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1225 IYANNOUGH ROAD/RTE132 (18)
lip �I�i PROD Mk ' ADDRESS: S �^ PERMIT# PERMIT DATE: M/P: oZ '7,� -- �� 3 LARGE, ROLLED PLANS ARE Tom: i B® SLOT �6-3 Data entered in MAPS program on: BY: �� i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ( � Map / Parcel 'Application lication # Health Division Date Issued t v Conservation Division Application F S.m Planning Dept. Per , e� Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis 0 C T _ 1 REC'D Project Street Address --T� n� �- By Village �a Owner Cv� ►�►-'• Address 1 `� I i�►9 �wg0J�� (L� �y �e {�►� Telephone Permit Request -6)de . I d n I�.f v�'�oy c A 70 p e 0 x L S D. o R C u t S7, ,c 13J iI '1 0 . �c �o��' td tX, q iZj� M�w��r� Square feet: 1 st floor: existing - proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 9co ° Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family.. ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name L n,)UO)s " We��S 4d,,�� ��, Telephone Number 3 f 3 r y Address .f (2 kC R�<_-� � k y� License # 0 ? �lv E )�^io* M oz I Home Improvement Contractor# N Worker's,Compensation # (1 9 S;� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN To—_5Z0 J 01-J E L Q yC L, r G- Z C 1) C IC 1 ►\1,, M 1 SIGNATURE DATE `w FOR-OFFICIAL USE ONLY APPLICATION# DATE ISSUED ` MAR/PARCEL NO. ;t ADDRESS VILLAGE OWNER 5 y DATE OF INSPECTION: , FOUNDATION,;! • i FRAME INSULATION . E FIREPLACE c - ELECTRICAL: ROUGH FINAL :. PLUMBING: ROUGH FINAL _ GAS:��° }�_, ROUGH FINAL F f ' FINAL BUILDING s DATE CLOSED OUT ti 3 ASSOCIATION PLAN NO. s I The Coin monw.ealih of Massachusetts Deparftnent oflndustrial,4ccidents Office of Investigations + 600 Washington Street Boston, M-A 02111 °� w•` www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeF_ibly Name (Bus iness/Organization/Individua]): �C LC ISO �CA Address: 1— F)C l� O e V`1 y b y City/State/Zip; l fV_`'LVJ'K IQ ®Z (Q,� Phone.#: 1 ' / Are you an employer? Check the appropriate bog: Type of project(required): 1 j"'""'am a Y emP to er with 4. [( I ama general contractor and I 6. ❑ New construc' tion employees (full and7or part-. •rnel.* have hired the sub-contractors 2.0 I am a sole proprietor or'partner- listed on the•attached sheet T. 0 Remodeling ship and have no employees These sub-contractors have g• Demolition workin for me in an capacity. employees and have workers' g y P tY• 9. .0 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 11.0 Plumbing repairs or additions right of exemption per MGL myself. [No workers comp. 12.�Roofrepairs insurance required_] t c. 152, §1(4), and we have no ,I \\ employees. [No workers' 110 Other comp. insurance required.] *Any applicant.that checks box#1 must also fill out the scction below showing their workers'compensation policy information. t.Homeowners who subnvt this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. IContractors 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 employces,they must provid8 their workers'comp.policy number. I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: L C/ ! C���� S� Expiration Date: 1 Job Site Address: 225- ! J N City/State/Zip: �l �►'?r�►�t� '�� .d2-100/ . 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 crimirial 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. 1-do hereby certify under thepains and penalties ofperjury that the information provided above is true and correct. Signature: Date: _ Phone#' Official use only. Do not write in this area, to be completed by city or town offeciaL City:or Town: Permit/License # Issuing Authority (circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6. Other (-nnfart PP.r.cnn: v Phone#: Infor ation .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 irnplied,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 tinstee 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." AdditionaIly,MGL chapter 15Z, §25C(7) slates "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 kith 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-coneactor(s)name(s),-addiess(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 bc'retvrned 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 A 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 fo 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 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: T t Commonwealth of Massachust" is Depazlznent of Industrial Accidents Office of rnyestigations. 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 cr 1-877-MASSAFE Fax # 617-72777749 Revised 11-22-06 www.mass.gov/dia ACORD CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDDaY'(YV) 9,'1.5 '2010 PRODUCER Ph.one.: 50P_-651.-17X1 Fax: 50d-653--9089 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Eastern 1ns=ance Group 'L_,C - Ccmsaerci al ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 233 des' Ce_; ra'. S' rat HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Natick _'d-1 0L7CU I INSURERS AFFORDING COVERAGE_ _ _ NAIL# INSURED I1,JSLIREP.A:A(,jnjral _InsuLanr�F ' ,i,p ]---_- We1.L i rr.CC�Ii"';7 {�OTirt.lrl'2Tf 1nC. � IfJSUREFB:,D,i^F', ;J�F - - I -------- 112 >ca:drmf AvaFUe - - i---- W'?Ymo,uth MA D 2 11 Z INSUREFC ....--------'-- ! NS'JRER D: j INSUREF E: I COVERAGES _ THE P<JLICIES OF TIJSURAC,CH LISTED BE.'_•Cid 71'TE BEEN ISSUED TO THE INSURED t'(APIEO ABOVE FJR TrE PCLICY PERiDD IFiDI(-A_'FE. N')Ti7rH9TAI,iDI?1G ANTY REQUIFHiENT, TERM DR. C,^.rdDIT:C OF ANY CONTP-ACT OR. or-iTR DOCUMEUT VITTH RESPECT TO WHIC3 THIS CERTIFICATE MAY BE ISSt;Ei; OF. isAY PERTAIN, IHE =NSURAUCE A.FFORCED BY THE PC:,ICIES DESCRIBED HEREIN IS S;TBJECT TO L7- THE TERMS, :;X US-ONS kND C0117DITICNS 7F SUCS _COLIC=ES. AGGREGATE LIMITS SHOWN TlAY HAVE BEEN R.EDUCEI' BY PAID CLAIMS $��� � ?QLICVEFFECTIVE POUCYEXPIRATIONT------------------ ----------- POLICY NUMBER iMM/DDIyYi DAT=IMMi r Y1 )_I_ LIMITS _ F> I GENERAL LIABILITY C;OOGCi222G0 12/8/2009 12/8/2010, 11 EACHOCCURRENCE "a (ii C D�JAT99AGGETi�R€13TELS �--- r y J ); a;O_MMEFCI.SLGE14ERAI.L!ABILITY o c 0C � _ � L.RFhaS�S tea ocemena�)_*$�l),.�1,1:-------- !CJ.AIM5MArF OCCUR I MEDE P(Anyarw.person) $F o(' PERSON.ALRADVINJURY 1$1 "'')(; ��;•11 - 1 3EMERAL AGGREGATE--- b L t-t,0'.. �.U'_it^ I L GEPJ'L AGGREGATE LIMIT APPLIES PER: I PRODUCTS-CC MPrOP AGG $1 ',ri C 0 i^_r r-- ---- 111 POLICY iiC -�i,l[CT 1j1C I r--- -------------'-- j AUTOMOBILE UABi1.ITY j COPABINED SINGLE11P.1{T ! �.. ANYAUTO Eaaccicvmt) - $ ---- - I �ALLON'NEDAUTOS ' �I -------------- BODILY INJURY SCHEDULEDAUTOS Per person) HIREDAUTOS — —� -- BODILY INJURY NOM Pet accid") ---- $ {iYJNEDAU'DCS � -I ------ PROPERTY DAMAGE jPeraccldpffl) $ GARAGE LIABILITY I AU-i0 ONLY-EA ACCIDENT $ --_ -- -- j ANYAUTO I OTHERTHAN EAACCi$ ! - --.-. ----....------- i AUTO ONLY: AGG--Il--------- EX $ _ MIUMBRELLALIABILDTY EACHOC_C_URRENCE_ J ocCUR -1 CLAIMS 1dADE ' AGGREGATE $ DEDUCTIBLE � � - -�$ —------ — ---- -- RE TENTIOU $ - ---- $ R WORKERS COMPENSATIONANG 109 ]2/3 2n10 k. 4CC S1.4 ll- OTH- EMPLOYERS'UABIUTY !•, 5_ r J 12/,71/2 T RYI.IMI'TS_-__1_.,ER -'------_-- ANYPROPRIETOR/PART*.R/EXECLITIvE ELEACH.4CCIDENi $��r'_,` ij� ------. OFFICER/MEMI3EREXCLUDED'i E.L.DISEASE.-EA EMPLOYEE $j'c�=IC,0.30 - md under escribe uer ---'-- IA.LPROViSIONSbslavr E.L.DISEASE POLICY LIMIT 1$i CI 0 0 OTHER I DESCRIPTION OF OPERATIONS i LOCATIONS;VEHICLES/EXr LUSIONS ADDED BY ENDORSEMENT J SPECIAL PROVISIONS :;7eta�bali>: CERTIFICATE HOLDER CANCELLATION SHOULD ANY Cl' THE.. ABOVE DESCR.-BED POLICIES BE CANCELLED BEFORE THE F PIR.A.'I'IOV DATE 'TEEB.}:)F, 'T:'E ISSUING INSURER Poirier and S1,Y I1C{e= Iris WT.T,I, ENTiEAVC"R TO MATT, 10 DAYS WRITTEN ^-OTICE TO THE 1? E.Ste_ling ;<d CERTIFICA.T.E HOLDER NIAMF-) TO THE LFFT, BUT Fi<:II:URE T:! DD SO B1.i12Z'i�d MA 01F62 SHALL IRVC,-E Ntl OBLIGZ'TIv3I riR LI:y.PT_LTTY OF ANY IK,IND UPON THE TIN-- FR, IT- A.�EgTS OR. Re PRE i�'ATII;ES. AUTHORIZED REPRESENTATIVE ACORD 25(2001;08) p ACORD CORPORATION 1988 3�f 4 a, Massachusetts- Department of Public Safet} Board of Building Re-ulations and Standards Construction Supervisor License License: CS 37338 Restricted to: 00 LOUIS M WELLS 112 ACADEMY AVE WEYMOUTH, MA 02188 Expiration: 1/10/2012 Commissioner Tr#: 12317 .. I,, Lb� . 112-Academy Avenue, Weymouth,:MA OZ188 Tele (78i) 331 3104 Fax_s.(781):331-5666 . - .. -. February 3- 2010. .. - . - -.-.- Mr.; Larry Potts .._._...��-�-�.--,..--..j-..--_.�,-..:-_,,.__--_--.I-..---.�.�-.----1��:-.-_.:.,-.�..--..-.-.--_�--:-..�:...--_-:��_--__��-.-�-..-:--..-_.::.---.--._:-.-.---"�-_-.-�..:-.�,_.--,Z-.------,,-,.-*�-..---.---_..-f_._-:-:,-_--_--.::.----:_,-:.-�:-�:-�__--,..---�-�---�--.�.--_�-.----..-.._.:-.�.-�-:-_,.�.---_--.-__�--:.-_.,---_--,-�-._.---�.-,....-_,-.._...-�..�-_-..�.--.-:-�,��-.:,_-------__.__�-�,_.._.:.�.:.:.1.:..._..-_.—---�..:.....1..:,-..-.�-.�-.,..--.--._...:.�::.,.-�,1,__.7 I.�..--.-.-_.:-.,,::�...�.,:..-_:�-*_-,-_._,-_�..:..:�.�.�.-_._".��.-_.-.-.__:-.�_:--,::..':-�,.:w.:�,:_-,.:�_._._.....:._-._-�..,:.�.._..%.,-_,__:'���-_,.--__.:_--.---,,-.-_.-I�_:�_-:.�,-��.-,7_��-.:.*-..__.._...�..-_,.--l--�-,__--__---,.:-,_,-�-_,--____._:_-_:-:..-;-;:_.:.-.__.�_-__,-:_-__.---�.,���-.-- Cape eoalder;:Resart :.,. 1225 Iyannough Road ...`:. Hyannis, MA . -02601 '- Re` . Reroo. .proposal :front stair `rand ng roof and=wall .of _ Building ib6- Dea Mr. Potts - Wels hoofing Co proposes to furnish:. all °material and laor necessary to pefor the fol3owing work, on the properly indi Gated above forte.sum° of :: 4900 - r _: h 1 ) Obtain b ild ng permit 2 =Remove existing stone` bal'ast, rubber roof system and under lying tat & ;gravel roof systetit 3) : Install,`pt Hailers required for new roof 4) lec�ranically _install '3" of rigid zsocyanura_te roof insulation 5) Install-.a fully adhered EPDM rubber membrane roof system, . membrane _:shall a =so be adered to existing `brick wall acid terminated under :existing`:wa13 capping;; 6) 'Fakir Gate, install, and flash <new ;bronze colored perimeter edgings 71 Proptlyremove all defiers. . : 8) Well°s Roofing shall warranty the new roof to be £ree from . - -,de ects in materials::-and workiaansh p for a 0: years Re`pecf 1 submitted, t oui-(s M ells 1 - � `� zs'.: _ . .__--_ . gVoim�;�! �� :�, . _:_ . . ::.. /1 .2 t��t . Z.. -S Residual Comanerczat [ndustnal �icen. . /insured r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. ,a FO��� Map �Z 7,3 Parcef.' D 23 Application # Health.Division Date Issued 0� } Conservation,Division Application Feet Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street,Address / `Z S` . yat�► o�c, 12c 60c/c/.. /I o,-,4 71S,,o4 { Village_ _ h11/a In I `s Owner .4 � /-�r,1 / s,�� ,A l�v Gov✓✓J Address /�'/ /.•►o✓�Z 6 /1�`' ,/� ��,5 Telephone Sa F( P 77/ �3000 Permit Request .7o.4 S1 �ol-- ms �11�o Ff 3 rya Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total nevv Zoning District I3_ 1,113 J 6 P Flood Plain G Groundwater Overlay yTe S Project Valuation /0,o G® Construction Type S-14 Lot Size 03 ` Ac Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes )(No On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other s0sX 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 ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization 0 Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number SO,?--3 Z 8-71 z.S— Address 3 8` W esl�- Ce JV---- S� License # y3 R 9 7 wesF c•'��e w .- PAA 0 7-379 Home Improvement Contractor# I!/A_ Worker's Compensation # _ W c. R 2 6 7 6 8 7- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOSIGNATURE DATE DATE Z A ��a� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. h ADDRESS VILLAGE "O.WNER 3 DATE OF INSPECTION: t FOUNDATION FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL I� GAS: ROUGH FINAL ,E FINAL BUILDING j DATE CLOSED OUT - \ ASSOCIATION P.�AN NO. 0 JOHN WILSON Commercial Construction president 389-G West Center Street West Bridgewater,MA 02379 jwilson@eastcoastcommercialconstruction.com Tel:508.427.6400 Ext.102 www.eastcoastcommercialconstruction.com Fax:508.427.6600 f w RO� ea / o�./ aaaadzuaek`a iBoard of Bmld�ng Regulations and Standards ' Constructlon Supervisor License Li'sn esn a CS 43997 Expiration 1 119120U9 T# 8508 . S@ trICt10 Q�Q" JOFiN T VUILSON W BRIDGEWATER,MA: 79 Commissioner FEB.20'2008 15:56 6177739920 TONRY #4848 P.004/008 MASSACHUSETTS ASSIGNED RISK POOL REQUEST FOR CERTIFICATE OF INSURANCE Use this form to request a Certificate of Insurance from the Assigned Risk Pool Carrier(Granite state Insur9nce�. Please provide all of the requested information, including the facsimile number(s) of the person or persons to whom the Certificate of Insurance should be issued. If this form is fully and accurately completed, the Certificate of Insurance will be issued and distributed by facsimile to each fax number provided below,within two(2)business days of the carrier's receipt. This Form may be mailed or faxed to the Assigned Risk Pool Carrier. To obtain each carrier's contact information refer to the Certificates of Insurance section located in the Producer Community section of the Bureau's website(www.wcribma.org). 1. Name, address, telephone number and facsimile number of the INSURED: Name: East Coast Commercial Construction, Inc. dba: Mailing Address: 389 W Center Street Unit G WeS Bridgewater MA 02379-1623 Physical Address: Phone: (508)427-6400 Ext. 102 Fax: (508)427-6600 2. Name,address, telephone number and facsimile number of the CERTIFICATE HOLDER: Name: Town of Barnstable Attn: Building Department Mailing Address: 1170 Phinnev's Lane Hyannis Ma 02601 Physical Address: Phone: Fax: Fax Number 3. Name, address, contact person, telephone number and facsimile number of the PRODUCER: Name: Albert) Tonry& Co., Inc Mailing Address: 300 Congress Street Quincy MA 02169 Contact Person: Janet G Trefry Phone: (617)773-9200 Fax: 617)773-9920 4. Policy Number, Policy Effective Date and Policy Expiration Date If a Certificate of Insurance is needed for more than one policy term, provide the Policy Number, Effective Date and Expiration Date for each policy term. If the policy has not yet been issued, you must attach a copy of the Notice of Assignment. Policy Number: WC8267682 — Effective Date: 02/24/2008 Expiration Date: 02/24/2009 5. List any special requests for optional coverages/endorsements (see Page 2 for listing of coverages available in the pool and the conditions of availability)or additional information (including changes in exposure not yet reported to the carrier)that will assist the carrier in the issuance of the Certificate of Insurance. NOTE:An additional insured(s) shall not be listed on any Certificate of Insurance unless such additional insured(s)Is a named insured on the policy. Pleasesend certificates for 2007 2008 and 008 2009 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): �c< < d- 6vc.S Cc��•, rz �'v, �o� S�n�c� � n /T-d�� Sd^ Address: 3 5 t =G W e:s�-- Cam)t- r_ 5'�-- . 0Z371 City/State/Zip: (N. Q s:�y� w - 01 A Phone.#: _5d P 3 Z if •- 7 Are you an employer?Check the appropriate bog: Type of project(required): 1. I am a employer 4. ❑ I am a general contractor and I with� 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 workingfor me in an capacity. employees and have workers' Y P h'• � 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 LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[A Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[N Other To b T��- e { 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. t Insurance Company Name: ✓. Ilex S„�/Q n r , C-0 l Policy#or Self-ins.Lic.M Expiration Date: ZI2-g Job Site Address: /Z2-S— :5 i, 12 J /lya,, 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 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 I do hereby certify under th pains-and penalties of perjury that the information provided above is true and correct i Si afore: �S• Date: 2- Phone#: SF - 3 Z-S-— 7/Z 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): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector t. 6.Other Contact Person: Phone#: , i 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 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 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 Department's address,telephone-and fax number: The Commonwealth of Massachusetts Dgwtinent of Industrial Accidents Office of Investigations . 600 Washington Street f Boston,MA 02111 Tel. #,617-727-4900 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia l � TOWA of Barnstable sues a & Regulatory Services Thomas B."er,_Dtetor, BW11ding DIVIsion ; Thomas Perry.CBO Building Comadssioner 200 Main Sb"; Hyannis,MA 02601 waw.town.barnstabie ma.= Office: 508-962-4038 Par. 508-790.6230 Property Owner Multi Complete and Sign This Section If Using A Builder' T, �►`' ` ���"'� C� ��� as Owner of the su blecc' ro P FertY bereibyauthorize_F�s 1, reams 1- Cm.wrkcG.'•-/ ( �-� to act on my behalf, in all matters relative to work auchotized this b a lication for. by ��6 Pt� PP (Address of Job) Signs of Owner Datie CA Print Name QaWPP116StEORMSMbuilding penult fomte\ECPRESS.dcc Revise020108 < TOTAL P.02 —i#'fix! Town of Barnstable Regulatory Services 11AMs'r.+BM * Thomas F.Geiler,Director 16 Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 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 t wo-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 responsflaility 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 permit is required shall be exempt from the provisions of this section(Section 109.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. En this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, ' that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such-a form/certification for use in your community. Q:IWPFlLESiFORM[Slhomeexempt.DOC r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 'a-7 Parcel Application#62WV _z,&? 9- Health Division Conservation Division Permit# Tax Collector Date IssuedCM (� i Treasurer Application Fe; / Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address y f;,ini&,i �,d Village 0-h n I S, EAR?N N't -7TLP I ra , ,ro.L Owner �A4Y9+J, �s?, �,��+ . � Address I L1 1 F-A I mo od K1 lJ y,1,vrj,s Telephone 50 '25" 7-7 I -00 Lf II Permit Request Re_,'©o� Z WC, 100, 2oz)F ArzF A q aoo S Rravnove- C_x 1s7,•-J< rnoVI S 11e,�s-ta Cb JC<C4e_ deco, 7Lig-411 ,Jtvi 1 g I loses ru g6er merh of 6,.e— rood Sy sue. rev-e�' R,�-�� I,ss�l��ro� /�►�� re-I�-led �I r�.,,✓G-S Square feet: 1 st floor:existing - proposed 2nd floor:existing proposed Total Zoning District Flood Plain Groundwater Overlay _T Project Valuation Construction Type -- Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting'umentat�,,n. P,+'g Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Hig way: ❑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 ❑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 BUILDER INFORMATION NameLoy iS 11 (a Telephone Number`?B 1-3 3 I^31 a y ? Address 1 I `� (4c_6 de�y A�� License# C S Q 3^]3 3 S Weyrv)a sN. M 0z1 5 Home Improvement Contractor# l ®7-7a�;L, Worker's Compensation# We- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO G r o:��Rr\ W isk- S er•���e s C����sea� M ►� SIGNATURE DATE I - 0 6 FOR OFFICIAL USE ONLY i r PERMIT NO. DATE ISSUED MAP/PARCEL NO. F } ADDRESS VILLAGE I OWNER 4 DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE - 3 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL - FINAL BUILDING r:. DATE CLOSED OUT ASSOCIATION PLAN NO. t. i Town of Barnstable Regulatory Services 9 BMASS AMST. i E Thomas F.Geiler,Director i639. �0 �rF16,39 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 Property Owner Must , Complete and Sign This Section If Using A Builder . t I,�JJ i n A h A11±fl , as Owner of the subject property hereby authorize L o o i S We-1 tS d b z We III RoaQlb. Co to act on my behalf, in all matters relative to work authorized by this building permit application for: I ZZS i (Aess of Job) Signature of Owner Date C Print Name i I i i Q:FORM&OWNERPERMISSION i The Commonwealth of Massachusetts ` Department of Industrial Accidents Office of Investigations d 600 Washington Street y` Boston,MA 02111 `,M 5 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): we—`1 i s R o a-Q; /J(r C a Address: 1 City/State/Zip: Wr_Yrn c J-r w M A n 22 i m 5- Phone#: Z 91 3 3/-3/0 V Are you an employer? Check the appropriate box:. Type of project(required): 1.54 1 am a employer with y 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5.. ❑ We are a corporation and its r 10.❑ Electrical repairs or.additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t 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: ,P 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Q _ r Insurance Company Name: !'J Policy#or Self-ins.Lic. #: �`� �- ��`� S Expiration Date: J o1 I31 b Job Site Address: J PS 5 1-/M Jo0c 1, � +L City/State/Zip:_ - /,9 ,i,v,S,T b`L(OO 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 ee fy under the pains atylpenalties of perjury that the information provided above is true and correct Signature: Date: b -/ l D.6 1 Phone 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 a 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,parmership, 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-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 permittlicense 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 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 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 5-26-05 www.mass.gov/dia From:Shannon Sperrazza A`MF&T Insurance FaxID:781-261-1111 To:Lou Wells Date:10/11/06 11:41 AM Page:2 of 3 AMR-0. CERTIFICATE OF LIABILITY INSURANCE OP S DATE(MMIDDr WELLSRl 10/11/0/06 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION MF'&T Ins. Construction Div. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Construction Division HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 77 Accord Park Drive Unit B-1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Norwell MA 02061 Phone:781-261-2000 INSURERS AFFORDING COVERAGE NAIL# INSURED INSURER A: Penn-America Insu=ante Co. INSURER B: American international Co Wells Roofing Company Att• Lou Wells INSURER c: 112 Academy Avenue INSURER D: Weymouth A 02188 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - LTR NSRC TYPE OF INSURANCE - POLICY NUMBER DATE(MM/DDIYY) DATE(MMI)DIYY) LIMITS GENERAL LIABILITY . EACH OCCURRENCE $1000000 A X COMMERCIAL GENERAL LIABILITY SUB10106303 12/08/05 12/08/061 PREMISE s"(E occurence) $100000 CLAIMS MADE FX I OCCUR - MED EXP(Any one person) $5000 PERSONAL&ADV INJURY $1000000 GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 POLICY jEa LOC AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS - BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ ' EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ - OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ - - $ WORKERS COMPENSATION AND TORY L BIMITS X ER IH EMPLOYERS'LUIBILITY ANY PROPRIETOR/PARTNER/EXECUTIVE WC8932185 12/31/05 12/31/06 E.L.EACH ACCIDENT $1000000 OFFICERIMEMBEREXCLUDED? - E.L.DISEASE-EA EMPLOYEE $1000000 ' If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1000000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Project: Cape Codder Resort CERTIFICATE HOLDER CANCELLATION BARNST2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION ' DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Town of Barnstable NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Building Department IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 200 Main Street Hyannis MA 02661 REPRESENTATIVES. A D REP E ATIVE.,� ACORD 25(2001/08) . /�� 0 ACORD CORPORATION 1988 FEB-15-2001 13:55 BKR RSSOCi.RTES INC 503 594 2914 P.02%03 6-ASYOCtses,Inc. r`" �p 94� ° V PI�JIiIrJt ' t 1F2 Crescgnc Screec eracicton,MA 02302 k r c—h i t e c t ure Interiors i,. Eel!508.583.5603 tar.;508,589,2919 e-maiklakaarchs h+aol.com February 16, 2001 Mr. Elbert Ulshoeffer, Building Commissioner Town of Barnstable 367 Main Street Hyannis, MA 02601 Re: The Cape Codder Resort Dear Sir: We are currently working on a projec_ t foru Can'I`Vliebster/Hearth'►i Fettle r--Managdment,C-orp:at`the Cape Colder Hotel of Hyannis. As you know, we are renovating one of the function rooms to accomodate a fixgd-seating restaurant. (211 persons) This area is now, and following renovations, will remain, fully sprinklered. Additionally, the existing function room is an A-3 use group and the restaurant replacing the function room will also be an A-3 use group according to the Massachusetts State Building Code. The interior finish requirements, according to the Massachusetts State Building Code, Table 803.4, for Use Group A-3, regarding ASTM E-84, flame spread and smoke development call for finish materials to be of a Class III rating. All finish materials at the interior of the restaurant meet this classification. Regarding the corridor directly adjacent to the restaurant, according to Table 803,4, corridors providing exit access shall have finish materials of not less than Class II, with the exception of Note c, which allows Class III interior finish materials for wainscoting or paneling for not more than 1,000 s.f, of applied surface area in the grade lobby where applied directly to a non- combustible base. Table 1011.4 of the Building Code references the required fire resistance ratings of corridors. i rES-16-2031 13:56 BKR RSSDCIRTES INC 508 594 2914 =.03id3 f, February 16, 2001 page 2 In an Assembly Use Croup, with a sprinkler system, the required corridor fireresistance rating is 0. Therefore the windows in the wail between the corridor and the restaurant require no further protection, if you have any questions regarding these items, please call me at the above telephone number. Respectfully, r.. Lori J. Anderson Project Manager cc: Lieutenant Eric Hubler, C11 Fire Prevention Officer Hyannis Fire Department TOTRL P.O3 I FEB-15-2001 i3:55 BKn' ASSOCIATES INC 588 584 2914 P.01/83 t4 BKA A30cfates,Inc. 1 I 142-6e1cent streot Brockton,MA 02302 Architecture Interiors ce1:.508.583.5d03 tax:508.58'1.I914 t•mail:Ekaarchs �sol.com FAX/MEMO TRANSMITTAL Company: %wn/O e �rC'�5%37.9BE Date: Attention: �g U� ' Re: G''➢,�� eo40E•2 e��sG7.Qr Fax#: s'o — 7-7d - G;Z,g o Pr0'ect 2e'e From: L o.e i �4.c%b.ps'O/v NUMBER OF PAGES INCLUDING TRANSMITTAL: l 3 aLetter/Memo LJ Graphic ®i Third Party Document ❑ Mail Original ADDITIONAL MESSAGE: �� FEB1 � 2001 � ,ivy w�w'.xr nogg ci COPIES TO; //Yi9iY✓Y/..s' s�iRE 0��� SKAAFAX.DM %Lk-resce tes,Inc. t Street Brockton,MA 02302 n �J Q Architecture + Interior s tel:508.583.5603 fax:508.584.2914 e-mail:bkaarchs @aol.com January 4, 2001 Richard Stevens, Building Inspector Town of Barnstable 367 Main Street Hyannis, MA 02601 Dear Sir: We are currently working on a project for Dan'I Webster/Hearth 'n Kettle Management Corp. at the Sheraton, Four Points Hotel of Hyannis. Our intent is to renovate one of the current function rooms, so as to accommodate fixed restaurant seating. This function room is approximately 4,053 s.f. in size and has a current occupant load of 270 persons (15 s.f. per person). Our intent is to place fixed seating in this area for 211 persons. This work is completely within the confines of the existing building and does not include any exterior walls of the structure. This area will be served by the existing kitchen of the hotel. This.area is now and following renovations, will remain fully sprinklered. Additionally, the existing function room is an A-3 use group and the restaurant replacing the function room will also be an A-3 use group according to the Massachusetts State Building Code. Respectfully, Lori J. Anderson TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2-7 3 Parcel O Z Permit# Health Division Date Issued Fee 0 ,12 2O ' Tax Collector Gl - Treasurer 0�(: c WST o . T10N p E ETAiN d uEWER MIT FROM THE ' IG9iv281iIP10 t'Vt810�88f0$TO D ve Plan Approve ar H' H Preservation Project Street Address Sxe,k, o,� Village Owner �e �� N ��74/k ('Q Address /Y/ fti�i�a✓d�4 /�/ /��^^• Telephone 7 7 00 Y0 /Z.9 - ,// C4 A, k Permit Request 22�ti., se -A k1j e ciryJ d ' Z�Xis ��� S.Ur.:, k 'r 74o Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation _�Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: Cl 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 ❑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 h „ BUILDER INFORMATION Name e';s.s )IV,v znC_ Telephone Number , Address 7O0 ler- S 04 License# 4 _3 ! 9 7 GU 46t, ' 0e" 14 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO -sc� SIGNATURE DATE /Z FOR OFFICIAL USE ONLY r i -• f o- PERMIT NO. r DATEIISSUED I MAP/PARCEL NO. I a ADDRESS VILLAGE r OWNER DATE OF INSPECTION: FOUNDATION FRAME i INSULATION F FIREPLACE ELECTRICAL: ROUGH FINAL k PLUMBING: ROUGH 'g FINAL ti GAS: ROUGH �p FINAL FINAL BUILDING ;DATE CLOSED OUT r ASSbCIATION PLAN NO. e F n ` 4� �C�,� i V �{� {q e :ka::•tiff'•. 1 42 0 }•. 1:: IT qQ gil- :.. :I :;•�'::.::::<: tiff.. C c• r ,�;:kk•i:ri> :• b s ::$;Y: .; b { ... . 8 .Y. :...:..:.: .J:i{•:::.:. ......:{.. iy is 'f `4}� G .V Ir { e o r. •r ::•W�• w.4 j�fG i:•Y':?:•: < �h eigg ,gg,YT'q�q.. 44 V a A a �• �y o 0 gg ��S� v! w� p :t Imo' iiiiiiiiii-M P :%k:O.O•r.: }...:$:%� � :x.t. '}r:r ;}�•.• ':'f':.:`:: to •�. ::Ykx y ,( N• 9 d 0 s / •Y: VJ f O .} G . S. }. 1 M V y a F•.: ..r: li �V .Stf is .. V\ N 4 ...a.:..01 Q y Spey. :£:`:??? �• .a. ti'::$k:� j9`�{ O � ?i>•ti+} :> :: i^'3'•:?:;' `•:k:';i.:. ::}:i:::•:i•�: :}F.�:•: :jS}k::S h':: fir, .i % r �• :•.rif: cr S. Q ? :::kYY::: iFrti•:t:•:i # fi:•: .} ':�+•..:: >%:lam M 3•:,i• :<•'Y:'COT :• :kS$ N t p r'�k6${ A A' $$:Yf Q fi:r.•w: b A 8 }•�f V :Y 013000 i$iY.T r ,yr. 4 a 4. N .,r ia• f +�,,, +�''�,� ►r } .r.a f.:. . dill r n M d j r y is f�•{ lei qy �r r. :%kk7'YIiiiiiiik �f �+ }h:; :• ;4'$$: {�, ::}•+:is ::: `r g is•:a' �$.... } TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 273 9ZW Parcel 0 ARNS)TA� TO � bryBLE Permit# Health Division Date Issued Conservation Division 003 JAN 21 Api 8: 36 Application Fee Tax Collector L9/Id Permit Feed Treasurer DIVIS#ON Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis 7 Uf, Project Street Address Z/hlfir i 0 v c R C Village 0wne " ^ I r- D_. - �e�f�i��errlc��ox � Address l 2."ZS T Ytlr4 nro v L, RIA Telephone -7-7 1- 7 0 L) Permit Request Reroo� L.-,4 is i oo 4- -wo . ��_� ex �°r,•J fr fro, IT--u P road A,JA f�� ��i 2.;� r►�P �r r E'- S?ogrr-- ►1 e =f- IS70o Sop- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 4"2 O C9 Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) _ Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other:. Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review#' Current Use Proposed Use BUILDER INFORMATION Name Leos we-its vie iis(zo©�,.,c (' , Telephone Number e) Address f 2 V)c n d e rr AY A v-- License# _)3 3 g WC_Jv--�jou'r to , IM tq O-L 1 9 S Home Improvement Contractor# " //9 Worker's Compensation# UO C(-.n`7`�80 C s ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Se- SIGNATURE DATE ��Z-1 /07 f FOR OFFICIAL USE-ONLY , "PERMIT NO. - DATEISSUED -- MAP/PARCEL NO. - - ADDRESS VILLAGE OWNER « DATE OF INSPECTION: FOUNDATION " FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ` f„ ASSOCIATION PLAN NO. _ The Commonwealth of Massachusetts - Department of Industrial Accidents Office iYUJIMs08005 t 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit e: location: hone# city ❑ I am a homeowner performing all work myself. ❑ I am a sole pr o n or and have no one workin in ca acitp din workers' co an nsation for e e mp mployees working on this job,.•!•.....•y:•..' :" y Y,Y::h: ;;::'x;,rvs;,: :«:v:;::::em 1 er rovi g mP ..,.:::...:.}:::.::}.'- ..::{.::.:.,:i4.}"•::... ..... ...: .l::."J::,..::.:.�f:r:::::n..r,n.n..r;r..:." ••:.:..::::::}...,..:....,......r. 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I do hereby certify under the pains- penalties of perjury that the information provided above is trup and correct Date J � z t —0 signature �S Print name_ Phone# .� ofddal use only do not write in this area to be completed by city or town official city or town: pe�tAicuue# � ❑Building Department OLicensing Board wired Selectmen's Office ❑the ifimmedlateresponee q ❑Health Department contact person: phone#; Other aryiod 9195 PIN r d Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the `law", 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. al MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance o who has renew of a license or permit to operate a business or to construct buildings in the commonwealth for a y pp not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying' company names, address and phone numbers along with a certificate of.insurance as all affidavits maybe suPP R. submitted to the Department of Industrial Accidents for confirmation of irmimnce coverage. Also be sure to sign and ;: date the affidavit. The affidavit should be returned to the city or townthat 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. City or Towns 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 pemlrt/hcense number which will be used as a reference number. The affidavits may be retumed'to the Department by mail or FAX unless other arrangements have been made. gations would like to thank you in advance for you cooperation and should you have any questions. The Office of Investi please do not hesitate to give us a call. The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 6QO Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 ; Property Location: 1225 IYANNOUGH ROAD/ROUTE132 MAP ID: 273/023/// Vision ID:20899 Other ID: Bldg#: 1 Card 1 of 1 Print Date: 01/21/2003 08 CONtR _ �,.. . . Element Cd. Ch. Description Element Commercial E Descry Elements US 141 59 Style/Type 9 otel Description 18 BAS + Model 4 ommercial 141 5 Heat&AC 3 TYPICAL 0 2812 Grade B ustom Grade Frame Type 2 WOOD FRAME 1 Baths/Plumbing 2 AVERAGE 135 14 8 Stories Stories 7 FU 1 Occupancy 6 Ceiling/Wall 8 YPICAL 0 141 A ooms/Prtns 2 AVERAGE Exterior Wall 1 14 Wood Shingle /o Common Wall 2 12 34 8 2 all Height 12 34 j 163oof Structure 3 able/Hip141 oof Cover 3 sph/F GIs/Cmp 8BAS n CODO/11�08XLE,lTQET FUS interior Wall 1 08 Typical Element ode Description actor BAS 170 1 nterior Floor 1 20 Typical Complex 141 119 184 48 7 11 2 Floor Adj 164 Unit Location 21 �15 Heating Fuel 6 Typical 11 FUS Heating Type 9 Typical Number of Units 1 BAS 3 14 C Type 4 nit/AC umber of Levels 3S 54 /o Ownership 48786 214 141 14 Bedrooms 0 Zero Bedrooms Bathrooms Zero Bathrms CUS7R7CETVALUATIDN ', U 2 7 0 Full nadj.Base Rate 80.00 Total Rooms Size Adj.Factor 0.70557 BAS Bath Type Grade(Q)Index 1.37 FBM 74 Kitchen Style 39 dj.Base Rate 77.33 Bldg.Value New 16,658,660 CAN Year Built 1973 2 183 4 k1I8 ff.Year Built 1980 rml Physcl Dep 20 uncnlObslnc 0 TS,' con Obslnc 47 Specl.Cond.Code 3000 HOTELS 100 _ Specl Cond% verall%Cond. 33 eprec.Bldg Value G AO'f Ann OOC/TBUILDING& TEMS(L)/XFillDINGEXTR�S EAIURL ( ., Code Description LIB I Units I nit Price Yr. I Dp Rt %Cnd Apr. Value SPL7 Indoor Pool B 1,600 20.00 1980 1 50 9,600 TEN Tennis Court L 7,200 1.25 1981 0 50 4,500 PAVlPAVING-ASPHALT L 100,000 0.90 1981 0 50 45,000 SPL3 Pool Gunite L 1,000 35.00 1996 1 50 16,100 _ WIN Ir.. :, ..T1111W. .;:.BZ7ILDING STI,B AREA SUMMA$YS CTIO�U� Code Description Living Area Gross Area E .Area Unit Cost Unde rec. Value BAS First Floor 118,454 118,454 118,454 77.33 9,160,048 CAN Canopy 0 800 160 15.47 12,373 CLP Loading Platform 0 462 139 23.27 10,749 FBM Basement,Finished 23,454 39,090 23,454 46.40 1,813,698 FHS Half Story 1,898 3,796 1,898 38.67 146,772 FUS Upper Story 71,318 71,318 71,318 77.33 5,515,021 Ttl. Gross Liv/Lease Area 215 124 233,920 215,42 Bld Val: 16,658,6601 K TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION map= - 7� Parcel 0 Z3 Permit# j Health Division Date Issued Conservation Division Z Leo, Fee 3 o S Tax Collector Treasurer ©9l23D0 I # OKICANT MUST OBTAl1Y�lIEWER CaN';Ew�p%ON PERMIT FROM THE, Planning Dept. ,�GahaERlN(;ulmStoN pwoR TO Date Definitive Plan Approved by Planning Board - Historic-OKH Preservation/Hyannis ; •Project Street Address Z Z d✓ ' J2c/ Village Owner A, ress '/y/ Telephone 5-0 7 / D O d Permit Request T^o �'��� 004 Z7,c Goa A- Y Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation 00 y Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfatliered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 33-v rS Historic House: ❑Yes No On Old King's Highway: ❑Yes XNo 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 l� Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No / Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# j Current Use Proposed Use I BUILDER INFORMATION e Nams OL 4- -S 7L c- Telephone Number S-0 d' yZ 7 d"Yao Address 700 6le-5 04 e-e, �- S License# l✓• /3�,�e G�� o 2-3 7 9 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO SIGNATURE DATE T FOR OFFICIAL USE ONLYJ ., of - DATE ISSUED MAP/PARCEL NO. + ADDRESS VILLAGE OWNER Ali DATE OF INSPECI IONw - , FOUNDATION eacn FRAME — INSULATION FIREPLACE }' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH 7 FINAL t GAS: ROUGH FINAL ._ FINAL BUILDING- DATE CLOSED OUT r ASSOCIATION PLAN NO. -= Department of lndasfneT,'Accidents 9 Wes#1la I UsMA MOSS • 600 Washington Street Boston,Moss. 02111 Workers' Com emation Insurance Affidavit name• iocation. 70 C) Wes }` (-P, `S city t)hone# SO vL7 6 YO 0 ❑ I am a homeowner performing all work myself: ❑ I am a sole proprietor and have no one waddn is aav I am an 1 ding workers'cmWensatkm for my emPlayees working on this job. effip�l�' .....................:...:::•:::r:::rv:.r:::::::::.,•:.:. •.x,:•xx::..:::..;•i.,•:.......::::::{::h•.i.v:•.......:.v:}:•::•.:.v:i:::.....:::•:::.::>:.::•. n v.•}.:.. .fire... my r... .. {,q .:••;••. n..r.............n.ry:w:nx.}:•}:}}::::vv:.J::::v:n..... ..........................::::.......................... fi.. :.x...., -........... .........-.. .............. ....... ...... ..............,.. .........:.:•.»•:,v::::::•;.;.•r.::•:.x::t:•::•}•:+:c?::r.•}:•}:.}:{•:;{o}ww:?•:: .. ,•.emu:;.;;;}}S:x:....,..�}+ .J..::.v:x::... ::•... ......}...... v.::.. .:' ..... .......: .. •. v ,..,.{.: .:b...{.r•:k•.... }iwry k•.L�+�.�:;}:ji::v:4i}{:•ri}v •:w:.:• :?fix•.: .kikS{k•..sX•:.t;... ..,..... �.:...-..... .'w::.v::.»v. .:.. .•.. r .;�.y.�.,rx• r.;.. „{ .. ,�..,....AA•:.n..:........:....!}:•::}::'ii::::::.v':.Y::n}W:-::v::::::::•.v. ..,. ...::::: ;.y{,. .. .�.1-::Y".^F .::.v:: k ,�^-*•.SYn.,}.;�.,?}}}{'•^4}:4.ry:::;•;'r,.i} •}:krt..:-. •� w x• :u:;:�:•{{::v ::Ll�:��:�?ills<iRkk�':+�:?:•:?•}}}}i}?:•x?{jJ}:{•. :...v.�.............. .Y...�y� n.x ..fi:•w.v,• }xJ:?r,{{xis$}'v,:tij•Y•,vti�?:i:•::>i?:}Y•}:•}}:r.•:r:.....y. }:.... .. ........... •: ........ nsmranceeQ:':;>{?, +r- .t' ix.'�`:.:::.:: r :.. :......:...:.::. olicv:#:,:. -.,::};:.};>:{,:x:,,...,,{:::>.:::::{,:::;,.:::.::} ❑ I am a sole proprietor,general contractor,or homeowner(cirde OBO and have hired the camtrac=listed below who have the workers' ensation fallowing OP..................P° .. .::::..::.,.:::.ro ::.:::.».:.::..%,w.}}:J�::«{�}xJ,�.}�w.�.Y.J,�Y:}:J}:.}x:.{�.w:.:.}:?<{L::}w:-}},,�} >:.•.�ww.::. ........ .. ....... .............. ............................... ..............n.......... :...}n....i..x:.x,••::}}:}::;::x:::r:.^,•:::x;}}ii^'{J:::•T':n}:v.. .. x.........:................:..:•..................v....................w:................................:;.}..v:w:;; ............. ++........... .r.:::•.vrh•Yi}::}}:'w:::::•:Lnv:::::::•::J:w::.;..:::•}:•:v....:.:.v .... ..r... :....{...... .........-.rrr................. .n.w»..................................... :::•./:... 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FaOms to seems eoverafe as esgsared under SecdOIM M of M M 1S2 a Ieed to tha�posifloaof e:ioamai peaaitles ota ene ap to slAm"ami/or SON yet>nprbomomd as wen as civa pemitks in the form of a STOP WORK ORDER aid a floe of S100.00 a day apindme. Iumkmtmd the a eopy of this sfatma d may be forwarded to the OIDa of Iavestipioas of the DlA hr co =P veiithmtlon. I do haw by cff*wader p ' and p ofPal�'t"the infomtadm pnvv"above is&w.and coned ate /Z/ZZ/dU -- Ptimtname ��' T e' yz Y oIDdsi we only do not write in this area to be completed by c ty or town offf" city or town: QI�2 B--md Q cheeklfimmediata rmP�is mid QSr]eat Deep once _ _ QHeaithDeparfaamt co�dad person: phone#' ❑Other (termed 9/95 PlA T1. �omvnon�uea�i o��aocac�u�aPlta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number. CS O43997 1 Expires.10MM001 Tr.no: 8036 Restricted To: 00 s JOHN T WILSON 700 W CENTER ST#4 W BRIOGEWATER, fiAA 02379 Administrator TOWN OF BARNSTABLE BUILDING•PERMIT APPLICATION Map z- 3. Parcel _ Permit# 50 Health Division Date Issued 14ro Conservation Division Fee G Tax Collector_ . ►- � `� `�/_ �1/�Q Treasurer oZ ����-�00 Planning Dept. ` Date Definitive Plan Approved by Planning Board ' Historic-OKH Preservation/Hyannis Project Street Address 4-t— l 3 PjE 19 9- Village Owner �A�.We�sa[cf/Jlen�F�+Ke le Nl►�N�4cerr�Pnl� Address 1y ( FA rno v t`►+ �Y7"vw,-Q OZbot Telephone 5`0$-77 1 D Permit Request Re,rooQ A o �' com P ley- q PPro K, 3 z S I_ �XISi i`W� ft7�� SYS'�e�-►S �� �� MLaC-k - r'ls4- ✓Lt D I So c)1A..ju /,rg7,i 1 r4 SJ 1 PY+10,J .-_T_fj,;APA A 4� )R Y 4d kel-e d- EPD i1 Ru6&-_2 Aoo-q S/S. r- r1ft14,t4&S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation 2-5Z,000, Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) o- L_ Age of Existing Structure .Zoy.,�5 Historic House: ❑Yes /No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full Cl Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Nurnb6r 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 O No Detached garage: ❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use `'l o+eA Proposed Use A) O c N Ad 6->✓�_ BUILDER INFORMATION Name Z_O V S �15 Telephone Number 2 Address_ i 12.- Ocr?Jim License# d 3-7 1'3 6 of /ro /a-L •ZuE5cb Home Improvement Contractor# tnt prce�i�,-- Worker's Compensation# �-Q C_ BOB P,00 co-1 Pl uS� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO G-1- ,Ar1,+V,, e- S-e-Ir\/�C-eS CA gss-ci M6 SIGNATURE DATE l 1 Z 1 l 0 D FOR OFFICIAL USE ONLY gPERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS _ VILLAGE . o-� OWNER ask jq�R - F DATE OF INSPECTIOI1 FOUNDATION r FRAME r• INSULATION FIREPLACE c . ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL t GAS: ROUGH FINAL FINAL BUILDING ~ F DATE CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts ^ Department of Industrial Accidents Ofliceol/V es1/gatioos 600 Washington Street Boston,Mass. 02111 Workers' Cora ensation Insurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am an employer providing workers' compensation for my employees working on this job. maim coMpanv name.: ' } ><::': '.::. :: >:. . .49 atvr:::.::�>�.�� 'y'7�.t•.,�. 1 � L. �. `.. .�...... shone#:.. ' .....:. ' .,.. �: .. ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices:::::. ::.,.::...::.::..:::.:::.::.::::.:..:.:::::::::::::.:.:::::::.:.:::::::..........................................................::.:..,:::..,:.., ::..::.. �cpmyanv name. adie .::::::::.:::::.......:............................................... «<>'>........... > fitine ? .................... ?. ...............::::... :. k•{.t...:.....v...4}............................ ... ..........................................: ii}:•:?;?•:•>?iii:•:4:.4:?4ilv.:''-�i:i!1:: :.. :.:..::... :address '- :::.:�;:�;:;�;::>;<:<>;<'�;;>:.:?»`�:;�::� :t:s�:�:s�;�:'t�:.!;::: p ''type#. ............... ............:..:.........::...::....... .............. Faitm to secure coverage as required under Section 25A of MGL 152 can had to the imposition of criminal pe zium of a fine sip to s14noo and/or one years'imprisonment as well as dvII penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby.c - under the pacts mid pe�naldels perjury that the information provided above is truce and correct Signature 6, l ` Date Print name L01_-J \ S AN otfldai use only do not write in this area to be completed by city or torn official city or town: permit/Rcense# ❑Building Department ❑Licensing Board ❑checkif lrnmediiste response is required ❑Seiectrnen's Office ❑Health Department contact person: phone#; - ❑Other. UrAwd 9195 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any cont rad 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 section 25 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,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 irm rangy regrriremea#s of this chapter have been presented to the contracting authority. FEMEMEEM Applicants '11&se fill in the workers' compensation affidavit completely,by checking the box that applies to your situatiam and `y`suplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be su'krmitted,to the Department of Industrial Accidents for cmdkmatiion of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be retntned to the city or town that the application for the pemut or licensais oeing requested,not the Department of IndizaW 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. --ity or Towns ?lease be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the �ffidavrt for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please ,e sure to fill in the pEiiit icense number which wM be used as a reference number. The affidavits may be remmed'to he Department by mail or FAX unless other ar angearents have been made. he Office of Investigations would IOce to thank you is advance for you cooperation and should you have any questions. Tease do not hesitate to give us a call. he Deparuneat's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents 0mce of levesugauOns 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 BOARD OF BUILDING REGULATIONS Llcense: .C.ONSTRUCTION SUPERVISOR Number-CS O43997 Expires 10H912001 Tr.no: 8036 Restricted To: 00 JOHN T WILSON 700 W CENTER ST#4- - W BRIDGEWATER, MA 0237 9 Administrator r" t r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _7 "3 Parcel -3 Permit# Health Division Date Issued Conservation Division Z 12 Z G c Fee Tax Collector A ' r �a/O� Treasurer /,/Z1—/7160 s Vn . PI nning Dept. n + Date Definitive Plan Approved by Planning Board C� Historic-OKH Preservation/Hyannisy Aj ji uvk � INL a Project Street Address S Ad �Oe oe7— /3.z �eti�se s `✓�� , Village Owner ess /// ��/ro✓�� �� /�y•.,,,,3 Telephone -5-0 - 7 7 — O O `/O 1c / Z/% 6"// .Permit Request O(fd a� �e�+o�%d.. d t- *.,—C/ Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 3 v Historic House: ❑Yes A No On Old King's Highway: ❑Yes A No Basement Type: ❑ Full ❑Crawl ❑Walkout `4 Other _.5/5 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: A Gas ❑Oil ❑ Electric ❑Other Central Air: A Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes _XNo Detached garage: ❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial X Yes ❑ No If yes,site plan review# Current Use /`Zd �� Proposed Use �^ ��^�e.cl/ BUILDER INFORMATION Name s�.s� ��4s �'r�� �^ Telephone Number /,5W�'— �217 O ` �3 /� % _ Address_700 GrJ Ce�, � License# O 7— �.S� Home Improvement Contractor# 1Y�1 Worker's Compensation# 5-2r7xs—y5 r—O ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 6W,,// r e Aave•-11' SIGNATURE DATE r FOR OFFICIAL USE ONLY J of ' _ _ • PERMIT NO. DATE ISSUED - MAP/PARCEL NO. , ADDRESS VILLAGE ' OWNER _ DATE OF INSPECTION: - - x . FOUNDATION 't FRAME INSULATION i FIREPLACE e ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL' - Y GAS: ROUGH FINAL t FINAL BUILDING DATE:.CLOSED OUT ASSOCIATION PLAN NO. ' . y t !BUILDING & ROOM NUMBERS M I1 lDs r ^ ;ram r 5 4 E Erg sR` � •151 Floor 1S1 • 257 N ? 2nd Floor'261-•269IS! 26S 253 O - nn e.� oN N Fl 76] ilfl[1?Y COkF: e rr r MA. r r 's1 �n On �n N 261 (V v e a Fft$ '� 220 21s v L o o u p�p "� v •240 '239 676- wo o: p 219 217 e 'i m 524 gm.!— s Ni ' g m '236 20 2133 654 • 620 Big E 61e '543 •578 A Fbvl POOL 210 •� Isl Floor 201. 220 ro4e 1541 Ss3 206 207 Ind Floor•221-•240 s1e st 512 �1e 'nt psi F7001 602- 626 •640 Isl Flour 500• 521 S39 '534 206 205 BUILDING92 2nd Floor•6l1-•656 9114 2nd Flow 1522-•S45 513 510- '2n53J 332 204 203 IIUILDINI;96 e102 BUILDING 05 '2t4 '21♦I *535 '530 CANOPY202 1 *640 0 5°3 Ss2 ICE iF 1 606 607 507 1 s04 COURTYARD IBM •6�7 1531 •s26 10 so2 120 Z '329 524 0 '132 1 Cfl P p �p 1P $1P n *C s 'S22 1130 �1]� W Q y 132S Ife Its s01 soo 1130 t1 33] lsi Floor 101- 120 o •134 •133 2nd Floor 0121-0140 '. a ICE /12 .1 t Q it I 131 took of BU1LD[NGpE 1 129 929 •127 RF! TAt1RANT 20 S2 O ' '[I• a 103 122 102 lot •122 •121 v TAVERN shopi ,u+1 2 ~ LOBBY m 1' =r,lkilig M DALLI N MEETING ROOMS ENTRANCE- FourPoffits ® w 11 O T E 1• S A <-RoIIlT 132_> Sheraton