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HomeMy WebLinkAbout0021 WIANNO AVENUE �. y � ,� i n ,. r �� 'Y. ,. �. o i A i _ �, � � -. .. � o � ` c r� a D v n " r '' ' s 'r, a - C � �: � ', A r. i i �. � � a ,. ,� d x v '^ it ,, ' � n � � c n o °� ,. � � � a n �, _ � � � ,.� ,,. C n *`„ n � a ,. a e „. n ,� ,'�, �, p, � � r � r d, � �' 1 ' i S � ram'�t n. �� �. .; _'^�'�.,,L'_ .+.��+'^_'n^'!�A.J'_`^!'..�.,tiy'��'�..�.—.*n+��r..r�.:.��.-,�'tir4....rFi'.. .�-++-,.-,,+era,., r�R�y,...�+wa...-....�^+rw--...mw►..+.,.M"T�.hsr'+'=".��.b.....r-�..�.+...-.'�r^vii+r.tM.t-.++++�.+.wF.+.-rw. Town of Barnstable �' _ _ Building aNwsrwei¢ Post This'Card So -Approved--That it is Visible From the Street Plans Must!be Retained.on Job and this Card Must be Kept s"9 �� Posted Until Final Inspection^Has Been Made. - �; ` , Permit 1k Where a Certificate of Occupancy is,Required,such Building shall Not be Occupied until a Final Inspection has been made.' Permit No. B-18-1244 Applicant Name: KEVIN J FARRELL Ap provals Date Issued: 07/19/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Commercial Expiration Date: 01/19/2019 Foundation: Location: 21 WIANNO AVENUE,OSTERVILLE Map/Lot: 117-098 Zoning District: SPLIT Sheathing: Owner on Record: BRIDGE,GARDINER W TR - Contractor Name``�,KEVIN J FARRELL Framing: 1 Address: 155 SMOKE VALLEY ROAD Contractor License: CS-096560 2 OSTERVILLE, MA 02655 Est. Project Cost: $12,500.00 Chimney: Description: VERISON WIRELESS WOULD LIKE TO MOUNT A WIRELESS ANTENNA ,I Permit Fee: $213.75 AND ANCILLARY EQUIPMENT TO AN EXISTING EVERSOURCE UTILITY Insulation: f POLE. POLE#64-3 IS LOCATED NEXT TO THE ADDRESS OF 21 Fee Paid: $213.75 WIANNO AVE _ _ y' Date: r% 7/19/2018 Final: Project Review Req: � Plumbing/Gas Rough Plumbing: `Building Official Final Plumbing: Rough Gas: i Final Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within.six months after issuance. All work authorized by this permit shall conform to the approved application and the approved,construction documents for which this permit has been granted. Electrical All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. 11 This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the Service: work until the completion of the same. ' _,...• Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Health 6.Insulation 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work shall not proceed until the Inspector has approved the various stages of construction. Final- "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application C; ` Health Division Date Issued '7 Conservation Division Application Fee Planning Dept. Permit Fee 9 Date Definitive Plan Approved by Planning Board cn 1 Historic - OKH _ Preservation/ Hyannis d t Project Street Address a lit Ue o (-oLA--3 01 Village Owner �vft'�purr,2- Address Ng_ )S (Jay U)eSt wDed, m14 � Telephone qN yy 1 -385f Permit Request Ven-Lcn Lalroles5 waJ h o 4 paF&�-� a titre -es6 artenna- ., and ill IQ ' u 1pment- +o an X xlshnu r 0 P cc 4►G��r � J -1�Vr�. 5 l vino Square feet: 1 st floor: existing ni A proposed n A 2nd floor: existing rl A proposed Total new Zoning District N A Flood Plain n 1 IA- Groundwater Overlay Project Valuation ID 5-co. °O Construction Type n I 1�`Ir o Lot,Size n I A Grandfathered: ❑Yes 4No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) n --a Age of Existing Structure n (� Historic House: ❑Yes I@ZVo On Old King's ljighway:�0 Ye ,VNo rv Basement Type: ❑ Full Ell Crawl ❑Walkout ❑Other •n `_' ry Basement Finished Area (sq.ft.) n 1 Pr Basement Unfinished Area (sq.ft) Y Number of Baths: Full: existing t'� new Half: existing Y) 14 new Number of Bedrooms: jn tft existing _new Total Room Count (not including baths): existing �_�new First Floor Room Count Vt- Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other n Pr Central Air: ❑Yes )4 No Fireplaces: Existing New n Existing wood/coal stove: ❑Yes)I No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size v_I A- 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 # n Current Use U'f ^ , PSI- Proposed Use LAP �.SL APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name V,:e iX.n-A: ffr-I Telephone Number R40 .-TV I1$1 -SU-ON Address 4 o`l, (Y)vA ja j License # C� b 9lQSlo(� n I (.a_(Yer , in(A (-_,g)35 Home Improvement Contractor# Email n OA-e( Q -fffflOM .Cl1Y)') Worker's Compensation # OGO I In ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE 0,L JL DATE y ao g FOR OFFICIAL USE ONLY - APPLICATION # DATE ISSUED MAP/PARCEL NO. : + ti ADDRESS :- VILLAGE . - OWNER DATE OF INSPECTION: _ FOUNDATION FRAME INSULATION FIREPLACE l` ELECTRICAL: ROUGH FINAL - r . S PLUMBING: ROUGH FINAL ' GAS- ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. • 1 .. -• • • PREPARED BY: i v r/4 f �; �s,,•�,;� �, x�,"`,w-; ! t 5� .. '� ice"�~ ``" '"� 4 - � •� �L1yy/,A`tom, .g „� `� '�q`S,����� `+�� _� . .:1 ♦ "�y� l' u. � 4.EXISTR ���+i�..�^"Z 4 W� DUPLICATION OR USE TITLE CUENT. w„ gypp.j I�e ! *,.\ •..p ` t ``,:& i... ;� '" fi :r. r'"1 3 lw� Iy1 w �1�i j I /^� `• 1.'A rsP�tOPOSED LfSS�EE'ANTCNNa WITHOUT THE EXPRESS WRITTEN �& CONSENT OF THE CREATOR IS RRH 7 y�'� i ^ STRICTLY PROHisnED. OaNT90 To c s +Gla/a11".17'SIZE PRINTED MEDIA ONLY. t STI Y"m -- ��-'•>u"t -- it �'r' 1 j'f', ,Q''k`4 .,i t'� A.,MALL OTHER PRINTED SIZES - `• : DEEMED'NOT TO SCALE ARE .ty- ! Yew f4 • �~� Fes . ` dSITE NAh(E: i11. SITE INFO: �_ c . , .• '� Y '�a,� • lL �� �� _ . � f.. �.. .•-*4 Y �`"�?;'w�`"�1 a. :� •ice. •w` +b •*f �`} \ .. • a ram`` SrrE ADDRESS: 4as g \�' • .< 1 'W �'1 EX15TING \. • �r ol PREPARED BY: F PROPOSED 12.0'0X}8.7 M ANTENNA ___ TOP oP PR.yp- NIfF]INA �S: IFACF FXHIert �f,�• tlr� 1. AN ANALYSIS OF THE CAPACITY OF THE EXISTING THIS TEASE PUN IS DIAGRAMMATIC IN NATURE AND W N E�.I U S PROPOSED POLETRUCTURE TO SUPPoRf THE PROPoSED LOADING C.L.0 OF PROPOSED ANTENNAS IS INTENDED TO PROVIDE GENERAL INFORMATION TOP MOUNT ---- ��,g•�• �� HAS NOT BEEN COMPLETED BY NEXNS. REGARDING THE LOCATION AND SIZE OF THE DRAWINGS ARE SUBJECT TO CHANGE PENDING PROPoSED WIRELESS COMMUNICATION FACILITY,THE W 8Wp0i gout°19�''tMO� ' OUTCOME OF A STRUCTURAL ANALYSIS. SITE LAYOUT WILL BE FINALIZED UPON COMPLETION C/] —-—- OF SITE SURVEY AND FACILITY DESIGN ¢ A&E CE. TOP OF 7A LYBERTY WAY PROPOSED FIBERGLASS POLE TOP EXTENSION A W-I WESTFORD'MA 01896 1(972)755-1882 l TOP OF LE EXISTING UTILITY POLE 1 PROPOSED 1/2•fXYJX CABLES I�I EXISTING GUY WIR FIF*)PfS5E0 12.XY4if}8.NA .• L` (TOTAL OF 2)R(1)RET CABLE .I ---- - i A.C.L. ANTENNA _ w/u-GUARD.TO ANrwwLsPrzr� o aaE I I PROPOSED WEATHER HEAD {( EXISTING SECONDARY PROPOSED 1I,-µ FIBEFCdASS EXISTING - " ICI POWER SECONDARY POWER 'FORE TOP ENXIE+BIQN III - A. III EXISTING STREET EXISTING TELCO CABLE " III LIGHT - i A.L - .. III /—EXISTING TELCO LLLV:ZD-U EXISTING TELCO/CABLE txmhg GLA'MARE, C.L OF EXImNG TELCO BOX __ I I) �ENC TELCO k ��'��-0 3 AG.L Q I EXISTING TELCO/CABLE IS DOCUMENT IS THE DESIGN ERTY AND COPYRIGHT OF NEXIUS V:21=fi i AG.L - PROPERTY FOR THE EXCLUSIVE USE BY THE I!i TITLE CLIENT. DUPLICATION OR USE C.L.OF EXISTING TELCO BOX _ I WITHOUT THE EXPRESS WRITTEN �EIEv: 19-6 i A.G.L. EXt5TTN0'iTREf4 LfOki( w CONSENT OF THE CREATOR IS i 6 PROPOSED DER FINER` STRICTLY PROHIBITED. ROOM� 11 DRAWING SCALES ARE INTENDED FOR i I EXISTING SECONiWtY PtlWER. 11'.17'SIZE PRINTED MEDIA ONLY. PROPOSED ROS i 'IX ALL OTHER PRIMED SIZES ARE CONDUIT TO METER I{ DPROPOSED EI4ARG FIBER E�XISFTM; ()., DEEMED'NOT TO SCALE'. CO/CASLE/ SUBMITTALS ({ PROPOSED AC/DC OW48 ER ..7.,� •� `""- '" REV DATE DESCRIPTION BY PROPOSED OIPLEXER5 (` MOUNTED BEHIND RRILY(TOTAL OF 2) (TOTAL OFMOU RPoR fft�ACl�.TOO SUITOT PROPOSED RiM15(TOTAL OF 2) W" VaSTINO h1c0 HOX SEE DETAIL 1 ti-.FOR ORIENTATION . 0 PROPOSED SAR-0(BEHIND) Flim- ' I PROPOSED AC WIRING HARNESS PRtlPOSFb TO AC CONVERTERS 'A'�r DEMARC U q PROPOSED ELECTRICAL EOUIPYENT T" SITE INFO: SFF OETM Inc_}FOR ORIENrAT10N PROPOSED SITE NAME: PROPOSED GROUND WIRE RUN IN BLACK OSTERVILLE—MA—SCO2 �j GROUND WIRE MOLDING AS REOUIR D U _.... ... SIZE ADDRESS: EXISTING 40'CLASS} _ _._..— = - U/P NO.: 64-3 _ I U/P NO.:64-3 q cRAo 21 WIANNO AVENUE EXISTING II 1 - A WNSTABLE, MA 02655 EXISTING (<� ... CHECKED BY: DATE: GROUND ROD , NB 06/14/17 (V.I.F.) PROJECT NUMBER. I. 4 } SHEET NUMBER,- r,N ELEVATION ° 2 PHOTO FDUAIL LE-2 SCALE:3/16•-1'-O- N.T.S GRAPHIC SCALE: 3/16'-1'-0' .p PREPARED BY: z F' 0.,p NEXIUS MPOED� �R , ¢ A&E OFFICE: PROPOSED :0 7A LYBERTY WAY (TOTAL OF 2) METER.BELOW 12•0 WESTFORD.MA 01888 1(972)755-1882 PROPOSED EXISTING 46 CLASS J 2 '3 0.'p AWS FIRM � - U/P NO.:64-3 2 EXISTING 7 2 ` CONCRETE VIDEWALK EXISTING CURB WIRELESS CONSTRUCTION.INC. PROPOSED PROPOSED pPlE7(E% 2 RADIO BRACKET POLE ALL MOUNT FOR DUAL PCS MOUNTED 70 FIRM BRACIKET.TO SUIT ITEM DESCRIPTION Ott. RRHPROPOSED POLE MOUNT 3 1 DOUBLE MOUNT 2 ANTENNA SPECIFICATIONS FOR DIUA1.RADIO BRACKET 2— IS RRH RACK W/ 1 COMMSCOPE- NH3600M-DG-2XR SUPPLIED HARDWARE .140 AVENUE 3 AWS RRH RACK W/ 1 DIMENSIONS 121..:I:SUPPLIED MARDWAR WEIGHT 33.7 1 ® n RRH MOUNTING BRACKET SPEC. 3 ANTENNA SPEC. -1 ODCUMENT Is THE DESIGN RRH ORIENTATION PLAN 2 NT.D NTS PROPERTY AND COPYRIGHT OF NEXIUS SCALE;N.TS AND T.TITLE CLIENT. DEXCLUSIVE UG E TION F EFY E OR USE I FCTRI Al NOTES' PROPOSED WITHOUT THE EXPRESS WRITTEN APPROX. NORTH A NNA CONSENT OF THE TLY PROHIBITED. EAT.R IS 1. GENERAL WIRING DIAGRAM TAKEN FROM E-MEMO PROVIDED BY JAMES F.CVAZDAUSKAS. A NNA '.�- Q S• P.E.DATED O1/72/2017 MOUNT/BRACKET DRAWING SCALES ARE INTENDED FOR "'I 11".17"SIZE PRINTED MEDIA ONLY. 2. ELECTRICAL CONTRACTOR SMALL INSTALL d_ANTENNA GROUNDING ALL OTHER PRINTED SITES ARE THE'PROVIDED WIRING HARNESS"PER THE (DEPENDING ON DEEMED"NOT TO SCALE'. REOUIREMENTS OF THE NEC AND LOCAL CODES. ANTENNA MODEL) ---- --_ SU8MI7TAIS —_ -- REV DATE DESCRIPTION BY SECONDARY UNES 0 _-7 4N o Tom 111V K — (2) I/2"COAX CAE &(1)REr 77 wEATHERHEAD(LEAVE CABLE IN 2"W RATED U-GUARDS .IL.IL 10'CONDUCTORS FOR @____ == ANTENNA FIBER FRONTHAUL UTILITY CO.TIE INS) Him &BACKNAUL x �� FROM ux ANTENNA FIBER DEMARC ON POLE BRACKET SITE INFO: pCS FIRM VARIABLE TILT.VARIABLE (2)DIPLEXER WEGHT:55.0 LOS. AZIMUTH ANTENNA BASE 11 ASSEMBLY FIBER JUMPERS IN 1-1/2" SITE NAME: 11 W RATED U-GUMO 6 (4) 1/2"COAX 11.8" 7.2' LENGTH IXCEE05 4' t—t CABLES OSTERVII I E MA—SCO2 AWS THRU-BOLT LLTIM FIRM PCs (3)/6 AWC WIRE IN BACK-UP PLATES. � FIBER JUMPER(TYP.) FIRM 1-1/4"W RATED PVC SITE ADDRESS: NUTS&WASHERS i....... .. 36 POLE TOP U/P NO.: 64-3 ocTEmKK oN.ORDER RUEL FROM DG POWER GROUND AWG COPPER 21 WIANNO AVENUE -- — MANUFACTURER WITH DELTA AC/DC GROUNO(TYP.) ---- — PRETop I, HOL S PER POLE coNVERTER(TYP.OF 2) BARNSTABLE, MA 02655 TOP MOUNT MANUFACTURER - M WEATHER PROOF SQUARE 1 AC POWER NO PROND D D TA CAT ND Y SURGE FRONT 5111E ____ _= EXISTING U/P MANUFACTURERS WIRING HARNESS SECONDARY SURGE ARREM CHECKED BY: DATE: ---_— —_ ON 20A 2P CIRCUIT BREA KB 08/14/17 WEIGHT.6.8 LOS. ==== == /2 AWG COPPER GROUND FRONT S!!1E SQUARE D DO-100A 8 SPACE. 16 OR OUTDOOR O IN 1/2"UV-RATED PVC PROJECT MUMMER: MAN LOAD CENTER WITH COVER.60A 2P MAIN AWS ARM CIRCUIT BREAKER WITH (3)20A.2P BRANCH CIRCUIT WEIGHT:56.8 LOS. BREAKERS(I FOR SURGE ARRESTOR&(1)PER FIRM) SHEET NUMBS. M3W 1K CAT NO.: LE-3 U2272-RL-ST9-BL SINGLE LEVER \120/240V, 1Qt 3W 125A METER `3/6'mat0'COPPER AD f.RDIIND RDD DIPLEXER SPEC. G RRH SPEC. C ANTENNA MOUNTING DETAIL GENERAL WIRING DIAGRAM 4 N.TS. G N.TS. v N.T.S. 7 N.T.S. _ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION, Map ~ Parcel Application Health''Division WI $ Date Issued Conservation'Division Application Fee + .GU Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board U �I q l R r-) Historic,- OKH Preservation/Hyannis Project Street Address Village ..// (�S)-4 R y Owner�N A 4 0612 �2GZ Address, Telephone Permit Request 7 Lo ,,k C, �. oVT Square feet: 1.st floor: existing • proposed 2nd floor: existing proposed Total new Zoning District BA Flood Plain Groundwater Overlay roject Valuation O 00 Construction Type Lot Size' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family y ❑ 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 �� �ew Number of Bedrooms: existing new � r Total Room Count (not including baths): existing new First Floor Flom Couw P__Heat Type and Fuel: ❑ Gas ' ❑Oil ❑ Electric ❑Other o Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/ oal stove: ❑des ❑ No r Detached garage: ❑existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑e isting ne�fi ' size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 2Commercial ❑Yes ❑ No If yes, site plan review# --I)urrent Use Proposed Use Y�l APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name 7A_ 6«a 5 oAaA Telephone Number Address T f�L C2 s :,�g w e 0 License # 0 o .3 9q Ito ti A Home Improvement Contractor# la6,7 7 7 Worker's Compensation # Y<C7 '7,3— ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TOSp11 Ce�n �, ' U Wc 1 SIGNATURE "y DATE QA=2,,2.X T, - " - �- FOR OFFICIAL USE ONLY ._ r APPLICATION# DATE ISSUED MAP/PARCEL N0. ' r ADDRESS I VILLAGE f OWNER DATE OF INSPECTION: ' FOUNDATION s FRAME b Io9 INSULATION ` FIREPLACE _ ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING J05 ; DATE CLOSED OUT ,1 ASSOCIATION PLAN`NO. ' The Commonwealth of Afassacliusetts Department of Industrial Accidents 0 ce of Investigations 600 Washington Street ' Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information T Please Print Le0bly Name (Business/Organization/Individual): � -?A / JL ytr Address: //O A,rt o S A 1 A 17 City/State/Zip: Nl.4S� p,o IMA. 0�6q5 Phone.#:. f��_ Are you an employer? Check the appropriate b x: 'Type of project 1.❑ I am a employer with (required): 4. Fl am a general contractor and I * have hired the stab-contractors 6. ❑ New constniction . employees(full and/or part-time). 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. �] Remodeling Ship and have no employees These sub-contractors have g. ❑ Demolition workingfor me in an capacity. employees and have workers' Y P t7 9. ❑ Building addition [No workers' comp.•insurance comp. insurgnce.t required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.[1 Other comp,insurance required_] *Any applicant that checks box#1 must also fill out the section below showing their workers'comps nsation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then.hire outside con tractors 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 ilic sub-contractors have employees,they must promidt their workers'courp.policy number. I am an employer that is providing workers' coinpensatiorr.insurance for my employees. Below is the policy and job site information. Insurance Company Name: �� (JQl1 �rr� .k A L i ✓fit Policy#or Self-ins. Lic. #: W42 e"3NS� 7 71 3-0ak Expiration Date: Q fob Site Address: o?v� / /i) �Nr.P City/State/Zip: ,S'TP ✓j ��ti 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 crimirial penalties of a fine tip to $1,500.00 and/or one-year imprisonment, as well as ci alties in the form of a STOP WORK ORDER.and a fine of up to$250.00 a day against the violator. Be adv' a copy of tbis statement may be forwarded to the Office of Juvesti ations of the DIA for insurance c e cation. I do hereby certify der the pains-an es ofperjury that the information providelabveis true and correct Si e: Date: 6 _ Phone#: 1.576 ce � ��O � O?Z0 0 Offu:ial.use"only. Do not write in this area, tb be completed by city or town officiaL City or Town: PermiULicense# Issuing Authority (circle•one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.EIectrical Inspector 5. Plumbing Inspector 6. Other Contact'Person: Phone#: 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 hiie,' 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 a dwelling house having not more than three apartments and who resides therein, or the occupant of the owner of 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 etnployez." 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 produred•acceptable evidence of compliance with the insurance coverage required." "Neither the commonwealth nor any of its political subdivisions shall Additionally,MGL chapter 152, §25C(7)states enter into any contract for,the performance of public work until' acceptable evidence of compliance pith the insurance requirements of this chapter have been presented to the contracting authority." Applicants Y . Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to our situation and, necessary, supply sub-contractors)name(s), address(es) and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies y(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 ofInvestigations 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 pernuts or licenses. A new affidavit roust be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone-and fax number: The Commonwealth of Massachusetts Department of Indust6al Accidents Office of Investigations 600 Washingfion Sfxeet Boston, MA 02111 TO. # 617-727-4900 ext 406 or 1-$77-MASSAFB Fax# 617-727-7749 evised 11-22-06 www.mass..gov/din . 01/12/2009 12:22 7816318965 IRRESISTIBLES PAGE 02 FROM MRCWILLIPPt5 FAX NO. BW4349835 San. =' 2009 11.27AM P2 �l.l 111+b?� 1�l;1% AiE316y55 TRREWSTITLES PAID 03 January 11,2008 M�.Jc@f i.auaar� Z'rwn of'33a1�4table Building Divisigcn 200 W11 Street Hyannis,MA 02601 Dw Mr.Lauacr AJ the owner of the building at 2¢Wianov Avenge,OdeMlin,111weby gi- my perrWssion for ,'Toot O'Kw%Ijo Amos Laming Ri.,Nee ea Mai to apply for a b%Cdire permit for ranovadons far w Imsistibks clothing store. Sri fnmely, gyp, Nomm;Boucher Imstee.W;anno Ph='Truit 03/04/2009 12:44 78i6K8965 IRRESISTIBLES PAGE 02 Town of Banastable Regulatory Services •.;.orcas F.Geiler,Xlirecter Building Divisiou Thbmas Perry,CSO Building 4Ce•tsurrs5iOD(1 20Q?da:a Yp_et, iXysutis,;Y,A G1nG: www.town.bc:•nstaale.ir:a.us ' C?fti'e: S05 tb2-403:i Fax: 5: 090.6230 2 rop e rty Clwne r Mu:s Complete and Sign This Section If. Using A Builder �!e ^j� U Owacr c,'�r�tieft�)rper_y : :r lJ�.yWad Alt. ::eby autb.on=e ?-Lt` _�—_��—=f�•� __,-o act on nr be}ialr, Z.matters;ela:Ve to T.•o:k autho:izec by criis i--l Ling perm:-appkcation for (Addcr.ss of Y�b� . pi134_1L 'I U'Nti.... iWF"tl.ES�FD LW S�Gr:it:tirg pen*;i::crms�E�FIG:.S.doc :viscC20I Cfi 10 Vie! 4T9ZSogE25 r GT/�e -Pammoou o�✓�aoaac%uoeQti Board of Building Regulations and Standards Construction Supervisor License License: CS 3844 - 0/2009 Tr# 3174 THOMAS F O ' 110 AMOS LANDI / - MASHPEE,MA 02649 Commissioner L ✓i�e �ooaw��anuie !I/ial o�✓Z�a uocu .�uu AseA' i a Board of Building Regulations and Standards { HOME IMPROVEMENT CONTRACTOR Registta_Uon. 106277 Pijo722J2008 Tr# 131716 _ - Type: DBA TOM O'HARA CONTRACTING Thomas O'Hara 110 AMOS LANDING RD. MASHPEE,MA 02649 Administrator ,s+,s w :i • OSTERVILLE Hi=}ORICAL MUSEUM Jennifer Williams Executive Director 155 West Bay Road P.O.Box 3 Osterville,MA o2655 5o8.428.5861 508.280.8882 cell jwilliams@OstervilleMusem.org www.OstervilleMuseum.org S ,G , (Pet;,al Town of Barltable °4 Regulat® S 14jd Thomas"F.Geile; tor 9. Building.-D �on, Tom Perry, Bufding Commissioner 200 Main Street, Hyannis,MA 02601 www.town.bat'stable.ma.us Office: 508-8624038 Fax: 508-790-6230 Permit# Building Official approving CC ,/ Application for Sign Permit APPlicant 0,5�f V I le I S ( CCLIessssors No.ly I �C 1Q lg Doing us s�s:V f n n i FC( I AMSTelephone No563 W. se G I Sign Location 2 / 1 G�. n 0 StreeVRoad: k(Lin (Lz- Zoning Districts Old Kings Highway? Yes6)Hyannis Historic District? Ye�gD Prop Namerty: Telephone: /-� 50 /1� f,'7U�h P� Telephone: 5oB "I 37' ;Sy3 y Address: Village: Sign Contractor Name: Telephone: Mailing Address: Description Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Yes/ To (Note:Ifyes,a wiring pemutis required) Width of building face ft/10- x.10 Check one Reface existing sign !or New Total Sq.Ft of proposed sign(s) Ifyou have additional signs please attach a sheetlisO4 each one with dimensions If refacing an existing sign please provide a picture of the existing sign with dimensions. I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of M §240-59 through§240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: Date SIGNS/SIGNREQU revisedl2110 r' Board of Directors President Kathleen Capo Vice-President Jacqueline Martin Treasurer Kathleen Silvia �. Secretary George R.Rowland Board Members Paul Chesbro Marilyn Colman Ann W.Crosby ( „ Jacey Germani C.Eldon Lawson. Mark Macallister Hugh MacColl John C.Mechem Will J.Price,MD Barnes Riznik Michael Schulz Richard Weir Anne Wildman Executive Director Jennifer Williams Curator Cathryn Wright Advisory Board Sarah Alger Tracy Buckley-Scott Richard C.B.Clark James Cote John Cotton,Jr. Bobbi Cox James Crocker,Jr. Malcolm Crosby 1 Robert P.Frazee David McGraw Peter Meyer J Mari Poss David Richardson Ann Rascati Mary Wells Richard Whitman A great,small museum bringing local history and people together P.O.Box 3 - 155 West Bay Road - Osterville, Massachusetts 02655 Phone 508-428-5861 - www.OstervilleMuseum.org 0 TOWN OF BARNSTABLE BUILDING PER-MIT APPLICATION Application n u -.0.Map Parce[­ Health Division ...Date Issued Conservation Division .`;Application Fee Planning'Dept, ..Perrhit Fee; Date Definitive;Plan Approved by Planning Board k A-01 Historic = OKH Preservation Hyannis Project Street Address Zgj &JIovold At (Zi Village Owner (\JP1AeV 15�01W R"!5��- Wddress � 00 Telephone c? 63/ PermltRequest M. 5-1c A/ 4410 7Y 8V05 OA: 41 17 s4 f,7 S- are.feet: i3t floor: existing '2nd floor: existing .q u x —proposed —proposed Total new Zoning District?i Flood Plain Groundwater Overlay Project Valuation Construction Type L6t Size Grandfathere'd: 0 Yes LJ No If yes, attach supporting documentation. Dwelling Type: Single Family 0 Two Family U Multi-Family (# units) Age of Existing Structure Historic House: El Yes 0 No On Old King's Highway: Q Yes U No Basement Type: Q Full U Crawl 0 Walkout Q 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: Ell Gas U Oil L] Electric Ll Other Central Air: Ell Yes L] No Fireplaces: Existing New Existing wood/coal stove: C3 Yes Ll No Detached garage: L3 existing Q new size_Pool: Q existing LJ new size Barn: Ll existing 0 new size Attached garage: U existing Q new size —Shed: L1 existing Q new size Other: Zoning Board of Appeals Authorization Q Appeal # Recorded U Commercial L]Yes El No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Na0e ,k 12,Telephone Number 7j, -6?1, Yr L Address License # Home Improvement Contractor# Worker's Compensation # Wca 6q ITS ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE f� _T FOR OFFICIAL USE ONLY APPLICATION# o DATE ISSUED MAP/PARCEL NO. ADDRESS ` VILLAGE { OWNER DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION FIREPLACE - :ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL � Y GAS: ROUGH FINAL FINAL BUILDING I i DATE CLOSED OUT ' - ASSOCIATION PLAN NO. i L • The Corn tit onwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 " y www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information PIease Print Le ibl �7 Name (Business/Organ ization/Individual): Address: City/State/Zip: ���! ,!.(A PPhoneA '?rl 63/- z Ye Ar�yoh employer? Check the appropriate box: Type of project(required): a employer with l2�0 4. ❑ I am a general contractor and I . employees (full and/or part-time). * have hired the sub-contractors 6. ❑ New construction 2.❑ I am a 'sole proprietor or partner- listed on the attached sheet 7. ❑ Remodeling shipand have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp.-insurance comp. insurance. $ 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 1.0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their l l.❑ Plumbing repairs or additions myself. [No workers' comp, right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 11 employees. [No workers' 13.�ther /Li✓ �/�t�il/i�(J 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.hirc outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'cornp.policy number. I ant an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: vj(J t/71/1'r- �.eJJ C� Policy#or Self-ins. Lic. #: W G Q G / /� Expiration Date: 9 Job Site Address: 2 411At,4,b City/State/Zip: tJJS 2d�t C1�,�l�l .0 ZGn� Attach a copy of the workers' compensation policy declaration page(sbowing 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby certify u er the pains and penalties of perjury that the information provided abov�'�' trmu and correct Si ature: J�C/ v I ll1D Date: Phone#: .7V-G 31. 1 Z VZ F l.use only. Do not write in this area, to be completed by city or town official Town: Permit/L,icense# Authority (circle one): d ofHealth 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector r Person: Phone#: i FN PANEL TO BE SINGLE. SEAMLESS PANEL'' 6-0"G & 2'-0- HIGH W/ 3/8' CHAMPON FACEGESS TO BE 9* HIGH. PANEL TO BE MIN. SOLI TO MAX- I' SMOOTH FACE MATERIAL: Mp0.OR SOLID PVC (��), . & EDGES SIDES NAVY BLUE SEMI-GLOSS FINISH: FRONT & ALL E KT �p MEL. 2 COATS MIN. By LITTERING: WHM p(ACT COPY PROVIDED . I IRRESISTIBLES. CTR• LOGO HORIZ & VERT ON PANEL T HEAD STAINLES W FLA • INSTALL � SUBSTRATE; TION. C SUBSTRA INSTALIA TO PREPARED PVC STEEL WOOD SCREWS UP SCREW ON �C BLUE- TOUCH O 1 r i IRRESISTIBLES Ow OZ OD �3 �Z mo < m° rn O O� y.Cl K of ..- ~' • V � - 1 � { az: + t t .r .. ,•� �t F Eet• r t ml 1 t n l ,Ti r rwP. Y �Y r., Q After 50 Ft 10 Ft Wall(to ceiling) each Window) Drink& Sink I landing To/go I I I &Stairs Fridge I I I I I Counter Counter F0O (45in height) (36 In height) Storage/Fridge 14 Ft z 20 Ft O MGd'� 30 x 72 Work Table O with Counter Rack 24 x 24 Fridge Grill Area c (45in height) Table ' O Register Display Take Out13 Wall(to Gelling)�� Fridge Area Bistro Table ISM for To Go I ' I I 0 � Q After rP' re 50 Ft 10 Ft Wall(to ceiling) (each Window) Drink& Slnk I Landing To/go I I I &Stairs Fridge I Counter Counter _ O (45in height) (36 In height) Storage Fridge 14 Ft 20 Ft O Baked 30 x 72 Goods Work ols a Table —ry O with �J Counter Rack 24 x 24 Fridge Grill Area (451n height) Table ORegister Display Take Out O Wall(to ceiling) Fridge Area 17 MB.throomBathroom 14 Ft ' Bistro Table Storage for To Go Hutch i El rill I 3/) r7- a dZ v (-L veAs � � , 7 � Y (�ke,/L- n n-L ire MA vi(IQ- YOU WISH TO OPEN A BUSINESS? For Your•Information: Business certificates(cost$40.00 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.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall)and get the Business Certificate that is required by law. DATE: 2 1 S Fill in please: ®®M T.`` APPLICANT'S YOUR NAME S: 1 U BUSINESS YOUR HOME ADDRESS: ;. : �, Ltl3 ?� 4 Br 7 Iv► 02/17 +� TELEPHONE * Home Telephone Number aua��lUesa�r.� NAME OF CORPORATION: NAME OF NEW BUSINESS t i TYPE OF BUSINESS IS THIS A HOME OCCUPATION? .YES NO ADDRESS OF BUSINESS 2 V L MAP/PARCEL NUMBER I l n^1� [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 in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmo Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate our•business in this town. 1. BUILDING COMM ER'S OFFICE 'tMQ.L _ L���r��p This individual ha e m d f n er it requirements pertain to this type of business. J�Oc� AM orizedZionab!r1 * . NTS' �"_ ._.. - JJ2 M _ 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. Authorized Signature** COMMENTS: • r YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 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.) You must first obtain the necessary signatures-on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1st FI., 367 Main St., Hyannis, MA 02601. (Town Hall) and get the Business Certificate that.is required by law. DATE- o f Fill in please: ^� YOUR NAME/S: SS is'rii<i•.'4)a'>>ir��.7,Yr`'" fti! `' :i APPLICANT'S 1,tax VIN"=z''8Y'i j j +' '' BUSINESS YOUR HOME ADDRESS: T :... U ",9"'=" .�L•���1lYY•'a�4,.1 TELEPHONE # Home Telephone Number 1-41� EIN #: g _ '7 rj E—MAIL: NAME OF CORPORATION: NAME OF-NEW BUSINESS TYPE OF BUSINESS YZP. IS THIS A HOME OCCUPATION? . YES .__No r_ —T • ADDRESS OF BUSINESS- l...k2��L�.l _ ?MAP/PARCEL NUMBER �D �, (Assessing) ._c2ski,-Vt I 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. (corner of Yarmouth ' Rd. & Main Street)•to make sure you have the appropriate permits and licenses required to legally operate your businn in this town. 1. BUILDING COM ISSIO R'S OFFICE b`T—the Uh This individu ha en 'nfs7m y p re iremerits that pertain.to this type of.business. uth rized Signature** - • COMMENTS: G `" 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. Authorized Signature** COMMENTS: . i Town of Barnstable a Regulatory Services. f " RichArd.V:Scali,Interim'Director irr• Building Division Tom Perry, Building Commissioner �- '200 Main Street, Hyannis,MA 0260.1 www.town.barnstable.ms.us Of;`ice: 508. 6,2-4038 Fax: 508-790-6230 Permit# Buildiiig(7lrrcial approviiig Application foraSign;Permit Applicant ( Assessors No. _ l I- 1)oing Business As- sign Location l� Strcet/Road-- � A! 1�1 y�vi(� ',a IL__ (/ Zoning Disftico Old BiAp Highway? YwpHyannis Historic,District? Y Property Owner. .Name: Telephone: 77� Address: S k-z�, Village:,("k,In 1/I.1A___ Sign.Contractor �1 ` Nance: 'Groo lg �l CW71$ `!'e.lephom Mailing Address:. B � YQn-mac fi ' r la: C)Z&t73 Deecaiption. Please follow,the cover,id. rectioru:,You must lrave an.:accurate rer►didon of sigri widi�dimensions and !oration.. --Ys*dm-,sign to be electrifies!? Yc/No (Note:IL'yes,a.winggle{ iit is nugidired) Width of building fake R,z;10 `� z 10- Z0 P Check one Reface exdatin8 aW, _;qr:New. Total Sq.A of I/jyou have'addibona1 sipiis please.azodi,a shcet/is&,-each one widi&MCI lions' If rWic ng an.existing sign please provide a picture of the existing sign with dimensions: I.he;tk cc'Aify that.I am the.owner or that l have:the:authority of the owncr to'make this application, that:tile information is con�ec[and.[hat ih,e,use:and construction Stull conform to the provisions of §240,59 through.§24459 of the Town of BaimsAft Zuking Ordinance, S&naium.of0w=/AuthoYize.dA, rDate Scanned by CamScanner THE Tp Town of Barnstable Regulatory Services MA-90a Richard V. Scali,Director jf16 9. Building Division Paul Roma,Building Commissioner 200 Main Street, Hyannis,MA 02601 . www.town.barnstable.ma.us Office: 508-862-4038 Fax 508-790-6230 Permit# Building Official approving y Application for Sign Permit Applicant: S S I Assessors No. 00 Doing Business As: VrV L-2, Telephone No. 419 ILP LP 23 - L01 Sign Location I ' % - w Street/Road: ,9q 0 I a nnC) �, ��P�V l c�-� rn Zoning District: Old Kings Highway? YesGo Hyannis Historic District? Yes4: Property Owner. _. Name: C wot'(�P,r 8AAAU:- Telephone: '740 Address: l5� c �0 Village: Sign Contractor Name: )WO IS4<Dos Telephone: /23 T Mailing Address, 20 /a'�M i r I �' 0`2 3 Description .Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Yes/No (Note:If yes,.a wiring permit is required) Width of building face ft.z 10= X.10=— - Check one Reface eidsting sign or.New Total Sq.Ft of proposed sign(s) If you have additional signs please attach a sheet listing each one with dimensions If refacing an existing sign please provide a picture of the eidsting sign with dimensions. I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the use and construction shall conform to the provisions of §240-59 through §240-89 of the Town of BanI6 Uble Zoning Ordinance. Signature of Owner/Authorized Age Date 41111 11�- signs/siprequ&app ° revised: 06/20/16 �.am 3a cam'' as 1 Town of Barnstable °^ Regulatory Services " F,?&-'""'" ' Richard V. 5cali,Director 1639. Building Division Paul Roma,Building Commissioner 200 Main Street, Hyannis;MA 02601 www.town.b arnstable.ma.us Fax: 508-790-6230 . Office: 508-862-403 8 . SIGN PERMUr REQUIREMENTS 1. A photograph showing the existing facade, on which has been indicated the proposed sign location. The photograph is to include a portion of adjoining stores or building. For a proposed building or new facade, an architect's elevation may be submitted in lieu of a photograph. 2. A scale drawing of the proposed sign. A scale drawing indicating: 1) The type of proposed sign(wall,hanging, free standing) 2) Dimensions of the proposed sign and any designs, logos, or lettering 3) A cross-section with dimensions showing edge detail. Minimum scale 1"= 1'. Minimum sheet size, 8.5 x 11". 3. A scale drawing of the bracket. A colored scale graphic indicating dimensions, showing colors,materials and method of affixing it to the sign and to the building. Minimum scale 1"= 1'.Minimum sheet size, 8.5 x 11". 4. A completed Town of Barnstable Sign Application, including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. 5. The width of the building face or the leased area. NOTE: the map/parcel number is required on the application. signs/sigurequ&app revised: 06/20/16 Y�. y F f o Y � x G ------------ Fj � a tit$ c Shea, Sally From: Shea, Sally Sent: Friday,April 21, 2017 11:31 AM To: 'tam322@comcast.net' Cc: Anderson, Robin Subject: Permit applicaiton missing address Attachments: nosuchaddress.JPG Hi Tammy, The permit application supplied for the sign requisition does not have a matching address in the town. The.map and parcel is missing from the application. Please see the numbers on the road (in attachment) and come in to amend your application accordingly. Thank you. Sally Shea Town of Barnstable Assistant Zoning Admin/Lead Permit Tech. 508-862-4031 1 � .� Town of Barnstable Building Feu. Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept 1AS& ,� Posted Until Final Inspection Has Been Made. Permit �• Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until aTinal Inspection has been made. Permit No. B-17-335 Applicant Name: TRAVIS W CUNDIFF Approvals Date Issued: 03/22/2017 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 09/22/2017 Foundation: Commercial ;- Map/Lot: 117-098� _'� Zoning District: SPLIT Sheathing: Location: 21 WIANNO AVENUE,OSTERVILLE ~� I Contractor Name TRAVIS W CUNDIFF Framing: 1 Owner on Record: BRIDGE,GARDINER W TR Contractor License rCS-092568 2 Address: 155 SMOKE VALLEY ROAD - - �'�� Est. Project Cost: $ 20,000.00 Chimney: OSTERVILLE, MA 02655 +. Permit Fee: $357.00 Description: minor interior alterations new vct flooring, relocate serving counter. 1 Insulation`. i Fee Paid: S 357.00 remove two partitions,add 1 partition-pineapple caper cafe Final: Date: 3/22/2017 Project Review Req: minor interior alterations new vct flooring, relocate serving counter. remove two partitions,add 1 partition -pineapple _. '` Plumbing/Gas caper cafe Rough Plumbing: — .Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after`issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and str,'uctures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the work until the completion of the same. f f Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work:; 1.Foundation or Footing /� Rough: 2.Sheathing Inspection - 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.W4ring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Figal Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDIN9 PERMIT APPLICATION Map I Parcel , Application # s6 / 7— 3 3 S t Health Division Date Issued "_Z Z7(7 P Conservation Division Application Fee ® C Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board 7 5 Historic - OKH Preservation/ Hyannis 3. - Project Street Address a I ICJ IrQA r)o LAVP-n0— Village dt Owner A�Arj,�J&nQ _ :j�jldlae_ (Address 24 k))'&41)r) Ave, 0Sk--Yvi1-1t- Telephone _ �J3-(P(o$ M21(` ,In y l Permit Request Ari✓OlZ 1�2%IZ -� r`;GNf: A✓Fw /rLooRoyr-. Aaoe4f/ ad Square feet: 1 st floor: existing proposed 2nd floor: existing proposed�:` Total.new o Zoning District Flood Plain Groundwater Overlay Project Valuatiorfc 0000. ' Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docume-'gtation. -� M-31 Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) y Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Ighway:-El Ye; ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use • APPLICANT INFORMATION (BUILDER-OR HOMEOWNER) - Name ✓�� GU^��1!/-/ Telephone Number Address l . �� K 7 ZV- License # O Home Improvement Contractor# Email �f �U��� G4"'� Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ~SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION # -DATE ISSUED ' MAP/PARCEL NO. ,f ADDRESS VILLAGE !` OWNER ' • f` DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION 1 FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ' FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. �� o11* .o S'9 The Pineapple Caper LLC 21 WIANNO REALTY TRUST COMMERCIAL LEASE 1. PARTIES 21 Wianno Realty Trust, under Declaration of Trust Dated June 24, 2015 and recorded in the Barnstable County Registry of Deeds, hereinafter called the "LESSOR", does hereby lease to "The Pineapple Caper LLC" herein after jointly and severally called the "LESSEE", the following described premises. 2. PREMISES The portion of the commercial building located on Wianno Ave, Osterville, Massachusetts which is known as and numbered 29 Wianno Avenue, Osterville, Massachusetts, the location, currently Wianno Green Cafe, containing approximately 2,000 square feet including the lower level. 3. TERM The term of this lease shall be for three (3) years commencing on April 1 st, 2017 and ending on March 31 st, 2020 and pending a signed lease termination agreement between Nathaniel V. Cote and the.21 Wianno Realty Trust. 4. EXTENSION LESSEE shall have the option to renew the lease for an additional three year period beginning on April 1 st 2020 with the same terms and conditions with the exception of the rent adjustment as outlined in sections 5 & 6. The extension will need to be agreed upon in writing and the lease renewal must be signed six months in advance of the end date of this lease. LESSEE must be in good and clear financial standing with the LESSOR for the duration of this lease to be eligible for an extension. 5. RENT LESSEE shall pay to LESSOR rent at the rate of Twenty Four Thousand Dollars ($24,000.00), payable in advance installments of Two Thousand Dollars ($2,000.00), payable on the first day,of each month. If rent is not received by the the last day of the month then a late fee of 10% of current monthly rent will be assessed and due. 6. RENT ADJUSTMENT A. Escalation The rent shall remain fixed at two thousand dollars ($2000.00) for the first twenty-four payments. Beginning on year three of this lease (April 1 2019) the rent shall increase by three percent (3%) to A..The business may not be closed more than 5 consecutive business days and not more than 10 business days per year. Business days are defined in this agreement as 5 days per week November - March and 7 days per week April - October unless otherwise agreed upon in writing. The leased space shall be open for business during special Osterville Village events, (for example the Annual December Osterville Village Stroll). B. LESSOR not responsible for the transfer of items, materials, equipment or other provisions pertaining to the purchase and sale between "Wianno Green Cafe" and "The Pineapple Caper LLC". C. LESSEE shall be allowed to use the rear parking lot for active loading of their cater truck as long as the driveway is not obstructed to the traffic flow of vehicles. No overnight parking is allowed. D. LESSEE shall be responsible for having the grease trap cleaned and the septic pumped at least annually unless required to do so more often by state or town regulations. E. LESSEE shall provide to the LESSOR a valid certificate of insurance for the The Pineapple Caper LLC cater/food truck. IN WITNESS WHEREOF the LESSOR and LESSEE have hereunto set their hands.and common seals this I 1 } day of re 3 . , 20 LESSEE: The Pineapple Caper LLC Tammy R s resident .4TamjMy01, Individually LESSOR: 21 WIANNO REALTY TRUST {. TTa Gardiner W. Bridge, T stee The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations ' 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizatiordlndividual): Travis Cundiff Associates, Inc. Address: P.O. Box 484 City/State/Zip: Osterville, MA 02655 Phone #: (508)428-1110 Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. / I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. ✓ Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.: required.] 5. We are a corporation and its 10. Electrical repairs or additions 3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp. insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AIM Mutual Insurance Company Policy#or Self-ins.Lic.#: AWC40070334092016A Expiration Date: 10/23/2017 Job Site Address: 21 Wianno Avenue City/State/Zip: Osterville, MA 02655 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties ofperjur ie-iufarmation provided above is true and correct Si agn t�� Date: 1/25/2017 Phone#: Office: (508) 428-1110 Mobile: (508)776-3154 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#: F Worker's Compensation Insurance: Sub-Contractor List Name: WjVAO',lE*vt-r Qilt44ft Address: Sw1 ,*A ff •✓0 d t L.NMN AlS u Phone Number: SD 7- S Name: D utSe G t' G Address: 93 Ile. M 990 Phone Number: ,gay r1 b - f s Name: 'S Address: P.O. 13aX ?VOL W,C fr wj;¢ lc MdOdd B Phone Number: So#-U-4- #'Vk Name: h(0 ,✓ Mlkwor2/t Address: .30 a;f A102r, 5 hw,-vv-rf Phone Number: ,Sp - 3 •6 Name: Address: Phone Number: Name: Address: Phone Number: Name: Address: Phone Number: Name: Address: Phone Number: January 15,2016 Workets Camp.lnsurnnce Sub ContracrorLiscdocx + Massac„lusetts Department of Public Safety Board of Building'Regulations and Standards License: CS-092568 Construction Supervisor " TRAVIS W CUNDIFF s; 17 CROSSWAY PLACE OSTERVILLE MA 02655 Expiration: Commissioner 06/20/2017 c; Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 183696 Type: Corporation Expiration: 11/4/2017 Tr# 272011 TRAVIS CUNDIFF ASSOCIATES, INC.= TRAVIS CUNDIFF P.O. BOX 484 OSTERVILLE, MA 02655 -r Update Address and return card.Mark reason for change. sCA 1 0 2OM-0511t � Address [—] Renewal [:] Employment E] Lost Card V/ee nclrc9effi Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 183696 Type: Office of Consumer Affairs and Business Regulation Expiration: ',11/412017 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 TRAVIS CUNDIFF ASSOCIATES,-INC. TRAVIS CUNDIFF f 17 CROSSWAY PLACE ' OSTERVILLE,MA 02655 Undersecretary Not valid without signature f Client#: 107782 TRACU ACORM ' CERTIFICATE OF LIABILITY INSURANCE DAME(MM/DD/YYYY) 12J19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy()es)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME CT Megan M.MacBey,CIC PUTA-Eagle Insurance Group PHONE 508 692-6904 FAX A/c No Ext: A/c Noy 866 676-9319 10 Commerce Way E-MAIL me anbe les.com ADDRESS: g .mac Y@P@peo P Suite 3 INSURER(S)AFFORDING COVERAGE NAIC 0 Raynham,MA 02767 INSURER A:Nautilus Insurance Company INSURED INSURER B:Pilgrim Insurance Company 21750 Travis Cundiff Associates,Inc. INSURER C PO Box 484 INSURER D: Osterville,MA 02655 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD UB POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD MM/DD A X COMMERCIAL GENERAL LIABILITY NN739612 10/26/2016 10/26/201 EAACCHpOCCURRENCE $2 OOO 000 CLAIMSMADE OCCUR PREMISES E occuEenc, $100 OOO MED EXP(Any one person) $S 000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000 000 PRO- X POLICY ECT Fj LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: $ B AUTOMOBILE LIABILITY PGC00001019087 1/25/2016 11/25/201 EOMaBB.Z SINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED M SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOSX HIRED AUTOSNON-OWNED PROPERTY DAMAGE $ AUTOS PeraccidentA UMBRELLA LIARX OCCUR AN032638 0/26/2016 10/26/201 EACH OCCURRENCE $5 000 000 I �( EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 DED I X RETENTION$$O $ WORKERS COMPENSATION PER TuTE OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? El N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Certificate of Liability detailing the Workers Compensation coverage will be sent directly from the insurer. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. II AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD #S772506/M772505 MMBMA FDATE(MM/DD/YYYY) A��® CERTIFICATE OF LIABILITY INSURANCE 12I19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Michael Bates FAX PEOPLES UNITED INSURANCE AGENCY INC. 14 P"°"o Ext: (508)692-6904 a No: ADDRESS: michael.bates@peoples.com ADDRESS: 1 GOODWIN SQUARE INSURERS AFFORDING COVERAGE NAIC# HARTFORD CT 06103 INSURERA: AIM MUTUAL INS CO 33758 INSURED INSURER B: TRAVIS CUNDIFF ASSOCIATES INC INSURERC: INSURER D: PO BOX 484 INSURER E: OSTERVILLE MA 02655 INSURERF: COVERAGES CERTIFICATE NUMBER: 112130 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 'TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF Pip EXP LTR LIMITS COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ JET LOC PRODUCTS-COMP/OP AGG $ POLICY El OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN X STATUTE PER ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLUDED? I NIA1 NIA NIA AWC40070334092016A 10/23/2016 10/23/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers'Compensation benefits Will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensationfinvestigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Newton ACCORDANCE WITH THE POLICY PROVISIONS. 1000 Commonwealth Ave AUTHORIZED REPRESENTATIVE Newton Centre MA 02459 Daniel M.Cro ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Town of Barnstable ` Regulatory Services BUM Richard V. Sca1i,Director - absq. Banding Division. Paul Roma,Building Commissioner 200 Main Sbwt,Hyannis,MA 02601 www.town.barnstable.mans Office: 509-862-403 8 . Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �• d►nR l V r (Ie,& as Dwker of the subject property V- Travis Cund 1;4:� hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for- ), ienno ��t', vice"vI �le, (Address of Job) **Pool fences and alarm are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of O5 er Signature ofq#c)nt c Print Name Print Nam `l'O� Date' QTMAS:OWNMERMISSIONPoOLS Town of Barnstable Regulatory Services pQT1HEE tb Richard V.Scali,Director Building Division w:xsrnsra, i Paul Roma,Building Commissioner 16 9. 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number Street nllage . "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: ' city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess'a license,provided that the.owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one hone in a two-year period shall not be considered a homeowner. Such'homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. I Signature of Homeowner i Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which•a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a.person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of-a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This tack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this-ease,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner.acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of'his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page- this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\E)PRESS.doc 06/20/16 TOWN OF BARNSTABLE 2c7i7 1'ij R 20 10: 11 D O � A fer .`D re 50 Ft 10 Ft Wall(to ceiling) each Window � Drink& Sink '— rinkTo/g Ira;tdi�ngFridgea _ Counter Counter O (45in height) (36 in height) Storage/Fridge 14 F4 �( 20 Ft O 30 x 72 MB.k.d Work Table O with - Counter Rack 24 x 24 Fridge Grill Area (451n eight) Table . O Register Display Take Out O Wall(to ceiling) E Fridge Area 17 Ft 14 Ft Bistro Table Storage Bathroom Bathroom ' for To Go Hutch / ❑ 0❑ - 3 � n o k) -o D Q After � 30 Ft(each Window) Wall(to ceiling) �l Drink& Sink To/go I Landing Fridge I I I I I I I I &Stairs I _ Counter Counter O (45in height) (36 in height) / Storage/Fridge 14 Ft �( -4j- 20 Ft O 30 x 72 Goods Work Is la Table O with — Counter Rack 24 x 24 Fridge Grill Area (45in eight) Table y ORegister `—� Display Take Out O Wall(to ceiling) P Y Fridge Area 17 Ft 14 Ft Bistro Table Storage Bathroom Bathroom for To Go Hutch El 11 LA 17 i I - Page 1 of 2 Parvin, Lindsay From: Tammy(tam322@comcast.net] Sent: Monday, March 20,2017 9:56 AM To: Parvin, Lindsay Subject: Fwd:eDEP Submittal Confirmation for DEP Transaction ID:907190 Begin forwarded message: From: eDEPConfirmation(@massmail.state.ma.us Date: March 20,2017 at 8:51:18 AM EDT To: travis(a,cundiffcom Cc: tam322(@comcast.net Subject: eDEP Submittal Confirmation for DEP Transaction ID: 907190 Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection. Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below.Please review it and keep a copy for your records. Please do NOT reply to this message,this email address will not receive messages.For assistance with eDEP Online Filing,please email the EEA Help Desk at mailto:EEA.ServiceDeskOState.MA.US or call 617-626-1111. MassDEP is interested in how we can serve you better.To help us make improvements to eDEP,please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/eea/a encies/massdep/service/online/edep-contacts-and-feedback.html. To contact MassDEP Programs,please see http://mass.gov/dep/about/contacts.htm. DEP Transaction ID:907190 Date and Time Submitted:03/20/2017 08:51:17 Form Name:AQ 06-Construction/Demolition Notification Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection. Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below.Please review it and keep a copy for your records. Please do NOT reply to this message,this email address will not receive messages.For assistance with eDEP Online Filing,please email the EEA Help Desk at mailto:EEA.ServiceDesk(a,State.MA.US or call 617-626-1111. MassDEP is interested in how we can serve you better.To help us make improvements to eDEP,please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/eea/a eg_ncies/massdep/service/online/edep-contacts-and-feedback.htmi. To contact MassDEP Programs,please see http://mass.g_ov/dep/about/contacts.htm. I 3/20/2017 f Page 2 of 2 DEP Transaction ID:907190 Date and Time Submitted:03/20/2017 08:51:17 ************************************************************************************** Form Name:AQ 06-Construction/Demolition Notification Payment Information DEP code: 139154 Date: 3/20/2017 8:43:37 AM Amount($): 100 Payment Detail:CUNDIFF TRAVIS--AccountType-- AccountNumber****1001 ConfirmationNumber: ************************************************************************************** i EMAIL ID OF THE USER:travisOcundiff.com EMAIL ID OF THE OTHER USERS:tam322(@comcast.net i i I 3/20/2017 I CENTERVILLE-OSTERVILLE-MARSTONS MILLS FIRE DISTRICT DEPARTMENT OF FIRE-RESCUE&EMERGENCY SERVICES 1875 Route 28 • Centerville, MA 02632-3117 7926 508-790-2375 x1 • FAX: 508-790-2385 Michael J.Winn,Chief Martin O'L.MacNeely,Fire Prevention Officer Byron L.Eldridge,Deputy Chief Michael G.Grossman,Fire Prevention Officer November 13, 2014 TO: Tom Perry, Building Commissioner Building Department Town of Barnstable 200 Main Street -Hyannis, MA. 02601 In accordance with MGL 148, Section 28A, the Centerville-Osterville- Marstons Mills Fire/Rescue Department brings to your attention the following potential violation(s) of 780 CMR: Massachusetts State Building Code for your review and/or interpretation of same. NAME/BUSINESS: Rockland Trust ADDRESS: 22 Wianno Ave Osterville OBSERVANCE: During the inspection phase for the construction at Rockland Trust, 22 Wianno Ave, it was noted that the fire department radios did not appear to have adequate coverage in the basement. Michael Grossman e revention Officer C.O.M.M. Fire District CC:Jeff Lauzon, Building Inspector CC: Paul Roma, Building Inspector "Commitment to Our Community" Official Website of The Town of Barnstable - Property Lookup Page l-of 6 Select Language I ♦ 1 Assessing Division Property Lookup Results - 2( 367 Main Street, Hyannis, MA. 02601 << BACK TO SEARCH << Print Fri Owner Information - Map/Block/Lot: 117 / 098/ - Use Code: 3250 Owner Owner Name as of BRIDGE, GARDINER W TR Map/Block/Lot GIS MAPS 1/1/16 155 SMOKE VALLEY ROAD 117 /098/ PO BOX 975 Property Address , OSTERVILLE, MA. 02655 21 WIANNO AVENUE Co-Owner Name WIANNO REAL ESTATE TRUST Village: Osterville Town Sewer At Address: No GIS Zoning Value: SPLIT RC;BA Assessed Values 2017 - Map/Block/Lot: 117 /098/- Use Code: 3250 2017 Appraised Value 2017 Assessed ValuePast Comparisons Building Value: $ 646,300 $ 646,300 Year Assessed Value Extra Features: $ 252,400 $252,400 2016 - $ 1,310,300 2015 - $ 1,227,100 2014 - $ 1,227,100 Outbuildings: $ 18,000 $ 18,000 2013 - $ 1,227,100 2012 - $ 1,211,200 Land Value: $ 393,600 $ 393,600 2011 - $ 1,211,200 2010 - $ 1,376,300 2009 - $ 1,234,800 2017 Totals $ 1,310,300 $ 1,310,300 2008 - $ 1,234,800 2007 - $ 1,234,800 http://www.townofbamstable.us/Assessing/propertydisplayscreen 17.asp?ap=0&searchparce... 2/3/2017 Page 1:of 1 ,t. dK"v-; } y t http://townofbamstable.us/propertyimages/00/03/03/06jpg 2/3/2017 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 1 l- 6c'A Map ` Parcel Applicati Health Division Date Issued 3 Conservation Division Application Fee VG� Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Pres ion/ Hyannis Project Street Addre/ss/ l Village Owner Address Telephone C Permit Request �� �� 1-r 6Y1 l- a s Square feet: 1 st floor: existing proposed 2nd floor: existing prod©sed -" T6. I new: Zoning District Ui 00D Flood Plain Groundwater Overla Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supRoltingrT. ocumentation. 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 0 Crawl ❑Walkout Cl 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 RYes ❑ No If yes, site plan review# Current Use Proposed Use _ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name -�`�'�XT r� _ >>�Ll�l _ Telephone Number � 7?1 Address 14 E5 License # 60 3c�'S H-VWMIS i",A Home Improvement Contractor# J Email 0 f� c16 m Worker's Compensation # 5? 901 l 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Gpyl13EYLS 5� SIGNATURE DATE 1 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED" MAP/PARCEL NO. is ADDRESS VILLAGE r y OWNER s DATE OF INSPECTION: 5 FOUNDATION FRAME `c INSULATION FIREPLACE ELECTRICAL: ROUGH F FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING. DA-TttLOSED OUT ' �' '.A-SSOG ATION PLAN NO: ..... 77te CoanittontteaMi of Vassachusetts epart neat Accidents Office Of Aisarestigations 600 Washington Street Bastan,MA 02111 wn-m inasngotildia Worke><s' CampensationInsuranceAlfidavit-Builders/Contractors/F ectricians/Plumbers Applicant Infarmafion f'm Please Print:Legibly Name( l6Fganiz�ion/Fn�v;�aq: E% J) 11 gy JC- 1 1 &-)L Address '1 �� &'i City/Statz/Zip: Phone#- - y 9 g Are au an employer?Ch l appropriatae bow T of ect(required): 4_ I scar con5ractor and I � l�1 ����- employer with ❑ 6- [—]New constructioa employees{full aaVbrpart-time)* ha°ehiredthe sub-contra- ❑ I am a sore proprietor or partner- listed on the attached sheet 7- ❑Remodeling ship and have no employees These sub-contractors have 8_ ❑Demolition wording for me in-y capacity employees and have workers' 9_ ❑Building addition WO workers' comp_inv ice comp.insurauce, req-irec'L] 5_❑ We are a corporation:and its 10_❑Electrical repairs cr additions 3_❑ f am a homeovmer doing all work officers have exercised their lLQ Plumbing repairs or additions myself [No workers'comp right of eaiemption per MGL 12 0 Roof repairs i:nmx'anre require&]T c-15Z §1(4} and we h ,6,e no emplayees [No workers' 13-. A—Q Tier &t l comp-insurance required-1 ;try� b-n,t that cheds box f1 mnsY slso fill otrt the section below showing theirat woee compensRdon policy infinmatkm Homeowners who submit this affidavit ind kating they are doing all tropic and dren hire onside coast mcmm=1 submit a stew affidarit n,"�rua lCoattscmrs dmt check this box must stteched air additional sbeet showing the name of the satf-oars and stale whether ornot those modes hive amptoyees_ If the sub-conttacfnts base empIoyee.%they most provide their wm-le s'comp policy number I am an errtpTi*yer ihat is prof rag tt,orken'corrrlterrsalion insuremce for rtty*enrpdvyee—% Beloty is thepodicy acid job sate information_ Insurance CompanyName: (�—Q Policy#or Self-ins_Lic-9 ') 3 0 13 Expiration Date: Job Site Address: Awat�ERMGU/tf-NWd 4ZA5 City/Steeiztp: Attach a copy of the mmrkers'compensation policy deZz.ratiou page(showing the policy nutaber• and expiration date). Failure to secure coverage as requiredvrtder Section 25A of MGL c. 152 can lead to the imposition of criminal penalfies of a fine up to$1,500.Oa and/or one-year imprisonment,as well as civil penalties in the fbrm of a STOP WORK ORDER and a fine ofup to MOM a.day against the violator_ Be advised that a cry of this stet maybe forwarded to the Office of Intrestigations of the DIET;far insurance coverage verification_ I dui hereby cerh;fy re pains and penalttas ofgerjury thatthe information pratidRd abase it and correct SieoaturE: Bate_ / Phone#: OfjZdal use only. Do not writs in this urea,to be campieted by city or town of ficiaL City or Town: PeradtUcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3_Citylff,own.Cleric 4_EIectrical Inspector S.P'lumbmg rsrspector .6.Other Contact Person: Phone#_ 6 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,emphoying 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 IocaI licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority_" Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,d. necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their cerr_'ncaie-(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 'I' e affidavit sbould 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. Sell-insured companies should enter their self-insurance license number on the appropriate lime. 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 permitfbcense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may, be.provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this aihdavit. 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: Tiro Commonwealth of Massachusotts Depaftmeat of hidustdal Accidents Office of kvestigatiGm 600 wash titan Stroet Boston,MA 02111 Tel.#617-727-49W W 406 or 1-977 MASSAFE Revised 4-24-07 Fax#I 617-727-7749 www.mas.-,,gciv1dia 1'1 ,.� Town of Barnstable �f0 MA'1 p Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize `X 77 M OL, 46U,/46 6� to act on my behalf, in all matters relative to work authorized by this building permit application for: nM1 R&0 S I (Address of Job) ryll Signature of Owner Date //Intel"/AiC '—Irc1SIZ'e h.Gu l- L /t-/ Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWPFILESTORWbuilding permit fonnsEXPRESS.doc Revised 061313 r; •-).., �• .,.,. ,. ,-•,- :' .:,. ::�. > " 1. O1`l" i Office of Coilsurnei= Affairs and Business �J �eguiation Park Plaza Stite 5 170 =: = Boston, l ass•aci�use�I:s 02116 Home, liriprove`nent Contractor Registration Registration: 110609 T\tpe: Private Corporation Expiration: 11/3/2014 Trg 233027 E J JAX I IMER, BUILDER, INC. \ ERNES I JAX T IMER. 48 ROSARY LN HYANNIS, MA 02601 Update address and return card.Mark reason for cl-iange. Address Renewal ❑ Ls ployment Lost Card )PS-CAI c: 5011,1-04/04-GiOQ16 `✓'i" (�./sume:Affairs&'�L �1a1>CCC tt.;S +' License or registration valid for individnl use oel . Office of Consumer affairs E Uslue;s k� iuia' g y HOME IMPROVEMENT CONTRACTOR before the expiration crate. If found return to: I i Registration: 110609 T;rpe' Office of Consunner Affairs and Business Regulation s�.,.• Expiration: 11/3/2014 Private Corporation 10 Park iPlaza-Suite 51170 Boston,MA 02116 E JJA.TIMER,BUILDER,INC: •'may �� �„ ERNEST JAXTIMER 48 ROSARY LN HYANNIS,MA 02601 Undersecretary Not valid without signature 4 Massachusetts -Department of Public Safety '--` Board of Building Regulations and Standards Construction Supervisor License: CS-003251 I RNIEST J JAX71']Ct�i ,R 48 ROSARY Li LN-Ffir' � ` e 1` Expiration Commissioner 0111412016 1 r A ® CERTIFICATE OF LIABILITY INSURANCE °A 2/312013) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Erica H O'Connor ' HART INSURANCE AGENCY,INC. NAME: 243 MAIN STREET PHONE 508-759-7326 x205 FAX No:508-759 7366 PO BOX 700 ADDRESS! BUZZARDS BAY,MA 025320700 'INSURE S AFFORDING COVERAGE NAIC# INSURER A: ARBELLA PROTECTION INS CO 41360 INSURED EJ Jaxtimer Builder,Inc INSURER B: ARBELLA INDEMNITY INSURANCE COMPANY 10017 48 Rosary Lane Hyannis,MA 02601 INSURER c INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY,THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSR ADOL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMID A GENERALLUIBILJTY 8500042039• . 01/01/2014 01/01/2015 EACH OCCURRENCE $ 1;000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED R MI a occurrence) $ 300,000 , CLAIMS-MADE OCCUR MED EXP(Any oneperson) $ .5,000 PERSONAL&ADV INJURY $ 1.000.000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LI MIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2.000,000 POLICY PRO- LOC $ B AUTOMOBILE LIABILITY 1020011547 01/01/2014 01/01/2015 COMBINED SINGLE LIMIT 1,000,000 Ea accident ANY ALTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE S HIREDAUTOS AUTOS Per acddant g A UMBRELLA LIAR OCCUR 4600042040 01/01/2014 01/01/2015 EACH OCCURRENCE $ 2,000-1000 EXCESS LIAR HCLAIMS-MADE AGGREGATE $ 2.000,000 DIED RETENTION$10,000 $ B WORKERS COMPENSATION 0053890113 O1/01/2014 01/01/2015 we STATu- oTH- AND EMPLOYERS'LIABILITY LIMITS ER — ANY PROPRIETOR/PARTNERIEXECUTIVE YIN NIA E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under ' DESCRIPTION OF OPERATIONS below E.L.DISEASE.POLICY LIMIT S 500,000 DESCRIPTION OF OPERATIONS)LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remark Schedule,If more apace Is required) CERTIFICATE HOLDER CANCELLATION Fax#:(508)8624717 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 230 SOUTH STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS,MA 02601 AUTHORIZED REPRESENTATIVE ©198 -20 0 WODCO4RPO:.:,TION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD —..�-ter_ y T. •�� � ;!S� � _ .�`� - Ls -Z``stA _ b►Nb f i ` �"'�� • ' I -�= �,; . � �. -,. T i�f �."� -� I�r. 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 the Town (WHICH YOU MUST DO according to M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1" FI., 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. 47�L- " M Fill in please: DATE APPLICANT'S YOUR NAME/CORPORATE NAME .cii' -rs :. � rul � C�t-t es c BUSINESS YOU R.HOME AD/DRESS:9 17 e b.-e cc4 LG„� Sga�Qc,,o�[� 5, Sci✓'.�Z29^ �IG�� GSFcYv11Le /t't� OZ�i�:S TELEPHONE # Home Tele hone Number S0g _ c(2F— y-1) S— NAME OF NEW BUSINESS cs ecPC— S --LOTYPE OF BUSINESS IS THIS A HOME OCCUPATION? YES NO ��� ��� , r� S� �u.i�a c Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS it r /nnno ��.� �s�ea';,•/(Q /444 c,2Cs5-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. — (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. I 1. BUILDING COMMISSIONER'S O E This individual has b r ed of y ermit requirements that pertain to this type of business. I ut orized Signature** COMMENTS: I 2. BOARD OF HEALTH This individual has een i rm d f the permit requirements that pertain to this type of business. � (( A tho ed Si ° t}'_re** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has f7n inf r e o the licensing requirements that pertain to this type of business. COMMENTS: �f'(J � Au orized Signatuye;� C,V 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) and 200 Main Street Offices at the Licensing counter. DATE: 2/ D$ Y ° yy< Fill in please: APPLICANT'S YOUR NAME:s �.�c7 *z^'a' .• R=.3 - iF / t:, 3asn � BUSINESS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number: Sad- ,9-V6 .- �Iioc NAME OF NEW BUSINESS_ TYPE OF BUSINESS t. :* 6-- Is THIS A HOME OCCUPATION? YES —NO/- Have you been given approval from the building,division? YES NO ADDRESS OF BUSINESS MAP/PARCEL NUMBER When starting a new business there are several things yo ust 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. - (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 COMMISSIONER'S FFICE This individual has =me�o any permit requirements that pertain to this type of business. i Au orized Signature* j COMMENTS: 2. BOARD OF HEALTH �.. This_individual s een J m d of t e pe it requirements that pertain to this type of business. Authorize igna ure* COMMENTS: i i i 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual ha been iC�jn rmed of the licensing requirements that pertain to this type of business. fAu oriz S1 ature COMMENTS: NEXIUS Accelerating Network and Business Transformation 1- Pole Structural Analysis 1� nr.r+'. -Z CO :::74 M Me�,k1E'Ei7aR#' 5 .+ 0 Latitude: 41.627633° Longitude: -70.384858' Address/Cross Street: 21 WIANNO AVENUE City. State, Zip: BARNSTABLE MA 02655 Prepared by: Jimmy Chendana, P.E. �P�tN OF �SS9C' JIMMY CHENDANA o STRUCTURAL No. 53634 /STE � `� 6/21/2018 4AF97FC05857423... NEXIUS MA Office: 7 A Lyberty Way,Westford, MA 01886 1 I NEXIUS Accelerating Network and Business Transformation Executive Summary This structural analysis report performed by Nexius Solutions, Inc. summarizes the capacity of the existing wood pole to support the proposed equipment loading VZW intends to install. The analysis shows that the controlling reaction at the pole base is less than the allowable pole capacity. Therefore, the existing wood pole is adecivate and can safely support the additional wind load and as well as the gravity load resulting from all the proposed VZW equipment. Table of Contents: ExecutiveSummary ...............................................................................................i 1) Site Information: ". .............................................................................................. iii 2) Purpose of the Analysis: ....................................................................................iii 3) Information and Data: ......................................................................................iii 4) Analysis Criteria and Primary Design Parameters: ".............................................iii 5) Analysis and Calculation: ..................................................................................iv 6) Loading: ...........................................................................................................iv 7) Conclusion and Recommendations: ......................................................................V 8) Assumptions & Disclaimers:.................................................................................v APPENDIX (Structural Analysis Calculations). NEXIUS MA Office: 7 A Lyberty Way,Westford, MA 01886 2 I NEXIUS Accelerating Network and Business Transformation 1) Site Information: Basic site information of the analyzed wood pole is listed below: Utility Pole ID #: 64-3 Address/Cross Street: 21 Wianno Avenue City, State ZIP: Barnstable MA 02655 County: Barnstable Structural Type:. Wood Pole 2) Purpose of the analysis: The purpose of this analysis is to evaluate the proposed wood pole structural capacity to support the loads resulting from the proposed VZW installation. 3) Information and Data: The pole information used to complete this analysis was obtained from some of the following documents: • Lease Exhibit drawing prepared by Nexius • Sites Photos 4) Analysis Criteria and Assumption: The existing utility pole was analyzed per NESC C2-2012 with the following analysis criteria. • Load Condition 1 — NESC Light (Rule 250B) • 4 psf Lateral wind pressure • Ice = 0.5" • Overload Capacity Factors • Vertical = 1.5 • Wind = 2.5 • Wire Tension = 1.65 • Strength factor : 0.65 • Load Condition 2 — NESC Extreme Wind (250C) • 85 mph lateral wind speed • No Ice • Overload Capacity Factors = 1.0 Strength factor 0.75 NEXIUS MA Office: 7 A Lyberty Way,Westford, MA 01886 3 f NEXIUS Accelerating Network and Business Transformation The Pole strength was checked by utilizing 0-Calc Pro. Ver. 5.02, a structural analysis software for utility poles. Software output for this analysis is provided in the Appendix of this report. The existing utility pole has the following geometry: Pole Length (ft) Embedment Length (ft) Length AGL(ft) Top Cir./Ground Line pole Type Cir. (in/in) 40 6 34 23/36 40' Class 3 Pole 5) Analysis and Calculation: The structural loads due to wind, ice and self-weight are determined according to the above listed codes and standards. (See Appendix for details of the structural analysis) 6) Loading: The following table lists the proposed VZW equipment loading on the existing pole: Proposed Loading Elevation Qty:' " :Description. (C.L. of equipment) 39.5' 1 Antenna NH360QM-DG-2XR Net Weight = 33.7 Ibf 10.5' 1 PCS + AWS RRH Net Weight = 125 lbf 15' 1 Fiber Demarc Net weight = 5 Ibf 19.5' 1 Existing Telco Box Net weight = 5 Ibf 23' 1 Existing Telco Box Net weight = 5 Ibf $, 1 Meter Equipment Net weight = 5 Ibf Note: Brackets, conduits and cables are shown on LE drawing. NEXIUS MA Office: 7 A Lyberty Way, Westford, MA 01886 4 NEX.IUS Accelerating Network and Business Transformation 7) Conclusion and Recommendations: Based on the loading criteria listed in section 6 and the loads of the new antenna configuration, the existing wood pole is found to be stressed below capacity. Maximum usage of the pole is 98.6%. 8) Assumptions & Disclaimers: • The accuracy of the proposed equipment loads listed in this report is the responsibility of VZW. This analysis was performed under the assumption that all information provided to Nexius is current and accurate. If the proposed equipment loads are different than those analyzed, this report should be considered obsolete and further analysis will be required. • It is the responsibility of the client and/or the structure owner to ensure that no un-documented equipment is installed on the structure between now and the construction phase. If additional equipment is installed on the structure, then this report should be considered obsolete and further analysis will be required. • This analysis assumes that the structural components, including all wood sections and attachment hardware, are in good working condition, free of dry rot, rust or other forms of corrosion. Furthermore, it is assumed that the superstructure and the foundation have been properly maintained and monitored since the original installation. This report should be considered obsolete and further analysis will be required if the structure and/or foundation does not meet all of the above criteria. • Contractor shall field verify and measure all dimensions of the structure before commencing construction. • The superstructure and foundation are assumed for the purpose of this analysis to have been properly fabricated, constructed, well maintained and to be in good condition with no structural defects beyond those stated in the above mentioned inspection report. NEXIUS MA Office: 7 A Lyberty Way,Westford, MA 01886 5 NEXIUS Accelerating Network and Business Transformation i APPENDIX Structural / Loading Analysis and Calculations / Documents (11 pages) I NEXIUS MA Office: 7 A Lyberty Way,Westford, MA 01886 6 i i • 64-3 ri ary I 0.848" Ted rt s T�sr Up e 7 25'6T I W ° 28.22 _ psf k , r with Guy Tension Fiber arc "are DQO_ PCs& RH 100gist. pane+ Mir • C47 AT No U2272_ RL-5T9-BL Meter .$ O-Calc® Pro Schematic View Pole Identification: 64-3 Report Created: 6/21/2018 File: Pole_64-3_pplx.pplx I I I I I V3 7 . 27_6 AN t 1 2. 22r ys COMMSCOPE NH360QM-DG-2XR HL-44 POLE EXT. EHS 3/8 Span/Head Guy 32.0 ft hgt Secondary 3160 105'0.648' (QUADRAPLEX 6 AWG) Secondary 200 67' 0.648" (QUADRAPLEX 6 AWG) Secondary 1390 85'0.648" (QUADRAPLEX 6 AWG) Streetlight-8 ft. Arm 8.0 ft arm Telco 3160 105' 1.000" (TELE 1.0) Telco 1390 85' 1.000" (TELE 1.0) 00 Telco 3160 105' 1.000" (TELE 1.0) Telco 1390 85' 1.000" (TELE 1.0) Riser 205.00 Telco 3160 105' 1.000" (TELE 1.0) Telco 1390 85' 1.000" (TELE 1.0) Exist.Telco Box Telco 3160 105' 1.000" (TELE 1.0) Telco 1390 85' 1.000" (TELE 1.0) Telco 250 67' 1.000" (TELE 1.0) Telco 250 67' 1.000" (TELE 1.0) Exist.Telco Box Fiber 3160 105' 1.000" (TELE 1.0) Fiber 1390 85' 1.000" (TELE 1.0) Fiber Demarc PCS&AWS RRH Square D QO-100A Dist. panel + Milbank CAT No U2272-RL-5T9-BL Meter Pole ID:PoIe_64-3_pplx.pplx O-Calc@ Pro Analysis Report Thursday,June 21,2018 2:12 PM Pole Num: 64-3 Pole Length/Class: 40/3 Code: NESC Structure Type: Guyed Tangent Aux Data 1 Unset Species: SOUTHERN PINE NESC Rule: Rule 250E Status Guy Wires Adequate Aux Data 2 Unset Setting Depth (ft): 6.00 Construction Grade: B Pole Strength Factor: 0.65 Aux Data 3 Unset G/L Circumference (in): 36.00 Loading District: Heavy Transverse Wind LF: 2.50 Aux Data 4 Unset G/L Fiber Stress (psi): 8,000 Ice Thickness(in): 0.50 Wire Tension LF: 1.65 Aux Data 5 Unset Allowable Stress (psi): 5,200 Wind Speed (mph): 39.53 Vertical LF: 1.50 " Aux Data 6 Unset Fiber Stress Ht. Reduc: No Wind Pressure(psf): 4.00 Latitude: 41.627633 Deg Longitude: -70.384858 Deg Elevation: 40 Feet Pole Capacity Utilization(%) Height Wind Angle (ft) (deg) Maximum 98.6 0.0 44.8 Groundline 98.6 0.0 44.8 [== Vertical 1.5 19.8 205.0 Pole Moments (ft-lb) Load Angle Wind Angle (deg) (deg) I Max Cap Util 62 721 34.6 44.8 CAT� 'di' . .°- Groundline 62,721 34.6 44.8 - GL Allowable 64,015 I _ Guy System Component Summary Load From Worst Wind Individual Maximum Load Angle on Pole Description Lead Length Lead Angle Height Nominal Wind Angle Max Load Wind Angle' (ft) (deg) (ft) Capacity(%) I (deg) Capacity (%) I (deg) Single Helix Anchor 60.0 25.0 0.0 44.8 0.2 220.0. EHS 3/8 (Span/Head) 32.01 0.0 44.81 0.6 220.0 System Capacity Summary: I Adequate Adequate User:jimmy.chendana NEXIUS Includes Load Factor(s) Page 1 of 4 Z Worst Wind Per Guy Wire 3 Wind At 44.8° OCP:5.03 Pole ID:Pole_64-3_pplx.pplx O-Calc@ Pro Analysis Report Thursday,June 21,2018 2:12 PM Groundline Load Summary-Reporting Angle Mode: Load-Reporting Angle: 34.60 Shear Applied Bending Applied Pole Bending Vertical Vertical Total Pole Load* Load Moment Moment Capacity Stress Load Stress Stress Capacity (Ibs) M (ft-lb) M N (+/-psi) (Ibs) (psi) (psi) M Powers 183 6.6 5,062 8.1 7.9 404 162 2 406 7.8 Comms 2,141 77.4 47,413 75.6 74.1 3,788 1,275 12 3,800 73.1 GuyBraces 4 0.1 116 0.2 0.2 9 24 0 9 0.2 GenericEquipments 130 4.7 3,663 5.8 5.7 293 283 3 295 5.7 Pole 262 9.5 4,609 7.4 7.2 368 1,495 15 383 7.4 Streetlights 40 1.5 1,751 2.8 2.7 140 112 1 141 2.7 Risers 7 0.3 106 0.2 0.2 8 37 0 9 0.2 - Insulators 0 0.0 1 0.0 0.0 0 46 0 1 0.0 Pole Load 2,766 100.0 62,721 100.0 98.0 5,010 3,436 33 5,044 97.0 Pole Reserve Capacity 1,294 2.0 190 156 3.0 Load Summary by Owner-Reporting Angle Mode: Load -Reporting Angle: 34.60 Shear Applied Bending Applied Pole Bending Vertical Vertical Total Pole Load* Load Moment Moment Capacity Stress Load Stress Stress Capacity (Ibs) M (ft-lb) N N (+/-psi) (Ibs) (psi) (psi) M <Undefined> 2,504 90.5 58,112 92.7 90.8 4,642 1,940 19 4,661 89.6 Pole 262 9.5 4,609 7.4 7.2 368 1,495 15 383 7.4 Totals: 2,766 100.0 62,721 100.0 98.0 5,010 3,436 33 5,044 97.0 Detailed Load Components: Power Owner Height Horiz Cable Sag at Cable Lead/Span Span Wire Tension Tension Offset Wind Moment NOffset Diameter Max Weight Length Angle Length (Ibs) Moment* Moment* Moment* at GL* (in) (in) Temp (lbs/ft) (ft) (deg) (ft) (ft-lb) (ft-lb) (ft-lb) (ft-lb) ff Secondary QUADRAPLEX 6 27.50 6.31 0.6480 1.18 0.156 105.0 315.5 105.0 500 4,278 -20 1,947 6,205 AWG Secondary QUADRAPLEX 6 27.47 17.02 0.6480 0.12 0.150 67.0 20.5 67.1 60 2,549 -1 126 2,674 AWG Secondary QUADRAPLEX 6 27.50 6.31 0.6480 0.93 0.156 85.0 138.5 85.0 500 -5,439 -17 1,555 -3,900 AWG Totals: 1,389 -38 3,628 4,978 Comm Owner Height Horiz Cable Sag at Cable Lead/Span Span Wire Tension Tension Offset in Moment (ft) Offset Diameter Max Weight Length Angle Length (Ibs) Moment* Moment* Moment* at GL* (in) (in) Temp (lbs/ft) (ft) (deg) (ft) (ft-lb) (ft-lb) (ft-lb) (ft-lb) (ft) Telco TELE 1.0 25.50 6.68 1.0000 0.27 0.400 105.0 315.5 105.0 500 3,967 -33 2,191 6,125 User:jimmy.chendana NEXIUS Includes Load Factor(s) Page 2 of 4 Z Worst Wind Per Guy Wire 3 Wind At 44.8* OCP:5.03 Pole ID:Pole_64-3_pplx.pplx Thursday,June 21,2018 2:12 PM . O-Calc® Pro Analysis Report Telco TELE 1.0 25.50 6.68 1.0000 0.18 0.400 85.0 138.5 85.0 500 -5,043 -27 1,750 -3,320 Telco TELE 1.0 25.00 6.71 1.0000 0.27 0.400 105.0 315.5 105.0 500 3,889 -33 2,148 6,004 Telco TELE 1.0 25.00 6.71 1.0000 0.18 0.400 85.0 138.5 85.0 500 -4,944 -27 1,716 -3,256 Telco TELE 1.0 24.00 6.77 1.0000 0.27 0.400 105.0 315.5 105.0 500 3,734 -34 2,062 5,762 Telco TELE 1.0 24.00 6.77 1.0000 0.18 0.400 85.0 138.5 85.0 500 -4,746 -27 1,647 -3,127 Telco TELE 1.0 21.50 6.92 1.0000 0.27 0.400 105.0 315.5 105.0 500 3,345 -34 1,847 5,158 Telco TELE 1.0 21.50 6.92 1.0000 0.18 0.400 85.0 138.5 85.0 500 -4,252 -28 1,475 -2,804 Fiber TELE 1.0 18.00 7.13 1.0000 0.27 0.400 105.0 315.5 105.0 500 2,800 -35 1,547 4,312 - Fiber TELE 1.0 18.00 7.13 1.0000 0.18 0.400 85.0 138.5 85.0 500 -3,560 -29 1,235 -2,353 Telco TELE 1.0 21.50 6.92 1.0000 0.04 0.400 67.0 25.0 67.0 500 17,065 77 68 17,210 Telco TELE 1.0 21.50 6.92 1.0000 0.04 0.400 67.0 25.0 67.0 500 16,757 91 68 16,915 Totals: 29,012 -140 17,764 46,626 GenericEquipment Owner Height Horiz Offset Rotate Unit Unit Unit Unit Unit Offset Wind Moment (ft) Offset Angle Angle Weight Height Depth Diameter Length Moment* Moment' at GL' in de de Ibs in in in in (ft-lb) ft-lb (ft-lb) Box PCS&AWS RRH 10.50 13.59 137.0 0.0 125.00 21.60 9.00 - 27.00 -45 227 182 Cylinder HL-44 POLE EXT. 35.50 0.43 0.0 0.0 10.00 48.00 - 12.00 - 0 1,398 1,397 Cylinder COMMSCOPE 39.50 0.67 0.0 0.0 33.70 45.10 - 12.00 - -2 1,461 1,459 NH360QM-DG-2XR Box Square D QO-100A 8.00 7.37 137.0 0.0 5.00 12.75 4.25 - 18.40 -1 49 48 Dist.panel+Milbank CAT No U2272-RL- 5T9-BL Meter Box Fiber Demarc 15.00 6.94 137.0 0.0 5.00 7.80 4.25 - 18.40 -1 56 55 Box Exist.Telco Box 19.50 6.79 25.0 0.0 5.00 12.00 4.50 - 8.50 4 212 216 Box Exist.Telco Box 23.00 6.58 205.0 0.0 5.00 12.00 4.50 - 8.50 -4 250 246 Totals: -50 3,652 3,602 Streetlight Owner Height Horiz. Offset Rotate Unit Unit Unit Unit Unit Offset Wind Moment (ft) Offset Angle Angle Weight Height Depth Diameter Length Moment' Moment' at GL' in de de Ibs in in in in (ft-lb) ft-lb ft-Ib General Streetlight-8 ft.Arm 26.00 4.15 45.0 45.0 75.00 24.00 20.00 3.00 96.00 677 1,045 1,722 Totals: 677 1,045 1,722. Riser Owner Height Horiz. Offset Rotate Unit Unit Unit Unit Unit Offset Wind Moment (ft) Offset Angle Angle Weight Height Depth Diameter Length Moment' Moment' at GL' in de de Ibs in in In in ft-Ib (ft-lb) (ft-lb) Riser 205.0° Riser 25.00 5.85 205.0 205.0 25.00 300.00 1.00 1.00 300.00 -12 116 104 Totals: -12 116 104 Insulator Owner Height Horiz Offset Rotate Unit Unit Unit Offset Wind Moment at (ft) Offset Angle Angle Weight Diameter Length Moment' Moment' GL' in de de Ibs in in ft-lb (ft-lb) ft4b Spool Spool2.5" 27.50 0.00 270.0 0.0 1.00 2.50 2.12 0 10 10 User:jimmy.chendana NEXIUS Includes Load Factor(s) Page 3 of 4 Z Worst Wind Per Guy Wire 3 Wind At 44.8° OCP:5.03 Pole ID:Pole_64-3_pplx.pplx Q-Caic® Pro Analysis Report Thursday,June 21,2018 2:12 PM Bolt Three Bolt 25.50 0.00 270.0 0.0 5.00 3.00 0.00 -2 0 -2 Bolt Three Bolt 25.00 0.00 270.0 0.0 5.00 3.00 0.00 -2 0 -2 Bolt Three Bolt 24.00 0.00 270.0 0.0 5.00 3.00 0.00 -2 0 -2 Bolt Three Bolt 21.50 0.00 270.0 0.0 5.00 3.00 0.00 -2 0 -2 I Bolt Three Bolt 18.00 0.00 270.0 0.0 5.00 3.00 0.00 -3 0 -3 Bolt Three Bolt 21.50 0.00 0.0 0.0 5.00 3.00 0.00 4 0 4 Totals: -9 10 1 Guy Wire and Brace Owner Attach End Height Lead/Span Wire Percent Lead Angle Incline Wire Weight Rest Length Stretch Height (ft) Length Diameter Solid (deg) Angle (lbs/ft) (ft) Length (ft) (ft) (in) ("/o) I I (deg) (in) EHS 3/8 Span/Head 32.00 32.00 60.00 0.375 75.00 25.0 0.0 0.25 58.19 0.00 Guy Wire and Brace Elastic Rated Guy Allowable Initial Loaded Maximum Applied Vertical Shear Load Shear Load Moment at (Loads and Reactions) Modulus Tensile Strength Tension Tension Tension" Tension' Tension' Load In Guy Dir At Report GL' (psi) Strength Factor (lbs) (Ibs) (Ibs) (Ibs) (Ibs) (Ibs) (Ibs) Angle (ft4b) (Ibs) (Ibs) EHS 3/8 Span/Head 2.30e+7 15,400 0.90 13,860 350 80 48 0 0 0 0 114 Totals: 0 0 0 114 Anchor/Rod Load Summary Owner Rod Length Lead Length Lead Angle Strength of Anchor/Rod Allowable Max Load' Load at Pole Max AGL (ft) (deg) Assembly Strength Load (Ibs) MCU' Required (in) (Ibs) Factor (Ibs) (Ibs) Capacity'(%) Single Helix Anchor 18.00 60.00 25.0 20,000 1.00 20,000 48 0 0.2 Pole Buckling Buckling Buckling Buckling Buckling Minimum Diameter at Diameter at Modulus of Pole Ice Density Pole Tip Buckling Buckling Buckling Constant Column Section Section Buckling Tip GL Elasticity Density (pcf) Height Load Load Load Factor Height' Height Diameter Diameter at (in) (in) (psi) (pcf) (ft) Capacity at Applied at of Safety (ft) (%Buckling (in) GL Height Height Col.Hgt) (in) (Ibs) (Ibs) 0.71 19.84 33.16 10.66 8.54 7.32 11.46 1.60e+6 60.00 57.00 34.00 229,402 2290.57 66.67 User:jimmy.chendana NEXIUS 'Includes Load Factor(s) Page 4 of 4 2 Worst Wind Per Guy Wire 'Wind At 44.8° OCP:5.03 Pole ID:Pole_64-3_pplx.pplx O-Calc@ Pro Analysis Report Thursday,June 21,2018 2:12 PM i j Pole Num: 64-3 Pole Length/Class: 4013 Code: NESC Structure Type: Guyed Tangent Aux Data 1 Unset Species: SOUTHERN PINE NESC Rule: Rule 250C Status Guy Wires Adequate Aux Data 2 Unset Setting Depth (ft): 6.00 Construction Grade: B Pole Strength Factor: 0.75 Aux Data 3 Unset G/L Circumference(in): 36.00 Loading District: Special Transverse Wind LF: 1.00 Aux Data 4 Unset G/L Fiber Stress(psi): 8,000 Ice Thickness (in): 0.00 Wire Tension LF: 1.00 Aux Data 5 Unset Allowable Stress (psi): 6,000 Wind Speed (mph): 105.00 Vertical LF: 1.00 Aux Data 6 Unset Fiber Stress Ht. Reduc: No Wind Pressure(psf): 28.22 Max 250C Wind (mph) 112.08 Latitude: 41.627633 Deg Longitude: -70.384858 Deg Elevation: 40 Feet Pole Capacity Utilization(%) Height Wind Angle y (ft) (deg) Maximum 96.0 0.0 45.6 Groundline 96.0 0.0 45.6 z Vertical 0.6 18.4 205.0 Pole Moments (ft-lb) Load Angle Wind Angle h (deg) (deg) t PCs Max Cap Util 70,702 40.6 45.6 •�"- "` TRdT a . •I ,,. Groundline 70,702 40.6 45.6 GL Allowable 73,863 Guy System Component Summary Load From Worst Wind Individual Maximum Load Angle on Pole Description Lead Length Lead Angle Height Nominal Wind Angle Max Load Wind Angle- (ft) (deg) (ft) Capacity (%) I (deg) Capacity(%) (deg) Single Helix Anchor 60.0 25.0 0.0 45.6 4.1 210.0 EHS 3/8(Span/Head) 32.01 0.0 45.61 5.9 210.0 System Capacity Summary: I Adequate Adequate User:jimmy.chendana NEXIUS Includes Load Factor(s) Page 1 of 4 Z Worst Wind Per Guy Wire 3 Wind At 45.6° OCP:5.03 Pole ID:Pole_64-3_pplx.pplx O-Calc@ Pro Analysis Report Thursday,June 21,2018 2:12 PM Groundline Load Summary-Reporting Angle Mode: Load-Reporting Angle: 40.60 Shear Applied Bending Applied Pole Bending Vertical Vertical Total Pole Load* Load Moment Moment Capacity Stress Load Stress Stress Capacity (lbs) M (ft-lb) M M (+/-psi) (Ibs) (Psi) (psi) N Powers 159 5.2 4,603 6.5 6.2 354 22 0 354 5.9 Comms 1,743 57.5 40,776 57.7 55.2 3,136 425 4 3,140 52.3 GuyBraces 3 0.1 113 0.2 0.2 9 7 0 9 0.1 GenericEquipments 338 11.2 10,412 14.7 14.1 801 189 2 803 13.4 Pole 664 21.9 11,044 15.6 15.0 849 997 10 859 14.3 Streetlights 107 3.5 3,425 4.8 4.6 263 75 1 264 4.4 Risers 18 0.6 308 0.4 0.4 24 25 0 24 0.4 Insulators 1 0.0 20 0.0 0.0 2 31 0 2 0.0 Pole Load 3,033 100.0 70,702 100.0 95.7 5,437 1,771 17 5,454 90.9 Pole Reserve Capacity 3,161 4.3 563 546 9.1 Load Summary by Owner-Reporting Angle Mode: Load-Reporting Angle: 40.6* Shear Applied Bending Applied Pole Bending Vertical Vertical Total Pole Load* Load Moment Moment Capacity Stress Load Stress Stress Capacity (Ibs) M (ft-lb) M M (+/-psi) (Ibs) (Psi) (psi) M <Undefined> 2,370 78.1 59,658 84.4 80.8 4,588 774 8 4,595 76.6 Pole 664 21.9 11,0" 15.6 1.5.0 849 997 10 859 14.3 Totals: 3,033 100.0 70,702 100.0 95.7 . 6,437 1,771 17 5,454 90.9 Detailed Load Components: Power Owner Height Horiz. Cable Sag at Cable Lead/Span Span Wire Tension Tension Offset Wind Moment (ft) Offset Diameter Max Weight Length Angle Length (Ibs) Moment* Moment* Moment at GL* (in) (in) Temp (lbs/ft) (ft) (deg) (ft) (ft-lb) (ft-lb) (ft-lb) (ft-lb) ft Secondary QUADRAPLEX 6 27.50 6.31 0.6480 1.48 0.156 105.0 315.5 105.0 500 1,170 -3 1,877 3,045 AWG Secondary QUADRAPLEX 6 27.47 17.02 0.6480 0.13 0.150 67.0 20.5 67.1 60 1,496 -1 178 1,673 AWG Secondary QUADRAPLEX 6 27.50 6.31 0.6480 1.14 0.156 85.0 138.5 85.0 500 -1,886 -2 1,528 -360 AWG Totals: 781 -6 3,583 4,358 Comm Owner Height Horiz Cable Sag at Cable Lead/Span Span Wire Tension Tension Offset in Moment (ft) Offset Diameter Max Weight Length Angle Length (Ibs) Moment* Moment* Moment* at GL* (in) (in) Temp (lbs/ft) (ft) (deg) (ft) (ft-lb) (ft-lb) (ft-lb) (ft-lb) ft Telco TELE 1.0 25.50 6.68 1.0000 0.90 0.400 105.0 315.5 105.0 500 1,085 -8 2,657 3,735 User:jimmy.chendana NEXIUS 'Includes Load Factor(s) Page 2 of 4 Z Worst Wind Per Guy Wire 3 Wind At 45.6* OCP:5.03 Pole ID:Pole-64-3_pplx.pplx O-Calc® Pro Analysis Report Thursday,June 21,2018 2:12 PM Telco TELE 1.0 25.50 6.68 1.0000 0.63 0.400 85.0 138.5 85.0 500 -1,749 -6 2,162 407 Telco TELE 1.0 25.00 6.71 1.0000 0.90 0.400 105.0 315.5 105.0 500 1,064 -8 2,597 3,654 Telco TELE 1.0 25.00 6.71 1.0000 0.63 0.400 85.0 138.5 85.0 500 -1,714 -6 2,114 393 Telco TELE 1.0 24.00 6.77 1.0000 0.90 0.400 105.0 315.5 105.0 500 1,021 -8 2,479 3,492 Telco TELE 1.0 24.00 6.77 1.0000 0.63 0.400 85.0 138.5 85.0 500 -1,646 -6 2,017 365 . Telco TELE 1.0 21,50 6.92 1.0000 0.90 0.400 105.0 315.5 105.0 500 915 -8 2,185 3,092 Telco TELE 1.0 21.50 6.92 1.0000 0.63 0.400 85.0 138.5 85.0 500 -1,474 -6 1,779 298 Fiber TELE 1.0 18.00 7.13 1.0000 0.90 0.400 105.0 315.5 105.0 500 766 -8 1,783 2,541 Fiber TELE 1.0 18.00 7.13 1.0000 0.63 0.400 85.0 138.5 85.0 500 -1,234 -7 1,452 211 Telco TELE 1.0 21.50 6.92 1.0000 0.04 0.400 67.0 25.0 67.0 500 10,103 52 136 10,291 Telco TELE 1.0 21.50 6.92 1.0000 0.04 0.400 67.0 25.0 67.0 500 9,921 67 136 10,123 Totals: 17,058 49 21,497 38,603 GenericEquipment Owner Height Horiz Offset Rotate Unit Unit Unit Unit Unit Offset Wind Moment (ft) Offset Angle Angle Weight Height Depth Diameter Length Moment` Moment* at GL` in de de Ibs in in in in ft-lb) ft-lb) ft-lb) Box PCS&AWS RRH 10.50 13.59 137.0 0.0 125.00 21.60 9.00 - 27.00 -16 522 506 Cylinder HL-44 POLE EXT. 35.50 0.43 0.0 0.0 10.00 48.00 - 12.00 - 0 3,876 3,875 Cylinder COMMSCOPE 39.50 0.67 0.0 0.0 33.70 45.10 - 12.00 - -1 4,107 4,106 NH360QM-DG-2XR Box Square D QO-100A 8.00 7.37 137.0 0.0 5.00 12.75 4.25 - 18.40 0 111 111 Dist.panel+Milbank CAT No U2272-RL- 5T9-BL Meter Box Fiber Demarc 15.00 6.94 137.0 0.0 5.00 7.80 4.25 - 18.40 0 128 127 Box Exist.Telco Box 19.50 6.79 25.0 0.0 5.00 12.00 4.50 - 8.50 3 510 512 Box Exist.Telco Box 23.00 6.58 205.0 0.0 5.00 12.00 4.50 - 8.50 -3 622 620 Totals: -18 9,876 9,867 Streetlight Owner Height Horiz Offset Rotate Unit Unit Unit Unit Unit Offset Wind Moment (ft) Offset Angle Angle Weight Height Depth Diameter Length Moment* Moment* at GL` in de de Ibs in in in in ft-lb) ft-lb) ft-Ib General Streetlight-8 ft.Arm 26.00 4.15 45.0 45.0 75.00 24.00 20.00 3.00 96.00 458 2,785 3,242 Totals: 458 2,785 3,242- Riser Owner Height Horiz Offset Rotate Unit Unit Unit Unit Unit Offset Wind Moment (ft) Offset Angle Angle Weight Height Depth Diameter Length Moment` Moment` at GL• in de de Ibs in in in in ft-lb) ft-Ib ft-lb) Riser 205.0° Riser 25.00 5.85 205.0 205.0 25.00 300.00 1.00 1.00 300.00 -11 303 291 Totals: -11 303 291 Insulator Owner Height Horiz Offset Rotate Unit Unit Unit Offset Wind Moment at (ft) Offset Angle Angle Weight Diameter Length Moment* Moment` GL` in de de Ibs in in ft-lb) ft-lb) ft4b Spool Spool2.5" 27.50 0.00 270.0 0.0 1.00 2.50 2.12 0 27 26 User:jimmy.chendana NEXIUS Includes Load Factor(s) Page 3 of 4 Z Worst Wind Per Guy Wire 3 Wind At 45.6° OCP:5.03 Pole ID:Pole 64-3_pplx.PPIx Thursday,June 21,2018 2:12 PM _ _ O-Calc® Pro Analysis Report I Bolt Three Bolt 25.50 0.00 270.0 0.0 5.00 3.00 0.00 -2 0 -2 Bolt Three Bolt 25.00 0.00 270.0 0.0 5.00 3.00 0.00 -2 0 -2 Bolt Three Bolt 24.00 0.00 270.0 0.0 5.00 3.00 0.00 -2 0 -2 Bolt Three Bolt 21.50 0.00 270.0 0.0 5.00 3.00 0.00 -2 0 -2 Bolt Three Bolt 18.00 0.00 270.0 0.0 5.00 3.00 0.00 -2 0 -2 Bolt Three Bolt 21.50 0.00 0.0 0.0 5.00 3.00 0.00 2 0 2 Totals: -7 27 19 I Guy Wire and Brace Owner Attach End Height Lead/Span Wire Percent Lead Angle Incline Wire Weight Rest Length Stretch Height (ft) Length Diameter Solid (deg) Angle (lbs/ft) (ft) Length (ft) (ft) (in) (%) (deg) (in) EHS 3/8 Span/Head 32.00 32.00 60.00 0.375 75.00 25.0 0.0 0.25 58.19 0.00 Guy Wire and Brace Elastic Rated Guy Allowable Initial Loaded Maximum Applied Vertical Shear Load Shear Load Moment at (Loads and Reactions) Modulus Tensile Strength Tension Tension Tension" Tension' Tension' Load In Guy Dir At Report GL' (psi) Strength Factor (Ibs) (lbs) (Ibs) (Ibs) (Ibs) (Ibs) (Ibs) Angle (ft4b) (Ibs) (Ibs) EHS 3/8 Span/Head 2.30e+7 15,400 0.90 13,860 350 818 818 0 0 0 0 107 Totals: 0 0 0 107 Anchor/Rod Load Summary Owner Rod Length Lead Length Lead Angle Strength of Anchor/Rod Allowable Max Load' Load at Pole Max AGL (ft) (deg) Assembly Strength Load (Ibs) MCU' Required (in) (Ibs) Factor (Ibs) (lbs) capacity'(°/a) Single Helix Anchor 18.00 60.00 25.0 20,000 1.00 20.000 818 0 4.1 Pole Buckling Buckling Buckling Buckling Buckling Minimum Diameter at Diameter at Modulus of Pole Ice Density Pole Tip Buckling Buckling Buckling Constant Column Section Section Buckling Tip GL Elasticity Density (pcf) Height Load Load Load Factor Height• Height Diameter Diameter at (in) (in) (psi) (pcf) (ft) Capacity at Applied at of Safety (ft) (%Buckling (in) GL Height Height Col.Hgt.) (in) (Ibs) (Ibs) 0.71 18.45 32.94 10.72 5.70 7.32 11.46 1.60e+6 60.00 57.00 34.00 313,307 2951.55 166.V User:jimmy.chendana NEXIUS 'Includes Load Factor(s) Page 4 of 4 2 Worst Wind Per Guy Wire 3 Wind At 45.6° OCP:5.03 P ,r Ver%ZOn wireless March 20, 2018 Dear Sir/Madam: Re: Kevin Farrell/NEEC Please accept this letter as notification that Kevin Far-r-eAl-working for NEEC, of Kingston, MA has been engaged to perform research on certain properties and real estate including submitting for zoning approval, building permits,and construction for Verizon Wireless'ongoing network enhancement. Kevin Farrell / NEEC is authorized to act on Verizon Wireless behalf for the purpose of filing and consummating any zoning and/or building permit applications necessary to obtain approval of the applicable jurisdiction for the installation and/or modification of Verizon Wireless' communication Facilities. Should you have any questions regarding any TRM, Inc's activities on behalf of Verizon Wireless,feel free to contact me at 508-320-2017 or via email at sean.conwav@verizonwireless.com Respectfully, Sean Conway Verizon Wireless Project Manager—Real Estate I VerfaVnwireless March 1, 2018 Dear Sir/Madam: RE:TRM Please accept this letter as notification that TRM, Inc. of Foxborough, MA has been engaged to perform research on certain properties and real estate including submitting for zoning approval, building permits, and construction of Verizon Wireless ongoing network enhancement. TRM, Inc., is authorized to act on Verizon Wireless behalf for the purpose of filling and consummating any zoning and/or building permit applications necessary to obtain approval of the applicable jurisdiction for the installation and/or modification of Verizon Wireless communication Facilities. Should you have any questions regarding any TRM, Inc's activities on behalf of Verizon Wireless,feel free to contact me at 508-320-2017 or via email sean.conwav@verizionwireless.com Respectfully, Sean Conway Verizon Wireless Project Manager—Real Estate K Its 11 , s D pa n of PublicSafe ' S Board of- Building Regulationsfind Standaards' License: -09- ' I �. Construction Suporvisor Oill Kit W3 F ARE LL J . r 1 1 � F 1 : _ ir ' on. commis-1n,e y The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly N3Tri6(Business/Organization/Individual): New England Electrical Contracting Corporation Address 21 Marion Drive City/State/Zip:Kingston MA.02364 Phone#.:781-585-0040 Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with 48 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp.insurance comp,insurance.i 9. ❑Building addition required.] 5. ❑ We area.corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.0 Other comp.insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information,. t Homeowners who submit this affidavit'indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors.have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name-Zurich American Policy#or Self-ins.Lic.#:WC0161691 Expiration Date:11/13/2018 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the.policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereb certify a er the pains and allies o er'u that the in ormadon provided above is true and correct. Si nature: Date Phone#: Official use only. Do not write in.this area,to be completed by city or town ofciat. 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#: r �1 Client#:23780 NEWEN16 DATE(MWDDNYYY) ACORD. CERTIFICATE OF LIABILITY INSURANCE 1 1 1/1 31201 7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT J Smith NAME: Sullivan Insurance Group,Inc. PHONE 508 791-2241 FAX 508 797-3689 A/C No Ext: A/C No 1 Mercantile Street E-MAIL Jsmith sullivan rou Suite 710 ADDRESS: g p•com Worcester,MA 01608 INSURERS AFFORDING COVERAGE NAIC If INSURER A:Gemini Insurance Company INSURED INSURER B.North Riverinsurance Company New England Electrical Contracting Corp - 21 Marion Drive INSURER C:Zud h American Kingston,MA 02364 INSURER D:Hanover Insurance Company INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR TYPE OF INSURANCE INDDL SUB POLICY NUMBER POLICY EFF MMIDDY EXP LIMITS A GENERAL LIABILITY X X VCGP002970 1/13/201711/13/201 EEAACMHA�OECCCURR�RENCE $1000000 X COMMERCIAL GENERAL LIABILITY PREMISES EaEtrrence $50 000 CLAIMS-MADE �OCCUR MED EXP(Any one person) $10 000 X BI/PD Ded:5,000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY x PROT LOC $ D AUTOMOBILE LIABILITY x x AWND095849 1/13/2017 11/13/201 EOMaBB"den SINGLE LIMIT 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED Ix SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS entX HIREDAUTOSNON-OWNED PROPER' DAMAGE $ AUTOS Per accid X rive Oth Car $ B X UMBRELLA UAB X OCCUR x x 5811075702 1/13/2017 1111312018 EACH OCCURRENCE $5 000 000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5 000 000 DED RETENTION$ $ C WORKERS COMPENSATION x WC016169101 1/13/2017 11/13/201 x WC STATU- OTH- AND EMPLOYERS'LIABILITYER Y/N ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT A 000,000 OFFICERIMEMBER EXCLUDED? a N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1 000 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addluonal Remarks Schedule,If more space Is required) Cert Holder named as additional insured.Policies are primary and non contributory.Policies include Waiver of subrogation. CERTIFICATE HOLDER CANCELLATION Sample of Master SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE tg� ' ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S333941/M333889 JJS NEXIUS Accelerating Network and Business Transformation 2-C CERTIFICATION Client: Verizon Wireless 400 Friberg Parkway Westborough,MA 01581 Site Name: Osterville MA SCO2 Site Address: Utility Poled 64-3,'21 Wianno Avenue Barnstable,MA 02655 Type of Survey: X GPS Survey X Ground Survey Horizontal Datum: NAD83 -expressed in degrees of Latitude and Longitude Vertical Datum: NAVD88 -expressed in feet Above Mean Sea Level(AMSL) Structure Type: —Self-Support Tower _Monopole Tower Guyed Tower _Wood Pole _Water Tank Smoke Stack _Roof Top _Church Steeple Temporary Site Silo X Other:Utility Pole Center of Structure: Latitude 41°37'39.48"N Longitude 70°23'05.49"W Ground Elevation at Structure: 0'(AGL) 40'(AMSL) Tap of Structure(Utility Pole) 34'-0"(AGL) 74'-0"(AMSL) Center of Proposed Verizon Antennas: 39'-6"(AGL) 79'-6"(AMSL) Highest Appurtenance: 41'-1"(AGL) 81'-l"(AMSL) Certification: I certify that the latitude and the longitude are accurate to within+/-50 feet horizontally,and that the ground elevation is accurate to within+/-20 feet vertically. The horizontal coordinates are based upon the North American Datum of 1983(NAD 83)and are expressed in degrees of latitude and Longitude.The elevations are based on the North American Vertical Datum of 1988 and are expressed in feet Above Mean Sea Level(AMSL). �ytH OF N, Signature: RONALOJ. Ronald J.Jackson P.E. 05 STRUCTU a NCTU N RAL y 0 27127 Date: June 14,2017 A ti n A&E OFFICE:7A LYBERTY WAY,WESTFORD,MA 0 1886 1 (972)755-1882 'APPENDIX IV Form 1 APPLICATION AND POLE ATTACHMENT LICENSE Licensee Verizon Wireless Street Address One Verizon Way,Mail Stop 4AW 100 City,State and Zip Basking Ridge,NJ 07920 Date 10/6/15 In accordance with the terms and conditions of the Pole Attachment Agreement,application is hereby made for a license to make 1 antenna,RRIVCabinet and meter attachments to poles and I Power Supply(ies)and other attachments located in the municipality of Barnstable in the State of MA This request will be designated Pole Attachment License Application Number OsteivilleMASCO2-384297 Attached are my power supply specifications'if'applicable.The cable's strand size is 0.5 and weight per foot of cable is 0.2. o Communication"Space X Power/Supply Space ti � Licensee's Name(Print)Barbara Kassabian _� Signature Barb Wa,Ka4aubtaw - O NSTAR d/bh EVERSO.URCE Power Company Title Site Acquisition Tel.No. 603-303-8001 y Fax No. N m E-mail bkassabian@trmcom.com *************«****«**For licensor use,do not write below this line********«******** Pole Attachment License Application Number is hereby-granted to make the attachments described in this application to attachments to JO!poles,, attachments to FOZ poles, attachments to JL13 poles, Power Supplies and other'attachments located in the municipality of , in the State of as indicated on the attached Form 3. Licensor's Name(Print) "1 cU'eN Signature (AGREEMENT ID#) Title C)C�Ar y\t U of Date �0 Tel.No. The Licensee shall submit an original copy of this application to Verizon New England F Inc. and NSTAR Electric Company d/b/a EVERSOURCE ENERGY. Revised 02/23/2015 NSTAR d/b/a EVERSOURCE A 1 Form 2 AUTHORIZATION FOR FIELD.SURVEY WORK Licensee: Verizon Wireless In accordance with Article III&Appendix I of the Pole Attachment Agreement, following is a summary of the charges which will apply to complete a field survey covering Pole Attachment License Application Number QstervilleMAX02-384297 in the municipality Of Barnstable in the State of MA FIELD SURVEY CHARGES :Field Survey #Poles Unit Rate Total Field Survey Application Fee 1 pole $139.00 $ 139.00 (includes 1st pole) Field Survey 2-200 Poles $ 13.45 per Pole $ Additional Travel Time* $200.00 pper Day $ TOTAL Charges $$139.00 *Based on average of 75 poles surveyed per day,add$200.00 travel time for each additional day required to complete survey. Please note,if you calculated the cost incorrectly,your check will be returned and a new check for the correct amount must be received by this office in order to schedule the survey. If you need assistance,please call the HOTLINE on 800-340-9822. The required field survey covering Pole Attachment License Application#Ost"nvMnsco2-389297 is authorized.I am enclosing an advance payment in the amount of$139.00. Licensee's Name(Print)Barbara Kassabian i Signature 13cwbcwa Xa0abiatw Title Site Acquisition Address 16 Chestnut St,Suite 420,Foxboro,MA 02035 Tel.No. 603-303-8001 Date 10/6/15 Revised 03/06/2015 Eversource Energy FORM 3—EVERSOURCE ITEMIZED Pole Make-Ready Work Charges PAGE OF RCE to Complete:Total Poles Surveyed Total Poles Requiring NSTAR Make-Ready Appendix IV Porm 3 t FIELD SURVEY.,- MARE READY WORK FORM SURVEYORS: DATE OF SURVEY: CWO u: Verizon =NZC:H2fn3tAb1t STATE: MA Exch Code: Munic.Code: Licensee Cralg Cody LICENSEE NAME:Verizow Wireless LICENSEE APPLICATION N:OAervuc'v"5C42.3$4297 EVERSOURCE ELCO NAME:EVERSOURCE NSTAR APPLICATION M' LOCATION:• t- = POLE 9' 'ATT . • OWNERSNIP 'CHARGE- WORK DESCRIFnON TEL RTE/STREET NAME Tel El F/C J.O. J.U. F.O. YES NO TASK*S / "Height List one pole per line P.S. Tei EI Tei El Tel .E[ REMARKS of Att. Rise r 21WlannoAve 64.3 NIA TOTAL& i. 'Hal gbt of Attsiehm int Might of Licensee AttaehmentsbsU be 40e bcloa ELCO MON ach otherr'vLe noted here by VeAron and.EVERSOURCE carve ar. Revised 03/06/2015 :Mceesen to co late botddtalfclzad arem anf. ProNdo*wn—hlp frjform ticn 1 knaain ' Revised 03/0612015 I L EVERS9URCE - Work Order Application FOR KEN KENDRICK: Customer Request In-Service Date:l/6/2016 WO Received Date: Service Address:Street: 21 Wianno Ave Suite:_Town:Barnstable Zip:02630 Customer Of Record: Customer Responsible for Payment of Monthly Electric Bills Name to appear on Monthly Bill:Verizon Wireless DBA—CIO Name: Billing Address: One Verizon Way,Mail Stop 4AW100 Basking Ridge, NJ 07020 Telephone: 508-320-2017 Tax ID Number: TBD Existing Account or Meter Number(if applicable): Property Owner Name (if different from above): Owner Address: Owner Phone Number: Party Responsible for Construction costs associated with work order(if different from above) Name:Verizon Wireless Address:400 Fribem Parkway,Westborough. MA 0.1581 Phone Number: 508-320-2017 Please Note that Articles of Incorporation are required for new commercial EVERSOURCE Customers Type of Service Requested: (Circle Appropriate) X New Service Service Upgrade Service Relocation Temporary Service Pole Relocation Disconnect/Reconnect Service Removal Metering Only OH Service from Pole, Pole#: UG Service from; Riser-Pole#: Padmount#: Customer Loading Brief Description of Work Attach (1) antenna (1) RRH/Cabinet and (1) Type of Load New Connected Load in KVA meter to the pole: WII require _60 amp single Single Phase Three Phase t)hase service. Lighting Electric heat Air Conditioning Refri eration" Cookin Electric Drver Water Heater COmDuter _ Process Equip. 14.4 Motors/Elevators Miscellaneous Totals 14.4 Number of Meters Required: Residential: Commercial: 1 Public: Main Switch Voltage: Amperage: Phase: Service Voltage: Amperage: Phase: Facility Type(ie: school,hospital): Telecommunications New Building Square Feet. ALL 480V SERVICES REQUIRE COLD SEQUENCE METERING(DISCONNECT SWITCR ON THE LINE SIDE OF THE METER If more than 1 meter is required,how will meters be labeled?(ie: Unit 1,2,etc, Unit A,B,etc.) Additional Equipment: Generator: KW: Phase: Purpose: Motor(S) : Total#: Largest HP: Phase: Locked Rotor AMP: Type of Starting Compensation(choose one): Hard Soft Capacitor VFD i *See Article 802 of EVERSOURCE Information and Requirements Book for Maximum LR current and Three Phase Protection* Contact Name(circle appropriate): Customer/Contractor/Consultant: CraigCudy Street Address: 16 Chestnut Street,Suite 420 City, State, Zip: Foxboro, MA 02035 Monday-Friday 9:00 a.m.to 5:00 p.m. Telephone: Best Time to Call. Pager: Fax: Cell: 781-831-1281 Electrician: TBD License Number: Business Name: Verizon Wireless Street Address:400 Friberg Parkway City, State,Zip:Westborough, MA 01581 Telephone 508-320-2017 Best Time to Call: Pager: Fax: Cell: Please note that by Interconnecting with the EVERSOURCE Distribution System the Customer of Record acknowledges that they have reviewed and are in compliance with the EVERSOURCE Information & Requirements for Electric Service(Blue Book). For New Commercial Services, New Residential Developments, New 13.8 kv Two Line Station Electric Service, please provide (2) copies of City/Town approved site plans that illustrates the new facility location and the proposed location of the new utilities(electric,.gas,'water,sewer,telecommunications)and a One-Line Diagram. For Service Increases at existing facilities,please submit a One-Line Diagram if available. For New Residential Services where a pole must be set,please provide(2)copies of a site plan that illustrates the proposed location of the new facilities. For Temporary Service Requests, please provide(2)copies of a site plan illustrating service location. You may Fax this Form or mail any additional correspondence to: EVERSOURCE ENERGY Electric and Gas One NSTAR Way Westwood, MA,02090 Tel: (781)441—3851 Fax:(781)441-3194 Cell:339-987-7059 H.Kendrick SW340 FOR NSTAR USE ONLY EVERSOURCE Revenue Allowance: EVERSOURCE Rate: KVA or KW rating of Existing Loads(if applicable): Existing Winter Peak Demand: Month/Date/Year: Existing Summer Peak Demand: Month/Date/Year: VIONOY MAP. LEASE — 8 LO Pd [ON EXHIBIT 1�= e L1161!�.IAJ.]l /%'•" ra.r m U-0 t� O 9 21 WIANNO AVE A BANNBTABLE, MA 02659 LEASE Exwbn SUBUT17ALS a n tmma tac Hm pWN 611 SS WE 111111lIR NET&T CO.#64-3 tpOP�NR4 � N 41' 37' 39.48* AERIAL MAP W 70' 23' 05.49" •.Yp11N 9 41lptlW1E �I L taltVq!W1.iM ygyltpfYfll OOWD LQ�NIL• ii eipxiuvauwnn rtva[uH, ;e,om7o^09 L9'0"�"`•N01`" VICINITY 8 P uttu.` =""mt t x.QAWA AERIAL MAP .t++c a.x.tuntun ate a mt wn w I a�nm wi taoaoi�m aum a ttu LE-1 ,. L!k?K��uil�w•tcWL i LEASE EXHIBIT �0�04 �oogOo EVILLE MI�HCO2 I TURNINGM[L1. tra 21 WIANNO AVE ,r�ro'u m,.•; SAHNBTABLE. MA 02859 LEASE EXM"SUBMIRALS S1TE PLAN �vanvc onrc wm . . f1tG�BI: 1i1 \ rOL \%Y {IGl)UDe, .Qt.YTOtl NEW,CO. #64-3 yeumiw-! I..an+a uwccw.rc omaunc iv aY aa,la• ura• r :,ratan i uowiNc uo e.tX.�v!roues -. .% aom.nxr ra'Iruc..i�ian orr. 'amrA°°eit°�m+~.,u �� N 41' 37' 39.48` H l w coelnova W 70' 23' 05.49" a..ota.mm»tout nmu oca>•ra \ -p M OUIN�VGi LRKC ro tS' .�.�16A1•. a.vrt ovw.ruv�eei+s aum a at.wsa ><N0a°u'.la.o•m SITE& m r:Nt.n uLL tmmauxn.tG' ins:uatm�:uan.IWN!eD aaun. DETAILED EXfSTINGSITEPLA_N_ n PROPOSED SITE PLAN SITE PLANE UQr,A L. Y a r LE-2 I .m�) Ryr nY c�NPfJW xlei tla0'JYp, ;','•"x z,arm .c000n,axt Ytmiw c o ar Low test sl LEASE EXHIBIT e'•,wsw•. rcur.Jo•uz,.0 m"1Np''""'"`•"'••1eJ' 7EI'-jMklll rAIV/.• o001VJ(D 1133[(A/m JN a;JRr sou.. - ssazu m unnr cawJxM �. Matlq ffeeYMw'm[a•feJ'L Aea_ �. TURN Na Mil.� CONStn�ANTS,IN ' ----,.:o mm/zac uu a zspL LCJ. .isam.Y•. - Renew —smno znno/uaz arts o zs..•L�a. �myyzm����o__a.��wyyrYce woven.uix[coil,.. zcin.a.oco/usi ass•uxL Lea_ ,d'F: �i+'i'w.�.. )'Y•eIYY(i:soa7. Eo],ae mze BO•o art J,CI_ m muJ �d 21 WIANNO AVE Y" BARNSTABLE, MA 02US •wi a ua wa®UssR LEASE D(HBIT SUHMMALS reow.so.m c - eaaaso rem diwe m' oea in� rem•pne' rae.o�ieti¢. •IJ • YJWY W Lr.-Rd •1 r - .Own iPWf • wNVY a}p •' .tJ 4n tRFl. a. IQIw i'-Y•YYYO II,UM1 YL1m 'JLMrI•L R _�-•�-C'. LPflalr fMl.e OBLm eh 1eJ - m1C NL1®l .tom, NEfkT CO. fi64-3 pa" N 41' 37' 39.48" ,r •,• 'ow.osma rs,.wa) W 70' 23' 05.49" POLE PHOTO 8 CONCEPTUAL UTILITY POLE 664-3 PHOTO 7,- CONCEPTUAL POLE ELEVATION /,1 ELEVATION LE-3 n.n t LEASE EXHIBIT STEVIIIE_MA_SCO , waao�'ueua.. u,ar w CTMFNG MILL' •n TAM we .uinat�+ M 21;ANNO AVE .m O° BARNSTABLE. mvonut a 9 B1O01" p MA 0206S 1r riarito 8 n o wo- tOlSC FJINUlU SU84RTA15 T• •'u..r rvonasm L n- fVlt%Ilf pIV.'N� R 0 . xam an Yfl aocm NEW CO. #64-3 taoerum ANTENNA DETAIL RRH DETAIL 8 NE RALLNIRING DIAGRAMS N 41' 3T 39.48° X/IC IdF . GWG�fX," C-. - • W 70' 23' 05.49" pm ime EQUIPMENT DETAILS LE-4 To: WIA130 PLA24 TRUST from: 9eb DeroCb°monC . .09-09 4:27am o. 2 of 2 ,� -C7? 2800 l � DATE(YrAiDO:YYYYI ACC)R CERT�PICATE OF LIABILITY INSUTANC _u_ PRGU,uCE9 PAUL PETERS AGENCY INC. _ THIS CERTIFICATE IS ISSUED A A %TATTER OF INFORMATION D ROA I ONLY AND CONFERS NO RIG -fS UPON THE CERTIFICATE '�8l!FALMGIjTH ROAD MASHREE, MA HOLDER. THIS CERTIFICATE D( ES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORI ED BY THE POLICIES BELOW. �508)477.002- Y C— _ INSURERS AFFORDING COVERAGI NAIL k INS9RED__—THOMAS OHARA INSURER A: LiDBr y Mutual Grou•.-- DBA TOM OHARA CONTRACTING I INSURER B: 110 AMES LANDING ROAD I!rtsuRrR a tv1ASHFEE MA 02649 h __----- -- -----4._.------ L_ _ _ _ j INSURER E.------- - ! COVERAGES I HE PCL!CIES Oh INSURANCE L!S'r_D 8EL(yr HAVE SEEN iSSUE7 TO THE INSU-RED NAMED ABOVE FOR I HE PO_IC'f AEI :)J:WI?IC4(-J.NOI WI rHS .4NDIVG ANY RE4aIREMENT.TE'RV OR CONDTICN OF ANY CGNTP,A.CT OR C-HER DOCUMENT WITH R=SP=CT TO`;''HIGH TH i CERTIFICATE MAY BE ISSUED OR i IVL4Y PERTAIN,YH_IVSt:RANCE AFFCRDED BY THE=OUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE T EPWS,cXC USIONS AND;ONDITICNS OF rQLiCIES.RGGREGArE LIMITS SHOWN MA"!IAV=BEEN NEDUCED BY FAD CLAIMS. INSR IAUD'L,-- -- i — 1 POLICY EFFECTNE POLICY EXPIRAI'i0N--- - ------- 1 TYPE Q?IN 4ugt NC ! POLICY NUMBER I(�A7c;MMfDOIYYYYI DA1E!} _ Y TYI I _---—UrfiT9 GENERAL L`P.nlLi'IY I (:_SChI C -'JR=ENCE !S I ! AL4AGI t-1ENTFr-' r Cfl,?A\ITFQ:d C•ErJER:,L I.IGA LT' ?RE.i�IS > EDcan rrer �'---- -.L .--- I CLAWS? rF L..j OCCUR I !AJF-D EX ;A,L0.,n u_'I9ci:u ! I =RSOr .I a Acv IN.uRY $ GENER, :,QGFEt'ATE 19' GFf+- Au(•.REGFTL-IM-TAcPIJFSI-'ER:1 I !--RCD4Jr COb1Fi0?!+f-- ` r i le !'AULO;::OBiL'c i.iR BIU!f ) I I--DL18:1• r•SIrVCiL[t'hti( - - -- -;.:Nv NIJTi � I;E3 accK rI) 4I.L CIVNE AL-'CS ' •WMLF L.(JRY ! i !SC!iEL'ULED AUii:S I I i:PSf pert n: I I HIRFDt.UTCS I 1301:I0 LAMY I g ' NC-N-OVTJEC WTOS ! I jP acc• I_... : I I—I — --- i I''RCP& LAMAIGE i --'----- I ; ! j GARAGE LIABIUTY j °AUT^C .'-EA ACCIDENT ' ,;NY AUrO I I I '' HER 1Ai4 EA,ACC!$ ..—. _ i 14VT::D -�------ �-"' I _ AGG i$ LCXCESS I UMBRELLA LIABIL1l" I EFC i O =IJRRENCE _..._ I OCC!JR I CL-ims""I" .4G^R°I CrE r—� DEDUCTIBLE i �yRETF.WT::JrJ +VORKERSCONPENSAI'tON ---�— h7/'ZC1Vg r•i'\•1 iTATU- CiH � A I WC2-3�S-3457�3-023 6/27/2008 6;c id iT\. I ; � C .AND crHFLOYERS'L:ABILITY Y/N I --O -�ja__ I EP — �1n/_� 'aHv PROry1IF ^R:PARTnER1FxEC'J7t1'F I I !E.I.EAC !ACC DENT !u 'I000Vl_•— �OFVCEP.M.=M�ER EA:XUD"? !?MandVory in NH; ! DSI ?8E-EA EP4PL`v''EFa f _f.U(}Q()[1 EC::AL PRCVI iI'NS D9a+: I : I_D!S� :iF RCLiC—Y i!A1!'. I$ —7=-- ---- -- —r— - — ;OTHER ! DL-BCRIPI':ON LW OPE4A1"!CINS I LOCA':ONS/VEH!CLES!EXCL'a SIGNS ADDED BY ENIDONSF.MENI/SKC AL PROVISIONS THE WORKERS COMPENSATION POLICY DOES NOT PROVIDE COVERAGE FOR THOM!AS JHARA CERTiFIC'ATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLL; iS BE CANCEL.LE O BEFORE THE EXPIRATON iNIANNO PLAZA TRUST ❑ATE THEREOF,THE ISSUING INSURER WILL I IUFAVOR TO MAIL 7— DAYS WRITTEN 20 WIANNO AVE NOTICE TO THE CER11FICATE HOLDER NAA7EC 074E LEFT,BUT FAILURE TO DO 90 SHALL OSTERVILLE MA 02655 IMPOSE NO OBLIGATION OR LIABIUT-OF AN mND UPON THE INSURER.ITS AGENTS CR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE _ ,1Bf:Eldndge ��"• ,) C i ACORD 25(2009101) i7 1988.2009 ACORD C )IRPORAT10N. All rights reserved. 3i? :C-;I o:i3:S; 1y Taq_ 1 DE 1 'GTSnodernl To: ;+1508-'3,26,17 5v85392517 (3 of 4) 03-: 3-2009 1C :S6 AM -0500 Pe9 P+P1 t9Y'{., �s i Da'.E IMN.:UDM'YY) A a/RD CERTIFICATE, OF LIABILITY INSURANCE � 1 3i13/'70,9 ?RCtD'JCSR (508)955-4SS3 TAX: (508)995-4525 THIS CERT1FiCA7E IS ISSUED AS e:MATTER OF INFORMATION Sylvia 6 Company Insurance Agency, Inc. ONLY AND CONFERS NO RICH E, UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOE i NOT AMIEND, EXTEND OR 500 Faunce Corner Pboad ALTER THE COVERAGE AFFORDS[ BY THE POLICIES BELOW. Building 100 Suite 120 1 1_ Dartmouth DIM 02747 _ INSURERS AFFORDING COVERAGE r1_ _ NtCu _ '.WURED — i q_,j,Er: Peerless Insurance_ — 24198 JORGE DFis[i^1ALL CO. INC. rd up-:Excelsior insurance 11045 124 STATE RD r,_u:_=c.National Union Lvirf ins_ Pl-URER D. — — —__ I N DART'MUTH MA 027E7• I i OVERAQES THE POLISIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEC A•3C'VE FOR TFE=OLICY PERIEX ::'JDICATEC.11,OTWIT!-STANDING AAY-I REOUIREMSNT,TERM OR CONDITION OF ANY CONTRA:;T OR OTHCP,DOCUMENT WITH RESPECT TO WHICH TH4 CERTIr'IC!< c MAY BE ISSUED OR MAY PERTAIN. THE INSURAN•::E AFFORDED 81' THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS At ) CONCITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHGL_VN MAY HAVE BEQN REDUCED BY PAID CLAIMS. INSR AUD? --�- POLICY EFFECTIVE POLICY EXPiR6.ION e TYPE CF INSURANCE POLICYNUMSER �DATE(MMIDOh-Y) CRATE.MIAIDD!rn !!MIT: GENFRAL �r r,lC:i r:•: _;7=`e•,r_ __I p 1,0.�.J,��i) 5 00 A ix ( ( -- ---�,;fPAsn-rE F - = I c.;gREGAJE'_!M AP=L!c5:"c a I I RE:12 101 e..v !4. =rr 000 0.1.--I AUTOMOBILE.L!AEI.TY ( I COetBINE FdN3_E-.i:IT -)0 `� Al1Y AIJT o'S IEe atfa Pl -LL 0W1.-ED: -C,' J EEa8136126 13/15/2006 3/1.5/2009 �JDILY I� -1.•, ! c If X '::Hc Ct4ED.+IJTiJS ("ter cer,n X -.i61-CiI.,P,ED`!JT_ 1 F.eCIaL.`r;ir•, t' 1,G ARAGE LEA°!CITY I A.1T0 ONi „9F._;�IL_EFt- �'`' t -�— 1,1,,•._+1I i-oc;tt j=XCESSIUMBRELS,LIA%L!TY �• i,Pc C'- ti I 70 Cf_UF ;L.:Ii.i?A!A>E 4ECREr,! A I I OE-Lr•:.T:SLc I"'J8126JSi 3/1I1/2002 13/15/2009 iT — X EIEI.I-ICI: 310.000 5 C IWORKERS COMPENSItTlCN ANC' EMPLOYE S'LIABIL:f 4:av „C PR!E70RrPA=TNGprc�_rI.IT'pr L�E1;N. t,QDEdt 3ti ry a;cRftAMSR E o_7C_0_09 319?35 - 21 i 2/15/2010 I ;g, - _MOF=ICE -----50--0-,-0-00 _CIA; , • 8E' 500,0: OTHER i —I I I OESCRIPTION OF OPERATION£::LOCATIONSM'S},ICL-ESE XCLUSIONS ADDED BY ENUORSEMENTSPECAL?RGVIS!ONS Project: 21 Wianno Avanuo, Osterville, W. j CERTIFICATE HOLDER CANCELLATION (508)539-2617 i SHOULD ANY OF THE ABOVE OESCRie'ED )LIIJES BE CANCELLED BEFORE THE 1 Tam O°Hsra EXPiRAP.ON OAW THEREOF. THE ISSUING INSURER WILL 'ENDEAVOR TO "WL 1.1.0 Amos Landing Road 10 uAYS W-mTTEN NOTICE TO THE CERTIF VkTE HOLDER NAMED TO THE LEFT.BL.'( I blaahpae, DA 02649 -- FrILURE TO:O SO SHALL IMPOSE N^ODLIGA; )NOR L!A_ILITY OF ANY KIND UPON 114E 1 INSURER,ITS AGEN7S OR R PRESENTATNES. Y AUTHORIZE:REPRESENTATIVE zP )0 's�-- ACORD 25(2001108) s ACORD CORPORATION 1288 INS025 Pi'!0d.;Ea aka 1.1 i 7/FEB/2009./FRI 11 : 11 C-0—MM FIRE DEPT FAX No, 5087902385 P, 001 • f �P W c�;. N ca CENTERVILLE—OSTERVILLE-MARSTONS MILLS. FIRE I)IST- CT DEPARTMENT OF FIRE-RESCUE & EMERGENCY SERVICES N m 1875 Falmouth Road, Rte.28 Emergency Nu ber: N Centerville, MA 02632-3117 Business: (508)790-2375 John M. Farrington Facsimile: (508)790-2385 Fire Prevention/Administration Chief of Department Facsimile: (508) 957-8239 Dispatch Center FAX COMMUNICATION MESSAGE DATE: -' 7-09 TO: PHONE: PHONE: ATTN: �tc�2arJ FROM: . 1 (A)'I Aowo At r WE ARE SENDING 4-� PAGES, INCLUDING THIS COVER SHEET. PLEASE CALL(508) 790-2375 IF YOU DO NOT RECEIVE THE TOTAL NUMBER OF PAGES: CONFIDENTIALITY NOTICE: This fax transmission may contain confidential information belonging to the sender and such information Is legally privileged and is Intended only for the use of the individual or entity named above. Any copying, disclosure, distribution or dissemination of this information or the taking of any action based on the convents of this communication is strictly prohibited. If you have received this transmission in error, please notify us immediately by telephone and return the original transmission to us by mail or delivery at our address above, We shall cover the cost of return mail. Thank you! 27/FEB/2008/FRI 11 : 11 C-0-MM FIRE DEPT FAX No. 5087902385 P. 002 FYRF DTPARTINIENTS OF THE TOWN OF BARNSTABL,E Tire Prevention Office--Rix)clrley Building 200 Main Street, Hyannis, MA 02601 (508) 862-4097 BUILDING CODE COMPLIANCE FORM Plans dated 09-77-0. for the property located at a✓ i Wi4m,,o Avc s—,re-vicx _also kDown as _ �R,'LcS�5r�3`E have been reviewed by ✓1.S%P4k ofthe. ❑ .Barnatabie• :9COMM .❑ Cotuit ❑ Hyannis ❑ West:Barnst;able--'•;,- Fire Department. THE CHART BELOW INDICATES THE STATUS OF THE REVIEW: TYPE OF,CONSTRUCTION DOCUMENT N/A RECEIVED REVIEWED COMPLIES 1. Narrative Reporl t� 2. Firefighting & Rescue Access 3. Hydrant Location &Water Supply ✓ 4. Sprinkler Systems 5. Sprinkler Control Equipment 6. Standpipe Systems 7. Standpipe Valve Locations B_ Fire Department Connection 9, Fire Protective Signaling System 10. F.P.S.S. &Annunciator Location t/ 11. Smoke Control/Exhaust ✓ 12. Smoke Control Equipment Location t/ 13. Life Safety System Features V, 14, Fire Extinguishing Systems ✓ 15. F.E.S, Control Equipment Location 16. Fire Protection Rooms 17, Fire Protection Equipment Signage v- 18. Alarm Transmission Method V., 19. Sequence of Operation Report ✓ 20. Acceptance Testing Criteria We believe this document to be-complete and compliant for the issuance of a building..permit. We have completed the acceptance testing for the occupancy permit and believe that within the scope of the building permit, the above Issues are in compliance. 51S71 I-" o &'L)V4AC=Q-.70 C"?"7 e:F' /�k�a2 � �i c Sa&u-eA �►°�� 1.�6vf-i'?�6 -a— ��� a�P1avF�uoS�fti�IL.S �e� �irtaSo Massachusetts Department of,Environmental Protection Bureau of Waste Prevention .Air Quality 1100085167 Decal Number BWP AQ 06 Notification Prior to Construction or Demolition Important: A. Applicability When filling out PP ty forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential buil nt of Environmental Protection cursor-do not use the return (DEP), Burea Validation process is running..... 10 CMR 7.09. Notification of key. Construction (2)ten (10)days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. "� B. General Project Description 1. a. is this facility fee exempt-city,town,district, municipal housing authority, owner-occupied Instructions residence of four units or less?❑Yes H No 1.All sections of b. Provide blanket decal number if applicable: Blanket Decal Number this is form must be completed in order to comply with the 2. Facility Information: Department of WIANNO PLAZA TRUST Environmental Protection a.Name notification 25 WIANNO AVE requirements of b.Address 310 CMR 7.09 Barnstable 1 IMA 1 102601 c.Citvfrown d.State e.Zip ode (508)728-2100 1 lamosllO@msn.com f.Telephone Number area code and extension) E-mail Address(optionao 600 1 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ❑✓ Yes ❑ No k. Describe the current or prior use of the facility: RETAIL I. Is the facility a residential facility? ❑ Yes ❑✓ No ®C m. If yes, how many units? Number of Units 0 3. Facility Owner: �N WIANNO PLAZA TRUST �0 a.Name .��0 2039 CLUB DR. b.Address VERO BEACH FL 132963 c.CitvfTown d.State e.ZiD Code (508)420-5585 f.Tele hone Number area code and extension .E-mail Address o tiona d NATHAN BOUCHER Q h.Onsite Manager Name agO6.doc•10/02 BWP AQ 06•Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention .Air Quality 100085167 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General General Project p (cont.) Statement:If ject Description cont. asbestos is found during a Construction or 4. General Contractor: Demolition THOMAS F O'HARA CONTRACTING operation,all responsible parties a.Name must comply with 110 AMOS LANDING RD 310 CMR 7.00, b.Address er21 and Chapter MASHPEE IMA 02649 Chapter 21 E of the General Laws of c.C /Town d.State e.ZipCode the Commonwealth. (508)728-2100 1 JAMOS110@MSN.COM This would include, f.Telephone Number area code and extension q.E-mail Address(optionaq but would not be limited to,filing an ITHOMAS O'HARA asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. TOM O'HARA CONTRACTING a.Name 110 AMOS LANDING RD b.Address MASHPEE IMA 102649 c.City/Town d.State e.Zip Code (508)728-2100 amos110@msn.com f.Telephone Number(area code and extension) g.E-mail Address(optionaQ NORMAN BOUCHER h.On-site Manager Name 2. On-Site Supervisor: THOMAS O'HARA On-Site Supervisor Name ® 3. Is the entire facility to be demolished? ® Yes 0 No N o 4. Describe the area(s)to be demolished: �o NO DEMOLITION N .�o 0 5. If this is a construction project,describe the building(s)or addition(s)to be constructed: ®V- SINGLE STORY RETAIL BUILDING/RETAIL FIT OUT �t0 r� O �Q agO6.doc•10/02 BVVP AQ 06•Page 2 of 3 I Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention .Air Quality 1100085167 Decal Number BWP AQ 06 Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project, were the structure(s)surveyed for the presence of asbestos containing material(ACM)? ❑ Yes ❑✓ No If yes, who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 10311612009 05/16/2009 a.Start Date(mm/ddtyyyy) b.End Date(mmlddtyyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ® seeding ❑ paving ❑ wetting ❑ shrouding b. If other, please specify: ❑✓ covering ❑ other 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization d.DEP Waiver Number D. Certification I certify that I have examined the THOMAS F O'HARA =o above and that to the best of my a.Print Name o knowledge it is true and complete. The signature below subjects the b.Authorized Signature N signer to the general statutes CONTRACTOR 0 regarding a false and misleading c. os io e �0' statement(s). STORE TENANT d.Re resentin W e.Date(mm/dd/yyyy) Q ■ ag06.doc•10102 BWP AQ 06•Page 3 of 3■ eDEP-MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System I Usemame:TOMOHARA V My eDEP I Forms NO My Profile c* Help Payment Confirmation Forms Signature Payment Submit DEP Transaction ID:229556 Payment Date:3/3/2009 2:67:01 PM $85.00 has been charged to Credit Card""""""3709 Transaction Information i DEP Payment Code#36801 Payment Confirmation#32676 Please note that payments received after 3:30 pm will not be posted until the next business day. print next MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.8.4.1.0©2008 MassDEP https://edep.dep.mass.gov/Pages/PaymentConfirmation.aspx 3/3/2009 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel - Permit# Health Division — 'Ct m U- OARNSTABLE Date Issued Conservation Division ""FAA Y /6 AH 9. 16 Application Fee Tax Collector Permit Fee .�isoo�Ta: SYSTEM UST BE Treasurer DIVISION pf�f5 ,----I Y ,LIEC IN COMPLIANCE Planning Dept. WITH TITLE 5 ENViF;O MENTAL CODE ANL Date Definitive Plan Approved by Planning Board T01714 REGULATIONS Historic-OKH Preservation/Hyannis Project Street Address Village �S�e r v Owner A r7rYY(-,C r bou c-Aetr Address sc,&Cd-,�U r n/t J) Telephone Permit Request g C-5 is (�S' Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation tP1000 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 Cl 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 E J-J au—+`x t r f wt r" C, 'nG Telephone Number ( 0 8 ) ?rig - 4 9/ Address �g fiosanz karu, License# do 3as I 1�uo h A X -S OZ.(aOi Home Improvement Contractor# 0 q Worker's Compensation# ALL CONSTRUCTION DEB S RESULTING FROM THIS PROJECT WILL BE TAKEN TO "0- MJr ' bU-f k-P s DATE SIGNATURE FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. a 2 ADDRESS VILLAGE OWNER DATE OF INSPECTION: ` FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING • h (ice • DATE CLOSED OUT ASSOCIATION PLAN NO. " - :-_--_!_— The Commonwealth of Massachusetts p< _ L Department of Industrial Accidents Office allnlvestigatians 600 Washington Street Boston,Mass. 02111 Compensation Insurance Affidavit������������������������������������������� name: J J&Y-TI rn.f�-7 . Er—, I UC, . location: city phone# ❑ I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. add X. X. company name �T.: ress.. � n r insurance-co.,, �4- VEMMEMMENNEEN / / / ///%/ ❑ 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: :.. . name: :.. . company :::.;:.;:.;:..:....:.. ::. .: ..: .........................:>::.:;:::..:.;:.;:::;::.;:.;>:;::.;::.;: address:.. : ..... . ..........:•.:..: ::... ;.;.:.:;:., .,,... ...:::::::.. .: .....::::.::::. ...:.:::.:..........:::,.:::.. Bone#::"`........:::; >:>> :' >[ ....... D - insurance:ca:: 11 xx ma co' any names ;>> _[ > »>::;:::;:::<`'::»::>:: ...:..:::.::::: . ..... address: :.::..:..: :::::::::..:::::.::....... .... .. ���� li"one ' .::` `:�'��'' p ....... ............. 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 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$100.00 a day against me. I understand that a copy of this statement may be fo arded to the Office of Investigations of the DIA for coverage verification. I do hereby certify un t e ains and penalties of perjury that the information provided above is true and correct 5 I Signature � Date I�� Print name lw r Phone# /D official use only do not write in this area to be completed by city or town official city or town: permit/Ucense# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (revised 9/95 PJA) gn7e Board of Building Regulations and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement'Contractor Registration Registration: 110609 Type: Private Corporation Expiration: 11/3/2004 E J JAXTIMER, BUILDER, INC. ERNEST JAXTIMER _ 48 ROSARY LN HYANNIS, MA 02601 Update Address and return card.Mark reason for change. '--i Address. I--] Renewal f vrnpinvment F.I Lost Card JOX e I ec'� adw4ea Board of Building (w1ations 4! `` One Ashburton Place, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Number: CS 003251 Expires:01/14/2004 Restricted To: 00 ERNEST J JAXTIMER 48 ROSARY LANE HYANNIS, MA 02601 s. Tr.no: 14213 Keep top for receipt and change of address notification. Town of Barnstable Regulatory Services 9BARMASS.NSTABEZg- Thomas F.Geiler,Director E1639n. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, '`y" , as Owner of the subject property hereby authorize �J OJ�-)C-'!J{'Yt,Q.�, ��j �h C to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) /Z 6/0 Z Signature of OWt« Date !V r�l//J41Gf/�l zr3(�C.C�,�'I Print Name" Q:FORMS:OWNERPERMISSION r BuDdi ag Division 367 Main Stacet,HyWmis MA 02601 Office: 308-790.6227 Mph Crasscn Fax: 308-790-6230 Building Commissioner Application for Sign Permit Applicant Doing Business As: f - Telephone No.�C�$ Sign Loca.don Street/Road:_ w��L Zoning District: _.. Old Icings ffighwayP Yes/,�Io J/ Property Owner � Narnc• 10(n Address:. . 1""y�1J'!1> _ 4C3 ' Sign Nad Address; .�._._..._. ..._.,,...._.__ ?•�a- . M _ _.. II Description Please draw a diagram of.'ot sho%jng,,:'ca6ora of buil&gs and evi:"UIg signs Mth d rnensions, loc.lbon and size of the n ,w sign. Thi: should be drawn on the r-Merle side of this appliCaiion• Al :T: .11$Ad ►U UC CiC4uli�c . •`...�..v ^•. .... �� `. :�. .._.. ....�r�l riprrtJ�' (.1:.,.. .�. l .� I.l� i 1'i.1�.. '►;.. 'Y` �1!" ®WTlrr to MaKC U113 ._ _ ,;,I •n� �ntr•^ , y - 'ri , : -L'ollstrue..,nn shall conform to the nr:,1::-r� • ..• dt%�ISUl1 W,', ` ie.'. .... .. ... .�J.��Sol.i.r• �r•} e�l'•j rJ*U1R311LQ'. it�34W� b� ...... •.�l►.o.i1 e..vfo ; '�,.i�l. /��'C•, 7���' ZL'(� 8.�11.e+• f Jigrtat�te of , '-,ng Otfit >> ..__Date;_.. -3a" 94, The Town of Barnstable Department of Health, Safety and Environmental Services HAM g Building Division 163 �m . 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Tax Collector Application for Sign Permit Applicant: fa -�. 'Pt-ZV?�1,3\64 Assessors No. /! Doing Business As:0!5T;-V,\JAe, C\jArCS<-S�Q Telephone No. 4-28 'iOA Sign Location rr . 11 Street/Road: �J �A iJ �• 4 O� �S5 1 Zoning District: Old Kings HighwayP Yes;Flyannis Historic District? Ye4zo Property Owner ` Name: 1,Prt J N O l�'�.�h���7�� Telephone: Address: �CO, C`� Z7L_t�o �A ` QWNS , &Village: Sign Contractor Name: Telephone: Address• —village: 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. Is the sign to be electrified? Y kNo (Note:ffyes, a wiringpermitis required) I hereby certify that I am the owner or that I have the authority of the owner to make this application, that the information is correct and that the usk and construction shall conform to the provisions of Section 4-3 of the Town of s le Ordinance. +, Signature of Owner/Authorized Agent: w-- Date: Ctlollzsci hd Size: Permit Fee• //.l`T .Sign Permit was approv Disapproved: Signature of Building Official: . / Date: Signl.doc dM R The Town of Barnstable NAM ' Department of Health, Safety and Environmental Services Bmlding Division 367 Main Shtd,Hyannis MA 02601 Office. 509-790.6227 mph Cwssen Fax: 508-775-3344 Building Commissio Sign Permit Requirements 1. A photograph showing the existing facade, on which has been indicated the proposed sign location. The photograph is to include a portion of adjoining stores or buildings. For a proposed building or a new facade, an architect's elevation may be submitted in lieu of a photograph. 2. A scale drawing of the proposed sign. A scale drawing indicating: 1) The type of proposed sign (wall, hanging, free standing) 2) Dimensions of the proposed sign and any designs, logos, or lettering 3) Colors, the drawing may be black and white, but color chips must be attached for colors other than black, pure white, or gold leaf 4) Materials, what the proposed sign and letters are to be constructed of ! 5) A cross-section with dimensions showing edge detail. Minimum scale 1"=I' Minimum sheet size, 8.5 x 11". Two Sets. 3. A scale drawing of the bracket. A scale drawing indicating dimensions, color,.materials and method of affixing it to the sign and to the building. Minimum scale 1"=I'. Minimum sheet size, 8.5 x 11". Two sets. 4. A completed Town of Barnstable Sign Application, including scaled diagram showing location of sign on building or location of free-standing sign. Show dimensions. , Assessor's map,and lot number ... ......�,..9...9r.............. Sewage Permit number ........................................................... Q�ofTMEro�` TOWN OF BARNSTABLE • BAWST"LL i 2639 ,e0�� BUILDING INSPECTOR � YPY a' • APPLICATION FOR PERMIT TO ........................................................ .............................................:...................... TYPE OF CONSTRUCTION .....:. C 4 Al YZ V 4 U)A r7 T) y. ................. .� ................................................................................ ............................... 19 `.. ................. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location 4 Tr;h a, _T n ..;A.A 9 ►C .. >"c,r! c'r R ���by >�t.D�•-:................................................................................................. ... .................................................................... Proposed Use ......................................e ( �a c•r4 r?S .�. ....... ....................................................................................................... . Zoning District .......... Fire District. ... "!.! Iry �d r — p I A,1�111e ................................ ................................................... d10 PAvi- 4ie124A"- . Name of Owner .............Address .......c.?•, e4 ., u r ,6 c r� &.Iew M,4K S....y. Name of Builder .('�•1^,!Unl...%1 t e�'., -r N C......................Address ...:� Ran 1 �. t, l!t , VAaz h oqt 4 Al A•< ........ . .................................. . . ............ Name of Architect .. ..^. : ...�AUCN Rr� ........................Address ..:�'�.AIN.. � I.. .c'f•�dt vl L1, ..................... ........ .......... ............................... Number of Rooms .......................................................Foundation .....:Q.,Aarr ..... Exterior .......�1 A:n to R !Z I, C 1� Roofing T A V 4��n fiu�=1� ..........:..................................................... ................ .:........................................................:. Floors � .......................... .Interior ...... �....................................................... Heating �. A.�. 1'Rr? Zt�a1' l Gl7:....................Plumbing ....... - Tl.0 �� lZ- �4Th.s................ ................ ..... ........................... Fireplace ............ .............................................................Approximate Cost ............... . ................... Definitive Plan Approved by Planning Board --------------------_-----------19________. Area ...... ?. !?..�r............... Diagram of Lot and Building with Dimensions Fee ?' ' ..av.................... SUBJECT TO APPROVAL OF BOARD OF HEALTH I ' I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... Jlnh a c ....... -3144.............. Wianno Plaza Trust A=117-98 18217 add to commercial No ................. Permit for .................................... building ............................................................................... Location V Wianno Avenue ................................................................ Os t e r vi 1 1 e Wianno ps t cn Owner ...............W..i.a;...............Plaza.z Tr..a....... ..................... X)DOM masonry Type of Construction .......................................... A .......................................................:...................... Plot ............................ Lot ................................ " 3 Permit Granted .......March. . ........................19 76 Date of Inspection .................................... 9 oU 01 �, �� Date Completed .............................. . I J PERMIT REFUSED . .................................0.1Z............... 19 ........... .... . ........ .M4. . ................ \ .... ......1. I . .. . ....I %A rA .......................... ... .... X................................ Approved ............................................. 19 (/) . %A . ........ .................................... ...................... % IV ... ................ ............................................................ 1 Assessor's 'map and lot number ...1!®7... }.?,T.............. �(l� SEPTIC SYSTEM MUST 3E (� INSTALLED IN COINIPLIANCE c Sewage P6rmit number ........................................................ WITH ARTICLE II STATE ` • N T SANITARV rnr)c i� ���o�t E o�� TOWN O F BiF)WL v O I� S T B E tz Z BASBSTODLi, i O 'A 9 � - BUILDING INSPECTOR am a' �- tz C , ' Q . r i APPLICATION-FOR1rPERMIT TO ............................................................................................................................. c TYPE OF CONSTRUCTION ........13)-Q!1k !`I.Aso.N.> .. (-�1.Q.V .......:................................................. G. /.. .......... ........../4..A..-1 C.AG......3...........19.N... C: TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: n < < Location ..../�.� .....MA12 K.1*Rk)9CF. LS7.R..N).< .... .................................................................... � n Proposed Use ........ .4.Yh.Yrt.4�'.4t . . .:./ .V..�I.N.. .s ................................................................................ Zoning District ....... Fire District .......e....�..'� ut I�� '" S 1��uil�e ................................................... ........ d`a Ph u A. M o 12GAIJ E Name of Owner kN[A/uN.Q.... .............Address .......YXh! &..d..AuC......../,QS E...;t +iW. i!7049S,,,, Name of Builder A—P-e-e.j-N0......................Address t?.0....R�.44:. LV......A.(z Name of Architect S.O .m...8A' NARI.........................Address ../..Ubl...S,I„.,......: Number of Rooms .........L.......................................................Foundation ......AL,U.hC.d.......1..,C ........................... Exierior .......M.NCAN Ry.....gl-: bC./{.................................Roofing ... ............................................ Floors .... ...Q..bl................................................................Interior ....... .................................................... HeatingA3...j.1t?1:................ .......up......................Plumbing ........ ...... ............ 5�... ............................................ Fireplace ........................Approximate Cost ..........� �...... Definitive Plan Approved by Planning Board -----------_______-----------19________. Area ....../b..-I.V.0...................... Diagram of Lot and Building with Dimensions Fee � ( .r� .1........ . . ........................ SUBJECT TO APPROVAL OF BOARD OF HEALTH i L . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....O.Ov..... . ... . ... Ate. '............. .j. . . . . 'Wianno Plaza Trust No ' ... 8~ ..`_Penn' for ....�dd..to..��� ���lal ___bo1l��ou__`,/____________.� . _ . m ��eo�e Lo ��a�ocohon ---._--_.---------�---.. � . ' . - Qoterv11la '^---~--------------.'\------'' g1aomxm Plaza Trust - Owner CJvvner - '--------------'`r------' - ' Typo of Construction .........�����.—. ^ . -------------------...--.---.. / Plot --- �t �—.... --� - ------�---- ' , March 3 76 Permit Granted .......... ' Date of Inspection [xxu» Completed 'z�1 ---]q ` � PERMIT REFUSED ' -----.--.._--.-_._------' lA ..--------~----------------. ^ --^—'^---''�---''r''�--~^^-----'. '� .-.-----.----.—..�-.----..—.—.--�� . � .-------.�.�`.-----~--.-------.. ~ . ' Approved ---------------.. lQ -------.-------------.--..—.^. . ^ , . . . ------------------------.~.^ . . ' ^ 6Y DATE SUBJECT " LA^�S�'E SHEET NO. OF CHKD. BY DATE JOB NO. ['77 ;I JQ ,r New_ partitions in color to be 2"x4" (minimum) studs 16" O.C. 1/210 sheet- rock in basemnt 2 sides* First paneling, or other material Floor for decor Pirst 'floor Basement r , k �s i ALTERATIONS TO STORE AT 23 WIANNO AVENUE • Floor Plans OSTERVILLE, MASS: March 21, 1973 scale 1/811 a 1:01 owner The Wianno Plaza Trust lessee YANKEE ACCENT R. A, Frazee alterations to be made by lessee r cA I ET°�`� TOWN OF BARNSTABLE, BARNSTAIL MAM IU3.y. . - INSPECTOR ou BUILDING I APPLICATION cr- FOR PERMIT TO ................R.L.,. . p......................................................L. NOZ* ............................... TYPE OF CONSTRUCTION .......... - .2 : ..................................................................... r-1 IV ) . ................................................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: LocationI. ............. ....... ........6.VFV.Uf.... OSFe..vl L.L.F.Proposed Use ......... ..... ............................... .... .. ................................................................ 0 Zoning District ............................... .....Fire District ........ ...................... Nome of Owner ... .........................Address .....R. ..................:'.......................... .. ...... Nameof Builder ............Address ..................................................................................... Nome of Architect ......Address ................................................. Number of Rooms ................ ......................................Foundation ............Cnf-4 7- C ............................C v�t Aw r- ra ta wqzz Exterior ................................................................................... Roofing ............ a-Rh I/C- /L .7 4- 7. ........................................................ Floors ..........09S.0 477..T14C.... ..Interior ............. te j 7,F/Z. .. ......................... ..... . ............ Heating ...................... -S.............................................Plumbing ... ARAM- Fireplace ..................................................................................Approximate Cost ..... . 0C)o ... ...M. ......................�/.... ............/. Definitive Plan Approved by Planning Board ---------------—---------- 44,OA, Diagram of Lot and Building with Dimensions M e- e, SUBJECT TO APPROVAL OF BOARD OF HEALTH \ � ��� �V :s' A -Q, I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . . . .. .. ..... ... .................... ..............................( WiAnno Plaza Trust 15913 No ................. Permit for ...., remodel interior............................... of store ............................................................................... 21 Wianno Ave, ............................................................... Location ............................0sterville................................................... Owner .............Vkanno Plaza Trust ..................................................... Type of Construction .......................store................... ................................................................................ Plot ............................ Lot ................................ 22 Permit Granted .........................Februax7...............19 73 Date of Inspection ....................................19 _Date' Completed .. . . .. ..... ......�.,,& PERMIT-REFUSED ............................................... ................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... ............................................................................... Y l i TOWN -OF BARNSTABLE SIGN PERMIT PARCEL ID 117 098 GEOBASE ID 5846 ADDRESS 21 WIANNO AVENUE PHONE Osterville ZIP - LOT BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT CO PERMIT 14792 DESCRIPTION VINTAGE FLOORS & .CO, LLC ( 10 SQ.FT. ) PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $25.00 �TME BOND $.00 , CONSTRUCTION COSTS $.00 Q� 753 MISC. NOT CODED ELSEWHERE ; BARN3PABi•E► , i MAS& OWNER MORGAN, FIELD P & i639. ADDRESS , BOUCHER NORMAN �� 2039 CLUB DRIVE BUILDING DIVIS ON VERO BEACH FL B ',1� DATE ISSUED 04/29/1996 EXPIRATION DATE `� � dThe own o arnsta _ . Department of Health, Safety and Environmental Services • Building Division 9A dm- 367 Main Stores,Hyannis MA 02601 11-a q-9 0 z5,071 Application for Sign Permit Applicant: - { t LG -Assessor's no. Doing Business As: Lh n/i A �Lory s J' Lo, L-� � Telephone /6 ,S -2�1� Sign Location streethoad: 0�� 010417' ril✓�t,�� Zoning District Old King's I�ghway District? yes_ no _4j4� Property Owner Name:=7/o�.� //c�, 10&(►nol-7 ('Z-wehl/ Telephone N. 1% dress: Sbn Contractor Name:L/t,,;// Telephone1,M),SUR Address: 1 Description Dia3am of lot showing Iocation of buil� dings and a dsting signs with dimensions, location and size of the new to b— drawn on the reverse side of this application. Is the sign to be electrified7 yes no (Note: if yes,'a wiring permit is required; I hereby certify that I am the owner or that I have the authority of the owner to make application, that.the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinances. Date Signature of Owner/Authorized Agent Size s . L �'" Permit Fee vet ved: �. 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') I r Map hnp://66.203.95236/arcims/appgeoapp/map.aspx?propertyID=11... Town of Barnstable Geographic Information System New search I Home I Help Parcel vmwren sfn,Qntom Map Abutters MaP Size ■ Itx�� Zoom 0-g�®O M®,N . ® 'y' �� `, Q —N_ — ® =]PG gyp: 117 Parcel: 098 Full r» Property 117102 n I 8835 - 17052 Location: 21 WIANNO AVENUE In 117090 1171O1 117100 ra 0803 7080 117DM Owner: MORGAN,FIELD P&BOUCHER,NORMAN TRS 4 117099 117091 8701 Location Irlfornlation t't �A i tD ��. Map&Parcel 117098 Location 21 WIANNO AVENUE 117179 to 117D92 Acreage 0.45 acres #22 Current Owner 117113 Ma rqg il)1tg Address MORGAN,FIELD P&BOUCHER NORMAN TRS 117114 [[117115 Il�g$ E WIANNO PLAZA TRUST i 44 021 1t I PO BOX 314 SOUTH DENNIS,MA 02660 1 O A ;-- ed Value(FY 2012) 117115 L Entra Features s0 032 Out Buildings $0 117004 Land $672,400 ® 042 Buildings $538,800 "a 117123 1043 Total Appraised $1,211,200 ��. 033 �g 117010 117122 117121 i43 Assessed Value(FY 2012) /23 et .f - Mittra Features $0 . ®a ! /�/. Out Buildings $0 $ Land $672,400 set stale Aerial P idw MAP DISCLAIMER Buildings $538,800 CowTigM X05.2010 Tam of Barnstable.MA AL rights reserved.Sena questims or comments to GiS 9arnstableMA v1.2.4379[Production) C� Q� SO. UAf C, 1 of 1 9/5/12 12:31 PM ` r t�yT tttl 5 lir :,•7i♦ t r +tQ �3 i i J H' i .. �; E _ iF" _ - ji .ii'�-'-' µ ��� I+ ,_ S� � r 1 �-�- � . _ 7/'�/ l ,. I / ���� b t k 1� ai IN AV- 46 . a u • 1 qg L • � �� � ,sue w Ahowr. ""x r, a �♦... Y .. r �' ..�. .„ � � r �„ ,mot .* •F� wn ^tF s e •- K 1' 'A17 x w,� r w ' �. �.- • �,.. ... tee. ..� ....: _ -. � .:. ul - • o i Y � a�i ' Y 4 b. Y. s \ F a k F y a, e. �� b��,.y �./s � 5 � d v� w � ce��no ��� - i 6� Ar Al .�. �•� si 1: elm AQ i w`.� -�,gym' `� r"Alla 21 r Y4y. r - s5 'i F - Fy P !'y. . 5 is� � • L� �s' • w� I s ����•` � ti y� tea,;,t � •-t I a{ • � � f ,J,r i 1 i i i i I i i f r � r a _ 7 ilk, r ` 1 s e � i L o�� 5�CAO S •, lip, i ip , ,y ..R w, 3 d f� GLEi "lu�vl�� "Technical Data Sheet"�,`r�s;s-� � Revision Date:6/18/03 Sunbrella® Awning/Marine 46" e 100% Solution Dyed Acrylic Fabric Construction:Ends ASTM D3775-98 Each 76 Fabric Construction:Picks ASTM D3775-98. Each 36, Fabric Weight ASTM D3776-96 Ounces/Square 9.00 Yard Finished Fabric Width ASTM D3774-96 Inches 46.0 Hydrostatic Test AATCC 127-1998 cm. 40.0 Oil Repellency. AATCC 118-1997 Grade -5 Spray(Large) AATCC 22-2001 Rating 100 Front (Modified) 100 Back Break Strength ASTM D5034-95 Lbs. of Force 285 Warp 180 Filling Tear Strength ASTM D5034-95 Lbs.of Force 12 Warp 8 Filling Tabor Stiffness ASTM D1388-96 Tabor Unit 12,0 Wyzenbeek Abrasion-Wire Screen ASTM D4157-92 Cycle 40,000 Warp 40,000 Filling California Technical Bulletin#117 TB 117 Pass/Fail CS 191-53 Class I Pass Colorfastness to Light SAE 1960J Grade Grade 4 @ 1500 hrs. Page I of 1 Sunbrella Awning-Marine 46(AND-QA-TD-004) 1 �X ACORD....:...:...:....:...­,......:'E.....F..i.l..T.... . ............. ......................F... 1.11. .. .... ..X.....,....................................................................... ...................................... .................................. DATE MM/DDIY Y) C ................ ..... . ( ... 11/04/08 ... ............. .. . .............................. PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE FEDERATED MUTUAL INSURANCE COMPANY HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Home Office: P.O. Box 328 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Owatonna, MN 55060 COMPANIES AFFORDING COVERAGE Phone: 1-888-333-4949 COMPANY FEDERATED MUTUAL INSURANCE COMPANY OR A FEDERATED SERVICE INSURANCE COMPANY INSURED 245-545-9 COMPANY CHARLES PERFETUO CO INC B PO BOX 709 NORWELL MA 02061 COMPANY C COMPANY D ............................... .............. ............................................. ...................................................................................... VI to E. .................................... ............XXXXXXXX.'­­............................................... ...... ........ IX I"-* .$ - ... .......... ............ .................**............ ..... .................................... ............. ............... ....... ............................................................................ ............... ........................... ....... .................................... ........... ...................... XXXXXXXXxxxx: . .*::::::::::::::::,-,-,-*::::::: , ..: .......... ....X.: ................ . . .... . ..... .. ............... ................................. .................... xxx: .......... ................................................... THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Co INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR TYPE OF IN 'DATE(MM/DD/YY) DATE(MM/DDIYY) GENERAL LIABILITY GENERAL AGGREGATE s 2,000,000 COMMERCIAL GENERAL LIABILITY PRODUCTS-COMP/OP AGG s 2,000,000 , ,A I CLAIMS MADE FR]OCCUR 9258406 12/20/08 12/20/09 PERSONAL&ADV INJURY s 1 000 000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE s 1,000,000 X -BUSINESSOWNER'S POLICY FIRE DAMAGE(Any one fire) $ 50,000 MED EXP(Any one person) $ AUTOMOBILE LIABILITY COMBINED SINGLELIMIT s-1� . ,000 000 X ANY AUTO A_­1 A.."k; F.T. ".1. ALL OWNED AUTOS *,-W� -% . 1%��'BbDILYINJURY'—' $ A SCHEDULED AUTOS • 9258407 12/20/08 1'. .12/20/09 (Per person). . I X HIRED;�UTbS G-'-' r-. i— _�6DILY_lNJU­R'Y'­­ UTOS (Per accident) 'NON-OWNED PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE EXCESS LIABILITY EACH OCCURRENCE s 1,000,000 A X UMBRELLA FORM 9258409 12/20/08 12/20/09 AGGREGATE s 1,000,000 OTHER THAN UMBRELLA FORM $ H- .............. ET WORKERS COMPENSATION AND X TW C STATU- O O R ..., y........'....l..1.1............. EMPLOYERS'LIABILITY EL EACH ACCIDENT s 500,000 A THE PROPRIETOR/ INCL 9258408 12/20/08 12/20/09 EL DISEASE-POLICY LIMIT $ 500,000 PARTNERS/EXECUTIVE OFFICERS ARE: EXCL EL DISEASE-IA EMPLOYW $ —500,000 ...................................... OTHER C= C=) c::) DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS ;Q CD .................. r...... GI"R .. ............................................................................................... . ..................................................................... ................. ............. ............................ ... . . . .........................................................................T .............................. ...........................%.. ............ ..... .... ................................ .. . ..... .... ........ .................... ... ............................................ ". ..... ................. X. ................................ ............. .... .................. ................................................................ . ................... .................. ................ ........ . .... .................................... ".: ":"..".."..."."..."..",.."... '* ."".."*::*,::":: ... ... .. .... ........ ... ......E KIN ............... 2455459 TOWN OF BARNSTABLE 27 SHOULD ANY OF THE ABOVE DESCRIBED POUC BE CANCELLED BEFORE THE --TOWN HALL BUILDING DIVISION s EXPIRATION DATE THEREOF, THE ISSUING COMPANY WILL ENDEAVOR TO MAIL -iATTN ELECTRICAL INSPECTOR 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 7..367.MAIN STREET BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY _HYANNIS MA 02648 OF ANY KIND UPON THE COMP,10V, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIWV /, . ................................ ............ ::t WIX, ......................................... -A .......................................... % ................... ................... IWO .. ........................ Cert Acct: 245-545-9 27 TOWN OF BARNSTABLE TOWN HALL BUILDING DIVISION ATTN ELECTRICAL INSPECTOR 367 MAIN STREET HYANNIS MA 02648 i 11/17/2008 11:23 7816318965 IRRESISTIBLES PAGE 02 NOTICE NOTICE To TO EMPLOYEES EMPLO �S E&I • N o r 2n x v, --a co �3 The Commonwealth of Massachus fts-D M DEPARTMENT OF TNDUSTRIA L ACCIDENTS .600 Washington Street, Boston, Massachusetts 02111 617-727-4900-- http://vrww.mass.gov/dia As required by Massachusetts General Law, Chapter 152, Sections 21, 22&30, this will give you notice that 1 (we) have provided for payment to our injured employees under the above-mentioned chapter by insuring with: MA Retail Merchants WC Group Inc. NAME O1~INSURANCE COMPANY 10 British American Blvd. Latham, NY 12110 ADDRESS OF INSURANCE COMPANY 014001a45580108 1/01/2008 - 1/a1/2009 POI.T.CY.NUMBFR. T_FFECTI.VF.UATU,9� First cardinal Corp_ 10 Arit1sh American Blvd. Latham, NY 12110-01r,1 NAMT OF TNSURATUCE AGENT. ADDRESS PHONE f Irrpsist3bles 7 Hawke•s Street Marblehead, MA 01945 EMPT OYER ADUltESS " EMPLOYER'S WORKERS' COMPS. 'SATION OFFICER(LF ANY) DATE . :MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of employment to.furnish adequate and reasonable hospital and m.cdical services in.accordance witli the provisions of the Worl..Ccs' Compensation Act. A copy of the First,Repoli of Injury must be given to the irljurcd cmployee. The:M11ployee may select bus or her own physician. The reasonable cost o- the ser- vices provided by the treating plysician will be paid by the insurer, if the treatment is necessary and reasonably connected Ua the work.rela,t'ed injury. Ju cases requiring hospital attenti.ori, cm plc>yecs arc hereby v.otif ed that the insurer has arranged for such attention at the N.Alvlr;OF ljoSpITAL ADDRESS TO BE POSTED BY EMPLOYER IRRESISTIBLU 7 Hawkes Street, Marblehead, Massachusetts 01945 (781) 631-1248 Fax (781) 631-8965 November 14, 2008 Ms. Robin Anderson Town of Barnstable Zonong Enforcement Officer 200 Main Street Hyannis, MA 02601 Dear Robin: Enclosed is a drawing showing the colors of our proposed sign at 25 Wianno Avenue, Osterville. Please let me know if you need any further information. Sincerely, John C. Doub f The Commonwealth of Massachusetts Department of Industrial Accidents 92 Office of Investigations 600 Washington Street Boston, AAA 02111 � y ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibAl�.. r� Name (Business/Organization/Tndividual): /y !/dA) �L /1LS1Y/XW Address: City/State/Zip: Zf U4 Phone 631-1Z7p Are yo n employer? Check the appropriate box: Type of project(required): 1. 1 am a employer with l2P 4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ 1 am a'sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' y p �'• # 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 LE] Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no l employees. [No workers' 13.9-&Cr^�/6i✓ 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 thcn.hirc outside cone actors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the sub-contractors have crrrployccs,they must provide their workers'comp.policy number. Aram an employer that is providing workers' compensation insurance fur my employees. Below is the policy andjob site information. Insurance Company Name: /1/ ZK (O/Z t/7yoft— Policy#or Self-ins. Lic. #: W G Q G �� /� Expiration Date: / Job Site Address: Z 3' 4404 At-b , City/State/Zip: a•,�1-41-C f A440 Z61)"_ 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 Iead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the 1DIA for insurance coverage verification. I do hereby certify u er the pains-and penalties of/perjury that the information provided above i tru and correct Si ature: C� �/G C I D Date: 7 6 Phone#: 70,,G 1— 2 YZ 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/Tovvm Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: l , Information and. InsA °u.cti®ns 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 bite, express or implied, oral or written." An employer is defined as "an individual,partnership, association,corporation or other legal entity,-or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance Frith the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation.and, if necessary, supply sub-contractors)name(s), address(es) and phone number(s) along with their certificates) 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 subunit one affidavit indicating current policy information(if necessary) and under"Job Site Address" (he applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked.by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog.license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The C6mmonwealth of Massaehuse>ts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-.727-490.0 ext 4.06 or 1-877-MASSAFE Fax# 617-727-7744 Revised 11-22-06 www.mass..gov/dia SIGN PANEL TO BE SINGLE. SEAMLESS PANEL, 8'-0' LONG & 2'-0- HIGH W/ 3/8' CHAMFER ON FACE EDGES. LETfERS'TO BE 9' HIGH. PANEL TO BE MIN. 3/4' TO MAX. 1' &MATERIAL- MOD OR SOLID PVC (AZEK). SMOOTH FACE ALIGN T.O. FINISH: FRONT & ALL SIDES NAVY BLUE SEMI—GLOSS EXT. ENAMEL. 2 COATS MIN. AWNING W/ B.O. LETTERING: WHITE. EXACT COPY PROVIDED BY IRRESISTIBLES. CTR. LOGO HORIZ & VERT. ON TRIM BAND PANEL INSTALLATION: INSTALL W/ FLAT HEAD STAINLES STEEL WOOD SCREWS TO PREPARED PVC SUBSTRATE; o FASTEN TO WD. TRIM � TOUCH UP SCREW HEADS NAVY BLUE, VERIFY ALL DIMS. ON LOCATION BEFORE MAKING SIGN ' � — O 1 to SQ. METAL TUBE NAVY BLUE FABRIC SUPPORT to 3 4 STRUCTURE (TOTAL z OF 7 FRAMES) IRMlsmps CROSS BRACING AT WHITE LETTERS — 4' HIGH-.-IC:) BOTH ENDS & AT 1 /3 NT ENDS ofWINc ?. POINTS (TOTAL OF 4 CROSS BRACES) SIDEWALK GR DE .0'-011 6 AWNING END ELEVATION 7 SECTION AT AWNING IRRESISTIBLES OSTERVILLE A2 in= 11-o° A2 1 n= it-On 11/7/08 B SIGN PANEL, SEE 16'-0" NOTES ABOVE SHINGLED ROOF ABOVE NEW FABRIC AWNING W/16" VALANCE, GUTTER COLOR: NAVY BLUE (EXACT FABRIC ---*— WD. SIDING AT T.B.D.) 4 HIGH LETTERS AT EACH IRRESISTIBLES END, COLOR: WHITE SIGN AREA PTD. WD. TRIM PROVIDE OPENING IN AWNING ..::... .�.. ::: :: :: ::, �::FOR DOWNSPOUT, HEMFABRIC AROUND OPENING : T. LQE :: EDGE OF EDGE OF IRRESISTIBLES VERT. IRRESISTIBLES STOREFRONT VALANCE STOREFRONT NEW LAMINATED \ DOOR E.T.R.; PAINT GC TO PT. WD. TRIM, TYP SAFETY GLASS AT FRAME WHITE FOR ALL AT IRRESISTIBLES FRONT DISPLAY PTD. WD. TRIM STOREFRONT (BLACK OR WINDOW WHITE, MATCH EX.) GUTTER DOWNSPOUT FIN. FLR. 0'-0° WHITE TRIM/FRAME AT WINDOW s EXTERIOR ELEVATION IRRESISTIBLES OSTERVILLE 11/7/08 I 01/12/2009 12:20 7816318965 IRRESISTIELES PAGE 01 IrMSISTIBLES 7, Hawkes Street, Marblehead, Massachusetts 01945 (781) 631-1248 Fax (781) 631-8965 FAX COVER SHEET January 12, 2009 From: Jobn Doub To: Sally, fax 508-790-6230 Subject: Landlord's permission letter Number of Pages Including Cover Sheet: 2 Message: Enclosed is a letter from the building owner authorizing us to apply for a sign and awning permit. This should complete all the necessary open items. Please call if you have any questions. c.. ,Z . car v �- co t 01/12/2009 12:20 7816318965 IRRESISTIELES PAGE 02 FROr MRCWILLIAMS FAX NO. 8604349835 Jan, 12 2009 11:27AM P3 IP.RES,IST12LES PALM az January 11,2009 Ms.Robin.Anderson Town of.Baas%ble Zoning r-zfbzaenaent Officer 200 Mama Street Hyannis, MA 02601 Dear Ms.Anderson: As the owner of the building at 25 Wianaa avenue,OsteTville,I hereby give my permission fbr Jolm Doub,owner of Irmsistnbles,to apply for a sign an,d avmir,g permit for A Ilew Irmaistibles oloibing store. .Sincerely, Norman Boucher Trustee,Wianno Plata Trust s, ,. ��,v.�. ?�.. t i:' s a j J P �ti �" ��� �_: _ - ' PRE-PARED BY: SITE NAME: (� OSTERVILLE_MA_SCO2 Barnstable Bldg. Dept. LOCATION CODE: 1 tl E� I V S Approved by: w �3�/� --THROUGH wm= a ALY OFFICE:W SITE ADDRESS: Permit w 7A LYBERMY WAY UTILITY POLE NO.: 64-3 a "�(9 2)755 8828 21 WIANNO AVENUE BARNSTABLE, MA 02655 r< t ! 1 �T•"Tr- � / • •,4 !' 4 } 4� ANY ,y)•�fyf7f, sr, •^��' � � 1y p• � � - -a -.w+ i \+ .� .r•r .'sr� ,'*► � - �yY�.•�.� _� THIS DOCUMENT IS THE DESIGN ti < ^• J ., PROPERTY AND COPYRIGHT OF NEXIUS � '� •� r .� ��' ♦ t f ' i`:�Ly `-r } J+ '» AND FOR THE EXCLUSIVE USE 13Y THE �,�» . ) .'6y r, c•� q '�+ \ { 1J �. t a.. TITLE CLIENT. DUPLICATION OR USE GI ` a t �s„ :;.}- �• �� flj• '> +7 �{i� ' '' T _ { WITHOUT THE EXPRESS WRITTEN Ali• ~^ , p> {f �"Fw• ' -� A Y �`•' v V" _ .,« '�' CONSENT OF THE CREATOR IS '�� ,»r > •• � rlz d h fi X•,.y STRICTLY PROHIBITED. • p r �. '.;�- ,- 5�74�I' DRAWING SCALES ARE INTENDED FOR 11"x17" SIZE PRINTED MEDIA ONLY. ALL OTHER PRINTED SIZES ARE .,r+• ': ', , ` DEEMED 'NOT TO SCALE'. SUBMI'17ALS 'i-�4'• - ` - �' ` �� T,� � + G REV DATE DESCRIPTION BY • F ♦ f�l a' i,1 .L ti - y�'� �r, �, �•c SITE INFO: ' +. '• �' rr ih• '-•-+r 'rw' f) •,,e '� SITE NAME: OSTERVILLE_MlLSCO2 .ramp t- \. �4. -+ 1*, •-.�,. ; 'cy",3" SITE ADDRESS: * 4 r- q 4 U P NO.: 64 3 < ,^. gyp. g": * • '' ``: 21 WIANNO AVENUE BARNSTABLE, MA 02655 CFIECKC-D BY: DATE: 50 0 50 100 200 XB 06/14/17 ® n KEY 1 PLAN I I I PROJEC"I'NIIMBL'R: SCAM. 1• 60' GRAPHIC SCALE: 1:50 (IN FEET) APPROX. NORTH SHEET NUMBER:POLE COORDINATES LATITUDE (NAD83) LONGITUDE (NAD83) 41' A.M (N 39.4 N 70. 23. 05.49" W LE l GROUND ELEVATION 40• A.M.S.L. AVD88) Y' 1 PM-TARED BY: PROPOSED 120'Ox3&7'H ~ ANTENNA _ _ TOP OF PROPOSED ANTENNA NOTES: LEASE EXHIBIT POLE C.L. � 1. AN ANALYSIS OF THE CAPACITY OF THE EXISTING IS THIS LEASE PLAN IS INTENDED TO PROVIDE DIAGRAMMATIC INFORMATION D N E�: I U S PROPOSED TOP MOUNT - - _ STRUCTURE TO SUPPORT THE PROPOSED LOADING REGARDING THE LOCATION AND SIZE OF THE HAS NOT BEEN COMPLETED BY NEXIUS. W DRAWINGS ARE SUBJECT TO CHANGE PENDING PROPOSED WIRELESS COMMUNICATION FACILITY. THE W �ran • .um� OUTCOME OF A STRUCTURAL ANALYSIS. SITE LAYOUT WILL BE FINALIZED UPON COMPLETION Do OF SITE SURVEY AND FACILITY DESIGN A6£ OFFICE: TOP OF PROPOSED DRENSION Q 7A LYBERTY WAY PROPOSED HL-44 FSERG ASS - - W WESTFORD, MA 01886 POLE TOP EXTENSION a 1 (972) 755-1882 III I II TOP OF EXISTING UTILITY POLE AT PROPOSED 1/2' COAX CABLES PROPOSED t2 0"*x38.i"H I II _ _ DfISTING GUY WIRE w 'ANTENNA (TOT OF 2-O &(1) RET CABLE ANTENNAS I ELEV: 32=0 t KG L m II PROPOSED POLE TOP MOUNT PROPOSED III HEAD I( EXISTING SECONDARY EXISTING PROPOSED HL-44 FIBERGLASS WEATHER POWER III SECONDARY POWER �� Tom' fXiEN�IONI ,� -' ;' •-•� I II L : 2 -6 t A.G. 40 " _ III EXISTING STREET EXISTING TELCO CABLE 40 II LIGHT ELEV. 25-6 t AG.L t� EXISTING TELCO/CABLE w ELEV: 25'-0 tom' A.G.L. . 1 46 EXISTING TEICO/CABLE w �� DGSTINC CLtY WIRE' - C.L. OF EXISTING TELCO BOX III EXISTING TELCO k ELEV: 24'-0 t A.G.L� ELLV: 23-0 t A.G.L. III CABLE EXISTING TELCO/CABLE THIS DOCUMENT IS THE DESIGN II ELEV: 21'-6 t AG,L. _ - PROPERTY AND COPYRIGHT OF NEXIUS j II V 4 •_,.. AND FOR THE EXCLUSIVE USE BY THE C.L. OF EXISTING TELCO BOX _ 11 TITLWITHOUT THE EXPRESS E CLIENT. DUPLICATION OR USE EE -6 t A.G.L. EXISIWG STREET LIGHT CONSENT OF THE CREATOR IS l� PROPOSED FIBER FIBER �' - 1 - STRICTLY PROHIBITED. PROPOSED kPROPOSED ylEXISTING SECONDARY POWER 0ll""x17G SIZCEE PRIALES NTEDNMEDIAEON OR PROPOSED RGS • ALL OTHER PRINTED SIZES ARE CONDUIT 1D LIFTER PROPOSED FIBER � EXISTING DEEMED "NOT TO SCALE'. DE]IARC w TELCO/CABLE (4) SUBMITTAI.S PROPOSED AC/OC CONVERTERREV DATE. DESCRIPTION BY PROPOSED DIPLEXERS MOUNTED BF}1MD RRH'S (TOTAL OF 2) r f 1 o y4 FCR Lava Kr 1(TOTAL OF 2) 'T� T.NTED TO TO ITPROPOSED RRH`S (TOTAL OF 2) x �gEXISTING TEt CO Box SEE OETAIL 1/LE-3 FOR ORIENTAM PROPOSED SAR-0 (BEHIND) AC MIRING HARNESS PROPOSED FIBER �4 M AC/DC CONVERTERS y OEMARC jlx{ in 1 PROPOSED EI.ECTRICAL EQUIPMENT SITE INFO: SEE DETAIL 1 AF-3 FOR ORIENTATION — ';� t. ROPOSED R SITE NAME: b OSTERVILLE-MA_SCO2 PROPOSED GROUND WIRE RUN IN BLACK aj GROUND WIRE MOLDING AS REQUIRED SITE ADDRESS: EXISTING 40' CLASS 3 - �_ - U/P NO.: 64-3 U/P NO.: 64-3 � _ •.. ,.,,. 21 WIANNO AVENUE I ExI 0T ?G, 1 0E BARNSTABLE, MA 02655 ELEV: 0- A.G. . {{ II I 1� EXISTING CHECKED BY: DATE: GROUND ROD ' toy ' KB 06/14/17 (V.I.F.) PROJECT NUMBER: lt/lh 4 SI1E•ET NUMBER: ELEVATION D 2'-8" 5'-4• 10,-8• PHOTO DETAIL LE-21 I SCALE 3/16' 1'-0' 2 N.T.S. GRAPHIC SCALE: 3/16"=1'-0" r 1 PREPARED BY: 2 w NEXIvow ousmem.TwumumUS ptommePROPOSED AC/DC B B '" I Q A&E OFFICE: CONyE(Sl1ER PROPOSED ;p 7A LYBERTY WAY (TOTAL OF 2) METER, BELOW 12*0 .wa WESTFORD. MA 01886 1 (972) 755-1882 PROPOSED EXISTING 40' CLASS 3 •3 '� ' AWS RRH U/P NO.: 64-3 2 L • O C EXISTING 2 CONCRETE SIDEWALK EXISTING CURB Q _� WIRELESS CONSTRUCTION, INC. PCS RRH OUNTED TO g POLE/WALL MOUNT FOR DUAL ap' P P ��-�TAL 224 RADIO'BRACKET wuCctl REM DESCRIPTION OTY. PROPOSED POLE MOUNT s 1 DOUBLE MOUNT 2 ANTENNA SPECFICA11ONS FOR DUAL. RADIO BRACKET PCS RRH RACK W/ 2 SUPPLIED HARDWARE 1 COMMSCOPE - NH3600M-DG-2XR WIANNO AVENUE AWS RRH RACK W 3 / 1 DIMENSIONS 12"0 x 38.7" SUPPLIED HARDWARE WEIGHT 33.7 LEIS RRH MOUNTING BRACKET SPEC. n ANTENNA SPEC. THIS DOCUMENT IS THE DESIGN ® n RRH ORIENTATION PLAN N.TS `7 TUTS PROPERTY AND COPYRIGHT OF NEXIUS AND FOR THE EXCLUSIVE USE BY THE SCALE: N.T.S. TITLE CLIENTHOUT HEDUPLICATION EXPRESS W OR USE ELECTRICAL NOTES: PROPOSED CONSENT OF THE CREATOR IS APPROX. NORTH ANTENNA STRICTLY PROHIBITED. 1. GENERAL WIRING DIAGRAM TAKEN FROM E-MEMO PROVIDED BY JAMES F. GVAZDAUSKAS, ANTENNA 1 1 g P.E. DATED 01/12/2017 _______ MOUNT/BRACKET DRAWING SCALES ARE INTENDED FOR 12" 5" L� --'1 11 LL SIZE PRINTED MEDIA ONLY. 2. ELECTRICAL CONTRACTOR SHALL INSTALL ANTENNA GROUNDING ALL OTHER PRINTED SIZES ARE I THE 'PROVIDED WIRING HARNESS" PER THE I DEEMED NOT TO SCALE-. e==e + REQUIREMENTS OF THE NEC AND LOCAL CODES. (DEPENDING ON _ I ANTENNA MODEL) SUBMIT7AIS e e REV DATE DESCRIPTION BY SECONDARY LINESmmmm I 0 iv ogee e e 0N 0 MM4111 FOR REYEf Kf N eeee e— (2) 1/2- COAX CABLES & (1) RET 1� WEATHERHEAD (LEAVE e e e o CABLE IN 2" UV RATED U-GUARDS 10' CONDUCTORS FOR e a e e e e ANTL]NA FIBER FRONTHAUL 1 UTILITY CO. TIE INS) 229 0 0 & BACKHAUL i x eeee ee I ANTENNA eeee ee N I FRONT SIDE BRACKET FIBER DEMARC ON POLE F VARIABLE TILT, VARIABLE (2) DIPLEXER SITE INFO: PCS RRH 11 WF]GFTT• 35.0 LBS• AZIMUTH ANTENNA BASE ASSEMBLY �w FIBER JUMPERS IN 1-1/2" j SITE NAME: UV RATED U-GUARD IF Ea (4 2" COAX lLL 1�1��8" 7.2' LENGTH EXCEEDS 4' I CABLES OSTERVILLE_MA-SCO2 7.3" 3.2" I I I I WS i RRH PCS (3)J6 AWG WIRE IN I I I I THRU-BOLT WITH + RRH 1-1 4 W RATED PVC SITE ADDRESS: 0 BACK-UP PLATES, FIBER JUMPER (TYP.) LI -- / " NUTS & WASHERS All 30'w-44 POLE TOP U/P NO.: 64-3 ORQISKIN• ORDER FROM DC POWER #2 AWG COPPER 21 WIANNO AVENUEMANUFACTURER WITH DELTA AC/DC GROUND (TYP.) BARNSTABLE, MA 02655 PRE-DRILLED HOLES PER POLE ---- CONVERTER (TYP. OF 2) TOP MOUNT MANUFACTURER 0eeee WEATHER PROOF SQUARE [ AC POWER NOTE: USE PROVIDED DELTA CAT NO.: SDSA1175 FRONT SIDE EXISTING U/P MANUFACTURERS WIRING HARNESS SECONDARY SURGE ARRESTC}IECKL•D DY: DATE: C e o e ON 20A 2P CIRCUIT BREAKKB 08/14/17 Wei. 0.6 Lam• ---e $2 AWG COPPER GROUND FRONT 5ME SQUARE D 00-100A, 8 SPACE, 16 CIR OUTDOOR O IN 1/2" UV-RATEO PVC PROJECT NUMBER: MAIN LOAD CENTER WITH COVER. 60A 2P MAIN AWS RRH CIRCUIT BREAKER WITH (3) 20A. 2P BRANCH CIRCUIT WEK*U.* 58.8 LBS. BREAKERS (1 FOR SURGE ARRESTOR & (1) PER RRH) SHEET NUMBER: MILBANK CAT NO.: U2272-RL-5T9-BL SINGLE LEVER 120/24OV, 10 3W 125A METER 3/4"000' COPPER T Cl An f.R1111ND ROD �DIPLEXER SPEC. LE- 3 n RRH SPEC. n ANTENNA MOUNTING DETAIL n GENERAL WIRING DIAGRAM TUTS `� NT"8 V N.T.S NTS I r e NOTSIA10 Wd h� Zd" 3101 91gd1SNUO d0 NhJOl 10 GWB AT WALL A2 A2 C.L UGHT BEYOND DISPLAY PLATFORM TYP 1x4 PM. UPPER TRIM COUNG SOFFIT BETW. PIERS 7'-6* AFF REVEAL. SEE MAIN CEILING 7*-8 1/20 AFF 'RY 9'-6-AFF MAIN CEI 1.LING 12/A2 IV 9-6-AFF UPPER PTD. 10 TRIM OPEN-APOVEr B.O.CENTER SOFFIT CUT THROUGH. ENDS AGAINST D.R. SIDE NY 8'-5-AFF WALLS DOOR HEAD AT.O.D.R DIVIDER WALLS I x3 TRIM, TYR IN DRESSING RMS. VV-10 1/2 Ei 8' SURFACE MT). �/8' L SURFACE M"ID. C.L UGHT ---CUT THROUGH WALL SHELF STANDARDS 11 x4 If TD. TRIKI SHE_LF I.EIND DS 7'-6* AFF P`TD. GWB AT V-4* O.C.. TY1:) AT 1'-4 0.(.. TY P`TD. GWB T­ LSOFFTT AT CE4TER OP TO OF STORE 8*.-5*' AFF 00 R L REA HANGING RAIL4 SEE MIRROR 4/A3 BUILT IN BENCH CORNER BENCH SEE 6/A3 A SEE I&2/A3 d4 FIN.FLR. f,6 FIN.F K V 0,-0. L.R. my 0'-0- 9 \"\-'SUR E MTD. SHELF STANDARDS CUT' \�. 1x6 PTD. BASE TRIM PTD. GWB, TYP. 2'-0" LOUVERED w.c. JOOR E.T.R A2 TO 7' L AT 1*-4" O.C., TYP.; MIRROR DOORS TYP TO F1 LL BASE-TRIM 0 7-5* AFF RETAIL AREA NORTH DRESSING ROOMS WEST A2 1/4 V-0* 1/411 1 1-011 GWB AT WALL A B BEYOND C.L LIGHT REFINISH EX. WD. TRIM AT !*-6* AFF MAIN CEILING MAIN CEILING WINDOWS, TYP ALL SIDES MAIN CEILING 9-6"AFF mV 9-6"AFF qF 9'-6-AFF Ap/ PID. GWB, TYP. SOFFITS 0 AB V 8'-8 1/2�AFF PTD. 1 x3 TRIM, TYP. PTD, 1 X3 TRIM, GW8 SOFFIT AT WAL TYP. 8*-50' AFF 8' L SURFACE MTD. A�_ 'ANN& .0 SHELF STANDARDS DOOR E.T.R. NEW LAMINA\TED MIRROR TYP. 1x3 DRESSING RM. DRE ING AT V-4" D.C., TYP. I SAFIETY GLASS AT TRIM FRONT DISPLAY 10 PTI). WD. TRIM 00 OW I UNDER MIRROR 1x: WD. TRIM AT-"'--'0K 10 OUTSIDE FACE, 41 1 x6 PTD. WD. BASE I BoTI4 SIDES, SEE d4 FIN.FLR. ---I------------A TYP. -10K 41 V 0.-0. FIN.FLR. 7/A3 FLR. FIN. my 0--0- 0.-0. L DISPLAY PLATFORM 1 x4 PTD. WD. TRIM BETW. DOOR & SEE 9/A2 MIRROR 3'-Ow LOUVERED DOOR' PLATFORM ALCOVE AT H.C., DRESSING RM. DRESSING ALCOVE SOUTH RETAIL AREA EAST RETAIL AREA W�ST r5 r3 1/419 11-011 1/4N 1'-0* A2-_) 1/411 1 1-011 3/40 AMICO LATHNINYL DRYWALL REVEAL JAMD-75 (3/4- NEW ACT COILING . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . REVEAL FOR, 1/2- GWB) 9'-6'AFF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - . . . . . SIGN PANEL TO BE SINGLE, SEAMLESS PANEI,. ,8'-O- . . . . . . NAVY SWE FABRIC . . . . . . . . . . . ... . . . . . . . . . . . . . . . LONG� & 21--0' HIGH W/ 3/8' CHAMFER ON FACE WHITE PAINT— EDGES. LETTERS TO BE 9" HIGH. AT WALL PANEL TO BE MIN. 3/4- To MAX. 1 ABOVE TRIM FACE OF CWB WALL 1/2- PTD. GYP. BD. MATERIAL MDO ORSOUD PVC (AZEK), SMOOTH FACE CEIIJING & EDGES FINISH: FRONT & ALL SIDES NAVY BWE SEMI"GLOSS SPACKLE & SAND SMOOTH 0 EXT. ENAMEL, 2 COATS MIN, —1x4 PTD. WD. TRIM; LETTERING: WHITE, EXACT COPY PROVIDED BY B.O. TRIM 8'�50 AFF ................. NEW GWB SOFFIT �L A7 IRRESISTIBLES. &R. LOGO HORIZ & VERT. ON WHITE LETTERS 4" HIGH; _J &-5"AFF PIER WALL PANEL APPUED M BOTH ENDS OF INSTALLATION: INSTALL W/ FLATHEAD STAINLES AWNING. TYP. STEEL WOOD SCREWS TO PREPARED PVC SUBSTRATE-, BRACE TOUCH UP SCREW HEADS: NAVY BWEI RABBET TRIM TO VERIFY ALL DIMS, 0 BEFORE MAKIK SIGN CRAY PAINT I RECEIVE SHELF At WALL STANDARD A B.O.SOFFIT ....... GWB CEILING REVEAL 13ELOW TRIM %PT-81 'AFF I x3 PTD. WD. TRIM AWNING END ELEVATION HALF FULL SIZE MITERED 0 OUTSIDE CORNERS A2 1/2 1'-0" 12- SIGN PANEL. SEE W-00 NOTES ABOVE SIDE OF PIER BEYOND VARIES, SEE PLAN SHINGLED ROOF NOTE: INSTALL SHELF e_ 8' HIGH SURFACE ABOVE STANDARDS SO THAT MTD. SHELF $LOTS ALIGN GUTTER STANDARDS (KNAPE HORIZONTALLY,ALLOWING NEW FABRIC AWNING W/16- i ALIGN T.O. VALANCE; COLOR: NAVY BILLIE WD. SIDING AT CARPET ON 1/2* PLYWD. VOGT JKV8OWH) FOR LEVEL SHELVES AWNING W/ B.O. TRIM BAND (EXACT FABRIC TMD.) 4* HIGH SIGN AREA LETTERS AT EACH END, COLOR: ,.,,-PTD. WD. TRIM MIRROR OR STANDARD 1x SOUD NAT. FIN. AT FACE OF PIER ............ -.......... . ........... ................ ------ ­- INTERIOR SECTION -...*" ': . . .... 1.­­'11.*.`1.1........................ C. WHITE ;.i.......... ................................. ....... ..... ...... ....................... ....... .... REFINISH EX. MAHOGANY TRIM AT FASTEN TO WD. TRIM MAHOGANY TRIM PERIMETER W/ 1/4 . ... ... .. ..................... FACE OF ELEVATIONS ....... ...... ... ... ................ .......... .... ..... ............ AT WINDOW GWI3 WALL INTERIOR DETAILS EDGE 0 ......... ....... L .. I ­ft— 2 1/2 I SO. METAL. TUBE EDGE OF REVEAL AT BOTTOM IRRESISTIBLES SUPPORT STOREFRONT IRRESISTIBLES: 1x PID 8' HIGH SURFACE E)(TERIOR ELEV. DTLS. X-40 v I MTD. SHELF STRUCTURE (TOTAL VALANCE STOREFRONT WD. TRiM FACE OF GW8 WALL 40 1 12 1 1 i W.. STANDARDS CUT M OF 7 FRAMES) INEW LAMINATED DOOR E.T.R.; PAINT Scale: As Noted. 7 LENGTH KNAPE SAFETY GLASS AT FRAME WHITE CROSS BRACING AT U GT #KV80WH Drawn By., JL PTD. WD. TRIM FRONT DISPLAY TRIM & vo C. PTD. WD. OTH ENDS & AT 1/3 WIN GUTTER DOWNSPOUT— Issue Date: 10/16108 POINTS (TOTAL OF 4 T z a 1x6 PTD. WD. BASE 1 x6 PTD. WD. BASE CROSS BRACES) C4 C*4 Project No., TA0508 CARPET 11 d4 SIDEWALK GWE 0 FINISH FLOOR FIN.FLR.Alk ........... F I ...... ............ d% V 0.-0. 0--0-T EX. 'WALL & L2x WD. \2—TYP. 1x6 WINDOW FRAME FRAMING & MD. WD. PET 5/8w IM BASE A2 r9 SECTION AT TYP. DISPLAY WALL ri 1_N� SECTION AT CTR. SOFFIT K7 SECTION AT AWNING EXTERIOR ELEVATION DISPLAY PLATFORM SECTION ri 0 A2 ) 1/401 = 1 f4l 1/4if 1 1�04 , : $1 A2 11/2' 1'-0 1 1/2" l'-O" A2 1 1/� 1 1-00 YM E ,XLT" L f I 5-6-AFF TYP. _ 1x8 NATURAL FINISH MAHOGANY HANGING .RAIL MAHOG. BUNGS (WALL TO WALL) N 1/4" rh GLUE TO WALL dt _ SCREW TO STUDS to- 4 /4" r. NOTE; IN H.C. DRESSING 30. ROOM, INSTALL HOOK WHERE. SHOWN ON PLAN O 4'-6" AFF MIRROR BASE BELOW 1/2. SHIMS (ALL PUBLIC \a' MIRRORS) iff 1 x PM. WD TRIM It 3 16 NOT USED 4 HANGING RAIL DETAIL A3 N/A A3 HALF FULL SIZE AV AM BASE BELOW Lm OUTER CORNER A PLAN i MOTE:ALL D.R.'DOORS TO OPEN ABOVE HAVE BRUSHED CHROME --- TO CEILING —•^ 3/'40 PTD. POPLAR, MATCH OPEN ABOVE. 2 5 8 NON-FULL HT. WALLS TO / HINGES b LEVER HANDLES / # --+-- CEILING —�- 3 4" PTD, 'PO LAR .10 TRIM BOTH SIDES, 6-10112eAFF MIN. TO FULL WIDTH OF D.R. BASE BELOW'. TRIM _.... ....::... ...:...:.... .......:. .. .. ADJACENT ABOVE WD. BLOCKING WALL PTD. 10 VERT'.. TRIM 1/2 SHIMS (ALLDOOR HEAD 2x WD. BLOCKING 3/4 MD. WD FRAME W-8"AFF PUBLIC. MIRRORS) 2' LOUVERED MD. :;. . —1x3 PTD. WD. TRIM WD. DOOR 1x3 VERT. TRIM BEYOND G OVER MIRRORED 3a ,. .. WALLS AND AT :..............:.... PARTh,L .•:• MIRROR, WHERE HT: WALLS PTD. WD. LOUVER ;:: _ AOL ;� 4J DOOR INDICATED ON. PLANS w (MTD. TO GWB IN D.R. MIRROR DOOR FRAME BEYOND ONLY) t BASE BELOW ::..:.:.. :.:...:::::...:::.: A: DOOR 'STOP BEYOND TYP. 2x4 WALL TYP. WALL CONST: 2x4 WD., BLOCKING NOTE LOUVER-BLADE CONST. BUTT MIRROR POSITION. UP SIDE �--� I AT CORNER W/ 5/8" PTD. OF LOUVER MUST BE GWB FINISH ON D.R. SIDE REGARDLESS OF q,)i DOOR SWING MIRROR JAMB PLAN EAD SECTION NON-FULL HT. WALLCIO A (VD.R. o B INNER CORNER PLAN D.R. DOORS DOORS TOP t I v , Mi RROR ALCOVE PLAN DETAILS 3 DRESSING RM. DOOR /'WALL DETAILS A3 31 = 1 I-ON A3 31 = V-0" i 2'-2- Jq :-> '"` MIRROR GLUED TO MIRROR GLUED TO :. PTD. WD. TRIM .::..:....:...: . UC. ::: ....... :: :: 2—C WALLAS APPLIC( ) DEPTH VARIES AT CORNER BENCHES WALLAS APP( ) GOING DOWN TO 1 x3 PTD. WD. TRIM 10 PTD. 'WD; TRIM BASE /�:J/�� LAMINATED MAHOGANY LAMINATED MAHOGANY MAHOGANY SEAT TOP OF UNIFORM TOP OF UNIFORM GRAIN do COLOR GRAIN do COLOR INTERIOR DETAILS R 2IV IV cV 3/4'x5 1�2- 3/4"x3 1/2" A3 c� :-:::::.....,:::- ::::':::.....,:.: MAHOGANY TRIM MAHOGANY TRIM PTD. WD. TRIM 2x FRAMING AS FRAMING AS REQ'D. !r5 Scale: As Noted REQ'D. BASE BELOW Drawn By. JL is 5/$" PTD. GWB 5/8- MD. GWB Issue Date: 10/16108 Project No.: TA0508 TYP, i x6 PTD. TYP. 1 x6 PTD. WD BASE WD BASE +/—V-0' RECESS TO ALLOW FOR 5' TURNING RADIUS IN ROOM; V.I.F. A,3 s H.C. DRESSING RM'- BENCH SECTION 2 DRESSING RM. CORNER BENCH SECTION 1 DRESSING RM. CORNER BENCH PLAN A3 M 11/2t, 1 -0 A3 1 112r = 1'-0° A3 1 1/2' _ 1,-0N ---------------------------