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BIGB20/SIS . CRPECCD+ISL !D :508-771-0046 CCT 18 '99 15 : 12 No .004 P .02 `
The Town of Barnstable
ttssssor Depnrt ont of Health, Safety and Environmental Sgrvlcev
BaUdin Division
367 Mah Hymsh MA 02601
Offics: $08462•40- a Mph Crosm
T`luc: 30f3•'i0f>�0 Wita�Od9nr ConUmixsinroe►
Ttar Colloe�tor
Application for Sign Permit
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Do*Ruslness Assn Telephone No.
So t Vilond- I r�
7AnbW DbWcc:�,�Old IGnp Homy? YeACCO 14yumis Historic District? YedlI W'
PropcKy Owner
Nwai C` l rIzalelll S �17-6 Tell hone:
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sip calo�
Ntou�et �o !����1 �• M,,.,,,,,Tclepluone:
Aciclresss: A, ' �� �..d-�..�► rev r
Dc scriipdon
Plew claw a diW=of lot showing locWon ofboldinp and eiishng wo with dimensions,
Ioeatdon and size of fhtr new sign. 'Ms"uid be drawn on the reverse We of dig application.
Is tiw sip to be aleca tledP e 10 OV&V.lP,e�e� �croycv Aqmiffd1
111creby mr*that t am the owner or that I have the authority ot'the owner to n ake No
applfcadon,Ma the WommWon it con=sand thu dw un imid si%u rucduu sIA confkrTn to the
VmYwo m of Station 4-3 of the Town of Banrafatblc '0 4 "C.Si mmure of Owwr/Authorized Agent Date: o U �
Sise; I / 11 eamit Firer
Sion Permit woos
Siigcracnrc of'i3tettd M tltfittiat: �''L--- ®are:
81�H,oes - n
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BIGBRO/SIS . CRPECOD+ISL ID :508-771-0046 OCT 1Q '99 15 : 12 No .004 P .01
FAX
BIG BROTHERS BIG SISTERS
1034 FALMOUTH ROAD
OENTERVILLE M A02632
PHONE: 508 771-5160
FAX: 508 771.0046
DATE: / 0 /s/q 9
TO: A,r�,C.. .
FAX#: `� qb
RE: 4R-,b 11
a0 OF PAGES:
FROM:
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.. — A=189-066
JOSEPH D. DALUZ \ - XXyyXX M1X.Xj9. WX
Building Commitfiontr - _TEiEFHO_NE£775�TTZQ-
XXXMU=XD7
TELEPHONE 508-790-6227
TOWN OF BARNSTABLE
BUILDING INSPECTOR
TOWN OFFICE BUILDING
HYANNIS, MASS. 02601
July 23, 1991
Big Brothers/Big Sisters of Cape Cod and the Islands
100 West Main Street
Hyannis, MA 02601
RE: 1934 Route 28 (Falmouth Road) , Centerville
A=189=066
Dear Director:
I have reviewed the material you presented relative to the activities
conducted by your organization. I have also conferred with our Town
Attorney Robert Smith about the contents therein in order to determine
if the educational exemption from the zoning regulations in accordance
with Section 3, Chapter 40A of the M.G.L. would be applicable.
It is important to note that the building is located in a residential
zoning district. It is, therefor, imperative that the educational pro-
gram actually be performed in this building to protect your exempt
status. An administrative office to administer the on site educational
program is permitted.
With this clear understanding the building and the use prescribed meets
the zoning requirements.
Good luck in providing for those young people in need.
Peace,
eph D. DaLuz
Building Commissioner
JDD/gr
cc: Town Attorney
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® TIG 9BROTHERS/TIG SISTERS
of Cape Cod and the Islands, Inc.
100 Wes Main t Street, Box 754 Hyannis MA 02601 •771-5150/428-4970/255-9445
S e
March, 1990
Dear Parent:
We are presently preparing for our Life Choices program.
Life Choices is a twelve week program; it will provide. your
son/daughter with an opportunity to explore what he/she
thinks about some of the choices he/she has in life, such as:
what is important to him/her; how to communicate with
others; how to deal with peer pressure; what he/she wants
to do when he/she is older ( career , marriage, children ,. etc ) .
He/she will have a chance to hear what other kids the same
age think about these things and learn some skills in
decision making . Life Choices will begin on Tuesday, March
27th and will run every Tuesday. through June 12th from 3:00
to 4:30 p .m. . We feel it is important for adolescents to
discuss these topics with, their parents. We encourage. you to
ask your child about the things he/she learns. I have
included a schedule for the twelve sessions. The sessions
will be held at the Falmouth Library. Kids who attend
Lawrence School will be within walking distance to the
Library; the kids who attends Morse Pond will be provided
with transportation by Big Brother/Big Sisters. We hope you
will discuss the program with your child . We look forward to ,
having him/her in the program.
Please call the office to sign your child up. Attendance is
required at all twelve sessions .
Sincerely ,
Rebecca Blake
1991
TOWN ATTORNEY
TOWN OF BARNSTAM
MEMBE . AGENT Y U :TE�� L'� �,Y BIG BROTHEPc ?IG SISTEP,S OF AMERICA
4
` LIFE CHOICES PROGRAM
a
i
#€ /77i40 session one: Getting Acquainted
t
This first session is a chance for everyone to start" getting
to know one another . It is also an opportunity for us to
tell the kids more about what we will be doing in the program
and answer any questions they have.
4/3/90 Session Two: Choices
The theme of Life Choices is making decisions. The first
step in making a decision is thinking about choices you have.
This session is designed to get the kids thinking about
choices they have in their life now and choices they will
have in 5 to 10 years.
We talk about how the way we act and the things we do and do
not do are choices, rather than conditions that exist. For
example, some kids may look at the fact that they make low
grades as just the .way things are . They do not always think
about how the choices they have about studying , paying
attention in class , doing homework , asking for help when they
don ' t understand something, and their attitude can all
combine to affect their grades.
4/10/90 Session Three: Values
A Value is something that is important to you. We ask each
of the kids to tell the group one thing he/she values and one
thing he/she does not value. We talk about the fact that
different people have different values. It is important to
be aware of your own values in order to make decisions that
are right for you.
4/17/90 Session Four: Career Awareness
We play several games to get everyone thinking about careers
and what kinds of jobs they are interested .in . Although the
kids will not need to make a decision about a career for many
years, .we thin.k it is important for them to start thinking
ahead and learning how one goes about choosing a career . We
also emphasize that they are making some decisions now that
will affect their career . For example: whether to study a
lot, to pay attention in class or not, to ask for help when
needed , etc .
4/24/90 Session Five: Decision Making
We feel this is one of the� most important sessions of the
program. We present a b step model that can be used when
faced with a decision . The model is:
First decide if you are going to make a decision now
or put it off until later . If you want to decide
now then :
it
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1 . Think of all poss�' � ! ties/choices .
f;
2. Think about consequences or results of each choice.
-, 3. Think of your values - which possibility fits in
with what is important or right for you?
4. Choose or decide among the possibilities/choices.
5. Act.
6. Take responsibility for the decision/actions.
We emphasize the importance of making your own decisions
rather than following peer pressure, thinking about
consequences of choices, and taking responsibility for your
actions.
5/1/90 Session Six : Assertiveness/Sex Roles
Being assertive means bei.na open in telling others how you
feel and what you think. . We v,ill demonstrate assertiveness
and compare assertive behavior- to oassive behavior and
aggressive behavior .
Kids are constantly being pressured by their peers to go
along with the crowd. Knowing skills in assertiveness..
increases their chances of standing up for what they believe
in and making their own decisions.
' In keeping with the program theme of making decisions, in this
session we will also explore how traditional sex roles have
r; restricted females and males from being free to choose a
j lifestyle or. career. We will explore how sex roles limit
individuality. This session reinforces the point that
everyone is free to choose careers, lifestyles, etc . for
him/herself . - -
5/B/90 Session Seven : Body Image
Most of the kids enrolled in the program will be going
through a critical period of physical development. In this
session we will explore the kids ' feelings about these
changes and relate these observations to their over-all self-
concept. It is hoped that this session will alleviate
awkwardness and embarrassment and promote a healthy attitude
toward puberty.
5/15/90 Session Eight: Sexuality
This session focuses on sexuality , consequences of having
sex , and the realities and responsibilities of being a
j parent. We will discuss some of the problems teenage parents
face, such as financial problems , not being able to do things
most teenagers do, and the pressures that marriage can bring
i to young people.
We feel it is important for kids to have accurate
f information . We provide an opportunity for them to ask
r
t
j
r
!"r
X
} questions they have on their minds related to sexuality .
We point out that the reason we are talking about sex is not
because we think they are having sex now, or should be having
r sex anytime soon . We want everyone to have accurate
information and be aware of where they can go to talk . to a
"- nurse or doctor when the need arises for them. Different
people have different values and choose to have sex at "
different times in their lives. The goals of our sexuality
session are to help them think about consequences and taking
responsibility.
i
5/22/90 Session Nine: Friendships
Being accepted and liked and having friends seems to be very
j important to 11-13 year old kids. At this session we have
the kids participate in a couple of games to explore what
qualities they look for in a friend andhow they feel about
different situations that arise in friendships.
5/29/90 Session Ten : Drug/Alcohol Awareness
Most young people are faced with making a decision about
drugs and alcohol at some point in their lives. There is a
good chance that your son/daughter has or will in the near
j � future be offered drugs or alcohol . During this session the
# kids will have a chance to think about and discuss the
j consequences of using drugs and/or alcohol .
is
6/5/90 Session Eleven: Cultural Awareness
Race, ethnicity and culture are all aspects of identity. How
we relate to others and how others relate to us may berooted
in ethnicity and culture. The focus of this session is for
each individual to recognize aspects of their culture and
I ethnicity and how these factors apply to their self-concept.
Making the kids aware of differences and broadening their
knowledge of other cultures and ethnic groups will increase
'i their sensitivity and help break down barriers that could
limit their relationships with others .
ij
6/12/90 Session Twelve: Last Session
�I
This session is a combination of saying good-bye and having
fun . We will spend some time having the kids talk about how
j they feel about the program ending . We feel it is very
important for people to learn how to end relationships in a
healthy way. This involves taking the time to say good-bye,
sharing feelings about the ending , and telling one another
what the relationship has meant.
The kids will decide on what they would like to do for a fun
activity. We may have a party , go swimming , out to eat, or
whatever they choose. We want everyone to h_ve a lot of fun
at this session so that the program ends on a positive note.
f
G
1
WE ARE: YOU ARE: TOGETHER WE ARE:
Children who feel rejected by the An adult vblunteer who is Volunteers involved in a non-profit
loss of a parent through death, committed to spending a minimum of social service agency. We are a part
divorce, or abandonment. Our most 3-4 hours a week with a child for a of a nationwide program that began
common problem is a low self-esteem. period to exceed one year. A Big in 1904.
We need you to help us feel that we Brother/Sister is anyone who is
are someone special. We're waiting interested in the welfare and well-being !1
for YOU! of a child. He/she must be willing to
3
make a moral commitment to a child's
growth -and development. There are no
specific Job qualifications;t ons, just a
•
•
willingness to share and be a friend. '
ir
lw
,. Y- .•thy���', � (Ei
i
+ Tw
r cam' • , f � f � .,.
The average wait for a Little Brother
to be matched with a Big Brother is
two to three years. ' 0
{
,��, � � f4
IF
Text & Photos by Dann & Joy Blackwood.
Prepress Services donated by Type Trends.
10 Washington Ave. (off North St.) Hyannis, MA.
YOU AREN'T WE AREN'T . " -
SOCIAL WORKERS JUVENILE DELINQUE
A 13ie 13iother/Sister is not We are children living in single
a 1-)rofcssional counselor. Some may t= .'`-_ parent families. It is true that we have
have 1)rcvions experience with children; a six times greater chance of getting
other , may not. However, Big '. into trouble with the law, and a four
�v yc
Broi hers/Sisters all have one thin -
g •. � ,. _�� '� ._ `'� times greater chance of dropping
in collrrllon: they were all children out of school before high school
(liciiisclves. Ever gone had that special
_
P graduation. That is why we are
1'rienci Mro helped them through the ;ti= `' _'
P g _ �,.Y� .`� » g involved in the Big Brother/Sister
gro\\hig-u1) process. YOU can become _ :. ... . � _ �°''.,,`�.�. program. It is a preventative program
a child's special someone. ,' '�'. ►, „ designed to provide a unique one-to-
one relationship with an adult friend.
Please help us to grow!
Wr
Y3f'M t F J'
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W.— q
BIG BROTHERS/BIG SISTERS
OF CAPE COD AND THE ISLANDS
Gr Mailing: N
�• P.O. Box 754, Hyannis, MA 02601 ' '�'` N
q9
1 rb r 771-5150 • 428-4970 • 255-944510
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.r
Member Agency Member Agency
`*III.. S;i':.'v43.�.ts�rk. gyp•/' ,
United Way Big Brothers/Big Sisters
r„„), ,• a of Cape Cod,Inc. of America
d* ;
t n
ORIENTATION
I. GENERAL
?. INTRODUCTION - PROGRAM OVERVIEIJ
2. ROLE CLARIFICATION QUESTIONS. STRESSING FRIENDSHIP (VS. BEING
COIJNSELOR, THERAPEST, SOCIAL WORKER, PARENT IN THE ROLE) - -
3. TYPES OF CHILDREN COtlu?ON '1PROBLEM -- POOR SELF IMAGE
. FEARS & APPREHENTION'S OF TH!" VOLUNTEER.
5. INSURANCE AND LIABILITY
6. PROBLEM SOLVING - SOME PROBLEM AREAS
A. DIFFERENCES IN VALUES. . .QUESTIONS ABOUT STEALING, LYING,
DRINKING, DRUGS', WORKING/NOT WORKING, SEX.
B. EMOTIONAL PROBLEMS . . .ACTING OUT, LYING AND MANIPULATION,
ATTENTION GETTING MECHANISMS.
7. CLOSING - WHERE DO WE GO FROM HERE?
r
t
W1JR is a child sexual abuse pTevent'or'
NWAT IS III' EMro
p
rograme We hold separate sessions regularly
for kids, volunteers, and parents*
increase awareness of child sexual abuse.
OBJECTIVE
S•• -to
_ .to provide children with the tools, words
- s.
and awareness they need to protect themselve
_to provide
volunteers with information
and ideas that will assist them in helping
their little sister/brother with Person
f
safety. _
to provide parents with information and
Ideas that will aid them In keeping their
child safe.
All children are vulnerable to child sexual abuse at any time, in any lilac., nfte
at we erceive as being safe can be dangert�us: scxudl• the
times those places th P
ter, church, even the home: Often perpetrators s to childr n:
I day care cen a dan Brous
Y
abuse are the last people we would suspect
being
perpetrator is ainlost always
teachers, baby sitters, clergy, Relatives, friends.
someone the child knows. It is important that significant adults in a child's l;fu
b becoming a part of the child's support network. A sup},urt
extend themselves y
j network consists of adults a child can confide in and trust.
i
/Bi Sisters are very coMMitted to helping kid. sta ct safe.
We at Big Brothersg our child better able to protect
r E Please help share in the effort to make y
din an EMPOWER Session. Together we can make the
him/herself by attending
A world a safer place for kids.
c EMppWER Sessions, dates
C
Check the newsletter each month for upcoming
�' and times, or call the office for information.
my tw.
(617)223-4242
DB�r�Bc�4 DaQo6�oQ
Internal Revenue Service
Date: In reply rein to:
JAN 10 1975 I AU:DO:M. Darr
p Big Brothers of Cape Cod,
P.O. Box 754 - �
Hyannis, Mass. 02601
Gentlemen:
Based on information supplied and assuming your operations will be as stated
are
in your application for recognition of exemption, we3) of theeInternalined. oRevenue Code.
exempt from Federal income tax under section 5privatefoundation within the mean-
We have further determined you are not a p
ing of secti n 0 (a) of t e Code, because you are an organization described in
section red 1?0�b)(1)(A)(vi). FICA taxes unless you file a waiver
You are not liable for social security (FICA)
of exemption certificate as provided in the Federal Insurance. Contributions Act.
You are not liable for the taxes imposed under the Federal Unemployment Tax Act
(FUTA) . rivate foundation, you are not subject to the
exemexcise
from
Since you are not a p
taxes under Chapter 42 of the Code. However, you are not automatically
other Federal excise taxes. provided in section 170 of the
Donors may deduct contributions to you as p our use are
Code. Bequests, legacies, devises, transfers, or gifts
to yousec ornso2055, 2106,
deductible for Federal estate and gift tax pure
and 2522 of the Code. ou must let
If your purposes, character, or method of operation is changed, y
us know so we can consider the effect
tyof the change on your exempt status. Also,
you must inform us of all chang ou are re-
If your gross receipts each year are normally more than $5,000, y
From
iTax, by the
quired to fileif9Rt f Organization
xnalaccountng period. The
15th day of the fthmonhafterthe end of your anu
-
of $10 a day, up to a maximum of $5,000, for failure to file
law imposes a penalty
a return on time.
ed to file
income a returns
unless
eo
u are sub
You are note lated busnessincomeundersection511ofthCode. If
.ject to the tax on
must file an income tax return on Form 990-T. In
you are subject to this tax, You whether any of your present or proposed activi-
this letter we are not determining in
ties are unrelated trade
r busies as defin
number eveneiflyou5havefnohemployees. If
You need an employer ave n0
00e a number
an employer identification number was not entered on your app that
will be assigned to Yondand
in all correspondenceou will be dwith1the PInternal lease eRevenue uService.
all. returns you file a permanent records.
Please keep this determination letter in your
Sincerely yours,
_)uin,,..
JCHN E. FORISTALL
District Director
Form L-178 (rev.7-7i;
P
' (3)
a
VI I. QUALIFICATIONS
The requirements and qualifications for, and classes of,
membership in this corporation, and the voting rights of the
members, shall be as set forth .in the By-Laws.
VIII. BY-LAWS
By-Laws of the corporation shall be adopted by the Directors
names in these Articles of Incorporation and may thereafter be amended
or repealed by the members of the corporation having voting rights, by
any method provided for in the By-Laws.
IX. PRIVATE PROPERTY OF MEMBERS NOT ASSESSABLE
The private property of the members , directors and officers
shall not be subject to the payment of corporate debts of this
'i corporation to any extent whatsoever.
I
tion under the laws
in this corporation of form P
i IN WITNESS WHEREOF, for the purpose q
of the State of Massachusetts, the undersigned, constituting the incorporators
of this corporation, and being the persons hereinabove named as the first
directors of this corporation, have executed these Articles of Incorporation
this 1 day of May, 1971.
i
i
i
�1
' b
• Y
(2)
i
(c) To enter into, make, perform and carry out contracts of
every kind for any lawful purpose (without limit as to amount) with
any person, firm, association or corporation, municipality, county,
parish, state, territory, government or other municipal or governmental
subdivision.
(4) To have and to exercize all the powers conferred by the laws
• of Massachusetts upon corporations formed under the laws pursuant to and
under which this corporation is formed, as such laws are now in effect or
may at any time hereafter be amended.
(e) This corporation is organized for and will be operated for
charitable purposes, is not organized for profit and will not be operated
for profit, and no part of its net earnings will inure to the benefit of
any member, shareholder, or individual.
(1) No property of this corporation will be used or operated by the
corporation or any other person so as to benefit any officer, trustee,
director, shareholder, member, employee, contributor, or bondholder, of
this corporation, or of the operator, or any other .person, through the
distribution of profits, payment of excessive charges or compensations or
the more advantageous- pursuit of their business or professions.— l
(g) No property of this corporation will be used by the corporation
or by its members for fraternal or lodge purposes, or for social purposes
except where such use is clearly incidental to a primary charitable purpose.
N All the property of this corporation is irrevocably dedicated to
charitable purposes and upon the liquidation, dissolution or abandonment
of this corporation none of the property of this corporation will or shall
inure to the benefit of any private person except a fund, foundation or
corporation organized and operated for religious, hospital or charitable
purposes.
VI. -DIRECTORS
(.a) The number of directors of this corporation shall be fifteen (15) . T
(.b) Authority is hereby granted to the members of this corporation,
entitled to vote, to change from time to time the authorized number
of directors of this .corporation by a duly adopted amendment of the
by-laws, of this corporation, provided that in no case shall such
number be less than five (5) .
Gc) The names and addresses (all of which are in Massachusetts) of the
persons who are appointed to act as first directors of this
corporation are :
President, Lawrence Newman, Irving Rd. , Hyannisport, MA
Vice Pres. ,John Riley, Winfield Lane, Osterville, MA
Clerk, Thomas McNulty, Esq. , 324 Bridge St. , Osterville, MA
Treas. , Frank Green, Esq. , Mill Way, Barnstable, MA
Hon. 9enry Murphy, Centerville Estates, Centerville, MA
ARTICLES OF INCORPORATIC14
OF
CAPE COD, INC.
KNOW ALL MEN BY THESE PRESENTS: That we, the undersigned, have this
day voluntarily associated ourselves together for the purpose of forming a
corporation under the laws of the State of Massachusetts, and we hereby certify
that:
I. NAME
The name of this corporation is:
BIG BROTHERS OF CAPE COD, INC.
II. PRIMARY PURPOSE
The specific and primary purpose for which this corporation is formed
and intends to initially engage is to organize, under professional direction,
A body of mature and responsible men to interest themselves individually in
the welfare and improvement of boys whose physical, mental anId-moral develop-
ment has been retarded, hindered or endangered because of inadequate parental
supervision, bad environment or other conditions, and to aid them in developing
a love of God and love of Country, and a usefulness to the Community and to
themselves.
III. KIND OF CORPORATION
This corporation is organized pursuant to the general Nonprofit
Corporation Law of the State of Massachusetts.
IV, PRINCIPAL OFFICE
The County in the State of Massachusetts where the principal office
for the transaction of business of this corporation is to be located is
Barnstable.
V. GENERAL PURPOSES AND POWERS
The general purposes for which this corporation is formed and its powers
are:
(.a) To take a direct, personal and friendly interest in underprivileged
boys and their families, and to employ methods that will tend to promote their
physical, mental and moral welfare and thus aid in making them better citizens
of their community and their nation.
(b) To obtain, receive, hold, administer and expend property and funds
in accordance with the policies and principles of the Corporation. Such funds
shall be obtained and secured in accordance with sound principles and policies
pertaining to the raising of funds for charitable purposes , and shall be de-
posited to the. credit of this Corporation.
Engineering Dept. (3rd floor) Map % yam Parcel D 4p Permit#
House# ��3 Date Issued, - f
Board of.Health(3rd floor)(8:15 -9:30/1:00-
Conservation Office(4th floor)(8:30- 9:30/ 1:00-2:00)
SEPTC S Tare
19
TOWN OF BARNSTA O N .6
Building Permit Application
Proje reet dress
Village L e.yj,,�le)5%
Owner v c��e.-v S r S Address \°l`� �_ �t► \n,��v-} e�T_
Telephone
-'Permit Request G s vet S�r Q 0,1 w o a, &A in o-- Ack k' �o tik ® 'e-sa-(.
Q R NL V.A � i•�
First Floor D-6 square feet Second Floor square feet
Construction Type t -1, co p C . M--+�
Estimated Project Cost $ �®pc3
Zoning District A R) Flood Plain Water Protection
Lot Size 4, ,ACC Grandfathered ®Yes ❑No
Dwelling Type: Single Family [ Two Family ❑ Multi-Family(#units)
Age of Existing Structure 'I`a- Historic House ❑Yes '®.No On Old King's Highway ❑Yes SNo
Basement Type: M-Full ❑Crawl ❑Walkout ❑Other
Basement Finished Area(sq.ft.) r!)S, A. Basement Unfinished Area(sq.ft) Q-0
Number of Baths: Full: Existing�_ New ® Half: Existing \— New
No. of Bedrooms: Existing 6 New C3
Total Room Count(not including baths):Existing New �_First Floor Room Count
Heat Type and Fuel: aGas ❑Oil ❑Electric ❑Other
Central Air ❑Yes ®No Fireplaces: Existing C.> New Existing wood/coal stove ❑Yes JA No
Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size)
❑Attached(size) ❑Barn(size)
None WShed(size) `Q_X C�
❑Other(size)
Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑
Commercial 51Yes ❑No If yes, site plan review# --
Current Use 0 t % e— Proposed Use �_ c e
n
Builder Information
Name Telephone Number
1 - n
Address v ,q License# C>- S
Home Improvement Contractor# C.a C,:.
C6 1M Ake� h l U t,e k� Worker's Compensation# f�4 '`j 6 — p�
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL\CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO
SIGNATURE _ DATE / (,
BUILDING PERMIT DENIED FOR THfFOLLOWING REASON(S)
FOR OFFICIAL USE ONLY
PERMIT NO.
DATE ISSUED
MAP/PARCEL NO. t
ADDRESS VILLAGE
i
OWNER
DATE OF INSPECTION: `
i -
FOUNDATION -
FRAME -
INSULATION ,
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: _` OU'GH FINAL _
GAS: ' UGH: FINAL
FINAL BUILDINGc
a .
4 F pp t
' DATE CLOSED O, Jf " ``
ASSOCIATION PLAN NO. t
f
dF�rqi,
uft The Town of Barnstable
'OlF1619. Department of Health Safety and Environmental Services
Building Division
367 Main Street,Hyannis MA 02601
Office: 508-790-6227 Ralph M. Crossen
Fax: 508-790-6230 Building Commissioner
October 7, 1996
Stuart Peoples
1934 Falmouth Road
Centerville, MA 02632
SPR-92-96 Big Brothers/Big Sisters, 1934 Falmouth Road/Route 28,
Centerville, (189/066).
Proposal: Addition of 16'X26' to existing building.
Dear Mr. Peoples,
The above referenced site plan was reviewed at the October 3, 1996 meeting of Site Plan Review
Committee and deemed approved with the following condition:
• Septic system must be upgraded.
Please be informed that a building permit is necessary prior to any construction. Upon
completion of all work, the letter of certification required by Section 4-7.8 (7) of the Town of
Barnstable Zoning Ordinances must be submitted. Also, all signage must be discussed with
Gloria Urenas of this Department.
Should you have any questions, please feel free to call.
Respectfully,
J
✓Ralph M. Crossen
Building Commissioner
r .
The Commonwealth of Alassachusetts
In
Department of IndustrialAccidents
Office olinvestl9MONS
_i !:._. ' 60(1 Washington Street
Boston, Afas.v. (12111
Workers' Compensation Insurance Affidavit
AmIicant Information• Please PRINT lebibly
m $
locit on, C A \V\ V, k,
phone 1il CC-
city CE' iv e�c v, \ t J -�•�S'S
(] 1 am a homeowner performing all work myself.
1 am a sole proprietor and have no one working in any capacity _ _w
I am an emplover providing workers' compensation for my employeesworking on this job.
om am name:
V. \ o.m ,e- ~ M cG V.M-e A-
•tticlres • -b$mil C �--�
� c
cite 02 �e, U l P S 7 shone#-
_ l f _
insur•tnce co 0O M M e Y C'41 A \� d policy# �( �� 1 - �•
1 am a sole proprietor• general contractor, or homeowner(circle one)and have hired the contractors listed below who have
the following workers' compensation polices:
company n•tmc-
address•
tit-• 12hone#•
ins urincc co poiicv#
.... ....._ . �-.. - .._. :-•try'- -•� a.- - :t•.r -...-._._�. ��.--a�aw���'T7`'�J':� .:..5'•:..F•.� '-:-?�'c�... -ram
company nimc•
•tddress-
city• phone#:
insur•tnce co policy
Attach additional sheet itnecessary�• Y � ^} s " ''•'• " "~ A-
-Failure to secure coverage as required under Section 25A of i1tGL 152 can lead to the imposition of criminal penalties of a fine up to S1.500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. 1 understand that a
copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do herehr c r ►' nder%,JpcLna1f of perjun'that the information provided above is true and correct.
Si_nature Date
Print name 2
J kA Phone# '4-�Fa5a -
�cial use onh do not write in this area to be completed by city or town ofrtcial r
city_ or town permit/license# t-1lluilding Department
C]Liccnsing Board
rl check if immediate response is required [3Sclectmen's Office
011calth Department
contact person: phone#: r lOther
ontsed 3roi PJAI
l
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
w" n e�ni l( gee is defined as eve person in the service o1 anothcr`'under any
tom the "law". a t D
employees. As quoted � .
contract of hire, express or implied, oral or written.
An etytp/nrer is defined as an individual, partnership, association, corporation or other legal entity-, or any two or more c
the foregoing enLa`_ed in a.joint enterprise, and including the legal representatives of a deceased emplover, or the
receiver or trustee of an individual , partnership. association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling hous
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an emplover.
MGL charter 152 section 25 also states that even state or local licensing agency shall withhold the issuance or
rene��•al of a license or permit to operate a business or to construct buildings in the commom�calth foram
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public Nvork until acceptable evidence of compliance with the insurance requirements of this chapter Ila
been presented to the contracting authority.
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Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names. address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date tlic affidavit. Tile
affidavit should be returned to the city or town that the application for the permit or license is being requested.
not the Department of Industrial Accidents. Should you have any questions regarding the "law" or if you are required
to obtain a workers' compensation policy, please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. PleaE
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned tc
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions
please do not hesitate to give us a call.
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_
The Department's address, telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations Al
600 Wasliington Street _
Boston,Ma. 02111
fax#: (617) 727-7749
phone #: (617) 727-4900 ext. 406. 409 or 37-5
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