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Bob Walker House - Certificates of Inspection
BOB WALKER HOUSE I� °FtHEr The Commonwealth of Massachusetts Town of Barnstable �,Sr,B�. TfD MPS s 2020 Certificate of Inspection l; Issued to Bob Walker House Certificate No. Type: Building Certificate of Inspection DBA Bob Walker House IC-19-233 Identify property address including street number, name, city or town and country Certificate Expiration Located at Map/Lot 101-040 8/12/2020 in the Town of Barnstable 55 J.6. DRIVE, MARSTONS MILLS Location Use Group Classification(s) Allowable Occupant Load 1st R-4: Residential care/assisted living (16 max) 5 Restrictions 5 Residents This Certificate of inspection is hereby issued by the undersigned to.certify that the premise, structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind clear glass and\or laminated and posted.'in a conspicious place within the space as directed by the undersigned, Failure to post or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Building Commissioner Brian Florence Date of Inspection 8/16/2019 Signature of Municipal Building Date of Issuance Commissioner 8/1/2019 �,►�E'��� The State of Massachusetts Town of Barnstable i New and Renewal Certificate of Inspection Application Date 8/3/2018 Fee Required 25.00 In accordance with the provisions of the Massachusetts State Building Code,Section 110.7,hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 55 J.B.DRIVE,MARSTONS MILLS Name of Premises: Bob Walker House DBA: Bob Walker House Purpose for which premises is used: - License(s)or Permit(s)required for the premises by other governmental agencies: Certificate to be Issued to: Bob Walker House (Corp,LLC,or name of Business) Address: 55 J.B.DRIVE,MARSTONS MILLSail Telephone: (508)420-0527 Z Owner of Record of Business or Fellowship Realty Corp.Of MA.INC ,4 Establishment: %O Address: 25 Blackstone Valley Place Lincoln, RI 02865 JS Manager or Persons responsible for Fellowship Health Resources daily operation: E-Mail: sduggan@fhr.net 110 SIGNATU E OF PERSON TOW CERTIFICATE IS ISSUED OR AUTHORIZED AGENT +4 I(� e SpOh-o-I PLEASE kINTNAMEv' INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# IC-1 69 EXPIRATION DATE 7/31/2019 �fME Town of Barnstable Building Division , 200 Main Street BARNbTABLE Hyannis,MA 02601 BARNSTABI,E MASS. .� (508)Z6 862-4038 w:ss-wi•:anxm� ii:un•�tiuixts� � M+AcidL.gRLS.t�EY4":.;E•'�:a4YSTAnIE 1e39-za;14 575 Inspection Report ❑ Notice of Violation Business: 2 Q ' b 56 Date of Inspection: Contact: Info: Address: �5 U, Q. QJr.IrIvk,_D few Info: Phone: Info: Email: Info: During the annual occupancy inspection of your premises,performed in accordance with Section 110.7 of 780 CMR, Massachusetts State Building Code,as amended the following deficiencies and/or violation(s)were noted: Section(s): Location: 0 Section(s): Location: 0 Section(s): Location: 0 Section(s): Location: 0 Section(s): Location: 0 Section(s). Location: 0 Section(s): Location: 0 Section(s). Location: 0 Section(s). Location: Actio a uired to abate the above violationsyou must: None:no violations were observed at the time of inspection 0 Make corrections immediately and contact this office for a follow-up inspection Re-inspection fee of$ is required and a re-inspection to be requested by business within days. 0 Make corrections prior to your next annual or semi-annual inspection. 0 Property/busine s owner or owners approved agent contact inspector for consultation Official/Inspector: Telephone: 508 862=4038 Received By: Pa9 Date: !6- VS �j V 11L_� Print Name: Section 102.6 existing structures-The owner as defined in 780 CMR 2,shall be responsible for compliance with provisions of 780 CMR 102.6 And,if aggrieved by this notice and order,to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal(specifying the grounds thereof with the State Building Code Appeals Board within(45)days of the receipt of this order and in accordance with MGL c. 143§100. Certifleate of n5p c lttTin, Report tSection 105 1 Permit Required Section"105.6 P&mit Suspension or Revocation �SSectiontSection1 5.7 ,Pha$ �„,e= eat of Permit flon site) Section 107.6 OHStructio-i, ("Outrol Section 1.1.0 3 Inspections Required. Seeti a IM7 erio�,Ii ° Inspectioa (validCertificate) Section i.f mf) Cer ificate o �'Ceu a cy Section f.f:f n5.3 Place of°Assembly Posting of Occupancy Section 114H1 Occupancyr Change 0' Us Section f f.5,0 S top"A'or k 0 rd e;�° ® Section 11.0 Unsafe Structure eetiu l 90t5 Testing of fare s/S ri kler Systern Section 901.9 Fire Protection Signage Section 904.12 Commercial A. sui Svsteju Section 90 .2.2 flood System Mamtenance Section 906 Fire.Exting,,y4shers Section 1001.3ni N.1affitenance of Stairs/Fire Section 1001,3 2 Testing/Certificate Exterior tairs[Fi e scape a Section .1.004.3 Bali f cculmney Lj mit 0 Section 1,005 Nlea s of egress Sizing _ Section 100 um'oer of Exits and access Doors Section 1008 Means off Egress Illumination a Section 1.0i0,1,9 I)oor Operation 0 Sectiovi 10 i.O.f m9, * ardwave (Locks and ;atches) a Section :1.O12.0.1,10 Panic Hardware or E > 50 :.� ection f0 i i sfilfi7va,vs Section 1.01.2 Ramps Section 10:1.3 'Exit -s « Section 10:1. :H.a.nelrai:i:s a sectiwl 1015 jar .s r - The Commonwealth of Massachusetts Town of Barnstable 1 a�0� 2019 Certificate of Inspection Bob Walker House Certificate No. Issued to Fellowship Health Resources Type: Building -Certificate of Inspection IC-.18-169 Identify property address including street number, name, city or town and country Certificate Expiration Located at Map/Lot 101-040 7/31/2019 in the Town of Barnstable 55 J.B. DRIVE, MARSTONS MILLS Location Use Group Classifications) Allowable Occupant Load 1st R-4: Residential care/assisted living (16 max) 5 Restrictions 5 Residents This Certificate of inspection is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind clear glass and\or laminated and posted in a conspicious place within the space as directed by the undersigned, Failure to post or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Building Commissioner Brian Florence Date of Inspection 8/3/2018 Signature of Municipal Building Date of Issuance Commissioner 8/1/2018 SHE 1phy4 The State of Massachusetts a Town. of Barnstable ED MA'S - - 1WF New and pp Renewal R n wal Certificate of Inspection Application Date 7/21/2017 Fee Required 25.00 In accordance with the provisions of the Massachusetts State Building Code,Section 110.7,hereby apply for Certificate of Inspection for the below-named premises located at the following address: Street and Number: 55 J.B.DRIVE,MARSTONS MILLS Name of Premises: Bob Walker House Purpose for which premises is used: f License(s)or Permit(s)required for the premises by other govern menta['agencies: t t Certificate to be Issued to: Bob Walker House Address: 55 J.B.DRIVE,MARSTONS MILLS Telephone: (508)420-0527 ,. Owner of Record of Building: Fellowship Realty Corp..Of MA.INC Address: 25 Blackstone Valley Place Lincoln, RI 02865 Y, Name of Present Holder of Certificate: . Fellowship Health Resources w Owner of Business: Fellowship Health Resources E-Mail: sduggan@fhr.net SIGN URi OF PERSON TO WHOWORTIFICATE `�� p IS ISSUED OR AUTHORIZED AGENT PLEASIk PRINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE F , 2)Return this application with your check to:, BUILDING COMMISSIONER,2.00 MAIN STREET,HYANNIS,MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# IC-1 47 EXPIRATION DATE 7/10/2018 ' �1�� �� r f N�-'��" �� i�A I mow+ `(.J _ _ __ _ - . S ' 1 The State of Massachusetts Town of Barnstable fO.MPt -New and Renewal Certificate of Inspection Application Date 7/21/2017 Fee Required 25.00 In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, hereby apply . for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 55 J.B. DRIVE,MARSTONS MILLS Name of Premises: Bob walker House Purpose for which premises is used: License(s) or Permit(s) required for the,premises by other governmental agencies: - •y Certificate to be Issued to: Address: 25 Blackstone Valley Place Lincoln RI 02865 Telephone: (508)420-0527 Owner of Record of Building: Address: 25 Blackstone Valley Place Lincoln RI 02865 Name of Present Certificate Holder: Fellowship Realty Corp.Of MA. INC Name of Agent, if any SIGNATURE OF PERSON TO WHOM CERTIFICATE IS ISSUED; . OR AUTHORIZED AGENT PLEASE PRINT NAME ` INSTRUCTIONS: 1)Make check payable to:TOWN OF BARNSTABLE 2)Return this application with your check-to: BUILDING COMMISSIONER, 200 MAIN STREET, HYANNIS, MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten (10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# IC-17-147 EXPIRATION DATE 7/10/2018 TOWN OF BARNST BUILO if �IfsA 3 [ . . xa U.S.POSTAGE>>PITNEY BOWES 200 MAIN STREET HYANNIS,MA 02601 A ZIP 02601 02 41 000.470 0000,3.36455JUN. 12. 2018. BOB WALKER 25 BLACKSTONE VALLEY PLACE LINCOLN;Rl-02865 ATTN: S. DU N 1,xI E a is F E —2. — --- 0 8 /1.T/18s RETURN TO SENDERATTEMPTED — NOT KNOWN tel: 9400921669,1671 XNK BC: 026561.400209 *0369-94205-1.3-42 ' I iii9a I Ilzi a a s a da5a 11111ill Jill, i I1ai { $ i ( FF ii yy E i t t i��!.�.s s��F I �i s r�� i s i � i 'i� I` .� ��i,s_ s: F� � .��' 1�! i +�i _-.` j ,f, , r � � - r, 1.�.:v. ti,� . � _..__ Town of Barnstable ti Building Department Ruvsen LE. « Brian Florence, CBO 1639. .�� Building Commissioner prFo Nw,�a 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ` Dear Manager: Attached please find an application for the annual Certificate of Inspection (COI) required by 780 CMR the Massachusetts State Building Code,Ninth Edition Chapter 1 - Section 110.7 which reads: 110.7Periodre Inspections. The building official shall inspectperiodically existing buildings and structures and parts thereof in accordance with Table 110 entitled Schedule for Periodic Inspections of Existing Buildings. Such buildings shall not be occupied or continue to be occupied without a valid certificate of inspection. Please complete the application and return to the Building Commissioner's Office with the required fee (amount as set on the top right-hand comer);the fee must be paid before the Certificate of Inspection may be issued. Generally periodic inspections are unannounced;however you may feel free to contact us for inspection once the application fee is paid. For your convenience,we will be testing emergency lights, exit signs to ensure that the batteries and lighting are functional and making sure that the doors work and the exits are clear.You will need to have any fire extinguishers, fire alarm systems and/or Ansel systems (stove hood /extinguisher)inspected and tagged and a copy of the technicians reports onsite for the inspection. If you would like to have your COI application emailed please provide an email on the Certificate of Inspection Application. Sincere Brian Florence;CBO " Building Commissioner °FSHE r°,k, Town of Barnstable ti °T Building Department RAxzvsxnsr.E, Brian Florence, CBO 2639. . Building Commissioner , prED" a 200 Main Street, Hyannis,MA 02601 www.town.barnstabIe.ma.us Office: 508-862-4038 Fax: 508-790-6230 Dear Manager: Attached lease find an application for the annual Certificate of Inspection (COI) required by p pp p 780 CMR the Massachusetts State Building Code,Ninth Edition Chapter 1 -Section 110.7 which reads: 110,7Periodic Inspections. The building official shall inspectperiodically existing buildings and structures and parts thereof in accordance with Table 110 entitled Schedule for Periodic Inspections of Exiaing Buildings. Such buildings shall not be occupied or continue to be occupied without a valid certificate of inspection. Please complete the application and return to the Building Commissioner's Office with the required fee (amount as set on the top tight-hand corner);the fee must be paid before the Certificate of Inspection may be issued. Generally periodic inspections are unannounced;however you may feel free to contact us for inspection once the application fee is paid. For your convenience,we will be testing emergency lights, exit signs to ensure that the batteries and lighting are functional and making sure that the doors work and the exits are clear.You will need to have any fire extinguishers,fire alarm systems and/or Ansel systems (stove hood /extinguisher)inspected and tagged and a copy of the technicians reports onsite for the inspection. If you would like to have your COI application emailed please provide an email on the Certificate of Inspection Application: Sincere Brian Florence, CBO Building Commissioner i (HE , The State of Massachusetts rl FMASLA Town of Barnstable New and Renewal Certificate of Inspection Application Date 7/21/2017 Fee'Required 25.00 In accordance with the provisions of the Massachusetts State Building Code, Section 110.7, hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 55 J.B. DRIVE,MARSTONS MILLS Name of Premises: Bob Walker House Purpose for which premises is used: License(s) or Permit(s) required for the premises by other governmental agencies: Certificate to be Issued to: Address: 25 Blackstone Valley Place Lincoln RI 02865 Telephone: (508)420-0527 Owner of Record of Building: Address: 25 Blackstone Valley Place Lincoln RI 02865 Name of Present Certificate Holder: Fellowship Realty Corp.Of MA. INC Name of Agent, if any SIGNATURE OF PERSON TO WHOM CERTIFICATE IS ISSUED OR AUTHORIZED AGENT PLEASE PRINT NAME INSTRUCTIONS: 1) Make check payable to:TOWN OF BARNSTABLE 2) Return this application with your check to: BUILDING COMMISSIONER, 200 MAIN STREET, HYANNIS, MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten (10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# IC-17-147 EXPIRATION DATE 7/10/2018 T P o, mmonwealth of Massachusetts .. S s, Town of BarnstAble Q _ .139 �00 J.• x Certificate of Inspection Bob Walker-House Certificate No. Issued to Fellowship Health Resources Type: Building-Certificate of Inspection IC-17-147 Identify property address including street number, name,..city or townand country Certificate Expiration Located at Map/Lot 101-040 - 7/10/2018 in the Town of Barnstable 55 J.B. DRIVE, MARSTONS MILLS Location Use Group Classification(s) Allowable Occupant Load 1st - - R-4: Residential care/assisted living (16 max) 5 Restrictions 5 Residents E This Certificate of inspection is hereby issued by the undersigned to certify that the premise, structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall,be framed behind:clear.glass andlor laminated and,posted in a conspicious place within the space as directed by the undersigned, failure to post or tampering with the contents of the certificate.is strictly prohibited. Name of Municipal Building Commissioner Jeff LauZon Date of Inspection 7/21/2017 Signature of Municipal Building Date.of Issuance Commissioner 7/10/2017 :ti - The Commonwealth of Massachusetts Town of Barnstable 9 , �q 2017 Certificate of Inspection y. Bob Walker House Certificate No. Issued to Fellowship Health Resources Type: Building -Certificate of Inspection IC-16-217 Identify property address including street number, name, city or town and country Certificate Expiration Located at Map/Lot 101-040 7/10/2017 in the Town of Barnstable 55 J.B. DRIVE, MARSTONS MILLS Location Use Group Classifications) Allowable Occupant Load 1st - R-4: Residential care/assisted living (16 max) 5 Restrictions 5 Residents This Certificate of inspection is hereby issued by the undersigned to.certify that the premise, structure or portion_thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind clear glass and\or laminated and posted in a conspicious place within the space as directed by the undersigned, Failure to post or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Building Commissioner Paul Roma Date of Inspection 8/18/2016 Signature of Municipal Building Date of Issuance Commissioner } �+,-.. 12/15/2016 I t. The State of Massachusetts , i Town: of Barnstable k. New and Renewal Certificate of Inspection ,application Date 6/8/2017 Fee Required 25.00 In accordance with the provisions-of:the M.ssachusetts State Building Code,Section 110,7,hereby applyfora Certificate of Inspeiltion for the below-named premises located at ti e following.address: Street and Number: 55 J.B.DRIVE,MA ISTONS:MILLS Name of Premises: Bob Walker Hous Purpose for which premises is used: Licenses)or Permit(s)required for the pre'Mses by other governmental agencies: _. Certificate to be Issued to: B` b Walker House Address: S, 1;8.DRIVE,MARSTONS-MILLS I. Telephone: ( 8)42MS27 Owner of Record of Building: Fie Ilowship Realty Corp.Of MA.INC Address: 2 .Blacksto.neValley Place Lincoln, RI02865 z Name of Present Holder of Certificate: Fe lowship Health Resources Name of Agent,if any Fe lowship Health Resource's E-Mail: A iggah@.fhr.net R ?Mt SIGNATURE OF PERSON TO WHOWI.CERTIF CATE IS ISSUED OR AUTHORIZED AGENT s1 Ku I Uj PLEASE PRINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BAR STABLE 2)Return this application with your checks : BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2}Application and fee must be received be ore the certificate will be issued. 3)The.building official shall be notified witl in ten(10)days of any change In the above information, MR OFFICE USE:ONLY: CERTIFICATE# TIC-17-147 EXPIRATION DATE 7/10/1018 oFtHE rq,, Town-of Barnstable Regulatory Services . t + BMMSTASL6. • v MASS Richard V. Scali,Director 9'pr16 3 9t"�0 Building Division' Paul Roma,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.as . Office: 508-862-4038 Fax: 508-790-6230 Dear Manager: Attached you will find an application for Certificate of Inspection as required by Section 110.7'of the Massachusetts Sate Building Code, Eighth Edition: Please complete the application and return to.the Building Commissioner's Office with-the required fee (amount asset on the top tight-hand corner); the fee must be paid before the Certificate of Inspection/Capacity Card may be issued. ` *Please contact this office once�aymentis made to arrange mspection4 . _ f Such buildings shall riot be.occupied or continue to be occ upiedwfthout a valid Certificate oflnspecdcin. (Current COI Expires � 10 U1 ' We nowhave the capability to email your COI. Please provide an Email address on the Cerd6cate'oflnspection Application. Sincerely, Paul Roma Building Commissioner ' gdrive:COI r - The State of&ARN?TWM.;' Town of Barnstable >> f0 MA A a .i' New and Renewal Certificate of Inspection Application Date .6/8/2017 Fee Required 25.00 In accordance with the provisions of the Massachusetts State Building Code,Section 110.7,hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 55 J.B.DRIVE,MARSTONS MILLS Name of Premises: Bob Walker House s Purpose for which premises is used: License(s)or Permit(s)required for the premises by other governmental agencies: Certificate to be Issued to: Bob Walker House Address: 55 J.B. DRIVE,MARSTONS MILLS Telephone: (508)420-0527 Owner of Record of Building: Fellowship Realty Corp.Of MA.INC Address: 25 Blackstone Valley Place Lincoln, RI 02865 Name of Present Holder of Certificate: Fellowship Health Resources Name of Agent,if any Fellowship Health Resources E-Mail: sduggan@fhr.net SIGNATURE OF PERSON TO WHOM CERTIFICATE IS ISSUED OR AUTHORIZED AGENT. PLEASE PRINT NAME INSTRUCTIONS: 1) Make check payable to: TOWN OF BARNSTABLE 2) Return this application with your_check to: BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS, MA 02601 PLEASE NOTE: - 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# TIC-17-147 EXPIRATION DATE 7/10/2018 MICHELE CUDILO, P.E. Consulting Structural Engineer 123 Cottonwood Lane,Centerville, Massachusetts 02632-1979 • (508)771-7601'• Fax(508)771-7163 mcudilo@comcast.net December 12, 2016 Town of Barnstable Building Department 200 Main St. Hyannis, MA 02601 Attention: Mr.Thomas Perry, Building Commissioner RE: EGRESS INSPECTION MARSTONS MILLS GROUP HOME,55 JB DRIVE,MARSTONS"MILLS,MA Dear Mr. Perry, Please be advised that this office reviewed as-built construction during various dates,and reviewed email and- ' photos with the representative,and find all work completed satisfactorily.- All work appears,and loads calculated,in accordance with Massachusetts State Building Code 8th edition. This office has inspected all exterior wooden stairways,fire escapes and egress components for structural integrity and safety,and finds them adequate,as amended. Sincerely, OF MASSA Michele Cudilo, P.E. cc: D.Campbell g Sja�G�R�� N /2016-241 , o No 3477 4o '° aEGIS��P �2 9GFFSS100 { k COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION Date August 4 . 2016 (X) Fee Required ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code,Section 110.7,I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 55 JB Drive , Marston Mills , MA 02648 Name of Premises: Bob Walker House j Purpose for which premises is used: Group Home I License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agen . Certificate to be Issued to: Fellowship Health Resources , Inc . ;z:; Address: 55 JB Drive Marston Mills KA 0264.8 c� Telephone: 508-420-0527 Owner of Record of Building: Fellowship Realty Corporation of Massachusetts , me Address: 25 Blackstone Valley Place , Lincoln RI 02865 Name of Present Holder of Certificate: Name of Agent,if any: PLEASE PROVIDE EMAIL: s d u g a a n @ f h r_n P t SIGNATUIM OF PERSON HOM CERTIFICATE IS ISSUED OR AUTHORIZED AGENT We are now able to email the certificate to you. Stephen M. Duggan PLEASE PRINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# 11 EXPIRATION DATE: I O V J020115c COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION Date July 7 , 2 0 1 6 (X) Fee Required a%, ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code,Section 110.7,I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 55 JB Drive , Marston Mills MA 02648 NameofPremises: Fellowship Health Resources , Inc . Purpose for which premises is used: License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be Issued to: Fellowship Health Resources , Inc . Address: 55 JB Drive , Marston Mills MA 02648 Telephone: 508-420-0527 Owner of Record of Building: Fellowship Realty Corporation of Massachusetts , Inc . Address: 25 Blackstone . valley Place , Lincoln RI Fq 865 2 Name of Present Holder of Certificate: _~ _n 03 Name of Agent,if any: can PLEASE PROVIDE EMAIL: s d u g g a.. f h�3 n e t SIGNATURE OF PERSO M WHOM CERTIFICATE. rsa IS ISSUED OR AUTHORIZED AGENT We are now able to email the certificate ta"3jou. Stephen M. Duggan PLEASE PRINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with you_r check to: BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 026.01 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: - - CERTIFICATE# EXPIRATION DATE: J020115c The Commonwealth of Massachusetts TOWN OF BARNSTABLE In accordance with the Massachusetts'State Building Code, Section 110.7, this CERTIFICATE OF INSPECTION is issued to FELLOWSHIP HEALTH RESOURCES Certify that I have inspected the premises known as: BOB WALKER HOUSE located at 55 JB DRIVE in the Village of MARSTONS MILLS County of Barnstable Commonwealth of Massachusetts. Construction Type: Use Group(s): RS The means of egress are suff cient for the following number of persons: Location Capacity Location Capacity RESIDENTS 5 Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 201504319 7/10/2015 7/10/2016 1 0 The building official shall be notified within(10) days of any changes in the above information. , Building Official PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 07/10/15 TIME: 13:26 -----------------TOTALS---- ---_--f._--,-- PERMIT $ PAID 25'.00 AMT TENDERED: 25.00 AMT APPLIED: 25.00 CHANGE: .00 APPLICATION NUMBER: 201504319 PAYMENT METH: CHECK PAYMENT REF: 174739 f COMMONWEALTH Or MASSACHUSETTS. 'DOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECT ION /� .� Date_ �f � �� (X) Fee Required.$ - r ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code,Section 110.7,1 hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Of Street and Number:_ 's4 Name of Premises: Purpose for which premises is used: R.�O�a.� License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agenc Certificate to be Issued to: `" elf- -Address: P � / / � S t(d.l�°ZS �r V (r(e (a C C . G�( -7 1-- n`{ Telephone: ���.� 9 ® � ~' f• �. � S ff � ,t Owner of Record bf Building: -Q'•`� -- Address: �-+� ®'I � -- Name of Present holder of Certificate: ' r' are Name of Agent,if any: • r'= 1 SIGNtsZtiFcE OF PEiwvir T � IS ISSUED Olt AUTHORIZED AGENT PLEASE P INT NAME INSTRUCTION:: 1)Make check payable to: TOWN OF BARNSTABLE - 2)Return this•application with your check to, BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 0.2601 PLEASE NOTE: _ I)"Application f6rm with accompanying fee must be submitted for each building or structure or part thereof to be certified: 2)Application and fee must be received before the certificate will be issued. '- - 3)The building official'shall be notified within ten(10)days of any change in the above information. w FOR OFFICE USE ONLY: CERTIFICATE i# N EXPIRATION,DATE J020115c 1 The Commonwealth of Massachusetts TOWN OF BARNSTABLE In accordance with the'Massachusetts State Building Code,,Section 106.5, this CERTIFICATE OF INSPECTION is issued to FELLOWSHIP HEALTH RESOURCES I Certify that I have inspected the premises known.as: BOB WALKER HOUSE located at 55 JB DRIVE in the Village of MARSTONS MILLS County of Barnstable Commonwealth of Massachusetts. Construction Type: Use Group(s): RS The means of egress are sufficient for the following number of persons: Location Capacity Location Capacity RESIDENTS 5 Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 201404228 7/10/2014 7/10/2015 101 040 The building official shall be notified within(10) days of any changes in the above information. Building Official I PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE , BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 .. k DATE: 06/26/14 TIME: 15:14 -=---------------TOTALS-----=` - ------- 1t:. PERMIT $ PAID 25.00 AMT TENDERED: 25.00 , AMT APPLIED: 25.00 CHANGE: .00 APPLICATION NUMBER: 201404228 PAYMENT METH: CHECK PAYMENT REF: 164168 Jun 12 2014 1:03PM .FHR Bob Walker House 15084201802i page 3 Jun. 9. 201410.48AM r „ l No. 2')68 P. 2 all 1 00 COMMONWEALTH QF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF(NSPECTMN; Date (X) Fee Required ( ) No Fru Required In accordance with the provisions of the Massachusetts state Bufld3ing Code,Section 106,5,t hereby,apply for a Certificate of Inspection for the below-named premises loch,-d at the following address; Street and Number; Name of Premises: 3 ,94 Cv� Purposo for which premises is used: Licenses)or Perm i:(s)required for the premises by other governma"tal agencies;, . Liause,or Pera t A eni vr.�t pit ..a `�;-, =--..�—�. , P��� � r` :�•a�""'--7' I Certificate to be Issued to: .t 16 twSt�Le v7S b^t�J . Address: .j Z'. :-j- p� • tom— `fr i s f G 'p l�r � Telephone: dS`� I1 ' Owner of Record of Building; jOf Address: ( �c'�s 1—c iP V r 1�(5 vyu/ /a•�s" .. `7— Name of Present H01der of Certificate: Nadu of Agent,if any: Cam• ,. � _ . SIGNATURE OF PER ON TO W5iaK CERTIFICATE IS ISSUED OR AtUTHOEUZEb CENT k PLEASE Vi f TT NAME INSTRUCTloNs: 1)Make check payable to: TOWN 017 BAR9STABLB 2)Rtturn this applica!ion with your check to; BUILDING COMNOS$IONER,200 MAIN STREET,HYANNIS,MA 02601 1)Application form with accompanying fee.must be submitted for each building or structure or part thereof to be certi fied. 2)Application and fee most be rocci'yed before the certificaw will be.issued 3)The building official shall be notified within ten(10)days ofany change in the above information.- PO FPIC9 USE ONLY- t . 'CERT1FICATB 9EXPIRATION 13A fE 102011Sa -ter•'".-_-. �,t_ __ - --tr....ww�.f�_ Communication Result Report .( Jun, 9. 2014 10:49AM ) . 1) 2) Date/Time : Jun; 9, 2014 10:47AM Pile Page No. Mode Destination Pg (s) Result Not Sent 2368 Memory TX 915084201802 P. 2 OK Reason for error e - E. 1) Hang uP or l i n e fai l E. 2) Busy E. 3) No answer E.'4) No facsimile connection E. 5) Exceeded max. E—mail sire Town of Barnstable _ Regulatory Services (r" f Rlehard V.Seali,Dimmer _ - q Building Division Tam Peny,CBO,Building Commusioaer ...200 M m Sheet,Rye-h,MA 4201 . emmlemm�ldema � ,. - . Ofr—"1-9624038.•. - IF=508-7906M hme 6.2014 - - - - - FELLOWSHIP HEALTH RESOURCES. BOB WALKER HOUSE - 55 JB DRNE - .. MARSTONS PALLS MA M46 Attached you will tmd an appiiralion for a CaUfficale of Inspection ss required by Section 110.7 of Ore Massachusetts State Buizibng Cede,Eighth Editimr. ' Please cor"te the appficaEion and Tatum le the BuEdIng Cononi"I'mers Office with the temdrad fee ou (.Ynt as on the top righl-Itand mmerl_The fee has been esfeblishad by Ore stale(Table 100),and amemled by the Bamstabla Tow.Council effective OW MI,and must be paid before the Cediificale of InspeacmiCalm*Card may be issued - - A copy of said Carthcate shall be kept po*W as spaeited in Serdimh 120.5 of the State Code. ._ Tam Perry .BWdmg Commissioner TOWN OF BARNSTABLE INSPECTION WORKSHEET Close; CERTIFICATE NO: 201404228 CANCELLED: MAP: 101 DBA: IBOB WALKER HOUSE PARCEL: 040 NAME/MANAGER: FELLOWSHIP HEALTH RESOURCES STREET: 155 JB DRIVE VILLAGE: MARSTONS MILLS STATE: MA I ZIP: 02648 SEQ NO: 10 BUSINESS TYPE: IGROUP RES CONSTRUCTION TYPE: STORY1: CAPACITY: USE1: R5 Capacity Under 50: STORY2: CAPACITY: USE2: STORY3: CAPACITY: USE3: Outside Seating: BY PLACE OF ASSEMBY OR STRUCTURE CAP1: 5 LOC1: RESIDENTS CAPS: LOC8: CAP2: LOC2: CAP9: LOC9: CAP3: LOC3: CAP10: LOC10: CAP4: LOC4: CAP11: LOC11: CAPS: L005: CAP12: LOC12: CAPE: LOC6: CAP13: LOC13: CAP7: LOC7: CAP14: LOC14: INSPECTION: DATE ISSUED: EXPIRATION: Print his screeFWl 07/11/2013 07/10/2014 07/10/2015 EE[PiRwn Cerkifi%a a ns ecti9n COMMENTS: r Town of Barnstable Regulatory Services SAW4*1rANA Richard V. Scali,Director 16 Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnsta ble.m a. Office: 508-862-4038 Fax: 508-790-6230 June 6, 2014 FELLOWSHIP HEALTH RESOURCES BOB WALKER HOUSE 55 JB DRIVE MARSTONS MILLS MA 02648 Attached you will find an application for a Certificate of Inspection as required by Section 1.10.7 of the Massachusetts State Building Code, Eighth Edition. Please complete the application and return to the Building Commissioner's Office with the required fee (amount as set on the top right-hand corner). The fee has been established by the State (Table 106), and amended by the Barnstable Town Council effective 08/06/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5 of the State Code. Sincerely, _ Tom Perry Building Commissioner Enclosure COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION Date (X) Fee RequiredV ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 106.5, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: Name of Premises: Purpose for which premises is used: License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit AgencX Certificate to be Issued to: Address: Telephone: Owner of Record of Building: Address: Name of Present Holder of Certificate: Name of Agent, if any: SIGNATURE OF PERSON TO WHOM CERTIFICATE IS ISSUED OR AUTHORIZED AGENT PLEASE PRINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2) Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET, HYANNIS, MA 02601 PLEASE NOTE: I)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2).Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: "CERTIFICATE# EXPIRATION DATE: J0201ISa Town of Barnstable Regulatory Services am Richard V.Scali,Director 039 06 Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma. Office: 508-862-4038 Fax: 508-790-6230 June 6, 2014 FELLOWSHIP HEALTH'RESOURCES BOB WALKER HOUSE 55 JB DRIVE MARSTONS MILLS MA 02648 Attached you will find an application for a Certificate of Inspection as required by Section 110.7 of the Massachusetts State Building Code, Eighth Edition. Please complete the application and return to the Building Commissioner's Office with the required fee (amount as set on the top right-hand corner). The fee has been established by the State (Table 106), and amended by the Barnstable Town Council effective 08/06/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be_kept.posted as specified in Section 120.5 of the State Code. Sincerely, Tom Perry Building Commissioner Enclosure TOWN OF BARNSTABLE INSPECTION WORKSHEET Close, CERTIFICATE NO: 201304408 CANCELLED: MAP: 101 DBA: IBOB WALKER HOUSE PARCEL: 040 NAME/MANAGER: IFELLOWSHIP HEALTH RESOURCES STREET: 155 JB DRIVE VILLAGE: IMARSTONS MILLS I STATE: FVA ZIP: 0264i3- SEQ NO: 10 BUSINESS TYPE: IGROUP RES CONSTRUCTION TYPE: STORY1: CAPACITY: USE1: R5 Capacity Under 50: STORY2: CAPACITY: USE2: STORY3: CAPACITY: USE3: Outside Seating: ❑ BY PLACE OF ASSEMBY OR STRUCTURE CAP1: 5 LOC1: RESIDENTS CAPS: LOC8: CAP2: LOC2: CAP9: LOC9: CAP3: LOC3: CAP10: LOC10: CAP4: LOC4: CAP11: LOC11: CAPS: L005: CAP12: LOC12: CAPE: LOC& CAP13: LOC13: CAP7: LOCI: CAP14: LOC14: INSPECTI DATE ISSUED: EXPIRATION: �. GinfThl Screen Q 0 2012 07/10/2013 07/10/2014 tint C0 Ific, of•Inspection COMMENTS: Town of Barnstable Regulatory Services g Y ""XAAW Richard V. Scali,Director . Building Division s Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 s ' www.town.barnstable.ma. Office: 508-862-403 8 Fax: 508-790-6230 June 3, 2015 FELLOWSHIP HEALTH RESOURCES BOB WALKER HOUSE 55 JB DRIVE MARSTONS MILLS MA 02648 Attached you will find an application for a Certificate of Inspection as required by Section 110.7 of the Massachusetts State Building Code, Eighth Edition. Please complete the application and return to the Building Commissioner's Office with the required fee (amount as set on the top right-hand corner). The fee has been established by the State (Table 106), and amended by the Barnstable Town Council effective 08/06/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5 of the State Code. Sincerely, Tom Perry Building Commissioner Enclosure k Com moubJeald) of Ala.5.5arbuatto TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this CERTIFICATE OF INSPECTION is issued to FELLOWSHIP HEALTH RESOURCES QLErtifp that I have inspected the premises known as: BOB WALKER HOUSE located at 55 JB DRIVE in the Village of MARSTONS MILLS County of Barnstable Commonwealth of Massachusetts. Construction Type: Use Group(s): R5 The means of egress are suff cient for the following number of persons: Location Capacity Location Capacity RESIDENTS 5 Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 201304408 7/10/2013 7/10/2014 1 040 The building official shall be notified within(10) days of any changes in the above information. Building Official PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 07/03/13 rlf . TIME: 08:33 tr -----------------TOTALS----------------- PERMIT $ PAID 25.00 • , AMT TENDERED: 25.00 ° AMT APPLIED. 25.00 CHANGE: .00 APPLICATION NUMBER: 201304408 PAYMENT METH: CHECK PAYMENT REF: 153025 1, i 'tWN QF BARNSTABLE COMMONWEALTH OF MAS ' 1C,JS 3 T�� . TOWN OF BARNST�E° L 18 APPLICATION FOR CERTIFICATE OF INSPECTION I / Date sr f cj.�— -- Y. Required $ DIVISI ( ) No Fee Required In accordance with tI provisions of the Massachusetts State Building Code, Section 106.5, I hereby apply for a Certificate of Inspection for the be]:>w-iamed premises locaied atthe following address: 1 ` Street and Number:_ Y - � i ✓'e- S' I Name of Premises: 73 C96 tya'I !'. 'f-�O--- Purpose for which pr mises is used: License(s) or Permit(;) required for the premises by other governmental agencies: Lice ise x Permit Agency 77 r / f !� �3 ��� Certificate to be Iss ied to: � t l(9 L".J� l�U � ��y e e -j A idress: �5� 61� Tele:jhone: 'z� o%� —( ( �{� 2-0/- Owner of Record of I wilding: add-'ess: G `t L1 �t ( f LC% '( �.. �,e c% 4-7 Name of Present Holt er of Certificate: ((C9 Ck Name of Agent, if an: SIGNATURE OF P:;ION TO WHOM CERTIFICATE IS ISSUED OR AUl HC RIZEED AGENT PLEASE PRINt N) ME— r INSTRUCTIONS: 1)Make check payab to: TOWN OF BARNSTABLE 2)Return this applica ion with your check to: BUILDING COMMISSIONER,200 MAIN STREET, HYANNIS,MA 02601 PLEASE NOTE: 1)Application form v ith accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fe, mu3t be received before the certificate will be issued. 3)The building offici.J shall be notified within ten (10)days of any change in the above information. FOR OFFICE USE O 4L`.,: r `( 10ao1� CERTIFICATE # V(10 qO EXPIRATION DATE: j020115a a +• or. i? COMMONWEALTH OF MASSACHUSETTS 7 TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION -06 Date (X) Fee Required$ ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 106.5, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: Name of Premises: Purpose for which premises is used: License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit A enc Certificate to be Issued to: Address: Telephone: Owner of Record of Building: i Address: Name of Present Holder of Certificate: Name of Agent, if any: SIGNATURE OF PERSON TO WHOM CERTIFICATE IS ISSUED OR AUTHORIZED AGENT PLEASE PRINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET, HYANNIS, MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will b'e issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# EXPIRATION DATE: J020115a I P, 1 Communication Result Report ( Jul. 1, 2013 3:29PM j 2) Date/Time : Jul, 1. 2013 3: 29PM File Page No. Mode Destination Pg (s) Result Not Sent -------------------------------------------------------------------------------------------- 5738 Memory TX 915084201802 P. 1 OK: . w _ — -------- —.------.----.--------------- ------------------------------------ .. H, '�R.ea.s:on f.or„ err6r < E 1) Hang up or l i ne fail E. 2) Busy E. 3) No answer E. 4) No facsimile connection E. 5) Ex c e e d e d ma x.. E—m a.i.1 s i z e y .'COMMONWEALTH OF MASSACHUSETTS ' TOWN OF BARNSTABLE APFLICATIONFOR CM=CATE OF INSPECTION bue (X) F.RnNiredS"" No Bee semimd In aemdana whh be provisions oflheMas dmabsStak&dId'mg Cade,Salim 106.5,.I hwe1w Wlyfora Cerfifcak or bwFwtinafor 16 bdow<auaed pre =bcakd at the fulloairg address: - Streetand Nnmhw: NameofPrtanisrx . Pvpme Su wlde6pmniaes fatued; Licase(s)wPermil(s)gaised for she prwim lryalzr goyuaiarnbal egrncici : CAri_orPmnt< A4eIXa Certifimk M 6e k..d uc ' A& x c ` T&pho ` .. ke Owns ofRecard Adli e N—fPreseM Rokrrol'Unfcoc Nmne ofASerrq ifury: SIGN ATUEEOBPERSONTOWE(,MCRU=CATSIS ISSUED OR AUTRORVAp AGHPI' PLEASE FAINT-NAM �c c- gMakacfiedrpryableM: TOWN OFBARNSTABIS 2)Relmn this appfsadm with you dmdc M:BUR2IING COMMISSIOMR,2"MAIN STREET,HYANNIS,MA 0260I PIEASBNOTe 2)ApplicffiwfoauwSlte�mpasyingfarmttlhe snimsi0ed 6rc I d f App ti...tldingm 3nreMre arpertMucofbbe certified. �:".a',�"' liaerinn anee must 6etxsived hef M Wi ll il he issood. 3)7Tn:hoildmg off¢ial shelf be oolified vdthin Orn(i0)days ofarrydange in dm shave iofermidou ''4`'r-" d FOR OFFICE USE NLY CWrIPFCATB I - E)MM77ON DATE: al2DI 15. a;r. Town-of,Barnstable Regulatory Services MAX Thomas F Geiler,Director t03q.' Building Division. Tom Perry,'CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma: Office: 508-862-4038 Fax:508-790-6230 June 8, 2012 FELLOWSHIP HEALTH RESOURCES BOB WALKER HOUSE 55 JB DRIVE MARSTONS MILLS MA 02648 Attached you will find an application for a.Certificate of Inspection`as required by Section 110.7 of the Massachusetts State Building Code, Eighth Edition. Please complete the application and return to the Building Commissioner's Office with the required fee (amount as set on the top right-hand corner). The fee has been established by the State (Table 106), and amended by the Barnstable Town Council effective 08/06/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said,Certificate shall be kept posted as specified in Section 120.5 of the State Code. Sincerely, Ic�lm � Tom Perry . Building Commissioner Enclosure TOWN OF BARNSTABLE INSPECTION WORKSHEET Chose: CERTIFICATE NO: 201203654 CANCELLED: MAP:: 101 DBA: IBOB WALKER HOUSE PARCEL: 040 NAME/MANAGER: IFELLOWSHIP HEALTH RESOURCES STREET: 55 JB DRIVE VILLAGE: IMARSTONS MILLS STATE: MA ZIP: 02648- SEQ NO: 1❑ BUSINESS TYPE: GROUP RES CONSTRUCTION TYPE: STORY1: CAPACITY: USE1: R5 Capacity Under 50: STORY2: CAPACITY: USE2: STORY3: CAPACITY: USE3: Outside Seating: ❑ BY PLACE OF ASSEMBY OR STRUCTURE CAP1: 5 LOC1: RESIDENTS CAPS: LOC8: CAP2: LOC2: CAP9: LOC9: CAP3: LOC3: CAP10: LOC10: CAP4: LOC4: CAP 11: LOC11: CAPS: L005: CAP12: LOC12: CAPE: LOC6: CAP13: LOC13: CAPT. LOCI: CAP14: LOC14: INSPECTION: DATE ISSUED: EXPIRATION: C,..?rint-Tl'is,Screen� 0 ' 06/ 11 07/10/2012 07/10/2013 r� ,Print Certiflcate;of.lnspe6gon COMMENTS: k Town of Barnstable Regulatory Services R" Thomas F Geiler,Director Sol Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma. Office: 508-862-4038 Fax: 508-790-6230 June 7, 2013 FELLOWSHIP HEALTH RESOURCES BOB WALKER HOUSE 55 JB DRIVE MARSTONS MILLS MA 02648 Attached you will find an application for a Certificate of Inspection as required by Section 110.7 of the Massachusetts State Building Code, Eighth Edition. Please complete the application and return to the Building Commissioner's Office with the required fee (amount as set on the top right-hand corner). The fee has been established by the State (Table 106), and amended by the Barnstable Town'Council effective 08/06/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. 3 A copy of said Certificate shall be kept posted as specified in Section 120.5 of the State Code. Sincerely, Tom Perry Building Commissioner Enclosure ILI\ o ���ccYjuPrr� TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this CERTIFICATE OF INSPECTION is issued to FELLOWSHIP HEALTH RESOURCES r QCBrt[fp 'that I have inspected the premises known as: BOB WALKER HOUSE , located at 55 JB DRIVE in the Village of MARSTONS MILLS County-of Barnstable Commonwealth of Massachusetts. Construction Type: Use Group(s): RS The means of egress are sufficient for the following number of persons: Location Capacity Location, Capacity RESIDENTS 5 Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 201203654 7/10/2012 7/10/2013 10 - 040 The building official shall be notified within(10) days of any 4 changes in the above information. Building Official I . i PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 06/18/12 TIME: 12:51 -----------------TOTALS------" - -- --- 1+ PERMIT $ PAID 25.00 AMT TENDERED: 25.00 AMT APPLIED: 25.00 CHANGE: .00 APPLICATION NUMBER: 201203654 PAYMENT METH: CHECK PAYMENT REF: 18925345473 COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION Date 4t C� �- (X) Fee Required ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 106.5, I,hereby apply for Certificate of Inspection for the below-named premises located atthe following address: Street and Number: j Name of Premises: 1 W`�'�' S-Z. . Purpose for which premises is used: License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit A enc Certificate to be Issued to: 0ou -e Address: Telephone: O Owner of Record of Building: �e l.f®� S,Inn Q -�a, 1 ` S0 r,PG`� Address: V Z 'S !a c4s' A-If UtA Nct G."- �r,k e o (11 r Name of Present Holder of Certificate: 110�$" l ��.1 f� (zQ) Name of Agent, if any: . =` , fl SIGNATURE OF PER ON TO WHOM CERTIFICATE IS ISSUED OR AUTHORIZED AGENT -• �' Lam ^ 4s G141,h It, PLEASE PR T NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2) Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# ' EXPIRATION DATE: - 5 J026115a t F, The eommouwealtb of lHam4acbuatto TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this CERTIFICATE OF INSPECTION is issued to FELLOWSHIP HEALTH RESOURCES 3 QCertifp that I have inspected the premises known as: Y BOB WALKER HOUSE located at 55 JB DRIVE in the Village of MARSTONS MILLS County of Barnstable Commonwealth of Massachusetts: Construction Type: Use Group(s): R5 The means of egress are sufficient for the following number of persons: Location Capacity Location Capacity RESIDENTS 5 Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 201103082 7/10/2011 7/10/2012 101 0 0 The building,official shall be notified within(10) days of any changes in the above information- Building Official PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE 200LMAIN STREET HYANNIS, MA 02601 DATE: : 06/10/11 TIME: 12:52 -----------------TOTALS------------ �-- PERMIT $ PAID 25.00 \` f AMT TENDERED: 25.00 AMT APPLIED: 25.00 CHANGE: .00 I APPLICATION NUMBER: 201103082 PAYMENT METH: CHECK PAYMENT REF: 18925327056 I CI � � • COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION Date a 0 l� f (X) Fee Required$ 5 ( ) No Fee Required In accordance with the provisions of the Massachusetts State'Building Code, Section 106.5, I hereby apply for a Certificate'of Inspection for the below-named premises located at the following address: Street and Number: �I ���y e. Q, It , Name of Premises: owS�7o Vzu Purpose for which premises is used: Pc-5 License(s) or Permit(s)required for the premises by other governmental agencies: License or Permit A enc Certificate to be Issued to: �Cmfvs�.�}� f af'7"! V0"f,C.rl> Address:. p/ G-� /"lGAi��"—p A4i f Telephone: .� �2 O — 0 S�2- 7 Owner of Record of Building:. Us)ct 1 it -t Address: D �� /Y Ci e V�1�� Pl�¢V, f!l."Cdl f7( �' Name of Present Holder of Certificate: Name of Agent, if any: r r .•s C) uy p { -Fd q R. SIGNATURE OF PERSON TO WHOM CERTIFICATE' IS ISSUED OR AUTHORIZED AGENT - ;� rn PLEASE PRINT NAME INSTRUCTIONS: 1)Make check payable-'to: TOWN OF BARNSTABLE 2)`Return this application-with your check to: BUILDING COMMISSIONER,200 MAIN STREET, HYANNIS, MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will-be issued. 3)The building official shall be notified within ten(10)days of any change in the above information FOR OFFICE USE ONLY: CERTIFICATE # �Q V �� EXPIRATION DATE: 110 o]�D J020115a TOWN OF BARNSTABLE INSPECTION WORKSHEET dose: CERTIFICATE NO: 201103082 CANCELLED: 0 MAP: 101 DBA: IBOB WALKER HOUSE I PARCEL: 040 .'NAME/MANAGER: IFELLOWSHIP HEALTH RESOURCES STREET: 55 JB DRIVE VILLAGE: MARSTONS MILLS STATE: MA ZIP: 02648 SEQ NO: 1❑ BUSINESS TYPE: IGROUP RES CONSTRUCTION TYPE: STORYI: CAPACITY: USE1: R5 Capacity Under 50: El STORY2: CAPACITY: USE2: STORY3: CAPACITY: '' U$E3 Outside Seating:: . BY PLACE OF ASSEMBY OR STRUCTURE CAPl: 5 LOC1: RESIDENTS CAP8: LOC8: CAP2: LOC2: CAP9: LOC9: CAP3: LOC3: CAP10: LOC10: CAP4: LOC4: CAP11:, LOC11: CAPS: L005: CAP12: LOC12: CAP6: LOC6: CAP13: LOC13: CAP7 LOC7: CAP14: LOC14: -INSPECTION: DATEISSUED: EXPIRATION: PintThisSScreen o ' 'fl6/68h�948� 07/10/2011 07/10/2012 Pt Certify o��f,lnswi5e,aior� - 06 COMMENTS: - t ALN Ebe Commoubjea tb of S&55sacbussett.5. TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this CERTIFICATE OF INSPECTION is issued to _FELLOWSHIP HEALTH RESOURCES . �1. QLErttfp that 1 have inspected the premises known as BOB WALKER HOUSE located.at :55 JB. DRIVE in the Village of MARSTONS MILLS County of Barnstable Commonwealth of Massachusetts. Construction Type: Use Group(s): R5 The means of egress are sufficient for the following number of persons: Location Capacity- Location Capacity RESIDENTS 5 r : Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 201003206 7/10/2010 7/10/2011 040 The building official shall be notified within (10)days of any changes to the above information: Building Official f • PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT . 200 MAIN STREET HYANNIS, MA 02601 DATE: 06/28/10 TIME: 13:32 -----------------TOTALS----------------- PERMIT $ PAID 25.00 AMT TENDERED: 25.00 AMT APPLIED: 25.00 CHANGE: .00 APPLICATION NUMBER: 201003206 PAYMENT METH: CHECK PAYMENT REF: 17373982061 COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION Date &A1_)v ( X) Fee Required$ ( . ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 106.5, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: .417-157 S. 13• (�/`i v e �f a:014 fool; Name of Premises: R D 6 W d' �e o^ ffau5 t_. Purpose for which premises is used: License(s)or Permit(s) required for the premises by other governmental agencies: License or Permit Agency Ge "Rc v &C-C c a�+- -- I ( C a K —'�O' co w c�.--If !n.5 i e G eP —�lt�lt 4 v �Ro-O��. Certificate to be Issued to: �((p S� n 'f e,d I eS sic , c S Address: . V 3 e At 0-f f t-y Telephone: b `t Owner of Record of Building: � o La-f cI D cc.- C-1c S } Address: �� Gt.c�s �„Q 1/ct (( Yc,, e Name of Present Holder of Certificate: - . Name of Agent, if any: t� SIGNATURE OF RSON TO WHOM CERTIFICATE IS ISSUED OR AUTHORIZED AGENT PLEASE VRINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with your check to: BUILDING COMMISSIONER,.200 MAIN STREET, HYANNIS,MA 02601 PLEASE NOTE: ; 1)Application form with accompanying fee must be submitted for each building or-structure or.part thereof to-be certified.. . 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten'(10)days of any change in the above information. . FOR OFFICE USE ONLY: ` CERTIFICATE# 05 D�O � �.� EXPIRATION DATE: 7 C-7 J020115a f TOWN OF BARNSTABLE INSPECTION_WORKSHEETCtose CERTIFICATE NO: 201003206 CANCELLED: MAP: r 1 DBA: BOB WALKER HOUSE_ _' PARCEL:, 040 NAME/MANAGER: IFELLOWSHIP HEALTH RESOURCES STREET: 55 JB DRIVE T VILLAGE: IMARSTONS MILLS STATE: MA ZIP: 02648 SEQ NO: BUSINESS TYPE: GROUP RES " j•. CONSTRUCTION TYPE: C� STORY1: CAPACITY: r USE1: R5 Capacity Under 50' ❑ STORY2: �� CAPACITY: USE2: Outside Seating: STORY3: �_ CAPACITY: USE3: ❑ BY PLACE OF ASSEMBY OR STRUCTURE CAP2: �� LOC2: RESIDENTS CAPS:- LOC9: CAP3: LOC3: CAP10: LOC10: CAP4: LOC4: ' CAP11: LOC11: CAPS: L005: CAP12: LOC12: { CAP6: LOC6: CAP13: LOC13: ' CAP7: LOC7: CAP14: LOC14: INSPECTION: DATE ISSUED: EXPIRATION:: i � Pnnt This Screen 0� — --- -- -, L--1111 �1 07/10/2010 L 07 0 1 �* Print Certificate of Insf ection COMMENTS: -- I TOWN OF BARNSTABLE INSPECTION WORKSHEET closM CERTIFICATE NO: 1 200903477 CANCELLED: MAP: 101 DBA: IBOB WALKER HOUSE PARCEL: 040 NAME/MANAGER: IFELLOWSHIP HEALTH RESOURCES STREET: 55 JB DRIVE VILLAGE: IMARSTONS MILLS STATE: F MA ZIP: 02648- SEQ NO; BUSINESS TYPE: IGROUP RES CONSTRUCTION TYPE: STORY1: CAPACITY: USE1: R5 Capacity Under 60: r STORY2: CAPACITY: USE2: STORY3: CAPACITY: USE3: Outside Seating: .r BY PLACE OF ASSEMBY OR STRUCTURE CAP1: 5 LOC1: RESIDENTS CAPS: L005: CAP2: LOC2: CAP6: LOC6: CAP3: LOC3: CAP7: LOC7: CAP4: LOC4: CAPS: LOC8: INSPECTION: DATE ISSUED: EXPIRATION: ., `"PrintTtiis;;Sc ee 07/10/2009 07/10/2010 �r�nt�ertifie�Ce bf Inspecti �' COMMENTS: Ebe CommonwpaYtb of Aaq;.5aCbU5ett.5 TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this CERTIFICATE. OF INSPECTION is issued to FELLOWSHIP HEALTH RESOURCES 1 Certifp that 1 have inspected the premises known as: BOB WALKER HOUSE located at 55 JB DRIVE in the Village of MARSTONS MILLS County of Barnstable Commonwealth of Massachusetts. y Construction Type: Use Group(s): RS The means of egress are sufficient for the following number ofpersons.: Location Capacity Location Capacity 'RESIDENTS 5 Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 200903477 7/10/2009 7/10/2010 040 The building official shall be notified within(10) days of any changes in the above information. Building Official PERMIT PAYMENT RECEIPT ` TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 07/27/09 TIME: 15:02 -----------------TOTALS----------------- PERMIT $ PAID 25.00 AMT TENDERED: 25.00 AMT APPLIED: 25.00 CHANGE: .00 APPLICATION NUMBER: PAYMENT METH: OTHER PAYMENT REF: COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION Date bCv c� (X) Fee Required $ ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 106.5, I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: u Name of Premises: Purpose for which premises is used: License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency Certificate to be Issued to: T Ile Sh ice_ /�'� Address: 67 13 / lk ti V c- ► 4 e S 4o Telephone: s 0 Owner of Record of Building: Q rqv i'//til Address: P6,ce- .cTeD ('h CC) /? L / T Name of Present Holder of Certificate: P PS d u-#-tt Name of Agent, if any: A SIGNATURE OF PERSO TO WHOM CERTIFICATE ' IS ISSUED OR AUTHORIZED AGENT Li Sex, e% PLEASE PRIN NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET, HYANNIS,MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE EXPIRATION DATE: J020115a f Town of Barnstable Regulatory Services MklifttAt4i� Thomas F Geiler,Director ifA4� a Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barn stable.ma. Office: 508-862-4038 Fax: 508-790-6230 June 8, 2009 FELLOWSHIP HEALTH RESOURCES BOB WALKER HOUSE 55 JB DRIVE MARSTONS MILLS MA 02648 Attached you will find an application for a Certificate of Inspection as required by Section 106.5 of the Massachusetts State Building Code, Seventh Edition. Please complete the application and return to the Building Commissioner's Office with the required fee (amount as set on the top right-hand corner). The fee has been established by the State(Table 106)., and amended by the Barnstable Town Council effective 08/06/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5 of the State Code. Sincerely, Tom Perry Building Commissioner Enclosure TOWN OF BARNSTABLE INSPECTION WORKSHEETC�os , CERTIFICATE NO: 200806303 CANCELLED: MAP: 101 DBA: IBOB WALKER HOUSE I PARCEL: 040 NAME/MANAGER: IFELLOWSHIP HEALTH RESOURCES ` STREET: 55 JB DRIVE VILLAGE: MARSTONS MILLS STATE: MA ZIP: 02648 SEQ NO: 1❑ BUSINESS TYPE: GROUP RES CONSTRUCTION TYPE: STORYI: CAPACITY: USE1: R5 Capacity Under 50: ri STORY2: CAPACITY: USE2: STORY3: CAPACITY: USE3: Outside Seating: BY PLACE OF ASSEMBY OR STRUCTURE CAP1: 5 LOC1: RESIDENTS CAPS: L005: CAP2: LOC2: CAPE: LOC6: CAP3: LOC3: CAP7: LOCI: CAP4: LOC4: CAPS: LOC8: P<�int ThisrScree%j INSPECTION: DATE ISSUED: EXPIRATION: ttt tr71 07/10/20081 07/10/2009 t-Certificate of Inspect n COMMENTS: Zbe commoubjealtb f J&5.5arfju ett TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this CERTIFICATE OF INSPECTION is issued,to FELLOWSHiP,HEALTH RESOURCES I QCertlfp that I have inspected the premises known as: BOB WALKER HOUSE located at 55 JB DRIVE in the Village.of MARSTONS MILLS County of Barnstable •Commonwealth of Massachusetts. Construction Type: Use Group(s): RS The means of egress are suff cient for the following number of persons: Location Capacity Location Capacity RESIDENTS 5 Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 200806303 7/10/2008 7/10/2009 101 040 The building official shall be notified within (10) days of any changes in the above information. --✓ — -- Building Offic'al _ r PERMIT PAYMEN1 RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS,: MA 02601 DATE: 11/10/08 TIME: 10:48 ------------- TOTALS=-k-------------- , PERMIT $ PAID 25.b0 ° !' AMT TENDERED: 25.00 , t, AMT APPLIED: 25.00 CHANGE: .00 APPLICATION NUMBER: 200806303 a PAYMENT METH: CASH `, PAYMENT REF: , :! +6 a i COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION Date 1 ad d'y (X) Fee Required$ 2,-5 ©!7 No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section_ 106.5,I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: �� V Name of Premises: i Purpose for which premises is used: License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit Agency ,. Certificate to be Issued to: Address: Telephone: Owner of Record of Building: Address: a Name of Present Holder of Certific Name of Agent, if any: SI RE ERSON TO WHO C IFICATE IS ISSUED O UTHORIZED AGENT 12 PLEASE PRINT NAME INSTRUCTIONS; 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The,building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# gZ ?;o EXPIRATION DATE: /`V L 7" J020115a C I �t Town of Barnstable Regulatory Services * anxxsrnsre, ,�AM Thomas F. Geiler, Director i639' ♦0 ArEo3,�a 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 October 30, 2008 Fellowship Health Resources Bob Walker House 55 JB Drive Marstons Mills, MA 02648 Re: Certificate of Inspection Attached you will find applications for Certificates of Inspection as required by Section 106.5 of the Massachusetts State Building Code, Sixth Edition. Please complete the applications and return to the Building Commissioner's Office with the required fee (amount as set on the top right-hand corner). The fee has been established by the Massachusetts State Building Code (Table 106), and amended by the Barnstable Town Council effective 8/6/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5.2 of the State Code. Sincerely, Thomas Perry Building Commissioner Enclosure . jcoilet TOWN OF BARNSTABLE INSPECTION WORKSHEET cCos CERTIFICATE NO: 200704235 _ CANCELLED: MAP: 101 DBA: IBOB WALKER HOUSE I PARCEL: 040 NAME/MANAGER: IFELLOWSHIP HEALTH RESOURCES STREET: 155 JB DRIVE VILLAGE: IMARSTONS MILLS STATE: MA ZIP: 02648 SEQ NO: BUSINESS TYPE: GROUP RES CONSTRUCTION TYPE: STORY1: CAPACITY: USE1: R5 Capacity Under 50: fi STORY2: CAPACITY: USE2: STORY3: CAPACITY: USE3: Outside Seating: . BY PLACE OF ASSEMBY OR STRUCTURE CAP1: 5 LOC1: RESIDENTS CAPS: L005: CAP2: LOC2: CAPE: LOC6: CAP3: LOC3: CAP7: LOCI: CAP4: LOC4: CAPS: LOC8: INSPECTION: DATE ISSUED: EXPIRATION: m`. Print,Th Screen 07/10/2007. 07/10/,7�008 `Z'dt'C.ertificate of Inspection~ COMMENTS: SENT COI LETTER 6/20/07, MOVED FROM 50 BENT TREE RD CommconWealtb of 41a.5.5arbu.5ett.5 TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this. CERTIFICATE OF INSPECTION is issued to FELLOWSHIP HEALTH RESOURCES �! Q�ertifp that I have inspected the premises known as: BOB WALKER HOUSE located at 55 JB DRIVE in the Village of MARSTONS MILLS County of Barnstable Commonwealth of Massachusetts. Construction Type: Use Group(s): R5 The means of egress are suff cient for the following number of persons: Location Capacity Location Capacity RESIDENTS 5 Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 200704235 7/10/2007 7/10/;.008 101 040 The building official shall be notified within(10) days of any changes in the above information. Building Official Ma rr Y r (. mom11 NAfMtkI hn 1 ii TOWN OF BARNSTABl BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02bU I DATE: 07/10/07 11ME: 14:08 - -- KAI 5 PERM T T $ PAIL; 0 00 AMT APPL11-1j: 2�j 00 CHANGE: 1110 APPLTCA 1 TON NUMF{E R. -10071.)1 13S PAYMENT METH: CHECK PAYMENT REF; 8471G19E? COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION Date 1 0 (X) Fee Required$ ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 106.5,I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: Name of Premises: C2 Purpose for which premises is used: I License(s)or Permit(s)required for the premises by other governmental agencies: --- — - License or Permit A en Certificate to be Issued to: ,� /42 A&IM &=WY )U UkxQ� A&V if Address: ,� d✓!(/ Telephone: -L0 Ada Owner of Record of Building: Address: (� 1 Name of Present Holder of Certificate: /626W> Name of Agent,if any: 411 S. OF PERSON TO WHOM CERTIFICATE IS ISSUED AUTHORIZE AGENT 146i.Ary Yoona. PL ASE PkINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 02601 PLEASE NOTE: IQIS� tt� 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building of cial shall be notified within ten(10)qeysajf y c8aFgeN he above information. FOR OFFICE USE ONLY: CERTIFICATE# EXPIRATION DATE: J020115a o C V-V), i f � 6/13/07 Tom, Oceanside, the limited group home that was at 50 Bent Tree Drive, Centerville, has moved. It is now called the Bob Walker House, 55 JB Drive, Marstons Mills. It is a group home for 5 residents, adults with mental illness. It is run by Fellowship Health Resources as was Oceanside and is licensed by the Department of Mental Health. I called Dept. of Mental Health to confirm that Bob Walker House is licensed and they no longer have a home at 50 Bent Tree Drive. I also reviewed their list of group homes, and we have COIs for the others: Larry Doughty House, 78 Pleasant Street, Hyannis Sea Winds, 47 Cedar Street, Hyannis c1 o 0K) Do group homes need any permission from Site Plan or special Certificate of Occupancy before opening? Would Bob Walker House be classified as a limited group home, R5 us�-ea p? For more information on Bob Walker House, we can call Sara Miller, 508 420 0527. I've attached a new COI letter. If okay, please sign and return to me. Lois grouphomes �FSHE r Town of Barnstable Regulatory Services r * ` * BARNSfABLE, .� tHAss. g Thomas F. Geiler, Director . �A .s6;9 ,0 tf1639 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 June 12, 2007 Sara Miller Fellowship Health Resources 55 JB Drive Marstons Mills, MA 02648 Re: Certificate of Inspection Bob Walker House Dear Ms. Miller: _ Attached you will find an application for a Certificate of Inspection as required by Section 106.5 of the Massachusetts State Building Code, Sixth Edition. Please complete the application and return to the Building Commissioner's Office with the required fee (amount as set on the top right-hand corner). The fee has been established by the Massachusetts State Building Code,(Table 106), and amended by the Barnstable Town Council effective 8/6/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5.2 of the State Code. Sincerely, Thomas Perry Building Commissioner Enclosure jcoilet COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION Date (X) Fee Required$ Z L ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 106.5,I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: Name of Premises: Purpose for which premises is used: License(s)or Permit(s)required for the premises by other governmental agencies: License or Permit A enc Certificate to be Issued to: Address: Telephone: Owner of Record of Building: Address: Name of Present Holder of Certificate: Name of Agent, if any: SIGNATURE OF PERSON TO WHOM CERTIFICATE IS ISSUED OR AUTHORIZED AGENT PLEASE PRINT NAME - INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with your check to: BUILDING COMMISSIONER,200 MAIN STREET,HYANNIS,MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# EXPIRATION DATE: J020115a 7 Airbill: 16299831553 Page 1 of 1 Waybill#: 16299831553 Origin: N ES Date Printed:5/24/2006 Webship API 02.00 (01/2004) To: Service: Robert McKech n ie 200 Main Street Hyannis, MA 02601 UNITED STATES Special Service: Attention To: Robert McKechnie Phone#: 617. Route:628-5700 B gC K gR NE H Ud From: Description: MOSTUE&ASSOCIATES Weight (Ibs.): Letter Dims:O X 0 X 0 www.dhl.com 240 A ELM STREET Pieces: 1 of 1 SOMERVILLE, MA 02144 Bill Shipment To:Sender UNITED STATES Ship Ref: 26024.0 Sent By: M.A.Trulli Phone#: 617-628-5700 wvvw.wwexship.com - -- - - --- - - - - Please fold or cut in half DO NOT PHOTOCOPY Using a photocopy could delay the delivery of your package and will result in additional shipping charge Create..New.Shi.pment View_P..end.i_n.g._Shpments DHL Signature (optional) Route Date Time y For Tracking, please go to www:dhl-usa.com or call 1-800-CALL-DHL d h Thank you for shipping with DHL Worldwide Express e https://www.wwexship.com/wwxchange/Label?id=16299831553 5/24/2006 --- lN�o�ec�yi F�-��o�✓ � � ��-c1Cc�' Co�u/tip ��o�n t�G Lo cc�s�f�P ���� I i I. J i ,,,.Barnstable Assessing Search Ruts Page 1 of 2 rse��srzss. �}33. ��GB•Blii b". � �f Home: Departments:Assessors Division: Property Assessment Search Results New Search 55 J . B. DRIVE Owner: 2006 Assessed Values: HANNON, MARTIN E&PATRICIA Appraised Value Assessed Value Map/Parcel/Parcel Extension Building Value: $231,900 $231,900 101 /040/ Extra Features: $2,600 $2,600 Outbuildings: $ 1,100 $ 1,100 Mailing Address Land Value: $ 163,400 $ 163,400 HANNON, MARTIN E&PATRICIA Totals $399,000 $399,000 55 J B DRIVE MARSTONS MILLS, MA.02648 2006 REAL ESTATE Tax Information: Tax Rates: (per$1,000 of valuation) Community Preservation Act Tax $56.58 Fire District Rates Town Barnstable-Residential $1.90 $6.31 Barnstable-Commercial $2.51 Commei C.O.M.M. FD Tax(Residential) $422.94 C.O.M.M.-All Classes $1.06 $6.54 Cotuit FD-All Classes $1.33 Personz Town Tax(Residential) $ 1,886.06 Hyannis-Residential $1.61 $6.49 Hyannis-Commercial $2.50 Other R; W Barnstable-Residential $1.60 Commur ` W Barnstable-Commercial $2.46 Total: $2,365.58 Construction Details Building Property sketch Legend Building value $231,900 Interior Floors Carpet Style Colonial Interior Walls Drywall Model Residential 'Heat Fuel Oil Grade Average Plus Heat Type Hot Water Stories 2 Stories AC Type None Exterior Walls Wood Shingle Bedrooms 4 Bedrooms Roof Structure Gable/Hip Bathrooms 2 Full http://www.town.bamstable.ma.us/assessing/assess06/displayparce106.asp?mapparback=pa... 5/15/2006 r Barnstable Assessing Search Re.,'its Page 2 of 2 Roof Cover Asph/F GIs/Cmp living area 2560 Replacement Cost $266558 Year Built 1977 i', Depreciation 13 Total Rooms 8 Rooms ' " fi Land � a Lot Size(Acres) 0.55 � Appraised Value $ 163,400 Sri ' � n rA x Assessed Value $ 163,400 Interactive Property Map: Map requires Plug in: I have visited the maps before ,r Show Me The Map r t 1 (X7 April 2001 photos available - Sales History: Owner: Sale Date Book/Page: Sale Price: HANNON, MARTIN E& PATRICIA Sep 15 1989 12:OOAM 6882/200 $ 157,500 SCHOONMAKER,JONATHAN W& Apr 15 1987 12:OOAM 5685/070 $ 1 SCHOONMAKER, KATHLEEN F Jun 15 1986 12:OOAM 5126/061 $ 1 WHITMAN,CHRISTOPHER ETAL 2688/66 $0 Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value SHED Shed 140 $ 1,100 $ 1,100 FPL3 Fireplace 1 $2,600 $2,600 Property Sketch Legend BAS First Floor, Living Area FST Utility Area(Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area UST Utility Area (Unfinished) (Finished) FAT Attic Area (Finished) GAR Garage UTQ Three Quarters Story (Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS FUII Upper 2nd Story (Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) http://www.town.bamstable.ma.us/assessing/assessQ6/displayparce106.asp?mapparback=pa... 5/15/2006 i r rop101026 #37 101094 l 1#111 101064 #36 a G yr X . e #25 k �I e x 101025 4 101042 > #23 #20 rt s b t 101095 r jA � F1re�, '�� r, rEi n#4a' a1{r TO, � ol - it 1D1033 #39 1 sY c #27 101043 i 101023 O #3 ,` i — a> �� 10#109 606 101034 #138 �5 �����m i 10#068 d51 � A 101010 v 101044 9 �Qj• #46 " 101067 t >, 101035 2 � #85 g ° #124 ,f 101'040 r 3 101008" ^/ ° CONAUME #700 101038 101045 101069 58' #16 .�. 101068 Jlij #85 f r s $ f� 101100 101039 _ b #69 Q g t �, A' '� }} #5 .1#8887 > �101-036 _ �".,� t 'f r�;_ f r `2 �s d �(NQ�� 3 #114 s �a a"E 1 101046 LwO�p r .. LA Ott A 4„`.wt a ' ,�` r. ,. ° ;,," ;' r';�""�4',t. ".�*x, .. t,'• �,� d�' s ry. a�; 101070 10103� d' 1;' s m" rx #13 a, 101.071 101101" #104 #100 a 1 101048003 01047+ #.223 #92 2 _ 5 p• S •: ,101102�zf 1#_O6Sw.W.�n�n� #112,' # I 240A Elm Street Somerville, MA 02144 Tel: 617-628-5700 Fax: 617-628-1717 www.mostue.com M O S T U E & ASSOCIATES Brooks A. Mostue,AIA Clifford J. Boehmer, AIA Ross A. Speer, AIA Z Iric L. Rex, AIA �i U w t— TRANSMITTAL. DATE: May 24, 2006 FROM: Ingrid Nunez TO: Robert McKechnie FAX No.: 200 Main Street Hyannis, MA 02601 CC: RE: Pricing Set PAGES: PROJECT: 55 JB Drive PROJECT No.: 26024.00 QTY. DESCRIPTION DATED 1 Hello Bob, (1 1x17) Please find attached updated drawing set for 55 JB Drive, for your 5.18.06 review. US Mail X Overnight _ Picked up _ Fax Courier Hand delivered E-mail As requested X For your use For review and comment Town of Barnstable Perrrut 49 Expires 6 non s from issue date o a 18d1SMV8 JO NMOlRegulatory Services Fee t� 90oz Z._ gnd Thomas F.Geiler,Director J®r Building Division JUK83d SS34doXCPerry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint i Map/parcel Number t 01 0 -' O(''� 470 C Property Address ���� �1 �� �LJ A?� /Ls— [ Residential Value of Wo43,d 0^ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address e4,LCVZtV, 000 LTH PC50c:4t eSS — 2c5," ,644eX1bt-;L- CIA111EV RLc Contractor's Name 4� �°1�Z� 1 Telephone Number` 17— `C�� dJ Home Improvement Contractor License#(if applicable) /54?o o 3 Construction Supervisor's License#(if applicable) �� 0 N0 u I. -Qand Standards ❑Workman s Compensation Insurance ✓� g�tding ops . Check one: Board oT T CONTRACTOR I am a sole proprietor HOME 1MPRpVEMEt4 ❑ I am the Homeowner Registratio�52083 ' log I have Worker's Compensation Insurance Exfa tron, $12008 we ttidual Insurance Company Name 6V AXrrf L�_ S� L js - a� ,,� �OSEPH MILLER z"=� r' Workman s Co Policy# Z� — t EpH MILLER t =_ 0 r Ad,uinistrato cos ` .. Copy of Insurance Compliance Certificate must be on file. 26 pOppLEBOTTOIJ ,'' Deputy SANDWICH,PiIA o2563 Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taki n=to te — A-Lu STAP C_ e-roof(not stripping. Going over existing layers of roof) ❑ Re-side ' ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 rs 4`1 1ne L ommonweairn of Ivlussuc nuse,,,Y Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors!Electricians/Pluammbers Applicant Information Please Print Legibly Name (Business/organization/Individual): Address: Z& � t — V tzo ZIL-M-, City/State/Zip:5 T7&1° A 4 ®7-Sb3 Phone#: 617 Rod& .s�6c- e�L Are you an employer? Check the-appropriate box: Type of project(required): 1.❑ I am a employer with 4• ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* have hired the sub-contractors 2.Q I am a sale proprietor or partner- listed on the attached sheet $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for mein any capacity. workers' comp.insurance. g. ❑ Building addition [No workers' comp. insurance 5• ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] I officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself: (No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information: t Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such iContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp•policy inforanation. I am an employer that is providing workers'compensation Insurance for my employees. Below is the policy andiab site information. Insurance Company Name: 64�N XtL- err. ZiEe� Policy#or Self-ins.Lic. #: W C Expiration Date: F-`t-0 6 . Job Site Address:S1,` U/.1 ®Cd A/P_ City/State/Zip;l W?� ,,/s tells Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead.to the imposition of criminal penalties of a fine up to$1,500;00 and/or one-year imprisonment, as well as.civil penalties in the form of a STOP WORK ORDER and'a fine of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature:/, IA— Date: Phone#: n 6/7 5�,Za 57-66 Cet- 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 laspector 6. Other Contact Person: Phone#: Information and. Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal.entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the .dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the Issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the.Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in . (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bias leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: f The Commonwealth o Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tei. #617-727-4900 ext 406 or 1-1077-MASSAFE rax # 617-727-7749 Revised 5-26-05 wwtiv.m2ss.crovlain Aq Town of Barnstable Regulatory Services YIAM v +$ Thomas F.Geiler,Director ' `��,Eo ,�►�� Building Division. Tom Perry, Building Commissioner 200 Main Street, 1Jyaffiis,MA b2601 www.town.b arnstable.ma.us )ffice: 508-862-403 8 Fax: 508-790-6230 f Property Owner Must Complete and Sign This Scction. -If Using ABuilder I, eS. ,as.Owner of the subject property hereby authorize j� � � _//Y to act on my behalf, M all matters relative to work authorized by this binding permit application for. , OQ (Addrefs of Job) ' eo Own D e r— Print Name Q:FORMS:ovr9MEXML4s10N y. t f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION y ' Map n Parcel Lt 10Application# Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee ! 0 Planning Dept. Permit Feed Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis l� Project Street Address �� �► . Mwer Village Owner �� � � 1{�D Address � �-f PLe Q Telephone q01 -333 �W Permit Request RETW00 E-IL — a xrsi,( q W614 l\L boo" Square feet: 1st floor:existing proposed 2nd floor:existing proposed Total new Zoning District U. Flood Plain Groundwater Overlay Project Valuatict Construction Type Lot Size *23 ''20 E,17. Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes -4.410 On Old King's Highway: ❑Yes 9�No Basement Type: 4Full ' rawl ❑Walkout ❑Other �y 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 VOil ❑Electric ❑Other Central Air: ❑Yes 1�t-No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No 'Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use `( Proposed Use BUILDER INFORMATION �-Q$,-qZ®-T,,,,QQ Name 'Jog Telephone Number 6/7 'BZV SZ&G C2 LC- Address 26 0006«D')f fWK License# Cz Q 7`1 IV SAIjow-pckc l - 02556L3 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO tM lam- SIGNATURE 14MU, DATE x FOR OFFICIAL USE ONLY 4 PERMIT NO. ` Y ' DATE ISSUED MAP/PARCEL NO. L - ADDRESS VILLAGE OWNER ' DATE OF INSPECTION::,' FOUNDATION FRAME C R/ � OILS INSULATION (� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH // �/� FINAL FINAL BUILDING`()�' I0 03 ob I/y DATE CLOSED OUT ASSOCIATION PLAN NO. °FIME t° Town of Barnstable ti r Regulatory Services vMASS. Thomas F.Geiler,Director �p i639• Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-62301 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ff�� Type of Work: 1��0t0k;0,_. Estimated Cost I30—00 0 Address of Work: s-S On-*`�V.' , Owner's Name: Fo-Low Sam N dq-L 1�1 ee-so 0(k-c fs Date of Application: /Z 6(6 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as agent of the owner: Date Contractor Signature Registration No. OR Date Owner's Signature Q:wpfiles.forms:homeaffidav Rev: 060606 i The Commonwealth of Massachusetts Ln Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 If www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): Address: 916 A lle�mo-t V. City/State/Zip: u®u c�rl. ,t-c^4, 02513 Phone#: 5?"g Me &-qq f- — 6 t 1 �2 2 SL 6 G Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.XI am a sole proprietor or partner- listed on the attached sheet.# remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required.] 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ 6MVVt-L' sr*-k Policy#or Self-ins.Lic.#:Luc yy7g "G-/ 'O q Expiration Date: 'Y Job Site Address:Jr- �1 P 4,VVC/L- City/State/Zip/WSMJ ELLS 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby rtify under the pains and penalties ojperjury that the information provided above is true and correct Si ature: Date: Phone#: G f 7- �8, 5 z66 S-6$--C(2-0-- W ?(- 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#: r 08-14-06 03:34pm From-AIC +973 331 8509 T-488 P.001/002 F-526 PRODUCER �� I THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Rogers&Gray Ins Agency Inc PO Box HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR South Dennis,i MA 02660 ALTER THE COVERAGE AFFORDED BY THE POLICIES,BELOW INSURED COMPANY A GRAN EIS7SATE INSURANCE COMPANY Joseph Miller 26 Popple Bottom Rd Sandwich, MA 02563, ••,GO, .E ` 1Ca � � I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE OR t'14 THE POLICY PERIOD INDICATED,NOT WITHSTANDING 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 THE POLICIES DESCRIBED HEREIN is SUBJECT TO ALL THE TERMS,EXCLUSIONS-AND CONDITIONS OF SLICH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, Co LTR Tree OF INSURANCE POLICY NUMBER POLICY EFFP.CTIVE BATE POL{ttir r=xplRATtoM DATE A ORKCRS COMP TION — NO EMPLOYERS'LIABILITY Jig PROPRIETORI + LIMIT'S' ARTNEWEXECUTIYE „y v OFFICERS ARC: INCL❑ExGL O 4390306 8/04/2406 STATUTORYLIMITs OTHER 8104/200T COmage Applloa Io MA Cparavans Only. EACH ACCIDENT $ 10010 DISEASE POLICY LIMIT $ 500,000, ESCRIPTION OF OI'ERAI'uNSNEHICLE9/8pECIAL ITEMS Dlseass-EACH E LOYEE 1 pp Opp CEITIFICATE HOLDER CANCELLATION TDWN 0�BARNSTABLE SHOULD AAIr OF THE ABOVE D3GR16ED POLICIES BE CANCELLED BEFORE THE BUILDING EXPIFATION oATE THERaCIF,THE MUING COMPANY WILL ENDEAVOR TO MAIL IQ 20O MAIN ST DAYS WRITTEN NOTICE TO THECERTIFICA7E HOLDER NAMED TO THE LEFT.BUT HYAN NIS,MA 02801 FAILURE TO MAIL SUCH NOTICE SMALL IMPOSE NO OBLIGATION OR LiABIItTY OF ANY KIND UPON We COMPANY,ITS A®ENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE I ISSUED BY THE STOCK INSURANCE COMPANY HEREIN CALLED THE COMPAIM rMerd.111i'm WITSM. ff�� GRANIT€ STATE INSURANCE COMPANY 75339-0000 WC 278-51-04 02 ------------------------------------------- 131 -- -' 013-66-0805-00 . . . PENNSYLVANIA PM N 151111Mr rr• r • • JOSEPH MILLER Member Companies of 26 POPPLE BOTTOM ROAD SANDWICH, MA 02563-0000 American International Group EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK, N.Y. 10270 SEE NAME AND ADDRESS SCHEDULE - WC990610 I.D# .. ..- ROGERS b GRAY INS AGCY INC WORKERS COMPENSATION AND EMPLOYERS PO BOX 1601 LIABILITY POLICY INFORMATION PAGE SOUTH DENNIS, MA 02660-1601 INSURED IS PREVIOUS POLICY NUMBER INDIVIDUAL I NEW OTHER WORKPLACES NOT SHOWN ABOVE:SEE NAME AND ADDRESS SCHEDULE - 0 10 ITEM 2 POLICY PERIOD 12:01 A.M.standard time at the Insured's mailing address FROM 08/04/05 To 08/04/06 ITEM 3 A. Workers Compensation Insurance: Part One of the policy applies to the Wo rs Compensation Law of a states listed here: MA B. Employers Liability Insurance: Part two of the policy applies to the work in each state listed in item 3.A. The limits of our liability undar,Part,;Two are: Bodily Injury by Accident$ 100,000 each accident ` Bodily Injury by Disease $ 600,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: SEE ENDORSEMENT - WC200306A ITEM a The premium for this policy will.be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Estimated Total Rate Per Estimated Classifications Cod n 100 OF_Re- Premium I r,Yia/ Imuneration [X]Annual ❑3 Year SEE EXTENSION OF INFORMATION PAGE - WC7754 q7, 1 2 2. 2005 TAXES/ASSESSMENTS/SURCHARGES $10 F GRAY 1N AGEN � EXPENSE CONSTANT(EXCEPT WHERE APPLICABLE BY STATE) $264 MA MINIMUM PREMIUM $500 MA TOTAL ESTIMATED PREMIUM $500 If indicated below,interim adjustments of premium shall be made: 11 Semi-Annually ❑ Quarterly Monthly DEPOSIT PREMIUM ENDORSEMENTS(FORM NUMBER) SEE ATTACHED FORM SCHEDULE - WC990612 09/14/05 ASSIGNED RISK 66 Issue Date Issuing Office Authorized Representative we 00 00 01 32967 FORMS SCHEDULE P61icy Number: WC 278-51-04 Effective Date: 08/04/2005 WC000112 NOTIF ENDT OF PEND LAW CHANGE TO TRIA 02 WC000414 NOTIFICATION OF CHANGE IN OWNERSHIP ENDT WCOFAC NOTICE REG OFFICE OF FOREIGN ASSET CTRL WC58509A WC - PREMIUM CREDIT APPLICATION 78052B PRIVACY POLICY WC000420 TERRORISM RISK INSURANCE ACT ENDORSEMENT WC200301 MA LIMITS OF LIABILITY ENDORSEMENT WC200302 MA ASSESSMENT CHARGE WC200303B MA NOTICE TO POLICYHOLDER ENDORSEMENT WC200306A MA LIMITED OTHER STATES INS WC200307 MA ASSIGNED RISK POOL ELIGIBILITY ENDT WC200403 MA CONSTRUCTION CLASS PREMIUM ADJUSTMENT WC200601 MA CANCELLATION ENDORSEMENT WC200604 MA POLICY DEFINITION ENDT. WC992002 MASSACHUSETTS PREMIUM DUE DATE ENDT. WC990610 NAMED INSUREDS/ADDRESSES WC990612 (Ed. 1/97) Page 1 Of 1 STANDARD WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY EXTENSION FORM WC 278-51-04 MASSACHUSETTS Policy Prefix & No. Schedule INTRA/Independent State Risk ID 013-66-0805-00 JOSEPH MILLER Item 4. Classification of Operations Premium Basis R t Entries in this Item,except as specifically provided elsewhere in this policy, Code Estimated Total Per$100 of Estimated do not modify any of the other provisions of this policy. No. Annual Remuneration Remuneration Annual Premiums RATING GROUP: 0001-01 CARPENTRY NOC 5403 1 ,00C 16.09 161 CARPENTRY - DETACHED ONE OR TWO FAMILY 5645 IF AN 9.93 DWELLINGS CARPENTRY - DWELLINGS - THREE STORIES 5651 IF AN 9.93 OR LESS STATE OF MASSACHUSETTS TOTALS TOTAL CLASSIFICATION PREMIUM 161 TOTAL UNMODIFIED PREMIUM 161 MODIFIED STANDARD PREMIUM 161 LOSS CONSTANT. 0032 50 POLICY MINIMUM DIFFERENCE 0990 25 UNDISCOUNTED PREMIUM 236 DISCOUNTED PREMIUM 236 EXPENSE CONSTANT 0900 264 TERRORISM RISK INS ACT 2002 0-03 9740 0 TOTAL ESTIMATED PREMIUM 500 MACHWC (SURCHARGE) 4.404 9690 10 TOTAL DUE 510 WC 7754 (Ed. 4-81) See Name and Address Schedule - WC990610 I PAGE 1 ENDORSEMENT This endorsement, effective 12:01 AM 08/04/2005 Forms a part of policy no.:.WC 278-51-04 Issued to: JOSEPH MILLER By: GRANITE STATE INSURANCE COMPANY LOC NO. NAME AND ADDRESS SCHEDULE FEIN UI # 0001 JOSEPH MILLER 025501875 2 POPPLE BOTTOM ROAD SANDWICH, MA 02563-0000 Issue Date: 09/14/05 Authorized Representative WC990610(Ed.1-97) Town of Barnstable Regulatory Services Thomas F.Geller,Director ' Building Division. Tom Perry, Building Commissioner 200 Main Street, $yamis,MA b2601 www.town.b arnstab l e•m a.us ffice: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Scction., 'If Using A Builder I ` ,as,Owner of the subject property hereby authorize 0� AJ�z /j,� to act on m7 behalf, in all matters relative to work authorized by this building permit application for, (Ad s of Job) eo Dae ' 4PrintN2ine ' Q:FOgMS:OyTNERPERMISSIDN ' Board of B uil`di ��R QQ , Standardu HOMEIMPROVEMENT CON T Registratt n; TRACTOR I 52 /2008 al JOSEPH MILLER JOSEPH MILLER ' p - 26 POPPLEBOTTO SANDWICH, MA 02563 Deputy Administrator •., .. '--_ �===woe :;.. -_ ._ I °f EOARp QF BUILQING REGULgTIpLS ` LlcQnsQ ONSTRUCTION SUPERVI$:QR �I Numb ,C 9074 -57 r -:06 j � Tr.no: 2763.0 5 JOSOPi- E L 26 P( PPLE tQ v S`ANipWI,GFi, `MA Commissioner 7. I • 7 f