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HomeMy WebLinkAbout0002 IRVING AVENUE (11) O-TIV i i I� G� PROJECT : NAME: ADDRESS: PERMIT# PERART.DATE: M/P: LARGE. ROLLED. PLANS ARE IN: s BOX ' SLOT Data entered in MAPS program on: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 2G26:— Parcel 0191 Application # 2 o ` CLb� (a Health Division Date Issued C0 Conservation Division Application F bb Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Ame Village 1A`J Anna,S PQlL'C Owner N�{O r,%mIL S It On.T C.L%n Address 2 1(L.1 uSg Azy, Telephone sc� ''(2 5 O"Cl Permit Request f'.3 J 4 �e C& AN.K) 3 SC%*.Pov1 C06&% N'Q� tJ.wA eJ 3- 4- CL..0 Tb ✓ bza%Lk-60 13 A u00 its C. AA&-A Square feet: 1 st floor: existi4,35'froposed Z-C-O 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2fib,OW Construction Type wado .Lot Size 1-(. DEG% Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 109 Historic House: ❑Yes ❑ No On Old Kings iighway�U Yew ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ses col) Basement Finished Area (sq.ft.) Basement Unfinished Area (s4zft) Number of Baths: Full: existing new Half: existing new.. Number of Bedrooms: fa/A, existing _new Total Room Count (not including baths): existing new First Floor Rooi Count Heat Type and Fuel: Ilid Gas . ❑ Oil ❑ Electric ❑Other Central Air: XYes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes $3 No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name XOGOLA -1- MOr,L^,scy ►f4c Telephone Number Cb$ #+%V- Lt 0` Address L4419'0ST-oWtLL!CGa jji SVrQwC&0 License # G' S • 1172999 �ST�ctIJ��.ulr MQ oZ.6�5' Home Improvement Contractor# 1(04,619'8 Email Worker's Compensation # Ufl��9'7'1P25'Z-1� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN r"A SIGNATURE DATE s ' FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED b MAP/PARCEL NO. — > ADDRESS VILLAGE OWNER DATE OF INSPECTION: ' r 1 FOUNDATION FRAME INSULATION FIREPLACE ; ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL . GAS: ROUGH FINAL r ` FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r f a The C'oarz;<t o nyveakh of Massac usegs Deparhnmt of fi str.ial AcciWents - Office of Investigations _ - 600 Washington,S eet - - Bostolj,,MA 02111 - wn w.ma=g&Wdia Workers' CompensatiauInsurance Affidavit:Birilders/Conti-actorsMectriciansTlumhers Applicant Information Please P`rinf L+ bly Name(Bsiae OrDmizatim ndividmo: ¢p a—Mar/ta-' l JC. Address: 4A-E S 0311r. CityfStat�efZip: Phone �04 �E2� - Are you an employer?Check the appropriate box: Type of pro]ect(required)_ 1-❑ I am a employer with 4_ ® I am a general contractor and I ti_ ❑New co nstruc#ion employees(fad andlor part-ime).* have hie the sub-contraciDrs 2_❑ I am a sole proprietor or partner- listed on the attached sheet; 7_ ®Remodeling sbip and h;n a no employees These sub-contractors have g_ ❑Demolition working for me-in any capacity_ employ and have workers' 9_ ❑Building addition [No workitrs,comp.insurance comp_insuranc'g l rexlnrred] 5. ❑ Vile are a corporation and its 10_❑Electrical repairs or additions 3_❑ I am a homecrwnmer doing all work' officers 1MV exercised their 11_0 Plumbing repairs or additions right of cxemption per MGL myself [No workers'coutp- 12_0 Roof repairs insurance required_]I c_1.52. §1(4) and we him a no employees_[No workers' 13_.❑Other comp_insurance required], `Anyappb that checks box#1 mist also fill cit theSeCtiDo.below showing flieir waters�conTensadon policy infnnnatiim- T M.W.ners who submit this affidavit i they are doing sal wosik sad the,hire onside contractors mist subunit a near affidavit mduating such tcbnt:actors that cleric this box must attacked an additional sheet shaa-ing the name of the soda-oo�ractois and state whether xnnt tbose Mies have employees. Nthe sub-contractors hsve employees,they rat provide their nmrki!rs'comp.polite number. I am an employer that rsprotaditrg workers'commnsation ins imnce for MY empFoyem Betow is the policy raid job site infotrtrathn_ Insurance Company Flame: N C"-00.41 man c"s LIf�A�tt� 1 a s Policy 4 or Self-ins-Lit-&-- l t42 —*97171? ZSZ— 14- Expiration Date: 1 JobSiteAdd ess: 2 1 RJ te%\C- AUL C1tylStawZip:14kF--1tC fbRx- AA. Attach a ropy of the Workers'compensation polio-declaration page(showing the policy number and expiration date). Failure to secure coverage as re uimdunder Section25A of MUL c- 152 can lead to the imposition ofcriminal penalties of a fine up to S1,500.00 andlor one-yearimprisortment,as well as civil penalties in the farm of a STOP WORK:ORDER-and a fine of up to$250_00 a_day against the violator_ Be advised that a cotpy of this statement may be forwarded to the Office of hnestigations of ttte DIA for m ce coverage verification_ Ida he"4,carlfy under tkepiIns an ena as ofperjury that the information provi ed abm ee is bus and correct, Signature: Bate: 1 Phone#: li,Ukial use on[y. Da not twite in fhis area,to be compleatad by dF or town offic&L City*or Town: PermitlUcense Issuing Authonty(drde one): 1.Board of Health .2.Building Department 3.City]Towix Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Information and. Instfuetions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or 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 alay applicant who has not produced acceptable evidence of compliance with the insurance.coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political si.ibdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.-' Applicants — Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their czrti.ncafe(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required- Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of ins uranae coverage. Also be sure to sign and date the affidavit. line affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obt_inn a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an.applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be.provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be iiI ed out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this aff davit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents office of JavestigafiGas 600 Washington Street $oston=MA 02111 Ted.14617-727-49-00 W 406 or I-9 MAS E Revised 4-24-07 Fax#617-727-7749 w .mass gov/dia R��M ROGERSsz1V ARNEY,INC. BUILDERS List of Subcontractors performing work at 2 Irving Ave.,Hyannisport,MA. Joyce Landscape.- (WC# 59B6S60UB-5B91624-9-14) Expires 4/7/15 Bay Colony Concrete Forms, Inc. —Foundation(WC# WC0002466) Expires 3/31/15 JD Custom Builders- Framing(WC 2001w7511) Expires 9/17/14 David Cox, Inc. —Roofing& Siding(WC#UB910X7422-14) Expires 7/16/15 Lafluer Electric Co. (WC# WCA9097899) Expires 7/9/15 Spencer Hallet Plumbing, Inc. (WC#BINDER355375)Expires 2/22/15 South Shore Heating& Cooling, Inc. (WC 094184522 MA) Expires 7/1/15 Colony Insulation, Inc. (WC#UB-513739068-12) Expires 08/18/15 Blueboard Specialist(WC#UB-0194N848-14) Expires 3/3/15 Andrew Powers Painting, Inc. (WC# 6005208012013) Expires 2/8/15 Pride Flooring, Inc. (WC#UB-6B033174-14) 6/15/15 Building Quality Homes Since 1968 • rogersandmarneybuilders.com Post Office Box 310,Osterville,MA 02655 •tel 508.428.6106 • fax 508.420.3550 • email gjs®rogers®marneybuilders.com l .x C3-1 i%13/2014 7.17 .31 AM PAGE 2/002 Fax Server 4 , CERTIFICATE OF LIABILITY INSURANCE DATE 1/1' n'14 FICATE 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 CERTIRCATE-HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. IfjSUBROGATION IS WAIVED,subject to the arms and conditions of the policy,certain policies may require and endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements. PRODUCER CONTACT NAME: NORTHWOOD ESHBAUGH INS PHONE FAX 540 MAIN STREET (A/C.No,Ext): (A/C.No): E•MM L HYANNIS,MA 02601 ADDRESS: 271DD INSURERS)AFFORDING COVERAGE NAIC# INSUREDINSURER A: HARTFORD UNDERWRITERS INSURANCE COMPANY ROGERS&MARNEY INC INSURER B: INSURER C:' INSURER D: P O BOX 310 INSURER E: OSTERVILLE,Io1A 02655 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: ANY RE(LIRBeU,TERA OR omEr cN CF ANY CONTRACT OR OTHETI DOCUMENT KITH RESPBCrTO V&KH THIS CEffnFICA7t MAY BEISSL OR MAY PERTAPI THE NSLRANC£ AFFORDED BY THE POLICIES r F Q iBED HEREIN IS SUBJECT TOALL THE TER4 EXCLUSONS AND COrDIT10PS OF 5LICA POLICIES LIMITS SHOM MAY HAVE BEEN REDUCED BY PAD CLAtl11S AOD POLICYff:DIIE POIIL•Y:D�DATE 's LTR TYPECFNSURANCE L R POUCYNUAWR PUDDYYYY)- .- '(M%MVy"- LIMITS GENERAL LIABILITY CH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE OCCUR. PREMISES(Ea occvrence) rERSONAL EXP(Any one person) $ . &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ERALAGGREGATE $ POLICY PROJECT❑LOC DUCTS-COMPIOP AGG S AUTOMOBILE LIABILITY COMBINED SINGLE S ANY AUTO LIMIT(Ea aoddent) ALL OWNED AUTOS BODILY INJURY $ SCHEDULEAUTOS I(Per person) BODILY INJURY $ HIRED AUTOS (Per accident) NON-OWNED AUTOS }PROPERTY DAMAGE $ (Per accident) i UMBRELLA LIMB OCCUR 1 EACH OCCURRENCE S EXCESS LIAR 0CLAIMS-MADE AGGREGATE $ S DEDUCTIBLE S RETENTION $ A WORKERStOMPENSATIONAND X WCSTATi1rCEN OTF61 EMPLOYER'S LIABILITY YIN UB 4977P252-14 01/012 TS 014 01/Ol/2015 UM ANYPROP13RITCR1PARTNERA»JTIVE a NIA E.L EACH ACCIDENT $ 560,000 CFRCEPAn831 EXCUIDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 (Mm ory In" It yas,d er E.L.DISEASE-POLICY LIMIT S 500.000 PTICN OF OPERATKM below DESCRIPTION OF OPERATIONS/LOCATIONSl1IEHCLESIRESTRICTIONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TOTHE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF BURNSTABLE SHOULD ANY OF THE ABOVEiDESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED. 230 MAIN ST IN ACCORDANCE WITH THE POLICY PROVISWO IK---�: AUTHORIZED REPRESENTATIVE �, �yF;�j✓ HYANNIS,MA 02601 ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 1988 2010 ACORD COR rjTits reserved. I f Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Super-isor License: CS-102999 i }fir GARY J SOUZA ! P.O.BOX 310 Osterville MA 02955 Expiration O811612016 Commissioner 1 , Office of Consumer Affairs and Business Regulation ` 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 164688 f Type: Private Corporation Expiration: 10/30/2015 Tr# 244188 ROGERS AND MARNEY, INC. GARY SOUZA P.O. BOX 310 OSTERVILLE, MA 02655 PL Update Address and return card.Mark reason for change. scn c,. 20M-05111 U Address Renewal E] Employment Lost Card ` Ufie�n�ran�o�uuealC�o�'�ela;;x�c�u�e(I; 0 . ice.o_f Consumer Affairs&Busiddess Regulation License or registration valid for individul use only _ MEIMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration 164688 Type; Office of Consumer Affairs and Business Regulation xpiration:• 10/3020.15 Private Corporatior 10 Park Plaza-Suite 5170 Boston,MA 02116 ROGERS AND MARNEY GARY- SOUZA 445:WEST.BA RN STA BLE RD. ©STERVI4l E MA 02655. a Undersecretary-�_. ,.... _.._. rY Not va 1'� hou. signature - - _ �TNE� Town of Barnstable . Regulatory Services BAM5rAB9MASS. '�I Thomas F.Geiler,Director E16�ca Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Ov.7 Must Complete and Sign This Section If Using A Builder I, IrP-V0 &-CIL as Owner of the subject property hereby authorize gc L(-C � wdwcl _"C- to act on my behalf, in all matters relative to work authorized by this building permit 2 1RJ,t-'�6 ST. kANAt-A,5161J nna (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. Signature of Owner Signature" ignature f plicant Print Name Print Nam Date QTORMS:OWNERPERMISSIONPOOLS 62012 Charlie From: eDEPConfirmation@massmail.state.ma.us Sent: Tuesday, September 09, 20141:58 PM To: helen@rogersandmarneybuilders.com Cc: Charlie@rogersandmarneybuilders.com Subject: eDEP Submittal Confirmation for DEP Transaction ID: 683896 Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection.Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for your records. Please do NOT reply to this message,this email address will not receive messages. For assistance with eDEP Online Filing, please email the EEA Help Desk at maiIto:helpdesk.eea@massmail.state.ma.us or call 617-626-1111. MassDEP is interested in how we can serve you better.To help us make improvements to eDEP, please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/eea/agencies/massdep/service/online/edep-contacts- and-feedback.html. To contact MassDEP'.Programs, please see http://mass.gov/dep/about/contacts.htm. ************************************************************************************** DEP Transaction ID: 683896 Date and Time Submitted:09/09/2014 01:58:18 ************************************************************************************** Form Name: AQ 06-Construction/Demolition Notification Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection.Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for your records. Please do NOT reply to this message,this email address will not receive messages. For assistance with eDEP Online Filing, please email the EEA Help Desk at mailto:helpdesk.eea@massmail.state.ma.us or call 617-626-1111. MassDEP is interested in how we can serve you better.To help us make improvements to eDEP, please take a minute to complete our eDEP Online Filing Survey at http://www.mass.goy/eea/agencies/massdep/service/online/edep-contacts- and-feedback.htm1. To contact MassDEP Programs, please see http://mass.gov/dep/about/contacts.htm. ************************************************************************************** DEP Transaction ID: 683896 Date and Time Submitted:09/09/2014 01:58:18 i ************************************************************************************** Form Name: AQ 06-Construction/Demolition Notification Payment Information DEP code:98443 Date: 9/9/20141:52:57 PM Amount($): 100 Payment Detail:SOUZA GARY--AccountType-- AccountNumber****3473 ConfirmationNumber: ************************************************************************************** EMAIL ID OF THE USER: HELEN@ROGERSANDMARNEYBUILDERS.COM ************************************************************************************** EMAIL ID OF THE OTHER USERS: CHARLIE@ROGERSANDMARNEYBUILDERS.COM ************************************************************************************** 2 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality BWPAQ 06 Asbestos Project Number Notification Prior to Construction or Demolition A. Applicability Important: When filling out forms on A Construction or Demolition operation of an industrial,commercial,or institutional building,or residential the computer, building with 20 or more units is regulated by the Department of Environmental Protection(MassDEP),Bureau use only the of Waste Prevention-Air Quality Division,under Regulations 310 CMR 7.09. Notification of Construction or tab key to Demolition operations is required under 310 CMR 7.09(2)ten(10)days prior to any work being performed.The move your following information is required pursuant to 310 CMR 7.09. cursor-do not g q use the return key. Is this a fee-exempt notification(city,town,district, municipal housing authority,state facility,owner-occupied residential property of four units or less)? r� ❑ Yes -dNo Type of Notification: Project Revision ❑ Project Cancellation Instructions: 1.All sections of B. General Project Description this form must be completed in order to comply 1. Facility Information: with the Department of H" tCQoM— CWIS Environmental Protection Name of Facility Street Address notification I"b%-.�r4a CCC4'r- f 411.4 02 L" So$'??S- 6669 requirements of City/Town State Zip Code Telephone 310 CMR 7.09 5 NNA$' A6C 2.Submit Facility Contact Person Contact Person Title Original Form To: S >V 7ZS —6669 5CCC ►S •_ CPgr_.CnMk Commonwealth Facility Contact Person Telephone Facility Contact Person Email of Massachusetts Asbestos Facility Size: Program P.O.Box 120087 1 Z Boston,MA Square eet Number of Floors 02112-0087 Was the facility built prior to 1980? Yes ❑ No Describe the current or prior use of the facility: G o,'� C.4- S!M Ar 'Kiev Is the facility a residential facility? ❑ Yes fg No If yes, how many units? Number 2. Facility Owner: 1 A SIrA l S F odl—' C-%.AA 2 %(L/ A IZ; Facility Owner Name Address 0Z 61}'7 5� 77 S-66641 City/Town State ZIP Code Telephone SC.�T sm1 1&.5 uJG wj� On-Site Manager/Owner Representative Address H4xp,s CeoA--r wyli,_ a b0 119--6661 City/Town State ZIP Code Telephone 07/14 BW P AQ 06•Page 1 of 3 LlMassachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality BWPA006 Notification Prior to Construction or Demolition B. General Project Description (continued) 3. General Contractor: Name Address City/Town State ZIP Code Telephone Telephone e S . SI�.� sour 4-C b- "Lg General Contractor On-Site Manager/Foreman Telephone General C. General Construction or Demolition Description Statement: If asbestos is found during a 1. Construction or demolition contractor: Construction or Demolition ebC+Q&_S operation,all Contractor Name Address responsible parties must comply with 310 CMR 7.00,7.09, City/Town State ZIP Code Telephone and Chapter C �LtZ Q Sp�p�J Chapter 21 of the Generall on Cstruction&Demolition On-Site Manager Telephone Laws of the 2. Licensed Contractor Supervisor: Commonwealth. p This would �.,ors/� 4� S A S �- 102.*A9 include,but S=/ = �� would not be Supervisor Name License Number limited to,filing an asbestos 3. Is the entire facility to be demolished? ❑ Yes ® No removal notification with 4. Describe the area(s)to be demolished: the Department and/or a notice �� u���,�kc�T of release/threat of release of a hazardous substance to the Department,if applicable. 5. If this is a construction project, describe the building(s) or addition(s)to be constructed: 44\CTt�Cr or-1 0r M--STZ#,� 3 S G-064tJ v.Yz> now- %,-uJ v i 0 c�-e z t ..I. Cs C�t.�.`L. `F� Sira.� 6. If this is a demolition or renovation project, were the structure(s) ❑ Yes'Z No surveyed for the presence of Asbestos-Containing Material (ACM)? 7. Was asbestos containing material (ACM)found? ❑ Yes Iff No If yes,who conducted the survey? Name Department of Labor Standards Certification Number 07/14 BW P AQ 06•Page 2 of 3 i Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality BWPAQ06 Notification Prior to Construction or Demolition C. General Construction or Demolition Description (continued) The Asbestos Abatement Notification Number for this address is: This project is: 19 Construction ❑ Demolition rr�� it Project Start I�I M/D 5 D/YYYY) Project End bat(MM/DDNYYY) 8. For demolition and construction projects, indicate dust suppression techniques to be used ❑ Seeding ❑ Wetting ❑ Covering ❑ Paving ❑ Shrouding ❑ Other—Specify: 9. For Emergency Demolition Operations,who is the MassDEP official who evaluated the emergency? Name of MassDEP Official Title of MassDEP Official Date of Authorization(MM/DD/YYYY) MassDEP Waiver Number D. Certification "I certify that I have personally examined the foregoing and am familiar with the information contained in this Print Name document and all attachments and that,based on my inquiry of those individuals immediately responsible for Authorized Signature obtaining the information, I believe that the information 1✓ r,p�/ is true,accurate,and complete. I am aware that there r✓ J 1 "I are significant penalties for submitting false P sition/Title information,including possible fines and imprisonment. T � M The undersigned hereby states,under the penalties of Representing perjury,that I am aware that this permit application or O, Zol notification shall not be deemed valid unless payment Date(U/ /YYYY) of the applicable fee is made." P.E.# 07/14 BW P AQ 06•Page 3 of 3 Mass. Corporations, external master page Page 1 of 3 William Francis Galvin Secretary of the Commonwealth of Massachusetts Corporations Division Business Entity Summary ID Number: 041465810 Request certificate 1 New search Summary for: HYANNISPORT CLUB The exact name of the Nonprofit Corporation: HYANNISPORT CLUB Entity type: Nonprofit Corporation Identification Number: 041465810 Old ID Number: 000008230 Date of Organization in Massachusetts: 07-12-1909 Last date certain: Current Fiscal Month/Day: / Previous Fiscal Month/Day: 00/00 The location of the Principal Office in Massachusetts: Address: 2 IRVING AVE City or town, State, Zip code, HYANNIS PORT, MA 02647 USA Country: The name and address of the Resident Agent: Name: Address: City or town, State, Zip code, Country: The Officers and Directors of the Corporation: Title Individual Name Address Term expires PRESIDENT JOHN A. SCHNEEBERGER 48 WHITTIER RD WELLESLEY, MA 2015 02481 USA TREASURER JOHN V CARBERRY 56 WOODCLIFF RD WELLESLEY 2014 HILLS, MA 02481 USA CLERK ALEX RODOLAKIS 83 BLANTYRE AVE CENTERVILLE, MA 2015 02632 USA VICE FREDERICK P FLOYD 50 OVER LEA RD HYANNIS PORT, 2016 PRESIDENT MA 02647 USA DIRECTOR SARAH C. BACON 301 BERKELEY ST - APT 2B 2014 BOSTON, MA 02116 USA http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=041465 810&S... 9/4/2014 Mass. Corporations, external master page Page 2 of 3 DIRECTOR CAROLEEN HUGHES 26 LONGWOOD AVE HYANNIS PORT, 2014 MACKIN MA 02647 USA DIRECTOR FREDERICK EC JURGENS 119 BLUE WATER DRIVE 2014 CENTERVILLE, MA 02632 USA DIRECTOR JAMES P INGRAM PO BOX 160 OSTERVILLE, MA 02655 2014 USA DIRECTOR JAY LEONARD 87 FIRST AVENUE WEST HYANNIS 2014 PORT, MA 02672 USA DIRECTOR GREGG A ANDERSON 61 MASSACHUSETTS AVE HYANNIS 2015 PORT, MA 02647 USA DIRECTOR SUSAN BUTLER 522 BAY LANE CENTERVILLE, MA 2015 02632 USA DIRECTOR NANCY GARRAGHAN 115 OCEAN ST WEST 2016 HYANNISPORT, MA 02672 USA DIRECTOR GREGORY HARDEN MARCHANT AVE HYANNIS PORT, MA 2016 02647 USA DIRECTOR RICHARD COVILLE JR 67 SPYGLASS HILL RD ` 2016 BARNSTABLE, MA 02630 USA DIRECTOR CHRISTOPHER J EAGAN 346 OTIS ST NEWTON, MA 02465 2015 USA DIRECTOR HUGH H MULLIN 35 SIMMONS POND CIRCLE 2015 HYANNIS PORT, MA 02647 USA DIRECTOR PETER CAMPBELL 41 CHESTNUT STREET HYANNIS, MA 2016 02601 USA DIRECTOR MARAGRET ERBE 33 PARK PLACE HYANNIS PORT, MA 2016 02647 USA r r Confidential 0 Merger r Consent Data Allowed Manufacturing Note: Additional information that is not available on this system is located in the Card File. View filings for this business entity: ALL FILINGS oil Annual Report Application For Revival Articles of Amendment Articles of Consolidation - Foreign and Domestic View filings Comments or notes associated with this business entity: L k http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=041465 81 O&S... 9/4/2014 Mass. Corporations, external master page Page 3 of 3 New search http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=041465 810&S... 9/4/2014