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A , ,:::::::::::rrrrrrrrr� I I ,:,� i:,�1,1� ,�� -1 011111 �i:�� I-i-,�� ",,'�":I ,,,,��?",� 11 "" , , , , , , , - ."1;��-, ,� ,��,,.;,�: , , ,,�,�,�." �;%,��i ��',is�lfil I - """"""""I ,;�,�,�,�,�,�,��.,,, -"I'll',� - 1 .��'i" "i ,�� �,�,11111111 ,,_� I'll rrrrrrrr I , �C��io,j�i,,. &�,'� :����i�,�,� _., � 1 'j��',� Sh. , N't , ", � 'A' �,, ,.,�, , .�� , 't, ,,��,� �, , 'j��',� 11,1i �� � � � � �, , i , �...... , _� Aii,l � �: , :;o ,,,,,, , ��,� � 'j��',� .�.i,,��,,�,� , , ,,�,�, , - , , , � c ; , I I of 'j��',� ," 11 �`,"�i, j�,��" j�,��"10..", _��!� j�,��"10..", ­,�, ; �, h S I ,;�m • fi �i PERMIT Town of Barnstable *Pe Fxpt man p rr�dote °r 13 Regulatory Services F _� s fr — A 1 59. 0P Thomas F.Geller,Director itSgq. � /1 TOWN OF BARNSTABLE Building Division. rom Perry.CBO, Building Commissioner 200 plain Street,Hyannis,%4A 02601 www,town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS-PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint IU1ap/p�ucel Numbe —_-- Property Address 35 Linden Ave . , Centerville , MA 02632 ®Residential Value of work 2 , 9 3 2 . 0 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Ernest Henderson III 35 Linden Avell-Le-Centerville , MA 02632 Contractor's Name_Atlas Alarm Corporation Telephone Number 781-337-8866 Home Improvement Contractor License#(if applicable)_ Construction.Supervisor's License#(if applicable)_ ❑workman's Compensation Insurance Check one: ❑ t am a sole proprietor ❑ 1 am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Excelsior Insurance Co . Workman's Comp.Policv# W C 2 2 9 8 8 3 0 � _.............___._y._._.___. _........_._...-._.__.__ Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over_ existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value _ (maximum.35)#ofwindows ® Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire.Permits required. •where required: Issuance of this pemtit dues not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. J A copy of the-Home Improvement Contractors License&Construction.Supervisors License is equired. - f `� SIGNATURE: 4 / 7 / 4' _,_...._.._............ — (':ilserskalecollik:lAppi)ata'�Locali'viicrowftiwindoiv'stTemporary internetFilestContent.OutlooklQftE67UBMEXPRESS.doe Revised 053011 1 ' 28 January 2013 Town of Barnstable Building Department 200 Main Street Hyannis, MA 02601 Re: Smoke & Carbon Monoxide Detectors for Henderson Residence 35 Linden Avenue, Centerville, MA 02632 Map Parcel: 208133 Dear Town of Barnstable, This letter is written to authorize the Atlas Alarm Corporation of 1239 Washington Street Weymouth, MA 02189 to pull permits and perform the necessary work at the above referenced property to upgrade the existing smoke and carbon monoxide detector system. Please contact our office if you require any additional information. Very truly Purs, e I ' oldstein "I"he H se Company PO Box 1166 Barnstable, MA 02630 The Commonwealth of Massachusetts Job #277. .......... Department of Industrial Accidents Office of Investigations y. 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Atlas Alarm C o r p o ration , Address: 1239 Washington Street City/State/Zip: Weymouth., MA 02189 Phone #: 781-337-8866 Are you an employer? Check the appropriate box: . general contractor and I a am I Type of project(required): 1: X❑ I am a employer with o v e r 5 0 4, ❑ g employees(full and/or part-time),* have hired the sub-contractors 6, ❑ New construction 2.�] 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers 9, ❑ Building addition [No workers' comp. insurance comp. insurance, required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.C] I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions ,m self o workers comp. right of exemption per MGL Y � ' P 12.❑ Roof repairs insurance required,] t c. 152, §1(4), and we have no employees. [No workers' 13,[ Other A l a r m Systems comp, insurance required.] *Ary applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iCo tractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have emF loyees. If the sub-contractors have employees,they must provide their workers'comp.policy number, I amn an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information, Insurance Company Name: Excelsior Insurance Company Policy 4 or Self-ins.Lic. #: WC 8 -3 9444 Expiration Date: 0 2—01—2 014: Job SiteAdd&ss: 35 Linden Street City/State/Zip:Cent erville , 02632 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Fayure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fin 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(tp 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 d hereby certify under the pains an /Penalties of perjury that the information provided above is true and correct S i nature: Date: o2.— 3 Ph ne M 781-337-8866 ffccial use only. Do not write in this area, to.be completed by city or town official �ity or Town: Permit/License# �ssuing Authority(circle one): Its Board of Health 2, Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector ,6. Other ;Contact Person: Phone#: 1 a SMOKE DETECTORS REVIEWED 7413 KNGDEPT. DATE FIRE DEPARTMENT DATE PORCH BOTH SIGNATURES ARE REQUIRED FOR PERMITTING, CLOSET KITCHEN t BEDROOM CLOSET DINING S BATH S CO LIVING BEDROOM S y' CLOSET ENTRY �7 ,-A"(✓ BATH s co s BEDROOM BEDROOM CLOSET WALK IN 1 ® C V k WOKE DETECTORS REVIEWED *k -T LE ill-DING DEPT DATE' FIRE DEPARTMENT DATE' BOTH SIGNATURES SERE REQUIRED FOR PERMITTING PORCH CLOSET KITCHEN BEDROOM, ' CLOSET DINING S • BATH S co LIVING BEDROOM ..FCLOSET, ENTRY /�,l�-fi r BATH F. BEDROOM BEDROOM ' CLOSET WALK IN ', 3 c® g a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t - oo� o°17a Maps Parcel 13 Application # Health Division 'Date Issued ka '4' Conservation Division Application Fee Planning Dept. Permit Fee �3 Date Definitive Plan Approved by Planning Board 2,4 Historic - OKH Preservation/Hyannis Project Street Address 3 5 U N�kai,4 Village -ryT► y11.iti Owner rv�d�.So� . tM�� T F I1\ 71z, Address F o ybox 4 7,0. �1Ovso fy A 1 Telephone SOS 1 03 03 0\ , Permit Request 1�0+_ko �L �x�s���n d 1 ; R�paR any� R� P1 n,c�. g-r-�►.�ca RooF SV\, CA L-,% StDt��. .�u I� C�-R�oPi \NZTzIL�dl. Qom..--�Ttc�r�lS iZ�^P-�oA�sL IC Ki sM t- PEA r"14• Square feet: 1 st floor: existing 3l 1 proposed S e 2nd floor: existing proposed — Total new Zoning District `. ' Flood Plain Groundwater Overlay r Proje- Va atiorr 30, oo Construction Type ��*-1� (\Qocm) c LotSize Zn� Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. L,_ -- Dwelling e: §Ingle Family' , Two Family ❑ Multi-Family (# units) a . Age of Exptingt-Structure 3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout j�Other SLAP> Basement Finished Area(sq.ft.) _ Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 1 new U Half: existing — new Number of Bedrooms: 0 existing v new t. Total Room Count (not including baths): existing. 1 new First Floor Room Count ►'' Heat Type and Fuel: ❑Gas ❑Oil 0 Electric ❑ Other Central Air: ❑Yes IX No Fireplaces: Existing New — Existing wood/coal stove: ❑Yes ❑ No Detached garag4 existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: Coexisting ❑ 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 Use1�� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name off-- tOc_ ��us�= P�''7 Telephone Number • �1 I d3 Address To 'ttk, License # Home Improvement Contractor# Worker's Compensation # 1, P., • 4-7 S-1 P 3-7"1 �- t v ALL CONSTRUCTION DEBRI RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU E DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED • [. 'I DA MAP/PARCEL NO_.. ADDRESS VILLAGE t OWNER 1 — DATE OF INSPECTION: l is --.,'FOUNDATION' _ FRAME -INSULATION!' FIREPLACE ELECTRICAL: ROUGH FINAL t xY l PLUMBING: ROUGH FINAL 4 �• -GAS: ROUGHQ, i fi FINAL ti u FINAL BU'ILDING� ° GGI .A. : i .DATE CLOSED OUT ASSOCIATION PLAN NO ! y ; ti i . The Commonwealth of Massachusetts Department of hrduslrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit BmWeWContractors/Ebactrician&Tkmbers Applicant Information Please Print Letldbly Name(BusmesslOtganizafiau/ludividual): CON Lac- rz>vt�A Cvt kP T Address:-- P City/State Z p: 02403 Ophone#- S—)$• '71 i• 03 D 3 Are you an employer?Check the appropriate box: Type of project(required): 1.4 I am a employer with oZ . 4. ❑I am it general contractor and I 6. New constructionnployees(full and/or part-trine).* have hues the SUb,con�actors ❑ employees 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling ship and have no employees These sat-contractors have 8. ❑Demolition working for men in any capacity. . employees and have workers' . [No workers'comp.insurance comp-iosurm M, 9- Budding addition required] 5.❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work 11.❑Plumbing repairs or additions myself[No workers'gip- eight of eaemption per MGL 12.❑Roof repairs insurance qua]f c.152,§1(4),and we have no employees-[No workers' 13.0 Other comp.insurance required.] wy-�s mxi checks boa#1®aat also fill out the section below showing th&wodeis'caVsauan policy infuMMHM fi Howwwaas wbo submit his affidavit iodicatmg they are domg'&U work and then hoe outside contmwn mast submit a sew affidavit indicating mclL. =Camractars that Chock this boot mast attached an addltlanal sheet showfag the name'of de Sob-otodmctots and state whether or not those entities have employees. If the sub-coottactcrs bave employees,dwy mast p¢wide their workers'comp.policy maW-. .lam an employer that is providing workers'compensation insurance for my amployeex Below is the policy amd job site information. Instance Company Name: -T'it.t ,4y=-LGt2� Go. P,��As=�il c� Policy#or Self-ins.Lic.#:- 1.1(3'�}'75�1{�31 -1 L Expiration Date: Job Site Address: 35Lt,�e�-A City/State/Zip: �-4Nc))6bL 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 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 jtqumce. coverage verification. I do hereby ce ' ,under the 'nsand na8ies of perjury that the information provided above is bus and correct S tore: Date: v• 1 Z Phone 0: offleial use only. Da noi write in this area,to be completed by city or town o i'i'ciaL City or Town: Permit/Lkense# 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#: 6 v,vv. 11 ews, rnv7] L/'VVL P6R OGJ:VtiI- 2 i gar "APH CERTIFICATE OF LIABILITY INSURANCE DATE rMlwonmrwt TWOC.MIFICATE 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,subjectto he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to he certificate holder in lieu of such endorsemen s PRODUCER CONTACT NAME: WELSH&PARKER INS AGCY' PHONE FAX 131 COOLIDGE ST STE 100 (A/C,No,Ext). (A/C,No): EMAIL HUDSON,MA 01749 ADDRESS: 29FDY INSURER(S)AFFORDING COVERAGE NAIC q . INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA OHC INC DBA HOUSE COMPANY,THE INSURER B: INSURER C: INSURER D: PO BOX 1166 INSURER E: BARNSTABLE,MA 02630 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERT""I"M ;E 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 15 SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY A P D CLAMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MKDDIYYYY) (MNDD%YYYY) LIMITS [GENERAL LIABILITY :ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAGE TO RENTED $ CLAIMS MADE ❑OCCUR. EMISES(Ea occurrence) ED EXP(Any one person) $ RSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY PROJECT❑LOC RODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY OMBINED SINGLE $. ANY AUTO IMIT(Ea accident) ALL OWNED AUTOS ODILY INJURY $ SCHEDULE AUTOS Per person) HIRED AUTOS ODILY INJURY $ NON-OWNED AUTOS Per accident) ROPERTY DAMAGE $ Per accident) UMBRELLA LIAR []OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-4759P377-12 07/21/2012 07/21/2013 LIMITS ANY PROPERITORPARTNER/EXECUTIVE N WA E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONSAM41CLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. i J CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 200 MAIN STREET BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT VE / HYANNIS,MA 02601 { r ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. i Towti of Barnstable Regulatory services dhonias F.Geller,Director Build ng D vis .o TOM Perry,Building Commiss.inner 200 Main Stre<rt,Hyannis,IVIr102601 rvwxv.town.b rnstabie.ma.us Office: 508-862-4038 Fax:508-790-6230 Property Owner Must Complete and Sign This Section' If•Cla A Builder as QWfW of the subject prrape.rty hereby auttzcst rr:.,,.,_.. __f!HC_Ing cilia Inc I r� r5c C ar�z a�r. —to sect on my behalf, V in nll matters.relative to work authorized by this building pern.ji,t alaplication for: __,.35 Linden Avenue,C:entelville,AIA 02632_m (Address cif Job) Sipature of Owner Date 1'rita:t:l�la rne* ti SYSTEM PROFILE EKED WITHCMAGNEnCTTAP o BE NOTES PROVIDE MIN. 20" DIAM. WATERTIGHT (NOT TO SCA�k7 COMPARABLE MEANS FOR FUTURE LOCATION. 1:,DATUM IS APPROX. NGVD Route 28 Rd'Old P ACCESS COVERS TO WITHIN 6"OF FIN. GRADE 2"PEASTONE OR GEOTEXTILE PROVIDE INSPECTION PORT TO WITHIN 3 OF FINAL GRADE MAIN DWEIING _ " 2. MUNICIPAL WATER IS EXISTING P TOP N . E 50.1 FILTER FABRIC OVER STONE i \ - 49.9' MINIMUM J5' OF COVER OVER PRECAST 2R SLOPE, EOUIRED OVER SYSTEM 49.5 3. MINIMUM PIPE PITCH TO BE 1/8" PER FOOT. 4. DESIGN LOADING FOR ALL PROPOSED PRECAST RECAST N-10 UNITS TO BE AASHO H-1,Q RISERS OW.) 2y 4'0SCH40 PVC 2'DOUB�F WASHED PEASTONE ..,, •-,- PIPES LEVEL 1ST 2' OR GELD LE:FABRIC 5. PIPE JOINTS TO BE MADE WATERTIGHT. �oS _ 45.8' I :a s47.38' 10• 1500 GAL H-10 14• 6. CONSTRUCTION DETAILS TO BE IN ACCORDANCE WITH 310 CMR 15.000(TITLE 5.) oc - 45.9' TEE SEPTIC TANK TEE 5 45 29' Locus c 7. THIS PLAN IS FOR PROPOSED WORK ONLY AND GAS BAFFLE;; �14 c NOT TO BE USED FOR LOT LINE STAKING OR ANY g�, 2 43.29' OTHER PURPOSE. 4' LID. LEVEL(ACME oR EOUAL).: 45.47 �o$`� 01 ,: • ,,^ ^-•"• - • -r.n-"• -n•'•o o H-20 3050.INFILTRATORS 8. PIPE FOR SEPTIC SYSTEM TO SCH. 40-4" PVC. mo ars s oe LAG f +:. .-o ovoo 6'MIN. SUMP �5 12"MIN. INT. DIM. 9. COMPONENTS NOT TO BE BACKFILLED OR 3/4" TO 1 1/2" DOUBLE WASHED STONE CONCEALED WITHOUT INSPECTION BY BOARD OF -�6"CRUSHED STONE OR MECHANICAL HEALTH AND PERMISSION OBTAINED FROM BOARD o v ocus BARN INVERT EL. 47.5'•. ( 2 R SLOPE) COMPACTION. (15.221 [21) OVERALL DIMENSIONS TO OUTSIDE OF STONE: 41.5' X 10.25' OF HEALTH. MIN. 5.79' ( R SLOPE) (-R SLOPE) 10. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING DIGSAFE(1-888-344-7233) AND LOCUS MAP MAIN DWELL.- 73' VERIFYING THE LOCATION OF ALL UNDERGROUND& SEPTIC TANK 18' D' BOX 3' LEACHING OVERHEAD UTILITIES PRIOR TO COMMENCEMENT OF BARN FNDN.- 15', FACILITY WORK. NOT TO SCALE BOTTOM TH-1 &TH-2 4` NO GROUNDWATER FOUND 37.5' 11. ANY UNSUITABLE MATERIAL ENCOUNTERED -THE INSTALLER SHALL VERIFY THE LOCATIONS OF ALL i "=�� \ SHALL BE REMOVED 5' BENEATH AND AROUND THE ASSESSORS MAP 208 PARCEL 33 UTILITIES AND ALL BUILDING SEWER OUTLETS AND ELEVATIONS ,( i -\ DIRT PROPOSED LEACHING FACILITY. INSTALLING' PRIOR TO INSTALLING ANY PORTION OF SEPTIC SYSTEM \DRIVE\ 12. EXISTING LEACHING FACILITY SHALL BE PUMPED VARIANCES FOR SEPTIC SYSTEM REPAIRS WHICH MAY BE TESTC l� LOGS / O \ \ AND REMOVED A PUMPEDNFA AND FILLED WITH CLEAN IMMEDIATELY GRANTED BY THE BOARD OF HEALTH AGENT OR HOLE LO S M \ +ae s3 SAND. BY HEALTH INSPECTOR D. GONSALVES, SE / ` 1_ \ \ PAPERWORK AND HEARING REDUCTION PROPOSALS APPROVE .: ENGINEER: / - \ \ 8Y THE BOARD OF HEALTH REVISED DURING A PUBLIC + WITNESS: D. DESMARAIS, RS / o` \ \ HEARING HELD ON AUG. 4, 2009 DATE: 10/31/12 - / / \ \ \ 3) FAILED SYSTEMS ONLY: SOIL ABSORPTION SYSTEM - \ - INSTALLATIONS PROPOSED MORE THAN THREE FEET BELOW PERC. RATE _ < 5 MIN/INCH �i� \\ \ GRADE WITH PROPER VENTING(PIPED TO THE ATMOSPHERE) -D NTH H-20 - 13777 - / tr - \ \ > - BE LOCATED MORE THANSIX FEETADING, BUT IN NBE OW GRADEO CASE . THE SAS CLASS I. solLs P# �/ \ \ ELEV. / LO 49.38 I-I �I / p• V 49.5' 0" Q 49.5' I 49. 49 ti \ SYSTEM DESIGN: 69.08 1 . \ A A > fi'a7.89 • 49.64 \ SL SL I,, 1 I BENGHMARK GARBAGE DISPOSER IS NOT ALLOWED • 3 lOYR 4 3 - - - / EXISTING ' > COR CONC.BLKHD 1OYR 4 / / 9 DWELLING 4 \ EL s 50.3' 14" 14" / P TOP FNDN. ELEC / \ DESIGN FLOW: 4 BEDROOMS ® 110 GPD 440 GPD B B 1 49.63 EL = 50,08' METER 9 USE A 440 GPD DESIGN FLOW LS LS 2 a/ �.i� SLEEVE SEWER LINE WHERE WITHIN 10YR 5/8 10YR 5/8 Q o/ 10'OF WATERLINE SEPTIC TANK: 440 GPD (2) = 880 36" 46.5' 36" 46.5' 9 2 w43 / USE (1).•H-10 1500 GAL. SEPTIC TANK Cl Cl P. - FS FS �/ / LEACHING: 2.5Y 6/4 2,5Y 6/4 { s.s ` 1 SIDES: 2 (41.5 t 10.25) 1.85 (_74) = 141 GPD 72" 43.5' 72" 43.5' I 02 EXIST. _ BOTTOM 41.5 x 10.2504) = 314 GPD / COV. BARN 'F 4SI C2 C2 I nno 49,90 FFLOOR 49.81 EL=50.4' \ TOTAL: 615 S.F. 455 GPD / 49.54 oy \ / POSS.CP Pis 5 8 49:6 USE (5) INFILTRATOR 3050'S WITH 3' STONE M/CS M/CS / +59.54 (SEE NOTE /, 5 I 2" TREE 12) +a .92 ?�• ✓as.e�4149.3 ALL AROUND . 447.31 1OYR 6/6 1OYR 6/6 144" 37_5' 14, 37.5' NO GROUNDWATER ENCOUNTERED ra9 �O CEssPoOL TH 2 1MA SEE NOTE 12 1 APPROVED DATE BOARD OF HEALTH / Ul / *,�1993 +49.9 �49.36 66 ] 36' TR E �o�oo \\ •�• TITLE 5 SITE PLAN s 35 LINDEN AVENUE \4 4z.85 9. �• CENTERVILLE \ LOTS 5&6 149.77 ( -�49.80 PREPARED FOR 35,961 SFf 1 \ 1 \ FROX. THE HOUSE CO. 5 A 49. PROP.VENT WITH CHARCOAL FILTER 1 49.83 49.76 AND BUGSCREEN (FINAL PLACEMENT BY NOVEMBER 7, 2012 BENCHMARK: CORNER OF \ CONTRACTOR WITH HOMEOWNER CONIC. SLAB AT EL. 50.2' \ / CONSULTATION) '. ,� c� - ,, oft 508-362-4541 fax 508-362-9880 \ j DANIEI A. CAME_\Tr I downcope.com O . Ya9.81 GYIL O;ALA down capo enginenring,inC. No. 0 civil en ineers .�S�Is�ea` !,,•.F �10`' R land surveyors •� L ^ice URvE 1• - 0 10 20 30 40 50 FEET 939 Main Sheet ( Rfa 6A) DATE DANIEL A. OJALA, P.E., P.L.S. YARMOUTHPORT MA 02675 12-271 } + Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Super%ix,r License: CS-042406 JEFFREY GOI-ASTEIN- •�. r. PO BOX 116E ti ` BARNSTAKF,Mk,"026j#0, Expiration Commissioner 03/18/2014 f __ _ y.� e:: _Y_' cY,,,`+a•.1�k�7�"'•. r� 7i� -.w t �.�'i"rl..� � - -... - �,k:. �T_. S �„ ,� • x - � ell j NO ItdAr y'�.Ft ,V '.s+'aY t Y�Nq t4;r .{', �§ � � ~� r '1� i��• � +�..k�: t j, •.1. a .� , h rr ITA -. 'fir' •w:.. ...•s..-'^s _ �t � 'd`� y �". yJ �rtr�� `4',.qe i` _.-04 ' �•'� I P,;:A � ��,,. j�..s,�r �.� -.:.' - r .. ,.... ^. ., ':wz. �:.. `"+�,es-.,4,'�,�e.:-.._ -� � , -• �.p� iil �, � �y ���te ,��.•l���Y,y�,30. ' :.,tr' ._'�.`�,��,+ t Y�.` s F .P:�IF�'1� �1� -,pC.__.__ �, ..4n. ».. r'A-.sp..:. � �.' 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PAGE 02 ORALDURABLE MIMA ATTbRNpY � � I+ ERNEST HEND,RsON, M the principal, of Wellesley, Norfolk County, IViaasachuaettq,hereby des ig ate my daughter,ROBERTA HEN gnn DERSO Worcester County, Massachusetts m _ �, �Bolton, atto><'a -in-fact r . p ey (hereinafter attarney")with aarthority to act on my behalf wrth regard to the follow'gf cad to as ARTICLE I—GENFta Af To exercise or,perform anyact,power,duty,rilifi ar obligation whatsoever that I now have or may hereinafter acquire in my individual capacity or in my capacity as Trustee of the Henderson Foux,dation:,.retatinE to any person,matter, transaction or pmperty,real or personal tangible or intangible now,owned or hereafter acquired by mc,including,without limitation,the following sppecifically enumerated powers.I grant to my attorney full power and.authorl'ng do everything necessary in exercising any of the powers tier,sin granted as fully as I might or could do if personally present,hereby ratifying and confirming a21 that my attorney shall herein g do or cause to be dove by vit'tue of,this power of attorney and the powers herein granted. Cx) k'ower of Collection and gmentr To forgive requ recover, collect, receive, hold all such sums of money, debts,duescam sue for mercial Papers, checks, drafts, aoeoants, d"its, legacies, bequests, devises, notes, interests, stock certificates, bonds, diiddeuds certificates of deposit, annuities, pension, prant sharing, retirement, soeiat security, insurance and other contractual benefim attd proceeds, all documents of title, all property.personal,,tangible or intan 'blep P riY real. or. whatsoever li uidate�d or unl gnidated, r hereafr e rights, and cernands q er awned by,or due,owing, amble or belonging to me, or in which I have or may hereafter.acquire an interest;to have,use and take all lawful means and.equitable and legal remedies and proceedings in my name for the collection and rrcovery thereof;and to ad' sell,com rormse,and agree for the same,and to execute and deliver for me,on my b fit and in my name, all endorsements releases, receipts, or other arges and.for.tb a same:;to assign,release and discharge mortgages, enter to foreclose,and do all acts requisite for the execution of powers of sale in any mortgage held fry me;and to sign, draw, endorse and accept checks, drafts, promissory notes and bills of exchange,including any parable to the order of my attorney; (22�c aLtrt Amnira R�.a soil•To acquire purchase,Whan to sell, and salt.and convey real ar Personal' , ,grant options interests the P property,tangible or intangible, or rein,on such terms and conditions as mq attom shall deem proper. For par,poses of this docuwent, my rc£erena herein t intarr ble property shall include stocks,bonds, 'mutual fund$,and.other m �trents�of the kind referred to in paragraph(8)below; (3) Manaaemen owe rx: To maintain, repair, imprvve, invest, mart insure,rexzt,lease,encumber,mortgage,and 7n any manner deal with any real or' personal property or property of the Henderson Foundation, tangible or Intangible,or any interests t avin,that I now own or may hereinafter acquire,in deem ny namand nd•for my benefit,upon such terms and conditions as my attorney shall prope(4)Hankins powers:To make,receive and endorse checks and drafts,deposit and withdraw funds,acquire and redeem certificates of deposit in banks,savings and loan associations and other institutions; execute or release such martgag deeds of trust or, other securiy a�cnts as rn be necessary or.exercise of the rights and powers In i n9 prof m me (s7 B ns�iness r„ra : To conduct or cipate in any Iawfxnl busiaeas of . Whatever nature forme and in MY name including,but not limited to any bu dbess conducted on behalf of the Henderson Foundation; agreements and amendments thereto; incorporate; redo partnershig consolidate,recapitalize,sell,Hquidate,or, di,„solve e� merge, officers, diimctors and agents = business;elect or employ sale Of agents;�9 out the�rovisiana of say agreement for the ba�siness interest orthe stocktherem-and to exercise voting night;.with respect to stock,whether in person or by proxy,and exercise stock options; TAX.,L'aM: To prepare, wmmte and file all income tax, tax, social security playment insurance and infarmation returns required by the Page I ofS laws of the United States, or of any-state or subdivision thereof, to confer with revenue agents, to Prepams execute and file refund maims, to collect any tax refunds from.the Hutted States or any state or subdivision,to execute agreements extending the Astute of limitations, to execute Internal Revenue Service and/or any state department of revenue powers of attorney, to represent me or obtain representation for me before the Tsar Court of the United States,any other court or,any administrative agency,including the Internal Revenue Service or any state departmcnt of revenue, in connection with any of said tax matters, and to do wWthing whatsoever requisite or necessary in connection with ail income tax,gift tax,social security and tinemploymexat insurance taxis required by the laws of the United States or any state or subdivision that I could.do in my own person.or as Trustee of the Henderson Foundation; (7)R!uC Bran oyee.Benefit Plan Powm:To deal with all retirement, Plans, pension profit. s a'Ing, or any-type of employee benefit plans or a ements ?including, but not Iiinited to, life and bean inaumnee Mans; disa ity plans;annuities and smek option plans)of which i am a member or over which I am a Trustee; (8)Secrnities_anIizuslge tic , :With respect to my brokerage accounts or those o t a Henderson Faundat�au,to effect purchases and sales (including short sales),to subscribe for and to trade in stocks, bands app�laons rights and warrans or other aecuritie,�, domestic or fioreign, whetherdollar or non-d'ollar denominated, ar limited partncrslrip irnterests or errvestYttents and trust units, whether or not i�a negotiable force, issneii or anissned, foreign exchange, commodities and contracts relating to sauce (including commodity futures) on margin or ottaerwise for nny account a»d risk;to deliver to my broker securities for any account of mine in my own name, or where i act in a fiduciary capaaty, including but not Iim@ted to the Henderson Foundation and to instruct my broker to deliver securities from any each accounts to my attorney or to others; to instruct may broker to make payment of moneys from any web accounts with ttry broker;to sell,assign,endorse and transfer may sleeks=bonds,options,rights and warrants or other securities of any nature, at any time standing in my name individually or as Trustee of the Henderson Foundation and to execute any documents neeessar.y•to effectuate the foregrn'ng; to z�eeive statements of t rsaCtions made for my accoumt(s); to approve and.confirm the same,to receive any and all notices, calls for marpmi or other demands with reference to my zt== a(s);and to make airy and all,agreements with my broker with refererm thereto for me and on mybehalf; My attorney may vote in person, or by general or limited prnxp, with or without power of substitution,with respect to any stock or other securities I may own individually of as Trustee of the Henderson Foundation. I authorize myy attorney to exmute on my.behalf any powers of attorney ire whatever. form which may be required by any stockbroker with whom I have deposited any securities whether suet.securities are held in my individual capacity or as Trustee of the Henderson Foundation. . am= . . s s To create one ar more tnrats,partneralrips, corporaiaons ctrtenan es er form of rownershi or entity for the'puroae of dewing with any property interest ofpanyy nature that i may have ar hereafter acquire , or as Trustee of the 1lexrdersozr koundation, under such terms ana. rovisions as my attorney cleerns in the best interests of myself and my his re azd, the fact that my said attorney may be a rouraanderman, partner, shareholder, co tenant,or beneficiary of, any such entity in connection) with any such transfer.hereunder shall not affect the validity thereof,nor by itself, constitute a breach of my attorneys fiduciary duty hereunder to transfer any or all property, taugf'ble, inta�i" e or. real, in which I may 'have any interest, individually or as Trustee the Henderson Foundatiax� rota a trust or trusts, hether revocableor in�vable, asrd whether created by me or, by my said attorney an my behalf and whether or ran#such trusts were created before or after the execution of this r�ur6 power of attorney,or to any other form of entity or ownership,including any form of co-tenancy; (za) Power to Borrow Mangy: To borrow money.and to secure any such borrowings with any of my assets or property whether.such assets or property are held in my individual capacity or as Trustee of the Henderson Foundation; (n) �C 112AtzRriint Counsel and Other Pigrents: To hire legal counsel, investment counsel,accountants and other agents; r pM9 ZOO A. (x2) Power to Met My Resignation atf a Member Qi�icer or l�5duciarv: To effect my resignation as a member or officer of arty organization or entity,or as a trustee,exeeutor,personal representative,or other fiduciary of an estate,trus% or foundation,however.denominated; (13)Power to M& Contracts:Make contracts in my name or as Trustee of the Henderson Foundation for the purchase of any real estate or other property and for all other purposes; - W)Powers h ReSUe to Leea1 Y tdm s: To bring and.prosecute any action, suit or pxviceeding at law or, in equity that my sold attorney may deem necessary or proper for. the enforcement or protection of any right or. interest of mime-or of the kTendemon Foundation,and, on my behalf,to.defend any such action, suit or proceeding at law or, in eqquity that may be brought nst me; settle, comprvmiee or submit to arbitration all accounts, claims and disputes between me and any other person;as-sent or object to any petition, motion or account;and othermse oat for me in any probate or other legal proceeding; ( ) A ►�a y to e s �r�t To file for any ebaptar of Bantauptcy available to me or to the Ilendetaon Foundation under Federal Law;whether to file as next friend or to file by sipixxg my Warne indicating it was signed by the attorney-in--{act aetit9 on my bibalf and submitting a cow of the power of attorney,with the filings; or in an other manner pehnim, by law;'to emplauy oy counsel to represent one in such filings;to select any and all decisions regarding plan or repayment/reorganization,if applicable;to discuss my affairs,and/or. . ploy any ddebbtt re-counseling service; to discuss my affairs with a credit counseling service and a debtor education service; {x6) flowers with Ries qt, Real PranertOwnc �: To manage and conduct all it to my interest im an rFal property I may own as an individual or as Trustee of the Henderson Foundation ilurcng my lifetime,for.me In..Try name,place and stead.as I could.do if personally present With regard to such real property and a»y Mher real property I may own it an individual ca'pacaty or as Trustee of the Henderson Founddat'on during my lifetime I intend to give m attorney the fullest pow ers possible and I do not intend, b specifying these .:'powers below,to limit or reduce them in any fasbion.Among the powers granted to my attorney with regard to such real estate are the following:. (a) buy, receive, lease, accept ar otherwise anise; to sell, convey, mortgage, hypothecate, pledge, quitclaim or otherwise encumber or . dispose •of; or to contract or agree for the acquisition, disposal or i encumbrance of said property,upon such terms as my said attorney shall think proper, (b) to take,hold,possess,in all of �lease,let or otherwise manage an or � my real,personal ar mixed property,or arty irrtcrest herein;to ejecd, remove,or relieve tenants or others from,and recover possession of,such property by all lawful means; and to maintain,protect, preserve, Insure, remove,store,transport, repair, rebuild, modify, or. improve the same or any part thereof; (c)to make,endorse, accept,receive, sign, seal execute,aclmowledge and deliver deeds, bills of We,assignments, certiAcates, hypothecations, checks, notes, bonds, vouchers, receipts, and such other instruments iv writing,of whatever kind and nature as may be necessary,convenient, or proper in the premises;and (d)to institute,prosecute,defend,compromise,arbitrate and dispose of legal, equitable or administrative herrings actions, suits, attachments, arrests,distresses or other proceedings,or oIerwise cWge in litigation in connection with the premises, (17) Other Powers: To compensate my attorney and any agent hired by my attorney fbr services rendered; (r$)To Do A11 Nee ry Thing:To do,take,and perform all and every act ; and#bing whatsoever requisite,or necessary itio be done,in tine exercise of nay of the rights and powers bereira grarxtut as fn y to all intents and purposes aF I might or could do if personall present,here my attorneym fact shall la __ yy b3'lie clone16Yni cotrff this all that 1 ' vvfully da or cause to be clone virtue of this power of , attorney and the right and powers herein granted; I, i Page 3 of s { y xt. tv 'J/84409423 SPEC ADMIIq ' PAGE 05 This instrument is to be construed and interpreted as a general power of attorney. The enumeration of specific.items,rights acts orpower,; to, nor does it, limit or. restricctt,, and is not to b construed or�inteerpot lrettenddas limiting or restricting,the general.powers herein granted to my attorney. (19)En Should a third party refiigc to recognize the exercise by m attorney of any aut ority hereunder,MY attorney may use any of my resources as may be neoessary to require such third party to abide by the. exercise of such authority,including litigation. RI`fC9 TI.—b—CUTION OF�OCTJM FN My attorney is empowered to execute my name, or my sttorne5*s name as attorney for me, to any agreement, deed, promissory ui ate, security agreement;, financing statcmen#,mortgage,bill of sale or any other document or instnnmout that my attorney may deem a vrsabls to carrying out any of my attoxncy's powers execution. hereunder. My attorney is also empowered to 801.ni e.�a owledge any such ator .id ARTICLE III--INTFRPRFTATrnr�T AND GOVERTV1Nn r nw Ibis instrument is to be construed.and.interpreted as a general durable power Of attorney.The enumeration of spedfic powers herein it not intended to,nor does i.4 limit or restrict the general ppowers herein granted to my attorney.This instnrment rR executed and delivered in the Commonwealth of Massachusetts,and the laws of the Commonwealth of Massachusetts shall govern its validity and effect and the construction of its provisions. ARTICL xv r ta,�Ir>rTY'OF ATTORtvFv My attorney shall only be liable for. any action,or failure to act,done willftelly and in bad faith ARTICLE V--DTSABILITY OF PRTNCtt+ar THIS POWER OF ATTORNEY SkIALL NOT BE AFFECTIED 13Y MY SUBSEQUENT D1fS.AEZI..M OR INCAP.ACIZT. AR7TCLB VI--•ItIGFFI'1"t5 Rtrnu'v I herein reserve the right to revolve this power of attorney. i ,�1$TICLEVII—'r�rTRD PA�tr'1"Sr Trrit raUrr; I Revocation or termination of this power of aftmey shall be ineffective as to any third party unless and until actual notice or knowleclgc of such revocation or terminatiou shall have been received by such third party.Paymert by any third party in reliance upon this power of attorney,and made prior to receipt by such third a 1 Of actual notice or knowledge of the revocation or ter; mi ation of this power of attorneeyy,sh ll constitute a release and discharge of said third party from all liability Por each 1 cleans to the extent of such pq=nt so made,and such t i. party cal*any Payment need not see to the application thereof. ? Any third.paw may amcludVely rely upon the fact that this power of attomry u ire foil fore a and effect wAvithstanding the lapse of time since its exeetttiion(i.e. no matter how"old" it might be), unless such third party has actual knowledge revocation or termination as aforesaid,and.that any attorney was fully authorized to take a particular action or execute a particular document. further, any third party i may conclusively rely upon the representations of my attorney hereunder or any licensed attorney at law as to all matters pertaining to any power granted to my 1 attorney,and/or as to all facts which may in any manner be gcnmanc to nny matter or thing ariAog to connection with this power of attorney. No third party who may act in reliance upon an authority granted to my at hereuOder shall.i acur anyliability the o�me or my ! i Page 4 of S f I MURT 12.? SPEC A a , 4 97$4409423 DMIN PAGE 06 estate as a result of permitting my attorney to exercise any power and.T for myself and for my heirs, executors, le represezitatives and assigns hereby agree to is indemnify,defend and hold h ess atay such third party from and against anv and, j all claims that may arise or be asserted against such third party by reason of such third party having relied on the provisions of this instmmeAt Any third patty may rely upon a copy hereof certified by n Notary Public to be a true copy of this instrument. ARTICLE VIIT—iNDZMNLUQ6U.nnr nfi AMQRNM My attorney may, from my assets and Property,indemnify my attorney with respect to any damages,costs and/or attorneys'fees inmirred by,or asserted aggainst, my attorney as a result of my attorney exercising any powers granted hueunder;so t ]orb cis my attorney acted,in.good faith in exercising such powers. l l 1�'I'ZCT E IX Ri�i.�p�P�Pr,�,�rroN ` A My attorney(inoluding any named successor attorney)sball have the right,by j written instrument,to delegate any or all of the foregoing�awers to any person or persons whom my attorney may select, but such delegation may be amended or revolted by my attorney(including aq successor)named herein,and any third partymay conclusively rely upon the fact that such.written delegation is in fail force and of mt unless and until actual notice or knowledge of its amendment or revocation f shall have been received by such third party, i i IN WITNESS WEM,REO , I have execated this General Durable Power of i Attorney,and I have directed that photocopics of this power shall have the same force 'and effect as an original. SIGNED this day of HLR C zo 7�RdVItii l f� ItaON,III fi i COMMONWEALTH OF MASSAGHUS`ITS • ���tz�I I� r se �c:k. 31 20{ I on this 3 ll day of �y$-1(G'� 2ozo,before me,the undersigned notary public, personally appeared EM, ENDERSON, Ilt, proved. to the i through satisfactory evidence of, ident(,cation, proved to me through satisfactory evidence of identification, being (cheeks wbichever applies): fi_�� fi own personal knowledge of the identity of the signatory,to be the person whose ' name is signed above,,and acknowledged the foregoing to be signed by his volwatu ily for its stated purpose. LESLIE S.sHEA, 1 I Notary Public �� I CommonvaezlthafMassachusetts 5 � �, �E��• My Commission Expires Pn i l 4 ado 15- XOtary Public April 9,2015 May commissiazt expires: .Page 5 ofS { Uut-o T E , - j i i APPOINTMENT OF TRUSTEE "ERNEST F. HENDERSON, 111 REVOCABLE TRUST-2001' 1, ERNEST F. HENDERSON, 111, under the provisions ' of Article EIGHTEENTH of said Trust and every other article and power, do hereby appoint [ as Co-Trustees with myself of said Trust immediately, the following named. individuals: ROBERTA HENDERSON, now of Bolton, Massachusetts; ERNEST F. HENDERSON IV, now of Wellesley, Massachusetts and LESLIE B. SHEA, now of Wellesley, Massachusetts. Witness my hand and.seal this / day of arch, 2010, Witne Ernest F. Henderson, III COMMONWEALTH OF MASSACHUSETTS Norfolk, ss On this 15th day of March, 2010, before me, the undersigned notary public, ` personally appeared Ernest F. Henderson, III, individually and as Settlor, and proved to me through satisfactory evidence of identification, which was based upon ' the notary's personal knowledge of the individual to be the person whose name is signed on the preceding document, and acknowledged to me that he signed it voluntarily, for its stated purpose. Kri i e M. Irving— Notary blic My Commission Expires: May 3, 2013 KRIS'NE M.IRVING Notary Public 1 Commonwealth of Mazidwseds My Commission.Bq*as Clay 31 ffi13 j l REDACTED COPY t i ERNEST F. HENDERSON,III REVOCABLE TRUST-2001 j { THIS TRUST AGREEMENT,made and entered into this 25"day of January,2001,by and E between ERNEST F. HENDERSON, III, now of Wellesley, County of Norfolk, in the . I Commonwealth of Massachusetts (hereinafter referred to as the Settlor), and MARY LOUISE HENDERSON,now of Wellesley,County of Norfolk,in the Commonwealth of Massachusetts,and the said ERNEST F. HENDERSON, III(hereinafter referred to as the Trustees), - i i WITNESSETH: ' WHEREAS,the Settlor desires to create a trust of certain property delivered this date to the 1 Trustees; and J4 WHEREAS,the Settlor or another person or persons may hereafter desire to transfer to the Trustees additional property or may wish to add to the.trust by gift or will; NOW,THEREFORE,the Trustees agree to hold said property and any other property which may be made subject to tl-iis trust(hereinafter referred to as the trust property),upon the following terms and conditions: F i FIRST: Trust May Be Revoked or Changed. This trust may be known as the "ERNEST F. HENDERSON,III REVOCABLE TRUST-2001"and can be amended,altered, • 1 revoked.or terminated, in whole or in part;by an instrument in writing signed by the Settlor and delivered to the Trustees in the lifetime of the Settlor; provided, however, that no duties of the j I f --,.Trustees hereunder shall be materially altered without their consent. On revocation of this trust in its i 1 { entirety, the Trustees shall transfer to the Settlor, or to anyone the Settlor designates in the revocation,all of the trust property. Upon the death of the Settlor this trust shall be referred to as the "ERNEST F. HENDERSON, III TRUST" dated January 25, 2001. i SECOND: Provisions During Settlor's Lifetime. During the lifetime of the Settlor,and to the extent that funds are available,the Trustees shall pay over or apply so much or all of the net income and/or principal of the trust to such person.or persons,including the Settlor,as the i Settlor may direct from time to time,or,in the event of the Settlor's absence,incapacity or inability to act,as,in the discretion of the Trustees,may be necessary or advisable to provide adequately and i f properly for the comfortable support and maintenance of the Settlor,his wife or issue. Any income undistributed shall,from time to time and at the death of the Settlor,be added to principal. f 1 THIRD` Trustees May Hold Insurance. The Trustees shall not be obligated to i pay any assessments or premiums upon the policies of insurance held hereunder nor keep informed " with respect to payment thereof,and their sole responsibility regarding same during the lifetime of the Settlor shall be the safekeeping of such policies. j FOURTH: Reservation of Rights in Insurance Held. The Settlor hereby reserves the j i following rights and powers with regard to any policies transferred to the trust: f f 1. The right to withdraw such policies,upon giving the Trustees a proper receipt therefor. I 2 l i f t i ti } aggregate amount,become payable to a minor beneficiary,or to a beneficiary under legal disability, or to a beneficiary not adjudicated incompetent,but who,by reason of illness or mental.or physical disability is, in the opinion of the Trustees,unable properly to administer such amounts,to pay out x such amounts in such of the following ways as the Trustees shall deem best: (a) directly to such 4 beneficiary; (b) to the legally appointed guardian of such beneficiary; (c) to the custodian of any E account established for such beneficiary under the Uniform Gift to Minors Act of any jurisdiction. i TWELFTH: Trustee Authorization..The Settlor authorizes the Trustees,with regard to S k i all trust property held hereunder,in their discretion,without limitation by reason of enumeration and r in addition to powers conferred by law,to: i l. Compromise,settle,adjust,or abandon any claims or demands by or against this trust and to agree to any rescission or modification of any.contract or agreement. 2. Retain any security or other property placed.in this trust by the Settlor so long., as such retention appears advisable to the Trustees,and no sale thereof need be made solely in order E i to diversify investments. s 3. Sell, exchange,assign,transfer and convey any security or property,real or i personal,held in this trust fund,at public or private sale,at such time and price and upon such terms i and conditions-(including credit) as they may deterr ine. 4. Invest and reinvest in such stocks,bonds, options and other securities and properties as they may deem advisable, including stocks and unsecured obligations, undivided s i interests, interests in investment trusts, mutual funds, common trust funds, leases, and property tf G, which is outside of the Settlor's domicile,to maintain margin accounts, and to invest in a manner i i i 28 i r I I I which may provide a greater benefit to one class of beneficiary over another class, as by way of i example and not as a limitation,an-investment which provides a greater current return as opposed to i future appreciation, and all without diversification as to kind or amounts. t i 5. Sell or exercise any"rights"issued on any securities held in any trust fund r r hereunder. 6.. Consider and treat as principal all dividends payable in stock,all dividends in E liquidation,and all"rights"issued on securities(provided,however,all capital gains distributions on shares of mutual funds shall be treated and retained as principal),and to consider and treat as income f all other dividends received. i 7. Charge the premiums on securities purchased at a premium either against principal or income (or apportion th.e.same) or amortize the same; and to credit to principal any discounts on securities purchased at less than par. r 8. Allocate receipts and disbursements between income and principal in such manner as in their discretion they may deem proper. t, 9. Vote in person or by proxy any stock or securities held, and to grant such , t proxies and powers of attorney.to such person or persons as they may deem proper. F 10. To execute and deliver in a trust and fiduciary capacity, bills of sale, i agreements, assignments, contracts, leases, deeds, powers of attorney, receipts and any and all. i instruments in writing necessary and appropriate for the administration of the Trust created i i hereunder. 11. Hold any and all securities or other property in the name ofthe duly appointed inee with or without disclosing the fiduciary relation. j i 29 i i .. j 12. Consent to and participate in any plan for the liquidation, reorganization, consolidation or merger of any corporation, any security of which is held. 13. Borrow money upon such terms and conditions as they may deem best and to 7 mortgage and pledge trust assets as security for the repayment thereof. E r 14. Manage real property in such manner as they shall deem best, including • i without limitation,the right to: Erect,alter or demolish buildings and vacate any of such property; i lease any such conditions and rentals and in such manner as they may deem advisable,and any lease j so made shall be valid and binding for the.fall term thereof even though same shall extend beyond the duration of the trust;make repairs,replacements and improvements, structural or otherwise,to i any such real property;subdivide any such real property;dedicate same to public use;and grant such. i easements as they may deem proper. 15. Maintain insurance on trust property against such perils and liabilities and for i such periods and amounts as they may deem proper. t 16. Make divisions and distribution of any trust or share,whenever required or f permitted hereunder,in money or in kind or partly in money and partly in kind;and to exercise all such powers after the termination of any trust until the same is fully distributed;provided,however, that any assets so divided or distributed shall be valued for that purpose at their fair market values determined as of the date of their division or distribution, as the case may be. i 17. Employ accountants,attorneys and such agents as they may deem advisable; and to pay reasonable compensation for their services. 18. Determine the market value of any investment of any trust for any purpose on �- --, ". the basis of such quotations, data or information as they may deem pertinent and reliable. { i { 30 • 1 i E 4 f 19. Participate in,including the investment in,the organization and/or purchase of f i a business enterprise, S 20. Create bank or other institutional accounts which allow the signature of individual Trustees to bind the trust,specifically including by way of illustration and not by way of j i limitation, checking accounts which allow one Trustee's signature. 3 E i F 21. Grant powers of attorney to such person or persons as they may deem proper s i to exercise a Trustee power hereunder. z THIRTEENTH: Special Provisions For.Dealing With the Settlor's Estate. The 3 Settlor authorizes the Trustees,in their discretion, to use the income and principal of each separate i trust held hereunder, provided the same proportionate amount is taken from each separate trust, except for any trust which qualifies and has been elected for the federal marital deduction, and except for funds held in any qualified retirement plan, annuity contract or custodial account I I t f described in section 403(b) of the Internal Revenue Code (hereinafter "code"), or individual retirement account,or from any distributions from any such plan,contract or account or the income therefrom or proceeds of any reinvestment thereof, and the Trustees are specifically authorized to i i borrow from any beneficiary or,from any other trust established by the Settlor in order to make the j payments set out in this Article, as follows: ' 1. To pay the funeral expenses of the Settlor and to pay the debts and expenses of i administration of the Settlor's estate and to pay all federal and state taxes in the nature of income, t t estate,inheritance,succession,gift or like taxes arising or owing on the Settlor's death,except such estate taxes as are attributable to the value of all property held in any trust included in the Settlor's I 3- i i • I F r r the Settlor's wife, except in a manner consistent with the Settlor's intentions as expressed in the 4 I - j preceding sentence. ! 2. No Trustee hereunder shall have the power or authority to make: (a) any decision relating to distribution of income or principal of Trust B to any beneficiary to whom said Trustee has a legal obligation of support; or(b) any decision relating to the income or principal of I { Trust B which would constitute a general power of appointment under Section 2041 of the Internal Revenue Code or any successor section thereto; and therefore, any other Trustee hereunder not similarly disqualified shall have the right to make such decision without action by the disqualified r i Trustee. r SIXTEENTH: Joint Trustees. During any period of time when two or more Trustees are acting hereunder, the powers and duties of such Trustees shall be exercised by then jointly r { I except as otherwise provided in Article Twelfth,paragraph 20, provided,however,that one or more j I of such Trustees may at any time delegate to the other Trustee or Trustees,by written instrument,all �. I or less than all of the powers conferred upon that Trustee or those Trustees,either for a specific time or until such delegation is revoked by similar instrument. } SEVENTEENTH: Order of Death Presumption. For the purposes of this trust, if the Settlor's wife and the Settlor shall die under such circumstances that there is not sufficient evidence to determine the order of their deaths; then it shall be presumed that the Settlor survived the Settlor's wife. { s i t 3t I 35 I i I { 1 I l r } EIGHTEENTH: Successor Trustee Provision. During any time when either the Settlor or the Settlor's said wife, MARY LOUISE HENDERSON, is living,any Trustee at any time acting or appointed to act hereunder may resign by written notice to the Settlor,but if he is then deceased,to the Settlor's wife,but if she is then deceased,to any beneficiary hereunder. In the event l of the death, resignation, refusal or inability to act of any Trustee acting or appointed to act hereunder, a successor Trustee may be appointed by the Settlor or the Settlor's said wife;provided, however,that if the Settlor is then living and acting as Trustee hereunder,there shall be no successor to the Settlor's wife,MARY LOUISE HENDERSON,as Trustee and the successor to ERNEST F. HENDERSON, III shall be Co-trustees LESLIE B. SHEA, now of Wellesley, Massachusetts, I ROBERTA HENDERSON and ERNEST F.HENDERSON IV. If at any time there is no successor Trustee named to act hereunder a successor Trustee shall be appointed by that person or a majority i of tho se_persons in the generation closest to that of the Settlor(if more than one person)qualified to receive notice of a Trustee's resignation. At all times duririg the term of this trust,there shall always be at least one Trustee who can make any discretionary distribution decision for each trust beneficiary hereunder. If at any time there is,no Trustee who can make such a decision for any j beneficiary hereunder, then an"Independent Trustee", as such term is defined in Article Twenty- Fourth,shall be appointed as Co-Trustee hereunder,by the then acting Trustee(s). Such Independent j Trustee shall make any decision required by this trust which any or all other Trustee(s) is/are i otherwise unable to make according to the terms of this trust. Any Independent Trustee acting hereunder, except LESLIE B. SHEA,may be removed at any time,by majority of the then acting Trustees, by an instrument in.writing delivered to such Independent Trustee, and there shall be no 1 requirement to appoint a successor Independent Trustee to the removed Independent Trustee unless 36 i f 3 otherwise required by this paragraph. If a successor Independent Trustee would be required, acceptance of the appointment of such successor Independent Trustee shall be required before the removal of the Independent Trustee is effective. 4 NINETEENTH: Trustee Incapacity. Any individual Trustee hereunder shall be i • f deemed incapable of acting as Trustee upon receipt by those persons who would receive notice of the resignation of such Trustee, of a letter by a physician (who is not a beneficiary, related to a E beneficiary, Trustee or Successor Trustee hereunder) attending such Trustee stating that in the _ l opinion of that physician,such Trustee is unable because of physical or mental incapacity to manage, the affairs of the trust. r ' 3 1 TWENTIETH: Removal of Trustees. Any Trustee at any time acting or appointed to act hereunder may be removed by the Settlor. After the death.of the Settlor,a Trustee, other than an Independent Trustee,may not be removed. Any Independent Trustee maybe removed by unanimous written consent of the then acting Trustees,not including the Independent Trustee, delivered to such Independent Trustee. I. ; TWENTY-FIRST: Successor Trustee Powers. Any successor Trustee shall be clothed and vested with all the duties, rights, titles, and powers,whether discretionary or otherwise, as if originally named as Trustee,but shall not be liable or responsible in any way for the acts or defaults. f c, ny predecessor. 37 i i i t i I . IN WITNESS WHEREOF;the Settlor has hereunto set his hand and seal, and the Trustees, in token of their acceptance of the trusts hereby created,have set their hands and seals on this 25th day of January 2001. k S 1 Settlor: ST F. ERSON, III r t Trustees: _ } 'MARY LOUISE HINDERSON c-�W7 ' NEST F,'HENDERSON, III 1 COMMONWEALTH OF MASSACHUSETTS Norfolk,ss. January 25,2001 Subscribed and sworn to before me by the Settlor and the Trustees,who are all-personglly known to me, and who did take an oath this 25' day of Jan ,2001. es r .-§CwNe6uy Wic commissi on'expires: May 11,.2001''. ' i f 43 i f i i i 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION— Map 20S Parcel, l ApplicationD Health Division Date Issued 117 Conservation Division Application Fee D Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board C09 6h1J/Z.. Historic - OKH _ Preservation/Hyannis Project Street Address S LivD� Nx f vxe Village GENT% V 1 Owner 1�eNbER.Sor1 V_-PAw�:N- Address FoZ�bx 41o, �Ob6Lg A Telephone Permit Request - n�� 1��u<T�►.�ca -rcEl�+�l - t�+s�1.1- � QT ��1-���cA'Ct o►�1 � 1 NTH t�ti, C�i�1�-�' Square feet: 1st floor: existing j proposed f 2nd floor: existing proposed Total new Zoning District `RQt Flood Plain Groundwater Overlay Project Valuation Ili od0 Construction Type Lot Size , I $ti S Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(# units) Age of Existing Structure 2>S Historic House: ❑Yes 0No On Old King's Highway: ❑Yes *No Basement Type: A Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) 1 i4o Number of Baths: Full: existing 0Z new Half: existing new Number of Bedrooms: existing 'new 0 4 -� Total Room Count (not including baths): existing new First Floor<'Ro',om CoufW S Heat Type and Fuel: ❑ Gas ❑i6iI ❑ Electric ❑ Other µ, M Central Air: ❑Yes ANo Fireplaces: Existing New Existing wood/coal stove: Zi3es A No o Detached garage: Elexisting ❑ new size—Pool: ❑ existing ❑ new size Barn: Allexisting`µ`❑ new size ozs+ 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 PR kw-TL�_ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 01r.� �bA 4o�Ss� �►�P�1- Telephone Number SUS ' �� •�3 03 Address ?0 bow I1\oL License# GS- UtA 4-0 (o Home Improvement Contractor# Worker's Compensation # r1 ?3,3 - Lf-V 9 P3_7r-_�-I I ALL CONSTRUCTION DEBRT RESULTING FROM THIS PROJECT WILL BE TAKEN TO �dl�A P1� IQFi.� SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# ti - DATE ISSUED ,_,,MAP/PARCEL NO.... . `. ADDRESS VILLAGE - OWNER ( f DATE OF INSPECTION: y _FOUNDATIOMv - F FRAME Z t`'INSULATION : Ik'k G t-L r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL „ } GAS ROUGH FINAL 01IFINAL B.UILDING', : u ;DATE CLOSED.AUT - - ASSOCIATION PLAN NO. i The Commonwealth of Massachusetts Department of Industrial Accidents QKce of Investigations 600 Washington Street Boston,MA 02111 nww.mas&gov1dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers AApplicaut Information Please Print L*6b1N Nam y arc, 1t, Address: w Plow 1 l to 1. City/Statd&p:��n�v�T 1�-1 la o �, u` Phone# ��5• 1 l • o'er y 3 Are you an employer?Check the appropriate box: T}'Pe P of ro,1 ect(required): 1.[� I am a employer with 5 4• ElI am a general contractor and I employees(full and/or pact-time)* have hired the sub-contractors 6. []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 have g. E]Demolition workin for me in any capacity. employees and have woBkers' [No wodoecs'comp.msura ce comp.insurance.i 9- ❑Building addition required] s. We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.F]Plumbing repairs or additions myself[No workers'cramp- right of exemption per MGL 12. Roof repairs insurance required.]T c.152,§1(4),and we have no employees-[No workers' 13.0 Other comp.insurance required.] ..., 'Any applicant that checks boa#1 urns t dw fill out the section below showing dwir warke&companution policy warmatiom. T Homeowners who submit this df&UM i&cmftg they ere doing all wa*end then hue outside contracmrs now submit a new affidavit m&cammg sash. konuaclors that check Ibis boa most attached an additional sb wt d wwmg the name of the sub-conmmcmre and state whether or not those entities hone employees. If the mb-comractaa bmve empl"mr,they moat p¢wide their workers'comp.pohcy - I am art omploper that is pmv&%W workers'compensation insurance for my ongdoyeex Below is the poUey nod job site information ^ . Insurance Company Name: �'R 1�� L tcfLS P` CAg��l C-D. 'OF I�as1LtL-_-4, Policy#or Self-ins.Lic.#: . 113 U fb - '}�S`�T P 3'►- -] - 11 E*pitation Date -I-- Job Site Address._IP 5 . N-6F_t , Nv1.= City/Statelzip: Uwe. A va i­. 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" coverage verification. I do hereby co under t e poi and penaWs of perjury that the information provided above is hue and correct: S Date: ti'��2o1 Y Phone#: 0 Offi fal use only. Do not eo to in this area,to be completed by city or tmm oficiaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Bu kiting Department 3.Cityfrown Clerk L Electrical Inspector S.Plumbing Inspector 6.Other d` Contact Perms: Phone#• �6 A DIYYM A65ZO CERTIFICATE OF LIABILITY INSURANCE DA08/2TE D/2011 �, OS/26/201 1 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: II the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. R UCER CONTACT NAME' WELSH & PARKER INS AGCY H N F 131 COOL I DGE ST STE 100 ac,NILo.Evil' AIC No:. MA ADDRESS; HUOSON MA 01749 INSURER(S)AFFORDING COVERAGE NAICO 29FDY INSURER A TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSURED INSURER E: OHC INC DBA HOUSE COMPANY, THE INSURERC PO BOX 1 166 INSURER D BARNSTABLE MA 02630 INSURER 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR . ADOL SUER POLICY 9FF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS GENERAL LIABILITY EACHOCCURRENCE _S DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence s CLAIMS-MADE 0OCCUR MED EXP Arq o-•e oerson S PERSONAL&AOV INJURY S GENERAL AGGREGATE $ GENL AGGREGATE LIMIY APPLIES PER: PRODUCTS-COMPIOP AGO POLICY PROJECT LOC S UTOMOBILE LIABILITY COMBINED SINGLE LIMIT IEa,cadent. S SCHEDULED BODILY INJURY Per rson S ANY ALTO AUTOS ALL OWNED NON-OWNED BODILY INJURY er accident S AUTOS AUTOS RO-ERTY DAMAGE HIRED AUTOS Per accident) S S i UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE, - AGGREGATE S DED1 IRETENTION 5 WORKERS COMPENSATION X WC STATU• OTH• A AND EMPLOYERS'LIABILITY (7PJUB-4759P37-7-Aft 07-21-11 07-21-12 TORYLIMTS ER ANY PROPRiETORIPARTNERfEXECUTIVE - OGFICERIMEMBER EXCL UD=07 YIN E L EACH ACCIDENT S 500,000 (Mandatory In NH) N NIA E L.OISEASE-EA EMPLOYEE S 500,000 if yes,describe uede DESCRIPTION OF OPERATIONS below E L DISEASE-POUCY LIMITS 500 000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREFO,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF BARNSTABLE AUTHORIZED REPRESENTATIVE BUILDING DEPT,200 MAIN ST HYANNIS MA 02601 //' @1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supcn i%or License: CS-042406 JEFFREY GOISTEIN, PO BOX 116t BARNSTAB]�E MA 02630 rU. Expiration. Commissioner 03/18/2014 07-1 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 100932 : Type: Private Corporation Expiration: 6/24/2014 Tr# .223401 OHC INC. DBA/THE HOUSE COMPANY Jeffrey Goldstein P.O. BOX 1166 BARNSTABLE, MA 02630 Update Address and return card.Mark reason for change. Address ❑ Renewal Employment Lost Card SCA 1 0 2OM-05/11 - Te�rrurirnnrnerrl(�nl�tr�.;rre�r%e(/1 Office of Consumer Affairs&Business-Regulation. License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 100932 Type: Office of Consumer.Affairs and Business Regulation pimtion: , 6/24/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 OHC INC.DBA/THE HOUSE COMPANY Jeffrey Goldstein 30 PERSEVERANCE WAYUNIT 2 �yannis,MA 02601 Undersecretary ali without signature Town of Barnstable Regulatory services Thoinas F.Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Www.town.lArnstable.aza.us Office: 508-862-4038 lax:508-790-6230 Property Owner east Complete and Sign This Section If Using A Bg lder s ?0/4 I, as QWRe of the subject ptaperty hereby authorize C)HC nc dba 1 he Hc�ti,se to act on my behalf, in all matters relative to work-authotized by this building permit application£or: �35 Linden Avenue,Centerville,NIA 02632_ {Address of Jab} . Signature of Owner Date Print I`=e Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston;Massachusetts 02116 Home.Improvement Contractor Registration Registration: 100932 Type: Private Corporation Expiration: 6/24/2014 Tr# 223401 OHC INC. DBA/THE HOUSE COMPANY Jeffrey Goldstein P.O. BOX 1166 BARNSTABLE, MA 02630 Update Address and return card.Mark reason for change. SCA 1 0 20M-05/11 ' [� Address Renewal Employment Lost Card ..............._-........ S Office of Consumer Affairs&Busidess Regulation License or registration valid for individul use only rxME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 100932 Type: Office of Consumer Affairs and Business Regulation piration: .6/24/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston;MA 02116 OHC INC.DBAI THE HOUSE COMPANY Jeffrey Goldstein 30 PERSEVERANCE WAY:UNIT 2 11yannis,MA 02601 Undersecretary ali without signature REMOVE EXST.DOOR 18'-4" E 5'-0„ r-4 T HARVEY 2442 REMOVE EXST. PARTITION - - - - - - - - - - - - - - - - - - - - - - - - (V I. o 9'-0"CEILING HEIGHT CASED 2x8 FALSE BEAMS 9014 %� TRANSOM I REMOVE EXST. REMOVE EXST. WINDOW WINDOW -..-. - � ANDERSEN 0 6068 C14 , " F LINE OF SLOPED CEILING ABOVE lI 2/6x616�. 4,-$„ FLAT CEILING 1/4x6/6 h. FLAT CEILING ACCESS I N r HATCH REMODELED BATH 3 x4/0 w L- 4'-7" HARVEY 2442 --1 HARVEY 2442 o s. _ :7T Pn w _ REMOVE �j /� EXST.DOOR Ji' L®®R IPT AN N07 - 7-0 541t-c-f-- THE HOUSE COMPANY P.O. BOX 1166 BARNSTABLE, MA 02630 NORTHEAST ELEVATION -r"' a. THE II Ud E NIP ANY P.O. BOX, 1166 BARNSTABLE, MA 02630 J Li SOUTHEAST ELEVATION THE � VE COMPANY P-0. 13OX 1166 BARNSTABLE, PEA 62-830 1�Evw�.wYL. ��Ca,ri1Cx P v ae"O"UTHWEST ELEVATION No, R.0. E30X 1166 BARNSTABLE, MA, 02630 I f 1 f NORTHWEST ELEVATION nor -� ��� . THE. tjGU,�-jvr p.0. BOX 1166 BARN S TABLE, MA 02'30 Coyle, Brenda From: Snowden, Laurel Sent: Thursday, December06, 2012 12:52 PM To: Coyle, Brenda Subject: Parcel Id 208-133 Brenda, Parcel Id 208-133, address of 35 Linden Avenue is paid in full for$3857.42. . They are all set Laurel Snowden I i c) O Ve Town of Barnstable *Permit# ®I V44 Expires nortihe f Hrissue date %egulatory Services Fee BARNsUB l Mass. �' dW Thomas F.Geiler,Director 1659. Building Division �a����e Perry,CBO, Building Commissioner �1 00 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax:508-190-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address .5 Lt N est:N ABC J C L'2vr L4 /..(A Duo b 1— J Residential Value of Work 3oL,)c2. Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name O>LAnLc` b0A TAE V\OilsG co►.. aNa `I Telephone Number Sofr 711 • 03u2--, Home Improvement Contractor License#(if applicable) 3 a s tL--z 114 Construction Supervisor's License#(if applicable) 40 U, -1j-1Ffr- z �o.�s�-�►.J ®Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name t-o or- N-Ls g! ljk cA Workman's Comp.Policy.# PJ V D - 4'7s- P3'i - -1 1 Copy of Insurance Compliance "ertificate must.accomp na each eay ch permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be•taken to S 4 J t-­kc-o\NJ, ❑Re-roof(hurricane nailed)(not stripping. Going.over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ` *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owne must sign Property Owner Letter of Permission. A copy of the ome Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: C:\Users\decollik\AppDa \Local I ' so8\Win ows\Temporary Internet Files\Content.0utlook\DDV87AAZ\EXPRESS.doc Revised 072110 I , low The Commonwealth of Massachusetts Department of Industrial Accidents 09we of Investigations 600 Washington Street Boston,ALL 02111 i www mass govldia Workers' Compensafion Insurance Affidavit:Builders/Contractors/Electeicians/Plumbers Applicant Informafion Please Print Letpbl�* N =ftsine�izatiawbdividuao: vvk \ M C=— C-oh-ktPW- Address: 1w Pbt7x_- 11 to L City/State/Zip: A o1-(p u Phone# 50v6•1 1 l 0'1.y 3 Are you an employer?Check the appropriate boa. Type of project(required): L n I am a employer with 3 4. ❑I am a general contractor and I employees(full and/or part-time)-* have hirers the sub-contractors 6: [-]New construction 2_❑ I am a sole propaetor or partner- listed on the attached sheet 7- ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition wcddug for me in i employees and have worms' �y capac i3`• t 9. �Building addi�od [No wodws'comp.insurance comp-insurance. 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 I LEI Plumbing repairs or additions myself[No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance required-]f c.152,§1(4X and we have no employ-[No w"kers' 13.0 Other cohrlp.insurance required.] 'Any spphice t#hag checks boa#1�also fill out the section below showing their worker!'a mpensafm policy infnamerdcm- ¢Ty,�.,Homeowners who sa�®t this a�daa�iu�catmg they are doh all wank nisi then hire outside court mans um9isubmit a new aff davit indicating such ZConlrzcom that check tors boa umst attached en additional sheet slowing the mmne of tbe mb-co arwims and state whether or not those enhnes have emphtyees. If the sub-contmams have employees,they must prwA&their warkers'comp-policy number. I am an employer that is providing workers'compensation insurance for niy ouiployem Below is this policy and job site infornhatiort. • Insurance Company Name: Q. pF Policy#or Self-ins-Lic-#: . ;'.l O-e P 3'I -_1 - 11 Expiration Date: 7 ti l . 20 i L Job Site Address: City/Statelzip:_Z� TL L_ t t Attach a copy of the workers'eompensatitm policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required undue Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,50D-00 andlor one-year imprisonment,as well as civil penalties in the fiorm 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 mmmahce coverage verification. I do Hereby under t e poi and penabies of pedirry that the informidion provided above is Into and correca Signature: Date: Phone#: "; 6C)b 0,0wal zoo only. Do not WP6 in this area,to be completed by city or tonm offiicial City or Town.: PermitLicense 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#- a • A ACC>RV� CERTIFICATE OF LIABILITY INSURANCE DATE /2011 OB/26/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND.EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER.AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. RO UCER CON AC WELSH & PARKER INS AGCY NAME ' PHONE it 131 COOLIDGE ST STE 100 AIc,No.Ext: AIC No: EMAIL ADDRESS: HUDSON MA 01749 29FDY INSURER(S)AFFORDING COVERAGE NAIC O INSURER A TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INSUREDINSURER 6: OHC "INC OBA HOUSE COMPANY, THE INSURER PO BOX 1166 BARNSTABLE MA 02630 INSURER INSURER 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 CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY,BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY FF POLICY EXP LTR TYPE OF INSURANCE - INSR WVD POLICY NUMBER' MMIDD/vYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES Ea occurrence S CLARAS•MADE F71 OCCUR MEO EXP Ar•ox person)S PERSONAL&AOV INJURY S CENERA! A.CGREMS-,c S GEML AGGREGATE LIMIYAPPLIES PER PRODUCTS-COMP/OP AGO POLICY PROJECT n LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S. ANY AUTO �6y8gULEO BODILY INJURY Perperson) S ALL OWNED AUTOS NON-OWNED gU7O3 BODILY INJURY A,er accident) S HIRED AUTOS PRO5ER T1r AM AGE accider.D S E UMBRELLA LIAB OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE g DED RETENTION 5 A WORKERS COMPENSATION WC STATU• OTH• AND EMPLOYERS'LIABILITY (7PJU8-4759P37-7-11) 07-21-11 07-21-12 X TORYLIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE OVFICER/MEMBER.EXCL UC-=D? YIN E L EACH ACCIDENT S 500,000 (Mandatory In NH) N N/A 500,000 E L.OISEASE-EA EMPLOYEES M yes,describe under DESCRIPTION OF OPERATIONS below 91 DISEASE-POLICY LIMIT S 00,000 DESCRIPTION OF OPERA TIONSR.00ATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREFO,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF BARNSTABLE AUTHORIZED REPRESENTATIVE ` BUILDING DEPT,200 MAIN ST HYANNIS MA 02601 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5.170 Boston, Massachusetts 02116 Home Improvement Contractor Registration „ Re qistration: 100932 - T Type: Private Corporation Expiration: 6/24/2014 Tr# 223401 OHC INC. DBA/THE HOUSE COMPANY Jeffrey Goldstein P.O. BOX 1166 BARNSTABLE, MA 02630 Update Address and return card.Mark reason for change. - ❑ Address ❑. Renewal U Employment Lost Card scn i Co zoM-osn i ���e�a»z�iearuuealt�o��C�/ll�r�ac�rrJelli Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: rxl,egist ration: 100932 Type: Office of Consumer Affairs and Business Regulation piration: -..6/24/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 OHC INC.DBA/THE:HOUSE COMPANY Jeffrey Goldstein 30 PERSEVERANCE WAY'UNIT.2' gP� hyannis,MA 02601 Undersecretary ali without signature A Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS-042406 JEFFREY GOIASTEIN- PO BOX 1164 A�, BARNSTAB�E MA 02630 Expiration Commissioner 03N 8/2014 r, Town. of Ba:mst ble ;egu atory services Thomas F.Geller,Director Building Division `Foil-t'e r..ry I.Irisldi,rig C;:)m missic)ner 200 NIaia Street,l l}Yaz�nni.s,NU 0260 www.to-ivnbamstabIc.rqa.us Office: 508- 62-4038 lax: 5€8--70-6230 Property Owner Must Complete.and Sign.This Section If Usine A Builder pis t� te�cif tkxc .six�>jcc t >tr�Ixcrtr hereby authorise:,� C)lE-lC lnqAlba'fhe House t":rat A nt�to act on my behalf., in all matters relative to work author zed by this building permit application for. ..,,.,:._..35 Linden.Av6nue,C:cmtersiille,MA 026:32_� (lclrlress of job) 7 Signature of C)�,vner e Date x Q�oFTHEro�� TOWN OF BARNSTABLE 1i BAHH9TADL8, i M° 9 a M a, BUILDING INSPECTOR °�. ay APPLICATION FOR PERMIT TO .......... Q/.!�C.. ....... ...... �i"! ............................................ TYPE OF CONSTRUCTION ..........hl» ," (�* �1'� !1L. 1 ,CA .................................................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .................. f......... .1R ... $!........A. .. ✓ ".................. . ¢',!41 1P +!��-. -............ ^., '. / �t�. `,v+ Proposed Use ....f�niff4..?.'.. .'Aa............�PtA.. ' r�. b ........ ��,/ ..........C:.e..4+!a.C+.*.................................................. ZoningDistrict .........................................................................Fire District .............................................................................. Name of Owner ..k.0. ...{1.,i U .... ...Address ......t 41.oie, ............................................................ Name of Builder � � /V...� d. ,��� .�` � �- , '., ../.�}'............. ..�; ���I�.......Address .. . .,.............................�......... ................ � .. Name of Architect .. /�1�, .1 ...... Address ........ .......................................................... Numberof Rooms ............... ................................................Foundation ...CA-- ���............................................... Exterior IAA O.r7... �.. ± ....... .....�� ! .........Roofing .....1/�,�.�. i.... I��6't!° - ..... Floors .......l +�i`...................................................Interior ....K .o.0. . S'.. h..f -.�...... ....� .......... ....... Heating ..................................................................................Plumbing .../... .. ... .................................................. Fireplace ........... ' ...............................................................Approximate Cost ....... ��Q`,�� .......................................... Difinitive Plan Approved by Planning Board ________________________________19________. e V Diagram of Lot and Building with Dimensions r A CA lip 'Ile THE PROPOSED METHOD OF PROVIDING FOR L SANITARY WATER SUPPLY, SEWA AND DRAINAGE IS HEREBY ��U 7v �f E f_ 61� ' TOWN OF BARNSTABL — BOARD OF HEALTH A LICENSED INSTALLER MUST OBTAIN SEWAGE PERMIT. AND INSTALL SYSTE M. hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .........................s ....4 .:...Oe�.fA.P� T Henderson, Ernest, III - 3 1 997 No ....�3282... Permit for .......,add toilet to ..............garage.................................................... Linden -. ® Location .......... � y. .... Centerville ............................................................................... Owner ............Ernest Henderson III .................................................. Type of Construction frame ................................. ........................... Plot ............................ Lot ................................ Permit Granted......Augu.st_.18........ .....19 70 Date of Inspection ....................................19 Date Completed .......�, ..:.../.z.........19 7C� PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... Approved .,,............................................. 19 ............................................................................... s i� ...............................................................................