Loading...
HomeMy WebLinkAbout0220 LONGVIEW DRIVE ago Go�u� View � �, - - - -- - - - _ � � �-o:5 r Town of Barnstable *Permit# y p� Expires 6 months fro x issue date Regulatory Services Fee • RAMWABL% Thomas F.Geer,Director _^ - i63q. il � Dit U Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax' 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY / yl Q Not Valid without Red X-Press Imprint Map/parcel Number 0 U Property Address q n n"S PResideritial Value of Worksn Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance X'P MESS Check one: I am a sole proprietor AUG.2 2 2012 I am the Homeowner I have Worker's Compensation.Insurance Insurance Company Name TOWN OF BARNSTABLE Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit R qu st(check box) YY Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to La-!I 7�7 �l ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof] 17 Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. i *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. c y f Home provement Contractors License&Construction Supervisors License is re I SIGNATURE: Q:\WPFILES\FORMS\build g permit forms\EXPRESS. oc Revised 053012 the Commonwalth of Massachusetts D4wrtment of Indushial Accidents Off we o,f Investigations 600 Washington,Street Boston,MA 02111 nmrmgmlrlia Workers'.Compensation Insmmiace Affidavits Builders/Cont ractors/Flectric ans/Plumbers Applicant Information Please Print L,embly Name Musmess D tioallndieidnal}_ ` 1� Address: "114�102 ) City/ tateL : Ane# `GB2,,6—o-70 Are you an employer?Cl eck the appropriate bow T of project 4. � ectp ] (required): 1.❑ I am a employer with ❑ I am � contractor and I 6- ❑New construction employees(full andlor part-time):* have hued the sub-contractors 2-❑ I am a sole proptie-tcw or partner listed on the attached sheet. 7- ❑Remodeling ship and have no employees: These sub-contractors have 8_ ❑Demolition o. and have wormers' watlring for nee in any capacity employees 1 9. ❑.Budding addition [No worloers'comp.insunume camp.msueanm required.] .5_ ❑ We are a corporation and its: 10.❑Electrical repairs or additions 3. I am a homer unu doing all:work officers have egemsed thm 11.❑Plumbing repairs or additions myself: [No workers'comp- right of exemption per MGL 12.❑Roof repairs insurance required_]I c.152, §1(4),and we have no employees [No workers' 13.0 Other camp:insurance required.] 'Any applicaQC Beat checks Loa#1 mast also fill out the section below showing their wodere campmsatiaa.polic9 infer w&IL Hameaanbers who submit this affidavit iDdl z=Z they are doing all wok and dim hue outside co®=mjs must submit a new affidavit m&catmg mcIL ICoatractos that cheat thisbo x must ettarhe d an additinaal sheet showing the name of'the m0o-r�s sad state whets ornat those entities ham employees. If the.sub<ontractots have employees,they must provide tteeir worlkere romp.policy number. lain an employer that is providing"vrkers'compensizfion.iumrance for pry emptnyee& Below is the policy and job sate information. Insurance Company Name:. Policy#or Self-ins.Lie.4:: Expiration Date: Job Site Address: City/State/Zip- Attach s copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A.ofMGL,c. 152 can lead to the imposition of criatinal 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$250.00 a day against the violat . Be advised that a copy of this statement may be forwarded to the Office of Investigations of DIA for insurance coverage verification:. Ida hereby card ar t$ aloes of perjury that Me infotmafion:pravided above is.bue and correct Si true: Date: O �/ Phone#: � .O b Official use only. Do not write in this area,to be completed by city or town offl"I City or Town: PermitfUcense-9 Issuing Authority(circle one). 1.Board of Health 2.BuMmg Department 3.C2ityffown Clerk d.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 A �IK Town of Barnstable Regulatory Services a s 9KAM '�,' Thomas F.Geiler,Director q'ArEo;o.,& Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: c./ JOB LOCATION: ILMJ V I �Iv V —+ Tmber street village HOMEOWNER 0�n ­1, 17 9 name Q home phone# work phone# CURRENT MAILING ADDRESS:TO bo� r city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersign "home o er certifies that he/she understands the Town of Barnstable Building Department minimum inspection proce equ a nts d that he/she will comply with said procedures and requirements. � 1 ' Si re of Homeowner ti 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"supervsor.i " . Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons..In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in . your community. Q:\WPFILES\FORMS\building pen-nit forms\EXPRESS.doc Revised 051811 snxrrsrwar�. Town of Barnstable �AjED MA't a Regulatory Services Thomas F. Geiler,Director Building:Division_ Thomas Perry,CB0 Building Commj�sioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us \508-862-40-38 Fax: 508-790-6230 Property Owner Must . mplete and Sign This Section If Using A Builder I, , as Owner of the subjec roperty hereb v authorize o act on my behalf, in all matters relative to work authorized by s uilding pe t application for: Ite (A ess of ) SigZayLre of Owner Dat \vq P/sil. Ifer is applying for permit, please complete the Homeowners License Exempti Form on the . re QAWPHLESTORMSUilding permit formsTYPRESS.doc Revised 051811 DURABLE POWER OF ATTORNEY AND NOMINATION-OF FIDUCIARY I,JOIW S.DALY,of 240 Longview Drive, Barnstable, (Centerville),Massachusetts, appoint my son,KELLEN K.DALY,presently of 40 Brewster Road,Mashpee, Massachusetts, as my true and lawful Attorney-in-Fact(hereinafter "Attorney") to conduct all my affairs, with full r power and authority to act in my name and on my behalf as fully as I could do if personally present. If my said son, KELLEN K.DALY,resigns or fails or ceases to serve as my Attorney I hereby appoint my daughter, KATELYN F. GINNETTY,presently of 9 Artisan Way, Sandwich.(Forestdale), Massachusetts to be my true and lawful Attorney as successor and she will have all powers and duties as set forth herein. Should KELLEN K.DALY be unable or unwilling to serve, a written affidavit signed by KATELYN.F. GMNETTY under oath, declaring that she is accepting the duties as my Attorney, and further declaring that KELLEN K.DALY,is not serving and'stating the reasons for his inability to serve will be conclusive evidence of her authority to serve as my Attorney under the terms hereof. IMMEDIATE POWERS. I intend that this Power of Attorney shall not be'affected by disability or incapacity occurring subsequent to the execution hereof,and all authority conferred hereby shall continue notwithstanding any subsequent disability or incapacity. I give my lawful Attorney full power and authority to exercise or perform any act, power, duty, right or obligation whatsoever that I now have or may hereinafter acquire in connection with, arising from,or,relating to any person, matter, item, transaction, business or property,real or personal,tangible or intangible, now owned or hereafter acquired by me, including, without limitation,the following specifically enumerated powers. I grant to my Attorney full power and authority.to do everything necessary in exercising any of the powers herein granted as fully as I might or could do if personally present,hereby ratifying and confirming all that my Attorney shall lawfully do or cause to be done by virtue of this Power of Attorney and the powers herein granted. Without limiting the generality of my Attorney's powers, I specifically authorize my attorney to do the following: DURABLE POWER OF ATTORNEY FO OHN S.DALY Page 1 of 14 (1) GENERAL GRANT OF POWER. To exercise, do, or perform any act, right,power, duty, or obligation whatsoever that I now have or may acquire the legal right,power or capacity to exercise, do, or perform in connection with, arising out of, or relating to any person, item, thing, transaction,business or nonbusiness property (real or personal, tangible or intangible), or matter whatsoever. In general, to do all other acts, deeds, matters, and things whatsoever in or about my estate, property, and affairs, or to concur with persons jointly interested with myself therein in doing all acts, deeds, matters, and things herein, either particularly or generally described, as fully and effectually to all intents and purposes as I could do in my own person if personally present and competent. By way of illustration, and not by way of limitation, such authority shall include the power to effectively disclaim, in whole or in part, any gift or any property receivable from a decedent by reason of an insurance contract, a will, or inheritance. (2) POWERS OF COLLECTION. To ask, demand, sue for,recover, collect, receive, and hold and possess all sums of money, debts,dues, goods, wares, merchandise, chattels, effects,bonds, notes, checks, drafts, accounts, deposits, safe deposit boxes,legacies, bequests, devises, interests, dividends, stock certificates,certificates of deposit, annuities, pension and retirement benefits, stock bonus plan and profit-sharing.plan benefits, stock options, insurance benefits and proceeds, documents of title, chooses in action,personal and real property,tangible and intangible property, and property rights and demands whatsoever, liquidated or unliquidated, and things of whatsoever nature or description which are now or hereafter shall be or become due, owing,payable or belonging to me in or by any right, title, ways, or means howsoever, and upon receipt thereof or of any part thereof to make, sign,execute, and deliver such receipts,releases or other discharges for the same as my attorney shall think fit or be advised. By way of illustration, and not by way of limitation,my attorney shall be empowered to enter and to make withdrawal,.either in whole or in part, from any safe deposit box. DURABLE POWER OF ATTORNEY FOR JOHN S.DALY Page 2 of 14 (3) POWERS OF LITIGATION. To commence,prosecute,discontinue,or defend all actions or other legal proceedings in any way affecting my estate or any part thereof or affecting any matter in which I or my estate may be in any way concerned; and to have, sue, and take all lawful ways and means and legal and equitable remedies, procedures, and writs in my name for the collection or recovery of any item or matter in which I have or may acquire an interest, and to compromise, settle, and agree for the same, and to make, execute, and deliver for me and in my name all endorsements, acquittances, releases, receipts, or other sufficient discharge for the same. (4) POWER TO ACQUIRE AND DISPOSE OF. To lease, purchase, exchange, and acquire, and to bargain, contract, and agree for the lease, purchase, and exchange and acquisition of, and to take, receive, and possess any real property, including my real property located at 240 Longview Drive, Centerville, MA, or personal property whatsoever, tangible or intangible, or any interest therein, on such terms and conditions and under such covenants as my attorney shall deem proper. (5) MANAGEMENT POWERS. To enter into and upon all of my real property, including my real property located at 240 Longview Drive, Centerville, MA, and to let,manage, and improve the same or any part thereof, and to repair or otherwise improve or alter, and to insure any buildings or structures thereon. (6) POWER TO SELL. To sell,either at public or private sale, or exchange any part or parts of my real estate, including my real property located at 240 Longview Drive, Centerville, MA or personal property for such consideration and upon such terms as my attorney shall think fit, and to execute and deliver good and sufficient deeds or other instruments for the conveyance or transfer of the same, with such covenants of warranty or otherwise as my attorney shall see fit, and to give receipts for all or any part of the purchase price or other consideration. DURABLE POWER OF ATTORNEY FOR JOHN S.DALY Page 3 of 14 (7) POWER TO TRANSACT BUSINESS. To engage in and actively transact any and all lawful business of whatever nature or kind for me and in my name; to conduct or participate in any lawful business in my name; execute partnership agreements and amendments thereto; incorporate, reorganize, merge,recapitalize, sell, liquidate, or dissolve any business; enter into and carry out the provisions of any agreement for the sale of any business interest, whether partnership,joint venture or otherwise, or the stock therein, upon such terms and conditions, including the making of such representations, warranties and indemnities, as my attorney shall deem proper. (8) POWER TO EXECUTE AND TRANSACT. To sign, endorse, execute, acknowledge, deliver, receive, and possess such applications, contracts, agreements, options, covenants, deeds, conveyances, trust deeds, security agreements,bills of sale, leases, mortgages, assignments, insurance policies,bills of lading, warehouse receipts, documents of title,bills, bonds, debentures,checks, drafts, bills of exchange, notes, stock certificates, proxies, warrants, commercial paper, receipts, withdrawal receipts, and deposit instruments relating to accounts or deposits therein, or certificates of deposit of banks, savings and loan, or other institutions or associations,proofs of loss, evidence of debts, releases, and satisfaction of mortgages,judgments, liens, security agreements, and other debts and obligations, and other instruments in writing of whatever kind and nature as may be necessary or proper in the exercise of the rights and powers herein granted. By way of illustration, and not by way of limitation, my attorney shall be empowered to exercise any and all rights to ownership of insurance policies upon the life of any person or persons (other than any policies on the life of my attorney in fact), annuities, pension and retirement benefits, stock bonus plan and profit-sharing plan benefits, and stock options, including specifically the right to change the beneficiary,thereon to any person [other than my said attorney]. (9) POWER TO TRANSFER PROPERTY TO A TRUST. To assign and convey all or any part of my assets, of whatever kind and wheresoever located and whensoever located(consisting of any property, real (including my real property located at 240 DURABLE POWER OF ATTORNEY FOR JOHN S.DALY Page 4 of 14 Longview Drive, Centerville, MA),personal, or mixed, tangible or intangible,of whatsoever kind and wheresoever located and whensoever acquired) into such trust or trusts created by me of which I am,an income beneficiary or any nominee of such trust as my attorney in fact shall deem proper irrespective of whether said trust is now in existence or hereinafter established.. (10) BANKING POWERS. To deposit any monies which may come to my attorney as such attorney with any bank or banker or other person, either in my or my attorney's own name, and to employ or expend as my attorney shall think fit any of such money or any other money to which I am entitled which now is or shall be so deposited; to withdraw, in the payment of any debts or interest payable by me, or taxes, assessments, insurance, or expenses due and payable, or to become due and payable, on account of my real and personal estate, or in or about any of the purposes herein mentioned or otherwise for my use and benefit, or to invest in my attorney's own name or any nominee in any stocks, shares,bonds, securities, or other property, real or personal, as my attorney may think proper, and to receive and give receipts for any income or dividend arising from such investments, and to vary or dispose of such investments.. (11) POWER TO BORROW. To borrow any sum or sums of money on such terms and with such security, whether real, including my real property located at 240 Longview Drive, Centerville, MA or personal property, as my attorney may think fit, and for that purpose to execute all promissory notes,bonds, mortgages, deeds of trust, security. agreements, or other instruments that may be necessary or proper. (12) EMPLOYMENT OF AGENTS. To engage, employ, compensate, and dismiss any agents, clerks, servants, attorneys at law, accountants, investment counsel, custodians, or other persons as my attorney shall think fit in the performance of the powers granted my attorney herein. This authority shall include employment of firms and companies in which my attorney owns an equity interest or in which my attorney otherwise has a pecuniary interest.. i DURABLE POWER OF ATTORNEY FOR JOHN S.DALY Page 5 of 14 (13) POWER TO VOTE. To vote at the meetings of stockholders or other meetings of any corporation or company, or otherwise to act as my attorney or proxy in respect of any stocks, shares or other instruments now or hereafter held by me therein, and for that purpose to execute any proxies or other instruments. (14) POWER TO ACT.To exercise any powers and any duties vested in me, whether solely or jointly, with any other or others as executor, administrator, or trustee, or in any other fiduciary capacity, so far as such power or duty is capable of validly being delegated. (15) POWER TO MAKE GIFTS. To make gifts and to institute gift programs to such activities and persons as my attorney shall deem appropriate. To make gifts or grants of a present interest from my property and transfers or convey any of my assets on my behalf(including the forgiveness of indebtedness and the completion of any charitable pledges I may have made) to my spouse if living, or to any one or more of my children or grandchildren, provided that If a gift is made to one of my children or grandchildren, a substantially equal gift shall be made concurrently to my other children and/or grandchildren; to make gifts to charitable institutions to whom I would normally consider making such gifts, transfers or conveyances taking into account the desirability of the reduction or elimination of my federal and/or state income taxes or estate and inheritance taxes on my estate or for any other estate planning purpose and that no such gifts will be made in such amounts,to any one person in any one year as will exceed the annual exclusion for federal gift tax purposes. These gifts may be made in such manner as my Attorney-in-Fact deems appropriate, including outright gifts, gifts in trust, and gifts to custodians under a uniform transfers to minors act. It shall not be deemed to be self-dealing on the part of my Attorney named herein to make gifts, transfers or dispositions to or for himself, herself or to my children or grandchildren because,my. children, and grandchildren are the objects of my bounty in harmony with my estate plan. i DURABLE POWER OF ATTORNEY FOR JOHN S.DALY Page 6 of 14 (16) GOVERNMENTAL ENTITLEMENT POWERS. To deal with any and all state or federal agencies from whom I receive or am entitled to receive governmental benefits. of any description or amount in order to: (i) prepare and file all documents required by such agencies; (ii) apply for the receipt or continuation of any public assistance benefits to.which I am now or hereafter may be entitled, including without limitation, Medicare, Medicaid, SSI, SSDI,unemployment workers compensation,,and Social Security;(iii) apply to the Social Security Administration to become representative payee of my Social Security benefit payments, and to then act as my representative payee in accordance with applicable law; (iv) modify the amounts or terms of such entitlements; (v) assert my rights against any curtailment or termination of benefits; (vi) appeal or compromise any disputed claim; and(vii) effect a termination thereof. (17) POWER TO DISCLAIM. To disclaim any interest otherwise passing to me by intervivos, testate or intestate transfer. (18) POWER TO EXERCISE RIGHTS UNDER RETIREMENT ACCOUNTS. With respect to retirement accounts in which I may have an interest, to exercise any option, or to roll over the proceeds of a lump sum distribution into an individual retirement account or into another qualified pension or profit sharing plan. (19) TAX POWERS. To prepare, sign and file joint or separate income tax returns or declarations of estimated tax;to prepare, sign and file gift tax returns with respect to gifts made by.me; to pay any such income or gift tax as may be due and to contest and settle in compromise the levy or assessment of any such tax; to consent to any gift and to utilize any gift-splitting provisions or other tax election; and to prepare, sign and file any claims for,refund of any tax. (20) SAFE DEPOSIT BOXES. To have access at any time or times to,any safe deposit box to which I have access,wherever located, and to remove all or any part of the contents thereof and to surrender or relin ish any safe deposit box or the access thereto, and . S . DURABLE POWER OF ATTORNE OR JOHN S.DALY Page 7 of 14 any institution in which any such safe deposit box may be located shall not incur any liability to me or my estate as a result of permitting my attorney to exercise this power. (21) CONSTRUCTION. This instrument is to be construed and interpreted as.a general durable power of attorney.The enumeration of specific items, acts,rights, or powers i herein does not limit or restrict, and it is not to be construed or interpreted as limiting or restricting, the general powers herein granted to my attorney. (22) REVOCATION. This general durable power of attorney revokes any previous powers of attorney granted by me. This general durable power of attorney may be voluntarily revoked only by me at any time by my written revocation entered of record in the Registry of Deeds of Barnstable County, Massachusetts. (23) NO BOND REQUIRED. No attorney in fact, shall be obligated to furnish bond or other security. Should a guardian or conservator be appointed on my behalf, my attorney in fact is authorized to waive any bond for such fiduciary and any sureties on it. . (24) COMPENSATION. My attorney in fact, and any successors serving hereunder, shall be entitled to reasonable compensation for services rendered. (25) LIMITATIONS. Any authority granted to my attorney in fact herein shall be limited so as t prevent o p en this power of attorney from causing my attorney to be taxed on my income (unless my attorney in fact is my spouse) or from causing.my assets to be subject to a general power of appointment by my attorney in fact, as that term is defined in Section 2041 of the Internal Revenue Code (or any successor provision). DURA13LE POWER OF ATTORNEY FOR JOHN S.DALY Page 8 of 14 (26) CONFIRMATION OF ATTORNEY'S ACTS. I hereby ratify and confirm all that my attorney in fact or any successor attorney in fact shall lawfully do or cause to be cone by virtue of this general power of attorney and the rights and powers granted herein. (27) THIRD-PARTY RELIANCE. Third parties may rely upon the representations of my attorney as to all matters pertaining to any power granted to my attorney, and no person who may act in reliance upon the representation of my attorney or the authority granted to my attorney shall incur any liability to me or my estate as a result of permitting my attorney to exercise any power. (28) INDEMNIFICATION OF ACTS OR ATTORNEY WHILE CARRYING OUT AUTHORITY. I hereby.bind myself, my heirs, devisees, and personal representatives to indemnify my attorney in fact and any successor attorney in fact who shall so act against any and all claims, demands, losses, damages, actions, and causes of action, including expenses, costs, and reasonable attorneys'fees that my attorney at any time may sustain or incur in connection with carrying out the authority granted in this general power of attorney. - (29) INDEMNIFICATION OF ACTS OF ATTORNEY WITHOUT KNOWLEDGE OF DEATH OR REVOCATION OF POWER. My death shall not revoke or terminate this agency as to my attorney in fact or any successor attorney in fact who, without actual knowledge of my death, acts in good faith under.this general power of attorney. Any action so taken unless otherwise invalid or unenforceable, shall be binding upon me and my heirs, devisees;and personal representatives. An affidavit, executed by my attorney in fact or any successor attorney in fact stating that he does not have, at the time of doing an act pursuant to this general power of attorney, actual knowledge of the revocation or termination of this general power of attorney,is, in the absence of fraud, conclusive proof of the nonrevocation or nontermination of the power at that time.. DURABLE POWER OF ATTORNEY FOR JOHN S.DALY Page 9 of 14 (30) HIPPA. (a)My attorney in fact is to be my personal representative and shall be treated as I would be with respect to my rights regarding the use and disclosure of my individually identifiable health information (including, without limitation, my medical records) needed to determine which of my medical bills have been paid or are payable by me and which need not be paid by me: This release authority applies to any information governed by the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and regulations promulgated thereunder. I authorize my health care professional or health care provider, insurance company, the Medical Information Bureau, Inc. or any health-care clearinghouse, to give, disclose and release to my attorney in fact all my individually identifiable health information and medical records regarding any past,present or future medical or mental health condition necessary to enable my attorney in fact to determine if my medical bills have been paid properly or should be paid by me. The authority given in this paragraph shall supercede any prior agreement that I may have made with my health-care providers to restrict access to or disclosure. The authority I have given in this paragraph has no expiration date and shall expire only in the event I revoke the authority in writing and deliver it to my health-care provider. I.understand that information disclosed pursuant to this authorization may be subject to nondisclosure by the recipient and no longer be protected by the HIPAA Privacy Regulation,just as if the information was disclosed to me. Anyone acting in reliance on this power of attorney may also rely on a notarized affidavit of the successor attorney in fact that my first named attorney in fact has resigned, died or become disabled, and need not determine such fact for himself. The successor attorney in fact shall have full power and discretion to determine the resignation, death or disability of my first named attorney in fact. The successor attorney in fact shall not be liable for any good faith determination of the incapacity of my first named attorney in fact. (31) HEALTH CARE DECISIONS. To authorize my admission to a medical, nursing, residential or similar facility, to enter into agreements for my care, to apply for medical insurance coverage, third- arty payments, or governmental benefits to pay for my care. DURABLE POWER OF ATTORNEY FOR J HN S.DALY Page 10 of 14 3 2 FUNERAL PLANS. To enter contracts form funeral, burial,or cremation and to pay ( ) y in advance for such funeral arrangements; to establish a bank account designated as a funeral account for purposes of my funeral arrangements. (33) NOMINATION OF GUARDIAN/CONSERVATOR. If Protective Proceedings for my person or estate are ever commenced in any court, I hereby nominate, whenever necessary,my true and lawful Attorney in fact, KELLEN K.DALY,to be and become the conservator of my estate and guardian of my person all as the case may be. If, KELLEN K.DALY is unwilling or unable to serve hereunder, then I hereby nominate, whenever necessary, KATELYN F. GINNETTY to be and become the conservator of my estate and guardian of my person all as the case may be. I direct that any fiduciary nominated hereunder shall be exempt from furnishing any surety on her or his bond except as may be required by any court of competent jurisdiction. (34) INTERPRETATION AND GOVERNING LAW. This instrument is to be construed and interpreted as a General Durable Power of Attorney pursuant to M.G.L.A. 190B §5 Part 5 any amendments thereunder. The enumeration of specific powers herein is not intended to, nor does it, limit or restrict the general powers herein granted to my attomey(s). This instrument is executed and.delivered in the Commonwealth of Massachusetts, and the laws of the Commonwealth of Massachusetts shall govern all questions.as to the validity of this power and the construction of its provisions. (35) AUTHORITY TO FILE BANKRUPTCY. To file for any chapter of Bankruptcy available to me under Federal Law; whether to file as next friend or to file by signing my name indicating it was signed by the attorney-in-fact acting on my behalf and submitting a copy of the power of attorney with the filings; or in any other manner permitted by law; to employ counsel to represent me in such filings; to select any and all exemptions available to me;to determine which if any debts to re-affirm; and to make any and all decisions regarding any plan or re-payment/re-organization, if DURABLE POWER OF ATTORNEY FOR JOH S.DALY Page 11 of 14 applicable; to discuss my affairs, and/or employ any debt re-counseling service; to discuss my affairs with a credit counseling service and a debtor education service. (36) ATTORNEY-IN-FACT DISCLOSURE. Any Attorney appointed hereunder may request of any other duly appointed Attorney;information and accountings of his or her acts or actions as such fiduciary, to be supplied in writing or orally, as the parties may agree. Provided however, my said spouse, acting as my Attorney hereunder, shall not be required to comply with any such disclosure request, and any actions undertaken by my said spouse as Attorney hereunder shall be conclusively presumed to be appropriate and performed with my full approval. (37), SIGNATURE OF A SINGLE ATTORNEY-IN-FACT. Any and all documents may be signed by any one Attorney duly appointed hereunder, and as such shall be fully binding on me and my estate and shall be conclusive evidence of the authority of the said Attorney to sign solely on my behalf. (38) REFUSAL TO HONOR POWER. Should any third party,including any bank, trust company, insurance company,brokerage firm, stock or bond company, or any other third party refuse to accept the validity of this Power of Attorney,and should I suffer any financial or personal damages as a result of such refusal, then I direct my attorney to use any of my resources, as necessary; to bring whatever legal action may be appropriate to compensate me, or my heirs for the damages suffered due to such refusal. (39) PHOTOCOPIES. Any Attorney acting under this Durable Power of Attorney and Nomination of Fiduciary is authorized to make photocopies of this instrument as frequently and in such quantity as the Attorney shall deem appropriate. All photocopies shall have the same force and effect as any original. DURABLE POWER OF ATTORNEY FOR JOHN S.DALY Page 12 of 14 i WITNESS STATEMENT On this 41h day of November, 2010, JOHN S. DALY, the principal, signed the foregoing instrument in our presence declaring it to be his Durable Power of Attorney, and as a witness thereof we do now hereby state that he appears to be of sound mind and under no duress, fraud or undue,influence. We are not the persons appointed as agent by this document. We further declare that we are not related to the principal by blood, marriage, adoption, and, to the best of our knowledge, we are not a creditor of the principal nor entitled to any part of his estate under any Will now existing or by operation of law. -6 vzs Alk eti4 Witness Address Witness Address COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. November 4, 20.10 Then personally appeared the above-named JOHN S.DALY, as Principal of the within Durable Power of Attorney and Nomination of Fiduciary,known to me or satisfactorily proven to be the person whose name is subscribed to the within instrument and acknowledged the foregoing instrument to be his free act and.deed, before me, Stuart W. Rapp,Esq.— ary u c My commission expires: 06/25/2015 RAP s'rUART W.E(o. r'l�u`'rRy PUBLIC --� ` O1,Ul;OMIVEALTH OF MASSACHUSETTS 61y Commission Expires June 25,2015 DURABLE POWER OF ATTORNEY FOR JOHN S.DALY Page 14 of 14 Law Offices of Stuart W. Rapp 749 Main Street • Osterville, MA 02655 Tel. 508.428.0400 - Fax 508.428.0096 Email: srapp@srapplaw.com On this 151h day of September, 20111 certify that the preceding documents is a true, exact, complete and unaltered copy made by me of the Durable Power of Attorney and Nomination of Fiduciary for John S. Daly. (SEAL) VJt Quinn—Notary P is commission expires: April 5, 2013 Janet E. Quinn * NOTARY PUBLIC Commonwealth of Massarho tts My:Commission Expkes.Ap.01 ,2013