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Home My WebLink About0276 FALMOUTH ROAD/RTE 28 (6) e4 �isc �- JI, 04E , Town of Barnstable - - � gr r ,� ��- mx � � �� •sit s :: ,,� � �,.� Post This Card So�That it is Visible'Frorn the StreetApproved Plans"Must be Retain°ed�on Job and;thls Card Must bye Kept i Sign Permit wRxsree�¢ v Mwss ;Posted UntilFlnal Inspection Has Been Made : ',' h ` ` 363P Q` ! ea Where a Certificate of Occupancy;is Required,suchBuildmg�shall Nof be Occupied until a Final Inspection has been made Permit#: B-20-332 Applicant Name: Best Price Signs and Printing Corp. Approvals Date Issued: 02/03/2020 Current Use: Structure Permit Type: Building-Sign Expiration Date: 08/03/2020 Foundation: Location: 276 FALMOUTH ROAD/RTE 28, HYANNIS Map/Lot: 293-031 Zoning District: HB Sheathing: Owner on Record: BORNSTU LP Contractor.Name: ` Best Price Signs and Printing . Framing: 1 Corp. Address: 297 NORTH STREET 2 HYANNIS, MA 02601 Contractor License 196767 . Chimney: Description: 36 sq ft sign for SMOKE SHOP Est Project Cost: $0.00 Perrnrt Fee: Insulation: $7S.00 Project Review Req: Fe Paid: $7S.00 Final: Date: 2/3/2020 �re Plumbing/Gas 1m. Rough Plumbing: Zoning Enforcement Officer Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within sixd t ion ths after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application"anhe�approved construction documents;for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structuresshall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. " . Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. WN Minimum of Five Call Inspections Required for Construction Work: p q . Rough: 1.Foundation or Footing �.. "' • 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: S.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT • Town..of.Barnstable oETKE.r Building.Department Briaii11be.ence, MO Bnildirig Commissioner BARNSTHLE • 1ARNSPAim ! ;►ss .�$ 200 Ma'in Street; 3.y04riis,MA 02501 " j'.16j9:. Eo �a wwivA0Wn.barnsbb1e maa8 Office:.5084 2-4038 Fax: 50&790-6230 Sign l erm.- ,Application r BUILDING DEPT. Zoning Districf f Permit`# JAN 0 9 2020 Historic. District E] TOWN OF BARNSTABLE Location by .2 0 Fa (wkovt k e o a.c► ,. y,.; !e , . �1!I&K r, r AAtk Street address and Village Applicant .tMSk Tr►1� S� s us a�.� ��n-ti Njap: &.Parcel Telephone Number �� '^ Ernacil S iS s �eS Ir%s 0,K8Prt-n+in •co w� Sign #1. Sign-#2 Wall Wall Freestanding 0 Freestanding' 0 Electrified* O Ele.etrified* Dimensions Sign #'I 12 x 3 3 b sr.-F+. C imenglons Sign-#2 Square feet Squi fe feet Reface Existing Sign L-i NewlReplace. Sign Zr Width of Building Face ft. X 10. — y2D X .10 *Lighting Type A wirin permif is required if signs electrified.. Si ature of Owner./Authorized Agent Mailing address 10 3 y N M ot,4—y o S� . _ _ '�ro��ctoh�+�+v� o z3o►o z3o► Town of Barnstable Building Department ss�+sra, 1 Brian Florence,CBO v 16 9. �� Building Commissioner prED NIA' A . 200 Main Street, Hyannis,MA 02601 www.town.barnstable maxs Office: 508-862-4038 Fax: 508-790-6230 SIGN PERAUT REQUIREMENTS v 1: A photograph showing the existing facade, on which has been indicated the proposed. sign location. The photograph is to include a portion of adjoining stores or building. For a proposed building or new facade, an architect's elevation may be submitted in lieu of a photograph.. 2. A-scale drawing'of the proposed sign:A'scale drawing indicating:. 1) The type of proposed sign(wall,hanging,free standing) 2), Dimensions of the proposed sign and any designs, logos, or lettering 3) A cross-section with dimensions showing edge detail. Minimum scale 1"= 11. Minimum sheet size, 8.5 x 11". 3.. A`scale drawing of the bracket. A colored scale graphic indicating dimensions, showing colors,materials and method of affixing it to the sign and to the building. Minimum scale 1"= 1'.Minimum sheet size, 8.5 x 11". 4. A completed Town of Barnstable Sign Application, including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. 5. The width of the building face or the,leased.area: NOTE: the map/parcel number is required on the application. signs/signrequ&app ' revised: 9/22/17 The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 s a- Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/ElectriciansiPlumbers. TO BE FILED WITH THE PERNHT.TING AUTHORITY. Applicant Information Please Print .Leeibly Name(Business/Organization/Iridividual): %e S.f ?r , C t Si S r s- a 06 d ?r.V%; i..t Address: 10 3 Ll /V IM.o h-4 c(0 Si cep_+ City/State/Zip: I`3rbC MA 02,3o l . Phone#: (Sd,0.3rs-(r — Are you an employer?Check the appropriate boz: Type of project(required): LffI am a employer with_/employees(full and/or part-time).* 7. O New construction in _ i employees workin for 2.❑I am a sole proprietor or parmersh p and have nog $. �Remodeling any.capacity.[No workers'comp.insurance required.] 3.D I am a.homeowner doing all work myself.[No workers'comp:insurance,required.].t 9. ❑Demolition I ` 10 0 Building addition . 4.❑I am a homeowner and.will_be.hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L E]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance? 13.0Roof repairs , 14.a0ther Si crs 6.Q We area corporation and its officers have exercised their right of exemption per MGL c. — . 152,§1(4),and we have no 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 thepolicy and job site information. Insurance Company Name: Al t IM V 4 va C�{00'T0Y S(o9 S20 0 A Policy#or Self-ins.Lic:#: A W Expiration Date: Orr L126,24 Job Site Address: Z y 0 IV a r 4.1_ S+c`F. + City/State/Zip: 4�t wo.:S rA IA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as.required under MGL c. 152;§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage verification: I do hereby rtify under the pains and penalties ofperjury that the information provided above is true and correct. Sigxrafure C� Date: . 1 l 1 2 y Phone# tlbfi) ?6-ir 16-164' Ofcial 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'havmg"noi 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 onto 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 certificates)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 foryou 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 e filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture. (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: � v J y - The Commonwealth of Massachusetts k Department of Industrial Accidents 1 Congress Street, Suite,100 rry`' Boston,MA 02114-2017 Tel. #617=727-4900 ext. 7406 or 1-877-1MIASSAFE Fax#617-727-7749 a r _ Revised 02-23-15 www.mass.gov/dia ACORD CERTIFICATE OF LIABILITY INSURANCE FOA08=2019" THIS CERTIFICATE 18 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 REPRESENTA7WE OR PRODUCER,AND THE CERTIFICATE HOLDER. NNPORTANT. If the cerlNkate holder Is an ADDITIONAL INSURED,the P011"Ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the tens and conditions of the polcy,cortoln policies may require an endorsement. A statement on this certificate does not confer rights to the cerlifiwte holder in Neu of such endorsenuen s PRODUCER Fausto Pins ACE INSURANCE SERVICES INCgin IS" g00 aoeinsllrartcese ahoo.conl 675 WARREN AVE BROCKTON MA 02301 INSU fERA.- AIM MUTUAL INS CO 33758 INSURED - RalRuna: BEST PRICE SIGNS AND PRINTING CORP etauR�ec: ' - eglMlBtD: - 1034 NORTH MONTELLO STREET e+suaetE, BROCKTON MA 02301 F: COVERAGES CERTIFICATE NUMBER: 442748 REVISIN 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. NOTVWTHSTANOING ANY REOU9tEMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT wm1 RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLIC(ES:DMPJBEO HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IC1r ow INSR TYPEOFes�N<AI10Epo=POL LENT COIYIRRCIALGB76NALLMBLITY EACHOCCURREMCE $ CLAVAS•MADE OCCUR I EI $ MEDEXP ens ) S N/A PERSONAL&ADV 114JlRtY S 7 rGENi AGGREGATE LIM�IT APPLIES PER: GENERAL AGGREGATE $ h2CT LOC PRODUCTS-COMPA>P ACID s HE S AUTOMOG ELIABLITV MIMS'"w-LIMFT S ANY AUTO (PtrPasant $ —_ ALL OWNED SCHEDULED AUTOS AUTOS WA- GODLY IN RIRY(Pwasddanq a HIRED AUTOS AUTOS ED - AM S s $ UMBRELLALYI8 LJ OCCUR EACH OCCURRENCE $ EXCESS Lin CUUMS.MADE WA AGGREGATE S DED RETEMONS S W'ORKERSCOMPENEATHNI - H, ANDEMPLOYWUTA91Y9Y YIN AT Ar1YPROPR�TOBIPARTNER�IECUTIVE EL EACH ACCIDENT S 1.000.000 A �iICER+MEMBERExcLUDEOY NM NG MIA /IVVC4007D3589tr2019A 08/29/2018 Q8129R020" (ManeateryInNMI E.L DISEASE•EAEMPLOYEE $ 1.000.000 Ir�nA rMaabe en0a DESCRIPTION OF OPERATIOM eebw E.L.DISEASE-POLICY LIMIT d 1.000.000 WA • DEscr�noeoFOPER11TaNsrLDCATbNS/vENlcLes(AcoaDrm,aaaaen,IRa1Mr�.sa:.aai~nrYa•ea»aanlH..e.ar�er.e) Workers'Compensedon benefits will be paid M Massachusetts empbyees only.Pursuant to Endorsement WC 20 03 08 B,no soorizalin is given to pay claims for benefits 10 employees In states other then Massachusetts N the Insured hires,or hsS hired those employees outside of Massachusetts. This Oedftta of insurance show$the policy in force on"date that this certificate was Issued(unless the e)q*&ion date.on the above policy precedes the issue date of this-cedificate of Insurance). The status of this coverage can be monitored daNy by acowsft the Proof of Coverage•Coverage Verificalion Search tool at www.mass.govikWworkwe-comports #wiinvwlgetbnaJ, CERTIFICATE HOLDER CANCELLATION - SHOULD ANY OF THE ABOVE DESCRIBED'POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WI TR THE POLICY PROVISIONS. AUTIM tDREPRESEIr V4 MA 02301 Daniel M.Cr CPCU.Vice President—Residual Market—WCRBMA W 1988-2014ACOND CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are reglatered marks ofACORD DRAWING REVISION DATE SIGN DETAIL _ CLIENT •.. HY MO SHOP ANNIS SMOKE S P EXISTING- t ADDRESS r w 276 Falmouth Rd, - a■ _ Unit 6 Hyannis, MA 'PROJECT s,r a SIGNAGE w . } gyp fii. ,� s a u k " FILE NAME. V� Hyannis Smoke shop A I _ DESIGNER`. i -� t GILMAR ..COMMENTS . sign :proposed is 36sq ft .total - 12ft x 3ft _. APPROVAL i. 42ft r .. y Best Price . M °' . GN &Printing JOB DESCRIPTION: ice; 508-388-9568 ALUMINUM SIGN E-mail:E'm. Cell: 508=825-3024 ail:signs@bpsignsandprinting,com VWVW.b Ssand .rntin .COro 1034N._MontelloStreet-Brockton;MA02301 FLATAGAINSTTHE BUILDING „ In p g DRAWING : REVISION : E , DAT SIGN DETAIL CLIENT SMOKE SHOP HYANNIS P EXISTING AQDRESS - - 276'Falmouth Rd, Unit 6- Hyannis,MA wr o PROJECT S GNAGE e ` t e y � � FILE NAME Hyannis Smoke shop. a.rw4 DESIGNER G I L MA R� , a COMMENTS w . sign .proposed ,is 36sgft total PROP ED 12ft x 3ft - _ APPROVAL s` 4 "uLO � SMOXESNOP��r�i . '1f � '12ft # r k A• —� _ Best Price A0 1 emowl f� - _ &:Printing JOB DESCRIPTION: E-mall:signsfttignsandpdnting;com; Office: 508-3 8-95 8 ALUMINUM SIGN O.Cell: 50&825-3024 FLAT AGAINST THE BUILDING v0N*.bpSlgnsand0rinting.COm- 1034N.Monfello Street-Brockton;MA02301 The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-201.7 www nms gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. AvOicant Information Please Print .Leeibiy Name(Business/Organization/Individual): USAa ?r' K ' 06 Address: l0 g4 N t-lou.-V2.1(o S4 ru--k- City/State/Zip: %r,5c , t A ti 2 3 0l. Phone#: (5 0 t 1 Fr tr —.4 5.b a- Are you an employer?Check the appropriate box: Type of project(.required): 1. rrI am a employer with (o employees(full and/or part-time).' 7. E]New construction 20 I am a sole proprietor or partnership and have no employees working for me in $. 0 Remodeling any capacity.[No workers'.comp.insurance required.] In I am a homeowner doing all work myself.[No workers'comp:insurance.required.]t 9. El Demolition 10 0 Building addition . 4.❑I am a homeowner and.will be.hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.0 Electrical repairs or additions proprietors with no employees. 12.QPlumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.= 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.M6ffier .Si �'v—C 152,¢1(4),and we have no 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, Insurance Company Name: Alm 1'1Au4wa 1 (in r. .C o. Policy#or Self-ins.Lic:#: ,AV G`I.O O 7 0 9 A Expiration Date: 0&/Z 9J 20 Z O Job Site Address: Z1(p eA(VVlOv4k Qtv,4 City/State/Zip: Yal�vy F,, . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as.required under MGL a 152,§25A is a criminal violation punishable by 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.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 theppains and penalties of perjury that the information provided above is true and correct" Sip-nature: Date: l q Ly Phone#: S09 .:99 TC.1,8 Official use only. Do not write in this area,to be completed by city or town ofBciaL City or Town: Permit/License#. Issuing Authority(circle,one): L 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 employment be deemed to be an employer." MGL chapter 152,§25C(6)also-states that"every state or local licensing agency shall withhold the issuance or renewal of a_license,or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until.acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials *; , Please be sure that the affidavit is complete and printed legibly{•The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the.applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit.one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to.the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture. (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: 'The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 ' Revised 02-23-15 www.mass.gov/dia y � A`ORD CERTIFICATE OF LIABILITY INSURANCE o 012019 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 cetiHkate holder Is an ADDITIONAL INSURED,the pollegles)must be endorsed. if SUBROGATION 19 WAIVED,subject to the terms and conditions of the policy,certain policies may require an sodemement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endomenertgs PRODUCER Fausto Pins ACE INSURANCE SERVICES INC (NII 54-5 Mft8900 sawnswwmuMces@yahoo.com 675 WARREN AVE IN s COVE NA,c s BROCKTON MA 02301 IMARRA: AIM MUTUAL INS CO 33758 INSURED ebYA"e• BEST PRICE SIGNS AND PRINTING CORP fMIIREIIc: aIwROI o• _ 1034 NORTH MONTELLO STREETp�E, BROCKTON MA 02301 RERF: COVERAGES CERTIFICATE NUMBER. 442748 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. NOTWTHSTANDING 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, INSLTTR TYPE OFDISURANCE POLICYNIJIGN AMRAffl Lucia Mf9BICNLGENERALNABLITY EACHOCCURRENCE f CLAIMS-MADE F�OCCUR f MED EXPft onePerm) S NIA PERSONAL&ADVINJURY s - GENi AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE s HPOLICY El LOC PRODUCTS.COMPAP AGO S OTHER S AUTOMOHLELIAeiITY E,=SINGLE MMITs ANY AUTO BODLY MJURY(Par Perm) SS ��ED AUTTOOSS DULED WA - BODLY HAIRY(Peraedden0 S HIRED AUTOS A��EO -0AMA0 S Pw o ' s UMBRVJALNB OCCUR EACHOCCURRENCE S EXCESSLIAB HCLAIMS4AADE NIA AGGREGATE S DED I I R NTION$ �/ s woRIceRscoMPO"TION V AT RN. ANDEMPLOYMLIABILITY Y/N ANYPROPMETWARTIrERlOIECtITIVE EL EACH ACCIDENT S 1.000.000 A �FICEtoryIn EREXCLUDEOY TUA NIA NIA AWC400703SO62019A OS/29IY019 08I29RO20 ELDISEASE-EA EMPLOYEE s 1.0KODO (MaAdarory In NNI If yes.desa*e.under DESCRIPTION OFOPERATIOWbebw E.L.DISEASE-POLICY LIMIT 18 1.000.000 NIA DESCMPTION OF OPOtATIDNSI LOCAW")YEMCLES(ACM IM.AdOWW RWWIW SOWMM mry bo wadMd N mm vPCO le nqW" Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03106 B,no authorizaDon 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 dally by accessing the Proof of Coverage•Coverage Verification Search tool at www.mass.govftwdhvorkers-compensauwlnveatigellonsl. 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. I AUTHORMOREPRESENTATME MA 02301 Debt M.Crow,ey,CPCU.Vice President—Residual Market—WCRIBMA Q 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks ofACORD mot , Sign TOWN OF BARNSTABLE Permit * BARNSTABLE. MASS, 9�Ar16 339. A°� Permit Number. Application Ref: 200906137 20070402 Issue Date: 12/16/09 Applicant: BORNSTU LIMITED PARTNERSHIP Proposed Use: DEPARTMENT DISCOUNT STORE Permit Type: SIGN PERMIT Permit Fee $ 75.00 Location 276 FALMOUTH ROAD/RTE 28 Map Parcel 293031 Town HYANNIS Zoning District HB Contractor PROPERTY OWNER Remarks REPLACE EXIST SIGN WITH 34.5 SQ LETTERS MATTRESS WORLD Owner: BORNSTU LIMITED PARTNERSHIP Address: 297 NORTH ST HYANNIS, MA 02601 ..........- ......... ......... ... ... .......... Issued By: PC POST THIS CARD SO THAT IS VISIBLE FROM THE STREET ................... of,HE, Town of Barnstable Regulatory Services �B'' MASS. Thomas F. Geiler,Director �p i639• �0 �fn�,,pra Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Permit# Building Official approving_------_---_ Application for Sign Permit 2 1 / J Applicant: r' k✓r__ �,�/1g?Pe_r -----------Assessors No. �-------- Doing Business As:_ _IA C1 G1_ p I—�vJP- _7 g� 2-�� _ __ Tele hone No. � Sign Location fy Street/Road: -1==------s--------- v - ��-- � Zoning District:---__---- Old Kings Highway? Yes IVo Hyannis Historic District? Yes/ f l� Property Owner r Name:-- 3�ce2a`�_ _-vj--------Telephone:------------------ Address:-------------------------------------------Village:---------------------- Sign Contractor -----------------Telephone:,-0--9-------- Mailing Address:_ L-0-��_p —5�--- 13-P-dlpo 1-c-Q- . I_A-_--------M —a v h Description Please follow the cover directions.You must have an accurate rendition of sign with dimensions ah'd ::-= c-i O location. Is the sign to be electrified? Yes No (Note:Ifyes, a miingpermitis required) Width of building face x 10 = -x .10= -? Check one Reface existing sign or New_ L Total Sq. Ft. of proposed sign (s) _ , If you have additional signs please amich a sheet listing each one wide dimensions If refacing an existing sign please provide a picture of the existing sign with dimensions. I hereby certify that I am die owner or that I have the authority of the owner to make this application, that the information is correct and that the use mid constr lion shall conform to die provisions of §240-59-through §240-89 of the Town of Barnstable Zo iiu Ordinance. Signature of Owner/Authorized Agent:_ Date________ _ SIGNS/SIGNREQU revised 103009 1 I RIP I },� �Ir •,l ':� FII i15 r l � �J a : i O f \ {l 1.1\ }�� iit;i'. ('.� �•.i i•J-?-'i' _-i'D3 i,h`i! '�Iw:`. �:'';f,iril�i.k'i .. 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NIA NO SCALE f9 eau X�7 Appro'aed By: As Is. rls Motes: C CC YRIGHT Beaxro�t S gn Co. SIGN C O. r.IS OESIOX IS TyE PAYE"Df KAUMOXT SIGN SO AU PRuCEST{S N 23_`rY"St `.an�36_:Sa MA 00OUPUMION r°itRS AWE RESERVED 6Y!•:AJMIT ,,, ' tour o+u:S08-98.1_9230 rFISM. TISOESIGXE]f? MAPEASONALUSEAND16hGTMEViED � Afs°? Revision&: Sheet9: - sos-sgo-not - L.Rogers - OUTSIDE YOUR OR644RA'tOX DR:EXIOTE014.NYF.ESHIOX. � -. 00 per _ ��f� hi /yl i ,� . . � �, }. ._ . .� . .. _ . t � o � _ � � 3 � 3 �- 3 � ,, f N v CJl f� CD CD LO CD 14 *"6t lP w4 7Lr �4j co Cn t co m LJD ti , FN r S auvd WLt ANI { INIM JS l-ta!z . CD CD u I r N • � r ' r J r - . TOWN OF BARNSTABLE BAR W Ordinance or: Regulation .77 WARNING NOTICE Name of Offender/Manager m,ki l ob. _ { Address of- Offender �1\ MV/MB Reg,# I Village/State/zip - Gl�'l+''1If .Business Name Business Address '� Signature ,of-'Enforcing Officer I Village/State/Zip _ ! Location of OffensY7 e-7�Q Enforcin D - g ept/Division Offens .� ( ( I Facts ti I This will serve only as a warning. At ;this time no legal action has been-Fa--ken. I It is the goal of Town agencies t.o ..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 , I r _.,....�".:.-:...�+"�...y.:•....�^- .r_.=........... � ti,- .f�.` n 4"TY...y.��, ,... � � ._.<.-e.n.,..'i,.•-.r.-^.,. - -�...�................ w."---r•-`-_-� .. :. 4 r�,..,..�ti-.Y^. =f?. Ytf'-v,y 'yf'Y?k 7.✓tir�^: ,"r-.-.r'.:.:..aa .. <�r- � TOWN OF BARNSTABLE BAR-W 677, Ordinance or Regulation WARNING NOTICE Name of Of fender/Manager )1( 4-"to'o ; � . Address of Offender MV/MB Reg.# Village/State/Zip - ;iL=tr . a . } `J~ ,— am/pm,} on,, •' / .� 20 JU Business Name / _ Business Address .1 Signature of'°Enforcing Officer Village/State/Zip f / Location of Offense 3 V Enforcing Dept/Division Offense f �. ! G �� t C— t Facts !n ,i 1 +11 g PA d Of L- I 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. TOWN OF BARNSTABLE BAR-W r3- 77 Ordinance or Regulation WARNING NOTICE Name of Off ender/Manager l ;jf Address of Offender MV/MB Reg.# Village/State/Zip Business Name am/pm, on 20 1 Business Address Signature of Enforcing Officer Village/State/Zip Location of Offense Enforcing Dept/Division Offense d;l Facts 'Anc 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. -Town of Barnstable Building Department - 200 Main Street BARNSTABLE, * Hyannis, MA 02601 MAC (508) 862-4038 9� i639• Certificate of Occupancy Application Number: 200905781 CO Number: 20100006 Parcel ID: 293031 CO Issue Date: 01121110 Location: 276 FALMOUTH ROADIRTE 28 Zoning Classification: HIGHWAY BUSINESS DISTRICT Proposed Use: DEPARTMENT DISCOUNT STORE Village: HYANNIS Gen Contractor: ROBERTS, MICHAEL Permit Type: CC00 CERTIFICATE OF OCCUPANCY COMM Comments: MATTRESS DISCOUNTERS Building Department Signature Date Signed ov TOWN OF BARNSTABLE Building Application Ref: 200905781 * BARNSTABLE, * Issue Date: 12/02/09 Permit MASS. 3r16 a�� Applicant: ROBERTS,MICHAEL Permit Number: B 20092345 Proposed Use: DEPARTMENT DISCOUNT STORE Expiration Date: 06/01/10 Location 276 FALMOUTH ROAD/RTE 28 Zoning District HB Permit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 293031 Permit Fee$ 682.50 Contractor ROBERTS,MICHAEL Village HYANNIS App.Fee$ 100.00 License Num 053861 Est Construction Cost$ 75,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND TENANT FIT OUT MATRESS DISCOUNTERS TO LEAVE AND THIS CARD MUST BE KEPT POSTED UNTIL FINAL SHERWIN WILLIAMS TO MOVE IN INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: BORNSTU LIMITED PARTNERSHIP BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 297 NORTH ST INSPECTION HAS BEEN MADE. HYANNIS,MA 02601 Application Entered by: PR Building Permit Issued By: Crw,6. THIS PERMIT CONVEYS NO RIGHT.TO'OCCUPY ANYSTREET,ALLY OR SIDEWALK OR ANY'PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY. ENCROACHEMENTS ON PUBLIC,PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,'MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLY'GRADE-1�11S'.AS WELT AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOE&NOT RELEASE;THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.111,AkiQLATION. 6..IV INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS I — C; 3 1 Heating Inspection Approvals Engineering Dept ' ept 2 Board of Health C� � Ila