Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
1441 MAIN STREET (COTUIT)
r f ,k is i `r t I d _ { 7/% r t�'( L�v�^rl Gc:'l�► C f,%'��y'i C_ °i >>1 -��v�C� w az GtD Yl e � 74 yll- k-lb G t.b . ' f" s }. Commonwealth of Massachusetts °� s T'bwn :,, f--B a rn sta01 RARNST e ; ., i' 9Q MASS mq ; 200 Main Street(508)862-4038 < .� jED MA't.a r ,` , ERM1- .• ,R EPORT 'BY ADDRESS -� � :< AddfeSS: 1411 MAIN STREET(COTUIT),COTUIT ); � � t - �.�« �. , ..,..,, >y< �,.< .f ...,... . -w :. . a r I ectton:>., L s ,ected.on Ins ection ; Ins ection ;.. ,,. :,.. .3 .- I ,< . .. A the ni Work Descrl tlon ns. , n,.. _,. ermlt.For P,arcel_.D .. a , 3 Status.A P _ .._ p p. P p;.. PI , p w, x_ y � _ a 13-2013-02262 Closed ,: . Demolition 017-010 KENNETH B VONA DEMO SINGLE FAMILY • � HOME 6.-2013-07506, Issued . Foundation Only : 017.-010 KENNETH B VONA ` CONSTRUCTION OF A Building Chimney. 1/12/2015 -Pass JLAU:THROAT NEW 2 BEDROOM ONLY OK RESIDENTIAL DWELLING 1ST { EXTENSION TO 4 EXPIRE.1/10/15 (GATEHOUSE) B-2093-07506 Issued Foundation.Only .'017-010 KENNETH,B:VONA _ ' CONSTRUCTIONOF'A Building 11/10/2014%.-'� Pass JLAU EW 2 BEDROO at N M, Found ion RESIDEENTIA1 i I a r DWELLIN ST EXTENSION TO EXPIRE 1/10/15 (GATEHOUSE);',. 8=2013=07506 Issued Foundation'Only '017-010•'` KENNETH B VONA . CONSTRUCTION OF A Building Frame 1/21/2015 Pass JLAU: NEW.2 BEDROOM. SHEATHING ' RESIDENTIAL ONLY OK { DWELLING 1ST• i• EXTENSION TO ' I y;EXPIRE 1/10/15 1 p (GATEHOUSE) B-2013-07506 Issued " ` Foundation Onl ` ' 017-010,, ; KENNETH B VONA.';' CONSTRUCTION OF A Building Frame 6/5/2015 Pass JLAU:' Y.. : ' �.. .., NEW 2 BEDROOM'. . :`: t _ PLUMBING AND RESIDENTIAL GAS`SIGN w ,. . DWELLING 1ST . OFFS ON CARD EXTENSION;TO i EXPIRE 1/10/15. (GATEHOUSE) ` f < 1 of 4 _ I Co m > onwealth of Massachusetts 1 �pF THE Tpy • Town of Barnstable. , 200 Main Street(508)862-4038 pTfDMP�A :PERM IT REPORT :BYADDRES.S <- .#.-• _:_:. _. s ..,> ><,.. ...� > ....:-.. w _ _.rs.. x... ee. ,.> >.. -4 `>v ,. , ,M<,: .v > ........ .: .... r.. >. .,... .>^. ... ,. .;. ,. ,...,..._ . .� ,•, - . . .,, _.< ... k.Descr� tion. :....Ins action- Ins acted on,,xlns ectio �,.�Ins action, ., , � ,: ��F Parcei�ID.�, �A Iltcant.. , Wor ;,.. u .. Permit Fo .�., p - p . �....... r.. „ >..� ,. � • �_,HRH < _ � ,. ,__ ..�,E. . . �..,. r � �, a Fa, ,, ` �...., � �: � , .,. ,n„ ... .e �; - B-2013-07506 :�` Issued Foundation Only .f�'` `'017-010 KENNETH B VONA , CONSTRUCTION OF A. Building Insulation 6/18/2015 Fail JLAU: NEW 2 BEDROOM..:'_ INSUFFICIENT k RESIDENTIAL' INSULATION 6 DWELLING 1ST: k EXTENSION TO t { - EXPIRE 1/10/15 , (GATEHOUSE) B-2013-075061 Issued - New Construction- , 017=010 : KENNETH'B VONA,, CONSTRUCTION OF A Building.Chimney. 1/12/201.5 Pass JLAU:THROAT . Rebuild House After, :, NEW 2 BEDROOM.' ONLY OK. Teardown , I RESIDENTIAL I : _ DWELLING " 1ST ? EXTENSION TO EXPIRE 1/10/15 ` l (GATEHOUSE) : B-2013-07506-1 .:. Issued New Construction 017-010 ;KENNETH B VONA CONSTRUCTION OF A Building 11/10/2014 Pass - JLAU: Rebuild House After l:; NEW 2 BEDROOM - Foundation Teardown fi 1 RESIDENTIAL 1 = DWELLING 1ST { ' EXTENSION TO. EXPIRE 1/10/15 k (GATEHOUSE) ,.4 B 2013=07506-1 Issued; New:Constructlon `` 017-010 KENNETH..B'VONA CONSTRUCTION OF A. Building Frame 1/21/2015 Pass JLAU: # Rebuild House After " NEW2 BEDROOM SHEATHING Teardown { >:RESIDENTIAL ONLY OK DWELLING 1ST .,. _ .. - -EXTENSION TO • ; EXPIRE 1/10/15 i (GATEHOUSE) kt, B-2013-07506-1; Issued New Construction_ 017-010 , ; KENNETH B VONA :` CONSTRUCTION OF A. Building Frame 6/5/2015 Pass JLAU:` Rebuild House After ! NEW 2 BEDROOM : PLUMBING AND Teardown RESIDENTIAL, GAS SIGN DWELLING 1ST: OFFS ON CARD EXTENSION TO i EXPIRE 1/10/15 (GATEHOUSE) - �+ 1 _a F .. .. " 1 � 2of4 r k . :Commonwealth of Massachusetts O T wn of B a rn stable! I. BARNS-CABLE. v MASS,$ 200 Main Street(508)862 4038 a639:A�0 I, t PERMIT= REPORT BADDRESS :n .�. . .... �, .. . : . : ., ,: •. . ., �x: ,. ..: ,. .•:. . ., ,< - -_� r_ : -F=.... ,, : � �. � �.. ,.. : scn ton. n=.. Ins ectt n _„ Ins .ected,on �lns e�t�on ns ection x. _�.,. . .- it,For.� parcellD. __ .�A ll�cant Work De. _ .. ,. - o_� I - ! Status r �..>,. .P,erm �. ._._. ,� ,.,. ., , p P. � ,�. - a.� � w> �- . � _, „� ,:. - .. ., :. . ,a,,�;� . dam °�.., ...-,.,.. .,.Yr.. s. ... .. ., .-,.....ems- �:�,. � � �.�_ . x. ,� ..S:tatus , .. .- 8-2013 07506-1.:,.: Issued .~„New Construction , ,017-010,, KENNETH B VONA, . CONSTRU,CTION OF k .Building Insulation 6/18/2015.. .Fail . .JLAU �~ "h :':;' NEW:2 BEDROOM INSUFFICIENT Rebuild House After , Teardown a i RESIDENTIAL INSULATION • DWELLING 1ST x t: EXTENSION TO i `r EXPIRE 1/10/15 r C (GATEHOUSE)` 13=2015-00813 Issued Sheet'Metal 017-010 WHITELEY PLUMBING TWO GAS FURNACES I &HEATING:' r IN THE ATTIC WITH 3 1; ZONES OF-HEATING- I. AND_:COOLING AND i t ;L NEW DUCT WORK i E-2013706352 'Closed .; Electrical-Temporary!: 1,017=010 DRISCOLL BRENDAN INSTALL TEMP Electrc Temporary 9/16/2013 Pass WAMA: VICE POLE`#9258` ; ervice E S _ SER (N58C) I .:ed 'Electrical Service 017-010 KENNETH B VONA' CONSTRUCTION OF A :.Electric.Final- 10/6/2015 Pass - EFOU: , E 2013-07506 Issu NEW 2 BEDROOM t RESIDENTIAL r ' DWELLING. ' D G T 1S , r EXTENSION TO EXPIRE.1/10/15 (GATEHOUSE) E-2013- 07506 Issued sy. Electrical Service,.I 017-010 KENNETH-B VONA' CONSTRUCTION OF.A- Electric Meter t'i/23/2016 ` Pass EFOU.' , . . NEW 2.BEDROOM ,.`. RESIDENTIAL DWELLING.,. 1ST,` s � ti EXTENSION TO EXPIRE 1/10/15 H SE G ATE OU E-2013-07506 Issu%ed Electrical Service i 'W_'010 KENNETH B VONA '. CONSTRUCTION OF A Electric Rough 6/4/2015 Pass EFOU: 4 # NEW 2 BEDROOM . t4 ;-RESIDENTIAL ,DWELLINGS _. 1ST . _ EXTENSION TO . 1 EXPIRE 1110/15_ , :. (GATEHOUSE) a • ' . { 30f 4 � i r _ f Com mbnwealth of Massachusetts 0p1HE . . Town of. Barnstable a k BARH�AB�.{i MAES $ i 200 Main Street(508)862 4038 ' sG r: PERMIT; REPORT. BY, ADDRESS + I r ' r .- . �F mit Fora... . Parcel ID _. A litcant ,W R_ - ,,,:4:;..-,.,��,.,•�"��:, ,<.�-_.,x.w., r�,w�% .. ..,�,..�.:,.w, ,,. -..,.<:...»_,,,,<._.,., -,<.�_-,,:�.,,",...._ ., ,.T..3... .:.: ,:�.<-:�.& .z�v...,• .'�,.. ,.,,v.4..,,, .,.. _r..� _ .<, �,., :�—. ....:�- �.:.>..� ��r tza,.;,,,+ssrx�,a. r E72013-07506 Issued .. Electrical.Service - 017-010 :' KENNETH B.VONA` CONSTRUCTION OF�ArElectric Trench, 10/23/2014 Fail WAMA,' I NEW 2 BEDROOM l : "RESIDENTIAL Reinspection DWELLING `. 1ST; 277339 created f' ' EXTENSION TO on 10/23/2014 by i EXPIRE.1/10/15 amaraw' " (GATEHOUSE)-. I E-2013-07506.„ Issued_ ;•` Electrical;Service. l ;017-610 e KENNETH B VONA'. CONSTRUCTION OF A Electric Trench" 10/27/2014 Pass WAMA:Created i NEW 2 BEDROOM_; from inspection 1 . RESIDENTIAL. 253847 on D WELLING 1ST 10/23/2014 by EXTENSION TO amaraw EXPIRE 1/10/15 .. I (GATEHOUSE) a TG 2013-07506 Inactive..' " Gas_; 017-010 KENNETH B;VONA CONSTRUCTION OF'A { NEW.2 BEDROOM 1 —RESIDENTIAL ,. !:. DWELLING 1ST • EXT ENSIGN EX TO EXPIRE 1/10/15 (GATEHOUSE • 1 " TP 2013 07506 Inactive Plumbing '017-010:' KENNETH B VONA CONSTRUCTION OF A NEW 2 BEDROOM E RESIDENTIAL - DWELLING 1ST j•R EXTENSION TO EXPIRE 1/10/15 ,.� l I (GATEHOUSE) z k Total Permits: 20 25285000 19730 t. l I j 4of4 4 yew Couzi ao uyveafth of :v,Ia.ssachuset1.s _ Sheet Metal Pez min L Date:_ Lal IV)rj Permit F Zo 1600's Estimated Job Cost: S ao,Ob OTPerinit Fee: S 15.00 Plans Submitted: YES Q ✓ FEB 17 2015 Plans Reviewed: YES NO ✓ Business License 1(o0 TOWN.OF WINNU 4ense_ o� Business Information: Property Owner/Job Location Information: Name: Q- E� rn Gv� Loh)T��L�,�I� : Name: M C C©l t r+ - —ALStreet: qt: i I�jin J City vn: C��a;-���a���� City/Town: (2 - + r Telephone: 509- 5.— I )00 Telephone: No o Photo I.D. required/ Copy-of Photo I.D. attached: YES �f NO .s ff Initial J-1 /TNI-I-unrestricted license J-2.1_M-2-restricted to divelllincs S-stories or less and co= rciai up to 10,000 sq. .I2-stories or iP-ss Residential: 1-2 fariily ✓ Multi-falnily- Condo/Tovvnlaouses Other Commercial: Orlce% .. _Retail Lzdustrial Educational InsiitutionaI ; Other Square Footage: under 10,000 sq.ft. V over 10,000 sq. it. -Number of Stories: Sheet metal work to be completed: Netiv Work: Renovation: HV aC e/ Metal- Watershed Roofing Kitchen Exhaust System 'Metal Chinnev/Vents _Air Balancinc, Provid-_ detailed description of tivork to be done: i LOo 9A Lzmae,6 1h the `V--- . a . } INSURANCE COVERAGE: I have a current liabilitv insurance policy or its equivalentwhich,meats the requirements of f:1.G.L. C. 112 Yes ! No❑ j If you have checked Yes, indicate the type of'cove�age by checking Via appropriate box below: e A liability insurance policy Otner type of indemnity I I bond LJ ! OWNER'S INSU PAN CE.WAIVER: I am aware thatthe licensee does not have the insurance coverage required by Chapter 112 of the N'tassachusetts General Laws,and that my signature on this pern-itapplication waives this requirement. i Check One Only Owner ❑ Agent ❑ Signature of Owner or Owners Agee; ! 4 By checking this box! , I hereby certify that all of the details and inormation l have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter'112 ofthe General Laws. Duct inspection required prior to insulation installation: YES NO _Progress Ins�ectios Date , - COI==IIlLs - - t Final IASl)-,Ctil)iil iType of License: I i 5y H Masie I / Title ❑ P�lasier-reSiricieu City ii ow, rneyperson ;ou v ✓ I ❑� Signature o Licens j - ❑Joum-yperson-Restri:zed License Number: v 7 i Fee SI ❑ Checkat5 . na=S. O':r,'d-! ! ! Inspector Signature of Permit Approval ! ji to CoTrxmmmrr cAh of- assac mseffs Deportmera of I?uZwshial,4ccT'.dmts Q'dice of IzwsiirFhoru r 600 Washizi on&'reef I Boston,MA 02111 wnm m=g'o-s-fdua Wurhers' -CompensafienIus=-ace Affidavit: Builders/❑antra:cfnrsMectrician&TIumbers APPEcant Infarmation Flease,Print Lzgib4 Name $usi P— � ni-af=oarl di 7daaD,_ W y-i-n o n J.l h It-)i P) "n ir,$ n 4 t.r, n S CC OL, 0a1,69 _ �-+ L_r CityF S tot- Zip_ L10 C-'-'aq g Are you an employer?,Clieclzt:hE appropriate bow: Type of o'ect r F 4. I am 6 enlal cant actor and I ,- I (-- mod: I�a�p 1oy er �it;7. �3 ❑ �. �_ (��r� :��on employees{�LI andtorpart ire) 1iave hi tae sob caatcacfors. r�! �. ii for o_par u LiR`ced otF tl e atiacsed she�c 01. ❑ I am a sofa prop ❑F tgdeling slip anL ha e.nc,Noyes_s Tlyy e sab-contractors ha-,re g_ ❑Denelitica �� m e an. employ's and have wr o�zrs' Hng }cap3.�,:cS 1 .9- ❑Bull ffi-adaLEon �'a wot�xrs' ccmp_+nuance comp_insurance- �_❑ We are a cotporau�and is 10_Q Ekotrical repairs or ad�ions . _❑ I am a h-,meo,,-,n-zr doing all work- OfEi=hate exercised fheL, I3-❑Pmru nl'ng repairs ar adeidc�s �ys�lf (N o ors'cep Wit of eLTmpfica per MGL 1= ❑Roof roc_ msLrance re'ai*cd_I E c_ 15?. g 1(4),and-—hwa,aG I _.❑Omer coma_inseranc reymra G_C'=e. -T_ Sio i-iUE: II.2TT W01REn. i�oa�or��csec s`b-=R ru�.3r:�iTM�c��__t f�e �::ir zrc�s_*d tsi�luc�--�d�c��.�to>�,.sa.^a�Y��•�3�y::n-,,-,rr.',-sacR Cc��rocs fi�<dh�--k this Ems:..m;=-t x cIL?s7:ditioa.I gLs-t Fha:: :b n oft-- rtaiz crhz�ocmot haT.— ss:^-co-=tac�lr _zaIc f-I'must g--Uui3F t=r-Rwkery tom-a.poLcp nUmb—r_ I cm ar em uZoy,5r tlirl isprmiding t.tarke-rs'cerr er srLf�a.n?n.r, rrtce fqr mt enTLyees: Eeiot is Fite aFicy artdjeb y to info r;rtaft'a;n. f� L---ac n_ce Comp as)r N= : H Lem ryt-t_IL n i 1 s u JL J Po li..y yr e-L-ram L.ic— U Q — °i `7 L E�-PL—ationDate: r / 1 Tofu Sim Add:--ess: 9 C ityFS tafelZip: it, cIt 3 spy of the workers'coatpe.nsadm p olicy-declxrstion page(shin the:policy-number and empirutioa date). Failrum to stmact-cav erage as. Sec6oa 25?.oE MGL c_ 172 can lead to the imposition of criminal pe!aa E es of a flaie up to$1,5tJGM andlor ai=yeari son as w--n as ci mil p.eualties in fe fo=t of a S'I'CP yA 0=OP..DPKa1d a 5, Te oT upp fi x$>?50_(x0 a day aaainrt the violator. Be advised that a cagy of this slat-anent mzy be forwarded to the Office of hiutbEi�tions of Ulm-DLA fi�T itlsqz'aace.cOver3ge VriE+cation- I da hezreby certify urEder thapilins aanrlpsnab*&?S o,f pz ury that the irzforrctc ion prop¢der£abax e is Ire and corrzct Date: QffZcia£u_re arty. Da not rarite in tHT arer,;a be carnp£eted by city or town offieTH City or Tom: Pmadtll icease Lssm,g Antharity{drde one}: 1.Board Q Heaits 2.D'uif'ding Deparfineut 3.Citylrowa Clerk 4-Electrical inspector i.Plumbing Iu_y_ettor 6.CEther Cau ,ct Pe so. . Phane 9: ,5 A� C:ERTIFICATE ®F LIABILITY INSU NCE osT24-2o1a 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 tile certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: ROGERS&GRAY INS AGCY PHONE FAX 434 ROUTE 134 E-raa ac'No Ezl: Arc SOUTH DENNIS,MA 02660 IR' INSURER(S)AFFORDING COVERAGE NAIC$ INSURER A:ACE AMERICAN INSURANCE.COMPANY INSURED INSURER B: W VERNON WHITELEY PLUMBING&HEATING CO INSURERC: INC&CHATHAM SHEET METAL INC P O BOX 1266 INSURER D: WEST CHATHAM,MA 02669 INSURERE: INSURERF: COVERAGES CERTIFICATENUMBER: F:v S N 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. INSR ADDLTYpEOFINSURANCE NSR SUB UWD POL[CYNUMSER MMIDD O POLICY E L1R INSR IYYYY) MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LLABILITY DAMAGE TO RENTED S PREMISES En occurranco CtAIMSMADE❑ OCCUR - MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COh1PIOP AGG S - POLICY D jEC El LOC S AUTOMOBILE LIABILITY I an!OMB, SINGLE LIMIT $ a aB ANY AUTO BODILY INJURY(Par person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED RROPERTY AMAGE S HIRED AUTOS _ AUTOS - Pe IMBRELtALIA6 OCCUR- -EACH-OCCURRENCE S EXCESS LIAB CLAIMS MADE AGGREGATE $ DED I I RETENTION S S WORKERS COMPENSATION WCSTATU- OTH- AND EMPLOYERS'LIABILITY YIN X TORY LIMITS ER ANY PROPRIETOR/PARTNERIEXECUTPJ N f A E.L.EACH ACCIDENT $500,000 i OFFICEWMEMBER EXCLUDED? 6S62UB - 10-01-2014 10-01-2015 (Mandatory In NH) 9972L664 E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under - E.L DISEASE•POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS f LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE 200 MAIN STREET CANCELLED BEFORE ,THE EXPIRATION DATE THEREOF, HYANNIS,MA 02601 NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I JOHN J.LUPICA,President 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD • l Fold.Then Detach Along All Pedorations F' COMMONWEALTH OF MASSACHUSETTS BOARD SHEET METAL WORKEEm RS:'' Sht ,'AS A BUSINESS ISSUES THE"ABOVE LICENSE TO TYPE E'RIC' T WHITELEY', i� 4J' VERNON :WHITELEY PLBG`AND _B .2 V.ILL:AGE LANDING G , PO BOX. 1266 W: CHATHAM 11A 02669 000 292629 16:0 12/22/14 29262.9 I . 1 AA _f - __ _ .c: A it•� f• Fold-Then Detach Along All Perforations ..� �'COMMONWEALTH OF'MASSACHUSETTS - ' BpARD OE FSHEET METAL WORKERS ` k`" �I SSUES THE FOLLQWI N6 LICENSE I= AS A MASTER UNRESTR�I CTED - ja ERI£ T WHITELEY �: P_0 BOX: 248 `� 'Ez WEST CHATHAM MA 02669 024,8 { � Day • �. = AS'SACHi7SETTS - DRI�1 ER'S r r� E ' ICEN�E USA END 4d N(iiiii S7p199?1.1 i- _ Fp 1� OL 1�107.0 �_-: W CHATHAM MA 02669 � • 5 DD 01-09 2014 Rev 07 1520a t Town of Barnstable i Regulatory Services u,gs. Richard V.Scab,Director �. Building D.'rvision ` 1 ,r Tom Perry;Building Commissioner s _. s.MAJ02601 — 200;twin Street,Iiyarni twww,to�cn banutable.ma.us T Office: -508-862-4038_.. . Fax: 508-790-5230 Property(honer Must Complete.and Sign Ties Section If Usin ABuilder 1 '� t~S e as Owner of the subject PIIO II y -i, t�.i it�a r� �- C»e,��'�'�1 k -Tn -�-�.. , heTEbyalAorize:. �A� V nd� j( So art onmy'cehaf, in`ll matters relative to work authorized by this building permit.application for. (,9ddicss of Job) iI Poolfences and alms are�e responsibility the applicant Pool - are not to be filled orsEized before fence is.installed and all final inspections are performed and accepied Ob -- �' S'• *e of r'�n li..ailt ; IA _. .. li�oxMs:o�->v�az�.Mtss:o!.aot;ts . t t a . , i , t PROJECT NAME: ADDRESS: �cxLVI s � PERMIT# DU U� �Ulv PERMIT DATE: �J ~ M/P: 40 O ) 0 LARGE ROLLED PLANS ARE IN: BOX 112, SLOT 2- Data entered in MAPS program on: t 31 14 BY: q/wpfiles/forms/archive oFTME r Town of Barnstable Permit# Fxpires 6 months u from is_ e date * Regulatory Services Fee �12` + anexseAB[.E, MASS.16. Thomas F. Geiler,Director iOrFD MA'S d Building"Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02661 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number DO Property Address + M 1M h`}w 5� C.C)jV t' Residential Value of Work 3. I (/(� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address k 104 (S"TI 1 Contractor's Name 117A WD 1110 S, Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) U E&Workman's Compensation Insurance Check one: J1A N- 2 ❑ I am a sole proprietor ❑ I am the Homeowner TOWN OF BARNS ABLE I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken,to El Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum.35)#of.windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,*.i.e-Historic,Conservation,etc., ***Note: Property Owner ust sign Property Owner Letter of Permission. aco f the "me Improvement.Contractors License&Construction Supervisors License is SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outl6ok\DDV87AAZ\EXPRESS.doc Revised 072110 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street h • �t Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plunabers Applicant Information Please Print Legibly Name (Business/organization/individual): Address: City/State/Zip: P o o g�� Phone#:_ Are you an employer?Check the-appropriate box: 1 Type of project(required):.[ I am a employer with� 4. ❑ I am a general contractor and I employees(full and/or part-lane).* have hired the sub-contractors 6 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet t ?• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance. 9, ❑ Building addition [No workers' comp. insurance 5. El We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12Q Roof repairs insurance required.] t employees. [No workers' comp•,insurance required.] 13•❑Other *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 surly =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'.comp,policy information. law an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie. #: 1����" (7j y — 36—3�E xpiration Date: I / Job Site Address:_ �M 1'VItR <4 City/State/Zip:_ r' Attach a copy of the workers'compensation policy declaration page(showing the policy number eexpiration Failure to secure coverage as required under Section 25A of MGL c. 15.2 can lead to the• date). 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 Penalties 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 here ert un h ains and enah*s of perjury that the information provided above is true and correct Si ature: Date: Phone#: 5 _q zb — �0.7 OVi al 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#: " DATE(I+1MlDO/YYYY) ACORQ, CERTIFICATE OF LIABILITY INSURANCE 01/17ID2011 PRODUCER S08.428.6921 - FAX S08.420.S406 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Leonard Insurance Agency Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 7 Wianno Avenue ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. . P 0 Box 494 Ostervi l l e, MA 02655 INSURERS AFFORDING COVERAGE . NAIC# INSURED Lagadinos Building & Design, Inc. INSURER A: National Grange Mutual Ins Co. 14788 13 Thankful Lane INSURERB: Chartis Cotuit, MA 02635 INWRERa INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRADD POLICY ECE EXPIRATION SR TYPE OF INSURANCE POLICY NUMBER DE(MMM1rfYY1 POLICY MI LIMITS GENERAL LIABILITY NSB87460 01/01/2011 01/01/2012 EACH OCCURRENCE $ 1,000,00q DAMAGE X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrrence ' $ 50,000 CLAIMS MADE [X]OCCUR MED EXP(Any one person) $ 10,000 A PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 2,000,060 POLICY 7 JECT PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO (Es accident) $ ALL OW NED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY 'AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EAACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION C STATU- AND EMPLOYERS'LIABILITY TORY LIMITS _ffER• ANY PROPRIETORIPARTNERIEXECUTIVE� WC 004-30-3313 01/02/2011 01/02/2012 E.L EACH ACCIDENT $ 500,000 B OFFICERIMEMBER EXCLUDED? El (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $. 500,0 $I CIALPRO ISSIIONSbelow EL DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Builder in Massachusetts CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO.THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Town of-Barnstable IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 Main Street REPRESENTATIVES. Hyannis, MA 02601 AUTHORMED REPRESENTATIVE Tina Correia/LEOTC1 v Cam .. ACORD 25(20091.01) 01998-2009 ACORD CORPORATION. All rights'reservbd. . IHEI, * RARNSPABIZ M"M Town of Barnstable i63q. 10 QED NAA'I A Regulatory Services Thomas F.Geiler,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 I, /T(W C ►1XST1M , as Owner of the subject property hereby authorize i h,- to act on my behalf, in all matters relative to work authorized by this building permit application for: 11 `f of 'AJ s�. Cox), � (Address of Job) Signature ner 4ate 4-164 0*S770/0 Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV 87AAZ\EXPRES S.doc Revised 072110 Massachusetts- Department of Public SafetY Board of Building Regulations and Stand.ti-ds Construction Superviso"r License , License:_CS 12653 Restricted to:. 00. NICHOLAS A LAGADI.NOS i 13 THANKFUL LANE a COTUIT;,MA 02635. - �--�- Expiration: 7/16/2011 Commissioner" Tr#: 19456 y - f 7Af er Af °,�� n License or registration valid for individul use only Office of Consumer Affairs&B siness Regulation g y ; HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registratlon:��.104804 Type: Office of Consumer Affairs and Business Regulation Expiration: = -112012 , Private Corporation 10 Park Plaza-Suite 5170 x_= Boston,MA 02116 *LaADINOS BUTA� C F-SJI$ INC Nicholas La adind' 13 Thankful Lane Cotuit,MA 02635 °:` X ,,/ Undersecretary Not valid without4signat i_ _ . 1' Commonwealth of Massachusetts 100174763 Asbestos Notification Form ANF-001 Decal Number ZE When�"ng out A. Asbestos Abatement Description forms on the 'D computer,use 1, a.Is this facility fee exempt-city, town, district, municipal housing authority,owne-occupied only the tab key residence of four units or less? I❑Yes Z No to move your I cursor-do not b. Provide blanket decal number if applicable: Blanket Decal Number use the return �1 key. 2. Facility Location: ;. i 9411 MAIN ST.LLC 1411 MAIN ST. a.Name of Facility b.Street Address Hyannis IMA 102636 r 16174388667 c.CityrTown �. . d.State e.Zip Code f.Telephone Number INSTRUCTIONS 3. Worksite Location: 1.All sections of this COT TIT �— !1 ST R form must be a.Building Name/Building Location b,Building# c.Ong d.Floor e.Room completed in order to comply with 4. Is the facility occupied? ❑Yes Q No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor. and the Division ofOocupational (NEALCASS INC I 1200 ADAMS ST Safety(DOS) a.Name b.Address notification requiremerdsof453 (BRAINTREE 102184 17817941432 CMR 6.12 a Ci !Town d.Zip Code e.Telephone Number AC000810 g. Contract Type:, ❑Written ❑Verbal f.DOS License Number h.Facility Contact Person i.Contact Person's Title NEAL A CASS AS072613 6. a.Name of On-Site Su ervisorlForeman b.Su ndsor/Foreman DOS Certification Number GERALD LEBLANC f AM031931 j �' a.Name of Project Monitor b.Project Monitor DOS Certification Number 8 ;ENVIROTEST AADOD128 a.Name of Asbestos Ana 'cal Lab b.Asbestos Analytical Lab DOS Certification Number 14/1112013 14/1212013 i 9' a-Project Start Date mmlddif b_End Date(mmicI ftyyy) 7-4 �7-4 N c.Work hours Mon-Fri. d_Work hours Sat-Sun. —0 10. a. What type of project is this? =� [✓ Demolition ❑ Renovation Repair ❑ Other, please specify: b_Describe 11. a. Check abatement procedures: o ❑ Glove bag ❑Encapsulation —o ❑ Enclosure ❑Disposal only AIL []Cleanup ❑Other, specify: � 4 Full containment b.Describe Z Q 12. Is the job being conducted: F Indoors? ❑Outdoors? �.. anfoOlap.doC-10f02 Asbestos Notification Form•Page 1 of 3 •r +•n Commonwealth of Massachusetts 100174763 Asbestos Notification Form ANF-001 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials (ACM)to be removed, enclosed, or encapsulated: 10 200 a.Total pipes or ducts(linear ft) oTotai oiner surfaces square c. Boiler,breaching,duct,tank i surface coatings Lin.ft. d.Insulating Dement Sq.R. Lin.R�. Sq.ft e.Corrugated or layered paper f.TrowellSprayer coatings r---- pipe insulation Lin.ft. Sq.ft. Lin.R. (Sq.ft g.Spray-on fireproofing Vn� Sq� h_Transite board,wall board t.—.-----! I.Cloths,woven fabrics I j.Other,please specify: !—� 200 Lin.ft. ft. Lin,ft. S .ft k.Thermal,solid core pipe —� (LINOLEUM insulation Lin.ft. Sq.ft. I.Specify 14_ Describe the decontamination system(s) to be used: !FULL CONTAINMENT 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): BALL ACM WET HANDLED, BAGGED, LABELED AND DISPOSED OF AT AN EPA APPROVED La 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: � e I � f i a. Name of DEP Official b.Title _ I s c.Date(mmidd/ )of Authorization d.DEP Waiver# e.Name of DOS Official f.DOS�61fiicial ride N g.Date(mmlddlyyyy)of Authorization h.DOS Waiver# �o 17. Do prevailing wage rates as per M.G.L.c. 149,§26, 27 or 27A—F apply to this project? ❑Yes L� No . �° B. Facility Description N �o 1. Current or prior use of facility: I �0 2. Is the facility owner-occupied residential with 4 units or less? E,Yes E,'] No 1411 MAIN ST. LLC 1411 MAIN ST. 3. a.Facility Owner Name b.Address COTUIT 1 102635 ! 617-438-8667 c.C' down d.Zip Code e.Telephone Number(area code and extension u. 4. a.Name of FacilityOwner's On-Site Manager b.On-Site Manager Address �zI l Q c.CttylTown d.Zip Code e.Telephone Number(area code and extension) anf001ap.doc•10/02 Asbestos Notification Form•Page 2 of 3 ^, Commonwealth of Massachusetts C _. 11001.74763- 1 _ Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cunt.) 5' a.Name of General Contractor Ib.Address l C.CitvITown d.Zip Code e.Telephone Number area code and extension f.Contractor's Worker's Comp.Insurer g.Policy Number h�mm/dd 6. What is the size of this facility? +a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site (if necessary): Note:Transfer a.Name of Transporter b.Address Stations must comply with the c.Cityrrown d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removalftemporary site to final disposal site: Regulations 310 CMR 19.000 SERVICE TRANSPORT GROUP a_Name of Transporter b.Address c.CitvITown d.Zip Code e.Telephone Number 3. a.Refuse Transfer Station and Owner b.Address c.Cityrrown d.Zip Code e.Telephone Number 4. IMINERVA ENTERPRISES INC a. Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name 9000 MINERVA ROAD IWAYNESSURG c.Final Disposal Site Addre s d.City/Town OH 44688 co e.State f.Zap Code g.Telephone Number �o D. Certification N The undersigned hereby states, under the WEAL CASS Roz Giil ° penalties of perjury,that helshe has read the a.Name b.Authorized Signature �° for the Removal, Containment or Commonwealth of Massachusetts regulations PRESIDENT 312912093 c.Position/Title d.Date mm/d Encapsulation of Asbestos,453 CMR 6.00 and 7817941432 310 C MR 7.15, and that the information contained in this notification is true and correct e.Telephone Number f.Representing ° to the best of.hislher knowledge and belief. 200 ADAMS ST. o Q.Address �LL IBRAINTREE 102184 Z tIn.City/Town i.Zip Code anfOolap.doc•t0/02 Asbestos Notification Form-Page 3 of 3 TI p �, FRO AAi lti,Ci3DE Niil�BER / OF a W SIG /) CACLRNEU. BACKS 1NImq jh6j� p�tloNED YVANTd� 44AS ........ YdU �N r AMPAD NO.23-176-400 SETS NO.23-376-200 SETS lane PPS Stsnmseth 5907CromweffDrive w1 ry t Betfiesd,",MD 20816 2 A my sm 74 fir. (Zal PK Cvn55ein Bk�lcliv�q Con�rnis5�a�er To wV% M AS 5 —Vu - x - ,.,- ... _,�._�- r �`` �_� '` t�`ig � .� 'ti b� � - � �,_ �, �. �. r �- a :.-�' �' -, �l �; i it € ir ;' i 3 ; :: ii + ii i � i iiq i _{ �' :! ' E � Et : i1; f ! I;;tiiE I ;Ei #F i :f 1 Carnegie Endowment for International Peace '0 � 'James A. - Schear 5907 Cromwell Drive Bethesda, MD 20816 May. 16, 1995 Mr. Ralph Crossen Building Commissioner Town of Barnstable Barnstable, MA Dear Mr. Crossen: . I am writing to raise with you the possibility of temporarily "parking" a small cottage on a vacant parcel that my family owns in Cotuit Highlands for a period 'of ninety days, pending approval by the Town's Planning Board of .a new iot :for the cottage. The Gotta a at present is located directly across from my house lot at 411 Ma® Street Cotuit and next to Arthur Pappas' house lot at 1424 M'&" reet. Pappas purchased this 'cottage several years ago from my uncle, the late James ' Dunning, and is planning to replace it- with. a larger,, year 'round house. - He has offered to sell the cottage to- me, -and I am presently working out arrangements with my brother, mother and cousins to create a new lot next to Pappas's that could accommodate the 241x 36' structure (currently my family owns two abutting strips, .each with 85' of frontage) . Unfortunately, this process is„not'4_moving as fast as we would like and Pappas has advised me that he wishes to proceed with his project., by mid=June Thus;:.-we' would like to ,"park" the structure temporarily -,in an existing'"open 'area on- bur property, approximately .100 feet or so to the north of its present location, in order to .enable Pappas to., proceed with his planned construction. This "parking" option would be purely temporary; it would involve no construction of any foundations, etc. , and the structure would be supported by equipment provided by . the housemover. The move and parking of the structure would not obtrude into any conservation resource area, nor would it involve any clearing of trees, given that the proposed interim location is already, clear of trees. Finally, I am in contact with the housemover's insurer to e arrange adequate insurance, and I would assume responsibility for demolition of the structure if, for some reason, I cannot obtain the permits or approvals that are necessary for ultimately relocating the house to its new permanent site. If there are -,,.any issues I haven't addressed. here to your satisf action,• please- let me know as soon as conveniently possible. My office. telephone;-is- (2D2) 862-7952 . Sin er`ely; YTOVhIN OF BARNSTABLE BUILDING DEPT. D MAY 2 5 '1995' 7� J nines A. Schear � 2400 N Street, N.W., Washington, D.C. 20037-1153/Phone:(202)862-7900/Fax:(202)862-2610 GJC'�Pirr�,J � PROJECT NAME: ADDRESS:��I�/l �i•J �� PERMIT#QD,/.3 PERMIT DATE: Z//j a M/P: /� d LARGE ROLLED PLANS ARE IN: BOX SLOT Data entered in MAPS program on: BY: I q/wpfiles/forms/archive ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel-0 10 Application Health Division Date Issued I 3k Conservation Division Application Fee Planning Dept. Permit Fee {�7 ��• i� Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation/ Hyannis Project Street Address j 41� I �� S4re�'I Village /►� 6afvfS Owner 1y11 Address ���' ��(V� • , y 'V'� i �� Telephone (508 3 - 1900 ` _ /Permit Request ON H N e SO oT q ►N �'a� i w q �w Square feet: 1 st floor: existing proposedai 14L 2nd floor: existing proposed Total new __a? 33 Zoning District F Flood Plain Groundwater Overlay Project Valuation f g 5 Ofl0 Construction Type WO 2q , Lot Size 1 . 9 9Co-tS Grandfathered: ❑Yes i No If yes, attach supporting documentation. �. Dwelling Type: Single Familyf ® Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ® No ' On Old King's Highway: ❑Yes ® No / 'lh4e- g rye g k0 areas J C24 W I s mac_• Basement Type: Full. ❑ Crawl _❑ Walkout ® Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) gala Number of Baths: Full: existing ~ new Half: existing new Number of Bedrooms:y _ _ -� existing a new C Total Room Count (not including baths): existing X new First Floor Room= ount T Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric Other U4 a �( ��{, � 710 P41'�'1� Central Air: Cd Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Xes A No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ neO size Attached ❑ existing garage: g new size _Shed: ❑ existing ❑ new size��Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # I ReS� KJ��K 11 �l. wi) (4 I owdrvy-) Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - - II Name? �./ T�C�I r�rAl� L Telephone,Number (�� Address /I �� (7--67 License# C'S A---D57 3 95 Home Improvement Contractor# 5 I Cl Email: Worker's Compensation # 5.5� AiT ho4,W ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO- &V G ANo �. ,20 c i�2� B� M - L V SIGNATURE �� -DATE r �� 9 FOR OFFICIAL USE ONLY L f �,�APiPLICATION# ` Y DATE ISSUED '. MAP/PARCEL NO. 'I ADDRESS VILLAGE _ OWNER DATE OF INSPECTION: r QfF:OUNDArT',10N1I19 Z,1 l ',o i q[) FRAME 'm ,d s- .! rwt3�� gs �S -,iiNSULATION f1 f= ',tf ►.._ > h rig . FIREPLACE Al' �►� �'8 P t S' L, r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL w GAS: ROUGH FINAL FINAL BUILDING;=:. DATE CLOSED OUT ASSOCIATION PLAN NO. , r- - 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/orgmization/Individual): K&W e-1 L{ C.&�$71LJcTj Address: x 14v, /y 460. City/State/Zip: wr4,,-i-j�14&t 449� ®yySI _ Phone#: '7S1-870-5;519 Are you an employer?Check the appropriate box: Type of project(required): 1.KI I am a employer with .SS 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ZLNew construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp. insurance comp.insurance.: 9. ❑Building addition required.] 5. ❑ We are a corporation and its . 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[1 Plumbing repairs or additions l£m se ' . right of exemption per MGL Y �o workers comp. 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.[1 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 hue 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$1,50.0A0 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 rti d the p ' rz�� of perjury that the information provided abov is true d correct Si ature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire,. express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance. requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain-a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The CQinmnwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 TO.#617-727-4900 ext 406 or 1-877-MASWE Fax#617-727-7749 Revised 4-24-07 WWW.mass.govfdia Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Stmet,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 as Owner of the subject property hereby authorize to act on my behalf in all hatters relative to work authotmed by this building permit (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner 4nature of Applicant Print Name y Print Name Date QFoxMs:owNWERIMSIoxPooL•s 62012 Town of Barnstable Regulatory Services `* ssn+srs. t Thomas F.Geiler,Director 163 . P' Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.townbarnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: village number street "HOMEOWNER"- mime home phone# work phone# CURRENT MAIIJ NG 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. DEFIlQITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs.more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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 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 persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often 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 at he/she understands the responsibilities of a Supei visor. On the last page permit application,that the homeowner certify th 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. C:\Users\decoUWAppData\I.ocahMcrosoR\wmdows\Temporary Internet Files\Contmtoutlook\QRE6ZUBNEXPMS.doc Revised 053012 Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor i.& 2 Family. License: CSFA-057385 KENNETH B VON-A 11 FOX RD y I W ALTHAM MA 7024'11 i P � i Expiration ` Gommissiaher 07/19/2,015 ` Restricted-One-and two-family dwellings or any's accessory building thereto,ui'espective of si .ze • e i I Failure to possess a current edition of the.'Massachusetts State Building Code is cause for revocation of this license. For DPS Lic2nsing information visit: www.Mass;GoS/DPS `flfGg ro�e9i�f �o s #tom ., dul use only U Oftice o onsnmer f�' ' & iness a u.a ron. License or registration.valid for tndivi HOME IMPROVEMENT CONTRACTOR before the 9WT.Ation date. Iffound return to: Registration A16519 Type: Office of Consumer Affairs and Business Regulation Expiration 6/22%2014 F�ivate'Corporation 10 Park Plaza Suite 5170 Boston,MA 02116 KE NETH VONAiCONST ING f KENNETH VON .At 11 FOX RD.. WALTHAM,MA 02451 Undersecretary ;< Not'valid without sign,ature 1 SHOPS KENOWHAPTON ARCHITECTURE T $I j NOVEMBER 1,2013 Mr.Thomas Perry Building Commissioner Town of Barnstable Barnstable,Massachusetts Regarding: 1411 Main Street,Gate House Dear Mr.Perry, I was notified by Jeff Ford of Michael Ford's office that our plans for the Gate House building on the 1411 Main Street parcel do not identify the address of-the building. Jeff asked if I could send a letter so that you have something in your files confirming the correct property address for this building. Therefore,please allow this letter to serve as confirmation that the Gate House building is to be built on the 1411 Main Street parcel. If I can be of other assistance in any way,please let me know. Best Regards, t< Michael O.McClung,AIA,Partner Shope Reno Wharton Associates cc. The Law Office of Michael D. Ford IS NIARSHALL STREET. SOUTH NORWALK, CT o6854 $h«ytrertowh art on.Coll? T..203 8.52 7250 fy ' Town of Barnstable 101ti ME4 _5 AIM 10 ?4 License and Permit Bond Bond No.p 8 SBGM4T646 KNOW ALL MEN BY"THESE PRESENT,that we 'Kenneth RVona Construction. Inc. of Waltham, `Massachusetts as Principal and Hartford Casualty Insurance Company " n'a corporation authorized underthe laws of Indiana and licensed to become surety on bonds and undertakings in the State of Massachusetts, as Surcty, are held'and firmly bound unto The Town of Barnstable, Massachusetts ,Obligee, in the penal sum of One Thousand dollars $1,,000 lawful'money of .x the United States,for which payment, well and tnily to be made, we bind ourselves, our heirs, executors, administrators,successors and assigns,jointly and severally; firmly by these present. �VHEREAS,the saidPrincipal has anplied to the Obligee for a,license or permit for/to Road Permit for Road Frontage Work- at 1411 Main• Street' ,Cotuit, MA F Y s + NOW, THEREFORE, THE CONDITIONS OF THE OBLIGATION_IS SUCH, That if the said Principal shall'laithtully perform the duties of such licensee-or'permitee, and in all things complywith-the ordinances, rules and regulations appertaining thereto, then,, this obligation shall be void, otherwise toxernain in full,'force and effect. ' The term of this bond is for.the period beginning on the lsth'day of April ; 2014 P and ending on the'1 ath day of--April This bond may be terminated at any by the Surety upon sending notice in writing, by certified mail, to the clerk of the municipality with whom this bond is filed and at the expiration of thirty (30)'days from th'e mailing.of said notice, the liability ofsucti Surety is thereby terminated and cancelled: and provide further, that nothing herein shall affect any righr or liabiiity which shall have occurred-tinder this bond prior to the date*of such termination. SIGNED,sealed and dated this 19th day of Januar'v 2014 J 4V ,Hartford Casualty Insurance Company Kennethion. Inc. Surety 'Princip�i 71 Joell La-Pi Y erre,Attorne In Fact Direct Inquiries/Claims to: THE HARTFORD POWER OF ATTORNEYOne HBond T-4 artford Plaza Hartford,Connecticut 06155 call:888-266-3488 or fax:860-757-5835) KNOW ALL PERSONS BY THESE PRESENTS THAT:; Agency Code: 08 080198 Hartford Fire Insurance Company,'a corporation duly organized,under the laws of the State of Connecticut . Hartford Casualty Insurance Company;a corporation duly organized under the laws of theState of Indiana . Hartford Accident and Indemnity Company,a corporation duly organized under the laws of the State of Connecticut 0 Hartford Underwriters Insurance Company,a corporation duly organized under the laws of the State of Connecticut Twin City Fire Insurance Company;°a corporation duly organized under the laws of the State of Indiana _ Hartford Insurance Company Of Illinois, a corporation duly organized under the laws of.the'State of Illinois Hartford Insurance Company of the Midwest,a corporation duly organized under the laws of the State of Indiana' Hartford Insurance.Company of the Southeast,a corporation duly organized under the laws of the State of FloridaY having their home office in Hartford, Connecticut(hereinafter collectively referred to as the"Companies")do hereby-make,constitute and appoint, up to the amount of UNLIMITED .. r JOELLE L. LAPIERRE, TERUKO REINERTSEN, VL: WHEELER, SUZAN.TURNER, GLORIA DIAZ, SANDI SMITH, }SUANNE COX,- - LISA E. BARROWS, SALLY P. GALLAND, FRANTZ'GEBARA," JULIO DELVALLE, KATHLEEN ADAMS, EMILY OLAN, GEOFFREY ' RAMPERSAD, SHELBY WIGGINS, NANCY DUDLEY, EUGENE HERRERA, CHRISTINA'HEATLEY, LORI,S. DAMRON, .SLOBODANKA BILIC, SHARI RUFF, TANYA RIOS, 'SHANTA.MAHADEO, AMY JO MILLER, ALPHA,.D., LAUREANO, REINA DAIL, JUDY BURTON, 1 LILIANA JOHNSON, TAMMY BROWN, SANDY HEAD, MICHELE CONLEY, JENNIFER,MORALES, STUART OWENS, JESSICA . CICCONE, GREGORY MARKHAM,—SARA DIFIORE, JENNIFER JENSEN, MELISSA HASKINS, BRADY MORIARTY OF LAKE MARY,T' FLORIDA ` their true and lawful Attorneys)-in-Fact,each in their separate capacity if more than one is named above,'to sign its name as s6rety(ies)only as delineated'2 above by®,and to execute,seal and acknowledge any and all bonds,undertakings,,contracts and other written instruments in the nature thereof,on behalf of the Companies in their business of guaranteeing the,fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in anyactions or proceedings allowed by law. ` '` „ — ' a' , ` e In Witness Whereof, and as authorized by a Resolution of the Board of Directors of the Companies on August 1, 2009, the Companies have caused these presents to be signed by its Vice President and its corporate seals to be hereto affixed, duly attested by its Assistant Secretary. Further, pursuant to Resolution of the Board of Directors of the Companies,the Companies hereby unambiguously affirm that they are and will be bound by any, mechanically applied signatures applied to this Power of Attorney: - urr ,�ySY IYtG� r Q\tL IN .�. pYltrs ry ar" WIN t C .,ra aaAr' �' � c�Y �� ^max ee rrurot i i 19 0 r M W+ -0 y �: nrayrot '�a vea tro M j ' w0� ,�� � >" o�r+e,erncv�� �••uM► � �yi;I97g a� s�197�,s�,t ? ]979 A''• � , _ � • t � �aF+\r' ,btwrN yA a PO. a • .,�k& w�� Nafs# - '`lj�YI.ai' Wesley W.'Cowling,Assistant Secretary, "" M:Ross Fisher, Vice President " STATE OFCONNECTICUT 9 ss. Hartford . "• COUNTY OF HARTFORD On this 12th day of July,2012, before me-personally came M. Ross Fisher,to me known,who being by me duly sworn,did depose and say:that. he resides in the County of Hartford,State of Connecticut;that he is'the Vice President of the Companies,the corporations described in and which executed' the above instrument;that he knows the seals of the said corporations;that the seals affixed to'the said instrument are such corporate seals;that they were so affixed by authority of the Boards of Directors of•said:corporations and that he signed his name thereto,by like authority. F, ' w Kathleen T.Maynard _ i CERTIFICATE *' Notary,Public i ,.. ' My Commission Expires July31,2016 1,the undersigned,"Vice'President of the Companies,:DO HEREBY CERTIFY-that the above and foregoing is a true and correct copy of,the.Power of Attorney executed by said Companies,which is still in full force effective as of Zanuary 19, 2 014 " Signed and sealed at the City of Hartford. t A ell, Y blab S o ax,e,r,cr ��a1a11► t 19 7 9 i 1 9, ' r Jm 3 ro` 8? * 1919 • ~ �T�.as'g�. �iwwewtE° b�A o eo`b 'r • �' „emu',d', y Gary W.Stumper,Vice President POA 2012 LAW OFFICES OF MICHAEL FORD ATTORNEYS AT LAW 72 MAIN STREET, P.O. BOX 485 WEST HARWICH, MA 02671 TEL. (508)430-1900 FAX (508)430-9979 lawofficeofmichaelfordnverizon.net MICHAEL D.FORD f e JEFFREY M.FORD ' Town of Barnstable July 14, 2014 ; Thomas Perry/ Building Inspector 200 Main Street, Hyannis, Massachusetts 02601 RE: 1541 Main Street & I4I I Main Street, Cotuit:MA Request for Extension of Building Permits # ' 02263, 20130823 � 0, 201308228 & 0 `�b '0 372 Dear Mr. Perry: Please accept this letter as a formal request to-extend the following building permits: Aa130::�50� Permit# 20448 (1411 Main Street) - Permit#201308230 (1541 Main Street Stable/Barn)- Permit#201308228 (1541 Main Street Cow Barn) Permit# 'ao j4wa 45}(1541 Main Street Farm Office) The owner has been working with the town to solve drainage issues relating to the farm, Main Street and Rushy Marsh Farm, all of which are currently pending bef6re the i Conservation Commission.This has resulted in a delay for the start of construction. y y & r Thanks as always for;- our time consideration. ' Very truly yours, Jeffrej M. rd, Esq. Town of Barnstable s; i Ii em°s4e and Permit Bond Bond No. 08BSBGM4646 KNOW ALL NIEIv Bff ''HE SE PRESENT,.that we • Kenneth Vona Constru .tion. rnc. Of Waltham, ,Massachusetts as Principal and Hartford Casualty Insurance Company , a corporation authorized under the laws of ' Indiana and licensed to bccome surety on bonds and undertakings in the State of Massachusetts, as Surcty, are.held and firmly bound unto The Town of Barnstable, Massachusetts , Obligee, in.the penal sum of One Thousand dollars,$1', 000 lawful money of the United States, for which payment, well'and truly to be made, we bind ourselves, our heirs, executors, administrators, successors and assigns,jointly and severally; firmly by these present. WHEREAS, the said Principal has applied to the Obligee for a license or permit for/to Road Permit for Road Frontaae Work at 1411 Main Street', Cotuit; MA NOW, THEREFORE, THE CONDITIONS OF THE OBLIGATION IS SUCH, That if the said Principal shall faithfully perform the duties of such licensee or permitee, and in all things,comply with the ordinances, rulc-s and regulations appertaining;thereto, then this obligation shall be void, otherwise to remain in full force and effect_ The term of"this bond is for the period beginning,on the 18th day of April , 2015 and ending on the i sth day of April ' ,. .02 16 This bond may be terminated at any time by the Surety upon sending notice in writing, by certified mail, to the clerk of the municipality with whom this bond is filed and at the expiration of thirty (36) days from the mailing of said notice, the liability of such Surety is thereby terminated and°cancelled: and provide further, that nothing herein shall affect any right or1lability which shall have occurred under this bond prior to the date of such., termination. SIGNED, sealed and dated-this 181h day of January , 2015 Hartford Casualty Insurance Company Kenneth Vona Construction. Inc_ Surety Principal Joe L, LaPierre,Atio ey{n Fact Stefano & May 21, 2015 Michael O. McClung,AIA Shope Reno Wharton Associates 18 Marshall Street South Norwalk,CT 06854 Re: Rushy Marsh Farm-Mwain Street, Cotuit, MA ,,Gate House Dear Mike, DeStefano& Chamberlain, Inc.served as the structural engineer of record for the new Gate House building under construction on the site. We engineered the structural framing and foundations for the building, and prepared the structural drawings that were submitted for permit. During the course of construction,our office performed site visits to review the progress of structural framing. Based on our site visits,we have determined that the structural framing has been completed in substantial conformance with our design,and can resist the structural loads prescribed by Chapter 16 of the Massachusetts State Building Code 780 CMR 81h Edition. Please contact our office with any questions. Sincerely, G vin hamberlain, P.E.,,SECB 1 .r 085TEFANO STi 1CiUAM. No.34112 J m . D tefano, P.E.,SECBp .qF �O o� G/-. FSS/ONAI E� cc: Ken Vona Construction file Structural a nd . Arch1tecturaI Engineering 50 Thorpe Street, Fairfield.CT 06824 a Tel.203.254.7131 a fax 203.254.0263 a www.cicstructural.com _ TOWN OF BARNSTABL E BUILDING PERMIT AAXhICAiTION Map O 1-:7- Parcel ® Application # Health Division Date Issued Conservation Division inc,.•�Z, uJr 'S� ^ Applicatiee Planning Dept. Permit Fee Q�4Z2. a Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis , Project Street Address 1) M e!I y S�rt e_ Village Cro+,, ry\J0-r,b& MA Owner �y l�q l N �T/uL-�T� Address V( 9 MQ inI 0 1'U))4 �f� ® Telephone 6 30 � I Permit Request d r r (n l OW rD 1�14)')d) vyml7 g�d Square feet:, st floor: existing proposed 2nd floor: existing proposed Total new 4 � , .� Zoning District Ar Flood Plain Groundwater Overlay Project Valuation 750.,000 Construction Type � FRP Lot Size Grandfathered: ❑Yes LW/No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) ® Age of Existing Structure 1,50 Historic House: ❑Yes JNo On Old King's Highway: ❑Yes ❑ No Basement Type: W Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing I new Half: existing I new 1 Number of Bedrooms: existing �new Total Room Count (not including baths): existing new Jr First Floor Room Count 3 ;E Heat Type and Fuel: ❑ Gas ❑ Oil ;9 Electric ❑ Other 5 - Central Air: ❑Yes ❑ No Fireplaces: Existing New _� Existing wooer al stoves❑YJg ❑ No � Detached garage: ❑ existing ❑ new size Pool: ❑existing ❑ new size _ Barn: ❑ asting ❑mew 29ize_ oAttached garage: ❑ existing W new size _Shed: ❑ existing ❑ new size _ Other: ra Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ w Commercial ❑Yes D(No If yes, site plan review# Current Use S- _ _- - ii Nam' iN Proposed Use i inl- Ju - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Kr=W N VONV1- Telephone Number Address License Home Improvement Contractor# W�VI�t AA& #Pr Worker's Compensation # X&JC3/9&78: ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Chi lPiM-1 C�i y C v V �1 a SIGNATURE DATE 3 9 /5 k' + FOR OFFICIAL USE ONLY APPLICATION# *DATE ISSUED - MAP PARCEL NO. A .4 'ADDRESS VILLAGE OWNER DATE OF INSPECTION: ,1 r.FOUNDATION FRAME INSULATION - �;• . i� FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING z DATE-CLOSED OUT 4 . ASSOCIATION PLAN NO r r -- - - -- —The-Common.wealth-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): A N naf y AV Address: / 4n AD City/State/Zip: (i✓ .� �Z�f�S Phone#: 70"1—g�0 Are you an employer?Check the appropriate box: Type of project(required): 1.4 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. IZIDemolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance.# 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No'workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors-must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. o� , Insurance Company Name: J �G(6p Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: AT// &ftfll cSj7. City/State/Zip: eOn/j_r A44!1 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year 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 p nd pena ties of perjury that the information provided above is true and correct Signafore: i Date: Phone#: 7190 t' 0 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions- Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or.local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants ?lease fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es).and phone number(s)along with their certificate(s).of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be.advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. � City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant tiat must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture ('i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. Tie Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Rev_sed 4-24-07 www.mass.gov/dia AC�® DATE(MMIDD/YYYY) ��. CERTIFICATE OF LIABILITY INSURANCE 12/11/2012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Construction NAME: Eastern Insurance Group LLC PHONE No . (508)651-7700 Fac Nol, 233 West Central Street E-MAIL ADDRESS• INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURERA:Union Insurance CO INSURED INSURER B Acadia Insurance Company 31325 Kenneth Vona Construction Inc. INSURERC:Star Indemnity & Liability CO 11 Fox Road INSURERD:EastGuard 14702 INSURER E: Waltham MA 02451 INSURERF: COVERAGES CERTIFICATE NUMBER:NASTER 2012.5 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 ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE Fx_1 OCCUR PA0296259-13 /1/2012 /1/2013 MED EXP(Any one person) $ 15,000 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 X PRO- LOC $ JFQT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 0300197-13 /1/2012 /1/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS NON-OWNED PROPERTY DAMAGE X AUTOS Per accident) $ Medical payments $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 `. EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000 DED I I RETENTION ISCCCLO1841612 /1/2012 /1/2013 $ D WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N EEL ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A' . (Mandatory in NH) WC318878 0/4/2012 0/4/2013 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1 000 000 `DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FOR INFORMATIONAL PURPOSES ONLY AUTHORIZED REPRESENTATIVE Rosemary Fulham/PMA ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INSA9ri �mnn.si n� Ti, Armor noma nnil Inn^--icf-el-Ire of Arnon I S Office o onsumer !fairs&�u§m.ess egq n_on icense;or registration valid for individul use only (HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to- Registration: 116519 Type: Office of Consumer Affairs and Business Regulation ' Expiration 6122f2014 Private Corporation 10 Park.P aza Suite 5170 Boston;MA 02116 KEi ETH VONAyCONSTjN_C KENNETH VONA{ 11 FOX RD. ,FksV .. 4� ., _ -- WALTHAM,MA 02451 z '+r Undersecretary Not valid ivithoutsignafure Massachilsetts-De1jartmefit of PUhi1C Sift' t ' Board of Building Rey=Sul,lions and Stantla�da Cons#r""uction-Supervisor License One.-and Two'FaM'I'Y,Dwellings Ucense:r CS 57385 KENNETH,B;UONA s, 1'l FOX RD WALTHAM, MA;0245I Expiration: 7/19/2613 {'+;nniisio,ii TrF#: 1'9297 9 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer'to; WWW.Mass.Gov%DPS `h s:f l Doc: 1 Y 20O s 951 -09--1 1-2012 1 1 : 4S Ctft: 198133 " BARNSTABLE LAND COURT REGISTRY QUITCLAIM DEED' I, MARGARET D. WERNER, TRUSTEE of the MARGARET D. WERNER REALTY TRUST, under a Declaration of Trust dated August 2, 2012, and registered with the Land Registration Office of the Barnstable County Registry of Deeds , as Document No . 1, 198, 027 of Princeton, MA 01591,' for consideration paid, and in full consideration of $900, 000. 00 - GRANT TO: 1411 MAIN STREET, LLC, a Massachusetts Limited Liability Company, c/o Paul E. Grover, Robert Paul Properties, 867 Main Street., .Osterville, MA 02655 . WITH QUITCLAIM COVENANTS, the land, together with the buildings thereon, situated at 1411 Main Street and 0 Main Street, Barnstable (Cotuit) , Barnstable County, Massachusetts 02635, as shown on• the hereinafter mentioned plans, described as follows:',, PARCEL I - 1411 Main Street Registered Land: LOT C as shown on Land Court Plan: 15600-C. Unregistered Land: SOUTHEASTERLY by Main Street- (formerly Rushy Marsh Road) 'by three courses and distances together measuring 200. 97, feet; ; SOUTHWESTERLY by land now or formerly of William G. Taussig, 282. 18 feet; NORTHWESTERLY by land now or formerly of William B. Dunning, 201. 98 feet; and NORTHEASTERLY by Registered land shown on Land Court .Plan 15600A, 297 . 33 feet Being" shown as land of William B. Dunning .on a plan entitled, "Subdivision of Land Court Number 15600A - Cert.. n •4 r 6824, Land in' Barnstable -` Scale 1 in. 50 ft. w September 17, 1947, Bearse, &, Kellogg - Civil Engineers. Parcel I as described, herein is conveyed 'subject to a Landscape Restriction for the benefit' of the abutting land on the North (139i: Main Street) . The buffer zone., shall be' thirty feet (301 ).. in width'. and shall extend along the Northerly boundary line of` Parcel I (1411 Main Street) for the purpose of visual' screening .by . maintaining trees and shrubs substantially ,:in their. existing vegetated condition. There will -be no buildings, fences or other structures and no clear cutting within the buffer zone. ' PARCEL 2: 0 Main Street: Lot 4 as shown on Land. Court - Plan: 15600-E. For, title to Parcel 1, see Certificate of Title No. 197825 and Book 26559, Page ,37. For title to Parcel, 2,. see Certificateof Title No. 197825. r I, Margaret D. Werner, Trustee of the, Margaret D. Werner Realty Trust, . hereby certify as follows: 1. I am, the duly appointed Trustee of said Trust and' have full -power and authority , to . convey, the property situated' at 1411`• and 0 Main Street, Barnstable (Cotuit) MA 02635, ' and -,to :`-'execute, acknowledge and ".deliver any instrument or instruments . as may be. necessary and proper or incidental. to the `completion of%the ,transfer. • ' 2. . 'The. Trust has not been ' .terminated, altered or amended, except as, may . appear of record, and is . still in full force and effect. 3. `-I' am ' executing- this ,certificate and performing the above act :.as' recited herein pursuant - to express direction- of the beneficiaries of said. Trust. • - nASSACHUSETTS STATE EXCISE .TALC ' . BARNSTABLE LAND COURT REGISTRY • ' . Gate: 09-11-2012 0 11:�`am Ct1;: 752 Doi_': 1200951 i�ii•i::f;CE�Gau$ :suo:1 i i!^;+�$ :e-� Fee: Q 078.00 Cons: $900 000.00 9' :TT 7T0Z-TT`t„ .�Dl1)(� • J,'�1SI9�y Iyflt7a afdUl 3l'd�?.1ata�5'i'r , ,. 4 . The beneficiaries of said Trust ,are of full, age and competent,.to give said express direction. WITNESS my hand and seal this day of August,] 2012. i MARGARET D. WERNER REALTY 'TRUST , Margaret D. ,Werner, Trustee THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, -,SS. August �� , 2012 Before me, the undersigned Notary Public, personally appeared Margaret D.. Werner, Trustee of the Margaret D. Werner Realty Trust, proved , to me through _M satisfactory evidence "of identification, which was a MA driver' s license, to be the • person whose name is signed on the' attached or preceding document, and acknowledged to me that she signed it voluntarily for its stated purpose. rNotary Public VJ My commission expires. KATHLEENM.DAGGETT a L X' Notary Public,MassachuseMassachusetts . 'a4 My Commission Expires June 14,.2013 • C.P,: • 1 BARNSTABLE REGISTRY Of DEE05 rr �o�.tsa rnstable r gulatory 5etvices 3 �s�`.'��* Tbomss F'.Gealer,Du actor"` " Budding])ion. 0-in-To rT ,Btuldbng.Comm ss,oner` w�rw Hy$nnzs,MA 02601 arnstabfeta$:. Once .Sfl8-862-40 =: 38' Fad 508-790 6230 P operty. Caner bus t Coxxzp�ete,a�ad Sigz :�C'hs Secfioa ?, you(� C�,,�,Y..,Mana-� 141! n'�'��e+, L.•t..0 .dthe in )ietebp t ject.pxopetty. � � to att on.tap behalf • . , d matters xelatcve do work authorize by thus buclingpectnit ' Pool fences and. alarms are the---mvb sxbxXitp of the aP lzcata . Pools axe dot.robe filed before fence is xtzstalled,3and ppoZs'are,not to be utxl�zed tutzi�all fit�..al`ins _ actions , :.. at�pe�fo�zaedax�.d:accepted ` zt�re ofApp�:vt _ _ Prt�t Name • P.ttnt N'atae � V 3 QFox�owrsor�oos, • . - oFTME To of Barnstable Regulatory Services .. MASS Thomas F.Geiler,Director. 1639. _tee prEn Building Division TOM FeLif,Building Commissioner 200 Main Street;Hyannis,MA 02601 www:town.bamstable.ma.us Office: 508-862-4038 Fax .508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby,authorize to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) *Pool fences,and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Sigqture of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONP00LS 62012 .Town of:Barnstable Regulatory Serviees Thomas F. Geiler,Director MA It& Building Division . Tom Perry,Building Commissioner. 200 Main Street, Hyannis,MA 02601 www.town.b arnstable.ma.us Dffice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: .JOB LOCATION: number - street. village a "HOMEOWNER": name home phone# work phone# j . 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 Person(s)who owns a parcel of land on which he/she resides or,intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the-Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other. applicable codes,bylaws,rules and regulations. The undersigned"homeowner'.'certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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 12TO Construction Control. HOMEOWNER'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 engages a person(s)for hire to do_such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, 'Rules&Regulations for licensing Construction Supervisors,Section 2.15) This lack of awareness often 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 fomi/certification for use in your community. Q:forms:homeexempt The Commonwealth of Massachusetts William Francis Galvin-Public Browse and Search Page 1 of 2 ;. The Commonwealth of Massachusetts �. William Francis Galvin Secretary of the Commonwealth,Corporations Division �•, One Ashburton Place, 17th floor Boston,MA 02108-1512 Telephone: (617)727-9640 1411 MAIN STREET LLC Summary Screen 19 Help with this form Re�g�est a Gertlf�ate: me a The exact name of the Domestic Limited Liability Company(LLC): 1411 MAIN STREET LLC Entity Type: Domestic Limited Liability Company(LLC) Identification Number: 001086844 Date of Organization in Massachusetts: 08/30/2012 The location of its principal office: No. and Street: C/O PAUL E. GROVER ROBERT PAUL PROPERTIES. 867 MAIN STREET. City or Town: OSTERVILLE State:MA Zip: 02655 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No.and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: PAUL E. GROVER No. and Street: ROBERT PAUL PROPERTIES 867 MAIN STREET City or Town: OSTERVILLE State:MA- . Zip: 02655 Country: USA The name and business address of each manager: Title Individual Name Address (no Po Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER PAUL E.GROVER ROBERT PAUL PROPERTIES,867 MAIN STREET OSTERVILLE,MA 02655 USA The name and business address of the person in addition to the manager,who is authorized to execute documents to be filed with the Corporations Division. Title Individual Name Address(no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY PAUL E.GROVER ROBERT PAUL PROPERTIES,867 MAIN STREET OSTERVILLE,MA 02655 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address(no PO Box) http://corp.sec.state.ma.us/Corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 4/10/2013 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 2 of 2 First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY PAUL E.GROVER ROBERT PAUL PROPERTIES,867 MAIN STREET OSTERVILLE,MA 02655 USA Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership _ Resident Agent _ For Profit _ Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS Annual Report Annual Report-Professional Articles of Entity Conversion Certificate of Amendment ewFlhngsk New;Search �. Comments ©2001-2013 Commonwealth of Massachusetts All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 4/10/2013 REScheck Software Version 4.4.4 CNJ/ Compliance Certificate Project Title: McCourt Residence- Gate House Energy Code: 2009 IECC Location: Cotuit,Massachusetts Construction Type: Single Family Project Type: New Construction Conditioned Floor Area: 2,568 ft2 Glazing Area Percentage: 11% Heating Degree Days: 6137 Climate Zone: 5 Permit pate: Construction Site: Owner/Agent: Designer/Contractor. 1141 Main Street Austin P.Regolino Brian Vona ' Cotuit,MA 02635 McCourt Group LLC Kenneth Vona Construction,Inc. 280 Beverly Road' 11 Fox Road Chestnut Hill,MA 02467 Waltham,MA 02451 (617)469-2681 (781)890-5599 austin@mcc:ourtgroup.com brian@kenvona.com Compliance: 0.2%6 Better Than Code_ Maximum UA: 505 Your UA:504 The%Better or Worse Then Code:lndex reflects how dose to compliance the house Is based an code trade-W rules It DOES NOT praAde an asflmate or energy use or cost relative to a Nnhuln•code horns. i Envelope Assemblies Gross Glazing Assembly Area or Cavity Cont. or Door UA Ceiling 1:Fiat Ceiling or Scissor Truss 1,409 30.0 0.0 49 Ceiling 2:Flat Ceiling or Scissor Truss 844 30.0 0.0 30 Wall 1:Wood Frame,16'o.c. 1,564 19.0 0.0 64 Window 1:Wood Frame:Double Pane with Low-E 343 0.290 99 SHGC:0.00 Door 1:Solid 158 0.290 46 Wall 2:Wood Frame,16"o.c. 1,467 19.0 0.0 88 Basement Wall 1:Solid Concrete or Masonry 1,122 0.0 14.0 65 Wall height:9.0' Depth below grade:7.0' Insulation depth:7.0' Floor 1:A117-Wood Joist/Truss:0ver Unconditioned Space 1,487 30.0 .0.0 49 A Crawl 1:Solid Concrete or Masonry 47 6.0 14.0 14 Wail height:7.0' Depth below grade:2.5' Insulation depth:2.5' r Project Title: McCourt Residence-Gate House Report date: 04/23/13 Data filename: \\Rdk-andover2\Users\kscarboroughWy.Documents\REScheck\McCourt RESCheck.rck Page 1 of'8' • s Compliance Statement: The proposed building design described here is consistent with the building plans,specifications,and other calculations submitted with the per i a pli alion.Th posed building has been designed to meet the 2009 IECC requirements in REScheck Version 4.4.4 and to comply with the mandatory q Ire a list the REScheck Inspection Checklist. Name-Title Signature '- Date 41 Or c J) d 1 r Project Title: McCourt Residence-Gate House Report date: 04/23/13 Data filename: \\Rdk-andover2\Users\kscarborough\My Documents\REScheck\McCourt RESCheck.rck Page 2 of 8 REScheck Software Version 4.4.4 Inspection Checklist Requirements: 100.0%were addressed directly in the REScheck software Text in the"Comments/Assumptions"column is provided by the user in the REScheck Requirements screen.For each requirement,the user certifies that a code requirement will be met and how that is documented,or that an exception is being claimed.Where compliance is itemized in a separate table,a reference to that table is provided. 20091ECC Pre-lnspectlonlPlanReview Plans Verified Value Value Field Verified Complies? Comments/Assumptions' 103.2 Construction drawings and ., Complies ;Requirement will be met. [PR1]' documentation demonstrate energy '[]Does Not Complyt code compliance for the building []Not Observable 1' envelope. ENot.ApplicaGle- 103.2, 'Construction drawings and UComplies Requirement will be met. 403.7 documentation demonstrate energy IElDoes Not Comply: [PR3]' code compliance for lighting and ;[]Not Observable 01, mechanical systems.Systems serving, Not Applicable ` 'multiple dwelling units must demonstrate compliance with the ,'commercial code. 403.6 :Heating and cooling equipment is Heating: Heating: flComplies Requirement will be met. (PR2]2 sized per ACCA Manual S based on t Btu/hr ) Btu/hr DDoes Not Comply l J ACCA M d loas per Manual or other , ' Cooling: Cooling: '0NotObservable approved methods. Btu/hr Btu/hr '[]Not Applicable • 6 t Additional Comments/Assumptions: 1 I High Impact(Tier 1) 2 Medium Impact(tier 2) 3.. Low Impact(Tier 3) Project Title: McCourt Residence-.Gate House Report date: 04/23/13 Data filename: \\Rdk-andover2XUsers\kscarborough\My Documents\REScheck\McCourt RESCheck.rck Page 3 of 8 2009 IECC Foundation Inspection Plans Verified. Field Verified Complies? Comments/Assumptions . ' . Value Value. 402.1.1 Conditioned basement wall insulation R- R- ❑Compiles" ;Seethe Enve ne Assemblies table for [FO4]' R-value.Where interior insulation is ❑Does Not Comply;values. O used,verification may need to occur f .[-]Not Observable t .during Insulation Inspection.Not f ;❑Not Applicable I' ,required in warm-humid locations in + r" Climate Zone 3. - 303.2 Conditioned basement wall insulation I OComplies ;Requirement will be met. [FO5]' 'installed per manufacturer's 4 []Does Not Comply b, (instructions. ,❑Not Observable i El Not Applicable 402.2.7 :Conditioned basement wall insulation ' ft `. ,. ft "FICompiies 'See the mblies table for [FO6]' depth of burial or distance from top of i ❑Does Not Comply values. wall. f ❑Not Observable ❑Not Applicable s 402.2.9 Unvented crawl space wall insulation t R- ; R- Eltompiies )See the Envebne Assemblies table for [F07]'. I R-value. R_" R_ ❑Does Not Comply dues. '❑Not Observable r 3 ❑Not Applicable 303.2 Unvented crawl space wall insulation t'❑Complies Requirement will be met, [FO8]1 +Installed per manufacturer's 40Does Not Comply_ instructions. ❑Not Observable T ❑Nol Applicable 402.2.9 ,'Unvented crawl space continuous ❑Complies 'Requirement will be met. [FO9]1 vapor retarder installed over exposed ❑Does Not Comply N. ;earth,joints overlapped by 6 In.and i❑Not Observable ! sealed,extending at Ieast 61n.up and E]Not Applicable attached to the wall. 402.2.9 Unvented crawl space wall insulation $ in. = in. ';❑Complies See the£nvelons Assemblies table for [FO10]1 depth of burial or distance from top of ❑Does Not Comply;values. _ ;wall. ❑Not Observable z I❑Not Applicable i r 303:2,1 A protective covering is installed to ;'Ocomplies - ;Exception:Requirement is not [F011)z protect exposed exterior insulation ,'❑Does Not Comply;applicable. and extends a minimum of 6 in.below t �❑Not Observable ( grade. ❑NolAppilcable j 03 2 controls and system '❑Do mplies Not Comply-Exception:Requirement is not [ h applicable. }❑Not Observable ;❑Not Applicable Additional Comments/Assumptions: ' • 1 High Impact(Tier 1) 2 Medium Impact(Tier 2)., 3'1 Low Impact(Tier 3). Project Title: McCourt Residence-Gate House Report date: 04/23/13 Data filename: URdk-andover2\Users\kscarborough\My Documents\REScheck\MeCourt RESCheck.rck Page 4 of 8 } Plans Verified Field Verified 20091ECC Framing/Rough-ln Inspection Value Value Complies? Comments/Assumptions 402.1.1, Door U-factor.- U- U ;❑Complies M See the Envelope Assemblies table for 402.3.4 ❑Does Not Comply,values-, (FRI]' t " ❑Not Observable u i❑Not Applicable ; 402.1.1, :Glazing U-factor(area-weighted U- U- ❑Complies ;See the Enwi ne Assemblies table for 402.3.1, average). t iDDoes Not Comply values. 402.3.3, k ❑Not Observable402.5 [FR2]' 1' ❑Not Applicable {' s' c i 303.1.3 U-factors of fenestration products are ' I❑Complies ;Requirement will be met. [FR4]' ;determined in accordance with the ❑Does Not Complyl ;NFRC test procedure or taken from ❑Not Observable .the default table. ICINot Applicable . 402.3.5 'Sunrooms enclosing conditioned U # U- ;[]Complies (Exception:Requirement is not [FRS]' space have a maximum fenestration ` 4 x❑Does Not Comply applicable. a ^ I U-factor of 0.50 in Climate Zones 4-8. * '❑Not Observable New glazing separating the sunroom , 1ONot Applicable 'from conditioned space must meet + } F _code requirements. t 402.3,5 "Sunrooms enclosing conditioned g U- - v U- ❑Complies ;Exception:Requirement is not [FR9]' space have a maximum skylight U- []Does Not Comply applicable. 4�. factor of 0.75 in Climate Zones 4-8. f ❑Not Observable ' p []Not Applicable 402.4.4 .Fenestration that is not site built is ❑Complies lRequirement will be met. [FR20]' 'listed and labeled as meeting r❑Does Not Comply! 'AAMA/WDMA/CSA 101/I.S.2/A440 or j []Not Observable } has infiltration rates per NFRC 400 99 i❑Not Applicable ; that do not exceed code limits. t ±- 402.4.5 (IC-rated recessed lighting fixtures a❑Complies "Requirement will be met. [FR16]Z sealed at housing/interior finish and '] ❑Does Not ComplyI i (labeled to indicate 2.0 cfm leakage at ] '❑Not Observable ' 7 1 5 Pa tQNot Applicable s ' _. , 403.2.1 'Supply ducts in attics are insulated to ` R ; R- ?[]Complies 'Requirement will be met. [FR12]' `R-8.All other ducts in unconditioned ; R_. R_ Does Not Comply- E s spaces or outside the building ONot Observable envelope are insulated to R-6. ` ] `❑Not Applicable p. i .. .... .. .. .F'.. 403.2.2 °All joints and seams of air ducts,air i i❑Complies Requirement will be met. [FR13]' ,handlers,filter boxes,and building R❑Does Not Comply1 {cavities used as return ducts are []Not Observable t sealed. ' - J❑Not Applicable 403.2.3 ',Building cavities are not used for ' t❑Complies (Requirement will be met. [FR15]3 :supply ducts. ❑Does Not Complyl ❑Not Observable !![ c❑Not Applicable *,, 403.3 ;HVAC piping conveying fluids above "'R R .. ❑Complies I Requirement will be met., [FR17]2 `105°F or chilled fluids below 55°F t ❑Does Not Comply;, i� tare insulated to R-3. ( t ❑Not Observable l • ;❑NoIA-pltcable 403A Circulating service hot water pipes are R- R- ;❑Complies ,Requirement will be met [FR18]2 :insulated to R-2. ❑Does Not Complyh ts: ! UNol Observable []Not Applicable . _ 403.5 Automatic or gravity dampers are i f❑Complies ;Requirement will be met. [FR19]z ;installed on all outdoor air intakes and i �01)oes Not Comply; exhausts. ❑Not Observable 1' ❑Not;Applicable 1. Additional Comments/Assumptions: 1 'High Impact(Tier 1) 12Fm,dium impact(Tier 2) 3 1 Low Impact(Tier3) Project Title: McCourt Residence-Gate House Report date: 04/23/13 Data filename: NRdk-andover2\Users\kscarborough\My Documents\REScheck\McCourt RESCheck.rck Page 5 of 8 20091ECC Insulation Inspection Plans Verified Field Verified Complies? Comments/Assumptions Value Value 303.1 All installed insulation is labeled or the. OComplies ;Requirement will be met. [IN13]2 `installed R-values provided. ❑Does Not Comply; tb ❑Not Observable ;[]Not Applicable 402.1.1, 'Floor insulation R-value. R- t R- ; Complies Seethe Envetnoe assemblies table for 402.2.5, t❑ Wood `❑ Wood ;❑Does Not Comply'values. [IN1]r 6 "❑ Steel +El steel I[]Not Observable p¢ ❑Not Applicable , 9 - t 303.2, ;Floor insulation Installed per 1 ❑Complies gRequirement will be met. 402.2.6 manufacturer's instructions,and in , 111Does Not ComplyE [IN2]1 substantial contact with the underside � + �• of the subfloor. ;❑Not Observable '[]Not Applicable j 402.1.1, Wall insulation R-value.if this is a R-. R- ❑Complies See the Envelope Assam fiNes table for 402.2.4, +mass wall with at least%2 of the wall ❑ Wood 4❑ Wood []Does Not Comply j values. 402.2.5 ;Insulation on the wall exterior,the ❑ Mass ❑ Mass ❑Nat Observable 'k [IN3]' lexterior Insulation requirement ;applies. ❑ Steel ❑ Steel []Not Applicable ,. 303.2 ;Wall insulation Is installed per ' 4[]Complies Requirement will be met. [IN4]' :manufacturer's instructions. aE]Does Not Comply, !,t i❑Not Observable ' i❑NotApplicabie, 402.2.11 `Sunroom wall insulation has a E R- ; R- ❑Complies �1Exce Exception:Requirement is not ; p q [IN8]' ;minimum R-value of R-13.New walls ]' ❑Does Not Comply;applicable. separating the sunroom from ;❑Not Observable conditioned space must meet code ❑Not Applicable 'requirements. 303.2 Sunroom wall insulation Installed per Compiles j Exception:Requirement is not [IN9]' ;manufacturer's Instructions. ':]Does Not Comply;applicable. l ❑Not Observable ::]Not Applicable t_.. ' 402.2.11 'Sunroom ceiling minimum insulation R- ; R ❑Complies Exception:Requirement Is not [IN10]' ;R-value of R-19 in Climate Zones 1-4,] ;; +❑Does Not Comply'applicable. i and R-24 in Climate Zones 5-8. ; []Not Observable t t t []Not Applicable Applicable ; 303.2 :Sunroom ceiling insulation is installed l ❑Complies 'Exception:Requirement is not a [IN11]1 ;per manufacturer'sinstructions. ❑Does Not Comply applicable. • ❑Not Observable ( + ❑Not Applicable t Additional Comments/Assumptions: 1 High Impact(Tier 1) _ 2 Medium Impact(Tier 2) 3 Law Impact(Tier 3j' Project Title: McCourt Residence-Gate House Report date: 04/23h 3 Data filename: \1Rdk-andover2\Users\kscarborough\My Documents\REScheck\McCourt RESCheck.rck' Page 6 of 8 20091ECC Final Inspection Provisions Plans Verified r Field Verified P Value Value Complies? Comments/Assumptions 402.1.1, 'Ceiling insulation R-value.Where>R-i R- R- i❑Complies ?See the Envelope Assemblies table for 402.2.1, 30 is required,R-30 can be used if P❑ Wood '❑ Wood []Does Not Comply:values. 402.2.2 insulation is not compressed at eaves.,❑ Steel +❑ Steel ❑Nat Observable ".. [FI1]' R-30 may be used for 500 It'or 20% F u (whichever is less)where sufficient f ❑Not Applicable F space is not available. r 303.1.1.1, Ceiling insulation installed per '[]Complies' ;Requirement will be met. 303.2 manufacturer's Instructions.Blown t❑Does Not Complyr [17121' insulation marked every 300 ft'. } 4 ❑Not Observable 0Not Applicable s 402.2.3 Attic access hatch and door insulation; R- i R- ❑Complies t Requirement will be met. [FI3]' R-value of the adjacent assembly. j. : '❑Does Not Comply ❑Not Observable l El Not Applicable. 402.4.2, Building envelope tightness verified ACH 50= ACH 50= .❑Complies 'Requirement will be met. 402.4.2.1 'by blower door test result of<7 ACH ❑Does Not Comply (Fi17]' ",at 50 Pa.This requirement may ❑Not Observable • ;instead be met via visual inspection, ] +in which case verification may need to v '[:]Not Applicable 4 occur during Insulation Inspection. 11d j S: 402.4.3 'Wood-buming fireplaces have ;❑Complies °Exception:Requirement is not IF1812 gasketed doors and outdoor 10Does Not Comply:applicable. combustion air. f❑Not Observable a' t i❑Not Applicable I 463.2.2 ,Post construction duct tightness test 1 cfm ; cfm `❑Complies ;Exception:All ducts and air handlers [FI4]' result of 8 cfm to outdoors,or 12 cfm r; ❑Does Not Comply are located within conditioned space. ,across systems.Or,rough-in test 1, } :❑Not Observable }, result of 6 cfm across systems or 4 , Icfm without air handler.Rough-in test ( ❑Not Applicable j ;verification may need to occur during `s Framing inspection, 403.1.1 ]Programmable thermostats installed (❑Complies s Exception:Requirement is not [Fig]2 Ion forced air furnaces. ±❑Does Not Comply,applicable. fEl Observable ❑Nol Applicable 403.1.2 Heat pump thermostat installed on ;QGomplies ;Requirement will be met. [F1101 #heat pumps. j❑Does Not Comply r ,❑Not Observable ] ;❑Not Applicable +. 403.4 "Circulating service hot water systems l ;❑Complles ;Requirement will be met. [F11112 E have automatic or accessible manual ❑Does Not Comply i. controls. .`, [:]Not Observable t ❑NotApplicable 403.9.1 Readily accessible switch on heaters l ;❑Complies Exception:Requirement is not IF11213 for swimming pools. , iOpoes Not Comply,applicable. + []Not Observable ;❑Not Applicable 403.9.2 .Timer switches on pool heaters and ! :❑Complies 'Exception:Requirement is not [FI1g]3 tpumps are present. YPP 'pDoes Not Com I is livable. 4 r P , ., ❑Not Observable f ❑NotApplicable 403.9.3 Heated swimming pools have a cover.} ❑Complies :Exception:Requirement is not [F[20]3 iCovers on pools heated over 90 OF ❑Does Not Complyfapplicable., are insulated to R-12. ❑Not Observable ❑NotApplicable_ 404.1 150`Yo of lamps in permanent fixtures (]Complies ;Requirement will be met. [FI6]' are high efficacy lamps. El Does Not Comply rl ❑Not Observable 1 • . ❑Not/Applicable A _ 1 High Impact(Tier 1) 2 Medium Impact(Tier 2)`. 3 -Ww Impact(Tier 3) Project Title:•McCourt Residence-Gate House Report date: 04/23/13 Data filename: \\Rdk-andover2\Users\kscarborough\My Documents\REScheck\McCourt RESCheck.rck Page 7 of 8 Fl . Inspection Provisions. Plans.Verified Field Verified 20091ECC Final Ins p Value Value Complies? Comments/Assumptions 401.3 ;Compliance certificate posted. i ❑Complies f Requirement will be met. [FI7J2 i❑Does Not Comply ❑Not Observable `e ❑Not Applicable. 303.3 Manufacturer manuals for mechanical ❑Complies Requirement will be mel (F118)3 and water heating equipment have { ❑Does Not Comply ,been provided. i ❑Not Observable .❑Nol Applicable Additional Comments/Assumptions: R ' • • t ... _ ... a . -J \ .x 1 Higti Impact.(Tier 1) ,2 Medium Impact(Tier 2) 3 'Low Impact(Tier.3)- Project Title: McCourt Residence-Gate House Report date: 04/23/13 Data filename:'URdk-andover2\Users\kscarborough\My Documents\REScheck\McCoult RESCheck.rck Page 8 of 8 2009 BECC Energy Efficiency Certificate LLMLD Wall 19.00 Floor 1 .. '. 30.00 Ceiling/Roof 30.00 a Ductwork(unconditioned spaces); Window 0.29 Door 0.29 - W _ Heating System: Cooling System: - Water Heater: Name: . Date: Comments: Jol f o Town of Barnstable .License and-Permit.Bond - Bond No..08BSBGM4646 KNOW ALL MEN BY THESE PRESENT,that we Kari,,h Vona onatruction, Inc.. of Waltham. "Massac'h s s as Principal and Hartford Casualty In, s an ompany , a corporation authorized under the laws of Indiana and°licensed to become surety on bonds and undertakings in the State of Massachusetts, as Surcty,'are held and firmly bound unto: T The Town bf Barnstable. Massachusetts ,Obligee,in the penal.sum of the United States for do llars.$1, o o o lawful money, o f -' One .Thousand , which payment, well, and tnily to be made, we bind ourselves, our heirs, executors,>administrators,successors and assigns,jointly and severally, firmly by these'pres eh. t WHEREAS,the.'said principal has anplied to the:Obligee for a license.or permit for/to :Road Permit for:Road Frontage work at 1411 Main Street Cotuit, MA x _NOW-,-.THEREFORE THE CONDITIONS.OF THE OBLIGATION IS SUCH, That if L, r the said Principal shall faithtully perform the duties of such licensee or permitee, and in all things comply with the ordinances, rules and regulations appertaining thereto, then this obligation.shall be voi`d;=otherwise to remain in full force and.effect. The term ofthis bond is for;the period beginning on the 18th day ofAeril , 2013 and ending on the lgth dayof April': 1.2014 -This bond may be terminated at anytime by the Surety upon sending notice in writing, by certi%fier( maii,'to the clerk of the municipality with whom this bond is filed and at.the expiration-of thirty(30)days from the mailing of said notice,the liability of such Surety; is thereby ieim r ated anil cancelled:..andprovide further, that nothing herein shall affect' any-60- Cr liab1litY which sba]l have occurred under this bond prior to the date of such termination: SIGNED, sealed and dated this 18th day Of April , 201 Hartford Casualty Insurance:>Companv Kenneth Vona Construction, Inc. Surety Principal Ellen :M. Dolan., Attorney In Fact r 4,_' r Direct 1nquWes1Claims.to: THE HARTFORD POWER OF AT O N5EY ..'One Ha�o d Plaza , a Hartford,Connecticut06155 ca/1:%888-266-3488 orfaxs860-757-5835) KNOW ALL PERSONS BY THESE PRESENTS THAT:: Agency Code: 08'• 08*0198 0 Hartford Fire Insurance Company,a corporation duly organized under the laws of'the State of Connecticut Hartford Casualty Insurance Company,a corporation duly organized under the laws ofahe State of Indiana Hartford Accident and Indemnity Company,•a;corporation duly organized under the laws of the State of Connecticut Hartford Underwriters Insurance Company,a corporation duly organized under the laws of the State of Connecticut x Twin City Fire.Insurance Company;a'corporation duly organized.under'the laws of the State'of Indiana':: Hartford Insurance Company of Illinois,a corporation duly organized under the laws of the State of Illinois 0 Hartford Insurance Company of the Midwest',a corporation duly organized under the laws of the State of Indiana sF Hartford Insurance Company of the Southeast,a corporation,duly organized under the laws of the State of Florida having their home office in Hartford, Connecticut(hereinafter;collectively referred to as the"Companies")do hereby make; constitute and appoint, up to the amount of UNLIMITED DONNA M. ROBIE,:, FRANK W. ENG.LAND,,.:FRANK J.. SMITH, ;. ELLEN J. YOUNG . , CHRISTINA D 'HICKEY, EILEEN M : RYAN, WILLIAM .J.. DOBBINS. JR. , ELLEN M.: DOLA7 CF. NATICK,.;`MASSACHUSETTS ,,. their,true and lawful Attorney(s)-in-Fact;each in their separate capacity if more than one is named'above,to sign its name as surety(ies)only as delineated above by®,and to execute,•seal and acknowledge any and all bonds,undertakings;contracts and other-written instruments in the nature thereof,on behalf of the Companies in their business of guaranteeing the.fidelity of persons;_guaranteeing the performance:of contracts and executing or guaranteeing bonds -and undertakings required or permitted in any actions or proceedings allowed by law.. fr In Witness Whereof, and as authorized by a.Resolution of the Board of Directors of the Companies on August 1, 2009;the Companies have caused these presents to be signed.by'itsyice.President and its:corporate,seals to•be hereto affixed„duly attested by its Assistant.Secretary. Further, pursuantto'Resolution of the Board of Directors of the Companies,the Companies hereby,unambiguously affirm that they are and will be bound by any . mechanically applied'signatures applied to this Power of Attorney.`: �. O t40o rIP If too if My,� ".,, a',Iw'•.�.{ - _ �. � � �a �tq.Tao• g r ' ,tu"'i�. .> �'•�mu �^ "'••�.,.. .- L i ;Wesley W:Cowling,Assistant Secretary M.'Ross Fisher, Vice President ` STATE OF CONNECTICUT x' Ss Hartford COUNTY OF HARTFORD On this 12th day of July,2012,.before me personally came M. Ross Fisher,to me known,who being by me duly sworn;did depose and say:that he resides in the County of Hartford;State of Connecticut;that he is the Vice President,of the Companies,the cor din and which executed the above in"sirurnent;,that he knor s;the^seal .of he said corporations that seals'affixed to the said`instrumenf are such corporate seals,:that theywere - y y. .9 y ty. v. so affixed b�authority of the.Boards of Directors of said corporationsand that si ned.his name thereto b like authori Kathleen T,Maynard +p; CERTIFICATE Notary Public , My Commission Expires July 31,2016 I,the undersigned,Vice Peesident,of the.Companies DO HEREBY CERTIFY that the above and foregoing is a true and correct copy of the Power. of Attorney,executed by said-Companies,which is still in full force,effective;as of. April 18 2013 - Signed and sealed;at the City of Hartford. w yyt \ Kfe,mr1� r�eiaM► 5�1D�0Jd' $ ��879jIr� �1i T914 ............tt+ y"b :iy1rr/.`�1 • agayLc�s , � yA v A� :• �.. ft[NOs. •bo,u� ' Gary W.Stumper,Vice President POA 2612 DATE(MMIDDIYYYY) TE OF LIABILITY CERTIFICATE LIABIL INSURANCE `,..� 4/18/2013 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 1NSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is.an ADDITIONAL INSURED,thepolicy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to . the terms and conditions of the policy,certain'policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - - - :CONTACT Construction NAME: Eastern Insurance Group LLC PHONE . (508)651-7700 FAX No: 233 West Centrel Street E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Natick MA 01760 INSURER A.Union Insurance Co INSURED - _ r INSURER B-Acadia Insurance Company 31325 Kenneth Vona. Construction Inc. INSURERCcStar .Indemnit .& Liability Co. - 11 Fox Road wsuliES D:EastGuard 14702 INSURER E Waltham MA 02451 INSURERF: - COVERAGES CERTIFICATE NUMBERMASTER 2012.5 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 ADDL SUER - POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence I $ 300,000 A CLAIMS-MADE OCCUR PA0296259-13 _ 7 /1/2012 /1/2013 MEDEXP(Any one person) $ 15,000. PERSONAL&ADV INJURY $ 1,000,000 �'s• GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE-LIMITAPPLIESPER: - PRODUCTS-COMP/OPAGG $ 2,000,000JECT . POLICY X PRO- - LOC $ AUTOMOBILE LIABILITY - - COMBINED SINGLE LIMIT ` Ea accident 1'000 000 B ANY AUTO '.' BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED 0300197-13 7/1/2012 7/1/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS . X HIRED AUTOS X NON-OWNED, PROPERTY DAMAGE AUTOS - - Per accident $ Medical payments $ X UMBRELLA LIAB •X OCCUR - EACH OCCURRENCE $. 10,000,000 `. EXCESS LIAB CLAIMS-MADE. - AGGREGATE - $ 10,000,000 DED RETENTION$ ISCCCL01841612 - /1/2012 /1/2013 $ D WORKERS COMPENSATION - - - X, WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N t- TORY LIMITS ER - ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCL � N/A E.L.EACH ACCIDENT $ 1,000,000 UDED? (Mandatory in NH) KEWC318878 10/4/2012 10/4/2013 E.L.DISEASE-EA EMPLOYE .$ 1,000,000 If yes,describe under - - DESCRIPTION OF OPERATIONS below- - E.L.DISEASE-.POLICY LIMIT $ 1,000,000 DESCRIPTION OF.OPERATIONS].LOCATIONS/VEHICLES.(Attach ACORD 101,:Additional Remarks Schedule,If more space Is required) RE: , SPECIFIC TO ROAD FRONTAGE AT 1411 MAIN.STREET — COTUIT, MA 02635 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE.EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF BARNSTABLE ACCORDANCE WITH THE POLICY PROVISIONS. 200 MAIN STREET HYANNIS, MA. 02601 AUTHORIZED REPRESENTATIVE - Rosemary Fulham/PMA ` ACORD 25(2010/05) ©1988-2010ACORD CORPORATION. All rights reserved. INS02517mnnssm Tha Arnon n2ma and Innn nra ranictaraAm2r4c of Ar^.r9Rr1 May. U 2013 11 :40AM NSTAR—SUMSW3 No. 4607 P. 2 ONSTAROne NSTAR Electric Gas Company NSTAR Way,Westwood,Massachusetts 021)90-9230 EL EC TRIO GAS May 8, 2013 Paul Grover 1411 Main St, Barnstable, Ma RE: 1411 Main St, Barnstable, Ma Dear Paul Grover: This letter will serve as confirmation that the electric service at 1411 Main St, Barnstable, Ma, has been removed as of 05/08113. Based on this information, there is no electric power to this building and you may proceed with the demolition. If you have any questions, please contact me at (888) 633-3797 Sincerely, ' �may.• ,,,�� � , Charmalne Fortes New Connections Office ' r CICIM NewTemplate + 05/25/2013 08: 40 508-428-7517 COTUIT WATER DEPT PAGE 01/01 ' yr fkL 'M �rt.ei1enrtn�eat c4rin•r FIRE DISTRICT�� 9 1924 4300 FALMOUTH ROAD, P.O. BOX 451 gyp'n.mLs COTUIT, MASS. 02635 PHONE 508-428-2687 FAX 508.428-7517 April 24, 2013 Jeffrey Nord., Esq, 72 Main Street, PO Sox 483 West Harwich,MA 02671 RED 1411. Main Strcet, Cotuit.MA—Acc#,0458 Dear. Attorney Ford, 'rhe water was turned off at the street;and the water meter, and materials ,Were removed from the meter pit outside the house loca.tcd at 14,11 Main Street. on 8/7/12. Sincerely, U) 4" t Chris Wiseman Superintendent ti nationalgrid May 21, 2013 Attn: Jeff Ford Re: 1411 Main St.. Cotuit, MA. This letter is to notify you that after our investigation it has been determined that there is no gas being supplied to 1411 Main St., Cotuit, MA. Diane Camar� Gas Customer Fulfillment US National Grid ............................................ .................... ....... ... ....... .............. ._........ . ...... ..................................................... ........................................ ............. .. ............_.............. . . __....... . ._ e t N. SBD NOMINEE TRUST ' LC CEP?T No. 159294 N/F 1411 MA/N STREET LLC LC CERT No. 19813300 392,19, FOVNDA PON ONL y co 127 8' ' N O � 221 .5 Pv o Z O LOT AREA / O � 1 f Ac.8 0 Nv 1Op ,pp, — OWNER: 1411 MAIN STREET LLC ASSESSORS MAP 17 PARCEL 10 . h _ 28 4 RUSHY MARSH FARM .2 6 TIFIED PLOT CER PLAN �`�. �yam_ ✓rM o MANzi #141=1-M-AINSTREET 273021169� _ GATE HOUSE i HEREBY CERTIFY THAT THE FOUNDATION IS IN . BARNSTABLE,- MA LOCATED AS SHOWN. H 0 1, (BARNSTABLE COUNTY) Z F .. �4 �' Sq = 1 ALE: 40 DATE: ti SC 11 10 2014 MICHAEL + A. a c� PUSTIZZI v, 0 40 80 120ft - --- ----- _, #46505 Precision Land Surveying, Inc. �FESS10Q- 32 Turnpike Road .•- �t_- - r, r, Southborough, Massachusetts 01772 `. "'" SURV IM NO.: (508) 460-1789 FAX NO.:(508) 970-0096 -MICHAEL PUSTIZZI, PLS DATE 429001.cP1.DWG ,t