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Home My WebLink About0520 SOUTH MAIN STREET I.I RI. ,a',• yA YF n 4 ' "'' �'t .. air`.: .;.. S , '-' � .„',. ..� - ,�..c' �+, � •. S? ..J, t '.-r� � � y``i 'te r M1 t� e it k i m v 11 INSULATION 2('€4 g p 19 �1. 6 KEEP .. "..YMSS 11-14+ SPYAT(OAM (Yf1YHDlD VARY YY R(YL IN(Y4A(N)N C(141NY( 1-800-696-6611 FV' ..Town of Barnstable Regulatory Services Building Division . : . 200 Main tit Hyannis, MA 02601 k Date: Y Dear Building Inspector' Hease accept this Affidavit as documentation that Cape Cod Insulation, Inc. performed &. completed the insulation and weathenzation work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit: application.,A.11 work has been inspected by a certified Building Perfonnance Institute . (BRO inspector. All work preformed meets or exceeds Federal & State Requirements. Property Owner Property Address Village MP'X�� (oAUs �� SMe?N /14, n sT terWIlle IIISLlltltion Installed: Fiberglass Cellulose R-Value Restricted' Unrestricted Ceilings Slopes Flours Walls 66 ( „) ( 13 ) 00 ( ) P!!t. J {Al .� d Sincerely r Hic L Cas, y Jr, President Cod 1 , ulation, Inc. -7 - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 Parcel Application #cyt/ k� Health Division Date Issued y Conservation Division Application Fee J ` Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 02o dr> ,�i�if� _rye Village `'��,, ,�`� Owner 4,J ✓ fZ /.S Address 1 Telephone Permit Request. /2 y-�' G,�,9 s s / G�/��a�� ?2 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District _Flood Plain Groundwater Overlay Project Valuation &'�¢ 6,,PConstruction Type ZgK Lot Size Grandfathered: ❑Yes ❑ No If yes, attaeyupportingydocimentation. D Dwelling Type: Single Family , Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ft No On Old Kings Highway: ❑_Y6 Q�No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other :< Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number,of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use 'APPLICANT INFORMATION ' (BUILDER OR HOMEOWNER) Name e-P Telephone Number5�- Address J f2 A��''�s iz za oe License# /�O Home Improvement Contractor# _/;5 Worker's Compensation #4>CrAOGs�z.SJgd� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE -�®�/� FOR OFFICIAL USE ONLY APPLICATION# �D«ATE_ISSUED� MAP/PARCEL NO. I ADDRESS VILLAGE OWNER i4 DATE OF INSPECTION:. i L)`FOU.,NDATIO.N r;zpH . ,yi:,,E-�u,mE)Ar z�.� — FRAME tk 1NSULATI.O.N i.p sa y uL.A ' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL !, GAS: _ ROUGH FINAL FINAL BUILDING -= :I DATE CLOSED OUT . ASSOCIATION PLAN NO. 06/16/2014 MON 16: 19 FAX 781 237 7455 Foodmark Inc /@002/002 OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at r r J / , t J (Property A dress) e YYA 0 1 S--?.2 (Ppbperty Address) , herebyauthorize lOr/� (Subcon r r) 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 Date ; The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600.Washington Street Boston,MA 02111 www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/'Plumbers Applicant Information Please Print Legibly Name (Business/Organi7ation/Individual): mac, Address: City/State/Zip: fnj 6 }@hone Are you an employer? Check the appropriate box: I am a employer y with 4. I am a general contractor and I Type of project(required): l. �-� employees (full and/or part-time).* have hired the sub-contractors . 6. []New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. F1 Remodeling ship and have no employees These sub-contractors have g_ Demolition working forme in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.: . 9. ❑ Building addition required:] We are a corporation and its 110.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their . � g 11.[I Plumbing repairs or additions myself. (No workers'.comp. right of exemption per MGL 12.[�Roof repairs ' insurance required.]t c. 152, §1(4),and we have no' 3a.[] I am a homeowner actin as a. employees. ' 13.0 Other�� Gk� g [No workers general contractor(refer to#4) comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compcnsation`policy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check:this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comP•policynumber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information, Insurance Company Name: �C! Policy#or Self-ins. Lic.#: y�Gf ,Expiration-Date: Job Site Address:� l 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 c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cents un the pains and penalties of perjury that the information provided above is true and correct Si a 7, Date: Phon #: Z• r 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): L Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person- Phone#• CAPECOD-27 KLIGETT ..P CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 13/2014 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(les)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 Ileu of such endorsement S). PRODUCER CONTACT :ogers&Gray Insurance Agency, Inc, NAME, Barbara DeLawrence I34 Rte 134 PHONE F _ iouth Dennis,MA 02660 IAIc.No xcy— 877 816.2156 _ E•MAII �AIC No: —)� ADD ES ;;bdelawrence ra ers ra .cam '• INSURERS AFFORDING COVERAGE �— INSURER A:Peerless Insurance COm an' — NAICN NS RED I INSURERB:COMMERCE INSURANCE COMPANY Cape Cod Insulation Inc INSURER C:Eyanston Insurance Company jl 18 Reardon Circle INSURER _ CHAR `— — — South Yarmouth, MA o266a RTER INSURANCE GROUP INSURER E: - - %O ERAGES INSURERF; CERTIFICATE NUMBER: ER- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSU RED NIAMOED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS C R;TIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED'HEREIN IS SUBJECT TO ALL THE TERMS, E C USIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY-HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY EFF POLICY EXP x COMMERCIAL GENERAL LIABILITY POLICY NUMBER MIDD/YYYY MMI DIY LIMITS lCLAIMS-MADE L_X'OCCUR CBP8263063 EACH OCCURRENCE Oa101/2014 Oa/0112015 TO -NTT $ 1,000,000 _I�_ __.._.___,•_ PREMISES(Ea occurrencel $ 100,000 MED EXP(Any ona�erson); $ 6,000 G NT AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY _ $ 11000,000 POLICY l_a JECOT LOC GENERAL AGGREGATE $ _2,00.0,000 OTHER ` PRODUCTS•COMPIOP AGG. $' 2,000 O00 AUTOMOBILE LIABILITY $ _! COMBINED SING E LIMIT ANY AUTO�• 1,4MMBCKVMK. - Ea accident $ 11000,000 ( ALL OWNED SCHEDULED 04/01/2014 04/0112015 BODILY INJURY Par person) $AUTOS _X AUTOS HIRED AUTOS X NON-OWNED BODILY INJURY(Par accident) $ AUTOS PROPERTY OAMAGE - - Per acciganl $ -X UMBRELLA LIAR X OCCUR $ EXCESS LIAR CLAIMS-MADE XONJ453514 EACH OCCURRENCE $ 1,000,000 DED X RETENTION 10-000 Oa/01/2014 04/01/2015` AGGREGATE $ WQRI(ERSCOMPENSATION Aggr@gate $ — 10 0 AND EMPLOYERS'LIABILITY YIN ORH ANY PROPRIEI'ORIPARTNERIEXECUTIVE WCA00625904 STAT TE OFFICERIMEMBER EXCLUDED? NIA 06/30/2014 06/30/2015 ------(Mnndslory In NH) E.L.ELEACH ACCIDENT $ 11000,000 II Yos, VT1'"eunder E.L.DISEASE•EA EMPLOYEE $ 1,000,00 DESCRIPTION pF OPERATIONS"slow : I E.L.DISEASE.POLICY LIMIT $ 1,000,000 I I IRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarke Schedule,may be attached If more apace Is required) (erq Compensation Includes Officers or Proprietors. Slot at Insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, I ITIFICATE HOLDER CANCFI I ATION / 0Massachusetts -Departniont of Pyt3blic Safety ,136ard of Building Regulations •nd Standards Construction Supenisot License: CS-100988 nr 1.1ENRY E CASSII)V 8 SHED,ROW WEST YAXtMOC,F111 Expiration Commissioner 11/11/2015 o,lime,ay,6oea,LPL cv - „ Office of Consumer Affairs and Business :Regulation T-- 10 Park Plaza Suite 5170 Boston, MassachLIsetts 02116 Flame Improvement Colt for Registration Registration: 156567 Type: Private Corporation Expiration: 12/15/2Q1�+ T1-� 233831 CAPE COD INSUL_ATION,;INC HENRY CASSIDY t 1 .;. r 18 REARDON CIRCLE : �. __ _ . ._.._.._........._._ _..............._.. CO. YARMOUTH, MA 02664 : ....... .a _-- -- - - ............ Update Address and return curd. Murk reasun for chango. C� Address. eiiewal 1!u to nient f:, 1wtCard•L�'��;`!`(�r./ira�tc�i•r.tac;ctll� c`�c-�Glc;,dctc6ttdellr f .: 0i'licc of Consumer Affairs 8t I3asiness llcgulmio„ License or registration valid for individul Ilse only ; OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ogistration: 153. 67 Typa.; Office of Consumer Affairs and Business 12obulution xpiration: 12/1.5/2014' Private Corporation 10 Parlc Plaza-Suite 5170 ` Boston,IYl•A02116 t(OD INSULA-1-I0N IlY (ASSIDY tA'DON CIRCLE , uti w�J rc' YA NIOUI•H,MA 02664 Aor itot wtudersecrela'Y h �IHE Town of Barnstable *Permit# Expires 6 months from issue date PER I Regulatory Services Fee 7/� �� BARNSTABLE MAM 9� 16 2914 Richard V.SCali,Interim Director QED MA't ` Building Division Tom Perry,CBO,Building Commissioner TOWN OF ARNSTABLE 200 Main Street,Hyannis;MA 02601 www.town.barnstable.ma.us m Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION. RESIDENTIAL ONLY 33 Not Valid without Red X-Press Imprint Map/parcel Number 7Prope Address �l v �c�L O V 1e. Residential Value of Work$ Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address , Contractor's Name Telephone Num 3 �b r o6 56�r' . Home Improvement Contractor License#(if applicable) � O q�� Email: Construction Supervisor's License#(if applicable) _.. 33 "� e Workman's Vimpensation Insurance R Che one: �. f APB — I am a sole proprietor k` i ❑ I am the Homeowner . a ❑ I have Worker's Compensation Insurance TOWN qF13A Insurance Company Name t P Y -_ Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Re t(check box) 'Re-roof(hurricanenailed)(stripping old shingles) All construction debris will be taken to t ❑ -roof(hurricane nailed)(iiot stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value Y' (maximum.35)#of windows #of doors: - ❑ 'Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner jLetter of Permission. A copy of the Home Improvement Contra tors License&Construction Supervisors License is requ ed. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 The.Commonwealth of Massachusetts _ Department of Industrial Accidents Office of Investigations 600 Washington Street _ Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electi cians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: k W Phone Are you an employer?Check the appropriate box: Type of project(required): I.❑ I employer with 4• [] I am a general contractor and I ` have hired the sub-contractors 6. New constriction loyees(full and/or part-time).* . 2. I am a sole proprietor or partner listed on the attached sheet. 7. ❑Remodeling. ship and have no employees These sub-contractors have g• Demolition workingfor me in capacity. employees and have workers' �y aP m'• . t 9. ❑Building addition [No workers'comp.insurance comp.insurance. required:] 5. Q We are a corporation and its I0.0 Electrical repairs or additions officers have exercised their a 1. PI bin repairs or additions. 3.❑ I am a homeowner doing all work ' 0 g P myself [No workers'comp. right of exemption per MGL . 12. in num ce required]t c. 152, §1(4),and we have no 13.�0�eh, employees.[No workers' . comp.insurance required] *Any applicant that checks box it must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. $Canttactors that check this box must attached an additional sheet shouting the name of the sub-contractors and stata 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 insunmce for my employees. Below is the policy and job site information. Insurance CompanyName: Policy#or Self-ins.Lic.#: 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 21A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA:for insurance coverage verification I do h under pains and penalties ofperjury that a information provided. ov is tru and correct Si atta•e:\ 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6. Other Contact Person: Phone#: Town of Barnstable Regulatory Services BAWISUBM MASS �* Thomas F.Geiler,Director 161 1� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder • as Ownet of the subject ptoperty hereby authorize 7&C—VU,VI0eto act on my behal in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and arcnpt . � tF Signature of Ownet tore of Applicant Print Name Print Name Date WORMS-OWNERPERMISSIONPOOLS 62012 xa Town of Barnstable _ Regulatory Services Thomas F.Geiler,Director 39AM 0. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EIMTION Please Print DATE JOB LOCATION: stn et village number -HOMEOWNERS: work hone# - name home phone# p 6URRE2IT MAnING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,Provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Si of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOM OWNEWSEXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often problems, articular) when the homeowner hires unlicensed persons. In this case,oar Board cannot results in serious p ,particularly Supervisor is e actin as proceed against the unlicensed person as it would with a Licensed Supervisor. The homeowner g P ultimately responsible. art of the To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as p 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 formlcertification for use in your community. C:\Users\decoUWAppData\Locai\Microsoftlwmdows\Temporary Internet Files\ContrntoudooklQRE6ZUBYMTRFSS.doc Revised 053012 B'k 28070 P:q 6 �13923 04-04--`014 61 ra 1 =22P nASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 04-04-2014 a 01:22pm MAT: 645 Doc.: 13923 Fee: $1r157.67 Cons: $33MOO.00 BARNSTABLE COUNTY EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Data: 04-04-2014 a 01:22am. QUITCLAIM DEED Ct1T: 645 DocT: 13923 Fee: $913.95 Cons' $338►500.00 I,Marjorie L. Woods,being unmarried and surviving;tenant by the entirety,of 237 North Main Street,South Yarmouth, Massachusetts 02664, for consideration of Three Hundred Thirty-eight Thousand Five Hundred and 00/100 ($338,500.00)Dollars paid, grant to Matthew.Gavris,,Trustee-of the SPRE Cape Realty Trust,under declaration of trust dated April 4, 2014, and recorded herewith, of 10 Edmunds Road;Wellesley, Massachusetts 02481,, with Quitclaim Covenants, - the land,together with the buildings thereon, situated in Barnstable(Centerville),Barnstable County,-Massachusetts,more particularly bounded and described as follows: _ NORTHERLY by land,now or formerly.of Sumner Crosby,et al,two-hundred thirty- one and,00/100 (231.00) feet; EASTERLY by various courses,a total distance of five hundred thirty-six and 73/100(536.73)feet; SOUTHWESTERLY by various courses, a total distance of three hundred and forty-gone and 05/100(341.05)feet,° .. NORTHWESTERLY by land now or formerly of John W. Cunningham et al;.a distance of twenty-seven and 96/100(27.96)feet; WESTERLY . , by a cedar swamp by the edge of the upland,one hundred seventy- seven and 00/100(177.00)feet, more or less;and SOUTHWESTERLY_ by a ridge boarding on said cedar swamp,twenty-one and 00/100 (21.00)feet. Be all of said measurements more or less however otherwise bounded and'described. I Z Bk 28070 Pg7 #13923 The granted premises are hereby conveyed subject to and with the benefit of rights of way, easements and restrictions of record,in so far as the same are now in force and applicable; and so much of the granted premises as is included within the limits of the way over said premises, 10 feet wide, is subject to rights of all persons lawfully entitled thereto in and over the same. The property address is 520 South Main Street, Centerville,MA 02632 For title, see deed recorded with the Barnstable County Registry of Deeds in Book 1679, Page 5. I,Marjorie L. Woods,hereby release to the grantee(s)herein all rights of homestead and other rights I have in and to the herein granted premises. WITNESS my hand and seal this day of Ma r-- ,2014. CS� Marjorie L. Woods COMMONWEALTH OF MASSACHUSETTS Barnstable,ss: On this l�i day ofG�� ,2014,before me,the undersigned notary public,personally appeared Marjorie L. Woods,proved to me through satisfactory evidence of identification,which was 0 r-N 6�,A to be the person whose name is signed on the preceding or attachM document,and ackn lewo dged to me that she signed it voluntarily and for its stated purpose. PHILIP MICHAEL BOUDREAU Notary Public Commonwealth of Massachusetts My Commission Expires JANUARY 12,2018 PhilijfN&c1ra6T Boudreau,Notary Public My Commission Expires: January-12,2018. BARNSTABLE REGISTRY OF DEEDS. III - e�pom�nzoruvea o�Cac�el7y�r Office of Consumer Affairs&Business Regulation License or registration valid for indrvidul use only ,ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to.: e Office of Consumer Affairs and.Business RiiAatiom g e isiration P .: 4 2ii922 '' <• - 10 Park Plaza-Suite 5170 ` zpiration 6/7/2015 Indiwdu :' w Boston,MA 02116 i, Peter.Kenned Y r: �s 1�- .Peter Kennedy �e) S _ i _ x 444 MISTIC DRIVE ' ftIIA.RSTON MILLS, MA 02Q4§- — Undersecretary Not V 'id without sipatuie ' u/ .._ Massachusetts -Department of Public Safet Y Board of Building Regulations.ulations.an d,St andards aids Construction Supervisor . Lice nse:nse: CS-073395I IS PETER J KENNED� 444 MISTIC DR . Marstons Mills MA 0264 e' Expiration Commissioner 11/02/2014-...,I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. Parcel '' Application # ((-),4J //ra Health Division Date Issued �1 Conservation Division �- 1N►^w�.ac��,�►�u�'.r�-� Application Fee Planning Dept. Permit Fee y Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Villag Owner +0 Address 1/l_ Telephone Permit Request l Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District _ Flood Plain Groundwater Overlay _a Project Valuation' Construction Typ Co < :< Lot Size Grandfathered:- ❑Yes ❑ No If yes, attach supporting doc mentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) f Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Hig hway:= ❑Yes 0-No Basement Type: ❑ Full Ja Crawl ❑Walkout ❑ Other , P, Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new ' Half: existing new Number of Bedrooms: existing _n w Total Room Count (not including bath : existing new First.Floor Room Count Heat Type and Fuel: ❑ Gas it ❑ Electric ❑Other Central Air: ❑Yes ;No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ exg ❑ new size Pool: ❑ existing ❑ new size — Barn: ❑ existing' ❑ new size_ Attached garage: existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION ( UILDER OR HOMEOWNER) Name Telephone Number `.X✓D � � � Address � License # C Home Improvement Contractor l0( EmailggWorker's Compensation # ALL CONSTRUCTION +IS RESULTING FROM THIS,PROJECT WILL B TAKEN TO SIGNATU DATE S FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO, ADDRESS VILLAGE OWNER . DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE:CLOSED OUT " i ASSOCIATION PLAN NO. �) t The.Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiomgiidividual): Address: i , L N, V 090 City/State/Zip: , % I�, Phone P0 Are you an employer?Check the appropriate box: Type of project(required): L❑ I em to er with 4• ❑ I am a general contractor and I p y 6. ❑New constriction loyees(fall and/or part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp,insumance comp.insurance$ required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑PI bing repairs or additions myself. [No workers'comp. right of exemption per MGL 12 insurance required.]t c. 152, §1(4),and we have no S employees.[No workers' ran 13. Othe comp.insurance required.] ' *Any.applicant that checks box#1 must also fill out the section below showing their workers compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ' Policy#or Self-ins.Lic.#: 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 c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK-ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I dohV&under pains and peenalties of perjury that t e information provided ov is u andcorreiSi at 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): 1.Board of Health 2.Building Department 3.Cityfrown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: �. 1 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged m'a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment.be deemedto be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with`their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submif multiple permitllicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (Le.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Qfce of Investigations 600 Washington St=t. Boston,MA 02111 Tel,#617-727-49 0 ext 406 or 1-877-MASSAFB Revised 4-24-07 Fax#617-727,7749. WarwMass.govf dia ponvn W(vea&l 02, as Office of ConsumerAffairs.&Business Regulation License or registration valid for individul use only -- E IMPROVEMENT CONTRACTOR _ before the expiration date. If found return to OM eg.-A tion 1�28922 pe Office of Consumer Affairs and.Business Regulation zpiration., 6/7/2f)15 Irdroidu0 Park Paaza Suite 5170 ` �r Bostoni.MA 02116 Peter.Kennedy Peter Kennedy ` kk 444 MISTIC DRIVE MARSTON MILLS MA 0 648" Undersecretary Not v id without signatu;:re t .. R Massachusetts -Department of Public Safety Board of Building Regulations and.Standards y Construction Supervisor License: CS-073395 'PETER J KENNEI��' I 444 MISTIC DR r. "Marstiins Mills MA 02� 4 - � F �..�,:� ✓J `.' Expiration Commissioner 1 1/0 2/2 0 41 i a Town of Barnstable t o Regulatory Services t RARNSTIRT�.R� MASSg Thomas F.Geffer,Director 1639. �a . Buff ding Division Tom Perry,Building Commissioner 200 Main Sheet,Hyamiis,MA 02601 www town.barnstable.maxs Office; 508-862-4038 Fax; 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subjectptopeq- herebp authorize VVIN. to act oa naY b ehal� in all mattets relative to work authorized by this budding p ettnit (Address of Job) Pool fences and alarms are the responsibility of the-applicant. Pools are not°to be filled or utilized before fence is installed and all final inspections are performed and aompted. • Signature of Ownet tore of Applicant. i lV� L�a Vf 11 Print Name Print Name .. - .f Date Q:F0RMs;0WNE"RRIMS1oNpoDL3 612012 G'k - 28070 P:q d ;13923 04-04- 2014 a3 01 =22P MASSACHUSETTS STATE EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 04-04-2014 8 01:22am CtIT: 645 Doc:: 13923 Fee: $1t157.67 Cons: $338Y500.00 BARNSTABLE COUNTY EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Date: 04-04-2014 8 01:22am_ QUITCLAIM DEED Ct1T: 64.5 DocT: 13723 Fee: $913.95 Cons: $333r500.00 I,Marjorie L.Woods,being unmarried and surviving.tenant by-the entirety, of 237 North Main Street, South Yarmouth, Massachusetts 02664, for consideration of Three Hundred Thirty-eight Thousand Five Hundred and 00/100 ($338,500.00)Dollars paid,grant to Matthew Gavris,Trustee of the SPRE Cape Realty Trust,under declaration of trust dated April 4, 2014, and recorded herewith,of 10 Edmunds Road,Wellesley,Massachusetts 02481, with Quitclaim Covenants, the land,together with the buildings thereon, situated in Barnstable(Centerville),Barnstable County, Massachusetts,more.particularly bounded and described as follows: NORTHERLY by land now or formerly of Sumner Crosby,et al,two hundred thirty- one and 00/100(231.00) feet; EASTERLY by various courses, a total distance of five hundred thirty-six and 73/100 (536.73)feet; SOUTHWESTERLY by various courses, a total distance of three hundred and forty-one and 05/100(341.05)feet; NORTHWESTERLY by land now or formerly of John W. Cunningham et al, a distance of twenty-seven and 96/100(27.96) feet; WESTERLY by a cedar swamp by the edge of the upland, one hundred seventy- seven and 00/100 (177.00)feet,more or less;and i SOUTHWESTERLY by`a ridge boarding on said cedar swamp,twenty-one and 00/100 '(21.00)feet. Be all of said measurements more or less however otherwise bounded and described. Z Bk 28070 Pg7 #13923 The granted premises are hereby conveyed subject to and with the benefit of rights of way, easements and restrictions of record,in so far as the same are now in force and applicable; and so much of the granted premises as is included within the limits of the way over said premises, 10 feet wide, is subject to rights of all persons lawfully entitled thereto in and over the same. The property address is 520 South Main Street, Centerville,MA 02632 For title, see deed recorded with the Barnstable County Registry of Deeds in-Book 1679, Page 5. I,Marjorie L. Woods,hereby release to the grantee(s)herein all rights of homestead and other rights I have in and to the herein granted premises. WITNESS my hand,and sea]this. C day of ha.rcL ,2014. Marjorie L. Woods COMMONWEALTH OF MASSACHUSETTS. Barnstable, ss: { On this day*of ,2014, before me,the undersigned notary public,personally appeared Marjorie L. Woods,proved to me through satisfactory evidence of identification,.which was R r Cs 6 to be the person whose name is signed on the preceding or attachet document,and ackn d ed to me that she signed it voluntarily and for its stated.purpose. PHILIP MICHAEL BOUDREAtI Notary Public Commonwealth of Massachusetts My Commission Expires JANUARY 12,2618 Phili ael Boudreau,Notary Public My Commission Expires: January 12,2018 BARNSTABLE REGISTRY OF DEEDS 01,E 1 �� ' '�. AA J _ S ' .. 1 3 k SCAL E ! 1NCH;mDATE �- MASS SAY SURVEY INC.. NEWTGN , MASS. Ast) 20 ` o: '4Auk s-v�-j -37 ur n, =: IN c z� 'l - L ',*?WS7?WLZ,1 scAt.E rNCM= C` DATE'_ AM-kW, MASS 8'AY SUR1[EX INC,. NEWTON v MASS, 617-797=734 2 REFERENCEi RECO06t. .N THE COUNTY REGISTRY- OF DEEDS. PLAN.-BY :PLAN GOOK PLAN- PAGE. -- oATEDAtic�? -0 _ i HEREBY :CERT:{FY THAT THE 601-01,N.�MON Tif1S PLAN ARE .LOCATED: ON THE GR:OUN:O.AS SHOWN, ANO CONfO44M 'M THE ZONING LAWS OF THE 1. GEkTIFY THAT :THIS 'LOCUS IS'.NOT WITHIN THE FLOOD HAZARD -ZONE AS DELtyEATEfl ON MAP COMMUNITY PANEL ✓ O f 6016 TN.{;S PLAN WA$ .N)OT MA FROM 4N INSTRUMENT SURVEY AND IS FOR THE. USE OF THE SANk ONLY; NOT TO BE USED FOR FENC.ES,WALLS, ETC. axi .,I s 1 ram_ - -- - --- -- - t -��. -• Jl' li cj h i