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HomeMy WebLinkAbout1168 IYANNOUGH ROAD/RTE132 i I �� �a�.��� �-� � .� � poi ` TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION n - ... ..F - .. Map k2774 Parcel' o q t�on Application #06 Health Division 6���_ Date Issued l (O l Conservation Division Application Fee Planning Dept. Permit Fee. gob bate Definitive Plan Approved by Planning,Board Historic - OKH Preservation/ Hyannis t Project Street Address l�6 S =YGi. h►no y Gr E-1 !Z.o 14D Village Owner�M jav►`hs tq,�'('� GEC- Address- '? 5. BOY. 96o0644,, Telephone Permit Request Square feet: 1 st floor: existing 11,2600 proposed 4A- 2nd floor: existing proposed Total new Zoning District Flood Plain >N 4 Groundwater Overlay Yes Project Valuation 0 1 1�(� Construction Type Lot Size 1,6Z AU Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure ZS Historic House: ❑Yes �4No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other 11 ot%c Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing C1s new ; Number of Bedrooms: — existing _new Total Room Count (not including baths): existing new First Floor Room Count€ , Heat Type and Fuel: �1 Gas ❑ Oil ❑ Electric ❑ Other -- Z6 Central Air: ❑Yes 14 No Fireplaces: Existing New Existing wood/`coal stove: ❑7d's ❑ No : a r Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing Qnevrl'size _ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # 'NA Recorded ❑ Commercial PkYes ❑ No If yes, site plan review # Current Use Vacavit Proposed Use APPLICANT INFORMATION BUILDER OR HOMEOWNER) Name + ► E I " <i A6 ., i,f , Telephone Number 570 -a U Address I EFQf2_Q �' P.O. 60k 9t.3 License # C.S l 9 1 `1 S _ e 14 • 6 Lg 4 O Home Improvement Contractor# Worker's Compensation # A ICA 2 9 9 D I Do ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 73®02N;F .60i-Jo R L SIGNATURE DATE Y / / as Ma►�a�er f :♦ FOR OFFICIAL USE ONLY APPLICATION# , a DATEISSUED MAP/PARCEL NO_ t r� ADDRESS _ VILLAGE , OWNER`S ✓ i art- J--y ro DATE OE INSPECTION: r f _FOUNDATION —' FRAME INSULATION: FIREPLACE { ELECTRICAL: ROUGH y-� FINAL I' PLUMBING: ROUGH FINAL GAS: t_. ROUGH m FINAL -FINAL BUILDINGi' r DATE CLOSED OUT r ASSOCIATION PLAN NO. 9 - l f One NSTAR Way,SW330 EL EC TA/C Weshvood,MA 02090-9230 GA S phone J FAX 781-041-3334 justin.reihI&Star.com November 4, 2011 Atlantis lyanough Realty P.O. Box 960696 Boston MA 02196-0696 RE: 1168 Route 132 - Hyannis WO# 01847013 To Whom It May Concern: At NSTAR, we're committed to delivering great service. This letter serves as confirmation that, as of October 11, 2011, the electric service to 1168 Route 132, Hyannis, has been removed. Based on this information, there is no electric power at this address and you may proceed with the demolition. If you have any questions, please contact me at (781)441-3334. Sincerely, Justin Reihl New Customer Connects y , national rod R November 2, 2011 . Atlantis I anon h Realty LLC. Y 9 Y Attention: William O'Brien Re:-1166R Ivanouah Rd., Rear. AKA#1168. Hyannis. MA. This letter is to notify you that the gas. service to 1166R lyanough Rd, Rear, AKA#1168,Hyannis, MA. has been cut off on 10/29/2011. Sincerely, Diane E. Camara National Grid _. -Gas Customer-Fulfillment, - 781-90.7-2927 781-522-1058 fax 40 Sylvan Road E-2 - - Waltham, Ma 02451 OFTNE'T Department of Public Works 4 d Yarmouth Rd. P.O. Box 326 Water Supply Division nis,M BARNSTABLE, vy26 6 yQ MASS. g -77 63 vpTa639- ��� Hyannis Water System Operations • FAX: 3 ED MA'S November 7, 2011. Town of Barnstable Building Inspector Town Hall Hyannis, MA 02601 RE: 1168 Iyannough Road Hyannis, MA Dear Sir: Please be advised that Robert B. Our located the (1) one inch service. It has been disconnected from the corporation and abandoned in place. The corporation has been capped. We have been informed by the owner that the building is going to be demolished. If you have any questions, please call the office at (508) 775-0063. Sincerely, ayne rtarck Hyannis Water System C0Vlf(q(Ad1_ The Commonwealth of Massachusetts Department of Industrial Accidents : Office of Investigations 600 Washington Street Boston, MA 02111 `'" •�°'•� www.mass.gov/dia Workers' Compensation Insurance Affidavit:.Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Itidividual)': LAVJP-let-►c—i L`f,N Cb\ W0Zf Address: q,le C� o_o S- P . ®k 13 3 two C� City/State/Zip j _gyp 121A , 02.Sgo Phone#: IDO' 5ff'% I$fl0 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 9. [ Demolition working for me in any capacity. employees and have workers' � 9. ❑Building addition [No workers' comp.insurance comp. insurance. 10.0,"Electrical repairs or additions required.] 5. We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself.,[No workers' comp. :right of exemption per MGL 12:❑Roof repairs'" insurance required.] t c. 152, §1(4), and we have no q ] 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. Icontractors 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: -1 co(Z fl Policy#or Self-ins. Lic. M "A�LCW 9R 9 4 1 I 0 Expiration Date: !-2— Job Site Address: I 1 boo `l°�/ �. .�. City/State/Zip:q*Nf� j6S . MA 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$250.0.0 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 certi nder thepains" nd pe aloes of perjury that the information provided above is true and correct " Signature: Date: /.C .Zak' 1 Phone#: J OO S4 Iff®0. 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#: t 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 of repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employmentbe deemed to7 be an employer.." IviGL 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-contractors)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 Pl ease be sure that the affidavit is completeand d 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 regardingthe applicant. Please be sure to fill in the�perriut/license number which will be used as a reference number.: In addition,an applicant that must submit multiple p.ermitilicense 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 locationsryiu_i % (city or _ town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this 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. ddress,telephone;and fax number:. The Department's a The Commonwealth of Massachusetts ' Doparkment of Industrial Accidents Office of Investigations 60TWAshingt6h Stroet Boston,MA 02111 Tel. # 617-7227-4900 ext 406 or 1-877-NIASSAFE .Fax#-617-727-7749 Revised 1 I'-22-06; www.mass_.gov/dia From: Lawrence Lynch 5085486917 11/08/2011 15:56 #063 P.006/007 . � CERTIFICATE F LI ILI` .I U 'A CF11/ DATE(Mfi6lDO/Y^Y) �-/ 7/2011 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 POLIdIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE / CONTRACT BETWEEN THE ISSUING INSURER(S), AUTF)Oc I ED 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 am endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such.endorsement(s). PRODUCER COONNTACT The Driscoll Agency, Inc. •. PHONE Fax 93 Longwater Circle Arc No E:t: 81-681- A/C,No:'7g - 81- 686 E-MAIL P.O. Box 9120 ADDRESS: jbd@driscol1 agency.com Norwell MA 02061 PRODUCER CUSTOMER ID 1):313 0 INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURERA:Old Republic General Ins Corp Lawrence-LynphCorp. 396 Gifford St. INSURERB:Star indemnity Liability Company _ Falmouth MA 02540 INSURER C:Travelers Indemnity Co. of CT 25682 INSURER D: - INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:405486464 REVISION NUMBER: THIS IS TO.CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE SR ADDL UBR POLICY EFF POLICY EXP NSR WND POLICY NUMBER MMfDD/YYYY MMIDD/YYYY LIMITS" A GENERAL LIABILITY A2CC99941100 4/1/2011 4/1/2012 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY - D C' O TED 300,000 PREMISES Ea occurrence $ CLAIMS-MADE a OCCUR_ MED EXP(Anyone person) $5,000 X Blkt Contractual PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY X ROT LOG $ A AUTOMOBILE LIABILITY A2CB99951100 4/1/2011 4/1/2012 COMBINED SINGLE LIMIT $1,Ooo,o00 (Ea accident) X ANY AUTO " BODILY INJURY(Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY(Per accident) $ X - - PROPERTY DAMAGE $ HIRED AUTOS - .. (Per accident) X NON-OWNED AUTOS $ X $1,000 Ded, Comp/Coll $ E UMBRELLALIAB X OCCUR SISCCCL00016411 4/1/2011 4/1/2012 EACH OCCURRENCE $10,000,000 X E)(CESSLIAB CLAIMS-MADE AGGREGATE $10,000,000 DEDUCTIBLE $ X RETENTION $N/A $ A WORKERS COMPENSATION A2C4199941100 4/1/2011 4/1/2012 X WC STATU X OTH-. USL&A AND EMPLOYERS'LIABILITY Y/N ORY IMTB ER .ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A EL.EACH ACCIDENT $5D0,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500,000 IF yes.desalbe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,b00 O Contractors Equipment QT660739X9338 4/1/2011 4/1/2012 Sched & Unsched See Policy Leased/Rented Equipment- - - ax Per Item: $500,000 Inscallat.ion Floater Limit Per Job Site: $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS rvEHIC LES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: Stop & Shop Site, Route 132 & Attuck Lane, Hyannis See Attached. . _ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Barnstable Building Department 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis MA 02601 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD as Board - Dcpu'rt►I tn,n fan hStandar'ds BouC Construction Rcuu Construction Supervisor License License: CS 19775 RICHARD D., ROBBINS 19 SHALLOW POND LN HATCHVILLE, MA 02536 Expiration: 1014/2013 Tr#: 4372 ('ummis.iuna•t t �OETHE T Town of Barnstable a a Regulatory.Services y BAABM ASSS, Thomas F. Geiler,Director 163 9,.ca Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder; k r, f (,(,G , as Owner of the subject property. here by authorize /(AAR 0 00513 114 S to act on my behalf, in all matters relative to work authorized by this building permit application for: CO S _t do c®e (A dress o Jo ) Signature of Owner a5 Mgv►a�er Date . kow C h a v� Print Name If Property Owner is applying for permit please complete the 3 Homeowners License Exemption Form on the reverse side. Q:FORMs:o WNEPPERmissioN Town of Barnstable THE y� Regulatory Services (+ HARNSTABLE, Thomas F. Geiler,Director MASS. a 1639. Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Offi3e: 508-862-4038 Fax: 508-790-6230 HOMEOWNER 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 extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF ROMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,.attached or detached structures accessory to such use,and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such `-homeowner"shall submit to the Building Official on a form acceptable to the Building.Official, that he/she shall be responsible for all such work performed under the building?permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned "homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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 109.1.1 -Licensing of construction Supen�isors);provided that if the homeowner engages a person(s)for hire to do such wo-k,that such Homeowner shall act as supervisor. Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Ruses&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a-fonn/certification for use in your community. Q:fcrms:homeexempt The Commonwealth of Massachusetts William Francis Galvin' -... Page 1 of 2 The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth, Corporations ` Division xre ''} ` One Ashburton Place, 17th floor Boston, MA 02108-1512 Telephone: (617) 727-9640 0 ATLANTIS IYANOUGH REALTY LLC Summary Screen Help with this form ut R?-guest a Certicafe= The exact name of the Foreign Limited Liability Company (LLC): ATLANTIS IYANOUGH REALTY LLC Entity Type: Foreign Limited Liability Company (Luc Identification Number 000925271 Date of Registration in Massachusetts: 05/25/2006 The is organized under the laws of: State: DE Country: USA on: 05/24/2006 The location of its principal office: No. and Street: 1385 HANCOCK STREET City or Town: QUINCY State: MA Zip: 02169 Country: USA . The location of its Massachusetts office,if any: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: CORPORATION SERVICE COMPANY No. and Street: 84 STATE ST. City or Town: BOSTON State: MA Zip: 02109 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First, Middle.; Last, Suffix Address, City or Town, State, Zip Code MANAGER . JOY A. BEATRICE 40 MCLAREN RD. TEWKSBURY, MA 01876 USA http://corp.sec.state.ma.us/corp/corpsearch/CorpS earchSummary.... 11/1/2011 The Commonwealth of Massachusetts William Francis ..Galvin -... Page 2 of 2 MANAGER KAY CHAN 165 CLEAR POND DR. WALPOLE, MA 02081 USA The name and business address of the person(s) authorized to execute,. acknowledge, deliver and record any recordable instrument purporting to affect an interest in real property Title Individual NameAddress (no PO Box) First, Middle, Last, Suffix Address, City or Town, State, Zip Code REAL PROPERTY JOY A. BEATRICE 40 MCLAREN RD. TEWKSBURY, MA 01876 USA REAL PROPERTY - KAY CHAN 165 CLEAR POND DR. WALPOLE, MA 02081 USA Consent Manufacturer — Confidential _ Does Not Require Data Annual Report X Resident For Profit Merger Allowed Partnership Agent — Select a type of,filing from below to view this business entity filings: ALL FILINGS Annual Report Annual Report-Professional. Application For Registration Certificate of Amendment MINE"' ilm S sl ��',New Sea ch�` . n9 �s �R�u aQ � Comments ©2001 - 2011 Commonwealth of Massachusetts 0 AlIRights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.... 11/1/2011 From:Lawrence Lynch 5085486917 11 /08/2011 15:55 #063 P.002/007 Y. • 7Massachusetts Department ct Environmental Protection Bureau of Waste Prevention a Per Quality �0©'37648 � ` Decal Number Notification Prior to Construction or Demolition or..: Important: �rQ out A. Applicability forms on the E- . omxrmputer,ast: . only the tab lacy A Construction or Demolition operation of an Industrial,commercial, or institutiorial building,or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection use ret not DEP).Bureau of Waste Prevention-Air Qualm Control R ulatiorns 310 CMR 7.09. Notfcation or use the return ( � � ley. Construction or Demoli ion opetations is required under 310 CMR 7.09(2)ten(10)days prior.to any work being performed.The following information is required pursuant to 310 CMR 7.09. near.. B. General Project Description 1. a.is this facility fee wwrnpt-.-city,town,district,municipal housing autharRjr,owner-occupled Instructlo� residence offour units or less? Yes ❑No 1.All sections of -b.Provide blanket decal number if applicable: Blanket Decal Number this form must be completed in order 2 Facility InfonrtatiOR: to comply with the ty Depart®terrt of E.B.MARINE Envinvrmnrerrtal Protwftn a.Name notifxation iIss rfANNOUGH ROAD . requirements of b"Address 310 ct,R 7.09 Barnstable MA 02609 f.Tehmharte Number area code and eztenslon E-rnJ Address 1200 1 h.Sim of Fadrrty In Situate Feet t.Number of Floats j..Was the facility built priorV 1980? ❑ Yes F-11 No k-Descnbe the current or prior use of the facilitf.. COMMERCIAL FOR REPAIRS AND SALES OF MARINE EQtM. I.Is the facility a residential facility? ❑ Yes R1 No 4 o m If yes, how many units? Number of Units 0 3. Facirdy Owner. - i ATLANTIS IYANNOUGH REALTY LLC �O a.Name �o PO BOX 960696 b.Address �r 13MON IMA 02196 �---• c 0 6176462238 aA KAY CHAN e Q KOnsite ManagarName ® agO6.doc•10102 BVVP AQ 06•Page 1 of 3 From:Lawrence Lynch 5085486917 11/08/2011 15:56 #063 P.003/007 thus Departmentt' men i Protection Environmental� Massa � 1`nvlr® Bureau of Waste Prevention.Air Quality 11WI37M Decal Number Notification Prior to Construction or Demolition slateffleft It B. General Project Description (cont.) asbestos is found 1 during a 4. General Contractor. Construction or Demolition LAWRENCE LYNCH CORD operafion.an +esponstble parties a.Name must comply with 1396 GIFFORD STREET 310 CMR 7.00, b.Address 7.08;7.15,and FALMOUTH MA 0254Q Chapter 21 E of the General laws of E city/Town d.Stage e.Zip Code Rio Corrmronwealft 150854111800 This wild hdude. C Tele hone Number area code and exterrslon E-mail Address(optional) limiteddtto.fling an EDMUND WILUAMS asbestos rernarrdl h.On-site Manager Name notification wish the Department and/or a notice of re asee of C. General Construction.or Demolition Description of a hazardous uftt10e to ft 1. Construction-or demolition contractor. Emmtr+ent if applicable. ITESTA CORP a Narne 360 AUDUBON ROAD D. rass WAKEFIELD 101M a cityrrown d.State e.Zip Code <i 812453555 L f.Telephone Number area code and extension resa(optional) ! JOSEPH PASQUEREL.LA h OWSW Manager Name 2, On-Site Supervisor. [TH 'I OMAS`BARTON On-Ste Supervisor Name J 3. Is the entire facility to be demolished? 0 Yes ❑ No a 4. Describe the area(s)to be demolished, ENTIRE BUILDING op � 5. If this is a-construction project,describe the building(s)or addition(s)to be constructed:. OP S SHOP �o 4 agO6.doc•10l02 BWP AQ 06•Page 2 of 3 From:Lawrence Lynch 5085486917 l 11/08/2011 15:56 #063 P.004/007 Massachusetts Department of Environmental Protection Bureau of Waste Prevention®lair Quality 100137648AV& � r Decal Number BWPAQU Notification Prior to-Construction or Demolition - C. General Construction or Demolition Description (font) 6. a. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing material(ACM)? © Yes ❑ No If yes,who conducted the survey? ARCADIS b.Survevor Name At0M660 c.Division of Occupational Safety Certification Number 77M4/2011 12J16I2411 7. Construction.or Demolition; a.Start Date(mmlddfyyyy) b.End Date(mmiddfyyyy) 8. a. For demolition and construction projects,indicate dust suppression techniques to be used: . ❑ seeding ❑ paving b.if other,please specify: ® wettm _ [] shrouding covering ❑ other S. For Emergency Demolition Operations,who is the DEPI official who evaluated the emergency? a.Name or DEP Official b Trtle , :I a Dade of AuthoftAon d.DEP Waiver Number D. Certification -" I certify that I have examined the IJOSEPH PASQUERELIA o above and that to the best of my a.Print Name. knowledge it is true and complete. lJoseph Pasquerolla ---- The signature below subjects the b.Aifficrized SigHaRture =N signer to the general statutes PROJECT MANAGER regarding a false and misleading c. ®,..o statement(s). JTEsTA CORD d.Representing 1113I2011 m e.Date(mVddfyyM �o ��.CY agMdoc•1 D102 BWP AQ OS•Page 3 of 3 From.-Lawrence Lynch 5085486917 11 /08/2011 15:56 #063 P.005/007 eDEP- MlassDEP's Onli-neFding System Page 1 of 1 MassDEP Home I Cortlact 'I Feedback I Tour I Privacy Policy MasaDEP's Online Filling System Ubemame:TESTA Nkknama:TESTACOW My eDEP I forms®{ My Profile EEO Help €J i Receipt €J reretpl . Summary/Receipt ' Your submission is complete.Thank you forusrng DEP's online reporting system.You can select'My eDEP'to:see a list of your transactions. DEP Transaction ID:429897 Date and Time Submitted.11/3/20114:01:04 PM Other Email Form Name:AQ 06-Construction/Demolition Notfication Payment Information DEP code Date Amount f$} Payment Detall Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab i MVeDEP MossDEP Home I Contact I Feedback I Tour 1 PrlvasyPolicy ' Massr)EP's Online Filing System ver.11:2.6_W 20'11 MassDEP hdw:/iedm.dep.mass.gov/Page&TtintRewipt.aspx 11/3/2011 Retail Plaza—Hyannis,MA LFR Levine-Fricke LFR Project No.010-12069-00 �a r dl s 4: �.� "'4� v �. w��•�.�'LYc '"s ":• '�,'a°5,"" :. ; ��'gl ytp�.h Rkr"�� "">2��.^"u �at��'•k,: rx,t F �,4�`�.`h' '?, �,a� ��2.a~K,.�r' �r�.i�l5 r��,,,,,z, ,•�. r°.i� � ;t t s a �{'p,. t3� �'r G�• 'S: A � ,a�T�'i.:, ri, �-;r� �t'u'8r.€° ��1J� �{Y• Se ,d '.R`l,; �� �� r s Sx' T� pp ,•.xt�' r.T4,x•=t;.� i.:,`r',;i. #; �_'�`: �1 U��:: Y _..n:,; � t���::r.,F ^�,.'anw'� �'".�r �u � .1 �. „r�C�rT 3 ��r it�'u }�„�u'"�; h -%:�. 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" ' M-01 12"x 12"White Floor.Tile with Throughout the Main Sales Area 8,p00 sq• NAD Black S ecks M-02 Mastic Associated with M-01. Througfiout the<Main Sales:Area 8;000 f{. NAD. M-03 Tan Linoleum FlooringMen's.&Womeni s:Bathrooms 120 s .ft. NAD M-04 - 4"'Tan Cove Base,Molding Northwest'Side of.the Store , 20 tin f. NAD M-05 Mastic Associated with M-04' Northwest Side of'the:Store. 20 tin. ft: NAD . M-06 Sheetrock Men's&Women's"Bathrooms 355:sq..ft.- NAD uanti included : NAD M-07' Seam Tape Associated with M-06 Men's&Women's;Bathrooms Q ' tY _ with W06 u included NAD M-08 Joint Compound Associated with Men's°&.Women''s Bathrooms Quantity tY . M=06 with M-06 Page 6 g . 8 SCHOOL STREET r _ - WEYMOUTH,MA 02189 tors s�v�ra sr+vt�+ 'ar.�asa�ervxras TEL: (181)337-9334 m FAX:(781)337-7642 i LM Bulk Asbestos Report Levine-Fricke-Recon&virontnental Date Remfveal 0=2002 Sib job No. 502011520 Corp. Date Examined 02/04/2002 P.o.#1 010-12069-00 At In:Michael F.Capozzi Page 1 of 23 144 Forbes Road $R: 010-12069-00: Retail Area; Hyannis,MA Braintree,:MA 02184 Client No./HGA Lab No. Asbestos Present Total % Asbestos 837760 502011520-01 No NAD M-01 Location:E&B Marine South East Side of Store Description:Off-Whim,Hnm09e1eons,12"xl2"FT(White/Black Speck) Asbestos Types: Other fl aterial:'Non-fibrous 100.% . 837761 502011520-02 No NAD M-01 Location:E&B Marine South West Side of Store IDesMp4iox:Off White,HOmOgencous,12"x12"PT(WteBlack Speck) Asbestos Types: Other Niaterlal:Non-fibrous 100.% 837762 502011520-03 NO NAD M-01 Location:E&B Marine Noah West Side of Store- Description: Off-White.Homogeneous,12"xl2"Fr(WhitieB2ack Speck) Asbestos Types: Other Material:Non-fibrous 100.% 837763 502011520-04 No NAD M-01 Location:EAB Marine Center of the Store Description:Off-White,Homogeneous,12"x12"Ff(WhitelBlack Speck) Asbestos Types: Other Materiah Non-fibrous 100.'la 837764 502011520-05 N® NAD M-02 Loeetion:E&B Marine Center of the Store Description:Black,Homogeneous,Mastic Assoc.w/M-01 Asbestos Types: Other Material:Non-fibrous 100.% I 31 Er Me 8 SCHOOL STREET __r< WEYMOUrH MA 02189 FvuS&MCNERV 02FU wracUaaaxnzaeres TEL: (781)337-9334•FAX'{781)337-7642 PLM Bulgy Asbestos Report Levine-Fricke-Recon Environmental Date Received 01/31/2002 SciLab JOb No. 502011520 Corp. Date Examined 02/04/2002 P.O.# 010-12069-00 Attn:Michael F.Capozzi Page .2 of 23 194 Forbes Road RE: 010-12069-00; Retail Area; Hyannis,MA Braintree,MA 02184 Client No./DGA Lab No. Asbestos Present Total 9ia.Asbestos 837765 502011520-06 No NAD M-02 Location:MB Marine South West Side of Store IDeasription:Black,Homogeneous.Meade Assoc.w/M-01 Asbestos Types: , Other material:Non-fibrous 100.% 837766 502011520-07 NO NAD M-02 Loceftn:E&B Marine North west Side of Store Description-Black,Homogeneous,Mastic Assoc.w/M 01 Asbestos Types: Other material:Non-fibrous 100 % 837767 502011520-09 NO NAD M-02 Lacetion:F&B Marine South West Side of Store won:Black,Homogeneous,Mastic Assoc.w/M-01 Asbestos Tykes: Other Matetriah Non-fibrous 100. 837768 502011520-09 No NAD M-03 :13&B Marine Mons Room South Side of Room Description:Tan,Homogeneous,Tan Linoleum Flooring Asbestos Types: Other Materha:Cellulose 25.%, Fibrous glass 5.%, Non-fibrous 70.% 837769 502011520-10 No NAD M-03 Lacation:1'sBLB Maxine Womens Room South Side of Room Description: Tan,Homogeneous,Tan Linoleum Flooring Asbestos Types: Other Material:Cellulose 25.`sn, Fibrous glass 5.%, Non-fibrous .70.A r INC. 8 SCHOOL STREET WEYMOUTH,MA 02189 cseanca r uaossrvaras TEL: (781)337-9334®FAX:(781)337.7642 PLM Bulk Asbestos R Report Lovine-Fricke-RecOn Envir0n=ntal Date Received 01/31/2= SciLab Job No. 502011520 Corp. Date Examined 02/04/2002 P.0.# 010-12069-00 Attn:Michael F.Capozzi Page 3 of 23 194 Forbes Road RE; 010-12069-00; Retail Area; Hyannis,MA Braintree,MA 02184 Client No.!HGA Lab No. Asbedw ftesent Total % Asbestos 837770 502011520-1l No NAD M-04 Location:E".Marino North West Side of the Store Description-Off-White.Homogeneous.Tan Covebase Molding Asia Types: Other Material:Non-fibrous 100.96 . 837771 502011520-12 No NAD M-05 Location:E&B Marine Nelth West Side of the Stnre Description:Of White,Homogeneons,Mastic Assoc.w/M-04 Asbestos Types: Other Mate W:Non-fibrous 100.%