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4120 FALMOUTH ROAD/RTE 28
-R, U R j -YC _ Town of Barnstable Building Post This Card So That it is Visible From the Street-Approved,Plans.Must,be Retained can Job and'this Card_Must be Kept 1' Posted Until Final Inspection Has'Been Made. Permit p�Y'TY11 i63ih v� sh Final 1 1 Where a Certificate of Occupancy is Required;such Building all Not be.Occupied until a nal.Inspection has.been made Permit NO. B-20-1576 Applicant Name: MICHAEL B TAVARES Approvals v Date Issued: 07/23/202tJ Current Use: Structure Permit Type: Building-Sheet Metal-Commercial Expiration Date: 01/23/2021 Foundation: Location: 4120 FALMOUTH ROAD/RTE 28,COTUIT Map/Lot 040-115 Zoning District: RF Sheathing: Owner on Record: PARADIGM INC Contractor Name°^,MICHAEL B TAVARES Framing: 1 r Address: 22 FALMOUTH RD Contractor License: 2423 2 MASHPEE, MA 02649 -�� Est. Project Cost: $0.00 Chimney: Description: Fabrication and installation of 12' make up airhood installation of ;t Permit Fee: $ 160.00 15'of 16" x16" welded duct to new upblast exhaust fan. Installation Insulation: of 10' of 12"spiral diet leadim to new Makeup air unit Fee Paid: $ 160.00 p• g � P � � Final: 7/23/2020 Project Review Req: Must be sized appropriately to match what is serviced below Plumbing/Gas Rough Plumbing: - Building Official Final Plumbing: 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 the`approved construction documents for which this permit has been granted. Rough 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. i Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open fo5public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: `y 1.Foundation or Footing Rough: 2.Sheathing Inspection - - - - - -� — g 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site _ All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �,�� Final: R Daniel Cunha Project Coordinator/Field Foreman 64 John Vertente Blvd.•New Bedford,MA 02745 Phone:508-985-9940 x 234•Fax:508-985-9965 Mobile:508-916-0563•E-mail:daniel(a)horacios.com Web:www.horacios.com r HORACIUS ® WE MADE THAT. STAINLESS STEEL FABRICATORS www.horacios.com. 4 4 Commonwealth of Massachusetts 81jl(Dl Sheet Metal Permit DING OEPT ii AIN 2 210 0 Date: I Permit# Tow � !J'`Jfv Estimated Job Cost: $ 0 Pen-hit Fee: $ RNSTABCE Plans Submitted: YES NO Plans Reviewed: YES NO Business License# I H 5 Applicant License# Zq 2—5 Business Information: Property Owner/Job Location Information: Name: 1:10ro Ins Inc Name: Mnbamed 5ha it Ue Street:(p H J b n\/?_r f e-ntp /P)l Va. Street: H 12.n Elmo, i t h 'R City/Town: . M c W /R C(I�O ra City/Town: C O jbl i MQ O 2 L,j 6 Telephone: F�QS- qS j- qqq() Telephone: Photo I.D. required/Copy of Photo I.D. attached: YES V/ NO Staff Initial -1 /M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family Multi-family Condo!Townhouses Other Commercial: Office Retail Industrial Educational Institutional Other Square Footage: under 10,000 sq. ft.-V— over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: &hr'i r_abon anA 'o nst a I lad inn n-� f eke up di r hand In5tallaf !on IJ_ r� IU"xI(n" wel e�lrt to new uphlast exhau5i lan . Insini lafion o-� INSURANCE COVERAGE: I have a current liabili insurance policy or its equivalent which meets the requirements of M.G.L.Ch. 112 Yes R(No❑ If you have.checked Yes,indicate the type of coverage by.checking the appropriate box below:' A liability insurance policy [y Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the:insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement: - Check One Only olk, Owner Agent ❑ Signature of Owner or Owner's Agent . i By,checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Progress Inspections Date Comments Final Inspection Date Comments Type of License: . By [Master Title ❑Master-Restricted City/Town pJourneyperson Signature of Licensee Permit# Eli oumeyperson-Restricted Z�f L3 License Number: Fee$ ❑ Check at www:mass.goV1dpl Inspector Signature of Permit Approval SIZE EXHAUST SUPPLY MATERIALS FILTERS LIGHTS DUCT SIZE CFM Sp . DUCT.SIZE CFM SP INT TOP QTY. SIZE TYPE. QTY. TYPE WATT L W H W L W L 12'-0" 51" 18" 16" 16" 3000 .75 . 12" 12" ' 2400 .50 S S S S S S . 520x ALUM. 1 UL-VAPORpgooF 100 EA. 24"1 NSFI GENERAL NOTE: ALL WORK SHALL BE INSTALLED IN CONFORMANCE WITH ALL NOTE: 1. HOOD SHALL BE EQUIPPED WITH. AN AUTOMATIC THE GOVERNING CODES, REGULATIONS AND .ORDINANCES. WET CHEMICAL EXTINGUISHING SYSTEM WITH INCLUDING, BUT NOT LIMITED TO, NFPA 96, NFPA 17A AND UL 300 UL-LABEL, ACTIVATION OF SYSTEM SHALL CLOSE -CONSTRUCTED FROM 18 GAGE, DOUBLE;WALLED, . GAS SUPPLY VALVE-SUPPLIED BY OTHERS TYPE 304 STAINLESS STEEL, NO. 4 FINISH-ALL SEAMS WELDED IN COMPLIANCE WITH 3. GREASE FILTERS .SHALL BE UL-LABELED N.F.P.A BULLETIN #96 3. MINIMUM CLEARANCE TO COMBUSTIBLES = 18 -3" AIR SPACE.WILL BE PROVIDED BETWEEN 4. 'EXHAUST DISCHARGE SHALL BE MIN. 40." ABOVE 1 THE WALL AND THE HOOD 3" AIR SPACE ROOF AND MIN: 10 FT FROM ADJACENT BUILDINGS, FRESH AIR INTAKES, WINDOWS & DOORS UNLESS VERTICAL'SEPARATION IS PROVIDED IN RIGHT-HAND SIDE SHOWN ACCORDANCE WITH NFPA 96, SEC. 4-8.2 5. EXHAUST FAN AND FRESH AIR FAN SHALL 51`' BE WIRED TO OPERATE SIMULTANEOUSLY EXHAUST DUCT FROM BACK OF HOOD SUPPLY DUCT WITH / FIRE DAMPER 18" 3" AIR SPACE UL \\\\ —3 AIR SPACE \.\ IN \\\ 144" TAIR \ SPACE GREASE TRAY BAFFLE"TYPE AIR SUPPL GREASE EXTRACTOR DIFFUSER AIR SUPPLY VAPOR PROOF LIGHT, � u MOHAMED SHARQUE DIFFUSER 4r . 4120 FALMOUTH RD / COTUIT, MA DRAWN BY:MIKE TAVARESAN C.AL ENGINEE N/A one. 6-1-2020 LO PRO MUA EXHAUST HOOD] DWG #1 GENERAL'NOTE: ALL WORK SHALL BE INSTALLED IN CONFORMANCE WITH ALL THE GOVERNING CODES, REGULATIONS AND ORDINANCES. INCLUDING,. BUT NOT LIMITED TO, NFPA 96. NFPA 17A AND UL 300 EXHAUST CFM: 3000 10'-0" MIN. ROOF 16"X16" DUCT FIRE INSULATED AIR INTAKE FIRE CFM: 2400 DAMPER 12" DIA . DUCT . 12'-0' NOTE: 1. CONSTRUCTED FROM 18 GAGE, DOUBLE WALLED, TYPE 304 STAINLESS 'STEEL, NO. 4.FINISH 2. ALL SEAMS WELDED IN COMPLIANCE WITH N.F.P.A BULLETIN #96 3. 3" AIR SPACE WILL BE PROVIDED BETWEEN THE WALL AND THE HOOD 4. HOOD IS UL LISTED PER 47356 MODEL H-1001 4*1 N.SF LO PRO MUA EXHAUST HOOD- Sos- IDE VIEW 4120 FALMOUTH RD / COTUIT, MA DESGNED BY.MIKE TAVARES CAME: N/A ENGINEER DATE: -1-200 DWG #2 r lm !� ®, DATE(MM/DDNYYY) .A 111 ) D CERTIFICATE OF LIABILITY INSURANCE 05/28/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Monica DaSilva NAME: Sylvia&Company Insurance Agency,Inc. HCNNo exc: (508)995-4553 FAX, No): (508)995-4525 500 Faunce Comer Road E-MAIL mdasilva@sylviagroup.com ADDRESS: Building 100 Suite 120 INSURERS)AFFORDING COVERAGE NAIC# Dartmouth MA 02747 INSURER A: Hartford Insurance Company of the Midwest 37478 INSURED INSURER B: Safety Property&Casualty 12808 Horacio's Inc INSURER C: AmGuard 42390 64 John Vertente Blvd INSURER D: INSURER E: New Bedford MA 02745 INSURER F: COVERAGES CERTIFICATE NUMBER: 20-21 GL BAP LIMB WC 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 AUUL15UI3K1 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ 10,000 A 08SBAAD2735 05/01/2020 05/01/2021 PERSONAL&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ®PET LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: Employee Benefits $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO BODILY INJURY(Per person) $ 1,000,000 B OWNED SCHEDULED 6209916 05/01/2020 05/01/2021 BODILY INJURY(Per accident) $ AUTOS ONLY. AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 10,000,000 A EXCESS LIAB 11 CLAIMS-MADE 08SBAAD2735 05/01/2020 05/01/2021 AGGREGATE $ 10,000,000 DED I XRETENTION S 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY y/N STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. ,000,000 OFFICERIMEMBER EXCLUDED? El NIA HOWC151250 06/14/2020 06/14/2021 .L.EACH ACCIDENT $ (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 I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 St AUTHORIZED REPRESENTATIVE Hyannis MA 02601 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD r l AGENCY CUSTOMER ID: LOC#: ACOIRV ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED POLICY NUMBER CARRIER EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: Mohamed Shafique 4120 Falmouth Rd Cotuit,MA 02635 I ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD I Fold,Then Detach Along All Perforations _�:.COMMONWE LTH ® MA88ANUSPTTS: � e o • ® e BOARD OF SHEET tJIETAL WORKERS ISSUES THE FOLLOWING LICENSE BUSINESS l� N11CIAEL B TAVARES iz la HORACIO WELDING AND SHEET 141ETAL INC 64 J6 VERTENTE BOULE+JAkD ' 'N NE1N BEDFORD,MA 02745 cZi I J 746 12/07/2020 .... 696793 i I `d Fold,Then Detach Along All Perforations CONTROL# J 1.16 313.7 IMPORTANT If your license is lost,damaged or destroyed;is inaccurate;or needs to be corrected,visit.our web site at rnass.gov/dpl for instructions to ensure the proper mailing of your Renewal Application and any other correspondence. This license is subject to Massachusetts General Laws and regulations.Your license is a privilege,and cannot be lent or assigned to any person or entity under penalty of law.Keep this license on your person or posted as required by law.and/or regulations. Please Visit our Web site at http://vvww.mass.gov/dpi/boards/Sm MICHAEL S TAVARES 8 PINECONE LN EAST FREETOWN,MA 02717-1649 (SM) Fold,.Then Detach Along All Perforations o::60MMONW6A of EJfAS � e e • e • I�®ARC of SHEET Cyl WbRKERS ISSUES THE FOLLOWING LICEt+iSE 111IASTER UNRESTRICTED MIPHAEL B TAVARES 8 PINECONE:L.:. . EAST FREETE3'U:'N;MA 027I7.-1:649 �Z :.:. 1U 2423."<;>.'": '' ` p7/2812020;..;; 512670 S . ....... Fold,Then Detach on _ _g All Perto Al rations NTROL 1078326 IMPO RTANT If your.license is lost,damaged or destroyed-is inaccurate;or needs to be corrected,visit our web site at mass: instructions to ensure the proper mailin Aoplicatlon and an g of your Rego atlpi for y other correspondence. This license is subject to Massachusetts General Laws and regulations.Your license is a privilege assigned to any person or entityg and cannot be lent or license on your under penal regulations, person or posted as required b o alaw.Keep this . Y and/or Lh ' r, Town of Barnstable Builds Post>Thls Card So That`it is.Visible,Frorr%,the Street=Approved Plans Must`.be Retained ohA' and this Card Must be Kept �� raaai�rne r Posted Until Final Inspection Has Been,Made ra Permit " . Where a Certificate of Occupancy is Required,such,6uilding shall Not be Occupied until a Final,lnspection has been made Permit NO. B-20-354 Applicant Name: JOSHUA X KOURI Approvals Date Issued: 02/26/2020 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only-- Expiration Date: 08/26/2020 Foundation: Commercial Map/Lot: 040-115 Zoning District: RF Sheathing: Location: 4120 FALMOUTH ROAD/RTE 28,COTUIT Contractor'N me:°,,,CAPE&ISLAND CONSTRUCTION Framing: 1 Owner on Record: PARADIGM INC CO INC. 2 Address: 22.FALMOUTH RD m ,aContractorLicense. 1659,36 ,. Chimney: MASH.PEE, MA 02649 ~" Est: Project Cost: $ 17390.00 r, � Insulation: Description: remove 6 existing support columns from first floor. Install new steel l Permit F"eke: $258.25 beam under existing girder Fee.Paid: $258.25 final Project Review Req: Structural work only submitted Date.:° 2/26/2020 Plumbing/Gas Rough Plumbing: ``� "^ ( !`-<( Final Plumbing: Building Official. r 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 the approved construction documents for which this permit has been granted. k: 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. y r v. Thispermrtsh II> visible from access street or road-and shall be maintained open for public inspection a be displayed ed p y in a location clearly n for the entire duration of the work until the completion of the same. "� Electrical The Certificate of Occupancy will not be issued until all applicable signatures'by the,Building and Fire officials are provided on this permit. Service: 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. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Final Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENTU�� '� ti THE Application Number. ......................... �.... * BARN3rABLE, WAS& � Permit Fee.......cpskt.5 ........Other Fee........................ 039. -Total Fee Paid...........:..... TOWN OF BARNSTABLE Permit Approval by....... .:. ...................on....2.�Z(;e.f.2.:.5.. BUILDING PERMIT Map -- APPLICATION Section 1 — Owner's Information and Project Location SCANNED Project Address ' 1 a v fi 6,,1 Village__( EI 16 Owners Name J c still mini, EPT Owners Legal Address - Ne ! � . ) a. City_ li�L��li� tom. State0F RA f LE Owners Cell# 'j Cam-366 Ll7 E-mail IYa zI G� Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet Commercial Structure under 35,000 cubic feet Single/Two Family Dwelling Section 3 -'hype of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment El Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar Renovation ❑ Pool ❑ Insulation Other.—Specify Section 4 - Work Description Lid r f l Tact nnrlatPA 1111 inoI R Application Number.................................................... : Section 5—Detail Cost of Proposed Construction l / 3 qo Square Footage of Project 60 - Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method MA Checklist 0 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 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 Rear Yard Required Proposed A Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 11/15/2018 • c�Jfee�poma�rearuaen./,l�g����l F office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR TYPE;; Moration 1 geuistratl6n.,. Expiration t Use only 1 o4/t)8/2020 i return to, 4' istration valid for indivi found elation CAPE 8 ISLAND C1QI CO INC. Reg. iration date• Business Reg betote the exp er plfairs and01 ? pf`fice of Consum , One Ashburton plac = n, A 02 JOSHUA KOURI 55 ELM AVE. Bosto M . y HYANNIS,MA 02601 Undersecretary of v li without signature ' mm Coonwealth of Massachusetts t Division of Professional Licensure Board of Building Regulations and Standards tessrestricteal. COnst� Constr ri bpprvisor then 8ui1 ucho gs Of t - ires 02/12/2021 35 000 cub feet(99 Y us9roor CS-074660 �� Ir � sr � space cubic a k'hic eno S)o/ Main / JOSHUA X KAIIRI r closes K PO BOX210 CENTERVILLE AR�i02. Sta eure to poS 8uu n Sess c Commissioner v"di 9 Coo current Call(g�I i?j 3�tion abo revoc the Massac j. 00°r viS'tut li�ensethis hhceh s lJ Se. �SS•9oy�bpl J�. 4 0 a ¢Estimate 1712 ,Date Jan 29,:2020 :Cape & Islands Constructions Co PO Box 210Termsr Centerville Ma. 02632 . 508.775.7663 ;Ship Date ,; k v T r C • Mohammad Shafique 111 Pine View Dr. Cotuit, Ma 4120 Falmouth Rd. Cotuit,Ma. ID Description Ext Photo GENERAL General 17,390.00 NEW SUPPORTING BEAM INSTALLATION. Using owner supplied engineering plan completed by Lars Jensen of INGhouse, Mashpee Ma. Using owner supplied steel beam supplied by Al A steel. SCOPE OF WORK`. Drill discovery holes at base of foundation walls under'beam pockets and at each lally column to determine presence of footing. (If no footing present,additional engineering and work may need to be completed.and is not include in current scope of work) Jack basement girder to level or as close as possible.Shore with steel plates. Build temporary 2x6 walls on either side of basement girder to help floor carry load of beam when installing. Jack first floor girder to level or as close as possible. Build temporary 2x6 walls to support ceiling for current,post removal. Open gable ends of building.to allow entry of new beam. Prep beam pockets for beam installation. Manage installation of new beam, installed by Al A Steel. Al A steel to Instal beam support columns,fasten to top of foundation wall and Instal new beam and prep beam for carpenters,all as shown on . engineering plan. . (Beam to be installed under existing girder.This is being specified as other engineering plans exist,showing girder removed) Re-frame gable end walls,sheath and fill in siding as necessary. Remove temporary walls. Dispose of all debris from above described work only. *See second page of quote below" a , Total k be 1 "` ;: Estimate 4712 Date Jan 29 2020 Cape & Islands. Construction:Co PO "Po Box 210 Centerville Ma.02632 Terms y 508.775.7663 s _ Ship Via E Ship Date ;€ Mohammad Shafique 111 Pine View Dr. Cotuit, Ma 4120 Falmouth Rd. Cotuit, Ma. ID Description Ext Photo IMPORTANT ADDITIONAL INFORMATION: Additional work if wanted or needed not included above,to be billed for time and materials. No plumbing or electrical work is included in quote. Damage to dust cap in basement due to lack of lally column footing, if not present,not the responsibility of Cape&Islands Construction. Other work on site before or after above scope of work,not the responsibility of Cape&Islands Construction.Owner agrees to indemnify Cape&Islands Construction from any claims arising from work on project not in above scope of work. Cape& Islands Construction to provide workers compensation and general liability certificates for above scope of work. 50%deposit required to begin project. 25%due on beam installation day. 25%due upon completion of scope of work. Balances due to others, Le. Engineer,Al steel,etc.To be paid by owner. Total: $1,7>390..00 ' Signature 4 r Page 2 ACC> CERTIFICATE OF LIABILITY INSURANCE °ATE`MM'°°"""' 5/14/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER FRANK L HORGAN INSURANCE AGENCY INC NAME:CONTACT 44 BARNSTABLE ROAD PHONE FAX A/C No): PO BOX 250 EMAIL HYANNIS, MA 02601 ADDRESS: INSURERS AFFORDING COVERAGE NAIC 0 INSURERA: LM Insurance Corporation 33600 INSURED INSURER e: CAPE& ISLANDS CONSTRUCTION COMPANY INC PO BOX 210- INSURER C: CENTERVILLE MA 02632 INSURERD: INSURER E.: INSURER F: - COVERAGES CERTIFICATE NUMBER: 48647555 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. 1�TR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/LDIDY EFF/YYYY MMIDD/mry LIMITS COMMERCIAL GENERAL LIABILITY EACHOCCURRENCE. $ DAMAGE To CLAIMS-MADE OCCUR PREMISES Ea oaurrence $ e MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑jE O- PROD LOC -DUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY - COMBINED IN LE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY!NJURY(Per accident) $ HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE - AGGREGATE $. - DED RETENTION$ $ A WORKERS COMPENSATION WC5-31S-377540-019 5/7/2019 5/7/2020 STATUTE ERH AND EMPLOYERS'LIABILITY Y/N _ ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100000 OFFICER/MEMBEREXCLUE ❑N NIA (Mandatory - - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $100000 II es,describe under DESCRIPTION OF OPERATIONS below - E.L.DISEASE-POLICY LIMIT $500000 DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) _ WORKERS COMPENSATION INSURANCE COVERAGE APPLIES ONLY TO THE WORKERS COMPENSATION LAWS OF THE STATE OF MA. ' This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 MAIN ST. THE EXPIRATION DATE THEREOF, NOTICE WILL BE `DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE Jon Smith ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 48647555 1 1-377540 1 19-20 WC 1 n0271703 1 5/14/2019 3:35:28 AM (EDT) I Page 1 of 1 gQk The Commonwealth of Massachusetts Department of IndustrWAccidents . Of f rce of Invesfigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electiricians/Plumbers Applicant Information ) / / Please Print Legibly Name(Business/OrganizatiorAndividual):� 17/���Y (�� �t I-It - . Address: �� u R City/State/Zip• uce ( Phone#:' �� 3 Arree an employer?Check the appropriate box: Type of project(required): 1.LVJ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or p time).* have hired the sub-contractors e 6. ❑New construction` 2.El I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have .8. ❑Demolition working for me in any capacity. employees and have workers' g. ❑Building addition [No workers'comp.insurance comp.insurance.: required.] 5. ❑ We area corporation and.its 10.0 Electrical repairs or additions e ] officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ � P right of exemption per MGL myself.[No workers comp. 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. t + $Contractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. -r k- I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: �7 �J S — 7 t-1w o7 gYExpiration Date: GJ ! a Job Site Address: L ��� City/State/Zip: ` Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct Signature: Date: Phone#• ' Official use only. Do not write in this area,to be completed by city or town gfj`icial 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 inchiding 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must 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 Rd re 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 Me of investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-4900 ext 406 or 1-877-MASSA.FE Revised 4-24-07 Fax##617-727-7749 www.mm.gov/dia 6 Application Number........................................... Section 9- Construction Supervisor Name Telephone Number Address City (-Ch 4vcj State (M Zip g 1� F, License Numli'er. 4 17&�o License Type f Expiration Date Contractors Email.. ��,/ ���� c� Cell # iiP&e t-t'�� ,, C v Ln E I understand my responsibilities( rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I-understand the construction inspection procedures,specific inspections and documentation required b 780 CXIR 7anda Town of Barnstable.Attach a copy of your license. SignatureA Date L Section 10—Home Improvement Contractor Name_ C, C - Gz. G{ Telephone Number�` -7�f,_ 4, (0 (� Address 0 6�4) .city 6ew State Zip a -Z Registration Number .Expiration Date -7- I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts Sta Buil ' g Code. I understand the construction inspection procedures,specific inspections and documentation req ` ed y 80 C and the Town of Barnstable.Attach a copy of your H.I.C... k?Signature Date Section 11 —Home Owners License Exemption Home Owners Name: t Telephone Number Cell or Work Number P 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 t documentation required by 780 CMR and the Town of Barnstable. f` Signature Date P LI f AN SIGNATURE _ Signature / -Date / a� Print Name s �,- ' _ Telephone Number �3c E-mail permit to: �� Last updated: 11/15/2018 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approval Section 13— Owner's Authorization i 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) Signature of Owner date ,I Print Name 1 i i • d i Last updated: 11/15/2018 ! F Town of BarnstableBuildingMXNEMAI P0 st4Tfiis Card So,That it,;�sVisible:From,the Street .Approved•Plans Must be Retained on lob and<this Card Must.be Kept t . Posted Unt�lFinallris `ection Has Been;IVlade r: -� ;` '' i63Q. 1 R f' f :.,...,a I� w:. J. _ - t,a. .... ,. r �..�... �t Wher a�Certificatecof Occupancy is Regwired,such Butldmg shall Not be,Occupied until a Final Inspection has been made 3g Permit Permit NO. B-19-3328 Applicant Name: DAVID A.WOODS Approvals Date Issued: 10/07/2019 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 04/07/2020 Foundation: Location: 4120 FALMOUTH ROAD/RTE 28,COTUIT Map/Lot: 040-115 Zoning District: RF Sheathing: Owner on Record: PARADIGM INC Contractor-Name-,-.DAVID A. WOODS Framing: 1 Address: 22 FALMOUTH RD . aContrartor License CS035693 2 MASHPEE,MA 02649 } Est Project Cost: $ 10,000.00 Chimney: Description: roof, (2) replacement Windows Permit Fee: $ 160.00 $ Insulation: Project Review Req: Fee Paid; $160.00 Date 10/7/2019 Final: um PI Bing/G as - Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized bq 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 documeh. for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by law"sand.codes. This permit shall be displayed in.a location clearly visible from access streef or road and shall be maintained open for publl&lnspection for the entire duration of the Final Gas: work until the completion of the same. ( � • �" Electrical Tj- The Certificate of Occupancy will not be issued until all applicable signatures by the Building andaFire Officials are provided on this permit. ; � - �, � ..:t Service: Minimum of Five Call Inspections Required for All Construction Work: t . 1.Foundation or Footing a Rough: ' 2.Sheathing Inspection , ,•-� ,e„ 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). - Fire Department Building plans are to be available on site Final All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT r Application number T r,, Fee . .............................................................................. WOW OCT . ` 7 2c1sy-1 Building Inspectors Initials.........., ....��... fo INN s JML� Date Issued.*............ ...................... Map/ParceL.........i/ v I�................................................ TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/S TOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: `7`1 ZC^ iou. NUMBER STREET VILLAGE Owner's Name - a z Phone Number Email Address: Pi-R t'/'f e L(:. C� 111&, G ex-,,. Cell Phone Number Project cost$ /d GD Check one Residential Commercial ✓ �� 1 OWNER'S AUTHORIZATION As owner of the above property I hereby authorize Z�/OV 116 f��12)I to make application for a building permit ,�,inna�accordance with 780 CMR � Owner Signature: /I/� ' 2L''/��. Date: TYPE OF WORK I - Q Siding Ob'Windows (no header change)# Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review E Roof(not applying more than'l layer of s�ffigles) 4- Construction Debris will be going to r - 1 . CONTRACTOR'S INFORMATION Contractor's name--/,,�,�,y Home Improvement Contractors Registration(if applicable)# r;? (attach copy) Construction Supervisor's License# s 0a,?T&- </'3` (attach copy) " Email of Contractor /}��9• G 6 ��� �f Phone number ;77`� ? '7Z-- ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY-IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER *For Tents Only* Date Tent(s)will be erected I Removed on number of tents total Does the tent have sides?Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or>Yes No______,if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval *WOOD/COAL/PELLET STOVES Manufacturer# A11121 Model_ /I.D. Fuel Typeg —Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number 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 required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE ����Signature Date /-3 4 Alt permit applications are subject to a building official's approval prior to issuance. + The Commonwealth of Massachusetts Department of Industrial Accidents P Office of Investigations + 600 Washington Street t Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): CP�✓�G � ���� G/�'�� �`�—�z�° �'��> . Address: City/State/Zipd� �'d�r Phone#: Are you an employer?Check the appropriate box: Type of project(required): ' I.❑ I am a employer with 4. 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 h'• _ 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] t 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 1.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0oof repairs insurance required.]t c. 152,§1(4),and we have no employees..[No workers' 13. ther ` 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 the policy and job site information. Insurance Company Name Policy#or Self-ins.Lic.#:9 / Expiration Date: 2 e Job Site Address:kid ),r;;�,4f-0 y zw 0006 City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.`Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi nder the paaiins an penald f perjury that the information provided above is tr and correct Si ature: 4 Da���� Date: Phone#: 2 7 7 1'? !S(� L Official use only. Do not write in this area,to be completed by city or town official City or Town: l Permit/License#. Issuing Authority(circlelone): 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-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must 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 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.gav/dia I • , lk tcrx��tisgt.tB f?ofi�+lstarrtr� _ • Commonwealth of Mass achusetts woo;t21;ttv out 10")Zu lit 4104!"Iblive Division of Professional Lii ensgre�c,h1o�e,, yvn,fdr� tt"8)'` f :€ttlJrtc10`� r< ift2z<. ' Board of Building Regulations and Standards fq . Constrgstb6 i bpe,rvisor 4 CS-035693 xpires: 01118/2020 DAVID A.WOODS 43 MATTHEW WAY ` 'r MARSTONS MILLS MA 02648 `� f:rf,tb ns+iti" Jn�anaa.�a tas�trMe * r ..�`'� -'.1Ii'3GIL"'.,•7 t�Xi'`?�Ub�'$!fi1I'7C1.!tkf'f1lltfUS MAN,' sort»iro�il'!f 3t:ar��s�}i3x��'tot�!'�n� •� t it;ot,t+3S,��G.y{.�aMttt:i`Jt�QJS€�C��t;t�}Iti Commissioner (',(�._ � � ' .��e �i�zin�2cueu,�Z1�a�✓GcoJ�ar�iuse/%s ". i office obconsumer Affairs&Business Regulation HOME IMPROV�EMEMT CONTRACTOR , Ykr 'heb Leeb", .tr, TYPE,Individual nc+!!> isruto,«y .:pl ..b 6 bi,,v 1704,01t. x��ratiQl3 +t?9 {237alfaS _ cirstlrtXt�arfa a. 1"3 ys�f 07/30/2020 fit; cse }sts� "+airr3rD�p , 0 DAVID WOO i�' t ctt.0a'ti M4`.J 00 fff 3 c JttS A.t DAVID A WOODSfGsr » , Cl „a, ` 43 MATTHEW MARSTONS MILLS,MA 02648 Undersecretary ""`" �- .. : caxtl , # � Bu$ci9 5 5 Construction Supervisor Unrestric ted Buildings of any use group .. ,- less than 36,000 cubic f c P contain feet(991 cubic meters +� t.of enclosed space. r: . '10Oalv4 - Yl.l f Yf�lt�°Q�.r.4}• Failure to possess a current edition of the Massachusetts State Building Code is cause for revoc For information about this lion of this license. ( Call 617)727-3200 or visit wwHr,mass.gov/dpl use only Ual U id for I' ivtd to: Resi n valid it found return r. . e expiration date. giness R�iation �y�+ � p + y P r.. bpeMce of consumer,Aftatrs and Bu on Street-Suite 710 .•.,r t 10001Nashingti r,COO, r Boston,MA 02116 i 4 s r � Not valid without signatu < �•: -�� A*4 r� Commonwealth of Massachusetts ram; - .. . . - 'Divi"sion of Professional Licensure*. :. . r. Boar1. d of Building Regulations and Standards 4.F Cor{struct+oSitpardi`sor _ CS-035693 _ Ezpires:0111812020 DAVID A.WOODS ti 43 MATTHEW WAY MARSTONS MILLS MA 02648 Commissioner - .��F.' (�!.'//!/7T!'/!{LAC!/_-LI�•{.f✓I�C{Ji/I.CI{iBf�l r ' ' . Otflee of consumer Affairs&Business Regulation'" HOME IMPROVEMENT CONTRACTOR TYPE:,Individual 132361 07l90/2020 DAVID WOODS 33, Ir;t�:+.�►':,�z�:: t. t3!2 err �`L DAVID A.WOODS 43 MATTHEW WAY MARSTONS MILLS,MA 02648 Undersecretary Construction Supervisor Unrestricted-Buildings of any use group which contain less than 36,000 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 Call(617)727-3200 or visit www.rnass.gov/dpl istratlon valid for Individual use only Reg ilid o date. N found return to:ulation before the on mer Affairs and Business Reg .+ s Office of Consumer 1000 Washington street-Suite 710 . Bostong MA 02118 signre Not valid With Mass. Corporations, external master page Page 1 of 2 44, Corporations Division Business Entity Summary ........... __�___-_________.__. ID Number: 043309752 Request certificate �.._.._._._...-..... i New search Summary for: PARADIGM, INC. The exact name of the Domestic Profit Corporation: PARADIGM, INC. Entity type: Domestic Profit Corporation Identification Number: 043309752 Old ID Number: 000529257 Date of Organization in Massachusetts: 03-04-1996 Last date certain: Current Fiscal Month/Day: 12/31 Previous Fiscal Month/Day: 00/00 The location of the Principal Office: Address: 22 FALMOUTH RD. City or town, State, Zip code, MASHPEE, MA 02649 USA Country: The name and address of the Registered Agent: Name: MOHAMMAD SHAFIQUE Address: 93 MAIN STREET City or town, State, Zip code, COTUIT, MA 02635 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT MOHAMMAD SHAFIQUE 93 MAIN ST,. COTUIT, MA 02635 USA TREASURER MOHAMMAD SHAFIQUE 93 MAIN STREET COTUIT, MA 02635 USA SECRETARY MOHAMMAD SHAFIQUE 93 MAIN ST,. COTUIT, MA 02635 USA DIRECTOR MOHAMMAD SHAFIQUE 93 MAIN ST,. COTUIT, MA 02635 USA Business entity stock is publicly traded: ❑ The total number of shares and the par value, if any, of each class of stock which this business entity is authorized to issue: Class of Stock Par value per share Total Authorized Total issued and outstanding http://corp.sec.state.ma.us/Corp Web/CorpSearch/CorpSummary.aspx?FEIN=043309752&... 10/7/2019 i 77 7,777,677,77",777, a fi ,Her • '" Panted On 1215/2019 e oh ..,� ,r �.k B" t4120 F' LMOUTH ROio► /RTE 28, {�COTUIT a m � i ,t m.r rfO � x h n m r s '' CS2 C"`1� 3 1`+ R f � . s s"' k• d wu wz.",e"".R' �,,.��' ='*-°-'5�"''"�^4?§"`�9ouvAdfiRdpA 4d� +r6 e`M'f„° "t'++'r'� a 4," Case#: C-19-314 Address: (.4120 FALMOUTH ROAD/RTE Date: 5/10/2019 28j�COTUIT Owner Info: Property Info: PARADIGM INC MBL: 22 FALMOUTH RD 040-115 MASHPEE . MA 02649 Owner Notified?: yes Complaint Details Type of Complaint Classification of Complaint Method of Complaint Gas, Interior-Exterior Maintenance, High Priority Dept Referral Building Code, Complaint Summary: Operational deficiencies at Pepper's Pantry including but hot limited to (lacking) smoke/CO detectors and improper/inadequate hood venting for pizza oven. Action History: Action Taken Date Description Fee Inspector Close Case 12/5/2019 no one is occupying $0.00 carter] building and property owner has been advised to do an informal site plan review before it reopens. Inspector Assigned to Complaint: carter] Filed by. andersor Comments: Comment Date Commenter Comment 5/10/2019 andersor Coordinated response scheduled between Building, Health and Cotuit Fire for morning of 5/10119. Last Health inspection reported to be 2015. 5/13/2019 carterj on 5/10 inspection performed(Building, Health, Fire, Plumb/Gas) -improper venting on pizza oven, gas leaking for burners in kitchen area,fire extinguisher's and ansul needs to be serviced, plumbed on grease trap not to code, exposed electrical wires in walk-in freezer, illegal bedroom in basement. Gas was shut-off by fire and plumb/gas which effects sanitary for food prep so no food prep/kitchen closed. can stay open for packaged food and convenient store items. No sleeping and all bedding needs to be removed from building with periodic inspections required. x a Date 1215/2019 w aA � x�Townof,Barnstable v Para,g 2 _ .- � oFTHET ■ y �- ����� �,��� �� '� �PantedOn 12/5/2f119m ` � i w � ?•; - ;: tiw»,f ai xin h., �r�'3k,'xd�rt," x ,,.«�4 x � 2UH ROADIR�TE 8�. CO T TUIT Vol; .. "rEOMa+° � a � �b� Q � Case#� C 19-314F q Ka& r 6/18/2019 carterj Pepper's Pantry has been completely closed for business for at least the last three week. door is posted that it is closed for renovations 12/5/2019 °" r Town of Barnstable hate" " „;,.ys� mm4sa �r „atas�*.„, OWL "Asses o's office(1 st Floor): Assessor's map and of um er i 1 LT Q It I S �-i't"¢� i TN( Conservation Board of Health(3rd floor): Sewage Permit number t : Dssa�r�nct Engineering Department(3rd floor): ~moo 039. \�d° House number - �o YSY►• Definitive Plan Approved by,Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN - OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO y�Ele?�E // / 'X/gx%es u TYPE OF CONSTRUCTION'= 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 4 V Cof`I co ' / /V� /02 0) Proposed Use Zoning District / Fire District �Ci��t 7- Name of Owner 4 4�%�•� Address G/ i Name of Builder ©/SrELS Address , Name of Architect Address Number of Rooms Foundation Exterior Roofing Floors �' Interior /9- Heating Plumbing Fireplace Approximate Cost low Area Diagram of Lot and Building with Dimensions Fee /Ga X OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name Construction Supervisor's License MURRAY, WALTER No 35911 permit For ADD STAIRWAY Building Location 4120 Route 28 Cotuit Owner Walter Murray Type of Construction Frame �. Plot Lot Permit.Granted May 28, 19 93 Date of Inspection 19 Date Completed 19 '- �obae�'' i � � e� �,� �- ����k� S� ��� � �� � �.� �� �� �^ � 1 � `J .:-=: fit. 3 �x.• .,y ��• ,— - r rt (Je, dc�. w ;P' Y `Y .. Town of Barnstable ` ..��'I"E'Owo Regulatory Services Thomas F. Geiler,Director * B" MAQs B'�' ` Building Division 9 Mns . �, EnaN,O Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 (� www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# Application for Sign Permit Applicant: 7 1?/� G'�2t� Map & Parcel# QVO / Doing Business As:�l S Telephone No..-9 " Sign Location` Street/Road: r+��r/ccTl� Zoning District: Old Kings Highway? Yes/ 10 .Hyannis Historic District? Yes Property Owner Name:Sk6 { QU C moo WV622 Telephoner�`'� `- Address: fif 21t ft'14811140� ,1V14, Village: C07V ri— Sign Contractor Name: C ,C S>6AJ Telephone: 6Z4 Mailing Address: 4Z"A WAee_74"9' ' 1.221. f-fcl4l IVi s V".A, Description /✓ Please draw a diagram of lot showing location of buildings and existing igns with dimensions, location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? 0Yeso (Note:Ifyes, a wiring permit is required) r Width of building face ft.x 10= x.10= Sq.Ft. of proposed sign I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of§240-59 through §240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: � "�-' Date: � Permit Fee: l Sign Permit was approved: Disapproved. Signature of Building Official: Date: In order to process application without delays all sections must be completed. Q:I WPFILESISIGNSISIGNAPP.DOC Rev.9/I2106 Pam✓ -_/ Qp�}/�5� �f _. 7-o Pz,tr Ct/M , A �ppt� BIG A, D e. f PIZZA SCRAMBLEPUZZA', 80Ab , DELICATESSEN".. i J FU . � � ECG y .....tea.m � t I ' NOTES i RECEIPT DATE �,f 39 NO. RECEIVED FROM o h 6 L�-O Fly ADDRESS - r (.,,i 1 �? r � ' � .� rY .�9.''_�..�'t" - .. n. r�•� �,1 I � `t4 fr �� (, jt FOR." ..,; a ,1 ' ,. ACCOUNT., HOYV:PA,ID,fi,eR' a ACCOUNT'; � CASH f r 1 PAID}4 CHECK :% BALANCE` MONEYt: BY + __._...._. ,: ORDER'. ©2001 RMFORM®8L808 ' C3 •. • Ln fi For delivery information,visit our websiteat www.usps.com". f� � I UPS;-E Lf') Cert9d Mail Fee Y ue Extra'Services&Fees(check box,add tee'as appropriate) O Q�return Receipt(hardcopY) $ O ❑i4eturn Receipt(electronic) $ P1o%nlark 0 ❑Certified Mail Restricted Delivery $ =� TIBr@ 0 []Adult Signature Required $ ❑Adult Signature Restricted Delivery$ O Postage O Total Postage and Fees �J Z O Fu¢L`✓t O J 2P. 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USPS postmark.If you would like a postmark on, e For an additional fee,and with a proper this Certified Mail receipt,please present your endorsement on the mailpiece,you may request Certified Mail item at Post Office-for the following services: postmarking.If you don't need a postmark on this Return receipt service,which provides a record Certified Mail receipt,detach the barcoded portion of delivery(including the recipient's signature). of this label,affix it to the mailpiece,apply You can request a hardcopy return receipt or an appropriate postage,and deposit the mailpiece. electronic version.For a hardcopy return receipt, complete PS Form 3811,Domestic Return Receipt;attach PS Form 3811 to your mailpiece; IMPORTANT:Save this receipt for your records. PS Form 3800,April 2015(Reverse)PSN 7530-02-000.9047 i Town of Barnstable Building Department Services Brian Florence, CBO dkA &DST Building Commissioner BARNSTABLE 200 Main Street Hyannis, MA 02601 °"°° �'�1639-2014 '""""'_ 7 Y �. 1639-2014 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation(s) and Order to Cease, Desist and Abate: Mohammed Shafique,4120 Falmouth Rd. Cotuit, MA 02635 and all persons having notice of this order: As property owner or tenant of the property located at 4120 Falmouth Rd, Cotuit,MA, Assessors Map 040 Parcel 115 and known as commercial structure,you are hereby notified that you are in violation of 780 CMR, the Massachusetts State Building Code Chapter 1 Section 111.1, and are ORDERED this date 5/10/2019 to: CEASE AND DESIST all functions associated with the following violation(s) on or at the above mentioned premises: Summary of Violation: On 5/10/20191 observed a violation of 780 CMR of the Massachusetts State Building Code Chapter 1 Section 111.1 Specifically, observed a bed set up in a basement room that appeared to be �d occupied as well as bedding stuffed into the closet in the second floor office. Property does not have a Certificate of Occupancy for this use. Summary of Action to Abate Violation: In order to abate this violation and to avoid further enforcement action by this office, commence immediately upon receipt of this notice the following action: Bed and all bedding needs to be immediately removed from all portions of the building. An inspection will be required to verify the removal as well as future periodic inspections to ensure compliance. And, if aggrieved by this notice and order;to show cause as to why you should not be required abate the violation in this notice,you may file a Notice of Appeal (specifying the grounds thereof) with the State Building Code Appeals Board within(45) days of the receipt of this order and in accordance with MGL c. 143 § 100. If, at the expiration of the time allowed, action to abate this violation has not commenced, further action as the law requires may be taken. By Order, Jeff Carter Local Inspector f THOMAS H. SOUZA Attorney at Law 143 Palmer Avenue, Suite 2 Phone: 508-280-5508 Falmouth,MA 02540 Fax: 508-858-5.502 ths.law@comcast,net June 18, 2019 1 Town of Barnstable Licensin Division Attn.: Richard Scali 200 Main St Hyannis, MA 02601 Re: Ammar Corporation d/b/a Peppers Pantry/Big.Daddy Pizza Dear Mr. Scal , Pursuant to our recent conversation.I am writing to request that Ammar Corporation be added to the Licensing Board's.Agenda for the meeting scheduled for July" 8,2019. The reason for this request.is to provide the Board with information,reg_arding the l proposed renovations to take place as well as an estimated re-opening date. Thank you for your,consideration and kind.'assistance: l 1 S r Thomas H. 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F-r \ yp U , 22.u �� 'I o 2G.o �UI� Awns 4 So,C 721 Te e.,v.g, ys't J� • y9 o° a U ,�Fa.Do - Tov yvD e, s 5-0-o c,Y,37-X1v 0—.s y�S • CERTIFIED PLOT PLAN IN ELr►�rgTi� .s g�se� o� AsSvMr� C�7-u MASS. Bcin/cj C oT 5'7 a.v PGi9ry QK a 8 2 Pl 17 X/S Tily 9f �i�o f'o$c 1J �l'iQit'Dc S ro /�ti<YIA cSSE�T/�«y 7W S,a47E IRA R.TH4CHER,JR. REG. LAND SURVEYOR SO. YARMOUTH, MASS. iAGE�-T' 3oA2D or iyE,�c�hy- _._ DATE _ SCALE. =30 DRAWN BY //LT. x SHEET / OF Z-- `tH OF y of M.4ss� I CERTIFY THAT,THE >� RIaARD IR °y 43�1c Di'vy -SHOWN ON THIS PLAN oQ. 'HEAR ^ CONFORMS TO THE ZONING BY- LAWS ,p OME69�N� v+ i _v w JR. OF THE TOWN OF ` 8i9 evsTi9gzE ISTEP� p .23214 O gND:s u iti --o - - - -4 REG. LAND SURVEYOR TOWN OF BARNSTABLE HEALTH INSPECTOR'S OFFICEHOURS: Item No. In the space below describe all violations checked. Page_of BOARD OF HEALTH 8:00-9:30 A.M. 367 MAIN STREET MON.-FRI. HYANNIS,MA 02601 79D-6265 FOOD_ESTABLISHMENT INSPECTION REPORT Establishment Name Z P/t.Qi✓� Q Vt�Y Date Z 3 ®(e: t/4 (i(-1 v �.4� ;t j q 6 Address --1,0 Flk wtOv�1�k ! 6-.4-k 4- Ir7 (out Telephone Type of Establishment Purpose D Food Servicet 3 - -iv 1 �t .Q d b�. /• -V v. Routine Owners Name T. /1/JG.Z' Retail Food Follow-up Residential Kitchen.Mobile Unit Complaint "CIO t l (,�,t 1 V+ y Person in in Charge UnitInvestigation Z rZ.� W (u V4 Temporary Food Service Oder Inspectors Name y✓t 6v- Caterer Based on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000.Each item is followed by the applicable section of the Massachusetts regulation.Non-critical violations are marked under column'N'and critical violations are marked under column'C'.Descriptions of each hem appear on the back of this form. Each violation checked requires an explanation on the narrative page(s).This report serves as official notice of violated provisions and official notice to correct said violations. 0 Z t Food N C Wr Sanitary Facilities N C Wr 1. Food Supply .062 4 29. Water Source .015 4 2. Food Containers .002 1 30. Sewerage .016 4 _ Food Protection 31. Cross Connections .017 4 3. PHF Temperatures 004 4 32. Toilets/Handwashing .018&.019 4 4. Facilities,Hot&Cold Storage .004 2 33. Insects/Rodents .021 4 5. PHF Re-service .006 4 34. Plumbing .017 1 6. Spoiled/Damaged Food s .003 1 35. Toilet Rooms .018 2 O ( {e 7. Food Protected .003 4 36. Handwashing Areas _ ..019 2 8. Food Thermometers .004 2 37. Garbage/Refuse (j1' J -OK .020 2 9. Cross Contamination .005 2 38.`Outside Disposal .021 1 10. PHF's thawed,cooked&cooled ` .005 2 39. Outer Openings .021 2 11. Food Handling .005 2 40. Pesticide/Rodenticide Application .021 1 12. Dispensing Utensils .006 L_j1 Physical facilities Personnel 41. Floors .022 2. 13. Employee Infections .008 4 42. Walls,Ceiling .022 2 14. Employee Hygiene .009 4 43. Lighting .023 1 -" 15. Employee Clothing 006 �- 1` 44• Ventilation .024 2 °quipment&Utensils _ 45. Dressing Rooms _025 1 16. EEquipment/UtensilOthertensil Clean&Sanitized .013 2 __- 17. Food Contact Surfaces 013 1 46. Toxics •.026' 4 -- _ 18. Non-Food Contact Surfaces .013 1 47. Premises .027 1 19. Food Contact Surfaces Clean .013 1 48. Living Areas .027 1 20. Non-Food Contact Surfaces Clean .013 1 49. Linen .027 1 !1. Wiping Cloths .013 1 50. Pets .027 1 Discussion with Management !2 Dish/Warewashing Facilities .013 1 51. Bulk Foods .031 1 T"At V i CL. t O t! v' j Ca 4.9- - d° !3 Pre-Scraped,Soaked .013 1 52. Salad Bars .032 1 LlV- ��� F -✓ - �, _ a '.4. Wash/Rince Water .013 1 No.of 13 Critical Items Violated ` 0.rf ' 5. Thermometers rest Kits .013 1 2 SLInV l, !6. Equipment/Utensil Storage .014 1 These items require immediate attention. Z F. S��k V s �. (�• (r t�� jt 7. Single Service Articles .014 1 !8. Single Service R se 012 1 SCORE 'ermit Posted? Y N Grease Trap Previous Pumping Date Grease Rendered? Y N Seats Observed? h Frozen De err Machines: /V Outside Dining Y ✓N ,elf Service tArait Service Provided Variance.Granted Y -.1"N Variance Letter Posted Y N Inspected by VL - Received by / ` TO TOWN OF BARNSTABLE HEALTH INSPECTOR'SOFFICE HOURS: Item No. In the space below describe all violations checked. Page of BOARD OF HEALTH 8:00-9:30A.M. 367 MAIN STREET MON.-FRI. HYANNIS,MA 02601 790-6265 a Z 3xto FOOD ESTABLISHMENT INSPECTION REPORT Establishment Name Ztfj Q L�J Date me: Address U r` (w;,�v�/t., GO Qiv`r-� In out l 1 Telephone Type of Establishment Purpose /, l Food Service Owners Name �(+ Retail Food Routine Follow-up Residential Kitchen Complaint Person In Charge_ Mobile Unit Investigation e_ Temporary Food Service Other Inspectors Name ,,E¢�.��. a// 1 Lvt� 2.S- Caterer 07 3ased on an inspection today,the items checked below indicate the violated provisions of 105 CMR 590.000.Each item is bllowed by the applicable section of the Massachusetts ,egulation.Noncritical violations are marked under column'N'and critical violations are marked under column"C'.Descdpfions of each item appear on the back of this form. Each violation chedurd'requires an explanation on the narrative page(s).This report serves as official notice of violated provisions and official notice to correct said violations. Food I N C WT Sanitary Facilities N C wr t0WG l it .1. Food Supply _ .002 4 29. Water Source .015 4 f�� 2. Food Containers .002 �, 1 .30. Sewerage .016 4 =ood Protection 31. Cross Connections .017 4 3. PHF Temperatures .004 4 32. Toilets/Handwashing .018&.019 4 4. Facilities,Hot&Cold Storage 004 2 33. Insects/Rodents t .021 4 5. PHF Re-service .006 4 34. Plumbing .017 1 6. Spoiled/Damaged Foods .003 1 35. Toilet Rooms .018 2 7. Food Protected .003 4 36. Handwashing Areas .019 2 8. food Thermometers .004 2 37. Garbage/Refuse .020 2 9. Cross Contamination .005 2 38. Outside Disposal .021 1 10.'PHF's thawed,cooked&cooled .005 p 39. Outer Openings .021 ; 2 - 11. Food Handling .005 2 40. Pesticide/Rodenticide Application .021 1 12. Dispensing Utensils .006 1 Physical facilities lersonnel 41. Floors .022 2. 3. Employee Infections .008 JU 4 42. Walls,Ceiling .022 2 4. Employee Hygiene .009 4 43. 'Lighting .023 1 - S. Employee Clothing .006 1 44. Ventilation .024 2- a/ t G -quipment&Utensils _ 45. Dressing Rooms .025 1 -- 6. Equipment/Utensi)Clean&Sanitized .013 2 Other 7. Food Contact Surfaces - .013 1r 46. Toxics .026 4 8. Non-Food Contact Surfaces .013 1 47. Premises .027 1 9. Food Contact Surfaces Clean .013 1' 48. Living Areas .027 1 .0. Non-Food Contact Surfaces Clean .013 1 49. Linen .027 1 1. Wiping Cloths '.013 1 50. Pets .027 1 Discussion with Manage ent U JJ ) Vj 2. Dish/Warewashing Facilities .013 1 51. Bulk Foods .031 1 act) r IOW -1 -F C CA,- 6 3 Pre-Scraped,Soaked .013 1 52. Salad Bars 0 1 In ~4. Wash/Rince Water .013 15. Thermometers/Test Flits .013 1 No.of 13 Critical Items Violated - a.anrv-l. -w . Gz6. Equipment/Utensil Storage .014 1 These items require immediate attention. wo. 6<-t� eX 0'L c w V7134' SM7. Single Service Articles .014 1 tL C h - 8 j $ a -0I.e. 8. .Single Service Use .012 1 !1 YQ° n _ �p SCOREermit Posted? Y N' Grease Trap Previous Pum IIng Date Grease RMered? Y Ni IQ Seats Observed? Frozen Desert Machines: AA Outsid Dining Y �Nelf Service Wait Service Provided A/ Variance Granted Y �N Variance Letter Posted Y N ted by Received by J , .ate': - ='�•f 'k^. - — i- - - y.' e - - .��.�'� �a�-•....-rJ' T+Y.� ..i•x» - >-t :fir :.•s - Y- :_ - �'ry�" "'E -:y. r "'-: t,' a „'2. C;:sx+t-a .. c '�9. y F _ Y _ - 4 AST - .... ; ... ARM I MOW ; r - FT _ 2. "L ? S.Es PT 4 C T.At�t F 4� s r ;1��55>�•�awTl6lc.f - -C►vT't_.'�S b t•�T 2►[3l!Flt��( _:.F3 d X._ � ?`-� Fr �" - - - r Aid , � f t _ 5,c <r- 49: .. ��"CVf-S>'_ •�1��. b SAP"t"�L -�"T��� � - - •' _ _ /000 C ALAC L Ai :';:y n .s_�. -C� rf:tg, r ��. 3_:� ��.r t �.d����~ �!`4µ3 •z-.c. r -a�-k.. i3 J.•'. -a-.... `-3? �..t .r., 44i�g• _ '1�sGe?,'� �•3-i.rti s.a•i aae.:.�LY,�,--,y.Y'y�'�, .,T _"� `-' 1�,�`��_.tom, �'� 'i r`t.t. sr.�- �,�; � _ '�4<, �, •f �� - e. *�"�G> O �mac.�'�• �=. ", n •u A oil! y. $ , r a.. 4 _ i �.•G' F �f 77. 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G : i�o G�� �000 � . �+F lc_ T pY.« IIIr; FAC'X'G�' ��12,_r-- oF•' S>v r�L':: its- et�•CS.T'T o 1-t 1=a-EE A 1;'•i L 6. "4 ' t7tca HA.NNOLF cizr;art� c;ti1Gi� Tom. 4, SG O t . K coy�.e s P-1Aw14oL •2 '7P :N In 40 WAl � t u S Ey•�P`1�^►G rp � r stir. I � � , J ''s F u•f t r t � :' �•�. �7•- � G R 413.A,1 D -w r �?���� .+i � r 2,er�ep•tfy� jtti! t.� - A+ ! $��t� .? I 'tr1=P - 1 S 1 � t . ... rye I k<.� tL S s NO,• �EG•UC .4 T OAI S lk _ • �'•�3�1�'�,�+�r Sew A'�E `S'ys';7 Jx�-Z o o,gTEo hro • F. N4..f1,�' ..SoS Fns.... ... ....n..... THE COMMONWEALTH"OF MASSACHUSETTS BOARD OF HEALTH '- 70.1/t/n/..........oF... /2N5'T/3 .��-�...................... AVVIiration far Di,sp,ial WnrkA CInnotrur#ion Vern fit Application is hereby made for a Permit to Construct'(,)(') or Repair ( ) an Individual Sewage Disposal Syst t- t//LO T _ . .T.. .... ...1`..... i.._r1 ._. /1G / T �.�1 ...¢. ............ ---....----._.........._...... Location•Address or Lot No. .....QL.1S1_S_.....h1.142T............ .:................................................................................................. caner a ................. ... __�... - p� c . Addres s r �..f......._....._..._......._._ _..._......._...................._ .......... ................................. .........Ins Address 6 Type of Building Size Lott?f--lOQ....Sq. feet Dwelling—No. of Bedrooms.........:.................--......_......_Expansion Attic ( ) Garbage Grinder ( ) Other—Type of Building ,.._....._. No, of persons.................... . Showers ?+ YP g ...-•---..._._... p •-•-••- ( ) — Cafeteria Other fixtures ....................................e. /nd... ._................................................................................................ WW Design Flow..........7C........................gallons per ts&day. Total daily flow.......... .t....................ga�ons. Septic Tank—Liquid capacity/,PIP .gallons Length..iC-4....Width¢!�,�V.Diameter................Depth...6,-_'..? Disposal Trench—No.....................Width..................Total Length...................Total leaching area........:...........sq.ft, 3 Seepage Pit No......../.......... Diameter..../0......... Depth below inlet..... ...........Total leaching area....Z.lo..I.sq, ft. Z Other Distribution boic V) Dosin tank ( aPercolation Test Results Performed 4T/JL.f.�....71Y..1�/.._G.'.!-`t19?5?-....................... Date.. ....$ y 1.1 Test Pit No. I---<.::...minutes per inch Depth of Test Pit....1.44:... Depth to ground water....... k. Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water........................ P4 ................................................... ......... O Description of ..................................... ................. U ................_.........-- ¢..-.�4...4..... `t�e4i�l.......147.F.o.. �oRrzsF.....�'�9NILt....................................... UW ............................................:.................................:...................... ........................... Nature of Repairs or Alterations—Answer when applicable........................................... .......................................................................................................................................................................................................... Agreement: - I . The undersigned agrees to install the aforedescribed ,Individual Sewage Disposal System in accordance with the provisions of TITLZ 5 of the State Sanitary Code—The undersigned further agrees not to place the system in operation until a Certificate of Compliance has De s the board of healt �c nod-/ .................. . .'.�?�`�... ............................. ...•.�.. Application Approved By...... G% �o�.............. :........... /•,�� �1'�........:._. Date Application Disapproved for the following reasons:................................................................................................................ l - ------------------- Date .. PermitNo......................................................... Issued-•.._.._.............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH .........r a,,,,, 1 TV'rtifiratr of ( =43fiantr THIS IS CERTIFY That th I iviflual Sewage Disposal System constructed (�) or Repaired.( ) by......................... �.......... .. . -- .... ......................................_:....__...._........_..._.._....._... Installer-... at...... ....2-�....------ . .................•-- has een ed in with rovisions of of (�•- r ...........................................the application foc11Disposalc\IVorkseConstruc on Permit i\,o..r� SO.SThe State Sanitary Code as described in THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE CONSTRUED AS A. UARANTEE THAT THE SYSTEM WILL FUNCTION SATISFACTORY. DATE........................1-!_//VZ1................................... Inspector-.�....d. . r'....v u..........._......._...........__.._..._ THE COMMONWEALTH OF MASSACHUSETTS - BOARD OF HEALTH p vim✓ FEH..Ik............... �ila�n.�tt1 nrkl� �nn,� ur�inn �rrmi#'� Permission is hereby granted....---•--._._.. _....__..... �. ¢...............................::.............................................. to Construct or Repair ( ) an In dual Sewage System atNo ... .. ._..._......_.._�ca................. .... `l../.... A.. ................................................ St reet as shown on the�aplcation for Disposal Works Construction Permit No..................... Dl ted..............................,........... : , -- �. DATE. q16 roc xeatlh' FORM 1255 HOBBS & WARREN. INC., PUBLISHERS - ' ` ` ^ --*�-----^ Fuo . THE COMMONWEALTH or'mASs^c*uscr`S . BOARD OF HEALTH ' .......................................op-- ` /� �r ~^ " - 'VV-___- for --~�_-,� ~~n~°° = m�urtwn Application is hereby made for u Permit to Construct( ) or Repair ( ) an Individual Sewage Disposal System ' ` . . Type of Building Address Size Lo Dwelling �� n� ''q--'-- -- Other—Type � ouuu�o �u d Garbage � __ �= ________. Showers ( ) -- Cafu^bu � Other fixtures Design ~allons-- '- ,---,- -, -~~ ... ..~ rea � 3�nxoe Pit No i -���tU�b�m'tz------' o�u o�m,i��----_�Tmu\leaching` �. ra-___-� ,L. osq. - ' � m,,umrmuuon�oz ( } omion�nk ( ) ' Percolation Test Results Performed by Date � Tot Paxu /-,-'-'m�u�sp��a oc�h � Trm�h-'--_ Dcmum �ou,u °�^r..��--_--' ^ � Test Pit m" z................minutes per inch Depth of Test Pit.................... Depth.m ground water---_--- ' � -------------- ----_--�_------- . DescriptionoJ Soil........................................................................................... --`_--'_--_-�,--_---_-. ' ---'------------_-----_-----_------.---'-_-_--.------_----- � '---_----'-----`---------'-------'--- . u Nature of Repairs or AlteVtions—Answer when applicable......TZ -------L... ./ Agreement: The Undersigned agrees to install the aforedescribed Individual Sewage Disposal System in accordance with the provisions azI��� 5�� S Sanitary Code � .^~ " "� "",mn �vu »�c m�a��m� ^ � operation until -Certificate of Compliance- has beenea qssue ' �- Application _ . . `~ ' Date Application Disapproved for the following reasons:................................................................................................................Date ( Permit ` ' . ... �� -' ' _ rxscnmmow,v�^�rxorm^ss^c*us�rrs . . BOARD OF HEALTH r ' of ' Toutpliatirr THIS zST0 CERTIFY, That the Individual Sewage Disposal System constructed/ by " - has been installed in accordance with the provisions of TITIE 5 of,The State Sanitary Coo 'us described in the ' application for Disposal Works Construction Permit No--.. ......... dated............................................... THE ISSUANCE op THIS CERTIFICATE seACL NOT us CONSTRUED AsA GUARANTEE THAT Y*s | sYaTsm WILL pumCzzpm sAT/ssAczmRx / ' . ` D"^ . .. ' , ' THE COMMONWEALTH orM^ss^cHussrrs 'BOARD OF HEALTH �c OF to Construct or Repair an Individual Sewage Disposal System Street 2 FORM 1255.HOBBS & WARREN, INC., PUBLISHERS ' ` ` . . - ' . I r - - - -- ;A9P?MLT puce s r c�T I � 1 .1 13 01,/ f ( Lh-�uiST 9' I o!SJ-. -30 1 2." CDX45H TI-I c�l. -- 112 tJLc * o0 a 0 -- S EC TT 10 �z P EF-7r,- GAT U T, .. SCALE: b APPROVED BV: DRAWN BY: x DATE: ,�2-9 REVISED A GL`LI�I��' I t'--�'rGl�l;=� I l•.j ��Z,jGi�i��T'. DRAWING NUMBER 1 TOWN OF BARNSTABLE SIGN PERMIT ' J PARCEL ID 040 115 GEOBASE ID 2543 { ADDRESS 4120 FALMOUTH ROAD (ROUTE PHONE i COTUIT ZIP - I LOT 47 ,BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CT 1� PERMIT 61005 DESCRIPTION PEPPER'S PANTRY — 6' X6' - PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $50.00 BOND $.00 Ox CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE EAwvsl'ABi.E. MA83. !!� s639. A1•� I BUI DL ING,,DI,'VISI a BY DATE ISSUED 05/09/2002 EXPIRATION DATE ` I ' r Town of Barnstable bd� yea ti� Regulatory Services Thomas F.Geiler,Director snxxs•rastX, 9� MASS. Building Division 039. iDrEn .t°' Peter F.BiMatteo, Building Commissioner .206 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Tax Collector Treasurer IA-L X �A 29 cZos C`�Cexarl LatE for Sign Permit Applicant: Assessors No. AVL' J Doing Business As: �, �� Telephone No. � Sign Locatio \Ajn Street/Road: �2� �,� 2� C$ 4�A M4 < ®Z(os S Zoning District:_Old Kings Highway? Yes To)Hyannis Historic District? Yes/V Property Owner Name: '4t-EX /�r`(Zgi c'6� /OCe at l My+(Z`T .L LL Telephone: 506_ Lab--)aso Address:4-1 l?-0 IP-Ae Zb Village:_LoA--3 A- L jlj\A 0,;2. L 3 Sign Contractor a Name: ` ' t 4M rUJ Telephone: Address: Go> 003 A Vm/V t;7 ' Village: Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? 6po (Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to.make this application,that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: Date: O Size: Permit Fee: l O Sign Permit was appro ed: Disapproved: Signature of Buildin Officia Date: O �► Signl.doc rev.122801 4w1. =iC7j'j\ plysignco@capecod.netP*no&IA Sign Co., Telephone (508) 398-2721 www.plymouthsign.com Iao. Sino® 1956 Fax (508) 760-3130 '-e � �-s TA107T(1-i 'bow A-o \-Z. ��rp 0(Av C Post Office Box 134, 63 Old Main Street, South Yarmouth, MA 02664 y (508) 398-2721 Telephone • Facsimile (508) 760-3130 plysignco@capecod.net • www.plymouthsign.com _ TOWN OF BARNSTABLE / ' OG=� G��e.� BUILDING DEPARTMENT COMPLAINT/INQUIRY REPORT D e o� Rec 'd _B """-'-- --- Assessor's No ast ame '/� ��� First Na a ORIGINATOR Street Vila e State Zi ele hone: Home r17 Wor esc i t ' on: ._4--100M'LAINT -L NQUIRY Requestor's Signature •y/U " COMPLAINT Street Address LOCATION GL OFFICE USE ONLY INSPECTOR'S Date ACTION/ Ins ector COMMENTS � �D��/ FOLLOW-UP ACTION ' _ADDITIONAL INFO. ATTACHED COPY DISTRISUTIONt WHITE - DEPARTMENT FILE PINK - INSPECTOR YELLOW - INSPECTOR ' (RETURN TO OFFICE MGR, ) Misci I 1 . r 4 05 HOLAF-01US6 I a � n x f � . _1 1 ' 1 ,F 4 05 POLAROIUO6 4 r yOfTM[tp _ .. 4' The Town of Barnstable '" who ISTAM ' Inspection Department 367 Main Street, Hyannis, MA 02601 508-790-6227 Joseph D.DaLuz Building Commissioner TO: Ruth Weil, Assistant flown Attorney FROM: Joseph D. DaLuz, Building Commissioner i SUBJECT: Zoning-Opinion/Pepper's Pantry A=40 115. 4120 Falmouth Road , Cotuit DATE: March 27., 1992 . It has been°.brou` ht t o m att ention 9 that hat approxim ately Y eight i (8) wooden picnic tables and. benches have been placed at the rear of Pepper's Pantry adjacent to Pineview Drive. The tables are used by patrons of the. convenience store. Prior i to the placement of the tables/benches the area had thel appearance of a "'pine grove" and to the- best of my knowledge was unused. As you know, the zoning in the area changed from Business Limited C to Residence F. Would you consider the tables/benches an extension of the non-conforming "small retail business common to a residence district"? 4 k r LOCKTION -- --- ,,,rcY NO. VILLAGE 77 DATE APPLICANT ADDRESS FEE - TELEPHONE NO. ' (Non-refundable) '.ENGINEER _TELEPHONE NO. DATE SCHEDULED (Applicant's signature) SOIL LOG SUB-DIVISN NAME = DATE_ -, 7 TIME EXPANSION AREA: YE ENGINEER ?: TOWN WATER PRIVATE WELL BOARD OF EIEALTE EXCAVATOR SKETCH: (Street name,etc. ,dimensions of lot, exact location.of test holes' and percolation tests, locate wetlands in proximiky to. test holes) NOTES: SI. �Ciu vfr Q. ( PERCOLATION RATE: TEST HOLE NO: ELEVATION: TEST HOLE NO: ELEVATION: 1 1 2 2 4 4. 5 5 6 6 7 7 8 8 9 9 1.0 10 11 11 12 12 13 13 1 14 1415 C, 16 _ 16 SUITABLE FOR�UBLStf FA - KGE: LEACHING FIELD LEACH G PITS__ LEACHING TRENCHES UNSUITABLE FOR SUB-SURFACE SEWAGE. REASONS: NOTE: ENGINEERING PLANS MUST SHOW NUMBER ASSIGNED ON PERC TEST APPLICATION N1 ORIGINAL: COMPLETED IN"ENTIRETY BY P.•_E. AND RETURNED TO BOARD OF HEALTH COPY: RETAINED BY APPLICANT .vV d�v 3'U 4 S Ll�j x W l h�`7 S{�uw;e I � I 0 � r vv t y pow ! IV' �ALcaNy � I'7 . v 3� 4Gt3;3 Don2 kN¢E w4a WALLS R-II kR/fF+ F/IC£ c,f�,Ndi 2-19 . k/ rs LO 1 s��dcrt w ;LNy WaNy Ec o FL VC�rZ ALum -FluinEn �_ � TNt�eirre ISM + S,wKit 3a OeruL SANK 0 / V, N e�eslu w CASE �OL irLt FLeore I .3"b" FIRST FLOOM F i y wau s Nxy 1-rl? PoSJS n Q Q Fnctd ,N 6A,-I i2ec 3' ', _fit- a VV qt K ZN . COOLER a. � .. r u u-e� THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / �C(�'J LI DATA i I y -7 v a , Chi vS i � A o� 7° ° Ui ILI o �ne log zo' Tts soiI 8•Iy.BI �� V ' I . T1F�Ep p ,�ri�t-'S vd CER aT u smear �LCY 7 01 �X � pro. iRA •THE �L�.VpgT/ores $ 5� R `i °P NY r /1r s RED, LAN �����cy y�`'m SO.YARN 70 - o DRAWN gY G D IIV . OF MA ��� sgcy S T� �P�SN OF Mq� CON THE TO\ sycy o �R OF a JAMES p HE RN v+ 023214 O 0' tu.694@- �f �FGISTE SZ� qNp,so TOWN OF BARNSTABLE Permit No. ----------_--------- l ��n.� Building Inspector cash --------------—------ -— �^e �aVal OCCUPANCY PERMIT Bond "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address •3LG 1*40l'i;iI :ii [ .7L�yS�YIIL1Lu:.i Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ...................................................... I9..._._ ................................................................................._.............» .». . Building Inspector -'A 6- 4///mil00 Assessor's mdP and lot number ........ ...... the r '4- � Sewage Permit number .S.0, .................................... gybe p� d o f� i7�����i T t7�C B9 B5TADLE i House number "/..rdF-/✓7 �V y� INSTALLED INA pMAIa�9 TOWN OF BARNSTA TUE'�....= ._ BUILDING INSPECTOR i L . /02 APPLICATION FOR PERMIT TO ..............R�..2`..�i..........'........................................................................................ TYPE OF CONSTRUCTION ..... .................. A4 .. ....����� 5� /Z .............................................. 19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accord* to the following information: ` // 4 U7/Location ........... .00..J`"5 i....... .8. .. ...... /�'% i� - �� rl. !`.�. .... ... ...�.1..a/� L, A1D11VG �u�cc �AAe7r ProposedUse ............... .............................................................................................. Zoning District ...........1.`1...! ...=C...................................Fire District ............. 0./.v/.. .......................................... Name of Owner ....... 9 1 A (/&.......��nl 7........Address ............. .. ..... ........... .......... ... ......................... Name of Builder ........95;. /......—57..16i 61..T.....Address �j �i71Ov h Name of Architect ........al/W.....s�F.�7....- . ......Address .....................`......................................... ................................... Number of Rooms ... �i�dD�Z..Foundation ..... ./ Exteriorr �-rl T� 454.... fl g ...............�.�. P'04'4. ....................................... Floors ...... ...........Interior .......... f, � ..�... Cr Heating r�'> .. ./...'" ../..�.: ................. .Plumbing ......�..4��f ..�f.....�IQ..Cl1 Fireplace ........ ...................... ....................................Approximate Cost ...........................1m. .............r........ ....... Definitive Plan Approved by Planning Board ________________________________19_______. Area ..../lam- '. ........ ... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH /V b r1A I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction., Name C............. . BENT, ARTHUR Build No . ......... Permit for .................................... Retail Store /Commercidl Lot 4147 4120 Falmouth Rd. tkLocation ...............�.*............................ ................... Cotuit ............................................................ .................. • � ' f i f . . � 1II W,A ..0 Ar Arthur. Bent . ... ............................................................. Type 4 f-.,I Construction Frame .......................................... ...... X, .............. ......... ................... Plot ............................ Lot ................................. -.00or October 5 81 Permit Granted ..............................,..........19 Date of Inspection/® ..................19- Date Completed ......... -:,;K"g 7 1sx 1' eq PERMIT REFUSED ol ............................................................. 19 ...........o......... ......................................................... ...................... ......................................................... t ............... ...... .................................................. ................ ........................................................... Approved ................. ......................... 19 ve ............................................. ................................. ................. .............................................. .............. Assessor's map and lot number ............................................... of THE To Sewage Permit number ...... ................. •?� � Z BJSTADLE, i r House number ........�/a2 8 l` r�f/ �,�, d 9 BHN a1639. - a YPY a' TOWN OF BARNSTABLE /„� BUILDING INSPECTOR APPLICATION FOR PERMIT TO / ! ........'5�_/�/� - .................. .............................................................................. TYPE OF CONSTRUCTION ............................I.;(,T A A F?.l.. A&Sr1.11:A e i!.............................................. ......19.& TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: L)i(� ! Locations........... ....... �..... ......k�. ,s.A ......( .....4.........�`"rT�/a..... ��f..... .�.'!9ll LA1�1111 ¢u<cC dsf�t1T" ProposedUse ...............:/;�„s x`„i •.i. ... ... .. ................,. ................................................................................. Zoning District /��...4_77.f....................................Fire District ............ f2./eX.f........................................... Name of Owner .......;/g l.�� (e.p... ....../-!1?W IV. .......Address .. ..... ........ Name of Builder ��/ ?1....... rr �! ..T.....Address �/ . j�l�v�h ................ ............. . ........... ...................�. ........... .. ... Name of Architect ...... ......Address ................. ......................................../.�......... ........ Number of Rooms iN. •lGor�..Foundation ..... .WW1,_,? 4AV ... r'Jv'� �......... r Exterior s 1 iTf �C�!✓Roofi g� ��'�� ....................................... Floors ...... /cr.. s, .-1 ,,...: s>s.i�a............Interior ..........��5"��f Heating ` , : ..., .i, ' T..,.. ' '`'.... ...................Plumbing ........... /,17a/-� Z Fireplace .......I.A/ ..........................................................., Approximate Cost ........... ... .. ....... . . .......... Definitive Plan Approved by Planning Board ---------------_---------------19________. Area .... !5..... �............:. Diagram of Lot and Building with Dimensions Fee , y e I SUBJECT TO APPROVAL,OF BOARD OF HEALTH 71 y I.hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .... ........................ BENT, ARTHDR � ^�33532 B��ilcl '~" —..�---. Permit for ------------ Retail S ' ' ���----------������/—�������������— Location .....Lot...#47....4l2O..J7AI/DPII.th..]lozacl ._____C�t�it____.____�__.'.__.. Owner ........Ar '8��t------.---- ' Tvpe of Construction ............................... ` . ---------.----------------. � Plot —.-------� �t,----------.. ' Permit Granted —0otobez`'5�---.lp 81 ' Doh* of Inspection ------------lA ' .Dote Completed ------------'lg ` . � � - ^ PERMur REFUSED � . � .......................................................... lV - , —Av�^x..ox�x.x^x»..��,�+*=--�^o�.��.a��--. ' � � ------ ...................................... � / ------() . '--------------' ' � ---------~—.----.--.—..----.— Approved ............................................. lg � ^ ---------------~—^--'------' � .............................. ' 'u «,, YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business.Certificate that is required by law. DATE: j. ?V 141 Fill in please: APPLICANT'S YOUR NAME/S: ArrrrnGrr/ C� rG/ i�7�1 BUSINESS YOUR HOME ADDRESS: V 2 62 Gr� �rTl/ �i,�<,d; Zc' I-z-/` �1'r,4 3-49-gib-4/7 q TELEPHONE # Home Telephone Number I NAME`OF CORPORATION ` NAME OF N1A/BUSINESS r,'S° cvvt i^ TYPE OF:BUSINESS IS THIS A HOME OCCUPATIONS YES NO: �r AODAESS OF BUSINESS '�1Z'! `�rcrn's : eoa! Cy� MAP PARCEL NUMBER yD/l Assessn When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSI LERrsOFFICE This individ al s e an A�mit quirements that pertain to this type of business. A th rize Sig a ** l COMM NT l (' 2. BOARD O HEALTH This individual has been informed of the permit requirements that pertain to this type of business. w Authorized Signature COMMENTS:. 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: ----�--- -- --_� - i i 1 v �.. YOUR WISH..TO OPEN A:BUSINESS? Far:Y.our;lnformation! Bus�ness.Certificates cost $40"OO for.�l `y EGISTERSS YOUR NA 3. 72- n VUHIC.H YO. ears A;Buslness Certifieate ONLY R ME m the. Tow (, U,-MUST Du acco.rdin .ta,XQ L ;it does not eve,: ou ermission too ,erate You must.first obtain the necessa_ J 9 Y la p > rY s na'fures on #his,:form'at 2QO,:Main.St H"annI" Take the 'Com feted form to the Town Clerk s Off ce 1' F.I: ,367 Mam'..S# H 'annis 9 a Y p t:• .Y MA TI2.60.9.(Town Hall) and get the Business Certificate that �s required by="Taw DATE /2 S� Fill m please APPLICANT'S YOUR NAMEICORPORATE„NAME.. �I'._ �-� BUSINESS TYPE: CeruetA�G`tC.t S trS :BUSINESS; YOUR HONII=ADQRES5� .2.2 �F" tu�t.ovf-t,, .: ROC 1 /4 51�9 a� TELEPHONE # Home Tele"hone Number -. NAME OE NEW BUSWES9 c. �{-r OR EIN Have you been?'gwenpproval from me budding tlrv� ,,en2 YES_; NO ` _ ADDRESS OFBUSINESS'�,IZO °`�e�wvtou 'k Roe.d MAP/PARCEL NUMBERC��f U11hen startm ':a new�business=there areseveral thins ou-must-do-44`..o r to be in coin :fiance with`the rules and re ulations of.the Town of<9 9 Y . p, 9 Barnstable This form ts, mtended:t0 assist you ►n obtairnng the;information;you may need You MUST GO T0.200 Main St (corner of YarmouthtRd, 8 Main Street) o;make;sure;you;have the.appropriate permits and licenses-required to 'legally operate your busRness i.n this town.; 1 ,- BUILDING CO IS 10. R'SOFF This tndivid alb s _.: n in#o d'` ny erm ,requireme is that pertain to this type of business: ,ut. 'razed: ignatur :_ ' C.UMMENTS /. .� 2 BOARD OF--HEALTH This individual:ha be �nfo ed,of the permit requirements;that pertain to this type,;of business_.;. �. tho i e' Si "* COMMENTS:t �.� .. LZ ��i 5 .VI tR �1/II C ( CENS G AUTHORITY) ' 3. CO Th iOhd vAiduaA as L.I n inf.f „the lice nsing;requirements::ahat',pertam:ao,this type of business _ Au, o�ized Signa, re** i:COMMENTS;r /I ;: . TO ALL NEW BUSINESS OWNERS DATE:2�0606 Fill in please: q APPLICANT'S '" YOUR NAME: V1J U-,4A4 BUSINESS YOUR HOME ADDRESS:39 �. 6%� �. 2-6 TELEPHONE � � Telephone Number Home s%--53 -2 NAME OF NEW 6USINESS { 1 � P TYPE C?F BUSfI�ESS . :� t IS THIS A ktOMI~ OCCl1PAlON? Y>~S O . Hayti yob been given ap rQva[fralm the bu�id in dEv'1s1or0J11i!!YI=S NO ADDRESS.,CJF BUSII�IESSNi ✓�nA :: MAP/R�IRCEL When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in,obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor-Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St.- (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER'S OFFICE This individual ha een inform f any permit requirements that pertain to this type of business.2 Authorized Signature* COMMENTS: 2. BOARD OF HEALTH This individual_has en informed a rmi equirements that pertain to this type of business. orized Sign ure COMMENTS: 3. CONSUMER AFFAIRS (LICENSING A THORITY) This individual h&I PX en inf d of the requirements that pertain to this type of business. Authorize, Signatur #* /' �,/ COMMENTS: D-f' (� let Business certificates (cost $30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town(which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. **SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. . . : The Town of Barnstable • a►srrsreez.E, • Department of Health Safety and Environmental Services 16 Building Division 367 Main Street,Hyannis MA 02601' Office: 508-790-6227' Ralph Crossen Fax: 508-790-6230 Building Commissioner For.office use only Permit no. Date - _ AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est. Cost �20Z)_& '— Address of Work: 13w A d7 - Owner's Name ' Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: y lI d l )-e w-w Date Contractor Name Registration No. OR Date Owner's Name v A� r The Cummunlrculth of Massachusetts . •t;r! :' �w Departmc•1•rt of I11dtlstriQl.4ccidclus Officeofftestlgatlons `lid ,• i i w IOI 600 11'ashingtun Strccl �4�••��`.��"� � Boston.A1uss. 0?I11 Workcrs' Compensation Insurance Affidavit - hpiirint inftirmatirin• '— .Ip._.._ Plc•ise PRINT'1a 61v Iticltinn• f >/9�l�d�-1 C-//Z cit%• nhnne 1 am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity Vg I am an emplover providing workers' compensation for m}'employees working an this job. conitmov n• tnei ��l��.eil ( `fi�5 T�lR7C�z n ldrlrccc• • city nhnne tt• incilrnnce co. Pon,o zz*c 3/S 34 3 7 I am a sole proprietor. general contractor• or homeowner(circle one) and have hired the contractors listed beiow who the following workers compensation polices: cnrnn:ln%, nntnc• 1dtirccc• city'• nhnnC a• inyllrnnrr rfl nnllCt'>4 .-...-.- .. ... .-�.—....... r.��.a�..�.- 1. coninnnv nnlnt- add resT- Clt\'• nhnne • incurrence co nniicy>Y .Attach additional sheet if neecsia_a re . � • ^�' .ya►Si =' ~• �-�w�• of— �• ale'`• �'••wa::- 6iiu to secure cityerace as required under Section:-SA of N1GL 153 can lead to the Imposition of criminal penaities a line up to S1S00.00 andi. unc.cars'imprisonment as-cll:Is 601 Penalties in the form of a STOP AVORK ORDER and it fine of S100.00 a day against me. 1 understand that cope of this.statement ma% be furivarded to the Ulrcc of Investigations of the D1A for coycrare verification. 1 do herebt•cerri order r •parrs and petralties un•that t/re informarion prof ided above is true raid correct. • A Si=nature Date Print namey�-uJ �``�G`Q7� Phone>; 'roRcial use only du not write is this area to be compicted by city or town oRcial cin or town: IlermitAiccnse# r itluiiding Department L atrcensinq Huard t check if immediate rr3punse is required C 3Scleetmen's URic �. �. - allcnith Department r Aassachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their -mPloyees. As quoted from the "la►►". an enlpl(�ree is defined as every person in tile service of another under any ontract of Jiire'express or implied. oral or►vrittett. .11 Vnplitrer is.dcfincd as an individual, partnership. association. corporation or other legal entity. or any two or more is fore�_oin�u, cn�sa�=cd in a,joint enterprise. and including, the le�_aI representatives of a deceased employer. or tite mciver or tnistee of an individual , partnership.-association or other legal entity, employing employees. However the �vner of a dwellinu house finving not more than three apartments and who resides therein. or the occupant of the Xcllina, house of another who employs persons to do maintenance , construction or repair work on such dwelliti�: hour oft the::rounds or building, appurtenant thereto shall not because of such employment be deemed to be an employer. 1GL cha.pter 152 section 25 also states that even- state or local licensing agency sltall withhold the issuance or ne►val of a license or permit to operate a business or to construct buildings in the common-wreaith for any piicant who has not produced acceptable evidence of compliance with the insurance coverage required. Iditionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the -formanee of public work until acceptable evidence of compliance with the insurance requirements of this chapter Im =n presented to the contracting authority. pllcants use fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and plying, company names. address and phone numbers as all affidavits may be submitted to the Department of .1strial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The davit should be returned to the cin, or town that the application for the permit or license is being, requested. the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required brain a workers' compensation policy, please call the Department at the number listed below. or Towns se be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of .davit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pleas ire to fill in the permit/license number which wilt be used as a reference number. The affidavits may be returned to )eparnnent by mail or FAX unless other arrangements have been made. Dffice of Investigations would like to thank you in advance for you cooperation and should you have any questions. e do not hesitate to avive us a cell. .�... ..�-.�.•v.+. .-+�.wr.•�..•n�►-�.w--.�w.•.i�.��T•rwww�w _ •Tvw��.�rw+.•• Department's address. telephone and fax number. Tile Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma 02111 fax #: (617) 727-7749 '��, phone #: (6I7) 7274900 ext. 406, 409 or 375 5 F i E f ea ROME INPRO y f Re EVENT CONTRACTOR 8lstration11?536 , Type DeA _ • z ,ExPiratlon � ,� 9 s 04/06/ 9 CONSTRUCTION ~ ADMIN ST►�ATO C' FRASER R 1 TARRA&ON COTUIT CIR v ` NA 4?6�, _ 35 h Bering Dept.(3rd floor) Map 040 Parcel 1 Permit# � �' ! " House# 4126 Of— Date Issued - 9 1� Board of Health(3rd floory(8:15 - 9:30/1:00-4:30) Fee ®. Conservation Office.(4th floor)(8:30-9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) oFTHE ra, Definitive Plan A roved by Planning Board 19 BARNSTABLE. 1639. rFO M . vt�-, � TOWN OF BARNSTABLL / Building Permit Application . Project et Address - 2, G 7 - Village }� Owner !a& r� Address Telephone G Permit Request ►2Q e p First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ OC3 Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes ❑No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of;•Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric. ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) • ❑Other(size) ti Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# - Current Use Proposed Use Builder Information Name DeigA3 �° t,AZ,4- � Telephone Number P Address 'T j1 7`/2g17Q�! ! C to License# C®7 -� I�/4 Home Improvement Contractor# //��-36 Worker's Compensation#&jO-%`2,/S-Y9Q 34 50/6 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �,�610 SIGNATURE DATE �a s BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) �:'� FOR OFFICIAL USE ONLY PERMIT NO. - --7 � ' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER F ., 4's DATE OF INSPECTION: FOUNDATION _t FRAME k . INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING , DATE CLOSED OUT . _ T ASSOCIATION PLAN O. TOWN OF BARNSTABLE TOBACCO CONTROL PROGRAM BARN5TABLE DEPARTMENT OF HEALTH 367 Main Street, Hyannis, MA 02601 Patrick R. McCormack, MPH Tobacco Compliance/ Health Inspector Tel: (508) 862-4644 E-mail: mccormackp@town.barnstable.ma.us Fax: (508) 790-6304 ETS INSPECTION REPORIr Board of Health: Village of: ❑Hvannis ❑Centerville ❑Osterville QCotuit ❑Marstons Mills ❑West Date:/.�/ / /00 Barnstable ❑Barnstable Establishment Name: Tevyq if e, -r Purpose of check- Address: `/1 Routine Telephone: Y;2 J-ZA 0 Follow-up Owner's Name Ifurru•S. /Turf:M , � � Complaint . Person in Charge: Other 1or PUBLICTLA ❑ Cigar club/bar ❑ Office ❑ Bar ❑ Retail store ❑"'Restaurant ❑ Public place ❑ Bar area of restaurant ❑ Indoor sports arena 2""Retail food establishment ❑ Public transportation vehicle ❑ School ❑ Based on an inspection today, the items checked below indicate the violated provisions of Board of Health REGULATIONS AFFECTING SMOKING IN CERTAIN PLACES. ❑ Smoking in public places ❑ No signage ❑ Restrooms ❑ Bar area not enclosed if applicable) ❑ Improper si ❑ Waiting areas ❑ Seating capacity(20%max/enclosed area) ❑ No ventilation(if applicable) ❑ ❑ Self closing doors (.if applicable) ❑ Improper ventilation if applicable). Cl C) egatively pressurized(if applicable) ❑ Entrance was ❑ a-, On this day, the above listed establishment, business, or public place is in compliance with BOH tobacco regulations Comments: N1 I r-J -74Q Inspected by: of rO TOWN OF BARNSTABLE TOBACCO CONTROL PROGRAM BARNSTABLE DEPARTMENT OF HEALTH BAMSrnBie, = 367 Main Street, Hyannis, MA 02601 v� , `�� Patrick R. McCormack, MPH AlED1H'��A Tobacco Compliance/ Health Inspector Tel: (508) 862 4644 Email mccormaek @fown Barnstable ma us Fax ;'(508)..790-63Q4 ETS INSPECTION REPORT Board of � Health: Village of: ❑Hyannis ❑Centerville ❑Osterville 2 otuit OMarstons Mills ❑West Date:/ /,25/01 Barnstable ❑Barnstable Establishment Name: Purpose of check: Address: Routine Telephone: - 7 -e Follow-up Owner's Name —' Complaint Person in Charge: Other TYPE OF BUSINESS or PUBLIC PLACE ❑ Cigar club/bar ❑ Office ❑ far ❑ Retail store - Restaurant ❑ Public place ❑ Bar area of restaurant ❑ Indoor sports arena V'Retail food establishment ❑ Public transportation vehicle ❑ School ❑ Based on an inspection today,the items checked below indicate the violated provisions of Board of Health REGULATIONS AFFECTING SMOKING IN CERTAIN PLACES. ❑ Smoking in public places ❑ No signage ❑ Restrooms ❑ Bar area not enclosed if applicable) ❑ Improper signage ❑ Wait ing areas ❑ Seating capacity 20%max/enclosed area ❑ No ventilation if applicable) ❑ ❑ Self closing doors if a Dlicable) ❑ Improper ventilation if applicable) ❑ ❑ZOn Ne ativel ressurized(if a licable ❑ Entrance ways this day, the above listed establishment, business, or public place is in compliance with BOH tobacco regulations Comments: / 1 J. Y n 02Y P C '6 Call r 7f1 Inspected by: � OK For 2001 Permit? Tobacco Sales Permit Inspection Report Form TOWN OF BARNSTABLE BOARD OF HEALTH Business Name Date t Business Telephone i Location //,�I� �: /U Time: In Out f�J/ V Gr!/`✓l 0 Gr�Gt /��n T_i' /O: 9`� Person in Charge / Purpose ' & r✓y 6tl,7 Routine Follow-up Inspector's Name Complaint IVIC v H Initial REGULATION COMPLIANCE Remarks or Yes No Recommendations Signs Posted [MGL 270/61 [tU I M b, Permit Posted [VIIa] ;,moo-ox � D.O.R. License IA/)/w o • /O W n x� Ar -Employee Signed Forms Kept On File [VIlb] Self-service Displays On Counter and Within 5 Ft. of a Clerk [VIId] No Floor Displays' [VIId] No Tobacco Products Free of Charge [VIIc] 9 Inspector: ` Person Interviewed: q:health:tobinsp FEES RETAIL FOOD STORE: FOOD SERVICE ESTABLISHMENT $150.00 RESIDENTIAL KITCHEN FOR RETAIL SALE SEATING: 0 RESIDENTIAL KITCHEN FOR BED+BREAKFAST MOBILE FOOD UNIT: ANNUAL: YES • TOBACCO SALES: $14.00 SEASONAL: CATERER: . TEMPORARY: FROZEN DESSERT: MILK: $7.00 TOWN OF BARNSTABLE ,BOARD:O.F HEALTH �, PERMIT TO OPERATE,A FOOD:.,ESTABLISHMENT PERMIT NO: 110 JANUARY 1, 1999 st fix' � '{ A �4 In accordanbe with regulations prorriulgatecf;under autbCity of Chapter 94, Section 395A and Chapter the General Laws, a permit is hereby granted to: IF '4 HARRY J. MARTIN, JR. Jf— D/B/A• PEPPER'S PAN-rkY Whose place of businegs,is-; 4120 FALMOU '�H RC1AD' .„ COTUIT,f . ► 02fi3 Type of business and any resyt All FO*OD,SERVICE ESTABLI� ; NIZO c 46. To operate a food establishm'bntl*.inethn..� -�,TOWN OF 6ARNSTABL `v Permit expires: December 311.999 ? Y�`t�a e BOARD OF HEALTH Susan G. Rask, R.S., Chairperson Ralph A. Murphy, M.D. RESTRICTIONS IF ANY: Sumne V Kaufma .S.P.H. Thomas A. McKean, RS, CHO Director of Public Health a._. Town of Barnstable Board of Health • snxrrSTAS . 9 MASS. g 367 Main Street,Hyannis MA 02601 039. ♦0 'HIED MA'S� CERTIFICATION OF ATTENDANCE Safe Food Handling Training Name: please print f: Name of Food Establishment: ,Today's Date:.. ---------------------------------------------------------------------------- This certificate of attendance expires two years after the date of attendance. Verficatio 0 Town of Barnstable ' Board of Health MASS. 367 Main.Street,Hyannis MA 02601 1659. CERTIFICATION OF ATTENDANCE. Safe Food Handling Training i E i i i E Name: Ar�� / ='1Ai�T,1'L/ please print i I " i Name of Food Establishment: ��Ire Jr i i p Today's Date: ._3�"!r/_ This certificate of attendance expires two years after the date of attendance. Verficatidd i Name: O. �P✓1 +�� .. please print Name of Food Establishment: Location of Establishment: street name and village Today's Date: l�'` � Town of Barnstable • sAxrtsrnsi.E. • Board of Health 9cb , `m� 167 Main Street, Hyannis,MA 02601 QED MA'S� i CERTIFICATE Of ATTENDANCE . Safe Food Handling Training ------------------------------------------------------=-------------------------------------------------------------------- __._ ...: OFFICE USE ONLY RECEIVED DF i, n 1 1999 This certificate of attendance expires two years after the date of attendance. TOWN OF BH NSTABLE HEAVerification Health Complaints 27-Mar-00 Time: 2:10:00 AM Date: 3/27/00 Complaint Number: 2288 Referred To: GLEN HARRINGTON Taken By EDWARD BARRY Complaint Type: NUISANCE CONTROL REG. 1 RUBBISH Article X Detail: Business Name: PEPPERS PANTRY Number: street: rt 28 ( FALMOUTH RD) Village: COTUIT Assessors Map-Parcel: Complainant's Name: Address: Telephone Number: Complaint Description: THE TRASH FROM THE PEPPERS PANTRY TRASH AREA IS CONSTANTLY'BEING BLOWN OVER TO THEIR PROPERTY f ALTHOUGH THERE IS A HOUSE BETWEEN/' e , THEM AND THE CONVIENCE STORE. Actions Taken/Results: Investigation Date: Investigation Time: jaw, Z `�'� � �?� `� o�v sb.� - !//l",,,,,., �rP eo.1 � , ��✓la•ice �� ;,,,y p cJ A, 4,t 7J Slat C�c.c, -y�� ,n �,. l�i 0 ti► L;:z.� pr. -y j (r,��) H G�Z ail �.,a�, etc.J G✓� A�-r�� /, 1 44 Gc,�,,,,.,.-�,Q , }vt c�,J G.•� c:., :v_/�-/r.jt�t cZ- 1 � �G.�d,.r�-R ,� C�CLa�Lc.;;U�'�"� l/G'"�✓G.� c�G�'~Cs2-�.Q 1`� ✓'%r.'•" Lsstz Ste`^{ d`,�i C�L i3OJ i L�C✓-2l�J-Q� � E PERMIT NO TOWN OF BARNSTABLE JANUARY 1, 2000 110 BOARD OF HEALTH PERMIT TO OPERATE A FOOD ESTABLISHMENT In accordance with regulations promulgated under authority of Chapter 94, Section 395A and Chapter 111,Section 5 of the General Laws,a permit is hereby granted to: HARRY J.MARTIN,JR. D/B/A: PEPPER'S PANTRY Whose place of business is: 4120 FALMOUTH ROAD , COTUIT, MA 02635 Type of business and any restrictions: FOOD SERVICE ESTABLISHMENT To operate a food establishment in the TOWN OF BARNSTABLE f RESTRICTIONS IF ANY: i SEATING: 0 ANNUAL: YES SEASONAL: TEMPORARY: FEES BOARD OF HEALTH RETAIL FOOD STORE: Susan G. Rask, R.S.,Chairperson FOOD SERVICE ESTABLISHMENT: $150.00 RESIDENTIAL KITCHEN FOR RETAIL SALE: Ralph A. Murphy, M.D. RESIDENTIAL KITCHEN FOR BED+BREAKFAST: Sumner Kaufman, M.S.P.H. MOBILE FOOD UNIT: Permit expires: TOBACCO SALES: $14.00 December 31, 2000 �Q FROZEN DESSERT: Thomas A. McKean, RS, CHO MILK: $7•0° Director of Public Health CATERER: NOT VALID UNLESS ISSUED IN CONJUNCTION WITH A COMMON VICTUALERS LICENSE s Property Location: 4120 FALMOUTH ROAD/RTE 28 MAP ID: 040/1151 Vision ID:2712 Other ID: Bldg#.: 1 Card 1 of 1 Print Date: 05/02/2001 , x s ry L.. X - Po,y `,& r y i4':�,.a.'. .fi,. SSA ..r �.�?r'�,. k is ✓ra''r. ':3�.�., 3N lenient ca. Ch. Description Gommerclaluata rlements Style/ ype 17 Store Element Cd. Ch. Description Model 96Ind/Comm ea Grade C Average Grade Frame Type 2 WOODFRAME Baths/Plumbing 2 VERAGE Stories .5 1 1/2 Stories Occupancy 0Ceiling/Wall 8 TYPICAL ooms/Prtns 2 AVERAGE Exterior Wall 1 14 nod Shingle %Common Wall 2 11 Clapboard Wall Height 3MT Roof Structure 03 able/Hip Roof Cover 03 sph/F Gls/Cmp GUIInterior Wall 1 5 Drywall A.= •_- `' 22 25 VO a , 2 ement Code Description actor QS Interior Floor 1 D5Vinyl/Asphalt Complex 2 Floor Ad] Unit Location eating Fuel 3 as Heating Type 4 of Air Number of Units C Type 3 entral Number of Levels FHS %Ownership BAS Bedrooms 0 ero Bedrooms 0 BMT 3 Bathrooms ero Bathrms 0 Full - na 1.Base Kate Total Rooms 1 Room Size Adj.Factor 1.28011 Grade Q) 1.12 ath Type Adj.Base Ratex 71.69 Kitchen Style Bldg.Value New 200,015 Year Built 1982 48 ff.Year Built 1982 rml Physcl Dep 18 uncnl Obslnc con Obslnc 25 peel.Cond.Code _,' pecl Cond% Code Designon Percentageluu verall%Cond. 57 eprec.Bldg Value 114,000 MR Code Description LIF Units Unit Price Yr. Vp Rt %cna Apr. vatue code hDescription LivingArea Gross Area Eff.Area unit Cost l n eprec. Value Ffir-ffl loor , BMT Basement Area 0 1,638 328 14.36 23,514 CLP Loading Platform 0 225 68 21.67 4,875 FHS Half Story 720 1,440 720 35.85 51,617 TtL Gross LivlLease Area g Val. Property Location: 4120 FALMOUTH ROAD/RTE 28 MAP ID: 040/115/// Vision ID: 2712 Other ID: Bldg#: 1 Card 1 of 1 Print Date:OS/02/2001 escription Loae Appraised value Assessed value PEPPERS PANTRY NOMINEE TRUST 120 ROUTE 28 OMMERC. 3250 114,000 114,000 801 OTUIT,MA 02635 OMMERC. 3250 2,300 2,300 Barnstable 2001,MA Plan Ref z5z/zl Tax Dist. 200 Land Ct# er.Prop. #SR T[ti T O�T Life Estate I S 1 l� •r L /�(�_ rY� DD I LOTS 47 Notes: Y' BUD 1 GIS ID: Total 5 ea'ta «.,.,,,.,zap '` .,� ._ s, e :- �,..=r , ,s;, .•,., -s . xe ,•.t a a v d V a Assessed,a,� DO rr. I Code Assessed valueue ENT,ARTHUR S JR&MEREDITH 9220/097 06/15/1994 U I 1 A ENT,ARTHUR S 7113/317 03/15/1990 U 1 1 A 2000 3250 116,4001999 3250 1164001998 3250 116,400 ENT,ARTHUR S 3391/131 U 0 D 2000 3250 2,3001999 3250 2:3001998 3250 2,300 ota: ota: 163,2uu Tatal:1 , is sign acknowledges a vtstt a ata o ector or ssessor St Year yp escripdon mount Code escription Number Amount COMM. nt. VALUE S Appraised Bldg.Value(Card) 114,000 Appraised XF(B)Value(Bldg) 0 Appraised OB(L)Value(Bldg) . 2,300 Total.1 Appraised Land Value(Bldg) 67,900 o. ' .:.' Special Land Value i FAN I KY Total Appraised Card Value 184,200 Total Appraised Parcel Value 184,200 Valuation Method: Cost/Market Valuation N—eff-ofa-FAppralsed Parce a ue , E IV . .. a escri don mount Insp.@.F ate. ., o, o n .:a rw.. yp p p p. Date omp. Comments ate WD urpos ermit Issue Date esu t B23532 10/1/81 NC 0 100 CO COM BL Use Code Description Lone Frontage Depthnits nit rice actor actor a I. Notes- ! peeia Pricing �. nit rice an a ue o es: Toial Cardan nit arcel Totaliand A real of. an a u , � � Pepper s WPantIfg GR25CERIES•ICE•BAKERY am ,f t� j ;�. ,,.,mays$ ` ��y( #"'' M a {�yi f. �'' �t• { +'�.'� i2a�y`'�a�t3$S,f r' Y i C°.t .r'• _.• 4�+rr^ ��h��.'V^R� `~ M f/i`'`•�" f a3^ '�� �. �✓� �* �X+« ��ti; !�'�:�_�•�,� �y, �yi {r�'°�vs��.*"y�l'"'tSf �t 1'.� � � +*jlA���`.�': �: r' �' � /r r f xti a 8 � �. t't '�i ir„ f�" t r r• } r E,z v. t r r r r.'"..•r�r-i.. :i -i"� • 'js¢.'l. '°' ^p «. re.:. "$''�. p,.. �.M�r • fi p� =4 1 �• i -- f` ------------------ .............. : .......W... .........-.....- ......................_.....:_. '...__........_..........._DRIVE :�.. _ 110 P 2� 1 ' --- y I P 0 3 >> �o o �7� 99 r(( T' l I ............................. .................. _FALMOUTH R TE 28 .......... H:\BARN\BASEMAP.dgn Apr. 12, 2001 10:51:12 MAP 040 SCALE: 1"=60' Property lines shown on this plan are for asse&3ing purposes only and do not represent actual cY; relationships to physical objects t V 000 254 Rarest.�.0000000 �•. De� Lpf LOTS 47 e $ C nt: MARTIN,HARRY S JR TR la � 325 PEPPERS PANTRY NOMINEE TRUST 81 Are, 00003078 4120 ROUTE 28 .s. `� al tlded�� 00 5 3 COTUIT MA 02635 100-0000-000 3eedDate 060194 11543 234 Condo Complex aitling> r v � ..0 Uni January.31stx MARTIN,HARRY S JR TR D �MYY 0694 Deed Ref 9220/097 h., x w e ..�� ,:. _Div,• ., .,r W ��`� �- �-vac,. ����a , �� � - � s.� a 000067900 0000000000 ?A ; Muss land �rl ' 000116300 ra Featu s. i location 4120 FALMOUTH ROAD/RTE 28 �koad Index " 0522 �mtg 0110 Fi Dist: CT STUB TOE ROAD eG.nde 1548 Fmtg 0171 n l ��•,ly �Y' d� H S�pvi,n :�` j �� 1� �§.v��� a"�1't _ �'� a`•���r x a`€ S Fyn fir//� .._✓ 3�'a5'�G a� '� ,r 1 ° � rF��, � �� "- �"� � � `v �, arangwry �= \�,��Find�Nia Parce : 040116 Find � � - t ��� '�` 040116 ',D:e��D• V `�Accourtt� q" : 000254 Pare _ 0000000 � `���' a�rcel tdt� Ns ttibarho 11 AC 1 � yy �� 4�' � �� -rA�a $_t •t5 �hk - Cu�rr Own MARTIN, HARRY J JR TR w PEPPERS PANTRY NOMINEE TRUST o Bl�gs � r Areas - 00002396 4120 ROUTE 28 Y, ddecl 00 COTUIT MA , 02635 's', s rr; 00-0000 ''Deed Date 060194 Re �n�e, 11543 296 y Gondo Com le, I uiiding ua rit MARTIN ,.. -._ men . -... �;.. �Y"a'sr:�•v. G(iq �b��.. �� ,Y'Ij� J nrys;. , HARRY J JR TRr eed-1NM 0694 DeedRef 9220/098 y yValues anc! 000045100 Bwldings 000173100 yEx#ra Features 0000000000 ;Location 4130 FALMOUTH ROAD/RTE 28 oa�gincex 0522 rn#g 0125 Fire Dist CT f Sec indexI• 1269 Frntg 0125 PINEVIEW DRIVE tar> wt ar - •ha Y f(. fr .rya _ �aGy '� t`�w � s 'd�" awM&I S� r rjf ANNUAL p ,g SEASONAL 7NE T �TAB'CE"- �af TEMPORARY gam? OFFICE OF i BAH MAO& = BOARD OF HEALTH Aa�. 'moo 1639' 367 MAIN STREET HYANNIS, MASS. 02601 DATE APPLICATION FOR PERMIT TO OPERATE A FOOD ESTABLISHMENT FULL NAME OF APPLICANT NAME OF FOOD ESTABLISHMENT-7-6 ADDRESS OF FOOD ESTABLISHMENT / � 4Q_i%� '/J'Li TEL. TYPE OF ESTABLISHMENT: FOOD SERVICE ESTABLISHMENT: RETAIL FOOD STORE MOBILE FOOD UNIT IF APPLICANT IS A PARTNERSHIP, FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION: FEDERAL IDENTIFICATION NO.00- Q 6 y y STATE OF INCORPORATION FULL NAME AND HOME ADDRESS OF: PRESIDENT TREASURER CLERK SIGNATURE OF APPLICANT HOME ADDRESS HOME TELEPHONE NO. 4 G RESTRICTIONS: a oF1ME' ti Town of Barnstable Department of Health, Safety, and Environmental Services ELUtNSTAMASS.019. �0 Public Health Division °rFO e P.O. Box 534, Hyannis MA 02601 Office: 508-790-6265 Thomas A.McKean,RS,CHO FAX: 508-790-6304 Director of Public Health SEATING O ANNUAL V SEASONAL ASSESSORS MAP AND PARCEL NO. DATE __ /;�-/S APPLICATION.FOR PERMIT.TO OPERATE A FOOD ESTABLISHMENT FL'LL NAME, OF APPLICANT �/-I/✓t>`J NAME OF FOOD ESTABLISHMENT ADDRESS OF FOOD ESTABLISHMENT (oTyi 7- /t'1.4 Oa&3J� TELEPHONE NUMBER TYPE OF ESTABLISHMENT: FOOD SERVICE RETAIL FOOD BED AND BREAKFAST CONT.BR. RES.KITCHEN MOBILE FOOD TOBACCO SALES. FROZEN-DESSERT CATERING" ;,.:SOLE OWNER:... YES.. . NO IF APPLICANT IS A PARTNERSHIP,FULL NAME AND HOME ADDRESS OF ALL PARTNERS: IF APPLICANT IS A CORPORATION:°FEDERAL IDENTIFICATION NO. STATE OF INCORPORATION FULL NAME AND HOME ADDRESS.OF: PRESIDENT 1�)e-601r li-4 C_ N'11-2%-^� 3� 1AJ11✓0,10 126 (�it• ��.C� /y,4. TREASURER ` CLERK SIGNATURE OF APPLICANT RESTRICTIONS: HOME ADDRESS 31 �! �Q✓"`'2 HOME TELEPHONE 3:i 3 � foodest/db/q GENERAL NOTES WOOD FRAMING NOTES 1.ALL STRUCTURAL WORK SHALL BE COORDINATED WITH THE FOLLOWING"GOVERNING STANDARDS: 1.ALL FRAMING LUMBER SHALL CONFORM TO THE LATEST EDITION OF THE AFPA"NATIONAL DESIGN SPECIFICATION FOR WOOD CONSTRUCTION";AND SUPPLEMENT "DESIGN VALUES FOR WOOD CONSTRUCTION",LATEST EDITION.MAXIMUM MOISTURE CONTENT SHALL BE 19%. y A.THE MASSACHUSETTS STATE BUILDING CODE,9TH EDITION(FOR ONE-AND TWO FAMILY DWELLINGS)AND ALL OTHER AGENCIES HAVING JURISDICTION. a 2.PRESSURE TREATED WOOD MEMBERS USED FOR PLACEMENT AGAINST CONCRETE OR MASONRY(SILLS,PLATES,ETC.)SHALL BE PRESSURE TREATED WITH ACQ O� B.THE NATIONAL DESIGN SPECIFICATION FOR WOOD CONSTRUCTION(NDS),LATEST EDITION. PRESERVATIVE,OR APPROVED EQUAL,TO MINIMUM RETENTION OF 0.6 PCF IN ACCORDANCE,WITH AWPA C3. C. SPECIFICATIONS FOR STRUCTURAL STEEL BUILDINGS ANSI/AISC 360(BUILDING CODE REFERENCED EDITION). 3.ALL EXPOSED WOOD MEMBERS USED FOR STRUCTURAL FRAMING,DECKING,STAIRS,RAILS,BRACING,ETC.SHALL BE PRESSURE TREATED WITH ACQ PRESERVATIVE,OR APPROVED EQUAL,TO MINIMUM DETENTION OF 0.6 PCF IN ACCORDANCE WITH AWPA C3. 2.THE CONTRACTOR SHALL PROVIDE TEMPORARY SHORING AND BRACING AND MAKE SAFE ALL FLOORS,ROOFS,WALLS AND ADJACENT PROPERTY AS s PROJECT CONDITIONS REQUIRE. 44.ALL CONNECTORS,CONNECTIONS,FASTENERS,ETC.USED TO SECURE ACQ PRESSUE TREATED LUMBER SHALL BE TRIPLE ZINC COATED HOT DIPPED GALVANIZED OR inghouse., STAIN LESS?STE E L. P.O.Box 182 MASH3.ALL CONSTRUCTION IS TO CONFORM TO THE MASSACHUSETTS STATE BUILDING CODE AND ALL APPLICABLE PRODUCT AND DESIGN STANDARDS. ph...:0 221-2980 phone:508-221-2980 ABSENCE OF SPECIFIC ITEMS FROM THESE DRAWINGS DOES NOT INFER THAT THE CONTRACTOR IS RELIEVED FROM THE STATUTORY CODE REQUIREMENTS. 5.THE FRAMING LUMBER SHALL BE OF THE FOLLOWING MINIMUM GRADE AND SPECIES FOR THE SPECIFIED USE.ALL LUMBER SHALL BE GRADE STAMPED BY A .h;www nghcuu.net RECOGNIZED GRADING AGENCY AND SHALL BE KILN DRY. 4.ALL MATERIALS AND METHODS.OF CONSTRUCTION SHALL CONFORM TO THE APPROVED RULES AND STANDARDS FOR MATERIALS,TESTS,AND ALL WOODIWALL FRAMING(STUDS,SILLS,PLATES,BRIDGING,BLOCKING ETC.SHALL BE 2x6 SPF#2. o o REQUIREMENTS OF ACCEPTED ENGINEERING PRACTICE AS LISTED THE MASSACHUSETTS BUILDING CODE. O . 6.LUMBER WHICH IS SPLIT,CRACKED,NOTCHED OR OTHERWISE ALTERED OR DAMAGED SHALL BE IMMEDIATELY REJECTED AND NOT ALLOWED FOR USE,UNLESS o z 5.THE CONTRACTOR SHALL VERIFY-ALL DIMENSIONS AND CONDITIONS IN%THE FIELD PRIOR TO COMMENCING WORK.ANY DISCREPANCY BETWEEN WHAT IS OTHERWISE APPROVED IN WRITING BY THE STRUCTURAL ENGINEER. SHOWN ON THE DRAWING AND ACTUAL FIELD CONDITIONS SHALL BE REPORTED BACK TO THE ENGINEER IN WRITING BEFORE PROCEEDING WITH ANY WORK. fi': 7.THE FRAMING LUMBER SHALL BE OF THE FOLLOWING MINIMUM GRADE AND SPECIES FOR THE SPECIFIED USE.ALL LUMBER SHALL BE GRADE STAMPED BY A RECOGNIZED GRADING AGENCY AND SHALL BE SURFACE DRY: 7.FOUNDATIONS,FIRST FLOOR AND ROOF FRAMING HAVE BEEN DESIGNED FOR THE FOLLOWING LIVE LOADS: DIMENSIONAL LUMBER(FOR NON-EXPOSED MEMBERS): A.GRAVITY LOADS: u -FLOOR}JOISTS&BEAMS: #2 SPRUCE PINE FIR: FB=875 PSI,E=1.4E6 PSI SNOW:Pg=30 PSF, Pf=25PSF -STUDS" #2 SPRUCE PINE FIR: FC=1150 PSI,E=1.4E6 PSI LIVE LOAD OTHER ROOMS:40 PSF 8.EXPOSED WOOD FRAMING SHALL BE SOUTHERN PINE,GRADE NO.2.OR BETTER AND PRESSURE TREATED. m B.WIND LOAD[=CONTROLLING LATERAL FORCE)(PER MASS.BUILDING CODE AND ASCE7 10): U o m WIND SPEED Vult.=140 MPH;'' 9.ALL LAMINATED VENEER LUMBER(LVL)TO HAVE A MINIMUM ALLOWABLE BENDING STRESS(FB)OF 2,600 PSI.THE MINIMUM ALLOWABLE COMPRESSION STRESS(FC) 3 z EXPOSURE"B n 3 PERPENDICULAR TO THE GRAIN SHALL BE 750 PSI.THE MINIMUM ALLOWABLE MODULUS OF ELASTICITY(E)SHALL BE 1,900,000 PSI.INSTALL LVL'S IN STRICT ACCORDANCE a W WITH THE MANUFACTURER'S INSTRUCTIONS.REFER TO FRAMING PLANS FOR HIGHER STIFFNESS LVL MEMBERS,IF NOTED AS"LVL(2.OE)",WITH ALLOWABLE BENDING - 8.NOTIFY THE ENGINEER OF ANY ARCHITECTURAL MODIFICATION OR.DIMENSION CHANGES THAT MAY AFFECT THE STRUCTURAL DESIGN. STRESS(Fb)OF 2,600 PSI,AND MODULUS OF ELASTICITY(E)OF 2,000,000 PSI(VERSA-LAM BY BOISE CASCADE). J +'" B 4M, r t' . 10.DETAILS,OF WOOD FRAMING SUCH AS NAILING,BLOCKING,BRIDGING,FIRESTOPPING,ETC.SHALL CONFORM TO THE LATEST EDITION OF THE NATIONAL DESIGN Q SPECIFICATION(AFPA),THE TIMBER CONSTRUCTION MANUAL(AITC). STRUCTURAL STEEL NOTES 11.ALL ENGINEERED LUMBER PRODUCTS SHALL BE AS MANUFACTURED BY WEYERHAUESER,BOISE CASCADE,LOUISIANA PACIFIC CORPORATION OR APPROVED EQUAL. Q 1.STRUCTURAL STEEL ROLLED SHAPES SHALLJ3EcNEW;STEEL CONFORMING.-TO THE FOLLOWING.ASTM DESIGNATIONS - 12.FOLLOW MANUFACTURERS'SPECIFICATIONS FOR ERECTION,INSTALLATION,AND PLACEMENT OF ENGINEERED LUMBER PRODUCTS.PENETRATIONS THROUGH z ENGINEERED LUMBER PRODUCTS IS EXPRESSLY NOT PERMITTED WITHOUT PRIOR WRITTEN APPROVAL BY THE ENGINEER. O O ASTM A36 ALL ANGLES,CHANNELS,PLATES AND MISC.FRAMING MEMBERS, r, C) UNLESS.OTHERWISE NOTED,(MINIMUM YIELD STRENGTH FY-36',000 PSI), 13.USE FULLY NAILED METAL CONNECTORS(USP,SIMPSON,OR EQUAL),JOIST,OR BEAM HANGERS WHEN JOISTS OR BEAMS FRAME INTO OTHER JOISTS OR BEAMS. t - PROVIDE METAL POST CAPS AND BASES FOR ALL POSTS.REFER TO FRAMING PLAN FOR CONNECTOR TYPES. ASTM A307 GR. A' ALL ANCHOR BOLTS,LAG SCREWS UNLESS NOTED OTHERWISE. . r r NAILS ASTM A500 GR C ,• •• ALL HSS STEEL 14.BUILT-UP BEAMS(3 PIECES MAXIMUM)USING CONVENTIONAL FRAMING LUMBER SHALL BE FULLY SPIKED TOGETHER WITH 2 ROWS OF 10d ANNULAR RING LS O COLUMNS(MINIMUM YIELD STRENGTH FY=50,000 PSI):-, it AND LVL'S WITH 3 ROWS OF 16d ANNULAR RING NAILS EACH SIDE AT 12' O.C.,OR AS OTHERWISE NOTED ON THE DRAWINGS,OR AS RECOMMENDED BY THE Z V - MANUFACTURER.NAILS USED FOR BUILT-UP PIECES SHALL BE ANNULAR RING NAILS. z ASTM A572 OR A992_ ALL W-SHAPE BEAMS(MINIMUM YIELD STRENGTH FY=50,000 PSI). 15.ALL NAILS,FASTENERS,AND CONNECTORS EXPOSED TO THE WEATHER SHALL BE HOT-DIP GALVANIZED.ALL CONNECTORS AND FASTENERS WHICH ARE USED WITH ALL ANCHOR BOLTS OR FASTENERS IN CONTACT WITH PRESSURE TREATED CUMBER SHALL BE HOT DIP GALVANIZED OR STAINLESS STEEL. PRESSURE TREATED WOOD SHALL BE AISI 304 OR 316 STAINLESS STEEL. Q 2.GROUT USED UNDER COLUMN BASE PLATES SHALL BE NON-SHRINK AND NON-METALLIC WITH_A MINIMUM COMPRESSIVE STRENGTH OF5,000 PSI IN 28 16.ALL WOOD PRODUCTS SHALL BE STORED IN A DRY LOCATION. Q DAYS.UNLESS OTHER APPROVED BY THE ENGINEER MAXIMUM APPLICATION THICKNESS OF THE GROUT SHALL BE 1Y2 INCHES.. !' � 17.IN NO CASE SHALLJOISTS,RAFTERS,BEAMS,POSTS,STUDS OR ANY OTHER FRAMING MEMBER BE CUT,NOTCHED,DRILLED,OR OTHERWISE MODIFIED WITHOUT THE 3.ALL STRUCTURAL STEEL DETAILS AND CONNECTIONS SHALL CONFORM.-TO-THE STANDARDS OF THE CURRENT AISC SPECIFICATIONS FOR DESIGN, WRITTEN APPROVAL OF THE STRUCTURAL ENGINEER OR SPECIFIED ON THE DESIGN DRAWINGS. �n FABRICATION AND ERECTION OF STRUCTURAL STEEL FOR BUILDINGS. i W W N 4.ALL WELDING SHALL CONFORM TO THE CURRENT STANDARD OF THE AMERICAN WELDING SOCIETY(A.W.S.).ALL SHOP AND FIELD WELDS MUST BE W < O MADE BY APPROVED CERTIFIED WELDERS. _ r z S.ELECTRODES FOR ALL FIELD AND SHOP WELDING SHALL CONFORM TO ASTM A233(CLASS 70).ALL WELDS NOT SHOWN SHALL BE AWS MINIMUM.ALL r $ J WELDS SHALL DEVELOP THE FULL STRENGTH OF THE MATERIAL BEING WELDED. 6.SPLICING STRUCTURAL MEMBERS WHERE NOT DETAILED ON THE DRAWING IS PROHIBITED. Barnstable Bldg. Dept. Q 0 Q 7.DURING THE CONSTRUCTION PHASE IT IS THE RESPONSIBILITY OF THE CONTRACTOR TO PROVIDE ALL NECESSARY,TEMPORARY SHORING AND BRACING TO MAKE THE STRUCTURE STABLE AND PLUMB BEFORE COMPLETION OF CONNECTIONS,STEEL FRAMES,SHEAR WALLS AND FLOORS.- ApprOVed by j �... O 8.TEMPORARY BRACING SHALL NOT BE REMOVED UNTIL THE STRUCTURAL FRAME IS PROPERLY SECURED TO THE LATERAL LOAD RESISTING ELEMENTS IN permit# a THE BUILDING.THE STABILITY OF THE FRAME DURING ERECTION IS THE CONTRACTOR'S RESPONSIBILITY. o �) 9.ALL STEEL SHALL RECEIVE SHOP APPLIED PRIMER PAINT.TOUCH UP ALL WELDS,SCRATCHES OR SCRAPES IN PAINT AFTER ERECTION. # 10.TORCH CUTTING OR HOLE BURNING IS NOT ALLOWED. BUILDING DEPT. 2� SHOF u G at SCANNEDF° l ARS JENSEN o o FEB 0 5 2020 o STRUCTURAL + d a No.50602 CA TOWN OF BARNSTABLE - e /,, L 12/06/2011 O PAGE I OF 3 inghouse.PC P.O.Boa182 MASHPEE.EE,MA026G9 . w b'a`Alb 221hou8ee net .. - <n C, O a, 15T1 G Fl0 R l 3 2X1 @'1 1O,C X z o _ o m o FLUSH W/STL 3 BASE PLATE EDGE o a o 0 EXIS ING( )-2x1 WOO GIRD R BEAM&2 CLEA S ON EACH IDE T REM IN - INST LL N STEEL GIRDER BE M DIRECTLY BELOWEXIS ING'G RDER BEAM. 1/4 NEW W24 76(P OVID 1/Z'C MBE .AT CE TER F,BEA ) - O HSS 3Y2 X 3Y2 X 1/4 COLUMN(TYP. EACH END OF F— s, _ NEW W FLANGE BEAM)W/ j Z Y2"THICK STL CAP PLATE TO MATCH WIDTH OF S-3 _ STEEL BEAM FLANGE, Z J CONNECT STL CAP PLATE VIA.(2)-3/4"DIA. LAJ ASTM A325 THRU BOLTS TO W-FLANGE. OC 4 '-6"± GENE AL CO TRAC OR T VERI Y EXA DIM NSIO SON ITE P IOR T 'STEE FABR CATIO ) - -PROVIDE 1' 6"x0' 6"x1"THK STL BASE PLATE; FLUSH EXTERIOR SIDE WITH HSS COL PROVIDE CC Z %a"DIA.ANCHOR RODS,DRILL&EPDXY INTO Z EXISTING CONC.FDN WALL W/6" EMBEDMENT Q DEPTH INTO CONCRETE. � o NOTE:PACK EXISTING BEAM POCKET BELOW c/) BASE PLATE SOLID WITH NON-SHRINK GROUT, p[ OR SOLID TIMBER BLOCKING,TYP. W ° Qe O.C. XIST1 G FLO R 101 TS W O 2x1 @ 1 J LL— a N 0 0 ' N g� 'LARSJEN$EN o STRUCTURAL Q 5_ No.50602 2nd' FLOOR FOAMING PLAN ,ST 5_2 Scale: 1/4"=1'-0" . 12/06/201I PAGE 2 OF 3 C rn u inghouse,PC P.O.Box 182 "HPEE,MA 02649 phone:508-221-2980 _ web:wwwioeh—w—t . O cn ID EXISTING PLYWOOD FLOOR $ z SHEATHING TO REMAIN AT UNFINISHED ATTIC NEW W-STEEL GIRDER BEAM �1 EXIST.2x10 1 t/ EXIST.2x10 m } FLOOR JOISTS t FLOOR JOISTS @ 16"O.C. r @ 16'O.C. F o t1D a 3" EXISTING GIRDER BEAM TO REMAIN %6"DIA.HOLES,STAGGERED AT 24"O.C.IN TOP FLANGE FOR ATTACHMENT OF NEW STEEL BEAM VIA.3Y2"LONG LEDGERLOK SCREWS TO EXISTING WOOD GIRDER BEAM Z ABOVE. C PROVIDE 16"DIA. HOLES STAGGERED AT ti 24"O.C.IN WEB FOR ATTACHMENT OF FINISHES(FINISHES&FIRE PROTECTION W BY OTHERS) Lu auj U `'" V - _ : :.- _ TYP. NEW STL GIRDER FRAMING SECTION CI- cc� z . N.T.S. (SCHEMATIC ONLY) o Q o a 0 a a 0 N H �SN OF 1i oW 02� r a g IARSJENSEN ~ ~~ G u u o STRUCTURAL o o- No.5W2 y d a q�4c GIST` : S73 12/06/2011 p PAGE 3 OF 3 I