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0589 OLD STAGE ROAD
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I `� Ii�.L l it # 4 "; , -,H , 'l; ,n"6e I (nl!Y°'11 'IIY.§+i..• Tffii. ] •A ,G I:s'tY' A,T"`� "''AP 'S' k F+5 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a Parcel Application #0161 Q 6 5 V Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation /Hyannis `Project Street Address `� 1,1� S T Gc R QlTL� Village C TC Z LLc OQ 6 �� Owner NEj9L Address cZ 5EME64 4 • S61VbKl� MA Telephone -.6'09--3 - 6ELL �D� RR-9- -3 Ia9= 14&mf Permit Request R x F� al 6-0 h-ZMTs " _57n #bE Colo S 'FROAA yD)-N5fj\1 MdVIF- S 70 hL01-1) T V k Q= Q tit + V'Ob L. PN HZ_Lc Square feet: 1 st floor: existing proposed 2nd floor: existing' proposed Total new Zoning District Flood Plain Groundwater Overlay Proj ct'Valu tion 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 4 Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:v®Yeses❑ 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 ,r (BUILDER OR HOMEOWNER) c ,3/01 Av"E Name yX1 'RiAiV d N �1�}� Telephone Number , �V&O-3 �D'I-S �� LL "Address a S NE'C/'9- }1Vi License# �4N�I,y.LGf MA . OQS-13 Home Improvement Contractor# F Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE / '' DATE �� ` r FOR OFFICIAL USE ONLY ' APPLICATION# - r• DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE i `4 OWNER DATE OF INSPECTION: ` FOUNDATION r FRAME r ' INSULATION a S FIREPLACE ELECTRICAL: ROUGH FINAL '`. PLUMBING: ROUGH FINAL ;.' GAS: ROUGH FINAL a FINAL BUILDING 's (to DATE CLOSED OUT ° N ASSOCIATION PLAN NO. r The Commonwealth o assac us s Department of Industrial Accidents Office of Investigations 600 Washington.Street Boston,MA 02111 UT www.mass.gov a Workers' Compensation'Insurance Affidavit: Builders/Contractors/Electricians/Pinmbers Applicant Information Please Print Lep-ibly• Name(Businessiorganizationadividual):�P}�h. �Ri)N''1 KEr'I �- Address: �N�r K 19-N1= �. .� .;, V Oa2a2, 1o� - -i 7 t�- �e City/State/Zip: N�L)��f,h�/ Phone.#: s'f� —3 i�-•-�� ?8- �LL Are you an employer? Check.the appropriate'bog: _Type of project(required):. 4. I am a general contractor and I 1.❑ I am a employer with � 6. ❑New,construction employees (full and/or part-time).* " have hired the stab-contractors 2:0 I am a sole proprietor or partner- listed-on the-attached sheet 7.. Remodeling ship and have no employees These sub-contractors have g• Demolition workingfor in an capacity.aci employees and have workers' Y P ty. $. I 9. ❑Building addition [No workers' comp, insurance. comp.insurance. ' equired] 5. We are a corporation and its 10.0-Electrical repairs or additions a 3! I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. night 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 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 tinder 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 c under_the-pain penalties f perjury thatfhe information provided above is true and correct Si afire: Date: ,p'L Phone# �� '3��-�5�8'Ity Official use only. Do not write in this area;to be completed by.city or town off ciaL 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#: Informaon 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,corporatio or other legal entity,or any two or more , of the foregoing engaged in a joint ente rise and includingthe le r res tatives of a deceased employer,or_the receiver or trustee-of an individual,partnership,association or other. egal a ty,employing employees. However _e owner of a dwelling house having not more than three apartments and W. resides therein, or the occupant of the dwelling house of another'who employs persons to do maintenance,co tion or repair work on such dwelling house or on the grounds or building..appurtenant thereto shall not because of ch employment be deemed to bean employer." MGL chapter 152, §25C(6)also'states that"every state or local lice g agency shaU withhold the issuance or renewal of a license or permit to'"operate a business or to constr et buildings in the commonwealth for any applicant who has not produced•acceptable evidence of compli ce with the insurance coverage required." AdditionaIly,MGL chapter 152, §25C(`4)states"Neither the co nwealth nor any of its political subdivisions shall enter into any contract for,the perfom�and of public work until- ceptable evidence of complizLce vzth the insrance requirements of this chapter have been prose ted'to the contrac ' authority." Applicants Please fill out the workers'compensation affidavr complet y,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),addres es) phone numbers)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or L' 'te iability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers mpensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this a vit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. o b sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for e pe t or license is being requested,not the Department of Industrial Accidents. Should you have any questio regar ' the law or if you are required to obtain a workers' compensation policy,please call the Department at a number ted below. Self-insured companies should enter their self-insurance license number on the appropriate ' e. City or Town Officials. Please be sure that the affidavit is complete an printed legibly. The De artment has provided a space at the bottom of the affidavit for you to fill out in the event :e Ofce of Investigations to.contact you regarding the applicant. Please be sure to fill in the permit/license a er which will be used as a re rence number. In addition,an applicant that must submit multiple permit/license app p cations in any given year,need y submit one affidavit indicating current policy information(if necessary)and under`fob Site Address"the applicant sh d wrife"all-locations in (city or town)."A copy of the affidavit that has bee4officially stamped or marked by the 'ty.or town may be provided to the applicant as proof that a valid affidavit is onffile for future permits or licenses. A n affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo an business or commercial venture (i.e.a dog license or permit to burn leaves-etc.)said person is NOT required to complet this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and ould you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and Lai,number: The Commonwealth of hiassaehusotts Deg"emt of bi&IsWal Accidmts ogee of jx ve�tigat � -600 Washingt6 Stt=t Bosttan, MA 02111 'del.# 617-727-4900 ext 406 or 1�-977- iASSAFE Revised 11-22-06 Fax#617-727-7749 www.massgov/dia tHKE r Town of Barnstable Regulatory Services saxxsznsr,E, : Thomas F.Geiler,Director 'Ar A Building Division FD Mp`l _ Tom Perry,Building Commissioner 200 Main,Street, Hyannis,MA 02601 www.town.barnstable.ma.us t . Office: 508-862-4038 Fax:' S08=790-6230 HOMEOWNER LICENSE EXEMPTION., .. Please Print DATE: �ry � JOB LOCATION: 15 F 01—b 1Sr�& Rbib CiEN)�k V_-Z-LLE. . number street. . village. "HOMEOWNER": D)gy.-Z c, b -. MjFAL .V9-- _309 36t/�_6_&C)k name home phone# work phone# CURRENT MAILING ADDRESS: .C;, _SZ 1j ej4 L A#J e—�6 0Q S 4, 3 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 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 M minimum inspection procedures and requirements and that he/she will comply with said procedures and` ` re ' ements. ------------ Atrd Signature of Zomeowner C_ 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.71n 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 f, several towns. You may care t amend,and adopt such a fomi/certification for use in your community. . Q:forms:homeexempt a.. a Town of Barnstable 'Regulatory Services y ass. g Thomas F.Geiler,Director 1639 'OrFCMa�� Building.Division Tom Perry,Building Commissio er 200 Main Street,Hyannis,MA 2601 www.town.barnstable. ams Officer 5 -862-4038 - Fax: 508-790-6230 `l Property Ow er.Must Complete and Sig This Section`-' If Using A uilder I, as Owner of the subject property hereby authorize to act on xny behalf, in all matters relative to.work uthorized this building permit: (Ad ess of Job) **Pool fences and alarms area t responsibility of the applicant. Pools are not to be filled or utilized befo fence is installed and all final inspections are performed and acce ted. Signature of Owner Signature o£Applicant Print Name Print Name vs Date Q:FORMS:OWNERPEFMISSIONPOOLS 6/2012 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map l Parcel. Application # i Health Division ' Date Issued �- 1 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board -sk-01 Historic - OKH Preservation/Hyannis Project Street Address .Village �'� �9V-=LLB Owner_ i ZZ, /✓ / 4,:75TN-rE % Address' ti t L CW Telephone SPE- .3 L-Y- S_1?_4R Permit Request (�� ' g o �� �6 /hzlyx 5 s'� i� Ct9B)M—WAIC-S .�c-n1 -r0 4 -F0RA) � "J t ..rL"m t o =5 c Z N �R�YU� ®F O UP �/� �S `>Ue Tie Ai Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family. ❑ Two Family ❑ Multi-Family (# units) J CD Age of Existing Structure Historic House: ❑Yes ❑ No On Old King' Highwat.Z❑Y ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other a ° Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing 0, rtew Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ►/sue �. /� � L-�^e RU57-54 Telephone Number Address _o2 .S IVEGvf ),A- , License# dCU 43 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��-SIGNATURE DATE i FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED L-_ MAP/PARCEL NO. F- } ADDRESS VILLAGE OWNER r' DATE OF INSPECTION: k I P t. FOUNDATION - 4 t FRAME INSULATION ` l c: x FIREPLACE •� ELECTRICAL: ROUGH FINAL ;r .r .5 PLUMBING: ROUGH FINAL GAS:, ROUGH,,, x ` FINAL ..-FINAL BUILDINQ DATE CLOSED-OUT ASSOCIATION PLAN NO. Town of Barnstable Geographic Information System April 25,2012 191009 w." #17 191006 191017 19I1 .� #613 #6 16 #152 i - 191005 #699 191168 191197 #7 #144 l A ` Lti • - p 191198 #134 , 191004 s .v v #589 ' Q 191199 #124 y 191003 #575 . 191200 #114 191002003 #561 190259 559 �'"�� ` # 1 201 6 Feet 1 191002002 ;81002001 # #557 #665 DISCLAIMERS:This map Is for planning purposes only. It Is not adequate for legal Map:191 Parcel:004 boundary determination or regulatory Interpretation. Enlargements beyond a scale of Owner:NEAL,PHILIP&CLARE D TR Total Assessed Value:$332700 Selected Parcel 1=100'may not meet established map accuracy standards,The parcel lines on this map areonly graphic representations of Assessor's fax parcels.They are not true property Co-Owner:NEAL NOMINEE TRUST Acreage:1.58 acres Abutters. _ `boundaries and do not represent accurate relationships to physical features on the map Location:589 OLD STAGE ROAD such as building locations. Buffe r ! /, € NOTICE RE NEAL FAMILY TRUST U/T/D 12/171993 - DECLINATION OF GORDON SCOTT NEAL AND APPOINTMENT OF SUCCESSOR TRUSTEE 1. Original Trustee. Phillip Neal and Clare D.Neal (Grantors) established the Neal Family Trust U/T/D 12/17/1993 (the Trust), serving as the initial Trustees thereof. 2. Death of Original Grantors. Clare D.Neal and Phillip Neal died on August'2, 1010 and October 18, 2010, respectively. 3. Successor Trustee. Article Sixteenth of the Trust names Gordon Scott Neal as the Successor Trustee of the Trust. 4. Declination of Gordon Scott.Neal. In signing this agreement Gordon Scott Neal confirms that he has declined to serve as Successor Trustee of the Trust.No alternate successor Trustee is named in the Trust. As a result,the office of Trustee is vacant. 5. Article Sixteenth. Article Sixteenth of the Trust provides that: "If there shall be no person in the office of Trustee, the beneficiaries of the trust then of full age and competence and entitled to the income of the trust shall appoint a new Trustee, by a notice in writing attached to this instrument, and if there shall be only one person in the office Trustee,the beneficiaries of the trust, at the request of such Trustee, shall designate an additional Trustee,by a writing attached to this instrument, and if they fail to designate an additional Trustee within thirty days, the Trustee then in office may designate an additional Trustee. 6. Beneficiaries. The beneficiaries of the Trust who are of full ageand competence and entitled to the income thereof are: Gordon Scott Neal, David Grant Neal, Helen K Bresnahan, and Phillip Robert Neal (the Benef ciaries). 7. Naming David Grant Neal as Alternate Successor Trustee. The Beneficiaries hereby appoint David Grant.Neal as alternate Successor Trustee of the Trust. 8. Attaching notice to Trust. A copy of this notice shall be attached to the Trust as provided in Article Sixteenth. Dated: 6NL Q5 , 2010 �G David Grant Neal / ��Dated: G2� 2010 Helen V. Bresnahan Date 2010 Philli ob eal Dated: Z ® • Gordon Scott Neal • NOTICE RE APPOINTMENT OF SUCCESSOR TRUSTEE FOR NEAL NOMINEE TRUST U/T/D 12/171993 1. Original Trustee. Phillip Neal and Clare D.Neal'(Grantors)established the Neal Family Trust U/T/D 12/17/1993 (the Nominee Trust) and served as initial Trustees'thereof 2. Death of Original Grantors. Clare D.Neal and Phillip Neal,the Trustees of the Neal Nominee Trust died on August 2, 1010 and October 18, 2010, respectively,without-naming a Successor Trustee. 3. Successor Trustee. Section 2.8 of the Nominee Trust provides for a successor Trustee to_ be named by the Trust Beneficiary.. The Beneficiary of the Nominee Trust is.David Grant Neal, as Trustee of the Neal Family Trust U/T/D 12/17/1993. 4. Appointment of David Grant Neal as Successor Trustee.. David Grant Neal, as Trustee of the Neal Family Trust U/T/D 12/17/1993 hereby appoints David Grant Neal as Successor Trustee of said Neal Nominee Trust. 5. Beneficiaries. The beneficiaries.of the Neal Family Trust, Gordon Scott Neal,David Grant Neal, Helen V. Bresnahan, and Phillip Robert Neal join in and.consent that appointment. Dated: /7 , 2012 David Grant Neal; individually ana as • Successor Trustee of the Neal Family Trust U/T/D 12/17/1993.E N Dated: , 2012 � Helen V.Bresnahan Dated J /� ; 2012 Phillip Jtbert"Ne"al . Dated: , 2012 Gordon Scott Neal R, AFFIDAVIT OF SUCCESSOR TRUSTEE TO THE NEAL NOMINEE TRUST County of Barnstable . ) State of Massachusetts ) The undersigned, DAVID GRANT NEAL, having.been first duly sworn, certifies under penalties of perjury that the following is true and correct: 1. That he is the duly appointed and acting Successor Trustee of the Neal Nominee Trust of December 17, 1993 (hereinafter Nominee Trust), which was entered into by Phillip Neal and Clare D.Neal as Grantors and as initial Trustees and who remained as its Trustees until their deaths. .. 2. Clare D. Neal and Phillip Neal died on August 2, 2010 and October 18, 2010, respectively,without having named a Successor Trustee', leaving that-office vacant. 3. Section 2.8 of the Nominee Trust provides that "If there is no Trustee in office . . °.through death of a sole Trustee without the appointment of a successor Trustee, a person purporting to be a successor.Trustee hereunder may record in the Registry of Deeds an affidavit . stating that he or she has been appointed by all of the Beneficiaries as successor Trustee: Such affidavit . . shall have the same force and effect as if the certificate of a Trustee or Trustees required or permitted hereunder had been recorded and persons dealing with the Trust or Trust.estate may always rely without further inquiry upon such an affidavit as so executed and recorded as to the matters stated therein." See Exhibit"A." 4. Section 3.1 of the Nominee Trust provides as follows: "The term "Beneficiaries"wherever used herein shall mean the beneficiary or beneficiaries listed in the Schedule of Beneficial Interests this day executed and filed with the Trustees. " See Exhibit"A." .5. A true and correct copy of The Schedule of Beneficiaries attached to the Nominee Trust is set forth in Exhibit."A." It provides that the sole Beneficiary of the Nominee Trust is "Phillip Neal and Clare D. Neal, as they are Trustees of the Neal Family Trust of December 17, 1993." 6. Phillip Neal and Clare D. Neal as Grantors,and initial Trustees also entered into the Neal Family Trust of December 17, 1993 (hereinafter Family Trust) and remained as its Trustees until their-deaths as aforesaid. - _ -- 7. The Family Trust provides that, at the Trustees'-deaths, Gordon Scott Neal was to serve as the,Successor Trustee. He declined to serve in that capacity. 8. The Family Trust provides in Article Sixteenth that"(i)f there shall be no person in the 4 office of Trustee, the beneficiaries of the trust then of full age and competence and entitled to the income of the trust shall appoint a new Trustee, by a notice in writing attached to this instrument. " See Exhibit"B." 9. The Grantors' children, Gordon-.Scott Neal, Helen Virginia Bresnahan, Phillip Robert Neal and David Grant Neal, are the beneficiaries described in Article Sixteenth of the Family Trust. 10. On November 25> 2010 the said Family Trust beneficiaries executed a NOTICE RE NEAL FAMILY TRUST U/T/D 12/-171993 - DECLINATION OF GORDON SCOTT NEAL AND APPOINTMENT OF SUCCESSOR TRUSTEE, appointing David Grant Neal to-serve as Successor Trustee of the Family Trust. A copy is attached hereto and incorporated by reference as Exhibit"C ', 11. r David Grant Neal accepted the Family Trust and is the duly appointed and acting Successor Trustee of which the sole beneficiary is the Neal Nominee Trust. 12. As Trustee of the Family Trust the Affiant appointed himself as the Successor Trustee of the Neal Nominee Trust pursuant to an Appointment of Successor Trustee, a copy of which is attached as Exhibit "D" and incorporated herein by reference. 13. The Family Trust nor the Nominee Trust are in full force and effect. Attached hereto as Exhibits "A" and "B" and incorporated by reference herein are authentic reproductions of the pertinent parts of said trust declarations. 14. DAVID GRANT NEAL further certifies that he has read this Affidavit completely and he understands its,contents. 15. DAVID GRANT NEAL is Familiar with the Nature of an oath and with the penalties provided by the laws of the State aforesaid for falsely swearing to statements made in an affidavit of this nature. Signed, sealed and delivered this 7t day of April, 2012. David Grant Neal, Successor Trustee of the Neal Nominee Trust U/T/D'12/17/1993 Sworn to and subscribed before me a Notary Public.this /day of April 2012 by DAVID GRANT NEAL who is personally known to me or produced a- Massachusetts Driver's pcense as identificat' n d take an oath. Not P o lic Commission Expires:—, —- - - Jeffrey D.Perry Notary Public Common"allb of Massachuseb My Commi¢slon Expires October 25,2013 The Commonwealth of Massachusetts ¢rfinent o . Dep ffndustrial.Aci cidents Office of investigations. -600 Washington Street _. Boston,M4 02111 www.massgav/dig Workers' Compensation Israr�nce Affidavit- S'uilderslContractors/Electricians/Plumbers ALrplicant Iuformation" Please Print Legibly Name qksinesY0rg=izaficaVh&vicbi t : ( �? /C, Z_• Address: oZ 5 E N C- ) City/State/Zip: Phone.# d - Are you an employer?Check the appropriate box: a of Project ect re uir- 4. I am a general contractor and I P 1 ( Q dJ ; 1.❑ I am a employer with ❑ 6. ❑New construction ' employees(full and/or part-time).* have hired the gab=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 ` �p Y S, ❑Demolition worming for �any capacity.{ employees and have workers' 9. addition [No workers' comp.insurance comp,iasizance,t` ❑ 5. Weareac =ehc)n2eo d] � ❑ arparation and its '10:❑-Electrical repairs or additions 3. II� wner officershave exercised their [] mg repairs or additions Inddoing aIl work 11. PhM3b' aiysel£ [No workers' camp• right of exemption per'MGL 12.0 Roofrepairs bmuance required.]t c. 152, §1(4),and we have no 13.[V]'Otber employees. [No workers' ,, - camp.insurance required]. *Any applicant that cheeks box#1 must also fill out the section below showing their workers'compmsat M policy infarmai= t Homeowners who subnut tbis affidavit indicating they arc doing all work and then hire outside ron, '-.rs must submit a new davit indicating such. #Contractors that check this box must attached an additional sheet showing the name of the sub�ontractnrs and state whother ornot those entities have employees. If the sub-c-tractors bane employees,they:nmst provide their workers'comp.policy number. tam an employer that 1s providing workers'campensation;insurance for my employees Below is the policy and job site" information. Insurance Company Name: Policy#or Self ins.Lic.# Expiration Date: lob Site Address: CnylState/Zp: Attach a copy of the workers' compensation policy dedla afan page'(showing the policy number and expiration date). FaDure,to secure coverage as requa•ed under Section 25A of MCIL c. 152 can lead to the imposition"af criminsl penalties of a fine up to$1,500.00 and/or one-year.imprisomment,as wen 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 statenimit may be forwarded to the.Office.of Investigations of the DIA for insurance coverage verification , Ida hereby ce .under the pains andpenalties afperjary fhat the in provided ahoy. is true and correct.. Si e: Date: �01 Phone fs>� Official use only. Do not write in this area, to be completed by city ar.town afficirrl a , City or Town: PermitUcense# .Towing Anthority(circle one): 1.Board of Health 2.Building Department I City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#:. �tM 'Town of Barnstable Regulatory Services MAM SrABLE, Thomas F.Geiler,Director 1659. 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 HOMEOWNER LICENSE EXEMPTION DATE: / Please Print �/1 JOB LOCATION: _!5-k4 04 f>�77ftflE L2 G /t/ +-W17ZL F number street p" r cvillage "HONE OWNER".. V.-I—L> 1 V fT L name home phone# r 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 su ep rvisor. 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 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 proc es and re ements and that he/ e will comply with said procedures and requirements. a Signature of Ho owner 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. 1 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 ag: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:\WPFILES\FORMS\building permit fonns\EXPRESS.doC _ Revised 05.1811 t;t OF ttlE sresr.E. � Town of Barnstable ATF p Regulatory Services Thomas F. Geiler;Director Building:Division t Thomas Perry,CBO Building Commissioner. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 ` �' — Fax: 508-790-6230 operty Owner ust �. . Comple a and Sign his Section If sing A- ' der caner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by thi uilding permit pplication for: % (Addy ss of Job) Signature of Owner Date - Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form o the reverse side. QAWPHLESTORMS\building permit forms\EXPRESS.doc j Revised 051811 j BIKE Town of Barnstable, #a-Ga3 Expires 6 months om is ue * Regulatory Services Fee 9 MASS i639, �0 Thomas F.Geiler,Director tEo�,Is Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA.02601 www.town.barnstable.ma.us'. Office: 508-862-4038 _ Fax: 508-790-6230 EXPRESS PERAUT APPLICATION .-' RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property YAddress ` r/ C_ Q'Residential Value of Work 06 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name �; e; � let-4 0 P /7 V— �.2Z ,� Tele hone Number. Home Improvement Contractor License#(if applicable) , J,� 7) tf Construction Supervisor's License#(if applicable) C..S /" D ❑Workman's Compensation Insurance " ® PERMIT Chuff one: I am a sole proprietor APR 2 Zd�Z ❑ am the Homeowner VI have Worker's Compensation Insurance Insurance Company Name / �e✓�` i'®WN OF BA NSTA-BLE Workman's Comp.'Policy#- ( k 13 — CD d Z Z_ Copy of Insurance Compliance Certificate must accompany 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 roof) Re-side #of doors 12"*Replacement Window OSliders..U-ValUe o 1 (maximum.35)#of windows *Where required: Issuance of this permit does not exempt compliance with other town department regulations,Le.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission: A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: QAWPFILESTORM Wing permit formslEXPRESS.doc Revised 051811 a T7xe Commonniahk of Massat-kusetts D4arhnent a•f Irtdusstrial Ac+cidents Office of Inmtigations 600 Washington Stmet _. Boston,MA 02111 . nm s mas&gov/dia Workers' Compensation Insurance AffidavitlinIderslC.nntractorsJEetricians/Fluffib Applicant Information Please Print I.egib�y` P� r Name(Businm'o��idual)- Address_ w ►� fi�r �' � City/state/zip-- ✓w, v,� r� .A L•�' Phone 4- r7-7 V- Are you an employer?Check the appropriate box: Type of project(required): 1.M am a employer with. 4. ❑ I am a general contractor and I employees(full andforprrt-time). * have hired the suit-c�ors 6. ❑New consum ion 2.❑ I am a sale proprietor or partner-, listed on the attached sheet.". T ❑Remodeling ship and have no employees. These sub-contractatrs have S. ❑Demolition wcddng for me m any capacity. employees and have warms' [No wortoers'comp-insurance comp-insurance� 9- El But7ding addition required] 5. ❑ We are a corporation and its 1t1.❑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'camp insurance of exemption per MGL 12❑Roof repairs insurance require&].T C. 1521 §1(4X and we have n - no ,�,� employees.[No wm1mrs' 13.1J Other J)'o o✓ ee- GCC comp,.msurance required-] •11ay applicant Pont checks box#1 nmu also fill an the section bebww showmgdmir waskes'cam4mnsatiaa policy infnrmztlazl Hon eoancers who sabmait this affidavit uAicatag they are doing all vat and rhea hire outside coUftacmn nmst mubmit a new affidavit imdicatimg sucb- rGoatr UM that cbeck this boat nsust attached an additiamal duvet showimg the n of the sub-co=acmas and state whe%er orntrt Pose eatitim bane emplMes. If the sib-caaaa on lie employees,fe;'xmust provide tbna workers,camp.policy am3ber.. I art an employer that isproviding workers compensation inmraR ce for my employea& Below is the policy wzd job site_ information. �/ Insurance CompanyName: - yFi.•l1 ems``e✓ Policy#or Self ins.Uc.#: n 'M<oL 'IJ 7 ,� Expizatian Date: 2 of U 11,3 t J ' Job Site Address: ' t��1 . /�c,� y GitylState�'�p: C'�1;�`e•-✓d G`lew►-� Attach.a copy of the workers'compensation policy declaration page(showing the policy member and expiration dati). 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 andlar one-year naprisona t: ,as well as civil penalties in the form of a STOP WORK ORDER and a&e 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 hemby=thepdns a allies afpetjuty that the irtfor9t:atcnrt:proviti ed above is true and correct Signature ?ate: Phone#: 7 t3,fjici .use only. Do not write in this area,to be completed b}�city ar town or ciaL City or Town: Permitffikense# :Lssuing Authority fdrele one}: 1.Board of Health 2.Building Department I.City/Town Clerk 4.Electrical Lnspector 5.Plumbing Inspector. 6.0#her: Contact Person: Phone#: 6 ' TRAI�ELERS Jft j WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6KUB-0072N72-8-12) RENEWAL OF (6KUB-0072N72-8-11 ) INSURER: THE TRAVELERS INDEMNITY COMPANY NCCI CO CODE: 11347 INSURED: PRODUCER: MILANO, JAMES A EASTERN INS GROUP LLC 38 WINTER STREET 233 W CENTRAL ST YARMOUTHPORT MA 02675 NATICK MA 01760 Insured is AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 02-20-12 to 02-20-13 12:01 A.M. at the.insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s)Fisted here: MA m� e� B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in item 3.A. The limits of our liability under Part Two are: I Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 100000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 0GA D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE a 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 01 -27-12 WC ST ASSIGN: MA OFFICE: ORLANDO INDUS AFF 161 PRODUCER: EASTERN INS GROUP LLC 2B2KY 000548 + INE ' ; 3ARNSTABI.t''w '� MASS. 039. ,. Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division M1 Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us_ Office: 508-8624038 Fax 508-790-6230: Property Owner Must Complete and Sign This Section If Using A Builder - I, 4LUIC L , as.Owner of the subject property hereby authorize J e- a f-e J 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 If Property Owner is.applying for permit;please complete the Homeowners License Exemption Form on the reverse side. Q:\WPFILESTORWbuilding permit forms\EXPRESS.doc Revised 051811 ° �t Town of Barnstable Regulatory Services MAM g' Thomas F.Geiler,Director q'pr ,1�9'.�a`` Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 - www.town.barnstable.ma.us Office: 508-8624�,3 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTI N Please Print DATE: =,. JOB LOCATION: number �� street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town s e i zip code The current exemption for"homeowners"was a nded to include own -occu ied dwellings of six units or less and to allow homeowners to engage an individual for hire who es not possess a li ense,provided that the owner acts as supervisor. F1vITION OF OMEOWNER Person(s)who owns a parcel of land on which he/she r ides or inte ds to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accesso to suc se and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeo er Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be res o le for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for ompli ce with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she derstands the To of Barnstable Building Department minimum inspection procedures and requirements and that he/she will co ply with said proce es and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings conta' ' g 35,000 cubic feet or larger will be equired to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION - The Code states that: "Any homeo ner performing work for which a builds permit is required shall be exempt from the provisions of this section(Section 09.1.1-Licensing of construction Supervis s); provided that if the homeowner engages a person(s)for hire to do such wor that such Homeowner shall act as:superviso " Many homeowners who use this a emption are unaware that they are assuming the r ponsibilities of a supervisor (see Appendix Q,Rules&Regulations fo Licensing Construction Supervisors,Section 2.15) Tfris lack of awareness often results in serious problems,particularly en 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 051811 91te -� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massa(,4usetts 02116 Home Improvement ( ontraCtor Registration -_—�-- Reqistration: 158718 �7 - Type: Individual Expiration: 2/26/2014 Tr# 221312 Ito• —e '�'— "` h JAMES A. MILANO JAMES MILANO 38 WINTER ST YARMOUTHPORT, MA 02675 rr1 " Update Address and return card.Mark reason for change. _.�.--- Address Renewal Employment ❑ Lost Card DPS-CA1 0 50M-04/04-G101216 �!e Office of Consumer Affairs&B siness Regulation " License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 1:58718 Type Office of Consumer Affairs and Business Regulation Expiration. -2/26/2014 Individual 10 Park Plaza-Suite 5170 E. Boston,MA 02116 JAMES`A. MILANOj_- c ? JAMES MILANO 38 WINTER ST YARMOUTHPORT,MA Q5 a Undersecretary Not valid without signature - �- Ntassachusetts- Department of Public Safety urn Board of Building; Regulations and Standards;4 ` ,.Construction Supervisor License License: CS 15046 'JAMES A MILANO Y 38 WINTER ST •YARMOUTH, MA 02675;' Expiration: 1 1/51201 3 Cunm�issiuner: Tr#: 7809 NOTICE RE NEAL FAMILY,TRUST U/T/D 12/171993 - DECLINATION OE GORDON SCOTT NEAL AND APPOINTMENT OF SUCCESSOR TRUSTEE 1. Original Trustee. Phillip Neal and Clare D. Neal(Grantors) established the Neal Family Trust U/T/D 12/17/1993 (the Trust), serving as the initial Trustees thereof. 2. Death of Original Grantors. Clare D.Neal and Phillip Neal died on August 2 1010 and October 18, 2010,respectively. , 3. Successor Trustee. Article Sixteenth of the Trust names Gordon Scott Neal as the Successor Trustee of the Trust. 4. Declination of Gordon Scott Neal. In signing this agreement Gordon Scott Neal confirms that he has declined to serve as Successor Trustee of the Trust.No alternate successor, Trustee is named in the Trust. As a result,the office of Trustee is vacant. 5. Article Sixteenth. Article Sixteenth of the Trust provides that: "If there shall be no person in the office.of Trustee,the beneficiaries of the trust then of full age and competence and entitled to the income of the trust shall appoint a new. Trustee, by a notice in writing attached to this instrument, and if there shall be only one person in the office Trustee,the beneficiaries of the trust, at the request of such Trustee, shall designate an additional Trustee,by a writing.attached to this instrument,and if they fail to designate an additional Triistee within thirty days, the Trustee then in office may designate an additional Trustee." 6. Beneficiaries. The beneficiaries of the Trust who are of full.age and'-competence and entitled to the income thereof are: Gordon Scott Neal, David Grant Neal, Helen V. Bresnahan, and Phillip Robert Neal(the Beneficiaries). 7. Naming David Grant Neal as Alternate Successors Trustee. The Beneficiaries hereby appoint David Grant Neal as alternate Successor Trustee of the Trust. 8. Attaching,notice to Trust. A copy of this notice shall be attached to the Trust as.provided . in Article Sixteenth. Dated: (��'- a , 2010 David Grant Neal Dated: i G `�:J 2010 Helen V. Bresnahan Dated: G� : 26 2010 Pli li ob eat Dated: 2010 D z ® , Gordon Scott Neal ( NOTICE RE APPOINTMENT OF SUCCESSOR TRUSTEE FOR NEAL NOMINEE TRUST U/T/D 12/171993 1. Original Trustee. Phillip Neal and Clare D.Neal(Grantors)-established the Neal Family Trust U/T/D 12/17/1993 (the Nominee Trust) and served as initial Trustees thereof 2. Death of Original Grantors. Clare D;Neal and Phillip Neal;the Trustees of the Neal Nominee Trust died on August 2, 1010 and October 18, 2010, respectively, withoutnaming a Successor Trustee. 3. Successor Trustee. Section 2.8 of the Nominee Trust provides for a successor Trustee to be named by the Trust Beneficiary.- The Beneficiary of the Nominee Trust is.David'Grant Neal, as Trustee of.the Neal Family Trust U/T/D 12/17/I993. 4. Appointment of David Grant Neal as Successor Trustee. David Grant Neal,as Trustee'of the Neal Family Trust U/T/D 12/17/1993 hereby appoints David Grant Neal as Successor Trustee of said Neal Nominee Trust. 5. Beneficiaries. The beneficiaries of the Neal Family Trust, Gordon Scott Neal,David Grant Neal,Helen V. Bresnahan, and Phillip Robert Neal join in and.consent that appointment. Dated: / ; 2012 . D David Grant Neal, individually ana as Successor Trustee of the Neal Family Trust U/T/D 12/17/1993, Dated: 2012 r Helen V. Bresnahan Dated 1 �. 2012 — Phillip , bert'Neal r� all Dated: ,.2012 Gordon Scott Neal . . . .E ,y AFFIDAVIT OF SUCCESSOR TRUSTEE TO THE NEAL NOMINEE TRUST County of Barnstable `` ) State of Massachusetts ) The undersigned, DAVID GRANT NEAL, having been first duly sworn, certifies under penalties of.perjury that the following is true and correct: 1: That he is the duly appointed and acting Successor Trustee of the Neal Nominee Trust of December.17, 1993 (hereinafter NomineeTrust), which was entered into by Phillip Neal and Clare D.Neal as Grantors and as initial Trustees and who remained as its Trustees until their deaths: 2. Clare D.Neal and Phillip Neal died on August 2, 2010 and October 18, 2010, respectively,' without having named,a Successor Trustee, leaving that office vacant. • 3. Section 2.8 of the Nominee Trust provides that "If there is no Trustee in office . .. through death . . . of a sole Trustee without the appointment of a successor Trustee, a person purporting to be a successor Trustee hereunder may.record in''the Registry of Deeds.an affidavit .. . -stating that he or she has been appointed by all_of the Beneficiaries as successor Trustee. Such affidavit shall have the same force and effect as if the certificate of a Trustee or Trustees required or permitted hereunder had been recorded and persons dealing with the Trust or Trust estate may always rely an affidavit as so and recorded as to without further inquiry upon such the matters stated therein." See Exhibit"A. ' 4. Section 3.1 of the Nominee Trust provides as follows: "The term"Beneficiaries"wherever used herein shall-mean the beneficiary or beneficiaries listed in the Schedule of Beneficial Interests this day.executed and filed with the Trustees: " See Exhibit"A." 5. A true and correct copy of The Schedule of Beneficiaries attached to the Nominee Trust is set forth in Exhibit"A." It-provides that the sole Beneficiary of the Nominee Trust is "Phillip Neal and Clare D.Neal, as they are Trustees of the Neal Family Trust of December 17, 1993." 6. Phillip Neal and Clare D.Neal as Grantors and initial Trustees also entered into the Neal Family Trust of December 17, 1993 (hereinafter Family Trust).and remained as its Trustees until their deaths as aforesaid. . 7. The Family Trust provides that, at the Trustees' deaths, Gordon Scott Neal was to serve as the Successor Trustee. He declined to serve in that capacity. 8. The.Family Trust provides in Article Sixteenth that"(i)f there shall be no person in the office of Trustee,the beneficiaries of the trust then of full age and competence and entitled to the income of the trust shall appoint a new Trustee,by a notice in writing•attached'to this instrument. _ ,, See Exhibit"B » 9.':', The Grantors.' children, Gordon Scott Neal, Helen Virginia:Bresnahan, Phillip Robert Neal and David Grant Neal, are the beneficiaries described in Article Sixteenth of the Family Trust. 10. On November 25, 2010,-the said Family Trust beneficiaries executed a NOTICE RE NEAL FAMILY TRUST U/T/D 12�171993 -DECLINATION OF GORDON SCOTT NEAL AND APPOINTMENT OF SUCCESSOR TRUSTEE, appointing David Grant Neal to serve as Successor Trustee of the Family Trust. A copy is attached hereto and incorporated by reference as Exhibit"C." d 11. David Grant Neal accepted the Family Trust and is the duly appointed and acting Successor Trustee of which the sole beneficiary is the Neal Nominee Trust. 12. As Trustee of the Family Trust the Affiant appointed himself as the Successor Trustee of the Neal Nominee Trust pursuant to an Appointment of Successor Trustee, a copy of which is attached as Exhibit"D'' and incorporated herein by reference. 13. The Family Trust nor the Nominee Trust are in full force and effect. Attached hereto as Exhibits "A" and"B" and incorporated by reference herein are authentic reproductions of the pertinent parts of said trust declarations: 14. DAVID GRANT NEAL further certifies that he has read this Affidavit completely and he understands its contents: 15. DAVID GRANT NEAL is Familiar with the Nature of an oath and with the penalties provided by the laws of the State aforesaid for falsely swearing to statements made in an affidavit of this nature. Signed, sealed and delivered this / Tit day of April,2012: David Grant Neal, Successor Trustee of the Neal Nominee Trust U/T/D 12/17/1993 Sworn to and subscribed before me a .Notary Public this /� ay of April 2012'by DAVID GRANT NEAL who is personally known to me or produced a . Massachusetts Driver's icense as identificat' n n d take an oath. ;Ko Py lic mmission Expires: Jeffrey D.Perry U*h Notary Public Commomreahh of MassachusM My commission Expires October 25,2013 ^ r Tow.n of Barnstable. Ze'romit�#�0 Expires 6 mmnth ontirfide Regulatory.Services Fee aeataareat.e, NAM Thomas F.Geiler,Director PERMI FD MA'I - ,. . Building Division Tom Perry,CBO, Building Commissioner 200 Main-Street,.Hyannis,MA'02601 www.town.barnstable..ma.us T O\NN O BARNSTABI. Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY ; Not Valid without Red X-Press Imprint Map/parcel Number a f � Property Address c`7s`� �i S`t, 1 (Residential Value of Work 3J Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address LLA-0 �5. ©L 0 c �`7�?-�1 c ltr, Contractor's Name`J L_ J Z:P. LC,�{t��-I Telephone Number )C)CC-, Home,Improvement Contractor License#(if applicable) Construction Supervisor's License'#(if applicable) C(q L(01 ❑Workman's Compensation Insurance Check one: ElI am a sole proprietor �I am the Homeowner ' I have Worker's Compensation Insurance x Insurance Company Name Ux 't� Workman's Comp.Policy# i ULS Copy of Insurance Compliance Certificate must accompany each permit. ' Permit Request(check box) dRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be,taken to %ti�x3wl r1 ;;5�(j ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side �#of doors ❑ Replacement Windows/doors/sliders.'U-Value (maximum'.35)#of windows *Where required: Issuance of this permit.does not exempt compliance with other town department regulations,i.e.Historic;Conservation,etc. ***Note: Property-Owner musi sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. •i SIGNATURE 011 C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Iles\Content.Outlo6k\DDV87AAZ\EXPRESS,doe Revised 0721.10 '. The Commonwealth of Massachuse[ts ;- Department of Industrial Accidents Offlee of Invadgadons 600 Washington Street Boston,MA 02111 www.tnassgov/dla Workers'Compensation Insurance AMdavk: Bntlders/Contractors/ElecMcisnL/Plumben A20-Mcut Information- Please Print L odbly Name(BusinessfOrganizatiotvindividu y i_l u a{Z V—t�,U` Address: Q I A)E - L,40 City/StatelZip:4Aa1%W-Q•0k OJ-Lr t*02J -7 ne fit: pe! b Aqo Fu an employer?Check the appropriate box: am a employer with Z 4. ❑ I am a general contractor and I [13.[--] e of projecjaid�n employees(bill and/or part-time).a have hired the sub-contractors ❑New con 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. Remodel ship and have tm employees . These sub-contractors have 0 Demolitio working for me in any capacity. employees and have workers' [No workers'comp•insurance comp.insurance.t " ]Building required.] S. (� We are a corporation and its Electrical tions 3.❑ I am a homeowner doing all work officers have exercised their Myself,[No workers'comp. right of exemption MGL ]Plumbing iomtin4urance required.]t c. 1 S2,§1(4),and we have ao �Roof ai employees.[No workers' Other comp.inatnance required.I Any appSesni that checks box of must also tin out the section below showing their wo kn.cc f Homeownes who submit this afdwit' won Policy infouladon. iCoahaot=that check dtia bwt must atuei ao"donaf sbeat sho wet and ntea hire oubide wntracton moat submit a new a@idavit cndicatina such. employees• V the su a ins�e name of dte sebcontractors and state whadw at not those entities lave b.cotnbsotara have anployees.they=Ad provide their workno'comp.Poky nwnber. I an an employer that Is providing workers eompensatlon bmunonee for asp employees Below is the policy and job site injormatloaZ Insurance Company Name: ���T-( c��q,L Policy a or Self-ins.Lic.#: �! (� Expiration Date: 2'Z� Job Site Address: .az (� &111 f a�-r ty/ ��� t Statelzip: RA- Attach a copy of the workers'compenaadoo policy deciaradon page i (showin the policy number and expiration date). Failure to secure coverage as required under Section ZSA of MGL c. g 152 can lead to the imposition of criminal fine up to S 1,500.00 and/or one-year imprisonment,as well as civil _ I vest/ of a STOP penalties of a of up to S250.00 a day against the violator. Be advised that a copy of this statement may be for wORK warded Office and a fine lions f D1 A for ns e c vera vtrrif 'ca I do Jireret3y a rtlf j►under the pouts and p !lies of perjury that the injoraration provided above is late and Co Phone 4., uj use on . Do not write in t area,IVcomp e p c or town o,okki City or Town: Permit/Licenseg ---------------- Issuing.tuthority(circle one): 1. Board of Health 2.Building Department 3.Clty/Towa Clerk 4.Electrical Inspector 9.Plumbing Inspector 6.Other Contact Person: Phone* f l _ I'h i'%I.1ss!chusetts:-Dl ➢.rr`tr37eitt if P`nr f' Board'of Buil:lin!,g 9,e�,ulation and St.lrrclrr t3a Construction Supervisor Specialty License License. CS SL 99167 Restricted to: RFNV i OLIVER KELLY 9 PEREGRINE LANE SOUTH YARMOUTHI MA 02664 Expiration 9128/2011 ✓re"C-ov>e lz g u gad ej✓lfiaac�euZo6 Boar of urlr�m a ulatlo s an tandaras License or registration valid for individul use only - % HOME IMPROVEMENT CONTRACTOR before the expiration date: If found return to: Registration: 128957 Board of Building Regulations and Standards `t- k Expiration: 6/14/2011 Tr# 284841 One Ashburton Place Rm 1301Boston,Ma.02108 Type::Individual Oliver Kelly Oliver Kelly 9 Peregrine lane South Yarmouth,MA 02664_ Administrator Not valid without signature r } ✓r KELLY ROOFING 8 RHINE ROAD YARMOUTHPORT PH 508 775 4498 MA. REG.# 128957 MA 02675 LIC.# 99167 Okelly52@comcast.net August 29,2010 INSURED Proposal submitted to Phillip Neal of 589 Old Stage Road Centerville We propose to supply all materials and labor necessary to remove and replace the existing roof on the Barn at the address above All debris to be removed to town transfer. —"— 'White-Aluminum-drip-edgeto-be-installed-on-all-eaves _ Ice and water damage protection membrane to be installed on first three feet of eaves and around all protrusions Remainder of deck to be covered with#15 felt paper. 30 year limited warranty Architect style shingle to be installed. (Black) Ridge vent to be installed on entire length of ridge with hand nailed caps Protect all walls, windows,decks,plants and shrubs etc. during roof strip Obtaining of town permit. At a total cost of$3100 Payment Schedule; 50%at project start, balance upon completion. --Respectfully-submitted,-Oliver-Kell.- —— _---- -. Proposal accepted by, Date g /3 j /2010 If acceptable,please si±anod7retum ne copy and keep one for your records. This proposal is valid for 90 days from date above ® DATE(MM/DD/YYYY) ►CORD CERTIFICATE OF LIABILITY INSURANCE 4 1 )DUCEa THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DOWLING &ONEIL INS AGCY INC ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO BOX 1990 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR HYANNIS, MA 02601 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. (508)775-1620 508 778-1218 INSURERS AFFORDING COVERAGE NAIC# URED OLIVER KELLY INSURER A: LIBERTY MUTUALGROUP 127 EVERGREEN STREET- INSURER B: SOUTH YARMOUTH MA 02664 INSURER C: INSURER D: INSURER E: )VERAGES _ -HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING tNY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR AAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH 'OLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. i DD' TYPE OF INSURANCE POLICY NUMBER DATE OLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE S _UAWAdrTURENTED COMMERCIAL GENERAL LIABILITY PREMISES a occurrence) S CLAIMS MADE 1J OCCUR- I MEO EXP(My one person) I S PERSONAL&ADV INJURY S GENERAL AGGREGATE S GEE GGREGATE'L A LIMIT APPLIES PER: % PRODUCTS-COMP/OP AGG S POLICY PRO- RO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) S ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE S OCCUR FI CLAIMS MADE AGGREGATE IS `J S DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION WC2-31 S-338804-029 12/28/2009 12/28/2010 1 WC STATU- ITOTTORY LIMITS ER AND EMPLOYERS'LIABILITY -- ANY PRbPRIETOR/PARTNER/EXECUTIVE Y I N E.L.EACH ACCIDENT S 100000 OFFICERIMEMBER EXCLUDED? Y- (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S 100000 If yes,describe Under - SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT S 500000 OTHER 3CRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Aers Compensation Insurance:Part One of the policy applies only to the Workers'Compensation Laws of the State of MA. IE WORKERS'COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR OLIVER KELLY :RTIFI AT HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXPIRATION ZOB BLANK DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS wRRTEN 166 THOUSAND OAKS DRIVE NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 3REWSTER MA 02631, IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE �f Jeff Eldridge ' -ORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. NQ.:,;7279496 CLIENT CODE: 1329955 Deb Derochemont 4/27/2010 3:23:12 AM Page 1 of 1 - i A., Town of Barnstable *Permit# ,001.0 A f �I Expires 6 months from issue date „ MASS , ; Regulatory Services Fee 0o as ¢ Thomas F.fiery Director S' ?Ea y°. Building Division { Tom Perry, Building Commissioner cJ 07 200 Main Street.Hyannis,MA 02601 Office: 508462-4038 Fax-, 508 790-6234 EXPRESS PER1VW APPLICATION RESIDENTIAL ONLY rr• Not Vaud without Red X Press Imprint :piparcel NumberVrty Address J� C' ? S�� Residential Value of Work L4 3 o o Minimum fee of•$25.00 for work under$6000.00 � ' veer s Name&Address �j /j--elk � �� 1-�c� V e �� e G; ,ntractor!s_Name /v t ) f tM D` eV Telephone Number >me Improvement Contractor License#(if applicable) 33 L ! --- rnstrucdon Supervisor's License#(if applicable) 1Worlanan'.s Compensation Insurance -PRESS PERMIT Check one: [] I am a sole proprietor MAY2�07 ❑ I am the Homeowner I have Worker's Compensation.Imsurance TOWN OF BARN STABLE e snraace Company Name orkman's Comp.Policy# = WC )py of Insurance Compliance Certificate must be on face. xmit.Request(check box) WV Re-roof(stripputg oId shingles) All construction debris vM be taken to 1—��I e 1 S I Pc'�. , G t 1��*�L j ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side D Replacement Windows. L7 Value (maximum.44)- *V4=required: Issuance ofthispermit does not ex IMI .` g ertowndepartmcaLregulations,i.e HistosigConservationetc ***Note: Property Owner must sign Property Owner]Letter of Permission. Home Improvement Cunt;# 'cone is oquired. Mst0630 4 .YG!/K1 irrawii vJ �riMiivM iNi Llwiiic rirdl •� �, Off ce ot'Investigations•' "' � .600 Washington Street Boston,AM 02111.4 www.mass gov1&a Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers - Awlicant Information '-' _ - Please Print Legibly Name(Business/Orgamzation/Individual)• 'Y"y Address: t• r t, i i° 1�7 r „ 4 u ;'t- {tiL +. z 1c 4 , ate/Z.i P r� Ga Vl s . /U I C1�S 7 Phone ty/St #• `jZ - �, �� � �'�,�� ,, , wr..�. Are you an employer?Check the appropriate boa: 1'''-'' ' r ' • - y # .� 'Type'of project(required): 1.[RI am a employer with 4. ❑ I am a general contractor and I 6. ❑+New construction .t:, '•, '' employees(M and/or part time).* , f., have hired the sub-contractors _ {. ' listed on the attached sheet.t '`7.. ❑Remodeling 2.❑ I am a sole proprietor or partaer- ship and have no employees These sub-contractors have =8. ❑ Deinolition, working for me in any capacity. - workers' comp.insurance - 9: Q Building addition_, _ _ a [No workers' comp.insurance 5. ❑ We are a corporation and its ,. v. required,]., ,, ,:cY, , � ;-, officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right o`f exemption per MGL` Of 11.Q Plumbing repairs'or additions , c, myself [No workers' comp r.t.� ,ce. 152,§1(4),and we have no' 12.[ Roof insurance required.]_t 1 ,,employees. [No woBeers' "' r 135 - comp.insurance required.]. *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy mformmtionc •', ` L ': . t H.wnas who submit this affidavit indicating they ate doing all work and then hire outside conttactus must submit a new affidavit indicating such :T tCont mum that check this box most attached an additional sheet showing the name of the sub-contractors and their worken' muip-policyiaformatioa •,;,.,...,...f- I am an employer that Is Providing workers'compensation insurance for my emp"a Below is the po&cy,and Jab s#e information. L -6 _ :l _ ► 4,41 Insurance Company4, Name: (� - "' - ` l�G� -�17 Policy#or Self-ins.Lic.#: /��C Z....3�S - - ;Expiration Date: /"C& -,. . 1 r=' I-. • ,i4`'" Job Site Address: O ST y- 'jC - i r: Citiy /LiStat Attach a copy of the workers' compensation policy declaration page(showing policy.number and eapiratioia date).r '� .. Failure to secure coverage as,regnired under Section 25A'of MGL c. 152166 lead do the imposition of criminal penalties,of a.,,,,' ' t, fine up to$1,500,.00 and/or one-year impriS6i3i1 nl;as well as`civil penalties in the form of a STORWORK ORDER and a fine,., x of up m$250.00 a day against the violator:"Be advised that a'copy of this statement may, forwarded to,the Office of- __"�- 1- �� {tr'i •8r •- . •::f -- - xr 6 .Y.. Investigations of the DIA for insurance coverage ven5cation. - - } -j i r r , I do hereby certify under the pains and penalties of perjury,that the information provided above is true and correct: r . ,�. ,�; " Date. Sienatmre•`�� ` w. - -.G . Phone#: �0 ���/" ,�G.�-- ( _.._. --- • - - ��:�,..�.. r.. � �� ..::��c�ra�Y. 5 ��� _,t i ' L official use only. Do not write in this area,to be completed by city or town of,f lcud p r City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector r, t%Other r'-t _-t' "- #: Contact Person: � t Phone lntormation 'anu'llla hl U%;LlivJ AO Massacpusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees' 1 ee is defined as"...every Person in,the service of another under any contract of hire; Pursaant to this statute, an emp oy express or implied,oral or written.".._ • . .Y�. . . . ,.. • . An employer is defined as ,an individual,partnership,association,corporation or o egal entity,or any two or more ther ed ' a°oint enterprise,and including the legal representatives f a deceased employer,or the J However the of the foregoing engaged to ' employees. How _ aztners ' , association or other legal entity, ymg emP indnal, mP 0 fan P receiver or trustee . owner of a dwelling hour a shaving not more than three apartments and who resid merein,or the occupant of e dwelling house of another who employs Pons to do maintenance,construct! or repair work on suchva7tdwelling house g t thereto shaIl not because of such loyment be deemn+cltcrhecer�loyer. or on the grounds or buildin& MGL chapter 152,.§25C(6 Also states that"every state or local lieensin agency shall withhold.the issuance or renewal of a license or pen*to operate a business or to construct dingsein the commonwealth for any applicant who has not produced acceptable evidence-of complianc the insurance coverage required•" Additionally,MGL chapter 152,§25C('l)states"Neither the commo e alth nor any of its political subdivisions shall ce of public work until acc table evidence of compliance with the insurance enter into any contract for theperforman' Pul? ' - . requirements of this chapterto hi4been presented the contracting uthority" ` � Applicants „ � � • s Please fill out the workers'comp lion affidavit completely by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s) e(s),address(es)and hone numbers)along with their certificate(s)of C or Limited iabfiity Partnerships(LLP)with no employees other than the insurance. Limited Liability Coro (LL ) . members or partners; are not required carry workers'- ation insurance. If an LLC or LLP does have employees,a policy is required. -Bead- ed that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance verage Al be sure to sign and date the affidavit. The affidavit should , be returned to the city or town that the 'cation for a permit or license is being requested,not the Department of lndustrial Accidents.-Should YOU have an questio regarding the law or if you are required to obtain a workers' _ ent the number listed below.-Self-insured companies-should enter their compensation policy,please call the Dep self-insurance license number on flee appro ° e City or Town O!fieials Please be sure that the affidavit is compl and ' ted legiibly. The Department has Provided a space h the bottom of the affidavit for you to fill out in the eut the ce of Investigations has to contact you regarding the applicant Please be sure to fill in-the permit/lic a number hick will be used as a reference number. In addition, an applicant that must submit multiple permitm a apphcati in any given year,need only submit one affidavit indicating current policy information(if necessary) d under"Job S- Address"the applicant should write"all locations in (city or town)."A copy of the'affidavit t has been offi ° stampai or marked by the city or town may be provided.m the applicant as proof that-a valid davit is on file for fu a permits or licenses. Anew affidavit mustbe filled out each year.Where a home owner or 'tizen is obtaining a.li a or permit not related to any business or coimmercial venture (it a dog licen§e or permit burn leaves etc.)said petso is NOT required to complete this affidavit The Office of Invest ns would like to flunk you in ad ce for your cooperation and should you have any questions, iga please do not hesitate to give ns a call.•, The Department's address,telephone and fax number - The CdMmonweahh of sachusetts Depa(I ent of 1AduiW9-Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,##617-727-4900 ext 406 or 1-877-MASSAFE - FaA#617-727-7749 _ ,.. t Town of Barnstable Regulatory Services. BAPJWABU& ; Thomas F.Geiler,Director Huss. 03 �`0� Building Division , Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.towri.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder \: r u' ,as Owner of the subject property 0.hereby authorizeN ✓''�1�� e�'�Q✓►`I to act on my behalf, in all matters relative to work authorized bythis.building permit application for. 01J (Address of Job) Signature ofiDwnef Date �} �� 11► 0eak Print Name a • Y • Y I r'- t .t a .'ire Q-.FORM&OWNERPERMISSION A Liberty Mutual Group Liber PO Box 7202 Alutual$ Portsmouth,NH 03802-7202 Telephone(800)653-7893 Fax(603)431-5693 March 23, 2007- TOWN OF BARNSTABLE ATTN:BLDG DEPT 200 MAIN ST HYANNIS,MA 02601- RE: Certificate of Workers Compensation Insurance Insured: MCAS LLC DBA NICKERSON HOME IMPROVEMENT PO BOX 2476 ORLEANS,MA 02653 Policy Number: WC2-31S-360989-017 Effective: 3 /l /2007 ElTiration: 3 /1 /2008 Coverage afforded under Workers Compensation Law of the follo,.vmg state(s): MA Employers Liability Bodily Injury By Accident: $ 100;000 Each Accident Bodily Injury by Disease: $ 100,000 ' Each Person Bodily Injury-by Disease: $ 500,000 Policy Limits As of this date,the above-referenced policyholder is insured by Liberty Mutual Fire Insurance Co under the policy listed above. The insurance afforded by the listed policy is subject to all the terns, exclusions and conditions. and is not altered by any requirement,term or condition of any or other documents with respect to which this certificate may be issued. This certificate is issued as a matter of information only and confers no right upon you, the certificate holder. This certificate is not an insurance policy and does not amend, extend, or alter the coverage afforded by the policy listed above. if this policy is cancelled before the stated expiration date,Liberty Mutual will endeavor to notify you of such cancellation. YL AUTHORIZED REPRESENTATIZTfi LIBERTY MUTUAL INSURANCE GROUP This Certificate is executed by L[BERTY N UTUAL hNSURANCE GROUP as respects such insurance as is afiarded by those companies. cc: .blsured: Producer of Record: ` MCAS LLC DBA NICKERSON HOME IMPROVEMENT ROGERS &GRAY INS AGCY INC PO BOX 2476 PO BOX 3700 ORLEANS,MA 02653 PLYM UT1-1. MA 02361 4 _----------..._-----..-.... ------------- ------... _ `�- ✓fie >nazzrzxanuw.allt c�.�luzssu�utelZi', Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: - Registration: 133851 Board of Building Regulations and Standards Expiration: 8/17/2007 One Ashburton Place Rm 1301 Type: Private Corporation Boston,Ma.02108 NICKERSON HOME IMPROVEMENT MARK NICKERSON 12 COMMERE DRIVE — ORLEANS,MA 02653 Administrator Not valid without sig_tature fil�lo6� Town of Barnstable * o� V�ro Permit# 5' Expires 6 months f issue date X-PRES,S PERMIlRegulatory Services Fee NOV U 2 Thomas F.Geiler,Director 2006 Building Division TOWN OF SARNSTAJC Perry,CBO, Building Commissioner 00 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint i#r Map/parcel Number Property Address e Vl esidential Value of Work Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address OA A QV4'j tw [din nxxt� Contractor's Name e-1-14 o�m5apl) Telephone Number Abffa CEa(Z Home Improvement Contractor License#(if applicable) j Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I pnihe Homeowner 04 have Worker's Compensation Insurance Insurance Company Name �. Workman's Comp.Policy#- Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) . ❑ Re-side ET"Replacement Windows. U-VaIue (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. :***Note: Uer�tymust sign Property Owner Letter of Permission. ent Contractors License is required; SIGMA Q:Forms:expmtrg f V 6 bI (5(A)r775_o7 S (SM) o rl � mot. Home Address: Nth (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): Proiect Information: I/We/You("Purchaser"), the owners of the property located at the above installation address, offer to contract with Home DepotU.S.A., Inc. CIFI tD of")to furnish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet# W �7 ,incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if, upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS (Subject to fund verification and/or credit approval.) rl1 l� ( 1ashim Check or US Postal Service Money Order CONTRACT AMOUNT $ ` / c payable to The[-ionic Depot). *LESS DEPOSIT $ �bS 2. Credit Card*and/or other payment options-Circle One Below Viva MasterCard Discover American Express BALANCE DUE The Home Depot Home Improvement Loan The Home Depot Credit Card ON COMPLETION $ ❑New Account [I Existing Account (HIL&HDCC ONLY) *Minimum 25%of Contract Amount due upon Available Credit:S (HIL&HDCC ONLY) execution of this contract. Acctm: Exp.Date: Dame as it appears on card: Indicate Payment Method For *By my/our signature below,I/We agree to allow Home Depot to BALANCE DUE ON COMPLETION: charae the above referenced credit card for the deposit indicated. Cardholder's Signature Date HIL or HDCC Authorization Codes Deposit - Final Payment # # Purchaser agrees that, immediately upon completion of the work, Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder, Entire AlZreement: This agreement and its attachments, including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time ,you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 25%of the contract amount if the job is cancelled by Purchaser AFTER the third business day. BY MY/OUR SIGNATURE BELOW, I/W'E AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. UWE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND ' E AUTHORIZE HOME DEPOT TO VERIFY AN.D REVIEW MY/OUR CREDIT RECORD WITH AeND EN CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROIvER MISSIONS OR ERRORS. /SUBMITTED BY: Date: A� !Jpys CorgsultgnlDate:ACCEPTED BY: meowner Date: F[omcowner ^-- NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 7-18-06 C-SC White-Branch File Yellow-Customer Pink-Sales Consultant , Cl �,EOOEZEirLL gotleW eRueQ f AL o Ml ash • 1 er?geeek#haappz'epristebos� . Type pfpr�ect(req�' : • . It you an emp ay oral=. twmrand1 6. Q New c=.ftci=. 4. ❑�am.ageu I=a� aii p c havc* dfte<� 7, ®1 do*g cmpweea( • orpactaac N*d oa the attacled t , & Demolition A 1=s solo ixa Thesa gab-coatractorelava [1. p1 have ao epI4Y wosltars'comp•fagaranca 9. j3� add ymtlog jrsnoin.any eBacwl. 3. O we are a corpqWaasadim IO.[]Blectdical%V*s or ad-dos � pomp " pia �' .$�aasaco• of&W bm a�iva 11.[]Fbvzo glV�°r�'�s •]. of eaaoapfeanP :.. � Iarna]tomaown C. aad�tehaveno 1Z.❑Aoofsegairs e �voftl V;°01*' esup]oyees.vo ! •�. ccomp.mg+uaccas%* l sll ont au>�ltaabelnW rho '00!°�enaspoZi°y"cam"ti°b� Y tFP c #1 saint�1ro ate dooms a11'7vrr�mtdffiea]�ta���a�sm vd%n R anew v!!at�c 1C • aad dtt�r wad FcT fafosso�3om. , � �baza+a+t+�0ilsn�ftiaad e8at e�e ofi6e ray w�rk�rs'co pensadan hLW'cnce faniny Oplcyees..$efaw is rlra rcltq+msd,�ob ante: ;r. n an aaaplgyesJeaf fs p t8 ... itce Compmy:K=A, �•Lh 1z;1 trot tj►l ltafiePLip'' (,'yy� d('9 r ILL&C��j� site M&CO• a ghowing the panty cumer an bd aptg%UOA date). tact a eop?of the worltere compena don declandonpAB t onalties"vf a vmW good= SA gfUQL c.132vid1ead to eimpasitioa of crim�alp �e aacmra•°m' �s zeq� �roli ae civ�pmaat ia9ta.fcnm a .a STOP WOttR and a ome OUR m i1,snoo sndlor ono-y+aat ink �t�a sb�t�Ybe�'�ed to Sic Office of ap to SZ50,OQ a day kgam�'�m����v�geed*at a coPY , v of to ` r rX o fParfsCry that the hiforn aeon provided above is ims and ean•ecA �O hara6y�dfj► P D tore' . • . - *L ds a%te•be mow by tat}erg offloW, �ermftlLieense# _ . City arToww. Urmlal Aldhw*(drele oae)c', Ot eder S.plumbic Ins t actor 1.BuNng D . Board of gealth ement 1. A0 Cterk. 4.Btectrieat Insg 8 p °F ►�,,, Town of Barnstable Regulatory Services f 9MRNMASS.ffrABM8+ Thomas F.Geiler,Director 1639.�iO�ED rya+& Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, hll�10 , as Owner of the subject property hereby authorize1( Jb F���y� to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Dat �11 � 1 !� Print Name Q:FORM&OV NERPERMISSION aC ae it� i Grid 1-000-746-6E86 RES 97 ENERGY PERFORMANCE RATINGS U-Factor(U.SJI-P) Solar Heat Gain Coefficient 0 . 35 0 . 26 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 . 43 . wnsA eer stlpuYhq M them renp mntam W a ffihblrt NRIC procedtM 110 df0 InN Oda prodtsc!patrtw+a.Nfi'IC redegs an damrmL*to a Poled set of#fl* meettil wsk8torr and a spud!*prfldtrct eta.Consort twwf+C4aare zx A:ss kr atlta pradud ptrrlhrmm ftmwmN taww.nhe.orp t, 1. 1 . Ia'ENfi1's>� � I : • Uuit qualities for toarp star •• Aegion(a): Northecn, Nacth � • I •.� crntcal, south cant:ral, . p southern I i DP : +25/®25 moo: p .'aLzoISS 3 eo-MS f iorder 50375 AS Board or Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 126893 Expiration: 8/312008 Type: Supplement Card • i THE Home Depot.,At Home Servic MCHARD FALLONE;. `•'- 3200 COBB GALLERIA PKWY#20 � ' AtIANTA,GA 30339 } Administrator i % y n "� '� ®� ®011-0, CERTIFICATE NUMBER MARS � � zE 19C ►T�� F II�SYaIVCEa �' . :,. . . _,.� �;_ � .> .,. . y,_ d ATL 000915907-11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER'THAN THOSE PROVIDED IN THE ATTN:BRENDA BOOKER (404)995-2504 . POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE MAYA MCCLURE(404)995-3206 OR AFFORDED BY THE POLICIES DESCRIBED HEREIN. TAMI ROUSE(404)995-3430 FAX(404)760-5663 COMPANIES AFFORDING COV RAG2 3,175 PIEDMONT ROAD,SUITE 1200 — ATLANTA,GA 30305 COMPAN`! ti 100492-IPUSA-GWA 03104 A STEADFAST INSURANCE COMPANY INSURED THD AT-HOME SERVICES INC. B ZURICH AIMERICAN INSURANCE COMR-A,NY 1, DBA THE HOME DEPO T AT-HOME SERVICES,INC. — ---- HOME DEPOT USA, INC. COMPANY 2455 PACES FERRY ROAD N'YJ C NEW HANiPSHIRE INS CCINIPa„1iY BUILDING C-8 ATLANTA,GA 30339 COMPANY D AMERICAN HOME ASSURANCE COMPANY `COVERAGES This certlfcatesupersedes alitl'replacesBny previously Isobwcertificatg„forthe pollcypenod rioted below, 3 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION LIMITS TYPE OF INSURANCE POLICY NUMBER LTR DATE(MMIDD/YY) DATE(MMIDDIYY) A GENERAL LIABILITY IPR 3757 608-01 03/01/06 03/01/07 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' - PRODUCTS-COMP/OP AGG $ 4,000,000 r CLAIMS MADE a OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL 8 ADV INJURY $ 4,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire) $ 1,000,000 MED EXP(Any one person) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-03 AOS 03/01/06 03/01/07 COMBINED.SINGLE LIMIT $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEOULEDAUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS X ELF-INSURED AUTO PROPERTY DAMAGE $ HYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM 1$ WORKERS COMPENSATION AND 6610998 AZ,ID,MD,VA WC STATU- OTH ;'. mt G EMPLOYERS'LIABILITY. ( ) 03/01/06 03/01/07 X TORYLIMITS C 6610995(AOS). 03/01/06 03/01/07 EL EACH ACCIDENT $ 1,000,000 G THE PROPRIETOR/ X INCL 6611326(OR) 03/01/06 03/01/07 EL DISEASE-POLICY LIMIT $ 1,000,000 P ERS/EXECUTNE 6610999 NY,WI 03/01/06 03/01/07 E OFFICERS ARE: EXCL ( ) EL DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER WORKERS E COMPENSATION CONTINUED 6610997(FL) 03/01/06 03/01/07 D 16610996(CA) 03/01/g6 03/01/07 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLESISPECIAL ITEMS " 'CERTIFICATE HOLDER P 1 CANCELLAI?ION �t ' SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, - THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL_3p•DAYS WRITTEN NOTICE TO THE FOR INSURANCE PURPOSES ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIFICATE. " MARSH USA INC. 2j BY: Walter Gilstrap �IlAi r z a N a ' x MM1•(3/02) e � VALID AS OF '02/27/06 '� ^"`v:...� '� .£,;S° .�k Aa:e� ;,°a. S',a>�,....��A��° '',g,i8��"+, x � �i�,.'�a�N"��` ..1�w.3p ::3� '` F �,�i.(. '.�"r;�L.�,wv.,'....4e:�,b-.,;; yT. .�.w,.ae. '"•�'±..,2z'�'..,.. c i..S..'4'tt?� ;'�,�£..:_ . • 5 Asses'or's oftioe<w(lst floor):= P UST BE INC r 9 I d l.�L DG `' Assessor's hmap°;and lot number ...... .............s IWALLED A i ,.. IN'C0NlPLIAN cos Board of Health brd floor):` WITH'T�'fLE 5 w Sewage Permit number ...e��, � I VIFION ODE eassrsnta �. Engineering' Department Ord floor): Bern '� M63I House number ... SOS On ePbRn�M0 "�a APPLICATIONS PROCESSED I3 30 9:30 A.M. and' 1:00.2:00`'P•M. on } h TORN DF BARNS 'A�L� Date BUILDING INSPECTOR APPLICATION <FOR,PERMIT TO .....�4..T.L ...........,..!..!. TYPE OF, CONSTRUCTION' ... t?012:...r_!.!q.(YJ,�.�................. ....:........................................................... ................................................19........ TO THE INSPECTOR OF BUILDINGS.,.. The undersigned hereby applies for a permit according to the following information: Location ..... ..... S6../. ... ...... �. ... G. T., .1�.............. ...:... .5.�:.�,f'�t.. . F ore.... ,ft. ..:...�....� .C�.. .:1..........Fed-....... .<4:.�.�......2 Proposed Use . — ZoningDistrict :.:.......:... .. ...................................................Fire District ............ ............................................................... /� , ... ............�;XC.�..,...Address Name of Owner ... . �-�... ..� /L/� L ��� --------- Name of Builder co �j S ice(` v..`► 6: #.....Address _Sor f IC........( ' A'S ........��:. Name of Architect .......... ..:...Address - Number of Rooms Foundation ......CBl�2. .Q�.. Exterior .....(!!eft/..T.. ::..Cr Q,h1/L..-S.:. :..................Roofing ....,.,?9 �...T............................................ :. .. Fr° T../....:....:.....:. P.yL�dUl�. .::Innterior .... ..�5:.. ..L�.......................... Floors ST 3 Ate' J ,�G Hedting /}/(y/`/� x U!.CpCl.1J s,j d.:u ::�r,/r_ "P�iu'm ng,;...,.:./j(G?t' ... „�... JF Fireplace ... ....:.A/ ............ ..:.:... ._........:...,.....: . ............,.Approximate Cost Definitive Plan Approved. by Planning Board .:_____ :.____...19 ._._ Area ....<o.? y.-sr .4. . Diagram of Lot and Building with Dimensions Fee ..... .......... y� 7 SUBJECT TO APPROVAL OF BOARD OF HEALTH 6(L #�#�wxs�.a,M1" k@t.,d' OYC v+i�q^;y r�..:aa".. 41,;r#:.�4.�k,-'t"+s.�x�,.,.,fk::.a,;,s;, - +..:.z.� ... - - - .a- '+-�^'-;•' 1 { OCCUPANCY PERMITS'REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name1. ed. . .. .... .................... L Construction Supervisor's License .. . NEAL,, HELEN . & PHILIP i Y ',No•.35437 Permit For BLD. .ATTACHED GARAGE Single Family Dwelling Location 589 Old Stage Road Centerville Owner Helen & Philip Neal Type of Construction Frame Plot Lot Permit Granted October 9, .. 19 92 Date •of Inspection 19 Date Complete 19 � s + S t I R +a , 1 I , I I I I i ..... _ -. _ - _ I ' i i r/ ! I � e j 1 : i 2 C A J • ; , , } { , , r a 1 r r , ( 1 s { ow V i _ , 9 i --- - - r� 0 -------- 1 �^gym --� - • r : - --- _ , r r r r _ _.— r _.- ._ _-_•• , _.._._._._ ..- ..ice. ;.._ --- --' : ----------------- 1_ , t : r 4 f - t t - I' { �r 1 ' I: l � , r , , _! 1 ----------------- I -- r - f - I. r + I r , , r t , G I _ r : I a t 0 { f � � 1 I --- w 1 -- - - i i , : r d Yo l ---- --- --- - 771 - - -- --- -- -- ---- - - - _ - - --- - r-- -- : 4 , 1 i ' 1 I , « � r I + r 1 r : r r r 'i : , I I I ' 1 r 1 ; Assessor's office(1 st,Floor):' � (� / ; . tNEA number m STA r� 2►thard LLED r 1i11 COMPLIANCE Sewage;Permit number `;1- .1� �' z # V=TE 5 .� • Engineering Department(3rd floor) 7 f�NVIRONfUEWAL CODE AMC �saa5T11DtL House number ) !,TOWN rrua / !' OWN REGULATIONS °o }-4 Definitive Plan-Approved by,Planning Board i I 1 �� Y APPLIGATIONeS PROCESSED 8:30-9:30 A.M.and 1 00-2:00 P.M.only~' s . TOWN' OFF BARNSTABLE w BUILDING INSPECTOR t APPLICATION FOR PERMIT TO 23el TYPE OF CONSTRUCTION P j19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location re 9 e5l_i� 0 3 2 Proposed Use 74>F C Zoning District Fire District Name of O OR Address,S'�4 �i_s �v�.C`a �/.td / n�-��Z Name of Builder I Address MV-IrA"(109, d v/ Name of Architect'` Address Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost `To O Area Diagram of Lot and Building with Dimensions Fee _SO fL 17 Ib . U 1.1 n 2t qq 135 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstabl garding th§14above construction. Name Construction Supervisor's License NEAL, PHILILP MR. & MRS. No 35340 Permit For BUILD DECK Single Family Dwelling Location 589 Old Stage Road Centerville Owner. Mr. & Mrs . Philip Neal Type of Construction Frame Plot Lot Permit Granted September 2 , 19 92 Date of Inspection 19 S DalftornIftit 19 zIM � It j 0 A .q W/7 ,0 cST l2� s ' CAPiZZI HOME IMPROVEMENT INC. / 1645 NEWTOWN ROAD COTUIT, MA 02635 fF6, 426-9513 / 1-600-262-5060 ... c71& yx& PT P C1LO i °ft"Er°�� TOWN OF BARNSTABLE 89BBSTSIILE, i 639 BUILDING INSPECTOR\0� . 'Fp ypY p,• APPLICATION FOR PERMIT TO ................................072 dW a �� I F4 4 TYPE OF CONSTRUCTION r4� ............19.1... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby.app�plliieess for(apermit according to the follow' iformation: Location ...�a707....... .�T.'..4!.....`'.T�? ......�C� .............-.........uia.,zFe. . .�. '� ................................... ,cj.. ProposedUse .... C'S UC'YI ................................................................................. .......... Zoning District ............................................................... ire District .1/ C'�'....................................I I ' te Vt................. Name of Owner 1AA.V....U.......:...�...........�...!K.........Address .................. .�/ ...X1c,% ..... ���1^��2 (/ h/ ram, Name of Builder t.C/4.. Sa. ......!`d.. 1 p-S.............Address .� 5..... ....................... Nameof Architect ..................................................................Address .................................................................................... pp Number of Rooms ...... .. t?O S....fi,!J�2eze� Foundation ... ...ur 6...... ci Exierior l.1.� rr1.. . ...................Roofing .........Q Y ...1 J.I e -..��..'.t..CS�. . s . . ................wo.J.......... (J Floors ....h r d c t�0 04 ...................Interior ...... ...c-'r J ± r...... V......7......+............I.-...................................... Heating ). .�...:........as:...�5...............................Plumbing ........(: .-. /a-- i,Q�-,�................................ Fireplace ........................Approximate Cost a ��pP ...............�t. .............................................. Definitive Plan Approved by Planning Board -----------__________________19 Diagram of Lot and Building with Dimensions , Pd SUBJECT TO APPROVAL OF BOARD OF HEALTH .� THE PROPOSED METHOD O-F SANITARY WATER SUPPLY, SEWAGE PROVIDING SAL AND ,DRAINAGE IS E�REBY APPROVED lC � C TOWN OF BARNSTABLE, BO ARD OF HEALTH LTH A LICENSED -INSTALLER MUST PERMIT. AND I STALL SYSTEM r OBTAIN SSEWAGE. I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name %./ �. ........ . ........... ... ..P�'... Helen Clare Dunham � Panfur —I �I/2-'�'��f�—.� — �. ' � dwe.^......... g==.==`==�`-...: :q-4:. ,................... � Location .......58A_. ��. ................. . � / —'------'—~~~~~~~-~~~''---'-------' Helen Clare Dunham Neal } . Owner ------------''------''—'—''' \ Type of Construction ..................fzaoma............. � / ( —~^^—'~—'—^^^^'----''^'----''--`--- � Plot ............................ Lot / — .-----,.— ..---------- \ Permit" Granted" ^ ' --- of .n-,_-_. ~ � . uu,e Completed . � . � _ PERMIT REFUSED -----.----.---..-------.--. 19 y / ` -^'^^~^----'—~----^—^^—`^^~--^'—`'' ` -------'---------'------'''-''-'-- � -_.----_..---_---_—__--~---'---- ' / .-.---..—.----.—.....^.--^..~—.-,......' \ ' Approved ................................................. 19 ^ . . ^ ^~ -----------'—'---^~'`^`—''--~'—`-' ----^-------^------^—^^—'`'~''~^'` r � . | q I I T EMME NONE ME ON ME M NEON ��: uv MEMEM MEMO E MI 0 ON ENO ME NoaM M ONNO No SON No loom ME MUM ME MEN M MEMME ME MEN! 0 ME ME MEEM ME ME ME 0 M ME mmom vME � MINE iir.= ON ME MUSE 0 M ME MEN mommi M MEN MEN ME MI 0 0 MEN NONE om No MEM r.I M N ME ME No NINEi ' mm ON ME No IN 101 MEMINIM M NONE 0 M 1p IN E 0 ii ME No 0 0 E M E �.6 � 0 ■ M No No M r4 Y,+' ( - } f h.. .) i ! , "KI , - ' ---"y^'*;'-• .:•,i_..t { i •�. 1 .+ I :.t, ' } 1, +. {{ "" •: ;. { .,_..y. -.J 1 f 1 1 �y' • {'.t - i - rsk'' I { � 1 ! t � t"" " �-� -;• 1 1 -+--F'-�- !�-.,t'.'•. 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