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Home My WebLink About0018 PHEASANT WAY WEST 4 9 '� k v 'fir ° +� yd r+. a K ,,.3/fra ,. :.� ..�..'. .. ✓-zx • •i.�.. r" ti";n rt' ..1,, i ::s.. f'r;;t� tI O a's x." ♦.ro VV a5, _ _ t. A.}�y; �..»;'x 7a$i e: r -,�'c�. '•�r �:. 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Al .� j� - I V - ::I P I B I , -: ,:., r.. s " - - .. ..: - ; .., , ,• y:.. . ,. , 0 7 ., 4-. .. { II .. , , 1 ..� . ... f , .:' �il tl r� ,; 8 d Y ,: .:. M V G. e I *Permit#Town of Barnstable Expires 6 months from issue date Regulatory Services Fee ;3 S i a ` * BARNSTABIA • MASS.16;q. Richard V.Scali,Director ^ ♦� Building Division Tom Perry,CBO,Building Commissioner OVER j 200 Main Street,Hyannis,MA 02601 ""�+�` www.town.bamstable.ma.usEB 2 �5, Office: 508-862-4038 ax: 5CF8-7 30 EXPRESS PERMIT APPLICATION - RESIDENTIAMWIN WARNSTABLE Not Valid without Red X-Press Imprint Map/parcel Number 14 867 Property Address $4m Residential Value of Work$ 0 zqw— Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addresses Frxz-� �y T_ctL i�`icy 1 uJ Ca�, 1 {1P.1�wrl�� n O-T- A-t A42 Contractor's Name 5c"r eti yiti\A c) Telephone Number 50c'3 G y 4/y 39 Home Improvement Contractor License#(if applicable) lt. :° 2yt 23: CL,. Email: Construction.Supervisor's License#(if applicable) EjWiorkman's Compensation Insurance Check one: a"'I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# eL/�2/2o yZyy Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: �moke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *.Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic;Conservation,etc. y ^ ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License'is required. SIGNATURE: .?'�h �y!✓ Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC Revised 040215 r: .� ?lie Commonwvealrtii o,f 1V'assachusetts Delraranent o,f 1ndrfstrial Accidents Offce o,f 1mwi igations 'b00 Washington Street y. . Boston,,MA 02111 wF{Y anus govIdia. 'Workers' Compensation Insurance Affidavit Bnilders/Contractnrs/EIectt cians/Plumbers Applicant Information Please Print LewbIy , Name�F3usiaess��Organizatiffafdi�sdual _�e �T' (.'cr��,`. Address:�? (2) An,c t—'Z I C ity/StatetZip v r yv,M 8z, phone 4: 1js-( /'3 Are you an employer?Check the appropriate box: Type of project(required). 1.D; am a employer mith r 4 ❑I am a general contractor and I employees(full atldlor part-time).* have hired.the sub-contractors ❑New construction 2.❑ I am a sole proprietor or partner- . listed on the attached sheet ❑Remodeling , ship and have no employees. These sub-conEractors have g_ ❑Demolition woAzing far me in any capacity. employees and have workers' [No n;orlcers' comp.insurance comp.insurance, 9 ❑Building addition required_] 5• ❑ �We area corporation and its 1'4'-E,&chical repairs or additions officers have�esercised their 3.❑ F am.a fiameoumer doing all work 11_Q Plumbing repairs ar'additions myself [No workers'camp. right of exemption per MGL 12.0 Roofrepairs insurance required.]a c.152, §IM and we have no employees-[No workers' 13.❑ Other' comp_insurance required_] •clay wKcant that checks box 91 mast also fill out the sectionbelowshmring their workers'compensationpolicy information Hom eoaaers who submit ibis af5datt indicating they are doing all vraak saddim him antside contractors mast submit anew affidarat indicating fCantractors that check.This boa mast attached an addition at sheet shoarmg the n—of the sub-contrs ctmm and state whether or not those entities hwe employees.If the sub-contractorshace employees,they musrpmtside dwir workers'comp.policy number. I ant air etnplo,�wr that isprotzdirrg ioorkers'congmzsatian irrsairauce for my enrpta3ees. Below is the policy and job site information. Irtsumce Company Name:t p l u.AA-L P+r-&A Policy or Self-ins.Lic_;�: 2 4 t?1 rt - F-VirationDate: Job Site Address-_I�L i��,z o�< ;t�..—t_-)22( 4y1rt._-Qh-a CitylStawzl p: r*,LF[c�e✓r t--. Attach a copy of the workers'compensatioapolicy declaration page(showing the policy number and expiration date). Failure to serum coverage as required.under Section 25A of MGL c 1522 can lead to the imposition of criminal penalties of a , fine up to,$1,50a 00 andfor one-year imprisonment,as well as civil penalties.in the form of a STOP WORK ORDER and a RM 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 ofthe DIA for insurance coverage verification. Ida hereby certifj,under the pairis and penances of that the information prat itfed abmw is tress and correct Sionture: Date: Z c Phone , Official use only. ,Do not mite in thb area,to be campieted by city orlown official, City or Town: Permitffikense if Issuing A.uthority(circle one): 1.Board of Health 2.Budding Department 3.Citffown Cterk d,Electrical Inspector 5.Plumbing Inspector 6.Oither Contact Person: Ph-one it: ty Information and lastrucflons Massachusetts General Laws chapter 152 regents an employers to provide workers compensation for their employees. pm-suantto this statutt,an.MPIayee is defined as_"_.every person is the service of other under any contract of hire, express or implied,oral or write." An rnpray�is defined as"an individaal,partnership,association,corporation or er legal entity,or any two or more of ther, i og engaged in a joint enterprise,and including the legal repres ' es of a deceased employer,or the receiver,\= dtee of an individual,partnership,association or other legal entity, loying employees. However the owner olling horse having not more�three apartments and who rest s therein,or the occupant of the - dwellingof another who employs persons to do mainisnance,constracti or repay work on such dwelling house or on thds or building appu�rUmant thereto shall not because of sack loyment be deemed to be an employer." MGL ch §25C(6)also stains that"every state or local Licensing a easy shall withhold the issuance or renewal a or permit to operate a business or to construct buiil gs in the commonwealth for any applicanhas otprodum-d acceptable evidence of compliance . th-e insurance.covearagereguired." AdditionGL tar 152, §25CM states"Neither the commonwe nor airy of i[s political subdivisions shall enter intontract r theperfannaamofpnbhoworkuntilacceptabl evidenceofcompliancewith the inctrranCE. rcq=em this have been presented to the contra ctiag autho " ApplicanAr=EM�t� Please Etilt Wor3s s7 co ensation affidavit completely,by ch the boxes that apply to your situation and,if necessaryly snh-contracto s)name(s), addresses)andphone n er(s) along with thtir certificate(s)of in crrranCtited Liability antes(LLC)or Limited Liability P erships(LI.P)with no employees other than the mtmbtrstners,are not r to canny workers' compensati insurance. Tin an LLC or LLP does have employeelicy is required Be vised that this affidavit may + to the Department of Industrial Accidentsconfirmation of insmai coverage. Also be sure sign and date the affidavit The affidavit should be retume city or town that the lication for the permit r license is being requested,not the Department of lnrt uctr;aTents. Should you have Suestions regardiz� e IaW or ifyou are requited#o obtain a workerscompensaolicy,please call the Dep ent at the numb lisiz:d below. Self-insuredcompanies should enter their self-i lmn- icense number on the app line. City or Town Officials f Please be sure that the affidavit is complete and le ly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the ce of vestiges is s has to contact you regarding the applicant Please be sure to fill in the pm it/license nvnber ch be used as a reference number. In addition,an applicant e affida indicating current submit on vit ' Ie ermit/lrcense Ii'cations' given year,need only ra�tng � that must submit mulhp p aPP Po information(if necessary)and under"Job Site_ dress"$e applicant-should write"all locations II (cry or town)--A copy of the-affidavit that has been offici \ ed or maimed by the city or town may be provided to the applicantP as 'roof that a valid affidavit is on file ,permits or licenses_ A new affidavit must be filled out each year.Where a home owner or citizen is obtaining license o�T p_mmit not related to any business or commercial venture (Le. a dog license or permit to bum.leaves etc.) d person T rec�to complete this affidavit The Office of Investigations would like to. you in your cooperation and should you have any questions, please do not hesitate to give us a call. \ The Dep_arimenfs address,telephone and. number. Deparimmt cif hidnstdal A zdenis Gffice of� e fig�tio % 604-washivml t 1 Bmtou.,MA 02111 TeL 4 617 727-4}[0 QXt 406 car 1-977-h_A_S9AFF Fax 617-727-7749 1 Revised 424-07 as gavldia IF It + swarrst•�sis, + MASS. Town of Barnstable ArED�A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street,- Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize_ ,`T' �.mr. �l,ih_� to act on my behalf, in all matters relative to work'authorized by this building'permit application for: (Address ofjob) ignature of Owners hate e Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WHILESTORMS\building permit forms\EXPRESS.doe Revised 040215 Town of Barnst le Regulatory Se ces �oFTHE rgtyti Richard V.Scali,Dir ctor, Building Div_ ion * saarrsr MY, Tom Perry;Building C mmissioner 9Q� 039. �� 200 Main Street, Hy s,MA 02601 www.town.bar table.ma.us _ Office: 508-862-403 8 Fax: 508-790-6230 HOMEO ICENSE EXEMPTION lease Print DATE: JOB LOCATION: number street village "HOMEOWNER": name h e phone# work phone# . CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was a ended include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire w does no ossess a license,provided that the owner acts as supervisor. DE ON OF HOMEOWNER Person(s)who owns a parcel of land on whic he/she resides r intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached struc es accessory to s ch use and/or farm structures.'A person who constructs more than one home in a two-year period shall not be cons' eyed a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/ he shall be res onsibl for all such work performed under the building permit, (Section 109.1.1) The undersigned"homeowner"assumes esponsibility for compliance th the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"ce ' s that he/she understands the Town Barnstable Building Department minimum inspection procedures and requirements and he/she will comply with said procedur and requirements. Signature of Homeowner Approval of Building Official Note: Three-family ellings containing 35,000 cubic feet or larger will be r uired to comply with the State Building Code Section 127.0 Construction C ntrol. HOMEOWNER'S EXEMPTION The Code states t at: "Any homeowner performing�a ork for which a buildi permit is xeuier}1`shall be�xefn t � l. from the provisions of thi section(Section 109.1.1,•�Iic°e `Wing of construction Supervi rs)• provic�efi�that°if'th`eo�u' oie� 4 .• ' , engages a person(s)for re to do such work,that such Homeowner shall act as superv' r." Many homeo ers who use this exemption are unaware that they are assuming t e responsibilities of a supervispr (see Appendix Q,Rul s&Regulations for Licensing Construction,Supervisors,Section 2.1 la, a often results in serious pro lems,particularly when the homeowner hires unlicensed persons. In t s ca's'�,�burVar ca o "« proceed against the nlicensed person as it would with a licensed Supervisor. The homeowne acting aOSupervisor is ultimately responsi 16 To ensure at the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, hat the homeowner certify that he/she understands the responsibilities of a Supervisor..On the last page of this issue is a fo currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215 02/12/2016 08:56 5087907955 OCEANSIDE INSURANCE PAGE 01/01 CERTIFICATE - DATE MMrD �..� ATE OF LIABILITY INSURANCE ' Wnyr 2/3.2/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT; If thO certificate holder is an ADDITIONAL INSURED, the pol(cy00S)must be endorsed- If SUIBROG the terms and conditions of the policy,c ATION IS WAIVED sub p II y,certain policies may require an endorsement A )sot to certificate holder in lieu of such endolsement(S), statement on this certificate does not confer rights to the PRODUCER The OceaBide Insurance Group ONE T Christian >3arbe�, CIC n �. (50a)775-0500 FAX l50e>750-795e AIL 52 West Main Straet: ADDR Hyannis WA 0260E INSURERS AFFORpINGCOWRAGE I NAICA� [INSURGO INSURERRA;Comm®rCe Insurance INSURER eAssociated Em to ers Ina CO cott Condinho, DBA: DC Uitlities O Box 521 INSURERC; INSURER D: West Hyannsiport MA 02672 INSURERE: COVERAGES I tiURERF; CERTIFICATE NUMBER:CL1621204274 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, NOTIMTHSTANDINQ 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. VTR, TYPE OF INSURANCE PL ICY F P LIGY POLICY NUMBER LIMITS X COMMERCIAL GENERAL LMIL,ITY A J CLAIMSQADE L•` OCCUR EACH OCCURRENCE $ 1,000,000 PR 8ES ce `fl 100,000 )3GNTTIC 9/23/2015 4/23/2016 MED PIP(Any one erson) E 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMITAPPI,IE6 PER: POLICY El jEOT F7 LOC GENERAL AGGREGATE $ 2,000,000- OTHER: PRODUCTS-COMP/OPAGG S 2,000,DOD AUTOMOBILE LIABILITY $ C BINED NGLE T $ ANY AUTO a aecid ALL OWNED (7J SCHEDULED BODILY INJURY(Per person) E AUTOS AUTOS HIRED AUTOS 'NON-OWNED BODILY INJURY(per ecrlaenQ $ ' AUTOS I P PER Per Wa AMAGE S UMBRELLA LIAR OCCUR $ EXCESS LIAR CLAIMS-MA DE EACH OCCURRENCE $ �' DED ENTI NS AGGREGATE, $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y I N. STATUTE E ANY PROPRIETOR/PARTNER/EXECUTI�'E R $ OFFICER/MEMSEREXCLUDED? ❑ N/A (Mandatory In NH) E.L.EACH ACCIDENT $ 500- 000 IIfyyes,deecrlbeunder WCC-500-501d7d3-20157y 6/3/2015 6/3/2016. E•L,DISEASE= DESC IPTION F OPERA ONS belovp EA EMPLOYE $ 500 000 E,L,DISEASE-POLICY Lima-,S a 500 000 DESCRIPTION OF OPERATIONS!LOCA'nONS I VEHICLES(ACORD 101.AddidOnel Rwnatke Schedule,may be attached if more apace Is required) t' M -- t'77 CERTIFICATE HOLDER CANCELLATION A SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Barnstable 367 Main Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis, MA 02601 ' AUTHORIZED REPQES'ENTAMVE Cora Sylvester/CS ACORD 25 2014/01 01988-2014 ACORD CORPORATION. All rights reserved. ) The ACORD name and logo are registered marks of ACORD INS025(201401) f ~' CARBON MONOXIDE ALARMS. W01 MUST BE INSTALLED PER M MASSACHUSETTS BUILDING CODE SMQK DETL=�..f s u� REVIEW-ED. T F DA P iiE J TA ILDi 7 .. S FIRE DEr ARTfv_i,;. DATE'S BOTH SIGNATURES ARE rC.r,tjF '�.fOR PERMITTING LA _`� ( 1 a r (cor UA-1 r\ ! o- US ti r • . - ; ~t.r .dam \� .. - - - - � - • G 4,uV,t le - 7 s�. .. -y � _ �. r, . �_ 4 . � � � - � F. � .. r d - '"'s \ � _ - � { . � � - . . . . . � f ` ,. a �.. n ` _ J�i� P�� oFINE r Town of Barnstable *Permit Expires 6 months from issue date Regulatory Services Fee 9 s ,�' Richard V.Scali,Director r`IV 4Aqvo�'� Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508'-862-g4'03`8 17 Fax: 508-790-6230 JUN 020MAESS PERMIT APPLICATION = RESIDENTIAL ONLY Not Valid without Red X-Press Imprint 35@0 NumU�rp -, Aw6r-:7�; w Property Address A aU Umloy,Re MA { N Residential Value of Work$ _ - —,Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address l ipl Contractor's Name-' *treqwtl t . 1 C Telephone Number 71q-qg-j-gt52 Home Improvement Contractor License#(if applicable) ADS " Email: Can& ter UP 6 UZAVA , Construction Supervisor's License# if applicable)_ 2 P ( 74Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance X. Insurance Company Name Alna81 -105. .,V A kA 14 (f W &-y V-1 eq A��,Gl°�Q� R vsts Workman's Comp.Policy# y e P Y �Y� Z��'� CX`tS 3 15 O Copy of Insurance Compliance Certificate must accompany each permit. - Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles)'All construction debris will be to ❑ Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value (maximum.32)#,of windows _ An&ram -70 Siti s #of doors: _ '❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. 4 �w *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the HomeMlenntractors License&Construction Supervisors License is equired. SIGNATURE: A Q0VTFILES\FORMS\building permit forms\E SS.doc Revised 040215 Big '28?03 Ps.3.�.2 " �24.358 to MASSACHUSETTS STATE EXCISE TAX ¢s r+_ - ;BARNSTABLE COUNTY REGISTRY OF DEEDS a a.a + :a}" `�;, ' " :. Date: 05=29-2015,, 03:09vm "'.'' Ct l:: 1322, r Doc; 24358 Fee: $76.9.50 Cons: $225►000.00 QUITCLAIM DEED ra We, Brian L. Proctor of 290'Route;149,.Marstons Mills;Massachusetts 02648, Sharon Gifford of ,lei t C-4 mm„n m=• 28 Pheasant Way, Centerville,-Massachusetts 02632`Bertram L.T:-Proctor of 983 Shoot*Flying Hill Road, Centerville, Massachusetts, Donald A. Hedderig of 81 Lauries Lane_, Marstons Mills, W Massachusetts and Theodore& L..' Hedderig ,-of y 795, Old -Falmouth Road, Marstons Mills,9 Ma h 4 I Massachusetts 026 8 , `• r b •{ � �. for consideration paid of Two Hundred Twenty-Five Tliousand.($225,000.00) Dollar's; rR { grant to.Sanford R. Tyler, P'O. Box 80, West Hyannisport, Massachusetts.02672; individually, .s { with QUITCLAIM'COVENANTS, that,certain lot•or'parcel of land, together.wrth the'build rigs , •", thereon, in the village of Centerville'and in the Town and County of Barnstable, Massachusetts, . { bounded and described as follows: ` ` r?P - One the North by.Lot 6 as shown on plan hereinafter mentioned; 150`'feet; s `On the East by Lot 9;as shown on said plan,-,.117 feet; + On the South,by Lot 4, as shown on said plan, 150'feet; ^ '� •' :x�'T. r 4 On the West by a forty foot way,ras shown on said plan, 117 feet. Containing.an area of about.17,550 square feet. ^r{ Said land is shown as LOT 5 on a plan entitled Subdivision of Land iri'Centerville-Barnstable- 4 1 Mass. property of Seabury W.; W: Elroy&Sarah F.. Bear'se"dated July.6 '1955;drawn byYBearse ' &,Kellogg, Civil Engineers, Centerville. z �t Subject.to any and all existing restrictions and encumbrances still in force and°effect: ` We, as Grantors,-hdreby waive.any and.all rights of'Homestead inand'to^the premises-conveyed, ~" hereby and warrant and represent that there are no-'person"entitled'.to{any rights of Homestead t . under M.G.L. c.d88 in-the premises conveyed by,this deed. `Neither we nor our.-spous have ever occupied the premises as our principal residence. Property Location: . 18 Pheasant Way,-Barn'stable;(Centerville),Massachusetts" Al ° Prepared by the Law Office of Patricia J.Mello,?C. 766 Falmouth Road,Mashpee,MA 02649~ •, . ir _ 508 477-0267 ',� SPKLEH ` r r • r - ' i .t' * •;' • S.� +:�-• •` ail � ? Yf art � v+ Said.land is shown as LOT 5 on a plan entitled-"Subdivision of Land in Centerville-Barnstable- Mass. property of Seabury.W., W. Elroy & Sarah-F,- Bearse' dated July,6, 1955,drawn by Bearse & Kellogg, Civil Engineers, Centerville. Subject to any and all.existing restrictions and'encumbrances:still in force and,effect ; We, as Grantors, hereby waive any and all rights of Homesteadin and to the premises conveyed . hereby and warrant and represent that there are no`person entitled°to any rights of'Homestead under M.G.L. c. 188. in the premises'conveyed by this deed. 'Neither we nor our spouses have ever occupied the premises as"our principal'residence:.: For Grantors title see Barnstable County Registry of Deeds'Book 25983, Page 55 Also 4see .Death Certificate of Charlotte M. Proctor and'Affidavit'of No Estate Tax Recorded herewith. Nil,. • , .1 r' � + rr ".. .. a •S> a , , - •, - ° _ i t, , Y • ��"Fr' � ° w * Y• , r r •A,• 1, t 'i • �• � OFF r•'•ri�t t '�, `;? a.X#- _ r � s• " #* ! *r+ s .. ' • =e,« � �. .�� .fey � j ¢^ � + r -t,.�+, .Vyo a. � 5�,._ `. • t ' Prepared by the Law Office of Patricia J.Mello,P.C., A. ' ` �766'Fa6outh Road,Mashpee,MA 62649. '. 508-477-0267 r;^ 2' r SPKLEH E WITNESS our hands and seals this 09 day of May 2015. A.A Brian L. Proctor Irn Sharon Gifford +' Bertra T. Proctor Donald A. He derig Theodore L. Hedderig COMMONWEALTH OF MASSACHUSETTS +. Barnstable, ss On this day of May 2015, 'before me, the undersigned notary public, personally appeare nan L. Proctor, proved to me through satisfactory evidence of identification, which was_personal knowledge of identity or , to be the person whose narrie is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarilyIr stated ose. A LISA E.MYCOCK t Notary Public ef` Massachusetts Commisslon Expires Mar 10.2017 Prepared by,'the Law Office of Patricia J.Mello,P.C. 766 Falmouth Road,Mashpee,MA 02649 ' 509-477-0267 3 SPKLEH z A ' COMMONWEALTH OF MASSACHUSETTS Barnstable, ss x ti'y tv On this ay of Ma,y 201�5; before`me-, the undersigned .notary public; personally appeared on Gifford; ;proved.to me through satisfactory,evidence. of identification,which " was_personal knowledge'of identity or y `::• ' ,'to be the person whose name is signed on the preceding or attached`document; and' acknowledged to me that she°signed it voluntarily f is stated purpose. x ,��+ d • �--ISA E. MON EALTH OF MASSACHUSETTS, Note Public Notary r �' r , (T u • ,.' B as achusetts Ct►mm Tres Mar 10 2017; +° � s ,day of-May,2015'.before me, the 'undersigned;y notary public,:personally appeared Be Proctor, proved_to me through satisfactory'evidence,of identification, which was _-.personal-knowledge of identity or to be`.the person whose name is 'gned`on, the preceding or attached document, and"acknowledged to me that he` x' signed it vol ly for its stated purpose. ` r/��MO ALTH OF MASSACHUSETTS LlSA E.I<4Yt)061C' - - t Not Public ^' B Massachusetts omt►i pares Mai 10,20 17' On this- "day of May 2015, before me,'the undersigned` notary' public,. personally , appeared Donald ' . eddeng, proved'.to ;me through satisfactory evidence of identification, `F which was _v personal a,knowledge of identity,or . : . , to be,the,person whose name is signed on the'preceding or•attached.document,'and ackno`wled ed to me that he g signed it volunt y for its stat ose. SS LISA E.MYCOCK �. — M ar Publi wrreiy the La Office of Patricia J.Mello,P.C. Mass nse , ' s Commission Explres.Ma� M th Road,Mashpee,•MA 02649 508-477-0267 ~ a, M ' SPKLEH , > r COMMONWEALTH OF MASSACHUSETTS Barnstable, ss On this day jof May 2015, before_ me; the undersigned notary 'public, personally appeared Theo . Hedderig, proved to me through satisfactory evidence of identification, which was _ personal knowledge of identity' or , to-be the ,person whose name is Wed on the preceding or attached document, and acknowledged to me that he sign i ily for its stated purpose. ` LISA E.MYCOCK Notary Public Massachusetts Commission Expires Mar 10.2017 , Prepared by the Law Office of Patricia J.Mello,P.C. ` 766 Falmouth Road,Mashpee,MA 02649 508-477-0267 g 5 BARNSTABLE REGISTRY OF DEEDS sPxLEx Y John F. Meade, Register �p>i/Mmo�ic�ecrr�� 4 Office of Consumer Affairs and Business Regulation w 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement CoiltraG:�or Registration ..-.::.:::. , Registration: 177365 i....... =_.�.. _l=�:::,_:' :": Type: LLC Expiration: 11/25/2015 Tr# 247073 TYLER AND TRAYWICK BUILDING, GO: LL'.C-- }: '=: SANFORD TYLER P.O. BOX 216 WEST HYANNISPORT, MA 02672 :._ v.`Update Address and return card.Marls reason for change. SCA 1 ij 20M-05/11 Address Renewal ❑ Employment � Lost Carr • // � V/2e �9YL91C6)LCOBCLLC/2 o1�(/CcrJJc,c/2uJeeed Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: registration: %177365 Type: Office of Consumer Affairs and Business Regulation xpiration: ;;_11l25/201.5. LLC 10 Park Plaza-Suite 5170 i= Boston,MA 02116 TYLER AND TRAYWICK BUILDING'CO LLC SANFORD TYLER 67 CRANBERRY LANE WEST HYANNISPORT, MA 02672 Undersecretary. Not valid ithout signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor � ' Licenser CS-060982 "— SANFORD R TYLR F �• ` PO BOX 80 W HYANNISPORT a r _ , a !t. , ly . Expiration Commissioner. 10/12/2016 w • The�Colare,maniverxlth tf�fiissrreJr3rsetl[s �-� Ip+rrranerrt ajfIndus&ial Accidents Office of luvesfiga ions 660 Washington Street' Boston H4 92311 wmv.rria-,mgov/diaa Workers' Compensation Insurance?'.davit:Budlders/CcmtractnrslEtectricianslPhimbers Applicant Information Please Print L.ea_ Name{B h,v,lFndiyidaal): 1 L LC Addre4s:T1�L-x citylStatelZip=l�� ojaei: a 8 Are yen an employer?Cdeck the ar. .rapr ate box: ) Type of projeet(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and 1 6_ []Idew conshuc-tion employees(fag andforpart-fine).* havehiredthe sub-contractors 7 d'I eta a sole prnpiietaF or part¢er- listed on the attached sheet �- ❑Remodeling ship and have no employees These sub-contractors ha-re g- ❑Demolition -working forme iti any capacity. employees and have weikers' 9. ❑Budding.,additiog o worlmm,comp-.in insurance comp.insurance rewired] ' 5. El Weare a corporation apd its 1 a.❑Electrical repairs or additions 3-❑ I am a hon=w=doing.all work officers gave exercised iitek 1 f_❑Plumbing repairs or additions •sel€ o workers' right of wtraptionp�iwfGL 12.0 Roof insurance ce required,]F P c-152,§1(4),arid.we have noemp repairs to o workers' 13,❑Other comp.insurance required.] 'may applk3m t=chedls boa#-1 mmst also Shout the section belowshowing f5eir wo$seis'campmsation policy informsfiau Himeowners who submit this afndsvit m&c3um they amdomg afl uva anal Shea hire outside canxacmrs umst submits new affidavit indicating such -*Conacmrs ihvi rhP,rtl this box must attached an addideml sheet showiug the asme of the W)-c�and state whether ar not Those erdfies have empiayees. IfthesuU-canntrsaas have employees,ffeymu provided[wwkers romp.palicy numb er I run act er�iplol ar t3iat ispr�o td rrg.ttfarlrers'caul rrsrdiarE irrsarrairce for trry�av;play*�e� Bdoiv is the po6q and job site is orrrtatir7n. �'ad;0.:TDO S Let CLn Q9- Isis mce Company 1`isiase:. �V z CeS Pfllicy,#car Selfins_Li,_ b� ptiaa Date: Job Site Address: City/S#atel2ig: Azt2ch a copy of the workere compensation policy declaration page(showing the policy member and expiration date). Failure to secure coverage as required under Section.25A of MGL c. 153 can lead to the impositioai of criminal penalties of a fine up to$1,50(-OG andior one-year imprisormuwt,as well as civil Penalties in tine form Of a STOP WGBFL OR=and a fire of up to$254_Q(9 a day against the violator. Be a&ised that a copy of this statmnent may be.forwarded to the Office of Iiwestigations of the DIA for insurance cm-erage veri ffcadt -- ...._ lib Trareby cr. ttrrx r# - s a s of 7icr}'t%at the irl,;formativ+nproi dedahaw is nw'A-nd correct Si Bate:` G �' Phone,- 7 y _ 197- C16 F.a Official use only. Do not write in this areg to be completed by city or town offidirl City or Town: Permit/I.icense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3. City/Town Clerk 4,Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: f ME 1p� * EARNSTABLE, * a 9� "�: ,�� Town of Barnstable prFD MA'I A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 �Y ProP a Owner Must Complete and Sign This Section If Using A Builder I, � �c, ��1�� , as,Owner of the subject property hereby authorizep.�� to act on my behalf, in all matters relative.to work authorized by this building permit application for: 18 AenoP . &A-VgMe (Address of Job) Signature of caner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILESTORMS\building permit forms\EXPRESS.doc ` Revised 040215 Town of Barnstable ;. Regulatory Services FINE tOy,� Richard V.Scali,Director Building Division BARNSPABM ` Tom Perry,Building Commissioner 9� 1639. 200 Main Street, Hyannis,MA 02601 AIEo �A www.town.barnstable.ma.us Office: 508-862-4038 ;. Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street vil e "HOMEOWNER": name home phone# work phone# . CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was ex\esnot nclude owner-occu i dwellin s of six units or less and to allow homeowners to engage an individual for hire whopossess a licejrede,'on ided that the owner acts as su ervisoION OF HOMPerson(s)who owns a parcel of land on which he/ s or intends t which there is,or is intended to be,a one or two- family dwelling,attached or detached structures ao such use an structures. A person who constructs more than one home in a two-year period shall not be consideredweer. Such" er"shall submit to the Building Official-on a form acceptable to the Building Official,that he/she shorisible for alrk performed under the buildin ermit. (Section 109.1.1) „ The undersigned"homeowner"assumes responsibility for comp 'anc with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands T of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with s ' proce ures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be re ed to comply with the State Building Code Section 127.0 Construction Control. - HO OWNER'S EXEMPTION The Code states that: "Any homeowner pe forming work for which a building p mit is required shall be exempt from the provisions of this section(Section 109.1.1 Licensing of construction Supervisors); ovided that if the homeowner engages a person(s)for hire to do such work,that uch Homeowner shall act as supervisor." Many homeowners who use this exemp on are unaware that they are assuming the respon bilities of a supervisor (see Appendix Q,Rules&Regulations for Lace sing Construction Supervisors,Section 2.15) This la \o�f awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. . To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,.that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\ATFILES\FORMS\building permit forms\EXPRESS.doc Revised 040215