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1600 FALMOUTH ROAD/RTE 28 (17)
mo a 771 1W- itltItttIIItIttItI ............IIIIIIIit ..........IIiIItitIItItitIIitittIIIIItIIIItititIl----------tI THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �C(�J IL DATA TOWN OF BARNSTABLE BAR-W Ordinance or Regulation WARNING NOTICE Name of Offender/Manager Address of Offender MV/MB Reg. # Village/State/Zip Business Name am/pm, on 20_ Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense Facts This will serve only as a warning. At this time no legal action has been taken . It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. I - WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. 4 600 Falmouth Rd Cent 7/2i 10 P, -4 WREN RED S P� �� S° KI DS SAT FREE ! Qom` �' �' 4s DATE(MM/DD/YYYY ACORD. CERTIFICATE OF LIABILITY INSURANCE 4/15/2009 ) 4/11/2008 PRODUCER Lockton Companies,LLC-1 Kansas City THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 444 W.47th Street,Suite 900 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kansas CityMO 64112-1906 HOLDER.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR (816)960-9000 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. _ INSURERS AFFORDING COVERAGE NAIC# INSURED 'CHARLEVSJNC-� INSURER A:.ZURICH AMERICAN INSURANCE CO. 14960 ATTN- JANIS REILLY INSURER B: LEXINGTON INSURANCE CO.(RMW) 3038 SIDCO DRIVE NASHVILLE TN 37204 INSURER C: LIBERTY MUTUAL FIRE INSURANCE CO. INSURER D: INSURER E: COVERAGES OCHIN01 DA THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS A THORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDT POLICY EFFECTIVE POLICY EXPIRATION - LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY _ EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY• GL09137282-02 4/15/2008 4/15/2009 PREMISEsOEa oCcurence $ 1,000,000 CLAIMS MADE FRI OCCUR MED EXP(Any one person) $ XXXXXXX X LIQUOR LIAB.$1.5M - PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 40,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- ' X POLICY JECT LOC A AUTOMOBILE LIABILITY BAP9137283-02 4/15/2008 4/15/2009 COMBINED SINGLE LIMIT $ 2,000,000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ XXXXXXX SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ XXXXXXX X NON-OWNED AUTOS t (Per accident) NXCOMP(1,000 DED) - PROPERTY DAMAGE $ XXXXXXX COLLISION 1,000 DED (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ XXXxxXX ANY AUTO NOT APPLICABLE OTHER THAN EA ACC $ XXXXXXX AUTO ONLY:, AGG� $ XXXXXXX EXCESS/UMBRELLA LIABILITY _ EACH OCCURRENCE $' 2O OOO OOO B 1210133 4/15/2008- 4/15/2009 X OCCUR CLAIMS MADE AGGREGATEN. 20 O0O OOO UMBRELLA t: $ XXXXXXX DEDUCTIBLE X FORM• $ ;XXXXXXX _ RETENTION $ it>3 $XXXXXXX A WORKERS COMPENSATION AND. WC9137280-02 - 4/15/2008 4/15/2009 X TORY LIMITS \ IMTS1\OTH- ER •• _ EMPLOYERS'LIABILITY r E.L.EACH ACCIDENT' $ '1:000,OOO ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? " If yes,describe under E.L.DISEASE-EA EMPLOt EE $ 1>000,0001 SPECIAL PROVISIONS below NO E.L.DISEASE-POLICY L14T $ 1,000,000 C OTHER YU2-L9L-527-227-048 4/15/2008 4/15/2009 250M LOSS LNIT,IOM FL /QKE, PROPERTY(ALL SUBJECT TO SUBLMTS MDEDS RISK/RC) IOM ORD/ICC DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS APPLICABLE DEDUCTIBLE&RETENTIONS APPLY. **THE COVERAGE LISTED ABOVE-DOES-NOT==EXT-END--AN-Y=FUR-T-HER THAN WHAT IS REQUIRED BY THE LEASE/CONTRACT.**RE:99 RESTAURANT-PUB#30088�1�60�OUTH RD.,.CENTERVILLE,.MA 02632 CERTIFICATE HOLDER CANCELLATION 2715855 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TOWN OF BARNSTABLE DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN 200 MAIN ST. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL HYANNIS MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESE E ACORD 25(2001/08) . For questions regarding this certificate,contact the number listed in the'Producer'section above and specify the client code CH r. ©ACORD CORPORATION 1988 L ' TOWN OF BAR TABLE BUILDING`PERMIT APPLICATION NS Map 47--ol— Parcel 0 1 (�6 VA- Application Health Division 4��t Date Issued Z p` Conservation Division Application Fee Planning Dept. r� Date Definitive Plan Approved by Planning Board B9 C(©J Historic - OKH _ Preservation/ Hyannis �I i7 C•7 Project Street Address (0O Village Owner o ajex Co-fPo t V-N Address _I GOO (en,�-e t of � , r1A Telephone 1 `7 `7 3 `7- )y 75 3 ®a 6 2LL Permit Request Co 3 van e V c c )(%--!nc A + d w� �� �� t oo �y - r G�e the � ` , - 1h a wlo v o.� O.l Zjo in sir A c `to _��`�6 r. c�Y. o�e^ rc)n ce c o v��o t-�.e 13-'f . / �`'� �Ccdj�v►co.Y,�' � ���j� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new „✓// Zoning District Flood Plain Groundwater Overlay Project Valuatioe- C, 000o 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 >ees ❑ No If yes, site plan review# Current Use A5sev_%bJ ,v (A -�;� Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 5i eVC, Lech§o7L4e Telephone Number Oil d' `70 a :70- S Address 11 License # Cs A 0`7 OF e � H N o i a 94 Home Improvement Contractor# 1` 6 3 1 o% Email JeVE.5gLAe. Co V_4Ai 0 V,\ � e�,�co c��o Worker's Compensation # YuJC- 100,60 f 8031a010 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 41k7116 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION — FRAME INSULATION FIREPLACE d ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING �� 211 DATE CLOSED OUT ASSOCIATION PLAN NO. T'lie Camnrorrivealth of 1Massap7r setts Dvar irterit cr lndusf ialAcddeyr#s Offi-ce of 1mv&igadons. i600 Washington Streetr � Boston,CIA 021.11 "4 fvitn f mas gm/diri NWarkers' Campensat anInsaranceAMdavit:$'mlderJCantraciurrsJEIecfricianslPlutubers Applicant Inform,atign Please.Print Legibly Iavae(HusmessfY3rganizationffzlnal _L e„ e s L Z tr Address: II in! 11 Cc 5 - �ityl t atel ig P'�.e+-� M A D) '3 91-1 Pliono-,a-- "VI I Z -7 D 8•- '7 O'n. .� Are you an employer?Check the appropriate bow Type of project(required): 4 I am a general contractor and I ' I.[�I atn a employer with � ❑ 6_ ❑New construction employees(full amUor part-time).* 'have hired the sub-contractors 2.❑ I am a sole proprietor orpastner- listed cn the attached sheet. _ 7. ,IRe-modeling shop and have no employees. Mese sub-conlrac#ors have g- ❑Demolition working forme is any capacity. employees andhave wodcers' [No ry-oricers'camp.insurances comp.insuranc�l g- ❑wilding addition: Y r ed- 5. ❑ pile are a corporation and its 10.❑Electacal repairs or a ddstiaus ' egrrrr 3.❑ I am.a hameau*ner doing atl want ofEcershave eesercised their 11_❑Plumbingrepairs or additions My � cBmF- sel£ o workers' right:of exemption per MGL ' 13.❑Foafrepaiis . _ ;nmrarice required-]Y ,. c-1.52 j1(4h and wehav- eno employem[Nowoikem' . . 13-❑Other comp_insurance require fl tAny appficsut tat cbecks box-I Mautthe sectionbelowsbohing theirwa3lEae camp—Mlinupa&cyinfocrosuaL Mmeawnem who submit ciiis Effidavif i :g they aze dais&Uwa k snA dbeahire outsideca tacrorsnmst submit a new affidavit indi-6n.- rcont<actorx tbzt Brea ihf box must a[tarhed as additional d teEt shoufug dm mine of the sub-ca=xcto and state whether or not fHnse entities bane employees.if the sub-cantmctarshave employees,theym istpmtade t-Mir worken'comp.policy number. I aaaa an euipla}Yrr tlirrt is prmzrIirrg n�ork¢rs'caarzperisrtif�xrt i�isrirancs f yr my*enrpl �e¢s Setow is tho policy andial,site €nforaararharL Insurance companyName: /1..i M }'l-Vi Toficy or Self-sus_Lic_ V UI L I OD OI 8 C`�3`1'- 2�O J A Expiation Date: I ,J '1 / f (o " Job&ifs Address: 9 600 It cA Cityl5tatel27T: Ce e r`v i '[ ,' n O'Q 6 3 0� Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and erp tiop date). FOure to secur-e coverage as regained use Se Llion 25A of MGL r 152 c=lead to the imposition of crimj"�1 penalties of a fine up to$1,5aa 00 andror one-ye-ariupxisonment,as well as civil penalties is the form of a STOP WdRFK ORDER and a one of ap to$250_GQ a clay against the violator. Be adidsed that a coPy-of this zft1amwt sway,be for�ded to the Office of firvest gatiom of the DIA for ivsuince coverage-verification- Ida IrerRby cerhfj�ustdar the pains and perrattres o. ter ur}r fl�atflaa iafarrriafior}pt i&d abmre is,true aiid carx'ect, Sastrature: Date phone ik -7 O� - �' B�1 Of j dal use onfy. Do rat write in 616 area,to be t:rrnspleted by cifp ai,tun'n officral. ' y City or Town: PerffitUcense# Issuing A.nfhorhy(drde one): L Board of Hiiealth 2.BuMmg Departmcat 3.Citplrowa Clerk 4.Electrical Inspector 5.Plumbing TTcpector b.Other Con€act Person: Phone#: Taformation and lastructions ... :. hfassaca„TSetEs Geheaal Laws chapter 152 regaires an euployers M provide workers'compensation far their empIoyees. p tr this ,an mnpLayee is dsfined as¢.every persanin$ie service of another under arty corftra.ct ofhire, express or mzplied,oral ar wrhen." Aa errplay v-is defined as-a m induvidal partnership,associafi&A corp Ora ion or other legal emit or ray two or more of the foregoing engaged m a Joint enterpase,and including the Iegal regresentaiives of a deceased employer,or the receiver or trastee of an individual,partaership,association or other legal entity,employing employees- However the owner of a.dwnffiog horse having not more than three apartments and who resides therein,or the occupant of the- dwelIing house of another who employs porous to do m.afig, nce,conshuction or repair work on such dwelling house . or on the grounds or bu fldmg appurfenantilieMt D shaH not because of such employment be deemed to be an employer." MGL chapter 152,§25C(t]..also gibes that"every state or local licensing agency shall withhold$ie issuance or ' renewal of a f[cerse or permit to operate a busmess,or tad"eonstruct b�uldm gs In the commonwealfih for any applicant who has notproduced acceptable evidence of complianeewith the ftmurance.coveragerequired;" Additionally,MC:L cbapter 152,§25C(7)states'W6ither the commonwealth nor ray ofits political subdivisions shall enter inb any contract for the pmfo=mce ofpublic WDIk until acceptable evidence of compliance vrith the;nc�rr�,ce.. requizemer1ts of this chapter have been presented to the contracting auiho&" App4can-b ' Please full oirt the workers'compensation affidavit completely,by cherkmg me boxes that apply to your situation and,if of necessary,supply sub-contractors)name(s), addresses)and phone n=ber(s) along vPith their cerap e;e s)th ii=mmce. LimitedLiabi ity Companies(LLC)or LimitedLiab1 ify ParfnenIips.(LIP)with employees other fhauthe members or partn=rs,are not regtm ed to carry woui-ers' compensation ihsor uce- If an LLC or LLP does have =ployees,apolicy is required. Be advised that this a$dayit may be sabmiue;d to the Department of Indn-strial Accidents for confurm.ation of mart- =coverage Also be sure to sign and datethe affidavit The affidavit should be resumed to tine city or tovru that the application for the permit or license is being mquestr�not the Department of n , Accide>li Mouldyou bane azry questions regarding the law or ifyour are required to obtain a workers' compensationpolicy,please call the Department at then=bmlisfed.below. Self-ins companies shou lcl enLtr$it r self-mince liceusenuimber on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and primed legibly. The Department has provided a space at.$ie bottom . of the affidavit for you to frIl out in the event the Office oflnvestig ons has to coDtr t you regarding the applicant. Please be sure to fll in the pemait/Iiceose mnaba which w,M be used as a reference number. In addition,an applicant that must sabmiL,multipleperuit/Hcense applications in any.givenyear,need only submit one affidavit indicatnng=ent policy i E l Mjation.(if necessary)and under`lob Site Address"the appliaatt'c should write"aR IocaEons in ( Y Or town)--A copy of the affidavit that has been officially siamped.:or-marked by the city.p or town.maybe provided to the pr ' applicant as oofthat a valid affidavit is on file for futur eeamits or licenses. A new affidavit must be Eled out cash year.Whew a home owner or citizen is obtaining a license or pewit not re7aie11 tQ•any business or commercial vent= (Le. a dog license or permit to bun leaves etc-,-)said person is NOT required to complete this affidavit The Office of Invesiigati wouldl e,to thank you i m adv-mce for your cooperation and should you have:any questions, please do not hesitate to give us a call tel hone andfax=nbet: The,Depffitmenf's address, ep The;C:G.=QUWMIth0f Mrs chv-Sdtts _ . l�egaz$ment cif 1�dr�ial Accidents .. _ CffiCe Of kVe&tigafiaL �R4 �Qn Bostoz4 MA 02111 T�1. 617-727-4 'ff-d 4-06 or 14771vsA 9AFE Fag 617-727-7749 Revised 4-24-07 p .Tn a s5 90VIdia. T, ���pomno7wieall�o��aaaar� ,� . O e!C Airs dc,dt ,Re$abti 0 i"FOR.. Tt...R i'yPe ` raffia►. IndNuel `N S7-I1/ t w: sT. .. ::. AM►0484+4 Uaderseesetary, IT 1 � :r x Ile, Massachusettsepaftment`of public Safety Board of Building Regulations and Standards ti Construction Supervisor .License: CS4)90705 �y STEVE LEVE9QI '` 11 WALLACE S ,t IYIETHQ)&N N. + �xpi.ration Commissioner 16 4 1 Town of Barnstable 'OrfD►,N.K� 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 14 Property OwnerMust Complete and Sign This Section if Using A Builder I _ as Own of he sub J ect roP - hereby authorize Levesque CmidnirAon LLC 'to act on my bebal in all matters relative to work authorized by this building permit application for: i l �0 0 •��.t 2d' �rt`�sv `1 Cna . (Address.of Job). LI S' atuae of Ownet _Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form:on the reverse side. Q:\WPM2S\FORMS\buildin r g permit foans\E3Q'RESS doc Revised 040215 XFINTTY Connect https:Hweb.mail.comcast.net/zimbra/h/printtnessage?id=279013&t... - �¢ drmage001.jpg ift _ 2 KB M. . 2 of 2 - _. _ - _ _ _ 4/21/2016 9:16 AM YYYl A��" CERTIFICATE OF LIABILITY INSURANCE . �oz/11�rzo1rvs 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: B 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 endorselrerd(s). ON PRODUCER NAMEACT Nicole Orlanzo BYETTE INSURANCE AGENCY INC. PHCN o : (978)851-6678 FnAc No; E-MAIL ADDRESS: nicole@akfowledns.com 200 Park St. INSURERS AFFORDING COVERAGE NAICO North Reading MA 01864 INSURERA: AIM MUTUAL INS CO - 33758 INSURED - , INSURER B LEVESQUE CONSTRUCTION LLC INSURERC: INSURER D: A 11 WALLACEST INSURERE: METHUEN MA 01844 INSURERF: r COVERAGES CERTIFICATE NUMBER: 30186 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS - CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUB POLICY EFF POUCYEIP POLICY NUMBER (MMIDD1YrYYl IMMIDOIYYYY) LIMITS COMMERCIAL GENERAL UABILT' - EACH OCCURRENCE $ CLAIMS-MADE❑OCCUR DAMAGES(.— PREMISES RENTED oaraa3 E MED EXP(Any one rson) $ N/A PERSONAL B ADV INJURY $-e GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY jEa nI. PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ Ea acddam ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Par accident) $ - NON-OWNED PROPERTYDAMAGE - $ HIREDAUTOS AUTOS Per accident E UMBRELLA UAB OCCUR EACH OCCURRENCE $ E%CESS WB CLAIMS-MADE N/A AGGREGATE - $ DED RETENTION E,' �/ $ WORKERS COMPENSATION X STATUTE ERH Im AND EMPLOYERS'LIABILTIY ANYPROPRIETORIPARTNER/EXECVE YIN E.L EACH ACCIDENT. $.100,000 A OFFICER/MEMBEREXCLUDED? NIA NIA NIA VVVC10060180392015A 12/172015 12/17/2016 - (MandatorylnNH) E.L DISEASE-EA EMPLOYEE$ 100,000 It yea,describe under DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY OMIT $ 510111,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It mom space Is mqulmd) r , Workers Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 8,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/twdhxorkers-compensationfirnestigations/. - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION-DATE THEREOF, NOTICE WILL BE DELIVERED IN - Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 382 Falmouth Rd. - ' �AUTHOR DREPNESENTATNE Hyannis - MA 02601 -0-0 L� Daniel M.Cr M ey,CPCU,Vice President—Residual Market—WCRIBMA 1988-2014 ACORD CORPORATION.All rights reserved._ _ ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I CERTIFICATE OF LIABILITY INSURANCE -DATE11/2D 6" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CER71RCATE 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 holder in lieu of such endorsemeld(s). PRODUCER CONTACT NAME: A 6 K Fowler Insurance PHOtAIC,NE (978)664-D366 . No:(978)664-2209 NO Park St Ea4AIL ADDRESS: INSURER AFFORDING COVERAGE RAIC9 North Reading MA 01864 INSURERA:Safety Insurance Company INSURED INSURER B Levesque Construction LLC INSURER C: - 11 Wallace St INSURER D: INSURER E: ' Methuen MA 01844 1 INSURER F: - COVERAGES CERTIFICATE NUMBER:CL1512210923 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, , EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IL R TYPE OF INSURANCE INSD VND - POUCY NUMBER MPOLICY EFF PPOODUCY EXP LIMITS R COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE®OCCUR DAMAGE TO RENTED 100,000 PREMISES Ea occurrence E BMA0024562 11/30/2015 11/30/2016 MED EXP(Any one person) $ 10,000 PERSONAL B ADV INJURY $.. 1,000,000 GENII AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY❑jE7 DLOG PRODUCTS-COMPIOP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea acddem A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED R. SCHEDULED SOS9073 1/16/2015 1/16/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS - Peraccident $ PIP-Ba' $ UMBRELLA LUAB OCCUR EACH OCCURRENCE $ EXCESS LUAB CLAIMSMADE - AGGREGATE - $ - DED RETENTIONS $ WORK ERSCOMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN _ STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTNE ❑NIA Workers CoapanaaTion--t E.L EACH ACCIDENT E OFFICERIMEMBER EXCWDEDy (Mandamry In NH) to follo separately. E.L DISEASE-EA EMPLOYE $ If yes.describe under DESCRIPTION OF OPERATIONS bekcx E.L DISEASE-POLICY LIMIT $ '- DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101.Addlelonal Remarks Schedule,may be aeached Ir more space Is required) Insurance verification - Please refer to actual policy for all other terms, conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 382 Falmouth Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Nicole Orlanzo/NMO ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 nm9ml 1 , I MOESER &• ASSOCI.A.TES 206 Ayer Road—Suite 2 Harvard,MA 01451 (978)456-6905 Office t Steven A.Moeser (978)456-9153 Fax F Architect. DATE: May 18,2016 TO: Building Inspector ' 'Jeff Lauzon FROM: Steve Moeser RE: Initial Construction Control Inspection Affidavit ' ` 99 Restaurant upgrade - -t 1600 Falmouth Rd: —;� CD Mr.Jeff Lauzon CM 'Attached for you records and in connection with-the building permit,pleases find my Control Inspection Affidavit fdF7 the above remodel. . r Please let us know if you require anything else. , Thanks - Steve Moeser Architect 4 Initial Construction Control Document ' To be submitted with•the building permit application by,a Registered Design Professional for work per the 8th edition of the Massachusetts State Building Code,,780 CMR, Section 107 Project Title: NINETY NINE RESTAURANT Date:May 18,2016 Property Address: 1600 Falmouth Rd. Centerville,MA Project: Check(x)one or both as applicable: New construction XX Existing Construction Project description: New image and decor upgrade I STEVEN A. MOESER, MA Registration Number: 5379 Expiration date- 08/31/16, am'a registered design professional, and I have prepared or directly supervised the,preparation of all design plans, computations and specifications concerning': XX Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to-the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts-State Building Code, (780 CMR), and accepted - engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals,by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as`applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and.this code. p Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the'building official. Upon completion of the work, I shall submit to the building official a`Final Construction Control Document' Enter in the space to the right a"wet"or V-0 Arc - electronic signature and seal: w 9 _N ° rn to arvat Phone number. 978-456-6905 _ Email. steve.moeser ~moeserassociates.com Q. • r � • ° FRGrH. Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other' is chosen, provide a description. Massachusetts Department of Environmental Protection Bureau of Waste Prevention Air Quality BWP AQ 06 1100241480 4 Notification Prior to Construction.or Demolition Asbestos Project Number# C.General Construction or Demolition Description(continued) The Asbestos Abatement Notification Number for this 16-0635 address is: This project C✓ Construction r Demolition is: 5/22/2016 5/26/2016 Project Start Date(MM/DD/YYYY) Project End Date(MM/DDNYYY) 8. For demolition and construction projects, indicate dust suppression techniques to be used r Seeding r Wetting I Covering 17.. Paving r" Shrouding r Other-Specify: 9. For Emergency Demolition Operations,who is the MassDEP official who evaluated the emergency? Name of MassDEP Official Title .......... Date of Authorization(MM/DD/YYYY) MassDEP Waiver Number A Certification "I certify that l have personally STEVE LEVESQUE examined the foregoing and am Print Name familiar with the information STEVELEVESQUE contained in this document and Authorized Signature •-- all attachments and that, based GENERALCONTRACTOR on my inquiry of those individuals immediately Rositionfritle responsible for obtaining the 99 RESTAURANT AND PUBQ information, I believe that the Representing information is true, accurate,and 4/27/2016 complete. I am aware that there Date(MM/DD/YYYY) are significant penalties for - submitting false information, including possible fines and P.E.# imprisonment. The undersigned hereby states, under the penalties of perjury,that I am aware that this.permit application or notification shall not be deemed valid unless payment of the applicable fee is _ made." r Revised:03/17/2014 Page 3 of3 Massachusetts Department of Environmental Protection . Bureau of Waste Prevention•Air Quality _ BWP AQ 06 100241480 Notification Prior to Construction or Demolition Asbestos Project Number# B.General Project Description(continued) 3.General Contractor: STEVE LEVESQUE 11 WALLACE STREET Name Address NEl}UEN MA 018446000 9187027095: City/Town State Zip Code Telephone STEVE LEVESQUE 9787027095 General Contractor's On-site Manager/Foreman Telephone General C. General Construction or Demolition Description Statement:if asbestos is found 1.Construction or demolition contractor: during a Construction or Demolition STEVE LEVESQUE 11 WALLACE STREET operation,all Contractor Name Address responsible parties must comply with 310 METHUEN MA 018440000 9787027095 CMR 7.00,7.09,7.15, City/Town State Zip Code Telephone and Chapter 21 E of the General Laws of JASON BURNETT 9783823087 the Commonwealth. Construction and Demolition On-site Manager Telephone This would include, but would not bw 2,Licensed Contractor Supervisor: limited to,filing an asbestos removal STEVE LEVESQUE CS-090705 notification with the Department and/or a Supervisor Name License Number notice of release/threat of 3.,Is the entire facility to be demolished? r Yes :No release of a hazardous 4. Describe the area(s)to be demolished: substance to the Department,if REMOVING 2 SMALL WALLS applicable. ----- MassDEP Use Only 5.if this a construction project,describe the building(s)or addition(s)to be constructed:. Date Received ?a 6. If this is a demolition or renovation project,were the structure(s)surveyed for the presence of Asbestos-Containing Material(ACM)? r Yes r No 7.Was asbestos containing material(ACM)found? r Yes F No If a survey was conducted,who conducted the survey? ENVIROTEST LABORATORY,INC A1900544 Name Department of Labor Standards Certification Number Revised:03/17/2014 Page Z of 3 `o Bureau of W aste.Prevention Air.(Quality BWP �i(1 A L ^ O6 1002041480 Notification Prior to Construction or Demolition Asbestos Project Number# A. Applicability A Construction or Demolition operation of an industrial, commercial, or institutional building, or residential building with 20 or more units is regulated by the Department of Environmental Protection(Ma'ssDEP), Bureau of Waste Prevention,Air Quality Division, under Regulations 310 CMR 7.09. Notification of Construction or Demolition operations is required under 310 CMR 7.09(2)ten(10)working days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09.is this a fee exempt notification(city, town, district, municipal housing authority,state facility, owneroccupied residential property of four units or less)? 1s this a fee exempt notification(city;town,district,municipal housing authority,state facility,owner-occupied residential property of four units or less)? r Yes R No Type of Notification: Revision of an Existing Form r Cancellation of Project Instructions: 1.Blanket Permit Project Approval,if applicable: ` Approval ID# 1.All sections of this 2.Non-Traditional Asbestos Abatement Work Practice Approval,if applicable: form must be completed in order to Approval ID# comply with the Department of B. General Project Description : Environmental Protection I.Facility Information: notification 99 RESTAURANT AND PUB ` 1600 FALMOUTH ROAD requirements of 310 CMR 7.09. Name of facility Street Address BARNSTABLE MA 026320000 5087908995 2.Submit Original City/Town State Zip Code Telephone Form To: Commonwealth of TOM HANN GENERAL MANAGER Massachusetts Facility Contact Person Contact Person Title P.O.Box 4062 5087908995 3088@99RESTAURANTS.COM Boston,MA 02211 Facility Contact Person Telephone Facility Contact Person Email Facility.Size: 3250 1 Square Feet Number of Floors Was the facility built prior to 1.980? f Yes r No Describe the current or.prior use of the facility: ASSEMBLY(A2) Is the facility a residential facility? r Yes F No If yes,how many units? 2. Facility Owner: BELL TOWER CORPORATION 1600 FALMOUTH ROAD Facility Owner Name Address CENTERVILLE MA 0263200010 6177371483 City/Town State Zip Code - Telephone JOANNE SOUTHWOOD .1600 FALMOUTH ROAD On-Site Manager/Owner Representative` Address CENTERMLLE MA 02632 6177371483 Cityrrown State Zip Code Telephone Revised:03/17/201.4 Page I of 3 r Bureau of Waste Prevention Air Quality , BWP AQ 06 Notification Prior to Construction.or Demolition • This is a revision to an existing form. Project ID for existing form to be.revised: r This job is being conducted under a Blanket Permit MassDEP assigned.Blanket Authorization ID: • This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: • None of the above conditions apply,generate a new form.. Revised: l l/l3/2013 Page l of l Massachusetts Department of Environmental Protection eDEP Transaction Cop Y IL Here is the file you requested for your records. To retain a copy of this file you must save and/or'print: Username: LCSTEVE Transaction ID: 826580 Document: AQ 06-Construction/Demolition Notification Size of File: 100.83K Status of Transaction: in Process Date and Time Created: 4/27/2016:12:58:40 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. TOWN OF BARNSTABLE BUILDING PERMIT.APPLICATION Map Parcel Application* Health Division Date Issued Conservation Division Application Fee b Tax Collector Permit Feed 5 L Treasurer 0'XIU toT4 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis ProjectStreet Address lLbo v Village Owner 019 �_ Address 146 mA Telephone W r 7 �-/67 Permit Request i1. c L J car AR C,01 ; Ae,, f ::L& 11 IVAIJ, ��111.:i0 �,. .-/ 'it1�f` �I./Z17. OLD IYV��J''�0✓ �G✓IijS . Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 9 3000. Construction Type t J Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. v 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 v Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing i new Number of Bedrooms: existing new = r Total Room Count(not including baths):existing new First Floor Roomdunt y 4 v > Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Cal Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal s ove: QYes0 No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exist ng ❑new sib 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 a ti Q ur a BUILDER INFORMATION 3 - _5`-7 L4 Q lg 7 U `FName� 13--733- � 33 e�—�d„- C_a LLC Tel�'�eph e Niarnber:�- � o� �Addr_ess �1 �✓Am�u-Ie ��re,4 License# GS b�7935� ,. /"- ' .iMA (24A Home Improvement Contractor# 'Worker's Compensation# (t)C 6 67Y9 q9 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO q E SIGN ATUR_`__E_� � "�'CJ FOR OFFICIAL USE-ONLY ' APPLICATION# DATE ISSUED r N.IAP/PARCEL NO. l V i ADDRESS VILLAGE OWNER 1 , DATE OF INSPECTION: FOUNDATION FRAME x INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations _ 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers-' AP.Plicant Information Please Print Le ibl Name(Business/Organization/Individual): ti 8od<s Address: City/State/Zip: 5/or;,,Q MA ojtl`6 Phone#: . q13- 733-'l33 Are you an employer? theck th appropriate box: Type of project(required): 1. g I am a employer with / 4. I am a general contractor and I 6. New construction ❑ employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the:attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g; Demolition workingfor me in an capacity. employees and have workers' y p �'• $ 9. ❑Building addition [No workers'comp.-insurance comp. insurance. 10.❑ Electrical repairs or additions required.] ' 5. ❑'' We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their I LEI Plumbing repairs or additions myself. [No workers' comp. right of exemption per.MGL 12.EJ Roof repairs insurance required.]t . c. 152, §1(4),and we have no employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. M w G 6 l Expiration Date: Job Site Address: ( City/State/Zip: Ce•.-",/z Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage veriftation. I do hereby certify under th ains and penalti s'of erjury that the information provided above is true and correct V� Signature: < Date: L r Phone#: 3— -/ 3 `� (f 3 3 ' Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): . I.Board of Heaith 2.Building Department 3.City/Town Clerk.4.Electrical Inspector 5.Plumbing Inspector 6.Other 'Contact Person: - Phone#: j Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, V express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced_acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance N;rith the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that_the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts liePartin ent of Industrial Accidents Office of Investigations f 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax#617-727-7749 wyutw.mass.gov/dia DATE(MM/DDIYYYY) ` PR'.CER RD1, CERTIFICATE OF8LIABILITYISINSURANCE ASAMATTEROFINFORMATION07 (413)737-3539 ( ) CERTIFICATE IS ISSUED Bates Ful l am Ins. Agency Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 110 Elm Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. West Springfield, MA 01089 'INSURERS AFFORDING COVERAGE NAIC# INSURED Allen & Burke Construction, LLC INSURERA: Netherlands Insurance 24171 37 Warehouse Street INSURERB. Excelsior Insurance 11045 Springfield, MA 01118 INSURERC: Peerless Insurance 24198 INSURERD: American Home Assurance Comp CISI02 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY CBP8049137 06/13/2007 06/13/2008 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 100,000 CLAIMS MADE a OCCUR - MED EXP(Any one person) $ - 5 r 00 A - PERSONAL&ADV INJURY $ 1 1 000 1 00 GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00( POLICY X JECaT El LOC AUTOMOBILE LIABILITY - - - BA8043738 06/13/2007 06/13/2008 COMBINED SINGLE LIMITf $ ANY AUTO (Ea accident) 1,000,000 ALL OWNED AUTOS BODILY.INJURY $ B X SCHEDULEDAUTOS _ - (Per person) - X HIREDAUTOS BODILYINJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ - I (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - - OTHER THAN EA ACC $ . AUTO ONLY: AGG $ - EXCESSIUMBRELLA LIABILITY CU8040839 06/13/2007 06/13/2008 EACH OCCURRENCE. $' 5,000,00 X OCCUR CLAIMS MADE AGGREGATE $ 5,000,00 C $ Fx DEDUCTIBLE] RETENTION $ 10,00 i $ WORKERS COMPENSATION AND WC6874949 06/13/2007 06/13/2008 X WC'RySTATLIMU- X I ER OTH- EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $ 500,000 D ANY PROPRIETORIPARTNER/DCECUTIVE OFFICER/MEMBER EXCLUDED? - - E.L DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under - SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS arpentry Contractor CERTIFICATE HOLDER CANCELLATION ' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, _ BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY For Bidding Purposes Only OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Proof of Insurance AUTHORIZED REP RESENTAnVE Ernest Bates, Sr./BATGLl �'�'° ACORD 25(2001108) ©ACORD CORPORATION 1988 PDF ire or - PDt=4rr�e v�.0 htt�:/h�v mi.Dd;'4 ree.com Taff Town of Barnstable Regulatory Services BMMSTABM r MASS. g, Thomas F.Geiler,Director t 16.19. n Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder k)i Ibvf-n as Owner of the subject property hereby authorize A I 1 C'N —r �V�('� � : 1�}��;-�-, to act on my behalf, . in all matters relative to work authorized bythis building permit application for: 6dc-) :)�Cd Nib U714 q" ' (Address of Job) /'� � +y A It r _ r •Q� . Signature of Owner Date Print Name If Property Owner is. applying for permit please complete the Homeowners License Exemption Form on the reverse side. QTORMS:O WNERPERMISSION Town of Barnstable �FZME taY 0, Regulatory Services M LF� : Thomas F.Geiler,Director ' MA98. � 16.59. .,erg Building Division 'OlEo MA't A Tom Perry,Building Commissioner 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 six 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 be/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 building 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 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 t amend and adopt such a form/certification for use in your community. Q:fonns:homeexempt BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 077938 Expires: 06/08/2008 Tr.no: 27243 Restricted: 00 JOHN BURKE 19 CAMELOT LANE., G WESTFIELD, MA 01085 Commissioner o0-35,000 cf enclosed space (MGL C.112 S.60L) 1A-Masonry only 1 G 1'&2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. )344-7233 DIG SAFE CALL CENTER: (888 CONSTRUCTION CONTROL AFFIDAVIT PROJECT TITLE: Ninety Nine Restaurant DATE: 01/21/08 PROJECT LOCATION: 1600 Falmouth Road Centerville, MA SCOPE OF PROJECT: Remodel of existing restaurant In accordance with Section 116.0 — 116.2.2 of the 6th edition of the Massachusetts State Building Code: I Steven A. Moeser Massachusetts Registration # 5379, being a registered professional Engineer/ Architect hereby CERTIFY that I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: ENTIRE PROJECT: ARCHITECTURAL: X STRUCTURAL: MECHANICAL: FIRE PROJECTION: ELECTRICAL: OTHER (SPECIFY): For the above named project and that to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, all acceptable engineering practices and all applicable laws for the project. Furthermore, I understand and AGREE that I shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that the work is proceeding in accordance with the documents approved by the building permit and shall be responsible for the following as specified in section 116.2.2: 1. Review of the shop drawings, samples, and other submittals of the contractor as required by the construction contract documents as submitted for building,permit, and approval for conformance to the design concept. 2. Review and approval of the quality control procedures for all code required controlled materials. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. I shall submit periodically, in a form acceptable to the building official, a progress repo pertinent comments. Upon completion of the work, I shall submit to the building official i tot he satisfactory completion and readiness of the project for occupancy. ��j�,N P No. 5379 N u) H va v, Signature of Registered Professional: F� S bscribed'and sworn be ore me this 21st day of January , 2008. — my commission a ires on October 24, 2008. of ry Public: Lau a nn Fleu File: A-08051 02-11-2008 , 10:14 FROM-ALLEN AND BURKE CONSTRUCTION. +4137337153 T-483 P.002/005 F-829 Massachusetts Department of Environmental Protection eDE P Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: JLAFOGG Transaction ID: 166671 Document: BWP-Demolition Form for AQ•06 Size of File: 137.839 K Status of Transaction: PAID Date and Time Created: 211112008::9:38:33 AM Note: This file only includes forms that were part of your _ transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals,pege. 02-11-2008 10:14 FROM-ALLEN AND BURKE CONSTRUCTION. +4137337153 T-483 P...003/005 F-829 r. Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 100067843 Decal Number BW P AQ 06 Notification Prior to Construction or Demolition Important A. Applicability When filling out forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or . to move your residential building with 20 or more units is regulated.by the Department of Environmental Protection cursor-do not use the return (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7,09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10) days prior to any work being performed.The following information is required pursuant to 310 CMR 7.09. B. General Project Description 1. a. Is this facility fee-exempt-tit , town, district, municipal housing authority,.owner-occupied Instructions residence of four units or less?�]Yes ✓1 No 1.All sections of b, Provide blanket decal number if applicable, Blanket Decal Number this form must be completed in order to comply with the 2. Facility Information: Department of gg RESTAURANT Environmental Protection a.Name notification 1600 FALMO ITH ROAD requirements of b,Address 310 CMR 7.09 MA 02632 c cityrrown- A-Zip Co 5087908995 E-mail Address o tionai h.Size of Facility in Square Feet I.Number of Floors j.Was the facility built prior to 1980? ❑ Yes M No k. Describe the current or prior use of the facility: RESTAURANT I. Is the facility a residential facility? ❑ Yes No o M. if yes, how many.units? Number of wits =° 3. facility owner. 99 RESTAURANT �.�p 160 FALMOUTH ROAD -- b.Address MA —� 02632 ME �—�- BARNSTABLE ° 5087908995 —C - - �Q h;Onsite Manager Name . "■ ag06.doc •10102: BWP AQ 06 -Page 1 of 3 .02-11-2Q08 10:14 FROM-ALLEN AND BURKE CONSTRUCTION +4137337153 T-483 P.004/005 F-829 LlMassachusetts Department of Environmental Protection 1000678�3 Bureau of Waste Prevention o Air Quality Decal Number BWP AQ 06 1 Notification Prior to Construction or Demolition General B. General Project Description (cont.) Statement;If ' asbestos is found during a 4. General Contractor. Construction or Demolltlon JALLIEN&BURKE CONSTRUCTION LL.0 operation,all responsible parties a. must comply with 137WAREHOUSE STREET 310 CMR 7.00, 'b,Address 7.09,7,15,and SPRINGFI ELD MA 01118 Chapter 215 of die rate e.Zip C de General Laws of c.Cityrrown the Commonwealth. 14137338233 This would include, f.Tele ho Number, a code a extens o -mail ells o 'anal but would not be JOWN BURKE limited to,filing an asbestos removal h.on-site Manager Name notification with the Department and/or a notice of release/threat of C. General Construction or Demolition Description release of a hazardous substance to the 1, Construction or demolition contractor: Department,if applicable, ALLEN &BURKE CONSTRUCTION a:Name 37 WAREHOUSE STREET b.Address SPRINGFIELD MA 01118 c.Cit Town - d,State e,Zi Gotlo - 41 V338233 f,Telephone Number area code and extension E-mail Address o tional JOHN BURKE h.On-site Manager Name 2. on=Site Supervisor: - JOHN BURKE On-Site Supervisor Name r 3, Is the entire facility to be demolished'? ' [] Yes ✓[� No �N �0 4, Describe the.area(s) to be demolished: _�o REMOVE EXISTING CEILING TILES IN DINING ROOM �N r•�O If this is a construction project, describe the building(s) or addition(s)to be constructed. RENOVATION �,ag06.doc -10/02 BWP AO 06 -Page 2 of 3 .02-11-2408 10:14 FROM-ALLEN AND BURKE CONSTRUCTION " +4137337153 T-483 P-005/005 F-829 Massachusetts.Department of Environmental Protection -` Bureau of Waste Prevention • Air Quality 1000s7843 BW P AQ 06 Decal Numbee Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont:) 6. a. If this is a demolition project,were the structurc(s) surveyed for the presence of asbestos containing material (ACM)? ❑ Yes ✓ No If yes,who Conducted the survey? b.Survevor Name c.Division of Occupatlonal Safety Certification Number 2r24i2008 �� 2/27r'2o08 7. Construction or Demolition: a,Start Date(mm/dd/yyyy) b.End Data(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: seeding paving b. If-other, please specify: ❑ wetting shrouding ❑ covering ❑✓ other PLASTIC 0. For Emergency Demolition Operations,who is,the DEP official who evaluated the emergency? a_Name of DEP Official b.Tide C to mm/dd/ of Auithqrization d.DEP Waiver Number D. Certification I certify that I have examined the JOHN BURKE o above and that to the best of my a,Print Name knowledge it is true and complete.. IJOHN BURKE The signature below subjects the b.Authorized Signature ---N signer to the general statutes OWNER �o regarding a False and misleading c, Posib6rVT1E1Q -c statement(s). IAII LEN &BURKE CONSTRUCTION LLC d.Representing 02111/2008 �to o.Date(mm/ddlyyyy) ' �d ag06.doc •10/02 BWP AO 06 -Page 3 of 3 FFB/08/2008/FRI 14: 49 COMM FIRE DEPARTMENT FAX No. 5087902385 P, 002 , FMF DEPARTMENTS OF THE 'OWN OF BARNSTABLE Fire Prevention Office - Hinckley Building 200 Main 8t>reet, Hyannis, MA'02601 (508). 862-4097 . .DUILDIN'G .CODE COMPLIANCE FORM Plans dated { f r;the,_property locaxed.at,. 6(j_0 &0 rAtL ..also known ash have.been reviewpd.by.. of the E] Samstable Cow.: ❑ Cotuit `.. El Hyannis- 0 West Barnstable ,.-,Fine De:pal tmont. THE CHART BELOW INDICATES THE STATUS OF THE REVIEW: TYPE OF CONSTRUCTION DOCUMENT N/A RECEIVED REVIEWED- COMPLIES, 1. Narrative Report 2. Firefighting & Rescue Access ' 3. Hydrant Location &Water Supply 4. Sprinkler Systems X ' It (� 5. Sprinkler Control Equipment 6. Standpipe Systems 7. Standpipe Valve Locations 8, Fire Department Connection 9. Fire Protective Signaling System <Q,�/� C 10, F.P.S.S. & Annunciator Location 11. Smoke Control/Exhaust 12..Smoke Control Equipment Location 13. Life Safety System Features 14: Fire Extinguishing Systems 15, F:E.S. Control Equipment Location ° 16. Fire Protection Rooms : 17. Fire Protection Equipment Signage 18. Alarm.Transmission Method 19, Sequence of Operation Report 20, Acceptance Testing Criteria We believe this document to be complete and compliant for the issuance of a building permit. We have completed the acceptance: �lncMpp ,pcta�pancy permit and believe that within the scope of the building permit, the above issues ia'nce: ---- - D.a. . TOWN OF BARNSTABLE _ SIGN PERMIT ; . PARCEL ID 209 014 GEOBASE ID 12812 , ADDRESS 1600 FALMOUTH ROAD (ROUTE PHONE ! CENTERVILLE ZIP LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT ' 59852 DESCRIPTION NINETY-NINE PUB - F0 SR FT ' PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: ' ARCHITECTS: Department of Health, Safety t and Environmental Services TOTAL FEES: $100.00 BOND $.00 ptr Tt1E ( CONSTRUCTION COSTS $_00 753 MISC_ NOT CODED ELSEWHERE * BARNWABLE, MASS. 1639. BUIL/DING DIv.Is01� BY " DATE ISSUED 03/22/2002 EXPIRATION DATE Town of Barnstable � - �OF1HE T Regulatory Services Thomas F.Geiler,Director + BARNSTABLE, « MASS. $ Building Division .9 i63 ��� i0lp Peter.F.DiMatteo, Building Commissioner .200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Tax Collector Treasurer Application for Sign Permit / Applicant: N�N��� 'N A,�Q S Assessors No. el Doing Business As: TovS T'iNv Telephone No. Sign Location . Street/Road: Zoning District: Old Kings Highway? Yes g>yannis Historic District? YeSE�) Property Owner Name:- C\P��Vk� /�1 �So�,s Telephone: 0 Address: �60 'F:2 5'1' SIT - Village:'B���ev,r Sign Contractor` m v Lm 5\�' (O ���s �j —a�j Name: Telephone: Address: . S� Village: S� Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? dpo (Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to.make this application,that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. . Signature of Owner/Authorized Agent, Dater S e: �'Size,: X 99 `�j 0 a� V U Permit Fee: !a� Sign'Permit was approved: Disapproved: Signature of Building O �ciaj: Date: Signl.doc rev.122801 r `� c�ced�� �a Cam , NIN T Y INE Restaurant • • 30" X 24' I � S0 63 OLD MAIN ST. S. YARMOUTH, MA. 02664 ign co., �508> 398-2727 �508� 760-3730 Fax =ao_ so. �a5g e-mail; plysigncomCa3capecod.net y, CUSTOMER PERMIT No. DUM BY DATE: rti� , II MATERIALS BY P.QAPPHOVED LOCATION: �.� SCALE REVISIONS: TOWN OF BARNSTABLE SIGN PERMIT' PARCEL ID 209 014 GEOBASE ID 12812 ADDRESS 1600 FALMOUTH ROAD (ROUTE PHONE CENTERVILLE ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 61341 DESCRIPTION NINETY-NINE PUB 60 SQ CHANGING COLOR PERMIT TYPE BSIGN TITLE SIGN PERMIT r CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $100.00 ME BOND $.00 Oki CONSTRUCTION COSTS $.00 753 MISC_ NOT CODED ELSEWHERE HAANSTABLE, # I MASS. I 039. FD MA'S BUILD -' BY r DATE ISSUED 05/28/2002 EXPIRATION DAT Town ®f Barnstable Regulatory Services Thomas F.Geiler,Director snxNsraBi.E, Mrs• 1639• $ ]Building Division ♦0 T ATE p Myr°' Peter F.D#VIatteo, Building Commissioner .200 Main Street, Hyannis,MA 0260.1 Office: 508-862-4038 Fax: 508-790-6230 5g '7C�0 3 / 3U Tax Collector Treasurer Application for Sign Permit Applicant: 1V �V� Assessors No. zo ! O Doing Business As: Telephone No. Sign Location �s Street/Road: �� r ALMO.^ Vb ��N� V��� A&A ®4Z( 3 Z Zoning District: Old Kings Highway? Yeq o Hyannis Historic District? Yes To Property Owner _a Name: �`�► CA►�� h Telephone: Q' Address: Village: ��%JAA Sign Cont or !L� Name: Afti kio Telephone: Address: .O C1flAi Village: `�` • Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,.location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Y( eo (Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to.make this application,that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: Dat Q 4, mw �l e` �_" -.- ®' Permit Fee: /�p I Sign.Permit was approved: - Disapproved: Signature of Building Offici � Date: — `a Z. Signl.doc rev.122801• � LJ`' r 99 Rest. & Pub Centerville., MA a ee�gi C . x LPM - 009S.J PG - 3#�'C'f' it�w,t'u , TOWN OF BARN STABLE § la s SIGN{PERMIT ::,.?�.;�A v?r�'.�! A +r 4 �. _.c c :, �i,� _ r' C..+�. _'iA `S:.� �.F }.� �, 1 , 1 r `�- r �' 3•y .e,Ci. .E+��'�'r Y a i r. �" r, r Vie",ry$ , JF t � } > a ! � rct• { r ,> � + -S r -1":•[''s�.•e. td .: Et i s e fi a ss ,,...ir..,.Y J,w-,+...sa, i,_.-;.:, t n.. ,.„ f t x{r -'�. r ) ::� y _rs 7 Z.t, .,G;i,� r' -dEOBASE ID ,,.:.,� . n :; : .. „L1TH 'ROF,D (ROUTE <rnx, s �n - x + ADDRESS �� 160ba,FALMO h =ZIP` ,. ,t • ' - +"� 4{v1 yCdt2 dry a t _.t faq� ,a Ys.t�y W �'t- .}c e,i� mCENTERVILLE . t..aT x ,.s.. .. r,+t .r��, z .�' � ��,•- -.;x _ f xh t-•+t '� "t';.r :} Y t d� ° yo^ t n �,�.,;., �...;i �Ri � :4 t��.�. £ti •" ::a 1 ;� � '$ a �wli..4:. ly}` e^g t.... fib,"� SLOT ,. 5 s� DISTRICT `CO , y st aY � '-DEVELQP,MENT ,n3tjs ', ant n .a g �47 :- t r . ''i"`,i.= j'`'-:3.^r ;w it 'C •� rw„G..m"2.�•. ,y... a�,... .;r, e. v�..Z*1 <.'. -, '� .:O.S.r., k4,?""-'•�'. 't. + <rF #w 1 A at:DBA .Y';y, p rr 4 iri 3 aS �'i c �Csa :a 1`pTMs C$ G � '�,ta , 3 Lr �`i. ^i 1'`a,,;kk t<r. s -3 N ,+n xX :. ,a+.<'3±z` t .c. t°'.�' x}''t'r , �>-vr'i":'E+:t,A t. , x < r-A�•^"^ S+- ¢,.. 'S-v tx.x t\>4i At",�, } t" s k F. r eT .. . .ttt *. kY ; i _. ..�� � ..,. T — NEPUB°x:;� T60SQt.FT ,i ��� F A�.DESCRIPTION 'NINE YNI, t. � at . .i ;`.� x :: ":, _ k '� x� �' , 59852 , � PERMIT, � .r s� aY. n ._,, Ft a .g �xt ,.? � � t<, Nxq, 4 ; ,frF ..,.. �., .. . �z . s; SIGN PERMIT x uyc :5 , kl, f :k t "�` +-T ITLE •::'�r. .�- ;5..'� F :•'mot •, i � .a�Y`� €. S-, ,E r, , si'y +�, �s4 4 `"s t: T�1�MIT TYPE ,BSIGN �, t; !� .A x�i R ' > p�f ��� "P,P.+ .� •r k:_"-' a'=:wy. ..,.., 'w�,,„ ;,,«.-C-'..' ..ss=iR `, ..r. `.y^ '' `* ,• `g •'t33 '.; ,[. c '`' k> ^t §:. •d�`�aY�,-,. _` ff'Y;`aua'..- MeAs }el rKC; a y # , eY � ��#r. �� ,,,'�r x. rt � Lk,-yA'.5 �'e 'i "+t' t.t�y.' '3 '�.�"m. .rk�.... sa{+`-.;L-. , ���_ .�.� k~7 , � ;,� ��}� ��ta��3�., ear=.,tment.of:�Health` Safety js Y as 3+xt ,. �a ,. ,. � � D�.- p 4 �kCONTRACTORS r rY N ,s; ,K >, xk ; � +. _ ,,� ti �F a :� in 'a ��:r �rARCHiiTEGT$ °, rt Yb � andEnvironmenal � ? a y 5� Fn j a �x �" 7a ct;r�t xri...E. • � "� ai"• a., �<'-`"N,. &yr,x'fye,a p "`1 pv� 'L�,''� },y�qv�� :d. R t.. @ ^t.�..,� q.. } + 4..eY' .7nc�', �00 OO ,i'Y*[ L,{t�,� "A; «7 rt01, :ti k i :t r'+�°" , ,Vl �5cYi y'�Sf<41 ar ri. TOTAL <FEES tf ;u f �� :. �� a S s zq =w n; - ter-.�� O O.3 rf .�t.'� ;a r '' *" '' ' L`>'y f-:'R3'i r.e «..XrM.' "f,-t t Y r `"`UY��fiG..S'}�c ,sxOO: ,y, fr. ?tk3..1�. "� ' . '� `.>.,r. h'^ ;CONSTRUCTION COSTS �� Y ' y':` t °tt� � r . as ,x � ! k :-yw - �9•F"' �"•S - � x�•? 'y+ -�"+ .�t'+ � '>f rF � i.._...- _ r 3 .�"��3'cl 5?� n -'�'.�� .M, [ •Ly x, � _ CODED ELSEWHERE - k MISC NOTr "�.r r C :'�•: e �o-,g.,,4: �s y';' tR F,,t 4 x..r..,r .�y.t,r a ���� '�'-urr`�ialr"a,�;. e��,.f:�3 +'c7� °-�y: e +ta sF,'?s � ,�,� .,r,'}�;x g�ac �• �` .` A-k•,�r r"i -� i�,..'`; ..,� r N �f L ,:v� ,, 5,..4 wit t"' .; �{,,4A7},-i # -1r�;���'d.. .'�"•r; y..�.} °�' .ti.� r� '�Mi.'�-�3"�` s:].. ,L .x s i�;,7� M1 t,..t •+'s�;"e yz#�.;b.�r,g,'.,S r p ' "' 4"F. r 3•,,�t3 <♦A �i� ssa*e�`�Y. cit � .; _. + . e + r a � �t tf ;,s kS "ri5✓ �,,'' ��iE1 z 4" �r� V. �..-'4- W , i th �s .�.. .� ,.. d w ^^s y z < t 'h - F2 ♦y 'L} a� 7 c t r. l 4 } �. 3 t ✓.Y +1 .. ¢w atar? �` i TT DI .ISM 1�x t }; yt t'rr' t } .'», e .�,� -7 ��.; a• t" � .,, o}ttf .�t. ti.n :a M i zk B a LLl .{.. x ::'�n,�?� ._£-��.,'�-J�`'�'{C�����}},,r t r... " ♦ Y� �� 5 -._ �rT -m wi n L r.f F a "� ,x .1 t a+ LX s::-". L 1Y 1 1T ON� E ra rDAT ',a` =r 03 22200 �EXPIRATI y* > DATE ISSUED / S t r — Eric r - . ,a Ch1Y7C printer profile .. _-=ault'screen • ''Z A t I ' 30!' 193/4!! 7 #—o n O : IO►J g 30,•. ZO" ExIsTIrJcr, s/y w.&LL slcnl. . P WAAcE Ex)sTW(El slc�nl w/oPT1o1J A "99" oPTIOnI � -' ,. No�sESNoE T�- IJEw sEL cotJ A,IIJED )rJ .. )LLum. c A, I J L T (J[y _ (/,q�) v FWO ACES 3TYELLOWHNMPACTACRYLIC LETTER AAl> vl►J4 (W-A.PN)cs. _y FACES HN ACRYLIC T- FACES HHMFACTACRYUC A A' h B� LLUMWHITENEON Y 1b nREDNEON A SLUMINATION. ILUN WHffE NEON - � ILLUMINATION. q Y AN TRSFORMERS 3dne Y TRANSFORMERS 30— B i} C� TRANSFORMERS 30me B `'•' ' Jm 33 red. ' C IC I � D� IO ECONOLITE LETTER io—ECONOLITE IETTER BACK +, - _ '�' Ia..ECONOUTE LETTERSACK NEON TUBE SUPPORTS NEON TUBE SUPPORTS 3m 25 yellow D V TRW NEON TUBE SUPPORTS D !r 11LACW CAP H y V TRIIM AP H ` - F� 22--T IM CAP - H - ED. • V WHO UMIN ALLS PAINTED E (C> .=/ ALUMINUM WALLS PAINTED WHME .000 ALUMINUM WALLS E f f� BRIGHT GOLD METALLIC J� a 4llaCl( TO R SOURCE.1/2 EL ICAL CONDUIT L y - �( TO POWER 112-ELECTRICAL SOURCE.DUR lFD !( TIQ ELECTRICAL O PoWER SOURCE. �FD� - - F OFF ATAC By OTHERS V FINAL CONNECTION BV OTHERS T/ {� Y - t /. _ FINAL CONNECTION BY OTHERS 0 oF.ATTACHMENP. G METHOD OF ATTACHMENT.' , G �.METHOD OF ATTACHMENT. metallic gold ENDING ON WALL ACCESS DEPENDING ON WALL ACCESS DEPENDING ON WALL ACCESS horseshoe CONDITIONS EIOR 311"LVANIZED WALLCONDITIONSSCREWS R GALVANIZED CONDITIONS EITHER GALVANIZED (tor I IOrSeSI IOe WALL DED R D R "WALL SCREWS OR 31S WALL SCREWS OR 18- THREADED ROD AS RED'0. THREADED ROD AS REDD .. THREADED ROD AS REOD. FLUSH MOUNT. FLUSH MOUNT. - N FLUSH MOUNT. returns — !, JDESIGNER _ T• NOTES: POY4 � CLIENT qq DES r. SALES Ep I DATE �A5� SCALE �"-1• o tJ�P t THE OFFICIAL WEB PRESENCE OF I JOB Number/TITLE GEIJ E v)LLE, MA S _ T R POYANT SIGNS-INCORPORATED. 0 Q 0 REVISIONS • . �• � PROVED BY: DATE } a 1 8 • • ' c • • L • • • • I •• •� • • • •� • .-. cs 1. .•cvc.. ..L_ L ,, .,.. :.- :, ,.,.,:. -::-. " - ..: i.,'- - .i`..:' .�...:�r TOWN OF BARNSTABLE i CERTIFICATE OF OCCUPANCY PARCEL ID 209 014 GEOBASE ID 12812 ADDRESS 1600 FALMOUTH ROAD (ROUTE PHONE CENTERV I LLE . -�' ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 60157 DESCRIPTION C/O FOR NEW " 99 RESTAURANT/ FIT-OUT PERMIT TYPE BC00 TITLE CERTIFICATE OF OCCUPANCY CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: BOND $.00 Ok tM1E CONSTRUCTION COSTS $.00 I 756 CERTIFICATE OF OCCUPANCY 1 PRIVATE P;*I�F ` # BARNSTABLF, • MASS. 039. A`0� FD MA'I BUILDj N, G DI�VISIOa DATE ISSUED 04/04/2002 EXPIRATION DATE BY _ TOWN OF BARNSTABLE � - BUILDINP, PERMIT PARCEL :ID "209 ;014 . CEOBASE ID 12812 ADDRESS 1600 YALMOUTH ROAD" (ROUTE PHONE' _ CEN`1ERVILLE ��... zIP LOT...,`, BLOCK.' LOT'•. SIZE DMA . °' ' DEVELOPMENT DISTRICT C w IPT�ICit� 1 r p FOR .NEW' °°99"/FIT—UP/NO WAIT YpEwl- � �UC � � � L����� �T�CO��! I CONTRACTORS. MICHAM CARDAMONE ARCHITECTS: t Department of Health, Safety TOTAL- FFES; _ '}0 $29Q, , :and Environmental Services BOND $.00 per CONSTRUCTION. COSTS $40;00.0.DO �•� 753 MIBC, NOT CODED ELSEWHERE I i PRIVATE P' Q s' * BARNSUBM +' 16 BUI G D I DATE ISSUED 03/05/2002 EXPIRA�'IOI PATE BY THIS.PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR,ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST IBE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROMTHE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK:. APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR t.FOUNDATIONS OR FOOTINGS I 2. PRIOR TO COVERING STRUCTURAL MEMBERS .HAS BEEN.MADE:WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND M FOR (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. CH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. 1618=011 • km m I = n ® e val 'I BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1A -- ' PR�3'- � 11 _ � I 2 . 3. 6 3 1', HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I 2: BOARD OF ALTH OTHER: n Ita2z SITE PLAN REVIEW APPROVAL r)pia I I WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA TION. NOTED ABOVE. TION. IL f �s MADIGAN F.W. MADIGAN COMPANY, INC . 54 MASON STREET rai RO. BOX 20670 a WORCESTEI MA 01602 ' TEL: 505-753-11459.rs,.FAX: 508-754-4483,r WWW.FWMAI�IGAN.COM �- April 18, 2003 Mr. Jack Fitzgerald Town of Barnstable Building Department 200 Main Street Hyannis, MA 026.61 !�RE:C:) Nine Nine Restaurant &Pub ` � 1600 almouth Road Cent.rvill M FW Project No. 0203 - Jac , A follow up to our discussion, the enclosed is a check for the building permit fee in the am unt of 11244.00 (TWO HUNDERD FORTY-FOUR AND 00/100 DOLLARS) for work performed at the above referenced location. This should allow you to close out the project on your end. Don't hesitate to contact me if you have any comments, questions, or if you require further information. Thank you. .Jk-G> o S. e&IdL4-�� Michael S. Cardamone Project Manager n04 S ` r GENERAL CONTRACTING 13 CONSTRUCTION MANAGEMENT a DESIGN/BUILD F W MADIGAN COMPANY, INC g P O BOX,20670 54 MASON STREET' FLAGSHIP BANK 53 287 WORCESTER MASSACHUSETTS016Q2 WORCESTER MA016g8' 113 z; i r DATE.: CHECK NO CHECK�AMOUNT a hg�4(��t190. 0 * 2 4 4 0 0 s PyF � 14''fa .K� +EMf� {I a alp "Itk ��FII ,tt t y } r My 6 2 .F � f� - • �• �� E ID 4y TO THE Town o; Banstable ORDER OF s AUTHORIZED SIGNA URE �` j II'004 266u 1:0 1 130 26 L6II: 00 L 00 168 L 9u■ REMITTANCE ADVICE DETACH BEFORE DEPOSITING F.W. MADIGAN COMPANY, INC. VENDOR NO. VENDOR NAME ggp 99 Restaurant ,.Cente ville _ Project #, 0203 Building Permit AMOUNT 'a + 19090 El i p 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel , Permit# '4W Health Division - og Date Iss ��--- ,,3� Conservation Divisi n Fee Tax Collector - —� •� Treasurer ` o?.� l�A Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address /&00 FALMOUTM 4AD (SELF Q1kA7Q MA") Village CeQ EIZV I I.LF Owner J T. CALAHAN (iELL T0yor:2 A( l Address Telephone 691 - 9300 Permit Request RENOVATION. TO THE FO/LMFg LONG geA TAVCI_N INTO A 99 R-g;M(JE&N1r PV8 W0R-V__ INCLUDES AN INCREASE TO RAP_ SIZE AEP A (LIT7' HEN 8A _ EQUIPMENT NEW FLOG MG � PAINT , MISC • PWMBING $ CLECT0-ICAL Square feet: 1st floor: existing* `?� proposed N A 2nd floor: existing N A proposed Total new O Valuation * 4,060. Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwejling 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: 0 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 lVCSTPVXA N 1 F PVC Proposed Use 9ESTA U(ZA N 1 PV8 BUILDER INFORMATION _ Name MICHAEL 5• CAADAMoNE Telephone Number (5081 798 9180 Address 84 possET SC License# 06q�9 1 W0[_CESTEF., , MA 61 io0 4 Home Improvement Contractor# trig�ll MUNRL Worker's Compensation# WC7- III- Z53504- 02-1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SF 1 WK;11 REC`(CL I N G- 61 GoMMONNENGTH AVE • s Y&P-MOVIH , MA SIGNATURE ( s_ �,w,.(�,,,,,,Y,� DATE 7-12-0IO2- t FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED - MAP/PARCEL NO. ADDRESS, +( VILLAGE _. OWNER s DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL . FINAL BUILDING tt DATE CLOSED OUT :•- '. ASSOCIATION PLAN NO. "' ---_- The Commonwealth of Massachusetts v =_ Department of Industrial Accidents Ofllce of/ore591811oos 600 Washington Street - = ;f Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name `A FESM949ANT 9 PUB location t600 r-AkA00TH POLL city (,' R-y I t-k. MA phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole rietor and have no one worku in capacity '%%%%///%/%% %// %%%%/ ////%//%/%/%%%%/G%%%/%���/��%���%/%%/%%%%��//%/G%�/�/%��%%%%%�/%%%%%/%%%/ I am an em 1. er roviding workers' compensation for my employees worlang on this•job. :: :::: ::: ::........:.................. :: say peen e« [ : >: r to mn > 1t dres�gd :....:.:.:... :::::::::. ..:.::::.:::._.:.::::::::..: ................ ..::.::.:. .�. ":'phone# ��� ci rv� > > ✓.: iy<i i ::.:.;:i:.;::;: 'Qlicv thstlTance co.. ..,.... :..:. . ... . I am a sole proprietor g=contractor,/r homeowner(circle one)and have hired the contractors listed below who • the following workers compensation polices: men an ,n - .....::::::. addre tL L t • :i\\4iiii`�ii::?::iiii: :;:.y' ':;:;�;;;:?�:;;;':?;:.>::>;?::<;r:;�}iii_?j;:;ii.2;:;:}issy:`:i`+:::.';:j::::�i .ii'::ti'n•v:.;'. 'e 1 :iY•''`:'i::::':::i::::+:':::iii;j :::�ij:i3ii >i::i:: :i:� ::::::i:>.:ii::� i>:iii:i:: 'r:<:Y.4iiii::i:::ir:�::�i::•:{{v:ii::iiij::; ::....�::.:�::::::.�:.;;:v:4:•iiiili4:J:ii�:J::i4:i:?:ii:•i:Ji'iL:C i:;i:ij•i::y-:}�:i•ii:;+$:ti:i`:i::':-::::i::y'::i::i:i:::::.�i:ii>::'i+�:iji?ii::::::y::::ilvQVu am^ y tiiS::•i"��:'�: :.:y;.;:;i??:'}:{:;:�}:;`':;?:;'isj`yyij::;::v':':•ii:�?:�:L:?;:}>:?::r:::::}j�:;Y:;i:•ii:•iii:i�:�t ♦.�:y: .............................. :::::::::::.�:ry;v i'•i:i:<4iiiiii:•::w::.i•:�•t!::�i:4:.i}iij:+:4:i?tii•:�iiiii:v%i>ii:!^:�:i�i::•iiiii:•iiii�::....::.::':'i::......•y;::.•�:;:v::::::::i::i:r:w::i- 'a:; :::::•.::•.:.::.....,;.....i::CJii:i•:i:.iii•:i•f::•:::.i:•ii:.:isi:•ii:•iii?iiiiJ}iiiiii•ii::•:iiii:!:•i:.isisY.i:?ii:::::iii ?:::•::i::iisi::(:::::i::::i:::ii::i:3::i:i:iLSi:::::: ols'.�:M::i::::::::::::;:j:.:.::_:Ji::i:;ii:.;;:;:•i:?:::::_i::iiiii :?}:i:{;:i:::>:i:::::::0:.::.iii::::lj:::::'::i;i;:•i`.' :... ... :.:.. a' fie lion ................ ::.:................................... ...... <,: o ry II�nrAnce >i i. Failure to secure coverage as required mrder Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to SI,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a Ste of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and coned Signatureu.�.a, l S' •• ! -• Date 212.0102. Print name MICNAE[. S GARpAMON>✓ Phone# �$ r official use only - do not write in this area to be completed by city or town official city or town: permit/license# r1Bu1ffi1dlngDeparhnent ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office UHealth Department contact person: phone#; _ ❑Other t - . omiad 9l93 NA) 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. 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 or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. `Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. d Applicants Please filloin 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 if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the.applicant. Please be sure to fill in the permitllicease number which will be used as a reference number. The affidavits maybe returned in the Department by mail or FAX unless other arrangements have been made:. _ ......_.._. ,_.__...... .. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. IN The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigadons 600 Washington.Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-490.0 eat. 406, 409 or 375 1 s j GTT �� �✓ BOARD OF BUILDING REGULATIONS License CONSTRUCTION SUPERVISOR Number Cs-' 069791 FI *Ab E gi#es�Ofr�13/20Q3 Tr.no: 11147 Restricted To 00 = j MICHAEL S CARDAMONE _ 84 COHASSET STREET � I 1NORCESTER, MA 01604 Administrator i I j 1 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 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.) Business Certificates are available at the Town Clerk's Office, 1.0 FL,367 Main Stradt,Hyannis,MA 02601 (Town Hall) DATE: at'7- 0-7 Fill in please: APPLICANT'S YOUR NAME: BUSINESS YOUR HOME ADDRESS: IGco Fo.1v�-�n�`! t�d k 1 a NNW TELEPHONE # Home Telephoneo `I -8�Number 5 8 O , v�►� c�co3 NAME OF NEW BUSINeS TYPE OF BUSINESS IS THIS:A HOME OCCUPAT10 ;_,_.�;_YES 11I0_2' . Have you bean'given approval fr m the buildin :.division? YES NO ADDRESS OF BUSINESS MAPf RARCEk:NUMO 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 200 Main St.--loorner 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 This individual.has n in ormed y permit requirements that pertain to this type of business: Authorm Signature COMMENTS: 2. BOARD OF HEALTH This individual has be orme a it requirements that pertain to this type ofbusiness. uthor' ed Signature**. COMMENTS: �1� f" wuB� r,T 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature COMMENTS: mot , Sign . , , AB • * TOWN OF BARNSTABLE Permit MASS. 6� iArF 3.�A Permit Number: Application Ref: 200707772 20070108 Issue Date: 12/06/07 Applicant:, BELL TOWER CORPORATION Proposed Use: SHOPPING CENTER- MALL Permit Type: SIGN PERMIT Permit Fee $ 50.00 Location 1600 FAL-MOUTH ROAD/RTE 28 Map Parcel 209014 Town CENTERVILLE R Zoning District - SPLT Contractor PROPERTY OWNER Remarks REPLACE EXISTING 45 SF SIGN NINETY NINE Owner: BELL TOWER CORPORATION Address: P O BOX 1461 SO DENNIS, MA 02660 Issued By: p -- POST THIS CARD SO THAT IS VISIBLE FROM THE STREET ` Town of ]Barnstable �F'THE Tqy, Regulatory Services y ~�; Thomas F. Geiler,Director ` BA AB MASSS.LE, Building Division 9�'DlEo3,•ip Tom Perry,Building Commissioner jpF PN 200 Main Street,Hyannis,MA 02601 ' www.town.barnstable.ma.us - Office: 508-862-4038 Fax: 508'790-6230 Permit# ao 6 70 -777Z. Application for Sign Permit Applicant: 610/ Map & Parcel # 0/ _ Doing Business As: � ze:RyfQ-n �— Telephone No. Sign Location _ Street/Road: 620 �1l�o4/l ��� 2&f1 //� Zoning District: Old Kings Highway? Y /No Hyannis Historic District? Y s/1Vo Property Owner Name: ,e�P//T�.��f ��,i,/J Telephone:��� Address: kO Sign Contractor. Name: .13a0-/ p S.13""",S Telephone: -LOO J-2 Mailing Address: &l d`Tl77 Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes/No (Note:Ifyes, a wiring permit is required) Width of building face�Tft.x 10= -25-0 x.10=_ Sq.Ft.of proposed sign I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of§240-59 through §240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agen . Date: 6 Permit Fee: Sign Permit was approved: Disapproved: Signature of Building Official: Date: • In order to process application without delays all sections must be completed. Q:I WPFILESISIGNSISIGNAPP.DOC Rev.9/12/06 ,i 2 JOB* F)I8 _ • _ 1 Circoils MANUFACTURE&SHIP. PG 1:ITEM A ONE SET NCL'5/LOGO/TAGLINE ON PAN BACKER wLamm Size W.lldctmess S"Sian 7 Z-7^ Ste6 tmgtli W.TkG:lmase PLATE W L _ RECEIVE&IN5TALL• - �. !a< y s+^ 75'SiO;ZEFR N+•`--'`�.+• }* rile - ,^r-".•-- "t�• .ePat4' Y (� GUSSETS W L ARGROR BOLTS L R M yft 1 PROP05ED 51GN LE 1 1 EXISTING SIGN SCALE:3/16'=1'•a' G� 2a-O.. ,LETiERs {,S �� 85 (team s; GLOSS BLACK RETURNS "Face: 732&WHITE FLEX Tfhm r BLACKDate coaameat Near: 65WWHTTE EDO 11-14 SEE PG 2 KORSMOE-SffE DETAILS PG 3 30" s/ 42„ Retmt�: GLOSS BLACK RETURNS ������yyyfff��•L Fate: NIHEHOE WHITE ``4 S :3B3 RED - :363o-75-55-7s MARIGOLD - great food, great drinkY' UNM 5HADES&HOLES:BLACK New. T'BLACKTRIM L Trim: 65WWHITE r-------------- r----1 -------- 5" - • • • • - • 9" TAGLINE 3q3;SG Rkwk -- - - t Fie 56sML3C1C `-------------- - •---------- CopIr vaiRE ------6•j5 ----i 9"TALL X 92"LONG X T'DEEP.125 ALUM.INCISED FACE WITH 7328 WHITE PLEX, ONE 84 T-12 CWHO LAMP QLSLEFAIdB LrFM 3fi30w49 BURGUNDY ITEM A ONE SET NCL'S/LOGO/TAGLINE ON 13ACKER W/BLACK BAND AT BOTTOM SCALE:3/8"=T•-0" t ALL BDflOR3ARE FOR RIPRIM3iTAI[ONONIg kaetFO► Exmda BatkLa Orainwofea Y ill Amber 99 RESTAURANT SEE ACWAI,&ffMIES FOR COLOR NAWL Facawtat FLEX Tic 3A6 Retunw aBBJOa tatA Tic •040 Oepth 5- Rod Amber RGB De> sate: locatimr t •i 1 Back wet ME® 'Id Loxan ..063 -lwrw 1- u Y ma* Cal S Satos: ' 16G0 Falmouth Rd. CENTS W�i.Lo By MA. . LT I�i1VS OSmtefaritala Oleave®S@n OD'�ase Ronan ® <C6p Otter. FLxd Sim, wiw! Ot�4o< Dag: ' OStmflar6asmaw O EIWA Eatimatiog: Oate: t PK Ul Stielmr lacati0rc ® Tap Only Rama o4 Neoe:1 wlMlk t5 T 8 T YYeather Station C� t50 Steebp St.N�soo•IOI OaaSt GENERAL INFO. Engiaeetinp: Dater ttn4/07 (F11t6Tk Fex 160T16/4 T660 Housings: Glass Fk's Pass Thm WA Comm: Fiber OC RF PM Cap otpPrBmmf0m11M DAM MW ro.aem.• air- ONE SET �'Ft: _ Sales: �' Centerville MA 071067811-14 (IgiiijoSame FWD aw Bud SD°w"Beck wlestwmasmr Mastex/Sleve Prodad=.— �s�aoaaeoiam.�maataosamva®aaoama�cm•m®.msan B-07-1 0 878 REV iers. R'mo Ro D[F O Nowa T Location want. eearay 6M Ste¢dmd Electronic C—P—Provided: Y N p�ga� sym: �f+'�s•' �. W F �i' SHEET OF 3 JOB#: 878 _- _. ----- y - Circuits " u Amp MANUFACTURE&5HIP: p 1 rohage PG 1:ITEM A •.'•.•^r _ - - U.L ONE SET NCL'5/LOGO/TAGLINE "' _ '--"-'— ON PAN BACKER � size - } Length Stub Sias Stub Length 12'-T W.Thidmess PLATE W L Th RECEIVE&INSTALL: .} i,v4.. I _ 75.5mREFRONr • � GUSSETS W L Th ANCHOR BOLTS IL JHMK Widtk Length Depth— PROP05ED SIGN ALE:3/16"=1'-O" � EXISTING SIGN SCALE:3/16"=1'-0" p� 20'-0" LETTERS BL � S ,k Gj A 85" 30 60 Retums: GLO55 MAIM RETUR ` NS v Face: 7328 WHITE FLEX ` „r M t 1 Trim: 1"BLACK e Hna '' s: 1x9;' Data Comment 6500 WHITE `�L ` Neon: �� J� 20" p r © ��'; 11-74 SEE PG 2 ✓ HORSESHOE-SEE DETAILS PG 3ETUR 30" 42„ L / Retums: GLOSS BLACK RNS - Face: 7328 WHITE FLEX NINES: RED SHOE: 630-75 MARIGOLD �� -• food, • - drink LINE5,5HADES&HOLES:BLACK �� nv� J Trim: t"BLACK TRIM ` 1 Neon: 6500 WHITE i----t �— f r--------------- • • • • • • 9" � T ^ TAG LINE r 3q3 ----------i " " - ' - a� \ �/" 1 Skies:SG Bkxk r---------------- -------t Fcce. _J BLACK r--------�� t &'TALL X 92"LONG X 7"DEEP.125 ALUM.INCISED Caps WHRE MUD r----__y• --- FACE WITH 7528 WHITE PLEX, ONE L34 T-12 CWHO LAMP V 0 DISHPAN:PTM 3630-49 BURGUNDY ITEM A ONE 5ET NCL'5/LOGO/TAGLINE ON BACKER W/BLACK BAND AT BOTTOM SCALE:3/8"=1'-0" Rea a Rss care 99 KE5TAURANT ALL COLORS ARE FOR R941M lTATION ONLY mm� Erderiar Bazk�rt Ore xolea r IN SEE AMAL SAMPLES FOR COLOR MAIVL Fee Mat PLIX T6 3A6 Reran Mat Tic Deptk 5- lnee®¢Mate: Sates 1600 Falmouth Rd. CENTERVILLE,MA. _�. 1 •1 1 Back met M®Lem Th:•O63 M,� 1" r Metek Cabinet Sae: ••r r r ' �'° i I G N S LT DAee for Barb ❑Lsays®Sko OD'apsse Momtiag Name" ® <Cfip other Pixel Saw MM : Date: t� sws PK ❑SUM(eQudomer O ❑WA TRT WeatherStetim Es g Date: o•e: 15t16,edASY.Iddso•.NN071of UL StiduQ laeatios ® Top Oar Rows al Neoa 1 MM: 15 GENERALINFO. Engmeemg: Date: 11/14/07 (SOTIHHax53e Fox c�leazTseB Housings: Maas Pk's Pasa Thor WA Comm: Fiber DC RF PM Can o GbVr�n ZOm TIE DAM 9mi g W- Sq.Ft rs®a®rasiwmr•nt�a�m�so•vm®•e®vaura® (,ertt wille MA 0710878 11-14 ONE 5ET 0 Master/Master Master/Slave s�soswssmamrs�n•®maeme®a®•os� Same Pb,m 90°Bend 90°Double Beek ptodapioo: Oafi: O D/T O N-ALL Tr®s.Locatim'� S/CmL Raceway gi 60MA Stasdard El ft a e Compete Provided: Y IN fug,, Um Date: V��"'�•'n�'° MEET 1 of 3 ® B�07���878 REYi