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0040 LUMBERT MILL ROAD
�. _ ,, .a , _ r i y A t ., - u r � , o ; r s .. �� e e �. o � . s , . � �� ao �� � ,x . � :� � ___ � o � Town of Barnstable ab GF THE Tp`,_ L�+ MUMSPABLE = Building Department- 200 Main Street MAS& w �$ 1639• m Hyannis, MA 02601 jOTEnee Tel. (508) 862-4038 Certificate Of Occupancy Permit Number: - B-18-1788 CO Issue Date: 7/25/2018 Parcel ID: 168-101 Zoning Classification: RC Location: 40 LUMBERT MILL ROAD, CENTERVILLE Proposed Use: Name of Tenant: Sprinklers Provided: Gen Contractor: Brian J Kinsella Permit Type: Residential - Single Family Type of Construction: Design Occupant Load: 0 Comments: 4 Bedroom single Family home Building Official Date: A Certificate of Occupancy is Required Prior to Occupying Space Building Code: 780 CMR 8th Edition Town of Barnstable Ul1111 •.' ' 'PostTh�s.:Card <" ued Ptans>NIu5t6'e Retained on Job and�this Gard Must ,e�K�e" t at tt isV�sible FrometheStreet Appro p 16 Posted Until Finai Inspection Has,Been Made : R .HARDWA �WhePermit - re a Certificate of Oecu Inc is Re uiretl suchr:Bgrldm shall Not be Qccu fed until an;Fanal,lnspect�on has'beenma�tle,, Permit No. B-18-1788 Applicant Name: Brian Kinsella Approvals Date Issued: 06/26/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 12/26/2018 Foundation: Location: 40 LUMBERT MILL ROAD,CENTERVILLE Map/Lot 168-101 Zoning District: RC Sheathing: JA Owner on Record: WILLOUGHBY,LINDA L Contractor.Name ,Brian J Kinsella Framing: 1 Address: 40 LUMBERT MILL ROAD x �� Contractor-License CS-072739 2 CENTERVILLE, MA 02632 - ESt Project Cost: $5,000.00 Chimney: Description: EXTERIOR STAIR CASE-BUILDING OF STAIRCASE REMOVINGP=ermlt Fee: $110.00 WINDOW AND TURNING INTO A DOOR ON SECOND FLOOR. Insulation: BUILDING EXTERIOR STAIRCASE ON LEFT SIDE OF HOUSE "USING A Fee�Paid: $ 110.00 , „? Final: THE NEW DOOR FOR EXIT TO NEW STAIRCASE Date 6/26/2018 Project Review Req: s g Plumbing/Gas RoughPlumbing: Building Official f m Final Plumbing: 3 � >� Rough Gas: v"A' Final Gas: This permit shal►be deemed abandoned and invalid unless the work authorzed by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved applicationzandgthe approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structuresshal b�e;n compliance with the local zoning byaws and codes. Electrical This permit shall be displayed in a location clearly visible from access street or road"and shall be rnafntained open for public inspection for the entire duration of the Service: work until the completion of the same. s ` Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed P Low Voltage Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Health 6.Insulation 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). � 3C s �i 6 %o i w w i,-J i koLL Al Number.. .......................... .......... .... 2018 ')UN -5 PM 4. 26 .................Other Fee :......... Permit Fee. TotalFee Paid........ .. .......................................... TOWN OF BARNSTABLE Pmm t Approval by.... _ ....on....l�.(. BUILDING PERMIT .............Pared...... .................................. APPLICATION Section I — Owner's Information and.Project.Location Project Add ess ® y% \A -9-D Village C e v% uc Owners Name L', j i Ny 3,u z t'� oe,s71 U P6rev ev- NSs - Owners Legal Address 'mo o L.`mac a l,s State OAAsS —zip., g-z r.a k Owners Cell# 56�• a S5_ 7 3a� E-mail C�id1�3�Q L�� Pe o ►�- eoo� 2 � �'- -„ '} a .Section Z—Use of Structure Use group ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial'Structvre under-35,000 cubic feet ` Q Single/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use { ❑ Demo/(entire structure) ❑, Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition m ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation h � Other—Specify Q-&A e_r k a r �� cx_ � +- C cA S e- Section 4 -Work Description E�J O G+� �£�I�SC� ;„e j T Act nndated--7/92018 ` 4e Application Number................... Section 5—Detail Cost of Proposed Construction M 0 Square Footage of Project Age of Structure Dig Safe Number # Of Bedrooms Existing Total# Of Bedrooms(proposed) d" 110 MPH wind Zone Compliance Method ❑'MA Checklist ❑ wFCM Checklist ❑ Design i Section 6—Project Specifics El wising Oil Tank Storage Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply 1 ❑ Public ❑ Private Sewage Disposal ❑ Municipal ® On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: \kr�^elu ^ �UC.$�� I am using a crane ❑ Yes No Section 7—Flood Zone Flood Zone Designation ❑ Within or adjacent to a wetland, coastal bank. Yes No Section 8—Zoning Information Zoning District - c�,Ac, Proposed Use -Lot Area Sq.Ft. 'Zd Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed ^LO` Rear Yard ; Required Proposed i� t Side Yard Required Proposed 16 Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No a • 1 Last undated 2 201 S z Application Number........................................... Section 9—.Construction Supervisor Name ; - Telephone Number_� _.24 I,? I Address 2i 1 4,6(44,1-_'�Ad City Ch State Tip License Number License Type Expiration Date P e� Contractors EmailA,j I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation r 780 and the To of Barnstable.Attach a copy of your license. 7 Signature Date r Section-10—Home Improvement Contractor Name� PA Telephone Number • <- -r-m Address ( City ftio�jCh State h/1 Tap G?, y Registration Number Expiration Date 7—r I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation.required by 780 CW and the Town of Bamstable.Attach a copy of your H.LC... SignatureDate _ Section 11-Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number T understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. s Signature Date APPLICANT SIGNATURE z Signature Date Print Name ( As1 Telephone Number rT v E-mail permit to: hrf N _ l i/Ull- t n 12—Department Section p Sign-Offs Health Department © Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required ❑ Fire Department ❑ - Conservation For commercial work,please take your plans directly to the f re department for approval. Section 13—Owner's Authorization I; I w i suG Pe o e av1 y (��e u � , as Owner of the subject property hereby authorize n� �C ' � ���,1,P_ , to act on my behalf, in all c matters relative to work authorized by this building permit application for: -"' �8 L-,tJ�(3.eri V`1i �l 1�� �` Cz^�:�r✓."L`�i,��� -- ,i`'�►4 ozc,3z ' j (Address of j ob) ' 04 Signature of Owner. date Print Name s f Last wasted:2/92018 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 01/12 LIVING INDEPENDENTLY FOREVER; INC. supported Inc'ependent Living For Young Adults With Leorning Disabilities HYANNIS • MASHPEE • PLYMOUTH June 20, 2018 Town of Barnstable Hyannis, MA 01111 C: � Attn: Brian Florence _ Fax: 509-790-6230 Re:40 Lumbert Mill Rd,Centerville v� w This letter is to confirm that W Lumbert Mill Road,Centerville, MA will be used as a residential group ` home for 4 disabled adults whom are all capable of exiting of the home on their own.This residential group home will be staffed 24/7 with 2 staff during the day and 1 staff overnight.Each resident will have their own private bedroom E nd they will share 3 bathrooms.. Following this letter are LIFE's Articles of Organization. If you have any questions,please contact Brenda Charles, Director,at 508-737-1818. Thank you, r Jenn Hamm " Director of Finance Living Independently Forever,Inc. Direct:508-418-5675 E-Mail:jhamm@lifecapecoc.org - • t Hyannis LIFE Community.550 Lincoln Road Ext.,Hyannis,Massochusetts 02601 •Fox(508)778-4919 Moshpee LIFE Community:175 Great Neck Road South,Unit 36,Mashpee,Massochusetts 02649 •Fax(SOS)539-8614 Plymouth LIFE Communily:30 One Hills Drive,Unit 2101,Plymouth,Massachusetts 02360 •Fox(508)591-7381 Office:(508)790-3600 •www.lifecapecod.org 0 info@lifecapecod.org 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 02/12 l JAN 22 g2. :'ROM BURNS-AI4D-1-EU I NSON--- • t5A3E •©02 OFFICE OF THE MASSA,CHUSET TS SECRETARY OF STATE F,zamr MICHAEL JOSEPH,COMVOL'LY, Secretary i ONE ASHBURTON PLACE,BOSTON MASSACHUSETTS 02109 _ ph TICLES OF ORGANUATION • ([lade[ G.L. Ch.;r.80) . ARTICLE I - — The naloo of.the cor?otatloa is, Name Approved Living Independently POt:over,, Inc. ' AR77CLE TI rn The putposb of the eorpomdOn is 16=gap Is the f0devag aarvi r. '' -n To CwWA cad operate residential units and to prow fl for tl��' continuous or perpetual care of the individuals who reside in their 5o bdilding��. Further, to operate an apprenticeship'progr to171ek�Wi]� provide i.ndividua.1s, the opportunity to learn a vocation,a 00 r-- To carry on any business and engage in any atativit •0s, wh n-T M,. �- br• iiot: 'rcjated to those specified in the foregoing pat:agraph, as tray. be pe,rmit:t td to a corporation organized under Chaptar' 180 of the Vener'a). Laws of the Cotuutommalth of HassAchusetta, ae from tiz to time mexldad, provided that such activities shall at: 911 tides -be cvtu%iuteat: with the provisions of Sa tion 501(a)(3) of- the ZnCez�a1 -Revenue Code of 19S6, as amended. P:A; - Nate:if•tbe op oft.provided under any"cle or item as tills forts is insutfalant.Qddldoaa shall beta foam on separaco MA x t J Atcc s of Pn' •_..� leaving ilea kmw mnrg�a of siloaet t lneh.Additions to mote tbaa oenordcLo may be_P"t need ob e,,jt4 baa 90104 0% aen,artiole►a4o4rir p.G egb O;ui:h ed"or. 6 dearly indicated, 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 03/12 . PAGF. 003 . . JAhI 23 ' 92 9: 46 FROM SUP.NS—AND—LEl'lllSOl�t ARTICAU AI . If the eorPoraeion has one of lllo[E elssYes of meflbem lA�deS,i�aiioa c*f fuCb clA0gG7y th6 nanaaer oS cler�iahor apyo�Ma+enta,tde dlis'ntion o(mttabesxhlg RA the qualiGddiou r,od rights indudiss8 yoliag riBbts,of tba members o[�eeeh class,may be aee forth in the by-lave oC rlac corporation or stray be setforib belpe. AR ft=IV ■ Otba lawful pr&Asiosts,if lse�',t Or the conduct and rogrdssioo of ft busies aad&Mmin of the aarporasop,far it#Yoluatnry diacoEofios>.Et for limning; fimiag sjRr,or iUdng cha powers oa ft oorporW oa,or of its dara�•6—or members.or of anq oats of membca.are a�rottoars da Se:a Continuation Sheet 4A attached hereto. • If!bare>ac no prov+®om,Aft?"None''. Note. I.tim i feast(�1 mid!hi err ceo6&red to be 0 ooh Roy OMY be�by�WV W! �rUr�ar of � 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 04/12 . ' ,OM EURIgS—AND—LEUINSOtd— , PPGE . OR6 ' tAN 23 52 9: 5C� i P I,IV�NG INDEpENDENtLY yOREVERI INC. NINCORP ORA L02bk__W T TR E 12* The .undez. igned� being all of the Incorporators of -Living Independent3.y F'orevEr, xnc. , do. hereby take the following actions. pursuant to C 150, Section 3 of the General Laws. of . =Massachusetts: _ 1,; We, hereby adopt as the By-Laws o the Corporation the ay-Laws attach(:d heret6 and incorporated ber6in. : . 2: ;We hereby. fix-the numlzex 4f Directors of the ' ; Coxpora,tionr 'Lvi].ess changed by vote 04 the Directors pursuant.to ' the By-Laws adi)pted' hereinzibove, at five (5) , and we hereby •Appoint the fo;l.:lowing persolls .as Directors of '-this corporation: Cxe A. Dopey Dennis Mahoney ; " Ri.chzrd Lavoie Jill Edelson Scott Smith - 3, y7e hereby appoint the following persons to the. of faces set .;forth•.oppo a ite their respective names President - Richard Lavoie p.-.ecutive Director Cxe A. Dorey agux^er Dennis Mahoney Clerk - Dennis. Mahoney ; " As»istant Clerk - Paul Stanzler 4• TVA' hereby adopt as -the- Articles of O:eg: aixation of this . corporation the Articles of Organization in the 'form ,afttadhed ..ho-reto, and vie direct that 'the. dtly executed original.. of. said' ; : - Astictes of Or'ganieatiori be filed with the Secretary oir the , CommonweaXth ,and the praper fee be paid therefor. . , Executed on ,. .1992f at • r -kassachusetts. : .' ;y .. .. .. : . . ; Dennis kiahaney '• - • .. Cre A. Dorey JoseFh Williams 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 05/12 a - PAGL . 0L7 JAN 23 ' 92 9: 51 FROM B N S UR -AIID-LEUI11SOh! , 4.A 4. The corporation shall'have the following powers ift furtherance of its corporate purposes: " (a) . Tk�,E corporation Shallhave perpEtua.3_ successi:bn Yn' i.ts corporate name. (b) The corporatioa may, sue and be sued.. G) The corporation xnay have a corporate seal which t . may' alter at pleasure. (d) The corporation may ei:ect or appoint. directors, offia r'sr• employees and other agg�.ts, fix their compensatiort� define their duties and obligations' and i.-nde i-fy .s•uCh corporate. persohnel'. (e;� The corporation' may puzchasa, receive, ttke by gra3t , gift, devise, bequest or otherwi.ge, lease;-'ox e other Wis ac�uibe, pwn. hold, improve, employr, usd and o therwise deal' in . and with x'ea:l .or per property, or any interest therea.n, . •; wherever •siplated, in an unlimited amount. , The corporation. may, solicit and- receiv& . bontr3�titiarrs, from any and all sources and may -.receive and- hold, in trust•or �5therwiser funds received by gift or bequest. (q•) The corporation may sell,, conveys. lease, ekah4s ge; t anaf z or 'otherwise dispose of, or mortgage, pXodget encumber . . or n eat@'a .securi.ty ,interest i n, all or, arty. of its propextyr ar•:, any interest thereiTi, wherever situated " ) The corporation may pv.xohase, t8ke, •receiver s6bbecri_be or,, or otherwise acquire, own, ;ho]_d, `vbte, =ezrlplo , gall, :�end., lease, exchange, transfer, or. tan N thdibands and mortgage-, pledge, .use and otherwrxse deal x txons, shares: or other securities..oz interests ocher obliya issued by' others, whether dAgaged in similar or different business,,; gc vez=ent al., or other adt i vzties . .. ' (i ) The corporation may make oontxacts,.' give guarantees .emd incur liabilities.. borrow money at such rates o� interssr;as the corporation may determine, issue its notes, bonds and othet ok,ligations, and secure any of its obligations' by all , mdrt.gage; p7.edge or encumbrance of, ox security. interest inr or any of i1:s property or any interest thereit,, Wherever I' situated. ^x_ ; 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 06/12 JAN 23' ' 92 9: 5?_ =ROM BURNS-AND-LEUiNSON- PAGE , r�pE , The corporation may, lend money, ,--..invest and • reinvest its funds, and take and.hold real and personal. property as security. for the payment of funds so loaned or invested. (k) The corporation may do business, Carry on -its opexati,ona, ' and have offices and exercise the power granted by Massachusetts General Laws, Chapter 180, as- nod,+ in force or. as.. .hereafter amended, in any jurisdiction within or without the United States , although *the corporation shall n6t•be operated for. . the primary purpose.of carrying .on for profi.t .a trade or'business unrelated to its, tax exempt purposes. (l ) The corporation•may' Pay pensions,, establ.i.sh and . 'carry out.pensionr p Wings, thrift. and other reti.zement and beneii.t. plans , trusts and provisi one for tl7e 'purpose cf providarig `...,reaso'nalale ccsnpexisatioa to .i.ts directors, offi6srs and employees..,. _--(iq ; The eorporatlon;'ziay make aontxibuti=s , ift such 'amounts as' t1te membera or direot'oxs• shall determine, •i,rrespecti've nf' corporate benefit, for the public welfare Or f0i: coinmul.ity ' charitable, TL11gious, 'ed.ucational r scientific; fund, ho piteLl, civic, Or sj-nui jar purposes,- and in time of war,or other nati.orial, emergcaxiCy in aid tneraof, •provided that if the corporation, -is ' ( ' entitl:ec9 to E.xamption, from federal incoma tax under Section the Internal Revenue Code, such contr.L.b Mi.ons may be made onl. , 103! religious, charitable; scientific, •li:tetary' or educa:tional purposes. ; _ (n' corp fihe oration' may be a partner., 'generai or, llmited; ih piny activity which it would have power to, ConctUct bar .: itself. . . The directors may.make, amend ,or repeal the .'by laws I xn 4,1101e or in pwt except with. respect to any provision thereof whicl.i by law or by the by-Xaws requires action by the ; members. (•p) ..Meetings of the members may be held anywhere in the United 'States (.a:) No part of tha' assets of the'aorppratS.on and no #part of any aet earnings of the corporation shall be .divi.ded .,among or inur.,e t0 the benefit of any officer or director of the corp r any private indivi oration adual or be appropriated :for ang purposes other than the puz�poses of the corporation as herein set forth';• and no substantial part of the activa.ties of the corpbration shall be the carrying oa of propagandai .or Otherwise a'ttcmptiraq, .to i.nfliAence legislation, and the ,corporation shall not p tf.cipate in, or intdrvene. ih (including -the publishing of :•distr'ibuti-Ag• of statements), any 'political campaignon behalf of any candidate for public office-. It is intended that the , 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 07/12 FAGE .003 JAN 23� ' 92 9 e 52 , FROM BURNS-"AND-LEIS I NSUN�-- corporation- shall be entitled to exempti=a from federal income tax wn.der Section 501(c) (3 ) of the Internal. Revenue Code and shall not be s private foundation under Section 509(a) of the internal Raveriue Code. �(r) upon, the JiVid.ation or dissolution of the corporation, 21ter pa,yndnt of all of the liabilities of the. corporation or due provision •hereof, all of the assEte of the corporation .Shall be disposed. of to one or more orgati.zatioris, • . exeatpt from fE:d9za1 income tax under section 501(c) (3) o . the xnteriiAl• Revarlue, Code. (s) Zn•tha event. that the corlioxatxon. is a private fnunda'ti:on as that term is defi.rted in Section 509 of. the 'Internal' .-Revenue Code, then notwithstanding any other provisions of the articles of 'o�,ganf�ation or the ,by-lays of the eo�o.r&t5.on1 'the. following;"prof► 8ibn8 shall apply-- ea Tiie .directors .shall distribute the•income .for ' ch not to taxable year at such time •and in such manner as become subject to the tax-on undistributed zxkcom0 '. -i*p<>aed by. .Section 4942 of the •internal .Revenue ocle, The directors shall not Onga-90 in arnp• .a.ct" of r selff-dealing as ,defined in S'ecticn 4941(d) of tna 1nt•3rna1 Revenue Code; nor retain any excess business . -.ho.,13i�ngs as defined in Section ( 43 3) (c) .o tho' _ xnG arnal Revenue Code; nor make any investmerlts 'in:such manner as to incur tax liability under Se cti.ori 494�','o.f ' the internal Revenue Code; nor• make- any taxable exp�ndit zres as defined in Section 4945(d). of the intarhal. .RevGnue Code.. ; Tho corporation may .have and exercise all sesefvx necoe`sary or oonveni.ent to effect- any or all ,of the pksrpo which the corporati.an is formed; .provided that no 'stash pcaWex shall -beex©zalsed in a manner inconsistent withMa$sachusetts Cenerai IJaws, Chapter 180 or any other Chapter of the General Laws of -the•commonwealth or Section 501(C)(3) of:the. zneern$1. Revenue Code. , (u) All references .herein to the Internal Revenue Code " Shall'-be deeu°,ed to refer to the lnteraal.' Revenue ,Code o£. now -in force or hereafter, aL eT�ded. -3- 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 08/12 j JAN 23' ' 92 . 9 53 =ROM BuRNs-RHP-LEVIN501'1-'- PAGE . 010 LIVING INDEPtNUNTLX FQREVFR, INC Co i t' eet 7-A Dirarss - � Res de ce ���. Of Tice Add��• ; ., • Cre A. Dorey . 135 W, Main•Stxeet 551 Route 6A Hyannis', MA 02601 �asC Saadwi,cN, MA Dennis Mahoney 1, Gobbett Lane as above East;ham, N,.A. 02642 icJiard La�raie 191 Ol.d Po5t'Road as :above 5 Centerville, m.02632. 3iI1 Edslsoi2 . 136 Uriadilla Road as . above. •Ridgewood, NJ 07450 S�btt Smith Wh stlOerry Drive ' as :&bove ' ' • . . : •, . : Marstorts•Mi�1s, Mk 0264E • ; • f 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 09/12 t ' •jAN ' 23' t92 9: 54. =ROM BURNS-AND-LEUINSON PAGC . 01i BustNESS CERTIFICATE. u11C .Lmttln.011wra[t;l pY aa5acilu:;rzi5 Tovn of. Sandwich ..............................19......•:, In conformity. with the provisions of Chapter one hundred and ten, Section five Of the GEneial_Laws,,>i amended, the undersigned hereby declarc(s) that a business 1;nder,the title of ........ ................. . . ......... .......... ............ .... ... ........... ....... ......,.....:.......:......,...,.....,.....,...... ,....... • is conducted ted at uc Number 51..8outa...6d ..................................................................... Street „F,ss t soma:� c ........ ..:.:..'........ :. . .......... ........... ... ... ..:..,.. .' by the following na Od persons. FULL NAME r „ Living Independently...Torevpr�.., nc:. ... ........ ....... . .. ..............I........._........... .7, .......: : .. ............. ............ .................... ...............,.,..,. . ........................ ................... ' -Signed .... ................. ' v '1416M4TUi.S> - $J ... ................. .......,.,.�9toaaTURfj� ........ ..... �FLSICb�rd La:vei�slcMNi, ?.:resident uflr Cf'mttmanwcaL 11 nl 3 s�,s 11 t2�• Personally appearl;d before me the ahoy qo ,R}chRrd I.. .fls Pra .....;c..„ c-na ed .,......... . "&f'-.Liviny,IndPrPeti;�,entl�+ ForevEr.l.. Itzc,•---................................................ _ .. .. ......... ................................................-----......: ...----..... .. •..... , and.made oath'that the foregoing statement is true. • +. certificate issueli in',aceorda.nce with this section shall be in for ce and effect for fouc.: years from the-date of issue and shall be renewed each four years thereafter so long as such. l utintss shall be conducted and shall lapse and be void unless so renewed. Expiration Date. . ... .. , . • •' ' .......... ........................ .....• ........... .... 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 10/12 JAN .23 82 5. 54 FR01�1 EURNS-ANT)-LEV1lgs0N- PAGE . 012 BUSINESS CERTIFICATE LIEF (�,D171fIl17ti►ltEuliii zif 3 arzinxi use Iv Tours of Sandwich .......................... .............19........, In conformity with the provisions of Chapter one hundred and ten, Section five of the General Laws, as amended, the urtdersigned hereby declare(s) that a business under the title of............ T .................I............ ..:.......:......,...................,.:........_.....,::..........•......................,...... ,.....,....:.::.. :. ............ ......... ---..._..................., ... ........ ............,,..,..... ........ ,...,...,is conducted at Nurrlber..: .SSL.:Rouke.._6A........ ,.,... . . .,..:...... . .............. : .... ...............Street East Ssndwicii.. .......... .,.., .,.. .. ................... CITY UA ....._.....,...........,.,. .. . the fallowing nam-d personts. •Pri pal••OffI'Ce Fi1l.4 TAME, ifi f,iv ri� I•naevexldenlj..y Forevert Tnc. 551,,,Route;5A. ...............,, .;....... • - .... ............. ,. ..... ... .... . ..,...i,.,,.1,. ..... _....� ............... _ �. ..5>'<R�W�Gk�.,... ?4..0;;� .�.................: ... , Signed ,�tG... .................... .................:_..... ...... , (SIGpA71Rx1 fYttr:f kYSl ReI Y' Ri chard Lavpz�S1O1�'iT° Pres U14 (Gammarlwalil?:'uf i#trslz>4uritts ...........................: .. ......�s. = .......:., . ......... : ...., Pe><sonall a ed before me the above-named .,. chsr... Lavoie„z�s,Presidenc;••• . .. Y. Ply' - •'• �'- . ... . Liv;r,4 7pdepeadetltl� FoXever.:.:Inc.............................................................. _................._...... „ ........:......_....---...................,................. and made oath that tier foregoing statement is'true. 'certificate issut�d.in accordance with this station:shall be in force and effect for fatlr' years from the data Cf issue and shall be'renewed each four•ycars thereafter so long,as such business•shatt be.conduated and shall lapse and-be void unless so renewed. . ' - �`' Expirafloa Date—,:........ ............. :.................................T�.r. .........., ,......... 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 11/12 r � , JAN 23 ' 92 9t49 FROM BURNS—AND-LEVIKSON- `; ` rY-laW�of C1te corporr<gots tract dui).t',iayted RAd the initLd direct om,presidalf,tr'cawny tod cleric ore Cher prc5idinR,Coanc.n!or record ing ofiiacx,w4o� 'mme3 ttrc 9d oU0.16w,have been drily elxtcd. i 1 r1n tR itz 7hc nftccdve dace of organiaavort of the co.paratien t h7a be the date of G1iag with the Soetetaiy of the Commonwealth or if A lat¢r date is dtsired,,ptseify deft. (odt'toort Than 30 days afte data of riling] The inforvtatloecootatiti« InARTICiEVais NOT a PERM ANBN"rpnttof the Artie leaof.OrgAnizedottandmaybeelrangedONlLX,byl:bng(besppcopt�izte form pto»dcd tberefor. ARTICLE YII rL The poet office:address of the Istiunt ptiaciPal oTfioe of tee eorporniloalli Iv1A5SAGHUSBTfS is: 551 Roi,t-a 15A, Mast Sandwich, MA 02537 b,The natxtc.a raidonca and paid 6!Ba'adi l resa of earl,of the irtltlrll6i,eclom rmd.following oMcerS'Of the corporation hm as WOW: ; NAME RESIDENCE LOST OFRCT ADDRESS hvgdedt. Richard Lavoie 191 Old 116st Road: -551ikout a 6A Cautervil-1e,• 1`A 02632 East Sandwich', MA'025:37' z` IteAsater- Dennis_Mahoney Z Cobbect: Lane 551 Route 6A Ea.schAm, MA 02632 Fast Sandwich,_Nk 02537 .0mi: �ennzs'Malic�no .: Same aS above 551 [route 6A i . Bunt Sandwich, MA 02537 Dbedorm (ar-of ken 6M1*llg e'0o'dd rs oCdd lCthr►r ;' NAB RESIDENCE MST CJF'k'!<CE ADDRESS 'Sacs Cor:tiatiation Sheet 7A attached hereto. l ycdr of the Lorpotaiion A U crid_ 'r Ikim Imt Qap of the C.The fisat otonth DE " • . . • . '. June r � � - ' ' d,The;%.•u 2&aod'BBSrRESS x4d.rrm of;1 RESIDENT AGENT oP thu Wporatlon,If aay,lc:' 1'/Wetb�e6elawraigc+a►INCORPOR�.TCftSdohorcayccrcifyaatktthelSaiacandpenaitiaofpetjatythatljvVeltavenotbeeacotn`kted•ofanjltximeart:lati4tg . toitcolfo)bfgamiaKwidiiri the pastten"[S.I/we dohombyfu hordertify thento the bcatoft yfoue1m*WkdVtbCabove-u4=. principal offtatahrtvcaol -# been simflac�coovicted.'if so eouvictcd;C#lpitt: . t [N WITI�S5S W�3fi OF and nn4er the pane and penalties of pecjnry,V Wli�whoa"a',gnstvre(s)appeal bd*w of ineoeporaior(sj aail•wboae aamd end busines�at irsldedud atldfe*ea)ARE CLIaAP.LY TYPED OR pEtildiED btinaath each rognatere do lteIttry rmbolate with the Window of fo=311 K this ` eotporwGaa and-the provisions of'Oebeiel Lava Chapter 190 aad do hereby sigh thcso Attwea Of Oruxnizadort m iaeorpot-Aor(s)tb;R day I of 19 �D'ef>_nis Mahoney Sze Et, Daray a s ep ems �. •• ' ,Nom. If An#kWxty.• xb%l lg corpo tkin it siting W&=Worawr,type foes d*emed evtrne of the earperrocte.�t9,e a�tn or oWat•jotbAdictlott•V k tt Mil ' bsoat9ot uuoed,Cbe of fFa!(,fir tan> ou bt�etf of said mkt porztfea tad the tNk bt/ebe bob&or outer Y by W"mCb "r tbftlt7l •• 06/20/2018 07:56 5087784919 HYANNIS LIFE PAGE 12/12 J.AN 23 ',S2 9: 50 =ROM ] URNS—ANA—LEVINSON�-- PRGE. 005 THE COMMOMVEALTH OF MA.SSACHUSMS ARTICUS of ORGAgMATION G NERAI.LAWS.r CkirkrTSR 180. t hereby aenify(bat.npott an Cxmd aticn of tb6 w'thim•vdrittca hs"es of o•�gazuration,duly rubmitW tome,it app m that The provlsiow of the Cn=nd Lave mJative to the orgaai7ation of oorporatlons have b.cn corapiitd with,Bud I hereby e Pprewe said„rtinlet:and the fdmgfee is the ammal of t35.00 bavias 1bsm d. ' a;tidcs eis dautod to hsva been filed with sno tlds '• . dap•of 19 Jlffrccwv dice MZCHAM JOSEP i CONNOLLY Sodretary of stoat A pHOTOOOPY OF THESE ARTIcEFs OF ORGANILATdON SHALL$E • • . r •' Via�F:/m Y , • _ . Jennifer S. *Addeo TO-' Burilph Levxamon = . �,2� Sua�•er Street Bos9ton MA 021 Telephone: �6 it 3000 The Commonwealth of Massachusetts Department of Industrial Accidents' Office of Investigations =•600 Washington Street Boston,MA 02111 www,mass.goy/dia Workers' Compensation Insurance Affidavit: Binders/C.ontractors/EIectrieLms/Plumbers Applicant Information Please Print Ledbly Name(Business organizaEon/IndMdual): t n� �j /1 ci? �Ce Address: At it 9$r�`{ ► e~ City/State/Zip: ' --Phone Are you an employer?Check the appropriate box: 'Type of project(required): 4: I am igeneral contractor and l 1.[] I am a employer with: 6. New emstruction employees(M and/orpart-time).* have hired the sub=contractors 2.El I am a sole propriet-r or partner- listed m the attached sheet. 7.,❑Remodeling ship and have no employees These sub-contractors have g, ,0 Demolition workingfor in an capacity. employees and have workers' f any t3'• $ 9. 0 Building addition [No workers'comp.insurance comp.insurance. required] 5. We are a corporation and its -10.El Electrical repairs or additions 3.El 1.am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL myself[No workers comp. 12.❑Roofrepaus insurance required]t C. 152,§1(4),and we have no employees.[No workers' 13.( Other � e s comp.msurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information 1 t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state vyhetber or not those entities have employees. If the sub-contactors have employees,they must provide their workers'comp,policy number. I am an employer that isproviding workers'compensation insurance for,my'employees. Below is thepo&y anal job site information. Insurance Company Name: �r 7lyt me-r c-&— GC- Policy#or Self-ins.Lic.#: PL% q 4? Expiration Date: Job Site Address: q® L a�,6ee< Cwstawnp: rule-e ��4102601 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 incnranc coverage verification. I do hereby certify ifer the p and pen s of perjury that the information provided above is true and correct. Si n.-X/- Date: !:� // Phone#• _ 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): Department 1.Board of Health 2.Building p 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector. 6.Other Contact person: Phone#: ELIZOND ACORO® DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 06/05/2018 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 have ADDITIONAL INSURED provisions or 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. PRODUCER 508-385-2464 NQ PACT E.J.McGrath Insurance Agency Edward J.McGrath Insurance PHONE 508-385-2454 FAX 508-385-5991 P.O.Box 1003 (A/C,No,Ext): AIC,No Dennis,MA 02638DORILss: E.J.McGrath Insurance Agency r' INSURERS AFFORDING COVERAGE NAIC# INSURER A:Commerce Insurance Company 34754 INSURED Minor EliZondo INSURER B:Acadia Insurance Company Major Minor Construction Co. 126 Higgins Crowell Rd INSURER c W Yarmouth,MA 02673 INSURER D s, INSURER E INSURER F: - COVERAG 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 TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF POLICY EXPLTR DDIYYYYl LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ❑X OCCUR 8008030013086 01/22/2018 01/22/2019 PREMISES DAMAGE TORENTED o $ 100,000 Business Owners - 5,000 _ MED IXP An one person) - PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: AUTOMOBILE LIABILITY (Ea SINGLE LIMIT a a r' en $' ANY AUTO BODILY INJURY Perperson) $ OWNED SCHEDULED AUTOS ONLY AUTOS t BODILY INJURY Per accident $ HIRED NpN-AWNED PeOacEciRdenDAMAGE $ AUTOS ONLY AUTOS ONLY L $ UMBRELLA LAB HOCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS-MADE AGGREGATE DED I I RETENTION$ B WORKERS COMPENS N ATION PER 1 SATX OR H AND EMPLOYERS'LABILITY MAARP303199 01/17/2018 01/17/2019 1,000,000 ANY PROPRIETORIPARTNER/EXECUTIVE Y NIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? - (Mandatory in NH) • E.L-DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION F OPERATIONS below E.L.DISEASE-POLICY LIMIT PROPERTY 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) CONTRA, CTOR CERTIFICATE HOLDER CANCELLATION BARNT01 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. 200 Main Street Hyannis,MA 02601 AUTHORIZEDREPRESENTATNE r: E.J.McGrath Insurance Agency ACORD 25(2016/03) - ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I pry �ila�ss€�husC#ts Dnpa_rttnc�ft4:�if 4��itili�S #sty �� Ltd c1�,itic#tng��g�il�t,ati��Rd Stindarcis - Lt�cenSe ��72y�9 :, Aid J KLN$f:Lt.A ' r ~BO�yUTA$&AS9�Tlt �w 4 Vfty"I s � � Xpif�ti:4?fi r , y 1W 7!6't?JK�/t k(tti�if� e f f+ �"` L Ottta4 S►f Congirmer A.fnirs&Butainia>as ReguleAlori' a NOM�IIVIPAO�EMENT; ONTRACTOEgg AMi�' A 'T-y trttlividual WOW Xoira lon r r iQw—q m°f} p Canstruct�gn Supervisor `: " i Restrteted to ,U restricted �uildir�gs of any use gioup wt�ch co.nta AST, 35,OQOScubie feet(991 cubic rr►eters)of. =,Qncbsed space � - { i=enure torpossess a current edition of the Massachusetts 9 AS`ta�`te,Butldrng Coif'e is cause fog ievocaUon of th�s'Ucense 9 DPS Li eosins infomiation�v�sitWWV11 MASS GOYiDPS lr rw, ������ `Registration`3aitc�for�indivtduat use only � r�'�� ,� �'�� ��� before�the�expiration date If found return to ?����� ,� 4 • �^ �� a s h0#Nce of Consumer Affairs+andf<Business fiegulation ,�'a r a arm .4 r NAME • -' � �4/���, � I,� !� lip"ii'�' 10-11 IRA .211,1 In �'►i� i � I ( �, �w.,m ���,w..�;+� „wr�.+ai�a ee w:h.�tr�.�.a rr�, 1 l� ,� 4 t i ! h '00JA 4 r t Y s X ♦t 4x, kry y 1. I Rn r OMB Approval No.2502-0265 Settlement Statement HUD-1 B.Type of Loan 6.File Number: 7.Loan Number: 8.Mortgage Insurance Case Number: 1.❑FHA 2.❑RHS 3. dConv.Unins. T26055 4.❑VA 5.❑Conv.Ins. C.Note:This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown.Items marked "(p.o.c.)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals. D.Name&Address of Borrower: E.Name&Address of Seller: F.Name&Address of Lender: Living Independently Forever,Inc. Linda L.Willoughby TD Bank,N.A. 550 Lincoln Road Ext,Hyannis,MA 02601 40 Lumbert Mill Road,02632,MA 02632 32 Chestnut Street,Lewiston ME 04240 G.Property Location: H.Settlement Agent: I.Settlement Date: 40 Lumbert Mill Road,02632 MA 02632 La Tanzi,Spaulding&Landreth 06/04/2018 8 Cardinal Lane,PO Box 2300,Orleans MA 02653 (508)255-2133 Place of Settlement: Disbursement Date: 8 Cardinal Lane,PO Box 2300,Orleans MA 02653 06/04/2018 J.Summary of Borrower's Transaction K.summary of seller's Transaction i 100.Gross Amount Due From Borrower 400.Gross Amount Due To Seller r - 101.Contract sales price 461,000.00 401.Contract sales price 461,000.00 102.Personal Property 402.Personal property 103.Settlement charges to borrower(line 1400) 4,737.65 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance 'Adjustments for items paid by seller in advance 106.City/town taxes 06/04/2018 to 06/30/2018 298.33 406.City/town taxes 06/04/2018 to 06/30/2018 298.33 j 107.County Taxes 407.County taxes 108.Assessments 408.Assessments .109 _r __ 409.110 410, 111. 411. 112_-- --- 412. 120.Gross Amount Due From Borrower 466,035.98 420.Gross Amount Due To Seller 461,298.33 200.Amounts Paid By Or In Behalf Of Borrower 500.Reductions In Amount Due To Seller 1201.Deposit or earnest money Mogan and Company, Inc. 15,000.00 501.Excess deposit(see instructions) 202,Principal amount of new loan(s) 368,800.00 502.Settlement charges to seller,(line 1400) 5,587.28 203.Existing loan(s)taken subject to 503.Existing loan(s)taken subject to 204. 504.Bank of America,N.A. � 151,760.52 205. 505.C-O-MM Water Department ( 34.00 2206. 506.Deposit retained by realtor } 15,000.00 07. 507.Platinum Title /SJ •f'' 250.00 208. 508. �I 209, 509. Adjustments for items unpaid by seller Adjustments for items unpaid by seller j 210.-City/town taxes 510.City/town taxes ' 211,County taxes _ _ 511.County taxes F 212.Assessments - 512.Assessments ...213. 513. _214 514. 215. 515. r 216. 516. 217. 517. 218. 518. 219. 519. 220.Total Paid By/For Borrower 383,800.00 520.Total Reduction Amount Due Seller 172,631.80 3-00.-Cash At Settlement From/To Borrower 600.Cash At Settlement From/To Seller rl 301.Gross Amount due from borrower(line 120) 466,0 55.98 601.Gross Amount due to Seller(line 420) 461,298.33 i 302.Less amounts paid by/for borrower(line 220) 383,800.00 602.Less reductions in amount due seller(line 520) 172,631.80 303.CASH From BORROWER 82,235.98 1 603.CASH To SELLER 288,666.53 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data.This agency may not collect this information,and you are not required to complete this form,unless it displays currently valid OMB control number.No confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to RESPA covered transaction with information during the settlement process. Borrower Living Independently Forever,Inc.,Diane Enochs,Executive Director Seller Linda L.Willoughby 4. y� *Items marked"(POC)"were paid outside the closing by the indicated party(Key:B=Borrower;L Lender;M=Broker;S=Seller;0=Other) Previous editions are obsolete Page 1 of 3 form HUD-1 (1/09) t, L.Settlement Charges 700.Total Real Estate Broker Fees Paid From Paid From Division of commission(line 700)as follows: Borrower's Seller's 701.$6,000.00 to Mogan and Company,Inc. Funds at Funds at 702.$11,525.00 to Starboard Real Estate Cape Cod Inc. Settlement Settlement 703.Commission paid at settlement(EMD$15,000.00 to Mogan and Company,Inc.P.O.C.) 2,525.00 704. 705. 706. 800.Items Payable In connection with Loan 801.Our Origination Charge (from GFE#1) l 802.Your credit or charge(points)for the specific interest rate chosen (from GFE#2) 803.Your adjusted origination charges (from GFE A) F 804.Loan Origination Fee($368.80 POC) (from GFE#3) 805 Appraisal Report Fees($512.00 POC) (from GFE#3) i 806.Flood Determination($5.00 POC) (from GFE#3) 807.Judgement Search($20.00 POC) (from GFE#3) 808. (from GFE#3) 900.Items Required By Lender To Be Paid In Advance 901.Daily interest charges From 06/04/2018 To 06/30/2018 (from GFE#10) 902• (from GFE#3) 903._ - (from GFE#11) 904. (from GFE#11) i 1000.Reserves Deposited With Lender 1001,Initial deposit for your escrow account (from GFE#9) rr 1002.Homeowner's insurance 1003.Mortgage insurance i 1004.Property taxes @$349.00/month 1 1005, 11006. 1007.Aggregate Adjustment $0.00 -j 1100.Title Charges j 1101.Title services and lender's title insurance (from GFE#4) 3,337.50 1102.Settlement or closing fee to La Tanzi;Spaulding&Landreth $2,000.00 ^1103.Owner's title insurance to First American Title Insurance Company (from GFE#5) 935.15 1104.Lender's title insurance to First American Title Insurance Company $922.50 1105.Lender's title policy limit $368,800.00 1106.Owner's title policy limit $461,000.00 1107.Agent's portion of the total title insurance premium $1,300.36 to La Tanzi,Spaulding&Landreth r 11108.Underwriter's portion of the total title insurance $557.29 to First American Title Insurance, _ Company 1109.MLC to Town of Barnstable $40.00 1110.Plot Plan to Olde Stone Land Survey $150.00 11111.Title Abstract to Atlantic Abstract $210.00 1112.Good Standing Certificate to Secretary of State $15.00 1200_Government Recording and Transfer Charges 1201.Government recording charges (from GFE#7) 440.00 1 1202. _ Deed$125.00 Mortgage$175.00 Releases$75.00 75.00 1203.Transfer Taxes (from GFE#8) 1204.City/County tax/stamps Deed$2,987.28 Mortgage 2,987.28 1205.State tax/stamps Deed Mortgage 1206.MLC to BCRD $65.00 from GFE#7 1207.Good Standing Certificate to BCRD $75.00 from GFE#7 1300.Additional Settlement Charges 1301.Required services that you can shop for (from GFE#6) 25.00 1302.Misc.costs,copies,postage,etc to LaTanzi,Spaulding&Landreth $25.00 1303. r 1j 304 � L1305, 1400.Tot al Settlement Charges on . 4,737.65 5,587.28 Borrower Living Independently Forever,Inc.,Diane Enochs,Executive Director Seller Linda L.Willoughby The HUD-1 Settleme Statement hi awe prepared i a true a d accurate account of this transactio . Igave caused or will cause the funds to be disbursed in accordance with this statement: Settlement Agent I Items marked"(POC)"were paid outside the closing by the indicated party(Key:B=Borrower;L=Lender;M=Broker;S=Seller;0=Other) Previous editions are obsolete Page 2 of 3 form HUD-1 (1/09) The Commonwealth of Massachusetts = W Mary Elizabeth Heffernan fO r Department of Public Safety secretary M w ' One Ashburton Place,Room 1301 Thomas G.Gatzunis,P.E. Commissioner Boston,MA ,02108-1618 Phone(617)727-3200 TfY(617)727-0019 The Commonwealth of Massachusetts . Executive Office of Health &Human Services JudyAnn eigby,M.D. Secretary Deval Patrick Governor Department of Developmental Services Elin M.Howe k Commissioner Timothy Murray 500.Harrison Avenue Lieutenant Governor Area Code(617)727-5608 Boston,MA 02118 TTY: (617)624-7590 BUILDING DEFT JUN 212018 TOWN OF BARINS- ABLE MEMORANDUM Jointly issued by DPS and DDS RE: Classifications of Group Homes under the Massachusetts State Building Code Date: November-21, 2011 The Departments of Public Safety(DPS) and the Massachusetts Department of Developmental Services (DDS) (formerly the Department of Mental Retardation) are issuing this joint memorandum to clarify the classification of group homes operated and/or approved by DDS under the Massachusetts State Building Code. The inclusion of group homes into the one and two family dwelling classification was the result of a "Conciliation Agreement" (finalized in December, 1996 and still in effect), to settle a complaint with the U.S. Department of Housing and Urban Development(HUD)alleging that the application of the then- existing special use and occupancy provision of the building code to homes built for persons with intellectual disabilities constituted unlawful discrimination under the Fair Housing Act and the Fair Housing Amendments of 1988 (42 U.S.C. sec. 3601, et.sea•). The recommendations were crafted by a workgroup comprised of representatives from DPS and DDS. As a result of the Conciliation Agreement, group homes operated or licensed by the Department of Developmental Services(formerly the Department of Mental Retardation)with five or fewer residents are exempt from the provisions of the Special Use and Occupancy codes and instead rCoMply with Section 308.2 of the Massachusetts State Building Code 780 CMR 8th edition"one and.two family"dwellings. Permits issued should be classified as a single family dwelling and/or two family dwelling if duplex. While DDS group homes with 5 or fewer individuals are considered one and two family dwellings, DDS will on occasion, require group homes to include additional features such as the installation of fire suppression systems. Requiring these systems does not, however, change the one and two family dwelling use designation. Fire suppression systems are classified under"1313"of the code and have to meet the requirements for this class. DDS homes-just like any one or two family home, are not required to be equipped with exit signage or exterior fire alarm systems. Adding requirements beyond those identified in the code, such as annual inspections,would result in disparate treatment of these homes and would be construed as in violation of the Conciliation Agreement. We hope this information helps clarify some of the confusion that may exist with review of proposed group homes operated by and/or approved by DDS for five or fewer residents, If you have any questions, please feel free to contact Tom Riley at(617)826-5250 or Gail Grossman at(617)624-7779. Thank you. Thomas G. Gatzunis P.E., C.B. Elin M. Howe ' I 4 , LUi ! VV-Lana tAKN11Vh,-) ,UMMAKY Em W loyee Reference Copy Wage Statement Tax 2017 017 COMPANY, AZQ 151 Total Employees e e oMa No. ,s4s-0008 152 Total Forms Count I Control number Dept. Corp. I Employer use only BOST/AZQ 152 Employer's name,address, and ZIP code 3,185,682.14 Gross 4,967.50 Dependent FSA/DCB 126,777.02 403B (E-Box 12) AZQ 18,143.84 Cafe 125 HSA (W-Box 12) Jf Employee's name,address, and ZIP code Employer's FED ID number a Employee's SSA number. B9.8I I y��}gG 22-3190452 1 1 l l ) Wages, tips,other comp. 2 Federal Income tax withheld 2922873.13 3 345751.97 JUN 2 1 2018 I Social security wages 4 Social security tax withheld ttl .L 3016088.07 186997.49 Medicare wages and tips 6 Medicare tax withheld 3049650.15 44219.90 TOWN �y ``'' Social security tips 8 Allocated tips o t_7N�'l�Y�Bf�.L1L i Verification Code 10 Dependent care benefits TOTALS 4967.50 1 Nonqualified plans 12a See ilstructionsfor box 12 For : BATCH NO. 2017/4/01121 ' For : COMPANY BOST/AZQ 4 Other 12b 12d l 13 Stat emp Ret.plan 3rd party sick pay ., 15 State I Employer's state ID no.16 State wages,.tips,etc.. 2922873.13 17 State income tax 18 Local wages,tips,etc. 130873.70 19 Local income tax 20 Locality name - 0 2017 ADP, ttC Balancing Form W-2/W-3 Totals to the Wage and Tax Register The Internal Revenue Service(IRS)stipulates that Box 15 of paper Form W-3(State and Employer's State 11)Number)contain the two letter state abbreviation and the employer's state identification number. If the W-2 forms being filed with the W-3 contain wage and income tax information for multiple states,an"X"should be entered under"State"and no state I.D.should be shown. (Note:Clients using the ADP Tax Filing Service or receiving a federal CD-ROMfor filing will not receive a copy of Form W-3. Your magnetic media filing will be populated correctly.) The total state and/or local wages and income tax_withheld in W-2 boxes 16-19 should be reported in the corresponding W-3 boxes. If multiple states and/or locals are being reported on the W-2s,a sum total of the various states/locals should be reported. Although individual state/local specific W-2 forms are produced for employees with earnings in multiple states/localities,there is only one total box on form W-3. If you have employees with earnings in multiple states and/or localities the total wages for these employees will display opposite the wording"Total Copy 2 State Wages"or"Total Copy 2 Local Wages". When balancing your Form W-2 totals to your Wage and Tax Register,the following formulas should be used: From the W-2: From the W-2: 'State Wages(Box 16)' `Local Wages(Box18)' plus `Total Copy 2 State Wages' plus `Total Copy 2 Local Wages' Totals from the W-2 calculations above will equal totals from Wage and Tax Register calculations below. From the Wage and Tax Register: From the Wage and.Tax Register: `State Wages'(Jurisdictional Recap) `Local Wages'(Taxable)**(Jurisdictional Recap) plus 'State 2 Wages'(Jurisdictional Recap) plus 'Local 2 Wages'(Taxable)**(Jurisdictional Recap) minus 'Puerto Rico State Wages'(Jurisdictional Recap) minus `Oregon Local Wages'(Jurisdictional Recap) minus 'Virgin Island State Wages'(Jurisdictional Recap) minus Other locals where W-2 Local Wage reporting is not required(e.g.St.Louis Expense Tax,ER Paid Taxes,or others with no EE deduction.) Local Wages(Subject)/Loca12 Wages(Subject),and not Local Wages(Taxable)/Local 2 Wages(Taxable),should be used for balancing the following Kentucky localities: Bardstown,Burkesville,Ohio County,Ohio County KREDA,Russell County,Wilder,and for the following Ohio local:Mercy West JEDD III. Subject wages,and not taxable wages,are required in box 18 of Form W-2 for these localities. Note: Jurisdictional Recap pages are not produced if there is only a single jurisdiction for the company. In that case the Company Total page can be used. Wages for non-employee taxing locals are not included on the Company Total page. The Jurisdiction Recap"pages must be used when employees have multiple jurisdiction movement. Also subtract any"credit"employee state/local total wages found on the SIT Credit Report Company Total Page,if present Do not subtract if the employee state total wages are also included in the state total wages on the Puerto Rico or Virgin Island Jurisdictional Recap(this would result in duplication). Note: If you have New York State,New York City,or Yonkers,New York employees,remember that New York requires the reporting of federal wages in the state/city wage boxes on Form W-2 and not actual state/city wages. Because the federal wages may differ from state/city wages,the following steps should be added to the balancing steps above: From the W-2: plus Actual New York State(or Local)Wages minus New York State(or Local)Federal Wages Box 12 Other: The IRS does not require a W-2 when the only thing to report is the cost of employer-sponsored health coverage(Code DD). Therefore if Code DD is the only qualifying item for the employee W-2,it will not be produced nor will the amount be included in the W-2 totals. It will be included on the Wage and Tax Register for reference. Box 14 Other: New Mexico State Disability Insurance(SDI)tax withheld is not required to be displayed on the state W-2 nor is it included in total SDI withheld on the federal W-2. -It is,however,included EMERGENCYEVACUATION SAFE TY PLAN FOR RESIDENTIAL SUPPORTS The Emergency Evacuation Safety Plan form has instructions for completing the different elements of the plan. For expanded guidance on,each element of the plan,please refer to the Emergency Evacuation Safety Plan Guidelines Handbook GENERAL INFORMATION Date of Completion: .June 21, 2018 Agency: LIFE INC. Address of Residential Support: 40 Lumbert Mill Rd Centerville, MA 02632 Names of Individuals Served At Site(not for site-based respite supports): Rebecca Adelstein Home is owned/rented/leased by the provider X Yes Individuals ❑ Yes . Type of Residential Support (check the appropriate box and give the #of hours of service provided): 24 Hour Staffed Home X Yes Site-Based Respite Support ❑ Yes 15 to 24 Hour Staffed Home ❑ Yes #Hours per Week ❑ Day❑ Shared Living(see definition page of Handbook) ❑ Yes #Hours per Week ❑ Day❑ Home Sharing(see definition page of Handbook) ❑ Yes #Hours per Week ❑ Day.❑ Version 2 6/21/18 1 i .Type of Building(check the appropriate box and give the number of floor(s)in the building,the floor(s) where bedrooms are located, and the floor(s)that the home occupies): Single Family Home(Freestanding) X Yes 3 #Floors Bedrooms located in basement: 0 Bedrooms located on 1 st floor: 1 Bedrooms located on 2nd Floor: 3 Attached dwelling(Townhouse type) ❑ Yes #Floors Bedrooms located on Floor(s) 2-3 Family Duplex,2 story, or triple decker ❑ Yes Home located on Floor(s) Bedrooms located on Floor(s) Multiple Family(Apart/Condo Bldg. <5 Stories) ❑ Yes #Floors in Building Home located on Floors) Bedrooms located on Floor(s) High Rise(>5 Stories) ❑ Yes #Floors in Building Home located on Floor(s) Bedrooms located on Floor(s) ENVIRONMENTAL STANDARDS Fire Safety Equipment(check the box at right to indicate the types of fire safety equipment present in the home): Smoke Detection System Smoke detector(s)located in bedroom(s) X Interconnected smoke detectors X Battery operated smoke detectors X Alarm system hard-wired to Fire Department or central monitoring station ❑ Other Safety Equipment Fire suppression(sprinkler) system ❑ Emergency battery-operated lighting X Automatic door closers ❑ Fire extinguisher in kitchen X Version 6/21/18 _ 2 Other(describe): SITE FLOOR PLAN Using page 13 in this document,create a floor plan of each floor of the home accessed by individuals, with each egress clearly marked using the following chart of egress types. Attach additional pages as needed. EGRESS TYPES a. Interior Stairs e. Handicap Accessible Ramp b. Elevator f. Basement Interior Stairs c. Door to Exterior Stairs to Grade g. Basement Stairs to Grade (Bulkhead Type) d. Door directly to Grade h. Door to common hallway to egress(s) i. Other(describe) GENERAL SAFETY REOUIREMENTS Required only for 24 hour staffed homes that are owned, rented or leased by the Provider and site- based respite supports. All others skip this section. All homes providing 24-hour staffed supports and site-based respite supports must meet the following general safety requirements. Mark the checkbox provided to affirm compliance with the standard. 1. There are 2 means of egress from floors at grade level and one means of egress and one proven,usable escape route leading to grade for all other floors. X Correct i 2. Bedroom doors that provide access to an egress do not have a lock. X Correct 3. Any locks on bedroom doors that do not provide access to an egress: a. may.be easily opened from the inside without a key and the individual is able to unlock the door from the inside; b. staff carry a key to open the door in the event-of an emergency. X Correct Version 2 6/21/18 3 4. Bedrooms of individuals requiring hands on physical assistance to'evacuate or who have a mobility impairment are located on a floor at grade level. X Correct 5. Smoking is prohibited in all bedrooms. X Correct 6. Staff do not smoke in the home. X Correct. 7. Ashtrays of non-combustible material and safe design are provided in all areas where smoking is permitted. X Correct If any individual in the home smokes, answer the following: Location of smoking area: 8. All vertical chutes(laundry, dumbwaiter, etc.)are sealed. X Correct PROPOSED ALTERNATIVES Providers of 24-hour staffed homes are allowed under DDS Regulations 115 CMR 7.07(8) to propose alternatives to the environmental standards and fire safety requirements of 115.CMR 7.07. This section does not apply to site based respite. Providers must clearly demonstrate below how the safety of residents is maintained by using the alternative being proposed. i Regulation Standard for which an alternative is proposed: Proposed Alternative:' Version 2 6/21/18 4 i Why is the standard not needed? How does the proposed alternative standard assure that.a comparable level of safety is achieved? Individual Abilities And'Safety Strategies This section is a summary description of individual characteristics that affect the ability to evacuate the home safely within 2 %2 minutes during an emergency. This does not replace the need for a thorough assessment of individual skills at the time of the ISP, but rather is taken'from those assessments. Refer to Emergency Evacuation Safety Plan Guidelines Handbook for information helpful in completing this section. For site- based respite, answer the questions in terms of the abilities of individuals that potentially could be served at the respite home. Answer the following: l. 'Does the level of ability(cognitive)of any individual prevent or limit their ability to evacuate independently in 2.5 minutes? ❑ Yes X No 2. . Does any individual have mobility issues that would prevent or limit their ability to evacuate independently in 2.5 minutes? ❑ Yes X No Version 2 6/21/18 5 3. Does any individual have health related issues that would prevent or limit their ability to evacuate independently in 2.5 minutes? ❑ Yes X No 4. Does any individual have social or behavioral issues that would prevent or limit their ability to evacuate independently in 2.5 minutes? ❑ Yes X No 5. Does any individual need adaptive devices or equipment to ensure safe and timely evacuation? ❑ Yes X No If all questions above are answered no, SKIP the following chart and go to the section on Group Interactions Note: Chart is not completed for site-based respite Instructions for completing the chart below: If any question above is answered yes complete the following chart for all individuals residing in the home. Add additional pages as needed. 1. Complete for each individual residing in the home, adding additional pages as needed. 2. The section on' m ability to evacuate"needs to fully address any individual's cognitive, obility, health, social or behavioral needs that affect the ability to evacuate. 3. The section on"staff assistance"needs to fully describe any needed staff assistance and also include the level of assistance provided to evacuate,taken from the following list-. a. Independent b. Verbal Prompt c. Physical Prompt(light physical direction) d. Physical Escort(actual physical support to evacuate) e. Full physical assistance- describe the amount of assistance needed; e.g.two person staff transfer 4. The section on adaptive equipment needed should describe the specific devices that-support evacuation; e.g.bed shakers, flashing strobe lights. Version 2 6/21/18 6 Name: Rebecca Adelstein Ability to Evacuate(describe Staff Assistance Provided(Include level of Adaptive cognitive,mobility,health, social, assistance provided from a-e above) Devices/Equipment or behavioral needs affecting If adaptive equipment is needed describe Needed evacuation) specific staff assistance provided Independent N/A Name: Ability to Evacuate(describe Staff Assistance Provided(Include level of Adaptive cognitive,mobility,health, assistance provided from a-e above) Devices/Equipment social, or behavioral needs If adaptive equipment is needed describe Needed affecting evacuation) specific staff assistance provided Name: Ability to Evacuate(describe Staff Assistance Provided(Include level of Adaptive cognitive,mobility,health, assistance provided from a-e above) Devices/Equipment social, or behavioral needs If adaptive equipment is needed describe Needed affecting evacuation) specific staff assistance provided Name: Ability to Evacuate (describe Staff Assistance Provided(Include level of Adaptive cognitive,mobility,health, social, assistance provided from a-e above) Devices/Equipment or behavioral needs affecting If adaptive equipment is needed describe Needed evacuation) specific staff assistance provided Version 2 6/21/18 7 Name: Ability to Evacuate(describe Staff Assistance Provided(Include level of Adaptive cognitive,mobility,health, assistance provided from a-e above) Devices/Equipment social, or behavioral needs If adaptive equipment is needed describe Needed affecting evacuation) specific staff assistance provided GROUP INTERACTIONS Are there any interactions between individuals being supported or any group dynamics that could affect timely evacuation,either positively or negatively? (Do not answer for site-based respite.) ❑ Yes X No If yes, describe: J EVACUATION PLAN The evacuation plan incorporates components discussed previously, including individual abilities, group interactions and dynamics, staff responsibilities,adaptive equipment, egresses. Minimum ratio of staff to individuals during awake hours 1/1 L Minimum ratio of staff to individuals during asleep hours Awake staff 1/1 Asleep staff Asleep hours are from 12A to 6a Using a bullet format as needed, answer each of the following evacuation questions, adding additional pages as needed.- Version 2 6/21/18 8 ` 1. Describe the sequence for evacuating all individuals and any staffs or supporter's responsibilities. Include the kind and level. of assistance needed for all individuals including staff support with adaptive equipment: ' Describe Evacuation Plan During Awake Hours. . x _ -Individuals will evacuate independently using the furthest egress from the hazard. -Residents will proceed to pre-appointed meeting site(end of the second driveway) -Interaction between residents will be restricted to maximized efficiency., -Staff will make a clean sweep of house to ensure all residents are out. -Head count will be taken to ensure all are accounted for. -Staff will call 911 and,stay online until instructed to hang up. , Describe Evacuation Plan During Asleep Hours. Individuals will evacuate independently during the night using the furthest egress from the hazard. -Residents will proceed to pre-appointed meeting site,(end of the second driveway) -Interaction between residents will be restricted to maximised efficiency. -Staff will make a clean sweep of house to ensure all residents are out. -Staff will call 911 and stay on line until instructed to hang up. 2. State the amount of time needed to safely evacuate all individuals. No more than 2.5 minutes 3. Identify the primary escape route . , Front Door 4. Identify the secondary escape route. Rear patio door ' 5. Identify the location of the central meeting place: End of the second driveway FIRE DRILLS DDS Regulations 115 CMR 7.08 requires that providers of 24-hour staffed homes conduct quarterly fire drills,two of which shall be conducted during nighttime hours. Complete the following: Number of annual.fire drills during awake hours: 2 Version 2 6/21/18 9 Number of annual fire drills during asleep hours: 2 Range of hours during which asleep drills will be conducted: 12a-6a Do the proposed fire drills differ from the number and schedule required in DDS Regulation 115 CMR 7.08 as described above? ❑ Yes X No If the answer is yes, describe the proposed schedule and why it differs from this regulation. Providers must clearly demonstrate how the safety of residents is maintained by the alternative proposal. This section should also be used to outline drills for individuals'in residential settings other than 24-hour staffed homes and site based respite supports., METHODS TO NOTIFY POLICE,FIRE,EMERGENCY.PERSONNEL,FAMILIES,DDS Are all staff and individuals, as applicable, aware of procedures for notifying police,fire,emergency personnel, and relevant"on I call" staff? X Yes ❑ No Who will make the call? Staff on duty When and where will the call be made? Once convened at the end of the 2nd driveway, staff will call 911 To whom will the call be made? 1'`9112nd program Director/Administer, On Call, P Executive Director What is the protocol for notifying"on call"staff of the provider,families/guardians, and the DDS area office? -1st 911 2 nd program Director/Administer, On Call, P Executive Director, families/guardians and DDS -Administrator Area office. Calls would be made from house cell phone,or neighbor's phone. -Administrator will notify everyone else. Version 2 6/21/18 10 TRANSPIRATION AND EMINMDIATE/TEMPORARY RESETTLEMENT What is the plan for providing immediate shelter(e.g.neighbor's home)during the emergency? Immediate shelter during the emergency would be Life's recreation Center located at the Hyannis property. If the emergency is serious enough to require temporary resettlement,what is the plan? -Should temporary relocation become necessary, residents would go to the Hyannis recreation center (or Mashpee recreation site, if necessary)until additional arrangements have been completed. -Residents will be given a choice to remain overnight at the center or going to stay with family. -If long term relocation becomes necessary, space in a resident's condominium on either the Hyannis or Mash ee campus would be coordinated with LIFE Independent Living staff How will people be transported to the new location in the event of temporary resettlement? Lumbert Mill has its own van Are staffs aware of the procedure for temporary resettlement? X. Yes 0 No CONTINUITY OF SERVICES AND SUPPORTS If resettlement is required, please describe below how continuity of services and supports will be maintained within the first 24-48 hours after the emergency occurs? If residents are living locally, staff will arrange transportation for residents to be able to continue their regular routines for medical and dental appointments, Day Programs, volunteer jobs and extracurricular activities. All administration of medications will be arranged by staff. Staff will also acquire clothing, bedding,toiletries and all other necessities for the duration of the temporary placement. Staff will encourage and commend residents for keeping their regular schedule as much as possible.Residents may also have the option of staying with their families,if possible. Version 2 6/21/18 l l OTHER COMAMNTS: (Optional) Please use this section to include any other relevant information not previously addressed. Version 2 6/21/18 12 Site Floor Plan Egress Types a. Interior Stairs d. Door Directly to Grade g. Basement Stairs to Grade(Bulkhead Type) b. Elevator e. Handicap Accessible Ramp h. Door to Common Hallway to Egress (s) c. Door to Exterior Stairs to Grade f. Basement Interior Stairs i. Other(describe) Address: Floor# Version 2 6/21/18 13 PROVIDER ASSURANCE FORM I hereby certify under the pains and penalties of perjury that the home or work/day support located at 40 Lumbert Mill Rd. Centerville. MA with a capacity of 4 individuals, and operated by LIFE INC. meets or exceeds, or with respect to anew (name of provider) support, agree to meet or exceed the requirements for assurances of safety as listed below and in accordance with the regulations of the Department of Developmental Services (115 CMR 7.08). r 1. The written Emergency Evacuation Safety Plan includes all the applicable components required in 115 CMR 7.08(3); or the current disaster and evacuation plan will remain in effect. 2. The Emergency Evacuation Safety Plan is designed for the safety of individuals requiring evacuation in an emergency, is implemented, and is periodically evaluated for effectiveness. 3. All required fire safety equipment as referenced in the safety plan is functional (i.e., smoke detectors, alarms, adaptive equipment, sprinklers, or emergency back-up systems, if applicable). 4. The following documentation, as applicable, is available for review: a. Fire Drill log; b. Emergency Evacuation Safety Plan; c. Documentation that each staff person/home provider has been trained in implementation of the Emergency Evacuation Safety Plan. -Provider: - 'Signed 4l ;G � Date: Print Name&Title`Diane Ehochs:.,Elective Director; DDS Area Director :I have reviewed and approved.the Emergency Evacuation Safety Plan as -submitted: _ Signed : Date: . Print Name&Title":Ridhard.Cavicchi .Area Director . Version 2 6/21/18 14 Town of Barnstable �`�► OpTME ray, Building Department Services o Brian Florence, CBO Building Commissioner g . ,�,,s.,.AB�, . BARNSTABI;E 9 MASS. _ 1WS�JISX l5 CS�'a'.1iLE�Li0.4L•/TMIF g 200 Main Street, Hyannis, MA 02601 E79-2914 s6;q. �0 www.town.barnstable.mams Office: 508-862-4038 Fax: 508-790-6230 July 9, 2018 1 Living Independently Inde endentl Forever Inc. c/o Attorney Peter L. Freeman Freeman Law Group, LLC 86 Willow Street Yarmouthport, MA 02675 RE: Site Plan Review#048-18 Informal Review - Living Independently Forever, Inc. 40--L�- mbbert_Wff-Road, Cen eerville7 Map 168, Parcel 101 Proposal: 4-bedroom congregate/group home for four (4) learning disabled adult residents for educational purposes. One or more full-time 24/7 staff person(not using a bedroom). Dear Attorney Freeman: At the informal site plan review meeting with staff held June 25, 2018 the above proposal received an administrative approval from the Site Plan Review Committee subject to the following: • Approval is based upon site plan entitled "Site Plan of#40 Lumbert Mill Road, Centerville, MA" dated May 18, 2018 prepared for Living Independently Forever, Inc." by Down Cape Engineering, Yarmouthport depicting adequate parking and location of proposed 2nd floor fire egress stairway as required by the Department of Developmental Services. • Building code analysis dated July 3, 2018 prepared by Brown Lindquist Fenuccio & Raber Architects, Inc (attached). • Approval as a congregate/group home and educational use for learning disabled residents under M.G.L. c. 40A, s.3 is subject to review by the Legal Department. The following information was provided by the applicant: o Living Independently Forever, Inc. Articles of Organization listing the primary purpose of the corporation as operating an apprenticeship program for instruction and training learning disabled for the purpose of improving or developing the learning disabled individuals' capabilities and providing an opportunity to pursue and acquire a vocation; and a Massachusetts Chapter 180 non-profit corporation that is exempt from taxation under Internal Revenue Code Section 501 (c)(3) as an educational and charitable organization. o Curriculum described by Living Independently Forever, Inc. attorney and staff including training in daily living skills, vocational skills and job searches, computer skills,healthy living practices, and human rights advocacy. Individual goals for residents vary based upon their capabilities, with the common goal of increased independence. o Memorandum from Commonwealth of Massachusetts Department of Public Safety and Executive Office of Health&Human Services (DDS) dated November 21, 2011 regarding Classifications of Group Homes under the Massachusetts State Building Code (attached). Applicant must obtain all other applicable permits, licenses and approvals required. Sincerely, Ellen M. Swiniarski Site Plan Review Coordinator CC: Brian.Florence,,Building_Commissionet,RR Chairman Legal Department Health Department COMM FD Attached: Building Code Review—Brown Lindquist Fenuccio & Raber Architects, Inc. Memorandum- Commonwealth of Mass Office of Health& Human Services (DDS) 4 } Iy f NOUN Ii BROWN LINDQUIST FENUCCIO & RA.BER ARCHITECTS, INC. July 3, 2018 Mr. Brian Florence (email Brian.forence@town.barnstable.ma.us) Building Commissioner, Town of Barnstable 200 Main Street Hyannis, MA 02601 Re: Proposed Group Home at 40 Lumbert Mill Rd., Centerville, MA Mr. Florence, We have reviewed the proposed use of the building at 40 Lumbert Mill Road in Centerville, MA per the current Building Code, IBC 2015, IRC 2015, IEBC 2015, and associated State of Massachusetts Amendments. It is our understanding that the existing building, based on the latest assessor's card, is currently a 4-bedroom single family detached home, 6,709 gsf (including garage and basement space). The intended use of this building will be as a group home for four residents managed by the Living Independently Forever, Inc. (LIFE), licensed by the MA Department of Developmental Services (DDS). There will be (non-resident) staff in the group home 24 hours per day, including 2-3 staff during daytime hours, and one staff at night. The current R-3 use, as well as the proposed R-3 use are under the jurisdiction of the International Residential Code (IRC) with State of MA Amendments. There are no provisions in the IRC regarding "Change of Use", therefore, the International Existing ,Building Code (IEBC) has been consulted regarding the Change of Use proposed for the Building at 40 Lumbert Mill Road. Chapter 2 of the IEBC 2015 definition: Change of Occupancy. "A change in the use of a building or portion of a building. A change of occupancy shall include any change of occupancy classification, any change from one group to -another group within an occupancy classification, or any change within a group for a specific occupancy classification." • The proposed DDS licensed group home does not meet the definition of a Change of Occupancy per the IEBC: o There is no change in occupancy classification. The existing group is an R-3, the proposed group is an R-3. o There is no change from one group to another group within an y occupancy classification. (Existing and Proposed Use are both R-3). 203 WILLOW STREET SUITE A PH 508-362-8382 YARMOUTHPORT MA 02675 FAX 508-362-2828 i WWW.CAPEARCHITECTS.COM p o There is no change within the group for a specific occupancy classification, (an example would be changing from an existing post office to a car wash-both considered and listed as a B- Business use). Chapter 10 IEBC 2015 -Change of Occupancy: Section 1001.2.1: Change of Use. Any work undertaken in.connection with a change of use that does not involve a change in occupancy classification or a change to another use group within an occupancy classification shall conform to the applicable requirements for the work as classified in Chapter 5 and to the requirements of Sections 1002 through 1011." • The proposed DDS licensed group home does meet the criteria for a Change of Use. • There is no work proposed at the interior of the group home, a supplemental exterior stair will be added from the second floor, per DDS guideline requirements, this.stair is not required per the code. Chapter 10 IEBC 2015 -Section 1004.1 Fire Protection. General. Fire Protection requirements of Section 1012 shall apply where a building or portions thereof undergo a change in occupancy classification, or where there is a change of occupancy within a space where there is a different fire protection requirement in Chapter 9 of the International Building Code. • There is no change occupancy as defined in the IEBC associated with the DDS licensed group home; Section 1004.1 Fire Protection does not apply. Existing Use Group = Residential R-3: Single Family Detached Residence (to comply with the International Residential Code with MA Amendments). Chapter 3 Use and Occupancy Classification of the IBC 2015; Section 310 Residential Group R; § 310.5 Residential Group R-3; revised per State of MA Amendments (10/20/17): "Residential Group R-3 occupancies where the occupants are primarily permanent in nature and not classified as Group R-1, R-2, R-4, or I, including' 1. Buildings that do not contain more than two dwelling units." Chapter 1 -Scope and Administration IBC 2015: 101.2 Scope, Exception (4)per State of MA Amendments: "Detached one- and two-family dwellings (townhouses) not more than three stories above grade in height and their accessory structures, and other buildings as described in 780 CMR may comply with 78.0 CMR 51.00: Massachusetts Residential Code. Section R313.2 (State of MA Amendments) "One and Two Family Dwellings Automatic Fire Systems...Only one and two family dwellings having an aggregate area greater than 14,400 SF shall have fire sprinklers installed in accordance with NFPA 13D." 203 WILLOW STREET SUITE A PH 508-362-8382 YARMOUTHPORT NIA 02675 FAX 508-362-2828 WW W.CAPEARCHITECTS.COM Proposed Use Group = Residential R-3: Single Family Detached Residence used as a DDS Group Home (to comply with International Residential Code with MA Amendments). Chapter 3 Use and Occupancy Classification of the IBC 2015; Section 310 Residential Group R; § 310.5 Residential Group R-3; revised per State of MA Amendments (10/20/17): "Residential Group R-3 occupancies where the occupants are primarily permanent in nature and not classified as Group R-1, R-2, R-4, or I, including: 8. DDS facilities in conformance with the occupant safety requirements of 115 CMR 7.00; Standards for All Services and Supports" (added per MA Amendments).". Chapter 1 Scope and Administration IBC 2015: 101.2 Scope, Exception (4)per State of MA Amendments: "Detached one- and two-family dwellings (townhouses) not more than three stories above grade in height and their accessory structures, and other buildings as described in 780 CMR may comply with 780 CMR 51.00: Massachusetts Residential Code." Chapter 1 Scope and Administration IBC 2015 (State of MA amendments): 102.2 Other Laws; Section 102.2.1 DDS Facilities. "Additional building features required by the Massachusetts Department of Developmental Services (DDS) do not change the classification of residences operated or licensed by DDS as dwellings subiect to 780 CMR 51.00: Massachusetts Residential Code." o. The only proposed work is the addition of an exterior.stair from the second floor, a requirement per DDS guidelines. o IRC 2015 Section AJ507.7 (State of MA Amendments): "Newly Constructed Elements. Additions, newly constructed elements, components, and systems shall comply with the requirements of 780 CM R 51.00." The new exterior stair must comply with the,iRC 2015 with State of MA Amendments: Appendix J _Section AJ102.3 State of MA Amendments Smoke, Carbon Monoxide, and Heat Protection: "Smoke, carbon monoxide, and heat protection shall-be provided when required by this section, and designed, located, and installed in accordance with the provisions for new construction. See sections R314, R314.5, and R315." o Per Section AJ 102.3.2 State of MA Amendments: installation of a new Smoke, CO, and Heat Protection system in an existing building is only required when a complete reconstruction is undertaken within the dwelling. 203 WILLOW STREET SUITE A > PH 508-362-8382' YARMOUTHPORT MA 02675 FAX 508-362-2828 W W W.CAPEARCHITECTS.COM In conclusion, based on definitions and requirements in the Building Code, Residential Code, Existing Building Code, and, associated Massachusetts Amendments; there is no change in occupancy. This particular condition does not meet criteria for a Change in Occupancy as defined in the Code.The Existing Use Group is an R-3, the proposed Use Group is an R-3. The Fire Protection Requirement associated with a Change in Occupancy does not apply to this Change of Use within the same use group. The new stair to be constructed as required by the DDS Guidelines must comply with the IRC 2015 Code for New Residential Construction with State of MA Amendments. Please feel free to contact our office with any additional questions. Kurt Raber, Principal Maria Raber, Project Architect Cc: Peter Freeman, Freeman Law Group, LLC. 203 WILLOW STREET SUITE A PH 508-362-8382 YARMOUTHPORT MA 02675 FAX 508-362-2828 W W W.CAPEARCHITECTS.COM j. . The Commonwealth of Massachusetts Department of Public Safety Mary Elizabeth Heffernan Seta ' '" One Ashburton Place,Room 1301 Thomas G.Gatzunis,P.E. Boston, A 02108-1618 commissioner. M SyO Phone(617)727-3200 rN(617)727-0019 The Commonwealth of Massachusetts Executive Office of Health &Human Services JudyAnn Slgby,M.D. Deval Patrick Secretary Governor Department of Developmental Services Elin M.Howe Timothy Murray 500.Harrison Avenue Commissioner Lieutenant Governor Area Cade(617)727-5608 Boston,MA 02115 TTv: (617)624a590 MEMORANDUM Y Jointly issued by DPS and DDS RE: Classifications of Group Homes under the Massachusetts State Building Code Date: November 21,2011 The Departments of Public Safety(DPS) and the Massachusetts Department of Developmental Services (DDS)(formerly the Department of Mental Retardation) are issuing this joint memorandum to clarify the classification of group homes operated and/or approved by DDS under the Massachusetts State Building Code. The inclusion of group homes into the one and two family dwelling classification was the result of a "Conciliation Agreement" (finalized in December, 1996 and still in effect),to settle a complaint with the U.S. Department of Housing'and Urban Development(HUD)alleging that the application of the then- existing special,use-and occupancy provision of the building code to homes built for persons with intellectual disabilities constituted unlawful discrimination under the Fair Housing Act and the Fair Housing Amendments of 1988 (42 U.S.C. sec. 3601, et.se . . The recommendations were crafted by a workgroup comprised of representatives from DPS and.DDS. As a result of the Conciliation Agreement, group homes operated or licensed by the Department of Developmental Services(formerly the Department of Mental Retardation)with five or fewer residents are exempt from the provisions of the Special Use and Occupancy codes and instead comply with Section 308.2 of the Massachusetts State Building Code 780 CMR 8th edition"one and two family"dwellings. Permits issued should be classified as a single family dwelling and/or two family dwelling if a duplex. F While DDS group homes with 5 or fewer individuals are considered one and two family dwellings, DDS will on occasion;require group homes to include additional features such as the installation of fire suppression systems. Requiring these systems does not, however, change the one and two family dwelling use designation. Fire suppression systems are classified.under"13D"of the code and have to , meet the requirements for this class. DDS homes-just like any one or two family home, are not required to be equipped with exit signage or exterior fire alarm systems. Adding requirements beyond those identified in the code, such as annual inspections,would result in disparate treatment of these homes and would be construed as in violation of the Conciliation Agreement. We hope this information helps clarify some of the confusion that may exist with review of proposed group homes operated by and/or approved by DDS for five or fewer residents. if you have any questions, please feel free to contact Tom Riley at(617)826-5250 or Gail Grossman at(617)624-7779. Thank'you. Thomas G. Gatzunis P.E., C.B.CY Bin M. Howe t 1 , ❑ ❑ ❑ ❑ EATBROWN LINDQUIST FENUCCIO & RABER 'ARCHITECTS, INC. July 3, 2018 8U/LI 11VG Mr. Brian Florence (email brian.florence@town.barnstable.ma.us) Building Commissioner, Town of Barnstable JUL l j 2018 200 Street Hyannis, MA 02601 7'OWNOF&A9NSTA Re: Proposed Group Home at 40 Lumbert Mill Rd., Centerville, MA Mr. Florence, We,have reviewed the proposed use of the building at 40 Lumbert Mill Road in Centerville, MA per the current Building Code, IBC 2015, IRC 2015, IEBC 2015, and associated State of Massachusetts Amendments. It is our understanding that the existing building, based on the latest assessor's card, is currently a 4-bedroom single family detached home, 6,709 gsf (including garage and basement space). The intended use of this building will be as a group home for four residents managed by the Living Independently Forever, Inc. (LIFE), licensed by the MA Department of Developmental Services (DDS). There will be (non-resident) staff in the group home 24 hours per day, including 2-3 staff during daytime hours, and one staff at night. The current R-3 use, as well as the proposed R-3 use are under the jurisdiction of the International Residential Code (IRC) with State of MA Amendments. There are no provisions in the IRC regarding "Change of Use", therefore, the International Existing Building Code (IEBC) has been consulted regarding the Change of Use proposed for the Building at 40 Lumbert Mill Road. Chapter 2 of the IEBC 2015 definition: Change of Occupancy. "A change in the use of a building or portion of a building. A change of occupancy shall include any change of occupancy classification, any change from one group to another group within an occupancy classification, or any change within a group for a specific occupancy classification." • The proposed DDS licensed group home does not meet the definition of a Change of Occupancy per the IEBC: o There is no change in occupancy classification. The existing group is an R73, the proposed group is an R-3. o There is no change from one group to another group within an occupancy classification. (Existing and Proposed Use are both R-3). 203 WILLOW STREET SUITE A PH 508-362-8382 YARMOUTHPORT MA 02675 FAX 508-362-2828 W W W.CAPEARCHITECTS.COM o There is no change within the group for a specific occupancy classification, (an example would be changing from an existing post office to a car wash -both considered and listed as a B- Business use). Chapter 10 IEBC 2015-Change of Occupancy: Section 1001.2.1: Change of Use. Any work undertaken in connection with a change of use that does not involve a change in occupancy classification or a change to another use group within an occupancy classification shall conform to the applicable requirements for the work as classified in Chapter 5 and to the requirements of Sections 1002 through 1011." • The proposed DDS licensed group home does meet the criteria for a Change of Use. • There is no work proposed at the interior of the group home, a supplemental exterior stair will be added from the second floor, per DDS guideline requirements, this stair is not required per the code. Chapter 10 IEBC 2015-Section 1004.1 Fire Protection. General. Fire Protection requirements of Section 1012 shall apply where a building or portions thereof undergo a change in occupancy classification, or where there is a change of occupancy within a space where there is a different fire protection requirement in Chapter 9 of the International Building Code., • There is no change occupancy as defined in the IEBC associated with the DDS licensed group home;Section 1004. 1 Fire Protection does not apply. Existing Use Group = Residential R-3: Single Family Detached Residence (to comply with the International Residential Code with MA Amendments). Chapter 3 Use and Occupancy Classification of the IBC 2015; Section 310 Residential Group R; § 310.5 Residential Group R-3; revised per State of MA Amendments (10/20/17): "Residential Group R-3 occupancies where the occupants are primarily permanent in nature and not classified'as Group R-1, R-2, R-4, or I, including: 1. Buildings that do not contain more than two dwelling units. Chapter 1 Scope and Administration IBC 2015: 101.2 Scope, Exception (4)per State of MA Amendments: "Detached one- and two-family dwellings (townhouses) not more than three stories above grade in height and their accessory structures, and other buildings as described in 780 CMR may comply with 780 CMR 51.00: Massachusetts Residential Code. Section R313.2 (State of MA Amendments) "One and Two Family Dwellings Automatic Fire Systems...Only one and two family dwellings having an aggregate area greater than 14,400 SF shall have fire sprinklers installed in accordance with NFPA 13D." 203 WILLOW STREET SUITE A PH 508-362-8382 YARMOUTHPORT MA 02675 FAX 508-362-2828 W W W.CAPEARCHITECTS.COM Proposed Use Group = Residential R-3: Single Family Detached Residence used as a DDS Group Home (to comply with International Residential Code with MA Amendments). Chapter 3 Use and Occupancy Classification of the IBC 2015; Section 310 Residential Group R; § 310.5 Residential Group R-3; revised per State of MA Amendments (10/20/17): "Residential Group R-3 occupancies where the occupants are primarily permanent in nature and not classified as Group R-1; R-2, R-4, or I, including: 8. DDS facilities in conformance with the occupant safety requirements of 115 CMR 7.00; Standards for All Services and . Supports" (added per MA Amendments)." Chapter 1 -Scope and Administration IBC 2015: 101.2 Scope, Exception (4)per-State of MA Amendments: "Detached one- and two-family dwellings (townhouses) not more than three stories above grade in height and their accessory structures, and other buildings as described in 780 CMR may comply with 780 CMR 51.00: Massachusetts Residential Code." Chapter 1 -Scope and Administration IBC 2015 (State of MA amendments): 102.2.Other laws; Section 102.2.1 DDS Facilities. "Additional building features required by the Massachusetts Department of Developmental Services (DDS) do not change the classification of residences operated or licensed by DDS as dwellings subject to 780 CMR 51.00: Massachusetts Residential Code." o The_only proposed work is the addition of an exterior stair from the second floor, a requirement per DDS guidelines. o IRC 2015 Section AJ501.1 (State of MA Amendments): "Newly Constructed Elements. Additions, newly constructed elements, components, and systems shall comply with the requirements of 780 CMR 51.00." ' The new exterior stair must comply with the IRC 2015 with State of MA Amendments. Appendix J-Section AJ 102.3 State of MA Amendments Smoke, Carbon Monoxide, and Heat Protection: "Smoke, carbon monoxide, and heat protection shall be provided when required by this section, and designed, located, and installed in accordance with the provisions for new construction. See sections R314, R314.5, and R315." o Per Section AJ 102.3.2 State of MA Amendments: installation of a new Smoke, CO, and Heat Protection system in an existing building is only required when a complete reconstruction is undertaken within the dwelling. 203 WILLOW STREET SUITE A PH 508-362-8382 YARMOUTHPORT MA 02675 FAX 508-362-2828 W W W.CAPEARCHITECTS.COM In conclusion, based on definitions and requirements in the Building Code, Residential Code, Existing Building Code, and, associated Massachusetts Amendments; there is no change in occupancy. This particular condition does not meet criteria for a Change in Occupancy as defined in the Code.The Existing Use Group is an R-3, the proposed Use Group is an R-3. The Fire Protection Requirement associated with a Change in Occupancy does not apply to this Change of Use within the same use group. The new stair to be constructed as required by the DDS Guidelines must comply with the IRC 2015 Code for New Residential Construction with State of MA Amendments. Please feel free to contact our office with any additional questions. G'�ERED ARCAI o No. 10563 BARNSTABLE, MASS. y�F PG 0 0�gS Kurt Raber, Principal Maria Raber, Project Architect Cc: Peter Freeman, Freeman Law Group, LLC. 203 WILLOW STREET SUITE A PH 508-362-8382 YARMOUTHPORT MA 02675 FAX 508-362-2828 W W W.CAPEARCHITECTS.COM ` L .r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map at Parcel 1013 Application # Health:Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board D I14JIL/ . � V Historic - OKH _ Preservation / Hyannis Project Street Address ' l GXJ- Z', T, Village '� j�, , Owner®,�rlf/�f,����D l��i'��3� Address oe Telephone Ir- 9 Permit Request f� )2� ����-7 �� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation /.3'70'0. D Construction Typ 7eA-0 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family,-a" Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes Flo 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 n Total Room Count (not including baths): existing new First Floor Rolm Count`' a Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing woodcoal stove: ❑des ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑'existing •fib new.: size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # _=-Current Use - --- - - _ --- -- - _ -Proposed Use- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �` ,CD C' T"i'l 61 Telephone Number 05`46 Address J!; � License # /1 V,4'& I i Home Impr Contractor# Worker's Compensation # ��i�D�4'r� 63� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Ov -OL-l" SIGNATURE DATE �J7i 4. ti < FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ¢ D • r MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER `i DATE OF INSPECTION: ' ! FOUNDATION FRAME INSULATION. 6 FIREPLACE ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH FINAL GAS: s ROUGH FINAL -FINAL BUILDING DATE CLOSED OUT r ASSOCIATION PLAN NO. 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 P Type: Private Corporation ry Expiration: 12/15/2012 Tr# 206433 Q14E�=jCAPE COD INSULATION, INC ? f X JE' f HENRY CASSIDY 455 YARMOUTH RD. - HYANNIS, MA 02601 Jr;Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card r DPS-CA1 is 50M-04/04-G101216 Office o`r�` mer Affairs ,u,��si ne Regal•tion License or registration valid for is divide!use en!y HOM Rf� '�°'eaZA� before the expiration date. if found return to: Registration: 153567 Type: Office of Consumer Affairs and Business Regulation s Expiration: 12/15/2012 Private Corporation 10 Park Plaza-Suite 5170 a -- Boston,MA 02116 OD INSULATION, INC Y HENRY CASSIDY $z, - 455 YARMOUTH RD HYANNIS, MA 02601`"y; UndersecretaryAt 4tsi* ne t..._ -'�>: wlflssalchusetts-Department of Public Safco Board of Btiitdin- Regulations and Standards", ®. Qonstruction Supervisor License License' CS' 100988 HENRY CASSIDYw - 8 SHED ROW ti WESpT YARMOUTH, MA 02673 Expiration: 11/11/2013 (Irminissii ner Tr#: 7620 1 The Commonwealthnof Massachusetts .' Department of'Industrial Accidents w Office of Investigations 600 Washington Street �a Boston, MA 02111 ' www alass.gov/dia Worker's compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): C5pe t , Address: City/State/Zip: Y S41A Phone#: " -7, 17 6 LZ4 Are you an employer? Check the appropriate box: a. Type of project(required): 1. UN I am a employer with_ ©_ 4•Q I am a general contractor and I have 6. .❑ New construction employees(full and/or part-time).* hired the sub-contractors listed on 7. ❑ Remodeling the attached sheet.t 2. ❑ I am a sole proprietor or partnership These sub-contractors have 8° ❑ Demolition. and have no employees working for employees and have workers' comp: . `' 9. ❑ Building addition me in any capacity. [No workers' insurance.$ 10. Electrical repairs or additions comp insurance required.] 5.❑ We are a corporation and its IL Plumbing repairs or additions - officers have exercised their right of ❑ 3• ❑ 1 am a homeowner doing all work exemption per MGL c. 152§(4),and 12. Roof repairs myself. [No workers' comp. we have no employees. [No workers' 13. Other insurance required.] t ` . comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attach 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 CompanyYName: Policy#or Self-ins.,Lrc.#: Expiration Date: Job Site Address: City/State/Zip: 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 a 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 ma e forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do here c under the ins and penalties of perjury that the information provided above is true and correct. Signature: Date:�GT�41 �i. Phone#: 27 Official use only.Do not write in thisarea,to be completed by city or town official City or Town:' _ Permit/License# r F Issuing Authority(circle one):` r' 1.Board of Health . 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Date: 4/19/2012 Time; 10:13 AM To: Cape Cod Insulation, Inc @ 1508-778-5735 Rogers & Gray- Ins. Page: 002 'ss Client#:4597 1. CCINSUL. ACORDu CERTIFICATE OF LIABILITY INSURANCE °ailsi2o,2"" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER _ * '•' NAME: Margaret Young - Rogers 8 Gray Ins.-So.Dennis uUNE Ext:508-760-4602 FAX 508-258 2102 434 Route 134 E-0AAa WC,No): ADDREss: youngma@rogersgray.com - P.0.Box 1601 PR DU ER South Dennis, MA 02660-1601 CUSTOMER ID INSURER(S)AFFORDING COVERAGE NAIC# INSUREDINSURER A,Peerless Insurance '`' _ 18333 Cape Cod Insulation Inc 455 Yarmouth Road INSURER B:Ohio Casualty Insurance Company.. Hyannis, MA 02601 INSURER C:Atlantic Charter Insurance INSURER D:Commerce Insurance Company 34754 r ' - 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. IN SR RDDL 3UBRI POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY1 (MMIDD/YYYYI LIMITS A GENERAL LIABILITY CBP8263063 04/01/2011 04/01/2012 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE T RENTED - ,�• s PREMISES Ea occurrence $100 000 r CLAIMS-MADE OCCUR' MED EXP(Any one person) $5,000 M 3 PERSONAL B ADV INJURY $1,000,000 GENERAL AGGREGATE' $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO- - - LOG g D AUTOMOBILE LIABILITY 11MMBCKVMK /01I2011 04JOI/2012 COMBINED SINGLE LIMIT ANY AUTO - - + (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY(Per person) $ ' - •` BODILY INJURY(Per accident) $ - X SCHEDULED AUTOS - ! - ; PROPERTY DAMAGE - X HIRED AUTOS + • _ (Per accident) $ _ rs X NON-OWNEDAlIfOS- - e } - $ " � - $ B UMBRELLA LIAR' X OCCUR 0001254514645 4/01/2011 04/01I201 EACH OCCURRENCE $1 OOO 000 EXCESS LIAR CLAIMS-MADE t,ar AGGREGATE $1.,000,000 ' DEDUCTIBLE X RETENTION 10000' $ AND EMPLOYERS'LIABILITY "..• C WORKERS COMPENSATION WCAO0525902 6/30/2011 06/30/201 X "c STATU- OTH- - Y� - IN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCL " N/A E.L.EACH ACCIDENT - $500 OOO tfDED? N _ _ (Mandatory In NH) - E.L.DISEASE-EA EMPLOYEE $500,000 "3 If yes,describe under , DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Comp Information Included Officers or Proprietors CERTIFICATE HOLDER:. CANCELLATION r . °tt SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ` ACCORDANCE WITH THE POLICY PROVISIONS. ' - 1 AUTHORIZED REPRESENTATIVE PA #11A r 01988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 'of 1 The ACORD name and logo are registered marks of ACORD , #S80552IM68179 MEE144 r R OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at y (Property Address) (Property Address) Coothereby authorize Cl �- —T1 a l�� G (Subcon ctor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature �2- i Date MAY 2 4 2012A w CA, COD W SAR�- � , INSULATION I? _ - NBRR GLASS StAM1E35 -SVRAT FOAM SUSYLNOFO BATTS GUTTERS INSUtAT1GN CSILINGS '.. 1-800-696-6611 C �g Town of Barnstable s able Regulatory Services Building Division 200 Main St Hyannis, MA 02601 Date: Dear Building Inspector Please accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute - (BPI) inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village )0Vj&j j+(4w4C4, UI)I aLL h bq Y0 LuFK 'l- A'l' Cam-th I -- Insulation Installed: Fiberglass Cellulose R-Value Restricted Unrestricted Ceilings ( ) ( ) ( ) ( ) ( ) Slopes ( ) ( ) ( ) ( ) ( ) Floors ( ( ) ( ) ( ) k44tW41(SWalls (X ) ( ) ( Ip ) ( ) (X) Sincerely He y E Cr , President Ca e Codn, Inc. I BUILDING .� 4 .TOWN OF BARNSTABLE, MASSACHUSETTS 168-1019 vf pp ' DATE 19_ 8;l PERM ITN _�g�� I. APPLICANT. 'e f r ��— g C. ADDRESS, IN ri ram: I �i •v�S.��eE �'...�. PERMIT TO - ..�•,,. NUMBER OF NO. STORY -� (PROPOSED •E1- - T JDWELLING UNITS .AT (LOCATION) �.nNO•) #q f [ I.>>rn�'l:.Yi' '1'i 1 1 I{lei :-r _�ri 1 1 ZONING (STREET) D ISTR ICT__4�fg' BETWEEN - AND 4.' (CROSS STREET) " (CROSS STREET) �. SUBDIVISION " LOT r.. LOT BLOCK SIZE bUILDINGAS TO.BE FT, WIDE BY FT, LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO..TYPE USE GROUP BASEMENT WALLS OR•FOUNDATION (TYPE) .. . REMARKS: -„ U4J71(ii1' ,($528,. 00), - AREA OR VOLUME'_ O_ 1rlc �i.IZ .y.y. PERMITESTIMATED COST _ 1 "��� nn , (CUBIC/SOUARE FEET) -7^�b'7 ! FEE OWNER 7 r 74 0 c ADDRESS BUILDING DEPT.BY i' • F THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY , -� PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THEREOF. EITHERNG TEMPORARILY ® PROVED BY THE JURISDICTION, STREET OR ALLEY GRADES AS WELL OASSIDEPTH AND LO.D UND OF THE PUBLIC SEWERS D MPORT BE OR FROM.THE;DEPARTMENT OF PUBLIC WORKS.- THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS, MUST BE AP- Be.OBTfUNED MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED.ON,J�OB AND THISFE PPLICABLE SEPARATE INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- AL PERMITS ENSTAOLLATDONSOR 2. PRIOR TO COVERING STRUCTURAL ,SUC AL, PLUMBING A,yp 3. FINAL INS(PECTDION BEFORE NIALDINSPECTBION HIAS BEEN MADE NG SHALL NOT BE OCCUPIED UNTIL OCCUPANCY. POST THIS CARD S®.. IT IS, VISIBLE FRCS STIDE BUILDING R1SP_CTION APPROVALS ET PLUMBING INSPECTION APPROVALS ' ELECTRICAL INSPECTION APPROVALS, 4 2 2 2 . 3 HEATING INSP ECTING APPROVALS REFRIGERATION INSPECTION Ap I nALS . ENGINE =J;r OF ELT 'NORK SrIA.LL NOT ? ROCEED UNTIL THE PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION iNSPECTIONS INDICATED THIS caRo --- :NSPECTOR HAS APPROVED THE VARIOUS- STAGES OF CONSTRUCTION. WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN BE ARRANGED FOR BY TELEPHONE PERMIT IS ISSUED AS NOTED ABOVE. OR WRITTEN NOTIFICATION. TOWN OF BARNSTABLE 31150 Permit No. ................ ! BUILDING DEPARTMENT Cash S28.00 (owner) I n.ann TOWN OFFICE BUILDING ""..... wa �ta4r HYANNIS,MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to DONALD E. TILLOUGHBY Address lot #9 40 Lumbert Mill Road, Centerville USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. April 19 , 19....8 ......... G( .... .,...--'i�''�*'G Building Inspector IL I FF O BARNSTABLE, MASSACHUSETTS BlJ-1L®I( 168u-1019 ' DATE - 19 ti PERMITNQ_ Q .APPLICANT.' ��- ADDRESS > t t,. 1�0.1 E - PERMIT TO . 1:7 it .:l 7 'NUMBER OF r�rre Oi irtPirpvET�EA'GI,. (.^p-) STORY 4'i r'irr7 •a T:6�`i� �i' iri'rJDWELLING UNITS - (PR OPOSEO / A:T.'(LOCATION) #9 [ 1',1Tmhorfi Si 1 i 14C1c'L! ( � '> > - 1 1 ZONING j, DISTRICT (STREET) t EET) BETWEEN (CROSS STREET),. , AND _ ,.(CROSS STREET)' SUBDIVISION . . LOT f LOT BLOCK SIZE r.. f .BUDDING IS TO BE FT, WIDE BY FT, LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION :TO.TYPE BASEMENT WALLS OR FOUNDATION k` USE GROUP _ (TYPE)' REMARKS - In ei#Q5"�4�i F UWIler $548 r' .. 00). : AREA OR -VOLUME,': )�ri�i CCL tt; PERMIT ESTIMATED COST 1 Z(1 n t 7 (CUBIC/SQUARE FEET) �- +-1,�-nN-o �(t� FEE': .L85 o 25 OWNER by 7 AS I . .ADORESS r c1d BUILDING DEPT, }--i1;�'� U t ® THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY PROV,EDENTLY, ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED 'BY. THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE MUST OBTAINED AP- FIR ANYHEIDEPARTME U OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY.APPLICABLE SUBDIVISION RESTRICTIONS. MINIM NSPE M OF THREE CALL APPROVED PLANS MUST BE RETAINED'.ON.JIOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR i ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. MADE, WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS, 2. PRIOR TO COVERING STRUCTURAL ELECTRICAL, PLUMBING AND MEMBERS(READY TO LATH). QUIRED,SUCH BUILDING.SHALL NOT BE OCCUPIED UNTIL 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE, OCCUPANCY. POST THIS CAR® SO--IT IS, VISIBLE FROM! STR��T BUILDING INSPECTION APPROVALS LE INSPECTION APPROVALS V' ELECTRICAL INSPECTION APPROVALS',• 2 2 2 I� 3 HEATING INSPECTING APPROVALS REFRIGERATION INSPECTION APftOVgLS ENGINEER OTHER "(_i L� ' ��-�`�[� -(•� .rJ 2 n j��8 --- -- 2 � B0 �OF EALTH -- co 1 WORK SHALL NOT PROCEED UNTIL THE NSPECTOR HAS APPROVED THE VARIOUS PERMST WILL BECOME NULL AND VOID IF CONSTRUCTION NSPEC710NS INDICATED ON THIS CARD $ STAGES OF CONSTRUCTION. WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CAN PERMIT IS ISSUED AS NOTED ABOVE. BE ARRANGED FOR BY TELEPHONE OR BE NOTIFICATION. Z :5 LoT 0 i Zo7- -0 9 /98/o sg1FT ' 7i� ro ZoT # , Ez ev, 7-pp 1.0 i- �'Xisri�G founij�,: Ai IN io' I �P /o r csQ i7+ z - al P,r BoX h _.• fI ' P Ivy p� AloT N CERTIFIED PLOT PLAN LOCATION . .CC-�vizl/i000 J !s'l/�ss. SCALE ...... DATE .Z?199.7 PLAN REFERENCE \H OF MAS . .�. . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . EDWAR / �tLLEY ' No. 26100 o I CERTIFY THAT THE �-"��sn'v. ajQ�� N, 'S it SHOWN ON THIS PLAN IS LOCATED ON THE GROUND �L L A itUSJ AS SHOWN HEREON AND THAT IT CONFORMS TO THE SETBACK REQUIREMENTS OF THE TOWN OF : �Jr��✓S:iIiGG WHEN CONSTRUCTED. DATEv� /RG iG!r4u ley- f C-77 T/oiJG T 77 REGISTERED LAND SURVEY.0�2, Rik", y / w : ShI&Z-7-. z o,� z S/y6Z_7s i TOP OF FOUNDATION CONCRETE COVER CONCRETE COVERS z�. a 4' CAST IRON 1I2nffr 12"MAX. OR SCHEDULE 40 4°SCHEDULE 40 P.V.C.(ONLY) P.V.C. PIPE PIPE- MIN. LEACH �•' PITCH 1/4"PER. PITCH 1/4"PER.FT PIT PRECAST -� LEACHING ,'. INVE T a e EL..3 rla.. INVERT . INVE T : . 0 PIT OR SEPTIC TANK EL. Tq.. . BI®� EL,3 ' >F ; EQUIV. ,.a INVERT F- 0 /Soo ,.• GAL. INVE T •" " 38F INVERT vw 0: •°. 3/4 TOIV2' e; EL.....:..�.. EL.... 39.70 ° ° EL......... 0 0: WASHED .�'• STONE DIA-q9• �. p PROFI LE OF WATER TABLE SEWAGE DISPOSAL SYSTEM) NO SCALE 77 SOIL. LOG WITNESSED BY : DATE r/�/y8S TIME. 9:-3o. y. �G� • • BOARD OF HEALTH TEST HOLE I TEST HOLE 2 G Dd�/6j1�, .��GLE ENGIN EER ELEV.. 40,70. . . ELEV. .39f . . . . . . 30" St�BrSoiG 30,. SJ� So,L DESIGN ®P-5®�-0 . Q,39.Zo Cof125� C2�y3 7. v NUMBER OF BEDROOMS 3 . . . . . TOTAL ESTIMATED FLOW . . 330. , GALLONS/DAY BOTTOM LEACHING AREA SO.FT. /PIT/:.P.A, Z-& 3¢70 _ SIDE LEACHING AREA . . , z ;Z . SO.FT./ PIT/.SLSC.pD, Ham/ �q�sE CoA�u� sgr/D GARBAGE DISPOSAL . Y.:s . . .(50% AREA INCREASE). SA-riD TOTAL LEACHING AREA SQ.FT PERCOLATION RATE Z- 5. 7709" 77-10 . MIN/INCH LEACHING AREA PER PERCOLATION RATE SQ.FT.IG.r?D, ^� .WATER ENCOUNTERED o/v� f3T WiTi3/„ NUMBER OF LEACHING PITS . . . . . . . . . . . . . APPROVED . . . . . . . . . . . . BOARD OF HEALTH �• T DATE. . . . . . . . . . . . . . . . . . . . . . . AGENT OR INSPECTOR A.A OF �J o� ED i Zo 7- KELLEY ff i .o lN6, 261100 �vtijP� TS �!/LC /Zo/YD ,r p FJ gEGrsiiR� PETITIONER 7>o,,i ya G WiZZ04,_ B,/ J MYCOCK, KILROY, GREEN & MCLAUGHLIN, P.C. ATTORNEYS AT LAW 171 MAIN STREET BERNARD T. KILROY HYANNIS, MASSACHUSETTS 02601 OF COUNSEL ALAN A. GREEN AREA CODE 617 EDWIN S. MYCOCK CHARLES S. MCLAUGHLIN. JR. MICHAEL D. FORD 771-5070 ADDRESS ALL MAIL JAMES M. FALLA P.O. Box 960 - HYANNIS. MASS. 02601 MARK D. CARCHIDI _ REFER TO FILE # October 24 , 1985 Mr . Joseph Daluz Building Inspector Town of Barnstable Town Hall Hyannis ; MA 02601 Re: Lot 9 , Lumbert 's Mill Road , Centerville, Mass .- Dear Mr . Daluz: This office represents Donald E. and Linda L . Willoughby in connection with the purchase of the above property:. We have done a title examination on the above property and, according to that examination, find title currently in Francis J . Brown and Marjorie L. Brown , husband and wife as joint tenants, by deed dated December 9 , 1976 and recorded with the Barnstable County Registry of Deeds in Book 2467 , Page 114 . There has been no change of ownership -•of-- said lot- - since that date , and the Browns never owned any land adjoining said lot during their ownership from December 9 , 1976 through the date of this letter . Ve y truly you r 4 dTi rrn K oy, BTK/.slc Enclosure As�kessor s ;nap.and lot number ............ . ........ ............ :. TNF ©K �o 10 T ;ow��`hAEPTIC SYSTEM Sewage Permit- number ......... 5 `..� .... INSTALLED IN CO d D �J WITH TITL BAR35TADLE, Housenumber ....... ........................................:....................... rasa ENVIRONMENTAL b s Y tr• TOWN OF BARNSTA ` ���DL�TI BU ILDING INSPECTOR APPLICATION FOR PERMIT TO 13 ./A......... .�...sJ T� ,/ GO�P !f...�%%...............:.. TYPE OF CONSTRUCTION ......Z2--..9eD.........,F.. . ................................................/........................ RF+ / �.,...... ......1. ......19... S TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the following information: Location ......................�,.�: .,ft 9.........��..✓.!r?. cis./:.... '1/.�� ,1� ar..rK— Y.J�F�!!/.l�.!................................. ......... ........ ProposedUse .............. . .4y y ...,/rI!!Y/.. ........................................................ ......I......................... /� Zoning District ...............��.......... ....... .JrsJ1!f�i?j!i — DL�I � [�I Fire District �'� (............................. Name of Owner !.?GY/t lP... .. .�z�i,�/.ov�.�./1 ....Address .....V.15,7.'!////./..1 Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...............Foundation ..... E;1erior ...................Gtl ®!�...................................................Roofing ............ `- ..................................... Floors ................................................................Interior ........../?/.7..`l.�!/ 1,�( .......................................... l ....................Plumbin` --`:.:..:Heating �05.............................. g ..........Z............................... ....... ............. Fireplace r• �fl OOe) p ......../.9.5...............................................................Approximate. Cost .........:..�...............................................� , Definitive Plan Approved by Planning Board ________________________________19________. Area ........ .. ...s....... Diagram of Lot and Building with Dimensions Fee . .PA ......'!_ SUBJECT TO APPROVAL OF BOARD OF HEALTH ,� ��U e 9 Xf,7 osrEX- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. . . ......... .. ..I/�% ..... .......... • C Construction Supervisor's License ... WILLOUGHBY, DONALD E. Two Story Permit for .........................i�......... ie Family Dwelling ... ........................................................... Location ...Lot #9 , 40 Lumb�ert Road ............................................................. Centerville ............................................... ................................ Owner ..Do.na.'L.d...E......Willoughby. ......... .... .. .. Type of Construction ..........F.r.arcte......... .. ....... ........... . ......... ...................................................................... Plot ............................. Lot ................................. p Permit Granted .....Se tember ..-2............................ 19 87 Date.of Inspection ...... .......19 Date Completed ... 'ep I .......... 0 40 j x 71AIk- -Pkot),E� Assessor's map' and lot number ...................... . ak"-r sTNE 10 -TD Mao Sewage Permit number ........ MAWSTAXLE, NAB& House number .......Y.C-)............?�)......................................... 1639- A!, TOWN OF BARN.$,. ABLE BUILDING . INSPECTOR APPLICATION FOR PERMIT TO ..........13YA1,P.......7 ..T. .................. TYPEOF CONSTRUCTION ...... ......... .......................................................................... .......................92..... ........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..................... . ... ...... ..... . .C... ........ . ...................... ProposedUse ........... ................................................................................................... Zoning District ...............PIJ .......................... Fire District ....... ...... Address ////&n Name of Owner Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ...................................................................Address .................................................................................... Number of Rooms ...................7 ...............................................Foundation ... ..................... Exterior .................. ...................................................Roofing ........... /g:' I............................................. Floors .................. .................................................................Interior ....... ......................... ....... 7- -/7.:- Heating ............... .......................................................Plumbing .................................................................................... ........... Hieplace .......... .............................................................Approximate Cost .. ........................................... Definitive Plan Approved by Planning Board ---------------- 17�----------------19--------- Area ........................................ Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH V65 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I h6reby agree to conform to all the Rules and.Regulations of the Town of, Barnstable regarding the above construction. .........Name ... ......... .... . . .. ...... .. Construction Supervisor's License ...................................... WILLOUGHBY, DONALD A=16F'�-1014 No ...31150 Permit for ........Two �:�RKY......... ..... S ngle..Family...Dwe l l ing....... Location ..Lot #9, 40 Lumbert Mill 11oad ........................ Centerville ' ........................................... . • Owner ......Doanld E. Willoughby...... ........................ Type of Construction .Frame............................ ................................................................................ Plot ............................. Lot ................................ .' t Permit Granted .., September?: ., 19 87 Date of Inspection ....................................19 Date Completed ......................................19 r i d ,tea Xl v AL� Y - YK 1.1 3 f'j All E �► �, � � �r{��`�'�ci 15 rL1Y s� 73 i I AA s :E • �' 1 F;—'5 df T �n7� F NOTES 1. DATUM IS NAVD88 oute 28 Fuller Rd. Sylvia R 2. THIS PLAN IS FOR PROPOSED WORK ONLY AND NOT TO BE USED FOR LOT LINE STAKING OR ANY OTHER PURPOSE. 3. CONTRACTOR SHALL BE RESPONSIBLE FOR CALLING 6`^ LOCUS DIGSAFE (1-888-344-7233) AND VERIFYING THE LOCATION OF ALL UNDERGROUND & OVERHEAD UTILITIES Road PRIOR TO COMMENCEMENT OF WORK. 4. EXISTING SEPTIC LOCATION PER TIE—CARD ON FILE Bump s e� WITH TOWN. �09 S� �o `r Lodd lj� spy LOCUS MAP SCALE 1"=2000'f 0 OSED 2ND F OOR ASSESSORS MAP 168 PARCEL 101 FIRE E RESS STAIR Q Q �O o. � o. ZONING SUMMARY ONVE ZONING DISTRICT: RC DISTRICT 2 0 EXISTING WINDOW T MIN. LOT SIZE 87,120 S.F. DOOR MIN. LOT FRONTAGE 20' MIN. LOT WIDTH 100' q5 MIN. FRONT SETBACK 20' EXISTING SIDE.-SETBACK, , 10' DWELLING DECK MIN. REAR SETBACK MAX. BUILDING HEIGHT 30' SITE IS LOCATED WITHIN THE RESOURCE 45 O O PROTECTION OVERLAY DISTRICT 44 SITE IS LOCATED WITHIN THE AQUIFER PROTECTION OVERLAY DISTRICT I � 44 �2 SITE IS LOCATED WITHIN ESTUARINE WATERSHEDS FOR POPPONESSET BAY, LOT 9 43 THREE BAYS, RUSHY MARSH, AND 19,810f SF CENTERVILLE RIVER �A � PAV q DRIVE �9 8 L 6 , k2 M° 45 j BFR� SITE PLAN q� 40 OF #40 LUMBERT MILL ROAD CENTERVILLE, MA i PREPARED FOR LIVING INDEPENDENTLY FOREVER, INC. �F MAs q DATE: MAY 18, 2018 !ZN°FMA ! DANIEL yGCJ, DANIEL Gn A. C c� ° � A. � � OJ;"=LA OJALA No. +0980 off 508-362-4541 o No.40980„ e a Q I fax 508-362-9880 °FEss'+°` °F�ss\° e�� ' t ° downcape.com r mown cope engineering, inc. - civil engineers Scale: 1"= 20' /crud surveyors DATE DANIEL A. OJALA, P.E., P.L.S. 939 Main Street ( Rte 6A) Lm BI CE # >8— > 68 0 10 20 30 40 50 FEET YARMOUTHPORT MA 02675 18-168