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0022 BENT TREE DRIVE
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S:>!r r �.�.. 1 "f`� ' r 5 • , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel v Q Application # l � D Health Division �^ Date Issued S t roe Conservation Division Application F - Planning Dept. A Permit Fee a Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis 1-ed Project Street Address F Village 6"4er V JiLe Owner Ji�v Address 7 76 41Qi4 Telephone Permit Request Zaic bow moaqkd4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing 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 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ---- - Name J �t L OxS)i Telephone Number Address License# a �e �Q•. ( S� Home Improvement Contractor# Email �� t�l a s- ° Worker's Compensation # S co 5 O6 y t(a aoa/ 4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO KZIASIGNATURE DATE ao l ` FOR OFFICIAL USE ONLY r APPLICATION # DATE ISSUED 3 MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE . • ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ` ASSOCIATION PLAN NO. Tlie Comrronlrealth of-Vassach=etts Department rf industrial Accideras f} ce_afrni.Wtigaticrrrs . . 600 Washf lgti on Street y Boston,AM 02 U1 � - tG'FV1ir 7fm smgorldi a 'Furkers' Campensaffan Insurance Affidavit:Bider`slCunfradursMechicians/Plumbers Applicant Infarmatian { / Please 1hintLe. 1V a=(Hush 'gaIIimfi a/�.i Lip .t J �GrKVL4- Citgl�fate/�igg lA1C�!��%,,�s .� Ls vh rx �z�s%�"P'hane� �O�7 7.� •—�.���_ . Are)7ou an emploTer?Check- the appropriatebox: ' Tplie'of project(required)- I general contractor and I I.El I area employer with ❑ am a b 6. ❑New cansEructiots employees(fall audlor part--time)-* have lured the sub.-Contm-fors am a sole etas or partner- listed on the.attached sheet 7. ❑Reunode�in 2' `� �l?n These sub-confractors lie slop and ire:no employees $..❑Demolifiort' wadring far me in employees a-ad workers' b y 1tY � 9. El Building adxiitioa. . INo wpd mrs' comp.insu=e COMP-meivaa 5. ❑ We are a mrporation and its 10:❑Electrical repaks�or additions rewired 3.❑ F am a homeowner doing all work officers have exercised their 1L❑Plumbiagrepaim or additions. myself_[No 1ct;rs'camp- 5 of exem and per have 1 y.❑RDofrepairs iun ance rem;red]Y c.152,�1(4 and we have no employees:[No wodoess' 13.❑other comp.,insurance required-] *Any appfic=t&stchecksboxit mast alsofMoutthesecd=b9wsTamdngdieirwoxiEWcompnmt; upenuiafnmmagaa_ I Z3meaaraerswbo sab=t dtis arbiia<<u ia&cating azy ire dmag znwa*=d ffi hEm oatmffewntcacfarsnmct mbmitaaewaffidavk in path-g-g mcb- fGoatzncfDrsthstcher3�t]x�bmcmvstaRtsr�saaddiGansls5r�tsbauiagtbenam�oftbesnb-cxs•snIlst�evrlretherarnatrbnse�titiesha� empluyeas.ifthesah-caata<carhave®.ployees,9hey=istpmvi&their warkea'-ramp.parMYn mben lam an empio1w that ispr4n ng warkers'caugwnsdiwi irmiraucefor ary enrproyear. Below is the paticy rind job s1f e in,jarmatiorL Insurance company Nance: "Policy-4'or Self-ius I ic_ FxpirationDate: lob Site Address: cityl5wdze .tp: Aft2ch a Capp of&e.worlame compensationpolicy.dechration page(shawing the policy number and expiration clate). Failure to secure coverage as requiredunder Section 25A of MGL c I5'f can lead to'the imposition of criminal penalties of a fine up to$UOD 4G mdror one-year iniprxri sound as well as civil penalties in the fang of a STOP WORK ORDER and a fine of up to 0-00 a day against the violaiur. Be advised flunt a copy of this statement.maybe forwarded to the Office of hwestigad=of the DIA,far iusu=c5 coverage v riff-cation. '.Ida hereby cerfrfjr wtder de pains and psnaWes ofgerjury$rattaEe irrfarisrnfiauprm rid abvtg is bars air d correct Date: Sizaatu>:e: 7�J Phone ik ``>U - `1 26 - O Edd use 611Tr. Do riot awrrte in thb area,to be crrurpteted by chy artowl afficiat ` c'ify or Tawu: PerumtiLicense# rnuing Au lmrity(circle one): 1.Board of Health. I Building 1!epart1UEnt 3.bty1rown aerb d,Electrical Inspector 5.Plumbing Inspezor 6.Other contact Person: Phone#- -- --- - 6 armation and lastxuctions Nlassar hush.-Geheaal Laws chapter 152 req¢Qes all employes Y o provide workers'compensation far then erpIoye'es_ {a this sty,an�Iayee is detme�as"_.every pe�san ih.the service of anther under any co:ofra.ct ofh:b e express or Mplied,'oral or vn:ft " An ezgp&Ter is defined as"aa mc&iffiA parfne� h p,association,corporation or other legal eu t I or any tWo or mare of the foregoing engaged in a Joint ,and mclndmg the legal repmseiffatives of a deceased employer,or the receiver or trustee of an individ nal,partnersbip,assocbfiou or other legal entity,employing employer However the owner of a.dwellmg house,fiavmgnotmore than tbree apartments andwho resides therein,or the;o=Tant ofibe- dw-aU g house of another who employs persons to do ma;,,tr_r,�„ce,consftuc fi on or repair work on such dw Oiag hDuse or on the grounds or bmYmg app=ft ar¢thtmto shall not because of sash employmentbe d=med to be an employer_" MGL chapter 152,§25C 6)also states that"everystate orIocal licensing agency shall withhold the issuance or renewal of a Ticerx r-or permit to operate a business or to construct buildings iu the commonwealth for auy aPPhc=f who has not produced acceptable evidence o � f compTian�with t5ce�sviauc�coY� ge required." Adonally,MGZ chapter 152,§25C 7)states INeithertbe connnQnwealthnor;�ay ofits political subdivisions shall enter ntD any coaixact for theperfonnanco ofpubhr,warkuniul acceptable evidence of complfaacewith the msarm=-- rur a rim fs of this chapter have been presented to the contxacti g auzflioft7 �PIican� . Please f DI obt the workers'compensation aff idavit completely,by rlrecIag&e boxes mat apply to your sitnation and,if necessary,supply sub-contractors)name(s), addresses)andphonenumber(s)alongwitb.their mrbfIc at*)of insrnnce_ Lf nitnd LiabB4 Companies(LLC)ox Limited Liability'Partnershigs g I P)wrthno employees other than the members or partners,are not rbqo:iud to carry workers'compensation msornce- If an LLC or LLP does have loyees,a policy is BeadvisedihAthisa�dayitmaybesnbmi� e dtot$ Deparfin fentof lndus W emp Accidents for confirmation of fns -m nzce coverage. Also be sure to sign and dateJre affidavit. The affidavit should be�tnmed to the city or tnwnih�the application for the permit or license is being requested,not the Department of dial A c�cid�. ST auldyon have airy gnestions regardm g tTie Iaw or ifyou a m requited to obiak a workers' .compsation policy,please call the Deparimeut at the nmaberlisted below. Self-fi sm-ed companies Should enter their eu s elf-i carer,ce li=mr.number on the appropriate lone: City or Town GfEldals Please be sore that the affidavit is complete MCI prhtedlegibly. The Depntmeathas provided a space at the bottom ofthe:affidavit for youto fi l oud iathe event the Office oflnvestiga has to contactyouregai-tube agpIicanf P leas e b e sure to fill in the p en ft cease m=ber which wM be used as a reference number. In addition,an applicant that must svbnt multiple permftMcense.applications is any giveny urn runt ear need only sabmit are affidavit indicating ' Or p olicy fnfrornation Cjif necessary)and under`Uob ate Aarme the applicant should ate-all locations in (�Y town)-'A copy of the-affidavi tiLAhas been officially stamped or marked bythe city or tovm maybe provided to the applicant as proofthat a void affidavit is oa f r.fur fates putts or Hc:=es- Anew affidavitnvrst be filled out each year.Where a home owner or citizen is obtaining a license or peonh not related in any business or commercial venfnm (fie. a dog license or pemh to buxom.leaves etc.)said pesos is NOT rimed to complete ihls affidavit nD Of of Inns wnuzld Luke to thank you fn advance for your cooperation and should you have any ga esti=. please do not hesitate to give as a cal The Deparfmcnf's address,telephone and fax ntmlber: CauMC6u WMIjh of . 1�eg�tm�nt�flud�ialA�ci��n� t ce Qf kvmtk-4tiugg, �4 man.Sizes Ben,MA EMI II Fax# 6I7 72'-'7� xevisea�24 07 gcg�dia ` THE� Town of Barnstable ` Regulatory Services B"M STAB Richard V.Scah,Director fo Building Division, Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property.Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize `�C `� �` to act on my behalf, in all tnatters relative to work authorized by this building permit application for. IDLI (Address of Job) **Pool fences and alarms axe the responsibility of the'applicant Pools are not to be filled or utilized before fence is installed and all final inspections e pe ormed and accepted. Signature of Owner Signature&AppliLnt All, Print Natne Print Name Date Q:FORMSAWNERPERMISSIONPOOLS Town of Barnstable Regulatory Services pUIKE Richard V.Scali, Director Building Division �xtvsTesi.�. Paul Roma,Building Commissioner MASS.1639• m� 200 Main Street, Hyannis,MA 02601 � www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": ' name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of sit units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to -be,a.one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the buildine permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. . The undersigned"homeowner"certifies.that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner . a; t Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. - HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor.", Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor.(see Appendix Q,Rules&&Regulations for Licensing Construction Supervisors,Section 2.15) .This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor.. The homeowner acting as•Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many.communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. V vc lo 4 'J %44 Nn , f BA MS LEBI ILDIN33 DEP . DATE F DEPA TC Q H`'! URE ARE QUIR D FD PER lTINGr= =ac_ CIO V, Y t/- S w � z t r I e T Al Town of Barnstable, 367 Main Street, Hyannis, MA 02601 REGISTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 sections 224-3 and 224-4. Please complete one form for each property in foreclosure (section 224-3)or already foreclosed for which possession has been taken(section 224- 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law,please state the reason(s)and complete section 1 (property information)and the first paragraph of section 2 (foreclosing party, court, etc. and foreclosing party representative,but not other representatives and attorney) so that the Town can review the exemption and update its records: N/A Section 1 —Propelly Information Property Add res •22 Bent Tree Drive, Centerville, MA 02632 P rh' s. Assessors Map#: N/A Parcel#: 168-050 Land area and description Lot of 16,988 sqft (or 0.39 acres) Building(s)description and contents Single Family Home of 1,254 sqft 0 Occupied: Y Occupant(s)(if borrowers so state and include name(s)) Beatrice A Bacon C/O Wells Fargo Bank, N.A. Phone: 877-617-5274 email: codeviolations@wellsfargo.com other: N/A Vacant: N Date: 10/23/2015 Anticipated Length of Vacancy: N/A Last occupant(s))(if borrowers so state and include name(s)) N/A Phone: N/A email: N/A other: N/A Has possession been taken No If so,please explain and complete and file the maintenance and security plan form(unless exempt as stated above)N/A Section 2—Foreclosing Party Information Foreclosing Party (full name/title) Wells Fargo Bank, N.A. Foreclosure Case Court: Docket# Date filed: Current Status: Active Foreclosing Party's representative(s) for property(entry,management,repair, etc.)(name, title,): Wells Fargo Bank, N.A. Company(if different from foreclosing party): Wells Fargo Bank, N.A. Address: One Home Campus, MAC F2303-04J, Des Moines, IA 50328 Phone: (877)-617-5274 email: Codeviolations@wellsFargo.com other: If an exemption is claimed,please do not complete the remainder. Other representative(s) (if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or,foreclosure,please so state and do not complete contact information(i. e. "none"or"see above")). Name, title, other: N/A Company(if different from foreclosing party): N/A Address: N/A Phone(s): N/A email(s): N/A other: NIA Name,title, other: N/A Company(if different from foreclosing party): N/A Address: N/A Phone: N/A email: N/A other: N/A Attorney representing foreclosing party N/A Firm name(if different from attorney's name): Orlans Moran PLLC Address: P.O. Box 540540, Waltham, MA 02452 Phone(s): 781-790-7800 email(s): info@oriansmoran.com other: I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. Digitally signed by Brittani D Brittani D Cole man�P�leman 10/23/2015 ,f Date:2015.10.23 16:05:33-05'00' Date: Name:Brittani D Coleman Title: Research/Remediation Associate I I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224.of the Code of the Town of Barnstable. Date: Building Commissioner,Town of Barnstable T , 1 MAINTENANCE AND SECURITY PLAN FORM FOR FORECLOSING/FORECLOSED PROPERTY Town of Barnstable General Ordinances, Code section 224-4,requires a mortgagee taking possession of a property before or during foreclosure, or after foreclosure if the mortgagee becomes the owner, to bring the property into compliance with the maintenance and security standards contained in Code subsection 224-4(B)within thirty (30) days of a notice from the Building Commissioner. Please either complete and file this form or another containing the same information with the Building Commissioner within thirty(30) days of the notice. If a mortgagee claims an exemption from the provisions of Code sections 224-3 and 224- 4,please explain, leave the remainder blank, sign at the end and file this form or letter of explanation and also complete and file the applicable sections of the registration form for foreclosing/foreclosed property N/A Town of Barnstable, 367 Main Street, Hvannis, MA 02601 (1) Registration date: 09/23/2015 If not registered,please complete the registration form and state date of filing or anticipated filing NSA (2) If commercial property, describe space utilization floor plans required by the Fire Chief and filing date (actual or anticipated)N/A (if in possession or ownership must be certified as accurate twice annually in January and July). (3)Describe any hazardous materials on the property as that term is defined in MGL c.2 1 K and the date(s)and method(s)for removal as approved by the Fire Chief UNKNOWN (4)Method(s)and date(s) all windows and door openings secured(or will be secured) UNKNOWN If left secured,name, address, and contact information of security personnel providing twenty-four-hour on-site security personnel on the property WELLS FARGO BANK,N.A. F2303-04J, 1 HOME CAMPUS, DES MOINES IA 50328, 877-617-5274 (5)Location(s)and date(s),"No Trespassing" signs posted or to be posted on the property UNKNOWN (6)Name(s), address(es) and contact information of person(s)responsible for maintaining: structures, lawns and shrubs in sound condition free from excessive growth and the property generally in accordance with the Barnstable Zoning Ordinances the definition of"maintenance"in this Ordinance; any other provision of this Ordinance; and for disposing of trash, debris and pools of stagnant water as provided in Chapter 54 of the Town of Barnstable General Ordinances WELLS FARGO BANK,N.A. MAC F2303-04J, ONE HOME CAMPUS, DES MOINES, IA 50328 I (7)If the Fire Chief of the Fire District in which the property is located has approved turning off the water or electricity,please state: Date of approval UNKNOWN Date(s) electricity turned off UNKNOWN on if applicable UNKNOWN Date(s)water turned off UNKNOWN on if applicable UNKNOWN (8)Name(s), address(es) and contact information pf person(s)responsible for maintaining all existing fences around swimming pools and spas or installing fences as required by. Chapter 210 of the Town of Barnstable General Ordinances WELLS FARGO BANK,N.A.,F2303-04J,ONE HOME CAMPUS,DES MOINES IA 50328 (9)Name, address, telephone number and email address,of person who can be contacted in case of emergency if different from the person named above or in the registration under section 224-3(A) (name and contact number to be posted on the front of the property if required by the Fire Chief or Building Commissioner WELLS FARGO BANK,N.A,F2303-04J,ONE HOME CAMPUS,DES MOINES IA 50328,877-617-5274 (10) Date(s) certificate of liability insurance on the property filed with the Building Commissioner SEE ATTACHED EVIDENCE OF INSURANCE (11)Date(s)cash or surety bond of at least$10,000.00 filed with Building Commissioner to remunerate the Town for any expenses incurred in inspecting, securing and making the premises comply and continue to comply,a portion of which shall be retained by the Town as an administrative fee N/A (12)Date(s) scheduled for inspections with the Building Commissioner and Health Director, who may at his or her discretion include the Fire Chief, in order to confirm that the land and structures comply with the provisions of this Ordinance UNKNOWN or to identify the provisions with which the property does not comply and establish a program to bring the property into full compliance UNKNOWN (13)Date(s) when the property was sold, or is anticipated to be sold, to the foreclosing party. If neither,please explain UNKNOWN I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. Brittani D Coleman`Digitally signed by Bhttani D Coleman Bate:2015.10.23 16:06:03-05'00' Date: 10/23/2015 Name: Brittani D Coleman Title: Research/Remediation Associate I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-4 of chapter 224 of the Code of the Town of Barnstable. r Date: Building Commissioner, Town of Barnstable J b WELLS FARGO HOME MORTGAGE CONTACT INFORMATION For questions or concerns regarding a property registration issue please contact the Property Registration Department. Property Registration Department Registrations@wellsfarso.com For other inquiries please route applicable requests to: Building and Code Compliance Department CodeViolations@wellsfargo.com Utility Bills ConvUtilityPmt@wellsfargo.com HOA or Condominium Dues or Fees HOAPmtRequestFH@wellsfargo.com Tax Related Requests: TaxGatekeeper@wellsfargo.com REO property inquiries PASAPinguiries@wellsfsargo.com Insurance Claims HazardClaims@welisfargo.com General Property Preservation- Property.Preservation@welIsfargo.com For questions regarding purchasing a Wells Fargo property please contact 1-877-617- 5274. You may also contact our dedicated property preservation call center at 1-877-617-5274 Monday— Friday from 8:00 AM —9:00 PM EST. Please note all legal documents should be sent to our legal mailing address below: Wells Fargo Home Mortgage 1 Home Campus MAC# F2303-04J Des Moines, IA 50328 21174 AC R® DATE(MM/DD/YYYY) ,. CERTIFICATE OF LIABILITY INSURANCE 3/25/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Wells Fargo Certificate Service Center Wells Fargo Insurance Services USA,Inc. NAME:PHO"u 404 923 3719 a/c NI I: 1-877-362-9069 3475 Piedmont Rd ADDRESS: wFis.certificaterequest@wellsfargo.com Suite 800 - INSURER(S)AFFORDING COVERAGE NAIC# Atlanta,GA 30305 INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: i Wells Fargo Home Mortgage INSURER C: � a division of Wells Fargo Bank,N.A. INSURER D: 90 South 7th Street, 14th Floor INSURER E: Minneapolis,MN 55402 INSURERF: COVERAGES CERTIFICATE NUMBER: 8901677 REVISION NUMBER: See below THIS IS-TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1L7R TYPE OF INSURANCE ADDL SUBR - LICY EXP POLICY NUMBER MM DD/YYYY MPOLICY EFF M DDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 304056 04/01/2015 04/01/2020 EACH OCCURRENCE $ 10,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED 10,000,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY PRCT O ❑LOC PRODUCTS-COMP/OP AGG $ 10,000,000 JE OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB HOCCUR y EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE a AGGREGATE $ DIED I I RETENTION$ $ A WORKERS COMPENSATION MWC 302638 STATUTE OERH ANDEMPLOYERS'LIABILITY 04/01/2015 04/01/2020 X ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N 1,000,000 OFFICERIMEMBER EXCLUDED? ❑N N/A - E.L.EACH ACCIDENT $ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEQ$ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION Wells Fargo Home Mortgage, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN a division of Wells Fargo Bank,N.A. ACCORDANCE WITH THE POLICY PROVISIONS. 90 South 7th Street, 14th Floor Minneapolis,MN 55402 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) I Vacant Building Plan Current status of the Building: The building is secured; all doors and windows are locked. If the property utilities are on when we find the property abandoned,we will transfer the utilities into our name and leave active. If we find the property to not have any utilities we winterize the property according to investor/insurer guidelines. Plan of action for exterior building maintenance: We inspect and maintain our properties. We work to keep the property secure and free of, any health hazards and/or debris. Wells Fargo also schedules our grass cuts twice a month. What improvements are planned? If the property is in need of repair to avoid a code violation,.we will review and take any appropriate action. If there are insurable damages,we will file an insurance claim and review for repairs. What is the scheduled date of re-occupancy? Approximately 90 days after the foreclosure sale is confirmed. Building to be sold or rented? .The building is to be sold. Certificate of Occupancy: The buyer will be responsible for re-certification and occupancy inspection with the city. Is property.to be demolished? There are no current plans for demolishing the property. The city will be notified if there is a change of action. Wells Fargo Home Mortgage MAC F2303-04J f One Home Campus Des Moines,IA 50328 Ph;87.7-617-5274 October 23,2015 Town of Barnstable Attn: Robert McKechnie Building Department 200 Main Street f . Hyannis,MA 026oi Completed Property Registration for: '- 22 Bent Tree Drue,Centerville;MA o�2632 �u <,..m.. ....,,.. ,-a am..,� ,.�M..w.. ...,—:, ...�. ... m-....,.�:��z�,��`,.a,,.«n...uv.�zR ..,..,'.�...:- ......i......M'�. ... ....��a........°u��....................�:,.a' TAX ID: £t68o50 . .p ._. . _ Mid . . Dear Sir/Madam: Please see the attached property registration form and use the below contacts to expedite any future requests. Code Violations: CodeViolations@WellsFargo.com Property Registrations: Registrations@WellsFargo.com General Property Preservation: Property.Preservation@WellsFargo.com Call Toll Free: 1-877-617-5274 - For questions regarding purchasing a Wells Fargo property please contact 1-877-617-5274• Sincerely, Wells Fargo Home Mortgage T :. MAC F2303-04J x.H One Home Campus 3 - Des Moines,IA 50328 ; britta ii 4 colerrian@well 5 sCJ " i r prj 1rQ rp 1 v••ii vi ""K KA0 f.f;KYKr- "YCCInIL ff p� Expires 6 months from issue date Regulatory Services Fee p ie' �0m° Richard V.Scab,Interim Director J' Building Division V Tom Perry,CBO,Building Commissioner �oi ' 1 200 Main Street,Hyannis,MA 02601 �, www.town.bamstable.ma.us Office: 508-862 3 Fax: 508-790-6230 EXPW ,S PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number C� 1 Property Address -'mac Z la-ea— brg�j-t l ®Residential Value of Work Minimum fee of$35.00 for work un er$6000.00 Owner's Name&Address �d•� 77 N�a�.- d� Contractor's Name_ "earl\ �i[}j�j .ttU� Telephone Number Wb` is-�j�� Home Improvement Contractor License#(if applicable) ,(+p�JCi Email: y-1 M RA.i n Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance. Insurance Company Name Workman's Comp.Policy# ALA 22-0 I Or Copy of Insurance Compliance Certificate must accompany each permit. Permit Requ (check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to eks�� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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. A copy of the Home Improvement Contractors License&Construction Supervisors License is requir SIGNATURE: T:\KEVIN_D\Building Changes\EXPRESS PERMIIIEXPRESS.doe Revised 061313 The Counnonivealtk of Mossochusetts I?eprrtrnent of Indusaial Acc-iderrts Office of Investigafions 600 Washington Street Boston,MA 02111 rn�tt�i:nrass,gfdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information l Please Print Le 'bh- Name(Business oiganizzation ): Address_ F _ City/State/Zip: 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 employees(full and/or yart-time). s have;hired the sub-contractors ❑New construction 2.❑ I am a sole proprietor or partner- listed on the.attached sheet 7-,❑Remodeling ship and have no employees - These sub-contractors ha-,a g- ❑Demolition working forme in any capacity. employees and have workers' 9_ ❑Building addition [No workers'comp-insurance comp-insurance j required.] 5- ❑ We.are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11_❑Plumbing repairs or additions mi o l£ workers' right of exemption per MGL �` � °0�- 12-❑Roof repairs insurance required.] c. 152,§1(4),and we have no ` employees.[No workers' 13. ]Other oast C� comp.insurance required] l Q� such- 'Any applicant that cbecks box=l must also fill out thesection beloR,showing rh&workers'compensation policy inforl�on- T Homeoaaers who submit this affid dt indicating they are dam.-all want and then hire outsid-e coattactors mast submi[a nets affidasit indicating such :Contactors tbm check this box mu-t attached an additions sheet shots the liaise of the sub-conimnors and state whathe=or not those entites have employees. H the sub-cantmctor have employees,they mist pnn,ide their a atkers'comp.policy number- lain an enlployeY that is pro sting luorkers'congwnsaffan insurance for my en I. e &Iotr is the poll �and job side - infortnation. / Insurance Company Name: 1453c�cILQd Policy#or Self-ins.Lic.v: CP—, -Soo Soo (t(a.G 1 N'r Expiration Date: Job Site Address: �CitylStatetZip: 1 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 e- 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and.jor one-year imprisonment,as ut ell 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 render the pa s and penalties of erjury atthe illfot7nadon prmlided above' " and correct Sienature_ Date: i3 Phone 9: - O 0fflei al use only. Do not write in this area,to be completed by city or town qfficiaL City or Town: PermitUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 0: Client#: 16665 2MEAGHERCO ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM1ODNYYY) 06/22/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Dowling 8c O'Neil Insurance Ag PHONE AX 973 lyannough Rd,PO Box 1990 (A E-MAIL Ext:508 775-1620 A No: 5087781218 Hyannis,MA 02601 ADDRESS: 508 775-1620 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Associated Employers Insurance INSURED INSURER B: Meagher Construction Inc. Timothy Meagher INSURERC: 776 Main Street INSURER D Osterville,MA 02655 INSURERE: -A INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSLTRR ADDLSUBR TYPE OF INSURANCE N A SR WVD POLICY NUMBER MI POLICY EFF DY EXP 1DD MMfD LIMITS GENERAL LIABILITY " EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES R occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ POLICY PRO LOC $ PRO- JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS ., Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WCC50050054422016A 6/23/2016 06/23/201 X T STATU- OTH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? YIN FNI NIA E.L EACH ACCIDENT $100 OOO (Mandatory in NH)If yes,describe under E.L.DISEASE-EA EMPLOYEE $1 OO,000 DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1724541M172453 LS1 I BAR:STABLE, Y� ,0� Town of Barnstable Regulatory Services Richard V.Scali,Interim Director 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 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize t� ' ` ( to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) G 6) Signa re o caner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN_Muilding Changes\EXPRESS PERM MEXPRESS.doc Revised 061313 I - - q 'Massachusetts -Department of Public Safety Unrestricted-Buildings of any-,use group w ch Board of Building Regulations and Standards � contain less than 35,000 cubic feet(991M)�f Construction Supervisor � enclosed space. i License: CS-102260 MICHAEL S ME40HER JR 97 EMERALD LA.NEjj`i3 Mai stons MMs r&k 02G48 ' Failure toP possess a currant edition of the Massachuset ts State Building Code is cause for revocation of this license. Expiration Commissioner 11/05/,2016" For DPS Licensing information visit: www.Mass.GoV/DPS . ".' - �.-... p,...., «.._:,.,-ram^• -- ^-^''�" _ _ dFxe �pomvrrtoozureaCC�a� ccee Office of Consumer Affairs&Business Regulation License or registration:valid for,individul:use only OME IMPROVEMENT CONTRACTOR before the expiration date If found return to: iUVExpi egistration; 162938 Type: `p. Office of Consumer Affairs and-Business Regulation ration im4/27/20'F7.; DBA 10 Park Plaza-S e 5170 Boston;lVIA 02 `_.G ' MEAGHER BROTHERS CONSTROCT10N j f. MICHAEt MEAG JRo HER - f 97 EMERALD`LN } a MARSTONSMILL,MA 02648 _ s y Undersecretary Not ivd wi bout signature( im --- ---� it - _ F " r Town of Barnstable Permit# Expires 6 mogul o is Regulatory Services Fee date o BARA'STABLF. 9cb M" i6.s�9. 0 Richard V.Scali,Director � QED►M't s Building Division Tom Perry,CBO,Building Commissioner ` 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY �y Not Valid without Red X-Press Imprint Map/parcel Number —� (.� _ Property Address �- KResidential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name C'CUPAS1R"kj t jt.Cl Telephone Number Home Improvement Contractor Li ense#(if applicable) e) -73 Email: /1!1 (�(ZC�. t f.� t ✓1 C_��(,+6N� Construction Supervisor's License#(if applicable) C_-S L�ca�. o � a Workman's Compensation Insurance PRESSCheck one: ❑ I am a sole proprietor ❑ I am the Homeo er T OCT 20 211+n I have Worker's C mpensation Insurance rr l ( r Insurance Company Name 5!5(D Q l 0 QULk Workman's Comp.Policy# V-X 600 1�s Q:� i D.0/4:;� A Copy of Insurance Compliance Certificate must accompany each permit. Permit est(check box) . of hurricane nailed)(stripping old shingles) All construction debris will be taken to !e-side rricane nailed)(not stripping. Going over existing layers of roof)e ent Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red Sand inspections required. Separate Electrical&Fire Permits required. *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. A copy of a Home Improve ent C tractors License&Construction Supervisors License is required., SIGNATURE: C:\Users\Decollik\AppData\L,ocal\Micro ows\Temporary Internet Files\Content.0utlook\2PI0IDHR\EXPRESS.doc Revised 040215- r, " BAaNsrABLP, MASS. Town of Barnstable 9� z6s¢ t `�� , Regulatory Services Richard V.Scali,Director 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 Property Owner Must , '. Complete and Sign This Section If Using A Builder pu 0— I, VVaswn h Owner of property hereby,author �cx � '� a. ,to act on my behalf, in all matters relative to work authorized by this building permit application for: aa Z. a lC� (Address of Job) f a0oi Signature of Owner Date P ]nt Name If Property Owner is applying for permit;please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.0udook\2PIOIDHR\EXPRESS.doc Revised 4 021�"0 Tlse Counnonweallh of Massachusetts . Departanent of Inrlrisls ial Ar-cidearls i Offi-re of Investigations 600 Washington Street Boston,MA 02111 irwit.niamgovIdia Workers' Compensation Insurance Affidavit: Baders/Contractors/]ElectricianslPlumber-S Applicant Information Please Print I.a ibis Name,(3usinezDrganiz 4mi vi 3)_ e - Address: City/State/Zip_ C sk"u.3 lea phone 4- �,U� _ Are you an employer?Check the appropriate box: T of project•r I am a general contractor and I J p ] (required): l-[� I am a emplo3 u*itia ❑ g h_ ❑New cznstauction employees(full and/or part-time)_* hav:hiredthe sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7- ❑Remodeling slip and have no employees These sub-contractors have g- ❑Demolition lworkino forme in any capacity- employees and have workers' [No ry orkess'comp.insurance comp-insurance-19. ❑Building addition . required.] 5. ❑ We are a corporation and its 10:❑Electrical repairs or additions. 3"❑ I am a homeammer doing all work officers have exercised their I LE]Plumbing repairs or additions Myself [No workers'pomp- right of exemption per MGL 12.❑Roof repairs insurancerequired-] c- 1527§l(4),andwe have no eaalployees.[No workers' 13.WrOther comp-insurance required] 'Any applicant that.checks box=1 met also fill out the se-ctfon below showing their©corkers'compensation policy information- t komeowni-_s who submit dais affidatit indicating they are doing all wad and then hire outside contractors mast submit a new such -Contactors dint check this box mm-t attached an additional met showing the none of the sub-contactors and state whether ur not those entides bzve employee;- If the sub-eouttactor ba-ve employees,they must provide they warkets'comp.policy number- I ant an employer t1UWd is pr 'dvig woFkers'congmirsatioii irrsnrarice for nif eii� Below is the pail =and}ob sate information. )) � Insurance Company Name: sv O�a Policy 4 or Self--ins.Lie-;9: CP—, -Soo.Soo (l{a.0/(o Expiration Da Job Site Address: CD CitylstateyziflaoA* �,(,J)AA1_'L 1 4, Attach a cogs 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 Head to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as citil penalties in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against the violator. Be advised that a copy of dais statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do]net-eby certify aenader l 4eFa" s andpeiialties of 'ity attire infontnataon protzded abaire. ' I nae Rd -arrest Si lure: Dater Phone S o cl C C)(IS Official use.only. Do not irrite in this area,to be completed bt oily or town o,,(jPiciai City or Town: Permit/License#. Issuing Authority(circle-one): 1.Soard of$ealth ?Building Department 3.City1rown Clerk 4.Electrical Inspector S.Plumbing Inspector b.Other Contact Person: Phone#: Client#: 16665 2MEAGHERCO ACORD. CERTIFICATE OF LIABILITY INSURANCE OATE(MM/DDNYM 06122/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED the olic ies must be endorsed.If B p y( ) SU ROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil Insurance Ag PHONE 508 775-1620 973 lyannough Rd,PO Box 1990 E MAILo Arc No: 508TT81218 ADDRESS: 508 775-1620 Hyannis, 02601 INSURER(S)AFFORDING COVERAGE NAIC# 62 INSURER A:Associated Employers Insurance INSURED INSURER B Meagher Construction Inc. NSURER c: Timothy Meagher LSURER D: 776 Main Street Osterville,MA 02655 SURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. VTR. TYPE OF INSURANCE - IN SR LAND POLICY NUMBER MNWDY EFF fNAOAIUDDY EXP LIMITS GENERAL LIABILITY • EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence 5 CLAIMS-MADE OCCUR MED EXP(Any one person) $ - . PERSONAL&ADV INJURY $ H _ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ POLICY El JE O LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMB Ea accident $ ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED - AUTOS, AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS - _ Peraccitlent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ A WORKERS COMPENSATION WCC50050054422016A 6/23/2016 06/23/201 X `"'�STATULti & AND EMPLOYERS'LIABILITY Y/N � ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $1 OO OOO OFFICERIMEMBER EXCLUDED? NJ NIA - (Mandatory in NH)If yes,describe under E.L.DISEASE-EA EMPLOYEE $100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed.to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER ' CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105). 1 of 1 The ACORD name and logo are registered marks of ACORD #S1724541M172453 LS1 �t Massachusetts -Department of Public Safety Unrestricted Buildings of any.use group w ch { f Board of Building Regulations and Standards contain less than 35,000 cubic feet(991m) f Construction Supervisor � enclosed space. License: GS402260 r .�` <2- �: A 1VIIC7�AEL S ME.� HER4JR . 97 EMERALD Matstons Mills E f Failure to possess a current edition of the Massachusetts S State Building Code is cause for revocation of this license. -)i'14' Expiration Commissioner 11/05/.2016 For DPS Ucensing information visit: www.Mass.Gov/DPS Office of Consumer Affairs&Business Regulation License or registration valid forindividul use only j. . r i OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration162938 Type: Office of Consumer Affairs and-Business Regulation WExpiration:��,---4/,2.7;i�2'6"-I�,-7- DBA F F 10 Park Plaza-Suite 5170 ' Boston,A 02- BROTHESONTbMEAGHER R 6 ION / f. f qw. f MICHAEL MEAGHER JR ,� ' ; 97 EMERALD LIVE MARSTONSMILL MA-02648" Undersecretarya * Not v d wi out signature } ; .L-A - .n t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 301 Ma Parcel '. 060 p ce BUILDING DEPT. Application # l� Health Division Date Issued,' Conservation Division OC 20 2076 Application Fee Planning Dept. TOWN OF BARNSTABLE. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village s �. Owner K Address Telephone In C/S nn Permit Request �--� 2� o� 1-�l( �2®ten S a'AL 00 6 iz- p /a..-,Cka,,� Square feet: 1 st floor: existing/ 4- proposed 2nd floor: existing 122 proposed Total new Zoning District RJC, Flood Plain 4 Groundwater Overlay Project Valuation 0CYQ Construction Type Lot Size �3 Grandfathered: ❑Yes L4<oo If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure 19 Co-3 Historic House: ❑Yes L)ho On Old King's Highway: ❑Yes rNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other p Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: 3 existing —new Total Room Count (not including baths): existing 7 new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil *lectric ❑ Other Central Air: ❑Yes WKJo Fireplaces: Existing New Existing wood/coal stove: ❑Yes 4o 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 i Z No If yes, site plan review# Current Use +c OL ' Proposed Use APPLICANT INFORMATION T �— (BUILDER OR HOMEOWNER) Name Telephone Number Addr s 1 Qc vim- -� License# C S Y 0 (e C s"- c_ co_(_011)1�) Home Improvement Contractor# / to Y Email A t'C--ell Worker's Compensation # 5�5D5*qQD.01 to ALL CONSTRUCTION DEBRIS SULTING FROM THIS PROJECT WILL BE TAKEN TO ID 0SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED 1 MAP/ PARCEL NO. ADDRESS VILLAGE ` OWNER 1 , ' DATE OF INSPECTION: i FOUNDATION FRAME INSULATION FIREPLACE ` ELECTRICAL: ROUGH FINAL 4 PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f 4 The Coinnnonwealth!of Massachusetts Deptar huivat of Industrial Accp�lerris Office of Investigations 600 Washington Street. r Boston,MA 02111 _ ivwinmamgmldia Workers' Compensation Insurance Affidavit: Builders/C ontractors/ElectriciansMumbers Applicant Information Please Print Legibly Name.(Busineezorgmizatio Address: "2?[� ` City/State/Zip: b k XLL lea �+`V�C Phone- i's U'� Are you an employer?Check the appropriate box- 1. Type of project(required):® 1 am a employer with � 4- ❑ 1 am a general contractor and I employees(full and/or pact-tirsae)_ have hired the sub-contractors 6. ❑New construction listed on the attached sheet: 7_ Remodelin 2. I am a sale -star or partner- g . ❑ �� ship and have no employees These sub-contractors have g. ❑Demolition .`corking forme in any capacity_ employees and have workers' 9_ ❑Building addition jNo rvorkecs'comp_insurance comp-insurance- re 3 guired_j 5- ❑ We are a corporation and its 10_❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L E]Plumbing repair or additions myself [No workers'comp- right of exemption per NIGL 12.❑Roof repair insurance required_] c. 152,§1(4),and we have:no employees.[No workers' 1�ther comp_insurance required] °Any applicant that checks box=1 nmst also till out the-section below shou-ing&&workexV compem impolicy ldorrnadon_ Homemvnm-s Who submit E€iis affidm t ina:atiag they are doin;all wwk sud then hire outaide canuxtora mast submit a new affidavit indicating such =Contractors that cbeck this box mwst attached an additional sheet sbowhng the name of the sub-con=tors and state whether or not tbose entity bate employees. If the sub-matmaor Moe emplayees,they mustpmtade there workers'comp.policy ntmrber_ I ant an employer that is pro 'd'zg nvrkers'conipensatioit insurance for my e.n� Below is flee polil nd job site inforneatioot. '� Insurance Company Name: C f3 � 4 Policy�or Self-ins_Lic_�_w�. Soo�� �t(a.G/ j� Expiration Date. Job Site Address_� \V l SeQ_. Q_ City/State0w � � L�e wq�, Attach a copy of the workers'compensation polio 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 fcue up to S1,500.00 and/or one-year imprisonment,as vvell 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 hetaky certify render the Dais and penalties of sty at-the it formation prot4ded abmw is trim and correct _ Si tine z C Date: ir Ur Phone : S©� ' Y 'U q S Official ficial use only. Do not write in this area,to be completed kr ck:or.town offs aZ City or Town: PermitfUcense# 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 0: Client#: 16665 2MEAGHERCO ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 06/22/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil Insurance Ag ;rN o ,508 775-1620 FAX aC No): 5087781218 973 lyannough Rd,PO Box 1990 E-MAIL ADDRESS: Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIL# 508 775-1620 INSURER A:Associated Employers Insurance INSURED INSURER B: Meagher Construction Inc. NsuRER li Timothy Meagher 776 Main Street INSURER 0: Osterville,MA 02655 INSURERE: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSLTRR ADDLSUBR TYPE OF INSURANCE NSR WVD POLICY NUMBER MPMIDDY EFF IP�pY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMA E TO Ea RENTED PREMISES occurrence) $ CLAIMS-MADE DOCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY MPRO- JECT n LOC $ AUTOMOBILE LIABILITY Ee MINEDacciden SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED F SCHEDULED BODILY INJURY Per accident)dent $ AUTOS AUTOS ( HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accid ent y 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WCC50050054422016A 0612312016 06/23/201 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L EACH ACCIDENT $1 OO OOO OFFICER/MEMBER EXCLUDED? FNI N/A I and f yes,describe under Mandatory In E.L.DISEASE-EA EMPLOYEE $100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) ' Insurance coverage is limited to the terms,conditions,exclusions,other N1, limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions: Y CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE'EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Dept. ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) -1 of 1 The ACORD name and logo are registered marks of ACORD #S1724541M172453 LS1 Massachusetts -Department of Public Safety Unrestricted-Buildings of any-use group w ch Board of Building Regulations and Standards contain less than 35,000 cubic feet(991M ) f Construction Supervisor enclosed space. License: CS-102260 ,V-T 'i t MICIAEL S JR '�. 97 EMERALD LAMES Marston Mills N1 02648 Failure to ossess a current edition ' h p of the Massachusetts State Building Cade is cause for revocation of this license. Expiration Commissioner 11/05/2016 For DPS Ucensmg information visit: www.Mass.Gov/DOS f U/Le tpamzirrwazcueall�a��c��ac�ufe� = �t� Office:of Consumer Affairs&Business Regulation Licen..se or registration valid for indi idul use only OME IMPROVEMENT CONTRACTOR` before the expiration date.Jf found return=fo: egistration: 1.62938 Type: Office of Consumer Affairs and Business Regulation �> Expiration 4/27/2047 DBA . 10 Park.Plaza-S e 5170 #n Boston,MA 02 6 MEAGHER BROTHERS-GONSTRUCTION t i - 1 MICkiAEL MEAGHER JR ,e,!� t k. 97 EMERALD.LN - Y MARSTONSMIL-L,MA 02648"" Undersecretary r Not v d wj bout siggature S i nnxtvsrnaM b''' . Town of Barnstable Q��6�Aim . Regulatory Services Richard V.Scali,Director 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 Property Owner Must Complete and Sign This Section - If Using ABuilder ►gyp,�-�`� . as Owner of the subject property hereby authorized ��. ,� �C 'n, to act on my behalf, in all matters relative to work authorized by this building permit application for: . (Address of Job) 6 ' Signature of Owner Date e. Imo. I Print Nam If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on'the reverse side. C:\Users\Decollik\AppData\Loca)NicrosoMWindows\Temporary Intemet Files\ContentOudook\2P101DMEXPRESS.doc Revised 040215 ssessor's map and lot number ..:r......'.L. ... . .v o SEPTIC SYSTEM MUST ,BE INSTALLED: IN COMPLIANCE Sewage Permit number ._.GC.......a.. ..,...:�...'J..�t.ly..�.......� , ......... WiTr6 � t - / • / / ,. , ARTICLE II STATE THE T ;�, SAP4ITARY Cu117 ip TOWM TOWN OF BARN�S� �A B C.o i HiflB9TODLS, i BUILDIN,G INSPECTOR 'FO YPy !n` 0 Iv Y . 14 APPLICATION: FOR .PERMIT TO ....a`.' 01)...... d... .fl, �... ...l ................. �. . TYPE OF ;�/)o CONSTRUCTION ............................. .19.7 TO: THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ��l........ 1�./L �L .....1� e...........�ill1�� ` .Y..��. 1 ... ..l.L/.. '...................................................... ProposedUse .)1�444.�. ......-kM............. .........................................................................................I......................... ZoningDistrict ...../..................................................................Fire District ............................................................................... Name of Owner .�`luylYrzly..... 4�%......'tag W!i.e�.....Address .5. ..... .....f��f...... ..................... Name of Builder ... ®S%���......!'.. � (f/Y/ ...de ............Address .l`�i � �.� d:....dlf !11.f�.` ........... .... ............... .... ............ . Nameof Architect ................................................................:.Address .................................................................................... Number of Rooms..'..........................................................Foundation 1.0(/!�4t`�....1��/.if�1� ............................... Exierior /.(.G .....4.�1��/41�... /(I/ �% .................Roofing A5, S........................... Floors ...�,4l .............................................................Interior s.... . Q ..l. <...................................................... Heatingt4 '. .� .......................................................Plumbing ...M(Offi ':...............:............................................... Fireplace .:... / ..� ..GfO.X.IZ................................................................Approximate Cost ... �.sJ....................................................... Definitive Plan Approved by Planning Board --------------------------------19--------. Area ...:li./�..®._,.,,S��,.��1.¢• Diagram of Lot and Building with Dimensions Fee rS (0............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH V I hereby gree to conform to all the Rules and Regulations of the Town of Barnstable regarding he ove consti uction. Name / .............................. banks, Kenneth E. NoPermit for ...Add!.n................. ................ ....................................... ..... .......... LocationDr........................................... Centerville -) o ............................................................................... Owner ..........Kenneth..E.....Eu ..banks................ ................ .. . .... .......... Type of Construction .........Wood ................................. ............................................................................... Plot ............................ Lot X..100.....L.5Q...... 1 Permit Granted ..............No....v...................19 77 a Date of Inspection ......... .:....... ........:.......19 Date Completed .. .. .......19 PERMIT REFUSED ................................................................ 19 s. ............................................................................... ............................................................................... ............................................................................... ............................................................................... Approved ................................................ 19 Q ................................................................................ ............................................................................... TOWN OF BARNSTABLE EARNSTAML BUI.LDI-NG INSPECTOR APPLICATION FOR PERMIT TO —.�l��.���—../��.�--. —. .�. %.�----------------. ' . ~. y ~ TYPE OF CONSTRUCTION — ........ ...�—.—.----.-----..lR.—�. . , [ -' � TO THE INSPECTOR OF BU|LD|NGS . The undersigned hereby applies for o ponnh according to the following information: Location '—+/--�i'��«7.—��'���/�..._/)//___..r .�//.� �\/)�./ *_�.. .��....................................................... . ' . '~�z� ///�� Proposed -xo r' ------'— ,-------^---^--------^—^----^—^^---^---`--------' � � Zoning District ---.--.----.------.------Fioe District -------------_---,________. � / Nome of Owner . iu —'/~--.. —.A66reo . —.�^�-'—/....~'................................................... ) ~- -~ �y�/ � � 7��y/ �� ��' Nome of Builder —u�e' -----'``..��.----�----Ad6�so .��.��--..............//....—.—.....—......../..../' ----. Nome of Architect --------'�-------------Address -----------------------.----' ^ ' . � Number of Rooms ' J[=—.......................................................Foundation ................................... � Exierior // ��.—. —|//// //^�/� /^--.__—�Roo�ng � ___�-. Y~_______~_ ^ Floors -4' 7................................................................Interior ........................... ........................................................ Heating —,—�.+ /—'/:—.----------------F1um6ng —.�./-./... Fireplace —/'��//..................................................................Approximate Cost ~'<�_�'u —____,__________ Definitive Plan Approved by Planning 800v6 lg----. Area ....... V � Diagram of Lot and Building with Dimensions Fee ........ ________' , SUBJECT TO APPROVAL Of BOARD OF HEALTH [ ----_- -_--_ . , � | `�^ ' / | / � | ^ | � » CIQ I hereby a"gree to conform to all the Rules and Regulations-of the Town of Barnstable regardingNthe above Name ) | ' ---.-----.-----------.~ ` / / Eubanks, Kenneth E No ..... Permit for ...A44'n . .......................... ............................................................................... 34 Bent Tree Dr. Location ................................................................ 0 Centerville 0 ............................................................................... Kenneth E. Eubanks Owner .................................................................. C �j Type of Construction Wood ......................................... ................................ .................I............................. Plot ............................ Lot .... L 50 ............... 77 1,0V Permit Granted ........................................19 ................. .................... 19 ............ Date of Inspection ...................................19 Date Completed PERMIT REFUSED .........................I .. .. ....... ..... ............ 19 f ......... . ...... ........ . . . ... ....... .. . ... ... ....... ..... ... .. ................ ................................... ......... ... . .. .. .. .... .. ... . . .... . ................ ...... .. .............. ............. ......... ............................. Approved ..'............................... ...... 19 ............................................................................... ............................................................................... f - Town of Barnstable SHE Regulatory Services OF rp� " Thomas F. Geiler,Director i '' N chi,s 146 Ti-,,B E Building Division ((� Ph ► BARNSTABLE. ` } J ' 7 9 MASS' $ Tom Perry,Building Commissioner �jDlfo Mpv aim 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us _ Office: 508-862-4038 Fax; 50-90-6230 Approved:_ �r iJ Fee: Permit#: X0?0615,3 HOME OCCUPATION REGISTRATION Date: �1 p, �/ ► Name: � � �4 MAL Phone#: 56g-:4. aZZ Address: 1`�--�+�,ALr �IeE lel A; Villager S /T! ey le, Name of Business: �I � Type of Business: i Map/Lot: :S INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings, subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit, located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke, dust or other particular matter, odors, electrical disturbance,heat, glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials, in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the'Customary Hcme Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned, have read and agree with the above restrictions for my home occupation I am registering. Applicant: �ll�.zZ AA9 dZ�:&2 Date: 0 Homeoc.doc Rev.5/30103 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates.(cost$30 OO 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:) Business Certificates are available at the Town Clerk's Office, 1 FL., 367 °` Main Street, Hyannis, MA.02601 (Town Hall) aui axra: a'n3 nuy,q '•' ' GATE- O ll [O . SLY,EgX. Fill in Fleasa: v APPLICANTS YOUR NAME: BU5IVE99 YOUR HOWADDAE AAE�147_TELEPHONE # 3 Home Telepho Number NAME OF NEW.BUSINESS / u( TYPE O.F BUSINESS: /.t Qi�,'cl�fj 2oc� 15 THIS A HOME OCGUFPATIOIV? S y_N Nav wen a n.g Tvis ? y" ADDRESOF BUSINESS , S :MAP/PARCEL NUMBER , 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 Barnstable. This form is intended to assist you in obtaining the information.you may need. You MUST GO TO 200_MQ St. — (corner of Y rmouth Rd. & Main Street),to make sure you have the appropriate permits and licenses.required to legally operate-your business in this town. 1. BUILDING COM ER'S O FIC j This indiv I h s en-info d• f permit requirementsthat pertain to,this type of business. . c MUST COMPLY WITH HOME A hpri tune** O OCCUPATION COMMENT RULES AND REGULATIONS-' FAILURE TO IESULT IN FINES. '2. BOARD OF HEALTH This individual has n infQr.med of the rmit require nts that pertain to this type of business. ' Au er`ized Signature* MUST COMPLY WITH ALL COMMENTS: HAZARDOUS MATERIALS REGULATIONS 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been info of the licensing requirements that pertain to this type of business. Aut orized Si 9 ture** COMMENTS:•