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3166 MAIN STREET
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J 'h wr0�,:2t,:.:r•L' r.f, .,_l,,z� �" .. k; u ,.., �. 1".�.r. r_ > ,.x..�i..,,.'�. ,.� .m ..-.r..-S a.,.v�.Gti: .., +.lx'4,dr spa` .,.«..rxl, b_.-i;�+, _^d�!�.M,< �-�. 'Wcw�...::', .,+r.,,,....w,:-. �..I.r,l �l ar:.......�_� �s.�.13�.6+t,,,.��:�.aa.wri..ra�'ti,�i..•.N;fi�'•�4i„$�'�. i'.� 1. .fi.��k. , Anderson, Robin From: Florence, Brian Sent: Thursday, July 25, 2019 4:27 PM To: Anderson, Robin Subject: RE: use of 3166 Main St. Barnstable Village Can you see if they can come in for a discussion? We can ask them to bring a site plan or look in our files for a plan to get an idea of parking. Maybe we can get them to get a parking agreement with someone for the event. I am not comfortable saying yes and having a parking problem but willing to consider it for a one weekend event with parking in place. -b From: Anderson, Robin Sent: Thursday, July 25, 2019 12:06 PM To: Florence, Brian Subject: FW: use of 3166 Main St, Barnstable Village The structure is in a residential zone. It was at one time a hair salon. It was last used as Late July—retail&office space. It's been vacant for a while.The site borders on the village business district in fact the driveway is in that district. There is always moving the zoning line 3o ft.to allow for the use. The only concern is the parking is very limited there. However,it's a week-end event during the month of August and court is not in session. It's walkable from there. Site plan? Just OK to go? Please advise. R From: DAVID MILLER [mailto:bertal@comcast.net] Sent: Thursday, July 25, 2019 11:40 AM To: Anderson, Robin Subject: use of 3166 Main St. Barnstable Village Jon Lewis, the owner of this building, is allowing us to use the empty building for the month of August for a Pop-Up Art Sale. The dates we will be open will be Aug 3 and 4; Au 10 and 11; Aug 17 and 18; Aug 24 and 25; Aug 31 and Sept 1 from 10AM to 4PM. We will be using 2 rooms on the main floor for selling artwork and one room just for storage. We have provided the owner with liability insurance and will be using one of our employees and some volunteers to work at the sale. Thank you for the information on permitting. Roberta Miller 508-612-9394 1 ;✓ . Roberta Miller Executive Director Cape Cod Art Center 3480 Rt 6A Barnstable, MA 02630 508.362.2909 www.capecodartassoc.org www.photographycenterofcapecod.org CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 2 1(a"IC )(Al • -P/L du0146(,ld,%r htvoc ) � demo Gam. a,L 14-0 s e� f • Town of Barnstable97 Blillding Por�st ThiswCacd_So That rt is UisibleYFrom the'�Street�:��A roved Pla�nsaMusL be�Re#arced on=,Job and=this Card,Must�be 7:dp,:e:,F,,i4:,4,"li.:!,''',',,,:'1,-- )i1AN''',/ ,: .Y § T i !. y:. s, n ,I,� d•!:. 'a 4' ' ,Fir �Z,"",�i •M Posted Until:Final Inspection F#as BeenMade f r . F �. , , _ i - Permith vWIIere.a Certificate of Akz# anc.,is Re ulr d,such Bu ldmg•„ ,, Not be Occupied untti„a Final l;nspect�on a ee .a ._ ,..., , p_. . :yr , q. : ,- . ..". .a Yti < .., < z ux.., ... ,��; .� :r. �� :;a. „fir::;. Permit No. B-17-555 Applicant Name: OHC INC. DBA/THE HOUSE COMPANY - Approvals Date Issued: 03/14/2017 Current Use: Structure Permit Type: Building-Addition/Alteration-Commercial Expiration Date: 09/14/2017 Foundation: 6ocation: 3166 MAIN ST./RTE 6A(BARN.), BARNSTABLE Map/Lot 300 004 Zoning District: SPLIT Sheathing: Owner on Record: LEWIS,JON ROBERT TR 4, Contractor Name MICHAEL S ROCKWELL Framing: 1 Address: PO BOX 1235 wtr- ;Contactor License CS-074034 2 BARNSTABLE, MA 02630 kZ Est Pr0.oject Cost: $ 100,000.00 Chimney: Description: remove 1&2 storyexterior addition,exterioe staff rand dormers. Permit�Fee: $ 1010.00 p '-;P Insulation: reframe roof opening and install new slate roof Misc carpentry , � v'. FeePa`id: $ 1,010.00 repairs emfAi Final: '"Date s 3/14/2017 Project Review Req: remove 1&2 story exterior addition, erioratairs ands , �% dormers. reframe roof opening and install new s al to oof Mesc1 - - / �: Plumbing/Gas carpentry repairs ` '� - Rough Plumbing: , 1� Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sib onths after issuance. All work authorized by this permit shall conform to the approved application and'the`,,approved construction documentsfor which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laves and codes. Final Gas: This permit shall be displayed in a location clearly visible from access streettorro adand shall be maintained open for3public inspection for the entire duration of the work until the completion of the same. " � ` g Electrical The Certificate of Occupancy will not be issued until all applicable signati s by the Building end�Fire Officials are provided on t permit. Service: Minimum of Five Call Inspections Required for All Construction Work: , 1 III �� a • 1.Foundation or Footing Ill Rough: 2.Sheathing Inspection ., �3 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: - 6.Insulation • 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Jso(:) Parcel OD Application # /62" / 7-5 5 s Health Division Date Issued 3/1 3/i 7 Am Conservation Division 0'4 Application Fee Planning Dept. Permit Fee f/e9 < lJ Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis b8P7 ,p� Z p'l Project Street Address ►lP to 1 -A h t ti MAR t ST' Village 1Iae.r4STr-P�t- N`74RL . Owner .or-! \17- Address Po15ox P�ralzr—,4 .�1 MA. Telephone �o"�4c / 52%.1' 1. 3o Permit Request k; i o l 4, 2- sr Dti- oN► (DR. , Roos= c' t A,M1 \N4-s�nl i� N�w SL�-�� c��F . 1�.Sc . CAR-? c"1sdrrrU-r Square feet: 1st floor: existing ILISI proposed 9'•co 2nd floor: existing to IN proposed 1 q3(o Total new 1 $71- Zoning District N? -A ; RE- oZ Flood Plain Groundwater Overlay Project Valuatio O0,ou0.- Construction Type \moot Lot Size . ►1 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure '$ to 0 Historic House: *Yes XNo On Old King's Rjghway: JilYes ❑ No Basement Type: Ul Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count \ Heat Type and Fuel: 1;i(Gas ❑ Oil ❑ Electric ❑ Other Central Air: ciYes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Ye ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new si 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 5400 o Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 0‘AL Names C-oMPArJ� Telephone Number •1 11. 030''� Address 3D cpa,�-�� 117 Sri L License # L+ \\-T1 .1,x1Ntv.S Ki p, 06).6o I Home Improvement Contractor# 'u o 31-- Email lN� l l-L\-oils k=-TCe) . Ltivvi Worker's Compensation # Plug `k- SIP 3 711 tP ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE OZ i.//x___. DATE 3 • I • 20► FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. • r + V - ADDRESS VILLAGE OWNER S 4 DATE OF INSPECTION: T `t FOUNDATION FRAME v INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING " DATE CLOSED OUT ASSOCIATION PLAN NO. f - - Town of Barnstable Old King's Highway Historic District DECISION Wednesday, January 11, 2017 6:30pm The Barnstable Committee of the Old King's Highway Regional Historic District Commission, acting in accordance with The Old King's Highway Regional Historic District Act, Chapter 470, Acts of 1973 as amended, has held a hearing and made determinations on the following applications: APPLICATIONS Lewis, Jon Robert, Tr., 3166 Main Street/Rte. 6A, Barnstable, Map 300, Parcel 004 Remove 22' x 27' rear addition with exterior stairs and dormers ***Certificate of Demolition or Removal Approved as Submitted*** Lewis, Jon Robert, Tr. 3166 Main Street/Rte. 6A, Barnstable, Map 300 Parcel 004 Restore building to original design and shape. Remove dormers, reroof main structure. Remove additions and stairs. Remove attic door and restore window and trim. Remove east door and restore to window. ***Certificate of Appropriateness Approved as Submitted*** McKenna, Bonnie, 25 George Street, Barnstable, Map 319, Parcel 064 Demolish existing dwelling and garage ***Certificate of Demolition or Removal Approved as Submitted*** McKenna, Bonnie, 25 George Street, Barnstable, Map 319, Parcel 064 Construct new 4-bedroom dwelling and garage ***Certificate of Appropriateness Approved with Conditions; the windows will have interior grilles which will be glued in place and permanently attached*** Powers, Randall & Marjorie, 66 Harvey Ave., Barnstable, Map 319, Parcel 108 Construct a new sun porch that will connect the house to the garage ***Certificate of Appropriateness Approved as Submitted, in addition, all new windows will be • added to the house, windows will be 6 over 6, with interior& exterior grilles *** Any person aggrieved by a decision of this Committee has a right to appeal to the Regional Commission within 10 days of the filing of this decision with the Barnstable Town Clerk. Date: January 12, 2017 Town of Barnstable Regulatory services Thomas F. Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Complete and Sign This Section If Using A Builder I, Jon Robert Lewis, TR ,as Owner of the subject property hereby authorize OHC. Inc dba The House Company to act on our behalf, • • - in all matters relative iiSW-8riiauihorized by iliii-bui.lding-Pertnit application for: 3166 Main Street/Route 6A,Barnstable,MA (Address of Job) rti6 Sign re of Owner Date Print Name • . - • • , 5 , • , • A, „1 The Commonwealth of Massachusetts , , , ,m , Department of Industrial Accidents Office of Investigations 600 Washington Street '" :,lzril Boston, MA 02111 . e www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): OHC Inc. dba The House Company ' Address: 30 Perseverance Way, Suite 2 City/State/Zip: Hyannis, MA 02601 Phone#: 508.771.0303 Are you an employer?Check the appropriate box: Type of project(required): 1. ✓ I am a employer with 2 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity_ employees and have workers' comp insurance. 9. Building addition [No workers' comp. insurance p required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL YP 12. Roof repairs insurance required.] t c. 152, §1(4), and we have no q ] 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: Travelers Property Casualty Company of America Policy#or Self-ins.Lic.#: 7PJUB4759P37716 Expiration Date: 7/21/2017 Job Site Address: 3166 Main Steel City/State/Zip: Barnstable, MA 02630 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the�ains a d enalties f rjury that the information provided above is true and correct. Signature: lye. c / ' 7 —/ - g / Date: l Phone#: 508.771.0303 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: DATE(MMIDD/YYYY) ACORD® CERTIFICATE OF LIABILITY INSURANCE 07/14/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: Brenda Boyer WELSH & PARKER INSURANCE AGENCY Nc°.No.Ext): (800)826-5652 FAX Nu): E-MAILSS: bboyer@welshparker.com 131 COOLIDGE ST.STE 100 INSURER(S)AFFORDING COVERAGE NAIC# HUDSON MA 01749 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER B: OHC INC DBA HOUSE COMPANY THE INSURERC: INSURER D: 30 PERSEVERANCE WAY SUITE 2 INSURER E: HYANNIS MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER: 69072 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POUCY NUMBER (MM/DDIYYYY) IMM/DDIYYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ ATO RENTED CLAIMS-MADE OCCUR PREM SGES(Ea occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY !$ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE , $ POLICY JEST LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $ _ AUTOS _ AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS _ AUTOS (Per accident) UMBRELLA UAB OCCUR EACH OCCURRENCE _$ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X PER ERH AND EMPLOYERS'LIABILITY - ANYPROPRIETOR/PARTNERIEXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 A OFFICER/MEMBEREXCLUDED? N/A N/A N/A 7PJUB4759P37716 07/21/2016 07/21/2017 - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 `" C Daniel M.Cr ey,CPCU,Vice President—Residual Market—WCRIBMA 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD r ____'""NN OHCINCO-01 BBOYER Ai ® CERTIFICATE OF LIABILITY INSURANCE DATE(MMJDD1YYYY) 7/1 412 01 6 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poiicy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to • . the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), . PRODUCER CONTACT NAME: Welsh&Parker Insurance Agency,inc.I Hudson Office PHONE FAX • 131 Coolidge Street,Suite 100 (ac,No,E«tl:(978)562.5652 I(A/C,No):(978)562-7120 • Hudson,MA 01749 EMAIL ADDRESS:______ INSURER(S)AFFORDING COVERAGE I NAIC# INSURER A'Main Street America Assurance Company INSURED INSURER B:Merchants Preferred 1112901 OHC,Inc.dba The House Company INSURER C: I 30 Perseverance Way,Ste 2 INSURER D: Hyannis,MA 02601 INSURER E: I INSURER F: I COVERAGES . CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. iLTR' TYPE OF INSURANCE I INV:,IW D I (I DDIYYYY) (MM/DD/YYYY)i LIMITS INSO i WVD POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY I € I i EACH OCCURRENCE $ 1,000,000 I CES(Ea 1 0 e) } CLAIMS MADE X 'OCCUR MPT4569F 07122/201 fi 07I22/2017 pREMiSEs(Ea occurrence) $ 500,000 i_ i i MED EXP(Any one person) j$ 10,000 I _ 1 i I PERSONAL 8 ADV INJURY I$ 1,000,000 1 GEN'L AGGREGATE LIMIT APPLIES PER: __ i I I GENERAL AGGREGATE I$ 2,000,000 1 X:POLICY JE LOC E i i t i f j PRODUCTS-COMP/OP AGG 1$ 2,000,000 I OTHER: i i ii i$ AUTOMOBILE LIABILITY 1 I I COMBINED SINGLE LIMIT I$ 1 (Ea accident) ,000,000 B 1 !ANY AUTO __ 1 MCA7015386 03121/2016'I 0312112017 S BODILY INJURY(Per person) '1$ ALL OWNED SCHEDULED 1 i X ;BODILY INJURY(Per accident $ AUTOS • 'AUTOS 1 i :` X NON-OWNED PROPERTY DAMAGE 1 HIRED AUTOS AUTOS {{ i {:{ (Per accident) I$ 1 I UMBRELLA LIAR OCCUR I i I I 1 i I EACH OCCURRENCE I$ EXCESS LAB :CLAIMS-MADE i I ,AGGREGATE j I$ $ t DED , r RETENTIONS ! i i I 1 I I$ :WORKERS COMPENSATION - ;AND EMPLOYERS'LIABILITY } I ! I 1 STATUTE t (OR- I YIN' ) } ANYPROPRIETCRR.cARTNER/_XECUTIVE (E.L.EACH ACCIDENT i$ IOFFICER/MEMBER EXCLUDED' I N/A ;(Mandatory In NH) i i 1 Ec.L,DISEASE-EA EMPLOYEE$ If es,describe under__ OF OP_FZATIONS below j j E.L.DISEASE-POLICY LIMITS I i I , • i 1 i i , , t i i DESCRIPTION OF OPERATIONS;LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) PROOF OF COVERAGE FOR THE WORKERS COMPENSATION POLICY WILL BE SENT DIRECTLY FROM THE CARRIER. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE . I ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD PJA..e ((JO47!/mone e,cla d/01/cmaa d elZ r r.at Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 100932 _ Type: Private Corporation Expiration: 6/24/2018 TdA 419291 OHC INC.DBA/THE HOUSE COMPANY- MICHAEL ROCKWELL 30 PERSEVERANCE WAY SUITE 2 HYANNIS,MA 02601 Update Address and return card.Mark reason for change.` scat o adawsnr f_i Address CI Renewal [Employment Lost Card ,r rnruin.aenrcn/N 1/n/Ire xrr4r dfi Offiee of Consumer Affairs&Business Regolaioo License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date.1f found return to: 'etg Registration: 100932 Type: Office of Consumer Affairs and Business Regulation Expiration: 6)2420t8 Private Corporation 10 Park Plaza-Suite S170 Roston,MA 02116 OHC INC.DBAI THE HOUSE COMPANY MICHAEL ROCKWELL 30 PERSEVERANCE WAY SUITE e_:- Hyannis,MA 02601 Uoderseeretar r Not valid without ignature # Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-074034 Construction Supervisor MICHAEL S ROCKWELL 4, • • 799 LUMBERT MILL ROAD .. MARSTONS MILLS MA 02648, q • ten Expiration: Commissioner 07[27/2018 Town of Barnstable Geographic Information System May 16, 2016 , ' 7'. 4. 300006 #3192 • • t 300046 #3152 ` 300004 i #3166 i 11300048 #31801 • i 278009 #7 O 299026 #3171 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:300 Parcel:004 N Owner:LEWIS,JON ROBERT TR Total Assessed Value:$684000 boundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map ;�t ,E are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner:BARNSTABLE SAVINGS Acreage:0.17 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:3166 MAIN ST./RTE 6A(BARN.) ,%• such as building locations. Buffer "'"/l�fr` ' ! 1 ! i • . i . 04 '40a - i A: .%›_ , 2 V - . • - o• 'ee i Sr • - •S - co.t. -&92; ci -".... %. Nii, ! k * 1) I : Lb% i t / / v a, • i kr q0 Q , . ., /1 / . i ; Z 500 t ° I SI I - 'iv At /q14 / . • gc- •0 0 ii, / . f • • w 1011/ i .... . ..9, V /. (0) / o ' ill 1 1 ...1 ii. 4 s, es c4 i. • Ai / 0 / : . —1/A _ • - & /0 I . / / • -, . / / : . -----...........i............4....... ., ; . ; . . _ rit-cfz-110S-7-11---sP4e 1- PLAN OF LAND IN BARNSTABLE VILLAGE , MASS. Be LONGING TO ______--. . . •_ _ TuRP I JOSEPI-I G. N - I.KNSTABLz: ; SCALE 1 I NCH 1 ZO Fr: OCT. 11. 1947 , , essAmse.; keLux.e,, Ct v tt. E.1.10ILS. CEATILICV:1..L S. MASS. / 0 'IS 014 ..CL ,.: ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ADO . Parcel Db 64 Application #06 1 Health Division Date Issued 1 c Application Conservation DivisionFee e ��6 5 4 O 5) Planning Dept. 2Permit Fee c(Q D Date Definitive Plan Approved by Planning Board p1" "7-2 !3 Historic - OKH Preservation / Hyannis Project Street Address 3 d C C %S Village 1. rkcs�-�v�,\o� j�tJ A� Owner 7a e 1 P- / l 1 i c ��(.. Address 4444 10 k ,°4k a.ot Telephone SD 'L$ q S S3�l' b ; V/V 262So Permit Request (L u'. th. access L CoAe- - ,D „„ Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation f).:500 Construction Type 1,)aoc& 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: M Yes ❑ No On Old King's Highway: 12i Yes ❑ No Basement Type: A4 Full 1111 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 S Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other a. Central Air: )0 Yes ❑ No Fireplaces: Existing New Existing woad/coal stove: ❑g s ❑ No Detached garage: ❑ existing CInew size_Pool: ❑ existing ❑ new size _ Barn:°0'existing newt size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 1 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ . : rri . Commercial ❑Yes ❑ No If yes, site plan review# Current Use C . c Proposed Use Sow APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Rim, [3aJA A6-L c, Telephone Number ( 01g) 7 3 7 9 34s Address 7 LIZ ki "9a License # C S ' [7.it c-k ®Zfl--5 Home Improvement Contractor# I 129 2 Worker's Compensation # Q &,o U�,-.0115004 ALL CONSTRUCT N DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO )4./-04-A.0 - ---;YS 4 SIGNATURE DATE 7/IS/ 3 FAR OFFICIAL USE ONLY `S4PPLICATION# DATE ISSUED MAP/PARCEL NO. • ti ti ADDRESS VILLAGE OWNER 7 } DATE OF INSPECTION: f u FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH - FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. } The Commonwealth of Massachusetts Department of Industrial Accidents =" t= f Office of Investigations `ari= 600 Washington Street ;. Boston,Mel 02111 ''*•:� www.mass.gov/dia' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Moocke, LC—. Address: . L ek to City/State/Zip: ' s„J - Phone#: `�O$) 3�j 'l 3 g 3 Are you an employer?Check the appr ate box: Type of project(required): 1.❑ I am a employer with 4. 1111 I am a general contractor and I 6. ['New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.11I Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. r Insurance Company Name: ,t,,., Policy#or Self-ins.Lic.#: CS6 0 O 15- �215 0 D xp �i '• � E iration Date: a ;,, Job Site Address: `3‘ (s(o A Ck!ta` City/State/Zip: ?/ t0`Q-d MA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D for insurance coverage verification. • I do h certify un • and e aloes of pedury that the information provided ab e is ue and correct. Signature: Date: 7 Phone#: (5ô ) -2-3 7- $3 41-5 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: • Information and Instructions `� , Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. -Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such erriployment be deemed to be an employer." MGL chapter 152, §25C(6)also states that``every state or local licensi agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct 5 uildings in the commonwealth for any applicant who has not produced acceptable evidence of complianc• with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commo wealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acc ptable evidence of compliance with the insurance requirements of this chapter have been presented to the contractin authority." Applicants \8 ' Please fill out the workers' compensation affi�°davit completely .y checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and p one number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or=Limited Li. ility Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavi-may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Al be ure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for th pi it or license is being requested,not the Department of Industrial Accidents. Should you have any questions reg ,'ing the law or if you are required to obtain a workers' compensation policy,please call the Department at the n sr',er listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed egibly. v.e Department has provided a space at the bottom of the affidavit for you to fill out in the event the Offic:.of Investiga ons has to contact you regarding the applicant. Please be sure to fill in the permit/license number whi g' will be used a reference number. In addition,an applicant that must submit multiple permit/license applications is any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Sit:,Address"the apph ant should write"all locations in (city or town)."A copy of the affidavit that has been officia y stamped or marke' by the city or town may be provided to the applicant as proof that a valid affidavit is on file fo r future permits or licen•,es. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining license or permit not rel.ted to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)s. 'd person is NOT required complete this affidavit. The Office of Investigations would like to thank ou in advance for your coope :tion and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax n ber: The Colo II onwealth of Massachusetts - Departilnent of Industrial Accidents Office of Investigations 6 0 Washington Street oston,MA 02111 Tel.#617-727-4 .0 ext 406 or I-877-MASSAFE Fax#.617-727-7749 Revised 4-24-07 www.mass.govfdia. - r 'ACORi3• CERTIFICATE OF LIABILITY INSURANCE 9ATE(MM/DD/YYYY) �' 07110/2013 THIS CERTIFICATE IS ISSUED AS A MATTER-OF-INFORMATION:ONLY:AND CONFERS NO-RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND,OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. :If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu.of such endorsement(s). pN PRODUCER 01962-001 NAME CT Bryden&Sullivan Ins Agcy Inc ((P C.No.Ext): (608)398-6060 (AArc.No.: (508)394.2267 PO Box 1497 EMAIL So.Dennis,MA 02660 ADDRESS: - INSURERISI AFFORDING COVERAGE NAIC# INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: John Suslo • Carpentry Services INSURER C: 8 Viking Drive South Dennis,MA 02660 INSURER D: INSURER E: INSURER F• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT 70 WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED D���B��Ypp PAID ppCLAIMS. gy�pp INSR TYPE OF INSURANCE INSR WVDR POLICY NUMBER (MM/DD/YYYY) (MM±DD/y ) LIMITS LTR GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL UABILITY PREMIDAMAGE TO RENTED $ PREMISES(Ea occurrence) CLAIMS-MADE OCCUR MED EXP(Any one person) $ • PERSONAL E.ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ }OLICY URO- LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT AUTOMOBILE (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OVVNED SCHEDULED i AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ yypRKDEERDg pp� ERNETTEENNTIION $ / $ AfNdyD ERM�PpLRO�YEH•�2P5�/LpIgARB7ILNREYwp� •` x T RY LIMITS OETRH " A OFFICER/MEMBER EXCLUDED?"'vEr�NI NIA AWC 400-7029166-2013A 6/2 2013' 6/22/2014 E.L. ACH ACCIDENT $° 100,000.00 �(}fMyya�rnsddatory in NnH)� ( I . .DISEASE-EA EMPLOYEE $ 100,000.00 DEI )ON OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) 'Proof of Coverage Only; John Suslo is covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION John Suslo 8 Viking Drive • SHOULD ANY OF THE ABOVE.DESCRIBED POLICIES BE.CANCELLED BEFORE South Dennis,MA 02660 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE / j @ 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD :v6-014Eics, Town of Barnstable Regulatory Services J2, Thomas F.Geiler,Director MASS. - Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 • www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-7.?0-6230 Property Owner Must Complete and Sign This Section • If Using A Builder I, \ 'r' -/- :ts ,as Owner of the subject property hereby authorize ?kcti, ae.\`/7/1612_ I C. to act on my behalf; in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. lir r'----��� a' Signature of Owner - Signature of Applicant c)cAt., ta..A Acieelt. C_, Print Name Print Name Da , Q:FORMS:OWNERPERMISSIONPOOLS 62012 <kti Town of Barnstable ' � Regulatory Services • BARNSTA LE : Thomas F.Geiler,Director ,,�`� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 8-862:4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: numbe street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: \townstate zip code The current exemption for"homeown "was extended to include owner-occ pied dwellings of six units or less and to allow homeowners to engage an individual fo hire who does not possess a license, rovided that the owner acts as supervisor. DEFINITION OFHOMEO Person(s)who owns a parcel of land on w i,'ch he/she resides or intends to res de,on which there is,or is intended to be,a one or two- family dwelling,attached or detached struc es accessory to such use and/or arm structures. A person who constructs more than one home in a two-year period shall not be consi' ed a homeowner. Such"hom owner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she •,all be responsible for all su work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibili• for compliance with e State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she unders,. ds the Town f Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply wi L. said proced es and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or 1. ^.er will be required to comply with the State Building Code \ Section 127.0 Construction Control. HOMEOWNER'S EXE or v ON The Code states that: "Any homeowner performing work for h .h a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of constr cti Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner sha act • supervisor." Many homeowners who use this exemption are unaware that th';y are a timing the responsibilities of a supervisor • (see Appendix Q,Rules&Regulations for Licensing Construction Supe ' ors,Se +'on 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unli tensed pers r,s. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supe or. The ho t,eowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibi Sties,many com ti unities require,as part of the permit application,that the homeowner certify that he/she understands th responsibilities a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t am-'d and adopt such a form/certification'for use in your community. CAUsers\decolldc\AppData\Local\Microsoft\Windows\Temporary Internet Files\ContentOutlook\QRE6ZUBN\EXPRESS.doc .Revised 053012 `�31�� M��� S+ c,ro55 2.G4 FOP ����. V 7/3A 3 C.- ''. ' . 4 4--/8‘\6,,Ae_.---) ,x4t (--A, - 5 .d '),?(8 LeiTsr. S P �•Q ! c -sf • l U Prop Sec —1Av000),\,Z,>11-,,, . .I . ' ' 7 . . . : 9.x 8 AZ.Q )( w'"`j %a 1} --J i s k c \ocl�t!,,,? ` �1 ^# 4 v {c- n Sip Cnhc�3'1e 4- 1S G-r .e o., Pave.rs Li` Bale,) ./ \ ��OOT l-,'�M-C O� \��///. .5(m& - P-opdse�.�ec.�` 7/3/3 * r Y (P,e,00,cc...,m,c.,,A\,) ;:y I (L.4.... o-c •L O,v,.k,iA� . 1oo,.)e 31 G(. rnc._,A ST 1,_0„.1;,,,,a - 1 .,,kskGVc kilt[kc�e P:,,N Jo.s-V •S4-,Ps As o 1� _ o, ../z.c.k.. • `G..\j,a. ._ I� �t i 1 (�' ,1 t I , "Doe_ Yo EX S 'JQ 10". CoA.Cy-m;v,c ye�w,e.� A- No-Zav-t (New Nett bc� • ® �� 4Mc1 Duo' S..e c9. SA 0‘ 11 i . �k _ Si : - ro-L,:,\'` /13113 .. • SlopLA . .-Da Coffer' • i) bode_, [\ C , - 2x 6 ;.1� 0..c-, ` 5'd sr S 0/4.0, S q X G 104c.LGk.. too oo�w�S . Ex;5\--:n Sc.� v�1,ruy . 4- 0A. Sao 16, + TOWN OF BARNSTABLE BAR_W i= 0 07 Ordinance or Regulation WARRING NOTICE Name of Offender/Manager dob Address of Offender MV/MB Reg.# Village/State/ZipSS# _ Business Name L ! �� \/ dam/fpm, on ` tC 20 Business Address Li ' �' t P filtA.it...4. �'1 ,�f � Signature .of Enforcing Officer Village/State/Zip i i f c Location of Offense r G C V _# II g C__ .,b G --. } Enforcing Dept/Division Offense ` © � 1"1 w � ~. ( C... ) C„.., -f'- RA of 4._ Facts This will serve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts>- and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK-ENFORCING OFFICER GOLD-ENFORCING DEPT. „•\ . ...it •,,,.. ''',..,,Airy,tio, -. .- .. . _ . . ...iiihm.;,:ii*, T i; 1 r-1, • 1-,..- 1 . 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