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1070 IYANNOUGH ROAD/RTE132 - BLOCKBUSTERS VIDEO
C�p` C' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r Map Parcel o Application #")6.106 0 Health Division Date Issued �- Conservation Division Application Fee / Planning Dept. `` Permit Fee Date Definitive Plan Approved by Planning Board V Historic - OKH _ Preservation/Hyannis Project Street Address y0 ti 0-0. sc, :4'e, f� Village 14 5 Owner � 1°A � 014 ���hpl W's Address ep Li, Telephone 11J.. I � ti A Permit Request Square feet: 1 st floor: existing fproposed ®' 2nd floor: existing proposed_Total new Zoning District Flood Plain Groundwater Overlay Project Valuation c4 r Construction Type M Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure JU I'- Historic House: ❑Yes J-1`40 On Old King's Highway: ❑Yes ❑-KoT Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft)-� _ Number of Baths: Full: existing C/ new a Half: existing 2Y —newJ ®` 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 J<es ❑ No If yes, site plan review# Current Use Proposed-Use.- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 8 e�� . �ors�� � Telephone Number Address P-Or License # 1 y t1 Z t/al, 61 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �4fA1-1 a fi sta"Y"L a SIGNATURE DATE 2�lC� 2�IZ T FOR OFFICIAL USE ONLY APPLICATION# t a DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL a PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED-OUT ` ASSOCIATION*PL.AN NO. f i The qarrrmorrtvealtli oflklrrssachuretfs D--P=tnera of-r1%d= -j&�4c cidenls ru'rul fj'ue ofInve ag bons 600 FYrzrhl Tfon Street�� Basforz, M4.DZIII . . • r r wttfw.rr>:ass.gav/rfza - Workers' Compensafion f�sFu-aneeA Affidavit. g.uRders/Cantracfors/EIectricia�s/P��mbers A- licant Information Please Prfnt Le ibly Wg7�e (Business/�rg�izBfior✓fndiYidual): OJ d Ll �YrS / ,1 Cify/state/Zip: �' �-t-v,��- twt, d�d Phone Are you an employer?Check the appropriate boz: 1•LP-ram a employer with 3 4. ❑ I am a general contractor and I �'Pe of project(regrrtred): employees(full and/onjom-t_time).*7 have hired the sub-contractors 6 ❑New construction 2. ❑ I am a sole proprietor or parer- Ifsted on the attached sheet $ 7• remodeling ship and have no employees These sub-contractors have B. ❑Demolition working for,me in any capacity, workers' comp, insurance, E 0 workers earn fnsutance 5. 9• ❑Building addition p ❑ We are a carporaiion and its required•j officers have exercised tt�e� I Q ❑EIectI-ical repairs or addi-dons 3, ❑ I am a homeowner doing all work right of exemption per MGL I I-0 Plumbing repairs or additions myself. [No workers' camp, c. I5Z ¢I(4), and we have n© instuance ired, t 12.[]Roof repairs• � ) employees, jNo workers' wrap,ir►mmace repaired) I3.0 Dthor tA-Y Applicant font cbrr.E3 box#I mast also SU old the section below showing their?mrkers'cotnparsation pof ley information t Hpmtpwncrs who submit this afndarit•md:irafing tbq are doing all wort;and fficu hie oulsidc contracfnrs mast submit a new s�Trdavit indirsting sack, �Contnetars Hrat ehrJc this box mast attached en additional sh�xsbpwiag tht name of the mb contractors and their workers'corup,pe[iry kbrmatinn. I¢nz an ezttpbvyer that is pravi4ng,70 ork'ars•'Cffr PMg-adon irrs¢ra?zce far In employees Befvyp is th e pofrry and job rice irrfffrnzorx. Insurance Company Name: Policy#or Self-ins. Lie. 261 g j f e Z z pjj Expiration Date: Job Site Address:_ f G iG -'h tA w ow s 4 �� .Sat /ls S'l�City� lZip: Attach a cafe of the workers' cam pensafion police declaration page(shoMngthe policy n¢mber and ezpirafioa date). Faflure to snr-=coverage as required under Section 2SA ofMCrlL c. 152 can lead to the irnposftion of criminal penalties of a fine up to$If5D0.00 and/or one-year unprfsorrmeni; as well as civil penalties in the form of a STUD WORK ORDER and a fa of up to S250.D0 a day against ti c-violater. Be advised that a copy of this statement may be forwarded to the Office of ine Investigations of the DIA far mstuaoce coverage verifica3on I L hereby care Hier lfce mz erL Cs of perTccry flirt the urfarmadon Pruv&ed ahrrpe is true cad correct ' Si a111r e: Date: 'hone#, G*r+ 9 21 acre ff rily.,I3a not Wrrte ire this area, to be eor7pleled by city or town 00cici( City or Town: Perni"ct/Lfcease Iss¢iug AgthQrity(circle one): I. Board of Health Z. Buhdiag Depart mant 3.Ci4,rTown Clerk 4.Ela-ctriral Inspector S,Pl¢mbing Iasper for Qtl7 ter 11 /22/2011 12 : 54 : 33 PM 3822 0 02/02 r - r CERTIFICATE OF LIABILITY INSURANCE TNT S CRRTIFICATE Is rssuED AS A HATTEP OP IRPOA'�.ATIOa On LS Aso )PEBRN PC R.TaN'+'S 7Pov Tim can-virinTN_HOLDER. THIS CERTIFICATE - DdE9.NOT AFFIRMATIVELY OR M3ATIVELY AMID; E=E80 OR ALTER SHE CO'JBRAOE AFFORDED BY TEE POL.ICLES BELOW. THIS CERTIFICATE OF xi8*RAHCE DOES R'OT :OR8TIT0'IE A CONTYACT BE79MEN THE ISe0IN0 IRS*RER(8)r AOTNORIEED. RefusENTATIVE OR FRODWCER, AND T= CC TIFICATO HOLDER. - 1UPUTAaT: If.the certificate holder is or. ADDITrom INSUSEDr the policy(ies) must.ba�endorsad. If 8VBROSRTx�a 19 VAIVED, subject to the tern* and conditions of the policy: certain policies may requite an endorsement. A statement on thin certificate does %at confer rights to the certificate holder Ir. lieu of such erdorsoment(s) 1 PiWVMi I miller MccaXtln Z11, [ay I dba bowlinq & O'Neil Ins A4C'I taa.W.. r t,: ! we.tl.): ---- _ i 973 Iyannough Road PZED'JCER- I Hyannis, 1A 02601 CUHTDlRR 7DY. _ _I ' - _' u)<Ilna tsi Y'IUSOlab t'L'VLYC►t YYIc t 1 William W Croston _InsoEFs a_A.I.M. Mutual Insurance Cc ---_ � 3 .58 dba William W Croston BuildingContractor MUM Uriti B, M B: -- RIM P 0 BOX. 138 MIU&1Y i ---i-- -�' Osterville, MA 02655 I mum A: COVEPMES CERTIFICATE Nunn: Rr'IISION NUMBER: xs .s cEIIT37Y THATBs tCIES OF 1MUS ISEMM TO Irm MIJUD ANVE T-R Ing PoLicy 80SWZ1SST}1SDL196-Any R22CXM20 r, 'T'nM OR COMLITIGa oT A*Y CCW-MACT On O%wn Ja.- T WM RE21ZCT To.I.M.-CH THIS Ce81•ZrICMM MM BE Issum SOP YMy ' Pnim. THE INSURANCE APN U= Y THE L I$a D 3•'4' M u .I B PO IC E - IBP,) .P3E=1 I3 9r8HECP TO ALL TH6"CEl$95. EX�CfT_ON3 An C09DITIOPS OP fIKR P�.ICIES.-.LIIii45'.S!10NP-.•-('. ! MAY al an,RWVCLD BY PAZD CSh=. - i" POIICt 9N1Is36 'oLidlt RP8 I 8oL2IY aNP Lr'm' TYPE or INSVRU1iCE { I Iffi/DDIYS7Y) .aS:7H/YSYtI I I . i ZMMAL 17MI11R4 cam( ocua caaca i.e _Q .:{-Hf .AG ilStaALLv.AL'[.I i �• - - UaaC1E fU Mtalrty I d i I �❑CW.I.L'S IfuS �CSiR ' I - I PR9lI>iPS(BC.DeactinnOn:: ME EXP (A.1,me qDe zrnnl e Cl .. i ¢SYS IaaI i aD♦I87U11 i S i ❑- 1 I taa�AR.ffiCRLME I-C -�. rH'r:'ee;mr In xnarT )rn�r:vs yr OTOLSCY oF7 rCT 1 - I ! I 1 RMVCTS-ion/aP A" 8 iI ---- I --! I Ia0 aMSrAUTMOBnx 11U&MITY .E LnIT dt)13—LCD I 8 . i tlBD11Y :W Y81t ryas S•e:ami) i Y ) M.:anEc n�-o3 i J �acu1-012D AMC, 1 I - -I. BLDItY FBTeNY(DQi aiDiae,t) (..e I - I I DIUMT Dwau r. IDQ :sidmq 1 Q.xeGeLxa_n: Elv.cuD ! ewc OCCOUMCE a i .• ❑BL.F:?MAS �.CIAM Mr2 ai Lf8t8 8 ' kJR C8B CGIIQSRSATLO - ------ -.1.. I x. A9D-SOSLO AS1i 9 LSItPII,ITIC ( ' 'IH6 GR?CDT,r,V/PLRT\FRSi �CGC�T:'E�:,FiICEF.3 Pikei E.L.tcn 2r<:caDt Y Sr000,000 A I _ - I � L.L. Otimie-DO1SC!LIIII ! , i p it-c3 p ?X15i- 701.319 4022011 E d l,00e;000 ! 09%03/20_1 09108/2012 I i' +. I e.a. Olsraia-ea ea¢LosE I s 1,000,000- —� -- ! WILLIAM tV CROSTON IS MOT COVERSL' BY THE POLICY, — WOOKERS COMP COVERAGE APPL115 2'0 MA MPLOYSES ONLY I • i I CERTIFICATE"HOLAER CANCELLATIGN ,BESTIVAL._OF YANNI$•LLC - _--- - •j------ --� C/0,KIMCO T-HYAY:-CORD I RYOMD A"OP in"ova r68crMn POLICIES RE CANCIUM RSIORE"M 68P2=09 DARE TP&t&08, QORTCE WILL BE DELMM DI WSCORDArCB 9STN THE 3333 NEW MIC PARK ROAD; STS 100 I PSL2CY 2IIC7ISTC113. . •,s. ...._� 1FDnf3MSID IrOTI63tSTMIiC�_--_-. �. NEW NYDEtPARff, NY 11042 - t 2836 __ .. ...... .... �i.,f.:to .,ni;.c •".,., 3-•. •. -' 'I I+� - •------ ----_.�. .__ - -- -------__.----- - flair eAf Town'd Barnstable $ Regulatory Services _ Thomas F.Geller,Director ELAM Building Division . Tom Perry, Building Commissioner. 200 Main Street,Hyannis;MA M601 Offices 508-862-4038 Fax: 508-790-623..0 . Property Owner Must Complete and Sign This Section If Using A Builder ^-►,5 c— d hlk t,NN',� C ,as Owner of the subject property hereby authorize t� Cey�s iv, do 11/9, �� f to act on my behal f is all matters relative to work authorized by this building permit application for.. lU7a ,�-Sc.HGwS�r �� SU.��sr �lG ah��S r+c., • (Address of job) . (j Signature o n-er - -' _ - te 1 P t Name Q:FORM.9 NERPERI SSION eDEP - MassDEP's Onliner'ilmg aystem MassDEP Home 1 Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System Usemame:BiLLCROS Nickname:VNLLEY My eDEP I Forms tm? My Profile lz� Help ( Receipt Forms Signature Receipt Q Summary/Receipt print receipt_„ -_:Exit, Your submission is complete.Thank you for using DEP's online reporting system. You can select"My eDEP"to see a list of your transactions. DEP Transaction ID: 452299 Date and Time Submitted: 2/17/2012 2:22:31 PM Other Email : Form Name:AQ 06-Construction/Demolition Notification Payment Information DEP code: 63006 Date: 2/17/2012 2:21:48 PM Amount($): 85 Payment Detail: CROSTON BILL--AccountType--AccountNumber, *#5037 Confirmation Number: Y Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab My eDEP MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.11.4.10.1©2011 MassDEP 2/17/2012 https:Hedep.dep.mass.gov/Pages/PrintReceipt.aspx e ire dePt No . 29/4P . 1/3 PO Box 94 JD VJ t,;r i a7 vw 3249 Main Street 4° Barnstable MA 02630 DIM Phone:(508)362-Ml 2 Fax(508)M-362-8444 y To-Fro" Fmc , Pagm c�: r-G z.: p Dated Rae Q Urqmet ❑ For Review '" D Please Congnent 13'Please Reply .0 Please Recycle eb 16 2012 1 UUPM BARNSIABLE tire dePtI. , NO. FIRE- 1)-C,F AR 1. .i'�'c�-en��on Oi'z`�ce Tixacl�le � uilcli� br H}%� alr, 1��''� �r60a 8622-409.7 BUILDING CODS "'DMP�LIANCE _�ORMI Dic1 S datB.0 -� ,1 I'Ji' 11 piCpi;i y lOcai-d a? -L`( gN�0U6N. 1 /t+J ' I�sT►�ts. ' . U.��� :also I<(i��\Nr} �5 1pCa� il�Ve �32 1 ,'eY{�' ad ii; Oi the, r`!7j�iPI � UDi�it � ✓ ''y8'1"s I. � '�N�Si �a�•1�StaCI? C C.jn� y.`I !�•-�1�gq1`I Irr��i I^mo., � "1�` `STAiUSOr ;il— P,=VIrU1�: ! TYPE OF GONS:i'UC DON ROCUl �N i , NIA TH D f ?;rV!�Vy�D ! COMF Li"S j 1. NarraTive Repor( Su L i 12. r irstighting Rascue ,cress i ;. �ydrani Locaiion &Wator Suppiy 4. Sprinkler Systems F. Spn kler Control 'Quipmen( I I 1 o. Siandpjpe Systems 7. Standpipe U'alve LocaiionsVII 8. Fire-Depart-men! Con.necLicn B. ~irE Protectjve Signaling SyJlvl,i i f ✓LAIC M O� I1 "LN)AA 10 ! ;0, R.S,S. & Annunci2ior LOCailo 1 I i 1.'Snoke Control/Exhaust ►/ 4 ",#� _ - � ,�, 12. Smoke Control �,auipmen; Location ^,3.. ?Re Saieiy Sysie:m eatures � '✓ I 14. - ire'=xiinguishing Systems 1'5. .S. Contro! Equipment Location !. ✓ 1 �. 15. Fire Protection Rooms 117. ,Ire-Rroiecllorl.Gquipman`'Slgnaga ! 18.:�,lerm 7ransnission IyieihoG . I �. 1� r i i 1.9. sequence of 0aeratjon Repon r ! �. Su31+�t� � !: I . I 20, ccapiancs Testing Crlterla i No: Sup +/1 E �?.ilaYB CIS .7OCIl1Ti�1 "o.�� ��7i1712¢E c�1Ci.COS IpI'ial l' lo,.thE !SS!lance of .buff di-n� p2ri i 111. !�1'2 rlaVc v0lipiaieG' The aCC p. i a;�a.,.!;)� or =n occ'up2ncv �?� i,11 and del:-\/� fiat \�rlr7„„"sr2 SCOpa�(� of tna building permi'L, the above;;ISS1ec 2re In,coi;lplla,�C3. � �v�511�—•• - r ' + NIassachusctts- Depa�rtmcnt(if Puhlic Safet� Board of Building Re(rulations and Stanch ds ¢ Construction Supervisor: License License: CS 14112 Restricted to 00 . WILLIAM W CROSTON JR 55 SUOMI R .. _ HYMNIS, MA:02661 Expiration: 4/25t2012 ('unmiisiuiicr' Tr": .20683 . fze.;�o?rvnzanureatCf, License or.registration 1�alid for mdividul.use only Office of Consumer Affairs&B siness Re;ulfltien a before the expiration'date. If.found return to: n WdME1MRROV�MENT CONTRACTOR Office of Consumer Affairs.and Business Re;ulation Registration: 100023 TYpe 10 Park plaza-Suite 5170 Expiration _618/2D12.V DBA ; �11b. � J _ Boston`,n7:A 0 BlLCCROSTON BUILflItQG CON— RACTOR WILLIAM CROSTON - g c,/ 55 SUOMI RD HYANNIS,MA 02601 Undersecretary < . Not valid without'signature t t0,E Sign TOWN OF BARNSTABLE Permit * BARNSTABLE, 9 MASS. g 1639• Permit Number: Application Ref: 200803080 20070178 Issue Date: 06/09/08 Applicant: FESTIVAL OF HYANNIS LLC - Proposed Use: SHOPPING CENTER- MALL Permit Type: SIGN PERMIT `Permit Fee $ 150.00 Location 1070 IYANNOUGH ROAD/ROUTE132 Map Parcel 295019X01 Town BARNSTABLE Zoning District SPLT Contractor. PROPERTY OWNER Remarks BLOCKBUSTER VIDEO 2 32 SQ - RELOCATE EXISTING Owner: FESTIVAL OF HYANNIS LLC Address: BILLBOX 01 8726 1053 PO BOX 7522 HICKSVILLE, NY 11802-7522 c� c' Issued By: p POST TINS CARD SO THAT IS VISIBLE FROM THE STREET Town of Barnstable, • a � �oFt►+E,ow� .Regulatory Services C 6 _. Thomas F. Geiler,Director `Fp2o; �� 2 `"M�`"B Buildin Division 1 MASS.1e3� 1�g g O �fne Tom Perry,Building Commissioner 6 200 Main Street,Hyannis,MA 026.01 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# Qo-a F d 3 LYE Application for Sign Permit Applicant: Map &Parcel# aqS" Doing Business As: �Lcx ���eZ �j"-d'e® Telephone No. (3 Sign Location ' � A� � `` Street/Road: �� w g U ��h15 ►" Zoning District: Old Kings Highway? Yes/No Hyannis Historic District? Yes/No Property Owner 1 l Name: K\,YA(0`ReysL Telephone: Address:��3 Jul�-c�.9 Ye' ,Qczk �U Slits it)<Z�Village: 1kv14a- soap Sign Contractor C, Name: 1`� � Si Telephone: 'Soo �3���1� Mailing Address:�`� t S i � 5�`��� k. Description Please draw,a diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sign. This should be drawn on the reverse side of this application. (qP5 Is the sign ?9 to be electrified > (Note:Ifyes, a wiring permit is required) 5 ` Width of building face 3�), ft.x 10= , C7 x.10= Sq.Ft.of proposed sign epc�k- c,i.loa - I hereby certify that I am the owner,or that I have the authority of the owner to make this application,that the information incorrect and that the use and construction shall conform to the provisions of§240-59 through§240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: Date: Permit Fee: Sign Permit was approved: Disapproved: Signature of Building Official: Date: 1� In order to process application without delays all sections must be completed. Q:I WPFILES6SIGNSI SIGNAPP.DGC Rev.9112106 0 � w a ([ e Y F y 1 � Ile gi ca • ' y, Y�A� O CJ { �0.0 r '� M � .�, {���� �_: r � �, '.d J ♦ ��1����,',/�/�/IVVV���///���`(((��r��,JJJ►►►��+��`l(((��' � 3 =yi fi $�* "� f:eT�'"+; `�$'�'�' t .. �tip�. � f - '� f+M t �..r•.�.'�4.y,-fiar}�. - .r37 r r• � 8� ��"r�r�� �'€ a4d'#t ''r�5 r s•, v �' .� '� 4Y�'- OVA TAki i - his x, 'rd. 9 W 00 i 4 jVQ 7 • a u xwl 00 s A a " � s.k M�yti.dks.p.�, •, 1 .-ti,^.� _ `+� a :Sri,f.'=-;�•' fi � _ •K F#: ��fi�i � �" � .^ � T-dui 6 " C] rL I I I p •tp` `.- jtI r _ - ' , tA 14 43, V t a� � A k } s a q i 9 4 n tt 444111fff .� �$" � � t f c F �:.Ga, �C-�: '.✓-e,�^-^u�ir•?i:,�t-,y'E� :•�i a.a,. .: 1 M.� � I' t S _ _ 1 g r{ !�I }, ' 4 b n i } w m if ,, 4 "EIS... `�.i� i l- T$3'�a"'._•:i i�Y.r^'a. 16 • Mx rt a A r f sb e t N r h �4 t d fu yyw•�� I A.JY1 •� 'KM1 �._ T' Y x r e i 1 i kJ k% ., ..� -..- �..�_,: :.�=. ��' ._: . .;, �, a.... �•,;:.. w'g.` i �,�yyw Y7 I w`-�¢'-h4,abif .. =-�.t ;;. ar �-��'.,eo.� - -:��-�:� j - . � qi - '�, � ' � t fir'.: N ��n � _ -..-. va•94^£;-w �sT'.3 . ,i t� A Y IIw:p; y S + l 1 ,b r +�e^*r -"v''�—�r it rrr . • s � `l s �' „�,�, - -z- -v� a �. ID '�--a...__-..z��-y+•-.....'may s��'. Al AM, n a ta- m a--: r,� _,,,, �`� .�'' ..,4-. � ..Jc.-. .as..�_cc+a_,-.�.,�•s--.n..�, ��. �r - m �.•, new h= i „ r �1 . - a r - ` ,3N1�. -. s•.,Cy' ..0.:0 . ..�5.�� �".4 �� �'L a � I � � ��_ y 'WI f��4' 'W'ItYF. t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION t Map Parcel 011 V- 1 Application # MID Health Division S A 3 8*7 5 Date Issued S l O Conservation,Division Application Fee. Planning Dept. Permit Fee �J d 6 Date Definitive Plan Approved by Planning Board Historic,- OKH _ Preservation/Hyannis , Project Street;Address - t� �"- Csv v,\ r Village "\J GXl n n Owner : -k' LL C- Address Telephone �)o —Sao\-C��'-\S C Permit RequestQ Square feet: 1 st floor: existing • proposed 2nd floor: existing p,uposed 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 ❑ Others — Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft),i N Number of Baths: Full: existing new Half: existing n0d 11 Number of Bedrooms: existing _new : Total Room Count (not including baths): existing new First Floor Rock Count— Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other ; Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/c` al stov� ❑`_s ❑'No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑e al 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 INFORMATION - (BUILDER OR HOMEOWNER) Name �^ ��D r' S�ItG S CO Q_%ff1WJephone Number -6004 2CPS'"(o75g3 Address i0 LhKF- 'SftRE_by kqe License # I` gz 4(o -rK* 13`3003 1 r / . �Towsntj,K k 0291! 9 Home Improvement Contractor# <2? Ica Worker's Compensation # �_,+ /ObIVIbOAL ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO CODS56 h905AL SIGNATURE DATE FOR OFFICIAL USE ONLY y e APPLICATION# t , DATE ISSUED MAP/PARCEL N0. i { ADDRESS VILLAGE OWNER `I DATE OF INSPECTION: FOUNDATION FRAME INSULATION 1 k FIREPLACE I ELECTRICAL: ROUGH i FINAL r PLUMBING: ROUGH FINAL GAS: ROUGH FINAL 1 s FINAL BUILDING DATE CL•,OSED OUT ASSOCIATION PLAN NO. i 05/20/2008 TUB 11: 50 FAX 860 561 0426 ximco Realty Corp. - CT ®001/001 P.01i01 JUN-13-1996 03:07 - .. Town of Barnstable s "� Regulatory Services Wasr`ag Thomas F.Gciler,Director Building Division Thomas Perry,Cad Bulldiag commissioner 200 Main StM4 Hymwu MA 02601 www.town.b=sUble.ma.us gax 508-790-6230 Office: 508-962-4038 Property Qwner Must Complete and Sign This Section If lising A Builder C L-L�- as Owner of the subject property to act on MY behalf, herebyauthonu �' `� in all maRers re]ative to work authorized bythis building permit application for. n;kG1 1010 os�4sob&) " (Addres APPROVED Y 2 0 2008 � o $ignaitilie ALTY ORP, ' ate �.P.M Print N� ,- Q:\wPFn.ESNF0RMS%bui1d1n9➢fit farj,,p"RESS,doc Revise020108 TOTAL P.01 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 r4 Name(Business/Organization/Individual): �K 7 (A Q'-'j�[�l e— -" SQ0,53 Address: Q LAX" S QU, X1\1r_ J City/State/Zip: T iw4tc)w ,�. i 0 Z 9 t`( Phone.#: ' �►"q��- � 13 CEw' $-Z�$-�59 3 Are you an employer? Check the appropriate bog: 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.VI 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 ME]Electrical r"epairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no � rW 65 employees. [No workers' 13.❑Other ,, c7l�' 1 X 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. tcmtractors 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.M Expiration Date: �p n Job Site Address: ID70 !JAq l_U l fit • City/State/Zip: �H�_� /•I►t �G���l . 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 MA for insurance coverage verification. I do hereby rtify under�he pains and pe ' s of perjury that the information provided above is true and correct � v - Signature:. Phone# Offi ial use only. Do not write in this area,_to be completed by city or town offtciaL 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 Phone#: Contact Person: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees: Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written" An employer is defined as"an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing.engaged in a joint enterprise, and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." 0 Additionally,MGL chapter 152, §25C(7)states Neither the commonwealth nor any of its political subd ivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance aZth the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,i.f necessary,supply sub-contractors)name(s),address(es)and phone number(s) along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a homeowner or citizen is obtaining a license or permit not related io any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone-and fax number. The C6mmonwwth of 1Massaebusexts Department of Industrial Accidents Office of Investigations 604 Washington Street Boston,MA 02111 Tel. # 617-727-490..0 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 11-22-06 www.mass.gov/dia t_ v T SAFE GAME Fr e If P4 LA O N � 3 r�,' ooita m SfirSOfl � a a I go/.so-d 606t% t-'K T Ob,T �'11AJW iSH3H1210N 62:L T v OOOZ-ZT-1-'i0 May . 15 , 2008 4: 15PM BARNSTABLE fire dept No . 5606 P . 1 3249 Main Street-,P.O.Box 94 17 �� i • Barnstable,Massachusetts 02630. ji3;, i, ?` ,e':. 508-362-331.2 FAX 508-362-8444 N" 2 0. Robert M. Crosby Christopher J.Olsen FIRE CHIEF DEPUTY CriIEF Building Code Compliance Form .This fire prevention bureau has reviewed-the plans dated ] IS-pS For the property located at 1n-�d �y.a.>J ;��-. "R- Also known as: ot1C gt,b}eds The chart below indicates the status of our review Type of construction N/A Received Reviewed Complies document Narrative report ✓ Fire Fighting/Rescue.Access � / ✓ Hydrant location/water sj4pply Sprinkler systems Sprinkler Control Bquipment �. ✓ '' Standpipe system V/ Standpipe valve locations f Tire department connection Fire protection signaling syst •.- ✓ F.P.S.S. &armunciator location -� Smoke control/exhaust Smoke control equip. location Life safety system features _ ✓ Fire extin fishing system ✓ -� F.E.S. control e ui . location ✓ ✓ -� Fire protection rooms a/ Fire protection equip-.si a e v v Alarm transmission method :✓ v Sequence of operation report Acceptance testin&criteria We believe the documents to be compliant fo the issu ce of uilding permit. Date: -5 s Signature: We have completed the acceptance testing for the oceupaxicy permit and believe that within-the scope of the building penzat, the,above issues are in compliance. y 05/15/2008 09:37 5087786448 HYANNIS FIRE PAGE 01 k . ►1VMS FEE ENT 9 HIGH,SbHOOL 1`113_ E-XT. HWANNIS,MA_02601 ' ^ HAROLD S. BRUNELLE, C_ hImp r 11c Yi PR VENT-10N. U & TT S7Y4 A17.AE tor�ee®aAr,or BI�SINE�S F�NON :(60¢)77"300 FACSIMILE PHONE:(508)778-6448 LT.1pliXC F_HURLER, Ck7[ F RB P V�31V' ON;U FIRE F EVIM%mo1V OMC-13R ,. • 'UlL0ING--- •'Q E O011rlKIANCE FORM `1 `CHI "FIRS=PpI IENTII�N:BI 5A-0,HAS-REVILWE)27Hl LAN5 DATED FOFR THE' PRC F,I L THE .ekAAT 'Br=L4W IND1,WATPS.• THE STATUS 'OF OUR R5VIEW. r y f d• c ), . •. J•, �.`p..ray_•. ,• :._. RECEIVI=D AEVI�WEf� . COMPS IES 44 �aLEI z 1.... r: ,r - ' '�. 'f� �'� pia .-•K_; ,:�:. � : : - 11= M �EtbN �IA rF =��t'EV � �it�llgxS !Is- .t : .' o:Nl C trC�Uapt�QCATI4N: r' gm.. V, .T8 TO BF COIyID O IANT FOR THE ISSUANCE OFA BUILDING WE HAVE CUfy1F'i< rCS,fiF{E'RCC�PTgNCE��9T%IlCl� F6 TH ANCY PERMIT AND BELIEVE THAT WITHIN THE 9COP'E'O TFIE.BUJ�X)! 3 Rr NIIT,'THEAF3Q IS,9 -- �I�E IN COMPLIANCE- YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1"FL,367. Main Street, Hyannis, MA 02601 (Town Hall) DATE: f 31 07 Fill in please: APPLICANT'S YOUR NAME: ►r ' �+ l m G v\ a 3 a - , BUSINESS YOUR HOME ADDRESS: o OLS,y -qqM PV(Annic, M ,4 TELEPHONE # Home Telephone Number P�?la--J g- 155 NAME OF KNEW BUSINESS _ G �' '1'YPS Op BUSINESS IS THIS A HOME OGCUPATION'T _;YES NO Have you been given.approval from the building divi ' ? 'YES—NO ADDRESS OFBU'3INESS MAP./PARCEL.NUMBER When starting a new business there are several things you.must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. -.Jcamer of Yarmouth Rd.&Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMa. winf9rrWi ER'S OFFICE he fan ermit re wr emants that ertain to this a of business. This individuP tYPYP qrized Sknature COMMENTS: 2. BOARD OF HEALTH This individual ha n infor f th perm' equirements that pertain to this type of business. Authorized ignature**. COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Mao CO Parcel X Permit# 7 O l0'Sll U yr fJf 3rii�SrRR Health Division Date IsW9- 7 /S 6'3 Conservation Division 15 Applidatid-flee Tax Collector Permit Fee I/&Z�7- C� Treasurer W I '"+ )W " —; -\= "ref MUST OBTAJN S�pCQi1N.EC PER .ENGINEERING DriMON IWOR TO Planning Dept. ��, CONSTRUCTION. Date Definitive Plan Approved by Planning Board g Historic-OKH Preservation/Hyannis Project Street Address IM(� � qA(V 0`5 MA Village bA l . OwnerAd-'dress G I J �1�COIN Telephone qbl - 33 q, 00 Q 65 .Permit Request E X 60 S Square feet: 1st 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: L 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 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 Telephone Number Address - License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE r FOR OFFICIAL USE ONLY Y .. 1' PEWMIT NO. DATE ISSUED MAP/PARCEL NO. tti ADDRESS VILLAGE OWNER DATE'OF INSPECTION: FOUNDATION - FRAME INSULATION FIREPLACE ' ELECTRICAL: ROUGH '. FINAL PLUMBING: ROUGH FINAL y GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i if M,�)U fib ) 1 --D I NJ HEA D 1 N PA 12 L N Sb 1 R O T© o PA a I � l2 E -mil EV 107 0 :f:\/--N ocJcy fj k-P -H Y M A- 06/12/2002 11: 44 15095613793 AMERICAN TENT PAGE 04 Certiitcate of Flame Resistance i REGISTERED ISSUED BY Date of Manufecture FABRIC JOHNSON OUTDOORS INC. NUMBER BINGHAMTON, NEW YORK 13002 MARCH 2O02 F-140.01 Manufacturers of the Finest Tent Products DOW111 ed Mersin This is to certify that the products herein haw been manufactured from material inherently dame retardant as here after specified by the material supplier. NAME: AMERICAN TENT&TABLE CITY: MORSTONS MILLS STATE: MA certification is hereby made that: The artic{es described on this certificate have been manufactured with an approved flame retardant chemical in compliance with California State Fire Marshal Code, NFPA-701•,Underwriters Laboratory of Canada,and have been tested in accordance with the Federal Test Method Spaciflo tkm and meet or exceed the Military Flame Specifications of 11ML-0-43MM, Type,color and weight of materiel 140Z. Vinyl WHITE BLOCKOUT pascription of item certified: 40X40 2PC GENESIS I Flame Retardant Process Used Will Not Bo Removed By Washing And j is Effective For The Life Of The Fabric Snyder Manufacturing, Inc. Manufodurer of Flame Retardant Vinyl Laminates TENT DEPARTMENT,JOHNSON OUT IN/ •Large Scale 06/24/2003 TUE 9:51 FAX 401 334 4909 NortheastAanagement Inc 444 SUSAN's office Z001/001 Jun-23-03 03; 20P FINARD and COMPANY 7814558461 P-01 FINARD & (' Oibi ) dNY HILLSI'1' E 0F1 1C1; BUII,DI,NG FACSIMILE TRANSMITTAL SHEET. ` TO: rxcanl: - Mary Arai Lamson Alicia C.Boutl4ette Senior Property Managet rONIPANY: 1>rrr•.: Northeast Management(Blockbuster) 06/23/03 FAX NUDMIEW '10TAI.NtI.OV I-MAA iVt;I.CpiNc c_17Yfat. 401-334-4909 VI IMF NC."tn1:N: sr�lal;K s xr•.rraii;lc,r;r;�nasl:x. 401-334-4900 RC: - YOUR 10:14"RIiNCI:NUM1 ER: Tent We Rcxluest 6S2 ❑L'W;1CVT ❑I;t)It iu vivw ❑11I.I AWCOMNIF, ❑Yl,b:rlSls ltl;]'L1" ❑ I'L{{1�h: Rl((;Y<;1.1•; ]Mary Ann: On behalf of the Lan.11otd,CH Realty dd/Hyannis U,C,we kindly authnrizc Be*to hold its annual Previously Viewed Movie Tent Sale at:he Festival in Hyannis_ Please be ads iced that Blockbuster will be ]acid responsible for any damage to the lot caused by the patvons of ' blockbuster,the staff of blockbuster or the installation of the tent. Blockbustcr will be responsible for removing of any trash or debris that.is caused by the tent We. Kindly forward to office a Certificate of insurance from your tent uperator naming CH Realty II/Hyanni,,l TIC and Finard&Company as additional insureds. Please call me with comments. 'Thank you. - 4 cia C.Bo Illette N1i1:1)II;IAI, NIA b2494 late: (781) 44.1-9903 FX! (781) 455-9461 i, The CommonwealthRof Massachusetts g „ -- - —01 Department of Industrial Accidents Office atiQYesli9atlans 600 Washington Street Boston,Mass. 02111 workers' Com ensation Insurance Affidavit name• � � - location: hone# [] I am a homeowner performing all work myself ❑ I an a sole rietor and have no one workin: in ca acitp rs co ensation for ury p oyee }vvri,y orke •.}hn+:{:h}:{:�r;;.:r.:i�;<f:.F�:y{�cf;:':;:k;#:##:f{v:.+L'`L;;:�;''"�K:fi#ft•`.'%`^kz`'{ `S`;:-x3'�;;)L}i 4,•�tE}£ {�#£< er providing w .. �:, ;,b...r.y.}.}:,;{.f,., am 9 .}.. ..h•}.•. 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I understaa3 that a one years'imprisonment as well as dvR penalties in the form of a STOP W0R�ORDER sand f Investigations of the DIA for covera copy of this statementmay be forstard ge verification. ed to the Ofnce o I do hereby certify under the pauis penalties'of perjury that the information provided ab°ve is iru�and tarred. Date Signature - •"" • ' Print name �O SQL Phone# omcizi use only do aotwrite in this area to be completed by city or town offldsd • perndtllicense# � ❑Building Department dty or town: ❑Licensing Board OSdiectmen'a Ofnce ❑checkif immediate response is required ❑Health Deparbuent r ❑Other phone#; contact person: r A f1evued 9195 PIA1 • i 1 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 e 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 inc,u=ce as all affidavits maybe submitted to the Department of Industrial Accidents for confirmation of umar-an_ce 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 ygu 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 peimit/license number which will be used as a reference number. The affidavits may be returned to the Department ent b 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 Departments address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents amce of fnvesugatloas 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 „u .,o a. 1617) 727-4900 ext. 406. 409 or 375 06/23/2003 03:30 5084202705 AMERICAN TENT PAGE 01 Cllen : 1 103 2AMERI ANTE _ ACORD- CERTIFICATE OF LIABILITY INSURANCE 0GATE JMWD 6109103GMrr) WWDUCER THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION Dowling&0'Nell Insurance ONLY AND CONFERS NO MONTS UPON THE CERTIFICATE Agency,Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 222 West Main St.PO Sox 1990 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC 0 INSURED American Tent and Table,Inc. INSURERA: Assoclata ran d Employers Insuce Coma _ - P.0.Box 1348 INsuRERS:INSURER C: Marston*Mills,MA 02M INSURER 0: INSURER E: COVERAGES 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 DESGRISEO HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITION$OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Ham LTR TYPE OF INSURANCE POLICY NUMBER EPOLICY EXPIRATIONDATE 06900ftD LIMITS GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL L1A81LITY' DAMAGE TO RENTED 3 CLAIMS MACE OCCUR - MED EXP(Anyone pagan) S ` r ' PERSONAL&ADV INJURY II GENERALASOREOATE 11 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG I POLICY PRO• LOCJec AUTOMOBILE LMWUTY COMBINED SINGLE.LIMIT ANY AUTO - - (Ert w0dert) 6 ALL OWNED AUTOS " BODILY INJURY SCHEOULED AUTOS (Per Parson) MIRED AUTOS BODILY IWURY - NON-OWNED AUTOS - IParaCCfdah4J L PROPERTY DAMAGE . (Per salftm) OARAOE LIABILITY AUTO ONLY-EA ACCIDENT S _ ANY AUTO OTHER THAN EA ACC S AUTO ONLY: AGO 1 EXCE0"MVRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S • r S DEDUCTIBLE $ _ RETENTION 1 E A WORKERS COMYENSATIDN AND dWCC5004"4W0612DW03 04lUO3 W23M X we STATUS OTH• EMPLOYERS'LIABILITY AN PROPRIETORJPARTNERJEXECUTIVE F.L.LrACM ACCIDENT t100,QOO OFFICEWMEMBER EXCLUDED? E.L.DISEASE•EA EMPLOYE $100 OOO Uyee. sclbe under SPECIALde PROVISIONS"low EA.DISEASE•POLICY LIMIT $=ON OTHER oESCMPTION OF OPERATIONS I LOCATIONS J VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS ` Operations performed by the named Insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AIAOV6 DRSCRIRaD POLICIES NE CANCELLED BEFORE THE EXPIRAY'WN DATE THEREOF,THE ISSWNO INSURER WILL ENDEAVORTO WAIL 16_ DAYS WRJTTEN NOTICE TO THE CERTInCAT!MOLDER NAMED TO THE LEFT,BYT FAILURE TO 5050 SKAlL L " IMPOSE NO OBLIGATION OR LIABILITY OF ANY KMD WON THE INSURER,ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPREB NT 11 'ACORD 25(2001109) 030351 MA 0 ACORD CORPORATION 1980 06/26/2003 THU 9:04 FAX 401 334 4909 Northeast Management Inc 444 SUSANS HONE FAX f 001/001 . . . ... NORTHMAN Client*. ..: DATE DD • n riRiODUCER D. -CtRTIFIEA'M OF �.IABILI "IiNS.Ur A 06124103 THIS CERTIFICATE IS ISSUEO.A5 A MATTER OF INFORMATION r.3 Shepley ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. RI 02901-0549 INSURERS AFFORDING COVERAGENAiC# INSURER A.TraVelers Insurance Company Northeast Management,Inc. INSURERS: 6 Blackstone Valley Place,Suite 202 IasuRERc: Lincoln,Rl 02866 INSURERD' INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW 1'IAVP 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CY EFFECT, POLICY EXP T10N ILIMITS LTR R TYPE OF INSURANCE POLICY NUMBER M AT6 MMIDD A GENERALLIAWrf 660857X204STIL 03/01103 03101104WAWOIEGATI NCE S1000000 TED s1OO 000 X COMMERCIAL GENERAL LIABILITYCLAIMS MADE CE OCCUR ne Person) SS 000V INJURY S1000 000 EGATE S2 000 000 GVWLAGGREGATIELnurAPPLIESPER! PRODUCTS•COMPIOPAGG $2000000 POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMB s (Ea mWent) ANY AUTO ALL OWNED AUTOS (�Per v INJURY S SCHEDULED AUTOS HIRED AUTOS BODILY INJURY t (Por acrldent) NON-OWNED AUCJS PROPERTY DAMAGE i (Per acdoen0 GARAGE LIABILITY - AUTO ONLY-EA ACCIDENT s ANY AUTO OTHER THAN EA ACC s AUTO ONLY: A� s EXCESSAIMBRELW LIABILITY EACH OCCURRENCE s OCCUR F-ICLAIMS MADE AOOREGATE s ., 8 S DEDUCTIBLE - RETENTION 6 s WC'STATU-WORMERS COMPENSATION AND EMPLOYERS'LIABILITY E.L.EACH ACCIDENT s ANYoFF FROPRIE BER EXCLUDED? ECUTWE E.L.DISEASE-EA EMPLOYE S OF 11 yyees,ducoibe under E.L DISEASE-POLICY LIMIT s SPECIAL PROVISIONS De10V9 OTHER DESCRIPnON OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS AMD BY ENDORSEMENT I SPECIAL PROVISIONS Finard&Company,LLC and CH Realty IIIHuannls LLC are listed as additional Insured with respect to Tent Sale of July 26.2003 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE niE EXPIRA'M Finald 8 Company,LLC ".rr n EREOF.TMISStANGINSURERVIRLLENDEAVORTDMAIL —3D— DAYSWRITTEN One Burlington Woods Drive NOTICETOTHECERTIFlCATENOIDERNAI#EDTOTHELEFT.BUTFNWRETODOSOSWILL Burlington,MA 01803 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED R�EPRE;SENTATME 1 1 `nlv�A.v Q ACORD 25(2001108) 1 of 2 #M63153 MBB 0 ACORD CORPORATION 1981 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map—lac,5 Parcel (8 Q Q `� nr gy �A�� rmit# &` W Health Division eLM // �C1� �L _ � � ' Date Issued Conservation Divisional t �"" Application Fee Tax Collector . ee Treasurer ""' U1 Oh G)�91 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address V () Village Am nJ [�A Owner N0N39e(JSf" N(A m f Address I�t4apa Telephone Lto I — goo ��01 Permit Request WC 4Q x Awn ran-V SP-4- ye -1 I C1 dav Sa�� 7/ao) 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 Cl 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 Cl new size Pool:❑existing ❑new size Barn:Cl 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 Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED r r MAP/PARCEL NO. r r ' ADDRESS VILLAGE -.-OWNER DATE OF INSPECTION: FOUNDATkQ,N FRAME INSULA ., Aj FIREPL E ELECTMIIL-l. ROUGH FINAL PLUMBING ROUGH FINAL GAS: ROUGH FINAL. 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Failore to secure coverage as required ender Section 25A of MGL 152 can lead to the imposition of criminal penalties of a Sue np to S1,500.00 and/or one years'imprisonment ss wen as dvII penalties in the form of a STOP WORK ORDER and a Sue of 5100.00 s day against me I understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verlScation - I do hereby certify under the pains an Id penalties of perjury that the information provided above is true and correct signature e /J Ovy)—tom'�• Ir--- Date a"In - Print name Phone# of vial use only do not write in this area to be completed by city or town official - city or town: permit/license# ❑Building Department ❑Licensing Board El check check if immediate response is required ❑Selectmen's Office ❑Health Department . contact person: phone#; ❑Other Unind 9/95 PJA) . r 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"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 ilie 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 retuned 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. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Me of Investlgallons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 06/11/2002 10:31 15095613793 AMERICAN TENT PAGE 03 r 05/07!2002 15:59 5084204474 GRA2UI,. INSURANCE PAGE 91 �^`—'_� DATE I '•i !"R-D. CERTIFICATE OF LIABILITY INSURANCE p TNIs A1'!Is 1W&V AS A MAMN- OF INFORMA ® ONLY A"D CONFEIK N RO atm UPON 04 CU MIFICAT vand JI 33/ tMLOER. TWO CE11MICATE DOES NOT AMEND, 61TWD 0 P.CALTER TW COVERAGE A"O"m By Tm "LIC1E —IL0% lmam miff. IR Qm i AFFORDI W COVERA46 y�Ar,�r..��.rrrrr mime" I N9UMP A AROO• M CC Amiclown x+wapte; P-Q UK 130 ;.Isun"c: off HU14 MR OMW IRAU11lP o: .. II��IP is cov�aA s tNE POLICIES OF INSURANCE LISTED sEGaW NAvf SEEN 196UED TO"M 1N8URM NAMED ABOVE"THE pOUCY PfRiQO IND14ATE0.NDTVVITMI-- 01 ANY REQUIREMEW.TERM OR CONDITON OF ANY CONTRACT OR OTHIM gpCUNENT WITH RlS�CT TO IVNICh i HIS CERTIFICATE MAY BE ISSUED MAY pERTA9Y.THE INWMAIMCE AFFCpst eD gy"o POLICIES OESCR1WD 1AERFIN a SUBJECT TO ALL THE TERMS.E xCLU91ON8 ANO CON IrIpNB OF Su POLICIE6,AGGREGATE LWArs SNOWN MAV NAVE MEN REDUCED fly PAID CLAM , iiditl • - .. • TrOIv ►nrPA LIN OP MffplANtl ppLlor f!NlRAL�IAfAJ�Y ,nac�occu�MCE f 1.c9l!�lft dfIIEAA%L64IU+'�' RIAf,7MVGL'IA'w eee a►. f I CLArM%MAN I �occtm' tileo Ex•tA,•T c-v POW"' f ' vg"gw"A ADu IN.AJII f •f (AP40AL AGGPEOATE OE»l AOGktBAr!TWIT APPL E6 PEP: PIIOAUC f comp-ov AGO; AIIf 0A1009 E LYl91LlTV ^CY81Nf0 SArO�,i UfAr f I - � Re na'q•^n �••�AW-AUTO - Au QVIIRD ALrtOE fQD'LY In;.YJAV f .qr 0!•nrnt v BCNEDUl6DAUf08 60011r'yAJp`• S I+PIfD Avroc i IPR�GG'�lwi1 NOfFCM�MEO AtiTC9 I .pop%ATV DAIAAOE f AUTOID14LV•Ell ACCIDt•NT AA{li A8[LtA�ILfl 0TME4'-IAM QAACt ANY AUTO !vC ONLY ! j EA�rO:�CVP�E'�4E i i •11cEM UAfRrh II a6GPEl ATE S .. 1 Occtl GtPII11B kvQc t O;OUCT9)LE� I eefefnlofl f l +ac A 1 t(WY L'Vi ip •q�eM OD919991AT971p Alk1 f1M/►OyfTe9'lIAlJTY I L F.ACwACVOEI'It :! ��frM 0&" t L.OKiA6E FA fvP�OvBE f wlryV�• 0 L O,eEAbt•A'DUGr_IMP fS� 0�7A 1 � Aoofo fr orl000lnfsfNf�PeaAL rTlowleeeNf CERTRWATENOLDEA AiMAeEiIi 1nM1IMPLfFR� CalllAj .IIDiaP Irf.M.fla A/9Ft rena�.D.a.Ic+Me!eAYti►Lro 9t/OM IPf e► OArF rn9temeP.f1w IOIA1fM t%flMfl OLL mIM0019 tY MAN DA•O ypff,TO To IN mAim NAMED To I"LEFT.OUT FAILU4+'o 00� . M09E UV arm"as LIUA.Ifr 01 AMr AA/D UPON TIQ ISGURER IT$'K AYTPOw1 T" 7 : Client : 31955 NORTHMAN CERTIFICATE OF LIABILITY INSURANCE 05j 8/02 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Star & Shepley ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE PO BOX 549 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Providence, RI 02901-0549 401 4 3 5-3 6 0 0 I INSURERS AFFORDING COVERAGE INSURED INSURER A: Travelers Insurance Company Northeast Management, Inc. INSURER B: 6 Blackstone Valley Place, Suite 202 INSURER C: Lincoln, RI 02865 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE MM/DD/YY DATE MM/DD/YY A GENERAL LIABILITY 6 6 0 8 5 7 X2 0 4 5 0 3/O 1/0 2 0 3/O 1/0 3 EACH OCCURRENCE $1 0 0 0, 0 0 O X COMM ERCIAL GENERAL LIABILITY FIRE DAMAGE(Any one fire) $10 0 , 0 0 0 CLAIMS MADE FRI OCCUR MED EXP(Any one person) s5, 000 PERSONAL&ADV INJURY $1 0 0 0 0 0 0 GENERAL AGGREGATE $2 O O O O O O GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS -COMP/OP AGG s2 , 000, 000 POLICY PRO- n LOC JECT I AUTOMOBILE LIABILITY II II COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ I HIRED AUTOS BODILY INJURY NON-OWNED AUTOS I (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS LIABILITY CUP 1014 A4 7 6 0 3/O 1/0 2 0 3/O 1/0 3 EACH OCCURRENCE s3 , 000, 000 X OCCUR CLAIMS MADE AGGREGATE s31000, 000 DEDUCTIBLE $ X RETENTION $10 0 0 O $ WORKERS COMPENSATION AND WC STATU- IOTH- TORY LIMITS ER EMPLOYERS'LIABILITY E.L.EACH ACCIDENT Is E.L.DISEASE-EA EMPLOYEE $ E.L.DISEASE-POLICY LIMIT 1$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Finard & Company, LLC, KPERS Realty Holding #38 Inc. , Lend Lease Real Estate Investments, Inc. , Madison Marquette Realty Services are listed as --additional insured with respect to Tent Sale of July 20, 2002 CERTIFICATE HOLDER ADD ITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Finard U Company, LLC DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1 0_DAYS WRITTEN One Burlington Woods Drive NOTICETOTHE CERTIFICATE HOLDER NAMED TOTHE LEFT,BUTFAILURE TODOSOSHALL Burlington, MA 01803 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. . AUTHORIZED REPRESENTATIVE a - ACORD 25-S(7/97)1 of 2 #M4 9 8 92 MBB 0 ACORD CORPORATION 198E I IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(7/97)2 of 2 #M4 9 8 9 2 06/11/2002 10:31 15095613793 AMIERICAN TENT PAGE 02 Cerwivo of IflawMw— �t puce REGIS MD tssu¢D BY Date treated or APPUCATION manufactured Ink Academy lent & Canvas CONCERN No, 5035 Gifford Ave. 114119/2000 F19.01 Los Angeles,CA 90058 (323)277-8368 This is to certify that the materials described below hereof have been flame retardant treated(or are Inherently nonflammable). FOR_ AMERICAN TENT lii TABLE ADDRESS 301 OLD FALMOUTH ROAD _ CITY _ MARSTON$MILLS STATE MA 02695 Certification is hereby made that:(Check"a"or"b") ❑(a) The articles described below this certificate have been treated with a flame-retardant chemical approved and registered by the State Fire Marshal and that the application of said chemical was done In conformance with the laws of the State of California and the Rules and Regula- tions of the State Fire Marshal. Nameof chemical used............................................................. Chem.Reg.No......................... Methodof D applicatlon..................................................................................................................... Marshal for such use;Fabric has been tested and(b) The articles described below hereof are made from a flame-resistant fabric or material regis- tered and approved by the State Fire passes NFPA701.96. VINYL F419.01 Trade name of flame•resistant fabric or material used.................................• Reg.No..:.......... The Flame Retardant Process Used ..P.N.°t...Be Removed by Washing (will or will noq David Bradley By Tom Shapiro - President Hama of Applicator or Production Superintendent Tdlo THIS FABRIC WAS USED IN THE MANUFACTURING OF THE FOLLOWMIG. 1EA 30X30 WHITE CANOPY TOP MIDDLE CONTROL NO. .._..._.--....----.... _ CUSTOMER ORDER NO. 42024 CUSTOMER INVOICE NO. 4/861 - YARDS OR QUANTITY COLOR STYLE --- DATE PROCESSED -- - •""ALL MATERIALS ARE CERTIFIED BY THE CALIFORNIA STATE FIRE MARSHAL AND MEET THE REOUIERMENTS OF;NFPA 701 AND UL 214W" 06/11/2002 10:31 15095613793 AMERICAN TENT PAGE 01 e rati sate of Flame .'esistance i REGISTERED ISSUED BY Date of mo rwtacture FABRIC JOHNSON OUTDOORS INC. NUMBER BINGHAMTON,NEW YORK 13902 MARCH 2O02 F-140.01 Manuledwora of Bw Finest Tate PmduM DowMed Ifamin This Is to certW that the producto herein have been manufactured from material Inherently flame retardant as hero after specified by the maloertal supplier. NAME: AMERICAN TENT&TABLE CITY; MORSTONS MILLS STATE: MA Certiflcatlon Is herot►tr mach Mat: The aniclss described on this cetllflcate have bean manufactured with an approved flame retardant chemical in compliance with California State Fire Marshal Coda, NFPA-701', Underwriters Laboratory of Canada, and have been tested Ih accordance with the Federal Test Method SpscdIcations and meet or exceed the MWary Flame Speoftellons of MIL-C-410060. Type,color and weight of material 140Z. Vinyl WHITE BLOCKOUT Description of item certified; 40X40 2PC GENESIS Flame Retardant Process Used Will Not Be Removed By Washing And Is Effective For The Life Of The Fabric j Snyder Manufacturing,Inc. Manufaclurer of Flame Ro*rOent*AwA Laminates TENT DVAAWMFNT.JOHNSON OUT SIN . 'Carps State I IT T'. � " - TOWN OF BARNSTABLE 4 BUILDING PERMIT s 1PARCEL ID 295 019 X01 GEOBASfi ID 41309 JADRRESS 1010 IYANNOUGHi"ROAD/ROUTE PHONE (617)932-124" HYANNIS, MA, ZIP 02601— 3 4 5 6 BLOCK LOT SIDE _ I . DEVELOPMENT . DISTRICT BA II' tMIT 54347 DESCRIPTION TEMP.TENT 7/20--7/23 L tMIT TYPE BMISC TITLE MISCELANHOUS PERMIT I TRACTORS PROPERTY OWNER"HITECTS: Department of Health,.Safety end Environmental Services +_AL FEES . $50.0t? - .00 THE .. � ".1STRUCTION COSTS $1,0 0.40 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE P Q FD IM1l� BUILDING DIV I N I BY DATE ISSUED 07/09/2001, EX^I." TIONT THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER.THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM,THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED.PLANS MUST BE RETAINED ON JOB AND WHERE APPLI,CAB.LE_ SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED.UNTIL FINAL INSPECTION PERMITS ARE REQUIRED, FOR 2. PRIOR TO COVERING STRUCTURAL'MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PA NCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANJCAL INSTALLATIONS. 3.INSULATION.. OCCUPIED.UNTIL FINAL INSPECTION HAS BEEN.MADE. 4:FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 ,1. 2 2 2 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS THE.INSPECTOR.HASAPPROVEDTHE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED.FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. " TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map e Parcel 0) X 0 l Permit# J� 3 Health Division r x�/lam �f9���51 Date Issued Conservation Division Fee 11 ° �- Tax Collector Treasurer Planning Dept. ' Date Definitive Plan Approved by Planning Board ;. Historic-OKH Preservation/Hyannis Project Street Address G5 ' v Village (IGLU Owner-Tya l �, 1 1 Address M ��t� � 0 � � 7 - �75`7 a500 Telephone n i sc� e oc BoosPermit Request A� _�L! ' n+ &t- op 5 i.77 a o o wn1 M O N ? a 3 ., 40 X 0 Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new 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) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing' New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING-FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Can DATE �� D I auo 50S -- 959 70 - FOR OFFICIAL USE ONLY bk, PERMIT NO. • r DATE ISSUED - MAP/PARCEL NO. ADDRESS _ �- VILLAGE OWNER h _. DATE OF INSPECTION: w FOUNDATION _ FRAME - F INSULATION FIREPLACE r ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL -' GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. - E w Iwo... ♦T♦.1QR_. r 1-,A{r� .1/2 vp �1'.l.f�t I"r1,(",.e1,;�li;C'}'.�;t1.?`i:13�.��,;�.•r1,�l�.t['s,dll, .laratC�7,2{3t?I NIS.NI-af'v'k=�.aasl�ou �1'oxtia+east M2439c3nent Inc, �5 Backstolke Valley Pb,c,Slate 202 d; .9urlresra;eticrr:fur �'rrxiv�rsty ►"jenwEdlyn!"feixt Sole 1.E+rsr brt+vet z Carxpbell/4fass Trs►;t("L andivrd^)rrnd rvargeusr jgan,7,, ent( xerru,+t")fvr r►'�, r ,at 1010 Xy����g1� �oErd,ffyaMn;s.MA(tote"1�remi�es'J In r.Pspc+rtse to Yrrn r Inter dred'une 2001„Now*tsmit Mynayetu�c►t xr.�y bole a kno� tent sale on�ulv 21.,2oei t era :O�Jru�x to 1 :GCtmu:. ire t+ t w�ilI shill be be s:t•up accardb',"t.7 the acts-�Ied Bxhbit A. Tcrant rerpern„olt for,the cost of t�,�+aizirl�wy da='es resulbng fr:In be placement of he t_nt P-no- to tcr,t sale Tertacxt�xxti r:gtri. to sub.mat a eerttf;catt 4i irsuralac�:isnn the ,sndlard,Ca+zaJalbell assac at tts'T"rlls and#}�� .11Ji t rr,T ,Wew tt la d,Inc.ra t aclditiona+irks ed. 9!r as< atrange z hAve the C"tri2icate forwarded to t(zy attc:It Oa at the address below. •r a::is f"POnSible for tmy°appUc,3bfn percrats if necessary ra-office), must! to rna7vo:z's J �Idt.ord reserves the ram#t to l aue'Fei]ant terminate evt;rr,,,y cant prior to July?1, 200; 1 Plew-e feet frtAe to cam;me at 161 T)757•,2539 ifyon t,Wve any ques+4can ' SickG.erely, oung \1 cc: Sbaroa Ho&dou 1 O sm, EneJaad,Inc. BI0CkbUStWVft 107O ty 'k Bldg'W0 Hyannis MA O2M' 1 i ' W a F9!.wF`1:�71:t:i E t,�,;i:sit ai1;�::;a;!"r:,w '� tJ,?S;�1 1�.9�ttl Ci17-;:`i7'zrg°+ •, JUN-25-2001 17:14 NORTHEAST MGMT. 1 401 334 4909 P.02/02 CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DO/W) 06/13/01 PROOUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAYION Love, Douglas �e Pope, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 34 8 0 Preston Ridge, Road HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 'ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 100 Alpharetta, GA 30005 INSUR ERIS AFFORDING COVERAGE Iris. _........... +NSUR6D Northeast Management, Inc. DBA INSUPEfiA;Utic^a (Mutual,INsuRER A: Blockbuster Video �• I 6 Blackstone Valley Place, Suite 202 RER C:iNNSJ9JRERD; Lincoln, RT 02865 F � INSURERS COVERAGES THE POLICIES OF INSURANCE LIUM BELOW HAVE BEEN ISSUED�'TO THE INSURED NAMED A90VE FOR THE POLICY PERIOD IND)CATED. NOTWITHSTANDINQ ANY REQUIREMENT- YEW OR CONDITION OF ANY CONTRACT PR"•OTHER DOCUMENT Wfhk1'RESPECT TO WHICH, THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE APFORDED BY THE POLICIES 01 SCRISED' HEREIN IS SUBJECV710 ALL THE TEFIRIIS;DMUSION3AND CONDITIONS OF SUCH POLICIES, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CL-AJMS,INSRI TYPEOFINSURANCE POLICYNUMBER CTIVE POL1�CYtEXPIR LTR DATE 0p OATS MM DO !* LIM TS A GENERAL LIABILITY CPP3100222 03/01/01 0$/011/02 6CHOOCURHENCE $1 0001.000 X 00MMERCIALee4ERAL LIABILITY, FIRE 3AMAG6(Anyanefire) 000, 000 �CLAIM$MADE®OGCUP MEDEXP(Amy one pemun) $10 000 _ PERSONA' 9ADv INJURY $1 9000,000 �. GENERAL AGGREGATE $2 OOO 000 i I rEv AGGREGATE LIMIT APPLIES PER; PRO DUCTS-COMP/OP AGO $1 000 000 10L10YI PRO- JECT F7, LOC ! A AUTO MOBILE LIAOI LITY CPP3100222 03/01/01 03/01/02 CbM BIN Eb SINGLE LIMIT x�ANYAUTO (Eneacidenl) $1,000,000 f ALL ON'NEDAUTOS BODILY INJURY $ SCkEDULED AUTOS (Perpersen) I X , 4IRED_AUTOS NON-DI NFDAUTO$ (PerpaLxiCangRY $ PROPERTYDAMAOE $ (PerCleenl) IGARAGELIABIL!TY _ AUTODNLY-EAAOCIDENT $ C ANYAUTO OTHER THAN EA ACC 3 I - AUTO ONLY:, AGG $ A E-ExcESSLIAaILIir CULP3142610 03/01J01 33/01/02 EACHOCCURRENCE 33 000,000 I XI OCCUR CLAIMS MADE AGGREGATE $3,000 000 DEDUCTIBLE i $ ! 1C1PETtNTION 310000 $ I WORKEAS COMPENSATION AND I LVC5TATU• OTIN- JE EM?LOYEAS LIABILITY ��Y 11dITS E.L.EACH ACCIDENT $ E1.01SEASE-EAEMPtDYEE S �OTMER EL.DISEASE-POUCYLIMIT $ D ES CRIPTI0N OF OPERATIONS/LOCATIONS/Y FH10LE3IEXCLUSi0NS AD D ED BY EN OCR EM EN ToPECIAL PAOVIS IONS TENT SAGE July 21, 2001 CERTIFICATE HOLDER ADDITIDNALtNsugEO"iNSURERLETTf:R: CANCELLATION ' HHOU LO ANYOF THE ABOVE 0 rBCR 9EDPOLICIEO02CANCELLED OEFORETH E EXPIRATION Campbell MdSS Trust CIQ TC New DATETHEREOF,"THEISTUING INS UR GA.WILL ENDEAVOR ToMAILIO.—OAYSWFUTTEN England, Inc. NOTICE WHECEATT19 TE MOLD ERNAMEDTDTHELE",BUT FAILURE TODOSDSHALL 125 Hight '$treet, loth Floor IMPOSE NOOBLIGAYICNORLIAB1LITVOFANVKINDUMNTHEINSURER,ITSAGENTSOR Boston, MA 02110 REPRESENTATIVES. Attu: Joan YOurig AUTHbAzeDREPpESENTATIVE gr k � ACDRD 25•S(,?jq?)l of 2 #S5836 0/M58359 rT.M 0 ACDAD CcxaanaeTIMW loan TOTAL Pll;:�0�2,n �0Iyarrat"oft MAY-18-2001 07 :39 AM AMERICAN TENT 5084202215 P. 04 Ce ftVicate of plameRes `1 REGISTERED =Stance FABRIC NUMBER JOHNSON ISSUED BY F-f 40.01 BINGHAM70N OUTDOORS INC, date of Manufacture I Manwaauwrs�a FinesORK t 3902 P4a Tent Pfodacts Deaodbsd Nerw/n Y 2 0 QA ' Thla 18 to certHy that the hers after SPOclfled b e material herein have been manufactu Y the materyal supplier rod from material Inherentlyflame NAME: American Tent & Table retardant as CITY: Marstorls Mills Certtft�anon la here STATE; The articleg d3 hO by made that; California State bed on this certificate have been to Fire Mar6hal Code, NFPA•7ot•, manufactured with an FOdertal Teat Method Specification®and meet or exceedd� approved flame retardant chemical in Compliance with i m Laboratory of Canada, and have been leafed in aac I the Military Flame S TYPO,color and Nm 14 O Z Ped!lcations of tested ordance whh the 19ht of material; t,1h i to Vinyl OescriPSion of item certified: 20 ' Mid for 40 ' Genesis Fume Retardant Process Used Will Not 9ved tent Is Effective For The Life Of The Fab 8y Washing And Snyder Man g U ,Inc.facturin i , Manufacturer or Flams Retardant Ylnyl Laminates TE I:PARTMENT,JOHNSON OUTDOORS INC. 'large Scare 49 III dII 1010 E 09 n. MA0Cf�� Sa,�- MAY-18-2001 07 :38 AM AMERICAN TENT 5084202215 P. 03 ij;r Cunumuksacaitn ttf Ma.var/tuxan -a- 1_- &''time lent 071'Industrial ACCUL,1115 Meg O/Wraff ftW 600 1 US/f HRIOn Street /hill Wurkers'Corn_p_cnsatiorl Ingnrance Affidavit t�1tn11ritnf It1tOCnt�tian: � h 199� I'1�1°lt° ���°�°�^��.� �.,._���� •� • �°��� ,� n i.u i e .e ■ ems-. tame' + Inc:srinp- ch%. nhr,nc o Q 1 am a homeowner perfortnin_all work mvselt. [j I am a sole proprietor and have no one working in any capacity I am an employer providin_workers' compensation for my employees working on this job. �f ('nrpu•tn. n rmr �N rF�M/ AV A$SQ c lq'TrS l f4C bjR JA AM6iZICArt 'TEArr SAL M fZuH p t PO 13 4 S rite- MAR5TDNS M/44S phone q• SD• 4 0 - 2/�2 t s inc11r:tnrr rn. G R N / �1ttlSY M C S �O� V G 1 am a sole proprietor. ,Iencr2l contractor.or homeowner(circle one)and have hired the contractors listed below who ha%c the following workers' compensation polices. cnntntlnr npmr t[Iltrrcc• airy phone M: iAcurnnre rn. nnNrt N ...�.:.a- ti.r.•.-.w T.�.n. •- C.,ry_.,*...y�—T-•vr�-.��f••.�.n`r!eC�s� _.yR•ti._ .w-rv...._._.�....._ nn1 1n.' n:11n1•' � ee• ram`" phone N• in'urinre re. pollee it AltacA a tldldona)sheet if nceaaarj%r j e w ��'r..... . ..'.._. ,_v..mow.• �_..r r'�-- .. :..�.�r.r�rw�.+.n+.�++..rwi��lr- - -� - -- - wn..l�iw•:di�Y••ws sti Futlurr to Yeenrr coverage its required under section 21A of AWL I52 can lead to the imposition of trtmmal penalties of_a lineup to St.Sa0.t11 andiur u.te,cars'imprisonment as%cit as civil penalties In[he form at it STOP WOR1c ORDER and a fine ut3180.00 a day against me. i understand that a Copy of 1116 sta.cment non% be forwarded lit the OMce of lnvallrations of the DiA br eevera0e votrillcation. Ltto hePcdr cerr//h under r/1[paifl7 at dpenallles of perjuq thor I/VC n{fO//ifation prm ded above it tam-and co _.._... Signature � rWl 1,�1�Q i.r � Date Print name Ow l D 14 MA-C1116 w S phone o S0I � 47-0 'Z219" oil �nmciai use unly do not.vote in this area to be eetnpleted by city or town eMcia! ehy nr towe- peftM icestse N 112nildblg Department j3Utealnp Board F Check itllntnedlatc respunse is required QYtlectmew's Ofner t C31lslllt Department eentact penpn: phone N• nOtherAaw �_� r.• . alp OaPI -A-MimploolLi SOLD OWIA �> ry +f ;_ 71 ti^ el 14 CL . v+�•- - nu-w.,�n..,.,, w..,.�.n.n � u - � � �-�.e tr�. u.muuvi.m.>a�...�..._.�-... z ./ T _ J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ( aj 5 Parcel Q l� ' v 4 Permit# r Health Division L /� 7 / �-` Date Issued D® Conservation Division Feel �� d Tax Collector ' Treasurer Planning Dept: Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Y A N N DO CD& "- Village A,4 4 N N tZ, < Owner . � U S�C.r eb I� dress (�I Gtc k�h N!,e kil-eq Pd Telephone L-E� 3 �{ �o j LUG CO I n P Permit Request 40K en "CV oV l� P r u F'( -7 1 oww '(� U rlca e r CC��J it e In+ CO y 5 i Square feet: 1 st floor: existing ' proposed 2nd floor: existing proposed Total new -Estimated Project Cost. # Zoning District Flood Plain Groundwater Overlay Construction Type " Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. < 4 , 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 ti 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 A' 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 BUILDER INFORMATION Name Telephone Number - Address k License# ' Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE . DA E ' FOR OFFICIAL USE ONLY PERMIT NO. n DATE ISSUED . . r MAP/PARCEL NO. ADDRESS" "- 3 VILLAGE OWNER • DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH ' FINAL i -FINAL BUILDING rr ' DATE CLOSED OUT ASSOCIATION PLAN NO. r07/03/2000 11:35 5087900609 UCTP INC PAGE 01 ' The Commonwealth of Massachl setts DVa"meat of Indus&W AecWenrts 6" Weshinsron SMcd " Bomvn,Mass. 02111 r r- worrke" .COm t'afatlOR Liuoraoce A18davk loeagm 1 e"hL w er 1 vm[`am a 6 all mywlf , 1 am a aolc and have no one vladdoz in !ff Our wvrlcaisY coon for my+ $ we}ob. 1 am an loser n8. .. .: .: ., .... •. ' ' .:.... ,..:.: ,..: • F ' ) < fit) -`>? <- >a ,� � Ir.. ..�y -�r� nos lli•�•�] '��'�'. �!'t� �'��1[ ���� <.A. M'i 1�'we�" �A V > �„ �'1�i 1.■ a� �..� 1 R6 i'S a r , t f 1 a Oak progrrotos.pmd cm rmor,of lameowm(ems awl and hm hired the ICOUMMtose lod bdm vim haft the fbllowiui m�ss<zoa poli r,*r�. 4x. XVi h i hilt, Yi, ,�:• r t iA ^ryP ��J gi lMvr M i '� .�nY v > > 4 '':..'-. ` •.�.;.�„ -e F,.. .. -'4!• i+.Y,L fix;• : u E ). f: � rk► ra, s� ti �ti x;, t_r ww,r�ht4�0R' 1a.tl4+�.9$.. .;7�.v iieneA is revs w�+�p•n�M�r 0eelte�98A arAQdl.lgi�teoi ev 41m d���[fie•t a��N Ii1,�e0tM td� we lwa'brMlrvraeat e'aea er da tk+�eMl�la sto ftm eta STOP O OIA bee RK R 0" aw of n s a f awe r a 1`�/we�'a� ' da&tfatoot ma he Omer"sotlr Olaoe d�M� dr brneb9� Baia rlbt p�� slPssf a�'e��e i+yerMdfen pv+�deul abut.L asR aa./ean.d r, priat memos {ar aab donut weft b d*awa is tit or amw b dh a d••armed i oads"t.,,eal r . m m tirattoe � t �� t�er� f eoleoCD m REGISTERED ISSUED BY FABRIC a Dote` ' Ln NUMBER TOPTEC, INC. manufactured •. : 2 1905 N.E. MAIN ST. L F,N s►`ApP SIMPSONVILL.E,.S.C. 2M, CD 5/8I93 m gEtr► 140.01 LD m m Cr CD This is to certify that the materials described on the reverse side hereof have been Rome- This retardant treated (or are inherently nonflammable). _ - FOR_ Undercover Tents ADDRESS Rn M' elter-k p-„ive._Unit 3 CrTyLsaur&I Yarmouth STATE MA Certification is hereby made that: (Check "a" or "b") ® (a) The articles described on the obverse side of this Certificate have been treated with a flame-retardant chemical approved and registered by the State Fire Marshal and .that the application of said chemical was done in conformance with the laws of, the State of California and the Rules and z Regulations of the State fire Marshal. Name.of chemical used. - - ..Chem. Rog. No. .. ... Method of application: -• •. =- (b) The articles described on the obverse side hereof are made froin a flame-resistont,fabric or material registered and approved by the State Fire Marshal for such use. The Flame Retardant Process Used WILL NOT Be lemoved By .Washing TOPTEC, INC. TX202000E ?o1e ieiit 40X60 YSW D MODEL m SEflIAIit 931250 CD_ N Name of ducllw►S�peri�Mend�nf ELOCK boSTEf�- VIDEO -Ac C-1 Nol Nr VIN Sir ..rt;nParinci r�P„+•«ra�r) Map Paicel Permit# House# / Date Issued = J Board of Health(3rd floor)(8:15 -9:30/`1:00-436) & 7%F����' Fee Conservation Office(4th floor)(8:30-9:30/1:00=2:00) Planning Dept. (19t floor/School Admin. Bldg.) SEWWER w' kIPLICANT IUS. -, De f' i e n Approved by Planning Board 19 t CON14F �QN R TO NGIidF, ? iRINU . BARNSTABLE. U CON8` 41JOT10i 1639. TOWN OF BARNSTABLE' Building Permit Application t Project Street Address �w (� 0 {� Village [ I f�� Owner I V o fYy g s� "y m-e of � O C LhU,(�k(Address ' Telephone ` Permit Request [�gC �,(� �i� �� _F SELL-.I y n F' .First Floor square feet Second.Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No 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 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: 0 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 yes, site plan review# Current Use Proposed Use Builder Information Name Telephone Number p Address License# Home Improvement Contractor# Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) ` "' FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS , VILLAGE' tt 1 OWNER ar t DATE OF.INSPECTION: FOUNDATION FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL f PLUMBING: ROUGH FINAL _ ' GAS:.: ROUGH FINAL s FINAL BUILDING „ DATE CLOSED OUT- ASSOCIATION PLAN NO. t , r z9 19, 9 1'1: 21 5�_10'7��Gil�h091 C�' Yi`t 'L L �,'� ._ ... _..zy� _ .. ;Y.iCY •-•: m'e!e�far• �'�,•�+^eP.ne°?xe ... '.w':mw.ssss.YJ _ MIS-- a „ . r � �" , .-jam � �`€,' a✓ � i� O s.t t 7 gyp In prs " 5 _ + TI. s�. �, � #�$ �• S�p ,� m � ,yam � � :� a of CL "i' oy to,z 'g- .pp�q -41 Cr . t.:�• Wit. a ¢� ' i _c 62 S� x W r + i Fes ' - mu— e rip— m rm in � � �Sr+ �i� ��K- �q yZ, p } .t dxs� .n„ +� ,dad ? Yt• 1. 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"� a„k�o-�,�`° ,.�,w�i&TM'ie+' s ,,r •W.`iy'"• iN ;;i? c { INS �,�� ��z's:",•" I �iN� y �}.��v`�� �'-� a xx P aq {1 } "� �'4.�r'ax Y� ��x� �k x „� � •e"'�."M'hn: }d tia; • "�;, ref:,; ✓1"'y�, w `� `� •. ° �'i``..,r *fF �'x. `,�._ ) S ��°,, � °,'drn L. �* v; '4`A-'` "' +�a f� p$ � t s d �:' a.x �'.:s,: �, '.a� 1 xQ i �, :��b�'"3°- �'� k�, '�,���ka*•,' �"�.�"�`,a { s+� �� �f,y sk t; v',. �T`g"�r�R y �a ��'�, d,,�i a�r .�t r,�� `°�' ' �k" ���4 s 's:�''�.. � � s � r '� •�i ..;.�' '� ,.f ° - � �$` i ,eu t`k�. x t, '3 tt i,t.-rl'k,S,rM-.S1fie�n� ,'r a'h - ._ ., ,. y" 7'.� 100 The Commonwealth of Massachusetts 4:-- . •:= �.� Department of Industrial Accidents Office o11J7Fest ffxzfVns - _ � 600 Washington Street � + Boston,Mass. 02111 Workers' Co m ensation Insurance Affidavit C/ to ion: ci hone# a meo perfo &n r myself. I am sole o rietor and have no one workin � ca acity ❑ II am an employer providing workers' compensation for my employees w rig on s job. company name:. tl r address {. . ' ci : a.✓ = v 1.:., �[J / hone#: O . insurance co. (D C� olicv# ❑ 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: company name address: -: City phone#. o: 61i 4 Insurance c com anv name. address: cth, insurance cor olicv# ��. Fafiure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a flue 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 fine of S 100.00 a day against me. I understand that a copy of this statement may be forwarded to the OfIIce of Investigations of the DIA for coverage verification. 1 do hereby certify under the par d penalties of perjury that the information provided above is true and correct Signature a _ . Print name 1 Y r 2 n Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check H immediate response is required, ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other :.;..,:.••;:....,>:•::: ...... .... .. ............ (rmud 9/95 PJA) I - 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'law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. r; 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 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 Invesugadons 600 Washington Street Boston; Ma. 02111 fax#: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 JUN-19-98 12 :53 PM P. 02 .00 jo L 1.1 J l t 7 S is 1 Dept. (3rd ) Map Parcel '0 [ Permit# e Q ` /House 07 D Date Issue (o '02•�' oard of Health(3rd floor)(8:15=9:30/1:00-4:30) �6�ZZ�9� Fee �. Lr�� Conservation Office(4th floor)(8:30-9:30/1:00;2:00) Planning Dep .(1st floor/School Admin. Bldg.) Definitiv a pproved by Planning Board 19039. MAM TOWN OF BARNSTABLE Building Pe 't Appli ation P treet Address ld�[� U s Vill ge a wnerl 0 nQi n Address Telephone ?J 3 //— C -:Permit Request . 27 "First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No D Type: Single Family ❑ Two Family ❑ Multi-Family(#units>King's Age of Existi Structure Historic House ❑Yes ❑No Oway ❑Yes ❑No Basement Type: ❑ 11 ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq. Basement wished Area(sq.ft) Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Ex' ' g New First Floor Room Count Heat Type and Fuel: ❑Gas ❑O' ❑Electric ❑Other Central Air ❑Yes ❑No Fireplaces: Existing New xisting wood/coal stove ❑Yes ❑No Garage: ❑Detached ze) Other Detached Structures: ❑ size) ❑At ed(size) ❑Barn(size None ❑Shed(size) - ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use J--_ Builder Information Name 11 Telephone Number `7 7 7 7 Addr,s License# Home Improvement Contractor# ' _--� Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t SIGNATURE DATE . C� BUILDING PERMIT DENIED FOR THE FOLLOWIN ASON(S) FOR OFFICIAL USE ONLY PERMIT NO. - DATE ISSUED f MAP/PARCEL NO. ' ADDRESS VILLAGE OWNER ► _ i DATE OF INSPECTION:' FOUNDATION FRAME f INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL ' GAS: i ROUGH r FINAL ' FINAL BUILDING s • DATE CLOSED OUT ASSOCIATION PLAN NO. . f STANDARD LEGEND 1 { NOTE:not all symbols will appear on a map -0- "Z —Z) GOLF COURSE FAIRWAY �^n^� EDGE OF DECIDUOUS TREES EDGE OF BRUSH ORCHARD OR NURSERY v-V-v-v EDGE OF CONIFEROUS TREES MARSH AREA HOO ® ' ¢ ® — - - - — EDGE OF WATER 1180 - MAP�74 DIRT ROAD 9#11oO ® � � �l 0 _ DRIVEWAY ¢ I AP 9S 0 PARKING LOT I O PAVED ROAD #1010 ---—--—-- DRAINAGE DITCH II �� �/ -- PATH/TRAIL PARCEL LINE 1 a ' 0 21 E MAP110 EL c PARCEL NUMBER #1860 - HOUSE NUMBER \\MAP 273 � � I I 2 FOOT CONTOUR LINE io— 10 FOOT CONTOUR LINE ' Elevation based on NGVD29 FP O 4 / ; 4.9 SPOT ELEVATION STONE WALL -X X— FENCE (75 RETAINING WALL RAIL ROAD TRACK 1#1090 2 STONE JETTY POOL , SWIMMING POOL MAP PORCH/DECK BUILDING/STRUCTURE MAP 294 MAP 294 DOCK/PIER 7 2 #10 56 #104 2 0 / HYDRANT C P 273 I � � /,. y e VALVE O MANHOLE T O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 N F O R M A T 1 O N S Y S T E M S U N 1 T O POST OFP FLAG POLE N PRINTED SCALE: IN FEET *NOTE: Planimetrics,topography,and **NOTE: The parcel lines are only graphic representations DATA SOURCES: Planimetrics man-made features were interpreted from 1995 aerialphotographs b The James -a SIGN ® STORM DRAIN P V 9 P P � ) P Y vegetation were mapped to meet National of property boundaries. They are not true locations,and V'Sewall Company. Topography and vegetation were interpreted from 1989 aerial photographs by GEOD 0 UTILITY POLE � TOWER vv a 100 0 100 Mop Accuracy Standards at a scale of do not represent actual relationships to physical objects Corporation. Planimetrics,topography,and vegetation were mapped to meet National Map Accuracy Standards S 1 INCH — 100 FEET* 1"=1001. on the map. of h scale of 1"=100'. Parcel lines were digitized from 2000 Town of Barnstable Assessor's tax maps. -0- LIGHT POLE o ELECTRIC BOX ...\sitemaps\Public\m295p19XO1.dgn Jul. 05, 2000 14:06:11 STANDARD LEGEND / NOTE: not all symbols will appear on a map ¢ GOLF COURSE FAIRWAY EDGE OF DECIDUOUS TREES EDGE OF BRUSH ORCHARD OR NURSERY + - EDGE OF CONIFEROUS TREES ® e P 274 ® + MARSH AREA HOO ® 1' I¢ ® EDGE OF WATER MAP 114 9_HOO ¢ f ---_= DIRT ROAD #1156 m-n® 0 ._, DRIVEWAY P 95 0 �- PARKING LOT O E__--- PAVED ROAD O #1010 DRAINAGE DITCH V PATH/TRAIL / PARCEL LINE 1MnPno PP# \, 21 a PARCEL NUMBER t #1860 - HOUSE NUMBER \`-, 273 I � I u 2 FOOT CONTOUR LINE I —!0— 10 FOOT CONTOUR LINE / Elevation based on NGVD29 Oo 4 ; 4.9 SPOT ELEVATION STONE WALL -X—X- FENCE _7 w RETAINING WALL 4 __ \\ - 1--� f—►- RAIL ROAD TRACK STONE JETTY #1090 p t iPOOL i SWIMMING POOL \J - P PORCH/DECK \� 0 BUILDING/STRUCTURE �\ M 2 4 MAP 94 DOCK/PIER #10 #1 40 ® HYDRANT l/ P 273 I I ' E) VALVE O MANHOLE T O W N O F B A R N S T A B L E G E O G R A P H 1 C 1 IN F O R M A T 1 O N S Y S T E M S U N 1 T O POST p" FLAG POLE N PRINTED SCALE: IN FEET *NOTE: Planimetrics,topography,and **NOTE: The parcel lines are only graphic representations DATA SOURCES: Planimetrics(man-made features)were interpreted from 1995 aerial photographs by The James SIGN ® STORM DRAIN vegetation were mapped to meet National of property boundaries. They are not true locations,and)` W.Sewall Company. Topography and vegetation were interpreted from 1989 aerial photographs by GEOD w e 100 0 100 Map Accuracy Standards at a scale of do not represent actual relationships to physical objects �' Corporation. Planimetrics,topography, and vegetation were mapped to meet National Map Accuracy Standards UTILITY POLE TOWER S 1 INCH = 100 FEET* 1"=100'. on the map. y at.a scale of 1"=100'. Parcel lines were digitized from 2000 Town of Barnstable Assessor's tax maps. LIGHT POLE o ELECTRIC BOX ..\sitemaps\Public\m295pl9XO1.dgn Jul. 05, 2000 14:06:11 i" Y j i i i d i + 1 i j : I 901) j' r - • ...'.li 6 ,.ail :. 41 - GENEML N07E4: 77. Q '. Alterations under this pondt shall conform to the Massachusetts state wilding Code,Fj" �M1 Edition. The classification Of Wmk Isdater- . 7. .. t 1 - udrrcd o be Level 2 as Odined M the mama- - . .<K•- �.:: ;i: - "Wid 114111111111 Coda 2009..The work consist - 1 tfe.�ra•n&1. - er dw nwnllyg-Mn•oi enlisting space,tba so _ - noonflpured-of tx"rneehaNnt,dec- sal Ee q¢e/. _i trlpal ad ed plumbing Wriems as shown on dtwfdW by callers.Want Is no aftsaidden to umc we w exwioi widows ad doors, The existing use of,the eamm spew pas at Mercantile ad the proposed use b M Mu- • • + - pantile. There'In no dmige of occupancy . cWsiflw m tion.:The himard category odas .. . .. - unchanged nbtlre to the existing, - y - The net won Brea hxdu*n of exterior wausl • Is 2.451 sf.Thrproposed net business am Is 1.984 SF. The Itml I m a&rwable oow- rty m trAd ' Pam load would.be 67'perwm par code. Th e max6tru d4mncs to an cdt b . - - Mu than 50 feet-,The spew Is to be fmW Umhlecd-aherubm to existing system . .:'A' I . . permda-mgineatdbyatfwra + i s_•` •- Regulations Of do ArtNteclural Amu Board. `• - _ `- - --—_ Tolbt comes allow"on plan`.shag bwr Pot- .,-. .. cures ad grab ban.sloe and locations as par ..l PeoP�sfr> �t.fJCRc�.fI•LIV - -_ _ _ - ArQdtKAccessni Aoaa Board rubs sold re"- •�, � /tet.0 C'A6ea elL;-wnlCsytonty' `. - • " dons. nra+c -f c r ws ax Tst 1Law- �.xlbnNc, [OPIDfrlollg fc fter-1 a tsft-c,Ai, Vs.t:c,>~teay.,vun'49wf.lh+nbl�izuic . M eVat/ra•do- 1sv eaWN¢C - , f70Ma�/B Cal.Fto6T'1TONy VJI"K P7 N01W ',`•_ • - REwoY9 Ott- Pl.uM9hK. Vj)"IcFh r - .q0lrbrictcD CMUM4 Gelb 9D wst4o�4 ODOt:T!pi C7 RP1sMBB.o . - - t4fiW Lt1uwG 7a.ch isl ew++eY W'ly''�+��fpt%oJN. - - Wli�i'1'iNr. t�ONi7rfICN4 FI.La�K - - Alterations to Suite G10 @ Festival Mall AKROASSOCIATESARCHrrECrs 10701yannough Road,Hyannis,Massachusetts 27FastrkwTernw,MannonsMub.MA 02WB Tel.and Fax:SO&419-1217 1 Or I (ZO L