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HomeMy WebLinkAbout0088 WEST MAIN STREET V • - NA-1 .. f i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map arcel . 0�bApplication # Health Division Date Issued 1 Conservation Division Application Fe G Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address �3� 1�[. Fain Sit'• Village 44 Ann it 5 Owner `I e 1 "j5¢_ Red14cJ -Thj-s+ Address P.0 . $6X 389, GAmilL, HA Telephone 5P6 77 t- 22A 51 -- I Permit Request �P_ aecl,, A- — e. w f -5EWPER IAA "_PX_ . 085 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation$ 1, Soo ," 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 Q: Basement Type: ❑ Full ❑ Crawl ❑Walkout . ❑ Other UBasement 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 12 Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/c al stoypi ❑res ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing �news a size_ C 03 c-n '- Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: " > a Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ co `•° Commercial ❑Yes ❑ No If yes, site plan review # Current Use 'De GL Proposed Use _ &y.L grce SS APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name V i 0 ta kSOCtak S Telephone Number 5 e8 . 77 Address 110 &52n4 Laf%L. License # C5 7f 33Z 4"ann t 5 I I M lk 02(Qo I Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4" Sl � SIGNATUR DATE Ills-IJ6 s FOR OFFICIAL USE ONLY a APPLICATION DATE ISSUED MAP/PARCEL NO. `. ADDRESS VILLAGE -.. OWNER DATE OF INSPECTION: FOUNDATION - r FRAME INSULATION `i FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - ` GAS: ROUGH FINAL _• FINAL BUILDING DATE CLOSED OUT ? ASSOCIATION PLAN NO. Vie Comrnonwealth of Massachusetts 1Departrnent of Industrial Accidents Office of Investigations 600 Washing-ton Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsrElectricians/Plumbers Applicant Information A 1 Please-Print Legibly Name (Business/Organizaiionadividual): 7"he, Address:T!0 $OTC 389 City/State/Zip:CenkfJ HA Phone.#: SO$ 7 71— 34S 7 Arne yo�n employer? Check the appropriate box: Type of project(required): 1.►SI am a employer 4. ❑ 1 am a general contractor and 1 mp yer with�— 6. New construction employees (full and/or part-time).* have hired the stab-contractors 2.El 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.imurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required_] t c. 152, §1(4), and we have no employees. [No workers' 13.❑ Other comp,insurance required_] *Any applicant that chocks 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 afii&vit indicating such. tContractors that check this box must attached an additional sheet showing the namo of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. //��c Insurance Company Name: f' ata t a X suea.ix't° Co. Policy#or Self-ins. Lic. CA d 2-150003 Expiration Date: 4 2_4 q Job Site Address: AMA Sf• City/State/Zip; Alannis , 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 Ent Lip 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 WA for insurance coverage verification. --- I do hereby certify rider the pains andpenalties of perjury that the information provided above is true and correct. Si attire: Date: ( S _ Phone#: official use only. Do not write in this area, to be completed by city or town officiaC City or Town: PernuWLicense# 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 Instr°Uctions 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." oho ter 152 25 7 states `Neither the commonwealth nor any of its political subdivisions shall Additionally,- MGL ,, § CO , P 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, i. necessary, supply sub-contractors)name(s), addresses) and phone number(s) along with their certifacate(s)of insurance. Limited Liability Companies'(LLC) or Limited Liability Partnerships (LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit, The affidavit should be returned to the city or town that the application for.the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the nurgber listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Towp 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 ivaltiplc permit/license applications in any given year, need only submit onp affidavit indicating current necessary) and under"Job Site Address" the a licarit should write"all locations in (city or polity information(if ne ary) PP town). A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be,filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said persoii 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 e6mmonwf th of Mas.5aGhus�,. Depaztme:nt of Industrial A.ccid'nts Office of WY. 'estigati.ons 600 WashinptQn Street Boston, MA 02 111 TQ1.. # 617-727-49,0.0 ext 4.06 or 1-877-MASSATE Fax# 617-727-774 Revised 11-22-06 www-.mass..gov/dia �0E-1HErp�L Town of Barnstable Regulatory Services RA"Y i SAS. Thomas F. Geifer, Director �Ar�t6_19. Building ]division Tom Perry, Building Commissioner 200 Main Street, Hyannis;MA 02601 www.to)vn.ba rnsta ble.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A wilder 1, :16�A io13 F '�l�E 7�GMW5�- , as Owner of the subject property R�`l T2.hsT hereby authorize y� &s-swct f=Ms to act on my behalf, in all matters relative to work authorized by thts building permit application for: y4- IMAlto S i 1' QJS j4A (Address of rob) 1l S O ignature of Owner D to Softj ►' V tMA Print Name I If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Town of Barnstable �oFir+e r � Regulatory Services aAtuvsrABt Thomas F. Geiler,Director D, MASS. 079. ,w Building Division Prfo �a Tom Perry,Building Commissioner 200 Main Street, Hyannis., MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 _________---------------- HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone N 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 Bc 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 caret amend and adopt such a forrn/certification for use in your community. ,. `` ,per ✓/ze �ommwouaealdz o�✓Olc;ooaclwoet7a �\ Board of Building Regulations and Standards License or registration valid for indivldul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Board of Building Regulations and Standards Registrations. 146436 One Ashburton Place Rm 1301 EI pi at on 6/2009 Tr# 267146 Boston,Ma.02108 i,, i`= gpePiv to Corporation VIOLA ASSOCIATES JOHN VIOLA 110 ROSARY LANE�41N1 .:�' � HYANNIS,MA 026 Administrator Not valid without signature Al G.lfzeam�naiuura/ -OX✓ aaac�uiiaeelld ' bard of Building Regulations:and Standards 1 Con struction.Supervisor License License .CS 76332 . f Birthtteg/514960 I lb 97 2,09 Tr# 4218 KEVIN BOYAR ; Pb BOX 71.6 W BARNSTABLE,MA 02668 Commissioner Fax:5083936983 Aug 25 2008 09:13am_,P002/00L.— ACQRD UtK i II-1(:A I t Ut- LIAMLI I Y IN,UKANUt CSR Cv VIOLAAS 08125408 PRODUCER' THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Kittredge Insurance Agency Inc HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 155B Otis St. , P.O. Box 1129 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW- Morthboro t-Sk 01532 Phone: 508-393-7744 Fax:508-393-6983 INSURERSAFFORDING COVERAGE NAIC 9 INSURED INSURERA: Acadia Insurance Company 31325 ... INSURER B: Cmtinenbel aeeaem Ina. Co. 10804 Viola Associates Inc. INSURERC: BOX 389 INSURER D: Centerville HA 02632-0389 INSURER E: COVERAGES THE POLICISS 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.INbK . FULICY EFFECT POLICY EZMATION LTR NSR TYPE OF INSURANCE POUCYNUMBER DATE MM/DD DATE MWDDfYY LIMITS GENERAL LIABILITY - EACH OCCURRENCE $1,0 0 0 000 A X cOMMERCIALGENERALLIABILITY CPA0217962 04/29/08 04/29/09 PREMISESIEmo=renee $250 000 CLAIMS MADE 7 OCCUR MED EXP(Any one person) $5,0 00 PERSONAL&ADV INJURY $1,0 00,0 0 0 GENERALAGGREGATE s2,000,000 , rGENGREGATE LIMIT APPLIES PER: PRODUCTS-COMNOP AGG s 2,0 0 0,0 0 0 ICY X JRO LOC Emp Ben. 1,000,000 AUTOMOBILE LIABILITY A ANY AUTO MAA0217963 04/29/08 04/29/09 COMBINED SINGLE LIMIT(Es51,000,000 (Ee accident) ALL OWNED AUTOS BODILY INJURY X. SCHEDULED AUTOS ;(Per person) S. X HIRED AUTOS t BODILY INJURY $ X NON OWNED AUTOS (Peracredern) PROPERTY DAMAGE $ (Per accidanl) GARAGE UABILI TY AUTO ONLY-EA ACCIDENT S ANY AUTO OrHERTHAN EA ACC S AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ S DEDUCTIBLE RETENTION $ $ WORKERS COMPENSATION AND X WC STATU71 FMPLTORT LIMITS ER B ANYP YER&OWP TY WC:A0218000 04/29/08 04/29/09 E.L.EACH AOCIDENT $500000 ANY PROPRIETOR/PARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? E.L.DISEASE-.EA EMPLOYEE $500000 If yes,desatbo under SPECIAL.PROVISIONS below E.L.DISEASE-POLICY LIMIT $50000.0 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL.20 DAYS WRITTEN . :NOTICE TO THE CERTIRCATE HOLDER NAMED TO THE LEFT„BUT FAILURE TO DO 50 SHALL TOWN Of Barnstable IMPOSE NO OBLIGATION OR LIABILITY DF ANY KIND UPON THE:INSURER,ITS AGENTS OR 20Q Main Street Hyannis;MA 02601 REP5EIArATIVES. Oq AUTHUPED REPRESFJJ TIVE AGORD 25(2001108) D ACORD CORPORATION 1988 ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map l Parcel l Application # 0 0 1 3 0 C Health Division Date Issued Conservation Division Val Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Addresl1s ���p�CS Village -I VAII Owner 6 Yjzi YN V I'D Address 2/4-7 Telephone kik 9--- Permit Request ,i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size o 31 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 9lo On Old King's Highway: ❑Yes 9 No Basement Type: Y Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) ZE Number of Baths: Full: existing new Half: existing nLn `"'e�w -= Number of Bedrooms: existing _new :� Total Room Count (not including baths): existing new First Floor Ro(m Count'` ro � Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other w Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/ oal stover ❑Wj3 ❑ No � I 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 `'s u r )4�_, C-% w Telephone Number ti - Address 0 License # /-C tvt Home Improvement Contractor# e e E��� eJ d S 60LGPP_Phd),rA.J,(loti g�rw c �i°-0� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /0 Z2 hl FOR OFFICIAL USE ONLY APPLICATION# - x DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: .�«FO.UNDATION-i- FRAME INSULATION FIREPLACE y ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING C DATE CLOSED OUT _ y ASSOCIATION PLAN NO. .. j The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: Co City/State/Zip: 1 I Phone#: - Are you an employer?Check the appropriate bog: Type of project(required): 1.2rI am a employer with 4. I am a general contractor and I employees(full and/or part-time).* 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; Q Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. o worke rs' 13.❑ Other LI`I 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: t LV l Policy#or Self-ins.Lic.#: L r C<_ 3/S -3 1 C"7 J —D /1� Expiration Date: Job Site Address: t"'A4t S T 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$1,50.0.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insur ce co erage verification. I do hereby certify under a a' t77 of perjury that the information provided ab ve is true and correct. Signature: 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. Pursuantto 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 certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit(license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASWE Fax# 617-727-7749 Revised 4-24-07 www.mass.govfdia 'G CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 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 endorsements . PRODUCER FRANK L HORGAN INSURANCE AGENCY INC CONTACT NAME: 44 BARNSTABLE ROAD PHONE HYANNIS, MA 02601 ac No E-MAIL ADDRESS: INSURER 9 AFFORDING COVERAGE NAIC p INSURERA: INSURED INSURER 8: CAPE& ISLANDS CONSTRUCTION COMPANY INC PO BOX 210 - INSURERC: CENTERVILLE MA 02632 wsURERD: INSURERE: INSURERF: COVERAGES CERTIFICATE NUMBER: 16291898 REVISION NUMBER: i 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 ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVV POLICY NUMBER MMIDD/YYYY MMMD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea ocwrrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ f I PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ 1 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMROP AGG $ POLICY PRO LOC $ AUTOMOBILE LIABILITY COMN a BI eD SINGLE $ 8 j ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS - AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY AMAGE AUTOS Per accident $ { $ 9 I $ UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ i DED RETENTION$ $ $ STA QTH $ A WORKERS COMPENSATION WC5-31 S-377540-013 5/7/2013 5/7/2014 ,/ W Y LIMBS ER x AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER EXECUTIVE OFF ICERIMEMBER EXCLUDED? rN] N/A E.L.EACH ACCIDENT $ 100000 ( (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. 'HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE Jeff Eldridge t/ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD W1it ND.: 16Z91B98 DLdi. Dan as 5/9/ 017 7;24:08 AM Pa 1 of 1S certificate canceyls and supersedes An previously issued certificates. TMEo . Town of Barnstable Regulatory Services y�M g Thomas F.Geiler,Director r Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize � �v` �S,C�t�/ S C'on/Si /C/�a to act on mp behalf, in all matters relative to work authorized by this building permit (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. SiAture of Owner ' Signature of Applicant "o V/ 4- Print Name Print Name Date Q:FORMS:OWNERPEPMSSIONPOOLS 62012 Town of Barnstable Regulatory Services * s NAM ' Thomas F.Geiler,Director 39- I Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: i 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,RLovided that the owner acts as supervisor. DEFINPITON 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 l 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. C:\Users\decolliik\AppData\Loca]\Microsoft\wmdows\Temporary Internet FUes\Contentoutlook\QRE6ZUBN\EXPRFSS.doc Revised 053012 Town of Bamstable Geographic Information System October 21,2013 290032 280081 #0 #27 x M 7n 290031 200162 ® *17 #124 � 290173CND #110 . 2901163CND 290080 010 #76 sy � 290030 , #88 29002OCND #100 290028 #112 NEST&7AIM sT 290101002 290100 0 2WI01001 #0 041 #106 DISCLAIMERS:This map Is for planning purposes only. it Is not adequate for legal Map:290 Parcel:030 boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner:MELODY REALTY,LLC Total Assessed Value:$154600 Selected Parcel 1'-i 00'may not meet established map accuracy standards. The parcel lines on this map W B are only graphic representations of Assessor's tax parcels.They are not true property Co-Owner Acreage:0.31 acres Abutters boundaries and do not represent accurate relatlowhips to physical features on the map Location:88 WEST MAIN STREET such t! su as building locations. Buffer B g 1 _ _ Ir Vol 3 1� I ��1 "i - - - - - - - - - -- - - - Ito I - - - - - l - -- - - - - - - -- - - - --1 00) sy - nT _ F 4 ir - I I _ 1__ l � _ _ � - - I I l i I I License or registration valid for.individuL use only. before the expiration date..If found return to: Office of.Consumer Affairs and Business Regulation i 10 Park Plaza:--Suite 5170 ' Boston;MA 02116 i �.1 i=' 6 al ty thout signature F— j. Massachusetts - Department of Public Safety Off, ceOf Consumer Affairs&BusinessRegulation Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Construction SulmrN isor Registration 165936 ! ;= Expiration- Type:. License: CS-074660 r� Private Corporation CAPE&ISLAND CONS.TR{ JOSHUA X KOURf r UCTION CO INC. - PO BOX 210 JOSHUA KOURI ti b CENTERVILLE MA 0263 55 ELM AVE. i HYANNIS, MA 02601 ,I i" Expiration - Undersecretary a 02/12/2015 Commissioner r Mass. Corporations, external master page Page 1 of 2 William Francis Galvin b` ' Secretary of • • of HOME DIRECTIONS CONTACT US Search SeC State.ma uS ! Search ......... Corporations Division Business Entity Summary ID Number:001078731 LRequest certificate New search Summary for: MELODY REALTY LLC The exact name of the Domestic Limited Liability Company(LLC): MELODY REALTY LLC Entity type: Domestic Limited Liability Company(LLC) Identification Number:001078731 Date of Organization in Massachusetts: 05-08-2012 Last date certain: The location or address where the records are maintained(A PO box is not a valid location or address): Address: 2167 FALMOUTH RD. City or town,State, Zip code,Country: CENTERVILLE, MA 02632 USA The name and address of the Resident Agent: Name: JOHN VIOLA Address: 2167 FALMOUTH RD. City or town,State, Zip code,Country: CENTERVILLE, MA 02632 USA The name and business address of each Manager: Title Individual name Address MANAGER JOHN VIOLA 2167 FALMOUTH RD. CENTERVILLE, MA 02632 USA MANAGER ALLISON VIOLA 2167 FALMOUTH RD.CENTERVILLE, MA 02632 USA In addition to the manager(s),the name and business address of the person(s)authorized to execute documents to be filed with the Corporations Division: [Title Individual name Address The name and business address of the person(s)authorized to execute,acknowledge,deliver,and record any recordable instrument purporting to affect an interest In real property: Title Individual name Address r Consent r Confidentlal Data r Merger Allowed r Manufacturing View filings for this business entity: ALL FILINGS Annual Report Annual Report-Professional ti Articles of Entity Conversion Certificate of Amendment 1�= [View filings Comments or notes associated with this business entity: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary... 10/22/2013 I Mass. Corporations, external master page Page 2 of 2 i ............... ... . New search William Francis Galvin,Secretary of the Commonwealth of Massachusetts Terms and Conditions http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary... 10/22/2013 96-75 o5--29-2f�i2 QUITCLAIM DEED We,John Viola and Allison Viola,husband and wife,tenants by then entirety,presently of 2167 Falmouth Road,Centerville,Massachusetts 02632,for consideration paid in full this day of One($1.00)Dollar grant to the Melody Realty LLC, a Massachusetts Limited Liability Company duly organized pursuant to M.G.L.C.156C,Section 12,with a usual place of business of 2167 Falmouth Road, Centerville,Massachusetts 02632 with Quitclaim Covenants,a certain parcel of land together.with the buildings thereon,situated in Barnstable(Hyannis),Barnstable County,Massachusetts,said land being bounded and described as follows: On the South by Massachusetts State Highway(Route 28),there measuring ninety-, nine and 41/100(99.41 )feet; On the West by Herring Brook,so called,there measuring about one hundred twenty-five( 125)feet; On the North by land now or formerly of Manuel Tracie,there measuring about one hundred three( 103)feet; On the East by a cart road,leading from State Highway aforesaid to land of George W.Toney,there measuring about one hundred fifty( 150)feet. Subject to and with the benefit of all rights,rights of way,reservations,restrictions, covenants and easements of record in so far as the same are in force and effect. For Grantor's title see Deed from Frances Peters and Elizabeth R. DeGrace recorded at the Barnstable Registry of Deeds on May 5,2008 in Book 22884,Page 192 W tress our an and seals this 13 day of Y 2012. John iola Allison Viola THE PROPERTY ADDRESS IS:88 WEST MAIN STREET,HYANNIS,MA. 1 Bk 26366 P9 -109 #29675 COMMONWEALTH OF MASSACHUSETTS Barnstable,ss On this t3 day of May 2012,before me,the undersigned notary public,personally appeared John Viola and Allison Viola,both proved to me through satisfactory evidence of identification,which was personal knowledge,to be the persons whose names are signed on the preceding,and acknowledged to me that they signed it voluntarily for its stated purpose. Joseph J.Berlandi y o 'ssion expires: March 30,2018 Josr.Pa 4 MyM40of sst ; March 30,201a ........ BARNSTABLE REGISTRY OF DEEDS 2 0 CAPE COS . INSULATION "`� � '��f , REIN" iL! IIY{P 0(.Sii f(0.m'(SS $YP\I1041 fuiY(NP(Y \glli PIlII{Yf IN{YNIION L{I(INQf 1-800-696-6611DIV .,., 'Vown of Barnstable Pled ulatory Services Buildn g Division 200 Main St Hyaimis, IVLA 02601 Date: Dear Building Inspector Please accept this Affidavit as doctunentation that Cape Cod Insulation, Inc. performed & completed the insulation and weatherization work at the property listed below. Cape Cod Insulation did this in accordance to the specifications listed on the building permit application. All work has been inspected by a certified Building Performance Institute (BPI) inspector. All work preformed meets or exceeds federal & State Requirements. Property Owner Property Address Village . �11►� + �Il�sv,n ��ol� �c�.�,� n � nls Insulation Installed: Fiberglass Cellulose R-Value Restricted Wirestricted Ceilings ( ) ( ) ) ) ) Slopes ( ) ( ) ( ) ( ) ( ) Floors 6411M(af ( X ) ( ) � � �) ( ) � X) Walls ;6X'e; ( X ) ( ) ( lZ) ( ) (X ) /4dl✓ S Plat f Sincerely He y E G sidy J , President Cape Cod nsulatian, Inc. t ! f ifi I � _ } + Nov TOWN C�, AR I�� T 2LE d , l / 2013 I9I 8 48 } � � i � � � ► fat�'�+ ► ► ; fit t Yef II y� xt Z4 .t l,-m,44► 4e,�', - - - I i/ 1 } + i l i f• — — — 1I ✓i + + - - 0000— Fromm ! Pih r*�r,, t/t i i i _ I i I f I Tb qqda 4 e s r . - fpIvyl u r I ,f. - 1........_.._ ,e.„. ' ,..y� ..�..e:...: ''f >-s � �r _..b~..- „ -- _....,.,�z,w,.,„,u.�- ....., � f�..A„..�s....,-..•—.r.:a..,.£;..R'.w-^_�.;._w�..�.,,,e.. - JJ .. � � •.•'*'"' ".........,_� , ....+.,.....K...�. ..s.».r- ..:f.,+w.«-..q.,.+�.m.f,.. �t � za✓�-�wz— i ,� A¢ '»e,p'.�. .re h!•r:. ... .ws�.m.:4.�u,e.p -v�...,r+i.>.•�strPr:.m'I :. .....t,rse.: -ncut.xr.--+ -ee wcx A. r� Rill ` 'e TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � Map Parcel `Z'V Application Health Division Date Issued Conservation Division Application Fee �. J Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address ,� �►" Village �I� ' r Owner lGV Address Telephone '0 Permit Request �i CGIPi+�i� !% d km Square feet: 1 st floor: existing proposed 2nd floor: existing proposed, vital rw "Zoning District Flood Plain Groundwater Overlay T, Project Valuation Construction Type 1 la Lot Size Grandfathered: ❑Yes ❑ No If yes, attach upportiri%doc�rentation. Dwelling Type: Single Family Z/ Two Family ❑ Multi-Family (# units) r•�a Age of Existing Structure Historic House: ❑Yes ❑ No On Old King s Highw�4: ❑1'es ❑,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 bat[):,,): 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 Au orization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ o If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION _T (BUILDER OR HOMEOWNER) 6 Name Telephone Number yJ Address 4(ple K 6vc1V License# • JVA Home Improvement Contractor# K;556 7 Worker's Compensation # (� D®✓�-S �0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WI L BE TAKEN TO &/Iru � dam - SIGNATURE DATE 2 1 1 d } 0. 1 n FOR OFFICIAL USE ONLY r "APPLICATION# DATE ISSUED y r MAP/PARCEL NO. x ADDRESS VILLAGE t OWNER ;j 't DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f OWNER AUTHORIZATION FORM 1, AwSoj VIO (Owner's Name) owner of the property located at 9 G✓,�s7� /*7 ti 11 S (Property Address) HeA 4 A/? 4 11 , (Property Address) r hereby authorize a 00j tot 1 Q N (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Ow s ignature 01 (t 1112 Date Massachusetts- Department of Public Safety Board"of Buil(lin�g Regulations and Standards. Gonstrutction Supervisor License Licence: CS 100988 ;4, tMr; HENRY CASSIDY ! 8 SHED ROW ` WE3iT.'JARMOUTH, MA 02673 ' Expiration: 1 1 11 1/201 3 ('uuuuissiunet' Tr#: 7620 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 153567 Type: Private Corporation Expiration: 12/15/2b14 Tr# 233831 CAPE COD INSULATION, INC HENRY CASSIDY 18 REARDON CIRCLE SO. YARMOUTH, MA 02664 Update Address and return card. Marls reason for change, L-] Address ❑ Renewal ❑ Employment (.-.� Lost Card SCA i C, 20M-05/1 r / � h��P�('Or/l.rltl+%FtLE!%!7(lft Pf�'<'�7:1J1T[%'LtGJL' Off-ice of Consumer Affairs& Business Regulation License or registration valid for individul use only IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ration: Office of Consumer Affairs and Business Regulation 9 153567 Type: g xpiration 12/1`5/2014 Private Corporation 10 Park Plaza-.Suite 5170 Boston,MA 02116 CAPE COD INSULATION INq HENRY CASSIDY 18 REARDON CIRCLE SO.YARMOUTH, MA 02664 ----- Undersecretary f Val' wito th Wat The Commonwealth of Massachusetts PrintForm _ ' Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/Individuaal):__:C4 6 dpil Address: " &MOPL � Vll�lit�j City/State/Zip: V Illti Or Phone #: y✓D0 7 " - IZ l Are you an employer?Check t e appropriate box: Type of project(required): l. 1 am a employer with M 4. ❑ I am a general contractor and I 6. ❑ * have hired the sub-contractors New construction employees (full and/or part-time).* . 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' comp. insurance.$ 9. ❑ Building addition [No workers comp. insurance p' 10.❑ :Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof re�jairs n, insurance required.] t c. 152, §1(4), and we have no 13. Other We���life� � employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 'Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information.Insurance Insurance Company Name: CkvI!L C�Vh�- Policy#or Self-ins. Lic. #: WGA 6)o 2, 0i Expiration Date:l - �nn99A%4�- rn Job Site Address: Q It1✓' %' City/State/Zip: ;07 Attach a copy of the workers' compensation policy declaration page(showing the policy numbL 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 cerftr qhger the ains nd penalties o er'ury that the in ormation provided above is true and correct. Si nature: IDate* 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#: ACORD,,. Client#:4507 CERTIFICATE OF LJABILITY INSURANCE U AIL(%%IIIWIM ) I E-4)An AMATTER OF IN FORM A:1]-*C')'N--C,'i-V-L"Y—ANP---------'*-------,---- ! 07/02120-12 CONFERS NO RIGHT8 UPON TI11F.UhMAFICATF HOL.rjj:�R,'I'Ills CERTIFICATE DOE',-N07'APFIRMATIVELY OR NEGATIVFIY AlVikNO,EXTEND OR ALTER'ri-ii:COV12"IZACC AFFORDED UY TI-11:POLICIES t'hLC)VV,.11-iltiCL-'rtI'lFICATCOF INSURANCE D 0 E N RF P RESE-.,N I-ATI VE Oft p 174()D L)C F R, AND I-IJF,CERTIFICATE I It tl)G r"ll"IfICUtu luldur ica an AbDll(UNAL INSUK I]-t- Itbi uctto 1-111 -such QAll�J�jl Zw,!IjjtmI(3). tililtoilleill i5ll fills cal-tilic"114!(IcIctj 1101 kikllll��l fivlll��w(fit; -NAW m 1 41 t YUUu(;I 4J4 RuCLI 'I J�j 508-760-4602 FAX L 4)16-2 W MA (Qfjio�) AQDRF,' bu8:014-191i0 AP-l'UNOIN(i COVE HA(W. I 114-SLIRER A:Peerless it'151.1ra11ca Cape cod lntw(aticln inc INSURf!R 2: ............. 'I"S Y,11111()Lilh RC)"I,j Nsur.ERc:AtLial-itic CIMI'tel'IW4 LI I'll MA 02001 Colliplilly 3,175.1 ........... ------------------------------ I(AVE BEEN ISSUED TO-111E INSURED�14AN11-DA00YL FOR 1-tIL ,it 00 ,I OF ANY CONTRACT OR OTHER DOCUMENT WITH [4ESP[-C I 'j-0 VvIlIc.1-1 rLU:;I(1NS AIVD CJNL)I"I IONS OF SUCH POLICIES. LIMB'S SHpwlv'I,, y QED BY THE POLICIES DESCRIBED HEREIN IS Sua,IECr TO ALI. 'ItIF. IAV9 KEEN IRCOUCED BY PAID CLAIMS. iMM)Ql)NWYj CBP82630634.12012 04/0'1120,1j eAci-I '1000 000 oAJNWL-Rk,L4,L(;LNIffW-LIAW1.11Y (A.AIW,,-h4AL)17: OCCUR AOV IN JUkY $1 000 000 -----------...... AwAk6-(JAI L LIMN APPLICkI PgR: ---------- p-u-I.-I a L; T— l2MMfiCWVmr, 4/01/20,12 0410 1/90 1 000(IOU AiqY^kj I U (�"Vl N I I I X ............ AUTOS' X 1,14(1,0 AUI Q,� X NON-OWNft) ............ ... ..... Ti AU r05 411i/211'[XC if 11111U11--LA LIAIJ XONJ453512 041011'�)Oj' CAcl.l !0 000 Oau X vL"?�"ILI��Q-qq c WVU"hLKkj I,uNIrLNtJA I IVN VV( 6 .U12 ANDithlill-01013'LlAbiLlty VVGA00525%)Ll!' 6.13U/21012 0@301-13011, x Y/N kX.-V IV9 [ N -Jk0-I ACCIO-NT NkA) "IA it y�q du'uw—m, to N OF p I ON N 11.1 u- 011tRAlIGNS I LOCAIICINS 1 VLHICL.ES(Ak(4.1,ACWIU M)r1wrs Cc),,,,) Ijlf()II-rIutj01I ** 11w1kititi(I Ofticerr� car ffppflDtur'S Coltlt'Cale IioIIJc r is lilQlLldQd w-i dn additional illSllftld UIILIUI Gullulal U30ifity WhUll ro(JUIrod 1)y written Of- CERMFICAIT,.1101,J)JER CANCELLATION C41)U C00 SHOULD ANYOF THE ABOV6 OESCRIOEQ POL.IClkii I:Jilm GANCM.LG11 13LI:OHL, THE EXPIRATION DATE THEREOF, NOTICE WILL bL WHILIVIEket) IN ACCORDANCE WITH THE MLICV PROVWIQN3. ............ AU MORI2F0 RENWSEN I 01VE AC(.jIjjj 14000RPOliklION,All lf�6384WM83b4jt) 1 of'I Pie ACORD Hama and lopaw rabl-aarod marks ofACORI) mky ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � rM�05� q Map Parcel 0 �ppion # Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board F Historic - OKH _ Preservation/Hyannis Project Street Address Village Owner v Address A Le V, '-v Telephone Permit Request 7 S 7 �G( L i 1i / ALAq y o,( P ;s << 411L U- -ee J, dfit ` j Square feet: 1st floor: existing roposed 2nd floor: existing_proposed t Total dew rr Zoning District Flood Plain Groundwater Overlay Project Valuation C) Construction Type . e�/n Lot Size 0 �2 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. .V p Dwelling Type: Single Family Tw Family ❑ Multi-Family (# units) " Age of Existing Structure 1�6A" storic House: ❑Yes YNo On Old :Kin 's Highway: ❑Yes �'No g 9 Y Basement Type: ❑ Full Crawl )tWalkout ❑ Other Basement Finished Area(sq.ft.) AP—_ Basement Unfinished Area(sq.ft) Number of Baths: Full: existing_ new Half: existing '661— 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 �dNo 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 -A �"4 fl b5_ ro.s APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number �' l� � � 3 Address �� (� � _T � License # f I n //,_0 we 4 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Z SIGNATURE A1114DATE FOR OFFICIAL USE ONLY , 5 APPLICATION# DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE OWNER ' t DATE OF INSPECTION: FOUNDATION r.«c Qojk QF /O z z -/Z FRAME INSULATION f FIREPLACE ELECTRICAL: ROUGH FINAL I'I i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 'Name(Business/Oro nization/Individuat):_ ,'�_l Address: . f J/ City/State/Zip: ✓V f /�� Phone#: Are y u an employer?Check the appropriate box: Type of project(required); 1. am a employer with 4. I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.El am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling shipand have no em to.ees These sub-contractors have p y � 8, �Demolition working for me in any capacity. employees and have workers'. [No workers'comp.insurance comp. insurance.$ 9. 0 Building addition required.] 5. ❑ We are a corporation and its 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.[]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12:[]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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ,. t4 . r\ Policy#or Self-ins. Lic.#: „) (� �-- �� Y�� b — Expiration Date: Job Site Address: (�() (Aj r `�'l!y — 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 violato Y. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA insurance overage verification. I do hereby certi un r e pains penalties of perjury that the information provided above is true and correct. Si ature: '`L Date: Phone#: F only. Do not write in this area, to be completed by city or town official n: Permit/License# hority. (circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector. 5.Plumbing,Inspector son. Phone#: L1•llr .�i c.zi c..vic.. v . 1..� . ... � .,.. ....�. .... .,.... ..... .�.r� . ..� AC CERTIFICATE OF LIABILITY INSURANCE 77E DYYYY) 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 FRANK L HORGAN INS AGENCY INC CONTACT NAME: 44 B A R N S TA B L E ROAD PHONE A/ No Ext: 508 775-5830 FAX a No): 508 775-6688 HYANNIS, MA 02601 EMAIL ADDRESS: INSURE AFFORDING COVERAGE NAICp INSURER A: LIBERTY MUTUAL INSURANCE INSURED ------ -- -- INSURER B: . CAPE & ISLANDS CONSTRUCTION=COMPANY INC PO BOX 210 INSURER C: CENTERVILLE MA 02632 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 13 95795 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. NOTVVITHSTANDINu 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IPOLICY EFF POLICY EXP L R ------TYPE OF INSURANCE 5U8R POUCY NUMBER NWDD( WWDDJYY LIMITS GENERAL UABIUTY EACH OCCURRENCE $ CONIMERCIAL GENERAL_LIABILITY PENEK occurrence) $ CLAIMS MADE u OCCUR MED EXP oneperson) $ PERSONAL&ADV INJURY $ -- GENERAL AGGREGATE $ GENL AC',GREGATE UMIT APPU ES PER: PRODUCTS-COMRIOP AGG $ POLICY PRC} — LOC $ AUTOMOBILE LIABILITY craw eil $ ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY AI JTM Al JTCS $ — - NON OANED a acd I� HIREDAUTC6 AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLA NC-MADE AGGREGATE $ — DED u RETENTION$ $ A MWERS COWENSATTON WC5-31 S-377540-012 5R/2012 5/7/2013 T�LLIMITS AND EMPLOYERS LIABILITY y/N ANY PROPRIFTOWPARTNEREXECLMVEa N/A E.L EACH ACCIDENT $ 10000d OFFICER+MCMTER D(CLUDED; ---- ------_._—.....------...-------._...__.._. (ryandatory in NH) E.L DISEASE-EA EMPLOYE $ 10000 II yyes,describe wde UESC:RIPTI('N()F OPERATICNS blow E.L.DISEASE-POLICY LIMIT $ 50000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHCLES (Attach ACORD im,Additional Rerterks Schedule,If more space Is required) Workers compensation insurance coverage.applies only to the workers compensation laws of the state of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE Jeff Eldridge ©1988-2010 ACIDRD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 'Lhl' IJu.: I W0)L�795 Alvle Ckrv-diet 5/15/2012 8:59:09 AM P3Je 1 of 1 nds Ce1tif1C.3Le CuICeL.S :111& Llf-rSeJes ALL previously issued certificates. - F f _ ' r x "stk ate 5452 a &ylslansConstruct�onCo . . CenteruaNe Ma0263� R.-„8 5D1 5 76si�� ai d Y s • John Viola 88 West Main St. Hyannis Ma.02601 ID Description Ext Ph• • CARPENTRY Custom Carpentry 9,650.00 New kitchen re-model. Remove existing kitchen cabinets. Remove existing sink. Remove existingr tops. Remove existing appliances. Install all new. s €,•• �t° E'"°"`' hxi t�.. �,. �� 1.-• �'. � :[ ?; ,,,.'Yfi t} 'Xy ;5sn. !'^+P' ,,,e s :�a' �; x � ..,:, zg �r , x, � .:` l Total 0 �. 9.:.650 00 f t ^. Rh -::.+y >•F d _. ,,sF t.' .a � e;Y Kz rS_3k ,. « ^ 7y :, z &�, 7 ..a f�-ss � s'� "' ,cs tea, '` � ;.' a� g, 9 € b : e' V �r°KZ. a l k..: k :.: a '..<;� z t a ,, �3 „g, s .g .,'° "� 3. u"-f, � N, ,� r �` gk ��`.�-.- `� ��� s3 :�.:-� �,?� ��. �3 .�.; .�' �.'� Yg�:���YE's,�'�t-� � 3'� �,:x§ .t�•�::,: ' �;y`�. 'r€ a'.. �",.��'`da.� .. �,?�z,'��� ,� �T �.-' ..,#p �^e, � � a .,�-' � •[[�-i s" tiE�� i A��x�a..:r,� ,�,,,s tt � � ec s � ��' �. �s�,� � r ` 7'n�'" r� °F��z,� '.^a`� � �a �� r r 2� �s;•r€ '�`� �" ,ca :��5���` �s t_ �` �,.� ' '. + t,.,: ,�A.: e. Y & s � & . n s t r e L 2 � `£ 0 M US s 3 s �•.,N,. d a �:: r"a' aEy. ;r.�, .r x7' %� + `s°' �'a a ,ex „ '„;•n `°p �» �. s€ :r a mats + �" „V tdA ; w € P � � a..:-M�. `, "4°' � `�. �. � �^, �x3�v"s� �,.���t" ;� ��z�. '•a- 'Sa e t'�r r:., �f �� "�'' ''� � s � .tsa,,��",t��oa{'�� `�`�` ., '�.a �. _.s ,..;.x. Z r r uildinD((Z .�trTt c . .tf 1 t tchu� ent r f Public S Boar( uI of B ct� Office°t cons°m�r"°�'N��ea/� �pl' Ul;ttions an(I Stundard� Affairs&Bus ness R� Construction Supervisor License HOME IMPROVEMENT CO Regulation Registration NTRACTOR License: CS 74660 r:^�'1.65936 Expiration: 4%9/20.14 TYpe:. CAPE.&IS F ` Private Corporatior JOSHUA X KOURI LAND CONSTRUCTION CO INC. a+� PO BOX 210 1 JOSHUA CENTERVILLE, MA 02632a I 55 ELM AVE. t,'' a HYANNIS, MA 02601 Undersecretary Expiration: 2/12/2013'---I ('nnmiissioncr• �� Tr#: 12106 License or reg�strat�on valid+for mdividul use only before the expiration.date Iff found:returii;to Office of,ConsumerAffairs and BtiMfiessRegulation j, 10 Park Plaza Suife:5170 ' j Boston,MA'02116 u - u f-al thout-sigMature �5 S. Va LA c f5 x 5 MCI, 4 44 )W d-Y6 shy �' �,,�e►NKI � to r I' Town ®f Barnstable �o�TMETp�� Building Department Services y� o� Brian Florence, CB® Building Commissioner BARNSTABI,E * aAxNsrABLE� * SXMV ABL-tITcAVIL'E-MU-H111P0 I MASS. N:FTO'6 HILLS•O MADE-WFSf8A.6.0 $ 200 Main Street, Hyannis,MA 02 Ol 1639.2014 �p a63g. ♦® .orFD MA'S www.town.barnstable.maxs �Dg Office: 508-862-4038 Fax: 508-790-6230 March 8, 2019 3) Mr. Fabio Zocante President,Air Rite HVAC of Cape Cod 330 Elliott Road Centerville, MA 02632 RE: Site Plan Review#013-19 Air Rite HVAC & Casabela Home and Office Cleaning 88 West Main Street, Hyannis Map 290,Parcel 030 Proposal: 'Change of use of the I"floor of a building used as a residence to office, professional business use for the owners only. Office will not be open to the public. Dear Mr. Zocante: Plans for the above site plan review application were administratively approved by the Site Plan Review Committee at the informal site plan review meeting held March 5, 2019 subject to the following: ® Approval is based upon informal site plans entitled"Existing Conditions Plan for Viola Associates" dated December 20, 2013 depicting the location of three (3)proposed parking spaces, signage and dumpster. The addition of pavement is not proposed. e Affidavit submitted in accordance to the conditions set forth by the Architectural Access Board of Massachusetts dated March 6,2019 (attached) certifying that the access to the building shall be limited to employees only and not to members of the public or any others not employed by Air Rite HVAC Inc. or Casabela Home and Office Cleaning. ® Approval is for conversion of a residence building for office use only. The converted office building may not be used as living space. o Dumpster is required to be screened from public view. o Storage of hazardous materials is prohibited on the Groundwater Protection Overlay District. r�. Applicant must obtain all other applicable permits, licenses and approvals required. Sincerely, Ellen M. Swiniarski Site Plan Review Coordinator CC: Brian Florence, Building Commissioner, SPR Chairman Health Department Hyannis FD AFFIDAVIT Now comes Fabio Zocante, President of Air Rite HVAV of Cape Cod Inc.with a principal place of business at 88 West Main Street, Hyannis, Massachusetts, making this affidavit under the pains and penalties of perjury, deposes and states as follows: 1. 1 am the signor and in the possession of a lease with an option to purchase 88 West Main Street, Hyannis, Massachusetts. 2. 1 am submitting this affidavit in accordance to the conditions set forth by the Architectural Access Board of Massachusetts. 3. Melody Realty LLC(seller)owns the property known as 88 West Main Street, Hyannis, Massachusetts(the `Building"), more particularly described in the Barnstable Maps Block 290/ Lot 30 4. 1 hereby certify that the access to the building shall be limited to employees only and not to members of the public or any others not employed by Air Rite HVAC Inc or Casabela Home and Office Cleaning. Signed under the pains and penalties of perjury this day of March 2019 — Fa i 'ca:n-t6,'President a ite HVAC of Cape Cod Inc COMMONWEALTH OF MASSACHUSETTS Barnstable, ss �"/r � (O 2019 On this 0 day of March 2019, before me,the undersigned notary public, personally appeared the above-named Fabio Zocante, personal[ known me to be the person identified in the attached instrument and acknowledged exec ti g th re ' instrument for its stated purpose. Notary Public M ommission Expires JOHN CLARK STEPHENSON Notary Public COMMONWEALTH OF MASSACHUSETTS My Commission Ex�sres Octobpr 29, 2021 Town of Barnstable Building ,y, ^' �:awa ,.r .., R'� = ,. -�ri r. :"tc� '- P,o'st Th�s.Card,So That s:Uisible From thA&et-A roved Plan`s,Must.be Retained on Job"and this"Card Must be;Kept ' •Alt MABLE.:• r .., zv, �. s 1 pp • 9AM Posted Until Final Inspection Has Been Made : s � �! n �.� ■■y���/�■■1■ JZ' Nth PeY'111it � s �Whee aCertificate,of Occupancy isRequired,such Bu�ld�ng shall Not be Occupied until a Final Inspection has.been made F a' r : Permit No. B-19-997 Applicant Name: MELODY REALTY LLC A : pprovals Date Issued: 03/28/2019 Current Use: Structure Permit Type: Building-Sign Expiration Date: 09/28/2019 Foundation: Location: 88 WEST MAIN STREET, HYANNIS Map/Lot: 290-030 Zoning District: HB Sheathing: Owner on Record: MELODY REALTY LLC Contractor Name: Framing: 1 Address: 2167 FALMOUTH ROAD z '�' ContractorLicense 2 CENTERVILLE, MA 02632 � Est Project Cost: $0.00 Chimney: Permit Fee: Description: 5'X5' FREE STANDING SIGN FOR AIR RITE HEATING AIR. $50.00 CONDITIONING CASABELA Fee Paid: 5 50.00 Insulation: Project Review Req: Date # 3/28/2019 Final: m^aY X3 Plumbing/Gas Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by ibis permit is commenced within six monthsafter issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: 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 work until the completion of the same. Final Gas: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing ".y Service: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed - Rough: 4.Wiring&Plumbing Inspections to be completed priorto Frame Inspection Final: 5.Priorto Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: Town-of Barnstable or Building Department ti Brian Florence,C.BO g BARNSTABLE Building Commissioner � IIARNSTABLE: .s .°""ir�'as nii`•'as•t�t.uC°i'-s"au-`a,'"oe: . Mass 200 Main Street, Flyanrus,.MA 02601 1639 201 'OtEo Mpta ww%,Aown.barnstable.ml.iis Office: 508-$62-4038 Fax:508-790-6230' Sign Permit Application Zoning District Permit # Historic District C-1 Location b y ' Street address and vilfage Applicant AN A Map & Parcel Telephone Number �c�& —3�-�+r;6?� Email 6 i �t�-�-��co,AAC, Sign #1 Sign #2 Wall 0 Wall 0 Freestanding 25 Freestan'ding 0 Electrified` 2�9 Electrified* 0 Dimensions Sign #1 5' .x 5' Dimensions Sign-#2 Square feet Square feet Reface Existing Sign New/Replace Sign ®" Width of Building Face ° ft. X 10 X .10-= `Lighting Type Ok oo s-6- n)e-c r- Q�E A wiring permit is req fired if sign is electrified. Sig ure o er/Authorized Agent Mailing address °�SHEI � Town of Barnstable °^ Building Department swaxsTnst.E. ' Brian Florence,CBO } v Ma39. ss. Building Commissioner . 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 SIGN PERMIT REQUIREMENTS 1 A photograph showing the existing facade, on which has been indicated the proposed sign location. The photograph is to include a portion of adjoining stores or building. ..For a proposed building or new facade, an architect's elevation may be submitted in lieu of a photograph. 2. A"scale drawing of the proposed sign.A scale drawing indicating: 1). The type of proposed sign(wall, hanging, free standing) 2). Dimensions of the proposed sign and any designs, logos, or lettering 3) A cross-section with dimensions showing edge-detail. Minimum scale 1 1'. Minimum sheet size, 8.5 x I P. 3. A scale drawing of the bracket.A colored scale graphic indicating dimensions, showing colors, materials and method of affixing it to the sign and to the building. Minimum scale P= 1'. Minimum sheet size, 8.5 x 11 4. A completed Town of Barnstable Sign Application, including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. 5. The width of the building face or the leased area. NOTE: the map/parcel number is required on the application. signs/signrequ&app revised: 9/22/17 1 3/28/2019 , road_sign.jpg Option 1 Frame Made from All PVC And slid down over 2 4" x 4" PT Posts P Panel is 1/4"Alupanel(Low Maintenance Option)$1250 a' o . Option 2 Made from All Wood Primed and Painted MDO panel &PT posts QeAir Rite With Graphics applied $1950 HEATING-AIR CONDITIONING. 1000 Option 3 casabelaaa HOME&OFFICE CLEANING - mY` Made from All Wood.Primed and Painted MDO panel &PT posts r With Graphics applied Posts Wrapped in Azek and Painted $2400 S Installation on any of the above will be $400 LED Lighting on any of the above will be approx. $950 (Power will be run to sign by owner's electrician) https:Hmail.google.com/mail/u/O/#inbox/FMfcgxwBWStKHXKKxKhLDQhdQQXLPDz?projector=l&messagePart1d=0.2 1l1 Town of Barnstable Building Post This Card So That it�s=Visible-From the Street-Approved`-Plans-Must be Retained on Job and this Card Mus#be Kept KAS& Posted Until Final=lnspect�on aBARINMA s Been Made era'Y17 t r llll ,Where a,Certificate'of Occupancy is Required,such Building shall Not be Oceupied until a Final Inspection has been made Permit No. B-19-699 Applicant Name: FABIO ZOCANTE Approvals Date Issued: 03/25/2019 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 09/25/2019 Foundation: Commercial Map/Lot: 290-030 Zoning District: HB Sheathing: Location: 88 WEST MAIN STREET, HYANNIS ) Contractor Name:,- Framing: 1 Owner on Record: MELODY REALTY LLC Contractor license 2 Address: 2167 FALMOUTH ROAD Est. Project Cost: $0.00 Chimney: CENTERVILLE, MA 02632 Permit-Fee: $75.00 'x Insulation: Description: CHANGE OF USE FROM RESIDENTIAL TO OFFICE AIRE RITE HVAC Fee'Paid:- $75.00 AND CASA BELA CLEANING , Date. t. 3/25/2019 Final: ' Project Review Req: Plumbing/Gas Building Official Rough Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afterlissuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the 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 Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: <'V Service: 1.Foundation or Footing 2.Sheathing Inspection Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed` 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 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. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons ntractin 7 with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: � Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: 30 Application Number. ........k ......... ...�. ........... BARNEMABM MASS. 4� � Permit Fee.......................................Other Fee........................ 1639. TotalFee Paid............................................................... ...... i TOWN OF BARNSTABLE Permit Approval by. � `�...........On.. 2 �g..... i BUILDING PERMIT ' Map........................................Parcel............................................. APPLICATION Section 1 — Owner's Information and Project Location - Project Address` Village Owners Name_ Owners`Legal Address 2 �.o L LL o 4' ?—c� City ce, e Zit,, ( C: State_ f-*N/'+ Zip ©Z G 3 2- Owners Cell# E-mail Section 2 —Use of Structure Use Group ❑ Commercial Structure over 35,000 cubic feet Commercial Structure under 35,000 cubic feet ❑ Single/Two Family Dwelling Section 3 —Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure=2 -Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment Sprinkler System ❑ Addition ❑ Retaining wall ❑ . Solar ❑ Renovation ❑ Pool ❑ Insulation Other—Specify. Section.4_-Work Description r . i Last undated: 11/15/2018 l f , � I Application Number.........:..... Section 5—Detail CCost-of Proposed Constructions ` - Square Footage of Project Age of.Structure Dig Safe Number # Of Bedrooms Existing ~ Total#Of Bedrooms (proposed) 110 MPH Wind Zone Compliance Method MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System y ❑ Masonry Chimney ❑Add/relocate bedroom a Water Supply ❑ Public ❑ Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Dis�o tY sal Facility: I am usinga crane ❑ Yes El Section 7—Flood Zone i Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No x Section 8—Zoning Information cc� Zoning District �-�1 Proposed Use ®Xi c.,ea Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage a �`o #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes No Last updated: 11/15/2018 N 5% Sheet 1 ( LA = Bath i- Foyer Air Rite Office Z, 44 cfm Hall Living / Kitchen �y CL2 CL 1 C ®, 244 d, �- Casa Bela Office 12 (o Job#. Scale:1:48 Performed for. PeP1 AIR RrFE WAC R9 tSutS&krivErS@I 2018 8BMST MAIN ST 18.Q32 RSLWO I-YANNIS,MAaW 2019MarZ 11:3W Ptnm 508.960-7662 Prgect1.w A ffUECCM'ACT@GMAILCCM r AFFIDAVIT Now comes Fabio Zocante, President of Air Rite HVAV of Cape Cod Inc. with a principal place of business at 88 West Main Street, Hyannis, Massachusetts, making this affidavit under the pains and penalties of perjury, deposes and states as follows: 1. 1 am the signor and in the possession of a lease with an option to purchase 88 West Main Street, Hyannis, Massachusetts. 2. 1 am submitting this affidavit in accordance to the conditions set forth by the Architectural Access Board of Massachusetts. 3. Melody Realty LLC(seller) owns the property known as 88 West Main Street, Hyannis, Massachusetts(the "Building"), more particularly described in the Barnstable Maps Block 290/ Lot 30 4. 1 hereby certify that the access to the building shall be limited to employees only and not to members of the public or any others not employed by Air Rite HVAC Inc or Casabela Home and Office Cleaning. Signed under the pains and penalties of perjury this day of March 2019 1 President ite HVAC-of2ape Cod Inc COMMONWEALTH OF MASSACHUSETTS Barnstable, ss Aol(�yl 62019 On this day of March 2019, before me,the undersigned notary public, personally appeared the above-named Fabio Zocante, personallI k own b ,me to be the person identified in the attached instrument and acknowledged exec ti the f e g instrument for its stated purpose. f� My Notary Public ommission Expires I JOHN CLARK STEP NSON NtStaly Public OOMMONdEALTH()f MASSACHUSETIS My commission Expires october 29, 2021 ' The Commonwealth of Massachusetts Department of IndustrialAccidents Oiue of Investigations 600 Washington Street Boston,MA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorsAElectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Orgmization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with- 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. employees and have workers' [No workers'comp.insurance comp.insurance.1 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑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 mast submit a new affidavit indicating such. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: 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 certify under the pains and penalties ofperjury that the information provided above is true and correct. Sianature: 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 id 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 auy 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 bwldmgs in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLQ or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to 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- me Commonwealth of Massachusetts Department of IndustrW Accidents Office of Investigations 600 Washington Street Boston,MA 02111 - Tel.#617-727-49M ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749 WWW M ss.gov/dia Application Number........................................... Section 9= Construction Supervisor Name Telephone Number Address City State Zip License Number License Type Expiration Date Contractors Email Cell# I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 790 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.Attach a copy of your license. Signature Date Section 10—Home Improvement Contractor Name Telephone Number Address City State Zip Registration Number Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors 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.Attach a copy of your H.I.C... i . Signature Date Section 11 —Home Owners License Exemption i 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 documentation required by 780 CMR and the Town of Barnstable. Signature Date �-- _ PLICANT SIGNATURE s Signature�V Date Print Name Telephone Numbers E= ailm permit: lis 60 Cy MIA�t • CoM Last updated: 11/15/2018 Section 12—Department Sign-Offs Health Department ❑ Zoning Board(if required) El Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ a For commercial work,please take your plans directly to the fire department for approval, Section 13— Owner's Authorization i 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 o job) cr-A n, k Q 1. V Signature of Owner dat _��� Print Name . a Last updated: 11/15/2018 r AFFIDAVIT Now comes Fabio Zocante, President of Air Rite HVAV of Cape Cod Inc. with a principal place of business at 88 West Main Street, Hyannis, Massachusetts, making this affidavit under the pains and penalties of perjury, deposes and states as follows: 1. 1 am the signor and in the possession of a lease with an option to purchase 88 West Main Street, Hyannis, Massachusetts. 2. 1 am submitting this affidavit in accordance to the conditions set forth by the Architectural Access Board of Massachusetts. 3. Melody Realty LLC(seller)owns the property known as 88 West Main Street, Hyannis, Massachusetts(the "Building"), more particularly described in the Barnstable Maps Block 290/ Lot 30 4. 1 hereby certify that the access to the building shall be limited to employees only and not to members of the public or any others not employed by Air Rite HVAC Inc or Casabela Home and Office Cleaning. Signed under the pains and penalties of perjury this day of Mjrhh 2019 Fi t_iH� e;PPside nt CoioAapeCo d Inc COMMONWEALTH OF MASSACHUSETTS Barnstable ss K/� 'G � 2019 On this bA day of March 2019, before me,the undersigned notary public, personally i appeared the above-named Fabio Zocante, personally known b me to be the person identified in the attached instrument and acknowledged exec ti g th re instrument for its stated purpose. Notary Public M ommission Expires N JOHN CLARK STEPHENSON Notary Public COMMONWEALTH OFMASSACHUSETTS My Commission Expires October 29, 2021 1 i �f Mal oQ { - .........ems.. 7. f r e c dMiM Close4 r YOU I �� VIM X_� t Town of Barnstable *Permit �RMIT Regulatory Services e e on Mn e i63� 1 12 Thomas P. Geiler,Director pTFD MA't�` TOWN OF BARNST Building Division ABLE Tom Perry, , 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 Not Valid without Red X-Press Imprint Map/parcel Numbe,2q(? Property Address �, f'�w�i 1, 5 (�f Cc.0 4) b 0 (Residential Value of Work_ �� � Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ,��vL V ,i-3 !! Contractor's Name_, _ 4 L1 0 Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) 7�� C/ . 'WWorkman's Compensation Insurance Check one: r ❑ I am a sole proprietor ❑ lam the Homeowner I have Worker's Compensation Insurance Insurance Company Name �� t. Y�'y 1'W y1,4 L Workman's Comp. Policy# (/V ` 345 •-3 ip/ t Copy of Insurance Compliance Certificate must accompany each permit Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping: Going-over existing layers of roof] Re-side #of doors 5 Replacement Windows/doors/sliders. U-Value; w(maximum.44)#of windows *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. iGNATURE: ' iWPFI MTC)RMSIbuilding permit farms R doe wised 070110 6/13/2011 5:51:09 AM PST (GMT-8) exuM: insurancevisions.COm--11-1: ruts/ /300011. edge: _ ul_ i� T DATE(MWDD/YYYY) A�OR� CERTIFICATE OF LIABILITY INSURANCEF6/13/2011 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 endorsements. PRODUCER-FRANK L HORGAN INS AGENCY INC CONTACT NAME: 44 BARNSTABLE ROAD PHONE o l 508 775-5830 FAX A/c No: 5( 081ii56688 HYANNIS, MA 0260 1 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: LIBERTY MUTUAL GROUP INSURED CAPE & ISLANDS CONSTRUCTION COMPANY INC INSURERS: PO BOX 210 - INSURER C: CENTERVILLE MA 02632 —- -- - INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 10385984 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 OTI IER DOCUMENT WITI I RESPECT TO WI IICI I TI11, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO.ALL THE TERMS, i EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADDL SUER.[- POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMIIS GENERAL LIABILITY EACH OCCURRENCE- DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea omwrence) $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ LOC POLICY � PRO- AUTOMOBILE LIABILII Y (Ea a.,,E.DISINGLE LIMIT $ BODILY INJURY(Per person) $ ANY AUTO ALL OWNED n SCHEDULED BODILY INJURY(Per accidentl $ AUTOS (�AUTOS 1�NON-OWNED PROPERTY DAMAGE HIRED ALITOS AUTOS (Per acrJdent $ $ UMBRELLA LI M OCCUR EACH OCCURRENCE $ EXCESS UA13 HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ $ A WORKERS COMPENSATION WC2-31 S-377540-011 5f7/2011 5/7/2012 ,/ WC STA TORY LIMITS L l AND EMPLOYERS'LIABILITY Y/N tRo ANY PROPRIETOR/PARTNER/EXECUTNE IN E.L.EACH ACCIDENT $ 100000 OFFICEWMEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000::'. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Altech ACORD 101,Additional Remarks Schedule,If more space Is required) - Workers Compensation Insurance:Part One of the policy applies only to the Workers Compensation Law of the Stale of MA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 200,MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE - � 1 Jeff Eldridge ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05.) The ACORD name and logo are registered marks of ACORD -EAT N0.: 103a5984 All. Chandler 6/13/2011 5:46:22 AR Pag? l:of 1 rrL5 certificate canoe Ls and supersedes ALL previously Lesued Certificates. i i:. ---. _.._.. .✓1�e -�arn�iw�.uded et1 o�✓G�aa,a,.,. -- O lice of Consumer Aff iu H smess Regulavou Hunt IMPROVEMENT.CelTRACTOR Re Ltration 9 ,. 1�� 65936 Type: Expira«ion: 419/2-0,12 Private Corporatro ; CA 8 ISLAND CC V *T �l�NrC0.I;iC.- _ iRE- ; f JOSHUA KOURI i 55 ELM AVE HYANNIS, MA 02601`?. �— i I = X. drrsciretam y ---Nlussachusctts g R`gula t on,t:and Standards gourd of Buil(1 ervisor License Construction Sup. License: CS 74660 ' JOSHUA X KOURI PO BOX 210 q, CENTERVILLE, MA 02632 Expiration: 2j1212013 License or registration valid for individul use only li I before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation j 10 Park Plaza-Suite 5170 Boston,MA 02116 i 'f of alid without signature 7,. ``uhu.�etts- Board of DePa►-tment ofp ruction" ReLrul.►tio'"s . uhlie.Batch Construction" ►nd, pervis St►ndard.� License: CS or License 74660 / 3OSHUA OURI PO BOX 10 CENTERVILLE, MA 02632 °nunissiugcy Ex it P ation; 2(1212013, Tr#: 12106 c ., The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations d 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): . c4 t G C69- 'tCN L , Address: lc7 P City/State/Zip: tl-eo �c1- { Phone.#: Are you an employer?Check the appropriate box: Type of project(required):; LP I am a employer with . 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a"sole proprietor or partner listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• '� 9. ❑Building addition , [No workers' comp.insurance comp.insurance.1' requi red.]ui 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions q ] officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: L,1�1 ;2' !�. `� L Policy#or Self-ins.Lic.#:� / 3/< - �"Yi c� L7 r - ©j/ Expiration Date: Z Job Site Address: 1 J i-. r City/State/Zip: /a 14/ii, 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$1,506.00 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 c ra e v rification. I do hereby certify under the pains p naltie of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only..Do not write in this area,to be completed-by city or town 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#: m t , 1 - ,v ,r 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 bean employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)'with no employees other than the members or partners, are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit'license applications in any,given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number:. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 VitWngtori Street Boston,MA 02111 Tel. #617-727-4900 W.406 or 1-877-MAS_.SAFE Revised 11-22-06 Fax#617-727-7749 www.mass.gov/di-a ,J } THE Town of Barnstable �} Regulatory Services s�xxszee�. MASS �. Thomas F.Geiler,Director 1639. Fo +� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit (Address of job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:O WNERPEF MIS SIONPOOLS a �IHKE Town of Barnstable Regulatory Services seartMBLE, : Thomas F.Geiler,Director 1639. �.•� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: 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 r 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. I 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:forms:homeexempt VIOLA W.. .AITE PO BOX 389, CENTERVILLE MA 02632 Ph:(508)-771-3457 Fax: (508)-771-3496 Sprinklers Water Gardens • Pools • Low Voltage Lighting February 14,2012 Town Of Barnstable 200 Main Street Barnstable, Ma. 02630 i To Whom It May Concern, I authorize Cape Cod Construction to replace the windows and sidewall at my property located at 88 West Main Street in Hyannis. Thank You, F John Viola ` U r� EXISTING HOUSE QN , OW atN►�p xN i P.T.2 x 10 LEDGER BOARD LAG BOLTED TO SOLID BLOCKING W/(2) LEDGERLOK BOLTS XI T. I EXIST. EXIST. 16"o.c.W/JOISTS HANGERS AT BOTH ENDS ^O�° C Lo NEW VERIFY DECKING& EXIST. RAILING MATERIALS Q D" DECKcn L-L - HOUSE . 'I IL N in I I VERIFY DECKING& t 2-P.T.2 x CIA W/ I q RAILING MATERIALS EXIST. 1 x 10 FASCIA eO,Jr•1r�6a.4'• Sit`6iPsO'`� G I D 1 I P.T.2 x 8's @ 16'!o.c. Fo6p i CAW It -S g REMOVE EXIST.DECK I MINEpB�AS Emom - L--- -------------------------------------- J MENT INSTALL LATTICE L----- ---------- --------------- ---------_--- mmm UNDER NEW DECK lu 12'-7't 5'-0" 12'-1 a't 30'-0"t (EXISTING) FLOOR PLAN z NEW P.T.4 x 6 POSTS ON 12"DIA CONCRETE SONOTUBES TO 4'0" 1 BELOW GRADE. USE SIMPSON ,x 1 ABU 46 POST BASE&BC 46 POST CAPS P.T.2 x 10 LEDGER BOARD LAG BOLTED TO EXISTING Q SOLID BLOCKING W/(2)LEDGERLOK BOLTS 16"o.c.W/JOISTS HANGERS AT BOTH ENDS BASEMENT A BUILDING SECTION @ NEW DECK E­' D1 z W � NOTES: Q E-4 1.) CONTRACTOR IS TO VERIFY ALL EXISTING CONDITIONS W & DIMENSIONS IN THE FIELD � � q 2.) CONTRACTOR TO VERIFY ALL INTERIOR & EXTERIOR MATERIALS, z D1 DETAILS, & FINISHES IN THE FIELD WITH OWNER 3.) FOLLOW ALL MANUFACTURER'S SPECIFICATIONS FOR INSTALLATION SCALE OF ALL SIMPSON COMPONENTS /4" = 1'-0.. 12'-z't 5'4' 1z'-1a't 4.) ALL CONSTRUCTION TO CONFORM TO 780 CMR MASSACHUSETTS DATE STATE BUILDING CODE, SEVENTH EDITION 11/3/08 FRAMING/FOOTING PLAN - DWG. NO.: DI