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0055 OLD TOWN ROAD
'To co go/ r one ca1l e"d a bi> 4 cc- �,s ri n rcj�y CAS 1 CAA p u"S �-4 W c � r Town of BarnstableBuilding . " Post,This Card So T1at it'is.Visible'From-the Street ApprovedpPlans Must be Retam'ed on Job and•this Card Must be Kept tARNS`C'ABLQ * y: - v MA ASS. Unt�l`Final Inspection Has'Been Made Permit � 639 S w. N m r A Where a Certificate:of Occupancy is Req"ia�red,such Bu�fdmg sti'all Not':be.Occupied until a Final Inspection has been made.. , ._ ._ .o.... . _ d. �::.a e �:. _. . . ..• � Permit NO. B-20-70 Applicant Name: CAPE COD INSULATION INC Approvals Date Issued: 01/13/2020 Current Use: Structure Permit Type: Building- Insulation -Residential Expiration Dater 07/13/2020 Foundation: Location: 55 OLD TOWN ROAD,HYANNIS Map/Lot: 267-059 Zoning District: RB Sheathing: Owner on Record: KERRICK,SARAH E Contractor Name: CAPE COD INSULATION INC Framing: 1 Address: 55 OLD TOWN ROAD Contractor License: 153567 2 HYANNIS, MA 02601 'Est. Project Cost: $5,200.00 Chimney: Description: weatherization Permit Fee: $85.00 Insulation: Fee P,.aid:' S 85.00 Project Review Req: Date: 1/13/2020 Final: Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within siz months after issuance. All work authorized by this permit shall conform to the approved applicatio i�§nd3he approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures'shall be in compliance with the local zoning by laws and codes. — This permit shall be displayed in a location clearly visible from access street or:road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Buildin and Fire Officials are provided on this;,permit. Service: Minimum of Five Call Inspections Required for All Construction Work: 3 1.Foundation or Footing ' 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Application Numb&.......13 � .. ........... 6............. ............................ ' Pe®it Fee................ ...................Other Fee........................ TotalFee Paid..................................................................... TOWN OF BARNSTA13LE pp IMIA0 effiit Appmval by...f�. . ..�.....On.... BUII�DING PERMIT P APPLICATIONmap ..........07 ... ..........Parma......... 5 Section 1 — Owners Information and Project Location Project Address 1; T.D W A/ Village d-A !e-7 Owners Name G' kewl A, i Owners Legal Address "JJ� City �7 State - Zip Owners Cell# E-mail Fp k Section 2—Structural Use Single/Two Family Dwelling ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure under 35,000 cubic feet Section 3—Type of Permit ❑ New Construction ❑ . Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm F Rebuild ❑ Deck Apartment ❑ Sprinkler System ❑ Addition ❑ Retaining wall ❑ Solar o y ❑ Renovation ❑ Pool EX Insulation z `v Other—Specify o z o h � � r Section 4—Detail z N rn D ---i w Cost of Proposed Construction i�WO•ad Square Footage of Projectrn " Age of Structure Dig Safe Number t #Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design 1 Last updated:l l/7/2017 Section 5 -Work Description K-10 &geld kx 4-o Section 6—Project Specifics ❑ Wiring , ° ❑ Oil Tank Storage . t ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑.Heating System ❑ Masonry Chimney Add/relocate bedroom Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane C Yes ❑ No Section 7—Flood Zone Flood Zone Designation J Within or adjacent to a wetland,coastal bank? Yes ❑ No ❑ I Section 8—Zoning Information Zone District Proposed Use Lot Area Sq.Ft Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed i Has this property had relief from the Zoning Board in the past? ❑ Yes No Last upastma:11nrz017 Section 9—Construction Supervisor Name ePll S G Telephone Number 17'� ' D Address -1 O& d M( VALCity �' a �°S�tate 1/�(9 Zip � Cvfo License Number-A Q License Type Expiration Date k / Contractors Email ea 6Ul �� rlt7 Lt� Cell# �. I understand re 'bilm'es under the rules and my sponsu regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and docMnentation re ' by 78 CMR and the Town of Barnstable.Attach a copy of your license. Signature A Date i Section 10—Home Improvement Contractor Name V ` Telephone Number �b 5 Address QUIti6(V City:fj C(V T�— State " Zip 40Z6& ' Regishation Number l'���61 Expiration Date l I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massach State Building Code. I understand the construction inspection procedures,specific inspections and documentation by 7 CMR and the Town of Barnstable.Attach a copy of your FLI.C... w Signature Date 2� Section 11—Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and docuinentation required by 780 CMR and the Town of Barnstable. Si e gnatur Date P T SIGNATURE Signature Date `l s Print Name 11" Telephone Number 47.E % E-mail permit to: G t(4 Last updated:I M12017 Section 12—Department Sign-Offs Health Department © Zoning Board(if required) Historic District ❑ Site Pian Review(if required) ❑ 1 Fire Departfiient ❑ I Conservation. ❑ For commercial work,please take your plmrs directly to the fire department for approval i Section 13—Owner's Authorization L , as Owner of the subject property hereby authorize to.act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of job) Signature of Owner date, . Print Name l Uscupaated:11/7rz017 r � , r 4 ~ Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons�!i,f&i0t<i� 1�gs V visor :•' I } � E�cpires: 11/11/2021 C. CS-100988 „ HENRY E CA SIDY-4Q, 8 SHED ROW;y `� C WEST YAR.MO}!TH y3 C�f.S'�'i:�� 1 • C Com r missione ��, !/•��_ , eJ/(lJ l.J.ram/Jr?%l'%�%Jl�•��t'GC��� ��,, �///�I;J�Jt!Gr!'�lrJ•��lrJ Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration Type; Corporatlon CAPE COD INSULATION, INC, Reglstretlon; 15.35V 18 REARDON CIRCLE Explratlon: 12/14/2020 SO,YARMOUTH, MA 02664 C „ ��c; zuna•�;;n r Update Address and Return Card, r �ir /rn iru/urvor/// V I/�rv.1��rYui•ii//J Otflce of ConsurnorAffair G Business Ftegulatlon HOME IMPROVEMENT CONTRACTOR Replstretlon valid for_Indlvidual uce only TYPE:CorporsUon before the expiration data, If found return to; Registration Exolratlon OMoe of Consumer Affairs and Business Rogulatlon 163667 12/14/2p20 1000 Washington Street•Suite 710 CAPE COD INSULATION,INC Boston,MA 02118 ' r 1 l r HENRY E,CASSIDY 18 REARDON CIRCLE 130,YARMOUTH,MA 026" Undersecretary a Ith t sign r ........... The Contnwnwealth of Massachusetts s,.. Department of Industrial Aecidents Office of Investigations 600 Washington Street Boston, KA 02111 www,mass.gov/dia i I orkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anplicant Information Please Print Leziblx Name(Business/Organizatiun/hndividual):_ Cape Cod Insulation Inc. Address: 18 Reardon Circle City/State/Zip: South Yarmouth, MA 02664 Phone #: 508-775-1214 Are you un employer?Check the appropriate.box: Type of project(required): i.V I am a employer with 48. 4, ❑ I am a general contractor and I employees(full and/or part time). s have hired the subcontractors 6. ❑ New construction 2,❑ l 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 mo in any capacity. employees and have workers' 9, ❑ Building addition (No workers' comp, insurance comp, insurance,l required,) 5. ❑ We are a corporation and its 10.[] Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ Pltunbing repairs or additions myself.[No worke>,,' comp, right of exemption per MGL 12 ❑ Roof repairs insurance required.)t c, 152,§1(4),and we have no WeatherlZatI0C1 employees, [No workers' 13.{Z Other comp. insurance required.) Any applicant that checks box N I must also flit out the section below showing their workers'eompenstuion policy inronne0on, Homeowners who submit this WTIdovlt indicating Uley are doing all work and then hire outside wnuacton must submit a rtew affidavit indicating such. ;C'nntrueu s that check this box must atuached an additional sheet showing the twm ol'the sub-contractors and state wheU>cr or not those entities havo employees. If the sub•contnamrs have employers,they must provide their workers'comp.policy number. ., I an)an employer thails providing workers'compensation Insurance for my employees, Below Is the policy and Job site Information, Insurance Company Ntu.ne: Atlantic Charter Policy+l or Salf•ins, Li/a`tl;,,WC 100136900 Expiration Date;0 30/2020 Job Site Address; �' l � � "�� — City/State/Zip: =m,:,i Attueh a copy of the workers' compensation policy declarstion'page(showing the policy number no expiration date). I.ailure to secure coverap as required under Scction.25A of MGL c. 152 can lead to the imposition bf criminal penalties of a tine up to S 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 tip to$250.00 a day against the violator. Be.advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coyeruge verification, I do hereby certify under the pains and penalties of perjury that the infornration provided ab ve/s true and correct Si matt _ Date: 7 Z� Phnnc a 508JU 12.14 0 Iola use only. Do n by not write in this area, to be completed c+ty or town official. City or Town: Permit/License H Issuing Authority(circle one): I. Bourd pf Health 2. Building Department 3,City/Town Clerk 4, !Electrical Inspector S. Plumbing Inspector• 6, Other Phone#: CAPEt.0D•27 ________7110•fNE.- t 1 CERTIFICATE OF LIABILITY INSURANCE DATE(MF,110DP(YY'I)711GILU1 cA S 1) e to _.—._./201..._ T IS`UED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEIZTIFIC.A'rF HOLDER, THIS E DOES NOI AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I fHIS CERTIFIC TE OP INSURANCE DOES NOT CONSTITUTE A CONTRACT SETWEEN THE ISSUING INSURER(S),AVTHORICEO SENTATIVE OR PR DUCER,AND THE CERTIFICATE_HOLOER, —�-� jffr�OR'rAN'r, If the Corti Icate holder is an ADDITIONAL INSURE?D,the pollcy(los)must have ADDITIONAL INSURED provisions or hD endorsed. I SU6!ROGATION IS WAI ED, sub)ect to the terms and Conditions of the policy,certain policies may require an endorsement, A statoment on lh19 certificate door not co Tfor ri lita to the certificate holder In Ilou of such endorsements ,� 'RODUCER T SAME• r Good —"' --- --' togors& Gray Insuranco Acd ncy, Inc, PHONE —— -- .�...r—....._ 34 Rio 134 A/c No Exl; 800 66 801 3.1 PAx . , �� ac Na; 817) II16.2156 outh Denn s,MA 02600 � ,mall rogers lray,com INSURt?RL`�L�O$�IIJ�1 GOVERAOE — -- NAIC u l —• INSURER AffiestAmerlcan Insurance Company �4393•__,....._. lsuneD IN$VRERe;Arbe Insuran om aptly lilc_41.3G0 Cape Cod Insula Ion,Inc, INSURER C,Endurance American Specialty Insurance Company 41718 18 Reardon Circl 3IN 'At Caro Insurance Comp an 14326. ._South Yarmouth, MA 02664 P_._�!__— INSURER F.; — — _ INSURER F --- :OVERAGE.,S CETiTIFICATH NVM8ER;___. r� REVISIQN NUME3ER'THIS _— IS 1'0 CL'R'fIFY THAT HE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUE[)TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTAN ING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH REESPEC'r TO WHICH THIS I CER'IFICATE MAY BE ISSU D OR MAY PFR1'AIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TEWAS,EXCLUSIONS AND CONDI'rIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ SR TYPE OF IIJSUftANC tApOL SUeR POLICY EPp PO ICY exp L POLICY NUMBER YYY i X' COt LI1dITSrIM11MCIAL GENERAL.LIABILITY —^ ---— EACH OCCURRENCE 1,000,OUOI CIAIhIS•MADE i�OCCUR BKW$3328201 4/1/2019 4/112020 OAMAf,;ETORENTED 100,0001 .P_HEFAI�ES.(E�pyeu(taaae ;�_�--^--.--_—.. _. An one or one 1'),000 ELJ�QJN(18A0V N Y_ 1,000,OUOI OgN'LAGGRE,OATF.'LIMI'rAP ll PER: P EN to•A r -- 2,000,0001 POLICY U JCCT LOCStBEStf1l1--Y—----- --_ PROD ZCTS•COMP/UPAG0 2,000,000 QTHER� �— AVTOMOUILE UA9ILITY COMBINE[)SINGLE LIbAIT 1000 UOOI ANY AUTO 1020081008 411/2019 4/112020 -tkaassldeDl) - -_,-___ OURNE OnLY X AUpoT OUyLNEEOp E3 ILY INJURY IPer•person— t_.,—„XAUUTOS ONLY AUN ONLY B�OPYR YUDAMAGEnccldel SST_ — — or rl�enll — VhIORELLALIA9 X 0 CVR '---^• -- i•----- 7( EXQES91.IAe C IMS•MAOF. EXC10006636004 EAQPI N P —_ 5 — Z,000,UUOI 4/112019 4/112020 RETE'ITIONS AOG Q�'rF. _ -- --2,000:000 )�WORKF.RSCOMPENSATION ^' Tom^ PER QTH. S --� AND(EMPLOYERS'LIAMIXrt _•�__... ANY?ROPRIETORIPARTNER!L•XEGI TIVE WC1.0013690Q 6130/2019 6/30/2020 E —'�'-- ( -I OFFICERIIdFMBBEREXCLUDF07 N/A E. .EAc A I 'I,000,QQQ (h4andaloryLt Nl1) H CC OENlT ^„ _ i lu os,doscribounder fl.l. ISFE.A F I•AI>LO'rE1C 1,000,UUU D,SCRIPT ION OFOP@RATIONSba yr u 1,OUt),000i --- E.L.OISEASE.P I.I Y LIMIT I! I SCRIPTIION OF OPERATIONS I LOCATI NS!VEHICk.es (ACORU 191,Addltlonol Romnrke Snitodulo,mny bo ottnohod If Moro since Is roqulrod) — -- , i DocuSign Envelope ID:F764678F-9E44-48BA-ACF7-B809A956CE61 Permit authorization M; 53ve Form Site ID: 3795549 Customer: Sarah Kerrick I, Sarah KPrri rk ,owner of the property located at: (Owner's Name,printed) 55 Old Town Road Hyannis, MA 02601 (Property Street Address) (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. EDooCuOs'gned bAy: �C�Owner's Sinature: `J — 94DD4BAC3C4ED... Date: 10/11/2019 1 1:13 AM EDT - 0000soa0000sosos000000sososos000000sososos000000sos0000000000sosoc000 FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: RISE Engineering i Phone: 401-784-3700 Email: Page 1 of 1 For Office Use Only Rev.102015 _ a Application number....::.� ..�... ..... ... . t` .., � .. Date Issued...............��` �,MASS g AUG 17 2018 Building Inspectors Initials....... .. N %8A[7 vi��� Map/Parcel...S.J.. .. ........................................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 'L;, (3-2,601 ��i NUMBER STREET VILLAGE Owner's Name: l�� (�Qrig (�j� Phone Number t�jC3$'�')q — Email Address: QApeAg3 -rec.k-tad (90� "(;ell Phone Number q5 Project cost $ 5-0® Check one Residential L-," Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby au - (C 49- to make application for a build' rmit in accord e with 780 CMR Owner Signature: Date: OT' F) 'l T TYPE OF WORK ❑ Siding ❑ Windows (no header change)# Q Insulation/Weatherization ❑ Doors (no header change)# Commercial Doors require an inspector's review ETeKoof(not applying more than 1 layer of shingles) Construction Debris will be going to ,� CONTRACTOR'S INFORMATION Contractor's name 0 �� A-0 Home Improvement Contractors Registration(if applicable) # 1 0 I (attach copy) Construction Supervisor's License# l.�g t 05� (attach copy) Email of Contractor CA\.RtC,0d ��� r��vPhone number y +�� Zb 6 ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY IS IN A HISTORIC DISTRICT, YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. APPLICATION NUMBER . *For Tents Only* Date Tent`(s)-will,be erected Removed on number of tents total Does..the tent have sides? Yes No (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent If food is being served at your event please obtain a Health Department approval between the hours . of 8:00am-9:30 am or 3:30 pm-4:30pm. Commercial events may require Fire Department approval. *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLI 'S SIGNATURE Signature ' ' Date All permit applications are subject to a bui ding official's approval prior to issuance. The Commonwealth of Massachusetts Department of Industrial Accidents Ur Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 1� Please Print Legibly Name (Business/Organization/Individual): btul kpliG', 0 ,l-� �' �gn Address: 26 9 a 1 ✓a !:A: City/State/Zip: L-111nool(I-SC� Phone#: Are you an employer?Chect the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I VI (full and/or part-time). uC1 * have hired the sub-contractors 6. ❑New construction 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. 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 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. 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: M� � C Expiration Date: Job Site Address: 76,+-n �"--�D. City/State/Zip: , 0%0 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 certi nder the pains and penalties of perjury that the information provided above is true and correct. c Signature: 'LIA Date: 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 Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee.is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also'states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificates)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on theappropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The.Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The 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 640 Washington.Street Boston,MA 021.11 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#61.7-727-7749 www.mass.gov/dia masSachusetts Departmen'tat Public. Satity `80-ard of Building Regulations aired S'tandarrds' c—onstruct►can Supervisor � BRAU Ll4:BRA f C3 x 25 UNCLE--STANLEY'S WAY " m SOUTH �E'NNIShcA 026 Y Commissionr 05r2312020 - Cftitaan� um Aalwir�as} uit�tlgt� Oval Et4'i' ta -T:�IACTt € TY + 1 , Wu BRAULIOSAMO 25 Uncle'S ► ;: Soutt�. �s; A 2,660Udercrry r ea ---� Town of Barnstable, 367 Main Street, Hyannis, MA 02601 = Uj REGISTRATION AND CERTIFICATION FORM FOR FORECLOSING/FORECLOSED PROPERTY Thank you for registering in accordance with Town of Barnstable Code chapter 224 rn sections 224-3 and 224-4. Please complete one form for each property in foreclosure (section 224-3) or already foreclosed for which possession has been taken (section 224- 4). Please file the original with the Building Commissioner and a copy with the Chief of the Fire District in which the property is located. If you claim you are exempt from registering under Massachusetts law, please state the reason(s) and complete section 1 (property information) and the first paragraph of section 2 (foreclosing party, court, etc. and foreclosing party representative, but not other representatives and attorney) so that the Town can review the exemption and update its records: N/A Section 1 —Properly Information Property Address:55 OLD TOWN RD HYANNIS MA 02601-3541 Assessors Map#: 267-059 Parcel #: 267-059 Land area and description Lot of 9,148 sqft (or 0.21 acres) Building(s) description and contents Single family home of 1,110 sqft. Occupied: N Occupant(s)(if borrowers so state and include name(s)) NA Phone: NA email: NA other: NA Vacant: Y Date: 12/02/15 Anticipated Length of Vacancy: unknown Last occupant(s) )(if borrowers so state and include name(s)) GLEN R WENNERSTROM c/o Wells Fargo Bank, N.A. Phone: 877-617-5274 email: codeviolations@wellsfargo.com other: NA Has possession been taken N If so, please explain and complete and file the maintenance and security plan form (unless exempt as stated above) Section 2—Foreclosing,Party Information Foreclosing Party (full name/title) NA Foreclosure Case Court: NA Docket# NA Date filed: NA Current Status: NA Foreclosing Party's representative(s) for property (entry, management, repair, etc.)(name, title,): NA Company (if different from foreclosing party): Wells Fargo Bank, N.A. Address: One Home Campus, MAC F2303-04J, Des Moines, IA 50328 Phone: (877)-617-5274 email: codeviolations@WellsFargo.com other: If an exemption is claimed, please do not complete the remainder. Other representative(s) (if foregoing representative is primarily responsible for property and/or foreclosure and is most likely to be able to address town matters concerning the property and/or foreclosure, please so state and do not complete contact information (i. e. "none"or"see above")). Name, title, other: NA Company (if different from foreclosing party): NA Address: NA Phone(s): NA email(s): NA other: NA Name, title, other: NA Company (if different from foreclosing party): NA Address: NA Phone: NA email: NA other: Attorney representing foreclosing party NA Firm name (if different from attorney's name): NA Address: NA Phone(s): NA email(s): NA other: NA I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. Digitally signed by Brian Jackson Brian J a ckso rr:tate:2015.12.02 14:49:17-06'00' Date: 12/02/15 Name:Brian Jackson Title: Research/Remediation Associate I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-3 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner,Town of Barnstable MAINTENANCE AND SECURITY PLAN FORM FOR FORECLOSING/FORECLOSED PROPERTY Town of Barnstable General Ordinances, Code section 224-4, requires a mortgagee taking possession of a property before or during foreclosure, or after foreclosure if the mortgagee becomes the owner, to bring the property into compliance with the maintenance and security standards contained in Code subsection 224-4(B) within thirty (30) days of a notice from the Building Commissioner. Please either complete and file this form or another containing the same information with the Building Commissioner within thirty (30) days of the notice. If a mortgagee claims an exemption from the provisions of Code sections 224-3 and 224- 4, please explain, leave the remainder blank, sign at the end and file this form or letter of explanation and also complete and file the applicable sections of the registration form for foreclosing/foreclosed property N/A Town of Barnstable 367 Main Street, Hvannis, MA 02601 (1) Registration date: 10/19/15 . If not registered, please complete the registration form and state date of filing or anticipated filing N/A (2) If commercial property, describe space utilization floor plans required by the Fire Chief and filing date (actual or anticipated)N/A (if in possession or ownership must be certified as accurate twice annually in January and July). (3) Describe any hazardous materials on the property as that term is defined in MGL c.2 1 K and the date(s)and method(s) for removal as approved by the Fire Chief UNKNOWN (4) Method(s) and date(s) all windows and door openings secured (or will be secured) UNKNOWN If left secured, name, address, and contact information of security personnel providing twenty-four-hour on-site security personnel on the property WELLS FARGO BANK,N.A. F2303-04J, 1 HOME CAMPUS, DES MOINES IA 50328, 877-617-5274 (5)Location(s) and date(s) "No Trespassing" signs posted or to be posted on the property UNKNOWN (6)Name(s), address(es) and contact information of person(s) responsible for maintaining: structures, lawns and shrubs in sound condition free from excessive growth and the property generally in accordance with the Barnstable Zoning Ordinances the definition of"maintenance" in this Ordinance; any other provision of this Ordinance; and for disposing of trash, debris and pools of stagnant water as provided in Chapter 54 of the Town of Barnstable General Ordinances WELLS FARGO BANK,N.A. MAC F2303-04J ONE HOME CAMPUS, DES MOINES, IA 50328 (7) If the Fire Chief of the Fire District in which the property is located has approved turning off the water or electricity, please state: Date of approval UNKNOWN Date(s) electricity turned off UNKNOWN on if applicable UNKNOWN ; Date(s) water turned off UNKNOWN on if applicable UNKNOWN (8)Name(s), address(es) and contact information pf person(s) responsible for maintaining all existing fences around swimming pools and spas or installing fences as required by Chapter 210 of the Town of Barnstable General Ordinances WELLS FARGO BANK,N.A.,F2303-04J,ONE HOME CAMPUS,DES MOINES IA 50328 (9)Name, address, telephone number and email address of person who can be contacted in case of emergency if different from the person named above or in the registration under section 224-3(A) (name and contact number to be posted on the front of the property if required by the Fire Chief or Building Commissioner WELLS FARGO BANK,N.A,F2303-04J,ONE HOME CAMPUS,DES MOINES IA 50328,877-617-5274 (10) Date(s) certificate of liability insurance on the property filed with the Building Commissioner SEE ATTACHED EVIDENCE OF INSURANCE (11) Date(s) cash or surety bond of at least$10,000.00 filed with Building Commissioner to remunerate the Town for any expenses incurred in inspecting, securing and making the premises comply and continue to comply, a portion of which shall be retained by the Town as an administrative fee 11/17/15 (12)Date(s) scheduled for inspections with the Building Commissioner and Health Director,who may at his or her discretion include the Fire Chief, in order to confirm that the land and structures comply with the provisions of this Ordinance UNKNOWN or to identify the provisions with which the property does not comply and establish a program to bring the property into full compliance UNKNOWN (13)Date(s) when the property was sold, or is anticipated to be sold, to the foreclosing party. If neither, please explain UNKNOWN I acknowledge that the information provided is accurate and correct. I also understand that any inaccurate information will result in non-compliance with section 224-3 of chapter 224 of the Code of the Town of Barnstable. BrianBryn JacksoWIDate:2 signed 2 Brian Jackson I .7 Date:2015.12.02 14:51:31-06'00' Date; 12/02/15 Name: Brian Jackson Title: Research/Remediation Associate • 9 I hereby certify that the above-named foreclosing party is in compliance with the provisions of section 224-4 of chapter 224 of the Code of the Town of Barnstable. Date: Building Commissioner, Town of Barnstable WELLS FARGO HOME MORTGAGE CONTACT INFORMATION For'questions or concerns regarding a property registration issue please contact the Property Registration Department. Property Registration Department Registrations@wellsfargo.com For other inquiries please route applicable requests to: Building and Code Compliance Department CodeViolations@wellsfargo.com Utility Bills ConvUtilitvPmt@wellsfargo.com HOA or Condominium Dues or Fees HOAPmtRequestFH@wellsfargo.com. Tax Related Requests: Tax'Gatekeeper@wellsfargo.com REO property inquiries PASAPinguiries@wellsfsargo.com Insurance Claims HazardClaims@wellsfargo.com General Property Preservation Property.Preservation(@wellsfargo.com For questions regarding purchasing a Wells Fargo property please contact 1-877-617- 5274. You may also contact our dedicated property preservation call center at 1-877-617-5274 Monday— Friday from 8:00 AM —9:00 PM EST. Please note all legal.documents should be sent to our legal mailing address below:' Wells Fargo Home Mortgage 1 Home Campus MAC# F2303-04J Des Moines, IA 50328 21174 / ® - DATE(MM/DD/YYYY) A� CERTIFICATE OF LIABILITY INSURANCE 3/25/2015 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 NAME: Wells Fargo Certificate Service Center Wells Fargo Insurance Services USA,Inc. PHONE 404-923-3719 Fn/c No: 1-877-362-9069 A/C No Ext 3475 Piedmont Rd E-MAIL wfis.certifi uestcatere wellsfar o.com ADDRESS: 4 @ 9 Suite 800 INSURERS AFFORDING COVERAGE NAIC# Atlanta,GA 30305 INSURER A: Old Republic Insurance Company 24147 INSURED INSURERS: Wells Fargo Home Mortgage INSURER C a division of Wells Fargo Bank,N.A. INSURER D: 90 South 7th Street, 14th Floor INSURER E: Minneapolis,MN 55402 INSURER F: COVERAGES CERTIFICATE NUMBER: 8901677 REVISION NUMBER: See below 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 ADDLTYPE OF INSURANCE INSD VVD SUER POLICY NUMBER MM/DDPOLICY/YYYY MMIDDEFF YIYYYY EXP LIMITS LTR A X COMMERCIAL GENERAL LIABILITY MWZY304056 04/01/2015 04/01/2020 EACH OCCURRENCE $ 10,000,000 _ DAMAGE TO RENTED CLAIMS-MADE Fx_1 OCCUR PREMISES Ea occurrence $ 10,000,000 MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 X POLICY PRO- LOC PRODUCTS-COMP/OP AGG $ 10,000,000 JECT $ OTHER: COM AUTOMOBILE LIABILITY (Ea accident SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ _ $ A WORKERS COMPENSATION MWC302638 04/01/2015 04/01/2020 X STATUTE OERH AND EMPLOYERS'LIABILITY YIN 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED9 �N/A 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Proof of Insurance CERTIFICATE HOLDER CANCELLATION Wells Fargo Home Mortgage, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN a division of Wells Fargo Bank,N.A. ACCORDANCE WITH THE POLICY PROVISIONS. 90 South 7th Street,14th Floor Minneapolis,MN 55402 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) Message Page 1 of 1 Mckechnie, Robert From: CodeViolations@wellsfargo.com Sent: Thursday, February 04, 2016 1:39 PM To: Mckechnie, Robert Subject: RE: 55 Old Town Road, Hyannis, MA 02601-3541 Unsecured Foreclosed Property Good afternoon, Wells Fargo Home Mortgage,Asset Management and Preservation Team are in receipt of your inquiry for the above listed property.Your inquiry has been assigned to a specialist within our Building and Code Compliance group for review.They will be contacting you directly with the outcome of your inquiry. Their contact information is below: Mark Beckendorf- Mark.Beckendorf@wellsfargo.com Thank you. Jessica Cozad Building and Code Compliance & Maintenance Department codeviolations@wellsfargo.com Our mission is to provide great customer service, please contact manager Britney Moore at britney.a.moore@wellsfargo.com with positive feedback and/or concerns. From: Mckechnie, Robert [mailto:Robert.McKech n ie@town.barnstable.ma.us] Sent: Monday, February 01, 2016 2:42 PM To: CodeViolations Subject: 55 Old Town Road, Hyannis, MA 02601-3541 Unsecured Foreclosed Property ATTENTION: This email is to notify you that the subject property is not secure. Please advise your property maintenance company to secure this property as soon as possible. Your prompt response will prevent further action by The Town of Barnstable to secure the property at your expense. I would appreciate an email when there is a plan to secure this property. Thank you, Robert McKechnie Local Inspector Building Department Town of Barnstable 200 Main Street Hyannis, MA 02601 508-862-4033 2/5/2016 TRAVELERSJTravelers Casualty and Surety Company of America Hartford,CT 06183 Date:August 03,2016 TOWN OF BARNSTABLE,BUILDING DEPT. Office at: 1000 Windward Concourse,Suite 100, 367 MAIN STREET ALPHARETTA,GA 30005 HYANNIS,MA 02061 CANCELLATION NOTICE License No. RE: WELLS FARGO BANK,NA 420 MONTGOMERY STREET SAN FRANCISCO,CA 94163 --3 - Bond No. 106356719 Former Bond No. .; Type of Bond/Policy: Contracting-Perf/Pymt to Muni You are hereby notified that this Company elects to cancel the above captioned bond requiredoby tI TOWN OF BARNSTABLE,BUILDING DEPT. This cancellation is to take effect on 9/7/2016 , in accordance with the terms of said Bond or Policy. Travelers Casualty and Surety Company of America By: Robert L. Raney, Senior Vice President F-129-P(8/00) Rev.2/05 TRAVELERS J BOND (License or Permit - Definite Term) Bond No. 106356719 KNOW ALL MEN BY THESE PRESENTS: THAT WE, Wells Fargo Bank,NA as Principal, and Travelers Casualty and Surety Company of America a corporation duly incorporated under the laws of the State of Connecticut and authorized to do business in the state of Connecticut as Surety, are held and firmly bound unto Town of Barnstable as Obligee, in the penal sum of Ten Thousand Dollars and 00/100 ( $10,000.00 ) Dollars, for the payment of which we hereby bind ourselves, our heirs, executors and administrators, jointly and severally, firmly by these presents. WHEREAS, the Principal has obtained or is about to obtain a license or permit for Loan No.106-1279022434;55 Old Town Road,Hyannis,MA 02601-3541 NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION ARE SUCH, that if the Principal shall faithfully comply with all applicable laws, statutes, ordinances, rules or regulations, pertaining to the license or permit issued, then this obligation shall be null and void; otherwise to remain in full force and effect. This bond is for a definite term beginning 11/17/2015 and ending 11/17/2016 and may be continued at the option of the Surety by Continuation Certificate. PROVIDED, that regardless of the number of years this bond is in force, the Surety shall not be liable hereunder for a larger amount, in the aggregate, than the penal sum listed above. PROVIDED FURTHER, that the Surety may terminate its liability hereunder as to future acts of the Principal at any time by giving thirty (30) days written notice of such termination to the Obligee. SIGNED, SEALED AND DATED this 11/17/2015 Wr Wells Far o Bank NA By: on Holt Principal Research/Remediation Manager Tr elers Casualty and Surety Company of America By: A ` nli ylor V Attorney-in-Fact' S-2151 B(6/10) I E "`ram WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER Q POWER OF ATTORNEY TRAVELERSJ Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company. Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 229962 Certificate No. 006501111 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and.Marine Insurance Company, St. Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Scot( Davis.Tina Kennedy, Dawn T. Kirkland, Steven L. Swords,Carol Philyaw,Cheryl Boozer,Annette Wisong,Joseph W. Hamilton,III,Joseph R Williams,Tracy Wallace,Julia Andeson,Chaun Wilson,Rebecca E. Howard,and Sarah Hancock of the City of Atlanta State of Georgia their true and lawful Attorneys)-in-Fact, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory iri the nature thereof on behalf of the,Companies in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or perrnittedi onsor,proceedings allowed by law. IN WITNESS WHEREOF,the Companies havelcaused this instrum nuo-be signed,- thet corporate seals to be hereto affixed,this 23rd � day of September "```• - 2015 Farmington Casualty Company) St.Paul Mercury Insurance Company Fidelity and Guaranty4nsurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwi ti ers,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company „vuiEY4 W"""'W C,,SU,F� yF1RE 6.�. \�M INSG •'•,11N....... Pl(Y ANO Y �,' '1 Qr r l4:' '4 ems. G CE" � m'. �iLOR PyRA>F•i C:' VORAI- � m � `O � HARTFDRD, iF6��' J`SE Ai:if l�:SEAL07 CONN. NN•' •R� �,,�� State of Connecticut By: City of Hartford ss. Robert L.Raney;tenior Vice President On this the 23rd day of September 2015 before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,.St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that he,as such,-being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof,I hereunto set my hand and official seal. Vnr G i My Commission expires the 30th day of June,2016. AI/BI�G * Marie C.Tetreault,Notary Public �s 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER S WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER r •, ' This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St. Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing au.hority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President, any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity,and,Guaranty� Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies;iwhich-is ii,full force,and effect and has not been revoked. �v � , IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the-seayls'of said; wanies this day of 20 4. Kevin E.Hughes,Assistant Sec tary GI.SU./( yF1RE 6 ��N_„�NSG "Y INSyq y4 p tY 4N0 3✓iN �,�,,YYY • �Q,7,'�'}"�(y J b O: P...........9 J s Nd f)p FY• `'p09'p�Hf b C3'�•0�°� e ,: Q: ..•,9 �J �S ��i fl �R � ��PORAIEO � m�a �iZORP,..A�>F�m lW4wRPORAtf�t ,� I F _._ .01 c NaRTFORD t 1951 �'e �`•SEALio: �L• ° CON AO Y�.�L � 'J•. SSAL;'3 �, N. p CDNN, N To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.com.Please refer to the Attorney-In-Fact number,the above-named individuals and the details of the bond to which the power is attached. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER Town of Barnstable Geographic Information System December 30, 2009 267061 #1s 267060#ss 267062 #so , n zs 7059 #t55 267063 267058 267065 #14 #38 $ 267067 �. .'. 4 267 #46 tro" 267071 287154 267179 #43 267162 #34 0 18 Feet �19 7y. v #,57 G DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:267 Parcel:059 f b F-1 wt� oundary determination or regulatory interpretation. Enlargements beyond a scale of Selected Parcel Owner:WENNERSTROM,GLEN R Total Assessed Value:$270500 E 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:0.21 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:55 OLD TOWN ROAD ' such as building locations. Buffer i 7 n O �2 TME Town of Barnstable *Permit># l �.�. Expires 6 menthsftom issue date ' snnrtsras Regulatory Services_ Fee. MASS. 1639. 10� Thomas F.Geiler,Director AIFD"AP`A Building Division Tom Perry, BuildingCommissionerX-PRESS PERMIT 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 SEP 0 5 2003 �ICm Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESITRQE,@ff1VSTABLE Not Valid without Red X-Press Imprint Map/parcel Number a&7 055 Property Address W Residential Value of Work-4136�0 iA m o Owner's Name&Address 4c vA,t t2 S 4/z c ti S 0/e/ 76cv., /?c(, Contractor's.Name Telephone Number 3 O fc y 7 O Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's.Compensation Insurance Check one: ❑ I am a sole proprietor ®'I am the Homeowner ❑. I have Worker's.Compensation Insurance Insurance Company Name Workman's Comp..Policy# Permit Request(check box) 2Re-roof(stripping old shingles) All construction debris will be taken to .4 r— ❑Re-roof(not stripping. Going over existing layers of roof) rn ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *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. Home Improvement Contractors License is required. Signature G to Q:Forms:expmtrg � Revised 121901 THE The Town of Barnstable Department of Health, Safety and Environmental Services • UARNSPABIZ • Building Division tdAN 059. ,0�' 367 Main Street,Hyannis MA 02601 TFD MA't A Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: ;;_7 Name:��c L�d�-� ,-�—" ef Phone l#• a y Address: 1W J cy iv 6C s/ Village: �� Type of Business: ©O/�I O©�S Map/Lot: lP 7 '~ INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residcnaal volumes. • The use does not involve the production of offensive noise,vibration, smoke,dust or other particular matter,odors,electrical disturbance,heat, glare,liunudity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use sliall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed indicating the Custornan• Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: Gi ' Date: ` C1 Homeoc.doc WhitePages.com - Online Directory Assistance Page 1 of 1 B CASH 55 Old Town Rd Hyannis, MA 02601 (508)778-4404 Find Neighbors http://www.whitepages.com/10001/search/ReversePhone?phone=508-778-4404 4/6/2006 4-3f3&-7 6-4-18- �VE r The Town of Barnstable Department of Health, Safety and Environmental Services WENS ABM Building Division MASS. t639. 0%, 367 Main Street,Hyannis MA 02601 rFl)MA't Office: 508-790-6227 Ralph M.Crossen Fax: 508-790-6230 Building Commissioner Home Occupation Registration Date: 41e 9I I` Phone #• �� Name: � 10_ Address:JSS ®[c �c��yy ?c(' Village: C7�if✓HJr S Type of Business: Map/Lot: .- INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration, smoke,dust or other particular matter,odors,electrical disturbance, heat, glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing,the Customary Home Occupation. • No sign shall be displayed indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. APplicarit: Date: Homeoc.doc