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1148 MAIN STREET (COTUIT)
i 14� ��n 5�"re.�'�" � ,� o. _. s v TOWN OF BARNSTABLE BAR-W 3226 Ordinance or Regulation WARNING NOTICE Name of Offender/Manager dob Address of Offender MV/MB Reg.# Village/State/Zip SS4 Business Name ' "''r{ (1( 444 < 4 ' am/pm; on 20 /9' Business Address Signature of Enforcing Officer Village/State/Zip -�(A Location of Offense '/y {ti � r r--kr M4-ir'1 {J It Enforcing ept/Division Offense Facts �',ilrl� This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD.JREG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT, f oco Application number .... ............................ Qa Fee . �- . f Building•Inspectors Initials....4! ... x�+s. a Date Issued.:.... ..... ..[........ ........................ ,®�� '�0�� Map/Parcel. .. .. .. ..... ......... ............ . TO" F BARNSTABLE 4 EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: //,%g /-4/9,`/U 51, 4!�- ' -e ` rNQ EN 4 5 C � S T VILLAGE Owner's Name:d i i y��r- $��ufr,,9r Phone Number_S-dy"'1;2 a-9,z/5 Email Address:s/ vVt/�� ' �N/��o� i�J Cell Phone Number Project cost$ Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize ' s;L to make application for a - 'lding 't in accordance with 780 CMR Owner Signature: r Date: ���Z TYPE OF WORK ❑ Siding ❑ Windows (no header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's Home Improvement Contractors Registration(if applicable)# (attach copy) Construction Supervisor's License# (attach copy) Email of Contractor S/� y1 i'��y/f e Phone number ()94, g-Oi;z/S 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. y _ APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)will be erected / 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 Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event L Check one: this event is a: for profit non-profit event Check one: Food served Yes—�,--/No j 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. I 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# Model/I.D. Fuel Type 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 J Date �lJ All permit applications are su ' ct t a building official's approval prior to issuance. Y Town of Barnstable BABSTABLE Regulatory Services R JUWABM eµs • ,. ' Building Division " Brian Florence,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Tent Information complete and attach to your online permit application (this is not a permit application) MAP/PARCEL ADDRESS / �,t VILLAGE NUMBER OF TENTS PURPOSE OF TENT /J,�5—t-e— -Ol-- Cc�%Ufc DIMENSIONS OF EACH TENT a r k /L �a ARE THERE SIDES ON THE TENT(S)? CHECK ONE YES '� NO If you checked yes you must attach a floor plan of the layout to insure proper egress for emergency purposes per the Building Code requirements. DATE TENT(s)UP ��S/ 2 TAKEN DOWN ON V vL t"' ATTACK THE FOLLOWING DOCUMENTS: • FLAME SPREAD SHEET FOR EACH TENT • FLOOR PLAN OF INSIDE OF EACH TENT THAT HAS ASSEMBLY USE • PROPERTY OWNER'S AUTHORIZATION IF THE APPLICANT IS NOT THE HOMEOWNER • WORKMAN'S COMP.AFFIDAVIT(AND CERTIFICATE IF REQUIRED BY THE DEPARTMENT OF INDUSTRIAL ACCIDENTS,INCLUDE POLICY INFORMATION PER FORM INSTRUCTIONS).. • LOCATION OF TENT ON SITE(PLOT PLAN OR G.I.S.MAP SHOWING LOCATION) PROPERTY OWNER NAME e?',i 5io4fi4, 4 L .SOG s`'� a�5/`I1P1/ ,L/ 'I' �� r APPLICANT NAME 5/E/'//,e U /t/e#/Sew rNATURE DATE"/ ,-70 1� I J APPLICANT PHONE NUMBER 5'OY ;Z/ y E-MAIL 5A46 eyeg If this is Town of Barnstable property,you must provide the property owner's authorization completed by the Town Manager.Using the Town Green?Call our Survey Department at 790-6400 x 4939 to ensure water lines are preserved for staling purposes. If you are utilizing Aselton Park call Structures and Grounds 790-6320 i Town of Barnstable ` Building Department Services s a ' '" Brian Florence,CBO ° a Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, ~� gs-) � �C`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: Gall U er (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. _ -- 2 Signature of Owner SignatLde of Applicant 5%A% Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Rev:08/16/17 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance.Affidavit:'.Builders/Contractors/Electricians/Plumbers Applicant Information Please`Print Legibly Name (Business/Organization/Individual): Address: /l``� /` , ,wl/ C 0 7 CJ i City/State/Zip:Cc« �¢ `D �3 5' Phone#: � Are you an employer?Check the appropriate box: . Type of project(required):. 1. I am a employer with 4. I am a general contractor and I employees(full and/or.part-time).* have hired the sub-contractors 6. New construction 2. 1 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' 9. Building addition [No workers' comp.insurance comp. insurance. required.] 5. We are a corporation and its 10. _ Electrical repairs or additions 3. 1 am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. _workers' right of exemption per MGL Y �o 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: #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.#: Expiration Date: Job Site.Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that'a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sipmature Date: Phone#: ` `-- Official use only. Do not write in this area,to be completed by city or town official , City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ORDER CONFIRMATION: # 6546-4` - Page 1of1 EVENT-DAY: Saturday: DATE: .. 07/20/2019 EVENT TIME. UNDERCOVER TENT DELIVERY THU:07N8/2019 SUBJECT TO CHANGE `drat Casa `le as �T, wrF c�ussuru+3 PICKUP: MO 07/22/2019 SUBJECT TO CHANGE. _ .. a y.'�•e SALES PERSON: PE PURCHASE ORDER#: 31 American Way South Dennis, A 0266 .. M 0,. .. ORDER DATE: . 01%23/2099- TERMS:. Phone:(508)398-9000 Fax:(508)398-9091 Website: www,undercovertent.Com BILL TO: SHIP TO: GINDY NICKERSON - = -,. - . CINDY NICKERSON (508)428-0461 COTUIT HISTORICAL SOCIETY COTUIT HISTORICAL SOCIETY 1148 MAIN STREET 1148 MAIN STREET COTUIT MA 02635 COTUIT MA. 02635 TEL: (508)428-0461 FAX: QTY ITEM DESCRIPTION PRICE TOTAL 1 20X40 FRAME TENT-WHITE 675.00 675.00 1 20X60 FRAME TENT-WHITE 875.00 875.00 14 7X20 CLEAR SIDE WALL(OPTIONAL TO POINT OF DELIVERY) 25.50 357.00 2 48"ROUND TABLE 9.25 18.50 23 36"ROUND TABLE 9.25 212.75 10 30"ROUND CAFE'TABLE 12.50 125.00 140 PURE WHITE SAMSONITE CHAIR 1.80 252.00 SPECIAL INSTRUCTIONS: SUB TOTAL: 2,515.25 SALES TAX: 157.20 DELIVERY: 70.00 LABOR: i 0.00 TOTAL: 2,742.45 Customer Signature ' Date *Customer is responsible for obtaining necessary permits and markings of any private underground utilities including Irrigation lines. 'Undercover Tent and Party,Inc.will contact Dig Safe for your site in regards to the marking of public utilities. *Customer has read and agreed to the terms and conditions as specified in attached documents. Page: 2 r MCP tttt� $� Ot Act t0tance Date Manufactured AZTEC TENTS Invoice Number. .0227212-IN 2/20/2018 2065 COLUMBIA ST .O.: Customer P TORRANCE,CA 90503 (800)228-3687 Customer Number. UNDE026 This is to certify that the materials described below.have been fie •tetardant I• treated(or are inherently flame retardant). -r. TIMAsh' fK•.. {•'.�. � 'v� Cd .CWn Ism•ac 14 14, 19m 419.01 Undercover Tent& Party .` •.0".> > w.t.9F m F sm.m 4•yy�._ ,4h:Sr..l 'Q at"Y"i 14qA jO9. F-59101 Undercover Tent& Party .gyp �t.,`y.'qJ`�'l ° F 0 P91 1gt0 nV F-. .1 31 American Way f. •ti.• .n ww=m F«601 South Dennis, MA 02660 . .. .. Pr°mps u°a •te° nv , • -1 T. am unrv.on .OI y°V We.m.nyan F•1 1 Certification is hereby made that the articles described below hereof are made "�,";;; P,,, F•1�1•° from a flame-retardant fabric or material registered and approved by the "v+n=•9. 9 T9P ,,., California State Fire Marshal for such use.The fabric has been tested and TA V40t.90 ^0."d we'. F 1 passes NFPA 701 Large Scale.See chart to right for trade name of "v`n"°° � .9. n a1 7,BI 1 •SID.01 flame-resistant fabric or material used and additionally referenced on the label of ` the fabric panel. . THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager-Manufacturing Name o(AppUeawr or Production Suparintendam Title of Applicator or Production Superintendent ITEM CODE ITEM DESCRIPTION UNIT ORDERED PRODUCED Z221 DV20CF2002 #20x20-2pc-l)V J•T biteI EACH . ..... w/Double Valance....... ... . . .. . ................ .... ............:...................... . . ...... SN4P Blockout White-w/8 Ratchet Tensioners #10"Indiana Scalloped Double Valance With Rope Una#To Match R217078# Z221DV20CM1002 #20x10•M"V-jT/dT-L-tte4•op•UVW EACH 4 4 w/Double Valance SN4P Blockout White-w/2 Ratchet Tensioners #10"Indiana Scalloped Double Valance With Rope Line#To Match R217078# Z221DV20CM1502 #ZOx'i-Mid-BV-JT/dT-L-Re-Top•UW- EACH 2 : 2 w/Double Valance SN4P Blockout White-w/2 Ratchet Tensioners #10"Indiana Scalloped Double Valance With Rope Una#To Match R217078# Z293F0017020 JT Lite Assembly Cable 20x EACH 6 6 Z293JT21006 JT Lite JT21016" EACH 12 12 Z221 DV3OCE3002 #3040 2pc DV JT/JT Lite Top UW EACH i 1 w/Double Valance SN4P Blockout White-w/8 Ratchet Tensioners #10"Indiana Scalloped Double Valance With Rope Line#To Match R217078# Z221DV30CM1002 #30x10 Mid DV JT1JT Ute Top UW EACH 4 4 w/Double Valance SN4P Blockout White-w/2 Ratchet Tensioners #10"Indiana Scalloped Double Valance With Rope Line#To Match R217078# Continued UNDERA OP •. A►CORO" DATE(MMIDDTYYYY) ' .� . CERTIFICATE OF LIABILITY INSURANCE' 0411712019 THIS CERTIFICATE IS.ISSUED AS A MATTER-OF INFORMATION ONLY AND CONFERS NO RIGHTS.UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY ORS 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 poilcy(les)must have ADDITIONAL INSURED provisions-or-be'endorsed. If SUBROGATION IS'WAIVED, subject to the terms"an' 4'c'onditions of the policy,Certain policies.may require an endorsement. A statement on this certificate does not confer ri hts to the certificate.holder In lieu of such endorsements. PRODUCER 617479-5500. c CT Michael Fithian 500 Insurance Group,Inc;.--. PHONE 6�7-1�79=5500 `. No.61Z-479.8761 500 Granite Ave.,Suite 2 - � '" - a AIC,No,Ext Milton,MA 0218ti .. Daniel P Sullivan ps n ncegroup.comc an sure INSURERS AFFORDING COVERAGE NAJC g INSU E A:Arch Insurance Company 11150 .1�S1JRED0 INSURER6:WeSCOlnsurance-CO ' ,Urnae cri Tent&Party 'Safety In g� m@nca INSU ER.0: y,Insurance. . South Venn a,NfA 02660 INSURER D: INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION UMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR TYPE OF INSURANCE DDL USR POLICY NUMBER LIMITS POLICY EFF POLICY EXP A' X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 CLAIMS-MADE QX OCCUR PRPKG00086 02 11121/2018 11/21/2019 DAMAGE TO RENTED 300,000 ED'•XP(Any one arson 10,000 PERSONAL 8 ADV INJURY 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 POLICY jge(� LOC PRODUCTS•COMP/OP AGO 2,000,000 O R: X AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 S OWnuro 2708556 11/21/2018 11/21/2019 BODILY INJURY Per arson S AURTEO�S ONLY X AAUUT�OpSWULEEDp 7 X AUTOS ONLY X AUTOS ONNLY BODILY INJURY Per accident Parr eccRdent AMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAR H.CLAIMS-MADE ... AGGREGATE DED I I RETENTION$ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS•LIABILITY C3382388 11/21/2018 11/21/2019 ANY PROPRIETORIPARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT 1,000,000 O FIC�E�.,,%Tt EXCLUDEDT N f A 1,000,000 ll e a ory n i E.L.DISEASE-EA EMPLOYE 0 SCdescribeunder1,000,000 DESCRIPTION OF PERATIO S bet • L.DISEASE-POLICY LIMIT A Floater 7 00086 02 11121/2018 11 2112019 Equipment 600,000_ 7 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Party Goods Rentals CERTIFICATE HOLDER CANCELLATION COTUITH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cotuit Historical Society THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1148 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Cotuit,MA 02635 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 'or, � cmcP Pepe: 2 Certa Date Manufactured AZTEC TENTS. Invoice Number. 0227212-IN 2/20/2018 TORRA CLE.CA 9 503 Customer P.O.: (800)228-3687 Customer Number. UNDE026 This is to certify that the materials described below.have been fla,�}�t tardant treated(or are inherently flame retardant). :r21 MaLh �K .•;'t .eC,�C'a�Ft Gd Vm•Tex, 1/, 1 1t9.l Undercover Tent& Party c:4 Ar"A' "'VA c ar W 1 , : x F ,o,u, PAFUndercover Tent& Party ' awvmpl . ,09. lT 31 American Way '�F..• •*:..`,1,. .r xpo Fq IILn ner -1 1. -� ' Ma South Dennis, MA. 02660 ; '= �^ F...anr."+T0 F-.N.O .. .. Rgxlpi .x01q NI•T.x nn F• .Ol _ • FV .N. Wco .+nr .On -SD1Al n .f W..Ol.np.n F.14.1 Certification is hereby made that the articles described below hereof are made Van", p,n, F.,,.o from a flame-retardant fabric or material registered and approved by the n an++9. elo 99 1., California State Fire Marshal for such use.The fabric has been tested and TM Vantage v'npua0 W.a°n F•0 9.11 +n1•9. We91on rAld". F-069A1 passes NFPA 701 Large Scale.See chart to right for trade name'of .n .9. ,vr„x,"el,,e s, 5,,.1 1. flame-resistant fabric or material used and additionally referenced on the label of the fabric panel. .. _ _. THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager-Manufacturing Name of Applicator or Production Superintendent Title of Applicator or Production Superintendent ITEM CODE ITEM DESCRIPTION UNIT ORDERED PRODUCED Z221DV20CF2002 #20x20.2pc-DV JT%iteJTop-UW EACH 1 1 w/Double Valance...... ... .... ............:...................... SN4P Blockout White-w/8 Ratchet Tensioners #10"Jndlana Scalloped Double Valance With Rope Line#To Match R217078# Z221DV20CM1002 #20A,G.M"V-JT/dT-Ldte-T-opUW EACH 4 4 w/Double Valance SN4P Blockout White-w/2 Ratchet Tensioners #10"Indiana Scalloped Double Valance With Rope Line#To Match R217078# Z221DV20CM1502 #20x4,5-Mid•DWJT/dTL-ite-Top•UW— EACH 2 : 2 w/Double Valance SN4P Blockout White-w/2 Ratchet Tensioners #10"Indiana Scalloped Double Valance With Rope Line#To Match R217078# Z293F0017020 JT Lite Assembly Cable 20x EACH 6 6 Z293JT21006 JT Lite JT210,6" EACH 12 12 Z221DV30CE3002 #30402pc DV JT/JT Lite Top UW EACH 1 1 w/Double Valance SN4P Blockout White-wl 8 Ratchet Tensioners #10"Indiana Scalloped Double Valance With Rope Line#To Match R217078# Z221DV30CM1002 ON10 Mid DV JT/JT Lite Top UW EACH 4 4 w/Double Valance SN4P Blockout White-w/2 Ratchet Tensioners #10"Indiana Scalloped Double Valance With Rope Line#To Match R217078# Continued UNDEIkA. A►COROA DATE(MWVDIYYYY) CERTIFICATE OF LIABILITY INSURANCE. 0411712019 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(lea)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS.WAIVED, subject to the terms and conditions of the policy, certain policies:may require an endorsement. A statement on this certificate does not confer rights to the certificate.holder in lieu of such endorsements. PRODUCER ' 617=479.5500, ' C CT Michael Fithian DPS Insurance Group,Inc PHONE 500 Granite Ave Suite 2 ExI.617.479.5500. ' FAX No"61Z-479.8761 Milton,MA 02189' ac.No, .. �: Daniel P Sullivan ps ns ncegroup.coiTI I an ura i SURER S AFFORDING COVERAGE NAIC# INSURER A:Arch Insurance Company 11150 1 3 RED WeSCo Insurance:Co " Tnc�erPcover Tent&Party INSURERS":Safe g7 Km rlca W INSURER. ty insurance.. South ennos IVA 02660 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ODL SuisK POLICY EFF POLICY EXP POLICY NUMBERiMMANIOM=IMMI ntyyyyl_ LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 11000/000 CLAIMS-MADE ®occuR PRPKG0008602 11/2112018 11/21/2019 DAMAGETORENTED PREMISES(Fa occurfence) 300,000 MED'EXP(Anyone erso 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY0 20T DLOC PRODUCTS-COMPIOPAGG 2,000,000 OTHER: X AUTOMOBILE LIABILITY COMBINEdd,D SINGL LIMIT 1,000,000 ANY AUTO, 2709656 11/21/2018 11/21/2019 BODILY INJURY Perperson) OWNED SCHEDULED X AUTOS ONLY AUTOS BODILY INJURY(Per aceldenlAO ONLY X ANOWD Pe�accldent AMAGE UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS•MADE ... AGGREGATE BED I I RETENTION$ B WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY WWC3382389 11/21/2018 1112112019 1,00 0,000 ANY PROPRIETORIPARTNERIEXECUTIVE Y I N K.FICpERR/IMEMg��EXCLUDED? NIA E.L.EACH ACCIDENT Ileso,y In NH) .L.DISEASE-EA EMPLOYE 11000,000 Iles desedbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-P ICY LIMIT I S 1,000,000 A Floater PRPKG00086 02 11/2112018 11/21/2019 Equipment 600,000 1 ...-T DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) Party Goods Rentals CERTIFICATE HOLDER CANCELLATION COTUITH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cotult Hlstorlcal Society THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1148 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Cotult,MA 02635 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) 01988.2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD try ve ,. u 's eK �a �pz - � I /b 16 X�o� ., --= Town of Barnstable Regulatory Services oYzr+e �s Richard V.ScaH,Director -� Building Division »Sz„ . : g BA�NSTABI,E sas $' Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230. TENT PERMIT MAP/PARAPPLICATION# 1 � - ISSUED ON - BY ' ADDRESS VILLAGE (:'_-'o1 j r' F CHECK ONE Residential i/Commercial NUMBER OF TENTS PURPOSE OF TENT AiVAIUAL IF THIS IS A NON-PROFIT EVENT CHECK HERE if not leave blank) DEVIENSIONS OF EACH TENT DATE TENT(s)OF �y<V/C ' � ,��/G TAKEN DOWN ON Xaitl oZ 3, y/G�J/4o ARE THERE SIDES ON THE TENT(S)? CHECK ONE YES NO✓(/ ®�� rqt, T If you checked yes you must attach a floor plan of the layout to insure proper egress for(qmergen ft purposes per the Building Code requirements. �9NSTq ATTACH THE FOLLOWING DOCUMENTS: a<F FLAME SPREADSHEET FOR EACH TENT .. FLOOR PLAN OF INSIDE OF EACH TENT THAT HAS ASSEMBLY USE PROPERTY OWNER'S AUTHORIZATION IF THE APPLICANT IS NOT THE HOMEOWNER WORKMAN'S COMP.AFFIDAVIT(AND CERTIFICATE IF REQUIRED BY THE DEPARTMENT OF INDUSTRIAL ACCIDENTS,INCLUDE POLICY INFORMATION PER FORM INSTRUCTIONS). LOCATION OF TENT ON SITE(PLOT PLAN OR G.I.S.MAP SHOWING LOCATION) PROPERTY OWNER NAME ,15%a/I.�CJ9L APPLICANT PRINT - NAME-15Y6 NtA)A1,A e*,,KSIGNATURE DATES RETURN WITH A COMPLETED APPLICATION BETWEEN THE HO OF 8-9:30 A.M OR 3:304:30 PM.M TO OBTAIN A HEALTH DEPARTMENT APPROVAL AFTER OBTAINING AN APPLICATION# FROM THE BUILDING DIVISION. If this is Town of Barnstable property,you must provide the property owner's authorization completed by the Town Manager.Using the Town Green?Call our Survey dept. at 7904400 s 4939 to ensure water lines are preserved for staking purposes. If you are utilizing Aselton Park call Structures and Grounds 790-6320 Town of Barnstable Regulatory Services � Thomas F.t;eiler,Director 6,19.A•� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.as Office: 508-862-4038 Fax: 508490-6230 HOMEOWNER 110ENSE EXEMPTION Please Print DAB: G/;zl ow JOB LOCATION: `� ✓�i�'n/ 57r" a 7'61 number strat village name home phone# work phone# CURRENT MAILING ADDRESS: C0Ti/iiT eity&D" state zip code The cuavat exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less-and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFT MON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be resaonsible for all such work performed under the bulldingpermit (Section 109.1.1) The undersigned"homeowner"_assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and ts. Signature of liomeown Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S F.RENIPTION The Code states that Any homeowner performing work for which a building permit is required shall be exem from the pt provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they ate assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. person as it would with a licensed To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that helshe understands the ieVousibtTtties of a Supervisor. On the last page of this issue is a foam cwjm tly used by several towns. You may care t amend and adopt such a form/cedificabon for use in your community. Q:\WPFII.FMRIv%omeexcmpt.DOC �• Town of Barnstable Regulatory Services ` BMWTAIM Thomas F.Geller,Director 9. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable maxs Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I� ����� /7�V�/yl �Z - ,as Owner of the subject property hereby authorize i/�G /� 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 Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q.FORMS:OWNERPE UMSION 17ze Conrntompealth ofMassacliusetts. 31eparBnt�zt of Ziulrrstrial�cciderrtr Office oflavestiga#ibim 600 Wasiiington Street Boston,MA 02111 mi 1t:11 asmgolIdia 'Workers' Compensation Insurance Affidavit Bmlders(ContractorslEIectridmL,,JPlumbers Applicant Information Pleaser Print Le�'bIy Name(susinessMVmizzdcm &v doai): 5•T�PIW cJ Address: CitylSta&Zip: Phan Are you an employer"Checkthe appropriate bo Type of project(required}: 1.❑ I am a employer with 4 E21 am a general contractor and I 6. NevP constructionemployees(full,aslei/or part-time)-* have hired the sub-coalzactozs ❑ 2.❑ I am a sole proprietor orpartner- listed on the attached sheet. 7- []Remodeling shipand have no employees These sub-conhactors have 8_ []Demrgliion woddag for me in any capacity. employees and have wo&ers'[No workers'comp_tasumnce 9.comp.msnranml ❑Building addition required-) 5. ❑ We are a corporation and its 10_❑Electrical repairs or additions 3_ElI am a officers have exercised their hameovraer doing all work 1L0 Plumbiagrepairs or addifiaas myself o Wmate night of exemption per MGL P c.152, 1 1— Roof repairs �tcranr 3ne required.]I § (4�and-we have no 13.❑Other - employees.(No workers' comp.iasviance:equined.]' °Anyappiicmttsarchedabexi`lmustalsofMcatheswdonbelowsbouigthetrwodces'mmp mthmpalieyiafot>aatian, t liarieawaecctcho submit this sfUmIt iadira— they nix doing-aIl wa*and&=him oumdecoanactors— submit a new affidtcit indicating socTi. :Cantncton that ched c this b=must attached an addidaasl sheet shovdg the acme of die sub-cotuscton and state-whether ar uot*we endtieshxm employee;.Irthesob-cannacmaftreemPlagees dLeyasscptovideaek wurkeWcamp.palkynumben I atri art enlpfoyer;dwtis prim g lrerkerm'compensation irrsrrraum for uty earptc fees. Below is tlrepolicy and job site information. Iusvrance,Company Name: Policy or Self-ins.Lic_f Fxpiration Date: Job Site Address: City/Stawz* Attach a copy of the workers'compeasationpolicp declaration page(showing the policy number and expiration date). Failure to seenre coverage as required under Section 25A of MGL a 153 can lead to the imposition of criminal penalties of a fine up to S1,500-00 and for one-year imprisonmenk as well as civil penalties is the form of a STOP WORK ORDER and a fine of up to$r50_00 a day against the violator. Be advised that a copyofthis statement maybe forwaded to the Office of Investigations ofthe DIA for instance coverap verification. 1 do hereby cer[i ,z cider d iie 'r an perfa�r`es ofperjury Biatthe irrfornutffon prmi&d above is mid correct si�arure: -i / / a Data: Phone . 5" Offidal use.only. Do not wrke in this area,to be coinpteted by city ortotrn_g rciat City or Town.• PermtlLict nse;9 Issuing Authority(carte one): 1.Board of Health 1.Building Department 3.(3tylTowa Gerk 4.Electrical Inspector 5.lUmbing Inspector 6.Other ContactPerson: Phone#: 6 a Commoublieattij of Ados;act�tt5 �ett 4� Nq 1 35arit5tab[e Collutp bberiff'S (Office 6000Shero's Place Bourne, MA 02532 (508)563-4300 FAX(508)563-4574 Sheriff lames M.Cummings Inlegrin. Professionalism. Compassion& Teanwork To whom it may concern: May 24,2016 , I have been asked by the Cotuit Historical Society to provide a letter regarding workers compensation coverage for inmates in the custody of the Barnstable County'Sheriffs Office who w will besetting up a tent in the Ton of Barnstable on or around June 21,2016 for the Cotuit' Historical Society's Annual Meeting.' These inmates are not paid wages for the services that they perform. They are providing a community service. They are not employees as a matter of Massachusetts law. They are not covered by Workers Compensation insurance nor are they eligible to receive such as a matter of Massachusetts law. The Sheriffs Office itself is self-insured for all purposes. That includes its activities,employees and the inmates in its custody. Therefore,the Sheriffs Office does not maintain a Workers Compensation insurance policy. If you have any questions you may contact me at(508)5634311. Yours truly, Matthew J.Murphy General Counsel Barnstable County Sheriffs Office BARNSTABLE BOURNE=BREWSTER CFIATUTAM-DENNIS-FASTIIAM:FALMOUTH-HARWICH MASHPEE ORLEANS PROVINCETOWN SANDWICH TRURO WELLFLEET-YARMOUTH IMPORTANT DOCUMENT Certificate of Flamesistance ISSUED BY Date of Shipment MiNnDUSTRIES 10/28/2014 -igistration Number.140.01zep INC. Sales Order# SO-613078 EVANSVILLE,INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described are inherently flame retardant and were supplied to: 76980 BARNSTABLE COUNTY CORRECTIONAL FACILITY 6000 SHERIFF'S PLACE BOURNE MA 02532 USA iSTE,� C AC 9��i� N►a qQ' � R E't IA4 Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved. chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric,has been tested and passes NFPA 701, ULC 109. Serial# 8002102(1) Description of item certified: FIESTA TOP 20WX40 WHITE SNYDER Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MANUFACTURING INC.PHILADELPHIA PA Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC 11-07-14P03:41 RCVD i c 4�5Cc-/w v v �v�w1 C � . x i, a%-� C 1 x v � � � Mass. Corporations, external master page Page 1 of 1 William Francis Galvin a of the Commonwealth ofMassachusetts H, Corporations Division Business Entity Summary ID Number: 237177654 Request certificate New search Summary for: HISTORICAL SOCIETY OF SANTUIT AND COTUIT, INC., THE The exact name of the Nonprofit Corporation: HISTORICAL SOCIETY OF SANTUIT AND COTUIT, INC., THE Entity type: Nonprofit Corporation Identification Number: 237177654 Old ID Number: 000012267 Date of Organization in Massachusetts: 03-23-1955 Last date certain: Current Fiscal Month/Day: / Previous.Fiscal Month/Day: 00/00 The location of the Principal Office in Massachusetts: Address: 1148 MAIN ST. City or town, State, Zip code, COTUIT, MA 02635 USA Country: The name and address of the Resident Agent: Name: Address: City or town, State, Zip code, Country:. The Officers and Directors of the Corporation: Title Individual Name Address Term expires PRESIDENT JOYCE C. GINOUVES 131 ABBEY GATE COTUIT, MA 02635 USA TREASURER , PEGGIE GRIFFIN BRETZ 146 LITTLE RIVER RD. COTUIT, MA 02635 USA VICE MARGARET RYDER .746 MAIN ST COTUIT, MA 02635 12-31-. PRESIDENT KORNBLUM USA 2019 CLERK TERRI GOLDSTEIN 12 TRUDY LANE COTUIT, MA 02635 12-31- USA 2019 DIRECl"OR $TEPHEW H.EMBERGER 1124 SANTUIT-NEWTOWN.RD 12-31- COTUIT, MA 02635 USA 2019 http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=237177654&... 5/16/2014 . - >Tr: Cre aft Certification is hereby made th_'i the organization herein named is an exarnpt purcnaser under Gienaral Lev is,Cheniar ouH, sections 6(d)and(a).,`ail purchases of tangible personal proparl}r by finis organi?�ttion a 3 carpi;ron ia;criron u nder said chap- ter to iha eutenYt inai such properly is used in the conduct of th--busies s of iiYe purchaser,key sibs or^1lStlsw.1f,his 0 rifitcat$ by an,;,is t-e::ampt organization or art,unauihorized use of this cei-dsicate bu any ind vii:.ia!:;oas,i i-,e9 ssClOus Viola°lion and:gill lead t0 rv'VCCa[IOn.tiUtllaut}YilsuSi'of this vBrTtiti.at@ Li i'8li3 tii3t,is 3i�3jaii'"G F.-rh 3iir::. igedf+n•='-n!'u_• ±iifa;rear in prison and S iu,-300 ItM- ,000 for corr+uraitons)in firies.(.Sec raver5c side.) y tij:fl.l.i.-= .tiartd :is - - - NDIF ASSIGNABLE OR 719ANSFEFAOLE r r, r Dear Taxpayer, A review of our records indicates that the Massachusetts salesluse tax exemption for HISTORICAL SOCIETY OF SANTUIT AND COTUIT INC,a tax-exempt 501(c) (3) organization,will expire on 09101/09. The Department of Revenue is issuing this notice in lieu of a new Form St 2, "Certificate of Exemption". The notice verifies that the Massachusetts Department of Revenue has renewed the salesluse tax exemption for HISTORICAL SOCIETY OF SANTUIT AND COTUIT INC subject to the conditions stated in Massachusetts General Laws, Chapter 64H, sections 6(d) or(e), as applicable. The organization remains responsible for maintaining its exempt status and for reporting any loss or change of its status to the Department of Revenue. Absent the Department of Revenue's receipt of information from the taxpayer by the expiration date of the current certificate that the entity no longer holds exempt status under the above provisions, the taxpayer's certificate is renewed. This renewal will expire on 09101119. The taxpayees existing Form ST-2, in combination with this renewal notice may be presented as evidence of the_entity's continuing exempt status. Provided that this requirement is met, all purchases of tangible personal property by the taxpayer are exempt from salesluse taxation under Chapter 64H or I respectively,to the.extent that such property is used in the conduct of the purchaser's business. Any abuse or misuse of this notice by any tax-exempt organization or any unauthorized use by any individual constitutes a serious violation and will lead to revocation.Willful misuse of this notice is subject to criminal sanctions of up to one year in prison and$10,000 in fines($50,000 for corporations). This notice may be reproduced. Sincerely, Navjeet K Bal Commissioner of Revenue Town of Barnstable Regulatory Services ' Richard V.Scah,Director . RAMST„BM • Building Division BARNSTABI,E � Thomas.Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 TENT PERMIT VAL3 o -i nzArrnAR � - 051 APPLICATION# ISSUED ON BY ADDRESS //16, MA'/v _!T-1 VILLAGE CHECK ONE Residential ✓ Commercial .NUMBER OF TENTS PURPOSE OF TENT T 45%E etc (.,5pi v,`i IF THIS IS A NON-PROFIT EVENT CHECK HERE if not leave blank) DIM XENSIONS OF EACH TENT a�O r �©�X f DATE TENT(s)UP 7 &'/Co TAKEN DOWN ON 'k_1 /e; ARE THERE SIDES ON THE TENT(S)? CHECK ONE YES NO If you checked yes you must attach a floor plan of the layout to imure proper egress�fggr emergency purposes per the Building Code requirements. 5, ATTACH THE FOLLOWING DOCUMENTS: T ✓(�,/� /��iO FLAME SPREAD SHEET FOR EACH TENT O� �Y''® FLOOR PLAN OF INSIDE OF EACH TENT THAT HAS ASSEMBLY Vf� PROPERTY OWNER'S AUTHORIZATION IF THE APPLICANT IS NOT do,6` HOMEOWNER ' N WORKMAN'S COMP.AFFIDAVIT(AND CERTIFICATE IF REQUIRED BY TH Tye DEPARTMENT OF INDUSTRIAL ACCIDENTS,INCLUDE POLICY INFORMATION PE INSTRUCTIONS). R FORM Zcc LOCATION OF TENT ON SITE(PLOT PLAN OR G.I.S.MAP SHOWING LOCATION) PROPERTY OWNER NAME `$ APPLICANT PRINT NAM.ES7-eR11,Fp0YbW36VI IGNA DATE RETURN WITH A COMPLETED APPLICATION BETWEEN THE HOURS OF 8-9:30 A.M OR 3:304:30 PM.M TO OBTAIN A HEALTH DEPARTMENT APPROVAL AFTER OBTAINING AN APPLICATION# FROM TAE BUILDING DIVISION. If this is Town of Barnstable property,you must provide the property owner's authorization completed by the Town Manager.Using the Town Green?Call our Survey dept. at 7904400 x 4939 to ensure water lines are preserved for staking purposes. If you are utilizing Aselton Park call Structures and Grounds 79o-637,0 ML see 2� eF 27m£'tmtrrm©mmdA of Hassachaseffs Dgmrf nmt af-4d rs&idAccidents 00 Washirigton greet Boston,MA 02111 tvn-ty rmasmgoP1dz't Wm-kme Compensa ' Tmsura ce davit B.uilders/ ogfractors/MectriciansIffumbers Appficant Information Please Print L ibly Name Qksim���aD: Oar �� tlitpltatYlzip:ZoiU�:. A4 Phoneme-Are you you au employers Check the aplWapriat��,,,gwendconfractor=dl L Cl I am a to whiz 4_ Tyke of 1►w con (required) �P Yg' `ti_ ❑Neu employees(full andfor part-time)-* bave biredthe 2.❑ I am a sole pnVrietor orpartner- lis6ed on the atbched sheet 7- ❑Remode1mg ship and hone no employees These sub-cmkactors have 8- ❑Demolifine Io and have vorkers' • � dmdcing m��Y ce � innssuranml Q_ Building addition req3ired 1 5-❑ We are a corporaticnand its 10-0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers bzve exerased their 11-0 Plumbing repairs or additions xw o t�v of esMR]Tiomper MGL t�� �P �IS 1 and we ' 1��of � kwj%z„=e regnire&] 2,§ (4} employees-[No vodo& 3 _0{)then cam-in=znce.reT -] ;tap Eager taaic3ecksvocc�l amstslso fllonci�sec�oaLeIaxs�aWioag eiea�naxea'cort�fioatge�auk . gomeewaEswhosabzait-d=jmdxvdi..nr�diceys_radmn_-sIIwc*and&mbieca ddecoaGactaamastspitsnewa�darii sorb -act=tha,T,,I,thisbmcmascarssrLedsraaeaitinnstsitsLn�ra�thenameof$�ea�drm xsmastabrorhetherocnai$sawPisss� ex*kyets_ Ifthe 1�,-ee em�Eagaes,me}ma;st ptav de tl r ss'comp.polscp aumohzr I am orz empinyes thatisprrntddtrrg trorl;am'comgiart dim ins;rm.%ce for my cnrpinycm Helo_w is the palicy and job sits it forneaii�n.' _ ' Insurance Company'Name- Policy:#er Sepias Lim ExpimtionDate-- Job Sibs-Addmss- CifgfStatdZip: Attach a.copy of the wGikers'compeusatima policy decTamfioupage(showmg the poFicy number and expiration dste). Failure fo se<-ate coverage as requi-eduader SeLHoxx 25A o€hML c I52 can lead to the imposition ofcrimiaal pewaies-Of a. fine up.tr}$I,StHkO(k andlor one- eatim{ui as�vet1 as civsl gtmalti es is ffie fvml of a STOP WOM OBDMand a fine of up t $?r50-00 a.clay against the violator- Be advised feat a cppg of this statement maybe krmrded to the Office of Iuredf p ions of file DIA for iasuraace coverage ver6mhon- , I dd hereby tka p#ns penal€es a y edwy thatfhe anjbrma[ivn pratik W abmterr's anh correct t';anats.rr /fG Date_ Phone;g. ©,f j Wal=a rant}: Da not wr&in flair area,to,be compered by city ox town qfficiar City or T'owu: Per►nitUcense# 'E mina Anthor:4(circle one); L Board of$eaIth-2.BuMieg Department 3.Cit frown Clerk 4.ElechicalInspector 5.Plumbing E=pector 6.Other Contact Person.: Phone-rat- 6 Town of Barnstable Regulatory Services Prof criiE rott,� Richard V.Scali,Director Building Division. " MASS, ' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 QED" www town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: /�/� • JOB LOCATION: l number street village ..xolocar ": %Sio2<`cL �<<2 d spa!u.`i G op7-y f name - home phone r work phone n ~CURRENT MAILING ADDRFSS:/ D eiiyAown sfa;e yip code The current_exemption for"homeowners"was extended to include oN Amer-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as suneMsor. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such`'homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building ermit {Section 109.1.1) The undersigned`-`homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner'certifies that he/she understands the Town of Barnstable Building Department minimum inspection proc eyes and re • e its and that he/she tv 10 comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be,required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNEWS EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,RuIes&ReguIations for Licensing Construction Supervisors,Section 2.15) This tack of awareness often results in serious problems,particularly when the.homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor- The homeowner acting as Supervisor is ultimately responsible: To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several-towns. You may care t amend and adopt such a form/certification for use in your community. Q:IWPFl1Y_W0RMS1bm1ding permit knaslE TMS.doc Revised 061313 I - w Town of Barnstable ° Regulatory Services 9 NSTA M Richard V.Scali,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Ovaier Must Complete and Sign This Section If Using A Builder I, Sy/�iS� Ni�//�'S' i�c�iC/2 ,as Owner of the subject property hereby authorize S 1 1 d to act on my behalf, in all matters relative to work authorized by this building permit application for. //9g /1'yi yfu 5-7— ca rv,'7 (Address of Job) Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owider Signature of ApAcaut Print Name Print Name Date QTORM&OW MERMISSIOINIP00LS I - commonweald) of f RagSacbu5ett5 { ,.� arnotable County fheriff's; ®ffite 6000 SheriFs Place Bourne. MA 02532 (508)563-4300 FA,Y(S08)563-4j7a Sheriff lames M.Cummings Integrity. Professionalism. Compassion& Teamwork To whom it may concern: May 23,2016 I have been-asked to provide a letter regarding workers compensation coverage for inmates in the custody-of the Barnstable County Sheriffs Office who will be setting up a.tent in the Town of Barnstable on or around July 23,2016 for Cotuit Historical Society at their Taste.of Cotuit event. The tent will be set up at their location. These inmates are not paid wages for the services that they perform. They are providing a community service. They are not employees as a matter of Massachusetts law. They are not covered by Workers Compensation insurance nor are they eligible to receive such as a matter of Massachusetts law. Hospice The Sheriffs Office itself Y Sc PALLIATIVE CARE 1ployees. and the inmates in its cus; ` of Cape Cod :ers Compensation insurance! We earn trust by delivering the finestservice and care. v If you have any questions (508)957-0200(800)642-2423 www.hospicecapecod.org Barnstable County Sheriffs Office BARNSTABLE BOURNE BREWSTER CHATHAM DENNIS-EASTHAM FALMOUTH=HARWICH MASI.IPEE ORLEANS-PROVINCE-TOWN SANDWICH:TRURO WC-LLFLEET•YARMOUTH • II IMPORTANT DOCUMENT Certificate, of Flame q sp stance ISSUED BY Date of Shipment 10/28/2014 gistration Number CO INC:® Sales Order# n- INDUSTRIES 140.01 ., � SO-613078 EVANSVILLE,INDIANA 47725 MANUFACTURERS OF THE FINISHED'TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described are inherently flame retardant and were supplied to: 76980 BARNSTABLE COUNTY CORRECTIONAL FACILITY 6000 SHERIFF'S PLACE BOURNE MA 02532 USA GAISTE� Certification is hereby made that The articles-described on this.Certificate have been treated with a.flame-retardant approved. chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric.has been tested and passes NFPA 701, ULC 109. Serial# 8002102(1) Description of item certified: FIESTA TOP 20WX40 WHITE SNYDER Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric SNYDER MANUFACTURING INC PHILADELPHIA PA Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC 11-07-14P03:41 RCVD UNDER4 OP ID:BC CERTIFICATE OF LIABILITY INSURANCE DA05/23/2016Y) 05/23/2076 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NONE:CT Daniel P Sullivan DPS Insurance Group,Inc. 500 Granite Ave.,Suite 2 P/c,N Ext:617-479-5500 1 ac No):617-479-8761 Milton,MA 02186 E-. AL Daniel P Sullivan ADDRESS' INSURER(S)AFFORDING COVERAGE NAIC B INSURER A:Nova Casualty INSURED Undercover Tent&Party INSURER B:Quincy Mutual - 9 Tony Priori 31 American Way INSURER C:WeSco Insurance Co South Dennis,MA 02660 INSURERD: INSURER E: . INSURER F: - - COVERAGES -CER IFICATE:NUMBER:. r.__._._ _,. REVISION-NWASER: 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 POLICY EFF POLICY EXP LTR TYPE OF INSURANCE WVDPOLICY NUMBER MMIDD MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE - $ 1,000,000 CLAIMS-MADE OCCUR RNTCLOO105050-1 .11/21/2015 11/21/2016 PREMISES Ea occurrence $ 300,00 MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLCY PRO- JECT LOC l [PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANY AUTO AFV206208 11/21/2016 11/21/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ UMBRELLA LIAR OCCUR .EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DIED I I RETENTION$ $ WORKERS COMPENSATION _ X AND EMPLOYERS'LIABILITY YIN - STATUTE ERH C ANY PROPRIETOR/PARTNER/EXECUTIVE WWC3166619 11/21/2015 11/21/2016 E.LEACHACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) E.L DISEASE-FA EMPLOYEE S 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 11121/201,.. 11/21I20.6.Equlpme^t-... $00,00 a...Equipment-Floater,-_.-._...._ RNTCLOC105050-1 . DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addloonal Remarks Schedule,maybe attached If more space is required) Party Goods Rentals CERTIFICATE HOLDER CANCELLATION COTUITH SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cotuit Historical Society THE EXPIRATION DATE THEREOF,..NOTICE WILL BE DELIVERED IN 1148-Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Cotuit,MA 02635 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD jerUttrate of Ylawle %tatatance I REGISTERED ISSUED BY 4' Date of Manufacture APPLICATION ` ANCHOR INDUSTRIES INC. NUMBER EVANSVILLE, INDIA1idA 47711 4 MANUFACTURERS OF THE FINISHED SERIAL#: F121.4 26958 3/24/93 TENT PRODUCTS DESCRIBED HEREIN E: • , This is to cd,rtify that the materials described have been flame-retardant treated (or are Inherently noninflammabIO) and were supplied to: NAME: AmggTr AN F,()TjTpmgNT T EAgjxG4TNj)F_.RC:mR Tymm k PARTY Twe, CITY READING STATE PA Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved I! chemical and that the application of said chemical was done in conformance with California Fire Marshall Code, equal to or exceeds NFPA 701, CPAI 84 GOVERNMENT CERTIFIED LAB #3056 Method of application: _LAMINATED U.L. - 214 MIL- C -43006 NYC -374-65 -SM Type, color and weight of canvas/vinyl: 15 oz BOYLES BIG TOP VINYL LAMINATE White Description of item certified: (1) 20w x 40 Century Canopy Flame Retardant Process Used Will Not Be 'Removed By Washing And is Effective For The "ice Of The fabric JOHN BOYL E& CO. Signed: Name of.Applicator of Flame Resistant Finish TENT DEPARTMENT--ANCHOR i I STATESVILI 'TRIES INC.E, NC �--� LOUIS R, BROWN 1 i I / V . L)5 /t Viva vE 1r,Giv�Db o/EN�a!Z �/� *IC K G"K�4 k 5 �d Tt� LO G/M 4Y�9k're� Mass. Corporations, external master page Page 1 of 1 William Francis Galvin Secretary of • • of corporations Division Business Entity Summary ID Number: 237177654 Request certificate New search Summary for: HISTORICAL SOCIETY OF SANTUIT AND COTUIT, INC., THE The exact name of the Nonprofit Corporation: HISTORICAL SOCIETY OF SANTUIT AND COTUIT, INC., THE Entity type: Nonprofit Corporation Identification Number: 237177654 Old ID Number: 000012267 Date of Organization in Massachusetts: 03-23-1955 Last date certain: Current Fiscal Month/Day: / Previous Fiscal Month/Day: 00/00 The location of the Principal Office in Massachusetts: Address: 1148 MAIN ST. City or town, State, Zip code, COTUIT, MA 02635 USA Country: The name and address of the Resident Agent: Name: Address: City or town, State, Zip code, Country The Officers and Directors of the Corporation: Title Individual Name Address Term expires PRESIDENT JOYCE C. GINOUVES 131 ABBEY GATE COTUIT, MA 02635 USA TREASURER PEGGIE GRIFFIN BRETZ . 146 LITTLE RIVER RD. COTUIT, MA 02635 USA VICE MARGARET RYDER 746 MAIN ST COTUIT, MA 02635 12-31- PRESIDENT KORNBLUM USA 2019 CLERK TERRI GOLDSTEIN 12 TRUDY LANE COTUIT, MA 02635 12-31- USA 2019 DIRECTOR ' STEPHEN HEMBERGER 1124 SANTUIT-NEWTOWN RD 12-31- COTUIT, MA 02635 USA 2019 http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=23 7177654&... 5/16/2014 �esu���yas�zas E •.��.- >ef �l�ei'�o-$ Exemption xem tion Revenue _ Certification is hereby made that the organization herein named is an e::ainpt purchaser under Genaral Laws,Chapier 64H, sections 6(d)and(e).All purchases of tangible personal property by this organization are exempt from ta;tation under said chap- ter to the extent that such property is used in the conduct of the business of the purchaser..kny abuse or misuse of This certificate by any tag:exempt organization or any unauthorized use of this certificate by any inuividual ionsiitii as a serious violation and will lead to revocation.Willful misuse of this Cert's;icate of EXenzption is subject to criniin3l sanctions oY up to one year in prison and$10,000(S50,000 for corporations)in fines.(See reverse side.) x Y3�Y i .-L , _G� �' r ,t f4? Ji -Y-nip• i,. i ,. - - f3. ? i�.i? aLti :t 't Li- :ii\iL. L Li i L a a 1':� _'.r`_RI 11:1CA* t_E'XT•i'ri=�'Jr•, _ 4 NOT ASSIGNABLE OR.i RANSFERABLE -- --- COMMISSIONER OF REVENUE h is jUil f a t Zi it- Dear Taxpayer, A review of our records indicates that the Massachusetts salesluse tax exemption for HISTORICAL SOCIETY OF SANTUIT AND COTUIT INC,a tax-exempt 501(c)(3) organization,will expire on 09101109. The Department of Revenue is issuing this notice in lieu of a new Form St-2, "Certificate of Exemption". The notice verifies that the Massachusetts Department of Revenue has renewed the sales/use tax exemption for HISTORICAL SOCIETY OF SANTUIT AND COTUIT INC subject to the conditions stated in Massachusetts General Laws, Chapter 64H, sections 6(d) or(e), as applicable. Tide organization remains responsible for maintaining its exempt status and for reporting any loss or change of its status to the Department of Revenue. Absent the Department of Revenue's receipt of information from the taxpayer by the expiration date of the current certificate that the entity no longer holds exempt status under the above provisions, the taxpayer's.certificate is renewed This renewal will expire on 09101119. The taxpayers existing Form ST-2, in combination with this renewal notice may be presented as evidence of the entity's continuing exempt status. Provided that this requirement is met, all purchases of tangible personal property by the taxpayer are exempt from sales/use taxation under Chapter 64H or i respectively,to the.extent that such property is used in the conduct of the purchaser's business. Any abuse or misuse of this,notice by any tax-exempt organization or any unauthorized use by any individual constitutes a serious violation and will lead to revocation.Willful misuse of this notice is subject to criminal sanctions of up to one year in prison and$10,000 in fines($50,000 for corporations). This notice may be reproduced. Sincerely, Navjeet K. Bal Commissioner of Revenue TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma �✓ ` Parcel D "rP: STAC� A lication # �� p pp Health Division f `j'' J! �« c , F Date Issuedl� r Conservation Division Application Fee ZS b Planning Dept. % Permit Fee ram' Date Definitive Plan Approved by Planning Board TO1 , Historic - OKH Preservation/ Hyannis Project Street Address l � /j i N .�' 7 J _ Village CCJrCJ 1 Owner S �,47V O I ca ry T• Address T Telephone Permit Request ice MZ' /� r�d f X�� � � eN � 7 0 ae, ;546P " AyrYAW :W 041>e coiv:i" XO Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District. Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. 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 f Baths: e o a s. Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name S��/�/y /�'���V ~�l�f !� Telephone Number Address />..O. 50 X License # GoTv, oaf 3� Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUR DATE FOR,OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: d s ; FOUNDATION ' �' T FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH i FINAL; PLUMBING: ROUGH .' FINAL GAS: ROUGH rT FINAL FINAL BUILDING .mil , DATECLOSED OUT ; AS'SOtIATION PLAN NO: f s 4". �- _ o 27re Ctamyna ryved&oafMassachusef Deprartrtrent of ri tr Accidents - f e of nvesagations 600 Wayhingtom Street Boston,AM 02L11 T WfL'm Ynass;.go'FSrdia Warkers:' Campensafion Titisotralace affidavit:Bifilders Can"ctorslFJectricians/Mumbers AppHcanf Lofarmation Please Priaf Lefibfy. I�Tame c> �ra>•ga>li�io�I�i�an: ��P/�'"G�� ./��I��r'�'2 . �0, ZCY)C Ctty/Stat&Zip:Go✓v;%17414 0^74 5 Phone Are you an employer?Checl:the appropriate box,; Type of. r -0-. atn a contractor Ne ractor and I 3 oect 1 (required):(required):1.El I am a employer with . 6_ New lion employees(full and/or part-#ime)-* have hired the sub-contractors. 2-❑ I am a sole proprietor or partner- listed on the attached sheet 7- ❑Remodeling . These sub-contractors have strip and hate do employees 8_ ❑IJemnliton w for mein an capacity. employees and have workers' ��� Y $ 9_ ❑Building.addition [No.WodcerS'conrp_iusmanre comp-� mired_] 5_❑ We are a corporaticn and its 14_0 Electrical repairs our additions 3.❑ 1 am a homeowner doing all work officers h ve exercised their 11_0 Plumbing rep or additions myself [No workers'romp- zit.of exemption per lvfGL 12 Roof 152, 1(4),and we he nog c- iumn-anre required.]l § {� have 13_❑Odmr employees-[No,workers' . comp_insurance required_]; . 'Tay applicant that checks boa"l-mn also fill out the section below showing their wu&eie compenssdon policy i72fi7rmeia7L T Homeowners vrho submit this affidavit ibEcstmg they are doing a9 noxic and rhea hag ou=&contractors—st submit anew afdnit i ntfir9tin well !Cmtoicmrs that check this box must studied an additions]street showh3,—the name of fie mb-comtacbxs and state whether ornot ihnse m i ties have employee,. Ifthe sutrconttactorsbave employees,they must piuvirde their workers'comp.policy mmmber_ am atz empLoyer that is prm idiag tt=orkers'comp 7Lvit on insrerarese far my enWIbyem Belau is the policy and,job site ia�armalio.n - Insu=ce Company Name: Policy 4 or self--ins Lie # Expiration Date: Job Site Address: Ctty/'StaWZip: Attach a cop} of the workers'compensation policy declaration page(sheNdng the policy number and expiration date). Failure to secure cotiurage as requiredundea Section 25A of MGL c 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or onL-yearirnprisonmenf,as well as civil penalties in the form of a STOP WORK ORDER and a fine ofup.to$250-00 a.day against the violator. Be advised that a copy of this sWemmt maybe forwarded to:the Office of Investigations of the DIA for inuxance coverage verification_ I da hereby cal n,rder tk8pains and snalties v fper�ur}�fJtatfhe lief orrandian prm idsd a ./=e" true anrt correct SiQnatrme: Bate_ Phone f#: OfEcral use only. Der not write in this area,for be completed by city or town officinL City or Town: PerrffitUcense# Issning Authority(drele one): 1.Board of Health 2.Building,Department 3.'Gity1rown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Ph'ane#: 6 Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuanito 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 appurtenantthereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or IocaI licensing agency.shall withhold the.tissuance or renewal of a license or permit to operate a business or to construct buildingsIn-the carnn�onivealth°foY. =lay applicant who has not,produced'acceptable evidence of compliance With the insurance cov,.era,ge required M ." Additionally, GL, chapter`152; §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the petormance of public work until acceptable evidence of compli.aice v i`h 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 cert,_ficaie(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno 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 Indusu-al Accidents for confirmation of insiTrance coverage. Also be sure to sign and date the affidavit Tht afadav t 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 lis�below. Self-insured companies should enter their self-i r ttlrance 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 apace 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/licease number which will be used as a reference number. In add tion,an.applicant that must submit multiple permit/hcense 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 bum leaves etc.)said person is NOT required to complete taus affidavit_ The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: '. A % fie Conmonwc,-an of Massachusetts Dega:nment of Industrial Aacirlgaits ti Q Itee o 7m tigations Boston,MA 02111 ` F-1..9 6I7-727-49GO W 4-06 or I-9T7-MASSAFE Revised 4-24-07 Fax#617-727-7-145 www-ina ssgov/dia i Town of Barnstable t Regulatory Services • anxxsrwsis, MASS. Richard V.Scali,Director 1°rEnMn�a ;',' Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 .� Fax: 508-790-6230 Property Owner Must;_� s �# ,.. , a... _ Complete` a: nd'Sign This`Secfion If Using A Builder,,.., as Owner of the subject property hereby authorize 5?1�/Ie tl /r71�"/+?/. /���� to act on my behalf, in all matters relative to work authorized by this building permit application for. /H9' 1V,,4.`N s-dr- GCV U, ! (Address of Job) 4 4 A .4■ 'Pool fences and alarms are the responsibility of the applicant. Pools' ` are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Apphont 1414 Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS Town of Barnstable • . Regulatory Services �oFtrre roiy,� Richard V_Scali,Director t �* Building Division * m�LF Tom Perry,Building Commissioner brass. i639- ,�� 200 Main Street, Hyannis,MA 02601 CEO ' A www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: V / JOB LOCATION: li�a A /Art/U 5 r 4 d(J 4 r nurryb;r C street village "HOMEOWNER": name home phone# work phone# CURRENT MAMING ADDRFSS: /-V• <.�OI� JK7 Cd 7_0-` city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. •Such."homeowner".:shal'l submit to the Building Official on a form acceptable to the Building Official,that he/she shall be r'es'Rbmible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. _ The undersigned"homeowner"certifies thai he/she understands the Town of Barnstable Building Department minimum inspection proced re dents and that he./she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. • _� ROMOWNER'S EXEMPTION ` The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section Section 109-1.1-Licensing of construction Supervisors);provided that if the homeowner P ( g P )� engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,'RuIes`&Regalations for Licensing Construction Supervisors,sl c . ri12.I5)'".This lack'of awareness often results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor_ The homeowner acting as•Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc Revised 061313 i Stephen Hemberger PO Box 242 Cotuit, MA 02635 774-810-6083 cell, email shembereer@comcast.net September 1,2015 Licensing Board-Town of Barnstable Dear Members, On October 3,2015,The Historical Society of Santuit and Cotuit will be holding their annual Fall Event. Our event, "Autumn in Olde Cotuit"will be onsite at the Historic Dottridge Homestead. The event will have hand crafters demonstrating their traditional skills. Skills such as open hearth cooking, knot tying, quilting and rug hooking will be demonstrated. Wampanoag Native American speaker will share traditional aspects of Indian Autumn Harvest. Food for the event will be bratwurst, hot dogs and hamburgers. Recorded music will be provided for the enjoyment of event goers. The day will end with a pie contest that will include 2 judging categories. The Historic Dottridge Homestead is located at 1148 Main Street,Cotuit, MA 02635. The hours of our"Autumn in Olde Cotuit" event will be from 11:00 am to 3:00 pm Sincerely, Steve Hemberger Historical Society of Santuit and Cotuit-Board Member Commontueald) of f tamumbugetto Oarttsubie 4Countp fteriff'S ®ffire 6000 Sherds Place a Bourne,MA 02532 (508)563-4300 FAX(508)563-4574 Sheriff James M.Cummings lmegrlo, Professionalism, Compassion&Teamwork To whom it may concern: August 28,2015 I have been asked to provide a letter regarding workers compensation coverage for inmates in the custody of the Barnstable County Sheriffs Office who will be setting up a tent in the Town of Barnstable on or around.October 3,2015 for the Cotuit Historical Society at their Autumn in Olde Cotuit event. The tent will be set up at their location. These inmates are not paid wages for the services that they perform. They are providing a community service. They are not employees as a matter of Massachusetts law. They are not covered by Workers Compensation insurance nor are they eligible to receive such as a matter of Massachusetts law. The Sheriffs Office itself is self-insured for all purposes. That includes its activities,employees and the inmates in its custody. Therefore,the Sheriffs Office does not maintain a Workers Compensation insurance policy. If you have any questions you may contact me at(508)563-4311. Yours truly, Matthew J.Murphy General Counsel Barnstable County Sheriffs Office BARNSTABLE BOURNE BREWSTER CHATHAM•DENNIS•EASTHAM•FALMOUTH HARWICH MASHPEE ORLEANS PROVINCE-TOWN:SANDWICH•TRURO•WELLFLEET-YARMOUTH IIVlrUM I.AN I 11JU1.UIVItN Catificate of(F& tance Date of Shipment ISSUED BY 7/13/2015 spa F .P—riistration Number 10.01 INDUSTRIES INC.® Sales Order# SO-620280 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described are inherently flame retardant and were supplied to: 76980 BARNSTABLE COUNTY CORRECTIONAL FACILITY 6000 SHERIFF'S PLACE BOURNE MA 02532 USA ♦STD Cs CALF 6 Certification is hereby made that: �the articles described on this Certificate have been treated with a flame-retardant approved ,chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. All fabric has been tested and passes NFPA 701, ULC 109. Serial# 8002102(1) Description of item certified: FIESTA TOP 20WX40 WHITE SNYDER Flame Retardant Process Used Will Not Be Removed By 'dashing And Is Effective For The Life Of The Fabric SNYDER MANUFACTURING INC PHILADELPHIA PA Name of Applicator of Flame Resistant Finish Signed: ANCHOR INDUSTRIES INC SO- IN Certification is hereby made that the organization herein named is an exempt purchaser under Genera!Laws,Chapter 64H,- sections 6(d)and(e) All purchases of tangible personal property by this organization are exempt morn taxation under said chap- ter to the extent that such property is used in the conduct of the business of the purchaser.iiTly abuse or 7-nisusa of this certificate by any tax-exernot organization or any unauthorized use of this certificate bi+any indiViuuai dOn. tittates a er1L711s V{Oiaiton and will lead 5G revocation.tllsil a4 r misuse C fY34' �s(i59CafG 1'w �r1p?i f 31 si3 3j:f 4'3 Criminal SsdYiti °fits F 3 T P�?{ 3Y Ej^(`t'1�tr 1 t-F-'-£ Z7', ,f} :s(•3.3 ,t••?0 a:Jt «oY"^i?,.�axaaY!S)tat firie5:($CQ reverse side.) EXENFIF T ION lltlPrBEI E .e i i4Sklrr .�Ai'U TRANSFERABLECERTIRCA-f'E EXPIRES ON! NOT ASSIGNABLE OR 00114iE;ilijSICJIEIEr;OF REVENUE Dear Taxpayer, A review of our records indicates that the Massachusetts sales/use tax exemption for HISTORICAL SOCIETY OF SANTUIT AND COTUIT INC, a tax-exempt 501(c) (3) organization, will expire on 09/01/09. The Department of Revenue is issuing this notice in lieu of a new Form St-2, "Certificate of Exemption". The notice verifies that the Massachusetts Department of Revenue has renewed the sales/use tax exemption for HISTORICAL SOCIETY OF SANTUIT AND COTUIT INC subject to the conditions stated in Massachusetts General Laws, Chapter 64H, sections 6(d) or(e), as applicable. Vie organization remains responsible for maintaining its exempt status and for reporting any loss or change of its status to the Department of Revenue. Absent the Department of Revenue's receipt of information from the taxpayer by the expiration date of the current certificate that the entity no longer holds exempt status under the above provisions, the taxpayer's certificate is renewed. This renewal will expire on 09101119. The taxpayer's existing Form ST-2, in combination with this renewal notice may be presented as evidence of the entity's continuing exempt status. Provided that this requirement is met, all purchases of tangible personal property by the taxpayer are exempt from sales/use taxation under Chapter 64H or I respectively,to the extent that such property is used in the conduct of the purchasers business. Any abuse or misuse of this notice by any tax-exempt organization or any unauthorized use by any individual constitutes a serious violation and will lead to revocation.Willful misuse of this notice is subject to criminal sanctions of up to one year in prison and$10,000 in fines ($50,000 for corporations). This notice may be reproduced. Sincerely, Navjeet K. Bal Commissioner of Revenue Mass. Corporations, external master page Page 1 of 1 L{ illia Francis Galvin Secretary 4 C i of • • of c_`ttJ. Corporations Division Business Entity Summary ID Number: 237177654 Request certificate New search Summary for: HISTORICAL SOCIETY OF SANTUIT AND COTUIT, INC., THE The exact name of the Nonprofit Corporation: HISTORICAL SOCIETY OF SANTUIT AND COTUIT, INC., THE Entity type: Nonprofit Corporation Identification Number: 237177654 Old ID Number: 000012267 Date of Organization in Massachusetts: 03-23-1955 Last date certain: Current Fiscal Month/Day: / Previous Fiscal Month/Day: 00/00 The location of the Principal Office in Massachusetts: Address: 1148 MAIN ST. City or town, State, Zip code, COTUIT, MA 02635 USA Country: The name and address of the Resident Agent: Name: Address: City or town, State, Zip code, Country: The Officers and Directors of the Corporation: Title Individual Name Address Term expires PRESIDENT JOYCE C. GINOUVES 131 ABBEY GATE COTUIT, MA 02635 USA TREASURER PEGGIE GRIFFIN BRETZ 146 LITTLE RIVER RD. COTUIT, MA 02635 USA ' VICE MARGARET RYDER 746 MAIN ST COTUIT, MA 02635 12-31- PRESIDENT KORNBLUM USA 2019 CLERK TERRI GOLDSTEIN 12 TRUDY LANE COTUIT, MA 02635 12-31- USA 2019 DIRECTOR. STEPHEN HEMBERGER 1124 SANTUIT-NEWTOWN_RD 12-31- COTUIT, MA 02635. USA 2019 http://corp.sec.state.ma.us/Corp Web/CorpSearch/CorpSummary.aspx?FEIN=23 7177654&... 5/16/2014 G t, pD a C((T j v TOWN OF BARNSTABLE BUILDING PER RI�KIfIC 15>E IN, All Ma Parcel d Mi ? p A hcti�n6# C _� p p Health Division , Date Issued 2 Conservation Division ) 'r` Ap ation - UP (0, u Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address i!I �l V 111 , Village �,O'1-U I�" _ IM A. Owner L-�3-w ill CWjya& C ffTU t f Address ✓-4 iJ S T. C 677A l• 0 3� J Telephone ( ( LI Z.0_ 140 Permit Request RO, 0-00F 6TT-R t h G-c N-GUf e t-v T(I0 Square feet: 1 st floor: existing proposed 2nd floor: existing 0 proposed _Total new O Zoning District R F Flood Plain C Groundwater Overlay Project Valuatiok 7 0 0 0 Construction Type_ Lot Size /, Z0 Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family :❑ Two Family ❑ Mult iy (# units) Age of Existing Structure . Z06 ;fig Historic House: ®' On I s , o9 9Old King s Highway: ❑Ye �"No Basement Type: Cg"Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 7O D' Number of Baths: Full: existing 0 new Half: existing ( new Number of Bedrooms: I existing -anew Total Room Count (not including baths): ex�istin�3 new 3 First Floor Room Count 3 Heat Type and Fuel: ❑ Gas ❑Oil IC9'E ectric ❑ Ot r Yp � � Central Air: ❑Yes &<0 Fireplaces: Existing New 0 Existing woo oal stove: Yes Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use rl�tl Proposed Use M APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name S 1 bwp Telephone Number Q 0 7 6-4A0 --_ Address __ KZ,O ✓1 Val, j- License # (h r) �3 C()TV I T ; ✓yV�l S Q 2-6 3'5- Home Improvement Contractor# I Worker's Compensation # _Ul/C� � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1 G SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: 3 FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Zt "F` The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations E 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): �P�1Jih�` InC �C1U %TL I,1-70 Address: Zd Al City/State/Zip: (dt-U Phone #: Are yo employer? Check the appropriate box: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. employees and have workers' y p �'• t 9. ❑ Building addition [No workers' comp. insurance comp. insurance. required:] 5. ❑ We are a corporation and its 1011 Electrical r 'rs or additions officers have exercised their 3.❑ I am a homeowner doing all work I I.❑PI mg repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] . *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: � � �LI�rU/1 `e_mp( q, e,1 Policy#or Self-ins. Lic.M (JIl CG k-OU 00 � (4 2 0I c.(<A Expiration Date: � I 1 _ Job Site Address: l `l g fNl t,� S City/State/Zip: rdnll q' , Y)1 ltrd 0?_i - Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under t pains and penalties o ' ry that the information provided above is true and correct: Signature: Date: I l y Phone M a Official use only. Do not write in this area to be completed b city or town official .f.T Y P Y tY ff 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#: Client#:38438 2CENTRALCA ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 05/15/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy()es)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil acO11N Ext:508 775-1620 FAX ac No: 5087781218 Insurance Agency E-MAIL 973 lyannough Rd., PO Box 1990 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC to Hyannis,MA 02601 INSURER A:National Grange Mutual Insuranc INSURED INSURER B:Associated Employers Insurance Central Cape Construction Company,Inc. INSURER c 820 Main Street Cotuit,MA 02635 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ) INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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. LT R TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LIMITS LTR I S POLICY NUMBER MMIDD/YYYY MMIDD A GENERAL LIABILITY MP19764Q 11/14/2013 11/14/201 -EACH OCCURRENCE $1 OOO 000 NTE X COMMERCIAL GENERAL LIABILITY PREMISES RE D ore $500.000 CLAIMS MADE I OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY jRa LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED / PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAS OCCUR EACH OCCURRENCE $ 14EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B AND EMPLOYERS'LIABILITY WORKERS COMPENSATION WCC50050091992014A 5/14/2014 05/14/201 X WC STLIffSATU- OTH ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT s500 000 OFFICER/MEMBER EXCLUDED? 7 N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $5OO OOO DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Steve Devlin is excluded from the workers compensation policy. Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town Of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S130527/M130526 LS1 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration -- �--- Registration: 131841 Type: Private Corporation Expiration: 9/26/2016 Tr# 256305 CENTRAL CAPE C0NSTRUCTI0NC0-1NC: � I STEPHEN DEVLIN 820 MAIN ST. t� COTUIT, MA 02635 IT r S 1+r Update Address and return card.Mark reason for change. SCA1 is 20M-05/e1 Address ` Renewal Employment Lost Card �/e�r,n��:,c���uer((/r c�'r�llrr,;1«r�,•s<�ll y Office of Consumer Affairs&Business Regulation License or registration valid for individul use only TOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: i31841 Type: Office of Consumer Affairs and Business Regulation 10i< tion:_w 9/26/ � _2016 Private Corporation 10 Park Plaza-Suite 5170 .����%Expira - Boston,MA 02116 CENTRAL CAPE CONSTRUCTIONCO.INC. 'V8 STEPHEN DEVLIN 820 MAIN ST COTUIT,MA 02635 Undersecretary No valid without signature Massachusetts -Department of Public Safety UJ Board of Building Regulations and Standards Construction Supervisor License: CS-047993 STEPBEN J DEVI,3N f 820 MAIN ST I COtuit-MA 02635= 1 ' Expiration Commissioner 02/04/2016 Gmail- Steve Devlin <centralconVRructionco@gmaii.corn> tp'.:rilk3iy�4. - i Cotuit Historical Red Cedar Roofing Permit i mes .ac�c Central Construction Co. <centralconstructionco@gmail.com> Thu, Sep 18, 2014 at 7:52 AM To: Steve Devlin <centralconstrictionco@gmail.com> Hell00000 Dot, Here is a permit application to re-roof the "Dottridge" home at the Cotuit Historical site. The problem is that the building is 200 years old and will require a historical sign off. The Cotuit inspector, Jeff Lauzon, said that because the red cedar roof we are replacing is exactly the same as the one I want to put on, that. we should be able to get that sign off without going to a hearing. In other words, the house is 200 years old but the roof is only about 20 so it will look the same, just new....See what you can do.. Ye Central Construction Co. 820 Main Street, Cotuit, MA 2635 Tel/Fax: 508-420-1340 Visit us at- www.centralcapeconstruction.com "The Excitement is Building!" I IMAMABM Town of Barnstable E0N1�A Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder j I, N�a�A 5 Lim ,as (bier of the subject property c hereby authorize -'F-tp cu I)-,V L,I" to act on my behalf, in all matters relative to work authorized by this building permit application for: VV\4� "-- Cuni (Address of Job) Signature of(5w= V 61..E1b 6o' Date �n ara�u Dorn�(,v�►ti. Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN_D\Building Changes\EXPRESS PERMIT\EXPRESS.doc Revised 061313 I _ , Central Cape Construction 'Company, Inc. Stephen Devlin 820 Main Street Fax/Phone — (508) 420-1340 Cotuit, MA 02635 January 28, 2014 } Town of Barnstable Building Department Hyannis, MA 02601 Attn: Jeff lauzon Re: Cotuit/Santuit Historical Society 1148 Main Street Cotuit, MA 02635 Hello Jeff Here,is a certified plot plan by Ed Stone Survey of Sandwich locating all buildings on.the. property as requested. Hopefully, this is enough information to retire any open permits on the property. Let me know if you need any additional information to do so. Sinc rely, eve Devlin t� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION o i I b��70t Map Parcel Application a V/ Health Division Date Issued �Z Conservation Division Application Fee c) Planning Dept. "Permit Fee 4 ILOO Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Y Village Owner — Address /Y� ° \�'➢� `L Telephone Permit Request 44, r V e W Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. 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 Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use — - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number Address License# /G A/, S Qo� Home Improvement Contractor# le C�o Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _ } SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# y `DATE ISSUED !4 M_AP/PARCEL NO. = L � ` _r ti ADDRESS, VILLAGE 1 OWNER : z - t DATE OF INSPECTION: v ' ` ,'_FOUNDATION. . S L FRAME INSULATION:.i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL z -GAS:-, &T!+ ROUGH' ��;,.� <� FINAL '~t i' •FINAL BUILDING ttoc::- �� o DATE CLOSEED-O.UT ASSOCIATION PLAN NO. sti , The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations 600 Washington Street. Boston,'MA 02111 c www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):' Address: City/State/ ip: Phone #: Ael an employer?Check the appropriate box: Type of project(required); 1. a employer with . ❑ I am a general contractor and I � 4 _ 6. ❑-New construction employees(full and/or part-time).* have hired the sub`-contractors 2.❑ I am a sole proprietor or partner- listed on the,attached sheet. # ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. workers' comp, insurance. Y P h'• 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions .required.] - 3.❑ I am a homeowner doing all work right of exemption per MGL. 11.❑ Plumbing repairs.or additions myself, [No workers' comp, c. 152, §](4), and we.have no 12.❑ Roof repairs insurance required.] t employees. [No workers' . comp, insurance required.] 1311 Other *Any applicant that checks box#I 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. `J� Insurance Company Name: Policy#or Self-ins. Lic. #: k1 G Expiration Date- Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c.. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under p ins and pe ties pe 'ury that the information provided above is true and correct. Signature Date: Phone#: y 0 U� G Official use only. Do not write in this area,to be completed by city or town official City or Town:. Permit/License# Issuing.Authority(circle one): ' 1. Board of Health 2. Building Department 3.City/Town Clerk "4. Electrical Inspector 5. Plumbing Inspector ; 6..Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'-compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more.than three apartments and who resides therein, or the occupant of the dwelling house of another A&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 bean employer." MGL"chapter'152;§25C(6),also states.that"every state or local licensing agency-shin withhold the issuance or renewal of a license or�peernit to operate a business or to construct-buildings in`the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required.", Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of,its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance"' requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have- employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom M, fc i the affidavit for ou.to fill out in the event the Office Investi' ati ii h of y g o s as to ontact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a refergnce number. In addition,an applicant that must submit inultiole permit/license applications in any given year,:n ed?onlysu6mit oiie a)"fidavit 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 , s F-a Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 6-17-727-7749 Revised 5-26-05 www.mass.gov/dia I HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN HE ISSUING INSURERS AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require and endorsement. A statement n this certificate does not confer rights to.the certificate holder in lieu of such endorsement. . PRODUCER Wllllam Palumbo Insurance 4327 Falmouth Rd Cotult, MA 02636 COMPANIES AFFORDING INSURANCE COMPANY A GRANITE STATE INSURANCE COMPANY r n' INSURED Hayden Bullding Movers Inc Po Box 496 Cotu It MA.02635-0000 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE"FOR THE POLICY-PERIOD INDICATED,NOT WITHSTANDING ANY.REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALLTHE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. w L M TYPt]OF.INaURANOE POLICY NUMBER POLIOY EFFECTIVE GAT! POLICY ExPIRA'noN DATE A WORKERS COMPENSATION AND EMPLOYERS'LABILITY LIMITS HE PROPRIETOR! " PARTNERS/EXECUTIVE OFFICERS ARE: II INCL❑EXCL❑ 4476634 2/06/2010. 2/06/2011 STATUTORY LIMITS a OTHER Coietage Applies IoMA operations Only. $ 100,00 EACH ACCIDENT ISEASE POLICY LIMIT $ 500,00 DISEASE-EACH EMPLOYEE 100,00 DESCRIPTION OF OPERATIONSNEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSYABLE SHOULD ANY OF THEABOVEOESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE 200 MAIN ST WIHTE THE POLICY PROVISIONS. HYANNIS, MA.02601 AUTHORIZED REPRESENTATIVE .. . . . all is Office0 o merz�t�tuairifsinegv HOME_IMPROVEMENT CONTRACTOR Massachusetts - Department of Public S►teh i a Registration: ,10620T . Type Board of Building Regulations and Standards ; Expiration: 7(22/2012 Private Corporation Construction Supervisor License H EN BLDG MQVERS I C� License: CS 16161 i }�— ricte.dto: 00 Robert Hayden v. Y 3ERT F HAYDEN PO BOX 496 ;HEOH ROAD COTUIT Mills,MA 026.35 �y4 Undersecretary , f U IT, MA 02635 „ Expiration 9/19/201 "t ('ununicioner Tr#: 4275 HAYDEN BUILDING MOVERS, INC. P.O. Box 496, FALMOUTH AVENUE,COTUIT MA 02635 TEL.428-6380 WHEEL WORK A SPECIALTY REFERENCES,INSURED,BONDED - - 0 �Ttati Towns of Barnstable Regulatory Services BARNsrASLE, MASS. Thomas F.Geiler,Director 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder G as Owner of the subject property hereby au orize _ � to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Joby ig ture/of Owner Date f Ja Print N e If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:OwNERPERMISSION T Town of Barnstable �apTFiE Tp�y o Regulatory Services aaxrrsreate Thomas F. Geiler,Director s�1 Building Division rEn Nu+'� Tom Perry,Building Commissioner 200 Main-Streeq,._Hyannis,MA.02601 Trww.to wn.b arnstable.ma.us Officer 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constrgcts more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that,he/she understands the Town of Barnstable Building Department rninimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that "Any homeowner perfomring work for which a building permit is required shall be exempt from the provisions of this section_(Section 109.1.1 -Licensing of construction Supervisors),provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuring the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hiTM5 unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns. You may care t amend and adopt such a forrn/certifrcation for use in your community. Q:forms:homeexempt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map 03 Parcel U 5 2 Permit# � 1 Health Division 1CA - GCkLt�LQ Date Issued hl ` Conservation Division % 2 Or,— r Fee Tax Collector o .": c Treasurer SEPTIC SYSTEM MUST BE Planning Dept. INSTALLED IN COMPLIANCE , {�- WITH TITLE s Date Definitive Plan Approved by Planning Boarflgh: ENVIRONMIENTAL COI° AND Historic-OKH Preservation/Hyannis w - Project Street Address r- Village Co`I't4 l T YY1f� Owner TWF_ '•1 ST©IZ(C6L— S©e.T'E_T'S' aV=Address 11 t}8 MAi N SE . CP 1 T� Telephone S 14NTu i r � Permit Request 7'© GOr _s-rd .vtcT ArA I I — O, X I —7 =-a T AA%,C_ 1 VOIL_ 5TP>R► t&E RCbM 77o '1}q_ EACJS-F OTC--• t 5(29 SOLA A.y- FAT SAIZ44 Square feet: 1st floor: existing 1509 proposed $ 2nd floor: existing h) /14- proposed Total newtift Valuations 5D• O O Zoning District F Flood Plain Groundwater Overlay NO Construction Type WWrR 'F AM— Lot Size�-3 540 0 ...+CSQ FT•. Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure ± 3 5 Y:O S Historic House: ❑Yes )*o On Old King's Highway: ❑Yes XNo Basement Type: ❑Full )d Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) .m- 19• Basement Unfinished Area(sq.ft) N �. Number of Baths: Full: existing 64, new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric Other rt 21aMP �Y FLEM 0-- Central Air: ❑Yes 72(No Fireplaces: Existing New Existing wood/coal stove: ❑Yes )&llo Detached garage:❑existing ❑new size Pool:❑existing ❑new, size Barn:O existing ❑new size Attached garage:O existing ❑new size 11m, Shed:0 existing 0 new size Other: Zoning Board of Appeals'Authorization ❑ Appeal# Recorded❑ Commercial XYes ❑No If yes, site plan review# T? = JM, �9 Current Use 14t's'jDR` C -4ba 1 MI Proposed Use ARrkI VAL Z *469 BUILDER INFORMATION Name—C.A. 4Assg--H Telephone Number -508 Address 1G I1 "AN St License# CS 439034), P.0► IBC 13 1 O Home Improvement Contractor# 1.30 5.31 �6154- cqTtA TT MA. Oa G 35 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO _L_. O T f SIGNATURE DATE 2-1 6 ZCCO 04• ... ) r FOR OFFICIAL USE ONLY Y t. PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS t VILLAGE - OWNER s DATE OFJNSPECTIdN: ` FOUNDATION 'f FRAME d ( + INSULATION K FIREPLACE - ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH-., w. FINAL M GAS: ROUGH FINAL. j s FINAL BUILDING _ DATE CLOSED OUT ":" ro ASSOCIATION PLAN NO. �t i I. iusT;N6- 8 CML, ,. 3 It. Dau-)!LS' -rjPq 3lANC-Ti'oN .WRIj 5f. _xgsTi(i6- PiRck VAL —o STRIAMRV— Rkel t:%TY { I I E3� I �W E CM U" ll . . 01 S=ice'_" !i �� ♦^� �w't� ; � � '� � .Yi--� n I F-x ISTi N 6-- 8�Cl�'1 Gl a. PiNg' F To M14TC_H R7,.3Ti N�i- ax 10 TJ'Z To i s T c 4 T 6-PL'fu r�y0 R-3o SA-FT IIVSOLATiON ax 6 P.T p4R'T� miL. vfEPoR MRRI'-R- 1 C nn U'W 6LL- 0 i It oowz�-S 5� a, 4` J 0� 4� �dd�ti 4,4 A t0 'comcar�TE- A d 4 A a � a 500 4'�2 � r T`{PiC14L Fou1NpRTioi�t_ F'o U NlD14T�o N �-i� FsX i C(6- R -mg t L F�fisTiN 6-- 12/3 Mus€kM =Ko RSQF}t'd.T Sf1( 1� Cis. i;O 6- 1 AA 10 AAFTF-r'L {g 16 O.C, ax ►� STuD yz �_9a � R-�1 DH-tt' tir`1Sc1� 17 0 Mi L fbL I DIt1'N6&L�. _e 1 F'X1STi N G- TYQJcAI- S�e-r6or( f c�---- I X 3 o FIN€ -rz� _ MAT:R FxiST4% irpc IsTrirCr- pM;.I-14 Trtu E I uAw yY1lktCH EXtSTV1Er IX 8 WR''f1=CZ�Rf3l.� QRI jjp So UT 4 fimftT I oN 4qp _ ' w i N Do uLS 'Ro BF— tl MZv i i'A o K F E.l.LA (n�i- s az ►t�'�- G-� (A 5uLA1V-U GA-P%S -MU D I V l 0 E ID S�L�T ff►Ntz_ 1-a YYt _ P-L.. (A( Ns Z%-o Al x -o` T-1 V,i C TllvL. 4LL W i NPoLV5 t DOC)R- LL � C3PrS�. �'PtCt�L FitAosi-F FLve iZ... To F /2 Df2Ywlgtt fRLL , - I 1 Y S. T$G- n,� i a. L•- S Ti4� t'1�-U To YY114� F.Q�IST'�� �" - s�LT CAaO t-htq ri tE- C.w-ro n-!F�4 nctH o � n t l_N ScalLs4tE- CcZ�VNVVb N UV ALL 4 �L� � 3�c -6�g 1 x �� shi(�L►q-p P�h� Tb w F n TS Ti N G- MtA 3 rz-GA W1 S V+O a: 14 } a-9 V w aL s -3-. M a Z) Q_L 731AJ-VIJ-A IM F -9 t4j-LTLxs �. Town of Barnstable _ ° Application for Site Plan Review. . m Location Business Name: -ME I{-sT=i C4L Soot ET-r or- S OMAI T e>7U I T Assessors Map and Parcel Number: MAP 3 4 Gktrml 5_( Property Address: 114-0 1M 4i ry ST C_o rut r yn g oa 6 3S. ( P,o. Box IL-84-. Owner of Property Anylicant Name: µ(S TaR i e 14 L so C 1 rz f Y or Name: u,sm1r1c,4L svei g77- Dr Address: Sr}N?ui+ Address: N TN 1� Ca Tu 1� J m i ry sT. co-m I'd m!4• .Phone: p o. 13OX 11 y-g o2z357 Phone: ;�2 8 o e f.6 I - FAX: Engineer /,3at.4DIN6- eorVef7 9Cp2/Z, Attorney Name C.f! . Gfl Ssj'7-7i Name Address: ,6 o x /3/D Address: Co T u/V- M19. 0263E ( Phone: 3og /f2o / 6-50 Phone: goo If2 o / e G 2 Fix FAX:W Storage Tanks Existing NONE Proposed No N.E Zoning Classification Number: Number. District: Size: Size: Groundwater Overlay: 6- Above Ground: Above Ground: Lot Area: Underground: Underground: Fire District Contents: Contents: Number of Buildings Utilities Existing: Sewer-Public6vate Proposed: I't )(9�10 Room Water Publi rivate Demolition: NON Electrical- eri nderground w Gas -Natural/Propane Ho NE_ Total Floor Area by Use Residential: aParking Spaces Curb Cuts Office: Required: 6 Existing: 0t4 E Medical Office: Provided: Proposed: f16 N E_ Commercial: On-Site 6 To Close: N6 N E Wholesale: Ofl'-Site: Totals:, Institutional: o? 34-6 SQ--Fr. hIP: 1- Industrial: (Specify Use) • 4 /41 5To2i CA L . 0.0 N C A T/'o4 � ViSRL;4 r F% c-tS o G - DATE: t}IE l� FEE: , 2 BARMABt.E. ( r KAM S REC. BY i079. Town of Barnstable SCHED. DATE: . Board of Health 367 Main Street, Hyannis MA 02601 Office: :08-790-6265 Susan G.Rask R.S., FAX: 508-790 6304 _ Sumner Kaufman.M.S.P.H. ( Ralph A.Murphy,M.D. VARIANCE REQUEST FORM LOCATION Property Address: _ 11 t1-S M t1r I N STRE>?T; CO T U I T . MA OA63S Assessor's Map and Parcel Number: MAP 3 lf�PARCEL 51 Size of Lot: • 'S 6 A C R E 5 Wetlands Within 300 Ft. Yes Subdivision Name: 4 No X Business Name: -n•'_ s.?'^n'CAL SDr 11zz T'f Offi S/4N TU I T Co TU I T l APP[.tCAII T CONTACT PERSON Name: E To. L SOCr T Name: jt!551CA RAPE CHASSE*t eD'F SArA-rUI-T CaTt,t1T Address: I 14-8 M W i N S T. CD'f U i Tr ►YI F�- Address:, P.O.' go X 1310 CoTU i f 0.2.63H Phone: Sr ,g • l+'Z go 4- 6 I Phone: ISO 8 • -2-0 1 $$D FAX: iA l4• FAX SOg 4-Z0 I. 8 VARIA NCE FROM REGULATION lust Res.) REASON FOR VARIANCE(May attach if more space needed) Wr— ARE. REQtAESTiN 6- fl ciL; • S o �4l- oPE VFIRSANCI= FROM THE otiLT 60 DAYS 31%(t PER 6AT _ >nH REQU►A-tiON UJWC1+ -1-5 Eq 8 hn. ME 1:Atil41 WAS REQuiRIzS "THE- UQ6R6pE oNj. uuA••f"pm CL-osEt d Two simws of S i �f4lc Cr.sSPo o t_s rLosl<p A rAor4+hs w A+m 0�!' w gEN APPL`ON G FOR A No 6NARooM�,ShowQrs,Tub s�t.aKn�t.7 RUi10iN Fs Q� Mit F0 L oR Di5f-25AI onV;+fC* is r7o[L STt�ft�491e INN AAfl1tioN No ir4cM45i:< iKTEA 3iTY 01; CASE. dtecklist(to be completed by office staff-person receiving variance request application) Four(4)copies of plan submitted(including septic system plans and/or restaurant floor plans) st be notified by certified mail at least ten days prior to meeting Applicant understands that the abutters mu date at applicant's expense(for Tide V and/or local sewage regulation variances only) Full menu submitted.(for grease trap variances only) Variance request application fee collected(no fee for rpu feud modification renewsla,presae wap variance renewals lw*•°u,Knleasce°^'yl outside dining vans=nmwa4(same o wnenlase`only 1,and vartanco w«pair failed sewage disposal sysrans lonly if no eaoamwn w the building pmposedi) O submitted at le ast l� days riot to meeting date Variance request submt P � , VARIANCE APPROVED-_ Susan G. Rask,R.S.,Chairman NOT APPROVED Sumner Kaufman, M.S.P.H. REASON FOR DISAPPROVAL Ralph A..Murphy,M.D. Q:/t•(P/vARIREQ TOWN OF BARNSTABLE �FI(HE m�P� wo OFFICE OF i DA"STAM i BOARD OF HEALTH NAM pj °o i639• �� 367 MAIN STREET �oYaY�" HYANNIS,MASS.02601 November 29, 1999 Jessica'Grassetti f P. O: Box 1310 Cotuit. MA 02635 RE: 1148 Main Street, Cotuit, MA. J Dear Mrs. Grassetti: Y You are granted a variance on behalf of the Cotuit-Santuit Historical Society, from the Board of Health Regulation listed as Part Vill,.SECTION 5.00, which. requires owners of septic systems consisting of one cesspool to be upgraded to . conform to 310 CMR 15.000, Title V, the State Environmental Code. This variance is granted because only a storage room is proposed to be added to the "existing barn." There is no sewage flow associated with the proposed addition. Sincerely yours, Susan G. Rask, R.S. fChairperson Board of Health Town of Barnstable SG R/bcs grassed ti jThe IBstorical Society of Sanrait and Comic 11-48 Main Street Cotuit,Massachusetts , ARCHIVAL STORAGE ROOM December 2000 Outline Specifications Site Remove trees and stumps as required from site Strip and stock existing loam Excavate for structure I Backfill as required Remove.surplus excavation material Spread loam and seed to blend ( Foundation Walls 8"x 4'-0 concrete masonry unit Footings 10"x 20"concrete @ 2500 psi Structural Frame Exterior Walls ' 2 x 4's at 16"on center with Y2"exterior plywood* Interior Walls 2 x 4's at 16"on center Floor System 2 x 10%at 16"on center with%"plywood Ceiling Joists 2 x 6's at 16"on center Roof 2 x 10's at 16"on center with %2"exterior plywood *All plywood to be agency certified • I Exterior Trim, Siding, Shingles.Windows Walls 16"White cedar shingles, `Extras"at 4 V2"to 5" ' to the weather Trim 3/a"Eastern white pine,to match existing Sheathing Y2"exterior grade plywood Roof Shingles IKO 3 tab asphalt shingles to match existing Windows All wood Marvin or Pella insulated true divided lite (as shown on plan) Insulation Exterior Walls 6"31 R 11 with 4 mil. poly on interior surface Tyvek or equal on exterior Ceilings 9 '/4",R 36 Drywall Interior Walls &Ceilings %"Drywall with three coat tape job Interior Trim Baseboard 1 x 6"square edge clear pine Window Casing 1 x 4"square edge clear pine Door Casing „1.x 4"square edge clear pine l ° I' Paint I Exterior Trim Prime knots with Binz or equal, one coat €abWs ,Problem Solver, Finish coat to maids existing White Cedar Siding No.coating,allowe4 to weather Inte=grim Oiie coat primer and two coats finish t Interior Walls One coat primer and two coats finish Flooring 1"'x 8"T&G Pine stained to match exisffi{g, 2 c6 ifs satin p61 H_ VAC System Samsung two component heating and.c g UO-with fAir cleaning function unit modelAQ6 A(seCr ached) Electrical Du ,mid is(as shown on plan) Two 4'=b''d6A Buc(eme&tube units fT'PMAo&9Mtrcomputer circuits Eck Add' sfifd heat detector from existing system Cireait forH'VAC system ^ n _ -• �`y _ '- L.L. N N O N I -PT.PLAN g 216 D aco U w LAND co CO z =o M MAIN STREET - " o� � o n PAVED APRON ' CB DH (FND) 215.79' j y coo 5 r co CB DH (FND) 0 N w o - SHELL DRIVEWAY < - - EXISTING. MUSEUM v LOT 14 J LOT 13 I LOT 7 LOT 6, s PLAN BOOK.157 PAGE 139 I LAND COURT PLAN 9216 D EXISTING N W MUSEUM a� CB DH (FND) _ CB DH (FND) o ciov� o33 B D NO) 94.3T 1 m ZONING REQUIREMENTS: ` r 1ts�3 PROPOSED ADDITION iO I DISTRICT RF LOT AREA.........43.560 LLI 102.92' CB OH I(FND) FRONTAGE.........150 FT CS DH FND FRONT SETBACK.......30.FT W tn F=1 SIDE SETBACK..........15 FT z REAR SETBACK........15 FT w = N o LOT 13 A I BUILDING HEIGHT.....30 FT LOT 4 LOT 3 n < o� o Z En En �W SITE AND 'SURVEY DATA (L a '= ox LOT 2 o = cc LOT 1 t I LOT AREA: 25,750tsf.0.59toc 3 �NOF a 00 Q- 30 0 Is So 09 +p ASSESSORS MAP 34 PARCEL 51 02 OAVID ! o' PLAN REF: PLANBOOK 157 PAGE 139 LOT 13 a ` IN FEET ) I PLAN REF LAND COURT PLAN 9216 D LOT 7 o v _ 1 inch 30 fL DATE OF SURVEY:DECEMBER 16. 1999 w ST/Lvfe� /2 Luoo �SHE dl I �� w TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -7 Ma vrcel pp = A lication# p Health Division Date Issued_ O Conservation Division Application Fee Tax Collector Permit Fee --%- -7► Uv Treasurer Planning Dept. "LIT, Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village __ L.a4yi` ' Owner 5�4 9,` ®G `e4 ss i m Telephone �s�r_S f4t i9.fL gC �j `U i/z5 Permit Request I)V 6 z�1c� e 7`_*Ada' r`xt,' � a��`®R z..,4llr ,o��sf q442 �1�rs,e�r•�,S�•��� PlJc�e__ Square feet: 1 st floor:existing le_?-6 proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 76 tJ m D Construction Type A/067 t2 Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure a 5_9,o4c44e_, Historic House: ,Yes ❑No On Old King's Highway: ❑Yes kNo Basement Type: ❑Full ❑Crawl ❑Walkout w,,other 6 16 6 Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing neW: Number of Bedrooms: existing new ? Total Room Count(not including baths):existing new First Floor Room.Count -- L%i GTt 'tip Heat Type and Fuel: ❑Gas ❑Oil Electric Other Central Air: Yes ❑No Fireplaces: Existing New Existing wood/coal tove: J yes No co Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑exi ing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use _ BUILDER INFORMATION 0- Name S�✓���,c/ h / All Telephone Number Soy= ZOO Address L7 7 ES'elotl6l01,v Wes. iQ License# 7 Home Improvement Contractor# _I Z0660 Worker's Compensatio`n��# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE `—'�`� 4 FOR OFFICIAL USE ONLY - •'' R+• `- APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ' OWNER ; DATE OF INSPECTION` A' I FOUNDATION FRAME �G o� o 8 2nt �J,I Ps -F /S�0Clr-9 �EG-�c� i � INSULATION FIREPLACE ,r ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL f t GAS: ROUGH FINAL y FINAL BUILDING �� 7 �7 � a DATE CLOSED OUT ASSOCIATION PLAN NO. i The Canznionwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' wttiw.mass.gov/dia Workers}Compensation Insurance AMddvit: Builders/Contractors/Electricians/Plumbers App [cant Information Please Print Lei 1 Name(Business/Organizatian/Individual): Le- `V L°/�/ � OL e 1 Address: iso i[ Ci /State&i Ce- Vv Vi`6 to 0,46:3 Phone. tY P• � >Pi Are you an employer?.Check the appropriate boar: :Type of prof ect(required):; 1.❑ I ant a employer with 4• (] I am a general contractor and I ' �6. ❑New construction ''employees(full and/or part time).*• have hired the stib-contractors 20 I am a'sole proprietor or partner- listed on the'attached sheet 7. Remodeling ship and have no employees These subcontractors have S. [�Demolition' �yorkin for me in an capacity. employees,and have workers g Y P tY• 9. ❑Building addition i o workers' comp.insurance comp,insurance,$' P 5. [] We arc a corporation and its 10.❑•Electrical repairs or additions required.] ' officers have exercised r 11.ised their Plumbin airs or additions ' '3.❑ I ani a homeowner doing ill-work g rep myself.[No workers'comp. right bf exemption per MGL 12,❑Roof repairs insurance.re uized t c. 152, §1(4),and we have no % _ ijler q ] employees. [No workers' 13 ther comp,insurance required] Q7f9 o-45 V AI A-n lrS *My applicant that checks box#1 must also fill out the section below showing their workers'compensation po icy information. t Homeowoers•who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anow affidavit,indicating'such. $Contractors that check this box mutt attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees, If the sub-contraotors have employees,they must provide:their workers'comp.policy number. ' I atn an employer that is providing workers'compensation Insurance far my employees. Below 1s.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lid.#: Expiration Date: r Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declarationpage'(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 lime of up to$250.00 a day against the violator•-.Be advised that a copy of this statement maybe forwarded to the-Office of' Investigations of the I)IA for insurance coverage verification I do hereby certify under the pains acid penalties of perjury,that the information provided above Is true and correct. Si afore: Date: Phone# 9 Official use only. Do not write in this area, to be completed by city or town officlal PeraWLicense# City or Town: ' • Issuing Authority(circle one): 1.Board of Health 2,Building Department 3. City/Town Clerk 4,Electrical Inspector 5•Plumbing Inspector r �'ldll.Ix.Z..�D(CClft'tAsltt� . prrserlptira psnksgd far(36"d T;c4A 1Jj ResldcatW 13vildingx'Hes n9t4' Fels • 144A�hiI7M ' M1MR3111�1( ,, tlfaxircg Glazln$ CclIfng Will Floor $tsanr4t Slab •Hcstiag/Caollrtg � cnt ,F�das AM'C!,) U-value' R-vAIMu' ' R-vslucl X-Yslu Wsll Taira Pa - ' r Psdcago I{-v3luat Igvnlua� • 5'/4I toI6500 I1ad1ag be gtxr hays' 1ZYr. 4.40 38 I3 I9 14 Harass! ' � Plcmzal • tr�s 0-52 30 I9 +19 t4. ism . 12f G.54 3A I3 I9 f 0 6 g f N/,�. Norma!• . � •' I3'lr. n36 � 38 I3 23 •T'UA . IS'/i d,dS 3S 19 I9 IV tI• .]Kcrmal I! M AFM Y ISY '4,44 3tt I3• 23 , NIA ' S 1yr I3Y. 0,32 30 t9 19 14 '� • . ISY. a.3x 38 • t3 . N/ NIA Nanzial ' •?► Normal Y 13%, Ml 39 19 24 'MIA NIA g4 ormd AFUZ 2 • Ilya &A4 31. 13 19 10' AA laY. a3n 34 19 t9 rt7 s�AFtlx 1. AUDRE55 OF 1'ROI'Eiuy,- r/C /"`R l.�/`• �� 5 QUA RL FOOTAGE OF ALL$XTERSOR WALLS: 3, SQtjARB FOOTAGE OF ALL MAZJNG: a/c 13LAZINO AMA 03 DIVMED BY•�-7); n t� gBLECT PACKAGE(Q L AA-see Chart above): NOTB: OTHER.MORE INVOLVED METHODS OF DE'1 MINIl-G Em-(3y REQ ARE A-VM ABLB, AM,US FOR TMS WORMATION1 BU7LDii iG L�tSPECTOR APFROVAL: , YES: NO: r Town of Barnstable Regulatory -vices Tom Perry, BaxUdhigCopunisslaner 200 Main Sheet;, Hyannis,impk 02601 ]ffice 5�} -Sb2 �l � :fax: 50$ O-6230' t Property Ovmer Must'Complete and Sign This Se.ctibnlf Usi ig A Builder of:he subject pig pwry �o� r hefieby autholizt—�� to ace On my y bel�ai , in all n}-acwrs rela .Ve o Oxk nudot red t-y d%is.bQdin per ,t.�pp[i a n ,oyi (address p job) �o j-e)-C&e e �,/goU Q;FQWIAS.O ERFERMI_ISSFOB boar"d oT u�i g l lCatiofis an an ar s - Construction Supervisor License' License: CS 46912 Birthdate 8/28/1961 i Expiration, 2812009 Tr�l 5281 I; I v irfl�estrlct On -0 I I STEPHEN M WFIENA rJ PO BOX 48l ` CENTERVILLE .MA 0263.2 Commissioner i I i - r j woIDde r7 rump �..--a.-=a�— -=--aa� -a��- - - - - - --- C�ri.�finr/000;>>(elui(�cci � � �,</r n..,+p����•S TU - he/✓ems wide - wilh rov c%u,Icrra,�e; b F. /ini:�hr-d=eiczi Pine inr'r xi3linq wall.,io GIfl whop ingcilafed u!-51 1±hail � io rw/ch kchivc 1,- om. � � in ullafion,Wall fin1317ed in:�ciccl pir)c hnardin j r � Ix s s2��✓ CUnfini�hedi fn malch eri5,finq. Q q f l e.ma's T-0 Gift whop � Tti �� e-ems f f lee I 1 P•lcw wind and weal'hrrNghl.xrah ' io czi.,linq horn door.-- I�IUSeU(7 1 e''x 30 Secf tcw fei.,iinq wall,i0 _ Mcr:5•um ilk:50/orcaf 5hel✓e7 l 1"wide�il __ _ Fife 7-ruck 1'I c/5euri U3i»q Pig hail Yn3ulafion,hi/all/ini3hed 3 tr•X d '' in�elecf pine hoardirej _ t hive lc'oori l�r+t/.✓ � Ncyl Irim in plea(laqucr ffni.,l ra,c-lci Pill, 1 la maic-h archive.'room fo c:xi,finq winiow.3, previov.�ly i»,ulufc�d _ _ �' � — --- - - wull:5lined v/ifh plain:!Occl pine, a1c cd mal Unlf --------` —�"--- .—. _ Amys s.G.�hvl•`1u':cm Woo l7()L ram./i 7cdcrvx(.Telly 1—cl l6 AV Merle ord Pl. '7crayirrcl Oolu+lrrmlodcd:�ccrcf/.i;HB!7a:n5LC:w(✓d,:"1oa�xhixN.e. Prexxdyroundlloor�'lar,,xdc'/'I"^;:L(P�lBi .�,v,o.l...,�'...1..., ?,,M 1 .1L8 raMA�74Y,k7 _.—. t ' t r tQ Q,��RS f� (*, OM w w / IV IIV 31mr-r- I � - { C8 DH (FND) 215.79° PAVED APRON CB DH (FND) SHELL DRIVEWAY -- EXISTING i MUSEUM - Li I 7 v LOT 14 LOT 6 _ LOT 13 LOT 7 , PLAN BOOK 157 PAGE 139 LAND C UR-T-P-LA. EXISTING MUSEUM I CB DH (FND) B D ND) 94.37• CB DH (FND), i ZONING REQUIREMENTS: 71 .,DISTRICT RF LOT AREA.........43,560 902.92' CB DH j(FND) FRONTAGE..........150 FT CB DH (FND) t FRONT SETBACK.......30 FT SIDE SETBACK..........15 FT REAR SETBACK........15 FT LOT 13 A BUILDING HEIGHT......30 FT ' LOT 3 1 LOT 2 SITE AND SURVEY DATA I LOT 1 30 ao so 1 LOT AREA: 25,750tsf 0.59tac _ 0 9s 120 �' ASSESSORS_MAP 34_PARCEL 51 PLAN REF: PLANBOOK 157 PAGE 139 LOT 13 ( IN FEET ) PLAN REF: LAND COURT PLAN 9216 D LOT 7 1 inch = 30 ft. ` DATE OF SURVEY:DECEMBER 16, 1999 eDEP: Print Receipt Page 1 of 1 Submittal Summary & Receipt Your submission is complete. Thank you for using DEP's online reporting system. You can select"My Homepage"to review your status. DEP Transaction ID: 163312 Date and Time Submitted: 1/16/2008 10:41:48 AM Other Email : Form Name: BWP -Demolition Form for AQ-06 Payment Information DEP code: 28881 Date: 1/16/2008 10:40:43 AM Amount($): 85 Payment Detail: Stephen m.Whalen--Card --7593 Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab https://edep.dep.mass.gov/Restricted/webpages/printreceipt.aspx 1/16/2008 °FTME 1p� The Town of Barnstable • BABNSTABUM& • MASM& � Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner PLAN REVIEW Owner: I A` fir^i eVu o ' Map/Parcel: D 3q- OS I S�vr�u'�� ,��� Cc�t'►� � nn '4 Project Address:_/ �/ Al� Builder: The following items were noted on reviewing: Ne- e-d V Y 65 yeV)+, 14�1,6 m 40e) AC.0-E.SS d-o C�CfaW1 Noce . 1,;2//of aio d Ju- Lvz.(,Q Please call 508 862-4038 for re-inspection. InspecteF&b. Date: � ' I /(J q:building:forms:review _rn- J E FT SIDE E I EV, -F 10 N i i C i t i t , AtUM[nY t/N4 FAri VE NT', y 7. 6 ----—._—_..._.._._.._...__... .. — - - — wHITE. CE VA,Y� ST?,I., LE 5 g x io T if- �11LE-1.'F-DdIi-SIiLrJ�l_E.,S_--__...__.._._.. a —_..__... •S"TD 1NFATl-l.�Fa.._ %1 7=1 ref CT_ ROE L E VA TI O tom _ 4 f PRANK LfH-_D-512519! - �ffi'-5H1� PtiALT- 7EFi .. - �.. SIfINGLf$ � � ! i SrrTo WEArriF n V r r .y✓_-----! IT TION tflA tV 1L .LN�.-J�2 '�-- - 2v' 7G i . _ 1 _. 00L00S { ' P�T. PtArcoR _ C -NOT kF_mnvC° exisl-I IG � .g..HiGsz,l<1S l Htr.GL1 5. F or RICiH $LUu fJl1LL BL— IIi I 1V SEUM 1 i F I R F &LCi i - .. II S7D12 AG.E..._ { { 0_F_FICE I 1'n MATCH 'FXiGTtN[�� i I I _ f _.1_. — - L - - G s.�1 � . PLAN ""°` ✓/ee�ammtanureall�t a�/�aaaac�u�ael� �. BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number'_CS - . 039032 Birthdate 1 121/1943 + Expires: 11/212001 Tr.no: 11078 — -- Restricted To 00:. ; CARL A GRASSETTI _ 1611 MAIN ST POBX'1310 .«..� COTUIT, MA 02635 Administrator tiE } - -- al Accidents . ^�,i•=_l= -f� Department of Indust�ri o s iOfll 9•;::;:�:~ = ~� ll�estl atloos . 600 Washington Street Boston;Mass 02111 Workers' Com ensation Insurance davit s name: location: hone 2 city ❑ I am a homeowner performing all work mvsel£ _ I am a sole aroprietoz and have no one worldng in I am an emplo�•er providing workers compensation for-rav empiovees. g.�:�Job-- env name: ;:.,,.: . . w•.,•:;::::•. .:; -.:.:;:;; >:.:.,:::.;•:,.;..,:: address. ..:,:::,.:;:•;::.......•.. ::.•::::.:.: hone•#:.. .::: insurnnce co /�/ --- i�AMvii� �/i�i�o����////�/G/ �on and have hired the contractors listed belotiv R'- �, I am a sole prop or contractor rhomeowIIe1`t have the follotiN1ng workers' compensation police : :::,.• : ::::: ' ": .:. :.... comnanv name ..A... _ _- .. F a.�-.. .. ._ I address- _- .....• :..v;}{. , m«x •. =7— insurnrice cr :;... camr.hnv name- : ,r IInn^� :.:• .> - address:41, „,. 0 insurance-co. //// / the oteri maal penalties gf a fine a to S1.S00.00 ant • Failure to seclim cove dull pe�tlin nth fo M��WORK OMER ���00 a day a soot me.�I tmdentand the �onecears imprisonment tionsofOwDIA for t�eM copy of the statement may be for�+arded to the Ofilce of Inv esligs 1 do heresy cenif under the tuns and na&ies of pedury thin the injorneatioa Prod above is ttu'and correct Date- i Z �� ZocrS Si�tature 20/9 SO Phone 43 k..�•.xPnnc name _ • do not write in tds area to be completed bf atf ortown ot8elal c' onliciai use only ❑Building Department permitlliceme it ❑Licensing Board city or town: ❑Selectmen's Office •? • (]$ealth Degartnent check if immediate response is required (]0ther 333$ phone#, :3 contact renon: Information and Instructions ' s all employers to provide workers' compensation fa the^u �4ass:�c •�ss Ge^eras Laws chapter 152 section 25 require p ion s. ?�s quoted from the "law",an employee is defined as every person in the service of another under any corru_ emp . of;;i; --ress or implied, oral or written- er is derived as an individuaL partnership, association, corporation or other legal entity, or any two or more c: An cirP ti the legal r resentatives of a deceased employer, or the rea�ye: 1:e fore_c' _, �:gaged in a joint enterprise,and including trust of n individual , partnership, association or other legal entity, employing employees. However the owner of a house of •E' -:rouse having not more than three apartments and who resides therein, or the occupant h theuse or•onngethe grounds a�a construction or repair work ou such dwelling anoTI, er-�,ho employs persons to do maintenance to be deemed to be an employer. building appurtenant thereto shall not because of such employment • -ter 152 section 25 also-states-that-every�t or.local licensing agency shall withhold the issuance or re ,N4GL crap.... . - licant svho h1, a a iic^_^se or permit to operate a business or to construct.buildings in the commonwealth for any-app evidence of compliance with the insurance coverage required AdditronaIlp,•neither the not prod cal acceptable caztaact for the performance ofpuolic work=u __,=,on7A,ea th nor any of its political subciiyisions shall eater into anYthu chapter have been presented to the:.contrac=u acc�table evidence of compliance with the ristzr anC=1equIrelnents of authority. / i ppiiczntS T tvorkeis' easatia�a affid3compietelX,by checlang the box that applies to.your situate aits may nd {jy ,... - co- }� f ':1r,ncn in the ^'-"r - .- �surallr. as �am v hone num ers-along,With b W a certificate o �y :ppiymg company. address,and. P �- t Department of Industrial {��mation:of insurance-coverage- Also b�sure�a «� ..na ;ubmitt to the Dee Iicaiion for the permit.or hose:s to the :or-town'that-the the a aavit. The affidavit should be ie>umed _ y qu sdons..regarding the "law." or u have M Industrial Accidents y _ �e� requested, not the Department :- at member listed below. ensatdaa policy P e,call the t _ a workers' caomp Dee arGmeni are required to obtain _ i . City or Towns of 'd ed a ace at the bottom . 1 The D ariznent has,,prgvi sp sure that the ofndavrt is complete and_pri printed,_ -Y� -_ eP li�"Wt'-'Pi J 1 Pn P pn$has to contact you regarding the''tpP _i. V NV davit for:•ou to fill out in the event the Office of invesizgati to nil in the pezmit!li ei number which will,be used as a reference member. The affidavits maybe ze^ t^ be sure have been made. the De_aarunent by mail or FAX unless Other Th� office e of Investigations would ItIm to thank you m advanc a for you cooperation and should you have any cru . ;Aease do not hesitate to give us a cal FBI D epar=ent's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations - 600 Washington Street 'Boston; Ma. 02111 fa=#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 e i Y.FS poll 11 mill MIMI ' E I lion I F all �III milli P. Ell I 1 � ■ eEll I MINI I � Mimi i i i 1 r� SPR Meeting Notes 9/30/99 Site Plan Review Meeting of September 30, 1999 Hearing Room, 2nd Floor Barnstable Town Hall 367 Main Street, Hyannis PRESENT: Ralph Crossen, Building Commissioner, Steve Pisch, Engineer, Thomas McKean,Health Division Director,Art Traczyk, Principal Planner,Rob Gatewood, Conservation. Also in attendance were: Carl Grisetti,Attorney Pat Butler,Dan Ojala, Engineer This meeting was called to order at 9:00 AM and adjourned at 10:55 AM. SPR 078=99 Historical Society of Santuit/Cotuit, 1148 Main St., Cotuit(034-051) -- �� r. The applicant seeks to construct an archival room annexed.to a barn without historic status. Art Traczyk questioned the applicant regarding the actual use of the proposed addition. The applicant responded that use would be restricted to staff members. He continued to expound, informing the committee that the room shall be dedicated to storage. A small work station is proposed to be installed in order to expedite the processing of sorting and storing available historical records. Tom McKean, Board of Health Director commented that no record of a septic system was on file. The applicant revealed that the existing system pre-dates the Town's recording process. It was also commented that the restroom facilities are located in the Dottridge. House museum building and currently a single cesspool services one facility. Steve Pisch, Engineer offered no comments. The Building Commissioner inquired about a climate control system and whether or not any chemicals may be used to preserve or restore any old records. The applicant informed the committee that an air conditioning/dehumidifier wall unit shall be installed but no chemicals are used on site. The Historic Society does not anticipate such a request as all sensitive records are sent off site for reconditioning or preserving. Currently, historic materials are stored in acid free paper and boxes. : Ralph Crossen reminded the applicant that the addition is located within two feet of the set- back requirement based upon a hand drawn rendering . He required the applicant to confirm these measurements with a certified engineer upon the commencement of the project. The Commissioner also inquired about the approval of Historic Preservation represented by Pat Anderson. The applicant responded that this project is not subject to Historic's approval as only the Dottridge House maintains historic status. Conclusion: Approved with the following condition: The Historic Society of Santuit/Cotuit shall apply for.and obtain a variance from the Board of Health excusing the cesspool upgrading requirement. Upgrading is currently necessary prior to receiving anew building permit. The argument offered in favor of this variance is based upon the exclusive and restricted use by staff members. SPR 085-99 Sentintel Polyoletins,Industrial Dr.,Hyannis 294-070.001, 294-070.002 & 294-013 The applicant's proposal for a 78 space parking lot was presented by Attorney Pat Butler. A brief introduction to the company was given revealing a thirty year employment history manufacturing plastics and their recent achievement of global status._ In response to Engineering's comments (faxed the previous day to Attorney Butler),the applicant offers a"right only"turn solution in an attempt to preserve a curb cut on Independence Drive. The committee was also informed that a decrease in warehouse space resulting from a conversion to office space may be entertained by the applicant in the future. Rob Gatewood recognized the applicant's effort to avoid disturbing conservation area, however, he noted that the silt fence is located within the 100' mark. After a brief discussion, Mr. Gatewood advised the applicant to relocate the silt fence outside the 100' buffer line. Art Traczyk requested clarification of the site. It is a combination of 5 lots totaling 7.9 acres. It was agreed that Pat Butler shall research the possible prohibition of curb cuts on Independence Drive and the current legal status of Fresh Holes Road designated as a discontinued way on this site plan. Art advised the applicant to provide outside lighting consistent with the Cape Cod Commission regulations. General discussion ensued determining that the landscape set backs in the Industrial Limited area are 30' side and 50' front. Tom McKean inquired about the provision of an outside dumpster. The committee was informed that a portable dumpster would be used on occasion. The applicant was informed that is necessary to enclose the outside dumpster with a screening device. Steve Pisch indicated that the Engineering Dept. was opposed to the curb cut on Independence Drive. Research will be necessary in order to determine if there is a covenant governing Independence Park that would prohibit or otherwise limit and effect a curb cut on Independence Drive. ��/� O �� -old w, .� eefiag ) Map `' Parcel Q Permit# 3/� Z House# 11Y9 Date Issue Board of Health(3rd floor)(8:15 -9:30/1:00-4:39) Fee r/_0 Conservation Office(4th floor)(8:30-9:30/1:00-2:00) Planning Dept.(1st floor/School Admin. Bldg.) ` THE►p;- Definitive Plan Approved by Planning Board 191� BARNSTABLE. MAS& p TOWN OF BARNSTABLE Building Permit A 'cation Project,Street Address n - Villa gef"'f+ Owner :STo a c, i we fiL Address ;.Telephone PPermit Request ei ,Pv cs✓-. 'l c,, c i�n 24 t' O First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ '�� 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) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes p No If yes, site plan review# Current Use Proposed Use Builder Information Name 91t Telephone Number 3S Address X�kLicense# Home Improvement Contractor# Worker's Compensation# 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 SIGNATURE 7Z DATE / BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) a FOR OFFICIAL USE ONLY PERIV IT NO. l r DATFASSUED MAP/PARCEL NO. , ! ADDRESS VILLAGE OWNER DATE OF,?INSPECTION: FOUNDATION- FRAME 'INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL . e � _ PLUMBING: ROUGH FINAL r a ' GAS:.` `ra." ROUGH '�' FINAL t . FINAL BUILDING ® -! DATE CLOSED OUT`. ASSOCIATION PLAN NO. bg. ,• c� KIA _ The Commonwealth of Massachusetts T2� Department of Industrial Accidents •,, :=::: •:; , �_'��� Olfice of/naestigations - 600 Washington Street Boston,Mass. 02111 Workers Compensation Insuranc�Ge Affidavit r name: p� — locatio • city hone# �-�— •� ❑ I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any ca acity ❑ I am an employer providing workers compensation for my employees working on this job. com any name• ' d address: city phone#: insurance co. PolicV it ❑ I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who have the following workers' compensation polices: com any name: address: dhr, —phone#�. com anv name: address: city phone#: :. •,. Insurance co Rolfcv# VA Failure to secure coverage as required under Section 15A of MGL 152 can lead to the imposition of criminal penalties of a Me up to SI,S00.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify 7unpains and penalties of erjury that the information provided above is truo and correct ,; Date Signature - Print name Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# • QBuilding Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person phone#; ❑Other_ (reysyea 9195.PIA) F f Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", 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, constriction 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 section 25 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,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be retur iR to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you 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 imles"gadoos 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 HOME IMPROVEMENT`:CONTRACTORS:. REGISTRATION Board �of {` Building Regulations ,andrStandards� Ashburton Place,'; Room `1301 3Y Boston ,, Massachusetts '02108 i t ui `a tf S W• $ .:. �' � E t b -a ri 4 p {. � y I 'fit a t� aS s HOME..IMPROVEMENT�tCONTRAC.T OR ` �I Registrati ,� -- -- --- on `1i3828 =z Expiration 07/19/994 ` Type , t INDIVIDUAL° f et l�i"'" r Y,':: ' q r i a qF :�% z I v - ..5��• 'Eu�, cx y'b3 - ' K 7 n y Srr.-k _ q -5,,•?�, t t R -t +3v t c v r a r s rt x ? a IMPROVEMENT CONTRACTOR U, HOME { _ .;I Registration 113828 f20SS M "NICKERSON� '-ff ;r� _'� � � tiF�F ` tm; 3I s 1; 1YPe'_ .INDIVIDUAL BOX 131% 1.8 MASHPEE RD ' 'ter` 'a ��}� I Expiration. 07/19/99 xw a 7 ay '� i bXi 4p„yl 9 a }� FA - F x COT.UIT MA 02635 ,1 '} • " ,* � ,. � i f } ROSS M. NICKERSON BOX 131/ 18 MASHPEE RD !!�?nb C T MA 02635 -44 s F:I' ADMINISTRATOR' Assessor's office(1st Floor): Assessor's ma and lot numb LJ < �` � THE t ,p SEPTIC SYST �#�., �e Conservation(4th Floor): - IN sASd7T�DtLINSTALLEDED IN Cdi" ., Board of Health(3rd floor. rlo meqw� WITH TITL ' OC Sewage Permit number ���'�� ��, � rui : Engineering Department(3rd floor): ! � c� ,�' House number _ —�- 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 TYPE OF CONSTRUCTION 19 _ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �L Location Proposed Use l� 2 Zoning District r Fire District Name of Owner •C» Address Name of Builder Address Av, Name of Architect Address Address Number of Rooms / Foundation xl r( d 111 " Exterior Roofing Floors�1i7� Interior L10 Heating a�U Plumbing Fireplace Approximate Cost Area Dia ram of Lot and Building with Dimensions Feed I i ( I Alf, 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. d Name Construction Si ipervisor's License COTUIT HISTORICAL SOCIETY y No 3.6532 Permit For BUILD ADDITION. Storage Barn f, Location 1148 Main Street Cotuit Owner Cotuit Historical R�c; Pty Type of'Construction Frame Plot Lot .J Permit Granted March 14 19 9 4 Date of Inspection: r Frame - � 18, , �' ' ,,,�— •` a f. !' ✓ Insulation 19 Fireplace 19 ' 19 Date Completed �a4 M�� � `� �` 1, Y� • _ � , .:.. ;: t }. .DEPARTMENT OF.PUBLIC SAFETY i ri - �. ` ( t 'ONE ASHBORTON PLACE , ` ` ! g � ,,~, BOSTON MA 02108' t' ,� t ? ti.. I l' �r `T� t'"t.' ,1 :: LICENSE'i 3 s ,,% . fi t % c r Lf t' t n jJt't , ,a . CONS.. . �UPERVISORf l,rlrt `;.11 ..,, t i`i , ::tl „ ':'il I , , If' it f , ]0 (1 f +' , �� i ' ��1 7 :f EFFECTIVE DATE:;4 , LIC NO, r,, t , � t511F' F i (YE`+' , r 1 �; 05/31;/1993 f I'047693 „4>V ,; �;.�� tX -�!�.a' , t u pp .: , a 1 ;( STEVEN P...MCELHENY ', ,,i�+( L H z`.`�'v S,_ . j.!q..a i t. 2 'PO 'BOX .282r `; L t ' ' i'p,h = z w,Q- d o, v Z .. COTUIT i1A..J, i �j �i*A o,-+Ea:,, o - I n �, ')' m :1. 1 a u.<' :I l 7' 1 - 'i N '1' ' -i. 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COMMON-W-EALTI-I -OF' . .=<cC 03= y,,,'-0UCCID�j�1?S ' 600 W*ASiiD\TGTO;N jamcs_ Ca---knocl i3OSTOiN. ). -/�$S1,Ci-jUSj---TS 02112 •one, 'ORK RS'COWENSATION INSURANCFAFRDI.VIT �Iiccnsccllacr-mia c) • with 2 prinap2l pl2ccofbusincsslraidcnacsc do hcrcb <GcylStacc!?aP) Y ccrsi fj:under the p2ins snd Pcrmldm ofper uty, Jj) I zm an cmplovcr providing the followingworkcrs'compcnsacion covcr2gc formycmployccs Korl;in�on his ob- Insurnncc rnpany Policy Numbcr 13 lams sole proprictor snd hew no one working for mc �) l 2m 2 sole proprictor,genes-]eonmaor or homeowner(eirdc one):nd h:vc hired the eontraaoa Iisced belo.t• %coo hzvc the following workc.^s'Compc=tion insumncc policicr. ?-Zmc of Conu«cror Insur-ncc ComP=y/Poiicr N=bcr ?��mc ofConcraor lnsurrncc Comp2nyalicyNumbcr I1:-Zmc of Contrczor In::=ncc Cemp=yfpolky Number ' D I =m z homcok-n&performing_11 ncc work mysdL 110T l�-cll:c�b of riot ror<L�Lr«<cicr it�� t � �� r�':ittccssc<,tct�insQiot of tcpsit�-oc'�oA t_<bacaco <r zJoo«s;1cs or cc tic FrovaLs or <c�r:2c«1 to be<r_plcy<rr L U =lcr <�ck<l pp� aa sttscrccoaccnocEcocr-llj' �'=7"cs=i,ot Act(Cl-CC 152,«CL J 0)).a appl;ctt;oa by s 6r co••-a<r fora I;c<os< p<rrnit r..:Y c"��<c« t_:<3<FJ r�r.•t cry<r_aoKr Cold Lac�orlCcrr - CorJpcoratroo f c.:c«:tin<crc,_ < co ci.< ; D<p_r;-cnc c�]n2C;cr;J/,<c�<ac'Or,c<c!l�:race for.«�<rc -nl t}_ f lir<u:«<r<cr. :i< r<cc�r<�ur.Lcr&C,;.Or.f<crrc,:c;:f c Sr b cf f rc of vYcSS.. C. _.IJcr i= r crn _ ?SfCI$� to crc ir..per:cccfl:irl;n: per._1 u=u 700.00 2dy ccf up to cr.<yc=nl C;V3 pU:.6a is t=x fcr.n cfc Sccp VC&Ot�'-cr—d 1 Signcd this 7 9 luccnsccIp mirzcc liccnsorlPcrrnirtot I - -(.D_ NEW APPIT. 1011 (2,5 I 5 1 q'-3 f _$CAL 2/1%4 Assessor's office(1st Floor): SEPTIC SYSTEM MUST BE t� ®3 Y, 0 S j INSTALLED IN COMPLIANU o �"E o,. ALOs�Sr�J&/ ,tP.�er .� t N Q Maw v r bVr p4 Sew"a Permit number �d _ �/i ` ENVIRONMENTAL COO , • a �" = DAWSTeDLE i En ineering Department(3rd floor): TOWN REGULATIONS rua H7se number '°o 1639• Definitive Plan Approved by Planning Board 19 APPLICATIO�S BFjfl FSWLS:-V-9:30 A.M.and 1.00-2:00 P.M.only , Barnstabl.. aatior1 G Vl r1 1 \ , OF B A R N S T A E L E Si gned � —g'- DING , , INSPECTOR Signedgned �at � _ . APPLICATION FOR PERMIT TO �. W c ad �J zty,, o-.Id j F,' l-o oo Fes'ase w e S k v"1 i TYPE OF CONSTRUCTION t_/ (/%dCieA r-k&-' LQ + c—#'h,5u Sf 3 d 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location �'i� 1T'h,�t//) C nl fit f" Proposed Use 5+6yt�'e— of ,M C) 6g-)11, e Zoning District TL I" Fire District ef ( f Name of Owner Co f tr Srna �t L4, s+,w& 56u,0�Address McitA S41LQO 6.&-tutT- Name of Builder a-f2 0i ,tL M G' P—L Ne✓1 1 CL lon Address M&. Cl�aa5 Name of Architect Address ��Q("L Number of Rooms Foundation r0/jCr-Q.k J&(OK Exterior Roofing5/' :f ta.S�e Floors Interior �`�k &u`n 5&v ce Heating Plumbing Fireplace Approximate Cost ( 0 " Area l Diagram of Lot and Building with Dimensions Fee i 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 0 -7�� COTUIT SANTUIT HISTORIC SOCIETY i No 345-52 PermitrFor ,BUILD ADDITION ' ,Single e Family Dwelling Location 1148 .Main 'Street _M a Cotul`t Owner. Cotuit $antut Historic Society Type of Construction Frame r Plot Lot A Permit Granted September 9', . 19 91 Date of Inspection `T �`�L '19 Date Completed 19 ;.. Ctr � 0M a . v Ito W dff t I"' rb.`,s•(t%11`":Sh...-...Fi *�+„t"`�,;•stv"T•++'T"r ` F;r .� .!q h �l{�p ,'!7•- ," Assessor's office(1st Floor): / t " AAses o' n and of umber 0 3 d t ( ;1 P�0I TN c to`' ���_ .�cQQ =r Board o Health e� Sewdge Permit number Z DAUSTSDLL i Engering Department(3rd floor): �o r,ua Hi-se number C i639• Ddinitive_Plan'.Approved by Planning,Board s APPLICATIONS PROCESSED 8:3.0-9:30 A.M.-and 1:00-2400 P.M.only TOWN OF .- BARNSTABLE ..... � = UILDIHG IHSFECTOR APPLICATION FOR PERMIT TO dad LAO" A.01 f c'r! f`o 00� �Se f1GM e S kad!. TYPE OF CONSTRUCTION r-ao-mg LAy!5,,1d 3 d 19 `t TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: { Location [I LI2 MAlII Sf22& ('r,_)4 f r - Proposed Use r, 'Zoning District �`—+� Fire District C 1 t l y Name of Owner C-0 u t r SenahA r (i sty Cc, %,Qu f>< Address I 1 I-lj pia,A <41LPO C^.j,1!T Name of Builder ( r(k�✓F/L ►M El_Nle✓1 li,i on Address U•6[ (SI CCAy�, f t56!Lot& Name of Architect f t2c.nl� (�� Address 9 h0((— �(.1 e r'r- It Number of Rooms ( Foundation r��Cry. 2 Lo 1 Exterior Roofing �5 kJ I- 1 s Floors Interior, Q o!!�k em u;, p S fit U - Heating Plumbing Fireplace Approximate Cost O 5 y Area O Diagram of Lot and-'Building with Dimensions Fee 6 S J •.Y tw t 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. Q70— w� pL - Name r r I Construction Supervisor's,License 6�(7 COTUIT SANTUIT HISTORIC SOCIETY � �- A=034-051 i A ; No A'S52 ermit For BUILD ADDITION Location 1148 Main Street Cotuit - Owner Cotuit Santuit Historic Society Type of Construction Frame Plot Lot Permit Granted September 9 , 19 91 Date of Inspection 19 Date Completed 19 R f E STAN ARD LEGEND o - ..- ------- -- 082 GOLF COURSE FAIRWAY note:not all mbols will appear n a mop ef DECIDUOUS TREES _.___.__ - ; ..._-......__._ �• EDGE OF BRUSH .- h EafiSsttA � R iN ., RCHARD OR NURSERY 0 _, ` .' •. � L�„ _ ' �' � CONIFEROUS TREES r MARSH AREA sMELL , EDGE OF WATER DR 'Up, ...___, � DIRT ROAD -4• O 3E-�-DRIVEWAYS r i!S,83 -- � > .=1 CAL scat, ETA Pt -F - i \\ PARKING LOT � �j' Ci GG _.._._.. P ROAD N / Val i A4R M - ^� DITCHES el.. c s� .- —'--' �, 1 Ih!C i:_.... --...._.._..._._ _........................ PATH/TRAIL oR�s 14ft�. t V l.. iZ�; 5 }�-i STo..,. ....-catL Fri v r4 Pit � .__.__.__ ; I r. PROPERTY LINES _ -- _ _..__.._......... ,I MAP QHOUSE NUMBER 1 SIT 21 E-- ; s � , UMBER 6 ' FOOT CONTOUR LINE ,k isTi n 2 FDD 10 FOOT CONTOUR LINE j E � X_ SPOT ELEVATION ( i -> STONE WALL r ; M - 'FENCE yam' lI f1// J J � ` t►Y�Rl4'T/ O/�( j, 1 R� W `7 RETAINING WALL SuR p J I ----- -- RAIL ROAD TRACKS FWT Q{M r ,1 S' :0 1 4 O I Kt' STONE JETTY R W 5 to ! i Oct Lf4 7 s�FT 1 8 gu,� G ,` SWIMMING POOL 1 �15.6 ' 1Q D O_u 7 �l PORCH DECK i' G�" BUILDINGS STRUCTURES �Jr09 s � DOCK/PIER/JETTY t MAP 34ASSESSOR'S MAP BOUNDARY r^ V+ rI _ ,j t�Y - .y m �1a Q I� _-.-- ._. A VALVE MANHOLES � � R'S MA Q20 : L p� �V Y, \/ '.-.__.._.._.. Y \ O POST FLAGPOLE C /• �FP \ � o SIGN. ® STORM DRAINS "3 V ; - - - Z� ,� � TOWER Y n ��. 5 , 0 � POLE --- "�•/' q LIGHT o ELEgBO% ...................P 5!t3 ............ i.......... mSITE MAP If �I . ._ B.GEOGRAPHIC INFORMATION SYSTEMS UNIT IT T 0 RAP n------ - ----- - - - - - - - - ; : -- --------a In feet p � 'J L C�¢� SCALE _ 0 � r r _-- ------_ 1 INCH — 20FEET' Jam' - _ 1 Z ILA* N ,t - - �~ f� zt . f , 1 i — Y'r J S HLE:basa•.dgn gisunt S ARE LNOT TRUE LOCATIONS REPRESENTATIONSY GRAPHIC h 8--3 94 • ., _ �` /'�/, PROPERTY BOUNDARIES,THEYA E I iNOTE:THE PARCEL FROM 1989 AERIALPHOTOS VFOE AT DATAVEGETATION AN i0P06RAPHY DAI . J J' P 1995 HOTOGRAPHY O PHOTOGRAPHY AT 1I 6600:BOTH ATA MAPPEDAO V=100'. IZE ' ��p1 ASSES1?9SORA DIGIT S MAPS ATV100.A O�PRINFOA DIFFERENT SCAU MAY DECREASE. ' °� STAN ARD LEGEND •.. �-- $2 � g 3 __ --- - 0 note not all Gals will appear on o map '•.... ---.—_____ --' '__-•... GOLFCOURSE FAIRWAY a6- VEGETATION DECIDUO EES EDGE OF BRUSH WUS TRORC RD - HA OR NURSERY CONI US EES FERO TRMARSH AREA �(� ED OFNICuDR1(�, �Ay . . _ — o- DIR WADTER r-. _ R' 30 ( T OAl!5 _.�y��� �EDRIVEWAYS N-J_ Jr./1vCAL J E+TY O',' PA PARKINGLOT Tr, ' FAKE S trN(„ �,... ._.._._.. ___ VED ROAD C� ( VL'.�' UeL V5�f e ._ I�IIZif MG- i DITCHES Ar1 TUt l T SAm c Tpr�Ih f i- _ — ... ........ PAT / RR�. Fri v�1X.a V�L _ � PROPERTY LINES C - R QHOUSE NUMBER ilsTid 2 FOOT CONTOUR LINE T110FOOTCONTOUR UNE X_ SPOT ELEVATION STONE WALL 14.2 FENCE • iNJ I ."q� (� jI _-- RETAINING WALL S N R 1 .... ` - RAIL ROAD TRACKS jen �IPEPN -- STONE IETTI tA Llq-W fv ' 837yszo NG � - SWIMMING POOL 0Oa / D �7 ` � BUPORCH/DECKES ` ILDINGS/STRUCTUR' (� F'i•f•A• DOCK/PIER/JETTY ' ''' ESSOR S MAP BOU 0 R ` N A Y MAP 34 ASS�� A VALVE @ MANHOLES _. - ---- ST O FLAGPOLE O � FPSIGN ® STORMORAINS . Lie5 0 .............. � POLE R T' 1 J................ .............- __ ._..._.... ----------- ................ 7f : m110 SI E MAP GEOGR INFORMATION SYSTEMS UNIT �'� CT O.B. APHIC---- - -- - -- SCALE:in feet --- ---- 1 INCH =20 FEET N W E S GRAPHIC REPRESENTATIONS OF _._..., E LOCATIONS cmh 8-3-94 NOTE:THE PARCEL ONES ARE ONLYYARE NOT TRU AND TOPOGRAPHY DATA INTERPRETED FROM 1989 AERIAL PHOTOS. PHOTOGRAPHY AIR P DOS.PHOTOGRAPHY At V=6600'O INTERPRETED BOTH MAPPEDAT I'=100'. PMOiI DATA DIGITIZED FROM I'=100'ENGIHfERIIIGASSESSORS AEAP51999. *DATA MAPPED AT I'=10p'.ACCURACY EAS MAPS PRINTED AT DIFFERENT $(AU AWY OECR[ASf. pr ills— _ V y' I M -- Lo 9216 D oIN N � RT PLAN LA ND oou c . CoCo Z Z) co - U U -j ¢ (un) x MAIN ' : S.TREET _ Lo o = U N CS DH (FND) 215.79' PAVED APRON [] � cooN v _ , Cn ao. V7r- N � CS DH (FND) Z, t¢ o SHELL_DRIVEWAY EXISTING MUSEUM C; . N LOT 14 90 LOT 13 l OT '7 \ LOT 6 z PLAN BOOK 157 PAGE 139 LAND URT PLAN . 16 0a to s EXISTING a o z MUSEUM W cn Cr w CB DH (FND) o U ui � 41 2 W U W I B D ND) 94.37' CB DH (FND') o c1 0 �n o I ZONING REQUIREMENTS: j 5.3 PROPOSED ADDITION _ DISTRICT RF o LOT AREA.........43,560 U 102.92- CS DH I(FND) FRONTAGE'..........150' FT W i CB DH (FND) FRONT SETBACK.......30 FT W cn ►_ . I SIDE SETBACK..........15 FT z m REAR SETBACK........15 FT N z LOT 13 A BUILDING HEIGHT......30 FT a_ w x N o LOT 3 LOT 4 � a o" N („ W ¢ I SITE AN 'SURVEY O Q � oz LOT 2 j _ D VEY DATA o o R LOT 130 I LOT AREA: 25 750tsf 0.59fac p�`(N.9FM�tS3, n o ¢ 0 15 3060 120 ASSESSORS MAP 34 PARCEL 51. o� OAVID 9cN 100 v o PLAN REF: 'PLANBOOK 157 PAGE 139 LOT 13 t:.- 1-- IN( FEET ) PLAN REF: LAND COURT PLAN 9216 D LOT 7 v y _ 1 inch = 30 ft. DATE OF SURVEY:DECEMBER 16. 1999 w t-- `T /2/LGc�O 99-100 LOCUS DATA b �_..__ CONCRETE BOUND CURRENT OWNER HISTORICAL SOCIETY FOUND OF SANTUIT & COTUIT, INC. T R� S 1 E 110.9T LOT 6 PLAN REFERENCE 157/139 & 9216-D t ' N 13 58 50 N F DEED REFERENCE 1157/555-557 ! OCEAN .: �- UTILITY AVE POLE REALTY ZONING DISTRICT RF vEM�NI p�} - ' HYDRANT �� LOT 7 TRUST EDGE F! \ (034-053 FLOOD ZONE C E- N 137 58 50 w- " CD 'p y� \. -001) ASSESSORS MAP 34 `=i r T., N PARCEL 51 . CONCRETE OVERLAY DISTRICT EPRA BOUND FOUND LOT AREA 25,753t S.F. \ -� CLAM SHELL o� g LOT I J N. \ PARKING » �^ -y RO THWELL CERTIFIED „SAMEUL a \ AREA ICE HOUSE N PLOT PLAN DOTTRIDGEcp o, 1 48 _ Mlle ST, 1808 0 cp CO TUI T N d BARNSTABLE, MASS DATE: JANUARY 20, 2014 cp i 1 OWNER APPLICANT: HISTORICAL SOCIETY OF \ E g4.43' L.C. CONCRETE SANTUIT & COTUIT, INC. r N 123q. 50 BOUNDAND FOUND 1148 MAIN ST. COTUIT "WILLIAM MORSE IRON Z ��z�OF kfASS9 SHEET 1 OF 1 FIRE MUSEUM PIPE \ LOT �3 �� �N. a EDWARD � FND o q. O?� \ N/F ST NE. N PREPARED BY: LOT 4 CONCRETE HANEY o. ` 980 '• E A S SURVEY, INC. /F BOUND FOUND �� \ (034-052) ° s ,S ?-° N , , SALERAN 6, , ��C AIA P . O. B 0 X 1729 (034-058) 1g. ?' W 102 g2 , SANDWICH , MA 02563 S 12p45 p„ W 1p2g1 LOT 2 \ 0 20 30 40� CONCRETE S 12 04 5 N/F PH. (508) 888-3619 BOUND FOUND \ CELL (508) 527-3600 AND- HELD `—LOT �`3—,q BRUNO (034-050) GRAPHIC SCALE: EAS.SURVEY©YAHOO.COM \ 1 INCH = 20 FEET 4 • Ad - L0C U S DATA -CONCRETE �• no-.. _ -. - - i/' :_ BOUND CURRENT OWNER HISTORICAL SOCIETY FOUND OF SANTUIT &`' LOT 6 COTUIT, INC. _ PLAN REFERENCE 157/139 & 9216-D N 135s'50 MA DEED REFERENCE 1157/555-557 1 ., -:,OCEAN MEW -- P �VE : TI LI TY POLE REALTY ZONING DISTRICT RF pp,VE�ENj tiO4.$2� p HYI�7RA1`!Tg L Q 7 TRUST Or (034-053 FLOOD ZONE "C,� EDGE 13,58�50 £ _ 00 ASSESSORS MAP 34 PARCEL 51 CONCRETE ca _ � k ' G 4 OVERLAY DISTRICT EPRA BOUND FOUND LA LOT AREA 25,753t-. S.F. - ,P 1 _ . \ CLAM SHELL o LOT 13 g - N. PA RKING CERTIFIED g : _ • AREA "RO THWELL- SA ICE. HOUSE N PLOT PLAN DO TTRIOG \ 1898 t - - 1148 MAIN ST. 1808 O. W CO TUr T- G BARNSTABLE, MASS 40• ��N� �, 5 << N,-��n DATE: JANUARY 20, 2014 �� - .N . OWNER APPL CANT.. �a$ HISTORICAL SOCIETY = OF w V _ a' 43' LC. CONCRETE'. SANTUIT 8c COTUIT, INC. r �{� ;50„ g4 BOUND. FOUND 3 y 'AND HELD 1148 MAIN ST. COTUIT MORSE IR ON A�» NCH OF FIRE V/M /SEU PIPE \ SHEET 1 OF 1 p c- o >=b �tD FN LOT Wa ©�.\ o TA. CONCRETE s o N/F PREPARED BY: LOT 4 BOUND FOUN HANEY: o EAS SURVEY, INC. (034-0$2) a .ti SALERAN " P. O. BOX -17 2 9 (034-058) �5 cr „ �, 102•92 N L Hn 44- SANDWICH , MA 02563 s S4 �, Q i 2�a�'` 102•g� � 0 - 3 40 CONCRETE` °4 5° LOT 2 , S 12 PH. (508) 888-3619 Nu FOUND. FouN - CELL (508) 527-3600 AND HELD . �- J� T � —,q BR o. (034=050) GRAPHIC SCALE, EAS.SURVEY@YAHOO.COM � '1 INCH = FEET f -