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Home My WebLink About0148 W MAIN STREET - 4r, ,. La o y Awn ..... .�...._._._e ____ s 4 a �� ,a �i I i , rq � � ', ;�. a � w ._. _ _ i i ,� a a � r x t z �^ ¢ i�� 9 ��+ � a� .� � � � 6 vM k e�S y � W x .5.. ��yy y�M1 !i� ; .' � �' ; � � � :, � , Town of Barnstable Regulatory Services nstc. Richard V.Scali,Director p' Building Division - Thomas Perry,CBO,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnsiable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLEASE FORWARD THE ATTACHED PAGE(S) TO: TO: FAWCETT'S POND APARTMENTS ATTN: BRETT FAX NO: 50 �-8702 "22- �--- l RE: CERTIFICATE OF INSPECTION APPLICATION FROM: BRENDA COYLE,PHONE NUMBER 508-862-4039 DATE: 8/6/2015 PAGE(S): 3 (INCLUDING COVER SHEET) Rev:121901 P. 1 Communication Result Report ( Aug. 6. 2015 2:20PM ) 2) Date/Time : Aug. 6, 2015 2: 19PM File Page No. Mode Destination Pg (s) Result Not Sent --------------------------------------------------------------------------------------------------- 2070 Memory TX 9150879C4113 P. 3 OK ---------------------------------------------------------------------------------------------------- Reason for error E. 1) Hang up or line fail E. 2) Busy E. 3) No answer E. 4) No facsimile connection E. 5) Exceeded max. E-mail size E. 6) Destination does not support IP-Fax Town of Barnstable t: t RegWatoryServices _ Rlrhard d.Sa4 bireGor Building Division . .• Th—Petry.CB0,33.M gC...Ju m 200 Mein m«4 uymn4 KA OMI www.tm+dhnmihhluoa.m otCaa 508 sa 4ws F=SOB-790b230 PLEASE FORWARD THE ATTACHED PAGE(S)TO: TO: BAWC6TrS POND APAMURNTS ATM 11RLtl r FAX NO: SN4n 8702 M- �� r t 3 RE: CERTIFICATE OF INSPECPION APPIJCATION FROD9:MkWWA COXLF,PHONE NUMBER 50&862-4I" DATE: R 2615 PAGES), (INCLUDING COVER SEDUM �.u�9m Town of Barnstable BIKE Regulatory Services Richard V. Scali, Director BuildingDivision * BARNSTABM * M^S $ Thomas Perry, CBO, Building Commissioner i639. ♦0 prEO N11'1 A 200 Main Street, Hyannis, MA www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Second Request July 22, 2015 Fawcett's Pond Apartments c/o First American Comm. Real Estate P.O. Box 167928 Irving,TX 75016-7928 Re: 148 West Main Street, Hyannis MA Certificate of Inspection Multi-Family (5-year Certificate) Attached_is an application for a Certificate of Inspection as required by Section 110.7 of the Massachusetts State Building Code, Eighth Edition. Please complete the application and return it to this office with the required fee for the five-year Certificate of Inspection: 100 units - $275.00 The fee has been established by the Massachusetts State Building Code (Table 106),and amended by the Barnstable Town Council effective 8/6/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5 of the State Code. Sincerely, r 2', Thomas Perry Building Commissioner Enclosure jcoiletmf COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION i MULTI-FAMILY FIVE-YEAR CERTIFICATE Date (X) Fee Required$275.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 110.7,I hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: I Name of Premises: Purpose for which premises is used:MULTI-FAMILYRESIDENTIAL TYPE OF UNITS NUMBER OF UNITS TOTAL STUDIO 1 BEDROOM 2 BEDROOM 3 BEDROOM OTHER Certificate to be Issued to: Address: Telephone: Name and Telephone Number of Local Manager,if any: Owner of Record of Building: Address: Name of Present Holder of Certificate: SIGNATURE OF PERSON TO WHOM CERTIFICATE IS ISSUED OR AUTHORIZED AGENT PLEASE PRINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with your check to: BUILDING COMMISSIONER, 200 MAIN STREET,HYANNIS,MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# EXPIRATION DATE: coiappmf y �.Y. Town of Barnstable Building Division ;.::;4 ''L 1)y. . 9,r^` _�.v'` r p `•..Y, 200 Main Street " Hyannis$&A 02601 _.jam '. 00001383424 JUL, 22. 2015. Qu ..i C Fa-%vicett's Pond Apartments C/o First American Comm. Real Estate P.O. Box 167 [ rik'a tvis 1 o14P �.0..7 Irving,T� 7. sa dy a r r M E Y fp a� "r r_s�e r e z .:L s i T N FZ3ST AtMERICAN TAX COMMERCIAL RREAL rr�eZc� nrrr rah WESTLAKE TX 7626Z-S31a RETURN TO SENDER � 11�'�1111�+l�1►11��16li11�111111'{'�f�ILl�III" ' �'iII�11H.IlII . ~0'=.1";�f�L.S•�.'��'��' ..r�. .7"llll......11...1.lr--r--rrtrr rr rn. . Town of Barnstable do Regulatory Services • BMWTABLE, « MASS. � Thomas F. Geiler, Director jF039. A Building Division Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLEASE FORWARD THE ATTACHED PAGE(S) TO: it TO: Village at Fawcett's Pond ATTN: Britt FAX NO: 508 790 4113 FROM: Lois Barry DATE: 7/27/10 PAGE(S): _2_(INCLUDING COVER SHEET) If you have any questions, please call 508 862-4039. r Town of Barnstable Regulatory Services en Mpg`E'� Thomas F. Geiler, Director •i639 ♦0 A�F1639 Building Division Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLEASE FORWARD THE ATTACHED PAGE(S) TO: TO: Village at Fawcett's Pond ATTN: Britt FAX NO: 508 790 4113 FROM: Lois Barry DATE: 7/27/10 If you have any questions, please call 508 862-4039. i Commonbjeattb of tea..9,5a.cbU5Ctt. TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this CERTIFICATE OF INSPECTION is issued to THE VILLAGE AT FAWCETT'S POND 3 QCertifp that I have inspected the premises known as: THE VILLAGE AT FAWCETT'S POND located at 148 WEST MAIN STREET . in the Village of HYANNIS County of Barnstable Commonwealth of Massachusetts. Construction Type: Use Group(s): R2 The means of egress are sufficient for the following number of persons: Location Capacity Location Capacity 100 UNITS 100 ONE-BEDROOMS Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 201003941 6/28/2010 6/28/2015 027 002 The building official shall be notified within (10) days of any changes in the above information. Building Official d rJu1. 27. 2010 10:30AM No. 0629 P. 3 COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION MULTI-FAMMY FIVE-YEAR CERTIFICATE Date s�� (X) Fee Required$ Z 1 00 ( ) No Fee Required In accordance with the provisions.of the Massachusetts State Building Code,Section 106.5,I hereby apply for a Certificate of Inspection for the below-maimed premises located at the following address: Street and Number: UK I M/o/� Sagar 014 WEI MA- 02-601 Name of Premises: \(LU&04 Purpose for which premises is used: MULTI-FAMILY"RESIDEN�IAL TYPE OF UNITS NUMBER OF UNITS TOTAL STUDIO I BEDROOM 2 BEDROOM 3 BEDROOM ,OTHER Certificate to`he Issued to: # NI 00(ra®I Address Telephone; Jr, Name and Telephone Number of Local Manager; 1 if any: ` .tt 12a 04ar6L °7l I 9-7C)� Owner of Record of Building: Address: IS() wi l n-F, SIPICEr 5+ , S20 MA y02-1 26 r � , SIGNATURE OF P ON TO WHOM CERTIFICATE IS ISSUED OR AUTHORIZED AGENT PLEASE PRINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Reium this application with you i check t'. BTJILD1NCx COMMISSIONER, 200 MAIN STREET,HYANNIS, 4A'02601 PLEASE NOTE: 1)Application form with-acc6mpanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be-issued. 3)The building official shall be notified within ter,(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# O/O C67 EXPIRATION DATE: coiappmf i f TOWN OF BARNSTABLE INSPECTION WORKSHEET CERTIFICATE NO: 201003941� CANCELLED: C� MAP: 290 DBA: ITHE VILLAGE AT FAWCETT'S POND PARCEL: 027 002 NAME/MANAGER: ITHE VILLAGE AT FAWCETT'S POND STREET: 1148 WEST MAIN STREET VILLAGE: IHYANNIS STATE: MA ZIP: C2601_� SEQ NO: I_7 BUSINESS TYPE: MULTI FAMILY CONSTRUCTION TYPE: STORYI: CAPACITY: USE1: �2� Capacity Under 50: ❑ STORY2: CAPACITY: USE2: III—STORY3: CAPACITY: Ed USE3: Outside Seating: ❑ �� BY PLACE OF ASSEMBY OR STRUCTURE CAP1: _ LOC1: 100 UNITS CAPS: LOC8: CAP2: LOC2: 100 ONE-BEDROOMS CAP9: _ LOC9: CAP3: LOC3: CAP10: LOC10: CAP4: I LOC4: CAP11: LOC11: _ — CAPS: L005: CAP12: LOC12: CAPE: LOC6: 1 CAP13: LOC13: CAP7: LOCI: CAP14: LOC14: I INSPECTION: DATE ISSUED: EXPIRATION: Prin�ThisScreen 0 98t39/Q665 06/28/2010 06/28/2015 O Oy/j p Print Certificate of Inspectio COMMENTS: 3D oFt►+Eroyti Town of Barnstable Regulatory Services &AMSrneLE, „ASS* Thomas F. Geiler, Director AtF16,39. 6. Building Division Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 MEMORANDUM TO: FILE RE: COI MULTI FAMILY USE PROPERTY ADDRESS: CERTIFICATE OF INSPECTION: IS REQUIRED: z_ FOR UNITS IS NOT-REQUIRED: NOTES: e7 'tot BUILDING COMMISSIONER DATE coiform 'i A r '.;M �. y.:: :',� a;L..��;,: }�'m @,,:�,F•'.� � ,^,i *a+rvfi ,� .,;,,ka'. my.-:�.�?..:, w._. � �.k � v ` :..�:.. .< ',' ""'."'""'�"�� t M File � it. Tools Help Year/Type/Bill No. 1Customer account ir#ormation _ k i-iISt4Tyr ��I� i t f i TR B 1€ .•> t .7 1! - a. y _ c Detail FA4'CETT°S POND APARTMENTS Property informi Lion P'O.BOX 1 2 ' 3 IR 'INO,Tx`7501& 2E i" Orig Bill € Parcel ID 29�42?-+( i Alt Parc r x ',Effect v Date - Prop Lcrc 1 8 illi EST MAIN STREET Den/Sale, �;o Spe 1 { _ a. - � cia n tGlnS eS_ Scan BiII r Quick Entry IrA Dt Billed At�t�A;�1t 'mt r>rrd Interest ,Unpaid Ira, Utility - l l,rolloi 1 S3&49 t 17 S S 4B , €III Customer ' f131{D2 11} 1 814. 1 v ( 17 1 w Qp 17564.0 w Narire . _ � _-. w. Fees/Pen. } 01} ' .00' tlCB u_ -. Parcel Totals '' T — }2 ''' d14 iB 25fs BS _ .00 Prop Fade " , NoteslAleits —" D, {# QS 4t1f} 00 I' Billing Dates ° Per diem .00 AN 1 Owner: FAWC1=TT 5 POND-APART, q,x Bill Audft r lrit Paid I ' Reprii;rt 'Ale"Oorurrpaidbills i Preferences Diagnostics .... .., . 1 13f 16, Display transaction history for the current ail, TOWN OF BARNSTABLE INSPECTION WORKSHEET Coos CERTIFICATE NO: 47108 CANCELLED: Q MAP: 290 DBA: ITHE VILLAGE AT FAWCETT'S POND PARCEL: F027 002 NAME/MANAGER: JCMJ MANAGEMENT COMPANY STREET: 148 WEST MAIN STREET VILLAGE: IHYANNIS STATE: MA I ZIP: 02601- SEQ NO: 1 BUSINESS TYPE: MULTI-FAMILY CONSTRUCTION TYPE: I STORYI: CAPACITY: USE1: R2 Capacity Under 50: r. STORY2: CAPACITY: USE2: STORY3: CAPACITY: USE3: Outside Seating: r. BY PLACE OF ASSEMBY OR STRUCTURE CAP1: LOCI: 100 UNITS CAPS: L005: CAP2: LOC2: 100 ONE-BEDROOMS CAPE: LOC6: CAP3: LOC3: CAP7: LOC7: CAP4: LOC4: CAPS: LOC8: INSPECTION: DATE ISSUED: EXPIRATION: '_ Print This Screen U �7 06/28/2005 06/28/2010 `.Print Certificate ofJnspection COMMENTS: I pFTHElp� Town of Barnstable Regulatory Services • M + BARNSTABLE, v MASS. g Thomas F. Geiler, Director 039. ADO Building Division Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLEASE FORWARD THE ATTACHED PAGE(S) TO: TO: Fawcett's Pond Apartments ATTN: Britt FAX NO: 508 790 4113 FROM: Lois Barry DATE: 7/20/05 PAGE(S): (INCLUDING COVER SHEET) If you have any questions, please call 508 862-4039. oFtHE, Town of Barnstable do Regulatory Services a a 9$ss" �`"�M � Thomas F. Geiler, Director 039. ° Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.mams Office: 508-862-4038 Fax: 508-790-6230 July 20, 2005 Fawcett's Pond Apartments 148 West Main Street 4 Hyannis, MA 02601 Re: 148 West Main Street, Hyannis Certificate of Inspection Multi-family Dwelling (5-year Certificate) Dear Property Owner: Attached you will find an application for a Certificate of Inspection as required by Section 106.5 of the Massachusetts State Building Code, Sixth Edition. Please complete the application and return to this office with the required fee: 100 Units - $285.00 The fee has been established by the Massachusetts State Building Code (Table 106), and amended by the Barnstable Town Council effective 8/6/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5.2 of the State Code. Sincerely, Thomas Perry Building Commissioner Enclosure jfaw The Commoubieartb of JfWq rbuatt! TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this CERTIFICATE OF INSPECTION is issued to CMJ MANAGEMENT COMPANY Q�EI'�[fp that I have inspected the premises known as: THE VILLAGE AT FAWCETT'S POND located at 148 WEST MAIN STREET in the Village of HYANNIS County of Barnstable Commonwealth of Massachusetts. Construction Type: Use Group(s): R2 The means of egress are sufficient for the following number of persons: Location Capacity Location Capacity 100 UNITS 100 ONE-BEDROOMS Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 47108 6/28/2005 6/28/2010 290 027 002 The building official shall be not f ed within(10) days of any changes in the above information. Building Official COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION MULTI-FAMLY FIVE-YEAR CERTIFICATE Date,. 7,;0-05 (X) Fee Required ( ) No Fee Required In.accordance with the provisions of the Massachusetts State Building Code,Section 106.5,I hereby apply for a Certificate of Inspection for the below-named premises located at the following address. Street and Number: WF,ST MA-jAi STP_EN r oil n t0 f M A 0260/ Name of Premises: / e, V(u aQt a-f, . ALOM tt rS V0 Af D Purpose for which premises is used:MULTI-FAMILY RESIDENTIAL TYPE OF UNITS NUMBER OF UNTTS TOTAL /0 D STUDIO I BEDROOM ✓ _ ?BEDROOM EDROOM - OMR 1 Ceftificate to be Issued to: 4wem �s_Tni1d, 4 Address: I49 log? (Al Telephone: 50?- 111— g 7 02 Owner of Record of Building: -4;W .Gtf`5. Or:) A��mfgT CD CNIJ IaQgQfsEmEgT Co"(4w/ Address: ISO Wtt.rtl - VeICQOtS SA1-r'{. SZO �D�'f0t`1 �� Oi(ZS Name of Present Holder of Certificate: 11te— YI It1 aA Q.L cab ao- t$ -I)DO ID Name of Agent,if any: n t .Ad rAt nt Y M_f n -• - Vt)t O - a SIGNATURE O P RSON O WHOM CERT CATE IS ISSUED OR AUTIIORI ED AGENT ri& P. D VAL&" PLEASE PRINT NAME Leturn TRUCTIONS: ake check payable to: TOWN OF BARNSTA13LE this application with your check to: BUII.MING COMMISSIONER, 200 MAIN STREET,HYANNIS,MA 02601 ASE NO]pplication form wiith accompanying fee must be submitted for each building or struchue or part thereofto be certified. pplication and fee must be received before the certificate will be issued. he building official shall be notified within ten(10)days of any change in the above information. R OFFICE USE ONLY: CIRTIFICATR;# / � EXPIRATION DATE: coisppmf �FIME ram, Town of Barnstable �O Regulatory Services • B&MW9rABLX, « „AN. $ Thomas F. Geiler,Director o;o. Building Division Thomas Perry, CBO,Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 May 16, 2005 Fawcett's Pond Apartments PO Box 167928 Irving, TX 75016-7928 Re: 148 West Main Street, Hyannis Certificate of Inspection Multi-family Dwelling (5-year Certificate) Dear Property Owner: Attached you will find an application for a Certificate of Inspection as required by Section 106.5 of the Massachusetts State Building Code, Sixth Edition. Please complete the application and return to this office with the required fee: 100 Units - $285.00 The fee has been established by the Massachusetts State Building Code (Table 106), and amended by the Barnstable Town Council effective 8/6/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5.2 of the State Code. Sincerely, Thomas Perry Building Commissioner Enclosure jcoiletmf Ft r Town of Barnstable Regulatory Services + BARN3fABLE, ,,ASS. Thomas F. Geiler, Director �p i6gq. ♦Q' tE039 A Building Division Thomas Perry, CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.ba rnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 May 12, 2010 Fawcett's Pond Apartments Management Office 148 W. Main Street Hyannis, MA 02601 Re: 148 W. Main Street, Hyannis Certificate of Inspection Multi-family (5-year Certificate) Attached you will find an application for a Certificate of Inspection as required by Section 106.5 of the Massachusetts State Building Code. Please complete the application and return to this office with the required fee: 100 Units - $285.00 The fee has been established by the Massachusetts State Building Code (Table 106), and amended by the Barnstable Town Council effective 8/6/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5 of the State Code. Sincerely, Thomas Perry Building Commissioner Enclosure jcoiletmf f Flla' diti Tdbls H4 � � �•�: h n ! , � itV ji K 4• ��,. ,. rµ., 4 i ry i- Action "' Year/Type/BiIINo Customer Account Infarmetion *x History 2005 1 RE-R 9410 ' 77 25382 Detail Property Information' FAWCETT'S POND APARTMENTS X3 .� �- �a w 'PO BOX 167928 � Orig Bill Parcel ID 290-027 002 , IRYING, TX 75016 7928 - •. Alt Par c EFfecuve Date _ Prop Loc 148 WEST_MAIN STREET '` `'� � Lien/Sal e ( Special Conditions/Notes "Wd H Qwck Scan, - — - Int Dt, "Billed, Abt/Adj Pmt/Crd- Interest Unpaid bal t ;Specific Bill , _ _ N 11/23/04 .. 36,436 32 00 36,436 32 0 00 tUtduy Acct 05/D3/05 36,386 31t 400. � 00� 641 99 � 37 028 30x 1Custoroer 1 Fees/PenF. _ Totals: y72,822 63 00 36`436 32 641 99; 37,028 30 fi �Parcel � � � .. o a' Name es/Alerts _ = s Due 05/16/2005 37 028 30 Not i Bil g.Dates h'JAN 1 Owner: FA4lCETT'S POND APART,i n K rY t Per Diem a 13 96` Int Paid, t 00 A `Preferences V1ew Pr�ar,tlnpay!Bills k. gDBG BILL HDR x " J {{ t �c f $ r O;4 4 ,0 3 Mid = i Ica let ,R o� y�Micros` Corine % g. °Ftr+e The Town of Barnstable - MAM �m�' Department of Health, Safety and Environmental Services �" Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner CERTIFICATE OF INSPECTION CAPACITY INSPECTION MULTI-FAMILY DBA t ancP M&P LOCATION_ q g C". )N\, OWNER C,�n ADDRESS L:fn )N*. ZONING NO. OF UNITS/FEE / a w� CLlA JL GLORIA URENAS APPROVAL DATE INSPECTOR DATE OF INSPECTION 'T J980309A as s achu s e tts The c o m m o n w e alth o f Nt TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code,Section 106.5, this CERTIFICATE OF INSPECTION is issued to CMJ MANAGEMENT COMPANY Certify . that I have inspected the premises known as: FAWCETT"S POND APARTMENTS located at . 148 WEST MAIN STREET in the Village of I-IYANNIS County of Barnstable Commonwealth of Massachusetts. The means of egress are sufficient for the following number of persons: Use Group Construction Type Location Capacity R2 100 UNITS 100 ONE-BEDROOMS 47108 6/28/00 6/28/05 Certificate Number Date Certificate Issued: Date Certificate Expired: The building official shall be notified within(10)days of any changes in the above information -- Building Official ,w COMMONWEALTH OF MASSACHUSETTS TOWN OF BARNSTABLE APPLICATION FOR CERTIFICATE OF INSPECTION MULTI-FAMILY / FIVE-YEAR CERTIFICATE Date l.0 Jci��l� (X) Fee Required$,,7—7 S fl� ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code, Section 106.5,I.hereby apply for a Certificate of Inspection for the below-named premises located at the following address:. Street and Number: 148 West Main Street Name of Premises: Fawcett's Pond Apartments- Purpose for which premises is used:MULTI-irA11r MY RESIDENTIAL TYPE OF UNITS NUMBER OF UNITS TOTAL STUDIO — 1 BEDROOM 100 2 BEDROOM - 3 BEDROOM OTHER Certificate to be Issued to: Fawcett's Pond Apartments Address: 148 West Main Street, Hyannis, MA 02601 ` Telephone: (508) 771-8702 Owner of Record of Building: Fawcett's Pond Apartments Company c/o CMJ Management Company Address: 150 Mount Vernon Street, Boston, MA 02125 Name of Present Holder of Certificate: Fawcett's Pond Apartments Name o gent,if any: CMJManaygement Company SI TURE OF PERSO TO WHOM CERTIFICATE I SUED OR AUTHORIZED AGENT Controller CMJ Management Company PLEASE PRINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with your check to: BUILDING COMMISSIONER, 367 MAIN STREET,HYANNIS,MA 02601? PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be'notified within ten(10)days of any change in the above information. CERTIFICATE# '/I 7/ O c;-` EXPIRATION DATE: 6 Z �O f FTHE The Town of Barnstable snxxsTABLFE 9� M�: ,�� Department of Health, Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner May 15, 2000 FAWCETT'S POND APARTMENTS 200 CORPORATE RIDGE#925 MCLEAN, VA 22102 Re: Certificate of Inspection Multi-family Dwelling(5-year Certificate) 148 WEST MAIN STREET, HYANNIS 290 027 002 Dear Property Owner: Attached you will find an application for a Certificate of Inspection as required by Section 106.5 of the Massachusetts State Building Code, Sixth Edition. Please complete the application and return to this office with the required fee: 100 Units - $275.00 The fee has been established by the State (Table 106) and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5.2 of the State Code. Sincerely, Ralph M. Crossen Building Commissioner RMC/lbn j000424a 29U 02'7 002 148 West Main Street /46 - - -—� We The Town of Barnstable • a�srrsrwa�, + ' Department of Health, Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner CERTIFICATE OF INSPECTION CAPACITY INSPECTION MULTI-FAMILY DBA,Pa M&P q a 22 7 0 0,;7, LOCATION 1-le GU OWNER ADDRESS 0-o q'zs— P/�' ZONING NO. OF _ UNITS/FEE yT�5 t' z © o GLORIA URENAS APPROVAL /O O DATE INSPECTOR DATE OF INSPECTION J980309A Town of Barnstable nF�EctPT 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-2113 Date Recieved: 7/6/2017 Job Location: 148 WEST MAIN STREET,HYANNIS Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: PETER A LAROCHE State Lic. No: CS-073097 Address: Centerville, MA 02632 Applicant Phone: (508)737-6862 (Home)Owner's Name: FAWCETT'S POND APARTMENTS Phone: (508)771-8702 (Home)Owner's Address: 150 MOUNT VERNON ST SUITE 520, DORCHESTER,MA 02125 Work Description: Replace one exterior door and two windows in the community room Total Value Of Work To Be Performed: $8,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). ' I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Peter Laroche 7/6/2017 (508)737-6862 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost: $8,000.00 1 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $160.00 7/21/2017 $160.00 15057 Check ..........__..............................._......................................_..........................................................................................................................._..........._......................_....._._.............................. Total Permit Fee Paid: $160.00 I r Town of Barnstable �c 200 Main Street, Hyannis MA 02601 508-862-4038 Application for Building Permit PP g Application No: B-17-2113 Date Recieved: 7/6/2017 Job Location: 148 WEST MAIN STREET,HYANNIS Permit For: Building-Siding/Windows/Roof/Doors Contractor's Name: PETER A LAROCHE State Lic. No: CS-073097 Address: Centerville, MA 02632 Applicant Phone: (508)737-6862 (Home)Owner's Name: FAWCETT'S POND APARTMENTS Phone: (508)771-8702 (Home)Owner's Address: 150 MOUNT VERNON ST SUITE 520, DORCHESTER,MA 02125 Work Description: Replace one exterior door and two windows in the community room Total Value Of Work To Be Performed: $8,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this-application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Peter Laroche 7/6/2017 (508)737-6862 Applicant Date Telephone No. Estimated.Construction Costs/Permit Fees Total Project Cost: $$,000,00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $160.00 7/21/2017 $160.00 15057 Check Total Permit Fee Paid: $160.00 F !7 Town of Barnstable4 ,; -.1 � cr a�sx�rrAats, ' 200 Main Street H annis MA 02601 508-862-4038 aa� Y Application for Building Permit Application No: TB-17-2113 Date Recieved: 7/6/2017 Job Location: 148 WEST MAIN STREET,HYANNIS Permit For: . Building-Siding/Windows/Roof/Doors Contractor's Name: PETER A LAROCHE State Lic. No: CS-073097 Address: Centerville, MA 02632 Applicant Phone: (508)737-6862 (Home)Owner's Name: FAWCETT'S POND APARTMENTS Phone: (508)771-8702 (Home)Owner's Address: 150 MOUNT VERNON ST SUITE 520, DORCHESTER,MA 02125 Work Description: Replace one exterior door and two windows in the community room ircy y� qq J ♦� 9 i.3 �« •.k ti CD Total Value Of Work To Be Performed: $8,000.00 '� r;J Structure Size: 0.00 0.00 1 000 can r -a Width Depth Tota�Areg I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). 1 understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Peter Laroche 7/6/2017 (508)737-6862 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $8,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $160.00 ...................... ........................................................................................................................................................... Total Permit Fee Paid: $0.00 TQWN OF BARNSTABLE BUILDING PERMIT APPLICATION ✓ j r J/ Map Parcel Application # l �� Health Division Date Issued `{7..(0 pe . Conservation Division Application Fee Planning Dept. Permit Fee 10 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address , l?. •`'C� _ Village Owner Address P5Z 122Lf Telephone Permit Request 4" 2 Ae&7 - 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 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: - ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zj Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ a Commercial ❑Yes ❑ No If yes, site plan review # — Current Use Proposed Use == Z, Co i APPLICANT INFORMATION (BUILDER OR HOMEOWNER) � r ._Name Telephone Number Address License #� 2/49 7 2 6zlleltx �' Home Improvement Contractor# /ADS IV r' Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 9-16 L� . Y t FOR OFFICIAL USE ONLY :. APPLICATION# DATE ISSUED MAP/PARCEL NO. t r ADDRESS VILLAGE ` OWNER DATE OF INSPECTION: k .--FOUNDATION. t � FRAME INSULATION i FIREPLACE r ELECTRICAL: ROUGH FINAL 4. 4 {, PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING x DATE CLOSED OUT ASSOCIATION PLAN NO. F r i s #A1A Document Al 07 - 2007 Standard Form of Agreement Between Owner and Contractor for a Project of UmNted Scope AGREEMENT made as of the Fourth day of January in the year Two Thousand Sixteen (In%vrds,indicate day.month and year.) ADDITIONS AND DELETIONS: The author of this document has BETWEEN the Owner added irdbrinatlon needed for its (Name,legal status, address and other information) cmVi don.The author may also have revised the text of the odgirtal Fawcett's Pond Apartments Company LP,Limited Partnership AIA standard form.An AdOborm and clo Corcoran Jennison Companies Dakftns ReW that mess added Attention: President Information as well as re0dons to 150 Mount Vernon Street,Suite 500 the al Aard form text is ahradabte Boston,MA 02125 from the authorand short be Telephone Number 617-822-7300 reviewed.A varttce+6ne In Me MR margin of tide dominant Indite where the author has added and the Contractor: necessary ifaform a&m and where time.legal status,addrew and other In ormation the wither has added tD or deleted f ) from the original Ala text KTM Properties LLC,Limited Liability Company This dominant has Important legal 25 Spaulding Road consequences.Corlatdtatton weh an Freestont,NH 03044 attarrm is ommrraged w6h respect Telephone Numbs:(603)437 2400 to Its cw#edon or nwdit born. for the following Project (Name.location and detailed description) Fawcett's Pond Siding Trim&Window Replant Buildings C&D 148 west Main street Hyannis,MA 02601 AU labor and materials per proposal from K ld Properties LLC to Village at FawceWs Pond,dated November 2Z 2015 for the stipulated am of$660,000 00. The Architect: (Name,legal status,address and other Inforrxatian) Timothy Pacheco,Individual 150 Mount Vernon Street,Suite 500 Bostlm,MA 02125 Telephone Number.617422 7212 The Owner and Contractor agree as follows. AIA Doan and A107"—2W.Copyrtglu•1931L 1951.1958.1061.1963.1966 IWO.ISM 19M 1967.1997 and 2W?by The American trhsttft of Architects.M e4lft reserved.WARNING:This AIAb Document Is protected by U.&Copyright taw and Inteinadonal Treaties.unnuthoAmd reproduction or distribution of this AIAP Document.or my potion of It.may result to severe"OW criminal penaltle&and will be prosecuted to � I the maximum utent possible under the law.This document was prodax;ed by AIA sottwaro at 11:37Z on 0?!11/l918 under Cider 193UW 1 wtddt emhas an 111t1312t%and is not for reeft and the Drawings and Specifications has sat' fled itself as to the conditions under which it will be obliged to operate in=forming the Work including any obstructions difficulties and restrictions attending the execution of the Work at the site:amount of Work:character and nature of the Work:the eguiMent and facilities needed preliminary to and during the prosecution of the Work:the accomrrOdation of the Work to and/or by work that may be performed by or for the Owner under other contracts all required connections of any sort to such work under other contracts.and scheduling of Work as required in coordination with such work under other contracts:and any other consideration which may affect the Work in any mariner Contractor shalLcomply with the manufacturer's instructiom qWjMjjrjy in connection with the windows and planking.MRecially the method of attachment(e g-the toe of fasteners stainless steel screws as opggsed to galvanized nails) Subject to the terms and conditions of this Agreement Contractor acknowledges and agrees that it is reMnsible for completion of the Work within the Contract Sum and Project Schedule provided by the Owner Contractor represents and warrants that it has reviewed and fully understands the scope of work set forth in the Drawings and Specifications issued by the Designer. No allowance will be made in this connection to the Contractor unless an agreement therefore shall have been made in writing by the Owner at the time o£or prior to,the signing of the contract. PAGE! After installation of the first window hereunder.Contractor shall g vim' e_Architect with the apgMity to review and Mgm gaMM&S with the Work, PAGE 18 The Owner may,at any time,terminate the Contract for the Owner's convenience and without cause.The Contractor shall be entitled to receive payment for work executed,and costs incurred by reason of such ermmation_ PAGE m this Aeat entered into as of the day and veer first written above w n la BE ( 4A 14Iid1ael J.Corcoran Tntstee . ahated name and Wk) ffWn ed aww and tide) M-80"S FM C"Smea" mum -41 an—MARRO, —a-, amp!1! 1 of Weviseeffift profit;Gone airo a- Oweep for Gogh-pel'aens;gad Addtttmes and Delottortg Repoli for AM Docutowd A1107A'—2W.CopyrtgM O/93a,1951,195L 1961.1483.1ML 197%1974.INS.1087,1t197 and 2W Tyrosttea,u lam brlsed p or dust is ARMNG TMs MA,t Doa mnt is protected by u.&Copyright Law and Intamattonal 3 let, any portion of IL may emit in severe civa and atminal penalties,and will be prosecuted to the maximum extant possible under the law.This doaaneed was produced by Ayr so tware at 11:V27 on OM Iola under order NaN1636252%1 wtfdt oxpltes an 111t1C11201a,and is not for Mato, t 8 Exhibit "A" iGF2— PROPLP-TOL 6 L LC 25 SPAULDIN( RP • .A)UITI= 17-2 - FRP-MONT. NE\V flAMPNJ9S_ 05044 r-iJ 603-895-0400 - FAx 603-895-0445 November 22, 2015 Village at Fawcetts Pond 148 West Main St Hyannis, MA 02601 RE: Siding,Trim,&Window Replacement Fawcetts Pond—Building C&D Dear Tim, As per your request and our site visit we are pleased to provide you with proposal to perform siding,trim and window replacement at the above referenced address. Scope of Work: • Remove and Dispose of existing siding and trim on buildings C&D (Approximately 260 sq) • Remove sheathing and replace with new%"plywood • Supply and Install new Hardi-plank siding,exposure to match existing • Supply and Install new PVC trim • Install new owner provided AC sleeves and trim out with PVC • Paint 2 coats on all siding and trim—Color SW BM 1490 Country Life • Supply and install 96 new Simonton 5050 white vinyl sliding windows with new PVC trim • Existing downspouts to be removed and reinstalled. • Price to include all disposal&permits_ R Building C&D Price: $395,000 Exclusions: • Balcony areas • Insulation • Interior repairs • Gutters&downspouts Add Alternates: 1. Supply and install new exterior entry door Allowance-$850 per door 2. Supply and install new storm doors Allowance-$450 per door If you have any questions,please feel free to contact me at 603.234.9213. Sinerely. 11 ( itcn.cGj� Charles Minasalli Guh�Tf�t—i \V1Ovk. TMP20PE277E_--)cam Z PROPMV9.6 L LC 25 SPAULDINC, FZD • SUITE 17-2 • FIZP-MONT. NP-\V fl4,MP5dlQlL 05644 PIJ 603-895-0400 - Fax 603-895-0445 - November 22, 2015 Village at Fawcetts Pond 148 West Main St Hyannis, MA 02601 RE: Siding,Trim,&Window Replacement Fawcetts Pond—Building C&D—Balcony Areas Dear Tim, As per your request and our site visit we are pleased to provide you with proposal to perform siding,trim and window replacement at the above referenced address In the balcony areas only. Scope of Work: • Remove and Dispose of existing siding and trim on buildings C&D (Approximately 170 sq)at 90 balcony areas • Supply and Install new Hardi-plank siding,exposure to match existing • Supply and Install new!PVC trim • Paint 2 coats on all siding and trim—Color SW BM 1490 Country Life • Supply and install 90 new Simonton 5050 white vinyl sliding windows with new PVC trim • Price to include all disposal&permits n Building C&0 Price: $265,000.00 Exclusions: • Insulation • Interior repairs • Gutters&downspouts Add Alternates: 1. Supply and install new storm door Allowance-$450 per door If you have any questions,please feel free to contact me at 603.234.9213. Sincerely, Charles Minasalli \V\V\V.IC TA jP20Pc-P-7'lE.---).CaA4 EXHIBIT"B" CONTRACTOR'S NUNDIUM INSURANCE REQUIREMENTS JANUARY 49 2016 Contractor shall comply with the reasonable registration requirements of Compliance Depot as directed by Owner, and shall maintain the following minimum coverages: Additloaal Owner -insureds: GeneratlAbilibt: Coverage shall be written on an Occurrence basis in accordance with your services performed and shall include,but not be limited to,Premises/Operations,Produce/Completed Operations, Professional Liability,Personal bt Advertising injury,Medical Payments,Blanket Contractual Liability,Contractors Protective Liability and Explosion,Collapse and Underground Exposures. Completed Operations coverage shall be maintained aft completion of the job with limits indicated below for the statute of rye in the stage of the projects location. Limits: ■ $1,000,000 Each Occurrence • 000 000 Mange- A Limits shall be on a per 1woject basis Wortcen Statutory coverages in accordance with your services in which the work is being performed(Both Commotion: your employees and any leased employees).including all State and Federal requirements. USL&H endorsement to be included where applicable. Certificate of Insurance must identify that coverage applies in the State in which the Project is located. Employers Liability Limits: • $1,000,000 Each Accident • $1,000,000 Disease-Policy Limit • $1000 000 Disease-Each F.m ee Automobile Owned,Non-Owned and Hired Automobile coverages to be included. If hauling hazardouis waste, Wab coverage shall include MCS 90 matt and the ISO Farm CA 9949(Pollution Liability Broadened Coverage for Business Automobite�Owner shall be named as additional insureds. LmlftL $1,000,000 Combined Single Limit iJmbrefls: $5,000,000 Limit per occurrence and aerate on an Umbrella form over General Liability, Automobile Liability and Employers Liability. Environmental Endorsements or policies are required for Contractors handling and/or involved in asbestos,lead co reralm abatement and any other hazardous matte. Contractors Pollution Liability policies for specific pollution work will be required at a limit of$5,000,000 per occamret<ce,$5,000,000 aggregate. This policy will have an aggregate limit on a per project basis. Additionl insureds will include the Owner and Corcoran Jennison Companies ETAL named as additional insureds for on-going and completed operations. Miscellaneous: Insurance certificates shall be provided prior to conmaeaioeatent of work,and upon request. Attached to each certificate of insurance shall be a copy of the A insured Endorsement that is part of the Contractor's Commercial General Liability Policy. These cerWicates and the insurance policies shall contain a provision that coverage afforded under the policies will not be cancelled or allowed to expire until 30 days prior written notice has been given to Owner. The Owner shall be named as an additional hmred on a primary and noo-oontrhbuuooy bents on all liability and excess policies. Coverage for Owner shall include completed operations coverage. To the tidlest extent permitted by law.Contractor waives all rights against Owner and its affiiides,and each of their officers,directors, members,shareholders,employees,agents,subsidiaries and partners for recovery of damages to the extent these damages are covered by commercial general Babft,commercial umbrella liability, business auto liability or workers compensation and einployers liability insurance. Qt �xeCt_�(1 f(/�Cfi1 j(.(•G'f't'tG•l/?` 1 Office of Consumer.Affairs� d Business Regulation -� 10 Park?laza-Suite 5170 G, Briton;lvlassachusetts;02 i 16 Horne Improvement Contractor Registration ` r�egissraiion> S6OS�9 Type: Supplement Card ERpireilom- e12S1101S KTM PROPERTIES, LLC: CHARLES MINASALL), 25 SPAULDING RD SUITE 17=2 PREMONT,NH 03044 Update,Addrtsa and return Card.mark reason for rbange_� o `?Address_V I Rtnewa( a mptayutent. i Log Card ''/ti.Yu.z�numu.r�,/!h tytY`/��.•.<�a.:ufii r. .. W'1110� t_Ireosepr qbistration valid.for individul use oatEM PROVEWNT CONTRACTOR. beforethe eipirstien date; if found return to: Offcce oPCanvume-`Affays anii'tiusinexs Re utat oa 'TYPO � .Eipiratiort (;� Uffi. Soppte±nsnt Gtird gestea k QL02116'i KTIA PROPERTIES.Ll C: CHaSYLES.MINASA[.f.t t t 25,SPAULDING RO SUITE 17-2 s�'�-•-e�--- ; ` FREMONT,MH 07044 t'No1.t ._ lindsnecreGry' , d wtthuatsit;nature S f s r 4` i t t f 4 s i 4 I i !I Massachusetts-Department of Public Safety board of Building Regulations and Standards 1 Construction Supervisor License:CS-071077 o \� f A � CHARL$S J MON ZS Spauldim Rd Fremont NH 0303 Y ry, t J )1 tt1 Expiration { Commissioner 0712512017 i _ t � } i f t i 4 1 i i 4 i The Commonwealth of Massachusetts . Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiott/Individug): K M Properties,LLC Address: 25 Spaulding Rd - Suite 17-2 City/State/Zip: Fremont, NH 03W Phone#: 603-895-0400 Are you an employer?Check the appropriate box: Type of project(required): 1. x❑ I am a employer with 25 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. Q 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.: 10. Electrical repairs or additions required.] 5. We are a corporation and its ❑ rep 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp, right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. I Union Insurance Company Insurance Company Name: Policy#or Self-ins.Lic.#: WCA51 5231 6-1 0 Expiration Date: 6/16/2016 148 West Main St. Hyannis,MA 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 here erdfy under the pains and allies ojperjury that the information provided above is trae and correct Si ature: `� �� t� Date: 03/1612016 Phone#: 603-895-0400 Official use only. Do not write in this area,to be completed by city or town ojyiciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I CERTIFIS 4- �*Wf;MCE Tres cEaTwcnTE 4 IN as:a MATTER Of eea4nTta:► ao nu�t4ta ewas+Tt+e . Ims csaTMlcnTe oaes"ftoTuaTnrgx o4s:raATw�.>as ;ex> :a OatEie,,TN doxEAnae a �w BELOW. INS CE4>;41FCATE.OF RMAUM �:.00RS�NOi�A�"84TWEEN TKE'188UtK01IN 1� - QITAi1YE OH PROdtfCBR,A41b THE QERtB tt pwpR MT'IF the cookm . . 6a:en ;wp Sa<e1!M:enAotttd $: 4Sr+. , to. .. itltbentane"ao tit..... tposo fi ttSayatepf4fafas lkataEomeatontltfseettiBCtfadA88aot=loflDe tttlAet Rau atttuA raaonaa. PApne'6 1 8rotrt►8s rown. t FwR.66�8A6� D� SWAM KM Pr+opwft LLC 28. RoIId e FtatYioM�03044 t 1HiB,iB.Td' TNATTHB` OF 9E�dSYlUWB 7pM5�ARp NAIulQO m 'MWATM NOTWRNSTAK%%:ANY .-TERN.QA fX18O11iOl1�OF Allk OR OTHER COQA*NT R8B�6Ct TOaWF�Jt MIS CRATEFPCATE MAY K O OR Wf PERTAN f1SB AFFdAOED 6Y 74S PC�CffA 1 t&4 Ci TO A1L TN$rTF13118' 0 ANO CONDMO/13OF:SIkH POI . .. ►iN►Y . .. B BI gY,PA�CIJ10d8 rn�iarawmitra .� ''_ . ae�u►ufsam - �+ t ''T A X ewr�eW.tn,Bei�wtutr ABS6;38�+44 9tBrXOSa ASN9918 mom. f i t; antlSaastt CICDacm - 3.. J o6AA6d1EAAt8Wrt aS8i8! - PA0011CIs f X' f �atra�eeattn�mtnY A AMA= 44 6Bt4elle4s moms � BfteLY cPst�+t • ��' � X : frrwnAMrQ*.tpaa�ul:'f Ix ta®arnit Xnowt t oa=. A uoomsuta a cme Si3t4�1S OBH8f�44S QsN81iO4s Aemom"!:. X: AG M tivtoraaeetamtttY Y 6Y118+fi 08f4Bf39t6 OdIt6Gt6i8 .E1 Ql01AR f �. p ^au ( WA S mAlq k� eta _�ily >�. oaaeavtaro►aveµno�pl{wei►nan�rmrnes pfaaea�oa9►ai:�gstradwpcao� soaer awyu.C:;.: JIM%"' ►OFiiimatfatie wta TLi�OF 1M6f..88 SI Fartiftf Putpmw � +t* Trovauoao J AC�Ima�9a� Tntaca4:atewtana�oana'� �+ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # Health Division Date Issued* ^1 -A 1p Conservation Division Application Fee / Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village r/ Owner Address Telephone 6 - YaV- 7V0 Permit Request f/L a� efii� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ =� Commercial ❑Yes ❑ No If yes, site plan review# c> Current Use Proposed Use h .ai APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name LTM Telephone Number /P 40 qS 4 4 Address S �? License# �5"0 21 -77 kJo �q Home Improvement Contractor# �) Email Worker's Compensation # � .5�/Sc�.� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS-PROJECT WILL BE TAKEN TO .,wC SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER I DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. § 21.21f a claim,dispute or other matter in question relates to or is the subject of a mechanic's lien,the party asserting such matter may proceed in accordance with applicable law to comply with the lien notice or filing deadlines. § 21.3 The parties shall endeavor to resolve their disputes by mediation which,unless the parties mutually agree otherwise,shall be administered by the American Arbitration Association in accordance with their Construction Industry Mediation Procedures in effect on the date of the Agreement.A request for mediation shall be made in writing,delivered to the other party to this Agreement,and filed with the person or entity administering the mediation.The request may be made concurrently with the binding dispute resolution but,in such event,mediation shall proceed in advance of binding dispute resolution proceedings,which shall be stayed pending mediation for a period of 60 days from the date of filing,unless stayed for a longer period by agreement of the parties or court order. If an arbitration is stayed pursuant to this Section,the parties may nonetheless proceed to the selection of the arbitrator(s)and agree upon a schedule for later proceedings. § 21.4 If the parties have selected arbitration as the method for binding dispute resolution in the Agreement,any claim,subject to,but not resolved by,mediation shall be subject to arbitration which,unless the parties mutually agree otherwise,shall be administered by the American Arbitration Association,in accordance with the Construction Industry Arbitration Rules in effect on the date of this Agreement. Demand for arbitration shall be made in writing,delivered to the other party to the Contract,and filed with the person or entity administering the arbitration.The award rendered by the arbitrator or arbitrators shall be final,and judgment may be entered upon it in accordance with applicable law in any court having jurisdiction thereof. § 21.5 Either party,at its sole discretion,may consolidate an arbitration conducted under this Agreement with any other arbitration to which it is a party provided that(1)the arbitration agreement governing the other arbitration permits consolidation;(2)the arbitrations to be consolidated substantially involve common questions of law or fact; and(3)the arbitrations employ materially similar procedural rules and methods for selecting arbitrator(s). § 21.6 Any party to an arbitration may include by joinder persons or entities substantially involved in a common question of law or fact whose presence is required if complete relief is to be accorded in arbitration provided that the party sought to be joined consents in writing to such joinder.Consent to arbitration involving an additional person or entity shall not constitute consent to arbitration of a Claim not described in the written Consent. § 21.7 The foregoing agreement to arbitrate and other agreements to arbitrate with an additional person or entity duly consented to by parties to the Agreement shall be specifically enforceable under applicable law in any court having jurisdiction thereof. . This Agreement entered into as of the day and year first written above. By.Faw 's d Tru t,its general partner. BY OWNE (Si atur CONTRACTOR( ignature) Michael J.Corcoran,Trustee Nk & P,L�— (Printed name and title) (Printed name and title) (Table deleted)(Paragraphs deleted) [nit AIA Document A107"'—2007.Copyright @ 1936,1951,1958.1961,1963,1966.1970,1974,1978,1987,1997 and 2007 by The American Institute of Architects.All rights reserved.WARNING:This AIAB Document is protected by U.S.Copyright Law and International Treaties.Unauthorized 20 reproduction or distribution of this AIM Document,or any portion of it,may result in severe civil and criminal penalties.and will be prosecuted to t the maximum extent possible under the law.This document was produced by ALA software at 11:37:27 on 02/11/2016 under Order No.6916362527 1 which expires on 11/03/2016.and is not for resale. Certification of Document's Authenticity ® 1m _ A!A Document 0401 2003 1,John Mostyn,hereby certify,to the best of my knowledge,information and belief,that I created the attached final document simultaneously with its associated Additions and Deletions Report and this certification at 11:37:27 on 02/11/2016 under Order No. 69163625271 from AIA Contract Documents software and that in preparing the attached final document I made no changes to the original text of AIA''Document A 107rm—2007,Standard Form of Agreement Between Owner and Contractor for a Project of Limited Scope,as published by the AIA in its software,other th s and deletions shown in the associated Additions and Deletions Report. (Sign (Title) r III (Dated) AIA Document D401 2003.Copyright O 1992 and 2003 by The American Institute of Architects.All rights reserved.WARNING:This AIA-' Document is protected by U.S.Copyright Law and International Treaties.Unauthorized reproduction or distribution of this AIM Document.or any portion of it, .� may result in severe civil and criminal penalties,and will be prosecuted to the maximum extent possible under the law.This document was produced by AIA software at 11:37:27 on 02/11/2016 under Order No.6916362527 1 which expires on 11/03/2016,and is riot for resale. User Notes: (845240651) i Exhibit "A" InF2— PROPMTE-6 L LC 25 �5P41-11-PA IZD • -A)uITE 17-2 • FIZLMONT, NE\V II4MP51.)9-E 03044 PJJ 603-895-0400 • FAx 603-895-0445 November 22, 2015 Village at Fawcetts Pond 148 West Main St Hyannis, MA 02601 RE: Siding,Trim, &Window Replacement Fawcetts Pond—Building C&D Dear Tim, As per your request and our site visit we are pleased to provide you with proposal to perform siding,trim and window replacement at the above referenced address. Scope of Work: • Remove and Dispose of existing siding and trim on buildings C&D (Approximately 260 sq) • Remove sheathing and replace with new Y:" plywood • Supply and Install new Hardi-plank siding,exposure to match existing • Supply and Install new PVC trim • Install new owner provided AC sleeves and trim out with PVC • Paint 2 coats on all siding and trim—Color SW BM 1490 Country Life • Supply and install 96 new Simonton 5050 white vinyl sliding windows with new PVC trim • Existing downspouts to be removed and reinstalled. • Price to include all disposal&permits Building C&D Price: $395,000 Exclusions: • Balcony areas • Insulation • Interior repairs • Gutters&downspouts Add Alternates: 1. Supply and install new exterior entry-door Allowance-$850 per door 2. Supply and install new storm doors Allowance-$450 per door - If you have any questions, please feel free to contact'me at 603.234.9213. Sincerelv. Charles Minasalli (010 0, cx�c7 \V\V\V.V,T`4P_aPLP_Tir_�5.COA4 6 2- 1 P OPU S.6 LLCM 25 SPAUL-DING IZD • 51JIT1117-2 • FREMoNT. NE\V 11AMP—S412—E 05044 Pia 6o3-895-0400 • FAx 605-895—o445 November 22, 2015 Village at Fawcetts Pond 148 West Main St Hyannis, MA 02601 RE: Siding,Trim,&Window Replacement Fawcetts Pond—Building C&D—Balcony Areas Dear Tim, As per your request and our site visit we are pleased to provide you with proposal to perform siding,trim and window replacement at the above referenced address in the balcony areas only. Scope of Work: • Remove and Dispose of existing siding and trim on buildings C&D (Approximately 170 sq)at 90 balcony areas • Supply and Install new Hardi-plank siding,exposure to match existing • Supply and Install new PVC trim • Paint 2 coats on all siding and trim—Color SW BM 1490 Country Life • Supply and install 90 new Simonton 5050 white vinyl sliding windows with new PVC trim • Price to include all disposal&permits Building C&D Price: $265,000.00 Exclusions: • Insulation • Interior repairs • Gutters&downspouts Add Alternates: 1. Supply and install new storm door Allowance-$450 per door If you have any questions, please feel free to contact me at 603.234.9213. Sincerely, Charles Minasalli \V\V\V V,TMPP-aPU-P-T/E--).CoM EXHIBIT "B" CONTRACTOR'S MINIMUM INSURANCE REQUIREMENTS JANUARY 4,2016 Contractor shall comply with the reasonable registration requirements of Compliance Depot as directed by Owner, and shall maintain the following minimum coverages: Additional Owner Insureds: General Liability: Coverage shall be written on an Occurrence basis in accordance with your services performed and shall include,but not be limited to,Premises/Operations,Products/Completed Operations, Professional Liability,Personal&Advertising Injury,Medical Payments,Blanket Contractual Liability,Contractors Protective Liability and Explosion,Collapse and Underground Exposures. Completed Operations coverage shall be maintained after completion of the job with limits indicated below for the statute of repose in the state of the projects location. Limits: ■ $1,000,000 Each Occurrence ■ $2,000 000 Aggregate(Aggregate Limits shall be on a per project basis Workers Statutory coverages in accordance with your services in which the work is being performed(Both Compensation: your employees and any leased employees).Including all State and Federal requirements. USL&H endorsement to be included where applicable. Certificate of Insurance must identify that coverage applies in the State in which the Project is located. Employers Liability Limits: ■ $1,000,000 Each Accident ■ $1,000,000 Disease-Policy Limit • $1,000,000 Disease-Each Employee Automobile Owned,Non-Owned and Hired Automobile coverages to be included. If hauling hazardous waste, Liability: coverage shall include MCS 90 endorsement and the ISO Form CA 9948(Pollution Liability Broadened Coverage for Business Automobile).Owner shall be named as additional insureds. Limits: $1,000,000 Combined Single Limit Umbrella: $5,000,000 Limit per occurrence and aggregate on an Umbrella form over General Liability, Automobile Liability and Employers Liability. Environmental Endorsements or policies are required for Contractors handling and/or involved in asbestos,lead Coverages: abatement and any other hazardous materials. Contractors Pollution Liability policies for specific pollution work will be required at a limit of$5,000,000 per occurrence,$5,000,000 aggregate. This policy will have an aggregate limit on a per project basis. Additional insureds will include the Owner and Corcoran Jennison Companies ETAL named as additional insureds for on-going and completed operations. Miscellaneous: Insurance certificates shall be provided prior to commencement of work,and upon request. Attached to each certificate of insurance shall be a copy of the Additional Insured Endorsement that is part of the Contractor's Commercial General Liability Policy. These certificates and the insurance policies shall contain a provision that coverage afforded under the policies will not be cancelled or allowed to expire until 30 days prior written notice has been given to Owner. The Owner shall be named as an additional insured on a primary and non-contributory basis on all liability and excess policies. Coverage for Owner shall include completed operations coverage. To the fullest extent permitted by law,Contractor waives all rights against Owner and its affiliates,and each of their officers,directors, members,shareholders,employees,agents,subsidiaries and partners for recovery of damages to the extent these damages are covered by commercial general liability,commercial umbrella liability, business auto liability or workers compensation and employers liability insurance. t V;toil;Van r AN, AT I lot own It 1,14j: RZ 0 Perk P� it 5 ' ji TYPO.,:; `a`up5t':ttCY�ertt{�'Htr! 25 i�, KPO PROPE€TI S;.U t:. xpjra�troRt t3d 25 PAU CC)I.tG .'L aLt -2 FRON1,;�t�i #A�iwca A�ttcewa and rgtvrn eu�tct. ark rcar��t'w�#an; .. acOf.t03006FAf", &Swaiaasa',tLegu�p",,u. Lzranccsiu S trat pn vwtid r�n�tsviAu':u4q r+nt W iMFOOV""COPEZfiltC`33R SsYcrsC ahr eaPar2tiw dncs tt iturrd eYac(F io { t} �w��u�sumes kk�'a�ra antt Ciws6ne�s e�utai�o�; - „�f,�s` :EaprraUorss 6 ,i2ty7;5 sUPtt1$m9i�E�'r-irSf..' �i`3C��,D�t#6.r. . K r R4 Pk?€>PERTL�S=i l€ lot 25 SPfit E 17t1d liCd3UiTE t7 ��ss a. �i+ FP AA.: .NH 0343A4 low NO too WK All f , i F. r t t �h Massachuse#ts-Department df public Safety f �.! Boarti of Bttiidin R uiaho g E9 ns and Standards ! construction suncrv`:or lice tse C9471077 t awiagj FreMMU NH 030$`4 : Gommissio►ier 07125=17 t t i I ? I E{ 1}s f t t 3 i s s 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): KTM Properties, LLC Address: 25 Spaulding Rd - Suite 17-2 City/State/Zip: Fremont, NH 03044 Phone#: 603-895-0400 Are you an employer?Check the appropriate box: .` _._.. Type of project(required): 1.0 I am a employer with 25 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. x❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.) 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 I LE]Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. )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'com ensation insurance or m employees. Below is the policy and job site P g P f YP Y J information. Insurance Company Name: Union Insurance Company Policy#or Self-ins. Lic.M WCA51 5231 6-1 0 Expiration Date: 6/16/2016 148 West Main St. Hyannis, MA 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 here ertify under the pains an/d P alties ofperjury that the information provided above is true and correct u Signature: ��,�_ � Date: 03/16/2016 Phone#: 603-895-0400 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: I Yfs- rFfCATE rs r$ +tg RS+�t.1R17ER�iF"tFFnr�r city +�` NOax uribf�tffc C�aYfr �a�c� �gat�FFfR�AA' �Y n�tu�a3�Tav�e.�`m�rsfef+rr� t�� 'r ��cc�urr�Ar�9��• � `>; I WAY, B�E�Or16'. `r}if$£E�T3FiCA`fE;OF INSURANCE GCB Af4T �Y 1U; #��fi1T3�'E�'�fr:EN�'tiE-:f8b1,H�3G�#�8afi �;. L� f? t?ifEfiEN1ATfS7xOAi�F30€t1IFrEkC A1df}"£Htf"* C1r Ti BtJF� f�9POR;ANT ff ffia c _in f aodofto& M SUAR SAW ast6. nlrGtns o1ow6wt1,clt1, taf�ra£tet{i�pm mi�vafnrst''' *#ateat�xn#hf�;cestftute?�pa� tr Yam. eke® eif! hWt3ertitfretrcf&GtGhanc�e9a»¢nI RENT 414VOW Ra ON QYJ�+4,ct7YNYO 4*5 �.ifi 1. k flW�"k:_ } ? '. E fsRe�r+iFmaefiNff Q3136S a Ief�tarfittae.C�tf¢ f KSUPF y j�F [Pr11PkIgtr�BA^rhhRJGr 7.7 ` Y4 MEMO fik Ct EiA B Ci Pk ul M Ifi:.:Tti C f j `TfiAT7Fi ±AQ# 1 9 C1f aNStfR N t$t f 9 4 far$ Fd � aJ!fY fN f ii� # ifF Tfi r �i�E 4� tN6tCA'rFLt Nt3TikiTH.T`T�AN(3�"A6IS 4r�iaiRE�df''+'��'.!$Y�C,Y�2�C2�b1��Qii -a9t��*Ci�fil'FI�R,G'P 07?il'TS•1�R tiO�Jis4�Sta`��L�lhi�@&�`�;'G4Y,��fibf�� .fdfiffCh7l~R7[tY:¢�€3 SSR f{tAY f' # '�F li�^s{EF1kF ISf�AEt�O'f�3�31i7 � 1�13 5C'�9�D fIEF�E7A6[.a$l}f3,lE�'T"�J A�� ICLlA7$IR3Yt$A9dIl id#t��C} ��j 4;#Y1tiS71Y ifi�ikL$$kftA N-C!t Y 1 EY H S3f � �YF?�4i SACM p -�~ 7'YPE�Cv H1SU7YANC$- MIA Y" PHR`t1�tdA4,3Rs1aS.�AY F ��v sa=ei�acaa�.a�anrE:uc�utrmat�++� 4 ,r?Ac�cts�^btraro�;�_ ,��i -�-�* Iry ��a• i�x 3 ,...,.. ;... .,..�. .�, � ,. A "l:r�'fauYe� CA155'I��l�l-Ft f?BPYGf�fl1� QBIfGf�ll�ff$ tht^r,N#>.tRtf!'i�p� � T au DO.: ,sc qq��n, ar I u+ix r aau i{i�t x j s 'AUT4Yf .t �l�{5KlFk � 1 :#3t�Rfl AtlfCKi. Ai�fU:4 gguasJi. rims A54ai� a ut} � osiaet�e�s n : ; ntmE+evsar 't�n.m A ;flrrrpt�y.� u��Fc�tes � ts'.hb'fG52:��16ryi! ��'�I�EF$ ti�tbl�QlFx IF:t�a�ia�r s � t¢ Y}"b5dVNvihBtlftt7e! is Y ,:� g _-..;. ._. .n^,.^^�+• :� wk»� �m.�w`".+�n i r, . RAMP All f 3 ''aE3t+0P'[iQKitf QDEtiAT[okl$IECJe&4�ii+S1YEk$C�s�k�Oh,,.f�i�lY t�ty�i�tt4"�*h�:$�rt�idt k£el4�,i?Y�1,+4a �uf*Ma,... .': . 3 � 7 A I3F4CATl3 s tl ` $}fj1RYt: Aff,M #HCA0C5�E$lE;3CEk�4'#�[teyl�a8@ ��33 For Nifiotne3tlo>32t r'u .& �. .: � 717E ��S9fJ i6Rtij6 THEREOF TIUT�U"'!:'�•S�46L- >� ►pC9� :d�f+�,p�t¢��V+'I'Cil'Xt6�4PtlE{c:V.l+t�t3t�)9f4S t3ttty15, t #f39 z t18fsB�kCdIR2dti�C341lifLffkg s+ ll f2R k s' !0$853.. Blta AGfa P f a 19grt&O t $att sfWl� dfG II r Town of Barnstable-:.. Regulatory Services • - e RI RR7CIy R{t • - $ Thomas F. Geller, Director. Building Division Thomas Perry, CBO, B¢ilding COMMisSIDner 200 Main Street, Ffyannis, MA 02601 • . ww>�.to�n.azarnstable.ma.us . - Office:-•SOM62-4038 Fax: 50&-790-6230 PLEASE FORWARD THE ATTACHED PAGE(S) TO: ATTN: JJl'Co I� FAX NO: XP RE: FROM: d DATE: _ 3 aNnUDDI G COVER S=E Rcy.-121901 1:/V13 10 : 25 AM FROM: Fax87. com TO : 5087906230 P. 3 Zoning DOMINION Contact: Zoning Official, From: Nicole Douglas 9 1)ur 1.)ilirv'nc•r Group Municipality: Town of Barnstable Department: Planning/Zoning Department Phone: 508-862-4038 FaX: 508-790-6230 Pages: 2 Date: 4/9/2013 AND 4/22013 0 Urgent ❑ For Review Please Comment Please Reply Please Recycle To meet the financing requirements of the loan program, Dominion Due Diligence Group is requesting your assistance on behalf of: Walker& Dunlop 500 East Pratt Street, Suite 1050 Baltimore, MD 21202-3133 This information is required for the HUD re-financing report for the following property: The Village at Fawcetrs Pond Apartments 148 West Main Street Hyannis, MA 02601 Please email completed letter to my attention at n.doug1as@d3g.b'iz If unable to send via email, please fax to me at 804-588-5758 before mailing a hard copy to .my attention. Thank you for your time, Nicole Douglas Research Analyst 804-358-2020 (p) 804-665-2913 (direct line) CORPORATE HEADQUARTERS 4121 Cox ROAD,SurrE 200 GLEN ALLEN,VIRGINIA 23060-3316 804.358.2020 FAX 804.358.3003 www.D3G.BIZ Providing nationwide service to protect your investments I �i5 o13 . 10: 25 AM FROM: Fax87. com TO: 5087906230 P. 4 2013-0534 1 Initials: ND COMPLIANCE REQUEST: Zoning and Code Enforcement Verifications Date: 4/W013 AND 4=013 Completed by, Name&Title: l°rl Department: J r U Direct Contact Info: - G� Re: Property: The Village at Favvaett's Pond Apartments Address: 148 West Main Street City,State &Zip: Hyannis,MA 02601 Attention: Sec.Shaun Donovan Applicant: Walker&Dunlop U.S. Department of Housing& Urban Development 500 East Pratt Street,Suite 1050 45171 Street S.W. Baltimore,MD 21202-3133 Washington, DC 20410 To meet the financing requirements of the loan program, Dominion Due Diligence Group is requesting your assistance on behalf of the above referenced applicant. Please confirm whether the above noted subject property conforms with the current zoning designation and whether or not the property has any Imown zoning violations ,, 1 () 1. This property is zoned: 6 I(4S(&° � 4 X 2. Is the property in compliance with local zoning codes? (a) Yes-It is legally conforming p �ntn (b) Yes-It is a legal non-conforming use Cv�S�t.�� (c) No-If no, please attach the most recent zoning inspection report or list detailed information below. If no, please note the violations and any required corrective actions(if required): 3. This property is pending a change of zoning. El Yes Reason No 4. . Can the building(s) be completely rebuilt as is if destroyed? Yes Reason(:!"J J oning Official Sj ature D to I1/9/?013 , 10 : 25 AM FROM: Fax87. com TO: 5087906230 P. 2 r2013-0534 Initials: ND COMPLIANCE REQUEST: Building and Code Enforcement Verifications Date: 4/wO13 AND 4=13 Completed by- Name&Title: d �� Department: Direct Contact Info: — a Re: Property: The Village at Fawcett's Pond Apartments Address: 146 west Main Street City,State&Zip: Hyannis,MA 02601 Attention: Sec. Shaun Donovan Applicant: walker&Dunlop U.S. Department of Housing & Urban Development 500 East Pratt Street,Suite 1050 451 7'Street S.W. Baltimore,MD 21202-3133 Washington, DC 20410 To meet the financing requirer-lent.of the loan program, Dominion Due Diligence Group is requesting your assistance on behalf of the above referenced applicant. Please confirm whether the above noted subject property has any known outstanding building code violations, open building permits, or any other known building code/maintenance code compliance issues. 1. To-the best of our knowledge,the property is free of any applicable code violations. Yes No Reason: 2. Last Inspection Date: Co� I r)saec+On — (ola6 If available,attach the inspection report. If no inspections are required, please list municipality's policy. 3. Local Building Code Enfcrcedc 16'J Building Code Enforced at the time of Construction � U r--\ 4. Are any permits available for former or current underground storage tanks? 0 Yes If yes, please attach a copy of all available information. No 5. Are any Certificates of Occupancy available or issued: Yes If so please include. No Reason: Please attach any available building permits,open or closed. 41 1 Building Offici ignature ate i i"' Assessor`s map and:lot number ...3p .'... ti+k i;�, 7 � ,� �) 0 7 "3 �£ G)Jt_L,� `CC& �� FTHET I (}i ! '/r /�- "/ ..� �(t 'S Gvcc�<< J �, r QUO Off♦ ,.,....,J�..�.Ii�,,..1._��.-!.-,��"�,,".'.I:!1g!,..,:...�'.,-.."I......�.4:.._'�1 �..�:4.��,,j1...,,�,,I�,-.�".�,�.o:.��,.�-.__"--z-._._��d t''.:�";,.....,,,..,.,,;:',�.�,,'.,.�""�".�F.�'--.,,C--".";-_ Sewage' Permit number ' a, . " � °w 1 L1:1 "r: {/ 1' t - r ` # IA frf _ ,-;f t 5 H6H3STAII IkC r House ,numbed r= +. 1 r Mnsa`L i _ 00 i639 E i a y s� ( r aMPY� Z ��1 1J. S.! j t `t 11 `,` : �,} {I . TOWNOF LBARNSTA"BLE I �;: r k£ f t }i} s;; a iJ 1 r r i t t t r 1 t a�. ra r" 've* - e o{ -1. (} = j {' 4ti r; gU1LDIHG IN3PECT�ORf[ ,14 1 f kt t �. ; APPLICATION FOR' PERMIT TO. : °�'< t uc d f.". k• �.. .. ..... I H+ ; �' ✓ TYPE OF CONSTRUCTION r; ': � �r��3:.(�r'4,..{ l -- ,�t c?�I:�..1vca�aci �rpun� b.pi .c in4. with lklbv„ator I y ,�� i. 3 - yy� i i w.i A Y .. , y . Y f . &3 q v a Te 4 t.. TO THE INSPECTOR OF';BUILDINGS. I They;undersigned hereby;applies, for..a permit according'to the:following m#o�mation LOCatian 1,C clr L1 1 E3 rJ t�c t 1cC l ; '� (�' a �y c1.I13VI'j�� ;1; . x. ' . I'.Y( wl.'),�.i,. f for t' ie ki:i C! 1' 1.U C3- �t..✓�>r taolc..ra C� ar, oamtx . r"> Proposed Use 1 �. .. trSrl f aOi1z 1. p ll"3 fd4�u t�l�cac3 Ll�t�r1G 13,t �if'dI1I11 E3 ' Zoning District .. .. .... Fire: District I'�7,,acett t; i'10M1 .A.j� riMi �c �ci �� , 77G I er�.tagO �TJr , ulll y, MA 02171. Name of Ov✓ner' ... .. r Address Name of. Builder' �tj I�,i1.t l <2v l 76 �1IC�"1tc3gL� Dr. , ,�uxn� MP, 02171t ti Address 17. i �� I Name .'of Archifect C,Uc7tIY r:. t c1t C r�r ..� A'`.'.�?O C t�Adclress k.Oylatol� at• , FfU�tOT1, P�iA 621� 6 334 c , r Number'of Rooms �� t.....:.. Foundation y-, , l P' ,..r .2 �'�'t G iax. .(. r�tc�nts/a ,ax t..!. �� r . Exierior .:;Cl j�s�OctCt� Roofing a .;4.A.... .011XIC),e13 3 , : 1 Ir l >l f lout , c:u�� xc'to Zz��ci & 3rtt, paaxa�� clrylraaLl ovL�xresc�cartit�.or xo Floors Interior t r: . .--..___�a f'C'1 ri P 1 c1 U c►:►-1 C� *� b E'Y f' I Heating .... . ......... .. Plu nbing4 x 12...... 11r1� , G,' 1C Ol Fireplace" ... ... Approximate Cost k. Definitive Plan Approved by Planning Board _____ _I9 _____ Area s �� sc ^ Efr f ' Diagra,m_.of Lot'and.,Building with Dimensions Fee I : . ,. : . :. j SUBJECT' TO APPROVAL OF :BOARD. OF.,HEALTH' E y r , rr ;`... e �.. ,- :l3 1_c"iiIf�r c3 anted .perni t:tLi jai,. i u; c ✓��P�,t al #kl l30- $• : i - ' � l' 1 ' d ,t r z r a ✓ ,i 2i. 4 t jjl l V f 1' i rr , tV. _ �.ii .. ; .. 3.t ,t k.... - - 1 i y _ - f P= 'zw'E '��. }Sys . .-. - O TOE Permit"•Now c' F B :EPT�T�EI,E: r - I , . h . $ Btu1ldln9Inspector s mm ., Cash Y ' ' �i —, - - - n 1s za 'x i �pY Bondi , 7 ,e 0CCUP�►i11CY PERMIT ry - '� } .. .. . ', 4 'Isssed to -iiic tip FM-C R�-"-___1_0„ ,Address ... - j t IImm mm BiisZI lFta.:f!C!! v 1?�o. 1�_5i L "'217t -5�i�®3-�.D"e a w6 ii3�T1 j; I re 0 Wiring;Inspector.- ��} / Inspection-date t '� s / y , c, : Plumbin Ibspector 4„ d , ) Inspection date _ L�L _ f l �. I t r. r sti `p MML _g e �- LM Gas Inspector ." z ,s 4 Inspect on date , Engineering Department � ,: _ r spection date - r K.. .... ,. _ - _ - _ --, r 13 Board of Health ' , `� _ Inspection date _ J r v yr z Syr- a - ,_- .. v� :t, -�r 'yA & '--.i_ , -,.— - ,r.`1 1 .THIS FERWT:_Bi'IY.L 1VOT BE VALID, AND THE :BUILDING SHALL NOT BE OCCUPIED UNTIY. j-�1' "— � x _ x 3 � SIGNED.' BY R'HT; BUILDYN.Qir INSPECTOR. UFO-N SATISFACTORY COHYPLI�PlCE NW�ITH�Y'OWN : s # -' REQUIRIE 4[EP]T18 ®NID YN ACCORDANCE -WfM-SECTION 119 O�OF THE RYASS®CHUSETTS 87L'ATE�,, , ;� k ' a. —E - t - } 3 � �k y -,. BUII.DYNG COIIDE _ _ _y.. i ) � _ � t y* _��- { y J tl _. .. r .a'... s'_'---R".`:1- e-r :{ :, . fin,.n�H `�Building, I_nspec or , -' '` y,a �x� W. {, _ _. ,�F. » .,!� m 7,m,,�,M,'�i . - - -,M:- - mim Hti ]�. ;- Mom,?; r d', t. _ d.. xr ytier �� a 7 �ti ,.�• _ - . tint�, .� � ,,,k,�.. -}. n m. _ --e.. - - .. , i rt ,. t 'g'O®9Ri OF ®RPT$T�BLE �'_Permit No V - _L r -- ,s <. 1 s Im �11�g�I't , ctor cash �" , , D Iq_ mm IL x r r 1f Q/�(/� ® [ yy� ry�� BOIId ! QLQ'/1S 1 r I w 5 a' 1 t _ -y I. f r mmm r{ , ', tI$sued to 9�my, 24 iS rC> � A 3 1� r r,,a :Address xm der�' �:"` �` r°.��- �•,� r -." -. 1 ,ftm�Im',,mm m,mM m_:mm m�,m�.:-,�::m.�.m1, u4. L w / t' "� ^'� } .. �/�^'',p IIIspectlon date _` _ .� r � �.mM Im:�.,7;m..m-��imm L_m.,—,,:,,.m.:��m':�-�"_Mm_,�;m.,M,mm,,m-�m;.--m.-,-:Mm.:-.�-.,"v,--,,..�m: rr ; Y' :Wiring Inspector . -ems' f f � ) g � � '� E Inspection date �1 , Plumbing Ihspector p !.; 3a r c x 'sue-._:t ,.._ t'ix :,,L r. , r L - . -.. k ." ) y � —,Q Z � -, t ram * r - �c gym ' Inspection date _ �E}sa , a t Gas Inspector r ' "�, x { E eerie De artmentz - r Inspection date ImMmm 1 r--�_,P v � " IBoardYbfa Healthy ' r f Inspection date;r mg �M ;k�Y THIS6`IP�,EmRY' W .H.g,r'NOT;BE V- AILID r AND 7��[[E--BUILDING SHALL NOT BE OCCUPIED UNTYI. �d rf& :TAIGA EYD BW:cTHE" UYI.YDING 1[NSFECTOR UPON. SATISFACTORY COIii[7PLYANC]E WHiL'IIII TOWN ;jg=lEQ Effi NT A IIN:ACC®]BIIDAIVCIE WIITE;SECTIION 119 0 OF TH[E BBAS6ACISIITSETT j'IlA'Il'E a'I,' LDIlNG CODIE 'fin b a' &,: ], n x wa a A r f A'7,��]� xg ,z f Bi111d1IIg �IIS a tc or a, t �'. yip.. _ s _ _ .11 ^r E � z'. �a - _ _ SJ- _ _ 1._, ,�.• _ - -...�ire.._ ._-._ P. s 1 Communication Result Report ( Apr. 9. 2013 3:45FM 1) 2) Date/Time: Aor, 9. 2013 3:41PM File Page No. Mode Destination Pg (s) Result Not Sent ----------------------- 3912 Memory TX 918045885758 P. 6 OK ---------------------------------------------------------------------------------------------------- Reason for error E. 1) Hang uo o r 1 i ne fa i 1 E.. 2) Busy E. 3) No answer E. 4) No facsimile connection E. 5) Exceeded max. E—mail size Town of Barnstable— RegnlatDry Services sen Th.;-F.6e1¢,Dfc b, . ASP BDIld.1Hg 1?IVIBIDII _ . 17im�arParp�CEO,Hatl�ngCommiuiwer - .. JDO Wi.sbeC liyemi;MA Mal - . .- - 9rnwirnLuor4bicma.m - '.O$ioe:-SU8.862.4036 � � - Fac 508-79D-6Z3D - PLEASE FORWARD THE,ATTACHED PAG$(S)TO: . TO:, .. - A�rn*: l CO IF_7_tb bt� RAX NO: - 4 ryH 3 I PAGIVS):-` ONCLUDING COVE@ SSEET) - Town of Barnstable .: Regulatory Services- Thomas F. Geiler, Dzrector. Building Division Thomas Perry,.CBO,Building Commissioner 200 Main Street, Ffyannis, MA 02601 : wwve.town.barnstahle.ma.us . Office:••509-862-4038 Fax: 50$-790-523Q PLEASE FORWARD THE ATTACHED PAGE(S) TO: AT"TN: FAX NO: �� FROM: DATE: PAGE,(S): . (D\ICLUDIhNG COVER SHEET) 2 �- ro-ke+�or ��nU_ • - D�� '��; -Tom`` i � � �..,. - • Rm-1219D 1 4/25/2013 THU 14: 25 FAX 4055284878 zoning-info 14001/001 F 1 i April 25, 2013 Town of Barnstable Building Department Fax: 508-790-6230 RE: Fawcett's Pond Apartments 148 West Main Street To whom it may concern: Please find this to be a formal request for zoning verification on the above stated property. We are researching these matters for a zoning compliance report. Please incorporate the answers to the following questions in a letter on letterhead: • What is the current zone of the property? 4 • Are there any overlay districts? W P G • Is this property a permitted use in this district? WA*) � r` 2-°r'` eAk�r • Did the property receive site plan approval, and if so can you provide a copy? • What are the abutting zoning districts? V\61— d M • Were any variances, special permits or conditional use permits issued? May we have a copy? wtS C#_ro� 5D&S= 47&5 -f-o�—Go rI'cS • Are there any outstanding building or zoning code violations? May we also have, a copy? D�'1��`(1� Dr\ ('�_'corccL' a,+4hi5-4-i/'t< ''t)u r b 18J • Was a certificate occupancy issued, and may we also obtain a copy? w Respectfully; , Nicole LaMonda �� C.unS f ��C.r1CS Research Specialist � w 44-\ 4W C 3555 N.W. 58 h Street Suite 505 LV Oklahoma City, OK 73112 Phone: 405.525.2998 ext.111 Fax: 405.528.4878 Email: nicole@zoning-info.com e �Yje c1Con�rrYor��e�rrth.-of AWgarbaaitt!6 TOWN OF: BARNSTABLE In accordance with the Massachusetts State Building Code, Section 106.5, this \\ CERTIFICATE OF INSPECTION is issued to CMJ MANAGEMENT COMPANY X Certify that I hm,e inspected the premises known as: THE VILLAGE.AT FAWCETT'S POND located at 148 WEST MAIN STREET in the Village of HYANNIS County of Barnstable Commonwealth of Massachusetts. Construction Type: Use Group(s): . R2 The means of egress are suff cient for the following number of persons: Location Capacity Location Capacity 100 UNITS 100 ONE-BEDROOMS Certificate Number: Date Certificate Issued: Date Certificate Expired:. Map Parcel 47108 6/28/2005 6/28/2010 290 027 002 The building official shall be notified within (10)days of any changes in the above information. Building Official THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) -A= IF I m �C&' -IL DATA 4•; 'xP s 1{ X cc �t�� #�..mot♦ _.: .. . .. i , TOW OF BAENBTABLE Permit No: N . Building..-!nspector cash 9' Bell •. Qt011 OCCUPANCY PERMIT Bond issued to ::. Address ^k.i r . ;t i i^' :Yrie 3 .�y 4 i{-,q�!^ ,�.'(..�•?� ', '?i e.� -"r- y''�• S` Inspection`date.. Wiring Inspector.- 1 s< r--r date Plumbing Inspector Inspection T- i�`; ,? Gas Inspector Inspection date . Engineering Department �.1 Inspection date Board of Health y Inspection date; : i THIS.PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL i SIGNED rBY _THE ,BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN � B.EQUIREMENTS AND IN.'ACCORDANCE WITH`SECTION 119.0 OF.THE MASSACHUSETTS STATE BUILDING n; .� . ........... 77MT� ,ding rasp kt,�r k TOWN OF BARNSTABLE Permit No. •� �'' ' ;.. Building Inspector}' � Cash "" , t OCCUPANCY PERMIT Bond Issued to: c<<ti'C� .tS r:?CIIC? A�art rime j`9ts CO3� Address Ut1-.. 1l-tin t�C. i:. 3.ts 1013-1!J L.01-235- .5 01_-31`: 148. ;c' f-. x.°it.?....,iI '-- it Wiring Inspector �� r.�- >f !_J Inspection date Plumbing Inspector^�.-� +' y ' Inspection date f Crss Inspector Inspection,date. Engineering Department IkWA Inspection date. A. = Inspection date Board of Health _._. .. 1 -.THIS PERMIT WII.L NOT BE VALID AND THE.BUILDING SHALL NOT BE OCCUPIED UNTIL � SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE. WITH TOWN •� BEQUIILEMENTS.AND IN ACCORDANCE WITH SECTION 119.o OF THE MASSACHUSETTS STATE • BUILDING CODE. . Building InspeA6 / . 1 Communication Result Report ( Apr, 26. 2013 10:40AM ) 2) Date/Time : Apr. 26, 2013 10: 39AM File Page No. Mode Destination Pg (s) Result Not Sent ------------------------------------------------------------------7---------------------------------- 4337 Memory TX 914055284878 P, 4 OK ---------------------------------------------------------------------------------------------------- Reason for error E. 1) Hang up or line fail E. 2) Busv E. 3) No answer E. 4) No fats i m i l e connect ion E. 5) E x c e e d e d m a x. E—m a i t s i z e wn Of Barnstable--.- : Regdawrp SerriceF rvs 35umr F.GeBc�.,�D�Jr[m�or ' . e �,. _ BQlTdfag blVBJ1fIl . - .. 7Ua Ferry,(BOr BuOdleg QDmm,Wouir . 201 Mebi Sb.%Hywmi;MA 02601 .- - . - - rere.mwuh•rw�bkma.m - . .OSma;^506402-4038 Fsc 5W79D6230 III PLFASE FORWARD-THE ATTACHED PA GkM TO r TO F"NO: RE: l cesvcO{-,fir A 1`lfr w.ryls n�S( 5I`�r1 S - IrizOK. V . .. PAG rgs):.q ONCLUDIl'NG COVIM SESBT) 1�S;nESS Z�2. VJOZfakCd',Or1 dM ...6M cc:- I PROJE MkM ' e . ADDRESS: I � PERMIT# 3�7 �oo? PERMIT DATE: M/P: �-9/1 —• O�-'7 0 D 2— LARGE ROLLED PLANTS ARE IN: tox �o SLOT-- Data entered in MAPS program on: BY: Citizen Web Request I �� Page 1 of 3 w _..�-• �;�, Logged In As: Citizen Request Management Monday, April 23 2012 TOWN\parvininl Route to Users Search Requests Create Reauests Request Information Request ID: 35831 Created: 9/28/2011 2:29:32 PM Status: Closed Assigned To: Parziale, Jim Health Office Anonymous: No Request Category: Chapter II : Housing Substandard Routine work: No Estimate: No Date scheduled: Estimated 10/13/2011 Change Estimated Sep October 2011, Nov Completion Completion Date: Date: Sun Mon Tue Wed;Thu Fri Sat: 25 26 27 28 29 30 1 2 3 4 5 6, 7 $ 9 10 11 12 13 14 16 17 1$ 19 20 21 23 24 25 26 27 2$ 30 31 1 2. 3 41 Created By: Parvin, Lindsay Priority: Medium Health Office Citation Numbers: Requestor Information Requestor Paul Rooney Request DETAILS: 148 WEST MAIN STREET LOCATION: 148 WEST MAIN STREET D107 D107 Hyannis Ma 02601 Hyannis, Ma 02601 508-364-2729 Request Parcel Number Map: 290 Block: Lot: 002 '. Requestor reports that the carpet - - 027 in his bedroom is moldy. Requestor reports that his entire unit smells of Parcel Lookup mold. He claims he has reported the issue to the maintenance department but it has not been addressed. Email: http://issgl2/internal,A,rs/WRequest.aspx?ID=35831 4/23/2012 i Citizen Web Request Page 2 of 3 rf Track Request Progress Request Work History: Internal Note History: Entered on 10/3/2011 3:30:13 PM Entered on 9/28/2011 2:29:32 PM by Parziale, Jim by Parvin, Lindsay went to paul rooney's apartment. he is looking The requestor can be reached in the for a mold specialist to do some air sampling in the afternoons after 1:00pm apartment. i explained that is not something the health department would be able to do and System entry on 9/28/2011 2:29:32 PM: suggested he check the yellow pages. the apartment had no visible mold but was very musty and stuffy Assigned to Parziale, Jim feeling. all of his windows were shut so i suggested to him in the meantime to open the windows and System entry on 10/3/2011 3:30:13 PM: get some circulation of fresh air through the apartment. Request Closed by parziaij Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) I Ngfi a Spell Check Spell,Check Add document or image link: r * You can also type in a folder name to see everything in the folder Current Links:; Time worked on request: 0.50 Response time: 8.00 *Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. ry Reopen 0 Reopen and notify citizen http://issgl2/internal,A,rs/WRequest.aspx?ID=35831 4/23/2012 V Citizen Web Request Page 3 of 3 r � Reopen Public Use: Printer Friendly Version Internal Use: Printer Friendly Version http://issgl2/internalwrs/WRequest.aspx?ID=35831 4/23/2012 Citizen Web Pa Request e 1 of 3 g g jot- a ►A . y �t Logged nAs: Citizen Request Management Monday,April 232012 TOWN\pOWN\parvinl Route to Users Search Requests Create Requests Request Information Request ID: 31788 Created: 8/11/2010 10:26:48 AM Status: Closed Assigned To: Parziale, Jim Health Office Anonymous: No Request Category: Chapter II : Housing Substandard Routine work: No Estimate: No Date scheduled: Estimated 8/25/2010 Change Estimated Jul; August 2010 Sep Completion Completion Date: Date: Sun Mon Tue W'ed Thu Fri Sat; 25,' 26: Z7 2,8 29 3D 31, 1 2 3 4 5 6 7 8 9 10 11 12 13, 14 15 16. 17 18 19, 20 21. 22 T 25 26 27 2;8 29 1 2 3 4 Created By: Wadlington, Ellen Priority: Medium Health Office Citation Numbers: Requestor Information Requestor Susan Labor Request Village at Fawcett Pond DETAILS: 148 WEST MAIN STREET LOCATION: 148 WEST MAIN STREET B101 Hyannis, Ma 02601 Hyannis Ma 02601 508-790-3164 Request Parcel Number Map: P07 Block: 027 Lot: 002 Parcel Lookup http://issgl2/intemalwrs/WRequest.aspx?ID=31788 4/23/2012 f Citizen Web Request Page 2 of 3 Work is being performed on r building. There is now a infestation of fleas in the building. All apartments. Have asked management to call exterminator and was told that is not their responsibility. I have bombed my apartment but people above and Email: beside me have fleas in their apartments. I now have more fleas in my apartment. Track Request Progress Request Work History: Internal Note History: Entered on 8/11/2010 3:36:41 PM System entry on 8/11/2010 10:26:48 AM: by Parziale, Jim Assigned to Parziale, Jim stopped at apartment complex on 8/11/2010. i spoke with property manager Britt O'Hara first System entry on 8/11/2010 3:36:41 PM: because the apartment # was recorded incorrectly. She assured:me that Susan Labor was not the real Request Closed by parzialj caller. i then went to see susan by myself and sure enough she had no idea of what i was talking about. we all got together, including the maintenance man, and discussed the issue. they're guess is that it was susan's mother who lives upstairs from her. appearently they have had some fueding problems in the past. closing complaint Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) P Spell C h k� Spell Gheck Add document or image link: Brerwse , http://issgl2/intemaINNTs/WRequest.aspx?ID=31788 4/23/2012 Citizen Web Request Page 3 of 3 r * You can also type in a folder name to see everything in the folder Current;Links; Time worked on°request: 1.50 Response time: 4.00 * Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. Reopen 0 Reopen and notify citizen Reopen . Public Use: Printer Friendly Version Internal Use: Printer Friendly Version http://issgl2/internalwrs/WRequest.aspx?ID=31788 4/23/2012 G 1 Citizen Nib Request � � Q n 16 W 14h Page 1 of 3 Logged In As: Citizen 1 Request Management Monday, April 23 2012 TOWN\parvinl Route to Users Search Reouests Create Requests Request Information Request ID: 21747 - Created: 4/14/2008 1:00:10 PM Status: Closed Assigned To: O'Connell, Timothy Health Office Anonymous: No Request Category: Chapter II : Housing Substandard Routine work: No Estimate: No Date scheduled: Estimated 4/16/2008 Change Estimated Mar April.2008 May Completion Completion Date: Date: Sun Man Tue Wed Thu Fri Sat, 3,4 31 1 2 3 4 5 6 7 8 9 1Q 11, 12 13 14 1 15 16 1 17 1$ 19 2Q 21 22 23 24 25 26 27 28 29 3_Q 1 2 3 4 5 6: 7' 8 9 10 Created By: Barrett, Caitlin Priority: Medium Health Office Citation Numbers: Requestor Information Requestor Ruth Connell Request DETAILS: 148 WEST MAIN STREET LOCATION: 148 WEST MAIN STREET D118 D118 Hyannis Ma 02601 Hyannis, Ma 02601 508-790-8558 Request Parcel Number Caller states she has been having Map: 290 Block: 027 Lot: 002 respiratory problems, went to doctor who told her to contact health dept. Parcel Lookup as mold may be causing her health issues. Please call tenant to scheudle inspection Email: http://issgl2/intemalwrs/WRequest.aspx?ID=21747 4/23/2012 Ciflzen.*?b Request Page 2 of 3 Track Request Progress Request Work History: Internal Note History: Entered on 4/14/2008 3:10:35 PM Entered on 4/14/2008 1:00:10 PM by O'Connell, Timothy by Barrett, Caitlin On 4-14-08 went to said property and talked Tim - this is a state licensed and inspected with tenant. I was told at some point there was a facility for the elderly, therefore is not registered, flood in said apartment. I did take measurements Not sure if we can help or if she should contact a with moisture meter and did not get any indication mold determinator? or the state? of moisture within rug. I suggested a de-humidifier or talk with a mold expert. Will close. System entry on 4/14/2008 1:00:10 PM: Assigned to O'Connell,Timothy System entry on 4/14/2008 3:10:35 PM: Request Closed by oconnelt Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) Spell Check Spell Check Add document or image link: * You can also type in a folder name to see everything in the folder Current_Links;; Time worked on request: 0.50 Response time: 2.00 * Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. 0 Reopen http://issgl2/intemalwrs/WRequest.aspx?ID=21747 4/23/2012 Ca, Citizen Web Request 1� W Page 1 of 4 µ .y yy ryrypp,, qyy ( y 21 Logged In As: Citizen Request Management Monday, April 23 2012 TOWN\parvinl Route to Users Search Requests Create Requests Request Information Request ID: 21289 Created: 9/10/2007 11:29:26 AM Status: Closed Assigned To: Stanton, David Health Office Anonymous: Yes Request Category: Chapter II : Housing Substandard Routine work: No Estimate: No Date scheduled: Estimated 9/24/2007 Change Estimated Aug September 2007 Oct Completion Completion Date: Date: Sun Mon Tue Wed!Thu ,Fri Sat, 26 27 28 29 3Q 31 1 2� 3 4 $' 6 7 $: 9 1 10 1 11 12 1 13 ,14 15 161 17 1 18 1.9 20. 21. 22. 23 24 25 26 27 2.$, 29 30 1, 2 3 4 5 6 Created By: Stanton, David Priority: High Health Office Citation Numbers: Requestor Information Requestor Request Fawcetts Pond Apartments DETAILS: LOCATION: 148 WEST MAIN STREET Hyannis, Ma 02601 Request Parcel Number Barnstable PD called, requested Map: 290 Block: 027 Lot: 002 Board of Health rep. Parcel Lookup Email: Track Request Progress http://issgl2/intemalwrs/WRequest.aspx?ID=21289 4/23/2012 f Citizen Web Request Page 2 of 4 Request Work History: Internal Note History: Entered on 9/10/2007 11:34:36 AM System entry on 9/10/2007 11:29:26 AM: by Stanton, David Last modified on 9/10/2007 11:53:24 AM Assigned to Stanton, David DS and MM went to said location. Location of System entry on 9/10/2007 11:32:38 AM: unit involved is D-112. Met with the PD and apartment managers. Occupant was removed and Estimated completion changed from taken to the Hospital. Police and Fire entered unit 9/12/2007 to 9/11/2007 for "Failure to Thrive" and help. Gentleman was taken to the hospital for help and further Entered on 9/10/2007 11:34:36 AM evaluation. Sheriffs dept took photos as well. by Stanton, David Orange Condemned sticker posted on door to unit. Last modified on 9/12/2007 3:34:29 PM Abutting unit had no complaints. Very strong odors present and fecal waste on bed. Condemnation Britt O'hara and Mark were apartment letter will be created. managers. Officer Jennifer Ellis of Barnstable PD, Case number 07-2215-OF. Village @ Fawcetts Entered on 9/12/2007 3:36:36 PM Pond Mailing address of 148 West Main Street by Stanton, David Hyannis. For Tenants, add unit number. DS went back to said location and spoke with System entry on 9/12/2007 8:31:37 AM: Manager on 9/12/07 to get mailing address of property and confirm that it does not need to be Estimated completion changed from mailed to Texas according to Assessors records. 9/11/2007 to 9/13/2007 They have removed the mattress and are currently ozonating the unit. System entry on 9/12/2007 8:32:21 AM': Entered on 9/19/2007 4:12:53 PM. Estimated completion changed from by Stanton, David 9/11/2007 to 9/13/2007 On 9/19/07 Owner called, will re-inspect on Entered on 9/12/2007 3:37:33 PM 9/21/:07. by Stanton, David Entered on 9/24/2007 8:12:31 AM Tenant is Kerry Mullaly. by Stanton, David System entry on 9/14/2007 9:13:56 AM: Re-inspect on 9/21/07 resulted in condemnation being lifted. No further action required. Estimated completion changed from 9/13/2007 to 9/17/2007 System entry on 9/17/2007 7:50:52 AM: Estimated completion changed from 9/17/2007 to 9/19/2007 System entry on 9/19/2007 9:22:18 AM: Estimated completion changed from 9/19/2007 to 9/21/2007 System entry on 9/21/2007 8:08:50 AM: Estimated completion changed from 9/21/2007 to 9/24/2007 System entry on 9/24/2007 8:14:23 AM: http://issgl2/intemalwrs/WRequest.aspx?ID=21289 4/23/2012 Citizen Web Request Page 3 of 4 Request Closed by stantond System entry on 9/24/2007 8:14:23 AM: -Please Review- email sent to McKean, Thomas Enter work progress: Enter internal note: (Viewed by everybody) (Viewed internally only) No Spell CheckF Spell Cheoki Add document or image link: 07V Ze7 * You can also type in a folder name to see everything in the folder Current:Links;;, 1\Health\Dave:\HOUSING\Fawcett.Pond Unit D-112 � Q:\Qrde-r-letters\Condemnations\Fawce-tts.pond unit d--112.doc Time worked on request: 7.50 Response time: 0.25 * Time entries are in hours. Examples of time entries: 1.25, 0.5, 0.75, 1, 3.5, 0.25, 0.10 * Response time: Measured from the creation date to your first actions on the request. * Do not include nights, weekends, and holidays in response time for most departments. @Reopen 0 Reopen and notify citizen Reopen Public Use: Printer Friendly Version Internal Use: Printer Friendly Version http://issgl2/intemalwTs/WRequest.aspx?ID=21289 4/23/2012 Citizen Web Request Page 4 of 4 r r http://issgl2/internalwrs/WRequest.aspx?ID=21289 4/23/2012 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION mo L-7 1, Map . D Parcel D 27 �� Z Application # L Zl co Health Division - Date Issued Conservation Division� L �,/Yt M Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board P Historic - OKH — Preservation/Hyannis I Project Street Address l y8 Village N�J Owner )tf_A v c-e�_77_r Pid,,vP&AvT-M� )8�d`dress Telephone a 2 1 7® 7-- Permit Request JV c-<c Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation i�o`� 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 9 o-S Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: c4 1 o 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 ��-�� f �- _eT__A-c__ Telephone Number Address e f 7 e7X o4t+y T'D-.%.J A— License# Y3 l A-- c016 D/ Home Improvement Contractor# S Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOoutiti�� SIGNATURE DATE J �d FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESSVILLAGE �' f OWNER - DATE OF INSPECTION: FOUNDATION FRAME ` INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH l FINAL- GAS: ROUGH FINAL FINAL BUILDING "-DATE CLOSED:OUT i ASSOCIATION PLAN NO. h. 1 - sY .. jq 't rc6 i. The Commonwealth of Massachusetts Department of Industrial Accidents ' Office of Investigations Y 600 Washington Street c Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lee ibl UU Y Name (Business/Organization/Individual):_^ Address: 1 -k o*4- 6' aZ6o � 3// o City/State/Zip: o¢N^'t f c, Phone #: �O 7 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. listed on the attached sheet. 7. ❑ Remodeling El I am a sole proprietor partner- ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers'comp. ❑ Building addition NO workers' comp. insurance comp. insurance. 5. ❑ We are a corporation and its ME] Electrical repairs or additions required.] 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 13.❑ Other employees. [No workers' comp. insurance required.] *Any applicant that checks box 41 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 thepolicy andjob site information. Insurance Company Name: Policy#or Self-ins. Lic.#: L(/ G g�(o 3 4 `(7 Expiration Date: / Job Site Address: z�e_I r l79;, ", C0-- City/State/Zip:_A4 �� U 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 i and penalties f perjury that the information provided above is tree 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. Instruction's Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an e�r�ploJ ee 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 le gal.representa.tives 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 pe.rsons`to'do maintenance, constriction or repair work on such dwelling house or,on the grounds or building appurtenant'thereto shall not because of such employmenibe deemed to be an employer." MGL chapter 152,§25C(6)also slates 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 numbers)along with their certificate(s) of iability Partnerships(LLP)with no employees other than the insurance. Limited Liability Companies (LLC)or Limited L 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 affrdavit. 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 wodkers' 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"al] locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or may be provided to the town 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 Ifor 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. 4 617-727-4900-ext 406 or l-87.7-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.inass.gov/dia License or registration before the g stration valid for individul use only expiration date. If found Board of Building Del)itr-tment of Public Safety One Ash Regulations return to: Massacbusetts- rton Place Rr 1301 and Standards Re:ulati(ins and Standards Boston,Ma.03108 Board construction Supervisor License 1. Construction Sup i License: CS 43 J Restricted to: 00 f RK a I of valid RICHARD W CLA without signature 65 ACRE HILL RD as MA 02630 BARNSTABLE, Expiration: 1/21/2012 --�-- �� Tr#: 11887 If Board of Building Reguons`/ r an ds HOMEIMPROVEMENTCONTRACTOR Registrat nR 100121 ExpiM1, on - 69/2010 Tr# 267890 pe—P vate Corporation I` OCEANSIDE, INC _ t r II 1� Richard Clark � „ I 217 Thornton Drry 1 - Hyannis, MA 02601 Administrator _ f I, ( I i � I I ' I , { I I I Oceanside, Inc. Inc. -;--- 1-- I I , 217 Thornton Dr. Hyannis, Ma 02601 ' I i 1 I I I I I ---; -•-- �---- I----- � i_---1- —, ' I � + I Hl' 3 I t I I i _ - ---{ -!-- --1 - -- 11 \Ll I ' Al i j 1 I I i !- --� -- --I - -- ---f i-- - -- j f !- _ -- ' I � ; IF t , -I----` -- --- t I I I _ . Oceanside, Inc. c. I � I t , I I --I - - -I - i---` - _ I - r 217 Thornton Dr. - -I -- -- I Hyannis, Ma 02601 - - - I i i --- -- - - - , i --I---' I I I i I � _ , r ! I---- - I-- -4-1 _ I Il - I ! ! I I I l r ' ! I Mill- C� I , I t I , May 05 2010 12: 45PM Corcoran Jennison Mgmt. 1 -508-896-8839 p. 2 MAY-05-2010 12:18 Oceanside 508 775 264E P.002 r Ing Town of Barnstable Regulatory Services ,uasa'd' Thomas F. Ceder,Director Building Division TomPerry,Building Commissioner 200 Mein Street Hyawtis,MA 02601 www,town.barosta Vie,ma.us Office: 508-862.4039 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Usin A Builder T -k,igg-0P I,(&LC10VW4> P`4 (L-%:4C-qc- ,as Owner of the subject property �+ D h hembyauthorize fix S�f t•ou n - Nr p-a won my behalf, in all rrntters relative to work authorized by this building permit application for. (Address of Job Signature f Owner ; Date 1Z C' Print Name If Prope Owner is applying for pennit please complete the Homeowners License Exemption Form on the reverse side. Q:FORM&O WNERFERM1SSION TOTAL P.002 ®® MAY-06-2010 09:09 Oceanside 508 775 2848 P.001i001 NOVICE NOTICE TO TO 1 tl EMPLOYEES EMPLOYEES 4 The Commonwealth of Massachusetts DEPARTMENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 - http://www.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30,this will give you notice that I (we)have provided for payment to our injured employees under the above-mentioned chapter by insuring with: rlstdvrial UIi M Fit-- ItSX-=a (b of Pitt:s>xagh PA NAME OF INSURANCE COMPANY lO Box 40 Rmsippiry, AU ADDRESS OF INSURANCE COMPANY -- W 0)9863647 V I10 to 1/1I11 POLICY NUMBER EFFECTIVE DATES PD9C-s &(day Try rc�r-e�E v 9 G.lirr St P1 trx rth. M4 Ci?T-n 5E-714F 13J 1 NAME OF INSURANCE AGENT ADDRESS PHONE# O:amside Im. 217 M=tcn I)r, Elya Tiffs, MA 02601 EMPLOYER ADDRESS EMPLOYER'S WORKERS' COMPENSATION OFFICER(IF ANY) DATE MEDICAL TREATMENT The above named insurer is required in cases of personal.injuries arising out of and in the course of employment to furnish adequate and reasonable hospital and medical services in accordance with the provisions of the Workers' Compensation Act. A copy of the First Report of Injury must be given to the injured employee. The employee may select his or her own physician. The reasonable cost of the ser- vices provided by the treating physician will be paid by the insurer, if the treatment is necessary and reasonably connected to thevork related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arranged for such attention at the IR6T&> ST NAME OF HOSPITAL ADDRESS TO BE POSTED BY EMPLOYER 1-1 n 1 ll n n 4 °F1HE Town able � ti Regulatory Services ro` `' .}. t ,.i� re , • • 4 LT # { 039.S. ,�g Thomas F. Geiler,Director 2511 c- i Public Health Division Thomas McKean, Director 200 Main Street, Hyannis, MA 02601 `'y`'1011 Office: 508-862-4644 Fax: 5087790-6304 Certified Mail: 7006 0810 0000 3525 0137 September 10, 2007 Fawcett's Pond Apartments Attn: Britt O'Hara 148 West Main Street Hyannis, MA 02601 EMERGENCY CONDEMNATION AND ORDER TO I� VACATE Finding of Unfitness for Human Habitation and Determination of Immediate Danger In accordance with M.G.L. c.111, sec. 127A and 127B, 105 CMR 400.000: State Sanitary Code, Chapter I: General Administrative Procedures and 105 CMR 410.000: State Sanitary Code, Chapter IT: Minimum Standards of Fitness for Human, David W. Stanton,R.S. and Marybeth McKenzie, Health Inspectors for the Town of Barnstable, on September 10, 2007 conducted an investigation of a dwelling unit located ata148TW_esfMain.S"treet;_Hyannis;Unit D 1 21 (Fawcett's Pond Apartments),Hyannis. The owner of this dwelling unit is Fawcett's Pond Apartments. Based on the results of that investigation, the Barnstable Health Department finds that the dwelling is unfit for human habitation. Pursuant to M.G.L. c. 127B and 105 CMR 410.831 (D), the Health Department further finds that the conditions within the dwelling are such that the danger to the life or health of the occupants of the subject dwelling is so immediate that no delay may be permitted in making this finding. Conditions found within the dwelling,which give rise to the emergency finding of unfitness and determination of immediate danger, include: 410. 750: Conditions Deemed to Endanger or Impair Health or Safety QAOrder Letters\CondenmationsTawcetts pond unit d-112.doc 410.750 (I) Objectionable odors emanating to the outside of said dwelling unit caused by the occupant of the unit. Occupant's bed was covered in feces. Based upon these findings any and all occupants are hereby ordered to vacate and the landlord/owner is ordered to secure the subject dwelling within 48 hours of receipt of this order. If any person refuses to leave a dwelling or portion thereof, which was ordered vacated she may be forcibly removed by the local Board of Health(Massachusetts General Laws C. 127B), or by local police authorities at request of the Board of Health. Furthermore, anyone who fails to comply with any order of the board of health may be subject to fines ranging from $10-$500. Each day's failure to comply with an order shall constitute a separate violation. Once vacated this unit may not be occupied without the written approval of the Board of Health. Note: This is an important legal document. It may affect your rights. PER ORD;cKean, O T BOARD OF HEALTH m s A. CHOIRS Director of Public Health Town of Barnstable Cc: Kerry Mullaly, Occupant Captain Farrenkopf, Hyannis Fire Department Chief Macdonald,Barnstable Police Department Mr. Tom Perry,Building Commissioner Robert Smith, Town Attorney Q:\Order Letters\CondemnationsTawcetts pond unit d-112.doc OASTAL NGINEERING OMPANY, INC. p1l tc 260 Cranberry Highway Orleans,MA 02653 Orleans 508.255:6511 ■ Provincetown 508.487.9600 Hyannis 508.778.9600 Fax 508.25�_6V700— ww`c�c�pecod.com STRUCTURAL INSPECTION REPORT # 3 To: Barnstable Building Department Project: Fawcetts Pond Job No: C16084.01 Location: Hyannis,MA Date/Time: January 18,2006 @ 10:00 P.M. REPRESENTATION C. J. Management, Attn: Tim Pachecco HUD Fee Inspector: James A Sergio ERI Construction: Leo P Leifestel A'co. ristructiori:inspecti.on-was..conducted at the above referenced project. The following is a report on observations and comments noted during inspection: 'i. Second"floor deck joists have been replaced with new galvanized metal joist hangers,new decking materials installed and completed. 2. Several deteriorated exterior perimeter spandrel beams on Building D require replacement 3. Installation of open face-mounted metal joist hangers at several remaining existing 4x10 beams required 4. Shop drawings for the proposed connection detail at the short cross-beam submitted to be modified to accommodate variability in cross beam to column offset shall. The shop detail (attached) is therefore being modified to reduce the number of stabilizer bolts into the underside of the existing beam from two 5/8" diameter to 1-3/4"diameter bolts. Side mount bolts shall also be modified from 5/8"diameter to 3/4" diameter as per the approved shop drawing. 5. Therefore the new L-5x3x1/4 galvanized seat angle shall be furnished with 5-3/4"diameter lag bolts: 4 into the glue-laminated column and 1 into the underside of the existing beam. The existing beam shall be also stabilized with 3- t/4"diameter x 3-1/2" SDS stainless steel screws each side of the beam toed into the column. Overall workmanship is good.and in general conformance with the design plans and specifications. Submitted by. John` .Bologna,P.E. JAB/dlb Cc:Representation D:IDOCI06000WO84V 6084.0/IInspectionslInspection3-0/-/8-06.doc ■Providing solutions for the benefit of our clients and community■ � N • O C� ` H t �\ z .1 I BY DATE COAST ENGINEERING CO.;INC. i ,,tom /O �4' L'orhpL-�;�.� Fu�.t �►^7� ter{_j�c,�'�rs' 0 u TOWN OF BARNSTABLE BUILDING PE IT A�TiPPLICATION MapA Parce& 7? X.� Permit# Health Division _ Date Issued ± �/S O Conservation Division W _57 a 6 Application Fee Tax Collector Permit Fee 541Q2 Treasurer ON �-tqw ,\& Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �lyd,ix�/s, Village /�✓;� ,�/�/.S Owner e/A_7?I1AL4JPN&rid. Address /r /�i�ii� &,EIa/&1i iY1� Telephone Off'27/4-7Zq;Z Permit Request Si � 7�� a�/ �r�d�i� �� 44421I G e"MAIV Square tfeet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 7 ,00 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 o On Old King's Highway: ❑Yes Cho Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil b 5 ectric ❑Other Central Air: ❑Yes [.ego 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 BUILDER INFORMATION Name 4444plij,,�L6. Telephone Number Sn 771-,-,?//0 Address 491117 /v'el J U License# GtD6Q 3 it cfz�i S / � Home Improvement Contractor# /40/o7/ Worker's Compensation# 1li'6I3 �` ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOua.c�e SIGNATURE / DATE 0�10,3,06 vim' ' FOR OFFICIAL USE ONLY r � EPERMIT NO. r l t 6 DATE ISSUED _ MAP/PARCEL NO. j ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: FOUNDATION l FRAME INSULATION FIREPLACE , ELECTRICAL: ROUGH FINALS PLUMBING: ROUGH FINAL' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN'NO. , NThe Commonwealth of Massachusetts c - Department of Industrial Accidents 1• :_ Office of Investigations 600 Washington Street Il;lis i Boston,MA 02111 M rvs' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): See1,4"5-_,0z__ /Ve-i Address: CV` /X0,0_aJ`V41 bl2,'✓E— City/State/Zip: IV,4 d 91a/ Phone #: SDf- 77/-3116 Are you an employer?Check the appropriate box: Type of project(required): 1.®"Tam a employer with /5- 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. $ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. 9. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑�terrS/P pairs insurance required.]t employees. [No workers' 13. f L�C'i/J•9i�s comp. insurance required.] "Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insura ceCompanyName: fZpOXil' 11 �Olijcy# Self-ins.Lic.#: Z�)G Expiration Date: / O Job Site Address: City/State/Zip: 67"?461 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 pains andpenalties ofperjury that the information provided above is true and correct. Si ature Date: e l3�Z Phone#: 50 F;771 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#: te: 5/3/2006 Time: 10:00 AM TO: @ 9,1,506 790 6230 R&G Ins. Agcy. Page: 001 t _ ' Client#:23059 OCEAINCI ACORD,- CERTIFICATE OF LIABILITY INSURANCE 05;®40601YYYY, PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.Agency,Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 341 Court Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE AFFORDED BY THE POLICIES BELOW. P.O. Box 3700 Plymouth,MA 02361-3700 INSURERS AFFORDING COVERAGE NAICS INSURED I INSURER A. Arbelle Protection Cc Oceanside Inc INSURERe American Home Assurance Att: Paula Clark ------ --- I 217 Thornton Drive INSURER C: � Hyannis„ INSURER C:MA 02601-8105- — _ INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REOUIREh9ENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERNS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY'PAID CLAWS. TYPE OF INSURANCE POLICY NUMBER --TPOLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE IMMIDDrYYI DATE MM100IYY LIMITS A GENERAL LIABILITY 8500029947 01'01/06 01101107 EACH OCCURRENCE $1 000 000 X COMMERCIA.L GENERAL LIAB!UT" CAM T^RENTED PREMISES tEa occurrence) $100 000 CLAIMS MACE OCCUR MEC EXP(Any one person! $5 QQQ 5_1 I FERSONAL&ADV;NJiURY $1000,000 _ GENERA.LAGCP,EG.ATE $2 000,000_ GENIA.GGREGATE LRAIT.APPLIES PER: FRODUCTS-COMP!OP AGG s2,000,000 POLICY PRO LOC -- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT � ANY AUTO (E3 inland) ALL 00NEU AUTOS ECDILY INJURY $ SCHEDI It AUTOS (For person i HIREDAUTOS ECDILY INJURY $ NOWOWNED AI.ITCS (Par accident) � I I I i PROPERTYDWUA.GE $ (Peracddentj GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ Er. ANY AJiO OTHER THAN �ACC $ AUTO ONLY: AGG $ EXCESSAIMBRELLA LIABILITY EACH OCCUR-RENCE $ OCCUR ❑CLAIMS MADE AGGREGATE $ —_ $ DEDUCTIBLE $ RETENTION $ _ ' $ B WORKERS COMPENSATION AND WC8934686 01/01/06 01l01/07 WCSTA7u- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOPUPARTNERJEXEL'UTPJE E.L.EACH ACCIDENT $SOOQQO OFFICE.RAAENIBEREXCLUMD? F.L.DISEASE-EA EMPLOYEE $500,000 frye�describeuncer i -- _ SPECIALPROVISIONSbelow E.L.DISEASE-PC'ICYI-IMIT $500,000 OTHER I DESCRIPTION OF OPERATIONS 1 LOCATE)N51 VEHICLES'EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WALL ENDEAVOR TO MAIL _10_ DAYS WRITTEN Attn:Building Dept. NOTICETOTHECERTIFICATEHOLDERNAMEDTOTHELEFT,BUTFAILURET00050SHALL 200 Main St. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Hyannis,MA 02601 REPRESENTATIVES. I _ AUTHORIZED REPRESENTATIVE .� ACORD 25(2001/08)1 of 2 #22031 � fn1r+✓� FJB_ 0 ACORD CORPORATION 1988 `! BOARD OF BIILD_I�IG.RE6#lUkTiONS J 3; Y` license. CONSTRUCTtON SUPERVISOR `r !�i\ iVu ~q SOS A0004:3 '. Tr. no: 131.92. RICHARtD W . =ACRE HILL RAT BARI�ISTABLE, s Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Re stra'` i .° ,00121 r gate Oarporison �; `�• � �' of RrOard 'Clark z f << 217 Thornton Dr Hyannis, AAA 02601 Deputy Administrator ------------- �FfHE Toy, Town of Barnstable �O " Regulatory Services a a a a saxtvsrascE, ;Mass. Thomas F.Geiler,Director ,oTFD 39. a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I 73r1.tt J7 Oar a rGt� as Qamw of the subject property hereby authorize to act on my behalf, in all mattets relative to work authorized by this building permit application for: (Address of Job) Signature o er Date _81 tt D. 6L Print Name Q:FORMS:OWNMERMISSION OASTAL _ �r eta �JY' -� };'S'ABLE NGINEERING ' � � C 12 P OMPANY, INC. �� 11 • 31 260 Cranberry Highway Orleans,MA 02653 Orleans 508.255.6511 ■ Provincetown 508.487.9600 ■ Hyannis 508.778.9600 ■ Fax 508.1�1Ikd%G_N_■ apecod.com STRUCTURAL INSPECTION REPORT # 2 To: Barnstable Building Department 7 Project: Fawcetts Pond Job No: C16084.01 Location: Hyannis,MA Date/Time: December 7,2005 @ 2:00 P.M. REPRESENTATION C. J. Management,Attn: Tim Pachecco g Contractor A construction inspection was conducted at the above referenced project.The following is a report on P P J g p observations and comments noted during inspection: 1. Work is progressing at the exterior deck. Second floor deck joists have been replaced with new galvanized. metal joist hangers installed at both buildings. 2. With the exception of the stair stringers and transition ramp,new decking materials installed and completed. 3. Exterior perimeter spandrel beam at second floor link has been repaired 4. As noted in the previous report, corroded joist hangers at a number of the existing 4x10 beams require replacement.Where the beams intersect the glue-laminated columns on the deck perimeter, open face- mounted metal joist hangers are acceptable. 5. Connection detail at the short cross beam shall consist of a galvanized structural steel angle,L-5x3xi/4 with 6-5/8"diameter lag bolts: 4 into the glue-laminated column and 2 into the underside of the existing beam.The existing beam shall be also stabilized with 3- '/4"diameter x 3-1/2"SDS stainless steel screws each side of the beam toed into the column. See attached sketch detail Overall workmanship is good and in general conformance with the design plans and specifications. Submitted by: Jo . Bologna,P.E. JAB/dlb D:WOO 6000116084116084.0111nspectionsAspection1-12-8-05.doc ■Providing solutions for the benefit of our clients and community■ 260 Cranberry Highway ■ Route 6A ■ Orleans,MA 02653 OASTAL PROFESSIONAL ENGINEERS AND LAND SURVEYORS Civil ■ Sanitary ■ Structural ■ Environmental ■Marine ■ Site NGINEERING 508.255.6511 Orleans FAx: 508.255.6700 508.487.9600 Provincetown E-MAIL: info©ceccapecod.com IOMPANY, INC. 508.778.9600 Hyannis WEBSITE: www.ceccapecod.com ®V ev-n U It aJ. r UILLa le- o�F +"WCC-Tt-S pol�jc)' iyc U., S-r (v;��`►J OASTAL Z : 0,0H UrBAROTABLE INGINEERING OMPANY INC. nn Nov i 08 c 3 D4 260 Cranberry Highway Orleans,MA 02653 Orleans 508.255.6511 ■ Provincetown 508.487.9600 ■ Hyannis 508.778,9 • .6700 a www.ceecapecod.com STRUCTURAL INSPECTION REPORT # 1 To: Barnstable Building Department Project: Fawcetts Pond Job No: C16084.01 Location: Hyannis,MA Date/Time: Wednesday, Oct. 19,2005 @ 4:00 P.M. REPRESENTATION C. J.Management,Attn: Tim Pacheco Contractor A_construction inspection was conducted at the above referenced project. The following is a report on observations and comments noted during inspection: -1. Work is progressing at the exterior deck. Second floor deck joists have been replaced with new galvanized metal joist hangers installed. 2. Exterior perimeter spandrel beam at second floor link is severely deteriorated and requires repair or replacement. 3. Corroded joist hangers at the existing 4x10 beams require replacement. Where the beams intersect the glue laminated columns on the deck perimeter, open face-mounted metal joist hangers are acceptable. At the interior cross beams, flush mounted face hangers are not practical because of the limited column dimension. Therefore, an alternate connection detail is required. Contractor shall submit alternate seat angle support detail for review. Overall workmanship is good and in general conformance with the design plans and specifications. Submitted by: 77 John/ . Bologna,P.E. JAB/dlb a Cc:-Representation- ...._.. .... . : ,:.:._- : ::.:.. __ .... .. .. .._.. D:WOO 6000V 6084 16084.01 VnspectionsVnspectionl-10-28-2005.doc ■Providing solutions for the benefit of our clients and community a 08l15{2005 09:22 5087786448 HYANNIS FIRE PAGE 01 HYANNIS ME DEPARTMENT �+ 95 HI�H.SCHOOL AD. EXT. H"ANNIS, MA..02601 Au Ktk f. HAR60 S. 9RUNELLE, CHIEF A ,ntt fTY d aE71E:r OCiiMi rewrlUa • F PREVENTION BUREAU 6USIN.ESS PHONE:(S08•)775-1300 FACSIMILE PHONE:(508)778-6448 IT.,bi}N4I D H.CI#ASE,JR-:.CF7 LT.ERIC F.MABLER,CFY ']FIRE PREVVEEN7CYON Og'FCICER E PUEVENMON OFgTCER BUILDING. COPE; COMPLIANCE FORM tHIS'1=1.Re:PREVF-NTION BUREAU.HA9 PISVIrWEDTHE PLANS DATED, _ FOR THE, PE 0PERTX. .6CA`TE® AT , E54I�cL' ALSO I(fVOWN ids: W t Y-W&y° THE .CHART sr:LOW INDKC-ATES, "rail= STATUS OF OUR REVIEW: WA RECEIVED RIF)AEWED COMPLIES I .I�II`I}iiAN CC) ATIQAI/ A7gA:i4oLy,,' 5'-SpftTfViCLER.��3f`J`Y�tdL �G�iJ1�31ar/1f�PIT C/ 6tTallotxi0E - ;. a�tibA 'fN1 ( GfEYk�N : 9,pfse C�Rt�TEMUE NNIJN010- 1Fi I N. .:.: 11-9MOK COhiTRQI I EX ST _ 1,�-SMOKE 00NTl4OL,Ept 1�,:L��AT)C1N;. : ✓. �, - 13�L.I -- t IrIRE f XTli'4 6$14INC ,15 F.T.S.C�:NTha.EQUIP LOCATION 00 • lE3rf=1F,�.f?RQ'��C''f`It;•�. . Rbf7NlS.� '; .•: . —77 ._ 17•FIF{ f�F#07 C`fIQI"1EZIIP .IG�ta.RE. . ✓ �._ _ -- ---- -- 1FiALA�tIG�:7F��l�SM16.�C9�Mir1'H�f�` i.9EQIIEIC...OI�'OPf .. . .. - AT! N REPt�R"F -- 20 Acr�rTr�YaNC .TS clI~ la aY U11 B LI VE.l'HE OCUMEIVTS TO E C 4ND COMPLIANT"FOUR THE ISSUANCE OF A BUILCING PERMIT, WE HAVE COlvtPI-F-TEb THE`ACCER TESTIN FOR THE OCCUPANCY PERMIT AND BELIEVE;THAT WITHJN THE SCOPE OF THE BUILDING PERMIT,THE ABOVE I t ARE IN GOMPLfANCE. i I olewder Aeo <.;G,)3 -a3y-�3?/ Environmental Restorations, Inc. " A professional approach to duality service General Contractors • Deleading• Sandblasting Asbestos Removal •Mold Remediation•Fire Restoration 10 Hazel Drive,Hampstead,NH 03841 Tel(603)329-6101 9 Fax(603)329-6234 www.environmentalrestorations.com TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a ParCel O,-A -7 — Permit# `VHealth Division g S Date Issued 7' .Conservation Division gg, ill, Fee (62 Tax Collector V14, s CONNE D SEWER ACCOUNT " Treasurer 97,;L. 7 6 — Planning Dept. Checked in By " Date Definitive Plan Approved by Planning Board Approved By J_ Historic-OKH Preservation/Hyannis Project Street Address 148 West Main Street Hyannis, MA 02601 Village Pond w n e r atAddress g <' Telephone _ d O �S4 b' 771 —Z7� Permit Request �` r? 0g 'S' i (� `D1 /. G/i~ G�. C�OV U,17 5 ) 140 76 &It' W"60.� NO Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new U� Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) /0A0 Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other � Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft)1 ;f S Number of Baths: Full: existing new Half:existing ? net T Number of Bedrooms: existing new r— Total Room Count(not including baths): existing new First Floor Room Count C Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other `I Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/c al stove:.,-_'❑Yes ❑No O .s- r-- Detached garage:0 existing ❑new size Pool:❑existing ❑new size Barn:❑Listing ❑new size Attached garage: 0 existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Cl No If yes, site plan review# Current Use Proposed Use -- - BUILDER INFORMATION Name Environmental Restorations, Inc. Telephone Number 603-329-61 01 Address 10 Hazel Drive License# DC000229 Hampstead, NH 03841 Home Improvement Contractor# 1 1 7 4 3 0 Worker's Compensation# WC 9 3 0 2 6 41 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Champion City 138 Wilder St. Brockton, MA 02301 SIGNATURE DATE -�� 5 7 ` t � � r - FOR OFFICIAL USE ONLY C PERMIT NO. d DATE ISSUED MAP/PARCEL NO. r Y r ADDRESS VILLAGE OWNER DATE OF INSPECTION: G FOUNDATION, 0 FRAME INSULATION _ tv _ FIREPLACE Ile m [ ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGI3 FINAL GAS: ROUGH FINAL ' FINAL BUILDING lC J r d CO DATE CLOSED OUT ASSOCIATION PLAN NO. r� Environmental Restorations, Inc. 4 professional approach to quality service n General Contractors • Deleading • Sandblasting • Asbestos Removal • Mold Remediation • Fire Restoration July 11, 2005 Corcoran Jennison Managemnet LLC Attn: Tim Pacheco The Village at Fawcett's Pond t 148 West Main St. Hyannis, MA 02601 Re: Decking Replacement at The Village at Fawcett's Pond, Rear Decks Buildings C &D Dear Mr. Pacheco, Per our site visit and your request, we are pleased to provide you with the following proposal to refurbish the decks located at the above referenced address. SCOPE OF WORK: ■ R&R all 2" x 6" decking and stair treads at the rear decks of both C &D buildings with 2" x 6" Certainteed Dock Plank, includes removal of existing fasteners. ■ Fasten all new decking with 2 3/4" stainless steel screws. ■ Install additional 2"x 8"PT Joists where the current joist spacing is greater than 16" O.C. ■ R&R all joist hangers with equilvalent Simpson,Galvanized hangers and nails. ■ R&R all post bases with equivalent Simpson Galvanized post bases and nails. ■' R&R all 1" x 4" pine trim located at front rim joists with 1" x 4" primed pine. ■ Replace any 1" x 8"joist trim that cannont be reused with 1" x 8" primed pine. CONSTRUCTION METHODS TO BE USED: Deck. Joist and Hanger Replacement E.R.I. will R&R approximately 20'*(two sections) of decking,joist hangers and joists per day. At the end of each workday there will be no unfinished sections. All decking will be fastened with stainless steel screws and all hangers and nails will be galvanized. This schedule is negotiable. Post Base Replacement E.R.I. assumes that the existing 8"x 6"posts are solid, continuous posts. E.R.I. proposes shoring the existing decks, cutting these posts below the I"floor deck joists and removing the existing post and base. A new post base will then be fastened to the 10 Hazel Drive,Hampstead,NH 03841 • Tel(603)329-6101 • Fax(603)329-6234 www.environmentalrestorations.com f - existing post and the post and base reinstalled over the existing pin. The post will then be plated at the post seam with a galvanized plate. Egress There shall be no more than one section(approximately 10 If) at a time without decking. Plywood will be or_hand and ready to be laid down, ensuring that egress is possible at all times should an emergency arise. EXCLUSIONS: 1. Painting or Sealing OWNER TO PROVIDE: 1. Parking lot spaces to accommodate a 45' trailer for storing stock& equipment. 2. Parking lot spaces to accommodate a 40 yard open top dumpster for debris. 3. Restroom facilities 4. Power 5. Continuous work schedule. PRICE: 21 x 6" Certainteed Dock Plank: 5/4"x 6" Certainteed Decking Alternate: If you have any questicns; please feel free to call me. , Sincerely, Environmental Restorations, Inc. Accepted By: =/ y Date: Ch es J. Minasalli President CJM/jmm fr g ,,.,.__. ,.,�is .a. ., - Yr. .�:,,, .F `� 4I �� . � . ;.a �. -, �,. 4 i �"i 1 et 'A f �k� ti � � �: � 1 J" Ifs _ ��_ .� .�� %�� r .J O t ��. -- �d � 1� A .� i! .. r ",f� + 7 �; .�; •��`'q 4 � � 3� t ';�}�`a"��`a+�sr� :ar '� �"' '. �"' ,� .�.g,�vj9�,,,,'�� " s`I� r ✓ ^ j�it �V" � � �1 •..t g�+�,��+�uy� Ac�''�' j a ,ti�' .t `i � � '# r t�}A i ��"+air►rm�.�l�' k." ;,,.9;'�•vrb, i ;`.-�a`:v,": :''dam - .,Prwu.r3"'w="w" `'. � •. o'�a .'a.*.. 1 .c 'rsr .r� rw u� ��%1�1.w'N��". � '•--e �., rt. io 4 ; 4ff �.I, s-f t .0 iR1s"ii i$a �7!%dL .t s�sSKKt!.xptt3 - k+ �f y,.• ,''tP'v.t"x• ;.;-tka lY'.,- '". •'' y•. ,i{�,+ I. !t •+i1ilYYih_:. Z 5Mf ^�i<kt a yTl 4 ,.�+,p a,_4 ,•, !''9'• 1y\ +i Eli •'E a.�`��j�i�,. ;.r• k ;�r �'� ,i � !T>>a!'�r+ �-` ,• a+„��• y °�'c� •.. s n. rry , � r � ,r, aj a Ir ,,: i ,�'..,41 o�C.t rt r f, +.,e�` :. �}� ty�{`+�• �' �• '+ � I e ' •q •4.a. *, y,. ti I'M Millk i v. � ��y Y •.. yr � a�} ,�}� / •IM` �,�,+ya, "'� .�4a }e�'i!."V1,4�++`4�1F'�' �y�,�� F T _ wr dy tlMR:� 50, •rn w+iia.v a�py 1 1 fi � �"'VI! I� , ..� +i (Il+��} �l a^�e •, till �� as "1ti t re r 1 I #p, j� .*, RITE, r, t �+. w�1aMA, t• ;i1F 1 ♦e'�1� i;� r�_��„�. + � - •`� .dr yy 7�tea`•� -�:`�, x '�' +� �1 ,4�' +y. , v f� q A. .• ` � �,.`Y? n v k,+^wM .�„F� ''��+p:� . g, 08/16/2005 09:53 6033296234 ENVIROMENTAL RESTORA PAGE 02 r; i a" i.. j07. �anrncaseuealr/i o�✓{� as�irteelk 's BOARD OF BUILDING RE( JLATiONS t 3 License: CONSTRUCTION SUt iRViSOR j� Number,^C5 071077 /19G0 OT2SV07 Tr. o: 13860 1 RestriC :.AGF CMARLES J MINASAL0 `-. 20 CRANE RD t E►tAI1APSTEAD, MA'03826 zle Commist.mo s .t I 4 - j 1 i. i _ 1 08/1.7•/.2005 05:15 6033296234 EHVIROMENTAL RESTORA PAGE 02 Town of Barnstable Regulatory Services s wi 'ner a ; Thomu F,Geller,Director s639. ding Division Tom Perry, Building Commissioner 200 Main S s,MA 02601 www.town.barnstablema.us Of oo. 508-862-4038 Fax: 508-790-5230 Property Owner Must ConNN Iete and Sign This Section If Using ABuilder I;l K.Q LIU d 2 C� . S ��c� ,as Owner of the suhjpct pzopert�r hereby ati xhvrixeKMa�.I%4a- le.-s W�� to art on my beajf, i 1 all matters meagre to wok:authorime�i.byt its wilding permit applicatzan fo (Address of job as- Signature of�?wner. -- 'qc.L � Date Print Na= QT0Rb4s:0 RRM1S3raia. AUG. 19. 2003 2:51 Pik NO, 0832 P. 3 i.y:Y ti\ - I A;ICS COMMERCIAL MORTGAGE CO.,L.P. I� 5Independence Way Princeton,NJ 08540 ! (609)720-0720 FAX(609)720-0446 August 19, 2003 Mr.David Mattos I Building/Zoning Dept Hyannis, MA 02601 Re: Property: Fawcett's Pond Apartm is Location: 148 West Main St.,l�y�nis,MA 02601 Units: 100 Dear Mr. Mattos, ARCS Commercial Mortgage Co., L. P., as lender for the above referenced property,requires certification as to the zoning which governs the use of the pri ect. We request your cooperations in determining the following: 1. Zoning Designation: 96 2. Permitted Use: RCS / V �F v C- u 3. Legal Conforming:_ 4. Legal Non-Conforming: .g k a.T S- Damage Restoration Limit: & if�a ai �I in the event this a legal non-conforming use property,we ne Ik to be supplied with proper documentation that in the event of a major destruction, the p oject could be rebuilt to current density. in addition to the zoning certification,please advise Nether this property lies in a special flood hazard area. Please certify to this by signing in the space provided below a d returning as soon as possible. If possible, please return this information via es'rnile to 6 720-0446 and follow with the originals through regular mail. Thank you for your assistance in this matter. if you have any questions,please do not hesitate to contact me at 609-720-0720 X202 I Very truly yours, rea rarip ni Loan Processor/Coordinator Acknowledged and Agreed Upon: Title: - tle:----------- - Date:--��- _----------- I I i THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) IM A � I / �C(�J L DATA j • TOWN` OF BARNSTABLE Permit No: —,------ Bullding "Inspector Cash OCCUPANCY PERMIT Bond Issued to ¢'.= c, ` s + 5 i,, Address Wiring Inspector .f' , r Inspection date' r` i Plumbing Inspector Inspection date Gas Inspector Inspection date I Inspection date Engineering Department f ra �r Board of Health Inspection date: THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL j SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. i f. Building Inspector, ,_,;� TOWN OF BARNSTABLE Permit No. },ucka Building Inspector cash .wa ' OCCUPANCY PERMIT Bond /A ISS12d t0 t r'iI4T{ ttS pC3r3�? A ;'t Address Wiring Inspector _ ,v ;' "r t r Inspection date Plumbing Insp�ctoi , �i/ / } Inspection date — Gas Inspector Inspection date. - Engineering DepartmentAVA Inspection date - Inspection date Board of Health i;a,.::,s iTHIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE. WITH TOWN � s REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. i building Inspecidi AUG 1.9, 2003 2:F i PPS NO: 9332 P JNRCS " I ® ` COMMERCLkL MORTGAGE CO.,L-P, 5 Independence Way Princeton, NJ 08540 (609)720- 720 FAX (609)720-0446 i August 19,2003 Mr.David Matzos Building Official Hyannis,MA 02601 SUBJECT: Properly. Fawcett's Pond Apartnt .is Location, 148 NVest Main St.,Hy nnis,MA 02601 Units: 100 i Dear Mr. Mattos: I I ARCS Commercial Mortgage,as lender for the above referenced operty,requires certification that no building or fire code violations are on record with your offs a at this time. Please certify by executing this document in the space provided and returning it the undersigned as soon as possible. If there are violations currently on record,please also provide us with copies of the violations. In addition,please provide us with copies of all Certificates of ccupancy issued for the above referenced project. If possible,please return this information via facsimile to(609)72 -0446 and follow with the originals through regular mail. Thank you for your assistance in d.'smatter. If you have any questions,please do not hesitate to contact me. ! ver%�Z my yours, ,I Andrea Frangipani Loan Processor/Coordinator I certify that there are no building and/or fire code violations on ie I ord. By:__d t�—'�Cx Title: 4o e w s T 14 Date: OR I certify that there are outstanding building and/or lire code violati ns on record and have ! enclosed copies of said'%zolations. By. Title: !I Date: I I r f TRANSMISSION VERIFICATION REPORT TIME: 08/25/2003 23: 31 NAME: FAX 915087906230 TEL 195087906230 DATE DIME 08/25 23:30 FAX NO./NAME 916097200446 DURATION 00: 01:27 PAGE(S) 03 RESULT OK MODE STANDARD ECM TRANSMISSION VERIFICATION REPORT TIME: 09/29/2003 02:12 NAME: FAX 915087906230 TEL 195087906230 DATE,TIME 09/29 02: 10 FAX NO./NAME 916097200446 DURATPAGE{S)N ©0: 01:41 RESULT OK MODE STANDARD ECM Town of Barnstable �a Approved Regulatory Services Fee y"d Thomas F.Geiler,Director Building Division Peter F.DiMatteo,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 Fax: 508-790-6230 p.,c" Home Occupation Registration Date: Name: F-F r,-, n/ Phone#: so2,7 90-l v -7 Address: �-Village: Name of Business: p. Type of Business: // 1�5 ��C�O � � r M,.t: 7qG ' 4 oZ 7 -O d k- INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling: there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes;and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter,odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. • There is no exterior storage or display of materials or equipment. • There is no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires,parked on the same lot containing the Customary Home Occupation. • No sign shall be displayed.indicating the Customary Home Occupation. • If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. • No person shall be employed in the Customary Home Occupation who is not a permanent resident of the dwelling unit. I,the undersigned,have read and agree with the above restrictions for my home occupation I am registering. Applicant: ��-,- -- Date: Homeoc.doc y TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 90 Parcel ,;t 7 -2- 4��S Permit# ®� c0 5m � l ciQ I i, S Date Issued Conservation Division Fee G -��' - LZ �. Tax Collector :� /d'�pD Treasurer Planning Dept. ` Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis. Project Street Address' ,L4L 1�1��dS:i A/,0 V 7� VillageA., /U / a �'N/ne' ,� Owner Address I�I JkQez�- )v Y-, ml '/, Telephone -"/ `T/.-- c4 '70 (9- Permit RequesR yw,� ,�5 .�1,rncl ��a `fin sin i/ �l1 Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new 06 Estimated Project Cos 612`b Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type:' Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing • new .Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ' '0 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: z Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial des ❑No If yes, site plan review.# z Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address /� /?') — License# �� )-dQ oja) " Home Improvement Contractor# /D 3 "7 / �f Worker's Compensation# 9 1 - ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU , - DATE FOR OFFICIAL,USE ONLY t PERMIT NO DATE ISSUED • MAP/PARCEL NO. ADDRESS "' VILLAGE ► :t Qt OWNER DATE OF INSPECTION: •, y FOUNDATION FRAME INSULATION , FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL c _ GAS: ROUGH FINAL FINAL BUILDING • - DATE CLOSED OUT ' ; • I 4 ASSOCIATION PLAN NO. , . f "a"� The Commonwealth of Massachusetts -; ,Y__1 -_ Department of Industrial Accidents office of/osestigatioos t 600 Washington Sheet ��;1 Boston,Mass. 02111 Workers' Com en on Insurance Affidavit rM11 /� name: ( 1 € /a /-- A400 F:� P/3 xi /1) - location )�L? k/E 2T 221 P,/x I •�`L city Whone# — ❑ I am a homeowner peiforming all work myself. ❑ I am a sole rietor and have no one worlds in any achy M..-.1: m an employer roviding workers' compensation for my employees working on this job. :: .. . . ::.. I:-.+.'j�;.:;:.-.ijI.w;::.:...jI-..',::W.�.:w.:�.:..:..::0...*�.:,...::....::�W..W:..:..:�.:.I.W...*+..,..:X.:.*.:..,......:.:,...W�-....".W:.::W1..*.:..:.,..��....,+....:..+.,.,.:'.:..*....:::.-.-�,.'i::.'...-....i.....I.-.'.wW::W--*�.WW A.i-.....:W-......�--W�.'.WW.:;.'...�.�.'w..,..:�..i..*.j--...-'..*..�'::--W�..'.+.W.-,j---".':i�:----...i..�---WW'i.,:�-...Wij.+*.i.l.;:+.-.....�.j--'...1:., :.. ::. con any name.. ::: :. ..,.>;:.; :: .......... .;::::.;;.;.... :::. .:..:..... ................ .. a :::. ::.:.;.:.::;:.:.::::::.:::::.:........................ city:. . t f phone#::: insurance co. //%% ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have . the following workers' compensation polices: COn1D any n ame• address..< ,>;;;.;:.;;.::;; :::..:: .: ::._.. ..................... ............................................... ... ............................................:::::::::•:::::.................... ..........::•:....... :... . ..........................................................................:............................................................................................................................. •:•:<.. one# ';>`>>s<><> ...:. <``>< ?':.... < `>` j 5> �> .. :..::.:::::::...:.;: :::::::::::.;:::;::.::;::: ;:::::::::::.:;:.:::..:;:.;;;::::::::.:.;::.::::..:....::......::::..::.:::::.::.:: »>uh ::..:::...::.:;..::>:; ,:;:<: <:><><.:.::.:»>:::>;.:;;...:<:.:'::: :>::.::>:>::.. < :;::::>..>:. :... :>::>:::<:;::»> ::>::-.:::..:.:, city �...:....>...:::. ......:. ::....:::::::..:.::.:::• ......................................... ;.::�::::;:.::::;:v :..::::.:::::,::::::.:::.:.::•:'+... .....................:.:::::::::.:.:::. :.. ..................... ...:..:...:.........:::..:...:.:.... :.:..........................:.............:.::.: ... .. ..........:................................................. ...........:.................. ::::::.: . .............................................:.,....................:::.::::..:..:........................ :.:.......,.:...:.:...............:...................:.......:. insurence.co..... ._......,....:...:.:......:...........:......:........... of :::.::;::;: .;:: ::; :-.N:>:;,:>,:::.,.;:::. ... % canraanv name:>.:,:.::<:::>;:>:<::;>::::>:......;I I::;::<:>;:;:<:<:•; address: ..:::::::.:::::........ d :.:....... i:.Yi;v:y;)i;i:i 4:::•:e:CO.:.:. "..........;:'.2:::%:?'.?:.....;:`:.:. :.::: ;;.::::`::<`: :';3 2::;::::.:;.;.>:t::::?.<.:;:;<::::i:::...?:.:;::.;..:.:?:.:..: ;s: ��i wa anC Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certify the pains penalties of perjury that the information provided above is true and con d �/ 4 signature Date - Print name 1' E�-( 9� ��...�Phone# �L e 2Z � l official use only do not write in this area to be completed by city or town official city or town: permibUcense# ❑Bufiding Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office . __ ❑Health Department contact person: phone#, ❑Other (owed 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for 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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the`9aw"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. lily The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Inves"godons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 I °F SHE The Town of Barnstable r L►RNSTABLE, • ; s�� Department of Health Safety and Environmental Services rFo 5+ Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements.�� f� )PE —/(-'00 Type of Work: `. 4 A Ja 7Ae-& -- Estimated Cost�v Address of Work: Owner's Name: Date of Application:` 16 0 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I he eby apply for a permit as the agent of the owner: Date Xontractor Name Registration o. OR Date Owner's Name q:forms:Affidav <.?+� ✓/Z{% '�O�llt/ljLlYl2GGK:C�GUL O�`i��-- `^""�� I 7 . ORS ' HOME IMPROVEMENT CNTRACTREGISTRATION i _ i Board of Building Regulations_ Room 1301 I Ope Ashburton Place Boston , Massachusetts 02106 i I )ME IMPROVEMENT CONTRACTExPiration 07/09/00 I � ./!�A G,IIIII/11111111,1.1!!/11 i ;I r a t ion 103714 HOME INPROVEHENi CONiRACi OR c1 PARTNERSHIP � =fir L = Registration 103714 Type - PARTNERSHIP CALEAUL I SONS ROOFING I �cg'c,f/ Expiration 07/09/00 PAUL J - i 3 SONS k00Fi Paul J _ Caze:ault 2701 I PAUL J. CAZEAULT . d dialt Rd . P •O - UOX I Paul J. Cazeault 22 G 1. O Orleans MA 02653 I r� 5..2?%iddialL Rd. P.O. Duz 2 _-1L I n—'4^1o1' Orleans NA 02653 Board of Building Regulation B Ashburton Place, Rm 1301 I� One ..1 111;.1 Boston, Ma 02108-161 Birthdate: 10/20/1959 License: CONSTRUCTION SUPERVISOR LICENSE Restricted To: 00 Number CS 026325 Expires:1012012001 PAUL J CAZL•AULT 1585 MAIN S I 55 OS,I'I ItVILLE, MA 026 Tr.no; 7665 and change of address notification. Keep top for receipt TOWN OF BABNBTABLE: SIGN PERMIT i ?ARCEL ID 290 027 00.2 GEOBASE ID 19542 1 ADDRESS 148 WEST MAIN STREET PHONE HYANNIS ZIP _ SOT 2&2A BLOCK LOT SIZE - )BA °. DEVELOPMENT DISTRICT HY 1 ?ERMIT . 37202 DESCRIPTION VILLAGE AT FAWCETTS POND (3-O. SQ.FT_ ) ?ERMIT TYPE BSIGN TITLE SIGN PERMIT ;ON TRACTORS: TE Department of Health, Safety ARCHITECTS: and Environmental Services 30NDCOTAL FEES:' $50 00 s. :ONSTRUCTION COSTS $.00. 'y 753 MISC. NOT CODED ELSEWHERE ; s BARNSTABM w MASS. , DAIr►� BU DIN DIVTNO BY DATE ISSUED 03/19/1999 EXPIRATION DATE i 1 i r PD RMIT w DATE: TOWN OF BARNSIABLE BUILDING DEIARiMEN7. 367 MAIN STREET IIYANNIS MA 02601 APPLICATION FOR SIGN PER14IT APPLICANT: � ASSESSOR'S E ASSESSOR'SJJOR�J i•tO. • U�J /�// • DOING BUSINESS AS: U11( S TELEPHONE: [ �V n SIGN LOCATION Street/Road: 146 46 A Ir <c G 'Z � D ZONING DISTRICT: c OLD KING'S HIGHWAY DISTRICT? yes no - PROPERTY OWNER Name: c:ci/+,CCJ ' 75.E k.( ck /�It JL I��Sci 3�J Address: City: /-1V/\f\i JKv1S Sta-e: AIA Zip: Tel. No. : - � 8?OC> SIGN CONTRACTOR Name: � . o-tJ Address : /��n-�•� �� 0, 6�� City: � �t�t/tC state: Zip: Z Tel. No. : DESCRIPTION DIAGRAM OF LOT SJJOWING LOCATION OF HUZLDINGS AND EXISTING SIGNS WITH DIMENSIOtIS, LOCATION AND SIZE OF THE NEW SIGN TO BE DRAWN Ott THE REVERSE SIDE OF TIIIS APPLICATION. Is the sign to be electrified? yes no (NOTE: If yes, a wiring permit is required.) !o� PLYUT;1— I hereby certify that I am the owner or that I }Javc: the authority of the owner to make application, that the information is correct and that the use and construction shall conform to the provisions of Sectjeon-w4-3 of -_he Town of Barnstable Zoning Ordinances. -3- Date 4signatur Cwner/Authorized Agent - - - - - - - - - - - - - - - - - - - - - - - - - _ - - ` For Office Use Size S Ft. _ © F� q• ) / Permit Fee Approved ✓ Disapproved Date Sin ure Of Building o "icial NISc,i �rr rot-`.....�. } r r*r: \ .•4, t .' £ y �� !r,�'.� - r+•.ilk '"-''+'9" p� �}�J'tps� tI� 3rr� 9� r� a+>�"v � e T t..: 9A,. � ��4+1�{•tPJ ,' ` $''i'� !t`,` 6 .•S +r,�`� �'��`,��'t,�°•F9r'9',�1 x 4 J'�. '�' dc�� r r a VI' NSstK �� JENNISON 'M� ►: �� ..�CAA u;�tf?Fv'�t' `f 6 Y .a ( s • .sr�.ryr r sM., �, �fi.��.y�L' �'�^ �•.'r - P r,'_.«w ..� � ��_ =�J?' i..:i: w f i• ...vTa��' to 9�rJ a 2'm12�J4C'�1V `-��AIIlSl1�2N1 l�(ll4(�►� 1'�7111�' AMIPQt(CQMPANX I N C O R P O R A T E D WOODCARVERS • SIGNMAKERS 376 Rte. 130,P.O. Box 681,Sandwich,MA 02563 (508)888-0565 FAX 1-508-833-0786 11�1�-fig : . The Town of Barnstable .50. v-e- • L►stvsr,�.e, • 1 .� Department of Health, Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-8624038 Ralph Crossen Fax: 508-790-6230 Building Commissioner MEMORANDUM TO: Gloria FROM: Lois DATE: 12/22/98 RE: Multi-Families Ralph has given me the go-ahead to work with you on the Multi-Family-Certificate of Inspection project. As a first step, let's check the properties of over 8 units that are on the Assessor's List but not in your file drawer: 308 106 559 Main 327 242 001 225 Main 274 011 1167 Phinneys L 269 127 290 W. Main Street �dLZiLGriC� �� 250 001 979 Route 28 '7 189 067 1927 Falmouth Road/Route 2817 189 055 1.84-:�Route 28 ( �� i Fl/5— a 290 027 002 1=48=West-Main-Street /aa er r G Do you want to check them out or do you want to teach me? g981222a -75 -7 I r h 9� � 'p or) Map Parcel Z Permit# ,._ -- House# 1" Date Issued S h_3rd.flapm oor�(EP-9:30/1:00-�3A) I;Of q �. F.j� Fee Conservation Office(4th floor)(8:30- 9:30/1:00--2:00) co J(:\S t 3 - 091 Planning Dept.(1st floor/School Admin. Bldg.) d 1HE r D initiv Plan Approved by Planning Board t 19 ; 1BARNSTABLE. 4 _ MASS . TOWN OYBARNSTABLE Building Permit Application e t et Address I 1+ Village U CA 1 Owner M ;\ AGo L`1� Address T' , Telephone II Permit Request L c qAfveA (. S a � moo, l w' ru{r N 'First Floor square feet Second Floor square feet Construction Type - Estimated Project Cost $��}©,r>DO Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) V Age of Existing Structure Historic House ❑Yes ?1 o On Old King's Highway ❑Yes INO 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 No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial Yes ❑No If ��If yes, site..plan review# Current Use�trt me,JC lt[r'IM �-F�t Proposed Use rnP Builder Information Name 66EL&j aj.L Al Telephone Number /' o-a S-1s Addres � W License# 010 5D s a Vo� Home Improvement Contractor# l O &�e:J�j o %1e�jS Worker's Compensation# \JG 3131-34-6 0 NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 4 — BUILDING PERMIT DENIED FOR THE F LLOWING REASON(S) FOR OFFICIAL USE ONLY _ PERMIT NO. f _ — � — '-- - _• = •.. .5 ;.. ' ._ -- .tee. DATE ISSUED. MAP/PARCEL NO. ADDRESS _ VILLAGE r, a OWNER F t 44, DATE OF INSPECTION:"FOUNDATION- FRAME r INSULATION FIREPLACE ELECTRICAL:, ROUGH FINAL r PLUMBING: ROUGH < FINAL . GAS: ROUGH FINAL` FINAL BUILDING t DATE CLOSED OUT ; ASSOCIATION PLAN NO. r The Commonwealth of Massachusetts ; �^_.� ~=— !, •'� Department of Industrial Accidents 600 Washington Street Boston,Mass. 02111 Workers' Corn ens Insurance Affidavit name: location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole roprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this job. com anv name O ei S tee-. address: M?ti city. L4 rtfvw k 5 insurance co. olivev,# MOM ioaiaiooaia/iai/i////////////////%////ari///%////////////////////// / ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: com anv name: . ......... address. Mr. phone#: i I insurnnce co. .... ./�/ company name: ::::•::.:...:.,:::::::..::.....:.. address: city- phone#: 01icv insurance co. .. # / iz to secure coverage as required under Section 25A of ME 152 can lead to the imposition of criminal penalties of a Me up to S1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a tine of 3100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. I do herebv certi y untie he p 'ns and pepsin' of perjury that thf information provided above is tra,and correct Signature Date Print name 41 IF J�j[4-1 v official use only do not write in this area to be completed by city or town ofQeial city or town: permittlicense is OBuilding Department ❑lAcensing Board ❑check if immediate response is required ❑Selectmen's OMce ❑Health Department contact person: phone#• ❑Other_ (my�p 9,95 PJA) Information and Instructions t' Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", 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 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any,of its political subdivisions shall enter into any contract for 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 in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns 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 pi number which will be used as a reference number. The affidavits may be retar d io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions. please do not hesitate to give us a call. i The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents _ Mce of ineesdoadon= 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 . � ;�T� �/kfMf�MrO�Of/MQUI1 I�. I/I7J.H/!Y►II1/IIl i OEpARTNENT OF oU8t1E SAFETY ' CONSTRUCTION SUPERVISOR 1.I(ENSE Number: Eroires: Birthdate: Y I tS 1113% 17123/1999 11;'1�19U — Restrletel T1: N 2S NAAVAIO ST c rA1NAlITN, AA 11661 ' IAMEKILAN tMNLUTtK5' RNZIUKAIV<,C %-umrArill ii ®MMERCIAL UNION A Stock Company, Boston,Massachusetts 02108-3100 • i:? I:.......... is>li: ABR306792 12/16/97 ' COMMERCIAL ACCOUNT POLICY TRANSACTION: RENEWAL COMMON POLICY PREVPOL►C/ ABR3067920097 DECLARATIONS REX NUMBER: 6B1KH8 NAMED MISURED end MAM1WG ADDRESS: CAPE COD HOME IMPROVEMENT i SEE END SL 25 IYANOUGH ROAD HYANNIS, MA_02601-4728 p I &WESS: CONSTRUCTION FORM OF BUSINESS. CORPORATION - ?I POUCYPERIOD. From 01/25/98 to 01/25/99 at 12:01 A.M. Standard Time at your mailing address. In return for the payment of the premium,and subject to all terms of this policy,we agree with you to provide the insurance stated in this policy. ►fi1�#.. fNi M ►N P 1? X. : : :::»::»>:::>::.:»:.<:;:>:: :;::::>:: >:. M fi/l. Aft.t .tHl .1y0t(CY. GRANITE`STATTE INSURANCE COMPANY 13102 71109 �1-34-60 SEND CORRESPONDS AMERICAN INTERNATIONAL CO. P.O.BOX 409 •"•'' • ' • PARSIPPANY, N1 07054-0409 a .• • • PHONE: 1-900.645-2259 HOME IMPROVEMENT SPECIALISTS OF CAPE COD INC Member Companies of 25 I YANOUGH ROAD 04M American International Group HYANNIS MA 02601-0000 EXECUTIVE OFFICES: 70 PINE STREET, NEW YORK,N.Y. 10270 I.Q# - WORKERS COMPENSATION AND ROGERS 6 GRAY INSURANCE AGENCY EMPLOYERS LIABILITY POLICY P 0 BOX 1601 INFORMATION PAGE 434 ROUTE 1334 SOUTH DENNIS MA 02660 INSURED IS CORPORATION PREVIOUS POLICY NUMBER NEW OTHER WORKPLACES NOT SHOWN ABOVE ITEM E POLICY PERIOD 12:01 AM.standard lime at the Insured's mailing address FROM 07/02/97 To 07/02/98 REM s A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to the work in each state listed In Item 3.A. The limits of our liability under Part Two are: 100.000 Bodily Injury by Accident S each swidertt Bodily Injury by Disease = 500.000 polity Iltnk i Bodily Injury by Disease s 100.000 -each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: i SEE ENDORSEMENT WC 20 03 06A ITEM 4 The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All Information required below Is subject to verification and change by audit. Eslimated Total Rate Per Estimated Classifications Code Number Remuneration rat 1�7 -s100 0f Re• Premium L.1 s,..,...� 1 1 e—_• muneratinn I M - 11 % HOME- IMPROVEMENT CONTRACTORS REGISTRATION Board of Building Regulations and 'Standards One Ashburton Plane - Room 1301 Boston , Massachusetts 02108 HOME IMPROVEMENT CONTRACTOR Y Registration 101014 Expiration 06/24/00 Type - PRIVATE CORPORATION CAPE COD HOME IMPROVEMENT SPIfC . - Robert A . MacLaughlin 25 Iyanough Road Hyannis- MA 02601 i f �/ :..; s s � � � ,. � ,:, j � �' � I, �,� '�� sx+1�'wr _ `. �....+ I _ i a creative design • quality construction Order No. Home Sheet NoFaae 1 A Improvement 25 Iyanough Road • Rte. 28 Specialists Hyannis, Mass. 02601 5/26/98 775-2815 Date +; os Cap•Cod MA Contractors Reg. p 101014 PURCHASER'S NAME WORK TO BE PERFORMED AT Name - Village at Fawcett ' s Pond ( continued SCOPE r eplace balcony decE::inq, deck: .joists where specified, s, roof trim, end and dividinq wall trim and ground level s and pasts. Add new railing and pests at C-mmun-i-ty--bu-i-l-d_ing�e. f. --------------- Type A style units : Fifteen ( 15 :) groups of four ( 4 i balconies for a total of 56 units. Type B style units : _ Two ( 2 ) groups of two ( 2 ) balconies for a total of four (4 ) units. 1 - Grade railings are at unit patios, steps and walks for a total of fourteen ( 14 :) locations plus one new section at community j building. 1 Gutters Replace three sections of aluminum gutter at units. j 02/02, 10/1 1 , and 12/13. Replace downspout at 01 . ' Sr' FEL IF'Ii ATION� DEC:k: JOISTS Add--unfinished 2 x 8 pressure treated center .joist with .joist hangers on 54 type A units. I - DECKING F'eplace decking on tye A and type B units with unfinished �� , x 6 pressure�flr—e�a��e —�d_e--�:_'F�ingon aliI sixty ( G�> i units. I RAILINGS Replace railings with unf_i-nd-she-d pressure treated wood7in ` same-s-t-yle=as_ex.i_sting with 2 cap rail , 2 x 6 top rail,2 E x 4 �a I�botto,m rail , 2 x ' balusters a d`4 4�p�ists-on gr�-e-ra-i1`i-n-gs-`set I into grade at same 1`� at ions-w -th-stone. Customer Initial WHITE FOR SELLER YELLOW FOR PRODUCTION PINK FOR BUYER creative design • quality construction Oder No. Nome Improvement 25 Iyanough Road • Rte. 28 sheet rya i - Specialists Hyannis, Mass. 02601 a. os cope cod 775-2815 Date 5/2 E/9s 'f MA Contractors Reg. a 101014 `+ PURCHASER'S NAME WORK TO BE PERFORMED AT Name Village at Fawcett ' s Fond ( continued j NOTE : Baluster quantity has been—inc-reased from—Hid Specifications to reduce spacing to 4" from it ' s present spacing, as required by the sixth edition of'—fl e a sachusetts State Building Code. � TRIM . I Install 1 x pre,prrimed pine to replace exist-ing=b-a-l-cony rc� �af� trim, deck trim, end / dividing. wal,l tr_-i-m,--fasc_i_a_and._s. ffits. j GUTTERS & DOWNSPOUTS Replace three sections of gutter as noted above with new 4" x 5" , one piece white aluminum gutter and one downspout as noted. I i Customer Initial (- WHITE FOR SELLER YELLOW FOR PRODUCTION PINK FOR BUYER � UFA j �. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION _. Maps O Parcel o`� � Pt.rca�rT nn,�,T�� r r;, Permit# TAIT ,,.,. AD_3 Pei INEERINc u n1V16iuN Phl„ : Date Issued r Conservation Division L Z �� c�TBUCTION Fee , (� Tax Collect F Treasur�' Planning Dept. =. ' Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis ' Project Street Address Lt West Main Stree�s, Hyannis, NA 02601 Village Hyannis 42 Owner CMJ Management Ca : >> . :-, L-i-c Address 150 �Aount Vernon Street Ste. 520 Telephone (508) 771-8702 or (617) 822-7300 Boston, HA 021_25 Permit Request ` o-_-'.s-ruct new, single stor.;T 11'-0" x l '•-6" wood— ra_rr- -)-n slab on grade at tached laundry rooza 1iOu y T_n g 3 washer machines and 3 driszv s. i t 714F- VI 4�a6 A-r rlJWCE7T S -PGA/0 Square feet: 1st floor:existing 12,C.u0 proposed 12,127 2nd floor:existing 12,000 proposed -.2,000 Total new 127 4E�,000 Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type `A Lot Size 5° ` 5 - cz c{'o Grandfathered: ❑Yes 0 No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) ;; Age of Existing Structure 16 gears Historic House: ❑Yes Q No On Old King's Highway: ❑Yes Q No Basement Type: ❑Full ❑Crawl ❑Walkout ®Other <,lab on grade Basement Finished Area(sq.ft.) N,/A Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 57 new 0 Half:existing '� new Number of Bedrooms: existing 57 new 0 Total Room Count(not including baths):existing 171 new 1 First Floor Room Count 5`? Heat Type and Fuel: ❑Gas ❑Oil - $Electric ❑Other Central Air: ❑Yes 2 No Fireplaces: Existing '°o 7 1 e New Existing wood/coal stove: ❑Yes W 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 H-2 Proposed Use R-2 BUILDER INFORMATION Name Join J., Curtis Telephone Number (617) 774-1.999 Curti- Construction Company, Inc. 02169 Address 29 Cr`t L a_ , S-e. a Quincy, ,A License# CS 073383 Home Improvement Contractor# —1-- vuri-h ITsurance Co. Worker's Compensation#6Zsi -444.44i5-?-•98 STRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Br•,wn?ng-r err-423 tie E DATE FOR OFFICIAL USE ONLY ; ,"PERMIT NO. DATE ISSUED MAP/PARCEL NO. - ADDRESS «. VILLAGE ; OWNER � � � } • � 1 1 a ' DATE OF INSPECTION FOUNDATI'ON:� - . FRAME O 1 l 1 s a INSULATION rVI 17 � L r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL �'• � ; < , GAS: ROUGH - FINAL ' FINAL BUILDING . } P DATE CLOSED OUT ASSOCIATION•PLAN NO. The Commonwealth of Massachusetts Department of Industrial Accidents - Office 01HY85089offs 600 Washington Street .►�� ;'� Boston,Mass. 02111 Workers' Com ensation Insurance davit ' ' name: UCi-1-5 CUR115 Cr NSVLUCTION CO. /NC,. location: Zvi CMrA66 -AVl: SUITE—' 1 city U I NCx � NSA 024 691 phone#(617) 174--(g519 ❑ I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. comonnv name: address: city phone#: insurance co. nolicy# ® I am a�tjle�re�l3ets eaera!contractor, hamesrrtler(circle one)and have hired the contractors listed below who have the following workers' compensation poles: compnnvname: P. Chester Pawlowsl.i d/b/a.'All Build address: 20 Walcott Street city Weymouth, :CIA 02191 . phone#r (7 g 1):: 3'7JS :,r.:.;.;.,<v;:::: ......... insurance co. -MAV60�ZS WSUi`ANC15- company name- •• address: 10 l Z FALMOOTH P-DA0 city: 14YA NN 151 MA 02-01 phone 5CPol insurance co. :.. J I)R� :;.:.:;: ;:;.:.:... oiicv# 8a� > <>:' : ; . a s ...... //%///%%//G////��/G%% / / / /// / / Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1.500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that a copy of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. I do hereby certify untie the p and penalties of perjury that the information provided above is true and correct p Signature Date AOiQI� �� /99 / Print name OHn/ f Cvz7r.S Phone /71�71 9 9 9 [IMci2luse only do not write in this area to be completed by city or town otIIcialtown: permit/license# QBuilding Depaelment❑Licensing Boardk if immediate response is required ❑Selectaun's Office❑Health Department person: phone#; Q Other (mmsea 9,95 PIA) Information and Instructions 1 0 Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for then employees. As quoted from the "law", an employee is defined as every person in the service of another under any contr- of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or,pther legal entity, or gay two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receme: 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 pf the Awelling house of another who employs persons to do maintenance, construction or repair work on such_awelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renews: 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,neither the . commonwealth nor any of its political subdivisions shall enter into any conttact for the performance of public work until acceptable evidence of compliance with the inm„r;,nce requirements of this chapter have been presented to the contracting authority. Applicants , Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is .being requested, not the Department of Industrial Accidents. Should you have any questions regarding the'law"or if you are required to obtain'a workers' compensation policy,please call the Department at the number listed below. City or Towns 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,cout=you regarding the applicant Please be sure to fill in the permittlicease number which will be used as a reference number. The affidavits may be returned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any 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 illxesugadons 600 Washington street Boston;Ma 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext. 406, 409 or 375 BOARD OF BUI DINGLAT ON License: CONSTRUCTION SUPERVISOR _ Number: CS 073388 Birthdate::0911211962 Expires.09/12/2002 Tr.no: 73388 Restricted To: 00 , JOHN J CURTIS 22 MARTIN RD AdministratorMILTON, MA 02186 1 . r D CROWN SERVICES GROUP I I e 5016 S. PLAZA DR. NEWBURGH, IN 47630 ALTA/ACSM SURVEYS ZONING REPORTS A Town of Barnstable Building Division SEP 1 6 REC'D 200 Main Street Hyannis, MA 02601 Re: 148 West Main Street, Hyannis, MA (Fawcett's Pond Apartments) Please provide me with a copy of the Site Plan for the address shown above. I spoke with a representative in your office that said you were in possession of a detailed site plan for this location. I have enclosed a check for$5.00 for the site plan as well as a Self addressed Fed Ex Envelope for the return postage. Thank you for your help and if you should have any questions regarding our request, do not hesitate to contact me. Sincerely, Allen Harding 812-455-3658 } Ph. 812 .490.5602 Fax 812.490.5606 TOW OF BABNSTASLE N Permit No qv . F 2 i:....: i B�ldang Inspector: cash OCCUPANCY PERMIT Bond. !ao23 a Issued to F�nmmefts PC9tld Apa i-- S C, ,. Address ; i r•' ,'i 7'12 Y; Wiring:Inspector -. Inspection date Plumbing Easpector �' Inspection date - Gas;Inspector Inspection date _ s s Engineering;;Department „*f } s' 'Inspection date, $' , F 4 s Board pf Health �`�� Inspection date r .:THIS PERMIT WILL NOT BE';VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL. r r'` SIGNED BY-£THE BUILDING. INSPECTOR`':UPON SATISFACTORY COMPLIANCE WITH- TOWN UI REQREMEjSft;AND 'IN_ACCORDANCE"WITH.SECTION.I19.0 OF THE MASSACHUSETTS STATE - �$uilding Inspector toter G v ♦r g _ ' TOWN"OF BA$NBTABLE ., permit No. _._^r __ Building,1&' Cash pector �T dam` q' 1,...� i� - y s. OCCUPANCY PERMIT Bond �_.1^__ �LD/1S Issued to ? %Ce r k-S onC 3'; T i_tS ;r� Address Wiring Inspector-'` Inspection date ! � Inspection date Plumbing Inspector p Gas Inspector Inspection date . Engineering Department , ,; Inspection date Inspection date Boar .. of Health d THIS PERMIT WILL 'NOT BE VALID, AND THE BUILDING SHALL NOT 'BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE_WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ................. Building Inspdetor lJ TOWN OF B.riRNSTABLE Permit No: Y_._ _'�' > --- Building Inspector - cash Nam —j � - - OCCUPANCY PERMIT Bond A. Issued to rl'+'(_'0 s t`_. : i)I'C' �j-ac f it�'?�t {�C Address T,k [' y>r, r 1y-21 �` .a,`z a f n ;. - i5�1.LLSI.r1�' ._ tV:l.�e�iS �\.:�'m..�! L�,JI. G�.! ��!�` ,� ''` -�g _.! .J..:_1 .hit,. Wiring Inspector ' •r`= X �. Inspection date Plumbing Inspector' fh � ,� y Inspection date Gas Inspector � 'f Inspection date Engineering Department 'A Inspection date t+ Board of Health j Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE. WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0.OF THE MASSACHUSETTS-STATE BUILDING CODE. y!'�Buildu►g Inspectors _ 1 I�s ksor''s Map 'and lot number Map 2 9 0 r Lot 2 7 (Part) ' *&J ew a Guu��r ro T-vu�c-� ,SC— Lc. �oF ropy S Pernjit number .... .............. .......... APPRO. SUBJECT TO q ` � THE � �'ARNSTABLE CONS LE, House number ....#.� ................................................ COMMISS101L 90 rasa C i639. TOWN OF - BARNSTABLE BUILDING r INSPECTOR APPLICATION FOR PERMIT TO .Construct . .............................................................................................................. 4 TYPE OF CONSTRUCTION ,,,,,three-story_ wood-frame buildings with elevators November...5�................19..81. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... 160 West Main Street. HYf .......... ...... ...... .... .... s ........:...................................................................... Proposed Use Housing for the Elderly -- 100 apartments and common facilities Zoning District Business/Residence B* ,,,,,Fire District .....Hyannis„ ........................................... Name of Owner ,Fawcetts Pond Apartments Address ,1776 Heritage Dr. , Quincy, MA 02171 Co Name of Builder' ..,.CMJ Builders ............................Address ,1776 Heritage Dr. , Quincy, MA 02171 Name of Architect Goodyr Clancy & Associatedress . 3.4 Boylston St. , Boston, MA 02116 .................. Number of Rooms „three rooms/apartment Foundation poured concrete ..... .............................................................. Exierior ....clapboard........................................................Roofing ...asphalt...shingles...................................... lst floor, concrete; 2nd & 3rd, Floors Interior ....painted drywall over wood partitions r..........wo o d...;. Heating Electric baseboard ,,,,,,,,,,,,,,plumbing .l. bath..:per unitj....2 public toilets ............................................................... Fireplace ,.,,None' ..Approximate Cost ....U.14QQ,.Q0.......................... Definitive Plan Approved by Planning Board ________________________________19--------. Area Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH *Variance granted permitting this use -- Appeal #1980-58. BOG / /3 E N E � � b OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby 'agree to conform to all the Rules and Regulations of the Town arnstable regarding the above construction. Name .... ................ .. ......... ....................... t 1i-64, FAIVICETTS POND APARTMENTS } COMPANY t 1 4423 ':Two} ThreStarBi��irigs NA, ................. Permit for .... ........�......... ....... Y t I�ou ing„for the„Elderly i 148 West Main Street L'ocation ................................................................ t t Hyannis . ..................................... ...................................... Fawcetts Pond Apartments Co. -Owner Type of Construction ..Frame ........................................ ................................................................................ ; fPlot ......................... . Lot ................................ . 1 October 1, 82 Permit Grantiqd ........................................19 I� Date of Inspection ` y ....:.......19 r Date Completed 477�-??::V..................194)d ' 66, Q15 Ile Y 3v1- /LY i May 6, 1982 Attorney Richard C. Anderson 436 Main S tree t Hyannis, PEA 02601 PE': The Village at Fawcetts Pond Dear Attorney Anderson: - 0n Monday, May 3, 19821 I met with representatives of Corcoran, Mullins and Jennison to review the revised plans for The Village at Fawcetts Pond dated April 28, 1982. Since the original plans had been approved we concentrated on the revisions which consisted mainly in the consolidation of the units into two (2) buildings instead of the original three (3). With the approval of the plans, I have beer_ assured that the site engineers would be on site immediately and constriction on the project w 11 c mence by May 7,. 1982. Thank you for your cooperation as the Attorney for the project. Peace., Joleph D. DaLuz Building Commissioner JDD/gr R � I'Tar 9 10 4ttoiney l'ichard C. Anderson 436 Main Street 1-11ynnn.i s, ;JA 02601 RI_',: The Villasoe at F'awcetts Pond :Hear Attorney Anderson: (ri i,fonuay, i''2y 33, 1982, I P.iot with representatives of Corcoran, !ullins and, Jerraison, to revie.,, the revised plans for 'ELe Village at Fa,wcetts Pond dated AT,ril 28, 1982. Since Che orir irD1 plans had been approved we concentrated on the revisions Nmich con sisted. mainly in the consolidation of the units into t-wo (2) buildings instead of the orizinal three (3). With Lhe approval of the planes, l have been assured that the sit^ engineers would lie o ce urmes?iatel:y and construction of the ,project T,,ill ccrmence by epri 1_V, 1982. `M,Ilanl;. yoU for y(yu.1ooperation as the Attorney for fine project. Peace, Joseph D. DaLuz Building Cormissioner JDD/gr '11 � s �2-6d/ � a '44 r f µ{ __ ___ �.._ _ __ _..__� ____ �______ _ .._`..rt�_—�___T _.�_. _ _._�___�_._ _ _ _ � __ _._ _ �� i � l .� �� 'I .. � �` 1 Tom• _` _ � ,v ' ` \ � � i`' _ �..._ t.� — _ ` -.r- ._.....� .. 11�'�, r i 1 � i � ' �.,, � ., ,� - --� ,y. �..� .._...�_ t �. JOSEPH D..0ALUz TELEPHONE: 77861120 R;ildin$ rairmisiionan EXT. }07 ' TOWN OF BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 July 13, 1982 Mr. Vincent A. Chiricosta Chief Architect 15 New Chardon Street Boston, MA 02114 Re: Fawcett Pond Village Dear Mr. Chiricosta: Reference is made regarding parking in the Town of Barnstable Zoning By- law under Section M. APARTMENTS, -paragraph f. which reads as follows: "f. Paved off-street automobile -parking spaces shall be provided on the- lot or group of lots containing an apartment structure and each such space. shall be easily accessible from a paved driveway on the property. There shall be not less than one (1) such -space per apartment dwelling unit on. the_property. _Each space shall be not less than two hundred (200) square feet paved area, exclusive of driveway. Each parking space shall be located not less than fifteen (15) feet from the base of the building." Additional parking is permitted in a suitable location on site for the visitors to the complex. I trust that construction can commence very soon. Peace, h D. DaLu uilding Commissioner JDD/gr cc: Mr. Alan Isbitz i 4 �- - Y � Z = �- �, ,,, ., :; t - � �. .. •.�. .. t y �, t i , ---- =;-.-u-�.-- . . _�._._�.....„.r_,_,. _ ____ ...._ . . '� �- .�__ � V ,� .. ;' .. c ,. � � � - n� R ^ ' - ,_ ..._ �.. ..,,,._...�.,r-.._._.,.,�,..�. _,.-_.. -.. �..r--..,._ �. - �-^- -.�-.-.�.--�...,._..._�-..-_........ I�� -�- � T t >, -.w r „- -�- r�, r'"" -• ,ttM .k�>n� �.. p"s'i�,,�w �r`R'i+, C� i n 113 om t yy ;1 " � _ ^�� •i ire � �'�� TOWN 0F B RN$TA' ermit`-No 47gM.- ON Biiildln9 Inspector Cashes � OCCUPANCY PERMIT * � . Issled t0 Ji TS+TCw tS` �.�i'c 'L>> Cc, ,Address it111ZZi nn11 � 12�5.. 1033 'S j�sii a r' WirmgInspector �` Inspection date ; s tS InspecWtion date Plumbing Inspector "" Gas Ins ctor= Inspection date Engineering Department WAInspection date y a � hw t I Board 10f Health��ms�y�' Inspection,date �" •n TffiS PERMIT, WILL`NOT BE VALID, AND THE;:BUILIDING SHALL NOT`4BE OCCUPIED h UNTIL SIGNED BY THE'':BUILDING INSPECTOR UPON SA7ISFACORY ,COMPIIANCEWITH: TOWN * , '$EQi7TAEIKENIIS AND IN-ACCORDANCE_ WITH.SECTION 119 0" OF THE MASSACHUSEkTl� 6TATE. � nc� BUILDING CODE x x �`'�•�Buildmg•Inspector 10, ay� alp s] c+rm ttand4CO alTtnm�1 '�"t� � G "$ *�' 'ga '^s- t�t`.,yq'n'• R.r�_'y • ?e 1� a _g,_ 6 fit` h� '�'P' rw"x ' > � _P �yw �:�h. 'r?✓�•�4' .pnivr �...�� m ^� :u � ' -'. r _ s+ .5'i,.y�,r;a f v.� 5S �,Ya+',�y3,��t5'3.s� •.:.5 a S za��"�-1 its E3+��,,7�'�,Y ; �. ..S" �'. .tee' ��'�j'•;:G;tr� - � .'��'<, �kp�`'"� r,',` z7"�y,h��. r�" �>,E r 1�r. oF: ar"� �,• •,� �'+� �: ."3yK' k gUg4r{.� �.�^v.',�'F�+a�l adkt Jl n. ¢.Sk`c - ..�<' 1551 j xj. t xK �.uf� d aka " e-( ��# 'a F� 1�`'✓l�i sr��v' f + hY °itti 't �x,.� 6 t�... �f"{e, r 1 r J i •t;.,+ Nh*� a�t' ��S - ' vtir i M ; rw a J.r(r J"bo-urS a`« ,¢� t y'> a 1r,:r'S.RrN�„ Rs k� S}7��h Y5� ,�1 r s l�µ_ 3�b'Ah�e'ft S t ✓t��'}r$k ,ft. RIA, i L t :rS eY ry h� f ' - � �"� _ ,.._+.r�. •,..«a;�ir.ram ,?u,�� •xxt +k f r hs t L ' 4, ail a' .. ,. ... .. tr• . Board of Appeals ._.....Hoxand....0......D.a,ane.f....T.rus:tee............_............_............._: Deed duly recorded in the ... Property Owner County.Registry-of Deeds in Book._..,.,.._. Corcoran, Mullins, JennisanG Inc ..... Page ........ .. .................a.. ....... _..... Registry Petitioner District of the Land Court Certificate No. Book_...:............. Pane . ._ .:.M Appeal No. 1980-58 mM_Octob� ..2 .....::.. 19 80' FACTS and DECISION Petitioner _Corcoran_._. Mullins Jennison•, Inc... filed petition on ...Au9ts`.1:....��.•-•--.- 1980 requesting a variance-permit for premises at .._..., ......_. ......•.- Street, in the village of _xyannzs ..... _......_ _.... . adjoining premises of ._...f .. t a � t...� . _...... _..... _ for the purpose of Modification of appeal no 1979•„Sl _..._. Locus is. presently zoned in_ ...Business_..and..Resir3ence:-B--zoned...dist�3.cts....- -- Notic+ of this, hearing was given. by mail, postage prepaid, to all persons deemed affected and Barnstable Patriot .& by publishing, iri Cape `Cod News newspaper published in Town of Barnstable a copy` �f which is att.a.cbed to the record of these proceedings filed with. Town Clerk. A puhliC hearing by the Board of Appeals of the Town .of Barnstable was held at the Town Office Buildiiig, .Hyannis, Mass., at 7 30 *W P.m. ^.September l8 _ µ_. .. 19 80 upon said petition under zoning by-jaws. Present at the hearing :were the following members: Frank P Congdon Luke .P.. ...La11r}_._.._. . Gail ...... gale„ ......:_.. . .... Vice- Cha reran i At the conclusion 'of the bearing, the rd took said petition under advisemei. 1 view of the locus was had by the Board. Appeal No..........1980,-.58 fake ..........2:..._.:.: of ..,......:2_...,._ On .:.:..... 19 ..$V The Board of Appeals found Atty. Richard C. Anderson represented the petitioner who is asking to modify by a. one-year extension, a previously granted variance (1979•-51), which has now expired, and which permitted the construction,'of buildings to house 100, one-bedroom'apartment. units for the elderly and handicapped at West Main St., Hyannis. Atty. Anderson said that the..petitioner had expended thousands of dollars on this project but was unable to go forward with the construction -since funds were not available from HUD. The petitioner diligently pursued this funding and anticipates that it wi11 become available after October1,1980, which is -the beginning of the new fiscal year for HUD. This project is first in line on CapeCod for funding of this type. None of the conditions affecting the locus have changed, and there still exists a critical need for housing the elderly and handicapped in a complex of this kind. There is a $3.8 mill-ion commitment from HUD to insure the mortgage 'on this'proj.ect and additional funding may be available from the Mass, Housing Finance Agency, No one spoke•in favor of or in objection to`the petition and the Board took 'the,. matter under advisement. . The Board'•voted unanimously, to grant ,the ,petit .oner's request for a one-year extension of the variance to allow construction .of housing for.the elderly and handicapped and found thaf the petitioner had assiduously pursued funding for 'this. project but was unable to comp.Iete the financial arrangements necessary to start construction within the allowable one-year time period. The one-year extension shall commence at the expiration of the appeal period of no. 1980-58. All of the conditions and restrictions imposed under no. 1979-51 shall remain in effect. f M.., M Clerk of the Town of Barnestabl'e, Barnstable. County, Massachusetts, hereby certify that tw;euty-one (21) days' have elapsed` since the Board of Appeals rendered its decision in the above ent.it.ied petition and that no. appeal of said dinision has been filed in :the office of the Town Clerk. Signed and Sealed this ._.!. ......__ day of ..:..... ...... _.._ 19 -..:::..._...... under the pains and penalties of perjury. Distribution:— Property Opener. ... ......._ : . .. _...... ........._... Town Clerk- Board of Appt,als Applicarit: Town of Barnstable Persons interested Building Inspector f' Public Iu�urination 13y r�:/�r�� r..��.,•a ...._ -Clutirman Board of Appeals. �-=-" ,✓` _ BOARD. OF APPEALS uxrsTLTI, r a t0)p. �0■ix M PARTIES IN INTEREST - APPEAL NO.1980-58 - CORCO RAN, MULLINS, JENNISON INC Ann Barros Allen H. -Bearse 'Jeanne, B. 'Bonner et al. Harold Brto, James L. '& Huldah T. Currie Anthony W. 'Dedecko Elizabeth R. DeGrace Calvin D. Ferris John M. Gingras Neil A. Gordon H & K Inc. Wilfred J. Harrigan, Jr. Martha M. Hastings Karen .Hil1 Mattie Jo .Hopewell' .Margaret E. Jackson, Spencer Jr. & Tiner_J. Lee Mildred Lightford Wm. G: Meyer et ali New Bedford Gas & Edison Light Harold L. & Gracelia Peterson Manuel P. & Julia M. Reis C.P. Richmond et als c/o Moyer J. R. Souza & Sons Inc. Taunton Cooperative Bank Pandi & Helen Tolko Frances L. West & Mary C. :Nye Elsie E. ,Redmond .Seine Pond Realty Corp. Katherine S. Smith . W.E. Cobb & R.-1N. Sriberg Trs; Eugene J. Tavares Pandi G. &.Helen Tolko VSH Realty Hugh J. White West c/o Hugh White Claude L. & Mary E. Young Barnstable Planning Board Yarmouth Planning Board . Sandwich Planning Board Mashpee Planning Board TOWN. OF B A.RNSTABLE { Board of Appeals _....Howard ............... Deed duly recorded in the Property Owner County Registry of Deeds in Book .....::.. .a:....... Gorcoranr...Mullins� ,Tennison:,. Inc. ......Page ..... ..........; ...... ................. Registry j Petiti_oter - District of the Land .Court Certificate No. '" 1 ,.__.... ., ..,,..._.. Book ......::Page ... :. Town Counsel Appeal No. ...1980_58... . ....... ......... .........Q12AQ e.c 22 .... 19 80 FACTS and DECISION i Petitioner _Corcoran Mullins,, Jerinison, Inc;,:„ filed petition on ....A..l?,5.! $ :._2j::. . 1980 , requesting a variance-permit for premises at ____ _:_.:.Yi'eS:l". i'�r��iz.� __.� _._......:.. Street, in the. village. H annis adjoining premises of for the purpose of ...Modification of appeal no 19R j..........._._. . .............. Locus. is presently zoned in.......Rus.Lness Notice of this hearing was given by mail, postage prepaid,.to all persons deemed affected' and Barnstable Patriot & • by publishing in Cape Cod. News newspaper published in Town; of Barnstable a copy -of which is attached to the record of'these: proceedings filed with Town Clerk. A public hearing by the Board of Appeals of the�Town of Barnstable was held at, the Town Office luildinp Hyannis, .Mass., at : y 30:.._._._. P.M. .September_18 ._. _;a. _ _ 19 80 , upon:said petition under zoning, by-laws: Present at the hearin6 were the following members:, L Frank P Congdon Lu1re;.P.:.....Lal1c}. Geil Nightingale ...... _ ....... .... .... Vice- Chairman f At the conclusion of the hearing,, the. and took said petition under ad,6seme A view of the locus was had by the Board, Appeal No.__.1980^ 58_ M .. . ._. T'at,►e" :::. ::... of . .......2.. s On 19 .tQ....-._, The Board of Appeals found Atty. Richard C. Anderson represented the petitioner who is asking to modify by a one-year extension, a previously granted variance (1979-51); which has now expired, and which permitted: the construction of buildings to house 100, one-bedroom apartment units for :the elderly and handicapped at West Main St., Hyannis. Atty. Anderson said that the petitioner had expended thousands of dollars on this project but was unable to .go forward with the .construction since funds were not available from HUD. The petitioner diligently pursued this funding and anticipates that it will become available after octoberl,198"0' which . s the beginning of the new fiscal year for HUD. This project is first in line on Cape Cod for funding of this type. None of the conditions;affecting the locus have changed, and there still exists a critical need for housing'the elderly and handicapped in a complex of this kind. There is a $3.8 million : coimtitment from .HUD to insure the mortgage on this project and additional funding may be available from the Mass. Housing Finance Agency. No one spoke in favor of f or in objection to the petition and the Board took the matter under advisement. E 1 . The Board voted unanimously to grant the petitioner's request for a one-year extension of the variance to allow construction of housing for the elderly and handicapped and found that the petitioner .had assiduously pursued funding for this project but was unable to complete the financial arrangements necessary to start construction within the allowable one-year time period. The one-year �. extension shall commence at the expiration of the appeal period of no. 1980-5.8. ' All of.the.conditions. and restrictions imposed under no. 1.979-51 shall "remain in effect. L _a _._.._._._ ....--- — :_�__.�_...._, Clerk. of the Town of l3arnsta,hl��, Barnstable � County; Massachusetts, hereby certify that Oventy-one (21) days have elapsed since the Board of Appeals rendered its decision in the above entitled petitinn and that no appeal of said decision has been filed in the office of the Town Clerk. Signed and Sealed this .._..........._....— day of ...— ..._.. ._..___......................................_ 19 _.:..... ... under the pains and � penalties of perjury. Distribution.— PropertyOwner ....... ....... ....... _.:. ...... ...... ............... Town Clerk Board of Appeals Appiican't Town of Barnstable ; Persons interested 1' Building Inspector I Public Information By ............... .................... .. ..... Board of Appeals Chairman i i ' 'Appeal No.'' 4 IN CLERK' r Fta¢ vuRNSTABLE,MASS. o ~ Date Received So AUG 21.-AM 9 53UV eal No. 1979- See ADD 51 TOWN OF E A STABLE RE-ESTABLISHMENT OF RIGHTS GRANTED BY VARIANCE PETITION FOR [JNDER THE.ZONING BYLAW To the Board of A...P.-eals> 1 P Hyannis; Massa Date August dAll, 19 80 i 'r The:undersigned petitioni the.Board of Appeals to vary, in the manner and for the reasons hereinafter set forth,the application of the provisions of the zoning by-law to the following-described premises. .1776 Heritage Drive Applicant: Corcoran Mullins Jennison Inc. Quincy, MA 02171 . (Full Name) _ (Winter Address). Owner: Howard C. Doane, 'Trustee-. 30 Oak Hill Rd., Hyannis;_MA 02601 '(Ffin Name) (Winter.Address) Tenant (if,'any): None (Vacant Land) (Full Name), (Winter Address) I.-Assessors map and lot,number. - Map 2t30, Lot-21 .(Dart) a Location-of.Premises .:West Main Street Area ix_anAi-�R_ (Name-df`'streef) (What section of Rbwn) 3. Dimensions of;lot about 150' about 750:' about'.250,77.0 CFiontage) (Depth) (square Feet) 4. Zoning'distriot-in'which premises are located Business::and RBA 5.How long has owner had title to the above:premises? °over 5-veais 6. How many buildings are:now on the iotf, one s 7. Give size of existing b s o t 1h a c ve - YtSLTp" - cN A q Proposed buildings L 150 sau ee J oY area. 8. State present use of premises Nme 9. State proposed use of premises Holls.ZnB for t_P Plder1Z and hdhdicaDDed 10, Give extent of proposed construction or*alterations: construction of three 3-story buildings containing 100 one-bedroom units and community building,.. 11.:'Nnmber of living;units for which:building;:is to be arranged one hundred (100) n.Have you submitted plans for above to the Building Inspectorf _N/A 1i Has he.refused a permitf°/A 14. What section of zoning-by-law do-you ask-io'be viried1, The Petitioner.is recruesting that the rights authorized by the variance granted in Appeal No. 1979-51 be re-established the same having_ 1!�psed by the non-ekercise thereof within one year. 15. State reasons £or variance or special permit: In Appeal No.1979-51,. the 2etitioner was ]ranted a variance to construct three 3-story buildings containing 100 one-bedroon.. snits for housing the elderly and handicaP,ped on premises located on West Main ltreet, Hyannis, partially in an RB Zoning District. A copy of the decision in such appeal is annexed- hereto and made .a aart hereof.:.. The Fetitionek., for lack. >f subsidized funding wa l>�i§lg to.'make ugik. the rights authorized by,the variance within one year'and such rights lapsed on 8/2.0/80. This, petition seeks co re-establish such: rights. . Respectfully submitted, Corco ,_'Mullins,; Jennison, Inc. (Signature). _ Petition received by c d C. Andersen, Atty. (Addieas) 43b Mas n St. ,:Hyannis; Mass. 02601 Hearing.date set for 19. Tel: 715-5625 • Filing fee of $9.5.00 required with this.petition. • This form may also be used for Appeals. (ovsk) The.following are the names and mailing,addr utY of,the'abutting,owners of property end`the' navies and addresses of the owners ofproperty abutting_the abutting owners of property',and .the names and-addresses of the owners.across the;street all with their conesponduig wing and`lot num'- bers according,to:the reeords in the Assessor's Offleer^at the:data of+flue appUcahoa r !LP 290 -:ot # Owner Address 107 V Claude L. & Mary E. Young 4525 Henry Hudson Parkway Riverdale„ NY 10471 108 ✓ Harold L. & Gracelia A. Peterson:: 6h W-.-::9.4th Street.- New York; NY 10000 G & 49 v`Mildred Lightford 51 M tcheLls; Way €: Hyannis, MA 02601;. 48 ' Henry M. Jr- & 'Antonia Lewis 23 Winstead, Street v Providence, Al 02900 u & 158 Mattie Jo Hopewell 2569 Seventh Avenue., Apt. 11K New York—NY 10039 & 39 J W. E. Cobb & R. M. Sriberg, Trs. : 140 Federal Street Boston, MA 02110 173 J Pandi. G. & Helen Tolko 106 West,Main :Street: Hyannis, MA 02601. & 162 '61 & K, Inc.' 59 Chipping Green 'Circle South Yarmouth, MA 02664 102 v Martha M. Hastings 13.5 West Main Street' Hyannis, MA' 02601 101.'V J. R. Souza & Sons, Inc. 29 Andover Street. Danvers, :MA 019`23 103 Karen Hill Bay Lane Centerville, MA, 02632 1: Neil A. Gordon 248 Beverly Road / Brookline, MA 02146 & 71 C. P. Richmond et als c% Moyer 220 West Main Street Hyannis, MA 0260.1 50 Spencer Jr. '& Tiner J. Lee 986 Laurel�Avenue ' Bridgeport, CT `06600 .9 & 120 James L.& Huldah T.. Currie 1 St. John Street `Hyannis, MA. 02601 ; 45 v Manuel P. & Julia M. Re s 248 Mitchells Way. Hyannis, MA 02601 46 v Margaret E. Jackson 40 West 55th Street Bayonne, NJ 07002 40 Harold Brito Pine Grove Avenue .Hyann'is, MA 02601 76 Katherine S.. Smith 58 'Pine Grove Avenue .-Hyannis. MA 0260;1 of G` B��RNSTABLE T ' Board of. Appeals '79 AUG 24 AN1'1 50 t _ Howard C. Doane_ Trustee Deed duly recorded in.the - -=---=-- Property Owner County Registry of Deeds in Book Corcoran, Mullins, Jennison, Inc. . Page _ .r.11 :Ls�k� _ -�-• -Registry . .Petitioner District of the Land Court Certificate No. Book _ Page 1979 Appeal No. — - FACTS_and DEQISION s; Petitioner Corcoran, Mul 1 i ns_,, Jenni sop.•,Y 4.R filed petition on 19 79 , requesting a variance-permit for premises. .at _ e�� y� __ Street, in the village of _.._.._...H.Ys�CtR.!_5.: adjoining premises of � i. n. : �sz..cQhS.i" cs_tj, -t11ree_sts�r_Xa.bui..l:ding s s-to — for the purpose of _....Y L elderlX� nd.� �nd1s�RR .d�_ Locus is presently .zoned in B nes•�-� a-- 5`.I de .�'�'"' Notice of this hearing was .given by mail, postage prepaid, ,to all persons deemed affected and Cape Cod News by .publishing in '8arnstable' Patroa newsp°aper'published in Town of Barnstable a copy of which is :attached to the record of these proceedings filed with. Town`Clerk.: A public bearing by the Board.of Appeals of,.the Town of Barnstable was held at the Town. Office Building, Hyannis, Mass., at -LAB--- P.M. 1979 , upon said petition under;zoning.by-laws. Present at the hearing were the following members: Rir Bo X c =- ELaAk.1'-_CgdacL . _._........had L. Chairman RE �� s IN ST ET Arq I 1 V _ TOYYtiJ OF BARNS.TAI., BOARCTOF APPEALS BU SS` AND'RESIDENCE B � � ,mow O DiSTRI& "" 'ICE OF PUBLIC HEARiNO� 'PUBUI14MARING LL B UNDFA ZONING BYE ISl ELD 0F1 THIS PE'rIT1ON AfT 4b ��To�elf�,peraona deemed * mtereated Ore by the Board APPEAL NO`1978-Z1 8 t)DJ'M t Appeais under Sec SotGhap� AIGHAF3D " A tDI LLO 40A f of Gen"I Lawa o the appealed t0 the m 80ARD F �Comonweaith of Massecttiusetta ' APPEALS nd,�petrtiantif� a =and 11 emendments theretb;?you LS0 Ell CIAL PERMIT D e11ow "?are7efebynotifiedthat F iLY,`AMUSEMEN GENTE. APPEAL NO 199 b0PM =CONTAIMINGCOIN OPERATED YVILLIAM E. DACEY ,11Shas rAMUSEMENT�DEVICESat GAPE appeal@ii, to�'�therf BOARiF �COD_MROU28AitJt3 APPEALS and petitioniito ►. HYANM1iin a Bl1StNESu ZONED e VARIANCE to siigw R�AL EfiTATEi"'D�TRICT, �OFFICEat MAINSTREETAPU8l1C,HEARING /Jttl E CENTERVILLEm.a RESIDENCE; D-1 ZONED OISTRICT� _• '� �ELDONTHISPETtT ON1Cfi800 t" s - A7F'UBUC HEARINGwW1lt BE � PTh Brings viii fre nth HELD O_N THIS PETSTIOhI ATT 30 HEARINC,�ROOM 70Wh�NACL P M " � 35T AAAIN STREET;HYANNISon tAPPEAL°°N0 1979-St,, a�petttwns for a VARIANC�rET,t4q5 aPiSoMw.- HURSDAYAUG UST2 1 kCORCORAN MULLLttJSFJENNi 97t8, yd -' You a e invtdsa S -NCft eo h ZONING"BOARD10iON PPEASdOF;A-BOARD APFEALS � _ • THREE;'3-STORY;8UILDINGS 4q �' duke P ally, I =c t be ronstructed:`�and usedfar h �zc`;`'Cler HOUSINGFORFTHE ELDERLY" mw AND MANO1CfiPPEDat%WEST (7�r18T9} � ,, i i ,u At the conclusion of the hearing, the Bye! "took paid petition`under advisemP"nt 0 yew of the x ' b locus. was had y the Board. - t ,x f 1'979-51 Page 2 of 3_ Appeal No. 4 y Y : 0 August 16 _ 19 79�---, The Board of Appeals found n Atty. Richard C. Anderson represented the petitioner, Corcoran, Mull ins, Jennison, Inc. , of Quincy, Mass. Mr. Anderson explained that the petitioner t 't f -had submitted a bid to the Barn table-Housi►�g Authority which was Identical,�, to the present petition and for seasons concerning teg:-a ,technic�a"1ItIes In the' � ¢:� 1 submission, he bid could not .be cons°idered; by t he, Hous.�ng 'Authoritym' Subsequen"tly, 4 State `Street Development was "the succes"sful •appli'cant and" will construct housing' ; units for the elderly and handicapped;on South Street, Hyannls. j�The Barnstable 4 Housing Authority was very,pleased with the proposa"1 fromiCorcoran, Mullins1 ".. Jennison, Inc. and now that addi'tiona federal funwvai hit, twould be located,on : the petitioner wishes to go forward with the project . West Main Street, Hyannis, in an area zoned for business and residential use. The , Beal and Ames Funeral Home property in question is located directly behind Doane, carters and is east of Fawcetts Pond. The site comprises approximately five and three-q acres. A plot plan showing the portion of the property .in the business district and the portion in the reside ntial :distr'ict was presented to the Board. Mr. Anderson said that the unique feature of this property `is that: the residentially zoned portion is landlocked by the business zoned portion and this condition does not exist else where in the. area." Access to areas zoned"" for residential use are by private or, pub.lic .� ways through the business zoned district of West M Street. A map` show wasg resented. apartment houses existing in" the .immediate- area. of the site .in .q.ues"ti'on, p "11. of the con to the Board.. The petitioner will' me.et aditions imposed under .Section M. , Apartments, and less than 0� of the :site will be covered by the proposed. buildings. From the. grade to the plate, the buildings will be �5 ft. high ratherTthan wilj te allowed be 35 ft. high and rear and s'ideyard setback requirementsbe no construction within 50 ft. 'of Fawcetts Poe av"a dOlable nce drSdrking paces wi 1970,$there has1been provided. Both town water and 'town sewer" ar a 45% increase in the over 60 age group in "the Cape area and the need for housing is critical .. Allowing the petition for the elderly and handicapped would not be detrimental to the neighborhood nor in derogation of the spirit ,and intent of the zoning bylaws. kechMiss Joan Goody, a member of A.1 .A., present"ed softthepex�istingttreess of he ttoaalloweap"view . posed buildings. There would be some thinnt,ng . Clerk of the Town of Barnstable, Barnstable County, Massachusetts, hereby certify thattwent1 .y-ope ('-'1) hays have elapsed since the Board of Appeals rendered its decision in the above entitled petition and that no appeal of said decision has been filed in" the office of the Town.Clerk. 19 under the pains and Signed and Sealed this _ - _ day of ».._ --- penalties of perjury: Distribution s Property Owner Town Clerk Board of Appeals - Town of Barnstable Applicant Persons interested Building Inspector / Public Information By "_-'" ._ _` "",. �._-_..._.... - Appeals Chairman 14 Board of _ V ,f'— ' *63 9, P Appeal No. 1979`-51vw,Page 3 of 3x��w 'f8`cP, "� d" of the pond but, otherwise, the` existing vegetation would be ma inta�ned xTheyd petitioner .wonId install, non glare light.in;g an, -en of theme units would aGcornodate � the Shandi,c'apped`. The ;exterior�finish on�a1�1 buildings woold�b.e wood5hing1e the Hyanni's F,i re Ch i':ef has g e ven �h� ). app nova 1 Hof the pra,l ect �f rom,a safety_ view e of nt. Rents w�.11he subs i Ali and HUD money wr l 1 be used to` f i Hance they prolect� � iw 'Awn No one spoke .i n favor of or n :obi ect r on fio _41the pet i t l an and the Baa rdIM took the' } a � � � � ft �t matter under adus Bement' ,v d ;a y <; a `s The Board found that the s i to i n, quest ion'`does comply with the requirements of . Sec. 10of Chap. 40A, M.G-.L. necessary to th,eg-rant i ng of t�a var i ance ti nasmuch as this single parcel has both res-identia1 'and business'zoned area's, rregular" inR shape, and does, not lend ii tsel f to res i dent i a 1 '.use -.for sing 1 e .fami,1�y�, dwel 1 �ngs:r', The'praperty `is loca ed in an` area of high den5ity:for both bus�nessand „residential,, d he et i t i'oner's f ro o'sal" for,e.l deny' hous i ng would have ,'a, Tess deleterious L. use-and t p P , p_ .f �s:t.ion existi.n, .``rn` this area, than, the lsus�ness" and.sUng,"e T. Ily effect on the con9e 9 res'i'denti'al use allowed .on thus s"ite'., , .Therefore, ,the Board voted .unanimously .to grant they pet it.i ones a va�r r mice to allow the construct iron of an apartment complex to house- the. eIde'rIy and handicapped subje& "to the "foTlowing. cestricti'on"s: 1'. The use of the property shall be far,'the construction of apartment buildings to house the elderly and handicapped only. 2. All ,cons Itrueflon -shad l be.,as per plans "submitted and citied as Jollows: "The Vi"Ilage At :Fawcetts Pond"-_'Goody, ,C1an;cy Z Associates:,' Lnc. Boston "Massachuse't.ts frolet 7s 33�+ Boyl Stan St. Arch rtect 20 =, Date: "l5 ,tune 1979" x + 'c POAkD- OF APPEALS 1 a/31- O0,0 PARTIES IN INTEREST - APPEAL NO. 1979-51 - CORCORAN, MULLINS, JEN'NISO.N,, INC. Atlantic Savings Bank Atlantic Savings Bank c/o H K Inc. t Barros, •Anna B°earse, Al len. H. Bonner, "Jeanne B- "et al , Brito, Harold Cobb, W. E.. & Sriberg; R. M. Trs`: Coleman, Ronald & Jeanette , Davis Ronald' et a1 DeGrace, Elizabeth R. DePamphlis, Thelma Ferris, Calvin D. Fisher, Jasper & Anne Gingras, John M. Gordon, Neil A. H & K Inc. Harrigan, Wilfred J. Jr. Hastings, Walter S. & Martha H i 1 1 , Ka r,en Hopewell , Hattie J'o: .Jackson, Margaret E. Lamar; Joseph M.. & John Landry, C. S. & Dranetz, C.S. Lewis, Henry M. Jr. & Antonia Lightford, Mildred Meyer, William et al Montei.ro, Mary R. New Bedford Gas et al Pena, Louis 1 . Redmond,, Elsie E. Reis, Manuel P. & .J:uIis M: Richmond., C.P. et al c/o Moyer Seine Pond Realty Corp. S'immo;ns,, Alan J.. Smith, Katherine S. J. R. Sousa &• Son, :Irtc. Tavares, Eugene J. Tolko, Pandi & Helen Veto, Mildred. A. c/o M. Washington V S H Realty, Inc. West:, Frances L. .& Nye, Mary c/o White, Hugh' White, Hugh H. - Barnstab,l.e. Planning' Board ' Yarmouth 'Planning Board Sandw'i ch Planning Board „ Mashpee Planning Board 1 c r TOWN OF BARNSTABLE 0 BOARD OF APPEALS 039. 397 MAIN STREET HYANNIS', MASSACH.USETTS 08601 APPEAL N0. ' 1980-58 Cor•co,ran; "MulTins, 'Jen:n son, Inc.. I hereby certify that the attached list of names and addresses, as required under Section 11 of Chapter 40A, Mass, Gent Laws- :are as they, appeaj- on the.:most recent tax .list 0.980 fiscal year),: to within 300 ft, or. to abutters to abutters within 300 ft, Rob�hrtty, Vr., of A. :ess i ng PROPERTY ADDRESS I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I STATE I PCS N9HD PARCFl CLASS KEY NO. 0148 WEST MAIN STREET 07 H8&RB 400 07HY 01/04/96 1121 00 HY09 R290 027.002 19542� LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T L:rnC By/Darr: S..e D�meng Y UNIT ADJ'D,UNIT ACRES/UNITS VALUE Desenplin FAWCETT'S, POND APARTMENTS MAP— CD. FFDe ab/Acres LOC./YR.SPEC.CLASS ADJ. COND. PE PRICE PRICE CARDS IN ACCOUNT — L APARTMENTS U X = 100 *309530.00 309530.00 1.00 309500 a 02 OF 08 A N MARKET D INCOME 4343600 A USE APPRAISED VALUE D D i C 4,343P600 A PARCEL SUMMARY T U LAND 645400 A S T BLDGS 4186600 M 0—IMPS 18000 TOTAL 4850000 F E N CNST 862410 E N DEED REFERENCE Type DATE RKpreea PRIOR YEAR VALUE A T Book Page lost' MO. Yr.D Seleg Prfpe LAND 645400 T S BLDGS T 9� 200 U TOTAL �WO R E S BUILDING PERMIT Amount LAND LAND—ADJ INC ME SE SP—BLDS FEATURES BLD—ADJS UNITS Number Dele Ty- 1 309500 Class Consl Total VCar Built Norm. Dosv. I Units menus Base Rale At11 Page Actual f A9e Deer. I C:_,. CND. I Loc. %R.G. Repl�Cos!New Atll.Repl.Value ton Heigh/ --- eE Rmg Balks •Fix. Partywall FK. 110a 001 100 101 00 83 11 93 125 100 116.2 309500 359900 3.0 1 1 6.0 24.0 �Dc scnpnon Pale Squaw,.eel Ropl.Cost MKT.INDEX: 1'0 o IMP.BY/DATE: RW /86 SCALE: ELEMENTS CODE CONSTRUCTION DETAIL S I 8AS 100 .00 i592 CNST Pc T 830 120 .00 1592 STYLE 00 0. o FOP 35 .00 52 ETTGN-ADSJMT_ -00 ---------- --U. U EXT-ER.WACLS-- -T2 -LAPBOARD ----0. C ____________; NEAT/AZ TYPE 03 IECTRfC---------ff: T I ! INTER. Q FINISH 04D MwiALL CT 0 ! FAWCETTS POND ! INTER.LATOUT_ 72AVER.TWO RMAL . U i ! APARTMENTS ! INTER.t�IfACTY 02S C A KE S EXTER. 6.0 R I ! FLOOR STRUCT 03 D JTTST BEAM 6 A . _ BUILDING C-18 L D � I - -----____+ FCaOR COVER - 04CARPET ---------0.0 - -- -------- ----- - E TplalAreag Auv = 2 sage- 1592 +----------------- bOF TYPE OTGABCE—ASPH SH___ Q.0 BUILDING DIMENSIONS ELrCTRICAL 02 BOVE AVERA6E Ef T A FOLINDATION 0i OURED CONC =__�4.9 ------------ - -- -------------- --------------- --- ---------------------- L LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 STANDARD PROPERTY ADDRESS I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHD IDENTIFICATION NUMBER KEY NO. 0148 WEST MAIN STREET 07 HB&RB 400 07HY 01 4/96 1121 0 HY 9 7 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T 195425 Lentl ev/Date Sae Dunes lion VP UNIT ADJ'D.UNIT gCRES/UNITS VALUE Desciption FAMIC ETT'S. POND APARTMENTS MAP— co FFoe m/nups LOC./YR.SPEC.CLASS ADJ. COND. E PRICE PRICE CARDS IN ACCOUNT — L APARTMENTS U X = 100 *456488.0 456488.0 1.00 456500 8 03 OF 08 A COST 4U5UU0U— N MARKET p INCOME 4343600 A USE p APPRAISED VALUE `p J C 4P343.600 A PARCEL SUMMARY T U LAND 645400 A S T BLDGS 4186600 M 0—IMPS 18000 TOTAL 4850000 F E IN CNST 862410 E N DEED REFERENCEI Type I DATE P Recorded PRIOR YEAR VALUE A T Bell Page O. v, p se'e'P,ice LAND 645400 T S BLDGS 98200 U TOTAL 3600 R E — - BUILDING PERMIT S Number Dale Type Amount LAND LAND—ADJ INC ME SE SP—BLDS FEATURES BLD—ADJS UNITS 456500 cons'. o'al vpar e m Norm, obs Class Units Uni's Base Rate ntll.Rate A9� 1'9 Age Depr. Contl. CND. Lac. %R.G. Rapt.Cost New Adj.Repl,Vnlue Stories Heignt Rooms eA Rms Bans I Fi a. Petlyrnll Fec. 108 001 100 101 83 83 11 93 125 100 116.2 456500 530900 3.0 48.0 Description Rate Square Fee' Rep'.Cost MKT,INDEX: 1.00 IMP.RV/DATE: RW /86; SCALE: ELEMENTS CODEI CONSTRUCTION DETAIL S BAS 100 .00 2288 GROSS AREA 4576 APARTMENT BUILDING CNST GP:01 830 120 00 2288 T STYLE 00 0. R FOP 35 .00 � 698 DESIGN_ _ _ ___ __ADJ MT 00 6- _ U EXTER__WALL S _12CLAP96AR6 0. C I +--------------------------+ HEAT/AC'TYP.E 03ELECTRIC-----------0.- T I ! ! INTER.fINISH 04DRYWALL -- - U ! FAWCETT POND ! INTER.LAYOUT 12 AVE R.AN6RAAL 0. R ! APARTMENTS ! INTER.Q UAL TY- 02SAME AS EXTER. 0_ A FLOOR STRUCT 03 6 J7�ST BEAM 6_ --- ' L p BIDG C-2 F LO ! OR COVER 04C,A-- -------- RPET 0. pp - - ----------------- TotalAreas Au><- 6 Base- 2288 +--------------------------+ E - - ROOF TYPE _01GABLE—_ASPH SH____0.IBUILDING DIMENSIONS T EIeCTRICAI 02A9OVE AVERAGE 0--- --------A FOUNDATION 0iPOUREO CONC 99. I --------------- --- ---------------------L LAND TOTAL MARKET " PARCEL AREA VARIANCE +0 +0 STANDARD PROPERTY ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CLASS I PCS I NBHD KEY NO. 0148 WEST MAIN STREET OT 4 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS I T C I..—ev/Date Sae omenson v UNIT ADJ'D.UNIT ACRES/UNITS VALUE Desoriptin FAUCETT'S, POND APARTMENTS MAP— co. FFDe In/ncres LOC./V R.SPEC.CLASS ADJ. COND. PE PRICE PRICE CARDS IN ACCOUNT — L APARTMENTS U x B= 100 *739960.0 C 739960.00 1.00 740000 B 04 OF 08 A COST N MARKET D INCOME 4343600 A USE D APPRAISED VALUE D J C 4,343.600 A U PARCEL SUMMARY T LAND 645400 A S T BLDGS 4186600 M 0—IMPS 18000 TOTAL 4850000 F E N N CNST 862410 E DEED REFERENCEI rYPe I DATE R�ortl� PRIOR YEAR VALUE T LAND 645400 A BOOK Page MO. Vr.D T S BLDGS f8200 U TOTAL 3600 R E S Number DBUILDING PERMIT Yp° Amount LAND LAND—ADJ INC ME SE SP—BLDS FEATURES BLD—ADJS UNITS 740000 Con st. Total wA�eqa�r Bill Norm. Obsv. C la as Units Units Base Rale A[1l Hale A t 1 1t9 Age Depr. Contl. GNp. Loc. -R.G. Repl.Cost New Arfj.Repl Value Stories I Height Rooms -Rms.Baths •Fix, Perly .11 F- 108 001 100 101 83 83 11 93 125 100 116.2 740000 860600 3.0 84.0 Desc. i Rate Square Feet Repl.Cost MKT.INDEX'. 1.00 IMP.BY/DATE: RW /86 SCALE: 1120.00 ELEMENTS CODE CONSTRUCTION DETAIL S BAS 100 .00 3773 GROSS AREA b APARTMENT BUILDING CNST GP:01 T 830 120 .0 0 3773 - -- ----- _00 ------ ------- - fOP 35 .00 1113 N STYLE 00 0- R FOP 35 00 � 368 ESIGN ADJ MT_ 00 ___ 0. t; EXTER.MIAILS 72CLAPBOARD 0.a - ---------------o--IIIII -"------------------------+ EAT7AC-TYPE 03 uECTRIC 0. T I ! N TER.KIN I§H _04DRYWAIL ___ 0.0 T U fAWCET7 POND ! NTrR.LAYOUT 12AVER.%NORMAL 0.0 R ! APARTMENTS ! INTER.9UALTY 0 2 S A M E AS EX TER_ J.0 LOOK STRUCT 53 D JT/ST BEAM 0.0 L D Aux A u ! BLDG C-3 ! E__LOOR_ COVER a4CARPET 0.0 E Total Areas 1 481 Base= 3773 +--------------------------+ OUf TYPE ---- -0i GABLE—ASPH SH--- If.O = BUILDING DIMENSIONS LET iE LRICAL__ 02 P ROVE -kV ERA G_E____ 0.0 A BAS 0UNOATION OIOURED CONC 99.9 --------------- --- -- -- - I --------------- --- --------------- L LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 STANDARD PROPERTY ADDRESS ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE IMRF=R LASS I PCS I NBHD PARCE KEY NO. 0148 WEST MAIN STREET 07 HBBRB 400 07HY 01/04/96 1121 00 HY09 R290 027,002 195425 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS IT Lana I Sze Dimension v UNIT ADJ'D.UNIT ACRES/UNITS VALUE De:eription FAWCETT•S, POND APARTMENTS MAP— Co. FF Je tb/Ac,es LOC./YR.SPEC.CLASS ADJ. COND. PE PRICE PRICE L APARTMENTS U X = 100 •739960.0 CARDS IN ACCOUNT — 739960.00 1.00 740000 a 05 OF pg ACOST 4Z_5� N MARKET D INCOME 4343600 A USE APPRAISED VALUE D D C 4.343.600 A PARCEL SUMMARY T U LAND 645400 A S T BLDGS 4186600 m 0—IMPS 18000 F E NOTAL CNST 4 850000 N 86241/0 E DEED REFERENCEI Type I DATE M R�oraea PRIOR YEAR VALUE A Booh Pe MO, Vr. 9e Inst. DI Setee Prig. LAND 6 4 5 4 C 0 T S BLDGS 3A98200 U TOTAL 3600 R F BUILDING PERMIT S Number Dete Typa Amount LAND LAND—ADJ INC ME SE SP—BLDS FEATURES 8LD—ADJS UNITS 1 1 7400001 Glass Con st. Total Base Rave AtlJ.H;ue Vear Bullt Age Norm. Obsv. CND. Loc. %R.G. Repl.Cos;New AO Re I.Value Stories Height Rooms e0 Rms Batns •Fi a. Pert 1 Fx. U nns Units A i 19 Depr. Ob%tl I P 9 ywel 108 001 100 101 . 83 83 11 93 125 100 116.2 740000 860600 3.0 84.0 Description Rate Square Feel Repl,Cost MKT.INDEX: 1-p0 IMP.BY/GATE: RW /86 SCALE: ELEMENTS CODE CONSTRUCTION DETAIL S BAS 1.00 .00 3773 GROSSAR APARTMENT -BUILDING CNST GP:01 T 830 120 .00 3773 STYLE OD 0.0 R - DESIGN AOJMT00 -------------------0. FOP 35 00 111 3 U FOP 35 .00 368 EXT.ER.WA_LCS__ _ AP 72CL80ARD 0. --------------------------+ HEATIAt- TYPE 03ELECTRIC----------0.- T ! ! IdTER.fINISH ._04DRYY _ ALL 0. u FAWCETT POND ! INTER.lAY0U7 12AVER �NORMAL 0. R ! APARTMENTS ! 1NTER.QUALT.Y. 02SAME AS EXTER. (5. ! FLOUR' STRUCT 03N6 JT�ST BEAM_ 0. A BLDG D-1 FLOUR COVER 04CARPET 0. L - ---------------------- -0--------C---- 4 Baae- 3773 +-------------------------- ROOF TYPE _0I6A_BL_E_—_AS_P_H_ S_H_____0._ E Total Areas UI = + • T BUILDING DIMENSIONS C-EC�7RIC/�L 02 BOVE AVERAGE 0. A FOUNDATION 0i OURED CONC 94. -------------- - --- ------------- L LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 STANDARD PROPERTY ADDRESS I I ZONING I DISTRICT CODE SP-GISTS.I DATE PRINTED I CLASS I PCS I NBHD NUMBER KEY NO. 0148 WEST MAIN STREET 07 HB&RB 400 07HY 01/04 9 1121 00 02 195425 LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS TY UNIT I ADJ'D.UNIT Lantl By/Dale o-cp F AWCETT• S. POND APARTMENTS MAP LOC./YR.SPEC.CLASS ADJ. COND. PE PRICE PRICE — CARDS IN ACCOUNT — L APARTMENTS U X = 100 *544768.0 544768.00 1.00 544800 a 06 OF 08 A COST N MARKET D INCOME 4343600 A USE APPRAISED VALUE D i C 4,343.600 A II PARCEL SUMMARY T LAND 645400 A T BLDGS 4186600 0—IMPS 18000 M TOTAL 4850000 F E N CNST 862410 E N DEED REFERENCE Typa DATE Recp,dad PRIOR YEAR VALUE A T Book O Yr.Page '"�' M p Sala>Prfca LAND 645400 T S BLDGS 3698200 U TOTAL 103600 R E BUILDING PERMIT S' Number Date Type Amount LAND LAND—ADJ INCOME SE SP—BLDS FEATURES BLD—ADJS UNITS ' ' S44800 Class Con si Tol al Base Rafe Atll.Rat r, Year Built Aga Norm. Obs v. CND. Loc, %R.G. Repl.Cost New Atlj.Rapt.Value Stories Heig nl Rooms eA Rms.Baths 1 FI Panywall Fat. Units I Units A4 11� Depr. Contl. . 108 001 100 101 . 83 83 11 93 125 100 116.22 544800 6336OU 3.0 D.-c twn R.I. Square Feet Repl.Cost MKT.INDEX: 1.00 IMP.BY/DATE: RW /86 SCALE: ELEMENTS CODE CONSTRUCTION DETAIL S BAS 100 .00 2802 GROSS AREA 5604 APARTMENT BUILDING CNST .GP:01 T 830 120 1 .00 2802 STYLE 00 0.0 R FOP 35 I .00 698 ESIGN ADJMT 00 ------------_------�.- FOP 35 I .00 88 EXTER.WALL S 12 CLAP bbAR6 0.0 U -------- --- --- ----------- ---------- FOP 35 .00 88 +--------------------------+ EAT/AC-TYPE a3ELEItTRIC 0.0 TFOP 35 .00 88 ! ! _N TER.FINISH 04DRYWA -L ----- 0.0 R ! APARTMENTS ! NTER.QUALTY 02SAME AS EXTER. 0.0 ! F LOOK STRUCI" 03 0 JT%ST BEAM 0.0 A ! BLDG D-2 ! LOOR _ COVER 04 AR PET 0.0 L D 1014 Base= 2802 +--------------------- +E Total Aa== ----- _OOF TTPE ___ 01 ABLE—ASPH SH___ 0.0 BUILDING DIMENSIONS LECTRICAL 02 80VE AV E.R-AGE 0.0 . AI 6U46ATION 01 OURED CONC 99.9 L LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 STANDARD PROPERTY ADDRESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHD KEY NO. 0148 WEST MAIN STREE LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS T t.andey/Dale s�<eoimen.�nn Y UNIT ADJ'D.UNIT ACRES/UNITS VALUE Daspripbpn FAWCETT`S, POND APARTMENTS MAP- CD. FF-0e m/AO es LOC./Y R.SPEC.CLASS ADJ. COND. PE PRICE PRICE CARDS IN ACCOUNT — L APARTMENTS U X = 100 1.0c 1.00 1.00 8 07 OF 118 A COST 48-50000 N MARKET D INCOME 4343600 A USE D APPRAISED VALUE D J C 4,343,600 A U PARCEL SUMMARY T S LAND 645400 A T BLDGS 4186600 M 0-IMPS 18000 TOTAL 4850000 F E N N CNST 862410 E DEED REFERENCEI Type I DATE Reed- PRIOR YEAR VALUE A T Boek Page Mo. Yr.Di sa'e'Pr;c. LAND 645400 T S BLDGS 8200 .0 TOTAL 600 R E BUILDING PERMIT S Number Dale Type Amount LAND LAND—ADJ INCOME SE SP—BLDS FEATURES BLD—ADJS UNITS I i � I Class Conat. Total gase Rate AU.Rate Year Bu;lt A Norm. Obsv. Units t Units I ,A�� iltl ge Depr. ConO CND. Loc. ^b R.V. gepl Cost New P.Oj.Repl.Value Stories Height Rooms ed Rms Baths •f;Y. Pertywell F.c. 108 001 100 101 83 83 11 93 125 100 116.2 3.0 48.0 Description Rate Square Feel Repl.Cost MKT.INDEX: 1-00 IMP_BY/DATE: RW /S6 SCALE: ELEMENTS CODE CONSTRUCTION DETAIL c SAS 100 .00 2156 GROSS AREA 4312 APARTMENT BUILDING CMST GP:01 B30 120 .00 2156 T STYLE 00• 0.0q R FOP 35 .00 220 c_XTER- A_LLST 112CLAPBOARO 0.0 � FOP 35 � .00 220 }--------------------------+ EATIAt- TYPE 03ELECTRIC 0. --------- --- T NTER.FINISH 04DRYWALL ---_ 0._ fAWCETT POND --------------- -- U INTER.LAYOUT. 12AVER./tdORMAL 0. -NTER -------- - --------------------- R ! APARTMENTS ! IN.TER.QUALTY OZSAME AS E_XTER.___ 0-- FLOOR STRUCT 03WD JT�ST BEAM 0. A - _ BLDG D-3 ! F_LOOR COVER 04tARPET 0. L D 970 2156 +-------- 0aFTYPE---_ -01 ABLEASPH -SH----O. Tol al Areas Aux Base -----------�------} E T BUILDING DIMENSIONS EL1 fTRICAL 02A80VE AVERAGE 0= A ti FDUN6AfiTON 01 OURE CONC __ 99.9 --------------- --- --------------- --------------- --- ---- ---------- L LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 STANDARD PROPERTY ADDRESS I I ZONING I DISTRICT CODE SP DISTS.I DATE PRINTED I STATE I pCS I NBHDFICATION NUMBER CLASS KEY NO. 0148 WEST MAIN STREET 07 HB&RB 400 07HY 01/04 96 1121 00 LAND/OTHER FEATURES DESCRIPTION AOJVS7MENT'(ACTORS T LanO By/D aie size Dnn en'ion Y UNIT ADJ'D.UNIT ACRESIUNITS VALUE D.. ., FAWCETT'S, POND APARTMENTS MAP— CD. FF.De Ih"cr es LOCJYR.SPEC.CLASS ADJ. COND. PE PRICE PRICE P'"" L APARTMENTS U x = 100 *458732.0 CARDS IN ACCOUNT — 458732.0 1.00 458T00 B 08 OF 08 A . COST 485UUUU— N MARKET D INCOME 4343600 A USE D APPRAISED VALUE D J C 4,343,600 A U PARCEL SUMMARY T g LAND 645400 A T BLDGS 4186600 M O-IMPS 18000 TOTAL 4850000 F E N CNST 862410 E N DEED REFERENCE Type DATE gecarCetl PRIOR YEAR VALUE A T Book Paga I'st. MD. Yr.D sale.Prise LAND 645400 T S BLDGS 108200 U TOTAL 3600 R E BUILDING PERMIT S Number Date Type Arraunt LAND LAND—ADJ INC ME SE SP—BLDS FEATURES BLD—ADJS UNITS 4587001 C.,s�. Uo al Year Bosh Class Base Rate Atl' Rate A Noi m. Obsv. o Units Units I I 1 1 A�, 119 go Depr. Contl. CND. loc. ro R.G. Rep,.Gpsl New Atl,.Repl.Value $(arias Height Rooms etl Rms.Bath. a Fir. I Pertywell fec. 108 OD1 100 101 83 83 11 93 125 100 116.2 458700 533500 3.0 48.0 Desn iplw Rate Square Feet Repl.Cosl MKT.INDEX: 1-00 IMP.BY/DATE: RW /86 SCALE: ELEMENTS CODE CONSTRUCTION DETAIL S I BAS 100 .00 2156 R PART ENT BUILDING CNST GP:01 T 830 120 .00 2156 STYLE 00 0.0 R FOP 35 .00 176 0E_SI-GN-AUJMT- -00--------------------0. U FOP 35 .00 925 EXTER.WALLS T2CLAPHOARD__ 0. ----- -- - --- ----- C ---* EAT/AC`TYPE 03ELECTRIC 0. INTER.FINISH 04DRYYALC 0. T FAW CETT POND I --- -- ------ - ------ --------- ----- U - INTER.LAYOUT T2AV£R.�NORMAL 0. i APARTMENTS ! INTER.DUALTT 02SAME AS EXTER. 0_0 A - FLOOR STRUCT 03W4 JT%S_T B_E_A_M___ 0. BL DG D-4 --------------- L D - ! COOR_COVER _04CARPET __ ___ 0.0 LT0I.'7Al7..j7Aux= 1101 Base- 2156 f--------------------------+EOOF TYPE _ _02GABLE—ASPH SH____0-0 BUILDING DIMENSIONS T LECfR3CAL 02 BOVE AVERAGE_ 0=0 A FOUNDATION 01 OURED [0N-C 99.9 I -------------- - --- -------------- --------------- --- ------ -------- L - LAND TOTAL MARKET PARCEL' AREA VARIANCE t0 ♦0 STANDARD TOWN OF BARNST88LZ SI3POBT SQPPLEMDNT88T/CONTIN'UATION ZZPOBT ; ANE (LAST, rxmv MIDDLE) DIVISION /DM Al OTE DETAILS i OBSERVATIONS-ITEAIZE EVIDENCE. SERIAL t5 ETC- /�9 r � d. PAGE / - - 1OPI?R I Y ADDTIESS I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTED I CSTATE LASS I PCS I NBHO KEY NO. _0149 WEST MAIN STREET 07 HB&RB 400 07HY 01/04/96 1121 00 HY09 =R290027,002 19542` LAND/OTHER FEATURES DESCRIPTION ADJUSTMENT FACTORS �, UNIT ADJ'D.UNIT rAPARTMENTS p ACRES/UNITS VALUEesarpt.— FAWCETT S, POND APARTMENTS MAP— noes LOC./VR.SPEC.CLASS ADJ. COND. PRICE PRICE u x = 100 *309530.0 309530.00 1.00 09500 B CARDS IN ACCOUNT — 02 OF OS MARKET INCOME 434360C A USE I D APPRAISED VALUE J C 4,343,600 PARCEL SUMMARY U S LAND 645400 T BLDGS 4186600 M 0—IMPS 18000 TOTAL 4850000 E INCNST 862410 N DEED REFERENCEI Type DATE Recorded PRIOR YEAR VALUE T Book Page Inst. Mo. yr.D sales Price LAND 645400 S BLDGS 3A08200 TOTAL '3600 I I 1 1 BUILDING PERMIT Amount LAND LAND—ADJ INC ME SE SP—OLDS FEATURES OLD—ADJS UNITS Number Data Type I 309500 Class Gmsr Tor ar Base Rare A., Rare Vear BUIIt Age Norm. Oo^v. CND. Lac. %R.G. Repl.Coal Naw M' Re t.Value Stories Height Rooms Rma Ballra •Fi:. Partywap Fae. Units Unna Actual 1 Depr. C d. I p 108 001 100 101 00 83 11 93 125 100 116.2 309500 359900 3.0 1 1 6.0 24.0 Descnplron Rate Square Feet Rapt,Coat MKT.INDEX: 1-00 IMP.BY/DATE: RW /86 SCALE: ELEMENTS CODE CONSTRUCTION DETAIL 9AS 100 .00 1592 INT _ B30 120 .00 1592 STYLE 00 0. FOP 35 .00 52 ----------------- ETTG N-716J MT- -00 - -Q.- EX7'ER_W LLS-- -T2 UkP8D_k96---------0. ---------------------------- HEAT/AZ-TYPE- -03 LECTVU---------Q. ! INTER.M11SW -04 RYWALI----------(T ! FAWCETTS POND ! INTER.LAYOUT` 12 YER.TNORMAL Q. APARTMENTS I NTER.41WCTY_ -0 2 SWKE x yr R----U. ! ! La6R S'rk(JCT 03 4W JTTSrt BEAM___(Y. BUILDING C-18 - - - - D - ! C06R ZOVER - 04 AR PET-----------Q.p Total Areas Asa _ 5 2 Base_ 1592 +--------------------------+ - -- -- - ----- - �, E OOF-TYPE---- 01GABLE�ASPH SH �T.O T BUILDING DIMENSIONS LECTRIt-KC 02 �UVE AVERAGE 0.0 q F 0J-10AT_I6N -Oi OIi0ED CONC Sr9.9 1 ' -------------- - --- ---------------------- --------------- --- ---------------------- L LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 STANDARD /ONIN(i IDIS1'RICT COD[ SP-DISTS.IDATE PRINTED) S1ATE I PCS I NBHD U148 WEST MAIN STREET 07 CLASS KEY NO. -- ' LAND/OfREIiFF/1IUIIESUESClllf'�IIC)1_J_ � AU_INifMI_Nl�ricliiils-HB8R8 400 7 Y _ 9 I.n^-1OyiDaln Sue V�nnn snn ---- -- V UNIT ADJ'D.UNIT ACRES/UNITS VALUE oe><,�Plrpn FAWCETT'S. POND APARTMENTS MAP— ` / cD ",f)"Pp IA—s LOC./VR.SPEC.CLASS ADJ. COND. P PRICE PRICE L APARTMENTS U X = 100 *456488.0 456488.0 1.00 456500 B CARDS M ACCOUNT - A 03 OF 08 N D MARKET A INCOME 4343600 USE -D D APPRAISED VALUE A U C 4P343.600 T S PARCEL SUMMARY A T LAND 645400 SLOGS 4186600 M O-IMPS 18000 F E OTAL 4850000 E N N CNST 862410 A T DEED REFERENC Type DATE Reoo,CSA PRIOR YEAR VALUE T S Boot, P.ge '^at MO. Yr.D S.I..Pnc. LAND 645400 U BLDGS 3A98200 R ; ; TOTAL 3600 E ' t S BUILDING PERMIT LAND L AND—ADJ I N C ME Na n°ef Data Typ. Amount SE SP—BEDS FEATURE 8LD—ADDS UNITS 456500 Class Cnnsr tot as Base Rate Atlt.Rale Yea`Buit' A Norm_ OOSV. Vnes Vnn AA� 11� 9e DePr. Contl. CND. Loc. 96 R.O. RePI.Cost New Ael.Rep' Velue SIO,iee ReiglM Rooms Rma B.IM1. /Fia. P.rtyvr.11 F.c. 10B 001 100 101 83 83 11 93 125 100 116.2 456500 530900 3.0 48.0 Oescriplon Rate Square Feel Rept.Cost MKT.IN 1-00 IMP.BY/DATE: RW 86 SAS 100 .00 2288 SCALE: ELEMENTS CODE CONSTRUCTION DETAIL S GROSS AREA 45T6 APARTMENT BUILDING CNST GP:01 T 830 120 .00 2288 TYLE 00 R FOP 35 .00 698 --------------- -- -------------------0. ESIGN ADJMT 000. U EXTER.MALLS 12CLAPBOARD 0. C +-------------------- --* HEATIAt- TTPE 03ELECTRIC ----- p�- T ! ! LNTER�FINISH 04DRTWALL p. U ! FAWCETT POND ! iNTER.LAYOUT 12AVER.�NORMAL _ 0._ R ! APARTMENTS ! INTERQUAITC _02SAM_E AS E_XTER.____0._ A ! = FLOOR STRUCT 03 D JT�ST BEAM 0. L D ! BLD6 C-2 ! FLOOR COVER-- -04CARPET ------------p=- ETOIalAreas Atu. 698 Bgse _ 2288 t------_____�_______ � __ __ _______ BUILDING DIMENSIONS ROOF TTPE 0�GABLE_ASPH SH___ 0. T ELECTRICAL OZA13 AVERAGE 0. A FOUNDATION 0IPOUREO CONC 99. L --------------- --- ---------------------- LAND TOTAL MARKET PARCEL AREA VARIANCE t0 t0 STANDARD I IItOPCIUv ADDH[tiS I I ZONING (DISTRICT CODE SP-DISTS.I DATE PRINTED CSTATE I PCS I NBHD KEY NI _ 0148 WEST MAIN STREET 07 LAND/OTHER FEATURES DESCRIPIION ADJIISIMFNI FACTORS ./ UNIT ADJ'D.UNIT '.antl BylDate sec Dlrncr"°" LOC./V R.sPEC.CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE Deacnp'lon fAWCETT'Sr. POND APARTMENTS MAP— CD FFDe In/Acres CARDS IN ACCOUNT L APARTMENTS U X B= 100 *739960.0 739960.00 1.00 740000 8 04 OF 08 A COST N MARKET D INCOME 434360( A USE D APPRAISED VALUE D J C 4.343.6O( A U PARCEL SUMMARY T S LAND 64540( A T BLDGS 418660( M 0—I14PS 1800( TOTAL 485000( E N E N CNST 86241( E DEED REFERENCE Type DATE Reco,CsO PRIOR YEAR V A L L A T Book Page Ins'. MO yr.D Sales Pri— LAND 6 4 5 4 0 C T S BLDGS 3�9820C U TOTAL 360C R E BUILDING PERMIT S Number Date Typo Ameunt LAND LAND—ADJ INC ME SE SP—BLDS FEATURES BLD—ADJS UNITS 740000 Class Cons'. Total Base Rate Atl Rdle Year Buill A NOrm. ObSv. Unils Vnns I A9� 119 BB Depr. COntl. CND. Loc. %R.G. Rep1.Cost New Atlj.Rep'.Value Stories Height ROOnta Rms 6alhs I Fix. P—,.l1 F.c. 108 001 100 101 83 83 11 93 125 100 116.2 740000 860600 3.0 84.0 Descnpt,n R.I. Square Feel Repl.Cos' MKT.INDEX: 1.00 IMP.By/DATE: RW /86 SCALE: 1/20.0O ELEMENTS CODE CONSTRUCTION DETAIL S SAS 100 .00 3773 E APARTMENT BUILDING CNST GP: 830 120 .00 3773 N T FOP 35 .00 1113 STYLE 00 00 0.. R FOP 35 00 368 ER ESICaN_ _ADJMT_ -00 ------------------ � U EXT .WAILS 12CLA 0 P80ARD 0. -------------------------+ 4 EATIAC TT PE 03 t LECTRIC----------- (1- T = NTER.FINISH _ 04 RTYALL 0. APARTMENTS 0 U ; FAWCETT POND ! NTER.LAYOUT t2 -if E NO R.% AMAL _ 0 R - _NTER 9U. ALTY _02 APlE AS _EXTER 6.. .0 ---------------------- A - LOOR STRUCT 03 D JT/S_T__BEAM_ 0.0 W BLDG C-3 -- --- L D 1481 E LOOR COVER 04CARPET -- 0.0 Total Areas Au. base. 3773 +--------------------- ------- ------- - ---------------- E OOf TYPE ___ OiGABLE—ASPH SH CT. IN DIMENSIONS --- ---- --- - ---------------------- T BAS LECTRICAL 02 80VE AVERAGE 0.0 A 0UNOAYI69 01 OURED CONC 99.9 I ' -------------- - --- ---------------------- L --------------- --- ---------------------- LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 - STANDARD IIHOVIi Ii I A[)UHF:SS I I ZONING (DISTRICT CODE SP DISTS.IDATE PRINTED(STATE I PCS I NBHDPARCEL 014E WEST MAIN 07 HBBRB 400 WHY CLASS KEY NO. ----- —.— 01/04/96 1121 00 HY09 1,290 27 2 • LANUIOIHEHFEAIUHESUESCHIPIION CARDS IN ACCOUNT AOJIISTMENIFACIORS 195425 C: a fl"o-, S.'...Oem,nswn v UNIT AOJ'D.UNIT Desprlptipn RTMEN CD FFDa mlAu es LOC./V R.SPEQ CLASS ADJ. COND. P PRICE PRICE ACRES/UNITS VALUE fAWCETTS• POND APA TS MAP— - L APARTMENTS U X = 100 *739960.0 739960.00 1.00 740000 rl 05 OF 08 A N MARKET D INCOME 4343600 A USE D APPRAISED VALUE D J C 4.343P600 A PARCEL SUMMARY T U LAND 645400 A S T BLDGS 4186600 M 0—IMPS 18000 TOTAL 4850000 F E N CNST 862410 E N DEED REFERENCEI Type DATE Reoo rtletl PRIOR YEAR VALUE A T eook Page Inst Mo. Yr.D Saba P— LAND 645400 T S BLDGS 3A98200 U TOTAL 3600 R I E BUILDING PERMIT S Number Oete Type Amount LAND LAND—ADJ INC ME SE SP—BLDS FEATURES BLD—ADJS UNITS 740000 C un st Total Vear Built Class Units Units Base Rate Atli.Rate A I Age Depr. Contl. CND. Loc. %R.G. Repl.Cost New Atli.Repl.Value Sterie Height Rpome Rma 8alhe a Fia. Plvlywell Fec. 108 001 100 101 83 83 11 93 125 100 116.2 740000 860600 3.0 84.0 Descriphon Rate Square Feat Repl,Cost MKT.INDEX: 1-00 IMP.BY/DATE: RW /86 SCALE: ELEMENTS CODE CONSTRUCTION DETAIL S BAS 100 .00 3773 T .BUILDING CNST GP:01 T 830 120 .00 3773 STYLE 00 0. FOP 35 00 1113 R FOP 35 •00 368 DESIGN ADJM_T_ 00 -----------------0. U EX7ER.YA_LLS '12CLAPe0AR0 0. - - -- - --- ------------- - C H AT1AC TYPE 03ElECTRIC 0. T ! I14 ER.FINISH 04DRY4AIL 0. FA WC ETT POND ---- -------- - - -- --- - U INTER.LAYOUT. f2AVER.�NORMAI _ (T. APARTMENTS ---- --- -- - -- --!-- --- -- R NTER._AIfALTY_. 02SAME AS EXTER. 6. A ! FLOOR STRICT 03wD JTTS_T__B_E_A_M_____0._ -- ---- -- -- - L p BLDG D— ! FLOOR COVER 04CARPET �: 1481 Base. 3773 +------ ------------- A------ - Total Areas Aux --------------------+ E BUILDING DIMENSIONS ROOF : TYPE 01GABLE—ASPH SH____0. T LSC-TRTEAL 02 BOVE AVERAGE 0: A FUU46ATION 01 FP OIRED CONC 94. i --------------- --- ---------------------- L ---- --------------- --- ----- ------------- LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 STANDARD RUI'I.111Y AIIUII I.t.b I I ZONING IDISIRICT CODE SP"DISTS.IDATE PRINT EDI CLASS I PCS I NBHD -------PAR C EL1QENTIFICATION HUM13ER KEY NO. 0148WEST MAIN STREET 07 H8&R8 400 07 1 4 002 195425 LANl1/OTHER FEATURES OE SC HIP PION _ADJUSI_MEN1 FACTORS _ `, UNIT ADJ D.UNIT i.�a nwoal,< sn/Drner.o- LOC./YR.SPEC CLASS ADJ. COND, P PRICE PRICE ACRES/UNITS VALUE Descrwuo- F AN C E TT O S P POND APARTMENTS MAP— as CAROSIN ACCOUNT — APARTMENTS U x = 100 *544768.00 544768.00 1.00 544800 8 06 OF 08 COST 485UUUTF MARKET INCOME 4343600 USE A APPRAISED VALUE i C 4.343.600 PARCEL SUMMARY u LAND 645400 S BLDGS 4186600 T 0—IMPS 18000 M TOTAL 4850000 E N CNST 862410 N DEED REFERENCEI Type DATE M Reeorded PRIOR YEAR VALUE T Boo. Pagel lnal. MD. Yr.DI sales Price LAND 645400 S BLDGS 3698200 TOTAL 3600 I l 1 .. BUILDING PERMIT Number Date Type Amount LAND LAND—ADJ INC ME SE SP—BLDS FEATURES BLD—ADJS UNITS 544800 Class Consl T"at Base R.I. Adj.Rate Vear Built Age NO 0.s CND. Loc. %R.G. Rapt_Co..New Adj.Rapt.Value Stories Height R_ma Rms Baths I Fig. PMywell F—. Vmis units A�161 1111 Dep, COnd. 108 001 100 101 83 873 11 93 125 100 116.2 544800 633600 3.0 Desuiphon Rate Square Feel Rapt.Cost MKT.INDEX: 1.00 IMP-BY/DATE: RW 186 SCALE: ELEMENTS CODE CONSTRUCTION DETAIL BAS 100 .00 2802 GROSS AREA 5604 APARTMENT BUILDING CNST .GP:01 830 120 .00 2802 STYLE 00 0.0 _ FOP 35 .00 69$ Lyra A-ADJMT_ _ _______00 (F FOP 35 .00 88 1 XTER.MALLS 2CLAPBOAR6 0.0 ----- -- ------- FOP 3 ---------------------------- EATIAC TTPE 03ELECT-R-IC 0. FOP 35 .00 88 ! ! NTER.FINISN 04 RYMALL 0.0 FOP 35 .00 52 ! FAWCETT POND ! NTER.LAYOUT f2 VE .TNO 0 RRMAL _ .0 ! APARTMENTS I NTERTWkf_ Y _02 ARE-AS _E_XTER. VA LOOR_STRUCT' 03 D JT%5TBEAM 0.0 _ p ! BLDG D-2 ! LOOR CO ___ ______ VER 04 AR PET 0.0 ---- ---A- ---SH ---- E Total A,eas Aurt _ - 4 Beaa_ 2802 +--------------------------+ OOF TTPE 0-1 -ABLE---- SP--H SH 0. BUILDING DIMENSIONS IECTRICAL 02 BOVE AVERAGE 0.0 A OUNDATLON 01 OURED CO NC 99.9 ------ -- I L LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 STANDARD '11U1'L.II I V AUIJI II.b' I I ZONING I DISTRICT CODE SP-DISTS.I DATE PRINTEDI CSTATE LASS I PCS I NBHD KEY NO. 148 WEST MAIN STREET LANDIOTHER FEATURES DESCRIPTION I ADJUSTMENT FACTORS I Ty UNIT ADJ'D.UNIT I.a nd By/Dale Si, 0^^ ACRES UNITS VALUE Desc,lpoon FAWCETT S• POND APARTMENTS MAP— CD FF De m/Acres LOC./VR.SPEC.CLASS ADJ. COND. P PRICE PRICE CARDS IN ACCOUNT — APARTMENTS U X = 100 1.00 1.00 1.00 8 07 OF 08 COST — MARKET INCOME 4343600 A USE D APPRAISED VALUE J C 4.343.600 U PARCEL SUMMARY AND 645400 S T BLDGS 4186600 M 0—IMPS 18000 TOTAL 4850000 E N CNST 862410 N DEED REFERENC Type DATE Rec.d� P R I O R Y E A R V A L U E T S Book Pay¢ 1n9 MO. y,.D Sal—Pr LAND 645400 I I BLDGS 3'a8200 l TOTAL 5600 I BUILDING PERMIT Number Data Type Amount LAND LAND—ADJ INCOME 111 SE SP—BLDS FEATURES BLD—ADDS UNITS Class Cons'. Total Base Rat¢ Adj.Rat¢ Vegar Built Age Norm. Ob- CND. Loc. %R.G. Re I Cost New Ad'.Re 1.Value St-iea Haight Rooms Rms 8alhs a Fis. PN Uni'S Unils Al 7 1111 Depr. Cond. p I p 9 ywall F.c. 108 001 100 101 83 873 11 93 125 100 116.2 3.0 48.0 Descriplion Rate Syuare Feet Rept.Cost MKT.INDEX: 1-00 IMP.BY/DATE: RW /86 SCALE: ELEMENTS CODE CONSTRUCTION DETAIL BAS 100 .00 2156 GROSS AREA 4312 APARTMENT BUILDING CNST GP:01 830 120 .00 2156 STYLE 00, 0. FOP 35 .00 750 ESIGN ADJMT_ _00 0._ FOP 35 .00 220 EXTER.YALLS _______12CLAP80AR0 0. ---------IIP_E_ - ___------------------- ---------------------------- _EAT/AC TYPE 03ELECTRIC 0. ! NTER.FINISH 04DRYWALL 0. ! - _ ------------- FAWCETT POND ! I.NTER.LATOUT. 12AVER.fiNORMAL ._ APARTMENTS ! IidTER.QUALTr 02SANE AS EXTER._ a.-- APARTMENTS BLDG D-3 FLOOR STRUCT 03 D JT1ST 8_E_A_M_____0. D - FLOOR COVER 04CARP ____ ET 0. E Total Are Aa 970 Base_ 2156 +-------- ----------------+ OL)E TWrE"--- -01 A_e C'L-_IWS P_A--S 0----0. t F _ _ _ __ __ _ ______ ,r BUILDING DIMENSIONS � ECG{.TRICAL 02 BOVE AVERAGE 0. A F0LfN6ATI0A - 0i Ol7REl1 CONC v9.9 -------------- - --- ---------------------- --------------- --- ---------------------- L LAND TOTAL MARKET PARCEL AREA VARIANCE +0 +0 STANDARD 1111f 111 III Y AI)URL`S I I ZONING (DISTRICT CODE SP-DISTS.I DATE PRINTED(CLASS I PCS I NBHO --- KEY NO. 0148 _WEST MAIN STREET 07 HB&RB 4 7HY 01/04 9 11 - LAN UIOIHER FEATURES DESCRIPTION AUJI/STMEN7'FACTORS I.n-iJ BylDat„ sve v UNIT ADJ'D.UNIT ACRES/UNITS VALUE oeeonphon FAWCETTIS, POND APARTMENTS MAP— , FF-0u Ih/AC,95 LOC./Y R.SPEC.CLASS ADJ. COND. P PRICE PRICE CARDS IN ACCOUNT - LL APARTMENTS U x = 100 *458732.0 458732.0 1.00 458700 B 08 Op 08 A ' N MARKET D INCOME 4343600 A USE D APPRAISED VALUE D i C 4P343.600 A u PARCEL SUMMARY T S LAND 645400 iA T BLDGS 4186600, I 0—IMPS 18000` E TOTAL 4850000, F N CNST 86241C E N DEED REFERENCO Type I DATE M R—dea PRIOR YEAR VALUE A T 8-1, Page 1na1 Mo. v,.p Sate'P'ic' LAND 645400 IT S BLDGS 2498200 U TOTAL 3600 R E BUILDING PERMIT S Number Dale Type Amount LAND LAND—ADJ INC ME SE SP—BLDS FEATURE BLD—ADJS UNITS 458700 Class Con st. Total Base Rate All,Rate yea,Built Age Norm. Obsv CND. Loc. 4b R.G. Repl.Cost New Ad,,Re I.Valve Sloes Nei ht Rtwnq Rma Bathe a Fix. Pa,tyrall Fat. V nits Unus A, � 19 Dell,. Cpne. j p 9 108 001 100 101 83 83 11 93 125 100 116.2 458700 533500 3.0 48.0 D-c—lon Rate Squall,Feet Repl.Cost MKT.INDEX: 1-00 IMP.BY/DATE: RW /86 SCALE: ELEMENTS CODE CONSTRUCTION DETAIL S BAS 100 .00 2156 BUILDING CNST 'GP: T 830 120 .00 2156 STYLE. OD 0. R FOP 35 .00 176 DEVrGR-A6JMT -00 -------------------0:_ U FOP 35 .00 925 EkTER:WALL3 T2CLAP90A9D 0. EAT/AL TrPE 03ELECTRIC 6. ! ! INTER.FItif9H 040RY9ALL 0. T ! FAWCETT POND ! INTER.LATOUT ____ TZ VER.�NORMAI 6. ! APARTMENTS ! NTER.9UALTT02SAME AS EXT ER. 0- R ! ! FLOOR STRUCT_ _ _D _03 JTf _ ST BEAPI O. A _ L D ! BLDG D-4 ! LOOR COVER 04CARPET 0. E TotalA,eas Ae._ 1101 Base- 2156 +--------------------------- OOF TYPE 0i T BUILDING DIMENSIONS -L-- CTfIGR -02 RA OBVLEE=AA VSPH A GSEH----00..- 00 q OUOATTON- 0i. OURED _CONC------94.9 --------- --- ---------------------- I --------------- --- ---------------------- L LAND TOTAL MARKET PARCEL AREA VARIANCE t0 t0 STANDARD 1 j ` , LlIIII 1 8 Ry e I B I NORTH WING-NORTH EL°NATION �y i f I FL 1 � BUILDING D 3� ° i— Q` a Q 316 I I I• 1317 �....... 319 31' m I I^ I Z NORTH WMG- EASY ELEVATION lij1�:.: KCCNC rL-0oR PLANIF s FIRST FLOOR:PLAN �- ; ❑' 1-1 �� 1 GIC 1 1 9 1 1 8 1 1 7 1'1.6` R EAR 3 NG- EST ELEVATION (off corner of 1 1 2) GOODY.CLANCY &ASSOCIATES,ITm w°nmcrn Inn r.r 4 BUILDING 'D' 8 BALCONIES I > I I I T1K VILLAGE AT tr*.am$ P. "t,/E11VAnou5, aK e• r • - _ - i �w ml tiii�a;s L m 307 1308 m Q m ID Q m ( = m 30'9 ~ '310 311 :wu' # 312I 207 208 m m 1 F11Q m Q 0 m 0.�4® m � 210 21 1 � �;,n - - : z 12 - r-1 -77 5LDC. 'C - EAST E_EVA..TION .......�- f-13_DG 'C - noRTr EL�v�T,oN 1 O9 110 1 1 1 REAR ji (STEP D (3 sectionsf - 1 COMMUNITY ~~ `o. ILDING BUI 301 3p0431 3 74 'Q Q 201 202 203 2042 1 % .x.. �' --- ADD' OFFICE „ 113 y - n5LDG'C' - SOUTH ELf_vATION ` - 2�i"+ CONTINUATION OF NOR T tt ELCVA7iCx4Tpm - - � - N�'•'K u � 3 f[S c`Ctdrw"W.r �an.own en �� I ® Q FIE ZI rl:_C_'C- CCJ P.TYARD EL.EV FaUnO �JUr.. BLDG'C-COURTYARD E;w `AUNG ONES- .� l GOODY•CLANCY &ASSOCIATES.I: _ BUILDING 'C' — -- -- 26 BALCONIES f- - - LT din 03 } Fcfp� �"�`.,lED BUILDING c -_� - - - t - I ' I - --— J,:z f�.; BUILDING ELCVATIONS ,�Le^raRD Ct�V. fh:.iNG -S�1TH ,I �5LDG.'C' QOUKKTYARD ELEV. FACING NORTH i I w, .N� Nod—,,,�, �.� - . . ea.,d 310 311 0 j/m I [Ell 313 21.0 211 I m _ m 3414 315 m Q "- �I -,ll ®_ _ i ®4a 1�5 108 �-�� 1'0 9 111 0�� /1 1 1 —CTR—ice Q 5_9G,'D' - :.45T Ci VA,iON WALK -�G �'- NoRTr. ELEVATION 1 1 2 1 z�l I ' I .�. 01 302 -- 303 364 mi 305 306 I �,•, ffi In AD mi 01 _ 202 r 203 04 - _ 205 2,06 I 207 Elm ( m 0-4 105 10610T ENTR REAR (/ 71 LEM Q Q I Q mEll - i I I J �. ` 7 ` - -� ''PIC COURTYARD `: u�LDG 'D'•COUP,-,YARD ELEV. PAGING SOUTH gc.DG.'D'-VVEST EUwATIUN I .. OOObY CI.ANft,- A ASSOCIATES,IN. BUILDING 'D' 26 BALCONIESLn I�I III �• -�- ! TN6 •c ' ''>. rn COURT YAIID CLEV FP.CI14G N — - _...... ____._-^____-_ -.-------- : �} `NA Iam;,?;.Ny ph;Wdnl;c0«a»Wu.ea W -- t - •urLLL� -_ � � r �1 I� 1 �•. 4YrIL1L M:L>J. t.>JrrLR T•tiI•hn 6VrnJQ FJL.� - 'YpYyI�.AYyi�i1�lll' T[lac011�s JUL Ui UJ ® ® ® ID ® _ Ell m ® ® r ID M F la0 YD,RI„ ® I q� _ i I • • -- — -_ . K L I i'_ 15T I•L'ti SLDG. 'D' - EAST ELEVATED ION 5LDr4 'D' NORTH ELEVATION �• =*s is _ � GON T. RJGG VCrvT ' -GYTTfF - } P. ! _ _ _ - - 11 lit r -- - t_. ® - _ In _ � Ei,z9•S P6 t sT fL'a- ®• I ® 111 SAT caLunN --\- ' �] CANTINUATION OF s A ON 3 BLD -.OUT ELEVATION —GOt•I-f, RI KaE VENT NGTts. ___ (pNT. t XaE KIT ID TTr,:J•�AS SHOWW ANq NDTia"' f _:•:+_E. _-- -_) / E S t.S�_ / _CILVATONS. PRWIDE � - —� �+3 n• ^'b pov.RaSDg1T AT.ETC11 i a•JT^J� Mao AS SHOvx. i •FOR 6 P,5�^T>r/�y,,�',y. $Rr.11 pE IRG WxtD, p(LRT ME • ..\ WIDGT� lLN0.DS SHALL GE USE7 m 'r WntZ6 GF12UIfit�.LJ( TIE•. rri CET.�S OIL TRIM.._ -1-G - _ �_ - -- - -- ---- G C ISE2 ELEV. 3/A3 I FOR cri>mNlJnnor� - .. CXi A i 4 6LDG V- COURTYARD ELEV FACING 5OUTH 5 BLDG.'D'— WEST ELEVATION &ASSOOIATES/ • L wrtC�[a1C1'8 a::fa•�>,vy,�e 9- . -F•r (�st CGNT. GC —T / _ - � 23i �f�REl: OSTbtC;MAffi/IGSOE>ZTI'd.•iOtlIQ[+w: �4� "A E HIM --- - --- '-- - --- -- Im -�- r w M� At," ,T 6 .Bfol I m ALI LDG 'D' - COURTYARD ELEV FACING NORTH +i } =-_=__-• [^ t ;`! �. -_____� `►o, Tvr1uL), No deWatlen 1•^m c on , rar•I plant;nd•perihnUons ,M w:7 TR, n o IwL°OIN 'tan he rtwdeul.lil a Rcq FHA Form T437has been ucst lur Ccn';,: plangc M r' J' , st Oiled al d .CIo d. b 1 . /6 c 1 r 1 f "�'�. ANClLE TO R/4UT 015TANCE \. \ \ GK/C. Af — �►�+ /3A OC OOP fRE��95Z I3�� JoA I � r _ 3y, LOC!!S 3 ' x= SCALE r y�/�/ dW CA ' �'. <" �' •• b rr7 —�dr tea' ry � 9 5 , � . :fit, col. e 144 O'-176 13 ' 'S ' (f i FOUND G ' C 8 F�uNO • � e . ra/z8lei) b j o' • a LOT 2 s �- �, /� P� • 2//,'474 t 3.P. .r 4.gg.AC. (s`�p�) F",9 W C E 77 'S 1 • z o e,, t �ON zD - �\ faUND 1 e/uAVAf VA /L n 6 r �� d M CV VL go ! sty e FOUNO /✓'�' �" .' 7 -' c�.... Y�,:/r c_, p/iv �. '• ,,�• G-- .di'`G• L C7 G. ^ ✓�'(}...� r ` • I \P•1 g , T. y' . -:Y `-' :t"i' T'>., r-..y C. � .i�a....,L-, -,v .".✓ 7'i.,-►[ 1 �p IA c O•vii'S GrY ��8aT `rV.+. l'S�' .7 Qrft;I'o� N , d Via'No SAts,1FS Gs ` o AFSt EY '' pn� s s ✓ S d` If y�Q• fir;- c S p . G 1 �j i. 9� %AA �EgIDEN/ / e A qB S 3 Z 10� !�•5 ZO�i rJE55 LOT ZA r 3 , 9 ' � - 'SOo g6S 40E 2'J65.1' er p49,Ot.4c. IV 14 oD� LOT 1d 1 U/1'F REST DEit/CE ,� 1 5/,SOI S•F. er/./Q2 2 R I tiI ONE i a —_�-- ---- ---- 3 h e, LOT 1 o j - ° /t323t4sm. ter•o. N - 444.A r � � N ` 5TOfty WOOp J 11-2 At N -P es --'y p.13 FovN : .. . N� � /^ •tom 7 ! ,_ � ,�.Z' � �p � r ♦•'� 9'St1 3 e'Zlij; - 1 I sue.S n mod` /� I59 00 _ _t�_—------ / d ('. ^/ •i L G a a,l/O,A/'!�I(/NJ 9 SS"•�o r�ul�` i ^� � _ ------ - _- f ' �OUNO l wE s T ,�,� NOTE : LOTS 1 AND IA ARE 7-O 4E C0A150L/pATE`D //VTO OAIE P4 RC E L . TOTAL AREA = 70,,5 2 5' 5.F LOTS -' nIp 2A ARE TO BE CON5oLIDATEO /NTO sir . ONE �a kGEL TOTAL AREA = 250, 770;5 ,F-. i 6- r A. ` ~ D K. •,ti' Cc 47 ,j I> c o� 'o - ♦� ge�Ly..-� PL A N OF L AND s ' r 1a�1zs ~ IN / HEREBY CERTIFY THAT TH/s ACTUAL 5URVEY ` BARNSTABL E (HYANN/S) MASS. WAS MADE ON T/4E gAOUND /N AC 0A0ANCE W/T// THE LAND GOUfiT /NSTRUCT/O/VS OF /97/ FOR BETWEEN vrUL Y 3/ AND AUJUST /, 1978. / ALSO CE- qT/FY TAUT T,UE COND/T/ONS ON THE DOANE, BEAL b� AMES, INC. GROUND ARE TNT SAME NOW AS AT TNe 77ME OF THE 0^1C./NQL SURVEY EXCEPT A5 NOTED. 6F/NG A SUBDIVISION OF L.C.C. /5847A SCALE / Jr 40' SEPTEMBER /, /981 DATE APPROVAL UNOER Sl,D/V/S N /Y LAW , �r. C —705 RE(r STE/'ZLD LAN S I'S r .A _._ _...` • 'i •"—../ `ice — — �� 1 / GLLwIRA CAPE COD SURVEY CANSMrAA/T5 �J 76 ENTERPRISE ROAD UA HYANNIS, MASS. +' JAVCS �ARNS7r.46LE PL4NN/�t/y ,C3C�dRl7 `0 s��` o Ie N Ie i fe jIe RAMP, i I%F FREDERICK C. MYCOCK FOR REGISTRY USE ONLY The certain parcel of land in Hyannis , Barnstable County , Massachusetts - -__-- -- - shown as Lot 2 on a plan entitled "Topographical Plan of Land" dated - -- - _ . - - Feb. 13 , 1980 prepared by BSC Engineering , Inc. , bounded and described -- --- 315 - -- - --- _ _ \. as follows : \ 1� Southerly one hundred twenty-seven and 42/100 ( 127 . 42) ft . by +I W c 11 S the northerly side of West Main Street; _ \� \\ Westerly by land of Charles P . Richmond, seventy-five and �`Sr \� N, 63/100 (75. 63) feet; .�, BAc on/r Westerly by Fawcett' s Pond plus or minus eight hundred twenty BALL h � 669/ a SAL CON r BALCONY (820+) feet; \ h ee.oe \ \ 2-STY APT\\ Q '495 Northerly by land of W.E. Cobb and R.M. Sriberg , Trustees , by �' �52\FF-23\40 99 e the centerline of a ditch plus or Minus three hundred P \ \\ry \\ z \ \ fifteen ( 315+) feet; �6.94 WOOOEN RETAINER (lYPI 292 \ j cn q Easterly by land of Arvid L. and Marie B. Anderson in three wc- r 5� courses of , plus or minus twenty five (25+) feet , one hundred sixty and 75/100 (160 . 75) feet , and two hundred \ �`� L : wN W1rH seventy and 98/100 (270 . 98) feet respectively. \\ \ - •` IW ( AND SHRJBS I \ I CERTI FY THAT THIS PLAN Southerly by land of Barnstable Building Co. , one hundred fifty w�sr 4rN �` sT \ ACE 'j \\ 4.06 O\ CONFORMS WITH THE RULES AND THE \ ` ►�- Ih ) REGULATIONS OF THE REGISTERS OF DEEDS. and 00/100 (150 .00) feet, OCUS Southeasterly by land of said Barnstable Building Co. , two hundred \ \\\ Jp -� _ \ , , , ninety and 59/100 (290 . 59) feet, \ \h �, 80 Southerly in Main St. , one hundred forty-nine and 15/100 BR/CX (149 . 15) feet; \\ \ h W O O D S I ��+\+ �/\ \\ FF=33 53\ /5 46 4 Southwesterly by Lot 1 as shown on said plan, two hundred forty-three \ LOCATION MAP \2- JT/.\APT\ �'�o and 00/100 (243 .00) feet, / 2000 LOT2REG/STERED (LCC 15847BJ \ \ a \ Be.1/ \ LOT 2A UNREGISTERED PB. 357 PG.7/ J,- -' 3455; a BALCONY BALCONY = Southerly by said Lot 1 in three bounds of seventy-five and LTA ; 2 Registered I_a urveyor \ LT ;iQp I LT T ELEC. - 00/100 (75 . 00) feet, twenty and 00/100 (20 . 00) feet / hundred fifty-five and 00/100 ( 155 .00) feet _ P< 9 Zi E33 and one �N6 � td ' s ° Da to o respectively; �'�LT L� TV W /� C Southwesterly b said Lot 1 in two bounds of ninety-six and 91/100 AREA- 5. 75jtAe• 2D\� `' ��11 } ( EES3 BOSTON, MASS. WORCESTER, NABS. Y Y - s/rrlN6 DOCK //.48 �" J � 0 �. � HALIFAX, MASS. NORWELL, MASS. (96 . 91) feet and one hundred sixty-eight and 00/100 �� ,� \ '+! (AMASS DEOE L/C'*922 s BEDFORD, MASS. LEXINGTON, MASS. (168 .00) feet, respectivd2 0 0��. �\� � � HYANNIS, MASS. MANSFIELD, Ir.11. Containin4 accordingto said plan , plus or minus five and 75/100 ( 5 . 75+) y 0 LT Q CRANSTON, R.I. DERBY, acres . A portion of the premises being registered pursuant to Land Court `,\ 04 Case 15847A and shown on Certificate of Title 60573 . For description of � unregistered portion, see plan recorded in Plan Book 165 , page 77 and deed recorded in Book 2404 , page 250 in Barnstable Registry of Deeds , lr 0 4� li - �tu J BALCONY O 4496 K ALCONY \ m I / \ �,� �^ % � B C :4Z 4404 FF=30.40 J q.s2 FF=2442� \ N/ y_ , 1 D LT TLT ��yS [.. 1--� ry r r r h 44.19 \\ ? - 1( O `J ON D _ O (A GREAT POND) � �' � � \ � O � � - � LAWN W/TH TREES SHRJBS� WATER ELEV. = 18. 4 (9-26-83) AND SYRUBS cH Cy` Q b �U NOTES: ��'' � 4.05 ct, . R/ -Zgs7) AL L ELEVATIONS REFER TO THE NATIONAL � vn� f \\\\� �3 0 RIM=28.00 LT,J � GEODETIC VERTICAL DATUM OF 1929 (SEE DEED BOOK 3391 P6.22) �� s 2.)BIN. USED : U. SC e GS. AND STATE SURVEY NO BUILDING OR OTHER STRUCTURE sT, STANDARD DISK SET IN CONCRETE MONUMENT- M280K EL.40. 958 OF ANY NATURE SHALL BE ERECTED ON r R 9 61 3.) BM SET: SEE PLAN. SUCH PORTION OF LOT 2. NEITHER THE 63� „ "'° \ 745 GRANTEE NOR ITS SUCCESSORS ENTITLE \" 2- ST\Y0 APT.\ N SHALL CAUSE OR SUFFER TO BE CAUSED FF=26.9 \ 13.98 0/4.26 R2B d4 Nc I I PARK/ ANY SUBSTANTIAL CHANGE /N THE EXISTING a F.F= 24.44 \ _ CAPE COD SURVEY 66.99 h L WOADFN CURB LANDSCAPING, VEGATAT/ON OR TOPOGRAPHY OF ' c? - �, REG/SrER f 0. T�/E PREMISES. THE OWNER OF LOT/ SHA L L ,�/ �' �_ , -CONSULTANTS HAW THE EXCL US/VE RIGHT TO MAINTAIN, wa,�,�- _ 150.00 �� ELEC. C.B. N. B6-//-/4 W. PO. BOX 56 b RETAINER AD H YA N N I S, MASS. 02601 CULTIVATE AND LANDSCAPE SUCH PORT/ON B�Si `cA'CF E r,P UTlL/T Y IIbTE= '�'F,S zo LAWN OF LOT 2. S tiF /3S cB. D Ce.I 617 775 -7155 ALL UNDERGROUND WX177£S SfKA19'V MERE COMPILED ACCORAWG TO A/A/LA&E BOSTON SURDfVtSK)Pd OF VEY CONSULTANTS P % N t 'COIRD PLANS FRom THE VARIOUS UTILITY COMPAN/ES AND PUBLIC AGENCIES /F H 8 K INCC. AAV ARE APfPyR00MATE ONLY. ACTUAL LOCAT/OWS MUST BE DETERMINED /N THE %7 FJ�ELD. 0 i ENGINEERING SURVEYWQ PLANAWiG " i pF TITLE: BEFORE EXCAVATING, BLASTING, INSTALLING, BACKFIL L/NG, GRADING, PAVEMENT RES70RATION OR REPAIRING ALL UTILITY COMPANIES, PUBLIC AND PRIVATE y aQ AS BUILT _ 7;-E 1/UST BE CONTACTED, INCLUDING THOSE /N CONTROL OF UT/L/TIES wT SHOWN 1 / cw THIS R-AA[ SEE CHAPTER 370, ACTS OF /965, MASS. WE ASSUME NO C,yq�CF o PLAN OF LAN D . R£SPONSABILITY FOR DAMAGES INCURRED AS A RESULT OF UTILITIES `S� / cB - - 41 TED OR IN SHOWN. C6*p�O / �Og o h REFERENCES WEST MAIN STREET RE'fGl4JE ��rM�W fVrVRE CONNECTIONS, THE ,4f A4IATf 10rXirr COMPANY i �. 'QE'sr�ic � � F'4�, q 'q�F � 2 � LT / N; °) LOGUS,- RF_GISTE.R�ED L CC /5847B - 'HE CONTRACTOR MUST AAD�FY UTIL YE COMPANIES 72 HOURS / ADVANCE // %y0 7`SFF s, /NG, CTF 87297 D. B A R N STABLE O RS N 3' UNREG/STERE DEED BK. 339/ PG 2/ MASS. C S• O Fj q �` �' N PB. 357 PG 7/ M AS OF CONSTRUCT/ON. rl'I!S MAYBE DONE BY CONTACTING THE DIG- SAFE CENTER �q�N� �iOF ,// �r ; EGEND (!- BOO-322-4844) FS� ti Co. L 3_ � � CrR� � cV S SEWER FAWCETT.� POND APARTMENTS V W WA;-ER W W Z r QO T TELEPHONE PREP41 RED FOR E EL C TRIC TV CA13LE T. V. CORCORAN, MULLINS 8 ✓ENN/SON This is to certify to The Department of Housing and ��o W W LT EMERGENCY CALL SYSTEM rk -k I � 11- 1 Urban Development and to all part/es Interested In the title ,SS z I LT D DRAIN scALE: 40 to the premises surveyed that this survey Was made on the e �� a 0 10 210 40 ground per record description and is correct; that there are © R 79 1 FEET a 20 40 80 no encroachments either way across property /fines; also., GfiF r I i BM_ N.E. COR. CONC. BD. DATE: AUGUST 31, 1983 REV. 9-28-83 that all Improvements to date have been shown to the best sl' EL. 36.67 COMP of my knowledge . �L.=30.00� �` - CHECK: Lw 4. Q/ CB .86-2' - W. DRAWN: A. FOLEY FIELD: R. JACOBUCC I R gistered L an Su e-yor Date S.M.H S SHEET: I OF: RIM 135.95 T /=/5.9 drawing number 567 job no. C - 705-7 MAKEVEACE r FA W CE T T#5 POND <A GREA T POND N. <\ 0 0 50 ' SETBACK +. 000i 0 40i DEEP x ?_ 10Z)C x /O LONG S`TO/VE /z Tl; 3 ' �S/ZF_� f V. 4 R E r / FILLED TRE/VICHES SHALL BE INSTALLED SUCH ESE • .,_l_ THAT THE BO TOM OF THE TENCH /S NO - "-'ter. .w. ..__ ~ ' rrr,:wis ww , rw,vn � j / \ �• � � G.OWER THAN L. 2/. 7 PATIO EE ARCH/TEC - OWNSPOUT P/CAL TURAL RAW/NGS FOR a � � � �-7-A DROP CEM NT CONCR TE � . PAT/ ( TVP/CAL I v'� /1 010 (� n P Za o , T v � t• F 5 ��` -, / .� � � , FL. .r--'- tiff APRON �` 1 Q ® ; �, . / ii WOOV I'll r _ E , Oil 4000, F LI- AS REQ� T P,dOV/ N�/ / f / 1- �....---.' �t � _-----•- ;� �c\ L � ®II IIIIIII �y-C I pE B K O CRE < + DEEP(I ' To 3 ) CAP SHE „ l ' �� Gp,ST cv�Pe 1, ._- -- " STONE B %4 Vill E�5 / R } 0y o �� t5q. o J, I 3.5 p 5 Z,Q P 3 % TOP OF BER P 0 Ito M / '� N :::. E y2 / y1 �� E 'f I I I I I I L f I 14. coo r " M.P. CE T '(� 'f gyp' PAINTED r I'll 8 PER C. '� tJ C � � N 1 �- TYP) E PQ'� .� l� / N_ C1 STRIPE i� — J P \ , 0 I I I U '� • - 4g� C A / CC q 5D �' I 3 0� I PRO POS D 3. o, � P r 00� EX/ST/NG TREES TO CM /N �7 pp C � v to P f ! /RING TREE WELLS ,$ i. E��O� }, ! 3 �� AMP (T REQU R= 27. f' 8 TERRACES SHALL BE DETERIM ,f �� 1 '� �'' ��E G G�EJ.-t)R� i O v ny a I /N THE FIELD. �TYP/CAL ;, ,.rr s t--- � III fff � � '00*11'''� �° 1 � g ��t�t� �� '��R otz GA _- , � � 8.15 � � , � P�� j �No � G C 0�. T 4� 1t "-�--- � i � 00 N P, C. � \ � � `� 8 �� /l24 � � � � � � O F2�' 0 `� i{ it g . '5 s 4 P/ 0 � 04 _ � R= l qL' E1NA p C ,� C,.. I � o, � � ,, yY �E P. �� '� ' 8" � == � is / � P 3 O 0 f 0 0 34 �> Bra. ARE 0� L, : I o5 `- = , L. o / cP�'� GOODY, CLANCY O .3 �� ,p coN R= Q�'i8 S.o.o - •(q R=z � __� cn � , �g � API & ASSOCIATES, INC. � PE 5 � � 5� 2 EGA' D �ER �V ZO 210.5 1= 2 13 �QR�f/N�j .S(fM/VJARy ARCHITECTS (6]7) 262-27 f ( YI O 1 P __L. , - O es C>.��(O' 0 p��(,� >�I- 3/ �?r O �� I 4[W) \ \;�, / tr / l -�`� SOSTANQgf?O SPACES = 90 334 BOYLSTON STREW 3G �% 4 N- P UhNA/VD/C.4P SPACES =/O �/ I .22. `�-.,� \CA •� ER BOSTON, MASSACY • y PROPOSED CEMENT RO - ' - o O G G f? PAVED WA R Yj CONCRETE DUMPS TER BARKING SPACES GRA�/O TOTAL - /00 "- ' \ \� _ G DEiYOTES GUEST PACK/NG SPACES i �- ��►(� °y` 7"H` if G G C � �TYP/G�.dL � 0 �.�8. ( T3�f•�tC'��1�� j $_ / � �?,.- � _ TOTAL AREA - z50, 7-20 t S F. SITE P � EXISTING CONCRETE BOUND FDUN - v ` G TO REMAIN UNDISTURSE"D r - G / BUILDING LOT COVERAGE - 9 /o !� G ^p ' -- L .C.0) LEACHING CHAMBER' /� `> G NOTES �3. G J� !. ' R= 21o. 85 \ , 7O \� I° \ G 0 THE APPLICABLE /�� C I- 2g.40 t Z G - 1, ALL WORK SHALL CONFORM T TAPPINGEEVE, G REGULATIONS OF THE TOWN OF B,'�RNST,�BLE ` GAT VALVE Box NSTABLE CONSERVA- TION C�/ D ,P ,W , AND THE TOXIN OF BAR EXISTING CHIMNEY C NECTIO / v. /9.as(PROP Atif4X. C. B.0) CATCH B.4S/N / __. .30�-- COf1I9ISSI0N ORDER OF CONDITIONS, FILE �},,, VERIFY ELEV. , LOCAT/O SI -EX T. 6" Ill. 26. 7 ') R= 06.-70 �i G �.-''` ..--�''�` NO , SE 3-617, DATED JULY 16, 1930 , VILL Ak EXIST/ G 24'' / -�''� ,r.---~'' '"'" —•-- -- 2 . DEPTH, L I AIIETER AND LOCATION OF LEACHING FAW CE TE' EP NE CONDU/T • � '`� � CHAIl1BERS SHALL BE ADJUSTED IF AND AS RE- EX/ST/ T E LINE' OUIRED TO MAINTAIN A I1INII1UI1 3 VERTICAL BARNSTA �o M �Q ,/ FLLT RPTWFFN THE BOTTOM OF CH,4I?BER AND THE S.M.y��EX/ST.) TO A IN `, / / ✓"�-�- -,•' '•� _ M, �. / .,,"" — M /` SEASONAL HIGH GROUND WATER. f PROJECT NO Q , I=20.4016 N C ', , _,•,,,. /"� PRIOR TO CONSTRUCTION OF LEACHING PITS, 84_0 • _ T=Is89,(S"EXIST. > , ,/ /� TEST PITS SHALL BE EXCAVATED TO DETERf1INE 7 - i4-8Z DRAWN by THE I:ATF_P, TABLE ELEVATION, - -82 / CHECKED BY e �� 0. BENCH MARK l /' �� *' �?E✓/SEO 5 - ZO-8a � C.B. No devicatlon from contract pl,?nS and specifications SCALE - 2 can e m�:de t .t i << � �; {: �t for Corsi: tr:.� i:_ ri C�.a�,ge N. W. MOORE ASSOCIATES. INC. / � _ QONSI, LTiN4 CNOINEERS DATE V -o FHA Form 243/, has been submitted and approved. �� S. 1 - A F�. I ,y; - , G— -� -— — r � \ r,�r. �� s d i .�"; �f� a , ' t. S.�+� as / M1 �� --- i f The Commonwealth of Massachusetts TOWN OF BARNSTABLE In accordance with the Massachusetts State Building Code, Section 110.7, this CERTIFICATE OF INSPECTION is issued to THE VILLAGE AT FAWCETT'S POND Certify that I have inspected the premises known as: THE VILLAGE AT FAWCETT'S POND located at 148 WEST MAIN STREET in the Village of HYANNIS County of Barnstable Commonwealth of Massachusetts. Construction Type: Use Group(s): R2 The means of egress are sufficient for the following number of persons: Location Capacity Location Capacity 100 UNITS 100 ONE-BEDROOMS Certificate Number: Date Certificate Issued: Date Certificate Expired: Map Parcel 201505576 6/28/2015 6/28/2020 2 0 027 002 The building official shall be notified within(10) days of any changes in the above information. Building Official Aug. 6. 2015 2:20PM No. 2070 P. 3 COMMONWEALTH OF MASSACHUSETTS TOWN OF 13ARNSTABLE APPLIC.A,TION FOR CERTIFICATE OF INSPECTION MULTI-FAMILY p FIVE-YEAR CERTIFICATE Date- b ' �q � � � (X) Fee Required$275.00 ( ) No Fee Required In accordance with the provisions of the Massachusetts State Building Code,Section 110.7,1 hereby apply for a Certificate of Inspection for the below-named premises located at the following address: Street and Number: 14� W(iG'l— M A-11J &TREVT Name of Premises: —n,\e k AA) "s �e�d Purpose for which premises is used:MULTI-FAMILY.RESIDENTIAL TYPE OF UNITS NUMBER OF UNITS TOTAL " STUDIO T' 1 BEMOM Co 2 BEDROOM 3 BEDROOM OTHER Certificate to be Issued to: 'I ►1� V a &t I'(A,W(#Zt`, 2wi d ' Address: ro A-I t4 StLeVE inn i'�� PA O &01 Telephone: 5-0 9- T 71— Name and Telephone Number of Local Manager,if any: I AA 1)• 00-0,1ra 0 9- `7-71^9-1 0 a Owner of Record of Building: (21IM3 Ma 1 i' iA� Address: M Ol�l Yl �yu*i D 1V� �d ' . �U't 5� 1� M Name of Present Holder of Certificate: x ��G(,(,Cy Palo SIGNATURE OF PERSON TO WHOM CERTIF ATE IS ISSUED OR AUTHORIZED AGENT fA— PLEASE PRINT NAME INSTRUCTIONS: 1)Make check payable to: TOWN OF BARNSTABLE 2)Return this application with your check to: BUILDING COMMISSIONER, 200 MAIN STREET,HYANNIS,MA 02601 PLEASE NOTE: 1)Application form with accompanying fee must be submitted for each building or structure or part thereof to be certified. 2)Application and fee must be received before the certificate will be issued. 3)The building official shall be notified within ten(10)days of any change in the above information. FOR OFFICE USE ONLY: CERTIFICATE# (9O IS O S S 7 EXPIRATION)DATE: coiappmf TOWN OF BARNSTABLE INSPECTION WORKSHEET ta ': CERTIFICATE NO: 201505576 CANCELLED: MAP: 290 DBA: THE VILLAGE AT FAWCETT'S POND PARCEL: F027 002 NAME/MANAGER: ITHE VILLAGE AT FAWCETT'S POND STREET: 148 WEST MAIN STREET VILLAGE: JHYANNIS STATE: MA ZIP: 02601- SEQ NO: 1❑ BUSINESS TYPE: MULTI-FAMILY CONSTRUCTION TYPE: STORY1: CAPACITY: USE1: R2 Capacity Under 50: ❑ STORY2: CAPACITY: USE2: Outside Seating: ❑ STORY3: CAPACITY: USE3: BY PLACE OF ASSEMBY OR STRUCTURE CAP1: LOC1: 100 UNITS CAPS: LOC8: CAP2: LOC2: 100 ONE-BEDROOMS CAPS: LOC9: CAP3: LOC3: CAP10: LOC10: CAP4: LOC4: CAP11: LOC11: CAPS: L005: CAP12: LOC12: CAPE: LOC6: CAP13: LOC13: CAPT. LOCI'. CAP14: LOC14: ' INSPECT N: DATE ISSUED: EXPIRATION: yPFsScn d 08/0 010 06/28/2015 06/28/2020 e COMMENTS: 7/10 C01 CORRECTLY ISSUED(TP) 3 BLDGS Town of Barnstable of Regulatory Services Richard V. Scali, Director ■ Building Division * sn[txseABM Hass. Thomas Perry, CBO, Building Commissioner 'OrF1639.Mop" 200 Main Street, Hyannis, MA www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Second Request July 22, 2015 Fawcett's Pond Apartments c/o First American Comm. Real Estate P.O. Box 167928 Irving,TX 75016-7928 Re: 148 West Main Street, Hyannis MA Certificate of Inspection Multi-Family (5-year Certificate) Attached is an application for a Certificate of Inspection as required by Section 110.7 of the Massachusetts State Building Code, Eighth Edition. Please complete the application and return it to this office with the required fee for the five-year Certificate of Inspection: 100 units - $275.00 The fee has been established by the Massachusetts State Building Code (Table 106), and amended by the Barnstable Town Council effective 8/6/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5 of the State Code. Sincerely, Thomas Perry Building Commissioner Enclosure jcoiletmf Town of Barnstable oFtwe rq,�, Regulatory Services Richard V. Scali, Director Building Division EAMMBLE, v� MASS. gS. ,�g Thomas Perry, CBO, Building Commissioner 1 9. 200 Main Street, Hyannis, MA www.town.bamstable.maxs Office: 508-862-4038 Fax: 508-790-6230 May 8, 2015 Fawcett's Pond Apartments First American Comm. Real Estate P.O. Box 167928 Irving,TX 75016-7928 Re: 148 West Main, Hyannis Certificate of Inspection Multi-family (5-year Certificate) Attached is an application for a Certificate of Inspection as required by Section 110.7 of the Massachusetts State Building Code, Eighth Edition. Please complete the application and return it to this office with the required fee for the five-year Certificate of Inspection: 100 units - $275.00 The fee has been established by the Massachusetts State Building Code (Table 106), and amended by the Barnstable Town Council effective 8/6/01, and must be paid before the Certificate of Inspection/Capacity Card may be issued. A copy of said Certificate shall be kept posted as specified in Section 120.5 of the State Code. Sincerely, Thomas Perry Building Commissioner Enclosure 9 jcoiletmf TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION J`�lMap � %D Parcel Do? DDT Application 1S J M Health Division Date Issued Conservation Division Application Fee gou �^u Planning Dept. Permit Fee., �� ,�,� DO Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address l' � �S� a�2allv c� , i(J v__,( L Lk2 Z VillageZ,�40121--ZAS Owner 5 4 Address PO ec�� I(DI 9 C--,)�3 Telephone -7-7 r` r U 1 Permit Requestd Ug Square feet: 1 st floor: existing proposed 2nd floor: existing proposed'= Total new, .Zoning District HS Flood Plain Groundwater Overlay ? Project Valuation �� Construction Type Lot Size �� Grandfathered: ❑Yes ❑ No If yes, attach supporting�d`ocw6ntation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure P 185 Historic House: ❑Yes U-?6o On Old King's Highway: ❑Yes 0-fdo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil P,11flectric ❑Other Central Air: ❑Yes 61No Fireplaces: Existing 0 New Ex sting wood/coal stove: ❑Yes 211116' Detached garage: ❑ existi4/C6'4i ew size_Pool: ❑ exist"ew size _ Barn: ❑ existi � size_ Attached garage: ❑ existi size _Shed: ❑ exis �aLnew size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan �review# Current Use ��= 1�-�... Proposed Use c Q � APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name PE-Jef- �� Telephone Number Address Y', C VJ License Home Improvement Contractor# OQ Worker's Compensation # VID(!?,-lUO-(,209 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO n n DATE SIGNATURE / .�� 'K FOR OFFICIAL USE ONLY t APPLICATION# DATE ISSUED k z MAP/PARCEL NO. 1 � ADDRESS VILLAGE OWNER DATE OF INSPECTION: +FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Ti`NI OF BARNSTABLE Vffr I } REJUGHT001Ce I•------ —= --=---- j Sisace 1971 I qqce Use Unly I w l 1 a.1 i JOB TIUMBER J. 217 Thornton Drive,Hyamiis,Mass.02601 508471-3110 800-46473318(MA.Only),77"70-2211 Fax- ASSIGNMENT AND AUTHORIZATION TO PAY The undersigned, herein called claimant; -has authorized and' ordet d. from Oceanside, Inc. , the materials and/or services requested: Undersigned hereby assigns to. Oceanside; Inc.. ;any unpaid p'robeeds due or to become due; under the claimant's policy with the .insurance company to pay- direct. to Oceanside., Inc. ..or to include its name :on a check or draft, for all requested work. In the event that Oceanside's. claim herein is not covered by, or paid by, an insurance company, claimant agrees to pay Oceanside, Irie within, sixty (60) days after work has been completed. Claimant understands that Oceanside, ,Eric is, working for them and not I the insurance company or the adjuster.. Payments remaining due and payable, after -the claimant has received Payment from. the insurance company shall bear interest at one and one- half (1-1./2%) percent per month. , i Iii the event that there is a breach by the claimant of any of the conditions of this -agreement,, Oceanside, Inc. -shall be entitled to recover, as additional damages, attorneys' fees, costs and any other collection expenses reasonable and attributable to said breach. If, payment is not received within 60- days, collection action will 'commence without further notice to the claimant. LOSS/DAMAGE ADDRESS MAILING ADDRESS (BILLING) ciqt STATE ZIP INSURANCE ADJUSTER >S NAME/CO.. LOCAL INSURANCE AGENCY NAME 1 ; PRINT NAME INS. CARRIER/POLICY UNDERWRITER DATE.; C IMANT ` ; SIGNATURE PHONE 71 D O Y. EMAIL:. ; gal I Massachusetts -Department of Public Safety Board Of Building regulations and Standards "onst"Iction.`UPW-i'isor License; CS-073097F T,; PETER A LARoc* 18 Cedric Road" Centerville 1VIA 01632" Expiration Commissioner 11/03/2016 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991m)of enclosed space. - i 1 i i i i a Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www_Mass.Gov/DPS i A, &Xe Office of Consumer Affairs d Business Regulation 10 Park Plaza. - Suite 5170 Boston, Massachusetts 02116 Tome Improvement.:Contractor Registration Registratlon: 100121 Type: Supp lement Gard Expiration: 6/912016 OCEANSIDE, IN PETER LAROCHE 217 Thornton Dr Hyannis, MA 02601 f': ..: . - "" . Update Address and return enrd.Wfork reason for change. KA 1 0 20M-W11 ❑ Address D Renewal ❑ Employment [] Lost Card v/ee �onrrr�Qnraea�l.�y1'C�'rlauac/uJeltJ Ifice of CoUsulner Affairs&Business Regulation License or registration valid for Individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation egistratlorl�;,jj y1`;;;;: TYPe= 10 PArk Plaza-Suite 5170 Expiratiq Supplement Card Boston,MA 02116 OCEANSIDE: INC. PETER LAROCHE 217 Thornton Or _ Hyannis,MA 02601 Undersecretary Not valid without signature • i 6 A f CERTIFICATE OF LIABILITY INSURANCE DATE`MM,DD"'�"' �� 01/1512016 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 04740-001 C ;pCT Miller McCartin dba Dowling 8 O'Neil Ins AgcyExt; (508}775-1620 _ AIC, 9731yannough Road EMAIL kboltonedoins.com ADOREss; Hyannis,MA 02001 INSURER(SI AFFORDING COVERAGE C# INSURER A A.I.M.Mutual Insurance Company 33758 INSURED INSURER B Oceanside Inc INSURER0- 217 Thornton Drive INSURER Hyannis, NA 02601 INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED yyB��YppPAIDppCLAIIyMS. ILTR TYPEOF INSURANCE I SR NND POLICY NUMBER MMI�DlYYYY MMl�O(YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY D RENTED PREMISES EMI $ S S E occurrence) CLAIMS-MADE 7OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EIIL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ LICY ECT OC AUTOMOBILE LIABILITY COMBINED SINGLE M $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHFJ7ULED BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRAUTOS ED At AUTOS fPer acc ent UMBRELLA LIARHCLAIMSMADE OCCUR EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED RETENT ON$ y�y7g7u 'ER- NO $ KERS�pmP N5 npp X TORY LIMITS EMPIOYERSF"LlAll'ITY E.L.EACH ACCIDENT $ 1,000,000.00 YR�pR��7�q YIN A AONYICROPMRIETORlPARTNERlEXECUTIVE� NIA VWG-100-6018802-2015A 1/1/2015 111I2018 E,L,DISEASE-EA EMPLOYEE $ 1,000,000.00 (MFyaFndaatRolryE)nMNBHE)R EEXXCCLLUUDDEEDD77 S.RilnioN OfdtPERATIONS below E.L.DISEASE•POLICY LIMIT $ 1,000,000.00 _T DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ,., C 1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 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):.O cean J(d e Address: 0 )7 Tho ra4n nm n \)P, City/State/Zip: !S Phone#: Q f l Are you an employer?theck the appropriate box: Type of project(required): 1.EKam a employer with�r _ 4• ❑ 1 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, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp,insurance.1 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 I LF]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-cont actors 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 h providing workers'compensation insurance for my employees. Below is the policy and job site information.Insurance Company Name:_A, T, N1 N1 u+u a q l Laurance 0-p o-)nn ni 1 Policy#or Self-ins.Lic.#: We - 1(_)y--�a0/q�C 9-oW ph'ation Date: Z(/-7J Job Site Address: i Ia /✓l DZIity/State/Zip: n l/j 6 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).d Z(p CS Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi r a. a s and penalties of perjury that the information provided above is true and correct. Si ature: Date: / / Phone#: 15.�111(;7qll Official use only. Do not write n 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#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map, 90� Parcel 0o� Apphcatio Health Division Date Issued'3� � I� YVIN Conservation Division Application Fee ff_�y U," Planning Dept. Permit Fee JS •00 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address /' ae'�/�) ',l�J/�: ��` JJ J I 17 Village Owner UJ c Pono+d.oa Address o e)a� to-79 a Telephone �� ( C�o� _-cr v► na , -TV -750 It-3 Permit Request 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 � � �� Grandfathered: 0 Yes ❑ No If yes, attach 0pporting doc entation. Dwelling Type: Single Family ❑, Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes UN6, On Old King' Highwa : ❑ems 0-110- Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) :,J rn Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including bath,): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil 44lectric ❑ Other Central Air: ❑Yes Q<o Fireplaces: Existing_C/_�5'N//ew Existing wood/coal��stove: ❑Yes �Pd'o Detached garage: ❑ existi/6new size_Pool: ❑ e 0Q new size _ Barn: ❑ existfnVg�Tnew size_ Attached garage: ❑ existinolaqvw size _Shed: ❑ eh � new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use D ( (.,,/�� ,aL Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) 7� Name V,ffl ',arpcAr)e__, Telephone Number �� :Z I r 1 V Address 117 �',I �((C r License# U_4MCA UZJ Home Improvement Contractor# Worker's Compensation # VW(':-IU1)-&0/132tQ--�2 UJS� ALL ONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO c p` SIGNATURE �_ �� DATE y r FOR OFFICIAL USE ONLY K r •APPLICATION# DATE ISSUED MAP/PARCEL NO. w ADDRESS VILLAGE OWNER DATE OF INSPECTION: , _.,FOUNDATION, FRAME 'x INSULATION FIREPLACE fr- ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT i ASSOCIATION PLAN NO. ,i I TOW 4 OF BARNSTABLE ' DAY. Yk`;N JItj . THE RIGHT CHOICE i-----------T----1 Siiice 1971 I Qffice Use Only I yiiiiiiiiiiiiiiiiiiiiiiiillllll deg ' JOB NUMBER i ,I Restoration ''---- ----- ------- 217 Thornton Drive,Hyaimis,Mass.02601 508-771-3110 800-464-3318(MA.Only),774-470-2211 Fax ASSIGNMENT AND AUTHORIZATION TO PAY The undersigned, herein called claimant, has authorized and ordered from Oceanside, Inc. , the materials and/or services requested. Undersigned hereby assigns to Oceanside, Inc any unpaid proceeds due or to become due, under the claimant's policy with the insurance .company to pay direct to Oceanside, Inc. or to include its name on a check or draft, for all requested work. In the event that Oceanside's claim, herein is not covered by, or paid by, an insurance company, claimant agrees to pay Oceanside, Inc. within sixty -(-60)"-days after-work-has-been-completed: - Claimant understands that Oceanside, Inc. is working for them and not the insurance company or the adjuster. Payments remaining due and payable after the claimant has received payment from the insurance company shall bear interest at one and one- half (1-1%2t) percent per month. In the event that there is a breach by the claimant of any of the conditions of this agreement, Oceanside, Inc. shall be entitled to recover, as additional damages, attorneys' fees, costs and any other collection expenses reasonable and attributable to said breach. If payment is not received within 60 days, collection action will commence without further notice to the claimant. A)ti Nt a.�.h sfr �-T flz�a.n n M+ LOSS/DAMAGE ADDRESS 1 41- W E`rT" M A-/1-i S -7— (0FF1 e e) AA4 kpaLi 1 , 144-- B)-&01 MAILING ADDRESS (BILLING) CITY STATE ZIP ,INSURANCE ADJUSTER' S NAME/C0. LOCAL INSURANCE AGENCY NAME PRINT NAME_ INS: CARRIER/POLICY UNDERWRITER ' DATE: . ' CLAIMANT'S SIGNATURE PHONE: rO 771 - EMAIL: hc�t-a Cyr q .r a P�vt l tit rv�� R . U Massachusetts -Department of Public Safety Board of Building Regulations g and Standards iottstriictioir Supervisor License:. CS-073097 ..; PET'ERALAROC, E �- 'I-,. 18 Cedric•Road ` S Centerville MA ' i 632 r re S -wit 1, � Expiration ' Commissioner 11/03/2016 Unrestricted.-Buildings of any use group which j contain less than 35,000 cubic feet(991m)of enclosed space. • 5 1 i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS licensing information visit; www_Mass.Gov/DPS j A, '- Office of Consumer Affairs nd Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Dome ImProvement.Contractor Registration . . t Registration: 100121 :• Type: Supplement Card OCEA11lSiDE, INC. Expiration: 6/912016 PETER LAROCHE 4 217 Thornton Or — - Hyannis, MA 02601 Update Address and return card.Mark renson for change. SCA 1 0 2OM-e5/11 Address Renewal Employment (] Lost Card t�e��nrrra�ttaealG�i r�(3�'laJ�aclttUv(lJ 0le ee of Consumer Atrairs&Business Regulation License or registration valid for Individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to; Office of Consumer Affairs and Business Regulation g1atratlog1r.190J21;:;,, Type: 10 Park Plaza-Suite 5170 Expirati Supplement Card Boston,MA 02116 OCEANSIDE,INC. PETER LAROCHE 217 Thornton Dr Hyannis,MA 02601 Undersecretary Not valid without signature • i A Ou � CERTIFICATE OF LIABILITY INSURANCE DATEiMMIDDIYYYY) ��, 01/1512016 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 04740.001 �aeCT Miller McCartin dba Dowling&O'Neil Ins Agcy (508)775-1620 973Iyannough Road EMAIESS: kboltonedoins.com Hyannis,MA 02601 -ADD INSURERtAI AFFORDING COVERAGE A.I.M.Mutual Insurance Company INSURED INSURER B: Oceanside Inc SURE O- 217 Thornton Drive INSURco Hyannis, MA 02601 INSURER E: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.�LIIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIIyMS..� ILTR TYPEOF INSURANCE I SR SWVCj POLICY NUMBER MMIDDIYYYF MMIDOIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ DAMAGEEISERENTED COMMERCIAL GENERAL LIABILITY (Ea occurrence) $ CLAIMS-MADE OCCUR MEDEXP(Any one person) $ __ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIIES PER: PRODUCTS-COMP/OP AG $ UCY F-ro OC AUTOMOBILE LIABILITY CONDSINGLE I accident) $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY{par accident) $ AUTOSAUTOS HIRED At NON OWNED pP faERdTY DAMAGE $ AUTOS UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMSMADE AGGREGATE $ OED RETENTION$ g7gTU $ yypRKERg�p�dP ySp rpN X TORY LIMITS ER AI�ID EMPLOYERSP"LIIf i64 AI Y P l�gRTNERlExECUiIVE Y I N E.L.EACH ACCIDENT $ 1,000,000.00 A O�FICERIMEEREXCLUDED7 N(A VWC-100-6018802-2015A 11112015 1/1/2016(Mandatory In NH) E,L,DISEASE•EAEMPLOYEE $ 1,400,000.40 D�nid PTION OF dPERATiONs below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE JGe 01988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 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 Nalne(Business/Organization/Individual):O cean S(d e Address: a )r7 —T1'1U ra4o n , m)P, City/State/Zip: !S Phone#: D '' qJ - 1 j Are you an employer?theck the appropriate box: Type of project(required): 1.221fam a employer with- )5 — 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6, El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp,insurance. t 9. Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself [No workers'comp, right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractots 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. qq Insurance Company Name:A , �� }-�"��J1 c�f�rant�'.e �� Policy#or Self-ins.Lic.#: V WO, " 100-6Q1 q�br1�_da%piration Date: f � Job Site Address: 4 (,l_�-P��('� ,V �� ai lCity/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).d`' 0) 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 r t. a' s and penalties of per,jury that the information provided above is true and correct. Si afore; - Date; Phone#: " Official use only. Do not write n 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map t/) 6 Parcel v ?Zno� Application D/J 0 jam` Health Division A Date Issued3-3 `! Conservation Division e3 Application Fee tSu Planning Dept. Permit Fees V Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Ad ress Village �� g Owner 5 ess 1(-)Q !2 6Y 0 Telephone =n Permit Request ;V p t 3 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed �=�Tot ew _ Zoning District f, 14 Flood Plain Groundwater Overlay .Project Valuation 41G11,1- — Construction Type IIJ M Lot Size .:,-7(, - Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes UNO On Old King's Highway: ❑Yes Flo Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfirished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ®"Electric ❑Other Central Air: ❑Yes W/No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Detached garage' ' "� isting ❑ new size_Pool: ❑ exis4hVl�9 new size _ Barn: ❑ existin? size_ Attached garage:O/b�its Ong ❑ new size _Shed: ❑ existi� i w size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Ypi § ❑ No If ye 1, site p review# Current Use �a�A� Proposed Use G�Q APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� Telephone Number -7-71 �5 I C Address IS C-06 License # Cf-) H -7 CQ �' ► 1� 1�7 l�JJ2 Home Improvement Contractor# ( Mir-;L Worker's Compensation # VW0_-100--(,Q1!??Q -,26 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL 3E TAKEN TO SIGNATURE DATE 10�27//S ti FOR OFFICIAL USE ONLY I APPLICATION# DATE ISSUED MAP/PARCEL NO. 4. L� ADDRESS VILLAGE G OWNER i DATE OF INSPECTION: c ,FOUNDATION F q FRAME INSULATION k FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL • GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i T11, q RARNSTABLE ��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 URN Name(Business/Organization/Individual): O ceana(de Address, O )r7 , _o I a,4n Y7 M n�)f, City/State/Zip: n aUW I Phone#: 07171 ' l Are you an employer?theck the appropriate box: Type of project(required): 1.[D,f am a employer with )tj _ 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, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp,insurance.t required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I t.❑Plumbing repairs or additions myself ' right of exemption MGL Y �o workers comp. on per 12.❑Roof repairs insurance required.]t a 152,§1(4),and we have no 13.❑ Other 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, .f 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. qq Insurance Company Name:A, I of, , N u+utll n5UranC(C -o a c n n� i Policy#or Self-ins,LL/i(c.QQ#:_ /V,, ''nn+�(� ��/n�1-�601 � - �� piration Date: � �/� Job Site Address: l`h U um_s� c I S± --- ity/State/Zip: I I ( a, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 6'LC O 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 r t., a' s and penalties of perjury that the information provided above is truce and correct. Si Mature: Date: of Phone#: Official use only. Do not write n 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: MMIDD AC�� 011151205120 f CERTIFICATE OF LIABILITY INSURANCE DATE `1fYYYY) t5 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 O INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED F 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 04740.001 CRRJACT Miller McCartin dba Dowling&O'Neil Ins Agcy N�o.Ext: (508)775-162D 973lyannough Road ADDRESS: kbolton@doins.com Hyannis,MA 02601 INSVRER(si AFFORDING COVERAGE NAIC A.I.M.Mutual Insurance Company 33758 INSURED INSURER B: Oceanside Inc INSURER 0• 217 Thornton Drive SURE Hyannis, HA 02601 INSURER E• COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WTH 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. t ILTR TYPE OF INSURANCE l SR Sp POLICY NUMBER MMI��fYYY MMI�oIYYYY LIMITS GENERAL LIABILITY EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY DA-PRE MI ENTED $ ISES a occurrence) ce CLAIMS-MADE El OCCUR IVIED ECP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ FHL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ LICY F7TERCO- OC AUTOMOBILE LIABILITY CO acccdentBIDSINGLE $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY RdT;DAMAGE $ AUTOS H $ UMBRELLA LIAR HOCOUR EACH OCCURRENCE $ EXCESS LIAB CLAIMSMADE AGGREGATE $ DED RETENTION$ gT U $ �'rP��Al��o`��'Rts�CISd�L?4� X TORY LIMITS ER Y 1 E.L.EACH ACCIDENT $ 1,000,000.00 A AONYIPROPRIETORIP�f�JUSfjl€)CECUT{VE N NIA VWC-100-6019802-2015A 1/112016 11112016 E,L.DISEASE-EA EMPLOYEE $ 1,000,000.00 (Mandatory In NH) tur DitiSG`RIPs ift OAF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(Attach ACORD 101,Additional Remarks Schedule,V more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010106) The ACORD name and logo are registered marks of ACORD a Office of Consumer Affairs nd Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Dome Improvement Eontractor Registration " Registration: 100121 Type: Supplement Card OCEAi1lSIDE, INC. Expiration: 8/9/2016 PETER LAROCHE 217 Thornton Dr - Hyannis, MA 02601 Update Address and return card,Mark reason for change. SCA 1 0 20M-05/11 Address Renewal Employment [] Lost Card. de�a7n•�rrarrraea�l.�o//�f�'la,y�crc�irua/75 Vb), of Consmnce Affairs&Business Regulation License or registration valid for Individul use only ME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: Office of Consumer Affairs and Business Regulation gistratlor� yp 1`.:; Type., 10 Park plaza-Suite 5170 Expiratio;c=@lik2Q•1: :a:;' Supplement Card Boston,MA 02116 OCEANSIDE,INC. PETER LAROCHE 217 Thornton Or4-4 Gs' Hyannis,MA 02601 Undersecretary Not valid without signature • i Massachusetts ,Department of Public Safety Board of Building Regulations and Standards Co"i Iction Nupet''isor License;CS-073097 ' + y PETER A LARoCjkE 1S Cedric Road {: Centerville NIA 02632�" � ?. �J 5 .)1'1411, Expiration Commissioner 11/03/2016 Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991m)of enclosed space. - i 1 i I I Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS eb s TMMGHT,CHOiCE i-----------------1 O Since 1972Office Use Only 0nSir%jaincoa JOB NUMBER �e .ortn �'- ---- ---- - 217 Thornton.Drive,Hyannis,Mass.02601 508.-771-3110 800464-3318(MA.Only),774-470-2211 Fax ASSIGNMENT AND AUTHORIZATION TO PAY The undersigned, herein called claimant; has authorized and ordered from Oceanside, Inc. , the materi.al.s and/or services. requested. Undersigned hereby assigns to Oceanside, Inc. any unpaid proceeds due or to become due, under the claimant's policy with the insurance company to pay direct to Oceanside, Inc. or to include its name on a check or draft, for all requested work. In the event that Oceanside's claim herein is not covered by, or paid by, an insurance company, claimant agrees to pay Oceanside, .Inc, within sixty (60) days after work has been completed. Claimant understands that Oceanside, .Inc. is working for them and not the insurance company or the adjuster'. Payments remaining due and payable. after the claimant has received payment from the. insurance company shall bear interest at one and one- half (1-1/2s) percent per month. In the event that there is a breach by the claimant of any of the conditions of this agreement, Oceanside, Inc. shall be entitled to recover, as additional damages, attorneys' fees, costs and any other collection expenses reasonable and attributable to said breach_. If payment is not received within 60 days, collection action will commence without further notice to the claimant. LOSS/DAMAGE ADDRESS MAILING ADDRESS (BILLING) CI STATE ZIP INSURANCE ADJUSTER'S NAME/CO. LOCAL INSURANCE AGENCY NAME -f f 1b 0 J PRINT NAME INS. CARRIER/POLICY UNDERWRITER DATE: CIAIMANTI eSIGNATURE PHONE; EMAIL: Message Page 1 of 1 Anderson, Robin To: tcyrus@bcgroupllc.net Subject: 148 West Main St Info Request k ; � f a � 'q � ,� max. x�E• f q h t i7 -� �. Dear Tom, In response to your inquiry: We do not perform an annual site inspection at this property. Inspections are performed based upon building permit applications for work(routine performance inspections) or the investigation of specific complaints. Rentals are required to be registered with the Health Division and unit inspections are arranged accordingly. Most recent permits: 2013 Permit-Building C Re-siding&trim 2013 Permits for Cellulose in attics Our file does not contain any notice of recent and/or outstanding code violations and as to the best of our knowledge there is no current violation. Found old references to complaints of mold/mildew in file . We do not regulate or inspect for hazardous materials as this is considered a residential property. Typical residential units are anticipated to utilize and store 25 gallons of haz mat and this is allowed as a matter of right. Commercial activity involving haz mat is not an allowed use in a residential zone or complex under zoning. The Health Division would receive, investigate and log any use or complaint involving haz mat. in both the residential and commercial arenas. Environmental issues would likely fall under the jurisdiction of Health or Conservation. Please let me know if you require additional information. 4 96in Robin C. Anderson Zoning Enforcement Officer Tl0141n of Barnstable 200 -%Iafn Street Hyannis, NA 026oi 5o8-862-4027 7/25/2014 Pandanus Consulting Date: July 24,2014 To: Town of Barnstable- Regulatory Services - Zoning Office Attn: Robin Anderson Fax:508-790-6230 From: Tom Cyrus 1426 Stoney Creek Circle Carmel, IN 46032 Phone:317-966-4946/ Fax:941-847-1054 RE: Village at Fawcett's Pond 148 West Main Street Hyannis, MA 02601 County: Barnstable (in Town of Barnstable) Parcel ID: Map/Block/Lot:290/ 027/ 002 Building Permits,/Code Enforcement Dear Robin: Pandanus Consulting LLC is preparing a Phase I Environmental and Property Condition Assessment of the above reference property. As part of our investigation we are required to contact the local authority in regards to the following questions. 1. When the property was last inspected, and is there a regular schedule for periodic inspections? 2. Per the most recent inspection were there any outstanding building code violations, open permits, and/or life safety issues affecting the property? And it so what are they? 3. Are there any records of hazardous waste activities, storage and/or incidents at the property? If so,what are they? 4. Are there any environmental issues maintained or on file for the referenced property? Any assistance you can provide will be greatly appreciated. If you have any questions or require additional information please do not hesitate to call me at 941-966-4946. Sincerely, Tom Cyrus tcyrus@bcgroupllc.net C ` FAX COVER SHEET TO Town of Barnstable - Zoning Office COMPANY Attn-: Robin Anderson FAX NUMBER 15087906230 FROM Joey Zimmer DATE 2014-07-24 16 : 02 :53 GMT RE Information Request COVER MESSAGE Dear Robin, Attached is our information request. If there are any questions please contact me . 0 � Thank You, Tom Cyrus C 317 . 966.4946 `"' Co. tcyrus@bcgroupllc. net , E a www.efax.com ,�:Hirzis�gT'+�ailktaad Burcarcisst3:��Aax�3:. �.,�c�Es�4-a;.� ,,5o$-i?�- Pie -R G Y Thomas Perry,,CBO Town of.Barnstable,Building Division NO Main Street Hyannis, MA 02601 RE-Insulation/Weatherization Permits Dear Mr.Perry: Tftiis affidavit is.to Certify that ali work completed foe insulation work at: 148-Wes Main'Stre.et-H -nnis o �a has been inspected by :certified Building Performance Instiu#e(S!?d)lnspectof� All uvork perfo ed meets or exceeds.Federal State requirement`. N CA r� Sincerely, ¢ , ffre T-onello P ,3� dialf, ,-�z'� _ U1�-' A y t a TOWN OF BARNS E BUILDING PERMIT APPLICATION Application # Mapa2 � Parcel 1 7 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board o �'��' �� c(i 33 Historic - OKH Preservation/ Hyannis Project Street Address . 4 ` Village Owner AAddress S Telephone Permit Request / _ t_ SI 1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type _&�a__� Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 1/ '• Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: v q Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ze w Commercial ❑Yes ❑ No If yes, site plan review# v Current Use Proposed Use W Ca APPLICANT INFORMATION r— (BUILDER OR HOMEOWNER) Name TM " ES LLC— Telephone Number I D08�3 7 c�V 40 Address ae *2a/aa License # 716 Z7 D 3 03 2 Home Improvement Contractor# 1 17 4��O Worker's Compensation #' I.IX�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4-01brmr, SIGNATURE , DATE 5— 0 '7 3 :TlY FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED a s MAP/PARCEL NO. I ADDRESS VILLAGE ~ k OWNER DATE OF INSPECTION: r- •r . €-� -FOUNDATION',, �r FRAME .�' INSULATION - ,r FIREPLACE = ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL '�. FINAL BUILDING r i J DATE CLOSED OUT ua. " ASSOCIATION PLAN NO. r r Office of luvesfigadons 600 Washington Street. Boston,MA;02111 ivww.massgov/dia I u;p Workers' Compensation Insurance Affaldtvit:Buflders/Contractors/ylectrician.s/Plumbers APpff nt Inforliation 'Please Print Lez-iblP Name(BnsmessfOiga fion/Individnan:. TM'PCIP°l1•Q `KES Lc� Address:A��P�►'1C�C��.',� — CS;� City/S ate/Zip: ` U 6 lj� 9 Phase.# 563 �-` 06 Are you an employer? Check the appropdate bom -Type of proj ect'(required):_ 1.�I am a employer with o2 D 4. [] I am a general conhartor and I employees(full and/or part time).* have)wed fe sub-co�ractars 6. ❑.New construction . listed on fm-;Tfiached sheet: 7. Remodeling Z.[J I am a'sole proprietor or partner- • ❑ . ship and have no employees These sob-co.LL'Lca1.;tU1N have : 'a. ❑Demolition working for me m'amy capacity: employees and have workers' ' • 9. ❑Burling addition [No worlds' comp,insurance.. 6amp'""R' nrP 10. Elec(ricalre am or additions req ) 5. ❑•We are a corporation'anrlits ❑ rap airs have exercised their 3.❑ I am a houieovmer doing a11•wor3c 11.❑Plumbing repairs or additions . myself [No workers camp. H&df MMOPtion per MGL 12.C1 Roof repairs in.arrr�nce required]t c. 152, §1(4),and we have no employees.[N6 workers' 13.❑ Other ' cam.lasu nee reqrdred] . kAny applimmt that checks box#1 umst also fIl out floe section below.showmg their wod=,compmsafion policy inhMafion. Homeowners who submit this affidavit indiica$ng they arc doing aB work and thm hips outside contractors must submit a new affidavit mdimf ng such. - Contracton that check this box must attached m additional sheet showing the name of the sub•wntrwb=and state whcthrr or not those entitirs have mployees. If fhc sub-conhactvrs have employees,fhcy mostpruvidt their wmizrs'comp.policy number. sin an employer that is providing workers'compensafion insurance for my employees Below is thepolicy and job site afarmaiwrc. • .• n . .- . osurance Company Name: olicy#or Self-ins.Lic.ff-M Je 3.:U '77 7/ ExpindonDatr: )b Site Address: I q� City/StaWZip. leach a.copy of the workers' compensation policy declarafion page'(showi the policy u rand expiration dafe). ailM-D.to secure coverage as required under Section 25.4 ofMGL c. 152 can lead to the imposition of criminal penalties of a oe vp to S 1,500.00 and/or one-year imprisonment; as•w!2 as civil penalties in the form of a STOP WORK ORDER and a fine up to$250.00 a day against lip violator. Be.advised that a copy of this statement may be forwarded to the Office of vestigations of the DIA for insurance coverage i f zr ca:ion. io•hereby certifyViler7ams-andpenaffes of perjury that the information provided above is true and correct Date: tone OffTrirrl rise only. Do oaf write in this area,to be can? lPfP/rfry city or town affzctaL 'City or Town: Permit(License# Issniag•A.uthority(circle one): L Board of Health 2,BuildingDepattrawnt 3. City,!Town Clerk 4.Electrical Inspector 5.Plumbing Inspector G. Other �ontact Person: AM Town of Barnstable o� Regulatory Services , t R�RNl�ILRTR t MASS g Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner. 200 Nam Sheet,Hyannis,MA 02601 irww.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Comple e and Sign This Section I Using A Builder 0 as Owner of the subject property . hereby authorize Cop"es L to act on my behal� in ail matters relative to work authorized by this building permit t�o U), Maio S\�. Lanmf� W4 (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. 04 Signature of net Signaturerp licant t J `i Print Natne Rdnt Name Date Q:F0RMS:0VnMPERMISSI0NP00LS 6/2012 KTMPR-1 OP ID: MS CERTIFICATE OF LIABILITY INSURANCE DAT 09118DTYYYI) 9118112 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 603-424-9901 NONE CT Brown&Brown(Merrimack) 603 424-3203 PHONEFAX 309 Daniel Webster Highway Alc No E Arc No): Merrimack,NH 03054 E-MAIL Chris McPhail ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC D INSURERA:The Netherlands Insurance Co 24171 INSURED KTM Properties LLC INSURER 13:Peerless Indemnity Ins Co 18333 26 Kendall Pond Road INSURER c:Technology Insurance Co Inc 42376 Derry, NH 03038 " INSURERD:Wesco Insurance Company 25011 _. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTRNS TYPE OF INSURANCE POLIC EFF POLICY EXP LIMITSINSR WVD POLICY NUMBER Mh11DD MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CBP1058505 06/16/12 06/16/13 PREMISES(Ea occurrence) $ 100,00 CLAIMS-MADE rx-1 OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X P J CTRO- F7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1 000,00 Ea accident) $ , A ANY AUTO BA1058506 06/16/12 '06/16113 BODILY INJURY(Per person) $ ALL OWNED N SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 B EXCESS LIAB CLAIMS-MADE ' CU8912645 06/16/12 .06116I13 AGGREGATE $ 5,000,00 DED I X I RETENTION$ 10000 $ WORKERS COMPENSATION I WC STATU- OTH- AND EMPLOYERS'LIABILITY - R IT R D ANY PROPRIETORIPARTNERIEXECUIIVE YIN C3042802(NH/MD) 06/15 2 06/15/13 E. .EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? ® N/A C (Mandatory In NH) TWC3327777(MAIRUCT) 06/1 M2 06/15/13 .DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Additional Insured as required by written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE KTM Properties LLC THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN P ACCORDANCE WITH THE POLICY PROVISIONS. 26 Kendall Pond Road Derry, NH 03038 AUTHORIZED REPRESENTATIVE J-4 O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts- Department of Public Safet,% Board of Building.Regulations and Standards Construction Supervisor License License: CS 71077 CHARLES J MINASALLI 9EPPING AVE 5, HAMPTON, NH 03842 Expiration /25/2013 ('ununissiunrr Tr#: 8 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: W W W.Mass.Gov/DPS ✓ire ioo9rrrr �� a�t/�aaaad �'eonu e Office of Consumer Affairs&Bu iness Regulation 1 .OME IMPROVEMENT CONjRACTOR J( - .Registration: Type: Expiratio 2 12d?14 Private Corporatior E ONMENTAI i.: #C3NS_INC 1 1 CHARLE5 MINISA�1LIf 90 HAZEL DR HAMPSTEAD,NH 03$41 '— y Undersecretary 4 k F�. f: License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 of valid without signature r y l a RDELiN�',_:� DE. lJ�'GON�TL�:ls��10�1, October 3, 2012 Village at Fawcetts Pond 148 West Main St Hyannis, MA 02601 RE; Siding and Trim Replacement Fawcetts Pond —Building C Gable end wall, gable end cheek wall & stairway .�----- Dear Tim As per request and our site visit we are pleased to provide you with proposal to perform siding and trim replacement at the above referenced address. Scope of Work: • Remove and Dispose of existing siding and trim • Supply and Install new Hardi-plank siding • Supply and Install new Azek trim • Paint 2 coats on all siding and trim • Price to include all permits Price: $30,800.00 If you have any questions, please feel free to contact me at 603.234.9213. Sincerely, x q K - : f 1 - Charles ,1 Minasalli ,nl>✓i,C �j President " l 26 iLENP LL p0 Izl? DEIZG2Y NIA 03D3'8 _ 6a342doo p�! 6o3a24ssTFAx V J,vaCTMorx � r.; � �� • � _ , �,, I �v q /� �-t .�� E 1 4, { TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel U A icati n Health Division Date Issued { �� Conservation Division Application Fee SD Planning Dept. Permit Fee _ Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address �`�a ) LV L S Village /_ Owner I Address PL ��,�7� /rV��1� J X ` Telephone��`�'>> / — 7 0 Permit Request �� J �,� ,� L/� - c ( /7 re sS-a aUd AA71 Cl ryZ&&W Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation de.000 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) � O Age of Existing Structure V 3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing lfz�! new" ' Number of Bedrooms: existing _new _D_ Total Room Count (not including baths): existing new First Floor Room Count ' Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: �0 Yes:0 No-' Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 4, LI a O Telephone Number (s-L-6 600 1-740 Address 7 .P4 Cl �� License # I Ma Home Improvement Contractor# /7 M L_ Worker's Compensation # IcJC S3/S 7I� s�3 v ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE �� 1 DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. a ADDRESS VILLAGE OWNER DATE OF INSPECTION: r FOUNDATION FRAME INSULATION w FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. a f 1ne uommonweacin u�trlu�aucrrccaCte� Department of Industrial Accidents Office of Investigatians 600 Washington Street Boston,MA 02111 (►/Iw.mass.gov/dia .' e Affidavit:Builders/Contractors/Electricians/Plumbers Workers' Compensation'InsIIranc Applicant Information Please Print Legibly Name(Business/Organ=ation/Individual): r-�1 �J (1C Address: 4�q e�ri_n� �c�`�d (cf. City/State/Zip: B U LLa dS Ock�v PhoneA CSC Are yo employer? Check.the appropriate box: .Type of project(required):. 1. I am a employer_with L 4. 0 I am a general contractor and I employees (full and/oi part time).* have hired the stab-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 •8. Demolition 'working forme in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp.insurance comp.insurance.t 10.❑Electrical repairs or additions required] 5. 7 We are a corporation and its 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right 6f exemption per MGL 12:KRo pairs insurance re ed t c. 152, §1(4), and we have no ,qui ] 13. J2Ct � 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. 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 subcontractors 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 Nam ��'&e: n r� n10J-ri�C,Af Ms Cie)- Policy#or Self-ins.Lic.P 1,Q d-S 3 1 J. 3 "7 O s- ,a 3 tJ 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 tmder 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 penaltie's 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 i surance coverage verification. I do hereby certify under.the pains-and penalties of perjury that the information provided above is true and correct Date: %� - �' •- / Si ature�- — Phone# Official use only. Do not write in this area, to be completed by.city or town ociaL . City or Town: Permit/License# Issuing Authority(circle one): A.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: i% > `luSSachu�cr(z - 0q);Ii-t own I ul hllll1IC ``:il(•I\ a Bo;ir(I nl BuiI(I ill_ Rc•;[ul;1tinn. :in(l `i;III(lard Construction Supervisor License License: CS 53202 r.-. JEFFREY R TONELLO PO BOX 1516 SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( , inn,i>einri. Trtt: 21481 � idac�•ru�eGZs • re,istration valid for individul use only c �� 't^amvrrtaruuea� a�.. License of d Affairs&Business Regulation x liration date. 1f found return to: �\ Office of Consumer A before the e. I o i n �. 0 R r Affairs and Business Reeulat o CONTRACTOR f Consume ——. :HOME IMPROVEMENT Type: Office o Registration: ..=171991 10 Park Plaza-Suite 5170 1 - _> Expiration:. 5/8/2b1a Corporation Boston,MA 0Z116 RESOLUTION ENERGY.:,;INC,.:::. JEFFREY TONELLOi 43 FIELDWOOD DRIVEt lid Out signature SAGAMORE BEACH,MA:.02562 Undersecretary UJ 1_71 LV 1L 1VLVV ! [�t't C'^1V C. Jl VUJ rdl: JG1 `J 1..1 _ DA (A3'ti'CQ'YYYt'j ANCE CERTIFICATE OF LIABILITY INSU THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS TIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE DOES NOT AFFIRMA I TITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR2ED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONS REPRESENTATIVEOR PRODUCER,AND THE CERTIFICATE HOLDER. Ih4PORTANT: If tl�e 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)_ j PRooucER SMALL BUSINESS INS AGCY INC CavrAcrrvAmE: ---------'--'-- 542 MAIN STREET P+prE(aGtvo,Ent I5081 i.�5 Qo35 _•_—_.___�F�xLG ^1.._.C558_ `l.8'5QO .I WORCESTF_P,, I+AA 016150022 E,�t��REss: --------•--------- -- _- INSURER AFFORDNC CLNERAGE t`LaIC r' i Lihr�lly Milt;,l�l Irsura0�e......_.._.-....--.--.._............... .L..... -� INSURER B INSURED - '--------- ..�- _. .-. RESOLUTI- ON ENERGY INCORPORATED INSURERC: I ay HERRING POND ER ROAD --•�-_---'-------'--._.__--- INSURER D: - ! BUZZARDS EAY MA 02532 -- INSURERE: INSURER F I -- REVISION NUMBER: COVERAGES CERTIFICATE NUMBER- 138g7741 THIS IS TO CERTIFY THAT 7}IE POLICIES OF INSURAIgCE LISTED BELCIA)HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR ThJE PCti1G'Y P=�,1( i INDICATED. fyJlltilT}�STANDI i ANY REOl.11RElAF..M, TIRIA OR CONDITICN OF ANY(XJN7-,tiACT CR OTHER DCM,JAJ0,lI V•,1-n-I ncSPE.T TO V`11HIC THIS f CERTIFICATE LJTV`BE ISSUED OR \Y PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEFIEIN IS SUBJEL-I'TO tit L THE TERrR.-', EXCLUSIONS AND CONDITIONS OF St.JCH POUCIES.LIMTS SHOWN Iv1AY HAVE SEEN PEDUCCED BY PAID CLAIIAS ----— i _ II•ISA I ) POLICY NUNIBER aCQ'Y TYPE OF IhISURAf.I;E YYYJ ( '/�a Y I UhfJ!S .�, I GENERAL LIABILITY I I(xYN�itF"�Ih EnIEF7AL�J4.Rl!IT1' ------" I�� U`1`-�Hid'' ...__._......... i E ' _ 1 I I !:rq td5•AiWL!EI ------'- -------- ......._...- i �..-_..- ?�^,�,'VAL`RDV IAUURY_I c 1 I i ! .. ...._-_... PFL�DU COv!G/O'ACT i=+ F.N_AuCiREC+1TE UPaIT AM E'';PER:PR I ('1)UGY I �y:T I i AUTOfVOSILE UANUTY I I _ - _ W nY(Per�rrl+) _....._._.... I A7F i ANY P;,RO -...-_ hiEDIAED I i I I I _Y I I:g 1RY .._.....i P'Lam: I I --- ---- .......... . --..._........ I `5 I'�i aUrG i PUrGS I I EF1 afG---ia -l --iN�VvrMEP I iJ FUREDP11TC5 ,---...;a,lrrO; ' I i i; , —I - I - -- ....._... . t.A+ABRELLA LIGIEI- J rgY."t IRE;.,.,H C..GUR _'--'-- - j RE•V';E j.S I I,�. I j P.C�RCGATE EXCESS Ua6 I_J C1_AIM_JtA4C!F -- L..._i : t I I ---...--- IEtL•VnCivr.I DEC)OED WOFtcEhS CCAUF 1sA110N 1 1 IWC5-31S-370523-052 1 3/1 J20i2 I312/2013 '.! ✓ !7 �LI�nTSI I� A I.AAID ENPLOYEF?LIABILITY Y/NI I E.L.EP.CH ACC I DE\rr !S io onna i PJvl'PRCIPRIET:a/PART-=%`YECI RIVE a'N;AI .---._ ( ICryCTvt in NIE�F OCG.UDFC7 N If I i E.L DISEASE EA BviRLOYE s-- -' -- 100Q, i It•' .de�iba trd[r i - I E.L.DISASE-POLICY LIMITj S 50!10!1f. I DEt_RlrMCNOFC•PERATI(__J;tTim-i 1__ — - �UESCrdPT1CtJ OF OPERATI�6'LOCATIOUNS1 VE/6CLES(Alraoti ACORD 101,Additional Rerrerks, dule If rro a sFace s requirEd) 1 I V-1orkers roripsnsalion insuranr.•e CDvarage applies onlyto the Workers compensation laws of the state I-AA. I I - _J4 :C E fiT.I P I C A T E.tiO L D E R „�,.,,r._.,...,...�-....-.--•a CANCELLATION - SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE USING ASSISTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED it`! HOUSING ACCORDANCEW17H THE POLICY PROVISIONS. 460 WEST MAIN STREET i HYANNIS MA 02601 AU`rii10 !ZEDREPRESENTArvc Jeff Cidridae --- :(7.1986-2010 ACORD CORPORATION. All rights reservec-' ACORD 25 (20101051 The ACORD name and logo areregislered marks of ACORD ,ny?- •:1,- '+:fh:� rr °• - r tom, r1 a:, 1? 12..17 FIS R _ c� -�:+c Y r.F::. ..+.:.P�,�':�i'+t'-`t+ '-^- c�.•l:-.i.iicaes. of r 9$Ar16yq. Town of Barnstable ...Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,' Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must - Complete and Sign This Section If Using A Builder as Owner of the subject property j t � hereby authorize �. ° _ to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) \� Signature of Owner r' r /` / Date Print Name if Property Owner is applying for permit,please complete the'Homeowners License Exemption Form on;the reverse-side. a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION E Map �U �� Parcel y( Application Health Division Date Issued �1 ' Conservation Division Application Fee .�D t Planning Dept. Permit Fee '1173 S Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/Hyannis Project Street Address Village Owner G UtQ S And aljaAf-lWkS Address d(SaSG (o 79J-6 lrpi n!� 7-X Telephone (S 77/ 620 . Permit Request 57 S Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuations OGU ' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) 19 301 Age of Existing Structure /9 53 Historic House: ❑Yes ❑ No On Old King's Highway:. ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new = Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: .❑Yes.-0 No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ ne_w size_ t� Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: - # "r 7 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ i .�a Commercial ❑Yes ❑ No If yes, site plan review # ` Current Use Proposed Use APPLICANT INFORMATION BUILDER OR HOMEOWNER) ( - Name LAA,--) � _ ✓�1dw Telephone Number 7 90 Address ,-1 /l.c,/ License # Home Improvement Contractor# 9 Worker's Compensation # Cy C 5,3/ S3 Uf 3 Usk ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO DATE SIGNATURE /U / .3 FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ' ADDRESS VILLAGE s OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION 't FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Ine uommonweatin uJ�rlu�a'ucnccsctt� Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 6•• • www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Inforination Please Print Legibly Name(Businesslorgw zation/Individual): 17 Aso (04- Orl �Yl t Address:- 49 - 14 a rr City/State/Zip: L�0LLA dSG" CAS3 tPhone.#: (SOO �c�9 �- I.�� O Are yo employer? Check.the appropriate box: .Type of project(required);. 1. I am a employer with 4• ❑ 1 am a general contractor and I employees (full and/or part fime,). * have hired the sub-contractors 6. El New construction . 2:❑ I am a sole proprietor or partner- listed-on the-attached sheet: 7. ❑Remodeling ship and have no employees These sub-contractors have •g_ ❑ Demolition 'working forme i employees and have workers' n any capacity. $. 9. El Building addition [No workers' comp. insurance comp.insurance. required] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their l l.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Ro repairs insurance required-]t C. 152, §1(4), and we have no , 13. ther_JJ�� cmployees. [ o 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 cntitics have employees. If the sub-contractors bave employees,they must providb their workers'comp.policy number. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information Insurance Company Name: Policy#or Self-ins.Lic.#: d S 3 157 3 7 O S d 3 y 5- Expiration Date: lob Site Address: City/State/Zip: �� l/aoi 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 4 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 dnd penalties of perjury that the information provided above is true and correct r}—� Date: .Id, 3 / Si afore:• ) — Phone# Official use only. Do not write in this area, to be completed by,city.or town official City or,Town: Permit(Lice.nse# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: 1JIIV ll/ /7/ GV1G 1V. GV . •/ ! [l!'1 C"HIl C. CERTIFICATE OF LIABILITY INSUI RANCE THIS CERTIFICATE IS ISSUED AS A MATTER,OF INFORMATION ONLY AND CONFERS NO RIG14TS UPON THE CERTIRCATE HOLDER. THIS ! CERTIFICATE DOES NOT AFRRMA71VELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE WEEN THE ISSUING INSURER(S). AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT, It 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 certlf!cate does not canter rights to the cerliticale holder in lieu of such endorsement(s). i PRODUCER SMALL BUSINESS INS AGC1' INC corrrAcrrvAmE: 542 MAIN STREET PtroNF(ac_No_F 1 -78-S OF f WORCESTER, (VIA 016150022 Enna ApoREss: _. --•-------------- _...:__..._ - j INSUREF(�AFFCY�GrR1G COVERAGE _._. I__f`L'+IC F I IhbLIREF A: Lih- I !Milt Z�l`Ir�urance.---------_...-------.._.... INSURED Ifv5l1RER8: RESOLUTION GNERGY INCORPORATED Insu.,Eec: I 49 I-IERRING POND ROAD -------•--- I BUZZARDS BAY MA 02532 LNSURERD: INSllREF,E: ---" I COVERAGES __�_ CERTIFICATE NUMBER: 136g7741 REVISION NUMBER: f THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I I-E PaICY P=nICO INDICATED. �Y,Tf1�1T}{$TANDIt�i Af�N REC?l.!IREIAF..fJT, TERM OR C'.ONDITIO4 OF ANY(XYIfRACT C^n OTHER DM,AIEI:T V`nTFf RcSPECT Trl V'fr lC 11-OS i CERTIFICATE I`,AY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DES RIBED HEREIN IS SUBJEo .TO AL THE TERM':. EXCLUSIONS AND CONDITIONS OF SI.!CH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BYPAID CLAIMS. IAl3lS'DSI$`---- �v11CCbb�' —r.. II'ISR I TYPE OF ILISURAhk;E r POUCY M.WBER I(t LTR GEN ERAL UABIUIY I !(X7JASC-F11:.IAL:;EiJ[riAL JG.RI!IT1' I � 'tO:J.F.'. I � i�l I' P;Fv'r �v r,Ilwtl ....._. I _ CcF."'"u4 ADVRY.-. PFC CCh/P/(k^.ACu GFN=_AGGREGATE UL:IIT APPIUES PER 5 —� PoD j R-.X (W I IA3, AUrONOBILEUABIUTY I ( I_Y INiURY(('e•lyrvn) i ANY A RO I I I --� _—........ (UN Y!iEDtFED I E I:_Y a UURY(PA-t dd�lf i rtFjl'UTAv�+G�- —j N YJ v1kIED I I i ja=aU tT RRED 4..(TCS _ :ALITO __.._._._._._.._.._.___.......... I i`.. --- I I I I E CHCrCURRE•y^E S -----._.. � I IAViBRELLA LIAEI �� rt;7;UR I � I �� ""�—'---�— I i EXCESS LIA6 I I !..__...t LIED RE1TNMM$ I WORKERS-MVP3'sATION I IINC5-31S-370523-052 13/12/2012 13t12/2013 !Tr� LIMTS1 I.AlD Sv>PLOYERS UABIUTY V/rdI E!_.EACH AC006,11' _ I:s 1000D(' MANY PRCIFRIZI'.FiFAFiTrCR!"Y.[CIfrIVE ,N1AI I !oFASEFJS BufPLOYE ---------'---.. ..... .. i J' ICL-i{%1.L=T/L'ER i]CG:JDI=D? i i I E.L D'- ti_--'- (MndRtry in NM v"L.:,.de�iW i viler i I E.L.DISE ASE-P�OUCY LIh.1rr j S S(10Q(4 .O�q—c.-,RIrMCNOFOPERATICDVSI'V02j I i ! I L - _ �UESCRII-TICY4 OF OPERATCx5+l0.r•1T1ONSf vF-'uCLES(Attadl ACORD 101,Additionaf Ran ks Schedule If tme space�required) ! k Itlorkers rompansafion inSUrallre coverage appliejs only to the worl(em cortlp=.nsuion labs of the state h-AA.. I I ERT.IPICATE110LDEP —_•_—,.•,,,,._- CANCELLATION___ — SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORF. F ING A'SSI�iTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE WLL EE DELIVERED IE•. HOUSING WEST STREET ACCORDANCE WITH THE POLICY PROVISIONS. i HYANNIS MA 02601 AUHOFZED REPRESENrATvE ' _ 1. ,J • ,_ . '/ 1988-2010 ACORD CORPORATION. All rights reserve, ACORD 25 (2010/05) The ACORD name and loqo are regis,ered marks of ACORD :.: ?44'7a •11.+-" 'Cf,4:: 1:,�. i sLy i art-rerL•.i ii CacFs. - Q� � + BARNSMBLE + 9$ ,�� Town of Barnstable ]regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,' Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the.subject property 7 hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: rye (Address of Job) Signature of Owner /` Date I Print Name If Property Owner is applying.for permit,please complete the Homeowners License Exemption Form on...the reverse.side. : . v `lu.S,(t•I1u ctt: fhli:rrirnont ..I' hulilit' �:ilt'I Bn;rrrl nl 611iltlin_ Rc:'rilntinn• ,Intl `iunrl;ir(I> Construction Supervisor License License: CS 53202 } ; t i�nr JEFFREY R TONELLOi PO BOX 1516 � (t� SAGAMORE BEACH, MA 02562 ,- -�;;,.$f..�;,�_ Expiration: 7/14/2013 ( : nnni..i, nrr Tr.`+': 21481 f Gxs Mid for individul use only �/ �a,,,.,,�Q,,,�.ealC/. a�✓/L �a�/{ License or registration v ulation \ Office or Consumer Arrairs&Business Reg before the expiration date. 1f found return o: HOME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation Registration: .:'=171991 10 Park Plana-Suite 5170 Expiration:, 5/9/2014 Corporation Uoston, MA 02116 �f RESOLUTION ENERGY::WC_ JEFFREY TONELLO J 43 FIELDWOOD DRIVE' t lid w out signature SAGAMORE BEACH, MA:-02562 Undersecretary a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION � 6 7 Parcel U ica?ion#3�� 5 Map � Q �{ Health Division Date Issued 1� Conservation Division Application Fee Planning Dept. Permit Fee T Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address y A/017 is Village Owner�&(; CL j<'� Address 66y_ /0?JP Telephone Permit Request ��cS . S ?S ,��c, -: �„� ^ 011reSk-7)'ri e Cl Swif-b kCI 9�L/&J1a� f 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 Grandfathered: ❑Yes ❑ No If yes, attach suRp•orting doggmer tion. co Dwelling Type: Single Family ❑ Two Family. ❑ Multi-Family(# units) f� Age of Existing Structure 0 5-3 Historic House: ❑Yes ❑ No On Old King's Highway: 0-Yes 0 No ram. Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other �? Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new : ►-," Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number �SQ5 - -1 o Address �i g Hg�j , ✓t r� ✓�_G� License # �S Home Improvement Contractor# Worker's Compensation # bJCS_3/ S3 7 4:I-d3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 9 ge..4Atr1$ wn iL SIGNATURE LZA_� d - w DATE `I3 S FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED r MAP/PARCEL NO. ADDRESS VILLAGE r - i II OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION A 1 FIREPLACE ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL t FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ' (� lne uommonweacin uj iyLaLN,)�ucnuatwa fib-\ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 �•, ••• • www.mass.gov/dia ' Workers' Compensation Insurance Affidavit: Builders/Contractors/El ectricians/Plumbers Applicant Information Please Print Legibly Name(Business/organizaton/Individnal): _?C77 so (o4- O/) r-!�) l J /1C -Address: 4�.. City/Stafe/Zip: 8 0 LLA clS 3(� Ill t1 (A S Phone.#: C5 (2-� 0 Are yo employer? Check.the appropriate box: .Type of project(required):. 1. I am a employer with` ( C7 4. ❑ I am a general contractor and I employees (full and/oz 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, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.❑-Electrical repairs or additions 3111 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.El repairs insurance required.]t c. 152, §1(4), and we have no , them jJe��1 I L� e.mployees.- No workers' 13. 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. TContiactors 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 — A Insurance Company Naate: Policy#or Self-ins.Lic.# L° S 3 ( S 3:7 0 SS d 30 5 a Expiration Date: Job Site Address: w �'1 Ql�7 S Yp Q_ City/State/Zip: fGC1�i'i Attach a copy of the workers' compensation_policy declaration page'(showing the policy number and expiration date). Failure•to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine tip 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 of perjury that the information provided above is true and correct, Sirnature: --' Date: Phone#• ebb -! 7 4- Official use:only. Do not write in this area;tb be completed by,city.or town official City or,Town: Permit/License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: V T �1;(.<nchu efts f>cI(;(ruvtcnt [d Pultlii `:ilct i 6o;tr(I of Bilildin_ Rc;Cul;ttinn. :roil Construction Supervisor License License: CS 53202 JEFFREY R TONELLO PO BOX 1516 ' SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( nnnic.i...... Trd: 21481 o �� o,,,,,r:a,uuea�C/z. a�✓ zldaz�•ru�el License or reuistration valid for individul use only \ Office of Consumer Affairs&Business Regulation before the expiration cinte. if found return to: HOME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation Registration:.—171991 10 Park Plaza-Suite 5170 Expiration:. 5l9/2.014 Corporation Boston, MA 02116 RESOLUTION ENERGY:%I. JEFFREY TONELLO ' 43 FIELDWOOD DRIVE'':,:..:;" — i t lid w' out signature SAGAMORE BEACH. MA;02562 Lindersecretary UUJ rQ.l: vc._ DATE(hT.i'C0'YYYY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEPMRCATE HOLDER. THIS I CERTIFICATE DOSS NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES j BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S)7 AUTHORIZED j 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 certlflcate does not confer rights to the certificate holder in lieu of such endorsement(s). i PRCoucr� SMALL BUSINESS INS AGCY INC COhITACTIVAfNE: 542 MAIN STREET aGr F,a: 508 !. b Oo35 --_—__--LF�x./ac v�lt._(S5�_ `a13 WORCESTER, (VIA 016150022 E+ 1 aDOR6s: —. --•-•------------ _.... . INSURgRgA�C1R GYh COVERAGE N4C iIt,b'YJRERA: Lih��!Mui',�allrsurar.ce_-.,,_.__. ' INSURED INSURER B. _--.---- - RESOLUTION ENERGY INCORPORATED InsuReRc: j 49 HERRING POND ROAD _ . .. BUZZARDS SAY MA 02532 uJsuRERD: COVERAGES CERTIFICATE NUMBER: 13897741 REVISION NUMBER: THIS IS TO CERTIFY THAT THE PQLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PRICY PEi,IC INDICATED. I 1 JI1ti1Tjq,SfANDII G ANY REOI.IIREMENT, TERRA OR CONDITICY4 OF ANY CX)NTR.ACT OR OTHER DCX,IYvlE1,I V•ATH RESPECT TC)VvHICH THIS I CERTIFICATE PRAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I.S SUBJEL;I TO ALL HE.TER^�':, j EXCLUSIONS AND CONDITIONS OF SI.JCH POLICIES.LIMITS SF AWN MAY HAVE BEEN REpD�UTC�EyD BY PA10 CLAItJIS. .._'_- —I'ATSDCTSOSRI'-'---- NrDD.' Tvrl. P017L1TE�P (LIsmR TYPE OF 1t15URPM E----- POLICY tW1V BER I(P e Y (NP!IXY VYY I OF 5 i GENERAL UA61Ull'' ( i EA LI C;Hr R.R E•V_-E i lXY'Nv4L-R;'.IAL C;EiJERAL JARI!JT i I ---- --- - - I ., ! t')- i i i i IEUEXP;Fv'�e_t•r�cn' ��-----__......__......... . - i I ! I I Pcn^a^]VAL:AD\I ItLIURY IS t4LFf,GR_FC.�•TE I PFQDU_—rS_GC1,AvlO'AC'i% I iaFN_AGGRE;>ATE'U6:11TAPFIjEPCR: ( � I �------- --- —' - I T I PR I INDUCY I I Q _!x AUTOMOBILE LIABILITY j I ' L D_ hWURY(Pe �rni _..._ _ Y IN JURY(f'e'x'dd?itT FSJ YtiEDI!LED I II -- - -'-- ..... .. i C�J i I A`urGS i A.urGS I ! ! T rFFjYT�S(7rG— �tJJii✓AyEP i j I i L(' - trr: c I J RRED A1.705 i ...;9:lITCYi I I --"-- - I is J i I E CHC CURRE•v E IAVi c ' I I BFELLA LIAEr I_11 .J,7AIR r• EXCESS LIAS I_J f;LxtsP?l LU i t i I j AC�RECJ TE -- 1 'DED i,,. ..J RETLNt M1 '; i i I I r v c.ter.AP II I (I i 31120i2 !I i?20 wRERSsAnoTN WC5-31S-370523-052 . . LlrnTFsnc5U jE1.EACH A(CIDE l fr3 EivPLOERA ANY PROPRIcTC I ocf OF=1CC-R%bL DC Iv6ER D!_UDI=O? i N 1 A i I E.L.DISEASE EA BUPLnfEE'S — — ___100.00 (AAand�ry'In NM) i I --- iIf n,g a itr�uvrJer I j I E.L.DISEASE-FY)UC`!LlM- j S 50000I :D�S RlrrnCN OF C•f CRATIG`VS t7Jnw —�i— , DESCRPTI(FJ OF OPERATIC%\6 i L(Y..ATKNJS!VE'-6CLES(Attaoti Af,'D 101,Additional Rerrerks S adule,if rroe space is requi rEd) I' nb the workers co )ensaiion laves of the state FAA. . 4 lflorkers rompensalior.insunJ•,r..e cove rage app IEJ„o /to I j I I ERT.IFICATE.HOLDtR CAP'CELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE EXPIRATION DATE THEREOF, NOTICE MLL BE DELIVERED iN HOUSING ASSI�,TANCE CORPORATION 460 WEST MAIN STREET ACCORDANCEW17HTHE POLICY PROVISIONS. i HYANNIS MA 02601 ALm'IORIZED REPRESENTATIVE ' I.(f Eidridae J ---- r�1988-2010 ACORD CORPORATION. All riohts resew== ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD - Nw? •:1..� 'CI4:: I':^ r•.t•, :'2C!2 L -. H.�e.,:._ .. .>r - I?,i�s ...._._._.:,C- �.._eis .,_ ..., ,...-•:ku ..a. lsr�;._:;uc.t} is_.a:J-c�crL i.iica:es. I ' . 16�q. Town of Rarns�table D 10 ArFD Mp`i�, Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO, Building Commissioner 200 Main Street,- Hyannis,MA 02601 www.town.barnstable.ma.us ' Office: 508-862-4038. Fax: 508-790-6230 tY ProP er 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 application for: (Address of Job) \� Signature of Owner �l x f � /` � Date i Print Name If Property Owner is applying foe permit,please complete the'Homeowners License Exemption Form on,the reverse.side. i v TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map s 6- Parcel as Application # 0D- c3Q 63 S S Health Division Date Issued Conservation Division Application Feed Planning Dept. Permit Fee 3 S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address / /(0) S4Y.e.o L 9� cjon C Village /� Owner 40(line-g5 / 66C( ZQ1XJ-ffU k Address �Ma, -7 2J Telephone(9)8 -2 1 , 7 0' Permit Request Ah 7E26,(JI, lt,,L lei aef ln'ol d 9�E-kk Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation O Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) /5' 3 / r Age of Existing Structure l ') Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood"al stove:'21 Yew] No:,- Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑lnew :size_ , C> ' Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: = Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Q � Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name dL&X"C, Telephone Numberl Address !qq 11cit-1nr- l"Und a C/ License # 0 S 3 v LL. )a, Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTII�NG FROM THIS PROJECT WILL BE TAKEN TO I/ SIGNATURE la DATE LP" Q } FOR OFFICIAL USE ONLY APPLICATION# 4 DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. lne uommonweaiin uj iau4-wunuactcz Department of Industrial Accidents Office of Investigations jd . 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information "� Please Print Legib 11ly Name(Business/Organization/Individual): C_1S0 (J4_� d/1 n C r-�) Address: rr_tn5. ,w`td (Lcf City/State/Zip: 1�aZLA e(S (YlF1 S3 Phone.#: CS" - I.-1.� Are yo employer? Check.the appropriate box: :Type of project(required):. 1. I am a e to er with` 4• ❑ I am a general contractor and I y * have hired the svb-contractors 6. ❑New construction . employees (full and/oz 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 employees and have workers' working forme in any capacity. 9. ❑Building addition - comp,insurance.l [No workers comp.insurance required'] 5. ❑ We are a corporation and its 10.ElElectrical repairs or additions 3.❑ I am a homeowner doing all work' officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL myself. [No workers comp. 12:❑Ro repairs C. 152, §1(4),and we have no , insurance required-]t 13. theme I 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 Company Name: Policy#or Self-ins.Lic. (: S 31 J. S 7 O .5S d 3 O S a Expiration Date: Job Site'Address: City/State/Zip: 14T C4r7n ',3',n9/4 Attach a copy of the workers' compensation.poficy 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$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverer a verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. cDate: Si mature:- ) ' Phone#• ' Official use:only. Do.not write in this area, th be completed by.city.or townofficiaL City or Town: Permit/License# Issuing Authority(circle one): .1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: f �pF Tt1E Tom, - P � *�BARNSPABL$ + .• . . . 9� "�. ,�� Town of Barnstable prfp Mp2��' Regulatory Services Thomas F. Geiler,Director : Building Division Thomas Perry, CBO- Building Commissioner 200 Main Street,- Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property r . hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: ann c� : (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on.the reverse-side. l 1- �i;t�sncl,u ctt.. - f)cltui'ti'ncnt I Pulilit' ilcl ? Bnnrtl i,I Buildiw_ Rc;(ul;ttinn. :incl Ci; n l;irtl• Construction Supervisor License License: CS 53202 JEFFREY R TONELLOh/ �)yY PO BOX 1516 '`. SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( nniiic<inr,. Tr»: 21481 c /,e �a,,r.irearuuea�Cl. a�✓ l�a��t License or re,,istrition valid for individul use only \ office of Consumer Affairs&Business Regulation before the expirtltion date. 1f found return to: HOME IMPROVEMENT CONTRACTOR Type office of Consumer Affairs and Business Regulation Registration: .•:-171991 10 Park Plaza -Suite 5170 l ` Expiration:. '519/2.014 Corporation Boston, MA 02116 RESOLUTION ENERGY; JEFFREY TONELLO 43 FIELDWOOD DRIVE`.'`:.:`:' SAGAMORE BEACH,MA 02562 Undersecretary t lid ev' out signature LI:•4 l// GZ/ GV1G 1V GV J / Ltl'1 t'HIl C. mil VU.7 r-CL JG1 -� DATE(ITNE- e'wrvl CERTIFICATE OF LIABILITY INSURANCE THIs CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIRCATE HOLDER. THIS CERTIFICATE DOSS 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)7 AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED;sub'ect to the terms and conditions of the policy,certain policies may reclulre an endorsement. A statement on this certlflcate does not confer rights to the certificate holder in lieu of such endorsement(s). 1 PRODUCER SMALL BUSINESS INS AGCY INC i 542 MAIN STREET Et {ar r,,b a1 (5081 5_Q635 �F�x.Lc w1t....(5�-7`4 5.0 WORCES T ER, hAA 01G150022 ( __ INSl1REP{S]AFFOR[;Ni::COVERAGE-------•.._. KWIC 4 _ j I bLSUR1F A: Li1>_�1y Miltual.lrsuraD�e..........._...----.._._...._...... .L.._. INSURED Il, ER B RESOLUTION ENERGY INCORPORATED INSUR.ERC: 1 49 HERRING POND ROAD ---------..._.__.—'-..._.--- _._.......-..-._... ._...... BUZZARDS BAY MA 02532 (NSLRERD: -- --- INSVREF INSURER F I -•----- _ COVERAGES CERTIFICATE NUMBER: 13897741 REVISION NUMBER: THIS IS TO CERTIFY THAT TFIE POLICIES OF INSCIFAJCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE P�IG'r P=�,li r INDICATED. NKTRN1THSrAN1DINa ANY REQI.IIREI-AF..NT, TERM OR CONDITION OF ANY a-S4TRACT OR OTHER DCXtJ�/1E!•:i V'nTH RESPECT T(1 V'4 IGH Tl IS CERTIFICATE PRAY BE ISSIJED GR f wv PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC I TG ALL THE TERM'.:. EXCLUSIONS AND CONDITIONS OF SIJO-1 POLICIES.UWTS SHOWN MAY HAVE BEEN FEDIJCED BY PAID CLAIMS. II.'TSA I ...__ --- IATSDLz'OBR!-"_-- fdVtCO'YCITD.P'r UhA'.S i TA_ TVPE 0=IrJSURANCE POLICY MJNIBER i(P ( mDrn'vm I GENERAL UABIUTY ItSE i CLAIr,Y,_•ndALIE ! G0rJ.11i ! D EXP lAfLe_Jvs i--- --------........-- �-' PcR3--Wf-`AD\/IWIIRY I c G FP"-DU�S-CU'vIP/Q'ACC,i M .___...._..-... j..-_F. . TEUl ---- --'---' T C.M_AvC,RC-(:+iTE UP:nT PFMJE:�PER: I r-•1 i i - S 1 r--- ---- PRO i 1 _ j I j I rChIL Y I I T tr AUTOMOBILE LIABILITY r T I ( ! 150Dh-Y INJURY(Per L2r>rn) ----i ANYP:ITO pJy1vED y hiEDl!LED ALIT4 i P1IrGS I I I I 101 FFjY �KyI'v�AVEP I 1 I hlY:I lJ RREDPVTCS '---...;a.LITO ( "BRELLA LIAO Cx7;l R I i !ETCH C CURREUCE s EXCESSUas I J "'A '�V DFi LIED ' F1E-tL,\,MCN°; vJOR<ERS CC§VPB'SAnoN I 4 IWC>-31S-37Q523-052 13I1 J2Qi2 I vi 212Q13 .I ✓!Tr._L11 1 Q-19 ___ I A I;MID ENPLOYER5 UABIUTV YIN I I ` - -- --__, __ ..._..... lJJ1'PROPFIETC�'iFAFT>`i,'7:E(;l lrlVE I i i I t�.EP.CH ACC IDc�1T - !:S. 1 f.1QDOC R+bGIT rlER c'7CCJ-UDF I I N J A I 1 i 1 (fVa,daiory'In fNHG 1 E.L.DISEASE EABVPLO'fEE 1 OQO --- "' I I I"( de iL�t irtda I E.L.DISEASE-R0UCY LIIAITJ f S SOOOO, DR irm-N OF OPERATIONS W,012 - I i UESC9PTICYJ OF OPER4T1o;\6/LOCAnO"1S/VE-fICL�(Artaoti AOOhlD 101,Additional Ren>3rks Schedule,if mxe space is required) — I 1 LA/orkers rompen atior,insuranr..e coverage applies only to the workers compensation lags of the state NIA. . I i rERT.IFICATE.HOLDER CANCELLATION _ - �� ^^�P SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. HOUSING ASSISTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE WLLL BE DEUVEREO it,! 46() WEST MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 gUTHORLZED REPRESENTATIVE �- Jeff Eidridoe (7 1 988-2 010 ACOR0 CORPORATION. All rights reserve' ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ,._ +uV?;4i ^a..t='' .T,F:: 1�.4;. ;- oY.., / :':Ol2 li:•I' H.o 2.�c_ .. .�. _ .. :.t= '_.ic... ,_.,:f/:a.'....I>,-...,sb; i.__,:r:J•tort iiica_Fc. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Mapc::),'W �� Parcel Application # C�,?6 DDT s Health Division Date Issued I Conservation Division Application Fee Planning Dept. Permit Fee 3r Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis If Project Street Address Nk S�Yxj_k, T7677012is Village Owner 13 Address Telephone Csb) -7-2J— 8 Permit Request l s kojl 7 r (J_L c9L Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �DO 0 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 19 *;�,308 Age of Existing Structure ��3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wooWcoal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑.existing '0 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 O Telephone Number SZ-6 bb6 Address ` �! �_«�<�� Jv n</ 2 c` License # »L�crncl S �Ce,li m62- Home Improvement Contractor# 1-71 5 / PP Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO q 9 0n SIGNATURE 4etLjd�A_tl� DATE t FOR OFFICIAL USE ONLY APPLICATION# ,+ DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. +(HABNSPABLE + '1659539• � Town of Rarns�table 1 �� ATEQ►J1A'�� Regulatory Services Thomas F. Geiler,Director Building ]division Thomas Perry, CBO. Building Commissioner 200 Main Street,, Hyannis,MA 02601 www.town.barnstable.ma.us ' Office: 508-862-4038. Fax: 508-790-6230 property Owner Must Complete and Sign This Section If Using A wilder as Owner of the subject property hereby authorize i to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of OwnerX, Date Pi7nt Name If Property Owner is applying foe permit,please complete the"Homeowners License Exemption Form on:the reverse.side. : . (Z1 lne uommonweatin uJ lrlu�au4Rtc�eEt� o -\ Department of Industrial Accidents rn Office of Investigatians 600 Washington Street Boston,MA 02111 SY www.mass.gov/dia Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual): . �Sc7I04- O �nCr• C - Address: 4R rrrn!E� d (Lcf City/State/Zip: 3 0 ZLir c-S Gc�_ (Y)o chi S 3-D-Phone.#: CS O - I. 0 Are you. employer? Check-the appropriate box: .Type of project(required):. 1. I am a employer_with ( � 4. 0 I am a general contractor and I employees (full and/oi part-time). * have hired the sub-contractors 6. El New construction . 2:❑ I am a sole o rietor or partner- listed.on the'attached sheet 7. Remodeling p These sub-contractors have ship and have no employees 8. ❑ Demolition working for me in any capacity. employees and have workers' 9 0 Building addition [No workers' comp. insurance comp.insurance.t - r 5. We are a corporation and its required-] 10. Electrical repairs or additions 3111 qu homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MC 12.0 Ro repairs insurance required.]t c. 152, §1(4), and we have no , 13. ther�Je0. kQ �' � 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. TContractors that check thi;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: / ,'6,f 101 d kd4J, S- Policy#or Self-ins.Lic.#: L° S 3 J 3 7 D S d 3 y S Expiration Date: . - / - 01 3 Job Site Address: w .�1 Q(�7 �r P City/State/Zip: yaorl i,S Attach a copy of the workers' compensation.poHcy 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 penalti6s;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 inc,nnce coverage verification- I do hereby certcfy under_fhe pains and penalties of perjury that the information provided above is true and correct Signature-* �--'' Date: Phone# Official use only. Do not write in this area, tb be completed by.city. or town official City or Town: Permit/License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone.#: f Y >=:w `I;Is S;(CIIUSCIts - Ocl(ni•1 I'll ell t nl PultlI �:ilcl a D B(mr(I nl Buil(lin Rc;Cul;(tinn. :in(I `(unil,ir(I Construction Supervisor License License: CS 53202 JEFFREY R TONELLO1�r � ' PO BOX 1516 SAGAMORE BEACH, MA 02562 �! "� Expiration: 7/14/2013 ( • nunic.inr,. Tr»: 21481 /ze �o,,,,,,ra�uuea�C/:. a�✓ »a��r License or registration valid for individul use only \ Office of Consumer Affairs&Business Regulation p before the exiration date. 1f found return to: —. HOME IMPROVEMENT CONTRACTOR Type. Office of Consumer Affairsnd Business Regulation a (Registration: . 1.71991 10 Park Plaza -Suite 5170 Expiration:, 5/9/2.014 Corporation Boston, MA 02116 RESOLUTION ENERGY":1NG:.: JEFFREY TONE L`LO 43 FIELDWOOD DRIVE' t lid w' out sicnature SAGAMORE BEACH,MA;02562 Undersecretary LI'IV LI/ LZI LV1L 1V�. GVV ! [>t'I YC1V C. _ DA7-, V'DQ'YYYY) 1 CERTIFICATE OF LIABILITY INSUIANCE 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: Ir the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED; subject to i 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 SMALL BUSINESS INS AGCY INC ---- 542 M,411V STREET P+-IONE(LgNg,,n1 (508) ,;.L—C 35 WORCESTER, KAA 016150022 E+NAIL ADDFess: — ---•-•---•.--------- --._...---._... INSURE P{SJAFFORD4tJGCOVERAGE NAIL 1 ! USURER-A:- �11 LiL� MiltIal.lrsurance.......... _...--'--................. L..... '" INSURER a. RESOLUTION ENERGY INCORPORATED Insu.,ERc: 1 49 H E R.R I N G POND ROAD --------•--- _.__._.---'.-.---"--. ._...._. ! BUZZARDS BAY MA 02532 LNSURERD: INSURER F: --- COVERAGES — CERTIFICATE NUMBER: 13897741 REVISION NUMBER: _ THIS IS TO GER-q- THAT THE POLICIES OF INSURANCE LISTED BELCW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR T f' PCLIG'y P;� IC r INDICATED. N 3T\NITHSTANDIN3 ANY REaAREMENT, TERM OR CONDM0\)OF ANY CX)NTRAC:T OR OTH=R DCX',UNAEl,I vnTl-1 RESPECT TO VIMICH tl IF CERTIFICATE VAY BE ISSUED OR fVAY PERTAIN, THG INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREII,J I.S SUBJE--TO A-IL THE T_PW.r. i EXCLUSIONS ANL)CONDITIONS OF SUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS _,- --- ur,�is I dSR I TYPE OF it4s,JRAN:E IA'6DCSUER!- POLICY MINIBER 1 Ir YVY) l �` vvh I .- i GENEFAL UABIUT'Y --- j MEU C�41t✓'S•r/wDE ! �O:/:J.F. ! i I -'---�----'=-----.._.._,._ L_.-_..._ ,........, I i AD D� 1 I SCNA_L` \I InuuA'y c i i I 1 I !GErdE.94LP!'fR_FC�TE -�A . ...._-'------_.._._................ .... .. f ._. _ . I � PFt:DU�S.C,:7J�G/�AC_- w i GEN'_A,3GRC-CA.TE UP.IIT APPIJES PER: I ---- --- -— i i....___ ,.._.__ PRO ! j ro Cy I T 1Y Jy: I AIJTCNVOSILE UABIUTY - 1 �DLYlNJUR(PEI V=rrni i - ANY AUTO I ----L. _.__ -_...._._. .. ...I p I i C- I_YIIllIJRY; g"ED SCHEDULED AuLr u ;sT6 _ ?.IrTO;WREDA1fTC6 _ I 1 I 1 MBRELLALIAB I EXCESS LIAR . I 1...._.i DED vvORKiT,SMVP=TSAnCAN I IWC5-31S-370523-052 13/12/2012 Iail2/2013 !Trr'v�LTATSI A I,AI,0 EWLOYEr'G LIABILITY V f N I —_-....... () ANY PROPPoETCPJPAR -r/7(ECI rrIVE I I i I E.L.EP.CH ACOIDETr - Is - 1000(1C1 �;N,A I -- 1 O ICLRR.[T L'ER DCCJ:UDI:C? N ! I E.L.DISEASE-EA SIPLOYEE'S - 10000E 1 (Nand3tory'in NHf tl•�Ex,de Ii'x3 LmJer I i i 1 I E.L.DISEASE-POOUCY LlMr s 50oa"' D�XRIP'nCNOFC'PCRAnCJ5is nw 1-- �UESCF;7p710N OF OPERAnGB+LOC:AnCNVSr vE&ZLETi (A1T3o'1 CORD 101,Additional Rerrerks Schedule,if more mace is required) I V-1orkers compensation.insural':ce GOVOrade applies only To the workers Gompensaiion laws of the slat?MA. .. j I 1 �ERT.IPICAT�.HOLOER _ _ CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED PCLIGES BE CANCELLED BEFORE. AS51�iTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HOUSING HO SINGWEST MAINSTREET ACCORDANCE WITH THE POLICY PROVISIONS. HY/1NNIS MA 02601 AUTIiORZEDREPRESENTATIVE ----- :g)1988-2010 ACORD CORPORATIOI,s. All rights reserV== ACORD 25 (2010i051 The ACORD name and loqo are registered marks of ACORD - ny?' •:1.- '.'r,f:: 1`;�:: � •.5•, ' :?l'l. 1_�t' -. S�L�c.,--,� .� I.a... ..._._._at? <...:-.is.•.,� ..., L.^•:b::'......1°7 .....sly L_..:;-'J-rm•L'.i.PicA:..�. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map 0��0 U�� Parcel �` p-lic�atilon�j#� 30 Health Division Date Issued 1 Conservation Division Application F4,- Planning Dept. Permit Fee . Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address -le UJ aS�-`Y1 Caw, su-, Ajoon, S Village Owner T ZW701'a 0811c/ A2�4w Address /n c) ,6Uk /& 7 S,� P IrV7 i2��C- Telephone (SZX M / - cF 3 a 4, Permit Request u o i c Yh c_ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation rd,O Construction Type f o Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 11 4N�3 �1 T Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: o:Yes Q No , Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other d 4� Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size — Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name J Telephone Number Address `i ;�/i Y�y y✓�U /�� License #'A S .-3 U d Home Improvement Contractor# /-7 / 57 S Worker's Compensation # PCS-3 30,S_ ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �0LL SIGNATURE �� l C a DATE " j F FOR OFFICIAL USE ONLY { APPLICATION# i DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME i INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' GAS. ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. lZ� Ine Uommonweaan uJ trlu�aucrcuaeEr� �-\ 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 Inforlmation Please Print Lez ibly Name(Business/Orgm zaton/Individual): G r1 (1C •Address: 49 . t4 Sri n$ '(JU•n d (Z L City/State/Zip: e(S.LG,, rY)i CBS3�-Phone.#: CS' � �- I.�� D Are yo employer? Check the appropriate box: :Type of project(required);. 1. I am a e to er with` 4. I am a general contractor and I 'y * have hired the sub-contractors 6. ❑New construction . employees (full and/oi part-time). 2:❑ I am a sole proprietor or partner- listed.on the-attached sheet 7. ElRemodeling ship and have no employees These sub-contractors have 8. Demolition employees and have workers' working forme 'many capacity. 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required] = 5. Q We are a corporation and its 10.❑Electrical repairs or additions 3.0 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.❑Ro repairs insurance required.]t C. 152, §1(4),and we have no employees.[No workers' 13. ther�;Je � L 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 bane employees,they must providb their workers'comp.polidy 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: !,,6 C/1�`i n1 d U qJ Ms. Cd Policy#or Self-ins.Lic.# L° S 3 Y J. 3 7 D S a 3 Expiration Date: . .Job Site Address: I W .n1 Q.(.-) 9-YeQ 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 of per that the information provided above is true and correct Si ature: �� Date: .%ad- Phone#• C � / �� ^ 7 4 C7 Official use only. Do not write in this area, fb be completed by.city.or town of City or,Town: PermitUcease# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector .5.Plumbing Inspector 6. Other Contact Person: Phone#: i �. `1:ts•achu�ctt� - fh'Irtrnncnt of Pulilir `:ilc'I� Bwtrd iil Buildin Rc:'ul;ttinn• antl tituntlartk ConstruCtion Supervisor License License: CS 53202 u ,l JEFFREY R TONELLO {L' htl PO BOX 1516 ' SAGAMORE BEACH, MA 02562 _ Expiration: 7/14/2013 ( nnnisi n,,i Tr-g: 21451 c /ze >Goo�wseoruuec��C/ a�✓ �az�'{ License or registration valid for individul use onlY �\ Office of Consumer Affairs&Business Regulation before the expiration clnte. if found return to: nd Business Regulntion HOME IMPROVEMENT CONTRACTOR Type office of Consumer Affairs a Registration: .-:�1.71991 10 Parlc Plaza -Suite 5170 Expiration:, 519/2D14 Corporation Boston, MA 02116 RESOLUTION ENERGY, JEFFREY 70NELLO ,I 43 FIELDWOOD DRIVE.:'.; ..: lid w' out signature SAGAMORE BEACH. MA:_02562 Undersecretary ypF SHE Tp� , v + • 1ARNSrABLE, + '"AS& 'T i639• own of Barnstable �� pTfp Mpl�' Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,' Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property ®wrier Must Complete and Sign This Section If Using A Builder I, a - as Owner of the subject property 1 P P rty hereby authorize ezP - to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner �r # / ,% Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on,the reverse.side. :. Lly� �,ri7r G�vlc 1v' GV ,Jr nrr C'r-fUC. DAT,-(Nw C(-YWYY) Acc->R CERTIFICATE OF LIABILITY INSURANCE- -'. THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEFMRCATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES i BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S>, AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. III4PORTANT: If tl,e certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED.subject to ! P policies require an endorsement. A statement on this certificate does not confer rights to the the terms and conditions of the policy,c_main p may Y eN certificate holder in lieu of such endorsement(s). i PRCOUCER SMALL BUSINESS INS AGCY INC CONTACTNAmE: -_-.- .------------ ! 542 MAIN STREET P gNUF(aGNo_�a1 f5081 i. 5=p635 --_-_.__._�FLx_LC1:._.L55�_7`:1 500 .I W O R C E S T F_P,, PA A 016150022 L ADoaEss: _- ------------------- -------- i INSIIREP{S]AFFORL�Ik:COVtRAGE--------.._. _IyA1C IhLSURERA: Lil>�11 Milr�al IrsurancQ....._..---_-------.._......_.. 1.... INSURED INSURER RESOLUTION ENERGY INCORPORATED INSURER C: 1 49 HERRING POND ROAD _.------ D: I BU-Z_ZARDS BAY MA U2532 INSURER-- ----._-• -----------------._. __....-- _ ; INSURER E: _.._ In6iJRER F •-----• I - REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: 13897741 ---THIS IS TO CERTIFY'fHAT THE R7LICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PaICY P*E;-,I(r; i INDICATED. WM1v1T1-I,SfANDIN3 ANY REQIAREIAFI NT, TERM OR CONDIT1 4 OF ANY a-J TRACT Cn^OTHER DOnJIv1Ely I WITH RESPECT TO V,MIC H 714S i CERTIFICATE p,taY BE ISSUED C MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERV!:,. j EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN INDUCED BY PAID CLAIMS _.-_- __�P.T56L'•51113R:,_._.—_.—.—_ i P OFF P15U Y EXl' Llt�`S ((� r 11•IS,�H I TYPE OE Ir15URA!`k;E r POUCY NUMBER I If DO'\'YY1')'(Nr'!rQ'YYV VVl l i GENERALLIAB!UTY I f3+G;HrTl1R.RE\✓-E _.. .-_---.....__.._. j I IXriN�1L--FYJAL:;EiyERALJG.RI!-17l• I I i --.---'- _ 17 .._. - I - n I '-,ci�EJ ' ! CLl+l;dr5-IVWDE ! I O?:J.F. I!�.---.- .----- ---..__....__.__....- I tEU EXP;Prime;>.r.in' ...�. � _....._ i L_.__.._ ; o� I I i i I ^a'VAL.`.ADV If,UURY !----------.. ! PFL)DU G EN!_AGGREGATE U101T APPLES PER: t K)iJCY . . I :T Gx —1 AUrt7NOBILEUABIUTY ANY PUTS (�n�� r��•�I'YIP1711RY;PA-�cd�i t1 g PU,L S I__I AUrc; I I I�KYJ v+`6VED i � L�'s.aUl-t:l I r iJ HREOP1frOS E- I S I IUMBRELLALIAR r m i ! CFIGv.CCURRENCE 7;l ' F�CESS UAs C Int,.rr�tALIE i, i I I ai GREGAT -_i` LIED RElZ MC VE; ! �-rAnl- qr , WORKERSCONPR SAT,ON I j1A105-31 S-370523-052 13/1212012 j 3i1212013 � �!T�?�urrnTS� I _N A I AND SVVLOYE S'LIABILITY Y I N( _ i ANY PROFRIcTC:FiFARi -Id7:CCIRIVE I UP I i I i E.L.EP.CH_AGC!DE1T i :ICL-i-49. LER LIv QCI-UDED" �N N 1 A I I I -_---- - I N in� I E.L.E.L DISEASE-EA Bv1PLOYEE'S-- 10�GQ'' I,•Er.de iW r.vdn I i ) I E.L.DISEASE-POLICY LU,1 I is 50CIQ0I� .D Rlrrn V O`C•PERATIMIS Wn1V _ ! L DES'CRP,nCTJ OF OPERATIG'S i LOCATiOf15/VE' CLE.S(Atmgo;ACOhID 101,Additional Rerrerks Schedule,Ii rttxe space is required) I 4 V-1orkers rompensalion insurance Coverage app!ie,s onlyto the workers rompensaiion laws of the state.b-AA. ! CERT.IPICATE.NOLDE- CANCELLATION I SHOULD ANY OFTHE ABOVE DESCRIBED PWCJES BE CANCELLED 6EFORF. HOUSING ASSISTANCE CORPORATION THE EXPIRATION DATE THcREOF, NOTICE 41 LL BE DELIVERED iF! HOUSING SINGEST AS I STREET ACCORDANCE WITH THE POLICY PROVISIONS. ! HYANNIS MA 02601 ALRI-QO Zm REPREMNTATIVE f 1.0 Eidridoe --= .)1988-2010 ACORD CORPORATION. All riohts reserved ACORD 25 (2010705) The ACORD name and logo are registered marks of ACORD :,t? _?ic. .:_ ... ;:,r:v:H:n ..,.: t:-,., sl•, .__:;crl acrl is ice.:e.. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 6'4-) Parcel Application # �O lw�jC oL Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 3 S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address F 60-ObO�— ( a iC¢,(� Village Owner 7 Cwne� Address r 06 e CDG /(o-)7, r lryt( �� Telephone ( � - 6 -7U J- Permit Request InS kt? 5 ?S S5 . 4�k. Qk (Jared)-L (Itt cl 9-7'K C� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation c�a UU� , 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 5F3 Historic House: ❑Yes ❑ No On Old King's Highway: &Yes 0 No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other 1 Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) 1 0 -' Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 42 V U�g-/ Telephone Number 7� / Address aerlI rt ` �✓ic� �-� License # ( S 9-3--)-c-) a- c,�U L-� Home Improvement Contractor# Worker's Compensation # U-0- 5-3 S 33U - ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ra4A5 �UnC/ � rl �ul � , 4" 4 SIGNATURE DATE " 13 FOR OFFICIAL USE ONLY APPLICATION# t DATE ISSUED 4 MAP/PARCEL NO. ADDRESS VILLAGE OWNER r , DATE OF INSPECTION: FOUNDATION FRAME INSULATION ,F FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING z DATE CLOSED OUT ASSOCIATION PLAN NO. y r lne Uotmonweacin uj lrlu�auc nuaett� Department of Industrial Accidents ' Office of Investigations 600 Washington Street Boston,MA 02111 6•• • www.mass.gov/dia Workers' Compensation.Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legib 1� ly Name(Business/organization/Individual): c—Sc7 y-'H d l) a'1 e r!�l - Address: 49 .r r-1 City/Stafe/Zip: L�UZtA,:c(S P)0 a 3'.;-Phone A: CS' I2."1 0 Are yo employer? Check.the appropriate box: .Type of project(required):. 1. I am a e to er with 4• Q I am a general contractor and I y * have hired the sub-contractors 6. ❑New construction . employees (fall 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' 9 Building addition [No workers' comp.insurance comp.insurance.$ - required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.0 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.❑ Ro repairs c. 152, §1(4),and we have no , d insurance required.]t 13. ther�X6�� i employees.,[N" 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 providb 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°l n1 y�U ZOL CCU• — �1 Policy#or Self-ins.Lic.#: jl� �° S 3 ( J. 377 O .s- d 3 O S Expiration Date: Job Site Address: I (.C) .f7�GLc,7 �Y Q_ City/State/Zip: 14 yG-rm P,5•,n�� 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•at penalties of perjury that the information provided above is true and correct Si �3—' Date: afore:� ) Phone# Official use only. Do not write in this area, fb be completed by.city.or town official City or,Town: PermitUcense# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: li >=. `lns�nchu�ctt� - fh•Itnrtrnt•nt nl hultlir `alcl� a Bo;trtl III' Buildin' Ru..!i1 rttinn, :intl `i,intl;irtl Construction Supervisor License License: CS 53202 JEFFREY R TONELLO PO BOX 1516 SAGAMORE BEACH, MA 02562 Expiration: 7/1412013 ( unuisinri. Tf~: 21481 c /,a �a„t,,,:o uuea�C/z a�✓ aa��r License or registration valid for individul use only _\ Orfice of Consumer Affairs&Business Regulation before the expiration cinte. if found return to: HOME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation Registration: .y=171991 10 Park Plaza-Suite 5170 - 67 Expiration:. 5/9/2014 Corporation Boston, MA 01116 RESOLUTION ENERG.Y;ING.::;:.::. JEFFREY TONEL'LO... - 43 FIELDWOOD DRIVE'-..:. t lid w' out signature SAGAMORE BEACH, MA02562 Undersecretary L� D ATE CERTIFICATE OF LIABILITY INSURANCE' -41 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 JTHOR DIES ED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. INAPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED; subject to the terms and condiiions of the policy,certain policies may require an endorsement. A statement on this certificate sloes not conger rights to the certificate holder in lieu of such endorsement(s)- — PRCOUCER SMALL BUSINESS INS AGCY INC CONTACT NAME: 542 MAIN STREET ptply= G lallo,En1. (508175Oo35 . W O R C E S T E R, MA 0161500 22 INSUREP AFFORLS'!�COVERAGE _ty41C.!:. j INSURER A: Li1>_�111 fJlip l Irsur�DSe..........._...----.............. ... .!..... `i ICISURE D INSURER a: RESOLUTION ENERGY INCORPORATED InsuR,ERc: I 49 HERRING POND ROAD ---"------------'—'--- --- —_._..__._......_.. ..T....... 1 BUZZARDS BAY MA 02532 (iSURER D: INSURER E: I -•----- •--_ _ I INSURER F COVERAGES CERTIFICATE NUMBER: 1313g7741 REVISION NUMBER: _ THIS IS TO CERTIFY-rHAT THE POLICIES OF INSLJRAIJCE LISTED BELOW HAVE BEEN ISSt lED TO THE INSURED FAMED ABOVE FOR THE POLICY RE,IC0 INDICATED. WO WITHSTAND+N;;ANY REO(1IREl•JEWT, TERM OR CONDM0,J OF ANY OOITrRr,ACT OR OTHER DO;tJrv0,11 VoTH RESPECT T()kN IICH 114.5; I CERTIFICATE NAY BE ISSUED OR tVAY PERTAIN, THG INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEC-1 TO 11 L The T_R^n',. i EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _- _ — —_.--.--___-__...._... . 1171 — P�j��OFF �CY EXP UhAS I•ISA I TYPE pr InLSURANCE + POLICY MINIBER I(P/7VtDD'YYYYi (M'IrIXJ/YYYN I 1TR i GENERAL LIABILITY I I EflCra!X�LIRRE•N:.E _ __j c_._..--....__.._. 1 r i i (XYN{EF�.LAL r:EnlErt4LIJa.9I!_ITY _... _I I I imEUEXP;Ar�e;t'I•.'r.�i I' CKIDJR PER^oJ"VAL:ADV NuuRv -IS - - SR .----- .. . .. I -T I.^.:.. ._.. ._ PP0DU., S—-COviP/O'AC•i w I 1 UFN�_AGGREGATE UfkIITAPFUESPER: I � i ---- - r-- - PoO. -1 I S 1 j 1 r1)i1l Y I T A'rOWOBILEUABILITY I �o ceri ac)DILY 1,\UURY(Per percrnl ANY AJrO EG IJ I PLL -..._,F/.J'iEDI!.ED I --�.__—'_---....._•..... ---•-Y II�L+IIRY/f e-�'ddxfi g. AurC`S ` i Pur('R pr'YPFF-s YrU*AA(�-�LfrrY3��VEP WFEDPI.JTC6 `--...;a dTfO'•i "- I I I -- M -- I EACH O'..CURRE V;E c I {UViBRELLA!LIAO IJ rAY.;IIR I �. -•----------_ . t EXCESS LIO6 I LIED ._.1 j I I I I '•til ! A I WORKERSCW'B.SA'n I%AIC5-31S-37 v �li I 1171l I = ! AND evFLOYERS'UAGIUTY YIN IEACH i ANY PROPRIETC:PsPAR-IWZ/7:EGIrrIVE I j E.L.EA.CH_AC,C+Dc^fT .—. y.___--__---_1p00pf� Or=ICL�1.LP LEF OCG+:JDI?0 ❑N i N'A j - -- —' - - + '(f�rl�n'in� i EL DISEASE EA Hv!Pi.OYEE'S 10�OQ� -- N,' E.L.DISEASE-FOUCY U1,47 1 S 50000f D�ti(RirrnCNOFC•PERAMONSt mvi 101,Additional Re ra ks Schedule if r DESCRPZICYJ OF OPERATICK 6%LCK�ITICNJS!VFU eCLES(Atra7h ALCO-hS) ro a mace requirEd) i I V-1orkers rompensalion insurance Covarage appiie)s onlytothe Workers compensation IaYvs of the state MA. , I I CANCELLATION — SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. lII ING ASSISTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE WI-L BE DELIVERED IN HOUS HO tESTMAINSTREET ACCORDANCE WITH THE POLICY PRVI OSIONS. HYANNIS MA 02601 Avrii0i�IzEDREPRESENTATIVE ` f G _ Jeff Fidridae l — *1986-2010 ACORD CORPORATIOP3. All rights reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ,uv'?:;` rl ',:,•f:� I".Sc+ „-,r. >2" ' i.-•el;: L?:!7:'.. c.I..,P.oge .u. - i.,l_.. -.._._._.'.�,t- ...._?i_'•�.�i ...i. ...r:N:a_..,,Ir ;.-_,ely L__:rcrJ-ccrL'i.iicaCec. i P � r s BARNSrABM '""3 i639• 'Town of Barnstable �� AIfD�.�6 ]regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,' Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 9 as Owner of the subject property i . hereby authorize b— c-,ft-cnelq r . ': to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) \� Signature of Owner x Date L � : - Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on.the P p reverse.side. :. o TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �S( Mapes Ia �� Parcel �� Application # c`O��3 I Health Division Date Issued �, 3 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address !4," &)2S L- _M t m 51'V�Q l�y� A cula ta4) Village Owner ('D: /0011C/4 MOA l-1 u*l Address P6&,-- 1 0 qd Iry-inn IX Telephon� l - 6 7 0 c- Permit Request Zn3 /-?Jj � &4 &C'/ Sp i�C/ 0',glc,�t11 L P L-A4 Square feet: 1 st floor`, existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation A Q 'Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 7 Age of Existing Structure 6 3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood coal stove;, LYYA ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: 0 existing LJ;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 A2 O Telephone Number ( 5 _0 4 Q Address 41 4 1 n! d c/ License # Home Improvement Contractor# /:2 l 7� � Worker's Compensation # 0613 LU a I_c.3OJ-a. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 49 6=AA I n 2Cl ZDIA,�, 0,1 DATE SIGNATURE TO� �C� �-� "13 ,o FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE 5 OWNER DATE OF INSPECTION: ,h FOUNDATION FRAME i3 INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. � o Y seRNS'reBLF + 9Q '""SS1.63;9. 'Town of Barnstable Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,' Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 9 as Owner of the subject property l r hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) 2-2 Signature of Owner f�, °_ Date Print Name If Property Owner is applying foe permit,please complete the'Homeowners License Exemption Form on,the reverse-side. lne Lommonwe=n uj lY a4sucnua of 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/Org=zation/Individual): -?C-So (04t G1) e r�1 �4 /1C - Address: 45 r(-rn� City/State/Zip: 8 U LL A dS 00 ►y)A CA S 3.-Phone A (S"Z-)q )(53 8- (^?� 0 Are yo employer? Check.the appropriate box: .Type of project(required);, 1. I am a employ er with 4. ❑ I am a general contractor and I * have hired the sub-contractors 6. ❑New constriction - employees (full and/oi part-time). �, Ramoden 2.❑ I am a sole proprietor or partner- ]isted•on the'attached sheet ❑ li g ship and have no employees These sub-contractors have •8. ❑ 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 officers have exercised their 1 l.❑Plumbing repairs or additions 3sa homeowner loin all work ❑ myself. [No workers' comp. right4f exemption per MGL 12.❑ Ro repairs c. 152 §1(4), and we have no , insurance required-] t 13. ther Ij.JeCt �I L 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. 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 far my employees. Below is the policy and job site information. / Insurance Company Name: ,6 C/t�! 01A U 4J. //1 S ("0 -- Policy#or Self-ins.Lic.iP L° 5 3 J.. 32 O S d .30 E-a Expiration Date: Job Site Address: /46 S�-r Q 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 VTORK 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 covers a verification. I-do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct c3---' Date: .Id, 3 t Si afore:� — Phone#- ebb ^(7 40 Official use only. Do.not write in this area, tb be completed by city.or town officiaL City or Town: Permit/License# Issuing Authority(cirde one): .'I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 4' > �I;Issachu•ctt. - fhllnrtrncnl nl Puhlic C. 1 ^ Bnartl nl L3liiltlin_ Rcttulatirin> anti �tunlLirtl Construction Supervisor License License: CS 53202 ,} JEFFREY R TONELLO PO BOX 1516 SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( nuni„inrr Try: 21481 c �/� L^anz�naracuea`� a �ii�ati�•ruleCGi License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. if found return to: HOME IMPROVEMENT CONTRACTOR Type office of Consumer Affairs and Business Regulation Registration: ..: 171991 10 Parl(Plaza-Suite 5170 F . Expiration:. 5/9/2b14 Corporation Boston, I\7A 021I6 RESOLUTION ENERG.Y':ING..::;::: :. JEFFREY TONEL'LO`. 'i r-:,•.a t 43 FIELDWOOD DRIVE'..::;'.'::: ��s--y� -- SAGAMORE BEACH, MA_02562 Underseuetary t lidw y- -utsignature LI'IV ll/ !7./ 4,V1L r l,'V.J r a is .J c i •:�,- par(na,fCc!'YYrvl CERTIFICATE OF LIABILITY INSURANCE ' l THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEPMRCATE 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. In4PORTAWP. If file certificate holder is an ADDITIONAL INSURED, the policy(ies)must ce endorsed. If SUBROGATION IS WAIVED.subject to i 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). PRDoucEll SMALL BUSINESS INS AGC1' INC gO AITNAME: ---- ------- 542 MAIN STREET I NN�acrv�,F�at f5081%.9L-Q635 -SQoc .I WORCESTF_P,, MA 016150022 INSUREP{S]AFFORIYNG COVERAGE--_----_ NwC ti INSURER A: Libeiw .........._...__.__................ l-. --------- --- '-- - INSURm RESOLUTION ENERGY INCORPORATED INSURERC' - ( 49 l-I E R,R I N G POND ROAD ----...---_.._ BUZZARDS GAY MA 02532 INSURERD: -----..._..--.__..._.......... _. INSURER F: ._.-- L CERTIFICATE NUMBER- 13tig7741 REVISION NUMBER: COVERAGESTHE THIS IS TO CERTIFY"THAT It-It- POLICIES OF INSUPJu�CE LISTF_D BELC)u'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR ECT TOLIGY INDICATED. I3;JfVVITfg,STANDIN3 Ar\'Y REQUIREMENT TERM OR CONDITIGJ OF ANY(XXJTti4CT C^n OTHER DCX IJ/1EIti I vnTH�cSPECT T(?VdHIC 71 I5 CERTIFICATE 1,JAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL HE T=Rrn, j MAY HAVE B TS S EXCLUSIONS AND CONDITIONS OF SUCH POUCIES,UMIFIJWN EEN REDI�ED BY PAID CLAIIJLS. -O —-EC- -pZS UI•R ---... - - -------------' rAN�� IATSt3L'•5013FL__.-- I� f✓!r GY3rY� r 5 II,ISR TYPE OF INSURANCE ,Ilycp I yyyp �UCY MMBER (f�I L!'r LTA: i GENERAL LIABILITY I� ,•wI __ __ _..__..k ..__........... C_I'• -I H ' �U EXP;Arr ale:'r•rs�-,� _ _ I --............... l � I I I J+IrJS•hiWLIE ! G.J.1P, ! _ i PeF.^�,.}"VAL F.AD\I If,UU I c RY _......_._14- CT ' _.___...__.._._..__........... .... .. i I ! PFODU' 5-CCtviDrOP AC_- i ti GFN G:AGGREATc Ulv11T APFUE:S PER: I I -------'- t roucy Pop. --'i Y i 5 I l'---' I ALfrOMDBILEUANUTY i I °L;pILY II�IiURY(PEr�r-lapfi ,. .I -'?AIJY AUTO T -- -- •-._ p'L rEJ ,Y';,hiEDUIED I ES_Y IN:41RY rPF -..__.. _- _._......_.. I �._�ALfrG ED 1, r J HIRED bifros I_ ,d.IITOS _._........ _--'-' I I I I E;.CHO'-.CURREvE^ - c I �- I IAVFBFELLAUAO IJ rgY.;UP. --',EXCESS LIAR I_J CLAI"c14 DEt f REILVTICN�:F I ' II-- j LIED I... 1AC`'TATLI- 'OI I -i A worTCEAscceuP�sanav I fWCS-31S-370523-052 13I1J20i2 I31'J20i �';Tc=>�LInoTSI I.AND OV1PLOYERS'LIABILITY YIN! I _t!E.L.EACH AC�DE\rr PJ4Y PRCtPRIETCPiPARTI�P:'7:EOtrrIVE : i i I ---- - '{M�C ryLlnNM cOtCLUDFC1 I NrA i I E.L.DISEASE•EA BVPLO'fEE S - - 107QQd I "t Iif••EG, r.,oily t.mja I i j I E.L.DISEASE•FC?UCY Uh1fT I,S -500.^,011t :0 cVR dt IfTnCNOFCPERAII( litrrnv I I f DESCRPTIDN OE DPERATIt_!Lo aT10NSr VE'•9ClFS(Arran ADD 101,Additional Pem3-arks 9d,adule If more space s requirEd) I 4 Ir./orkers rompansation insuranr.,e coverage RIIpIiE,e,or.lyto the worl<ars compensetion laws of tha state tJIA,.. I I i ;CERT.If ICATE.NOLDtP ----a CANCELLATION — - SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. HOUSING ASSIL+TANCE CORPORATION THE ENPIRATION DATE THEREOF, NOTICE WLL BE DEUVERED it. d60 VdEST MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 ALJMIORIZED REPRESENTATIVE 1 - _ Jeff 6idridoe -- d-, ;�1988-2010 ACORD CORPORATION. All riohts reserved ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD .. ,4`.+L? - ic^ ,_ ... L.._•:6.;-., .... pr�...r:.l•, L�:;.�J�cerL it ica:ec. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map oZ�ld Q� • Parcel Application # Health Division Date Issued k1 L Conservation Division Application Fee Planning Dept. Permit Fee �3 4 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address V-, �CuM S LrtL. - 7�, n� S Village _ ' /' YY�� / - Owner 72u,/(�P. fPolrlAp�o-yw Address P6 Qc c �� I/�yJ ►'t S J Telephone Permit Request S �n�� i�r',eS J--n e-tt-c( S•c,O k C/ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total,new -� Zoning District Flood Plain Groundwater Overlay Project Valuation ' Construction Type r Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 3 ( ^? v Age of Existing Structure 2) Historic House: ❑Yes ❑ No On Old King's Highway: ❑E* O1No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 12 76 (D Telephone Number Address Q� �-f P 1-6 n 5 License Home Improvement Contractor# Worker's Compensation # 60(�- 3 3 U 3 U ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED 4 MAP/PARCEL NO. E i ADDRESS VILLAGE OWNER t DATE OF INSPECTION: f FOUNDATION FRAME r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL i GAS: ROUGH FINAL FINAL BUILDING s DATE CLOSED OUT ASSOCIATION PLAN NO. Ine Gornmonwearrn uj lvtusauc rcuartcp Department of Industrial Accidents Office of Investigations y 600 Washington Street Boston,AM 02111 ' www.mass.gov a Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(BusinesshJrg=zadon/Individual): -?�—,s8 (o4H all •F:::i_ne r�) �.j /1C - -Address: 4-9 • 4crrrn� w �C( (L City/State/Zip: 8 U Laird S Ga CYlH C,B S 3.;L-PhoneA CSC - I.^1 0 Are yo employer? Check.the appropriate box: .Type of project(required);. 1. I am a employer with 4. ❑ I am a general contractor and I employees (ftill and/or part-time). * have hired the sub-contractors 6. New construction . 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 •8. ❑.Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.insurance Comp.insurance.t required] 5. ❑ We area corporation and its 10.❑Electrical repairs or additions 3.0 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 12.7 Ro repairs insurance required.] t c. 152, §1(4), and we have no XC employees. [No workers' 13. they IM 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 ttais 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: I ;! ✓lam; n1 I L-i�G bn S �O.J. J. Policy#or Self-ins.Lic.P C° 57.3 1 J. 3 -7 Q .SS d 3 y S Expiration Date: O/ 3 Job Site Address: 146 w ��a(*,l LYP P City/State/Zip:4 l/GCim 1,3,� q 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 dry 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 of perjury that the information provided above is true and correct. Si Date: .%� 3 / afore:� ) Phone#• (,Snb Official use;only. Do not write in this area, tb be completed by.city.or town official City or,Town: Permit/License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: i/ :-. �t;i<.;,cliu.ctt� - f)cl�urtrncnt ul Pulilit' �;ilcl� 1 Bo;wd nl Biiildiit_ Rt;;ulatinn> ;roil �funilaril Construction Supervisor License License: CS 53202 JEFFREY R TONELLO PO BOX 1516 1 SAGAMORE BEACH, MA 02552 �h Expiration. 7/14/2013 Trx: 21481 �/e ,°oo,,.,tarzu�ea a�✓ l�a��` License or registration valid for individul use only Oflicc of Consumer Affairs&Business Regulation before the expiration date. if found return to: HOME IMPROVEMENT CONTRACTOR Type office of Consumer Affairs and Business Regulation Reoi:;tration: .•,'171991 10 Park Plaza -Suite 5170 Expiration: 5/9/2014 Corporation -Boston, MA 02116 RESOLUTION EN ERGY.: ING.::;`i;;. JEFFREY TONELLO � 43 FIELDWOOD DRIVE'.:':::;:;: lid w' out signature SAGAMORE BEACH,MA'-02562 Undersecretary J 4,v DATc(N'M CfYYvv1 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFCATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES i TITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONS 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 i 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 sucli endorsement(s)- PRODUCER SMALL BLISINESS INS AGCY INC cavrAcrNAmE: -------8 -- ) 542 M.AIIV STREET PY, E(AC_nlo_FJ¢1 (50817�50635 �F ..LG"�1'..-.(5�- `-'8.., -� WORCESTF_R, 11AA 016150022 En�L aDOFEss _- ----------------- - _ INSUREP{S pFFORa COVERAGE-- NAG _...__--.._............... 1.... INSURER 9: RESOLUTION ENERGY INCORPORATED N-19J REF c: 49 HERRING POND ROAD ---...---- -_.__.—.---.-----'.--._..___._..._.. ._........ ! BUZZARDS BAY MA 02532 INSURER ID: I -• -- COVERAGES CERTIFICATE NUMBER 13$47741 REVISION NUMBER: THIS IS TO CERTIFY THAT TFIE POLICIES OF INSUFA,4CE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TFti PRIG' P:� !i r. i INDICATED. W,TIlti1T}aI;TANDIN;3 ANY REUJIF1E1•AF..NT, T!=RI,4 OR CONDITION OF ANY a)NTRACT CR OTHER OCx lhvlEl,i VATH RESPECT TO V'fr11(,H 11 ! j INDICATED. plLgY BE ISSIJED C(? f✓AV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DE�RIBED HEREIN IS SUBJEC TG �! HE T_RPA'1. i EXCLUSIONS AND CONDITIONS OF SI.)CH PC)UCIES.UMITS SF-0VVN MAY HAVE BEEN FEDUCED BY PAIID LSR I )!'A I UrIT.S1mr..sO R POUCYNUMBER III, NNE= TYPE OF I1`I9URA :E11•TA i GENERALUABIUTY ! E>CF{_<Y.Zl1RRE•vLE _._-;-._..---..._-'-' I. Ti _.- i ;tX7N tER.IAI!:ENCRaL JAPI!_IT' I I I -------- - � I15EC EXP oERSC)VAL:AD1/If,Ul1Ry Ic GE^JE.=IALFC,GP�FC�TE _IS PF<,DU i S-CCIV,P/OP AC'i:+ -AGGREGATE PER. ! I -------' r--• i S I —, roucy AU'rOMOBILEUABIUTY DLY INiURY(Per l-.. I ___....._ .. .. I (A,JY A;-TO ( i I ! Y II�UI Y(PA a-ct rET .-..._, Uri_ J ,c 1 � P'L ONNED Y•I;EDL!:.ED I �_ .R _ -g.---- .... N;YJ vJMEP I I i c a�aw�-t! _ - .., i�HIRED A.UTCS ' AUrrh I _....._._._..._..--' ..._..... Is I+ ! i EACH CCCURREwE -j S !uMBRELLALIAB-T I rxY.A1R i EXC'ESSUA6 1...._.DED ' RETEVnt7l.".• -- --.1 • `'TATLE OT�+, WORKIERSMVPEPSAT1ON I , �WC5-31S-370523-052 1311J20i !^2 ai2/2013 A ( ✓!TVIti LIMTSI I cF I N,0 evFLOYERS'LIABILITY Y-1 I ij AN ' E L.EACH IT I.'' --- (mon q YPRRE � fll N;A i _UJ: 7 E.L OSE_YE-EAENPi-OE - ('111F GS c�GE ti 10OQ� -- I N•'r~,desaiba u de. j I E.L.DISEASE-POLICY Llmrr i$ 50000f)< D�.ti"C-.RIPTICN OF C'PERATIC NIS ! 1_ CJE$CRPTICYJ OR OPERATI5F6%LO=ITiOf'JSI VE�6CLEi (Attad,ACOh'D 101,Additional Rerrerics Sd,edule,If rrtre sf,2cs is requirEd) I 1 I (larkers rompensation insurance coverage applies only to the Workers compensation laws of the state.f•AA. i ! i LC EF 7.IPICAT2_IiOLDER __�� CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE TI THEREOF, NOCE WSLL BE DEUVERED i HOUSING ASSISTANCE CORPORATION F•! HOUSING ACCORDANCE WITH THE POLICY PROVISfONS. 460 WEST MAIN STREET HYANNIS MA 02601 AUT}ORIZED REPRESEI ATIVE ft V 'J �- - _ �Jeff Cidridae ..�. ,, •_ .% ---- :c�1988-2010 ACORD CORPORATION. All riohis reser'v=cr ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD IT '!197 41 •:!.'_ ct,P:: I' r,oz� ....,, 2i'.t2 t2:?' F.,n r-nc_ -,. S[? ?ib -..;n-5_tM.....,. 1',-..:]us L•, i.a_:rr-J-.ect..i.r.'iG�:Fc. + 1ARNsrABLE, - 9� ,�� Town of Barnstable pTFp rAA'�� Yieguiat0 ry Services Thomas F.Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,'Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder -d h a ' In ; 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: y (Address of Job) t� Signature of Owner �� `° ,� �h�y�� / Date } Print Name If Property Owner is applying for permit,please complete the'Homeowners License Exemption Form on,the reverse.side. .., .r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map s-9Q �� Parcel Application # �d�c�D Health Division Date Issued i 1 Conservation Division Application Fee Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address ! 4F 60gsS - �1220.1/) Village / Owner P61110Aauku4iT Address 100,&X / (a .lrYtty-2� 17 Telephone ( 0(9 ) :D/—H7UoL- Permit Request ZI-2 S sey U C�WAL I�LQ V_ f_J4 _ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation f Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Q b Age of Existing Structure 19�—.3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: 0 existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ 1 c? Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: o+ C) Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ + Commercial ❑Yes ❑ No If yes, site plan review # '- Current Use Proposed Use ra rn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name v Telephone Number � )a9b — Address License # ij Zc-uAds 4a.L/ M64 0<" a Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO :19 Ac trr o�^, Pond acl SIGNATURE _� /l2 v DATE �� '.r FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED MAP/PARCEL NO. L ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME a INSULATION 4 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL y= .5 GAS: ROUGH FINAL FINAL BUILDING t t DATE CLOSED OUT `�. ASSOCIATION PLAN NO. t lne uommonweaun uj 1r1uNi's'ucaustr tta . 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/Organizadon/Individual): �SC7 J -ti C9r1 e q �-1 (1C Address: 49 . 4cnrri. C City/State/Zip: L�UZuir dS� P*) (A53'� Phone.#: CSC Are yo employer? Check the appropriate box: .Type of project(required):. 1. I am a e to er with 4. [� I am a general contractor and I y * • - have hired the sub-contractors 6. New construction . employees (_?ull and/or part-time). 2:❑ I am a•sole proprietor or partner- listed-on the-attached sheet 7. El Remodeling ship and have no employees These sub-contractors have -8. [.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 3.0 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.❑ Roo repairs c. 152, §1(4), and we have no , insurance required]t 13. there 'd I L 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. 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 workcs'comp.policy number. I am an employer that is providing workers compensation insurance far my employees Below is the policy and job site information / Insurance Company Name: M Cl k Uaj, M s C C� Policy#or Self-ins.Lic.M. C S 3 1 S 3 7 O S Expiration Date: . Job Site Address: I ��Q[,7 Y Q_ City/State/zip: l/aoin P.3 ,M/q 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 MA for insurance coverage verification. I do hereby certify under,the pains-and penalties of perjury that the information provided above is true and correct. c --' ' Date: %.Id, 3 / Signature.. — Phone# 1��'J� ^ Q Official use:only. Do not write in this area, to be completed by.city.or town official City or,Town: PermitlLicense# Issuing Authority.(circle one): .1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: I r > �In•�;ichu<ct(: fhlu,rtrncni nl hulilIC Bo;trd ,I Buildin_ RC;(ulntinn. :in l `t,nnl;ii-d- Construction Supervisor License License: CS 53202 JEFFREY R TONELLO hr; r PO BOX 1516 SAGAMORE BEACH, MA 02562 Expiration: 7/1412013 ( nui,i<sinr,, Trt: 21481 u /,e �a,,r,,na,uuea a�✓f ��{ License or registration valid for individul use only Ofricc of Consumer Affairs&Business Regulation p before the exiration date. If found return to: nd Business Regulation HOME IMPROVEMENT CONTRACTOR Type office of Consumer Affairs a Regimration: .:=171991 10 Park Pla za -Suite 5170 - . Corporation tion: 5/9/201q Boston, NZA 02116 Expira RESOLUTION ENERGY,',`INC.:::...... JEFFREY TONELLO _ 43 FIELDWOOD DRIVE.:.:... t lid w out sicnature SAGAMORE BEACH, MP.` Undersecretary.02562 j r - LI'1V llI L7/ LV 1 L 1V�. G V •l I (-,t'I ['('Ill C. / VV.J r-cL _ DATE(WAC ) E TIFI Alf OF LIABILITY INSURANCE 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 TITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR12FD BELOW. THIS CERTIFICATE OF I11SURANCE DOES NOT CONS REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. l I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be,endorsed. If SUBROGATION IS WAIVED. subject e 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). j PRCOUCER SMALL BUSINESS INS AGCY INC I _—_ a 8-7--9_-S 50 ? 542 MAIN STREET gVL -06 � Lc—_I_(5� _ .� OaG5 % S _ WORCESTFP, NIA 0161 50027_ I INSUREP AFF(�il�tvGCOVERAGE NAIC✓: ! .. -...__......._... iNSUREr-A_Lil?�ij{MigtL�!Insurance..-.._...._.. -- ................ L....- 11 NSURED RESOLUTION ENERGY INCORPORATED I,�RERc: 49 HERRING POND ROAD _..--- --'—--------- —"--._....--- ' BUZZARDS BAY MA 02532 INSURER D: — ------ INSURER F: - REVISION NUMBER: COVERAGES CERTIFICATE NUMBER: 13E347741 ,__ THIS IS TO CERTIFY THAT Ir1t:POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TIE PC ICY -,H T - INDICATED. WTnrvITHSTANDII K3 ANY REQ(.1)REI•AF..IJT, TERM OR CONDITIC N OF ANY CMaNTr,ACT Cn^OTHER DCX lJV1ElaT V.47H nc$PECT TO Vf ICH THIS CERTIFICATE MAY BE ISSUED OR WAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREII.1 IS SUBJECT TO ALL THE EXCLUSIONS AND CONDITIONS OF SI•JCH POUCIES.UMITS SHOWN MAY HAVE BEEN FEDUCED BY PAID CLAIMS. II;ISR I ..mS-q I P �(MPYYYh'- Mars POLICY MIVBER i(P TYPE OF tSURAW-E TRi UABIUTY I GENERAL �`- ! EACF{`.Y.xl1R.RE• 'E '`� _....__.._. i !(�$NdEF�.IAL'.!ENERAL JP.RI!_IT1' I�-'------ . -IIsEU�E PIA,� AIr O. ,CS•IvwUE ---- i PER"a?' JAL.ADV INUURy c---____.............. ALA[-CtE IS ... - GFN'_AGGRE ATE UIOIT APPiE:S PER: I S —� TL7Ul;Y I I PRCT i--�' I i AUTOMOBILE UABIUTY I 1 Ia—i^�-L—._..... - LYIWURY(Per!�rrn! is 1 II .. i A:lJ.lY1-C`AUTO I'.-_--...;i yAa..UlrTrGOSe III j IIi I_r:. Y F.I-P�_-L._!-!T-�J.R.—._Y.v.u..r_a_.-_�._a.--._...d_0..-.p.(.T_t)..I. p LOQj hiEDAPD i._a''` _...... ---' . __------------ P1TC5J MREO --- ......... _ i EtCH CCCURRENCE — J I lAV!BRELLP.LIAR I J - , 1?G3REGATE I 1.._...-_ EXCESS LIA6 R-1 LV._nT "_;0ED — I- r A IwORKER3'C-"-EPSAT,ON I ` �tA1C5-31S-370523.052 I311J20i2 I312/20i3 Twrcv_dLItinrsI I = AJ�ErvvtPLOY ER5 UADIUTY YIN! ,I I E.L. -_. ._......L.EACH AGCJDErr i S t 011000 Ie,N1'PROFRIEi:�iPARil�r/7:CCtRIv£ IN1AI I I-'' - 0 ICE-Ftw1.t=MEEKCa_uDl:r.? I I I i I E.L D!SE4;E EA B�/�PLOYE 5.--..--------1000C 1 (NandaSory in 1JFD i N,•'E~,de the Lrder E.L.DISEASE-POLICY Ur'07 1 S 50000_(�. D�c ;RIFnONiOFC•PERAIICI!,t*jFdrn+ I I �r- 1_ I — �1. ESCRPTION OF OPERATICS S i L(X�'1-nwS/VEI-CLE5(At Ma F ACORD t01,Addrttonal Re re lcs Schedule If rtme ice;required) ,/arkers rompensatior.insuranr.,e rovarago Ipp!ioJ,only to the workers cortipensztion laws of the state DlIA.. ! r CANCELLATION CERT.IPICATE.HOLDER ---- _ SHOULD ANY OFTHE ABOVE DESCRIBED POLICES BE CANCELLED 6EFpRF. THE EXPIRATION DATE TH2REbF, NOTICE WILL BE DEUVERED It'! HOUSING ASSISTANCE CORPORATION ACCORDANCE WITH THE POLICYPROVISIONS. 460 WEST MAIN STREET ; HYANNIS MA 02601 AUri�OiIZEDREPRcBENTATiVE �- Jeff C!dridae —- rc),988-2010 ACORD CORPORATION. Ail rights reserver-' ACORD 25 (201C/05) The ACORD name and logo are registered marks of ACORD sie. .^•:i.,.. ..,.. Pry ., rl� .__,._. 2AlZ t7 c.,. f of THE r ' BARNSrABL.E i659• Town of Barnstable �O �� Regulkory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,, Hyannis,MA 02601 www.town.barnstable.ma.us ' Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section Jf Using A Builder 4 as Owner of the subject property r hereby authorize ` to act on my behalf, U in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner ,, � �'/`� � Date Print Name If Property Owner is applying foe permit,please complete the Homeowners License Exemption Form on:the reverse.side. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o?�1C) Cam' Parcel 6�-- lication #�3�� Health Division Date Issued 3 Conservation Division Application Feed Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village �7 ; Owner (�0 CYl( � ,/x(��M�VI� Address 106,� 10 7d-P I nA n q l K Telephone Permit Request/h S /2t�U 5 2 S- Lil <�L Ube S hi c- &14ec� i CaAAX- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation d �00 ' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting doc`umen ation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 10 r Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: 0 Yes J No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) I Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number �� "n4� Address I n Pd,U Cl C/ License # C� �3 0 UL� Home Improvement Contractor# /-7 / � 5 l Worker's Compensation #a16 3 /S 3 7 6 Y�d 3 U ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE �' - 3 P FOR OFFICIAL USE ONLY APPLICATION# r DATE ISSUED MAP/PARCEL NO. 3 ..p 'r ADDRESS VILLAGE OWNER 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 lne uommonweaiin ud 1vlasaa�rcec�rtta Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 a4 .•• ' www.mass.govIdi Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/plumbers Applicant Information / Please Print Lei ibly Name(Business/Orgmizadon/Individual): - Address: 49 rnn!s� w•�d 2cf. City/Stafe/Zip: 1�U Lcards Ga P')it O.s 3.�L Phone.#: (S-09 )(568- (� - Are yo employer? Check.the appropriate box: .Type of project(required);- mp er 4. I am a general contractor and I 1. I am a e to with ( 6. ❑New construction . employees (full and/otpart-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 stib-contractors have -g. []Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp.insurance, - required-] 5. Q We are a corporation and its 10-❑Electrical repairs or additions 3.F-1 I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself workers comp. right of exemption per MGL 12.❑Ro repairs insurancee required-]t c. 152, §1(4),and we have no , a ' employees., o workers' 13. ther�Je �I �' [N 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,thcy 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: �`e'6� M ill� //l S �d Policy#or Self-ins.Lic.#: IQ �° S 3 � S 3 7 O S d 3O S Expiration Date: 013 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 incmmance coverage verification. I do hereby certify under the pains•and penalties of perjury that the information provided above is true and correct Simafore: c7--' Date: .%d 3 Phone# Official use only. Do not write in this area, tb be completed by-city.or town of . City or,Town: Permit/LiIceuse# Issuing Authority(circle one): A.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: . `1itsS,iCl III<ctt OCliurtrrl ell t nl Pulilir `:ilcl a Bnar-tl nl Btiiltliit_ RC:'tihttiun• aril �I,inil;ii'tl> Construction Supervisor License License: CS 53202 } t JEFFREY R TONELLO 0: i PO BOX 1516 SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( nuni..inri. Try: 21481 c 672Le �anr.irzarcueal� a� � sac/•"`� License or registration valid for individul us(: only -\ Office—or Consumer Affairs&Business Regulation before the expiration date. 1f found return to: HOME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation _ Registration: ..=1.71991 10 Parlc Plaza -Suite 5170 Expiration:, 5/9/2b1a Corporation Boston, MA 02116 RESOLUTION ENERGY =ING,:'s,;,. JEFFREY TONELLO 43 FIELDWOOD DRIVE' t lid w' out signature SAGAMORE BEACH,MX.02562 Undersecretary J LI',lJ Ill ,:.7/ LV1L 1V • LV Vf HL'1 �HIl C. / l.1/iJ r'Q1: JG1 V l.i CERTIFICATE OF LIABILITY INSURANCr THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THlS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE ET O POLICIES DIED j BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IRnPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(iss)must be endorsed. If SUBROGATION IS WAIVED;subject to i the terms and condilions of the policy,certain policies may require an endorsem=nt. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- — PRooucr� SMALL BUSINESS INS AGCY INC F-IONE� 542 MAIN STREETVJOR ESTEP,, MA 01615002.2 AmFEss: _ --- ---- -- - I I INSUREP{SJaFFC�tar:CGC1utRAGE � NIAIC4 ..INSURED RESOLUTION Eh1ERGY INCORPORATED NSLIP,ERc. 1 ;fo I-ICR.RING POND ROAD BUZZARDS 'BAY MA 02532 (NSURERD__-- INSURER E: INSUF.ERF C L CERTIFICATE NUMBER: 138g7741 REVISION NUMBER: _ OV _ THISERAGES IS TO CEfiTIFY"THAT TFIE PCX ICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR Th' P("IC Y P;� Il ' INDICATED. I\YSf1ti1THSTANDIN;ANY RECh.11REFAEJJT, TERM OR CONDMO)OF ANY a-)N tAACT CR OTHER DCX;UMEI\r 104TH RESPECT TO NMICH 7H1' CERTIFICATE rhAY BE ISSUED OR rMY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJEI I TG-I L Tt E TERr�f SSOWMAYVEBEEN F�DUCED BY PAID CLAIPJS _.--... EXCLUSIONS APDCQNDITONSOFSJG POLICIES.LIMIT — I•15,1 I TYPE OF IrlSURAM;E !M POLICY Kt.b SER i(t Cb�YY!"`i 1NTA�I� I Ln'f �E UNLS—- L1� ---- I GENERAL UAB':UTY" I ' I R`r� J ___.....__.._. I (xyN�IL-RC.IAL C;EnIERAI=Ja.81!_IT' � I i�bt::•:Lr,i�rHrwl i I�tEUEXP;Ar�e;rr5C1� ,�__ Oprr,•r/1oL1E ..-'_.. l l PFL�DUS CO C(DJP/p?AC r f S 1 I v-FN°_AuC3REf3_1TE iJP.11T AFF'IJES PER:mucy , P.O AUr0M081LELIABILITY i o c+Yi ' I'"Y hV.iURY(Per fir,-n) ;, -'IAN'fAITO c' I` E�' I'YIh 111RY I,('A•F-od�f41 ,; _ ALIrC.• I AUrCS 1 I :rEFjYT3S�+C"---ja JMF.ED Alf TCS i_ .J a•LrroY I ---._._.._._._.._....._-._....__.. ''' I --- I LASA8RELLALIAEt IJ r• ><? I i i EACHCCCUR -'-----------..._.. 1 REN^E �S I L� EXCESS UA6 I ar..3REcAr I J LIED i... .. RE'1LV11(Y`15` -i-._...- r-- j I $ _ {I i N.0--TATi+ G7 1 WORKERS MVPDSATION I , 1AIC5-31 S-370523-052 1 3112/2012 13112/2013 :I !TU?VI 16ATS I I A I.AJ`D ENPLOY ER5 LIABILITY V!N I I i E!.EACH AC:IDB\r7noonr- I FNY PRCIPFI T;�PiFART>`PIEY.CCL RIVF. I N;A — i i OPFICCCIPRI:NL-ER J RT-I`- 1=T7 i j I I I E.L.DISEASE F1S BJ.PLO'fEF. S_— ------ 1 O G0.-� (Wrid3bry In NM I I' C„E,r•.de gilaa l lydg I .EL.DISEASE-POUCY umi-T j s 50001) DE-:RI saiW OF C•PERATICJS t7�na _ I UESL"F�PII J Ck�+Loc'-nO"ts/VEI-fiCLE"i(Atraoti A�RD 101,Additional Remarks Schedule,If mxe space is requi rEd) ` I V•/orkers rcl tpen,atior.insuranr.,e rovarage appliE)s only tofhs ti`lorkers colTg7ensuion Ia ss of the state hAA.. . I j _ ___J ( ER7.fFICATE.ttOLDtR ^_�_ _. .- -- CANCELLATION _ SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORF. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED iN HOUSING ASSISTANCE CORPORATION ACCORDANCE WITH THE POLICY PROVISIONS. 460 WEST MAIN STREET i HYF\NNIS MA 02601 AUMHOFZZEDREPRESEMATiVE �- - — - _- Jeff Eidridoe ----- c,7 1 988-201 0 ACORD CORPORATION. All rights resew= ACORD 25 f20110/05) The ACORD name and logo are registered marks of ACORD - = '741 -etc. .z•:b:c..,.•,lrr-...l 1-D; i._sura-cerl.i 2ia]�es. I_ i BAnxsres[.E. + . i639• Town of Barnstable �� ]regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,, Hyannis,MA 02601 www.town.barnstable.ma.us ' Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A wilder , I, 1 �T ; as Owner of the subject property hereby authorize .- - to act on my'behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date �B— V1, Punt Name if Property Owner is applying for permit,please complete the*Homeowners License Exemption Form on..the reverse-side. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o2'�Q (D d- Parcel O oL Application # a?d/30 Health Division Date Issued k Conservation Division Application Fee Planning Dept. Permit Fee '35- Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address 4P (A � S�7'.&_`--, Village Owner-/-7_�ujoe' ± /Qn Oce^ k Address �C) 6C. �(o Telephone _[ Permit Request &S WJ ,�7 5 & (JAre s}—/-, L &T c/ R#-kCl (Yt,1 (d_tw 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 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) 1�*30-_ Age of Existing Structure ff 3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new c Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: 0`Yes 0 No Detached garage: ❑ existing ❑ new size Pool: ❑ existing ❑ new size Barn: ❑existing ❑ news size 9 9 g — 9 — 9 C., — Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ I Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use b APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number (5 ��29 1_740 Address _ 7 &4A n 5 4)/1CJ /tG License# 0 0� c Home Improvement Contractor# Worker's Compensation # Z�j 01 1 J = I O c,C J() ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE L rc)(1-0 10 DATE �� "� FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: r FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ,t DATE CLOSED OUT ASSOCIATION PLAN NO. 1ne Gommonweatin uJ 1rlu�a'ucreccsCEe� Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 w 5,. rvww.mass.govldia ' Workers' Compensation:Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busines&Orgauizadon/Individual): Rc's0 04 < 0,-) n e r-�1 �4 �1C - Address: 4'9 rr'(r) w.ncf. 2.r�. City/State/Zip: 8 0 LLards Qx_kv rn A C 4 S 3.;t-Phone.#: Are yo 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. El Remodeling ship and have no employees These sub-contractors have -8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insuuance comp.insurance.$ - required-] 5. ❑ We area 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.❑Ro repairs insurance required.]t c. 152, §1(4), and we have no , employees. o workers' 13. they (Ye-0.��1 �'� [N 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 bave 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: k e"&n° k l u,�P PJ aj, bl S ("O- �- Policy#or Self-ins.Lic.#: d-S 3 157 377 0 S d 3 y,7.)_ Expiration Date: Job Site Address: / -0 w- M CI.I'7 S�^lP Q City/State/Zip: V al')i'i i.S 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 covera e verification_ — I do hereby certify under_the pains•and penalties of perjury that the information provided above is true and correct: i c�—' Date: .Id- 3 t - S afore:• ) — Phone#• / ebb -1 -7 4-0 Official use:only. Do.not write in this area, tb be completed by.city or fown afficiaL . City or,Town: Permit/License# Issuing Authority.(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone.#: f of n•+e r L+xxsreat.E, 9� ,�� 'Town of Barnstable Regulaiory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street," Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section -if Using A Builder as Owner of the subject property q hereby authorize i to act on my behalf, in all matters relative to work authorized by this building permit application for: ryl (Address of Job) Signature of el Date Date r Print Name If Property Owner is applying foe permit,please complete the Homeowners License Exemption Form on;the reverse-side. .. ..._ : I/ =. �I,u�achu rrt fh'Itnrirncnl [d Pohl lc �':ilclt a D Bnartl nl Liuiltl.in_ Rc;fulatinn> ,uttl `tnntl;irtl Construction Supervisor License License: CS 53202 r„ JEFFREY R TONELLO PO BOX 1516 SAGAMORE BEACH, MA 02562 :f _ Expiration: 7/14/2013 Tr»: 21481 c /,� T anvor:aruuecz��. a� �l�ril�ac�reCs License or registration valid for individul use only \ Office of Consumer Affairs&Business Regulation before the expiration date. Tf found return to: HOME IMPROVEMENT CONTRACTOR Type• Office of Consumer Affairs and Business Regulation ; Registration: .,:=171991 10 Park Plaza -Suite 5170 _ Expiration:, 5/9/2014 Corporation -Boston, MA 02116 �• tip__ _ RE—SOLUTION ENERGY INC.::;:;;:. JEFFREY TONE C�0 43 FIELDWOOD DRIVE'.:`.,.;::: lid w out si SAGAMORE BEACH, MA;:02562 Undersecretary LI'IlJ ll/ !7./ EVIL 1V. GVV r earl r-e-tUC. e Vv.g FCL .../ei •,�,_ r � DA7c(n's.1C CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE Is ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I 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. ONAL INSURED, the policy(ies)must IMPORTANT: If the certificate holder is an ADDITI be endorsed. If SUBROGATION IS WAIVED,subject to i the terms and ConditionsA of the policy,certain policies may require an endorsement. statement on this certlflcate does not confer rights to the cerliticate holder in lieu of such endorsemeni(s). PRODUCER SMALL BUSINESS INS AGCY iNC COWACr NAME: ---.— .------------ ) 542 MAIN STREET _ONE(aC_1,$q 1. 7.�5_P635 WORCESTER, (VIA 016150022 INSURER PFFORL�Ik COVERAGE----_-.-' KAJC IP4URED INSURER 9 RESOLUTION ENERGY INCORPORATED nstl.ERc: I ag HERRING POND ROAD --- ------- -- - -� / INSURER D_----,_-- BUZZARDS BA\ MA UL532 INSURERE: INSURER F I COVERAGES � CERTIFICATE NUMBER- 138g7741 REVISION NUMBER- THIS IS TO CERTIFY T_HAT THE POLICIES OF INSUFAg0E LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TF'',E POLICY P ;,'II.O INDICATED. N)T\tvIT1aSfANDIN,G ANIY REOU)RO-AFNIT, TERM OR CONDITION OF ANY(XY\TRACT CR OTHER D(rtj tEI T VATH ncSPEGT TO VPHICH 71-�IS i CERTIFICATE MAY BE ISSUED OR VAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TCJ ALL THE TER VC I EXCLUSIONS AND CIDNDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PADL�CLAIMS — -__—..''ur�rs I d5R I ..._.._ TVPE Or Ir1SURMk;E POLICY NUMBER (P Y (NTA VVVI LTA i GENERALUABIUTr' ! EACt({Y.xl1RRE• 'E ___:... 1 R iT..IJIFn� `: O�IrCypwDE ----RY I�SECt E:(P(Arse;'t`r;Oii I _ ,.I �_.�__.._ o�^,�'Vfll.`AD\I ILUIIRy I t� I I � - - - .,.. Pr- QDU-TS-C vir/O?_AC"i=i ._.----._..._.._... I EN_AuGREG+IT_E UP.IIT AP�ES PCf?'. � i -- --- ' 1— I •5 —1 rmucY I I PRO. ;�lr.., 1 j � ,� .._. ,• L• :Q, i cL0 Ff Y:l AUTOMOBILE UAEIIUTY 1 .BODILY I1\UURY(Per�;errn) P'L(TAMED -C1 iEQLF�D I �7D1 Y I," D J IIRY,ne a d(1 rt/ AIJTCS �KYJ O+6NEP `)"P.EE.PIJTCS t -... ALITO; I I -- _........__._.......... I'''.. I j r I Er"»H CCCUR -- � IRVI I BRELLALIAEI I, I rgY.;ltt? I I i ;,. -•------------_._... EXCESS LIA6 I rIFIMFrt NC E, i, I j PC�REG4T 1 .... .i DED : RE EIMC N SS I ! 4 wDrtcERSCeeuE3sAnoN I ItAJC5-31S-370523-052 13I1J2012 I y12/2013 / !Tr� LAn_njTSl I A I O EERSMRSUABIUTV Y/NI I i ANY PRCIFRIZ.'.F'iFARTIu----EOt rrroE 1 jE1.EACH A(,:JDEYP i OF=1CL•i�TL=NL'ER EXG.UJfC:7 N N;A I ' ! -,------ -.. . (bland rY In I j I EL.DISEASE EA EMPLOYEES 10 Gn If•'<;:.,d�ail�LIrr1B 1 I i I E.L.DISEASE-FOUCY LII'.4R!S 50000 D�ti(RlrMONOFC•PERA7ICJSYrow i _—L S:LO AMONSI VE 9CLE5(attaoti ACOhY)101,Additional Rena more ks Schedule If ,a mace s required) �DESCRPTICIN OF ui-PA-n 1 € Vlod(ers compensation insurance cmrera0e applie 5 Orly to the workers compensaiion laws of the state MA. . I ! I —J CERT.IFICAT-.HOLDER CC ELLATION _ ULD ANY )FTHE A50VE D.ESCRIEED POLICIES BE CANCELLED 6EFOREHOUSING ASSI�+TANCE CORPORATION EXPIRATION DATE THEREOF, NOTICE WILL EE OEUVERED iF•!HO WESTMAINSTREETORDANCE WITH THE POLICY PROVISIONS, i HYANNIS MA 02601 AUTHDRIZED REPRESENTATIVE --- :g)1 988-2010 ACORD CORPORATION. Ail riohts reserV=d ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1�4V�- •�I— ',-J'.f.: I�r::• i '.'1.• 1 ;.1.1.'. t c.,A r :,L= -e ie- r ... 1._r:fr:.� ......1> ..-.:sly .__.�.-1-cc1:L•'.iiea.__ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel �� Application # Health Division Date Issued Vl Conservation Division Application Fee Planning Dept. Permit Fee 3 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation /Hyannis Project Street Address Mc� L ' S Village ,��p //�, n ) �� Owner W(JC�ts1 1'UV�(A/�dT�e.�•t kJ Address /0 1CO M 7 Telephone (W8 ) 7 T 5 -7 Da �/ Permit Request ��5� �� T. M_ UnYPS �`..(�Lt �U O - - - Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay -Project Valuation0 O(D 0 l 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 1T 3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑?Yes 0 No i Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other w Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name (o Telephone Number(�� Address / ' 11 (l l G �7-(�*+��0 (' � License # �- �yL Home Improvement Contractor# 1 S Worker's Compensation # Oie 9-3/ 5_37 O s a 3�Sa ALL CONSTRUCTION DEBRIS RESULTING FROM THIS/PROJECT WILL BE TAKEN TO SIGNATURE /v✓�Q 4 ( � DATE Y f _ ' r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL ' r GAS:, ROUGH FINAL 1 F' FINAL BUILDING L. f DATE CLOSED OUT ASSOCIATION PLAN NO. 1 i I ne Gommonweaan ud Iriu6i4a aascte-b Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,MA 02111 6•• www.mass.gov/dia Workers' Compensation.Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le>,dbly Name(Business/orgm zatowTndividual): 11 �Sc7 I y�—i curl �he �1 I �1C Address: 4-9 . t4 cranes -(Dc):n8 City/State/Zip: B u Luv:c.IS ac Phone.#: C S2 L 6 F- 17 0 Are yo employer? Check.the appropriate box: .Type of project(required):. 1. I 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 . I❑ 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 employees and have workers' working for me m any capacity. $. 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.❑ Ro repairs C. 152, §1(4), and we have no , � 1 '^nA insurance required.] t 13. they l��l.�'' W' 110-1 t�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 subrait 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 wbcthcr or not those entities have employees. If the sub-contractors bave 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: k�6 e l P� nl yj V C b l S <�d Policy#or Self-ins.Lic.# L° S 3 J; 377 O SS d 30 Expiration Date: Job Site'Address: I w �'l Qc�7 Y P �- City/State/Zip: vet orl f,S 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. 1.52 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 covers a verification. I do hereby certify under,the pains•and penalties of perjury that the information provided above is true and correct Si c —' Date: .%� 3 t afore:� l — Phone# C SLt b ^L7 4-0 Official use:only. Do not write in this area, th be completed by.city.or town official City or Town: Permit/License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: I i > ISS;IChu Cttz f) ;I1•i I'll cIII ul ht III IIC IICI\ " Brt;trd of Bliildin_ RC;;uI;Itinn, :Intl tilunll;lydl, Construction Supervisor License License: CS 53202 JEFFREY R TONELLO PO BOX 1516 ' 'r�r SAGAMORE BEACH, MA 02562 :`ts'"" •iZ _ Expiration: 7/14/2013 Try: 21481 c /ze Va��rv�:aruuea a ✓�ildac/t.ruleGxi License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: — , HOME IMPROVEMENT CONTRACTOR Type. office of Consumer Affairs and Business Regulation Registration: .•.=171991 10 Parl(Plaza -Suite 5170 Expiration:. '5/9/2014 Corporation Boston, MA 02116 RESOLUTION ENERG.Y,'fIJG.::.:.. JEFFREY TONE � 43 FIELDWOOD DRIVE";...,j.. t lid out si i SAGAMORE BEACH, MA'.02562 Undersecretary / l LI'IV l// L7/ LV1L 1V • LV •l! [ll'1 Yr-1V C. r CL J G 1 •/1, _ DATF(?VFA'CCYYYY:') ANCE E OF LIABILITY INSU CERTIFICAT THIS CERTIFICATE IS ISSUED AS A MATTER,OF INFORMATION ONLY AND CONFERS NO RIGi{TS UPON THE CERTIFCATE HOLDER. THIS IVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGAT i BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S)7 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 certlficate does not confer rights to the certificate holder in lieu of such endorsement(s). a, CER SMALL BUSINESS INS AGCY INC COfY7ACTNAME: —_—.— -------------- 542 MAIN STREET Pf ON=tac_nu_F�E 508)i35 p635WORCESTF_R, MA 016150022 INSURER AFFCK2L+N'GCOVERAGE— n�C4 I IM6URE D Ih&URER 9: RESOLUTION ENERGY INCORPORATED INSURERC: ( 49 HERRING POND ROAD i BUZZARDS BAY MA 02532 wSuRERD: _---.--- ---------'--- - —_. _ . INSURER E: - Ir�J^r.ER F •---- (COVERAGES CERTIFICATE NUMBER: 13897741 REVISION NUMBER: ; THIS IS TO CERTIFY THAT 71-IE POLICIES OF INSURANCE LISTED BELCrN HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I I'ti P0.1G r P.�1ICC' INDICATED. NJrttitTF IST4NDII�k�ANY REOI11RGI-AFNIT, TERKJ OR CONDITICN OF ANY CX)NTRAC.T C^n OTNER DCX Uti1El i VnTH�cSPECT To VvrICH 1HIS I CERTIRGATE NIAY BE ISSUED OR 6/AY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DECCRIBED HEREIN IS SUBJECT TO ALL THE T_Rn�.;, I EXCLUSIONS AND CONDITIONS OF SUCH ROUCIE.S.UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAII✓LS. ___--- -- ------ nyvllT� �� Urns 11•ISA I TV?E OF INSURAN:E �ADg �UCY M1�VIBER I(f '( A` I c, L �i GENERAL UABIUTY I ` i EACNJxl1RRE• 'E __....__-.-' L...', . --- i I cX7JI 1CFl IALC:EiJE✓t4L JA.RI!IT' I p,IrJS•Pd�LE i I I I 1 i j i Prs^,a'�VA_L�RDV It`LiURY I S ------.... .-- ` I I I CENER4LAGGFEGATE---ilk_ PFt Dlt�'-15 COAL/-R'AC`S - uENI_A;,C,RE'C?ATE UTAIT AF JE?�PER: r-- o -- I fC)i.1GY I P.CT I i jr, L I AUTOMOBILE LIABILITY �a ;,;nL Y L\UURY(Per{pr:':01 i XJYAITO i + I i - —._.._...._...... I CANLYIPJIIRY,Pe'�-dti??t-1,`.._....__.___.._....... + ED A�LrF1 L--I AUfGS I I I 1-R �KYJ• v6VEP �'e_a s rt! iJ wRED A1fros ;-_-...;A.Ur(7; I : I l { E HC CURREN-E s - --- U+ABFELLA LIAEI iJ ra7AIR EX..... -j,_J_C;�Inr.E,rTtAL1E I i r-- 1 --I ..UEO i... REILVT7CYJ WORKERS-CCA4'ErJSAT,ON I JiA1C5-31S-370523-052 13/12/2012 13il2/2013 �T5I A I.AID BvFLOYERS LJABIUTY V 1 N 1 1 I l',NYPROPFIErC�PiFAFi1�P;`7:l"CIRNE I. I %E!.Ep.CH_Af,:IDEYr OF=1CL•RR. IvL'ER EXQ.UDED? N I E.L.DISEASE•EA I3_VPL91S S 1000Q (Manry in NM I i L'6w-deaorlw urdw I i !E.L.DISEASE-FOLIC Y LIMIT i S 50CIor 0�c.,RIfTr1CNOFOPERATIOVih4r)w --� 0E5)CF,IFp0r,,i OF OPERATICI,\S+LOCATICY'IS1 vF-CLE'"i(AR53"'A�R0101,Additional Rerrerks Schedule,If more space is requirEd) Workers rompen>atior,jnsural.r..e Coverage Ipplifis orl/to the workers Cort,p s2tion laws of the state PAP,. .. I I , i CEfi7.IFICATE.Ci'OLDER CANCELLATION w r. .. .�.a SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. HOUSING ASSISTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED it., HOUSING ACCORDANCE WITH THE POLICY PROVISIONS. 460 WEST MAIN STREET HYANNIS MA 02601 AU-ft QA ZED REPRESENT ATvE 11 I... IJ ff Eidridae - :g)1988-2010 ACORD CORPORATiOPi. All rights reserve ACORD 35 (.2010/05) The ACORD name and logo are registered marks of ACORD _ �!IGT7 _�y'c ,_ ... L..z•:F�:.. ..+.:,P, .._.+_LY L__..:.-:1-ccrL iiica:F_... _ , I o�s ram, t + BARNSPABLE. 39- + - . Town of Barnstable 6 �� ' Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,' Hyannis,MA 02601 www.town.barnstable.ma.us ' Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder . as Owner of the.subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) �\ Signature of Owner Cad /` Date Print Name If Property Owner is applying for permit,please complete the"Homeowners License Exemption Form on:the reverse side. . TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a90 O-) Parcel AFIcation#,� Health Division Date Issued t Conservation Division Application Fee Planning Dept. Permit Fee 3 s- — Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address (;1 e4 - �:Mo_clyl S�. (aQ h "S Village //�� I� OwnerU�.J&-Y Atl d �J-mf Address 106 6(k J lO cic� �" Ir0k'I� Telephone -7 -(g d�-- Permit Request k�k Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation o2,008 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) /9 -P� 31 -1 Age of Existing Structure Nd 3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)' < - Number of Baths: Full: existing new Half: existing new_ Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Jd1w Telephone Number r?-1 0 Address 19 prr.1-1(15U c/ Gl License S L1 Home Improvement Contractor# Worker's Compensation # W( ,-S-3 I S 3 2 04 J 39,�� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILLBE TAKEN TO g9 NCB/!�� T"D11C� l l �U L I �C( 1 SIGNATURE U 6 IU DATE - 3 _ FOR OFFICIAL USE ONLY t APPLICATION# DATE ISSUED MAP/PARCEL NO. 4 `f ADDRESS VILLAGE OWNER A DATE OF INSPECTION: y, FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL-BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f Ine Gommonweacia uj trlu�aucnuaCtc� Department of Industrial Accidents rn F Office of Investigations 600 Washington Street Boston,MA 02111 . www.mass.gov/dia Affidavit: Builders/Contractors/Electricians/Plumbers Workers' Compensation:Insurance Applicant laform" ation / Please Print Legibly Name(Business/Organizationadividual): —,so vim O/1 - Address: 49 re-1 nl:;• .H&nc( (L f. City/Stafe/Zip: Q U LLgr m�l (A S 3'_•-Phone.#: Are yo employer? Check.the appropriate box: .Type of project(required);. 4. I am a general contractor and I 1. I am a employer with.` 6. ❑New construction . employees (full and/oipait-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 i [No workers' comp insurance comp.insurance.t 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. Plumb' repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Ro repairs insurance required.]t c. 152, §1(4), and we have no , L � employees. [No workers' 13. ther�Je4�l 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 bave employees,they must provide their workers'comp.policy nrmrber. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. / � ,f Insurance Company Name: !� C/ i n1(j�tl�t�C Ins Co Policy.#or Self-ins.Lic.#: l t� L° S 3 1 J. 32 Q S d 3 y Expiration Date: Job Site Address: City/State/Zip: 1 VuOn F,3' 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 of perjury that the information provided above is true and correct Si afore: �" Date: l� 3 l / Phone# Official use:only. Do not write in this area, tb be completed by.city.or town official City or,Town: Permit/License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: f v �. �l;INS; c fit •ctts - f)cli;ii'ti'ncIII I hultliC �:ilcl a Bo;trd nl Biiil(lin_ Rcttukiiinn> :in(I �t,inil;irtl Construction Supervisor License License: CS 53202 ter: �4 JEFFREY R TONELLOt*=hFY,,:Si PO BOX 1516 SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 i P ( nuni.ci nri Tr»: 21481 U /,e �o»,.�rzancuea�C/• a�✓fsaac�t"� License or registration valid for individul use only Orrice of Consumer Affairs&Business Regulation before the exhirntion clnte. if found return to; HOME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation Registration: .,,'171991 10 Parl<Plaaa -Suite 5170 Expiration:. 5/9/201a Corporation Boston,MA 03176 RESOLUTION ENERGY::;INC.::2 ;. JEFFREY TONELLO w. 43 FIELDWOOD DRIVE',;..'.!:;; lid w' out signature SAGAMORE BEACH,MA;.02562 Undersecretary VV.:i r ;Y •�-�^� „Q DATE(.:i'CG?'YVYvJ CERTIFICATE OF LIABILITY INSUANCE THIS*CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFCATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES i BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 1 IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED; subject to the terms and condilions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certjfjcate holder in lieu of such endorsement(s). PRODUCER 'SMALL BUSINESS INS AGCY INC CONTACT IVAME: —_-._ .---------------' 'i 542 M.411V STREET (aGNo_gaI. (508)%.Q5-0635 WORCESTF_P,, MA 016150022 PI-g e ELAAIL ADOFEss: ---_•-------------- -- i � INSUREP AFFORDf�COVERAGE NA1C ti (INSURED INSURER 9__-__ � I RESOLUTION ENERGY INCORPORATED INSURERC: 49 HERRING POND ROAD ------'--- -- ----- BUZZARDS BAY MA 02532 NSURERD: INSURER E: COVERAGES CERTIFICATE NUMBER- 138g7741 REVISION NUMBER: THIS IS TO CERTIFY THAT 7I 1E POUCIES OF INSURANCE LISTED BELCM)HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE aIC,'Pr-�)i:O i INDICATED. hY3T1ti1T1 ISTANDIf ki ANY REQ(.JIREI-AFM, TERM OR CONDITION OF ANY CAM-r+ACT OR OTHER OC ,imEI41 VATH RESPECT TO V,PrlICH THIS CERTIFICATE VAY BE ISSUED OR VAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DES RIBED HEREIN I.S SUBJEI l TJ ^LL THE T_RP i. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UM!TS SI-OM!VWY HAVE BEEN FEOUCED BY PAID CLAIJ AS - ---:-------------- P�1z .FF P�uCv FOP — rvl W. TAoot'Soe2! urr 11 ISR I T'1'PE OF ita-RANCE POLICY MhVIBER I(P a YYYY)'(tyl'A`IXYYVIM I ' i GENERA(.LIABILITY EACiA C„CLIRRE'V,c _..-_—._...__..,..__.._. i !(-OAstER,IAL - ! I v�°3tJS•MWLIE ! I Crl7.F.'• j I I I j DEED EXP!Fve i j I i PcRovVAL`RD\/It`UURY PFr-)D l _;TS'CCJJG/�AC' j ti I..^.: .. I G ENI_AGGREr:ATE Ub:11T AMjE;'PER I I I r----------�-�-- ----- j 111DU1-Y I I I 1 I P i I AUTOMOBILE LIABILITY —_•---._._..---._........_ i I 15cni;,Y InllURY(Per ly n)r I N L C,`5SJ ' IiEOt4ED I I I E�DU_Y II UI IRY(Pe 'oc4xk r. _ AUT i i aUrCS MREDAI.TC6 a.lfTr.Y-_• - i _._........_.......... 1 I ' I IABRELLA LIAR J rRy."IR i L E CH CrCURREy^,E -- : EXCESS LIA6 I� ...__1 DED FOT` lM7 ; I I A r WORKERS CI I ` IWC5-31S-370523-052 13/1J20i2 I3'12/2013 j !Trv`C2�_ILn/nTsl I I;AID EA.�LOYEP5 UADIUTY Y1N I I E.L.EP.CH Ar,0DS\IT S 1000D(` i fNY PRIIPRIErCPPARTtCRl7ffCl rrlVE r. OF=1CC�4.LT�L'ER EXG.UDI=DT �N N;A I i I - -- -- (fVandaary In fJIO I I E.L DISEASE-EA EMPLOYEE'S 10�Gn 116Ei de site r.uily i i I !E.L.DISEASE-POUCY'LIf.1fT j S 50000f) 0 Rii7nC7N OF C•PERATIMIS tP!rnv I I i Irequired) I «( I , UESCRIPIKYJ OF OP•=RATIOS ILCCATTOUNS r VE'-BCLES(Attaoti ACORD 101,Additional Perrerks Shcedule,If rtnre space is I I \Norkers fOmper aljon jnsumance coverage applies orlytothe Workers compenset!on laws of the state hAA. ._ I i J CEfi7.(fICATC.HOLDER �� CANCELLATION ..- SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN HOUSING ASSISTANCE CORPORATION 460 WEST MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AU'rCZZED REPRESENTATIVE Jeff Eidridae J ----- ---- tg)1988-2010 ACORD CORPORATION. All rights reser'v== ACORD 25 (201'3/05) The ACORD name and logo are regjsiered marks of ACORD i4v'- •:1.;- ','J.F:: 1'�• i 'r1-, ' i"tu l2 13't' FM R' _ t.•1... ...._._._�.4L<•1....'�1,. ..r. .. :. 1..._.;{^.. ..t.i.I:;'...t_Iy t_....::-"J�C'C4't:.lC 1CT:"_. I. i of TME rod, - BARNS ea[.e MASS.. $ i6gq. $ 'town of Barnstable � 1m - a . Regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,' Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder s as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) ��.. "� pig .•,. I� 'J d I �d Signature of Owner r' " �� ' -/ Date r VI U, Print Name If Property Owner is applying far-permit,please complete the Homeowners License Exemption Form on:the reverseside. - .. .... .. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map oZ'�O �� Parcel 0_.'�_ Application # Health Division Date Issued 4 Conservation Division Application Fee Planning Dept. Permit Fee �'3j ' Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis k� W_ez�- S�,e Q a o is Project Street Address C[_l,v� i/ dl Village Owner�uwoLO i nclA,Calfir"k Address P6 3 -/-s� Irw ti� 1 X Telephone c,� J / -8-7 d Permit Request 117 S Sle_#k Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,060 ' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) /�`J �13 Age of Existing Structure 1, Z Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new" = `� Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room,ECounit j `",' Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other t ' C) to Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No F 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 v U Telephone Number Address �QC��S C� ( _(G License # /YS S-3 d-)_ ,bow_ Home Improvement Contractor# / 9 Worker's Compensation # WO-53i S 37 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4 q 14 vmj r ns A,-Yj 2J -A ia -at SIGNATURE �. v DATE FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED E MAP/PARCEL NO. }4 > ADDRESS VILLAGE OWNER F DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. z lne t,ommonweatm u1 iytaN,a'auaasrua Department of Industrial Accidents IN - 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(BusinesslOrganizadonadividual): +�Sc7 J t C9/1 �n C Address: 49 ' 4 c rr-tn d (Lcf, City/State/Zip: 8 U LLri.r dS G_-k 1l')A (,4 S 3-a-Phone.#: (5 - (2 Are yo employer? Check.the appropriate box: .Type of project(required):. ` 1. I am a e to er with` 4• [� I am a general contractor and I 'y have hired the sub-contractors 6. El 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' 9 Building addition [No workers' comp. insurance comp.insurance.t - 5 We are a corporation and its 10.(]Electrical repairs or additions required .] - ' 3.0 I am a homeowner doing all work officers have exercised their l 1.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Ro repairs c. 152, §1(4), and we have no insurance required-]t 13. ther(JeCt_P,*1 L � 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 provides their workers'comp.policy number: I am an employer that is providing workers'compensation insurance far my employees. Below is the policy and job site information Insurance Company Name: bl s Cd- Policy#or Self-ins.Lic.# 6-S 3 Y S S 7 0 S d 3 y 5 Q Expiration Date: Job Site Address: l w- M a'(,7 ,S Q City/State/Zip:�V a,17 ri 13' (J,�- 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 of per that the information provided above is true and correct. Siafore c3-� Date: .Id, :� — Phone# S ) ebb -l -7 40 Official use only. Do.not write in this area,tb be completed by.city.or town officiaL City or Town: Permit/License# Issuing Authority,(circle one): own Clerk 4.Electrical Inspector ,5.Plumbing Inspect-or e artment 3.City/Town/T g P J.Board of Health 2,Building D ty P g P _ 6. Other Contact Person: Phone#: LLRNSTABLE. 6j;q. m� 'Town of Barnstable Regulatory Services Thomas F. Geiler,birector Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,-Hyannis,MA 02601 www.town.ba rnsta b le.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 i hereby authorize e3"nt&-'ftginl 4le to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) T Signature of Owner x / ' Date Print Name If Property owner is applying foe permit,please complete the Homeowners License Exemption Form on;the reverse.side. i% �'. Yi;iancliiut•tt� - Ocltnrirncnt nl htiltlir �alt'I� 1 Bo;tl-d III' Biiildin_ Rc;Cul;ttinn. :�ntl �luntl;irtl• Construction Supervisor License License: CS 53202 JEFFREY R TONELLO PO BOX 1516 "` SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( :nnmicci„nrr Trg: 21481 c 92- 1°om.�rtancuea��• a�✓l �aL�r License or reuistration v;tlid for individul use only Office of Consumer Affairs&Business Regulation before the expir lion date. if found return to: HOME IMPROVEMENT CONTRACTOR Type office of Consumer Affnirs and Business Regulation Repitration:.•:=171991 10 Park Plana-Suite 5170 ` Expiration:. 5/9/2014 Corporation Boston, MA o'_116 RESOLUTION ENERGY,;INC,::;:.;.. JEFFREY TONEL '0' 43 FIELDWOOD DRIVE'..,.,'.`: : — -- t lid w out signature SAGAMORE BEACH, MA Llndersecretary;02562 �' 1 V . L V OAT•=(�3'•S'CQ'YVYVJ 1 � ��1f E OF LIABILITY INSU =ANIC� ��rl� ; 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)7 AUTHORIZED REPRESENTATVEOR PRODUCER,AND THE CERTIFICATE HOLDER.IMPORTANT: It the certificate holder is an ADDITIONAL INSURED,the policy(iesJ 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 certlflcate does not confer rights to the certificate holder in lieu of such endorsement(s)- — PRwUcER SMALL BUSINESS INS A G C l' I N C CorrrAGT NAME: —_—.— ------------- 542 MAIN STREET E±1 E(ac_tvo,E#i `i. WORCESTER, ItAA 0161S0027_ I INSUREP AFFC)gDI�C.OVERAGE ryaC+r .. _. . ..O E INSURER a. RESLUTION ENERGY INCORPORATED InsuRERc: I 49 HERRING POND ROAD --- ------ --'—' --- -- .... I BUZZARD INSURER D:S BAY MA 02532 _.—.-------•------.._. _. ._._ _ INSURER E: -. --'-- INSURER F ---- %OVERAGES CERTIFICATE NUMBER: 13897741 REVISION NUMBER: _f THIS is TO CERTIFY THAT THE POLICIES OF INSUFV+JJCE LISTED BELCH'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PG"ICY INDICATED. NYLMNIT)gST'AN1DINi ANY REa.)IREI•AF..N7, TERM OR CONDITION OF ANY a-WT-RAC:T OR OTHER DCX,UME1,I VATH R.-SPECT To yr lCH T1 15 I CERTIFICATE f^AY BE ISSUED CA MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DES RIBED HEREII•J IS SUBJEL 1 T,Z)tiI L THE TERPA'', EXCLUSIONS AND CONDITIONS OF(SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS iLT� I-ISR I TYPE OF inSURAN: MINIBE R i(P DD'Y F Ir tXYYv i U LTA :E POLICY 'GENERAL�L1LI-ARBILIfATL YI:Ei�I[Fi4l= I I i I 7-E JAP_IT1 H1w1__ � �CLPJtJ',i•P/'PL1E ! �Cr'i:J.lr. 1 i i I mEU EXP PER-S _ P,D\/InUURY'-!C-------.............. i i I --- I . I i � i Gc•.JE.=ta P.�R_F:'�Tc j A . j I PFt)DU��S-GC7�AG/Q'AC'IS FN_AGGRE(-_AT_E U10IT APM�E:;PIER — r 1r..,AUTOMOBILE LIABILITY SDI Y I1\UURY(Per per ni _._._....._._ .. _..I A;JY AUTO IALL�NED Y'I'iEDl�:EOIPI II1RY(f >,'a- -dcYra ir: _ ALIfC_ i A.LJrC.S ( I I I I 'Y, EFjI'>331V+O�- is ---I I--i ls IJ HPEOP1fros i__...i ALITO; ---'- ------- LA+ABRELLA LIAR r• IR : I�IEXCESSUA6 I-J CIl.IN°rt�V+UEt �I it _.— -....._..._ I 1 ' DED{{ I we crATL L7J I A I YvoRKERsa�uPErsanoN WC5-31 S-370523-052 1 3/12/20 12 13/12/2013 ! ✓':T r un 1Ts .AJ,0 ENIQLOYERS'LIABILITY Y 1 N I E.L.EACH ArID6,17' F;NY PROFRIcT.'.�7FAR1 -I-;7:EfLRNE❑ WAI i i O'=1CL-r-c1•LR"LER`J CG.UJI=C N i I E.L.O:SE/LE-FJ{EMPLOYEE S_-_ (flan ry'in N!-0 , ! 1 - . E.L.DISEASE-FOUC N•'«•de rlsL a rJa ! Y Llh4r' S -50000t� 0�,.'(.;RlFnCNOFC•PERATI(_'VSIT?_nvr � I I �UESCIaFT1C+J OF OPERATICI^5+'CO ATIolSr vE'-6CLES(AttaOti ACORD 101,Additional Rernarks Schedule,If ro e space required) I I 4 V/orkers rompsnsation insuranr..e coverage applies only to the workers comp..=ns2lion laws of the state PnA.. . I CERT.IF'CATS OL .tiDER --.- CANCELLATION _ SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WLL BE DEUVERED iN HOUSING ASSISTANCE CORPORATION VI ACCORDANCEN'ITHTHE POLICY PROSIONS. 460 WEST MAIN STREET 4 HYANNIS MA 02601 ALJTFCO ZED REPRESENT AT'VE �— — — �JeH Eidridae J --- :�1988-2010 ACORD CORPORATION- All riahis res0I've ACORD 25 (2010/05) The ACORD name and loqo are reaisiered marks of ACORD ....�.-.._ txty.:..: 1......`, ..a',E: Ir t r..•,sic i.ca -.. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 90 U., Parcel C Application # Health Division Date Issued � Conservation Division Application Fee 6Z ' Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address c l :::7-AkJ- Pud'o �S Village / Owner G Address J V /YV/n�, l X Telephone 1 ' 3 d L Permit Request �hcS � .�? ��_ LP- C o"7rP Stir' &__�&rl se rl Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 7 000 '-Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) t in Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: O Yes 0 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 W - Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Courit Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No j 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 ff (BUILDER OR HOMEOWNER) Name d/U_ ID Telephone Number Address 4 _ License # S 3 Home Improvement Contractor# Worker's Compensation # W(I S-3( � �' 30 r,)- ALL CONSTRUCTION DEBRIS /RESULTING FROM THIS PROJECT WILL BE TAKEN TO t�y✓tC U 6>J 1- Ct SIGNATURE I DATE / -(F 43 FOR OFFICIAL USE ONLY i #PPLICATION# t DATEISSUED MAP/PARCEL NO. t ADDRESS VILLAGE 1 r L OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r r lne Gommonweaan uj 1rlu�auc nuacE�� Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 w www.mass.gov/dia Workers, Compensation- assurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Infoririation / C Please Print Legibly Name(BusinesslOrganization/Individual): ��S0 y(—� CY/1 �1 t-1 /K- - -Address: 'PC) d (Lcf. City/State/Zip: 8 0 Lt�icc.�S � (Y.)� C b S 3�-phone.#: CS"� Are yo 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 . have hired the sub-contractors employees (full and/or part.time).* listed.on the-attached sheet 7. ❑Remodeling 2:❑ I am a•sole proprietor or partner- ship and have no employees These sub-contractors have •8. [] Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp.insurance. - 5. We are a corporation and its 10.7 Electrical repairs or additions required.] . 3. I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' right Of exemption per MGL ❑ comp. 152 §1(4) 12. Ro repairs -' c. , insurance recfured] t ,and we have no 13.§16ther�Je � 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 Homeowuers 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.,entitics 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 far my employees. Below is the policy and job site information. Insurance Company Name: �`e'6,f n10-vat /t15. �d Policy#or Self-ins.Lic.#: l y d-S 3 ( 5. 377 C, S d .3 tJ.5- Expiration Date: . Job Site Address: w- 1 et r�� Q- City/State/Zip: 14 l/Gl•t'Ji'1 w-,Q,914 d,)-(o0 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$256.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of _ Investigations of the MA for insurance coverage verification. I do hereby certify under.the pains•and penalties of perjury that the information provided above is true and correct. Si mature: c3--� Date: .%d- 3 7 / Phone# Official use:only. Do not write in this area, to be completed by cily.or town of City or Town: PermitUcense# Issuing Authority.(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone.#: LI'1V tJ/ /Z/ LV 1L 1V GV •J! ['l'1 YHI.l C. DAi`(A'Ett'CO'YYYVI A,L & CERTIFICATE OF LIABILITY INSURANCE �ANCE THI CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS s CERTIFICATE DOSS NOT AFRRdMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE T HORI IED j BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER S). 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,sub'ect 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)_ i CONT --. ! aRcoual� SMALL BUSINESS INS AGCY INC ACT NAME: 542 MAIN STREET PHONE ac_rJo,En1L_ )508 05 Qo35 ____._..�F�x..L-1t._l�_..:.._ •--.% .� 1 WORCESTER, MA 016150022 C--MAL ABOFESS: --•-_---'.— --- —__.___ INSURER(S)AFFORDING COVERAGE----- I_4 JCF i INSURED I ------ RESOLUTION ENERGY INCORPORATED Ins(J.,eRc: 49 HERRING POND ROAD BUZZARDS BAY MA 02532 !INSURER D: - --- INSURER E: i INSURER F CERTIFICATE NUMBER: 13t347741 REVISION NUMBER: COVERAGES __ r THIS IS TO CERTIFY THAT T>IE PC7�ICIES OF INSUFJ+NCE LISTF_D BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TF'ti POLICY P=�li INDICATED. NCTR'0-l! c,;TANOINki ANY REOI.AREI• ENrl', TERM OR CONDITION OF ANY CXMfT,r,ACT CR OTHER D(T,(JNIEh�i VATH�cSPECT TO V,AHICH T1-1, CERTIFICATE MAY BE ISSUED C. MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJE( I TC,AL! EXCLUSIONS AND CONDITIONS OF SUCH K)UCIES.UMITS SHOWN MAY HAVE BEEN REDUC�`E�D,BBYY PP��LNA� -urA�...------ IIISRIB -•- POUCY MINIBER Ilrw'TTT I�!'LVml ...__.._. f TYPE OF IriSt.lRa•10E �•+ I 7 GENERAL UABI UTY _ PRL�/1EE:�1•;G,.-t III I E+�:w� i I1�7NelEF�;IALC:Ei1[FiSI'JG.RC_IT\' I I \.'- i i 14tEU EXP(Prime;1'6il�i 111rJS•IVPLIE ,......_;C. J.F. i I — PcRaJVAL:AD\/IAULIRY I i CENIE.R4L ACC-R_ECA i c.. l j I I I pF-C,DV-15-G^1Jv/O?AC' M L.._.,, I I ---- --- I ,a:,FN_AuGREC:•ATE UP;11T APi'UEi)PCR: l ;Smuoy 1 PRO r- � I AUTOMOBILE UABIUTY i -, ! o Hrt BO Y IN.iURY(Pe,pqr-�ni c . A:NY AL.rrO �..._i I l I Et'�I YI P!AJRY(r'A-ULED �'o(1?rr f I AurcS pUrC p�Y I a C�- J HR.EDA11TOS '---'ALIT(.7: I II i I I ----'-----._.._....__._....-..... f I I 1 ,B, I, J - I I EACH O'-.,CUR .. . ... .REV^E _Is UMBRELLA UAB iJ .1,Y.;L r 1R I - ----- -' I I. EXCESS LIA6 I_J f;LFJM�rf�V+DF. I I REGATE 1....J DED is , � I . ,,,, wOPCEfsCc�m�sanoN I ` INIC5-31S-370523-052 I311J2012 I3J12/201 - A I.AND EMPLOYERS'UABIUTY Y I N I I E .F?.CH A(.;IDE�ff _ is _,—,__--_--t.f?1�ORr iAM'PROPRIcT.�PiPARTIPI7:EGlRNE 1NJA; I ! I _ . J=>=1CL-w'6L'T/L'ER OCG_JDEC? I j E.L DSE0.-E-EA Bv1PLOYEe ti-- (Mandgbry In fJM I "t I N,•Er.,de.�ila3urdrr E.L.DISEASE-FOLICYLIr.4fi i g —5()000f� I D�. IPTIC7N a`C•PFRATI(:Nf W.ov', ^�r- I DESCRPTICYJ OF OPERATICY;61 LOCATIOPIS I VEi6CL� (Alraoti ACDRD 101,Additional Rerre lcs Schedule If r n e mace requi rEd) I kNorkers ronlpensalion insurance covaracJe applies or,ly to the wlorl(er5 colTlPensation laws of the stale MA. , I i • J ` ,,,,,_,.�.�._., -•---- CANCELLATION _ LCER-fJ1 ICATE.NOLDtR SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED 6EFORF. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED iN HOUSING ASSI�;TANCE CORPORATION ACCORDANCE WITH THE POLICY PROVISIONS. 460 WEST MAIN STREET - HY/NNNIS MA 02601 Aun-ioRzEDREPRESENTATIVE '"988-2010 ACORD CORPORATION. All riohis reserve'_ ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD -cr:r>i. ..... p, ,., '•iryu::L•; .,�:,..J ccrl sicac..- L 4' > �1,(��achu ctt f>clta trncni ul Pultlii �:ilcl Bn:trtl nl Builtlin Rc;Cul:t(inn. :intl Construction Supervisor License License: CS 53202 JEFFREY R TONELLO PO BOX 1516 ;r• SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( „nuni<ci, nvr Tr»: 21451 o /,� �o,,,,nonujea a�✓f aa4�'{ License or recistrntion valid for individul use only \ Office of Consumer Affairs&Business Regulation before the expiration dnfe. if found return to: (� HOME IMPROVEMENT CONTRACTOR Type. office of Consumer Affairs and Business Regulation Registration: .•>=171991 10 Paric Plaza -Suite 5170 ll ` Corporation Boston,MA 0'116 ' Expiration:, 5/9/2014 RESOLUTION EN ERG.Y7,;ING.:::: ,.,. JEFFREY TONELLO 43 FIELDWOOD DRIVE t lid w' out signature SAGAMORE BEACH, MA'.02562 Undersecretary �pF THE Tp� O - + HARNSTABLE. • . i639• Town of Barnstable Regulaiory Services Thomas F. Geiler,Director Building Diyision Thomas Perry, CBO. Building Commissioner 200 Main Street,, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A wilder as Owner of the subject property hereby authorize tL to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date � ' xt tL _? - - Print Name If Property Owner is applying for permit,please complete the'Homeowners License Exemption Form on.the reverse.side. I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map c),90 W_� Parcel Application #o26126 Health Division Date Issued I l^1 Conservation Division Application Fee Planning Dept. Permit Fee 3 S Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/Hyannis Project Street Address c� Sl'Y" 0-414%V0 Village / n /� 1�- Owner7U/CLh��,, ✓lCl /�pct�� Address P 6'O >( 1 7 W frol'-16 X Telephone �" ) `7 - O� Permit Request b 5 kgc 5�i. - c�i�. Unl'eS &C � uz Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay r Project Valuation OC�v Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units)A�t303 Age of Existing Structure 9 63 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: O'Yes 0 No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ u Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: - Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ r•a rr{ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed, Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 71,116 Telephone Number e''Zb)4656 5- 17 I0 Address 99 ALIA iII !� 1004cl Il d License # C S S3 d o�- : �, Home Improvement Contractor# 7 S 5 Worker's Compensation # L&L 2 Y,37DJ_JL3U-C"c)— ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Pic( c/ SIGNATURE O/� (� DATE -/.3 FOR OFFICIAL USE ONLY APPLICATION# r DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION F` FRAME L i INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING s' DATE CLOSED OUT ` ASSOCIATION PLAN NO. Pv � r + .EARNSTABLE + 9Q Town of Barnstable v i639. 1� ]regulatory Services Thomas F. Geiler,Director Building Division Thomas Perry, CBO. Building Commissioner 200 Main Street,, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A wilder , I, t�[4—e� as Owner of the subject property hereby authorize � ;�el u� ` to act on my behalf, e in all matters reladve to work authorized by this building permit application for: ann (Address of Job) Signature of Owner Date ' L - Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on,the reverse.side. ({� lne Lommonweatin uj ina3,,'J'u4rcua tt-3 '-\ Department of Industrial accidents Office.of Investigations 600 Washington Street Boston,MA 02111 •�• • www.mass.gov/dia Workers' Compensation'hasurance Affidavit: Bnilders/Contractors/Electiicians/Plumbers Applicant Information / Please Print Legibly Name(BusinesslOrgmdzatiowIndividual): 11�SC7 yi—t Cp/1 �Y1C �1 l 1 (1C Address: 4 rr'tn!s� "wnd (cf. City/State/ZiF,: 13 0 LLArdS•c., fy)f+ CL S 3 Phone.#: CS"00 Are yo employer? Check the appropriate box: .Type of project(required):. 1. I am a employer with' 4. I am a general contractor and I employees (fall and/oi part.time). * have hired the sub-contractors 6. El 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 -8. E] Demolition employees and have workers' working for me in any capacity. 9. ❑Building addition [No workers' comp insurance comp-insurance.$ quired.] re 5. We are a corporation and its 10.❑Electrical repairs or additions. 3.0 I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions right of exemption per MGL myself. [No workers comp. 12.❑Ro repairs insurance required.]t c. 152, §1(4), and we have no , L � ' employees. [No workers' 13. ther�JeCt � comp.insurance required.] , *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowacrs 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 subcontractors and state whether or not those entities have employees. If the sub-contractors bave employees,they must provi&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'�i /�1(��u 615. CO- Policy#or Self-ins.Lic.P. d-S 3 .r J. 3 7 O S d .3 y$ Expiration Date: Job Site Address: I w ��Qr,7 l Q 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 MA for insurance coverage verification. I do hereby certify under.the pains and penalties of perjury that the information provided above is true and correct Si c3—� Date: afore:- ) — Phone# Official use:only. Do not write in this area, th be completed by.city.or town official City or Town: Permit/License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: r . N1aSS;ic lit :ctr�; - (h Ilu -II'IICnr ul PIIhII C �alc1 Bn;rr(1 nl' 611iI(linu RC:!UIaIIni1? ;tn(I �r;tntlar(I Construction Supervisor License License: CS 53202 u, �v7 JEFFREY R TONELLO ;f4i PO BOX 1516c'r' SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 Tr»: 21481 c �/� Lanzonarccusa`�� a� i�ri�dcac%{"� License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. if found return.to; HOME IMPROVEMENT CONTRACTOR T Office of Consumer Affairs and Business Regulation ype Registration: .'171991 10 Park Plaza -Suite 5170 l = , Expiration:, 5/9/2014 Corporation Boston, l\'TA 01116 RESOLUTION ENERGY^, INC.. :,. JEFFREI' TONEL'LO J 43 FIELDWOOD DRIVE.:'-.. WI lid �� out signature SAGAMORE BEACH,MA:02562 Undersecretary 1 V L V J Jl l.'VJ C'd:: JGl v�•_ ICE (�DATry �n�1 LYyyv) CERTIFICATE OF LIABILITY INSUIRAN 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)7 AUTHORI?ED ! REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder is an ADDITIONAL INSURED, the policy0es)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 cerliticate holder in lieu of such endorsement(s)- - nRCOUCER SMALL BUSINESS INS AGCY INC CONTACT NAME: ___— .------------- = 642 M.411V STREET P gN�ac_Iao,F�?i. I50g) WORCESTER, MA 016150022 FMRJL A '5S: ----'---------- — i _- -INSlJRE.P{S]AFFORDt:i;COVERAGE--------'—'�—I'U+IC 4 i ' INSVRER e RESOLUTION C—NIERGY INCORPORATED INSURERC: ( 49 HERRING POND ROAD --------•---._.__.—.---...----..—_._.......___ INSL[RER D: I I BU--7_ZARDS BAY MA 02532 INSURER E: __._.___...__.__ I —•---- "— COVERAGES CERTIFICATE NUMBER- 13897741 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSUF,ANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THEPQICY INDICATED. N:3TVvITH,5TANDIN3 AN C)Y RE AREI-AFM, 7'ERI%4 OR OONDITICN OF ANY CX)1\17RACT OR OTHER DCX Uti1El;ii k"TH��SPEGT TO V'f l(H ll IS CERTIFICATE 1•.4AY BE ISSUED CR t✓AY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED H ]REIN IS SUBJECT TO ALL HE T_RrA'; i EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.UMOTS SHOWN MAY HAVE BEEN PEDUCED BY PAI D CLAIIvLS. EYE,: ' f. II,rR I --�APOIJCY K�4VIBER I It Y ( A' y\'V1 I UFFTS t TYPE OF Ir15URAN:E GENERAL LIABILITY j.....-: I __._..._ t,R�iA+� ci rl J i I(X6lAiLP.";IAL C;ENERaL"JARCITI' '---- ...--..:.._•. DEXP!Ar. aie;r_11,ol ,. I _ —_---_—__ .......... : I CU•arr,5�nwDE �......_,C.J.F. I i I I` L__ .. .. j �cR,>,JVAL.ADV It`UL1Ry I c i ! ... .. I ( PFO � SDUry EU6117APJE;PER:AuGREtAT ro r-- - Po uGY I I l -L L• Q — AUTOMOBILE LIABILITY i ANYAUITU I -- CyyNgj Y riEDl!ED L I E�iLY II UI IRY(f A ddxri;S AUTG i.-_i A.UfCS I l I ,'fir:'rEFjl'T1"LIvTiiCv—._I y..__.. -.._......_ I�KYJ v+`AVEP I i I e �crr:! Er:CHC,CURREN::E V AA � rh7�l P(:�RUJTE Si EXCESS .F1V l —_'_-- . LIED '• i RETLV17tYNS; I I i ---..... -i--...----........... sanoN , IWC5-31S-370523-052 1311J20i2 I 312/2013 �' r_L IITS woRERscvP6A c AAID EMPLOYERS LIABILITY YIN j E.L.EACH A(.:IDefT i:S 1 O1)O(1(,'I� 'ANY PRC1PFIcTi'FiFARi -r; :ECI IrIVE❑(N,'AI I I I - _- .. N ICL-OPF1I1ICTQv O(C1_UDFD7 N I EL.DISEASE-EA Bv1PL(DY6L'S ----------10000r (fVWn&tory in NH) SOOOOtJ,. I;-w dewiW 1 irde i i I E.L.DISEASE-POLICY LI1,47 i$ ,,I 4 :D��:RIP'i1CNOFC•PERATI(hl;I�n�v -I i- i I -{ UESCPBPIICrd OF OPERAT O^s:L�ATICNlSI VE'-BCLES(ATaoh ACORD 101,Additionaf Plena-arks Schaduia If more ice requirEd) I (/orkers rompensalior.InSUial1Ce CANCELLATION COvarage appli;)s Orly to the workers colllP w ens?lion laws of the stale hnA., I • i _ s �CERT.IFICATE.HOLDER ___ ._.. A.. SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. USING ASSISTANCE CORPORATION THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED iN HOUSING ACCORDANCE WITH THE POLICY PROVISIONS. 460 WEST MAIN STREET i HYANNIS MA 02601 AUTHORZED REPRESENTATIVE ) gaff Fir16ric J --- t 1g)19BB-2010 ACORD CORPORATION. All riohts reserve ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1 J'•f:: 1`.�'::. - C„'.1�,!.:,,,ri: r:ll2 l_:?' C.,.h f•'.n _ ,t _ i..L... ..._._,_.:,C� �;ro--:�:• .,_ _.,,n-::-r:k:a.,'.,.,.lm .....mLy i._�:,-a-cecC.i.['ica'ec. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map c�90 Cam-_? Parcel Application #o?6 Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 14P GU.co�- Village n Owner-lz�wN_4' Aolicl 4,6m GV IT Address PA P Chi �� 7 7c Irian Telephone (22n 2:2-7 - 'P 70,)- Permit Request _1 ,5` S"7 5-t 9G. lZJ--• 6 ( _ f7-c/_4e.(�cl _ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 12,000 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) &-f3o 4 Age of Existing Structure /9�3 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room.,Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other r a 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 -� w Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: q i N ' J 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 12, D Telephone Number (6-Db )&bb - -7-10 Address AAA 106 n c l /L.'d License # 61S S 3 a-O-Z n"�L-1_a'A�A 66tv ania- Home Improvement Contractor# /71 I L Worker's Compensation # GJ(' S 3/--3_7 D ZJ SOr,4- ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �9 & nn 9 P11d a Cl Z y LLQAcIS SIGNATURE r d DATE �- ^ (.3 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME INSULATION S FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL b GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. �O*me r • BARNsrABLF. 77 '""SS. i639• Town of Barnstable 1� pTfD Mp`t a . Regulatory Services Thomas F. Geiler,Director Building Division, Thomas Perry, CBO, Building Commissioner 200 Main Street,'Hyannis,MA 02601 www.town.b a rnsta b le.m a.us Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must , Complete and Sign This Section If Using A Builder ' . I, Y' as Owner of the subject property hereby authorize ,=C ° to act on my behalf, U in all matters relative to work authorized by this building permit application for: fis (Address of Job) Signature of Owner ;;x; '�/ ,i Date F _ (, Print Name if Property Owner is applying foe permit,please complete the Homeowners License Exemption Form on;the reverse.side. (� l ne uommonweatin uj lrLaLNo u;AamJ'tta �.\ Department of Industrial Accidents Office of Investigations a 600 Washington Street Boston,MA 02111 '' 6Y•�� //!w/..mass.gov/dia Workers' Comp ensation•InsuranceAffidavit: Builders/Contractors/Electricians/Plumbers Applicant Information C Please Print Legibly Name(Business/OrganizadowTndividual): -R�—Sc7 (04Oi) Address: 41 rr'rn!E� '(D&nc( (Z_c'l. City/State/Zip: 8ULLir dS• 2, m19 c4S3�D_phone A: CS-00 �c��- I�� 0 Are youlall employer? Check.the appropriate-box: .Type of project(required):. 1. I am a employer with' L 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 -8. ElDemolition working in any capacity, employees and have workers' ng for me 9 ❑Building addition [No workers' comp.insurance comp.insurance.$ required 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.0' 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.❑R69f repairs 152 1(4), and we have no , insurance required.]t c. '.§ 13. ther,�JeCly11 �Gt,i'td 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. indicating such. t tin the- are doing all work and then hire outside contractors must submit a new affidavitB Homeowners who submit this affidavit indicating y g $Contractors that cheep: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. e1 is the policy and job site I am an employer that is providing workers compensation insurance far my employees. Below p cy J i information Insurance Company Name: 6,f r n1 Cl k- V aj, /11 S cy — Policy#or Self-ins.Lic.#: tQ C 5 3 Y ,571 ,5.. 3 7 O S d 3 y $ Expiration Date: Job Site Address: w' ��Q(�7 �Y P City/Sta.Wzip: 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 of perjury that the information provided above is true and correct. Date: ./d, �' t Signatare: ) — Phone# 5nb / dab _1 -7. 4- Official use:only. Do not write in this area, tb be completed by.city.or town of . City or Town: Permit/License# Issuing Authority(circle one): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: i% > �las�acl,u ctt. - Ocliui'tivtcnt ul hiiltlic �:ilcl a ' Bo;ird d' Bilildin_ Rc:-ul;ttinn. :mtl �tnn'lartl� l ' Construction Supervisor License License: CS 53202 x JEFFREY R TONELLOi PO BOX 1516 SAGAMORE BEACH, MA 02562 Expiration: 7/14/2013 ( nmii..i nrr Try: 21481 c /,e 1Gom.�rzaruuea�C� aL1-/1*&lja-,17{6"0 License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. if found return to: HOME IMPROVEMENT CONTRACTOR Type Office of Consumer Affairs and Business Regulation Registration: .7:�'171991 10 Park Plaaa -Suite 5170 _ Expiration:. 5/9/2014 Corporation Boston, l 01116 RESOLUTION ENERG.Y? ING.:::::,. JEFFREY TONEL'LO , `;..,•; ': . ,t n, 43 FIELDWOOD DRIVE' ..'.:: �/o - � t li'd out signature SAGAMORE BEACH, MA 02562 Undersecretary 7.1 4,viL 1V LV •J r [�l'1 YHUG / l,`U�? f'd:: JG1 %l.._ L�'1V r� 1 CERTIFICATE OF LIABILITY INS,�!1�=AN HTS UPON THE CERTIFCATE HOLDER. THIS THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIG CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES f BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING I NSURER(S}, AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT: I;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). i vRCOUCER SMALL BUSINESS INS AGCY INC AGTIVAm 20 E: .----------- ---- - I P+IonF(wGNO-Eg (508_'.2SQ63 -_ �------------ls---_.-...-'--..Q.? 542 M41V STREET WORCESTFP KAA 016150022 .-.----•- .DICOVERAGE __-.._.. -ryalC� _- -INSURERt]5 NSURER A: Li��g Milt Jul Irsur2ncE.........._...__.__............... L._ . .... ... ...__ . INSURER B. INSURED -- --- '— - RESOLUTION ENERGY INCORPORATED INSURERC: 49 I-IER.RING POND ROAD IN$L ERD: BUZZARDS 13A1 MA 02532 _---._-- -.--------'------_ _... ' INSURER E: COVERAGES GkRTIFICATE NUMBER' 13897741 REVISION NUMBER: THIS IS TO CERTIFY THAT T-IF POLICIES OF INSURANCE LISTED SELCM1 HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE: PRICY INDICATED. N;,�Vv)T)-4STANDINi ANY REC)IJIFIG•✓1F..NT, TERM OR CONDITION OF ANY CX)NTRACT CF OTHER DCY lJiy1El I l/ATH ncSPEC'T TC)Vvrl( T1-US i CERTIFICATE p11AY Be ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED IS TO ALL THE TERAn9. FORDED BY THE POUCIES DESCRIBED HE j EXCLUSIONS AND CONDITIONS OF SUCH POUCIE,S.LIMITS SHOWN MAY HAVE BEEN FrcDUCED BY PAID CLARJS. .- _,-_.- _.-....__ . .i —--.-._. II•ISR I TYPE OF II`aJRAM:E i POLICY M.MVIBER I(PP Y F ( nu b EACH -__ � .. i L YM UfvTr TR I GENERAL UABILII-Y i !c CEN�1EfY;aALC;En!EriaL_IG.BI:J \ i _......_ i . kiEUEXP(ArL'�ie;rHc i C Air;�•P/w0E ! G�:J.fi, ! 1 -'- ----- ........... . G'RE c I PF0DL771 S-CCI,tPlO?ACC I S .___...._.-. I. GFN'_AGGREGATE UNIT AP�E,'PER. 5 -� _.._ rOUCY I--- Poo. r I I — j rT 1 J- _L'ET L ao eri ......... AUiDNOBILE UABIUTY -----_...---. 1 i YhWU IS i A:NYALRC.' ESI:Y huiJWy(f e-P'oAxtT N 1EU I Yhit�l!lED I T14SfC�- . , .. --... ... P . ._... I{ _�AULLTO.. i._—I P hl(vd'6VED I I I' Ear ---I�--...------.............. ...J WRED P1.JTCS H Cr.,CURFE•V.^,E L E,C -'-I-- IbABRELLALIAB J rXY.AR I j PCGREGIITE i I EXCESS LIAB I I ((FIM...... i qEo RL1ZVn(T`S wof7cERSCL�maSAnON I y IN1C5 315-370523.052 1 3/1J20i2 I v12/2013 ! / !Trp�LnaTSI 10=!_�_.._.._•-.----._._ _ { A I.A7oQJPLOYERS'UABIUTY Y1NI E.L.EACH A(-:IDB\(f i ANY PROPAI:TC'FiFARiT:�=!`7:CGlmvE NIA i 1 e .__ .. . i OF-1CL-N�1.L=NLER CI:JDFD7 N i .L O:SEASE EA Bv1PLOYEE 5.----- - 107GQ.c 0( (1Vandainry In w itl„rrG,dasaiba r.rc'der ' i I E.L.DISEASE-POUC ,I1,4(T 1 5 50000fl D�;X;RII'T1ON OF C•PERATIOV itx�neJ I f I DESGTaPIKrJ OF OPERATtO,7S 1�n01"S/VF-I CLI='i(AtMEti ACQRD 101,Addrtrmal Rena ks Schedule If o e mace s required) tP•/orkers COmpen atiiln I115UraI',f.,e COVdf2ge 1pphE7s onl/toihE:u,'DrkErrs compensation laws of the stata IAA. I I J, �C----CAT-"rit DER -- CANCELLATION SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. HOUSING ASSISTANCE CORPORATION TF[E EXPIRATION DATE THE N' THEREOF,, NOTICE BALL BE DELIVERED I ACCORDANCE WITH THE POLICY PROVISIONS. 460 WEST MAIN STREET HYANNIS N.A 02601 ALMFIORSZD REPRESENTA-r,vE Jeff Eidririr --- �__�--- 1988-2010 ACORD CORPORATIOPI. All riches reservRd ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 20 17 t 11. ,r - . �•'r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a 9 D d-7 Parcel Application # a dl3 d d Health Division Date Issued 1 _ l Conservation Division Application Fee Planning Dept. Permit Fee 3 S Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address a-,, Village Owner�ZQu 6UA P6a c 6 Address NQ 6CV-/ ( 7 9 J_(P I rV70!i /x Telephone Permit Request /12�5 hIL 5-7 S_ c9�i. Uj--. &L (, _r_v ,tr r/ 5�e-1 i Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation t,D y D --Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) A f Existing Structure /9 3 y Age o s g S uctu e �7 Historic House: ❑Yes ❑ No On Old King s Highway. ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Q, 1 Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: `q Yes, U No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: -� { a J 73, Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) r�— Name d4� /L 1C)a0J10 Telephone Number(s; ,) B60-/7%d Address 49 &A.41 v]!�i pvnC//L d License #___0 5I-A .►/a/yan �xtec ) /2/)/P'" Home Improvement Contractor# -7/ Worker's Compensation # � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO n/ U SIGNATURE r9-m _j ld DATE /�p - 1-3 Ar FOR OFFICIAL USE ONLY APPLICATION# DATEISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. S 2� 1 ne uommonweacin uj inmvxauaast� to �-\ 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 Inforihation / Please Print Legibly Name(Business/Organinton/Individual): ?C—ScD 1 Jim Gr1 ne r-!j 11 OL - -Address: 4.9 . 4'e_-rr(n J d 2c•f. City/State/Zip: a U LLAr .(S 0;(-k f'l A Phone.#: C S`DO ��- (-�� 0 Are yo employer? Check.the appropriate box: _Type of project(required);. 1. I am a employer with ( 4. 0 I am a general contractor and I employees (fell and/oi part-time). * have hired the strb-contractors 6. ❑New construction . 2:❑ I am a sole proprietor or partner- listed.on the-attached sheet 7. ❑ Remodeling ship and have no employees These sub-contractors have -g• Demolition employees and have workers' working forme in any capacity. 9. ❑ Building addition [No workers' comp. insurance comp.insurance,$ 5. We are a corporation and its required.] 10-0 Electrical repairs or additions qu ' 3111 qu a homeowner doing all work officers have exercised their 1 LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑P,oPf repairs insurance required.]t C. 152, §1(4),and we have no e to ees. [No workers' 13. they 11JeCt '�� mP y 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 Us box.must attached m 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 providd their workers'comp.polidy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information I Insurance Company Naine: Policy#or Self-ins.Lic.# bl� C-S 3 •( J. 3 -7 O S a 30.5-d, Expiration Date: Job Site Address: `' w ��Ql,7 S�Y P Q 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 of per that the information provided above is true and correct c3--' Date: :%d, 3 -- / Signature:. ) — Phone-#: C Official use only. Do not write in this area, tb be completed by.city-or town official City or Town: Permit/Liceuse# Issuing Authority(cirde one): .-1.Board of Health 2,Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: i VVD ram. �cl •/i._ DATE lRZ,'DLYYYVY) CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CEF91RCATE 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 1 h policy,certain policies may require an endorsement. A statement on this cer'tlffcate does not confer rights to the 1 the terms and conditions o the p y, ceriificale holder in lieu of such endorsement(s). i nRca�CER SMALL BUSINESS INS AGC`./ INC CONTAGTNAME: —__._ --------------- -' I 542 MAIN STREET WORCES T F_P,, hAA 0 16150022 E hA� F65: j INSUREPgAFFORG�t COVEFAGE NwC b I IJSVRER B:rSURED 1 RESOLUTION ENERGY INCORPORATED ns(J.,eRc: 1 :fig HERRING POND ROAD ! BU-I_ZARDS BAY MA 02532 IJ5I RERD: ER INSURER E: .. i I —.---- INSURER F: _— COVERAGES CERTIFICATE NUMBER: 13847741 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELCMI HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR I)-ti POLICY PS Ii:G INDICATED. N(JTVvIT!-ISTANOIN3 AfnK REQ!JIREI-AF.NT, TERM OR CONDITION OF ANY CX)NTR,AC:T OR OTHER DM,JIMEN7 VoTH RESPECT TO vvHIG,- 11-Ilc I CERTIFICATE A.WY BE ISSUED OR tMY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES OESCRIBED HEREIN ISSUBJECT TO A_I L THE TRW.-'-. i EXCLUSIONS AND CONDITIONS OF SUCH POUCIES.LIMITS St AWN MAY HAVE BEEN PEDUCED BAY PAID CLAIIJS. - — n�DD' WYlC� . .._ 11.15R I TYPE OF Ir15URANi,E POUCY M.4VIBER tr r v r!�r�cr-v\'vvYt I Ulr`Sf L M I GENERAL UA'BIUTY ! EACH rl1R.PE>✓•c c. _....__.._. I --- �JCJ`,i•hiNL1E ! O?:J.F.'. I j i I�tEU ExP;.Wr/,a,e_i•rsa�= -----._....._-..._....... I PER t. i SCNAL E ADV It`UURV I c--`---...._.....- " " _ I I i CE"JE(4LA:rR_R>STc I$ ENL A C6REGATE Ub:11T APF JES PER:Poo I j j N)iJt;Y I AUTOMOBILE UASIUTY �lµV Y'hiEDl!�D I � I ESI_Y IIVIJRY --i�KXJ iN/VED I 1 I E -,PrR I c !J HPEDAIITOS i A.LI O I I I I a 1�GC-- i I ' LMNBRELLA U4H iJ r Y.;l F1 CH OCCURRENCE - -�s ----- -XCESS'_IAB ' I '1Lfff-WV+DF !..-......1 UED .t... REtLNn(7J..n. WORKEFS-CQvpFsAnON I IWC5-31S-370523.052. 1311212012 13i1212013 '! ! �i�LAATS, A I AID ETJPLOY ER5 UABIUTY Y/N I E.L. _ ✓ .TrJ.. ANY PROPRIf Q�PARTNEPl Y.FG1 IVE I. t!.EP.CH_A(,CIDEfr — :5_.-----------1(1l)ODC75 �iNlA I I 10�Gncf O==ICL 49.LTvLER EXCL'J71=C N E.L D!�EASE EA -- (`Mndat0ry In NH) -- "� I;••E,deil7Jn.vdeJ i I I E.L.DISEASE-FOUCY Jr,4 j S SQOOOI.q l ;DRIf'T1C7N OF C•PERATI(IJS tr±rnv i I I '_^ I I I I - UESCRPTICYJ OF DF'ERAnC%�6+LG'v'AnOP1S/VE-6CLE 3(Afraoti ACOM 101,Additional Rerrerks Schedule,If more mace required) t I Mlorkers rompenation insunl•,r.,e cmvara0e applies only To the workers romp=nsuion laws of the stata r:nA,. I ' i ANCELLATION _ 1 LCERT.IFICATE.tiOLDER _ �. . ._�.7[ALM40RIZE]DREPRESENTATIVE j SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. HOUSING n,SSISTANCE CORPORATIONTHE EXPIRATION DATE THEREOF, NOTICE bVTLL BE DELIVERED iF! HOUSING WEST MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HY/tNNIS MA 02601 rjr. yf Jeff Eidridoe - L--_--- — :q)1988.2010 ACORD CORPORATIDI•I. All riohts resLcveff ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD - 1,(ry?— ':1.- - 'r:1'•f:: I':>.� ,�,- Y1.,' � ` .�l? 1=: ��1�h I"n:-,� �. ,r . �.n_. ,.._._._.:;Le �.._>ac• .,_ ..., r.:_+.b:....r.� 1>�•,....r.:•D, .__::-:1-.crl•i.iica_e_. r • ' • BARNSrABM 'Town of Barnstable 9dj t6;q. 059. ,fig' ' pTtD �g, Regulaiory Services Thomas F. Geiler,Director Building .Division Thomas Perry, CBO. Building Commissioner 200 Main Street,' Hyannis,MA 02601 www.town.barnstable.ma.us ' Office: 508-862-4038. Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder , 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: ALI(Address of Job) it P Signature of Owner io 9 � � �'�/`��,,.� � Date tt > � - Print Name If Property Owner is applying for permit,please complete the'Homeowners License Exemption Form on,the reverse.side. : . r *=. `1;t��achu:rtt. - fh'irirtincnt ul Public `:ilt'( � Bnurtl nl C3uiltlin_ Rc;'uf;itinn. ;Intl �t,intlartl� Construction Supervisor License License: CS 53202 �.fsP�iv JEFFREY R TONELLO ;frpi PO BOX 1516 5� SAGAMORE BEACH, MA 02562 ;` T; •. -:m,5j.. a Expiration: 7/14/2013 ( rnnii.<inrr Tr:: 21481 _ �� a„7,,,to zu a�C/z a�✓ ��ati�{ License or registration valid for individul use only ion i ation c)nte. If found return to: Office of Con &Business Regulation Consumer Affairs before the expi oulation HOME IMPROVEMENT CONTRACTOR e. Office of Consumer Affairs and Business Red Registration: .:'171991 Ty 10 Park Plaza -Suite 5170 Expiration:. 5/9/2014 Corporation Boston, NIA 02116 RESOLUTION ENERGYY;;ING,::: ,;.. JEFFREY TONE LLO 43 FIELDWOOD DRIVE.-:.. SAGAMORE BEACH, MA'-02562 Llndersecretary t lid w out sicnature