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HomeMy WebLinkAbout1225 IYANNOUGH ROAD/RTE132 (4) � -. � ��_._.. .. e,�% ��a� - --- - - - - - -- --- - --_ a_ __ I! . l a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION f , 'ZIP Map 3' Parcel Application Z Health Division Date Issu Conservation Division Applicati e Planning Dept. _,Permit Fee L 5L4 • �� Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation/Hyannis Project Street Address 107,15 Village s Owner rArrAN,►,c ps Pam' 'y ,Q,r„ Address /�� F z dll7W f`D �I�HViV�S Telephone (5-00 77/- Permit Request Jms-Zi4-Zl C-AN&PY sys-'f w\- PAUTt� =T/4Dn/ 01-4 �Yy,¢�� J FF- K .-Square feet: 1 st floor: existing proposed 2nd floor: existing 'proposed Total new Zoning District Flood Plain Groundwater Overlay dtl Projec-tYValuation, q0d t 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 WNo On Old King's Highway: ❑Yes dNo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing ci new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room!Count "T' C:) Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/doal stove:�❑YQ ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing Qnewr'size_ ,w 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 (BUIkDER OR HOMEOWNER) Name _ Telephone Number Address c License V—e66 X / Home Improvement Contractor# i Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE---- .................../ DATE � rj-6 3 r. FOR OFFICIAL USE ONLY APPLICATION# QATE ISSUED MAP/PARCEL NO. I ih ADDRESS VILLAGE OWNER DATE OF INSPECTION: 11-1 YFOUNDATION . &" FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING • I 1 fi DATE CLOSED OUT i ' ASSOCIATION PLAN NO. ,f r 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): m r}P�> kf A -P 1.i4 A1a4` V f-10-7 dag:5 ` AC, ible A Ay 4wxA4 Co, Address: Id Y- rk ti-Nv n c. 4E N u-c City/State/Zip: 0 0 6 tNl.N Mt'�' 01 M Phone#: (-I-0/ Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *My 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. 1 Insurance Company Name: Al,Ig _U %V A[. Ttv S , �t9 ' Policy#or Self-ins.Lic.#: ijc G j-o l t)6 j q 0 12 Dl Expiration Date:'!f Job Site Address: MUZ-5TYI�1J N b o Ea 04 �- City/State/Zip: %1 iy, N 0.5 i 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$1,50.0.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify 4a der the p rs and pe ties of er' that the information provided above is true and correct Siana e: Date: Phone#: 3 ft 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#: i f 04/10/2013 12:29 19785214669 COWAN INSURANCE PAGE 01/01 R '.. CERTIFICATE OF LIABILITY INSURANCE DATE(MmIDDIYYYY) PRODUCER 4110113 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cowan Insurance Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 359 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Haverhill MA 01830 INSURERS AFFORDING COVERAGE NAIL# INSURED Maple Leaf Capital Ventures Inc dba INSURER A`Employers Mutual Casual Com n Morgan Awning INSURER B: SafetyInsurance Com an 10 Atlantic Avenue INsuRER C__Associated Emplo eIs Insurance Com an Woburn MA 01801 ��.. INSURER D: COVERAGES INSURER E; THE POLICIES OF I NSURANCELISTED BELOWHAVE BEEN ISSUEDTO THE INSUREDNAMEDABOVE FORT14E POLICY PERIOD I NOICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCEAFFORDEDBY"THE POLICIESDESCRISED HEREIN IS SUSJECTTOALLTHE TERMS,EXCLUSIONS AND CONDITIONS OFSUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICY NUMBER POLICY eFFECTIVB POLICY EXPIRATION GENERAL LIABILITY LIMITS A I X COMMERCLAL GENERAL LIABILITY 3D6T415 EACH OCCURRENCE 81000,000 01/08113 01/08/14 DAMAGE TO RENTED CLAIMS m . X❑ OCCUR RE, ISEs fl"a��r,.nnce) S 100,000 x Blanket additlOnal insured MED EXP An one parson $5 000 PERSONAL 8 ADV INJURY $1000,000 GENERAL AGGREGATE . $2,00,I 0 C.EML AGGREGATE LIMIT APPLIES PER K POLICY PRO LOC PRODUCTS-COMP/OP AGG, S 2 OOOrOOO AUT MO$ILE LIABILITY ANY AUTO - 9021689 COMBINF•D SINGLE LIMIT 09120/12 09120M3 (Ea eeddant) s 1,000,000 ALL OWNED AUTOS x SCHEDULED AUTOS BODILY INJURY $ HIRED AUTOS (Per Penton) - kx NON-OWNED AUTOS BODILY INJURY $ x Blanket add.Insured ( barn) PROPERTY DAMAGE $ GE LIABILITY (Par accidon) GARA ANYAUTO AUTO ONLY-EA ACCIDENT S OTHER THAN ACC $ AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY A K OCCUR CLAIMS MADE 3JB7415 NCH OCCURRENCE S 5,000,009 01108/13 01/08114 AGGRF,pATE s 5,000,000 L UCTIBLE S xENTION S 10 000 S WORKERPENQATIONAND $ ANY EMPLOYERS'LIABILITY YIN X �ATU. OT11- C ANY PROPRIFTORIPARTNERIEXECUT WCC5010619012013 01110113 01/10/14 OFFICER/MEMBER EXCLUDED, NN E.L.E'ACW ACC (Mandatory In NH) g �Q00 �- If yea,IA aPrl OVI�dBr S ba E.L.DISEASE.ER PLOYEE $e� 006 10T I IER E.L DISEASE-: ,L). Y LIMIT 0OO 000 DESCRIPTION OF ORERATIONS/LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT!$pEggL PROVISIONS hd I'J lAwningmanufacture sales&installatio CERTIFICATE HOLDER n.All parties as required b contract are listed as additional insureds on the eneral Ilabll' Insurancepolicy. ,v s CANCELLATION Town Of Barnstable SHOULD ANY OF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 200 Main Street OATS THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL �O NOTICE TO TINE CEEN RTIF40ATE HOLDER NAMED TO THB LEFT,BUT FAILURE TO DO AO SHALL ►lyannIS,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY O NO UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTMOR1�Ep REPItESEN Fax: g08 36$•9001 ACORD 25(2009/01) RATION. All rights reserved. The ACORD name and logo are registered m of ACORD 04/08/2017 06:36 FAX IM 0002/0002 TOWN, of mor an � hN 16 �AWNING DIVIS1 Town of Barnstable April 10, 2013 Building Division 200 Main Street Hyannis, MA To Whom It May Concern, Please be advised that Stan Kazamias is employed as an engineer by Maple Leaf Capital Ventures Corporation, a Massachusetts corporation, doing business as Morgan Awning Co. Thank you for your attention to this matter. Sincerely, ) Gr` am H. West Maple Leaf Capital Ventures Corporation DB/A Morgan Awning Co. 10 Atlantic Avenue Woburn, MA 01801 Morgan Awning Company,Inc.,10 Atlantic Avenue,Woburn,MA 01801 tel 781.569.6311 fax781.569.6318 web www.morganawning.com I �'ME Town of Barnstable Regulatory Services •. s�xxsr�, • ems, Thomas F.Geiler,Director '0h�p�„pr► Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 50&790-6230 Property Owner Must Complete and Sign This Section If Using A Builder l 1, J- P � �� , as Owner of the subject property hereby authorizeU'S �V�� � to act on my behalf, in all matters relative to work authorized by this building permit (A ess of Job) *Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant � 1, II 1�aVV,, C&IL', _ Print Name Print Name Date QTORMSDVINMRPERMSSIONPOOLS 62012 1 � S -s V p i 1,344 , 2 t��k�5 <r 3 L, .................. -. 'a CUSTOMER STAMP AND SIGNATURE X=9.4 Wall mounting Q X=6.7 Ceiling mounting. Y=Slope(see page 4) max in.512 ° 0 ° �12 1.2 �� I c� o QTY. REFERENCE Y. _ DIMENSIONS Width inches © Projection* ; inches r © Wall height(under supports) inches Attention.- 13 Pillar height inches the.projection measurement always includes the wall beam(S17)if installed COLORS MOUNTINGS CANVAS C ivory ❑ECL15SI re Ly ❑ECLISSI.white ❑ECLISSI ivo grey ❑ Direct to wall(standard) _ E ❑Brown White ❑ECLISSI PLUS white. 16 Matching ❑ To wall with beam code ❑White protective 0 ❑Ivory ❑ FERRARI 502 color W ❑ Other ❑Anthracitecovers iS El Grey ❑:.Ceiling Go Z ❑ ®Antidrip system(for weldable fabrics) (Iridium foot on the ground) Z %o o Valance(see page 7) type h.inches, R OPTIONS DATE&SIGNATURE r cv COMMAND V � . = o ❑ M Ad n runner Purchase.date ,N ❑ Electric type 3(remote control included) ❑ Add-on intermediate support tube nr. Required'dispatch week 00 ❑ Retractable gutter(no front valance ) r ^ (purely indicative see order confirmation) o ❑ EM Frontal beam(required for projection of over 157 in.) pC 0 Signature O_ ❑ ®Wall beam pC LLJ O O mation with final pricing and delivery dates. ,;; Upon receipt of this order form, Corradi USA will review its contents and forward the order confir Corraldi USA Conrad OUTDOOR LIVING SPACE "kW r7 da'���, ;fig �b4by Pik; 04', .` :5 t,B, s .' kI Mb'em y ""hrqvv&,too, � p l41 � N ! f,% rN;0 z s r w 4a vaS . l , ate 5w PERGOTENDA°Collection 01- Per otenda® is the Corradi patented retractable covering system: innovative materials, cutting-edge technolo Y9Y gm and refined design to best enjoy every outdoor space and transform it into a welcoming harbor, even in the worst weather conditions. IN Pergotenda®is designed in Italy and produced by Corradi USA and can be installed for commercial or residential use. L 1 www.corradiusa.com 1 � r + WE • • • • • • • . �., _. ,.... i (��I I III ' � . 1 1 _ v�. 11 :♦ as 4 4 e14e} � 4 4 YY ! ea : f ll LIVN e wl •..+ jy} A www.corradiusa.com m ., . INV -. . Litt� � .� � •. �- ".. � ._.. low �r,,� orb " t'eT '� .�_ .� �� �■ t`��` -- TI 4114. b = 41 E u� a , dm r v pR— uuuu y a .. JA 141 a 3 „a yu a t h � r rvY y' Y � F f� PURCHASE AGREEMENT MORGAN.AWNING_COMPANY.---.. _ .._P.O.Date: January.. - -- __._10.Atlantic Avenue f` �w Woburn,Ma.01801 P.O.Number: ..,.. Phone:(781)569-6311 Fax:(781)569-6318 Color and No. www.morganawning.com Sold To: INSTALL: Company/CustomerP508-771-0883 ospitality Group Brick Address: uth Road Stucco City/State: a Zip/Postal Code: Wood Phone: 040x129 Asphalt Fax Other Contact Name: William Catania Details Work: L4 t i r R Apiw5, f� TERMS C.O.D. lug �14.._.... . .... . . ... . ..... .. ........................................ Labor 4 aluminum runners with post,aluminum wall beam,Eclissi fabric 1 $49,900.00 $49,900.00 ................................._......_........----......_.....__._._..............._..........._..................................................._..........................._......................................................................._._......................................................................................................................................:.............................................................. ..... and type 3 electric drive.with remote controls. `a o ......._..........._......_..................._.................__.....---..._.........._..._............-........._.._.........................-_..._..._.............._....................................._..............._................_........................................._...........................-.................._..................................................................................._................ . .�3...................................... ............... System includesprotective hood. Price includes 6 drop curtains,manual roll-up,and will be clear with white borders.The bar end will have a stationary curtain wall. — r ^ J Total Price $49,900.00 Sales Tax � .$2,495.00 Permit _..................._............................. ............_........_...._......_._...... Down Payment .........................-.........._.,._._:.:..._._........._._.._..._................_......_.................................... All Orders Subject to Acceptance of Balance $52,395.00 MORGAN AWNING,COMPANY Date. Salesperson: Y5 Date Authorized By: Company Official Date: Buyer: :PLEASE READ CONDITIONS OF CONTRACT ON BACK OF PAGE IRIDIUM OPTIONS d ` f.. o S c �. ®Ant�dnp`system m Add-on runner ®Add-on intermediate support tube Weldable pvc profile on the upper part of the canvas,for Iridium runner complete with pillar 2.4 x 4.7,stainless steel Complete intermediate support tube with stoppers,joints lateral rainwater prevention complete with antispray supports,sliders,support tube joints,central transmission. (where present)and intermediate sliders. tprofil&l idium preassembled on runners. shaft with bushings. k 1 . 5.9 0® 3.5 9.1 Retractable gutter '' EM Frontal beam ®Wall beam. Extruded aluminum profile connected to end support Finishing aluminum profile or for the application of Aluminum profile for uneven walls,where standard ' -tube-for rainwater collection,only for pitched versions. closures.Mandatory(additional cost)in order to fastening to supports is difficult;or to deal with minor � One drainage caPP er runner. strengthen the structure with a projection over 157 inches, bumps in the wall.- but not necessary in case frontal Ermetikas are applied. Rev.-04/2011 CORRADI-PRICE LIST 2011 35 1 I ,, JJ - i tf LL— i m I : /S t . e'•f 1• §A V �i ,�4 4 6 S t i t anti�` �` •. "`.. y r >' ZIA ..I• 4 tY: L• S 9 � _.-.r.--,. �A, ° k a-'....- - ... ._ � Y.�.'`...r^,^n.� •arm.. .aL+ v „r,.,,...`,..=v ...� ; �� ^ ^ t • F r 5 k ' F .;. S �. viassacnuscits- oeparimcnt of runic �atet) .9 Board of Building- Re!-ulations and Standards Construction Supervisor License License: CS 86626 — STANLEY KAZAMIAS 15 MEADOWOOD DR EXETER, NH 03833 Expiration: 10/2/2013 ('unmiissiuner Tr#: 6122 Y k e`- ea P &0t8hda° 'Sa ri il F rir I USA ab cs PrCo a ECLISSI° (98"') - �' ar„ -�i�fjlli�il i �� i•{t!i jai��'r�7` Yri� � - - y{ #'#,�i _ J ti4�1 ! llil. td�} tP If t%i r ii� � i f 4611 NIF,t a, �i'�� i �t17iqq t �% t 1,f=,•t2 yto,Y � .. ��llf,ril i7 t �I �I t} �,a &ii9 f IN7 S� l r�{ � - r) 1 a lti1�r3#r# 3 i ��1 �1 Of t t jj !Grey Ivory White 0308:0 ) 00923 00922 \\\ White also available in Eclisi Plus® 03280 DACRONO SAIL FABRIC III Ij {a fw 1 I�q{jjj#'jqv,jl ,fi�ili IM 41 q i% � E.!fr 1i;i I,lily I ��'{ I�i1lf,irirrr,,r fi 1+,, tjiq��rifjf�,jjlq� #f!}ki� }rtfi it F�t �r r r ,rhlir a F i, 4J N r ,,r�l I i I titlGirit!{I�� f 1iEi}rl�s - 'Burgundy Beige White goten a & sait"Fa...... br (71 Pergotenda® Fabrics Eblissi® - 5 year wa&9Rty y Available with folding and rollable systems Fabric width 98 inches 1 K •- Electric weldable ; a;= Waterproof Anti-transp ent ' , z Fabric v ei t 23bz�pe q.ya-. fq-�, ,2Self-ex&OM 9(clasis ) .. T ctk n s (we ire)27511.Y.per inch coon strength(w V2751b.per inch Ediipsi® Plus - 10 year warrant �- eAvallable with folding and rollable systems q 0 abric width 98 inches' t Elec 'C weldable - l Watell i r n •, ; F�f3ricl�, ht 23oEa per sq.ya. Self-extinguishing(class 2) _1 Traction strength(weave)2751b.per inch Traction strength(weft)2751b.per inch Sail Awning Fabrics Dacron", - 2 year warranty Available only with rollable systems Fabric width 55 inches Fabric weight 11 oz. per sq.yd. 100%polyester Anti-UV finishing CORRADI USA T 800 882 8393 F 800 778 7329 1 E info@corradiusa.com W www.corradiusa.com Town of Barnstable Geographic Information System April 11,2013 4 'g, vON x i\« '� �� "4', 273082 a � sv � #1165� CV amtp k OR' v� .Y v v v3 `� IN ' i � �L 273023y r #1225 3 24 WIN Vg t� v �.,N , r, , 273125 0949 � e 273090 273122 273126 =0 7 Feet#1140 #° DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:273 Parcel:023 Selected Parcel F boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:HEARTH'N KETTLE PROPERTIES Total Assessed Value:$15303000 1`100'may not meet established map accuracy standards. The parcel lines on this map are only graphic representations of Assessors tax parcels. They are not true property Co-Owner: Acreage:12.54 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:1225 IYANNOUGH ROAD/RTE132 such as building locations. BUffer " ''� e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION CIL Map-2-7 3 Parcel Applicatio,�"114 Health Division- Date Issued 1 Conservation Division '� Application Fee Planning Dept: Permit Fee (o 60 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address /Z- 7 5— --_Y 4.,. o✓y � De� Village AZIV „ .1 Owner Address Telephone_ Permit Request Ac CAi o / AfC_/�-�-�+Et C6CI .. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District 11g 4'P Flood Plain Groundwater Overlay --f Project Valuation �Z/o el o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting do�umeri'Iation. Uri Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) _ Age of Existing Structure � ZO V��s Historic House: ❑Yes ❑ No On Old King's Highway: g Yeses❑ 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 A- Proposed Use APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name Telephone Number 9- -3-L ? " 7/ Z,_ Address 3 ei" 6 G��s �cr,/� 61 License #_ �/�31�7� 7 ,�Ajled �r. w� o 2-37 5 Home Improvement Contractor# ✓��/ Worker's Compensation # GCC.5 8 7 YM ALgL� CONSTRUCTION DEBRIS RESULTING FROM rT�HIQS PROJECT WILL BE�TJAKEN TO i1/�L✓ L���� �C.s • J O �/��.i+sl'CTry A/i SIGNATURE DATE .3 z/Z Y FOR OFFICIAL USE ONLY ' APPLICATION# OATE'ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION <; FIREPLACE ELECTRICAL: ROUGH FINAL C PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations " 600Washington Street Boston;MA 0211.1 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): coi»r+e!c�^� / �G,s f�✓G�`0^ T^ ¢— Address: 38 9 r C. City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). i 2.0 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' y p ty. 9. ❑Building addition [No workers' comp. insurance comp.insurance.$ required.] 5. ❑ We are a corporation and its l0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. / / Insurance Company Name: !/% 4 df , a-s ::2� Policy#or Self ins.Lic.#: G-- CG -5-00 VS-0 /Z 013 Expiration Date: Job Site Address: City/State/Zip: //y 4 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section.25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u4der th pains and penalties of perjury that the information provided above is true and correct. Si ature: X� Date: Phone#: ,-Or e .3 2-�1 7/ZS� 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#: r I , L- CERTIFICATE OF LIABILITY INSURANCE D/21/ATE IDD13 �� 3/21/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Laura Wiesner NAME: Morse Insurance Agency, Inc. PHONE (508)238-0056 FAX (508)230-8367 285 Washington Street pOpRR :laurawiesner@morseins.com ` INSURERS AFFORDING COVERAGE NAIC# North Easton MA 02356 INSURER A Nautilus Insurance INSURED INSURER B Arbella Indemnity 10017 East Coast Commercial Construction Inc. INSURER CEvanston Insurance Co. 389 West Center Street INSURER 0 Associated Employers Ins. Unit G - INSURER E: West Bridgewater MA 02379 INSURERF: COVERAGES CERTIFICATE NUMBER:2013-2014 Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCEADDLSUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MWDD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES Ea occurrence $ 100,000 A CLAIMS-MADE OCCUR 313.91 /24/2013 /24/2014 MED EXP(Any one person) $ -5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE - $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMRIOP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY Ee COMBINED SINGLE(LIMIT $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED OW X SCHEDULED 1020014594 /24/2013 /24/2014 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident Underinsured motons BI split $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ - ONJ339113 /24/2013 /24/2014 $ D WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) CC500B945012013 /24/2013 /24/2014 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below F E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Laura Wiesner/SAM I +2--+'�� W--O_ ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r9m1nnsl ni The Arnon nomc nnel Innn oro roniefororl mor4e of Ar'non The Commonwealth of Massachusetts William Francis Galvin -... Page 1 of 3 The Commonwealth of Massachusetts William Francis Galvin a Secretary of the Commonwealth, Corporations . Division One Ashburton Place, 17th floor Boston, MA 021.08-1512 Telephone: (617) 727-9640 EAST COAST COMMERCIAL CONSTRUCTION, INC. 0 Summary Screen Help with this form ReGu 11- 1 I ernfic'afe' k The exact name of the Domestic Profit Corporation: EAST COAST COMMERCIAL CONSTRUCTION, INC. The name was changed from: EAST COAST PROPERTIES INC. on 3/7/2002 11:58:56 AM Entity Type: Domestic Profit Corporation Identification Number: 042912469 Old Federal Employer Identification Number (Old FEIN): 000230424 - Date of Organization in Massachusetts: Nov 26 1985 Current Fiscal Month / Day: 12 / 31 Previous Fiscal Month / Day: 09 / 31 The location of its principal office: No. and Street: -, 389-G WEST CENTER ST. City or Town: WEST BRIDGEWATER State: MA Zip: 02379 Country: USA If the business entity is organized wholly to do business outside Massachusetts, the location of that office: No. and Street: City or Town: State: Zip: Country: Name and address of the Registered Agent: Name: JOHN T. WILSON No. and Street: 389-G WEST CENTER STREET City or Town: WEST BRIDGEWATER State: MA Zip: 02379 Country: USA The officers and all of the directors of the corporation: http://corp.sec.state.ma.us%corp/corpsearch/CorpSearchSummary.... 3/22/2013 The Commonwealth of Massachusetts William Francis Galvin -... Page 2 of 3 Title Individual Name Address (no PO Box) Expiration First, Middle, Last, Address, City,or Town, State, Zip of Term Suffix Code PRESIDENT JOHN T. WILSON 389-G WEST CENTER ST W BRIDGEWATER, MA 02379 USA TREASURER JOHN T. WILSON 389-G WEST CENTER ST W BRIDGEWATER, MA 02379 USA SECRETARY JOHN T. WILSON 389-G WEST CENTER ST W BRIDGEWATER, MA 02379 USA CLERK JOHN T. WILSON 389-G WEST CENTER ST W BRIDGEWATER, MA 02379 USA DIRECTOR JOHN T. WILSON 389-G WEST CENTER ST W BRIDGEWATER, MA 02379 USA business entity stock is publicly traded: — The total number of shares and par value, if any, of each class of stock which the business entity is authorized to issue: Par Value Per Total Authorized by Articles Total Issued Class of Stock Share of Organization or and Outstanding Enter 0 if no Par Amendments Num of Shares Num.of Shares Total Par Value CNP $0.00000 1,000 $0.00 1,000 Consent Manufacturer — Confidential' _ Does Not Require Data Annual Report — _ Resident Partnership Agent For Profit Merger Allowed - - http:Hcorp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.... 3/22/2013 The Commonwealth of Massachusetts William Francis Galvin -... Page 3 of 3 Note: There is additional information located in the cardfile that is not available on the system. Select a type of filing from below to view this business entity filings: i ALL FILINGS Administrative Dissolution Annual Report Application For Revival Articles of Amendment ;TV View;Filings � wy �NewSe `archw � Comments ©2001 - 2013 Commonwealth of Massachusetts All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.... 3/22/2013 . \ \Massachusetts- D atkelp Public Safet v. \ . - Board a Building kclaan andStandards . . . yCon/u t nSupervisor Lee s . � �. . . . . . . 'License- CS� .�7 . , >» OHNƒ ILA6 2 © . . . � _ �� r 2389 WET (�� T/« 2 \ } © \Wamb¢(WA{RA02p9f\ . z `y/. �® Aaton: /. fr#::6 \ 2 rar NvldA �a )RIOM d0 v3Hd m. A!� A,,-jA ��r/ice/ri��/���/��ri��/i�r/i/i/i// � -------------------r � m 30�Namrriri//rr//// /r/rrirrir rir r/r /, rr r/ /r rrrr i/r it ri/ /r////i//i/ire/rr�rr / r )rj3a aOla3tx3 Vd5 8 j.uos3u,d3400o 3dVJ ,.. ZZ m.■ j/j j/�%//�j/fir 15 • ami�if4a✓V , iwa�auuwaJg mwaaw 59 amp auk •Iwn^OG}�ya� J`O►✓S�'1� LOS a LEGEND DT COVEFAGP P""S' MAX"". SED ON S K"URES 2 21% 3C. It.,—1 A-- f \ Ra �--- A FOR PAACEL 23 111—AC.) I—t,&pAWING — XAXR — XtX 71 0 EASED MCA PARCEL 23 (12, AC D2 MAN— 17 C`- ,A, .1 R NOTE PLO 2 I.BUILDING NUMBER:1225 A A ASSESSOR'S NUMBER:273-023 3:ZONING DISTRICT:B.HB&CP LOCUS MAP A FLOOD HAZARDZONES:C BENCHMARK: AS SHOWN a .1 iO WALE 0,TOPOGRAPHIC INFORMATION BASED ON AN \—nwa. PARCEL 2-1 ON THE CR NO INSTRUMENT SURVEY ACRES Z.ELEVATIONS SHOWN ARE BASED ON THE NATIONAL I 8 REFERENCE: VERTICAL DATUM L. LAND COURT PLAN 31689-A PLAN BOOK 576 PACE 40 PLAN B 5 Oc BOON 54:PACE 31 9.LOTS ARE LOC ATED TED WIHIN THE GROUND WATER vqPROTECTION OVERLAY DISTRICT \' / 'V. Y� \ � O -31 Ak w! 0 lil NoT'C k, IS DATE DESCRIPTION Drawn necked ............ R E V 1 5 1 0 N S o PLAN OF EXISTING CONDITIONS EPARED FOR CAPE CODDER RESORT & SPA FOR#1225 IYANNOUGH ROAD I CERTIFY THAT THE BUILDING IS zi N LOCATE IN FLOOD PLAIN ZONE C AS HYANNIS BARNSTABLE MA SHOWN CN FLOOD INSURANCE RATE MAP PARCEL 122 COMMUNITY PANEL NO.250001 OW M S C 24, .S.F. SCALE:i'-V I DATE:JUNE 25,2007 AND THAT FLOOD PLAIN ZONE C IS NOT I CERTIFY THAT THE BUILDING IS holmes cnd I'1 cqrolh. inc. A SPECIAL FLOOD HAZARD AREA, LOCATED ON THE LOT AS SHOM, GRAPHIC SCALE k INI "m Im I "Id lul-y-11 .0 ZI 0 1 12. qIf?or*d­st,C' 08)541 1161�IH.0'11' 362 ..1 08)54 folm 4 0 DRAWN: PF ICHECKED:—DATE REGISTERED PROFESSIONAL REGISTERED PROFESSIONAL LAND SURVEYOR LAND SURVEYOR )t,. JOB NO: 207118 _IDWG. NO.:87-3-15 SHEET i March 21,2013 Town of Barnstable Hyannis MA 02601 To Whom It May Concern: This letter serves as authorization fbuMr. John Wilson of East Coast Commercial Construction Company to obtain a construction permit to perform deck repairs on an existing deck at.the Cape.Codder Resort& Spa: Thank you; William V. Catania President Catania Hospitality Group 141 Falmouth Road Hyannis, MA 02601 508-771-0040 Route 132&Bearse's Way, 1225 Iyannough Road 4 Hyannis,Massachusetts 02601 (888) 297.22000 Fax: (508) 771.65644 www.CapeCodderResort.com i s.. \v �. \�\�a � �a g $ '� i' ¢•��w�� � �� �. �; a a':� '•,day$ Z�. a VY „"' {°�,A,..-,,,.� ,,,vim,�� •\�,. L4fF• � � 6\`Fxu � \1 \l a E� � 3 1S gggq ,, tP �.a S .'''> ,\. \ ::".,.� � s. .�� u�2a � •o.•,u"` w.,„� � .... � d�&u:.; dE� ��F..._ � P s f >9 za a 7 ..s_.sxx .. `�.;':. � s �,:.' ... ....E a ..:. � •. 4 k ,,, �£,�, ,. :, gym.., ,.. ... _a e�. ., ,..,. ,✓a � ,...". ,;:. 3 ..�1 yam,. qM.' a" r c• �