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Home My WebLink About0000 SCHOOL STREET O CSC/?oo l �ti�c of �� w �� i I 1 I I I i 'I ,1 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ) 6 Parcel 6� Application� Health Division Date Issued 41 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Stjreept Address Village C. It Owner A -" Address Telephone Permit Request J l CPb Xj-;o —,)-v �1 3< 1/ 11 are feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning ict Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# -nits) _ Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ out ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq'ft) o _ -n Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including bath;): existing new First Floor Roo Count`1 r Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other .c Central Air: ❑Yes ❑ No Fireplaces: Existing New Existi wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn. existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use .Proposed Use. -- -- - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NamAH��LI� 7rr4V7___ Telephone Number JDi 'A Address A) �� License# A_ Home Improvement Contractor# 7 Worker's Compensation # Y'(� eJ4/dam � �' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO -s SIGNATURE DATE \ FOR OFFICIAL USE ONLY ( / .APPLICATION+ \ ~ °DATE ISSUED ^ MAR/P RCELNO. / $ ` ADDRESS VILLAGE OWNER ' [ . . { & DATE OF INSPECTION: / ® . FOUNDATION { , { . . > FRAME ( { INSULATION { FIREPLACE ELECTRICAL: ROUGH • -,FINAL / PLUMBING: ROUGH FINAL { GAS: ROUGH FINAL § FINAL BUILDING ` \ . & \ ( DATE CLOSED OUT . . ( : \ ASSOCIATION PLAN NO. - { I 'A 0 H CERTIFICATE OF LIABILITY INSURANCE DATE(MWOO1ffM0410412014 . `...� THIS.CERTIFICATE 19.ISSUED AS A MATTER OF INFORMATION ONLY AND.CONFERS NO RIGHT'S UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR,NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BEL . THIS CERTIFICATE P INSURANCE T ONSTITUTE A CT BETWEEN THE ISSUING INS RER S AUTHORIZED OYV O RANCE DOES NO "C CONTRA ETWEE .0 ., REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT-If the certificate holder is an ADDITIONAL INSURED,the pollcy(ies)must Oe endorsed. dISUBROGATION IS WANED,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 Deu of such'eridorsemeng-S). p PRODUCER 06082_001 NAME: DPS"Insurance Group Inc ;•(617)47MSW N,; (617)479-8761 SW Granite Ave Suite 3 ass: Milton,MA 62186 1NSURE8MQEQ=NG=ffl80AE A.I.M.Mutliaf Insurance Company 26158 INSURER B: pasuREo American Tent&Table tnc 'INSURER C P 0 Banc 1548 Maiishm Mills,MA•02648 INSURER F COVERAGE$ CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S.TO CERTIFY THAT THE POLICES'OF INSURANCE.iltIIED BELOW HAVE BEEN ISSUED 101HE INSOREDNAMED ABOVE FOR THE POUCY PERIOD. INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR.CONDMON OF ANY CONTRACTOR OTHER'DoWMENT 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 REDUCEDBY PAID CLAIMS. TYPE OP INSURANCE WWI , Pot ICY NUII�ER umrrS GENERAI.LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DANINC&TO RENTED $ CLAIIASMADE' OCCUR M90 Da'(A!y&i DeisM). S. PERSONAL,ACIV INJURY 'S , GENERAL AGGREGATt $ . GEISMAGM43ATELIMITAPPLIESPiER: PRODUCTS-COMPIQPAGG S ". .. CY 171RA OC AUTCMOB&ELIAr>= COMBINED SINGLE LIMIT $ ANYAUTt7 BODaYWJURY(1!&P—) S b EP BOULEP BODILY INJURY(PeF apddw) $ HIRED AUTOS AwDWHED- PR PERTYDAMAGE S UWIRELLA U WHCMR*MAM OCCUR EACH OCCURRENCE t MWESSLIM AGGREGATE S DIED RETHITION$ S jA E.L.EACH ACccew s _100;000.00 A N NtA AW0 400 7026128-2014A 415)2014 4 4*015 Qbnmatwy Io.Ntq E.L DISEASE-EA UIPLOYEE $" 100,000 00 PERATIONSbelow E..LDISEASE••POLICY LIMIT $ 500,000m DESCRIPTION OPERATIONS/LOCATION$/VENCLES(AtraeA AC(M 101,Addidabai Remarks Seheduk B mcm3paee M a : CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF.THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 114 ACCORDANCE WRH THE POLICY PROVISIONS. Atrh O ED REPRESENTATIVE 01988.2010 ACORD CORPORATION:All rights reserved: ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Barnstable The Town of Barnstable Office of the Town Manager IF 367 Main Street,Hyannis MA 02601 04medoCill =^BPJWSrABLE, = www.town.barnstable.ma us Office: 508-8624610 Fax: 508-790-6226KAM �• E a•0� APPLICATION FORM 2007 USE OF PROPERTY,PARADES,MARATHONS,TRIATHLONS,ROAD RACES The approved application must be on file in the Town Manager's Office at least thirty(30)days prior to event. ParadefRoad Race applicjktious must be received nine 90 days prior to scheduled date. Date of application: r!Ll J?5(p Fee amount: $43.00 per request :Total paid: YES ck# OR cash) NO *Each request means each event such as a parade,followed by an event on the Town Green,for example. This application must be complete/all signatures prior to submitting to the Town Manager for final approval. You may be required to leave application at various Departments'to wait for appropriate signature. 1. CALL TOWN MANAGER'S OFFICE TO TENTATIVELY RESERVE DATE OF EVENT-CHECK AVAILABILITY Request for: Hyannis Village Green Aselton Park Parade Benefit Run/Walk Marathon/Triathlon__ `�Other(pleaee specify); Certain facilities may require additional.fees for services by DPW depending on location,use of staff 8,sizTIf event. The fees will be determined by DPW and paid directly to that department. 2. Name of Event: ETA Day/Date of Event:SU : �/_7,,%Z. 1 Rain date: 7 /3• /K 3. Name of Sponsoring Organization:_ L- -{ LtG% �ti� e�C�f�s u Q.u�+�,� Mailing and physical address: CA a 4. Contact perso � —c/,.e7c � �l/cr, /,�y Phone: �L'g ! ZLzz—X 5. Person in charge DAY OF EVENT: rs74,m,-ce,( Cell phone: -426—q-7X 6. Set up time: a.,. Actual event start and end time:%w s Clean up time:5- 7. Estimated number of volunteerstparticipants: � Estimated number of spectators: >>POLICE DEPT will determine if extra detail necessary. 8. Admission fee/registration charged to participants?_1/_No If yes: Amount: Will there be food or craft vendors at event? Yes No >>If yes,indicate the number of vendors and type(food/merchandise/etc): »Will+there be merchandise avail le for sale? Yes No N/A Vendors need to complete application for special licenses at the Licensing Division-200 Main Street,Hyannis. 9. Map attached(REQUIRED)for road race/parade event.' >>Are street closures required: Yes No >>Detail of route and rest stops attached/indicated on map. 10. Food prepared/served at event? V Yes No >>If yes,will there be cookingtheating involved?jYes No , CENTS.STRUCTURES.ENTERTAINMENT DEVICES*Attach map for layout of event including structure placement TENTS REQUIRE ADDITIONAL PERMIT FROM BLDG DEPT. Structures&Grounds have designated tent friendly zones. Should you require tent elsewhere other than these zones,location needs to first be cleared with Structures&Grounds. >>No open flames in tents or propane storage use without a fire permit. 11. Are you installing or constructing any structures,including buildings,climbing structures,etc? _Yes -k1N0 12. Are you installing any tents or canopies? —ZYes No 2C)25 - Quantity and size:46 )Own or rent??/w. "Rental compan aG(il. 13. Do you plan to have any sound amplification? ZYes No Music _Other(please describe) 14. Is electrical power required? Yes No (for sound amplification(PA system),lighting,popcorn machine,etc) >>If yes,circle: will you provide portable generator? OR will you require TTOB temporary service? � y. >>List maximum wattage required and location for hook-up: If more than'usual hookups,please note there will be overtime costs if Town Electrician setting up and removing "A-frame"or dropping service before/after event outside of business hours. CONES.BARRIERS. 15.Do you have need for barricades/cones? Yes No >>If yes,describe for what use: / &,,— 47 E,nL'i Lza u � DEPOSITS: $5.00 each cone. $50.00 ac rric s(quantities/deposits arranged through DPW). 16.Will you require access to the town building? Yes _ No >>If yes,describe for what use: VEHICLES 17.Do you plan to drive vehicles onto property? If yes,provide details: Specific loading zones to be reviewed with DPW/Structures&Grounds. �' o fr' , Organization will be liable for any damages vehicles may cause the ground. COMFORT STATIONS. PORTABLE TOILETS AND HAND WASHING SINKS 18. Do you plan to provide portable toilets and/or hand washing sinks at your event? Yes No »If yes:fflF1 #of regular toilets _/_#of handicap accessible toilets ___Z _#of hand washing sinks Public Comfort Stations located at Town Hall Parking Lot,North Street and Barnstable Village Fire Station are open from 9AM to 9PM,daily. If event absolutely requires early open,it must be reviewed with DPW. GARBAGE AND RECYCLING SERVICES 19. Trash pickup is the responsibility of the organization requesting this permit. Please provide your plan for the cleanup and removal of garbage and recyclables during and after your event: �� Number of recyclinggcontainers: 2— Number of garbage receptacles: 5 A one time disposal fee for use of Town containers may be assessed. Any fee will be.determined and collected by DPW. The cost is based on size of event. SECURITY/SAFETY 20.Will there be demos,displays,materials that are potentially hazardous/impact public safety?_Yes No >>If yes,describe: 21.Have you made any provision for on-site security? _Yes o 22.Have you made an provision for on-site medical services? Yes Ao PARKING 23.Please provide description of your parking plans(where event attendees vAl park): 4 »Plans for disabled parking: ¢ , 2 -u,-i•,a�_- .- -r.G..ti� >>Plan for emergency vehicle access: »Please describe your plans to notify residents,businesses impacted by this event: SIGNS/ADVERTISrNTG 24.Will the event be advertised? If yes,where: >>Do you plan to distribute flyers or ads before or du Mg this event? _ Yes No >>Do you plan to place any signs or banners or other advertisement at the event site? Yes No >>If yes,please indicate where: ft _i2 i7vr� �I-� It-7 >>Provide sign/banner detail ano dimensions and method of attachment or support: I (Signage may require additional permits). I have read, understand and agree to abide by each numbered item on the attached"Rules and Regulations for Use of Village Green and other Town Property" H "Rules and Regulations for Parades, Walkathons, Road Races" and as the agent for the sponsoring organization, agree to abide by said rules and any oth specia_44l conditions etters may�be attached) established for this particular event. i ature of sponsoring agent/Date Printed Name: leyolugt—j i " o—rge4— APPROVED B CHIEF OF POLICE DATE: (Barnstable Police Dep ent, 1 0 hinn 's Lane,Hyan ' 08-778-3805) CHIEF OF,FIRE DEFT( _ _ DATE (Village Fire Department,A resses vary) RECREATION T DATE: b✓ (Hyannis Youth&Commu ' ente t e H annis 508-790-6345) PUBLIC WORKS DATE: ��--2,o ii/ (382 Falmouth Rd.H ni 08-7 -640 ) ' REGULATORY SERVICES - .e_. DATE: (200 Main Street,Hyannis508-862-4j674) BOARD OF HEALTH 1`� l ' V� Y' DATE: (N/A for Parade/Race permits unless serving food.508-862-4644) BUILDING DEPT � 8&,A fa DATE: Z O (N/A for Parade/Race �permits suunless erecting tents. 508-8624038) TOWN MANAGER DATE: (Town Hall,367 Main Street,jnI floor,Hyan ' 508-862-4610) SPECIAL CONDITIONS and ANY FEES(As determined by Department's above) DETAILED AS FOLLOWS: .�^ �T The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Prmt Legibly Name(Business/Organization/Indiyidual): '��'�y� Address: _i City/State/Zip Phone#:6ZY /�7 v Are you n employer?Check the appropriate.box: 1• am a employer with 4. ❑ I am a general contractor and I Type of project(required): employees(full and/or part-time).* have hired the sub-contractors 6• El New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 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 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I L Plumbing re myself. ❑ g pairs or additions y [No workers'comp. �right of exemption per MGL 12.❑ f repairs insurance required.]t c. 152,§1(4),and we have no' employees. [No workers' 13.�er MA S 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-cdntractors 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 ft the policy and job site information. . Insurance Company Name Policy#or Self-ins.Lic.#: d/ Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'co ensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of " Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si atur Date: d Phone#: — - � Official use only. Do not write hi 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#• .i e i Ica a 'o ame � esis ancePAGE: 1 . Date Manufactured AZTEC TENTS 12/17/2010 2663 COLUMBIA ST INV NUMBER: 0184178 7 s TORRANCE,CA 90503 P.O. NUMBER: " (800) 228-3687 CUSTOMER NO: AMER026 ..kN This is to certify that the materials described below have been flame reta treated(or are Inherently fl rdant y} ame retardant)'. e a AMERICAN TENT&TABLE INC. 8n^^ ^ _•:::.a ; P.O. BOX 1348 pm- Marston Mills, MA 02648 i Ge3Yaw1 af70Qa ` ON GerN�lOgal F-591.01 &Outwa,p Imp gMY'•.:l9n ta.e. F-a1a01 :?+5•• (. II eltM aKanVlMt Sot ws..01 - ,, � +a AOWN din!J02 F-M.oa X: ; gyp,tl.aiH Rf1MT.R li.tl� , .r.' �' F lh Sayap we�.aersPY. F-140.01 < 3 Certification is hereby made that the articles described below hereof are made y y m iN vaaeape Pura Soo •i 2i-0S SK;from a flame-retardant fabric or material registered and approvedY b the "°'"°0` %v*ao =•121.,C 1Y vanage we7lcn F•oW.01 L'.4.:A Y � California State Fire Marshal for such use.The fabric has been tested and ...,g! t . passes NFPA 701 Large Scale.See chart to',right for trade name of flame-resistant fabric or material used and additionally referenced on the label j of the fabric panel, .. THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING k3' David Brad i� lr General Manager-Manufacturing v Name of Applicator or Production Superintendent Tdle of A �•• i pplicator or Production Superintendent C r`14�,. tom -{♦, i. � }1 ♦t+, ,(t!�. } ) j. N( ,!} 2. � ��.'. ��,i,'.YF'' ":�:'Y�,:� ��(t ..��f3.mow ldE't�Yi't��.1!'v.•�^.'Fy�'�t.� A. s� l., ITEMS MANUFACTURED Ip TYPE PRODUCED 30x30 2pc Std Top Only UW ATC Style Clasp S 2(� 20x20 2pc Std Top Only UW I S 2 ATC Style Clasp Stock Ws 6957,6958 20x20 1pc Top Only UW I S 2 Stock #'s 6947,6948 20x10 Std Middle Top Only UW S 3 ATC Style Clasp Stock#'s 6502.6503, 6504 30x10 Std Middle Top Only UW �� S 3 ATC Style Clasp _ 15x15 2pc Std Top Only UW S 1 ATC Style Clasp 15x15 Std Middle Top Only UW S i ATC Style Clasp 10x10 2pc Std..Top Only UW 1� S 2 ATC Stye Clasp I0x10 Std Middle Top Only UW � g - 2 ATC Style Clasp 3000 2pc Series 1200 Top UW S 1 w/New-Plates&#2 Grommets iII 18 I" -- Ottific"6 o a___m- e-- Re a n cePAGE: 1 Date Manufactured AZTEC TENTS 2665 COLUMBIA ST INV NUMBER: 0181366' 06/22/2010 TORRANCE,CA 90503 P.O.-NUMBER: l , (800) 228-3687 CUSTOMER NO: AMER026 This is to certify that the materials described below have been flame retardant treated (or are inherently flame retardant). MIn `r f •+lbq ks b Bruln Mesh F222.04 AMERICAN TENT&TABLE INC. C2liftrMa Come. talm 12,14,16,1em F-419.01 i P.O. BOX 1348 Coated Fae„6 Clear Vnryl 16ge/20ga F-570.02 '1 DAF Clear Vinyl 16ga/20ga F593.01 381 OLD FALMOUTH ROAD UNIT 41 '1 G 'i I r DAF OAF F593.02 i.: �' Exdush,ely Hlpo Pol ySatee U.. F-434.01 Marstons Mills, MA 02648 � h� Fema„ Frecontaint 502 F-444.01 Fama„ PR [mint 702 F-444.08 j Phillips T.Mies R„I-T Uner F-500.01 l$G` PVC Tech. Deco Cloth/Velon F504.01 • E - Snyder - Weatherspan F-140.01 — E - Th Vantage Fneslst Sun"la F-368.05 I Certification is hereby made that the articles described below hereof are made T„Vantage Patio 500 F-121.02 ' TO Vantage Big Top F-121.10t : from a flame-retardant fabric or material registered and approved by the TA Vantage lVanguard Wealun F-059.01 California State Fire Marshal for such use.The fabric has been tested and TnVam,, I.M./C Ine F-069.01 passes NFPA 701 Large Scale. See chart to right for trade name of Verseldag IDuraskin B1673,81515 F-530.01 flame-resistant fabric or material used and additionally referenced on the label of the fabric panel. , THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager-Manufacturing ,a Name of Applicator or Production Superintendent Title of Appligtor or Producton Superintendent ITEMS MANUFACTURED TYPE PRODUCED 20x5 Std Middle Top Only UW S 1 ATC Style Clasp 30x5 Std Middle Top Only UW S 1 ATC Style Clasp *2732 + t �a The Town ®f Barnstable Barnstable Tp ?�oF THE Office of the Town Manager IF 367 Main Street,Hyannis MA 02601 BARN ABwww.town.barnstable.ma.us Office: 508-862-4610 Fax: 508-790-6226 �• 77�,,, 1'16jig. a � APPLICATION FORM rEn � USE OF PROPERTY,PARADES,MARATHONS,TRIATHLONS,ROAD RACES 2007 The approved application must be on file in the Town Manager's Office at least thirty(30)days prior to event. Parade/Road Race applications must be received nine 90 days prior to scheduled date. Date of application: Fee amount: $43.00 per request*:Total paid: YES(ck# OR cash) NO *Each request means each event such as a parade,followed by an event on the Town Green,for example. This application must be complete/all signatures prior to submitting to the Town Manager for final approval. You may be required to leave application at various Departments'to wait for appropriate signature. 1. CALL TOWN MANAGER'S OFFICE TO TENTATIVELY RESERVE DATE OF EVENT-CHECK AVAILABILITY Request for: Hyannis Village Green Aselton Park Parade Benefit Run/Walk Marathon/TriathlonOther(please specify): a-pt Certain facilities may require additional fees for services by DPW depending on location,use of staff&size if event. The fees will be determined by DPW and paid directly to that department. 2. Name of Event: ��-� JJ�� Day/Date of Event: n ,, ? /Z /� Rain date: / 7 ,/3. 1�4 3. Name of Sponsoring Organization:_ Mailing and physical address: 747 4. Contact persoif Qfi�c� � ,p�/n Phone: 5. Person in charge DAY OF EVENT:�l"/.� ,&e* c� Cell phone: —47�5 —q-2 F`— 6. Set up time: 7 Ct,,-,.. Actual event start and end time: 10-*� 157,07, Clean up timer 7. Estimated number of volunteers/participants: Estimated number of spectators: >>POLICE DEPT will determine if extra detail necessary. 8. Admission fee/registration charged to participants?j/_No If yes: Amount: Will there be food or craft vendors at event? /Yes No »If yes,indicate the number of vendors and type(food/merchandise/etc): >>Will there be merchandise avai a le for sale? Yes No N/A Vendors need to complete application for special licenses at the Licensing Division-200 Main Street,Hyannis. 9. Map attached(REQUIRED)for road race/parade event. >>Are street closures required: Yes —k—INo >>Detail of route and rest stops attached/indicated on map. 10. Food prepared/served at event? V Yes _No >>If yes,will there be cooking/heating involved? Yes No TENTS.STRUCTURES.ENTERTAINMENT DEVICES*Attach map for layout of event including structure placement TENTS REQUIRE ADDITIONAL PERMIT FROM BLDG DEPT. Structures&Grounds have designated tent friendly zones. Should you require tent elsewhere other than these zones,location needs to first be cleared with Structures&Grounds. >>No open flames in tents or propane storage use without a fire permit. 11. Are you installing or-constructing any structures,including buildings,climbing structures,etc? Yes _kl No 12. Are you installing any tents or canopies? ZYes No ie3s Quantity and size: )Own or rent Rental company f'k�il. /di, Tel# 13. Do you plan to have any sound //amplification? zVes_No_Music _Other(please describe) 14. Is electrical power required? Yes No (for sound amplification(PA system),lighting,popcorn machine,etc) >>If yes,circle: will you provide portable generator? OR will you require TOB temporary service? >>List maximum wattage required and location for hook-up: If more than'usual'hookups,please note there will be overtime costs if Town Electrician setting up and removing "A-frame"or dropping service before/after event outside of business hours. CONES.BARRIERS. 15.Do you have need for barricades/cones? Yes No >>If yes,describe for what use: e�-dt�? l ,B- 47 Gv � DEPOSITS: $5.00 each cone. $50.00 ac arrica s(quantities/deposits arranged through DPW). 16.Will you require access to the town building? Yes _IZNo >>If yes,describe for what use: VEHICLES 17.Do you plan to drive vehicles onto property? If yes,provide details: �� Specific loading zones to be reviewed with DPW/Structures&Grounds. Organization will be liable for any damages vehicles.may cause the ground. COMFORT STATIONS. PORTABLE TOILETS AND HAND WASHING SINKS 18. Do you plan to provide portable toilets and/or hand washing sinks at your event? jYes No »If yes:A0#of regular toilets __,L#of handicap accessible toilets �_#of hand washing sinks Public Comfort Stations located at Town Hall Parking Lot, North Street and Barnstable Village Fire Station are open from 9AM to 9PM,daily. If event absolutely requires early open,it must be reviewed with DPW. GARBAGE AND RECYCLING SERVICES 19. Trash pickup is the responsibility of the organization requesting this permit. Please provide your plan for the cleanup and removal of garbage and recyclables during and after your event: Number of recycling containers:2_ Number of garbage receptacles:__:— r A one time disposal fee for use of Town containers may be assessed. Any fee will be_determined and collected by DPW. The cost is based on size of event. SECURITY/SAFETY 20. Will there be demos,displays,materials that are potentially hazardous/impact public safety?_Yes No >>If yes,describe: 21.Have you made any provision for on-site security? _Yes Ao 22.Have you made any provision for on-site medical services? Yes Vio PARKING G�-G 23.Please provide description of your parking plans(where event attendees wil park):.D Gz� V >>Plans for disabled parking: IJ/2�✓ �- �� >>Plan for emergency vehicle access: >>Please describe your plans to notify residents,businesses impacted by this event: SIGNS/ADVERTISING 24.Will the event be advertised? If yes,where: >>Do you plan to distribute flyers or ads before or du Mg this event? _1�Yes No >>Do you plan to place any signs or banners or other advertisement at the event site? Yes No l >>If yes,please indicate where: Gt-7'L �-'!X— c. >>Provide sign/banner detail and dimensions and method of attachment or support: F F/ (Signage may require additional permits). I,have read, understand and agree to abide by each numbered item on the attached "Rules and Regulations for Use of.Village Green and other Town Property // "Rules and Regulations for Parades, Walkathons, Road Races" and as.the agent for the sponsoring organization, agree to abide by said rules and any oft special conditions (letters may be attached) established for this particular event. , i nature of sponsoring agent/Date Printed Name: ��► r� l c� r-�e./� APPROVED BY: CHIEF OF POLICE DATE: (Barnstable Police Department, 1200 Phinney's Lane,Hyannis 508-778-3805) CHIEF OF FIRE DEPT(S) DATE: (Village Fire Department,Addresses vary) RECREATION DATE: (Hyannis Youth&Community Center, 141 Basset Lane,Hyannis 508-790-6345) PUBLIC WORKS DATE: (382 Falmouth Rd.Hyannis 508-790-6400) REGULATORY SERVICES DATE: (200 Main Street,Hyannis 508-862-46714) BOARD OF HEALTH L' I�r`►r I DATE: " "-I j (N/A for Parade/Race permits unless serving food. 508-862-4644) BUILDING DEPT )J a-,)A ol, DATE: (N/A for Parade/Race permits unless erecting tents. 508-862-4038) TOWN MANAGER DATE: (Town Hall,367 Main Street,2"d floor,Hyannis 508-862-4610) SPECIAL CONDITIONS and ANY FEES(As determined by Department's above) DETAILED AS FOLLOWS: I /C4 liry • SHier The Town ®f Barnstable Barnstable okti - H�P o„ Office of the Town Manager F 367 Main Street, Hyannis MA 02601 a9 Nnm1lcat�tlr BARNSrABLE, : www.town.barnstable.ma.us Office: 508-8624610 Fax: 508-790-6226 9�ATE MASS. � 8' APPLICATION FORM 2007 USE OF PROPERTY,PARADES,MARATHONS,TRIATHLONS,ROAD RACES. The approved application must be on file in the Town Manager's Office at least thirty(30)days prior to event. Parade/Road Race applications must be received nine 90 days prior to scheduled date. Date of application: Fee amount: $43.00 per request*:Total paid: YES(ck# OR cash) NO *Each request means each event such as a parade,followed by an event on the Town Green,for example. This application must be complete/all signatures prior to submitting to the Town Manager for final approval. You may be required to leave application at various Departments'to wait for appropriate signature. 1. CALL TOWN MANAGER'S OFFICE TO TENTATIVELY RESERVE DATE OF EVENT-CHECK AVAILABILITY Request for: Hyannis Village Green Aselton Park Parade Benefit Run/Walk Marathon/Triathlon Other(please specify): CCl*'-Y 17 V/Ll1?40: Certain facilities may require additional fees for services by DPW depending on location,use of staff&size of . event. The fees will be determined by DPW and paid directly to that department. 2. Name of Event: C '/�FT��ST C.—l 4, 17 Day/Date of Event: Rain date: /-/C3 3. Name of Sponsoring Organization: C C- 74,1 T "e"aeX,9 y-ro L'f�Li/lcf7 Mailing and physical address: I'O OCR)e 'f 3/ l. 41—a 4. Contact person: /inn lee- `I A"�eit Phone: 5. Person in charge DAY OF EVENT: Ac- 7 eW oCG nX/t Cell phone: 2-7,1- 6. Setup time:`'"'c•c A'�-1 Actual event start and end time: Clean up time: 7. Estimated number of volunteers/participants: / c Estimated number of spectators: %4 t, s >>POLICE DEPT will determine if extra detail necessary. 8. Admission fee/registration charged to participants? No If yes: Amount: Will there be food or craft vendors at event? i/Yes No >>If yes,indicate the number of vendors and type(food/merchandise/etc): >>Will there be merchandise available for sale? x Yes No N/A Vendors need to complete application for special licenses at the Licensing Division-200 Main Street,Hyannis. 9. Map attached(REQUIRED)for road race/parade event. >>Are street closures required: Yes X No >>Detail of route and rest stops attached/indicated on map. 10. Food prepared/served at event? �Yes _No w/ >>If yes,will there be cooking/heating involved? Yes No Nam'.T Tq< G�< . a TENTS.STRUCTURES.ENTERTAINMENT DEVICES*Attach map for layout of event including structure placement TENTS REQUIRE ADDITIONAL PERMIT FROM BLDG DEPT. Structures&Grounds have designated tent friendly zones. Should you require tent elsewhere other than these zones,location needs to first be cleared with Structures&Grounds. —No open flames in tents or propane storage use without a fire permit. 11. Are you installing or constructing any structures,including buildings,climbing structures,etc? _Yes No 12. Are you installing any tents or canopies? Yes No Quantity and size: Own or rent? Rental company: Tel# 13. Do you plan to have any sound amplification?._Yes No Music _Other(please describe) 14. Is electrical power required? _Yes No (for sound amplification(PA system),lighting,popcorn machine,etc) >>If yes,circle: will you provide portable generator? OR will you require TOB temporary service? >>List maximum wattage required and location for hook-up: If more than'usual'hookups,please note there will be overtime costs if Town Electrician setting up and removing "A-frame"or dropping service before/after event outside of business hours. CONES.BARRIERS. 15.Do you have need for barricades/cones? Yes _�,-No >>If yes,describe for what use: DEPOSITS: $5.00 each cone. $50.00 each/barricades(quantities/deposits arranged through DPW). 16.Will you require access to the town building? Yes No >>If yes,describe for what use: VEHICLES 17.Do you plan to drive vehicles onto property? If yes,provide details: 1\16' Specific loading zones to be reviewed with DPW/Structures&Grounds. Organization will be liable for any damages vehicles may cause the ground. COMFORT STATIONS. PORTABLE TOILETS AND HAND WASHING SINKS 18. Do you plan to provide portable toilets and/or hand washing sinks at your event? Yes No >>If yes: ? #of regular toilets #of handicap accessible toilets �` #of hand washing sinks Public Comfort Stations located at Town Hall Parking Lot,North Street and Barnstable Village Fire Station are open from 9AM to 9PM,daily. If event absolutely requires early open,it must be reviewed with DPW. GARBAGE AND RECYCLING SERVICES 19. Trash pickup is the responsibility of the organization requesting this permit. Please provide your plan for the cleanup and removal of garbage and recyclables during and after your event: V' ✓lR/%e5 Number of recycling containers: Number of garbage receptacles:_ A one time disposal fee for use of Town containers may be assessed. Any fee will be determined and collected by DPW. The cost is based on size of event. SECURITY/SAFETY 20. Will there be demos,displays,materials that are potentially hazardous/impact public safety?_Yes_k,No >>If yes,describe: . 21.Have you made any provision for on-site security? Yes No 22.Have you made any provision for on-site medical services? Yes No X PARKING 23.Please provide description of your parking plans(where event attendees will park): Z aw41e ,�%dx K >>Plans for disabled parking: 1:�-12e u f Gr GN4,rC1/ 4 >>Plan for emergency vehicle access; S >>Please describe your plans to notify residents,businesses impacted by this.event: Si��/S ADS SIGNS/ADVERTISING 24.Will the event be advertised? If yes,where: 9`?�G /✓�+v� >>Do you plan to distribute flyers or ads before or during this event? _ Yes No >>Do you plan to place any signs or banners or other advertisement at the event site? 'Yes No >>If yes,please indicate where: nt) C/1-e- -,4y >>Provide sign/banner detail and dimensions and method of attachment or support: 0 CR 4A (Signage may require additional permits). I have read, understand and agree to abide by each numbered item on the attached"Rules and Regulations for Use of Village Green and other Town Property" // "Rules and Regulations for Parades, Walkathons, Road Races" and as the agent for the sponsoring organization, agree to abide by said rules and any other spec'al nditioris Jett rs may be attached) established for this particular event. � 7��f� Signature of sponsoring agent/Date Printed Name: f/ ey APPROVED BY: CHIEF OF POLICE DATE: (Barnstable Police Department, 1200 Phinney's Lane,Hyannis 508-778-3805) CHIEF OF FIRE DEPT(S) DATE: (Village Fire Department,Addresses vary) RECREATION DATE: (Hyannis Youth&Community Center, 141 Basset Lane,Hyannis 508-790-6345) PUBLIC WORKS DATE: (382 Falmouth Rd.Hyannis 508-790-6400) REGULATORY SERVICES C�-�-� DATE: I (200 Main Street,Hyannis 508-862-467.4)) —7 BOARD OF HEALTH t/k(V i yi DATE: 1 I (N/A for Parade/Race permits unless serving food.508-862-4644) 1 BUILDING DEPT :Z 6-a4 17-,}'a__ DATE: J! 7 V (N/A for Parade/Race permits unless erecting tents. 508-862-4038) TOWN MANAGER DATE: (Town Hall,367 Main Street,2"d floor,Hyannis 508-862-4610) SPECIAL CONDITIONS and ANY FEES(As determined by Department's above) DETAILED AS FOLLOWS: i 5 Sick -Prom o der`s b Cei)y i mu.5f-�=i I,e a pp I co-$ ov) r DVS C� n vLf Li Le�� L�C�v�St� t. 0 rrt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Appli1# Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ®r- Historic - OKH _ Preservation/ Hyannis Project Street Address oiq Village 6-0-ry I Owner ` 71-b 0 /Q � � ��AL��l�� Address-�� &A) Telephone ✓ �� 7 Permit Request &/JT'S Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning 'strict k, Flood Plain Groundwater Overlay Project Valuati Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. 0 Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) C? Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: sy4 s ❑ Np Basement Type: ❑ Full ❑ Crawl ❑ out ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) ? Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existi wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ' Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ahi ir_Z4 0," �J i�3'�61k, Telephone Number Address �� lG License # l� ST�1�s. /LDS rJf� Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO_!!�104= SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# c DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER _ y DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL , FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusej& Departnt of IndusbUlAccidents ,Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance'kffidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letibly Name(Business/orpniradonandividual): Address: Y City/State/Zip: f7.445?— los /1/4-1—S 1 t7vf hone 301.1® •off-/S Are you an employer?Check the appropriate bog: T of ro'ect 1.❑i�I am a employer with .D 4• ❑ I am a general contractor and I P ! ( 1 )= employees(full and/or part time).* Have hived the sub-contractors employees ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling all ship and have no employees These sub-contractors have i,i S. ❑Demolition working for me in any capacity. employees and have workers' 9. Building addition lu (No workers'comp.insurance ;,; insurance.:omp.insurance.: required] 5. ❑ ,Ve are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1113Plumbing repairs or additions myself.[No workers'comp. of exemption per MGL 12.❑Roof repairs urance ins required.]t c. 152,§1(4),and we have no mployees.(No workers' 13.�er �/ S - comp.insurance required.] +Any applicant that cheeks box#1 must also fill out the,section below showing thezr workers'c ompe�tion policy information. Homeowners who submit this affidavit indicating they are doing', l work and then hire outside contractors must submit a new affidavit indicating such. tContractors that cheek this box must athachpd an additional sheet;showing the narne of the subcontractors and state whether or not those entities have employees. If the sub-contractors have employees,they must 'Imo;',,vole their workers'comp.policy number. I am an employer that is providing workers compensation insurance for ray employees Below in thepoliey and job site information. Insurance Company Name: —AT#. 1107—l},0C., //ySV1eR A) 1 Policy#or Self-ins.Lic.#:h w e—.-Y,00— 70 a Z / ; g -a V j 3 A Expiration Date: — —/ Job Site Address: City/State/Zip: �A� - Attach a copy of the workers'compensation policy declaratio a(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can 1,ead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,is well as civil penalties M" 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 verLfication. I do her a under the eby p and enalties ofperjury that the information provided above is true and correct Si e: :?I Dater -/ f2 Phone#: Offw d use only. Do not write in this area,to be completed by city or town gjj`ieiaL {II - City or Town: PermiVUeense# 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 CERTIFICATE OF LIABILITY INSURANCE I 04111/2013 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 INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONALJNSURED,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 06082-001 CONTACT NAME: DPS Insurance Group,Inc. PHONN.En: (617)479-6600 Fes.No.: (617)479$761 500 Granite Ave. EMAIL Suite 3 ADDRESS: Milton,MA 02186 RER S F NAIC# INSURER • A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: American Tent&Table Inc INSURER P 0 Box 1348 Marstons Mills,MA 02648 : INSURER E e COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED B�YpPAID CLAIMS. �IeTSRR TYPE OF INSURANCE AD W VD POLICY NUMBER MM/DDIY A 411r w LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIALGENERALLIABILITY DAMAGETORENTED $ PREMISES Ea occurrence CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ ]POLICY F— 'RO OC AUTOMOBILE LIABILITY I, COMBINED SINGI-5 LIMIT $ (Ea accideM)— _-- ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED # POP YDAMAGE $ AUTOS t Per accident k $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS MADE I: AGGREGATE $ yypRKD�EDDg pM RRETENNTIIO�N$ $ AqND EIPI�PpLOCYERS'LS�R7%N w X TO LIMITS OER IN A OFFICERlMEMBER EXCLUDEFECUTIVE Ya NIA A AWC00-7026128-2013A 4/5/2013 4/5/2014 E.L.EACH ACCIDENT $ 100,000 (Mandatory �iinn NH) @ E.L.DISEASE-EA EMPLOYEE $ 100,000 DaRIION OF OrPERATIONS below EL.DISEASE-POLICY LIMB $ 500,000 ii i h Y DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,if more space is required) p) L k CERTIFICATE HOLDER G CANCELLATION Cahoom Museum PO Box 1853 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cotuit,MA 02636 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE pk I ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/06) The ACORD name and logo are registered marks of ACORD CC; �~ oTME` ,. The Town of-Barnstable Barnstable r: o„ Office of the Town Manager F 367 Main Street,Hyannis MA 02601 sARNSfABLE, * www.town.barnstable'.ma.us Office: 508-862=4610 Fax: 508-790-6226 MAM A• APPLICATION FORM • - Fo USE OF PROPERTY,PARADES,MARATHONS,.TRIATHLONS',-ROAR RACES 2007 approved application must be on file in the Town Manager's Office at least thirty(30)days prior to event. ® arade/Road Race applications ust be received ninety 90 days prior to scheduled date. Date of application: f g• ` a 3 , Fee amount: $43.00 per equest*:Total paid:r ,f� YES(ck#_ OR cash) NO *Each request means each event such as a parade,followed by an event on the Town Green,for example. t This application must be compllete/all signatures prior to submitting to the Town Manager for.flnal approval " You may required-to leave application at various Departments'to wait for appropriate signature. 1. CALL TOWN MANAGER'S OFFICE TO TENTATIVELY RESERVE DATE OF EVENT-CHECK AVAILABILITY Request for: Hyannis Village Green ., Aselton Park Paradew . Benefit Run/Walk Marathon/TriathlonOther(please specify)• B Certain facilities may require ddditional fees for services.by DPW depending on location,use of staff&size of .• event. The fees will be determined by DPW and paid directly to that depa_r went 2. Name of Event: Orr Day/Date of Event: , A 3. Name of Sponsoring Organization Q y Mailing and physical address:.. T77�10 �GtoJ �ni-ii 17� 4. Contact person: 9 � jt�;Q Phone .5Z8-' 5: Eerson':in charge DAY:OF EVENT: �tilQ: cl<° - ems' Cell phone: 6.cSet up•time: start and end time: /( .; lean up time 7. Estimated number of volunteers/participants: .'Estimated.number of spectators:: • •.4 >>POLICE DEPT will determine if extra detail necessary. 8. Admission fee/registration charged to participants?_p/No If yes: Amount:.f { Will there be food 6r craft vendors at event? Yes No , • >>If yes,indicate the number of vendors and type(food/merchandise/etc): » ' t, >>Will there be mzr'chandise available for sale?_,/Yes No _N/A a { Vendors need.to complete application for special licenses at the Licerisirig Division-200 Main:Street`Hyannis. 9. Map)attache&(REQUIRED)for road"race/parade event z4 �:; A <4 a »Are:stre' IOSU72S required F, ; e Yes` _`:�•a� NO »Detail of route and rest'stops'attached/indicaied on map' l Q.;F..ond:prepared served at event? >>If yes,will there be cooking/heating jnvolved? Yes' No i TENTS REQUIRE ADDITIONAL PERMIT FROM BLDG DEPT. Structures&Grounds have designated tent friendly zones. Should you require tent elsewhere other than these zones,location needs to first be cleared with Structures_ &Grounds. n >>No open flames intents or propane storage use without afire permit. 11."Are you installing or constructing any structures,including buildings,climbing structures,etc? _Yes No ' 12. Are you installing any tents o-r canopies? /,Yes No Quantity and size: X4i S nor rent?Rental company; �;Ac el Do you plan to have any sound amplification? •-Yes. `No Music-4 t Other(please describe) ' 14. Is electrical power required? Yes - No + (for sound amplification(PA system),lighting,popcorn machine,etc) 5 •' ` >>If yes,circle: will you provide portable generator? OR will you require TOB temporary service?� , >>List maximum wattage required and location for hook-up: ' If more than'usual'hookups,please note there will be overtime costs if Town ElectlZian setting up and removing "A-frame"or dropping service before/after event outside of business hours. 15.Do you have need for barricades/cones? V Yes No >>If yes,describe for what use: DEPOSITS: $5.00 each cone. $50.00 eacfi/b ` cades( uantities/deposits arranged through DPW). - .16.Will you require access to the town building? . Yes No >>If yes,describe for what use: 17.Do you plan to drive vehicles onto property? If yes,provide details: Specific loading zones to be reviewed with DPW/Structures&Grounds. Organization will be liable for any damages vehicles may cause the ground: s 18. Do you plan to provide portable toilets and/or hand washing sinks at your event? Yes No I »If yes: �#of regular toilets _#of handicap accessible toilets, f #of hand washing sinks Public Comfort Stations located at Town Hall Parking Lot,North Street and Barnstable Village Fire Station are open from 9AM to 9PM,dail . If event abuolutely requires early open,it must be reviewed with DPW. 19. Trash`pick up is the responsibility of the organization requesting this permit. Please provide your:plan for ' the cleanup and removal of garbage and recyclables during and after your event:' Number of recycling containers:��• Number of garbage receptacles: - -A one-time-disposar-fee tairfers-may'Se-assessed:— fee witrbe'determine and collet y The cost is based on size,of event. 20.Will there be demos,displays,materials that are potentially hazardous/impact public safety?=YesjAo P >>If yes,describe: 21.Have you made any provision for,on-site security? ._Yes o' 22.Have you made any provision for on-site medical services? Yes No 23.Please provide description of your parking plans(where event attendees will park): . >>Plans for disabled parking:.. - >>Plan for emergency'vehicle access: »Please describe your plans to notify residents,businesses impacted by this event: - 24.Will the event be advertised? If yes,where: you >>Do plan to distribute i]y p t flyers or ads before or d 'ng is event. _ Yes No _ >>Do'you plan to place any signs or banners or other advertisement at the event site? Yes NO »If yes,please indicate where: r Provide sign/banner detail and dimensions and method of attachn4nt or support; . (Signage may require additional permits). 2, , k e I have read, understand and agree to abide by each numbered item on the'attached"Rules and Regulations for Use of Village Green .and other,Town Property" H "Rules and Regulations for Parades, Walkathons, Road Races and as the agent for the sponsoring j .organization, agree to abide by said rules and any othe pecial conditi s (letters may be' attached) established for this particular event. ' "SI afore of sponsoring agent/Date.' , r Printed Namel60A.1jc�-V, o( � '-(-�%t!• f APPROVED BY: CHIEF OF POLICE DATE: (Barnstable Police Departme 120. P an inn ane,HynJ50878- 805) CHIEF OF FIRE DEPT(S) I TE: O�! !J _. _.. __...,(Village-Fire.Department,Ad sses vary),...._ RECREATION AA,3 V DATE:- 11.3 (Hyannis Youth&Community Center, 1 asset art ,Hyannis 508-790-6345) r PUBLIC WORKS ^ / DATE: rt + (382 Falmouth Rd.Hyannis 8- 40 ) S REGULATORY SERVICES DATE: / !� (200 Main Street,Hyannis 508-86 -4674) BOARD OF HEAL L 6 14ih FV!0 ATE:% l T1. _ (N/A for Parade/Raee er!!ip unless serving food:508-862=4644) BUILDING DEPT 4 4f— DATE. (N/A for-Parade/Race permits.unless erecting tents. 508-862-4038) TOWN MANAGER �fi DATE: { (Town Hall,367 Main Street,2". floor,Hyan 508-862-4610) *� SPECIAL CONDITIONS and ANY FEES(As determined by Department's'above) , DETAILED AS FOLLOWS: t .. ram-- . C 4 / ♦ L _ t y i. s .4 _ a^ g .. a AL 211 ~r, Aim (;ert ticate, o ame, esis an PAGE: 1°Ns Date mwm�aw,rea pZTE TE ' { 03 26 2010 INVPNUMBER 0179991 _ s2665 COLUMMU ST / ^ TORR lCE,CA 909M P.O. NUMSdt. . ft300)228-3687 CUSTOMER NO AMER026 This S to certify flat�maberia5 desaibed below have been flame r�ndant trued(or are inherently flame retardant). AMERZCAN TEfNT>�TABLE INC G Pau- �� P.O.am 1345 x �r R x FORAM :� 381 OLD FALMOUTM ROAD UNrr 41s Marstons Millis,MA,0sm 2648 hereby ma Certification made{ttrat the aMdes described below hereof,are made from a flame-rebwdant fabric or n>aWftl registered and approved by the wo'e « . eoeena CaWbmia State Fire Marshal for such use.The fabrlC haS been tested passes NFPA 701 Large Scale.See chart Wright for trade name of flame-resis�nt fabric or matenal used and aWitionaly refere a on the label of the fabric panel -. THE FLAME RETARDANT PROCESS USED WILL NOT BE:REMOVED BY WASHING ff�f-*fAppkM OW�.WYMwA� F i.J Tif.G o 4W koducdm SY� ITEMS MANUFACTURED PRODUCED 3ftW 2pc SW TOP Only UW 5 2 ATC Style Clasps ° Stock its G �p Male•S9411,,C594c2A f l :"46�S9471��} CT 3 20�Q0 2pc Std Top Ony UW S 2 - 30x10 Sul Middle Top only t11M S 3 ATC Style Clasp' 4 ' J ZO�c10 Stud Middle Top 0" UW � � � �� ,� S 3 °�• '� ATC style rasp 3 20x5 SW Middle Top Ony A i ATC ,2 iSx S 2pc SW'TOp Only UW' f7 d a fig. r ATC z s . 4.00 Akan CP Lioliom x 9'0" y 4.0'Alum CP'Top Section 9'0't -, y 3: S S 4.0'`Alum CP x 3'EXT . - % d 'L. i 1 �tCertificarte �f , 'lame ReOt slantjt PAGE: 1 Date Manufactured � AZTEC TENTS 2665 COLUMBIA ST INV NUMBER: 0184178 12/17/2010 TO P.O.CA 90503 P.O. NUMBER: i(8001 228-3687 CUSTOMER NO: AMER026 This is to certify that the materials described below have been flame retardant treated(or are inherently flame retar(Jant). 1 AMERICAN TENT&TABLE INC. 'l zzlow~SW P.O. BOX 1348 � Marsbx Mills, MA 02648 f Fwaoa wcTee. aasivmn Fsv.Aa FSOOl Certification is hereby made that the articles described below hereof are made from a flame-retardant fabric or material registered and approved by the California State Fire Marshal for such use.The fabric has been tested and passes NFPA 701 Large Scale.See chart to right for trade name of flame-resistant fabric or material used and additionally referenced on the label of the fabric panel. THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley j General Manager-Manuring Name of ApplkaW or fto&x on Supedmvwe4, Title of AWkaW or Rodudion SuperhandeM ITEMS MANUFACTURED I TYPE PRODUCED 30x30 2pc Sid Top Only UW S 2 ATC Style Clasp 20x20 2pc Std Top Only UW S 2 . ATC Style Clasp } Stock#'s 6957,6958 ;+ 20x20 ipc Top Only UW S 2 Stodc#'s 6947,6948 20x10 Sid Middle Top Only UW S 3 Stock#s 6502AS03,6504 30x10 Std Middle Top Only UW S 3 ATC Style Clasp ✓15x15 2pc Std Top Only UW ' S i ATC Style Clasp l 15x15 Std Middle Top Only UW j S i ATC Style Clasp �/Ox10 2pc Std Top Only UW S 2 ATC Style Clasp } S 2 i0x10 Std Middle Top Only UW ATC Style Clasp 1 S 30x30 2pc Series 1200 Top UW wl New Plates&#2 Grommets I i I i ' I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 'Map Parcel (10 Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 10 -S 1+00 % C�r�a I Caw Village (1,0-ru I I Owner T__D k2 A) (�N (3/`�"!�V � r.��- Address d Telephoned Permit Request AU )vg- 1.1 77 & v J (Y1l A "o, Al 11 U S6CJ uare feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning ' trict Flood Plain Groundwater Overlay Project Valuatio Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Wall t ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new ,21 --� Numk\-r of Bedrooms: existing _new D d ## Total Room Count (not including baths): existing new Floor Room"Count NO Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other 11-4 CIO C� Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/c stoveo?❑Yet ❑ No Detached garage: ❑existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: Lf isting 'new size_ Attached garage: ❑ existing ❑ new size —Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name H�i VfAf T— f 77)6 Li-- Telephone Number r 4_5 Address License # y /0 b 1;11L4-f h I-V Home Improvement Contractor# y,' 4 X Worker's Compensation # 2w �o ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE --lS`0�-- t� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER f. DATE OF INSPECTION: FOUNDATION FRAME INSULATION " FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Feb 13 12 03:46p Carter 508-428-4766 508-428-4766 p.1 The Town of BarnstableBarnstable y Office of the Town Manager N 367 Main Street,Hyannis MA 02601 T � www.town.barnstable.rna s Office: 508-862-46]0 Fax:50$-790-6226 �• APPLICATION FORM USE OF P RA PROPERTY,PARADES,MARATHONS,TRMTRI.ONS,ROAD RACES 2007 The approved application must be on file in the Town Maaager's Office st least thirty(M)days prior to event, ParadelRnad Race aimlitations must be received nine"M d s prior to scheduled date. Date of application: / / Fee amount: S43.00 per request*:Total paid: YES(akin/ OR cash) NO 'Each request means each event such as a parade,followed by an event on the Town Gwen,for example. This application must be complete all signatures prior to submitting to the Town Manager for final approval. You may be required to leave application at various Departments`to wart for appropriate signature. I. CALL TOWN MANAGER'S OFFICE TO TENTATIVELY RESERVE DATE OF Evwr-CHECK AVAILAB[Lt1Y Request for. - Hyannis Village Orwo Aselton P Parade, n l3ensfit RnmlWallc MarathpnlTriatblon Other(please specify): q oe Certain facilities may require additional fees for services by DPW depending on Iocation,use of staff&size of event The fees will be determined by DPW and paid directly to that department. , 2. Name of Event:k r-et`f' Day/Date ofEvent SPL,+, . Mat�, 241-2 " Rain date:5-t.rti ZO/Z 3. Naive of Sponsoring Organization: _eaakoom UA"rP_AA✓+s Mailing and physical address �14 76 ./ a w. iizoa��C _eo-fk;.-+ , kdA- 0-ir-6 2-i �.emluq,r'd Gc�.�-�a�' •:SZ�3-¢z�—�76(0 4. Contact person: _P 1 n M rid t�5cef-Q-'r"I'QteSe- Phone:5- SFZR r 7644 5. Person in charge DAY OF EVENT:L"6,=Tel Ce. .ram—Cell phone: 7 7q—S-'?-J —S4-TY9 6. Setup time Actual event start and end time: / Clean tithe: 1n , � ..:' � 7. Estimated numbu of volunteers/participarns: O Estimated number of spectators LYD'D >>POLICE DEPT will determine if extra detail necessary. 8. Admission feolregi kzdon charged to participants? VINO Ifycr. , .`Amours Will there be food or craft vandals at event? I✓ Yes No »If yes,indicate the number of vendors and type(foodlmcnvhandise/etc): --- -w , p dine d v »`Vill there be merchandise'avatiable for e? Yes No" ` N/A Vendors need to cornplete,application for special licenses at the Licensing Division-20Q Main Street,Hyannis 9. Map attached{REQUIRED)for road raceJparade event' r . � k >>Are sbmt closures required: Yes r L,�LNo `. »Detail of route and rest stops attacbed/indicated on map. I0. Food prV=d/saved at event? ✓ Yes No? »if yes,will there be cookingltieaAng involved? Ycs No reb 13 12 03:47p Carter 508-428-4766 508-428-4766 p.2 TENTS REQUM AMMONAL PERIVar FROM BLDG DEFT. Strnctares&Groaeds bave ft ft dW teat Mendly zones- Sbould you require trait eltiswhM after tram t3�5e zones,location needs to fba be cleared with Struc0ues'de Gram »No open dances In twits or propane,image an teithoed a limed:permit / It. Aire you iasmll-mg or wostrnctiug any strmuu s,includ-mg banding dimbing s1 uuctsues,de? Yes it No 12re A you installing arty",t cOmpiesR V Yes No quantity and size cr rc=A7jg&u�i�COSY= . Tel� 13. Do you phha to have awry sound amnpliiicatiicn? j ycs_No Musib —Other(please describe) 14."Is electdcatl power required? Yes No (for sound arnplific on(PA'sysb=) bgbtin&popcorn machine,ate) »If ycx,t iretc: nil!you provide parable Beane 1,7 OR will you requfi -MB Urnpormy service? »List mwarn mm wattage rvomd and location for hookup: if rttore than%rsuar hookup§,please note there wi be ovesr5me costs if Town Searkian selling up and removing A-ti 2OW or drwpinq service beforwa0er event o-dside of business hours, 15_Doyon.ha_v-e need for bwrkadesleocs? ales_ >>Nyes.desen-bee for wbat use: 4 -f; gf= U e* ct.v-7ht4p 4 i-L_ DEPOSITS: $5.01)dncb conc. MOO eadilbwii ades(qbanfiticsIdeposits arranmod through DPW)- I&Will you require aooess to the town bw'Idutgt Ycs -11—No >>fyes,desar3e for vAM use: 17.Do you plan to drive vehicles dmw property? If yes,provide details: - J2S Specific load-mg zones to be reviewed with DPWIStruducas R Grounds. `'� r- Orpanization will be liable for any damages vehicles unay cause the ground- IS. Do you plan to provide portable toilets and/ar hand washing sinla at your event? Yes Wo t of re gular tollcts _Lg of handicap accemiloin toilets -_Z-4 of hand washing sins Pubvc Coanfod Stations located at Tmn Flap Paddng Lot,Norlh Street and Barnstable Val W Fire Station are own fiorn 9AM to 9PNL d -. If ewer--a uses eawW opwL k rust be reviewed wah DPW. 19. Trash pick up is.tut: respo-Wxity of the awMization rung this permit: Please provide your plan for the cleanup and texaeval of garbage and ne ycidd s during and after your evtt N-mmbcr of reaydiag contain tsv Ntunbcr of garbage=ccpMcic :. .A one-tipe-&-sLasal foe for ma wvn eoaeaiaers may be assessed. Any vdil be detarmnd and co0c�d by DPW. _ - --- -- The cost is based on size afeveotq Td _ - _- __ . ._. _. - _ 2d.Wilt there be demos,displays,materials that am po ntiWly bazardouslinwa d public safely?Yes >>If yes.describe: 21-Have you rrmde airy.provision for oat-sift ss:cw*? ,Yes,i,/No 22 Have tru-de ' roan for aai-site medical suirias7 Yes No ) 23.Plow provide descripfw-of your pazlcmg plains(where:event aRtendees V0 parl*S »Pisan for disabled parlong- ' ..can o r �-. >>Place for coactsuncyvebick ads »Please describe}nwr plans ter notify residents.-buss ;impeded by this event 24.WM the overt be advatrsocd? Eyes, >>Do ymm plan to&lint-lxft Syers or as bcfare or dhaiag evem? all- Yes _ o »Do ytm plo to pleoe any signs ar bmtom or od w adva4scrnent at the event - No »If yes,please indieeete wba --i- '�-G tSfit� 4.. fJa�' - >>pruvido sigWbum detail apd Asiong and Me&W of atterimcat or support (Sigasge pW requite adMouat r=ft). Feb 13 12 03:47p Carter 508-428-4766 508-428-4766 p.3 I have read, understand and agree to abide by each numbered item on the attached"Rules and Regulations for Use of Village Green and other Town Property" I/ "Rules and Regulations for Parades, Walkathons, Road Races" and as the agent for the sponsoring organization, agree to abide by said rules and any oth r special conditions (letters may be attached)established for this particular event. alp --�' � i tore of sponsoring agent(Date Printed Name:�ee�Lra y�� C4 r 4e� APPROVED B CHIEF OF POLICE D AT / (Bamstable Police Department, 12 e,Hyannis 8- 8.3805) CHIEF OF FIRE DEPT( + ATE: (Village Fire Departrment,A sses vary) RECREATION IN"— DATE: t (Hyannis Youth&Comm ty f 'nter,141 Basset L e, yannis 790-6345) PUBLIC WORKS DATE: (382 Falmouth Rd.H annis 508-790-6400) REGULATORY SERVICES DATE: (200 Main Street,Hyannis 508- 62A674) BOARD OF HEALTH rI�,P t71 v' Ary A V DATE: BUILDIlVG DEFT_1�--'� _ f��2/! G�.IJ -•-... DATE: , . 508-862-4039) *TOWN MANAGER V DATE: (Town Hall,367 Main Street,2 floor,HyaWis 50&862-0610) SPECIAL CONDITIONS and ANY FEES(As determined by Department's above) DETAILED AS FOLLOWS: � .kj 'fit"P o- - ,`,' r r..;.x " .rod �;:• s t�-;sT� y 0. 8 v �, 's-r 4-'"` �� "s "� ; 3,. ,, N �Mp, n z 4 e n sang r s �s'' tN �a ti LL ifC��t' ��ii& mi� .x' -;5`i 4i5 �xr.f. ,n"z.r x'�h�'",�.+4+SiS p:Y't"h �+ i-s ..,k !e- Pi, : V,s„w;€'�F, d$EgK"lULAI _.!'„ $Tn S �' $i w_S aY 1 :Yd-♦�e �, rF's"-v" _.�.. _ / / : �Certif i rate f fame "Ke5figtance REGISTERED AZTEC TENTS Date nested or APPLICATION 2665 C®LUMBIA ST mareutactured CONCERN NO. 1. 1 TORRANCE,CA 90503 r 0412009 1 L CONS Fd19.01 (800)228-3i87 R ICA This is to certify that the materialss descnb�below hereof have been Dine rl�ra�airt tried(or are irrtrev®ntiy n ►. $$ FOR x 5 AMERICAN TENT& TABLE '? ATTN:ALLEN SYLVESTER a' 381 OLD FALMOUTH ROAD UNIT 41 y sJ, MARSTONS MILLS, MA 02648 Certification is hereby made that: (check "a"or"b") (a) The articles described below this certificate have been treated with a flame retardant chemical approved 4 ❑ and registered by the State Fire Marshal and that the applicationof said chemical was done in confor- mance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. ; Name of chemical used............................................Chem.Reg.No. ................ ... � � Meathodof application .......................................................................................... (b) The articles described below hereof are made from a flame-resistant fabric or material registered and approved be the State Fire Marshal for such use; Fabric has been tested and passes NFPA701-96. Trade name of flame-resistant fabric or material used..t.aminaeedF do Reg.No.......�tMq? y+^a2Ht k� \hJR The Flame Retardant Process Used ...ILL NOT Be Removed by Washing (wnl or win rwt) David Bradley� Chuck Miller- .President ��;'� Name of Appliratw or Production Sap�irde+tderd Title }..�^'��'�r � "1=PIe r•z v •;� �u �t -� t_ u :tom' � r a �ri� a 3 str' r rt,t� '�'.:z a � t r � v•.�� '-,. ,-..;:�....: -=,u.Ei-.�r, .�.:� �„�.-.�� +�" �. s7 „ �'' ,.. rn ": ��£';'.. .��}�,pr :�. � .�4 � ,,.._ 4t � s 'e; ;.r �3. :£ �y,c�"�pxi�'V +'� M �'�.. .. .#. .�. ,� �.. .,s" `'hn ..,..: V'�. � ! .::,'R7ti�' �.w:-.u. •6 .JAG �. .�"'. ..s ��.-,�S �a';�<.ts.�.��r.>fi-v.> e%G A�S��4�,�l�,�}s s��x�•�y"�'��i.46�iv� k�. '3�°,T?.v:..cn.>�f u,.�j��'.. 5a.+f....�1�;--�.�n � .��+.�.. � '-;`.�u_: ��..•"l'��77;t'4f4�in..F¢`��'�5 �%�.'�3'a� �..�?ye- a"Y p^ J yS�x-�;y„�,h�Cf.k,�<; 4< :.�: .a- �.r" �. ,.�. .,. �, ��,; �s � � f. �. ��: >s 1 ,. r;n�'k. - .. •,- -_ i � h 4 -... 5-!"2. v �.;r: 3.>,. J CUSTOMER ORDER NO. R174684 ITEMS MANUFACTURED: 8- 10x101PC TOP ONLY-UW 2-20x20 2PC STD TOP ONLY-UW 3-20x10 STD MIDDLE TOP ONLY-UW 2-30x30 2PC STD TOP ONLY UW 3-30x10 STD MIDDLE TOP ONLY-UW e ica e o am esis PAGE 1 an e ce Date Manufactured AZTEC TENTS 03/26/2010 2665 COLUMBIA ST INV NUMBER: 0179981 i TORRANCE, CA 90503 P.O. NUMBER: ' f (800) 228-3687 CUSTOMER NO: AMER026 2 This is to certify that the materials described below have been flame retardant treated (or are inherently flame retardant). nun Ma I ras a me -rrfrl Bruin Mesh F-222.04 AMERICAN TENT &TABLE INC. California Comb. Lam-Tex 12,14,16,18oa F•419.01 P.O. BOX 1348 coated Fabrics Clear vinyl 16ga/20ga F-570.02 DAF Clear Vinyl 169a/200a F•593.01 MdP5t0 S Mills MA 02648 ROAD UNIT 41 DAF DAF F•593.02 Exclusively Expo PolySateen IJner F-434.01 Ferrari Precontraint 502 F-444.01 }ti_ Ferran Precontraint 702 F-444.08 Phillips Textiles De ztile5 Phil-Texco Cloth/Velon F-504.01 r '•'-^! Snyder Weathers an F-140.01 •. n a° s - •` Tri Vantage Firesist Sunbrella 7368.05 :. Tn Vantage Patio Soo F-121.02 Certification is hereby made that the articles described below hereof are made Tn Vantage jBig Top F-121.10 from a flame-retardant fabric or material registered and approved by the Tri Vantage vanguardWebion F-069.01 California State Fire Marshal for such use. The fabric has been tested and TA Vantage weblon/Coastline F•069.01 passes NFPA 701 Large Scale. See chart to right for trade name of veseidag D°rasidn61673,B151s F-530.01 l flame-resistant fabric or material used and additionally referenced on the label i of the fabric panel. THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING David Bradley General Manager-Manufacturing Name of Applicator or Production Superintendent Title of Applicator or Production Superintendent - ITEMS MANUFACTURED TYPE PRODUCED 30x30 2pc Std Top Only UW S 2 ATC Style Clasp Stock#s Male: 5941, 5942 Female: 5946, 5947 . 20x20 2pc Std Top Only UWS 2 ATC Style Clasp 30x10 Std Middle Top Only UW S 3 ATC Style Clasp 20x10 Std Middle Top Only UW S 3 ATC Style Clasp 20x5 Std Middle Top Only UW S ATC Style Clasp 15x15 2pc Std Top Only UW S 1 ATC Style Clasp 4.0"Alum CP Bottom x 910" S 3 4.0" Alum CP Top Section 9'0" S 3' ' 4.0'r Alum CP x 3' EXT S 4 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 �4 .:•`'� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetricians/PIumbers Applicant Information Please Print Lezibly Name(Business/Organization/Individual): �� Address: City/State/Zip:&W_5a,V_S&Z/� �y�¢ Phone.#: Are you a employer? Check the appropriate box: Type of project(required): P y 4.' I am a general contractor and I 6. ❑New construction 1. am a em to er with ❑ employees(full and/or part-time):* have hired the.sub-contractors' 2. or partner-' listed on the attached sheet T. 0 Remodeling El I am a'sole proprietor ship and have no employees These sub-contractors have g• "�]Demolition workingfor me in an capacity. employees and have workers' Y P t5' $ 9. ,E]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 11.0 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.[�.0flier / 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. xContractors 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.#: ��0110�� 1 /�— Expiration Date: y� Job Site Address: ! City/state/Zip: � r/�/� :5% •; ��1� �'lN 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 e. 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 'ns a d penald of perjury that the information provided above is true and correct j Si ature: . Date: Phone#: % O " �4�/ 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#: DATE NMMD/YYY) CERTIFICATE OF LIABILITY INSURANCE 04i06/2012 TH19 CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AM---ND, 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 rec(Uire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT - Berry Insurance Agency Inc HIM; PHONE FAX 9 Main Street (A/C. N°' Ert). 8-MAIL Franklin MA 02038 ADDRESS` PRODUCER - CUSTOMER ID#. IESURED(S) AFFORDING COVERAGE NAIL I INSURED rnEwmx A: A.I.M. Mutual Insurance Co 33758 American Tent & Table Inc . INSURER B: P O Box 1348 msD C: Marstons Mills, MA 02648 INSURER D: MEURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT., TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. nur POLICY EFF POLICY EXP - LT2 TYPE OF INSURANCE POLICY NUMBER. � �/rm> 1wVm/rrrr7 LIMITS GENERAL. LIABILITY EACH occUPANCE 8 ❑CODSfERCIAL GENERAL LIABILITY TO AMR= PREMISES(Ra.occoi-- $ ❑❑CLAIMS MADE ❑OCCUR MED EXP (ARY one Pei%—) S - PERSONAL 6 ADV INJURY $ os GENERAL AGGREGATE S. GFM'L AGGREGATE LIMIT APPLIES ER: DPOLICY ❑FAOJECf ❑IOC - PRODUCTS-CODPIOP AGO $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (ea—ident) ❑ANY AUTO BODILY INJURY (par person) $ nALL OWNED AUTOS r [:]SCHEDULED AUTOS '. • BODILY INJURY(Per a ident) $ PROPERTY DANAGB 5.., HIRED AUTOS - (Per--JA t) - ❑NON-OWNED AUTOS $ UMBRELLA LIAR Q OCCUR EACH OCCURRENCE - $ I]-..- LIAR ❑ CLANS MADE AGGREGATE $ DEDUCTIBLE $ ®RETENTION $ } S WORKERS COMPENSATION RR .. ®AND EMPLOYEES EMPLOYEES LIABILITY Loax txNlrs THE PROPRIETOR/PARTNERS/ E.L. EACE ACCIDENT $ 100,000 A EXECUTIVE OFFICERS ARE ® incl ❑ excl 7026128012612 E-L-. DISEASE;-POLICY LIMITS 500,000 04/05/2012 '04/05/2013 S.L. DISEASS FA EMPLOYEE $ 100,000 { CO➢LYENTS/DESCRIPTION DF OPERATIONS OR LOCATIONS: - CERTIFICATE HOLDER CANCELLATION CAHOON MUSEUM SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE PO BOX 1853 POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE COTUIT, MA 02635 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 4 Mapa Parcel dV` JApplicatiorr# -1 Health Division Date Issued Conservation Division i Application Fee Planning;Dept.; Permit Fee Date DefinitivePlan Approved by Planning Board Historic - OKH Preservation/Hyannis R Project Street Address Village Owner`f ' Address r/ /i r �� Telephone -- �� i Permit Request - lo I a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new f Zoni District' Flood Plain Groundwater Overlay Project Valu n Construction Type Lot`Size Grandfathered: 0 Yes ' ❑ No If yes, attach pupporting dQcurQgntation. A 3- Dwelling Type: Single Fa ily 0 Two Family ❑ Multi-Family (# units) < Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway..-❑Ye ❑ No Basement Type: ❑ Full ❑ Craw ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing ne Half: existing new m Number of Bedrooms: existing _ne Total Room Count (not including baths): existing n First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New xisting wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size __ arn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Oth Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �-1'l�"Ii�/�i �� ,/�%_ Telephone Number Address fo °-�" �� License# Home Improvement Contractor# Worker's Compensation # .YB LJ/Q ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE�� FOR OFFICIAL USE ONLY .� APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE k OWNER DATE OF INSPECTION: FOUNDATION .FRAME iy INSULATION i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 5 The;Commonwealth of Massachusetts Department of Industrial Accidents f, Office of Investigations I` 600 Washington Street Boston, MA 02111 •••'•y www.mass.gov/dia i Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Legibly Name(Business/Organization/Ind�ividual): /�/gY� /!/I - / Address: D}�f� �� City/State/Zip: i �&aS A1/1-Lehone.#: ;yd' . yob to Are yo an employer?Check the appropriate box: Type of project(required): am a employer with 4. ❑ 1 am a general contractor and I ❑ -hie). * have hired the sub-contractors 6. New construction employees(full!and/or part ..2.❑ I am a•sole proprietor or'partner-' listed on the attached sheet T. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me:in an ca aci I employee's and have workers' Y P ty 9. ❑Building addition [No workers' comp. insurance i comp. insurance. required.] 5 ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work ! officers have exercised their 11.0 Plumbing repairs or additions i right of exemption per MGL myself. [No workers comp. 12.0Roof repairs insurance required.]t i c. 152, §1(4);and we have no q ] employees. [No workers' .13.[tO er comp.insurance required.] *Any applicant.that checks box#1 must also;fin 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. TContractors that check this Vox 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.Lie#: X 11 U Expiration Date: I . _ I Job Site Address: i 0 • City/State/Zip: d a d . �� Attach a copy of the workers'c pe'nsation 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 tip to$1,500.00 and/or one-yea-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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certi under th p 'ns i nd penalties of perjury that the information provided above is true and correct. Si ature: Date: Phone#: Official use.only. Do not write in atis area,to be completed by city or town officiaL j y .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 1.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: i i c9enw.4$1m 99no1s33 ACORQrr CERTIFICATE OF LIABILITY INSURANCE , IMI THIS CERTIFICATE IS ISSUED AS A MATTER OF 66091MATIM ONLY AND CONFERS NO RIGHTS UPON THE t RTNaCATE HOLDER THIS cERTiRcATE DOES NOT AFFmATmEL oR NEGATNELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF N4.4URANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUNG N*WR0X4 AUTHORIZED REPRESENTATNE OR PRODUCER,AND�CERTIFTCATE HOLDER. 060ORTANT,N the corlificate holder is afl ADDIT10NAl.NSURED,the poll oes)must be endbrsed.N SUBROGATION IS WANED,subject M the tens and conMon of the policy, f n poNcies mW►e*dre an endormam t.A,',', , -ondftcerdroatedossrotcr, So rights to the oeibficate holder in lieu d stldl ems} ' PRODUCER CONTACT MAIM USI Renal SpocbW s °HONE 800 8643296 PA.Box 53310 AooaEws: Irvine,CA 92619 800 854-3298 cusiroMER1D9, HOURERRAFFORMMCOVERAGE aacs 11 WStIRER A.St Paid Fire&Marine Utsw=we 24767 American Tent&Table Ina. tp�t} P O Box 1348 vmURER s:Phoenix Insurance Con 25623 Marston Mills,MA 02M 01StlreR c: FISMAIRD: MRE: - WGUrIER F: COVERAGES CERTIFICATE NUMBER- REVISION 11A116ER: THIS IS TO CERTIFY THAT THE POLICIES OF INSqRANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NWW HSTArDM ANY�Q1 fT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIK THE INSURANCE AFFORDED BY THE POLICIES D HEREIN IS SECT TO ALL THE TERMS. D(CLUSIONS AND CONDITIONS OF SUCH POLICIES. E E D POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PA CLAIMS. �� TYPE OF NSURAN EFF OW CE POLICY Nl�et A CEItEaALLUHLrIr CK00223058 �2'WI 011MIM2 EACHOOCURRO E $1 X CO1*AW0ftGEh9RAI.UA01L1TYP11113AGESigaimunermi sloolow CLMAS44ADE a OCCUR MED EXP(Arw one person) PERSONAL&ADV solar S1 GENERAL AGGREGATE s2,00o,000 GB?LAGGREGATEUIXTAPPUES:PBR: PRooUCTS-COIP/OPAGG $1 ,000 X Palo P iOc i i MIin11DBN.E LIAeNJTY comommspiewuwr i (6 aoriderq ANYAUTO BODN.YINAJRY(Perperson) i AU.OWNED AUTOS SOMY VMURY mw aooidwo S SCHEDULED AUTOS PROPERTY DAMAGE i il6i®AUDO6 '� (Pe►aoo�derb NO*0WNED AUTOS i S 1 31A LJAB 00" EACH 3pfOE i E710E9S LIAB cLvm% ADE :; AGGREGATE s vexcTimi B coum3mvmLIABILITYXNU85819Y97511 IMM I 0 IMM X wO srATu on+ s Off t7CCLUt�o�lrrlvFn Tin 1 I E L EACH AOE:IDENf $100,000 in I 1EJ-0SEASE-EAEhWL0M $100.000 OF TIONS belor E.L D13PASE-POLICY uw 000 A E**mm nt Floater I 10002012M mmmi mmr201 $450,00 Limit Form $5 Deductible DE$dIOT10MoPCPBtAiIONS�LOCATtoNB�YB/CLES(A�fi#=M lei,Moo"ftm IsSolw&ftima V—is'O*"* ;This tterti amw is i="as a hatter of GOV. i VERTIFCATE HOLM CANCEIIATION SHOIN.D ANY of THE ABOVE DAD POLICES BE CMMM-LED BEFORE THE E7~UM DATE THEREOF,NOMM MILL BE DEt VW"M ACCORDANCE WITH THE POLICY MWVIS OM AImaII�o IaTrwTNE TION.Aq TiI,�Its Tesenled. i ®1WIPM09 ACORD CORPORA .mm o(20t1W08) 1 of 1; The ACORD na1Re and logo are Teg'Iseered males of ACORD cXA m 8S62T1901/M5264603 a .:7 «�`• sr:.is %� _ '%."y"�'1' ;.''(j' :.;9'$: •:.i./:'o^✓is :.,�..:..� >_' o`' -F�F:r.7i=°�:f '> sr.�f�j•`'a'"� •s: csr'�'�•�! y?=:P':_."'3,. '-,..,,v '4 u`.•--^�:.�`-•__•;•::.- . 'yyS� ,aYrh"'r.'.i:J' •'y,-,�Lp/��'y �y}�'�• ' . .`s Eb.• -max_�.r.�---- -- _. s (citirt Icatit lot ame DIAL sea"* - AZfEC TEWM naoe used CONCERN NM TOWAMMCASON3 04(2009 COW F4110 -= 7tisisa,�aiatgiemal�rialsdeseri�edLe'roM►heraofha�� AMERICAN TENT& TABLE ATTN:AUM SVLVESTER 381 OLD FALMOUTH ROAD UNIT 41 =i AIARSTONS MILLS, MA 02648 -r made Ural:(elreCk"a"or`b� Ceryfication is hereby _ (a) The a dcle a Qe �a�e Pars and un�in cantor and by of am stale Fse idarst�ai- nlcejSt aye lam of the stale of caff= oa and um fibres and al dmoged used Yeaa odcfappscadw aflame-yes faEric c�a e � A. Them ocaea de$~hafow hereof me made fiom lfFp11701-SG. •�► appeoMed be aye!tale tie for such �c �,.��► an0 g,po'..._.�-- Trade name of r fandc of n alerial ;.. 'ff Flame R�1it ProcOW Used . 'L IIfOT....... Be R�e�ed by VIAThe _ l J.s'y.� G '•''PSY.'��,[\"'�s�y t4�'` �.L FK P��+..rf''S�_';o-�,��,dTJ•� �� '�1�'TJ y �'�J��R 3 v.x�R ' 2_Y�k.f�c:-S ...—� ��Ltis i•s.w L... .y. i c r � ��j"'��t`� � S,r� -� .- .."'..'{ 'r• _ `t.n,...�a� :a :rs.:.� �� ,�Gf.r,:�I; t, ^..•-rL. C i.� a. ':'>" "�; ,. .. • - - =b= CIRS&mow CUSTOAAER ORDER NO. . ITEMg MANUFACTURED: S.1&to Ipc TOP ONLY OW f� 2.2"WCSTDWPW Y-UW3-NdDsmmgxxz TOP W \/ V 2.MW VC srD TOP �„UW 3-MdO SW efmDW TOP AkAk I s . f ceruticate o a KeswstancePAGE: 1 Dabs Manufacbned AZTEC TENTS 03/26/2010 2"S COL UMWA 9F INV NUMBER: 017MI TORRAMCE,CA 90503 '. P.O. NUMBER: (9001228'3687 CUSTOMER NO: AMER026 This is to Certify dot the rnata Is described below have been flame retardant treated(or are in hereittly flame retardant). AMERICAN TENT&TABLE INC. Tm k 240 Z P.O.BOX 1348 `m"' %wp I R'6700% 381 OLD FALMOUTH ROAD UNIT 41 � 1� r Marston Mills, MA 026" erne - eesQ a.3a"a ,ernes �ueQ s-s000i ;..�, Aeae. ao"e/Mem rim . Ceitifiption is hereby made that the articles described below hereof are madeRK from a flame-retardant fabric or material registered and approved by the , CaKwnia State Fire Marshal fur such use.The fabric has been bested and passes NFPA 701 Large Scale.See chart to right for trade name of flame-resistant fabric or rnateriai used and addil5onally referenced on the label of the fabric panel. .05 THE FLAME RETARDANT PROCESS USED WILL NOT BE REMOVED BY WASHING ' David Bradley CAMMAI Manager—M(9NlIHg < ftw*of AppicWr or Production SuperftterAeM rOe of AppftWar or PnWucbm Soper&*erAff* ITEMS MANUFACTURED TYPE PRODUCED 30x30 2pc SW Top Only UW r S' 2 ATC Style Clasp swa*s Male:S941,S942 Female:S946,S947 2040 2pc Std Top Only UW S 2 ATC Style Clasp 30x10 Stiff Middle Top Only UW S 3 ATC Style Clasp 20x10 SW Middle Top Only UW S 3 ATC Style Clasp 20xS Std Middle Top Only UW S 1 ATC Style Clasp 15x15 2pc Std Top Only UW S ATC Style Clasp 4.0"Alum CP Bottom x WW S 3 40 Alum CP Top Section 9'0" S 3 4.0'Alum CP x X.EXT 5 4 �' jo I have read,understand and agree to abide by each numbered item on the attached"Rules and Regulations for Use of Village Green and other Town Property" // "Rules and _ Regulations for Parades, Walkathons, Road Races and as the agent for the sponsoring organization,agree to abide by said rules and any other special conditions kietters may be attached)established for this particular event. '> Signature of sponsoring agent/Date " Y Printed Name: Af reye APPROVED BY- CHIEF OF POLICE DATE: (Barnstable Police Dep ent,1200 hinny'.• a Hyannis -77 -3805) CHIEF OF FIRE DEPT(S) d ATE: (Village Fire Department,Addresses vary) �. RECREATION ` { .l DATE: -- t. (Hyannis Youth&Community tcr,141 Bass e, is 508-790-6345) PUBLIC WORKS < - DATE: (school Admin Bldg,lMouth Street,4 I r 50 - -4090) qK. REGULATORY SERVICES L+ DATE: 1 h (200 Main Street,Hyannis 50 862-4674) •� BOARD OF HEALTH LATE: (N/A for Parade/Kaee9erQits unless serving food.508-862., BUILDING DEPT ' \` DATE: f ° (N/A for Parade/Race per ' un es ng tents. 50 -862-4038) TOWN MANAGER DATE: /L (Town Hall,367 Main Street,2° floo yannis 508-862-4610) SPECIAL CONDITIONS and ANY FEES(As determined by Department's above) DETAILED AS FOLLOWS: • I I s `r 1 r The Town of Barnstable Bam.stabblle ti U„ Office of the Town Manager W 367 Main Street,Hyannis MA 02601 A54kM1=Cft saniasresr� WWW.town.balnstable.maxs Officer 508-8624610 Fax:508-790-6226 9q, i639 ,� APPLICATION FORM USE OF.PROPERTY,PARADES,MARATHONS,TRIATHLONS,ROAD RACES 2007 The approved application most be on file in the Town Manager's Office at least thirty(30)days prior to event. Parade/Road Race applications most be received nine 90 days prior to scheduled date. Date of application: / /O& I Fee amount: $43.00 per request*:Total paid: si-60 YE „(c OR cash) NO *Each request means each event such as a parade,followed by an event on the Town Green,for example. This application must be complete/all signatures prior to submitting to the Town Manager for final approval. You may be required to leave application at various Departments'to wait for appropriate signature. 1. CALL TOWN MANAGER'S OFFICE TO TENTATIVELY RESERVE DATE OF EVENT-CHECK AVAILABILITY Request for: Hyannis Village Green Aselton Park -Parade BeneSt Run/Walk Marathon/Triathlon _�L_Other(pieam spceify):Cci Sri i ✓1cir74-4:-4W-1,K! Certain facilities may require additional fees for services by DPW depending on location,use of staff&size of event. The fees will be determined by DPW and paid directly to that department 2. Name of Event: G ieX4 91-15,'l O,<f Day/Date of Event. -5;9 7 ,T4`Z}' '7 Rain date: Su h> /G 3. Name of Sponsoring Organiration:. -7uS' 06 /9tr��rc P,r� /9Ri Mailing and physical address: plq/ " ,f7-1,,, 0e 4. Contact person: A/cr4.11f0 Phone: 5. Person in charge DAY OF EVENT- Coll phone: 6. Setup time:• 4 f Actual event start and end time: Clean up time: ..' 7. Estimated number of volunteers/participants: Estimated number of spectators: >>POLICE DEPT will determine if extra detail necessary. S. Admission fee/registration charged to participants? i/No If yes: Amount: Will there be food or waft vendors at event? yYes No >>If yes,indicate the number of vendors and type(food/men handise/ete): >>Will there be merchandise available for sale? X Yes No N/A Vendors need to complete application for special licenses at the Licensing Division-200 Main Street,Hyannis. 9. Map attached(REQUIRED)for road race/parade event >>Are street closures required: Yes No >>Detail of route and rest stops attacbedfrndicated on map. 10. Food pmpared/served at event? Yes No >>If yes,will there be cooking/heating'involved? X Yes No i s •' TENTS REQUIRE ADDITIONAL PERNDT FROM BLDG DEPT. Structures&Grounds have designated tent friendly zones. Should you require tent elsewhere other than these zones,location needs to first be cleared with Structures&Grounds. —No open flames in tents or propane storage use without a fire permit 11. Are you installing or constructing any structures,including buildings,climbing structures,etc? _Yes - No 12. Are you installing any tents or canopies? Ycs No Quantity and size: �c 3G�wn or rent?, !/1 Mental company:/PrtFICREJ axJT Tel# 13. Do you plan to have any sound amplification? )fYes No Music Other(please describe) 14. Is electrical power required? _Yes No (for sound ampli5cation(PA system),lighting,popeom machine,etc) >>If yes,circle: will you provide portable generator? OR will you require TOB temporary service? >>List maximum wattage required and location for hook-up: b& If more than,usuar hookups,please note there will be overtime costs if Town Electrician setting up and removing 'A-frame"or dropping service before/after event outside of business hours. 15.Do you have need for barricadeecones? _Yes No >>If yes,describe for what use: e�/ /9117 wee DEPOSITS: S5.00 each cons $50.00 each/barricMes(quantities/deposits arranged through DPW). 16.Will you require access to the town building? Yes )e No , >>If yes,describe for what use. 17.Do you plan to drive vehicles onto property? If yes,provide details: T,4 � K A409,G'`f. Specific loading zones to be reviewed with DPW/Structures&Grounds. Organization will be liable for any damages vehicles may cause the ground. 18. Do you plan to provide portable"toilets and/or hand washing sinks at your event? XYes No >>If yes: 3 #of regular toilets 1 #of handicap accessible toilets #of hand washing sinks Public Comfort Stations located at Town Hall Parking Lot,North Street and Barnstable Village Fire Station are open from 9AM to 9PM.daily, If event absolutely requires early open,d must be reviewed with DPW. f 19. Trash pick up is the responsibility of the organization requesting this permit Please provide your plan for The cleanup and removal of garbage and recyclables during and after your event Number of recycling containers: a Number of garbage receptacles: S A one time disposal fee for use of Town containers may be assessed. Any fee will be deterinined and collected by DPW. The cost is based on size of event. 20.Will there be demos,displays,materials that are potentially hazardousrmpact public safety? Yes_.�'No >>If yes,describe: 21.Have you made any provision for on-site security? _Yes XNo 22.Have you made any provision for on-site medical services? Yes Flo 23.Please provide description of your par3dng plans(where event attendees will park): /R 140 ser A*g;" .virll zBf »Plan for disabled partdtrg: »Plan for emergency vehicle access: »Please describe your plans to notify residents,businesses impacted by this event 24.Will the.event be advertised? If yes,where: S/CAS , �cs7.E.c5P�/�`YS/9 V'' - >>Do you plan to distribute flyers or ads before or during this event? X Yes .No >>Do you plan to place any signs or banners or other advertisement at the event site? X Yes No >>If yes,please indicate where. Provide sigu/banner detail and dimensions and method of attachment or support (Signage may require additional permits). TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION s. G Map Parcel 0O Application # Health Division Ulm Date Issued s l 2' Conservation Division Application Fee / Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board pe-v Historic - OKH Preservation/Hyannis Project Street Address � Village �Y�t�Le, l� Owner O Ld pi Address �36-2-�W/ti Si Zy,��iv�s Telephone Permit Request d A) T 0 A.) are feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning Di ict Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ kout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Exis ' g wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Ba • ❑existing ❑new size_ •.ryt ii •- Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other'. ca Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ = ' Commercial ❑Yes ❑ No If yes, site plan review# 1 Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) `1 Name IQ 1 &AA/ T T r9'6Lif Telephone Number Address _ `� �DX Oy(? License # Home Improvement Contractor# Worker's Compensation # / l ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO f�Y SIGNATURE DATE .�� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS - VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL t ' FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts Department of IndustridAccidents Office of Invesfigadons ' 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aip plicant Information Please Print Legibly Name(Business/Organization/Individual): fi&AWj GAS %"��j%-7;�&g LO L Address-—A City/State/Zip: A�J V.D�� (f Phone#: I Are yowzi employer?Check the appropriate box: 1.LrI am a employer with ❑ I am a general eneral contractor and I Type of project(required): � employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition 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.❑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' 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. tContractors that check this box must attached an additional sheet showing the name of the sub-c6ntractors 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: at) " "(. • a Policy#or Self-ins.Lic.#: c � Expiration Date: a/ Job Site Address: `��oK C� ` C�� 1 City/State/Zip: C&1 b; l�1 n Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: °-�"._. Date: 0 Phone#: c � ' official use only. Do not_wrrte in this area,to be completed by city or town offkdal 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#: v, Client#:431777 99001533 ADO ,- CERTIFICATE OF LIABILITY INSUR 01126lANCE 1126/1 0D/YY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION USI Rental Specialties ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O.Box 53310 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Irvine,CA 92619 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 800 854-3298 INSURERS AFFORDING COVERAGE INSURED wsURERA: St Paul Fire and Marine Insurance Co American Tent&Table Inc. INSURER B: Travelers Property Cas.Co.of Amerl P O Box 1348 Marstons Mills,MA 02648 INSURER c:INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DATE M DO D M/DDNY) LIMITS A GENERAL LIABILITY CK00222037 01/21/10 01/21/11 EACH OCCURRENCE $1 000 000 X1 COMMERCIAL GENERAL LIAB ILITY FIRE DAMAGE(Any one fire) $100,000 CLAIMS MADE OCCUR MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY S1,000,000 GENERAL AGGREGATE S2,000,000 GEN'L AGGREGATE LIM ITAPPLIES PER: PRODUCTS-COMP/OPAGG $1 000 000 X POLICY PE O- LOC AUTOMOBILE LIABILITY ANY AUTO (a accl dEent)SINGLE LIMIT $ ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ _ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Peraccldent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ AOTHER THAN y AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND XJUB5819Y97510 01/21/10 01/21/11 X WRSTATU- OTHH. EMPLOYERS'LIABILITY E.L.EACH ACCIDENT $100 000 - , E.L.DISEASE-EA EMPLOYEE $100,000 E.L.DISEASE-POLICY LIMIT $500,000 A OTHER CK00222037 01/21/10 01121MI quipment Floater $450,000 Limit ecial Form $5,000 Deductible DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS This certificate is issued as a matter of proof only.*Except 10 days notice of cancellation for non-payment. CERTIFICATE HOLDER ADD mONAL INSURED;INSURER LETTER: - CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION -Cahoon Museum DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TOMAIL30*DAYSWRITTEN P.O.Box 1853 NOTICETOTHE CERTIFICATE HOLDER NAMED TOTH E LEFT,BUTFAILURE TODOSOSHALL Cotult,MA 02635 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES, AUT ORI2E REPRESENTATIVE ACORD 25-S(7197)1 of 2 #M4221572 AXLJG © ACORD CORPORATION 1988 PESO L� i...��.[af"�,y't'��:�°v ..5[sY3✓x ry n... s`.y ,�'�'..?"�3y.H i chs.,:s'.1+�..�: ,.es.`�)" s`'y�a Y off. rff r�F �3:�C 3 a�is�f' r t ate. PE , 'i P" r'�' •"�- )yr. �%- a >a ,} �t 9;•t r. f�.,:'. 'Y 3_�+ -z.. f t, * 3.�9 a o�a�'t' �f:`f.•u 'k v �a;' v Certif t,rate of la� " Z REGISTERED ISSUED BY: " Date treated or S APPIlCAT10N manufactured °s AZTEC TENTS&EVENTS H" tY CONCERN No. 490 ALASKA AVENUE I TORRANCE,CA 90503 �e CAL COMB F-419.01 (310)328-5060 This is to certify that the materials described below hereof have been flame retardant treated(or are inher- endy nonflammable). FOR AMERICAN TENT& TABLE " "aDOREss' 381-OLD.FALMOUTH ROAD.,STE 41 M1h cny MARSTONS MILLS STATE MA..02648 y w'- Certification is hereby made that: (check"a"or "b") -< }. ❑ {a) The articles described below this certificate have been treated with a flame retardant chemical approved and registered by the State Fire Marshal and that the applicabonof said chemical was done in confor- w manse with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. < Name of chemical used............................................Chem.Reg.No..................... y ;><. iper, Meathod of application . 31 ..................................................... ..... >f (b) The articles described below hereof are made from a flame resistant fabric or material registered and approved be the State Fire Marshal for such use;Fabric has been tested and passes NFPA701-96. a� ; Trade name of flame-resistant fabric or material used..c-ted FkbTic .Reg.No....................... ` WILL NOT --, The Flame Retardant Process Used Be Removed by Washing .... ............... r (will or will rot) pfy_ �! David Bradley Chuck Miller- President. Name of AppGrator or Production supenntendent 't._�.� �Y.� r; .; � �•:k��7k L s 0 rp 3 A r 3r� r o ". rk tl•'�K �} .' "4r GtY"q:. .,4�..�?�n.,rCo 'rs ✓, v<x9 r 4- 1� a ��l,T .�°s 1.e C��r n�� )f �s��x'i�1�.� �lt' C i i� �A��r.� .c¢2�� 's �'$�C.,�a ��'�i,�' CUSTOMER ORDER NO. 0134713 - R134713 ITEMS MANUFACTURED: 2- 10 X 10 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, 2- 10 X 10 STANDARD FRAME CANOPY MIDDLES-CLASP ULTRA WHITE, 2-15 X 15 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, 3-20 X 20 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, 3-20 X 10 STANDARD FRAME CANOPY MIDDLES-CLASP ULTRA WHITE, 2-.30 X 30 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA-WHITE: 3-30 X 10 STANDARD FRAME CANOPY MIDDLES CLASP ULTRA WHITE. / x J-V 1 . Barnstable The Town of Barnstable c„ Office of the Town Manager F 367 Main Street,,Hyannis MA 02601 y www.town.barristable.ma-us Office: 508-862-4610 Fax:508-790-6226 s639. . APPLICATION FORM USE OF PROPERTY,PARADES;MARATHONS,TRIATHLONS,ROAD RACES 2007 The approved application must be on file in the Town Manager's Office at least thirty(30)days prior to event. Parade/Road Race application appliUtionj must be received nine 90 days prior to scheduled date. Date of application: 1 / 1 Fee amount: $43.00 per request*:Total paid: ES(c S 'OR cash) NO *Each request means each event such as a parade,followed b ent on the Town Green,for example. This application must be complete/all signatures prior to submitting to the Town Manager for final approval. You may be required to leave application at various Departments'to wait for appropriate signature. 1. CALL TOWN MANAGER'S OFFICE TO TENTATIVELY RESERVE DATE OF EVENT-CHECK AVAILABILITY Request for: Hyannis Village Green Aselton Park Parade Benefit Run/Walk Marathon/Triathlon X Other(please specifyi: Z•r-Tivi7" b-lM&Oe,64. R Certain facilities may require additional fees for services by DPW depending on location,use of staff i size of event. The fees will be determined by DPW and paid directly to that department 2. Name of Event: Cs/161;7 Day/Date of Event: _!7- t74L i/0 Rain date: 3. Name of Sponsoring•Organization: C•llf eGCiJ j1 ze 5-eefffr .-e%e Mailing and physical.address: W 7 Z /Z 0 127-919 Cc 74l 17 /'7,4 6%7,!° '73 4. Contact person: C-�s�;7� ' %✓i c:«a-Sc�J Phone J.5 ois=`+'`a1� - 2E Sfz , 5. Person in charge DAY OF EVENT: /Z. ��/ '-`� Cell phone: ✓c��-7`7� �S S�s� f 6. Set up time: 7:e'ej'/h Actual event start and.end time: A%`-e 1417 Clean up time: 7. Estimated number of volunteers/participants: Estimated number of spectators: /.G >>POLICE DEPT will determine if extra detail necessary. 8. Admission fee/registration charged to participants?:' +--.No If yes: Amount:^ Will there be food or craft vendors at event? y Yes No >>If yes,indicate the number of vendors land type(food/merch(a`ndis/ee/etc): + �_ >>Will there be merchandise available for sale? Yes No. _N/A Vendors need to complete application for special licenses at the Licensing Division-200 Main Street,Hyannis. 9. Map attached(REQUIRED)for road race/parade event. >>Aie street closures required: .; Yes. No,`. >>Detail of route and rest stops attached/indicated on map. 10. Food prepared/served at event? Yes No x >>If yes,will there be cooking/heating involved? Yes No Page 2 of 2 a TENTS REQUIRE ADDITIONAL PERMIT FROM ELDG DEPT. Structures&Grounds have designated tent friendly zones. Should you require tent elsewhere other than these zones,location needs to first be cleared with Structures&Grounds. >>No open flames in tents or propane storage use without a fire permit. 11. Are you installing or constructing any structures,including buildings,climbing structures,etc? _Yes No 12. Are you installing any tents for canopies? Yes _-No Quantity and size: X ;,CV 3v) Own or rent?P-" Rental company: Tel# 13. Do you plan to have any sound amplification? Yes No Music Other(please describe) 14. Is electrical power required? X Yes No (for sound amplification(PA system),lighting,popcorn machine,etc) >>If yes,circle: will you provide portable generator? OR will you require TOB temporary service? >>List maximum wattage required and location for hook-up: j f"t If more than'usual'hookups,please note there will be overtime costs if Town Electrician setting up and removing "A-frame"or drogginq service before/after event outside of business hours. CONES.BAlZRIE16. 15.Do you have need for barricades/cones? 1C Yes No >>If yes,describe for what use: PI&A--A/-' !s/ "-,6 r > we-If r DEPOSITS: $5.00 each cone. $50.00 each/barritades(quantities/deposits arranged through DPW). 16.Will.you require access to the town building?—Yes No . >>If yes,describe for what use: 17.Do you plan to drive vehicles onto property? If yes,provide details: '7_05%>TS, AA-6LAX t;txr"e Oz� Specific loading zones to be reviewed with DPW/Structures&Grounds. . Organization will be liable for any damages vehicles may cause the ground. Ac 18. Do you plan to provide portable toilets and/or hand washing sinks at your event? V Yes No >>If yes: #of regular toilets #of handicap accessible toilets �_#of hand washing sinks Public Comfort Stations located at Town Hall Parking Lot,North Street and Barnstable Village Fire Station are o en from 9AM to 9PM,daily. If event absolute! requires earl o en,it must be reviewed with DPW. 19. Trash pick up is the responsibility of the organization requesting this permit. Please provide your plan for the cleanup and removal of garbage and recyclables during and after your event: 7A17 s 14 e4. LS Number of recycling containers: .2 Number of garbage receptacles: S A one time disposal fee for use of Town containers may be assessed. Any fee will be determined and collected by DPW. The cost is based on size of event 20.Will there be demos,displays,materials that are potentially hazardous/impact public safety?—Yes XNo >>If yes,describe: 21.Have you made any provision for on-site security? _Yes_ o 22.Have you made any provision for on-site medical services? Yes �'No 23,Please provide description of your parking plans(where event attendees will park):��ivAT�Ht�s n,�rt�?Bf >>Plans for disabled parking: >>Plan for emergency vehicle access: S'c if cc%t .1 r GX 1-14111 Si' >>Please describe your plans to notify residents,businesses impacted by this event: 24.Will the event be advertised? If yes,where: WArIJ Pc-Sr-,e S n l e4-5-/sAW >>Do you plan to distribute flyers or ads before or during this event? _�C Yes No >>Do you plan to place any signs or banners or other advertisement at the event site? Yes No >>If yes,please indicate where: >>Provide sign/banner detail and dimensions and method of attachment or support: L%-�� iC %G`� i•iJ T�s�Yf (Signage may require additional permits). 5/4/2010 I have read, understand and agree to abide by each numbered item on the attached"Rules and Regulations for Use of Village Green and other Town Property" H "Rules and Regulations for Parades, Walkathons, Road Races" and as the agent for the sponsoring organization, agree to abide by said rules and any others eci_ co diti s (letters may be attached)established for this particular event: . Signature'of sponsoring agent/Date Printed Name: APPROVED B CHIEF OF POLICE AATE: (Barnstable Police Dep ent, 1200 P n ey's Lane yannis 8-778-3805) CHIEF OF FIRE DEPT(S) DATE: I,f (Village Fire Department,Addr es vary) ; RECREATION DATE: (Hyannis Youth&Commum ter, 141 Bas Lane,Hyannis 508-790-6345) PUBLIC WORKS < .�rr�/' i l l—/f DATE: llwm (School Admin Bldg,230 Soutl 9 treet,4ffi oor 508-862-4090) 1¢1 1 D REGULATORY SERVICES ' F �^ ( DATE: (200 Main Street,Hyannis 5 8-8 2-4674) . r 1fj� BOARD OF HEALTH L t li, N DATE: (N/A for Parade/Race ermits unless serving food.508-8 -4644) BUILDING DEPT G /1 DATE: (N/A for Parade/Race permits unn a'cting tents. 508-86 -4038) TOWN MANAGER // DATE: (Town Hall,367 Main Street,2".flo r,Hyannis 508-862-4610) SPECIAL CONDITIONS and ANY FEES(As determined by Department's above) DETAILED AS FOLLOWS: a T n TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION.. Map Parcel O O ` Application # ; Health Division Date Issued , Conservation Division Application Fee_ Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH Preservation/Hyannis Project Street Address Village Owner Address-"40 D / /`kL Telephone Permit Request s C&�v D k ; GU J-4 Square feet: 1 st floor: existing proposed 2nd floor: 'existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type - Lot Size Grandfathered: ❑Yes ❑ No If ye ach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Famil units) Age of Existing Structure Historic House: ❑ ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout her Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing ew Half: existing new Number of Bedrooms: existing —new Total Room Count (not including ths): existing new First Floor Room Count Heat Type and Fuel: ❑ Ga ❑Oil ❑ Electric ❑Other Central Air: ❑Yes No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached gara e: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning and of Appeals Authorization ❑ Appeal # Recorded ❑ Co ercial ❑Yes ❑ No If yes, site plan review# ' rrent Use _Proposed_Use__-_ _ -- cn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) . r_ Name Telephone Number Address 7 ® &v License# ✓` /OS Home Improvement Contractor# ba) Yr Worker's Compensation # U� dl ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO r7—o /�- SIGNATURE DATE ��'` il. FOR OFFICIAL USE ONLY APPLICATION# , DATE ISSUED MAP/PARCEL N0. + ADDRESS VILLAGE OWNER r. DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE , ELECTRICAL: ROUGH FINAL a PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts - Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 v www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print ULAbly Name(Business/Organization/Individual): Address: 1 y City/State/Zip: h juj S /Ilr Phone.#: AVI an employer? Check the appropriate bog: Type of project(required): 1. m a employer with 8 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g• ❑ Demolition. workingfor me in an capacity. employees and have workers' y p �'• $ 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. xContractors 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 Policy#or Self-ins. Lic.#: Vso 8 oO / IS09 Expiration Date: 0_17 " Job Site Address: , City/State/Zip: J � ( Attach a copy of We 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 tip 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 DL4 for insurance coverage verification. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct+ Si afore: Date: Phone Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees: Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more e a joint enterprise, and including the legal representative's of a deceased employer, or the of the foregoing engag din � rp g g P 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 ' completely,b checking the boxes that apply to our situation and,if compensation affidavit co 1 Y Y Please fill out the workers mP mp y, y $ PP necessary,supply sub-contractors)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies*(LLC) or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required..Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current Policy information(if necessary) and under"Job Site Address" the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Cormmonweaith of Massachusetts Department of Industrial Accidents Office of Investigatims 6.00 Washington Street Boston, MA 02111 TO. # 617-727-4900 ext 40fi or 1-S77-MASSAFE Fax# 617-727-7744 Revised 11-22-06 www.rnass..govfdia ;,610537 5/7/2009 3:58:42 PM PAGE 2/003 Fax Server C CERTIFICATE OF LIABILITY INSURANCE U07 PRODUCER THIS CERTIRCATE IS ISSUED AS A MATTER OF INFORMA7M USI Rental Specialties ONLY AMID CONFERS NO RIGM UPON IM CITE s P.O.Box 53310 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EKTMD OR ALTER THE COVERAGE AFFORDIM BY THE POLICIES DELOW I►vine,CA 92619 800 854.3298 INSURERS AFFORDING COVERAGE INSvRE° RSA: St Paul Fire and Marine bmwane Co American 48 &Table Inc. I �T y Cas.Co.of Aimed P O BOX 9348 INSURER c Marston Mills,MA 02648 INSURER a - INSURER E - COVERAGE.$ THE POLICIES OF INSURANCE LINED BELOW HAVE BEEN ISSUED TO THE IUD NAMED ABOVE FOR THE POLICY PERIODINDICJ1IIED.NORWRHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE COTI F[CATE MAY BE DIED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBA=TO ALL THE TERMS,E=LUSK)NS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR TYPE DBE POLICY POLICVEFFECTWE ERPB&nw LTRA GENERAL unEwy CK00220040 01121109 01121110 EACHOCCURRENCE $1000 000 X COMMERCIALGEN074ALLABILITY FIRE DAMAGE —We $100000 CLAIMS MADE NJ OCCUR _ .. MED EXP(AaWaw Pam) ADM PER &ADYINAIRY 41,000,000 GENERAL At EMTE 000000 GENLAGGREGATEUMITAPPLIESPER: PRODUCTS-COMPIOP AGO $1 00C X POUCY JECI PRO. IF]LOG i AUPOMBILE LIABIJTY ! COMINNIM SIRYA.E ULSIT ANY AUTO Ib ►) $ { i ALL OWNED AUTOS 60myW,BM $ SCHEDULED AUTOS (ft P—) HIRED AUTOS ICILY INJURY NON43WNED AUTOSPROPERTYDAMAGE $ GARAGEUABLITY AUrOONLY-EAACCID631ET $ ANY AUTO OTHERTHAN EAACC $ AUTOONLY: AGO EXCESS UAMU TY EACHOCCURRENCE s OCCUR CIAIMSMADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION B WORKERSCOMPENSATMANO XdUB5819Y975O9 01/21/09 09/21/t0 X wCSTATt� E MPLOYEWLIABRM - EL EACH ACCIDENT $100 000 EL DISEASE-FA EMPL s1 000 -- EL.DISEASE-POLiGY uMrr s500 000 A OTHER CK00220040 01121/09 0112'1/10 uipment Floater $MOOD Limit 3paclal Forth OOO Deductible DESCRIPTION OF OPERA71ORSI1ACA71OHM ICLESIIERCLUSIOM ADM BY ENDOWEVENTASPECIAL PROVISIONS This certificate Is Issued as a matter of proof ENhly.*Except 10 days notes of cancellation for nonqmiyment. CERTIFICATE HOLDER mOIT NIALINMIRED REnLETTFA: CANCELLATION $MOULDANYGMEABMDESCROEOPOUMSBECANCELLEDBEPOMTI#EES UMM The Cahoon Museum DATE THEREOF,Tare ISSUNS INSURER WALL ENDEAVOR TONA2.3W—DAYSWRRTEN 4676 Falmouth.Road NOTICETUTHE CERWICMHOLDERRRAN®TOTHELEFT,§WFAWRETODOMMALL Colult,MA 02635 IMPOSE NOOBLIGATWNORLIABW YOFANYNINDUPONTHEINSURE MAGENTSOR REPRESFMATIYES. OEM 1A119Z - ACORD 2"(7197)1 Of 2 #S3834203IM3266806 A)M,,Je 0 ACORD CORPORATION 1988 (CertifmsV�i rate ofIN : REGISTERED ISSUED BY: Date treated or manufactured �O �►p9 APPLICATION AZTEC TENTS&EVENTS CONCERN NO. 490 ALASKA AVENUE 1' ,4 tr TORRANCE,CA 90503 A,1 � :: CAL COMB F-419.01 (310)328-5060 �A This is to certify that the materials described below hereof have been flame retardant treated(or are inher- endy nonflammable). , AMERICAN TENT&TABLE- ADDRESS 381-OLD.FALMOUT.H ROAD,...STE 41 CITYMARSTONS MILLS STATE MA..02648 ` Certification is hereby made that. check "a"or "b" The articles described below this certificate have been treated with a flame retardant chemical approved ' and registered by the State Fire Marshal and that the applicationof said chemical was done in confor- mance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal Name of chemical used............................................Chem.Reg.No......................... Meathodof application.......................................................................... ................. (b) The articles described below hereof are made from a flame-resistant fabric or material registered and approved be the State Fire Marshal for such use;Fabric has been tested and passes NFPA701-96. Trade name of flame-resistant fabric or material used..Coated Fabric .Reg.No. WILL NOT The Flame Retardant Process Used ........ Be Removed by Washing W (will orwfll not) Y ` David Bradley Chuck Miller.-..President �M Name of App6ptor or Production Superintendent _—T+�e— —_----_--- d� a 1 a '4 r� r � c �4 s' � J�� „+ A� 1,+ Yy �,F� •�4xC+A�� {��T�' d A�,�'�+„�,�`tJ '+!i + +. � 0 d ll t l y, o '..v` �, ? .-'�tYr E � + f n�?t �z c§i -4 .�'>.� kai 4.. �> �+ 4r <✓ .fTa, .e+' .,Gt� .d '.�`Y CUSTOMER ORDER NO. 0134713 - R134713 h ITEMS MANUFACTURED: 2- 10 X 10 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, 2- 10 X 10 STANDARD FRAME CANOPY MIDDLES-CLASP ULTRA WHITE, 2- 15 X 15 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, .� 3-20 X 20 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE,' ' .. 3-20 X 10 STANDARD FRAME CANOPY MIDDLES-CLASP ULTRA WHITE, 2 30 X 30 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, 3-30 X 10 STANDARD FRAME CANOPY MIDDLES-CLASP ULTRA WHITE. 05/06/2009 11:01 FAX 508 790 8226 TOWN MANAGER 2001 ,:. 'he- 'T ow of Barnstable Bamrsscaatste Mee ofthe'Town A anager 11 367 Main Street9 Hyannis NIA 02601 _NWrvW WMhg table JMA!_Us Office: 5DB-862-46 10 Faa:508-7M0-6226 APPLICATION FORM - USE OF PROPERTY,PARADES,MARA'P'MONSo'Y'kdU'f'MONS,ROAD RACES 2007 Ile approved application must be ors file In the Town Miandger's Office at least tbirty(30)slays prior to event. Paraadt%oad Race;R221kagons must be received Hisao 90 ds s rioP to seha doled date Date of applka iora: � � _ - — _ Fee ar acnint: $43.00 per request*:'Total paid: f��.ds7 (ck� 2�.�.�R cash) _w�10 *Each request means each event such es a parade,followed by";;,cv Mft—tr"r-own Oreen,for-marnple. Thla application must bs'conplatelall 69natutesr prior to submitting to the Tower Manaarger fnrtbrial approval. You may be required to leave application at vaarlous Departments'to wait for appropriate signaaturep 1. CALL'TC)WN r IAN' AGER.'S OFFICE TO TENTATIVELY ttESERVE DXTE OF EVEW-Cf1LCK AYAIL.AB7LiTY Ragasost for Hyannis Village Green �4selton Park _Parade eneflt Run/W,9a9ilG lvYarathpnfTTrictLrlorr _ t°f�th®r tptea�e spcoify): G �, �`,�C•.f a-If carteain%riO4ias may require addltionai fuse for services by DPW depending on loretlon,use of staff ri size of ever L Thebes will be datenn fined by DPW and paid directly to that depaarbnaraL 2. Name of Event:� �G� Daay/P?ats of Event: 5%i9> r7 4'd-I " `I Rain date: 14 74-4 f-/,> 3, Na rno,of Sponsoring Orgmi.Tatiorr._ C/ J _/`��5� r_r� �lr� �ee i2 r r,i A Mailing and physical address: 7 F'l-n rue,"rg_a^-o !_ 4. "ContR on: 0 l Fhone;_ S. Persmi is charge DAY OF EVENS": &7`eX r��-/ia, ra Cell p'hane: 6. Set up time: t',r- !!Actvat9 event start and and time: 't? 3Gc J4" Clean up titan: ' Se-,/3 7. Est4aded number ofvolunteers/pas licipaants: 6�J E-Mmaatted number of Spectators:. >>POLICE DEPT%ill determine if'extra detail ntmssairy. a R. fldmi'Qion feaslregisKration charged to participants? 1+io if yes: Ariount:_ Will tha:te be food ormd vtmdom at event? S`cs No »bf Yes; ndkaatr the numb r of vendors and,type(food/rnerchaandiselete): ,�y >>Will Oin be mw6handise available for sale? ,Yes �No R11A ��-- Vmmdwi need to=wltft applicadion for special licenses at the Licensing Divisiorr200 Win street,Hyannis. 4, Map Wttached TXQUIRED)for road ratcetpa mde event. >>Are strtet closures required-_...__yeg No >--D of route and rest stops attacbWindicaawd on niap. 10. Food prepared/= ed ail event? ,_T'el �No »I'yes.,WW there be eooldng/hesating involved? ZYcs_ 140 05/06/2009 11:0 ; FAX 508 790 6226 TOWN, MANAGER Z 002 w , i TIt11 8 REQUMM A73I) TONAL PERM T FROM BLDG ISEPT, Stractures&Grounds have daignsted tent friendly=mes Should you,require tmt elsewhem other than gloss zones,looetioa needs to first be clewed with Structures&Grounds. >> o open]flumes In tests or propaoate stovage use without as fire permit. „ 11. Are;you hlzr e•lling or constructing any structures,iDcluding buildings,climbing structures.etc? . , 'Yes -2!�Nd' 12. Ara;you lru;Wling tany tarts or caanopi;s? :eyes —Nei Quantity and size: Al Own or rent? Rental company: i!�W.4/P4a� Jrt-.#i Tel# - 13, eta you plan to hive any sonaad araapli paation? 2-Yes No Music x �Gltftrr(please describe) 14. 1G clectrrical power required? -Lycs. No (fear sound gunplif Won(PA systeaa),ligl time,p°"Pom machine,etc) . >>If yes,cirxie: will you provide portable generator? OR will you require TOO tempurs+ry service? »List rnaximaurn wattage required and IDcation feu•hook-up: !`�3 Coe^fZ .wt71- ff rrarm than'usual'hookups,please note there wlll be over costs if Town Eleactrfclan setting rip and removing "A-Imme" d semis be to lter event outside of business hours. 15.17u you have need for barricaadssiconts7 yX aces 14o »lf yes;describe for whaat use: re G /r eweidifi L"EPOSM: $5.00 each cone. S50.00 eaachr'baaricades(quintities/deposits aaraau through AP°+'+5- 16.Will you a•equim aacress to the town building?___Yes __X No »Tf yes,data ibe for whet use: 17.Do you p6n to drive veMeles onto propertY7 IfYts,provide;dam„ �h;Eg ces�'1�1��'re Spoi;Ze loading zones to be reviewed with DPW/Structures&Grounds. Orgulzalion wall be liable for any denageu vehicles may cause the ground. 19. Do yowpla3n to provide portable toliats and/or had washing sinks at yourevent? Yes No . »lfyes � all cfregsalaaa toilets _L#of tmilicap accessible toilets __-/ #of hand wmnhing sinks Publk,,Comfort Stations loured at Town Hell Paa&Jng Lot,North Street and Baaas•astable Village Flag Station rare o n front l to 5PK dal If event absolute ulren$ariaopen it must be ree�iaaaxecll writla DPW. 19. Tmsh pick up its the responsibility of the orgy katsou reque9bg this permit_ Please provide your plan for the cleanup and removal of gage and mcyclables during and after your event: 7 445,p-o e.-oA " 'Nlumbea of rea yoling x atain INumhcr of gaarbogc Mctptaa:lcs:- A One Brno disPossl fee for uaa of Town cnratsaieaeas -nay be mmssed. Aiaay iim *10 be a9eteamined and rallezted by f:pw. The em is based Do size of ova* 20.Will there-be chinos,displays,maatedels that care potentiaally"a=r&%9sr1M"P8d"pub1jc"sa&ty7Y No >>i f yam,der..e.-ra'be 21.Have you Tirade spy provision for On-site swurity?--- Ye€ )`No 2Z Nays.YO4 anade my ProyWon fior sitc uneHcal ? Yes No - 23.Plea -;pervade de aiptlsrx of yottr paddng pDaaaas(Viktm overat anvoicim will prsrk). iV.#I--,�e+*� [f� »Flaw for ft bled parking; R,, »Pl _ w for ctawginicy isle access:---.�"L17 L i•,� rat ST>>fle ex dez lbt your plans to notify regideuts,businesses impacted by eve%te _ _ — 24.Will dire event be edvmILW? If yM where: 5/ `_�s sr�,C S N4W;1PA/V11 >Do you plum to distci rtt flyer or tads before or dtu event?� Year .Na »133o you pier;to place tarty sib or baarsa>ras or other advratis -anent at the event site? Yea »if•yes.pleast indimtc+vh=. _ Paxivitde sigAanner detail and dhensioraa and OfaltSChMW Or support ;' d/X po ••_��'-AKA. (Sipage may require additional paralts). 05/06i2009 1.1:WS FAX 508 790 6226 TOWN MANAGER "]003 I have read, understand and agree to abide by each numbered item on the attached"Rules and Regulations for Use of Village Green and other Town Property" /./ "R des and Regulations for Parades, Walkethons, Road Races" and as the agent for the sponsoring organization,agree to abide b said rule, and an , "i� � ethers c'a.l ct.radc " ns letters ma be attached established for this particular _ event. Signature of sponsoring agent/Date Printed Name:_4- 12 A-4 A-ex 9+?bB•�#dYc#dt�lkBP+b�'N#dtC�.hE•ki#kR#K&t4 ikFrAwkfk'k0@d#kii4#i#4*6p60+Md�+kt+#?a-k4'#k4is4�0iARikGtAORs�# APPROVED BY, 1.7 CHIEF OF POLICE J� D E. (Bam' stable Police Btpartment, l2 Kinney' Lane,Hyan 's 508-778-M05) J GRIEF IRE DEPT'(5) OF FIRE (Village Fire Departmcn4.Add es vary) JRECRYAL'TIOTf DATE: � C! (Hyaruais Youth&Community Cent L5 ��}Hyarmis 508-790-6345) PUBLIC WORMS DATE: (School A.dnin Bldg,230 So� Floor 508-B62-4090) J REG TORY SERVICES� �DAZE:, ✓ �� Lfr�4 �� 200 Main 5tree a ree IAARD OF IZAL`rfi + (N/A for Pereda/Ige its I wing fond' 509-8 -4b44) BU`ILDMgG]DEPT DATE-. 1�- (N/A for,Parm&%ca permits, Mcting teits. 508-862-4030) TOWN MANAGER _ DATE: �r�2G i S' (Town Hall,367 Mai; oor.Hyea�.is 508-862.4610)- �� SPEEClAL CONDITIONS a=.d ANY PEES(As determined by Department's above) DETAW,M AS FOLLOWS: Ve> tea'! The Town of Barnstable Bares P o„ Office of the Town Manager E 367 Main Street,Hyannis MA 02601 A1141mliftaC111 * � Office: 508-862-4610 Fax:508-790-6226 s�w wwwtown.barnstable.ma us I f. APPLICATION FORM 2007 USE OF PROPERTY,PARADES,MARATHONS,TRIATHLONS,ROAD RACES The approved application must be on file in the Town Manager's Office at least thirty(30)days prior to event. Parade/Road Race applications ipust be received nine 90 days prior to scheduled date. Date of application: Fee amount: $43.00 per request*:Total paid: YES(ck# OR cash) NO *Each request means each event such as a parade,followed by an event on the Town Green,for example. This application must be completelall signatures prior to submitting to the Town Manager for final approval. You may be required to leave application at various Departments'to wait for appropriate signature. 1. CALL TOWN MANAGER'S OFFICE TO TENTATIVELY RESERVE DATE OF EVENT-CHECK AVAILABILITY Request for: Hyannis Village Green Aselton Park Parade BenefitRun/Walk MarathowTriathlon Other(pleasespecify): CC741/7- VIZI.4a Certain facilities may require additional fees for services by DPW depending on location,use of staff&size of event. The fees will be determined by DPW and paid directly to that department 2. Name of Event: 1V S �� Day/Date of Event: S'� T T4-1 r l Rain date: `Y" / 'T" t /2 3. Name of Sponsoring Organization: C,09 flaw Mailing and physical address: d 7 7 1119 - P,cw� -� p�,,�,e ��h�� •for �-�,� �i�/ 4. Contact person: �� OQGp X i ��/fe.�� Phone: & F 17y- 5. Person in charge DAY OF EVENT: IeTe/L ��/ice n Cell phone: 6. Setup time: ' Ot "Actual event start and end time: Cleanup time: 7. Estimated number of volunteers/participants: �G Estimated number of spectators: GG >>POLICE DEPT will determine if extra detail necessary. 8. Admission fee/registration charged to participants? I/ No If yes: .Amount: Will there be food or craft vendors at event? V'—Yes No >>If yes,indicate the number of vendors and type(food/merchandise/etc): f�ftnBa,eG�� HGT/�G�s �fi�'r 5ccu7 »Will.there be merchandise available for sale? x Yes No N/A Vendors need to complete application for special licenses at the Licensing Division-200 Main Street,Hyannis. 9. Map attached(REQUIRED)for road race/parade event >>Are street closures required: Yes No >>De:tail of route and rest stops attached/indicated on map. 10. Food prepared/served at event? )4 Yes No >>If yes,will there be cooking/heating involved?_ZYes No i I have read,understand and agree to abide by each numbered item on the Ir, attached "Rules and Regulations for Use of Village Green and other Town Property" H "Rules and Regulations for Parades, Walkathons, Road Races" and as the agent for the sponsoring organization, agree to abide by said rules and any other special_Condit' ns (letters may be attached) established for this particular event. Signature of sponsoring agent/Date Printed Name: 4f%,n XoGh IrrE, APPROVED BY: CHIEF OF POLICE DATE: (Barnstable Police Department, 1200 Phinney's Lane,Hyannis 508-778-3805) CHIEF OF FIRE DEPT(S) DATE: (Village Fire Department,.Addresses vary) RECREATION DATE: (Hyannis Youth&Community Cent , 141 Basset Lane Hyannis 508-790-6345) 41 PUBLIC WORKS_s�� P ,-G DATE: (School Admin Bldg,230 South gtreetf Floor 508-862-4090) REGULATORY SERVICES-s C DATE: 2O i 1 91� 5 (200 Main Street,H � y rc —POARD OF HEALTH 1 DATE: 2 a O � l uhll c (N/A for Parade/Rs its unt serving food.508-8 4644) BUILDING DEPT _ DATE: (N/A for Parade/Race permits unless erecting tents. 508-862-4038) TOWN MANAGER DATE: (Town Hall,367 Main Street,2" floor,Hyannis 508-862=4610) SPECIAL CONDITIONS and ANY FEES(As determined by Department's above) DETAILED AS FOLLOWS: wy i i i gar The Town of Barnstable s Office of the Town Manager IF 367 Main Street,Hyannis MA 02601 nerlca i BARNSrABLE, : www.town.bamstable.ma.us Office: 508-8624610 Fax: 508-790-6226 KAM 1639. IN APPLICATION FORM rEnr USE OF PROPERTY,PARADES,MARATHONS,TRIATHLONS,ROAD RACES 2007 The approved application must be on file in the Town Manager's Office at least thirty(30)days prior to event. Parade/Road Race applications must be received ninety_90 days prior to scheduled date. Date of application: _ - -- ). ' _)/+-1-7 - �P_ _-P eye,7 Fee amount: $43.00 per re `est*:Total paid: YES(ck# OR cash) NO *Each request means each event such as a parade,followed by an event on the Town Green,for example. This application must be complete/all signatures prior to submitting to the Town Manager for final approval. You may be required to leave application at various Departments'to wait for appropriate signature. 1. CALL TOWN MANAGER'S OFFICE TO TENTATIVELY RESERVE DATE OF EVENT-CHECK AVAILABILITY Request for: Hyannis Village Green Aselton Park Parade n Benefit Run/Walk I Marathon/Triathlon Other(please specify): Certain facilities may require additional fees for services by DPW depending on location,use of staff&size of event The fees will be determined by DPW and paid directly to that department 2. Name of Event: ► S Day/Date of Event: C� / d S// fit'c'9 Rain date: ly ct-?,r�e_ 3. Name of Sponsoring Organization: 0e) `Y Mailing and physical address: 1 -' f c ��(� �" `��t �'11 Z� 3 s S 4. Contact person: Re-'t-e.r �d /t �1 42 C Phone: s-6 q j 5. Person in charge DAY OF EVENT: p e+-c f ��i✓/�F',Q' Cell phone: � /c� �� " q sk, 6. Setup time: ' t'o'41'1 Actual event start and end time; °� fit' ��'Cleanup time:3 7. Estimated number of volunteers/participants: Estimated number of spectators: 0 >>POLICE DEPT will determine if extra detail necessary. 8. Admission fee/registration charged to participa/nts? No If yes:. Amount: ��. Will there be food or craft vendors at event? V Yes No >>If yes,indicate the number of vendors and type(food/merchandise/etc): 61 >>Will there be merchandise available for sale? t- ` es No N/A Vendors need to complete application for special licenses at the Licensing Division-200 Main Street,Hyannis. 9. Map attached(REQUIRED)for road race/parade event. >>Are street closures required: Yes No >>Detail of route and rest stops attachedlindicated on map. / S�''u U 10. Food prepared/served at event? ` Yes No/ >>If yes,will there be cooking/heating involved? V Yes No i I have read, understand and agree to abide by each numbered item on the attached"Rules and Regulations for Use of Village Green and other Town Property" // "Rules and Regulations for Parades, Walkathons, Road Races" and as the agent for the sponsoring organization, agree to abide by said rules and any other special conditions (letters may be attached) established for this particular event. Signature of sponsoring agent/Date Printed Name: -�� `��l �i �� -e-r APPROVED BY: CHIEF OF POLICE _Y DATE: (Barnstable Police Department, 1200 Phinney's Lane,Hyannis 508-778-3805) CHIEF OF FIRE DEPT(S) DATE: (Village Fire Department,.Addresses vary) RECREATION ;? DATE: (Hyannis Youth&Community Ce er,.,I'h Basset Lane,Hyannis 508-790-6345) PUBLIC WORKS / f /. / G DATE: %� Q (School Admin Bldg,23 South Str et,4 lo jjr 5508-862-4090) REGULATORY SERVICES &t DATE: LZ2 (200 Main Street,Hyannis 508-862-4674) BOARD OF HEALTH C# etlt,/ej-- Ll DATE: o-L (N/A for Parade/Rac its less ing food. 508-8 -4 4) BUILDING DEP Ct'/l/1�Z(�_ DATE: CO (N/A for Parade/Rac permits unless erecting tents. 508-862-4038) TOWN MANAGER DATE: (Town Hall,367 Main Street,2'd floor,Hyannis 508-862-4610) SPECIAL CONDITIONS and ANY FEES(As determined by Department's above) DETAILED AS FOLLOWS: 140�r� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map" Pei CO Application# Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis O Project Street Address Village GNU 1 4 Owner a r in.S`1 c I� Address _ S� r✓t rD'`} Telephone _. z&— /6 4 Permit Request ) I`& 1 I�X� / �J� J_�' 136 �l 11 hs— --- A 3/0� , (�SOU � J S/-t'Q a) Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. O Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing F new Number of Bedrooms: existing new . Total Room Count(not including baths):existing new First Floor Roorrt_iliount <- Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Cr Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/co I stove: Yet ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑ xisting S newAize r*r Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION ,.Name 7- iC '� /l•'T..`�� Li Telephone Number ' Address U License# A2_& 1-7)1,46 hn' Home Improvement Contractor# y' Worker's Compensation# X v yq 75 � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE { FOR OFFICIAL USE ONLY s PERMIT NO. DATE ISSUED i . MAP/PARCEL NO. i ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i ` Iite Co nnv aft of Massochumas { 4 , D ►at v,f Industrial Accidents Office of Investigations 600 Waskinton Street Kam"Z, Boston,M4 02111 wow- Wssgovfdi[d Workers' Compensation Insurance A avit: Builders/Contracto.rs/ElectriciaiiuMumbm Au®liMt Inforffiation Please Prin!Left Name($usiness/OrgaanizatioroIndiyidual} L�fe— Address: b !. •� City/State/Zip: ' i euS u t�-r Phone#.. ��(f f Are you an employer?Check the appropriate box: Type of project(rtq ). I.❑ I am a employer with 1 am a general contractor and I employees(full and/or part-time).` have hired the.sub-contractors 6. C]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 2- Remodeling ship and have no employees -Mere sub-contactors have g. Demolitionworking for me in any capacity. workers'comp.insurance. . Building addition [No workers'comp. insurance 5- 0 We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.[1 I am a homeowner doing all work right of exemption per,,%iGL 1 i.E1 P'lUMbing;repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no I2.F-1 hoof repairs insurance required.]; employees. [No workers` Jj comp, insurance required.] ` 13.�E3ther E� *Any applicant that checks box#}must also fill out the section betoa sbo%ine their workers'compensation Pe4tcy ibrmation. Homeowners who submit this affidavit indicating then ate doing all work and then hire outside contractors nrjg submit a new•affidw n Wkwing _ �Coatractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers,comp.policy infummlion I am an enw1oyer that is providi)W worm'conrensadon ensua ee ear infovnr[rtio f ex. Below is tkep ff,�V and Insurance Company Name- Policy#or Self-ins.Lic.#: Y, tr1 �j i19 "f Y`� � �•� t ` — Expiration Bade. Job Site Address:_I C/IJ— / �7City.'StateiZip:�i C)rr. Attach a copy of the workers`compensation policy declaratiomm .(showing po 'number ate expinMon mil, Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition as:criminal penalties of a fine up to S 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 dais.statement may be forwarded to the office of Investigations of the®IA for insurance coverage verification. I do hereby certo�under the pains andpenaNes rr.f pedmiy that the Q u f provided above true and correct Si ature: Date: (� Phone 1 ®,f t'eial use only. Do not writet/ais area,to be conVieted 1y city or towar OAWOL City or Town: P,erw .'cem# Issuing Authority(circle one 1. board of Health Z.Building Department 3.CitYaawn CleFk #. Metrical I or 5.Plumbing Inspector 6.Other Contact Person: USI South Coast 5/15/2008 9:59 AM PAGE 2/003 Fax Server ml 99001538 CERTIFICATE OF LIABILITY INSUPANCE7 am mom PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF I TIO USI Rental Specla(ths-EP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.B.Box 53310 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Irvine,CA 92619-3310 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 800 854-3298 INSURERS AFFORDING COVERAGE INSURED SISURER A: St.Paul Fire and Marine Insurance American Tan Br Table FO Box 1348 INSURER B: Travelers Indemn Comparri of Amert Marston Mills MA 02648 INSURER a INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 'HUED TO THE INSURED NAMED ABOVE FORTHE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF My CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T.H18 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN E SUBJECT TO ALL THE TERMS.EXCLUSIONS AND COPDITION$OFSUCH POLICIE&AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUC®BY PAID CLAM. TYPE OF INSURANCE POLICY NUMBER E7tNRA7TON LOTS A faENERALLIAeum ' CK00220040 01121/OS 01/21/09 1;ZOCMRRENCE $1000000 X COMMERCLALGENERALLIABILRY FIRE DAMAGE arlefbre) 8100000 CLAfn1S T•=E a OCCUR MED EXP(Arw as ) $$OOO PERSONAL IADMIURY $1 000 GENERAL AGGREGATE MC" GENLAGGREGATEUMITAPPLESPER: PRODUCTS-CO $1000 X POLICY Lac AUTOMOBILE LIABRJTY OOMSBR:D SNGW LlDT ANYAUTO (Eaaad&d) b ALL 06%TD AUTOS &MEDULED AUTO8 BODLY INAIRY $ (Pspmm) HIREDAUTOS NON•OVNEDAUTO9 (Pga ) $ PROPERTYDAMAt $ {per saddenlj IiAIWGE LIABILITY AVTOONLY-FAACCIDENT $ ANYAUTO EA ACC $ AUTOONNL AGO $ EXCESS LLMLITY EACH OCCURRENCE $ OCCUR 0 CLANS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ B WORHERSCOMPENSATIONAND XFNB5819Y97508 01/21/08 01M109 X wcSTATv- EMPLOYERWUABILITY EL.FACHACCIDENT $100 OOO EL.DISEASE-EAEMPLOYER4$10 000 El-DISEASE-POLICY MIT] $5ld. A OTHER CK00MNO 01/21108 01/21109 tquipment Floater $45D,000 Limit iai Form E 000 Deductible DESC U MON OF OPERATIONbiLOPAT QN&%I HICLEgfp(q UglM SADDED BY DIDONEIgMMECIM PRO1I ONS This certificate 1s Issued as a matter of proof only.*Except 10 days notice Of cancellation for non-payment CERTIFICATE HOLDER mDnwALIK8URED-K8URERL6TT1It C N SHOM AMYCFTHEABOYE DESIRED PMJCIE$BE CAMMLLED BEFORE THE E> Cahoon MMSBUm DATE THEREOF,THE ISSUING NSURER VEIL ENDEAVOR TONAL W DAYSWRITM P.O.BOX i853 NOIICETOTHE CERTIFICATE HOLDERNANEDTOTHELEFT BDrFAILURE TODOSOSHALL CONK,MA 0205 BBPOSENOOBLIGAMONORLIABILRYOPANYIUNDUPON THE NSURERMA6ENTSOR REPRENWATIYER, NMJMMRP -,REPRESENTATIVE ACORD 25-S(7191)1 of 2 #=62692N2233561 AXUG 0 ACORD CORPORATION 198R 0 ,11.3!2008 11.:57 FAX 508 790 6228 '':'OWN MANAGER APPLICATION-FOR TOWN PROPE USE OF VILLAGE GREEN RK—y (FEE EFFECTIVE 111/97.$43.00) 4, a . �' 'B FEE PAID (f07 PN-i.Use orAy): YES NO Dzte of s�plslica�tio -�_ _ ---... lJoc.ation Requested �5�`?`�`�td Date Requested:__i d !~a� I ay Of` "ca i et Star: E( d Sponsoring Organization: jail Mailing contact Person:,�Da qv.�(vam f Phone: 1. DFaSCRIPTION OF El VENT: include name of event(if any),type of activities,elpested number Gf persons,and any equipment,tables,structures,tents,etc.that will be erected on the Village Gr^en c9r other property locations.If a tent or structure is being placed on'Village Caen, must speak with DP8N about placemeut, 2. Will the event be free? _ not,boar much` '11 it cost°' 3. List vehicles (if Jerzy) that will require permission to enter the village green or park location? AM ' .'F$^^ 4, Will you;require access to the town building? If so,a janitorial sera ice fee will be required. 5. Do you require electrical services for the event? _ YES_ If 50 N � what is the maxim€am wattage aneeded? watts. Where vri11 electrical service be required" . 6. How many police afficers will be on 7,> Hours police officers needed: S< How a,vill clean up and trade removal be handled`' p�a� qmv iris 9, Wi11 there be food ve adors? lrdor is required#o apply for temporary food perz�#(.$)frame the board of Health a4least four(4) ac}�f d ve ys prior to th, eve-it.) r 66/1.312008 11:58 FAX 508 780 6226 TOWN' MANAGER 002 Does use of this facility g y facile uire any additional feesi services by the Rec.Dept.? ��S J!NO Te 18. Will a staff persrn be assiped to this evert? —YES Ef NO If YES what is thc,: Er,? --- " '-,ave read the attached "Rules and Regealations for Use of 1Tllage Green and ether Town Property"' and,as '-"�xnt for ifee spomor°ing orgarnizatim agree to abide by said rules and regulations and any other guidelines r r our articulaar eve" I understand that our organization will be responsible for retedrna�g tleee establYshed p °incurred b tla properly to& original condition rOr to or�r Beret, and we will be responsible for arz� cots e � Department of.Public Works as a result of damage. (print) 16 (signature) APPROVED BY CHIEF OF POLICE DATE: (Barnstable Police Depa v00 ey's Lane,ale ,I FIRE CHIEF - --- - v (Fire Dept.relative to village loci ion.of event) � Yt�,,CA"Ti0?V It DATE:�� CTC9 � (Kennedy Pdnk, 141 Bassett Lane,Hyannis) J � ,i6 t � m PUBLIC IC WORKS 3,230 South Staett,41 Floor) DATE REGULATORY SERVICES V (2.00 Main Street) HE ALTH IOC (2 tj00 Main Suee ' ]DATE. AT . r BUILDING DI;a'ISION (200 Main,Streets {` ANAGER (Tovm Hall,Secood Floor) DEPOSIT REQUIRED(See#18 of Rules&Regatations)NO YES--HOW MUCH? Deposits are.to be made payable to the jo3r.,of BarrntabLe and shall be submitted to lht` own Managcz`s Office at 367 Main St.,Hyamms,MA 02601, 509-862-4610 30 days prior to the event, *Special ca3nditaa s: (Addillot l ages rna`°be attached) r Certificate of jflame Rem',quitre t REGISTERED AZTEC TENTS Date treated or 1 APPLICATION 2665 COLUMBIA ST manufactured CONCERN NO. TORRANCE,CA 90503 CAL COMB F-419.01 (800)228-3687 0412008 This is to certify that the materials described below hereof have been flame retardant treated(or are inherently nonflammable). FOR AMERICAN TENT& TABLE INC. 381 OLD FALMOUTH ROAD UNIT 41 � �� MARSTONS MILLS, MA 02648 l Certification is hereby made that: (check "a"or "b") (a) The articles described below this certificate,have been treated with a flame retardant chemical approved and registered by the.State Fire Marshal and that the applicationof said chemical was done in confor- mance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. ` } ? = Name of chemical used............................................Chem. Reg.No......................... Meathodof application .........................................................:...................................... (b,) The articles described below hereof are made from a flame-resistant fabric or material registered and ® approved be the State Fire Marshal for such use; Fabric has been tested and passes NFPA701-96. Trade name of flame-resistant fabric or material used..LemnaWFabri¢ Reg. No. ......F?194t...... The Flame Retardant Process Used .WILL:NOT Be Removed b Washing - .... y (will or will not) David Bradley Chuck Miller - President Name of Applicator or Production Superintendent Title CUSTOMER ORDER NO. R169643 ITEMS MANUFACTURED: 2 3OX30 2PC STD TOP ULTRA WHITE ATC STYLE CLASP 3 30X10 STD MIDDLE TOP ULTRA WHITE ATC STYLE CLASP 2-2OX202PC-S-TD-TOP UL—T-RA-WHIT-ATC STYLE CL-ASP-- ----- _s 3 2OX10 STD MIDDLE TOP ULTRA WHITE ATC STYLE CLASP -y 215X 15 2PC STD TOP ULTRA WHITE ATC STYLE CLASP 1 15X10 STD MIDDLE TOP ULTRA WHITE ATC STYLE CLASP 1 15X15 STD MIDDLE TOP ULTRA WHITE ATC STYLE CLASP � CN, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �o� d Parcel off`; f �. t35f �L Application# ?00$,0�, S'� Health Division to MAY 22 �ir� ��• S� Conservation Division Permit# Tax Collector Date Issued v8 Treasurer Application Fee Planning Dept. Permit Fee c� Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address `r !d GO ^ SCFFOOL ST, Village 'ru Owner UL Address Telephone _-43r�r fZ ll) . I_U4L_Fq Permit Request 9 1�) 10 )11 2j0 I I xI - 30 X 5p Square feet: 1st floor:existing proposed 2nd floor:existing proposed !Total new Zoning District Flood Plain Groundwater Overlay I .n Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No r r• Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) �e. Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new^ r Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas O:Oil ❑ Electric ❑Other f Central Air: ❑Yes ❑No/ Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existirg ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal-# _ '" Recorded❑ CommerciV"❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name &�J JW=i nAa,' 'r f 7� L `N(,... Telephone Number Address �� r : �� f License# Home Improvement Contractor# Worker's Compensation# IX.ya 151 `1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOl ' SIGNATURE DATE 17 'D f j� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. x ADDRESS VILLAGE i 1 • OWNER DATE OF INSPECTION: ; t FOUNDATION i i FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL s, PLUMBING: ROUGH FINAL 1 s GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. T ' 4 r,` ` The Commanwealeh of Massachusetts ,q DeparrtMent of Industrial Accidents I ®f�f ice of Investigations �®� `.� ashingt®rt.Street K` '! Boston,MA 0211.1 fvww- tas&goY1dint Workers' Compensation Insurance Affidavit:BuiUderstContractors/ElectridansMumbers Applicant Information Please Priatt I.eaibty Name(Business/Organizatior individual): g C C,4 ,I. _3 _dL,r Address: to /3 City/State/Zip: iZ,c�s le-4-.5 iL7 Phone#: �;D(f ` 'Je-1 S5 Are you an employeIr?Check the appropriate hoX: 1. Type of project(requite).❑ [am a employer with 4. El am a general contractor and t employees full and/or part-time),* have hired the sub-contractors 6. ❑New construction ( part ) , 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet.i 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'com,,p, insurance. q_ ❑Building addition [No workers'comp. insurance 5., ❑ We are a corporation and its required.] officers have exercised their I0.❑Electrical repairs or additions 3.❑ I am.a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions myself.[No workers'comp. c. 152,§10),and we have no t2.❑Roof repairs insurance required.],t employees. [No workers' comp•insurance required.] 13.�Other�fJ'% *Any applicant that checks box#1 must also fall out the section below showvng their workers'oompertsation policy information. r Homeowners who submit this affidavit indicating they are doing all work and then hire Outside contractors must submit a new allydavit imting Such.Contractors that check this box must attached an additional sheet shosi ing the time of the sub-cotaercetom and their workers'camp.policy information_ d am an employer that is pmt4d ing workers'compensation insurame for nor earlopee& Bdlow is the poky mdjob information. ske Insurance Company Name: s ,w oz j y f ins. Polio #or Self-tins.Lic.#: T Expiration Date: � Job Site Address: !./W1#ity/StateiZip: Attach a copy of the workers'compensation l� policy declaration page(showing the policy number and Fail expire date ure 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 twee of Investigations of the DIA for insurance coverage verification. l do hereby certrfy render tke pains andpena/ties ofper/uory t*od the informaioa pravirled above is true and csrrert Si ature: ¢ Date: Phone#: Official use only. Do not write in this area,to be conrlded by city or town o,, war City or Town- Permit/License# Issuing Authority(circle one): I. Board of Health. 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plum Inspector, 6.Other Contact Person: #, ,4CORD CERTIFICATE OF LIABILITY INSURANCE OP IIDFtD 2 DATE(MMlDD/YYYY) 05 19 ae PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Berry Insurance Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 9 Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Franklin MA 02038 Phone: 800-824-5201 Fax:508-520-6914 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: St Paul Fire & Marine Ins. Co. American Tent & Table, Inca INSURER B; ' One Beacon Ins Allen Sylvester INSURERC: P.O. Box 1348 INSURER D: Marstons Mills MA 02648 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INS TYPE OF INSURANCE POLICY NUMBER POLICYEFFDATE MWDED TN ATE M I TIO LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,OOO,OOO A X COMMERCIAL GENERAL LIABILITY CK00220040 01/21/08 01/21/09 PREMISES(Eaoccurence) $100,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $5,0 0 0 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEWL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1,000,000 POLICY ECT El LOC AUTOMOBILE LIABILITY r B ANY AUTO FBIR08133 01/21/08 01/21/09 (EaCOMBINED SINGLE LIMIT $ 1,000,000 CO accident) $ ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) , 9 PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS A ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE XHUB5819Y97508 01/21/08 01/21/09 E.L.EACH ACCIDENT $IOO,000 OFFICERIMEMBEREXCLUDED? E.L.DISEASE-EAEMPLOYEE $100,000 If Syes,describe PROVISIO E.L.DISEASE-POLICY LIMIT $5001000 SPECIAL PROVISIONS below OTHER A Equipment Floater CK00220040 01/21/08 01/21/09 Limit $450,000 Deduct. $2,500 DESCRIPTION OF OPERATIONS I LOCATIONS?VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations usual to equipment rental/Tents for the Cotuit Green 5/22/08 5/26/08 CERTIFICATE HOLDER CANCELLATION JIMPOWE 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 _ Jim Power & Company IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 27 Winding Cove Road REPRESENTATIVES. Cotuit MA 02635 AUTHDRI EPR ENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988 F Yfi_41 'yr'�^' �{PF }IraR. :�e+••a 'S"#'�•�k, i�aS tit a > '^ '( YY kt 7r ..r 3 f-r ,� _!s }s iirate 1 REGISTERED ISSUED�cY. Date Lr..t d APPLICATM AZTEC TENTS&EVENTS manuiaetured � f CONCERN No. 490 ApL��A��,S/a�KAp AVENUE � 4.wi.: /�� •�ry�� C`.I/p(�.p TORY�i'4i'tOi Ep 4�./d}1AyFJVJ s 'v` • {3 � € k�} WfL Ct71�B l^1,9.01 r. (J t�dGil".6LW ' _ ff ••-. f (� '> 1' y+ 4 This is to certify that the maferiais described below hereof have been flame retardant treated(or are inher- -tM Y " ently nonflammable). FOR AMERICAN:TENT B TABLE ADDRESS 381 OLD-FALMOUTH ROAD,_STE 41 a, e�zv AARSTONS MILLS STATE MA.0268 c t' Certification is hereby rrtads that. (check "a"or "b'j �{ e � (a) The articles described below this certificate have been treated with a flame retardant chemical approved and registered by the State Fire Marshal and that the applicationof said chemical was dome in confar- n' chance with the lams Of the State of California and the Rules and Regulations of the State Fire Marshal. f Name of chemical used.--.... ..Chem.Reg.No.._ Nleathod of application........ ___..._....,.. 1 .......................z_�........................_............................. r t t< (b) The articles described below hereof are made from a flame-resistant fabric or material registered and ! approved be the State Fire 1Rlarshal for such use; Fabric has been tested grad Basses IpA7�196. F*1��.�� Trade name of flame-resistant fabric or material used..c _ ,, Reiff No }r 1, The Elaine Retardant Process WILL NOT s Used . _.... BeR Removed by Washing t i David Bra€tlau Chuck Miller -. Presic�erlt x 7 .t?, 1! --sr � z x r:^��.s't ,.�--4 - r> �k �'x 9 9'' �. Y� � ✓' �,.�� '.,- 4. c yy ) r z a is-. b � CUSTOMER ORDER NO. 0134713 v R134713 ITEMS MANUFACTURED: 2- 10 X 10 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITF_ 2- 70 X 10 STANDARD FRAME CANOPY MIDDLES-CLASP ULTRA WHITE, 2- 15 X 15 STANDARD FRAME CANOPY 2 PC. TOP ENDS CLASP ULTRA WHITE, 3-20 X 20 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, 3-20 X 10 STANDARD FRAME CANOPY MIDDLES-CLASP ULTRA WHITE, 2-30 X 30 STANDARD FRAME CANOPY 2 PC. TOP ENDS-CLASP ULTRA WHITE, 3 30 X 10 STANDARD FRAME CANOPY MIDDLES-CLASP ULTRA WHITE. T Y _ f �( Certt,f i acre ofjflame Rem'.5tanre REGISTERED ISSUED BY: Date treated or moo.��!;►p\9 APPLICATION AZTEC TENTS manufactured CONCERN No. 490 ALASKA AVENUE M20N TORRANCE,CA 90503 CAL COMB F419.01 (310)328-5060 4E'1< This is to certify that the materials described below hereof have been flame retardant treated(or are inher- ently nonflammable). FOR AMERICAN TENT& TABE,INC. ADDRESS 381 OLD FALMOUTH ROAD CITY MARSTONS MILLS STATE MA, 02648 Certification is hereby made that: (check "a"or "b') (a) The articles described below this certificate have been treated with a flame retardant chemical approved a and registered by the State Fire Marshal and that the application of said chemical was done in confor- mance with the laws of the State of California and the Rules and Regulations of the State Fire Marshal. Name of chemical used .........................Chem.Reg..No......................... . ................... Meathodof application................................................................................................ (b) The articles described below hereof are made from a flame-resistant fabric or material registered and approved by the State Fire Marshal for such use; Fabric has been tested and passes NFPA701-96. ; Trade name of flame-resistant fabric or material used.. Reg.No. .....F!W!...... The Flame Retardant Process Used . NOT Be Removed by Washing (will or will not)• David Bradley Chuck Miller- President Name of Applicator or Production Superintendent itie I t CUSTOMER ORDER NO. R160230 ITEMS MANUFACTURED: 2-305r30'(2 PC.)STANDARD TOP ONLY-ULTRA WHrrE `4-305r10'STANDARD MIDDLE TOP.ONLY-ULTRA WHITE 2-205r20'(2 PC.)STANDARD TOP ONLY-ULTRA WHITE 4-205r10'STANDARD MIDDLE TOP ONLY-ULTRA WHITE Cerfifit& laoistance c G�S � REGISTERED�V p4 4tiR Q'AP� a9a0 ISSUED BY Data treated or APPLICATION manufactured m ' � Academy Tent & Canvas " Q i CONCERN No. 5035 Gifford Ave. 03108/2000 Q 9�F a so -419.01 Los Angeles, CA 90058 (323) 277-8368 This is to certify that the materials described below hereof have been flame retardant treated(or are inherently nonflammable). FOR AMERICAN TENT& TABLE ADDRESS 381 OLD FALMOUNTH ROAD CITY MARSTONS MILLS STATE MA 02695 Certification is hereby made that:(Check "a"or"b") F](a) The articles described below this certificate have been treated with a flame-retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in conformance with the laws of the State of California and the Rules and Regula- tions of the State Fire Marshal. Name of chemical used............................................................. Chem.Reg.No. ........................ Method of application'... pplication:. ................................................................................. ............................... (b) The articles described below hereof are made from a flame-resistant fabric or material regis- tered and approved by the State Fire Marshal for such use;Fabric has been tested and passes NFPA701-96. VINYL F419.01 Trade name of flame-resistant fabric or material used ................................... Reg.No. ............ The Flame Retardant Process Used ..A!I.Not...Be Removed by Washing (will or will not) David Bradley By Tom Shapiro - President Name of Applicator or Production Superintendent Title THIS FABRIC WAS USED IN THE MANUFACTURING OF THE FOLLOWING. 2EA 30X30 UMW 2PC TOP ONLY 1 EA 20X30 U/W 1 PC TOP ONLY 3EA 30X10 U//W MID ONLY 3EA 20X10 U/W MID ONLY 2EA 20X20 U/W 2PC TOP ONLY 4EA 10X10 U/W MID ONLY CONTROL NO. 40389 CUSTOMER ORDER NO. CUSTOMER INVOICE NO. 39896 f YARDS OR QUANTITY COLOR � J STYLE DATE PROCESSED ' ALL MATERIALS ARE CERTIFIED BY THE CALIFORNIA STATE FIRE MARSHAL AND MEET THE REQUIERMENTS OF;NFPA 701 AND UL 214""" I ' F ic& ! a fe SrElE iSSU£D BY Date treated or ? Canvas API�LICAT manufactured Academy Tent $c - CONCEffift 5035 Gifford Ave. 0512212001 F—M% Los Angeles, CA 90058 (323) 277-8368 This is to certify that the materials described below hereof have been flame retardant treated(or are inherently nonflammable). FOR AMERICAN TENT&TABLE ADDRESS 381 OLD FALMOUTH RD#41 CITY �t4txr$RSTONSp BRILLS .�p }gym �p �q j�jSTATE 02648 Certification is hereby made that .(Chec "a"or"b 7 F-] (a) The articles described below this certificate have been treated with a flame-retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done in conformance with ti4 laws of the State of California and the Mules and Regula- tions of the State Fire Marshal. Nate of chemical used....................................:......................... Chem. Reg.No...................... -- Methodof application............................................................... ...................................... ....... X (b) The articles described below hereof are Blade from a flame-resistant fabric or material regis- tered and approved by the State Fire Marshal for such use;Fabric has been tested and passes NFIRA701-96. VINYL 419.01 s Trade name of flame-resistant fabric or material used The Flame Retardant Process Used Not Be Removed by Washing (will or v�ril rsoi) -----,,,-,David Bradley _ ` — By Torn Shapiro -President Name o r pptieator or Production SvYt?sintendent Tate THIS FABRIC WAS USED IN THE MANUFACTURING OF THE FOLLOWING 2EA 10X10 2PC X211 WHITE CANOPY TOP 3EA 20X10 MID X2R WHITE CANOPY TOP CONTNUR620 2PC X211 WHITE CANOPY TOP X212 WHITE CANOPY TOP CUSTOMER ORDER NO. 46455 4EA 30X10 MID X2R WHITE CANOPY TOP X2R WHITE CANOPY TOP CUSTOMER INVOICE NO. 46822 1EA 8X5 213C GABLR MARQUEE WHITE TOP ---- 1EA 1 6X1 5 MID X2R WHITE CANOPY TOP YARDS OR QUANTITY (i COLOR STYLE---------..--- - ---- , /� DAB E PROCESSED ALL MATERIALS ARE CERTIFIED BY THE CALIFORNIA STATE FIRE MARSHALL AND MEET THE REQUIREMENTS OF THE NFPA 701 AND UL214- APPLICATION FOR USE OF VILLAGE GREEN AND TOWNT PROPERTY (FEE EFFECTIVE 1/1/97- $43.00) i STRUTS=I.O�TSPlease complete`'h�s 1�ati`on�and oh�n�sz atures�_�� o e Usted�be�lo��v �� r -`z�' ?Y, .�: -u� 3'rr`x��i �w ;�`v"�'��"._•��,ya'��`,�a z,�°�,,'�,fid'�'it�'��; �'� �.4'p.. F� d`��v>.tzC''"_s+�.'.� d•3i� �`"" i g; 'ra�;' _->; �,�' "_, ��T'-",�-<., ��OT •� ��L-SIGNA�T��tES�AN HE �PL� CA IO�`,F�,EE�O �$�43 �TI�C��/C� �� 3� ,�J1D• - x PRZORTOUBlV1T?ALTQ�fHETON ;NAGRR Il\r4LPRo, r > � �� E Date of Application: e FEE PAID (for TM use only): S f � .f N Location Requested: In&I Pavk- Date Requested: Day Of Week: �(W Sid Time: Start t�a End Sponsoring Organization: Mailing Address: Z� yV1VlC�idlG� l D� 1� ��1�/S�'ihcs l��l5�5 , 0 Z648 Contact Person: <1 j V'�S►f1�lt, Phone: 50�. b . gOS� Fax:. 1. _ DESCRIPTION OF EVENT: Include name of event(if any), type of activities,'expected number of persons, and any equipment,tables, structures, tents, etc. that will be erected on the Village Green or. other.property locations. If a tent or structure is being placed on Village Green, must speak with DPW about placement. Sea Cb r�- MM 0yt �S,f V,4( An _.i AA S�wte�JQvt{-s oc I 2. Will the event be free?. if not, how much will it cost? S(f wr G�IMcSSite1 S 3. List vehicles (if any) that will require permission to enter the village green or park location? 4. Will you require access to the town building? VLO If so, a janitorial service fee of will be required. 5. Do you require electrical services for the event? 9C YES NO. If so,what is the maximum wattage needed? watts: Where will electrical service be required? 6. How many police officers will be on duty? GLS 1�2GlUt 7. Hours police officers needed: 8. How will cleanup and trash removal be handled? 'by 6►Aa"i3-0- .-qua-- 9. Will there be food vendors? QS — RA l'tc, (Each food vendor is required to apply for temporary food permit(s) from the Board.of Health at least four(4) days prior to the event.) _ r D'oes use of this facility require any additional fees/services by the Rec. Dept.? YES ✓NO 11. Will a staff person be assigned to this event? YES ANO If YES.what is the FEE? I have read the attached "Rules and Regulations for Use of Village Green and other Town Property"and, as agent for the sponsoring organization, agree to abide by said rules and regulations and any other guidelines established for our particular event. I understand that our organization.will be responsible for returning the property to its original condition prior to our event, and we will be responsible for any costs incurred by the Department of Public Works as a result of damage. (print) (signature) APPROVED BY: - CHIEF OF POLICE DATE: f (Barnstable Police Departure , 1 00-Phinney's Lane,Hyannis) - FIRE CHIEFG /�" DATE: (Fire Dept.relative to village location of event) RECREATION DIRECTOR DATE: l� (Kennedy Rink, 141 Bassett Lane,Hyannis) PUBLIC WORKS Z ? DATE: .6f,f/D Y (SAB,230 South Street,4 Floor) REGULATORY SERVICES �1 G� DATE: r (200 Main Street) q HEALTH DIVISION DATE: (200 Main Street) BUILDING DIVISION DATE: .5 lj?lok- (200 Main Street) TOWN MANAGER DATE: (Town Hall, Second Floor) DEPOSIT REQUIRED (See#18 of Rules&Regulations)NO - YES HOW MUCH? Deposits are to be made payable to the Town of Barnstable and shall be submitted to the Town Manager's Office at 367 Main St., Hyannis, MA 02601, 508-862-4610 30 days prior to the event. *Special con 1 tio s: (Additional pages may be attached) TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 020 004 GEOBASE ID 778 ADDRESS . 0 SCHOOL STREET PHONE COTUIT ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT ~DISTRICT CT PERMIT 91306 DESCRIPTION TOB Conveys Area Santuit, River 8 x 7 PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: �-: r Department of ARCHITECTS: Regulatory Services TOTAL FEES: .BOND $.00 CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE • wtxsrAsi.E, MASS. 0,19. <BUILD N,�„DIVISION By cf J DATE ISSUED 04/06/2006 EXPIRATION DATE o I i I I l i i i I I i r I i 1 �I s Town of Barnstable t"Elo►y,,o� Regulatory Services Thomas F.Geiler,Director MASS.9 ' Building Division 1659.,t a Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us ce: 508-86.2-4038 Fax: 508-790-6230 Permit# P Application for Sign Permit - Assessors No. Applicant: M G G Z� ri✓t w Doing Business As:_ Telephone No. �t 662 YV/ n M�v _ -� ��--- Sign Location� Street/Road: 2 .� 1 S?�f Zoning District: Old Kings Highway? Yesleo Hyannis Historic District? Yes/ to Property Owner 10� Name: Telephone:_So?)U� - ' Address: � �� /t��, 5a-. Village: � ' -r Sign Contractor S �^ _ 7 Z 1 Name:_ ��9 Y �Cn) 1 17M, vt Telephone: Mailing Address: Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes To (.Note:If yes,a wiring permit is required)A Width of building face ft.z 10= X.10= /V I hereby certify.that I am the owner or that I have the authority of the owner to make this application,that the . information is correct and that the use and construction shall conform to the provisions of§240-59 through§240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent* Date: Size: Permit Fee: O Sign Permit was approved: 3 Disapproved: Signature of Building Official. Date: � yy C0 ,06 'E 'RVA -T-100 :A ; ` �A , i a is V z. , i a 4 �,' x.�,..«,ari '� A ..a xt � .✓` jj� � : j4 h �!. `� `.,r � . i ¢ s INI •1„e w 1nr �•.n G::�,.•'"'e'YP,f`."fi".�✓l.'¢�'rx � 4T �_ r ...u..u...��,n.�. ,u_:% ��,� r I i. r^a -sit.�, ..•�..., �� "`�� "#� ��,��+�,°' 3...., i $ � ry s F't.• at-sys3»y��.,..•fix-r ,.. ��a_ 4 lam >i'i ✓ 3a x � „w--.•_,.,,:............. 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Governor Commissioner Kerry Healey G� hG) Thomas P.Hopkins Lieutenant Governor t F �j , ��OD t� 22 Director Edward A.Flynn ��0� s� �� www.state.ma.us/aab / / Secretary June 4, 2004 Peter DeMatteo Building Commissioner 200 Main Street Hyannis, MA 02601 Re: Status Report for Hovey Construction Property, School Street, Cotuit(Docket#VO4-057) Dear Mr. DeMatteo: I am writing to'you today on behalf of the Architectural Access Board regarding the above referenced property. On April 26, 2004, the Board voted to DENY the variances requested for Section 20.1, accessible route to new launching platform; and Section 24.2, ramp slope and rise. The Notice of Action was sent via certified mail to Mr. Robert Gatewood, applicant, with the Return Receipt signed and returned to the AAB office verifying that the Notice was received. At present we have not received any request for an Adjudicatory Hearing and the thirty(30) day allowance for filing for said hearing has expired, leaving the only avenue of appeal to be with the Superior Court. I am writing to request a status report on the items that were denied by the Board in the Notice of Action. Since the Board has denied the variances and an appeal has not been brought back before the Board at this time, these matters are required to be brought into compliance with 521 CMR. The Board is seeking your help in verifying that compliance has been achieved in regards to Section 20.1 and 24.2 as referenced above. Compliance must be verified by both written and visual (i.e. pictures)verifications. I am enclosing a copy of the Notice of Action and Return Receipt for your review. Thank you for your time and if you have any questions please feel free to call our office. Sincerely, ' ' ThomasR. Hopkins '" r .. :r;. c; : ;•, .w.,t..� sly f7 -,� �; . ,��u'u 1f R. E: �f..>...t . Director cc: Robert Gatewood, Applicant Local Disability Commission Independent Living Center Encls. rr: O ,�7 '; .(ice/G /6� 0210-11/7� Kevin J.Kelly WG Mitt Romney �/� Acting Commissioner Governor. � ",�J210660 Thomas P.Hopkins Kerry Healey Director��00 rJ2��222 Lieutenant Governor wwwsrate.ma.usraab Edward A.Flynn Secretary. FILE upy TO: Local Building Inspector Variance Number: 04 057 Local Disability Commission Independent Living Center FROM: ARCHITECTURAL ACCESS BOARD RE: Hovey Construction Property School Street Cotuit Date: 4/27/2004 a Enclosed please find the following material regarding the above location: Application for Variance /Decision of the Board Notice of Hearing Correspondence Letter of Meeting The purpose of this memo is to advise you of action taken or to be taken by this Board. If you have any information which may assist the Board is reaching ! a decision in this case, you may call this office or you may submit comments in writing. ~ Kevin J.Kelly vC/O�J Mitt Romney GG�/L, Acting Commissioner /� q Governor vs!/� /7G/ O��O Thomas P.Hopkins c/Kerry Healey G� Director ��00-�2�7222 Lieutenant Governor www.state.ma.uslaae Edward A.Flynn Secretary NOTICE OF ACTION RE: Hovey Construction Property, School Street Cotuit 1. A request for a variance was filed with the Board by Robert Gatewood (Applicant) on April 5,2004 The applicant has requested variances from the following sections of the 20 02 Rules and Regulations of the Board: Section: Description: 20.1 Accessible route to new launching platform 24.2 Slope and rise 2. The application was heard by the Board as an incoming case on Monday, April 26,2004 . 3. After reviewing all materials submitted to the Board,the Board voted as follows: DENY:the variance to Section 20.1 and 24.2 for the reason that impracticability has not been proven in this case. e s reconstruction renovation addition or alteration NOTE: If the work being performed complianceis with this decision must be achieved by completion of the project and prior to final approval by the building department.Otherwise, if the work being performed is new construction, compliance with this decision must be achieved prior to the issuance of an occupancy permit.' Any person aggrieved by the above decision may request an adjudicatory hearing before the Board within 30 days of receipt of this decision by filing the attached request for an adjudicatory hearing. If after 30 days, a request for an adjudicatory hearing is not received,the above decision becomes a final decision and the appeal process is through Superior Court. Date: April 27,2004 ARCHITECTURAL ACCESS BOARD cc: Local Building Inspector Local Disability Commission Independent Living Center ChairP ers t i l 1 SENDER:COMPLETE THIS SECTION COMPLETE THIS SECTION ON DELIVERY ■ Complete items 1,2,and 3.Also complete A. Signature item 4 if Restricted Delivery is desired. Cl Agent ■ Print your name and address on the reverse X ❑Addressee i 30 that Can return the card to you. S. Received by(Printed Name) C. Date of Delivery ■ Attach this card to the back of the mailpiece, ,J ' or on the front if space permits. y O-O I t,Article Addressed to: 0. Is delivery address different from item t? ❑Yes f if YES,enter delivery address below: ❑ No Robert Gatewood 200 Main Street Hyannis, MA 02601 3. S�e�ry eType lI Certified Mail ❑ Express Mail ❑ Registered ❑ Return Receipt for Merchandise . ❑Insured Mail Cl C.O.D. 4. Restricted Delivery?(Extra Fee) ❑ Yes 2. Article Number (Transfer from service label) PS Form 3811 August 2001 Domestic Return Receipt 2ACpgl Z ages UNITED STATES POSTAL SERufCE First-Class Mail Postage&Fees Paid III LISPS Permit No.G-1.,T • Sender. Please print your name, address, and ZIP+4 in this box The Contmonwecdth of Massachusetts Department of Public Safety Architectural Access Board i One Ashburton Place - Room 1310 Boston. MA 02108 Cop . f �- j �IIi:l,.l�„dli-IL I I , I k oFINE rqy, Town of Barnstable Regulatory Services BAMSTnst.e, ,Kass. Thomas F. Geiler,Director 0,19. �0 ° Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.ba rnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 June 8,2004 The Commonwealth of Mass. Dept. of Public Safety Architectural Access Board Attn: Thomas P. Hopkins,Director One Ashburton Place,Room 130 Boston,MA 02108-1618 Re: Status Report for Hovey Construction Property, School St., Cotuit(Docket#VO4-057) Dear Mr. Hopkins: This letter is in response to the correspondence of June 4, 2004 regarding the variance denial of April 26,2004. Since this request was denied,the Conservation Commission has decided to abandon this proposed project. Enclosed are some recent photographs of the area that was proposed for the launching ramp showing that no work has taken place. As a side note,please update your files as to Peter DiMatteo being listed as the building commissioner for the Town of Barnstable. He left the employ of this town in May 2001. As always, we look forward to working with you on future matters. Please do not hesitate to contact us with any concerns that your board may have. i ncerelyhomas Perry Building Commissioner TP/AW _ enclosure 1 ! ' k ' .may.�`�n �\'� � � ` •_' lam. r 0 scf�60l •� XY/0 Kevin.J.Kelly Mitt Romney �� / 0277U Acting Commissioner GovernorfLP� �O////2/-DODO Thomas P.Hopkins Kerry Healey Director lieutenant Governor www.statexw.usraab Edward,A.Flynn �6'��20665 Secretary TO: Local Building Inspector Variance Number: 04 057 Local Disability Commission Independent Living Center FROM: ARCHITECTURAL ACCESS BOARD RE: '. Hovey Construction Property School Street. co, Cotuit r ' m I `S a F #` 42 Date: 4/7/2004 Enclosed please find the following material regarding the above location: /A pplicatio for Variance - Derision of the Board Notice.of Hearing Correspondence Letter of Meeting The purpose of this memo is to advise you of action taken or to be taken by . this Board. If you have any information which may assist the Board is reaching a decision in thiscase, you may call this office or you may submit comments in Lwriting. The Commonwealth of " f a Massachusetts Docket Number: c Department of Public Mitt Romney. Safety Kevin J.Kelly Governor Architectural al Access Board Acting Commissioner Kerry Healey Thomas P.Hopkins Lieutenant Governor One Ashburton Place , Room 1310 Director Ed war A. Boston, Massachusetts 0 210 8 - 1618 wwmstate.ma.us/aab retary Phone ( 617 ) 727 - 0660 Voice and TDD 1 - 800 - 828 - 7222 Fax ( 617 ) 727 - 0665 APPLICATION FOR VARIANCE In accordance with M.G.L., Chapter 22, Section 13A, I hereby apply for modification of or substitution for the rules and regulations of the Architectural Access Board as they apply to the facility described below on the grounds that literal compliance with the Board's regulations is impracticable in my case. 1. State the name and address of the owner of the building/facility: - Town of Barnstable, Conservation Division, 200 Main Street, Hyannis, Ma 02601 Tel: 508-862-4093 2. State the name and address or other identification of the building/facility: Hovey Conservation Property, end of School,Street, Cotuit, MA 3. Describe the facility: (Number of floors, type of functions, use, etc.) Public Use/Conservation Area 4. Total square footage of the building: NA Per floor: a.total square footage of tenant space(if applicable): 5. Check the work performed or to be performed: _x_New Construction _Addition Reconstruction, _remodeling, alteration_Change of Use 6. Briefly describe the extent and nature of the work performed or to be performed: (Use additional sheets if necessary). When the State rebuilt the School St.Bridge in Cotuit, they added rip rap and tied a guard rail into a bank making public access to the base of the bridge difficult. The Conservation Division started to look at ways to improve access. Our goal is to construct a pathway, from an existing parking lot, elevated wooden walkway, stairs, and small craft launch (kayak launching platform). The walkway and stairs will be constructed on a steep coastal bank to provide recreational access to the Santuit River in Cotuit, MA. 7. State each section of the Architectural Access Board's regulations for which a variance is being requested: 7a. Check appropriate regulations: x 1996 Regulations 1982 Regulations 2002 Regulations SECTION NUMBER LOCATION OR DESCRIPTION 20.1 accessible route 24.2 slope and rise 8. Is the building historically significant?_yes _x_no. If no, go to number 9. 8a. If yes, check one of the following and indicate date of listing: National Historic Landmark Listed individually on the National Register of Historic Places Located in registered historic district Listed in the State Register of Historic Places Eligible for listing 8b. If you checked any of the above and your variance request is based upon the historical significance of the building, you must provide a letter of determination from the Massachusetts Historical Commission, 80 Boylston Street, Boston, MA 02116. 9. For each variance requested, state in detail the reasons why compliance with the Board's regulations is impracticable. State the necessary cost of the work required to achieve compliance with the regulations. PLEASE NOTE THAT YOU SHOULD SUBMIT WRITTEN COST ESTIMATES AS WELL AS PLANS JUSTIFYING THE COST OF COMPLIANCE. Use additional sheets if necessary. The Barnstable Conservation Division is requesting a variance for this project based on the cost for the handicap accessible design for the elevated walk way and stairs down a coastal bank. The enclosed plan shows the accessible design in blue and the non accessible plan in red. The bank has two tiers. If the Town constructed the red design we would be following a natural 3 foot path that runs along between the two banks.This is shown in yellow. No elevated walkway would be constructed here. If the Town constructed the blue design it would need several switch backs, an additional section of elevated walkway and resting.platforms at each corner of a switch back. Red design $35,000—$40,000 Blue design (100% accessible) $71,000 (These estimates were obtained from Horsley and Witten Inc. through a program called Costs Works.) Not o my i s the additional cost an issue, but we fear that we might have a problem getting the accessible plan (in blue)through the Conservation Commission permitting process. This plan would require much more disturbance to a coastal bank. 10. Has a building permit been applied for? no Has a building permit been issued? 10a. If a building permit has been issued,what date was it issued? 10b. If work has been completed, state the date the building permit was issued for said work 11. State the estimated cost of construction as stated on the above building permit. 11 a. If a building permit has not been issued, state the anticipated construction cost: 12. Have any other building permits been issued within the past 36 months? 12a. If yes, state the dates that permits were issued and the estimated cost of construction for each permit: 13. Has a certificate of occupancy been issued for the facility? If yes, state the date: 14. To the best of your knowledge, has a complaint ever been filed on this building relative to accessibility? yes no. 15. State the actual assessed valuation of the BUILDING ONLY, as recorded in the Assessor's Office of the municipality in which the building is located. Is the assessment at 100%? If not,what is the town's current assessment ratio? 16. State the phase of design or construction of the facility as of the date of this application: Draft design work on a plan. 17. State the name and address of the architectural or engineering firm including the name of the individual architect or engineer responsible for preparing drawings of the facility: Horsley and Witten Inc. contact'person: Amy Ball Telephone 508-833-6600 90 Route 6A Sandwich, MA 02563 18. State the name and address of the building inspector responsible for overseeing this project: Tom Perry Telephone 508-862-4038 200 Main Street Hyannis, MA 02601 PLEASE NOTE: The Board may, in its discretion, hold a hearing on your application for variance. The Board may also decide your application without a hearing, based upon the information you submit. You should therefore include all relevant information with your application. At minimum the plans should include a site plan, all floor plans, elevations, sections and details. Photographs of existing conditions are extremely important. Date: March 22, 2004 PRINT: Robert Gatewood Name of owner or authorized agent 200 Main Street Address Hyannis, MA 02601 City/Town State Zip Code AK-- ,�. "L_,e_---� �bS�-Y , 4 o9 3 Signature Telephone PLEASE ENCLOSE: A FILING FEE OF $50.00 (CHECK/MONEY ORDER) MADE PAYABLE TO THE COMMONWEALTH OF MASSACHUSETTS, AS WELL AS THREE ADDITIONAL COPIES OF THE ORIGINAL APPLICATION FOR VARIANCE AND ALL SUPPORTING DOCUMENTATION. �p pJQ N a ,DINE O � - PINE AlA, p a L �i .o O NfA— _ PINE o* f P t9AK ORANI O ROAD 80UNI UTILITY O cb' STEEL POLE ("AIIR(-)PAII I/ AT/ 1 nA ( 231� Ac)veti wcces '?o�ej 'woLlkLAX%y "406 4 a ry ` A T �tl- W—A. 44 '�`....< �� °L flr„ ., �yi a* r3'.` s*\'- :..� 'y 4; »��L ,�°'v.`�''`;i *Jd •1� �� r`�.r� a,� Y� r... '�,7. �"'• +c� -�a •� � �„ +ate "'.p ',. ++'� �� ,.; •' <,.; •ram "�" .� ;,.» w�4 , .. ,• :- ,,,,x 4 - �"� fir" r'�.. -'-tn.,e�''- x a Ian" $tea ffi R "'t }¢ i p 47Ai E r� F- " , • WAD ! yy yt x e t e° • P � Apt. �a Ra