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0021 PINE STREET
_..— �� .. 02 � J� — — �._____ — -- _--- �. - � j , . �. �i 1� e P k si � C ., ' k� ' _ 't Joe- OF THE Tp� • Town of Barnstable *Permit P\ Q ° Expires on .s fr m issue date ;V' V, Regulatory Services Fe *; s�vsrasr.E, 163 � Richard V.Scali,Director -' Building Division oTom 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 Map/parcel Number Not Valid without Red X-Press Imprint s \ Property Address ❑ Residential Value of Work$/o 0044• ill Minimum fee of$35.0IF 0 fo work under$ 000.00 , ,,Ad, V Owner's Name&Address 4 j lzej--j Contractor's Name Telephone Number Home Improvement Contractor License#(if appl ble) 11& Email: ,C m&&` Z�? Construction Supervisor's License#(if applicable) CS — ellg Y/f ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner J.I have Worker's Compensation Insurance Insurance Company Name/ Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box)XRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to A/WW ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit fonns\EXPRESS.doc Revised 061313 F A The Corr moratrealth of Massachusetts Department of Industrial Accidents i! ry �J Q, i€'e of'Irxwstrgatronu 600 Washington.Street Boston,JVA 0211I Workers' Compensation Insurance Affidavit: Builders/ContractorslEI i 9ansiplumber s Applicant Information Please Print Ise ib Naive jfltL,3imesvX)rgan zaaoufFndi-,idual): A� Address_ Cityfstate Z p_ Phone# c ® Are you an employer?Check the app apazate.box: Type of project(regniirt c ffn a employes with 340 4. ❑ I am a genneral contractor and I employees(full auorpart-time}- * have hired the sub-cntractors New construction 2.❑ I am a sole proprietor or partner- listed on the attached vheet. 7- ❑Remodeling These mb-contractors have ship and 13az�e no employees These ❑Demolition woriz ing for me in any capacity_ employees acid have workers' [No wotiers'eoinp_rxrc3rranre camp_insurance: 1 p_ ❑Building addition required-] 5. ❑ We:are a corporation and its 10.❑Electrical repairs or additions -3 officers have exercised bea❑ € ILL]Piumbingrepairs or additions myself.[No tivorkess'comp_ right of exemption per MGL I of rep i s �,152 c_ 1 4),andwe have no islsuuance required-];` � 13.El Other employees-[No workers' comp-imurance required] •hay appficsnt fat thecksbox'l rm also fill out the section below showing their waiters'conpensation policy infurns ton- Faniewwners who submit this of uharitin&cs-ling they are daiag all woA and,dLm hire antsi32 contmctnnmast nib k anew affidavit indicates such- `CoubwFors thsT rhea tdds box must attached an sdditiooat sheet showing then of the sub-cone--#ass and state whether or not those entities have enapiayees. Ifthe sub-contractors have etnplayees,they mustpratdde their workers,comp.policy u-uu ber. l arcs art employer that is pras!idiri.b porkers'cotirpeivafion itts irrutce for nty'ettsplo3�ees. $elflty is the policy "idjob site itrfOrrrrllfifld[. � Insurance Company Name.- �ej�� t �� t4A& � Policy of SeSf-ins,L n� �7 E® xpirauonDate: Job Site tlddtess:G'/ A&_--A GityfStatezip: Attach a cop} of the workers'compensation.policy declaration page(shoring the policy a ber and expiration date). Failure to secure coverage.as requited under Section 25A of hfGL r 152 can lead to the imposition of criminaI 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 fiste. of up to$250.00 a day against the violator_ Be advised that.a copy of this statement may be fiarwarded to the Office of Investigations of'the DIA for insurance coverage verification_ T do Mere.byr cerfi cruder trr:e paitrs ar rta s of pet miy.fltattlte irtforrrurtion preii-ded ubore is trra-e aiid correct Siana Date: Phone A: Official Jim ordy, Do not tt'rite its this area,to be cornpleted by city or totcn ofciaL City or Toix'n: P'ermidUcense 9 Lssuing Authority(circle one): 1.Board of Health 21.Building Department 3.C ity/Ton'n Cerk 4.Electrical Inspector S.Plumbing,Lnspector 6.Either. Contact Person: Phone 0: -- — - -- - - ----------- Q�°FTHe r�� * anxxsrner.E, MASS. ,�� Town of Barnstable prEo�,y a Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, , 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: 4V ez - AX/ Aee&,A� A mww�v (Address of b) fob YIVA4,ct,. 6 • �y -� � Signature of Owner Date C- r 5c>^ Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. i Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 061313 T r Town of Barnstable Regulatory Services P�oFir+eTo Richard V.Scali,Director Building Division &UMSTABLE. ' Tom Perry,Building Commissioner MASS. 1639• 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Pax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is,or is intended to be,a one or two- family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a 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 permit. (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 undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section (Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules & Regulations for Licensing Construction Supervisors,Section.2.15) This lack of awareness often . results in serious problems, particularly when the homeowner hires unlicensed persons. 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 permit formS\EXPRESS.doc Revised 061313 ,acoRoQ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 05/07/2015 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 Phone: (978)851-9600 Fax: (978)851-4848 CONTACT Sullivan Insurance Agency SULLIVAN INSURANCE AGENCY PHONE 885 MAIN STREET (978)851-0600 FA'( (978)8514848 ac No 6d: AIc No E-MAIL TEWKSBURY MA 01876 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER : XS Brokers Insurance Agency,Inc INSURED INSURER B ACE Group THOMAS A HILCHEY DBA THOMAS A HILCHEY CONSTRUCTION INSURER C 82 OLD CHATHAM ROAD INSURER D: HARWICH MA 02645 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 23083 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD'L SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MMIDD MMIDD LIMITS A GENERAL LIABILITY 3DV8222 09/26/14 09/26/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50 000 PREMISES(Ea occurence) CLAIMS-MADE Fx]OCCUR MED.EXP(Any one person) $ 1,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,0009000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED P Y INJURY(Per accident AUTOS AUTOS BODILY ) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (per accident) UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION 6S62UB-2E09540-0-15 03/16/16 03/16/16 X TORY7LIMITS ER $ AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YYIINN E.L.EACH ACCIDENT $ 100,000 Oland cry in NH) EXCLUDED? ! Y NIA E.L.DISEASE-EA EMPLOYEE $ 100,000 (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 D DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Thomas Hilchey is excluded in the workers comp policy CERTIFICATE HOLDER CANCELLATION Town Of Dennis SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO Box 2060 THE EXPIRATION, DATE THEREOF, NOTICE WILL BE DELIVERED IN South Dennis,MA 02660 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: ACORD 25(2010/06) ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 05/24/20,25 10:06 17814409017 FINANCE PAGE 02/02 Mayinsfitute 41 Pacella Park Drive Randolph.,M.a.��achusetts-02368. Tel:781.440,0400 Fax:781.440.0401 www.rnayinstitute.org June 25, 2015 Town of Barnstable 367 Main Street. Hyannis,MA, 02601 Re: B _ uildin Permit 21 Pine Street H antes NtiA 02 601 To whom it may concern:: Please accept this letter as confirmation that we have luired W.Thomas Hilchey to perform roofing and siding repairs to 2.1 Pine.Street,Hyannis, MA 02601. Sincerely, Jeff Pyke Director of Facilities 14 Pacella Park Drive Randolph, MA 02368 Massachusetts -Department of Public Safety Board of Building Regulations and Standards }- Construction Supen-isor License: CS-034718 ~_$ THOMAS A)f J�MY i 82 OLD CHATHAM Rb �: s HARWICH AA+r" Expiration commissioner 0911912095 Vtao TQomvrizo�ztueal o�C/G� ac�iueelld • � ®tics of Consumer Affairs.&Business Regulation License or registratio®valid for individut use only before the eapiratian date. If found return to: OME IMPROVEMENT CONTRACTOR eglstra4lon ;106d9 Type: Office of Consumer Affairs and Business Regulation 10 Park Plana-Suite 5170 Explration:_.-*-Al /2016 Individual Boston,P1dA 02116 THOMAS A.HILCHEY THOMAS HILCHEY 82 Old Chatham Road----:' HARWICH,MA 02645 Undersecretary Not valid without signature � I Mass. Corporations, external master page Page 1 of 3 William Francis Galvin Secretary of the Commonwealth of Massachusetts �. Corporations Division Business Entity Summary ID Number: 042197449 I Request certificate I New search Summary for: THE MAY INSTITUTE, INC. The exact name of the Nonprofit Corporation: THE MAY INSTITUTE, INC. The name was changed from: MAY INSTITUTE FOR AUTISTIC CHI on 01-18-1991 Merged with FRIENDS OF THE MAY INSTITUTE FOR AUTISTIC CHILDREN, INCORPO* on 06-30-1995 Merged with MAY BEHAVIORAL HEALTH, INC. on 07-01-2000 Merged with MAY SOUTH, INC. (GA) (Note: Entity is not registered in Massachussetts) on 06- 03-2008 Merged with MAY PROFESSIONAL ASSOCIATES, INC. on 08-17-2010 Entity type: Nonprofit Corporation Identification Number: 042197449 Old ID Number: Date of Organization in Massachusetts: 04-05-1955 Last date certain: Current Fiscal Month/Day: 06/30 Previous Fiscal Month/Day: 06/30 The location of the Principal Office in Massachusetts: Address: 41 PACELLA PARK DR. City or town, State, Zip code, RANDOLPH, MA 02368 USA Country: The name and address of the Resident Agent: Name: STEPHEN YOUNG Address: 41 PACELLA PARK DR. City or town, State, Zip code, RANDOLPH, MA 02368 USA Country: The Officers and Directors of the Corporation: .Title Individual Name Address Term expires PRESIDENT LAUREN C. SOLOTAR 191 GRANT AVENUE NEWTON, MA 12-13- 02459 USA 2015 TREASURER DEBRA BLAIR 5 PLATTS STREET HOLBROOK, MA 12-13- 02343 USA 2015 http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=042197449&... 6/24/2015 Massa Corporations, external master page Page 2 of 3 SECRETARY NEAL TODRYS 53 INDIAN HILL ROAD MEDFIELD, 12-13- MA 02052 USA 2015 CHAIRPERSON STEPHEN YOUNG 63 CHESTNUT STREET BOSTON, MA 12-13- 02108 USA 2015 VICE MARY LOU MALONEY 224 FLORENCE STREET BOSTON, MA 12-13- CHAIRPERSON 02131 USA 2015 ASSISTANT KELLI LEAHY 19 PARTRIDGE DRIVE HINGHAM, MA 12-13- SECRETARY 02043 USA 2015 DIRECTOR JORY BERKWITS 37 ATLANTIC AVENUE 12-13- SWAMPSCOTT, MA 01907 USA 2015 DIRECTOR JONATHAN KATZ 16 CROSS STREET NEWTON, MA 12-13- 02465 USA 2015 DIRECTOR JOHN MURPHY 71 FEARING DRIVE WESTWOOD, MA 12-13- 02090 USA 2015 DIRECTOR DON RICCIATO 28 FOREST STREET MEDFIELD, MA 12-13- 02052 USA 2015 DIRECTOR JOCELYN FREDERICK 32 FRESH POND PLACE CAMBRIDGE, 12-13- MA 02138 USA 2015 DIRECTOR RICHARD WICHMANN 216 WINCHESTER STREET, UNIT 2 12-13- BROOKLINE, MA 02446 USA 2015 DIRECTOR ROBERT YELTON 65 EAST INDIA ROW, APT. 25G 12-13- BOSTON, MA 02110 USA 2015 DIRECTOR STEPHEN YOUNG 63 CHESTNUT STREET BOSTON, MA 12-13- 02108 USA 2015 DIRECTOR NANCY NAGER 246 WALNUT STREET NEWTON, MA 12-13- 02460 USA 2015 DIRECTOR MARTHA SLOAN FELCH 78 WAVERLY AVENUE NEWTON, MA 12-13- 02458 USA 2015 DIRECTOR MARY LOU MALONEY 224 FLORENCE STREET BOSTON, MA 12-13- 02131 USA 2015 DIRECTOR NEAL TODRYS 53 INDIAN HILL ROAD MEDFIELD, 12-13- MA 02052 USA 2015 r r Confidential r Merger r Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Annual Report Application For Revival Articles of Amendment MM Articles of Consolidation - Foreign and Domestic i 1 View filings Comments or notes associated with this business entity: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=042197449&... 6/24/2015 I 06/241/�025 15:36 17814409017 FINANCE PAGE 01/01 MayInstitute 41 Pacella Park Drive • Randolph, Massachusetts 02368 Tel:781,440.0400 Fax;781.440.0401 www.mayinatitute.org Tune 24, 2015 Town of Barnstable 367 Main.Street Hyannis,MA 02601 I Re: Building Permit—21. Pine Sim et,Hyannis, MA 02601 To whom it may concern: Please accept this letter as confirmation that we have hired Mr. Thomas Hilchey to perform roofing and siding repairs to 21 Pine Street, Hyannis, MA 02601. Sincerely, Debra Blair Treasurer and Chief Financial Officer The May Institute, Inc. 41 Pacella Park Drive Randolph, MA 02368 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION -7 1� Map �: Parcel `Application # Health Division Date Issued Conservation Division Application Fee Planning Dept. ;.Permit Fee Date Definitive Plan Approved by Planning Board �V— Historic - OKH Preservation/ Hyannis Project Street Address les 1 Village e Owner Address Telephone Permit Request If04� -Slf6ykej -� :a Square feet: 1 st floor: existing proposed 2nd floor: existing proposed_Total new Zoning District Flood Plain Groundwater Overlay o.v - " Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family . ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name _7,�e"rrn 7-e:Ak s Telephone Number ,S Dk =779-9Y-00 Address 50 yNA License # C,S 3.U.V Q Home Improvement Contractor# /17 9i Worker's Compensation # — "n ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO Ah r tVl) 'h SIGNAT t DATE 4[ C�`� s FOR OFFICIAL USE ONLY APPLICATION# __.DATE ISSUED _ r - i MAP/PARCEL NO.. �- f i j� j ADDRESS VILLAGE OWNER, DATE OF INSPECTION: s: FOUNDATION`-- FRAME t INSULATION'.' FIREPLACE ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL i i GAS: _> ROUGH FINAL "FINAL BUILDING", i DATE CLOSED OUT J !': ASSOCIATION PLAN NO. The Commonwealth of Massachusetts c ^` Department of Industrial Accidents Office of Investigations 600 Washington Street \\ U M R Boston, MA 02111 r\; www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): '� r� J e v�}L,1.v�S Address: i 5-M ywa_�A 54- City/State/Zip: t e-.�nr +►Mc� �3,6 5` Phone #: 7766 Md Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.P9 I am a sole proprietor or partner- listed on the attached sheet. $ I ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for.me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.0 Other 144•e4p &A4P 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below,is the policy and job site information. Insurance Company Name: . Policy#or Self-ins. Lie. #: Expiration Date: Job Site Address: [ ?1'11.e, .5 ' I Y�il'il-lS wM City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby and the pains a��nd��penalties of perjury that the information provided above is true and correct Si ature: "ti' Date: y /I Phone#: fin 91 ,. �_.�C 811d 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 oldie nsumer Affairs& o�✓�acfiva n. License or`re istration'valid for md►vidul use-only Office of Consumer Affairs&Business Regulafion g Y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registratiom ype' Office of,Consumer Affairs and Business Regulation Expirations 2/3/20.13 Individual 10 Park Plaza .'Suite 5170 Boston MA 02116 JE Y JENKINS _ c JERRY JENKINS 502 MAIN ST HARWICH, MA 02645 y L ' Undersecretary Not valid ithout signature J ` 9001, :#Jl lauissiunuo I,1.OZ/S/9 :uoiiendx3 Sti9Z0 VYY 'H01M?JVH iS NIVYY Z09 ' SNINN3f M A6N3f 00 :oI Pahusa - i a 6CSCZ SO :asuaoil 9sua0.1 Josim6dnS uogonl;suo0 Pur. tiuo�lrin.�aa 411119.;o prog � I r r r , Town of Barnstable Regulatory Services s r LlAN6TASLF. w�aq g Thomas F. Geiler,Director µ9t" Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, 31'm M i \ws. ' , as Owner of the subject.property hereby authorize e06 to act on my behalf, in all natters relative to work authorized by this building permit application for: (Address of Job S nature of Owner Date Print Name If Propedy Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. . ! R ! E I 3 f t i 1 i I { S. i LA • f 1r1 � S7'o tZ y _ I°it v�p S-� yx ,✓ :a+ t- f d 1 fit'f tr , ZONING DETERMINATION t TFiE LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON EITHER WAS IN COMPLIANCE ,WITH LOCAL ,Autl 1 !APPLICABLE ZONING BYLAWS IN EFFECT WHEN CONSTRUCTED WITH.RESPECT TO HORIZONTAL DIMENSIONAL REQUIREMENTS ONLY OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS. G.L. TITLE VII, + CHAP. 40A, SEC. 7, UNLESS OTHERWISE .NOTED OR SHOWN HEREON. A CONFIRMATORY INSTRUMENT SURVEY IS ADVISED WHEN STRUCTURES ARE SHOWN TO BE ONE FOOT OR LESS FROM PROPERTY OR REQUIRED ZONING SETBACK LINES. FLOOD DETERMINATION THE DWELLING SHOWN HERE DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A MAP OF COMMUNITY .it 250001 0005 C AS ZONE C DATED 8/19/85 BY THE NATIONAL FLOOD INSURANCE PROGRAM. e CERTIFICATION } I CERTIFY TO ROBERTS, FARRELL s ®Ibe atone laub &urbep Co. ROWLEY, & ITS TITLE INSURANCE +� COMPANY, THAT THERE ARE NO VISIBLE Lett Velbp Ronb. ENCROACHMENTS OR EASEMENTS EXCEPTQ1UebfOrb, �l 02745 $ CAA'fER 1c,° r AS SHOWN AND THAT THIS PLAN WAS rr�r•rnur•:n (rNnr•R MY TMMET)TATF•: 1 -800-993-3302 �� SUPERVISION. lax 1-800-993-3304 r GENERAL NOTES:This mortgage Inspection plan was prepared for the above mentioned client only as of this d e nd Is n 3` , ; descriptions,construction or establishing fence,hedge or building lines. The land as shown heron Is based on client furnished Intended or represented to be a land or property line survey. No corners were set. It cannot be used for preparing deed information and may be subject to further out-sales,takings,easements and rights of way. No responsibility Is extended to the land owner or occupant. It Is not Intended to be recorded. + z '' is✓°-'t'` r V �,.. .. 1 I i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _,qs Parcel Permit# '� Z Health Division C_ Date Issued - o0 Conservation Division 4/00 t e-- Fee Scrz}. Tax Collector" Ed a,rs/C f� SEPTIC SYS'f � } Treasurer INSTALLED IN CO Planning Dept. WI-rH TITL5 5 ENWRONMEN-rAL C01172 x Date Definitive Plan Approved by Planning Board TOVVN REGULAf100$- Historic-OKH Preservation/Hyannis Project Street Address Village Owner -6TTo ie- Address rw1 c14, Telephone -dl 30 —0?'7 9 ,Permit Request A U 2 9-amp -T® i—t?o u-r EfE0,101- 0-e-e-1C T'g is @O-OrA A oA- CAW b V_,C y0r1Z. KQ/J?' S'€�9 � Y)LL ?a � 42' Square fee • 1st floor: existing proposed 2nd floor: existing proposed Total new Valuatio , o0o Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) 3 Age of Existing Structure Historic House: ❑Yes 'IVo r On Old King's Highway: ❑Yes Basement Type: ❑ Full ❑Crr 1 ❑Walkout ❑Other Basement Finished Area(sq.ft.) / Basem nt Unfinished Area(sq,ft) Number of Baths: Full: existing new , I-,' Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil Electric ❑Other Central Air: ❑Yes ❑ /Unew aces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existi size Pool:❑existing ❑new size Barn:❑,existing ❑new size Attached garage:❑exi isize Shed:❑existing ❑new size Other: QMAIP Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use 1 1 BUILDER INFORMATION Name Aelf 00112AChel— Telephone Number (12 Address 6�C ��� �°-� License# O 1 0 9 8 x�•c Y•^ Home Improvement Contractor# 106 ®�f Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO N SIGNATURE b�u �.�-� DATE - /!� a 0 FOR OFFICIAL USE ONLY PERkIIT.NO. ' DATE ISSUED' MAP/PARCEL NO. d sA i ADDRESS . VILLAGE r1F� OWNER r DATE OF INSPECTION. - ti , i FOUNDATION FRAME ' INSULATION , K FIREPLACE e ELECTRICAL: ROUGH ` ' FINAL PLUMBING: ROUGH FINAL ` GAS: ROUGH FINAL FINAL BUILDING S DATE CLOSED_ °OUT , ASSOCIATION•PLAN NO. } s ' '' :��.' t.\':, `i t� \�� t I \::'•.i �i `•'� - � - \� t l't' `l�� ,•\ 1 P;,Fi. + �/ /� �/ \ \�\��. III �•;J,. ��\ - u � >�,+"• ;. s ►�iN \ a�� t + r ! t \L I kv - II[aIi /r '! , Awl owl • I1� t , i , t �O i k: - �_ • o ��, f i �, �t715 npp• j�iw — /� ''••,t: ��k t. � � j rQ � �� M1 m i is t Ftt,, ♦ a } : \ r �1 + m ' t y(4=�� r 7) an � 1 i 1 (: TheTown of Barnstable Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 _ Ralph Crossez Fax: 508-790-6230 Building CommL�: Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more thaw fow dwelling units or to struemres which are adjacent to such residence or building be done by registered cmmactors,with certain exceptions,along with other requirements. Type of Work: Pra,yviQEp jacr Estimated Cost Address of Work:_42 1 ( ro-p 0> Owner's Name: Date of Application: I hereby certify that: Registration is not required for the following reason(s): O Work excluded by law OJob UnderS1,000 [3Building not owner`occupied QOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME InVMOVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR-GUARANTY FUND UNDER MGL c. 142A. SIG 4M UNDER PENALTIES OF PERJURY I hereby apply for a p ' as the agent of the owner. 7 -11Y.4 RA. 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G'to A Cr 93 gr Et Q (►fitj S t�ii gr tof": � �"h �0 0 � V! e� 'C1 01kj. ,j1• � ' � g A• t7 p• y . � g � O �o •ti P N H Lit O •tl (� o o Oil 0 rw US tn C3 arms A p. �• � P O • E i ti : . w A � 94 tr Ln El 2O to \ w •.; o (0 c�. ~y (►,° ; qt ��� '� 1•d � � N• �• `.�� gyp• a P 1 t3• � `• •-t � O cr to co ta. :� t �. -t to '1, c� o €t jr . `�\ t . U ,� • .�;� 1 `.••. ,jJ .. 1 0 r�.s1 n 1 1 17 r 1 I 1 r !n + l ii. r•.r ;��, •.,� ,,Pl i, ` �. h i . (�1)�1 A •r 1.11.:q r '• l0 1 ; ` 1, o�ii���ZG6GG""""___ t ."-- BOARD OF BUILDING REGULATIONS . CONSTRUCTION SUPERVISOR . i N�unberCkS" 014978 ASS; _ s res� 1?l2002 Tr.no: 23205 R tDONALD"d NRDER _20 EILEEN ST Administrator . VFARMOUTFt:MA.026�5' 2 QUERY PROPERTY: QUERY END QUERY PROPERTY PENTAMATION----------------------------------------------------------- 11/08/96 PARCEL ID 248 081 GEO ID 15478 LOT/BLOCK DBA PROPERTY ADDRESS OWNER THE MAY INSTITUTE, INC. 21 PINE STREET - Centerville 940 MAIN ST. SOUTH HARWICH, MA 02661 PHONE (508) 432-5530 DISTRICT HY DEVELOPMENT STATUS C ASSESSOR' S CODE CAPACITY(NOTES) ZONING DIST/ZOC B SEWER SYSTEM FLOOD PLN/ELEV. WATER SYSTEM OKH? ## BEDROOMS ZBA DECISION FAMILY APT LOT SIZE 13939 . 2 OPER/MGR NAME WET LANDS MULT ADDRESS USE 101 (N) EXT / (P) REVIOUS / NO (T) ES / PER (M) ITS / (V) IOLATIONS / (G) EOBASE / (E) XIT This value is not among the valid possibilities QUERY PERMITS : QUERY END QUERY PERMITS PENTAMATION----------------------------------------------------------- 11/08/96 PERMIT NUMBER 17423 PARCEL ID 248 081 21 PINE STREET PERMIT TYPE BREMODC COMMERCIAL ALT/CONV DESCRIPTION INTER.REMOD.BATHRMS/CHG.GARAG.DR. /DECK/A-CON CONTRACTOR PERMIT FEE 50 . 00 VARIANCE STATUS A ACTIVE CONSTRUCTION TYPE 437 GROUP TYPE 1 APPLICATION 08/21/1996 EXPIRATION VALUATION 30000 . 00 DATE ISSUED 08/21/1996 COMPLETED DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE---- (N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/ PR(0) PERTY/ (I) NSPECTIONS/ (H) ISTORY/ (F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E) XIT I Engineering Dept. (3rd floor) Map a Parcel % /Grmit# pZ House# Date Issued ' 02 I �9& Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) 5 0 Conservation Office(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept. (1st floor/School Admin. Bldg.) SEMC SY e l CE D4finifieApproved by Planning Board 19 INSTA ED �� � 8 A' TOWN OF BARNSTAB' Building Permit Application Prddress �—. s //���n'c q An A f Village . Y(/��a Owner, 7-e/F zjjA l Lw Tta rF. L/M Address yL/U IM(lY S/—. . W• Telephone (6-0S) 139- 6 ,3 6 XW'7 Permit Request gi 7n61)EL E4Z i a Z Kf4 .AATd21X S� .1Z:In6 61 �'A,,�14 E 'r2U�'J NntI ALOE N-)O R n) c-MI.' 141YD EYYT/Ec/ Z�OR t A LN8LncYY Or hOX 4 T 64!2A OP 461t a�C , pa AJ 6 'VErY-r7a-d , k rYY ,) �x CF.�E1'YT First Floor /c/00 square feet Second Floor rYb/YE square feet Construction Type P,ynO/J CR,�qmk Estimated Project Cost $ ,9y, 00 Zoning District Flood Plain lyn Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family (� Two Family ❑ Multi-Family(#units) 1 v U� Age of Existing Structure (ge_Z Historic House ❑Yes 4 No On Old King's Highway ❑Yes j No Basement Type: 0 Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing -1/ New Total Room Count(not including baths): Existing I New First Floor Room Count rJ Heat Type and Fuel: ❑Gas ,Oil ❑Electric p Other Central Air ❑Yes LA No Fireplaces: Existing / New Existing wood/coal stove ❑Yes No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) Q4 Attached(size) l__'4P-. ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use Builder Information Name PTelephone Number Address License# 40/ 7a O o2� Home Improvement Contractor# Worker's Compensation# �� NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE lz2CDATE _/ .9' q� BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)/ FOR(OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. 1 1 • •ice + ' rl ,.i ,v ' j ADDRESS VILLAGE r= ` OWNER DATE OF INSPECTION: } FOUNDATION i. FRAME i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL _ PLUMBING: -'a ^ROUG:H FINAL GAS: -a .• UCH FINAL, E� h..4 '.:��Y:l f f ✓ FINAL BUILDING: `" DATE CLOSED PVT- ASSOCIATION PLAN NO. ' f D6!AR4KBB4 OP PUBLIC SAFETY CONSTRUCTION;SUPERVISOR LICENSE Nn�tia : Expires: AO98RtJ B NICKERSON Xmow2A5 lO3E4INGHOUSB RD EAS4HAK, KA 02642 .- Restricted To: 00 0A - None 60926 lA - Kasonry only 1G - 1 & 2 Faiily Hoies Failure to possess a current edition of the Kassachusetts State Buiilding Code i is cause for revocation of this license. - 0 Io�r ►� �1 �.,� �� i NOTICE NOTICE TO A TO EMPLOYEES EMPLOYEES � y\ v The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22& 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: -- ----- -------- _�� L r mmoan n___l�.----------------------------------------------------- NAME OF INSURAbJCE COMPANY mom 0 -CC_t_I______&&A _ ____ __ -_-_J--JP m _ 0 ADDRESS OF INS CE CO ANY go --------------------------------------------------------- -- - - -------_— POLICY NUMBER CTIVE DATES --------------------------------------------------------------------------------------------------------------------------------------- NAME OF INSURANCE AGENT ADDRESS PHONE =D r A LA"J�� ;0 EMPL ------ OYER ADDRESS y b -- I sy;-- --------------------------------------------------------------------- ----- EMP YER'S WORKERS COMPENSATIO OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the services provided by the treating physician will be paid by the insurer,if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention,employees are hereby notified that the insurer has arranged for such tention at the NAME OF HOSPITAL 4VDRESS f TO BE POSTED BY EMPLOYER tl trelct Item#WCMA 6.5 To reorder call NRdirect toll tree 1-M-346.1231. ®Recycled paper • "'•'� Tlie Canintanwealth of Atassacftusettti ,zr'; �'j••� .�r Department ojbrdustrial Accidents 60p 11 axbinepw Street . ..� ..�x�::�;�+� Buxton.Musa 02111 �•�' Workers' Compensation Insurance.AtTd-avit In citti• nhane ❑ lam a homeowner performing all work myself. ❑ (am a sole proprietor and have no one working in any capacity Q 1 am an employer providing workers' compensation for in employees working on this job. phone 1t• .�d 3 7� —sS 3 4 nolicr�! ❑ 1 am a sole propriet neral contrac r Homeowner a one)and have hired the contractors listed below who h. the following workers compensation pot r ,v 'ut) phone$11 lh sum mInv .fi phone#- insnr•�n o "offerto :Minch additioaai'sheet if ceeessar�, Failure to secure coverage as required uader Section 3A of h1GL 15-can Indio the imposition otcnmmal penalties of s fine up to 61JWD ammo: one Years'imprisonment as midi as civ ii pensides in the form of a STOP WORK ORDER and a tine ofS100.00 a day agaitut me. 1 understand that cop.*of this statement may-be forwarded to the Ofree of ltn'estigatiorn of the D1A for coverage verifkation. 1 do herehr carffl• the pains and penalties ojpcdury that the infornrmion pmrided abow is ire mid correct: ttu . Sienattu+e Print name y -none0 7Wr / �cc ///.4y sT/ , �C' J �T SOY Cial use only do not write in this area to be completed by city or town official permitAleaue 0 rnfluilding Department ein or to". DLicetuuag Board check if immediate response is required OSelcetmen's Office 13 Ctieaith Department contact person: phone il; pother,__ information and Instructions Massachusetts Gencral Laws chapter 152 section 25 requires all employers to pmvidr worg:ers' compensatibii-for tl • another under any » � on in the service of . defined as eve person employees. As quoted from the "law".an emplgt ee is every p contract of hire.express or implied.oral or written. 1 An emplgrer is defined as an individual,partnership,association.corporation or other : gag entity,or any two or in 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 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 wort:on such d�veliin0 or on the grounds or building;appurtenant thereto shall not because of such employment be deemed to be an emplo; MGL chapter r52 section 25 also states that every state.or local licensing;agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for asi}• applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally.neither the commonwealth nor any of its political subdivisions shall enter into any contract for tha performance of public work until acceptable evidence of compliance with the insurance requirements of this chapte been presented to the contracting;authority. ..••----""' ^ :� •1 i� ;a•�.•,,;!wh y.r r,,T:z7MMAX. v .^r.o:.� :n .r� ,';r::.77.—•'.' t• •r;•�r•. 'L.'i': :_:«., _ �p»•.T�.•i• � ,..�1 ,�L� ••\�..•�+'..:. `7`;<Y.•' ::�t•...w..:J'L.'.iV�4� i::.. Applicants Please fill in the workers' compensation affidavit completely,by checking the boa that applies to your situation anc supplying-company names.address and phone numbers as all affidavits 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 requir to obtain a workers' compensation policy,please call the Department at the number listed below. .. •.e. .� M�' :1-i. r. ray fp,.... FisT• City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom the affidavit for you to fill out in the event the Office of be used as alrefereons nce num to ber you regarding The affidavits may be r�eiurtiec be sure to fill in the permit/license number which will the Department by mail or FAX.unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any quesm Please do not hesitate to give us a call. T*tt�. ��- ;•;•... .•,.•.� ',w.•r+Y: :^ `iL1•1i•..+.;s u'.-� «�•Z' ...�::..•.vr� ..n.::.w... •t._:er.;The Dep artnient's address, telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents -- Office of lwesdgodans ,, .... . r 600 Washington Street _. _ Boston,Ma. 02111 fax#: (617)727-7749 •. phone#: (617) 727 4900 ex 406 409 or 375 n�IAN CAPE & ISLANDS GLASS CO. , INC. 1 73 IYANOUGH RD.(RTE. 28),HYANNIS, MA 02601-4729 775-7742.394-4599 1-800-540-7742 71 FINLAY RD.,ORLEANS,MA 02653 SANDWICH IND,PK„SANDWICH,MA 02563 255-8131 888-6565 AUTO ® COMMERCIAL ® HOME OWNERS FREE MOBILE SERVICE&ESTIMATES AUTO GLASS•PLATE GLASS e WINDOW GLASS•MIRRORS INSULATED GLASS•SCREENS•PLEXIGLAS•SUNROOFS, FILE t A1442 CENSUS TRACT 127 CLIENT: ,!- DEED BOOK PAGE OWNER: EVELYN M ANDERSON PLAN BOOK 145 PAGE 87 LOT 1 APPLICANT:THE MAY INSTITUTE, INC. ASSESSORS PLAN R248-081 PLOT MORTGAGE INSPECTION PLAN OF LAND LOCATED AT SCALE: 1^=70- 63 PINE STREET HYANNIS, MASSACHUSETTS APRIL 30, 1996 Lo'r Z nl a V f W ' 7 li l 3 6AleAGE- _a- m � O ^? r—'— Ir d X/ ZONING DETERMINATION THE LOCATION OF THE ORIGINAL DWELLING SHOWN HEREON EITHER WAS IN COMPLIANCE ,WITH LOCAL !APPLICABLE ZONING BYLAWS IN EFFECT WHEN CONSTRUCTED WITH.RESPECT TO HORIZONTAL DIMENSIONAL REQUIREMENTS ONLY OR IS EXEMPT FROM VIOLATION ENFORCEMENT ACTION UNDER MASS. G.L. TITLE VII, CHAP. 40A, SEC. 7, UNLESS OTHERWISE NOTED OR SHOWN HEREON. A CONFIRMATORY INSTRUMENT SURVEY IS ADVISED WHEN STRUCTURES ARE SHOWN TO BE ONE FOOT OR LESS FROM PROPERTY OR REQUIRED ZONING SETBACK LINES. FLOOD DETERMINATION THE DWELLING SHOWN HERE DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD ZONE AS DELINEATED ON A MAP OF COMMUNITY -t 250001 0005 C AS ZONE C DATED 8/19/85 BY THE NATIONAL FLOOD INSURANCE PROGRAM. CERTIFICATION I CERTIFY TO ROBERTS, FARRELL s ®Ibe btoue Tlaub burbey Co. ROWLEY, & ITS TITLE INSURANCE 19en Velby Rub ��� F*0 'COMPANY, THAT THERE ARE NO VISIBLE $ D R y ENCROACHMENTS OR EASEMENTS EXCEPT ReW Webforb, PAR 02745 AS SHOWN AND THAT THIS PLAN WAS t 800 993 3302 PRFPARF:D IINDF:R MY TMMI?nTATF: D� SUPERVISION. Jax 1-600-993-3304 t/av GENERAL NOTES:This mortgage Inspection plan was prepared for the above mentioned client only as of this d e nd Is n Intended or represented to be a land or property line survey. No corners were set. It cannot be used for preparing deed descriptions,construction or establishing fence,hedge or building lines. The land as shown heron Is based on client furnished information and may be subject to further out-sales,takings,easements and rights of way. No responsibility is extended to the land owner or occupant. It Is not Intended to be recorded. i � � � �� 3 L2-� J C r , _, � [ ] [R248 081 . ] LOC10021 PINE STREET CTY110 TDS] 400 HY KEY] 154781 ----MAILING ADDRESS------- PCA] 1011 PCS] 00 YR] 00 PARENT] 0 MAY INSTITUTE INC MAP] AREA] 55DC JV] MTG] 0000 BOX 708 SP1] SP21 SP31 UT11 UT21 . 32 SQ FT] 1792 CHATHAM MA 02633 AYB] 1959 EYB] 1970 OBS] CONST] 0000 LAND 26400 IMP 110400 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 136800 REA CLASSIFIED #LAND 1 26, 400 ASD LND 26400 ASD IMP 110400 ASD OTH #BLDG (S) -CARD-1 1 110, 400 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 21 PINE ST TAX EXEMPT #RR 1258 0143 1114 0127 RESIDENT' L 136800 136800 136800 #SR OAK HILL ROAD OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE105/96 PRICE] 137000 ORB110220232 AFD] I LAST ACTIVITY] 08/01/96 PCR] Y I R248 081 . A P P R A I S A L D A T A KEY 154781 MAY INSTITUTE INC LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=B 26, 400 110, 400 1 A-COST 136, 800 B-MKT 112, 300 BY 00/ BY /00 C-INCOME PCA=1011 PCS=00 SIZE= 1792 JUST-VAL 136, 800 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 55DC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 55DC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 264001 LAND-MEAN +0% 1368001 80445 IMPROVED-MEAN +37% 2506 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10096] LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR] AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] R248 081 . A P P R A I S A L D A T A KEY 154781 MAY INSTITUTE INC LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=B 26, 400 110,400 1 A-COST 136, 800 B-MKT 112 , 300 BY 00/ BY /00 C-INCOME PCA=1011 PCS=00 SIZE= 1792 JUST-VAL 136, 800 LEV=400 CONST-C 0 ----COMPARISON TO CONTROL AREA 55DC -- TREND EXCEEDS STANDARD NEIGHBORHOOD 55DC HYANNIS PARCEL CONTROL AREA TREND STANDARD 101 10 LAND-TYPE 264001 LAND-MEAN +0 1368001 80445 IMPROVED-MEAN +370 250 ] FRONT-FT ] 100 DEPTH/ACRES TABLE 02 10001 LOCATION-ADJ APPLY-VAL-STAT 1 LNR] LAND LFT/IMP] ADJS/SB/FEAT STR] STRUCTURE ARR] AREA-MEASUREMENTS NOR] NOTES COM] MARKET INC] INCOME PMR] PERMITS GRR] GRAPHIC FUNCTION- [ ] STRUCTURE-CARD NO- [0 0 0] DATA- [ ] XMT [?] ] ] [R248 081 . ] TAX ACCOUNTING [ ] 1929- [ 1547811 RECEIPT NO. PAYMENT TAX YEAR/B.G. AMOUNT DATE TYPE PID 0 ------CERTIFIED OWNER------ TAX DUE 2, 082 . 10 ] OUTSTANDING . 00 ANDERSON, EVELYN M P ] TAX CODE 400 ] CITY 101 DISTRICTS HY ------JANUARY 1 OWNER------ ACTION ] MORTGAGE CODE A0000] ANDERSON, EVELYN M P ] ----CERTIFIED VALUES---- -------CURRENTOWNER------- TAX EXEMPT . 00 ] MAY INSTITUTE INC ] TAXABLE . 00 ] BOX 708 ] RESIDENT'L 136, 800 . 00 ] CHATHAM MA 026331 TAXABLE 136, 800 . 00 ] 00001 OPEN SPACE . 00 ] ] TAXABLE . 00 ] -SPECIAL LEGAL DESCRIPTION- COMMERCIAL . 00 ] #LAND 1 26, 4001 TAXABLE . 00 ] #BLDG(S) -CARD-1 1 110, 4001 INDUSTRIAL . 00 ] #PL 21 PINE ST ] TAXABLE . 00 ] #RR 1258 0143 1114 0127 ] ] #SR OAK HILL ROAD ] ] avmmoniue-A4 of Aassac4usetts TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 120.0, this CERTIFICATE OF USE AND OCCUPANCY is issued to THE MAY INSTITUTE �-nrtff-that I have ins cted- STAFF DEPARTMENT known as PINE STREET RESIDENCE ocated a PINE STREET in the VILLAGE of HYANNIS Co t of Commonwealth of Massachusetts. The building is hereby certified to be in compliance with the Basic Code and for the purpose stated below. USE GROUP R-5 FIRE GRADING OCCUPANCY LOAD 4 l" NOVEMBER 30, 1994 7� Date Certificate Issued Bui444g official The building official shall be notified of any changes in the above information. J GENERAL REQUIREMENTS - --- 1. The Contractor's responsibility shall include all supervision, labor, ma�erials, tools, equipment, services, insurances, permits, inspections and approvals and temporary r 111� !`4' -/�,'�✓i' utility services required for the proper completion of the project indicated on all these Drawings in accordance with all applicable provisions of the State Building Code I ( i it VI and all other applicable codes and regulations. By beginning work the Contractor shall ! � � agree and warrant that he has complete familiarity with all these Drawings, - 9 P Y 9 specifications, schedules, site and utility conditions and all applicable Codes, Zoning Bylaws, Regulations and reference specifications, and shall comply with the same and ALE procure all permits, inspections and approvals required by the State or Local Codes and GD N weIm U.R. Regulations. Contractor shall carry out and properly complete all project work in a �2,(�\�I(\f timely manner in conformance to the highest applicable industry and trade practices and Nno 40 standards and shall warrant all project work to be free from any defects or deficiencies MV GARAGE for 1 year from date of completion of his work (this warranty shall not reduce or Ag`f WORK c`I � L I CoAyi- invalidate any other warranties or legal rights the Owner may have a ainst the Ig �r� � I BEDRM#4 DINING RM KITCHEN ( LDY Contractor for defective products or workmanship). � �n � BEDRM#3 -__ _ _ a s- 2. Use adequate numbers of skilled and, where required by Codes and Regulations, licensed ' `I~ u J M) ��T' Ii KEN "AM N rYR-f �•���V � tradesmen and workmen, who are thoroughly trained and fully experienced in the required i !!"� 1 �� I� 1 r I i JCODNIERI'oP5 4 �NIN• �ToN 41" "7 ___ �1•IO/2 �l-0 -1U/ I AMIhNWn V5 N5 - trades and crafts and completely familiar with all these Drawings, specifications, �f pp I I �I•�L'W � O�yNER _ 14'Xto�O Codes, Regulations and related concerns and the proper methods required for the WV COON 41TYR ' r �� completion of this project. At I"�V� ' �•0,� I \ I 3. Use all means necessary to protect all materials and work before, during, and after installation and until the Contract Work has been completed. Construction safety and 0 protection of the workmen and public and adjacent property shall be the responsibility { `L of the Contractor, who shall take all measures necessary to prevent injury or damage to J. _ _ 1 , Q __ ____ __ __—___ FE\V ,y d_ 3 Oi all people and property. Maintain entire jobsite and work areas clear of all trash and + ' ; �I �7 i ( It d� yoy1�Z 1 AL debris at all times and thoroughly clean entire project at completion of the project L work. eo \� I -_ WN! ` 41 OP(�." L04Q•D - A +I , fii:�V UP SI;T POT @ WcT locD,l'14N �� tL�•I ; N�V _- -- --- - - — — — — — -- -� 4. Dimensions indicated on all these Drawings are generally taken to/from the centerline or �.. r"�ATI14�2,1 i i �� 'j 1 TOP C -Ia, 1V � edge of materials, unless obviously indicated otherwise. Verify field dimensions prior giv II I ��X� o �M- FIN. IFLiL• 44ITWE N to carrying out work and notify Architect of any discrepancies with all these Drawings; L_ i I '4_4 LA`t�V any adjustments between field dimensions or between field and Drawing dimensions shall Wn I I E-+ be made as directed by the Architect. Do not scale dimensions from any of these PR \VAu. C ' + a` j >< F-, H v Drawings for any purpose. BATH 3-x I ' 1 #1 i + +. ; `HALL LIVING RM i a H N 0) N T 5. Report any discrepancies between the requirements or information contained on all these T ±j ` ` - ° ' �- - ---- - ---� y , ,V I I I � � CN Drawings and the actual work conditions prior to carrying out work, any discrepanci 5 shall be resolved as directed by the Architect. I — _ = _-' -- - FOYER I I aw � rn Za~oa 6. All concrete shall be "transit-mix" type and shall have a 3,000 psi strength at 28 days. I G/�V`VIN CL ors � - Ni L � (naoawLn Do not place concrete in any manner or during any weather period that could damage or T11CM - ` - ti w x Z reduce the strength. O n`AT f- F1�11 w 0 o x 4OVA ' �� ?f_�Ev. \VD• � a a a w7• Rough carpentry work and materials shall comply with all applicable provisions of the i � lf�1�5 (� TTI _ tO1.D State Building Code, Article 34; particular attention is hereby directed to Table 3403.2 PFastener Schedule, and Section 3403.2.7 Firestopping. All wall, partition, and similar I) -- - -------- v - - light framing shall be "stud grade" kiln-dried Spruce-Pine-Fir (SPF) or equal. All 1 �I I yJ ! N ( 1 li -` I I a-1Q 5•,q f 2 0 I•i _ - -- - - it floor, ceiling, and roof framing shall be "No. 2 grade" kiln-dried Spruce-Pine-Fir (SPF) I __._ � ` ___._ ____� -- —' ___ NOTES o N or equal. All plywood products shall be Fir (Exposure 1) clearly marked with the I (! i --FT `' U•Tn 1 ^ / p A' to appropriate APA Certifications. Do not impair the strength of any framing members by �I +� — F.I• V NIP)' tARDIN�fi 111 9(?KXdLIC F14. improperlyoinin cutting, or notching. All rough carpentry work shall be neatly and I _ joining, 9 9 9 P Y Y I ON PT WD K. 1 u, accurately cut and fitted and securely attached with proper fasteners. BEDRM#2 Ii BEDRM#1 4- i All new interior and exterior wood framing shall be 2 x 4 @ 16" oc. , unless noted o " otherwise. 4 8. Contractor shall be fully and solely responsible for providing all supervision, labor, - P T• ,Vp STLPCJ ,�� N�i�1'S�IP 1'IN ON � N m materials, equipment, tools, services, means and methods that are not indicated on these CL ( �� 2 FEWF = Face of existing wood frame(ing) a >4 FT. 1<I� S I�v~R� @ �2 `�'L' Ii FNWF = Face of new wood frame(in 44 -�' < Drawings, but are required for the proper completion of this project. Prior to -- �- {{�� �..,Gt H 9) o g q p p P P 3 - ( n�AX• F1✓M �O (uobED) • WK TREAD ' i�. FWA = Face of wall above proceeding with any work, Contractor shall meet with the Owner to determine, identify I!, - ► y 4J N and agree to any such above items. _____._ __._ __ 7LA __— �•y �i •� My o 0 ___ �•T \ D RRII. ��I•u51 YQ G✓��•- �J�D >D►�Y 3. Bath #1: Tub = Kohler #K1561 (white) 9. Do not cut and patch structural work or building components in a manner resulting in Top/ Lk RDiX > 1�AD N Cy111I('1 All other plumbing fixtures as selected by Owner Z o a � reduction of load-carrying capacity or decreased safety. Do not cut and patch exposed 11A p, T G Q`' 'N work or finishes in a manner resulting in reductions of visual qualities of finished _ _ _ 1 `�I2� �II� `TffiS�DRAtyL1 Vl�ol ✓�D ��k f•'f�JY• Floor Fin. = Slip-resistant type as selected by Owner U n surface. Provide materials for cutting and patching which will result in equal or TQP/ 1NDl►V& I R�NQ NQyl�0' `u i° '' better work than existing work. Restore exposed surfaces of patched areas and extend ETY Fan/Light = Nutone #QT 140L duct to exterior and switch separately E afinish restoration onto retained work adjoining in a manner which will eliminate I Nam u evidence of patching. Because the work indicated herein involves an addition to and R 4, Bath #2: Shower = Kohler #K12465-SS (white) renovation of an existing building, the Architect cannot, and does not, assume any 1 Tf' All other plumbing fixtures as selected by Owner responsibility for the accuracy of dimensions indicated or liability for any problems or , 'd 3 unacceptable or hazardous conditions that may be a result of the conditions of the Grab Bars = 1 @ 36" L. 8 1 @ 24" L.. stainless steel with peened finish. Mount '� v existing building. Contractor shall be responsible for reviewing all Code requirements @ 34" above fin. floor on solid wd. blocking Q o pertaining to the existing building with the local Building Inspector and Owner. Cover Q '4 t and protect furniture, equipment and fixtures to remain from soiling or damage when v Vanity Top = 30" W. x 22" D. plastic laminate on wood frame and steel J u ti ar demolition work is performed in rooms or areas from which such items have not been �1 removed. Erect and maintain dust-proof partitions and closures as required to prevent brackets with china bowl. Mount @ 32" above fin. floor with "m w spread of dust or fumes to occupied portions of the building. Perform selective 27"min. clearance to underside. ►o+ 3 demolition and off-site disposal in a systemmatic manner of those portions of the 0 existing building as indicated on all these Drawings or otherwise required to properly Floor Fin. = Slip-resistant type as selected by Owner O ro accommodate the new project work. OOR �� l Fan/Light = Nutone #QT 140L duct to exterior and switch separately J ° a -1 N LL aom 1/4'=1'r-0' N BLDG NORTH O O W cc Luz W CO zQ ? WZ awa ZZ 2 I U CL Q w L) M >' r a Y cp = +1 N