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HomeMy WebLinkAbout0481 MAIN STREET (CENT.) :�S F a S , , ,! ,. {"...:Y,. Y�ca, nt.'.,,i, t�.,. .� ya�,rt'' .�, ,e:;�,�,,,,dy �,;.. .. '. a. i,. "sa ce, �} {� z ..B ,'£ ,:,a .ti--.. $''^"` •:+�- r�- wy +";,.` /■p.(t .J a Ae...,.� �. ., �4 .. -... � .T ..,k.:.. .. .: y 1 i.rt4', q.. ..;.-. . r: ,Y. �" F {R:', f y.'� Y �4-'. =ice ��. t F rj'f ":c�.,M1:.. __ f1' , r yt s i-.• Art' F u, a � tir s ; o� r k i , „ „ 4 6 4 0 t Application number.. ....... �:�. ....... Fee.............................................................................. Building,Inspectors Initials. .. APR o t v 2019 Date lssued....yA ?.. ........................................... M Map/Parcel.... � 1J��� BLE TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO W S/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION V I r -X-Address of Project: f`1c,.�lti. 5� . ��.u��i`p NUMBER STREET VILLAGE, Owner's Name: _` (� c,,j Phone Number �jb z Email Address: lCC Cell'PhoneNumber Project cost$ o 1 v Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorized,.nr� j�J ,,,r S to make application for ibuilding peg#in accordance with 780 CMR Owner Signature: Date: -�' TYPE OF WORK ❑ Siding ❑ Windows (no.header change)# ❑ Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review Roof(not applying more than 1 layer of shingles) Construction Debris will be going to jZ-\n.v\_ } CONTRACTOR'S INFORMATION Contractor's name Home Improvement Contractors Registration(if applicable)# 6 � (attach copy) Construction Supervisor's License# c�(S^ (attach copy) Email of Contractor �►.,t - 'hone number ?7q-��6,7962k_ ALL PROPERTIES THAT HAVE STRUCIURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. { APPLICATION NUMBER............................................................ *For Tents Only* Date Tent(s)lwill be erected Removed on number of tents total Does the tent have sides? Yes No ' (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can'be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event ' Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each'tK Fuel source being used LP tank 20 lbs. or>Yes No , if yes, a gas permit is required. n Natural Gas Yes No ,if yes,a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hour of 8:00am-9.30 am or 3.30 pm-4.30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT'S SIGNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. ACCOR" CERTIFICATE OF LIABILITY INSURANCE ;DATE(MMIDDIYYYY) �. 03/07/2019 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(%,AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Allison Petkiewich-Sousa NAME: Risk Strategies Company ATONEC. Ext: (781)986-4400 A'X No (781)963-4420 15 Pacella Park Drive E-MAIL ADDRESS: apetkiewich-sousa@risk-strategies.com Suite 240 - -INSURER(S)AFFORDING COVERAGE NAIC#- Randolph MA 02368, INSURERA: AIM Mutual Insurance Company INSURED - INSURER B - D3 Builders Inc,DBA:D3 Builders Inc INSURERC: 65 Treasure Lane INSURER D INSURER E: Mashpee MA 02649 INSURER F t COVERAGES CERTIFICATE NUMBER: Master 02/14/19 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 MAYBE 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. POLICY INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDY EFF) (MMIDDfY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED. a CLAIMS-MADE OCCUR - - - PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY - $ . GEN'LAGGREGATE LIMIT APPLIES PER: . GENERAL AGGREGATE $ PRO- LOC PRODUCTS-COMP/OPAGG $ - POLICY JECT _ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $- - - Ea accident ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED - BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED - PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY - Per accident $ UMBRELLA LIAB OCCUR - - EACH OCCURRENCE - $ H ti EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I RETENTION$ v UT $ WORKERS COMPENSATION -- STAT U �RH ' AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBER EXCLUDED? NIA WCC50050193032018 08/22/2018 08/22/2019 (Mandatory In NH) - - E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required). - J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN The Legislative Leaders Foundation ACCORDANCE WITH THE POLICY PROVISIONS. 481 Main St. - AUTHORIZED REPRESENTATIVE Centerville MA 02632 4 ©1989-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents = Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit:guilders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: Ci /State/Zi ty p: 10.'G �6 Phone#: ��— Are you an employer?Checkhe a propreate box: Type of project(required): 1.�am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8..❑'Demolition working for me in any capacity. employees and have workers' $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ` �/ U, ����.ram✓i.�. Policy#or Self-ins.Lic.#: S11DO Loll 30 32c Expiration Date: 0—� Job Site Address: 1Y\ "1` City/State/Zip: „^A��lr�, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties.of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ceVYyuytpains and penalties of perjury that the information provided above is true and correct Signature: Date: 4-1 y" q Phone 2 3 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4..Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: T Information and Instructions " 7 7 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 www,mass.gov/dia • r e -Y--- M achusetts onwealth al Licensure Commonwealth omm of Protession. Standards ti DNision Regulations and Board of Building uSiS.peNisor Constro-A `jj res.. 1112912020 � T CS`_101506 1 1 R tp W DAV EASUR�'%pNE i r 66 TR p py649 �5 MASHPEE M. `�VO1S5 �0 Commissional ,,pp�� _..�e�poayuraiaruaea`�a��%liLccadcce�uu�e��,'. ' �\ Office of Consumer Affairs&Business Regulatio:> H0n9E IMPROVEMENT CONTRACTOR TYPE:Individual Rea+stration Expiration -bbl, ,! 07./2B/2019 DAVID W ILLIAM RICHYPRDS lII 16 `f DAVID RICHARDS = 1 �C�� 65 TREASURE LANE U MASHPEE,MA 02649' Undersede . Lauzon, Jeffrey From: Lauzon,Jeffrey Sent: Tuesday, May 08, 2018 12:08 PM Y To: 'SALES@CAPECODALARM.COM' Cc: Lauzon,Jeffrey Subject: ViewPermit, Permit No:TB-18-1161 Applicant, Please be advised that the above application has been forwarded to the Fire Department for review.Additionally the following is missing from the application and is required to be submitted: 1) Floor plans showing the location of all devices for the fire detection/protection system. Failure to submit the above will result in the denial of the application.Thank you for your attention in this matter. Jeffrey Lauzon Chief Local Inspector (508) 862-4034 jeffrey.lauzon(a)town.barnstable.ma.us t v i-7 (q f ' U�k(9C9 k � s IME HE Application I tuuaber.r e _>.>>.>.............>,....>..... R W,10 .� r ........Other Fee......................... . N OF BARNSTABL PeYmitFee............. a g. �� v 7 14 4 Total Fee Paid TOWN OF BARNSTABLE Permit Approval by.............-..................On........................... i PI _ Map......... ............ ...................Parcel.,.. ..k.5 4-I( ITCATION Section 1I — Owners Infoltmation and Project Location Project Address "it9l LUO.\ 5'i ree^ Tillage ayi-'ervi22e i Owners Name Owners Legal Address l ( J)ociVl SCOT e CT City CZYNn-e ryi L Le- State Zip �o Owners Cell# ,�08" 17 1 92� _E-mail Section 2 —Structural Use ❑, Single/Two Family Dwelling ❑ Commercial.Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty Fire Alarm Rebuild ❑ Deck Apartment El Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar ❑ Renovation ❑ Pool ❑ Insulation. Other—Specify Section 4—Detail 00 Cost of Proposed Construction4 9 ®d Square Footage of Project - Age of Structure Dig Safe Number # Of Bedrooms Existing Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Last updated:11/7/2017 3 Section 6—Project Specifies [] Wiring ❑ Oil Tank Storage rV Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression El Heating System ❑ Masonry Chimney ®Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District [] Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes ® No Section 7 Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No ❑ Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq. Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard. Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief morn the Zoning Hoard in the past? ❑ Yes ❑ No Last updated: 11/7/2017 s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): CAPE COD ALARM CO., INC. Addiess: 204 OLD TOWNHOUSE ROAD City/State/Zip:WEST YARMOUTH, MA 02673 phone #: (508) 398-6316 Are you an employer? Check the appropriate box: Type.of project(required): 1. ✓❑ I am a employer with 30 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. [1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.* 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.Z Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Associated Employers Ins., Co. Policy#or Self-ins. Lic. #: WCC-500-5006433-2017A Expiration Date: September 1, 2018 Job Site Address: q U 1 LU M0 Sw'Lr{ e- City/State/Zip: �, V�t'L Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up�to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify u der tl: pains ndpenalties ofperjury tltat the information provided above is true and correct. Si ature: s—z, l Q - Date: Phone#: �c�6 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: f =COMMONViIEALTH QF MA W"Go-H JSETTS::: ;.:>;< Commonwealth of Massachusetts ® ® e ® ® Department of Public Safety BOARD`QF I License: SSCO-000248 Y Y Securit S stems -S-License "::1SSUES THE„01—LOWING LICENSE AS A IV rw E2 GISTERED SYSTEMGO.C�TRACTOR- f �� v ..>.:. IQ GENE CORMIER _ GENE A CORMIER Employer.: _ ;ZAP'E CODALAWCO INC CAPE COD ALARM 204 OLD.T.-OWN HOUSE .WEST;:YARMOUTH, MA--i02673-1531 n , Expiration: iration: 'i592 i� 07/31/2019,;;»;;;;;;<; 123442 Commissioner 11107/2 01 g ti .a OMMON1ni�Ai.TH ®F;MAW-AC rrs: :. ® ® A jq!j;jjjjjjj ® ` MUM BOA[l7 O E WING'<L{CENS.. ISSUES THf=FOLLO W;: REGISTERED SYSTEM TEGHN1ClAN' �r � IF z SOUTH AENNaS, iUTA ,0260 2667 �f. w .,:: zi .. 07/31/20.1 212 8 805 1507��>�:: • Systems Contractor License#1592C Cape Cod Alarm Co., Inc. All employees bonded and insured 204 Old Townhouse Road Protection System West Yarmouth, MA 02673 Proposal www.capecodalarm.com Telephone: 1(800)468-8300 Fax: 1(508)398-5666 ' � Email:info ca ecodalarm.com Q P Client Information @ -- 8> � Technicians Total Sheet it Mem STATE LEGISLATIVE LEADERS 481 MAIN STREET JOB TYPE Proposal Number 10343 CENTERVILLE, MA 02632 Date 4/11/2018 Account Rep. S007 Bill Fallon Customer Fax .Phone 1(508)771-3821 Ext. GREG Alt. Phone Ext. mail *Proposal to modify/consolidate the various commercial fire systems &devices onto one system.* Qty.Ordered Description Qty.Installed Remarks F—C] Silent Knight-SK5208- 10-Zone Conventional Fire Alarm Control Panel ItemID SK5208 O To replace existing control panel O Built in 10 zone support, expandable up to 30 zones. ( ) Includes two 12-volt 18-amp hour batteries. ( ) Requires an electrician to hardwire 120 vac t' to supply primary power the device. 14 System Sensor-4WTA-B- Smoke Detector; 4-Wire with Sounder ItemID 4WTA-B BASEMENT: O Boiler room - d'd new ( ) Bottom of stairs - replace existing ( ) IT/Power area - replace existing ( ) Storage/kitchen - replace heat detector w/smoke detector FIRST FLOOR: O Lobby- replace existing O Above FACP , dd new O Board room - replace heat detector w/smoke detector O Main hallway (w/flag)-radd new O Grand room (rear) Ladd new(Note: old smoke&wire buried above new ceiling; CCA to install new when area complete) SECOND FLOOR: ( )Top of stairs/outside bathroom - replace existing ( ) Owner's office - replace existing , THIRD FLOOR: ( )Top of stairs - replace existing ( ) Marketing office - replace heat detector w/smoke detector ( )Top of stairs/outside of office - replace existing 0 Firelite-BG-12- Dual-Action Pull Station With Hex Lock ItemID BG-12 ( ) Basement-,replace existing Proposal 10343 www,CapeCodAlarm.com Page 1 of {\rtfl\ansi\ansicpgl252\deff0\nouicompat{\fonttbl{\f0\fnil\fcharset0 Tahoma;}{\fl\fnil Tahoma;}} {\colortbl ;\red59\green59\blue59;1 {\*\generator Riched20 10.0.162991\viewkind4\ucl \pard\cf1\f0\fs16\lang1033 4/16/18-Ok to Go to Service Natali\par 4/16/18-Paperwork to Barb Natali\par 4/11/18-Receive sign proposal. Maria will mail 50% deposit check. Natali\par 4/11/18-Emailed to finance@sllf.org Natali\par I ram. 1 Systems Contractor License#1592C Cape Cod Alarm Co., Inc. All employees bonded and insured 204 Old Townhouse Road Protection System West Yarmouth, MA 02673 Proposal www.capecodal arm.com Telephone: 1(800)468-8300 Fax: 1(508)398-5666 L Client Information Email:info@ca ecodalarm.com - 8 Technicians Total Sheet STATE LEGISLATIVE LEADERS JOB TYPE Proposal Number 10343 481 MAIN STREET Date 4/11/2018 CENTERVILLE, MA 02632 Account Rep. S007 Bill Fallon Customer Fax Phone 1(508)771-3821 Ext. GREG Alt. Phone Ext. mail Qty.Ordered Description Qty.Installed Remarks ( ) First floor lobby - replace existing ( ) First floor board room - replace existing System Sensor-P2RL- Red Horn/Strobe; 2-Wire; 12/24VDC ItemID P2RL O Basement - replace existing { O First floor lobby- replace existing O First floor board room - replace existing ,.. O Second floor- replace existing X 2 ( )Third floor- replace existing 0 CCA to remove 3 existing pull stations; (2) on 1st floor&3rd floor; ItemID I Cape Cod Alarm to remove all other existing 110-volt, wireless & low voltage fire alarm devices 0 Commercial Fire Alarm Long Range Wireless Communicator ItemID AESFIRE **No phone lines needed** There is a one time $650.00 fee for the lease of Cape Cod Alarm's long range wireless alarm communicator. Also included in this fee is a plug in transformer and a 12v 7ah back up battery. **The plug in transformer will require a NON-GFI electrical outlet. 0 Monitoring Via Wireless Radio ItemID MWR $45.00 Per Month Electrical permit(included in proposal) ItemID Building Dept. permit(included in proposal) -ItemID 0 Fire Dept. permit(included in proposal) Proposal 10343 www.QgeCodAlarm.com Page 2 of 3 {\rtfl\ansi\ansicpg1252\deff0\nouicompat{\fonttbl{\f0\fnil\fcharset0 Tahoma;){\fl\fnil Tahoma;}} {\colortbl ;\red59\green59\blue59;1 {\*\generator Riched20 10.0.162991\viewkind4\ucl \pard\cf1\f0\fs16\lang1033 4/16/18-Ok to Go to Service Natali\par .4/16/18-Paperwork to Barb Natali\par 4/11/18-Receive sign proposal. Maria will mail 50% deposit check. Natali\par 4/11/18-Emailed to finance@sllf.org Natali\par I FIRE ALARM CONTROL SILENT Model 5208 KNIGHT Fire Alarm Control Panel by Honeywell with Digital Communicator The Fire Alarm Control Designed to Grow with Your Systems Needs, Without The Growing Pains. The SK-5208 is a microprocessor based control panel with built-in UL listed communicator designed for applications requiring smoke detection, manual pull stations, and sprinkler supervision. It features an easy to read LCD display with programmable English readout and user friendly tactile keys. The basic unit offers 10 zones of initiation and is expandable up to 30 zones for larger applications. The SK-5208 has a complete line of supervised accessories that provide remote annunciation, auxiliary control zone expansion. Ideal for new and retrofit applications, the SK-5208 delivers the performance to handle your installation. Features Built-in synchronization for • 10 zones, 8 Class B(Style B)and 2 appliances from AMSECO@, Class A(Style D)or Class B (Style Gentex@, Faraday, System Sensor@, ■ B)zones, expandable to 30 zones and Wheelock@ • Supervised zone expanders and l/O Programmable date settings for modules can be mounted remotely Daylight Saving Time �` r from the main control panel Clock source setting options for 50 • Event History Buffer(150 events) Hz, 60 Hz, or internal (uses the with date/time stamp panel's internal clock) • All zones are compatible with 2-or Specifications 4-wire detectors • 8 selectable/programmable output Operating Voltage: . 24 VDC patterns for notification appliance Primary AC: 120 Vrms @ 60Hz, 2A circuits Total DC Load: 6 Amp • Built-in Digital Alarm Communicator Current Draw: Transmitter(DACT) Standby: 140 mA • 4 Notification Appliance Circuits Alarm: 460 mA • 4 programmable general purpose Flush Mounting Dimensions: relays Height: 24.75"(62.9 cm) • Programmable smoke verification, Width: 14.5"(36.8 cm) pre-alarm delay, cross zoning and Depth: 3-7/16"(8.73 cm) enhanced verification mode features with 5/8" protruding that can help minimize false alarms Overall Dimensions: SK-5208 • Programmable from the built-in Height: 26-3/8" (67 cm) Plex-2 Door Option control panel touchpad, remote Width: 17-3/16"(43.66 cm) SK-SCK Seismic Compliance Kit annunciator, or Windows@ SKSS Total Depth: 4"(10.16 cm) downloading software Operating Temp: 32°to 120° F Listings and Approvals • Direct connect port for on-site (0'to 49' C) UL Listed up/downloading with Windows@ Humidity: 10-93% noncondensing CSFM Listed SKSS downloading software MEA approval 429-92-E Vol.XIII • Built-in walk test feature Optional Accessories OSHPD (CA)OSP-0065-10 Single or dual interlock water SK-5235 LCD Remote Annunciator releasing capability SK-5217 10 Zone Expander • Plex door option combines a dead (2 max. per system) front cabinet door with a clear SK-5280 Status Display Module (8 window, limiting access to the panel max. per system) while providing single button 5220 Direct Connect Module operation of the reset and silence 5824 Serial/Parallel Printer Interface functions Module • Programmable AC trouble relay SKSS Downloading Software FIRE ALARM CONTROLPANEL Model 5208 Fire Alarm Control Panel with Digital Communicator Engineering Specification The system shall contain a fire alarm control panel to supervise and operate heat and smoke detection devices, manual fire alarm devices, alarm notification devices and visual annunciators. The system shall also be capable of monitoring for sprinkler supervisory and water flow conditions. The system must have a built in UL listed fire communicator that can be enabled/disabled as needed on a per job basis. In addition, the system will sound alarms locally for purpose of evacuation. Telephone Line 1 Telephone Line 2 pp- Direct Connect For On-Site Programming 2 Class A(Style D) or Class B (Style B) Initiation Circuits Programmable Form C Relays 8 Class B (Style B) r .Y ke , R Notification Initiation Circuits Appliance Circuits G 5235 Remote Annunciators o SBUS Devices � 5280, 5217, & 5824 To AC . - 1 This document is not intended to be used for installation purposes.We try to MADE IN AMERICA SILENT keep our product information up-to-date and accurate.We cannot cover all KNIGHT specific applications or anticipate all requirements.All specifications are FORM#350318 Rev E ® subject to change without notice. For more information,contact Silent Knight ©2013 Honeywell International Inc. by Honeywell 12 Clintonville Road,Northford,CT 06472-1610 Phone:(800)328-0103, Fax:(203)484-7118.For Technical support, Please call 800-446-6444. www.silentknight.com r SENSOR Smoke Detectors with , Sounder and Relay Option . 0 System Sensor i3-sounder and relay smoke detectors apply the guiding principles of installation ease, - 3 intelligence,and instant inspection in a series of specialty conventional devices. Features Installation ease.Throughout the i3 series,installation is simple 85 dB sounder with its installer-friendly base and plug-in design.The base accommodates a broad range of back box and direct mounting Form C relay options and provides ample space for pre-wiring the device.To Isolated thermal sensor complete the installation,the i3 detector plugs into its base with a simple Stop-Drop'N Lock action. Plug-in design(base included) •In-line terminals Intelligence.To reduce the likelihood of nuisance alarms,all i3 detectors are equipped with both drift compensation and Flexible mounting options smoothing algorithms.These capabilities minimize both short-and Stop-Drop'N Lock"attachment to the base long-term causes of nuisance alarms,such as RF interference and dust accumulation.When connected to the 2W-MOD2 loop test/ Removable cover and chamber maintenance module or an i3 Ready-panel,2-wire i3 detectors can Remote maintenance signaling generate a remote maintenance signal when in a maintenance or freeze trouble condition.To measure the sensitivity of any i3 detector, Drift compensation and smoothing algorithms the SENS-RDR displays the reading,in terms of percent-per-foot Simplified sensitivity measurement obscuration,within seconds. Dual-color LEDs Instant inspection.i3 has red and green LEDs to simplify local status indication during power-up,standby,alarm,maintenance, and freeze trouble conditions.When in alarm,i3 sounder models generate an 85 dB temporal tone.If connected to the RRS-MOD reversing relay/synchronization module,all i3 sounders on the loop will activate when one detector is in alarm.The RRS-MOD also synchronizes i3 sounder output to ensure a clear audible signal. Agency Listings Should the application call for differentiating between a local and a general alarm,the i3line offers an isolated thermal model,which MEA MSFM initiates a local alarm when smoke is detected,and a general alarm TI' LISTED O approved ��I I,us when the thermal sensor is activated.. APPROVED approved pp 5911 3015195 7272-1653:164 372-02-E 2133 3180932 Smoke Detector Specifications AMR Operating Voltage Nominal:12/24V non-polarized LED Mode Green LED Red LED Condition Duration 2-wire:8.5 V to 35 V Power up Blink every Blink every 10 Initial LED 80 seconds 4-wire:1 OVto 35 V 10 seconds seconds status Maximum Ripple Voltage 30%of applied voltage(peak to peak) indication Standby Current 2-wire:50 NA maximum average Normal Blink every 5 off 4-wire:50 NA maximum average (standby) seconds Peak Standby Current 2-wi re:100NA Out of off Blink every 5 4-wire:n/a sensitivity seconds Maximum Alarm Current 2-wire:2WTR-B:130 mA limited by control Freeze off Blink every 10 panel trouble seconds 2WTA-B:130 mA** Alarm off Solid 4-wire:4WTA-B,4WTR-B:35 mA 4WTAR-B,4WITAR-B:50 mA **Direct Power(Non-Reverse Polarityh 130 Condition Duration mA limited by panel.Reverse Polarity Power: Initial LED 80 seconds 30 mA for the 2WTA-B in alarm;12 mA for all status other 2W7A-B units on the loop.Add 25 mA indication for the RRS-MOD reversing relay alarm current. Alarm Contact Ratings 2-wire:n/a Smoke detector shall be a System Sensor i3 Series model number 4-wire:0.5 A @ 30V AC/DC listed to Underwriters Laboratories UL 268 for Fire Protection Signaling Form C Contact Ratings 2 A @ 30 V AC/DC Systems.The detector shall be a combination photoelectric/thermal equipped with a sounder(model 2WTA-B,4WTA-B),a Form C relay(model 2WTR-B),a combination sounder/relay(model4WTAR-B),or an isolated Operating Temperature 323F to 100'F(0'C to 37.8'C) thermal/sounder/relay(model 4WITAR-B).The detector shall include a Range mounting base for mounting to 3'/z-inch and 4-inch octagonal,single-gang, Operating Humidity 0 to 95%RH non-condensing and 4-inch square back boxes with a plaster ring,or direct mount to the Range ceiling using drywall anchors.Wiring connections shall be made by means Thermal Sensor 135'F(57.20C)fixed of SEMS screws.The detector shall allow pre-wiring of the base and the Freeze Trouble 41'F(5'C) head shall be a plug-in type.The detector shall have a nominal sensitivity Sensitivity 2.5%/ft.nominal of 2.5 percent per foot as measured in the UL smoke box.The detector shall be capable of automatically adjusting its sensitivity by means of drift Input Terminals 14-22 AWG compensation and smoothing algorithms.The detector shall provide dual- Dimensions(including 5.3 inches(134 mm)diameter,2.0 inches color LED indication that blinks to indicate power-up,normal standby,out of base) (51 mm)height sensitivity,alarm,and freeze trouble conditions.When used in conjunction Approximate Weight 7.1 oz(200 g) with the 2W-MOD2 module,2-wire models shall include a maintenance Sound Pressure Output 85 dBA(models 2WTA-B,4WTA-B,4WTAR-B, signal to indicate the need for maintenance at the alarm control panel and and 4WITAR-B only) shall provide a loop testing capability to verify the circuit without testing each Mounting 3'/2-inch octagonal back box,4-inch octagonal detector individually.When used in conjunction with the RRS-MOD module, back box,single-gang back box,4-inch square all i3 sounder models on a loop shall sound when one sounder alarms,all shall back box with a plaster ring,direct mount to be synchronized,and all sounders may be silenced from the panel. ceiling Ordering Information 2WTA-B Yes 2-wire 130 mA max.limited by RRS-MOD Reversing relay/synchronization module control panel 2W-MOD2 2-wire loop test/maintenance module 2WTR-B Yes 2-wire 130 mA max.limited by SENS-RDR Sensitivity reader control panel RT Removal/replacement tool 4WTA-B Yes 4-wire 35 mA A77-AB2 Retrofit adapter bracket 4WTR-B Yes 4-wire 35 mA 4WTAR-B Yes 4-wire 50 mA 4WITAR-B Yes 4-wire 50 mA (\\`� `�1 STEM// Product ®2009 System Sensor. ✓✓��YYY �®� 3825 Ohio Avenue•St.Charles,IL 60174 Produ specifications suhJea to change wlthouc nonce.msit sys[emsensoccom(a �� �� Phone:BOO$EN5OR2•FaX:63O 377 6495 current productinfamaeon,includingthelatestversionofthisdatasheet. �� SENSOR' A05-034d-004.6/09•#2I70 r DF-52004:A1 •F-050 BG-12 Series � Fll'"���1�'E '�L�'''1'Y1S Manual Fire Alarm Pull Stations Py Honeywell General The Fire-Lite BG-12 Series is a cost-effective, feature-packed series of non-coded manual fire alarm pull stations. It was designed to meet multiple applications with the installer and end-user in mind. The BG-12 Series features a variety of mod- els including single-and dual-action versions. The BG-12 Series provides Fire-Lite Alarm Control Panels (FACPs), as well as other manufacturers'controls, with a man- PUSH IN ual alarm initiating input signal. Its innovative design, durable PULL DOWN construction, and multiple mounting options make the BG-12 Series simple to install,maintain,and operate. Features • Aesthetically pleasing,highly visible design and color. • Attractive contoured shape and light textured finish. • Meets ADA 5 lb.maximum pull-force. • Meets UL 38,Standard for Manually Actuated Signaling Boxes. • Easily operated(sing Ie- or dual-action), yet designed to pre- vent false alarms when bumped,shaken,or jarred. " • PUSH IN/PULL DOWN handle latches in the down position to clearly indicate the station has been operated. Construction • The word "ACTIVATED" appears on top of the handle in Cover, backplate and operation handle are all molded of bright yellow,further indicating operation of the station. durable polycarbonate material. • Operation handle features white arrows showing basic opera- . Cover features white lettering and trim. tion direction for non-English-speaking persons. . Red color matches System Sensor's popular SpectrAlert@ • Braille text included on finger-hold area of operation handle Advance horn/strobe series. and across top of handle. • Multiple hex-and key-lock models available. Operation • U.S. patented hex-lock needs only a quarter-turn to lock/ unlock. The BG-12 manual pull stations provide a textured finger-hold • Station can be opened for inspection and maintenance with- area that includes Braille text.In addition to PUSH IN and PULL out initiating an alarm. DOWN text,there are arrows indicating how to operate the sta- • Product ID label viewable by simply opening the cover; label tion,provided for non-English-speaking people. is made of a durable long-life material. Pushing in and then pulling down on the handle activates the • The words"NORMAL"and"ACTIVATED"are molded into the normally-open alarm switch. Once latched in the down position', plastic adjacent to the alarm switch(located inside). the word"ACTIVATED"appears at the top in bright yellow,with a • Four-position terminal strip molded into backplate. portion of the handle protruding at the bottom as a visible flag. • Terminal strip includes Phillips combination-head captive 8/32 Resetting the station is simple:insert the key,twist one quarter- screws for easy connection to Initiating Device Circuit(IDC). turn, then open the station's front cover, causing the spring- loaded operation handle to return to its original position. The • Terminal screws backed-out at factory and shipped ready to alarm switch can then be reset to its normal(non-alarm)position accept field wiring(up to 12 AWG/3.1 mmz). manually(by hand)or by closing the station's front cover,which • Terminal numbers are molded into the backplate, eliminating automatically resets the switch. the need for labels. • Switch contacts are normally open. • Can be surface-mounted (with SB-10 or S13-1/0) or semi- flush mounted. Semi-flush mount to a standard single-gang, double-gang,or 4"(10.16 cm)square electrical box. . • Backplate is large enough to overlap a single-gang backbox cutout by 1/2"(1.27 cm). •. Optional trim ring(BG12TR). • Spanish versions(FUEGO)available(BG-12LSP,BG-12LPSP). • Designed to replace the Fire-Lite legacy BG-10 Series. • Models packaged in attractive, clear plastic (PVC), clam- shell-style, Point-of-Purchase packages. Packaging includes a cutaway dust/paint cover in shape of pull station. DF-52004:A1•04/22/08—Page 1 of 2 Specifications Agency Listings and Approvals PHYSICAL SPECIFICATIONS: The listings and approvals below apply to the BG-12 Series pull stations. In some cases, certain modules may not be listed by certain approval agencies,or listing may be in process.Consult pull station SB-1/0 SB-10 factory for latest listing status. Height 5.5 inches 5.601 inches 5.5 inches • C(UL)US:S711 (13.97 cm) (14.23 cm) (13.97 cm) • FM Approved Width 4.121 inches 4.222 inches 4.121 inches • CSFM:7150-0075:184 (10.47 cm) (10.72 cm) (10.47 cm) . MEA:67-02-E Depth 1.39 inches 1.439 inches 1.375 inches . patented: U.S. Patent No. D428,351; 6,380,846; 6,314,772; (3.53 cm) (3.66 cm) (3.49 cm) 6,632,108. 52004dim.tbl ELECTRICAL SPECIFICATIONS: Product Line Information Switch contact ratings:gold-plated;rating 0.25 A Q 30 VAC or BG-12S: Single-action pull station with pigtail connections, hex VDC. lock. ENGINEERING/ARCHITECTURAL SPECIFICATIONS BG-12SL: Same as BG-12 with key lock. Manual Fire Alarm Stations shall be non-code, with a key- or BG-12: Dual-action pull station with SPST N/O switch, screw hex-operated reset lock in order that they may be tested,and so terminal connections, hex lock. designed that after actual Emergency Operation,they cannot be BG-12L: Same as BG-12 with key lock. restored to normal except by use of a key or hex. An operated BG-12LSP: Same as 1BG-12L with English/Spanish (FIRE/ station shall automatically condition itself so as to be visually FUEGO)labeling. detected as activated. Manual stations shall be constructed of BG-12LOB: Same as BG-12L with "outdoor use" listing. red colored LEXAN (or polycarbonate equivalent) with clearly Includes outdoor listed backbox,and sealing gasket. visible operating instructions provided on the cover. The word FIRE shall appear on the front of the stations in white letters, BG-12LO: Same as BG-12L with 'outdoor use" listing. Does 1.00 inches (2.54 cm) or larger. Stations shall be suitable for not include backbox. surface mounting on matching backbox SB-10 or SB-I/O; or BG-12LA: Same as BG-12L with auxiliary contacts. semi-flush mounting on a standard single-gang,double-gang,or BG-12LPS: Dual-action pull station with pre-signal option. 4"(10.16 cm)square electrical box,and shall be installed within BG-12LPSP: Same as BG-12LPS with English/Spanish (FIRE/ the limits defined by the Americans with Disabilities Act(ADA)or FUEGO)labeling. per national/local requirements.Manual Stations shall be Under- writers Laboratories listed. SB-10: Surface-mount backbox,metal. NOTE:'The words"FIRE/FUEGO"on the BG-12LSP shall appear SB-1/0: Surface-mount backbox, plastic. (Included with BG- on the front of the station in white letters, approximately 314" 12LOB.) (1.905 cm)high. BG12TR: Optional trim ring for semi-flush mounting. -® 17003: Keys,set of two.(Included with key-lock pull stations.) 17007: Hex lock,9/64".(Included with hex-lock pull stations.) NOTE: For addressable BG-12LX models, see data sheet DF- 52013. PUJEY Fire-Lite® Alarms, SpectrAlertO Advance, and System Sensor® are registered trademarks of Honeywell International Inc. ©2008 by Honeywell International Inc.All rights reserved.Unauthorized use of this document is strictly prohibited. This document is not intended to be used for installation purposes. ISO 9001 We try to keep our product information up-to-date and accurate. We cannot cover all specific applications or anticipate all requirements. MCINEEMING 8 MANUFACTURING All specifications are subject to change without notice. QUALITY SYSTEMS Made in the U.S.A. For more information,contact Fire-Lite Alarms.Phone:(800)627-3473,FAX:(877)699-4105. www.firelite.com Page 2 of 2—DF-52004:A1•04/22/08 V 7788F/ 7744F ' Series' �: " E§ IntelliNet CORPORATION I For Alarm Monitoring Wireless Fire Alarm Communica rs for IntelliNet Features —All models • UL Listed commercial fire alarm applications. • Meets NFPA 72 requirements • Direct reporting to AES receiver across IntelliNet mesh radio network _ �- • Each Subscriber acts as "°� •` �f transmitter/receiver/repeater Simple and fast activation on network On board status LEDs for easy set up 8 programmable zone inputs-7788F 4 programmable zone inputs and 4 reverse polarity inputs-7744F �^ � •7 Easy programming via AES handheld k , programmer or PC Rugged metal housing ideal for any commercial fire alarm application • Narrowband compliant t Mode17788F r �� - LISTED Models 7788F/7744F-ULP with IntelliPro Fire also includes Advanced Wireless Alarm Monitoring IntelliPro Fire transmits full alarm data from I As expensive dedicated landlines, required for UL864 compliance disappear, and the virtually any fire alarm panel digital future of GSM for alarm transmission becomes increasingly uncertain, the AES communicator I IntelliNet mesh radio network continues to offer unmatched reliability and speed in Alarm format support for Contact ID,Pulse, delivering wireless alarm signals to a central station without any third-party fees or as well as Bosch Modem Ile and Modem Illa reliance on networks operated by companies outside the alarm industry. The Easy installation in AES subscriber 7788F/7744F Series Subscribers provide the wireless communications link between Operates in applications with or without a the fire alarm panel and the central station receiver. Ideal for most commercial fire phone line alarm applications, each 7788F/7744F Series Subscriber is housed in a full-sized, red, locked steel cabinet and supports a range of alarm panel inputs, including EOL fire, EOL supervised, and direct voltage from the panel (non-fire applications). Supervised Operation _�- �•; AES Subscribers offer fully-supervised operation that includes monitoring of " operating power(both primary AC and battery back-up)and the connection to the mesh radio network. Each subscriber"checks-in"with the AES central station receiver at least once every 24 hours. The supervision check-in time can be set to as often as needed for the application, as appropriate for the network. Because the central station operates the wireless network,there is no additional cost for air time Wireless mesh networking is an innovative to transmit supervisory signals. technology adopted by many industries with Full Data Reporting from Alarm Panel Digital Dialer applications that need to communicate data over a large geographicv area with a high level of Models 7788E-ULP and 7744E-ULP come equipped with an IntelliPro-Fire Full Data reliability at a low total cost of ownership. Module (AES-7794)which enables reporting of full alarm data captured from the The advanced design and 2-way alarm panel's digital communicator. IntelliPro-Fire supports most alarm communication communications capability provides easy formats including Contact ID, Pulse, as well as Bosch Modem Ile and Modem Illa2 installation,expansion,and management when (when converted to Contact ID format). compared to alternative communication methods, both wired and wireless. Series 7744F/7788F - IntelliNet CORPORATION I For Alarm Monitoring Technical Specifications 7788F/7744F Series Subscriber Dimensions Antenna Cut/Communication How to Order • 13.25"H x 8.5'W x 4.3"D Trouble Output Model Description (34cm H x 21.5cm W x 11 cm D) Form C relay;fail secure; 7744F 4 Zone Fire Alarm Subscriber with 4 Weight rated for 24 VDC 1A resistive reverse polarity inputs • Approx.7 pounds(3.2 kilograms), Reset Button excludes battery. • Located on main circuit board. 7744F-ULP 7744F Fire Alarm Subscriber with Radio Frequency Operating Temperature IntelliPro Fire full data module • Standard Frequency Range: • 0°to 50'C(32°to 122°F) 450-470MHz Storage Temperature 7788F 8 Zone Fire Alarm Subscriber (others available in 400-512MHz range) —10'to 60'C(14'to 140°F) • Output Power—2 Watts Relative Humidity 7788F-ULP 7788F Fire Alarm Subscriber with Antenna 0 to 85%RHC,Non Condensing IntelliPro Fire full data module • Included 2.5 db tamper resistant antenna mounts on enclosure AES-7794 IntelliPro Fire Optional Accessories • Multiple remote antenna options available Packaged with 7744F-ULP and 7788F-ULP 7041 E Subscriber Handheld Programmer Power Input Input/Output Connections • 16.5VAC,40VA transformer(not included) RJ11 connection to AES subscriber for module 7794 IntelliPro Fire Full Data Module (AES 1640, ELK TRG1640,MG Electronics data and power MGT1640—UL Listed for use) RJ11 connector for Handheld Programmer/PC 1640 Plug-in Transformer: 16.5VAC,40VA Backup Battery programming • Will charge 12V battery up to 7.5 AH.Requires RJ31X Telco connections-T and R both in 12VDC 7.5 AH battery for UL 864. and out via terminal strip and RJ45 Alarm Signal Inputs(subscriber) Alarm Panel digital communicator T and R . I • 7788F—8 individually programmable zones both in and out via termina strip and RJ45 • 7744F—4 individually programmable zones Trouble output:Form C relay detects if i and 4 reverse polarity inputs Subscriber is off the network UL Standards Alarm Formats • UL 864 Edition 9—Standard for Control Units • Support for Contact ID and Pulse formats as and Accessories for Fire Alarm Systems well as Modem Ile and Modem IIla2 converted "u"•� " • UL 365—Standard for Police Station to CID SECURITY Connected Bur IarAl rm Units and Systems Size I cNETWORK �•�,1=17 • UL 1681—Standard for Central Station Burglar 2.8 x 5.0 inches(7.1cm x 12.7cm) A•�.a,�� oAMERICA Alarm Units Power Requirements , • 12 VDC nominal-primary and backup power yA U provided by the AES 7788F/7744F or other ®L NFPA Subscriber AES-IntelliNetTM is the industry leader in delivering high-quality mesh radio networks to the fire and security industry in commercial,corporate,govemment,and educational applications with its broad line of products and advanced network management tools.Users ofAES-IntelliNet networks have gained significant revenue,communications,and cost advantages while meeting the high standards of reliability required for the fire and security industry.AES-IntelliNet alarm monitoring systems are deployed at hundreds of thousands of locations in over 130 countries. ®oAREA IntelliNet CORPORATION For Alarm Monitoring For more information Call 800-AES-NETS (800-237-6387) AES Corporation 285 Newbury Street I Peabody, MA 01960 USA Copyright 2012 AES Corporation Tel. +1 978-535-7310 1 Fax+1 978-535-7313 AES-IntelliNet is a registered trademark of Email info@aes-intellinet.com I Web www.aes-intellinet.com AES Corporation 7788-7744F/l/12/R4 I i Systems Contractor License It l Cape Cod Alarm Co., Inc. i All bonded and insured I 204 Old Townhouse Road Protection, System ' West Yarmouth, MA 02673 Proposal Telephone: 1(800)468 8300 Fax: 1(508)398.5666 MSCA Email:info@capecodalah-m.com 33 N o L"� 1b ti Client Information - W "—' �i$ ; STATE LEGISLATIVE LEADERS µ 481 MAIN STREET Proposal Number 10343 j CENTERVILLE, MA 02632 pate 4/11/2018 Phone 1(508)771-3821 Ext.GREG Account Rep. S00713111 Fallon Email PROTECTIVE SIGNALING SYSTEM MONITORING AGREEMENT THIS AGREEMENT made and entered Into this day of acceptance of this proposal by and between CAPE COD ALARM CO.INC:hereinafter called the"Company",and CUSTOMER t hereinafter called the'Subscriber. 1.Company agrees to provide or cause to be provided at the address above indicated the.servlce.and/or connection:specified in Paragraph.4 hereof below. j 2.Subscriber agrees:to pay Company,•Its successors and assigns,for ongoing monitoring the annual charge as state i.on this proposal and payable by customer as also stated on this 1 proposal;In advance commencing the first day of the month following the date of Installation completion and/or connection payable throughout the term of thls:Agreement, 3.Telephone line Installation charges and monthly charges for the leased lines used In connection with services rendered under this Agreement shall be paid directly to the Telephone Company by the Subscriber. 4.The-schedule of monitoring Is as follows:PROTECTIVE SIGNALING SYSTEM MONITORING. 4a.`If Cape Cod Alarm shall be required to_ptace any sums outstanding In the hands of another for collection,I agree.to pay.all cost of collection,including,but not limited to attorneys 3 fees.(notto;exceed 33 1/3%)and court costs. FINANCE,CHARGES:, I have the right to pay the sums due within the credit term granted without Incurring a finance charge.If I do not pay within said terms,1 agree to pay,inaddltlon.to the sums due,a l finance charge-of one and one half percent per month(which Is an:annual percentage rate of18%)on the next monthly balance, i 5.If any agencyor bureau having.jurisdictlon,or Subscriber by his own act requests to make any changes in the system as originally proposed,Subscrlber agreesao pay for the cost of j such changes,The.Subscriber also agrees to pay any City,State or Federal taxes,fees or charges now In force or hereafter Imposed,applying to this,installation and service, j 6.The Initial term of this Agreement is THREE YEARS from the date each system Is installed or connected and becomes operative:and thereafter for consecutive terms of.one(1)year undl such time as either party upon thirty(30)days written notice,advises the other party of Its intent to terminate the Agreement at the end of the then.current term.It1s further agreed that after one(1)year from the date of this Agreement,the Company may periodically adjust the service charge,Within thirty(30)days of receipt of notice of such adjustment, the Subscriber may terminate this Agreement by thirty(30)days written'nothce to the Company,provided`Subscriber Is not in default of any terms or condltions in the Agreement. ! 7.It is understood and agreed by the parties that Company Is not an Insurer and that insurance,if any,:covering personal injury and property loss orclamage on Subscriber's premises I shall be obtained by the Subscriber;that the Company is tieing paid for:the connecting and/or monitoring of a system designed to reduce certain risk of loss and:that the amounts being charged by the Company are.notsufficlent to guarantee thatno loss will occur;that the Company ls:not assuming responsibllity for any losses which may occur even If due to Company's negligent performance or-fallure to perform any obligation under this Agreement, THE COMPANY:DOES NOT MAKE ANY REPRESENTATION OR WARRANTY,INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS,THAT THE SYSTEM OR SERVICE SUPPLIED MAY NOT BE COMPROMISED,OR THAT THE SYSTEM.OR SERVICES WILL IN ALL CASES PROVIDE THE PROTECTION FOR WHICH IT IS INTENDED, Since it is Impractical and extremely difficult to fix.actual.damages,if any,which may arise due to the=faulty operatlon of the system or failure of services provided,if,notwithstanding the above.provlsbns,there should arise any Ilablflty on the part of the Company,such liability shall be7lmited to an amount equal to one half the annual service charge provided herein or $250 whichever is.greater.This sum shall be complete and exclusive and shall be paid and received as liquidated damages and not.as a penalty,:In the event that the Subscriber wishes to Increase the maximum amount of such liquidated damages.Subscriber may,as a matteror right,obtain from Company a higher limit by paying an additional amount,proportioned to the Increase In liquidated damages. Subscriber agrees to and shall Indemnify and save harmless the Company,Its employees and agents,for and against all third party claims,lawsuits and losses alleged tobe caused by Company's performance,negligent performance.or failure to perform Its obligations under this Agreement. ! B.Subscriber hereby authorizes the Company to make Installation and/or connection at Company's convenlence.If Subscriber desiresinstafladon or connection to be done at a time other than normal working hours or on weekends,added cost will be paid for by the Subscriber at Company's standard rates.Any Installation or connection charge quoted in this Agreement Is based.upon Company performing the Installation or connection with-lei own personnel;If,for any reason this Installation or connection or any part thereof must be performed.by.outside contractors,.sald Installation or connection is subjectAwrevlsion. R.This agreement does not cover repairs due to abuse,misuse,construcdo.n/renovatlons/upgrades,and/or'acts of nature, 10,Itis understood and agreed by the parties that this Agreement constitutes the"entire;Agreement between the parties,and there is no verbal understanding changing or modifying any oftheterms=of this Agreement This contract.may not be changed,_modified or varled except by writing,and signed by an authorized representative of the Company.This Agreement shall not become binding:on the Company until approved by Company's Management As provided below.SUBSCRIBER HEREBY ACKNOWLEDGES THAT HE HAS READ AND UND.ERSTANDS.THIS ENT]RE AGREEMENT..:IF.THIS.IS.A:HOME:SOLICITATION.:SALt,YOU,..THE.BUYER,MAY CANCEL-THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT.OF THE---- THIRD BUSINESS DAY AFTER DATE`00 THIS TRANSACTION. CCA recommends Wireless monitoring,if you use telephone lines then we,recommend using standard P.O.T,S,telephone line(Plain Old Telephone Service)for all Digital Monitoring. If you have Cable/V.o.I.P phone service,or DSL please contact your Account Manager. i Permits Are Extra We Propose:hereby to furnish.this Protection'System.including,material and labor-complete in accordance with above specifications,for the Total Amount Shown.All material Is guaranteed to:be as specified, All work to be completed during normal business hours Ina workmanlike manner according to standard practices.Any alteration or deviation from the above specifications Involving extra costs will be done only upon written orders,and will become an extra charge over and above the estimate. All,agreements contingent upon strikes, I accidents or delays beyond our control.Dwnerto carry fire,,tornado and other necessary Insurance,All parts&laborguaranteed for one year. Additional Terms: 36 month monitoring.contract required unless othwlse.noted,If system Is not monitored add$20D.00 to Installation amount.We recommend a daily test$4,00 per month.Any 110VAC work Is not part of this proposal.You will:need to contract a licensed elctdclan.for any 110VAC work. ***Carbon Monoxide detectors are required by law to be replaced every FIVE(5)years.(CONTACT US)*** Deposit Required:1/2 Down&Balance Dft On Day Of Installation. A late fee of$5,00 or 1.5%per month, ichever Is gr ter, will be charged. 1 All major credit cards accepted, ***PLEASE SIGN OR INITIAL x U i i Proposal 10343 V94fww,CageCodAlarm.com3 i i 1 r �O CL RTGL ICATE OF LIABU L En [INSl'J'RANiCE DATE(MM/DD/YYYY) . THIS CERTIFICATE tS'ISSUED AS A MATTER OF INFORMATION ONLYAND CONFERS NO RIG 8/30/2017 HTS 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 have ADDITIONAL INSURED provisions or be eridorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT Rogers&Gray Ins.-Dennis Branch NAME: 434 Rte 134 PHONE .508-398-7980 E-MAIL FAC .877-816-2156 South Dennis MA 02660 ,mail@rogersgray.com INSURERS AFFORDING COVERAGE NAIC# INSURER World Surplus Lines Insurance Corn an 24319 INSURED CAPECOD-54 INSURERB:Arbella Indemni Insurance Com an Inc. 10017 Cape Cod Alarm Co., Inc. INSURER c:Associated Employers Insurance Corn an 11104 204 Old Townhouse Road West Yarmouth MA 02673 INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 1330374015 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 AD L POLICY EFF POLICY EXP LTR TYPE OF INSURANCE - INSD VIVD POLICY NUMBER MMIDDIYYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY Y Y 5200178001 9/1/2017 9/112018 LIMITS. EACH OCCURRENCE $1,000.000 CLAIMS-MADE X OCCUR. DAMAGE TO RENTED PREMISES Ea occurrence $100,000 MED EXP(Any one person) $10,000 , GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $1,000 000 POLICY E]PRO LOC GENERAL AGGREGATE $5,000,000 JECT OTHER: PRODUCTS-COMP/OPAGG $5,000,000 $ B AUTOMOBILE LIABILITY Y Y 1020005044 9/1/2017 9/1/2018 C MBINED IN LE LI IT ANY AUTO Eaaccdent $1,000,000 OWNED X SCHEDULED BODILY INJURY(Per person) $ AUTOS ONLY AUTOS HIRED NON-OWNED BODILY INJURY(Per accident) $ X AUTOS ONLY X AUTOS ONLY PROPERTY DAMAGE Per accident $ $ A UMBRELLA LIAB X OCCUR Y Y 5201058601 9/1/2017 9/1/2018 EACH OCCURRENCE $3,000,000 X EXCESS LIAR CLAIMS-MADE D X RETENTION$0 AGGREGATE $3,000,000 DE C WORKERS COMPENSATION - $ AND EMPLOYERS'LIABILITY N WCC50050064332017A 9/1/2017 9/1/2018 X PER OR" ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N STATUTE OFFICER/MEMBER EXCLUDED? ❑N N/A _ - E.L.EACHACCIDENT $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Certificate holder is provided additional insured status for ongoing and completed operations, primary/non-contributory including waiver of subrogation with respect to general liability when required in a written contract or agreement. Certificate holder is provided additional insured status with respect to auto liability when required in a written contract or agreement. I i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 200 of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 Main Street ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis MA 02601 AUTH RED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Name c5 E v)e e n 3''Y'Sl`�e-f Telephone Number _T7 09 2)0`9 - D)G Address 901 �0 2-&'�OW'Vi eat'?��Ity w' yDf,^ra�o� �t state ( } Zip d,2�'113 . ocnoZ License Number 159 2 - C License Type6j$;e m cov rc iration Date - '�)OJ_9 Contractors Email 9 P-V1 ('_oZ o P-co CL 4l Let's ry),Co Cell# g 1 I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and if documentation required�by 780 C d the Town of Barnstable.Attach a copy of your license. Signature - ,: � / Date Section 10 —Home Improvement Contractor Name Telephone Number .Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your H.I.C... Signature Date Section 11 —Home Owners License Exemption P-e Oct c ' p41-r Wo f Irk Home ®umers Name, . Telephone Number Cell or Word.Number I understand my responsibilities under the rules_ and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CUR and the Town of Barnstable. Signature - Date PLICAXT SIGNATURE Signature Date q Print Name 13 ( FA-ll&,� Telephone Number C- rjrjy -3S 3 "�o g E-mail permit to: Aigs o cm&00,6 iatim t cum bast updated: 11/7/2017 1 i.v?.._._•'.'_. � �vr 14G:.�TJ.0 f_fi.tr.Hl:H. 1..:�.n'Y 1`„��� _i!N;j '_=ealth Fepartx��ent Zoning board(if required) Historic.District . � Site.P•lan Review(if required) D Fire Department ❑ :_ _ #._ _ - Conservation For carnr4ea-cgal work,please iake your plans dat-ec ly to the fire depar anent f os-appp®a aL Section 113 — Owner's A uthodzation 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) Signature of Owner date Print Name i i Last updated: 11/7/2017 r -C -� 7 Commonwealth of Massachusetts et Metal Permit Map Parcel Date: 11 JU02 2017 Permit Estimated Job Cost: $ J o o" RNSMBLE PermitYee: Plans Submitted: YES NO Plans Reviewed: YES NO 1� — a S Business License# _ Applicant License Business Information: � Property Owner/Job Location Information Name- Street: Name: � 6vc (A�� -, ' Street: tt ( t lu City/To,Arn: .r� City,Pl own:. 'WA(G Telephone: Z 1 Z C Telephone:._ -- Photo I.D.required/Copy of Photo I.D. attached: YES v,-' NO starrlmie8: J-3 /M-1-unrestricted license d-2 I M-2-restricted to dwellings 3-stories or less and commercial up to 101000 sq. ft./2-stories or less Residential: 1-2 farnily Multi-family Condo;Townhouses Other Commercial: Office // Retai.l Industrial Educational Fire Dept..kpproval Institutional_ Other Square.Footage: under 10,000 sq..ft.. over IO,000 sq.t'. Number of Stories: Sheet metal work to be eompieted: New Work: Renovation: v HVAC_L-�Nletal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailedd description of work to be done: u.�1Z K � 1 NSURANCE COVERAGE: i have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 .Yes a;4e❑ If you have checked Y_Vj,indicate the type of coverage by checking the appropriate box below: + r d A liability insurance policy � Other type of indemnity ❑ Bond El OWNER'S INSURANCE WAIVER:i am aware that the licensee does not have the insuranc verage required by Chapter 112 of the ;Massachusetts General Laws,and that my signature on this permit appilcatiorl�j this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner vner's Agent By checking this bozo,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO Prfsga-ess Jxisgeetions Date Comments Fiat Im>Aectio Date Comments Type of Licen :-- 3y _ ster i tie ❑Master-Restricted -ty/7own s C" ❑Joumeyperson Si n ture of Licensee :Iemlit# E 0�,- 8 G❑Joumeyperson-Restricted Licen Number. , =ee 3 I ❑ Check at W=MjMa-g$dldP1 nspector Signature of Permit Approval The Commonwealth of Manachusefts Prtnt Form Department of Industrial Accidents Office of Investigations. 1 Congress Street,Suite 100. ` Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Amplicant Information Please PrintLegibly Marne(Business/Organization/individual): bmird Address: �� ! City/State/Zip: 406bAfto tl L Phone Areu an employer?Ch k the appropriate bogs Type of project(required): 1. m a employer with_ Y A. ❑ I am a general contractor and I b ❑New construction employees(full and/or part-time).* _ have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have ship and have no employees ,. 8. ❑Demolition ` • , working for me in any capacity..., employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp.insurances, required.] 5 ❑ We are a corporation andJts 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner,doing all work officers have exercised their I I.0 Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.rZer�_ A�_ f repai insurance required]f c. 152,§1(4),and we have no employeess. [No workers' 13• comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all'work and then hire outside contractors must submit a new affidavit indicating such tContrac tors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-oontractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees Below is the palky`and job site information. ( - Insurance Company Marne ` �� f ' Policy#or Self-ins.Lic.^#: U 5 7 /`I Expiration Date: l Job Site Address: '1 �+1N S'I City/State/Zip: `C[7, 1- �C Attach 9-copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine . of up to$250.00 a day against the violator. Be advised that a copy of this statement,maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. �Idd&phhere b a un the ins d enalties of edury that the information provided above is true and correct tore: Date. official use only. Do not,write in this area,to be completed by city or town official City o'r Town: Permit/License# Issuing'Authority(circle one): 1.Board of Health 2.Building Department'3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector -6.Other f Contact Person: Phone.4: _ w , COMMItR ONW.EALTH OF:MASSkCHUS'El TEgan S' BOi4Rf3 OF SHEET METAL WORKERS ISSUES THE FOLLOWING LICENSE,AS A MASTER=UNRESTRICTED FABIO G ZOCANTE: x a _az 330 ELLIOTT RD CENTERVILLE,MA �02632`3561 a. }J $586 0'/2877 /2018 90428 _� � ` BOURQUE 9 HEATING & COOLING CO. INC. •FICE: SERVING CAPE COD SINCE 1986 MAILING: 1199 Pitchers Way P.O.Box 770 Hyannis,MA 02601 Marston Mills,MA 02648 508,790.2887 1 508.771.9696 FAX info@bourqueheatingandcooling.com www.bourqueheatingandcooling.com To Whom It May Concern: Mn I authorize rAbI� r /CIA U to pull sheet metal permits for Bourque Heating &Coo1ijZgHHVvAC projects. Robert Bourque President v s Town ofBarnstable Regulatory Services nma F.rimer,nit" ems¢ Bofldi ng Division Tom Ferry,Sanding C=mbdaw 200 Mam 9fieet Hyannis,TEA 02601 W�'W.tAW31..b8[`118tA�3i8,11i$.b13 Offices: 508•-862-4038 Fay 508-790-6230 Propetty Owned MUSt Complete and Sign This Section If l dog A_Mulder 1 , L -,as owner of the subject Px°PMly hereby authorize to ace on mybaif, in a}t mratters relative to wad authorize$by this peumit r a r (Addfess of Job) Pool fences and alarms are the responsibility of the applicant Fools are not to be Mkd before fence is installed and pools are-not to be utilized..until illZmAinripections are perfamaed and accepted. AZIA e 4 Qavnet W atuxe o PP�t t ► p.�t s mt 1 tNan�e Data QYORMS.O NMPER ssarmOors f 06-02-'17 12:05 FROM- T-179 P0001/0004 F-899 0-4 5/22/2017 7:48:58 AM PACE 2/002 Fax Server CERTIFICATE OF LIABILITY INSURANCE. DINE= TIFICATE 15 LSSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS.UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND ORALTER THE COVERAGE AFFORDED 13Y THE POLICIES 9fI,OM(, THIS CMRTIFICATE OF INSURANCE DOE-3 NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE MPORTANT:If the aDlHfic3te holder is an ADDITIONAL INSURED,the policy(im)must tie m0omcd- If SUBROGATION IS WAIVED,Subject to e terms and conditions of the policy,Certain Policies may require and endorsement. A statement on this certificate does not confict rictus to the eertlficals holder In IIOU of such endorsenx s_ PRODWER CONTACT NAME ROGERS&GRAY INS AGCY Pr ONE FAX 434 ROUTE 134 - (aC.No,QM. (AIC,Nos t�waa . SOUTH DENNIS.MA 02660 aooRt:se: 72WPB INBVRERIO)AFFORLMO.COVERAOE NAIL 0 INSURW INSURER A- C TALCASCTALTYCOMPAW'Y, BOURQUE HEATING&COOLING CO INC INSURER B: iNsuRm c: INSURER D: PC BOX 770 96 MARSTON S MII1S,MA 02643 INISUR R FI COVERAGES CERTIFICATE m LODE R, rr>=vraow NLIWEI . TH15I5 TO GCRTIrTTnATTNCroLv_CS Or p4*u %mrc LhtTCOog O,*watAVCua=r33Dm To TnEnlsuRm m%Aim ABOVEPORTHEPoucy P000Dnoir.ATm NOTWIrH5TANDING ANY RMU0WVMiT,TERM OR COMITION'OP"Y CONTRACT OR Omen 000iblCNT Wwrl azwCGTTO"MH Trhr3 GMTW=ATGmarDc wi;;L=OIt,MAY MtYAN_THG&MRANGC AFPORDW BY THE POLICIES DEWMBED MEREM 13 SUR-ECT TO ALL THE TERMS.EXCLU39M AND ODhtOlTKM Or WCN POU S ,LrATS 3WWM MAY MAYS&MN RMCED DY PAD CLAWS. [NSA ADD IRIM POLICY W DATE POLICY W DATE Lm TYPE OF YrBURANCE L R POLIO/M1h8ER INSDOWYrf) (WWWWV n Laws 004EPAL L A9LLITY COCIJRRENCE q COIUMERCIAL GENERAL LIA8ILr1Y CLAIMS MADE OCCUR. EAh%CE TO RENTED L I9E3(E®oGamencs EXP(Any one pa--) $ [DILY ONAL S AD V IN IURY S 4EN'L AgUFWGAT E LIMIT APPLIES PIS RAL AGGREGATE $ POLICY a PROJECT Q L OC LICTS=COMFYOP AGGUTOM091LEL(ABILITY INEOSINGLEANY AUTO (Ea accident)ALLOWNED A1/T08 INJURYSC►EDULEAUTOS en HIRED AUT08 LYLPL tlF2YNON-OWNED AVrOSERTY.DAMAGE S (Per e ' UMBRELLA LIAt3 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS•44AOE AGGREGATE s DEDUCTIBLE RETEMTION S $ A wom re ComPQOATION AND we sTATurORY oTu€a EVIPLOYEWOLIABILITY YIN US-58395MA�17 05/172017 OSH72018 wars ANY PROPER vE a NIA rE.L EACH ACCIDENT S 1000 000 D�ICErvnn61UB4~!GxcwDm'+ Irvu■,daWYM04H) DISEASE-EA EMPLOYEE S 1,000,000 Ir yr r,otscrloQ unotr oJ8EA6E-POLICY uM rr $ 1,000,000 090ORIPTION OF OPBRATI�caiew DSWRPTION OF OPiRAT10NSILOCATIPXWVi iMICMAIESTRICTIONStSPBC1AL ITIIYIP,' 71W REPLACES ANYrUO'R CSR7 FICAT'H 75S=TO TITS CTit'TIF(Ci178 BOLDER AMCM-M WOWU RS COAaP COVERAGE CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SMOtnDANY 00 flMABDVEOEsewemPOLICESBE QMCEL ED EEFORETH RATION DATE 7HMWF.NOTICE ra WILLAF e n�MM 367 MAIN ST IN ACCORti�VdVM THE POLICr P!, HYANNIS.MA 02601 avrHD RfFAWN z..r ACORO 26(2C10105) The ACORD name and logo are registered marks Of ACORD 188&2010 ACORD CORPORATION. Alt rig • 'rowwed. f JoiaN W. KENNEY ATTORNEY AT LAW 12 CENTER PLACE 1550 FALMOUTH ROAD CENTERVILLE,MASSACHUSETTS 02632 TELEPHONE 771-9300 FAX NO.775-6029 AREA CODE 506 e-mail:John@Jwkesq.com October 18, 2016 Paul Roma, Building Commissioner ~ Town of Barnstable Building Division 200 Main Street Hyannis, Massachusetts 02601 Re: Fernbrook Inn 481 Main Street Centerville, MA 02632 Dear Mr. Roma: I represent the State Legislative Leaders Foundation, Inc. ("SLLF"). I am writing to follow up on two issues that arose in our meeting with you last week concerning SLLF's purchase of the property known as the Fernbrook Inn located at 481 Main Street, Centerville, Massachusetts ("Fernbrook"). SLLF; a non-profit educational organization for state legislators and legislative bodies around the globe, currently has eight (8) employees. The organization plans to expand to ten (10) employees in the next 1-2 years. SLLF intends to use Fernbrook as its office headquarters. We have submitted a Site Plan for review anticipating that there will eventually be ten (10) employees at the property. The Zoning Ordinance requires that we provide 18 parking spaces and the Site Plan submitted shows 18 spaces. There are 13 existing spaces on the site and five (5) new spaces are shown as part of the circular driveway in the front of the building. Although the five (5) new spaces are shown on the Site Plan, we are requesting that we not be required to build these spaces unless 'a parking problem develops in the future. A October 18, 2016 Page 2 r Although SLLF currently has eight (8) employees and plans to expand to ten (10) employees in the next few years, it is rare that all eight employees are in the office at the same time. Often times less than half of the employee workforce is in the office at the same time. Given the "specialized" type of use by SLLF combined with the fact that the property is a historic site with grounds designed by Frederick Law Olmstead, my client would prefer not to have to construct the five new parking spaces unless the need arises. The second issue we discussed concerns handicapped accessibility to the property. Although we do not trigger any requirement to make the property handicap accessible, you strongly recommended we provide one handicap parking space; add a handicap ramp to allow access to the first floor of the building; and provide a handicap accessible bathroom on the first floor. Mr. Steve Lakis, President of SLLF, was in attendance at our meeting with you and expressed his agreement with your recommendations. Mr. Lakis agreed with you that this could present an issue with SLLF at some point in the future and he expressed his commitment to follow through on making the first floor accessible to all. Due to financial considerations, this is something that is not in the budget for immediate action but will be addressed in the near future. Thank you for having taken the time to meet with us to discuss SLLF's plans to acquire Fernbrook. If you have any other questions, please do not hesitate to contact us. Very truly yours, ohn W. Kenney, Esq. Attorney for State Legislative Leaders Foundation, Inc. Cc: Stephen Lakis r 1 w . JOHN W. KENNEY ATTORNEY AT LAW 12 CENTER PLACE 1550 FALMOUTH ROAD CENTERVILLE, MASSACHUSETTS 02632 TELEPHONE 7TI-9300 FAX NO. 775-6029 AREA CODE 508 e-mail:JohR@Jwkesq.com October 18, 2016 Paul Roma, Building Commissioner Town of Barnstable Building Division 200 Main Street Hyannis, Massachusetts 02601 Re: Fernbrook Inn 481 Main Street Centerville, MA 02632 Dear Mr. Roma: I represent the State Legislative Leaders Foundation, Inc. ("SLLF"). I am writing to follow up on two issues that arose in our meeting with you last week concerning SLLF's purchase of the property known as the Fernbrook Inn located at 481 Main Street, Centerville, Massachusetts ("Fernbrook"). SLLF, a non-profit educational organization for state legislators and legislative bodies around the globe, currently has eight (8) employees. The organization plans to expand to ten (10) employees in the next 1-2 years. SLLF intends to use Fernbrook as its office headquarters. We have submitted a Site Plan for review anticipating that there will eventually be ten (10) employees at the property. The Zoning Ordinance requires that we provide 18 parking spaces and the Site Plan submitted shows 18 spaces. There are 13 existing spaces on the site and five (5) new spaces are shown as part of the circular driveway in the front of the building. Although the five (5) new spaces are shown on the Site Plan, we are requesting that we not be required to build these spaces unless a parking problem develops in the future. October 18, 2016 Page 2 Although SLLF currently has eight (8) employees and plans to expand to ten (10) employees in the next few years, it is rare that all eight employees are in the office at the same time. Often times less than half of the employee workforce is in the office at the same time. Given the "specialized"type of use by SLLF combined with the fact that the property is a historic site with grounds designed by Frederick Law Olmstead, my client would prefer not to have to construct the five new parking spaces unless the need arises. The second issue we discussed concerns handicapped accessibility to the property. Although we do not trigger any requirement to make the property handicap accessible, you strongly recommended we provide one handicap parking space; add a handicap ramp to allow access to the first floor of the building; and provide a handicap accessible bathroom on the first floor. Mr. Steve Lakis, President of SLLF, was in attendance at our meeting with you and expressed his agreement with your recommendations. Mr. Lakis agreed with you that this could present an issue with SLLF at some point in the future and he expressed his commitment to follow through on making the first floor accessible to all. Due to financial considerations, this is something that is not in the budget for immediate action but will be addressed in the near future. Thank you for having taken the time to meet with us to discuss SLLF's plans to acquire Fernbrook. If you have any other questions, please do not hesitate to contact us. Very truly yours, l ohn W. Kenney, Esq. Attorney for State Legislative Leaders Foundation, Inc. Cc: Stephen Lakis t 'fin - i yr Town of Barnstable - Regulatory Services BARNSTABLE wnnsrRalc•C*I(IGYIl_f•Ob!VR•IIY.A'nR Richard V. Scali,Director =639 wxsmxsMw.usrrnvcit.*a*e�rscwe * ■ARNSTnate, ==*=< MASS. Building Division Paul Roma Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us October 24, 2016 ' Mr. Stephen Lakis State Legislative Leaders Foundation c/o Mr. Matthew Eddy Baxter Nye Engineering & Surveying 78 North Street Hyannis, MA 02601 RE: Site Plan Review#030-16 State Legislative Leaders Foundation -(481 Main Sfreet,•Centerville,;;Map 208, Parcel 085-004 Proposal: No site construction modifications are proposed other than the addition of five parallel parking spaces. The intent is to document existing conditions, identify- existing use as an inn/bed&breakfast, and identify zoning criteria for proposed change in use to exempt educational office use. Dear Mr. Eddy: n Please be advised that at the formal site plan review meeting held October 20, 2016,the above proposal was approved subject to the following: •. Approval is based upon and site must be substantially in compliance with.the plan entitled "481 Main Street,.Centerville, MA", Scale 1" =20', dated September 29, 2016, 3 Sheets, prepared for Steven Lakis, State Legislative Leaders Foundation by Baxter Nye Engineering & Surveying, Hyannis, depicting existing conditions and the location of 5 additional parking spaces along the existing gravel drive to the West. • The installation of 5 additional parking spaces as depicted on the plan.will only become necessary if the provision of the 13 existing parking spaces are determined to be deficient for the office use. • Existing kitchen in the basement apartment in the main house will need to-be removed with a Building Permit and the basement space used as storage only. I t • Existing 1-bedroom cottage may be used for overnight guests associated with the office use. • Although not a requirement, applicant has indicated willingness to make property HC accessible as finances allow. • For occasional special events and annual meetings, guests will stay at local hotels and be bussed to and from this site as proposed. Subsequent to installation of the 5 additional parking spaces if required,upon completion a registered engineer or land surveyor shall submit a letter of certification,made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan(Zoning Section 240-105 (G). A copy of the approved site plan will be retained on file. Sincerely, Ellen M. Swiniarski . . Site Plan Review Coordinator CC. Paul Roma, Building Comfiii over. .i Attorney John Kenney 1 n or 0 I r• { r 1 t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map zim Parcel U S7'o6 9 'Application #Q01 f l 3 Health Division Date Issued 2 Conservation Division Application Flee / Planning Dept. Permit Fee D 1 ILJ�• 00 Date Definitive Plan Approved by Planning Board D Historic - OKH _ Preservation / Hyannis 1� Project Street Address '54 �e•.�,/ ;?�3� Village Owner 4L7 Aw Address_y1/ Telephone Permit Request g �7 xz4ns e- r,Vo w -30 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District 0. Flood Plain Groundwater Overlay e� 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: des ❑ 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 ❑ 0ommercial ❑Yes ❑ No If yes, site plan review# ' Current Use Proposed Use `; n - APPLICANT INFORMATION 3-1 (BUILDER OR HOMEOWNER) Name VX� -74Vw+AS � � dry �. Telephone Number 5::0- ZZ 52 / sue Address —y lf, �ac l�o° License # , MA 0d a Home Improvement Contractor# Email Worker's Compensation # Am/ W 7ill ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO fir✓ SIGNATURE DATE % �5� tw FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. *DDRESS VILLAGE OWNER s DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. o The Ctar2manywah*of Vassachuse#ts ffepartmmt of 1n&sftid Accidents 600 Washurgton,S`reet f Bestory,,MA 41-UI "Il rricrsmgoWdia Wortrers' CampensationInsarance A-ffidavit:Builders/Contractorsf£lectriciansMumbers Appliranit Iufarmation Please Print Legibly Name( sine Organization&divitlnao- i /�rr•� ov Adiire-ss_ �� 75 dX' 4,64P y City/State/Zip: one — f Are van an employer?Check the appropriate box: T of project (r 4. I erns. ctmfractor sad'I 3� ����� I. atn a employer with J ❑ 6- ❑Neu emsfruction. employees{full and/crpatt-#ime}* have hirea the sub-contracim 2._❑ I am a sole proprietor or partner- Listed on the attached sheet y- ❑Remodeling sInp.and hate no employees These sub-contractors have S-.❑Demolition woAing for me many capacity_ employees and have workers' 9_ ❑Building addition L`o workers' comp_insurance comp_incuvan rPLlRtred 5._❑ We are a corporation and its lf3_❑Electrical repairs ar additions 3_❑ I am a home ner doing all wail` ofEners hwaa-exercised their I I ❑Pnerqiairs g repairs or additim myself [No workers'ccmg- rat.of e mption per ivfGL I2_. insurance reqaired.]F c-1.52,§1(4),and we hwe no emp1ayees-[No ems' 13_0 Other comp_insurance regarred.l *_Aay anpUcmt that checks boa xl burst also f M out the section below showing iheir woakeie compensation policy au&tmato� i Homeowners Who submit this afhdsvif ir,,ffcstmng they are domg off Zrcnic and then Lire omtn&contractors mast szabcaa a sew affidarit mdieatm such_ tCoatmctnrs t L%t check this b=most sttached as additional sheet shawiag the name of the Wk-oohs and state vrbietlter ecnot tbose sties hxve Eaplayees- If the sfSrcont mct0n hsse employs,they mast provide their workers'comp.policy number. lam an empZgyer that ispmrid&W workers'compensa6o.n irm;raace far my emplayem Betaty is thepalicy and job site irzformatiatr_ Insurance Company Name: i'vl ty►+ vcc policy 4-or Self-ins-Lic-;--- W FxpirationDate. —a Job Site Address: ell /1�I4/ i^�l Citylstatel : ..,N 10A UY',3 Attach a copy of the workers'compensation policy declaratian page(shoving the policy number and esga-ation date). Failure to secure cm-erage as requinAuuder Section 25A of MGL c 152 can lead to the imposition ofcritninal penalties of a fine up to$1,500.Oa andlor one year impris t,as well as ciiai penalties in ihe form of a SWOP WORK{ORDER and a fine of up to V50.0+0 a.day against the violator- Be advised that a copy of this stew==may be forwarded to the office of Imiestigations of the DIA far insur-ance coverage verification_ dv IrEcr ebl c,erhfy under-tks pains and pennaaLffiess ofpedury thatthe ftrjotmtr#ran pratidcrd abvs�e is bps Anrf correct. Siffiattu e ("-1T `' Bate_ C//' Pita e = N�' 3a� A Official use on[y. Da not write in this area,to pia compLeted by cio} or town offiiLiaL City or Town: PermitUcense# Em ing Authority(drde one)-. 1.Board of Health 2.Building Department I CitylTown Clerk 4_EIectrical Inspector S.Plumbing Inspector .6.Other Contact Person: Phone#: 6 416 Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written_" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the Iegal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. Kowever the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also stales that"every state or IocaI licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for alay applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the petormance of public work until acceptable evidence of compliance,,,rith the insurance requirements of this chapter have been presented to the contracting authority." Applicants — Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addresses)and phone numbers)along with their certificates) of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(L LP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required_ Be advised that this affidavit may be submitted to the Depa anent of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the afd2vit- 'Ihe of idavit 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 obt il-?a azorkers' compensation policy,please call the Department at the number listed below. Sell insured companies sb.ould enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addidcn, an applicant that must submit multiplEperiniYlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write'rail locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number. n`h Commonwealth of Massachusetts Depaitment of Industdal Accidents Office Of InvI�Sf?ga€om 600 wa--,] �Gn.Street; Boston,MA 02111 Tel,A 617 727-4900 W 406 or I-9 -MASSAFE Fax 9 617-727- Revised 4-24-07 �4r9 y .mass gov/dia I • a * lAENSfABLE, • - 9$ ' ,�� Town of Barnstable .erED NIA'1 A 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: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) i Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doC Revised 061313 _Office of Consumer Affairs&Business Regulation -BIOME IMPROVEMENT CONTRACTOR Registration: 145954 Type: z. ,-Expiration: 3/15/2015 Private Corporatior DOYLE+THOMAS CONST INC - TROY THOMAS 499 NOTTINGHAM DR -— - c CENTERVILLE, MA 02632 Undersecretary I Massachusetts - Department of Public Safety Board of Building Regulations and Standards License: CSSL-099913 TROY A THOMW 499 NOTTINGHAM 1) CENTERV LLE MA;P� Expiration Commissioner 04/13/2016 istration valid for individul use only If found return to: �ja'A aeff License or reg c-,� cueall, d� iration,date. Business Regulation T"-Mo'� a ulatioa before the exp er Affairs and {fairs&Business R g Office of Consum Consumer A CONTRACTOR 10 park Plaza-Suite 5170 ffice of OVEM,ENT Type 1'' A 02116 ME IMPR 145954 Corporatio I, Boston,M registration Private s�xpiratton 512017 T INC +THOMAS CANS out signature `T r' id wi ---. Not of yr TROY �.. R 499 NOTTINGHAM D 2 Undersecretary 0263 , --- . CENTERVILLE,MA , v Ac® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDMIYY) 09/02/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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: Kristine Fernandez Mark Sylvia Insurance Agency,LLC PHONE N.,ExtIa 508 957-2125 FA Not:508 957-2781 404 Main Street Centerville,MA 02632 ADDRESS:kdstine@marksylviainsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INsuRERA:Farm Family Casualty Insurance INSURED INSURER B: _ D&T Construction,Inc. PO BOX 166 INSURER C Centerville,MA 02632-0168 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MID MMID LIMITS A COMMERCIAL GENERAL LIABILITY 2001XO485 7/2 1 0 4. 712112 15 X � EACH OCCURRENCE $ 1,000,000 CLAIMS MADE ❑X OCCUR PREMISES EaENTE occurrence $ 100,000 DAMAGE TOMED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 M'OTHER: LAGGREGATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JERCOT- ❑LOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABILITY - .. -" C BINED SINGLE LIMIT $ a accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Pera Aent $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 2001 W7501 7/25/2014 7/25/2015 PER OTI+ AND EMPLOYERS'LIABILITY YIN - STATUTE ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 N/A Y❑-OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE S 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) ' Carpentry CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE D&T Construction Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ' PO Box 168 ACCORDANCE WITHTHE POLICY PROVISIONS. Centerville,NIA 02632 i AUTHORIZED REPRESENTATIVE ' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r In the event that while stripping the roof we find rot that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract rice,the homeowner agrees to compensate the contractor for an repairs or restoration at the hour) P g p Y p Y rate of$75.00 for a carpenter and$45.00 for a carpenter's laborer, plus the cost of materials. -Roof to be stripped and cleaned of all old shingles and debris -Roof to be papered with weather watch leak barrier,Synthetic roof underlayment,and installed with Landmark architectural shingles using galvanized nails. (Storm nailed) -All new 8 "drip edge and pipe flanges to be installed -Cobra ridge vent to be installed on all ridges -A 5 yard dump trailer will be needed on site; and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start; and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the workmanship completed under this contract for a period of ten years from the date of completion. During the stated warranty period the contractor shall be responsible for the service of the repair or adjustment, but the contractor shall not be responsible for the normal maintenance, repair due to abuse, misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form,content,and notices contained in this contract are intended to comply with the applicable portions of the Mass. General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: Date: Homeowner Contractor ..sue. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map O Parcel 1s �y Application Health Division Date Issued C41Z� Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 1.1 hril 7 oll' Historic - OKH _ Preservation/ Hyannis Project Street Address f-11?1 /'X«,N <Vi&;� MA 6- 6 Village d'4L."14 Owner &A--,±, p-g- Address clY` /1104 150�L Telephone 15-a Permit Request ST 7f f' /� 3 Si/ d-0 S V -1476 e-1e AA10 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ,AProject Valuation 6-ao 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: !ems ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other o Basement Finished Area (sq.ft.) Basement Unfinished Area ( ) €� C-) Number of Baths: Full: existing " new Half: existing '-° new ;2 w c:) Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Ro m Cour a 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 r�,a Telephone Number JVU ZV lx 7f Address Ads Say- /a License # Home Improvement Contractor# Ze� Worker's Compensation # ,&!2 &-4?f4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � SIGNATURE DATE ®a �'Od12 5=. ' FOR OFFICIAL USE ONLY : APPLICATION# DATE ISSUED y MAP/PARCEL NO. ` ADDRESS VILLAGE S, i OWNER DATE OF INSPECTION: FOUNDATION FRAME t INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL F GAS: ROUGH FINAL FINAL BUILDING 't DATE CLOSED OUT -- l�l:�ar .... w .L.. . .1�tr ASSOCIATION PLAN NO.- The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Bu der s/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: P& zoo City/State/Zip: 00632 Phone#: 6 A,rree,yo an employer?Check the appropriate box: Type of project(required): 1.L l am a employer with_�_ 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees - These sub-contractors have g, (]Demolition working for me in any capacity. employees and have workers' [No workers'comp:insurance comp.insurance.: 9. []Building addition, required.] 5. F1 We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.�oof repairs insurance required.]t a. 152,§1(4),and we have no 13.�Other employees.[No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number, I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 11 6.1 Insurance Company Name: ti,�.. ►L „K ` � // �_�;NS. �t Policy#or Self-ins.Lic.#: �(nJa 3�� Expiration Date: Job Site Address: f�l /Ylc»v V"W1 City/State/Zip: d�it,ut Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: i Date' /o `e99-�rJl� Phone#:' 5V Official use only. Do not write in this area,to be completed by city or town official , City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: AC40 CERTIFICATE OF LIABILITY INSURANCE °ATE /20"YYY' 08/1414/ 12 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 Mark Sylvia Insurance Agency,LLC PHONE Donna Ostrowski FAX 404 Main Street c t 508 957-2125 A/c Not: E-MAIL ADDRESS: Centerville,MA 02632 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Farm Family Casualty Insurance INSURED INSURER B Doyle& Thomas Construction, Inc. INSURERC: PO Box 168 Centerville,MA 02632-0168 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/VYYY MM/DD/YYYV A GENERAL LIABILITY 20OIX0485 7/21/2012 7/21/2013 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 50,000 CLAIMS-MADE 1X] OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION 2001 W639O 7/1/2012 7/1/2013 WC STATU- X OTH- AND EMPLOYERS'LIABILITYTO ANY PROPRIETOR/PARTNER/EXECUTIVE Y I N N/A E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101;Additional Remarks Schedule,If more space Is required) Carpentry t CERTIFICATE HOLDER CANCELLATION (508)420-7989 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Doyle&Thomas Construction Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 168 ACCORDANCE WITH THE POLICY PROVISIONS. Centerville,MA 02632 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD �-� Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME,IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration::,-%)4:5954 Type: Office of Consumer.Affairs and Business Regulation 1 10 Park Plaza-Suite 5170 Expiration 3%15/2013 Private Corporation Boston MA 02116 DOYLE+THOMAS CONS�I ING off: TROY THOMAS 499 NOTTINGHAM bR � � �� _ .►/r �' CENTERVILLE, MA 02633 Undersecretary Not v id w' out signature A�t Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction.Super isor Specialty 1' License: CSSL-099913NNrM ,�,�\;.'1 TROY A TH0.1 6s' 499 NOTTINdHAM#DRIV.E CENTERVILLE MA�02632 Expiration Commissioner 04/13/2014 In the event that while stripping the roof we find rat that needs to be replaced,the homeowner then has to agree and authorize any replacement or restoration. Then in addition to the above contract price,the homeowner agrees to compensate the contractor for any repairs or restoration at the hourly rate of$45.00 for a carpenter and$30.00 for a carpenters laborer,plus the cost of materials. -Roof to be stripped and cleaned of all old shingles and debris, watch leak barrier and synthetic roof underlayment, installed - with wea ther y f to be papered w t Roo p p with Certainteed architectural shingles using galvanized nails. (Storm nailed) -Ail new 8 inch drip edge and pipe flanges to be installed -Cobra ridge vent to be installed on all ridges -5 yard dump trailer will be needed on site;and will be removed at completion of the job -Contractor will be responsible for all building permits needed at the property NOTICE REQUIRED BY LAW With the agreement of the contract$500.00 of estimate is due. Further payments under this contract are as follows: 1/2 of the estimate due at the start;and remainder due at completion of the job. Balance of all materials and labor shall be payable in full upon completion of work described in this contract. Payment as agreed upon shall be made when due. Any payments which are delayed shall be subject to a finance charge of 1.5%per month. The contractor warranties the work completed under this contract for a period of one year from the date of completion. During the stated warranty period the contractor shall be responsible for the service of. the repair or adjustment, but.the contractor shall not be responsible for the normal maintenance, repair due to abuse,misuse,and or normal wear and tear,which shall be the responsibility of the homeowner. All warranties for the materials supplied by the contractor shall be passed directly to the homeowner. The homeowner may be required to register or mail in such warranty card or evidence of ownership in order to activate such warranties. Homeowner failure shall not create any responsibility for the contractor under the warranty provisions;the choice of repair of replacement shall be at the discretion of the contractor. The homeowner acknowledges that the form, content,and notices contained in this contract are intended to comply with the applicable portions of the Mass.General Law Chapter 142A, and regulations promulgated there under. In the event of any instance of non-compliance,only such portion shall be invalid and the remainder of this contract shall be in full force effect. In addition,any such portion not in compliance shall be read and interpreted so as to have its intended meaning to the maximum extent allowed under such law and regulation. Signed as a sealed instrument on this date: - Date: Q �� L/ Homeowner/ Contractor a ¢ i� I - tooQ ( q �C3 rjw rosy TOV4'n Of Ba rns' table Permit# Lrpires 6 moirlhs rot 1ssue rlate egul�tory ServicesFee * $ARVsrxBLE, + .Q #ASS. D 1619- Thomas F. Geiler, Director Building Division Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.,town.barnst6ble.tria.us Office: 508-862-4038 F.ax, 508 790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valirl tv1lhorul Red X-Press Lnpril Map/parcel NumberJ�j Property Add Tess 7 q ) [ ' esidential Value of Work C�C(. f minifnum fee of S35.00 for work under S6000.00 T�--r I Owner's Name & Address IVN Contractor's Narne Dr)02�! Telephone Number <� Home Improvement Contractor License #(if applicable) J L'776 10 Construction Supervisor's License#(if applicable)_ $7 , '- PERMIT,' ❑Workman's Compensation Insurance ���f ; Check one: ❑ I am a sole proprietor TOWN OF BARNS` ABLE ❑ I am the Homeowner ' tQ I have Worker's Compensation Insurance Insurance Company Name �, 1 a ty\ Workman's Comp. Policy (� S s. Copy of Insurance Compliance Certificate must accomp,ny each permit, Permit Request (check box) ' Re-roof(hurricane nailed) (stripping'old shingles) All construction debris will be taken to ❑ Re-roof(hurricane nailed) (not stripping. Going over existing layers of rood ❑ Re-side _ [Replacement Windows/doors/sliders. U-Valu #of doors e ✓� (maximum .35) #of windows *Where required: Issuance of this permit does not exempt con Pliance with other town department regulations, i.e. Historic,Conservation,etc. LIGNATURE, ote: Property Owner must sign Property Owner Letter of Permission, A copy of the Home Improvement Contractors License & Construction Supervisors License is required. : Y The.C•aninioirweallh oflfassachuselis -- —--- Department of/industrial_Accidews fi Ogice of Investic,,alions _ 600 Washi.n lon Streel Boslotr M—1 02111 ivn w.mass.gow'dia 'Workers' Campeusation lusut-anc.e Affi.&nit: Builders/Con.tr-.-ictol-&/Electriciaus/Pl:iunbers .Applicant Information Please Print LegibIN Name. (Busine&V}Orgmizntion,Zndividnal) sT"0 tv— Acl:dress: 1 eL 1 City/State/,Zip: GPhone 4: Are you mi etnp.loy'er? Check the appropriate boa.: T}-pe of project(t equiled): 1..LJ 1 am a employ&with 4. ❑ 1 aut a geu•eml contractor and I employees(full and/orpart-tuue).� have h' 'the s-ab-contractors 6_ ❑.New c'onstnictton 2.,❑ I am a sole proprietor orpa:rtner- listed on the attached sheet_ L12. ❑.Remodeling shipand have no employees.ees. These sub-contractors have P 5 ❑.Deuw.lition working :for me in any capacity. employees and have uiorket•s' .Builds addition [No workers' camp.isis:irance comp-insurance..1 ❑ . 'e tire.a cos. oratiou.andits ❑Electrica airs o> additions required.] ❑ P 3.❑ .I am a.home ovmer doing.all work officers have exercised their ]Plunhbing repa'-s or additions myself. [No worken`comp, right of exemption per itiIGL Raofrep9irs insurancerequred.]i c-, 152, §1{4), and.'we have noemployees.[No workers' Other comp.:insurance.req:trir-&d.] 'Any appticavt thstchecks box#1 mast also fill out the section below sbawing their workers'compenssti.an policy inforvratiaci t Hameowners who submit this affidavit indicating they are doing all work and then hire outside.contractors must submit.a new affidavit indicating such- =Caniractnrs that check this box must attached sn sd&don21:she.et showing the n=*of the sub-eontrsctgrs sti.d state trheth.er or not chose entitaes haute - enTployeu. fft ie sub contractors:hsve employees,ihey.must provide their workers'comp.policy number. I am an employer that is pro)ti. rig hisurartce for rrty,employews. Below is the policy and joh site irformatiom Z Insurance Company Naive: Policy#or Self-ins.Lc.#:-7 o J(� �o Exirntron Date: Job Site tl ddsess: y k CLI city/state/zip: Attach a copy of.the teal kern'cvtnpeatsrttiori ptiliry declaration page(stoning the policy namber and expiration date). Failure to secure coverage.as required under Section 2.5A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1.,500.00 and/or one-year uuprisariment,as well as ci-tril penalties in the form of a STOP'WDRP ORDER and a fine of up to.$250.00 a day against the violator. Be advised that a copy of this Statement may be forwarded to the Office.off . Investigations of the D.IA for insurance coverage verifica;tion., I do he".kv nertify under the paws andp811aLties ofpeduty'that the iz forrtiatfott protrided.abotre is tru.a.and correct. Siena re. Dote: Phone#: FOther e only. Do not write in this area,to be couipLcrted by city or town o�ciaL n: Permit/License# hm ty�(circle one): Health 2,Building Department 3,C`itg/fown Clerk 4, Electrical Inspector S.Plumbing Inspector son: Phone M 1 Y 4 L i G Try T + N Y + aARNSPAHLE, • . Ass. Town of Barnstable prfD Mp.'�a Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis MA 02601 www.town.barnstable.mn.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and .Sign This Section If Using A Builder I as 0wner'of the subject property hereby authorize', . 4, to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signa ft e of Owner Date ary�n��e Print Name If property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. QAWPFILESIFORMSIbuilding permit formslEXPRESS.doc r� .. ��ot rotiy Town of Barnstable Regulatory Services ,g4ytsTnatE,1Ass. Thomas F. Geiler, Director• � $ b; ,�A�� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 5�8-8624038 Fax: 508-790-6230 ------------------__________—_ HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER" _ name home phone N work phone N CURRENT MAILNG ADDRESS: city/town state zip code The current exemption for"homeowners" was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OFHOMEOWNER 'Person(s) who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official, that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws, rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minitnum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowncr Approval of BuildingOFficial Note: Three-family dwellings containing 35,000 cubic_feet or larger will be required to comply with the State Building Code Section.127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2,15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannotproceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities ofa Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a Corm/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc n . - ,In THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) I A , m / � LI DATA o RTIFICATE OF LIABILITY INSURANCE DATE(NWDDIYYYY) q 86033 FAX 508-760-1667 12/23/2009 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION , ... W� } 91lrance Groins LLC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ion Ave t arrtlouth MW 02664 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. ynthia ]enks INSURERS AFFORDING COVERAGE NAIC# wsuRED YEN L. �IELLAR INSURER.4: Associated Industries Of h�/Assi ned disk ]99 i'ERCIYAL DRIVE INSURER S: W. SAR16TABLE, MIA 02668 INSURER C: ` - INSURER D: INSURER_: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUA�EN l TM TH RESPECT r S ECT i T 0 WHICH THIS MAYMAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN . SUBJECT TO ALL THE TERMS,EXC'EXCLUSIONS ANU ONDITIONS OrSUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR D TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE GENERAL UA8L POUCY EXPIRATION I_iMITB T' EACH OCCJRRENCE i COMVERC',Y GENERAL LA3IL'TY - `AMAGETORENT: C_XV..SMADE D OCCUR - _ _ MED GYP(Any one person] ; 'ERSONk.&AC`J'NJJRY 3 '— wENERAL 4GGP,EGATE fi GEiNL AGGREGATE LIM'?h°Pt'ESPER: 1 PL'.Y 'P.ODUC'S•COMPrOPAGG OL JEC _CC AUTOMOBILE LIABILITY A:N".4UT0 COMB'NEO 51N:•L E:IM'T ALL OWNEDAJT05 acrdeni) SCHEDULED AI_TOS BODILY INJURY ,Per person HIRED AUTOS _ NON-0 30DILY!NJURY 6 U{PIED AUTOSf p er m oeni; I 'ROPERTY DAMAGE Fer m0eni: PEXCESStUMBRELLA, rnRAGE LIABILITY . AUTO O,tl_Y•EA.4CC'DEPI` g AN°A'UT'O OTHER THA,'N. EA ACC b _ 4U?OON_Y: AGG � LIABILITY EACH OCCJRRENCE g OCCUR D CL.4TAS MAD_ AGGREGATE b DEDUCTIBLE 3 RE"ENTICN S E ElaPLO RS COMPENSATION AND Ak 702038501211 12/27/2009 12/27/201A !4 ;EN PROPAB'LIABIAR 0 INAL TO FOLLOW FRDMI A ANY PROPp MEI-zR ARTNER/EY•ECUTI\'E E,L EACH ACCfDEN Fr-, Ell0,000 OFFIGERRvtEh1BEREXG_tJDED? � CARRIER _ R yes,desmoeunm E.L DISEA.>E-EA EMPLOY ]fieSPECIAL PP.O\RS!ONSbekw _.L Dr- ASE.POLICY LIMI 5�e OTHER Steven Mlel l er xcluded for Workers covers e DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES!EXCLUSIONS ADDED BY ENDORSE9'ENT!SPECIAL PROVISIONS videece of Insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUWG INSURER WILL ENDEAVOR TO MAIL DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAKED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION CR LIABILITY I' OF ANY KIND UPON I+EINSURER,iTIR MI NTSOR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE zynthi a 7 JenksACORD ZS(2001l1)8) - - 7ACORD CORPORATION 1988 1, t Licensee Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 49879 Restriction 00 - - - Name Steven L Mellor City,State,Zip W Barnstable,MA,02668 Expiration Date 5/22/2012 Status Current No complaints found for this Licensee. - - - - - - - Back To Search , x , http://db.state:ma'.us/dps/licdeiails.asp?tktSearchLN=CSL49879 11/15/2"010 ✓ne coanv�c��.rea�c�z o�✓aUzwa���uaeaa License or registration valid for individul use only Office of Consumer Affairs&B siness Regulation g Y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: R ; Registration: ,s117610 Type: Office of Consumer Affairs and Business Regulation Expiration 10/25/2012 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 ST EN L. MELLOR STEVEN MELLOR ` 199 PERCIVAL DR 4 �� �• W BARNSTABLE, MA 02668 _ Undersecretary Not valid without signature Massachusetts-Department of Public Safet y 11LIMarl Board of BuildimriW C g, Re�T ulation;s and Standards j onstruction Supervisor License License: Cs 49879 Restricted.to: 00 STEVEN L MELLOR 199 PERCIVAL DR ` W BARNSTABLE,-'_MA 02668 Expiration:-5/22/2010 ('unmiissiuncr Tr#: 26789 TOWN OF,BARNSTABLE BUILDING PERMIT APPLICATION. "Applicat Map- Parcel ion # Health Division Date Issued Conservation Divisio n App)itatioh Fee 0 Planning Dept '','Permit Fee! G11 (i) Date Definitive;Plan Approved by Planning Board Historic =OKH Preservation Hyannis Project Street Address Village Owner 4kr OcT\In-L rY Address Telephone 0 a Ll Permit Request a.A IPA A e- Square feet: 1 st floor: existing proposed '2nd floor: existing proposed new, rT1 Zoning District: Flood Plain Groundwater Overlay Project Valuation A-0 060.0conistruction Type T;1 Lot Size Grandfathered: J Yes LJ No If yes, attach su rting dFeumentation. Dwelling Type: Single Family - K Two Family Ll Multi-Family (# units) Ln Age of Existing Structure Historic House: L3 Yes U No On Old King's Hig way: L'JYes LJ No Basement Type: IN LJ Crawl LI Walkout LI Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing h new 0 Half: existing new b Number of Bedrooms: existing (I new Total Room Count (not including baths): existing new First Floor Room Count p Heat Type and Fuel: k-Gas VOil LJ Electric LJ Other Central Air: LI Yes Ll No Fireplaces: Existing New Existing wood/coal stove: UYes L] No Detached garage: Q existing Unew size—Pool: L3 existing Unew size Barn: LJexisting Llnew size Attached garage: L3 existing Unew size —Shed: LJ existing Unew size Other: Zoning Board of Appeals Authorization U Appeal # Recorded LJ Commercial LJ Yes Q No If yes, site plan review# Current Use V)-eA a 1 f0f-A Proposed Use APPLICANT-INFORMATION- (BUILDER OR HOMEOWNER) Name S4 J- -v-N 0-le NC Telephone Number �O Address Ee-,r Cam) License# Home Improvement Contractor# r Oo Worker's Compensation #0,W C,7 07�1;4 b ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO XA DATE SIGNATURE "Al--CA�, FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED S . t MAP/PARCEL N0. ADDRESS _ _ VILLAGE - OWNER DATE OF INSPECTION: FOUNDATION ' s ' FRAME I INSULATION f, FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL -' GAS: ROUGH FINAL` FINAL BUILDING DATE CLOSED OUT - ASSOCIATION PLAN NO,. F i • 1/3J/�QQ9 9; 26: 1.6 AM PAVE L/003 t'a.X ;Dt.z•vbl' i:I � rax Server .. '� — -- -- INSURANCE DAME{M1N1:,0lYYY`,'a a CERTIFICATE OF LIABILITY INS 01/30/2009 PRODvcaR - 9 -6fl33 AX 0 - - JALTER S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eester0 1ftl19P�nCe td'OYO LLC LY AND , NFERS NO RIGHTS UPON THE CERTIFICATE LDER T3il3 CEIBT}FICATix DOES NOT AMEND,EXTEND OR S19 St�t7Ofi Ave TA_COVERAGE APFCRD>FD gY THE POLICIES 8€LOY►'. SO Yeft►�uth A!4 02664 RERS AFFORDING COVERAGE NAIC 6 Cynthia Jenks nsuaaR a. gssociat us-tries o ffR/Ass lfisk INURED WON- 199 PEACY•V/LL DRIVE :vum c: € . lw1A0TABLE. Jill 0366X !vsuafia IV9URER� tVSUR?:P goviams THE TrE POLICIES OF INSURANCe UST BELOVY HAVE SEEN!SS LED OTHER QOC'JMENT WITO RESysC�RO N^IICH THIS CER DF CATS MAY BE ISSUED AR DING ,qr{v REQUIREMENT,TERNI OR CON DiTiON OF ANY iTRA: kAh,Y PERTAIN.THE INSURANCE AFFORDED BY'rNE POLICIES DCSCRISED HEP.EIN IS SUSJSCTT0 ALL T4ETERMS,EXCLUSIONS AND^.ONOI"fONS Ca:SJ.N. FOUCIES.AGGREGATE LIMITS SHO'vYN MAY HAVE SEEN RECIUCEp BY FAIJ CLAUUS. . UCFEC OUCYEXPIRA-10-4 L!WrS MwGENERAL TYPE OF INSURANCE F:: ,POLi V NIUMN I F T :,1G►.CCCJRW21vCE S L!Ad'LTY 'z COMMERCIAL G@NVAL LIB.Tv 'v t, ti18O 6.ti'I�rr one��r�n. I b C. •�E" .G6 CCC.iR G::�•;4rr.REGATE:Irt'T APPL'E2 FER �• AU-OMOBILI LIABILITY 1:8a a• znt, AV`AUTO ALL VMV .JT03 w NrJR" } p✓,'�Scn CC++EO.LEC W1RW AUK I I,Fer ewden! P�1CCC!M,7 GARAGE LIA 1LITY I_AGE C'GJaoE"aGE 5 6lC&s5tum5RELLA LIASILIT'I i--� I A31R4Ga'2 OCCUR I IG:A'M3mA,'e ! ; l�J I i i Do`CUCT!£LE I i• VCRRERS=W-l*sATIONAND _: EACr!Aocl�en- a 100.00 EMPLOYM'UA3tLiT1' tax, L TO �J.(W A a"i �RCpRiE'CRi=AQTNEwfiY.EGL�ti'E � 3 L OFS'anSfi•rs;EN,fl'.0'.$P i mod, OFPI:ERIn!EMB'sRE`G, sL'% cR1Ua+ I. os Q8''a:.�1.• umcw 6L l.Ki:.S_•PC' 0S3Tiyi�lAdi PP,C:"SIUNSbe'ai 5mven xcTuded for W*?* ►rS DESCRIPTION OF OPERATONO 1 LOCAT CNb i VIM CLES 1 SXCLUSIONS ADDeD SY ENDCRSENIE4T bPLCiAt PRC�°1S`ON' C RTIFhOLDER N SrsOJLD A.4Y CP THEASOVE DESCN+BED POLICIES SE CARCeLLBD BEFORE THE EXPIRATION DATE TkEREOP.THE iS3U1NG mijRER'NiLb.ENDEAVOR TO MAIL i. 1Q DAYS WAirrlN NOTCE TO THJ CERTIFICATE MOLDER NAME:TO THE LEFT. TWI Of 6afWStabTe eLR PA!LLPA TO MAIL SUCH kOTI:E SMALL IMPOSE NOOSUI10;04 OR LIABILITY hf7Td7np Dot OF ANY KIND WON--INSURER.T5AGENTSORR5PRESENTATfVE6• 2W Mail! Stmet ALIT4iOR12E0 ASPRESE WIVE Lwansis, m 0?601 nthia .J Jenks ACORD 25 g200'IM) FAX: (SOS)M-6230 t3ACORG CORPORATION 1888 IRE r :Town of Barnstable Regulatory Services atxxsxes[e MAS& $, Thomas F. Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main.Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder , - j I, , as Owner of the subject property hereby authorize Ato act on my behalf, j in all matters relative to work authorized by this building permit application for (Ad ss of Job) 8ijnatrue of Owr Dante AA R rVw Cryc CASH Pant Name If 'roDerty Owner is applying for pen-nit ple4se complete.the Homeowners License Exemption Form on the reverse side. Q:FORMS:O WNERPERMISSION Town of-Barnstable OF THE A Regulatory Services t awttivsrwste = Thomas F. Geiler,Director q 03 Building Division Tom Perry,Building Commissioner 200 Maui Street, Hyannis,MA.02601 _. RWv.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner act supervisor. DEF)NMON OF.130MEONVNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intemged to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1). The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,#'rules and regulations. The undersigned"homeowner"certifies that_he/she understands the,Town of Barnstable Building Department,. minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner ` Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided'that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor.,. Many homeowners who use this excmption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with.licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a,form currently used by several towns. You may care t amend and adopt such a form/certification for use in your cornmunity. Q:forms:homeexempt B9461 e lefiftWW�1'z k4 (. WtfA License or registration valid for individul use only I HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 117610 Board of Building Regulations and Standards I One Ashburton Place Rm 1301 i Expiration: 10/25/2010 Tr# 275430 ! Boston,Ma.02108 Type: Individual , STEVEN L.MELWIIJE / STEVEN MELLOR 'z 199 PERCIVAL DR W BARNSTABLE, MA 026fi8a Administrator Not valid without signature j Dchartmcnt Building R Of Public S.►ret , Board of• Construction Supervisor License ds License: CS 49879 Restricted to 00 '•r P_. STEVEN L MELLOR_ ? "" ,199 PERCIVgL W BARNSTAOLE,,,- 02668 L p (' Expiration: unnnissi uncr` 5/22(2010 Tr#: 26789 The Commonwealth.of Massachusetts .Department of Industrial Accidents Office of Investigations ' d 600-Washington Street Boston, MA 02111 . www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): V t -, >� 1 1 , Address: City/State/Zip: one.#: 7 9 1 Are you an employer? Check the appropriate box: Type of project(required): 1.® I am a employer with 4. ❑ I am a general contractor and I . employees (full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner listed on the attached sheet. T. ®'Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' $ 9.` ❑Building addition [No workers' comp. insurance comp.insurance. 10. Electrical repairs or additions . required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their l l.❑Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL. 12.[]Roof repairs . insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp.insurance required.] "Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / Insurance Company Name: , Policy#or Self-ins. Lic.#:h w c. (� k (� �.0 p Expiration Date: Job Site Address: � S5 I 1 ' , City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do,hereby ify under the pains and penalties of perjury that the infa?*atiomprovided above.is true and correct: Si nature: Date: Phone#: - 1-1D I� Official use only. Do not write in this area,to be completed by city or town offWaL .City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#': Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their.employees. Pursuant to this statute,an employee is defined as"..,.every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association.or other legal entity,employing employees.' However the owner of a dwelling house having not more than three apartments and who-resides.therein,or the occupant of the g dwellin house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance v�zth the insurance requirements of this chapter have-been presented to the contracting authority." Applicants Please fill out:the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required: Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a-workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete"and printed legibly. The Department has provided a space at the bottom of the affidavit for you to.fill out in the event the Office of Investigations has to contact you,regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant,should write"all locations in__(city„or town),"-A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business,or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street &oston,MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-774 Revised 11-22-06 Wwwpass.gov/dia i I i `� • � = I _ - M7 • -° i. a`�` 1 /30/2009 11 : 49 : 16 AM 8868 ® 02/02 :.. f.l'l. gNffiiy:,,:2''�i°:"isi��:'.n ISSUE DATE 01/30/2009 3 � r .3 "3�iv'9;> hs�� sv� PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Eastern Insurance Group LLC CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE 33 West Central Street DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE. POLICIES BELOW. Natick,MA 01760 COMPANIES AFFORDING COVERAGE INSURED Steven L Mellor 199 Percival Drive COMPANY A A.I.M.Mutual Insurance Co West Barnstable,MA 02668 LETTER s.y: f.({ --. r.3.IN Rio $1dn„3. .,3 ,.n: l'�., ✓:�.5. 'dr.,, h.'f, .Y .Sr:.J ,s.. .1< ,.�.+. h r t, .. ,:..,., .. :,v,' �'`'s+,i:'✓,... J,t:». .,.vs. s ...4.3:R`3tik.,.,s:. ✓e*�',�,. THIS IS TO CERTNY THAT HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD*ICAMD,NOTW THSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH;THIS-,(,�ZRTIFICA j�AAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL T? TERMS,EXCL1jWNS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO .(n POLICYEFFECTIVE POLICY EXPIRATION LTR APE OFM RANGE '� POLICY NUMBER DATE(M MlDDlYY) DATE(MMIDD/YY) LIMITS GENERAeLIABILI4'sK GENERALAGGREGATE $ __... PRODUCTS-COMP/OPAGG. CO,FRCIA�SE,NERAL LIAB LITY PERSONAL&ADV.INJURY CLAIM"ADE=O•CUR EACH OCCURRENCE OWNER'S&CONTRACTOR'S PROT. FIRE DAMAGE(Anyone tire) MED.EXPENSE(Anyone person) AUTOMOBILE LIABILITY COMBINED SINGLE S LIMIT MANYAUTO ALL OWNED AUTOS BODILY INJURY (Per person) SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS BODILYINIURY S GARAGE LIABILITY (Per azcident) PROPERTY DAMAGE EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE S OTHERTHAN UMBRELLA FORM WORKERS COMPENSATION AND STAT LIMITS STATE OTHER EMPLOYERS LIABILITY x MA HE PROPRIETOR/ ELEACHACCIDENT $ 100,000 A PARNERS\EXECUTIVE FFICIERS ARE: 7020385012008 12/27/2008 12/27/2009 INCL ®EXCL EL DISEASE-•POLICY LIMIT g 500,000 EL DISEASE--EACH 100,000 EMPLOYEE COMMENTS/DESCRIPTION OF OPERATIONS OR LOCATIONS: STEVEN L MELLOR IS NOT COVERED BY THE WORKERS'COMPENSATION POLICY. :i .r v.t4r 3{ d �s,a%'.sii:i%{s4ti".`3'i%'ai7:'.:?y, •`F�f.,.c�'�gs'i ,>�''✓a:.. .,y«Iy...d.5 u'. ,s,r5,. `'�J`?As+4`s%C'i'�r'.i:'--„ eta f✓i'l ufd`...., .,t,:s..,t,::t,.s.xr..:x-ss,..: ;s..f..,. ..�t"i k,axl .d..n"FSE.3n.3:.3:.�5.:3 .}..,, a.$.., .-$r' SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 15 WRITTEN NOTICE TO THE CERTIFICATE OLDER NAMED TO THE LEFT,BUT FAILURE TO MAIi,SUCH NOTICE SHALL IMPOSE NO OBLIGATION TOWN OF BARNSTABLE OR LIABILITY OF ANY RIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. TTN: BUILDING DEPT. 00 MAIN STREET YANNIS,MA 02601 UTHORIZEDREPRESENTATIVE 5161 - i My File'. Edit 'Tools r Help, t Pik . t� Status Coromerh ' PrerE uisne �De't ` deeded b roved VW; Status'- 01 02/02/2W9 APPR INTERIGR ONLY! HIST BARNS 4201 02./02r2003 APPR INTERIOR ONLY! 7 -Auk dity History #� HEALTH 65N 02/02,2W9 02,/U/2009 MM1CK APPR 7bed B&B I TAX 6300 i VJORK COMP 6300 Prerequisite , CONS CONSERVATION DEPARTMENT r;T Needed F_ T ICI- i - _ _ rt qV �J I Action type APPROb`AL j:�� Inspector �"""'`� z t Responsible dept. 6701 COt ISER WATION .• ;� I Inspection type reference fa � Status APPR APPROVED � _ �;T � _ _ _ w .. �.. Applicant resp F . date` Approved 2+ � ' forcflov approved code INTERIOR ONLY 1 T i 1 � ►1yj` • 1 of S �. C1UR , y Tv Fax Server 9; 26; 26 AM PAGE,. J)P,r V0-r, rDAYE(I�gRtiDU+YYY:') M CERTIFICATE C� LiA�ILiTY INSURAN�CEDASAMATTEROFINFORMATION PRoauclsR - � - AX 0 - -j THIS CERTIFICATE S Eestt"°n TnitNlfCt G!t+dtD LLC ONLY AND CC NFERS NO RlGNTS UPON THE CERTIFICATE HOLDER.THlS CERTIFICATE DOfiS NOT AME�iD,EXTEND OR 539 StgtlaA Avle . .. ALTER THE COVERAGE AFFORDED BY THETHE POLIGlES BELOYV. 5o YitlAat�ti" N4 02664 INSURERS AFFORDING COVERAGE i NBC F Cyntbis Jenks !.suaeR> ASsariat I str is a , /Ass Risk W3URED 199 VAL DAM W. TADLIE, 44 0166i IvauReR 6. IV3URER� iVSUR£P.8. %19!95 I THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN=5SUE0 TO THE IHSUFtEO NAMEO ABOVE FOR THE POLICY OsRIOD INDICATED.11OTNTHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CvOItiTRACT OR OTHER DOCUMENT WITH RESPECT TO W.-I1CH THIS CERT FiCAT MAY BE 155UED OR 4S4Y PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DF.SCRIBED HEROIN IS SUBJSCT'rO ALL THETEP.MS,EXCLUSIONS pND CON01'1ONS C�S :H Pt UL .IES.43REGATE LIMITS SHOWN MAY HAVE SEEN REDUCEO By Pa-t:)CLAUVS. f TR POLICVNUMBER UCY FFECT! POLICY ELPI Y04 l-ws TYPE OF lNsje KC� M.MmmoM zA6'�OCCJ:Rfit,GE GENlRAL.UA$LTY le CaM`1w't0Y•i.;:G4BR.4 U4%'71 + �•e` Anna 6.<. Ark Ona�arsu+; ;_•_ ' 3�'vEati.gciGR�6:.'e E =RODUC" •CV.'.PW C.GC F G-y'.aGGREGA's:j%V-r APPLEe Pm Crtw ^ Pti?:v �ecr oc AuxMOEr euAelLrY !-ctVNa - { 1:fia ac: k. I AV•nUTO AL,L O`NVE^. J703 SCHEDUL=n AL703 :Irfic.AU^41 i or 3 a den,. R e Tay ! !:a�o, r_e J .Pw rx�:nY; e b 3 �B'VT "RACE-IAE+IUTY E YR�NA, AT.....c, i EX.ESStUMBRELtA UASILITY OJCUR pC:AhISUA�: } RE'E%V0t: 3 2 T I;; ,. vcRon;owm TIUNANO 0 365 1 EMPLoYeRE'UA31UTY QNAL TO FOLLOW EAcr�AcaZEN- a - -lot A AN+PROPRIE'^Rr'??TWERIfiY.ECUTVc G4RR�E 1L D13fiASE•8A fiNa.pr,4 i 1+40 f aFr,CER+:EMB s0O t`;es,oesa'be a^aer IL Ct£4SE.Po:' `.!t' 4 °sm"n N977or xc lads/ for Wor*otv _ DES vRIPT10N!Me e LLOCAT'ONS r VE CCLES I FJ 06 WONS ADD°D Sy ENDCIR91!MB4T?SPEC!AL PRO'!'*ON3 F vidtnct Of Znsufanct t T F R' ` . CANMLLAIION SrIOJLD A,VT OP THE ASOVE DEISCA;eED rALICIt:S 6E CAA.ELLED BEPORe THE Expiu IDN DATE THEREOF.'HE i9SULNG rNBi,,rmk U.ENCEAVOR TO MAIL �Q DAYS W i TT`sk NOT CB TO THi C6RT!FtCAT6 HOLDER NA�6E.TC114e LEFT. TOM Of Barnstable SLIT PA!LUMTo MAP-SUCH NOTICE SHALL IMR S_No 0SUGATIO4 OR L141UTY b!Vim Dot OF ANY KIND LF'ON TFEINWR@R. TS AGENTS OR REPRReSENTATIVSS. 2w !Milt" str"t AU'HOpInD REPRE9Fd1TAT1VE Nyan"rls, MA 02601 ntAfa .7 ltnhs ACORD 26{2001=) FAX: (SOS)M-6130 �ACORD CORPORATION 1988 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION V Map 0 Parcel 0 �� „ (} Application# d0616 I yOLt Health Division `s Conservation Division Permit# Tax Collector Date Issued / Treasurer V Application Fee ,6 Jyl a3,U7 1 Planning Dept. \ .; Permit Fee # �9! . 60 Date Definitive PI a Ap rove lanning Board J� Historic-OKH2 es ation/Hyannis Project Street/Address '( Village Owner Address 9 1 �1C-,tom, Telephone d 7 Permit Request `� r ,,-� C c , _ vim, Square feet: 1st floor:existing �a—tV proposed "' 2nd floor:existing proposed Total new Zoning District s� ject Flood Plain Groundwater Overlay Pro Valuations _� Construction Type Lot Size 9 C?0 �7 '�- Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family `fi7 Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes &Ao On Old King's Highway: ❑Yes Ift Basement Type: '!`Full IdTrawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 0 � Number of Baths: Full:existing (0 new Half:existing new Number of Bedrooms: existing_ new Total Room Count(not including baths):existing new —'s' First Floor Room Count Heat Type and Fuel: ❑Gas Id-Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing _ New Existing wood/coal stove: ❑Yes O=No r-� Detached garage:❑existing ❑new size Pool: existing El new size Barn:❑existing ❑newer size ,,?, W _> Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: 3� Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ PO CU F_ co r� Commercial ❑Yes ❑No If yes, site plan review# Current Use �-- Proposed Use ,, - 1 j BUILDER INFORMATION Name 1_, 1^ � Telephone Number 55,- Address �i �n�r�n,-e,�( �r License# R 1�'� u a f�sa a Home Improvement Contractor#—I 7610 Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO C— )ID Va ,/ SIGNATURE DATE i FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED MAP/PARCEL NO. r _ S ADDRESS VILLAGE OWNER ! - DATE OF INSPECTION: 1 FOUNDATION FRAME i . INSULATION 'd-7 FIREPLACE 'i ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL t GAS: ROUGH FINAL 1 FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ` =v i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 wM s� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Letzibly Name(Business/Organization/Individual): . Address•19.9 VD �r C U City/State/Zip: Phone.#: Are y u an employer?Check the appropriate box: 0 Type of project(required):. 4. I am a general contractor and I 1. I am a employer with 1 ❑ 6. ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling These sub-contractors have g, ❑Demolition ship and have no employees working for me in any capacity. employees and have workers' 9. Building addition ' [No workers' comp.insurance comp.insurance. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their �11.[1 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. r Insurance Company Name: Policy#or Self-ins.Lic.#: 7203 2 SO ),),0 6 C Expiration Date: 1 (� p�Job Site Address: 7"2S MU r City/State/Zip: c ft)Ci . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).• Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investikations of the DIA for insurance coverag2 verification. I do hereby cert' nder the pains and penalties of erjury that the information provided above is true nd correct. Si ature: g� Date: Phone# Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector. 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver-oLtrustce of an individual,-partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until-acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, - please do not hesitate to give us a call. The Department's address,telephone-and fax number: The:Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,ILIA 02111 Tel. # 617-727-4904 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax 4 617-727-7749 www.mass.gov/dia 1 V Yr JUL VA J.N"A JL1.0 L"A71 V pf ° Regulatory Services - t'arxxsra$ . *' Thomas F.Geller,Director NAss. $ 9�pr�6 Building Division Tom.Perry,Building Commissioner .200 Main Street, Hyannis,MA 02601 www.town..barnstable.ma.us flee: 508-862-4038 Fax: 508-190-6230 Permit no. Date AFFIDAVIT HOME ZIPROVEMENT CONTRACTOR LAW -SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, irnprovernent;removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units,or to structures which aze adjacent to \ such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ;� Type of Work: stimated Cost v Address of Work:4 9r—�--- S� � f Oyaner's Name: PC)CA ' Date of Application: '�3 ��__ I hereby certify that: Registration is not required for the following reason(s); OWork excluded by law M•Job Under$1,000 []Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OVER9 PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDERMGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply fora permit as the agent Ao er; Date Contractor Signature RegistrationNo. OR Date Owner's Signature Q;wpfles.farms:homeaffidxv Rev: 060606 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $50.00 ' Alterations/Renovations S 50.00 Building Permit Amendment $ 25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq,foot= x.0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS.OFEXISTING SPACE _ square feet x$64/.sq,foot= � x.0041= i plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq,ft.= x.0041= ACCESSORY STRUCTURE>120 sq.ft. ; >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 . >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building pernit: square feet x$96/sq.foot= x.0041= STAND ALONE PERMITS Open Porch x S30.00= (number) Deck x$30.00= (number) Fireplace/Chirfiney x$25.00=' (number) Inground Swimming Pool $60,00 Above Ground Swimming Pool $25,00. Relocation/Moving S150.00 (plus above if applicable) Permit Fee Projcost • Rev:063004 Table JS.ZIb(cautioned) Prescriptive Packages for One and Two-Family Residential Buildings Heated with Fassil Fuels MAXIMUM MINIMUM Glazing Glazing Ceiling Wall Floor Basement Slab Heating/Cooling Area' U-value= R-valuer R-values R-value° Wall Perimeter Equipment Wicieacy' Package R-value' R-valuer 5701 to 6500 Heating Degree Days' Q 12% 0.40 38 13 19 10 6 Normal R 12% 0.52 30 I9 19 10 6 Normal S 12% 0.50 38 13 19 10 6 85-AFUE T 15% 0.36 38 13 25 NIA NIA Normal U 15% 0.46 38 19 19 10 6 Normal V 15% 0.44 38 13 ZS NIA NIA 85 AFUE W 15% 0.52 30 19 19 10 6 85 AFUE X 18% 032 38 13 25 NIA NIA Normal Y 18% 0.42 38 19 25 NIA NIA Normal t 18% 0.42 38 13 19 10 6 90 AFUE AA 19% 0.50 1, 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: Mat 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 0D G 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q--AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a 780 CMR Appendix J Footnotes to Table ALM ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%.of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 il?of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling,R-values do not assume a raised or oversized truss construction:If the insulation-achieves--the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum.of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example,an R-19 requirement could be met EITHER by R 19 cavity insulation OR R-13 cavity insulation plus R 6 insulating sheathing. Wall requirements apply to wood-frame or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as.unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding. glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement de-scribed in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes elebtric resistance heating use compliance approach 3;4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see.Table J5.2.1a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35.Door U-values must be tested and documented by the manufacturer in accordance with the NFRC•test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling,wall, floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 ' f = Town•of Barnstable o Regulatory Services 9BAOSTA Thomas F.Geiler,Director XAM �p s6g9. ,Eo►�� Building Division Tom Perry, BuiIdiug Commissioner 200 Main Street, Hyannis,MA 02601 lice:. 508=862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Ownet of the subject property . 1. J? pay hereby authorize Z!��W to act on my behalf, M all mattets relative to work•authorized by this building permit application for: i i (Address of job) : S'� e of Owner Date X/ Print ame 0.F0RM5:0WNERPERMBSI0N fifi � 1 ot, 31+ Ad& - /5 I � i x € 5 4k J .+.� +ta•.. .. 4 - _c"' '� � ,J„y:,;w �4 L./� R�� ..✓J: yew � —....,... , , ' t n 4, I , t s . : �cz -71 JI Y 7, 44—-n- y 4 ,J¢r91 G , !.5' Tk&— a �✓ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR I I Nwmber (; 049879 B'O.h e957 i0222gD8 Tr. no: 25107 Rest¢e�fi r i �rL' i i STEVEN L MELLOR 199 PERCIVAL W BARNSTABLE, MA 0266$r C �� Commissioner ✓�ee -�jarnmzaruuea� o� �iuQel�4 Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR i Registrations--A 17610 gkoffi tl 0125/2008 Tr# 124413 I' Typ (ndwidual STEVEN L MELLO�2 ;� STEVEN MELLOR`` f j 199 PERCIVAL DR W BARNSTABLE,MA 02668 Administrator. 2.2/'23/2007 12: 24 5087601667 EASTERN INS YARMOUTH PAGE 01/01 •. DATE(MMMDIYYYY) APW CERTIFICATE OF LIABILITY INSURANCE _ 02/21/2007 PRODUCER 508-398-6033• FAX SU8-760-1667 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern Insurance Group LLC ONLY AND CONFERS NO BIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 1 Atlantic Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW So YarnLauth 14A 02664 NAIL 0 Cynthia Jenks INSURERS AFFORDING COVERAGE INSURES TEVEN Li MELLOR INSURFRA: Assaociated Industries of MA 199 PERCIVAL DRIVE INSURER B: W. BARNSTABLE, MA 02668 INSURERC: INs'UREFt D; INSURER E; OVE S THE POLICIES OF INSURANGE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NO-rWITHSTANOM 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 POLICES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR OD' TYPE OP INSURANCE POLICY NUMBER P C FFECTIVE POLICY EXPIR TI N UNITS EACH OCCURRENCE $ GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY DAMAGE., RENTED CLAIMS MADE OCCUPP, MFD FXP(Any one person) $ PCRSONAL A ADV INJURY Is GENERAL AGGREGATE Pawl AGGREGATE LIMIT APPLIES PER! PRODUCTS-COMPIOP AGO 9 PRO- t8CH8DULFD JEC7 LAC AUTILITY COMBINED SINGLE LIMIT 8 (Ea accldan$ �^ UTOS BODILY INJURY 5. (perpereon) UTOS FIIREbAUTQS BODII,YINJURCY $ (Per ac:IdeMj NON.CWNED AUTOS PROPERTY DAMAGE S (Per Aaalaant) GARAGE uABILIYY AUTO ONLY•EA ACCIDENT It ANY AUTO OTHER THAN EAACC $ AUTO ONLY: ACG R CXCESSNMBRFU.A LIABILITY EACH OCCURRENCE $ CCCUR CLAIMS MADE AGGREGATE $ $ I DEDUCTIBLE g j RETENTION $ $ WORKERS CCIdPENSATiON AND AWC7020385012006 12/27/2006 12/27/2007 X sTATu• oTrl- EMPLOYERS'LIABILITY ORIGINAL TO FOLLOW FROM E.L.EACH ACCIDENT $ 100 '000 ANY PROPRICTOR/PARTNF.RIEXECUTIV7 DISEASE•Fit EMPLOYE S 1OO OOO OFFICERIMF.MBER EXCLUDED? CARRIED E.L.DI If+es.describe under E.L.DISEASE-POOCY LIMIT S 500 OO SPECUAI.PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES J EXCLUSIONS ADDED BYENDORSEMENT I SPECIAL PROVISIONS, Evidence of Insurance SHOULD ANY OF THE ABOVE OESCRISEO PO:LN ELLED BEFORE THE EXPIRATION DATE THEREOF,THE 133UINO INDEAVOR TO MAIL10 DAYS WRITTEN NOTICETO THE CERER NAMED TO THE LEFT,TOWn OP Barnstah�a BUT FAILURE TO MAIL SUCH NOTICE SHALL ILIGATION OR LIABILITY 200 Main Street 6F ANY KIND ON THE INSURER,ITS AGENNTATIVES. Hyannis, MA 02601 AUTHORIZED �TAT ACORD 25(2001108) FAX: (508)790-6230 / � QACORD CORPORATION 19M TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# 60�6 l y'CS Health Division Conservation Division Permit# Tax Collector Date Issued Treasurer Application Fee Planning Dept. Permit Fee &5T, Date Definitive Plan Approved by Planning Board otG 3>3�l°7 Historic-OKH Preservation/Hyannis Awl Project Street Address Village Owner /� (Rld�IZ Address Telephone Permit Request T c�l'►nbQ; MIN " 2WSS Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay .Project Valuation r Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family 2 Two Family Ll Multi-Family(#units) Age of Existing Structure la 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: )Q1 Gas 4 Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes. ❑No Detach e arage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garag ❑existing ❑new size Shed:❑existing ❑new size Other: x Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ T Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name ow Telephone Number � CL�2 �` 4 ,� Address Ov License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM T IS PROJECT WILL BE TAKEN TO. IGNATURE DATE � / ��'10 FOR OFFICIAL USE ONLY f PERMIT NO. �..% 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. i The Commonwealth of Massachusetts Department of Industrial Accidents = Office of Investigations. d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name(Business/Organization/Individual): . IUN kP Address. s - City/State/Zip:J �. Phone.#: Are you an employer?Check the appropriate box: Type of project(required):. 4. I am a general contractor and I L❑ I am a employer with 6. ❑New construction . employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. F Demolition workingfor me in an capacity. employees and have workers' y p tY 9. ❑Building addition [No workers' comp.insurance comp.insurance. $ required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.LEI I am a homeowner doing all work officers have exercised their l 1.[1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4), and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. Tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Invesdi?ations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties o.perjury that th 'nforma on provided above is true and correct. i afore: Date: S Phone rIssuing only. Do not write in this area, to be completed by city or town official wn: PermitUcense# thority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An empl i�r'is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the for going engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver•di-d stee of aan individualpaitnershin,association oz other legal entity,employing employees. However the t owner of a d`elluig,liouse having not more tlian,thiee apartments and wlio tesides therein,or the occupant of the dwelling housa of another who employs persons to do maintenancegonstiuction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deem_ea"to be an pinployer." MGL chapter 15Z, §25C(6)also states that`-'every state or local lice ns ing agency shall.vrithhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has\not produced:acceptable evidence of compliant a with the insurance coverage required." Additionally,MGL\chter er 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contr ,the performance of public work until-acceptable evidence of compliance with the insurance requirements of this have been presented to the contracting�thority." Applicants Please fill out the workers'c pensation affidavit completely,by hecking the boxes that apply to your situation and,if necessary,supply sub-contract (s)name(s),address(es)and phonp number(s) along with their certificate(s)of insurance. Limited Liability Co anies(LLC)or Limited Liabili Partnerships(LLP)with no employees other than the members or partners, are not requir d to carry workers'compens #ion insurance. If an LLC or LLP does have employees,a policy is required. Be a vited that this affidavit be submitted to the Department of Industrial Accidents for confirmation of insuranc coverage. Also be sur to sign and date the affidavit. The affidavit should be returned to the city or town that the ap 'cation for the permi .or license is being requested,not the Department of Industrial Accidents. Should you have any uestions regardin the law or if you are required to obtain a workers' compensation policy,please call the Deparb t at the numbe listed below. Self-insured companies should enter their self-insurance license number on the appropriat ' e. City or Town Officials Please be sure that the affidavit is complete'and printed ly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of vestigations has to contact you regarding the applicant. Please be sure to fill in the permit/license Lumber which used as a reference number. In addition, an applicant that must submit multiple permit/license applications in an give ear,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Addr ss"the a cant should write"all locations in (city or town)."A copy of the affidavit that has been officially sta ped or mark by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future ermits or licens A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not relat to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said perso is NOT required to c lete this affidavit. The Office of Investigations would like to thank you in ad ance for your coop and should you have any questions,-- please do not hesitate to give us a call. 'k w 1 The Department's`address;telephone-and fax number:' The Canim4v i of Massachusetts ' pvpartment of Finvestigations ustrial A.eeiaents office of ` 604 Washington' Street Boston1 MA 42111 Tel. #617-727-404 ex 406 or 1-877-MASSAFE Fax##61' -727-7749 Revised 11-22-06 vtww.mass.gov/dia Town of Barnstable Regulatory Services BARNSTABLE, : Thomas F.Geiler,Director y MASS. 039. ��� Building Division 4i'°rEn Mp`l° Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 ------------------------- HOMEOWNER LICENSE EXEMPTION I Please Print DATE: 3 .,/ 3 . O'� JOB LOCATION: number street � � village "HOMEOWNER': ,�J/ name home pTione# work phone# CURRENT MAILING ADDRESS: city/town state zip code, The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under theresponsible for all such work under the building (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. mature of Home r Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. , HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:forms:homeexempt �oFtTOwti Town of Barnstable c� Regulatory Services saxxsznBie Thomas F. Geiler,Director web 16 9. � Building Division ArED'A°�A Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 16, 2007 Barnstable First District Court Clerk Magistrate Robert E. Powers PO Box 427 Barnstable, Ma 02630 Re: Mary Ann Wurthrich/Fembrook Inn Docket No. 0725 AC 000841 Citation No. 70350 & 76026 Dear Magistrate: - After careful consideration of material recently submitted, and in recognition of the corrective measures since taken, I no longer find conditions at the Fembrook Inn property to be in violation of either Chapter 240 Section 11 of the Barnstable Zoning Code or the governing special permit 1980-060. As a result, I respectfully request that the aforementioned enforcement matter pending before you on April 12, 2007 be immediately dismissed and all parties be officially noticed accordingly. Sincerel o " erry Building Commissioner CC: Thomas Geiler,Director Linda Edson,Amnesty Investigator Mary Ann Wurthrich,481 Main St,Centerville,Ma 02632 v Citizen Web Request Page 1 of 2 Citation Information Offender Account #: 24926 Offender: Wuthrich Marianne Contact: Address L1: //. Address L2: 481 Main St City,State,Zip: Centerville, MA 02632 % Memo: Violation / Warning e Citation #: 70350 Ordinance: Chapter 240: ZONING - 11-A-1 RB, RD-1 and RF-2 Residential Districts Legal Description: Principal permitted uses in the RB, RD-1 and RF-2 districts Offense: Multi family house in single family zone Violation Date/Time: 12/1/2006 1000 Offense Location: 481 Main St Offense Village: Centerville Enf. Department: Building Issued By: Edson, Linda Badge #: Fine: 100 Balance Due: 0 Payment Disposition: Cleared Voided By: Pre-Court Arraign/Report Generated on Date: Clerk's Hearing Request Date: 2/23/2007 Court Hearing Date: 4/12/2007 Docket #: 0725 AC 000841 Hearing Disposition: http://issql/INTERNALWRS/citation.aspx?ID=70350 3/15/2007 Ct%izen Web Request Page 1 of 2 Citation Information � P Offender Account #: 24926 Offender: Wuthrich Marianne Contact: .. Address Ll: Address L2: 481 Main St City,State,Zip: Centerville, MA 02632 Memo: Violation J Warning Citation #: 76026 Ordinance: Legal Description: Offense: Having more than allowed bedrooms and Kitchens Violation Date/Time: 12/1/2006 1000 Offense Location: 481 Main St Offense Village: Centerville Enf. Department: Building Issued By: Edson, Linda Badge #: Fine: 100 Balance Due: 0 Payment Disposition: Cleared Voided By: Pre-Court Arraign/Report Generated on Date: Clerk's Hearing Request Date: 2/23/2007 Court Hearing Date: 4/12/2007 Docket #: 0725 AC 000841 Hearing Disposition: Arraignment Date: http://issgl/INTERNALWRS/citation.aspx?ID=76026 3/15/2007 MAP PAR MASSACHUSETTS UNIFORM APPLICATION-FOR PERMIT TO DO PLUMBING .(Print or Type) Barnstable ,'Mass. ate 20 Permit# 4 �� r s wner's Name .. CC U- A. Build' g L�ation 16A Type of Occupancy 7 Ne v�llage�Ftenovaon .� Replacement ❑ Plans Submitted: Yes ❑ No ❑ FIXTURES z � d I Fes- --� W W W i 0 $ (}� Ir CC O W _ CC ~ `t ~ Q- Cl `c d. t� z � � � W ::-W cc Go cr ern o .xo7 ten- O 'er U c CC © tzi� coin � d ~ z 4 p dM — uj0 cc SUB-BSMT. 77 BASEMENT 1ST FLOOR 2ND FLOOR 3RO FLOOR 4TH FLOOR I u<t _ 5TH FLOOR I 6TH FLOOR r i 17TH FLOOR 8TH FLOOR Check one: Certificate w Installing Company Name MD PEREIRA PLG&HTG u ,,orporaxion Address CENTERVILLE MA 02634 p ❑ Payership �.�Firm/Co. • Business Telephone 1-0 Name of Licensed Plumber INSURANCE COVERAGE: I have a current liability policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes❑ No❑ If you have checked yes, plea Indicate the type coverage by checking the appropriate box. A liabilityinsurance olic Other type of indemnity ❑ Bond 0 P Y OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have•the insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner ❑ Agent ❑ I hereby certify that all of the details and information I have.submitted (or entered) in above application are true and accurate to the best of my knowledge and that all plumbing work and Installations performe nder the permit issued for this application will be in compliance with all pertinent provisions of the Massachusetts P ing a and Ch 2 of the General Laws. By Title Signature of Licensed Plumber City/Town Type of License: Master Journeyman ❑ APPROVED (OFFICE USE ONLY) License Number 1-- — ►�M F FFEN°� BAR 76026 i TOWN OF ADD FFEN RNSTABLE s A Z COD _ BA DA 0 &flTH OF FE plF"a 1, ERA LICENst NUmow MV/hP REGSTRATIDIIINUMBER/ v K $ OFF lu N O �� e� el xrAr t i MASS. p •� �+ WAI d. IbMK�\ O W TIME AND DATE OF VIO Z NOTICE OF .M. P.M. 20 C0 VIO 7A;j ) j S FORCING ON EN R NG BADGE VIOLATION s 0 OF TOWN Y ACKNOWLED E RECEIPT OF CITATION X a ORDINANCE nable to obt, s' na ure of ender. THE NONCRIMINAL FINE FOR THIS OFFENSE IS QQ OR Date mailed W YOU HAVE THE FOLLOWING A ERNATIVES WITH REGARD.TO DISPOSITION OF THIS MATTER.EITHER OPTION(1)OR OPTION(2)WILL OPERATE AS A FINAL REGULATION . DISPOSITION WITH NO.RESULTING CRIMINAL.RECORD. H (1)You may elect to pay the above fine,either by appearing In person b or etween maillng8`.3d A.M.and 4:00 P.M.,Mon through Friday,legal holidays excepted, L Hyannis.MA 02601 WITHIBarnstable N TWENTY-0 200 Main ONEminal O r�gDyAoTE baFyTHIS a check money.orrdeerr or note to Bamsteble Clark,P.O.Bmc 2430, � BARNBTABLE DIVI ON,desire to contest CCOURT'COMPOis matter In A n UND,MAIN STREET,BARN 3'ABLE,do so MA 028,0.Atlnwritte�21 D Naxxiquest to minalRHearings COURT annd enclo��of a citation for a hearing. (3)N you fall to pay the above offense or to request a hearing within 21 days,or if you fail to appear for the hearing or to pay any fine determined at the hearing to be due,criminal complaint may be Issued against you. ❑ I HEREBY ELECT the first option above,confess to the offense.charged,and enclose payment in the amount of 8 Signature • s Incident Report March 12, 2007 481 Main Street Centerville Marianne Wuthrich I answered an ad in the Cape Cod Times for an apartment. The lady who identified herself as "Marianne", told me she has built the apartment for her son. He no longer needed it and she wanted to rent same. I checked her file and found that she had a Special Permit for a Bed and Breakfast. Jeff Luzon and I made a surprise visit and found a kitchen is the cottage in the rear. I thought that she was in violation of her special permit. Tom Perry has to make the decision for the apartment in the main house. The cottage has to remove kitchen unit. _Linda dson Special Investigator Amnesty Program Building Department oFWE r� Town of Barnstable gyp' c Regulatory Services Thomas F. Geiler,Director e * BAMSTABM MAM 9c� 039. � Building Division ArED""Ar� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 March 16, 2007 Barnstable First District Court Clerk Magistrate Robert E. Powers PO Box 427 Barnstable,Ma 02630 Re: Mary Ann Wurthrich/Fembrook Inn r Docket No. 0725 AC 000841 Citation No. 70350 &76026 Dear Magistrate: After careful consideration of material recently submitted, and in recognition of the corrective measures since taken, I no longer find conditions at the Fernbrook Inn property. to be in violation of either Chapter 240 Section 11 of the Barnstable Zoning Code or the governing special permit 1980-060. As a result,I respectfully request that the aforementioned enforcement matter pending before you on April 12, 2007 be immediately dismissed and all parties be officially noticed accordingly: Sincerel o erry Building Commissioner . CC' Thomas eiler,Director o s G Linda Edson,Amnesty Investigator Mary Ann Wurthrich,481 Main St,Centerville,Ma 02632 481 Main Street Centerville. B &B called Fernbrook Ad in Cape cod times.....owner told me she had made apt for her son and he no longer used same. Site visit with Jeff L. 11/22/06 Owner too busy to show us around. She had to leave. Jeff and I looked around and saw a"Murphy"kitchen unit in cottage and the apartment in basement looks relatively new. ( � C p S l l _l She is only allowed to have one kitchen and 8 bedro ms. f - i n r a OFTHE r Town of Barnstable Regulatory Services BARNy MSS. Thomas F.Geiler,Director 1039. Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4024 Fax: 508-790-6230 September 25, 2006 Ms. Mary Anne Wuthrich 481 Main Street Centerville MA 02632 Re: Illegal Apartment: 481 Main Street Centerville MA. 02632 Map 208 Parcel 085/004. Dear Property Owner: Our records indicate that your house at the above-referenced location is currently being used as a multi-family home,which is contrary to Barnstable Zoning Ordinances and your Variance. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. You must contact this office within 14 days to either: • Apply for a building permit to restore the property to a one-family home • Apply to the Amnesty Program • Prove that this is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. ince , coda Edson Amnesty Zoning Enforcement Officer Building Department gforms:zoning3 o application tee.vast serv- Distinctive Homes,Condos, u I ice.Call Now We Can Help! Ia _ investment properties.Take BARNSTABLE 3WALK TO TOWN 62-7777 advantage of the'Buyer's BUZZARDS BAY:2 BR,$1125 Large clean rooms, some w/ CENTERVILLE 428-0049 HARWICH PORT. market".All financial pkgs plus includes heat & hot water. private ba,kit privile es$120/ CHATHAM 945-0060 OPEN HOUSE SAT 2-4 . No pets.508-394 7221 VINEYARD 693 0012 Reverse Mortgages-all pace d wk&up includes. 75 5611. A V' 64 SCHOONER DR. ranges availab�e. /apecogeana'lapartments.co •� O MASHPEE: Lakefront 2 br, NANTUCKET 325-0047 Large 4 Br.,31h ba.Cape, Consultations during Oct. CENTERVILLE:2'Br�1*_ba-, NEW BEDFORD 992-1400 1h mi.to beach,2 car ara e, Faye Doyle 941-504-7496 c e I nova -,—estate $last includes utils.p 1st 1 yJ 'APR 71/4%3 r$10K min RE/MAX s —y last&security.No pets. 0 0Y hdwd f!rs, F.P., open r pan R AX Properties �area,�$12001mo.-includes 508-364-M5 p� Free application on Internet $729,000. DIR: Rt 28 to Jul- View online:fayedoyle.com —heats&=sable=508=775-4334 D www.ccnm.com lian Or to left on Schooner Or E- NTERVILLE y"Cra, w11e NEW BEDFORD: Luxury 2/3 STAGE HARBOR R.E. MARCO ISLAND: gg bedrooms. ask about area. 508 945-0058 Garden style o, 1st fir, Beach ut s 608�42t3 9518 From $850,ask about sen 1 br,1 ba dated,immac- ulate. for discount.508 998 2227. HARWICHBREWSTER LINE: ulate. rnkey. Walk to CENTERVILLE: Immaculate 1 ONSET:Cory 2BR,1st Rr.No ® THE HARWICH KEYES, new bea $314,5 0.Owner br, furnished, private en- Utilities, smokingg or pets. homes. Prices starting at (508)394-9840 trance,all utils,1st&secun- $700/mo 508-'2 -206r ] $399,900. Open Houses„ ty•:$850.(508)7901773 everyday, 10 . DIR: R � CENTERVILLE: New studio, OelectnNSTV�&$900/moding ] take exit 96,follow t riine L -,, Rd. & turn right ollow to ideal fior 1,private entrance Call 508 255 1370 RM ESTATE Old Chatha d, & turn MASHPEE: $139,900 e &driveway,avail now! NON 1 right.Fall to Depot St.& 38 acres,great level corner smoking, no pets.$750 in- ORLEANS: 1 BR, renovated, Bamsta e Homes 601 take Ys mi.on right. lot w/deeded beach rights. cludes.Call(508)771-3038 furnished, Bunnyy, walk to C.Johnson&Co. beach, deck, $850 month Boume Homes 602 B elch 508-776-2443 (508)790 1647 CHATHAM: 1 br, avail now. includes all(508)255-7353 Brewster Homes 603 r Clean, bright, 1st fir. No smoking/pets. $10001mo. OSTERVILLE:Studio,all utili- �Chntham Homes 6 @� N s includes.508-237-5817 ties included,$900/month. Dennis Homes 605 -s 508-775-1234 Golf Community CHATHAM/HARWICH: 1 & 2 �, Eastham Homes 606 MORTGAGE RATES: See bedrooms No pets.Begin at SAGAMORE BEACHBOURNE: Elegant open fir plan,3br,2ba "Economy"in Sunday Cape $875.508-945 5350,x101 Largge 2 bedroom apartment. Falmouth Ho 607 & 2 car garage, master suite Cod Times or Internet $13oo $1400/mo+. 1st, Harwich es 60B w/spa tub, gas tp,hdwd firs. wrww.capecodonline.00m DENNIS: Studio. Ideal for 1. last, security+1 year lease. Mqs Homes 609 A/C&irrigation.$559,900 $700 includes util. 1stAastt No pets.508-564-5900 Wa uoit Bay Area! security/references.No pets/ eons Homes 610 Waterfront, Dock 3br, 2ba, smoking(508)385 2371 SAGAMORE:Yr. round, 2 Br. finished suite over ara e. appts. Immediate openings. Provina�town Homes 611 gg gg �1 ► DENNIS,W.:1 Br.,1 ba..heat $754-$848/mo. heat & hot Sandwich Homes 612 Newly renovated.$849,000 &hot water included.Avail. water•included. Call for de- C21 REAL ESTATE SHOW immediately. $875-925/mo. Truro Homes 613 WXTK 95.1 SAT 10-11AM Call Mr.Mello at tails, Mon-Fri. HO. 4:30. v Century2l Regan 477-5200 508-888-3608. EHO. Wellfleet Homes 614 1-774-353-8313 SANDWICH:1 Br.apt.,$900/ Yarmouth Homes 615 MASHPEE: RENTALS round W:1 Br,1st flr,year mo. includes all. 1st, last, Martha's Vineyard Homes 616 OPEN HOUSE round apt.$675+ utils. 1st, security. 508-833-6311. Nantucket Homes 617 Lodging,BBB 703 last,security,references.No Saturday 1-3 pets,non smokingg. SANDWICH:2006 redone 1B- P th Homes 618 11 Stratford Ride Wanted to Rent 705 (508�394 6919 Walk to beach non smok 9 ing,$950(50$)-BB8-5806 Wareham Homes 619 Stratford Ponds House Sitting. 707 DENNIS W: 2Br heat & elec b Condominiums �620 Beautiful Stratford Ponds with Vic, non smoking, no pets, SANDWICH:clean 2Br.,spa park like surroundings, pool, Roommates 710 avail. 10/1, $1200/mo 1st cious, convenient location Real Estate Trades 621 tennis and nature dings,is the last security.518-399-7033 $1150/mo+.508-362-2658 9 r1 care-free setting for this ra- Home Sharing 712 Buyers ants �y622 9 g DENNIS,WEST:Studio. SANDWICH VILLAGE: cious town home featuring Rooms to Rent 715 Studio Apartment$800 J Timesha a 625 1900+SF of versatile living $650/month. Includes heat 2 Bedroom Apt.$1050 Mobile 30 space. 1st floor master w/ Apartments 720 and electricity.First and last months.No ets. All include Heat private bath,attached ara e, Non-Smoking/No pets Ca es 35 Houses Yea 725 508 685 1 07 g central AC. $424,90 . K. dY 508-737-3836 lda Pr e 636 Route 130(Main Street) near Condos Yearly 730 DENNISPORT:1 &2 Br.Apts. 1 640 Mashpee-Bamstable town line dY Utilities included. No Pets. YARMOUTH: 1BR, Avail. 10/ Commercial 645 is entrance. Summer Rentals 732 $925/mo:$1225/mo. 1e $all Kim. Includes 141 i ties.Call Kim 508 360 3141 Shirley&Darryl Enders . 508 428 9518. listings Wan 650 508-362-1300 x731 Winter Rentals 733 View photos&details online DENNISPORT:1BR.($875)& YARMOUTH,co, S.: Bass River. Propedy Wan 5 Off Cape Rentals 734 2Br.($1095) includes all. Small cozy, 2Br. house www.AtHomeCapeCod.com first, last & securt�y, no $1006/mo+.508-778-2446. ea Estate,General 6 0 Florida Rentals 735 per•508 760 2756 ns 65 YARMOUTH, S: Cory 1' br. View Upcoming Vacation Properties 737 Close to RT.28 & town. DENNISPORT: Cute and sun Nursing Homes 740 ny half duplex, 1 bedroom, Walk to water. Quiet area. • �� � � Open Houses 9 $800/mo.+ (508) 394-0705 Y3�n vnth large yard, small pet Toda RealESfiate.eom Commercial 745 considered,$795/mo. between 6 9 p.m. BARNSTABLE: Cummaquid y 508-760 6622. YARMOUTH, W.:2-3 Br. Du- Heights,great 3 BR home w/ Space For Rent 750 pp x, Q rg y ********* Rentals Wanted 755 $1250/mo 508-398 9$16 2 fpls 8 much more!$579K DENNISPORT:Spacious 1 BR www.Hom h mprel$57com apt.Close to beach.$800+. ` UNIQUE PROPERTIES TODAY REAL ESTATE 508-394-3821 YARMOUTH, W: 3 Bedroom, Rental Services 760 800-922-2324 800-305-1898 modem duplex security & EASTHAM:1 BR STUDIO near references required $1195+ HYANNIS/CENTERVILLE: NHS, Nauset Light reason q OPEN HONES SUN 1-3 gg (508)362 2509 - �p , w ,v able terms 774 722 3541 at 48 Square Rigger Lane, CENTERVILLE: Mature adult, EASTHAM: Furnished 1 Br., YARMOUTH,W.:Newty reno- take Phinney s Lane to 2 br, kitchen, bath $750+ utils. included, pprivate, voted furnished 1 room Cobblestone Landin 508 360-6727 $800/mo.508-685-8588. units w/private bath,micro - Cobblestone ( ) entrance & follow ReMax wave,fridge&kitchenettes. signs to this pristine 7rm,3br, COTUIT: 2 rooms bath. In EASTHAM N: large 2Br fur-. All utilities. YEAR ROUND 2.5 ba contemporary featuring cludes utilities. (Jon smok nished, W/D, wooded area. RATES,$185-$250. 2400 sq.ft., huge brs, cethe- MASHPEE:RANCH ing$165/wk.508-364-8737 $800/mo (508)240 0250 Call(508)7901272 dral ceilings,skylights galore, $289,800 ((20611317)) , p E �"+gipp@@t,, paddle fans,1st fir Master br, Today R.E.506-888-8008 DENNIS S.:Responsible F,toVwtt office in basement,Onty 2 mi. v. M ` to �Craigville Beach, Won't t +�� r a share(louse,no pets,$200/ last!! Priced below assessed I $t s week. 508 394 73sa. value at$484,900. r w � �� 9 Call Paul Collard at ORLEANS,EAST:, SAGAMORE BEACH:f to share ReMax first Choice, OPEN HOUSE quiet lovely home near ca- nal,X 285 MO bus line, beach, 61. mo+utils.508-888-4961. HYANNIS: SAT., Sept.23rd, 11-1 LISTINGS WANTED! 6 SEASIDE WAREHAM:For apt.,all utils., DIR:Main St.to Beach Rd.to no drinking, non smoking, If your looking to sell your right on Cedadand Rd. to $440/mo.508-291-2236 8.i home for the best possible right on Seaside.See signs. New Homes price in the shortest amount WAREHAM W: large private of time call Paul Collard, put STARTING AT$379,900 his 24yrs of experience to Nearby Nauset beach,charm- room in newer home.Coun work for you!! ing half Cape,open floor plan, try setting, but close to OPEN HOUSE EVERY DAY 10AM-3PM Re/Max First Choice ppnvate semngg, highly desira- Routes 28, 495, & 195. Directions:From Rt.6 take exit 9B.Follow to Airline Rd.& 1-800-879-0108 X285 ble location,$729,000. $150hvk.(508)291 7246 tum right.Follow to Old Chatham Rd&turn right.Follow to B! iEAL ESTATE Ann Rosen 508-241-0459 YARMOUTH W: responsible Depot St.&turn left;Y4 mile on right is the Harwich Keyes. or 508-255-2202,ext.1,1t1- female,3Br home.$650/mo. eonta Bob Welch at 508-776-2443 �. __ ._-_ - --.- -1-.+..........M nnn•. .--,..A-- cno I AOc•] • • • • e •mmCMI • '# rF4 Y 'ramy Al, r ' �• 1i is lit WN d s s* �t w •a u�*w J ar.• '� rol 4. !;�em, VA 5 ° - :.� t''4 ! 'a4 +fir.; � ,� tte�3µ, I •• x i-9_ \ALL•. ����,,,,,,p�. $• :�, -.M -Ks •• • 11• • • .• - • -• • • • • .• 1 •• • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a r "Parcel t4 , Permit# 'ig T Health Division — �a O� Date Issu `d 73 ' 0 L Conservation Divisi n I ZOO 2 Fee Tax Collector 11, c" Fr FIE r . Treasurer / 1111 INS ALLED HN COMPLIANCE Planning Dept. K WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIRONMENTAL CODE ANDT TO RFECULATIC463 Historic-OKH Preservation/Hyannis Project Street Address Village 644t Owner MAn Address Telephone ' ( �^ ,1L q!q Permit RequestLIM, lhie.t� Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay 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 BUILDER INFORMATION Name rLl Telephone Number Address / (' License#filkA t / f Home Improvement Contractor# X7 (� Worker's Compensation# IZ74.5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO &_1 SIGNATUR DATE Za�fc% /2 Z2 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED z -MAP/PARCEL NO. - ADDRESS VILLAGE OWNER s DATE OF INSPECTION: FOUNDATION }�i�a o 1 Cu r D FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL " FINAL BUILDING b 11 S — 04 DATE CLOSED OUT , ASSOCIATION PLAN NO. n The' Tomm of Barnstable `" L-Lg Regulatory Services �'°Tfn'�►�iy"1� Thomas F. Geilert Director Building Division Peter F. DiMatteo,Building Commissioner 367 Main Street Hyannis MA 02601 . :e: 508-862-4038 Fax: 508-790-6230 Permit no. Date F �✓0 2 . AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations.renovation,repair.modernization.conversion, improvement,removal.demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors;with certain exceptions,along with other requirements.. . Type of Work:. &nz::�JEstimated Cost llh�r �66 Address of Work: Owner's Name: e- Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law []Job Under$1,000 []Building not owner-occupied []Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED. CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the ow Date Contractor Name Registration No. OR Date Owner's Name a:forms:Affiddv:rev-070601 w-Tcdz ll� Q Z� _Q ACORDM CERTIFICATE OF LIABILITY INSURANC OP ID�IMFATION (MMIDOYY) PROOUCER LL- 2/07 02 ORMTHIS CERTIFICATE 18 16SUED ASMTT F Northwood Eahbaugh Ina.Ag Y enc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 426 E. Falmouth H HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR E• ralmouth MA 02536 ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW, phone: 508-540-1223 Fax:S08-S40-0441 ! INSURERS AFFORDING COVERAGE o ER A' RP . ._MWCA _—•— I INSURER B Hell Island Foolm, Inc, 1 — Dudley at. uRERC_ Leominsto r MA 01453 IIN-SURER D —'— COVERAGES INS RER E. THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTAND!NO ANY REOUIREMENT,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.AOOREGATE LIM(TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. L TYPE OF INSURANOE I — POLICY NUMBER GYM jMMIG Y ' LIMIT9'09NERAL LIABILITY COMMERCIAL GENERAL LIABILITY I I EACM OCCURRENCE FIRE DAMAGE(Any one sire; f --^•. — C.A MS MADE F_. OCCUR M-ECC FXP;Any one person) I f PI ERSONAL 9 ADV,NJURY --- I OENERAL AOOREGAA E f JEN L AGGREGATE LIMIT APPLNES PER 1 POLICY : I PRO I LOC I Pj ROOUCTS•COM91ICP AGO ; S AUTOMOBILE LIABILITY r— ANY AUTO 'COMBINED SINGLE LIMI" f i (Ee ecadenq I ALL OWNED AUTOS SC-ED,jLEO AUTOS i BODILY INdJRY f (Per Dereo HIRED AJTC9 I n) .. _, --1---- i NON-CA NEJ AUTCS I BODILY INJURY` f I PROPERTY DAMAGE I S (PereccidenC I GARAGE LIABILITY ' AN"?AVTO _ I I I AUI TO ONLY•EA ACCiDE4T f EA ACC 1 —_ OTHER THAN f I I AUTO ONLY --- A03 I S LlxCESS L+Ap�UTr r EACH OCCURRENCE S OCt:UR I CLA.'MS MACE I I —1 ' AOOREOATE DECxICT,KE i f I RE'•E�TION L —. I f WORKERS COMPEL SATION ANO EMPLOYERS'UIB0.+YY I $ TOR Y LIM,'g; tiER 177650Y ! 06/13/01 I 06/13/02 E.L EACH ACCIDENT _;f 100000 EL DISEASE•EA EMPLOYEE f 100000 O: (R M I I rEL.DISEASE PoLICYL:m.T f 500000 � I I Of SCR!►T,Oy OF OPER•TIOtiSr,OCAT ONSNEn:C, YOtis• Cb/E!'C.0 DDEO Y�[NO..RStrd[NT4►fWAL FROv SOha CERTIFICATE HOLDER N :ADD'IOhAL:0%Z6R[D.INSURER LE1t[R. CANCELLATION WNSTA I Sao'J.D A.\Y CE list AeoJE O[SCR BED rouC'u BE CArc.:ED BE►GRc THE cAP,vT:c ?Gan of Barnstable DAt(THEREOF 'NS 41U.W0 INSURER WILL ENDEAVOR TO VAIL ZQ_0•rS WR:T'Elr Building Dept. NONCE TO THE CERTIFICATI rO;D[R NAVOD TO THE:EFT.OJT►AIL6019 TO DO 30 S■A;L IMPOSE NO 08.10AT1os OR LIAR.? Y OF ANY KlND NPON rMf 0#30RER,ITS ACENTf OS Barnstable HA 02601 RtPRct►fF:T.-Ncc AUTNORtfO RE►RISEtiTATN( ACORD 264(?,,By, Rona d J. Wayerowitg ItACORD CORPORATION iin NONE 1011401 (011li(t" Relistritior 11M4 Esrirstiol: OIi0SR012 irle� 011 SURER ►OOES I NONE IN►RO NIRREN StNERER Ao►.asrwva+ l30 MARINER EER f0fUI1 Na 02435 BOARD OF BUILDING REGULATIONS Llcwm: CONSTRUCTION SUPERVISOR Humber: CS O42838 Blroxkb: 05=1950 i Expires:05/22=2 Tr.no: 22926 E Rastrkted To: 00 E WARREN F SCHERER 630 MARINER CIRCLE COTUIT. MA 02W5 Administrator pp 3A Ri l00 DIGITAL... a . SMART NEATER t * � t �x a x " r®L w display (LCD) use selectionand(heater settings 5t 2. ,. + � =psi eaders re�ent�rust stains from p �N . � 3 I`s u trf ce }0, ggt } ' ectly,6fro q provded�2k'PVC threaded union e Processor cobntrols diagnostic read-out a sly r ;onitorsZY woperating status n w e a°P y�ie d serviceabl { ; _ a'on t�o�harmheater: a AIN 'r - gidrelabi l ity a a orfcssmartr U r r �`ijµ { a #ate. "�" fi � � �'"��'4�,y�`•^.G?f'�*;`. 2.1 S.wimmin Po_01 Heater ' B • 4 3/8" (3-3/8°ASME) (C) L (7-1/2'ASASME)INDOOR DRAFTHOOD C SYSTEM SWITCH o ° 40' 38' o ° o STACKLESS 0 26-1/2' o OUTDOOR TOP o (28-1/2°ASME) o *21-1/4' 13-1/4' o 0 GAS o 0 CONNECTION o 0 A s� 26-1/2--- ►� Shipping Weights(lbs) BTU (A) (B) (C) (�) Cast Iron Capron Heater Heater Indoor Heater Input Cabinet Flu Indoor Gas Water w/Stackless w/Stackless Draft Model* (000) Width Dia. Drafthood Conn. Conn. Top Top Hood R185A 181 18-1/4" 6" 62-5/8" 12-1/16 3/4" 2" 191 172 12 R265A 264 22-3/8" 7" 62-7/8" 11-1/8" 3/4" 2" 214 195 15 R335A 333 25-3/4" 8" 63-3/4" 10-3/4" 3/4" 2" 234 1 215 17 R405A 399 1 29-1/4" 1 9" 65-3/8" 12-1/2" 3/4" 2" 253 234 20 * Designation for Propane is "EV and Natural Gas is "EN". Prefix "C" for Cast Iron (ASME) headers; "P" for Plastic(Capron®) head- ers. Above input ratings are per A.G.A.specifications. Reduce input 4%for each 1000 feet above sea level when installed above 2000 foot elevation. Manufactured under Patent No. 3,623,458. Note: Plastic(Capron®) headers cannot be used for ASME installations. How to.Pick the Right Size Heater Proper heater size is based on the time required to heat the pool or spa. If water is heated for each intended use, ener- gy-saving rapid heating may be appropriate. If water is gradually heated to the desired temperature and then maintained at that temperature, a smaller heater may be acceptable. To determine proper heater size, use the following formula. A. Desired water temperature OF °ESIGIV B. (Minus) Average air temperature OF C. (Equals) Total heat rise OF C D. Total heat rise/hours required to heat equals required heat rise per hour. CE�E° Use the charts below to find the appropriate heater for your pool or spa. POOL SIZE-SQUARE FEET SPA/TUB SIZE-GALLONS Heater 300 1 400 1 500 1 600 1 700 1 800 1 1000 Heater 300 400 1 500 1 600 1 700 1 800 1000 Model DESIRED TEMP.RISE IN°F PER HOUR Model DESIRED TEMP.RISE IN°F PER HOUR R185A 1-1/20 1-1/40 10 10 3/40 — — R185A 59 45 36 30 25 22 18 R265A 2° 1-3/4 1-1/2° 1-1/2° 1° 3/4" — R265A 84 63 51 42 36 32 25 R335A 30 2° 20 1-3/4° 1-1/4' 1° 3/40 R335A 104 78 63 52 45 40 32 R405A 3-1/2° 2-3/40 2-1/2° 2° 1-1/2° 1-1/4o 1° R405A 128 96 77 64 55 48 38 ( o Raypak, Inc. 31111 Agoura Rd,Westlake Village,CA 91361-4699,(818)889-1500.Fax(818)889-4522 X" Raypak Canada Limited 2805 Slough Street,Mississauga,Ontario,Canada L4T IG2.(905)677-7999.Fax(905)677 8036 �` 9 umnm m"rrs,wm , ^�"• r Wig: www.raypak.com Litho in U.S.A.©1999 Raypak,Inc. Catalog No.6000.12D Effective:2-1-00 Replaces:7-1-99 Raypak reserves the right to change these specifications without notice. TM Ppo ' Gpid C VERTICAL GRID D . E . FILTERS ,TM: � Hayward Pro-Grid is a high- performance filter series that provide_s superior water clarity,efficient flowy.' and large cleaning capacity for pools t of all types and sizes. r b Pro-Grid filter tanks are now molded from new and stronger PermaGlass Xl_ M an improved glass reinforced copolymer, _ providing the ultimate in strength, durability,and long life. rot�sl�. Pro-Grid filters also � combine high technology features with a"service-ease" ' .. n_ design for dependable operation and y low maintenance. Pro-Grid filters are also available with s the unique SP0740DE Selecta-Flo control valve,the only filter control valve designed specifically for D.E.filters. For the quality conscious pool.owner, Pro-Grid filters are an unparalleled filtration value. ■DE7220 Pro-Gridr"t 72 ftZl/ertical Grid D.E.filter with optional SP0740DE Selecta-Flout 4-position control valve. Large capacity 72 ft!filter,made of durable PermaGlassXl';can be used in both commercial and large residential applications for years of non-corrosive,trouble-free performance. Featuring �_ PermaGlass='=" - . Filter Tank Material + p HAYWARD America's *1 Pool Water Systems Pro-GridTMvertical Grid D . E . Filters 9 s Innovative Automatic Air Relief purges any trapped air automatically during filter operation. -- Screenless Internal Air Relief provides continuous airventing and eliminates clogging. _ r, Improved High-Strength Filter Tank molded from new and stronger PermaG lass XL' pT material for extra durability for dependable,corrosion-free performance. High Impact Grid Elements designed for up-flow filtration and top-down backwashin .I 9 P 9 P P 9 for maximum efficiency. r Self Aligned Tank Top and Bottom make access to servicing grid elements fasty *r and simple. ` Heavy-Duty Tamper-Proof One-Piece Clamp securelyfastens tanktop and bottom together and allows quick access to all internal components without disturbing piping or connections. f Marked Short Element and Manifold provide clearguidelines for re assembly of grid s — elements during cleaning. * is Inlet Diffuser Elbow distributes flow of incoming unfiltered water upward and evenly ` ''� to all filter elements. Noryl®Bulkhead Fittings for extra strength and heat resistance. Full Size'IT'Integral Drain provides fast,100%clean out and easier flushing of tank. € Union Locknuts make disassembly and reassembly of filter from piping fast and easy. Plumbing Versatility.Select from a wide variety of valve options for customized control �r of your filtration system,including Hayward's 2",2-position slide valve. FILTER TYPE: Vertical Grid Diatomite:24,36,48,60,72 ft2(2.2,3.3,4.4,5.5,6.6 ml). k %; FILTER TANK: Injection molded PermaGlass XU11 FILTER ELEMENTS: Monofilament polypropylene cover fitted over 8 curved, high-impact grids CONTROL VALVE: 1 Y2"or 2"6-Position Vari-Flo?"'2"4-Position Selecta-FIoT"" ff 2"2-Position slide valve.May also be plumbed singularly or in series t with quick-connect union couplings(less valve). ` PERFORMANCE RANGE: %to 3 HP(30 to 120 GPM) DIMENSIONS: DE2420—32"H x 23"W(81 cm x 58 cm) Fully Automatic Air Relief with double seal DE3620—34"H x 23"W(87 cm x 58 cm) eliminates the need&manually vent filtertank ('C after system start-up and prevents backdraining DE4820—40"H x 23"W(102 cm x 58 cm) NSF® during pump shut-down. DE6020—46"H x 23"W(107 cm x 58 cm) DE7220—52"H x 23"W(132 cm x 58 cm) Above dimensions are for filter only.Overall width with slide valve is 30'(76 cm); n ; overall width with either 4-or 6-position multiport valve is 33"(83 cm) Performancedata Model Effective Design Turnover Filtration Area Flow Rate" Gallons Kilo Liters Number ft' m' GPM LPM 8 Hr. 10 Hr. 8 Hr. 10 Hr. DE2420 24 2.2 48 182 23,040 28,800 87 109 DE3620 36 3.3 72 272 34,560 43,200 131 164 DE4820 48 4.4 96 363 46,080 57,600 174 218 '> DE6020 60 5.5 120 454 57,600 72,000 218 273 DE7220 72 6.6 1 144 545 69,120 86,400 1 261 327 Removable Clamp Tool makes tightening and "Determined by pump size and piping system hydraulics. 2 piping is recommended far flow rates of 90 GPM(341 LPM) loosening of clamp quick and simple,providing or more. Flow rates above 120 GPM(454 LPM)are not usually required for residential pools. easy access to filter Internals. NSF is a registered trademark of the National Sanitation Foundation HAYWARD® America's 01 Pool Water Systems 1-888-HAYWARD www.haywardnet.com ©2001 Hayward Pool Products,Inc. PG01 TM Supep ar- ear QUAD - CLUSTER TMCARTRIDGE FILTERS 4�� Seas°n �onq a ayward Super Star-Clear cartridge filters establish new horizons in high performance and operating convenience. t - Utilizing a cluster of four reusable d a polyester cartridge elements, they provide a choice of 200, 300, 400 or }� 500 square feet of heavy duty dirt- � �� • _ � - holding capacity and 'extra long filter cycles—proven to handle an � f - x entire season without cleaning. t �. ti &s Super Star-Clear ®ta�ly filter tanks are zM ^k now molded from '"e 9„P'�� PermaGlassXLTM proeuc5 a glass reinforced copolymer, providing the ultimate in strength, durability, and long life for even the toughest applications and environmental conditions. For crystal clear water and easy maintenance, step up to Super . ,; Star-Clear. You and your family will be glad you did all season long. ■ Super Star-Clear 400 ft z large-capacity cartridge filter for crystal clear water with minimal care. Featuring PermaGlass:=_l Filter Tank Material p 0 HAYWARD Hydrogen,Oxygen and Hayward. The elements of clear water TM r� Super Star-ClearTM Q u a d - C I u s t e.r TM C a r t.r i d'g e F id t e r6 • ' � �w Automatic Air Relief purges any entrapped air during filter operation. Non-Corrosive Top-Closure Plate prevents elements from lifting aP O and allowing unfiltered water to by-pass back to pool or spa during --- operation. • Heavy-Duty,Bolted Center Flange Clam secure) fastens 9 P Y -' tank top and bottom together.Allows quick access to all internal ' -d filter components without disturbing piping or connections. ;i�' Quad-Cluster"Cartridge Elements provide 200,300,400 or 500 ., f ziilu �bl II y„�w tv,dluu Iul�(i square feet of filter area and extra dirt-holding capacity for long filter ;, I,I cycles.Precision-engineered extruded core provides extra strength V �l i5 II, illli '� r I and superior flow. .ill Ilea 2 nIIII�IPiI a `, High Strength Filter Tank molded of PermaGlass XL?l provides extra — 17 durability for dependable,corrosion-free performance. I u lVur r I oIIIl11I(c�1 Uniform Low Profile Tank Base Design makes removal of cartridge I'I I; �" i1 ilj of ,r� 1 OII I 9 g � 11�II�IIIIIj elements fast and sim le. ;Furl �1„Illrl�' p I ;I II411 r�1 {I, I I 'll , , II JII�A _ �4II,1111, Ill,l,;ly; Full Size 1V Integral Drain provides fast, 100%clean out and easier flushing of tank. Noryl°Bulkhead Fittings for extra strength and heat resistance. Union Coupling Connection provides plumbing options of 1%"or 2"piping.2"internal piping for maximum flow performance. z FILTER TYPE: Quad-ClusterT"cartridge elements: 200,300,400 and 500 ftZ total(18.6,27.9,37.2,and 46.5m2). s,. q 11 is Il i f III III (�P FILTER TANK: Injection molded PermaGlass XL I ( I I t 'F u TM �� � .,. I III i FILTER ELEMENTS: Reinforced Polyester t_ I I I f I;d ll; 1i11ft t PERFORMANCE RANGE: %TO 3 HP(30 to 120 GPM) 0.37 to 2.2 KW(114 to 454 LPM) I I I # III DIMENSIONS: C2000—31-V'H x 23"W(80 cm x 58 cm) , i a 1 III "'rlf'II I IIII'jl�j ,, C3000—36-/z"H x 23"W(93 cm x 58 cm) C4000—42-Yz"H x 23"W(108 cm x 58 cm) C5000—48-V'.H x 23"W(123 cm x 58 cm) k Performance Data Effective Design Turnover EASY TO CLEAN CARTRIDGE ELEMENTS. Model Filtration Area Flow Rate* Gallons Kilo Liters Hayward cartridges have extra dirt-holding Number ft 2 mZ GPM LPM 8 Hr. 10 Hr. 8 Hr. 10 Hr. capacity and are engineered of durable,high- C2000 200 18.6 150 568 72,000 90,000 273 341 quality materials to last for years with only C3000 300 27.9 150 568 72,000 90,000 273 341 minimal care.Simply remove the cartridge C4000 400 37.2 150 568 72,000 90,000 273 341 element and hose off with Hayward's EC2024 C5000 500 46.5 150 568 72,000 90,000 273 341 Jet-Action Cleaning Wand to restore to clean operating condition. *Determined by pump size and piping system hydraulics. 2°piping is recommended for flow rates of 90 GPM(341 LPM)or more. Flow rates above 120 GPM(454 LPM)are not usually required for residential pools. HAYWARD POOL PRODUCTS, INC. Hayward Pool Products,Inc. dayward Pool Products,Inc. Hayward Pool Products Canada Hayward S.A. 900 Fairmount Avenue 2875 Pomona Boulevard 2880 Plymouth Drive Zone Industrielle de Jumet o Elizabeth,NJ 07207 Pomona,CA 91768 Oakville,Ontario L6H 5R4 B-6040 Charleroi(Belgium) 19D97 ©1999 Hayward Printed in U.S.A. • • • • • • • • • • • • • s F t l'Y i RM r e _y x p� VI Lij .Ki �'``'YAd f' t i DDEL MD .OGL Ef N;V- ` e m \ 10 . rd°�r� d ha mmo d..,e+ ,r i"���" '4 .,�- `� f ' i "3: •,.:M. ®.-CHLORINEF � -..^ix.• b+l'*'�'yO O. w x' r 3� 3g' at y3 S 0 �. �<" y w,?a�' r - ✓-CI'� J b 2 7 ooEe of ■u�s� J'a r � xs.�sra �.��.w ✓�rt �.e per, d- - ^s c yr r'�/✓3 - e Ord��,�/ � "",�- _ d&,. •._<. ? .$ �x{�4�>em^,"^"'° �J r. xxz x / 4MW .^ °" a� •HAYWARD AUTOMAT1C LL ; PRESSURE STYLE ' , 4 CHLORINE FEEDERS FEATURES: so �k « EASY-LOK COVER ASSEMBLY has thread-assist mechanism to provide dependable sealing plus conven- t ient access for adding tablets or sticks. CHLORINE CHAMBER has extra large capacity.CL-100 0. series feeders hold up to 4.2 lbs. of Tri-Chlor tabs, while • ryry `.f the larger CL-200 series has a 9 lb. capacity to meet the VL q a ,' ,� requirements of all sizes and types of pools. Corrosion- proof, versatile design accommodates large.or small F° slow-dissolve tablets or sticks. DIAL REGULATING VALVE is easy to use and lets you control and adjust the rate of feed for your pool's variable Qq requirements and chlorine demand. ¢ FEEDER TUBE provides controlled outlet flow of highly IN concentrated chlorinated water plus serves as an auto air relief to expel entrapped air from the chlorine chamber. VERSATILITY for new or existing pools. Select either direct in-line or off-line unit to make installation easy for • , ,C�f`:2�ItE�I! CT�1t3L4UfT ©ijfNy.. ,, our pool P Y ool or a system. ;V, s PUMP PUMP „ HEATER FILTER .+f ¢ zti HEATER FILTER talledl r (Iflnnalled) x t ' ; ° I FROM RETURN I. FROM POOL> 1 TOOL POOL-a RETURN f- f , # TOPOOL �+* rti f—.OUTLET a:mtf-1NLET tgR i' is s CL-100 and CL-200 IN-LINE ze CL-110 and Cll220`OFF-LINE �« FEEDERS are furnished with 11/2' ° FEEDERS install next to filters s y , 0! FPT threaded inlet and outlet.For p tem,and work on system pressure . rigid PVC piping installations, 11/2' differential. Connects easily' with. ® D >r< socket flush union connectors are compression couplings for new or L available to provide a professional p existing ,system All`''necessary spa"HOLE ,Y Lc: f installation that allows for future Optional . connectors' and tubing are fur Saddle Clamp Assernbly 4 service. Union Connectors `„ nished with each feeder For easy installation system piping. `1 r sit New economical automatic chlorine feeders sized to handle the sanitizing needs of most residential pools.They $ have 4.2 lbs. capacity and feature an incremental dial control valve for , ` , accurate metering of feed rate. 50 CAUTION: Hayward automatic chlorine feeders are designed to ° (t" = 3 S t �"ts, use only Trichloro-S-Triazinetrione tablets(or sticks)-slow dissolving type.Consult your pool dealer for complete information. ,,�� ��. 9� � ^� � ��, • , CL 110 CL 100 e 5 t ,� iz• f..i e �. tj. nCfuA, HAYWARD HAYWARD POOL PRODUCTS,INC. 900 Fairmount Avenue,Elizabeth,NJ 07207 ` . . '• 4 di California: Canada: Belgium: Hayward Pool Products,Inc. Hayward Pool Products Canada Hayward S.A. I�I 2875 Pomona Boulevard 2880 Plymouth Drive Zoning de Jumet .; Pomona,CA 91768 Oakville,Ontario L6H 5R4 B6040 Jumet,Belgium 01988 Hayward Printed in U.S.A. i. Supep um C HIGH - PERFORMANCE PUMP SERIES ra a ` 7�£ E ■ Super Pump:high performance and quiet operation. Hayward's Super Pump is a series For super 'performance and safe, quiet of large capacity, high technology pumps operation, Super Pump sets a new that blend cost-efficient design with standard of excellence and value. And durable corrosion-proof construction. you know its . Designed for pools of all types and ® � quality through- sizes, Super Pump features a large out because "see-thru" strainer cover, its made by Hayward rota��y super-size debris basket, — the first aywar n and exclusive "service- ease" design for extra ; choice of pool professionals. convenience. HAYWAR D® America's *I Pool Water Systems SupePPump° High Performance Pump Series Exclusive,Swing- Lexan®See-Thru All Components Heavy-Duty,High- Aside Hand Knobs Strainer Cover lets you Molded of Corrosion- Performance Motor make strainer cover see when basket needs Proof PermaGlassXUm with air-flow ventilation for removal easy.No tools cleaning and eliminates for extra durability and quieter,cooler operation. required...no loose guesswork.Special self- long life. parts...no clamps. adjusting seal assures Heat Resistant,Industrial Mounting Base provides dependable sealing.. Size Ceramic Seal. stable,stress-free support,plus Long wearing,and 100% versatility for any installation drip proof.For fresh or salt requirement.Adapts 48 and 56 t � waer use.'�- frame motors. Super-Size Housing has extra air handling* capacity to assure rapid priming. • t Totally Balanced, t, Service-Ease Design gives Corrosion-Proof Noryl® simple access to all internal parts. Impeller has smooth,wide Motor and entire drive group openings to prevent fouling or assembly can be removed,with- clogging.Energy-efficient out disturbing pipe or mounting design produces more flow at connections,by disengaging just equivalent horsepower. four bolts. Overall Dimensions Size KW inch inch rn 4 • SP2600X5 1/2 0.37 11/2" 111/4' 286 1 ' °emmi 1 I�lwm 1�1 SP2605x7 3/4 0.56 11/2' 11/a" 295 1' i31 �jr SP2607X10 1 0.75 1'/2" 11'/e° 302 "t SP2610X15 11/2 1.12 1'/2' 121/4° 311 9 by SP2615x20 2 1.49 2" 131/4' 337 r-list mm� �11Y,mm� ; e.sre' SP2621X25 21/2 1.86 2° 133/a° 349 �316 mm) �pli • Super Pumps are also available with dual speed motors. 'I m ft. 30 100 27 90 ' 24 80 21 70 W 18 60 s 1x25 SUPER-SIZE 110 CUBIC INCH BASKET has J 15 50 - extra leaf-holding capacity and extends time ~ 12 40 s s,sxz between cleanings.Rigid construction with 9 30 (2HP-1.49 J load-extender ribbing assures free flowing oper- ation for heavy debris loads. 6 20 s 610x1 3 10 oox sPzs nno (1'i,x Super Pum ®Series Pumps are listed b : tv> P-o xwJ sPzs sx� P P P Y 0 0 (axP- ssxw 0 10 20 30 40 50 60 70 80 90 100 110 120 130 140 GPM i i i III I I I I I i 1 1 0 38 76 114 151 189 227 265 303 341 379 416 454 492 530 LPM U NSF® CIP CAPACITY PER MINUTE HAYWARD® America's *1 Pool Water Systems 2693 1-888-HAYWARD www.baywardnet.com ©2000 Hayward pool Products,Inc. f Fernbrook Inn 481 Main St. Centerville 508-775-4999 Attention:Mr. T. Perry Barnstable Building Dept. Regarding an existing Apt. At the Fernbrook Inn t Dear Sir: I have enclosed copies supportive evidence _ of the existence of this apartment going back to the early fifties, in chronological order.l 1951 : Copy of blueprints by a Boston architectural firm, Thomas Byrd Epps for then Fernbrook owner, Herbert Kalmus. 1997: Comments on the Apt. by a private building inspection report at the time of the Fernbrook sale. i 2002: An insurance claim due to water damage to said apt. at Fernbrook with before photos. Sincerely Mary Anne English f . Town of Barnstable , Regulatory Services HAMS'ABL& ` Thomas F.Geller,Director �cbAr1MAW 6. Building Division Thomas Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www:town.barnstable:mams Office: 508-862-4024 Fax: 508*790-6230 September 25, 2006 -� - Ms. Mary Anne Wuthrich 481 Main Street Centerville 1VIA 02632 -Re:Illegal Apartment: 481.Main Street Centerville-MA.-02632 Map 208 Parcel-085/004: Dear Property Owner: Our records indicate that your house at the above-referenced location is currently•being used.as a multi-family home,which is contrary to Barnstable Zoning Ordinances and your Variance. Violation of zoning ordinances is a misdemeanor, conviction for which results in a criminal record. } You-must contact this office within 14 days -to-either: • Apply fora building permit to restore the property to a one-family home O Apply to the Amnesty Program r Ae • Prove that is a legal multi-family home. Please contact this office immediately to tell us what direction you wish to take. inc , inda Edson Amnesty Zoning Enforcement Officer Building Department 41 a /a �''t'; �'���r `�,' r:�..r�,•, ry,A��f�("r�"'�,��,,�1,��z�r�i��'""�, :x;�!�'°�„�. .;s'"'"�''��°'�-.�•-^--+ a � ,k - ,�y� f5�„ �, �.. L�.• 'x :.8'{r I`,--•'^'�` �' rtY• 'ii'Lr �t •' .,�"3 •'t Ile , �+»1`s . r:. ��Y„"�,••4 ... j «•. -.tP .o:.�,, ' �3''• �„" �•�•:� ti - G.. �lr tEira� � <.....Y: �,f� '�,,,�.,y� �•• t pAq-�•ry...•;.. ;;.?�,�'•sr�r ` ��`r •e. Y� Z r•i / -YL•_ • �1 . lY ., J �.f �;ry J.� ...• W�`J� J. (LLJ CAn coo N 1 a.�. . a•t , ' BUILIHNG WIT INSFEMON OFFICES LOCATED AT erFranClfiso Office 366 While Oak Trail,Centerville,Mass- 02632 Michael P.Mu 'rphy SOS 77�-8270 .'l r '• m �. �• . O Executive Office 33 Church Street,West Dannis,Mass.02670 RobedJ.8eautieu 5�-398 9387 '+' � J,r,\, O Franchise Office 15E0 Route 6A Brewster,Mass.02631 William Busty 508-896-73d1 <•`- r A•." �• is zc - 1• This inspection does not Guarantee or Warrantee nor give file ex 9i pectancles at any system,Item. ?' '• t. y •-:`.. control,motor,appliance or component,mechanical or electrical.In part or in whole, ex r S:� or Implied . BUILDING INSPECTION SERVICES INC-shall not be liable d'trecfly of Indirectly for pressed sany od 33 opinions based upon the building Inspectors proressloncf visual in ion.Aopinion ` '" personal c- specf ny "� •:, expressed is based only on practical experience and honest conviction and acting In good !� �� •'�� 1_ ui , •.�;,;.,���:, faith. The standards set forth in ihls Inspection are designed to Identify and disclose certain s_ � �•�+ 1- conditions of the systems Inspected as these conditions exist of tit©time of this ins inspector is not responsibis for any hidden detects or for the condition of the Inspection.The property. This cerhticota is not a guarantee or an impIled womanly. U �.G i tt`' 3itL3C3Tqe Q. 1 » '�.. :7-• d i41I�,+,T^LF 9 F( y`ii�, '� . "� . K CASE NUMBER Ptfi+ t l ? . Igo. a J c�rtr�t, s ut � DATE u . • t y }`�C� �qt yya OF LNSPEC'nON SERVICES-INC. J 1 P (not Valid unless stamped) •.; a`. ' �` '� F- IN ,_ref i S S,�i .F I hereby cent ta7at 1 Have r _N _ p oPerty roported my findings card conclusions. ti�`�r• (�. � •y 6.�/t••t �!. /'I/.Y .r/.s �. .r ,+�r+v.,..-ar� w•�.I f ��•-a�rw. /s•� : f�s.,.,�,•,,�.•. - J �a • •� •. .•�\'� . - - �Kr�• �..L.d r-I %w.j�� N�'iw•r�1.�• _ Y/1i .rli•.�.�...� '�� ••• , ,� ,` ' - :1, a •m t t. a ter, '�✓,:.ar.,,-,• .%. :E`�.r�.'�.:::fu'.!."'�'_--+.•.�:... t0• 3' �p f5'- ,,, •r /j•�'r••�2�.1 �i'J�' - .v`'. .•t t 5. ;` ,, •`.t' •� �r MI `- .n A r A• sY�/• .� MA4i ^►�1F`?�'"r + %�.+� 'r�t3`•++r c��^:r �'`.A.�� ` f�/A;, iy4 r .��ti+� ,. .X� �•. t f' , •�,",'�` iy�'s`�*�1►t. m �.:+� .;s,:: �cT :"' ',y. t� •� s;� isEw�7L�..a -�.r:'J a'. .: : a-•wt •.':.2F F.yi•L'0>,;. 5 ! 1 .r�^ �' r .�• C�;. :R'� `���. �' ��• '+ -i t � �y . .,- y;.`w w =�•L'� i N^�^ •W.a1 � J�i�,4• ! l:. _ Ir t .N��`�. Rl�. �•f i C.� � �. ��� M .G� �.:•.•:s�w ,,yv_ � � !"f•�i .�a ���c'ta, •.va'�, ,�.'�••. �• � +s�'. - s, „+ R:, �y'': e� .w,. IL ;M:.;'M' " ;,:4-" .�V'%�'--�::iM r.,•,a V"`�y,^'J'..J k a:,• •..,.a-'"� `'';�5. .. 's`'�:•,._ sf.:... �• A• •:S,'.,, 1 •:. •.r.:a .,C ;�:v. •++.vy�' +y q .,+a..;ti•;_ r. '.cro_u a ,•„S`'' r °'•S .ayR:!„ ::. :.t•fr" x, ' ' P+ r•. -+ +a.: S"-F `'�'a":%. ., aY, ,t•r •a,,, a �i cr-tr, �.•,•o`tJv •sF'i>`;.�. •�•2yY:xK:�f-. -•`ti�r'' - �'j�''9 �.y. `Wi.���•� ,�T .w •t}�� W �` F-94>� .[w Y.^� \ n'.?s• egt •'•"�+d5'w'r•`•`G•�•V1- rFr�.i�Al •.y. rY' P M. -'W - �. F>>''y )r.f.t.Si•C-►`.� 4 q> : NOTES AND COMMENTS ON PLUMBING SYSTEM D NONE 401, 64- •SF+[41AWt •_ .� !`i vs CAPE oco 1 4 r C4S 13UILDING q�N rLp INSPE s T[ SzPT1L`SYSTEH,- CESSVODiS f t ! HOLDING TANK, D:STAIDVyrON COHCRc TEr6LOCK { 90X AND LBACH]HG F7«U`. PIT WIN CRUSHED Sfarns of sin lcs toilet t 6owl s & tubs I . �i X T H E ,l��A�C�Y �AU CE'�'� w Red Indicates Iron- Iron in voter in a conceniration of 0.3 mg/ ,-r. or more may give the water a bittersweel tosle and cause an unpleosont odor. Brownish color causes staining of laundry and porcelain.The average concentration of iron in cope cod'swoter is0.2 � 1 J to 0.6 rng/I. Although the presence of iron in water may cause the 30 b 1,2a problems mentionedabove, it is not considered deleterious to heolth. o PEPPS a PERPS p DROPS 0 �P Iron moy be removed by o number of dilferent iron removol sysiems. MINUTE o ► INU3E 0 MINUTE MINUTE b Blue/Green Indicates- Copper. Due to the acidic nature of the ° 90 p 192 310 0<xs b waier on cope cod, copper tends to leach from pipes. This normally GALS. PER 10 P R °PER does not present a health hazard, however, concentrolions in excess o LAOMTM o MONTH o JAONTH o M0N7H ° t t •t of 1.0 mg/I may couse o meiallic tosie and / or o bluer gfeen stein HOT WATER LEAKS on fixtures, ADD TD YOUR ENERGY BILLSr Gallons Kwh's) Propane/ Month Month 30 Drop sil-linute 22 1.02 60 DropstMinutt 46.38 2.22 90 Drop stMinute 77.6A 3.48 t 120 Dro:W%inuie 146_E3 4.69 3'Solid Stream 274.27 1273 Avvaoo toss or water from teakinq fQ%Mels over a pedod of t mp9th fL 1 - F� t00% UTICA NATIONAL INSURANCE GROUP ® Insurance that starts with you. MARY ANNE WUTHRICH DBA: FERNBR OOK INN 481 MAIN ST. CENTERVILLE MA 02632 f .. .�'1^Y.. x l�:i - ..•♦t:.: :> •::h;ijr.v....v\.. "i.Jr -r i .. ::}:i}:}}}}}}.i::-;v:,h: v:-v-• .....rr...........:.::::............ r:...:r r -: ri..::.:.>::. :.::............:.........:::::::+:;,.•.!: ' ..:fi?i ,/:.:r.... .....i,........LnC.•f r,.r. :...Y..:�.:..f.. ............,,, r.... ........F. .:.::.r. 1{ ,:r..::...... 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J!. ..• ... :.fv.,ri,�v}}v .J;::};vJ n?:.'••.;•::r r.:}:::f:.nv,.{+J.;.}...yvv: : :-.::{.. r.:.:..........:..:•:::.:.f!i:.d..r..................v.n.vv. ..v..,... i v..... ... ... .......:.�/....x.vl...f}i}}'if{•. •Jrr{ r�'f +: ur....?rf�:...r.:::.�:,�:::,... .i ,.�v:•wr:2:;r.. .•�.::•..r::rrr:!r... !.:x:..,,..,.,,.,,,..,,1..,..:.,,.�....... ...d..»k, •}y+;,.ax�:'.:•r}.c.,.,� !'.C�•..•...,�r. :::::.. :.....: .r.�.::i.:v,:::ii::':::::::jy;i%iY::is tf!•?}}i?:i!... i}'fr:" :41;:i% r.!'Jf!•: r.^}..IrY. ...:... :.:......... ..n :: r r:::.:::.v.....:.1�4:::ii:�}ti'rv::i• ,vb!:{-?{:tC:' rwd�:r•Si:/x 'f ` s IF YOU HAVE ANY QUESTIONS PLEASE CONTACT:.. USA MACCINI-BARR TELEPHONE:(781) 224-2600 DRAKE SWAN&CROCKER INS 77727 s ' s f 3 e. 790-2375 { FIRE DEPT. , CENTERVILLE-OSTERV.ILLE-MARSTONS MILLS., j ALARM RESPONSE NOTIFICATION DATE �I.lNe©1 TIME numicR\OCCUPANT L; Q� ��•R'��,Q O- LOCATION Ll F.D. CALLED BY ("1 I CAUSE OF ALARM IF DETERMINED W'nA'g ( 7� OWNER OR REPRESENTIVE ON LOCATION OR NOTIFIED OF ALARM 1 . ACTION TAKEN BY F.D.AT LOCATION C tee, f~ o , J �II i I ReadyRooter READY - ROOTER, INC. [WorkNumber P.O.Box 371 Sandwich,MA 02563 Phone: 508-888-6055 Date of ervice Fax: 508-888-0242 11 CUSTOMER NO. SAVE THIS INVOICE FOR YOUR GUARANTEE CUSTOMER CLASS13 RESIDENTIAL COMMERCIAL C R NAME CUSTOMER PHONE TENANT PHONE l n BILLIJJG/�D S �� a FEDERAL I.D.NUMBER PURCHASE ORDER NO. 04-3441584 y — TAT ZIP CHARGE AUTHORIZATION MAP CODE ADDRESS(JOB ADDRESS IF DIFFERENT THAN BILLING ADDRESS) STATE ZIP APARTMENT NO. TENANT NAME DESCRIPTION OF SERVICES k t � F YY- TERMS:DUE UPON COMPLETION GUARANTEE OTHER CHARGES INVOICE A W5 U N T S I HAVE THE AUTHORITY TO ORDER THE ABOVE WORK AND DO SO ORDER AS OUTLINED ABOVE.IT IS i I TOTAL AGREED THAT THE SELLER WILL RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL t - PARTS FINAL AND COMPLETE PAYMENT IS MADE AND IF SETTLEMENT IS NOT MADE AS AGREED,THE SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY $ LABOR DAMAGES RESULTING FROM THE REMOVAL THEREOF DISCOUNTS $ TOTAL AUTHORIZED SIGNATURE OTHER TYPE OF SERVICE TERMS OF PAYMENT In the event check is returned, TAX EXEMPT PLUMBING ❑ HEATING CASH ❑ CHECK ❑ "the company will charge the Tax SEPTIC ❑ SEWER AND DRAIN❑ ACCT.REC. ❑ CREDIT CARD ❑ customer a$25.00 processing tee. TOTAL EXPIRATION DATE CREDIT CARD NO. # This is to acknowledge completion of the above described work which has been done to my complete satisfaction. . a DATE TOM ER SIGNATURE SERVI ETECHNICIAN'SNAME INVOICE NO. 1431 PART d DESCRIPTION,VENDOR&P.O.N PRICETO CU . • PART d DES Rl N OF PAR! PRICE TO CUST. OTV USED It, W t� � . •G'�1 S o a _ - of t1^+n rlr = k ReqyRoterdO READY - ROOFER, INC. work Order Number P.O.Box 371 Sandwich,MA 02563 Phone: 508-888-6055 Date of Service Fax: 508-888-0242 CUSTOMER NO. CUSTOMER CLASS SAVE THIS INVOICE FOR YOUR GUARANTEE RESIDENTIAL DIcoMMERCIAL C ST ER NAME .---- CUSTOMER PHONE TENANT PHONE rn I�r� BI I qD SS FEDERAL I.D.NUMBER PURCHASE ORDER NO. r 04-3441584 STATE ZIP CHARGE AUTHORIZATION MAP CODE AD SS(JOB ADDRESS IF DIFFERENT THAN BILLING ADDRESS) STATE ZIP APARTMENT NO. TENANT NAME DESCRIPTION OF SERVICES r , TERMS:DUE UPON COMPLETION GUARANTEE OTHER CHARGES INVOICE AMOUNTS. . I HAVE THE AUTHORITY TO ORDER THE ABOVE WORK AND DO SO ORDER AS OUTLINED ABOVE.IT IS TOTAL AGREED THATTHE SELLER WILL RETAIN TITLE TO ANY EQUIPMENT OR MATERIAL FURNISHED UNTIL PARTS FINAL AND COMPLETE PAYMENT IS MADE AND IF SETTLEMENT IS NOT MADE AS AGREED,THE SELLER SHALL HAVE THE RIGHT TO REMOVE SAME AND THE SELLER WILL BE HELD HARMLESS FOR ANY - - LABOR - DAMAGES RESULTING FROM THE REMOVAL THEREOF. DISCOUNTS .$ TOTAL -10 AUTHORIZED SIGNATURE OTHER TYPE OF SERVICE TERMS OF PAYMENT TAX EXEMPT PLUMBING ❑ HEATI CASH In the event check is returned, ❑ CHECK P -®the company wilt charge the # Tax SEPTIC SEWER AND DRAIN❑ ACCT R __e-- DIT CARD ❑ customer a$25.00 processing fee. TOTAL - EXPIRATION DATE - CREDIT CARD NO. This is to acknowle kompI tion of the above described work which has been done to my complete satisfaction. V C"a , 1 r # DATE CUSTOMER SIGNATURE• SERVICETE HNICWN'SNAME INVOICE NO. PART# DESCRIPTION,VENDOR&P.O.# PRICETO CUST. OTV USED • • ;x PART# DESCRIPTION OF PART PRICE TO COST. OTV USED • e e 1 • r - - _ _ E r t �' :_, 4;:®:.: #L_ �. �►. .;� � �� f „' � ,i f e# .a I ', 4 .,``� TOWN OF BARNSTABLE BUIL'gING PERMIT APPLICATION Map -ZO9— Parcel �V�-�� Permit# 'Health Division Date Issued '7— , ejqConservation Division S, l0 Fee 2-6 0t Tax Collector (�I� Treasurer SEPTIC SYS .EM MUST BE INSTALLED IN COMPLIANCE Planning Dept. WITH TITLES Date Definitive Plan Approved by Planning Board E113VIl7NtENTA,I.CODE AND TOWN FMOULATIONS Historic-OKH Preservation/Hyannis Project Street Address �.51 �G��•,r� � �D/� Village &C�J_\.JA h 1 Owner S�- t. Address Telephone Permit Request Q_ Square f2t: 1st floor: existing roposed 916 2nd floor: existing proposed Total new Valuation 4(oning District Flood Plain Groundwater Overlay 'Construction Type Lot Size 5f _ Grandfathered: O Yes ❑No If yes, attach supporting documentation. Dwelling Type: Si0eamily lld' Two Family ❑ Multi-Family(#units) Age of Existing Structure [ D 0 L-V\p Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes 0 No Basement Type: Cull b"Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing Li new Half!existing new Number of Bedrooms: existing new _D Total Room Count(not including baths): existing 0 new_ 0 First Floor Room Count Heat Type and Fuel: UGas ❑Oil ❑Electric ❑Other Central Air: ❑Yes CXo Fireplaces: Existing New Existing wood/coal stove: ❑Yes 0 No Detached garage:❑existing ❑new size Pool: 0 existing ❑new size Barn:❑existing ❑new size Attached garage:0 existing 0 new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# OL)I 2ecorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use" - �� Y roposed Use BUILDER INFORMATION / —7 t Name rQ_V�� Q.� o� Telephone Number �o A la Address , f 1 �f�ax License# 0�1 9 8- 7 7 (�_ _ Home Improvement Contractor# I :7 6 ] Worker's Compensation# �!k- 30 U� 0 C b� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Cl C\ SIGNATURE DATE I r FOR OFFICIAL USE ONLY e ' 4 S i PERMIT NO. DATE ISSUED MAP/PARCEL NO: ADDRESS -` VILLAGE OWNER DATE,OF INSPECTION:' ' POUNDATION ' FRAME + INSULATION FIREPLACE _ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH - : ' ` FINAL GAS: ROUGH a; : . FINAL FINAL BUILDING - A - DATEyQLOSED OUT ASSOC ATION PLAN NO. " i RESIDENTIAL BUILDING PERMIT FEES ' APPLICATION FEE New Buildings,Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE r SG 0 square feet x$96/sq.foot= ) x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE .0 square feet x$64/sq.foot= I';;L 5S x.0031= ` b plus from below(if applicable) ACCESSORY STRUCTURE>120 sq.ft` >120 sf-500 sf $35.00 >500 sf-750 sf 50.00 ->750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= " 6 (n&Tber) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee projcost The Town of Barnstable Y � &UU ; s` o;9. Regulatory Services �'ATf ;ya�0 Thomas F. Geiler, Director, Building Division Peter F. DiMatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. �c,b Date 3 _ ��. AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be'done by registered contractors,with certain exceptions,along with other . requirements. -�- Type of Work: lax �tom. d' "���13�� Estimated Cost C'l l'���� Address of Work: Owner's Name: ' i 1 Date of Application: b I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT OR GUARANTY FUND UNDER MGL cE ACCESS TO THE ARBITRATION PROGRAM .142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the ag t the owner: Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav:rev-070601 ne Commonwealth of Massachusetts _•_ Department 7f indusenal Accidents _ � :: �- r Of/ICCOf/OYCSUg8U00S 600 Washington Street T Boston,Mass. 02111 =ram, Workers' Coen ensation Insurance Affidavit L name: location. city a Q�nf'IJIOW 'ern phone# -7 1 rl 7 ❑ I am a homeowner performing all work myself: ❑ lam a sole etor and have no one workin in any ////u �//�///f' %/%%%//////2/ %/////���� on this'ob workers' ensation for my worlang com aav name..- .. :.....:: ......... ... ..................... :ik::i7:':k:k::;k::};:ir}: {. k•::{{ :.;..:......::......... 4 employ�T prow addres ...... .. . ry.y.;?ri: 6L ........::::::::::.::::::::..:.:,.::•.:::::::.:.:::•.}}?'rca....:"::::::::...........'::::' ;;:':;:':;:: i`:.>.:,;!':':..... ;::...!....iii`:f:;i:'i{:::::: :<j^:;':':i•;;:3+`.. ::-}?fill iii::ii i:,:i•:.�}?.':.i:•:..":i:i:" Z. :::::::...:.::::::::•:.i:3::.?`::?i::.::::::;.i.:::ii:}iii}i:'::}:?}iy;.;.J.}{'?i4ii;:::;.::::: {: ... .. .. ...i.......... ,L o 4 airs t: p h .Q tV♦ � 4 { : X is inJtlraRCe'C6 _' ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hued the contractors listed below who have ' compensation olives: workers P :..:::::::.....:.:::.::::.::::::::.:.?:;.?;:.}:.??;:.?:.;:.};}:: the following mP.:..:,..:::.:.::::::.:::::::::. 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Li}:{{•}}}}'•}:4:}:'}Y?}}}ii??:vii4?:4%{?k:i?:{•}y 7:C}':w:::.:........:v::::::::'•" :n:.:,;. ............:.:.::::::::::.}}}?:4?:;•:??isv::::::::::::::::::::::.;:::::.:.......:::::::::::::n::v::.}}}:v}:O}:•::{{•:•isv:V::::i}?:•}7}?:•}}:{•}:•.::�v:h'•}:•?:{•: .................................. .. ...................:............::.................:. ......................:......v.............-.....::,.........-............. :••4v..%...... ...... ... .... ... . ........................ .:::::................:•::......................................::w.v::....•' ...x. ..n+v{:v.{i{.}ti{-}w:^:{:::.:::::.,:•}:::7{Y{C:::::nv:. .;:.:.::.. aRYr ddi es ..... ...:.:.:}:is ......:::;.:••p?i.. . •':li:'?}+!`:;''i},:}':i:<,'.i'ij:>i:':<:4i:}'7:ivi':i>'riiil:::j:isj?'. ;isi>;:;:j�>2k:"5:+;:?`:'":.'v:r:'>i: ......:"::.:..:.... .....: :a?::•;.......is ............,.....:.. .. .... ......... .......... ........... .................. ............................................ .......,..... ......:..........:i}}..........iii{ .... .............. ..................::•:•}::?i:;}}:;:{:::.,,...:,'•:•}>:::...........::•:::::::::::•:: ;}:.; :{:•y:a:•:;:{;•}:a;::iv iiiY:•i:xi::;�i::i:i i`:i:i ti:iy::?:.. ::•......:::::...:.....:::.:::.......::::::::::::•.......................... ..v.::•::w:•. ..........::::::........::•::::....,...:.,..-...................................................... ....4K:�:{{+{iii?:� :' ........:.. .. nnirance Failure to secure coverage as tegaired wader Section 23A o[MGL ro can lead to the imposition of cry penalties of a Sae up to suca.00 and/or one yes,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of SIOLanon. a day a;stoat au: I understand that a copy of this statement any be forwardtd to the Once of Investlgations of the DIA for coverage veritieation. I do hereby certify under the paias and penalties o perjury ih&&ei#W=adon provided above is irw and coned sigaature Print name Phone# S UCc official use only do not write in this area to be completed by city or taws of&cW Pervo ❑$uMiag Department city or town: - Ltaue ❑Livening Board ❑Selectmen's O®ce checkif immediate response is required ❑Health Department QOther contact person: — phone f!; arilud 9195 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation forth employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal resematives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal ., employing employees. However the owner of a dwelling house having notpore than three apartments and who 'des therein,or the occupant of the dwelling house of maintenance, construction repair work an such dwelling house or on the grounds or another who employs persons to do building appurtenant thereto shall not because of such emplo ent be deemed to be an employer. MGL chapter 152 section 25 also states that every state or 1 cal licensing agency shall withhold the issuance or renewal �P o ha s of a license or permit to operate'a business or to constru buildings in the commonwealth for any applicant wh not produced acceptable evidenci of compliance with th insurance coverage required. Additionally,nertherthe commonwealth nor any of its political`subdivisions shall into any contract for the performance of public work until acceptable evidence of compliance with`•the insurance of this chapter have been presented to the contracting authority. ,90 Applicants Please fill in the workers' compensation affidavitE lately,by checking the box that applies to your situation and affidavits ma be . cafe Of insurance as all Y supplying company names,address and phone along with a certificate i submitted to the Departzn=of Industrial for canfirmatioa of insurance coverage. Also be sere sign and date the affidavit. The affidavit should be to the city or town that the application for the permit or l lcense is being requested,not the Department of Accedes. Should you have any questions regarding the"law"or if you are required to obtain a workers'compensation ohcy,pleas call the Department at the number listed b ow. City or Towns Please be sure that the affidavit is complete printed legibly. The epartment has provided a space at the bottom of thr affidavit for you to fill out in the event the ffice of Investigations has contact You regarding the applicant. Please be sure to fill in the permit/license number 'ch will be used as a number. The affidavits may be retztmed io the Department by mail or FAX unless arrangements have been made. The Office of Investigations would like thank you in advance for you coop 'on and should you have any questions. please do not hesitate to give us a call. �j i The Department's address,telephone an fax number. ' lie Commonwealth Of Massachusetts Department of Industrial Accidents Office of linestlnatlons 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 7274900 exL 406, 409 or 375 \, 780 C MR Append'&J 'f:ableJL=-b(eontlsaed) Prescriptive Preka;a for One and Two-FIRIEW Reeidmdai BoiWlnp Heated M&Foaad Fuels MAXIMUM lY@illilUM Glazing Glazing Ceiling wall E7oor o isestiO�mdmw Area'(%) U-value= R-valued It value WWIUO wall �°PiO� Package &walwO &value' 5"1 to 6500 Heating De6ese Dap' Q Ir/. 1 0.40 38 13 19 10 6 Normal R 12% 0.52 30 19 19 10 6 Normal S 12% 0.50 38 13 19 10• 6 85 AFUE T 15% 0.36 38 13 25 WA Wf Normal U 15% 0.46 1 38 19 19 10 6 Normal V 15•/0 0.44 38 13 25 WA WA 85 AFUE w 15% 0.52 30 19 19 10 6 83 AFUE X IS•/. 032 38 13 25 . WA WA Normal Y 19% 0.42 38 19 2S WA WA Normal Z ( 18•/. 0,42 38 13 19 10 6 90 ARM AA 18% 0.50 30 19 19 10 6 90 AFUE 1. ADDRESS OF PROPERTY: ! � \ FOOTAGE OF ALL EXTERIOR WALLS: y 2. SQUARE FO , 3. SQUARE FOOTAGE OF ALL GLAZING: 4. %GLAZING AREA(#3 DIVIDED BY#2): 5. SELECT PACKAGE(Q—AA-see chart above): NOTE: OTHER MORE INVOLVED METHODS OF DETERMINING ENERGY REQUIREMENTS ARE AVAILABLE. ASK US FOR THIS INFORMATION- BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-f980303a r 780 CMR Appendix f Footnotes to Table A2.1 b:: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors, skylights, and basement windows if located in walls that enclose conditioned space,but excluding opaque doors)to the gross wall area, expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 'After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table JI.5.3a. U-values are for .whole units:center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R 30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation: Ceiling R values represent the sum of cavity insulation plus insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the sum of the wall cavity insulation plus insulating sheathing(if used). Do not include exterior siding,structural sheathing,and interior drywall.For example,an R 19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-frame ae or mass(concrete,masonry,log)wall constructions,but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces(such as unconditioned crawlspaces,basements, or garages).Floors over outside air must meet the ceiling requirements. Tire entire opaque portion of any individual basement wall with an average depth less than 50%below grade must mc:t the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned br..,ements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3,4,or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment,the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. , 'For Heating Degree Day requirements of the closest city or town see Table J5.2.l a NOTES: a)Glazing areas and U-values are maximum acceptable levels.Insulation R values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 035.Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate 0-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c) If a ceiling,wall,floor,basement wall,slab-edge,or crawl space wall component includes two or more areas with different insulation levels,the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). 43 Doc:965, W 03-19-2 ` 3:06 BARNSTABLE LWO GWRT REGISTRY 263¢'�A 5 Town of Barnstable Zoning Board of Appeals 6 Decision and Notice 9 • Appeal 2002-012 - Wuthrich Modification of Variance 1998-60, Conditions 1,4, and 6 - i Summary: Granted with conditions Petitioner: Mary Anne Wuthrich Property Address: 481 Main Street,Centerville,MA Map/Parcel: Map 208,Parcel 085-004 Zoning: Residential C-2,Residential D-1&Resource Protection Overlay Districts Relief Requested&Background: The subject property is a 0.91-acre lot in the Village of Centerville commonly addressed as 481 Main Street. The property is improved with a 5,425 sq.ft.three-story wood frame house and a 312 sq.ft. accessory cottage. The property is commonly known as"The Inn at Fernbrook". Including the cottage,there are a total of 8 bedrooms on the property. According to the Assessor's records,the house was constructed around 1880. It is on the National Register of Historic Places. In 1998,the Board issued Variance 1998-60 to the property allowing it to be used as a seven room Bed and ? Breakfast. The variance permitted 6 guest rooms in the principal structure, and a seventh guest room in the accessory cottage structure. The principal structure also has another bedroom—an eighth-for the owner. In issuing Variance 1998-60,the Board imposed nine conditions. The applicant is seeking a modification of that Variance to permit improvements to the property. According to the plans presented, an addition is being proposed for the south side of the structure and new porches for both the south and north sides of the structure. To accomplish the plan,the applicant has requested a modification of Variance 1998-60, Conditions Number 1, 4 and 6. Those condition read as follows: 1)The*property shall conform to and be maintained in its existing condition. Parking shall be provided as shown on the submitted site plan prepared for Mary Ann Wuthrich by Yankee Survey J Consultants. 4) The total number of bedrooms or size of the dwelling shall not be increased or expanded without further relief from the Zoning Board of Appeals. 6)Vegetation in the front and side yards, and around parking areas that act as screening for the parking areas and building,shall be maintained. Shrubs,trees, and other plants that die shall be J replaced with new vegetation. The proposal was before Site Plan Review on January 24, 2002, and January 31, 2002, at which time the plan was found approvable. Procedural&Hearing.Summary: This appeal was filed at the Town Clerk's Office and at the Office of the Zoning Board of Appeals on January 08, 2002. A public hearing before the Zoning Board of Appeals was duly advertised and notices sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened February 06, 2002, at which time the Board granted the modification to permit the additions. Board members deciding this appeal were Daniel M. Creedon,Thomas A.DeRiemer,Ralph Copeland,Randolph Childs and Ron S.,Janson. Attorney John Kenney represented the applicant who was also present during the hearings. Mr.Kenney stated that this was part of on-going renovations at Fernbrook. These renovations would allow the owner to centralize the laundry operations, office and modernize the kitchen. Mr. Kenney requested modification of conditions 1,4,and 6 of Variance 1998-60. , The Board and Mr.Kenney discussed the amount of square footage to be added. Mr.Jansson expressed . concerns that the additions could.be substantial. Mr.Kenney did not have the actual amount of area to`be added. It was determined that the estimates given in the staff report included those porch areas to be removed. The addition of the second floor was determined to be approximately 80 sq.ft. The Board discussed the reasoning for the restriction in the size of the structure. Mr. DeRiemer stated that he was present at the prior hearing and recalls that the conditions were to limit the number of rooms for rent. The Board conferred on nature of the relief xequested and its process. Town Attorney,Robert Smith addressed the issue,recommending that variance relief is appropriate given that the existing Variance 1998-60 . governs the property. Mr. Copeland noted that the relief requested'was to modify,an existing variance were findings for its grant was already established and that no new findings needed to be entered into the record. Decision: At the open public hearing of February 06,2002,a motion was duly made and seconded to grant the modification request to allow for the expansion of the structure as per plan presented entitled, "Site Plan`of Land.Located in Barnstable,MA(Centerville)prepared for Mary Ann Wuthrich" dated April 8, 1998,and last revised date of January 8, 2002,drawn by Yankee Survey Consultants with the stipulation that all. condition of Variance 1998-60 shall remain in effect. The vote was as follows: AYE: Daniel M. Creedon,Thomas A. DeRiemer,Ralph Copeland,Randolph Childs and Ron S.Janson NAY: None .. Ordered: , The Board has permitted the structure to be expanded as presented. All conditions imposed in Variance 1998-60,.shall be applicable to the,structure and the additions permitted in this modification. This decision must be recorded at the Registry of Deeds for it to be in effect. The relief authorized by this decision must be exercised within one year. 2 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 Town. Clerk. _ 20 1 1 ,02— Ron S.Jans Ch rman 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 thkttp, &-a q4 of the decision has been filed in the office of the Town Clerk. •, t t CI• !� Signed and sealed this .day of2� !underte pains and penaltsf u -'I r i ` �• D . / Q,. Linda Hutchenrider;Town Clerk; Ilk\ -jK 3 Abutters Within 300' of Map 208 Parcel 085-004 This list by itself does NOT constitute a certified list of abutters and is provided only as an aid to the determination of abutters. The requestor of this list is responsible for ensuring the correct notification of abutters. Owner and address data taken from Assessor's database November 5,2001. Mappar Ownerl Owner's Address City Stat Zip Country 207043 a BARNSTABLE,TOWN OF(REC) 367 MAIN ST HYANNIS MA 02601 207- � ]MERCANDET-R PAUL L&SONDRA A 508 MAW ST CENTERVILLE MA 632 1103 CENTERVHXE MA 02632 07045001 a MILLS;CLARENCE H&ETHEL L ' X 207045002.MILLS, OX 1103 CENTERVILLE CLARENCE H&ETHEL L 02632 07046 CAMPBELL,GEORGE K&LOREITA,TRS CAMPBELL NOMINEE TRUST 90 MAIN ST CENTERVE LE MA 02632 207048 o CENTERVILLE HIST SCTY INC PO BOX 491 CENTERVII LE MA 02632 207109 MERCANDETI,PAUL L&SONDRA 508 MAIN ST fENTERVILLE MA 02632 08085001` DACEY,BRIAN ET ALS CIO PHYLIS KEANE 56 FERNBROOK LN CENTERVIi LE rMA 2632 08085002 a FORD,MORRIS&SUSAN 69 MAW ST CENTERVII.LE MA 02632 08095003 GLADCHUK,CHESTER S JR S, GLADCHUK,KATHLEEN B 3410 ARDENT OAK CIR HOUSTON 177059 �gO 208085004 WUTIiRICH,MARY ANNE 7� 81 MAW ST ENTERVILLE A 102632 208085005 H"ON,CHARLES R&SANDRA 489 MA STREET VILLE MA 02632 W 2 TREET 02632495 MAWS 08084007 DEVLN,MCHAEL G&ANITA 208085016.HQ L,RAYMOND J JR& HQ L,DEBORAH J 70 FERNBROOK LANE CENTERVILLE MA 632 „ page 1 of 2 Monday,January 14,2002 Mappar Ownerl Owner2 Address City Stat Zip Country 20808501?• SHIELDS,JOHN T&LYNN H 69 FERNBROOK LN CEN I ERVIL LE 02632 P445018 a RUPERT,DAVID J&OBR EN,JUDITH A 2 RUSTIC LN WESTPORT CT. 06880 08089001 Y OAKWOOD LIVING CNTRS MA INC 120 SOUTH MAIN ST CENTERVILLE MA 02632 208099003/ HERBERGER,MELVINA C 45 MAIN ST CENTERVILLE rA 02632 06126 ICRAWFORD,J DAVID&MONIQUE 63 MAIN ST CENTERVILLE 02632 08127 JDIEHI,CLARK E&ANITA l 497 MAIN ST CENTERVILLE rA 0202. Fi� LE,KEVIN P 151 TREMONT ST,UNIT BOSTON 02111 14K 09131 • rllAHUF,ROBERT J& PATRICIA B DONAHUE P.O.BOX 208 TERVILLE 02632 208132 KNIGHT,RONALD F&LINDA H 54 MAIN ST CENTER VILIE MA 02632 Monday,January 14,2002 Page 2 of 2 1, i'ialon M. 14726 Odor ID: �Lcvej c a av oa en KATHLEEN B as m on S PORTER RD APO1,11%MD 21402 e ccoun ax Dist 300 Land Ct# er.Prop. #SR Life Estate DL I LOT 5& Notes: DL2 C&BLC ID: 14726 CMTER S JR& 9201/073 05/15/19 Q I 243,500 DONALD&RITA J C97695 08/15/19 Q 1 207,000 TATE BUILDING CORP 08242 03/15f1982 Q 0 ET AL 01/15/1"2 U U5,000 N �rfYPe1VWcnpftox AM= We DesenplOn er TOOL, slue acne on o , se aDampffan Mmn"e , IJWMnusUnace a or e ram UM AL r9u a LEGAL NOTICES TOVM.OF BARNSTABLE ZONING BOARD OF AOPEALS' NOTICE OF PUBLIC HEARING UNDER THE ZONING ORDINANCE FEBRUARY S.2002 To all persons interested in.or.>lEfected by the Zoning Board of Appeals under Section 11. of Chapter 40A of the'GeneiN Laws of the-Commonwealth of Msssachtisetts,and all ' amendments thereto you are hdrgby notified that: 705 PM Mary Anna MfytWIGIs-The inn at Fennbrook Appea111•2062.12 Mary Anne Wythrich has applied for a Modification of Variance 1998 60,Conditions 1,4, .and 6.The applicant seeks to incorporate two,existing porches into an addition to the first floor that would allow for upgrading the kitchen,laundry and office. Also being proposed-. ' is the building of two new%t floor porches and incorporating roof decks over the addition and porches. The property is know as'The Inn at Fembrook'and is shown on Assessor's •, Map 208, Parcel 085-004,commonly.addressed 481 Mein Street.CentenAlle.MA,in a Residential C-2 and Residential D-1 Zoning District. Ir30 PM PJC Beaky Inc/Brooks Pha ina W Appeal 2002.13 PJC Realty.Inc.,has applied fora Special Pemiit under Section 3-3.0(3)(A)HB Business District,Conditional Use,Section4.4.4(2)Nonconforming Building NotUsed as a Dwelling. Section 4.4.5(1)Change of a Nonconforming Use to Another and any additional relief that may be necessary or required to permit the use and structure. The applicantseeks to construct a 91922 sq ft'Brooks Pharmacy' on the locus. The property is shown on Assessors Map 269,Parcels 014,013 and 012.commonly addressed as 506 8 530 West Main Street and 15 Bradford Road,Hyannis.MA,in a Highway Business and Residential B Zoning District. 740 PM PJC Realty Ino/Brooks PhannscV Appeal 2002-114 PJC Realty, Inc. has applied for a Variance to Section 3-5.2(7)(C)Lot Coverage in a Wellhead Protection Overlay District and any additional relief forthe use and/or dimensional requirements. The applicant seeks to construct a 9.922 sq.ft'Brooks Pharmacy'on the locus and associated site improyements with a 09.35%impervious lot coverage where the' maximum allowed lot coverage is 50%;The property is shaven on Assessors Map 269; Parcels 014.Ot 3 and 012,:commonly addressed as.506 6 530 West Main Street and 15 Bradford Road,Hyannis,MA,Iq a Highway Business and Residential B ZonlndDistrict. 740 PM PJC Reslty'lno/Brpoke PParahacy Appeal 2002.15 PJC Rfty lnc:has applied*Fa Special Permit under Section 4.4.4(2)Nonconforming Structures not.used as a S�ily Dwelling.The applicant is seeking Mlef from the requirements of Section 4-2.7;repar&g the location of parking; Section 3-3.6(5)regarding the 45 foot front yard landscape setback requirement.Section 4-2.10 reduction of parking spaces;Section 4-2.6(2)3(3)regarding landscaping withiirthe perking lot and any other relief required forthe proposed use,stricture end site development as per plans submitted. The applicant seeks to constrict a 9.922 sq,ft'Brooks Pharmacy'on the locus.. The propertyis shown on Assessors Map 269,Parcels 0 14,013 and 012.commonly addressed as 506 5530WescMain Street and l5 Bradford Road,Hyannis,MA,Ina Highway Business and Residential B Zoning District. These,Public Hearings will be hetd at the Barnstable Town Hall,367 Main Street,Hyannis. f MA,Hearing Room,2nd Floor,Wednesday.February 6,2002, Plans and applications may be reviewed at the Zoning.Board of Appeals Office,Town Offices, 200 Main Street, I Hyannis.MA. , Ron S.Jansson,Chairman Zoning Board of Appeals The'Bemstable Patriot January 18 and January 25.2002 BARNSTABLE RENSTRY 0,i1; S BOARD OF BUILDING REGULATI License: CONSTRUCTION SUPERVISORNN `. 049879 } Number— � '4 Birlttdate' '05ra 1957 ` 3' Tr:no: 25093 Expires• 4 _ _JJ - t Restricted Too4 00. -- STEVENL MELLOR'-`^ PO BOX 334 -W BARNSTABLE, MA TAN Administrator Board o(Baildiag R.eBulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 117610 . Expiration- 10/25/2002 Type: INDIVIDUAL STEVEN L MELLOR • STEVEN MELLOR 0 T99 PERCNAL ORtPO BOX 334 „�. ,�*�''; W BARNSTABLE,MA 02668 Administrator l 3� MEMORANDUM TO: Zoning Board of Appeals FROM: John W. Kenney, Esq. APPEAL NO.: 2002-12 DATE: February 6, 2002 APPLICANT: Mary Anne Wuthrich PROPERTY: 481 Main Street, Centerville, MA 02632 ASSESSOR'S MAP: Map 208 Parcel 85-4 LOT SIZE: 39,520 square feet ZONING DISTRICT: RD-1 Residential District RC-2 Residential District GROUNDWATER OVERLAY DISTRICT: GP-Aquifer Protection District RELIEF REQUESTED: Modification of conditions numbered 1, 4 and 6 of Variance Number 1998-60 CORRECTION TO ZONING APPLICATION My apologies in advance to the Board, but I repeated an error I made on the earlier application for the Variance granted for this property in 1998. On both the variance application and the current application to modify the variance I indicated that the building was not a historic structure and is not located in a historic district. However, upon further review, the Inn at Fernbrook is listed in the National Registry of Historic Places and is located in the Main Street, Centerville Historic District. I have discussed this application with Pat Anderson of the Town of Barnstable Historic District Office. Ms. Anderson informed me that given the size of the existing structure and the minimal additions being proposed no historic.commission reviews are triggered. Also, because of the limited size of the addition, no Cape Cod Commission Review is required. Attached hereto is a revised site plan which was approved by the Site Plan Review Committee. The plan differs from the site plan filed with the zoning application in three areas: 1. One parking spot on the south side of the property was .eliminated and the.expanded parking area on the north side is shown; 2. A landscape buffer between the addition on the south side and the existing parking was added; and 3. A fenced-in trash storage area was added next to the new porch on the south side. BACKGROUND The Inn at Fernbrook is located on Main Street in the heart of Centerville. The property is split by a Zoning District Boundary Line,and lies within both an RD-1 Residential District and an RC-2 Residential District. At a hearing held on April 29, 1998 the Zoning Board of Appeals granted a variance to allow The Inn at Fernbrook to be operated as a bed & breakfast inn. The variance allowed for six (6) guestrooms in the main house and one (1) guestroom in the cottage located on the premises. In granting the variance the board imposed nine (9) conditions (see attached copy of Variance 1998-60). . The applicant has applied to this board to seek approval to modify conditions 1, 4 and 6 of Variance 1998-60. The modification of these conditions is necessitated by the applicant's plans for renovations / expansion of the main structure on both the northerly and southerly sides of the building. These renovations will require the elimination of one parking spot on the southerly side of the building, an expansion in the size of the dwelling (BUT NOT the number of bedrooms) and the removal of some vegetation in the side yards. The purpose of the renovations on the southerly side is to allow the applicant to upgrade the kitchen and create an area to install a computer, telephone and laundry facilities on the first floor of the property. The applicant operates The Inn at Fernbrook by herself. Presently her computer used for reservations is located on the third floor. The laundry area is located on the 4 second floor. The kitchen, which is over sixty years old, is located on the first floor. The applicant is seeking to expand the kitchen area by enclosing two porches located on the southerly side of the property. A porch will be added to the easterly side of the proposed addition and a landscaped buffer area will be created between the addition and the current asphalt parking. One parking space will be eliminated in this area. However,the loss of the parking space is made up by the expanded parking area located on the northerly portion of the property. There is an additional reason why the applicant is seeking approval for the expansion of this structure. During recent renovations, the applicant discovered that there were approximately five eight foot by eight foot water cisterns buried under the asphalt parking area. She has been advised that this creates an unsteady foundation for the parking area and the cisterns should be removed. As part of the expansion process, the cisterns will be removed, and some of the fill from the excavation of the new foundation will be used to fill-in the void created by the removal F of the water cisterns. By pouring a new foundation wall it will created a safer foundation for the southerly side of the building. The upper portion of the expansion on the southerly side of the building will contain a replacement bathroom and a roof deck. The roof deck gives the second floor a fire egress which does not presently exist. The proposed expansion on the northerly side of the building also includes the creation of a new porch with a roof deck. The purpose of the roof deck on that side is also fire egress. The reason for the proposed expansion on the north side is that a new water line is going to have to be brought in to the property. A water line will be run in along the northerly side of the property from Main Street and enter the house in the area of this proposed porch. The applicant intends to install the water line within the next year. She is uncertain whether she will proceed with this proposed porch and roof deck, but has included it as part of this application so that if she decides to move in that direction she will not have to come back to the Zoning Board of Appeals for further approval. All of the proposed additions meet the setback requirements of the zoning districts within which the property lies. There are no changes proposed to the operation of the Inn. There will be no change in food service (breakfast only) or the number of guestrooms (six in the main house and one in the guest cottage). But for the conditions set forth in Variance 1998-60 the applicant would be allowed to make these renovations/additions to the property as a matter of right. CONCLUSIONS .The proposed renovations/expansion of The Inn at Fernbrook will allow the applicant to centralize operations of the Inn on one floor. Additionally, the creation of the two roof decks will provide fire egress for the second floor bedrooms. There will be no intensification of the Inn operations. The relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of the Zoning Ordinance. Respectfully Submitted, IW. Kenney, Esquire/ the Attorney for Petitioner I i BE CALL- 2001 -- ENGINEERING REPORT ------------------------------------- GENERAL DATA -------------------------------------- System - Joist I Live Load - 40 PSF I Dead Load - 15 PSF Spans - 1 1 OC Spacing - 16" 1 Partition Load - 0 PSF Left Cant - No I Duration - 100% 1 Repetitive - Yes Right Cant - No I Slope - 0/12 1 Construction - Glued -------------------------- -----------------------------------------------❑ ------------------------------- PRODUCT DATA -------------------------------------- Single - 11 7/8" BCI 600s ----------------------------------- ENGINEERING DATA ----------------------------------- E/10^6 = 2.00 EI/10^6 = 469.80 K = 6.52 Allowable resistive moment at 100% = 5307 ft-lbs Allowable resistive end reaction values at 1008: 1.75" to 3.49" bearing = 1225 lbs 3.5" or greater bearing = 1475 lbs 1.75" to 3.49" bearing (w/ web stiffener) = 1475 lbs 3.5" or greater bearing (w/ web stiffener) = 1525 lbs Allowable resistive intermediate reaction values at 100%: 3.5" to 5.24" bearing = 2900 lbs 5.25" or greater bearing = 3550 lbs 3.5" to 5.24" bearing (w/ web stiffener) = 2950 lbs 5.25" or greater bearing (w/ web stiffener) = 3650 lbs -------------------------------------- SPAN DATA ---------------------------------------- 1: DEAD LOAD I SPAN 1 I LOADI Begin Endl 20.0 PLFI 0' 18.1 MOMI 0.0 0.01 SHRI 180.0 -180.01 REATI 180.0 180.01 UPLIFTI - - I REAT LLI 0.0 0.01 REAT DLI 180.0 180.01 BENDI 810.0 1 DEFBI 0.101 1 DEFSI 0.012 1 0 2: DEAD LOAD PLUS LIVE LOADS AT 100 PERCENT DURATION I SPAN 1 1 LOADI Begin Endl 20.0 PLFI 0' 18.1 53.3 PLFI 0' 1811 MOMI 0.0 0.01 SHRI 660.0 -660.01 REATI 660.0 660.01 UPLIFTI - - I REAT LLI 480.0 480.OI REAT DLI 180.0 180.01 BENDI 2970.0 I DEFBI 0.369 1 DEFSI 0.044 1 3: DEAD LOAD PLUS ALL LIVE LOADS I SPAN 1 1 LOADI Begin Endl 20.0 PLFI 0' 1811 53.3 PLFI 0' 18'1 MOMI 0.0 0.01 SHRI 660.0 -660.01 REATI 660.0 660.01 UPLIFTI - - I REAT LLI 480.0 480.01 REAT DLI 180.0 180.01 BENDI 2970.0 1 DEFBI 0.369 1 DEFSI 0.044 1 4: UNBALANCED LIVE LOAD (DEAD PLUS ALL LIVE LOADS) AT ODD SPANS I SPAN 1 1 LOADI Begin Endl 20.0 PLFI 0' 18'1 53.3 PLFI 0' 1811 MOMI 0.0 0.01 SHRI 660.0 -660.01 REATI 660_0 660.01 UPLIFTI - I REAT LLI 480.0 480.01 REAT DLI 180.0 180.01 BENDI 2970.0 1 i DEFBI 0.369 1 DEFSI 0.044 1 ----------------------- END DATA / / / / I / y S ' 1 1 1 11 1 1 1 1 1 1 1 1 1 11 1.//�. • 1�1 .il.. 11 1 • .E •. .. 11 • A. 111.�1 I'' .1. • 1 ' .1111• . _ •. ... / . 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M • 1 .••G •111 • of e • Kt11 I • all 11 II •.t01111 V-1 IIIIII • .t •'1 t I 1 7\ all. .t 1 /0 0 IA // • •loss-• •. all.1/1 • • 11 \1 It• • It.1dl/ .1\ • .•II -$IA 1 *1 -6 11✓. // • 1 w • •Y.1• •11 • • • /1 .11 . • Mrs vr, • •II I l / 0 • • 1 .11 • 1 w • 0 e • I• a w`I I Y.I 14 • L Ir•; 1 • •1•-01 •\ v • • •n m114 ry 11 u1 •.I 1 1 11 11 1 1 1 � 1 1 1 . /11 614 1 I I / 1 ' 1 I I 'Tr 1 1 1 1 1 t l l ` I l I I 1 1 1 1 1111 - 1 ' II It I ' 1 r---- - - � - -- - - ---, -_-_-_.--- -_ --��. �� � .e���� � Qt l� 1 �z � e v� ��(� Z� �� f �� � � ��� � ��, � �� 2 y'r�\ �r�'Yl 1 'C � S 1 � c,��> f i �oFtNWE t Town of Barnstable Regulatory Services �&MMSTABM MASSS. Thomas F.Geiler,Director 039. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 July 9, 2003 Diane P. Caggiano,Esq. Caggiano &Joakim, P.C. Attorneys at Law 404 Main Street Centerville, MA 02632 RE: 481 Main Street, Centerville Dear Attorney Caggiano: This letter is in response to your faxed letter dated July 8, 2003 regarding the above referenced property and your two questions. 1. A permit is required to put up a tent each time it is erected unless special arrangements are made with this office for multiple dates. 2. There would not be any grandfathering as to the present structure. The structure may help your argument to the ZBA but there would need to be a finding under Section 6 of Chapter 40 that the proposed structure or use will not be intensified. This would not be done under a modification but would most likely require a variance. I hope this clarifies the matter. If you should need any further assistance please feel free to call the Building Department at 508-862-4038. Sincerely, Tom Perry Building Commissioner TP/ST JUL-09-03 12 :45 PM DIANEPCAGGIANO 978 534 9369 P. 01 -0 Dime•.0 G° c' " -fvne(600)77e&0 r VIA FACE=E July 8, 2003 Mr. Thomas Perry, Building Commissioner, Town of Barnstable, 200 Main Street, Hyannis, MA. 02601 Re: 481 Main Street, Centerville, MA Dear Mr. Perry Pursuant to your telephone conversation with Charles and Sandra Harmon regarding a metal frame structure located on the above-referenced property, I am writing to verify and document your opinion with regard to two questions. (1) Would a property owner, who purchased this property in 1997, now be required to obtain a permit from the Town of Barnstable for purposes of erecting a tent on such structure? And (2) If the present homeowner wished to erect a garage on her premises at the site of said structure, would the present structure"grandfather" the homeowner so that she could proceed to build by obtaining a"modification" as opposed to a"variance"? Thank you in advance for your assistance in the clarification of these matters, If you have any questions, or require additional information, please do not hesitate to contact me, Ve ruly yours, Diane P. Caggiano, Esq. Cc: Tom and Sandra Harmon AUG. 20. 2002 (TUE) 07:01 CENTERVILLE FIRE 5087902385 PAGE. 2 0 1 o3 Flra Rescue&Emergency Somm COMM REPORT I&A FDID S CI920 • 075 Route 2S,Conk llle,MA 02632 TW*�' Gas leak(natural gas or L,PC-,) Q8118l02 Ate" 02-F-0683 shift: District: 1-2-3 I of Call: Reponing BARNSTAB;E POLICE toce�tlon: 460 MAIN STREET = Calibeck wllon Business: 01spok6er' Simmons,Michael Tel.B _ N,is con Reed on: Telephone tie-line to FD Apparatus/Personnel Response: lniarrnetion/AALTO CONST. EHO 302 0 ENO= 0 RE9 3z4 0 Comments: EN©304 0 LAD 314 0 RFSJ123 1 0 Time, : 10;54 10:55 10:58 Rat' 00:00 In 00:00 ®31g 0 Bat+317 0 REs 32e 0 Alr Weather Temp. 0 W lnd: :npb ST.300 0 BRK 316 0 BOAT 0 BRUSH: Cless: Coal: $ 0 Arse I CHF 301 0 OPT 320 0 $C 321 1 slag: Other.307 3 BUILDINGS: T et Crooupancy: Total#or personnel: 4 Owner. OwneYli Ownses Addretxe: Tel.N: Tenant: ena s Tenerfe Address: Tel,0: Auhmotic ro Alaiffi CIAM'FIRE Form set Classlilcolon Code: Left Wtlh/At: =iikius Materiels yet !do Sudatance: Prosant9 SWIPMENT: Typo, Looalion: Vea►: make: Model: 8srlai Na. MOTOR 7YPe: Yepr: Mato: Model: Reg. Slate: S: vehlele VIN>s: COWS: Owner A44reea&Tel,0 Operator. Addrm a Tel,8 OTHER AGENCII06 NOTIFIED: Contact person: Phone: Time: By: I NARRATIVE REQUIRED ON ALL CALLE, 321(1)&307(3)dispatched to 481 Main Street in Centerville for a reported gas main break. On arrival I found that an excavator from J.C.Aalto Construction had inadvertently dug up a 2"service line leading into the Fernbrook Inn. Prior to our arrival the Inn had been evaacu:ated due to prevailing winds blowing the gas Into the building. The involved gas main is crimped off. Investigation Inside the Fembrook revealed no accumulated gas,staff and guests were allowed back into the property. Keyspan arrived after sometime and secured the shutoff at the street, the necessary repairs will be made.321 &307 cloared the scene. LIST ITVA&HEWING r a¢aC REPORT Mosley, Sarry oar: 08/19/02 acn CHIFF ! d BY: sIeHATURE pT SIONATURe: ,1 . - TOWN OF BARNSTABLE SIGN PERMIT j PARCEL ID 208 0865 004 GEOBASE ID 1,2707 ADDRESS- 481 MAIN STREET (GENT. ) PHONE CENTERVILLE ZIP - LOT 6 LC14 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO { PERMIT 30836 DESCRIPTION FERNBROOKjINN (6SQ.FT. ) PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: . Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: ., $25.00 BOND $.00 �� ,� CONSTRUCTION COSTS 753 ._ MISG.._-NOT CODED ELSEWHERE HAAN3TABM MASS. 1639. B ILDI DIVI-IONS DATE ISSUED 06,/12/1998 EXPIRATION DATE The Town of Barnstable Department of Health, Safety and Environmental Services MAM Building Division 16 9. �, 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 S �' Building Commissioner Application for Sign Permit Applicant: Assessors No. vd7 Oo'/ IV� e lioneiNo. Doing Business As: Sign Location Street/Road: j M AI-rJ Zoning District: Old Kings Highway? Ye O/No Property Owner w 6� 2 L D 4� 775 `��► 5 Name: O'Cj2 /SY�yy Telephone: Address: � �N 5 Village: CG�/7( 2cJ/LC�i r ' Sign Contractor�� � Name:_ �?/ &76 ',C/1�2%4�elephone: Address: 2 C1 s ��� Village: �✓ SA"- "'kllC�4— Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Y s/No (Note:Ifyes, a wtrmgpermitis required) 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 Section 4-3 of the Town of s le Wing r ce. Signature of Owner/Authorized Agent: Date: Size: C� Permit Fee:— Sign Permit was approved: Disapproved: Building Offi Date• `—// ` I Signature of g F NBREROOI� INN �x Z, ° WE The Town of Barnstable BAMSTABLE • Department of Health Safety and Environmental Services 6`9. Building Division '0o t A 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph M. Crossen Fax: 508-790-6230 Building Commissioner April 27, 1998 Attorney John Kenney 12 Center Place 1550 Route 28 Centerville, MA 02632 Re: SPR-032-98 Fernbrook, 481 Main Street, Centerville (208/085.004) Proposal: Legitimize operation of B & B with continental breakfast. Dear Mr. Kenney, The above referenced proposal was reviewed at the Site Plan Review Meeting of April 16, 1998 and approved under Section 4-7.4 (2) of the Barnstable Zoning Ordinance with the following conditions: • Manholes must be identified on site plan. • Easements must be explained. • Document history of cottage. • Discuss Zoning Board of Appeals step with Building Commissioner. • No food preparation allowed. On April 24, 1998, the requested information was submitted to this office and meets Site Plan Review conditions as of this date. The proposal requires Zoning Board of Appeals action to permit a B&B within a residential district. The B&B had been operating since 1987 without proper zoning relief. Drainage, parking, egress/ingress were found to meet Ordinance. COMM had concerns regarding fire protection within cottage. 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 Division. Should you have any questions, please feel free to call. Respectfully, Ralph Crossen Building Commissioner Doc:13651 L36 03-19- 3056 BARMSTA81E L PMD COURT WG[STRY . BK 11476 PG 198 40190 173--199s� IL 02 236 t 1 ve MAY -8 P3:48 Town of Barnstable Zoning Board of Appeals Decision and Notice Appeal Number 1998-60-Wuthrlch-Ferbrook inn I` Use variance to Section 3-1.1 and Setdlon 3.1.5-Principal Permitted Uses. summary: Granted with Conditions Applicant: Marianne Wuthrich(Fembrook inn) �L. Property Address: 481 Main atnrek Centervitle p Assessor's MapfParcol: Map 208,Parcel 085.004 Area: &91 acre Building Area: 5,284 sq.f6, Zoning: RD-1 Residential D-1 Zoning Ds W a RG2 Residential C-2 Zoning DWW Groundwater Overlay: AP AquNer Protection District Background: The property Is a 0.91 acre lot in the Village of Centerville commonly addressed as 481 Main Street The property is improved with a 5,425 sq.ft three-story wood frame house(Commonly known as"Fembrook t 3 Inn')and a 312 sq.R accessory cottage. Including the cottage,there are a total of 8 bedrooms on the property. According to assessors records,the house was constructed around 1900. It is on the National Register of Historic Places. The petitioner has reported that a seven room Bed and Breakfast lodging house,Including the guest cottage,has been operated at this location for approximately the past 10 years. The applicant,Is seeking to legitimize the operation of this Bed 8 Breakfast Inn. The property Is located in two residential zoning districts;an RD-1 and RC-2 District. The applicant Is requesting a use variance to Section 3.1.1 and Section 3-1.5 of the Zoning Ordinance to allow the continued operation of Fembrook inn as a Bed& Breakfast. The home and site of this appeal was originally the Kalmus mansion and grounds,apparently built in C- 1900.and known as'Fembrook'. In 1969,the Ind and home came into the possession of the Carmelite Sisters for the Aged&Infirm. On March 31, 1976,Appeal 1975-90 was approved by the Zoning Board of Appeals to permit the development of the a 120 bed eklery retirement home to be located on the back 11 acres of the property t.. and accessed from South Main Street(then Pine Street). This plait was not implemented. In 1982,a 15 lot Subdivision Plan No.4e7,"Fembrook',was initiated for the back 11 acres. The plan was approved by the Barnstable Planning Board on October 18,1962. Also at this time a 6 lot Approval Not Required(ANR)Plan was developed for the remaining six(6)acres fronting on to Main Street It was this ANR Plan that created the 40,000 sq.lt lot upon which the home(5,284 sq.ft)and two accessory structures are located,a guest cottage(estimated 286 sq.ft.)and a gazebo. This Is the subject site of the appeal before the Board today. Procedural Summary: This appeal was filed at the Town Clerk's Office and at the Once of the Zoning Board of Appeals on March 16, 1998. A public hearing before the Zoning Board of Appeals was duty advertised and notices sent to all abutters in accordance with MGL Chapter 40A. The hearing was opened April 29,1998,at which time the Board granted the request with conditions.Board Members hearing this appeal were;Gene Burman,Gall Nightingale, Richard Boy,Elizabeth Nilsson,and Chairman Emmett Oynn.Attorney John W. 7 f `� �U • -...BK 1 1476 PG 199 40190 Town of Bamslabie•Zoning Board of AApeab•Deckim and f+fotice AWeel No.1998-0-Wuthrich Vaftne to Section 3-1.1 b Sedlon 3-1.5-Prtncipal Pas.. ed tfm Kenney represented the applicant,Mary Ann Wuthrich,who was present Attorney Kenney had previously submitted a memorandum to the,file and all Board Members received It Hearing Summary: Attorney Kenney reported the applicant Is the new owner of the*Fembrook Inn'. She Is seeking to IegWn*e the operation of this Bed a Breakfast Inn with a Use Variance. Tiro property Is k=ted In two residential Zoning Districts. The RD-1 zoning classification allows for the renting of rooms as a Bed 8r Breakfasts as a Conditional Use with the granting of a Special Perna,the RC-2 District does not permit renting of rooms. Therefore,the applicant is seeking a Use Variance. Attorney Kenney gave a brief account of the recent history.noting that prior to 1988,the property was used as a private residence by Howard Marston.In 1986,the property was purchase by Brian Gallo and Salvatore Dit do and they operated it as the*Inn at FembroW until their sale of Be property in the Fall of 1997. The petitioner,Ms.Wuthrich,acquired the property on October 22,1997, Ms.Wuthrich is seeking the variance to operate the Inn as six(6)guest rooms In the main house and a seventh guest room In the garden cottage. The only Hood service that would be part of the inn operation would be a Continental Breakfast and no food preparation is anticipated. Attorney Kenney clarified that the Inn has rights to use the two curb arts onto Main street He also cited that the curbauts are also used by the residents of Fembrook Association and not Just for the Inn property. Mr. Kenney submitted the deeds and land court plans granting the rights to use both curbcuts and ways Into the property. As to parking,eleven spaces are required and there are thirteen spaces;eight on she,five Off site. A letter was submitted granting permission for the off site parking. As to Variance conditions under MGL Chapter 40A,Ssc*on 10,Attorney Kenney reported the lam cons" of a 39,520 square foot parcel of land with a 5,425 square toot main horse and a 312 square feet cottage. The property contains the historic Fembrook Rose Garden and other gardens designed by Frederick Law Olmsted. As part of the Fembrook Association the petitioner maintains the rose garden that is restricted by protective covenants, By allowing this property to continue to be used as a guest house.the property can generate Income to maintain both the house and these unique gardens,a substantial financlal hardship. These structures and gardens are the unique topographical features which especially effect this land,but do not effect generally the zoning district In which it Is located. Attorney Kenney Indicated that this property was previously operated as an Inn for the last ten years.This request,to continue the operation In the same fashion,can be granted without sulbstantial detriment to the public and without nullifying or substantially derogating from the intent or purpose of the zoning ordinance. The Town of Barnstable'&local Comprehensive Plan(LCP)encourages Bed&Breakfast operations in larger older homes to provide an adaptive reuse for these structures and to enhance the historic and economic vitality of the town. Attorney Kenney submitted a septic Inspection report from September 17,1997,which states the system passed for Title V and it states the system is adequate for 9-10 bedrooms. Both the cottage and the main house use this system. The property has received Board of Health Approval. Attorney Kenney clarified that the cottage is one single guest room with a bathroom. There Is a shower, toilet and sink-no kitchen. it is rented as a guest room only. Public Comments: No one spoke In favor or In opposition to this appeal. There Is a letter of support from Susan H.Rohrbach In the file. Attorney Kenney submitted a letter,signed by three abutting property owners,In support of the appeal. Findings of Fact: At the Hearing of April 29,1998.the Board unanimously found the following findings of fact as related to Appeal No. 1999-W; 1. The applicant is Mary Anne Wuthrich d/Wa Fembrook Inn. 2 BIC 1 1476 P0200 40190 Town of Bamstebte-Zon ft Board of AWMs-DadWm and Nosoe Appeal No.199&8 -WuVvM Vwimm to Seoaon 3-1.1 a Section 3.1.8-Prlrtdpal Permitted that 2. The applicant Is seeking a variance from Section 3-1.1 and Section 3.1.5 for a Use Variance to allow continued operation of the Fembrook Inn. 3. The property address is 481 Main Street,Centerville,MA as shown on Assessor's Map 208..Parcel 085.004 and located In the RD-1 Residential D-1 Zoning District and the RC-2 Residential C-2 Zoning District. 4. The locus consists of a 39,520 square foot parcel of land with a main house totft 5,425 square feet and a cottage containing 312 square feet 5. The property also contains a portion of the Fembrook Rose Barden and is a part of the Fembrook Association which owns and maintains the gardens designed by Frederick Law Olmsted. These structures and gardens are the unique topographical features which especially effect this land but do not effect generally the zoning district in which It Is located. S. As stated.the main house was originally constructed in 1881. During the 1650'e There were several additions to the property. The garden cottage was constructed In the 1 Q30'9. The combination of the two structures lures located on one lot the size of the main house;Its unique arohiteclurai design,layout,and features of the main house;and the Olmsted designed gardens make this property unique. 7. The house has a 748 square foot function room and a guest mom Which was formally a chapel and contains a leaded stained glass window. The age of the structure,Its size,the unique architectural features,and the magnificent gardens make 4 simply impossible for these structures lures to be used and properly maintained as a single famlyr residance. S. The hardship in this case relates directly to the topographical structural conditions which make Oft property unique. Owing specifically to the unusual nature of the buildings themselves.In particularly the fact that the total square footage Is as large as it Is,and the buildings are as old as they are,and these conditions are not normally found in the zoning dh&K the literal enforcement of the zoning ordinance would be a significant hardship to the Petitioner because the failure to be able to rent seven guest rooms In this house would pose a significant financial hardeMA which would prevent the Petitioner from being able to maintain the property. Its loss would be a great loss to the ttwrn. 9. A seven bedroom Bed and Breakfast Lodging House has been In operation at this property for the last ten years. 10. The applicant's site plan was found approvable by Site Plan Review on April 16,1998.subject to the Wowing conditions: • The applicant submit documentation describing the various easements which exist on the propery, The applicant submit a letter documenting the use of the manholes which exist on the property. • The applicant provide a historical background of the previous use of the cottage. - Al of which have been complied with. 11. The property Is served by public water and a private on-eke septic system that complies with Title V Regulations. 12. The property Is located in two residential Zoning Districts;on RD-1 Residential D-1 Zoning District& RC-2 Residential C-2 Zoning District. The RD-1 zoning classification allows for the renting of rooms as a Bed&Breakfasts as a Conditional Use with the granting of a Special Permit[from the Zoning Board of Appeals). The RC-2 District does not Therefore,the applicant is seeking a Use Variance. 13. The property is located off Main Street Centerville In the village center. This is a good location for a Bed&Breakfast. The house Itself Is a relatively large structure consisting of 21 rooms. The Local Comprehensive Plan encourages Bed al<Breakfast operations In larger older homes to provide an adaptive reuse for these structures and to enhance the historic and economic vltatity of the town. 14. The relief may be granted without substantial detriment to the public good and without nulllytng or substantially derogating from the Intent or purpose of the Zoning Ordinance. Decision: Based upon the findings a motion was duly made and seconded to grant the Applicant the relief being . sought with the following terms and conditions: 3 J - Town of8amstaba-Zan Bailed of BK 11476 P0201 40130 bq Appeals-Ded"MW Notloe ADPe+t No.t 998.t30-wWtrkh Variance to section 3.1.1&Secdan 3.1.8•Pdnerpef pennRted UM 1. The property shall conform to and be maintained In Its existing condition. Parking shall be provided as shown on the submitted site plan prepared for Mary Ann VlAfth by Yankee Survey Consultants. 2. The owner of the property shall be responsible for the operation of the property and shall be resident when the Bed&Breakfast 15 In operation. 3. The property shall contain not more than seven bedrooms,to include one guest room in the back cottage.to be occupied by not more than a total of 14 lodgers. Thera shall be one additional bedroom authorized in the main residence for purposes of owner-occupancy only. This room is not to be used for guest occupancy. 4. The"total number of bedrooms or size of the dwelling shall.not be Increased or expanded without further relief from the Zoning Board of Appeals. 5. No cooking facilities including but not limftad to stoves,microwave ovens,toaster ovens,and hot plates shalt be available to guests,and no meals except breakfast shall be served to guests. 6. Vegetation in the front and side yards,and around parking areas which acts as screening for the parking areas and binding,shall be maintained. Shrubs,tress,and otter plants which die shall be replaced with new vegetation. 7. Exterior lighting shall be low level,and shall not cause its illumination to fall onto adjacent properties. $- One sign not to exceed four sq.R in area shall be allowed. 9. The locus shall comply with all Town of Barnstable Building and Health Divisions IZegutstiors,and Fire Department Requirements. The septic system must meet Tits V requirements without variance from the Board of Health. The Vote was as follows: AYE: Gene Burman,Richard Boy,Gall Nightingale,Elizabeth Nilsson,and Chairman Emmet;Glynn NAY: None Order. Use Variance Number 199840 has been granted with conditions. This decision must be recorded at the Registry of Deeds for it to be in effect, The relief authorized by this decision must be exercised In one year. Appeals of this decision,If any,shall be made pursuant to MOL Chapter 40A,Section 17.within twenty (20) after the date of the filing of this decision. A copy of which must be filed In the office of the Town Cie - 1 ego Emmett Glynn,Chairman 08feSigned i Linda Hutchenrift,Clerk of the Town of Barnstable, that twenty(20)days have elapsed since the ZoningBoard of Appeals County,Massachusetts,hereby certify appeal of the decision has been fde in the o of the Town Clerk ts filed this decision and that no Signed and sealed this d of under Ina and penalties of per)ury. HutWtenridar, Q 1 HARIISTABGE r10, IgAS9. • _ �,�� t6�g, ,\fib, 4 y L 14.TG'•'�0202 40190 PARS N20$ ODi.004 PARS 8208 126. KEYS 121071 142 CODES300 CEYs tallas Tat 000E8300 DI9LONI0. SALYATON! S C#AY90U. J DAYIO 8 NONI40E . GALLO# i "SAN TR$ 46S MAIN it XNYTNR309E. RANT ANNE CANTBIVILLE MA 02432.0000 491 MAIN ET CENTERYILL! NA 02632-0000 PARS 9206 099.003 PARS Ra0A 089.001 FAMS•4108 045.002 KITS 127311 TAX C6618100 KISS 12729s TAX 906E8304 CET[ 1AtOSS TAX CO513300. N1a61a6tN. NILYIRA C OAKNOOO'LIYiNG CNTNS RA INC DUSTA/SON. PN1LIP.E A 44S NAt" IT STANSUARD 09ALIN Itasca S11SUYSONP 09LLN P CINTENYtLLE 114 026AI-0000 6PS ATLANTIC AYN 11TN•YLOOR 469.MAIN iT OOfTON MA 02111+0000 CtNTSRYILtE NA 02672.0000 PARS a20t 085.901 PARS a208 ODS. FAA$ 4208'Ois.841 KEYS 127062 TAN CDDES300 . . RETS 12723S TAN COOSS300 "it- 121044 tat COOES360 iLAOCNUXP CNESTIR i 41 S CARNELITE ilil!#i - DACE1. ORIAN ET ALS SLASCMUR& KATNL990 N 4690 [N[in LLOTD♦ T N 8 KSL4010 D T 123 MANIC NOAD OOK 656 9ld46100K LANE ASSOCIATION CNESTNUT MILL MA 01167-OND ' CENTERYILLE MA •01632-0000 dos 9f CadTaaVILL9 MA 02632-0900 PANS a200 095.016 PARS a20S 083.017 PARS .4201 085.013 KEYS' 12Y/97 TAX C06E1100 KITS 127204-TAN CODE1300 &ITS 122213 TAX COOE1300 HILL. RAYN0116 1 41 6 KILIOT. PEt6Y N GA1bd91v VALT92 A i RANT'0 ` NSLL• OEDOAAN i 69 YERNNDOD AYE 61 9SANSNODK L441 70 FENNOROOK LANE CINT94WILLI NA 026fi•0000 CENTiAYELLE RA 02632-0000 ClMT[NY1LL[ NA 02632-0000 PANS 1201 085.00S PANS N206 Oas.007 PANS. 4208 127. KISS 127060 TAR CODE4300 KITS 121106 TAX C06E1300 LETS 127112 TAX C66E000 NARMOM. CHARLES R 8 BARORA 01YLS%v NICMAIL•i R ANITA, DISMLO CLARK E i Ant TA i 439 MAIN STAERT 493 NAIN if 497 0494 at CENTERYILLE Ra 02632-D000 CENTERYILLE MA Wass-0000 CddTENYSLLS AA 02632-0000 • t PARS 4208 043. PANS 1208 046. PAa/ 420E 130. r KEYS 126?31 TAN COOES300 KITS _. 126140 TAX CON93300 Kill 127721 T4t'000E8300 E4AYES. OANi[L P NNITNORIN. E LEO 419 14 CNAPPLE• KEYIN P P 0 DOR 740 ii as ALIT ?RUST 151•T aENONT $T. V49T 1419 ttOVINY1LLt AA 02631-0000 3SO RAIN STREET 608104 44 02111-0300 CENTERYILLE NA 02632-0000 PARS 4206 131. BARS a20E 1$2. PAIS RIOT 044. KITS 127Y30 TAN C0694300 KEYS 12?149 TAR C66E8300 Kai$ 125190 TAt 908E1300 904ANYl. RODEAT 4 a KNIGHT* 104AL6 9 8 LINDA N "499 4to 692169 d 6 SHARON PATRICIA 8 DOMANU9 414 NAIN 31 $440 •ANSIAT STAGE? P.O. OON 204 CENTERYILLE NA 02631-0000 101611E ""am M6 21162-0000 CENTERYILLE NA 02632-0000 _ PANS 4201 043.001 ►AR& 4201 045.001 PA41 N20Y IOS. K911 123/99 TAR 000E1300 KITS 12SZO6 was C06aS300 ' tags 125421 Tat C00ES300 HILLS. CLARENCE M A ETNEL L NILLS• CLARINCE N i ETAIL L A1894110EI2. ►AUL L i SONDRA BOX 1103 DOR 1103 304 MAIN IT CINT[499LLE AA 026U!-0000 CENTERYILLE MA 02632-0000 CENTERYILLE AA 02632.0000 PARS R20? 043. PANS 3201 049. 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Report Appeal Number 1998-60-Wuthrich -Fernbrook Inn Use Variance to Section 3-1.1 and Section 3-1.5 -Principal Permitted Uses Date: April 21, 1998 To: Zoning Board of Appeals From: Approved By: Robert P. Schernig, Director Reviewed By: Art Traczyk, Principal Planner Drafted By: Alan Twarog, Associate Planner Applicant: Marianne Wuthrich(Fernbrook Inn) Property Address: 481 Main street, Centerville Assessoes.Map/Parcel: Map 208, Parcel 085.004 Area: 0.91 acre Building Area: 5,284 sq.ft. Zoning: RD-1 Residential D-1 Zoning District&RC-2 Residential.C-2 Zoning District Groundwater Overlay: AP Aquifer Protection District Filed:March 16, 1998 Public Hearing:April 29, 1998 Decision Due:June 24, 1998 Standing: The property is shown on assessor's records as owned by Salvatore Diflorio. The petitioner's application states that she has owned the subject property for about 5 months. Staff suggests the applicant submit a copy of the Purchase and Sale Agreement or Property Deed to show standing before the Board. Background: The property that'is the subject of this appeal is a 0.91 acre lot in the Village of Centerville commonly addressed as 481 Main Street. The property is improved with a 5,425 sq. ft. three-story wood frame house (Commonly known as Fernbrook Inn ) and a 312 sq. ft. accessory cottage. Including the cottage, there are a total of 8 bedrooms on the property. According to assessor's records, the house was constructed around 1900. It is on the National Register of Historic Places. The petitioner has reported that a seven room Bed and Breakfast lodging house has been operated at this location for approximately the past 10 years. There is a question of whether or not the cottage has been used as a guest room in the past. The applicant is proposing to use the cottage as one of the seven guest rooms. The applicant, the new owner, is seeking to legitimize the operation of this Bed & Breakfast Inn. The property is located in two residential zoning districts; an RD-1 and RC-2 District. The applicant is requesting a use variance to Section 3-1.1 and Section 3-1.5 of the Zoning Ordinance to allow the continued operation of Fernbrook Inn as a Bed & Breakfast. Site History: The home and site of.this appeal was originally the Kalmus mansion and grounds, apparently built in 1900) and known as"Fernbrook".. That site originally contained an estimated 16 acres inclusive of two ponds. .The.site raped around Our Lady of Victory Church grounds,and fronted on both Main Street and South - Main Street(formerly Pine Street). In 1969, the land and home came into the possession of the Carmelite Sisters for the Aged & infirm. '. t r . Town of Barnstable-Planning Department-Staff Report Appeal No. 1998-60-Wuthrich Variance to Section 3-1.1 &Section 3-1.5-Principal Permitted Uses On March 31, 1976,Appeal 1975-90 was approved by the Zoning Board of Appeals to permit the development of the a 120 bed elderly retirement home to be located on the back 11 acres of the property and accessed from South Main Street(then Pine Street). This plan was not implemented. In 1982, a 15 lot Subdivision Plan No. 487, "Fernbrook", was initiated for the back 11 acres. The plan was approved by the Barnstable Planning Board on October 18, 1982. Also at this time a 6 lot Approval Not Required (ANR) Plan was developed for the remaining 6 area fronting on to Main Street. It was this ANR Plan that created the 40,000 sq.ft. lot upon which the home (5,284 sq.ft.) and two accessory structures are located, a cabin (estimated 288 sq.ft.) and a gazebo. This is the subject site of the appeal before the Board today. Staff Review/Comments: The applicant's site plan was found approvable by Site Plan Review on April 16, 1998, subject to the following conditions: • The applicant submit documentation describing the various easements which exist on the property. The applicant submit a letter documenting the use of the manholes which exist on the property. • The applicant provide a historical background of the previous use of the cottage. The property is served by public water and a private on-site septic system. The applicant should be prepared to present evidence to the Board that the septic system has recently been inspected and that it meets Title V requirements for the proposed use. Staff also suggests the applicant submit a floor plan of the main residence and the cottage to the Board identifying the use of the rooms and those to be rented. The portion of the property along Main Street(about 180' deep) is zoned RD-1. The remainder of the site is zoned RC-2. The RD-1 zoning classification only allows single-family residential dwellings as principal permitted uses. The renting of rooms for not more than 3 non-family members by the family residing in the dwelling is permitted as an accessory use. The renting of rooms to no more than 6 lodgers and Bed & Breakfasts is allowed as conditional uses provided a special permit is first obtained from the Zoning Board of Appeals. RC-2 Districts only allow single-family residential dwellings as principal permitted uses. The renting of rooms to non-family members and Bed & Breakfast operations are not allowed as conditional or accessory uses in the RC-2 zoning district. It appears a use variance is necessary to legitimize the current use of the property as a Bed & Breakfast. The petitioner's application states that the existing Bed & Breakfast has been in operation for approximately ten years. The property has been zoned in its current configuration since July of 1974 when a portion of the property was rezoned from RC to RC-2 (STM 7/31/74, Art. 12). The remainder of the site continued to be zoned RD-1. It appears the use of the property as a seven room lodging house has never been legally permitted.. The property is located off Main Street Centerville in the village center. This is a good location for a Bed & Breakfast. The house itself is a relatively large structure consisting of 21 rooms. The Local Comprehensive Plan encourages Bed & Breakfast operations in larger older homes to provide an adaptive reuse for these structures.and to enhance the historic and economic vitality of the town. Variance Findings: In consideration for the Use Variance, the Petitioner must substantiate those conditions unique to this lot that justify the granting of the relief being sought from the Principal Permitted Use for a single-family.. dwelling. 2 Y Town of Barnstable-Planning Department-Staff.Report Appeal No. 1998-60-Wuthrich Variance to Section 3-1.1 &Section 3-1.5-Principal Permitted Uses In granting of the Use Variance the Board must find that: unique conditions exist that affect the locus but not the zoning district in which it is located, a literal enforcement of the provisions of the Zoning Ordinance would involve substantial hardship, financial or otherwise to the petitioner, and • the relief may be granted without substantial detriment to the public good and without nullifying or substantially derogating from the intent or purpose of the Zoning Ordinance. Suggested Conditions: If the Board finds to grant the relief requested, they.may wish to.consider the following conditions: 1. The property shall conform to.and be maintained in its existing condition. Parking shall be provided as shown on the submitted site plan prepared for Mary Ann Wuthrich by Yankee Survey Consultants. 2. The owner of the property shall be responsible for the operation of the property and shall be resident when the Bed & Breakfast is in operation. 3. The property shall contain not more than seven bedrooms, to include one guest room in the back cottage, to be occupied by.not more than a total of 14 lodgers. There shall be one additional bedroom authorized in the main residence for purposes of owner-occupancy only: This room is not to be used for guest occupancy. 4. The.total number of bedrooms or size of the dwelling shall not be increased or expanded without further relief from the Zoning Board of Appeals. 5. No cooking facilities including but not limited to stoves, microwave ovens, toaster ovens ,and hot plates shall be available to guests, and no meals except breakfast shall be served to guests. 6. Vegetation in the front and side yards, and.around parking areas which acts as screening for the parking areas and building, shall be maintained. Shrubs, trees, and other plants which die shall be replaced with new vegetation. 7. Exterior lighting shall be low level, and shall not cause its illumination to fall onto adjacent properties. 8. One sign not to exceed four sq. ft. in area shall be allowed. 9. The locus shall comply with all Town of Barnstable Building and Health Divisions Regulations, and Fire.Department Requirements..The septic system must meet Title V requirements without variance from the Board of Health. Attachments: Applications Assessor Map Plan Reduction copies: Applicant/Petitioner Building Commissioner. .. 3 I I 1 BEING SOUGHT I�= ZONING ahG REND V C• L,`,i3 DETE ��dw SSE TOWN OF BAFtNSTABLE EJitpovia zoning Board of Appeals BPI low A licataon Petition _for a Variance - Date Received `r Forr-_Offi-ne Use '"one:, , . Town clerk office ��//���� Appeal # PWt� , Hearing Date Decin 0a L.;?NSTASLF The undersigned hereby. appl~ie' os$o{ c Board of Appeals for a variance from the zoning ordinance, in the manner and. 0r.TF57"reasons hereinafter set forth: (508) 775-4999 Petitioner Name Marrianne Wuthrich Phone (617) 266-2806 Petitioner Address: 5 Symphony Road, Boston, MA 02215 Property Location: .481 Main Street, Ganterville, MA 02632 Property owner: same , Phone same Address of owner: same If. petitioner differs from owner, state nature of interest: N/A Number of Years owned: Five months Assessors Map/Parcel Number: 208/85-4 zoning District: RC-2 Groundwater Overlay District: AP See. oN3-/. 1 6 -1 Variance Requested: Section 3-1.5 RC-2 Residential District Cite Section & Title of the zoning ordinance Description of variance Requested: Seeking Variance to allow continued operation of a seven .(7) bedroom-Bed and Breakfast lodging house in a residential district. Description of the Reason and/or Need for the variance: Property is located in RC-2 Residential Zoning District which does not allow for the operation of a Bed and Breakfast lodging house. Discription of construction Activity (if applicable) : General clean-up and maintenance; interior and exterior pairij'inr/; minor repairs. ` Existing Level of: Development of the Property - Number of Buildings: 1 Present Use(s.) : Bed & Breakfast Lodging House Gross Floor Area: 5.284 sq.ft. ` Proposed Gross:Floor. Area to. be Added: N/A Altered: N/A Is this -property subject to. any .other relief (Variance or special Permit) from the .Zoning Board: of Appeals? Yes [)q No [ ] if Yes, please list appeal numbers or applicant's name 1975-90 Application to Petition for a variance Is the property within. a Historic District? YeS [] No +;. Is the property a Designated Landmark? yes [] No [ For Historic Department Use only: Not Applicable . . . . . . . . . . . . . . . [] OKH Plan Review Number Date Approved signature: Have you applied for a building permit? Yes [ ] No I Has the Building Inspector refused a permit? Yes [] No .YY, All applications for a variance which proposes a change in use, new construction, reconstruction, alterations or expansion, except for single or two-family dwellings, will require an approved Site Plan (see section 4- 7.3 of the Zoning ordinance) . That process should be completed prior to submitting this application to the Zoning Board of Appeals. For Building Department Use Only: Not Required [ ] site .Plan Review Number Date Approved signature: The followings information must be submitted with the Petition at the time of filing, without such information the Board of Appeals may deny your request: Three (3) copies of the completed Application Form, each with original signatures. Five (5) copies of a certified property survey (plot plan) showing the dimensions of the land, all wetlands, water bodies, surrounding roadways and the location of the existing improvements on the land. All proposed development activities, except single and two-family housing development, will require five (5) copies of a proposed site. improvements plan approved by the site Plan Review Committee. This plan must show the exact location of all proposed improvements and alterations on'the land and to structures. See "Contents of site Plan:" section 4-7.5 of the Zoning ordinance, for detail requirements. The petitioner may submit any additional supporting documents to assist the Board in making its determination. p �ignatuk6: La-�. Date: Petitioner or igentllAignlature JOHN W. KENNEY,ESQUIRE Agent's Address: 12 CENTER PLACE Phone: 7 i1 l. 66 T 1550 ROUTE 28 Fax No. CENTERVILLE,MA 02632 'aeQ p o o-vim "M AhW Avi)a �''�„ -� v� Q� 0 �-� ♦ Gip,dv. � _� .�.'�,.�� ,. WMI gm mu, ow- ma I Ali` � �,, � - .��� v�. ��11,� � ,� , •��o1�G. ��� ®r� J;g Rol OMAN ad Ulf � gnu WIVA MR P i122 124 - ' _ ni D 85-15 85 14 ' t 3 *eA *a 15 RY PL. s' mom *20 zm0.0 AC Ac 8516, O 89-3 *p , a tom e 85-12 85-19 d r 19 A< *apt � 85 17126 ORK OAK g �53- /� 17 uK Y'O \ � \� ' O 85P18 l 132 — — — r 131 _ 5 - INAC Ala - _85-1 �- 13 87 . 3 130 12,7 46 np 36 40 A( t44 ` '� q8 J o 51, #42 c� - ' y 499 aesA t ' 3? �.I n+t,T ri r L139 uoAc _ _ •5 �- 138 1is8yS--'4 ' - - j *59 �i, 63 „ N Scale: 1 — 180 Wuthrich Map 208, Parcel.085.004 w j-- - 3660 Main Street Barnstable s - JI�� 6 .. .. _ _ ASPHALT PARKING reer r1�T� . cB )YAY& E177UTY EASEMENT 1 I I I I I I i3 CREW Old LOT 5. ASPHALT DRtlalTA r _ Mir T — � LOCUS gI�GSA _.T . 1 \ IPARNGI I: oocb surlBa T LOT 5. I I cp ASSESSORS LOT 95-4 \F\�� • L9.0'I �O AR£A.99.520t,SQ. 17 \ al lmxr 1+ �� RrS. ZONE RD-I' 0 0 AAA/Nold \\ \ B[Ip LOT B FLOOD ZONE .�• ASSESSORS MAP ZOa a O M GRASS /#' S \ 0 .•!t4'Sh 4 4' A.wOIZ \ - - ---------- tv _ TArj%-- AT FERNBROOK------� DRJI `'-____=----- _ m oAx _---------- ffALL JOJt / N® $ �` =__Je �� .sPccs •-. c"(' BO.Ol�A2 E %` o I I uc4xt `� ==o ISURi TJ 60.49 . SCOOT T_<<_�--—— - ASPHALT BUCK EA GRA _ y � - ' TREE GARDLN �( _� OLl,V!(0�~ AREA L`] ..� �®� CONC 1 AREA 11 � .4RBOR)9TES J4--P "�_ \ PECK `� SITF. PLAN C.D 20$36. �` (iDR SITE PLAN REQE)V OF LAND LOCATED IN UARNSTABLE. AM a - (r£Nr£R)7LLe) LOT 7 PREPARED fVR MARY ANN HTITNRICH 1 CERTD•Y 711,471 THIS SURVEY AND PLAN NTRE AI.4DE 1N ACCORDAnt'Ej h9TH THE PROCEDURAL AND MCNAJCAL ST.4AWARDS OM TtL PRACTICE OF LAND S(,WlVZ%G IN THE COATA(0A:4'S,,07( OF.WSY-4CNCSL97S. { PAUL A. 1/£RJ•l:IL4w P.LS DATE GRAPHIC. SCALE ).4NKeE SURVEY CONSULTANTS CCY?1.p O �D yyD aB5 ROAD w 1.41111 ' AI.LLS, L�AS:S "648 r!8 42B-0055 FA.Y 420-5553 (M rR'1 1 i�e• zo n • _- - JOB 0I64 OA6— l� PARCEL IDENTIFICATION NUMBER PROPERTY ADDRESS I I ZONING (DISTRICT CODE SP-DISTS.I DATE PRINTED(STATE I pCS I t,NBHD �- KEY NO. CLASS 0485 MAIN STREET CENT. 10 RC-2 30C loco 07/09/95 1011 JJ 54AA 1220k: 085.004 127071 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS Y UNIT ADJ'D.UNIT Lana By/Dale Site D�menswo LOC./V R.SPEC.CLASS ADJ. CORD. P PRICE PRICE ACRES/UNITS VALUE OescripUoo D I f L O 1 O♦ S A L V A T 0 R E MAP- CD FF De Ih/Acres #L A A D 1. 76,400 CARDS IN ACCOUNT - L 10 18LOG.SIT A x .91 =10C 105 79999.9S 83999.9 .91 764UJ 4OLDG(S)-CARD-1 1 584,300 01 OF 01 #PL 481 MAIN ST COST. 66070C A N BATHS 6.2 U X F= 100 54600.00 54600.00 1.00 54600 .3 :9DL LOT 6 LC14972-D MARKET 380,900 E) - 1/2 6SMT S x F= 100 2.65 5.56 1907 1060U-a 4S1 12/81 24 $00172600 I INCOME FIREPLACE U X F= 100 6500.DC 6500.00 3.00 1950U J 4 k 095D 0110 USE A EXT F1REPL U x F= 100 28CO.0 2800.UG 3.00 64JU 3 APPRAISED VALUE D A. 660,700 D PARCEL SUMMARY A U AND 764CO Ts BLDGS 584300 A _T T •-IMPS M _ I TOTAL 660700, EN CNST F - DEED REFERENCE Tyw DATE geco,G.� R.I O R YEAR VALUE E N Bqq. P,ge Ine' MD YL ID sap P.ice AND 76400 A C1D5370 I05/86 340000 DLDGS 584300 T S �;7y24 ;70/00 TOTAL 660700 U I I R S T I M A T E D-8 3 BUILDING PERMIT EE Number Del, Type Amount LAND LAND-ADJ INC ME SE SF-BLDS FEATURES BLD-ADJS UNITS 76400 71900 Cons,. Total Yeat Built Norm- Obsv. p Cosl New Ad Repl Value Slopes Nei ht Rooms Rms Bslhs a Fla. P-ny.-FO Class Un'ls Umts Base Rale Aol.Ral¢ A t A9e Dept. Conti, CND lac %R G Re I 1 9 01x- OJO 125 125 92.10 115.13 00 75 19 80 100 100 80 730367 5d43JJ 3.J 21 4 6.2 25.0 Cee pl.on. Rale Square Feet Repl.Cost MKT.INDEX: 1.00 IMP.BY/DATE. / SCALE: ELEMENTS CODE CONSTRUCTION DETAIL S BAS 1JU 115.13 1907 21 9553 AREA SINGLE FAMILY DWELLING CAST "iF:'JO T 830 120 133.16 1907 263471 SYL'- 1 L I L D STY T LE 0.0 FSF 9 G .0 103.62 40 4145 DESIN ADJMT J�DESIGN ADJUST 25.0 R FOP 35 40.30 240 9672 THIS HOUSE CONTAINS DIMENSIONS AND/OR' ADDITIONSEkTc2. ALLS U1 , OCD FRAME 0.0 USF 60 69.08 108 7461 TOO DIFFICULT TO VECTOR B A!Y THE COMPUTER. AND AtAc TYPE: J4 .It 0.0 C FOP 35 40.30 32 1290 STILL REMAIN LEGIBLE. PLEASE ASK FOR THE INT_R.E TN_ISH ilu 0.0 T USF 60 69.06 106 7322 SKETCH CARD IF YOU WISH TO -SEE THE DIMENSIONS. INTi2.LAYJUT J1 O.0 U USf o0 69.08 106 7322 1Wrz-R. aUALTY 32iAME AS EXTER. .R FOP 35 40.30 168 67.70 FL,SR 5f,2UCT SU 0.0 A 1SB:. .00 I 3057 131461 +---------------------+ FLDOR C?11JE4 - -JD ---- --- --0.0 L D 531 ! ! .0DT TY?-L---- -DO Areas ---- --- ---------�J.O Total Ars Aus _ ease. -- ----------------- BUILDING DIMENSIONS ! SEE ABOVE ! �L :C T R t C A L ' T. E T ! NOTE! ! vU4DAT10N- - 30 --------- -------99.� AI ------------ -------------------- ! ! --- -NEJ,N8jO N000 54AA MAIN S7. CENTERVILLE L +---------------------+ LAND TOTAL MARKET PARCEL 76400 660700 AREA 20874 VARIANCE +0 +3065 3T.kfiUARD 25