereby certify render the pants and nenala :c of erjttry that file in orrrratian provided above is trn and'correct. Siy_nature: Date' Phone 4:50&567-6706 Official use only. Do not write in this area,to be 6ompleted 6y eitjr or,towit official„ Citv 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 -- Office of Consumer Affairs and Business Regulation r% 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Cdnt actor Registration Registration: 180747 " Tvpe: 'Corporation Expiration: 12/29/2016 Tr# 261507 INSULATE 2 SAVE INC.ROLAND LANGEVI� 1-1 U3 1'�41 N �� 410 GROVE ST , FALLRIVER, MA 02720 - - -- — " -- -- - Update Address and return card.Mark reason for change. Address Renewal 'Employment (� Lost+ and SCA 1 eo 20M-05/11 '�l/,e�a�rra�en.r.�feczl�n����ra�arfieae%(�, of Consumer Affairs& Business Regulation License or registration valid for individul use only lr ,DOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: `Registration: ,180747 Type: Office of Consumer Affairs and Business Regulation '-y 10 Park Plaza-Suite 5170-Expiration- 1-2129I2046 Corporation s Boston,MA 0211.6 -I 21 it s INSULATE 2 SAVE,INC.. ! w -i ROLAND LANGEVIN � k 410 GROVE ST } FALLRIVER,MA 02720 Undersecretary Not valid without signature Massachusetts Department of Public Safety 1 Board of Building Regulations and Standards i . . License: CS-103861 Construction Supervisor _ ROLAND LANGEVIN 56 HIGHCREST ROAD FALL RIVER MA 02720 (�, �A l_/L_ Expiration: Commissioner 08/24/2017 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 14 Map Parcel Application # Health Division Date Issued 6P Conservation Division Application Fee i Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address uN1"-PA 'T" �s Village k r,3 Owner ;;�� Address f /�� y S� ti/2�` )Okw,� n, Telephone 6"V E 35!y Permit Request St^.io Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ le5ru"Iti-Family (# units) F Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's";--Hi'ghway: ❑Yes...._❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq. C .., t Number of Baths: Full: existing new Half: existing neyv Number of Bedrooms: existing _new yam_ Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Aevwf'L Proposed Use APPLICANT INFORMATION (BUIL-DER OR HOMEOWNER) - -- Name / f`6 J �f S4h Telephone Number _ C0 f- fJs �y�y Address License# 4C� �S 6/s �'�^�°`fK- D`�t D'L-C rr Home Improvement Contractor# Email L'rw shah CVH 6�^r.0-c-�le 10 5cA , orker's Compensation # /��✓�- �1� ��1 d yly-- �19 ALL CONSTRUCTION DEBRIS RESULTING FRQM�THIS PROJECT WILL BETAKEN TO 67 N SIGNATURE DATE W/C FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED v MAP/PARCEL NO. tk l 7.S ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL j GAS: ROUGH FINAL r FINAL BUILDING tom' DATE CLOSED OUT ASSOCIATION PLAN NO. II �/^ �q y�p� q LIAg�I� ip p �{�gq n r� DATE(MMIDD/YYYY) p ry '. 09!12/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY tAND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS ' CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,'EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE. A CONTRACT BETWEEN•THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 04740-001 1 CONTACT Miller McCartin dba Dowling&O'Neil Ins Agcy LONrvo_Ext}: (508)775-162-0 -- ~ }�A/c.No.: - 973!yannnuah_Road N (EMAIL - 77-77 Hyannis,MA 02601 -- �- - ADORE kbolton@doins.com _ 7_ INSURERS)AFFORDING COVERAGE.-- NAIC» _ r-. - INSURER A:, A:I.M.Mutual Insurance Company 26158 INSURED William W Croston William Croston BuildingContractor p1tINSURER c P 0 BOX 138 INSURER D Osterville,MA 02655 LNSURER E. IoINSURERF, ' COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW"HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD —INDICP.?ED:-PJOPN.I?H-ST-A.NIDINO-ANY-REQUIREMENT;TERM_OR_CONDITION_OF_ANY_CONTRACLOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN; THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN'IS"SUBJECI`!U ALL`THt ItRiViS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDUSWUBRI POLICY NUMBER. j POLaCY EFF�1 POLICY EXP, LIMITS +l LTR I IINSR I YD I (MMI DlYYYY) (POLICY GENERAL LIABILITY ) z� It i` 1 �"EACH OCCURRENCE is L_I COMMERCIAL GENERAL LIABILITY a I� I iDAMAGETORENTED `S t �PREMI$ES(Ea occu rence) CLAIMS-MADE 1_,�OCCUR MED EXP(Any one person) S "-- i F I PERSONAL[&ADV INJURY S GENERAL AGGREGATE 1 S �— 'GEN'L AGGREGATE LIMIT APPLIES PER I t PRODUCTS COMPIOP AGG.'S PRO--�j �',LOC p i � .« - , ) �-d'�.'.'..f,�.-,.. ,...... ..-^-� _—s..-•� - , AUTOMOBILE LIABILITY j .l�...-,-�_ _ « COMBINED SINGLE LIMIT S " } I r(Ea accident)T��— ANY AUTO `• i BODILY INJURY(Per person)-�S _ ALL OWNED ( SCHEDULED I 5—-- AUTOS 4 AUTOS (I ! t BODILY INJURY(Per accidenq l}S� HIRED AUTOS { NON-OWNED t I PROPERTY DAMAGE 4�S � t AUTOS ) �4-T �(Peraccident) _` + -I UMBRELLA LIAB [[ I OCCUR I �. I !EACH OCCURRENCE I'S I EXCESS LIAB t CLAIMS NIADE �. ` d AGGREGATE 1 S. y— Di RETENTIONS S — igTATU I� IOTH I — (WOpRKERS Cp RS'LIABILITY A ILIT ! t ITX 'TORN LIFAITS__ n - I AND EMPLOYERS'LIABILITY •' �� i p ANY PRPRIETORIPARTNER/EXECUTIVE Y-) - F F L EACH ACCIDENT S 1,000,000.00 A }OFFICE. /MEMB_ EXCLLIDEC. -� j.Y .;NIA; i AVI!C-400-7013419-2014A` ;, 9/8/2014 t 9/8/2015 `' (Mandatory in NH) --^-) I ( - ( - ', E.L.DISEASE-EA EMPLOYEE S 1,000,000.00 If _ I D C RPTrION uOFOERATIONS beow 'kk ! I • '_, � .. !E.L.DISEASE' POLICY LIMIT is 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach-ACORD 101,Additional Remarks Schedule,if more space is required) Worker's Compensation Coverage Applies to Massachusetts Employees Only , The workers compensation policy does.not provide coverage for William,W Croston ^ 'ERT1V HOLDER CANCELLATION -M1 1 3 N\.... YS`�i0�LD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE { CC T EEXPIRATION DATE "THEREOF, NOTICE WILL BE DELIVERED IN Y' ACCORDANCE WITH THE POLICY PROVISIONS. au-Hc� RcPr-- r AUTHORIZED REPRESENTATIVE - ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Uc' •SSNN its Sales•Rentals Property Management June 8, 2015 To whom it may concern: 1, Ronald Bourgeois, owner of 80 Yarmouth Road, Hyannis, give Bill Cron permission to replace the roof. As always, please do not hesitate to calyk ow have an questions. Y Y Yq Sincerely, "g IN Ronald D. Bourgeois (508) 394-4446 Monday- Friday, 9:00 am(Io_;4 O0 pm ron@bassriverproperties coin = Al n, 4 RDBfm r 0: 508-394-4446 F: 508-394-4819 BassRiverProperties.com 150 Main Street, West Dennis, MA 02670 ffa;A=�HA ME - f��'�L� �s�rrana��ri'a•erf-R�-r�r�ar-cf4"`- t��/��-F�-�c-iarr�lP�Fnt**�,-� . Are yam an emiplUw7 C.'he&Amap1mo-giadt-bQ= 4•❑ I mxtl ccnft�.=61 =rp Dyees{E31I MWOrP ±�fi�)-# ide s ❑ ❑ I a sole pry orpar�er- listed oa the rl#ache3 sheet 7- ❑ g hs-ve - stag assd ham nr•eaoployccs 8_ wad:ing±)rme is agy capacay an$ha WksEl Bux-h*g ' addi u 1 5_ ❑ 'fie are a caipocatia.Laad ifs addi ions s'-❑ I aLn a hmmvmm&Ding 4 watt cuss hxve e=cised•[ck IL[] g or a aas comp-Mmxancz '~Bap�ap��¢chr�fsbarsl�ct+dsa£Il acd't3��br7axshac��ffiES\PC'�r�T mnaperTs3- . �C.o�a����bazm� e3�u3difx�sI shot�ivairgthan�eaf S� m3.e�uhetSFr o��rS�s� 5.-ra _ �tlopePs_Ift� �e��ti�eg�st gmuide 8� 'n•�mg.paw�m� ttlir mr1 lopes rlraf isgra�idng trkers'coutt far t$ ea�Fnyess $elvtr isega art&joh ' morn � , ,- • . p•: .•}, . Facm�tnr-r.�gQ� mriR- � ti /vl '� ��.4,P/'�l �GI.SIJf^e.-•fit„ • ���� €��� - -�� .--�1�.-��r ���� sty - - ���� � • Taber a:�,•;�- �r�-,.(�• � � _�n`a .Bv�.c_ a2GG� . acFf a 4f$xe rn�pe�au�pmi� aer:�sii on 1 l t Fo3'user$�3 Ana }: Faamm to sm=m corsage asn e3uffder sect?5A of MM c 152 cm lead to the imposi�=cf aiminal gemzffirs of$ Ttf P up to L_saQ GD•avdlat�yeari as weII as cdrd geaalfies in•the of a S'.EI P I3R1 {� and a fist cEfup.fa$25Q_00adayagzi3stfheviolater_ Be advisedt9a copy offfsigsl id maybe madtotheQfffireof Ffrr�c3rt;m�of ffm DTA R3rfinucw=ca•umnge v £c a RM by ,,A^A f s ps ier burp fffc �uz vr�a#iva pravi d rtk�+ is hu$cEud m ect - - • �:a�t�- �� Dates � / �� . . lea#� .� v� 771. ••J ��! f EMI ass Do-"t wrifria ffz&wwa,da Be=vWlcW by city ar;b=affic4TL Is�.g.c'�xfharitg{mr�e aue� . . •. .^ - - L Boo d y€IirxTlii I Rd73Fmg I atpTum O=k . if���3,, �sI Lo-�s I52 recp�es aII emgltJye�to pride was'�e�n fg enzplDyczs, . l' tD QiS gb&±'y an MzP&Y L is dared B-S=_=:y p=NM rR'lie sea vtce Df qnoffi=nudes M13r=OtW t Dfhn!> s' cc meet, anal oI4'iLaten-" An m p&ym-is d�esi as 4an ind,a*p ,dun,OmpmatInn or off Ieaal e iy,or a cr more - bfthe foregoing Mgagr-d in.aJoio± and iffi legal re vet of a d eiployq-or fan, reeefvrs r�r trustee of an pa ,a=DC'rE±I or other legal eery,,=gdoynag�P�Ye�s Hnwe�e�ffie owner of a d_weffmghouse haviugnotmore f=tTi=apartneufs anti who resideS theaein,or fe D=4rdat Df{fhe dWP�g hDIIS`e of another WhD emplDyS pea=tD do � ���' °n•or repay wuik on such dweIinz g house or on th$grounds ar bmlding agpnrf mz± shall not because of such employmnut be deemed to be-an ezaploy er." IYEM chapter I52, §25CC6)also sfates or local li==m.g agency,shall withhoIff'he issuance or renewal of a nc=se Dr permsto operatn-a basiaess or to construct'buildings is the commonwnith for any apghrant•mho has not produced gt'rRpfable evidence of coiaphauc_�-ith.�e rasur-�nce coverage requ�ecL� . gy,IAM chapt=I52y§25CM sWns"Neie=fe commonw=hhnor any of it political Subdiy SI= Shall ear into any Co-Mt-art fur fhe pCE&MaMce Df public wcrIuntU acceptable evidence of Trance.w1 h the ms=3n m regtritr nemfs of tbas chaptrr have been pry to$e=&a j mg miffs Y' Plesse;-MI orb the leas'armpensafion affidavit completely,by chug ijie boxes that apply to year situation and,if ne�esary, S13Tply SC7b-�DIl�8LtDt[S)namets).SddTeS�eS)and pI3, nu r t:r( alDllg thC7S CC£LE ate( )of ;,,.once_ Limifad Liability Campam�s(LLC)or Lanrted Liah2*ParineshipS CLEF)whhno employees other Than the members Dr par[nexs>are nDtreq=,--d to catty workexs' compensation;nem-ance If as LLC Dr LLP CID=have employees;a policy is required B e advised that this affidavitmay be submitted tD the:Departmmt of Industrial Accidents for mnfamaiiDn offno=ce Coverage A33o be SUr`e to sign and date the affidavit. The affidavit should be retznned tD the city or town thatthE application for the peanit or license is being iequm ed>not the DepaAment of Inamstial ADeide nts. Should you have any gacstons rtgm-ding th e law or if you a='rid to obtain a *orkers' rrompensation policy,please call the Deparfinertt at the number&sh�i below. Self-ii:s r companies should enter their self-m sa==lict:6se number on the appropriate line- City or Town Officials - - f,�•:• - - Please be sure t�the affidavit is complete and pad legibly- The Department has provided a space at hot a - o f the affidavif for you to fill out is the event the Office ofh:vw6gatio3u has to contact you.regaFdmg ibre applicant ' Please be sine to fi1I.mthepermit/3icease number .Tddch-w beuscd'as amfErm=nraber. Iu addition,an applicant.. that must submit mi1ItipIe peffiitlfi.cense applita ions irl any given year,need only submit one aiitavit indicating current policy info tan(ifn y)and under-Job Sim AAclre:ss"the applicant should write¢aft locations ia (city or town).-A copy Df the affiAavit brat has been officially stamped or maxked by lhe city or town maybe provided the applicant as proof that a valid affidavit is an file fur future permits or licenses. Anew affidavit must be fne.out earl year_Whea-e a home owner or citiLm is obtaining a Han se or permit natrelated tD-any business or commercial ventrae Cie,a dog li=mr,or pe=it to bum leaves etx.)said person is NOT rid to complete this affida.)it Tilt Office of Invesdgadnns would hke tD thank you in advance fryour eoopeaRtiDn and ShDuldyDu have auy.quesiions, please'd.D not hes�f�in give tiS a call_ - . The Departments address,trlephDne'and fzxnumber. TIh�f O��w-'s.Ith OfM=aCH - - .D��mt�t ckf��c�id�nts - . - - • T6L.9 6I7-727-4 =t06 ur I 477 hLA R=4 6I7-727' Rovised 4--24-07 - � - ,LOC],0,080 -YARMOUTH_ROAD - CTY] 07 TDS] 400 HY KEY] 245586 - -MAILING rADDRESS------- PCA] 1211 PCS] 00 YR] 00 PARENT] 0 KRAJEWSKI, NANCY J TR MAP] AREA] P015 JV] MTG11002 WEST WIND TRUST SP1] SP21 SP31 156 MAIN STREET UT11 UT21 . 19 SQ FT] 2340 HYANNIS MA 02601 - AYB] 1920 EYB] 1975 OBS] CONST] 0000 LAND 17300 IMP 99500 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 116800 REA CLASSIFIED #LAND 1 17, 300 ASD LND 17300 ASD IMP 99500 ASD OTH #BLDG(S) -CARD-1 1 99, 500 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 80 YARMOUTH ROAD HY TAX EXEMPT #RR 1890 0081 RESIDENT'L 96100 116800 116800 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE101/95 PRICE] 107000 ORB19536/276 AFD] I S LAST ACTIVITY] 08/18/95 PCR] Y R328 185 . P E R M I T [PMT] ACTION [R] CARD [000] KEY 245586 /`� f�5��� 2 00000000] PURMIT-NO MO YR TYPES� VALUE CK`BY MO YR oCMP NEW/DEMO COMMENT [B34945] [04] [92] [AD].'/ 250001 [LK] [01] [93] [100] [NEW ] [HY DORMER ] A R328 185 . A P P R A I S A L D A T A KEY 245586 KRAJEWSKI, NANCY J TR LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=PRD 17, 300 99, 500 1 A-COST 116, 800 B-MKT 92, 700 BY 00/ BY ME 6/93 C-INCOME PCA=1211 PCS=00 SIZE= 2340 JUST-VAL 116, 800 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA P015 ----------------------------- PROFESSIONAL ZONE PARCEL CONTROL AREA TREND STANDARD 101 30 LAND-TYPE 173001 LAND-MEAN +0% 1168001 IMPROVED-MEAN +0% 500 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 80°61 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADDS/SB/FEAT STR] STRUCTURE ARR]AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] C!. ,1 �i� �����', �Jl�l� ���L T�il�q �,v �2/1 fPc7- CO-��i7ia� TOWN OF BARNSTABLE ZONING BOARD OF APPEALS SPECIAL- PERMIT AND VARIANCE DECISION AND NOTICE APPEAL : 1990-32A AND 1990-326 APPLICANT: RONALD C. FERRO, TRUSTEE OF W.G.F. At a regularly scheduled hearing of the Barnstable .Zoning Board. of Appeals, held on May 24, 1990 and June 7, 1990, notice of which was duly published in the Barnstable Patriot, and notice of which was forwarded to all interested parties pursuant to Chapter 40A of the General Laws of Massachusetts, the petitioner, Ronald C. Ferro, trustee for W.G.F. , through Attorney Peter Freeman, appealed to the Board for a Special Permit pursuant to Section 4-4.2, Change of a non-conforming use; Section 4-2. 7, Off-street parking; and Section 4-2 .8 (Appeal 1990-32A) . The petitioner also petitioned for a. Variance from the Zoning g Bylaw pursuant to Section 2-3 . 1 , Conformance to use regulations; Section 3-2. 1 Uses in the Professional Residential District and Section 3- 2. 1 (2) (A) , Renting of rooms to not more than ten ( 10 ) lodgers in the Professional Residential District (Appeal 1990-32B) . The Board chose to combine the two appeals and hold one public hearing for both. The petitioner's property is located at 80 and 88 Yarmouth Road and is shown on Assessors' Map 328 as lots 185 and 198. It is in the Professional Residential Zoning District. A Site Plan for. the proposal was approved May 17, 1990 by the Site Plan Review Committee. Attorney Peter Freeman represented the petitioner. Mr. Freeman submitted to the Board a memo that explains the basic proposal and gives information on the zoning history of the property. The use. on the property is a pre-existing non-conforming use due to the fact that there have been ten ( 10) lodgers and six (6) kitchens on the site and there has been no family member residing in the structures. ' Currently, the Zoning Bylaw requires a Special Permit for the renting of rooms to no more. than ten ( 10) lodgers if no family member is residing in the structure. The petitioner submitted copies of affidavits of two (2) individuals who indicated their familiarity with the site. - Mr. Freeman stated that the recollections of these individuals date back to 1947 at which time the use was allowed. The petitioner is proposing to demolish the existing structures , unite the two lots and construct a new structure ) which would consist of two storys and a basement . This structure would be connected to the Town sewer system. Photographs of the exising buildings and area were submitted to the Board. The Board discussed the Plans for the proposal . The structure will be an adult day-care facility for people with the early stages of Alzheimers disease. There will be twenty (20) bedrooms, including one ( 1 ) resident manager's apartment . The basement will contain the , day-care facility which will be used by both residents and non-residents. The bedrooms , living rooms and solarium will be located on the first and second floors and there will also .be a congregate dining room on the first floor. There is a total of six (6) kitchens in the existing structures and there will be six (6) kitchens in the new structure. One of these kitchens will be for the day-care facility, one will be for the congregate dining area and four (4) will be - in bedroom un its that wil l have their own kitchene tte. The developer has reached an agreement with the Barnstable Housing Authority whereby the four (4) kitchette units will .be for low or moderate income residents . The four (4) units represent twenty percent (20%) of the total available units. There is a guareentee from the Housin g Authority that these units will be available to low and moderate income tenants for the next twenty-five (25) years. The petitioner submitted a copy of a memo between the Barnstable Housing Authority and the petitioner. ADRDA of Cape Cod, the local chapter of the national group known as Alzheimer's Disease and Related Disorders, Inc. , will run the facility on a long-term lease. Mr. Freeman stated the development will provide a greatly needed social service for people with Alzheimer's disease and their families. Mr. Wlliams, President of .ARDRA of Cape Cod, stated that there are approximately 4, 000 to 4,400 cases of Alzeheimer's disease on Cape cod and that nursing homes are not able to deal with the large number of Alzheimer's patients. Submitted to the file were thirteen ( 13) letters from Health care providers and Social Service Agencies who strongly support the approval of this facility in order to provide long-term care to people with A.lzeheimer's disease. The Board questioned the number of employees on the day shift. Mr. Freeman responded that there will be between six and e.ight. (6 - 8) employees working from 8:30 to 4:30 to provide care for the day-care patients. The employees would include a nurse and a resident manager. At night there would be the resident manager and one other person. Mr. Freeman stated that the building will be secure. The doors will have alarms and will be locked. A courtyard area to the rear of the building willbe fenced. The patients . will not be able to wander outside of the building and every effort will be made to prevent such an occurrance. The patients will be closely monitored by the staff. Mr. �A f Z Freeman stated that .the facility is being based on a similar sucessful facility in Gardner, Maine. FINDINGS OF FACT: Based on the information presented, the Zoning Board of Appeals ma de ade the following findings gs of fact . 1 . The non-conforming use has been substantiated; 2. There is a definite need. for this type of facility in the. Town of Barnstable; 3 . The site's proximity to. Cape Cod Hosiptal makes it a good location for this type of facility; 4. The Site. Plan Review Committee has found that the eleven ( 11 ) spaces that are available at the site are adequate for this type of use; 5. The proposed building will be connected to the Town sewer system; and 6. The proposal would not be substantially detrimental to the neighborhood. The vote on the findings of fact was as follows : AYES: BLISS, BOY, BURMAN, LALLY, NIGHTINGALE . NAYES: NONE DECISION: Based on the information presented and the findings of fact, at a meeting held on June 7, 1990, by a motion duly made and seconded, the Zoning Board of Appeals voted to grant the relief requested with the following conditions : 1 . The proposal will be constructed according to submitted Plans entitled "Specialized Congregate Home for Early Stage Alzheimer's Disease and Related Dementia" prepared by Land Use Technology, Inc. , revised date 5/17/90; and 2.. The petitioner must comply with all State and local building codes. . The vote was as follows : AYES: BLISS, BOY, BURMAN, LALLY, NIGHTINGALE NAYES: NONE PROPERTY ADDRESS I ZONING I DISTRICT CODE SP-DISTS. STATE I FICS NBHD I DATE PRINTED I - KEY NO. CLASS 0080 YARMOUTH ROAD 07 PRO 400 07HY 07/09/95 1211 , 00 P015 R328 185. 245586 YLANLDHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T�, UNIT ADJD.UNIT ACRES/UNITS VALUE Dascrivrivn F.Hsi INC - -M AP- 5:<eDimension LOC./VR.SPEC.CLASS ADJ. COND. PE PRICE PRICE #L'AND 1 17P300/ cD. FF.oe ml2cres CARDS IN ACCOUNT — .SIT .1 Xi _1 J = 8 316 50 71999.9 91007.9 .19• 17300 JfdLDG(SJ-CARD-1 1 99,500 01 OF 01 8PL 80 YARMOUTH ROAD HY A BATHS 8.0 U X C= 100 211000.0 1 28000,01 1.00128000 3 NRR 1890 0081 MARKET 92700 _�j — 3/4 BSMT S X C= 100 1.65 1.65 1152 1900-3 _ INCOME D JSE A APPRAISED VALUE A 116P800 D i ARCEL SUMMARY A U AND 17300 T S LDGS 99500 A T —IMPS M TOTAL 116800 IN CNST F E RIOR YEAR VALUE N - DEED REFERENCE T7ve DATE - q.c«d.a E Book P C Insl. MO. Vr. Salas Pr:4l AND 17300 A S 7933/246, 1iO3/92 L 30000 LDGS 99500 7437/279: V02/91 'L 75000 TOTAL 116800 U 5204/346: IOU/86 113000 R AND ADJ FOR E - BUILDING PERMIT Namber Dale Type Amounl RESIDENTIAL S TOTAL 8 OATHS LAND LAND-ADJ i INC.6I,ME SE SP-BLDS FEATURES .:' BLD-ADJS UNITS I P7300 I I 26100 I 834945 4/92 1 AD i 25000 IEEE AGE 1970 TC; _ 14975 PLUS 314 Class Base Rate -ir Rain B II Norm. 0.b%. ____m s U nss .0 nlias I A u r .t Age Depr. Conti. CND Loc °b R G I HePI Cosl New AUI Repo valoe Stories HalgNl Rooms Rma Balks I Fiz. I r:.:ywtlt fi.:. �C,*T 1/9 3. 106C 000 100 100 58.65 5.3.65 20 75 19 80 100 80 124379 99500 1.5 10 8 8.0 25_0 ^_npL^n Rale Square Fees 1.00 IMP. IDAT'E: E 6/ SCALE: 1100.77 ELEMENTS CODE CONSTRUCTION DETAIL _I RAS i0C 58.65 j 1152 67565 "Li U SP j FFB b50 65.00 ; 36 2340 J *------ - * TYLE 10 LD STYLE U_CI 815 42 '124.63 i 1152' 1 28374 i ! B15 ! PESTGN-A�JMT- QG ------------------�-C R ! ! XTFR:.IAtIS-- ;tt D-60-S-HTNGLFS-`-TMaC! U ! IAATf;C-- YPE- -0 = ------ 16' . .0; C I I I ! ! [INTtK.FTNISH- -QS tASTER ----------U.OI T i ! ! I'NTcR:LAI'QUT- T2 VERBlW0RMAt----- L�T..ai U I ! _ NTER�QJALTY- -02 AME-AT-EXTEK.-- LTmCI R I ! ! *-* COTTR STR-UCT- J2 301S798f�11 T:<0; --- A i . Iw 36 BASE 36! E F LOUR CO-VER-- -08 IWE FIXORIWG---7J.0 L D 1152 I ! FFB2 - RO Of-'TYPE---- -03 TF=ASPH-SHTWG TY_O E Total Areas Au• = ' BUILDING DIMENSIONS Base= ! ' L E-CT RI�A`L 01 YERAGF ------ --U_QI T BAS W32 N36 E32 S1 FFFB E03 S12 20! F 0U-WDATI-O-N- - -02 UNCRETE-BLVCK 9V.-91 A W03 N12 .. BAS S2 0 .. B15 :N36 a *_* -- -- -- ----- - - -- - -- ------------ 1 I IW32 S36 E32 __ ! ! IPROF-ESSIOTCAC T6NE---- ___...._. LI ! ! LAND TOTAL MARKET ! PARCEL 17300 116800 -----------32----_- ---X AREA VARIANCE +0 +0 STANDARD 50 RESIDENTIAL PROPERTY !} ti MAP NO. LOT NO. FIRE DISTRICT •:'w - °:; STREET 80 Yarmouth Rd. Hyannis SUMMARYr 3 '2 185 �3 LAND CG6u ..w OWNER H rn BLDGS. TOTAL RECORD OF TRANSFER DATE BK PG I.R.S. REMARKS: 7y- LAND � BLDGS.. 2-S D • e p - r; B TOTAL Z 3 3 O ° ,°° , Babcock, 'Milton M. & Ann-B. 2 2 1678 Ol .1 a LANDBLDGS. D.2(a l TOTAL LAND BLDGS. TOTAL i LAND BLDGS. i, TOTAL _ LAND a) BLDGS. TOTAL LAND — _ BLDGS. TOTAL 1' LAND - INTERIOR INSPECTED: l ;vim( �', �1 - �" _ (mil BLDGS. - DATE: 3 702 �CVv1 �. VVL ✓` i l'� TOTAL 7 LAND ACREAGE COMPUTATIONS BLDGS. LAND TYPE OF ACRES PRICE TOTAL DEPR. VALUE --- TOTAL HOUSE LOT X,51"'r y , 11 ------ LAND CLEARED FRONT yD O 0 (> � �J v Q `�"Qs� - a) BLDGS. REAR pS -- TOTAL WOODS&SPROUT FRONT 4- --- -- LAND REAR -- - — BLDGS. rn _ NASTE FRONT --- TOTAL REAR __- LAND BLDGS. TOTAL LAND' 0) BLDGS. 'f LOT COMPUTATIONS LAND FACTORS TOTAL FRONT DEPTH STREET PRICE DEPTH % FRONT FT.PRICE TOTAL DEPR. COR. INF. VALUE HILLY TOWN SEWER LAND -- ROUGH TOWN WATER 0, BLDGS. HIGH GRAVEL RD. TOTAL LOW DIRT RD. LAND SWAMPY NO RD. BLDGS. TOTAL FOUNDATION BSMT. & ATTIC 1Z.-UMBING PRICING LAND Corr •• Conc.WallsFin. Bsmt.Area A LeflBath Room Base _ BLDG. COST Conc.Blk.Walls Bsmt. Rec. Room St. Shower Bath/)7Er Bsmt. "r :' PURCH. DATE- Conc. Slab Bsmt.Garage St. Shower Ext. Walls PURCH. PRICE . Brick Walls Attic Fl.&Stairs Toilet Room Roof RENT t Stone Walls Fin.Attic Two Fizt. Bath Floors (Q Piers INTERIOR FINISH Lavatory Extra Bsmt. F 1 2 3 Sink 3 Attic y'-- :J ..'�/Q• -�••, r/4 Plaster Water Cie. Extra EXTERIOR WALLS Knotty Pine Water Only Bsmt. Fin. ..3 Double Siding Plywood No Plumbing _ Single Siding Plasterboard Int.Fin. AsP�ShIngles TILING A10 Conc. Blk. G F P Bath FI. Heat 7(r(/ 3 (� 3 Face Brk.On Int.Layout 71Bath FI.&Wains. Auto Ht.Unit Veneer Int.Cond. Bath FI F . &Walls y/(� t BW ireplace /s/ i Com. Brk.On. HEATING Toilet Rm. Ff. Plumbing { /7•',r� Solid Corn. Brk. Hot Air Toilet Rm.FI. &Wains. 8 Tiling Steam Toilet Rm. FI. &Walls — �e �• Blanket Ins. I Hot Water St. Shower f Total Roof Ins. Air Cond. Tub Area j; •1 ✓ 7- T/ Floor Furn. _ COMPUTATIONS /r/'�•_/..�.?1'2;�1�.i •✓. ROOFING S. F. Asph. Shingle ✓ Plpeless Furn. Wood Shingle No Heat Cj S. F. /5 /(� /11 ` Asbs. Shingle Oil Burner S. F. Oi7 J it Slate Coal Stoker 5!o S.F. Tile Gas C I/ S.P OUTBUILDINGS it ROOF TYPE Electric S F 1 2 3 4 5 6 7 181 9 1 101 1 2 31 4 5 1 61 7 1 81 9 110 MEASURED j Gable Flat Mansard FIREPLACES S. F. Pier Found. Floor Gambrel Fireplace Stack / Wall Found. 0.H. Door Li FLO R Fireplace Sgle.Sdg. Roll Roofing Conc. LIGHTING Dble.Sdg.' Shingle Roof D TE ,—Earth No Elect. Shingle Walls Plumbing Pine Cement Blk. Electric Hardwood ROOMS PRICED: TOTAL `; •":�C,,. Brick Int. Finish Asph.Tile Bsmt. is Single 2nd.3 3rd FACTORt REPLACEMENT "' , r•3 OCCUPANCY CONSTRUCTION SIZE AREA CLASS AGE REMOD. COND. REPL. VAL. Phy.Dep. PHYS. VALUE Funct.Dep. ACTUAL VAL. , f•,.�,� OWLG. 'A/>T• - /' .BSA C _ 1 2 4 — -- — 5 ---- I 7 _ .. g 9 j 10 TOTAL .�TM�tti� The Town of Barnstable Department of Health, Safety and Environmental Services IMMMA1314MAM Building Division 059. 10$ 367 Main Street Hyannis MA 02601 rFo t�a Y Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Conunissioner Home Occupation Registration Date: 17 Name: 7 C j d /'go e-e— Phone#: -og'770 ' 77-�?6 Address: S� (/ga'tyro U f!j rC� Villaze. Type of Business: :,9 Map/Lot: V y — I INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive.materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be . included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: \ vC�l� ; Date: + / Homeochoc The Commoftea ltb of l.a g;5a rbuottg TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.S, this CERTIFICATE OF INSPECTION is issued to WEST WIND TRUST I Certifp that I have inspected the p LODGING HOUSE(NANCY KRAJEWSKI,TR.) located at 80 YARMOUTH ROAD in the Village of HYANNIS County of Barnstable Commonwealth of Massachusetts. The means of egress are sufficient for the following number ofpersons: Use Group Construction Type Location Capacity R1 LODGING ROOMS 8 (10 LODGERS MAX.) 28073 1/7/99 1/7/00 Certificate Number Date Certificate Issued: Date Certificate Expired: The building official shall be notified within(10)days of any changes in the above information Building Official Assessor's office(1st Fioart): f Assessor's ma d lot number' . / 3 a b S 2N�c__ P *THE to`. Conservation Jv� - "✓� • --)�:, rl vv ew Board of Health(3rd floor): • ruL Sewage Permit number MUST CONNECT TO TOWN SEWER t sus y Engineering Department(3rd floor): �© ��o rsr►��� House number Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2-W P.M.only TOWN OF . BARNSTABLE BUILDING . INSPECTOR APPLICATION FOR PERMIT TO I,l3 � TYPE OF CONSTRUCTION f 19 2 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �© � �-u /4/ XAfS' Proposed Use �� i as 5 i2� Zoning District �' -`L� Fire District 84eA. �� Name of Owner Address Te>5<2 Z�d� sd Name of Builder Z1 c t o,,u As-Au s Address 6�K 2- Name of Architect Address Number of Rooms 9 Foundation s Fk-t, (Iu Exterior /3Ord-4 A Roofing A-ffP-4-z5---V— Floors 106191�0 Interior Heating /T 6' Plumbing Fireplace Approximate Cost �2d9e� o G�" Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regardin a ov tructi I Name Construction Supervisor's License C F H, INC. ` .RENOVATE 'INTERIOR/ No Permit For ADD DORMER Lodging House Location 80 Yarmouth Rd. ' Hyannis ` C `F-H, -'INC.- Type ofjConstruction Wood Frame Plot / `Lot =y t r ` ' ? Permit Granted April 6 19`92 Date of Inspection ' e 19 1 r t Date Completed 19 t '1 Z .,.as. IN r i i 10 i r SENT BY: 3— 8-95 ;10:23AM 5087786448-► 1 508 790 6230;# 2 MASSACHUSETTS FIRE INCIDENT REPORT 10 FDIDO0 FINK, I F: 02i2'r e DFPARTiM EaATn nis Fire ®e went RReeApvl oarorten n Arr r. Feorrvm ce Incident M 317/®. xNIII 00Date0 ayThursda 20:61 21 :03D lu SITUATION a?OUND ACTION TAKEN MUTUAL AID GAS L :4 O Re 8 EAK move Hazard 4 FIXED PROPERTY USE (OCCUPANCY) � � "fi IGNITION FACTOR -Apartments 7 - 20 Units :, 4 3 CC ' NOTA FIRE EQ 0-1-1 CORRECT ADDRESS ZIP CODE CENPUS TRACT 00 YARMOUTH RD. 02001 000040 1 1 OCCUPANT NAME (LAST, FIRST, MI) TELEPHONE ROOM or APT. UNKNOWN KITCH OWNER NAME (LAST, FIRST, MI) ADDRESS TELEPHONE lZ PARK SO. MOLT. 136 MAIN ST. 300 775-5611 13 METHOD OF ALARM CO, DIET. PERSONNE4 ENG RESP, JAERIALS RESP, 1 RESP. 0 1 0 4 SHIFT aZ MAT PREBENT? N TANK. RESP. 0 ER OTH RESP. RESCUE 627 140, AL SUBSTANCE 0 0 SPEC. E UIF. USED? r d aIPRYxC1F s ® 0 OTHER Q y ® o ® KOBILE PROPERTY TYPE VEHIC3+# 6T0 LZ1W '? ESTIMATED 'TOTAL INSURANCE CO. DOLLAR LOSS TOTAL INS, am.. 0CLAIM FD 0 30 YEAR MAKE MODEL COLOR LICENSE NO, '1IN4 40 IF EQUIP INVOL. YEAR MAKE MODEL SERIAL NO, IN IGNITION COMPLEX AREA OF EQUIP INVOLVED IN ION, �, ORIGIf1 "� FORM OF HEAT IGNITION ° DdATE uAL JFCRM TYPE fi.cu ` IGNITED METHOD OF LHEVaL OF ORIGIN Number of 5toriea CONSTRUCTION TYPE ® EXTINGUISHMENT EXTENT OF DAMAGE Flame -Choke DETECTOR PERFORMANCE SPRINKLER PERFORMANCE Material generating FORM TYPE .no®t amok,e AVENUE OF SMOKE TRAVEL WEATHER CONDITIONS Y'. . or fice+r in Charge: Date JOSEPH P.CABRAL JR. CAPTAIN 3 f 7 f 9 4 Comments for this incident have been printed an an additional OoMMOMt6 0a0e, f SENT BY:. ; 3- 8-96 ;10:24AM ; 5087786448-► 1 508 790 62304 3 CoMmsnts for Incidsn9: 66 000241 Exposure; 00 Dote, 317195 RECEIVED A RADIO CALL FROM RESCUE 827 ON SCENE OF A RESCUE CALL ATSO YARMOUTH RD.A ROOMING HOUSE THAT HAS A COMMON KITCHEN.THE CREW ON THE AMBULANCE COULD SMELL GAS AND THE ODOR WAS COMING FROM THE KITCHEN,THEY REQUESTED THE ENGINE COMPANYTO THERE LOCATION.RESPONCE ENGINE S22ONLY WITH FIREFIGHTERS WASIERSKI AND COLTON, UPON ARRIVAL MET FF HOLIGAN IN THE KITCHEN HE REPORTED AN ODOR OF GAS NEAR AND ARROUND THE GAS RANGE. THE RANGE IN QUESTION HAS BEEN THE SUBJECT OF SEVERAL INVESTAGATIONS.THEY HAVE ONE BURNER THAT HAS A OrF/ON KNOB MISSING AND THERE IS A PIE-QE ur tLI;CT I HICAL TAPE IN THE FORM OF AN X,APPARENTLY MEANING DO NOT USE. I WAS UNABLE TO DETERMINE WHAT THE EXACT PROBLEM WITH THE RANGE WAS,ACTION TAKEN THE GAS TO THE RANGE WAS SHUT DOWN UNDERNEATH AT THE GAS COCK. ENGINE SU CLEARED THE CALL AND RETURNED TO QTRS.AT 2103 HRS, FOR THE FIREPREVENTION OFFICE COULD YOU FAX A COPY OF THIS REPORT OVER TO THE GAS INSPECTOR RICHARD BURNAM AND REQUEST THAT HE INSPECT THIS RANGE IT MAY BE ONE THAT HE WOULD CONDEMN, CAPTAIN JOSEPH P,CABRAL JR, 317/95. FPO. V� C3C L uN UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS Print your name,address and ZIP Code in the space below. • Complete items 1,2,3,and 4 on the reverse. U.S.MAIL o� • Attach to front of article if space permits, otherwise affix to back of article. PENALTY FOR PRIVATE • Endorse article "Return Receipt USE, $300 Requested"adjacent to number. i RETURN Print Sender's name, address, and ZIP Code in the space below. TO Mr. Richard R. Bearse, Building Inspecf%or TOWN OF BARNSTABLE j 367 Main Street Hyannis, MA 02601 ® SENDE •`Complete items 1 and 2-when additional services are desired, and complete items 3.and' '.",«-""`. f?Srt your address-in'the "RETURN TO" Space on the reverse side. Failure to do this will prevent this card l faom being4W.uriled>to you.The return receipt fee will'provide you the name of the person delivered to and the date of deliver . For additional fees the following services are available. Consult postmaster for fees and check o cles" or additional service(s)-requested. 11 ❑ Show=to=whom delivered, date, and addressee's address. 2. ❑ Restricted-Delivery — (Extra charge) (Extra charge) 3. Article Addressed to: 4. Article Number P 017 014 347 Mr. Ronald C. Ferro, Trustee Type of Service: ~ W G F Nominee Trust ElRegistered b Insured N Quivett Neck Box 872 ❑ Certified, . 11 COD, ❑ Express Mail ❑ Return Receipt i EAst Dennis, MA 02641 for Merchandise Always obtain signature of addressee IY or agent and DATE DELIVERED. j 5. Signature — Addressee 8. Addressee's Address (ONLY if iX requested and fee paid) 6. Si nature — Agent X 7. Date of Uelivery PS Form 3811, Apr. 1989 +U.S.G.PO.1989-239-815 DOMESTIC RETURN RECEIPT P 017 014 347 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) Sentto Mr. Ronad C. Ferro Tr. Street andWO.G F Nominee Trust P.O.,Statenc.RPf)g"nis, MA 02641 Postage S Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered Ln o�i Return Receipt showing to whom, .Date,and Address of Delivery d j TOTAL Postage and Fees S 0 Postmark or Date c+� E 0 LL a STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES. (see front) r 1. If you want this receipt postmarked,stick the gummed stub to the right of the return address leavin& the receipt attached and present the article at a post office service window or hand it to your rural carrier. (no extra charge) 2. If you do not want this receipt postmarked,stick the gummed stub to the right of the return address Cif the article,date,detach and retain the receipt,and mail the article. 3. If you want a return receipt,write the certified mail number and your name and address on a return receipt card,Form 3811,and attach it to the front of the article by means of the gummed ends if space peY- mits.Otherwise,affix to back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee,or to an authorized agent of the addressee,endor RESTRICTED DELIVERY on the front of the article. /1 5. Enter fees for the services requested in the appropriate spaces on the front of this receipt. If return receipt is requested,check the applicable blocks in item 1 of Form 3811. 6. Save this receipt and present it if you make inquiry. :r U.S.G.P.O.1987-197-722 JOSEPH D. DALUZ 790-6227- - TELEPHONEQ7RjKXWX Building Canimirrionrr '4 �}jX�rx TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 October 23, 1990 Mr. Ronald C. Ferro, Trustee W G F Nominee Trust Quivett Neck Box 872 Re: A=328-185 _ .. .,� East Dennis, MA 02641 C-80 Yarmouth-Road-,-H-yann s Dear Sir: This office has received a complaint re property owned by you located at 80 Yarmouth Road, Hyannis.. An inspection of the property revealed that although the ground floor doors and windows are secure, entrance to the building has been made through the second floor windows. The building must be secured immediately to prevent access by unauthor- ized persons. " Please contact this office with a timetable. Very truly yours, i Richard R.. Bearse Building Inspector RRB/gr J cc: Town Manager Certified mail: P"017 014 347 R.R.R. } zt- )8&t4ok � ce 9PJ `u-�.ar vas B�l�v OC 080 IE'Al-Rik'10"LITH C'--"V'1 7 T�,-)5 0 o Hy' K '1 2 4 5.5',8 6 L I I I . L J '�k . r- .1 AL" DSS--- ----- P A 101 1 ( Y1 0 PMANO ADRE Cj1 i '0 ) R.1 A R E N Ir FERRO. RONALD C TES' IF)A F A RE A P 6)12 13V T 61, 9.1 2 N' F ' ONINFE TRUS'W 9 P'l 6 P 3.1 j n.", lyr 1 F bOA U T 19 SQ! Tj 223 0 2 IIA 02-41 AY B I J 0 AN 54000 1111' OTHER 0000 CRl—DTlrON----- T F"U E 11 136400 R r"A C.tl*, r..'.r.I Fl E D L A 9 D� 54. 0 A SD 1,N D 54000 AS.F- fit v 400 ASD OTR #B-T D,G' S.) C A RD 1 82 400 DESCRIFT.TON lrA,.X, IVR CURRENT EXEMPT TAXABLE t #FL 8-0 "I'ARMOUTE! WOAD fl,Y TA.."- 1 #RR 1890 008dT R �T L 13 b 4 0 OFlEN 5-FA-CE 0 M,In i A S T Rl A L E x F 11 1Z,T Ar 0 N S fl,f L I 0 0 OR' 1-5 0 4 `3 4 A F D I AFE -W-71"' - FRA I 1 1 31, 7 AST AClr.rv.F7"Y 708 12 8 P"R 1 LJr 41-diti5 A -5- y /�5'7 ., c,7 7 �S r l — Thomas F. Geller D.u.r •� TOWN OF BARNSTA.BLE Licensing Agent .*aa 7)0-6252 yew' Y El New Applicalion S Renewal LICENSE APPLICATION ❑Transfer Print or type only ❑ Other........................ (Please bear down hard) Date ... ...... .... Name of Applicant ....... rl n ...............................D/B/A ......,.......................................................................... Corp. Name if Different ...............................................................................................................FID # Permanent Address of Applicant ..... r Local Address of Applicant ..............Place of Birth ........ ca.5..i ,�t�.. .:...../ /' .................. ,......... Type of License .....�— <<� � .G�...... /�. .......................Status: Annual ...............................Seasonal ............ Nameof Manager ... ... �.. ....... ...................:............................................................. �.....:... � '�.• � . Permanent Address ......�..a�...... /�:�....�........... .. /l,'�................................................................... :. LocalAddress ....... ,/$�1..4...........................................................::.:...................................................................................................... .....................Place of Birth ......�.r.@:�':5✓..�1.�,..:.. . :�s/...i.........,................................................................ Telephone # of Applicant: Home ....................:.....Bus (............. .......... Telephone # of Manager: Home ...... �h� ...............................Bits (.............).....a .�........... (...:.............) �.�?.::-....... .. 1 l Location of Business ...........3'.r-�.....:o/ ,YL lla . ........:.............1. ! !' .L,).,.......� �.: '........................................ Mail Address if different .... ...... .......11-4t- 1..If— ......................................................... Assessor's Map #(s) .......................3.Q...5.1...........................................Parcel #(s) ..........f...��................................... ............ Any flammable substance or hazardous waste use in business (specify) .........4kv............................................................ Ifnew license - date of proposed opening .......:. .. ................................................................................................................... This form must he completed at least twenty-one (21) days prior to the effective elate of license. 'Tills applic�t- tion will not he forwarded to the Licensing Authority for approval until all necessary inspections <tre com- pleted. Inspections will be carried out during the twenty-one (?I) days prior to the effective elate, and if the premises to he licensed are not ready for inspection the issuance of any license will he delaved pending reinspection at the convenience of the inspectors. Applicants must contact the Building Commissioners Of- fice. the Board of Health Office and the appropriate Fire District Office to schedule inspections. NO BUSINESS M4Y (.4) I JT—Q.VAI-lD LICENSE ON THE PREMISES Signatureof Applicant............ .. ... ...... .................................................................................................................... ------------------------ -------------------------------- 4/ !Fol-Ow ugse(only License Fee $....... .`!.'...........................:..Date Paid./�'�.......(...!...!.........Application Fee $.................................- Date Paid... INSPECTORSAPPROVAL........................................................................................................:................................. Building/Zoning.......................................Date.,............:............................... Board of Health....................................... Dale...........:.. Wire......................................Date......................Plumbing........................... Date......................Gas.......................:................Date.... .. FireDist......................................................Date.............................................. Licensing Agent....................................... Date.............. LicenseGranled.......................................Denied............................I............ Daic.........................................................I....... Numher....... I While Li(clis�ilig;11ahori(.1 Oci1urnnrm Goh! - Ruihli ig (ommis.siairr Pink - 1-in,lA-parmicilf ' r F i q 1 ra x • 41 Ft it 0 ! 1 F- CF_ 't ' l s"-4 t E >s/A LL Ct_ i i i I � e r I SCALE: APPROVED BY: DRAWN BY: [DATE- REVISED - DRAWING NUMBER n