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0556 YARMOUTH ROAD
ss6Ji�mo� �. i ACTIVE TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ "1 Parcel r;/ [� ~ Application # Health Division Date Issued a Conservation Division _ Application Fee 7 Planning Dept.t. " Permit Fee _ Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/Hyannis Project Street Address 5 Y6 Yeymooy-�Gf_cC4 Village r c`S` Imf+ 3 S a� Address Owner a-iw�- 5blph`o e I 735-k-lop en, ° Pit Requ se t U�&Q r\o 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 ,TM> a Total Room Count (not including baths): existing new _First Floor Room Cob-Al Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other I. F M Central Air: ❑Yes ❑ No Fireplaces: Existing New _ Existing wood/coal stone: 0�'es O No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing .❑ new size _ Barn J.,ex sting i�.0 new size Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size Other -0 nn Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) A5sot- k- Vd Te1e0hone'Number=w--,...1413- 5-36,"00�4 CAdd'r'ess 'nLicense j "o" oO C`t�cU�- � c�. o i&_73e� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATIDRE: DATE '�` w t FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED. t MAP/PARCEL NO.. 7 A x ADDRESS VILLAGE w " i OWNER 4 DATE OF INSPECTION: FOUNDATION,, ` FRAME INSULATION. , FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH a FINAL ;FINAL BUILDING ;a Y f_ DATE CLOSED OUT, _ ASSOCIATION PLAN NO. Vim`: E T 03 � a A of 4 `Regulatory.Services EARN3rAMX, ♦ r r mass 'Thomas F. Geiler,Director 16 3 9. a�� fi Building Division r Tom Per-ry, Building Commissioner ro k 200 Main Street,Hyannis, MA-02601 , www.town.ba_ rnstalle.ma:us Office: 508-862-4038 Fax: 508-79076230. i NOTICETO THE BUTLDING'DIVISION OF WITHDRAWAL OF LICENSED CONSTRUCTION SUPERVISOR FROM PROJECT vll r r N 4 . Construction Supervisor License k. :: # (� - •herbby certify that:I am no longer the Construction`Supervisor-listed' on the application,for the project,under constructionxas authorizedi by,'buildi'ng permit - a�l abo 5 x >slued to.(property address) .5u f' �"_ �. - ya yLyt( on. 02 D , 201 I also certify that ori, a� .201 . , I notified the property owner, that the . project under construction must cease untilla successor-licensed Conshaction.Supervisor, a, is submitted on the records of the Building Divs>on. 7. ICENSE HOLDER DATE q/forms/newcontr reference R-5 780 CMR 'rev:110410 IA V' .. L� �GNIP''�, Regulatory Services y Mass. . �, Thomas.F.Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Street,.Hyannis;MA 02601 Www.town.barnstable.ma.us Office: 508-862-4038 Fa -x: 5 OS_ 90 a 7 6230 NOTICE TO THE BUILDING DIVISION OF LICENSED CONSTRUCTION SUPERVISOR m ASSUMPTION OF RESPONSIBILITY P Construction Su ervisor License _ #"!�7as gI , hereby certify that I have assumed responsibility for the project under construction, as authorized_by building,permif# �. issued to o ll� rTr e address) f ppy (property )" ��f� on a..�t ;� 201 . The following documents are attached: copy of my.Massachusetts State Construction Supervisor's license or Homeowner's License Exemption.form (if applicable) = copy of my Home Improvement Contractor registration (if applicable)-_ ' Commonwealth of Massachusetts Workers' Compensation Insurance Affidavit. Road Bond (if applicable) )C . LICE HOLDER DzI q/forms/newcon trb mv.'1 10410 tt ` APO ASSOCIATED BUILDERS, INC. 4INDUSTRIAL DRIVE-,SOUTH HADLEY,MA 01075 6(413)536-0021 FAX(413)596-0908• April 3,2012 Perry,• Thomas Pe Building Commissioner . • Town of Barnstable Building Division 200 Main Street Hyannis,MA 02601 RE: Building Permit#96340—Change of Contractor ' Balise Hyundai,556 Yarmouth Road,Hyannis,MA Dear Mr.Perry; On behalf of Balise Automotive Realty Limited Partnership;Associated Builders,Inc.resp.ectf illysubmits'an application fora Change of Contractor for the above referenced project. As requested:by the Building Department,we are providing you with(1)original and(1)copy of the following documents • Town of Barnstable Building Permit Application'for Change o f Contractor . • Application fee in the form of a check made payable to the Town of Barnstable for$35. • Notice to the Building Division of Withdrawal of Licensed Construction Supervisor From Project dated 3/26/,12. • Notice to the Building Division of Licensed Construction.Supervisor Assumption of Responsibility dated 4/2/1.2.. Workers' Compensation Insurance Affidavit dated 04/2/12 • Workers Compensation&.Empl'oyers.Liability Policy:dated 11/16/11. : . •.' Construction Supervisor License for Paul J.'Ciolek dated 3/25/2013: • Proof of Employment for Paul,J:Ciolek and Michael J.'Ciolek from the Secretary of the Commonwealth,Corporations Division. • Agent authorization from property owner dated 4/2/2012: We look forward to working'with your department to.ensure that this work is performed in compliance with Massachusetts State Building Code: Sincerel"Kimberl'y"M.' uk,P.E. Project Engineer cc: Balise Automotive RealtyLLP(1)' Associated Builders,Inc.(1) ' 'ail f ►.'"ousetfc- Dcli ntmcnt of Puhlic S.ifch- Bourd'61 Building Regulatiuns and Si�ndards Construction Supervisor License License: ;CS -52581 PAUL J CIOLEK r- ` 7 DOVE HILL. SO,HADLEY,:MA 010T5 Expiration 3I25/2013s <'nnmMCNincr: Trtl 11502 /HARTFORD; AVELER5.1 WORKERS COMPENSATION TOWER SQUARE AND CT 06183 EMPLOYERS LIABILITY POLICY TYPE V INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (DTHUB-8298M11 -4-11 ) RENEWAL OF (DTHUB-8298M11 -4-10) INSURER: THE TRAVELERS INDEMNITY COMPANY OF AMERICA 1 t NCCI CO CODE: 13439 INSURED: PRODUCER: ASSOCIATED BUILDERS, INC. T P DALEY INS AGCY INC 4 INDUSTRIAL DRIVE PO BOX 1150 SOUTH HADLEY MA 01075 WEST SPRINGFIELD MA 01090 Insured is A CORPORATION . Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 11 -01 -1 1 to 11 -01 -12 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 500000 Each Accident , Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 500000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MD ME' MI MN MO MS MT NC NE NH NJ NM NV NY OK OR PA RI SC SD TN TX UT VA VT WI WV D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS — EXTENSION OF INFO PAGE o 4. The premium for this policywill be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made'ANNUALLY. DATE OF ISSUE: 11 -16-11 MM OFFICE: HARTFORD 084 } PRODUCER: T P, DALEY INS AGCY INC G7940 016739 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents (ice"I..� ---=1i�,.,4 Y},� Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ASSOCIATED, BUILDERS, INC . Address: 4 Industrial Drive City/State/Zip: South Hadley, MA 01075 Phone#: 413 536-0 2 Are you an employer?Check the appropriate box: Type of project(required): 1.® 1 am a employer with 30 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have 8• ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp. insurance required. *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information.' ' t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site, information. Insurance Company Name: Travelers. Policy#or Self-ins.Lic.#: D TJUB-8 2 9 8M11"-4-1 l r Expiration Date: 11/01/2 012 Job Site Address: YA,_/MC,1 �/u�l,d)��,`R&—City/State/Zip: ' A�f7 621$, ®a,�6[ -- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised.that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi de h a es of Per`u that the in ormation provided above is true and correct. Si nature: _ ._. __ _ . .•.. . . _ Date:: Phone#: (413) 536-0021 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk ,4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#:.. f The Commonwealth of Massachusetts William Francis Galvin- Public'.-Browse and,Search: ,Page•F of 2 '" • - The Commonwealth of Massachusetts rf William Francis Galvin n Secretary of the Commonwealth,Corporations Division. One Ashburton Place, 17th floor . Boston,MA 02108-1512. Telephone:'(617)727-9640 ASSOCIATED BUILDERS, INC. Summary Screen Help with this.form Request;a Certificate • The exact name of the Domestic Profit Corporation: ASSOCIATED BUILDERS,INC. Entity Type: Domestic Profit Corporation Identification Number: 042489813-. Date of Organization in Massachusetts: 12/10/1971 Current Fiscal Month/Day: 10/31.. Previous Fiscal;Month/Day:00/00 The location of its principal office: No. and Street: 4 INDUSTRIAL DR City or Town:. S.-HADLEY State:NU Zip: 01075: Country:USA, If the business entity is organized wholly.to do business outside Massachusetts,the,location of that office:: : . No. and Street: Cityor Town: State: Zi p. Country: Name and address of the Registered Agent: Name: MICHAEL J..CIOLEK,JR. No. and Street: : 4 INDUSTRIAL DRIVE City or Town: SOUTH HADLEY State:MA : Zip.: 01075 Country:USA . The officers and all of the directors of*the corporation:', Title Individual Name' : Address(no Po Box) Expiration First,Middle,Last;Suffix Address,.City or Town,State,Zip Code of Term PRESIDENT MICHAEL J.'CIOLEK g DOVE HILL S. HALDEY',MA USA "9 DOVE HILL$: HALDEY,MA USA' TREASURER PAUL J.CIOLEK' 7 DOVE HILL;S', HADLEY,MA USA 7 DOVE HILL;S. HADLEY,MA USA SECRETARY THOMAS,A.CIOLEK ' • ' 39 PINE ST.,$0. HADLEY.,MA USA .39 PINE ST.,SO. , . . . ., HADLEY,MA USA ,.• .' business entity stock is publicly.traded: The total number of shares and par value, if any,of each class of stock which the business entity is authorized to issue: http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True&... 4/3/2012 . The,Commonwealth of Massachusetts William Francis Galvin-Public.Browse and Search. Page 2 of 2 Par Value Per Share Total Authorized by Articles Total Issued Class of Stock Enter 0 if no Par .. of Organization or Amendments and Outstanding Num of Shares' Total Par Value: Num of Shares_ No Stock Information available online. Prior to August 27,2001, records can be obtained on microfilm. Consent Manufacturer Confidential Data Does Not Require Annual Report Partnership Resident Agent For Profit Merger Allowed Note:There is additional information located in the cardfile that is not available on thesystem: Select a type of filing from below to view this business entity filingsi ALL FILINGS - I(�' Administrative Dissolution Imo' Annual Report f Application For Revival .. Articles of Amendment �J Aiticles`of'Charter Surrender View Filings I New Search I, Comments O 2001-2012 Commonwealth of Massachusetts 'All Rights Reserved ..Help http://corp.sec.state.ma.us/corp/corpsearcl/CorpSearchSummary.asp?ReadFromDB=True&... 4/3/2012. . ' n • t • Town of Barzstahle . . R.,egW Cory Services `eg _nomax F.Gdler,Director Btdldin D vIdbion ToYn.Perriy,Boil ag cotm*ziorw 200 MKin$t t; . miss MA 02601, ' ww�itown. �rnrtabie:maaa Office: 509-8624438 F1z: 508=790 230 i r . " Property C}Wile:rMust Cemplete and Slign This Section If USIng ABuilder i F I, James E.• Balise. ,as.Ownerof the sub"ett to I P PertY h=6ya:urho (Associated Builder Inc. toai;ton m3rbehaY in al=ttmm-re}arivE to work aurhouzed by this buiMingpmnit appl cadon:for Balise Hyundai_ 556 'Yarmouth- Road, ltyanni , MA (lcddnss of job) of Owner Date James .E<. Balise. Print-Nair i If Prop ertv Omer is applying for permit please co=plete..te Homeowners'License Exempt 0n l DIM on the reve4.e side. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i Map Parcel! � :Application # 6 + Health Division Date Issued 2 Z� Conservation Division 7 Application Fee Planning"Dept. Permit Fee; Date Definitive Plan Approved by Planning Board Historic - OKH Alm - Preservation / Hyannis T Project Street Address 6Z9 Ya4 N-V 1 4 Roacl Village n Owner 1� - L-- _ L LOAdlss ' S�6(1 j u,�� QA ��`��Vl✓l.c S Telephone 7,# leg / 2 /3 Permit Request 2 y el? Z 61 P 1,. N(r / aR% �' i NT,�i�l�, Square feet: 1 st floor: existing proposed :2nd floor: existing /V proposed Total new Zoning District Flood Plain /\J: Groundwater Overlay �r Q i- p Project Valuatio (� OG O d/Construction Type Lot Size •3�� 1-► cc Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) -A) � Age of Existing Structure LIS Historic House: ❑Yes Lt No On Old King's Highway: ❑Yes 0 No Basement Type: ❑ Full ❑ Crawl �/❑J Walkout ❑ Other Basement Finished Area(sq.ft.) N r ! Basement Unfinished Area (sq.ft) NA Number of Baths: Full: existing-- I�-�- new Half: existing negv Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Ho"oj-n Counter dd �a Hijat Type and Fuel: t Gas ❑ Oil ❑ Electric ❑Other ' Central Air: N Yes ❑ No Fireplaces: Existing New Existing wood/ oal stove, LITZ ❑ No M Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: 0 existing Onew 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 A VA-0 rVVV6 le Oealf Proposed Use 0 A-,0 e ��( APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name AAAAleQ e C(J L(\,AtAd0i Telephone Number 21 -4 Address -� e LCX License# 7 0 ll 4v1 L LU Home Improvement Contractor# Y\-C" Worker's Compensation # ALL CONSTRUCTION EBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Cl Y1 Kao SIGNATURE WO P DATE Z f J ow FOR OFFICIAL USE ONLY APPLICATION# s DATE ISSUED i' f r FMAP/PARCEL NO. :h ADDRESS VILLAGE, OWNER , DATE OF INSPECTION: FOUNDATIONS >. FRAME INSULATION. FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 0' GAS -f-I ROUGH, afu '•�,"� FINAL _!"FINAL BUILDIW4• m-�: DATE CLOSED OUT ASSOCIATION PLAN NO. 1""' VL Ft r 4 a - �r� The Commonwealth of,Massachusetts ^; i Department of Industrial Accidents Office of Investigations i; 600 Washington Street,. Boston;MA'02111 1. www.Tass.gov1dia_ Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectricians/Plumbers Applicant Information ti �Q. ` Please Print Legibly Narne (Business/Organization/Individual): I(\ Address: Lob City/State/Zip: 0 Phone,#:'- _c _'T. Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer er with 4. 9 T am a general contractor and I • P Y - 6, 0 New construction . employees(full and/or part-time).* have hired thesu- contractors 2.0 I am a sole proprietor or partner- listed on the attached sheet t 7• Remodeling ship and have no employees' These sub contractors have 8: 'Demolition working for me in any capacity. `workers' comp. insur"ance. 9. ❑Building addition [No workers' comp, insurance„ 5. O'We area corporation and its officers have'exercised their 10.0 Electrical repairs or"additions required.] 3.0 I am a homeowner doing all work' _right of exemption-per MGL 1 1;0 Plumbing repairs-or additions myse If.'[No workers',com' c. 152, §1(4);:and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.0 other ' comp.insurance required,] *Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy informatior% t Homeowners who submit this affidavit indicating they are doing'all work and then hire outside'contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. ' I am an employer thatis providing workers'compensation insurance for my employees: Below,is the policy and'ob site information M /' �� I Insurance Company.Name:-1..._1'\C/l, %JoeQ 1• Policy#or Self-ins. Lic #: nn(�� (,� Expir Date: Job Site Address: G� n-,,0 City%State/Zip: Attach a copy of the workers' compensation policy'declara on page(showing•the'pofty number and expiration date).` Failure to secure coverage as required under Section 25A of MGL e°.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 STDP.WORK ORDER and a fine of up to$250.00 a day against the violator: Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification.' I do hereby c tify ride the pains and penalties of perjury that the information provided above is true and correct. /l Signature: Dater � OLO �A Phone#: Ar Official use Vily. Do not write in this area,to, o be;completed by city or town official City or Town: x; .Y, Perm it/License# 'Issuing Agthority(circle one): t. z 1. Board of 13ealth 2: Building Department 3.City/Town Clerk• `4. Electrical Inspector 5.'Plumbing Inspector ' 6. Other 4 ® f CERTIFICATE OF LIABILITY 1NSURANCE DATE(MWDDiYYYY) 1/5/2012 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 1NSURER(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 endorsemen s . PRODUCER CONTACT Beth NAME: Sheehan Winslow Warren Insurance Agency PHONE (508)668-1612 FAX (508)668-7906 896 Main St. E-MAIL .beth@winslowwarreninsurance.com P. 0. Box 71 INSURERS AFFORDING COVERAGE NAIC 9. Walpole MA 02081 INSURERA.:Peerless Insurance. 2419'8` INSURED INSURER B Hannon Electric, Inc.. INSURERC: 15R Commerce Way INSURER 0: INSURER E.: Norton MA 02766 [INSURERF: COVERAGES CERTIFICATE NUMBER:MasterCertificate2012 REVISION NUMBER: THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED,NAMED,ABOVE FOR.THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT.OR OTHER DOCUMENT WITH RESPECT TO WHICH.THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED.BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,: EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE:BEEN REDUCED BY PAID CLAIMS. I POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ADD POLICY NUMBER. LIMITS GENERAL LIABILITY EACH OCCURRENCE..... S` . 1,0.00 i 000 X: COMMERCIAL GENERAL LIABILITY WJMGPREMISES EEa occurrence. $ 1001000 � 1/11/2012 ,1/11/1013 A CLAIMS-MADE L..^_J OCCUR X B85274195 MEDEXP A oneperson)t._ $ 15;000 PERSONAL B ADVINJURY. $ 1,000"000 GENERAL AGGREGATE $. 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; PRODUCTS-COMPIOP AGG $ 2,000,000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY. COMBINED SINGLE LIMIT,_ ANY AUTO - BODILY INJURY(Per person) .S - A ALL OWNED SCHEDtlLED A527418A. /T1/2012 :� /11./2013 BODILY INJURY(Per accident) -$ AUTOS AUTOS X HIRED AUTOSN NON-OkAMED PROPERTY DAMAGE AUTOS ' $ Pip-Basic .$ I8 0 0 0 X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS MADE AGGREGATE $ 1,000,0'OO, DED X I FIETENTtou$ 1o,000 X CUSS22156 /11/2012 /11/2013 $ A WORKERS COMPENSATION WG STATU- OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? NIA A C5274191 711/2012 /11/2013 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If as,describe under DESCRIPTION OF OPERATIONS below EL-DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/'VEHICLES (Attach ACORD 101,Additional.Remarks Schedule,If mom -apace Is required) All electrical contracting operations of the insured. Project: Balise Ford. Advantage Construction, Inc., Wayne Rurker, Balise Auto Group, and the Town of Barnstable .are named as additional insured on a primary and non-contributory basis except for workers, Compensation CERTIFICATE HOLDER CANCELLATION (781)848-3.774 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE' THE EXPIRATION. DATE THEREOF, NOTICE WILL BE DELIVERED IN Advantage Construction, Inc. ACCORDANCE WITH THE POLICY PROVISIONS, 2 .Adams Place, #100 Quincy, MA 02169-7456 AUTHORIZED REPRESENTATIVE I.Beth E. Sheehan : -- ACORD 25(2010I05) ©'f988-2010.ACORD CORPORATION. All rights reserved. INS025(2R1005).01 The ACORD name and logo are registered marks of ACORD Alm OR& , DATE(MM/DDIYYYY) `,,,� CERTIFICATE OF LIABILITY INSURANCE . 09/282011 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 CONTACT Diane Shaw Fred C.Church,Inc. NAME: 41 We6'men Street PHONE 978 3227272 FAX (978)454-1865 Lowell,MA 01851 (AIC,No Ext: AfC No): E-MAIL dshaw@Gedcchurch.com (800)225-1865 ADDRESS: INSURERS AFFORDING COVERAGE NAIC S INSURER A: Citation Insurance Company 40274 INSURED - National Union Fire Insurance Company of Pittsburgh,PA 19445 Advantage Weatherization,Inc. INSURER B INSURER C: Navigators Insurance Company 42307 Two Adams Place.Suite 100 Gemini Insurance Company 10833 Quincy,MA 02169 INSURER D: INSURER E: Starr Indemnity&Liability Company 38318 INSURER F: COVERAGES CERTIFICATE NUMBER: 18556 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. ILTR TYPE OF INSURANCE IN S B POLICY NUMBER POLICY MMfDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000, X COMMERCIAL GENERAL LIABILITY DAM GETO NTED PREMISES Ea occurrence $ tOq,000 CLAIMS-MADE M OCCUR - MED EXP(Anyone person) $ 5,000 D VUMA0000890 4122011 4/212012 PERSONAL&ADV INJURY _ $.1,000,0W GENERAL AGGREGATE $ 2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY P O- LOC X $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1.000,000 Ea accident $ ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED X SCHEDULED B8NT98 4/2/2011 4/22012 AUTOS AUTOS BODILY INJURY(Per accident) $ X X NON-OWNED PROPERTY DAMAGE HIREDAUTOS AUTOS Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 E EXCESS LIAB CLAIMS-MADE .S(SCCCLO1523811 &W2011 ti/20r2012 AGGREGATE $ 5,000,000 14DED I X I RETENTION$0 $ WORKERS COMPENSATION X WC STATU- OTH AND EMPLOYERS'LIABILITY - OR LI ITS E E.L.F?,CHACCIDENT $ 1,000,000 B ANY PROP171ETORIPARTHERJEXECUTWE Y f N _ - • OFFICER/MEMBER EXCLUDED? N/A 006436048 6/20/2011 6/20/2012 1,000.000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 10,000,000 X of$5.000,000 C Umbrella NY11EXC7111931V 620/2011 6/202012 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) A Certificate is issued as evidence of coverage regarding the Balise Ford,Hyannis Project CERTIFICATE HOLDER CANCELLATION own of Barnstable R SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1200 Phinneys Lane THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE p Client# Mst# Cert Holder# ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD ACC>RiYCERTIFICATE OF LIABILITY INSURANCE NUDDIYYYY) 1/23/2023/2012 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 endorsements). PRODUCER CONTACT _ _ .NAME: Kelly E tano ' The Driscoll Agency,Inc. PHONE FAX 81-421- 498 93 Longwater Circle E-MAIL .No. Alc No: 81-4 1-2499 P.O. Box 9120 ADDRESs:Ke tan driscoll agency.c Norwell MA 02061 INSURERS AFFORDING COVERAGE . NAIC 9 INSURER A:V I e Forge Insurance CO 0508 INSURED 6795 INSURER B:National Fire Insurance Coma 0478 New Century Roofing,LLC INSURER c:CNA onbn ntal Casualty Co 20443 8 Academy Place Orleans MA 02653 INSURER D INSURER E: • INSURER F: COVERAGES CERTIFICATE NUMBER:1951513855 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 SHOVMJ MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY W MM/DDIYY A GENERAL LIABILITY 4029191185 /13/2011 /13/2012 EACH OCCURRENCE $1,000,000 A X o Residential Excl ` ' /13/2011 /13/2012 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence s300,000 CLAIMS-MADE IT]OCCUR MED EXP(Any one person) $5,000 X Contractual PERSONAL&ADV INJURY $1,000 000 X XCU Coverage r GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $2,000,000 POLICY X PRa LOC Contractual Liab $Included B AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT /13/2011 /13/2012 Ea accident $1 000 000 4029191221 ANYAUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIREDAUTOS X AUTOS - Peraccident $ Coll&Comp Ded $500 C X UMBRELLA LIAB X OCCUR 4029191204 13/2011 /13/2012 EACH OCCURRENCE $5,000,000 _ EXCESS LIAS CLAIMS-MADE AGGREGATE $5,060,000 DED I X RETENTION$10 000 - $ C WORKERS COMPENSATION VVC429191249 /18/2011 /1812012 X Toc STATTS OTH- AND EMPLOYERS'LIABILITY Y/N RY'4�_ '— ER "— OANY FFICER/MEMBER EXCLUC PROPRIETOR/PARTNER/EXECUTIVE� NIA E.L.EACH ACCIDENT $500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500.000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Installation Floater 29191185 ` /13/2011 /13/2012 Installation Limit $100,000 Business Personal Property BPP $60,831 Contractors Equipment Scheduled Equip $41,500 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,IF more space Is required) RE:work performed at Balise Hyundai, 556 Yarmouth Road, Hyannis Advantage Construction is included as Additional Insured for Automobile Liability on a Primary Basis for the conduct of the(Named)Insured, but only to the extent of that liability. Advantage Construction is included as Additional Insured for General Liability,for ongoing and completed operations on a primary,non-contributory basis, perform G140331-C,as required by a signed written contractor agreement with e Named Insured. See Attached... CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Advantage Construction - ACCORDANCE WITH THE POLICY PROVISIONS. 2 Adams Place#100 Attn: Bruno Plres AUTHORIZED REPRESENTATIVE Quincy MA 02169-7456 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name"and logo are registered marks of ACORD AGENCY CUSTOMER ID: 6795 LOC#: A ADDITIONAL REMARKS SCHEDULE Page,a9 1 of 1 AGENCY NAMED INSURED The Driscoll Agency, Inc. New Century Roofing, LLC POL(CYNUMBER - 8 Academy Place Orleans MA 02653 CARRIER NAIC CODE ADDITIONAL REMARKS EFFECTIVE DATE:- THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE The General Liability and Workers Compensation Policies include a Waiver of Subrogation in favor of Advantage Construction on whose behalf the Insured is required to obtain this Waiver under a written contract or agreement executed prior to a loss. Notice of cancellation provision is 30 days,except 10 days applies for non-payment of premium. { ACORD 101(2008101) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD G-140331-C (Ed. 10/i0) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS WITH PRODUCTS-COMPLETED OPERATIONS COVERAGE This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE(OPTIONAL) Name of Additional insured Persons Or Organizations (As required by'written contract'per Paragraph A. below.). Locations of covered Operations (As per ihe'written contract, provided the location is within the'coverage territory'of this Coverage Part.) A. Section 11-Who is An insured Is amended to Include 2. We will not provide the additional Insured any as an additional insured: broader coverage or any higher limit of Insurance I. Any person or organization whom you are than the least that is: required by. 'written contract" to add as an a. Required by the`written contract% additional Insured on this Coverage Part;and 2. The particular person or organization, if any, b. Described In B.I.above;or scheduled above. c. Afforded to you under this policy. B. The insurance provided to the additional insured Is 3. This insurance is excess of all other insurance limited as follows: available to the additional Insured whether on a primary, excess, contingent or any other basis. 1. The person or organization Is an additional , But If required by the 'written contract,' this Insured only with respect to liability for 'bodily insurance will be primary and to Injury," 'property damage,' or "personal and relative to insurance on which nthe�addittiiona advertising Injury'caused in whole or in part by: insured is a Named Insured. a. Your acts or omissions;or 4. The Insurance provided to the'additional insured b. The acts or omissions of those acting on your does not apply, to 'bodily Injury,' 'property behalf damage,' or 'personal and advertising injury arising out of: In the performance of your ongoing operations specified In the'written contract';or a. The rendering of, or the failure to render, any professional architectural, engineering, or c. 'Your work' that Is specified in the 'written surveying services,including: contract` but only for `bodily Injury' or 'property damage' included in the 'products- (1) The preparing, approving, or failing to �— completed operations hazard,'and only if: prepare or approve maps,shop drawings, opinions, reports, surveys, field orders, (1) The 'written contract' requires you to change orders- or drawings and provide the additional insured such specifications;and coverage;and (2) Supervisory, Inspection, architectural or (2) This Coverage Part provides such coverage. engineering activities;or G440331-C includes oopydghlsd material of insurance Services office,Inc.,with its permission Page f of 2 (Ed. i 0/10) G-140331-C (Ed. 10/10) b. Any premises or work for which the additional We have no duty to defend or indemnify an Insured is specifically listed as an additional additional insured under this endorsement until we Insured on another endorsement attached to- receive from the additional Insured written notice this Coverage part. of a claim or`suit.' C. SECTION IV—COMMERCIAL GENERAL LIABILITY 2. With respect only to the insurance provided by this CONDITIONS is amended as follows: endorsement, the first sentence of Paragraph 4.a. 1. The Duties in The Event of Occurrence, of the Other Insurance Condition Is deleted and Offense, Claim or Suit condition is amended to replaced with the following: add the following additional conditions applicable 4. Other Insurance to the additional insured: a. Primary Insurance An additional insured under this endorsement will This insurance is primary as soon as practicable: p mary and non- contributory except when rendered (f) Give us wri tfen notice of an `occurrence' or excess by endorsement 6-140331-C, or an offense which may result in a claim or when Paragraph b.below applies. 'suit` under this Insurance, and of any claim or'suit'that does result; D. Only for the purpose of the insurance provided by this endorsement, SECTION V — DEFINITIONS is (2) Except as provided in Paragraph B.3 of this amended to add the following definition: endorsement, agree to make available any 'Written contract' means a written contract or written other insurance the additional insured has for agreement that requires you to make a person or a loss we covet under this Coverage Part; organization an additional insured on this Coverage (3) Send us copies of all legal papers received, Part,provided the contract or agreement: and otherwise cooperate with us in the 1. is currently in effect or becomes effective during Investigation, defense, or settlement of the the term tl this policy;claim or'suit';and P y;and (4) Tender the defense and indemnity of any 2. Was executed prior to: claim or "suit' to any other Insurer or self a. ,The'bodily Injury"or"property damage';or insurer whose policy or program applies to a loss we cover under this Coverage Part. But b The offense that caused the 'personal and If the'written contract'requires this Insurance advertising Injury' to be primary and non-contributory, this for which the additional insured seeks coverage provision (4) does not apply-to insurance on under this Coverage Part. which the additional ,insured is a Named Insured. G-140331-C Includes copyrighted material of insurance Services Office,Inc.,with Its permission Page 2 of 2 (Ed. 10110) ; lk CERTIFICATE OF LIABILITY INSURANCE 20�'�°D""Y"I 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 CONTACT Diane Shaw Frad C.Church,Ina NAME: 41 Wellman Street PHONE 978 3227272 FAX (978)454-1865 Lowell,MA 01851 A/C No (800)225.1865 EDDRIE : dshaw@fredcchurch.com. INSURERS AFFORDING COVERAGE NAfC# INSURER A: Chants Property Casualty Company 19402 INSURED Charter Oak Fire Ins.Co. 25615 Advantage Construction,Inc. INSURER B: - INSURER C: Navigators Insurance Company 42307 Two Adams Place,Suite 100 Travelers Casualty Insurance Company of America 19046 Quincy,MA 02169 • INSURER D: INSURER E: Starr Indemnity&Liability Company 38318 INSURER F: COVERAGES CERTIFICATE NUMBER:18537 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD/YYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X AGE TO RENTED COMMERCtAL GENERAL LIABILITY _13—PREMISES Ea occurrence g 300,000 CLAIMS-MADE M OCCUR _ MEO EXP(Any one person) $ 5.000 B 464D1464 6/20/2011 -6/20/2012 PERSONAL&AOV INJURY $ 1,000.000 GENERAL AGGREGATE $ELI LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000.000 POLICY X PRO, LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident- ANY AUTO - - BODILY INJURY(Per person) $ D ALL OWNED SCHEDULED 810464D1476 6/20/2011 6/20/2012 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS X gtOjTNOSWNED P.opWdenDAMAGE $ X $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ $5,000,000 E EXCESS LIAB CLAIMS-MADE SISCCCL01523811 620/2011 6120/2012 AGGREGATE $ $5.000,000 DED I X I RETENTION$0 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A 006430048 620/2011 6/20/2012 l' 1,000,000 (Mandatory In NH) E.L..DISEASE-EA EMPLOYE $ It yes,describe under 1,000,000 ? DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $10,000,000 X of$5.000,000 _ C Umbrella NY11EXC7111931V .620/2011 6/20/2012 - DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) - -• - Certificate is Issued as evidence of coverage. CERTIFICATE HOLDER CANCELLATION own of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1200 Phinneys Lane THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis;MA 02601 AUTHORIZED REPRESENTATIVE Client# Mst# Cert Holder# ©1988-2010 ACORD'CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD . RKSCONSTRUCTION CONTROL AFFIDAVIT Project Name:' Balise Hyundai Project# 1 155 Project Location: 556 Yarmouth Road Date`. 1/12/2012 Hyannis, MA Project Description Exterior Renovations To the building commissioner of the city/town of Hyannis,in accordance with The Massachusetts State Building Code I,Wayne E Benson,Jr., Registration No. 10731, being a registered professional engineer/architect in the following discipline: ARCHITECTURAL ® STRUCTURAL- ❑ MECHANICAL ❑ FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER ❑ Hereby certify that I have prepared'or directly supervised the preparation of all base building Architectural Plans, Computations and Specifications.for the above named project. o t To the best of my knowledge, information and belief, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, acceptable engineering practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary professional services and be present on the. construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved for the Building Permit. I shall submit periodically, a progress report together with pertinent data to the Building Commissioner, Upon Completion of the work I shall submit Final Report as to the satisfactory completion and readiness of the project for occupancy. AAA n Therefore, I request a Building Permit be issued for the above address. b����D ARC�y wC����F,OS(7N�F�sc a �0. J073�t�, W Seal: �0. co raoR��+MA �� SIGNATU l � rH OF SS: On this 121h day of January, 2012AD before me,the undersigned notary public personally a Wayne E. Benson,Jr., proven to me through satisfactory evidence of identification,which were MA State Drivers License,to be the person whose name is signed on the.preceding or attached document in my presence. (Notary Public) My Commission expires: /al/�'��'/�h v Notar y Public VAUN OF 2612.61.12 CC Affidavit.docx my BB 040b*t®.2013 Bo.--ird ()- f BuildinfF Retyull' atiwis and Still. Constructioin Su earvisor . Likens ., c e n se: GCS 06340 K RYAN BERTHELETTE 4 ALLISON AVE A' ASSONET MA OZ. T-� �- �� � A •.Yl 1 0/1 1 1201 2 A. . lDVANTAGE Construction, Inc. ' January 24,2012 Tom Perry Town of Barnstable 368 Main Street Hyannis,MA 02601 Re: Balise Hyundai 556 Yarmouth Road Hyannis Ma 02601. ' Dear Tom Perry: Please accept this letter of notification that Ryan Berthalette an employee of Advantage Construction,Inc.,has been appointed to be our full time Superintendent for the project listed above. If you have any question,please feel free to contact our office at(617)237-1840 Sincerely Advantage Construction, Inc. =Join C.Kelly L/resident ADVANTAGE CONSTRUCTION INC. Two Adams Place, Suite 100, Quincy, NIA Q21S9 Telephone 781.848.8787 Fax 781.848.0774 w.raw.advantagecon.structioninc.c:om Town of Barnstable ` Regulatory Services r � i pp 4 v MAS g Thomas F. Geiler,Director •Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.to.wn.barngtable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject.property, hereby authorizeV`S T7 (mot '� to act on my behalf, in all matters relative to work authorized by this building permit application for. Y6�rNw (Address-of Job) Signature of Owner bate Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Massachusetts Department of Environmental Protection Bureau of Waste Prevention� . Air Quality Y 100141615 i 1 B WP AQ 06 Decal Number Notification Prior to Construction or Demolition- Important: Wh A. Applicability Important- Men filling out pp bility forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your cursor-do not 9 residential building with 20 or more units is regulated by the Department of Environmental Protection use the return (DEP), Bureau of Waste Prevention -Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10) days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. rah B. General Project Description _ 1. a. Is this facility fee exempt-city,town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?❑Yes ❑✓ No 1.All sections of b. Provide blanket decal number if applicable: this form must be Blanket Decal Number completed in order to comply with the 2. Facility Information: Department BALISE HYUNDAI Environmental Protection a.Name notification 556 YARMOUTH ROAD requirements of D.Address 310 CMR 7.09 Hyannis MA 02601 c.Citv/Town d.State e.Zip Code 5087780500 f.Tele hone Number area code and extension g.E-mail Address(optional) 11500 1 h.Size of Facility in Square Feet i.Number of Floors j.Was the facility built prior to 1980? ✓❑ Yes ❑ No k. Describe the current or prior use of the facility: AUTOMOBILE DEALERSHIP I. Is the facility a residential facility? ❑ Yes ✓❑ No 0 m. If yes, how many units? • Number of Units 0 3. Facility Owner: �N 5-2 LiC .�0 a Name 0 b.Address dress ITH ROAD b.A =� HYANNIS MA 02601 c.Citvlrown d.State e.Zip Code �O f.Tele hone Number area code and extension .E-mail Address o tional JIM LANGWAY eQ h.Onsite Manager Name ag06.doc-10/02 BWP AQ 06•Page 1 of " Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality 100141615 BWP AQ ®6 Decal Number L7,1� Notification Prior to Construction or Demolition General Statement:If B. General Project Description (cont.) asbestos is found during a Construction or 4• General Contractor: Demolition operation,all ADVANTAGE CONSTRUCTION, INC. responsible parties a.Name must comply with 2 ADAMS PLACE,SUITE 100 310 CMR 7.00, b.Address and Chapter KA Chapterer 21 E of the QUINCY MA 02169 —� General Laws of a Ci /Town d.State e.Zip Code the Commonwealth. 17818484878 This would include, f.Tele hone Number area code and extension but would not be .E-mail Address o tfonal limited to,filing an IJOHN KELLY asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threatof release of a C. General Construction or Demolition Description hazardous substance to the Department,if 1. Construction or demolition contractor: applicable. ADVANTAGE CONSTRUCTION, INC. a.Name 2 ADAMS PLACE,SUITE 100 b.Address 4UINCY MA —� 02169 —, c-City/Town d.5tate e.Zip Code 7818488787 f.Telephone Number(area code and extension) g. -mai ress op Tonal) JOHN KELLY h.On-site anager Name 2. On-Site Supervisor: RYAN BERTHELETTE On-Site Supervisor Name 3. Is the entire facility to be demolished? ® Yes ✓[]� No sN �0 4. Describe the area(s)to be demolished: �0 SELECTIVE DEMOLITION �0 �0 5. If this is a construction project,.describe the building(s) or addition(s)to be constructed: =� RENOVATIONS � ia �o El ag06.doc•10/02 BWP AQ 06•Page 2 of 3 ll i Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality, 100141615 —� t Decal Number BWP ACC ®6 Notification Prior to Construction or Demolition C. General Construction or Demolition Description. (cont.) 6. a. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing material(ACM)? ✓❑ Yes ❑ No If yes,who conducted the survey? UNIVERSAL ENVIRONMENTAL CONSULTANTS b.Survevor Name AA000177 c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 2/6/2012 — I 6/30/2012 a.Start Date(mmldd/yyyy) b.End Date(mmlddlyyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving specify: b. If other, please s ❑ wetting ❑ shrouding p �' covering ❑ other 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization d.DEP Waiver Number D. Certification I certify that I have examined the JOHN KELLY �O above and that to the best of my a.Print Name �O knowledge it is true and complete. John Kelly —� The signature below subjects the . b.Authorized signature �N signer.to the general statutes PRESIDENT —o regarding a false and misleading c.ROOM I Me ®0 statement(s). JADVANTAGE CONSTRUCTION, INC. d.Representing 1/25/2012 �O e.Date(mm/dd/yyyy) O o , =Q 0 ag06.doc•10102 BWP AQ 06•Page 3 of 3 t valise Hyundai 556 Yarmouth Road Hyannis, MA Subcontractor Address City,State,Zip Selective Demolition Advantage Weatherization, Inc. 2 Adams Place,Suite 100 Quincy, MA 02169 Light Gauge Metal Framing/Drywall Advantage Weatherization, Inc. 2 Adams Place,Suite 100 Quincy, MA 02169 Electrical& Fire Alarm Hannon Electrical 15R Commerce Way Norton, MA 02766 Message Page 1 of 1 Roma, Paul From: Shea, Sally ., Sent: Wednesday, January 25, 2012 3:56 PM To: Roma, Paul Subject: FW: Balise Hyundai, Yarmouth Rd -----Original Message----- From: Lt. Don Chase [mailto:dchase@hyannisfire.org] Sent: Wednesday, January 25, 2012 3:12 PM To: Shea, Sally Subject: Balise Hyundai, Yarmouth Rd All set for exterior renovations to above. (Bill Kelley). Thanks Don Lt. Don Chase, Jr., FPO Fire Prevention Officer Hyannis Fire Department 95 High School Rd. Ext.' Hyannis', MA 02601 508-775-1300 x106 D - 2/1/2012 r _ - R . .51 n g TOWN OF BARNST ABLE Permit sARNSTABLE. 9 MASS FOPermit Number: Application Ref: 201102717 20070600 Issue Date: 05/24/11. Applicant: LM-2 LLC. Proposed Use: AUTOMOTIVE SALES.:& SERVICE Permit Type: SIGN PERMIT Permit Fee $ . 75.00 Location 556 YARMOUTH ROAD Map Parcel 344076001 Town HYANNIS Zoning District g Contractor PROPERTY OWNER Remarks RELOCATE FREESTND &2 WALL SIGNS BALISE &HYUNDAI 47.76 SQ FT TOTAL ALL SIGNS Owner: LM-2 LLC Address: 556 YARMOUTH RD HYANNIS, MA 02601 Issued By: p POST THIS CARD SO THAT IS RISIBLE FROM THE STREET PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 05/24/11 TIME: 11 :12 -----------------TOTALS-- ----------.. ___ PERMIT $ PAID 75.00 AMT TENDERED: 75.00 CHANGEPLIED: 75.00 APPLICATION NUMBER: PAYMENT METH: CHECK PAYMENT REF: 9245 °F ZHE Town of Barnstable ti Regulatory Services r r r v�MAS& Thomas F. Geiler, Director ArFo;;. A�� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us / Office: 508-862-4038 Fax: 508-790-6230 Permit # Building Official approving( — -------- - Application for Sign Permit . , Applicant:__CUQ__ ___________________Assessors N34'�__o _ 3y� _ :07,-o)o► Doing Business As:__ c1�iSg._� _u �5u_�Y_ e C _-Telej�lione No. 5o8__y 30 I U Sign Location Street/Road: 5I awd 55 �'rv1o� �oc,� N Jv�li. Zoning District:--__---_ Old Kings HighwayP Yes No Hyannis Historic DistrictP Yes, Do Property Owner �R.CAC_,Q� ^ Name: __ -- - --------------------Tele 1hoi�e:--- - - --- �GU 5�- ----------L- 0 5 l B a�� 5------ - -- Acldress:__ S(o -Y5�r�o—Ld�__ aGc __Village:__ rvYvl °,-- — A-------- Sign Contractor Name:_�9YyLQr _ � l��u-- --------Telephone: 508 Marlin Address:__ q YV W i _ _ Aescripdon Please follow die cover directions.You must have an accurate rendition of signs with dimensions and location. Is die sign to be electrified? Yes/No (Note:I%yes, a wring—permit is required) 8 _ W l G. f4J �� I Width of building face_I I O____ft. x 10— � � Uv _x .10=_1�Q_ �' VA�� �S 4 Check one Reface existiii sign____ or Newal_ Total Sq. Ft. of proposed sign (s) `q TTt7,r_� Royn Q4 s4k�ew> S f�c'fy H�%��;s t7�q ` - I%you ba ve'I&A60ilal Signs please atmcll a sheet listing•each 01lc with d1menSio11S If refacing an existing sign please provide a picture of the existing sign with dimensions. I hereby certify that I am the owner or that I have die authority of tlic owner to make this application, drat the information is correct and that die use and constj-uction shall conform to die provisions of'. §240-59 through §240-89 of die'Town of Barnstable %o ing Ordinance. Signature of Owner/Authorized Agent: _ �&,K, jljjj!,� Date5 a31A0) I SIGNS/SIGNREQU revised 12110, 'f LAW OFFICES OF MICHAEL FORD ATTORNEYS AT LAW 72 MAIN STREET,F.O. BOX 485 WEST HARWICH, MA 02671 TEL. (508)430-1900 FAX (508)430-9979 lawofficeofmichaelford gverizon.net MICHAEL D.FORD JEFFREY M.FORD Town of Barnstable Building Division Tom Perry, Building Commissioner 200 Main Street,Hyannis, MA 02601 May 23,2011 RE: Temporary Sign Permit Application/518 & 556 Yarmouth Road Cape Hy, Inc. /DBA Balise Hyundai of Cape Cod' Please find attached a copy of an application for sign permit for 518 & 556 Yarmouth Road, Hyannis, MA. The Applicant, Cape Hy, Inc., DBA Balise Hyundai of Cape Cod is relocating their existing dealership located at 268 Stevens Street to 518 & 556 Yarmouth Road. Their intention is to move the current signs from Stevens Street to their new Yarmouth Road site at least temporarily until they determine what if any new signage they will apply for at the new site. The Applicant fully understands this would require an additional sign permit application going forward, if and when they decide to pursue any changes. As indicated in the pictures, the Applicant is proposing to install the "Balise" sign(16.6 sq ft) on the top left corner opposite the main door entrance of the dealership. The "Hyundai" sign (15 sq ft) will be placed on the right side opposite the main door entrance. The Pylon sign consists of two separate sections, the first"Hyundai" sign consisting of(14.16 sq ft) and the second "Balise" sign consisting of(approximately 2 sq feet), for a total square footage of(16.16 sq ft.) The pylon sign will be placed to the left side of the front of the building where two signs currently exist from the prior dealership which occupied the site. Please let us know if you will need any additional information in order to sign off on this application. The Applicant is scheduled to open for Memorial Day so if there is anything we can provide you with to expedite the process just let me know. Very my ours, Jeffrey M. rd, sq. CC: Clients 15 .NO , F} F N ,.,�..,: .,... ,o. .<.:. •,.:•• ,.� '-:�. �. �� cam•:: ,r � r � � �^ � g, Y s e •�` � � � �• ���� � .tea:: ,..�„ a> � �'� :� ���.... •�Via.• ,� � � _ ,_Via:-.�! ,. .�.�...^''. _tea_ ....... .. _ ... _ __. �_ '.�. � � �.�:- � ...�_ _.. ._. .m__ '�. -=- � �4._ F a f I lob - - . r �• .: `t t =fs 44 d c -d7f:l m cl 3 _ r o - ,� 1� �jFt � ,�c, .� .. F�. ""�,. sl�o� A ',•'S _ � p is } 1 � .t t _ zf S I. ..r ��- HY Balise . _ �.�. � - 1�„rf�.4 - �2�?�i7awi• Mom' v Y a A ^ar .x4 - ... t r8 .l��Y / �. }W. � �'K >•Ttil �'` ��"ri� 1 i 1 f j. gh�� K ( �! � iF;. F r•. 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Anderson, Robin From: Jeffrey Ford Oford21@verizon.net] Sent: Tuesday, May 24, 2011 1:43 PM To: Anderson, Robin Subject: RE: Yarmouth Road Hyundai Site Hi Robin, That is correct, the free standing sign is going to be located in .the same spot as the existing one depicted in the photo. I will also pass your comments on to the clients and inform them they must make sure it does not impede.bn 'any site distance. I am not 100 percent sure of what shape the old sign was, but believe it may have been square. Thanks again for your time & consideration, Jeff ` LAW OFFICE' OF MICHAEL FORD JEFFREY M. FORD, ESQ. 72 MAIN STREET, P.O. BOX 485 WEST HARWICH, MA 02671 TEL. (508) 430-1900 FAX (508) 430-9979 EMAIL: jford2l@verizon.net -----Original Message----- From: Anderson, Robin [mailto:Robin.'Anderson@town.barnstable.ma.us] Sent: Tuesday, May 24, 2011 12:157 PM To: Jeffrey Ford Subject: RE: Yarmouth Road Hyundai Site Hi Jeff, Thank you for the photos. I will attach them .to the application I processed earlier today. Just to clarify, the freestanding sign is to be located in the exact same spot as depicted ` in the photo, correct? Also, please make sure it does not impede the site distance of traveling vehicles including those entering or exiting the site as I believe the shape of the "relocated" replacement sign differs from that of the old sign. Wasn't that one square as opposed to rectangular? Thank you for your prompt response to my request. Robin Robin C. Anderson Zoning Enforcement Officer Town of Barnstable 200 Main Street Hyannis, MA 02601 r 508-862-4027 -----Original Message---- From: Jeffrey Ford [mailto:jford2l@verizon.net] Sent: Tuesday, May 24, 2011 12:09 PM To: Anderson, Robin 1 Subject: RE: Yarmouth Road Hyundai Site Robin, Thanks for your assistance this morning with our sign application. We' really appreciate you taking the time out to issue us, the' permit right away. Attached are the requested pictures of the site showing the existing:Pylon Sign. The Hyundai / Balise Pylon will be put in its place. Please let me know if you need anything; further for your.file. Thanks again and have a great afternoon, Jeff Ford Your message is ready to be sent with the following file or link attachments: i t NUMBER FEE } THE COMMONWEALTH OF MASSACHUSETTS $100.00 TOWN OF BARNSTABLE AGENT'S OR SELLER'S LICENSE - CLASS FOR THE SALE OF,§ OTOR VEHICLES❑ In accordance with the provisions of Cha a 40 ra a thereto Leominster Inc. APE COD CURYMAZDA ------------------------- - ----------- - --- - --- -------------------- ------ ----- whose principal business is the sale of ehicl t of th Ford Motors ----------------------------------------------------- -- ------- --- -- --- -- - -- ---------------------------------------------------------- or who has a signed contract as requi a bS tion ed to r a d sell, as incidental or secondary thereto, second-hand motor vehicles o. S on premises described as follows: C ETAL 2 ENT T .YARMOUTHROAD. 3+ACRES, 12, SO UILDING. PR XIMATE NG SPACES WITH SO FOR CU N RESTRICTIONS:. Hours: 7.00A.M. - 7.00P. ............................... ............ .. . . ..... a ............................... P. 4a!4 , THIS LICENSE EXPIRES JANUARY 1, 2004 �. f THIS LICENSE MUST BE POSTED IN A CONSPICUOUS PLACE UPON THE PREMISES. oFt tq,,, Town of Barnstable Regulatory Services r r vBMW BM MASS. � Thomas F. Geiler,Director `bi°rFo 39. 6. Building Division Thomas Perry,CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 August 10, 2005 Cape Cod Lincoln-Mercury-Mazda 556 Yarmouth Rd. Hyannis,MA 02601 To Whom It May Concern: This correspondence is in regards to the Cape Cod Lincoln-Mercury-Mazda dealership located at 556 Yarmouth Rd.,Hyannis. Without the benefit of relief from the zoning board of appeals this. business would not be allowed to expand as a right beyond its present footprint. If I can be of any further assistance please contact this office. Sincerely Thomas Perry Building Commissione TP/AW TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION f • � Map 3 Parcel ®76 ail° 01" BARINISTAS LE Application# Health Division US JAN 18 AM j 1; 36 Conservation Division Permit# Tax Collector _ _ _.,•. °;.sf; j Date Issued laz- ino Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 55 Cv Q r m p O+i-\ CA Village t'� Q n n \ S Owner Lc#4 0d 1 I n Coln Merl A ess 55 1-0 Telephone — -1 s-- 1 y 44qannts Permit Request r v rean L erT Wa P, ry A C kA-C D 1"- --Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 10 000� Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial'4Yes ❑No If yes, site plan review# Current Use Proposed Use - BUILDER INFORMATION Name CQ,_,7,e Al) S out Telephone Number 2—S Address 1 0-N MGM N 54— License# 0 ZCv 3 Z Home Improvement Contractor# /O ?J 7 o (o SS Worker's Compensation# 0 600q S,6l0 L AA ALL CONSTRUCTION.DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO v SIGNAT RE DATE 1 G - 1 3 FOR OFFICIAL USE ONLY 1 t =PERMIT NO. 1 s DATE ISSUED MAP/PARCEL NO. 1 ADDRESS VILLAGE OWNER i DATE OF INSPECTION: 1 FOUNDATION { FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. a Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. l (print) Ern— G � as Owner Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing Inc. to act on my behalf, in aft matters relative to work authorized by this building permit application for.- Address of Job 55 6 IIY., y,,y is IM OLG O 1 Signature of Owner . ,J� Mailing Address of Owner 55( y v ryl o y7k- Telephone# Date /—// - zoos (Please return this form to Cazeault roofing along with your signed contract; It is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you)fax#508-420-4555 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesdgations 600 Washington Street Boston,MA 02111 www.mass govA a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leg><bly Natne(Business/Organization/Individual):_PQ� C Address: p ti '{� I 4_ 4 City/State/Zip: O s+,e p\ l t 1 M R l9�(c65 Phone#: 50 8 y Z8 11 Are you an employer?Check the appropriate box: Type of project(required): I am a employer with `Z 4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 El New construction 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.# 9• ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11-❑Plumbing repairs or additions myself.[No workers'comp, right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no 12oof repairs employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'comensation policy information. "t Homeowners who submit this affidavit indicating they are doing all work and then hire outside conptractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: pt:�[ele Y-',' S Policy#or Self-ins.L^ic.#: 03 OQ W y A -0 Expiration Dat=9 �(lO 6 Job Site Address: R G% City/State/Zip: A z (p Q Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator: Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce fy nder the pai7-andalfies o f perjury R ormadon provided abov istrueanSi afar 'Date:Phone#: C/,� Ofj'icial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I i� , 1031 Main Street Osterville,MA 02655 T41;1508)428-1177 Fax;(50 420-4555 w+�w.easeeuitcamr 1 Cape Cod Lincoln Mercury Pate Mayer. DATE j 556 Yarmouth RA HyaanrniN MA 02601 1/c1lZ(l0� Phone# S(18-77S-laa+i DoWption of work to be perfromed Roof on beck of Showroom and galley behmen tm buildings rflghly 41X80, Install IIr polyiso itt Astion. Install .080 Carlisle sure-sepal or RPI rubber rnernbrans,fully adhered. Fiaesh all curbs.pipes, posh ar►d other penetrations In acnoWance with manufactures spaeifrcations.. ImUll .032 aluminum flashing on perimeter edges. Ali tooting rued rubbish to be r>emowd frown pneemise, Material has 30 year warranty and labor five years for Installing over exsting fiat mW(layover) COST 113 due whh signed oont et, 1/3 due when job is half doers, 1/3 clue` T � �� � ct,st�ar t3i9ingtur» rrm Wmve ova, aged evae -IM waft mbry arW homay secagoo.Yotr an suit and to do Dae of Aweptaece ffitd Worst as MOVOW psyment lb be M;Wp W OcrrlbreO Quote.. . ?n*Miti4t to the Above.tf Ctt6Qnaw Ws to=ka psymml scl lbrth mbwmb thm Custaamer utpx.-es 10 psy lxana)J,CW= rnn►"Mbla cwnkv and f6m tivvdlld t� but twt limitod to ActoarragOe Peep}ini973rM in ctalltctang parnlmt fk m Cusi naer. R 0 0 F 1 G DATE, PHONE ESTIMATE DONE BY(CIRCLE) MIKE KEVIN RUSSELL PAUL m� I i ti .Its 1 f SOUARESIFLAT SOUARESISHINGLES �/ P rc 1031 Mein Straw batan4110,MA 02655 Tel-1So81428-1177 FIX*ism;47.0•.4566 wwruceaonuil.ar►n1 Cape Cod Limoln Mercury Nl7. 43i.0t1n.Hofban,, Gm Mgr. DINE 556 Yarmouth.Rd. Kyunfis,MA 02601 1/9/2008 Phone 0 5092r5-1449 D4me"Ption of work to be wrImmed Building out back in parking lot Remove existing flan mling eywom. install 1/2'polyiso Insulation_ Install 1/2'hardboard underieyment, Inmail .oeD Garliste Bum-Seal or RPI rubber meornbmne,fully adherbq, Plash SH curW,plpM pow and other penetrations in®owdance with menufacturss speeffiications. Install W2 aluminum flasttting on pedmeter edges. All roofing religed rubbish to be removiod frorn premise. 30 year material.&five year Iepclr wa COST 1/3 due with sued coratraM 1/3 due whrm job is half done, 1/3 dire T# 1 Cualomw Sowdure -J The above prim WOOMAOM Ina oOv► WWK no Payrgo O th be 0 RWG M ago"" do $�, Quote valid f in addition to the sbovc,if Customer lams to �,P,TYMLM%set Dxr sboMc;Jbim' Cneto=—'gVvcs to pay Paul).Cwzault& ismnmmblc chain and fmx(includigq but not limited to Act mc.Vs few)incurred in collexting payment from Cuutamer. R O O F I N G DATE PHONE ESTIMATE DONE BY(CIRCLE): MIKE PHIL RUSSELL PAUL - ar I 1 I I I i` I I ! I I ! I 1 I I i i I l i i I I i I I i I I i41111 i I ! I i i ( I I ; I 1 I 1 I I I I , Ll i ; 1 i FF I II ; 7H i 1 I I i i SGUARESISHINGLES SQUARES/FLAT — 8/24/2007 1 :21 :48 PM PAGE 003/003 Fax Server I .. AGORD. CERTIFICATE OF INSURANCE DATE(MMWD\YY) 08-24.07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE DOWLING&O'NEIL INS AGC HOLDER. THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 973 IYANNOUGR ROAD 2ND FL .ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PO BOX NISS,M 90 HYAN MA 02601 COMPANIES AFFORDING COVERAGE COMPANY 22LGR A TRAVELERS DIRECT ASSIGNMENT INSURED COMPANY PAUL J CAZEAULT&SONS INC. B COMPANY 1031 MAIN STREET C OSTERVILLE,MA 02655 COMPANY 0 COVERAGE THIS Is TO CERTn'Y THAT THE POLICIES of INSURANCE USTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR THE POUCY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OP ANY CONTRACT OROTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UM M SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICYEFP POUCYEXP LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MMIDDIYY) LIMBS GfiNGRAL LIABILITY OCCUR, GENERAL AGGREGATE S COMMERCIAL GENERAL LI a CLAIMS MADE OCCUR., PRODUCTS-COMP/OP AGO. OWNERS INJURY S OWNERS d8 CONTRACTORS PROT, EACH OCCURRENCE a FIRE DAMAGE(Any one fire) S AUTOMOGIL6 UASIUTY MED.EXPENSE(Anyone person) S - A COMBINED SINGLE LIMIT $ OWN AILLL OWNED AUTOS SCHEDULE AUTOS BODILY INJURY( BODILY INJURY PcrAcdd )ent S NON-OWWNEDNED AUTOS HIREO PROPERTY DAMAGE $ GARAGE UABIUTY ANY AUTOS AUTO ONLY.EA ACCIDENT S OTHER THAN AUTO ONLY: EACH ACCIDENT S AGREGATE S EXCESS LIABILITY UMBRELLA FORM EACH OCCURRENCE S OTHER THAN UMBRELLA FORM AGGREGATE $ WORKER'S COMPENSATION AND A EMPOLYER'SLIABILITY UB-0095B64A-07 08-10-07 08-10-08 STATUTORY LIMITS X THE PROPRIETOR/ EACH ACCIDENT $ 100,000 PARTNERWEXECUTIVE X 'INCL DISEASE-POLICY LIMIT S 500,000 OFFICERS ARE: EXCL DISEASE-EACH EMPLOYEE $ 100,000 I OTHER DESCRIPTION OF OPERATIONSILOCATIONSAlEHICLESIRESTRICTIONSISPGCIAL ITEMS THIS REPLACES ANY PRIORCERTMCATE ISSUED TO THE CMMFICAIE HOLDER ABFECTING WORKERS COMP COVERACIE. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE OESCRISED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUIt1G COMPANY WILL ENGEAVOR TOMAIL III DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BJT FALURETOMAIL SUCH NOTICE SHALL IMPOSE NO 013LIGAITON OR LIABILITY of ANY- tUNO UPON THE COMPANY,ITSAGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Charles 7 Clark -V omi d - Board of Building Regulati ns andards and St One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2008 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault ------------. __._-- .- 1031 MAIN ST -- OSTERVILLE, MA 02658 Update Address and return card. Mark reason for change. Address .�] Renewal I j Employment Lost Card DPS-CAI 0 5OM-05/06-PC6490 f �re �anvaiaraurea/,l/ o�✓�aaauc/ucoe�.la . hoard of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only before the expiration date. If found return to: Registration;,,103714 Board of Building Regulations and Standards Expiration: 7/9/2008 One 6sMWrton Place Rm 1301 I :1 Type: Private Corporation Bo on,M .02108 PAUL J.CAZEAULT 8 SONS INC'. r � Paul ,Cazeault � •�_ 1031'MAIN ST (' OSTERVILLE, MA 02658 '' Deputy Administrator r._._.- _-. _.._.___..._..... ... I Notva11 witho ignature ;} Boa"o /uoiT tan aids One Ashburton Place - Room 1301 Boston, Massachusetts 02108 11 I Construction Supervisor License License CS: 26325 i I , Restriction: 00 z F BirthdaEe: 10/20/1959 8 Expiration: 10/20/2009 Tr# 6311 PAUL J CAZEAULT '� f 1031 MAIN ST ----- --- OSTERVILLE, MA 02655 `c Update Address and return card.Mark reason for change. i '' (] Address Renewal ❑.Lost Card DPS-CAI is 5OM-07/07-PC8490 -----____— ,.- __ - d .� , � p ✓lie [�anzmomrir o ✓T�aavu.`ueaella ( ,'.Board of Building Regulation and Standards A' Construction Supervisor License License CS 26325 x, =� Expiration 10720/2009 Tr# 6311 ?� Restriction40 PAUL.J CAZEAULT3 t 1031 MAIN ST I OSTERVILLE,MA 02655" -'~'w' Commissioner -_= Board of Building Regulati ns and Standards ° One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2008 PAUL J. CAZEAULT` ONS, INC. Paul Cazeault 1031 MAIN ST OSTERVILLE, MA 02658 Update Address and return card. R1:u•It casou for change. L..I Address .�; I Rcocwal I j I;mpl n►cul Lust Card PS-CA1 0 50M-05/06-PCO490 ,per �� •G�,z�z�,�/ o, .��� ,\ Board of Building Regulations and Standards cease or registration valid for individul use on HOME IMPROVEMENT CONTRACTOR be ore the expiration date. If found return to: u,p Registration: 103714 Bo. d of Building Regulations and Standard Expiration: 7/9/2008 On shburton Place Rnt 1301 Bosto Ma.02108 Type: Private Corporation PAUL J.CAZEAULT'..&SONS'INC. Paul Cazeault 1031 MAIN ST OSTERVILLE,MA 02658 Deputy Administrator Not v. id without s' nature Jk Boar o ui ing egul ons s One Ashburton P ce - Rood 1301 Boston, Ma achusetts 02 08 Con 'st ructi Supervisor Lip, se License CS: 26325 Restriction: 00 Birthdate: 10/20/1959 Expiration: 10/20/2009 Tr# 6311 PAUL J CAZEAULT 1031 MAIN ST — OSTERVILLE, Mj 2655 Update Address and return card.Mark reason for change. Address I_J Renewal [).Lost Card DPS-CA1 G 50M-07/07-PC8490 �•_...__.__....... .._-. J!a*, xis .. ,M'•Fjc ,I ✓/ C �f/ �llldJ, ze 'oovszmo7ruiea i. off'i• dr ry Board of Building Regulation&and Standards Construction Supervisor License %`. License: CS 26325 j _iji EXpl0gg0, 10/20/2009 Tr# 6311 �•jh' �*j Restriction :00. PAUL,J CAZEAULT:.`: 1031 MAIN ST --4— OSTERVILLE,MA 02655 Commissioner f-- _ ------- 'OWX OF-BARNSTABLE BUILDING PERMIT APPLICATION / Map 3 Parcel (U�L'O -" /J ` �l I �� I I I� Permit# 7 Y 2 Z Health Division,- --__-., '��- _G'�i?" - NOV $ 2001 Date IssuedrA _� t _ Conservation Division � � l �' �/ Fee _ �D A .1 I/i9/D! `�V Tax CollectorM @I� � fl p�i INSTALLED InJ ®s`�. P �Ya P Treasurer z / WfTM TITu Planning Dept. ��MENTAL C Y,WtICANT MUST OBTAIN REGULAR A ROAD FROM ENGINEERINGLINGPERMIT Date Definitive Plan Approved by Planning Board PRIOR CONSTRUCTION Historic-OKH Preservation/Hyannis Project Street Address AAA4,1U7W /ZZOA r--.> 3• q Village Owner' CA Pk- C&,p LWCV A1A ,/, I�C Address S 1,n rD-,P771 Telephone Permit Request 1?EI.D,a&Z/AJA a IAh7 0-0 :5PA C-S A &I,ri,, Square feet: 1st floor: existing I lT proposed _ 2nd floor existini q10 proposed Y/ Total new Valuation (;'!5-I Zoning District 60SIAVZS Flood Plain �O Groundwater Overlay �P r4spArk Construction Type aWO SWO4 MVMLSiAo6i_. Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Cam; V-6AL Of' Age of Existing Structure Historic House: ❑Yes &lo On Old King's Highway: ❑Yes CI-No Basement Type: ❑Full ❑Crawl ❑Walkout WrO-ther SLA-6 o J 64A-4e' Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing °4 new Number of Bedrooms: existing new sfsA- Total Room Count(not including baths): existing new First Floor Room Count / Heat Type and Fuel: O'Gas ❑Oil ❑ Electric ❑Other Central Air: @1es ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes [WNo 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 M�Yes ❑ No If yes, site plan review# WA, Current Use AuYb L6-&,sw,1P _ Proposed Use BUILDER INFORMATION Name C® 0�, loic— Telephone Number Address f 0. &rX a-7S- License# 05 cy)S'e 5 ►AloA fi4ill, AAA 025b2. Home Improvement Contractorf# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO etc Pt ivs SIGNATURE DATE l!" 2(- r s x FOR OFFICIAL USE ONLY , PERMIT-NO. DATE ISSUED y MAP/PARCEL NO. ADDRESS r VILLAGE %a ` OWNER. `- DATE O�INSPECTION: FOUNDATION - FRAME INSULATION ,< i FIREPLACE ELECTRICAL: ROUGH '• " FINAL r :xx PLUMBING: ROUGH FINAL GAS: ROUGH FINAL " FINAL BUILDING 1 a^, Ate( ZrZv4.1 CJ Y � / DATE CLOSED OUT - en a-,=� ASSOCIATION PLAN-NO: A 1� f i s TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map3`f` 61 bD0 ( Parcel Permit# o® Health Division �� �°°� Date Issued ® `� Conservation Division �3—&n y-JL r5 Fee Tax Collectordb Treasurer -MC- —(2k -- l(/M Planning Dept. j Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address TS�� 1AXMe7T+ KOAD Village Owner Address Telephone -6d Permit Request 1+021 1%eA A6 A-40a—irlll Square feet: 1s floor: existing 11 proposed _ 2nd floor: existing g 0 proposed C Total new Valuation IDSocso ZoningDistrict 81)5 J .S Flood Plain YJO Groundwater Overlay wP Y E.cl � Cons5truction Type Jew Srug J my rr..Prix, �D � Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ , Multi-Family(#units) 131 Age of Existing Structure Historic House: ❑Yes &3 o On Old King's Highway: ❑Yes &No f Basement Type: ❑Full Cl Crawl ❑Walkout WOther 19- sA 5 &✓Aw cy Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) t i 4. Number of Baths: Full: existing new Half: existing `f new Number of Bedrooms: existing new 4-A Total Room Count(not including baths): existing new First Floor Room Count l� Heat Type and Fuel: &tas ❑Oil ❑ Electric ❑Other Central Air: Games ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Cho 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# 4.4. Current Use AVS �'O"1._5tfi P Proposed Use 5,wi;� BUILDER INFORMATION Name (.Jr, , Telephone Number Address I" D &nz License# e5 CC)�t 7 S��if,41 ►�A o 25�� Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO >�� Pws SIGNATURE ATE 1 1301 0 L 4' r' FOR OFFICIAL USE ONLY r ` PERMIT NO. DATE ISSUED k MAP/PARCEL NO. 1 ! - �y ADDRESS VILLAGE �'- - zi OWNER DATE OF INSPECTION: FOUNDATION FRAME x ; INSULATION FIREPLACE j i ELECTRICAL: ROUGH FINAL ' �. PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t s FINAL BUILDING P/C/N DATE CLOSED OUT ASSOCIATION PLAN NO. 4 `' f I - - - a 4 ✓lee �i o�r�naa�zw�ea��• a�✓�lcU.��actu�aelC6 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR .Number: CS 005157 ' Expires:'05123/2002 . Tr.no: 22818 Restricted To: 00 ROLAND B CATIGNANI �i e'er� 60 GEMINI DR [ W BARNSTABLE, MA 02668 Administrator , The Commonwealth of Massachusetts .� Department of Industrial Accidents == office Of/DYBsffoo m0OS . 600 Washington Street f Boston,Mass. .02111 Compensation Insurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole r rietor and have no one workin in capacity //%%%%%%%%/%%%%%%%%%%/%/%/%%/%/%/%%%%%%%/%%%%%/��%%%//G////%%%%%%%%//G%/%%%%%%%%/O%��%%%%%%%%//////�%%%%%% I am an em toyer providing workers' compensation for my employees working,on this : :::: ::::: :::: :: :: toniiatzv name ' tYilres s o DIM e ci tw 4 $ h .::::::::::........... rev #.nil ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have n polices: the following workers compensation p .........................................................: ::.::.:::.;:::;.:;:-;:.;:.:<;.;>::;.;;:>::<::;::>:<::<:<:»:>.;:>;: ..............::.:.::.:::::::::::::::::::::::::.::.:...:..............:....:.::::-::::::::::::::::::::. :::..................:::::::::::::::::.:.....:....................:::::::::.::::::::.:::,:.........:..:::.:::::.:::.:::::.:. ......:.:: ......... . ..;.:.. :.. :...,.................................... �.:...... 0 ..... ............................................................................................................... #tuluran ::name................... . K. >inh tin - .�.�w....� �•.��'�:C�221:;:`:;::%:i�i'?';3'S�i%�`:;i:';r:?i ?'i ?i'2'is�i:Bi�:;:%;:i:;t :�';:::::';:+::;:;:::;;;;':%;`;;':"Sfi ;`;%;.%':+.:%:::�;::;>: muraace j/ Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a One up to,51,500.00 and/or one years'imprisonment as well as dva penalties in the form of a STOP WORK ORDER and a One of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification I do hereby c under the pasts anMenakies ojperjury that the information provided above is trrw and coned Signature Date �?1 Z- —. - Print name Rbl, O CAT1 i dAI J 1 Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑sdechnen's Office OHeslth Department contact person: phone#; _ ❑Other_ ([evi ed 9/95 PJA) l Information and Instructions ' 4- a Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their d from the "law", an employee is defined as every person in the service of another under any contract employees. As quote 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 or another who employs persons to do maintenance, construction or repair work be dwelling rn Ming house or on the grounds building appurtenant thereto shall not because of such employment be deemed employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance orV renewal of a license or permit to operate a business or to construct bdildings`in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of,its political subdivisions shall enter into any contract for the performance of public work until = . acceptable evidence of compliance with the insurance requirements of this,�chapter-have;been presented,to.the�contra cting authority. ,_5,.. ''.., )�� '• ,..i '.� .�, `Ltit Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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 forge permitor is you being requested, not the Department of Industrial Accidents. Should you have any questions regarding the are required to obtain a workers' compensation policy,.please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the.applicant. Please ....., � be returned to be sure to fill in the peimit/license number which will be used as a reference number. The affidavits may the Department by mail or FAX unless other arrangements have been made: The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions• please do not hesitate to give us a call. %//////%%//ENN�/////////M The-Department's,^address,telephone and fax number. � _ , Y,J The Commonwealth Of Massachusetts Department of Industrial Accidents Office of InvesdoWons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 eat. 406, 409 or 375 The Commonwealth of Massachusetts 1 - •! Department of Industrial Accidents • ,� - men Of/aYBsaffsaODs 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name 1 location: N cityL " hone# J����f�¢t ��.► � ❑ I am a homeowner performing all work myself: ❑ I am a sole pro=*etor and have no one worldn in anv cavacitv worlds on this Job dm workers ensattoa for my g.:::.::..}:: ;'; ::::;_::::::::::::::::.... ....... ::.....::::. lover g =npe ::;.}:.>:.;::..;:..;::»;::>;::>; »':::::>::>::::>::»::;::>:::;;::» I am an employer P ....... .......:::,::...,,..:.::: ...::._::; ,. comaanv na :::;.};....... ........ < <<.....:..;.:.::.:::.:...:..::..::..::..... ................... _ 4� .. + n atV• -------------------------- ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have on ohces: ensatt ' workers ...............,....,........:..:.:..........:::.:.r..:.................................,.....:....,..:........tt:..,,r..::..,t?:N?.{.,?:.,:.;.:, the following ........... ...:.:::::.::::.:..:.:::::.:::::.:::,,..>:::.}:.;::;.:::}:::::...:.::::::. :....::.::::::::::::.:...:::::.:::::.:::::::.:::.:::.,..:::.::::::..::::::.:.::,:::::::....::::::::::::::.:::::: -names coma .i},'v,{'rp',v,'iriii�;}:::;};;i:�i:�':}:}ii.'•:-0v:!::i::••};�:}:}:ii::i:::;'.;:}4:;:;i: T:;`:.:?{::<:?ii:J.': .nv::::::::::.v:•::•.:::•.v::::.:{i:C}i?ii?}14:::::::::•:::::::w.:�:i:w.�..v:.::.........v::::::v:::;-:};f:�:.: idaress; ... ......... ........ .......................... .•....•.,.v..:.•..,?'^i:f{:';i}:•}}J{Y v. WJW^^'•nvn::S::::.......:{.::v..:.:.. .. .. ............ ..........................:::::::::::::.v:::::::::::::v:S}}h........ .r. w :..t.,r... ............r.•n..,:v:.:r. ';;•};}:{:w•;M:v.}::•:9}}F{;v;"}: : ........ ....... ........ ................ ........................ ..:. r..v ::S.v.r.r .. •Y}:{r:;Y.;it?L:'?vvn^i`?iiv:.'::�•:ii}:t, ....................................:a,. .Y............. .. ... v ..... w. x:x:-}:}'.is•::..: .r. r.....................................4.........................::.v:::::::nv::::x, ..... ::�. .v/ v...y-.�},.:::::;•hC?:::.}:•}:.. yy�y��{:!.......:::::<}}::�:.v?::::::•....:......., .... ..:..:a.�•}r}:i.}Y-•:�1:.}}:3i;.}:v.v::::::::n...................¢•••.::•}r}:x;:•:w:.4.?4.:!•.?:C�.:i.:...::::v:�•:::•:•v.:....... ..................!:..:..:............... ............. .... <<>= :address. : bII :<:;:;:: • .......::;;:.. cl ......t. _- ne ond or Faibae to secure coverage as requireder und Section 25A of MGL 152 can lead to the imposition of crim Iinal penalties Of fine nP to SI,S00.00 ffist s one Years,imptisomnent as wen as civil penalties in the form o[a STOP WORK ORDER and a fine of S100.00 a day against me. a copy of this statement may be forwarded to the Oice of Investigations of the DIA,for coverage verification. I do hereb under the pains aloes of Perjury that irtform�n proWded above is tru.and coned A Al Date Signature �A i D Phone# r— Print name official use only do not write in this area to be completed by city or town olfl" permitlllcuse# ❑Building Department city or town: ❑umsing Board ❑Selectmen's Office ❑che&if immediate response is required ❑Health Department -- ❑emu' contact person: phone#• (tenaad 9195 PJN Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to Providehe serviceworkerscompanother wrien for under anytheco irrac employees. As quoted from the "law", an employee is defined as every person in of hire, express or implied, oral or written. lover is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of An emp . ed the foregoing engaged in a joint enterprise, and including the legal representatives of to ece However the owner ofof a the receiver trustee of an individual, parmerslup,association or other legal entity, employing emp Y 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 c building appurtenant thereto shall not because of such employment be deemed to be an employer. ter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renep MGL chap applicant who h' of a license or permit to operate a business or to.construct buildings in the commonwealth for any neither the not produced acceptable evidence of compliance with the insurance coverag forequired.the poAdditionally,� bli commonwealth nor any of its political subdivisions shall enter into Ofthis chapter have been presented to the contracting acceptable evidence of compliance with the insurance requirements authority. Applicants ' easatiOn affidavit completely,by chug the box that applies to your situation and Please fill in ,he workers �P hone numbers along with a certificate of insurance as all affidavits may be supplying company names,address and p of insurance coverage. Also be sure to sign and submitted to the Department of rm of Industrial Accidents for confiarim ermit or license is date the affidavit. The affidavit should be returned to the city or town that the application for the p the ��w„or is yr Should you have any questions regarding being requested,not the Department of Industrial Accidents please the Department at the number fisted below. are required to obtain a workers' compensation policy, City or Towns . has provided a space at the bottom of t Please be sure that the affidavit is complete and printed legibly. The Department p the applit please affidavit for you to fill out in the event the Office of Investigations has to contact you regarding be sure to fill in the permitllicease number which will be used as a reference number. The affidavits may be mmah�t^ the Department by mail or FAX unless other arra Wments have been made. The Office of Investigations would 1�1ce to thank you in advance for you cooperation and should you have any questions• t hesitate please do no to give us a call. � Er E The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents 8mce of lovesduadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 exL 406, 409 or 375 , } BOARD OF BUILDING REGULATIONS : License: CONSTRUCTION SUPERVISOR Number; cs 005157 Expires:05✓23/2002 Tr.no: 22818 Restricted o: 0 ROLAND B CA 60 GEMINI DR ' W BARNSTABLE, MA 02668 � ! ' n Administrator .:��T�• Y �R^icy'f""^'c.�-r�.�,.R^":�•R�va-«. { ' i A Project @ Lincoln Mercury Garage Page 1 of 1 Giangregorio, Robin From: Lt. Don Chase [dchase@hyannisfire.org] Sent: Wednesday, November 28, 2001 8:50 To: Robin Giangregorio Subject: Project @ Lincoln Mercury Garage Hi Robin, Could you please forward an OK to Building regarding the Lincoln/Mercury renovation project on Yarmouth Road. It does not appear to involve any alarm or sprinkler. Thanks Don 11/28/2001 T FE5-15-02 FRi 10:31 Abe CONSERV GROUP IIiC FAX:1 508 886 6566 PAGE 1 FPCM DEC, I1gC FAX NO. 781 B26 0825 Feb. 15 2002 0841AM P2 Post-It"Fax Note 7571 late TO .2./- 'G PA:769 �. —�� From •'� Co. ap:. rCO. Phcne a Fa.;a - Fax# kN-9�-ER—C'1S A RJCTIOAr CONTROL. A>+'FIDA� T AT PRO.I`EC 7 INCEPT t(7N Parcel Number: 344 DZ6_001 Project Name; — ------- J Cape Cod Lincoln Mercury Project Owner: Cape Cod Lincoln Mercury, InC. , _ 556 Yaz;nonth Road. Hyannis, MA 02501 t (/rnjeci 1y0C8tiott: —556 Ymx1Gl41�t 4 ..htA Scogeof Project, o int4rior renovations and new ahowr,)out facade. In accordance with Paragraph 116.0 of 780 CMR,Lhe Mass$cllusetts State Building Code,i, Edward J. Detnone FE MassachusemRegiatr0tiOA umye3r 30723� _ being a Registered Frote$sional Engineer hereby certify that all plans,computations and gppCifications, and changes thereto,involNring tie Subject project will be Prepared by or Vnder the direct supervisiorr,al'a Massachusetts Registet`W Pre fessicnal Easiness and bear his or her original signature snd seat as de>rncd by Massachusetts General Law(M.G.L.)c 112, �81 R. 1 furtber certify that I will be present cn the coustmotion site at.intervals appropriate to the stage of construction to bee MV generally familiar a+lth the progress avid quality of the work to determine,in general,ifthe work was being performed in It mann8'r consistent with the c onstruction document!. Date P ��5 w> EDWARD). � STktJLkktE Al. �, Aa.3M3 NOV. 0 1998 3:3?PM A11TOtiIOTLVE SERVICES NO. 3215 P, 1/5 Pleb-Ling Lac. Date: 11/4i 98 70: Gloria U.ren.as,Town of Barnstable Bldg.Dept, Cd: File From: Gregg Duncan RE: Cape Cod Lincoln-Mercury sign permits Gloria Urenas- Attached are renderings of the brand sign and used car sign as proposed by Lincoln-Mercury. The existing sign heads will be removed and scrapped and the columns will be covered with a fiberglass "cladding". The foundations are to remain as is and we have engineering confirming the wind load. Please review and call me next week to discuss. Thanks for your help: Gregg L.Duncan (800)444-7446 ext,497 (423)947-8531-fax V I� V 11/4198 ? I ,NOV, P i a94_ : :38PII AUTOMOTIVE SEP,V I DES N0. '2115_P,, 2!5 ,:y — -- ----- 11 T. i ' I! 11 I i I 21'-10 314. i I _ I I I I I i i i i I ' i 75 SF Sign shown with Pf 6 Column Rio Nam. tB175SF Sign on?i6Coil. Plastr-Len®, Inc. safe: 1:32 "W ey: i Property of v/eahi-UM,/me.Mf Iti &WdaeO Qsle: 2iffUG9F !Jets: 'U T 0 T F E R V I C 13 1 4m 5-6 718" ( i No=77 318 14'-7314" i . file Naft, fO B2-13-73 on P16 ,jPftsti-Lino, Inc. &-ole. 1:321 Approved 6yr Pmmm of Pwit4ina,I-Nw to Date; 04NOV98 Date. NC,V. 4-� 19:?8 3:3)F)FIVI �,JT t-:�IyI�,T!i,c. SEL�� �,� P���,), ;���, 4, .- ay i i i i i i i i i 1 T-613/16" i i I i U-8-4o Used Car Sign an P.12.5 I File Name; lIV U-d-lO Sign /. s#i-LIAe, Inc. - Scale: :32 ApRmved Sy, Plapeny orPisatl-line,Inc.Not to ba Gupllatae NO: 210c79$ Date: L N,0 V 0 J VI WAIDTLVE HRV:CES- -NO F F 8'-3 7/8" USED T-1 0" CAR 1 7 161-01' U-8-32 on P12.5 Column SCALE- 1 :24 F14 ftme,, FO U-8-32 on P-12 5 Plasti-Line, Inc. kale: 1:24 Approved ify: PIOPOV or Plead-i n,(M_AW 20 00 Mofi"f*O Dfife" 04UOV98 Date: The .Town of Barnstable KUL Department of Health Safety and Environmental Services EOMo•1� Building Division 367 Main Street,Hyannis MA 02601 Office: Ralph Crossen Fax: 508-790-6230 Building Commis PLEASE FORWARD THE ATTACHED PAGE(S) TO: TO: ATTN: v FAX NO: � FROM: DATE: 1V9 9 PAGE(S): (EXCLUDING COVER SHEET) TOWN OF BARNSTABLE R_4 SIGN PERMIT PARCEL ID 344 076 GEOBASE ID 25057 ADDRESS 556 YARMOUTH ROAD PHONE HYANNIS ZIP - LOT 8 15 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY F PERMIT 71026 DESCRIPTION 32 SQ FT MAZDA PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of 4 ARCHITECTS. Regulatory Services TOTAL FEES: $50.00 BOND � CONSTRUCTION COSTS $.00 tMf 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE KAM 039. BUILDIN IVISI N Y DATE ISSUED O8/22/2003 EXPIRATION DATE �� 'rA Y �.�nr�v2M's�,�,�,3 q +�� `.t { � * wcnof Barnstable . �' � x 2`63' rt• �i5 ,nor r .t ;SHE ��� '��r��;r�x� o �Y 'R`e+glalratorY�Ser. ices c„ �ThomastF Geiler Director + UAMSTABLE, • }s r w x � e> t 03q �,Btuldirig Division' y MASS. k Yk { _ A 1d xt a}a a S rFn i,w�°' Peter.F D11 Mdtteo Budding Commissioner - " Main Street; H r f7 ,r yannis,MA 02601 i, " Office: 508-862-4038 e.wsr a {`, ,_;; Fax. 508-79076230- j > Tax Collector r i= Treasurer A Application for Sign Pernut r Applicant: No.tN 2,Ic :1Vlw 'P` 3�+ "assessors r rFrk s I r x o Fy Doing Business As.CvaaCod LlN`Cy N Me�cv'wy Telephone No. T7 S� L�t{ Sign Location' y �4 rir Street/Road: �wr\VV1J M C�a(� y, �r�"emu•r� I�'Y t{"„� .; —' iF: £ 1 figr RA e Zoning District: 'Old Kings�Highway�;, Yes�Hyannis Historic District? Yeg� irt' 343« 2 f'li` ryE Property Owned� Name: J��;-?-7S_ ' Telephone: ! Address: Mc�1�D >I�� VkE illage: �/� c�v\�5 �Vl Sign Contractor,Nr �3 Telephone: Address: Village: Description Please draw a'diagram of lovshowing location of buildings:and existing signs with dimensions,location and size of the newsign``This should be�drawn on the reverse side of this application. Is the sign to be electnfiedi{t Yes q (Note:,If yes, a wiring permit is required) I;hereby.certify that I am the owner or that Irhave the authority,of.the owner to.make this application,that the information incorrect and'tliat the itse'and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance 1 z Signature of Owner/Authorized Agent 3 _50c v s Permit Fee: a c t r n is, Permit was a roed APPv y Disapproved ` cSignature.of Building Official Date: f .. d J. f s _rev122801 --f 14 SPEC'J'FiCATION ]--OR. 4'--to 7/8' -3 0 PYLON USk" OR NEUSE 'CIF TWS 90aWFNT FOR OTEMER WCATiONS IS fG -'F' -)RD;-AMfl"Z-[) W-,-V0Ul'-APll .WVAt. Of-- P,hKAT4EJR.,N- i SiGNI.- P-30 -rlyLONN' SIGN H-j %VM'Lj0AD,- :90 MPH I. COINTRACTOR SH' Al-t- VERIFY ALL STE ZQkNrjJTJ'0N!3 AND DIMENSIONS- 2- k,'CN!CRE--fE S�-`ALL SE READY 'AMED AND DES'GNIED "10 0cVc-Lo A MIMMU"IM, f-:0MIPRESSIVE STRE!N(3TIH lt' 28-DAYS. 3- RlE*JNF0fZC!oW'G SHALL CONFDR?,;,, -A-0 A.31M A--615 GRADE 60 Mril'H iDEFORMA710INS W 4CON""DWING WITH ASTM A--3.135 143, /2" x S 4- -MIE H/�S N.C.-T TJ-!F -HAT.E. IT SHALL BE T4E 1-5 1/�2- X 11/4, OWNER'S OR HIS AGENT'S RE--,F'DNSj9'LTY. D---,Pj 5. SCAL C'APACI-rY�: A LAT'--:TeA[- SGIL. RESI�TANCF' OF -150 PSF/FT RE 0J! UMN D ' 1 AL SLAB 01 DFP�` BEZf USE", -N Ti71 LR c THI'S DRYWONT,113 -CONTAIMS iXSTAL US FOR VERTICAL SLAB CAISSON FOUNrWTIONS. 2 VEF.11CAL SLAB FOUNDATION ,IF CONCRETE'. 3 YARDOS "K.Uh �� - la -7 PAN- 00-00-006-4033 ELEC- it CONDUIT ',ST1 -- Lll F. INC.RLA 1'1 P.Q. k3ox 9043 37950-9043 5JA jD'WC-BY- SJ BY: --- _t4Z;:h ----rDA TE- -9Q F-3U, ' itISTALL .90 P H 011 DA-1 E IMP- -ECtq .L DESCRIF7'TIONf-�)F CHANGE AAAZDA- PROPERTYti r�Awl�� -NIDT {.a-' B 231981 �v C-4 Post4t M l Fax' aLe 7671 To ,ry ?4j ww Phone Phone Jew Fax it Fax ff r- AYMOUTH SIGN CO. P.O. BOX 134 SOUTH v° R.A OUTH, MA 02664 Phone (503)393-2721 FAX(503) 760.3130 a � k t } et u - t� a t ��AC�ti Y10 S1c \3 w tT Nc 5106 -r--2 9.M L--) -A v �2 TOWN OF BARNSTABLE SIGN PERMIT 0 PARCEL ID 344 076 GEOBASE ID 25057 ADDRESS 556 YARMOUTH ROAD PHONE HYANNIS ZIP — LOT 8 15 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 71027 DESCRIPTION 77 SQ FT LINCOLN MERCURY PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of ARCHITECTS: » TOTAL FEES: $100.00 Regulatory Services BOND .00 CONSTRUCTION COSTS $.00 � • I 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE * BABPTSTABLE, Mass. 1639. Fp�CIA , BUILDINg ISIO Y DATE ISSUED 08/22/2003 EXPIRATION DATE N 4 Y ,x • ter.4.��� .,� .x '�, ,, � ,�, , . T®wo Arnstable r, pIKE # Regulatory Services a + Nam: �•n yr)' e.v4d 'gwn §hL{ x i'in :t r"C Y a; �,T�homasF-Geiler,Director * 3AItNsrABL.Er • ,` i 2*.. i�'S�+t i.'{ N�s�"r"''?�'�•r - -i.; MASS . { ; ��B ulding 1DiAsion gjAr 1639• a� y j' 4 ski m fn nw� Peter F aDiNTatteoBuildm Commissioner raa.g xs d`200`Main,Stree i4� 1nnis,tMA 02601 1 ' Office: 508-862-4038 Y r ; Fax 508-790 6230. Tax Collector Treasurer > " w , 'B Applieation;for Sign Permit t�} Applicant:C CoG� �N Co\��M�e2� Z� fV��4 amiss 3�L1 0� (o/ADO( �� essors No. +, T r qa r4., at � ,. . • ti Doing Business As:Cva Gdd�L�NtCe,'l N M2�cc�w�j Telephone No. `�s^ �� S Y Y z Sign Location Street/Road: eTr�c?v� ,'Rv v� nv\LJ r f. - Zoning District: FOld„Kin `s�Hi hwa' ,5.Fiji,t g yj g� y� YesHyannis Historic District? Ye o Property Owner AAA y / �1v` 1 111 T Y t,�)St-i t l y f.9v 75 Name: � Telephone:, O Address:��S� ��e`R M'c� :�CZ (/�` , V�Y\Vii 5 Village: �'( 1 Sign Con tracto Name: .``�W10J )�\cNCD Telephone: Foos 1� 3 cc3 o Address: Village: 3Description:' Please draw a'diagram of;lotshowg locahonof 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 electnfied? Yes q�' Note I es, a wirin � fy g permit is require) Ihereby certify that I amaerowneror that I have the authority of the owner to.make"this application,that the r 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 /`6 Date: +- j Permit Fee )' �" ;Si Permit was a t roved' , <. M PP Disapproved: Signature of Building Official Date: 2( f f 5 v. SignLdoc rev.12M01 f wA Vn'e.w stayj ac) 17�5 ►c 11'-311 6'-11" ,fl 12'-011 ti 5'-1 1/4" B2-12-75 Sign @ 12'OAH t Account LINCOLN MERCURY Drawn By.r R.KECK All ideas, plans or arrange- ments indicated in this — - — ProJect Title 82-12-75 @12'.pdf IP Rep. J.JOHNSON drawing are copyrighted and owned by ImagePoint and PO Box 59043 ;Scale 1:32 Approved By shall not be re-produced, imaPoint '_Knoxville,TN 37950-9043 Date Created 09 JUL 03 Date Revised &Xu 2002 used by or disclosed any 1-800 444-7446 person, firm or corporation ge n wv,-w.irnagepoinLcom ` for any.purpose whatsoever without written permission of Image•Point. _.` a� , i1 ,`Q... J ir AwQ IL :i--�sw ........... n _ N r.. eh u. �� ��•, ,� -e� ter.' - � .�. a i a - y A TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 344 076 GEOBASE ID 25057 ADDRESS 556 YARMOUTH ROAD PHONE HYANNIS ZIP - LOT 8 15 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 71028 DESCRIPTION 37 SQ LINC MERC/23 SQ CAPE COD/48 SQ MAZDA PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of u ARCHITECTS: Regulatory Services TOTAL FEES: $150.00 BOND $.00 CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE „ 0 • saxrrsrnBLE, MAS& 1639. Fp��a B U I L D I DIVISIbl M BY DATE ISSUED 08/22/2003 EXPIRATION DATE .Tlp ®f°�arnstabie ; THE t OF Regulatory Services Thomas'F...Geiler,Director * BARRSUBLE, Ma y. �0�' gu lding Division : 1DlEn�„pr°i Peter F.Di1VIatteo,;Building Commissioner .200 Main Street;'Hyannis*MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Tax Collector Treasurer t Application for Sign Permit APPlicant:C!� COGt Lk"CokN �A2CLcul7zq 111t�A ssessors No 3�rLl O-1 (o coo Doing Business As:C CU N M e`zc v Telephone No. 'g" 5- 1114 Sign Location Street/Road: 5 S Zoning District: Old Kings,Highway? YesoHyannis Historic District? Ye Property Owner j Name: C-M a- C,L C-1, Telephone: j OF) -7 5— I tl�f�( h Address:-5 5(, ( R MOL)41 V�' Village: P`(o Y\vv S /\A la Sign Contracto Name: (WIOJ� �.\�/�1 C0, • Telephone: i Address: CC3 O C_V) fig��N 5T S<� �{0,cvv�o�-�' Village: "Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this,application. Is the sign to be,electrified? Yes o ' (Note:If yes, a wiring permit is required) . I hereby certify that I am.the owner or.that I have the authority of the owner to.make this application,that the information is correct and that the use and`construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/ uthorized Agent: Date: l� d 5 C r= .,,,Size: Permit Fee: � 5 Si Permit � was approved: . . Disapproved: Signature of Building Official: _ Date: 2f Signl.doc rev.122801 ,_ I PLYMOUTH SIGN CO. P.O. BOX 134 SOUTH YAR1001°7 PI, NIA 02664 Phone (508)398-2721 FAX(008) 760-3130 � I c S �IRf s u - ... _ .r`�+'"_ `" �... ,may `,.rw,..-•+-�T �� �� � �'r_ I _ x r+a Aries ie F— 9'-4" r' azm CAPS COD LINCO N MERCURY 1:96 29'-111/16" I— ( o / I '-}$��It6 37.SV+ 19�' 1 L`�; lV 0 Imo_ �� M E .RI U6'31/4' 69/32—n ,14'-8 15/16324 aass ,sue �� A �� �� �� �'� � I [ 11.31 a3A4�1 1:96 Account LINCOLN MERCURY Drawn RY M.MICELI All ideas plans or armirgr menu up coped tni r _ Protect Title LM Cape Codelewai IP Rep. J.JOHNSON drawing are copynghto[etl and owned by Image Point and I - - - - IPO Box 59043' 6wle N07E0 Approved By shall not be re-produceo, ` �r1721gf:'POlflt.� Koaville,TN 37950.9043 used oy or disclosed to any b Date Created 06 MAR 03 Date Revised person lion or corpora[on 1$00434 ra96 far any purpose whatsoever F w.imagepo.nt.com w thout wntten pe•ud ss on �. s 1f 1 or Image Pont I Rom` AMOUTH SIGN CO. P.O. BOX 134 SOUTH YARMOUTH, MA 02664 Phone(508)398-2721 FAX(508) 760-3130 t USED CARS ,it� i uJ 1 �. uc 1 Sc N�a �cT Rp_ Ac(Aj w crt-� )�j T Z-�W STA AJkA( ti� 'vn ®f Barnstable To *Permit o # �V Expires 6 months from issue d tc �. = Regulatory Services MAS& Fee F, 16196. `e� Thomas F.Geiler,Director ArF0 MAt Building Division Elbert C Ulshoeffer,Jr. Building Commissioner 367 Main Street,.. Hyannis,MA 02.601 w Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION Not Valid without Red X-Press Imprint Map/parcel Number —Ij O I u Property Address ❑ Residential OR QjConvncrcial Value of Work Owner's Name &.Address 6 OC2a() l Contractor's NamciY/, / T�l�7 ��� �� ter— `� ^ Tcic lionc Number, p. .Home Improvement Contractor License #(if applicable)_ ./ Construction Supervisor's License#(if applicable)_ e2-e4lc 2w,orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner Q have Worker's Compensation Insurance ESS PERM' Insurance Company Name Workman's Comp. Policy# f y STABL RARN Permit Request(check box) TQ Rc-roof(stripping old shingles) ❑ Re-roof(not stripping. Going over existing layers of roof) Rc-side ❑ Replacement Windows. U-Value (maximum .44) ❑ Other(specify) Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Consm-ation:cic. s -alert Signature 1 cxpmtrg l o E " COL QIX Constriction;Inc. .. .. C1asTOG wgt;wrttt E 7lte ATOM AP7d."S oasrwr YSTEM ro srOft"W"r srsrEA r0 ce FMMAN Y FEW ALM MOMP SM I EVANQ LQRNJ"PRESSRE rRGTEP WOOP PROVLE cacmAS t•DBts a-A - PAN!L AOIIF O / 5LL5 AYI�70 NEW LLPYREIE CBR"D N9V MerAl C0IPOSTE PN8 ATi AL / •1.AD.SeARG Pf 5lL PUTS r0 N3V MTBA P846 6U54 TO PE W% . AI MLRS PM&WTE / /J ./ // - CAILRETE aro /t'Du HLn ss w�WA TOR 0445k5ka �r0 Mwi[cr. nRA,6M Nfo MEr& J ALM P / - KWK CA.i.TlftEe EPANSILN .. SrID / /l AY.KRS AT T-0 WACACM WN TWO ATTAC4tAWr a WrIt PA8_ - PN8 MTS FER 5LL M NN MRMR/• rO LPBd CA / - W - - rkD arcMltMb,Ine r H TO f�0'r _ to MAi AOMJPP/s /� s�C f-d vm,M.a aaco ,A.e® �.RmC,.mn ./ TING' Roo #:. : 7' N=wSicM P,YPi:6Wa7BA BaSTNb AAM Ao EIA:f. vFa[cr. J 6fq>59tOKr SYSTEM r0 CE MOPrED I yP.�� IIIY A CcR AD ED ro .. �'EL&ATYIIS r , - ...... ....... / r RELOCAT TO ALLOW :,.. NP ML LONe Hr ' / t EXTERIOR RENOVATIONS Lm a / 556 YARMOUTH ROAD i� N % / 4 Be mm WAIL w m Dnnw,u% _ HYANNIS,MA Arr PA8 ki1Re / / / / / '� -/ AG TTl 1TAg*AD r EEni"ALI-XZMXts ATfACAWNIr AL / / - - - - . NL'NORS re ALL R}ETRATE TFROXdI EFS MD MO MEr/L nRAFW E ADD qrO LErAL Yap EO°+'TN6 Alm A P 6LAS5 STIR L2YA0. - /' //' eEYQAA. !RE ELRLNr 6YS7BA 70 tC AYAf°® J J _ PROMe NEW ALAI PA8,A1QX BEVATYAY' WALL s OF teW ALM PA8 r MOM WKVW SO NO WACT TO OP M rRAAE PAIC 006M&EPs f PTIO TO WTOH TIE ACM PA9_ Lte a vasnw,9-AO ON 6RAR rO RBAAK, - 1 ALM P N T7O5 GR ow oom /j 005TNO PAVE KW TO F49,M MR Tt"AMA ON - - TNs DjNWN6 / ! - / F / _ / • WA LL WR 05G' fps WALL a W-W PA8 1 sw wow. SYrB TO AO n8 Y e A PANEL FtS MZOA WLYAV WNO WAOr To nwAPAC MA5FBE TTTFL1G Nro r0 M A5'N6 .. EJOSrCX AIM AP % /; T _ TO CiKS:SrQtBRLNr ICE E95TN6 B%MD SrPo WALL LLNGT10N - . .. 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