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0165 YARMOUTH ROAD (5)
.114 f- .......... Y37 F � �� G +� i �,: fi Y } I i 1 I` w TOWN OF BARNSTABLE BUILDING PERMIT PARCEL-' ID 328 238 GEOBASE ID 24610 ADDRESS 165 YARMOUTH ROAD PHONE HYANNIS ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 85216 DESCRIPTION 16 SQ. FT. SIGN TO REPLACE ROFF SIGN PERMIT TYPE' BSIGN TITLE SIGN PERMIT CONTRACTORS: PROPERTY OWNER ` Department of ARCHITECTS: Regulatory Services TOTAL FEES: $25.00 BOND .00 CONSTRUCTION COSTS $,00 �4 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE p * BAAMSI'ABM MASS. 16g9. 1� BY ISION DATE ISSUED 67/05/2005 EXPIRATION DATE r • `'` Town of Barnstable pTNE1 _. ti Regulatory Services 0 Thomas F.Geiler,Director • BARNSTABM ► NAss. ,� Building Division t639• �0 _ ar fp Mp`l° Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# S � Application for Sign Permit Applicant: Assessors No.gcA "` c-R38' Doing Business As: 41114-1 Telephone No. j 0P 3 C J 4 0 1 Sign Location - Street/Road: Zoning District: Old Kings Highway? Yes of Hyannis Historic District? Yes Property Owner Name: �z Ate Telephone: -too W Address: fV Village: 41"d Adkor Sign Con actor Name: ��Q S S� Telephone: Mailing Address: V 4,4. . S T Description c . Please draw a diagram of lot showing location of buildings and existing signs with dimensions,loca and size of the new sign. This should be drawn on the reverse side of this application. c�t cc > . C) Is the sign to be electrified? Yesf/NoJ '(NorA te:If yes, a wiring permit is required) v> Width of building face 00 ft.x.10= x.10= cv Co 00 rn I hereby certify that I am the owner or that I have the authority of the owner to make this application,Lat the t information is correct and that the use and`con tru tion shall onform to the provisions of§240-59 through§240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: Date: Size: [r� ! x � Permit Fee: . Sign Permit was approved: Disapproved: Signature of Building Officia • Date: k2�C Q:1WPFILESISIGNSISIGNAPP.D0C QO i I ram.-• ,, �-���` �"i t0ti_L I.L.r•�� � .� r p� .tom• , �'y � -5; �••,t _ �MATTRESS7& �y tFURNITURE i8 '�•,`.:� CLEARANCE":CENTER r' :�� �4•x, ,�tit��..- ...ram �'� � polillill • � t, RS1Y i��a •:� snz f � s • -,��5 'fit,.. _ ". � �,•. .� 'meµ��'a• Milk MATTRESS & FURNITURE: CLEARANCEWCENTER Y f TOWN OF BARNSTABLE ..� SIGN PERMIT ' PARCEL ID 328 238 GEOBASE ID 24610 ADDRESS 165 YARMOUTH ROAD PHONE HYANNIS ZIP LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 83344 DESCRIPTION 40.5 SQ BARBO'S PERMIT TYPE BSIGN TITLE SIGN PERMIT i iCONTRACTORS: Department of ARCHITECTS: Regulatory Services (, tOTAL FEES: $50.00 BOND $.00 �tME CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE 1 0 * BARIVSTABLE, MAW I 1634. ♦� BUILD��TG V�ION BY JJ , DATE ISSUED 04/12/2005 EXPIRATION DATE / r r •�. ry s._ *� � t*r -; �e F+T',n r•,° t i# '.i t�r 't. �•�lV.��M�.,�-s'F c�.;.6.1�'�'z� QcTHEa�;. ��; gp 1 1 r--w.e6.h:l..i..'LS �'� l.i E..t� 6.5+:7 .• •t e dti 8 LE Thomas F.Geller,Director + BARNSTABLE, r. ;_' - MASS. a Building Division 266 APR i i 2- �6L ab g @@ Fom Perry, Building Commissioner 200 Main Street, Hyamiis,MA 02601 DIVISION Office: 508-862-4038 Fax: 508-790-6230 Tax Collector Treasurer Application for Sign Permit. Applicant: 2 `/?130 Assessors No. ( 3� Doing Business As: af� � �,� =S r ; ; ;-�Jd> Telephone No..,:j� JY C� a. Sign Location ,' Street/Road: dlr,`� i if / A. ta ,�/<f % Zoning District: Old Kings Highway? Yes/No Hyannis Historic District? Yes/No Property®caner Name: -Z r � l �" ;.�/® Telephone: Address: ��� rso Village: d 1Y . XAJ �. Sign Contra for 3 Name: I-r 0�✓ S Telephone: —7�y Address: 3 . /va. Village: w, /�a rr•,t C h ALL 02 6-7+( Description Please draw a diagram of lot showinglocation of buildings and existing'signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? De/No (Note.,If yes, a wiring permit is required) I hereby certify that I am the owner or,that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance Signature of Owner/Authorized Agent. Date: Size: Z�0 �i�r Permit Fee: ; Sign Permit was approv 1!' / Disapproved:. } Signature of Building Official:. Date: • Signl.doc rev.122801 WAYSIDE FURNITURE ft . f P . { r r' 'OFURNITURE S yr_4 .r e olioT r �2oPoRrMWAC ) o TOWN OF BARNSTABLE SIGN PERMIT PARCEL, ID^328 238 GEOBASE ID 24610 ADDRESS 165 YARMOUTH ROAD PHONE HYANNIS ZIP — LOT BLOCK LOT SIZE i DBA DEVELOPMENT DISTRICT HY i } PERMIT 83345 DESCRIPTION 18SQ BARBO'S PERMIT TYPE BSIGN TITLE SIGN PERMIT i CONTRACTORS: Department of ARCHITECTS: Regulatory Services TOTAL FEES: $25.00 ff. BOND $.00 �tHE I: CONSTRUCTION COSTS $.00 i 753 MISC. NOT CODED ELSEWHERE I. PRIVATE 4 R BATMMBLE, Mass. pr 039. A,� 1 BUILDI G DSION BY AI DATE ISSUED 04/12/2005 EXPIRATION DATE Town Of Barnstable FTHE Tp� 'i cf :BARNS Regulatory Service Thomas F.Geiler,Directoj, os APR 1 , �" 02 RARNSTABLE. 9 MASS. wilding Division �iOrEn 39. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MM DIVISION Office: 508-862-4038 Fax: 508-790-6230 Tax Collector Treasurer Application for Sign Permit. Applicant: d'4vl'o A&P-1,3 a Assessors No. Doing Business As: � U f S � � i /�� Telephone No. Sign Location Street/Road: A Zoning District: Old Kings Highway? Yeg�N)d Hyannis Historic District? Yes/No Propert Owner � Name: L s 7 Telephone: j0 Address: ,t/�T y Village: ✓' Sign Contractor Name: r l- w S hS k C� Telephone: 5Q�-3 c 7 Y L6 Address:3 S i 1y oe v- S Village: k-, /-/"Z-rcv# L `7 . /14 a zc7 l Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? es o (Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. f I/AA Signature of Owner/Authorized Agent: Date: i� It Size: Lf 7 X Permit Fee: Sign Permit was approved: xlrs + Disapproved: Signature of Building Official: ;�( //z Date: 4111110,r Signl.doc rev.122801 �N dq _ N x a F �'i`"i`� �� �' '.�3- r-n�a_''T�v i'. _.fit' _'tJ• �-'te' � *t- _ _ .,� . µ 5 � r� y ` S f Y Y� s � '' ` E�ct'/'G .'^'A�y1 y � _, - - � � r. .! , , J � - s � ��r _. r � V Y » 1 - � � P J P �. r�t fie'`.., -. y � � �� � J _ t V ` �. _ /i WAYSIDE FURNITURE j f 7 s } i - • • t ` f TOWN OF BARNSTABLE T - SIGN PERMIT PARCEL ID 328 238 GEOBASE ID 24610 ADDRESS 165 YARMOUTH ROAD PHONE HYANNIS ZIP - LOT BLOCK LOT SIZE p DBA DEVELOPMENT DISTRICT HY p I PERMIT 83346 DESCRIPTION 20 SQ BARBO`S i PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of ARCHITECTS: Regulatory Services TOTAL FEES: $25.00 BOND .00 CONSTRUCTION COSTS $.00 t>NE I � I 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE T I * BARNSTABLE, + 9 MASS. 039 I BUILDIN'�DIV IO ' BY I 9 DATE ISSUED 04/12/2.005 EXPIRATION DATE rat F THE _egu ry Thomas F.Geiler,Director [ p pp () • BARNVSTABLE, a s0t! HI:(1 2' 112 MASS. ° Building Division om 1Derry, Building Commissioner , 200 Main Street, Hyannis,MA 02601 "DIVISION - Office: 508-862-4038 Fax: 508-790-6230 Tax Collector Treasurer Application for Sign Permit. Applicant: A/0) kd 13y.ce�° Assessors No. � RV Doing Business As: / ,' i�i s`� !- '5 In" ' 9 6 Telephone No..;-, ,e. r - Sign Location Street/Road: X/;z.15 &_71112�,&, Zoning Distri( Old Kings Highway? Yes/No Hyannis Historic District? Yes/No Property Owner Name: i � A/ �' �J Telephone: ., ` ...?�s —6) n:C3 Address: (4 1 '>': 1� Village: j,, Sign Contractor Name: S. ",s CIL, 'e Telephone: ����5 y'� qZF.� Address: 3 �� �'E r Irl Village: w� Eta C, 6 7 l Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. t Is the sign to be electrified? Yes o 's'(Note. If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance: ' Signature of Owner/Authorized Agent:' &4 -Dates Size: ITT; 24/ . WI), ZO Permit Fee: Sign Permit was approved: S _ D'isapp owed: Signature of Building Official: �; Date: Signl.doc rev.122801 9 ° ► BA �3 u�. .......... : "�AYSIDE i 1 , ell , r� r r ► �, 7z gapY . j I ------------ _. 4 � 13 li 7 � � � -. jP�^�r`^•�•+�r:wJT .,5..„.Y..+.a:Mw.�+ �„ v. SS 1 i px a:. If r � i s J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a Parcel ��J� Application # " I I i Health Division Date Issued Conservation Division Application Fee l vy Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street Address �� �-• �� Village 4gw) Owner k � " J" Address Telephone 6? °& Permit Request 7 4 i r�. -a;� ,� y 2-1 Z-xl RL.Yrvalw U LC I ea 6-0 r 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 ❑ 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 woo&coal stQv_e: 'es ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn existing 0 n w size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: w. Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ • b 0, e r+ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use - _. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 0 A 1 ' `"1121 v �� VIL-AA-T`���Telephone Number Address Ri A -Crd e,�r W License # �,j Q -e-41 0 2-b b O Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 0 s FOR OFFICIAL USE ONLY APPLICATION# F- DATE ISSUED MAP[PARCEL NO. F ADDRESS VILLAGE 5 t OWNER I� k DATE OF INSPECTION: FOUNDATION FRAME �= INSULATION I: FIREPLACE i n ELECTRICAL: ROUGH FINAL. PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING r ' DATE CLOSED OUT s' ASSOCIATION PLAN NO. F i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations' 600.Washington Street Boston, MA 02111 www.m ass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information Please Print Le 'bl Name(Business/Organization/Individual): Yi 64)vt/ -T—e-'4 Address: si Mr_r7. 'r-ov. d City/State/Zip: iv �n n1c Phone.#: 3ca ATII ou an employer?Check the appropriate box: Type of project(required): 1. am a employer with 4. 0 I am a general contractor and L employees(full and/or part-tim.e). * have hired.the sub-contractors6. ❑New construction 2.[] I am a sole proprietor or partner-' listed on the attached sheet.` 7.. O'Remodeling ship and have no employees These sub-contractors have 8. D,Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance. required.] 5. F.� We are a corporation and its '10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised.their I LEI Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 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 anew 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. t Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information �_. Insurance Company Name: a Policy#or Self-ins.Lic.#: X EV Expiration Date:. p l 11 /r Job Site Address: iLC �/ City/State/Zip: c: fl S 0 (J b Attach a copy of the worke s' 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 Iof 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 Ido hereby certify under the pains andpenalties ofperjury that the information provided above is'true and correct Si ature: l�..1/ Date: r13 ll Phone#: 3 F only. Do not write in this area, to be completed by city or town official n: Permit/License# hority(circle one): Health '2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: fu 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 representatives of a deceased employer, or the engaged in a joint enterprise,and including the legal p P of the foregoing � rp 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 n dwelling house of another who employs persons to do maintenance, construction repair work on such dwelling p g house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for,the performance of public work until acceptable evidence of comapliance,%zth 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-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 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 Depa tment has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town),".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to 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 Indu-stri.al Accidents Office of lnvesfigaitIOUs•• 600 Washington Street Boston, MA 02111 ' Tel. #617-727-49-00 ext 406 or 1-877-MASSAFE Fax# 617427-7749 Revised 11-22-06 www.mass.gov/dia 06/20/2011 11:09 FAX 15083983630 BARBO'S FURNITURE 2 001/001 ORDER#: 9286-3 EVENT DAY: THURSDAY' DATE:07-21-2011 - , 9dKovff EVENT TIME: DELIVERY: TUE 07/19/11 PER CUSTOMER :Y-3 Y -W Dennis,MA 02660 PICKUP: MON-07/25/11 PICKUP PER CUSTOMER 'Phoha ,(5i�8)398-9000 :(508)�398-9091 SALES PERSON:BH PURCHASE ORDER#: dercovertent.net ORDER DATE: - 06.14 TERMS: NET 10 DAYS ..t TO SIB TO: u%AN AND DAVID i BAIW98 wA kSJDE FURNITURE 165 XARMOUTH ROAD f.Q.BOX 157 HYANNIS MA ;DM NISPORT MA 02639 * TEL: (508)398-3601 FAX:(508)398-3630 QTY .ITEM DESCRIPTION , :,. PRICE' TOTAL 1 30X60 FRAME TEE-n(WIIITB) 975.00 975.0o 9 7X20 SOLID SIDE WALL 25.50 229.50 9 'SIDEWALL CABLE ' 0.50 4.50 v�l DIG SAFE ARAINGEMENTS 0.00 0.00 Alt SPECIAL'INSTRUCTIONS; TOTAL. SgabO- DAN AND DAV W HME IS YOUR.ORDER /aO I PLEASE MAKE SURE YOU HAVE A HOSE AND WATER ON SITE SALES TAX: 84:W TTIAW YOU DELIVERY: 45.00 LABOR. 0.00 TOTAL: mer Sigutiu'e ate *Customer is responsible for obtaining necessary permits and marking of any undergroimd utilities. r7 cerufteate of si-ame . V I ISSUED BY REGISTERED ®° ga �® FABRIC , Date ae ® F T®PTEC, INC. manufactured �. 0 NUMBER ® 1905 N.E. MAIN ST. SIMPSONVILLE, S.C. 29681 8-15-96 °4p F191 This is to certify that the materials described on the obverse side hereof have been _ flame-retardant`treated (or are inherently nonflammable). F®� UNDE-RCOVER TENTS �` _,�,®®RESS 80 MIDTECH DR CIS' -,', ARMOUTH STATE MA . sa cedificatiorri `is hereby. made that.- (Check "a" or "b°°) (a) The articles described on the obverse side of this Certificate have been treated with'a' flame-retardant . chemical approved and registered by the State Fire Marshal and that the application. of. said Chemical was done in conformance with the laws of the . Slate of California, and the Rules and Regulations of the State Fire Marshal. Name of chemical used............. .:..................... ......Chem. Reg. No. ........................... Method of application...... ........................•-- - ... ......._..............._._........:.:..... ..- ._... ... ... ... ... (b) The articles described on the obverse side hereof are made from a flame-resistant fabric'or material registered and approved by the State fire Marshal for such use. The Flame Retardant Process Used* WILL NOT Be Removed By Washing T®PTEC, INC. - MODEL TTA730ZV FT- 30X,e0 XZ 492 r/`� Priam®.- Production Supmrint®ndent SEI�I�LS 962 - OP ID:AK DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 06/20/11 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 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). CONTACT PRODUCER 800-824-5201 NAME: BerrX Insurance Agency PHONE FAX 9 Ma Street 508-520-6914 AIC No Ext: A", /C No Franklin,MA 02038 E-MAIL Daniel P.Sullivan ADDRESS: PRODUCER UNDER-1 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED Undercover Tent&Party INSURER A:St Paul Fire&Marine Ins.Co. Tony Prizzi INSURERB:Quincy Mutual Fire Ins.Co. 15067 31 American Way South Dennis,MA 02660 INSURER c:The Travelers Insurance Co. 19038 INSURER D: INSURER E: • INSURER F: _ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. 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 DDL UBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDIYYYY MM/DDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CK00222216 05/02/11 05/02/12 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY PRO LOC I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) B ANY AUTO AFV205655 05/02/11 05/02/12 BODILY INJURY(Per person) $ ALLOWNEDAUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- - AND EMPLOYERS'LIABILITY Y/N C ANY PROPRIETOR/PARTNER/EXECUTIVE XEUB1999T91210 11/21/10 11/21/11 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Equipment Floater CK00222216 05/02/11 06/02/12 Limit 600,000 Deduct 1,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (AffachACORD 101,Additional Remarks Schedule,If more space Is required) Party Goods Rentals CERTIFICATE HOLDER CANCELLATION BARBOSW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Barbo's Wayside Furniture ACCORDANCE WITH THE POLICY PROVISIONS. 165 Yarmouth Road Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 06/23/2011 09:15 FAX 15083983630 BARBO'S FURNITURE 11 002 Mill LaneM 231 WILLOW STREET YARMOUTWPORT, MA 02675-1744 'r.. 508.375.0005 FAX 508,375,0303 anagement INC. June June 20,2011 Mr, Dave 13arbos PO Box 157 Dennisport,MA 02639 RE: Tent Sale Dear Dave: As requested,permission is granted to operate a tent sale on.July 21-24, 2011, on the property at 165 Yarmouth Road,Hyannis, MA. Reg ds, Richard Brown Manager I Map Page 1 of 1 Town of Barnstable Geographic Information System New sear Parcel Viewer F Custom Map Abutters Map Size ® ® Zoom Out „I®,,,ln nn�� by n Elyi— � `a=7PG Turn map layers on/off selecting check boxes below 0 rl Town Boundaries t � few i rj Road Names - Voter Precincts �1 Will I Map&Parcel Numbers ' rl Parcels 1 a o ❑ 4P ' - ❑ FEMA Q3 Flood Zones(Old Maps) Will be Superceded in 2010 13 AE(100 yr flood) 9 AO(100 yr flood) 111 VE(100 yr flood w/wave action) all 0 X500(500 yr flood) J Neighboring Towns i r r water. 1. r; Streams t' rl Jetties - - r—1 Edge of Water . r Marsh ® 0 r Drainage Ditches 0 1 9F t �I Water Bodies Set Scale 1"=149 I Aerial Photos _! I MAP DISCLAIMER ❑ Transportation Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v1.2,4113[Production] http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=328238 7/14/2011 ;' .. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application#�d Health Division Conservation Division Permit# Tax Collector Date Issued ^Z� Treasurer Application Fee E Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Addresso — Village HU a MA Owner o Address Telephone 3 4e 6 I Permit Request 77� 3 ox(,o /►L �jL U Z2_4�Z Square feet: 1st 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 supportingn&t umentatiR a Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) u Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yeses ❑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❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 1P ��t/ t r Telephone Number 567 3 4l �0 6d Address A ccv'. 1k)cj License# /✓1A D 2tR66 Home Improvement Contractor# /U�p Worker's Compensation# f 4 rr S L 4H ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ��— ' FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED a MAP/PARCEL NO. - 4 3 i ADDRESS VILLAGE i p OWNER 1 s DATE OF INSPECTION: t FOUNDATION FRAME i INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING �• DATE CLOSED OUT -a ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . + d 600 Washington Street Boston,MA 02111 ,�. www.mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le 6bly Name(Business/Organization/Individual): . LI-A A-r P a,,'.-ten� Address: W City/State/Zip: S.1k D,�n K�A 114k Phone.#: S 3qi Are you an employer? Check the appropriate box: Type of project(required):. I am a employer with 4. I am a general contractor and I 6. ❑New construction . employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling b These su -contractors have ship and have no employees 8• ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY $" 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof re ' insurance required.]t c. 152, §1(4),and we have no -6 employees. [No workers' .13. Other comp.insurance required.] " *Any applicant thatchecks 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 anew 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. Iam an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: r `-L Policy#or Self-ins'.Lic. iqf di T y t/!Z Expiration Date: Job Site Address: 0� S / 2, W.2 V-+) d2� City/State/Zip: r,n n't s Ol�j 6 IF 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-statemeritmaybe forwarded to the Office of Investigations of the DIA foz insurance coverage verification. I do hereby ce fy under t pains"and penalties of perjury that the information provided above is true and correct Signature: Date: Phone#• "ES bq 3 el,-q Official use only. Do not write in this area,to be completed by city or town o jeciai 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)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. 'The affidavit should be returned to the city or town that the application for the-permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number..In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year,where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves-etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number:. The Commonwealth of Massachusetts Dcparbment of 1ne trial Aceidmts Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax 4 617-727-7749 www.mass.gov(dia -.'P. UNDER-1 OP ID:AK DATE(MM/DD/YYYY) `..,� CERTIFICATE OF 'LIABILITY INSURANCE 06/15112 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 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 _ - 800-824-5201 CONTACT , BerryInsurance A NAME: FAX 9 Min Street Agency . 508-520-6914 AH,CNNE,,Ext:r ° C No): Franklin,MA 02038 E-MAIL Daniel P.Sullivan E ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# wsuRERA:St Paul Fire&Marine Ins.Co. INSURED Undercover Tent&Party, - ,INSURERB:Quincy Mutual Fire Ins.Co. - 15067 Tony Prizzi INSURER C:The Travelers Insurance Co. 19038 31 American Way South Dennis,MA 02660 INSURERD; ' INSURER E: INSURER F:. COVERAGES CERTIFICATE NUMBER. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY,PERIOD INDICATED. 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. IR TYPE OF INSURANCE DDL UBR POLICY NUMBER.- MM POLICY /YYYY D M EFF M LICY EXP LTR DD/YYYY LIMITS LT GENERAL LIABILITY. - EACH OCCURRENCE $ °1,000,000 A X COMMERCIAL GENERAL LIABILITY CK00223592 05/02/12 05/02/13 PREMIDAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person)" $ 5,000 PERSONAL&ADV INJURY $ ,1,000,000 ` GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1,000,000 ` 17 POLICY PRO- LOC ' i ' ,.. $ ' AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - 1,000,000 Ea accident $ B ANY AUTO q- AFV205655 05/02/12 05/02/13 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $'• AUTOS, _ - Per accident UMBRELLA LIAR OCCUR _ - ` EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ # $ WORKERS COMPENSATION X, WCY LATU- OTRH- AND EMPLOYERS'LIABILITY Y/N ' IMITS C ANY PROPRIETOR/PARTNER/EXECUTIVE XEUB1999T91211 11/21/11 11/21/12 E.L.EACH ACCIDENT^ $ 1,000,000 OFFICER/MEMBEREXCLUDED? NIA - (Mandatory in NH) s, ", E.L.DISEASE-EA EMPLOYEE $ -;1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Equipment Floater IM00201705 05/02/12 05/02/13 , Limit 600,000 Ded. 5,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) ` Party Goods Rentals 4 CERTIFICATE HOLDER CANCELLATION BARBOSW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Barbos Wayside Furniture ACCORDANCE WITH THE POLICY PROVISIONS. 165 Yarmouth.Road Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE. ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD `4AE Town of Barnstable �i ir'N ti Regulatory Services BAMSrAIMM'$ Thomas F.Geiler,Director 26 N9. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62.30 Property Owner Must Complete and Sign. This Section If USm* g A Builder I Gt.✓� �t/ � as . Owner of the subject property 7:) hereby authorize A t cv- c i Z ' 1 to act on my behalf, in all matters relative to work authorized by this building permit application for; . L(�S r�r�6✓`��- ��. �nrils (Address of Job) J S' of Owner Zate U 2 Print Name QFORvIS:O WNERPERMISSION a Lnr1-rrj�nl nn, 11�� PLIVNOM IMI P ® R T A N T DOCUMENT U M E N T�n� �n�nrrr��n�nrn�nr�rs���n�n�n�rnr�r1-rnr�-crrntn�n�n o s .(17erttfirate of yante 'Re.5tMantr - c5 SREGISTERED ISSUED BY 5 5 APPLICATION a e Date of Manufacture S NUMBER LOINDUSTRIES WC. 04/24/00 5 � �- S � EVANSVLLLE, INDIANA 47711 ' Order Number _ 5 S [FI40.1MANUFACTURERS OF THE FINISHED 5 TENT PRODUCTS DESCRIBED HEREIN S 'This is to 'certify that the materials described have been flame-retardant treated 5 . (or are inherently nonihflammable) and were supplied to: S S 5 SS . `UNDERCOVER TENTS 5 80 MID TECH DR UNIT 3 r 5 WEST YARMOUTH MA 02673 S SCertification is hereby made that: e SThe articles described on this Certificate have been treated with a flame-retardant approved 5 chemical and that the application of said chemical was done in conformance with California Dire 5 5 5 Marshal Code, equal to exceeds NFPA 701, CPAI 84, ULC 109. S The method of the FR chemical application is., SSerial #: 8I51100(3)` • 5 m certified:Description of item S CEN MID 60W X 30 SNYDER W W S' S Flame Retardant Process Used Will Not Be Removed By 5 5 Washing And Is Effective For The Life Of. The Fabric _- S 5 SNYDERMFG NEW PHILADELPHIA,OH Signed: 5 Name of Applicator of Flame Resistant Finish TENT DEPARTMENT—ANCHOR INDUSTRIES INC. S n��6-rcummnui to =r . -.¢ ' � �. °1,. � � .M � .. -# .. *. � � T,; x k. � - T ; ' . . _ ° . . •. � � - . �. t . ,. .. i { s ORDER #: 9810-2 EVENT DAY: TUESDAY DATE: 06-19-2012 Under(over Tent & rt EVENT TIME: DELIVERY: MO 6/18/12 PER CUSTOMER- 31 American Way South Dennis, MA 02660 PICKUP: MON 0.6/25/12 P. CUSTOMER Phone: (508)398-9000 Fax: (508) 398-9091 SALES PERSON: BH PURCHASE ORDER#: Website: www.undercovertent.net ORDER DATE: 01-16 TERMS: NET 10 DAYS BILL TO: " SHIP TO: - DAN AND DAVID BARBOS WAYSIDE FURNITURE 165 YARMOUTH ROAD P.O.BOX 157 HYANNIS MA DENNISPORT MA . 02639 TEL: (508)398-3601 FAX: (508)398-3630 QTY ITEM DESCRIPTION PRICE TOTAL r✓ d c� 1 30X60 FRAME TENT(WHITE) f q 975.00 975.00 9 7X20 SOLID SIDE WALL 25.50 229.50 1 TENT PERMITTING FEE 150.00 150.00 9 SIDEWALL CABLE 0.50 4.50 1 DIG SAFE ARAINGEMENTS 0.00 0.00 n2,0! � SPECIAL INSTRUCTIONS: TOTAL: 1,359.00 DAN AND DAVID HERE IS YOUR ORDER. " PLEASE MAKE SURE YOU HAVE A HOSE AND WATER ON SITE _ SALES TAX: 75.56 THANK YOU DELIVERY: 45.00 LABOR: 0.00 • } TOTAL: 1,479.56 Customer Signature Date *Customer is responsible for obtaining necessary permits and marking of any underground utilities. 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