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0016 WEST BAY ROAD
w Z,-5T— n C ':� -_ a..,i•....- ,_ems._ tee..-�,..� 4!"n,r+. .^"t., . . �^. ,T.. +.-�.- .. w(..----r"/"_.'` - .r,.c•.....�,�F,.._;,�+^ —,�..-.��_,,.. YL,,.: PRE C `V'OL G WFSH TO OPEN A SUSIINIESS? � �iissi �lF•'�• nt ., For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS 'YOUR I in., w-1i yoq must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this fo 20 St.`� - ainis. Take the complete form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, /\AA 02601 (Town Hall) and get the osip, -rtifiglite fiat is required b law. '••: �auB+?°o� U SFtttt�t�`� lki� ,�, ;-; � _ fDATE: —z3 2ca1 g Fill in please: APPLICANT'S YOUR NAME/S: ��,R 1 1'BUSINESS YOUR HOME ADDRESS: 2 R E-7-'T-j!�j LN, i»nR I �* TELEPHONE # Home Telephone Number '�09 --G6' - 3 �•� iE �a 3' �i�irr+ C - NAME-OF CORPORATION: � NAME OF NEW BUSINESS X TYPE OF BUSINESS \i C IS THIS A HOME OCCUPATION? YES f"O ADDRESS OF BUSINESS G \ C e:,r J `' MAP/PARCEL NUMBER (Assessing) . 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 ir) obtaining the information you may need. You MUST GO TO 200 Main St. - (corner 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 CO M ISS[ ER'S OF , This indivi an irS o e flyp mit re uirQments hat pertain to this type of business. r' ad Sign e* COMMENTS: � I0&zot �m W III)AAIA AIJ 1--A 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. j Authorized Signature** COMMENTS: b �1 h.. M i. �h West Bay Road , Osterville 6/7/10 Y O cl O . (n CD I 11 NO 1 � - '1f�11�11If♦11111♦f��i�1'�IIIa♦+f♦I♦ p f 11�1+11♦Iif11j11111�p♦1♦1♦Ij1 ii♦1 if1 f 11 i 1♦f�lilffi♦11�1,�, � __ � �w`1♦i1111ii+��s1ij�'�1♦f�1l�'♦ l `` `' � , x�� �� f♦f1fl�rlflfif11ii11f*s " 11111♦f 1 •a�0010104 nrarr, ROOM ;, %kAw If TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map,,,,*' & Parcel Application# aalo-a If ,Health Division Conservation Division Permit# i Tax Collector Date.Issued k oil Treasurer Application *w: Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �1i J09 Historic-OKH Preservation/Hyannis Project Street Address Village Owner Address Telephone ZZLrl Permit Request peg S9 I o o � s a r Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Y Zoning District _Elmd Plain Groundwater Overlay Project Valuation �� Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting ocumentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) �1 Age of Existing Structure Historic House: ❑Yes No On Old Kin 's Highway: ❑Yes A'No 9 9 9 Basement Type: ❑Full ❑Crawl p 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�A :r Telephone Number Address /���1 ,L��i� '� License# ,OA Home Improvement Contractor# Worker's Compensation# !Q 9 7 �� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1,71 / /,_s a FOR OFFICIAL USE ONLY t r y PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: I FOUNDATION FRAME INSULATION FIREPLACE > ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING � DATE CLOSED OUT ' ASSOCIATION PLAN NO. I The Commonwealth of Massachusetts Page 10 of 10 ,^ { Department of Industrial Accidents Office of Investigations 600 Washington Street Un j Boston,MA 02111 r�- www.massgov/dia Workers' Compensation Insurance Affidavit: ]Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizati.onAndividual): PA U L -3- C2 Z e Q U I e O n S 00�- Address: City/State/Zip: (`)5 e r-V y M oZ(o S S Phone#: So - y 28 - 1 1 ^1-7 Are you an employer?Check the appropriate box: Typpe of project(required): 1.0 1 am a employer with 1 Z 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.t 7• ❑Remodeling ship and have no employees These subcontractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its ME]Electrical repairs or additions required.] officers have exercised their 3.❑ i am a homeowner doing all work right of exemption per MGL I LE] Plumbing'repairs or additions myself..[No workers.' comp. c. 152, §1(4),and we have no 12,IR Roof repairs insurance required.]t employees. [No workers' 13.❑Other comp. insurance required.] 'Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who..submil this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Li c.#: Expiration Date: q Job Site Address: City/State/Zip: �/—,/&�, o,Z� Attach a copy of the workers' compensa on policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator.. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: jo8 Official use only. Do not write in this area,to be completed by city or town offw-W City or Town: PermitfLicense# Issuing Authority(circle one): 1.Board ofllealth 2.Building Department 3.City/Town Clerk 4, Electrical Inspector S.Plumbing Inspector 6. Other Contact Person- Phone#: i • � CSR RF DATE(ARF9IDDlYYYY) 1.�CQ, D: CE�i 'iF1' > ►Tf= OF LIABILITY INSURANCE CpzEA-5 69 11108 PRMUCER THIS CERTIFICATE tS ISSUED AS A MATTER.OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MacIr_tyre Fay & Thayer Ins Agy HOLDER-THIS CERTIFICATE DOES NOT AMEND,EXTEND;OR . 77 Accord Park Drive Unit B-1 ALTER THE COVERAGE A'FFOi2DED BY THE POLICIES BELOW: Norwell MA 02.061 Phone: 781-261-2000 Fax:781-261-2099 INSURERS AFFORDING COVERAGE NAIC 9 INSURED (INSURER A: American International Co. .INSURER S. I Paul 3 Cazeault & i INSURERC: Sons Roof inq. Inc_ 103'1 Main Street 1 INSURER D: Osterville MA 02655 .INSURER.E: i 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. .. I.. POLICY NUMBER i P E T10 LIMITS LTR RNSRD TYPE OF INSURANCE : DATE MM1DD DATE MWD ` 16I NERAL LIABILITY EACH OCCURRENCE S I ! .COMMERCIAL GENERALLIABILITY .P.REM15ES-IEeoccurence) S i r� '• MEO EXP(Any one person) S CLAIMS MADE u OCCUR ; .. I PERSONAL 8 AOV INJIIFiY $ ! GENERAL AGGREGATE ;S . __—. AGGREGATE LIMIT APPLIES PER: I I PRODUCTS-COMPIOP AGG j S � I I �I POLICY i l FCT i LOC PRO- i ! I' ! AUTOMOBILE-LIABILITY ! ! I II COMBINED.SINGLE LIMIT ` I l(Ee accident) S ANY AUTO I 111 I' � r r ALL OWNED AUTOS i BODILY INJURY $ I p (Per Person) .SC14EDULEDAUTOS HIRED AUTOS j IBODILY INJURY S NON-OWNED AUTOS 1 I I PROPERTYOAAAGE ($ (Per accident) i I GARAGE LIABILITY ! ;AUTO ONLY-EA ACCIDENT !S I I f-ANY AUTO 'OTHER THAN :ACC, S` ! AUTO ONLY: AGG S EXCESS/UMBRELLA LIABILITY I 3 EACH OCCURRENCE S f I I I OCCUR CLAIMS MADE i i AGGREGATE S I �— I S i DEDUCTIBLE S I RETENTION S i I i WORKERS COMPENSATION AND s I X jT0vvRA`Y0UMA i ER-i EMPLOYERS'LIABILITY 697B565 08/10/08 OB�lO�O9 (E.L.EACHACCIOEMT $100000 A �ANY PROPRIETOR/PARTNER/EXECUTIVE OFF!CF_RIMEMBEREXCL'UDEU7 k .£L.DISEASE=EAEivIPl4YEEj S 1'600 00 If yes.describe:alder I I ci DISEASE-POLICY LIMIT 1 S 500000 SPECIAL PROVISIONS betaw I OTHER I I ! ! I DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION FOR REC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAYOR.TO_MAIL.9-31) DAXS-lNRt7[ NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL For Information 'Purposes IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AU EDR£P S TATlY�� .[ ACORD 25(2001108) ©ACORD CORPORATION 1988 Client#: 19989 2CAZEAULTPA ACORDTM CERTIFICATE OF LIABILITY INSURANCE DAT29/E(PdM/D2U0 ' •;YY1� 04/ PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling$O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. j 973 lyannough Rd., PO Box 1990 Hyannis, MA 02601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Western World Paul J.Cazeault 8r Sons , Inc. INSURER B: 1031 Main Street INSURER C: Osterville, MA 02655 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. NS A TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MM DD/YY DATE MM/DD/YY LIMITS A GENERAL LIABILITY BINDER286389 04/30/09 04/30/10 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $50 000 REMISE occurrencel CLAIMS MADE 51 OCCUR MED EXP(Any one person) $5 000 X BI/PD Ded:1,000 PERSONAL&ADV INJURY $1 00O 000 GENERAL AGGREGATE $2 000 OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $1 000 000 POLICY PRO LOC JECT ' M AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS , (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ LIMITWORKERS COMPENSATION AND FR WC STATU- OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Insurance coverage is limited to the terms,conditions, exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 1O— DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - - ACORD 25 12001/08)1 of 2 #S56749/M56748 LS1 0 ACORD CORPORATION 1988 Property Owner Must Complete & Sign This Form If lasing a Roofer/ Builder. 1 (print) ^ ove6,��< <So�z� , as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault'& Sons Roofing-Inc. to act-on my behalf, in all matters relative to words authorized by this building a permit application for: Address of Job Signature of Owner _�A� Mailing Address of Owner Telephone# Y Date (Please return this form to Cazeault roofing along with your signed contract;.It is needed for us to obtain the building permit required.by your town, to complete your roofing project;thank you) fax#508-420-4555 Boar o ul m e ula on an an �rs g g One Ashburton Place - Room 13.01 Boston. Massachusetts 02108 Home Improvement:Contractor Registration Registration: 103714 Type. Private Corporation Ai. PAUL J. Expiration: 7/9/2010 Trtf 269847 CAZEAULT & SONS, INC __ Paul Cazeault — 1031 MAIN ST - ' OSTERVILLE, MA 02658 J,w Update Address and return card.Mark reason for change. Address- ❑ Renewal Employment Lost Card 'S-CAl C� SOM-07/07-PC8490 ✓�z8 �L>fl74g7ZO�LwE2L(/Z P�✓/�GCI.ddR�t(CdP.� ,' .. .. . Board or Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 103714 Board of Building Regulations and Standards Expiration-,.7Y9/2010 Tr## 269847 One Ashburton Place Rm 1301 1 Boston,Ma.02108 Type:-Private Corporation PAUL J.CAZ EAU'0T'90`ONS Paul Cazeault -,0 i IMEMO= Boar o ui m e�ulatons an g b tan arils . i One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Construction Supervisor License - -- -=— License CS: 26325 iEf `— — Restriction: 00 Birthdate: 10/20/1959 Expiration: 10/20/2009 T r# 6311 PAUL J CAZEAULTT� �T 1031 MAIN ST "1' OSTERVILLE, MA 02655 = ' Update Address and eeturn card.Mark rellson for change. DPS-CAI u SOM-07107-PC8490 -- —..— (� Address Renewal .Lost Card ' :F%L�r ��`a?' .J 1LC VO'Ill//7tOO1L�C�GCIL ✓GQd10C/LUdEG[6 . Board of Building Regulation andl'Standards �r Construction Supervisor License. r Lic..Pte- CS 26325 `. Exiratioa�^ Tr#.6311 ;P --1.0720l2009 PAUL.J CAZEA -:-� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 11� Parcel ��� Permit# oC i Health Division Date Issued 1 d Conservation Division Application Fee Tax Collector Permit Fee Treasurer 3��Ip9 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address �/�/ 'Je Z , 6 � , Village (5 i'!i` a L ..r Owner Z444 Address /V Telephone l3,TOlf Permit Request e Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new l� Zoning District Flood Plain Groundwater Overlay Project Valuation . s� Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. ;" Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) c 0 1 .M Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes %<0 t c C Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) o ' `i Number of Baths: Full: existing new Half: existing n_I new) Number of Bedrooms: existing new ( w �. 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;e/sAppeals Authorization ❑ Appeal# Recorded❑ Commercial ❑No If P ,es site Ian review# Y Current Use Proposed Use BUILDER INFORMATION Name ,PAS /yd�,�,�� .�e�J Telephone Number s `',Z� , 2,7 Address L�� f17��� r� �-- License# Home Improvement Contractor Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO fin- i SIGNATURE DATE FOR OFFICIAL USE ONLY e 1. PERMIT NO. ; DATE ISSUED : MAP/PARCEL NO. ADDRESS VILLAGE OWNER ii DATE OF INSPECTION: FOUNDATION FRAME ' INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL. I` GAS: ROUGH FINAL v FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. P • The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 9 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name (Business/Organization/Individual): J F&l Address:/ .?/ LS/f� City/State/Zip:�6;k !46 fJe Phone#:C27J` Are you n employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I aim a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner_ listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in an capacity. employees and have workers' Y P tY• 9. [] Building addition [No workers' comp. insurance comp.insurance required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]_ c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other - comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: 14 Policy#or Self-ins.Lic. Expiration Date: Z2 Job Site Address: City/State/Zip:n� _ /oj Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of die DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct Signature: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: C-08D CERTIFICATE OF LIABILITY INSURANCE . CSR.RF DATE(MMIDIDNYYY) CAZEA-5 08 11/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MacIntyre Fay & Thayer Ins Agy. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR . 77 Accord Park Drive Unit B-1 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, Norwell MA 02061 1 Phone: 781-261-2000 Fax:781-261-2094 i INSURERS AFFORDING COVERAGE NAIC# INSURED ,INSURER A: American International Co. : INSURER B: j Paul 3 Cazeault & 1NSURERC: f Sons Roofing. Inc. 10'31 Main Street INSURER D: Osterville MA 02655 INSURER.E: 1 COVERAGES _ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH' POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. � ...... _ i .. LTR jNSRD TYPE OF INSURANCE POLICY NUMBER 1 DATE MM/00 DATE MWD LIMITS ( !GENERAL LIABILITY EACH OCCURRENCE S ? COMMERCIAL GENERAL LIABILITY I PREMISES_(Eo oxurenoe) S j CLAIMS MADE u OCCUR. MEO EXP(Any one person) S i I ,PERSONAL&ADV INJURY ;$ GENERAL AGGREGATE $ GE L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG j$ �;POLICY I I JET LOC I 1 AUTOMOBILE LIABIUT-Y j ! I COMBINED.SINGLE LIMIT I (Ea eccidenq $ - ANY AUTO i ALL OWNED AUTOS i I BODILY INJURY ; SCHEDULED AUTOS i (Pe`person) g HIRED AUTOS i I BODILY INJURY $ NON-OWNED AUTOS I I I(Pereciidenl). _J I PROPERTYDAMAGE ;$ (Per accident) : - 1 1 GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT 1$ I�ANY AUTO ` I OTHER THAN EA,ACC S' I AUTO ONLY: AGG $ [EXCiSSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE S ! S DEDUCTIBLE RETENTION S j I S- 1 WORKERS COMPENSATION AND X ITORY LIMITS ` ER(EMPLO _.. ...... ._.._ _ - A ANY,PRYERIEI'OPILITY 6978565 09/10/08 08/10/09 'E.L.EACH ACCIDENT $100000 ANY PROPRIEI'ORlPARTNER/EXECUTNE OFF!CERIMEMSER EXCLUDED! i E.L.DISEASE-EA EMPLOYEE 3 l'0'O O'O O 111 yes,describe under SPECIAL PROVISIONS.below E E.L.DISEASE-POLICY LIMIT S 500000 (OTHER I. I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION FOR REC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR..TO-MAIL. 0.30 DAY.S_WRIT," NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL For Information "Purposes IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES: AUL£DREP S TATty& ACORD 2S(2001/08) ©ACORD CORPORATION 1988 Dowling&O'Neil Insurance ONLY AND CONFERS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NO.T AMEND,EXTEND OR Agency ALTEk THE�COVER AGE AFFORDED 13Y THE POLICIES BELDW. 973 lyanough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# INURED INSURER A: Western World Paul J.Cazeault&Sons,Inc. - INSURER B: 1031 Main.Street INSURER C: Osterville,MA 02655 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 CONTRACTOR 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. POLICY EFFECTIVE POLICY EXPIRATION LT NS TYPE OF INSURANCE POLICY NUMBER _DA _DAT MIDD __ LIMf,TS A GENERAL LIABILITY NPP1145484' 04130/08 04/30/09 EACH OCCURRENCE $1 000 000 DAMAGX - COMMERCIAL GENERAL LIABILITY PREMIS 70 RENTED } ;;.Oro ddIILP $;OO CLAIMS MADE F;OCCUR .MED EXP(Anyone person). .$506 X BI1PD Ded:1,000 PERSONAL&ADV INJURY $1 00O 000 GENERAL AGGREGATE $2 0OO OOO GEN'LAGGREGATEL-IMIIAPPLIES,PER,'; PRODUCTS-COMPIOPAGG .$1:j000.000 POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ . ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS - BODILY INJURY NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ . (Pnf aCO eftt). GARAGELIABILDY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTOONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ .. WC STATU- OTH- WORKERS COMPENSATION ANDLIMITS EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE 'g.L..EACkt•AGCIDENT OFFICER/MEMBER EXCLUDED? EL.DISEASE-EA EMPLOYEE.$ If yes,describe Under SPECIAL PROVISIONS below E.L DISEASE-POLICY LIMIT-'$ OTHER DESCRIPTION OF OPERATIONS)LbCATIONS/VEHICLES I EXCLUSIONS ADDEO•BY ENbORSEMENT.1-SPECIAL.PkOVISIONS Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED'POLICIES BE CANCELLED BEFORE THE EXPIRATION Paul J.Cazeault&Sons DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _4n DAYS WRITTEN Roofing,Inc. : NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 1031 Main Street IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Osterville,-MA 02655 REPRESENTATIVES. AUTHORIZED R RESENTATIVE ACORD 25(2001108)1 of 2 #52027 LS1 0 ACORD CORPORATION 1988 Property Owner Must Complete & Sign This Form If Using a Roofer / Builder. / (print) �� So z,L , as Owner / Agent of the subject property hereby authorizes Paul J. Cazeault & Sons Roofing-Inc. to act on my behalf, in all matters relative to work authorized by this building permit application for: J Address of Job a Signature of Owner Mailing Address of Owner Telephone# Date (Please return this form to Cazeault roofing along with your signed contract;.It is needed for us to obtain the building permit required by your town, to complete your roofing project, thank you) fax#508-420-4555 Boar o ui m e ula ns an an ar s g g One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improveinent"Co.ntractor Registration Registration: 103714 Type: Private Corporation Expiration: 7/9/2010 Tr# 269847 PAUL J. CAZEAULT & SONS INCJ -= ' _ Y Paul Cazeault =- 1031 MAIN ST OSTERVILLE, MA 02658 ^!r => " M.=:f' /. '`" Update Address and return card. Mark reason for change. Address. Renewal Employment Lost Card S CA7 G SOM-07/07-PC8490 ,/�tC �/0�7Z97tO�uuECLGUt 6�✓I�GCldJ2C1L[[6C�6 .. .. . . .. . Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 103714 Board of Building Regulations and Standards Expi ration_T/9/2010 Tr# 269847 One Ashburton Place Rm 1301 - Type:. Private Corporation Boston,Ma.02108 PAUL J.CAZEAULT&iSONS,=INC. Paul Cazeault i. BETTriffm eaulat ons an t i g b an arils i One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Construction Supervisor License ! _ License CS: 26325 Restriction: 00 -/;, M._-__ Birthdale: 1 0120/1 95 9 Expiration: 10/20/2009 Tr# 6311 PAUL J CAZEAULT 1031 MAIN ST OSTERVILLE, MA 02655 - - Update Address and return card.Mark reltson for change. Address Ej Renewal .Lost Card DPS-CAI G 50M-07/07-PC8490 _ -- --.-- _ .. . r',1�• �� �omunzov:laea��i a�✓��aaoac,�wvelfa Board of Building Regulation and Standards Construction Supervisor License. Fn License: CS 26325 I � • �. _ Exprrrafioii:-1:0%20L2009 Tr#.6311 �� F,testiiction:=00•.,~�d • PAUL.J CAZEAUCI TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel S Permit# 2 23 Health Division 7t_R5 G;� 1 1�s- Date Issued 2 - P) b �� Conservation Division ��(�� — Application Feele�f/. Tax Collector Permit Fee 21b , (o U Treasurer 7 9[7 0.S SE s'1C 9'YGTFF,-± a�, Wig`{d, I'M CON91PLIAN':._: Planning Dept. WITH TITLE 5 Date Definitive Plan Approved by Planning Board ENVIR-ONAENTAL CODE AND TOWN MGULATIONS Historic-OKH Preservation/Hyannis Project Street Address -)So 1�?1r=- S� 1s14y KZs�s4� Village %jS rY)e-v)LL,(6_ Owner kAW 0rcF.t.-fi-,K� ^FYI- S Address `77 I t>L'n14Atw ' rif &)_0 a3MR Telephone 4-4o 1- --7 FS 1- 113 43)'7 Permit Request dc: x �SS'►�]�� C` T3��Lrs1�yv9�rEcQS 12�Ft »C� wig \f�V ���rr�ur�ar,�� O PAA-x-� k, Yc)K) h 00-L_Gl2 SOvI t e n 6N h e22&,J x !-' Square feet: 1 st floor: existing proposed 2nd floor: existing proposed r Total new. Zoning District Flood Plain Groundwater Overlay Project Valuation Q onstruction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting�documentation.p Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) , r-- Age of Existing Structure Historic House: ❑Yes ❑No On Old King's H�.ghway: `O 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# i Current Use Proposed Use BUILDER INFORMATION Name 7:3-© Telephone Number So If• IuA?X• 3gso o Address Z H License#' E7 ko°I )c43 �x 6t)Q o zv Home Improvement Contractor# Worker's Compensation# 1A J C 1/ OVS 5�3V0 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO . SIGNATURE DATE Y FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. s ADDRESS- VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION ' FIREPLACE ' ELECTRICAL: ROUGH FINAL s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL E FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t- _ The Commonwealth of Massachusetts - Department of Industrial Accidents' 6001 Washington Street Boston,Mass. .02111 Workers' Co wensation.InsuranceAffidavit-General Businesses Y;' i54ly�wLY '-fir®'. �y,e, .FQ,+qy�. .. •°' �:'y`_ . u1 name D1LloOkl C'opiil 1) L.LC— — :.�ri address: Z4- C/�'2�1�'1'11J t✓ A�1 v� Q •. City' NV a :12 state: Zip: CZO3S phone# work site location(full address): fZ-=0u e, )'`' k ❑ I am a sole proprietor and have no one Bµsiness Z`ype: El Retail❑ Restaurant/Bar/Eating Establishment worldng in any capacity. ❑Office❑ Safes(mcludmg Real Estate,Autos etc.)' ®I am an employer with/ em�l�ees�full& art time.. ❑Other V20/ 1/%%%��%/% %//%%/%%�%%/ /l%///G/%%/O////////�%%%%�%%//%��/%/%%/O�%% :%�//�%k I am an employer providing viorkeas' compensation for my employees working on this job.. Minna6.3i met. '� :=1 C) • l •cad T"' 'F'.� .,:I �':. • 1, '•a-;:'. '� ,: .. ,.,•�.•. .'•A,-. ! - is ',�: .t :•t'.:� -' .. . ' t�n7C. � �, •: .:.,;: !`:;' ..,'.':s.:.;,- :i'.'• ;'t._r� .::''r.c:;: ,., city '.•-b?�CT•�` +;sue 1•�-' ..D•hone:•#:��.' .`� �'�•-'�P.1'll•�'`:.'7-''V�✓"` .irisuratice.c0'' �" .i- =�:.�, ::;,: -�:� •,;'i'�:'t::.. oh '.#�' :`• , . I am a sole proprietor and'have hired the independent contractors listed below.who have tie following workers' compensation polices: ¢6II1paIIV D8I[te` - -- address:. " f'' - .t' :r 3.• -S '•:.�:e:'% i i 1, l city phone, . .••t •i.e..' S:j.,- r0•lIC � .+.Pi:zi•:,:`,�7�,�'`'•'• - :'fti.; irisurence:co.: E:;,:=:'.: ;: r' '•° „t'; :.•.. . '!'.::t(.,. •,i�+ ,ter. :C:�'. - comnan ,. . ,•: :. .. t.,y address:. .�.�•" ,�1�/MJ�1✓ ''�•"V��=�• . ��'uhone#: �'C�•'�r' �' .'�':' L ' x•. +' fiisarance�cb'�:�'�: '-lic:`•:#•;`x`•I` :.•. •'•�;�.:1'�,'�<•?:.` . Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that it copy of this statement may be forward o the Office of Investigations of the DIA for coverage verification. I do hereby c ify nd ai a enalties of perjury that the information provided above is true and correct Signature Date11 Print Hama ri11 Phone# [.:hif�:medi. w.tis nly do not write in this area to be completed by city or town offcial : permit/license# ❑Building Department ❑Licensing Board -check Ifimmediate response is required ❑Selectmen's Office []Health Department son• phone#; ❑Other 03) Information and Instructions Massachusetts General Laws:chapter 152 section 25 requires all employers to provide Qvorkers' compensation for their.. employees: As quoted from the 9aw", an employee is.defined as every person in the service of another under arty 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 ajoint enferprise, and including the legal representatives of a deceased,employer, or the receiver or trustee of an individual,partnership,.association or other legal entity, employing employees. 'However the owner of a. dwelling house having*not more than three apartments and-who resides therein, or the.occupant:of the.dwelling house of-: another who employs persons to do.maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such.employment.be deemed to bean employer. MGL chapter 152 section 25 also*s' tes that every. state br 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 '. coirmionwealth nor.any.of its political subdivisions shall enter into any contract for the p erformance 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..'Please supply company name, 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 of Accidents. Should you have any questions regarding the•"law"or if you are requested, not the 1Departrrient required to obtain a:workersr compensation policy,please call the Department at the number liste�cl:below. , City or Towns . Please be sure that the'affidavit is complete andprinted 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.:ia the permit/license number.which will be used as a reference number. The.affidavits•may.be:retumed 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 OHIO of Westl nt 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 ext:406 r I' t �00 �0 • C/���m f Cumberland Farms,Inc. 348 Allens Avenue,Providence,RI 02905 FWTFW O Phone:(401)781-1730 Ext.4317 Fax:(401)941-2964 Email Lcouture(@cumberlandfarms.com To Whom It May Concern: 1-Feb-05 I herby authorize the following named individual to sign as an authorized representative of Cumberland Farms for a building permit only. John Dillon This authorization is only for a permit application located at the following locations. Cumberland Farms 16•West Bay Rd. Osterville, MA 02655 Sincerely, Lucien RJ Couture Store Construction Remodeling Supervisor 1 BOARp,pF g�NG R �waelta ' CATIONS Lice_nse.: .CONS�I:RU�C�TI,ONrS•U'�ERVI�SOR ' iwmb 069143 a• � _ '6 Tr. • i.l no: 581.0 Rest �t$• = i JO'HNrP 'D'lLLO� 24 C�A7,M Neap Commissioner " ��� �� �� �� s o� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map / Parcel Permit# n Health Division 3 (D Date Issued //� Conservation Division �� �' c� 8 Application Fee Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village (91540 Owner "\Ck'A �U�nVv� X�—g j G Address —M-7 I UI hw, 51,� Cu/Nibn,M 62CLI Telephone Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Z� ® ' ®� 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: I Lf —, L Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ E Commercial ❑Yes ❑No If yes,site plan review# N� co CD 2_1 Current Use Proposed Use co r BUILDER INFORMATION Name aj , ac, Telephone Number U U� 6 C, Address Zl t - License# CS oy- b `.C D _QU"G.S Ol3Z. Home Improvement Contractor# Worker's Compensation# I �o�p,T C, �,OLI(IloD ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO A)I w SIGNATURE DATE 12,3 ` t i FOR OFFICIAL USE ONLY l PERMIT NO. DATE ISSUED MAP/PARCEL NO. ' T - a c - n ADDRESS VILLAGE i OWNER t J DATE OF INSPECTION: V FOUNDATION ! i FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL-BUILDING DATE CLOSED OUT ASSOCIATION PLAN,NO. _ The Commonwealth of Massachusetts Department of Industrial Accidents • - Office ofiMS119917APHS 600 Washington Street Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit aSIMMIROMMI RON name i J&�Cx bs%Nn� location: city __ phone# I am a homeowner performing all work myself. ' I am a sole proprietor and have no one working in any capacity Jill IM am an employer providing workers' compensation for my employees working on this job. t �s v,.x .,+•�-y, +,c— �--•c: f �i�niL�c F yy�.�(v �"-:�� .S`�.d�'�' ��3't,.ks�3���.,�".Q •d' ,�'"�7.� � �` t� t.. � �'"...c^sC_l lira, ,... "vim. t,a"�T � r`�'=7��'S, ¢� 'h�� hi- tt .rw�.,�iF� `r `'4 �0..� .s�� lc�•2� 5 '�; ram' ��""�� -:� .in^ X s�'T� }�F�+«�i.s'�.,CY tt�-�,..�uS�-�s�y�'+ '''_' ��*"',,�i•��`.r a.,r,'�'.,•t`ry.�r„, j�n'�� `�'a'�. t' `s�K :.>• 2. +i c " S�ttit�""!t ts'-*ir4 t r l.['ir r5..w �' {a�d �: .aA S � �, ,�,5,u r •c>�t,;i-p �r r i�,�,. � .y iy�3 vn M, cv�.". -f' fir " �y' .'�`m ,'1r' t:• C z{�• ���c� ,��g- t _„y y;en�FT"�t •y.3 t'Rj � 'r u �h��f��r.i1071C�.���''�4�. � �t'FS •q� .. I.X:.t S��jc -r C � 4 �a'�• �• s. 2 tCl -5i, � Y' ♦ h _ ". y E�sc.°�rti:.n'"51•� ,�. G S �7. t t'�c", �. f �� r .sr .r� r°?•e.r ..,1e .�,�5�,'�,t,�..C'��a'��s�fs 1 scat' _ v, 7 s'Lr-,-1 :.co:... -. ._. ..: _ - .. .. .4` y� `"ys� �'d.F .tar i'OTI'l�,r �4,'�' t -..•e....,J <;+ _ .��;k4? •t kv�,Tf1�v'�. u ' t .a. me _r......�q a. y, _� '�����•�._. _,-+�+s-a..t N��� 0 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 s L , �'' pl Y' s•.. �t4;jy. 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S'r ggt � •^ ;t Jrx-?e• 'i-.�'�,fi '�+����� la k'T+Ck sYi at ��'+ 4 5�� ^�� k Y T•S��g�y F 5�w�v�¢�", �.� '���,,��,'�"3+ + ;;i7';���..r+E���7^ � 5 Cs�S9.'�• � sw+a -" P`�� 14�i t--�*.�x("•z +'� 3,S'^+.arrr°i '�.wa. �+' -,y'"+-r'.�'Ys .. a.. • .. w � .� - 1 � ala s•.K��rl� •ac cif�'Yi`k"¢Er�"�,'eciw� �pl �a;,. x y,,tl� �d•"a+'4�.r'^ ''a+ ,sF�. - •�`' Mi.,�.ci"`G�"t' �ty<'^F a��.�r ., •�'<,'�7� ' �`' �,;? 7 ... •-k��r�'rF'1.'�;�'F'.!,°� ?�t'""�.'y-,.'t'.�t`�'..� � ilOn.0 �.5 n'?. e'� � ,"� ��,�.3 -�c P t�ti -�,y%r._'- ✓ SF y k >� a a.•-d'"�&r lrxr•rx #� �C`�`ir� � -.�•�-.,�'6 .� r 3 "� �tk e b t ran �}'s.:"�� 1 a�w i.�c.•.��,, �� � �al�.t J f� 'k- t�� Srt� x`rg Ta�ha.'l'i .!t f^t,¢ .§� "3��5'"a y�Ls'7x"' 7 f$ i1.t `S,f", �.t• ;+J yCj�'i`�t � p.��. tiilsuce CO ! �. fik n'3yx Failure to secure coverage as required under Section 15A 01 MGL—Z can lead to the imposition of criminal penalties of a fine up to$l¢00.00 and/or one years'imprisonment as well a, eivil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against-me. I understand that a copy of this statement may be fd6varded to the Office of Investigations of the DIA for coverage verification. I do hereby c under the pains and p nalties of perjury that the information provided above is true and correct. V. Date �Z3 10� ' Signature --`` _ Print nam � e Vi A V. UbInlnen Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# MBuilding Department ❑Licensing Board O check if immediate response is required []Selectmen's Office ❑Health Department contact person: phone fl; nOther (revised 9/95 PIA) 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 akemployer. 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. en Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you'have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at-the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out-in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or VV ,X 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 Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617) 727-4900 ext. 406 APR 23 2003 10:44 FR CFI—PLANNING DEPT —781 830 4090 TO 917704454789 P.03iO4 Town of Barnstable 4 Regulatory Services ' - Thomas F.Geiler,Director' Building Division Tom Perry, Building Commissioner 200 Main Stzee� Hyannis,MA 02601 Office: 508-862403 8 pax: 508-790.6230 Property Owner Must.Complete and Sign This Section If Using A Builder I I, Francis Sheflin for Cumberland E,as Nfnelot the subject property hereby authorize (!C_, C L C, to act on my behalf, in all matters relative to work au onzed bythis binding permit application for(address of job) April 23, 2003 JS �tureofnez Dace Francis Sheflin for Cumberland Farms, Inc. Print Name APR 23 2003 09:43 PAGE .02 r. . LETTER OF TRANSMITTAL STEELTEC CONSTRUCTION MANAGEMENT,LLC Date: 4/23/2003 210 Paulding Lane Dallas, GA 30132 Job Cumberland Farms Phone: (770) 505-5917 Osterville, MA Fax: (770)445-4789 TO: Mr.Tom Perry Bldg. Commissioner,Town of Barnstable 200 Main Street Hyannis, MA 02601 508.862.4038 WE ARE SENDING THE FOLLOWING ITEMS: COPIES DATE NO. DESCRIPTION 1 Application for Bldg. Permit 1 Worker's Compensation Affidavit 1 Property Owner Letter of Permission 1 Check#009053 in the amount of$50.00 for permit application fee 1 Check#009054 in the amount of$50.00 for permit fee for job value $7,270 1 Set of"before" and"after" photo layouts 2 Sealed 11"x 17"drawing showing proposed fascia 1 Sealed full size drawing showing proposed fascia 1 Copy of CS License-Mike Deubel,full time Steeltec employee REMARKS: Mr. Perry Please find the enclosed building permit application for new colonial fascia at the existing Cumberland Farms store in Hyannis. I will call you to follow up. Thank you for your assistance. I SIGNED • ✓�ie i�oarvnzoozcue� o`�,� uaella BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS O48148 Expires: 10/18/2003 Tr.no: 16180* Restricted: 00 MICHAEL R DEUBEL 1446 ECHO MILL DR POWDER SPRINGS, GA 30127 Administrator I r j a _ `t � { I _ e i t• ,! A r li �l V _ ,� >ta y ? •tYtk txr� l. Yea i. i 1 - i.ixkl. I f[,w� XY F}�f •> 'i7 GEL 04/21-2003 ISSUE DESCRIPTION DRAWN BY CHECKED BY I DATE STEELTEC CONSTRUCTION MANAGEMENT, LLC 210 PAULDING LANE,DALLAS,GEORGIA 30132 (770)-505-5917 SITE FOR TITLE JOB# DWG.# OSTERVILLE, MA OSTERVILLE LEFT 2003-xxx '� _ t,` ; i �; :- _ � __ _ �' I a� Y �`✓ — C Y �� �"�:. _. _ .. .... _ ti ,., - s_ � R� `:rYM� �� --.. .. �. h... � ■ f• t GEL 04121103 ISSUE DESCRIPTION DRAWN BY CHECKED BY DATE STEELTEC CONSTRUCTION MANAGEMENT, LLC 210 PAULDING LANE,DALLAS,GEORGIA 30132 (770)-505-5917 SITE FOR TITLE JOB# DWG.# OSTERVILLE, MA OSTERVILLE FRONT 2003-xxx i � 1 �. 7.7 2r� 4` ti t of _ I _ � ���•"��,'%rif�n, _ � _ _ { Jam~ _ _ ,. L uA; ,gar• ,,.r:,- � _ . i� � owl". ,� - _—�_•.� ...ram---.... .. GEL 44/21/03 ISSUE DESCRIPTION I DRAWN BY CHECKED BY DATE STEELTEC CONSTRUCTION MANAGEMENT, LLC 210 PAULDING LANE,DALLAS,GEORGIA 30132 (770)-505-5917 SITE FOR TITLE JOB# DWG# OSTERVILLE, MA OSTERVILLE RIGHT 2003-xxx t-..�. �---•:'-v l . �rny?ri"'Q �*.�`. &,�,r.�..r._,..,,, F^•..�- '�'t�:mow-z�-tn+:..-'�__^•*r++..n�... �,�..,_.-.-i..-__�-•—=tom. ,.:, f' i'�C `°"'n°q�ct ate- a3°�l�'�i''qr�e+'' ... - � • -..... ' TOWN OF BARNSTABLE BAR-Wjj$ Ordinance or Regulation WARNING NOTICE Name of Offender/Manageroum&/.O/K,�r/rl_s Address of Offender MV/MB Reg.# Village/State/Zip Business Name �amrAmi) on e 20 M Business Address e� — � Signature of Enforcing 0 ficer Village/State/Zip (/ (✓i Location of Offense 'Saa j- f"o GZ;bi'mo .._,." 1� f Enfo(r^c&ng Dept/Division O f f e n s e Facts T' I 1 n (` A�`' �� �/�i ►r� This will se"rve only as a warning. At this time no legal action has been taken. It is the goal of Town agencies to achieve voluntary compliance of Town Ordinances, Rules and Regulations. Education efforts and warning notices are attempts to gain voluntary compliance. Subsequent violations will result in appropriate legal action by the Town. WHITE-OFFENDER CANARY-ORD./REG.-PROG. PINK'-ENFORCING OFFICER GOLD-ENFORCING DEPT. tAl, Assessor's otfi oe (1st floor): T E tO Assessor's map and lot number ......... Board of Health (3rd Poor): Sewage Permit number ................. ..........11...................... 1368d9TAIME. Engineering Department (3rd floor),: NAG& 1639- Housenumber ......................................................................... Ibl. APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only T-OW- N-"- OF BARNSTABLE BU", LDI'NG INSPECTOR APPLICATION FOR PERMIT TO ... .g-Mod 'Food Store 'Food TYPE OF CONSTRUCTION ...Con.c.re.te Block........... .................... .......................................................... ...... . .... . . .... . .... 4 V.11................ .......................19...TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....West..Bay Road,90sterVi-fle (Barnstable) Ma. .......................................................................................................................................................................... Proposed Use .....Retail Fp6d Store ................................................................................................................................................. ....................... ZoningDistrict ........................................................................Fire District ............................................................................... Name of Owner ..Qqmb.qrla.n.d..Fa.r.ms...I.nq.........................Address ...777 Dedham Street: Canton, Ma 02021 . ...... . ...... . .. .... . .... ............................................:.................................. Name of Builder QqpbgrjaAOJA.rms...I.nc.,......................Address ...$ame..a.s...above...................................................... Nameof Architect ......N/A.....................................................Address .................................................................................... Number of Rooms ......N/A....................................:................Foundation ....con.c.re.t..e.......................................................... ...... . .... . Exterior Cqpqpete...&...Br.i.c.k....venee.r...............................Roofing ......s.teelv*a.a.r....................................................... .. . ...... . . . .... .......... . . FloorsConcrete ......................Interior ..................................................................................... Heating .................................................................Plumbing ............................................................................ Fireplace ....... ............... ...................................................Approximate Cost ... 0qo:.-.0 0.......................I........................ Definitive Plan Approved by Planning Board --------------------------------19-------- - Area ch ........ .... . ........ Fee ........ .. Diagram of Lot and Building with Dimensions F ............................ SUBJECT TO APPROVAL OF BOARD OF HEALTH' OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name.... .............................. 111000464 Construction Supervisor's License .................................... CUMBERLANO, FARMS, INC. 'A=117-095 "30503 REMODEL.............. Permit for .................................... . ............... Food Store Location ..............West......4y...j�qp�d.......................... B Osterville .. .................. .... .................................... Owner C..umberl..and Farms x... Type of Construction ........F.1Z?K1A.e........................ ............................................................................... Plot ............................ Lot ................................ Permit Granted ........M.ar.c:h...1.0............1,9 87 .. .... .. .. Date of Inspection ....................................19 Date Completed .......................................19 Ah,,l tires M76 Mot, Assessor's offioe Ost floor): _ t L Assessor's map and lot number 09� ' C`-( o�TNetc ................. Board of Health (3rd floor): Sewage Permit number ' Z PAUSTAXE, i Engineering Department (3rd floor): +o r"°a O t 39• 9 / House number .......................................................I................ o ray a` APPLICATIONS 'PROCESSED 8:30-9:30 A.M. and 1:00•2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ......ft-MQd�l ood„Store....................................................................... TYPE OF CONSTRUCTION ...12" Concrete Block ................................................................................................................. ................. . .J....�..b.............19... .� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...;West Bay Road, Osterville (Barnstable) Ma. ........................................................................................................................................................................ ProposedUse ......Retail...Food...Store. . ... ........ . .... . ................................................................................................................................... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ..Cumberland. Farms... ....77.7...Dedham••Street; Canton, Ma 02021 Name of Builder Cumberland„Farms„•Inc..•„ ••,••,,,,•,•,,,,••••Address ....$.ame•as••above Nameof Architect .......N/A....................................................Address .................................................................................... Number of Rooms .......R/A....................................................Foundation ....concrete........................................................ Exterior .Concrete. & brick veneer Roofing ......steel. w/tar . . .................................................................. Floors .,.concrete. . ••.•....•••.•.Interior ...... . ..................................................... HeatingE?�r...g...................................................................Plumbing ..Ex............................................................................. Fireplace .......N/A...................................................................Approximate Cost ...$5.,000.00 ................ Definitive Plan Approved by Planning Board _______________________________19________ . Area ...... .� ..."Ka.� Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. 4 vj P pia z-vwS Iv . Name ... ......N-1......................... Construction Supervisor's License .4�000464 . . .................... CUMBERLAND FARMS, No ..3,0503. Permit for REMODEL . .. .......... . .................................. Food Store .......................................................................... Location ....West Bav Road .................. ....................................... . ................................................................................ Owner ......Cumberland Farm ........................................ Type of Construction :..Frame ..................................... .............................................................................. Plot............................. Lot ................................ Permit*Granted ........March-...1.0...........�.19 87 .. .... .. .. Date of Inspection ............... .........19 Date Completed ............ ...... 19 i t-PROVIDE NEW CO2'TANK-FOR , CHILL ZONE 0 B'-0•CHAIN LINK I FENCE EKCLOSURE A,-GATC—P(INSTALL NEW LONG. AD Ir SIDEWALK ] o OOCSN•T CX15T AT THIS LOCATION \ .. KEYED GONSTRUOTION NOTES: ' n-0 T NIP) y 2B'-r:(MODIFIEDwALK-IN LooLEa Box-Vlr--) REFER TO 2/A2.1 I ! AHARONIAN ❑1 INSTALL NEW 9'-0•x W-B'DOOR a FRAME.STYLE.PROFILE AND MATERIALS TO yyy 6 ASSOCIATES INC. MATCH EXISTING.PAINT TO MATCH CXISTING DOORS A FRAMES. I /It ❑ O 1 T�K ARCHITECTS ❑2 INSTALL NEW PARTITION WITN I LAYER OF GYPBM WALL BOARD EACH SIDE. PROVIDE KNEE WALL STOR (I TOILET \ 5CCURC TO 5TRlLTVRE ABOVE A5 RCQUINED FOR PROPER SUPPORT.STUD SIZE IN PARTITION FOR aee AND TYPE TO MATCH EXISTING.PROVIDE FINISH WALL MATERIALS AND PAINT CHILL ZONE VCNTING _ (.00C-A2.2FOR$PCC_J� 1y,Oge Rnode land PROVIDE NCW COOLER STORAGE cLe ma v 1ay TO MATCH EXISTING ADJACENT`RFACE5. II \ SHELVING Sulte 100 (SEC DETAIL 9/A2.11 Q \ b INSTALL C.PARTITION WITH I LAYER Or GYPF%M WALL BOARD ON ONE SIDE - PROVIDE-NEW'INSVL. 0 2 e e ONLY. SECURE TO STRUCTURE ABOVE AS REWIRED FOR PROPER SUPPORT. ) NEW COOLER %`� /r LOOLCR WALL 1 WALK—IN COOLER STUD SIZE AND TYPE TO MATCH CxISTING.PROVIDE IINISH WALL MATERIALS ` �` / ., 1 L ]]-11 01 0 DOOR // CEILING PANELS MODII'IED / AND PAINT TO MATCH EX15TING ADJACENT WRr-ACE9. T 1 01-]]1 1 0]) `�•\ UT T (13 ARDCO 23'DISPLAY DOORSi) , WNW.ARI]f-ENa.IXIY ❑4 INSTALL NEW CUMBY'9 CHILL ZONE WAY,EQUIPMENT AND 516NAGC.REFER TO I/A2.2 rOR EQUIPI.ICNT DETAILS. S'-23 4'-6" 1'-a• 3'-0' ) _ 1 �I.11-I�..I .I I �J a'�' a WW-01- ! ® INSTALL NC-W ARDLO 9 DOOR COOLER D15PLAY WIT:23'DOORS 1 I —— _ I— '(DOdx tnT.NIHF.�I.Ia.DA Oq.NIHx '�ID Dtx�N OM.NIN1. '�.Ig.000N nPGNIwa x]r-.oPCNI © INSTALL NCW ARDCO 2 DOOR COOLER DISPLAY WIT;23"DOORS ❑ ! � Q PROVIDE NCW WALL FINISH TO MATCH EX�nNG. � '—• © I] ❑S ® I] I dll I 2n•-10 1/B• 1 I I I • OPENING FOR(3)A—M35T2 9--.-I 1 M ARDLD ML2912 2-oa2R WITS 1 135•II/ T-0�, /I I NLW'COMB."a I LHILL 20NC'� /\ PROVIDE tW 9ANr WILH LOOLE`y 1 -` (SEE A2.2 r-OR SPECS)--- dI�1 1 KEY PLAN GENERAL PLAN NOTE5: _ -0 IJ THC CONTRACTOR SHALL OBTAIN ALL PCRMIT5 AND INSPECTIONS NECESSARY TO NEW DEEP BA51N STAINLESS STEEL INSURE IS' OF AN OCCUPANCY PERMIT UPON COMPLETION OF THE WORK. HAND SINK(LACROSSE eDIIaCO,./ I i 1 I `\/ STC 2J THE CONTRACTOR SHALL MAINTAIN ALL INSURANCC REWIRED BY THE OWNER CNNECTGOOSENECK fEX15T ASSEMBLY) -< RETAIL SALES AREA I AND/OR 60 RNMENTAL AUTHORITICS,AND SHALL PROVIDC PROOF Or SUCH 4, TCi TO C%IST.SANITARY YiCOUN _- I INSURANCC AS REWIRED. 0 WATER SUPPLY PIPING BELOW COUNTER n _ (SEC SHY.A2.2 FOR �,•[ I' ! ! PROM DC NCW RiCP:BAR fl%TURC LAYOVf) I I J-G• � 3'-6' � � BASE CABINET I COUNTERTOP I 3J ALL WORK SHALL BC IN STRICT ALCORDANCI WITH ALL APPLICABLE CODES. ..i• .N (SEE A29 FOR DIMS)( TO Or O'TrRVILLE.MAShACM)SCTTS REWIFCMCNTS AND AS NOTED.WHERE I I 11 CONrLICTS OCCUR THE MOST STRINGCNT RCOJIRLMCNT5 SHALL BC MET. CEILING CL.WN A,. 4J THE GON'I'RACTOR 5HALL BE RESPON515LC FOR BRACING ALL WORK BRING VGT rLOOR I CONSTRUCTION. I 5J THE CONTRACTOR SHALL VCRIFY ALL DIMENSIONS AND CLCVATION5 BEFORE COMMENCING CONSTRUCTION AND REPORT AND DISCREPANCIES TO TIC ARLHITLCT BEFORE PROCEEDING. CONSTRUCTION PLAN 11 THESE PLAN5 HAVE BEEN PREPARED IN ACCORDANCC WITH ALL LOCAL.STATE 20. AND rCDCRAL REQUIREMENTS.AS WELL AS CL'MBCRLAND FARMS POLICIES FOR SCALE: I/4"=I'-O" ' HANDICAP AGCL551BILITY.ALTHOUGH THESE FLANS IN SOME CA5ES MAY EXCECD THE MINIMUM LOCAL,STATE OR FEDERAL REQUIREMENTS.STRICT COMPLIANCE DY THE CONTRACTOR WITH i1Q5C BANS IS MANDATORY.ANY DEVIATION FROM THESE PLANS WILL BE AT THE'SOLE DISCRETION.oZ-.�ONVSILITY AND LIABILITY OF THL REVISIONS CONTRACTOR, IL 34'-2•1 CxIST.COOLER Box NIr) NUMBER REMARRY DATE 1 a'-4= _y 1 L%19\ELEGY. LUT COOLER I / MCfCR BALK PAN 11 '1 til, CXIST.LCT. 5 O TOILE" IT R. IRELOCATE Ex15TING `; FRGIDAIRE STORAGC UTILIrRECZER EXIST.MOP SINK F-- ` WALK—IN COOLER ' 9 (To REMAIN IN PLACU ) Y h 14 DOORS 126•AROCO) / i Y /'�'�REMOVE-COOLER.WALL / RLMOVL' \� y 7ANELS,-ROO1-PANELS � UTILITY DOOR' i'If!l / I ACCESS DO" R�V/ \. FRAN.E/� IIIV r--I---I---1r— --�r— --�r---1---1r-- ---Ir---1---I--� ., EXIST.3-COMP.SINK (- II I II I II I II I II I I I (TO REMAIN IN PLACU -I"I�"I I•,�I ( �!I I I I I II I II I II I II I II I I I d M I� Is-2�n n— '-2�-.n 1 I!� a III II FOR CONSTRUCTION CRCMOVE PORTIo�+ fi II. rr or-vuANLEJI ! REMovE �JI �-1I --1I �_ll ,-II --II �-II �-� �-ll �-D I I I I WALL I EwsnNG vALANCE \ i PRadLT TITLE REMOVE COOLER DISPLAY DOOR UNITS' TO REMAIN IN PLALC I O LONIT.2e4 SILL I I }.I �� -_-.. ! ♦ rr_^^v.� I RCMO•/C POR11[r:N ..U..• :.ui:;. (J-(Hy�f(f(�aPo57 I Or-/iSANLC - 5"jO) I'\ I M Dedham Street,Canton,Massachusetts 02021 b pP REMOVE i \ EXISTING COLUMN TO REMAIN I E9G� 54ND.',N /�—\\ VERITY LOCATION IN FIELD STORE #2269 SO III LOOLCR fr LI III I r\ �DGC n II I� II• /+' 16 WEST BAY ROAD T COUNTER I aVJCEJlV11Jn/ `.._-.. i I I dl V u \ I OSTERVILLE, MA m u \ 2.4 STUDS 0 la•o.L.(rYPJ a -- IIIII To DTING so-FIT RETAIL SALES AREA (TO R UPRIGHT FREEZERS _ (TO RC-MAIN IN PLACE) I IN (REMOVE/RELOCATE EXIST.CI I i- C�� lu FIXTURES AS RrOV. \ I BRACING TITLE ? LAYER 9/6"GYP.BOARD TO � DEMO&CONSTRUCTION CgVER ENTIRE KNEE WALL RETAIN SAND RT- ! `\ CONY.2e4 SILL �U I' RETAIN SAN�'AR'(,_WPSufC 1 WATER '�' `\\ ! 5CCURCD TO FLOOR SUPPLY P-W,FOR USE IN NEN LAYOUT CEILING EL.-q•-4- \`I NOTES&PLANS — U VGT FLOOR 1� DATE P1w.ND. I ! 1 JAN. 18, 2005 0482 DRAIFN BY CHEERED BY KNEE WALL DETAIL DEMOLITION PLAN °" FDA SCALE: NOT TO 50ALE I SCALE: I/4"=1'-O" DRAWING NUMBER A2. 1 SHEEL,. 1 Dtt 4 I t p. F,. AHARONIAN ` A ASSOCIATES INC. 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I COOLER IAL(SIER Der? ❑ I do REVISIONS H I� gg 73 NUMBER I, �sL4?r1cr NDBNQD LCNr nXNMES t^ A` COUN?M i i I ❑ Iry�� I - I I I I I I AS BUILT ~ ---' -------- ----- -- ---- -------------- I : I I RETAIL SALE5 AREA �'SURMCC LgUMED L6Nr MUM I PRwwr rTTLE I t Kr 1LO7 Levi Or VAIAICF�J � ms !d.; I ABOVEI ro(.r�a I I M Dedham Street,Canton,NaaachuseDs 02021 STORE # 2269 I ---------------.... _. ------- I 16 WEST BAY.———--——— ———————————————————— ' ///P lO•XN(iNL --------� L Er—__ OSTERVILLE, MA 1; I DRAWING TITLE I EXIS"PING FLOOR PLAN E' DAra PRQI. AU Sept 14, 2004 2269 DRAWN BY CNECEED BY EXISTING FLOOR PLAN JJC CDA DRAlINO NUMBER EX1 . 1 , SNEAT. I OP. 2 r� AHARONIAN E ASSOCIATES INC. 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ARCHITECTS e elodulma VoOey Ras Salle 100 Lh,Wn,Rhode Itlmld 0 2 e e 9 r .al•222-solo r .a1-22.•voe) www.Nea—rNacw NCW C ERAMIC PLC WALL FINI4M -•'EVERBRITC'NON-ILLUMINATED INTERIOR LETTER REY PLAN SET(� IREPAIR/RCFLALE EXIST.WALL SUBSTRATE 'x II'-0')PIN 5TRZTI TO VALP.NCC PER AS REDID.TO AGLEPT NEW WALL FINISH) \ MANIFALNRCR5 INTRLTION9 A—RO%.CORNER OF EXIST.VALANCE/ -GUT EXISTING VALANLC L WA SOFFIT RENRN9 BALK TORD LIGHTING BACK TO PAGE \ OF MEN WALL 1I I i,. , CXISTIN6%ATNALL Great Coffees and More... / SY5TCM TO REMAIN- ____ _-- 2 ,' __ _ _._____ -(�</<•lX< L {<.< <, < `\ GYP.BD.WALL FINISH-PAINT ® 000O0 —oar IJ EXISTING CHECKOUT / PROVIDE EULLNOSE \ NCN 4•VINYL \ HEW COFFEE COUNTER LOUMTCR TO REMAIN GERAMIL TILE TRIM AT CDGC WALL BASE DASEC INETS n/PLASTIC L ABAMINATE REVISIONS FINISHv 40LID SURFACC COUNTERTOP Q NUMBER REMARKS DATE SIDE NALL ELEVATION SGALE: I/4"=1'—O" FOR CONSTRUCTION . O3 % Lllr EXIST.VALANCE. PRwECr TITLs LIGHTING BACK TO PALE U(14TNG VALANCE 0 EXIST.VALANCE/ 1 / OF NCN GMILL ZOMC UNIT RELOCATE EXISTING 516NAG[ \ / TO REMAIN IN PLACE 0 SOf-PIT N LIGHTNG l CUMBY5 GRILL ZONE 1 RE CORRESPOND TO NEN (TO REMAIN IN PLACE) \ I I/ / PAINT MCM HALL / MERCNANOISIN6 v COOLER � U i0 MATCH EXIST. DOOR LAYQIT 171 Dedham Street,Canton,tkssachuselh 02021 L*MTBO.n/ /• / � ... - - STORE #2269 LLMDTS LMILL ZONE Beverages ��Deliry !� GRAPHICS f 16 WEST BAY ROAD \-�L-t.r I O oa • ,li pl ,h dI I i l I �• p \,III o— REcR%UV 71 . o , to OSTERVILLE,I IvfA I II I I\'�A I� I�' II' ��• ly' IN' I� Ik• I I, ✓' ( I � ..� —I. 1 1 NCW 4•VINYL I...INSTALL(3)MCA AROCO 3 DOOR UNITS ML23'x17' --I \ EXIST.DOOR a DRAWING TITLE NCN COFFEE COUNTER NCW 4•VINYL / BASECABINCT5 n/PLA5TIL/ WALL BASE \ WALL BASE v(1)MCA ARDCO 2 DOOR UNITS ML23'x12' FRAME TO REMAIN INTERIOR ELEVATIONS LAMINATE F-IN15H v SOLID NCW DOOR a FRAME SURFACE COUNTERTOP DATE PRw. N0. JAN. 18, 2005 0482 DRAWN Br CHLLRED DY DH CDA REARNALL ELEVATION DRAWING NUMBER SGALE: I/4"=1'-0e A2.3 smear,' 3- ov: 4 AHARONIAN A ASSOCIATES INC- ARCHITECTS e 61°°Y° Vdt*y A°u .11°100 W° ,I`—Idm,O r INISNEO CND 0 2 e e S PANEL BCLOW f 1°1•]]1-�OSi www.ula-F11GI.'011 II II I �W� IIM� (TYPICAL 0 PLKCSJ I I c, II II II �I 4'SOLID°J.RfAC,C- II• BALNSPLASN II KEY PLAN li J II ...•I� it II os it W '< O 2I II I II II I li REVISIONS ¢CO. ED. o NUMBER RELARRS DA7E O I LINEII BEL(X B CABINETS BELOWINDICATED \ II I II BY UASIILV LINES II II 2'O DRILL MOLE IN---TOP PLASTIC,GROMMLT; (\ — — — — — fOR POWER CARDS L \ — J II y S'.DRILL HOLE IN C,QINTCRTOP n CPTAC GROMMET:L 2 LACE REGCFTKLCS(TYPICAL 3 PLKC5) II I_ al II II FOR CONSTRUCTION I I I I PRIM=TITLE CITCVT IN GOLPttCRTCP rOR NAND M Dedham Street,Canton,Massachusetts 02021 III SINK(VERIFY DIMESNIONS SINIc SPECS) STORE #2269 — —� — — — 16 WEST BAY ROAD PANEL O LO ECIR Wr,D ._.-_ -. I I T• PANEL BELOW R_J1✓'r7] I OSTERVILLE, K A ' (BASE CABINET DIM) 2'-N• DRACINC TITLE B•-0• �. COUNTER PLAN (C,OUITERTOP DIM) (COFFEE BAR) DATE PRO% Na JAN. 18. 2005 0482 DRA9N BY CHECMD BY DH CDA COFFEE COUNTER PLAN DRASINC NUMBER . I SGALE:I•=r-o• SNEM' .4._or- 4 r I W'-ION•l U 0/0 TOP OP NEW FASMA "^" 43'-6•AT TOP OP OUMM EDGE OP EXIOTM MANSAM ocletN*SOFFIT A MAMA o AREA •r-a OPACRID an DETAIL l• iII _ ___ _ _ _ _ _ _ <oa Ir_- _ ___ __ __________ __ _______ YAWNS 4 l I I I 4V x t•x toGA l i i i i i I n PERLNX�.AT1 AN" bITOP Vim -E 2x2'xrGA Ie �y I III �' III I E)trTNo °RAC ecRs � III I I I I ? ORoaN u K i'AEK6 I it I III I ;; I IaraNe •�'�•ePACNo u / u� ExIeTINS 6WN6LEe S-e x y TO CN3 REMOVED AT AT WWWTR1altlP METAL AREA OF NEW 6UPPORI! TO WOOD 6OREW l6 PER ANGLa/ 7•X 2•x r GA AI10L8 MWNG PLIUJOCID EXrTRD STORE PAERKATE eARucTWe 1 Cu 21-61 m 1.SAMRT •Io. TWO 1 PAWIA(:1" l2 PE LOCATIOW _ 1 aXUTNACTM 7� O r OA COVER AP / PA6CIA V' X P PAW WEAD TWA 02'-6 6PACM MAX. / / r GA BRACKET FASCIA PLAN ec&E: V8•• V-m• •.- TM 20 OA BAN M MDNS *2�6PAON0 90 k 1'TEND STQL POP mvm •4'-0'WACNG TY EXISTING FASCIA SECTION (T�Ip1 l2PERLOGATIow 1 - SEE OETAp.'A• uill EI 1 TY . Nr=Lu F SCIA armlION EI FLA6WN3 I STANDARD to 1 PAeCdA OUIRI016ER MrG.PRAMNS - PA=A FRONT ELEVATION +~ Milk—,tR6T mom t NO rcN1NAL LOADS WILL BE APPEND TO THE ExrTN6 eUILDRNb eTRI16TWE WRW tWH ExGEPTION OP AN ♦ �'fI)S ♦♦ ADDITIONAL DEAD UJVW4T OF TWE WEW FAWAA AND MOLOM W43I US AppROXMAT6LY r L06.PER LNF.AL SCALE, M'• Iv-Vu / \ FOOT.NEITHM 6TMTM LLC NOR LAMMMCE R.PIlCK PE WILL A=Wr fa&-M Nr6SILITY POR STMVIWAL 6arrOM TMM ADEG"AOY OP EXIVNIS EILLDRD 67Ia=M BERM OR AP1ER APPLICATION OF NEW SKIN PAWIA MTEll I / L PABOIAI 6UPPOR►6TRI1MM AND ATTACWMEM6 WAVE SEEN DESIMM FOR A Se POP LATERAL WIND LOAD O O I N ACCORDANCE WIM THE 6TW EDITION OP TWO MA66 ELDG CODE. 4' i i i tH Of At4Ss A FOR PERMITS dUD 4/22/03 \ / +;.`� ocsc�row eT a6c amT6'e MaX 20•RNE ♦. .� CONT.BRAD OF o♦ Nar LAWRENCE R. Gm REVEON4 oa/TOUCU-uP1 P'GL'vPWTMANE ♦ PI LON It P EOM,PE .b / q fW Dove f9 UCTURAL vILLe.NYr6a & ��jLT7-(c �c n1�o.�iER ���__��� ft.goa1•TWa6 d� • STANDAM @A. Ou"t ooaR -- t, N . ffi9032 6R• DETAIL "A11 DETAIL 'IB11 E s CIST MAL G IDMIAS,G)I3O LAM %7 TONAL sa: COLONIAL- iRETROFIT D 3 TKIM Pwa ARE SU&M TO OSTERVILLE.MA AAYM�641E `" l&OF P wa FM m RO. oaRMS melN OION CUMB.FARM IrmTI>c.uc.1s Pao em $3-3 x 49 6II Z0m3m193 47Awu s8E1w P1iIvT scrzD TIRE STORP O6n N0. ow a3 D 3 UNDER W]PATENT NO.D16 M7 FASCIA LAYOUT El OF I ' 1 ar-IOa•l U olo Top OP 1mu PAwAA 41j'-6•AT TOP OP OUTIM EDGQ OP MOTM MANOARD EMOrM OQPIT•MANOMW AREA 4•p ff •7'-O'OPAClIbC40 IL"0• O®pOtA 1"-------- ------------ --------- - ------1 i 1 TM i - .. •4'i•OP ACMS i'x!•x r 6A 1 III 1 11 I o PER LOCATIOW AlaLM i•X i'X r aA r aA TOP I" ANSLe EXrTNd _ .aRAMAD VXT a LA 1 x L i F< TOP CAP ~h'-s OAP MAX i ANM�x r OA 111 1 11 1 ? CROM OA i•TEK5. liI 1i1 i pp�ppn •V-W SPANs iU Lli i EXrTRG aw"u EO TO 06 RO'IOVED AT %-D x 4'MN )/ ! AREA OF NEW OIPPORTS TRU4MP METAL r r-O�• 1 TO WOOD OCREW (6 PER ANOLE) 1 i•x i•x r 0.4 pEOTNp PLIU1000, ANSLE 1 EXIOTM WORE PAEYmGATE 1 OTXLcTWR 1 OU TRIOOERO i O Ream 1 PAOCIA CL" h PER LOCATION/ °. __ 1 6TRUO71w 6 Is 04 COrE16P PAOCW b x p PAN HEAD TOM ) 02'-6 OPACM MAX. / / r SA DRAOMT FASCIA PLAN U.rTW& 20 OlA"M MM LONE •2'4.OPACNS 4O t!t'TEKS &ML POP R.1RRO •4'-0.OPACM W Or-MAx. li PER LOGATIOW 1 TYP. EXISTING FASCIA SECTION (TOICN IP) OEE DETAIL•A• 'ILI ul el 1 TY N W FA CIA SECTION Ei I FLA664M if OTAIIDARD M '1 PAOCIA oUT MMER r MIOC.IRAMNS PAOGA FRONT ELEVATION , "'°`,m �,, ADD�ITI�ONArc.D6 D um"OF�)M AND O'�W�N�°I TM D `IA " Foor.NEIT118R eta. LLC NOR I61LtTY MR aTreJeTURAL. - T6f., LAuiasxca R PuoN.P6 WILL ACCEPT RBOPON SCALE V8 1 0 sOrTOM 1RlM / \ OU11000eR ADFAYAGY Q mf16TNm E4oLDNs 67plCTI✓f1E 06ORB OR AMER APPLCATION OP fETu 8KN FAOCW OYOT6Tl % i.FABCM OIPPOW OTFJGT M AND ATTAGNPO O MAVr.MM DEOIOlED FOR A 36 P'W LATER&WND LOAD O O I N ACCOMANM WITH TN6 6111 EDRION OP TAR PWM SLOG WOL i i I P4j�0f ASS A FOR FI$RMITS I JJB 1 4/12/03 \ O ��L�' q�'yG Esc otscarroN or CWL am LaWR�NCE R. ,n REY6ON9 RwE»MAX ia �� �� \\-PPOLYWE�TI.a �� FILCN r-, ItPLOKre OG(TO1CNAP) .:ri I i W DRWp a)�o■Y Tmm tt)�1D K 1'Tt�ae f,cy c ":•T L 34L wLLe.Nr uwTR(CZ No 39032 ZS aJ,d J-6.9 11 11 C�I �+cTER� "All 20 PAUL DHRTRnH.&NM DETAIL A DETAIL 5 ° ZONAL DAII.B&%G1BOlIGU30M MVkM&5919 1 U'f sT: COLONIAL RETROFIT MOE Furs AM SUaI=TO OSTERVILLE,MA FfcExu:.coPTRroxr uws AQr use. s wlX* roe COMB.FARM in NO. \ OPRESS WPJM P069M ON OF sm=ur is PWHB n $3-3t1 x 4S'-6" 200301W 4 3 vr�i>m rr a rt STORE on Na FASCIA LAYOUT El OF I 53'-loin (t)OJO-TOP OF NEW FASCIA 49'-b" AT TOP OF OUTER EDGE OF EXISTING MANSARD EXISTING SOFFIT 4 MANSARD AREA Q Q hZ x -j TEKS __ _ _ ____ i - -_ -- - ---- ----_ - ----- --- -------- 2'-®" SPACING SEE DETAIL "B" _ _ _ ______—___.. _____ --------�- I ------�--------------------------�---- ------ U.� 1 j I t-- —,1 j .I � � 4'�" SPACING x-in TEKS Z° X Z" X 18 GA. Q I I i i I I 4`2 PER LOCATION) ANGLE Z" x 2" -X 18 GA. I i i i I 18 GA. TOP TRIM +M' I� TEK II II BRACKET EXISTING SCREW I j �-- TOP CAP °8 X i" PAN HEAD TEKS 2" X 2" X 18 GA. Q I _ *2'-6 SPACING MAX. ANGLE 4 dy I I I ' III I Q ., 014 E x " TEKS w i CRouN 2"-0" SPACING EXISTNG b MOULDING — TO BE IREMOVEEDD AT - �U L.Lr.. �- ' 9-15 X 4" NtUN co AREA OF NEW SUPPORTS TRU=GRIP METAL TO WOOD SCREW (6 PER ANGLE) Z ANCsL EXISTING-PLYWOOD XZ X18GA. E r EXISTING STORE FABRICATE r r STRUCTURE OUTRIGGERS 2'-8" O.C. -. r i" SUBGIRT r 410 x " TE1C5 r FASCIA CLIPS CZ-PEIQ LOCATION) i -EXISTING STORE STRUCTURE f 18 GA COVERUP ! FASCIA - - +8 X I" PAN HEAD TEKS ! *2'-6 SPACING MAX. ! ! 18 GA.BRACKET FA5GIA FLAN SCALE: 1/8" = t'-0" 1014 x in, TEICS 20 GA.BASE MOULDING 02'-0" SPACING ow x in TEKS STEEL POP RIVETS * 4',-0" SPACING 30" O.C.MAX. !Z PER LOCATION K'_I"'�TYF. EX15TING FASCIA SECTION (Trxu;+-I UP) �fi it 1 SEE DETAIL "A" rl'' TYF. NEW FA5G IA- 5ECT I Oil �1 FLAgHIT STANDARD aA FASCIA OUTRIGGER MISC.FRAMING - ---^- FASCIA - - r MISC. TRIM LNNO ADDITIONAL LOADS WILL BE APPLIED TO THE EXISTINGBUILDING STRICTURE WITH THE EXCEPTION OF AN FRONT ELEVATION 'I T33 ADDITIONAL DEAD WEIGHT OF T14E NEW FASCIA AND MOLDNG, WHICH 1$ APPROXIMATELY 15 L138. PER LNEAL 1/��� - .1,.�n FOOT.NEITHER STEELTEC, LLC NOR L.AWRENCE R.PILON, PE WILL ACCEPT RESPONSIBILITY FOR STRUCTURAL OUTRIGGI=R ADEQUACY OF EXISTINGBUILDING STRUCTURE BEFORE OR AFTER APPLICATION OF NEW SKN FASCIA SYSTEM. BOTTOM TRIM *XMT34 2. FASCIA SUPPORT STRUCTURE AND ATTACI.IMENTS HAVE BEEN DESIGNED FOR A 35.PSF LATERAL WIND LOAD ! -IN ACCORDANCE WITH THE 6TN EDITION OF-TWE MASS-13LOG CODE. Q � r f A FOR PERMITS JJI3 4n2/03 O ISSUE Bi CHK. DATE REVISIONS: STEEL POP OF RIVETS MAX 30" GONT. BEAD OF POLYURETHANE LAWRENCE R.'PILON, PE O.C. (TOUCH-UP) / 51 MAPLEVIEW DRIVE F'EhWELLVILLE,NY 13132 (Z) 010 x " TEKS _ _ ---'- (Z) 01OUTRIGGER _ LICENSE * OUTRIGGER STANDARD SA 210 EIAUItZRN(G IAA: DETAIL IIAII 2ETAIL 11511 EIAULa. GRDROA 30132 (770)W5-5%7 SITE: COLONIAL RETROF I T -THESE PLANS ARE SUBJECT TO �`�*4tN of R. OSTER�/ILLE, MA e FEDERAL COPYRIGHT LAWS r waENCE R R. ANY USE OF SAME WITHOUT THE $ TR CTURAL y FOR: JOB NO. EXPRESS WRITTEN PERMISSION "OF N�39032 CI,IML~3. �,�RM STEELTEC, LLC. :IS PROHIBITED €� a ��� X �9�-gip a ?0030��3 VASC A T E fit PROTECTED roM� TMF-- SToRE DWG. NO.