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I I I I � . �I I . � I I" 1, I I� , , , I I I I I I I I I . ,� , I� � , �I I � I , � I I I I � I I � � ,, I I I �, � I I.,, . I I . � I , I I I � .� I I `, �I I I�, �I 11 I I I . \1 I Town of BarnstableBuilding PostA:This CardSo That it is V�s�ble-From the Street jApproved'Plans;Must be.Reta�ned on Job and"this Card Mus be Kept 6ARAt3'CAf3LY, ,, r x 5S" Permit t6,19v MAss �` Posted Untilfmal Inspection Has Been Made s +°` Where a Certificate of Occu anc'>IS Ke u;ired;=such Bu ldI �shaU Not:be Occupied until a Final Inspectiorr has been-,made ::��. .._ .u,pn,1. p.: ,$ �_.". . � A, b� ,_, Permit NO. B-18-3816 Applicant Name: STEPHEN M CHILDS Approvals Date Issued: 11/19/2018 Current Use: Structure Permit Type: Building-Smoke Detector-Fire Alarm Dection . Expiration Date: 05/19/2019 Foundation: System• Map/Lot 169-088 Zoning District: RC Sheathing Location: 100 TARAMAC ROAD,CENTERVILLE Contractor"Name: -.,STEPHEN M,CHILDS Framing: 1 Owner on Record: MILITARY WARRIORS SUPPORT 'Con 32325 2 Address: 211 N LOOP 1604 EAST SUITE 250 Est Pro ect Cost: $0.00 J Chimney: SAN ANTONIO,TX 78232 Permit Fee: $35.00 Description: installed 4 smoke alarms,for upgrade in existing house, 2 t - Insulation: S 35.00 photoelectric,2 combo co smokes 5' F..ee Paid Final: Date 11/19/2018 0 /g Project Review Req: TWO BEDROOM. UNFINISHED BASEMENT Plumbing/Gas Rough Plumbing: _ _ - •r BuildingOfficial Final Plumbing: r t , a Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by''h s permit is commenced within six Yr onths,after issuance. Final Gas: All work authorized by this permit shall conform to the approved application"and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street,,,,or:road and'shall be maintained open for public inspection for the entire duration of the Electrical work until the completion of the same. `A Service: The Certificate of Occupancy will not be issued until all applicable signatures bythe Building and`;Fire Officials are'prouided on this permit. Rough: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing Final: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: 4G' PT too._- 1 Application Number............................. ...... = � � NOV19HIS PCmzitFee........................................Oth a Fee........................ NAM TOWN OF SARNSTAGL TotalFee Paid............................................................... ...... TOWN OF BARNSTABLE Pm=&Appr6val by • • cc BUILDING PERMIT MV.... ...� .. ..............parcel.. ..... -__�}. .o ... ........... .. 1 . APPLICATIONs - Section 1 - Owner's Information and Project Location Project Address �G � 74�1: oZq lw,,,4 c ' Vfflage � ny�R vi Owners Name Owners Legal Address Cm, State d Zip 24 3-'�L Owners Cell# E-mail ~ F— Section 2--Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ ercial Structure under 35,000 cubic feet CSe/Two Family Dwelling Section 3-Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ElDemo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty El Fire Alarm Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition . ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify Section 4 -Work Description wow- � S Tstct muLgtrd 71 t=8 Application Number.................................................... Section 5—Detail Cost of Proposed Construction ` Square Footage of Project Age of Structure _ Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms(proposed) 4 110 MPH Wind Zone Compliance Method 0 MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring E] Oil Tank Storage (� Smoke Detectors ❑ Plumbing [ Gas ! . ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: 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 Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed 3 Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes. ❑ No F Last imdated 2/9201 S r BIKE Town of Barnstable Building Department Services 33AMSMAstp. ` Brian Florence, CBO MASS Ea 63C9. k � Buading Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 509-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section - If Using A Builder as Owner of the subject property . hereby authorize _� J/4r /,�-,o r to act on my behalf; in all matters relative to-work authorized by this building permit application for. (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 accepted. . 01 igna er Signature of Applicant Print Name Print Name Date Q:FORMS:ovniaPERMISSIONPOOLS Rev:08/16/17 Town of Barnstable Building ]Department Services Brian Florence,CBO o Building Commissioner 200 Main Street, Hyannis,MA 02601 MAM www.town.barnstable.ma.us 165 Office: 508-862-4 03 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEAffnON Pleue Print DATE: JOB LOCATION: number street. vMage "HOMEOWNER": nsme home phone# work phone# CURRENT MAILING ADDRESS: city/towaXxtma state zip code The cuaent exemption for"homeowners'"was chide owner-occupied dwell�ncs of six units or less and to allow homeowners to engage an individual for hire wossess a license,provided that the owner acts as supervisor.ON OFHOMEOWNER Person(s)who owns a parcel of land on which s or intends to reside,on which there is,or is intended to be,a one or two- famnly dwelling,attached or detached structuresuch use and/or farm structures. A person who constructs more than.one home in a two-year period shall not be consideer. Such"homeowner.shall submit to the Building.Official on a form acceptable to the Building Official,that he/sheble for all such work errformed under the buildin ermit (Section 109.1.1) The undersigned"homeowner",assumes re onsibility for complian e with the State Building Code and other applicable codes, bylaws,rules and r&gulah"'s. p The undersigned"homeowner"certifie he/she understands the To f Bamstable Building Department minimum inspection procedures and requirements and that: she will comply with said proce s and requirements. Signature of Homeowner Approval of Building Official Dote: Three-family dwe gs ebntaining 35,000,cabic feet or larger will be re ' ed to comply with the State Building Code Section 127.0 Construction Contro HOMEOWNER'S ENZAI riON The Code states that: " homeowner performing work for which a bail ' g permit is required sliaIl be exempt from the provisions of this section action 109.1.1- causing 6€a 'on ors);provided that if the homeowner engages a person(s)for hire to do snc • at such Homeowner shall act as supervisor." Many homeowners who.use this exemption are unaware that they are assuming•the responsibilities of a supervisor (see Appendix Q,Rules*&Regulations for Licensing Construction Supervisors,Section 2.15),This lack of awareness.often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against'the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part.of the Permit certify that helshe understands the responsibilities of a Supervisor.'On the last page a homeowner rtrfy application,that the ho this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFMES\FORMS\building permit fo=\EXPRESS.doc 08/16/17 r Tor/oo t %mac 94, een4crV,� Vd J x L ,3 SMOK` DETECTORS REVIEWED ol U DIN EPT JDE l� x5 FIE EPARTMENT'9TH SIGNb URES kRE f crE" '^° °ERMITTING 4 . t~' C �y ON �An `l 00 r eel, � a f The Commonwealth of Massachusetts Department of IndustrialAccidents 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/Organization/Individual): Q �/ Address: /40 Chef City/State/Zip: G ' <_ �' Phone#: .2 h'G Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I e ployees(full and/or part-time).* have hired the sub-contractors 6. New construction 2.[lam a sole proprietor or partner- listed on the attached sheet. 7.'[.remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'comp.insurance comp.insurance.: required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their - I I.El 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 employees. [No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors 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 thepolicy and job site information. Insurance Company Name: � �/� e 1 _ Policy#or Self-ins.Lie.#: 4 j a Y,:[ Expiration Date: e Job Site Address:L!/l1 ,�� dC ',rtid�/ City/State/Zip: G 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 certify un er the pants andpenalties of perjury that the information provided above is true and correct. Si afore: , - 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.Plumbing Inspector 6.Other Contact Person: Phone#: 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 in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance 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-contractor(s)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 permittlicense number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense 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 (i.e.a dog license or permit to burn 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 Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia Application Number........................................... Section 9—.Construction Supervisor Ik NameY419,4e_4 Cy j L TelephoneNumber Address 4/ City_� State zipGh License Number License Type Expiration Date. w Contractors Email Cal" Cell# 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 reqairepy 780 CUR and the Town of Barnstable.Attach"a copy of your license. Signature _ - - Date r Section.10 Home Improvement Contractor Name Telephone Number Address City State Tip ' Registration Number Expiration Date I understand my responsu under the rales 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 CMR and the Town of Barnstable.Attach a copy of your H.LC... Signature Date Section 11—Home Owners License Exemption � Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the isles 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. t Signature Date APPLICANT SIGNATURE Signature Date Print Name Telephone Number S d`P E-mail permit to: � �� c�,��1' S ,�T/• 'Ieej lVd T e.w•....A.w.A.�rnnnio i Section 12 —Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required ❑ Fire Deem tnent _ i 1 Conservation ❑ For commercial work,please take your plans directly to the fire department for approvaL _ 1 Section 13 —Owner's Authorization L , as Owner of the-subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) ,1 Signature of Owner date Print Name _ l I r a 4 ' r r Last undated:2/9/2018 I Town of Barnstable U111I1 g PostThis Card So Thatrtis Visible From the Street Approuetl,,Plans Must be^Retained*onlJob and;this Card Must be Kept z ,,: Posted Until Final Ins ect�on Has Been Made �� Permit 1639.R �,: F p i t ,. .:�.f x" � a :.,, i ermit Wherea�Certificate of Occupancy is Required,swch Building shall NotbeOccupied,u,ntil a FinalInspecUon has been made � ,...,...�.. ':< _,,,.....a.».,�..,...»..;bpat;: ......„..�.�. ..,:�.c...N.-..�.....P3�'�... a�..�..,._«,,..,�«...�.. e..........�,e.,�,�a. �,�,«�.§�°....:�.»»ram.-..o...�.,.�-,.,:M�.m. � .,,,�,-:a,....a...�.�.n..:.�,,..,,�as�.::.�..�,�"..-«...��F Permit No. B-18-2409 Applicant Name: SUNRISE RESTORATION COMPANY INC. Approvals Date Issued: 08/13/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 02/13/2019 Foundation: Residential Map/Lot 169-088 . Zoning District: RC Sheathing: Location: 100 TARAMAC ROAD,CENTERVILLE r 5 _ Contractor'Name. .SUNRISE RESTORATION Framing: 1 Owner on Record: MILITARY WARRIORS SUPPORT i `COMPANY INC. 2 Address: 211 N LOOP 1604 EAST SUITE 250 - Contractor�Llcense 1903,52 12 Chimney: SAN ANTONIO,TX 78232 € m EsWProject Cost: $30,000.00 i Insulation: Description: replace insulation,drywall,trim and flooring.' Permit Fee: $203.00 L 411F Project Review Req: gFee Paid`. $203.00 Final: Dates 8/13/2018 r•. Plumbing/Gas c Rough Plumbing: Final Plumbing: Building Official Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months;after issuance. All work authorized by this permit shall conform to the approved application and theJ"rapproved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures�shal(a in compliance with the local zorong by laws and codes. This permit shall be displayed in a location clearly visible from access ,.road,,,a shall be maintained open for public mspectiojn for the entire duration of the work until the completion of the same. a Electrical Y Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire "are provided on,this permit. r Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Perso s con cting with unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). Fire Department ccl Final: Building plans are to be available on site Cam. All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT .. . ................�......... c Appli�ioarhmiber.. ,.. ......... .4 * # . r � + r a Permit Fee........P05....06 ....:............Other Fee.................:...... 03 BUILDING DEPT. .....: ..................... ...... JU L 25 2018 Total Fee Paid............................................ TOWN OFt �► � - -�'W. . .-......OIL.:�.! r S`�� 3 Permit Approval by..:... .. .......... BUILDINGPERMIT Mv...:............................ Pam.......... ....._...................... APPLICATION Section I— Owner's Information and Project.Location Project Address f ® Wage V a �nOwners Name c � Owners Legal Address75 T City h n State TT zip S ✓�- � Owners Cell# 1"I + / Rb — E-mail E,w,Q W-'AI(PAAn SIL 11 S Section 2—Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet ❑ ' Commercial Structure under 35,000 cubic feet # ErSingie/Two Family Dwelling i Section 3—Type of Permit New Construction ❑ Move/Relocate :❑ Accessory Structure ❑ Change of use ❑ Do/(enure structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment E] Sprinkler System ❑ Addition. ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ hsulatio t e Other—Specify o'Z- Section 4 -Work Description - Tact m,dated:2/9/201 S r , Application Number.................................................. 7 Section 5—Detail Cost of Proposed Construction c� S Footage of Project P �'e � Ject Age of Structure Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wmd Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics 4; ['Wiring ❑ Oil Tank Storage Ea-Smoke Detectors ❑Plumbing -, [v�Gas ❑ Fire Suppression Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private 1 Sewage Disposal ❑ Municipal '12"On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes BNo Section 7—Flood,Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No E' Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No 9 i Last wdated_2J92019 t 4 t 7` S p1 d ,t . �vV • A IL on a . I Office of Consumer-Affairs and Business Regulation, One Ashburton Place- Suite 1301 Boston., Massachusetts 02108, Home Improvement'Contractor Registration Type Corporation " Registration 1W0 52 SUNRISE RESTORATION.COMPANY INC' / ff--.4 E (ration¢ 01/18/2020 P.O.box-8 f _- xP SANDWICH,.MA s02537. t { 1 Y ki M e seni_C,: zani-ns,ilf Update Address and Return Card. - OMce',of Consumer Affairs&Buslness Regulation HOME IMPROVEMENT CONTRACTOR Registiation.valid for individual use-.only TYPE:.Corooration before the expiration date. N found return`to: Reaistratlon Expiration Office of Consurner Affairs and Business Regulation 190352 01/18/2020 10 Park Plaza-Suite 5170 SUNRISE RESTORATION COMPANY INC. Boston,MA 02116 e- W ILLIAM FEDER 480.ROUTE 6A SANDWICH,MA 02537� t valid Undersecreiary O, Without SlarlatUCe i Commonwealth of Massachusetts �p Division of Professional Licensure Board of Building Regulations and:Standards Gons#roc't"on%up?rviSO GS-105323 Spires: 03l1412020 WILLIAM.M FEDEt2 r } 24 PARRISH WAY ; WEST BARNSTABLE MA`0266fll ` Commissio:ner Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,0.00 cubic feet(991 cubic meters)of enclosed space. Failure to possess a.current edition of the Massachusetts State Building Code'is.cause for revocation of this license.. For information about this license CaID(617)727-3200 or visit www.mass.gov/dpl I The Commonwealth,of Massachusetts Department of IndustrialAccidents 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/Organization/Individual): Address: qChu `E z5 # a � � 3 �� 7-7 City/State/Zip: c9 c 1M Phone#: 5 Are you an employer?Check the appropriate bog: Type of project(required): 1.L� 1 am a employer with 4. ❑ I am a general contractor and I 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. ❑Remodeling ship and have no employees These sub-contractors have g• ❑Demolition workingfor me in an capacity. employees and have workers' Y P t3'• t 9. ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their. 11.❑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 employees. [No workers' 13.❑Other_ ce comp.insurance required.] - *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors 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. am an employer that is providing workers'compensation insurance for my employees Below is thepolicy and job site information. II Insurance Company Name: Policy#or Self-ins.Lic.#: ��ZZ / l0 '-N3 J Expiration Date: Job Site Address:6-0 vv.tL t City/State/Zip: � 0 3 i Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ' Investigations of the DIA for insurance coverage verification. I do hereby certify under,* penalties of perjury that the information provided above is true and correct. Si afore: Date: Phone#: 0 e -7 lD 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.Plumbing Inspector 6.Other Contact Person: Phone#: 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 in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." s MGL chapter 152, §25C(6)also states that."every state or local licensing agency shall withhold the issuance or renewal"of a license or permit to operate a business or to constrict 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 permitllicense number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town 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 (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice 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 Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www.mass.govfdia DocuSign Envelope ID:-4AO6D29D•D2AF-4A98-8347-E8CF3COA6CBA Agreement Between Owner and Sunrise Restoration`Company; Inc. This AGREEMENT is made as of the day.of _2018 BETWEEN Military Warriors Support Foundatioiifor property Located At: 100 Taramac Road,Centerville,MA.02632 andSunrise Restoration Company,Inc.:480 Route 6A,East Sandwich,MA 02537 Federal ID#27-4682573 HIC Registration#19.0352Expration January18th,2020 CSL License#105323 Expiration 03/14/18: The Project is: Complete all repairs at propertyper Scope approved by the insurance company. The Owner and Sunrise Restoratio n Company,inc.,agree as set forth below. ARTICLE 1 THE CONTRACT DOCUMENTS The Contract Documents consist of this Agreement,the Scope of Work attached hereto as Exhibit A,The Approved Insurance Company Estimate. addenda issued prior to execution of this Agreement,other documents listed in Ihis Agreement.and Modifications issued after execution of this Agreement.The'Coniract represents the entire and integrated agreement between the parties hereto and supersedes prior negotiations,representations or agreements, either written or oral. Contractor shall prepare detailed estimate's for any items that were not accounted for in the original I Insurance company estimates. (These estimates shall be submitted to the insurance company in the form j of al Supplemental Claim. Contractor agrees to complete the work included in the supplemental claim including all code upgrade work for the amount agreed upon with the insurance company. Upon the owner's receipt of funds regarding a supplemental claim(s),these funds shall be due and payable to the Contractor. ARTICLE 2 THE WORK OF THIS CONTRACT Sunrise Restoration Company,Inc.,shall execute the entire Work described in the Contract Documents, except to the extent specifically indicated in the Contract Documents to be the responsibility of others or excluded on the Scope of Work attached hereto as Exhibit ARTICLE 3 DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION 3.1 The date of commencement is the date from which the Contract Time of Paragraph 3.2 is measured, and shall be the date the first building disbursements are made. 3.2 Sunrise Restoration Coppany,Inc.,shall use best efforts tO achieve Substantial Completion of the entire Work not later than t 9 WA pending favorable weather conditions,no unforeseen conditions, availability of and access to work areas,availability of Owner-selected or furnished items and various decisions made by Owner such as for cabinets and paint color--subject to adjustments of this Contract Time as provided in the Contract Documents.The actual dates that construction will commence and be completed may vary due to:the time required to apply for and obtain necessary permits;delay caused due to necessary inspections;delays in the schedule of work crews;the presence of hidden conditions or necessary additional work discovered during construction;delays in the receipt of equipment and/or i DocuSign Envelope ID:4AO6D29D-D2AF-4A98-8347-E8CF3COA6CBA materials which must be.ordered.and/or delivered to the.site-acts of God;weather;strike:labor disputes; and other causes beyond the controlof Sunrise Restoration Company,Inc.,," 3.3 The Owner hereby acknowledges 8 agrees that the scheduling dates are approximate and that such delays that are not avoidable by Sunrise Restoration Company,Inc:,shall not be considered as violations of this Contract.The Owner further hereby acknowledges and agrees that in certain repair and remodeling work,the demolition of portions of the preexisting structure may reveal additional defects, conditions,or the need for additional work which must be repaired,altered or carried out such in order to commence or to complete the work described under this Contract.In such case(s),the Owner agrees that the duration of the work and the scheduled date of completion may differ from the dates contained in this Contract and that such variation which is not avoidable by Sunrise Restoration Company,Inc.,shall not be considered to be a violation of this Contract: 14 Sunrise.Restoration.Company,Inc.,agrees that when such delays as referenced above become .known.to Sunrise Restoration.Company,Inc.,Sunrise Restoration Company,Inc.,will give the Owner reasonable notice of same: ARTICLE-4 CONTRACT SUM . 4.1 The Owner shall pay Sunrise Restoration Company,Inc.,in current funds for Sunrise Restoration Company,Inc.'s performance of the Contract allReplacement Cost Amounts as described in the Insurance.Company Estimates and Supplemental Claims including the Depreciated Amount,the Depreciation Holdback;Overhead and Profit from the claim and for all its subcontractors and Owner's Insurance Deductible.Owner will also be responsible for the cost to repair or replace the item that failed unless included in the payment from the insurance company,All these funds constitute the Contract Sum and will be added to this document here$ when the numbers are settled with the insurance company.This final number is subject to additions and deductions as provided in the Contract Documents. 4.2 The Owner may request changes,additions and deletions to the Scope of the Work which shall only be effective in the event agreed to by Sunrise Restoration Company,Inc.When such changes,additions and/or deletions result in a net increase in the Total Contract Sum,such increase shall be due upon commencement of the change,addition and/or deletion. ARTICLE 5 DEPOSITS AND PROGRESS,PAYMENTS 5.9 The:Owner.shall paythe balance of the Total Contract sum as follows- Due,as funds are distributed from insurance company. ARTICLE 6 TERMINATION OR SUSPENSION 6.1The Work may be suspended by the Owner only upon the written approval of Sunrise Restoration Company,Inc, ARTICLE:? MISCELLANEOUS PROVISIONS p 7.1 It is agreed and understood that payments due and unpaid under the Contract shall bear interest from the date payment is due at 1%per month(12%per year).In addition,to the fullest extent allowed by law, the.Owner agrees that in the event that Sunrise Restoration Company,Inc.,is forced to engage legal counsel,to enforce any of the provisions of the Contract Documents,including but not limited to the right to payment,Sunrise Restoration Company;Inc.,shall be entitled to receive reimbursement of its DocuSign Envelope ID;4AO6D29D-D2AFAA98-8347.E8CF3COA6CBA reasonable legal fees from the Owner.Such legal fees shall be added to any amounts otherwise due under this agreement. 7.2 Sunrise Restoration Company,Inc.shall apply for and obtain all necessary construction related i permits.If the Owner obtains his own construction,related permits for the work described under this Contract,the Owner may be relinquishcertain rights otherwise available by law. 7.3 Certain home improvement work(i.e.,additions,garages,porches,etc.)may require other permits including,but not limitedto:Variances and Special Permits under Zoning By-laws through the Board of Appeals,Board of Health Permits for expansion of sewage disposal system,Conservation Commission for an Order of Conditions,etc.Such permits,which may require non-construction related engineering, technical or legal representation for or on behalf of the Owner,shall be the sole responsibility of the Owner. 7.4 CLAIMS BY THE OWNER IN WRITING.All claims for alleged losses damages,adjustments,repairs, I replacements,refunds and warranty work shall be.made by the Owner,in writing,and mailed by postage prepaid first class mail to Sunrise Restoration Company,Inc.,at Sunrise Restoration Company,Inc.'s regular business address,with thirty(30)days of the discovery of the issue or condition giving rise to same.To the fullest extent allowed by law,it is agreed and understood that compliance with this section 1)shall be considered a material part of this Contract,2)a CONDITION PRECEDENT to the Owner's right to recover such for any such losses,damages,-adjustments,repair,replacement,refunds and warranty work and 3)shall be an absolute bar the Owner's right to recovery for such losses,damages, adjustments,repairs,replacements,refunds and warranty work. ± 7.5 The failure of Sunrise Restoration Company,Inc.,to insist upon the strict enforcement of any terms.or # rights under thisContract shall not be deemed a waiver of such term or right. I 7.6 The Parties acknowledge that the form,substance,{ content,and notices.contained imthis Contract are intended to comply with the applicable portions of Massachusetts General Laws,and regulations promulgated thereunto.In theevent of any instance of noncompliance,such portion not in compliance shall be read and interpreted to the fullestextent possible to be in compliance with the law. 7.7 It is agreed and understood that any dispute,disagreement,claim or controversy concerning or arising out of this contract,the work and/or the formation of this contract will be subject to mediation before a neutral to be.agreed upon by the parties or to be appointed American Arbitration Association pursuant to the Construction Industry Rules and Mediation Procedures then in effect in the event no agreement on a neutral is made within thirty(30)days of written demand and that,the good faith completion of such mediation shall be a CONDITION PRECEDENT to the ' Jurisdiction any arbitrator or any count to hear same(unless such filing is necessitated by a statutory deadline or statute oflimitations;in which case it is agreed and understood that such proceeding so filed shall be stayed by agreement,otherwise to be summarily dismissed upon request of the non-filing party). € 7.8 To the fullest extent allowed by law,the Contractor and the Customer agree that they will keep the substance and subject matter of any dispute or disagreement as may arise between them completely confidential and that neither will disparage or otherwise make any negative comments about other in any I public or private forum.Nothing herein shall be construed as limiting what a party or its representative may advocate or disclose in connection with any mediation,arbitration or in=court proceeding to which 1 they are both parties,or,in connection with a properly issued subpoena as might be served upon either party in connection with a matter in which they are riot both a party.In the event that such a subpoena is [ served,the recipient shall give the other party prompt written notice of same upon receipt. ( 7.9 The Owner acknowledges that by signing this.Contract,the Owner has.read and understands this. Contract and has had the opportunity,to the extent desired,to consult with legal counsel of the Owner's choosing.Accordingly,to the fullest extent allowed by law;the Parties acknowledge that the rule of contract interpretation requiring the language of this Contract to be.construed against.the drafter shall not apply. 1 ..-..__......._.. �. DocuSign Envelope ID:4AO6D29D•D2AF•4A98-8347-EBCF3COA6CBA 7.10 Provided.that the Owner has made full payment as called for hereinj Sunrise Restoration Company,, Inc.,hereby warranties.that its work shall be free from substantive,defects for a period of 1 yearfollowing substantial completion of the work.This warranty does not cover materials supplied by the.Owner,items, for which the Owner has received a manufacturers or suppliers warranty,normal wear and tear from use, misuse by the Owner or its agents,or issues arising in the event that the Owner hires others to:perform repairs or maintenance on the work. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK.SPACES OWNER(S) Sunrise Restoration Company,'Inc. Or Authorized Owner Representative Authorized Representative. .Co usleneg ey: FdfR51Rp('p]Se).. 4/6/2018 Date: Date. All Contractors&Subcontractors engaged in Residential(Home Improvement)Contracting,'unless, specifically exempt from registration by provisions of the Massachusetts General Laws,must be registered with the Commonwealth of Massachusetts.Inquiries about registration and status should be made to: Office of Consumer.Affairs:and Business Regulation Ten Park Plaza;Suite 5170,Boston MA 02116(617)973-8700 a 1 _ AC"REP® CERTIFICATE OF LIABILITY DATE(MM/DD/YYYY) `..� ITY INSURANCE 07/23/2018 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 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). PRODUCERCONT - - 'NAMEACT EIIySIa MOreIS - THE INSURANCE AGENCY OF CAPE COD INC PHONE FAX N Ext (50$)888 2766 A/C No: E-MAIL P 0 BOX 1053 ADDRESS: ellysia@insuranceofcapecod.com SANDWICH MA 02563 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:,AMERICAN ZURICH INSURANCE COMPANY _ 40142 � - - • INSURER B: - SUNRISE RESTORATION COMPANY INC INSURERC: INSURER D: P 0 BOX 802 INSURER E: EAST SANDWICH MA 02537 INSURERF: COVERAGES CERTIFICATE NUMBER: 294606 REVISION NUMBER: -THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR - ADDL SUBR POLICYEFF TYPE OF INSURANCE POLICY EXP LTR . Jhm POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS_ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE DOCCUR - - DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ NIA PERSONAL B ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO-OTHER: JECT ❑LOC PRODUCTS-COMP/OP AGG $ I AUTOMOBILE LIABILITY - _ COMBINED SINGLE LIMIT $ Ea accident ANY AUTO `ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS N/A BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE - AUTOS Per accident $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ DED RETENTION$ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY Y/N X STATUTE �RH - ANYPROPRIETOR/PARTNER/EXECUTIVE - a• ' A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 6ZZUB2E96443717 11/29/2017 11/29/2018 E.L.EACH ACCIDENT '$ 100,000 (Mandatory in NH) If yes,describe under - E.L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 - N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) - Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,-no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER` CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Barnstable Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE '. Hyannis MA 02601 I,.- Daniel M.Cro, ey,CPCU,Vice President-Residual Market-' WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD t Application Number........................ Section 9-.Construction Supervisor Name Telephone Number Address `{c : Q6L rY° j. City LA, rr�,State Tap o D.-C 6 8 d License Number CS 1 o 5 3 2 3 License Type CS Expiration Date Contractors Email �p�Q-rec '(� Cry C.L c'�. Vj_e,�— Cell#5 o 7 7 I understand my responsibilities under the rules and regulations,for Licensed Construction Supervisor is accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedm es,specific inspections and fdocumentation by 780 CMR and the Town of Barnstable.Attach a copy of your license. p Signature C i Section-10—Home Improvement Contractor w Name��n s:�c y2 r_s ��. Co .�n C Telephone Number s30� -q 1—-2 7-2 Address` v 2, . City t,,; ��1 State _Tap o�_�3� i Reesttation Number ° Expiration Date t; r' I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Build'Build4 Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 and the Town ofBamstable.Attach a copy of your H.LC... / Signature i !�-. - Date � Section 11—Home Owners License Exemption Home Owners Name: . Telephone Number Cell or Work Number I understand my responsibilities;under the rules and regulations for Licensed Consttvction,SupmVisor 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. Signature Date k r APPLICANT SIGNATURE r Signature /IjDate —7 Print Name k/V i Q✓M �o�,Q(� Telephone Numb _77 E-mail permit to: � T n..4....A..a-.7.11 MAA7O Section 12 —Department Sign-Offs M Health Department ❑ Zoning Board(if required - Historic District ❑ Site Plan Review(if required ❑ 1 Fire Department ❑ s r Conservation ❑ For commercial work,please take your plans directly to the fue deparbnent for approval Section 13 —,Owner's Authorization I, as Owner of the-subject property hereby authorize " , to act on my behalf in all matters relative to work authorized by this building permit application for: y (Address of job) i Signature of Owner, date . Print Name ` C _. Last undated:2/92018 " ' h Town of Barnstable Building PosttThisCard So That it is Visible Fromm m the Street=Approved Plan ''s Must be Retained on Job and this Card Must be Kept OhIL"7lTCAU1.G • a uu r p + J b r r Posted Until Final ins ection Has Been Made t - ,; • \� �� . , ,I � w Permit \ WFier�e a�Certificato of Occupancy is Required;such Building shall Not be Occupied until a Final'Inspection has been made j Permit No. B-18-497 Applicant Name: WILLIAM M FEDER Approvals Date Issued: 03/02/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 09/02/2018 Foundation: Residential Map/Lot w169-088 Zoning District: RC Sheathing: Location: 100 TARAMAC ROAD,CENTERVILLE 7 Contractor Name':` ,SUNRISE RESTORATION Framing: 1 _ Owner on Record: MILITARY WARRIORS SUPPORT �' ; COMPANY r Address: 211 N LOOP 1604 EAST SUITE 250 ' 0 2 contractor License 160037 - Chimney: SAN ANTONIO,TX 78232 Est Project Cost: $5,000.00 t Y. x Description: DEMO INTERIOR ONLY-DRYWALL, INSULATION,CABINETS 1,Permit Fee: $85.00 Insulation: INTERIOR DEMO FIRST..FLOOR RANCE ;f Fee Paid: $85.00 Final: Project Review Req: DEMO PERMIT ONLY. HOME HAD WATER DAMAGE AND 1NI_LL Dater 3/2/2018 NEED PERMIT TO REPLACE TO NEW. g ap Plumbing/Gas Rough P umb'n zM771 Building Official Final Plumbing: .E ;l ( _ Rough Gas' g This permit shall be deemed abandoned and invalid unless the work authorised by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the�approved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or'road and shall be maintained,oPen for public inspection for the entire duration of the Electrical work until the completion of the same. Service: 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: Rough: 1.Foundation or Footing Final: 2.Sheathing Inspection 3.AII.Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Final: 6.Insulation 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site - All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT qq 0U/tQ f/V Application Number..: s s - `► gAgN$rA$Id�,. * cQ Mees. ,. y® Permit Fee..... ... ..........................Other Fee........................ 05 '4�/�� Total Fee Paid............................................................... ...... TOWN OF BARNSTABLE Perm Approval by..........(.....................on.... .......�,�... BUILDING PERMIT (Q� par�1........ !J ........�........... ............. ........................ APPLICATION Section I — Owner's Information and Project Location Project Address l U J *7FA f A- VY)Q C: - Village Owners Name J Owners Legal Address Q IJ, to op r , oq E10- ' `' �;L--o r State` zip City q� 9010el t.c� Owners Cell E-mail Section 2—Use of Structure r Use Group ❑ Commercial Structure over 35,000 cubic feet ❑,/Commercial Structure under 35,000 cubic feet LJ 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 ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation , 1 Other—Specify. M O 1 � Q Section 4 -Work Description ' T act Tmdated-?A201 8 Application Number................... . i Section 5—Detail Cost of Proposed Construction L Square Footage of Project ( o , Age of Structure Safe Number 677 #Of Bedrooms Existing 2 ZWt. Total# Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6-Project Specifics ❑ Wiring ❑ Oil Tank Storage Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ municipal, ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ❑ No 3 Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? , Yes ❑ No ❑ Section S—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage" Percentage of Lot Coverage #of Dwelling Units (on site) y Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed d Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No T....a..�.i..ae.i.1 M^AI 0 i k - Application Number........................................... Section 9—.Construction Supervisor Name . Q+i`^ Telephone Number - .L{ `7 Address 2- Gt,�:�� City A ljan^kt IPState^� =-Zip — : License Number<2 3 License Type CS Expiration Date Contractors Email,� ��.I e�.P� Lama �-;;OA� Cell # 5-0 8 '.2- 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 documentatio 'requuired and th Town of Barnstable.Attach a copy of your license. i; Signatm~ Section.10—Home Improvement Contractor Name �_ v/1 re�a�1 �� Telephone Number A3b •'� `� `1 AddressAb 4 City � 0. State DP Zip D Registration Number D v3 Expiration Date - I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 C CMR the Massachusetts State Building Code. I understand the construction inspection procedures,'specific inspections and 1, documentation d b 80 CMR and of Barnstable.Attach a copy of your H.LC... c Signature Date Section 11 —Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number �. I understand my responsibilities onsiblities under the rules and re gulations 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. -Signature Date APPLICANT SIGNATURE Signature . Date L( G (� Print Name �� u.>� °E-�.rL Telephone Number f E-mail ermit to• ��L P 4jerLc, &VV% 'ems t' Section 12—Department Sign-Offs Health Department ❑ Zoning Board if re ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval i Section 13 —Owner's Authorization L , as Owner of the-subject property hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for: (Address of job) j Signature of Owner daze Print Name 9 I - - -Last uadated:2/92018 AC401?& CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) �....��' 02/01/2018 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 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 CONTACT NAME: EIIySIa Morels THE INSURANCE AGENCY OF CAPE COD INC AHIC No Ex : (508)888-2766 . FAX A!C No EMAIL "a ell SI p ADDRESS: ellysia@insuranceofcapecod.com ecod.COm P O BOX 960 INSURER(S)AFFORDING COVERAGE NAIC# EAST SANDWICH MA 02537 wsURERA: AMERICAN ZURICH INSURANCE COMPANY 40142 INSURED INSURER B: SUNRISE RESTORATION COMPANY INC INSURERC: INSURER D P O BOX 802 INSURER E: EAST SANDWICH MA 02537, INSURERF: COVERAGES CERTIFICATE NUMBER: 235706 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 T.O ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF 'POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV IN URY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOM0 BILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY IN bJRY(Per accident) $ NON-OVHJED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ �/ _ $ WORKERSCOMPENSATION X SPR TATUTE ERH AND EMPLOYERS'LIABILITY Y!N ANY PROPRIETORIPARTNERlEXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED? NIA NIA 'NIA 6ZZUB2E96443717 11/29/2017 11/29/2018 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES ACORD 1( 01,Additional Remarks Schedule,maybe attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.govAwd/vvorkers-compensationfinvestigationS/. i CERTIFICATE HOLDER . CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE' Hyannis MA 02601 •... .... �,•• Daniel M.CroWjey;CPCU,Vice President-°Residual Market-WCRIBMA ©1988-2014 ACORD CORPORATION. All rights.reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD - r The Commonwealth of Massachusetts Deparf rent of Industrial Accidents Office of Investigations - - - - -- - ----- ---- 600 Washington Street ----= ----� -------- -- - Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/PImnbers Applicant Information Please Print Legibly Name(Business/organizat milffidhidual): City/Stawzip: �aC� Phone#: Are you an employer?Check the appropriate bow 'Type of project(required): 1.[► I am a employea with 4. I am a general contractor and I 6. ❑New construction, (full and/or part-time).* have hired the sob-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. El Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurance.: required.] 5. [] We are a corporation and its 10.❑Electrical repass or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself[No workers' comp. right of exemption per MOL 12.[]Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and them hire outside contractors most submit a new affidavit indicating such. tContradms that check this box must atfached an additional sbeet showing the name of the sub-oontractors and state Wbetber or not those wfidrs bave employees. If the sub-contractors have employees,they must pmvidq 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: r�Ci'� — Policy_ #or Self-ins.Lie.#: lv Expiration Date: �o li �/ -e_ e — Job Site Address: City/StatelZi- ti— r '1 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of.a fine up to$1,500.00 and/or one-year hprison m.eaf;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of ibis statement may be forwarded to the Office of Investigations of the DIA for insurance coverage ver cation, I do here u r, a pains nalda of perjruy that the information provided abov is true orred Sim Date: C/M I Phone#: r ficial use only. Do not write in this area to be completed by city or town official y or Town• PermitlLicense# ssuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: Details http://elicense.chs.state.ma.usNerification/Details.aspx?agency_id=1&... i 1. e s +. •.. I - �• gencies Licensee Details Demographic Information �Fu Name: WILLIAM M FEDER lOwner Name: I' License Address Information City: West Barnstable State: MA Zipcode: 02668 Count : United States License Information License No: CS-105323 License Type: Construction Supervisor Profession- Building Licenses Date of Last Renewal:. 3/8/2016 €Issue Date: Expiration Date: 3/14/2018 !License Status: Active Today's Date: 1/31/2018 Secondary License Type: A 'Doing Business As: :Status Change Reason: - Prerequisite Information No Prerequisite Information Clo..�o§ Window j ©2011 Commonwealth of Massachusetts Site Policies Contact Us'F —.--we.,�.��s � �+„^. .v.`�- ..k 3 �,- ..,�.. y; y b a- s r ,t - aAil '4 e= k� 444 ''h+ s ��t�' {y -�N t'f �,,firar s 're .i +,,,¢ s •r n rsa r00, yt €1 � s Fr �' e`. t � a �+"f+^�'� yy�. >R '4� "� ci " � r a �'��t t• � ~Ti :$A -gFt 9 � '�' u. ".' . -.i �.>§ R Mfk# ��, 3 a .� f f ,`: #ii }r c•'�• c, n a , r ))� 5 °r3+t�swr �� s r ",r�.I3 a � ' e r�t�� .d a fT.. ?�a..:3i...�..Ci,�9si,;Ysa...,SL':s�ia a.�w�.�•a�,.�-;:�...0 __ s....r& 1 of 1 1/31/2018,3:28 PM Office:of Consumer Affairs and-3 uslness Regulation 10 Park:Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration; 160037 Type: DBA N_ Expiration: 6/19/2018 Tr# 288U0 SUNRISE RESTORATION COMPANYY • 4 WILLAIM FEDER P.Q. BOX 802 _._-- E.,SANDWICH, MA 02537 Update Address and return card;Mark:reason for.cbange. SCA 1 0 2OM-05/11 Address Renewal :` Employment Lost Card <. lation, License or re�\ Officeiof Consumer Affairs•&Business Regulahoo gistration valid for individual use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 160037 Type: Office of Consumer:Affairs and Business Regulation Expiration: 6/f9/2018 DBA 10 Park Plaza-Suite,5170 Bo on,IVMA 021i6 SUNRISE RESTORATION.COMPANY WILLAIM FEDER 480 RT.6A P.O.BOX 802 E.SANDWICH,MA 02537 Undersecretary Not valid without signature . y r 6t�1LDi��ti�a�� Q TOWN OF BARNSTABLE' - -1U ri J �]\ !D r 1 i � \ n .. �� ±, f . , , � .. i, ty i � � 3 �� '� ` r r° t \_ i Wells Fargo Bank,N.A. I Home Campus MAC:.NO012-01 G Des Moines,IA 50328 0001 " t Ph:'877-61.7 5274 z r, December 6, 2017 ,-4 y r 0 Town of Barnstable Attn: Robert McKechnie Building Department 200 Main Street Hyannis, MA 02601 Regarding Property Registration at: 100 TARAMAC RD CENTERVILLE MA 02632 Tax ID/Parcel#: 169-088 i Dear Sir/Madam: The property above was sold to a third party as of 11/30/17; therefore, Wells Fargo no longer has interest in the property and is no longer the responsible party. Please update your registration records. Thank you for your assistance in this matter. Sincerely, Amy Rogers,Wells Fargo Bank, N.A., Research/Remediation Associate Wells Fargo Bank, N.A. amy.l.rogers@welisfargo.com J WELLS HOMEMAC F2303-04J },� '• BOWES FARGfO MORTGAGE U tea. ?t� _ �Des Moines,IA • ir,L[t }•j� 000 ♦i �.�. ♦v�,�♦t)�!)�l,)�t)��)�{)♦!)�('>�j>�{>'�!)♦{poi>�t?♦��{>1�S)►��> 11 Jill ()A��'►t��°+t)♦ rya �►`.►� �a ►�,►•��,.�,a ►a ►�,►a,►�►��.►� �A��,.►�� ► ►^ �.►` ��,► �,a.►a}�i7�`� ♦ii7 ►.w9'i.r�♦ •• �� ♦.r7 •iG`7 ♦ir? ►i `?ii ��P7 � ►�►�a��►�,�}►�a�1►��►�a�)►�a1)��{j��►Ial�►��{)►��S�►�a�(►��{�►��{�►��►7��►�i��►�i5�►�a�.)►�a .(♦r/�i�ri�{�♦/r♦J/�r �7`ma's ►r ►7 ♦. ♦.'�r �i�♦i �7/ter ►r Y �i ♦ ♦ ♦r>�ij S►��►��►�i��►�aS Y►��,►�a7�►��r►�i{1►��►�.5�►��i��►��)►��)►tea{S��1)►�a<1►�aS)►�a �,�♦ �ii �iii7�♦isi7//7rii ♦i�:rp:`rr �7•�7 ♦i�7ii��►"♦7/I►r �►i ��(0:1��♦r►��{.)►�a1��a{)►��►��)��a})►�a`)►��S�►,�{)��a�,>►�aS�i�aS�►�a11G1a11►�aS�►��)►��{r,�al)►�i5��5)►�a _ �� ♦� ♦i ♦r ►i r ♦iDi ►ii7 ♦r�►� ♦r ♦ri`7��7♦� ♦i �� ♦i �i��rl��)►��S►��)►1a{S►�i��►�aj)��►�iS)►w�►�a5)►��1►��>��{��_�f 1►��►��S�►�ij)��i5�►�� . ♦.�r i�s.r;�5 y♦. �i'`�71►��{��7 r��{�� ♦fir��!~�!i!�(♦��!`♦��i�G►i Pw�l i♦— ,_�'..- . :M _ . ,<'��- - �. i �a. �-��;, ,- ,,_�. �.� _, ��`�, _ ,, z' "' r_ �fi. -�r�. x:�9'• ' ` • ' Bk 30954 Pg259 #62990 12-11-2017 @ 11: 46a 100 Taramac Road,Centerville,MA 02632 QUITCLAIM DEED Grantor, Wells Fargo Bank,N.A, is a national association, organized under the laws of the United States, whose mailing address is 8480 Stagecoach Circle,Frederick, MD, 21701, for consideration paid of One Dollar($1.00) as a donation,'grants, to Grantee, M Military Warriors Support Foundation,whose address is 211 N. Loop 1604 East Suite 0 250, san Antonio, TX 78232, with quitclaim covenants, the following described parcel gof land, and the improvements and appurtenances thereto in the County of Barnstable, ; Commonwealth of Massachusetts to wit: 4 N Commonly Known As: 100 Taramac Road, Centerville, MA 02632 Parcel No.: 169088 04 Legal Description: The land in Barrstable(Centerville). Barnstable County, Massachusetts, described as follows: _ F Being shown as LOT 71 as shown .on a plan of land entitled: "CENTERVILLE CROSSING. Subdivision Plan of land in Barnstable (Centerville), Mass., for Copley Turnpike Trust, Scale: 1 in.= 80 ft.,August 19, 1968; Thomas F. Kelly, Surveyor, South Yarmouth,Mass."which plan is duly recorded in the Barnstable County Registry of Deeds in Plan Book 223, Page 139. l � This conveyance is in the ordinary course of business and does not constitute a transfer , of all or substantially all of the assets of Wells Fargo Bank,N.A., in Massachusetts.— � �e r m 210-MA-VI 1- 1 Bk 30954 Pg260 #62990 IN ITNESS WHEREOF,the said Grantor has signed these presents on all Wells Fargo Bank,N.A, I e7 CHINA LEM! NameYice'Presfdent,Loan Documentation Title: State of Iowa County Dallas On this day of Nov;;m%z t ,A.D. 2-011 ,before me,allotary Public in and for said county,personally appeared 014 NO LE.M ,to me personally known,who being by me duly sworn(or affirmed)did say that that person is VPLO (title)of said Wells Fargo Bank,N.A.,by authority of its board of(directors or trustees)and the said(officer's name) C141N6 UM acknowledged the execution of said instrument to be the voluntary act and deed of said(corporation or association)by it voluntarily executed. (Signature) (Stamp or Seal) Notary Public t� NICK DIMARCO r Commission Number 799566 M,Commission Expires ° September 30, 2019 PAS Number:0484746649 210-MA-VI JOHN F. MEADE, REGISTER BARNSTA)LE COUNTY REGISTRY OF DEEDS RECEIVED 6 RECORDED ELECTRONICALLY Wells Fargo Bank,N.A. I Home Campus MAC: N0012-OIG Des Moines,IA 50328-0001 Ph:877-617-5274 December 6, 2017 Town of Barnstable Attn: Robert McKechnie Building Department 200 Main Street - Hyannis, MA 02601 4�3�1� Regarding Property Registration at: _ 100 TARAMAC RD C_ENTERVILLE MA 02632 Tax ID/Parcel#: 169-088 Dear Sir/Madam: The property above was sold to a third party as of 11/30/17;therefore, Wells Fargo no longer has interest in the property and is no longer the responsible party. Please update your registration records. Thank you for your assistance in this matter. Sincerely, Amy Rogers,Wells Fargo Bank, N.A., Research/Remediation Associate Wells Fargo Bank, N.A. amy.l.rogers@welisfarg6.com 1 S I A IC, n , Town of Barnstable, 367 Main Street, Hyannis, MA 02601 REGISTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 sections 224-3 and 224-4. Please complete one form for each property in foreclosure (section 224-3)or already foreclosed for which possession has been taken(section 224 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law,please state the reason(s) and complete section 1 (property information) and the first paragraph of section 2 (foreclosing party, court, etc. and foreclosing party representative,but not other, representatives and attorney) so that the Town can review the exemption and update its records: N/A Section 1 —Property Information Property Address: 100 TARAMAC RD CENTERVILLE MA 02632 Assessors Map#: n/a Parcel#: 169-088- Land area and description 19,602,sqft (or 0.45 acres) Building(s)description and contents , single family home of 1,120 sgft Occupied: X Occupant(s)(if borrowers so state and include name(s)) Robert E Johnson & Janet L Johnson do Wells,Fargo Bank, N.A Phone: 877-617-5274 email: codeviolations@wellsfargo.com other: fax: 866-512-0757 Vacant:•no Date: 9/7/201'6 Anticipated Length of Vacancy: n/a Last occupant(s))(if borrowers so state and include name(s)) n/a Phone: .877-617-5274 email: codeviolations@wellsfargo.com other: fax: 866-512-0757 Has possession been taken no If so,please explain and complete and file the maintenance and security plan form(unless exempt as stated above) see attached vacant building plan Section 2—Foreclosing_Party Information Foreclosing Party (full name/title) Wells Fargo Bank, N.A Foreclosure Case Court: n/a. Docket# n/a Date filed: 9/14/15 Current Status: active Foreclosing PartyyIs representative(s) for property (entry, management, repair, etc.)(name,title,): Wells Fargo,Bank, N.A , Company(if different from foreclosing party): Wells Fargo Bank, N.A. Address: 1 Home.Campus, MAC N0012-01 G, Des Moines, IA 50328 Phone: (877)-617-5274 email: CodeViolations@weifsFargo.com other: fax:866-512-0757 If an exemption is claimed,please do not complete the remainder. Other representative(s) (if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure, please so state and do not complete contact information(i. e. "none"or"see-above")). Name,title, other: see above Company(if different from foreclosing party): n/a Address: n/a Phone(s)- n/a email(s): n/a other: n/a Name, title, other: n/a Company(if different from,foreclosing party): n/a J Address: n/a Phone: n/a email: n/a other: n/a Attorney representing foreclosing party Firm name (if different from attorney's name): Orlans Moran PLLC Address: PO Box 540540 Waltam, MA 02452 781- 90-7800 info@orlanmoran.corl n/aPhone(s): 7 ema (s): h : Y I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. Neema Matiyabo,Research Digitally signed by Neema Matiyabo,Research Remediation Associate,Wells Fargo,";Remediation Associate,Wells Fargo Bank,N.A Bank,N.A f Oa'te:zots.og.o7tt3tsz-os 9/7/201oo' Date: 6 Name:Neema G. Matiyabo Title: Research Remediation Associate' I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the-Town of Barnstable. Date: Building Commissioner, Town of Barnstable l _o Y { , p - _ 21174: � DATE(MM/DDIYYYY) ACORO C40RV CERTIFICATE�OF LIABILITY INSURANCE 3/25/2015 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 CONTACT Wells Fargo Certificate Service Center Wells Fargo Insurance Services USA,Inc. PHONE 404-923-3719 FAX 1-877-362-9069 C o xt• AIC No 3475 Piedmont Rd E-MAIL wfis.certificaere uest wesfar ADDRESS: tq @ g Suite BOO F ll o.com INSURER S AFF ORDING COVERAGE NAIC p ' Atlanta,GA 30305 INSURER A: Old Republic Insurance Company 24147 INSURED INSURER B: Wells Fargo Home Mortgage INSURERC: a division of Wells Fargo Bank,N.A. wsuREli D 90 South 7th Street, 14th Floor INSURER E: Minneapolis,MN 55402 INSURERF: COVERAGES CERTIFICATE NUMBER: 8901677 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DDY� MM/DDYr� LIMITS X COMMERCIAL GENERAL LIABILITY 10,000,000 A r MWZY304056 04/01/2015 04/01/2020 EACH OCCURRENCE $ CLAIMS-MADE FxI OCCUR DAMAGE TO RENTED 10,000,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 10,000,000 'GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X PRO- ❑ LOC POLICY PRODUCTS-COMP/OP AGG $ 10,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea..'dent ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS .BODILY INJURY(Per. 'dent) $ NON-OWNED PROPERTY DAMAGE $ HIREDAUTOS AUTOS Para.Zt $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION MWC 302638 04/01/2015 04/01/2020 X STATUTE ORH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? ❑N NIA - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) Proof of.lnsurance ' t CERTIFICATE HOLDER CANCELLATION - Wells Fargo Home Mortgage, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN a division of Wells Fargo Bank,N.A. .�A000RDANCE WITH THE POLICY PROVISIONS. 90 South 7th Street, 14th Floor Minneapolis,MN 55402 AUTHORIZED REPRESENTATIVE 9�_ ��- The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) i r 1 OEM Barnstable, MA Vacant,Buildin Plan ` Current status of the Building: The building is secured; all doors and windows are locked. If the property utilities are on when we find the property abandoned, we will transfer the utilities into our name and •leave active. If we find the property to not have any utilities we winterize the property according to investor/insurer guidelines: Plan of action for exterior building maintenance: We inspect and maintain our properties. We work to keep the property secure and free of any health hazards and/or debris. Wells Fargo also schedules our grass cuts twice a month. What improvements are planned? If the property is in need of repair to avoid a code violation,we will review and take any appropriate action. If there are insurable damages,we will file an insurance claim and review for repairs. What is the scheduled date of re-occupancy? Approximately 90 days after the foreclosure sale is confirmed. Building to be sold or rented? The building is to be sold. Certificate of Occupancy: The buyer will be responsible for re-certification and occupancy inspection with the city. Is property to be demolished? There are no current plans.for demolishing the property. The city will be notified if there is a change of action. f WELLS FARGO BANK, N.A. . CONTACT INFORMATION For questions or concerns regarding a property registration issue please contact the Property Registration Department. . Property Registration Department Registrations@wellsfargo.com For other inquiries please route applicable requests to: Building and Code Compliance Department CodeViolations@wellsfargo.com Utility Bills ConvOtilityPmt@Wellsfargo.com HOA or Condominium Dues or Fees HOAPmtRequestFH@wellsfargo.com Tax Related Requests: TaxGatekeeper@wellsfargo.com REO property inquiries PASAPinguiries@wellsfsargo.com Insurance Claims HazardClaims@wellsfargo.com General Property Preservation Property.Preservation@welIsfargo.com For questions regarding purchasing a Wells Fargo property please contact 1-877-617- 5274. You may also contact our dedicated property preservation call tenter at 1-877-617-5274 Monday— Friday from 8:00 AM —9:00 PM EST. Please note all legal documents should be sent to our legal mailing address below: Wells Fargo Bank, N.A. 1 Home Campus MAC# N0012-01G Des Moines, IA 50328 i Wells Fargo Home Mortgage MAC F2303-04J One Home Campus Des Moines,IA•50328 Ph:877-617-5274 September 7,2o16 P Town_of Barnstable Attn: Robert McKechnie L ' Building Department oz i 01 200 Main Street Hyannis,MA o26oi U) Lo "N r- i '-n M R Completed Property Registration for: ,.. e ° oo TARAMAG RDCENTER�VILLE lVIA o,�26�32 : ��, °' ,� "' TAX ID. Dear Sir/Madam: y Please see the attached property registration,form and use the below contacts to expedite s .4_, any future requests. 2' Code Violations: CodeViolations@WellsFargo.com •��_ ` Property Registrations: Registrations@W61lsVargo.com General Property Preservation: Property.Preservation@WellsFargo.com Call Toll Free: 1-877-617-5274 For questions regarding purchasing a Wells Fargo property please contact 1-877-617-5274• Sincerely, Neema G Matiyabo _ Wells Fargo Home Mortgage MAC F2303-64J One Home Campus ; Des Moines,IA 50328 , �neema g matlyab�ellsfargo o�m ,� N Town.of Barnstable, 367 Main Street, Hyannis, MA 02601 REGISTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 sections 224-3 and 224-4. Please complete one form for each property in foreclosure (section 224-3) or already foreclosed for which possession has been taken (section 224- 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law, please state the reason(s) and complete section 1 (property information) and the first paragraph of section 2 (foreclosing party, court, etc. and foreclosing party representative, but not other representatives and attorney) so that the Town can review the exemption and update its records: N/A Section 1 —Propegy Information Property Address: 100 TARAMAC RD CENTERVILLE MA 02632-2724 Assessors Map #: Parcel#: 169-088 Land area and description 19,602`sgft (or 0.45 acres) Building(s) description and contents Single family home of 1,120 sqft Occupied: Y Occupant(s)(if borrowers so state and include name(s)) ROBERT E JOHNSON & JANET L JOHNSON c/o Wells Fargo Bank, N.A. Phone: 877-617-5274 email: codeviolations@wellsfargo.com other: NA Vacant: N Date: 10/23/15 Anticipated Length of Vacancy: NA Last occupant(s))(if borrowers so state and include name(s)) NA Phone: NA email: NA other: 'NA Has possession been taken No If so, please explain and complete and file the maintenance and security plan form (unless exempt as stated above) NA Section 2—Foreclosing Party Information Foreclosing Party (full name/title) Wells Fargo Bank, N.A. Foreclosure Case Court: Docket# Date filed: 09/14/15 Current Status: Active Foreclosing Party's representative(s) for property (entry, management, repair, etc.)(name, title,): Wells Fargo Bank, N.A. Company (if different from foreclosing party): Wells Fargo Bank, N.A. Address: One Home Campus, MAC F2303-04J, Des Moines, IA 50328 Phone: (877)-617-5274 email: codeviolations@wellsFargo.com other: NA If an exemption is claimed, please do not complete the remainder. Other representative(s) (if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure, please so state and do not complete contact information (i. e. "none" or"see above")). Name, title, other: NA Company (if different from foreclosing party): NA Address: NA Phone(s): NA email(s): NA other: NA Name, title, other: NA Company (if different from foreclosing party): NA Address: NA Phone: NA email: NA other: NA Attorney representing foreclosing party NA Firm name (if different from attorney's name): ORLANS MORAN PLLC Address: P.O. Box 540540 Waltham , MA 02452 Phone(s): (781)790-7800 email(s): info@orlansmoran.com other: NA I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. Digitally signed Brian Jakson Brian JacksonDate:2015.1023Y09:20:29c0500' Date: 10/23/15 Name:Brian Jackson Title: Research/Remediation Associate I _ I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable 4 r f MAINTENANCE AND SECURITY PLAN FORM FOR FORECLOSING/FORECLOSED PROPERTY Town of Barnstable General Ordinances, Code section 224-4, requires a mortgagee taking possession of a property before or during foreclosure, or after foreclosure if the mortgagee becomes the owner,to bring the property into compliance with the maintenance and security standards contained in Code subsection 224-4(B) within thirty (30) days of a notice from the Building Commissioner. Please either complete and file this form or another containing the same information with the Building Commissioner within thirty (30) days of the notice. If a mortgagee claims an exemption from the provisions of Code sections 224-3 and 224- 4, please explain, leave the remainder blank, sign at the end and file this form or letter of explanation and also complete and file the applicable sections of the registration form for foreclosing/foreclosed property N/A Town of Barnstable, 367 Main Street, Hvannis, MA 02601 (1) Registration date: 10/23/15 If not registered, please complete the registration form and state date of filing or anticipated filing N/A (2) If commercial property, describe space utilization floor plans required by the Fire Chief and filing date (actual or anticipated)N/A (if in possession or ownership must be certified as accurate twice annually in January and July). (3) Describe any hazardous materials on the property as that term is defined in MGL c.2 1 K and the date(s)and method(s) for removal as approved by the Fire Chief UNKNOWN (4) Method(s) and date(s) all windows and door openings secured (or will be secured) UNKNOWN If left secured, name, address, and contact information of security personnel providing twenty-four-hour on-site security personnel on the property WELLS FARGO BANK,N.A. F2303-04J,�1'HOME CAMPUS; DES MOINES IA 50328, 877-617-5274 (5)'Location(s) and date(s) "No Trespassing" signs posted or to be posted on the property UNKNOWN (6)Name(s), address(es) and contact information of person(s) responsible for maintaining: structures, lawns and shrubs in sound condition free from excessive growth and the property generally in accordance with the Barnstable Zoning Ordinances the definition of"maintenance" in this Ordinance; any other provision of this Ordinance; and for disposing of trash, debris and pools of stagnant water as provided in Chapter 54 of the Town of Barnstable General Ordinances WELLS FARGO BANK,N.A. MAC F2303-04J ONE HOME CAMPUS, DES MOINES, IA 50328 I (7) If the Fire Chief of the Fire District in which the property is located has approved turning off the water or electricity, please state: Date of approval UNKNOWN Date(s) electricity turned off UNKNOWN on if applicable UNKNOWN Date(s) water turned off UNKNOWN on if applicable UNKNOWN (8)Name(s), address(es) and contact information pf person(s) responsible for maintaining all existing fences around swimming pools and spas or installing fences as required by Chapter 210 of the Town of Barnstable General Ordinances WELLS FARGO BANK,N.A.,F2303-04J,ONE HOME CAMPUS,DES MOINES IA 50328 (9)Name, address, telephone number and email address of person who can be contacted in case of emergency if different from the person named above or in the registration under section 224-3(A) ( name and contact number to be posted on the front of the property if required by.the Fire Chief or Building Commissioner WELLS FARGO BANK,N.A,F2303-04J,ONE HOME CAMPUS,DES MOINES IA 50328,877-617-5274 (10) Date(s) certificate of liability insurance on the property filed with the Building Commissioner SEE ATTACHED EVIDENCE OF INSURANCE (11) Date(s) cash or surety bond of at least$10,000.00 filed with Building Commissioner to remunerate the Town for any expenses incurred in inspecting, securing and making the premises comply and continue to comply, a portion of which shall be retained by the Town as an administrative fee NA (12) Date(s) scheduled for inspections with the Building Commissioner and Health Director, who may at his or her discretion include the Fire Chief, in order to confirm that the land and structures comply with the provisions of this Ordinance UNKNOWN or to identify the provisions with which the property does not comply and establish a program to bring the property into full compliance UNKNOWN (13) Date(s) when the property was sold, or is anticipated to be sold, to the foreclosing party. If neither, please explain UNKNOWN I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. Digitally signed by Brian Jackson Brian Jackson= Date:2015.10.23 09:21:22-05'00' Date: 10/23/15 Name: Brian Jackson Title: Research/Remediation Associate I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-4 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable l G r WELLS FARGO HOME MORTGAGE CONTACT INFORMATION For questions or concerns regarding a property registration issue please contact the Property Registration Department. Property Registration Department Registrations@weIlsfargo.com For other inquiries please route applicable requests to: Building and Code Compliance Department CodeViolations@wellsfargo.com Utility Bills ConvUtilityPmt@wellsfargo.com HOA or Condominium Dues or Fees HOAPmtReguestFH@wellsfargo.com Tax Related Requests: TaxGatekeeper@wellsfargo.com REO property inquiries PASAPinguiries@wellsfsargo.com Insurance Claims HazardClaims@wellsfargo.com General Property Preservation Property.Preservation@wellsfargo.com For questions regarding purchasing a Wells Fargo property please contact 1-877-617- 5274. You may also contact our dedicated property preservation call center at 1-877-617-5274 Monday— Friday from 8:00 AM —9:00 PM EST. Please note all legal documents should be sent to our legal mailing address below: Wells Fargo Home Mortgage 1 Home Campus MAC# F2303-04J Des Moines, IA 50328 21174 A �® DATE(MMIDD/YYYY) C CERTIFICATE OF LIABILITY INSURANCE 3/25/2015 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 CONTACT Wells Fargo Certificate Service Center Wells Fargo Insurance Services USA,Inc. PHONE 404-923-3719 FAX 1-877-362-9069 AIC Ext: A/C No 3475 Piedmont Rd AIL ADDRESS: wfis.certificaterequest@wellsfargo.com Suite 800 INSURERS AFFORDING COVERAGE NAIC# Atlanta,GA 30305 INSURER": Old Republic Insurance Company 24147 INSURED INSURER B Wells Fargo Home Mortgage INSURER C a division of Wells Fargo Bank,N.A. INSURER D: 90 South 7th Street, 14th Floor INSURER E: Minneapolis,MN 55402 INSURER F: COVERAGES CERTIFICATE NUMBER: 8901677 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD .INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSD ADDL WVD SUER POLICY NUMBER MMILDDY� POLICY M DDIIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY _ A MWZY 304056 04/01/2015 04/01/2020 EACH OCCURRENCE $ 10,000,000 CLAIMS-MADE a OCCUR DAMAGE (RENTED 10,000,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY 0 PRO ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 10,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE a AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION O4/O1/2015 O4/O1/2020 PER OTH- A MWC 302638 X STATUTE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION Wells Fargo Home Mortgage, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE a division of Wells Fargo Bank,N.A. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 90 South 7th Street, 14th Floor Minneapolis,MN 55402 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) Y £. m Wells Fargo Home Mortgage MAC F2303-04J O One Home Campus p 0 - Des Moines,IA 50328 > Ph:877-617-5274 October 23,2015 r"? Town of Barnstable ; -53 Attn: Robert McKechnie Building Department _7 200 Main Street - --� Hyannis,MA 026ol ' v rn �Y - Completed Property Regist,u '; for'— - _� _ ioo TARAMAC RD CENTERVILLE MA 02632-2724 TAX ID: 169-o88 Dear Sir/Madam: Please see the attached property registration form and use the below contacts to expedite any future requests. Code Violations: CodeViolations@WellsFargo.com Property Registrations: Registrations@WellsFargo.com General Property Preservation: Property.Preservation@WellsFargo.com Call Toll Free: 1-877-617-5274 For questions regarding purchasing a Wells Fargo property please contact 1-877-617-5274. Sincerely, Brian Jackson Wells Fargo Home Mortgage M.A,C F2303-04J One Home Campus Des Moines,IA.50328 brian.a.jackson@wellsfargo.com - 7 V 'v �Z ' � '.*.-. �. 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Assessed Values 2012 - Map/Block/Lot: 169/088/- Use Code: 1010 2012 Appraised Value 2012 Assessed Value Past Comparisons Building $87,200 $87,200 Year Total Assessed Value Value: Extra $34,900 $34,900 2011 -$237,300 Features: 2010-$237,300 Outbuildings: $2,900 $2,900 2009-$279,400 Land Value: $108,700 T $ 108,700 2008-$306,600 2007-$305,800 2012 Totals $233,700 $233,700 2006-$273,200 Residential Exemption Received=$88,785 Tax Information 2012 - Map/Block/Lot: 169/088/ - Use Code: 1010 Taxes C.O.M.M.FD Tax(Residential) $334.19 " Fiscal Year 2012 TAX RATES HERE Community Preservation Act Tax $36.61 Town Tax(Residential) $1,220.18 $1,590.98 L Sales History - Map/Block/Lot: 169 / 088/- Use Code: 1010 l History: Owner: Sale Date Book/Page: Sale Price: JOHNSON, ROBERT E&JANET L 11/15/1988 6536/120 $130000 NORRIS, GEORGE L 9/10/1981 3358/13 $0 Sketches - Map/Block/Lot: 169 /088/ - Use Code: 1010 - - �Contact http://www.town.bamstable.ma.us/Assessing/propertydisplayscreenl 2.asp?searchparcel=l... 8/31/2012 I • Official Website of The Town of Barnstable - Property Lookup Page 2 of 4 http://www.town.bamstable.ma.us/Assessing/propertydisplayscreen12.asp.searchparcel-1... 8/31/2012 Official Website of The Town of Barnstable - Property Lookup Page 3 of 4 http://www.town.bamstable.ma.us/Assessing/propertydisplayscreen 12.asp?searchparcel=l... 8/31/2012 Official Website of The Town of Barnstable - Property Lookup Page 4 of 4 Owned and Operated by The Town of Barnstable-Information Technology Home Departments&Services I Boards&Committees I Residents&Visitors I Doing Business I Town Calendar I Phone Directory Employment I Email Town Hall r http://www.town.bamstable.ma.us/Assessing/propertydisplayscreen l 2.asp?searchparcel=l... 8/31/2012 i Town ofbarnswie Building Department ' l ComplaintAnquiry Report Date: �' ' 9 Rec'd br: Assessor's No.• Complaint Natne: Location Address: Originator Name:- Street: vim: CL,7y S- e: Zip: Telephone: D/L Complaint 7 Description: Inquiry Description: For Office Use Only F Inspector's Action/Comments Date: Xe --�— Inspector._ �— 74 Follow-up Action ' Additional Info. Attaclied ! �� Gaps-Disaibua_•on VL7ute•Depa=cnt File ] PAR' ) Real Estate System -, General Property Inquiry] Help [ ] • Parcel Id: 169 088- Account No: 95747 Parent : Location: 100 TAR.AMAC RD Neighborhood: . 36AC Fire Dist : CO Devel Lot : 71 Lot Size: .45 Acres Current Own: JOHNSON, ROBERT E & JANET L State Class : 101 100 TAR.AMAC RD No. Bldgs : 1 Area: 1120 Year Added: CENTERVILLE MA 2632 Deed Date : 110188 Reference : 6536/120 January 1st : JOHNSON, ROBERT E & JANET L Deed MMDD: 1188 Deed Ref : 6536/120 Comments : Values : Land: 29000 Buildings : 59700 Extra Features : Road System: 100 Index: 1693 (TARAMAC ROAD ) Frntg: 211 Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 091589 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax. Title : Account : 4625 Taken: 030893 Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ) Parcel Number [169] [089] [ ] [ ] [ ] O Health Complaints 09-May-96 Time: 1:45:28 PM Date: 5/8/96 Complaint Number: 175 Referred To: JEROME DUNNING Taken By: THOMAS MCKEAN Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 100 Street: Taramac Village: CENTERVILLE Assessors Map_Parcel: Complainant's Name: Frank Paparo (Anonymous) Address: 48 Bridgett's Path Telephone Number: 428-5011 Complaint Description: Two camping trailers (full-sized) at the side of the driveway. Also,two sheds in the back yard with lights on at night. Complainant has seen several cars of people park there at 4:00 to 4:30 each afternoon,then leave in the morning. Complainant believes there are people living in the sheds and trailers. Actions Taken/Results: DZM received this complaint anonymously from Frank Paparo. Reported it to Gloria Urenas. DZM observed 3 cars and a truck and two full size I[ailers-beside..the house. Windows o trailers are blocked with ihades. fdown. DZM WILL LEAVE IT UP TO JERR'�' ., DUNNING TO FOLLOW THROUGH ON THE INVESTIGATION. Investigation Date: 5/8/96 Investigation Tlmei 1:45:00 PM 1 Town of Barnstable Building Department Complaint/Inquiry Report Date: Rec'd by: '� -Assessor's No.: Complaint Name: ------------ Location Z� Address: WP- Originator Name: Street Vdbge: �vSt e: Zip: Telephone: D/>r Complaint ' Description: Inquiry Description: For Office Use Only Inspector's t Action/Comments Date. - '— 9 Inspector. -�— Follow-up /y Action F ;,/Zz/-& w. Adclitional Info. Attaclied Capr Distribution: Uld e:-Department File I"ellory-Inspector f Health Complaints 09-May-96 Time: 1:45:28 PM Date: 5/8/96 Complaint Number: 175 Referred To: JEROME DUNNING Taken By: THOMAS MCKEAN Complaint Type: CHAPTER II HOUSING Article X Detail: Business Name: Number: 100 Street: Taramac Village: CENTERVILLE Assessors Map_Parcel: Complainant's Name: Frank Paparo (Anonymous) Address: 48 Bridgett's Path Telephone Number: 428-5011 Complaint Description: Two camping trailers (full-sized) at the side of the driveway. Also,two sheds in the back yard with lights on at night. Complainant has seen several cars of people park there at 4:00 to 4:30 each afternoon,then leave in the morning. Complainant believes there are people living in the sheds and trailers. Actions Taken/Results: DZM received this complaint anonymously from Frank Paparo. Reported it to Gloria Urenas. DZM observed 3 cars and a truck and two full size tai.Ipers.beside.lhe house. ( s of trailers are- blockdd-with sh'hdes.� , down. DZM WILL LEAVE IT UP TONNING TO FOLLOW THROUGH ON THE VESTIGATION. Investigation Date: 5/8/96 Investigation Th 6:___._ 1:45:00 PM 1 ] PAR' ] Real Estate System - General Property Inquiry] Help [ ] , Parcel Id: 169 088- - Account No: 95747 Parent : i Location: 100 TARAMAC RD Neighborhood: 36AC Fire Dist : CO Devel Lot : 71 Lot Size : . 45 Acres Current Own: JOHNSON, ROBERT E & JANET L State Class : 101 100 TARAMAC RD No. Bldgs : 1 Area: 1120 Year Added: CENTERVILLE MA 2632 Deed Date : 110188 Reference : 6536/120 January 1st : JOHNSON, ROBERT E & JANET L Deed MMDD: 1188 Deed Ref : 6536/120 Comments : Values : Land: 29000 Buildings : 59700 Extra Features : Road System: 100 Index: 1693 (TARAMAC ROAD ) Frntg: 211 Index: ( ) Frntg: Control Info: Last Auto Upd: 050695 Status : C Last TACS Update : 091589 Land Reviewed By: Date : 0000 Bldgs Reviewed By: Date : 0000 Tax Title : Account : 4625 Taken: 030893 Account Status : Hold Status : Cancel [ ] Press XMT for more data Next screen [PAR ] Action [ ] Owners Name [ ] Road Index [ ] Road Name [ ] Parcel Number [169] [089] [ ] [ ] [ ] r\� V s :•..i..'.f i..« t•...�.:�. - ..::.Jir�l.«%..:.s ti. ..'.�`...•:)f1r:.��a/ �.. .•JuriJ.:•r�.ltl;LVr••.r�,`«�i%:Ji�l•w�./��:ai.�. • SOVP14 or 88888zS8L� 884/0933 =VZ=w Amm T=7(ZA =. 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