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HomeMy WebLinkAbout0307 MAIN STREET (HYANNIS) Id 47 1*"? S T -rD I I � Town of Barnstable Building k��'' � .t � z ,��;< � yr, Post�Thls Card So That�t,is V�sib.le�From the,.S,treet A„..,roved Plans.:M,ust be�Retamed on Job and this Gard�Must be�Kept �� PP •AFLh"f3'PABTd. � ,, .br y � >,�. ,: .� _ -. �,:e�za ti �Y�'� :F e r:- '�`�"`x.3 ,.� � 4 `.r z ,�,.'��',.+.:x • 6' PostedUnti(Final Inspection Has Been Made t �� £ .y®moo �a.<:.y " � erili�� _ Wher„e�a Ceficate of OccupancyRegrd such Bu ding shall Not becu�dul a Final inspection has�eenrn de Permit No. B-18-1294 Applicant Name: Glenn Kornichuk Approvals Date Issued: 05/23/2018 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/23/2018 Foundation: Location: 307 MAIN STREET(HYANNIS),HYANNIS Map/Lot: 327-103 Zoning District: HVB Sheathing: Owner on Record: CAPE COD BANK&TRUST CO Contractor Name GLENN P KORNICHUK Framing: 1 GCS Address: 380 WELLINGTON ST,TWR B, 12TH a Contractor License. O49055 2 CANADA,. EstProject Cost: $418,000.00 Chimney: Description: Replace Exterior Windows in kind. h gpermit Fee: $ 160.00 Insulation: Project Review Req: � Fee Paid $ 160.00 t ,Date e 5/23/2018 Final: �,� ... Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved appl cation ndR he'approved construction documents for which this permit has been granted. ' � Final Gas: All construction,alterations and changes of use of any building and structures shall Lie in compliance with the local zoning by laws and codes. �"� This permit shall be displayed in a location clearly visible from access street aor road and shall be maintained open ffor publ inspection for the entire duration of the work until the completion of the same. �, Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures bythe Building antl FireJOfficials are prodded on th_is permit. Minimum of Five Call Inspections Required for All Construction Work - Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: .'.'persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire.Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Town of BarnstableR$E E PTA 200 Main Street, Hyannis MA 02601 508-862-4038 \� a Application for Building Permit Application No: TB-18-1294 Date Recieved: 4/26/2018 ¢� Job Location: 307 MAIN STREET(HYANNIS),HYANNIS ✓✓✓ Permit For: Building-Siding/Windows/Roof/Doors . ' Contractor's Name: GLENN P KORNICHUK State Lic. No: CS-049055 Address: Lakeville, MA 02347 Applicant Phone: (508) 695-6005 (Home)Owner's Name: CAPE COD BANK& TRUST CO Phone: (267)400-0170 (Home)Owner's Address: 380 WELLINGTON ST,TWR B, 12TH, CANADA,. . Work Description: Replace Exterior Windows in kind. Total Value Of Work To Be Performed: $418,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: Glenn Kornichuk 4/26/2018 (508)695-6005 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $418,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $160.00 4/26/2018 $160.00 XXXX-XXXX-XXXX- Credit Card 9764 Total Permit Fee Paid: $160.00 THIS R,., . : PROJECT NAME:' : el—Wc- ADDRESS: PERMIT# "PERAU T DATE: t p LARGE DOLLED PLANS ARE IN: ;s BOX SLOT -D �A - Data entered in:MAP S program on: I t 1-4 BY: \ — PROJECT NAME: l ADDRESS: cn PERMIT# Oj PERMIT DATE: E rnr�: i63 LARGE ROILED. PLANS III e Box SLOT Data entered Mn "s program on: BY: Coyle, Brenda From: Finnegan, Jeffrey(DEP) <jeffrey.fin negan@state.ma.us> Sent: Monday, June 25, 2018 2:21 PM To: Crocker, Sharon Cc: Coyle, Brenda; Baran, Cynthia (DEP) Subject: Asbestos Project 307 Main St., Hyannis Sharon, Per our discussion,the TD Bank at 307 Main St in Hyannis is about to undergo a window replacement project. The window caulk was recently tested and determined to contain asbestos. As such, an asbestos abatement will remove the windows over the next few weeks. There are over 50 windows and the contractor expects to remove about 4 per day. The contractor plans to begin the work this evening, and will likely not work 4th of July week. Please keep me informed if there are any complaints or concerns. Jeffrey J. Finnegan Environmental Analyst MassDEP I Bureau of Air and Waste I Southeast Regional Office 20 Riverside Drive, Lakeville, MA 02347 Phone (508) 946-2756 Fax(508)947-6557 � � O 0 as Dv s V�i YW 10 rn 1 i 1 y5 Commonwealth of Ma . achusetts Sheet Metal it Map Parcel N 3 a Date: -o�--!'r � ��0 �� Permit# SC�S" Estimated Job Cost. $ �, �� Permit Fee: $ 166 Plans Submitted: YES NO �.�,`�► Plans Reviewed: YES NO Business License# ` Applicant License# �oZd Business Information: Property Owner/Job Location Information: Name: Name: ED 60-4-9 a B 3 Street: Su r iLc" 41-20 Street: 7 rh itl.A- s/ City/Town: 4r 0.2,fr4l City/Town:�1-)�1,9�•�R-j Telephone: ®� 7,zT 9 t Telephone: 1 Photo I.D. required/Copy of Photo I.D. attached: YES NO tall Initial J-1/M-1-unrestricted license J-2/.M-27restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft. /2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other Commercial: Office Retail Industrial Educational Fire Dept.Approval Institutional- Other - ( R y+oUt3 Ft r(�' Square Footage: under 10,000 sq. ft. .f over 10,000 sq. ft. Number of Stories: -7 Sheet metal work to be completed: New Work: Renovation: V HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents ' Air Balancing Provide detailed description of work to be done: ��t `✓�G� f�'I12 /LJ�.vl�l c� Q.d-�)0 /�- ��.��s�.�.?' /•�•1�I''-� t INSURANCE COVERAGE: have a current liability insurance policy or its equivalent which meets the requirements of M.G.L.Ch.112 Yes o No ❑ If you have checked y21,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent By checking this box❑,I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation: YES NO Progress Inspections I Date Comments Final Inspection Date ` Comments Type of License: By aster Title ❑Master-Restricted Cityrrown ❑Journeyperson Signature of Licensee Permit# ❑Journeyperson-Restricted License Number: Fee$ ❑ Check at www.mass.gov/dnl Email: { tlamIA-1,—P Fm s%. 'o.+� Inspector Signature of Permit Approval The Commol"veakh gfMam&usetts D4parament efludusfyidAeddaft Office of lF11 afims 6M Washfizo0n Shrzf Boston,MA 02111 mY14t.mas&gv?1WI a Workers' Compensa6m TIISur2nceAffidavit:Bui-IdersICentmchwsMecfticiansdqmbers ATmIiamt Informiatiou Please Pit Name : �✓l'rly`r�y� ,a�t�i= 'Lf SG ✓1�C�S Addre= Zd 3 V s T � S K t �.'Lfy� 1�TIF � � D ed Phosie�• aP ��- '"/��/ Are you an employer?Checkthe appropriate bow ' Tyke of project(required}: I.[l] I out a employ witb l e 4- ❑I ant a general coairactor and I 6. ❑New corisftuctkm emglo (f all andforparttime)* havehiredthesub-coatmctom 2.❑ I am a sale proprietor arpartaw- listed oalhe attached sheet 7- ZR=odeHng ship and have no employees . These sub-cosdractars have 8_-❑Deawldtion. working forme is any capacity. eiuployees andhave wodowe 9. B,uil addition ��xa_o INQ wp6mrs'comp-isire coy -insa[Rn l ❑ ra,.,ire ] I We am a CmPoration and its 10-❑Elechical repairs or additions 1❑ I am a homeowner doing all work offi ers have emmed their 1L❑Hind ingrepairs or gdchiicns myself o Roo! w�EEs'ip righE of css on per.HfGL 7 repairs ksmm=e required-]l c.152,11(4�and we have no L emoloyees.[No wadoew 13-0 Other cow insmmce rsequire&] *Amy appbos dwtchedshos#1 omit Rho Moutthe swfi=b9awshrvEmZ d&vcd ae c mpaznf=parkyiz � I f€a�aers Wba salm it do �s s dfida in they Smdaino aiE w SA&m bim aatside cawxwammist mbn&a new zffldaiat indite inch rCaa>rac Iu ffi cherk tMs boar mast r tsrhed m addiliaoal ShEd Shaming 9mm—of die xnd stda vhe m armtthnse eosities ha'm ampkiyees If the 5ab-cm�base emplapws,dwy=stpmmde&w wadm '•mmp•parry amalTez lam ffe&w is tfiegnficy anal jab Sao iflfOrA'iQ1tOtS Insurance Company Dame:a-,I iae •Paficy,A*or Self ins-I.ic_ FnpiisiionDate: L O Jj Job SiiteAddre= 3e`1 114)r Sz V Cify/StafeE :/�l�l�.y9 Attach a copy of the workers'rnmpeusationpolicy declaratiaa page(shavving the policy number and expiration date). Failure to serum coverage as requiredunder Section 25A o€MC3L a 15-7 can lead to the imposition of criminal penalties of a fine up to$150QOD andlor arse-year imprisoumemit,as well as civil.peaalties in the form of a STOP WORK ORDER and a fhe of BP'to$250-00 a day against the violatun Be advised that a copy of this statemect maybe Forwarded,to the Office of Inyestegations ofthe DIA,far insmmme coverage verification- Ida heraby ntder the, ' s arulpsrraNes ofyaejary fhatfJse&farmma&wpn*ikWabm%&bars and correct Sizo_ s Date 6-J 7 -Phone Ojykial ass wily. Do zwt mite in dds axes,to be ctrrrrpleted by Gi[p artown offmraL 'may or Tawra Perm if Icense 9 Issuing Authority(circle one): L Board of Health 2.Building Department 3.CStyfrown Clerk 4 Electrical Inspector S.Phuubmg Inspector c.Other Contact Person: Phone#- Info and Ins-rnc-Cions ' iVFz��Ge'aeaal Laws chapter M regnaes an=4Aoyeus to pruYide'wo5ms'coarse on forfhea eaxplayees. Rasaantto tbM sftnfe,as Er-T&T�is defined as.6_e;yeaypeasoain the service of another nudes any co�rart oflihe, lr express or iinpliect oral or wzh:n_" An,=player is defined as`pan ink per,assoCiiam,CO'IPaZ or of ff legal ME ,or arty two or more of ffie,fxrgoiag engaged in a Joint eoteaprise,and mcbr mg the legal=preseatafives of a.derxased employer,or the rt;cMM or trustee of an mdrvirb 4 parineaship,assocMian or other legal entLy,employmg employees. However the owner of a dweIIing house having not mcim t7um fb a apartmeats and who resides thm ic6 cr the occapm.tf oftbe - dwmUing house of mwfa r who moploys persons to do inam cc,consfrr ct on or repair work on such dwel ing house or on.the grotmds or building gTmt nzdI i=:fD shaIlnotbecanse of such emplaymentbe deemed In be an moployer" MGL d2apter 152,§25g6)also that"e:very state or local licensing agency shalt withhold the i=mznce or renewal of a rcense or permit to operate a business or to construct bufldings k the commonwealth for my applicantwho bus not produced acceptable evidence of cdmpr=m with the snrance.covexage required." Addit7onaIly,MM chapter I52,§25�states aldefther f c roman artwealth nor nay of its po�ical snbdrvisions shall enter into any cunt mat for the pm- ofpuhho work until acceptable evidence of campliagcewith the iitsmaace:. regtjk7eEjeM jS of this chapter have Been presented to the MfhoriLy:. A..pPIirants ' Please fiII oil tine WmI=s,compensation affidavit compleft1n by checking the boxes that:apply to pour sifnafion and,if necessary,supply sub-coutracf s)name(s), address(ex)and Phone:number(s)along with their=tda—cat*)of mom„-an=. L�it�d Lmbiil ty Compan:=(LLC)or Lm ifad Liabilit-y Pmt=sbps(LLP)wrthno = Io3'�D . . than tb e Members or pmt=s6 are not regard to carry wojs' =mpensafim i asarnce- If sn LLC or LLP does have employees,a policy is regau,✓d. Be advised that this affidavit maybe sum to the Depart neat of Indusftial Accidents mr conf maiim of msarmm coverage Also be sure to sign and date the affidavit- The affidavit should be-r a mmed to the city or town that fm appfic-.atim for the p—it or license is bong requeshA not the Department of Judasftwj.A c dents_ Should you have nay q=stions m c the law or ifyo are requhed to obtain a woMicers' =33pe,safiurn policy,please caathe:Depmhnztat the Mutmberlistedbelow. Self-insua,=cicampaniesshould— their self-finmance license number an.the agpnYpzisf-line. City or Town Officials Please be sure that the affidavit is cample�and printed legibly The De�arimenthas provided a space at the:bottom of the affirb. for you to f II out inthe event the Cffice ofIuvestiigatioas has to comactyao regarding the applicant Please be sure to fill in the pen�idlicense mnnber wbich.vM be used as a re5x=co n=ber. In addition,an applicant that must submit miltiple pemmitfIicemo appHtations is any gives year,need only suhmrt one affidavit indicafmg cosent . policy kfon ation.Cif necessary)and tmdea`rIob Site AdAc&*the applicant should vmitr-'sII locations in (city or _� a or fawn be provided to Iha ' e-affdavittiiathasbe�o edormarkedbyth city �3' P town)_ A copy of th ffimsg9�P applicant as pr oof that a valid affidavit is on file for fatm 'permzts or Tice:oses. Anew affi.day t mvs-t be fMcd.oirt each year.-Wh=a homeowner or citizen is ob unmg a license or permit notrelate ,to any b>lsmess or wmmmuial.vet= (Le. a dog license or permit to buzn Ieaves etc-)said person is NQT rMgCdMd to complete this affidavit The Of of Inv��^n would Ilb-_in tbauk you in advance for your coope r d ion and should you have any questions, please do not hesitatc to give ns a call The Deparf�s address,telePhane and fax nnn ca_ . �cif Inds Accidents r ,M&02111 T6L 4 617' -49W cat 4-06 or I-977 lv4'A SAFE Fax 617 727-'74 IZevisexi¢24-07. WW Mug 9WIdia_ 09-26-17; 11 : 34AM; # 1/ 3 i AC R® CERTIFICATE OF LIABILITY INSURANCE FDATE(MMroD1YYYY) �� 09/29016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT MARSH USA,INC. NAME: 1166 AVENUE OF THE AMERICAS PHONE MC No NEWYORK,NY 10036 EMAIL Aft Emcor.Cedrequest@marsh.00m/Fax:203.229.6787 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC 13 045228-New E-Mech-16.17 INSURER A:COntlneMal Casualty Company 20443 INSURED NEW ENGLAND MECHANICAL SERVICES,INC. INSURER B•American Casualty Company Of Reading,Pa 20427 166 TUNNEL ROAD INSURER C:Transpodalion Insurance Co 20494 VERNON,CT 06066 INSURER D.- INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: NYC•DO7635429-35 REVISION NUMBER:23 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 A POLICY NUMBER MMIDDYlYV1� POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY GL6042969882 1O/01/2016 10/01/2017 EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE OCCUR EMIS ORE 7E ff- PREMI E occurrence $ 1,000,0D0 MED EXP(Any one arson) $ 25,0DO PERSONAL&ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 6,00D,000 POLICY E]JERCOT- LOC -PRODUCTS-COMP/OP AGG $ 14,000,000 OTHER $ A AUTOMOBILE LIABILITY BUA 6042969845 10/01/2016 10/01/2017 COMBINdEenD SINGLE LIMIT $ 2,000,000 X ANYAUTO BODILY INJURY(Per parson) $ ALL OWNED SCHEDULED BODILY INJURY(Per aodden0 $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTYDAMAGE $ AUTOS P acadent Auto Physical Damage $ Included A X UMBRELLA LIAB X OCCUR L20682DB285 10/01/2016 10/01/2017 EACH OCCURRENCE $ 5,ODO,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,ODO,OOD DED I X I RETENTION 1O0D0 $ B WORKERS COMPENSATION WC 6042969800(AOS) 10/01/2016 10/01/2017 X PTAT TE �H- AND EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNERIEXECVTIVE YIN NIA WC 6042969614(CA) 10/01/2016 10101/2017 E.L.EACH ACCIDENT $ 1,000,000 C OFFICERIMEMBER EXCLUDED? (Mandatory in NH) WC GM2969795(AZ.WI,OR) 10/01/2016 10l01/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,001) If yes,describe under DESCRIPTION OF OPERATIONS below E.LDISEASE-POLICY.LIMIT $ 1,0D0,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION NEW ENGLAND MECHANICAL SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 166 TUNNEL ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN VERNON,CT 08066 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Heidi Bauermeister ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD r DRIVER �11 1 c � lip z m -- ---- O EOMMONWEpLTH OF MA SS�I�HUSETCS q mod w� � —' :� • o f mt n SO t ,y SHEET Nf TAL WORKEk `ram 7FE OLL OWING LfCE1VE o - NFASTER UNRESTRffiCTE .o. ` `c$ a o-y," *a s i ,' 1_._ �`5��/Sys �¢ a w BRIANf P�1QUI _ >_ G ✓ a z °' N. 89 iNIOODYeHILLRQ �; _ �� . i" fr I HORE/AL Elf, RF02832 1254 ME w x "720712%28/2018 199779 e i Shea, Sally From: Brian Paquin <Paquin@nemsi.com> Sent: Thursday, September 28, 2017 3:35 PM To: Shea, Sally Subject: RE:TD Bank-Hyannis building dept.form Larry Decker ; VP Regional Development Services Manager I Enterprise Real Estate I TD Bank, *1 will out of office/work beginning Friday, 9/29, 4pm. returning to ofice/work on Wednesday, 10/11, 9am. Brian Paquin Project Manager/Estimator EMCOR Services-New England Mechanical 203 Concord Street Suite 421 Pawtucket, RI 02860-3490 C: 401-499-4202 P: 401-728-9211 ext: 1006 F: 401-726-0531 www.nemsi.com Now Englarrd A49chwical e From: "Shea,Sally"<Sally.Shea@town.barnstable.ma.us> To: 'Brian Paquin"<Paquin@nemsi.com>, Date: 09/28/2017 03:26 PM Subject: RE:TD Bank-Hyannis building dept.form Do you know what the title is of the person signing? 1 Town of arustobl Pun - 00 Af0cr. 508-8624038 00-7% 4230 Ptoparty Owner must Co pleto and Sign ThAs $action Win A aullder 4 bbp audaez tca act on my 3 t ^4CCc�S dw 4 fit: ugpl cs�.Gt t , A WWI "Pool fence$and alg a a=the ROpq slbMty of the applicant.Foal. axe r�ot be car udlld,bc ' xe is lstailad sod s inspections are peefo .led sna ac pted Nrw St*Wlee ..- a? of Ovwv arc - Olt .: � f - _ k Qrt3ti}�I+tAV'Tt3�PFkMt�.�►t9Nl..9 :� tti�i Atil16/I7 j 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # ZQ 50 dYy Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee \Y D -d v Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 3_-7 Myn Village d q n nl s AAew Owner Tn � w_A' : , 9A Address 3 6-7 /V44 ry 0- ES Telephone 50% io6 Z " 0 g®0 Permit Request 0 CJd'l '- Raw ye &P I&ee, /�, 0 OS S r Square feet: 1 st floor: existing proposed 2nd floor: existing - proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 50j000 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 Atel I &Afpk 10 Telephone Number 7V 600 Z32 3 Address LA 6050 L o � License # CS— 0957779 0 244 ZdemmfHome Improvement Contractor# w'SS6 73 3W73 Email (' com Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE .3 d ;a4�_ 3 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED ' MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: } FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t . PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. The Commwnweafth of Massachusetts Department o Accidents Of ice of b vestigatfons 600 Washington Street Boston,AM 02111 • www.mass:govYdza Yorkers' Compensation Insurance Affidavit:Builders/Confractors/L+Iect ricians/Plumbers Applicant Information _ _ _T._ _^_�—_ Please Print Le�ibiy - Name(Business/organiratimM Mdual): r,"L` 1�GV e,l W ¢ Xh C y Address: Ip O (.. o d1 S TeA lC( 'e City/State/Zip: 1k1�1 wl Cre 1$- ��© one#: Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. 191 am a general contractor and I employees(full and/or parme)_ have hired the sub-contractors 6 ❑New construction t ti 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9 -Building addition [No workers'comp.insurance COMP.insurance.t �] 5. We are a corporation and its 10-Q Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I.0 Plmmbutg repairs or additions �o workerslf myself comP. right of exemption per MGL Y 12-Q"Roofrepair - insurance required_]t c. 152, §I(4),and we have no employees.[No workers' 13.[:1 (Miter comp.in arance required-] *Any applicantthat checks box#I mnst also 01 outthe section below showing thcfrworkcrs'compensation policy information- t Homeowners who submit this affidavit indicating they are doing all work and then hue outside contractors mast submit a new affidavit indicating such_ fCoutractors that check this box most attached an additional sheet showing the narn of the mb-contractors and state whether or not those entities have employees. If the sub-cont raetnrs have employers,they roust provide their workers'comp,policy=her, Ian an employer that is providing workers'compensation insurance for my employees, Below is the poH(y and job site information• /� ✓ Insurance Company Name: 4 meyI 5y a - 5- Policy#or Self-ins.Lie.# l I q�o Expiration Date: Job Site Address: ® City/State%Zip: D Attach a copy of the workers' compensation poli declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section25A 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 vedficafion. I do hereby certify under the airs and penrl ofpm jwy that the informadon provided above is uP and correct. Si ature: Date: �JTO Phone Official use only. Do not write in this area, to be completed by city or town offzciaL City or Town: Permit/License# Issnin.g 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. po suant-to this statute,an employee is defined as"_..every person m the service of another under any contract of hue, express or implied,oral or written." An emplayer 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 mole than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or oa the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shalt 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 ofpublic work until acceptable evidence of compliance with the insurance._ requirements of this chapter have been presented to the contracting auflhority." 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 ;ng=ce. Limited LiabiliVCompanies(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 Ldustrial Accidents. Should you have any questions regarding the Iaw 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 foi you to fill out in the event the Office of Investigations has to contact you regarding the applicant- Please be sure to lilt in the permitllicense nunnber which will be used as a reference number. In addition, an applicant that must submit mult e P i le permit/liceas 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 tours 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-t. a dog license or permit to bum leaves etc.)said person is NOT mquaed 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 n-amber. Tjje CGmM able-alth-of Massachusetts ; Dtpartnant of liidustdak Accidents office at Xnvestigatiow ��Q��tQn Strut I Boston,MA 02111 Td.9 617 7-4900 06 or 1-8-77-MASSAFE Fax 9 617-727-7749 Revised 424-07 , • - www.mass_govf dia Workers Comp Subcontractors Roofing Subcontractor for TD Bank 307 Main St, Hyannis MA: Centimark Corp 101 Brick Kiln Rd. Chelmsford, MA 01824 -----, CALDE-4 OP ID: RAL A��- CERTIFICATE OF LIABILITY INSURANCE DA03118/201TE 11 03/18/2015 ` THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Brown&Brown of Florida,Inc. NAME` 1201 W Cypress Creek Rd#130 A/CNNo Ell:954-776-2222 FAX No):954-7764446 P.O.BOX 5727, E-MAIL Ft.Lauderdale,FL 33310-5727 ADDRESS: Scott H.Buser,CRIS INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Amerisure Mutual Ins.Co. 23396 INSURED CAL Development,Inc. INSURER S:North River Insurance Company 21105 6850 Lyons Technology Circle INSURER C:Amerisure Insurance Company 19488 Coconut Creek,FL 33073 INSURER D:Federal Insurance Co. 20281 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 TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD MM/DD GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 GE TO REN A X COMMERCIAL GENERAL LIABILITY GL2082195 04/2512014 0412512015 PREMISES Ea oaxirrence $ 300,00 CLAIMS-MADE a OCCUR MED EXP(Any one person) $ 10,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000900 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,00 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COEa..dentS MBINED INGLE LIMIT 1,000,000 C X ANY AUTO CA2082194 04/25/2014 04/26/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per.cadent) $ AUTOS AUTOS NON-OWNED - PROPERTY DAMAGE $ HIRED AUTOS AUTOS PER ACCIDEN $ X UMBRELLA LIAB N OCCUR EACH OCCURRENCE $ 10,000,00 B EXCESS LIAR CLAIMS-MADE 5811028416 04/26/2014 04/25/2015 AGGREGATE $ 20,000,00 DED I X I RETENTION$ 0 $ WORKERS COMPENSATION X WC STATT- OTH- AND EMPLOYERS'LIABILITYYLIM C ANY PROPRIETOR/PARTNER/EXECUTIVE Y I❑N N/A WC2082196 05/0312014 05/0312015 E.L.EACH ACCIDENT $ 11000100 OFFICER/MEMBER EXCLUDEDT (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 Byes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 D Crime 82257158 04/25/2014 04/2512015 Limit 1,000,00 Ded 10,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,B more space Is required) CERTIFICATE HOLDER CANCELLATION BROOKFI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Brookfield Johnson Controls THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Canado LP 7400 Birchmount Rd Markham,ON L3R4E6 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved: , ACORD 25(2010/05) ' The ACORD name and logo are registered marks of ACORD ,f f A ` r I, Vv Ql4lf' W ' )Ti' Tj-.141 Pal rr" "'.T. O'u lzt' 'JF Iltu"'All 9 1 h,,r, re jf, vi� !J ill A'A r t ,. - ,, i,cM1.i 1 'I I. '90=.1A AC 4f,i H' j Xn Alois March 20, 2015 Town of Barnstable Regulatory Services Building Division 200 Main Street Hyannis,MA 02601 Re: Letter of Authorization to Obtain Permits and Approvals for: TD Bank Roof,307 Main Street,Hyannis,MA 02601 Dear Permitting Department: I,Eithne Keane, CEO of CAL Development,Inc., hereby authorize Neil Murphy to act as my agent with regards to applying for and obtaining any documentation and/or permitting paperwork for the Town of Barnstable. If you have any questions, please do not hesitate to contact me. Sincerely, Eithne Keane CEO THE STATE OF RIDA COUNTY OF: ' BEFORE ME, t e undersigned authority, on this day personally appeared e f�_4d e , known to me to be the person signing this document. GIVEN UNDER HAND AND SEAL OF OFFICE this ,"�l day of 2015. Notary Public in and for the State lori a, otary P soy%"Y PAUTADAWOV"�EGIDAI�9ission expires * * MY COMMISSION#EE 12M7,^w s �0 EXPIRES:August 30,2015 6850 Lyons Technology Circle,Coconut Creek,FL 33073 Phone:954-564-0655 1 Fax:954-564-0667 Toll Free:855-CAL-DEV1 www.caidevelopment.com aaatisTeBLFE 9$ MASS. Town of Barnstable RFD MA'l A Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 w�r-w.town.barnstoble.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I; Ct now lVLCLI z �1 UA3K f!!A,as One a the subject properrs bereb7 aIJAHOt ze A )C to act on a-lr benall; in aLl rna ters re?.atrce to Work ai:sthorj2ed by Ibis building perm:-ap,p ic2uva;o-: (Address of Job) signa ale of Owner Date Ck�-o.J&-'e&�� k Print\lame ff Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. J Q VI?ILE:ST ORVIS.building Permit fonr2EX.-PteSS.coc Revised 061313 Unrestricted-Buildings of any use group which contain less than 3500 cubic feet(gglm3)of enclosed space. Failure to possess a current edition of the Massachusetts State Building code is cause for revocation of this license. For DPs Licensing information visit. www.mass.Gov/Dps Massachuse tts _Department of Public Board of Building Re Safety Constr Regulation and Standards License: C&095772 15�'ODBUgyPHi i Commissioner Expiration --- 06/07/2016 _ i RE-ROOFING/RESIDING/WINDOWS (COMMERCIAL) ❑ If located in OKH or Hyannis Historic Dist ct- Certificate of Appropriateness required unless same color/same materials specified on application ❑ Map/parcel number Approval Sign-offs from: ❑ Tax Collector ❑ Treasurer ❑ # of squares of shingles or square footage of roof or sidewall to be shingled/sided ❑ Specify stripping old shingles or going over old roof. If going over ❑how many roof layers existing now ❑what size are rafters? What is span? ❑ Owner's name & address ❑ Project valuation must be entered ❑ Builders Information ❑ Signature ❑ Workman's Compensation Insurance Affidavit State form must be completed and.a copy of Insurance Compliance Certificate must be submitted. ❑ A copy of the Construction Supervisor license is required. Effective March 1, 2009 ❑ Check expiration date, no restrictions ❑ Permit fee$160.00 ❑ Property Owner must sign Property Owner Letter of Permission. Projects requiring the use of a crane must complete the forms issued by the Aeronautics Commission i c-forms/bldgpermits/permitchecklists rev.070610 FAX TO: Town of Barnstable- Regulatory Services From: KariThompson Building Division FAX: 508-790-6230 FAX:954-564-0667 PHONE: PHONE:954-716-9739 SUBJECT: Permits for 307 Main Street, Hyannis, DATE: March 27, 2015 MA 02601 COMMENTS-2 Documents attached: Letter of Authorization to Obtain Permits and Approval • CAL Development's Letter of Employment `IJ� � t— - GD 4 s _ .•, •• r ••�:•:'. -:-:r..,._.. •-•;;•,.::. ,# ..r;•::•r..1.::•a:.-"�" ..K°via:"'"•awrrr,'�,aGe `:F,"�^{t:r;:t"r_ '�C�.h`•�.'`":r:•'•;�9:r;~:i%:c.7:!-�••"'1^�� :,[��•'=%.''w"M1:�• P �1d;+,iS,.. ,^t::,'^xt.'4r�' r"c r�'C:.7 s•. ::r�,rn'r•, rn•, �� ,,•�• � �sf i'' `.r�r[k:.`;'.'.rvw ek:d:,_:,;�•.:..r..^,:.i._. H\:_�i;�.._lr..r.cx::r.:r;.: �Chyjr:7.5 .. •:�• •. , . '� 4, �:.i'R�•;y,_. .I. .1+.y.t��n7•�gZ('a.�=",WWII •w��w:.,`kR� tl�,�y3r.^ F" ::Y.:i.q:`�c:a'� •Y._� - g z � _a... •.., ter• .,..... .... .. .. .. ..... .... ..4. .. .. .. ... __. -- 14. ..... .•�=mac? .o,. - ,:.:..r '-..:.v:. ...... ...•, _ March 20, 2015 Town of Barnstable Regulatory Services Building Division 200 Maim Street Hyannis, MA 02601 Ire: Letter of Authorization to Obtain Permits and Approvals for: TD Bank Roof,307 Main Street,Hyannis,MA 02601 Dear Permitting Department: I,Eithne.Keane,CEO of CAL Developmen%Inc., hereby authorize Neil Murphy to act as my agent with regards to applying for and obtaining any documentation and/or permitting paperwork for the Town of Barnstable.. I If you have any questions,please do not hesitate to contact me. •, Sincerely, Eithne Keane CEO THE STATE OF R A COUNTY OF: �. BEFORE ME, t e undersigned authority, on this day personally appeared known to me to be the person signing this document. 26 GIVEN UNDER HAND AND SEAL OF OFFICE this day of 2015. A( 0 Notary Public in and for the State �jklori a� off,P .T P PAWADA*UF"Wission expires / MY 60Mt BION t 5E 12W EXPIRES:August 80,2016 A� estded rt�1 a71egQl► etY seMse� 6650 Lyons Technology area,Coconut Craek,FL 33073 I Phone:954-564-0655 1 Fax 854-W-0667 Ta11 Frea:655-CAL-0EV1 wvMcRldcvelopment.com March 77t", 2015 Town of Barnstable Regulatory Services Building Division 200 Main Street Hyannis, MA 02601 ` RE:Neil Murphy-CAI.Development's Letter of Employment. (Supplement to Letter of Authorization to Obtain Permits and Approvals for:TD BANK Roof,307 Main Street,Hyannis,MA 02601) Dear Permitting Department, Neil Murphy is a full time employee of CAL Development. As a Senior Project Manager,he is CAL's representative for the North East region of the United States. ly, Cas lione Senior Vice President-Construction , f s i r—L, m oami I Phone:854-564-0855 1 FAx:954-564-0567 Tall Free:855-CAL-DEV1 I www.caldevalovmentcom YOU WISH M 0PI3V A BUSINESS? For Your I nformetiort Business certificert¢s [cost$3 D-00 for 4 yea rs]. A b usin ess certificate ONLY REGISTERS YOUR NAME in tawn [which i VW must do by M.G.L-it does not give you permission to operate.] Business Certificates are availeWe at the Town C3erlr's Office, q-FL,367 m Win Street,Hyannis, MA O2IM1 r9 (Yawn Hall) w r y DATE. Jul 3, 2008 M�:. Fill in please: TD Bank. N.A. A m APPLICANTS YOUR NAME/S; By: John R. OP Darman, EVP&General Counsel BUSINESS YOUR ADDRESS: One Portland Square, Portland ME04101 508-862-6505 . - TELEP9-ME 4 Telephone Number 207-756-6852 NAME OF OORPORATHMN TD Bank, N.A. M NAME OF NEW BUSINESS TD Banknorth TYPE OF BUSINESS bank m IS THIS A FIOIIIAE OCM PATION? YES X NO � ADDRESS OF B2JSINESS 307 Main Street;Hyannis, MA 02601 M�p/PARCEi.NLti1AHER p��� IE g1 3 r When starting anew business there are severai thimp you must d Q in order W be in comp iance with the rules and regulations of the Town of 0 z Barnstable. This farm is intended to assist you"in obtaining the irrformeDan you may Head. You MUST t3O TO PDO DJlain St.- (cornEraf Yerrranutli Rd&Main Street] to make sure you have the appropriese permits and licensers required to legally operate your business in this town. 1. 6UILDING CO 5 EITS OFFI This individu I en irife.rm 10 a unit requirernents that ertain to this type of business, u or zed Sign * �J P coeuliulENlrs ) 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS; 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed ofthe licensing requirements that pertain to this type of business` Authorized Signature** fl0fv MENTSc ' m A TOWN OF BARNSTABLE BUILDING PERMIT,APPLICATION_ Map2� Parcel /�� Application # o706�0//6,6 Health Division Date Issued l� Conservation Division ' Application Fee dVG Planning`Dept Permit Fee Date Definitive Plan Approved by Planning Board Historic OKH Preservation/HyannisAV&44;V( )*00 1116? Project Street Address —?-Ao7�AIAZd :57�e y- IV - Village #aA,74d Owner /l0! Address 117,4eG/ /4--A Telephone �sF z12Yt 7/2 Permit Request /a 4d4 4d ZIJ6,& Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatio- d 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) b 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 I Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/co I stove•]Yes ❑ No C. Detached garage: ❑existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ Qi. ting Clew size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ v l new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ .Commercial ❑Yes ❑ No If yes, site plan review# � CO Current Use Proposed Use APPLICANT INFORMATION - - - �- - (BUILDER OR HOMEOWNER) Dame Mi c14,6 l T llo 11Ary o Telephone Number Address f .�6 l�f A-+'I sZ2e-_� License # 69, _113 s . Home Improvement Contractor# Worker's Compensation # JAJCD o66 clef 06/D ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 3 c FOR OFFICIAL USE ONLY -APPLICATION# DATE ISSUED r MAP/PARCEL NO. ,4 ' ADDRESS — VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH .hY FINAL GAS: ROUGH FINAL FINAL BUILDING C - DATE CLOSED OUT ASSOCIATION PLAN NO. f-' t r I ` The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers" Compensation Insurance.Affidavit: BuiIders/Contractors/Electricians/Plumbers Applicantinformation. ff Please Print Le 'bl Name (Business/organization/Individual): /� l D`�A�UO ✓des ' (//t5% •T'rc, •Address:1,?�AIIA-iii •Veer _ City/State/Zip: t ), 4Aeei ,-V Nf A Phone.#: ��`` ��5�• y27� Are you an employer? Check the appropriate box: Type of project(required):, . I am a general contractor and I 1.[�I am a employer with� 4 _ � 6, ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a•sole proprietor or partner- listed on the'attached sheet. 7, [Remodeling ship and have no employees These sub-contractors have g, Demolition. working for in an capacity. employees and have workers' g Y P ty. t• 9. ❑Building addition comp. insurance. [No workers' comp. insurance required.] 5. [] We are a corporation and its ME]Electrical repairs or additions officers have exercised umin '3.❑ I am a homeowner doing all work h their 11,0 Plb• g repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4), and we have no . employees, [No workers' 13.❑.Other comp. insurance required.] , 'Any applicant Ibat checks box#1 must also fin out the section below showing their workers'compcnsation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. xContractars that check this box must attached an additional shect sbowing the name of the sub-contractors and state whether or not those entities have cniployees. If the sub-contractors have employces,they must providb their workers'comp,policynumber. lam an employer that is providing workers'compensation insurance for my employees. Below isthe policy and fob site information. Insurance Company Name: TnfJran Le- policy#or Self-ins,Lic.#: C O 6 6 92"6 6!D Expiration Date: 13. ZQ>b Job Site Address: j0_7 /v[/�z59 u�T?Gc T 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 iip 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 certi :ender the pain •and penalties of p rjury that the information provided above is true and correct: Sienature: Date Phone#: Official use only. Do not write in this area,Yo be completed by city or town o jcciaL City or Town: Permit/License# Issing u Authority(circle one): 1.Board of Health 2.Building Department 3. City/Towu Clerk 4, Electrical Inspector S.Plumbing Inspector 6. Other Contact Person, Phone#: ACORD CERTIFICATE OF LIABILITY INSURANCE 2DATE/6%2009 ' PRODUCER (781)986-4400 FAX: (781)963-4420 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Risk Strategies Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE g p y HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 15 Pacella Park Drive ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Suite 240 Randolph MA 02368 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:NGM Insurance Company M Holland Construction, Inc. INSURER B:Travelers Insurance Co 1126 Main Street INSURER C:Insurance Co State of PA 19429 INSURER D: Weymouth MA 02190 INSURER E: OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING AN 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. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER DATEYMM/DDTIVE PDATE EXPIRATION MIDO TIONINSRD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY PREMISES TO RENTED occurrence) $ 500,000 A X I CLAIMS MADE OCCUR MPK39348 6/l/2008 6/l/2009 MEDEXP(Any oneperson) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X JEC LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 B ALLOWNEDAUTOS DT8107351L968COF08 10/12/2008 10/12/2009 BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLALIABILITY EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 0 A DEDUCTIBLE CUK39348 - 6/l/2008 6/l/2009 $ �XRETENTION 10,000 C WORKERS COMPENSATION AND Officers are included - X WC STI IT- O R EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE in coverage E.L.EACH ACCIDENT $ 500,000 N OFFICER/MEMBEREXCLUDED? WC006940610 1/3/2009 1/3/2010 E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Issued as Evidence of Insurance. CB Richard Ellis and its related entities and Bank of America and its related entities, are listed as Additional Insured(s) to General Liability coverage as their interests may appear and as per policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE CB Richard Ellis EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL BOA Supplier Contract Administrator 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT 525 N. Tryon Street FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE NCI-023-04-01 Charlotte, NC 28255 INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE Michael Christian/HE ACORD 25(2001/08) ©ACORD CORPORATION 1988 INC(194,n.nm no.. P.—1 r f 9 J T6wn- of Barnstable. Regulatory Services b i 790a Thomas F. Geller,Direefor Building Divisi0>a Tom Berry, Building Commissioner - 200 Main Street, Hyanuis,MA 02601 www.town,barnstable.ma,us Office: 508-862-4038 Fax: 50.B-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder , as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized bythis building permit application for; tfo (Address of rob) igna e Date Print Name gFOR M S;OwNERP ERMIS S ION - , ,/vruaoac/urae�a fie Pomm�uu � Board of Building Regulations and Standards i ervisor License 4 - Construction Sup Lice se: CS W03 j Tr# 12910 ' Expiration 1/2812010 iTMl2estncti 00 !' f r E fl � MICHAEL J HOL Sl3�NU _ r t _�7 _ �J 1126 MAIN ST 0 I!� ' i S WEYMOUTH, MA 02190 Commissioner 1 • Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: JPBARRON Transaction ID: 172128 Document: BWP-Demolition Form for AQ-06 Size of File: 138.077 K Status of Transaction: SUBMITTED • Date and Time Created: 312112008::2:32:26 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 1100069504 • BWP AQ 06 Decal Number Notification Prior to Construction or Demolition Important: A. Applicability When filling out forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-donot use the return (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations 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. OQ B. General Project Description 1. a. Is this facility fee exempt-cit , town, district, municipal housing authority, owner-occupied Instructions residence of four 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 to comply with the 2. Facility Information: Department of,, TD BANKNORTH HYANNIS Environmental = Protection a.Name notification 1307 MAIN STREET • requirements of b.Address 310 CMR 7.09 BARNSTABLE MA � .. 22601 c.Cit /Town d.State e.Zip Code 5084247124 f.Tele h n Number area code and extension) E-mail Address(optional) 2000 1 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ✓❑ Yes ❑ No k. Describe the current or prior use of the facility: IT WAS A BANK I. Is the facility a residential facility? ❑ Yes ❑✓ No �° m. If yes, how many units? Number of units ° 3. Facility Owner: �N KEVIN J. MELLEN �o a.Name ° 15 PARK STREET,P.O. BOX 9111 b.Address f FARMINGHAM MA 01701.91 _ _0 c.Cit /Town d.State e.Zi Code �O 5084247124 Kevin.Mellen@TDBanknorth.com f.Telephone Number area code and extension Q.E-mail Address(optional) t _O _Q h.Onsite Manager Name ag06.doc •10/02 BWP AQ 06 -Pagel of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality 100069504 BWP AQ 06 Decal Number L7,J Notification Prior to Construction or Demolition General Statement:If B. General ProjectP Description Cont. asbestos is found during a 4. General Contractor: Construction or Demolition MICHAEL HOLLAND OF M HLLAND AND SONS operation,all responsible parties a.Name must comply with 11126 SOUTH MAIN STREET 310 CMR 7.00, b.Address and Chapter WEYMOUTH MA 02190 Chapterer 21 E of the General Laws of c.Cit /Town d.State e.Zip Code the Commonwealth. 17813354275 mholland@holland-construction.com This would include, f.Tele hone Number area code and extension .E-mail Address o tional but would not be limited to,filing an IMICHAEL HOLLAND asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of C. General Construction or Demolition Description release of a hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. IMICHAEL HOLLAND OF M HLLAND AND SONS • a.Name 1126 SOUTH MAIN STREET b.Address WEYMOUTH MA � CO2190 c.City/Town d.State e.Zip Code 7813350427 1 Imholland@holland-construction.com f.Telephone Number(area code and extension) E-mail Address(optional) MICHAEL HOLLAND h.On-site Manager Name 2. On-Site Supervisor: MICHAEL HOLLAND On-Site Supervisor Name 3. Is the entire facility to be demolished? ❑ Yes ✓❑ No EMMMMEMMMN �0 4. Describe the area(s)to be demolished: �o TELLER LINE, CARPET REMOVAL, CHANGING DOORS N �0 0 5. If this is a construction project, describe the building(s) or addition(s)to be constructed: r NEW INTERIOR FIXTURES- NEW PAINT, CARPET, DOORS �o o , .. �O - • �Q ag06.doc -10/02 BWP AQ 06 -Page 2 of 3. Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention • Air Quality F100069504 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 ❑ No If yes, who conducted the survey? BRYAN THOMPSON b.Survevor Name AL 060472 c.Division of Occupational Safety Certification Number /15/2008 � 7. Construction Or Demolition: 5/15/2008 6 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 b. If other, please specify: ❑ wetting ❑ shrouding ❑✓ covering ❑ other • 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization h d.DEP Waiver Number D. Certification I certify that I have examined the JAMES P BARRON -------=O above and that to the best of my a.Print Name �o knowledge it is true and complete. IJAMES P BARRON The signature below subjects the b.Authorized Signature �N signer to the general statutes JOB CAPTAIN -O regarding a false and misleading c.Position[Title o statement(s). IMICHAEL HOLLAND OF M HOLLLAND CONSTRUCTION d.Representing 03/21/2008 e.Date(mm/dd/yyyy) �O �Q ■ ag06.doc •10/02 BWP AQ 06 -Page 3 of 3 ■, 3 Mike Holland rom: eDEPConfirmation@massmail.state.ma.us nt: Friday, March 21, 2008 2:46 PM o: Mike Holland Subject: eDEP Submittal Confirmation Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection. Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below. Pleabe review it and keep a copy for your records. Please do NOT reply to this message, this email address will not receive messages. For assistance with eDEP Online Filing, please email the DEP Help Desk at DEP.HELP@state.ma.us or call 617-556-1100. MassDEP is interested in how we can serve you better. To help us make improvements to eDEP, please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/dep/service/compliance/edepsurv.htm. To contact MassDEP Programs, please see http://mass.gov/dep/about/contacts.htm. ************************************************************************************** DEP Transaction ID: 172128 Date and Time Submitted: 3/21/2008 2:29:41 PM Form Name: BWP - Demolition Form for AQ-06 Payment Information DEP code: 30068 Wate: 3/21/2008 2 :29:29 PM mount ($) : 85 Payment Detail: Michael J Holland --Card -- 7971 Contractor Contractor Number Name Address Supervisor Project Monitor Lab ************************************************************************************** EMAIL ID OF THE USER: jbarron@holland-construction.com EMAIL ID OF THE OTHER USERS: mholland@holland-construction.com - 1 ARCHITECTURE ENGINEERING PLANNING SM1I�111L��N I A IVI INTERIORS SYMMES AINI 8 MCICEE ASSOCIATES CONSTRUCTION CONTROL AFFIDAVIT PRE-CONSTRUCTION Name of Building: TD-Hyannis Project Location: 307 Main Street.Hyannis,MA Nature of Project: Interior branch renovation In accordance with Section 116.0 of the Massachusetts State Building Code (Sixth Edition), 1, Mark Spaulding, Registration No. 30736, being a registered professional hereby certify that I have prepared or directly supervised the preparation of design plans, computations and specifications concerning: ENTIRE PROJECT ❑ ARCHITECTURAL ® STRUCTURAL ❑ MECHANICAL ❑. PLUMBING ❑ FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER: for the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, acceptable professional practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I, or people under my direct supervision, shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that, in general, the work is proceeding in accordance with the documents approved for the building permit as per Section 116.2.2 of the Massachusetts State Building Code and shall be responsible for the following: a 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review of the quality procedures for code-required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix A of the State Building Code. Pursuant to Sections 116.2.3 and 4, I shall submit to the buildi ction reports and records of tests and measurements as requested by the building offic' Up p ion of the work, I shall submit a final report o Aatfct co letion and readiness of the ro for occu ancy. gr MASS. 1?fj OF ISA Af Design al Seal Ign u S . On �C" day of �N���! 2009,AD before me, n4 t,17Tw- a Notary Public, duly pearedLGC iD 1 M , being duly sworn, deposes and says that the above statements by him/her are true. I Yyy7'lg I7/\{J.Gfi1L lam. (Notary Public) My Commission expires: 1000 Massachusetts Avenue 400 Westminster Street Cambridge, Massachusetts 02138 Providence, .Rhode Island 02903 T 617.547.5400 F 800.648.4920 T 401,421.0447 F 800.648.4920 www.sninia.com Document2 ARCHITECTURE ENGINEERING PLANNING SM� �( A1L�l INTERIORS lI�lI SYMMES MAINI & MCKEE ASSOCIATES CONSTRUCTION CONTROL AFFIDAVIT PRE-CONSTRUCTION Name of Building: TD-Hyannis Project Location: 307 Main Street. Hyannis,MA Nature of Project: Interior branch renovation In accordance with Section 116.0 of the Massachusetts State Building Code (Sixth Edition),I,Richard Croswell,Registration No. 39014, being a registered professional hereby certify that I have prepared or directly supervised the preparation of design plans, computations and specifications concerning: ENTIRE PROJECT ❑ ARCHITECTURAL ❑ STRUCTURAL MECHANICAL ❑ PLUMBING ❑ FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER: for the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, acceptable professional practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I, or people under my direct supervision,shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that,in general, the work is proceeding in accordance with the documents approved for the building permit as per Section 116.2.2 of the Massachusetts State Building Code and shall be responsible for the following: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review of the quality procedures for code-required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix A of the State Building Code. Pursuant to Sections 116.2.3 and 4, I shall submit to the building official all inspection reports and records of tests and measurements as requested by the building official. Upon completion of the work,I shall submit a final report as to the satisfactory comp etti�:i�' rE diness of the project for occupancy. �ya.VA O KNARD N CMf � STRl1C11 m� Design Professional S I NGAM Signature ��gIST�P *� SS: On this an., �ONAI, R C day of �/1t jLb09,AD before me, , a��.�,�r���, ; duly appeared eing duly sworn, deposes and says that the above statements by him/her are true. (Notary Publi My Commission expires: 1000 Massachusetts Avenue 400 Westminster Street Cambridge, Massachusetts 02138 Providence, Rhode Island 02903 T 617.547.5400 F 800.648.4920 T 401 .421.0447 F 800.648.4920 www.smma.com DOCUment2 d ARCHITECTURE ENGINEERING PLANNING S� ll MA INTERIORS ll� SYMMES MAINI & MCKEE ASSOCIATES CONSTRUCTION CONTROL AFFIDAVIT PRE-CONSTRUCTION Name of Building: TD-Hyannis Project Location: 307 Main Street. Hyannis,MA Nature of Project: Interior branch renovation In accordance with Section 116.0 of the Massachusetts State Building Code (Sixth Edition), I, Murat Alkim, Registration No. 47066,being a registered professional hereby certify that I have prepared or directly supervised the preparation of design plans, computations and specifications concerning: ENTIRE PROJECT ❑ ARCHITECTURAL ❑ STRUCTURAL ❑ MECHANICAL ❑ PLUMBING ® FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER: for the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code, acceptable professional practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I, or people under my direct supervision, shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that, in general, the work is proceeding in accordance with the documents approved for the building permit as per Section 116.2.2 of the Massachusetts State Building Code and shall be responsible for the following: 1. Review of shop drawings, samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review of the quality procedures for code-required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix A of the State Building Code. Pursuant to Sections 116.2.3 and 4, I shall submit to the building official all inspection reports and records of tests and measurements as requested by the building official. Upon completion of the work, I shall submit a final report as t completion and readiness of the project for occupancy. ' MURAT S ALKIMt MECHANICAL Yk 118 Si n ure S: On thiis10 day of"*14104 2009,AD before me, a Notary Public, duly appeared being duly sworn, deposes and says that the above statements by him/her are true. (Notary Public) My Commission expires: 1000 Massachusetts Avenue 400 tit�esttaTinster Street. Canlbridac, Massacliuser.ts 02138 Providence, Rhode Island 02903 T 617.54.7.5 400 F 800.648.4920 T 4:01.421.0-1:47 F SWC,48.4920 DOCU n1Cll 2 ARCHITECTURE • + ` ENGINEERING PLANNING SM INTERIORS SYMMES MAINI & MCKEE ASSOCIATES CONSTRUCTION CONTROL AFFIDAVIT PRE-CONSTRUCTION Name of Building: TD-Hyannis Project Location: 307 Main Street,Hyannis,MA Nature of Project: Interior branch renovation In accordance with Section 116.0 of the Massachusetts State Building Code(Sixth Edition), 1,Mark O'Brien, Registration No. 37356,being a registered professional hereby certify that I have prepared or directly supervised the preparation of design plans,computations and specifications concerning: ENTIRE PROJECT ❑ ARCHITECTURAL ❑ STRUCTURAL ❑ MECHANICAL ® PLUMBING ❑ FIRE PROTECTION ❑ ELECTRICAL ❑ OTHER: for the above named project and that, to the best of my knowledge,such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, acceptable professional practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I,or people under my direct supervision,shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that,in general, the work is proceeding in accordance with the documents approved for the building permit as per Section 116.2.2 of the Massachusetts State Building Code and shall be responsible for the following: 1. Review of shop drawings,samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit,and approval for conformance to the design concept. 2. Review of the quality procedures for code-required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix A of the State Building Code. Pursuant to Sections 116.2.3 and 4,I shall submit to the building official all inspection reports and records of tests and measurements as requested by the building official. ZN ®F Upon completion of the work,I shall submit a final report as to the 1 and readiness of the project for occupancy 0 � MARK E. O'BRIEN MECHANICAL No. 37356 Desi '�� ion Signature `Af �T L•�' NAI SS: On this day o � 4 2009,AD before me, �►�+ a Notary Public,duly appeared i being duly sworn,depos s and says that the above statements by him/her are true. VJL�►r�y b9 • �.rl.GC6lw.• (Notary Public) �. � My Commission expires: y � 1000 Massachusetts AvenuC 400 \'Vestmin.ster Street Proe e, � ole lalCMIII>riiigC, 0'' 01290a T 61;.u-1-i.64-00 F 800.648.11.920 T 1-0 1.` 2 1.04 4 r F S00.646.,1920 WNV mill a.coil Docu file ni4 (_ 11 f ARCHITECTURE ENGINEERING • PLANNING SIB _ /( /� INTERIORS 1�1111�11.1�11 SYMMES MAINI 8 MCKEE ASSOCIATES CONSTRUCTION CONTROL AFFIDAVIT PRE-CONSTRUCTION Name of Building: TD-Hyannis Project Location: 307 Main Street.Hyannis,MA Nature of Project: Interior branch renovation In accordance with Section 116.0 of the Massachusetts State Building Code (Sixth Edition),I,Brian Gardner,Registration No. 40445,being a registered professional hereby certify that I have prepared or directly supervised the preparation of design plans, computations and specifications concerning: ENTIRE PROJECT ❑ ARCHITECTURAL ❑ STRUCTURAL ❑ MECHANICAL ❑ PLUMBING ❑ FIRE PROTECTION ❑ ELECTRICAL ® OTHER: for the above named project and that, to the best of my knowledge, such plans, computations and specifications meet the applicable provisions of the Massachusetts State Building Code,acceptable professional practices and applicable laws and ordinances for the proposed use and occupancy. I further certify that I, or people under my direct supervision,shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to determine that,in general, the work is proceeding in accordance with the documents approved for the building permit as per Section 116.2.2 of the Massachusetts State Building Code and shall be responsible for the following: 1. Review of shop drawings,samples and other submittals of the contractor as required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept. 2. Review of the quality procedures for code-required controlled materials. 3. Special architectural or engineering professional inspection of critical construction components requiring controlled materials or construction specified in the accepted engineering practice standards listed in Appendix A of the State Building Code. Pursuant to Sections 116.2.3 and 4,I shall submit to the building official all inspection reports and records of tests and measurements as requested by the building official. �N OF Upon completion of the work, I shall submit a final report completion and readiness of the project for occupancy. s ® ORLem'T. CARWER i ELECTRICAL e�3 No.40445 eal Ignature IONAL SS: On this Al� day of,�"eh 2009,AD before me, a Notary Public, duly appeared being duly sworn, deposes and says that the above statements by him/her are true. �i�c..rcu AOV (Notary Public) My Commission expires: 1000 Massachusetts Avenue 400 Westminster Street Cambridge, Massachusetts 02138 Providence, Rhode Island 02903 T 617.547.5400 F 800.648.4920 T 401.421.0447 F 800.648.4920 www.smma.com Document2 r�;` �t r� �:����,... m [ i 1 b Imo" � �' ' w �4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �;2 a o o gC��3�1 Parcel � � �, y' S Permit# Health Division S131H Date Issued Conservation Division I?, I L73- Deb Application Fee 00d� Tax Collector Permit Fee .7, Treasurer. ' 00 3 Planning Dept:' CONNECTED SEWER ACCOUNT Date Definitive Plan Approved by Planning Board # Historic-OKH Preservation/Hyannis Project Street Address -301 ICI i41J Village Owner CAP45 6 64a4K-A1_?�VS7 ' Address Telephone _tee � ��rl1,g4`70 '�/i� &a: cd, ELM r, PAgm� _� Permit Request g&l- 94tn A-40 25aSpif&kor 6fne,,6- 4gW,0V 77&,1S' — S�i ATTA w cow a , 3 sp / Z v- Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District M15 Flood Plain ►fib Groundwater Overlay Project Valuation�3ta. O-CFD . — Construction Type 315 ?SAS A Lot Size Grandfathered: G&Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes LirNo On Old King's Highway: ❑Yes &NO Basement Type: a*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 7 � s &�"t.p Heat Type and Fuel: ZGas ❑Oil ❑ Electric ❑Other Central Air: &Yes ❑No Fireplaces: Existing New Existing wood/coal stove: 0 Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:O existing ❑new. size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial E(Yes O No If yes, site plan review_# Current Use Proposed Use BUILDER INFORMATION Name CVr''r, cw� loz . Telephone Number Address QD a�� License# CS 0o5197 -5A4 Q 455W*� a 0 ol J 6A Home Improvement Contractor# Worker's Compensation# 93p W 3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �� / �>%�1�L SIGNATURE DATE F /ZdJ FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ,.c ADDRESS— VILLAGE OWNER r DATE OF INSPECTIONr FOUNDATION ' FRAME f r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL!,, PLUMBING: ROUGHS FINALfn fJ` J / GAS: ROUGH FINAL ' FINAL BUILDING 03 DATE CLOSED OUT J _ ASSOCIATION PLAN NO. a 0 _—� The Commonwealth of Massachusetts Department of Industrial Accidents Office 01/nyesti9stions - 600 Washington Street Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit name: location: city hone# I am a homeowner performing all work myself. I am a sole proprietor and have no one working in any capacity am an employer providing workers' compensation for my employees working on this job .Fa c ac ,.er�iba^tt'�z'CnI� .r'x'� "itj.".''',i'•4r+"+3st. , .. w .y, �,. ti z?,r c• 1 T! s 's"4°t Si to h�) NY .a- �'.' .4 , 0 .t'�S•�kiT dom a:n t;name r t s!_-•r -.ci L' c3, �"'€�'z.s' 5re_ �zi+u'w, a�s'i?�`•c h�,2?=h::.' x'' "-:Y: h,r'c eJ'i�.{:t ..",xu''m t 1..1 W.mv�uC-"":i rit 9cY:3l�,tY`a'ra�y.y"},r�a 1 im=t5 9}!✓,'u::..JCx S 43.�1.�.,,.,Ly.r"i'Af hx�k."�3�h.iy ix"f..,.t.'YEi.IEt.'rs"adtt a zs: �,r}' t'u., y f.t,:t t t ut•,�r^c1n..'+f.3 Fk�vy.c...�'c,..u4" 1 rry^.ti9��.�-a_ (X!!r•�v..ri Fadd'ess � : a� i c" ',t,.�u'7 ar-s-m� "'e a kx f ,.r x)t t7 „i .c ' z,��{ry � i.I "x'It�r•t: �nF� `-'ri.i y ,1: tom, �TFt�," "'4t,f+I!-`t �1`U r.: �r33��`r,,��rr,,1.��`zs.Y?b- { � 'tar�1��efi�"s+�y, �r�,sLr�'�Y, ea{{.�,E�rk�.,r :,r77y.+a'��'{*, ,.q f'�J i;(n�4" i �:. ,r 7�y Clr�>�i✓��qq �"y� ft 5 vr`. n". �xft �. Y 'St r 3' F tx��t� z- iR,�y'�t�,�ir ,�� rs);k }. a: ,,�• ^x rY`n ��}. r , f __ -V''�`�- [] I am a sole proprietor,general contractor,or homeowner(circle one and have hired the contractors listed below who have the following workers' compensation polices --yT:t1� .� '1 "b k .Y`�"�'�'� [xT.9n�J11€r.,F�.s,:.»;�'iT'�ili.'3'.'L�uw ..'.a t 4X�' --}x _,17-0}4'' c X,r Lx .�A'�' .,`e.a'1.M 4 f •yL-y � - 5. 5. A.. �'(. G.f 1 I' 1'•A1 4r Ai 5`T° tl'?` ir' mg vC' »h Fn Y 1 a :,� c� t.( wYa"! k,2; �3't•`fi a _ z :::t- r s <r '� 7 "+Y•kF b-3� t fit.' a �compa4rname tik4 y "a xv' sy �TrXi xr r rr •* ' R i'::4 {'1 io ���'T63 •� 'C'.5 kT'M f ti ',f 4�' �F�{__ l,j� IS.y( 5 I.i Y t r 1 A E li .1� 'Sy19 � i .�.ryf I its id.- { F . 5... 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'1" at t�.�,.r •� s^` i-- `N x� °f I�x�:u.}v r cc.,�.L4 � .t z� ky(� t 'xl'"�r,;�-r ii?;.Nd� z'1Q: 'f�. �•.1_-` ,ia '+ Y.t2^ '�,eiY 1�r54''"' .t E xtxrz z et" { .. t, �w�� s.x�,s' x txx"��y� i rfa yt�.lHPt-t',, } C t 'fi�ia � iI-h.t"i:.`�^t,•is '�'°tE'ii r.L ak'4r e 1' hone if < -, �*5..,. i�+t � EM' mil+ �'.��5`��'a Sr ' F .,4",. -�` �ra�` `t ��s < ��rU '��1 ,<.° -�f-va n `1 f'P�`'q : � 1 t. k 'v'�„r ��. �•txrk�'' �iw,.2 }.� r�u'��„ke ak �T' r-r;�) `s +.co u• :, i � IC '� 3 / _ l 1 :€.,:.,_..' � .5 _ Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or ' nment as well as civil enalties in the form of a STOP WORK ORDER and a fine of$100.OD a day against me. I understand that a one years Imprlso p copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby cent' er the pains and a 'es of perjury that th 'nformation provided above is true and correct. Signature GiI Date Print name L Chi Phone# official use only do not write in this area to be completed by city or town official city or town: permit/license# nBuilding Department [)Licensing Board []check if immediate response is required ❑Selectmen's Office []Health Department contact person: phone#; MOther r (revised 9/95 PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the`law", 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 section 25 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 1 Al applicant who has not produced acceptable evidence of compliance with the idsurance.coverage`required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter,into any pontract for the performance of public work until acceptable evidence of compliance I." ith the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits 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. City or Towns 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. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, a give us a call please do not hesitate to g x. INI 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 fax 4: (617) 727-7749 phone#: (617) 727-4900 ext. 406 Town of Barnstable ti y�P Regulatory Services * spBtvf = Thomas F.Geiler,Director 9 MASS& $ e f1639. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must.Complete and Sign This Section If Using A Builder I, E'ti��- �- G��L'a�' �!CClS► , as Owner of the subject pr peo e hereby authorize (�0�/� -✓ AWC1. • to act on my behalf, in all matters relative to work authorized bythis building permit application for(address of job) ignature of Owner Date C-l'UC (TALI✓�4vt�it Print Name Y f. F :o 1 �BO R'©,Oa G REGU License CONSTRUCTION SUPERUfSOR 9 Numbe 0051+57 Tr.no: 22397 JA ReS' ced00 i ! ROLA 4 II60 GEMIiNI DR `� I I W BA AB Mfg 5r /y Commitsioner II 3 t PROJECT NAME: 6ea&L' u4wt9bl�zl ADDRESS: AM PERMIT# ,c.UD 0 D ED PERMIT DATE: LARGE ROLLED PLANS ARE IN:, BOA �1 SLOT Data entered in MAPS program on: BY: r � q/wpfiles/archive PROJECT - NAME: ADDRESS: PERMIT# 141,! /l(Aims PERMIT DATE: MUP: 3 Z`7 LARGE ROLLED PLANS ARE IN: BOX SLOT. Data entered in MAPS program on: s o BY: V q/wpfiles/archive i o�INET TOWN OF BARNSTAB;LE Buildng Application Ref: 200801016 ° * BARNSTABLE, * Issue Date: 04/24/08 Pe MASS. 039• ��� Applicant: HOLLAND,MICHAEL J prFD MA'I A Permit Num er• 20080812 Proposed Use: BANK BUILDING Expiration te: 10/ /08 Location 307 MAIN STREET (HYANNIS) Zoning District HVB Permit Type: COMMERCIA ADDITI X AL ERATIO Map Parcel 327103 Permit Fee$ 2,511.00 Contractor AND ICHAEL J Village HYANNIS App Fee$ 100.00 License Nu 05510 ' Est Construction Cost$ 310,000 Remarks AP ROVED PLA S MUST ETAINE ON JOB AND INTERIOR REM9DEL OF OFFICES TO BE ALL NON G CONS RU(fI`W CARD MU T BE KEP POSTE NTIL FINAL ON,REPLACING OFFICE PARTITIONS,DROP C ING,CO ETIC TCINSP CTION S BEEN MA HERE A CERTI ATE F OCCUPANCY IS REQUIRED,SUCH Owner on Record: CAPE COD BANK 8T TRUST CO UILDING L NOT BE OCCUPIED UNTIL A FINAL Address: C/O CBRE-BOULOS PROP MGMT I PECTION S EEN MA ONE CANAL PLAZA ' PORTLAND, ME 04101 Application Entered by: PR Buil 'ng Permit ssued By: THIS:PERNIIT CONVEYS NO RIGHT TO OCCUPY A Y STREET,ALL `OR SID WALK OR'ANY PART. HEREOF;EITHER TEMPORARILY PERMANENTLY. ENCROACHEMENTS ON PUBLIC PROPERTY,NOT,S, CIFICALLY PE ITT D UNDER THE BUILDIN CODE MUST BE APPROVED BY'THE'JURISDICTION. STREET`ORALLY GRADES.AS,WELL AS DEPTH-AND OCATION OFPU :SEWERS MAY BE OBTAI ED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMITDOES NOT:RELEASE THE APPLICANT F �M THE CONDITIONS OF`ANAPPLICABLE SUBDIVISION,RESTRICTIONS. MINIMUM OF F/NGR IN ACTIONS REQUIRE FOR ALL CONTSTR TION WORK: 1.FOUNDATIONIN S. 2.ALL FIREPLA E INSPE TED AT T ROAT LEVEL BEFORE ST FLUE LINING IS INSTALLED. 3.WIRING&PLSPECTIONS TO BE COMPD PRIOR TO FRAME �SPECTION. 4.P"TOR TO COTRUCTURAL MEMBERS( ADY ATH). 5.1 ILATION. 6.1 _AL INSPECORE OCCUPANCY. WHERE APPLICARATE PERMIT ARE REQU D FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NEED UNTIL TH INSPECTOR S APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILME NULL D VOID IF C NSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABO PERSONS CONTRACTING WITH EGISTERED CONTRAC RS DO NOT HAVE ACCESS TO GUARANTY FUND(asset forth in MGL c.142A). BUILDING INSPECTI APPROVALS P MBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Application Map Parcel b V .33 Health Division Date Issuedof Conservation Division Application Fee Planning Dept. Pe mit Fee �S Date Definitive Plan Approved by Planning Board IT kp Historic - OKH _Preservation /Hyannis Project=Streel/Address S® Village Owner Address moo-* 1-6A e3 Telephone '.dog . —1 SeD 6-7 5 C. Permit Request ReNayi- c- Ego s r i nq 0 FF1 Cc G'Q_C-- OF 1'100 5 F. 1"1 a-o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation FD i 0:90 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 Highv : ❑Wes ❑sNo •o 0 1 Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Ln c Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) o Number of Baths: Full: existing new Half: existing CO >, umber of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room CouhC oho .c,) r Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other -- M 3 Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No NZI Detached garage: ❑ existing 0 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 Used t4_►k 6ra-I CE Proposed Use �� APPLICANT INFORMATION (BUILDER OR HOMEOWNER) .Name Kc.NAk=_1 _T 6L_LA N-0 Telephone Number Address I 1 A G _55f= License # HA os-s- 103 Wt:- -f M W+3 \ A MAR • 02Z490 Home Improvement Contractor# Worker's Compensation # YC.fx7Fg!A G(a 1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO t e A� C_• O SIGNATUR DATE 6 120 I 2-o I t9 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED r MAP,/PARCEL NO. i ADDRESS ; VILLAGE OWNER y DATE OF INSPECTION: ` FOUNDATION FRAME INSULATION 3I i; FIREPLACE ELECTRICAL: ROUGH FINAL - PLUMBING: ROUGH '` FINAL GtA& + ;. ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. _ The Commonwealth of Massachusetts y Department of Industrial Accident r` Office of Investigations ` 600 Washington Street t Boston, MA 02111 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information please Print X,e�ibly Name (Business/Organization/Individual): N( "0L.l _&,.N0 `%- '501sS Address: 1 0, a:A 02-19 Phone #: —7si• 3.SSS• �27 S' City/State/Zip: 4 A• Are you an employer?-Check the appropriate box: Type of project(required): 1.9-1 am a employer with 2— 4• ❑ 1 am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors- .___...___... listed on the attached sheet. 7. lgie'modeling. 2_❑ I am a sole proprietor:or partner- These sub-contractors have ship and have no employees 8. ❑ Demolition employees and have workers' working for me in any capacity. 9. ❑ Building addition o workers' com insurance comp. insurance.# � p� 5. [] We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 1 l.❑ Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. I52, §1(4), and we have no employees. [No workers' 13.0 Other comp.insurance required.) *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. tf 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 jab site information. Insurance Company Name: Policy#or Self-ins.Lic.#: V 1c eB 0 C-,t Expiration Date; f 3 Job Site Address: ��' City/State/Zip: 1- 9�rno� L`4 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under.Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or,one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under thepains andpenalties ofpe ry that the information provided above is true and correct. Signature: Date: 2-0 • ZC) 1 0 Phone#: 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 In 6. Other Contact Person: Phone#: l fnformatzon and bstructiOPS Massachusetts General Laws chapter 152 requires all employers to provide workers' compe.nsalion for their employees. Pursuant to this statute, an emplo)jee 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 r, or [he of tl,e foregoing engaged in a joinLenterprise, and including the legal representatives of a deceased employe r or trustee of an individual, partnership, association or other legal entity, employing employees. However the receive ree apartments and who resides therein, or the occupant of the owner a dwelling house having not more than th dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house all not because of such employment be deemed to be an employer or on the grounds or building appurtenant thereo sh ." MGL chapter 152, §25C(6)also states that "every state or local licensing agency shall fvithhold 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 insuUance 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), addresses)and phone numbers)along with their certificates) of insurance, Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation i s have nsurance. If an LLC or LLP doe 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. Shouldyou.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 1. 1 l l i 1Please be sure that the affidavit is complete and printed legibly,)The Department has provided a space at the bottom t of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant, ch will be used as a.reference number. In addition, an applicant Please be sure to fill in the.permiUlicense number whi le ermit/license a licadons in any given year, need only submit one affidavit indicating current tistsubmitmulh p PP (City or that m P ( y policy information (if necessary)and under"Job Site Address" the applicant should write all locations in town)."A copy of the affidavit that has been officially stamped or marked by the city or sown 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 (ix. 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: i 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 Fax # 617-727-7749 Revised 4-24-07 www.mass.Rov/dia Town of Barnstable Regulatory Services v " I e� Thomas F.Geiler,Director f1639. 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 I, CAPI 1�rC. �aV`C_ , as Owner of the subject property hereby authorize 1`1 tc. A c -' }6 ^m Q to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) i Signature of Owner Date Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OWNERPERMISSION Town of Barnstable oFtKKE Regulatory Services znxrtsznar E,)% Thomas F.Geiler,Director MAW Building Divisiob ArfO MA'I A Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us , Office: 508-862-4038' Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name- home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner}occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one 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 perfohn6d under the building permit. (Section 1'09.1.1) ' 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 Supervisors);provided that if the.homeowner engages a person(s)for hire to do.such work,that such Homeowner shall act as.supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. 'In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner;acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certihcation for use in your community. Q:\WPFILES\FORM S\homeexempt.DOC I 02? -'� Massachusetts- Department of Public Safety Board of Building Regulations and Standards ,Construction>Supervisor License ;License: CS 55103 Restricted to 00II ,w " SRI i MICHAELJ `WOLLAND 1126 MAIMSTg S WEYMOUTH WN 2190 Expiration: 1/28/2012 Cummissiainer Tr#: 13123 t ....._ f l Bank America's Most Convenient Bank® August 18, 2010 Barnstable Planning&Zoning 200 Main Street Hyannis, MA 02601-4002 To whom it may concern: Please accept this letter as authorization for Michael Holland with M. Holland construction to act on behalf of TD Bank for the renovation shown on Nelson's plans for 307 Main Street, Hyannis, MA. Should you require additional information, please do not hesitate to contact me at 856-470-3212. Thank you: Sincerely, TD Bank, N.A. Callie P. Poole US Real Estate Officer TD Bank N.A. US Real timle Department 9000 Atrium Way Mount Laurel,NJ 08054 888-751-9000 08420/2010 09:35 7813400077 HOLLAND CONSTRUCTION PAGE 01 Massachusetts Department of Envlronmental Protection Bureau of Waste Prevention •Air Quality 100069504 Decal Number L BWP AQ 06 Notification Prior to Construction or Demolition Whentant llingout A. Applicability 4 forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential buil fit of Environmental Protection curuse the return not (DEP), Burea Validation process is running..... 10 CMR 7.09_ Notification of use the return key. Construction (2)ten (10)days prior to any work being performed.The following information is required pursuant to 310 CMR 7.09. m B. General Project Description 1. a. Is this facility fee exempt-cit town, district, municipal housing authority,owner-occupied Instructions residence of four units or less? Yes [ONO . ,All sections of b Provide blanket decal number if applicable: Blanket Decal Number this form must be completed in order to comply with the 2 Facility Information: Department of rp BankNorth Hyannis Environmental - Protection a.Name _ notification 307 Main Street aulrements of p.Address •.._.�0 CMR 7.09 H annis MA 02601 State e.zip Code (508)424-7124 f. I n E-mail Address(optional) m 2,000 1 � h.Size of Facility in Square Feet i.Number of Floors j.Was the facility built prior to 1980? ❑✓ Yes ❑ No k. Describe the current or prior use of the facility: it was a bank �� August 16, 2010 Town of Barnstable Regulatory Services: Building Division strategies Tom Perry, Building Commissioner interior design 200 Main Street, Hyannis, MA 02601 architecture information services Re: TD Bank , 307 Main St. Hyannis, MA work t ce services ering Dear Commissioner: " ` In accordance with Section 116.0 of the Massachusetts State Building Code, we hereby philadelphia certify that we have directly prepared all architectural design plans and specifications atlanta for the above referenced project and that, to the best of our knowledge, such plans and baltimore bangalore specifications meet the applicable provisions of the Massachusetts State Building Code, beijing and all acceptable practices and applicable laws for the proposed use and occupancy. boston We further certify that a qualified professional in our employ shall perform the charlotte necessary professional services and be present on the construction site on a regular and chicago periodic basis to determine that the work is proceeding in accordance with the dallas delhi documents approved for the Building Permit and shall be responsible for the tasks as hartford outlined under Section 116.2.2. Upon completion of the work, we shall submit a final hyderabad report as to the satisfactory completion and readiness of the project for occupancy. jacksonville (D \` melbourne Sincerely, �' >:Y 7 mexico city ' Q O� minneapolis No. 7716 �mumbai a, �' cn ik. .� E3OS101Y, }- newyork , Nun fliAiJ. f newark , Orlando dley T. Back, MA Arc . License No. 7716 Principal ; 9atar s�,-z---����• e richmond P francisco san jose Subscribed and sworn before me this 16fh day of August, 2010, the above named person seattle singapore appeared before me and is personally known to me. shanghai st louis sydney tampa tokyo toronto N ry Publlc Wilmington RESA HELA NE GRAY ton-salem {rotary Public My commission expires wealth of Massachusetts My Commission Expires November 3,20-12 112 Beach Street Boston,MA 02111 T(617)423 2697 N ELSONon line.corn biackcowarchitects.com ARCHITECTURAL AND ENGINEERING SERVICES OFFERED BY LICENSE/AF .UAT7F-.S r A� CERTIFICATE OF _ °ATE LIABILITY INSURANCE (MMIDD/YYYY)1/12/2010 PRODUCER (781)986-4400 FAX: (781)963-4420 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Risk Strategies Company ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 15 Pacella Park Drive HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Suite 240 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Randolph MA 02368 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:NGM Insurance Company M Holland Construction Inc. INSURER B:Insurance Co state of PA 19429 1126 Main Street INSURER C: Iwaymout1l MA 02190 INSURER D: COVERAGES INSURER 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 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 OISUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. WiW ADD'i - POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INEUMNCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 500 000. A CLAIMS MADE ❑X OCCUR KPB0820S 1/3/2010 1/3/2011 MED EXP(Any one arson) $ 10 000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENI AGGREGATE LIMIT APPLIES PER:7X POLICYPRODUCTS-COMP/OPAGG $ 2,000,000 PRO LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 A ALL OWNED AUTOS aBO820S 1/3/2010 1/3/2011 BODILY INJURY X SCHEDULED AUTOS (Per person) $ X HIREDAUTOS BODILY INJURY X $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG S EXCESS UMBRELLA LIABILITY EACH OCCURRENCE $ 5 00O 000 OCCUR CLAIMS MADE AGGREGATE $ 0 $ A DEDUCTIBLE CM0820S_ 1/3/2010 1/3/2011 $ X RETENTION $ 10,000 $ B WORKERS COMPENSATION EXCLUD WGSTATU OTH- AND EMPLOYERS*LIABILITY ANY PROPRIETOR/ R/EXECUTIVE a -E.L.EACH ACCIDENT $ 500 000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 9CO06940610 1/3/20 1/3/2011 E.L.DISEASE-EA EMPLOYE $ 500 000 if es,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ OTHER 500 000 EDESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Issued as evidence of insurance CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION For Infomatlon Only DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 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. AUTHORIZED REPRESENTATIVE --- -- Michael Christian/GZ - `�- -: ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION All rights reserved. INSD25(200ooso�) The ACORD name and logo are registered marks of ACORD 02/21/2008 03: 41 5087786448 HYANNIS FIRE PAGE 01 � `'Iff ri - F DEPAR ' NT 8`2 -95,.HIGH.SCHOOL RD, 1=XT- HY'ANNIS, MA.02601 HAROLD S. BRUNELLe, QHIEF ,TIEnc tAWAIE It 01INE EOYc�T1oN Vllrt PREVENT11 N .BUREAU 'BUSINESS PHONP_(6b8)' 75-1300 FACSIMILE PHONE:(SOB)778-6448 I.T.IDU N. LI)Ii,CI M.Al jl -a CFI LT.EMC F.IIUBLEP.,CF[ 1F E PftE`�LN Ol'¢:OFI T FIRE PrtEV)MIMON OFFICER ; lII✓l�IN '- G.( [ E OOkVKIANCE FORM - TMI FIt�( Pf�EVENT1dN=BL1RfA�J.HAS RtyVI1JVEQ THE P N TED OFi THI�,'PKO-KRT, OCAT '-p AT' AL$Q r i ta�NN � t� , - THE• .CHART 15E: OW INDICATES: THE STATUS OF OUR REVIEW; D 'COMPLIES RECEIVED RIvIEVVE �-' `'`11,✓�l�ti,i'� �f',7.;�'/:. .Tip � ^' ,.. A t .1^ ��.a'' _ �(•. �.t.^ .l�.jy�,l.,'.�y., ..�..q0..y� ...^�. .��� "t11:�`+� ♦ .`a i.. -',�I'• �1'f I •VT��°C7 I9,•. .'.�.•r ..•��4'.':,"r •i.'. _ ..�..a�:a P', ... =;3;tY`L;FI,AIV ''LY ; �i`TICSN'% .max: -g .,;5pf )II� E.l . � '1 `Q,r ST (.�=r•: :�7: . " N11`I'N. ITbf�' �4i'Y,I��Nr,• 11-SMQK;`C'tJ�1rF1C i XKAus7 ' +' �' '1•�-�N1�K�.CON1'F�O��.E�l�J.� ;;`��,�l�Tj,'�N� . . .. :15- T EC1U11?�;4� A1 f©N 1 -Ki ETI`,: R ��. 00 Y... U111(F:f�ITS TO LEE COMPLIANT FOR THE ISSUAf4CE OF A BUILDING RM'IT: WE HAVE COIv1PL "I'� TN 'ABC pTgNCE TI=STW 'FOF}THEE OCCUPANCY PERMIT AND BELIEVE THAT ' WITHIN THE SCOPE bF 7'HE BUILDIhdG R9jIMIT,•THE ABOVt aRE IN COMPLIANCE_ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��1�Parcel ( � 3 Application#. ���7�01 Health Division Date Issued Conservation Division Application Fee ��� ^ '— Tax Collector Permit Fee Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address 3 b 7 M,4,.v <' Village �✓��1 Owner C&e- C&A Address v edo- -9 U ULor �ti Telephone C-rr, t Permit Request i /L (�. D O/L.s Z-0,0 a Square feet::existing 03 proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay roject Valuation 11 d Construction Type--Al000 MA4,01-" Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Cr't ok e,AC Age of Existing Structure 17 41ZA-e-L Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: P,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 d- 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:❑existi?g ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: I — Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial es U No If yes, site plan review# j Current Use r< Proposed Use �� BUILDER INFORMATION Name ��-�—,4.✓c/ C Telephone Number -®4a Address I ? o��.- „�,.. (7ti License# r Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO alo_u SIGNATURE DATE l�� 7CJ0 F FOR OFFICIAL USE ONLY a ' APPLICATION# DATE ISSUED = MAP/PARCEL NO. �r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL x PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING i DATE CLOSED OUT t i ASSOCIATION PLAN NO. 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/Electridans/Plumbers A licant Information Please Print Le ibl r Name(Business/Organizatiowbdividual): . n�� �r " Address: f 7 f tip-�"� r•- J lr`'tiC1 City/State/Zip: Phone.#: rU Are you an employer?Check the appr priate box: :Type of project(required):. '� .-- 4. ❑ I am a general contractor and I 1. I am a employer with 6. ❑New construction . employees(full and/or part-tim ).* • have hired the sub contractors . 2.❑ I am a'sole proprietor or listed on the-attached sheet. 7. ❑Remodeling partner- These sub-contractors have g, ❑Demolition ' ship and have no employees employee$and have workers' working for me in any capacity. 9. ❑Building addition [No workers' comp,insurance comp.insurance.$' 5 ❑ 10.❑Electrical repairs or additions . We are a corporation and its required.] officers have exercised their 11.0 Plumbing repairs or additions ' 3.❑ I am a homeowner doing ill-work . right of exemption per MGL myself.[No workers comp. 12.❑Roofr ' s insurance.required.]t c. 152, §1(4),and we.have no employees. [No workers' 13.❑ Other *t L 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. Jam an employer that is providing workers'compensation insurance for my employees. Below is.the policy and job site' information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: lob Site Address: 3a -Cr City/State/Zip: itiCf Attach a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date). Failure,to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy-of this statement maybe forwarded to the Office of Investigations of the bIA for insurance coverage verification. I do hereby certify under t ins•and penalties of perjury that the information provided above is true and correct. Si ature: �-� Date: U � 10, Phone# �® . -7 ? 3l l U rffcial use only. Do not write in this area, tb be completed by.city or town official y or Town: ' PermitfLicense# 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#: NOV-07-2007 08:51 Oceanside Inc. 508 775 2848 P.02 AC®RD,� CERTIFICATE OF LIABILITY INSURANCE 01/17/07 DATE(MMIDDIYYYY) PRODUCER- THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.Agency,lnc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0.Box 1601 South Dennis,MA 02660.1601 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Arbella Protection Co Oceanside Inc 217 Thornton Drive INSURER B: American Home Assurance - - INSURER C: Hyannis„MA 02601=8105 INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DILATED.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. POLICY EFFECTIVE POLICY EXPIRATION LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE MM/DD/YY DATE MM/DD/YY LIMITS A GENERAL LIABILITY 6500029947 01/01/07 01/01/08 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED.PREMISES(Fa occurrence) $100 000 CLAIMS MADE 51 OCCUR MED EXP(Any one person) $5 QQQ PERSONAL&ADV INJURY S1,000,000 GENERAL AGGREGATE $2 OOO OOO GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 00Q 000 POLICY PE OT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS _ BODILY INJURY $ SCHEDULED AUTOS (Perperson) HIRED AUTOS - BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accidenl) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR ED CLAIMS MADE AGGREGATE $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND IWC1766193 01/01/07 01/01/08 WC SLIMIT OTH- EMPLOYERS'LIABILITY AN.Y.PRUPRIt10WPARTNER/EXECUTIVE E.L.EACH ACGiOENT $500 000 OFFICEWMEMBER EXCLUDED? If yes,describe under E.L.DISEASE-EA EMPLOYEE $500 OOO SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT- $500;000 OTHER rCD - r .�i -J ? DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS -1 Re: Lyman Job, 180 Scudder Lane,Barnstable CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable, Att:Sally DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN P O BOX 1360TC NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 Of 2 #26584 JB 0 ACORD CORPORATION 1988 TOTAL P.02 o���2aac �c,�u�aea :I ' BOARD OF BUILDING'REGULATIONS;' License:'CONSTRUCTIONSUPERVIS.OR Number GCS 000043: Birthdate 01/21'M949r. ' Expires 01/21'/2008 Jr.no: 13192. j rnnctriirti(n._`[G ;i s., Restricted { RICHARD W CLA`RK' r 65 ACRE HILL BARNSTABLE, Commissioner - __ I I " i OCEANSIDE,INC 1- 4d C� Ft ? �. 217 THORNTON DRIVE D.0 2. S. 7'o �4 A v c. lL) `-� 4 S .S �f /v fI f�° HYANNIS,MA 02601 tr/6 / 07 I'I .D rt1 o ti M A � rJA i y. -~ - �" - •FIRE/WATER/SMOKE CLEAN-UP s EMERGENCY BOARD-UPS •ODOR CONTROL •VANDALISM CLEAN UP&REPAIRS •BUILDING AND REMODELING -- •PAINTING&REDECORATING r - �-„ _ _ . l • - d keanside RICHARD W.CLARK Since 1971... "THE RIGHT CHOICE" Building Repairs&Restoration Remodeling•Redecorating Damage Appraisal 508 771-3110 24 HR EMERGENCY SERVICE 800-464-3318 508-775-2848 FAX richard@oceansideinc.com 508-693-9950 ISLAND# 217 THORNTON DRIVE www.oceansideinc.com HYANNIS, MA 02601 f February 10, 2011 Commissioner strategies interior design Inspectional Services Department architecture Hyannis, MA information services workplace services engineering re: TD Bank P 13307 Main Street o-7 � +f r NELSCAML Hyannis, MA philadelphia atlanta Construction Final.Affidavit baltimore bangalore beijing We hereby certify that we have visited the above referenced project site on a regular and boston c charlotte periodic basis, and have observed the construction at TD Bank, 307 Main Street, Hyannis, MA chicago and to the best of our knowledge, the project was built in accordance with the documents dallas approved for the,Building Permit and meets all applicable provisions of the Massachusetts delhi hartf lhi State Building Code and all applicable laws and ordinances for the proposed use and houston occupancy. hyderabad jacksonville melbourne � = �.)1 h',i :.;�a mexico cit Sincerely, , -/ "gg y EY 7 % minneapolisdCf mumbai Co �t No. 7716 r new york �' BOS+'u'lV, A _'' newark f�9nS6. " q norwalk Orlando "'tr v" qatar richmond san Francisco sanjose *Bradley . Black seattle Principal seoul singapore st louis Subscribed and sworn before me this 10th day of February, 2011, the above named person sydney appeared before me and is personally known to me tampa tokyo toronto washington,do wilmington Notary Publi winston-salem RESA HEUMNE GRAY My commission expires � Notafy Commonweatttl of Massnimsetts- -- My Commission Expires 112 Beach Street November 30,2012 s Boston,MA 02111 iy 1 T(617)778 7229 _ F(617)687 7666 NELSONonline.com 1 �tME TOWN OF BARNSTABLE B-u,,i.r&tng. . ti Application Ref: 201004333 BARNSTABLE, Issue Date: 08/25/10 Permit MASS. 1639• ��� Applicant: A>FD .l a Permit Number: B 20101737 Proposed Use: BANK BUILDING Expiration Date: 02/22/111 Location 307 MAIN STREET (HYANNIS) Zoning District HVB Permit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 327103 Permit Fee$ 728.00 Contractor HOLLAND,MICHAEL J. Village HYANNIS App Fee$ 100.00 License Num 055103 Est Construction Cost$ 80,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND TD BANK:RENOVATE EXISTING OFFICE AREA OF 1200 SF INTO O ,E THIS CARD MUST BE KEPT POSTED UNTIL FINAL LARGE CONFERENCE ROOM INSPECTION HAS BEEN MADE, WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: CAPE COD BANK 8i TRUST CO BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: C/O CBRE-BOULOS PROP MGMT INSPECTION HAS BEEN MADE. ONE CANAL PLAZA PORTLAND, ME 04101 Application Entered by: PR Building Permit Issued By: THIS PERMIT CONVEYS NO'RIGHT TO OCCUPY ANY STREET,.ALLY OR SIDEWALK OR ANY PART THEREOF,EITHERTEMPORARILY.OR PERMANENTLY. ENCROACHEM'ENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLY:GRADES AS WELL AS DEPTH AND LOCATION OF,PUBLIC SEWERS MAY BE OBTAINED.FROM THE,DEPARTMENT OF PUBLIC:WORKS. THE ISSUANCE,OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM'.THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS: x MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3 RING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. OR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). "S. ULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF ti DATE THE PERMIT IS ISSUED AS NOTED ABOVE: PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(asset forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 ?.�� 3 lr O ( C 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health ' h z r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel V Application # � � �[ t W 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 aC � '►;A,, cz Village Vi\Jo�,n nn% C-WS } Owner-ID "Batilk- t w Address 9 Telephone i'cs Permit Request s-3 e4•.1 des..re C s�Yta� W6rit 0�rt Square feet: 1 st floor: existing 3_A proposed 2nd floor: existing proposed Total new Zoning District A Flood Plain Groundwater Overlay Project Valuatio 54600.00 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 qb jAl,,bA Historic House: ❑Yes UdNo On Old King's Highway: ❑Yes ZNo Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing I 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: LdGas ❑ Oil ❑ Electric ❑ Other Central Air: &//Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No ,Qetached garage: ❑ existin r,�vy size_Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑existing new size _Shed: ❑ existing ❑ new size _ Other: C., Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ -. Commercial ❑Yes ❑ No If yes, site plan review# i Current Use Proposed Use _ 40W t APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER)__ q 1 Name �Aoi�Aj%ln t le!(�,rrru ily\ Telephone Number -769 3`3 G-• -Aaq Address 0�,-\ License# &AA CS LAB- e'2,6 r. Home Improvement Contractor# 1-m Z 7 B r Worker's Compensation # \4 C GOIS A n`A3 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO E.A.c,6 SIGNATURE s'"s- FOR OFFICIAL USE ONLY ArPLICATION# Mi y `$`DATE ISSUED - MAP/PARCEL NO. ADDRESS { :y � VILLAGE - OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH i FINAL ' PLUMBING: ROUGH FINAL `GAS: ROUGH ;FINAL t i FINAL BUILDING s , ��- DATE CLOSED OUT 4 r ASSOCIATION PLAN NO. Y 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/Plumliers - Applicant Information Please Print Legibly Name(Business/Organization/Individual): 1-}n1k J tQ Q Gw 8 '5�16 A S Address: 02►`1Q City/State/Zip: . (,,� �A, Phone.#: LAa -7 5' Are you an employer?Check the appropriate bog: Type of project(required): 1. I am a employer with 2_0 _ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 7. RLkemodeling ship and have no employees These sub-contractors have g, ❑Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. required:] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp- right of exemption per MGL 12.❑Roof repairs insurance required.]t c.152, §1(4),and we have no 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 subcontractors and state whether or not those entities have employees. If the subcontractors have employees,they must provide their worker;'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: -ryrj,,,AnW_ C'A 4 MAC Policy#or Self-ins.Lic.#: Lt�c t r-H 3 - Expiration Dater Job Site Address: MA e% 4-PTIZe,67 City/State/Zip: k - 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 ertify under pain a pe alties of perjury that the information provided above is true and correct Signature: Date: 2- Phone#• `761 3 A.9(1' Official use only. Do not write in this area,to be completed by city or town offrciaL 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 representative's 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-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 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 io 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. #617-727-490.0 ext 406 or 1-877-MASSAFE Revised 11-22-06 Fax# 617-727-7749 www.mass.gov/dia Town of Barnstable r • + BARNS MLE, • 1639. � Regulatory Services ArE p►��s 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 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1, as Owner of the subject property hereby authorize , ��, �\ )Ab1\A JO to act on my behalf, in all matters relative to work authorized by this building permit application for. °1 LAI (Address of Job ell2 • 2� ZcvyE /U1G'1'J UA4��. nature of er Date Print Name QAWHILESTORMS\building permit forms\EXPRESS.doc Revise020108 J Town of Barnstable Regulatory Services RAMSTAMAQQ s Thomas F.Geiler,Director �b 's� & Building Division ArED MA't Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us E� _ .:., ... Office: 508-862-4038 Fax:haw•'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 su ervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and Ithat 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 Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\homeexempt.DOC CONSTRUCTION CONTROL AFFIDAVIT (SECTION 116.0 OF MASSACHUSETTS STATE BUILDING CODE) (PRIOR TO ISSUANCE OF PERMIT) On this 19th dam of February,2008, before me, qualified for the Commonwealth of Massachusetts,personally appeared Donald R. Lonergan who,being duly sworn, deposes and says that he has supervised the preparation of all the design plans of TD Banknorth_ 307 Main Street,Hyannis,Massachusetts and that he will supervise and/or check all the working drawings and shop details for construction; and will make site observations at intervals appropriate to each 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 approved plans, and that such plans conform to the Codes of the Commonwealth of Massachusetts, and will review and approve the quality control procedures for all code-required controlled materials. Be such building or structure is permitted to be used or occupied,the licensed Professional Engineer and/or Registered Architect who prepared and filed the original plans and who observed the erection of the building shall file an Affidavit stating under oath that the provisions of the Codes have been fully complied with and that the building meets all the requirements of law for the proposed use and occupancy. Also,agrees to submit reports,at intervals appropriate to each stage of construction,relative to the materials,procedures and further tests that may be required in connection s job. a � 0 No.4027 Original Signa & Seal Date PEMBROKE. e+ 'S A DRL Associates hitects,Inc. 2 West Street i G Weymouth, 2190 Oi Subscribed and sworn to before me this 19t'day of February 2008. `����oanoNwwoq� p�� �`�`®,��ssioxE•eFFy� � •1k= (Notary Public) •; siji i •y <• R Nfp 0.00000a g �2sab8E�••G IB 11�°1►���a� 77 -.2 1<4 Ifu, $4T16W')'3 u a -T�i P r'-,5 bOvisque end ad as;e1c, briu; wI"rvjqu;i 1111w -m l.dfifi b""'; f1i"m --6! -JAS wS bat Rgnipmh YKAV111 toll r1o), ti nag Id pup"I mob 01 kv kloiv -,-ti I fc +Ji I,' lbvk; I 'firft bra ?JI0qJbwo-qqr Al rbivi upir Lois h*-,iop .-I- ibr"a fln't St zvvjf."""')(r I q jc-,!T.-I W1 J'I( If, b it WAY-1,'i Mquix 10 boat A Oj bwAnw! tdi Tit"4 bw; -Avl W" in 9AWs Av-,ttirIA MR Qkud 50110 rwinum wS &VIOP& -'ru"fl psumd Al We do w Wqmoy fo Isud ?5Lo ) j:x'o itl!AXev '' Uf, ?, imsynnnouss aps Saw 01 3SKJOIqua Awlyow 10slys jifrwlis- A bn Jtp:iz iA w , A ,ass Ih }tt 10,-nn . ban byOwnd ACORDN CERTIFICATE OF LIABILITY INSURANCE 1/8/2008' PRODUCER (781)986-4400 FAX: (781) 963-4420 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Risk Strategies Company HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 400 North Main Street ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Randolph MA 02368 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A:NGM Insurance Company M. Holland Construction, Inc. INSURERB:St. Paul Travelers 1126 Main Street INSURER C:Insurance Co State of PA INSURER D:CNA Insurance Weymouth MA 02190 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. AG REGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION TYPE OF INSURANCE POLICY NUMBER DATE MM/DDIYY DATE MMIDDIYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 5OO,OOO X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS MADE rx]OCCUR MPK39348 6/l/2007 6/1/2008 MEDEXP(Any oneperson) $ 10,,000 PERSONAL&ADV INJURY $ 1,00a 000 GENERAL AGGREGATE $ 2,000:,000- GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,O.00,:O.00 X POLICY JECOT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 B ALL OWNED AUTOS DT81073511968COF07 10/12/2007 10/12/2008 BODILY INJURY SCHEDULED AUTOS (Per person) $ X HIREDAUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) -o PROPERTY DAMAGE $ (Per accident) . GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA A C $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY CUK39348 6/l/2007 6/1/2008 EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 5,000,000 A DEDUCTIBLE - $ Hx RETENTION 10 000 $ C WORKERS COMPENSATION AND WC6984043 1/3/2008 1/3/2009 wcs,TMIT- X oTR- - EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNER/EXECUTIVE Corporate officers are E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? included in coverage. E.L.DISEASE-EA EMPLOYEE$ 500,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 n OTHER Fidelity Bond 287179559 12/31/07 10/31/10 $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIEXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Issued as Evidence of Insurance. CANCELLATION �® O ® par SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE d /' EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL. M.HOLLAND&SONS CONSTRUCTION,INC. 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT www.holland-construction.com WIN ® ® FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE, INSURER,ITS AGENTS OR REPRESENTATIVES. MICHAEL HOLLAND , h AUTHORIZED REPRESENTATIVE mholland@holland-construction.com Michael Christian/NB H®LL,A I® ©ACORD CORPORATION 1988 1126 Main Street ® Weymouth,MA 02190 CONSTRUCTION D' 1 7181.335.4275 t ® 781.340.0077 f Design&ConstMction ' � � ��ie �anarrrza�ruueccl� o���/�a�Jaczc><ucaelr6. AF Boar&of Building Regulations and Standards " Construction Supervisor License License: CS 55103 l ' 'ter Explratlon 1128/,2010 Tr# 12910 i ' r.Restrlct n 00 f,; r i ( MICHAEL J HOLLrAND, s 1126 MAIN ST mr � - -- S WEYMOUTH,MA 02190' Commissioner ; FBIN Board of Building Regulations and Standards (_ } 2- HOME IMPROVEMENT CONTRACTOR _ of i Z,IWRegistration: 131278 Expiration: 6/28/2008. type: Private Corporation M. HOLLAND&SONS CONSTRUCTION, INC. MICHAEL HOLLAND 1126 MAIN ST WEYMOUTH, MA 02190 Deputy Administrator o 1u)" , i\ � � aY'F y ;-�-� x 3x c n'b,ae 11,S22372'567 wi "I p �11ir44, -`MI,!1,� F MCHAELl �I� 321 SHEILXWAlYj u674-nysu0,7g,uBzraQ }LL00'0b£'L8L 9LZ17'S££'L8L NoilDn,d SIVOD 0620 VW'Hino-AaM ® 4aajis uiew 9zLL (INN 10H woxuoiianaysuoa-pUello4@)pUello4u' (INV110H 13VH:)IW ® ® ® ® WOD'UO I;D nJ;suoD-pu el loq-mm M. - he �NI'NOI1JfkLLSNO:)SNOS'8 4NV11OH M �� Mike Holland From: eDEPConfirmation@massmail.state.ma.us Sent: Friday, March 28, 2008 11:56 AM To: Mike Holland Subject: eDEP Submittal Confirmation Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection. Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for your records. Please do NOT reply to this message, this email address will not receive messages. For assistance with eDEP Online Filing, please email the DEP Help Desk at DEP.HELP@state.ma.us or call 617-556-1100. MassDEP is interested in how we can serve you better. To help us make improvements to eDEP, please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/dep/service/compliance/edepsurv.htm. To contact MassDEP Programs, please see http://mass.gov/dep/about/contacts.htm. DEP Transaction ID: 172128 Date and Time Submitted: 3/21/2008 2 :29:41 PM Form Name: BWP - Demolition Form for AQ-06 Payment Information DEP code: 30068 Date: 3/21/2008 2 :29:29 PM Amount ($) : 85 Payment Detail: Michael J Holland --Card -- 7971 Contractor Contractor Number Name Address Supervisor Project Monitor Lab EMAIL ID OF THE USER: jbarron@holland-construction.com EMAIL ID OF THE OTHER USERS: mholland@holland-construction.com ' 1 Massachusetts Department of Environmental Protection eDEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: JPBARROW Transaction ID: 172128 Document: BWP- Demolition Form for AQ-06 Size of File: 138.077 K Status of Transaction: SUBMITTED Date and Time Created: 3/21/2008::2:32:26 PM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. 4 l Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 1100069504 Decal Number BWP AQ 06 Notification Prior to Construction or Demolition Important: A When filling out A. Applicability forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-do not use the return (DEP), Bureau of Waste Prevention -Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations 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. ItS & B. General Project Description 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?y❑Yes Z No 1.All sections of b. Provide blanket decal number if applicable: Blanket Decal Number this form must be completed in order to comply with the 2. Facility Information: Department of TD BANKNORTH HYANNIS Environmental Protection a.Name notification 1307 MAIN STREET requirements of b.Address 310 CMR 7.09 BARNSTABLE IMA1 102601 � c.Cit /Town d.State e.Zi Code 5084247124 f.Tel hone Number(area,code and extension) .E-mail Address (optional 2000 ri h.Size of Facility in Square Feet i.Number of Floors j.Was the facility built prior to 1980? ❑✓ Yes ❑ No k. Describe the current or prior use of the facility: IT WAS A BANK I. Is the facility a residential facility? ❑ Yes 0 No 9-0 m. If yes, how many units? Number of Units ° 3, Facility Owner: �N KEVIN J. MELLEN ° a.Name �° 115 PARK STREET,P.O. BOX 9111 b.Address FARMINGHAM MA 01701-9111 c.Cit /Town d.State e.Zi Code ° 15084247124 Kevin.Mellen@TDBanknorth.com f.Tele hone Number area code and extension .E-mail Address(optional) O I �Q h.Onsite Manager Name ag06.doc •10102 BWP AQ 06 -Page 1 of 3 Massachusetts Department of Environmental Protection L7�1- Bureau of Waste Prevention • Air Quality l000s95o4 ecal Number BWP AQ 06 Notification Prior to Construction or Demolition General Statement:If Description Project B. General ption cont. asbestos is found during a 4. General Contractor: Construction or Demolition IMICHAEL HOLLAND OF M HLLAND AND SONS operation,all responsible parties a.Name must comply with 11126 SOUTH MAIN STREET 310 CMR 7.00, b.Address _ 7.15,and Chapter WEYMOUTH (�MA 02190 Chapter 21 E of the t General Laws of c.Cit /Town d.State e.ZiD Code the Commonwealth. 17813354275 1 Imholland@holland-construction.com This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an MICHAEL HOLLAND 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. MICHAEL HOLLAND OF M HLLAND AND SONS a.Name 1126 SOUTH MAIN STREET b.Address WEYMOUTH [MA 02190 � c.City/Town d.State e.Zip Code 7813350427 1 Imholland@holland-construction.com f.Telephone Number(area code and extension) E-mail Address o tional MICHAEL HOLLAND h.On-site Manager Name 2. On-Site Supervisor: MICHAEL HOLLAND On-Site Supervisor Name _ 3. Is the entire facility to be demolished? ❑ Yes ✓❑ No N 0 4. Describe the area(s)to be demolished: �o TELLER LINE, CARPET REMOVAL, CHANGING DOORS N �O 0 5. If this is a construction project, describe the building(s) or addition(s)to be constructed: NEW INTERIOR FIXTURES-NEW PAINT, CARPET, DOORS 0 �O �Q ag06.doc •10/02 BWP AQ 06 -Page 2 of 3 Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention • Air Quality 1100069504 Decal Number BWP AQ 06 Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project, were the structure(s) surveyed for the presence of asbestos containing material (ACM)? ❑✓ Yes ❑ No If yes, who conducted the survey? BRYAN THOMPSON b.Survevor Name AL 060472 r, c.Division of Occupational Safety Certification Number 5/15/2008 � 6/15I2008 7. Construction Or Demolition: 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 b. If other, please specify: ❑ wetting ❑ shrouding ✓❑ covering ❑ other 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization d.DEP Waiver Number D. Certification I certify that I have examined the IJAMES P BARRON =o above and that to the best of my a.Print Name �o knowledge it is true and complete. IJAMES P BARRON The signature below subjects the b.Authorized Signature �N signer to the general statutes 9 9 JOB CAPTAIN =o regarding a false and misleading c.Position[Title _o statement(s). MICHAEL HOLLAND OF M HOLLLAND CONSTRUCTION d.Representing 03/21/2008 co e.Date(mm/dd/yyyy) o a--Cl i ■ ag06.doc •10/02 BWP AQ 06 -Page 3 of 3 M.HOLLAND&SONS CONSTRUCTION,INC. www.holland-construction.com MOCHAEL HOLLAND mholland@holland-construction.com HOLLAND 1126 Main Street ■ Weymouth,MA 02190 CONSTRUCTION 781.335.4275 t ■ 781.340.0077 f Dengrt&CmLructzon I � e Mike Holland From: eDEPConfirmation@massmail.state.ma.us Sent: Friday, March 21, 2008 2:46 PM To: Mike Holland Subject: eDEP Submittal Confirmation Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection. Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for your records. Please do NOT reply to this message, this email address will not receive messages. For assistance with eDEP Online Filing, please email the DEP Help Desk at DEP.HELP@state.ma.us or call 617-556-1100. MassDEP is interested in how we can serve you better. To help us make improvements to eDEP, please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/dep/service/compliance/edepsurv.htm. To contact MassDEP Programs, please see http://mass.gov/dep/about/contacts.htm. ************************************************************************************** DEP Transaction ID: 172128 Date and Time Submitted: 3/21/2008 2 :29:41 PM Form Name: BWP - Demolition Form for AQ-06 Payment Information DEP code: 30068 Date: 3/21/2008 2 :29:29 PM Amount ($) : 85 Payment Detail: Michael J Holland --Card -- 7971 Contractor Contractor Number Name Address Supervisor Project Monitor Lab ************************************************************************************** EMAIL ID OF THE USER: jbarron@holland-construction.com EMAIL ID OF THE OTHER USERS: mholland@holland-construction.com 1 r 11/08/2007 11:50 5087786448 HYANNIS FIRE PAGE 01 I]VAN S, FIRE DEPARTMENT °�• �+ rn►�sr: - "$5.HIP H.SCHOOL AD_ EXT. HYANNIS, MA.02601 { HAROLD S. BRUNELLE, CHIEF FRfo'kpin6� IME MAHN t10FLHCATYDX FRAVENTION . BUREAU `9USINESS PHbN:E:(5D8)775-1300 FACSIMILE"PHONE: (606)778-6448 IT, U11L9LD :CTSE;jR;CFf LT. ERIC F.HUELER, CFI KRR #i.MV)t31V'noN.OFFICER FIRE PREVENMON OMCER ; UILDINO."Q.0-E OOk�l'�PLIANCE FORM ' tHIS'FIRS:PPiEVEN-riON:BUREiA.U.HAS'REVI�WED7HIZ PLANS DATED FOR TFIE,'PR�'ptrRY LQCATEQ AT' Q�. _ AL0O KN�UU'JN' t .THE .CHART BELOW INDICATES: THE STATUS OF OUR REVIEW: .. :: •• '=r."���.. .��, ..�. �, N�.,:r•'. � ,;N/A RECEIVED REVIEWED COMPLIES �1�' ;1':�:F�I`�A'Tkt'/;E,R�.(�1���!"':'� ::e;.:: �•.;�:r,,;�;;:';:'• FiyDi '�glVl"1:O ATIQ;: %:WAT:: K'"S'[JP'f� y.. INK 'h.'6 TFt( Ql1Ip:Iv� Nfi iTk ,... -9 R:TIVI t�IT'' t�fICI�C:TIC3►al:: A r •. ;J;FIRE'1?: OXE `11 -, I '; IIV ..5�8T :,: _ ;.. Fir 8. WO A- 11-SMQK 'CIJNTIQ�% XHAUT + '1 -SMOKE.CONTROL EQ(J;11',aLt A JQN _ ' { n'."wPE �IFET �S . T' M,F A7 't i4. FIR 'E r 15-FrF:�.'CQ:NT CJL::EQV,IP'�LO, TfON 1�:�I�����rl�rufiii�.i�i �,ai'iJ'I�'�1; �;';�:�;•. ' : , ; , 1 ;1 .�ALAP,,.Ti A Sty(1 00►��`Nj�7'.;i E .�.,'i4�liJ'l�l R�WQAT'' 14ZIA,• 20-AiCPTRIV TETI .. ..�.'.. Wc.��ukvV�-yk�ff f) -.0., 1iI N• C PLETE AND.COMPLIANT'FOR THE ISSUAtitE OF A BUILDING : . WE HAVE COMPLr`7 M'THE ACOI,�pTP,NCE l)=STING F -R TWA.OCCUPANCY PERMIT AND BELIEVE THAT 1/VITHIN THE$GQpE'O THE Bvlt`DI(JG P• { MIT,' .THE ABOVE ISSUES'ARE IN COMPLIANCE.