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1667 FALMOUTH ROAD/RTE 28
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Date Issued l- - 1-7 Conservation Division t.�X\AG Application Fee Planning Dept. `� Permit Fee Date Definitive Plan Approved by Planning BoardQ� Historic -'OKH _ Preservation/ Hyannis QF �iWl Cq It d Al Project Stre t Addrne�ss, (eca� rn °� Village tt " l I e Owner Address Telephone ,�,,ff Permit Request -To L h a ea vt e I� I aid C o w^eV' erV t Square feet: 1 st floor: existing proposed 2nd floor: existing , proposed Total new Zoning District i Flood Plain Groundwater Overlay Project Valuation�h 00 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 0 No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing. new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing 0 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 YkOLA C Telephone Number _ CI -771 'N 4 C Address oe t( License# Home Improvement Contractor# Email GeV ' >S Lt rd( el Worker's Compensation # C 115 6 C0 62:C ALL CONSTRUCTION D RIS RESULTING OM THIS PROJECT WILL BE TAKEN TO SIGNATURE 1 ate°'` DATE � 66. 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 FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. T Ja a3nSS131d4 #Not ld�.-. Department of lndirsh id Accidents Offwe afM-W-ftations 600 Washington S`reet Boston,MA 02.1I ' t4�rvt"u ma�gFm��iiirt I Wkw1mrs' Compensation Insm ancB .davit B•�deislContr=tnrs/EectricianslPhEmbers �ipp�ica�t InfmrmafII Please Print Leei�y I pp � •I`�I�ame M �X To�,4 A I �vcr� (7L� Addres C;igftr1 CQ V M Z Phonsig�_ Are you an employer?Gheckthe appro 'ate bykc Type of project r �P 4. I am a geueni confractm and I 6_ Idety consirg �I_❑ I am a 1 uith employees(frill andfor part-time).* have bired the suit-coadractoss . ❑ t 2.❑ I am a sole PrqPjjdCHr or s- tided cathe attgched sheet I ElRemoddligg These sub-contractors have sltsp and have as employees- ❑Demolition woddrg for me ia•any capacity employees acid have wodcem' 9. ❑Bauldmg addition. [No`v-admrs'wmp.irtsmunce Camp-in ranm 5_ ❑ We are acorporation and its ibk El Electrical repairs cc additionsreg3ked 1 offices i`hum esemsed their Plumbsn airs or additions I❑ I am a homeownu doing all work 1L❑ lare P F*E[No worlmrs'camp. rigfit of egerBp#ion get 1srIGI. L_❑Roofrepairs msu m. nce required.]I c.152,g1t4h aadwe five na employees_[NovroADers' 13_❑Otfier coal-kmmnnce mquirexl_I Oday appffrmtdat chedmboz#1 test e]sa fi7lovEthe sectioabeTamsbatdag�eawodcex�`ca®p�•�fi�,,,pa&cgi�o¢marian #Flamevamers Who sabo>�t this a�dat"u i�aiiag tfeey aa�daia:�a3Fwaoic sad d�haE auisiae toabscmrsaamct submit aaiemaffidae�t indi�tiao sacii fCaattscto6$ut check tiffs boat most sttadrea an additi®al siixet sbon�g thtaa of the suns-t�sclaa and state Whether ar notthnse evutigsba emplo31ees.Ifthe sub-caahadMS hm Mgacyea%ffieg Pmud&thdr trarkeW cDmp.poIky numbeL I am apt enipIoyRr tl�atisprm�irIir;,yvorkers'caorpreresafies uesruaacs�or nzy emplay�ees: $eTasv is ii�te paTicy aced jni5 srte . information Insurance CompanyName: Policy 44 or Self-ins_I.ic_ FxpifatiouDate: Job Site Mdre= City/State zkr Attach a copy of the workers'compensation policy declaration page(shooing the policy amber and espir atioa date). Failure to secure coverage as requireduuder Section 25A,of MGL m 15.7 can lead to the imposition of criminal penalties of a fine up to$150QOD anj for one-yearimprisortment,as wea as civil penalties n$ie fora of a STOP WORK ORDERand a ime of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe fxvwded to the Office of Itcvestigatiom of the DIA.for insurance coverage vac ati= I d'a hersiry cerfiffly die pains mtdpsrral es afprdiuy t7ratflis infarma imr pnni&zT abmra Is bm arrd carrect Date: 1 Phone i OBEdi <use aprij. Do rat tvi*e in 66 area&be-cairipft d by city artaicn a,�rciat City or Town: PermitUceuse g rssuing xf1writy(drcTe one): L Board of Ilealtb ,Buff mg Department I Cityi rmn Clerk 4.Electrical Inspector S.Phrmbiing Inspector 6.Other coact Person: Phone#: 6 K-,Ph Town of Barnstable Regulatory Services RIAINSMABM ` Richard V.Scaly Director 6 ►��$ Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize -NA,% t to act on my behalf, in all matters relative.to work authorized by this building permit application for: �- � < lS1 (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final ` inspec ' ns are performed and accepted. `�atore of Owner. Signature of Applicant T �. . Print Name Print Name I ; Date QTORMS:OWNERPERMISSIONPOOLS `..,; A g'1 nrCwacx I. , nr�rtwlru. I o ,ce I oFRCE I 1 I I I _ LilI 1 _ t .. .. CONFERENCE I I I I I I 1 • 1 1 I ,665 9r.78 - - ,661 Rr 28 UNIT#6 UNIT#5 ,�00 SQ.FT. I V76 Safr.. 1 I I L I I I ------------------------- 5A FIRST FLOOR PLAN * - SCAT-E- 1/4" = I'-0° r Town of Barnstable Buildin ' �ost his Card ,, �TFfat��t�s�V�sible'From the Street��Appro„yed>��tans:MustHbe��Retaineci on Jbb andth� rd Mu,,;, be Ke'# � r AB1,E.'� �r�si A�� "�n�r��z. �` s,�o', r � t� �,;y� � 5. ,��£p� . Posted Untinal nspection ,�as Bee Made.� /� � � � :t �� �� �; g s� -f - c-u anc .�s�°Re wire •F�siuch ` `h' �'� �`action h ' s` Permit ', �{N�ere Cert�fi te'of�,0 c Y, q d, Bu Iding 5. aIF N #be Occu ied p ax been made . ,..:. :.:u:., ,.�,.�.:k�..r ,�.w;:u.;,.'�'�:�" :�,.u.' .,.�-r„�a.�.,s�...�a?ts„z„�u .,v: -'d::3�fF� .�". �i✓i'r ��i':+z..,✓r,.zxs;'i�.s, ,. '.�.,...-����.c, a .�' «,,. .�� Permit No. B-17-1029 Applicant Name: DACEY,BRIAN TTR Approvals Date Issued: 04/12/2017 Current Use: Structure Permit Type: Building-Sign Expiration Date:, 10/12/2017 Foundation: i Location: 1667 UNIT 5 FALMOUTH ROAD/RTE 28,CENTERVILLE Map/Lot 209 087 10E Zoning District: SPLIT Sheathing: Owner on Record: DACEY,BRIAN T TRx Contractors ame. framing: 1 Address: P O BOX 95 Contractor License a Y '., d .. 2 .CENTERVILLE,MA 02632 "`` ' Est Project Cost: . $0.00 Chimney: Description: REFACE 2 SIGNS`ONE 21 SQ FT ONE 7 SQ FT 28SQfTTOTAL FOR QUIK Permit Fee:' $75.00 PACK&SHIP ONE LADDER ONE BUILDING SIGN " Insulation: r Fee Paid: $75.00 Project Review Req: REFACE 2 SIGNS ONE 21 SQ FT'ONE 7 S' k -5 SQ FT TOTAL FOR ate 4/12/2017 final: ,QUIK PACK&SHIP ONE LADDER ONE BUILDING SIGN Plumbing/Gas "h Rough Plumbing: Zonin g Enforcement Officer final Plumbing:' This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within sixmpnths after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All Gas: All construction,alterations and changes of use of any building and strictures shall be in with the local zoning by laws and codes. Final Gas: . -This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for pwt lic mspe, Gh for the entire duration of the work until the completion of the same: Electrical The Certificate of Occupancy will not be issued until all applicable signatures b the46dd6ng and Fire Officials are'provided is"'permit. Service: Minimum of Five Call Inspections Required for All Construction Work: y 1.Foundation or Footing �a _ Rough:_ 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (asset forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT tHE r Town of Barnstable Regulatory Services Richard V. S cali Director ass. n g6 Building Division Paul Roma,Building Commissioner �.. 200 Main Street, .Hyannis,MA 02601 . www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508,790-6230 Permit# Building,Official'approving ` Application for Sign Permit Applicant: ".� , ecp e6K) .Assessors No. OW O -- j Doing Business As: Telephone No.° �� - ' Sign Location Street/Road: dt — y ^�ljX'Z/1GL Zoning District: Old Kings Highway? 'Yes Hyannis Historic District? Yes16 Property Owner �� Name: < �- Telephone: /-I Address: ,�P 41 ` Villager 1 t.Lt;' Sign Contractor �Q Q Name: Uf�Y/Vf 2 Telephone. J Mailing Address': d LCr Description Please follow the cover.directions.'You must have an accurate rendition of sign with dimensions and location. _ Is the sign to be electrified? Yes/No (Note-If yes, a wiring permit'is required) Width of building face ft.x 10= X.10=e P 1 Check one Ref a e sfing sign or New Total Sq:Ft. of proposed sign(s) .fY I ou have additional signslease attach a sheet listing each one with dimensions imensons 1 P �l DL�� If refacing an existing sign please provide a picture of the eldsting signwith dimensions. �f I hereby certify that I am the owner or thatI have the authority o e o' er to make this application,., l that the information is correct and that the use and constru o shall co orm to*the provisions of §240-59 through §240-89 of the Town of B ble o ' g din e . Signature of Owner/Authorized Agent: 6N� 17 )/V signs/sigprequ&app revised: 06/20/16 (/ypf�Jtil k \ 6kl i ,. VE Town of Barnstable # °+ Regulatory Services '• KAS&esi.E, Richard V.Scan Director E 63� Building Division Paul Roma,Building Commissioner 200 Main Street, Hyannisi MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 "Fax: 508-790-6230 SIGN PERAUT REOMEMENTS 1. .A photograph showing the existing facade, on which has been.indicated the proposed `x .sign location. photograph is to include a.portion.of adjoining'stores or building. For,a proposed building or new facade, an architect's elevation maybe submitted in . lieu of a photograph. - 2. A scale drawing of the pr posed sigri'A scale drawing indicating: roposed sign(wall,hanging, free standing) 1) The type'of p 2) DimensionsWthe proposed sign and any designs,logos, or lettering '" rV 3) A cross-section with dimensions showing�edge detail. Minimum scale 1"= 17. Minimum sheet size, 8.5 x H."'. 3.1 A scale drawing of the bracket. A"colored scale graphic indicating dimensions, ._ showing colors,materials and method of affixing it to the sign and to the building. ' ` Minimum scale 1"= 1': Minimum sheet size '8.5 x 11" Y k `4.• A completed Town of B instable Sign Application;including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions; yy 5. M The width of the building face or the leased area 8 `. NOTE:, the'map/parcel number is required on`the application: a #^ 6 a 4k Al a .. .. a signs/signrequ&app revised: 06/20/16 � h 3/20/2017 5:37:33 PM � ' ,I o . . Vol -PROOF r �� VERSION: 1 2 3 4 5 1 " V T28 s NO PROOF ��� plence . ; E-Mailed Called NO PROOF - - ., ANER§� CUSTOMER INFO COMPANY; :� ,� ,.;:� �.. 1 EERVIL-LE. , �tr t, k M CONTACT .�: CQ y .. PERSON: STREET: e Tsu Vih - CITY: STATE: ZIP: I C H -PIZZA,Y ' PHONE: _. FAX: EMAIL: M • •� w DESCRIPTION X' ' V]►-•�Jr�•-a-ry o 1 �n.r�-"•a +vim a z, File Name:Quik_Pack 8 Ship_FORESTDALE directo li h oafs '. . f y� Folder Name:\\Backup\e\FLEXI_FILES\Q\Quik Pack. " THIS RENDERING IS INTENDED AS A SAMPLE ONLY.COLOR,TEXTURE,MEASUREMENTS;AND ACTUAL APPEARANCE MAY VARY SLIGHTLY FROM COMPLETED WORK AND IS CONSIDERED NORMAL&USUAL. Please check layout(artwork,spelling,dimensions)and fax back.with signature.Production I HAVE REVIEWED THE ABOVE SPECIFICATIONS&HEREBY FULLY UNDERSTAND THE cannot begin until written approval is received:Additional charges:will be applied for any changes : CONTENT OF WORK TO BE PERFORMED that are needed after approval is received.SIGN*A*RAMA is not responsible for any errors in.: AND APPROVE THIS PROJECT TO BEGIN spelling,layout,or dimensions that have been approved by the customer.This Proof is for listed 1• CUSTOMER APPROVAL SIGNED BY: - 771 items only.Any changes or deletions by the.customer not:shown or charged herein will be billed. 12 Whites Path-Suite 6;South Yarmou8_3th,MA 02664 .. - .. .. - separately.50%DEPOSIT DUE AT TIME OF ORDER(full amount if under$100),balance due Phone:50 nail:c san Fax:50:net: 1760 . u on time of installation.1 HAVE READ AND AGREE TO ALL TERMS. INITIAL Email:ccsar@verizon.net. PRINT: DATE: P . www.signarama-syarmouth.com THIS ORIGINAL DESIGN AND ALL INFORMATION CONTAINED THEREIN IS THE PROPERTY OF SIGMA'RAMAAND ITS USE IN ANY WAY OTHER THAN AS AUTHORIZED IS EXPRESSLY FORBIDDEN.THIS PROPERTY MAY NOT BE REPRODUCED OR DUPLICATED WITHOUT WRfrTEN PERMISSION OF SIGN'A'RAMA OR THROUGH PURCHASE MEN CONTACT INFO DATE, CUSTOMER INFO COMPANY: PHONE:.: � -- 3/20/2017 VERSION:: 1 2 3 . 4 5 CONTACT PERSON: -:17:39 PM E-Malled. Coiled NO PROOF STREET: FAX: REQUIRED CITY: STATE: ZIP: EMAIL: - - • p. : . v File Name:Quik_ ack�&_Ship_FORE TDALE building lightbox.fs T Folder Name:\\Backul FILES\Q\Quik Pack iy lit uoi F e 11 ''al"! - .ay, . , W' 0 � Q D. e o 4 o ' t f'� . .•. 77 „a_ .ra. � "E*,?�sa>„ �°:....9�"r� urxs"` 'er ",,.�.�' . °. - =s�,.:. .��. a�.a_.,+ �' :t„ x "'^..^.�°.�• a s ,t- �c ,'�.a" �:�: qt.':.. y �r3.., 'AI ....y.,t R y"* �4 ,r b'*1 'aBpl6 ,�$:. y •"1,y R:� �° k eti -- �. ro r 1 3 lr MIMI- e a �kr, b 'A- ag � ~s �nsmraaw.la a Fx + ¢� vp. a ^ uc a c%xss Y . .. .m, .�,s�- THIS RENDERING IS INTENDED AS A SAMPLE ONLY.COLOR,TEXTURE,MEASUREMENTS;AND ACTUAL APPEARANCE MAY VARY SLIGHTLY FROM COMPLETED WORK AND IS CONSIDEREDNORMAL&USUAL. Please check layout(artwork,spelling,dimensions)and fax back with signature.Production I HAVE REVIEWED THE ABOVE SPECIFICATIONS&HEREBY:FULLY UNDERSTAND THE cannot begin until written approval is received.Additional charges.will be appliedfor:any changes ® 0 CONTENT OF WORK TO BE PERFORMED that are needed after.approval is received.SIGN*A*RAMA is not responsible for any errors in AND APPROVE THIS.PROJECT TO BEGIN spelling,layout,or dimensions that have been approved by the customer.This proof is for listed CUSTOMER APPROVAL SIGNED IN .. items only.Any chahgesOr deletions by the customer notshown or charged herein will be billed_. 12 Whites Path-Suite 6;South Yarmouth,-MA 02664 .. _ .. .. _ .. .. separately.50%DEPOSIT DUE AT TIME OF ORDER(full amount if under$1001,balance due Phone:508-398-9100 Fax:508-398-1760 . upon time of installation.I HAVE READ AND AGREE TO ALL TERMS.; INITIAL Email:ocsar@vermon;hef PRINT: DATE: ._ wwwsignarama-syarmoulh.com ' THIS ORIGINAL DESIGN AND ALL INFORMATION CONTAINED THEREIN IS THE PROPERTY OF SIGN•A•RAMA AND ITS USE IN ANY WAY OTHER THAN AS AUTHORIZED IS EXPRESSLY FORBIDDEN.THIS PROPERTY MAY NOT BE REPRODUCED OR DUPLICATED WITHOUT WRRTEN PERMISSION OF SIGWA'RAMA OR THROUGH PURCHASE. iPage 1 of 1 Anderson, Robin From: Jeff Anderson [gwikpackship_capecod@msn.com] Sent: Friday, February, 17, 2017 1:56 PM To: Anderson, Robin Cc: Jeff Anderson Subject: QWIK PACK&SHIP special permit request to occupy 1667 Falmouth Rd Centerville, MA Hi Robin, I am requesting a special permit from the building de t. in Barnstable to move from m p g p Y current location at 1481 lyannough Rd. Hyannis, MA to 1667 Falmouth Rd Centerville, MA. The space at unit 1667 is 20ft wide by 60ft. The ladder sign dimensions are 1ft by 6ft. = Landlord is Brian Dacey- Bayside Building 508-221-1041 The business use is "Packing and Shipping" and small business services of copying, faxing, scanning, printing, passport photos. We will have only two employees at this'location. Hours of operation M-F 8am-6pm, Sat 8:30am-2pm. Our:website.is www.QPScapecod.com Thank You! Jeff Anderson QWIK PACK &SHIP 280E ROUTE 130 STE#2 FO.RESTDALE, MA 02644 508.888.1798 w tea Visit us online and track your packages at www.QPScapecod.com rn ou S 2/1:7/2017 As E UNk�EjZ- J � � 77 FA Y � 'ro . �., r-' .t � } � � �' ` / . r J� ,. r �� Y -> � � fit' �� � `i f � � / nt iy h i; � � } t f �� f � , 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma Par D ' A li i � � � ce NN catn• Health Division �-i Date Issued Conservation Division qA 0"°je-lee� � Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis tbo ND Project Street Address 6yt.(,V11 Village i( Alk 0 3�_ o _ Owner c- `j _O&GCy Address a,4QT-Vf I Telephone_ _ S�QA �-{ - (0 go Permit Request e� �nw cob -aCG'Ss No Square feet: 1 st floor: existing proposed 2nd floor: existing proposed_BUfLbWdgd Zoning District UL Flood Plain Groundwater Overlay Project Valuation 4$10 0V Construction Type FEB 17 2017 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sLT rQ @ W&_% Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name T A�r a b ac a 4 Telephone Number Address 11Ok License # CS —00 f 5— CD dory[Y(0-r �z , 1)X39 Home Improvement Contractor# Email 7( A G n h CW J d0 Af.&' A -COON Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUREW DATE ,alE" FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL i' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. V .7Ze Comwol! reah1 of-4&nadrtsetls 600 Washhigion Street Boston,AM 02 I kPfVt masmgop/dia Workers' CoffipensaffanInsuriuce Allidavit:BuildeFs C ntarxctnrs/MeL�,c •,;,,.1..ers APPHcaud Infmrm..aiian Please Prixd Na= .• C¢y/sta C ry M Phone iuk_ f—N 1 fD Are you an employer?Qreckthe appro ' to b I.Elrt I a a employer ui& 4_ I am a general contractor and I Type of project(required).- employees(full=&or parwime�* have hired the sub-contmc�tocs 6_ ❑New oonsfrmtEios� 2.❑ I am a wle proprietor orparinw- listed on the aitched sheet. 7_ ,❑Rerrmo&Hng s and have no employees. These sub-contractors have �P �P� $. ❑Demolition wod-ing for me in•auy capacity employees and have wmkem' c i„ ,a,�,�I 9. ElDuildiag addition �4�CF�:LECS Camp.irevtranr� onlp_ 43.�-- regrured] 5_ ❑ We are a corporation,and its _10-❑Electrical repairs cr additions 3.❑ I am.a homemAmw doing all work officers hm exercised their 1LEI FlumHngrepairs or additions nVself[No workers'comp- Ti9U of exemption per Me- �. insura=e required.]t c.152,g1(4h and we haven L❑Roafrepairs employees.[Noworkem' 131]'Other comp_iusuranm required_] Any WffCaDtffat Chedsb=#1 mast elsa fiIlontthe secBaahelmvshrrrtsiag tfieawodsets'caaape2*sa++�*policg info�s�io� Hmmeoamers who submit tlris Effidavir in&caling fty ere doing zUwc*and ffim hire outside conwa ,rsm submit a new afdMVk indicating sacTL TC'a�es�yt checkthi5 bmc mast ached�additinnal sheet sbo�cFagthen�of the sub-cs.aod stare whether arnotthnse et�tiesha� . employees.Iftheso oatxcktshweemployee%titeymnstpmvidetbe'u wo&ew comp.polkyaumbem lam art erripbr tleatis prauidirrg workers'camperrsrdirrrr utsrirarrce for asry enrpla}�ee Setoav is tltepu8cy arcd jab ate information. Insurance Company Nam: "Policy or f-ins.lic_4`_ Expir-afronDate_ Job Site Addresw CitylStatel2sg- Attach a copy of the workers'compensationpolicy declaration page(shaving the policy number and expiration date). Failure to secure coverage as required under Section 25A o€MGL c_15�7 can lead 10 the imposition of criminal penalties of a fine up to$04a Oa andlor one-yearimprisonment,as well as civil penalties is the fom of a Slop WORIK Ol DERand a ire of up to$250_00 a day aggaiast the violator. Be ad-used that a cup of this statern e t sway be hxvwded t0 the Office of 1"estigatinns of the DI&for iflsutauce coverage v erification_ ydfa hem& csrfify "Is Pons andpsrra es afvedW7 Mat trio iruformatzmrprM dadabotv is bars and correct - Phone ik D, eiaL uss wanly: �Da nit�rrita inn tFa s area tit be compWad by crfp srtojPn a,�j`rafat City •Fawn:or Pe?•ndtff;,.ease# hms A flMritg[circle one]: L Sward of Health 12 BurilAing Deparhneat 3.CRY-frown Clerk 4.IIeetr ical Inspector $.Plumbing Inspector b.Other Contact Person: Phone 9: Taformation and Instructions M carJ me GeMeral LAWS ChBptEx I52 requires all employers to provide wcaj S'compensation fQr them'CmplOyees. pursaantto this Vie,an=nP&YW is defined as.�.every person in$.e sravi m of anodzer under any contract ofhire, cxpr=or imp1Tul oral or wzn=f An ez,P&yBr is dcaaca as-air mdxvidnal,partnership, associafion,c poration or oth legal enjity,or any two or more of the fnregoiag=gagtd inaloint� ,and mcladmg the legal�sentatives of a deceased employer,or the receiver or trastee of ma individual,pMt3=:ship,association or other Iegal entity,employing employees_ However the owner of a.dwelling house havmgnot more than three apartments mad who resides therein,or the occupant of the - dwBMI19 house of another who ermploys persons tm do ice,consliucton or repair Walk on such dwelling house tiiereto shallnotbecanse of surds employment be deemedto be an employer." or on the grounds or bn1Zdmg appm�a� . MGL chapter 152,§25C(6)also states that"every state ar locaI hcensnag agency shall withhold the iss¢ance or renewal of a license or permit to operate a bnsmess or to construct buildings is the cor¢monweaith for any applicanwho has notproduced acceptable evideum of crimpuance with the insurance coverage regaka& Additionally,M(�chapter 152,§25C(7)stairs¢I�Teithar the nor ray of ifs political subdivisions shall ewer into any contract for the pmfbi manse ofpnblic work until acceptable evidence of compliance with$te in=�.. rcT_dr ter¢s of this chapter have S-_=presented to the eo—f*acting aoihomty-' Applies " Please fill Out the WorlGrs'.compensation affidavit completely,by cheClang ille boxes that apply to your situation anti,if necessary, upply sub-co�or(s)�e(s), Ces)�Phone mzmber(s)along with their c�cate(s)of msmanee. Limited Liabi ity Companies(LLC)or Li�itEdLiabfiiiyP s.(I U)W no employees ocher ihaa the members or partners,are not rbqukmd to carry workers' compensation insurance. If an LLC or LLP does have . employees,a.policy is regnnrd- Be advised that this a$dayitmaybe sobmitfed to the Department of Industrial Accidents for confnmation of insurance coverage Also be sure to sign and date fine affidavit The affidavit should be retvoned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accideo� shouldyou have any questions regardmg the law or ifyou are requited to obtain a wozkcrs' compensationpoliey,please call theDepaitnenf atthenz mbea]istndbelow Self-fimurdcompanies should entinz. it self-i saia ce license number on the approp¢iate ae. City or Town Of icia.Ls f Pleaso be sure that the affidavit is templet_andprirt,-,aIegRIy. The Department has provided a space at,the bottom of the affidavit for you to fill out in the event the Office of Iuv� �has to con tar tyourcgardingthoapPlicant Please:b e sure to,H 1 in the pe�icrose miiaber Which will be used as a refr.=ce number Im addition,an applicant t that must submit multiple pennW icense applications in any given year,need only submit one affidavit indicating'"'TR policy inform �information Cif nesmY)and under"lob Site Address"the applicant should write:"all locations in ( O1 town)-"A copy of the•affidavit that has been.officially�pe�or madced by the city e1r town maybe provided to the .applicant as proof that a valid affidavit is on file for toter_p�or licenses A new affidavit must be fiIle�oia each year.Where a home owner or citizen is obtaining a license or permit not related.tQ any business or commercial vEE&U-0 Cie. a dog license or permit to bum leaves e3�_-.)said person is NOT reTMked to complete this affidavit The Office of Investigations would like to thank you is advance for your cooperation and should you have any questions, please do not hesiizLtr to five us a call- The Departimmfs address,telephone and fax mmmber: Tn-COM=Wealtir Of MASSB&USEM D mt cif Inftztdal Amidealts B 0�111 T�1. 617' -49W eat 4-06 car 1-9�7v�;4&IAA Fax It 617727 7M Keyised 424-07. p � WE Town Town of Barnstable Regulatory Services i ' KAM ' � Richard V.Scali,Director i639. Mea Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property.Owner Must Complete and Sign This Section If Using A Builder ITAwT 'D ,as Owner of the subject property hereby authorize -wk 7c "'b& to'act on my behalf, in all matters relative to work authorized by this building permit application for. 0 (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspec ' ns are performed and accepted. tune of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNERPERMISSIONPOOLS I ' I. , MECFi�WiGAL I I OFFCE _I OFFICE a I - I R _ I �— TodET - I: I El OFFICE 1 CONFEPENCE I I I I 1665 RT.26 I _ 1667 Rr.2B UNIT#6 UNIT#5 1200--aFT. I V 78-'Q.FT. I I � f I I I , , I I -------------------------- I FIRST FLOOR PLAN SCALE 1/4" = I'-0' r I I I I 3Q 1 3 I 9Q I I I HEQW�OG^L I MEGh4WIC.AL OFr10E � I OFEIGE I I I I I roo.ET I I � I I I I I TaIFr 1 I I I I 1 REF. OVEN I I I L 00 00 l L— I r CONFERENCE I I I I I I I I I OARCH O I I I UNIT#6 UNIT#5 171J0 SQ.FT. I 776 SO.Fr. I I I I I I 9� 3� I I I I I � EXISTING FIRST FLOOR PLAN SCALE, 1/4" = 1'-0" f Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-005645 e Construction Supervisor i BRIAN T DACEY PO BOX 95 CENTERVILLE MA 0 �2 Expiration: , Commissioner 04/19/2018 t i Ilan, 30, 2017 1 , 09PM DOWLING & O`NEIL INSURANCE Ni), 2633 P, 2 GtHI IFIGA•TE OF LIABILITY IN5URANGE 01/30/2017 THIS GFRTIFICATF IS ISSIIE❑ AS A MATTFR OF INFORMATION ON]Y ANn rONFFRS NO RIGHTS UPON THE f FRTIFICATF Hot PIFR THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AI=FoRaEU 13Y THE POLICIES RKI nW TI4Ii4 P'FRTIKII ATF r1F INSI II7GNr r rirIFc; mf)r r nPdgTITIITF A r nhITOAr'7• RFYWKZ=N 'rWr IRc;mrjr3 IAf WWF;g(R), AI ITHnPi7rn R�EpP�RpE•�SpEN7T•ATIVthE OR PRODUCER,AND THE CERTIFICATE HOLDER- r h �nr r q��g� '��'n G y�plVFr� { t I11Y5 PrrIrIONT1:if. t&ff 1Sf�S�1�n%ilq AL�nJPAT,�>� 60P3109.2. �,���l���l{��r�lRStatl�ll�r�Y1Yt��r�ru4sf FtIKI11Ln��ll t]t��rlli[-4b11t6r aILII�'n certificate holder In HoU of such andorsernant s- PRODUCER CONTACT gqlIlIiiyy UUWLINU & U'NLII, INjUKANUIn AUE-NUY PANKL 11Ll �8 fp%2U 'c aou INL2 Isulllvan(c"D.doins.com 913 IYANNOUGH RD. INSURI_R 3)AFFORDING COVERAGE NAIC41 t'1'intJhllJ MA 02001 INSURERA: AOADIA 1115 00 b IStb INSURED INSURER p; SMJ CARPENTRY LLC INSURERC: INSURER D: _ 9 CENTER L : LANE INSURERE MVCh1 (;t:KIIF'IC:AIC NUMkSKqYAz INAIIRFRF KCV151UN NUMLILK: THIS IS TO CERTIFY THAT THE POLICIES OK INSURANCE LISTED BELOW HAVE BEEN IS$VED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY MEQUIRCMCNT, TERM OR U-iWAYIbN OP AITT t.%DNYAACC OR U(NER rjOrJMErg1 Whri KE6rtLLi 'Ill drrlll)h'IM16 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AU.THE TERMS, L/�VLVJIVIYJ/\IYV VVIVVIIIVIYJ V/ JV VII rVLKAL-Q,I.IIVII IQ JI IVVYIr IVIA1 I'1/iYr_UCL-IV nL-V Vury Ul rMIV VLHIlV1J. INSR ADDL SUBR POLICY EFF POLICY EXP Cift TYPE OF INSURANCE POLICYNUMBER o 0D LIMITS rn�ucorinl rtllecnl Iln oil ITY —1i 5 CI-AIMS-MADE 1 -1 OCCUR PREMISES(Es ap ifr6llta $ MED EXP(Any one N/A PERSONAL&ADV INJURY S oa1YLMoonwnlculnn r,rru�arFn, our�IwLr�ovn�Lwr� a POLICY❑PRO-ECT J LOc PROpUCTS-COMPIOPAr,O $ OTHER: AUTOMONLELIABILITY COMBINED SINGLE LI IT $ IEs stdd6 ANY AUTO war Ilyd�N) nl Irrl Palnaur a ALL OWNED SCHEDULED OS AUTOS NIA BODILY INJURY(Pcr accident) $ HIRED AUTOS NO OWNED PROPER, M%GE HD $ AUr03 Pei,b 'dent A UMBRELLALIA9 OCCUR EACH OCCURRENCE $ EXCESS LIA13 CLAIM°-MADE NIA AGGREGATE $ DED RETENTION $ WORKEKSCOMPNNSAVON A CTATI ITG GP YIN ANYPROPMETOWPARTNEWEXECU IVE — EA.EACH ACCIDENT $ 500,Ut}0 A OFFICER/MEM9EREXCLLIOrD9 NIA NIA WA MAARP30i157 01/22/2017 01/22/2018 (MandaforyInNH) E_LIG':EA E EAEMPLMYE sooloo0 DESCRIPTION OF OPERATIONS below E.L-DISEASE•POLICY LIMIT $ ODU,UVU N/A nFArRfFTinpinrniwPnATInN,RrIFHOTInN9IVFHIrIFR farnRn1M 0lftllllnniiRtmorYY,4Phirlultmtuhtillvh■diFmnr'mrnvsimr■nllir.d) Workers'Compensation benefits will be pall to Massachusetts employees only.pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay olaimo for bonofito to omploy000 in ototoo othDr than Ma0000huootto it tho inourod hiroo,or has hirod th000 omploycoo outeldo of Maa000hueotto, This certllloate Of Insurance shows the policy In force on the date that this certificate was issued(unless the expiration date on the above policy precedes the ILfbVV lltLtC Vr dlw UCl t[Auiku Vf ll lsulul lUU). I IIC utumu Ur%lilts UUVCIUUt:Uall UG illullIIult:0 Ually Uy uuutl sslrig mu r1UVl ul L uvt;j Wt;-uumi]Ut:VullIIUallull Search tool at www.mass.gov/lwd/workers-compensadonrinvestigailotis/- CEKT)FIryATE HBLISZR 0ANZELLATIGN SHOULD ANY OF THE ABOVE DESCRIBED PQLICIE$BE CANCELLED BEFORE t�y THE EXPIRATION DATE THERIOF, NOTICE WILL BE DELIVERECI IN Boyside Building Inc. ACCORDANCEWITH THE POLICY PROVI$IQNS. PO Box 95 AUTHORIZED REPRESENTATIVE t Centerville MA 02632 Daniel M C oQey,CPCU,Vice President--Residual Market—WCRIBMA rr`119RR.7D9d A!nwn f flwunwATiflhl All rlohte mirnnind ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD F p MEW-1 OP ID, MD ER e IFIICATE O LIABILITY INSURANCE DATE(MMIDh/YYYY) THIS CERTIFICATE IS ISSUED AS A ri7A7TER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER CERTIFICATE DOES NOT AFFIRMATIVELY OIL NEGATIVELY AMEND, EXTEND OR.ALTER THE COVERAGE AFFOl�pED gY Tt9E POLICIES BE THIS CERTIFICATE OF i111SoJRANCE DOES NOT C0NST1fUTE A CONTRACT BETWEEN( THE ISSUING INsLIRER(S}, AUTHORIZED REPRESENTATIVE OR FRODUCi R,AND THE CERTIFICATE HOLDIa T. IMPORTANT: If tlte certificate holder Is an ADDITIONAL lNSUREp, the policy(les) nJu$t be ehdorsed. If SUBROGATION IS WAIVED, subject to the terms hod holder in lieu o of the policy,certain pollcfes may require an endarsernent. A statt3ltlent on this cerkificate does not confer rights to the the terms holder in lieu of such endorsements W.PRODUCER Kerry Insurance Agency Inc. CON CTW Scott Kerry P.O. Box 1945 PHONE N.Eastham,MA 02661 A/C + I;508-255-13000 Arc W.Scott Kerry E-MAIL @e rFVC•Npl; 8�8-240-1860 AD��3'-1C rry_ c4.ne4 ' INSURER{S)AFFGRDING COVERAGP! INSURED Melvin K Reed INSURERA;Associated Employers Insurance NAICir 159 Donegal Circle INSUR,EIR B:NNorfolk&Dedham Ins Co Centerville, MA 02632 INSURER C; INSURER D: INSUfiE;R E t COVERAGES INSURER ; CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF fNSURANGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE THE POLICY PERIOD IND1CgTED. NQTWiTHSTAN[)ING q[�Y 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 DESCRII=ED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE SEEN REDUCED BY PAID CLAIMS, INSR AO a R LTk TYPEOFINSURANCE OLICYE Q POLIC POLICY NUMBER MMID LIMITS CdMMERCIgL GENERAL-LIABILITY MMIDDIV CLAIMS-MADEEACH OCCURRENCE g 9,000,000 nC OCCUR X R1518334A 07/21/2016 07/21/2017 '- X Business Owners ftREMISES�aOcc�rrencc $ 50,000 ME0 EXP(AnyPne p6tean) $ 5,000 GED7'L gC•CikEGATE LIMIT APPLIES PER; PERSONAL&ADV INJURY g 1,000,00 X POLICY JECT LOC GENERAL AGGREGATE $ 2,000,000 OTIIER: PRODUCTS-COMPIOPAGG $ 2,000,000 AUTOMOBILE LIABILITY 00 BINED SI 9LE LIMIT .._ ANY AUTO) Ea accjrignt�` $ ALL OWNED f:HEDIJLED 6ODILY INJURE'(Per AUTOS HIRED 20DILYINJURY Pcraeeldent 3 111REQ AUTOS NON.04VNEU ( ) AUTOS ETr Ekoolden DAMA� "$ UMBRELLA UAB $ DccUR MS EACH OCCURRENCE $ GMGESSLIAB C,�AIMv-"MAOE AGGREGATE F DED ftE'rEtdTIGN g WORKERS COMPENSATION g AND EMPLOYERS'LIABILITY X H- Q ANY OFFICER/MEMBER BER EXCLIUpEID?ECUTIYE Y R � N JA WCC50050135942016A 07/21120 STATUTE 16 07/21/2017 E.L.EACH ACCIDENT E (Mandatory ItI NH) - $ 500,000 It ye6.desribr und8r E.L.DISEASE-EA EMPLOYE $ 500,00 DESCRIPTION OF OPERATIONS Wow E.L.DISEASE-POLICY LIMIT $ 500,000 PROPERTY 5,1)00 DESCRIPTION OF OPERATION$J LOCATIONS I VEHICLES(ACORD 101,A00101181 RegtZrkB solledule,ma Yba attached Irmorc spare IJ;requlraa) drywall,plastering Certificate Hodder is included as additional insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DI;QVERED IN Sayside Building Co ACCORCRANCE WITH THE POLICY PROVISIONS, 3 Bayberry Square 1645 Route28 AUTHORIZED RE-PRESENTATIVE Centerville,MA0263,2 Q 1988-2014 ACORD CORPORATION. All rig his reserved. ACORD 25(2014107} The ACORD name and 1090 are registered marks 4f ACORD f Client#:761491 2CICIRELLIMI AC®RM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 11/15/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling A O'Neil Insurance Ag PHONE 508 775-1620 FAX(AI 5087781218 973 lyannough Rd,PO Box 1990 E-MAIL Ext: a/c,No Hyannis,MA 02601 ADDRESS: 508 775-1620 INSURERS)AFFORDING COVERAGE NAIC# INSURERA:National Grange Mutual Insuranc INSURED Michael Cicirelli INSURER B:Associated Employers Insurance i 121 Pine Street INSURERC: Hyannis,MA 02601 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSRLSUBR WVD POLICY NUMBER MM/DDY EFF MPOIDCp�Y LIMITS A GENERAL LIABILITY MPT3948Q 1/07/2016 11/07/2017 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500 000 CLAIMS-MADE ®OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY _$1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY JEC LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION tlVCC50050140662016A 1/19/2016 11/19/201 }( WC STATU- OTH- AND EMPLOYERS'LIABILITY Y LI ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500 000 OFFICERIMEMBER EXCLUDED? ® N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Bayside Building,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1645 Falmouth Road ACCORDANCE WITH THE POLICY PROVISIONS. PO Box 95 Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S180345/M180344 LS1 r O DATE(MMIDD/YYYY) ACOOR® CERTIFICATE OIL LIABILITY INSURANCE 07/22/2016 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. ;MPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Liz Dorr GERMANI INSURANCE AGENCY a°NN Ell: (508)428-9194 a No: E-MAIL @9 ADDRESS: certs@germaniinsurance.com 908 MAIN ST. INSURERS AFFORDING COVERAGE NAIC# OSTERVILLE MA 02655 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: WILLIAM B CAMPBELL INSURERC: CAMPBELL PAINTING INSURERD: 285 OLD TOWN ROAD INSURERE: HYANNIS MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER: 71294 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TR TYPE OF INSURANCE IANSD DDL SUBR WVD POLICY NUMBER MM/DDY EFF MMIIDI DYE LIMITS H271M MERCIAL GENERAL LIABILITY EACH OCCURRENCE $ To CLAIMS-MADE OCCUR DAMAGES(RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL BADVINJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY E JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLELIMIT $ (Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY Per accident AUTOS AUTOS ( ) $ NON-OWNED PROPERTYDAMAGE HIRED AUTOS AUTOS Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X1 SPER I TATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 100,000 A OFFICER/MEMBEREXCLUDED? N/A N/A NIA AWC40070001262016A 07/13/2016 07/13/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500.000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. Continuation of above Named Insured:WILLIAM B CAMBELL JR CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN [ARD ide Building ACCORDANCE WITH THE POLICY PROVISIONS. almouth Rd AUTHORIZED REPRESENTATIVE ille MA 02632 Daniel Cr ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. 25(2014101) The ACORD name and logo are registered marks of ACORD f Suzanne Harrington MurrayandMacDonald (2/2) 02/08/2017 11 : 53 : 34 AM -0500 CERTIFICATE 4F LIABILITY INSURANCE DATE(MMIDDIYYYY( 2/8/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an andorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsernent(s). PRODUCER Gabriel DeSouza NAME: Mu.Liay & bia L;DuualLl IuS ui auc:c get vlL;cS, IuL;' A1ONNE Ext: t5D8)540-2400 FAN No: I55612B5-All! 550 Mao7Lrthur Blvd. E-MAIL gabriol@riskadvice.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# Bourne MA 02532 INJUKGKAAiIl 1111 Mu Lual I115 LLia11lC 17000 INSURED INSURERB Arbella Protection Insurance 41360 CarYcL Baru, ILIL;. wsURERCMass Retail Merchants' WC Grou 719 Main Street INSURERD: IV�UKCK C: Falmouth MA 02540 INSURERF: COVERAGES CERTIFICATE NUMBER:16-17 Maztar 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. NOTWITIISTANDING ANY REQUIREMENT,TERM OR CONDITION Of ANY CONTRACT OR OTI IER DOCUMENT WITI I RESPECT TO WIIICII TIITS 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. IN SR PnI ICY FFF Pni WY FNP LTR I Trt Ur INZiUKANUt POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMI I J X COMMCRCIAL CCNER AL LIABILITY 1,000,000 tAUt7 UUUUKKtINUt � A CLAIMC-MADE �OCCUR DAMAGE TO RENTED 75n nnn PRf•IvIISPS Ca uLt,w lent.e' 7520026701 03 5/1/2016 5/1/2017 MEDE.XP(AnyonnPercon) S 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENTAGGREGATE UIa11T APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X (POLICY D PRO J tUI FI LOC PPODUCTO-COh91`101"ADO $ 2,000,000 OTHER: Employee Dishonesty/ERISA $ 100,000 AUTOMOBILE LIABILITY V.UIVIDINCU JIIVULE LIMI I (Ea aCaden aacadent $ 1,000,000 B ANY AUTO DODILY INJURY(Per porcon) S ALL OWNED x SCHEDULED 1020018229 5/1/2016 5/1/2017 BODILY INJURY(Per arridenf) $ AUIUS AUIUS NON-OWNED x PROPERTY DAMAGE HIRED.AUTOS x AUTOC Der occident Uninsured motorist BI split limit $ 50,000 n UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,0UU,U00 B EXCESS LIAR HCLAIMS MADE AGGREGATE $ DED I x RETENTION$ 10,000 4600046787 5/1/2016 5/1/2017 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN STATUTE I ER ANY PROPRIETGRIPARTNERIEXECUTIVP t.LtACHAUU1UtN1 $ 5UU UUU OFFICER/MEMBER EXCLUDED? �I N I A C (Mandatory In NH) - 014000500212116 1/1/2017 1/1/2018 t.L UISLASt-to tMPLOYt $ 500,000 Uf yqes describe under DESCRIPTION OF OPERATIONS below E-L.UISEASt,-POUCY LIMI 1 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Bayside Building Inc. PQ BQx 95 Centerville MA 02532 is listed as a additional insured, CERTIFICATE HOLDER CANCELLA11ON SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Bayside Building Inc. THE EXIIIf2ATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Whitney Bodurtha ACCORDANCE WITH THE POLICY PROVISIONS. Po Box 95 Centerville, MA 02632 AUTHORIZED REPRESENTATIVE S Harrington, CIC/SMH 0o1988-2014 ACORD CORPORA110N. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks ofACORD INS025(201401) WVERNON-01 THORNE ACOROO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmm)9/26/2016 FTHIS 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 �r BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 A/c No Ext: A/c No):(877)816-2156 South Dennis,MA 02660 E-MAIL ADDRESS: ers ra ADDRESS: l:. 9 s Y•com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Protection Insurance Company,Inc. 41360 INSURED INSURER B:National Liability&Fire Insurance Company 20052 W.Vernon Whiteley Plumbing&Heating Co,Inc. INSURERC: Chatham Sheet Metal,Inc. P.0.Box 1266 INSURER D West Chatham,MA 02669-1266 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE I S NSD WVD POLICY NUMBER MMIDDDUBR Y EFF EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED CLAIMS-MADE a OCCUR 8500052832 10/01/2016 10/01/2017 PREMISES Ea occurrence) $ 100,000 MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JET �LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: EMPLOYEE BENEFI $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 n - ANY AUTO 1020006346 10/01/2016 10/01/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTYDAMAGE $ AUTOS per. X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4,000,000 A EXCESS LIAB HCLAIMS-MADE 4600052833 10/01/2016 10/01/2017 AGGREGATE $ 4,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE I ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN V9WC757688 10/01/2016 10/01/2017 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEd$ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Plumbing,Heating&Air Conditioning Contractor --General Liability Endorsement 30AP2037 Provides:Additional Insured Status to Certificate Holders,Primary Non-Contributory,Transfer of Rights of Recovery and Per Project Aggregate as Required by Written Contract —General Liability Endorsement 30AP2039 Provides:Additional Insured-Contractors-Completed Operations Coverage As Required by Written Contract --Commercial Auto Endorsement 26AP1034 Provides:Additional Insured Status to Certificate Holders,Primary Non-Contributory,Waiver of Subrogation —Workers Compensation Includes Blanket Waiver of Subrogation as Required by Contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL W DELIVERED IN Bayside Building Co.,Inc.P.O.Box 95 ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632-0000 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD f ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued Conservation Division s`''� i Application Fee Planning Dept. Permit ee Date Definitive Plan Approved by Planning Board Historic OKH _ Preservation/ Hyannis Project Street Address j.,nG `tad n fff PQ `9 ►' S Village C�r"�I� Owner EbWD Address o`2P"- Telephone BSI - v a 04 P rmit Request �z rG of �l c�,� A10L Slf1-13+.1 a— IAA c &V , Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation/0 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 QId King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other trtt�/LO/ Basement Finished Area(sq.ft.) Basement Unfinishedj%a�sq.ft) �pT, Number of Baths: Full: existing new Half: � new Number of Bedrooms: existing _new eA�NSTq B Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use =, APPLICANT INFORMATION (BUILDER OR HOMEOWNER) A�-n2 Q_ Name f/� �, Telephone Number Addres Q License # �� q0 l Wes- o z, Home Improvement Contractor# Email Worker's Compensation # ALL CONST UCT DEBRIS TING FROM THIS PROJECT WILL BE TAKEN TO &t�_�V+5L SIGNATURE DATE C cr { FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED { MAP/ PARCEL NO. j F ` ADDRESS VILLAGE _.1 f :s OWNER DATE OF INSPECTION: FOUNDATION ~: FRAME INSULATION FIREPLACE w ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. E 10 t . t TOWN OF BARNSTA,BLE BUILDING:PERMIT APPLICATION " Map .� �Parcel Application # 40 Health Division Date Issued Conservation Division Application Fee i1• ; Planning Dept. L rmit Fee IR - j ) Date Definitive Plan Approved by Planning Boards Historic OKH _ Preservation / Hyannis_; + 1) s Project Street Address Village ( f�iTU►�(P Owner Nvom Address oZ �PQE� .� • �. �i1stlU�� Telephone %/ - D R F a P rmit Request of mac,_,, (—N- ('t�J NArL �.9 ewe Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay, w 4� -' - LF Project Valuation/Or WO Construction Type 4.4 F Jj Lot Size Grandfathered: ❑Yes ❑-Nod<If yes,.a adfi�s ppo iif�db'cu entation. Dwelling Type: Single Family ❑ Two Family ❑ Multi`Family(# nits)E-"# l.ab>I>k L,I "" Age of Existing Structure Historic House: ❑Yes &No On OId.King`:'s High a'.: ❑Yes U•No °r - Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil 0 Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use "~ APPLICANT INFORMATION v (BUILDER OR HOMEOWNER) tName �a'`-� - ��� ., Telephone Number `( 353 71 QN Addre s J �wl e9 License # " Gl Home Improvement Contractor# " '= Email Worker's Compensation # `f ALLCONST UCT N DEBRIS TING FROM THIS PROJECT WILL•BE TAKEN TO SIGNATUR .:DATE n FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i • ' .3'Ir.�e Comrr-romvealdr afMa:ssa<rJi=etts DVarfrrtewt c&f rnd—us-id Acci&Tr& • ��a,�.lrnt�estigaficarrs. . 600 Washurgtort��treet Bastotrr A 02HI • 4 t4'f{�'f:711FfS��t9P/�llrll . "Warkers' CumpensationInsurauceAffidavit:B.mldersICantraclur--JEfecfridansJPhmibers $cant Eafarmaffan A Ple-ase PHUt Le��x�bT 1V 87IYP. $11S*SSi' Ig3II1 [FIIl�nri'cc�tirta7 _ L Add CIfy��lf,3t�J i<ar� -�w�Ir QflG t Ai a you an employer?aieckthe appropriate,box: Type ect r of ra ' . I am a general confoctor and I p ] -I.El I am:a employer with. ❑ . employees(filff andlorpart-time).* havehired.•the sub-contractors 6- New cons5ra>cfiog Z_ I am-a sole prRp>;etotr orparfner Listed"'lse attached slxeet 7- []Remodeling s • and have no 1 ees. Miese sorb-confractors have ffiP 8. ❑Demolition wor1z ing far me i a any capacitr- employees andbave workers' 9. B.ui1d"m addition[No wormers•'camp.insurance comp-insuranc�l g required-] 5_ ❑ We are a-corporation and its 16❑Elecfrical repairs cr addifi•,ons officers have,m=ersed their- 3_❑ I am fiomeowner doing all^�orac 1L�+Plutabiagrepaiss or additions set€ o wcxkecs' right of exemption per h iGL in c_ § n anweavena try-❑Rflafrepairs mcrrr arire regaimd�[ 152� I d 'h , employees.ENaWo&=3 13-❑•otfier comp-inm=,ce required_] 'Aupap r1—s :accbed-sbasrlmadalsofilloutth�ese oabrIowsUatdag�e¢wuaes'campeumt; rpaycpis�o�suoa #�aTM . ha snbagt this sf5davii indkxth%tky im doiin.-zUwca c ma tEmhire autsiaec&a.xct= amstsabmitanewaffid2vt'"��sar-TL rCan*9Cr=tTa�tcbe-IrtWs box must attsrb mtaddiiiamQ shed slowing die nnneof the sub-contrw amsndstalewhetherornotibaseendtksh1ve e-PIDYIies.Ifthesub-•ccatractnesUveempigees,theyn srpmsvidetheirzradrrrs'iamp.galicgnumber- Zanr art e1liplvJ�crr flir�isprm-zdircg�varkers'coa�rerisc>��rc irrsruaaca jnr may*enipla}�ees �8efoav is�ItRgaTiry•ru�t3 jab sitR irzformrrlrorL ' . 'i Insurance Company. aule: Policy 4."or f--ins.Lic.;g 1=�piratu Date: Job gate Addrem- CiLy1Stafel7!p: . Attach a copy of the wwkers'compensafioapolicy declaration page(sh whag the policy,number and.ezph-AiwL Sate). FaRwe to secmm coverage as req*ed under S=Ebn 25A of MGL c.152 cam lead to the imposition of criminal penalises of a lime up to$I50D-Oa a'or one yearimpiiso a:s w&as cirwil penalties is ifie fo=of a STOP WORK ORDERand arm of up to$250-00 a against 0te violatmr_ Be adxised that a copy of this statement maybe forwarded to the Of of . Iayresfsgations tsf If4 age s�c�iom f d a herwbp c ju&r s an r!a ' s af1mr Fuly hTwUlte irrforma imFpro1,ii da �h;tr t ug mid correct. ,sismifixrr Date (JC�—�J Phone P tl,Wat rise anTy. Da jwt wrke in flit area,to be ctrnspWad by city artown ajqlciat City or Fawn: lserr>asfl A ease f T ing A;ufimrfty,(cacIe one): - L Board of$ealth 2.Bur'Itf'aag D epm,Imeut 3.CityfTown Clerk d_Electrical hmpmtor S.Plum-bm1;E 2�p ec for b.Other Coo act Person: Phone" OF THE t0� O� ► HARNSUBt . MASS. Town -f Barnstable 165g6 ��� . Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403.8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section, If Using A Builder I c�o - Th, , as Owner bf the subject property ' hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) Signature of -r Date L)V� )AL) Print Name IfProperty Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. • t Q:\WPMESTORNMbuilding permit formslEXPRESS.doc. Revised 040215 Massachusetts Department of Public Safety Board of Building Regulations and Standards a License: CS-069386 Construction Supervisor ANDREW R DAVISON 350 QUAKER MEETINGHOUSE EAST SANDWICH MAV2�i lJ—r Expiration: Commissioner 08/10/2019 Bays i de Building, Inc. P.O.Box 95 • Square BayberryS uare • 1645 Route 28 Centerville MA 02632 ' ".Quality 7o Live By' 508 771-1040 • Fax:508 775-0155 • www.baysidebuilding.com May 26, 2016 Mr.Jeff Lauzon Building Division Town of Barnstable 200 Main Street Hyannis,MA 02601 Dear Jeff, Please be advised that I am the owner of Unit 5, Centerville Plaza, 1661 Falmouth Road. I have a fully executed lease with Phuong Trong of 25 Osprey Drive, East Sandwich, MA. Through me, the tenant has retained Pesce Engineering and Associates, Inc. It is my understanding they have met all of the requirements for the Board of Health. Should you have any further questions, please do not hesitate to contact me directly on my cell at 508-221-1041. Sinc , ria acey BTD/wvb "vIL®ING Q �T JUN p 3 ZO'i S'�a , COMMERCIAL LEASE This Lease Agreement made this 1st day of June, 2016, by and between Brian Dacey, Managing Member of Centerville Plaza, LLC of 1675 Falmouth Road, Centerville, Massachusetts 02632 (the Landlord); and-Phuong Truong, 25 ... Osprey Lane, E. Sandwich, Cape Cod, (the Tenant). W I T N E S S. E T H: In consideration of the mutual covenants and agreements hereinafter set forth, the parties hereto do-hereby covenant and agree as'fcllows: PREMISES AND IMPROVEMENTS A. Landlord hereby l eases exclusively to Tenant, and Tenant hereby . takes from Landlord, Unit 5 of a building located at 1661 Falmouth Road, Centerville, MA 02632. B. So long. as Tenant is not ,in: ,default hereunder, Tenant shall have peaceful and quiet use and possession of the premises without hindrance.on the part of Landlord. C. This Lease shall .. at the election of Landlord be subject and subordinate to all'mort gages which may now or hereafter affect the real estate of which the premises form` a part, and to all renewals, modification's, consolidations,. replacements -and, extension thereof. In confirmation of :such subordination,Tenant agrees..at the request of Landlord from time to time to:enter into a subordination`agreement with any holder of any such mortgage which shall bind and benefit the respective parties and their successors. D. Tenant is given the right of non-exclusive use, in common with others entitled thereto; of the sidewalks, parking area and loading area at the building These common facilities shall at all times be subject to the exclusive control and management of the,Landlord, which shall have the .night to establish, modify a'nd enforce reasonable.rules and.regulations with respect to the.same.. Tenant shall be responsible for removal of snow and ice from the sidewalks used to access the leased premises. Page 1 of 11 , In witness whereof, the said parties hereunto set their hands and seals this 1st, day of June, 2016. Centerville Plaza LLC , by r Br''Br' 'K Dac , ManagirZ Member ,T COMMONWEALTH OF MASSACHUSETTS Barnstable,ss. _ On this day of June, 2016, before me, the undersigned notary public, personally appeared by and ;proved to me through satisfactory evidence of identification;which was a`Massachusetts driver's license, to be the person whose name is signed on the: preceding or attached document, and acknowledged to me that he/she signed i voluntarily for its stated purpose. Notary Public My Commission Expires: COMMONWEALTH OF MASSACHUSETTS Barnstable,,ss. On this ddy 4of June, 2016, before me, the undersigned notary public, personally appeared Centerville Plaza LLC•, by Brian Dacey, Managing Member and proved,,to me through satisfactory evidence of identification, which was a Massachusetts driver's license, to be the person whose name is signed on the preceding or attached document, and acknowledged rto me that she signed it.voluntarily for its stated purpose. Notary Public , My Commission Expires: Page 11 of 11 Materials Stored On Site 1 gallon of Acetone 1 gallon of Isopropyl Alcohol 1 gallon of Body Lotion 1 gallon of Cuticle Softener L Psi Town of Barnstable Regulatory Services �l j ((��7 dx") r AeRNRR'�R�.F ♦ - - MAS& Richard V. Scali,Director 05g6 En r�xi'' Building Division lily IZU �'/ Perry, g ° Thomas Per ,Building Commissioner. / 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Officer 508-862-4038 Fax: 508-790-6230ttad Building Permit Procedure for Commercial Additions/Alterations ❑ Map and Parcel number I� ❑ Letter of Approval from Site Plan Review(if applicable). � � Jv r ❑ Site Plan must also be submitted showing the location and setbacks of existing/proposed. structures, septic,parking, eta ❑ Historic District at 200 Main Street: Certificate of Appropriateness is required. LL Old Kings Highway Historic District(north of the Mid Cape Highway) Hyannis Main Street Waterfront Historic District(See map,for boundaries) Historic Preservation(if applicable). ❑ Construction plans-one complete set of full sized plans and one complete.set reduced to 11"x17"and fully dimensionalized must be submitted with the building permit application. Both sets must have an original architect or engineer's stamp. Note: The applicant must also submit a set of plans to the appropriate Fire Department for review. The application package will not be accepted without prior approval from the Fire Departfnent. ❑Approval from the following departments,located at 200 Main Street,must be obtained ❑Health Department Hour`s(8:00-9:30 AM or 3:30-4:30 PM) ❑Conservation Department Hours (8:00- 9:30 AM or 3:304:30 PM) ❑Tax Collector I ❑Treasurer ❑ Permit must contain full description of the project,correct square footage,valuation of project(do not include hvac)owner's name, address and telephone number, contractors information and signature and dated ❑ Workers Compensation Insurance Affidavit State form must be completed and a copy of Insurance Compliance Certificate must be on file. ❑ A copyof the Construction Supervisor license is required. Note: Construction Supervisor's license holders are not entitled to supervise construction of a building or an addition (regardless of size)to a building with a total cubic volume greater than 35,000 cubic feet In that case,the application must be accompanied by controlled construction documents as indicated in 780 CMR sections 116& 1705. ❑ Check expirations-date,no restrictions ❑ Controlled,Construction ❑ If sprinkler or fire alarm system is required, do not accept application package without prior approval from Fire Department(phone call or in writing) ❑ Have you submitted the AQ 06 form with the State?www.mass.gov/dep Any question on completing form call Caroline McFadden 617-292-5766 A NON-REFUNDABLE Application Fee of$100 must be paid upon receipt of application number, check made payable to the Town of Barnstable. Permits are$9.10. per$1000 of value of work.Minimum permit fee$60.00 Property owner must sign.Property Owner Letter of Permission. Projects requiring the use of a crane must complete the forms issued by the Federal Aviation Administration(FAA)(Form 7460)AND the MassDOT Aeronautics Division(Form E-10).Forms and procedures may be obtained from the FAA and MassDOT websites. Note: No wall is to be covered before wiring,plumbing and frame inspections. 'Q:forms/bldg/permits/CADDALT Revised 02/27/15 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' � Cif ,> mm',. ., �� i:���� �• l,, Map Parcel Del.— +et__ Application Health Division 7[111' '':: ' 23 11 3: 50 Date Issued Conservation Division Application Fee Planning Dept. Permit Fee tJ "f ` Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis X Project Street Address I W 017611 D iAdl Village h Owner F2rlao P4 Cei4 Address it-, PO D t5 Telephone SD • o 49- rM4 b -e,7_ Permit Request 4? 1 —Oof c o ' Cam✓ TT- T Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number `� � �C�g• 5 0D! Address L25 OSP04 LC2 License# O Home Improvement Contractor# Email fin 62 .T c>rJ Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �C //� FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: 1 FOUNDATION r FRAME INSULATION -FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: - ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. +•l'^.,v'ti ^— `,. S- r•a. �:.iy'.:; -.4rL r' yrn ., ;a-Fnw,.�„4 xM'^F: . a ,A fs wJ*.• .r e. '�1+.• .1` _�• n ..., �--, r�f TOWN OF BARNSTABLE(BUILDING PERMIT APPLICATION r Map c2 � Parcel GS`! -� �Ft3°/I Applications ` � /.,1Health Division `"i ''",'i ' 3 YJ ` : 50 Date Issued Conservation Division ';4pplication Fee I r. Planning Dept. t Permit Fee I Date Definitive Plan Approved'by Planning Board f Historic - OKH _ Preservation/ Hyannis Project Street Address. }- '�` Village _J?J1 k1t>L 1,e' Ownerr"t Tr �u Address lieYoQ(D p� Telephone 5c-)8 • (A 2,14 (� Yv0 1 c/A k'., Permit.Request <-% KQ 11 i ,t 4 Square feet: 1 st floor: existing proposed 2nd floor: existing - proposed Total new ' r Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type r t , Lot Size ' i Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. ,,Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) - Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type`- ❑ Full ❑ Crawl ❑Walkout ❑ Other 'Basement,.Finished Area (sq ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing' new Number of Bedrooms: existing —new Total Room Count (not including,baths): existing new First Floor. Room Count Heat Type and Fuel: ❑ Gas ❑Oil, -0 Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing, New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size = Barn: ❑ existing* ❑ new size_ Attached garage: ❑ existing ❑,new size _Shed: ❑ existing ❑ new size —Other: Zoning Board of Appeals Authorization ❑ Appeal # 'Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use' APPLICANT INFORMATION __ �. (BUILDER OR HOMEOWNER) l •Named Telephone Number `) (� '-7F7K. `� % ` 4 Address r an o License # Q .\Cif t!Y✓14 t)r-1,a 61P 0,2��� Home Improvement Contractor.# :� - .. / ' 49 Email- F11 1A C-)0^ . 6P , I P h v is-r �,�; w''rr ` ..CO*?Worker's Compensation # � ALL CONSTRUCTION DEBRIS RESULTING�rROM THIS PROJECT WILL BE TAKEN TO AV SIGNATURE DATE �� A - I t . 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 FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. _ 27M Comurornvea##ofMassradrmseft Offwe afinvem*atiens' ' 600 WasLdngton SS reef Boston,CIA 02111 ' kvfvx�m�gfrv�ctia - Workers' Campensatianlnsm-mce BzdlrleF�/CuntractGrs/Mec-frici hEmbers pp aIIt r3TfmIT213 I! Please Prin Le. �Zffie�ncinR�f1[�aniaatir�nJEnr � . Address: city/statm�-: Phono Are you an employer?Check the appropriate bus: Type of project Cres;�ed)t L❑ I ant a employes wi& 4 ❑I am a general confractor and I * huge lured1he suer-con''tca tm 6_ ❑Resat oons�ctiart • eutplo�(fall audfor part time_ 2.❑ I am a sole prcpzietag orpartaer- listed oathe attached sheet I ❑ReemodelFaxg �lxese sob-contractors have ship and huge no empl�*ees. 8_ ❑Demolition warlang forme in any capacity employees andbare woA:ers' [No w0domrs'COMP-irnana.,�e comp-insarance_$ g- ElRuilt3mg addition recluired 1 5. ❑ We are a corporatim and its 16-❑Electrical repairs or adds 3_❑ I ama 1wm�eoRmer doing all vardt Officers have PXRfT tsed fizrwir 1L❑FhmA)ingrepairs or additions Fysdf[Na 'gyp- right of esemgfian per M(M ❑try_ Idooafr insa ance required-]f c.�,§1{4�andwe'ha�vena �� employem[Nowadoeis' 13_0 otfier cony.insurance mquire.3) *Any Wficzat&at cbeclssbox R upeHgy infmM&5(doM- t H..Mzem who mbaft ffm E ida[dt sdTamit a newaffidavk bMarfiag such rCanftMctd fMLt-lip AribisAdamastat>acbed additidaal sheet sboaridgtheaamecEahesub-centrsdrsmadstye what"drnattbaseeattinhave emp3dyees.Ifthascb-t�abave empIoyers,Efie}'ma pm-&&e w uarkew•rump.policy"3 W- I arrr an zzttplojow float is prauidirrg tc rkers'compensm6an ursnrancs for acz}1 earrgt rS.-OM ffF.l O V i4 tJts prxliep tlRti job site i�i,formalrarz � . r InsnmceCcmpanyName: "Po-ficg lt'or Self-m s_Iic. Eapi�atioa Rafe: Job Eta Address_ Cifg/St wzip: Attach a copy of the warl`ers'compensation policy declaration page(showing the poficy Sher and expiration date). Failmm to secure coverage as regsnred.unde<Se-ctiam 25A o€MGL a_15 can lead to the imposition of criminal penulhies of a fine up to$154a 00 andfor one-yearimprisaameut,as vt&as ciud petialfies n the fana of a STOP WORK ORDERaz d a fine of up to 50_0!0 a day M-Just the violator. Be aditised that a copy of this statement sway be fxwarded fn the Office of lavestTgations of the DIA for insurance coverage verifrcatiem- I rfa&ers£ay cerlrfy asarder ttrR pmrrs mrd psnaI�s af�erjury flrat tlrs urfat^auufLvrr-protidrd ubo��is bzrs airrd correct .. siioraatam- ]date Phone a Of jWd um milt' Da not unite in firs area,to be' campieted by city artown o f,�rcraL City orTawm: Perin f fficense g Lwaing Auflmridp(circle one): L Baas of Keg& 22.BmTMmg Deprar(ment s.CRyfrmm Clerk 4.Eieetrical k%pectar S.Plumbing Inspector 6.Other Coact person: phone P: 1 . THE TQ� Town of Barnstable. Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601_ www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 Property Owner Must Complete and Sign This Section. If Using A Builder I , as Owner of the subject property ' hereby authorize to,act on my behalf; in all matters relative to work authorized by this building permit application for. (Address of Job)' Sigmtute of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWFILESTORMSUBding permit formsUMRESS.doc Revised 040215 COMMERCIAL LEASE - This Lease Agreement made this 1st day of June, 2016, by and between Brian Dacey, Managing Member of Centerville Plaza„LLC of 1675 Falmouth Road, Centerville, Massachusetts 02632 (the Landlord); and.Phuong Truong, 25 :. Osprey Lane, E. Sandwich, Cape Cod, (the Tenant). W I T WE S S E T.H: y In consideration of the mutual covenants and agreements hereinafter set forth, the parties hereto do-hereby covenant and agree as.-follows.. : PREMISES.AND IMPROVEMENTS ; A. Landlord hereby leases' exclusively tojenant, and Tenant hereby . takes from Landlord, Unit 5 of a building located at 1661 -Falmouth Road; Centerville, MA 02632. B. So long. as Tenant is n.ot':in: default hereunder, Tenant shall have peaceful and quiet use and possession of the premises withouthindrance.on the part of Landlord. C. This Lease shall:: at the election of Landlord be subject and subordinate to all moogages which may now or hereafter affect the real estate of which the premises form a part, and to all renewals, modifications, _ consolidations,.. replacements and )extension thereof. In confirmation of :su_c:h:.. " subordination,Tenant agrees.-at the request of Landlord from time to time to enter into a subordination';a`greeme.nt.with any.holderof any such mortgage which.shall.'. bind and benefit the respective parties and their successors. D. T.enant is given the right of non-exclusive use, in common with others entitled thereto; .of the sidewalks,. parking area and loading area at the building. These common'facilities shall at all times be subject to the exclusive control; and management of the:Landlord, which shall have the right to establish, modify an.:d enforce reasonable:`rules and regulations .with respect to the.same.. Tenant shall be responsible for removal of snow and ice from the sidewalks used to access the ' leased premises. Page 1 of 11 - .. In witness whereof, the said parties hereunto set their hands and seals this 1st, day of June, 2016. Centerville Plaza LLC , by r B ' Da c , Managi Member - ,T COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. _. On this day of June, 2016, befoi Vie, the undersigned notary public, personally appeared by and � proved to u n'ae.. -through .satisfactory evidence of identification; which wa a`iV[e sa,chusetts`drivers license, to be the person whose name is signed on the:_preceding or�atfiached document, and acknowledged to me that-he/she signed.VbIuntdnlyrfor its stated purpose.' Notary Public 'My Commission Expires: COMMONWEALTH OF MASSACHUSETTS Barnstabbfe,ss. On day;' of June, 2016, before me, the undersigned notary lR" public, persbribily appealed Centerville Plaza LLC ,. by Brian Dacey, Managing Member and -pr yed.Jb me through satisfactory evidence -of identification, which was a Massachusetts driver's license, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that she signed it voluntarily for its stated purpose. Notary Public My Commission Expires: Page 11 of 11 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued Conservation Division Application Fee Planning Dept. PermitFee*_ Date Definitive Plan Approved by Planning Board b Pj i � Historic OKH Preservation/ Hyannis , l Project Street Address E b O r t4 �fl Village o2S Owner Uoyn lryt�h0� Address a!5 E Telephone 00 �c P rmit Request "'z rG- CC- art) S6kSoc,-� AJAR- !�+&O-J CA—IV, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation/O., 000 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other 0 140/ Basement Finished Area (sq.ft.) Basement Unfinished,/,&Nad sq.ft) T EAT ��Number of Baths: Full: existing new Half: R" � new Number of Bedrooms: existing _new ��RNSTq B Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new. size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size — Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) y n n i game ,;._p _ Tc�ephone=Number_ _ - Addres " Q VLA, License# CS ��ts Home Improvement Contractor# Email Worker's Compensation # ALL ONST UCT DEBRIS PES46kTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE (2�/( hot 1 Town of Barnstable !,7 E g CE311P .. �l * " 200 Main_ Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-16-1561 Date Recieved: 6/3/2016 ' Job Location: 1667 UNIT 5 FALMOUTH ROAD/RTE 28,CENTERVILLE Permit For: Alteration INTERIOR Work Only-Residential Contractor's Name: ANDREW R DAVISON State Lic. No: CS-069386 Address: East Sandwich, MA 02537 `Applicant Phone: (Home)Owner's Name: DACEY,BRIAN T TR Phone: (Home)Owner's Address: P O BOX 95, CENTERVILLE,MA 02632 Work Description: OPENING OF NEW NAIL SALON REMOVAL OF 1 WALL(NON-LOAD BEARING)FOR FOUR SEASON NAIL SALON INSALLIN PEDICURE CHAIR,MANICURE STATIONS) Total Value Of Work To Be Performed: $10,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance.. Signed: ANDREW R DAVISON 6/3/2016 Applicant Date Telephone No. Estimated Construction Costs[Permit Fees Total Project Cost : $10,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $191.00 6/3/2016 $191.00 3469 Check ..... ....... Total Permit Fee Paid: $191.00 I �OFZNE r Town of Barnstable • Regulatory Services � , BUiI.DING BARN M ` Richard V. Scali,Director DEPT -Building Division JUL p ° Tom Perry, Building Commissioner �a'� 200 Main Street, Hyannis;MA 02601 TOWN OF BARNSTAIKE www,town.barnstable.ma.us a Office: 508-862-4038 'tax:* 508-790-6230 Permit# c Y` Building Official approving 'Application for Siga Permit .Applicant Assessors No , T , �b � Doing Business As: �. Telephone No. � " Sign Location , Street/Road , !v/,fin (]2rp4Z Zoning District Old Kings Highway? Yes/No, Hyannis'Historic District? Yes/No Property Owner . Name: Brlevto Telephone: `JO'� -2 AD�66 Address `t�` oZo Village: ' '�/)fi i/o i (t C'_ Sign Contractor Name: --'P 1:5 'iq nJ C <'`/CST/" Telephone: _�La ;T Mailing Address: --( r-)(V r , / ,? Description. Please follow the cover directions:You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Yes/No (Notb:. yes,a wirmg-permitis required) Width of buildingface �oZ�ft_x 10 = �X.10_ } Check one Reface existing sign IV/ or New ,Total Sq. Ft of proposed sign (s) 4 Ifyoo have ad&donal signs please attach a sheet1&dDg each one with dimensions If refacing an existing sign please provide a picture of the existing sign with dimensions. I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of §240-59 through§240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent Date I SIGNS/SIGNREQU revisedl 10413 t �-- -•- Town of Barnstable Regulatory Services BARN LE'$ Richard V. Scali,Director 16 3�A�� Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 SIGN PERMIT REQUIREMENTS 1. A photograph showing the existing facade, on which has been indicated the proposed sign location. The photograph is to include a portion of adjoining stores or building.For a proposed building or new facade, an architec't's elevation may be submitted in lieu of a photograph. 2. A scale drawing of the proposed sign. A scale drawing indicating: 1) The type of proposed sign(wall,hanging, free standing) 2) Dimensions of the proposed sign and any designs, logos, or lettering 3) A cross-section with dimensions showing edge detail. Minimum scale 1 = 1'.Minimum sheet size, 8.5 x 1179 . 3. A scale drawing of the bracket. A colored scale graphic indicating dimensions, showing colors, materials and method of affixing it to the sign and to the building. Minimum scale 1"= 1'. Minimum sheet size, 8.5 x 11". 4. A completed Town of Barnstable Sign Application, including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. 5. The width of the building face or the leased area. NOTE: the map/parcel number is required on the application. - 7 i SIGNS/SIGNREQU revisedl 10413 �f' y Storefront = 20' Existing Wall Sign 24 x 144" (24 sq. ft.) Proposed lettering 12" x 144" (12 sq. ft,) Free standing sign face 12" x 84" (7 sq. ft.) 6w&yu"Z& DATE: CLIENT: CONTACT: PHONE: FILENAME: APPROVED BY: 103 ENTERPRISE RD., HYANNIS, MA 02601 .o o• e e `^ 508-280-6511 •' "� : ,. ., .. le l uteri erT p a I f j IND s y y 1. . 3 PHYSICAL THERAPY SOLUTIONS �- J.4 , 4 David Stepanis Physical Therapy Solutions 1663 Falmouth Road Centerville,MA 02632 Town of Barnstable Richard V. Scali,Esq. Director of Regulatory Services " 200 Main St. Hyannis,MA 02601 May 24,2016 P Mr. Scali, Thank you for taking my call on behalf of Kristin Terkelsen Tuesday 5/24/16. I appreciate your interest with regard to the property owners at the Centerville Plaza and the process of approving a new business within our building. In addition,we would appreciate consideration of septic and wastewater issues going forward- Property Rights and Usage As 1 stated,a nail salon will be opening at the vacant unit, #1667 between Bayside Designs and the Centerville Pie Company.Please reference = Condominium Building Plan prepared by Baxter and Nye 08/05/08.Unit 5 is the proposed Nail Salon.The prior usage of units 4 and 5 were as an office and or mortgage business.Historically unit 5 NEVER had plumbing or a bathroom because it was part of a double unit.At some point units 4 and 5 divided into two separate units,the Pie Company taking one side with the bathroom/plumbing which ` currently services their retail store,while unit 5 was left without a bathroom/plumbing. We certainly respect the rights of property owners within the plaza as there might be a point in time that Ms. Terkelsen may want to sell her two units. Our concerns are two- fold. , One,how was it that a unit that previously had no contribution to the flow into our septic was allowed to add plumbing without any change of use or regulation or consideration of the impact on our commonly shared septic?The use of the space as a nail salon will add to the flow into our system.Each chair has its oven tub producing waste water.Also there is additional waste water from washing towels, tools,equipment, hands,floors etc,.' # Secondly,we would like clarification on the process by which a unit owner could potentially divide an existing double unit. Would the addition of bathrooms and/or wastewater contributing plumbing be allowed in a subdivided unit where none existed prior?Would we be entitled to add plumbing and bathrooms while subdividing our units? As stated,it seems there will be the addition of plumbing to unit#1667 for the nail salon, which until now has had no plumbing. Would the addition of plumbing require a change of use for this space from the perspective of the town? Would this added discharge to the existing system need to be considered for permitting this business? We are aware that even the addition of a seat within a restaurant in the plaza is closely regulated- Wastewater Concerns ' A major consideration prior to the purchase of our property was the condition and maintenance of the septic system. Our attorney felt that in the case of a septic failure,we would most rely be required to upgrade to a de-nitrification septic system at a tremendous cost and disruption to the businesses in the plaza.. A septic consultant I asked felt that certain chemicals potentially discharged by a nail or hair salon could eliminate the bacteria in a leaching field causing a system failure. With these concerns in mind,is the quantity of anticipated discharge from the nail salon ` not regulated by the town or permitting process? The contribution to the septic from the nail salon would be a result of the number of workstations;number of employees,number. of clients served daily, etc.? Is this regulated by the permitting process? Is there concern for the chemicals discharged into the septic system as demonstrated by the permitting process for this type of business?Would having a clothes washer for cleaning the linens be regulated by the town permitting process? Should there be a holding tank for the discharge from the nail salon?Could the business expand into the adjacent unit 6 without regards to these concerns due to the nature of personal services permitting?Would there be any cap on the workstations and or discharge with a potential additional unit? Permitting We were surprised at the speed at which the renovations and retrofitting occurred. Monday 5/23,the noise of jackhammers seemed to be coming from our bathrooms located against the common wall with unit 1665,Bayside Designs, giving us cause for concern. In the past,we had multiple episodes of sewage backing up in our bathrooms so our concerns are not. It wasan ongoing issue not long after opening the clinic and all too frequent to the point of being a potential health issue for employees and patients alike. I decided to follow the noise to the adjacent unit where I found two men working on the plumbing in the Bayside unit.I expressed my concerns to them but an apparent language barrier made my questions go-unanswered when I asked about permits,the scope of the work etc. I did find the toilets had been removed and the cement floors cut open exposing our sewage outfall pipe. Deep trenches had been excavated from our common wall shared with the Bayside unit all the way across into the nail salon unit. I am guessing that the outfall from the nail salon will be directed across the Bayside unit into the waste line that f - we use for our bathrooms. Certainly we are concerned that the additional waste could. cause our sewage problems to reoccur. This prompted me to go to the town offices and I spoke with Sally just before noon Monday.I asked if any permits had been issued for the work and she responded no. This was surprising since Kristin had a conversation with Ms.Anderson last Tuesday in which Ms.Anderson led her to believe that all required permits were in place.This included a reconfiguration of the space,plumbing and electrical alterations as well as an engineering assessment provided by the unit owner.It was our understanding from the conversation that the zoning label of"personal services"would not require the town's regulation with this new business. There were no concerns to be addressed with any septic,wastewater,parking or traffic in the permitting of the new business. Next,I called both the enforcement agent,Ms.Anderson,and building inspector,Mr. Lauzon.Neither person answered so I left messages explaining that construction had begun possibly without permits in place. I asked if they would come out to inspect the changes that were being put into place. Upon phone conversations with both Ms. Anderson and Mr. Lauzon Tuesday morning, an inspector stopped at the unit during business hours on Monday. The nail salon unit was locked,windows covered and no one responded to knocking at the door. I was at our adjacent unit between 5 and 6pm Monday and there were still many work trucks outside the entrance as there had been all day.'Although I was not present,our office staff noticed there were again many construction vehicles outside 1665 and 1667 this morning,even into spaces in front of our unit.It is certainly my hope that all the work has been done by licensed plumbers based on an engineering plan. It is my understanding a permit for the nail salon was issued late Monday,but not for the Bayside unit that we share the sewer waste pipe with. Summary As I am sure you are aware,the town is currently dealing with a new problem of contaminated well supply water in Hyannis. What initially had been considered"Safe" practices of chemical disposal into an area of contribution now turns out to be a potential health concern for residents and possibly a very expensive issue for the town. Taking into consideration there are already 3 nail salons between Phinney's Lane and Old Stage on route 28,would it not be prudent to direct location of future nail or hair salons to existing sewered properties?I would consider a salon as a non-essential service and in an already saturated area with traffic,parking and sewage concerns,would it not be wise to consider a moratorium on permits in areas of contribution using private septic systems? Regards, David Stepanis of a _t m� �g1 Na�� FA \o pA • i! L \ 29 IF c 9 2 gg ItIt bb O rw.LounaLai q i d Sr YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$40.00 for 4 years]. A business certificate ONLY REGISTERS YOUR NAME in town (which you C must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. --,� Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: / Fill in please: o APPLICANT'S YOUR NAME/S: BUSINESS YOUR HOMED S . . ada TELEPHONE # Home Telephone Number - NAME.OF CORPORATION: NAME OF.NEW BUSINESS yon ( SPA- TYPE OF BUSINESS o IS THIS A HOME,OCCUPATION? YES NO . ADDRESS:OF:BUSINESS MAP/PARCEL NUMBER b 00 (Assessing)'_ � rn�- az�32 When starting anew business t ere►l h� ,are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St: -'(corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO M oSs ' 'S OFFI ,,,z,Q/�� This individu Inor d f ny er it a uire ent hat pertain to this type of business. � Ged Si na u r . g COMMENTS: 01 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: 4 f ' - 2.BAARa31AB1E.,p� - Town of Barnstable Zoning Board of'Appeals Decision and Notice Special Permit No. 2011 005.-Teen Exchange:LLC Conditional Use in Highway Business:District($ection'.240 25C(1)) Conditional Use Special Permit to allow an existing 1,140,sgft.commercial unit to be` used as a retail store for the resale.and consignment of clothing Summary: Granted with:Conditions , Petitioner: Teen Exchange, LLC'(Pa a Managerj. Property Address: 1661 Falmouth Rc d, Unit #3, C nterville (Centerville'Plaza) Assessor's Map/Parcel: Map 209 Parcel 08..-10E Zoning: HB Highway Business District Decision Date: March 9, 2011 , Recording Information: Deed: Book 1.1186 Page:300: Plan:. Book 352 Page 43. Background v In Appeal 2011-005, the applicant,Teen Exct ange,'LLC, sought to:use on existing 11410 square foot tenant space in the Centerville Plaza shopping.center for retail use; specifically for resale and consignment of clothing.: The only uses permitted as-of-right in the Highway Business district.are office uses and banks. ;Retdil uses''require,a Conditional Use Special Permit. v The owner of the shopping_center is the Centerville:Plaza-.Trust. Brian.T.Dacey,.Trustee,, submitted a letter authorizing the,application. The shopping center is served.-by 65 parking spaces. .Nor-exterior changes to the building.or the,site.were proposed bythe Applicant. The Building.Commissioner issued an administrative.site plan approval for the: change of use.on February 42011:; This area is designated in the Barnstable Comprehensive Plan as an Auto Oriented. Transportation Nodeanda Commercial Center; the Centerville Village Plan states that residents view this area as the commercial center of the village., Procedural &>Hearing'summary Appea[No. 2011-005 fora Conditional,Use Special Permit in the.Highway Business District was filed at the Town Clerk's Office and at the Office.of the Zonihq-. oard of Appeals on:; Town of Barnstable Zoning Board of Appeais-.Decisiorrand''Notice Teen Exchange, LLC-Special Permit No.,2011-005 Conditional Use: February 9, 2011. The applicant'is;the Teen Exchange, LLC, represented by Pamela i Mulhern, Manager. A public hearing before the Zoning Board of,-Appeals was duly advertised and notice sent to all abutters in accordance with MGL Chapter 40A. The hearing;was opened'March 9,. 2011 at which time the Board.found:to grant the.,Conditional Use,Special Permit subject'to conditions. Board Members deciding this appeal.were Board Chair Laura F.Shufelt, William H. Newton, Craig G. Larson, Michael Hersey, and Alex M'.;Rodolakis. Attorney David Lawler'represented the applicant'before'the Board. He:provided an overview of the request.and the proposed business,.which is,a consignment store for teen clothing. Attorney Lawler addressed issues of parking at the,shopping center"and potential traffic:generoted,by the-business. Public,commeht'was.requested::and no one'spoke,in favoG.of in,oppos.itidn to`the.requett Findings of Fact At the hearing of March 9., 2011,'the Board unanimously,made the following'fii dings of fact: 1. Teen Exchange, LLC has petitioned fora Conditional Use_Special Permit in ti e Highway Business zoning district;underr Section.240-25(C)(1),,which;allows retail sales in 1 the- district with a grant of a Special.Permit by the:Zoning Board of Appeals. 2. The applicant is seeking to use a 1,410 sq:ft. tenant space'in the`C;enterville Plaza shopping center for retail use,,sp.ecifically.for resale and.consig;nment�of`clothing'. 3. On February 4, 2011,;the Building..Commissioner;issued an.adrninistrative site plan., approval for use of 1,140 square:feet of space located at 1661 Falmouth Road Unit #,5 for retail use. . 4. Parking available:onsite,has,:been;eygluated and measured-and shown to{'be: adequate.. 5. After an evaluation of all the;evidence presented,the,proposed',use fulfills'the spirit and intent of the.zoning ordinance:and would not represent.a-substantial detriment-to the public goodor the neighborhood affected.or adversely affect the public health, safety,welfare, c`omfort'or convenience of the community. Decision Based,".on-the findings of fact, a motion was duly made_and seconded to;.grantSpecial 'Permit No.20VI'-005:subject fo.the following conditions:. 1. This conditional use special'permit is issued to. Teen�Exchange, LLC for"the use of a* 1,410 square foot tenant space within the Centerville.Plaza,shown'on Assessor's,Map 2 I Town of Barnstable Zoning Board of Appeals—Decision and Notice:. Teen Exchange, LLC-Special Permit No.2011-005 Conditional Use 209 as parcel 087-10E,to be used for aretoil store;specifically for the.resale and consignment of clothing. 2. The use and unit shall.be required to comply with all applicable provisions of Section"240- 65 for signs in the HB District and'Section*240-70 Shopping Center Signs as_applicable: 3. This decision must be,recorded'at'the,'Barnstable` County Registry of'Deeds and a copy must be submitted to the Zoning Board of Appeals-and Building:Division office priorto issuance of a building permit. The relief`authorized herein must be executed within two years of the date this special permit is,filed with the Town Clerk's'Office. Ordered Conditional Use Special Permit No.1201 l-005 has;`been granted subject to conditions. This decision must be recorded at the Barnstable.Registry,of Deeds for it to be ineffect and notice of that recording submitted to the Zoning Board of Appeals`Office. The relief- authorized by this decision must'be-exercised within two years unless extended. Appeals of this decision, if any, shall be.made pursuant to_MGL Chapter-40A.Section 17,within twenty (20) days after the date of the filing of this decision. A copy of which must be filed in the office of the Barnstable TownClerk. Laura F. Shufelt, Chair Date Signed, I, Linda Hutchenrider, Clerk of the Town of Barnstable, Barnstable County; Massachusetts;. hereby certify that twenty(20) days have elapsed since the Zoning'_Board of Appeals filed this decision and that no appeal of the decision has'been filed in the office of the Town Clerk. Signed and'sealed this. `� day of under the pains and penalties t. of perjury. Linda Hu chenrider,Town Clerk 3 lown. of B.arn.9table Assessing]Division 3E7.Main Street,Hyannis:iVIA 02601 www.town.barnstable.ma.us Office: 5084624022 Jeffery;A.Rudzisk,NIAA FAX: 508-8624722 -Director of Assessing ABUTTERS LIST'CERTIFICATION February 28, 2011 RE: Adjacent Abutters List For Parcel: 209 087—0.01 CND: Mulhern L Teen Exchanger 1661 Falmouth Road / Rte.28 As requested, I hereby certify the names and addresses as zubmitted on the attached sheet(s) as required under Chapter 40A,,Section 11 of the Massachusetts General Laws for the above referenced parcels as they,appear on the most recent tax list with mailing addresses supplied,. Board of Assessors Town of Barnstable Attachment 1 q CMomnents and Settingslhendersllnesktop\ABUTTERS\abutters-blank.DOC Zoning Board of Appeals (ZOA.) Abutter List for flap ° Parcel(s): '-209087001_CND" Parties of interest are those directly opposite;subject lot.on any public.or private street or way and abutters to abutters:Notification of all properties within300 feet-ring of the subject lot. Total Count: 631 � Close -M=ailing Map&Parcel Ownerl Owner2 Addressi,. Address'2 Country:Deed e CityStateZp POYANT, MARCEL R. CENTERVILLE., 20F'CAMR`OPECHEE CENTERVILLE, USA 12763/217 209003" SHOPPING CTR:NOM TR TR ``E .. :RD M MA 02632. , CENTERVILLE POYANT,MARCEL R. 20F CAMP OPECHEE CENTERVILLE, 209004 SHOPPING CTR.NOM USA 12763/217 TR TR: BD MA.02632` CENTERVILLE POYANT, MARCEL R 20F CAMP OPECHEE CENTERVILLE, 209012 SHOPPINGCTR NOW12763/217 TR TR RD MA 02632 20F CAMP�OPECHEE CENTERVILLE, 209013 POYANT,MARCEL R: - USA C131734 RD MA 02632 WILLIAMS.,EARLE C C/0 THEODORE A 1185 CENTERVILLE, ` 209063001 ONE SENTRX.PLAZA FAl:MOU,TH _ #06P1144TF ESTATE OF SCHILLING,TR ROAD MA 02632 GARTHEE,AIMEE S OLD POST RD REALTY CENTERVILLE, 209063002 5.9 OLD POST ROAD 216,90/192 TR TRUST MA 02632 DAYSTAR HOUSE HARWICHPORT, 209063003 5 DAMS LN': 21058/344 LTD MA I)2646 209063004 CENTERVILLE, LESLIE; EDWARD E 226 MAIN STREET 22900J88 MA 02632'. MASS SOCIETY:FOR OF CRUELTY TO. - CENTERVILLE, 209083 PREVENTION ANIMALS(MSPCA): `157.7.FALMOUTH RD MA 02632 1617 FALMOUTH RD ONE„ROBE)RTS, PLYMOUTH,:MA 209085 SERIES OF PB&C; ROAD 02360 22610/234 LLC VENDOLA, .CENTERVILLE, 209086A01 VEO TRUST 38 RAIN801N:DR' USA 11262/,131 KATHLEEN.S TR. MA 02632 209086A02 GLATKI, CLAIRE S TRAVANA REALTY .26,W00DCREST MURRELL'S USA` 7009/028' TRS TRUST' WAY INLET,SC.29576 209086A03 JOHNSON, BAYBERRY SQUARE 1645 FALMOUTH CENTERVILLE, 23085/398 CATHERINE:C TRS :REALTY TRUST' ROAD MA 02632 209086A04 .GLATKI, CLAIRE TRAVANA REALTY 726 WOODCREST MURRELL'S USA 7009/028 TRS TRUST <WAY INLET,,SC,29576 _ cL.E.^INVESTMENT' 18 CRESENT HILL EAST: 209086BOI LIU, DIANkW TR TRUST ROAD SANDWICH,MA 24552/137 02537 CENTERVILLE, 209086B02 KLOTZ,SUSAN A 51.MAPLE AVE USA 7070/261 MA:02632 ' `209086B03 JOHNSON, BAYBERRY SQUARE 164S_:FALMO.UTH CENTERVILLE,: 23085J348 CATHERINE C TRS. REALTY TRUST ROAD MA 02632 °209086B04 JOHNSON, BAYBERRY'SQUARE 1645 FALMOUTH.• CENTERVILLE; r23085/348 CATHERINE C TRS '.REALTY TRUST ROAD r', MA 02632 . 209086C01 CROUGHWELL, PO BOX 88 OSTERVILLE, MA USA 6141/137- MARY C&OWEN F 02655. 209086CO2 CASE, B LORI TR 49 BELDAN LN CENTERVILLE, USA: 108,34/203 MA 02632 � BAYSIDE BUILDING CENTERVILLE, 209086CO3 CO INC P 0 BOX 95 MA 02632 8167/268 i f BAYSIDE BUILDING CENTERVILLE; US 1209086CO4 P 0 BOX 95 MA 02632 A 7435/197 CO INC NASTASIA,THOMAS SHAKALISR& . CENTERVILLE, !USA 3926/047 209086D01 1645�RTE:28 V FALCO, P A' MA 02632 209086D02 LOWERY,JEFFREY P 8&BAY RD OO6 SIT,:MA USA; 3918/274 &NANCY C 209086D03 JOHNSON, BAYBERRY,SQUARE 1645 FALMOUTH CENTERVILLE; 23085/348 CATHERINE C TRS REALTY TRUST ROAD MA 02632 JACOBSON, 1645 FALMOUTH.RD CENTERVILLE'. USA 22147/335 209086D04 RUSSELL J TR MMCR REALTYrTRUST BLDG F A-04 MA 02632 209086D05 PRICE,WILLIAM.A, CHEQUAQUET 17CHEQUAQUET` CENTERVILLE, USA_ '7877/253: JR TR NOMINEE TRUST WAY MA 02632 t s , • f 201 9086D06 PRICE,WILLIAM A CHEQUAQUET 17 CHEQUAQUET CENTERVILLE, USA 7877/253 )R TR- NOMINEE.TRUST- WAY 'MA.02632 NASTASIA,THOMAS SHAKALIS; R R& CENTERVILLE, 209086D07 V& FALCO, P A '1645 ROUTE 28 MA.02632, USA 6113/066 NASTASIA,THOMAS SHAKALIS, R R,,& C04TERVILLE1 209086D08 1645 ROUTE 28. 6113/066 V& FALCO,.P•A MA 02632. 209086009 JOHNSON, BAYBERRY SQUARE "1645 FALMOUTH CENTERVILLE, 23085/348 CATHERINE C TRS REALTY TRUST ROAD, MA 02632 L E INVESTMENT 18 CRESENT HILL., EAST 209086E01 LIU, DIANA W TR TRUST ROAD.: SANDWICH,,MA 24552/137. 02537, JOHNSON,, BAYBERRY:SQUARE 1645 FALMOUTH CENTERVILLE; 3085/348 209086E02 • CATHERINE C.TRS REALTY�TRUST ROAD AA JENSEN,JAMES N 3.83 WILLOW' WEST 209086E03 III STREET BARNSTABLE,; 20468/024 MA:02668 BOSWORTH, CENTERVILLE, 12552/2S4.; 209086E04 WARREN C JR R0 BOX b85 MA 02632: 209086EOS BOSWORTH, :PO'BOX.685. CENTERVILLE, .12S52/254 WARREN C JR MA,_:0-632, 209086E06 JOHNSON' BAYBERRY SQUARE 1645 FALMOUTHCENTERVILLE,, 23085/346 CATHERINE C TRS REALTY TRUST ROAD �MA 02632 JOHNSON, BAYBERRY'SQUARE. '1645 FALMOUTH CENTERVILLE, 209086E07 CATHERINE C TRS REALTY TRUST ROAD MA 02632, 23085/348" 209086E08 STATE LEGISLATIVE 1645 FALMOUTH RD. CENTERVILLE, USA 13714/499 LEADERS FNDN INC BLDG,O MA,.02632-2932 209086E09 STATE LEGISLATIVE 1645 FALMOUTH RD: CENTERVILLE, USA 11714/199 LEADERS FNDN INC, BLDG Da M&02632>2932, 209086E10 STATE LEGISLATIVE 1645 FALMOUTH RD CENTERVILLE, USA-11714/199 LEADERS FNDN INC BLDG,D MA 02632-2932 STATE LEGISLATIVE .1645.FALMOUTH RD CENTERVILLE, USA 11714%199 209086E11 LEADERS FNDN INC BLDG D MA,:02632-2932 209086E12 STATE LEGISLATIVE 1645 FALMOUTH.RD CENTERVILLE, USA 11714/199 LEADERS FNDN INC BLDG.D MA 02632-2932. 209086F01 CASE, B LORI TR 49 BELDAN LN MA 02632 CENTERVILLE, USAl10834/198, LORI CASE-INV-, CENTERVILLE,. 269086F02 CASE,B LORI.TR -49:BELDEN AVENUE' MA 02632' 23735/130 TRUST 209086F03 JOHNSON, BAYBERRY-SQUARE ;1645 FALMOUTH CENTERVILLE, 23085/348 CATHERINE C TRS REALTY'TRUST ROAD MA. -02b32 209086F04 JOHNSON, BAYBERRY.SQUARE :1645 FALMOUTH CENTERVILLE, 23085/348 CATHERINE CTRS REALTY TRUST ROAD MA 02632' 209086F05 )OHNSON,: BAYBERRY;SQUARE 164.5,FALMO_UTH CENTERVILLE, 23085%348 CATHERINE CTRS REALTYTRUST ROAD MA."02632 LYNCH, ROBERT,E FRAMINGHAM, 209087002 JR 92 KENDALL AVE MA:01`70.1 USA 9976/116 MARFATIA, NILESH 1815 FALMOUTH,RD CENTERVILLE,, 23141/294 2090871OA AMAN,REALTY TRUST P TR: STE D2 MA 02632 RIGAS,`EMILIOS& 1663 FALMOUTH CENTERVILLE; 23098X66 20908710E. ANASTASIA TRS AE REALTY TRUST RD,-UNIT 2 MA 0.2632.. CENTERVILLE PLAZA CENTERVILLE, 1,20908710C DACEY,BRIAN T TR P 0 BOX 95 MA 02632 ;USA 11186/300 � TRUST 1 CENTERVILLE PLAZA CENTERVILLE,. i 20908710D DACEY, BRIAN T TR. TRUST P 0 BOX 95 MA 02632 USA 11186/300 I CENTERVILLE.PLAZA CENTERVILLE, 20908710E DACEY, BRIAN T TR TRUST P:O BOX 95 MA 02632 USA 11186/300 CENTERVILLE PLAZA - CENTERVILLE, TRUST . 2090871OF DACEY, BRIAN T TR P'O BOX,9 MA 02632 5, USA 11186/300 CENTERVILLE:.PLAZA CENTERVILLE' 20908710E DACEY, BRIAN T TR P O BOX 95 USA 11186/300_ • TRUST MA 02632 CENTERVILLE PLAZA CENTERVILLE• 20906710H DACEY, BRIAN T TR P'O BOX 95 ' USA.:1186/300 TRUST � MA,02632 KRANIOTAKIS, ANNA& ' CENTERVILLE;,, 20908710I A&S REALTY-;TRUST 39;BELDEN:LANE 23141%326 CH RISTAKIS,r MA:02632 SOPHIA BARNSTABLE,TOWN HYANNIS, MA` 209088 OF(CEM) 367 MAIN ST USA 02601. 1209091 ALLEN, BETH-ANNE 126 OLD POST CENTERVILLE; USA 19631/239 F ROAD MA 02632 ROCHER,EDOUARD CENTERVILLE,. 209101 77 OLD:POST RD USA.11151/129 Y&FRANCOISE M MA.02632 209102 KIRK,JOHN N.& KIRK.FAMILY REALTY 4337 36TH ST S' ARLINGTON VA 20041/062 ARTEMIS G TRS TRUST ` 22206 MORESHEAD ANNE MORESHEAD FAMILY CENTERVILLE, 209103 99 OLD POST RD USA 19424/140 C TR TRUST MA 02632' This list by itself does NOT constitute a.certified list of abutters and is provided.only,as an aid to.the determination of abutters.If.a certified list of abutters is required,contact the Assessing.Division to have this list certified.The ovirier:and address data on this list is from the Town of Barnstable Assessor's database as of 2/10/201,1:. r - , Town of Barnstable Geographic information System February U,2011 A 190256 210002� 210151 #25f 210190 210189 [#64 #25 210181 #14 966 �__._�-•-���209020 #340 #65 r '97 21 210179 �. #18 210134002 f 0195, 210147 #46 2#51V #48 _ 190106 4210 001 + .�f 0 33 #51 / #22 2115192 f�210134003 #20#322 #51 210195 #40 21010 9 21093- ?' 15 #5 189136002 �J tF 50� •210152 19 189136001 �[ #`08► #39 t / 209014 209016 ` 1_ 209097 209089 94 36 fl #33—w- -mow. #1600 O 209095 #22 /� E209017; ' #31 189037 #1498 209013 tti :,209012 209016 i #319 # #1620 #1550 +� t209010 Z a t#10 ` 189135� Y#283 209003 209004 . : if 1708 .. ... .: • 209084 / 209o82 101495 EALMOUTH RO 1 R7E 2t1 #1597 4R1621� v r. � 1617 0 #1817 09083 ib. 2 09065001 F � 209088t„NO #1577 a #1845� 20905�=55002� #133/ 1B�J055 209087001CND Z0y #1815 :: aD #1861 4 #050123 7 08054 2090e1o02 p1.� 209052001 209#05850 #126. 209061 #11G #175 q -: .- 7y ` / 20905200Z ram. W, ._ 208088 n, 2091 \L, a #99 / =209029 - "- #1705 em �57• #18 s 209052002 #120' 1169079 188080 "r�2090 04 2090630016 209062 #181 `� 630 �^ #111 #131 #145 209122 20 AW 171 .r2, `+�; #169 209052004 2 209088 Y W 12 # 209052066 S y #110?ni -�-�VGA C/y �ry .� X " 189082 " � 209102 209063002 _ #17 189081 209701, #87 209063003- #123 �+ #77 209104 Nz#121 w 1 fa 2aa oo #se zo90 aoo6 `':C #87 ` 209120 #169 #.73 Q - O 209066j y • 209030 #2874 �#177 #59` '� 209119 �`. #6� 2#61 #92 F�jJL = 209067003 #67 209058 f 20910 209119 B o- • #66* 209067 209050 #47AA .#9 209117 F. 091070 e w/.' #.43 189'147 189089 #63 9 #16- �,%� 209032 ,K 300 209088002 r 209109 1 gel 1 3 -20 99 �#21. 2090670o1 209067002 209116 ;,�tiF 209108 #22' o 9 9.`� ` 209031 ffP 9�D 0. 1 e 6 209068004 208070 '#34 #43 . 49 -''r /� #31 $38 #51 '{► �t #29 209047. 209040 #142 / #126/ / #20 % #36 't DISCLAIMERS:This map Is for planning.purposes only. It is not adequate forlegal Map:209 Parcel:08710E Zoning.Board of Appeals(ZBA) Q boundary determination or regulatory Interpretation. Enlargements beyond a scale of Selected Parcel i=10o may not meat established map accuracy standards. The parcel ones on this map Abutter List Type-Parties of Interest are those directly opposite subject lot on are only graphic representations of Assessor's tax parcels.They are not true property any public or private street or way and abutters to abutters. Notification of all Abutters E boundaries and do not represent accurate relationships to physical features on the map, Oropertles within..300 feet ring of the subject lot. 'such as building locations. - Buffer ,ZONING BOARD OF.APPEALS',.-, NOTiCE.bFPUBLICHEARINGS: tll1DE9 THE:ZGNING ORDINANCE r { yMARCH 9,2011 ., To•aB persons;nmerested;in or affected by the acdtons of ttie Zoning Board of Appeals,you are;hereby notified, pursuaM' tD"5er n 11:of Chapter 40A of the Ger 6W-Laws of thp; Commontiveailti of Massadhusetls;anti all amendments thereto;' Otata pubhC hearing qn the fokw�g appeals iM71 be held on March 9;2011 at the f ft indjceied:. , w �:T:10t'M Appeal No 20t1-004 Boststm-Prime U.0 .� BotsiniPmiie;LLC has appealed=`the December 30 2010;. daaston of the Budding Cwnmrssroner''BoLvm Prime riLC in a' v leiter:to tlua$ciilding Commrs§roner recered December�T ZO10; , had-requested that the t3uddrng rCommiss3oner revoke bu0duig, permits�ssued,to,'the Bamstabla Mun lapaf Anport Comrtussron. P r atr pr'=' oonstru';U6 to begin on the Airport Expansion Protect e, and<refusmg to enforce the Cape Ctd Commsop s EnaMurg Re and-issum ' 9u'a6orrs 9 permds iri vrolatioir thereef •The property:;, . is located a1480,Bamsbble.RdM Hyannrs MAas shavm:on Assessots Map;329 as parcel 003 It�s m the iruluslnaYjlND),`. Busuress B H` BuSmess HB and H nrs Ga fi ' ( ) hy ( �, yan ka TOWpt of Bna�tsraBLEr°, � (HGj aonntng districts . x t• ZONING BOARD of AE'P..EALSr ; 7:20 pm /pPeal No 2011005 m; NOTICE OF PUBLtC iFARING y Mulherh d/bfa The, een Exchange ` ' r {t ,UNDERTHE ZONINGORDINANCE Pamela L Mulhem Manager elb/a Teen Exchan0e UC has.: r 4 ' `�MARCH 9,2011 petAigned(or a'GonddronaLUse Sped;Permit rn:dre Higtnvay=• Tc(ail persons interested m affected by tfie adrons of the Business OB)inning distncf The pet3tlofier,as lessee of tlntt* ZLng go of{WPe@ts You'are hereby,notfied Pu.,fit `a fl i.of 66tr Falmouth Road owner by Brian Dacey as Trustee'of; tq Se oA 11.of Chapter 40A af,-the General taws of tho Centennile Plaza Trust rs requesting a CondNonai:Use Special"; Permit pursuant to Section 24425 C{ityof the zoning ordfiauoe> of Maesachusetts and ati amendments tirereto to apovu a consignment shop whereas a'prolessronai afljde use a pubklcleanng on the fQ)hnving eppeais vwli be held on March, i had oust existed The ro 911 at the Ume fndcated y A PAY lsra£ed at 1661 Falmouth' u 40 PM pLL iVo 04 Bostsmr Pnme LLC- ffaad Unft#5 Cehfem(Ie MA as ahoygp.on l r s Map 20g;+ BotsirlrPnme LLC pealed s �30, 2010 as,paii�108710E It rs in a H�ghway�y�stness zonuu�dutnd, w� dedsron 5,!he Building Comm s met,Bots Wdrfie LLC,in a,.i Thee pubfic heanngs ti ba held al the Bartrstable Town �e Bwkfmg Comma er received 1�c2 tier 17,2010 ? HaQ 367 Main Street,Hyannis MA Hearing Room end Floor: Wednesday March 9 2011 t Plans and,epPucatwns may . tpd requestml,that the Butltlmg Coinmissroner`ieva�ce bwhfmg - be renewed at:the Zoning-Board af;Appeals CTffice Growth; Permits rsaued fotre Damstable Munidpai Aitpat Commissfpn Management pepartrrtent, Town Offices 200 Main,Street authodnng coristrucbon tq'begln�on the Arrport Expansion end rofusing to erdorce hQ Cape CodCarPm-4wn s Enabling !. Hyannis MA r , s in vrdlaOr+there�t�heproperty Laura F ShufeK Chair Regulation and issuing pennds p a )sxlorated at 480 Bamst@¢te toad liyanms MA as shown on • Zoning Board of 4ppeals r Assessesg parce!003 'ft ar m tits lndixstrial{N!D) ` ThiMistablePatnot Business B Hr Business B and= nn�Gat { February 18 FeDNu 25'2011 (t3(3- Zoning distracts. }•Muihem dibla The Teri Exchange r ; PamR ela t;Mulhetn;Manager;dlbla Teem Ezrhange t1G;has . pehtiotted fora Conddronal Use Special Perntt.in the Higirvealr Business(H(3)Zoning 0* The ppiffir t as lessee af:Urut • ;YS.of 166i,FalmarOr Road owned by Bnan'Dacey as Trustee of CenterviTle;Plaza T# ss Te uestmg:a Conditional lse Special Pemul pursuant.to Setxron 240-25 C:(1)of ihe:zomng onirnance s;i tD.-'a a consignrmnt'stiop whereas pp. otfite°u� ;� tie prev�rxrsiy exited The property!:ts boated at 1661 Falmou�4. itaad UntklkS;:Certtemlte'tv1A as shpwn on Assessor s Map209�' asparce1087-10E to is In a Higlnvay Brtess zoning drslncL . 'These public hearmgswfii be held at the Barnstable Town < Haft 367 Ma!n Street I miiii'-'MA'A Room"end Fioprr;i . ' ednesday Mara 9 :2011 w,Plans and appficabonsy may ;be;LeNeuF 'at"the Zoning Boardof.Appea!s"Office Growth.^ _ ManagemevDepartnient Town Offices 2UD Main+StieeE:; Hjannrs ° d Laura=F ShufE?L Chap s Zoning Board otAppeals ?The Bamstatile Painot > 2011 Februaryl8,February 25 ` Parcel Street Owner 1661 FALMOUTH ROAD/RTE 28#1 - Multiple Address (1675 FALMOUTH ROAD/RTE 28- Route 209-087-10A 28 Convenience) MARFATIA, NILESH P TR 209-087-10B 1661 FALMOUTH ROAD/RTE 28#2 RIGAS, EMILIOS&ANASTASIA TRS 209-087-10C 1661 FALMOUTH ROAD/RTE 28#3 DACEY, BRIAN T TR 209-087-10D 1661 FALMOUTH ROAD/RTE 28#4 DACEY, BRIAN T TR 209-087-10E 1661 FALMOUTH ROAD/RTE 28#5 DACEY, BRIAN T TR 209-087-10F 1661 FALMOUTH ROAD/RTE 28#6 DACEY, BRIAN T TR 209-087-10G 1661 FALMOUTH ROAD/RTE 28#7 SES OUTCOME ONE LLC 209-087-10H 1661 FALMOUTH ROAD/RTE 28#8 SES OUTCOME ONE LLC KRANIOTAKIS,ANNA&CHRISTAKIS, 209-087-101 1661 FALMOUTH ROAD/RTE 28#9 SOPHIA � 9�1.ti1e� cl�cr� s�aw,�aaa�nma�onr�a���)�;r��x�+•.•�}C7. O noxnac,�ma>r,9m.,azAwmsw.mauar.TieNr�,�,o.,ie �. ,-_. ra,�ms/re/murtmue.mhve t,sda�n�s Ame A,gpen.Mede .... ....- Smt 5•e15/IB/i016 raaia1 - To: Cnyk•betla �s aE unra,oenama raez;we •., v3, 4.` Muhi�e Addresses by Mao Parcel � wn waa �m _ 0 9 =1087 IP ..Search ,. 111 Pra,,Next> Pagel of l {l] Add Record 209087001 1661 FALMOUTH ROADIRTE 28—Pinocchlo Pizza CENTERVILLE 0522 "h 209087001-1663 FALMOUTH ROADIRTE 28—Ph siotherapy Assoc. CENTERVILLE 0522 {' 209087001 1667 FALMOUTH ROADIRTE 28—Bayside Builders CENTERVILLE 0522 209087001 1669 FALMOUTH ROADIRTE 28—Dunnnte.Mortgage CENTERVRLE 0522 209087001 1671 FALMOUTH ROADIRTE 28—Cape Cod Chicken CENTERVILLE 0522 R: ` 209087001 1673 FALMOUTH F2OADhiTE 28—KeOys Mush Empadum CENTERVILLE 0522 1675 FALMOUTH ROADIRTE 28—Route 28 Convenience ! 209087001 Store - CENTERVILLE 0522 n-, Message Page 1 of 2 Coyle, Brenda From: Ruggiero, Amanda , Sent: Wednesday, May 18, 2016 10:26 AM To: Coyle, Brenda Subject: RE: 1675 Falmouth Road Centerville - Hi Brenda, I am looking at the parcel and addressing information right now. r 5/18/2016 Message Page 2 of 2 Amanda Ruggiero, PE 99 , Barnstable DPW-Assistant Town Engineer Office: 508-790-6400- Cell: 774-487-2834 Amanda.Rugpiero(otown.bamstable.ma.us From: Coyle, Brenda Sent: Wednesday, May 18, 2016 10:18 AM To: Ruggiero, Amanda Subject: 1675 Falmouth Road Centerville Hi Amanda, We have a situation where the owners need to be notified of their address the giving Y are g g to tenants. This came up this morning where a nail salon wants to go into 1675 Unit 6 Centerville, when you do a search through our Assessing Dept. this address does not exist. The address is actually 1661 Falmouth Road, Centerville. Can you notify the owner of this property that they need to request an address change. Please let me know if this is possible. I do know that Centerville Pie Company is in this same block of stores. Thank you, Brenda Coyle 5/18/2016 a YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on.this format 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1-st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and.get the Business Certificate that is required by law. DATE: 2. i Fill in please: APPLICANT'S YOUR NAME/S: Cwsnyln BUSINESS YOUR HOME ADDRESS: - ' TELEPHONE # Home Telephone Number 1 -708 -5q-O NAME OF CORPORATION: NAME OF NEW BUSINESS amour S-n �� ►la �t'/� TYPE OF BUSINESS A;n; I 5a love IS THIS A HOME OCCUPATION? YES NOS_ ADDRESS OF BUSINESS MAP/PARCEL NUMBER 2AZ e92E (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Mein St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SSIO ER'S OFFICE This individu I h e n.i ed o an p egmit re uirements that pertain to this type of business. u orized Signat COMMENTS: + Q T r 4 2. BOARD OF HEALTH been informed of the permit requirements that pertain to this e of business. This individual has n q P type Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) ` This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: R YOU WISH TO OPEN A BUSINESS? ` r For Your Information: Business certificates(cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you ' must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. ` Take the completed form to the Town Clerk's Office, 1 st Fl., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is. required by law. DATE: 0 Fill in please: APPLICANT'S YOUR NAME/S: I r ��. 0 .. BUSINESS YOUR HOME ADDRESS: /f � TELEPHONE # Home Telephone Number �g( — O NAME OF CORPORATION: NAME OF NEW BUSINESS.:F�aLtr L-/I_J A S{'C TYPEJ0F BUSINESS OniI . IS THIS A HOME OCCUPATION? YES NO r ADDRESS OF BUSINESS AP/PARCEL NUMBER Z6f - 1� [Assessing). When starting a new business there are several things you must do in order o be iri compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist ydu in obtaining the informati�ou may need. You MUST GO TO 200 Main St. - [corner of Yarmouth Rd. &'Main Street) to make sure you have th+e appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COdMMhas' This d b en i orrmed of an erftt requirements that pertain to this type of business. Y P q � P YP r Authorized Signature* COMMENTS: iCo �+ 2. BOARD OF HEALTH _U 1 This individual has been informed of the permit requirem •nts that pertain to this type of business. Authorized Signature COMMENTS: V ' 3. CONSUMER AFFAIRS (LICE19SING AUTHORITY) This individual has been informed of the licensing requirements tha pertain to this type of business. Authorized Signature* COMMENTS: o� --SP& ODA ES2 _6 3A I E 'r P oue 5g,2 v- ` f i a S�- OF BARNSTABLE �CttinrboNl Oit`fCi1 23 Ali : cat 6 DIVISTOIN DOOR h L c2W „ lalr U Orr - ►Bra � ...��ri _ .. 'w --V _..---- r Q U It C- - pooR �ppR �X srt q4o N#7 ,� GSM�( 5' Z �PP; tte-s 94braler-oom a— I ga i A�-oVje _ in ¢Zu _ yr_ 4 4.Z t Ai �1A1 Ala i - 13 I�3/err E i JB B RNSTABLE 3 ' .E _ r • 3 - -- Doolz Flee oo v T Tim 14 a i F�, I -�l �lz yam stokpoe-s �-[ora Ranh jai', Ace4vyw- 42 • 4z� 42.E q,a q'2: r �+2" µme; A� � �ur� 4 �3� 1 c) I C • f i. F - L xv Q l; r K BUILDING JUN 03 2016 Towly O'F BARN8,--rA8LE r f. 49 fa I qIT, w) R f . f --TI ' I a f