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0655 IYANNOUGH ROAD/RTE132 (11)
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G 0...M1.Ibe1 bi wMm4. °°1°PYlc,Yromm.Pb.IlYncmw,Acl A,Yheeel mf R—ld Sheet Notes uvPamrtnnml wnmw..n .n �GCPmo.mw,mmmn.7r��w. ❑ o a o a b���>Ymm,.P.,�,bm...Pn,P ,,Exterior Elevation Weat �W�yy 0 W Z s 3 ,n g o 0 0 o a o .mnu.PP,: �e mu.Ya �em0ee nawme z °m°mtlonu.gnr. wo MYn r�Exterior ElevatlortSouth Exterior Elevations a' A-201 PROJECT � (1 NAME: r�✓�d _` �oS✓ic-5 ADDRESS: PERMIT# 06`?3 3 PERMIT DATE: LARGE ROLLED PLANTS ARE IN: OX 1A SI,O'I' 2 Data entered in MAPS program' on: 1 z- L� BY: • q/wpfiles/forms/arehive TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 1 Parcel Application # vG 3 Health Division Date Issued _ Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address SS �� �y��y�► �� c� Village {�y�h" r- , INA 0,26-P/ Owner M' 11 Zape- `` Address a-3 l N/lvw St`. �a r�cu,��r1; Telephone �' "375-000 S` Permit Request ov, eve e"©,e,f l' c7Z,er Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �`� �Q$z ' y - Telephone Number Address 3d YS 5-,s 4 f7�-,IX License# 0 S-79 /9 1�" Y 3 j Home Improvement Contractor# Worker's Compensation # CM05_30 9G ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 7)6' r SIGNATURE DATE �_ FOR OFFICIAL USE ONLY K�' APPLICATION# DATE ISSUED " f, MAP/PARCEL NO. Y p}t 7 ADDRESS VILLAGE OWNER �t DATE OF INSPECTION: G� 'r FOUNDATION FRAME i INSULATION '}- FIREPLACE ELECTRICAL: ROUGH FINAL k" PLUMBING: ROUGH FINAL f GAS: ROUGH FINAL s r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r Town of Barnstable Regulatory Services * sn M S& Thomas F,Geiler,Director 9�p 1639 Tentiura Building Division . Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA'02601 www.town.barnstable.ma.us 1 Office: 508-862-4038 Fax: -508-790-6230 NOTICE TO THE.BUILDING DIVISION OF LICENSED CONSTRUCTION SUPERVISOR ASSUMPTION OF RESPONSIBILITY Construction Supervisor License # e 5 15- 7P�, hereby certify that_I have assumed responsibility for the project under construction,-as authorized by building permit#0?6I ( 7 , issued'to address)' G S'S- a r,� a�.(property add ) � i /I/a iJ i S on , 201 l . 1. The following documents are attached.- copy of my Massachusetts-State Construction Supervisor's license or Homeowner's License Exemption form (if applicable) copy of my Home Improvement Contractor registration (if applicable) Commonwealth of Massachusetts Workers' Compensation Insurance Affidavit. Road Bond (if applicable) LIXNSE HOLDER DATE I q/forms/newcontrb rev:1 10410 o ' Regulatory Services- sAl MASS. e Thomas F. Geiler, Director 9Q ASS. � _ rFo. ta Building Division Tom Perry, Building Commissioner• 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-79076230 NOTICE TO THE.BUILDING DIVISION OF CHANGE OF LICENSED CONSTRUCTION SUPERVISOR e'V> or owner of property located at 5 hereby certify that, is no longer Construction Supervisor listed on the application for the project under construction as authorized by building permit dQ[ W ; issued on 1 201 w I understand that the project under'construction must cease.until a successor licensed Construction Supervisor, is submitted on the 'records of the.Building.Division. PROPER ER DATE q/forms/newcontr reference R-5"780 CMR rev:1 10410 Of THE j0� Town of Barns' t b e Regulatory Services ncass �, Thomas F. Geiler,Director E b Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstab le;M2.as Office: 508-862-4038 = Fax: 508-790-62: FProperty Owner must . Complete and Sign This Section ,. If Using A Builder as Owner of the subject property. here by authorize p ' !� to act_on my behalf,. M all matters relative to work authorized by this building permit application for.. : (A:ddress of 4ateZ job) l Signa e of Owner Pant Name }If Properly Owner is applying for permit please corriplete the Homeowners License Exemption Form on the reverse side. QMRMS.O WNERPERMiSS10N The Commonwealth of Massachusetts r I Department of Industrial Accidents ., E Office of Investigations ,1 600 Washington Street Boston,MA 02111 F=� ,www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): e_. Address: 0Lt + AUC City/State/Zip: 0.4 Phone #61 ` S GG Are you an em*yer?Check the appropriate b Type of project(required): h❑ 4 I am a employer with . 1 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. t 7Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance S. ❑ We are a corporation and its officers have exercised their 10.❑ Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work right of exemption per MGL 1 I.❑ Plumbing repairs.or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t. employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box 91 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 their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. �f��/� Insurance Company Name: � AAAC-ICY Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the-policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage.verification. I do hereby certif un r the ins and penalties of perjury that the information provided abov is tr a and correct; ' Si afore: Date: 1� Phone#: G1 c� c� �L)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 S. Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant.thereto shall not because of such employment be deemed to be an employer." *•. It , MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permifto operate a business or to construct buildings,in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally, MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contmctor(s)name(s), address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits-or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts _ Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax # 617-727-7749 www rn:ass..gov/dia OP ID: MM ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 03/16/11 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 endorsements. PRODUCER CONTACT Insurance Agencies of Ohio 614-848-3000 P o Mary Ellen Mathews FAX 7100 N High St Ste 300 614-848-7698 AIC No Ell:614-848-3000 (,C,No):614-848-7698 Worthington,OH43085-2333 E-MAILADDRESS:mmathews@insagenciesoh.com Ralph L GlYdraSCl PRODUCER CONSTA CUSTOMER ID t. INSURER(S)AFFORDING COVERAGE NAIC# INSURED Construction One Inc. INSURERA:Cincinnati Insurance Co 10677 Construction First Inc. INSURERB: 3045 E Fifth Ave INSURER C: Columbus,OH 43219 - 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 ADDINSR TYPE OF INSURANCE SUB VYVD POLICY EFF POLICY EXP LTR INSR POLICY NUMBER MM/DDfYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X CPP1063896 01/01/11 01/01112 AMAGEESS(Eaoce N E DREMIS Durrence $ 500,000 P CLAIMS-MADE a OCCUR -, MED EXP(Anyone person) $ 10,000 PERSONAL&ADV INJURY - $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident)A X ANY AUTO CPP1053896 01/01/11 01I01I12 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIREDAUTOS (Per accident) X NON-OWNED AUTOS $ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 A CPP1053896 01101/11 01101112 DEDUCTIBLE $ RETENTION - $ , $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY TOR,LIMITS ER A ANY PROPRIETORIPARTNER/EXECUTIVE YIN CPP1053896 01101/11 01/01/12 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? ❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Rented Equipment CPP1053896 01101I11 01101/12 Amount 250,0010 pecial Perils Repl Cost Blanke DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE:Jo Ann Fabrics#814,655 lyannough Road,Hyannis,MA 02601 Certificate Holder is named as an Additional Insured as perform GA472- Automatic Additional Insured CERTIFICATE HOLDER CANCELLATION JOANNA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN JoAnn Stores,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. and it's subsidiaries ATTN: Risk Management Dept AUTHORIZED REPRESENTATIVE FA55 Mrrnw Rnad --) - i ACCO CERTIFICATE OF LIABILITY INSURANCE DATE IYYYY) 04/19/2012011 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(les) 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: (508)987-0333 Fax: 508-987-0063 , CONTNAMEACT Oxford Insurance Agency Inc. OXFORD INSURANCE AGENCY INC PHONE o Ext: 508 987-0333 F Ho; (508)987-5517 P O BOX 370 E-MAIL OXFORD MA 01540 ADDRESS: PRODUCER 22526 CUSTOMER ID: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER Hanover Insurance Co A.S.JONES&COMPANY,INC. 7 HASTINGS STREET INSURER :Allmer(ca Financial Benefit Insurance MENDON MA 01756 INSURER :Citizens Ins Co of America INSURER D: Citizens Ins Co of America INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 69361 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, INSR TYPE OF INSURANCE ADD'L SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MMIDD MMIDDIYYYY LIMITS `+ GENERAL LIABILITY ZBN453304401 11/06/10 11/06/11 EACH OCCURRENCE $ - 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Eaoccurence _$ 500,000 CLAIMS-MADE I_7 OCCUR MED.EXP(Any one person) $ 10,000 X AGGREGATE LIMIT PER LOC PERSONAL&ADV INJURY $ 1,000,000 o- GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY D PRO-IEC LOC B- AUTOMOBILE LIABILITY AWN453298601 11/06/10 11/06/11 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO r BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) $ X NON-OWNED AUTOS - - - $ I' A UMBRELLA LIAB X OCCUR UHN453435401 11/06/10 11/06/11 EACH OCCURRENCE 1,000,000 EXCESS LIAB CLAIMS-MADE - AGGREGATE 1,000,000 DEDUCTIBLE - RETENTION $ _ $ - WC STATU- OTH Y/N D WORKERS COMPENSATION WBN4962208-02 02/03/11 O2/O3112 TORY LIMITS $ AND EMPLOYERS' LIABILITY - ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT SOO,000 OFFICERIMEMBER EXCLUDED? El - (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE 500,000 If yes,describe under - - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ ,500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Electrical Contractor RE:Construction One Inc and JoAnn Fabrics Hyannis listed as additional insured with respect to General Liability for work performed by the named insured as required by contract CERTIFICATE HOLDER CANCELLATION Construction One,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 3045 East Fifth Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Columbus,Ohio 43219 AUTHORIZED REPRESENTATIVE - email to VWardle@Constructionone.com Cnieset@Constructionone.com 64kR &d ' �Attention: an M. av e ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ® DATE(MM/DD/YYYY) Rv CERTIFICATE OF LIABILITY INSURANCE °PM-2W 10/11/10 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE THE HAUSER GROUP HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 8260 Northcreek Dr. Suite 200 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Cincinnati OH 45236 Phone: 513-745-9200 Fax:513-745-9219 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Everest Indemnity Insurance Co F.L. Moran Alarm & Monitoring INSURER B: Valley Forge Insurance Co. 20508 Services Grosse Pointe Alarm, Inc. INSURERC: Nat'l Fire Ins Co of Hartford 20478 33341 Kell Rd INSURER D: Fraser MI 026 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE(MM DDC/YYYY DATE M POLICY M/DD YYOY LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 A X 4XI]ncludes OMMERCIAL GENERAL LIABILITY SJGL003418-101 10/10/10 10/10/11 PREMISES(Ea occurence) $250,000 CLAIMS MADE X❑ OCCUR MED EXP(Any one person) $5,000 A E&O 10/10/10 10/10/11 PERSONAL BADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/O?AGG $2,000,000 POLICY X jE LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT C X ANY AUTO 1077473174 10/10/10 10/10/11 (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY (Per person) $ SCHEDULED AUTOS + r X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ $1,000 Comp PROPERTY DAMAGE $1,000 Coll (Per accident) $ GARAGE LIABILITY (U LU Iu AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $. (� AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $5,0 00,000 , A X OCCUR � CLAIMS MADE CC001652-101 10/10/10 10/10/11 AGGREGATE $5,000,000 RDEDUCTIBLE � $ X RETENTION $10,0O0 $ WORKERS COMPENSATION X TORY AND EMPLOYERS'LIABILITY ` $ ANYPROPRIETOR/PARTNER/EXECUTIVE[::]� 1077473126 10/10/10 10/10/11 E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 S ECIALSPROVISIO E.L.DISEASE-POLICY LIMIT $1 000 000 SPECIAL PROVISIONS below r r OTHER C Leased Contractors 1077473143 10/10/10 10/10/11 ' Limits $25,000 Equipment Dedt $1,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Construction One Inc. is included•as additional insured as respects project JAS-San Jose, CA. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION CONSTRU DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. Construction One Inc. 3045 East Fifth Ave A ORIZED REPRESENTATIVE olumbus ,OH 43219-2895 ACORD 26(2009/01) ©1988-2009 ACORD WIMIRWTION. Ali righ erved. The ACORD name and logo are registered marks of ACORD I , Client#:91 FIRES ACORD,. CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDDIYYYY) 4/13/2011 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 NAMEA Laura Caramadre Mastors&Servant/USl Ins. A No at:401 885-5700 aIc N;; 610-362-8882 5700 Post Road AD P.O.Box 1158 'Ess:. LCaramadre@msins.com • INSURER(S)AFFORDING COVERAGE NAIC# East Greenwich,RI 02818 INSURER A:Crum&Forster Specialty Compan INSURED - INSURER B:Beacon Mutual Insurance Company Encore Holdings,LLC INSURER C:Argonaut Insurance Company s dba Fire Suppression Systems Group r 70 Bacon Street INSURER D Wausau Underwriters Insurance C Pawtucket,RI 02860 INSURER E: INSURER F: J 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 L1 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS ]� CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE.TERMS, n EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUB POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MMIDD MMIDD LIMITS A GENERAL LIABILITY X X GL0211001 9/30/2010 09/30/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGET ENTED 7 AM occurrence) $300 OOO CLAIMS-MADE �OCCUR MED EXP(Any one person) $5 000 r - I PERSONAL&ADV INJURY $1,000,000 - GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $2,000,000 POLICY X E O- LOC $ D AUTOMOBILE LIABILITY X X ASKZ11260493010 9/30/2010 09/30/2011 Ea a.d.n SINGLE LIMIT. 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED- PROPERTY DAMAGE CIA AUTOS Per accident $ $ s�3m A UMBRELLA LIAR X OCCUR XS0170996 9/30/2010 09/30/2011 EACH OCCURRENCE $10 00O 000- �DED EXCESS UAB CLAIMS-MADE AGGREGATE $1O 000 000 X RETENTION$1 O 000 $ B WORKERS COMPENSATION 63299 10/19/2010 10/19/2011 X STATII- OTH- WC AND EMPLOYERS'LIABILITY, LIMIT EB— ANY PROPRIETORIPARTNERIEXECUTIVE Y/N N/A E.L.EACH ACCIDENT $1,000,000 C OFFICERIMEMBER EXCLUDED?(Mandatory In NH) WC477478309384 10/19/2010 10/19/2011 E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,desTION OF OPERATIONS below under ) E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIP - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If r 1sofibe is requliia RE:Jo-Ann Fabrics&Crafts,Hyannis,MA i 1 APPI i CERTIFICATE HOLDER CANCELLATION Construction One,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2045 East Fifth Avenue ACCORDANCE WITH THE POLICY PROVISIONS. Columbus,OH 43219 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25,2110/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S376977/M367481 LCA HtK-14—�1)!t IHU. U_;4t Fr. no name rAX NU. UU6 S24 4bi'L V, U1iUl 04/14/2011 IC 47 FAX 8174886501 UNOERWRTTINQ �061loci FAbo" 41IMATAMIblMAaASAATTUI plr iNraedrATta.I ONLY AOOIM SNOMW"UPONT}laCSRTDI¢�ATI9 TMeIPWMCA7V DO!!NOT VT:I.Y UR Nl4ATIVEd.Y ARM, MMW OR ALTER Tt1C CW4V A"gFom BlfTIN:POLICRIMOW.THI�S OCR 7OF IN/UtdWCI:00CD YRUTk p CEMItACT mITW!!N THIS NtIIANO INWIIER .AU9 MOR{s011�PI1/iMNTiRggUCkR.ANP TMC C 6RTJFlCItR'kOLQO:Rdhs ► nW AODfRONALiN6URiDh 1Ns i t ee AnAWn.d.tl ruiROwT�+a I nt;h�u pat oonAnan4.tiF&O "OA lun ER andamemnnL A i OMRN7� hold rIn Ilw of �tldolMf uarit.Insurance Agcm,lac. (S00)676 03 0 o"Road Ful Rer,MA 02720 FluugNVA ruv�er�n in r .. MHURM AFFORMNO COVE NAIL 0 vow Adknilc Cl lnsolnsoMM Co VAa+►C WM PWnOnL h-A i► 32 C►rawell Smi P411 Fhw,MA 02724 at+ruAr�ee u�u+lenr• COVFMGR$; CFRTMATE NUGS6R, ION N MBER: TfQ>'I$yGag""fairTM pW=dpjHjURAgOj LOW RC w WAYp O Ia=TO TNe DIOURAD NAIL ADRYE FOA PRIM MOMIM.MOMM0TANOWOANYUMMMEW.TIIWOSCOM "CWANYOMTRaUTOROTNNDOGYMPWw1'ffIRfRR1i T T CM WICATISAYDAMMORMAYFWAIN.TRFRMUW"AFFORliiPYYT"P9WRIate' OHIMUNaBUIWWMt10ALL, TE NS. MMM AND OON MOND CP aUDN POUCIp,6Wf TE(IWOM MAY MAVI(IM MMLM O BY MID RIJIWY= LAIR lYrnorwaMANoe uo wo Pain w~Tf" p„s :,,d I aw OWN" pNWPA1.4M�►m -. - - naovwmNoe. t atoONt wx f- COIpItR01F10NiiiNPj���IK1N111NiV OiAnIt Ouaa 07 rW9+ P�q t aaov ttAAlr : - i AA7i t GiNL ADG1ACa�UYR APr{mt lit oDyR�A= ►Roar a rRO= L- AdiYDN004{lUAWW" elwm�ldltR A AW MRC r wIVIW "6 W~AUM aReA ❑❑ WHO" r Rv I itwmNlioe DAMAO 1 wWKantwoavrot - u ❑ occue 1 T! I n�wr+►a 1 . . ' • i NLitNIWR - A LADYAY WCVOlY9Q1000 07l20(2010 07/30I I uws Wvra YOU _ .aaalNT s 100,004 M�ICIoOItIIgJ�Dto► N NU qrw � yigrAl/ow IONt 1 •fOUCYNYN A 50%000 i E i, ...._ O •EACH IIlAtb4lin 7 1�,� opcRPna+atlDwTA�•caa�rowwNro�a w�sAaoa+a.Ataeeiw n�.ac�wk ranw tow�t�+l I.[7ANY TMEA9�D iEClWOEL6b0tNi►CRitTME DWMTKNI OATS TMMM,TWD l�uNo ANY VMtL RNOCAWOR TO MAR. Cansavaioa One,YacJJoan Pabric 32 BAYS nwriDe TO T cnmr�cA HOLM NA SD To THE«r, 3045 Rag 501 Ave T1ON C R UMs M CWu kv&OH 43214 YuT F ew.LL Of ANT KI OR UPR561eN_EVEs. AIRNDA1a Aot11tD L o*flOFIIOD 11ON.AR 1� Page I Of IC�pT sA►It:A'l>E 110LD1�R 0FOF k"TSIA�CONSTRUCTION : INC.® CONSTRUCTION MANAGER/GENERAL CONTRACYOR� April 26, 2011 4;;! Town of Barnstable Curt Nieset has the authority to pull and pick up Permits from the Town of Barnstable for Construction One, Inc. I herby confirm Curt Nieset is cohered.under Ohio Workers Compensation and is a full time Employee at Construction One, Inc. I . IN WME55 OF, the undersigned has executed this instrument this 26th _. day of April ' 2011 William A Moberger, President Construction One, Inc. By Signature i 3045 EAST FIFTH AVENUE COLUMBUS,OHIO 43219.2895 TEL: 614.235.0057 FAX:614.237,6769 www.constructionone.com 1 _ Massachusetts - Department of Public SSafct: g Board of Building Re�-ulations and Standards Construction Supervisor License, License: CS 95785 Restricted to: 00 ' _ �+• CURT NIESET , 3045 E 5TH AVENUE COLUMBUS, OH 43219 hw Expiration: 4/8/2012 Commissioner Tr#: 25188 r• 4 s . t , PROJECT NAME: : ADDRESS: ry Gyivtcs; J A Vl,VX PERMIT# o�C� 10 n PERMIT DATE: 1 LARGE ROLLED PLANTS ARE IN: BOX SLOT D Z . Data entered in.MAPS program on: BY: i o e / fi les/f rms/archiv q TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3,1 oo$ Application, Map Parcel Health Division Date Issued t O CCD Conservation Division Application Fee Planning Dept. Permit Fee O Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village �ore¢r $e'l�zc`�rti ✓ �2. R.r 131. A¢�cf Owner 4Y Address 23 Telephone 5618 Permit Request ;/ ^' �" 1 V"s�1 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District 3 Flood Plain Groundwater Overlay Project Valuation onstruction Type 3 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: XGas ❑Oil ❑ Electric ❑ Other Central Air: Yes ❑ No Fireplaces: Existing New Existing wood/coal stovE&1 ❑ No Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing Fine o size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ 3Cn Commercial XYes ❑ No If yes, site plan review # s Current Use Proposed Use o rn APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name « �<0 �- f 9 Telephone Number �,Address In License # 10YY1?1!K Lod Home Improvement Contractor# Worker's Compensation # A/C,A#3 69,3 91 ALL CONSTRUCTION DEBRIS RESULTING_ FROM THIS PROJECT WILL BE TAKEN TO Ztlq SIGNATURE DATE i 11 t FOR OFFICIAL USE ONLY C) } APPLICATION# DATE ISSUED MAP/PARCEL-NO._ _ ADDRESS VILLAGE OWNER r i 'DATE OF INSPECTION: a !-' FOUNDATION! FRAME INS_U_LATIO_N•I ti FIREPLACE E z ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: t'_: ROUGH A FINAL f FINAL BUI LID ING 1 i DATE CLOSED OUT ASSOCIATION PLAN NO. r CONSTRUCTION,INC; IRS. 1/ 229 Main Street, North Easton,MA 02356 Nea Cohen (� C-508-989-6605 P-508-205-6262 direct P-508-587-1326 F-508-580-2812 www.dmrconstruction.com email: nbc@dmrconstruction.com The Commonwealth of Massachusetts Department of Industrial Accidents F I' Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): b/t1(2 C.•V s4Y'u cAt4,► Address: 1.-)5 /►�Sw ��- City/State/Zip: 9. oA 1v m r+ ex;s6 Phone #: Svc 557-o 132-6 Are you an employer?Check the appropriate box: Type of project(required): 1.A I am a employer with f .4. [] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet, 7. Remodeling ship and have no.employees These sub-contractors;have g. 0 Demolition working for me in any capacity, employees and have workers' comp._insurance.$ 9. 4Building addition [No workers' comp. insurance- P�, required.] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their I I, Plumbin re o additions 3.❑ I am a homeowner doing all work." _ ❑_ g' airsr p myself o workers comp. right of exemption per MGL Y P 12.0 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. tContractors that check this box must attached an additional sheet showing the name-of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Man" Policy#or Self-ins. Lic. #: W G 41 b$5: �0 5°? Expiration Date: 2)7�l►� Job Site Address: 66s- rjg1✓^40 0S4 1,241 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 we'll as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains,and penalties'of perjury that the information provided'above is true and correct. Signature:Add—__ Date: 1 25/i o ; Phone#: �o St�.7 - 132(, 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such"dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information (if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax # 617-727-7749 www.mass.gov/dia 1 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 1100113981 a ecal Number BWP AQ 06 Notification Prior to Construction or Demolition Important: A. Applicability When filling out Pp Y forms on the computer,use only the tab key A Construction or a emolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the a epartment of Environmental Protection cursor-do not use the return (a EP), Bureau of Waste Prevention-Air Quality Control o egulations P10 CMo 7.09. Notification of key. Construction or a emolition operations is required under P10 CMo 7.09 (2)ten (10) days prior to any work being performed. qhe following information is required pursuant to P10 CMo 7.09. B. General Project Description 1. a.fs this facility fee exempt-city,town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?y❑✓ Yes ❑No 1.All sections of b. Provide blanket decal number if applicableW this form must be Blanket a ecal Number completed in order to comply with the 2. cacility fnformationW Department of JOANN FABRIC Environmental Protection a.Name notification 1665 IYANNOUGH ROAD requirements of b.Address _ 310 CMR 7.09 H annis , MA 02601 c. I / .Zin Code (508)587-1326 1 Inbc@dmrconstruction.com f.aeleohone Number are code and a ensi n .E-mail Address(optional) 17,500 1 h.Size of cacility in Square ceet i.Number of cloors j. Was the facility built prior to 1980? ❑ Yes ❑✓ No k. a escribe the current or prior use of the facilityW RETAIL SALES I. Is the facility a residential facility? ❑ Yes ❑✓ No �O m. If yes, how many units? Number of Units —pc) 3. Facility Owner: �N DOREEN BILEZIKIAN TRUST RT 132 REALTY TRUST �o a.Name �0 1231 WILLOW STREET b.Address YARMOUTHPORT MA 02675 r. w o (508)375-0005 f.Telephone Number(area code and extension) Q.O ED MULLIN E-mail �Q h.Onsite Manager Name ag06.d,oc•10/62 BWP AQ 06•Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 1100113981 a ecal Number � BWP AQ 06 Notification Prior to Construction or Demolition General t tion iB. General Project Descr con . Statement:Ifp (cont.) asbestos is found during a Construction or 4. General Contractor: Demolition DMR CONSTRUCTION, INC. operation,all a.Name responsible parties must comply with 1229 MAIN STREET 310 CMR 7.00, b.Address and Chapter NORTH EASTON MA � 02356 Chapterer 21 21 E of the General Laws of c.City/Town d.State e.Zip Code the Commonwealth. (508)587-1326 1 Inbc@dmrconstruction.com This would include, f.Tele hone Number area code and extension Q.E-mail Address o tional but would not be limited to,filing an INEAL COHEN asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. D&M CONSTRUCTION a.Name 4 MEMORIAL DRIVE b.Address MEMORIAL MA 101844 c.City/Town d.State e.Zip Code (978)457-2914 f.Telephone Number area code and extension .E-mail Address(optional) DICK MARCHAND h.On-site Manager Name 2. On-Site Supervisor: DICK MARCHAND On-Site Supervisor Name 3. Is the entire facility to be demolished? ® Yes ✓,I No N 0 4. Describe the area(s)to be demolished: �o THE BLOCK WALL IN THE BACK IS GOING TO BE REMOVED �N -0 5. If this is a construction project, describe the building(s) or addition(s)to be constructed: A 5500SF ADDITION TO THE EXISTING JOANN FABRICS �o �d �Q aT06.dRF•10/02 B: 3 AQ 06.3age 2 R 3 N Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention • Air Quality 1100113981 �1 ` BWP AQ 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project,were the structure(s) surveyed for the presence of asbestos, containing material (ACM)? ❑ Yes 0 No If yes,who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 10/01/2010 10 7. Construction or Demolition: _ 12/31/20 a.Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving [I wetting El shrouding b. If other, please specify: ❑✓ covering ❑ other 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? NIA a.Name of DEP Official N/A b.Title 09/28/2010 c.Date mm/dd/ of Authorization d.DEP Waiver Number D. Certification I certify that I have examined the NEAL COHEN o above and that to the best of my a.Print Name �o knowledge it is true and complete. The signature below subjects the b.Authorized Signature �N signer to the general statutes pM �o regarding a false and misleading c. osi ion e =o statement(s). IDIVIR CONSTRUCTION, INC. d.Re resentin e.Date(mm/dd/yyyy) �O �Q ■ DT06.Cic•10/02 B: 3 A4 06•3 Dye 3 R 3■ eDEP -MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System Usemame:DMR1326 Nickname:DMRBIDDING My eDEP I Forms'311 My Profilesm. Help a ' Transaction Overview Trans#338463 ID#100113981 AQ 06-Construction/Demolition Notification Farms Signature Payment Submit h Review and Submit your Transaction I ,.Exit t Please review your transaction.If you are satisfied,scroll down and click submit. An email confirmation will be automatically sent to the owner of this account at _....._.............._..............._-.....__................................................._......_........__............................._......._- n be@d mrco n stru ctio n.co m ................................................... ................................__..... _.....................................__....__....... If you would like to send this confirmation to others please enter their address below separated by a semicolon; .......... _................................_....._........................................._......__..............._._...................... e DEP Transaction ID:338463 Date and Time Submitted:09/28/2010 05:28:29 Other Email: Form Name:AQ 06-Construction/Demolition Notification Payment Information DEP code:49121 Date:9/28/2010 5:28:20 PM Amount($):85 Payment Detail:COHEN NEAL—AccountType—AccountNumber****5838 ConfirmationNumber: Contractor Contractor Number Name Address,, Supervisor Project Monitor Lab MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.9.8.5.1©2010 MassDEP httDs://edeD.den.mass.L-ov/Paizes/ReceiDt.asDx 9/29/2010 eDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact I Feedback i Tour I Privacy Policy MassDEP's Online Filing System Username:DMR1326 Nickname:DMRBIDDING My eDEP( Formes 90 My Profile 9W Help Receipt Forms Signature Paymnt Re©pt Summary/Receipt . print receipt,;, •.Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select"My eDEP"to see a list of your transactions. DEP Transaction ID: 338463 Date and Time Submitted: 9/28/2010 5:28:56 PM Other Email : Form Name: AQ 06-Construction/Demolition Notification Payment Information DEP code: 49121 Date: 9/28/2010 5:28:20 PM Amount($): 85 Payment Detail: COHEN NEAL--AccountType--AccountNumber****5838 ConfirmationNumber: Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab I My eDEP MassDEP Home I Contact I Feedback ( Tour ; Privacy Policy MassDEP's Online Filing System ver.9.8.5.1©2010 MassDEP https:Hedep.dep.mass.gov/Pages/PrintReceipt.aspx 9/28/2010 Page 1 of 1 Shea, Sally From: Dean Melanson [dmelanson@hyannisfire.org] Sent: Wednesday, October 20, 2010 4:45 PM To: Shea, Sally Subject: Jo-Anne Fabric Sally, We are all set with this building permit application. They have provided us with the info we needed. You can sign the permit for us. Let me know if you want me to come over and,sign it instead. Deputy Chief Dean L. Melanson Office 508-775-1300 Fax 508-778-6448 dmelonson@hyannisfire.org f 10/21/2010 COMcheck Software Version 3.8.0 Envelope Compliance Certificate 20091ECC Section 1: Project Information Project Type:Addition Project Title:Addition/Renovations to Joann Fabrics Construction Site: Owner/Agent: Designer/Contractor: 655 lyannough Road Mill Lane Management Brown Lindquist Fenuccio&Raber Hyannis,MA 02601 231 Willow Street 203 Willow Street Yarmouthport,MA 02675,MA.02675 Yarmoutport,MA,MA 02675 Section 2: General Information Building Location(for weather data): Barnstable,Massachusetts Climate Zone: 5a Activity Type(s) Floor Area Addition Gross Area(Retail) 5530 Section 3: Requirements Checklist Climate-Specific Requirements: Component NamelDescription Gross Cavity Cont. Proposed Budget Area or R-Value R-Value U-Factor U-Factor(a) Perimeter Roof 1:Insulation Entirely Above Deck 5528 — 21.0 0.046 0.048 Exterior Wall 1:Concrete Block:12",Partially Grouted,Cells 3384 13.0 3.8 0.090 0.090 Empty,Normal Density,Furring:Metal Door 1:Insulated Metal,Non-Swinging 80 — - 0.149 0.500 Door 2:Insulated Metal,Swinging 42 — — 0.157 0.700 Floor 1:Slab-On-Grade:Unheated,Horizontal with vertical 4 ft. 1192 — 10.0 — — (a)Budget U-factors are used for software baseline calculations ONLY,and are not code requirements. Air Leakage, Component Certification, and Vapor Retarder Requirements: 1. All joints and penetrations are caulked,gasketed or covered with a moisture vapor-permeable wrapping material installed in accordance with the manufacturer's installation instructions.. Lj 2. Windows,doors,and skylights certified as meeting leakage requirements. 3. Component R-values&U-factors labeled as certified. 4. No roof insulation is installed on a suspended ceiling with removable ceiling panels. 5. 'Other'components have supporting documentation for proposed U-Factors. 6. Insulation installed according to manufacturer's instructions,in substantial contact with the surface being insulated,and in a manner that achieves the rated R-value without compressing the insulation. o 7. Stair,elevator shaft vents,and other outdoor air:intake and exhaust openings in the building envelope are equipped with motorized ° dampers. r 8. Cargo doors and loading dock doors are weather sealed. 9. Recessed lighting fixtures installed in the building envelope are Type IC rated as meeting ASTM E283,are sealed with gasket or caulk. 10.Building entrance doors have.a vestibule equipped with closing devices. Exceptions. Building entrances with revolving doors. i Project Title:Addition/Renovations to Joann Fabrics Report date:09/27/10 ` Data filename:H:\_Current Projects\CommercialUo-Ann Fabric Expansion\Admin\MiscellaneousUo-Ann ComCheck.cck Page 1 of 2 +* Doors that open directly from a space less than 3000 sq.ft.in area. Section 4: Compliance Statement Compliance Statement: The proposed envelope design represented in this document is consistent with the building plans,specifications and other calculations submitted with this permit application.The proposed system has been designed to meet the 2009 IECC requiremen in lAMcheck Version 3.8.0 and to comply with the mandato equi nts in the Requirements Checklist. �l�'• Nam Title Si- a Date \ FO A q , o ►�. 10563 BARNUABLE. w ` 0' MASS. J' r f' q�TM Of MRSS�G. i - F t i Project Title:Addition/Renovations to Joann Fabrics Report date:09/27/10 Data filename:HA Current Projects\Commercial\Jo-Ann Fabric Expansion\AdminWiscellaneous\Jo-Ann ComCheck.cck Page 2 of 2 ti COMcheck Software Version 3.8.0 Envelope Compliance Certificate, 2009 IECC Section 1: Project Information Project Type:Addition Project Title:Addition/Renovations to Joann Fabrics Construction Site: Owner/Agent: Designer/Contractor: 655 lyannough Road Mill Lane Management Brown Lindquist Fenuccio&Raber Hyannis,MA 02601 231 Willow Street 203 Willow Street' Yarrnouthport,MA 02675 MA 02675 Yarmoutport,MA,MA 02675 Section 2: General Information Building Location(for weather data): Barnstable,Massachusetts Climate Zone: 5a Activity Tvae(s) Floor Area Addition Gross Area(Retail) , 5530 Section 3: Requirements Checklist Climate-Specific Requirements: Component Name/Description Gross Cavity Cont. Proposed Budget ` Area or R-Value R Value U-Factor tl-Factor(a) Perimeter Roof 1:Insulation Entirely Above Deck 5528 — 21.0 0.046 0.048, Exterior Wall 1:Concrete Block:12",Partially Grouted,Cells 3384 13.0 3.8 0.090 0.090 Empty,Nonnal Density,Furring:Metal Door 1:Insulated Metal,Non-Swinging 80 — — 0.149 0.500 Door 2:Insulated Metal,Swinging 42 — — 0.157 0.700 Floor 1:Slab-On-Grade:Unheated,Horizontal with vertical 4 ft. 1192 10.0 - — (a)Budget U-factors are used for software baseline calculations ONLY,and are not code requirements. Air Leakage, Component Certification,and Vapor Retarder Requirements: ❑ 1. All joints and penetrations are caulked,gasketed or covered with a moisture vapor-permeable wrapping material installed in accordance with the manufacturer's installation instructions. ❑ 2. Windows,doors,and skylights certified as meeting leakage requirements. ❑ 3. Component R-values&U-factors labeled as certified. - ❑ 4. No roof insulation is installed on a suspended ceiling with removable ceiling panels. ❑ 5. 'Other components have supporting documentation for proposed U-Factors. ❑ 6. Insulation installed according to manufacturer's instructions,in substantial contact with the surface being insulated,and in a manner that achieves.the rated R-value without compressing the insulation. ❑ 7. Stair,elevator shaft vents,and other outdoor air intake and exhaust openings in the building envelope are equipped with motorized dampers. ❑ 8. Cargo doors and loading dock doors are weather sealed. s meeting ASTM E283 are sealed with gasket or caulk. ❑ 9. Recessed lighting fixtures installed in the building envelope are Type IC rated a m g _. g ❑ 10.Building entrance doors have a vestibule equipped with dosing devices. Exceptions: ❑ Building entrances with revolving doors. Project Title:Addition/Renovations to Joann Fabrics Report date:09/27/10 Data filename:Hft Current Projects\Commercial\Jo-Ann Fabric Expansion\Admin\Miscellaneous\Jo-Ann ComCheck.cck Page 1 of 2 Doors that open directly from a space less than 3000 sq.ft.in area. Section 4: Compliance Statement Compliance Statement: The proposed envelope design represented in this document is consistent with the building plans;specifications and other calculations submitted with this permit application.The proposed system has been designed to meet the 2009 IECC requiremen in COMcheck Version 3.8.0 and to comply with the mandato equi nts in the Requirements Checklist. 44Z? 2 ZdG� Nam -Title Si a Date o No. 105643 t t g 8ARF1Sk;,BLE, w` 0, MASS. q�Ty OF 1R�`SSP Project Title:Addition/Renovations to Joann Fabrics Report date:09/27/10 Data filename:HA—Current Projects\CommerciaNJo-Ann Fabric Expansion\Admin\Miscellaneous\Jo-Ann ComCheck.cck Page 2 of 2 *` Massachusetts- Department of Public Safety Board of Buildin-, Regulations and Standards Construction Supervisor License License: CS 54914 � - �1 Restricted to:, 00 D R COHEN�RICHAR 11 WESTFIELD DRIVE BROCKTON, MA 02301 Expiration: 10/7/2011 ('ununissiuuer Tr#: 6592 J ACORQ' CERTIFICATE OF LIABILITY INSURANCE °A'� i7 09/27/2010 ' 2010 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 WANED, 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)237-1515 Fax 781-237-1805 CONTACT DELAND,GIBSON INSURANCE ASSOCIATES,INC. ME: John Akerman P O BOX 81266 M.No E,a: [FAX E-MAIL ac rm WELLESLEY HILLS MA 02481 ADDREss: Jakerman@delandgibsonins.com PRODUCER CUSTOMER ID: 666 INSURED INSURERS)AFFORDING COVERAGE NAIC 0 D M R CONSTRUCTION,INC. INSURERA :Valley Forge Insurance Company 229 MAIN STREET INSURER :Transportation Insurance Company NORTH EASTON MA 02356 INSURER :Commerce Insurance Company INSURERD: Valley Forge Insurance Company MSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 55198 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, INSR ADDL SUBR LTR TYPE OF INSURANCE INSR VW0 POLICY NUMBER MN POLICY Eff POLICY EXP LIMITS A GENERAL LIABILITY GL2097364278 05/23/10 05/23/11 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY - DAMAGE TO RENTED PREMISES Ea oca,rence $ 100,000 CLAIMS-MADE I X OCCUR MED.EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN•L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC C AUTOMOBILE LIABILITY $ I OMMZP9270 O5/23/10 05/23/11 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS - BODILY INJURY(Per person) $ X SCHEDULED AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS PROPERTY DAMAGE (Per accident) $ X NON-OWNED AUTOS I $ B :UMBRELLA LIAR X OCCUR CUP2093220784 05/23/10 05/23/11 EACH OCCURRENCE 5,000,000 DCCE39 LIAB CLAIMS-MADE AGGREGATE 5,000,000 DEDUCTIBLE X RETENTION $ 10,000 D WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY WC413688093 02/27/10 02/27/11 we rAru YIN TORY LIMBS OTH $ �' PROPERIME IETORIEXCLUDE/EXECUTNE E.L.EACH ACCIDENT 5,00„000 OFFlCERMEMBER EXCLUDED'! N/A (Mandatory in NN)and E.L.DISEASE-EA EMPLOYEE $�OQ��QOO tl Yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 5,00„000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) II PROJECT: ADDITION TO JOANN FABRICS AND CRAFTS CERTIFICATE HOLDER CANCELLATION TOWN OF BARNSTABLE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BARNSTABLE,MA 02601 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Attention: 4 . ACORD 25(2009/09) Be rly S.Wiseberg The ACORD name and logo are registered marks of ACORD J t of THE lob i - i HARNSTABLE, • . >1'i619• Town of Barnstable �m , prfA MA'1 A Regulatory Services Thomas F. Geiler, Director Building Division Thomas Perry, CBO Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fav 508-790-6230 Property Owner Must Complete and Sign This Section Zf Using A Builder I, Char]PG r Ri1 A-7;kiap as Owner of the subject property DMR Construction. Inc. to act on m behalf, hereby.authorize - Y in all matters relative to work authorized by this building permit application for: Jo-Ann Fabrics at Christmas Tree Promenade 665 Iyannough Road (Rte. 132) Hyannis, MA (Address of Job) - I 9/28/2010 Signature of Owner Date Charles G. Bilezikian Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. QAWHILESVORMMuilding pennil rormslEXPRESS.doC Revised 072110 r , ARCHITECT CONSTRUCTION CONTROL AFFIDAVIT Project Name: Jo-Ann Fabrics Project Title: Alterations to Jo-Ann Fabrics Project Location: 665 lyannough Road (Rte. 132) Hyannis, MA Scope of Project: Addition of approximately 5,500 sq.ft. of retail space to thesear of existing store Architect: Brown Lindquist Fenuccio& Raber Architects, Inc. In accordance with paragraph 116.0 of 780 CMR, the Massachusetts State Building Code, I, Kurt E. Raber Massachusetts Registration Number 10563 being a registered professional Architect hereby certify that all plans, computations and specifications, and changes thereto, involving subject project will be prepared by or under the direct supervision of a Massachusetts registered architect or Massachusetts registered professional engineer and bear his or her original signature and seal or by the legally recognized professional performing the work, as defined by Massachusetts General Law(M.G.L.)c. 112, §81 R. For the above named project I, or a registered professional architect/engineer under my cognizance, will review the design concept, shop drawings, samples and other submittals which are submitted by the contractor in accordance with the requirements of the construction documents. I will review and approve the quality control procedures for all code-required controlled materials. further certify that I will be present on the construction site at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine, in general, if the work is being performed in a manner consistent with the construction documents. Pursuant to 780 CMR 116.2.3 I will provide the results of structural tests and inspections to the building official and owner. I will submit, periodically, a progress report with all pertinent comments of the'site visits and compliance of all pertinent items to the building official. I port as to the satisfactory completion and the readiness of the project for occ �� '4, . 1055 1 3_ — TIX V Architect Kurt E. Raber o amass. aa Date ti G P Fqt r Subscribed and Sworn to, before me is day of 2010, the undersigned notary public, personally a peared 'f` provide to me through satisfactory evidence of identification, which is v to be the person whose name is signed on the preceding or attached document, and acknow edged to me that he signed it voluntarily for its stated purpose. i 310 /`7 Notary Public Notary Pubtfc a Notary Commission Expires 6omnarIlh of Commission"Expires on Mat 1%mt7 ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #Z Health Division Date IssuedAJ Conservation Division Application Fee 116 CV Planning Dept. Permit Fee 1 Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street Address 6 s 5 _-�'� w►����J �3 _P� 2 Village 41ANN IS - Owner MILL LRN� IIA&IYIT 1NG - Address 231 WILI.vW S-P' Y�2MOVr(tpoa,T Telephone ;0 8- 3'15 - 0 0 05 Permit Request Mf F 94 0 �- 6 NG 1 L g V I VLt- D NO S�RUr✓1U1Z.19L / L�t/Zc"K/TM- Qi!/!tj Square feet: 1 st floor: existing proposed A 2nd floor: existing proposed N ,A Total new Zoning District Flood Plain Groundwater Overlay Project Valuation x00 000 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) T Age of Existing Structure Historic House: ❑Yes "No On Old King's Highway: ❑Yes )�No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other II� Basement Finished Area(sq.ft.) N' A Basement Unfinished Area(sq.ft) OVA Number of Baths: Full: existing new Half: existing A new Number of Bedrooms M14 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 0 New _ Existing wood/coal stove: ❑Yes WNo Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑.existing ;0 new ,size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:', Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ a Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed UseJ APPLICANT INFORMATION a ` (BUILDER OR HOMEOWNER) 4F�• v s�o p Name WNW=== Telephone Number •�V l�� Y 2 �� D Address G/y��!?���i� License # l a�� M�•/� � � SY/77_ � Home Improvement Contractor# ft PVO ;V*9)/r OZ�Io � Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE c r I I ' > FOR OFFICIAL USE ONLY APPLICATION# -DATE ISSUED hi.1,7,, ' . MAP../PARCEL NO, ? ADDRESS- VILLAGE ` ! ` OWNER ' DATE OF INSPECTION: 'FOUNDATION;-. f i FRAME S �r INSULATION N. ' is FIREPLACE " ELECTRICAL: ROUGH FINAL ` PLUMBING: ROUGH FINAL - -i G. +e '-�ROUGH ��, if :; FINAL _ i .._ - - - 1 'FI,NAL BU-ILDING '' ' _ :DATE CLOSED OUT . ASSOCIATION PLAN NO. Kurt Raber. From: Itdon [Itdon284@verizon.net] Sent: Wednesday, March 02, 2011 9:27 AM To: tom.perry@town.barnstable.ma.us; Kurt Raber. Cc: dmelanson@hyannisfire.org; dchase@hyannisfire.org;jcosmo@hyannisfire.org Subject: Jo-Ann Fabrics-all set for permitting interior rehab. Jo-Ann Fabrics # Plan review-3/2/2011. (Notes for Kurt) Interior renovations Construction. Type= III-B Exits-ok, travel distances-ok, egress-ok, no additional sprinkler.work in,existing store.- A231 Plans show retail space to take up 50% +-of new addition Storage space for new stock will be limited. - No stockpiling of commodities will be allowed outside the building due to lack of warehouse space. A231 -South and West egress paths are to remain clear and accessible at all times. -Compactor alley containing egress from adjacent.tenant shall remain clear and accessible at all times. - E101 - Lighting plan-explain "bale storage"outside west exit. (see A231 above) SP101 - Project meetings (012000) (B. Include fire department in re-construction meeting. P 9 C. Include fire department in at least 1 progress meeting. Occupancy Inspections - Provide required Fire Alarm and Sprinkler NFPA test documents prior to or during the final inspection, (NFPA 72 and 13)This would include the sprinkler above ground and 200#test report. r - Provide certification, on company letterhead, attesting to the installation (to NFPA code) of all fire protection systems. , - Documentation may be faxed to Hyannis Fire.Department @ 508-778-6448 or provided during inspection. i Any questions or assistance needed;-feel free to call the office @ 508-775-1300 Fire Prevention Lt. Donald H. Chase, Jr., FPO Fire Prevention Officer Hyannis Fire Department ' 508-775--1300 (w) 508-778-6448 (f) dchase _hyannisfre.org i i i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations - i 600 Washington Street Boston, MA 02111 N www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeZibly Name (Business/Organization/Individual): tM WW-44'0 3—a— Address:.O'3 W46w g}' • SWet e— A City/State/Zip: 1�✓w�6rt.- ,/�- _ OA/V"Phone #: dQQEl'' SCO2.^ o92, Are you an employer?Check the appropriate box: Type of project(required): 1.M'II am a employer with 4. 0 I am a general contractor and I 6. ❑ .New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and have no employees These sub-contractors have _ 8. ❑ Demolition working for me in.any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 1 I.El Plumbing repairs or additions myself. [No workers' comp. c. 152, §,1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who 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 their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ( V (X Policy#_or Self-ins. Lic. #: Expiration Date: Job Site Address L City/State/Zip: Attach a copy of the workers' compensatioupolicy declaration page(showing the policy num Per and expiration date). " Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties-of a fine up to-$1,500.00 and/or one-year imprisonment,as.well as civil penalties in the form of a STOP.WORK ORDER and a fine of up to$250.00 a day against the.violator. Be-advised that a copy of this statement may be forwarded to the Office of .. Investigations of the DIA for insurance coverage verification. 1 do hereby Gerd nde ins and penalties of perjury that the information provide above is true and correct Si ature: Date: zz Phone#• ` 2-- 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#: d -,� .tom -�,,'',a.,f e: �'� .. �a >y,Iv.'..S k. ; ,�« d.. �:+�sA' ,Y;�.,�„ � 's � X„u'�,.n f �� h a D M, ,t p y l - V1 [9 �� K N �� � � 1 r: ��55ii L p, s� 9 - rµ+.. '� ��r � jnr t,u ���9..i�.r1 � � ) YV i,�„�f �* Y�Lx yM1�Trc � lr,;•�� ,Y � -- ~ ,.,� .,.�,. t - t' A '� ...s' P:..� �.� r��- i f! �'+ � fi ,r t t �s �� �.!4€ , ,j-ryt..'' t. u•.t � �'.a 7 i rt l N ft '� .s • � . k 3 �.�!�„� "a �'rs.�h�'L�" _ � yam.. "�..r y q`Y A,,{i,9. �} ! Lt .1 y ; � � ` `� e rt h ,: .' ` � �� �, . _..: x 08/24/2010 14:00 5084209227 MARK W SYLVIA PAGE 01 r1N DT. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DQ/Yyyy) 08/24/2010 rk Sylvia Insurance Agency (506)428.OdaQ THIS CERTIFICATE IS ISSUED AS A M A17ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1 Main Street HOLDER- THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, ervills MA 02655 INSURERSAFFORDING COVERAGE NAIC wn,Lindquist,Fenuccio&Raber Architects INSuRp A: Farm Family Casuals Insurance Inc 203 Willow St Suite q INSURER B: Travelers - — Yarmouthport,MA 02675 L RERC: — RER D: - COVERAGES RER E: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 VIIITH RESPFCT TO WHICH THIS CERTIFICATE MAY sE ISSUED OR MAY PERTAIN,RE INSURANCE AFFORDED BY THE POLEEN R ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOyy(N MAY HAVE SEEN REDUC>p BY PAID CLAIMS, INSR DD' - ?OLICY EFFECTIVE POLICY EXPIRATION POLICY NUMBF,R GENERAL LIABILITY LIMITS A 2001X0670 EACH OCCURRENCE g 1,000,000 CpMMERCIAL GENERAL LIABILITY 7116/2010 7/10/2011 AM EN CLAIMS MADE D OCCUR !mg.M1&E ur:apccymDLg)_ $ 150,005 , �xx BUSINESSOWNERS MEDEXP(Anynne pardon _ 5,000 LIABILi �' PERSONAL&ADV INJ�7RY $ GE,N'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $ 2,000,000 POLICY PRO- LOC PRODUCTS,-COMP/OPAGG S Z,000,QQQ B AUTOMOBILE LIABILITY ANY AUTO DA-1262P658-09-SEL 10/8/2009 10/8/2010 COMBINED SINGLE LIMIT ALL OWNED AUTOS (Ea accidenq S 1,000,000 _ pvxl SCHEDULED AUTOS BODILY tNJURY (Per PnrmQn) gGARAG. RED AL rrOg d ON-OWNED AUTOS BODILY INJURY (Pwr Accident) $ PROPERTYDAMAGE LIABILITY (Per Accident) $ YAUTO AU700NLY-EAACCIOENT 91OTHER THAN EAACC $/UMBRE(.LA LIABILITYAUTO ONLY: AGG $ CUR CLAIMS MADE EACHOCQURRENCF ._-$ AGGREGATE tOPFICGRIMEMBER EDUCTIBLE — $ FrENnaN g $ - OMPENSATION AND $ EMPLOYERS'LIABILITY 200IM662 3/2211010 uVC&rnrU• X oTfa_ TORIPA"NER/EXECUTIVE 3�2!2011 •.TJ7SlLLIMIT _ E BER EXCLUDED? E,L EACW ACCIbEwTe underNO OTHERvISIONs holmy E.L.DISEASE-EAEMPLrnEF $ 500,000 OTHER E.L,018EASE•POLICY LIMIT S 500,000 ryESCRIPTION OF OPF,RATIONS I LOCATIONS/VEFIICLESJ EXCLUSIONS ARCHITECTS' AObED BYf,NDORS@MpNTf SPECIAL PROVISIONS 'CERTIFICATE HOLDER CANCELLATION (508)24"$10 SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEt)BEFORE THE EXPIRATION - DATE THEREOF,THE ISSUING INSURER WIU ENDEAVOR TO MAIL DAYS'- NOTICE TO TWC CERTIFICATE HOLDER NAMED TO THE LEFT,aUT FAILURE r0 DO SO SHALL WRITTEN i IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,URER, REPRESENTATIVES, ITS AGENTS OR AUTHORIZED REPRESENTATIVE ACORD25(2001/08) 9D ACORD CORPORATION 1988 ' ` - Fold,Then Detach Along All Perforations ONfICI�NEALTH OF MASSACk1SETTS BOARD ARCHITECTS = AR ASus�S�IiEiEtTET v�i 3 TYPE RABER a. r F �0_3 WILL'9W e:ST y SW�TER,,A ,o � YARMt©kTHP0R1 y�'MA 02675 177©� } 866273 { Fold,Then Detach Along All Perforations t. i S Trti Town of Barnstable. Regulatory Services n x,�xxsrAsr.E, v NAM � Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-740-6230 r Property Owner Must Complete and Sign This Section If Using-A Builder I, ep �� �1N r/Vl1L� �,d�1VE h�lG r/�d'�s,Owner of the subject property hereby authorize ( ,AZAq S /L&act on my behalf, in all matters relative to work authorized by this building permit application for - (Address of Job) Z-z Signature o ate f Owner. D Y Print Name x If Property Owner is-applying for permit"pleas e complete:the Homeowners License Exemption Form on the reverse side:. Q:FORMS:OIA NERPERMISSION Town of Barnstable �pIHE 1p� Regulatory Services BARK.-reBLF, ; Thomas F. Geiler,Director Building Division rfD '� Tom Perry,Building Commissioner 200 Main-Street, Hyannis,MA.02601. www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 130)\'IEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village 'HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was,extendrdjo,include owner-occupied dwellings off six units::dr less and to allow homeowners to engage an individual€or hu'c'"vrho ddest 't possess`a Imense,provided That the owner acts as supervisor. W s �• , E 7NTIT,ONp OF'H'®WO*E T-1 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 constrgcts more than one home in a two-year period shall not peocopsidemd a.bomeoavner. Such "homeowner"shall submAo the Bu4ding`.O;fE r�l n�a"f4n-L,atceptab16Ap°the Bi lffij�dffcial, that he/she shall be responsible for all such work performed under the'buildin�gFertntt.•`(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 Departrnent m;n;r.,um inspection procedures and requirements and that he/she will comply with said procedures and 4 _ requirements. Signature of Homeowner 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 1 D9.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a pe son(s)for hire to do such work,that s�utch Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they an 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 x)icensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responnbilities,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:forms:homccxempt TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION GG Map Parcel Permit# Health Division Date Issued Zi Conservation Division ,- .3;�* Application Fee 1 Tax Collector r" '- t,. t Permit Fee i0v _1 Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address Village 0" fit STA-lks _ 10 Owner Address /VocZf Telephone g —2t Permit Request — Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count ` Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: O Yes 0 No Detached garage:0 existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE _ DATE t� FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH r !FINAL PLUMBING: ROUGH FINAL GAS: ROUGH -'FINAL ' FINAL BUILDING f DATE CLOSED OUT ASSOCIATION PLAN NO. - TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ( Parcel TOWN OF BA€NSTABLE Permit# Health Division Date Issued Conservation Division `s APR -3 � �' Fee ig Tax Collector „ GjDn Treasurer a IOPt Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address nW 2ABQ C LS Village &• its,—M)cs _ Owner Address Telephone 4Y-ANWLS Permit Request � a Qa i tr (Z 2vwo C, r Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric Cl Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:O existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: ❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION D Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE � � J PCi A A)!) FOR OFFICIAL.USE ONLY z - rz PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL c=s 1 k PLUMBING: ROUGH FINAL 1 GAS: ROUGH FINAL r FINAL BUILDING z - • DATE CLOSED OUT ASSOCIATION PLAN NO. ' :a F o rn 00 to CG4 T� in 4 e SIT 1 q, 7a Vim" g al .sTo R 1 ` 5 qCE peir �04 — 3 ( 3 ROUTE 28 �o 7 z 3) ca r-� 70 o 0 LOCUS MAP (NOT TO SCALE) h m Q cv lJ U H IN. 4 / 0 o i S / k lv \ ©N�RETE g a� REVISIONS S f o� $ SY itS TORE 9 9 55 z s 4 STORE d' 0 0 0 \ © g g o STARE �� o �' \ 8 9 RE3 5 1 �/ m STC 4�� / > m s u ° �o AS TREE SNCP 5 (n o 0 cc REMOVE CROBOWFLX 2 514RE# ST CAE Z4;���' • \ - ------ f \ 9 / FOR DETAILS OF ROUTE 132 ENTRANCE AND CURBS 9 FOR DETAI OF 9 SEE DWG. S-8/ ROUTE 28 URBS V WIDE LANDSCAPED WRX �' ISLANDS (TYP.I / d. AND ANCE SEE $ /� , � D NO. S-8 \ 6 ` v , co N MBOL D REt TEAM C-SSM / t~ , Lo f .. 00 4" PROPOSED SIGN Z Ln \ rb �jf X PROPOSED 11 ct2 9 Cl 9 / C� °. \ 9 ! LiLn 3 3 � 4 \ 4 2 3 \ J � (3f ! i cr- ce m \ APp�,OX N / m NOTES,— F..� 3 Wz m � � ToeE Z � 1. THIS DRAWING TO BE READ IN CONJUNCTION �� ADDED � ,,,� ,� TDT� lv OF SAS M THIS AISLE REDUCED WITH RLL OTHER SITE DRAWINGS FROM 25 TO 2+. � • U� tV . cl: (rl ® s 0 uj H I—' o _ O V oz Dac. W.