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HomeMy WebLinkAbout0050 AIRPORT ROAD 7 u o YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $40.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1s, Fl., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE Fill in lease: cc APPLICANT'S YOUR NAME/CORPORATE NAM / �� ((/�� ©7 ��C BUSINESS YOUR HOME ADDRESS Z� Cc-0 / / TELEPHONE # Home Tele hone Number NAME OF NEW BUSINESS 1 OR EIN:Have you been given approva rom th uilding ivisio YE NO MAP%PARCEL NUMBER PADDRESS OF BUSINESS �` 2S 2 When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COM SION R'S OFFICE This individu I h infor a fan p rmit requirements that pertain to this type of business. th ized Sign tur COMMENTS: 2. BOARD OF HEALTH This individual has teen rm d of the permit requirements that pertain to this type of business. MUST XMPLY WITH ALL ll�i 0 HAZARDOUS MATERlA(.:c P'.., n- Authorized Signature"* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has V&n in e o the licensing requirements that pertain to this type of business. A�t� rid zed nature"�I 'ZC-�- COMMENTS: Par TOWN OF BARNSTABLE BUILDING PERMIT,APPLICATION., L . Map Parcelol Application # Q'{ 1 Health Division Date Issued . CJ Conservation Division Application Fe Planning,Dept. Permit Fee' Date Definitive:Plan Approved by Planning Board Historic -OKH —Preservation / Hyannis Project Street Address _ S-0` 61 P,n Village 14 V AAA 15. Owner '�?zt1 A. DWI-5 Address ��Q/ 1n� �`i r C + �i�/ Telephone (S-0f 796 C:)' Permit Request ICE 4 Leith —T A-V- 1,07- LWt /IiYJ1z11 / S � x In-hjL N (T O)L t - rg S Q7 I F igyc;gr w 6T To �atc> ��tic n�y 7c� Lod Gc�rS: Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Q Construction Type V-EAX Lot Size 7`-r.135'.51 _;°F`r"_ Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family .0 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 VOther MAI, Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing. new g , _ j g _� Half: existing nevus Number of Bedrooms: existing Z�ew Total Room Count (not including baths): existing new �_First Floor Rooml:,Count Heat Type and Fuel: &Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes WrNo Fireplaces: Existing New Existing wood/coal stove: U Ye o Detached garage: ❑existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑exiJing ❑ rfe-W size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new 'size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial W(Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER)Name Vy\l A_ 0.4ylS Telephone Number (505) 7q 0 3239 Address 2K MI6) STEMIF'T License # 5 a 1`7 3 3 77!v 62-6 3,a Home Improvement Contractor# Worker's Compensation # 65(,0 oB--y&gp/q_a-1 D ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 3! l(p )d o1 y FOR OFFICIAL USE ONLY APPLICATION# y DATEISSUED MAP/PARCEL NO. ` ADDRESS VILLAGE r` OWNER DATE OF INSPECTION: FOUNDATION FRAME 1 `INSULATION .'FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' t } } 'v GAS: ROUGH FINAL { ` FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts 4.� '. Department of Industrial Accidents Office of Investigations _ e 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Ii dividual):.. �{NC- - Address: 56� fa,&D City/State/Zip: ,UylS Q d Phonet 62d) 775- R5�3 Are you an employer? Check the appropriate box: .Type of project(required):; 1.L1d �,/ 4. I am a general contractor and I 1 am a employer with � ❑ 6. ❑,New construction . employees(full nth br 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 workingfor me in an capacity. employees and have workers' Y P t3'• 9. ❑Building addition [No workers' comp.insurance comp, insurance.$, 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 I.❑Plumbing repairs or additions myself. [No workers' comp. right bf exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.�ther � 11C� comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners•who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such, *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: /,�Y{T'�d 20��/ i21 tS AlJ� � Policy#or Self-ins.Lic. #: (a S 3— i-16 Cl s P 19 - o - I Expiration Date: 0 1 "0 l - 90 11 Job Site Address: 50 /�12,DOr'd1" 2e�4 L� City/State/Zip: )JV�ISM / - 09601 Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure.to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA fo ance covera e verification, �do herebyIrt er the p ' sand penalties of perjury that the information provided above is true an'd correct ature � Date: D h Phone# r9ffficial only. Do not write in this area, to be completed by.city or town official, n: 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 anct 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 employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced:acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter..152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of coipliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members'or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have ' 4 employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. 'Also'be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit.or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant. that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information-(if necessary)and under"Job Site Address"the applicant should write"all locations in (city' or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a,call. The Departments address,telephone and fax number:. The Commonwemlth of Massarhusctts Department of Industrial A cddents Office of Investigations 600 WasWngtori Street Boston,-IOTA 02111 Tel. #f 17-727-4500 ext 406 or 1-877-M-AS.SAFE Fax#617-727-770. Revised 11-22-06 www.mass..gov/dia V I - VDAC IfnnTFoan WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S60UB-4098P19-0-10) NEW-10 INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY 1, NCCI CO CODE: 80411 INSURED: PRODUCER: MASHPEE ROTARY INC COWAN INS AGENCY INC 50 AIRPORT ROAD 359 MAIN ST HYANNIS MA 02601 HAVERHILL MA 01830-4000 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 01 -01 -10 to 01 -01 -1 1 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) listed here:. MA o� B. EMPLOYERS LIABILITY.INSURANCE: Part Two of the policy applies to work in each state listed in m item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 500000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit Bodily Injury by Disease: $ 500000 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 06A o� D. This policy includes these endorsements and schedules: r o- SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE o� 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 -19-10 ML ST ASSIGN: MA OFFICE: ORLANDO DA HTFD 05G PRODUCER: COWAN INS AGENCY INC 285HT 003320 Bk 210397 P s 64 -W`37348 �� r— —?a off ► 02 = 17c� WE, LOUIS A. DAVIS, KEVIN A. DAVIS and STEPHEN J. DAVIS, TRUSTEES of the L.K.S.REAL ESTATE TRUST a/d/t dated as of October 29, 1985 and recorded with the Barnstable County Registry of Deeds in Book 4778,Page 187,all with a mailing address of c/o Stephen J. Davis, 197 Main Street, Centerville, Massachusetts 02632, for consideration paid and in consideration of ONE and 00/100 ($1.00) DOLLAR, grant to LOUIS A. DAVIS, KEVIN A. DAVIS and STEPHEN J. DAVIS, as tenants in common, all with a mailing address of c/o Davis, 50 Airport Road, Hyannis, Massachusetts 02601 with QUITCLAIM COVENANTS, the land and any buildings thereon located in Barnstable (Hyannis), Barnstable County, Massachusetts, more particularly described as follows: PARCEL A,containing 74,135.51 square feet,and shown on a plan entitled"Plan of Land in Cd Hyannis,Barnstable,Mass.for L.Paul&Lila Lee Lorusso Scale: 1"=30' March 23, 1984 Doyle Engineering Associates, Inc., 31 Main Street, Falmouth, Mass.", which plan is b recorded at the Barnstable County Registry of Deeds in Plan Book 381, Page 39. x oSaid premises are subject to and with the benefit of all rights, rights of way, restrictions or a reservations of record, if any there may be. CD Said premises are subject to a mortgage recorded with the Barnstable County Registry of Ln Deeds in.Book 17805, Page 111. USaid premises are subject to a sewer betterment recorded with the Barnstable County Registry of Deeds in Book 9496, Page 330. Said premises are subject to a lease recorded with the Barnstable County Registry of Deeds in Book 6986, Page 73. For title see deed to the grantors dated October 29, 1985 and recorded with the Barnstable County Registry of Deeds in Book 4778, Page 196. Locus: 50 Airport Road,'Hyannis, Massachusetts 02601 THIS DEED IS GIVENINACCORDANCE WITH THE TERMS AND PROVISIONS OF THE L.K.S. REAL ESTATE TRUST UID/T DATED AS OF OCTOBER 29, 1985 AND RECORDED WITH THEBARNSTABLE COUNTYREGISTRYOFDEEDSINBOOK4778, PAGE 187. rn r Nea 29 8 so AN silt_ scmew *vcff PI V„ a d2 >T A/tA. f✓� r ' r LOGOS MAP 2000' 'J S 7/'lea, r Ste. 0 j. �P t o N v _ q S - - il� t>MAIR TO CMAPTFR SRO ACTS OF 196L I RFRFBY CUM THAT THE;PLANARE INE UPF DrANORG-e9[SfN DR THIS ` OW FR- SHIPS.AIIDSWF ONES Of ME.fr0.tl7lS'AD WAYS SROWRAR"Now 6FWMLOoPpNAFF c it q OR WAYS AIR, C o '.J RlY p URFS FOR DIYIS,3R W rp,jmG m*URSRIP GR FOR I�jr �! •� NW WAYS ARE SHOW& Q � 'S+si-a4- ' N 7Z' 26• /2" W Lt ^ 1 ` PBOY SCOUTS OF AMER/G!a /CERT/FY T.�f!/T Ti/f.S PLf,YY yAS ,I AN OF LAAID 61EE/Y PRE/99RE0//Y CONFL4RM/TY �✓/T/�/THE I4C/LES .4N0 REGl/l�iTf�1 �^/ a� THE REG/STERS Of'OEEO�s OFT'yE /ly.1N�//S BA.PNSTABL.E -KA55. C/ Ef�;�OTN/qFJE,/YEGA/SdL�GNi OF MLg4SNS�H!/SETTS. ! CONTRZ—,4 EGy/ I-OR v5s0 SCALE- -90' MARICN 23,/9B4 C T TNAT W/Ti'!Lf//YO COURT STANOARQS Gam- —'— ,�Y�Uf7f/CY ANO — �O//YTS SNOy✓N ON THE.%A/YEX/ST B ' »� REG/3/f.l�, LfiNO SUf7YEYGUT BNSTABLE PLf�NN//YG �9i40 DOyLB ENG/NEERAAA.4I /t/C. 31 A"/STREET, fn ,d ''f rtrs - Nip Zo 8 so MIS* SS Q 0 L� �fL L/LA LEE :ARu550 sp se •�'+a�,....,,�_ L ,ice! , f Locus nr+P .--2oov• �,, q 0 '✓j' , f .74,/35.51 jr aN 0) axi l;' pIWffiMf m tllAptfR�u ut3 OF 1 x[xBl' 1. tY ma Tii:4n- OSIIEB V S• fk_�, _ � '�. .Q PLAN Au IN:16'� pYtNK:8 iW115 AV s TAVe AFHWi ppN4F c is 2 �. •F SYs. t. � 7 AM MY&I i o0 '�•i sr- A• IIQS Pt offis'a OI rfI•Ii:ir J*ISLMP 0 PGR . 7 pOXWSAKSOWL o , ol e0y .scoursER/cA P PL AN OF LAND BEN REf4�4E0 N C TffE REG/%sTER ��E�ow 7xg- /fY/1N�//S BA�/U-`TABLE C.Q,.�/ylpy/,/E.�Ti/ GL�'f`7ASSfd'CH!/SETTS Faa �EG/S LREO LF�NO Sl/igyEYG?R A�pL (�p1/GZER SVE /Y/SfG�✓ L£�' LORUSSO �R�Lgy,iNOT REc'�l//REO ,�/LA - PATE- 29.1984 FCL^URF�CY�O Ti�T TzlEHE/4 __ eo�a•: - �o - Z'S at/NTS ,5•y0y✓N ON T!-fE_�Y�9/YEX/ST ——�--—-'� oca,.� o cw ST�Fei E PLAN" RL�/37f`� LgNO SURYEYGW ASSOG/AYES, /NC. 4 DpyLE EN-9-SIM � ovTy ,W133 3/ ,vtq/N STREET, � +ffnssar4usettgi •• / OFFICE OF THE MASSACHUSETTS SECRETARY OF STATE ` MICHAEL J.CONNOLLY,Secretary j� ONE ASHBURTON PLACE, BOSTON, MASSACHUSETTS 02108 ARTICLES OF ORGANIZATION r (Under G.L. Ch. 156B) ARTICLE I The name of the corporation is: - —---- I oved MASHPEE ROTARY, INC. A LTICLE 11 The purpose of the corporation is to engage in the following business activities: To engage in the business and activities involving the purchase and sale, at wholesale and retail, of automotive fuels, including gasoline and diesel fuel, as well as any and all other motor fuels, automotive and heavy equipment parts and supplies; truck, trailer, bus, automobile and he equipment repairs, remanufacturing and other services; towing and roadiservice for motor vehicles; purchase, sale, lease and repurchase of new and used motor vehicles and heavy equipment; sale at wholesale or retail of variety shore items including food and tobacco products, drygoods and other "convenience store" types of goods; and to engage in the purchase, sale, pledge, mortgage, leasie, rental, repair, manufacture, remanufacture, development and construction of all nature of real and personal property, as owner, lessor, lessee, landlord or tenant; and to engage in' any and other lawful business and activities permitted under! the.business corporation law of the Commonwealth of Massachusetts, whether orinot expressly included in the foregoing, or otherwise. 24 x I I i _ I C ❑ P M ❑ A. ❑ Noie: If the space provided under any article or item on this form is insufficient,additions shall be set forth on separate 8�/,x I 1 sheets of paper leaving a left hand margin of at least I inch.Additions to more than one article may be continued on a single sheet so long as each article requiring each such addition is clearly indicated. .,.. _.. .. 4 .. .. _.etTC.....a... . . .d.,_ ..ir,..... .,...LL .t[d i 1�. ., .._.. ,•..4._.....lw.n. _......�.... ._...n.. .._u . t ARTTCLE III The type and classes of stock and the total number of shares and par value,if any,of each type and(class of stock which the corporation is authorized to issue is as follows: WITHOUT PAR VALUE STOCKS I WITH PAR VALUE STOCKS TYPE NUMBER OF SHARES TYPE NUMBER OF SHARES PAR VALUE COMMON: COMMON: ; 12,500 NONE PREFERRED: PREFERRED: NONE NONE ARTICLE IV If more than one type,class or series is authorized,a description of each with,if any,the preferences,voting powers,qualifications,special or relative rights or privileges as to each type and class thereof and any series now established. N/A ARTICLE V The restrictions,if any,imposed by the Articles of Organization upon the transfer of shares of stock of any class are as follows: See attached Sheet. V.a. If I' j i i ARTICLE VI Other lawful provisions,if any,for the conduct and regulation of business and affairs of the corporation;for its voluntary dissolution,or for limiting,defining,or regulating the powers of the corporation,or of its directors or stockholders,or of any class of stockholders: (If there are no provisions state"None".) See attached Sheet VI.a. and Sheet VI.b. Note:The preceding six(6)articles are considered to be permanent and may ONLY be changed by filing appropriate Articles of Amendment. ARTICLE V The restrictions, if any, imposed by the Articles of Organization upon the transfer of shares of stock of any class are as follows: Any stockholder, including the heirs, assigns, executors or administrators of a deceased stockholder, desiring to sell or transfer such stock owned by him or them, shall first offer it to the corporation through the Board of Directors, in the manner following: He shall notify the directors of his desire to sell or transfer by notice in writing, which notice shall contain the price at which he is willing to sell or transfer and the name of one arbitrator. The directors shall within thirty days thereafter, either accept the offer, or by notice to him in writing name a second arb t—rator and these two shall name a third. It shall then be the duty of the arbitrators to ascertain the value of the stock, and if any arbitrator shall neglect or refuse to appear at any meeting appointed by the arbitrators, a majority may act in the absence of such arbitrator. After the acceptance of the offer, or the report of the arbitrators as to the value of the stock, the directors shall have thirty days within which to purchase the same at such valuation, but if at the expiration of thirty days, the corporation shall not have exercised the right so to purchase, the owner of the stock shall be at liberty to dispose of the same in any manner he may see fit. No share of stock shall be sold or transferred on the books of the corporation until these provisions have been complied with, but the Board of Directors may in any particular instance waive the requirement. SHEET V.a. n ARTICLE VI i 1. The Directors may make, amend or repeal the By-Laws in whole or in part, except with respect to any provisions thereof which by law or the By-Laws require action by the Stockholders. 2 . Meeting of the Stockholders of the Corporation may be held anywhere in the United States or its possessions. .3 . The Corporation may be partner to the maximum extent from time to time permitted by law. 4. The Directors shall have the power to fix from time to time their compensation. 210 person shall be disqualified from holding any office by reason of any interest. In the absence of fraud, any Director, officer or Stockholder of this Corporation individually, or any individual having any interest in any concern which is a Stockholder of this Corporation , or any concern in which any such Directors, officers, Stockholders or individuals have any interest, maybe a party to, maybe pecuniarily or otherwise interested in any .contract, transaction or other act of this Corporation, and: a. Such contract, transaction or act shall not be in any way invalidated or otherwise affected by that fact; b. No such Director, officer, Stockholder or individuals shall be liable to account to this Corporation for any profit or benefit realized through .any such contract, transaction or act; and C. Any such Director of this Corporation may be counted in determining the existence of a quorum at any meeting of the Directors or of any committee thereof which shall authorize any such contract, transaction or act, and may. vote to authorize the same; d. The term "interest" including personal interest and interest as a Director, officer, Stockholder,. Shareholder, Trustee, member, or beneficiary of any concern; and the term "concern" meaning any corporation, association, trust, partnership, firm, person or other entity other than this Corporation. 5. Indemnification of Officers and Directors. Any person made a party to or involved in any litigation (including any civil, criminal or administrative action, suit or proceeding) by SHEET VI.a. ' P• f reason of the fact that he, his testator or intestate, is or was a Director or officer of the corporation or of any corporation which he, his testator or intestate served as such at the request of the corporation, or by reason of his alleged negligence or misconduct in the performance of his duties as such Director or Officer, shall bey indemnified by the corporation against the reasonable ', expense, including attorney's fees, actual and necessarily incurred by him in connecting with any appeal therein, except in relation to matters as to which it shall be adjudged in such litigation that such Director or officer is liable 'jto the Corporation or to any such other corporation, for negligence or misconduct in the performance of his duties. (A conviction or judgment in connection with a compromise or settlementof any such litigation shall not by itself be deemed to constitute an adjudication or liability for such negligence or misconduct) . As used herein the term "expenses" shall include fines or penalties imposed and amounts paid in compromise or settlement of any such litigation only if (a) independent legal counsel designated by a majority of the members of the Board of Directors other than those who have incurred expenses in connection with such litigation for which indemnification had been or is to be sought shall have advised the corporation that in the opinion of such counsel such Director or Officer is not liable to the corporation or such other corporation for negligence or. misconduct in the performance of his duties in respect to the subject of litigation, and (b) a majority of such members of the Board of Directors shall have made a determination that such compromise or settlement was or will be in the interest of the corporation. Any amount payable by way of indemnity under this provisions may be determined and paid pursuant to a resolution of a majority of the members of the Board of Directors' or the corporation, other than those who have incurred expenses in connection with such litigation for which:,, indemnification has been or is to be sought; or may be determined and paid pursuant to an order allowance by a Court of the Commonwealth of Massachusetts. The right of indemnification shall not be� deemed exclusive of any right to which person shall be entitled to a part from this provision. h SHEET VI.b. r ARTICLE VII The effective date of organization of the corporation shall be the date approved and filed by the Secretary of the Commonwealth.If a later_effective date is desired,specify such date which shall not be more than thirty days after the date of filing. The information contained in ARTICLE VIII is NOT a PERMANENT part of the Articles of Organization and may be changed ONLY by filing the appropriate form provided therefor. ARTICLE VIH i 122 FalmoutMoad, Route 28 a.The post office address of the corporation IN MASSACHUSETTS is: P.O. Box 795 , Mashpee, MA !02649 b.The name,residence and post office address(if different)of the directors and officers of the coloration are as follows: F NAME RESIDENCE POST OFFICE ADDRESS � I President: Kevin Davis Hyde Park Hyde Park Centerville, MA Centerville, MA 02632 026312 Treasurer. Kevin Davis same same i Cleric: Kevin Davis same same) Directors: Kevin Davis same samel F II 4 c.The fiscal year(i.e.,tax year)of the corporation shall end on the last day of the month of- December , d.The name and BUSINESS address of the RESIDENT AGENT of the corporation,if any,is: N/A I� i ARTICLE IX I, By-laws of the corporation have been duly adopted and the president,treasurer,clerk and directors whose names are set forth above,have been duly elected. IN WITNESS WHEREOF and under the pains and penalties of perjury,I/WE,whose signature(s)appear below as incorporator(s)and whose names and business or residential address(es)ARE CLEARLY TYPED OR PRINTED beneath each signature do hereby associate with the intention of forming this corporation under the provisions of General Laws Chapter 156D and do hereby sign these Articles of Organization as incorporator(s) this 24th day of A it 1992. l� Kevin Davis Uyde Park e�_ - Centerville, MA 02612 NOTE: if an already-existing corporation b acting as Incorporator,type In the exact name of dw corporation,the state or other Jurisdiction where It was Incorporated,the name of the person signing on behalf of said corporation and the tide he/she holds or other authority by which such action Is taken. �r u'C',1 J `I ' t --------------- -------------- Aj , ' `I i� 8 4 �L V . iV �� � I r ^ V\ � yJ.�i � �.f7 �--4._._..-- -- -- Town of Barnstable �0*1HE r Regulatory Services Thomas F. Geiler,Director * BARNSCABLE, Building Division 9 MASS. 039• `bpr f p µp,�a Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Fax: 508-790-6230 Office: 508-862-4038 COMPLAINVINQUIRY REPORT Date: Rec'd by: aint Name: s l u Map/Parcel9q Compl tZ Location Address: �0 122;1 J a Originator Name: /' f Street: (U" i' 1 Village: to Zi Telephone: Complaint Description: .-/c? 15 /Vi el <' n—V ex FOR OFFICE USE ONLY Inspector's Action/Comments Date: Inspector: Additional Info.Attached * , TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application O(�O Health Division Date Issued Conservation Division Application Fee 1Ar r Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic;- OKH Preservation/ Hyannis Project Street Address ' /�2R��T IS Village /�Y* VCV Owner 41 AEe/_=E leaner Y l u . <-Cv+des d Anef",o 4 T" RID NYRf*VAAS Telephone �S Q 7 7/ - (r,Co Permit Request 06 Y— r-act S F? RG5 C PDM -2/D E ZO S 5 C616rojo-(, y v1 AJ ya. r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Tot;Pnew�� ? Zoning District Flood Plain Groundwater Overlay Project Valuation fi��� Construction TypeD� ON Lot Size Grandfathered: ❑Yes ❑ No, If yes, attach supporti g documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ Noi On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new , Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing 0 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 1h.1 V c-,J*P-9 S Telephone Number Sd 8 98� Address 0% CaNSTOr"cp License # l o-w\oit� w&A 0j.4 `l 3 Home Improvement Contractor# l yY I y Worker's Compensation # W / ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��S �,'(\CQ �(��del�J•S Wes. SIGNATUR DATE - (C -C)S J FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: , a FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL p i ' GAS: ROUGH FINAL — .J p FINAL BUILDING DATE CLOSED OUT - ASSOCIATION PLAN NO. ti i 4,}� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): { Address: C01y5`C-1fr�yC� tA-tJ� City/State/Zim, t� b'+ o -t Phone.#: S081 �N L(S9,5 Are you an employer?Check the appropriate bog: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2V,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 me in an capacity. employees and have workers' Y P t3'• # 9. ❑Building addition [No workers'comp.insurance comp'insurance' 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 1 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[:1 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then.hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'camp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead tolthe imposition of viral penalties of a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce under the i and penalties of perjury that the information provided above is true and correct Si atur : p Date: Phone#: 5 0 � n1 gS LS Official use only. Do not write in this area,to be completed by city or town offuiiaL I City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical i Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions f 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 representative's of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: 'The Commonwealth of Massachusetts Deparhnent of Industrial Accidents ' Office of Investigatim 600 Washington Street Boston,MA 02111 Tel. #617-727-49,00 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/dia f I F1K Town of Barnstable 0 Regulatory Services �s IE�; Thomas F. Geiler,Director i63q. _ rF0.19ya Building Division Tom,Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This !Section If Using A Builder as Owner of the subject property hereby authorize �� ���� ++ �5 to act on my behalf, in all matters relative to work authorized by this building permit application for: 60 & (ZrPa(Z7 �� :S (Address of Job) kz' Signature of Owner Date cJ�� �. Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. THE Town of Barnstable �pP Tp�� Regulatory Services saxxsTesL>, Thomas F.Geiler,Director MASS. Building Division PjEO I'"p�a Tom Perry,Building Commissioner . 200 Main Street, Hyannis, MA 02601 wyny.town.barnsiable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner 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 minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be,required to comply with the . State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building pen-nit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. .