HomeMy WebLinkAbout0165 YARMOUTH ROAD (2) f � -�- VOL Ct.,2� E-
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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. i
DATE: � .
Fill in please:
x� � APPLICANT'S YOUR NAME/S: �i
r {k� s,= BUSINESS YOUR HOME ADDRESS: c�-.. c i AOO
v rrE MIR
TELEPHONE # Home Telephone Number 7
"41fa mg
NAME OF CORPORATION "
NAME OF NEW BUSINESS 'r `TYPE OF BUSINESS
IS THIS>A HOME,OCCUPATION� YES NO = Z
QDOR.ESS,OF.:';BUSINESS r MAP%PARCEL NUMBER (Assessing]
� .
When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of
Barnstable. This form is intended to assist you in obtaining the information you may.need. You MUST GO TO 200 Main St. - (corner of Yarmouth
Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town.
1. BUILDING COM 1S510 R'S OFFICE
This individu hA b for d an er it require ents that pertain to this type of business.
\\ v
Ilu orized Signature*~
COMMENTS:��J
2. BOARD OF HEALTH
This individual has been informed of the permit requirements that pertain to this type of business:
Authorized Signature*
COMMENTS:
3. CONSUMER AFFAIRS (LICENSING AUTHORITY)
This individual has been informed of the licensing requirements that pertain to this type of business.
Authorized Signature*
COMMENTS:
r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
ANNIS FIRE PREVENTION BUREAU",
IYANMS FIRE4ESCUE DEPA T
Map.. Parcel 9S GH SC O O, cin � 60
f 02601
Health Division Date Issued
Conservation Division Application Fee f
Planning Dept. � pir ��� �eermit Fee
Date Definitive Plan Approved by Planning Board
�r L6
Historic - OKH _ Preservation / Hyannis
� Pro'ject Street Address -. i" oLtM U a6—o
Village
Address Ilo : 6 WC) ,1
Telep ��'"
Permit,Request�
Square feet: 1 st floor: existing proposed 2nd floor: existing 'proposed Total new
'Zoning District Flood Plain Groundwater Overlay
`Pr-oje�uatidn), 0y Construction Type r)v
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 Ro Count
c,
Heat Type and Fuel: ❑ Gas` ❑ Oil ❑ Electric ❑ Other
Central Air: ❑Yes ❑ No. Fireplaces: Existing New Existing wood/coal stove❑ ❑ No
Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing OJnew;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)
d ' L6w,rner6 Name e � S
1_�%ddr�ess
tt) behk716, a2-670 Home Improvement Contractor#
Email Worker's Compen a o�n`_#A""`
ALL-CONS,T.RUCTIONFDEBRIS,RESULTING,FROM THIS.PROJECT WILL BETAKEN TO
rDATE_._._
SIGNATURE-
FOR OFFICIAL USE ONLY
'i APPLICATION#
�DATE_ISSUED
' MAP/PARCEL NO.
'S ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAMES
INSULATION
-' FIREPLACE
ELECTRICAL: ROUGH FINAL
i—h;,tg
C)
PLUMBING: ROUGH FINAL
G S ROUGH FINAL
t�
FIQ5BUILDING
� u
D#NTE CLOSED OUT
c AS—S-01 ANION PLAN NO.
• s�
The Commonweakh of Massackusells
11►eivr hnent of Industrial Accident
Office`ice of Investigalions
+600 Washington Str Beet
Boston,MA 02111
�.wwnmaxLgov1dta
Workers'.Compensation InsuranceAffidavit: BuiIders/Contractars/Electricians/Plumbers
Applicant Information Please print LezibIy
Naive UkIsinre=uxg ,'zrt,���+��l) hAV L U/ hr hl)P/-
1;::7A ess: 12 60aane ' 1.1&4
CCitylStatelZip: .0 n t P '02-0 D Phone 9-
Are an employer?Check the appropriate bog: - T of project r
1.LI I am a em to er with � - 4. ❑ I am a general contractor and I
Type P ] ( �=
P Y 6_ ❑New construction
- to full and/or -time., have hired the sub-contractors
employees( Part )/�
2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7- [:].Remodeling
• ship and have no employees. These s6b-contractors have g_ ❑Demolition
w for me in an c employees and have wodcers'
wing y ��3'- 3 9_ ❑Building addition
[No workers'comp.insurance camp_insurance
required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs cd additions
3.❑ I am a homeowner doing a11.work � ---- _ officers have exercised their 11.❑Plumbing repairs or additions
myself o workers' of exemption per MGL
my [N comp- 12_❑Roof repairs
insurance rewired]1 c_152, §1(4�and we have no
employees-[No workers' 13.0 Other
comp_insurance required_]
'any spplic=that checks box;#1 mast also fill out the section below showing their workers'comtpensMion policy infonastieb
I Homemn+ers who submit this afhdsrit indicating they are doing all work and then hire outside camuactors mast submit a new a$idarit indicating such.
fConttactors test check this box must attached su additional sheet shovdag the name of the sub-conamcton and state whether or not those entities hwe.
entployees. If the.sub-coataactets have employees,dtey must provide.their workers',comp.policy number.
I am an emplo ew that is providing workers',.conrpensatiort insrirance for niy eniployees. Below is the policy and jab site
information. .:
Insurance Company Name:
Policy#or Self=ins_Lic.#: Expiration Date:
Job Site Address: Cty/Statelzip: ,
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required unties Section 25A of MGL c_ 152 can lead to the imposition of criminal penalties of a
fine up to$1,500.00 and/or rue-rear imprisons as well as civil penalties in the form of a STOP STORKORDER 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€or insurance coverage verification.
�I rdoo-he" 1)5? the andpenabYes of perjury,that the information provided aboire is tr and correct
CSi7 Date:
Phone#
official use only. Do not write In this area,to be completed by.city or town ofrciat
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of H-Mth 2.Budding Department 3.CGltsfrown Cluk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact.Person: Phone!!:
6
I
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY)
FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS
r,co,,R
RTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
IS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE
OD AND-ME CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the policy(las),must be endorsed. If SUBROGATION IS WAIVED,subject to the
terms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the
certificate holder In lieu of such endorsement s
PRODUCER CONTACT
NAME
SULLIVAN INS GROUP INC PHONE FAX
10 CHESTNUT STREET (A/C,No,Ext)c (A/C,No)
WORCESTER,MA 01608 EMAIL
ADDRESS:
22JKY INSURER(S)AFFORDING COVERAGE NAIC#
INSURED INSURER A: TRAVELERS INDEMNITY COMPANY OF AMERICA
L.AMMERS,DAVID WYNOTDBA WYNOTS GENERAL INSURER B:
CONTRACTORS INSURER C:
INSURER D:
12 BUCCANEER WAY INSURER E:
WEST DENNIS,MA 02670 INSURER F;
COVERAGES CER71FICATE NUMBER, REVISION NUMBER:
MIYREMAFE ENT TERMORC01 M"CFAWCONTRACrOROrIHERDOCLMMW MFMWWTIDWIM THSCERnRcATEMAY13EISSIiEDORMAYPERTAIN 7FEINSURANM
AFPORDIDBYTHE�OLIdESD1St�iSO EMNISOMEarTOALLTWTERNISl7ICll1SIONSMDCONDI DGCFWCHpOUgp3,LIMIMSHOMMAYNAVEBEENREdMBY
pAIDCLAQMS
tNSR ADD SUB POLICY 6f DATE POLICY EXP DATE
LTR TYPE CIF INSURANCE L R POLICY NUMBER Q t,DD\YYY1n (NMDp1WM LINTS.
GENERALLIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY x DAMAGE 70 RENTED
CLAIMS ME OCCUR $
PREMISES(Ea o=nTonc e)
RPRMUCTS
P(Any one persrn) $
NAL&ADV INJURY $ '
4EN'L AGGREGATE UMR APPLIES PER.
ENE
POLICY $
POLICY PROJECT LOC COMP/OP AGG $
AUTOMOBILE LIABILITY . COMBINED SINGLE $
ANY AUTO LIMIT(Ea acddent)
ALL OWNED AUTOS I30DILYINJURY $
SCHEDULEAUTOS (Per person)
HIRED AUTOS BODILY INJURY $
(Per acddern
NON�WNFJ)AtJfOS PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAR OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DEDUCTIBLE - $
RETENTION $ $
A WORKER'S COMPENSATION AND WCSTATtnm OTHER
EMPLOYER`S LIABILITY YIN UB- B054446-,13 W1111 013 =18W14 X UMTS
A FFICER lEMBER 19CU I YDCECUi1VE � NfA E.L EACH ACCIDENT $ 100 000
CFR DCClI1DED?
( "In" E.L.DISEASE EA EMPLOYEE $ 100,000
If yyeess desv>'be trder
DESCRIFTICN OF OPERATIONS below E.L.DISEASE-POLICY.LIMIT $ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONSIVBiCL.ESIRESTRICTIONSISPECIAL ITEMS
THIS REPLACES ANY PRIOR CER MCATE ISSUED TO THE CERTIRCATE HOLDER AFP=NG WORKERS COMP COVERAGE
LAMMEM DAVID WYNOT IS COVERED BY THE WORKERS'COMPENSATICOY POLICY.
CERTIFICATE HOLDER CANCELLATION
TOWN OF YARMOUTH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
1146 ROUTE 28 BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED
IN ACCORDANCE WITH THE POLICY PROVISIONS.
S YARMOUTH,MA 0?6b4 AUTHORIZED REPRESFM (VE
ACORD 25(2010/05) The ACORD name and logo are registered maNls of AC.ORD 1988.2010 ACORD CORPORATION. All rights reserved.
Massacfiusetts -Department of Public.Safety'
i Board of.Building Regulations and Standards
Construction Supervisor
License:.CS-0122.09
S.
DAVID W LAM VWRS
i 12 BUCCANEERMA
West Dennis MA;02670 I
Expiration
111201
" 01/ 6
Commissioner
"r�
Off.Ao sum r A airs Bdsiness egu ah�on
HOME IMPROVEMENT.CONTOACTOR "
Registration 108082 TYPe
x f Individual
Expiration %17J2014
p `W LAMMERS fig
David Lammers \ x
12 BUCCANEER WAY
W. DENNIS,MA 02670 �,'' Undersecretary
x L-
1
1 .0 Massachusetts -Department of Public.Safety `
Board of Building Regulations and Standards
ConstructionSupervvisor
License CS-012209
DAVID W LA 'RS -
12 BUCCANEER40VA"
nnis MA 702670
West De
�r ��� Expiration T
P' 011.1112016
Commissioner
License or registration valid for individul use only
f before the expiration date If found return to:
Office:of Consumer IT and,Business Regulation
Y.h" -.
AO: :'SuiteS170 F 1
Boston,MA 02116
- ` ,t
Not valid with t sig ature
n -
# tYf[4\Si[faDm
0 ,e Town of Barnstable
Regulatory Services
Richard Scali,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main,Street; Hyannis,'MA 02601
www.town.barnstable.ma.us
-uE):#L' Fax: 508-790-6230
Property Owner Must .
Complete and Sign This Section
If Using A Builder
I, _ 3/4.e z I /--j ,y w• , as-sue of the subject property
hereby authorize. �2,4';--r 0 Ly L.0 �'m Q � s to act on my behalf,
t - - - -.
in all matters relative to work authorized by this building permit application for:
s p.�(Address,of Job)
tore of Owner Date
lLl=,Yh Yl LF_'Zi kl .?w
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
Q:\WPFILESTORMS\building permit forms\smokecarbondetectors.doq
Revised 050412
Town of Barnstable
Regulatory Services
o�T Richard V.Scah, Director
Building Division
wBMM
STAB . " Tom Perry,Building Commissioner
KAM
�e� 200 Main Street, Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
HOMEOWNER LICENSE EXEMPTION
Please Print
DATE:
JOB LOCATION:
number street village
"HOMEOWNER":.
name home phone# work phone#
CURRENT MAILING ADDRESS:
city/town state zip code
The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and
to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts
as supervisor.
DEFINITION OF HOMEOWNER
Person(s)who owns a parcel of land on which he/she resides or.intends to reside,on which there is,or is intended to
be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A
person who constructs more than one home in a two-year period shall not be considered a homeowner. Such
"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be
responsible for all such work performed under the building permit. (Section 109.1:1)
The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other
applicable codes,bylaws,rules and regulations.
The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department
minimum inspection procedures and requirements and that he/she will comply with said procedures and
requirements.
Signature of Homeowner
Approval of Building Official
Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the
State Building Code Section 127.0 Construction Control.
HOMEOWNER'S EXEMPTION
The Code states that: "Any homeowner performing work for which a building permit is required
shall be exempt from the provisions of this.section(Section 109.1.1-Licensing of construction Supervisors);
provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act .
as supervisor."
Many homeowners who use this exemption are unaware that they are assuming the responsibilities of
a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15)
This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed
persons. In this case,our Board cannot proceed against the unlicensed person as it would with.a licensed
Supervisor. The homeowner acting as Supervisor is ultimately responsible.
To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,
as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a
Supervisor. On the last page of this issue is a form currently used.by several towns. You may care t amend
and adopt such a form/certification for use in your community.
s
Mass. Corporations, external master page Page 1 of 1
u:
s b-
Corporations Division
Business Entity Summary
ID Number: 001043311 Request certificate New search I
Summary for: RAILROAD CROSSING, LLC
The exact name of the Foreign Limited Liability Company (LLC): RAILROAD CROSSING,
LLC
Entity type: Foreign Limited Liability Company (LLC)
Identification Number: 001043311
Date of Registration in Massachusetts:
01-03-2011
Last date certain:
Organized under the laws of: State: DE Country: USA on: 12-23-2010
The location of the Principal Office:
Address: C/O TURTLE ROCK, LLC 231 WILLOW STREET
City or town, State, Zip code, YARMOUTHPORT, MA 02675 USA
Country:
The location of the Massachusetts office, if any:
Address: C/O TURTLE ROCK, LLC 231 WILLOW STREET
City or town, State, Zip code, YARMOUTHPORT, MA 02675 USA
Country:
The name and address of the Resident Agent:
Name: JEFFREY D. BILEZIKIAN
Address: C/O TURTLE ROCK, LLC 231 WILLOW STREET
City or town, State, Zip code, YARMOUTHPORT, MA 02675 USA
Country:
The name and business address of each Manager: .
Title Individual name Address
MANAGER CTS CAPITAL 231 WILLOW ST. YARMOUTHPORT, MA 02675
MANAGEMENT LLC USA
The name and business address of the person(s) authorized to execute,
acknowledge, deliver, and record any recordable instrument purporting to affect an
interest in real property:
4
http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001043311&... 4/25/2014
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LARGE PLANS ARE FILED IN:
BANKERS BOX
. FILED'ALPHABETICALY BY STREET
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