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0905 ATTUCKS LANE
w� 0 0 �:I r. 'OWN`OF BARNSTABLE BUILDING PERMIT APPLICATIO Map Parcel Application # 1 Health Division Date Issued Conservation Division Application F V Planning Dept. Permit Fee �(J�, Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Pro'ect__Street_'Address 51®� /4�4!C r 4n1V 1 LVillage" °-`` C a.,� le aez 7`� ALI,' ,.Owner. I ..e v� �l/� Address��.3� ll�l�ldu TelofpWdn S Dc�-175-- �36 �/l�il/�� jaclzrc �Permit•Request n��� Saar `� f��ear � � �w /�e G.. ��(�1�q S ,�,r �r�.-�ram, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay kl r,_ 'on 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-- Highway?-❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (s .ft) Number of Baths: Full: existing new Half. existing c:_new O 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 V ,q C,-Ao1j- Proposed Use Ale . ' &Z o «.-P—.1 // APPLICANT INFORMATION ` 119 � (BUILDER OR HOMEOWNER) Narrie '*� ��� ��e r���%�� �i�✓ r-Telephone`N'u`rn_ber, 7r/,-,F 7/_ r Addr"esst -,. C) &3C 3 3 5— License;# S C 2 i 003 � �Iz V. M N_ 76 Home Improvement Contractor# LALL MNSS Pit fc pewmfl at � � �d, C WA_ Worker's Compensation # WC-1 06 1 �O TO ONSTRUCTION DEBRIS RESULTING FROM THIIS PROJECT WILL BE TAKEN TO ATURE a/1 DATE. 7,15 FOR OFFICIAL USE ONLY r , APPLICATION# DATE ISSUED 1 , MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME - INSULATION ` FIREPLACE ELECTRICAL: ROUGH FINAL ,PLUMBING: ROUGH FINAL ' t •GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. F M http://elicense,r-hs state.ma,us/Verificaton/Detail-,.aspx?3tIFnL-/ id=182icense id=7206278L �Bin��� - -- ..s n e'. _ e a . B py .. &�k s *._, -C% a S rGCT , n ; 'aF ." rdltt < f, r t ' _ r � # ,,� F avorites- ". ��es ?��it�s- x ' s :.,."�.� .wb ���...... ...:. .. ,r:,_ .---_• ,�.. ..wB�..:;" .� s..�..e._ -.�t..'s. -a sq,.-�... - ,sa. ss m.;x:. I . .:. .,. 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Details... .,�.. .r_� . ,:-.• � ,- ,. : _.'�- _ .F �_ _�., x ,�` ;� ,�a 1� i .��..- .t�'�:.:s: .._ Fa.,,..�a... � -,: "., ..^. �.....,x-..� .,.._.�,�. -- 3s'..�.-�,r,.'•..; -•.=S��:�a .,..a. ��a ., � `r 'a k;.= °_ �, -`� .. �,�,.�,: s r �� � i 'l DernoHgrM,hie Information Full Name: RONALD W LAZISKY, JR z Gender_ s� Owner Name.: E License Address Information l y Address: . i; Address 2: City: Rockland 71.I State- A 1 F IVI Zipcode: 02370 Country: U n ited States License Information - io l License No: SC-210034 License Type: Sprinkler Contractor ; Ir; Profession: Engineering Licenses Date of Last Renewal- 3/4/2014 r> issue Date: Expiration Date: 4/18/201 fi License Status: Active Today's Date. 4/14/20 5 ^ � nd 'Seco ary License. .cc x Doing Business As-- M ^ Status Change: License issuance , �> f i Prerequisite information - �' No Prerequisite Information3 E, { .i k < ., Sa. . :::5 `t rt.,.fff, Ts'3 .�•W �. s x.. ,'". r. .. _ 41t.�.—ram .ji ¢'"` #. net.:'.'"t '„. mc+ -" .r,.µ�.v. _ p.. •.,v, A-r. 'r3..... ap�'at*.w. I. W € . E ternet r � 125°i�_ °�� - Start _. J B ENGINEERING, INC. 96 RESERVOIR PARK DRIVE ROCKLAND, MA 02370 Tel:781-871-8277 Fax:781-871-0156 www.jbengine@aol.com ---------------------------------------------------------------------------------------------------- April 7, 2015 FIRE PROTECTION NARRATIVE Office Building 905 Attucks Lane Hyannis NM BASIS(METHODOLOGY)OF DESIGN Section 1 -Building Description 1. Building"Use"Group: 780 CMR 304.0. Business Use Group 2. Total square footage of building: Approximatley 18,000 sq.ft.. 3. Building height: Varies with pitch of the roof 4. Number of floors Above grade: One Floor Above grade w/attic space Number of floors below grade: No floor below grade 5. Type(s)of occupancies(hazards): Light hazard 6. Type(s)of construction: Wood framed w/wood trusses 7. Height storage of commodities No storage will exceed 12 feet 8. Site access arrangement for Site accessible emergency response vehicles Section 2_Applicable Laws and Governing Codes 1. Building Code: Massachusetts State Building Code,780 CMR, 8th Edition&the 1BC Code 2009. 2. The following sections of chapter 9(Fire Protection Systems)relate to this facility 3. All of section 901-General 4. Local Fire Prevention Requirements 5. Applicable Sections of M.G.L..,Chapter 148 Fire Protection 6. Applicable Federal Laws such as OSHA,ADA,etc. Section 3—Design Responsibility 1. J B Engineering,Inc.is providing renovated sprinkler head location plan and narrative The design will be based on Fire Protection Systems,Chapter 9,Guidelines for the Preparation of the Narrative Reports. 2. The professional Fire Protection Engineer of record will be James N McHugh.,Massachusetts No.38572 for the sprinkler system only.. 4ss�® 9c JAMES N. yG McHUGH m FIRE PROTECTION No.38572 Section 4—Fire Protection System to be installed 1. Sprinkler System a. The sprinkler system is a new dry type system. b. New 6"underground supply is being fed from water main in Street C. Install return bends to relocate heads to meet new partition layout.First floor only. d. Any work that is to be done will meet the requirements of NFPA 13 2007 and the requirements of the Hyannis Fire Department. e. All sprinkler heads will be quick response in office area. Section 5—Special Consideration and Description 1. Sprinkler System a. The sprinkler system will be based on "prescriptive code requirements". No variances will be required. b. Maintenance,inspection,and testing will be done as per NFPA 13, 2007 Section 6—Sequence of Operation 1. Sprinkler System a. Dry System—When a single heat activated sprinkler fuses and discharges water,pressure switch at the main sprinkler rise assembly is actuated and sends an alarm signal to the main fire alarm control panel and notify the Hyannis Fire Dept. 2. Section 7—Testing Criteria 1. Sprinkler System a. Notify the authority having jurisdiction and Owner's representative of the time and date of all testing b. Perform all required acceptance test as required by NFPA 13,2007 C. Complete and sign the appropriate Contractor's material and test Certificate(s). Approval Requirements The following approvals are necessary prior to the start of work: 1. Approval of Sprinkler plans, 2. Permit from local Authorities no work is to proceed until all permits have been obtained. 3. All sprinkler work is to be performed by a Registered Massachusetts Sprinkler Contractor. -2- H Y D R A U L I C C A L C U L A T I O N S COVE R S -H E E T Office Building located at 905 Attacks Lane Hyannis W A T E R S U P P L Y STATIC PRESSURE (psi) 51 RESIDUAL PRESSURE (psi) 34 RESIDUAL FLOW (gpm) 949 B O O S T E R P U M P S NUMBER OF BOOSTER PUMPS 0 S P R I N K L E R S MAXIMUM SPACING OF SPRINKLERS (ft) 12. 67 MAXIMUM SPACING OF SPRINKLER LINES (ft) 9 SPECIFIED DISCHARGE DENSITY (gpm/sq. ft. ) .131 THIS SPRINKLER SYSTEM WILL DELIVER A DENSITY OF .131 gpm/sq. ft. FOR A DESIGN AREA OF 2535 SQ. FT. OF FLOOR AREA THIS SYSTEM OPERATES AT A FLOW OF 365.89 gpm AT A PRESSURE OF 38.33 psi AT THE BASE OF THE RISER (REF. PT. 3) PIPES USED FOR THIS SYSTEM -------------------------------------- -------------------------------------- 001 SCHEDULE 40 002 SCHEDULE 10 Office Building located at 905 Attacks Lane Hyannis PAGE 1 SPRINKLER SYSTEM ANALYSIS TO SHOW THE MAXIMUM DENSITY AVAILABLE ~ WITH ZERO PRESSURE REMAINING NNNNNNNNIN.NNNNNNNNNNNNNN NNNryNNNNNN NNNN THE FOLLOWING SPRINKLERS ARE OPERATING [ ] TEST AREA 1 [ ] TEST AREA 2 [ ] TEST AREA 3 [ ] REMOTE AREA Elevation of sprinklers = Elevation above water test. REF. PT. K ELEV. FLOW ---- PRESSURE (psi) ---- ft gpm Total Velocity Normal 40 5. 60 26.50 16.74 8.94 0.00 8.94 41 5.60 26.50 16.74 9.12 0.19 8.93 42 5. 60 26.50 17.00 9.64 0.43 9.22 43 5. 60 26.50 17.66 10.72 0.78 9.95 44 5. 60 26.50, 18.88 12.63 1.27 11.36 45 5. 60 26.50 16.96 9.17 0.00 9.17 46 5. 60 26.50 16. 93 9.33 0.19 9.14 47 5.60 26.50 17.17 9.84 0.44 9.40 48 5.60 26.50 17.83 10.93 0.79 10.14 49 5. 60 26.50 19.07 12.89 1.29 11.59 50 5. 60 26.50 16.75 8.94 0.00 8.94 51 5.60 26.50 16.73 9.11 0.19 8.92 52 5.60 26.50 17.02 9. 66 0.43 9.24 53 5.60 26.50 17.71 10.78 0.78 10.00 54 5.60 26.50 18. 92 12. 69 1.27 11.42 55 5. 60 26.50 16.77 8.97 0.00 8. 97 56 5.60 26.50 16.73 9.11 0.19 8.92 57 5.60 26.50 17.02 9. 67 0.43 9.24 58 5.60 26.50 • 17.74 10.81 0.78 . 10.03 59 5. 60 26.50 18. 98 12.75 1.27 11.48 60 5.60 26.50 19. 96 12.71 0.00 12.71 61 5.60 26.50 19. 92 12.92 0.27 12.65 62 5.60 26.50 20.23 13.66 0. 60 13.05 THE SPRINKLER SYSTEM FLOW IS 409.47 gpm THE OUTSIDE HOSE FLOW AT REFERENCE POINT NO. 1 IS 100.00 gpm [ ] THE INSIDE HOSE [ ] RACK SPKLR'S. [ ] YARD HYDT. FLOW IS 0.00 gpm THE MINIMUM DENSITY PROVIDED BY THIS SYSTEM IS 0.147 gpm/sq. ft. THE FOLLOWING PRESSURES & FLOWS OCCUR ---> AT REF. PT. 1 <--- STATIC PRESSURE 51.00 psi RESIDUAL PRESSURE 34.00 psi AT 949.00 gpm Office Building located at 905 Attacks Lane Hyannis PAGE 2 TOTAL SYSTEM FLOW 509.47 gpm AVAILABLE PRESSURE 45. 63 psi AT 509.47 gpm OPERATING PRESSURE 45. 63 psi. AT 509.47 gpm PRESSURE REMAINING 0.00 psi THE ABOVE RESULTS INCLUDE 5.00 psi FRICTION LOSS AT REF. PT. A 3 FOR A [ ] BACKFLOW PREVENTER [ ] METER [ ] DETECTOR CHECK VALVE [ ] OTHER DEVICE Office Building located at 905 Attacks Lane Hyannis PAGE 3 ------------------------------------------------------------------------------------ --------- HYDRAULIC CALCULATIONS AT SPECIFIED DENSITY --------------------------------------------------------------------------------------------- THE FOLLOWING SPRINKLERS ARE ,OPERATING IN: [ ] TEST AREA 1 [ ] TEST AREA 2 [ ] TEST AREA 3 [ ] REMOTE AREA Elevation of sprinklers = Elevation above water test. REF. PT. K ELEV. FLOW ---- PRESSURE '(psi) ---- ft gpm Total Velocity Normal 40 5.60 26.50 14 . 96 7.14 0.00 7.14 41 5. 60 26.50 14 .92 7.24 0.15 7.09 42 5.60 26.50 15. 14 7. 65 0.34 7.31 43 5.60 26.50 15.77 8.55 0.62 7. 93 44 5.60 26.50 16.94 10.15 1.01 9. 15 45 5.60 26.50 15.12 7.29 0.00 7.29 46 5.60 26.50 15.07 7.39 0.15 7.24 47 5.60 26.50 15.30 7.81 0.35 7.46 48 5.60 26.50 15. 95 8.75 0. 63 8.12 49 5.60 26.50 17. 13 10.39 1.03 9.36 50 5.60 26.50 14 .97 7.15 0.00 7.15 51 5.60 26.50 14 . 94 7.27 0.15 7.12 52 5.60 26.50 15.17 7.68 0.34 7.34 53 5. 60 . 26.50 15.79 8.57 0.62 7.95 54 5. 60 26.50 16.94 10.16 1.01 9.15 55 5.60 26.50 14.99 7.16 0.00 7.16 56 5.60 26.50 14. 96 7.29 0.15 7.14 57 5.60 26.50 15.21 7.71 0.34 7.37 58 5.60 26.50 15A3 8. 61 0. 62 7.99 59 5.60 26.50 16. 97 10.19 1.02 9.18 60 5.60 26.50 17.87 10.18 0.00 10.18 61 5.60 26.50 17.83 10.35 0.21 10.14 62 5.60 26.50 18.12 10. 95 0.48 10.46 THE SPRINKLER SYSTEM FLOW IS 365.89 gpm THE OUTSIDE HOSE FLOW AT REFERENCE POINT NO. 1 IS 100.00 gpm [ ] THE INSIDE HOSE [ ] RACK SPKLR'S. [ ] YARD HYDT. FLOW IS 0.00 gpm THE MINIMUM DENSITY PROVIDED BY THIS SYSTEM IS .0.131 gpm/sq. ft. THE FOLLOWING PRESSURES & FLOWS OCCUR ---> AT REF. PT. 1 <--- STATIC PRESSURE 51.00 psi RESIDUAL PRESSURE 34 .00 psi AT 949.00 gpm Office Building located at 905 Attacks Lane Hyannis PAGE 4 --------------------------------------------------------------------------------------------- TOTAL SYSTEM FLOW 465.89 gpm AVAILABLE PRESSURE 46.45 psi AT 465.89 gpm OPERATING PRESSURE 40.01 psi AT 465.89 gpm PRESSURE REMAINING 6.44 psi THE ABOVE RESULTS INCLUDE 5.00 psi FRICTION LOSS AT REF. PT. # 3 FOR A [ ] BACKFLOW PREVENTER [ ] METER [ ] DETECTOR CHECK VALVE [ ] OTHER DEVICE Office Building located at 905 Attacks Lane Hyannis PAGE 5 --------------------------------------------------------------------------------------------- FITTING Equivalent Length per NFPA 13 1994, 6-4.3 '-' Indicates Equivalent Length. 'T' Indicates Threaded Fitting 1=45 Elbow, 2=90 Elbow, 3='T' /Cross, 4=Butterfly Valve, 5=Gate Valve, 6=Swing Check Valve FROM TO FLOW PIPE FITS EQV. H-W PIPE DIA. FRIC. ELEV. PRESSURE (psi) (gpm) (ft) (ft) C TYPE (in) (psi) (psi) Pt Pt DIFF Pv Pv Pn Pn --------------------------------------------------------------------------------------------- 1 2 365.89 75.00 235 25.28 140 1 6.250 0.004 0.000 40.01 39.65 0.36 2 3 365.89 3.00 2553 41.00 . 120 1 6.065 0.005 1.083 39.65 38.33 0.24 3 4 365.89 8.00 26 52.71 120 2 6.357 0.004 3.467 38.33 29. 60 5.27 4 5 365.89 . 78.00 32 30. 10 120 2 4.260 0.031 0.000 29. 60 26.28 3.32 5 6 365.89 15.00 2 8.98 120 2 4.260 0.031 6.500 26.28 19.06 0.72 6 90 365.89 28.00 23 30.10 120 2 4.260 0.031 0.000 19.06 17.28 1.78 90 7 78.58 4 .34 0 . 0.00 120 2 4 .260 0.002 0.000 17.28 17.28 -0.00 90 8 287.32 4 .00 0 0.00 120 2 4.260 0.020 0.000 17.28 17.20 0.08 8 9 209.59 9.00 0 0.00 120 2 4.260 0.011 0.000 17.20 17.09 0.11 9 10 131.77 9.00 0 0.00 120 2 4 .260 0.005 0.000 17.09 17.05 0.04 10 11 53.82 9.00 0 0.00 120 2 4.260 0.001 0.000 17.05 17.07 -0.02 7 100 78.58 1.00 3 6.40 120 1 1.610 0.203 0.433 17.28 15.34 1.50 8 101 77.73 1.00 3 6.40 120 1 1.610 0.199 0.433 17.20 15.01 1.75 0.28 16.92 Office Building located at 905 Attacks Lane Hyannis PAGE 6 --------------------------------------------------------------------------------------------- FITTING Equivalent Length per NFPA 13 1994, 6-4.3 '-' Indicates Equivalent Length. 'T' Indicates Threaded Fitting 1=45 Elbow, 2=90 Elbow, 3='T'/Cross, 4=Butterfly Valve, 5=Gate Valve, 6=Swing Check Valve FROM TO FLOW PIPE FITS EQV. H-W PIPE DIA. FRIC. ELEV. PRESSURE (psi) (gpm) (ft) (ft) C TYPE (in) (psi) (psi) Pt Pt DIFF Pv Pv Pn Pn --------------------------------------------------------------------------------------------- 9 102 77.82 1.00 3 6.40 120 1 1.610 0.200 0.433 17.09 15.03 1.63 0. 15 16.94 10 103 77.96 1.00 3 6.40 120 1 1. 610 0.200 0.433 17.05 15.08 1.54 0.06 16.99 11 104 53.82 . 1.00 3 6.40 120 1 1.610 0.101 0.433 17.07 15.89 0675 40 41 -14. 96 12.42 0 0.00 120 1 1. 610 0.009 0.000 7. 14 7.24 -0.11 41 42 -29.88 12.42 0 0.00 120 1 1. 610 0.034 0.000 7.24 7. 65 -0.40 42 43 -45.02 12.42 0 0.00 120 1 1. 610 0.072 0.000 7.65 8.55 -0.90 43 44 -60.79 12.42 0 0.00 120 1 1.610 0.126 0.000 8.55 10.15 -1.60 44 101 -77.73 18.00 3 6.40 120 1 1. 610 0.199 0.000 10.15 15.01 -4.86 45 46 -15.12 12.42 0 0.00 120 1 1.610 0.010 0.000 7.29 7.39 -0.10 46 47 -30.19 12.42 0 0.00 120 1 1.610 0.035 0.000 7.39 7.81 -0.42 47 48 -45.49 12.42 0 0.00 120 1 1.610 0.074 0.000 7.81 8.75 -0.94 48 49 -61.45 12.42 0 0.00 120 1 1. 610 0.129 0.000 8.75 10.39 -1.64 49 100 -78.58 18.00 3 6.40 120 1 1. 610 0.203 0.000 10.39 15.34 -4.96 Office Building located at 905 Attacks Lane Hyannis PAGE 7 --------------------------------------------------------------------------------------------- FITTING Equivalent Length per NFPA 13 1994, 6-4.3 '-' Indicates Equivalent Length. 'T' Indicates Threaded Fitting 1=45 Elbow, 2=90 Elbow, 3='T'/Cross, 4=Butterfly Valve, 5=Gate Valve, 6=Swing Check Valve ------------ --------- FROM TO FLOW PIPE FITS EQV. H-W PIPE DIA. FRIC. ELEV. PRESSURE (psi) (gpm) (ft) (ft) C TYPE (in) . (psi) , (psi) Pt Pt DIFF Pv _ Pv Pn Pn --------------------------------------------------------------------------------------------- 50 51 -14.97 12.42 0 0.00 . 120 1 1. 610 0.009 0.000 7. 15 7.27 -0.12 51 52 -29. 91 12.42 0 0.00 120 1 1. 610 0.034 0.000 7.27 7.68 -0.41 52 53 -45.08 12.42 0 0.00 120 1 1. 610 0.073 0.000 7. 68 8.57 -0.89 53 54 -60.88 12.42 0 0.00 120 1 1.610 0. 127 0.000 8.57 10.16 -1.59 54 102 -77.82 18.00 3 6.40 120 1 1. 610 0.200 0.000 10.16 15.03 -4.87 55 56 -14 .99 12.42 0 0.00 120 1 1. 610 0.009 0.000 7.16 7.29 =0.13 56 57 -29. 95 12.42 0 0.00 120 1 1. 610 0.034 0.000 7.29 7.71 -0.42 57 58 -45.16 12.42 0 0.00 120 1 1. 610 0.073 0.000 7.71 8.61 -0. 90 58 59 -60. 99 12.42 0 0.00 120 1 1. 610 0.127 0.000 8.61 10.19 -1.58 59 103 -77.96 18.00 3 6.40 120 1 1. 610 0.200 0.000 10. 19 15.08 -4.88 60 61 -17.87 12.42 0 0.00 120 1 1.610 0.013 0.000 10.18 10.35 -0.18 61 62 -35.70 12.42 0 0.00 120 1 1.610 0.047 0.000 10.35 10.95 -0.59 62 104 -53.82 42.67 3 6.40 120 1 1. 610 0.101 0.000 10.95 15.89 -4.95 Office Building located at 905 Attacks Lane Hyannis PAGE 8 --------------------------------------------------------------------------------------------- FITTING Equivalent Length per NFPA 13 1994, 6-4.3 '-' Indicates Equivalent Length. 'T' Indicates Threaded Fitting 1=45 Elbow, 2=90 Elbow, 3='T'/Cross, 4=Butterfly Valve, 5=Gate Valve, 6=Swing Check Valve FROM TO FLOW PIPE FITS EQV. H-W PIPE DIA. FRIC. ELEV. PRESSURE (psi) (gpm) (ft) (ft) C TYPE (in) (psi) (psi) Pt Pt DIFF Pv Pv Pn Pn --------------------------------------------------------------------------------------------- A MAX. VELOCITY OF 12.38 ft./sec. OCCURS BETWEEN REF. PT. 49 AND 100 Sprinkler-CALC Release 7.2 Win By Walsh Engineering Inc. North Kingstown R.I. U.S.A. Town of Ba3ricistable ,. gtx R.elatorp Services S I:icbffd V.Sea,INreotor ' vaA � A1VXSioIl - •-- . � ---•• ... _ ._. _ .. -- ' 'Y'om�en�p,���Gommisszoner 200 Mai=StyY �,M�`02601 i www.town ba�stablemans . i Fay: 508-790-6230 $ce: 508-862-403 8 4 P petty C�wner MUSt ECO ' Complete and Sign This Section Us ��A Bvi dez as Ow=of rJac subject propeity r h=eby 2.UthWiZe in all mattes relative to'work aUrhorized by,this bIl ding permit application for: -' (address of rob) �. of tbe-a licant. Pools "Pool fences and alarms axe the x�espoasibility insta]Ied ar�d all fina_l are aot to be filed or,, rIs.ed before fence is inspections are peifoimed and acceptecL S' of Owner ° aa+ • Ste`° �� �� � l� . �r'xnt Name Pax Name o�nxMs:owrtst��'ssrort�oors .:y ,4co CERTIFICATE OF LIABILITY INSURANCE D D""'"' `..� 4/2/202/2015 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 Marjorie Sullivan Eastern Insurance Group LLC PHONE (508-923-2205 FAX 500 Forest Avenue ADMDR •msullivan@easterninsurance.com INSURE S AFFORDING COVERAGE NAIC# Brockton MA 02301 INSURER A'Admiral Insurance Company INSURED INSURERB:Selective Insurance Group Mass Fire Prevention•Inc INSURER C:Inde endence Casualty Ins Cc PO Box 335 INSURER D Acadia Insurance Company 1325 INSURER E: Rockland MA 02370-0335 INSURERF: COVERAGES CERTIFICATE NUMBERxtaster 2/10/15 - 5/6/15 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. ILTR TYPE OF INSURANCE ADOL BR POLICY NUMBER MPOLICY EFF MPO�ppY EXP LIMITS . GENERAL LIABILITY EACH OCCURRENCE. $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES a occurrence) $ 50,000 A CLAIMS-MADE FX]OCCUR X Y CA00001901702 /10/2015 /10/2016 MED EXP(Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY Ea COMBaccidINED SINGLE LIMIT 11000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED 9094788 /6/2014 /6/2015 AUTOS M AUTOS X y BODILY INJURY(Per accident) $ X HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAS CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ io,00c X Y BFX096131200 /10/2015 /10/2016 $ C WORKERS COMPENSATION Y, X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ - 1,000,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) I00116801 /10/2015 /10/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 D Equipment Floater IM503903012 /10/2015 /10/2016 Rented/Leased Equipment 25,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Cape Cod Health Care American Construction Corporation, Joe Keller Company and Cape Cod Health Care and all other entities required by specific contract are included as Additional Insured on a Primary and Non-contributory basis on all coverages other than Workers' Compensation. Additional Insured coverage on General Liability and Excess Liability includes Completed Operations. Waiver of Subrogation applies in favor of certificate holder on all policies. 30 Days Notice of Cancellation will be provided except for non-payment of premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN American Construction Corporation ACCORDANCE WITH THE POLICY PROVISIONS. 54 Oakville Street Lynn, MA 01905 AUTHORIZED REPRESENTATIVE John Koegel/MSULLI ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 r9mrxKt nt Tho A(ORn namo anri Innn aria ronictorori markc of A(tnRr1 The Commonwealth o Massachusetts. eP o c eats Office of brveskgutions 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/ContractorsMectricians/PluiAers - — Applicant Information --Please Print Le' ib� Name(Bnsiness/organiration/Indmduai):��5 S 1—or C.. PI'4 Address- 0" '?sr City/State/Zip: X641aMA ,2J26 Phone#: Are you an employer? Check the appropriate box: Type of project(required): l. Firm a employer with 4. ❑I am a general contractor and I employees(fiiIl and/or part time)_ * have hired the sub-contractors 6. ❑New construction 2.[1 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 many capacity. employees and have workers' insurance_ 9. Building addition [No workers rr comp.insurance comp. re;Cluire -] 5. We are a corporation and its l0.❑Electrical repairs or additions • 3.❑ I am a ho m officers have exercised their eowner doing all work I I.0 Plumbing repairs or additions myself [No workers'comp. rat of exemption per MGL 12 Q Roof repairs c.152 insurance required_]t ' §1O'and we have no [� employees. [No workers' 13. Other comp.incm-ancerequired_] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infarmaBon. t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors must submit anew affidavit indicating such. 'Contactors that check this box must attached an additional sheet showing the name of the sub-contactors and state whether or not those ma ities have employees. If the sub-mnt actors have employes,they nmst provide their workers'comp.policy amber. I mn an employer&at is providing.workers'compensation insurance for my employees. Below is the poFicy and job,rite information. Insurance Company Namef �GT e DZ6Yi -h C-( �.t✓o����/ � e7 G Policy#or Self-ins.Lic.A- IV (,Ob/J L lf-&/ Expiation Date: rob Site Address:_ D s- t om/ y G � k1 city/State/ziP: X*k`f Me -- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Secdon25A of MGL c. 152 can lead to the imposition of criminal penalties of a foe up to$1,50D.00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a time 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 insuranm coverage verification. I do hereby cce�rdthe and pen ofperlury that the information provided/above is trice and correct Si atztt-e: Date: ?' •/ Phone Official use only. Do not write in this areg to be completed by city or town oikiaL City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Ofher Contact Person: Phone# . -Information and Instrucffon� Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pun Mtn to this statute,an employee is defined as"__.every person is the service of another under any contract of hire, express lied,oral or written_" xp or implied, An ernplayer 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 oa 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 Iocal 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(-/)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance ofpublic 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 checldng 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 inm=ce. 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 he sure to sign and date the affidavit_ The affidavit should be retuned to the city or town that the application for the permit or license is being requested,not the Department of LLdu,strial 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 t 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/licease number which will be used as a reference number. In addition, an applicant that must submit multiple perm.itllicense applications in any given year,need only submit one affidavit indicating current policy info=ation(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.,he city or town may be provided toe applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture. (i_e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to than 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 CQmmanwealth of Massachusetts Depart rent cif hidusirial Accidents Office of flivestigattoxus GGO Washivon Street Dcastan=MA 02111 ` d. 4 617` 7-4900 ci)t 406 4r I-9-77-MASS.AFE Fax#617-727-7749 Revised 4-24-07 www mass_gov/dia TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel So Application # 0?0/ S 6 D Health Division Date Issued Conservation Division Application Fe �o Planning Dept. Permit Fee 7M l`CU 2,57 Date Definitive Plan Approved by Planning Board 735 s� Historic - OKH _ Preservation,/-Hyannis ` Project Street Address 90,5- '41,4e W-S 1*rt, ee- . /�f/sf'n•.i.�s Village ML4tvivr_. Owner vas j4Z Alle4e . Address /d Xf a 1J h lec/, /9MV-6a Telephone 2 - 7.5- 21 oy Permit Request e�aoic.;o As,-74Ar- o�G/9�r'/�r ^1-ows'-f� �. 1,0,Ur /�-0o , 6/lia ��?�l�l � /trl"Ag l �' w 62co A/P 9Ak' _-'Q!'-e , Square feet: 1 st floor: existin9P41` proposed 2nd floor: existing -- proposed — Total new '- Zoning District / Flood Plain Groundwater Overlay Project Valuation 3*'a20 Construction Type 484til.Z,uvr,or- F.c,-e. Lot Size 2Q,coo Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure IV4WX- Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other j)AAe ��1 ... Basement Finished Area (sq.ft.) Basement Unfinished Area (sqt Number of Baths: Full: existing new Half: existing it new y 71 Number of Bedrooms: — existing - new , Total Room Count (not including baths): existing new First Floor Roo Counter Heat Type and Fuel: dGas ❑ Oil ❑ Electric ❑ Other u, M Central Air: ll9 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 Aes ❑ No If yes, site plan review# Current Use Proposed Use OFPr Ce APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name -DNSai w Telephone Number 9IP/ 1?6 5` 6 S-V3 Address License # D 574V 3 W 0/,A 0/0o6` Home Improvement Contractor# Email ec,—a&4&g10 a"c.2,"4,�,qA , 40M Worker's Compensation # hk2- 3/5 .310,111-o2Z ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE E: - FOR OFFICIAL USE ONLY APPLICATION# r ` DATE ISSUED 0 MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: R y 7 FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL'' GAS: ROUGH r FINAL FINAL BUILDING DATE CLOSED OUT ` ASSOCIATION PLAN NO. AMERI-4 OP ID:WM DATE(MM/DD/YYYY) `.� CERTIFICATE OF LIABILITY INSURANCE 01/05/2015 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 McLaughlin Insurance Agency NAME: Melrose,Lynn Fells Parkway PHONE Ext:781-665-2775 FAX No: 781-665-0295 Mel MA 02176 E-MAIL John E.McLaughlin Jr. ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Acadia Insurance Company INSURED Attn: Mar CobuConstrn Corp. INSURER B:Union Insurance Company Attn: Mary Coburn 54 Oakville St. INSURER C:Liberty Mutual Lynn,MA 01905-2817 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. INSR DL UBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCEINSR WVD POLICY NUMBER MM/DD/YYYY) 1MM/DD1YYYY1 LIMITS GENERAL LIABILITY EACH ANAOCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CPA5040457-13 04/01/2014 04/01/2015 PREMISES Ea occurrence $ 500,000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 1-1 POLICY PRO X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B ANY AUTO MAA5042585-12 04/01/2014 04/01/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS X AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS PER ACCIDENT $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS LIAB CLAIMS-MADE CUA5042733-12 04/01/2014 04/01/2015 AGGREGATE $ 5,000,000 DED X RETENTION$ 10000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY X TORY LIMITS I I ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N TO BE ISSUED BY CARRIER 11/09/2014 11/09/2015 E.L.EACH ACCIDENT $ 500 OFFICER/MEMBER EXCLUDED? ❑ N/A ,000 (Mandatory in If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Coverage applies to operations usual to the insured. The certificate holder is included as an Additional Insured under General Liability if required by written contract or agreement. CERTIFICATE HOLDER CANCELLATION BARNS02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Division ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CS-057683 SAU GUS MA ()Iggl 08/15/2015 r i LICENSE s« �. . ?•io a� yr^ tr END 4d NUMBERq �p .p? �.�} .NONE S8eQ.ata°.562, "aka` �v.1IXP ^`' ' '!- OGB 15w2018 G8.�.a P 1957 1 -ctZ i REST 15 SEX M NCT 540 'NONE �. � v WRN a g i PATRICK M • a 6 PRANKER RD SAUGUS,MA O1906-2756 �" - � - `-�-"�"'•�- 5 DC 01.2?-ZC14 Rcv 07-1S29G9 1 ne uommonweatrn of iwassaenuserts 1 .__.___�.._, Department of Industrial Accidents Office of Investigations r` I Congress Street, Suite 100 Boston, MA 02114-2017 ov/dia www.mass. - g Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): American Construction Corp. E Address:54 Oakville Street City/State/Zip:Lynn, MA 01905-2817 Phone #:781-584-6178 Are you an employer? Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for 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' 13.0 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Liberty Mutual Policy#or Self-ins. Lic.#:WC2-31 S-380111-022 Expiration Date:11/09/2013 Job Site Address: 7cl�� E Ae�� 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 fo ' rance coverage verification. I do hereby cer 'y u e ins anAperafdes o e information provided above is true and correct. Si Date:l ature• f/s^ _ -- - -- --------- f`—'�----- -- --- _—--I Phone#: lg 91!; 3 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#: Town of Barnstable Regulatory Services t yMASS. Thomas Thomas F.Geiler,Director i639• ♦0 'tifn►ru•�°` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property O•vcmer Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize to to act on my behalf, in all matters relative to work authorized by this building permit (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. C Sign ture of Owner Signature of Applicant Print Name Print Name Date Q:F0RMS:0WNERPEFMISSI0NP00LS 62012 Mass. Corporations, external master page Page 1 of 2 1 Corporations Division Business Entity Summary ID Number: 001100295 Request certificate I New search, Summary for: FRESH POND REALTY TRUST LLC The exact name of the Domestic Limited Liability Company (LLC): FRESH POND REALTY TRUST LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 001100295 Date of Organization in Massachusetts: 02-20-2013 Last date certain: The location or address where the records are maintained (A PO box is not a valid location or address): Address: 1436 IYANNOUGH ROAD f City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and address of the Resident Agent: Name: CT CORPORATION SYSTEM Address: 155 FEDERAL STREET, SUITE 700 City or town, State, Zip code, BOSTON, MA 02110 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER JOSEPH'KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 USA MANAGER CHARLES ROBINSON 434 IYANNOUGH ROAD HYANNIS, MA 02660 USA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Title Individual name Address SOC SIGNATORY CHARLES ROBINSON 434 IYANNOUGH ROAD HYANNIS, MA 02660 USA http://corp.sec.state.ma.us/CorpWeb/CorpSearch/QorpSummary.a... 3/4/2 015 I Mass. Corporations, external master page Page 2 of 2 SOC SIGNATORY I JOSEPH KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 s USA The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address REAL PROPERTY JOSEPH KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 USA REAL PROPERTY CHARLES ROBINSON 434 IYANNOUGH ROAD HYANNIS, MA 02660 USA Confidential r Merger Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS 57 Annual Report Annual Report - Professional $x"; 5 Articles of Entity Conversion Certificate of Amendment View filings Comments or notes associated with this business entity: 'r New search bttp:Hcorp.sec.state.ma.us/CorpWeb/CorpSearcli/Co'Summary.a... 3/4/2 015 Initial Construction Control Document To be submitted with the buildin `permit aP lic %107 RAJSTABL off Registered Design Professional 5 .r ea; for work per the 8ffi edition of the ; ? 10: 5�. Massachusetts State Building Code, 780 CMR, Section 107 Project Title: CCHC Wound Care/Rehabilitation Date:2-11-2015 Property Address: 905 Attucks Lane Project: Check(x)one or both as applicable: New construction X Existing Construction Project description:New Exam Rooms and Office area I Gregory B. Siroonian MA Registration Number: 9748 Expiration date: 8/31/2015 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': x Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be.present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments,in a form acceptable to the building official Upon completion of the work,I shall submit to the building official a`Final Construction Control Document'. Enter in the space to the right a'wet"orz electronic signature and seal: 1 t Nr— r yx Phone number: 508 759 9828 Email: gbs@MEDCO' ' chi Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 11 2013 Mass. Corporations, external master page Page 1 of 2 w a o �r , fib: ._et✓sz $." `§. i" '<xa ';'¢�' %' Corporations Division Business Entity Summary ID Number: 000900634 Request certificate New search, Summary for: AMERICAN CONSTRUCTION CORPORATION The exact name of the Domestic Profit Corporation: AMERICAN CONSTRUCTION CORPORATION Entity type: Domestic Profit Corporation Identification'Number: 000900634 Old ID Number: Date of Organization in Massachusetts: 08-01-2005 Last date certain: Current Fiscal Month/Day: 12/31 The location of the Principal Office: Address: 54 OAKVILLE ST City or town, State, Zip code, LYNN, MA 01905 USA Country: The name and address of the Registered Agent: Name: PATRICK M. COBURN Address: 54 OAKVILLE ST City or town, State, Zip code, LYNN, MA 01905 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT MARY ELLEN COBURN MRS 6 PRANKER ROAD SAUGUS, MA 01906 USA TREASURER MARY ELLEN COBURN MRS 6 PRANKER ROAD SAUGUS, MA 01906 USA SECRETARY MARY ELLEN COBURN MRS 6 PRANKER ROAD SAUGUS, MA 01906 USA VICE PRESIDENT PATRICK MICHAEL COBURN MR 6 PRANKER ROAD SAUGUS, MA 01906 USA DIRECTOR PATRICK MICHAEL COBURN MR 6 PRANKER ROAD SAUGUS, MA 01906 USA http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.a.... 3/4/2015 Mass. Corporations, external master page Page 2 of 2 Business entity stock is publicly traded: r The total number of shares and the par value, if any, of each class of stock which this business entity is authorized to issue: Total Authorized Total issued and Class of Stock Par value per share outstanding No. of shares Total par No.of shares value CNP $ 0.00 100 $ 0.00 0 r r Confidential r Merger Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Administrative Dissolution i Annual Report ` Application For Revival Articles of Amendment _I__ _L View filings Comments or notes associated with this business entity: New search I http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.a... 3/4/2015 PROJE / NAME &j & ADDRESS: ` AZ?w 4 PERMIT# 4V/ PERMIT DATE: MIP: a - 070 LARGE ROLLED PLANS ARE IN: BOX SLOT - Data entered in MAPS program on: �y BY: Lool q/wpfiles/forms/archive Final Constructioa-Control Document 8 To be submitted at completion of construction by a Registered Design Professional r��E �j OF AR STABLE va for work per the 8th edition of the Sje tl i APE t 'i1' 10: 53 Massachusetts State Building Code, 780:,CMR,,Section 107 Project Title: CCHC Wound Care/Rehabilitation Date: 7-28-2015 Permit No. DI1.1 N : Property Address: 905 Attucks Lane Project: Check(x)one or both as applicable:'-New construction X Existing Construction. Project description:New Exam Rooms and Office Area .I Gregory B Siroonian MA Registration Number:9748 Expiration date: 8-3 ,am a registered design professional,: and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: X Architectural Structural Mechanical Fire Protection Electrical Other:Describe for the above named project: I,or my designee,have performed the necessary professional'services°and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: ' 1. Have reviewed,for conformance to this code and the design concept, shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. . 2. Have performed the duties for registered design professionals in 780 CMR Chapter 1.7; as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progr9ss and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. . Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Mr Enter in the space to the right a"wet"or' k electronic signature and seal: t, m g? Phone number: 508 759 9828 Email: gbs@MEDc6March.com =� Building Official Use Only Building Official Name: Permit No.: Date: V.er�ion 06 11 2013 , 16. CERTIFICATIONS AND APPROVALS(conanuem 16A Property or Owner Representative: accept this system as haul installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name:44.✓ c t I--Date: 1�' 5::r Organization: Title: Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications.with its approved sequence of operations.and with all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: OWN :3- . I e NFPA 72, Fig. 10-18.2.11;1 (p. 12 of 12) Copynprtt 0 2M NaMW Fire ProteCW Assoaftm Pus form may be atpw for m&vt&W use WW anon for rosato 0 may not aR oopred for eammeraal We or dkwl Wron is .. 115; RECORD OF SYSTEM OPERATIONAL ACCEPTANCE'TEST ®New;system All operaUbnal features and functions of this si tem were tested b}:;or it lhepresence:oj(Ire signer shm%n Moir.ai the date shown below.and were found to be operattitg properly in accordance with the requiremenis for the fdUmving: Q'Modifieationslo en existing system 4`fl newly madifred aperation�rl features and junclfotu of ihe-sysleot mere tested hy;or:in t/re preaence'oj the signer shown below.on the date shod^n belotd,gird were found to be operating properly,in accordance with the. , requirenienra ofthe following.; ®,vrP,4 ?.anion:, 2010 ®,VFPA 70.National hJecirical.Co. ;A'rucle,760,Edition: 20.11. C9 MMufacturer s published instructlons ^ Other(specify): ®Individual devic0 trstingdocumentation[Itispedib i and Testing Form(Cisurc 14.6.2.4)isattachedj Zoe ZI 1 Si ned• - :�Hhtcd name David S Santos Date: Organization: Prime systems Inc Titici ;,President,' M Phone' 40t-781-9200` - ,. ..4. 16. CERTIFICATIONS AND APPROVALS 16.1 System lnstallation Contracior: This system,as sPecificd herein, been installed and tested according to 51l l\E'Wstandards cited tiercin. Sipte .w ;Panted"name. ` 4e L D"ate Organization: Bayside Electrical Title:, Phone: 508-T71-7270 0 161 System Service Contractor`:: The undersigned has a service,comraci for this system to i Tf as ofthe date shown.helots^; t Signed, ;1'nnted name David5.Santos7// _i Organization: Prime Sysi ems,Inc. '' 11u0r' President, !'hone: 401 78t-9200; 163 Supervising Station This system,as,sprrci)ied heron;Atll be"rnonrtoredaccortling to all'YFPA standards cited herein:; Y. Signed; g 1'nrited name r Data. Orguri Mtign: 1'Itle' Phone } NrPA.72, Fig::1O•.18'2A1.1 (pr.'l1 of tit) h. `. Copyrfghi 02o0S Nesknal Fite Not eco6n Ass6dafion.This turn+Mai to wp�ed t 1r 0iv�du81 use.ctrw it; fai resole h May M be oopoed for c mmetaai safe, asv j;utron' en 13. SYSTEM POWER(cominued) 133 .Notificition Appliance Power Extender Panels z ®This systemA6ds not h xtcndcrponcls: 13.3A Primary.Power R . Input voltage of power ext�ndcr g- 'I s); Po��cr extender panel asmps:- Overcurrent protection: Type:. Amps: s Location(of primary supply panel board): Disconnecting means location: 13.3.2 Engine-Driven Generator ®1'hwmdoes nut ha�ea gener`ato' r Location of gcncrator: Location of fuel storage., Type`orf foci;. - ' 1313.3 Uninterruptibl,e?ower System s ®Phis system:does not have a UPS. Equipment po%cercd by a UPS systefri 1 Location of UPS system: Calculated capacity of:UPS batteries to drive the system components connected to it: t In standby mode(hours): In alarm mode(minutes); . n 13.3.4 Batteries p: Location: Type li oininal voltage. Amplhour rating: Calculated capacity of batteries to drive the sy,tein: '. In standby mode(hours);: In alarm mode(minutes) 0 Batteries are marked.%�ith date nfmanufacture, 0 Battery c'k6lations arc attached N , 14. RECORD OF SYSTEM INSTALLATION ; 1'ill oil afier;a//Aisrallatson rl rohiplete turd wsrin has bee checked for opens chnrr ground frrrrlls;'ara!improper ' branching,bail before cd�rrhrcrin operational uc'clrh lance`lests. This is, I cw system ®Modification to an existing system tPermit number:. The"system has been installed'in accordance'with the follo��`tng requirements:(Note"uny or all.that apply.) ®ATP.4 71.Edition: '2019' . ❑AWN 70.Nalional plecirical`aek.Arttcle•766.Edition: 201^1 0 manufacturer s published instructions System deviations frorrr`r�firenced[s1"RA stand4d'. None' 1 frnued'namc;,' David S::Santos, . 'Data.. Orga►'ization; Pinie ystemsjnc: Title; President - •Phone: 401781.9200 t - 1 a,` r 2,Fig:, (1 18' ,1 r:t (prlt1 of 12} •• copynght'02M N040naf*o PrOtOCiOn AssoCi0tion T li$f0m mey 00 Copied 1011lWiw0001 Use olftOr t IOr f05010..II may n0f-b0 tOptOd fdr o0mmoreial sale O16rBtriDuLOn. - ;. -,r. 13. SYSTEM,POWER(continued) 13.1.3 Umnterruptible Power System ®Thissysteni:does not have a.UPS. Equipment powered by a UPS system: ' Location of UPS'systcm; Calculated capacity or ups batteries to drive the sysiem com.`ponciits c6finectLd to it: In standby mode(hours): f In alarm made(minuies)i 13.1.4 Batteries " Location: FACP' ' ^� type Lead Add, i�ton11 pl voltage: .24: Amp/hour stirs t 7AH Calculated capacity of batterics to drive thcsV stem; In standby mode;(hours): 24,, lei alarm modc(mmutes' 5; Batteries are marked with date ofmanurh6ure, 0 Battery calculations are attached 13.2 ln-Building Fire Emergency Voice Alarm Communication.Systern or Ma3s'Nokcation System ®This system does not have an EVACS or MNS system: V 131.1 Primary Power Input voltage of EVACS or MN'$panel:; EVACS or MNS panel'amps', Ovcrcurrent protection: Type: Amps: Location(of primary supply panchboard)':. ' ' Disconnecting means lacation: � � 13.2:2 Engine-Driven Generator system does not have a gcngm or. Location ofgeiieratori ri Location of fuel storage;} TA,c 131.3 Uninterruptible Rowel System t ® f7tis system-dues not haven UPS. Equipment powered by a UPS system,. Location of UPS system: Calculated capacity of UlyS batteries to dri�'e the s�stem components connected to"it: i In standby mode(hours):; 1n alarm mode(minutes): .131.4.Batterie3 ` • R Location: Type:; Nominal vofiagi:, Amp/tiour rattng> Calculated capacity of bahcrtt.ti to;dnvt thcsystem; In standby mode(hours)- µ In alarm.motie(minutes): 0.Batteries arc;narl.etl tv It dateof manufacture ' S ❑Battery calculations are attiiclicd. NFP,4-72, Fig. 10,1II12.1r,11 (p:'9 of 12) Copyr pnt 0 2W9 National Fee Prolectson A=Oation,This form may be'copied for individual use other then for renal®,11 may not 08 copu d fat CofnnlMC 91 sale ai distribution � ea I ' t ' 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS t6n'tinaedJ 113 ;Area of Refuge(Area oCRescue Assistance)Emergency Communications,Systems; ®This systcm does not hive an area of refuge(area of nccuc assistance)emergency communicattonsaystcm: Numbcr ofstationst Locution of"central control point: Dkvs and hours.when central control point is attendcd: Location of alternate control point: Days and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems T ®This system does not have an:clevator emergency communications system: Number of:elevators with stations: Location ofcentraf,control point: Days and hours when central control,Oint is uttcnded: Location of'afteritate control point: Days and hours whcn alternutc.rontrol point is uttcndcZl: ' IS OtherWo-Way Communication Systems '.Describe: .. . 12. CONTROL.FUf : TIONS; r k This system activatCs the following control fuctigns: Hold-open door'rclutsmg devil is O Smoke management ❑H'VAC shutdowh ❑F/S dampers ❑Door unlocking Eler-aOr recall ❑Fuel source shutdo��'n O L'tinguishing'agentvelease . Elevator''stiunt trip p Mass notification system override of lire alarm notific5uon appliances; " Other(specify): 12.1 Addressable Control Modules F ❑T-b' ystcm does 6 'h e.contrnl modu.les.. . o N be of dev Other(spccif}•). 1,3. .SYSTEM POWER 13.1. Controi Unit 11111.1 Primary PoWie input'voltage of control panel:° 12py,AC Convol panel'umps: Oveecurrent proiecUon: I ypC:: I�reaker Am s 20 Location(of primary supply panel boariij: Ele'cfric/ Sprinkler Ro p,om` " Dlcconnceung'm. ans`I,cication •. r 13 1:2 Engine-Driven.Generitor ®This.sysiem does not have a generator. Locat tn.ofgeneratori' Location of fuel storage: Typeo(1'uef. AVOIN NFPA1 72,fig, l0 1$°2_`1.1 ip;8 of. 12) Copynpht 02M9.NOOnal Fire Prolection Ais=ation This form may De copied for ftividual use of rI than.lor fgsalA.It fndy rtol o® ,ed for'rbmmercial We ar as(ritxruon, 10. MASS NOTIFICATION CONTROLS,APPLIANCES,AND CIRCUITS ®This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: rF Location 2: R. Location 3: 102 High-Power Speaker Arrays Number of HPSA speaker initiation zones:. Location I: Y' Location 2: w* Location 3: 10.3 Mass Notification Devices Combination fire alarmMNS visible appliances: MNS-only visible appliances: Textual signs: Other(describe): C. Supervision class « 103.1 Special Hazard Notification ®This system does not have special suppression predischarge notification. Q MNS systems DO NOT override notification appliances required to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ®This system does not have,a two-wa)telephone systcin.' Number of telephone jacks installed: ` Number of warden stations installed: Number of telephone handsets stored on site: ' Type of telephone system installed: ,Q EIettricall wend; " )� [3 Sound powered.. 112 Two-Way Radio Communications Enhancement System ®This system does not have a two-way radio communications enhancement s)-Aem. Percentage of area covered by two-way radio service: Critical areas:- % General building area: " % ;. Amplification component locations: Inbound signal strength: dBm Outbound signal strength: dBm'm' Donor antenna isolation is: dB above the signal booster on Radio frequencies covered: Radio;system monitor panel location: ry; .' .. 1. NFPA72 Fig •10.18:2 1,1 (p 7of-12) Capyrfn 0 2=Newel Foe PmMum Aeeoast�on lloe fmm may to oopwd for o dm d"uao annr non for reauw a may from be aopoed for omemerdm sate or dm&&-eon T. MONITORED SYSTEMS 7.1 Engine-Driven Generator ®:This system doer not have.a generator. " 7.1.-1 CeneratorFu_nctions Supervised O.Engtnc or control-panel trouble ❑Generator running i Selector s�►itcli not m auto D LOw fuel ❑Other -specify): 7 2 S :ecial Hazard Su ress op S stems " `""` p. pP , y. � ®Thl�sya�tem dtirs noCinonttor spcctal hurard systems:. Description.of special hazard system(s): 7.3 Other Monitoring Systems ®This.system aties no monitor other systcros Description:of special haiard:systcm(s); 8. ANNUNCIATORS p This wstcm dk;s not have 1rinUnciafaiSl 8.1 Location and Description of.Annunciat ors ` Location 1:' Location 2•! Location 3: S. ALARM NOTIFICATION.APPLIANCES 9.1 ln-Building Eire Emergency Voice Alarin Canimuncahon System ®'I`Liis system doixnot havcain LVAGS. Number of single vice alum channels: Numbu of multiple voice aiafm channelsi Number of spi�akcrs Number of spcal.cr citcuittii Location ofainplificalion aridsound prni essing cquipmcr t Location of paging microphone stations: Location 1• Locatllin.2' , Location 3: 9.2 tiomoice'Notiftcation Appliances; ❑This s}stem does not hnvc iionvoicc notificuti�n ttppliancrs Hornsi Vith..vtstble 1i Bells: Witt '3�Wblrc Chimr�s: . �-with, icible: Visibie only' 7 Otter(descnlc�:; 9.3 Notification.Appliance Power Eictender'Ranels ® I is systcm.does not have po��cr extender panels Quantity.' Locations;:< t NPPn 7,, Fig., (p_6 of`1.2) Ccpynghl WM' National Fire Protection Assoclatton.Th4 form may copiod for iroC Aual use other than for rosaie,.Itmby not tie copied Poi CoiitmordBl Salo 6 or atritiution,. r 5. ALARM INITIATING OEVICE$'(conttnued) M 51A Addressable Monitoring 1ltodules 0 This systcm does not have:monitontigrnodules. Number of devices: 4; 5.2.7 Waterflow Alarm Devices ❑Thts system'does not have��aterflow alarm devices: Type and number of devices:, Addressable: _2 Ganventional. Cndui: Transmitter 5.2.8 Alarm Verification ®This system discs not ncoiporate alarm venticatian. Numberof devices subject to alarm yen'rkatiori Alarm verification set,for seconds 5.2.9 Presignal 0 This s',vstem:dozs not incorporate pre-signal: Number of devices subject to liresignai:, Describe prt$iglial functions: , 5.2.10 Positive.Alarrn Sequeo`ce(PAS) 0'1 his system docs_not incorporate"PAS:; 'Describe PAS: y 5.2.11. Other Initiating Devices 0 This system does not have other initiating devices. Describe ' S. SUPERVISORY'SIGNAL-INITIATING DEVICES 6A Sprinkler'System Supervisory Devices ❑Thta s ' does not huve spnnklcr's Werviso)devices;.'. Type and,no bcrofdevices Addressable: 2 j.Conventional: Coded: Transmitter: Other(specify): 6.2 Fire Pump Description and Supervisory Devices 0 This system does not have a Are pump. Type fire pump- ❑'ElcOric;pomp ❑-Fngirile Type and number of devices: Addressablc: C6hvcnti6nal: Coded: .7 ransii itteri- Other(spccify):: 61.1 Fire Pump Functions'Supervised ti 4 (]Power itunriing 0 Phase reversal ❑Scleet, r swwit'not.in auto 0 Engine or control pahel trouble L6i,fuel Other(spceify);. r 6.3 Duct Smoke Detectors(DSD`s). ®Thls system dots not have DS[7s cauctng supervisor} sisnals Type and nunibcr pf deyiees Addressable: C6 writtonal: y �, Other(spi cifv): , T�pe of covcrigc: Tv pi ol`amokc detector xnsing technology O lgtp tion ®Ohm ptlectric ❑AspfrAiing_ (j f3cant 6 4 Other Supervisory Devrces. , ® I his system dues not,havt other-,supervisory devices.: Describe' IV)t1aA 72,'Pig: 10.1.8.2,I (p:5 of 12)- Ccpynght 02p09 Natonal f'ue Prcfecurn Association;This form may be Copied for trelowal use other than tot resale,11 may not,tie copied 6 cammatdal We or distritilaim, 5. ALARM INITIATING DEVICES L e 5.1 Manual Initiating Devices: . 5A.1 Manual Fire Alarm Boxes ti This system does not have manual fire alarm bores. Type and number of devices: Addressable 5 'Convventional:.° Coiled: ' "1 ransmitter Other(spccifv) 5.1.2 Other Alarm Boxes °�This sysie m tlors not have other Want 68kc-s.' Description `- Type and number ofdeWces: Addressablc:. Conventional: Coded: Transmitter. Other(specify): 5.2 Automatic Initiating Devices - 5.2.1 Smoke Detectors A ., This swvtcm dins not have smoke detectors. Typc and number of devices: Addressable: 2 Cdnvcntronalt Other(specify): Type of coverage: [I Complete area ®Partial area ❑Nonreyuired partial area Other(specify): Type of smoke detector sensiu technolog}; i]Ionisation ®PhotoclectrlC• ❑mUlUlfrtefl8 ❑Aspirating ❑liKam Other(specify) i 5.21 Duct Smoke Detectors'',, r []This s}st_em does not have.51arm causing duct smoke detector. Type and number ol'dcviccs: Addressable: 4 Connentronal. Other(specify): ,. - •I'vPc of coverage:; Type of smoke detect&sensing technology:` O lomiation ®Phdtoelectrie �Aspirating ❑E36m 5.23 Radiant Energy(Flame)Detectors 01•his system does not have radiant�ncrF� detc�cfors: t Type and number Of devices: Addressable: - Conventional: F Other(specify):. e Typc of cd%ce gc:, , 5.2.4 Gas Detectors 0 This s�stem dais not,have gas dttc'ciors p ;of detector(s)i �, e. Numberot'deviccs: Addressable: •Conventoonal: Type of coverage:' 5 25 Heat Defectors. ® Iltissyetcm does not-li a heat detectors. T*and number of devices Adddressablciry ., Conventional., `a , 7 3pc of'co�eragei Q COOT etc area ®Pan ial area ❑Nonrequircd psriral area ❑1'.inear ❑.Slior x `T) e.ohat detector se sin .te._h.n.ola 'y, ❑Ip e sed tCmperaturc S Rail=of,-rise; 0 Rate compen atcd , . fNFP.41 72:F Iq. 1018.2J A (p4 of l?). `° Copyright 0 2009 National Ftro Protect on Association This form may be cop ed for mCiYidual use ahoy roan lor'rasale p may not tie copied for cornmorc.W safe or mstnt uuan: :: 4 4. CIRCUITS AND PATHWAYS U Signaling Line Pathways 4.1.1 Pathways Class Designations aad'Survivability S '. y Pathways-class: A Survivability kv.cl;` 1: Qutintn� 1 '(See NFPA 72.Sections 12.3 did 12.4) 4a.2 Pathways Utilizing T*o or More'r9edia, ` Quantity: Description; 4.1.3 Device Power Pathways ❑No separate power pathwoys from the signalin line pathway i]Power patMKays are separate but of the same'pathway.classtfication as the signaling line pitili%6y ❑Power pathways are separate,and different classification;from the signaling line pathway 44.4 Isolation Modules Quantity: 3' rrn 4.2 Alarm.lnitiating Devtce.Pattiways ; .4.2.I Pathways Class D.esigttations'an-d Survivability, y Pathways class: Survivability level: Quantity: (See NFPA 72.Sections 12 3 find 12.,4) ' 4.21 Pathways'Utilizing Two or More Media Quantity: Description: . 1 4.73 Device Power Pathways ❑No separate power pathways from the intuating-device patliiti�ay „ ❑Pow r pathways are separate but of the sannepathway classification as the initiating device pathmiay ®Power pathways arc separate and ditrercnt classification tram the.intttating device pathway 43 Non-Voice audible System Pathways 4,311 Pathways'ClassDestgoaions and Suivivtbility Pathways class: Satvivaliility level: � Quantity '(See NFPA 72,:Sectionr 12.3 and 12:aj . 4.33 'Pathways Utilizing Twd"o-r More't1 eidla Quantity: Description: 43.3 Appttance Power Pathways '. ❑No separate power pathw ys from the w,oufication appliance pathway ®Power path}*ays are separate;but of flid sanic ptithway.classification as the notification appliancy pathwayY ❑Power pothwca%,'s are separate and dttl'ereiit classification from the notification appliance patii► ay tVFP.a 72,Fig, 10 15.2 1,1 (p^?of'I2) Copynght m 2009 Naticnal'Fae Protection Association This form maybe copied for individual die otnm tim'for resale,it may not be cooed for commercial sale or distntltition. h{' 3. DESCRIPTION OF SYSTEM OR SERVICE fcontinneo, f\rFN 72 edition: 200Additional deseripttOn ofsystc.m(s)i. New System' 3:1-Control Unit Manufacturer: Silent Knight/ForenhyE. Model hum b&:' *io'00 3.2 Mass Notification System ®This s rstem dots not incorporate on iMNS,, 3.21 System Type: ❑In-building MNS=combiga•ion ❑In-building MNS--stand alone Q Wide-area MNS ❑Distributed recipient MNS I]Other('specify) , 3.2.2 System Features: ❑Combination fire alarm/MNS b rowtiuionisrrious control unit 0 Witte-area MNS to ivgional,national alerting interface, ®Local ope0ung console(LOP;). El Direct recipient MNS,(DRMNS) '�1Vide-area MNS to RRMNS,i.ntecfaco` ❑Wide-irea MNS to high poWer'spcaker array(HPSA)interface ,O In-build.ft-NINS to'wide-area M\S interface, [I.other(specify): 3.3'System Documentation. ®An owner's manual,a copy of the manufacturer`s instntctions,a written sequenec;oi operation,and a copy:of the numbered record.dr9vings are stored on site., Location: Eiedric Room 3.4 S 'stem Software ' y O Tina s,,sten dots not have altcrahicsh Mpeclfic software. Operating sj�stcm(c�ecutivc)sofi►arc rwiston Icvcl . - Site-specific soflfvarc.revision date:; NIA Revision completed by: ®A copy of the site-specific software is stored ori'st e; Location FACP..Is Oft Premises Si nal Transmission;, ' >; 0 This syo t does not have AT-premises transmission: Ninkof organization rccuving alarm signals wit6.phune numbers: Alarm: •Supen isory: Phone: Trouble; Phone: - , Entit?,io i6icli alarms airs it-transmutedi, Marsttins Mills Fire Department Phone: '508-790 2375 a k iliod of ictransmi'ssioni If Chapter 26,specify'the means of transmission.from the protected premises to the supervising statiiiw II Chand r 27,specify the t)fic oFauril ary alarm systerw ❑Local cnggy ❑Sfii nt ❑Wind Q Wircic • I' NFPA 7 ; Fie), `tC.1S 2;1.„9 tp:2 of 1-2) Copyright C 2.009 Natoonw Fire Protection Associet_ron,Thin torw may be copied for indm mt utie-oemr than for resole:it may not be cope"toroommerciai sate or distntuhoii I ON FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION. To be completed by th_a slslem installation contractor ar tlrr rime ojslwteni accepranre and aplirovcul. It shall be permitted ip mydifvt/ris jaunt as needed to pr`vride a'more evnuplere ancUar Bler record. a /ncerl A44 btall unused lines: 9ttacl►addrt orial sheers,.darn,or:calctrlardons as nee6sory'70 prav de.t conipletc record: 1. PROPERTY INFORMATION Name of p4 penyi 'Cape Cod Medical " Address: ;9o5 Attueks lane=Hytlnnis.MA' Q- Description of property: Ambulatory Care. ' Occupancy t}pc: Business Name of proper representative: NIA w CID` Address: SAME Phone; Fir. E•mal V• - Authorin hay ing jurisdicUan gvci this:pro }:> Hyannis Fire:Qepartnnent t Phone: (508)778.6448E=maul ° ►. ,., 2. INSTALLATION,SERVICE,AND TESTINGCONTRACTORINFORHATION Installation contractor for this equipment: 6aysidi Efe6trical Contractors; T Address 380 Yarmouth Road=HyarIhisj MAL, _ ' � r License or certification number: Phone: 401=781-9200 Fa:,: £-rnaiL admin @prfinesyste'msn.. rn Service.organisation for this equipment Prima Systems Inc.' Address .96Jefferson Boulevanl License or iirtifrcationnumber.; i02968 Phone:, 401-``'81 9200 "'Faxc E-maul: atlmin rQprimesystemsri cam A contract for,testand inspection in tf ct rdanc,d,viih NNPA.standaids is in effer t as.iif ,March 2015 Contracted testing c6mpan.y;: Prime Systems Inc: . Address 96 Je#erson Bouil' d Warwick RI 028t38 , „- Ph6n4: 401-781 9200 'E=mdil, :admin@prlmesystemsri Con Contrnct expires: ConCract.numbcr.: N/AFri gurney of routine inspections: Sem1-annual & DESCRIPTION OF SYSTEM OR SERVICE ' ®Fire alarm system('nonvoice) ' ❑Fire Iilarm%pith nt wilding flue emergency tote alarm'communieauan system(EVACS) ' ❑,iris notification system'(`iviNS) "Gomhmafion system.,with the following coutiponcnts Fin:alarrii ❑Ev ,cS ❑,MSS ❑Tact.wtty,in-building emftcncy 0gmmunicatronsisterrt r, ❑'c5tlicr(rpccify); NFPA 72,Fig, 10.18.2.1.1 (p.1:`of 12) Coppn9M 0 2W9 NaWhai-Fine Profov;on AssoGat on.'1Tis form may be coprod for iix!Nidual use 00W Utah rbr roaale,It may not be cop od for oommare ai$olo or dislnDut on: Form 4 T014 A. Automatic Sprinkler Systems Contractor's Material and Test Certificate: = 'a„Y _ '"- 5e for Aboveground Piping s,Y PROCEDURE 751VI S I 5N Upon completion of work,inspection and tests shall be'made by the contractor's representative and witne' dby an owner's representative.All defects shall be corrected and system left to service before contractor's personnel finally leave the job. T A certificate shall be filled out and signed by both representatives. Copies shall beprepared.for approving authorities; owners,and contractor. It is understood tlie'ownee's representative's signature in no way prejudices any claim against contractor for faulty material,poor workmanship,or failure to comply with.approving authority's requirements or local ordinances. Property Name, CAPE COD HEALTH CARE. Date: 8/9/15 Property Address: 905 Attucks Ln,.Hyannis Ma - Accepted by approving authorities(naines)V Hyannis Fire Dept Address .95 High School,Rd Ext,Hyannis Ma; , Plans Installation conforms to accepted plans, ® Yes Q No; _. Equipment.used is approved.if no,'explain deviations Yes-, Q No Has person in charge of fire equipment been instructed as to location ® Yes Q No of control valves-and care and maintenance of this new equipment? If no;explain instructions Have copies of the following been,left' on the premises?. 'YeS Q No 1.System components instructions Yes Q No ,., 2.Care and inaintenarice instructions Yes Q No 3.NFPA•25 <. _ . . ,,,. .._ ;,. ,_ �` Yes 0 No:` Location of Supplies buildings. - system Year of Orifice Temperature Make Model 'Quantity _ , . manufacture., size ratin Globe Pendant 2014 . -1 2`' .115 165*_ - Sprinklers ------------ Pipe and Type of pipe ASTM/NF-PA, - fittings Type_of finings A$T{vl/NFPA` H—W NFPA Water-Based Fire Protection1 of.4 Systems Forms Form 4 Maximum time to operate Alarm.device' . through test connection, Alarm valve Type Make, Model Minuses Seconds or flow indicator System Sensor pressure PS-10 ;0 3' switch 1- ;Dry valve Q.O.D ` Make' Model . Serial No. ._Make. Model" ,_Serial,No. Reliable. D. Time to trip Trip Time water: Alarm- through test Water Air point air reached test. operated' Dry pipe connect ion'.2 ressuie ressure reSSure Outiet,2 r0 erl Operating test .' s Minutes Seconds psi psi psi min. sec: Yes Without 0 14 55'` 46. -10 . 0 20 0 .O:D With 0.D If no explain: . Operation . : p �PneuinaGc' ❑Electric a❑Hydraulic , Piping supervised ❑yes ❑No Detecting media'supervised ❑yes ❑`No Does valve operate from the manual trip;remote,.or both control ❑Yes ❑No , s there an accessible facility in each"circuit foriesting? ❑Yes ❑No' Deluge and preaCtiOn if no;explain valves Make Model Does each circuit operate supervision loss alarm? ` ❑Yes ❑No. Does each circuit operate valve release? ❑Yes ❑No Maximum,time to operate release Minutes Seconds Pressure Location and boor Residual pressure a FIowT, reducing valve Static pressure (flowing) rate test Make and model: Inlet . Outlet Inlet Outlet Flow (psi) (psU (psi) (gpm) Setting; Test HYdrostat�c Hydrostatic,tests shall be made at not less than 260 psi(13.6 bar)for 2 hours or 50 psi 'description (3 4 bar)above static piessure excess.of 150 psi(10.2 bar)for 2:hours.Differential dry-pipe clappers shall be Ieft open during the Pest to prevent damage.All aboveground piping leakage.shall be stopped. Pneum ish 4 psi(20 .7 bar)air pressure and measure drop;which shall not'exceed I'/:psi: (0.1 bar)m 24 hours Test pressure`tanks at normal water level and air pressure and measure air, : pressure drop,which shall not exceed 1'2 psi(0:1 bar)in 24 hours:. NtX NFPA Water-Based Fire Protection Systems Forms 2 of 4 � , Form 4 Measured from time inspector's test connection is opened 2 NFPA 13 only requires the 60-second limitation in specific sections All piping hydrostatically tested at(200 bar)for 2 hours If no,state reason Dry piping pneumatically Yes ❑ No Equipment operates ® Yes' No Do you certify as the sprinkler contractor that-additives and corrosive chemicals,sodium sllicate.or derivatives of sodium silicate,brine,or other Y.es ❑No corrosive chemicals were not used for testin s stems or stopping leaks? Drain Reading of cutoff gauge located near water'supply test connection.5_5 psi(- - bar) test: Residual pressure with valve in tesuconnection open wide:50'psi( - bar) Tests Underground mains and lead-in connections to.system risers flushed before connection made to sprinkler piping Verified by copy of the Contractor's Material,and test Certificate for Underground Piping ❑ Yes ❑No .®Other Explain: Flushed by installer of underground sprinkler—piping ❑ Yes: ❑No If powder-driven fasteners are used in concrete,has representative sample ❑ Yes i]No testing been satisfactorily completed? If no,explain Blank Number used Locations Number removed' testing _ gaskets Welding piping ❑ Yes ❑No - if yes. Do you certify as the sprinkler contractor that welding procedures used ' ❑ yes _0 No complied with the minimum requirements of AWS B2.1,ASME Section lX Welding and Brazing Qudlificahi ns,or other applicable qualification standard as.required by the AHJ? Do you certify that the welding was perforrii6d by welders or welding operators qualified in accordance"with the minimum requirements of AWS B2.1 ASME ,Yes El No Welding` section iX Welding and Brazing Qualifgdt ons,or other applicable qualification staridard as required by the AHJT Do you certify that the welding was conducted in compliance with a documented quality:control procedure to ensure that(1)all discs are retrieved; Yes ;' No (2)that openings in piping are smooth,that slag and other welding residue are removed;(3)the internal diameters`of piping are not penetrated;(4)completed welds are free from"cracks,'incomplete fusion;surface porosity greater than 1/16 in.tliarrieter,undercut deeper than the lesser"of25%of the wall thickness or 1/32 in.;and(5)completed circumferential butt weld reinforcement does not exceed ll .. .. Cutouts Do you certify that you have a control feature to ensure that all'cutouts(discs) Z. ,Yes ❑ No (discs)', are.rdrieved2. Hydraulic, Nameplate provided ® Yes ❑ No data name late If no,explains ' Remarks Date left in service with ail control valves open +Fax NFPA Water-Based Fire Protection- P 3 of 4 Systems Forms Form 4 Name of sprinkler contractor ,MASS FIRE,PREVENTION INC. I Tests witnessed by The,property owner or their authorized agent(signed) Title Date Signatures Kayla Coburn 8 9 15: For spri a ontrac signed) Title Date Operations manager •8 9 15 Additional explanations and notes; r k s INIPPXNFPA Water-Based Fire Protection S Ystems Forms 4 of 4 � � n . t tie.. y PO Box 335 Rockland,MA 02370 SC 408 T 781 8710131 F 781 878 4799 Report To: Cape Cod Health Care Inspector: ' Ron Lazisky Street:905 Attucks Lane License#:SC210034 City&State: Hyannis,MA Date:08-09-2015 1. GENERAL YES' ` N/A NO a. Is the building occupied? x b. Is occupancy same as previous inspection?(new system) x c. Are all systems in service? x d. Are all fire protection systems same as last inspection e. Is building completely sprinklered? _x. f. Are all new additions and building changes properly protected? _x g. Is all stock or storage properly below sprinkler piping? x_ h. Was property free of.fires since last inspection(explain any fire on separate sheet) L In area protected by wet system;does the building appear to be properly heated in all areas,including` blind attics,perimeter areas and are all exterior openings protected against entrance of cold air? Must Maintain•heat throughout ' 2. Control Valves(See Section 16) a. Are all sprinkler system main control valves open? x b. Are all other valves in proper position? _x c. Are all valves in good condition and sealed or supervised? _x 3. Water Supplies(See Section 17) a. Was a water flow test made and results satisfactory? x 'µ 4. Tanks,Pumps,Fire Dept.'Connection a. Are fire pumps,gravity tanks,reservoirs,and pressure tanks in good condition and properly maintained? rc _X_ b. Are fire dept.connection in satisfactory condition,couplings free,cap in place and check valves tight? x J. www.massfireprevention.com PO Box 335 Rockland,MA 02370 SC 408 T 781 8710131 F 781 8784799 P YES N/A NO- S. Wet Systems(See Section 13) a. Are cold weather valves open or closed as necessary? _x_ b. Have anti-freeze systems been tested.and left in satisfactory conditions? . x c. Are alarm valves,water flow indicators and retards in satisfactory condition? -x- 6. Dry Systems(See Section 14) ' a. Is dry valve in service and in good condition? b. Is air pressure and priming water level normal? f' x_ c. Is air compressor in good condition? x_ d. Were low points drained during fall and winter inspections?' _x_ e. Are Quick Opening Devices in service? x f. Has piping been checked for stoppage within past 10 years? x_ g. Has piping been checked for proper pitch within past 5 years? x_ h. Have dry valves been trip tested satisfactorily as required? _x ` i. Are dry'valves adequately protected from freezing? _x_ j. Valve house and heater satisfactory?Y x_ 7. Special System a. Were valves tested as required? x b. Were all heat responsive system tested and results satisfactory? _x_ c. Were supervisory features tested and results satisfactory? x ` 8. Alarms a. Water Motor Gong test satisfactory? x. b. Electric alarm test satisfactory? _x_ c. Supervisory alarm service test satisfactory? x 9. Sprinklers-Piping - a. Are all sprinklers in good condition,not obstructed and free of corrosion or loading? b. Are all sprinklers less than 50 years'old? _x s www.massfireprevention.com �r PO Box 335 Rockland,MA'02370 SC 408^ T 781 8710131 F 781 8784799 YES N/A NO c. Are extra sprinklers readily available? _ x d. Is condition of piping,drain,valves,check valves,hangers,pressure gauges,open sprinklers,strainers satisfactory? _x_ e. Are all sprinklers of proper temperature rating? _x_ f. Are portable fire extinguishers in good condition? x g. Is hand hose on sprinkler systems satisfactory? x_ h. Are there misaligned or trapped sections? x— i. Are low points drained? Free of corrosion? x_ 10.Date Dry Systems Piping last check for stoppage: 11.Date Dry Systems last checked for proper pitch: 12.Date Dry Pipe Valve last trip tested: 13.Wet Systems: 1 Make&Model? 14.Dry Systems: Make&Model? 6"Reliable Model D 15.Special System: Type k Make&Model? Condition? 16.CONTROL VALVES No. SIZE Type? Open Secured Closed Signs Condition YES NO YES NO YES NO YES NO City Connection Control Valve:1 6" Butterfly x x x, x New Tank Control Valves: Pump Control Valves: Sectional Control Valves:., Systems Control Valves: 1 6 Butterfly ` x x x x New ' www.massfireprevention.com ' 'PO Box 335 Rockland,MA 02370 SC 408' T 781 871 0131 F 781 878 4799 a 17. WATER FLOW TEST Water Pressure? 55 City PSI �, Tank PSI Fire Pump PSI Water Flow Test?50 PSI Drain Size 2" Flow Pressure PSI' _ (If none made,why) > Do flow results differ by more than 10%from previous test Yes A No 18.System protects following areas: Entire building: YES_x_NO 19.Underground service size:6" - 20.Description of back flow preventer:6"Zurns Wilkins' 21.Type of Control Valves:2-6 Butterfly Valves { 22.Size of Sectional Control Valves,if applicable:' N/A 23.Spare head cabinet YES spare heads YES head wrench YES , 24.Pressure gauges condition:N64, 25.Fire Dept Connection type 4"stortz condition: N� 26.Central Station,`if applicable:Atlas Alarm 1-800-696-6900 27.Alarm pass code,if applicable;1037 passcode 5820 28.Fire Dept.24 Notice.if applicable YES ,NO_x r 29.Fire Dept test fee,.if applicable 30.Water Motor Gong Yes No N/A_x_ + 31.Electric Bell Yesl x No ;N/A` 32.Location of Inspector's Test valve:In gym area above ceiling 33.'Alarrn tripped in_3 seconds .,' t 34.Fire Master box#,if applicable: www.massfireprevention.com - .:r ' PO Box 335 Rockland,MA 02370 SC 408 T 781 8710131 F 781 878 4799 35.Summary— Deficiencies • None NOTE: This sprinkler system has just been installed as per NFPA standards DRY SYSTEM NOTE: �. Be advised this is a dry pipe sprinkler system,any Drum Drips(low point piping areas)are drained by us and should be checked for hissing noises when weather is below 32°by Maintenance Person which we can show . them how to do it,very simple to do this; The Valve Room has water in the wet side of the Dry Valve and must be heated during the cold months. I recommend low temp.alarm which can be wired into trouble,monitor this device and Central Station can notify on call persona&give time for room to be addressed to avoid'costly repairs and call sprinkler co.asap - ` t ,r � a• ,rr _ i www.massfireprevention.com i 75 Hill Street Norwood.Ma. 02062 (781)769-9267 Fax(781)769-8365 ` Air &.Water Testing and, Balancing Report Project: w Cape Cod Healthcare' Hyannis, Ma. , Prepared'For: Commercial Air Control, Inc. 19 Rantoul Street South Weymouth, ma: 02190 i July 1,2015 75 Hill Street, Norwood,Ma, 02062 (781)769-9267 Fax (781)769-8365 PROJECT: Cape Cod Healthcare v PROJECT NO: 7397_ DATE: 7-1-15 , SHEET#: 1-A, CONTRACTOR :.Commercial Air Control, Inc. • J . OWNER: r ARCHITECT: Medcom Architectural Group' ENGINEER : CSI Engineering The system specified for the subject project has been balanced to the requirements of the plans and", specifications as reported herein, , WECS TBCC TESTING AND BALANCING CERTIFICATION COUNCIL CERTIFICATE-NO. 20014 ^ ``,``yiyµy'iirnNNrrArr �r%(../�/V�.gqry SIGNED• ' CHNICIAN :-n'- �`? 20014 y� SIGNED. 1 �'y/��'!'V V. /ll��r iiiiii•••' ```` TECHNICAL REVIEWER t REGIONAL AIR BALANCE Co. Sfteet AIR MOVING EQUIPMENT TEST SHEET Date: Project: C�1 [ c'�T) / �L.7"/�. �/�/� Project No. �79 SYSTEM No. �`1 U f � �7 Ls' �/ p A p o L f LOCATION �7/� ��`t � /� � MANUFACTURER 7W4,(/C IJ6 ��'7 A)C MODEL No. zr-*w v 0C!/ao�/r�E/ A 7;x!c 0,3 n 0,49 /A 7-g c.6 SnA I.Al 7 P )c-),.',w A,, 4 4caEx.�4 ls' � , SERIAL No. � ..j�D 8 J T�.��� 3�nk�) OPERATING CONDITIONS SPECIFIED ACTUAL. SPECIFIED ACTUAL SPECIFIED ACTUAL SPECIFIED ACTUAL TOTAL �p ) / CFM 3000 30 96 3 �0U 3 C7Q'� �5 0� 361zo . �%l} /X . RETURN �a 1 / / o CFM !�� 23 �5 � 3gZ O.S.A. CFM li(�n �y 2� (� (^) Le ? Q ' ci (, '3 O EXHAUST .; CFM `�_ _ ., . r. _ TOTAL 1 S ?;t, l STATIC SUCTION / STATIC DISCHARGE - - STATIC EXTERNAL / f, r p STATIC BHP 07, � `` MOTOR /_3I� )14�., MANUFACTURER 6C lg�9al SIZE (HP) 3 -F VOLTAGE .Z/^R D8 .fir' ^ p •�O S 0 8 " �� nR RPM MOTOR 1 ,� C>Q /�S 1R� /.2 SAFETY FACTOR RATED RUNNING RATED RUNNING RATED RUNNING RATED RUNNING AMPERAGE ,�' } 7 7�&' ti J� '� + RPM FAN ' SHEAVE POSITION E'er I = T'm"A l 1 p E L u G R S N 6 4 0-/ e-) ti,1 p REGIONAL AIR BALANCE Co. Sheet# EXHAUST FAN TEST SHEET c Date: Project: 6164L.7`�'l C Project No. 73 97 SYSTEM No. LOCATION MANUFACTURER MODEL No. SERIAL No. ��/'��jl��G /-�� ?.,�lJ/�L /�/ 4/ ,�_��� / J�2'� iJ k OPERATING CONDITIONS SPECIFIED ACTUAL SPECIFIED ACTUAL SPECIFIED ACTUAL SPECIFIED ACTUAL TOTAL EXHAUST CFM 3 �.v: 3�5. 3 - 76 2 3000 TOTAL STATIC �3 J�ti �s `' % J� �' r?�'^ , Jb ft SUCTION S STATIC 0 DISCHARGE STATIC J BHP 77 Q! 7�. 7 e , MOTOR MANUFACTURER SIZE (HP) VOLTAGEi'r, RPM MOTORS -/7Zs .7 0 30 0-l7.11 / 7 U �o o- I Fin(7 N �6 �R�ra—Al A SAFETY FACTOR — RATED RUNNING RATED RUNNING RATED RUNNING RATED 'RUNNING AMPERAGE �� ,�, '� r �, �•: ��� <.) .�� � /�"' ,7 RPM FAN .%1� 3L) -7�v 1• O �l, / /� ,) 1/ SHEAVE POSITION L� I REGIONAL AIR BALANCE Co. Sheet# EXHAUST FAN TEST SHEET Date: 7 Project: Co 7) L7 ) � - !'J� Project No. 7 3 7 SYSTEM No. r� LOCATION MANUFACTURER �.r 61) 4? 4e7NAI6e MODEL No.SERIAL No. yr- -�y�4 �' ��� ` �� OPERATING CONDITIONS SPECIFIED ACTUAL 'SPECIFIED ACTUAL SPECIFIED ACTUAL SPECIFIED ACTUAL TOTAL EXHAUST / CFM TOTAL STATIC 76" . l SUCTION C/ `. ,� STATIC 7 S ,,fit'? �( M DISCHARGE rI v 3 srarlc • �. ------ . BHP 3 MOTOR � MANUFACTURER :Y t �� =N ✓���'"Crt". � ' �� ' C. SIZE (HP) l It- // Q 30) VOLTAGE I c' -?,�? J RPM MOTOR 3" . 174,T- eV-49, 30o --!4S /7 -'\7.S SAFETY FACTOR RATED RUNNING/ RATED ` RUNNING RATED RUNNING' RATED RUNNING AMPERAGE RPM-FAN �,�t�e'`'. •�'' .<'�(j t) /l1 ' ` SHEAVE POSITION Z) ?7 y t REGIONAL AIR BALANCE CO.,INC. SHEET# DIFFUSER&GRILLE TEST SHEET DATE: x711 C�.o� co..rJ ,����-rt/ c rrl����'� ��'�Jivr'✓�.5 /"1A, .. PROJECT: ADDRESS: TESTING AND BALANCING AGENCY: Effective REQUTAm TWRESULTS MIN CFM MIN CFM Room No. Outlet No. Code Size Area F.P.M Vel C.F.M. F.P.M Vel C.F.M. *REQUIRED RESULTS 2.7 0 $b ' A -10000 .376 l� y S �� n Remarks Sheet'Code Type Code Model Mfg. i REGIONAL AIR BALANCE C0.,INC. SHEET# J� DIFFUSER&GRILLE TEST SHEET DATE: 7/ PROJECT: ADDRESS: TESTING AND BALANCING AGENCY: Effective REQuiRm TWRESU« MIN CFM MIN CFM' Room No. Outlet No. Code Size Area F.P.M Vei C.F.M. F.P.M-Vel C.F.M. REQUIRED RESULTS IV r� -8� 1 a 36�C7 Sheet Code Remarks Type Cade. Model Mfg. 1 r ■�■�■����®�■■�®ate®� ���®■�■��®®mot®® �■■■r r®■���v ism��s■■�a ®®�®���®�■�®ems Sheet Code �iii�iii�mlmm® REGIONAL AIR BALANCE CO.,INC. SHEEP# 7 . k DIFFUSER&GRILLE TEST SHEET m ` j DATE: �.9.�� COO .yFAzy"•�•/ C-9�P�' ' _ �y/)�J�vfs � ���q PROJECT: ADDRESS: TESTING AND BALANCING AGENCY: Effective AEQuuRo MIN CFM MIN CFM Room No. -Outlet No. Code Size Area F.P.M Vel C.F.M. FAM Vel C.F.M. REQUIRED RESULTS 10/ s .�111�,w .../= Sp liloe C ✓ 7 IV 3T U Sheet Code Remarks Type Code Model Mfg. 5 REGIONAL AIR BALANCE CO.,INC. -SHEET# g DIFFUSER&GRILLE TEST SHEET DATE: Ci9l�� COD /�.��9L.TJ7/ �,�.p�'. �y�q/vlV/S• .. , � PROJECT: ADDRESS: .,�U-1C��� �. �i.+? ��91 -�?Vic/� �" • , TESTING AND BALANCING AGENCY: Effective REQWRo . TWUSU"s MIN CFM MIN CFM Room No. Outlet No. Code Size Area F.P.M Vel C.F.M. F.P.M Vel C.F.M. REQUIRED RESULTS z9�z,f" f�/ d 3 �1 0 7-1- v f76' /per 7pT�L-q in Sheet Code Remarks Type Code Modes Mfg. { REGIONAL AIR BALANCE CO.,INC. � t. SHEET# DIFFUSER&GRILLE TEST HEET DATE: 4Y� oy PROJECT: ADDRESS: TESTING AND BALANCING AGENCY: Effective REMUMED W rREMTS MIN CFM MIN CFM Room No. Outlet No. Cade Size Area FAM Vel C.F.M. FAM Vel C.F.M. REQUIRED RESULTS UrV)T Sheet Code Remarks Type Code `' Model Mfg. - . REGIONAL DIFFUSER & GRILLE TEST'SHEET Date_ 7111.., Sheet No. 6 ,lob Name Address Testing &' Balancing AgencyG-/G'J✓i9L. �J /? .T.�.� �/y1£V Room Out-let ffectiv wln R:e��Ra Testlte No No, Code Size Area ;..nM. r..x.. Vet v.i t.tT.M At / 2v c 0 t /19 411� v f/7 o X//G' /`7 z_ 3 , SReet Code Remarks Type Code Model Mfg. REGIONAL AIR BALANCE CO.,INC. SHEET# DIFFUSER&GRILLE TEST SWEET l DATE: 7///11 PROJECT: ADDRESS:F , TESTING AND BALANCING AGENCY: Effective REQUIRED TWRMUTS MIN CFM MIN CFM Room No. Outlet No. Code Size Area F.P.M Vel C.F.M. F.P.M Vel C.F.M. REQUIRED RESULTS V , 3d -7 7J'- 13t) 0/6 7 Sheet Code Remarks Type Code Model Mfg. REGIONAL AIR BALANCE CO.,INC. SHEET# DIFFUSER&GRILLE TEST SWEET DATE: PROJECT: ADDRESS: ,• �'�<r..�n MCI L. �9�� �s,��.��v c i TESTING AND BALANCING AGENCY: Effective REQUIRED TEST RESULTS MIN CFM MIN CFIVi Room No. Outlet No. Code Size. Area F.P.M Vel C.F.M. F.P.M Vel C.F.M. REQUIRED RESULTS yr e1*1 A.,-r c v �l 76 �1n G y \V 7S" LIZ Sheet Code Remarks Type Code Model Mfg. 3 REGIONAL AIR BALANCE CO.,INC. SHEET# %3 DIFFUSER&GRILLE TEST SHEET . DATE: PROJECT: ADDRESS: TESTING AND BALANCING AGENCY: ' Effective, REQUIRED TEST RESULTS MIN CFM Mitt CFM Room No. Outlet No. Code Size . Area F.P.M Vel C.F.M. F.P,M Ve,l C.F.M. REQUIRED RESULTS !!feti Is— Of IF } Sheet Code - Remarks Type Code Model Mfg. 1 1 ��■�■®ate®®�■����®® ar■�■�■�®�■�■�®®tea® REGIONAL AIR BALANCE CO.,INC. SHEET# DIFFUSER&GRILLE TEST SWEET � DATE: J C Ga 0 �G/7 ?�� Rom' `" . y,ry�//mil. AM PROJECT: ADDRESS: �nh1,4 L ///ham ,644- .9Av TESTING AND BALANCING AGENCY: Effective REQUIRED TSTRESULTS MIN CFM MIN CFM Room No. Outlet No. Code Size Area F.P.M Vel C.F.M. F.P.M Vel C.F.M. REQUIRED RESULTS W/o 3 1 v c ✓>n re I A Sheet Code Remarks Type Code' Model Mfg. F` 1 1 ��v�■■��■�����■ems�� ��®®■■tee®�■�■�®®® _��■�t�t�®ter®®�® .. f ------------ RE: DUCT TRAVERSE SFIVET - ZONE TOTALS REGIONILL nr,Te 7 ///•T PROJ. ACTUAL ACTUAL ZONE DUCT EMCTI VE REQUIRED TEST REQUI RED TEST N0. SIZEARE LZr2--i-VKEL-ocITY rpm VELOCITY C.r.H. C.F'.11. - ------------- �---- 1 , KEf111l11CS : ` • SLFPMITTED BY kREGIONAL Sheet G WATER . De1e CIRCULATING R PUMP DATA E we-1,11 c"� Project 7.3. 97 , Project; ��' Numbar MOTOR DATA Specified Actual Test Data PUMP DATA ' Final Gallons running suction dis. pressure pump mode m Dump l otor T. D. H. T.O.H. serving volts H.P. phase amps. minur te amps pressure pressure dill. no., manufacturer number manufacturer _ f Q� �,r'� �:?o 'A x z.�o� Gt?f1NbFos t�/ G���� � s 5C-<n,.i flA R�! r 17-3 t�M � -l 30 Cr ��� 3 . 9 -z ' 3. 3 • '' t 91 b-7� 3-- 4 n cn m Fi� a y m t NT (1 ) m rl N a z 'Q `3 0 J1 d e . e r n V 1 V ri 4 41— cit fV r.. _' � o 0 a .. ►A W CN �! A C � -. �' Town ' of Barnstable Building Department - 200 Main Street lARNST"LE. # Hyannis, MA 02601 9 MASS. (508) 862-4038 d0 i63q. Certificate of Occupancy _ Application Number: 201501061 ' -CO Number: 20150175 Parcel ID: 294080 CO Issue Date: 08105/15 Location: 905 ATTUCKS LANE Zoning Classification: INDUSTRIAL DISTRICT , Proposed'Use: INDUSTRIAL DEV LAND Village:, HYANNIS Gen Contractor: COBURN, PATRICK M Permit Type:. CC00 CERTIFICATE OF OCCUPANCY COMM Comments:• CAPE COD HEALTHCARE Building Department Signature Date Signed i 4 ` � �.. ...- - .. ... TOWN OF BAPNSTABLE ------------------------ Z U 1 -5 - - im a #% ,gqhA ff uOldo' Ulu bi _ _ #_ r1s�ABL% Issue Dade= ...... r M.it ®37I3/t�: Applicant: CC�BURN PATRICK M . . . ..... �$���`��.�, . ... _. . .. _.... _ Permit P umber:`B 201 0494 Proposed Use: INDUSTRIAL DEV-LAND Expiration Date: 09/10/15 Location 905 AT TUCKS LANE Zoning District IND Permit Type: COMMERCIAL ADDITION ALTERATI Map Parcel 294080 Permit Fee$. Contractor COBURN,PATRICK M Village HYANNIS App Fee$ License Num. 57683 —__ Est Construction Cost$ Remarks ----�� APPROVED PLANS MUST BE RETAINED ON JOB AN] OFFICE FITOUT WITH PATIENT TREATMENT ROOMS,RECEPTION kRftis CARD MUST BE KEPT POSTED UNTIL,FINAL j WAITING RM FOR CAPE COD HEALTHCARE-R FrERIOR ONLY, INSPECTION HAS BEEN MADE. 'WHERE A ` ----------------- CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH on Record: CUNNINGHAM,JOHbi flAll T IZ BUILDING SHALL NOT BE OCCUPIED UNTIL A FINA CEftITEP.VILLE,MA 02632 Address: COVE ISLAND INSPECTION HAS BEEN MADE. Application Entered by: PF t Building Permit Issued By: / LOBTAINED IS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS 0 PUBLIC fROPERT ECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY I FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION STRICTIONS. MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS, 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. 7. FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRfCAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF COfISTRUCTION WORK.IS NOT STARTED WITHIN SIX MONTH- OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISIERED CONTRACTOR'S I PACTORS DO NOT HAVE,ACCESS TO GUARANTY FUND(as set forth in MGL c.i42A). ---� t �'� :��i- Ei..�^� Lr $X s,� `ca ��� ��, � y � .�._,5,�. ;�a"r•drlyt. fi r+�M.i';;�1i � �` .t t t s.� # dEje'Nfih',.✓�'A'k9"1`k'_� 4�^('= "-'�'�,:.• - BUILDING INSPECTION APPROVALS PLUMBE,TG FNSPECTIOIN APPROVALS ELEC•IRICAL INSPECTION APPROVAL / �.. 010V0, 107�//eo -- - -- , 3Q I �� a9�a3T� ta•�;,I't�I�uN� 11l�y�,�i, ,I,---------- 10 1�1' 0 3 GW6;, 1b4. i REVISIONS: ; . . . .. NO,', DATE, DESCRIPTION 0 2/09/15.. ISSUE FOR 'PERMIT APPROVED TOWN OF BARNSTABLE - ❑ GAS ❑ WIRING PLUMBING ❑ BUILDING i PROJECT NO: . DATE OF ISSUE 2/,09/ 15 DRAWN BY: J P CHECKED BY: G B S r : DRAWING NUMBER • °FTHE rj Town of Barnstable ti '�. Regulatory Services " MASS.t E Richard V.Scali,Director ArEo,,,pt► Building Division ' Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 ' www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village ..HOMEOWNER": Jti���o� �/�r?� �-09 5 9 f�� name home phone# work phone# CURRENT MAILING ADDRESS: e. 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 su ep rvisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be'responsible for,all such work performed under the building permit (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection' procedures and requirements and that he/she will comply with said procedures and requirements. , le ,IA Si ature of omeow er 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 persons)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often .. results in serious problems, particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in ` your community. Q:\WPFILES\FORMS\building permit forms\smokecarbondetectors.doc Revised 040714 4 ��ZFtiE Tp� , • BARNSTABLE, • p,0� Town of Barnstable Regulatory Services ' 'Richard Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.i6wn.barnstable.ma.us Office: 508-862-4038 '; Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If UsingA Builder T "t Y` t Me � , as Owner of the subject property - hereby authorize Z2 h !Ive fi--te K -� _ to act on ray behalf, in all matters relative to work authorized by this building permit application for: C 6 R (Address of Job) s Sinature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. :\WPFILES�FORMS\building permit formAsmokecarbondetectors.doc Q Revised 040714 PROJECT �((� � �✓�l I��V�. dV� , . �� . ADDREss: . . P . PERT)M DATE:' LARGE DOLLED PLANTS ARE M . ::BOX E �: Data entered in MAPSprogram.on: q 'P files/forms/archive.: Commonwealth of Massachusetts Sheet Metal Permit Map Parcel Date: Permit# Estimated Job Cost: $ 12C S� Permit Fee: $ Plans Submitted: YES NC ? Reviewed: YES NO S Business License# F Applicant License# 7 j A Business Information: c Property Owner/Job Location Information: Name: �� � J h mg'a,� Name: c a 2 71 _I4 e, ._ Street: J 0 C9 wo LA ��I O f21 F!Ztreet: City/Town: +O CL ID-nd = o- Jp City/Town: �/`7 yam_ i"�Y1 G< Telephone: 23 ) —1-7 l ,�3 0 0 7 Telephon Photo I.D. required/Copy of Photo I.D._ attached: .YES NO ffinitial J-1/M-1-unrestricted license J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: n Ice Retail Industrial Educational ` Fire p . pp ova Institutional_ Other Square Footage: under 10,000 sq.ft. over 10,000 sq. ft. Number of Stories: _� } Sheet metal work to be completed: New Work: r Renovation: I/ Watershed Roofing `----" `._ Kitcheri'Exliaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: a� . {_ .-.' _ -.-.+. ....,n...`r ..�_--�y"_'�'.."'�'�„',may'.'y.• s1 INSURANCE COVERAGE: I have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes❑ No ❑ If you have checked YU, indicate the a of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent [9. Signature of Owner or Owner's Agent By checking this boxAh hereby certify that all of the details and information I have submitted(or entered regarding this application are true and 1 9 9 PP accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections Date Comments 1D Final Ins ection I Date Comments Type of ' ense: By aster Title [ Master-Restricted City/Town ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted S _ a 797 Fee$ License Number: ❑ Check at www.mass.govIdol Email: Inspector Signature of Permit Approval i } a , t Y` yGOt4MONWEALTHOFIIASSICH.ISrE7Ta.`.` . • "� ��OAt G-OF w "k r'SH,EEEALg'WORKEfts �b # ISSUES TNE,�FOL'LOWINC €.iCENS� � �r ' - �� RF S �4ASTERWNFtESTR CTED 5 &fi#EfN D TOLl1z1/ER � 'a {Nn �af � 3 , � A A o278a 4�6 � ,235686� ��� Mass. Corporations, external master page Page 1 of 2 •r d r Corporations Division Business Entity Summary ID Number: 042837048 Request certificate New search Summary for: ZEOLIE SHEET METAL, INC. The exact name of the Domestic Profit Corporation: ZEOLIE SHEET METAL, INC. Entity type: Domestic Profit Corporation Identification Number: 042837048 Old ID Number: 000211628 Date of Organization in Massachusetts: 09-05-1984 Last date certain: Current Fiscal Month/Day: 09/30 Previous Fiscal Month/Day: 12/31 The location of the Principal Office: Address: 200 ROOSEVELT RD. City or town, State, Zip code, WEYMOUTH, MA 02188 USA Country: The name and address of the Registered Agent: Name: WILFRED ZEOLIE Y , Address: 200 ROOSEVELT RD. City or town, State, Zip code, WEYMOUTH, MA 02188 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT WILFRED V. ZEOLIE 200 ROOSEVELT RD., WEYMOUTH, MA 02188 USA TREASURER WILFRED V. ZEOLIE 200 ROOSEVELT RD., WEYMOUTH, MA 02188 USA SECRETARY DOUGLAS HAGAR 100 APPLE TREE LN., WEYMOUTH, MA USA Business entity stock is publicly traded: r The total number of shares and the par value, if any, of each class of stock which this business entity is authorized to issue: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=042837048&... 4/27/2015 Mass.,Corporations, external master page Page 1 of 2 A k . p t M ,a v y Corporations Division Business Entity Summary ID Number: 001100295 Re quest certificate I New search Summary for: FRESH POND REALTY TRUST LLC The exact name of the Domestic Limited Liability Company (LLC): FRESH POND REALTY TRUST LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 001100295 Date of Organization in Massachusetts: 02-20-2013 Last date certain: The location or address where the records are maintained (A PO box is not a valid location or address): Address: 1436 IYANNOUGH ROAD City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and address of the Resident Agent: Name: CT CORPORATION SYSTEM Address: 155 FEDERAL STREET, SUITE 700 City or town, State, Zip code, BOSTON, MA 02110 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER JOSEPH KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 USA MANAGER CHARLES ROBINSON 434 IYANNOUGH ROAD HYANNIS, MA 02660 USA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Title Individual name Address SOC SIGNATORY CHARLES ROBINSO'N 434 IYANNOUGH ROAD HYANNIS, MA 02660 USA http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001100295&... 4/27/2015 Mass.,Corporations, external master page Page 2 of 2 SOC SIGNATORY JOSEPH KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address REAL PROPERTY JOSEPH KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 USA REAL PROPERTY CHARLES ROBINSON 434 IYANNOUGH ROAD HYANNIS, MA 02660 USA r r Confidential r Merger r Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Annual Report ' Annual Report - Professional Articles of Entity Conversion Z;,, Certificate of Amendment 11 t View filings Comments or notes associated with this business entity: New search http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001100295&..; 4/27/2015 The COMMIQNrnMM of massachweft rA D eparttnent of 1nd=&ial.Accidmts Office of Inueestrgadons 600 washinghm Street Bastonx 02111 www.mamgoVdia Workers' Compemsatim Insurauce Affidavit Rudders/Co ctnrslldectriciansrPlumbe€s licant Inhwmaafinn Please Print Legibby Name ZFi0' l NI P� Imo .e A to 2 D o Of-L D i>- T - tm t 4- r Are you employer?Check appropriate boz; T3 of prnjeet regnireci : L am a oitployervvith �D 't- I am a.general oomtractor and I ❑ to frill andfor * have liked the sub-vontractars . emP ) listed on the attached sheet. 7. 2❑ I am a sale pzupxietw or partner ship and have no employees sees an trat:.te have 8. ❑Demolition employees andlia«a�aticrss' working forme in amy .capac `- I la. El Budding addition [No wmkem'tip.insurance ' COS "' ' 5. ❑ We are a coipcxation null its .10_0 EltxEtical or minas required] officers have exercised their 11.[]Plumbing repairs or adtfi#icros 3_ElI am a homeowner daiag all ti�cttk myself o workers'ooMp_ of eaomipfson per h+IGL 12.❑Ibofnepairs insurance rued.]1 c.152,§I(d%and we lave no 13-❑o&Ier employees.[No woda!!rs' " comp.insurance -] "Any app thai cbeds boz*I emu also fain am the section below showing&ea wasters'. wpo7 idannsii= �IiameaamersvrhosubmitfhJ&zMd=nitmdKxtmgtheyMdombAMmuk813dhcahmoutsideeouacjcnmjsisaomitanewafdseit.mdw gmcb- $Con#wtors that cbea fts box mxt attached as additional sheet slowing the name of ft and state whaftw wme those waities hxm employees. If the snb-cw ua bane ewes;they muaF0vide their workers'aomp.policy muobeL Tam era!empllrr wr that is pnniAkg warkers'conTensalfim insurance for trty enrAYem Below is the policy and job sfte treformatzon. Insurance Company Name-: Tr-" VS. _._ Palicg#or Self-ins-Uc #�` yU �� �6—(� C//Ja First nD&te: Job Site Address. 9 66 et n-P City/Statelzip: Attach a copy of the workers'compensation polky declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c 152 can lead to the imposition of criminal penalties of a fine up to S 1;54(}OD ancVor one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDEK and a fine of up to$250M a day against die violator_ Be advised that a copy of this statnuent may be forwarded to the Office of Invesfigatioms of the DIA for insurance coverage verification. I do he•re6y certify unclear the and nabjes oRfpedwy that the information provi&ff abaile is true and correct. Phone `7 2—C2 7) qO 6) ©;dal;use only. Dot not car;ate in this area,to be completed by do:or taevu official- CRY or Town: PerwitlLicense 9 Issuing.Authority(tar de one): L Board of Health 2.Bufl ft Department 3.CityfFown Clerk #.Electrical Inspector S.Plumbing Inspector s.Ocher Contact Pierson: Phan r� Information and Instructions ` Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pm�an-t o this smtuf e,an w plvyee is defined as"_.every person in the service of another under any contract of hire, express or implied,oral or wi h=- An mployer 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 slates that"every state;or Iocal 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 airy of its political subdivisions shall enter into any contract for the performance ofpublic work until acceptable evidence of compliance with the inmn-anc0. requirements of this chapter have been presented to the contracting au ffimify." Applicants Please fM out the workers'compensation affidavit completely,by checking the boxes that apply to your-situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of insurannce. 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 ifyou 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 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 EE out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the.permit/license number which will be used as a reference number.'In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current p olicy 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 maybe provided to the applicant as proof that a valid affidavit is on file for futmn permits or licenses. A new affidavit must be filled oumt each year.Where a home owner or citizen is obtaining a license or permitnot related to any business or commercial venture (Le. 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 numiber. The CGmmcmvealth of Massachusetts Department of 11�idurtdal Accidents Office of javesfig,atio= 600 Washizoan Strom Bastw,MA 02111 TvL#617 727-4900�xt 4€6 or 1-977-MASS.AFF, Revised 4-24-07 Fax#617-727-7749 w in _gQvfdia l Fre,M.TWINBR00K INSURANCE 781 848 6100 04/07/2015 08:07 #678 P.001/001 ............ � 'AC RDL CERTIFICATE OF LIABILITY INSURANCE oaTE(MMr4/7/15 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 BELCYN. THIS CERTIFICATE OF INSURANCE DOES NOT CONSifTUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUT HORZED 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 th s certificate does not confer rights to the certificate holder in lieu of such endorsenent(s). PRODUCER CONTACT NAME: Carol McHugh Twinbrook Insurance Brokerage PHONE FAX (A/C,No Ext: (781) 843-7000 tA.tc,Nol. (781) 848-6100 400A Franklin Street E-MPJL : cmcHu h@twinbrook.c t Braintree, MA 02184 INSURE R(S)AFFORDING COVERAGE NAIC# INSURER A:Travelers Insurance INSURED INSURER s Zeolie Sheet Metal, Inc. INSURERC: 200 Roosevelt Road INSURERD: ureymouth, MA 02188-361 INSURERE: INSURERF: COVERAGES CERTIFICATE N UMBER: 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. NOT'A."THSTANDINC-ANY REOUIREIAlaiT,TER°.R 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.LIIAITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAM. INSR ADDL SUER POLICY EFF POU CY EXP LTR TYPE OF INSURANCE INSRUIVD POUCYNUMBER RAMAS)/YYYY) (MMIDDIYYYY) LIMITS A GENERAL LIABILITY I y 680397D10861442 2/23115 2/23/16 e.AcHOOCIrReru:E $ 1,000 000 X CC4,10ERCIALGEI+tER4LLI,ABILITI' DNAZAGE TC RENTED PR�tiISES(Fy:ncwrrenca' � 300 000 ^LJN ?vtr'7E 1]Ccup. WED_TP±Arnineperr�n) $ 5,000 PERSONA'_4 1,000 000 _N, AG r REG,aa $ 2 1000 1000 sGREG-T=_urnlTg�_f7LI=SP=_R PRODu��S-r-nm:�r• Pay $ 2 000 000 PRO- A AUTOMOBILE LIABILITY y BABA95513214SEL 2/23/15 2/23/16 ( 83c�7,^'INGL.=_Ll hnlr $ 1,000,000 AfJY.AUTO BODILY INS IR`r`(Psr tiH xni -__O'r°NEC %s,HEDULEO o .._, X .%:UTOS ODILYIN,A1RY(Per azeid&nt) $ NON-OWNED PROPE"n'.Y DFFA1.GE X IREC.=-.UTOS X ;IiT0S (P-r=rid-nt) $ A X UMBRELLA LIAB iX oo'-IiR CUPOE9825031542 2/23115 2/23/16 EACHOCCURF'BfJCE $ 2 ,000,000 IEXCESS LIAB CL,AIMS44, AGG REC..ri :$ 2 '000'000 nP�- RETalTI:-_,r•'8 5,000 A 'v1ORKetScoMPENSATIDN IEUB-7C85887-2-14 2/23/15 2/23/16 g T'e C -11- oTH- AND EMPLOYERS LIABILr1Y Y/N 1 F 500,000 rJ N��_F ET�FP?riN '.r-r���UTI'rE =i :�;; rdT CF R4:1-_FACER-_<rLia-j:_D; N NIA _. (PolandatDryinNH) F.L.DI:. s=-=aEraPLarEE $ 500,000 Ifyss,.,uujcGc undsr - D=SC IPTION:= uPE4. li,PJS7eh,w E1 DIS=F>E-POUCYUMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS!VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is regui red) Project:Lowell Firefighters Credit Union 642 Chelmsford Street Lowell, MA 01851 MacLeod C3eneral Contractors, Inc. and Lowell Firefighters Credit Union, are added as additional insured on the General Liability and Auto per written contract. CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED @J MacLeoad General ACCORDANCE WITH THE POLICY PROVISIONS. Contractors, Inc. 255 Centre Avenue AUTHORIZEDREPRESENTATIVE Abington, MA 02351 ijoseph P Rizzo/LD 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD rrame and logo are registered marks of ACORD Phone: Fax: E-Mail: Dat*,im.ma,^.leodi..c.".,a.. 1 Zeolie Sheet Metal, Inc. HEATING•AIR CONDITIONING•VENTILATION RESIDENTIAL• COMMERCIAL 200 ROOSEVELT ROAD WEYMOUTH,MA 02188 TEL• 781-871-5007 FAX• 781-878-7469 M " , n a,...,. '. ❑ � �'; ,.;".-� t' _ � ? e, http:i c�rp.se_,state ,v' gr a-,ne ,:x +.�. « ,w-v....,,fig w-�p.. ,„;�'`.c'-77", '"Z, ....,. -. ._ n.-r &^..,. �t ,�#: Fa OFIteS .<}' i "-- u9�ested�l~:es s � r� ww '..A2�... " - ++•H �.��..:.+ ..r..� :,. ...».�i+#..+.../...°.. `fir R k— Y r ..�}.'; 1. `" 1 e:. .: '. :..-,,...xti 4+: --#i Y.x:.. a,t:. �1d' e.s_ ^.". .• ,.. ::. x ..: .fir- N 4-n.. v..T�.: i7'.es+2— ��a'+ -+.. ..:.� .8,.:v'w .. 4,... ff Safe *T-_.�5 fiJ :�7 n�-� 00 Bulldln .,, r ,. � ,. a . ., . .,...•,.^. i II .�«....m_, a '" ,�5#�^wx:�i°. �t��, ,d-.�'.�- «�.� ^"w �:' � i �.: :,56,+4'� •i�. +M� :s F,_ s• u l j ?ate of Organization in Massachusetts; 02-20-2013 East date certain. The location or address where the records are, maintained (A PO box is not a valid location or address): Address: 1436 IYANNOUGH ROAD' City or town, State, Zip co e, Country: HYANNIS, NBA . 02601 USA s i - � The name and address of the Resident Agent: t Name.: CT CORPORATION SYSTEM Address: 155 FEDERAL STREET, SUITE 700 11KI City or town, State, Zip code, Country: BOSTON, MA 02110 USA l if The name and business address of'each hllanager. t �� "-4 � �.- � � .a'• e _"* ,rm , tea "+ ,. ��. £� 1 `- # ''a ..� .y-: '- an.4 -�.. �� e \�' I A a. s MANAGERa. JOSEPH KELLER 1436 IYANNOUGH ROAD HYANNIS, NBA 02601 U MANAGER CHARLES ROBINSON 434 IYANNOUGH ROAD HYANNIS, MA 02660 U�,;`! � 1 In addition to the rmanager(s), the name and business address of the person(s) authorized,to execute dc ` i be filed with the Corporations division; SOC SIGNATORY I CHARLES ROBINSON , - 434 IYANNOUGH ROAD HYANNIS, NBA 02660` - I Y �� J 4G_Tli "1BN(�t'_ICI B_R:ClA,17 �''A118�VT:S. 1A [l? �1, t �' �,,,� r„„ .:as.u.,Ew+d�P'.rt�is�n �:�,s,.«,:.i s,- �...,., =�,TMt>''.....�.,. a r.�y,a� add` ,u,•':- >�,+ - ..,„.4r;. ,�,Sn.. ..�;+ a ry�. �,,,.✓�����:� .,ii �� �,f �On ti — 941 ,r, ., ��,�; r'��c e�(� e S'0 9 77 0 2 tg,2- ecrc TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map C�y y Parcel ® Application #00, 30 S O S Health Division Date Issued Conservation Division 5Z3 13 Application Fee /:� Planning Dept. c� I�,r. - 13.6L • 24_ pw �u4�Z Permit Fee �If�i �� to Date Definitive Plan Approved by Planning Board Q s• �� -2© _ 3 Historic - OKH F� _ Preservation / Hyannis IUD Project Street Address a-5 UC*E 41 Village o Owner )7e)�g 4e_14,4 — Address _7' A jed Telephone S 1 7,57- ,Permit'Request dwsa cr /e,ae26 64��6eg 3a1L&,aG r Square feet: 1 st floor: existing proposed � 2nd floor: existing proposed Total new �_�(�� Zoning District Flood Plain Groundwater Overlay Project Valuatio C�a Construction Type Lot Size 2. 0(o g P_ s 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 Areas ft. Basement Unfinished Areas f Number of Baths: Full: existing new Half: existingrt�'e3w Number of Bedrooms: existing new 01 ; Total Room Count (not including baths): existing new First Floor Room CounR Lo Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other s� Central Air: *Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: `a 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 ' / G Telephone Number Address .A�,IC ed License # 5 7 Y� S. 1kd 1- 4 of'(9 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS SULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE t `n . FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ' ADDRESS r VILLAGE OWNER DATE OF INSPECTION: ._FOUNDATION= $ FRAME; INSULATION y FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH .. FINAL . GAS: ROUGH FINAL y FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. z: The Commonwealth of Massachusetts Pnnt 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 Name (Business/Organization/Individual): American Construction Corp. Address:54 Oakville Street City/State/Zip:Lynn, MA 01905-2817 Phone #:781-584-6178 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 4. ❑ T I am a general contractor and I struct employees(full and/or part-time).* have hired the sub-contractors ❑New con .ion 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and-have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' comp. insurance.$ 9. ❑ Building addition [No workers' comp. insurance P• , required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I-❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] 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:Liberty Mutual Policy#or Self-ins.Lic. #;WC2-31S-38011.1-022 -Expiration Date.1.1/09/2013 Job Site Address`.P Mucks Lane , 14y M!!zk IV A City/St ate/Zip:Hyannis, MA 02601 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 maybe forwarded to the Office of Investigations of the sup coverage ve Oacftion. I do hereby rti der ain and pe !:jua that the in ormation provided above is true and correct. Si nature: ._. ___ _ Date:..... _'_"� ZC? _l Phone �6- r6 5�5- 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#: AMERI-4 OP ID: BS !�np CERTIFICATE OF LIABILITY INSURANCE °A'�'M 07/29/139/13""' 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 Phone:781-665-2776 NAME:CONTACT McLaughlin Insurance Agency 828 Lynn Fells Parkway Fax:781-665-0295 a/CC N Ext ONE FAX No: Melrose,MA 02176 E-MAIL John E.McLaughlin Jr. ADDRESS: ' - INSURERS)AFFORDING COVERAGE NAIC# INSURER A:Union Insurance Company Attn:M INSURED Americanttn Mary Coburn Construction Corp. INSURERB:Acadla Insurance Company 54 Oakville St. INSURER C:Liberty Mutual Lynn,MA 01906-2817 INSURER D: INSURER E: i 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. INSR ADDL UBR - POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. B X COMMERCIAL GENERAL LIABILITY CPAS040457-12 04/01/13 04/01/14 PREMISES Ea Occurrence $ 500,000 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'LA GGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY PRO-JECTLOC $ AUTOMOBILE LIABILITY COMBINED NG BINED SILE LIMIT E accident) $ 1,000,00 A ANY AUTO MAA5042585-11 - 04/01/13 04/01/14- BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAB CLAIMS-MADE CUA5042733-11' 04/01/13 04/01/14 AGGREGATE $ 5,000,00 DED I X I RETENTION$ 10000 - $ WORKERS COMPENSATION WC STATU- OTH- - AND EMPLOYERS'LIABILITY TOR Y LIMITS ER C ANY PROPRIETOR/PARTNER/EXECUTtVE Y/" TO BE ISSUED BY CARRIER 11/09/12 11/09/13 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER.EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,00 If yes,describe under E.L.DISEASE-POLICY LIMIT''$ 500,00 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) -- Evidence of insurance CERTIFICATE HOLDER CANCELLATION BARNSO4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02060 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts- Department'of Public Safeth Board ttf Building Regulations and Standards 1!J Construction Supervisor License License: CS 57683 PATRICK M. COBURN 6 PRANKER:.RD " 3 SAUGUS, MA01906 Expiratio 2013 ('ommisiunrr T 20 8 ' _ j Initial Construction Control DocumentrOWN F -RARNISTAR-1 E To be submitted with the building permit application by a _ a Registered Design Professional 2013 Wro' 16 AMI 10: 2 for work per the 8 h edition of the Massachusetts State Building Code, 780 CMR, Section 107.6.2 DIVISION Project Title: Attucks Lane Office Building Date: 07-17-2013 Property Address: 189 Attucks Lane-Hyannis.MA Project: Check(x)one or both as applicable: X New construction Existing Construction Project description: New 10,000 SF Office Building and associated site work. I Kurt E.Raber MA Registration Number: 10563 Expiration date: 08-31-2013 ,am a registered design professional, and hereby certify that I have prepared or directly supervised the preparation of all design plans,computations and specifications concerningl: Entire Project X Architectural Structural Mechanical Fire Protection Electrical Other: for the above named project and that such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I •understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable.. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. When required by the building official, I shall submit field_/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official Upon completion of the work,I shall submit to the building official a `Final Construction Control Document'. Enter in the space to the right a"wet"or . electronic signature and seal: � �J p o No. 10563 BARNSTABLE, oy MASS. Phone number: 508-362-8382 Email: kurtraber(&canearchitects.com Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Trial Version 10 09 2012 Initial Construction Control DociTM&W BAPN.. To be subriiitted with the building permit applic n b g a > Registered.Design Professional 16: N 2 5 for work per the 8th edition of the Massachusetts State Building Code, 780 CMR, Sect 1,07.6.2 Project Title: Attucks Lane Office Building Date: 07/29/2013 Property Address: 189 Attucks Lane-.Hyannis;MA Project: Check(x)one or both as applicable: . X. New construction Existing Construction Project description:.New 10,006 SF Office Building and associated site work. I Ben*amin M. Schlick MA.Registration Number: 47578 Expiration date: 06/30/2014 ,am a registered design professional, and hereby certify that Lhave prepared'or directly supervised the preparation of all design plans, computations and specifications concerning': Entire Project Architectural . X Structural Mechanical Fire Protection Electrical Other: for the above named project and that such plans, computations and specifications meet the applicable provisions of the, Massachusetts State Building Code,(780,CMR),,arid'accepted engineering practices for the proposed project: I •tnderstand and agree that I(or my designee), hall perform the necessary professional services and be present on the construction site on a regular and:periodic basis to: 1.: Review,for.conformance to.this code and the design concept, shop drawings, samples and other submii.ttals by the contractor in'accordance;with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable: 3. Be present at intervals appropriate.to the stage of construction to become generally familiar with the progress and . quality.of the'work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. When required by the building official, :I shall.submit field/progress reports(see item 3.)together with comments; in a.form acceptable to:the.:building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. OF Enter in the space to the right a"wet"or ®� � electronic signature and seal'. BTRUCiURAI.No.47578 Phone number: (508)923-1010, Email: bschlick(i�allenmaior.com Building Official Use Only uilding Official Name: Permit No.: Date: .Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is:chosen, provide a description: Trial Version 10 09 2012 The Ohio Casualty Insurance Company 62 Maple Avenue, Keene, New Hampshire 03431 BOND Bond#601063819 KNOW ALL MEN BY THESE PRESENTS:That we American Construction Corp. 54 Oakville Street Lynn MA 01905 Street Address City State ZIP Code (Full Name Itop linel and Address[bottom linel of Principal) (hereinafter called the Principal)as Principal,and, The Ohio Casualty Insurance Company with principal offices at Keene,New Hampshire(hereinafter called the Surety)as Surety,are held and firmly bound unto Town of Barnstable 200 Main Street Hyannis MA 02601 Street Address City State ZIP Code (Full Name[top linel and Address[bottom linel of Obligee) (hereinafter called the Obligee),in the penal sum of Two Thousand Five Hundred and 00/100 (Dollars)$ 2,500.00 for the payment of which well and truly to made, we do hereby bind ourselves, our heirs. executors, administrators, successors and assigns,jointly and severally,firmly by these presents. WHEREAS,the Principal has made or is about to make application to the Obligee for a Permit for Building Permit-905 Attucks Lane, Hyannis, MA for a term beginning on July 30, 2013 and ending on*July 30,2014 (*strike out if license or permit is for an indefinite term) NOW, THEREFORE, if the Principal shall indemnify the Obligee against any loss directly arising by reason of failure of said Principal to comply with the laws.or ordinances under which said license or permit is granted, or any lawful rules or regulations pertaining thereto,then this obligation shall be void;otherwise to remain in full force and effect. PROVIDED,HOWEVER,AND UPON THE FOLLOWING EXPRESS CONDITIONS: 1. This bond shall be and remain in full force during the term of said license or permit unless canceled in accordance with. paragraph 2 below;but if said license or permit was issued for a specific term,and is renewed for one or more specific terms,this bond will be extended to cover such additional term(s) upon-the execution by the Surety of a Continuation Certificate, provided such certificate is acceptable to the Obligee. In no event , however, shall the liability of the Surety be cumulative from year to year or from period to period,nor exceed the penal sum written in this first paragraph of this bond. 2. The Surety shall have the right to terminate its liability by notifying the Obligee in writing ten (10) days in advance of its intention to do so. SIGNED,SEALED AND DATED July 30, 2013 America Construc'on Corp. �7 r By: The io Casualty Insu ompany By: Erm M. Lyons iAttorriey-in-Fact, r S=3853 License or Permit Bond (Unnumbered) Prin' al: American Construction Corp. POWER OF ATTORNEY p Agency Name: mow. THE OHIO CASUALTY INSURANCE COMPANY John McLaughlin Agency Obligee: Town of Barnstable Bond Number:601063819 Know All Men by These Presents:That THE OHIO CASUALTY INSURANCE COMPANY,a New Hampshire Corporation,pursuant to the authority granted by Article IV,Section 12 of the Code of Regulations and By-Laws of The Ohio Casualty Insurance Company,do hereby nominate,constitute and appoint:John E.McLaughlin Jr, William B.Markhard,Erin M.Lyons of MELROSE,Massachusetts its true and lawful agent(s)and attorney(ies)-in-fact,to make,execute,seal and deliver for and on its behalf as surety,and as its act and deed any and all BONDS,UNDERTAKINGS,and RECOGNIZANCES,excluding,however,any bond(s)or undertaking(s)guaranteeing the payment of notes and interest thereon. And the execution of such bonds or undertakings in pursuance of these presents,shall be as binding upon said Company,as fully and amply,to all intents and purposes,as if they had been duly executed and acknowledged by the regularly elected officers of said Company at their administrative offices in Keene,NH,in their own proper persons.The authority granted hereunder supersedes any previous authority heretofore granted the above named attomey(ies)-in-fact. In WITNESS WHEREOF,the undersigned officer of the said The Ohio Casualty Insurance Company has hereunto subscribed his name and affixed the Corporate Seal of said Company this I st day of December,2012. P�IY INS&R _ c2GOgP ORS F92n o7.1919� � —� y Fiy �Q 0 yAMP5. L STATE OF WASHINGTON Gregory W.Davenport Assistant Secretary COUNTY OF KING On this Ist day of December,2012 before the subscriber,a Notary Public of the State of Washington,in and for the County of King,duly commissioned and qualified,came Gregory W. Davenport,Assistant Secretary of The Ohio Casualty Insurance Company,to me personally known to be the individual and officer described in,and who executed the preceding instrument,and he acknowledged the execution of the same,and being by me duly sworn deposes and says that he is the officer of the Company aforesaid,and that the seal affixed to the preceding instrument is the Corporate Seal of said Company,and the said Corporate Seal and his signature as officer were duly affixed and subscribed to the said instrument by the authority and direction of the said Corporation. IN TESTIMONY WHEREOF,1 have hereunto set my hand i and affixed my Official Seal at the City of Seattle,State of Washington,the day and year first above written. , 3 NOTARY = n�•.d ^fir O 2 Qs ?°'G Notary Public in and for County of King,State of Washington My Commission expires December 9,.2013 This power of attorney is granted under and by authority of Article IV,Section 12 of the By-Laws of The Ohio Casualty Insurance Company,extracts from which read: ARTICLE IV-Officers:Section 12.Power of Attorney. Any officer-or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subject to such limitation as the Chairman or President may prescribe,shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Corporation to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bond,recognizances and other surety obligations: Such attomeys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall have full power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation. When so executed,such instruments shall be as binding as if signed by the President and attested to by the Secretary. i Any power or authority granted to any representative br attorney-in-fact under the provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. This certificate and the above power of attorney may be signed by facsimile or mechanically reproduced signatures under and by authority of the following vote of the board of directors of The Ohio Casualty Insurance Company effective on the 15th day of February,2011: f VOTED that the facsimile or mechanically reproduced signature of any assistant secretary of the company,wherever appearing upon a certified copy of any power of attorney issued by the company in connection with surety bonds,shall be valid and binding upon the company with the same force and effect as though manually affixed. CERTIFICATE I,the undersigned Assistant Secretary of The Ohio Casualty Insurance Company,do hereby certify that the foregoing power of attorney,the referenced By-Laws of the Company and the above resolution of their Board of Directors are true and correct copies and are in full force and effect on this date. IN WITNESS WHEREOF,I have hereunto set my hand and the seal of the Company this 30th day of July 2013 �•1Y INS& yJ GOaP ORS R m Q .4 021919Wo MP sa Ht * t David M.Carey Assistant Secretary' OpIHIEr Town of-Barnstable Conservation Commission 200 Main Street Hyannis Massachusetts 02601 � EO MAY Office: 508-862-4093 F 08-778-2412 �E-3 ermit No. Statement of Applicant/Applicant's Agent,upon Obtaining a Building Permit Application Signoff from the Barnstable Conservatiod'Division I fully understand that although I have obtained a signoff on the Building Permit Application for my project,site work may not begin under the Order of Conditions until the following requirements(from Section I1 of the Order of Conditions)have been met: Not Met. Met ❑ 1. Within one month of receipt of this Order of Conditions and prior to the commencement of any work approved herein, General Condition number.8 (recording requirement)on page 3 shall be complied with. --Must be met prior,to,sign-off. ❑ 2. It is the responsibility of the applicant,the owner and/or successor(s)and the project contractors to ensure that all conditions of this Order are complied with. The.applicant shall provide copies of the Order of Conditions and approved plans(and any approved revisions thereof)to project contractors prior to the start of work. Barnstable Conservation Commission Forms A and B shall be completed and returned to the Commission prior to the start of work. ❑ X3. General Condition 9 on page 3 (sign requirement)shall be complied with. ❑ V4. The Conservation Commission shall receive written notice 1 week in advance of the start of work. ❑ ❑ 5. The work limit line shown on the approved planshall be,staked in the field by the project surveyor/engineer. ❑ 6. Staked strawbales backed by trenched-in siltation fencing shall be set along the approved work limit line. Effective sediment controls shall remain until the site is stabilized with vegetation.. ❑ 7. A sequence of color photographs'showing the undisturbed buffer.zone shall be submitted to the Conservation Commission. Note: the str bales siltation fence must show in the foreground or bottom of thephotographs. � ( ) Applicant or Applicant's gent Signature Date n 2 6 0 Company Name Phone# Zq v Print Name.. ' q:iorms_bldsignoff # 6 Y r °�"'E rOj�•� Town of Barnstable 200 Main Street,Hyannis,Massachusetts 02601 * swaxsrnsLe. ib 'OrFDMn+& Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner Phone(508)862-4679 Fax(508)862-4725 www.town.barnstable.ma.us July 9, 2013 Fresh Pond Realty Trust, LLC c/o Matthew Eddy, P.E. Baxter Nye Engineering & Surveying 78 North Street, 3`d Floor Hyannis, MA 02601 e 5 T RE: Site Plan Review# 009-13 Fresh Pond Realty Trust CA05 189 Attucks Lane a/k/a 0 Attucks Lane, Hyannis Map 294, Parcel 080 Proposal: Construction of a new 9,995 s.f. building. Site improvements for access, parking, circulation, paving, drainage, landscaping and utilities will be made. Part of the parking for adjacent Barbyann's Restaurant falls on the subject lot. Existing parking will remain and a cross easement agreement has been provided. The new parking lot for the office building will interconnect to the existing Barbyann's Restaurant parking lot to provide enhanced site circulation. Dear Mr. Eddy: Please be advised that subsequent to the formal site plan review meeting held April 4, 2013 revised plans for the above-referenced proposal were administratively approved subject to the following: • Approval is based upon and must be substantially constructed in accordance with the following plans entitled: "Fresh Pond Realty Trust, LLC Site Construction Plans" 12 Sheets, Scale 1"=20', by Baxter Nye Engineering&Surveying, Hyannis, MA dated March 27, 2013 with final revision to Sheet C3.1 —Landscape Plan;May 1, 2013. • Priority Habitat filing and Conservation Commission Notice of Intent must receive approvals. • A formal address must be assigned to this lot prior to application for a building permit. Consultation with Frank Schlegel in DPW is recommended 508-790-6400 ex. 4942. • Approval is for construction of a one story 9,995 s.f. building with no additional mezzanine space. Cape Cod Commission DRI mandatory referral threshold for new construction is 10,000 s.f. • Consultation and final approval by the Hyannis Fire Department for hydrant location as well as sprinkler design, FDC location etc. will be required at the building permit stage. • A road opening permit must be obtained from DPW to perform work within the Town road layouts. • Consultation and final approval must be obtained from Hyannis Water Department for water service at the building permit stage. • Consultation and final approval of sewer tie in design must be obtained from the DPW at the building permit stage. • Storm water system maintenance plan must be implemented. • Applicant must obtain all other applicable permits, licenses and approvals. • Upon completion of all work, a registered engineer or land surveyor shall submit a letter of certification, made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan (Zoning Section 240- 105 (G). This document shall be submitted prior to the issuance of the final certificate of occupancy. A copy of the approved site plans will be retained on file. Sincerely, 7a Ellen M. Swiniarski Site Plan/Regulatory Review Coordinator CC: Tom Perry, Building Commissioner SPR File Hyannis FD Roger Parsons—DPW Hans Keijser-Hyannis Water QUITCLAIM DEED I, JOHN M. CUNNINGHAM, TRUSTEE of JKC Airport Road Nominee Trust, a/d/t dated June 10, 1996 and recorded at the Barnstable Registry of Deeds in Book 10249, Page 276, of 24 Cove Island Road, Centerville, Massachusetts 02632 for consideration paid in the amount of FIVE HUNDRED THIRTY-FIVE THOUSAND AND 00/100 DOLLARS ($535,000.00) grant to FRESH POND REALTY TRUST, LLC, a Massachusetts limited liability company, having an address of c/o 1436 Route 132, Hyannis, Massachusetts 02601 with QUITCLAIM COVENANTS The land in Barnstable (Hyannis), Barnstable County, Massachusetts, more particularly described as follows, ing Parcel C .shown on a plan entitled "Plan of hand in Hyannis, BARNSTABLE, Mass:for_L' _& LILA LEE LORUSSO Scale 1" = 80' December 7, 1982 Doyle Associates Falmouth, Mass-", which said plan is recorded with the Barnstable County Registry of Deeds in Plan Book 370, Page 1. Subject to and with the benefit of any rights, rights of way, restrictions, reservations, or easements of record, if any there may be, so long as they are now in full force and effect. Together with the right to use Attucks Way in common with others entitled thereto for all purposes for which ways are used in the Town of Barnstable. Property Address: 189 Attucks Lane, a/k/,a 0 Attucks Lane, Hyannis, MA 02601 I, JOHN M. CUNNINGHAM, TRUSTEE of JKC AIRPORT ROAD NOMINEE TRUST u/d/t dated June 10, 1996 and recorded with the Bamstable Registry of Deeds in Book 10249, Page 276, being under oath hereby certify as follows: 1. That I am the sole Trustee of the above-mentioned Trust; 2. That said Trust has not been altered, revoked or amended and is in full force and effect; 3. That the beneficiaries of the Trust are of legal age, they are not disabled and have all assented to the sale of the trust property; and 4. That I am duly authorized on behalf of all of the beneficiaries of said Trust to convey the property known as 189 Attucks Lane, a/k/a 0 Attucks Lane, Hyannis, Massachusetts for consideration in the amount of Five Hundred Fifty Thousand and 00/100 ($535,000.00) Dollars to Fresh Pond Realty Trost, LLC. For title, see Deed recorded at the Barnstable Registry of Deeds in Book 10249, Page 281. t LO WITNESS my hand and seal this. day of March, 2013. JKC AIRPORT ROAD NOMINEE TRUST BY: �k. � JPnM .Cunningham, ustee COMMONWEALTH OF MASSACHUSETTS Barnstable, ss. On this dayof March, 2013, before me, the undersigned notary public, personal) appeared John M. Cunningham, y pp g ,.proved to me through satisfactory evidence. of identification, MA driver's license, to be the person whose name is signed on the preceding or attached document, and acknowledged to me that he signed it voluntarily for its stated purpose as Trustee of JKC Airport Road Nominee Trust. o ry Pu lic: J6hn W. nney y commission expires: 01/18/2019 w BARNSTABLETCOUNTYTEEGISTRY OFXDEEDS Date: 03•-08-2013 a 12:40om Ctla: 733 Doc:: 14376 FOP: $IY829.70 Cons: $5351000.00 BARNSTABL.E COUNTY EXCISE TAX BARNSTABLE COUNTY REGISTRY OF DEEDS Data: 03-08-2013 a 12:4-Opm �.� Ctl74: 733 Docr: IQ% Fen: $IY444.50 cons: $535v000.00 BARNSTABL,B MISTRY OF DEEDS 7-0- E r d ryo j FR ES y f�. ylly •„09•'_- 0 n n ab so,000ryf 0 ca a �k e - aPPROV R SUBO/Y/S/ON �,. .. CONTROL ZA W N IVOOT r 9j v S1dvL -- -V• ' /78.00' Q A ------- kV 63 PZ r'3 ------ AIRPORTS <`�> ------- NQTE.` A9RCEL C 7b BE COM�EYEO - TQ ROB.ERT-.3/+'/EGOS • BARNSTABGE.PL.9N'�///YT'BOARO - - ' •- /CE.4T/FY TNgT TN/S PLAN /:AS ` BEEN PREPARED•//Y CONFORM/TY 1✓/TN THE RUGES ANO REGUL AT/DNS Ad Flgly OF L AND - OF T//E REG/STERS OF OEEOS GiF T//E COMMON WEAL Tf/ OF MASSACh'USETTS. /N �_�c�— .Iz-t-s� .vY.tw.v/s Bi9RNST�7BLE,•�Aoss. /CE eriFY ncAr rvrs PLAN Was /-7 Zo L.PAUL #L/LA L EE L OfZC/SSO I W/TN LANO COURT 37,1*NgR05 OF ACCURACY AND'THAT THE PERMANENT �� - Po/NTS S�.'Ol✓N GVV T/!E PLAN EJf/ST ON THE GROUND. - ao�c SCALE: /'HBO' OECEMBER 7-.,/9B2 OOYLE gSSOC/gTES f-AL MOG/TH/K9S.S. 20NE0:-/NO. d?: ZONING TABLE BAXTER NYE W r r / y i mxWc ms RMsk l Woos RU w mS ac s m P � a.E, ENGINEERING& M 7' LO'•Ea USC:OtFi(£ IOTLL ftOtlt NiE•�9.aW.5 3 SURVEYING vc-VACMT PROP roTAL SRE BV—FOOTPRINT-A99•.5 iR El— 1 14 W M;JS Sur ofeprt i+i GBH TOIAI PARCEL AREA:90.—2 S.P. 7B NonA Street-7r0 hoar E.I 2 PRO—CD Hp E,uafl ..tts U601 LOT AREA: 90.000 SF Rgam 4 PNPne-(5Ea)7n-7501 z �]ram,. R s9E:PT F - (508)M-7622 / J I// BNIMxc SETBAfxS: SD R 15>R m.D tc-nAcdn �2 °«R A N P IT11P PARKMG SERIACC FROUT -REM R 5, .6)R w.-Tv:—�- __.___..-� 4AY&DG.x0(iIRSTOftl6k 3 SinMES pt]0 R(2Z CO "STgry iJ i , WK lqT KRAGE(S1RlglUPES}. 25i 3 SF) li(9.991.]SF) cowlA¢(MPERuous MEAk •s,mo s(sod n,nT s(•s.>s) . sTArE ]ox —1 21.000(]Oa) PRGP.uma>:(aTq q�/` AT A '4 :::i: if \ / / // i STREET IRFES-fApR YAfR, 2O 2G(PROMBEV BY xSUI TAxT (1/]O R OF FRONTAGE)- O. ELSnN6 nKEa) c . /; 9 ESACP O \ / / P c uTb ssO:0.1-iE—s 2.— 2.4e9 uETAxT E`EV / / / REFS-PAMWG AREA(,/B P T T S) F. J 50 SPACFS/S-3.25 ' -a]., ]•EPAas so SP.Aas FTeeh moond Trust LLC Narnough Road µv_PAR—G ]•svAas so SPAas i4k 02M \ dGM PNMIxG(Taro-NM) 2/1 SPACEs 2/S SPACES •r• / / / / ?) {/ / J / scx wrmE AssNTo vAs SIGN SUrwwv AAec°t Ka mr'®".x..na:r"M"': 2 /l \Vr xuu9eRa' sPEaPtunov TExT aAxnn ♦�i YIDM MEN>IT B w•II// E. tr f i i V \NOTES: u 9 OE li I ^ 1 r /`\ ,.Au wNsmucnox sNAu to PEAw 0 W AanlmMCE wT>,u>mss..I— _.i ( ! I 16 -i(. /j Q I I \ / \ oROWwEEs.REOI1WEUENiS.MD sPEt2FrwnoNs 2.THE C17NIRACIOR iP—CONTAOf TIIE ENWNEER TO—EE-E A PRE-COE6TRUCigN o m /h i I IN / I I NEEI9IG AT tFASr Tao(2)WE S PIBOR TO O01NEUCWG CONSTRUCTgN. e µTHE BRKiA CTOR SHALL RARE PROOM-TO THE ENGRIEER FOR APPROVu R60RE EABR,cAnaN OR DEurur a PRDDucrs OR uATEwus 9 ----- —.—�--- E%KTY1G PANNG 0—S BE SAW W To CREATE A clflN EDGE—E R IS To nE/ BE Wfa NEW PANNO.qt wxERE ASPMLLT 6 RFIIWED AGVCEM TO SPRKT YMICII rl IRT ,N "w� I q sS� y 1. I O E I REP— —aROrt�M`lEO"COVW"�A(MTE�D PAYE— CRRPL PER P�VEMEWu—ON —E O OK—MNON. _ / n"cl,," u.nt. I \ OWN ME TO O—D FACE OF FWNDATgN OR FILE OF CURB wHFAE�� r S.duENSgNS SN E PA¢ss I I IR I 1 e2 j \ aPvuc9aLE. \ s.Au vAVEuvrt ursmws MD srRwwc sNAu raLavR uurcO srAxouros. E $ }-ev(rAA nu I I \ WOTN FOR tANE um srAu srRwxO s,uu BE a Wa¢s untsss oTNETa9rsE NOTm. sy WG A1.OR.SIGN F� I R 1 I \\ 1. NID SRE—E9WL uEET REWWEYFMS OF TOWx ZOx / aAl- - 1 I I Layout and Dimension r I Plan ,>•.,o,w�� I t sx E fi r 10 f..'•q / 1 3. zo O 2O a __�e,.e w.1}•T.P —..._____-� I s rcm w T.ssrr N }� Wrc // \\ EE:1 —E W FEET Loop Up Print Page 1 of 2 . Owner Information-Map/Block/Lot: 294/080/-Use Code: 4400 Owner Map/Block/Lot GPS 294/080/ IS MA Owner Name as of CUNNINGHAM,JOHN M TR property Address 1/1/12 1436 ROUTE 132 HYANNIS,MA. 02601 905 ATTUCKS LANE Co-Owner Name %FRESH POND REALTY TRUST, LLC Village: Hyannis Town Sewer At Address: No GIS Zoning Value: IND . Assessed Values 2013 -Map/Block/Lot: 294/080/-Use Code: 4400 2013 Appraised Value 2013 Assessed Value Past Comparisons Building $0 $0 Year Total Assessed Value: Value Extra $0 $0 2012 - $ 471,600 Features: 2011 - $ 309,400 Outbuildings: $ 0 $ 0 2010 $ 309,400 Land Value: $471,600 $471,600 2009 -$ 331,200 2008 - $ 331,200 2013 Totals $471,600 $471,600 2007- $ 331,200 . Tax Information 2013-Map/Block/Lot: 294/080/-Use Code: 4400 Taxes Hyannis FD Tax (Commercial) $,499.69 Community Preservation Act $ 111.63 Tax Town Tax(Commercial) $ 3,720.92 Fiscal Year 2013 TAX RATES HERE 5,332.24 . Sales History-Map/Block/Lot: 294/080/-Use Code: 4400 History: Owner: Sale Date Book/Page: Sale Price: CUNNINGHAM, JOHN M TR 6/15/1996 10249/281 $260000 LORUSSO,LILA LEE 5/15/1990 7148/191 $75000 SHIELDS,ROBERT M SR 3/15/1987 5632/091 $325000 SHIELDS, ROBERT M JR 10/15/1985 4740/195 $300000 SHIELDS, ROBERT M SR TR 4/15/1985 4486/178 $1 http://www.town.bamstable.ma.us/Assessing/printl3.asp?ap=0&searchparce1=294080 7/29/2013 Loop Up Print Page 2 of 2 SHIELDS,ROBERT M 2/15/1983 3683/223 $175000 FRESH POND REALTY TRUST,LLC 3/8/2013 27191/293 $535000 . Photos 294/080/-Use Code: 4400 There are not any photos for this parcel . Sketches-Map/Block/Lot: 294/080/-Use Code: 4400 A sketch is not available for this parcel. AsBuilt Card N/A . Constructions Details-Map/Block/Lot: 294/080/-Use Code: 4400 Land USE CODE 4400 Lot Size(Acres) 2.07 Appraised Value $471,600 Assessed Value $ 471,600 Construction details are not available for this parcel. . Outbuildings &Extra Features-Map/Block/Lot: 294/080/-Use Code: 4400 There are not any extra building features on record at this time. . Sketch Legend Property Sketch Legend 132N Barn-any 2nd story area FPC Open Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished) FUS Second Story Living Area(Finished) TQS Three Quarters Story(Finish( BRN Barn GAR Garage UAT Attic Area(Unfinished) CAN Canopy GAZ Gazebo UHS Half Story(Unfinished) CLP Loading Platform GRN Greenhouse UST Utility Area(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front UTQ Three Quarters Story(Unfinis FCP Carport KEN Kennel UUA Unfinished Utility Attic FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUS Full Upper 2nd Story(Unfinisl FHS Half Story(Finished) PRG Pergola WDK Wood Deck FOP Open or Screened in Porch PTO Patio http://www.town.bamstable.ma.us/Assessing/printl3.asp?ap=0&searchparce1=294080 7/29/2013 Town of Barnstable Geographic Information System July 29, 2013 295013 295018H04 #765 295020 #0 329003 #805 312032 #480 Z #206 41.. V 294079 V #866 .� —A 312031 #880 312004 #174 N 294080 #905 294071 #96 294013 294014 #70 #120 �� A�RPaRr Ro r, ;0011 .� 91 v t, m R 1 t a is r < 312014GND W 11 3 #80 s01 ti 312003 a 77 312017CN D #�4 294015 ". 294064 #111 312019 #95 - 294077CND 312018 #35 312029CND #,38 #14 #30 DISCLAIMERS:This map is for planning purposes only. It is not adequate for legal Map:294 Parcel:080 boundary determination or regulatory interpretation. Enlargements beyond a scale of Owner.CUNNINGHAM,JOHN M TR Total Assessed Value:$471600 Selected Parcel 1"=100'may not meet established map accuracy standards. The parcel lines on this map _ are only graphic representations of Assessor's tax parcels. They are not true property Go-Owner:%FRESH POND REALTY Acreage:2.07 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:905 ATTUCKS LANE such as building locations. Buffer PareelEdit. Page, I of 1 him Logged In As: Tuesday,July 16.2013 Frank Schlegel Pa rce l Application Center Road Svstem Reoorts Road Svstem The record has been updated. Parcel Detail Parcel ID 294080 Sew*r Acct: T/R FYUpdate, Devel Lot: 1LOT. C Owner: CUNNI.NGHAM JO.HN M TR Co Owner: 1,%FRESH POND REALTY TRUST, LLC __.__. .. .__._ Street: 1436 ROUTE 132 _ City: JHYAN�NIs State: MA ( zip: 02601 --------------- „w v Location': JATTUCKS LANE Village:" Hyannis Road Index; 0048 _ 3 Pri Frontage: 1.3 To set road., you can also enter road index and tab out.of•field.. SecondaryRoad: AIRPORT ROAD jH3 x, _ Sec Index: OD10 1 j Sec Frontage; 236 ti Visions Location: 0 ATTUCKS LANE . .; Last Updated: 7/16/2013 3 45:08 P .No. Bldgs: 10 No; 208420 ; Lot.Size (acres): 2 069 9541 .... .E State Class: 4400 Year Added;. ro - } Fire.Dist: 4 _^ Deed.pate:. 6/15/•1996 Deed Ref,. 10249/281 j Land Value: 471600 Bldgs Value: 0' Extra.Fe.atures: �0 Condo'Complex - 1 Building: _... Unit. 1 Update� ` E httri•// ccnl�/intranetlnrnnrlata/AarnelF.riifi acnxDTTl=7'�A7� 7/1 F/�(ll The Commonwealth of Massachusetts William Francis Galvin -... Page 1 of 3 The Commonwealth of Massachusetts William Francis Galvin i Secretary of the Commonwealth, Corporations E� Division One Ashburton Place 17th floor Boston, MA 02108-1512 Telephone: (617) 727-9640 AMERICAN CONSTRUCTION CORPORATION Summary Screen Help with this form IEReq�est a C rtificat � The exact name of the Domestic Profit Corporation: AMERICAN CONSTRUCTION CORPORATION Entity Type: Domestic Profit Corporation Identification Number: 000900634 Old Federal Employer Identification Number (Old FEIN): Date of Organization in Massachusetts: 08/01/2005 Current Fiscal Month / Day: 12 / 31 The location of its principal office: No. and Street: 6 PRANKER ROAD City or Town: SAUGUS State: MA Zip: 01906 Country: USA If the business entity is organized wholly to do business outside Massachusetts, the location of that office: No. and Street: City or Town: State: Zip: Country: Name and address of the Registered Agent: Name: PATRICK M. COBURN No. and Street: 54 OAKVILLE ST City or Town: LYNN State: MA Zip: 01905 Country: USA The officers and all of the directors of the corporation: http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.a... 8/6/2013 The Commonwealth of Massachusetts William Francis Galvin -... Page 2 of 3 Title Individual Name Address (no PO Box) Expiration First, Middle, Last, Address, City or Town, State, Zip of Term Suffix Code PRESIDENT MARY ELLEN 6 PRANKER ROAD COBURN MRS SAUGUS, MA 01906 USA TREASURER MARY ELLEN 6 PRANKER ROAD . COBURN MRS SAUGUS, MA 01906 USA SECRETARY MARY ELLEN 6 PRANKER ROAD COBURN MRS SAUGUS, MA 01906 USA VICE PRESIDENT PATRICK MICHAEL 6 PRANKER ROAD COBURN MR SAUGUS, MA 01906 USA DIRECTOR PATRICK MICHAEL 6 PRANKER ROAD COBURN MR SAUGUS, MA 01906 USA business entity stock is publicly traded: The total number of shares and par value, if any, of each class of stock which the business entity is authorized to issue: Par Value Per Total Authorized by Articles Total Issued Class of Stock Share of Organization or and Outstanding Enter O..if no Par Amendments Num of Shares. Num of Shares Total Par Value CNP $0.00000 100 $0.00 0 Consent Manufacturer - Confidential _ Does Not Require Data Annual Report _ Resident For Profit Merger Allowed Partnership Agent http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.a... 8/6/2013 I The Commonwealth of Massachusetts William Francis Galvin -... Page 3 of 3 Select a type of filing from below to view this business entity filings:. ALL FILINGS Administrative Dissolution Annual Report �Yn' t�,� Application For Revival �--- Articles of Amendment m View Filmgs � 'r New Search . Comments ©2001 - 2013 Commonwealth of Massachusetts Q All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.a... 8/6/2013 HE• . o 7 f Town of Barnst able'�. ble y Regulatory Services $ Thomas F.Geiler,Director 1619. Building Division Tom_Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.b arnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Alust Complete and Sign This Section If I-sing A Builder I; UL> drC�GGsZ_ :. as Owner of the subject ro _ - Pe PrtY hereby authorize to act on my behalf, in all-matters relative to work authorized by this building permit application for. (Addiess of Job) ti 3 S-' ature of Owner Date Print Name i if Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse::side Q:FORMS:OVJNERPERMISSION. The Commonwealth of Massachusetts William Francis Galvin -... Page 3 of 3 ©2001 - 2013 Commonwealth of Massachusetts All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.a... 8/6/2013 The Commonwealth of Massachusetts William Francis Galvin -... Page 2 of 3 The name and business address of the person in addition to the manager, who is authorized to execute documents to be filed with the Corporations Division. Title - Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code SOC SIGNATORY JOSEPH KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 USA SOC SIGNATORY CHARLES ROBINSON 434 IYANNOUGH ROAD HYANNIS, MA 02660 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver and record any recordable instrument purporting to affect an interest in real property Title Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code REAL PROPERTY JOSEPH KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 USA REAL PROPERTY CHARLES ROBINSON 434 IYANNOUGH ROAD HYANNIS, MA 02660 USA Consent Manufacturer — Confidential _ Does Not Require Data Annual Report _ Resident For Profit Merger Allowed Partnership Agent — — Select a type of filing from below to view this business entity filings: ALL FILINGS Annual Report Annual Report-Professional Articles of Entity.Conversion ] Certificate of Amendment LL i j 1 View Filings =,, z� :1 _ `New;Sea�ch Comments http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.a... 8/6/2013 , The Commonwealth of Massachusetts William Francis Galvin -... Page 1 of 3 The Commonwealth of Massachusetts William Francis Galvin . y;l Secretary of the Commonwealth, Corporations ' _ ' Division One Ashburton Place, 17th floor Boston, MA 02108-1512 Telephone: (617) 727-9640 FRESH POND REALTY TRUST LLC Summary Screen Help with this form - 'Request Z FZ;ifi a eg 771 - -- _ The exact name of the Domestic Limited Liability Company (LLC): 'FRESH POND REALTY TRUST LLC Entity Type: Domestic Limited Liability Company (LLQ Identification Number: 001100295 Date of Organization in Massachusetts: 02/20/2013 The location of its principal office: No. and Street: 1436 IYANNOUGH ROAD City or Town: HYANNIS State: MA Zip: 02601 Country: USA If the business entity is organized wholly to do business outside Massachusetts, the location of that office: No. and Street: City or Town: . State: Zip: Country: The name and address of the Resident Agent: Name: CT CORPORATION SYSTEM No. and Street: 155 FEDERAL STREET, SUITE 700 City or Town: BOSTON State: MA Zip: 02110 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code MANAGER JOSEPH KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 USA MANAGER CHARLES ROBINSON 434 IYANNOUGH ROAD HYANNIS, MA 02660 USA http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.a... 8/6/2013 f r i BP'10249-0281 96-06-1.2 1 :52 #033637 DEED I, LILA LEE LORUSSO of 15380 SW 72nd Avenue, Miami, , FL. 33157, for consideration paid in the amount of TWO HUNDRED SIXTY THOUSAND AND N0/100 ($260s000.00) DOLLARSt grant to JOHN M. CUNNINGHAM, TRUSTEE OF JRC Airport Road Nominao Trust, u/d/t dated3u,A /D , 1996 a r orded with the Barnstable County Registry of Deeds in Book , Page a rNo' of 24 Cove Island Road, Barnstable (Centerville) , arnstable County, Massachusetts 02632 WITH QUITCLAIM COVENANTS The land in Barnstable (Hyannis) , Barnstable County, Massachusetts, more particularly described as follows: Being Parcel C as shown on a plan entitled "Plan of Land .in Hyannis BARNSTABLE, Mass. for L. PAUL & LILA LEE LORUSSO Scale 1" = 801 December 7, 1982 Doyle Associates Falmouth, Mass.", which said plan is recorded with the Barnstable County Registry of Deeds in Plan Book 370, Page 1. Said property is conveyed subject to and with the benefit of any rights, rights of way, restrictions, reservations or easements of record, if any there may be, so long as they are now in full force and effect. This conveyance is subject to Development Regulations for Independence Park, Inc. recorded with the Barnstable County Registry of Deeds in Book 2983, Page 155 and filed with the Land Registration Office as Document No. 263,606. This conveyance is subject to an annual maintenance fee of one-half of one percent of the purchase price of the land due and payable on or before January 31st each year. In making this conveyance the Grantor reserves all rights and title in the private way known as Attucks Way as shown on said plan and does not intend to convey any fee in said way to the Grantee. However, the Grantor does grant the right to use Attucks Way in common with others entitled thereto for all purposes for which ways are used in the Town of Barnstable. Property Address: 189 Attucks Lane, Hyannis, MA. For Grantorfs title see deed recorded in Book 7148, Page 191. WITNESS my hand and seal. this 16* day of JW, 1996. 41& Lefr Lbrusso CA"UliWbWbyAW BPOI0243-0282 96-06-12 1 :52 #033637 COMMONWEALTH OF MASSACHUSETTS BARNSTABLE, SS. , a= la , 1996 Then personally appeared the above-named Lila Lee Lorusso and acknowledged the foregoing instrument to be her free act and deed, before me Cy ?commission a y ubl c a-,"G/,expires: �i���Qp DEEDS REG 01 BARNSTABLE COUNTY KAR0TABLE p 06/12/96 06/12/96 . Diffifl TAX 594.80 TAX 889.20 TOTAL 592.80 CHCK 889.20 CVJE CK 59 .50 1419A000 13:50 0011 EXCISE TAX 001 01fii 13:49 COUNTY EXCISE TAX 2 BARNSTABLE REGISTRY OF DEEDS SHE TQ� $� Town of Barnstable BARNSTABL&, D) pattment.of Public Works y MASS. �'Apen +a�0 382 Falmouth Road, Hyarnis MA 02601 http�://www.town.barnst6ble.ma.,us Office: 508-790=6400 Daniel Santos;:Director Fax: 5.081-790-6406 Roger'Parsons;;PE.,Town Engineer SUBJECT:Numbering:of'Buildings Map No. `25 / Parcel No..Qgd Date: uLk/ 16, ;L0 . D..ear Prop erty-Owner, Notice is hereby given in accordance withzthe General Ordinances.of thelown of Barnstable; ChapterlII,Article V, Numbering of Buildings; adopted'March 3,1931,revised July 21,19'9.4, public convenience and necemity.requires the assignment of`numbe_r 10§ for our_ , property located on Ar7VOtS 4A^)6F t±VArWU STREET NAME VILLAGE This number should be affixed to your building so that it is visible:from the ogtreet as outlined in Exhibit"F% Town of Barnstable Rules and Regulations for Numbering of Buildings. Please contact Mr. Frank Schlegel at the>Engineering Division,a't(50.8) 790-:6400 x-4942 and be prepared to;provide all telephone numbers at this location so that,your.E-911 account records can be confirmed when the:correct building number is posted. CAIo* rQvtrca � Roger Parsons, P.E. Town,Engineer encl.:— T.O.B:.Rules &Regs. — Common,Questions Site;Map; Assessors.Change Form, r Page 1 of 1 Schlegel, Fraink From: Eliza Cox[ECox@nutter.com] Sent: Friday, July 12, 2013.9,50 AM To: Schlegel, Frank Cc: 'Matthew Eddy' Subject: Attucks Lane/Airport Road-Map 294, Parcel 80 Hi Frank,. Thank you so much for speaking with me about 0 Attucks Lane (Map 254, Parcel 80). As requested, attached is the ste;planwhich.has been approved`by.the-Site Plan Review Committee (one;of the:conditions of approval is confirming the address with you) As l mentioned, the client is closing on construction financing for-this project next week, so we.would:really appreciate it if you can let us know the address as soon as possible so that we can use it in the,loan.d6cuments(and also he permit applications at Town Hall): If you need anything else from me, please let,me know. My phone number is li'sted"below: Kind wishes and thank you'l - Eliza Eliza Z. Cox Nutter Nutter McClennen& Fish LLP' 1471 iyannough Road Hyannis, MA 02601 Direct line 508.790.5431 Fax 508-771.-8079 www.nutier.com This Electronic Message contains information from the law firm of.Nutter, McClennen & Fish, LLP, which may be privileged and confidential. The information is intended to be for the use of the addressee only;. If you have received this communication in error, do not read it: Please delete it from your system without copying it, and notify the sender by reply e-mail, so that.our address record can be corrected. Thank you. Circular 230 Di closure; To ensure compliance with IRS Gircula±'230,we.iriform you that any,federal tax advice;included.in this communication,(including attachments)is not intended or written to be used,.and R cannon e used,for the purpose,of(i)avoiding, the imposition of federal tax penalties;or(ii).promoting,marketing or recommending to another party any transaction or matter. addressed herein. 7/16/2013 TOWN OF BARNSTABLE D.P.W. t " b C 'lfff J 0 7- 0 1 # 00 o= r O w ti -Ik o. a� O e Q.i o basemaps.dgn 7/16/2013;3 46:45 Pm Property fines shown on this PlaO are for easessing purposes only and do not mpresent actual relation physical objecM ZONING TABLE BAXTER NYE w z {tt 1 '� ( -E Gm. w \?�/ /^� j ,/' .:o tt` 'Rr`Rr`rts�1•,�w°usTa'u :ENGINEERING$ ' tm u'IOTIl.SITC BWIDWO'r061P RMT-H.991.5 .usr aeO SURVEYING USE'vAC4Y RW //( RqiW Rut Su�S XJ r dond SurveKvs W Z a I / `4i: r �/ '/ lolll ynacEl..REw:`Ho.00O x sr: :78 nbrtn sv ,-7.e rt3or 7 � � � 1 .• J f \�)✓ — R wro ftwv�+awa3.mn�,ti azso, 33/.�.�etr a• ^� --�--: \ /\. 1/ // 10 woods Haom sr :Pnone-(508)ni-75o= wC ERR aExst. ° ' z.lar4 /' ��- /` T /'• / I' / / uA1C oUm NOQITSi umu 3 STWIES OII J°re °5la+r ?r .ar..tiv non ., ` ,Rf//\\- / 1. / uuE aol mvFancE.fsv:ucTUREs): zsx(u soo fin lux sq ,,• P / r I ` • ,, /. t`( • /I, ./' u.rtaAL srnlE :J2i 'Ensr nam(Joz) 0.0R:unm ss(5s.]Xj I .� i. 1' •¢ .,\ OONSUE'TANT ,NeENi .. w.., f •a:. a. - \. 1 �/- -1 J - / sraEeT,arcs aeNT .tm o.mm� 55F�BV�pHG.. 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Issuance a. r OOC b.G Amended OOC a.First Name b.Last Name c.Organization FRESH POND REALTY TRUST LLC d.Mailing Address 1436 IYANOUGH ROAD e.City/Town HYANNIS f.State MA g.Zip Code 02601 4 PropFf erty Owner r a.First Name b.Last Name c.Organization FRESH POND REALTY TRUST LLC d.Mailing Address 1436 IYANOUGH ROAD e.City/Town HYANNIS f.State MA g.Zip Code 02601 5�Pro�ectLocation a.Street Address 189 ATTUCKS LANE b.City/Town `BARNSTABLE c.Zip Code 02601 d.Assessors Map/Plat#294 e.Parcel/Lot# 080 f.Latitude 41.67343N g.Longitude 70.29568W 6 ;Property recorded at the Registry, o .e for > a.County b.Certificate c.Book d.Page BARNSTABLE 27191 293 7 Dates a.Date NOI Filed: 4/l/2013 b.Date Public Hearing Closed: 4/30/2013 c.Date Of Issuance: 5/30/2013 8.Fina1 Approved,'Plans„and Othe Documents, a.Plan Title: b.Plan Prepared by: c.Plan Signed/Stamped by: d.Revised Final Date: e.Scale: BAXTER NYE SITE PLAN EINGINEERING& MATTHEW W.EDDY,P.E. 3/27/2013 1"=20' SURVEYING B. Findings 1 Findings pursuant to the-Massachusetts Wetlands Protection Act Page 1 of 9*ELECTRONIC COPY i L11Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection-Wetlands MassDEP File#:003-5084 WPA Form 5 - Order of Conditions eDEP Transaction#:567040 Massachusetts Wetlands Protection Act M.G.L.c. 131, §40 City/Town:BARNSTABLE. Following the review of the the above-referenced Notice of Intent and based on the information provided in this application and presented at the public hearing,this Commission finds that the areas in which work is proposed is significant to the following interests of the Wetlands Protection Act. Check all that apply: !� a ❑ Public Water Supply b. CI Land Containing Shellfish c.r Prevention of Pollution { d. r Private Water Supply e. Ci Fisheries f. ri Protection of Wildlife Habitat . g. r Ground Water Supply h. r Storm Damage Prevention �iiG Flood Control r 2 Comrnrsston hereby finds the protect as proposed,rs Approved subject to: a. [i The following conditions which are necessary in accordance with the performance standards set forth in the wetlands regulations.. This Commission orders that all work shall be performed in accordance with the Notice of Intent referenced above,the following General Conditions,and any other special conditions attached to this Order.To the extent that the following.conditions modify or differ from the.plans,specifications,.or other proposals submitted with the Notice of Intent,these conditions shall control. Denied because: b.Ci The proposed work cannot be conditioned to meet the performance standards set forth in the wetland regulations.Therefore, work on this project may not go forward unless and until a new Notice of Intent is submitted which provides measures which are adequate to protect interests of the Act,and a final Order of Conditions is issued.A description of the performance standards which the proposed work cannot meet is attached to this Order. c.r The information submitted by the applicant is not sufficient to describe the site,the work or the effect of the work on the interests identified in the Wetlands Protection Act.Therefore,work on this project may not go forward unless and until a revised Notice of Intent is submitted which provides sufficient information and includes measures which are adequate to protect the interests of the Act,and a final Order of Conditions is issued A description of the specific information which is lacking and why it is necessary is attached to this Order as per 310 CMR 10.05(6)(c). 3'r Buffer Zone Impacts:Shortest distance between limit of project disturbance and the wetland resource area specified in 310CMR10.02(1)(a). a.linear feet Inland Resource Area Impacts (For Approvals Only) 5 Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement w a linear feet '' b linear feet c linear feet d linear feet S.Ci Bordering Vegetated Wetland a.square feet b.square feet c.square feet d.square feet 6 C Land under Waferbodres'and Waterways, � , ,�'x F� ,r` ,.„� ` ,,ry ' a square feet b square feet c square feet d rsquare feet Y 1 y dredgeddredged ... ..._,. .. .,.. 5 `� 7.r7j.Bordering Land Subject to Flooding a.square feet b:square feet c.square feet d.square feet Page 2 of 9 *ELECTRONIC COPY Massachusetts Department of Environmental Protection Provided byMassDEP: Bureau of Resource Protection-Wetlands MassDEP File#:003-5084 WPA Form 5- Order of Conditions eDEP Transaction#:567040 Cityffown:BARNSTABLE Massachusetts Wetlands Protection Act M.G.L. c: 131, §40 Cubic Feet Flood Storage e.cubic feet f..cubic feet g.cubic feet h.cubic feet t 8 4C�Isolated Land Subject to Flooding; � � a square feet' b squazefeet ; Culiic Feet Flood Storage c cubic feet d`cubic feet e' cubic feet h f cubic feet . . .: , .,9.Ci Riverfront Area a total sq.feet b.total sq.feet Sq ft within 100 ft c.square feet d.square feet e.square feet f.square feet Sq ft between 100-200 ft g.square feet h.square feet i.square feet j.square feet Coastar esourceArea Impacts, »..r: .. .. ,...; . .,. ... , .1 _... Resource Area Proposed Permitted Proposed Permitted Alteration Alteration Replacement Replacement Designated Port Areas Indicate size under Land Under the Ocean,below 11.1-j Land Under the Ocean a square feet b.square feet c.c/y dredged d.c/y dredged 12:�Bamer Beaches Indicate size under Coastal Beaches and/or Coastal Dunes below 13.❑Coastal Beaches a.square feet b.square feet c.c/y nourishment d.dy nourishment a square feet b square feet c dy nourishment d c!y rgunshmeut 15.❑Coastal Banks a linear feet b.linear feet 16 G'Rocky Intertidal Shores', a'squaze feet b square feet 17.❑Salt Marshes a.square feet b:square feet c.square feet d.square feet 18 I� Land�Under Salt Ponds r ` ` � � '� ' tab a.square fee square feet, r c c/y dredged`d c/y dredged 19.F--j Land Containing Shellfish a square feet b.square feet c.square feet d.square feet _.. .. _....._. ........._ Page 3 of 9*ELECTRONIC COPY Massachusetts Department of Environmental Protection Provided byMassDEP: Bureau of Resource Protection-Wetlands MassDEP File#:003-5084 r` WPA Form 5 - Order of.Conditions eDEP Transaction#:567040 Massachusetts Wetlands Protection Act M.G.L. c.131, §40 City/Iown:BARNSTABLE x Indicate size under:Coastal Banks uiland B`ank;"Land Under the 20 r FnshRuns Ocean,and/or inland Land Under Waterbodies;and Wafervvays, L1 , above �t r 21.❑Land Subject to Coastal Storm Flowage a.square feet b.square feet s C1' Restoration/Enhancement(For Approvals Only) If the project is for the purpose of restoring or enhancing a wetland resource area in addition to the square footage that has been entered in Section B.5.c&d or BITc&d above,please entered the additional amount here. a.square feet of BVW b.square feet of Salt Marsh r Streams Crossing(s) If the project involves Stream Crossings,please enter the number of new stream crossings/number of replacement stream crossings. a.number of new stream crossings b.number of replacement stream crossings C. General Conditions Under Massachusetts Wetlands Protection Act The following conditions are only applicable to Approved projects I. Failure to comply with all conditions stated herein,and with all related statutes and other regulatory measures,shall be deemed cause to revoke or modify this Order, 2. The Order does not grant any property rights or any exclusive privileges;it does not'authorize any injury to private property or invasion of private rights. 3, This Order does not relieve the pennittee or any other person of the necessity of complying with all other applicable federal, state,or local statutes,ordinances,bylaws,or regulations. 4. The work authorized hereunder shall be completed within three years from the date of this Order unless either of the following apply. a.the work is a maintenance dredging project as provided for in the Act;or b.the time for completion has been extended to a specified date more than three years,but less than five years,from the date of issuance.If this Order is intended to be valid for more than three years,the extension date and the special circumstances warranting the extended time period are set forth as a special condition in this Order. 5. This Order may be extended by the issuing authority for one or more periods of up to three years each upon application to the issuing authority at least 30 days prior to the expiration date of the Order. 6. If this Order constitutes an Amended Order of Conditions,this Amended Order of Conditions does not exceed the issuance date of the original Final Order of Conditions. 7. Any fill used in connection with this project shall be clean fill.Any fill shall contain no trash,refuse,rubbish,or debris,including but not limited to lumber,bricks,plaster,wire,lath,paper,cardboard,pipe,tires,ashes,refrigerators,motor vehicles,or parts of any of the foregoing. 8. This Order is not final until all administrative appeal periods from this Order have elapsed,or if such an appeal has been taken, until all proceedings before the Department have been completed. 9. No work shall be undertaken until the Order has become final and then has been recorded in the Registry of Deeds or.the Land Court for the district in which the land is located,within the chain of title of the affected property.In the case of recorded land, Page 4 of 9 *ELECTRONIC COPY i 1 , Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection-Wetlands MassDEP File#:003-5084 f' WPA Form 5 - Order of Conditions eDEP Transaction#:567040 Massachusetts Wetlands Protection.Act M.G.L. c. 131, §40 City/Town:BARNSTABLE the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land upon which the proposed work is to be done.In the case of the registered land,the Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is done.The recording information shall be submitted to the Conservation Commission on the form at the end of this Order,which form must be stamped by the Registry of Deeds, prior to the commencement of work.. 10. A sign shall be displayed at the site not less then two square feet or more than three square feet in.size bearing the words, "Massachusetts Department of Environmental Protection" [or'MassDEP"] File Number:"003-5084" 11. Where the Department of Environmental Protection is requested to issue a Superseding.Order,the Conservation Commission shall be a party to all agency proceedings and hearings before Mass DER 12. Upon completion of the work described herein,the applicant shall submit a Request for Certificate of Compliance(WPA Form 8A)to the Conservation Commission. 13. The work shall conform to the plans and special conditions referenced in this order. 14. Any change to the plans identified in Condition#13 above shall require the applicant to inquire of the Conservation Commission in writing whether the change is significant enough to require the filing of a new Notice of Intent 15. The Agent or members of the Conservation,Commission and the Department of Environmental Protection shalthave the right to enter and inspect the area subject to this Order at reasonable hours to evaluate compliance with the conditions stated in this Order,and may require the submittal of any data deemed necessary by the Conservation Commission or Department for that . evaluation. 16. This Order of Conditions shall apply to any successor in interest or successor in control of the property subject to this Order and to any contractor or other person performing work conditioned by this Order. 17. Prior to the start of work,and if the project involves work.adjacent to a Bordering Vegetated Wetland,the boundary of the wetland in the vicinity of the proposed work area shall be marked by wooden stakes or flagging.Once in place,the wetland boundary markers shall be maintained until a Certificate of Compliance has been issued by the Conservation Commission. 18. All sedimentation barriers shall be maintained in good repair until all disturbed areas have been fully stabilized with vegetation or other means.At no time shall sediments be deposited in a wetland or water body.During construction,the applicant or his/her designee shall inspect the erosion controls on a daily basis and shall remove accumulated sediments as needed.The applicant shall immediately control any erosion problems that occur at the site and shall also immediately notify the Conservation Commission,which reserves the right to require additional erosion and/or damage prevention controls it may deem necessary. Sedimentation barriers shall serve as the limit of work unless another limit of work line has been approved by this Order. NOTICE OF STORMWATER CONTROL AND MAINTENANCE REQUIREMENTS 19. The work associated with this Order(the"Project")is(1) r is not(2)n subject to the Massachusetts Stormwater Standards. If the work is subject to Stormwater Standards,then the project is subject to the following conditions; a) Allwork,including site preparation,land disturbance,construction and redevelopment,shall be implemented in accordance with the construction period pollution prevention and erosion and sedimentation control plan and,if applicable,the: Stormwater Pollution Prevention Plan required by the National Pollutant Discharge Elimination System Construction General Permit as required by Stormwater Standard 8.Construction period erosion,sedimentation and pollution control measures and best management practices(BMPs)shall remain in place until the site is fully stabilized. b) No stormwater runoff may be discharged to the post-construction stormwater BMPs unless and until a Registered Professional Engineer provides a Certification that:i.all construction period BMPs have been removed.or will be removed by a date certain specified in the Certification.For any construction period BMPs intended to be converted to post construction operation for stormwater attenuation,recharge,and/or treatment,the conversion is allowed by the MassDEP Stormwater Handbook BMP specifications and that the BMP has been properly cleaned or prepared for post construction operation, including removal of all construction period sediment trapped in inlet and outlet control structures;ii..as-built final construction. BMP plans are included,signed and stamped by a Registered Professional Engineer,certifying the site is fully stabilized;iii: any illicit discharges to the stormwater management system have been removed;as per the requirements of Stormwater Page 5 of 9 *ELECTRONIC COPY f t Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection-Wetlands MassDEP File#:003-5084 WPA Form 5 - Order of Conditions eDEP Transaction#:567040 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 City/Town:BARNSTABLE Standard 10;iv. all post-construction stormwater BMPs are installed in accordance with the plans(including all planting plans)approved by the issuing authority,and have been inspected to ensure that they are not damaged and that they are in proper working condition;v.any vegetation associated with post-construction BMPs is suitably established to withstand erosion. c) The landowner is responsible for BMP maintenance until the issuing authority is notified that another party has legally assumed responsibility for BMP maintenance.Prior to requesting a Certificate of Compliance,or Partial Certificate of Compliance,the responsible party(defined in General Condition 19(e))shall execute and submit to the issuing authority an Operation and Maintenance Compliance Statement("O&M Statement")for the Stormwater BMPs identifying the party responsible for implementing the stormwater BMP Operation and Maintenance Plan("O&M Plan")and certifying the following:i.)the O&M Plan is complete and will be implemented upon receipt of the Certificate of Compliance,and ii.)the future responsible parties shall be notified,in writing of their ongoing legal responsibility to operate and maintain the stormwater management BMPs and implement the Stormwater Pollution Prevention Plan. d) Post-construction pollution prevention and source control shall be implemented in accordance with the long-term pollution prevention plan section of the approved Stormwater Report and,if applicable,the Stormwater Pollution Prevention Plan required by the National Pollutant Discharge Elimination System Multi-Sector General Permit e) Unless and until another party accepts responsibility,the landowner,or owner of any drainage easement,assumes responsibility for maintaining each BMP.To overcome this presumption,the landowner of the property must submit to the issuing authority a legally binding agreement of record,acceptable to the issuing authority,evidencing that another entity has accepted responsibility for maintaining the BMP,and that the proposed responsible party shall be treated as a permittee for purposes of implementing the requirements of Conditions 19(f)through 19(k)with respect to that BMP.Any failure of the proposed responsible party to implement the requirements of Conditions 19(f)through 19(k)with respect to that BMP shall be a violation of the Order of Conditions or Certificate of Compliance.In the case of stormwater BMPs that are serving more than one lot,the legally binding agreement shall also identify the lots that will be serviced by the stormwater BMPs.A plan and easement deed that grants the responsible party access to perform the required operation and maintenance must be submitted along with the legally binding agreement. f) The responsible party shall operate and maintain all stormwater BMPs in accordance with the design plans,the 0&M Plan, and.the requirements of the Massachusetts Stormwater Handbook. . g). The responsible party shall: 1.Maintain an operation and maintenance log for the last three(3)consecutive calendar years of inspections,repairs, maintenance and/or replacement of the stormwater management system or any part thereof,and disposal(for disposal the log shall indicate the type of material and the disposal location); 2.Make the maintenance log available to MassDEP and the Conservation Commission("Commission")upon request,and 3.Allow members and agents of the MassDEP and the Commission to enter and inspect the site to evaluate and ensure that the responsible party is in compliance with the requirements for each BMP established in the O&M Plan approved by the issuing authority. h) All sediment or other contaminants removed from stormwater BMPs shall be disposed of in accordance with all applicable federal,state,and local laws and regulations. i) Illicit discharges to the.stormwater management system as defined'in 310 CMR 10.04 are prohibited. J) The stormwater management system approved in the Order of Conditions shall not be changed without the prior written approval of the issuing authority. k) Areas designated.as qualifying pervious areas for the purpose of the Low Impact Site Design Credit(as defined in the MassDEP Stormwater Handbook,Volume 3,Chapter 1,Low Impact Development Site Design Credits)shall not be altered without the prior written approval of the issuing authority. IJ Access for maintenance,repair,and/or replacement of BMPs shall not be withheld.Any fencing constructed around stormwater BMPs shall include access gates and shall be at least six inches above grade to allow for wildlife passage. Special Conditions: . Page 6 of 9 *ELECTRONIC COPY Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection-Wetlands MassDEP File#:003-5084 WPA Form 5 - Order of Conditions eDEP Transaction#:567040 r t Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 Cityflown:BARNSTABLE D. Findings Under Municipal Wetlands Bylaw or Ordinance 1. Is a municipal wetlands bylaw or ordinance applicable?0 Yes E-1 No 2• The Conservation Commission hereby(check one that applies a. [ DENIES the proposed work which cannot be conditioned to meet the standards set forth in a municipal ordinance or bylaw specifically: 1.Municipal Ordinance or Bylaw _ 2.Citation Therefore,work on this.project may not go forward unless and until a revised Notice of Intent is submitted which provides measures which are adequate to meet these standards,and a final Order or Conditions is issued.Which are necessary to comply with a municipal ordinance or bylaw: b. r; APPROVES the proposed work,subject to the following additional conditions. 1.Municipal Ordinance orB law TOWN OF 2.Citation S.237-1-237-14 p y BARNSTABLE 3. The Commission orders that all work shall be performed in accordance with the following conditions and with the Notice of Intent referenced above.To the extent that the following conditions modify or differ from the plans,specifications,or other proposals submitted with the Notice of Intent,the conditions shall control. The special conditions relating to municipal ordinance or bylaw are as follows: SEE PAGES 7.1,7.2,AND 7.3 Page 7 of 9 *ELECTRONIC COPY SE3-5084 Name: Fresh Pond Realty Trust,LLC Approved Plan= March 27,2013 Site Plan'(12 sheets) by Matthew Eddy,P.E. Special Conditions of Approval I. Preface Caution: Failure to comply with all Conditions of this Order of Conditions may have serious consequences. The consequence may include: issuance of a Stop Work Order; fines; requirement to remove un-permitted structures; requirement to re-landscape to original condition; inability to obtain a Certificate of Compliance,. and more. The General Conditions of this Order begin on Page 5 and continue through Page 8. The Special Conditions contained herein and all Conditions require your compliance. II. Prior to the start of work,the following conditions shall be satisfied: 1. Within one month of receipt of this Order of Conditions and prior to the commencement of any work approved herein,General Condition Number 9(recording requirement)shall be complied with. 2. It is the responsibility of the applicant,the owner and/or successor(s) and the project contractors to ensure that all conditions of this Order are complied with. The applicant shall provide copies of the Order of Conditions and approved plans(and any approved revisions thereof)to project contractors prior to the start of work. Barnstable Conservation Commission Forms A and B shall be completed and returned to the Commission prior to the start of work. 3. General Condition Number 10(sign requirement)shall be complied with. 4. The Conservation Commission shall receive written notice one(1)week in advance of the start of work. 5. The work-limit line shown on the approved plan shall be staked in the field by the project surveyor/engineer. 6. Staked strawbales backed by trenched-in siltation fencing shall be set along the approved work-limit line. Effective sediment controls shall remain until the site is stabilized with vegetation,then they shall be . removed. 7.1 7. A sequence of color photographs showing the undisturbed buffer zone shall be submitted to-the Conservation Commission. Note: the strawbales and siltation fence must show in the foreground (or bottom of the photographs. ffi. The following additional Conditions shall govern the project once work begins. Note, especially,Special Condition Number 15, requiring verification of the locations of the foundation and strawbale line. 8. General Conditions,Numbers 14 and 15 (changes in plan)shall be complied with. 9. General Condition Number 18 (maintaining sediment controls)shall be complied with. 10. The work limit shown on the approved plan shall be strictly observed. 11. There shall be no disturbance of the site, including cutting of vegetation,below(on the pond side of)the work limit. This condition 'shall continue over.time. 12. The Conservation Commission, its employees and its agents shall.have a right of entry to inspect for compliance the provisions of this Order of Conditions. 13. Unless extended,this permit is valid for three years from the date of issuance. 14. All work shall conform with the approved plans and the notes thereon.. 15. Upon completion of the foundation,the project surveyor or engineer shall verify in writing or by plan to the Commission the correct-location of the foundation and work-limit line, and note any discrepancies from the approved plan. If verification.is in the form of an"as-built'plan,the plan provided shall be drawn at the same scale as the approved plan. 16. Any fill used for this project shall be clean fill. Fill shall contain no trash,refuse,rubbish, or debris. 17. Drywells or graveled trenches along the drip lines shall be installed to accommodate roof-runoff. 18. During construction,no area shall be left un-mulched or un-vegetated for more than thirty(30)days. All areas disturbed during construction shall be re-vegetated immediately following completion of work at the site. Mulching shall not serve as a substitute for the requirement to re-vegetate disturbed areas at the conclusion of work 19. All proposed lawn areas shall be underlain with a minimum of six(6)inches of loam. 20. Herbicide,pesticide and fertilizer use is discouraged on lawns within Conservation Commission jurisdiction. If fertilizer must be used,only slow-release low-nitrogen(with 30-50%water insoluble nitrogen or`W.I.N') and low-phosphorus fertilizers shall be applied. Over-fertilizing shall be avoided 7.2 (not-to-exceed limit= 1 pound of nitrogen per 1,000 sq. ft. of lawn per application). No fertilizer shall be spread on hard surfaces such as driveways and sidewalks. 21. Work limit markers(wood stakes)shall remain in place until a Certificate of Compliance is issued for this proj ect. 22. A half-rail fence(or approved alternative)shall be constructed and maintained along the work-limit line. IV. After all work is completed,the following condition must be promptly met: 23. At the completion of work, or by the expiration of this Order,the applicant shall request in writing a Certificate of Compliance for the work herein permitted. Barnstable Conservation Commission Form C shall be completed and returned,along with the request for a Certificate of Compliance and appropriate fee. Where a project has been completed in accordance with plans stamped by a registered professional engineer, architect,.landscape architect or land surveyor, a written statement by such a professional shall be submitted,certifying substantial compliance with the plans,setting forth what deviation(s), if any,exists with the record plans approved in the Order. This statement shall accompany the request for a Certificate of Compliance and fee, along with an updated sequence of color photographs of the undisturbed buffer zone. t 7.3 Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection -Wetlands SE3- _50 y. �/ MassDEP File# Ll WPA Form 5 — Order of Conditions Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 eDEP Transaction# Barnstable City/Town E. Signatures r Important: This Order is valid for three years, unless otherwise specified as a special MAY a 0 -701� When filling out condition purtuant to General Conditions#4,from the date of issuance. 1.Date of issuance forms on the computer,use Please indicate the number of members who will sign this form. only the tab key This Order must be signed by a majority of the Conservation Commission. 2.Number of Signers to move your cursor-do.not The.Order must be mailed by certified mail (return receipt requested) or hand delivered to use the return the applicant..A copy must be mailed, hand delivered or filed electronically at the same key. time with the appropriate MassDEP Regional Office. Si . by hand delivery on ❑ by certified mail, return receipt requested,on MAY 3.0.2013 Date Date F. Appeals The applicant, the owner, any person aggrieved by this Order, any owner of land abutting the land subject to this Order, or any ten residents of the city or town in which such land is; located, are hereby notified of their right to request the appropriate MassDEP Regional Office to issue a Superseding Order of Conditions.The request must be made by certified mail or hand delivery to the Department, with the appropriate filing fee and a completed . Request of Departmental Action Fee Transmittal Form, as provided in 310 CMR 10.03(7) within.ten business days from the date of issuance of this Order. A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission:and to the applicant, if he/she is not the appellant. Any appellants seeking to appeal the Department's Superseding Order associated with this appeal will be required to demonstrate prior participation in the review of this project. Previous , participation in the permit proceeding means the submission of written information to the Conservation Commission prior to the close of the public hearing, requesting a Superseding Order, or providing written information to the Department prior to issuance of a Superseding Order. The request shall state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act(M.G.L. c. 131, §40), and is inconsistent with the wetlands regulations (310 CMR 10.00). To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or regulations, the Department has no appellate jurisdiction. P PP J wpa5sigs.doc- rev.02/25/2010 Page Oef P Massachusetts Department of Environmental Protection Provided by MassDEP: Bureau of Resource Protection-Wetlands MassDEP File#:003-5084 WPA Form 5 - Order of Conditions City/Town:BARNS eDEP Transaction#:567040 TABLE - t Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 E. Signatures This Order is valid for three years from the date of issuance,unless otherwise specified 5/30/2013 pursuant to General Condition#4.If this is an Amended Order of Conditions,the Amended 1.Date of Original Order Order expires on the same date as the original Order of Cgnditions. Please indicate the number of members who will sign this form.This Order must be signed by 6 a majority of the Conservation Commission. 2.Number of Signers The Order must be mailed by certified mail(return receipt requested)or hand delivered to the applicant.A copy also must be mailed or hand delivered at the same time to the appropriate Department of Environmental Protection Regional Office,if not filing electronically,and the property owner,if different from applicant. Signatures: SCOTT BLAZIS DENNIS R.HOULE LAURENCE MORIN FAT PIU(TOM)LEE LOUISE R,FOSTER PETER SAMPOU 17,11 by hand delivery on ❑by certified mail,return receipt requested,on Date Date F. Appeals The applicant,the owner,any person aggrieved by this Order,any owner of land abutting the land subject to this Order,or any ten residents of the city or town in which such land is located,are hereby notified of their right to request the appropriate MassDEP Regional Office to issue a Superseding Order of Conditions.The request must be made by certified mail or hand delivery to the Department,with the appropriate filing fee and a completed Request for Departmental'Action Fee Transmittal Form,as provided in 310 CMR 10.03(7)within ten business days from the date of issuance of this Order.A copy of the request shall at the same time be sent by certified mail or hand delivery to the Conservation Commission and to the applicant,if he/she is not the appellant Any appellants seeldng to appeal the Department's Superseding Order associated with this appeal will be required to demonstrate prior . participation in the review of this project Previous participation in the permit proceeding means the submission of written information to the Conservation Commission prior to the close of the public hearing,requesting a Superseding Order,.or providing written information to the Department prior to issuance of a Superseding Order. The request shall state clearly and concisely the objections to the Order which is being appealed and how the Order does not contribute to the protection of the interests identified in the Massachusetts Wetlands Protection Act(M.G.L.c. 131,§40),and is o inconsistent with the wetlands regulations(310 CMR 10.00).To the extent that the Order is based on a municipal ordinance or bylaw, and not on the Massachusetts Wetlands Protection Act or regulations,the Department has no appellate jurisdiction. Page 8 of 9 *ELECTRONIC COPY Massachusetts D&partment of Environmental Protection _ Provided by MassDEP: Bureau of Resource Protection-Wetlands MassDEP File.#:003-5084 r' WPA Form 5 - Order of Conditions eDEP Transaction#:567040 Massachusetts Wetlands Protection Act M.G.L. c. 131, §40 City/Town:BARNSTABLE G. Recording Information This Order of Conditions must be recorded in the Registry of Deeds or the Land Court for the district in which the land is located, within the chain of title of the affected property.In the case of recorded land,the Final Order shall also be noted in the Registry's Grantor Index under the name of the owner of the land subject to the Order.In the case of registered land,this Order shall also be noted on the Land Court Certificate of Title of the owner of the land subject to the Order of Conditions.The recording information on this page shall be submitted to the Conservation Commission listed below. BARNSTABLE Conservation Commission Detach on dotted line,have stamped by the Registry of Deeds and submit to the Conservation Commission. .......................................................................................................................................................................................................... To: BARNSTABLE Conservation Commission Please be advised that the Order of Conditions for the Project at 189 ATTUCKS LANE 003-5084 Project Location MassDEP File Number Has been recorded at the Registry of Deeds of ti County Book Page for. Property Owner and has been noted in the chain of title of the affected property in: Book Page In accordance with the Order of Conditions issued on: Date If recorded land,the instrument number identifying this transaction is: Instrument Number If registered land,the document number identifying this transaction is: Document Number Signature of Applicant Rm 4nr2010 Page 9 of 9 *ELECTRONIC COPY I ToRENAN - roBRNO)NWD� O M E D CO M' • emrWO DOON - C-P' ']) B'-2}A 10'- ,�• te'- 14' mRDYaI ) ARCHITECTURAL GROUP Sy' 1 17-2 10'-1 ME0IGLSCOMMERCALARCHRERURE NIA•P FXBi.COIUWI D®t.k-BRMniG IOGTroI MR•P DET.COIiAo1 MM w NEIA.Br iLVE MA xFYIL AS gDSE 10 - MITI S bYP.ON RoaE Beume,MA Oi5Ti YS r IETK Snn 4-) b A6 PO.59BLL - ]-3 YerK tTui P�O.Baa 15i Mmunat Beaty IMOiss3 NN 7C.-ITE,R,, 3 - D i.k-BMCYC 3El 11-i55 . TT9. CLEAN ® ( ,a ^ AFs 4-)/Sb r®E III MEPcoMAaEN mM • SPECML NS 9.F. `CC,�++`'' 0E fpGry npCOMAci.GREGORY51RO0Mnx sY.? . ® ®INEM'� aF.iye ® Dii DrtCQRMOON n S.F. ! 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BOM SIDES.ERpI FLOOR BIAS FIDOR SUB 10 U.S.DECIK ABWE B(MRp.EROY BOOR SLAB TO DECK j°BME NG ro 6!L DECK ABOVE CAPE COD HEALTHCARE CA A DNG •�//� SOFS cNlllaMO 801119D6 � _ dCar Fit-up R—bilitatim Services Flrst . -I .. 9TG%RATED _ __RATED *wn/uM $ILLS RATED SOS Attucks Lane 1 HaR RIRED WALL TYPE g4 WALL TYPE B5 WALL TYPE !1 WALL TYPE Y3 HYannis,MA EXISTING WALL �)tn•�1'd WALL TYPE I2 IIOAc''n•-''d ,,n,rd 11nEe,,K_,.�• . � RESTROOM LEGEND AND WALL ACCESSORIES SEE RORE Pull DLVEE - TOP -FBDLOS OR SAI 12'FROII COAT _ OIFA rolFi- TOVAL roFROM Cr FRO. VE SIDE SIDE eowL FwsM � I ®® / rd FROTrt mE rDE E .R twY torw a. FRaRr SIDE I FRONT mE � p Q ®® I k NLY O OB © OrO © ` OGO 01 ON © OY © ® ® (D OD OY OW OE tiArr �ua GRAB BARS TdIET"PER PAPER TOrFl 1NI31 fWSH-VALVE CMT MOON BNaENFf NI:RBK AMERf/M DTY) ,MNpwAtT,FABCEI �� 1WIp:NASH Sb1K DISPERSER aSPENSp aVNE FWME PUTS RECEPTADIE CHASE-LOOMED D6FOSVL RIE7>DwR IAVOORi O,K.,60 FNICEIS FLU H-HM SIN( OIBIEBWf SAlIRRER BROp_W -TTNN�X� NONIFR� LOCNp� DECK-LKIUIfIED Al"lo :V """R `t INNt6/D19 BD9aOF DO,St RESPONaR GIASS MRROR Bo.tcx - YIAIER CIOBEF A9-DOD q,q F KOHIFA MPEIKiE" CC,,G 116FALID EIXAY WEI)20 EIXAY full 1 RpMA✓WNL wawa EYpA91 QLL+R s.E - S- IYBB A1rL C.G EGaLLEO iH aG ANB FAUCET'L' \ Td CIEN rd aFM Yd O1F/R Wd C1FM Sd aFM Yd - .Yd rd AFAR o ' TAE TO TOE TO RESTROOM GENERAL NOTES 6 nIE ro 1D'AFr. nLE TD u•—F. No- TILE - 'd AB'AF.F, ro Q. OM IREI, TEE ro/S' ,Iq[1�J �1/*� V!y@�.i�6 ')s ® IETAL ArF.r ® rAU. A.FFTFYO m"KF' .� T rpAll a-D BEfO3AESO.ffimlBEIIEIOS \ .•+ BC3tlTRNE, ,+>a TPoM „ -® A WE C O)F CWE STATE OLL ACDLLVXT HYSAR YIIM THE AfA,v,S%iEEL BY✓H06 \s;; Y y- _ ,• r , % M BONG 4N87 TOR THE STATE OF YL9YCIAAEIis IRO TIE AKD VIBURE 71MT iM6 .7 .) .� AClll'I WILL BE IC®BlE lME FDIICWINC 6 A (Apt PMBIK�ISF OF RDGAPEII[NR ����sJ��nn 'b • T f, _ 1' ALL 00010 1NL Il1K A YMMUY Q<1 d CIFIA ON nE t/01R1 • I b � b b q :...� 1 b (PIED SIDE 6 THE DDOTL vd�'-0 _ q _ \ - b .�.$ - \ �. DaDR wTs AND THM6EOID3 TD BE A MAmlw a 1/Y Mlwl _ y H {IIIt: w MAItUYNE 9HY1 E YaIIIED BEIIYFDI]D'NID.E•ABDIE NCDIt TTT 1.Try DOORS TO ILVMBdH NEA9 TO HYE KINRIID IMMgE3. !; RESTROOM ELEVATION Al RESTROOM ELEVATION A2 RESTROOM ELEVATION A3 RESTROOM-ELEVATION A4 RESTROOM ELEVATION AlRESTROOM-ELEVATION R7 RESTROOM ELEVATION R3 RESTROOM ELEVATION B4 D• row"+ ttwc IN'-r� ttt»tH•-to mLC Vt-Ve rYc tK-ra .,,c t/r.r0 tuc VT-ts• oc tK-V-r A UYAroRY ro I,pE IOTA 111NDIE6 aR 6>NmEO fIBCEIs. ' . - - a A COAT MDDK M'ABOVE TXE i1DIM rRl BE YDIIYIFD Qt 1HE Btl1f fi� I' . OF WE IILIOKNRED STA.DOOR D'd r-d)5• Sd ram(,' } a IDUTe THe wAtp 1.a�y. 0.nsiT e•rnoY M amp arc aP ra rams - �� TD ro THE WAIL. TIE SEAT HlL BE Ir TO lo•IBaT THE neOR ro �ISSUED FOR PERMIT ' T!E TDP of THE SEAT. OlE F M'AFr. AB'ALr. ON M'R a 1 1/2-TWO u•IDnEc N 1 1 XE salsa OMIETEn PmED arrAB TILIS, February 9,2015 d 1 D f I WE WALL WDN NE BFOEND RK CNCR. r FROM TIE rWl. 14' HALL AMAOYE FMV WEro HnI1CIDSETATlYFptIHEFIIII.JO•PNMILELPETAL TIE TO AB•THY10 AMD ABOY£n1E E UM1tliY ro E YpIH1p].'ABOVE TIE FDAOIED ii110R ro HY YTT1,NNFE . : ,. y i, b b 9PKE DF]D'1x Wmx.ND ZY 0I IEIOrt. DH01LL YRRDR W'ABOVE WE FM ED FIDOR(TO BMW Aic n-ro TOP: b G DISPpSEAS TO BE NOLRIIED A MANYUM OF Ir ABO.E WE RDOR ro All OPDMTIKG a 06Fo®Ic SIDES 1L m,Er FAPp 1aFotsoo YDIAv1m xe•ro mnp inE Atlox T1e FLnaa. - WALL TYPES, 1 + RESTROOM DETAILS, RESTROOM ELEVATION C1 RESTROOM ELEVATION 02 RESTROOM ELEVATION O REMOOM ELEVATION C4 AND ELEVATIONS tuR tN'-fd ECIFICATION tKRR tn•-t•� ».A V�-Y.• tlwR Vr-.t•e Pwg2•Va lA .IM RrvtmLM I O --)0 lw w fbTln l A—tgD ted H1%wALm4 a9-1PYYWw ) DATE IEW�IgI IA0Ke1.An note.18. ]D Eacn Fr.nw M IY t, . •((Tl'»n p1Y YRPL) E 1S tSSOE FOR PE1MIrt . IAdm.L01 b.wllttv,b DID!®(2)tASs wib Iwr - IOBrVL . r ,n 2/09/15 WAM of. JP aimGBS . 1. DMTi ILtlBi A1 .2 f t TOWN OF BARNSTABLE d 4 r t General Notes: 1" GLOBE This drawing is intended to show the general arrangement and VALVE extent of work to be done. The locations given are approximate 22 WASS UPRIGHT SPen a.Ex 1" PLUG and are subject to modifications as may be found necessary le M DRY SYSTEM > „R. �,,,,N„ f DRAIN to meet any structural or job conditions. The fire protection contractor is to visit r EXTRA HEAVY WISE NIPPLE I'XI/2'REDO m�n+G quaff on (I°"W" FROM END OF SYSTEM CAPACITY 395.16 GAL MODEL 5OK14—IT OR EQUAL axe-a�w 3/4 HP AUTOMATIC AIR COMPRESSOR the lob site to verify all dimensions and job I'NIPPLE ,wts� AN HLIN � WITH LOW AIR SWn conditions. i'T► E"��°" \ I'TMtE^°ED TEE SMOOTH BORE G CORROSION RESISTANT All pipe dimensions shown on this drawing are approximate and the r EXTRA WAVY CLOSE NIPPLE -1�� EXTERIOR WALL fire protection contractor is to verify all dimensions. ''aw" IIRANCR LINE __3111113.111111 All work to be comply with the Massachusetts State Building Code REDUCING COUPLING RE M a�I'DawT SPRM-ER �,�, '�°`"� OUTLET GIVING FLOW Eighth Edition and the latest NFPA 13 Standards. EQUIVALENT TO ONE FULL FLOW TEST VALVE: 365.89 GPM g # ,���/ SPRINKLER � 6" DRY VALVE W/TRIM CAPPROVED BACKFLOW PREVENTOR All pipe 21/2 and larger to be schedule #10. All pipe smaller than 21/2 SUSPM"c SYSTEM st- 1. UNION W/� 4 TO FIRE DEPT CONN 21/2� VALVE W/LOW PRESSURE SWITCH to be galvanized 1/2" RESTRICTED 45' GALV. 2V2�ELL s OS&Y W/TAMPER SWITCH All hangers and attachments to be as per the latest NFPA #13 standards. t>� nr�>o e ORIFICE ELBOW Sprinkler head temperatures to be as specified or verify with job conditions. elocate/replace DRAM Recessed sprinkler heads in all suspended ceilings to be centered in tile. " Sprinkler sub-contractor shall be responsible for field coordination of all sprinkler NOTE: Note: ti minimize condensation of water in the drop to the test 4 CHECK VAL P P P connection, provide anipple-up off of the branchline. NDERGROUND head locations With mechanical and electrical trades. LOCATE HEADS ABOVE AND BELOW DRY TEST CONNECTION (PER NFPA 13) 71-71-77 Sprinkler sub-contractor shall prepare shop drawings for review and approval of IN ALL CONCEALED COMBUSTIBLE SPACES NOT TO SCAE BACKFLOW & SPRINKLER RISER DETAIL Architect. Shop drawings shall show the location of all sprinkler heads,mechanical NTS ducts,diffusers and electrical light fixtures. DRY INSPECTORS TEST OWNER TO PROVIDE SUFFICIENT HEAT ABOVE CEILINGS TO MAINTAIN 40°. 1 2 3 4 5 6 7 8 9 17' 17' 18"-0" 17' 17' 18'-0" 17' 17' re oca a jrep ace a oca a rep ace w hi h tem . whihtem relocate/replace] re oca a rep ace whihtem . whihtem . - - - _- .. err.» - - - - - - - t1z t•1 1 t 1 t/ _• t/2„ A :. 1,- .i " ____. INSTAL[ LO`�' �""01 _ E -P„ _ DECK I Y c m e e c °-� '„ •• replace re oca a(replace M RO? D!� 112 ER I whihtem . re oca a replace I /2 __ t7 2 t t " 1'V2 t " 2 /Ze oca e 1 1/2 t whih tem . — Q- 7 - ---�.1 ' �� re oca a rep ac om Pc c _ . - ,.��. i whihtem - a�.._, 3 - c e• RANDWASH =' w hi r oda a rep c `} eloca a re�ra N w"hi h temp. _ re oca a replace ; r> re oca replace o' � c : - c illy i 1 whih tam . w hiht - _ *UP fE) elo at a lac i l 1/2" t f 1 1/2, / 1 V2. c " t - _ I i2 2 11 PC e•-v i c, s ' C O - P 3 ET Fr-elocate ra a oca I e ce e at . re a e R Roy w hi h a hinh R DOR j R i CI r ___ Ct ff re oc @ , _K R t c e m n �, lw/hi6h : t 1 2 1 la �, 1 /2 ,�: rGt.: 1 z" n s TM re oca a rep a �� •�- M P. C7 Y� relocate I R oca r pla a x W - RI�R N p e s NEW O '-0- C 0• .�� I •. Y. -- R re oca - f@I .. <.r.' t N c,P. W I D .-0. .. _ e rep ace w hl temp, I C, e high.f m tF yy,a._. 1•/ 1 /2" r, _0' t 2" r,l. 2 t . yii C, 9 ' w} i h RR ..: :. --- - @ I EAT. e FE _ J - ..�'»•` ' •. ': :-'1'Dhl KING WA1ER -: _ relocate rep ace c w h to relocate/rep re C �AnENrtocK whihtem . -` R �, � w Ihtm . - . re lace w hi h tem . t t " t „ w/high temp,T " ® w 'hi tem 1 tJ2" 11/2" P 1�/2„ _ so" relocate replace SINK ., . reI ate re lac II I�—II I _- - - _= - - -- 3 : ' .DREA,, r w ern - `` - . Jam- - --. �/h gh mp. : :. C�1 I ct tr ar _ .. WOK TI N Z. -.-. :..: - o ,M 1 - z LOCATE HEADS ABOVE AND BELOW ; „ „ ali� e :t;! dAFF � 5..�. p IN ALL CONCEALED COMBUST BLE SPACES „ 1/2 1 t/ .--!t!-- �r �� I��� _ SPACING TO CONFORM TO N PA-13 LIGHT -, �, >a'-s ® " HAZARD STANDARDS - -.__ SPRINKLER ROO D n I ELECTRICAL _ v�� I , 04 ROOM �0 C) JAMES N. ��yG I MCHU ca UGH R, 6" BACFLOW/RISEF? _ ; ; FIRE PROTECTION 6" DRY VALVE �J o NO.3857 N P 4" FIRE DEPT CONN ,, `-------------' -- J ' t/2" BALL DRIP r/r = relocate/replace ------------ rR ' ---- --E7fIS,Y1G EYER(:flJCY L•'r.i0l? "• yI 01 DOWNUW IN CANOPY ELECTRIC BELL w/high temp. ���,V WATER MOTOR GONG TYPE AND LOCATION TO BE APPROVED BY HYANNIS F.D. REVISED 4/3/ 15 HYDRAULIC DESIGN DATA CONTRACTOR: MASS FIRE PREVENTION SPRINKLER SCHEDULE & LEGEND CALCULATION # 1 CALCULATION # 2 CALCULATION 3 S 50L SPRINKLER DESCRIPTION ORIFICE 'K" TEMP. FINISH QTY. J B ENGINEERING OFFICE BUILDING NORTH Hazard Class. OQ OR RECESSED PENDENT 1 2 5.6 155 CHR 92 96 RESERVOIR PARK DRIVE z Hazard Class. ADDRESS: 96 RESERVOIR PARK DRIVE ROCKLAND MA 02370 ROCKLAND, MA 02370 905 ATTUCKS LANE HYANNIS O OR UPRIGHT 1 2 5.6 155 BRAS 6 781-871-8277 DESIGNER TRACY BJORKLUND System Type WET WET WET REVISION DensityGPM i GPM 10 GPM i I9 OR UPRIGHT , 2 5.6 212 BRASS SPRINKLER SYSTEM Calculated Area DATE DESCRIPTION �" S Reliable Quick Reson a New 1 2 5.6 noted Chr 110 SCALE Area per S rinkler a CHECK BY JAMES N. MCHUGH Demand GPM® Psi GPM® Psi GPM® Psi FLOW TEST INFO: Firepump: GPM® Psi Dote: Time: Test By: MASS FIRE PREVENTION FILE NUMBER 13-209 Location: IMPORTANT APPROVAL HYANNIS FD Orifice Size No of- Outlet Pitot Press Psi Static Psi Residual Psi Flow GPM U G Pi e:1 00 TO PREVENT FREEZING OF WATER IN WET PIPE SPRINKLER PIPING, I DATE 12/20/13 2 FtJ OWNERS TO PROVIDE SUFFICIENT HEAT THROUGHOUT AREAS WHERE HEAD CAB'T & WRENCH ES PROVIDED TOTAL COUNT THIS SHEET = 96 RESERVOIR PARK DRIVE ROCKLAND MA 02370 SEAL MUST TO BE VAUDGNED AND DATED L-3SAFETY PSI SPRINKLER PIPES ARE INSTALLED, UNLESS AN ANTI-FREEZE SYSTEM. FlreAcad Design Software 8 n,r"-FERING DRAWING NO. Sp- 1 PHONE 781-871-013t FAX 781-878-4799 General Notes: 1" GLOBE This drawing is intended to show the general arrangement and VALVE extent of work to be done. The locations given are approximate nRASS u 1" PLUG I' TO DRY SYSTEM and are subject to modifications as may be found necessary „ 2" DRAIN to meet an structural or job conditions. The fire protection contractor is t0 visit I'EXTRA HEAVY CLOSE NIPPLE '—IXI/F���M unNff I'0"'•` Oak i 6 FROM END OF SYSTEM CAPACITY 395.18 GAL. Y I MODEL 5OK14-1T OR EQUAL P NIPPLE ,w,s•a BRANCHLINE ti 3/4 HP AUTOMATIC AIR COMPRESSOR the lob site to verify all dimensions and job =C_aAw WITH Low AIR swn conditions. I•THREAnEn aBly 1•rN�1EAnEn TEE aw SMOOTH CORROSIONRE RESISTANT All pipe dimensions shown on this drawing are approximate and the I•EXTRA WAVY POSE NIPPLE -1 b IIE ,�mmm 9mcam EXTERIOR WALL fire protection contractor is to verify all dimensions. I'DROP NICE — 11IE —1=No ;�,� All work to be comply with the Massachusetts State Building Code I•xvr °�'„� 9no„9� 9,ae•R FLOW p y 9 REDUCING COUPLING_ �� a Pramarr sw 011®t � w 111110 OUTLET U TLE EQUIVALENT GIVING ON E FULL FLOW TEST VALVE: 365.89 GPM Eighth Edition and the latest NFPA #13 Standards. 6" DRY VALVE W TRIM All pipe 21/2 and larger to be schedule 10. All pipe smaller than 21/2 um SPRINKLER / 6"APPROVED BACKFLOW PREVENTOR P P g # p•p SUSPENDED asmG SYSTEM � 1" UNION W/ 4 TO FIRE DEPT CONN 21/2' VALVE W/LOW PRESSURE SWITCH to be galvanized 1/2" RESTRICTED 21/2"ELL 6" OS&Y W/TAMPER SWITCH >� I �' ORIFICE 45' All hangers and attachments to be as per the latest NFPA #13 standards. �:. �:i/tr,9 ��. ELBOW Sprinkler head temperatures to be as specified or verify with job conditions. I E r"` IN= relocate/replace DRAM Recessed sprinkler heads in all suspended ceilings to be centered in tile. an Sprinkler sub-contractor shall be responsible for field coordination of all sprinkler NOTE: Note: To minimize condensation of water in the drop to the test , CHECK VALV P P p connection, provide a nipple-up off of the branchline. NDERGROUND head locations with mechanical and electrical trades. LOCATE HEADS ABOVE AND BELOW PIPE HANGERS FROM BOTTOM OF BEAM,PURLIN OR TRUF� DRY TEST CONNECTION (PER NFPA 13) Sprinkler sub-contractor shall prepare shop drawings for review and approval of IN ALL CONCEALED COMBUSTIBLE SPACES BACKFLOW & SPRINKLER RISER DETAIL Architect. Shop drawings shall show the location of all sprinkler heads,mechanical NTS ducts,diffusers and electrical light fixtures. DRY INSPECTORS TEST OWNER TO PROVIDE SUFFICIENT HEAT ABOVE CEILINGS TO MAINTAIN 40°. 1 2 3 4 5 6 7 8 9 17' 17' 18'-0" 17' 17 18'-0" 17' 17' re oca a rep ace hi 'to re oca a rep ace w hi h temp. re oca a pace relocate/replace w hl to � w hi h tem . cc� re - - - - A�-- - w hi #em t 11/2 1 " L LOW POINT DRAIR E -w - ER, DE K d _ eloc to re lac relocate/rep ace 4 • 1 °°" /2 P reloca a replace 1 12 2 L /2 11/a" 11!2" w hi h temp. 1w/hiah tem . - 1 `2 cl •-d MA'n re oca a...r a Pc c - -— _*_ ..- t .._ J 3 oca e'4re w, 7�•j Y - Bloc T ww°wASH hihtem . d � °' w hi Ilte N p c a e/repla N relocate rep ace °' -d hi h temp. c main T - e rep a w hihtemCI _> r elocate lac 1/2" IP- -i..... 9 i dl I Y:�- 2 t o �, , c C1 9 d C ® PC 1relocate/rep ace l ° R °t w/high_tem - e dca a re a e R�:g re oca a rep ace ._ • wr w kti h 1w/hiah tem _° coR DOR 4L'W •4LW R ct _ 9 d - �- � _ re oca e ; 9•-� C- \ -. cte ma' cte main I �, a d W hi h 2 1t 1 i re oca ace I n s - TM W hi = m 0 91 M 9_111.1 A ON pl N s cote replace -- — w2 °R — yr810 8 rep a N�tv .�. • d am„\F. c 9 N crv. i fi tem -- remove R ooM felo D re oca a rep ace MV re M ' - n c, a lbw hih ,. : 1 2• r. "�- „ Y CAT CI t 2" r I •1" t _ n • i:I i w iht -- - I • RRI @ _ _ r_I T remove >== e J ct C _ �'.0 `1n 'DESIGNATED i :. r@lac` W NG .r~ r ' rep ace w h to relocate reel c ': ; - _ _�� - .4011 NC �� tOCKE S -SPACE_ 1 relbMw/ t 9-d R .._-� •-1-- 9 P "" re ca F�ATtENT 1oGK w fii h tem �t ® , w high tem T _ r lace w high tem . /h $" 7 - w hi #e >. P / -- --- _ /2 1 2 2 I ,c _ -REw b'ra.soFtTr� . wQ ' rO ' R Ct 8' We I .._-._ :Of . �C felooate -- - _ _ - _. lac ' I "—" ' °- - - - - - rielocat eplace— M - w hi h tem - ire w/high imp. N r, "r INS LOCATE HEADS ABOVE AND ELOW ® ° -+- 1 1 ,iIGR ab aeARD.,,r VAFF 1/2 •1/ •1/2 Ct 9' Z ^ ____„_ 1 t/�1� I I t/„„ t q ROOF 1'R165t3'..� IN ALL CONCEALED COMBUST BLE SPACES — - `, t I , 1 / ""° _ SPACING TO CONFORM TO N PA-13 LIGHT ,f ;M' C, 9•-6, 4L 4�W, LW;;R HAZARD STANDARDS I ' _ T SPRINKLER I ROOM ELECTRICAL ° .: . p_77 Ll I Oti Of n U D -.__ --- ROOM I_ q - � I 1 � II �� FIRE PR HUGH +� r I PROTE t;'±' 6" BACFLOW/RISER N0.OT 2TION cJ j 6' DRY VALVE f �Jc �, 1 4" FIRE DEPT CONN '`FS` �st11F'° i`--------------- -------- 1 r r = relocate re lace --------- /z BALL DRIP / / P Q `-DOWN"°D"� ND R ELECTRIC BELL w/high temp. "01 DDWlAJ E 9,cn ;i WATER MOTOR GONG TYPE AND LOCATION TO BE APPROVED BY HYANNIS F.D. _ REVISED 4/3/ 15 HYDRAULIC DESIGN DATA CONTRACTOR: MASS FIRE PREVENTION SPRINKLER SCHEDULE & LEGEND CALCULATION # 1 CALCULATION # 2 CALCULATION 3 SYMBOL SPRINKLER DESCRIPTION ORIFICE "K' TEMP. nNISH QTY. J B ENGINEERING OFFICE BUILDING NORTH Z Hazard Class. 96 RESERVOIR PARK DRIVE ADDRESS: 96 RESERVOIR PARK DRIVE ROCKLAND MA 02370 O QR RECESSED PENDENT 1 2 5.6 155 CHR 92 Hazard Class. ROCKLAND, MA 02370 905 ATTUCKS LANE HYANNIS System Type WET WET WET REVISION O QR UPRIGHT 1 2 5.6 155 BRAS 6 781-871-8277 DESIGNER TRACY BJORKLUND DensityGPM 10 GPM * GPM 0 QR UPRIGHT , 2 5.6 212 BRAS SPRINKLER SYSTEM Calculated Area 10 � DATE DESCRIPTION BY SCALE 1 8" =1' � Reliable Quick Reson a New 1 2 5.6 noted Chr 110 f' Area per Sprinkler ro Ip e CHECK BY JAMES N. MCHUGH Demand GPM® Psi GPM® Psi GPM® Psi FLOW TEST INFO: Firepump: GPM® Psi Date: Time: Test By: MASS FIRE PREVENTION FILE NUMBER 13-209 Location: APPROVAL HYANNIS FD Orifice Size No of Outlet Pitot Press Psi Static Psi Residual Psi Flow GPM U G Pipe: IMPORTANT 1 1 1 1 00 TO PREVENT FREEZING OF WATER IN WET PIPE SPRINKLER PIPING, DATE 12/20/13 SEAL MUST BE SIGNED AND DATED 2 Ft OWNERS TO PROVIDE SUFFICIENT HEAT THROUGHOUT AREAS WHERE HEAD CAB'T & WRENCH ES PROVIDED TOTAL COUNT THIS SHEET = 96 RESERVOIR PARK DRIVE ROCKLAND MA 02370 TO BE VAUD 3 SAFETY PSI SPRINKLER PIPES ARE INSTALLED, UNLESS AN ANTI-FREEZE SYSTEM. FireAcad Design Software JBENGRIEERING PHONE 781-871-0131 FAX 781-878-4799 DRAWING NO. SP- 1 TiUCKS BAXTER NYE ENGINEERING & Tarr Locus SURVEYING oQ v Registered Professional Engineers L�Z and Land Surveyors 78 North Street -- 3rd Floor Hyannis, Massachusetts 02601 Bdh , tom""" BVW 11 = fnd) .S�82�, F '�'G� Phone - (508) 771-7502 Fax - (508) 771-7622 1i,1,��s9 www.boxter-nye.com BVW 10 l / LOCUS MAP SCALE. NOT TO SCALE # AA�D A �o STAMP STAMP P 294 PARCEL 79 7 r 4 AM R h�ti -BVW 9 N/F 155 ATTUCKS WAY REALTY TRUST DEED BOOK 24166 PAGE 179 4P N. 41t4 LOT 8 - PLAN BOOK 408 PAGE 80 RECORD OWNER: FRESH HOLES � ASSESSOR'S MAP 294 LOT 80 POND — t FRESH POND REALTY TRUST, LLC BVw 8 / 1436 ROUTE 132 INOUGH ROAD) 7 HYANNIS, MA 0260YAN r; 309.4$' / A DEED BOOK 27191 PAGE 293 - REBAR I(set) i CONSULTANT ZONING TABLE: BVW s T: INDUSTRIAL IND 10j) 2 CRITERIA REQUI EXISTING ,NO� BVW 5 �/ MINIMUM LOT AREA 90.000 S.F. 90 000± S.F. l 4t�;�0 g - - / CONSULTANT MINIMUM LOT FRONTAGE 20 FT. 178.00 FT. 419.64 FT BVW 4 /�' 01 /Q MINIMUM FRONT YARD 20 FT. N A * 3 P MINIMUM SIDE YARD 30 FT. N/A * o / MINIMUM REAR YARD. 30 FT. N A * BVW 2 '$ MAXIMUM HEIGHT 30 SFTT. OR NSA * BVW 1 w �/ OVERLAY DISTRICTS: GROUNDWATER PROTECTION OVERLAY DISTRICT GROUND MOUNTED SOLAR PHOTOVOLTAIC P ` / PREPARED FOR : — * SUBJECT. PROPERTY CONSISTS OF VACANT LAND �� � ROD �, / i , � Fresh Pond Realty Trust, LLC Cr s,90 / / / c% Keller Company FLOOD NOTE: , - `$ CP I 1436 lyannough Road THE PROPERTY IS LOCATED IN ZONE C OF THE FLOOD INSURANCE RATE MAP �1'n d)dh ��COMMUNITY PANEL No. 250001 0005 C, WHICH BEARS AN EFFECTIVE DATE OF ,,, O / Hyannis, MA 02601 AUGUST 19, 1985 AND DOES NOT FALL WITHIN A SPECIAL FLOOD HAZARD AREA. FRESH HOLES POND IS MAPPED AS A FLOOD ZONE B (500YR.). '' 7 :r / i / F � c IQ c�5'•c / own I I � i W I t t 3 �W I � yr fV air ; ' i ca i IL own 15-FWT NFDE 31 ,�•E W ��� g I UTRJTY EASE'/IENT NSg� v Qa Q (PLAN BOOK 346 PACE 23) V I I 40 = N N %587.* SF. I i .,7 I i "' I I = J N � 1 ''`��;v Y�cZ 4 Oot R N I I i ILO 'Q � v � WLgo MAP 294 PARCEL 80 1 i 1 46 = •a O MA Wa.� z �8�� 90, S.F. I I 1 � r � _ m it 207t ACRES I I I w = Q _ 1 � 9LZPV OCc>OR O � � i Cti a S70010UD"IY� 15.A0 - 13 (set) /� _R=30. w � z i 47.1 � �+ IIle � a 0 � — z --� AIRPORT ROAD SHEET TITLE N RUM - 1942 BARWARE COUNTY LAYOUT - KOW MADE N . . . ---\ (umn c�ONSTRuem) Foundation Certification EDGE OF PAVEMENT (TYP.) —————————` � f---------------------, �----- � Plan I CERTIFY THAT TO THE BEST OF MY KNOWLEDGE THE FOUNDATION SHOWN HEREON IS IN COMPLIANCE WITH THE DIMENSIONAL SETBACK REQUIREMENTS AS NOTED IN TOWN OF BARNSTABLE ZONING BYLAW AND IS NOT LOCATED WITHIN A SPECIAL FLOOD HAZARD AREA SHEET NO THIS PLAN IS NOT TO BE RECORDED NOR IS IT TO BE USED TO ESTABUSH PROPERTY UNES. _- -- - -- -- -- -- -- -- -- CB BROKEN 0:C01 �F (fnd) a �gss9�ti !a 23 - ' hs DATE : 10 02 13 —M. BRENNER, P.LS. � SHAN ATE 30 0 30 60 CD BREPdNER N o No.45917 SCALE IN FEET c;sr���° SCALE : 1"= 30' L LAND 1o_Z��l ,� �� DRAWN/DESIGN BY: SUB CHECKED BY: SUB JOB NO: 2012-022 C A D D FILE: 2012-022A&dwo 4