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0110 ANNABLE POINT ROAD
//O fJNrv>7-6tg +°r mil• UPC 12143 No•3L N ec000l'ar Osre HASTINOS,UN YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L..-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town,Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the:Business Certificate that is t required by law. DATE: 1 ': l� Fill in R lease: APPLICANT'S YOUR NAME/S: BUSINESS YOLIRHOMEADDRESS: HO P-N N I�OI TELEPHONE # Home Telephone Number. NAME OF CORPORATION: —Qy--3 NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES O_c I ADDRESS OF BUSINES Of � MAP PARCEL NUMBER � (Assessing) CAA-fesu\l -rr- 0 Zb When starting a new business there are several things you must`do in order to be in.compliance with the rules and'regulations of the Town of Barnstable. This form is intended to assist you in:obtaining.the information you may need. You MUST GO TO 20D Main St: - (corner of Yarmouth Rd. &Main Street) to make sure you have,the appropriate permits and licenses required to legally operate your business in this town. 1 BUILDING COMMISSIONER'S OFFICE`'' A This individual has been informed of any permit requirements that pertain to this type of business. Authorized Signature COMMENTS: 2. BOARD OF HEALTH This individual has been informed ofthe permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business.` Authorized Signature* COMMENTS: NOT FOR PUBLIC VIEW r PARKING SPACE LICENSE AGREEMENT THIS PARKING SPACE LICENSE AGREEMENT(the"License").is made::by and between Licensor and Licensee (each as identified below)as of the later of the two dates-indicated on.the signature page. RECITALS: A. Licensor owns a parking lot("Parking Lot');.the purpose of which is to.accommodate:patrons„tenants;employees and other invitees visiting the Shopping Center(as defined below).. B. Licensee desires to license space for the parking of.`motor vehicles("Vehicles") in the Parking Lot for a purpose other than to visit the Shopping Center. C. Licensor is willing to permit such use of its Parking Lot upon the terms and.conditions;setforth herein.. NOW, THEREFORE, in consideration of the foregoing premises and, the rents, covenants and agreements hereinafter se t t forth,Licensor and Licensee agree as follows: a. Basic License Terms. In addition to the other terms that are defined elsewhere in this License, the N following,whenever used in this License,shall have the:meanings set forth:in this Section 1: Licensor: Licensee: Legal Name: MAYFLOWER CAPE C.OD,.LLC, a Richard Meade, Delaware:Limited Liability Company d/b/a Cape Cod Shuttle. Address: 769 Iyann.ough Road Il 0 Annable Point Road Hyannis,Massachusetts 02601 Centerville, MA 02632 -Telephone No.: 508-771-0201 508-847-5557 Contact Person: James Alexander Richard Meade Shopping Center: Cape.Cod Mall Number of:Par-king Spaces:. 1:0 Location of Parking Spaces: As'indicated on.Exhibit A hereto. Each car MUST display a.hanging 'tag on their rear view mirror during all times,to avoid being deemed illegally parked and risk being towed at the owner's expense.Any parking spot used by Cape Cod Shuttle OVER 10 will be charged$25,00,per spot,per day to be.paid by Cape Cod Shuttle, Start Date: June 1,2017 End Date: September 30,2017 Licensed Days: Every Day Licensed Hours: 8am to 6pm Total License Fee: See,Section 6. Monthly License Fee: See:Section.6. PARKING SPACE LICENSE AGREEMENT THIS PARKING SPACE LICENSE AGREEMENT(the"License")is made by and between Licensor and Licensee (each as identified below) as of the later of the two dates indicated on the signature page. RECITALS: A. Licensor owns a parking lot("Parking Lot"),the purpose of which is to accommodate patrons,tenants,employees and other invitees visiting the Shopping Center(as defined below). B. Licensee desires to license space for the parking of motor vehicles ("Vehicles") in the Parking Lot for a purpose other than to visit the Shopping Center. C. Licensor is willing to permit such use of its Parking Lot upon the terms and conditions set forth herein. NOW, THEREFORE, in consideration of the foregoing premises and the rents, covenants and agreements hereinafter set forth,Licensor and Licensee agree as follows: 1. Basic License Terms. In addition to the other terms that are defined elsewhere in this License, the following,whenever used in this License, shall have the meanings set forth in this Section 1: Licensor: Licensee: Legal Name: MAYFLOWER CAPE COD,LLC, a Richard Meade Delaware Limited Liability Company d/b/a Cape Cod Shuttle Address: 769 Iyannough Road 110 Annable Point Road Hyannis, Massachusetts 02601 Centerville,MA 02632 Telephone No.: 508-771-0201 508-847-5557 Contact Person: James Alexander Richard Meade Shopping Center: Cape Cod Mall Number of Parking Spaces: 10 Location of Parking Spaces: As indicated on Exhibit A hereto. Each car MUST display a hanging tag on their rear view mirror during all times to avoid being deemed illegally parked and risk being towed at the owner's expense.Any parking spot used by Cape Cod Shuttle OVER 10 will be charged$25.00,per spot,per day to be paid by Cape Cod Shuttle. Start Date: June 1,2017 End Date: ' September 30,2017 Licensed Days: Every Day Licensed Hours: . 8am to 6pm Total License Fee: See Section 6. Monthly License Fee: See Section 6. . � a f • 2. License. Subject to all of the terms and conditions hereof, Licensor hereby licenses to Licensee the right to use the Space described in Section 3 during the Licensed Hours on the Licensed Days during the Term(as defined herein). 3. Permitted Use. The sole permitted use hereunder is for Licensee's non-exclusive use of portion(s) of the parking lot of the Shopping Center as designated on Exhibit A attached hereto(individually and/or collectively the"Space") in connection with Licensee's "park and ride" shuttle service to Providence, RI (the "Service"), as more particularly described below and subject to the provisions of this License. L e s a receive, on anon- c usive basis: (i)the right for customers using the Service to use up to the number of parking spaces specified above (comprising a portion of the "Space"for the purposes hereof), and(ii)the right of access to the Shopping Center premises for the buses to be used in the operation of the Service. Licensee shall be permitted access to and from the Space along a.prescribed route and on a schedule to be determined by Licensor and Licensee and as set forth on Exhibit A. 4. Restrictions on Use. Licensee shall use the Parking Spaces for the parking of motor vehicles and for no other use or purpose whatsoever. Licensee shall not park any commercial trucks or other vehicles which exceed the size of an individual parking space; and Licensee expressly acknowledges that the use permitted hereunder does not include the right to park buses at or on any portion of the Shopping Center premises. No campers,mobile homes or other vehicles used for lodging purposes shall be permitted in the Parking Spaces,nor any overnight parking. No"tailgating"or other social or entertainment-type activities shall be permitted in the Parking Spaces or the Parking Lot. Any signage or other marking to be placed on or near the Parking Spaces (e.g.,to indicate the location of the Parking Spaces) shall be subject to Licensor's approval in Licensor's reasonable discretion. No third party signage of any kind shall be permitted except for one A-frame sign no large than 4'X3"to be placed on the comer at or near spot one (1). Licensee shall not make any use of the Space which is offensive as determined by Licensor in its reasonable discretion,nor do any act tending to injure the reputation of the Shopping Center; and Licensee shall abide by all rules and regulations established by Licensor. Licensee shall not do or permit anything to be done in or about the Space or appurtenant common areas which would constitute a nuisance or hazard,or which will in any way obstruct or interfere with the rights of other tenants,licensees or occupants of the Shopping Center or injure or annoy them. Licensee shall not obstruct the free flow of pedestrian or vehicular traffic on walkways, sidewalks, stairways, escalators, roads, driveways, parking lots or any other area regularly used for such traffic within the Shopping Center. 5. Term-,Licensor's Right of Early Termination. The term of this License ("Term") shall commence'on the -Start Date and end on the End Date, unless sooner terminated as herein provided. This License shall terminate without further notice at the expiration of the.Term. Any holding over by Licensee after expiration of the Term shall not constitute a renewal or extension of the License or give Licensee any rights in or to the Parking Spaces. Notwithstanding anything to the contrary herein contained, Licensor may, at any time during the term of this License, in its sole discretion and with or without cause,elect to terminate this License upon thirty(3 0)days' advance written notice to Licensee. In the event of such election by Licensor, Licensee's obligations hereunder shall be apportioned as of the effective date of such termination. Licensee understands and agrees that it has no rights to the Parking Spaces beyond the Term; and Licensee acknowledges that no one has made any representations or promises to Licensee with regard to renewal or extension of the Term, or limiting or eliminating the Licensor's right to terminate on short notice as set forth herein, or regarding relocation or possession of other space in the Shopping Center, or in any other manner contradicting, qualifying, or limiting the express provisions hereof. 6. License Fee. (a) As consideration for the use and possession of the Parking Spaces,Licensee covenants and agrees to pay to Licensor,without notice, demand or offset,at Licensor's Address set forth above, an amount with respect to each calendar month (the"License Fee")equal to the greater of(i)Five Hundred Dollars ($500.00)per month(pro-rated in the case of a partial month)(the "Fixed License Fee"); and(ii)twenty percent(20%)of Licensee's Gross Revenue generated during such month(the"Percentage License Fee"). (b) Licensee shall pay to Licensor the Fixed License Fee in advance upon the first day of each and every calendar month of the Term. If the Term commences on a day other than the first day of a calendar month,Licensee shall pay to Licensor the pro rata portion of the Fixed License Fee applicable to such partial month, on or before the Start Date. If the Percentage License Fee for a calendar month exceeds the Fixed License Fee,Licensee shall pay such excess to Licensor on or before the fifteenth(15th)day of the following calendar month. 2 „ i f (c) On or before the fifteenth(15th) day of each calendar month,Licensee shall deliver to Licensor at the address set forth above, a written statement certified under oath by an officer of Licensee, showing(i) Gross Revenue received during the immediately preceding calendar month, and (ii)the number of parking spaces used on each day of the immediately preceding calendar month. If Licensee has used more than ten (10) parking spaces on any day during such month, Licensee shall pay to Licensor along with such statement, an amount equal to Twenty-Five Dollars ($25.00) per excess space per day as additional License Fee for such month. If Licensee fails to prepare and deliver any such statement within the time specified above, Licensor shall have the right, in addition to the other rights and remedies set forth in this License (x)to collect from Licensee a sum which shall be equal to One Hundred Dollars ($100.00)which shall be deemed liquidated damages for administrative and overhead expenses to Licensor resulting from Licensee's failure, and (y) to estimate Licensee's Gross Revenue for any non-reported period and bill Licensee's License Fee accordingly. (d) The parties recognize that damages will be suffered by Licensor on account of late payment which will be extremely difficult and impractical to quantify. Accordingly,the parties have made their best estimate of damages and hereby agree that Licensee shall pay Licensor as liquidated damages on account of late payment of the License Fee a sum equal to ten percent(10%) of any payment of License Fee which is not delivered to Licensor within five (5) days of the due date. (e) If Licensor or Licensee is liable for zany state or local sales tax or parking tax in respect of the receipt of the License Fee, Licensee shall pay such tax to Licensor on a monthly basis in addition to the payment of the License Fee. Licensor shall notify Licensee of the rates of any such taxes from time to time. (f) For purpose of calculating the License Fee,"Gross Revenue" shall mean all revenue collected by Licensee in connection with the provision of the Service or the use of the Space,excluding sales and use taxes. 7. Maintenance. Licensor shall maintain the Parking Spaces and access lanes thereto in a manner consistent with its maintenance of the remainder of the Parking Lot. 8. Insurance. Licensee agrees to carry Commercial General Liability insurance and/or self--insurance during the Term, naming Licensee and naming Licensor, Simon Property Group, Inc. and:Licensor's property management company, and all their respective shareholders, partners,members, directors,related and affiliated entities, ground lessors, managers,management companies,employees,agents,guests,customers and invitees(collectively the"Licensor Parties") as certificate holders with terms and companies satisfactory to Licensor, on an Occurrence form with limits of not less than $5,000,000 per occurrence and $5,000,000 aggregate. Licensee agrees to carry Worker's Compensation insurance in compliance with any and all statutes requiring such coverage in the state where the premises is located,which shall contain an endorsement in which the Licensee's insurance carrier waives all rights of subrogation against Licensor.Licensee agrees to carry Employer's Liability insurance and/or self-insurance in the amount of$5,000,000 each accident, $5,000,000 each employee, and$5,000,000 policy aggregate, covering all of Licensee's employees involved in the provision of the Service at the Shopping Center. Licensee agrees to carry Commercial Automobile Liability insurance and/or self-insurance in the amount of $5,000,000 combined single limit for bodily injury and property damage for vehicles used as part of the Licensee's Permitted Use under this License. Licensor shall be given a minimum of sixty(60)days'written notice prior to cancellation,termination or change in such insurance and/or self-insurance. On or before the Start Date,Licensee shall provide Licensor with certificates or,at Licensor's request, copies of the policies, evidencing that such insurance and/or self-insurance is in full force and effect and stating the terms thereof, including all endorsements. r 9. Indemnity and Exculpation of Licensor. (a) Except to the extent of the Licensor Parties' own liability and as permitted by law, Licensee shall assume liability for and shall indemnify, defend, and hold harmless the Licensor Parties. from and against any and all liabilities, obligations, losses, penalties, actions, suits, claims, damages, expenses, disbursements, attorneys' fees, or costs of any kind and nature whatsoever("Claims") in any way relating to or arising out of, (i) any act or omission of Licensee (including without limitation the acts or omissions of Licensee's officers, directors, employees and/or agents), (ii) any 3 occurrence that takes place in or about the Space or the Parking Lot as the result of Licensee's gross negligence or willful misconduct, and(ill) any damage to the Space or the Parking Lot excluding claims arising solely from the gross negligence or willful misconduct of Licensor Parties. (b) Except to the extent of the Licensor Parties' own liability and to the extent allowed by law, the Licensor Parties shall not be liable to Licensee for, and Licensee waives all claims against such parties,for injury,death, or damage to person or property sustained by Licensee or any person claiming through Licensee resulting from any condition, accident or occurrence in or upon the Space, or any other part of the Shopping Center.. (c) Licensee agrees that the License Fee payable hereunder does not include the cost of guard services or other security measures, and that Licensor shall have no obligation to provide same. Licensor shall not be liable for any theft of or from the Vehicles. (d) Except to the extent of Licensor Parties' own liability, the extent of insurance coverage and as permitted by law,Licensee shall indemnify and save Licensor harmless from any and all claims, demands,or suits that may be brought against Licensor by any employee,representative, or agent of Licensee,or any legal representative or successor of any of them, in any way arising out of or incident to this License. (e) The indemnification and waivers contained in this Section 9 shall survive expiration or early termination of this License. None of the forgoing indemnifications shall be construed as an obligation to indemnify or defend Licensor for damages arising out of the negligent acts of the Licensor Parties. The forgoing indemnifications apply to or will extend to cover losses caused by Licensee's concurrent, comparative, or contributory negligence to the extent of Licensee's proportion of liability,but it shall not indemnify Licensor or the Licensor Parties for any liability, claims,losses, damages, actions or judgments arising or resulting in whole or in part from the sole negligence or intentional misconduct of Licensor or the Licensor Parties nor from the negligence of third parties. 10. Limitation on Licensor Liability. There shall be absolutely no personal liability on persons, firms, or entities who constitute Licensor,or any management company acting under contract with Licensor,or any agent,employee, officer, partner, shareholder, or joint venturer of Licensor 'or such management company ("Licensor Affiliates") with respect to any of the terms, covenants, conditions,and provisions of this License,or of any other events, acts,omissions,or occurrences arising from or related to this License, and Licensee shall look solely to the interest of the Licensor in the Shopping Center(including the Parking Lot)for satisfaction of each and every right or remedy of Licensee in the event of default or other liability of Licensor or the Licensor Affiliates. Such exculpation of personal liability is absolute and without any exception whatsoever. 11. Return of Space. Within thirty (30) days following the expiration or early termination of this License, Licensee will return the Space to Licensor, remove all of Licensee's personal property(if any), repair any damage caused, by such, removal, and peaceably yield up the Space, broom clean and in good order, repair and condition, damage by unavoidable casualty and ordinary wear and tear excepted. Licensee agrees that all personal property remaining within the Space after such 30-day period is conclusively deemed to be abandoned by Licensee and the property of Licensor. Licensee waives its rights, if any, under any statues or other legal doctrines requiring Licensor to remove, store, return or auction such property, and Licensor may dispose of such property as it sees fit, free Hof any claims of Licensee or others claiming through Licensee. 12. Alterations, Additions, Signs. Licensee shall not make any alterations or additions, or permit the making of any holes in the asphalt or other Parking Lot surface, or permit the painting or placing of any exterior signs,placards, or other advertising media, banners, pennants, awnings, aerials, antennas, or the like, within the Space, without on each occasion-obtaining prior_written consent from Licensor,which shall not be unreasonably withheld, conditioned or delayed. 13. No Mechanic's Liens. Licensee shall not suffer any mechanic's lien to be filed against the Space or the Shopping Center by reason of any work,labor, services,or materials performed at or famished to the Space or to Licensee, or to anyone acting in concert with Licensee.Nothing contained in this License shall be construed as a consent on the part 'of the Licensor to subject the Licensor's estate in the Space or Shopping Center to any lien or liability under the lien laws_ of the state in which the Shopping Center is located. 4 I ' 14. Subordination. (a) Mortgage. This License shall be secondary,junior and inferior at all times to the lien of any first mortgage or mortgages which now or hereafter'are a lien upon any part of the Shopping Center. (b) Construction, Operation and Reciprocal Easement Agreements. This License is subject and subordinate to one or more Reciprocal Easement Agreements entered into or hereafter to be entered into between Licensor and other owners or lessees of real estate(including but not limited to owners and operators of department stores)within or near the Shopping Center(which Agreements have been or will be recorded in the official records of the County wherein the Shopping Center is located)and to any and all easements and easement agreements which may be or have been entered into with or granted to any persons heretofore or hereafter,whether such persons are located within or upon the Shopping Center or not and Licensee shall execute such instruments as Licensor requests to,evidence such subordination. 15. Licensee Default. In the event of any failure of Licensee to pay any sums or to perform any of the terms, conditions or covenants of this License to be observed or performed by Licensee when required or within ten (10) days following Licensor's written notice of such failure, Licensor may at any time thereafter,terminate this License by written notice to Licensee and/or pursue all other legal remedies available to Licensor. If Licensor incurs any expense(including, but not limited to, attorneys'fees and court costs),as a result of Licensee's failure to perform any of Licensee's obligations under this License, all amounts so.paid or incurred shall, on written notice to Licensee, be considered additional License Fee payable by Licensee with the first installment of License Fee thereafter becoming due and payable,and may be collected as provided in this License and/or as by law or in equity provided in the case of rent_Notwithstanding the foregoing or anything contained herein to the contrary,Licensee shall not be in default hereunder if the breach is of such a nature that it cannot reasonably be cured or remedied within the ten(10)day period and Licensee diligently commences to cure the same during the ten (10) day period, and thereafter,with reasonable diligence and in good faith, proceeds to remedy or cure the same. 16. Additional License Fee. Any liquidated damages provided in this License or by rules and regulations promulgated by Licensee, as well as any and all other payments, fees or charges provided herein or in such rules and regulations,shall be considered to be additional License Fees which shall be immediately due from Licensee to Licensor on delivery of notice thereof. 17. Compliance with Laws. Licensee shall be solely responsible at its sole cost and expense to keep the Space in full compliance with the Americans with Disabilities Act and/or any applicable regulations and with other applicable federal, state or local accessibility law, code or regulations, including without limitation provision of an accessible route from the Space to any other location on Shopping Center property if the installation or operation of the Space or the operation of the bus service on Shopping Center property as provided for herein requires the provision of an accessible route that would not otherwise have been required on Shopping Center property. Licensee shall comply with.all.laws, rules, regulations,orders,ordinances,directions and requirements of any governmental authority or agency,now in force or which may hereafter be in force, including without limitation those which shall impose upon Licensor or Licensee any duty with respect to or triggered by a change in the use or occupation of, or any improvement or alteration to,the Space contemplated by this License. In the event there are any licenses, or permits required by and any governmental agency or authority with respect to the type of activity carried on and/or in use of the Space,Licensee shall be responsible for obtaining such licenses, authorizations and permits. 18. Anti-Terrorism Law: (a) Licensee represents and warrants to Licensor as follows: (1) Neither Licensee, its constituents. or affiliates nor any of their respective agents (collectively,the"Licensee Parties") is in violation of any law relating to terrorism or money laundering, including,but not limited to,Executive Order No. 13224 on Terrorist Financing,the U.S Bank Secrecy Act, as amended by the Patriot Act, the Trading with the Enemy Act, the International Emergency Economic Powers Act and all regulations promulgated thereunder, all as amended from time to time (collectively, "Anti-Terrorism Law"). 5 I (2) No action, proceeding, investigation, charge, claim, report, or notice has been filed, commenced, or threatened against any of the Licensee Parties alleging any violation of any Anti-Terrorism Law. (3) None of the Licensee Parties has, after due inquiry, knowledge of any fact, event, circumstance,situation or condition which could reasonably be expected to result in any action,proceeding, investigation, charge, claim, report, notice or penalty being filed, commenced, threatened or imposed against any of them relating to any violation of or failure to comply with any Anti-Terrorism Law. (4) None of the Licensee Parties is a"Prohibited Person". A Prohibited Person means any of the following: (A) A person or entity that is "specially designated" on the most current list published by the U.S. Treasury Department Office of Foreign Asset Control or which is owned, controlled by or acting for or on behalf of any such person or entity; (B) A.person or entity with whom Licensor is prohibited from dealing by any Anti- Terrorism Law; (C) A person or entity that commits, threatens; or conspires to commit or.supports "terrorism"., as defined in any Anti-Terrorism Law. (5) None of the Licensee Parties: (A) Conducts any business.or transactions or makes or receives any contribution of funds, goods, or services in violation of any Anti-Terrorism.Law; (B) Engages in or conspires to engage in any transaction that evades or avoids,has the purpose of evading or avoiding or attempts to violate any of the prohibitions of any Anti-Terrorism Law. . (b) Licensee covenants that it shall not: - (1) Conduct any business or transaction or make or receive any contribution of funds, goods, or services in violation of any Anti-Terrorism Law; (2) Engage in or conspire to engage in any transaction that evades or avoids, has the purpose of evading or avoiding or attempts to violate any of the prohibitions of any Anti-Terrorism Law. (c) Licensee agrees promptly to deliver to Licensor(but in any event within ten(10)days of Licensor's written request) any certification or other evidence requested from time to time by Licensor, in its reasonable discretion, confirming Licensee's compliance with the foregoing. 19. Miscellaneous. (a) . Entire Agreement. There are no representations, covenants, warranties, promises, agreements, conditions or undertakings, oral or written, between Licensor and Licensee other than herein set forth. Except as herein otherwise provided,no subsequent alteration,amendment,change or addition to this License shall be binding upon Licensor or Licensee unless in writing and signed by them. (b) Governing Law; Choice of Forum. This License shalLbe construed under the laws of the State where the Shopping Center is located, notwithstanding any state's choice of law rules to the contrary. Any action, suit or proceeding relating to, arising out of or in connection with the terms, conditions and covenants of this License may be brought by Licensor against Licensee in the Circuit or Superior Court of Marion County,Indiana. Licensee hereby waives any objection to jurisdiction or venue in any proceeding before said Court. Nothing contained herein shall affect the right of Licensor to bring any action, suit or proceeding against Licensee in the courts of any other jurisdictions. 6 (c) Waiver. No waiver by Licensor or Licensee of any breach of any term, covenant or condition hereof shall be deemed a waiver of the same or any subsequent breach of the same or any other term,covenant or condition. The acceptance of License Fee by Licensor shall not be deemed a waiver of any earlier breach by Licensee of any term, covenant or condition hereof, regardless of Licensor's knowledge of such breach when such License Fee is accepted. No covenant,term or condition of this License shall be deemed waived by Licensor or Licensee unless waived in writing. (d) Notices. All notices to be given hereunder by either party shall be written and sent by registered or certified mail, return receipt requested, postage pre-paid or by an express courier delivery service or by an electronic transmission, addressed to the parry intended to be notified at the address set forth in Section 1. In addition, if Licensee sends a notice to Licensor,Licensee shall send a copy of such notice to: Simon Property Group,L.P. 225 West Washington Street Indianapolis,IN 46204 Attention: Director of Parking Services Facsimile: (317)263-7074 Either party may,at any time,or from time to time,notify the other in writing of a substitute address for that above set forth; and thereafter notices shall be directed to such substitute address. Notice given as aforesaid shall be sufficient service thereof and shall be deemed given as of the date received or the date on which delivery is first refused, as evidenced by the return receipt of the registered or certified mail or the express courier delivery receipt, as the case may be. (e) Cumulative Remedies. Any rights and remedies reserved by, or granted to, Licensor under this License, at law or in equity, are distinct, separate and cumulative, and the exercise of any one of them shall not be deemed to preclude, waive or prejudice Licensor's right to exercise any or all others. 7 IN WITNESS WHEREOF,Licensor and Licensee have caused this License to be executed by their duly authorized officers as of the dates indicated below. LICENSOR: Cape Cod Mall-Hyannis,Massachusetts(Entity#4919) MAYFLOWER CAPE COD,LLC, a Delaware limited liability company By: MAYFLOWER REALTY LLC, a Delaware limited liability company, its sole member By: SPG MAYFLOWER,LLC, a Delav limited liability company, its Managing Member By: Printed:Allen Smith Title: Acting Mall Manager Date: LICENSEE: RICHARD MEADE d/b/a Cape Cod Shuttle By: Richard-Me' a Date: F II 8 EZIMIT A LOCATION OF PARKING SPACES AND BUS ROUTE (See attached.) ` y SUM R' ;4�n' v a } k.>• K�r5�I�r,�"v"a, F r e y i.rd he q>k.V v : i §!Syr rt^.dr'+ >',/j'f r n'rF'eF N..,,rtrtitu F,y. .J, will t t�A� a 1 Fr *i �any5 ,, h*�,•-;+_�`U,' r I ,�*ra.:er� 'Jf1'2 H f ,. +{ r rma, �,ra �� � e t g��s v I ''6^5 13p� s 4 '{ r Y a 3 'k, '4 r � p rc e c ri^^p �' .�, ° °'G,yMy4°` '+ ' a` �r+' +r"• '"y,A , "i,�5,, { r t b�:sar t"!t�y'•�i# 1 e} \,h"ix+"r57 r` a .. 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A' , :q,I.r.'-St�''':l;,ri � Slf.:iN' ii`w r•,,y,, ::t�':� ��\, I �1� i' .�i').pq• :,i31r;�(:�r•^-'' tir,• ��5 up }L-'. tF. - �h, ii",.t. r_f ¢ �� {i• ti';�,�ie,:n:!.,vigw?�.ti a ,r'11w{'!;'`,i�= ill'; 'nla i I.-:!r' I I+.��='h:!�.tL"`�..a".Y,ej II k;?•F r i, 9XV Sent from my iPhone I , Message Page 1 of 2 Anderson, Robin To: Gallant, Therese Subject: Richard Meade Hi Therese, I quickly read the lease you copied for me (again -sigh). Here are my thoughts: 1 DBA Form I can approve an administrative office use at his home address of 110 Annable Point Rd. This action restricts his ability to bring the shuttle home. Mr. Meade has been made well aware of this prohibition as we have discussed it at length when he first sought " approval at the end of 2015 and certainly when he left me a dba form to sign on 1/17/17. He is restricted from employees at his residential home as well. Shuttles How many shuttles are to be provided? What routes are proposed? The lease says Providence but I thought P-Town was the '.target. More than 1 shuttle?) What is the daily schedule? `How do patrons pay (credit card, cash, on-line at the site?) What are the hours of operation? Where are the shuttles stored overnight? If the10 spaces are otherwise consumed, where will shuttles be parked (assuming that they stay on the mall lot)? Applicant must identify what other arrangements he has made to address this (i.e paying the 25.00.penalty per space per the lease). Mall Parking_Provision A.clear map & outline of the 10 spaces dedicated to this use is requested. The copy I have is not adequate. How will the spaces be designated? The lease allows for alterations but only with advance written approval. Itis recommended that signage of some kind identify these 10 spaces as a preventive measure to keep rainy day shoppers away and consequently have a patron inadvertently park in an unapproved space Si na e A`sign`permit is necessary. The location of the sign shall not be situated in such a manner to disrupt pedestrian or vehicle sight distance. Provide vehicle parking signage graphic with dimensions (if not on the pavement or curb stops). The proposed location of the temporary A-frame sign shall be noted on the same plan,,,. depicting the 10 subject spaces. Security 5/17/2017 f Message Page 2 of 2 1 The'lease clearly indicates that Mall security is not responsible for the vehicles/belongings in these 10 spaces. Will some form of security be arranged for this area? If not, how will the patrons be advised of this? License It seems that a license may be necessary and if so the argument to identify the 10 spaces with signage is even more imperative but I:defer to the Licensing Authorities to first determine those actual requirements based on this proposal. FYI: I have a copy of his lease and an unsigned (original) dba form in the street file for his . home address in Centerville. 0�9btz Robin C.Anderson Zoning Enforcement Officer Zoo Main Street Hyannis,MA 026oi 5o8-862-4027 a 5/17/2017 Type of Permit: Vehicle for Hire—Limo( ew Transfer Town Manager Filing Fee to the Town: $100.00 Hearing Required: Yes X No Fees: State$ None Post 48 hrs.before: Yes X No Town$ See below Advertise 10 days before Yes X No State Forms Town of Barnstable Forms ehicle for Hire Application None CORI Workers Compensation Form �—� C y of Insurance Certificate ' ~ CURRENT BUSINESS CERTIFICATE, Detailed explanation of assessment of the need for additional service in the area of your application —�� Articles.of organization/LLC papers r ; Town Fees: $50.00 per permit—Town Manager $50.00 per vehicle—Police Dept. $50.00 Annual Safety Inspection Applicant for a transfer is the existing Licensee; must provide a letter agreeing to Sale of the business c�-b,� C),c C Issued by.by Town Manager Rick Meade /UBER driver,shuttle service,airport Amended 5111ax Q/Consumer/wpfiles/licensing/forms/p40form e Town of Barnstable Regulatory Services Director dFt Richard Scali Regulatory Services ---------- * Consumer Affairs Supervisor Richard V. Scali Director KAM � � Elizabeth G.Hartsgrove. 1639. Weights and Measures Program ---------- 200 Main Street,Hyannis,MA 02601 weights&Measures Program Manager Telephone: 508-862-4671 Fax: 508=778-2412 Jane Zulkiewicz www.town.barnstable.ma.us The Vehicle for Hire Permit must be submitted with: 1. A detailed explanation of your assessment of the need for additional service in the area of your application. 2. Copy of Insurance Certificate for the vehicle. 3. Business Certificate 4. CORK form 5. Fee: $50.00 per permit $50.00 per vehicle $50.00 semi-annual safety inspection fee REQUEST FOR VEHICLE FOR HIRE PERMIT Type of Service Proposed: Taxi Limousine Other Public Automobile 5 t4O�G Name (S40L d/b/a� Phone�jC� Cell Phone Business Address 1 (� - W&AP U�_ NI&X . . Mailing Address �(�I Email Address �� <; C�� U/I 'l L C d►�/1 Vehicles to be garaged at LW360 Proposed Number of Vehicles Number of Employees 0* Hours of Operation `-- l If vehicles are to be operated from fixed location, state location(s) Y Bus station,train, etc. ` �I Description of vehicles to be utilized THIS PERMIT REQUIRES A PUBLIC HEARING AND THE TOWN MANAGER'S APPROVAL Approved: Town Manager,Mark S.Ells q:\wpfiles\pkgw&mveh\vehiclest&l\vehfhirepermit I Town of Barnstable oF�"E T°w Regulatory Services Richard V.Scali,Director } snxxsraste. 9 . ems. Licensing Authority �'°rfn Mt+y Alm 200 Main Street Hyannis,MA 02601 www.town.barnstable.ma.us Telephone: (508) 862-4674 Fax: (508)778-2412 CORI REQUEST FORM The Barnstable Licensing Authority has been certified by the Criminal History Systems Board for access to conviction and pending criminal case data. As a(prospective) employee/volunteer for the position of , I understand that a criminal record check will be conducted for conviction and pending criminal case information only and that it will not necessarily disqualify me. The information below is correct to the best of my knowledge. SIGNATURE OF APPLICANT/EMPLOYEE APPLCANT/EMPLOYEE INFORMATION (PLEASE PRINT) LAST NAME FIRST NAME MIDDLE MAIDEN NAME OR ALIAS IF APPLICABLE PLACE OF B TH FORMER ADDRESSES: SEX: h HEIGHT: FT. " 71' _IN. WEIGHT: EYE COLOR: C ***THE ABOVE INFORMATION WAS VERIFIED BY REVIEWING THE FOLLOWING FORM OF GOVERNMENT ISSUED PHOTOGRAPHIC IDENTIFICATION REQUESTED BY: @ZV�L=� SIGNATURE OF CORI AUTHORIZED EMPLOYEE QAWPFILESUCENSINGTORMWORI FORM-NEW.DOC The Commonwealth of Massachusetts r w; 'Department of Industrial Accidents y tj„ ' office of Investigations t7Q ! 600 Washington Street 1� ,; Boston,MA 02111 {r www.mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses Applicant Information PI ease-Print Le'bly Business/Organization Name: Address: PoJQA�LF PDIa City/State/Zip: ( C j aJ2 Phone#: SO�5 �3L4� ' S Are you.an employer? Check the appropriate box: Business Type(required): 1.❑ I am a employer with employees(full and/ 5. ❑Retail or part-time).* 6. ❑Restaurant/Bar/Eating Establishment 2. I am a sole proprietor or partnership and have no 7. Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers' comp.insurance required] 8• ❑Non-profit 3.❑ We are a corporation and its officers have exercised 9. Entertainment their right of exemption per c. 152, §1(4), and we have 10.❑Manufacturing no employees.[No workers' comp.insurance required]* 11.❑Health Care 4.❑ We are a non-profit organization,staffed by volunteers, with no employees. [No workers' comp.insurance req.] 121.Other *Any applicant that checks box#1 must also fill out the section below showing their walkers'compensation policy information. **If the corporate officers have exempted themselves,but The corporation has other employees,a workers'compensation policy is required and such an organization should check box A. I am an employer,that is providing workers'compensation insurance for my employees. Below is the policy information. Insurance Company Name: Insurer's Address: City/Stateaip: Policy#or Self-ins.Lic.# Expiration Date: 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 ofMGL 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 maybe 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. Si afore: Date: �7 Phone#• 1rn& Official use o"n,Zy. 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.Licensing Board 5.Selectmen's Office 6. Other ' Contact Person: ' Phone#: wwwTms.gov/dia MAPFRE Commerce Collaborative Edge ' el 5 U A " Quote Summary Report Quote for: RICHARD MEADE Quote No: 2 Company: CwF Rated: 1/17/2017 9:31:25 AM Quote Description: 1000 DED NO RR Effective Date: 1/17/2017 Expiration Date: 1/17/2018 Trans. Eff. Date: Office/Agent: 1-P45 Policy No: State: MA Fleet/Commercial Ind: C Policy Type: Involuntary Experience Mod: Liability Physical Damage Schedule Mod: Liability Physical Damage Group Discount: Policy Summary Vehicle Coverage Annual Premium AP/RP Other Liability Coverage Annual Premium AP/RP Compulsory Bodily Injury $1,195 Drive Other Car BI Personal Injury $404" Drive Other Car PD r Optional Bodily Injury INC Drive Other Car UM Property Damage INC Drive Other Car UN Combined Single Limits $3,469 Drive Other Car MP Auto Medical Payments $19. Drive Other Car Comp Uninsured Motorists $12 Drive Other Car Coll Underinsured Motorists $105 Hired Car BI $94 Comprehensive $318 Hired Car PD $10 Collision $1,135 Non-Owned Employees BI $94 Loss of Use Non-Owned Employees PD $10 " Towing and Labor Non-Owned Volunteers BI Non-Owned Volunteers PD Total Policy Premium $6,865 Vehicle Summary Veh# . Year Make Model VIN Annual Premium AP/RP 1 2015 CHEVY 15 PAS $6,657 NOTE: This quote is subject to company verification and approval of coverages, rate classes, and modifications. This quote does not constitute a Binder of Insurance, Certificate of Insurance, or any type of coverage commitment. i The Cape Cod Shuttle need of additional service 1 . This is a great way for visitors and locals to travel to one of the Cape's most popular destinations. Most visitors don't know how to get there and might just want to relax and enjoy a scenic ride. 2. This will help a little with traffic with less vehicles on the road during a very busy time of the year. 3. A service like this is not currently offered. 4. This is a round trip from the Cape Cod Mall to Provincetown running daily from 6/20/17 to 9/19/17 Tuesday through Sunday. 5. The pick up location is behind TD Bank in the Cape Cod Mall parking lot. 6. The rate is $85.00 round trip and $50.00 one way. Children under 12 are FREE. 7. This may also prevent someone from drinking and driving for this trip. 8. 1 have spoken to a few hotels in Provincetown and they have summer help that may use this service. I offered them a discounted rate as long as they show proof of employment and there is room on the shuttle. Message Page 1 of 2 Anderson, Robin From: Anderson, Robin Sent: Wednesday, May 17, 2017 4:40 PM To: Gallant, Therese Subject: Richard Meade Hi Therese, I quickly read the lease you copied for me (again - sigh). Here are my thoughts: DBA Form I can approve an administrative office use at his home address of 110 Annable Point Rd. This action restricts his ability to bring the shuttle home. Mr. Meade has been made well aware of this prohibition as we have discussed it at length when he first sought. approval.at the end of 2015 and certainly when he left me a dba form to sign on 1/17/17. He is restricted from employees at his residential home as well. Shuttles How many shuttles are to be provided? What routes are proposed? The lease says Providence but I thought P-Town was the target. (More than 1 shuttle?) What is the daily schedule? How do patrons pay (credit card, cash, on-line at the site?) What are the hours of operation? Where are the shuttles stored overnight? If thel0 spaces are otherwise consumed, where will shuttles be parked (assuming that they stay on the mall lot)? Applicant must identify what other arrangements he has made to address this (i.e paying,.:. the 25.00 penalty per space per the lease). Mall Parking Provision A clear map & outline of the 10 spaces dedicated to this use is requested. The copy I have is not adequate. How will the spaces be designated? The lease allows for alterations but only with advance written approval. It is recommended that signage of some kind identify these 10 spaces as a preventive measure to keep rainy day shoppers away and consequently have a patron inadvertently park in an unapproved space Signage A sign permit is necessary. The Iodation of the sign shall not be situated in such a manner to disrupt pedestrian or vehicle sight distance. Provide vehicle parking signage graphic with dimensions (if not on the pavement or curb stops). The proposed location of the temporary A-frame sign shall be noted on the same plan depicting the 10 subject spaces. 5/24/2017 Message Page.2,of 2 Security The`lease clearly indicates that Mall security is not responsible for the vehicles/belongings in these 10 spaces. Will some form of security be arranged for this area? If not, how will the patrons be advised of this? License It seems that a license may be necessary and if so the argument to identify the 10 spaces with signage is even more imperative but I defer to the Licensing Authorities to first determine those actual requirements based on this proposal. FYI: I have a copy of his lease and an unsigned (original) dba form in the street file for his home address in Centerville. 0�g6En Robin C.Anderson Zoning Enforcement Officer 200 Main Street F Hyannis,MA 026oi 5o8-862-4027 ' 5/24/2017 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 i i pp t 1 Map 7 4 Parcel_ i4 3 Permit# l c Health Division V Date Issued Conservation D. . .orl � &r_-ne1o0)_ oA J Application Fee UZ Z� Tax Collector Permit Fee Treasurer �✓� '7 —�o�' iP, SYSTE , t� L'a INSTALLED IN CC�MPLI�;a��. , Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE AND TOWN REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address PQ Village l�s��;��-L�\B'� '\�_ Owner 6du.it,) IA-ci—, Address V" Telephone Permit Request rUr� r\ >111r� rJ\ �PA ���iC��►� Square feet: 1 st floor: existing i�� proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ' ; ZD Construction Type wo Oc Lot Size n, Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) CD Age of Existing Structure �� Historic House: ❑Yes ,'q No On Old King's Highway: ❑1� No Basement Type: ❑ Full A Crawl ❑Walkout ❑Other cn �; Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) I Number of Baths: Full: existing new Half: existing newt- ca Number of Bedrooms: existing new n Total Room Count(not including baths): existing t new First Floor Room Count q Heat Type and Fuel: Af5as ❑Oil ❑ Electric ❑Other Central Air: ❑Yes &No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: -Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial Cl Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION �7 Name 1t4j e u - r�lephone Number so 05 0 Address S >�3 SesV ( CA _ License# _0�Ri� �_Lo M 7,S( Home Improvement Contractor# 0 iJ 0 Worker's Compensation# C) c r�2— I ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO _Ez'so"Irce— A ✓ti rI�J SIGNATURE r DATE r { FOR OFFICIAL USE ONLY f PERMIT NO. DATE ISSUED MAP/PARC_ EL NO. ADDRESS ; •VILLAGE OWNER ,•L": � -"` - f; "..,` -_ _ - , DATE OF INSPECTION: FOUNDATION, FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL'. c _ PLUMBING: ROUGH FINAL' GAS: ROUGH FINAL FINAL BUILDING � DATE CLOSED-OUT ASSOCIATION_PLAN NO. - , RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $50.00 AlterationvRenovations $25.00 idment $25.00 Building Pemut Ame . FEE VALUE WORKSHEET NEW LIVING•SPACE square feet x$96/sq.foot=_ x.0031= plus frombelow(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE _ square feet x$64/sq. foot= x.0031 � plus from below(if applicable) ACCESSORY STRUCTURE>120 sq. >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 >750 sf-1000 sf 75.00 >1000 sf-1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq. foot= x.003 , STAND ALONE PERMITS Open Porch _x$30.00= (number) Deck —x$30.00= J (number) Fireplace/Chimney ( x$25.00= Ingro.und Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee pmjcost . °FINE T° Town of Barnstable Regulatory Services r • 9BAjKpMBLK Thomas F.Geiler,Director `bArE0.39. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 0260.1 Office: 508-862-4038 Fax: 508-790-6230 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. Type of Work: 1���1� "e 0 Estimated Cost�J Address of Work:�� �f P�"ram ��� fit\ Owner's Name: A f uo Date of Application: 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 the agent of the owner: p t1 Date Contractor Name Registration No. OR Date Owner's Name F Q:forms:homeaffidav The-Commonwealth of Massachusetts De artment o f Industrial Accidents olflce olineestiffo fens • _ 600 Washington Street Boston,Mass. 02111 Workers Comv ensation Insurance Affidavit name: f location: V\YNA.k> 1, U In cis \ A d� � i!`1 1 � a 1 2.,:7 Z phone# - - ❑ I am a homeowner performing all work myself ❑ I am a sole ro rietor and have no one workii in ca acity I am an em to er roviding workers' compensation for;my employees working on this job. dress.::.;:::. ..�::.... ........ .:.: NMI-. •is.....•}i:.:.?:.?:.i:•>?>:t•? 1 � ::..: :. .. hone. .:: ::::::.:::. ali. ...#......................... lastirancd::co:> ��+}:.::;. ❑ I.am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have n olices: the followingworkers compensatlo p XN X. ...'Y:......... corn au >nam <: > addre ....J.+................... ........................................::::::::::. .:::::::::.v:...............i':::..�:..iy.•;........:^......:.........:..: ........................:•v::::::v:n............a...................:::::::.................:............:.......::........ ............... .. .. 3:nh 1 :..: .. rii:Yi:3:'+viA F:::•:::::::::::::::.::....................................... vn�ii •.::S.Fr... i%n•n•. ,x ........... :�::-?}:--?:4:L•ii:•i??:L•.• ii?:; .... .........:.1v.�.�:: ..:::::::.... 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Failure to secure coverage as requited ender Section ISA of MGL 152 can lead to the imposition of crhninal penalties of a fine up to s1,5o0.00 and/or one years'imprisonment as well as dvfi Penalties in the form of a STOP WORK ORDER and a fine of s100.00 a day against me. I understand that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby.cerd under the pains d penalties of perjury that the information provided above is true and correct I � signature Date I r Print name U'" ���i 1^ 'r t Phone# l K `"r t,4 ' ✓�` official use only do not write in this area to be completed by city or town official city or town: pernut)license# ❑Bufiding Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office _❑Realth Department contact person: phone#; ❑Other 0evind 9/95 PJA) ' 1 . Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is.defined as every person in the service of another under any contract of hire, express or implied, oral or written. 7 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 section 25 also states that every state or local licensing agency shall withhold the issuance orrene*al 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,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 authorriy. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law".or ifyou are required.to obtain a workers' compensation policy,please call'die Department at the number listed below:. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom oj_&_ 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 penautll'dense number which will be used as a refeience number. The affidavits maybe retaaned tip+ the Departmen by mail of FAX unless other arrangements leave been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have anyguestions. . Please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts DePartment of Industrial Accidents Office of Inves"gations 600 Washington Street Boston,Ma. 02111 fax#: (617) 127-7749 phone#: (617) 7274900 eat. 406, 409 or 375 • Tab1a JS=h(aeaalsa ed) Hamad with Fo"a Fasis ' for a a+aad TwaFam�7' ' preteriptire Pseks� huN IIiAaC1MUM Msub Mudag Ceding Wall Floor Haaemeac P Emd=a)" Area'(•/.) Uwslue= R-values R•valua' Rrvalt� Its l wEbw PIIe 6T01 to 6500 Hes Dew 19 to 6 Normal Q 12!'agU2 3i lI N==l 19 10 6 R• I2% . 30 19 10• 6 95 AF'UE 19 Ncrmal 1Z:'. . 3i 13 MA W r 15% 036 . 31 13 25 6 Ncimal U 1 SY. 0.46 3i 19 i4 10 WA is AFUE l3 25 N/A 115 AnM v 1si. o.a4 33 6 W 15•/8 042 30 19 19 10 N!A Nonaal X .18% 032. 31 13 25 WA N=m!d 19 25 Ii/A Li y 11% 0.42 #11 90 AFUEy 11Y. 0.42� 13 19 10 ' 90 AFtJEAA IIt Os0 t9 I9 t0 1'. ADDRESS OF PROPERTY: • �1%,�,rs �1�� Mom' � � � <1060� 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: J/hq' 3. SQUARE FOOTAGE OF ALL GLAZING.e G ARE j� A(#3 DIVIDED BY#2): _ 1�/�f 4. /a GLAZIN 5: SELECT PACKAGE(Q—AA-see chart above): DS OF G ENERGY�REQUMEMENI'S NOTE: OTHER MORE INVOLVED S FME?FiTxIS INFORTMA ARE AVAILABLE. ASK U BUILDING INSPECTOR APPROVAL: YES: NO: ' g4orms-580303a Footnotes to Table J5.2.Ib: Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area. expressed as a percentage. Up to 1%of the total glazing area may be excluded.fiom the U-value requirement. For example;3 ftl of decorative glass Maybe excluded from a building design with.300 ft:of glazing area. = After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or•takea'from Table 11.5.3a. U-values are for whole units:'center-of-glass U-values cannot be used. The ceiling R-values do not assume a raised or oversized traw construction. If the insulation achieves the fu.I1 insulation thickness, over the exterior walls without compression, R 30 insulation may be substituted for cavity insulation and R-38 insulation .may be substituted for R=49 insulation. Ceiling R-vzlues represent the sum of caviry insulation plus insulating sheathing (if.used). For ventilated ceilings,.insulating sheathing must be placed between the conditioned-spate and the ventilated portion of the roof. Wall R-values represent the sum of the wall cavity.insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing,and interior drywall.For example,an R-19 requirement.could be met EITHER by R-19 cavity insulation•OR R-13•cavity insulation plus K-6 insulating sheathing. Walt requirements apply to wood=frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. s The floor.rcquirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements,' or garages).FIoors over outside air must meet the ceiling requirements. ' Tire entire opaque portion of any individual basement wall with an average depth less than 50%below grade must mc_t the same R-value. requirement..at above-grade walls. Windows and sliding glass.doors of conditioned bzoements must be included with the,other glazing. Basement doors must meet the door U-value requirement d-scribed in Note b. The R-value requirements are for unheated slabs,Add an additional R Z for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3;4, or S. If you plan to install more than one piece.of he equipment or.more than one piece of cooling equipment, the equipment with the lowest• efficiency must meet or exceed the efficiency required.by the selected package. For Heating Degree Day requirements of the closest city or town see Table J5.2.1a, NOTES: a) Glazing areas and U-values are maximum acceptable.leveLs.Insulation R-values are minimum acceptable levels. R-value requirements arc for insulation only and do not include structural components• b) Opaque doors in the building envelope must have.a U-value no greater than 0.35.Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-valve in Table J1.5.3b. If a door contains glass and an aggregate U-value rating far that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door.' One door may be excluded from this requirement•(Le.,may have a U-value greater than u c) If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with des different insulation levels,the.component complies if the area-weighted average R value is greater than or equal to the R-value requirement for that component. Glaring or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). . _ 43 ugwp ERR Vi10 80A?�eF�l1C�1'OGI S ,I � TSB.no 2-4000 0 - oCCl�\1 �i.i�2eLk �'.l ' HOHE IOROVEMNI COHI .Registration: RAGTOR y hPiratim: 0511 13093D Type: , Indiuidual211002 ✓�. JESSE 0. CAPRIO ADMIN— TgqTOR �L ACK�4PRIO ISwhy {` e , HA 02649 W i appmoom ^ txMnto wet MOM&LMNb ROOM r-e a-ice• fa' � - �� - sa COW -�. Ya' . � PfiaTadRp Saw manui�urc�+ 9 p b v �a a COMM 8OLM asrm �eoa, SAT.Owd" 4 ^ I MTP O ORaCE :F x S = OLDS CAf E IBUIL.DERS, INC. 3W SMACE LOAD •BANOW CH •MA °"r1tDOM 4/Ns/02 J81m P. Cmnw WWOV1kr aoeer 11D ANNA�IL k� E POINT ROAD C04TERVII-LE MST MOM PLAN A-1 e lac R� VAULTED CEILINGS�B 3/4" STRAPPING 1/2" SNEETROGK R-30 INSULATION EXISTING 2X4 WALLS R-13 1NSUL.ATION I/2" SWEEiROCK AL EXISTING FLOOR JOIST EXISTING DRAWL. SPACE E1100ANNASELLE CAPE IWILDERS, INC. ICE ROAD • SANDWICH * MA APPMUVEU ;s JESSE p, CAQR(O REVISED TIONS AT HATCH RESIDENCE POINT ROAD • CENTERVL-LEION A ER A2