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0508 MAIN STREET (CENT.)
Vv � 4+ �� ,}�.. �� -=--- � � �� � t g P..' _. � .. A _ .. - - y �. - r, N .:. (� .. 4 r _ � a "' �A R .. I } � .. E _ n ,. y 1 Town of Barnstable *Permit# Expires 6 months from issue date ; Regulatory Services, Fee — • snaxsr�.s. • . uasa Richard V.Scali,Director ti Building Division A�' p 5 2016 Tom Perry,CBO,Building Commissioner , i` 200 Main Street,Hyannis,MA 02601 U TOWN U I U`�r gp Rt7�STA D L www.town.barnstable.ma us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 0207 — I"O" / f Property Address G r" .i - 5 t 6-g-4/idvvte/!-C_ [Residential Value of Work$ 4 '' Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address M�--� ' Y Contractor's Name �"�f Cam. 49' t N C Telephone Number Home Improvement Contractor License#(if applicable)_)�J S��/ Email:,j0 6 4(ke t Construction Supervisor's License#(if applicable) ork nan's Compensation Insurance ; Check one: ❑ I am a sole proprietor . ❑ I am the Homeowner 0--Aave Worker's Compensation Insurance Insurance Company Name Y Workman's Comp.Policy# t Copy of Insurance Compliance Certificate must accompany each permit.' Permit Request(check box) 2"e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to L4114,a-al� ❑Re-roof(hurricane nailed)(not stripping. .Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and'inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations;i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A co f the Hom Improvement Contractors License&Construction Supervisors License is e it SIGNATURE; Q:IWPFILES\FORMS\b 1 g pe f RESS.doc Revised 040215 . 3•^t 1. y a S u:i~ s• ^+k S �`� {- pY, s 3 4-11 Y u n x,. .. a g g * � r�s t 3 .7 , Q `:gn x ,.- are &<f ,� 5 ,�kB. 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"fie a � s �Vl a '''�� t tkp s P.�(� a ,, at t , 'i d11" 11 S .c r h�� `� 'f1�Y t - �Z ;� S ...e S.e vv... . kn'Y �}..�w.. .a, :a.✓6L._. ..9.. Mtm._u ' Je �fv't Y,. ,x Y�:s n.fr..... .. .....f: .. r lv .w 3„"1.,,. n` _Res,-, f,«':,...Ji. 'i�.... .: . _ - - _:: Rob Mazza 50. (510)Main St. Centerville,Ma.02632 , : : _. 1. . .: r r- . CERTAINTEED Certainteed shingle Roof 1:',: 00 - Strip.existingshingles;from front of rogf approzi ': t'. 4 squares total: ,. "Secure any loose sheathing Install Wcks;b'rand Dented aluminum dnp edge Install:Wip brand Ice&Water Shield to all eves:;f.rakes,valleys and all,protrusions Install Rhino,brand Synthetic Felt:, h0erlayment -. Install Cora teed Quick:Start`startershingles' bI to,all rakes&;eves. ., Install Certa.ir teed LIFETIMElandmark architectural shingles . Storm nail all shingles (State building code requires;4 nails :we"95e..6) Re-flash all vent i es with new boots PP. . n. Install Rigid Vent II ridge venting Remove and dispose;of all job related waste ` II k . leave your property looking like we were:never thereI .. Provide all r iI. and LIFETIME warranty on our.labor if it ever fails due to:our workmanship we . . hxt,.foreverl, Et'sThe Best Iq'Tiie`Business.'' . Please note our wind warranty. .also the best AndIongest available ANYWHERE" . ..... .._... :: .... ........ ...::. _.. .. ..._.:: ?3 . -) \: t - . , . . z R # . Total $1800.00 r. s � � , � ' SignatureP " taxi r � { �� 1 � z � I ; �� r r a .tt a. o Y erg'",% '. r{ A ;� §,�' �S+ 'S �, Via,,,. k - T ar �'.F"mz vy rs ryy�� - a a r., ,� P l a s s- 3 a11, n{ 3 % - �, r a s: k, i f✓. 5 '� a . �+r •wq'ss ' r t a� { 9 f � t ': 5.p � lta,: Xi- sate - a r r 'F-'�3 P ;' .: {Yk. 3 k �' Sr".ia z ray �� ¢ .x, z { , :� y r- a ds F .i p,# A - 3 IP Y..6q 3 :, 1- tom' �. j �.>w.. , x r ., P ... Y s. �a. } .:._._,. .._ .. : - Tlie Commompeah*of-Vassadi=etfs Deparhmenf efIndzirshialAcciald7ds offwe-ofb"WS69adem 600 Wasiraaigfon beef Bast on,21".02111. }vrvmmaxLgorldia ' Wariers' Campensafian Insn-IIIAffidavit: BuildersdC mbracfiar&Mecticians(Flumbers Applicant ease Print Address~ 0 `L9 Are you an employer?Check the appropriate bay Type of project{r equired}: 1_��a employer / 4_ ❑I am a general contractor and I . • employees(full anVor part-timer* bave lured ffie sub-contractors 6. F New coastcut•Eion 2.❑ I am a sole proprietor orpartuer- fisted oathe attached sheet: 7- ❑Remodeling ship and have no emplciyee% Ilese sob-comtractam have 8- ❑Demolifion working forme in any capacity. employees andbne warms' c i,suranct # 9_.❑Building addition. Ilea tvork�ers'camp-insurance �F- required] 5.'❑ We are a corporafiou and its 10❑Electrical repairs or ad&Eons 3.❑ I am a homeo-umer doing all work officers have exercised their 1L❑Plumb ngrepaizs or additions- myset€[No workers'c=g- #0&of em=pfim per M(M insurance required_]i c-152,§1(4k andwe have no 1-._�❑Roof repairs emplo o wor ors' '13_❑Other comp_msurance required_] Any WHcsntmatcheersboxft1r ia al,oSIloutth�set�oaheTowshotdagtheiranskers'compersatioapoTzcgffrmsaon fi HomemnEm ulna sabmnt il3s afodavd iL&L�they are dck-'ag WU*mi them him outside con=cmmmn, 5IIB=a new affida&iadk 'pg sacb- fCauusc=tT=ch—Ir this box must attariv aa.ode iiiopal sheet amring the name of the sub-ce&sctom=d=fe arlsethec ar nat fhase enfitieshwe . employees.Ifthesnb-2�haveeorpIcy�—s,theymusipmideth,�eir worken,imm . a P F RF aumbez I aim an euoploper i iatis prauidb "oJ*efs'campensal vII insrirance for troy*eHT10JIeL Below is fifer pa£iry and job site inforfnaftom Insurance Company mane_ LY61 I 4;-yOke D Policy-441-or Self-ins_Iic_4: - C, F-kpinitiDaDate: Gi 7 b/1 Job Site Addre _ G'B �/Yt r�:�i_ �,� Citylstatdrrp: Attach a copy of the workers°coaapensationpolfcy declaration page(showing the-policy,number and expiz ation state). Failum to secum coverage as required.under Sertica 25A of MGL c 152 can lead to the imposition of crimi ual penalties of a fine up to$L,5aa OD anctfor one yesrimprism=enk as Weil as civil peu,altim.im the fora of a STOP WORK ORDER and a fine of up to 0-DO a day against the violater. Be advised that a copy of this statement may be forwarded to the Office of Iuvesfigations of the DIAL for insurance coverage ve�cati� Ida Hereby cerfiJY ' s dpenawes afpeU47 that the informafimr prmfded T is bare and correct �'ratmma- Date: Phone a,YciaL am only: Do-not evrke in dds arefy to be competed by rife orfown o,jj4cia£ City or Town: Permibl-ieense;9 h3ming=Aafordy(code one): L hoard of Health I Building Department 3.City1rown Clerk 4.Electrical Inspector S.Phimbing Inspector b.Other Conbct person: Phone#- Information and Instructions Ymsmr_]nett s General Laws chapter 152=tar s all emg10yas m PMde WM1M&compensation for tbzU eMFIoyees` P=Mmt-to this statute,an.ea?&yz'--is detmed as."-.every pmsonin i e service of soother under any contract ofhfi-, express or implied,oral or wrn=f AIL employer is defined as"an huRvidnat parfnesab�p,association,coxporadon or ather legal entdy,or any two or more of the fx egoing=gaged is a3oint entelp6se,and inchudhig the legal Fepreseufafrves of a deceased employer,or the reiver or trustee of an bI idaal, tn parership,association or otherlegal entitY,employing employees. $oweverthe ec owner of a dvmUh3g house having not mare tlm three aparfmmts and who resides or the occupant of the - dwPT�house of anoflier who earploys persons to do maitman.=,c^nsftuct on or repair work on such dweI mg home or on the grounds or bmldmg appur�t thereto sballnotbecause of such employmentbe d5=.edtn be m eaxployez:" MGL chapter 152,§25C(•S)also'sfaff=that"every stale or local Piceasirg agency shall withhold$ie issuance ar th for 'tense or permit fn o erate a business or do construct baz�dings in the co�umoaweal _ any renewal of a h P P n the fiance covets I appIrcantwho has notprodnced accepfable-evidence of coxapTiance wrf3i � e4�d- Additionally,MQ.chapter ISZ, §25C(7J states aSeitherthe commonwealfhnor�ny of its political subdivisions shall ear tutu any contract for the performance ofpnblio wafictn E acceptable evidence of compliance with the fiMMd ace:.- reTnrZane±s of tuts chapter have beep presented to the cauftwdag anthozity_" AppliCdiitS Please fl1 out the worlo?as'compensation affidavit completely,by checTsmg L$e boxes that apply to you sitaaiion and,if necessary,amply s°b-cont- or(s)name(s), addresses)and phone mnnber(s)along with for r certificates)of jas�=ce_ Limited Liability Companies(LLC)or Limited Liability Partneasbips(LLP)vvithno employees other than the members or partners,are not requn-ed to carry wxuicere compensation insurance. If an LLC or LLP does have employees,a policy is rmpired. Se advised thatfhis aff davit maybe submitted to the Department of Indusfrial a a Accidentsforconformationofinmcecverage. Also berefn sign andd �d - The affidavit should be retuned to the city or town that the application for the peanit or license is being requested,not the Department of LnihistdalAccideutl MimM you have any questions regarding the law or if you are regazired to obtain a woii=' compensat onpolicy,pleasecallthe'Depadaxentattbennmberlistedbelow` Self-fimn"d companies shonlden�rtheir s elf-ms2traace license nmnber on the appropriair-line. City or Town Officials . Please be sate that the affidavit is complete and prtard legibly. The Depemaot has provided a space at fbe bottom of the affidavit for youto fill Dirt iathe event file Office oflnvestiD o�has to coactyouregardingthe aPPU� Please be sure to o fill in the pexmitllicrose number which,wM be used as a reference numb ur er. In addition,an applicant that mnst submit mutiiple pen WJlcense applitaflons in any given year,need only submit one affidavit indicatng cusent policy inl�matian(if neccs�ry)and under`lobe Adriess"fie applicant as write"all locations n (may or town)-"A copy of the-affidavit that has been officially stamped or maiced by the city or town may be provided to the applicant as proof that a valid affidavit is on file for b3 me permits or licenses Anew affi.davitmust be fMed oitt each year.Where a homeowner or citizen is obtaining a license or permit not related to any business or commercial ve'atnre (ie. a dog license or pemit to bran leaves eta_)said person is NOT required to complete this affidavit The Office of InyesLigEdions would Ifim to thank you is advance for your cooperation and sbould you have nay questions, Please do not hesitate to givens a call The DeparrfinenfS address,telephone and fax nnmbear C'MQn 'ft of Massachnsettg ' Degartmmt of I ustdal Accident Ofu=Qf�lvegtitkti= Bwton=MA Oil I Te,-L 617' -49W cit 4-€6 or 1-M-MAS AFF Fang 617-727-7M P,evised¢24 7 THE FOLLOWING IS/ARE THE BEST i IMAGES FROM POOR QUALITY ORIGINAL (S) M A11 �-I C(� C DATA AIS CERTIFICATE'^IS ISSUED•qs A`ma -�". .�, �' BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTrrt.1TE 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 endorsements . PRODUCER FRANK L HORGAN INSURANCE AGENCY INC NCONTACT AME,- 44.BARNSTABLE ROAD PHONE FAX PO BOX 250 c vc Nn HYANNIS, MA02601 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC N - wsuRERA: LM Insurance Corporation 33600 INSURED INSURERS: CAPE& ISLANDS CONSTRUCTION COMPANY INC ' PO BOX 210 INSURER c: CENTERVILLE MA 02632 ) INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 24610723 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 INSD WVD POLICY NUMBER MMbD MM/DD/YYW COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE DOCCURPREMISES DAMAGE PR I occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JECT POLICY PRO LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BOCILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PRCPERTY DAMAGE HIRED AUTOS $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ A WORKERS COMPENSATION WC5-31 S-377540-015 5/7/2015 5/7/2016 STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? �N N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE _$ 100000 If yes,describe under 500000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks.Schedule,maybe attached If more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers'compensation coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE . THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD CERT No.: 24610723 Anne Chandler 5/8/2015 1:54:54 PM (EDT) Page 1 of 1 ` I Massachusetts -Department of Public Safety : Board�of Building Regulations and Standards uuau uuluu Ju(7Cl rhur License: CS-074660 t``ti\.T 1.ti Il�ti JOSHUA X KOIII�t POBOX210 I@�� CENTERVILLE WA Expiration commissioner 02/12/2017 Unrestricted-Buildings of any use group which ; contain less than 35,000 cubic feet(991M )of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www•Mass.Gov/DPS r License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation , 10 Park Plaza-Suite 5170' i ,. Boston,MA 02116 jf'-Aot al' without signature jj l i r ,per C-/fee�omvmaruoec>�l�i a��l.aoaaeluweCta �� Office of Consumer Affairs&Rosiness Regulation i; HOME IMPROVEMENT CONTRACTOR <" i Registration:'1`65936 Type: .'. e Expiration Private Corporation CAPE&ISLAND cdkl - C$�;�b INC. � , JOSHUA=KOURI j. 55 ELM AVE. q'+ HYANNIS,MA 02601 Undersecretary r f �oF� rti Town of Barnstable eft[#ab o 7e 53� Regulatory Services Erpires6,rr�rlhsLorrIiscrrernle 13LAaysrtiBLE. t Fee v ttnss. 1619-$ ,0� Thomas F. Geiter, Director Arm hw�a k Building Division 10Itt'l,� Tom Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town,barnstab le:ma.us Office: 508-862-4038 EXPRESS PERMIT APPLICATION RESIDENTIAL Fax: 508-790-6230 Not Valid wilhoul Red X-Press Inrprinl SS PERMIT Map/parcel Number .ePO OCT M i(li Prope rty A d d ress / ` 'v S" (�C��� 1 (�� " OWN OF BARa rfaB - . residential Value of Work av �E Minimum fee of$35.00 for work under$6000.00 Owner's Name &Address -T 3 ® elvlt:�rw'Ili Contractor's Narne �� Iv� r1,4 ,,,�z�„� _ p Telephone Number d � -o Home Improvement Contractor License #,(ifapplicable) ---------------- Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [1� I have. Worker's Compensation insurance Insurance Company Narne f Vr 12wi �- -4 Workman's Comp. Policy# �n Copy of Insurance Compliance Certificate must accompany each permit. . Permit Request(check box) ❑ Re-roof(hurricanenailed) (stripping old shingles) All construction debris will be taken to., ❑ Re-roof(hurricane nailed) (not stripping. Going over existing layers of rood ❑, Re-side v , d placement Wind #of doorsows/doors/sliders. U-Valtle d : (maximum .35) #of windows 1 *Where required: Issuance or this permit does not exempt compliance with other town department regulations,i.e. Historic,Conservaiion,etc. ***Note: Property Owner must sign Property Owner Letter-of Permission. A copy of the Home Improvement Contractors License &Construction Supervisors License is re uired. SIGNATURE QAWPFILESIFORMSIbuilding permit founslEXPRESS.doc Revised.072110 $; . The Commonwealth of Massachusetts Department of e Industrial Accidents P Office'of Investigations .w a 600 Washington Street' Boston;MA 02111 w„ ;:•`� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Tlease Print Legibly Name(Business/Organization/Individual): ChUled r et�etfr� } Address: 1+owl rS ST S'/1�C�w�c1� �'�'I.9 d2-513 City/State/Zip: 2.S'^ �9N� i c�►j' Q43 Phone.#: �f t ! P� Are you an employer:?Check the appropriate box: Type of project(required): 1.P;f`am a employer with 4.'0 I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2:0 I_am a sole proprietor or partner-' listed on the attached sheet. : 7...0 Remodeling These sub-contractors have . ship and have no employees 8. EjDemolition workingfor me in any capacity. employees and have workers' Y P h' 9. D Building addition [No workers'comp.insurance comp.insurance.$ required.) 5. E] We are a corporationand"its - 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]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' 13.0 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 con tractors,must submit a new affidavit indicating such.z 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: /! i, r Policy#or Self-ins.Lic. M WC 400 P 2—f Apa Expiration Date: Job Site Address: 374 114W"J City/State/Zip: rP411 ef-o'lle Attach a copy of the workers'compensationpolicy declaration page(showing the policy number and expiration date). Failure to secure coverage.as required under-Se.ction 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 statemerif may be forwarded to the Office of Investigations of the DIA for insurance coveraae'verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: A Date: l0" Phone#: • �2 0 v 9 (7 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#: i Informatron4ird Instructions----- -- p� 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 engkhoe in a joint enterprise,and including the legal representativeso`f a deceased empryeraor the receiver or trustee ondividual,partnership,association or other legal.`entity,employing employees. However the owner of a dwelling having not.more than three apartments and who resides therein,or the occupant of the dwelling house.of anothe who employs persons to do maintenance,cofnstruction or repair work on such dwelling house or on the grounds or buildg 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 li ensing 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 produce acceptable evidence of complihnee with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . for the err rmance of public work until cce table evidence of com fiance vszth the insurance enter into any contractp p p P requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compens\appropniate ffidavit complete ,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)n ), address(es)an .phone number(s) along with their certificate(s)of insurance. Limited Liability CompaLC)or Limited lability Partnerships(LLP)with no employees other than the members or partners, are not requireworkers'co pensation insurance. If an LLC or LLP does have employees,a policy is required. Be that this affi vit may be submitted to the Department of Industrial Accidents for confirmation of insura age. Also a sure to sign and date the affidavit. The affidavit should be returned to the city or town that thca 'on for t permit or license is being requested,not the Department of Industrial Accidents. Should you havque lions r garding the law or if you are required to obtain a workers' compensation policy,please call the ent t th number listed below. Self-insured companies should enter their self-insurance license number on the riate ' e. City or Town Officials Please be sure that the affidavit is complete and pr' ted egibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the ffice o Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which wi be used as a reference number. In addition,an applicant that must submit multiple permit/license.applica on s in any gt en year,need only submit one affidavit indicating current policy information(if necessary)and under"Jo Site Address"t applicant should write"all locations,in`_(city or . town)."..A copy of the affidavit that has been o cially stamped or ked by the city or town may be provided to the applicant as proof that a valid affidavit is on fil for future permits or h XpsesA new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit notto any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT requmplete this affidavit. The Office of Investigations would like to.thank you in advance for your cooperation ah-,shy ould you have any questions, please do not hesitate to give us a call. . The Department's address,telephone and fax number: The Co onwealth of Massachusetts Uepartrnnt of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 02111 Tel. # 617-727-49�00 ext 406 or 1-877-MASSAFE Fax#'frl 7-727-7749 Revised 11-22-06 www.mass.gov/dia of Try r x BARNSTABLE, " 9 . Town otBarnstable 47 39. s67 9• ��� prFp Mp,�A Regulatory .Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town,barnstable.ma.us Office: 508-862-4038 Fax: 508-790 6230 Property owner Must Complete and Sign This Section If Using A Builder } , n , as Owner of the subject property hereby authorize N� ac o:r to act on my behalf, in all matters relative to work authorized by this building permit application for: crr 60f 1",w Sr L tW!1 (Address of Job) 6 ct 20 I 0 Signatur6lo7of Owner Date Print Name If Property Owner is applying for permit, please complete the Homeowners License Exemption Form on the reverse side. QIWPFILESIFOR Muilding permit PbrmsTXPRESS.doC Revised 072110 � c t i t 1►+e r ti Town of Barnstable P 0 Regulatory Services " gAF(ASS. , lass. Thomas F. Geiler, Director y � °;9,. a`� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnsta ble.m a. Office: 518-862-4'038 Fax: 508-790-6230 �.. HOMEOWNER LICENSE EXE PTION Please Print DATE: �O JOB LOCATION: q number street village "HOMEOWNER" name home phone# work phone# CURRENT MAILNG ADDRESS: city/town late zip code The current exemption for"homeowners"was extended to incl e ow er-occtt ied dwellin s of six units or less and to allow homeowners to engage an individual for hire who does not posses li ense, provided that the owner acts as supervisor. DEFINITION OF I MEOWNER Person(s) who owns a parcel of land on which he/she resides or inten to reside, on which there is, or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such us a d/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Su h "homeowner"shall submit.to the Building Official on a form acceptable to the Building Official, that he/she shall be res onsible r all s h work performed under the building permit. (Section The undersigned"homeowner"assumes responsibility for comp) cc with the St e Building Code and other applicable codes, a;? bylaws, rules and regulations. The undersigned"homeowner"certifies that he/she understands. e Town of Barnstable ilding Department minimum inspection procedures and requirements and that he/she will comply with s d'procedures'and,requirem ts. ` Signature of Homeowner Approval of BuildingOfficial t Note: Three-family dwellings containing 35,000 cu is feet or larger will be required to comply with the State Building Code Section.127.0 Construction Control. . HOME !VNER'S EXEMPTION The Code stales that: "Any homeowner performing work for Mich a building permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing ofconstruction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as Supervisor." lr 1 1 ' . . ' ' Man homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor see y P Y g p p ( 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:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 072110 Mar. 5. 2010 11:03AM Insurance AgencY of Cape Cod No. 9�19 r. c A�'® CERTIFICATE OF LIABILITY INSURANCE 15/2 oio PRODUCER (508)888-2766 FAX: (508)833-0909 TM CERMCATE IS ISSUED AS A MATTER OF INFORMATION 7il Insurance Agency of Cape Cod ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND EXTEND 480 Rte 6A ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOWOR, P O Box 960 X Sandwich MA 02537 INSURERS AFFORDING COVERAGE NAIC 8 INSURED MSUIMR A.Harleysvills wOroasteX Ins Co _ Nicholas F. Gianferante m6um&Safety~Insurance Company 10 Charles Street RCGranite State Ins. Campmy _ INtiUREi2 a Sandwiall MR 02563 INSURERe 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 CONDITLON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE WSUJRANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 13 SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF5UCH POLICIES.AGGREGATE LIMBS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WSR D PONCYNUYBER POiJCY EfiGCRVE POLICY EXPIRATION LIIItDB OENERALLIAUMTV EACHOCCURRENCE s 1.000.000 168 COMMERCIAL GENERAL LL451L.ITY E 100,000 A CLAMS MADE a OCCUR OE3486 3/27/2010 3/27/2011 MEo el(P(mono a 5.000 PERSONAL&MWDIUIRY S 11000,000 GENERAL WWREWE S 2.000,000 NLAGGREGATE LIMIT APPLIES PER: PRODUCTS.COWMP AGG a 2,000,000 $ POLICY PRO- LOC AUTOYOHILE LIABILITY LIMIT _ ANY AUTO H ALL OVVNED AUTOS 2399527 8/14/2009 8/14/2010 s 100000 X SCHEDUUM AUTOS HRM AUTOS BODILY MAW NON-DVOIEDAUTOS (Pareoodolel a 300000 PROPER IV DAMAGE S 100000 (Per q) GARAGEUANLRY AUroONLY-EAACCIDENT a ANY AUTO OTHM THAN .!iA ACC s AUTO ONLY: AGO 9 EXCESS I UMBRELLA UABBITY EACH OCCUR a OCCUR CLAIMS MADE A9GREGA7E 4- DEDUCTIBLE - a RETENTION if X YIN C WORKEM COMPENSATION WC bTATU- OTIi AND EUPLOVERS'L LIABILITY ANY PROPRIETUWPARTNEREIIECUTiVE E.L EACH ACGWD S 100000 ! OFFMEWNEMBER EXCLUDED? - (Menda"in NH) KC. 008 2n-398 3/15/2010 3/15/2011 EL o6mm EA Immom s 100000 If Yes.dvArbe wow SPECIAL PRROVIi,S below EL DISEASE-POLICY LWT a S00000 OTHER DE3=FMONOFOPERATIONSILOCAIICWIV9RCLE8IEWA49 MAIDMMBYENDORSFYdEW/SPECIALPROY$IORs CERTIFICATE HOLDER CANCELLATION SHOULD ANYOFTMEABOVE OESCIDBIED POLICIES eECANCEI&E-D BEFORE THEVIPIRATION Town of Sandwich, Building Dept. DATE THOMOV,THE ISSUING INSURER WILL ENDEAVOR TO MAC Xw_% E t 16 Jstl Sebastian Drive NIMWE TO THE CEROWAnB HOLUM NAM W TIE LEST,BUT FAILURE TO 00 80 emu Sandwich, NA 02563 IMPOSE No 0e1.19ATBDI OR LIABRITY OF ANY PM URN THE INSURER,US AGENTS OR REPRESENTATNES. ATNE I ' DJA ACORD 26(2009101) 6 1988-2009 ACORD CORPORATION. All tights Dewed. INS026 team) The ACORD name and logo are Teglabmd ma tcs of ACORD Office of Consumer Affairs and usiness Regulation 10 Park Plaza- Suite 5170 = � Boston,Mass4phusetts 02116 Home Improvement Contractor Registration Registration: 120372 Type: Individual tz Expiration: 12/3/2011 Tr# 290658 DANIELLE ENTERPRISES NICHOLAS GIANFERANTE 10 Charles Street SANDWICH, MA 02563 _ P-! r Update Address and return card.Mark reason for change. Address [] Renewal Employment Lost Cart DPS-CA1 0 50M.0004-G101216 ✓fie�ommzo�zueaftfe a�./�.Czoaae�ivael� —.-. ., ._..._—.. —-- ---- — -- License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date_ H found return to: HOME IMPROVEMENT CONTRACTOR. Office of Consumer Affairs and Business Regulation Registratiorf±--1,20372 10 Park Plaza-Suite 5170 Expiratiort_ Oi 1 Tr# 290658 Boston,MA 02116 T e'—-fidjPAd 4V DANIELLE ENTERPMESE," NICHOLAS GIAP7QE MR T 10 Charles Street SANDWICH,MA 02!t Undersecretary Not valid without signature _s: �ta._act, setts- Departl�lc-it'if Public`at'ct� gourcf of Buildin�� Ite��ulation�and Standard Construction supervisor Libense License: .CS 50328' Restricted to:.00 ` NICHOLAS F GIANFERANTE 10 CHARLES ST SANDWICH, MA 02.563 Expiration: 1/23/2011 ('ununi.aPmcr , Tr#: 85§7 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. -it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: 3 l b a 9 Fill in please: APPLICANT'S YOUR NAME S BUSINESS YOUR HOME ADDRESS: 5/d Mai,7 J5 - er SAS 3gS oning f e M eu OZ&5,L TELEPHONE # Home Telephone Number So B - 3`lS-yo6ft NAME OF CORPORATION: 6011v--5 NAME OF NEW BUSINESS_ l3roi u,� 1]b e�ynP S TYPE OF BUSINESS 0c4eiAi C h06- TrPe:*'fS IS THIS A HOME OCCUPATION? X YES NO ADDRESS OF BUSINESS Sb 8' iot -5 t 6�;7p—rzw la- 0210 3 Z MAP/PARCEL NUMBER cp�- Q /�~! (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMI�IIfSS LER'S OFFICE MUST COMPLY WITH HOME OCCUPATION This individual s #o hr ed any permit re uirements that pertain to this type of businessRULES AND REGULATIONS. FAILURE TO Autho d Signature** COMPLY MAY RESULT IN FINES. f� COMMENT , v C7. �.: j C. �., i 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Town of Barnstable Regulatory Services o Thomas F.Geiler,Director Building Division + RARNSTA13M v KASS. �* Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: 91b1c) Name .`/ Pa'1 rl 1 0 L�l hVl e ll Phone#: 5-0— 3 I c --O.C7 Address: -60 Ma"n S 7L Village: 0,en11•byf//lP Name of Business:9 U 1 J n- DQ q Type of Business: D afl ( e �JQMap/Lot: INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation' within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the- premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is tamed on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space; • There are no external alterations to the dwelling which are not customary in residential buildings, and there is no outside evidence of such use. • No traffic will be generated in excess of.normal residential volumes. • The use does trot involve the production of offensive noise,vibration,smoke,dust or other particular matter,' odors,electrical disturbance,heat,glare,humidity or other objectionable effects. o There is no-storage-or-use of toxic or-hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met.on the same lot containing the Customary Home Occupation,,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation, other than one van or one pickup-tr.uek-aot-to•exceed•one ton;..capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation: _ • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit . I,the undersign4havead agree with e above restrictions for my home occupation I am registering. Q Applicant' Date: 3L10 Q '1 IUD I k t 44e_ -- —� ' Jun 10 09 08:39a p.2 committed to empowering young adults with le •ng disabilities towards the Yalaemon is comet P secure fostering a e dedicated to fo g ' r autonomous living. V►�e ar realization of them potential for environment that will help ensure ab ridge a towards independent th•v• g while r oviding a"welcome-home"atmosphere.Although the young- adults of Palaeon learn many lessons outside of 508 Main Street the majority of their growth happens wi • its confines through: one- on_one and group meetings,basic life stalls such as cooking, cleani ag and organization of a household,budgetingibanking, social skills and conflict resolution,as well as ts ace plaid inic to Palaemon will provide "independence with a safety net as y g successful situations with the knowledge that there are going to be obstacles and anxieties l ties tely, relative to new experiences_ Yet from new experiences arise confi ence, growth autonomous living. b James R.O'Connell N INC PALAEiVIO , 10 09 08;39a p.1 n _ i _ John C. Cartwright ATTORNEY AT LAW 3010 Main Street•Barnstable,MA 02630 Tel:(508)362-5070•Fax:(508)362-5093 E-Mail:lawyer@cape.com The Commonwealth of Massachusetts William Francis Galvin-Public Browse and Search Page 1 of 1 The,Commonwealth of Massachusetts r� William Francis Galvin #t Secretary of the Commonwealth, Corporations Division Ono Ashburton Place, 17th floor Boston,MA 02108-1512 Telephone: (617) 727-9640 Public Browse and Search - Entity Results Help with this form 1 Records Matched Your Begins With Search for Entity Name: Palaemon Inc (Page 1 of 1) Identification Old Principal Office Entity Name Number Identification Number Address, City, State,Zip, Country 508 MAIN- PALAEMON, INC. 000981823 ST., CENTERVILLE, MA 02632 USA New Search ©2001 -2008 Commonwealth of Massachusetts All Rights Reserved `-1*1x y � _ f fo n ogre XIc�o� fafit,,, S http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchEntityList.asp?ReadFromDB=True&UpdateAllow... 8/22/2008 BizCentral USA 5016 Application Page 1 of 5 �,Your One StOP Shop for r; 501c3 Application The fields marked with* Ere mandatory. Organization Name: *Palaemon,INC. * Educational Please type your Mission or Purpose statement. (A few sentences at minimum) Mission Statement: Palaemon is cOmmitt d to empowering young adults w-th learning disabilities towards the realization of their po=ential for autono ous living. We are dedicated to fostering a secure environment that will help ensure a *bridge towards independent living while providing Narrative explaining your s rvices(please add as much details as possible): maximum 1500 characters ealaemon caters to oung adults who warrant continued support with :heir day- to-day living, social, and vocational skills pr viding one-on-one support while keeping in mind the individual needs of each young *adult. Palaemon Provides des individualized: Contact Name: *James R. O'Connell Address: (NO P.O. BOX's) *510 Main street City: *Centerville County: ~ *Barnstable State: * Massachusetts Zip Code: *02632 TEL: Day *508-775-365 TEL:Alternate 774-269-1182 EMail: *jamesroconnell@hotmail.com http://'A�w-W.bizcentralusa.com/501app.asp 9/9/2008 Z-d dZ510 60 60 unf BizCentral USA 5016 Application Page 2 of 5 Web Address: Please answer the followin if.Xou_choose SOic3.Tax Exempt Sewice: 1.Are you incorporated? Yes No EIN#: 26-4636098 Board of Directors: Title(Pres/Tres/Sec): President Last Name; O'Connell First Name: ' James St Address: * 510 Main Street City: * Centerville State: * Massachusetts Zip: * 02632 Title(Pres/Tres/Sec): Sec Last Name: Maiocca First Name: Jennifer St Address: * 510 Main Street City: * Centerville State: * Massachusetts Zip: * 02632 Title(Pres/Tres/Sec): Tres Last Name: Maiocca First Name: . Jennifer St Address: 510 Main Street City: http:/./ww-..v.bizeentralusa.com/501ap .asp 9/9/2008 £•d d£9:W 60 60 unf BizCentral USA 5010 Application Page 3 of 5 * %,enzervwe State: * Massachusetts Zip: * 02632 2. Do your annual gross receipts(donations)averaged or are they expected to average more than$10,000 per year? Yes o No 3.Do you or will you have any employees or officers receiving or will receive compensation of more than$50,000 per year? Yes No 4.Were you formed under he laws of a foreign country? if"Yes",which country? Yes •6 No 5. Will you operate in a fort ign country?List country and regions,describe operations in each. Yes o NO 6.Any family or business relationships relationship between any officers and directors? Jam sand Jennifer ,(pre., . and Sec./Tres.) are Engaged to be married o- Yes No 7.Are the listed officers/dirt ctors also officers/directors of any other organization,profit or non-profit,from which they receive compensation and work together? Yes a No S.Explain how you avoid being influenced in setting compensation or in business deals. Jenn and I are corms ted to ensuring the s fety.and devel pmenz of our young Yes No adult3 and remain 9.Will there by any compensation which is not fixed and pre-determined,including discretionary bonuses?If ye,,;,the details of the compensation plan must be explained and who qualifies.Include how ii will be determined that the compensation does not exceed reasonable compensation for services. Yes q. No 10. Do you buy or sell any g ods or services from the previously named individuals? If yes, http://ww%,w.bizeentralusa.conV501ap .asp 9/9/2008 d dC9:l0 60 60 unr - BizCentral USA 5016 ApplicationPage 4 of 5 explain in detail and how will you ensure the transactions are fair and at market value. Copies must be attached of any contracts or other agreements of such transactions. Yes o. No 11.As above,any contra ,agreements,loans,or other must be described and copies must be attached. Disclose the identity of the firm or individual,the arm's length negotiation of terms and how they are de rmination to be at fair market value. Yes o No 12.Disclose in detail any ttansactions with organizations in which any of the directors are also directors, officers,or h ustees,or in.which they have a controlling interest,greater than 3 5%. Yes o No 13.Have you taken over or wfll take over the activities or another organization,25%or more of another organizations net assets,or established from a conversion of an organization?If yes,explain in detail. - Yes o No 14.Do you or will you oper ite bingo or other gaming activities.if yes,explain in detail including financial transacti ns. - Yes 4 No 15.- Will others operate bing or other gaming activities for you?If yes,explain in detail including financial transactions. Yes U No 16.List State and local juris ictions in which these activities will take place. : Yes No 17.Will you do fundraising or others? Will others do fundraising for you?Explain any "Yes"in detail. J http://m,Nvw.bizcentralusa.com/50Iap .asp 9/9/2008 g-d dC510 60 60 unr BizCentral USA 5016 Application Page 5 of 5 Pal emon will be inv lved in volunteering and possible fundraising . wit it its community if, .0. Yes No called upon 18. Will anyone develop oi manage your facilities other than your staff or volunteers? Yes o. No 19. Will you have Joint Ve tures? e Yes O No Submit Application If you experience problems Jue to computer settings or browser please print and fax your questions. Print h-ap://Www.bizcentralusa.com/501app.asp 9/9/2008 9-d dig;60 60 60 onf �k t�O.` (Zoo r^ NANA 3 • Fj o � LA f fig L L 14) 910 IAoo Parcel Detail Page 1 of 4 ' T THE Bht{!ti LE i r : _ iw w r ++4l4laiw'bMFnM1►�� 4 'ti h1.A55 � .:r,;,..""P.• �xwC ��" �.' ` l wa..:-w:,,� '"�i:... '�S$'": „y�,�' s ez Logged In As: Parcel Detail Monday, Jt Parcel Lookup Parcel Info Parcel ID;207-108 I Developer Lot SLOT 1 Location [508 MAIN STREET(CENT.) rI Pri Frontage[100 Sec Road ! I Sec I Frontage r Village ,CENTERVILLE I Fire District-C-O-MM Sewer Acct VW �! I Road Index :0950 �^ _ Asbuilt Septic Scan: Interactive Map �� 9k ,' T 207108_1 'Z7 Owner Info Owner'TJLC LLC ~_— I Co-ownerI Streets .PO BOX 1223 Street2 i City.MADISON —..I State FCT zip'06443 Country Land Info r_._._ Acres 0.46 Use (Multi Hses MDL-01 I zoning RD-1 Nghbd 0112 Topography 1"vel Road .Paved Utilities,Public Water,Gas,Septic Location Construction Info Building 1 of 2 Year w_. - Roofr _._. Ext 1850 rGable/Hi Wall Clapboard JJ Built . Struct ._.__ __P_ P. Effect Roof . AC 3159 I As h/F GIs/Cm None Area Covers p p I Type _ I Style Conventional Int i Plastered �- Bed 7 Bedrooms ~^ I Wall I Rooms Int Bath ModelResidential Floor _ _ __ ___� Rooms 4 Full _ �. _.� - Total Grade�N Luxury Minus Type!Hot Water I 12 Rooms Rooms http-.Hissgl2/intranet/propdata/ParcelDetail.aspx?ID=14596 6/8/2009 Parcel Detail Page 2 of 4 r P" m Uzi B Alt . ( _—j Heat I--- -- Found- __ ____ Stories 2 1/2 Stories 1 Fuel{Gas I ation Typical I F T sus z41•; ,, Building 2 of 2 Year -- � ._ Roo f r ,_ r _,, _ .y_ Ext Built 11920 Gable/Hip Clapboard Struct�----- Wall Effect Roof AC Area40- -- _ ____I Cover[Asph/F GIs/Cmp Type None � _. __ _ Intr__�_.._ _ ____ Bed Style Cottage I Wan 'Drywall I Rooms 11 Bedroom I k Int Bath ^�__ �BASi. +, r 0 Model Residential Floor" Rooms 1 Full I �. - —-- _ --_ r---�--- Grade;Average Plus Type iElec Baseboard I Rooms 3 Rooms r H Fuel ,eat Found- YP -`^ Found- Stories 1 1/2 Stories Electric I ation .T ical --- —------ Issue Date Purpose Permit# Amount Insp Date Comrr 10/1/1995 10873 $5,400 1/15/1996 12:00:00 AM CE AC Visit History T Date Who Purpose 3/18/2009 12:00:00 AM Tony Podlesney Sale Review 9/17/2001 12:00:00 AM Paul Talbot Meas/Listed-Interior Access - Sales History Line Sale Date Owner Book/Page Sale P 1 2/29/2008 TJLC LLC 22716/138 2 8/15/1993 MERCANDETTI, PAUL L& SONDRA 8751/079 3 11/15/1991 BOSTON FIVE CENTS SVGS FSB 7741/349 4 5/15/1984 DACEY, MICHAEL J & DONNA 1 4108/346 ; 5 4/15/1984 KOMENDA, NANCY D 4074/211 6 3/31/1978 KOMENDA, JEFFREY F 2682/2 - Assessment History Y http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=14596 6/8/2009 t',.,11ss ssor's Office(1st floor) Map ; 0 Lot job r Permit# ����3 Conservation Office(4th floor) i u I ate Issued /D /.R Board of Health(3rd floor)(8:30-9:30/'1:00-2:00) Fee Engineering Dept.,(3rd floor) House#1 ®� `Q Pla ANSTA5--- _ BLE, 19 TOWN OF BARNSTABLE Building Permit Applications :/U' etAddress— Village 46 F f Owner ` �YY'.�( w7)2 t `/ddress "A=,A / Telephone '9 U— ImE /Permit Request 10 r' 9 ' �x 7EP OFr Total 1 Story Area(include 1 story garages&decks) I JqY square feet To al 2 Story Area(total of 1st&2nd stories) square feet Estimated Project Cost $ ��� Zoning District Flood Plain Water Protection Lot Size Grandfathered ? Zoning Board of Appeals Authorization Recorded Current Use Proposed Use Construction Type Commercial Residential Dwelling Type: Single Family Two Family Multi-Family Age of Existing Structure Basement Type: Finished Historic House Unfinished 'Old King's Highway Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached. Other Detached Structures: Pool Attached Barn None Sheds Other Builder Information Name moa6us "Telephone Number - ?' j6 Address f license# 0 6 "Z W\p ✓!Dome Improvement Contractor# Worker's Compensation# ()00 a NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE -----'DATE .� ,. BUILDING PERMIT DENIED OR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY k` PERMIT NO. _ t DATE ISSUED 1 MAP/PARCEL NO. • ADDRESS r VILLAGE ` OWNER K DATE OF INSPECTION: — FOUNDATION s FRAME" INSULATION T• i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: DOUGH. FINAL ' GAS: ROU61,1=. FINAL FINAL BUILDING DATE CLOSED OUT ASSOjfCIATION PLAN NO. , f 03 ' .- �4 { The Town of Barnstable tWAS.om$ De artment of Health Safety and Environmental Services P Building Division 367 Main Street,Hyannis MA 02601 Office: 508 790-6227 Ralph Cross= Fax: 508 775-3344 Building Commission: For office use only Permit no. Date AFFIDAVIT HOME V"ROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,remo%al, demolition, or construction of an addition to any pre-existing owner occuPted building containing at least one but not more than four dwelling units or to structures which am adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type of Work:—„ ji4,a Est. �� Address of Work:' 5-04?�- � /Owner.Name: /Date of Permit Application: toll I q I hereby certify that: Registration is not required for the follo%;ing reason(s): Work excluded by law Job under S1,000 uilding not owner-occupied Owner pulling own permit Notice is hereby given that: CONTRACTORS OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGID 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 owner. Date Contractor name Registration No. OR Date Owner's name 1 2x Fr)Pt's (c d i I . ii opf/) Po i cii I i j I -,2xq _lb :e.C — �lD�r fiDUr!p `ris TB ' 49 �,t► I � 1 1 ,fir, `4i�►A�O.ir!�c'��r►�'r� '—.�.''� � '�� �®��I �, �,ar~•®� � yr�r Sri �j�� � �''�•,�•� --:.��;�.��'s.:.����►.►..��..��®. � �I �; -� �/lam sad l � ♦ S•�