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0776 MAIN STREET (HYANNIS)
��� .��� �, _ _ _ ____ _ _ r ,,_ _ -_ f �,,� i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION-Q.-K.4 l �_ s � J MI E :3A,P STABLE 'C Map Parcel ' Application # - Health Division fa' 'bate Issued Conservation Division Application F Planning Dept. —Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address , h711 �u�, <1V- _��n�rrs c..�k �_7 r" -n b Village AQn hhl�l Owner NP,C�c�tr�c32 Address kosw '2- & Telephone Permit Request rF�l ? ins 0u h96tc/1�l� -~•GJt►'Co.�.R S errTl-_n__Y1 1 Vim'�� �r �ryKr�yIFuner� / L L{i+ I �ry.. - .r•rrw•+.er�.r 11 Square feet: 1 st floor: existing1 proposed �2nd floor: existingproposed 1�! Total new Zoning District II Flood Plain Groundwater Overlay TT� ��✓, I-� Project Valuation 00 Construction Type. o 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 I� $ Basement Finished Area(sq.ft.) Y) V� Basement Unfinished Area (sq.ft) T Y+ Number of Baths: Full: existing_ new Half: existing n 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: Y� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use �� 1 Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name } � j �G.�(�C�`� Telephone Number- Address License #�S l'4 rUP Y', m n Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Sa(d ulok__ "YW0 SIGNATURE DATE � 2 FOR OFFICIAL USE ONLY APPLICATION # ` ~A�DATE ISSUED MAP/ PARCEL NO. _ ADDRESS VILLAGE X g OWNER a �> DATE OF INSPECTION: G FOUNDATION FRAME yr. h INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL I PLUMBING: ROUGH FINAL GAS: ROUGH FINAL jr FINAL BUILDING DATE CLOSED OUT, ASSOCIATION PLAN NO.' Town of Barnstable Builfflng i Fr m:, h Street A ravedzPians Must°.be=Retained on,Joband this Cacd;Must be Ke t Post � - Posted3 Until F,anal Ins ect�on.;Has B"een,Made. . ,� �;�.,-, .. .,r p � � 4� � � � � � � i " W,he'�a=Cert�fieate of Oca ane s;:Re uired�such Buildm shalloNot be Occw ied'until a F,tnat.Ins ect�on,has been;made „ ��1 1� Permit NO. B-17-1299 Applicant Name: KEVIN J FARRELL Approvals Date Issued: 05/08/2017 Current Use: Structure Permit Type: Building-Addition/Alteration-Commercial Expiration Date: 11/08/2017 Foundation: Location: 776 MAIN STREET(HYANNIS), HYANNIS Map/Lot 308 001 001 Zoning District: OM Sheathing: Owner on Record: RAILROAD CROSSING LLC Contractor Name: KEVIN J FARRELL Framing: 1 t , Address: 231 WILLOW STREET ��sf �Contr�actor License �,.,CS-096560 2 YARMOUTH PORT,MA 02675 .;� Est Project Cost: $ 12,500.00 Chimney: Description: VERIZON WOULD LIKE TO MOUNT WIRELESS ANTENNA AND Permit Fee: $213.75 ANCILLARY EQUIPMENT TO THE EXISTING UTILITY POLE LOCATED AT Insulation: THE ROTARY ACCROSS FROM 776 MAIN STREET F e Paid:" $0.00 �- Final: t 5/8/2017 Project Review Req: VERIZON WOULD LIKE TO MOUNT WIRELESS ANTENNA AND::; ANCILLARY EQUIPMENTTO THE EXISTING UTILITYPOLE Plumbing/Gas P. LOCATED AT THE ROTARY ACCROSS FROM'77fi MAIN",STREET Building Official Rough Plumbing: ' This permit shall be deemed abandoned and invalid unless the work allth' ri e616y this permit is commenced within ix months after issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and tlieapproved construction documents,for which this permit has been granted. All construction,alterations and changes of use of an building and structures shall be in com liance with the local zomn .b laws an'd codes. Rough Gas: g Y g p BAY This permit shall be displayed in a location clearly visible from access street or roadand shall be maintained open for public inspection for the entire duration of the completion of the same. 1 Final Gas: work until the com P � r The Certificate of Occupancy will not be issued until all applicable signaturesiby+the'zBuildang and�Fire Officials are provided on this Perm it. Electrical Minimum of Five Call Inspections Required for All Construction Work:. 1.Foundation or Footing- Service: � 2.Sheathing Inspection ' " ?r 3.All Fireplaces must be inspected at the throat level before firest flue linmg:isnstalled' 41 - Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Final: 5.Prior to Covering Structural Members(Frame Inspection) a 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: 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. Health Per,w.ns contracting with unregistered:contractors:do_not have access to the guaranty fund (asset forth.in IVIGL c-.142A). Final: Building plans are to be available.on site Fire Department All Permit Cards are the property of the"APPLICANT-ISSUED RECIPIENT Final: �r ' "• - �` N x•� e r ;,� 'e•sa 9ax� �,- ,,� ��d..« �""r+ xx u "� x *... �" - t. '. s ,h$m r .r a mr "1,'6 z"`- �4x 7M ' "w•b' -,«£ `,did ms z $°` `« r d, ras,„, ii �` „�&Ry ;.;� ".t9:d. 4. a r ti m h. d r,,a ..h"`'.m' �, •r,y. y` � .eY F,r�4 �*ate ? 't�;" �+ '`�u ,� � '�� .t *•` r � r� �' �� � � `", �_ g&11, - 4 - ,�° « C''�r �, 'k,� tom, n=q b ba F� ad it= k r� s_ a Y z , i '. �: 2 ..,«? -' n �` '' ` xad. aM his ":+$'..,1 �' a' `�c "'. 441 , a - * s�;. r G s, r 4 1' a�. ;, 6 a r -r fin. &5,'t x t.� imaip "'i". l , VI aw° r o ors a leg y tod U"I d i rqj�R and� •f1*= '°Y' i C't , #z4"I �n k i. ev1, .r It e` ' s toti:J• i sy"`« 2 ..SG �� j0111i ,~ f m , Lv jfJ Aft { n 4+ r DO l�d � xis,. "� � 4 r;.r'. t i<titli 8S �+P} r, '4 i+ � ' ab t� a 50.E��, N3Y' r w ti ���w x a Fe M i � � ".. �r t• " ma IN ? let < 3 a t All roVmA V `m $ �•. � � s�� �� � tt W- < ,a'" �+�h�,"�mtc5�d ! ,�=ry`+t3'' � "a a�Gr�11 ,71 ` ( M I �s a4 � n azy A. A ... C s .,' 'z- "z tY`��.;�'..�.� F an•w t dr°' 's ri m� t � t '`<r re- �". 31m�{r.'��,a � x.. a ItA �� ��� �€r ..� w � � '""�� }.�. • '� .:n, � a:�., b ,f 441 yy¢y'3 � �:'�� ><'" '. "" .�, '� +s �. ; � � s ^ P �` r.� t•, ""mod �y.. as. '��v,, +� �"fie � Ow k�'�'¢'£4 ,,y`�0 �'YTS �s � •S x �. fR. ..t'��'i � � p 5 �' =�,'F �r"�.4A '!'�'. �� � � ��'��" ,e °- 4;;:cz�� ° s� ¢ air. ir3, x.t k� n!N i 411 ' " •A& :. «. 3` + .k' o- t€. *,'+�, V�" '• 3�G na;.o �, tm', :� 1�=. .. u �" " x r ° i, w ait� x' hA:7� , C arr4 un a '8"Psdd Mn �1 ``� YMq� .�i n r o Ai k t �4 .: T :. e4. w.��•��i-; ,.F`«,.F M ZogS zy i `^°. y„ i, *,•, } v* a Y -rA ; y �, F.a ; 4. d& s° Yb %` A$t ryk`, `,•e, # .».fi ¢$, ' ..`?` s,. 'tt Fry R,:a' 'e �, �sn��,,,q, y� I��i ,o,`M�� .�� „rvfy,�t�" Tt�'�, « s'3i e a' .;i .$` m' wr ':G§ '+ t «$t+ . r" ti'"•' -. , "...5 '*,Yy t .,. o a� r «", ,. r3 s:e t r.. mew Aar'-- '` "'� t ,.:, �.r�i ..'fit • �4d'�n �' dmal�a :' '.t `• '* ai ' �y l t 1 The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):New England Electrical Contracting Corporation Address:21 Marion Drive City/State/Zip:Kingston MA 02364 Phone#:781-585-0040 Are you an employer?Check the appropriate box: Type of project.(required): 1. ✓❑ I am a employer with 48 4. ❑ I am a general contractor and l 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 me in an ca aci . . employees and have workers'' g y p 9. ❑ Building addition [No workers' comp. insurance comp. insurance+ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs.or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs xor 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' 110'Other comp.insurance required.] - *Any applicant that checks bok#1 must also fillout the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors,must submit a new affidavit indicating such. :Contractors that check this box;must,attached an,additional sheet showing the name of the.sub-contractors and state whether or not:those entities have employees.. If the sub-contractors have employees,they must provide their woikers'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 NameZurich American Policy#or.Self-ins.Lic.#WC0161691 Expiration Date)1/13/2017 Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date), Failure to secure coverage as required under Section 25A of MGL c.;152 can.lead to the imposition of criminal penalties of a fine up to 1$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 hereb certf 'un thef ains and genalti o. er ur that the in ormation provided above is true and correct.. Si ature Date Phone# rM 5-V w`/p Official ose only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City. /Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.,Other Contact Person:. Phone#: Client#:23780 NEWEN16 ACORD,, CERTIFICATE OF LIABILITY INSURANCE F11/1512016 ATE(MM/DDNYYY) 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 J Smith NAME: Sullivan Insurance Group,Inc. PHONE 508 791-2241 FAX 508 797-3689 AIC No Ext: A/C No 1 Mercantile Street E-MAIL Jsmith Sullivan rou Suite 710 ADDRESS: 9 p•com INSURER(S)AFFORDING COVERAGE NAIC# Worcester,MA 01608 INSURER A:Gemini Insurance Company INSURED INSURER B,North River Insurance Company New England Electrical Contracting Corp Zurich American 21 Marion Drive INSURER C Kingston,MA 02364 INSURER D:Hanover Insurance Company 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR TYPE OF INSURANCE NSRADDLSUBR WVD POLICY NUMBER POLICY EFF MMLDDY EXP LIMITS A GENERAL LIABILITY X X VCGP081520 11/13/2016 11/13/2017 EACH OCCURRENCE $1000000 X COMMERCIAL GENERAL LIABILITY PREMISES EaE occurrence) $50 OOO CLAIMS-MADE a OCCUR MED EXP(Any one person) $1 O 000 X BI/PD Ded:5,000 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 PRO- LOC $ D AUTOMOBILE LIABILITY X X AWNA947880 11/13/2016 11/13/201 7 COMBINED SINGLE LIMIT Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED 1xx SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident B X UMBRELLA LIAB X OCCUR x x 5811075702 11/13/2016 11113/2017 EACH OCCURRENCE s5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE s5,000,000 DED RETENTION$ $ TORYC WORKERS COMPENSATION x WC0161691 11/13/2016 11/13/201 X WCSTATU- OTH- AND EMPLOYERS'LIABILITYLIMI ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? � N/A " (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Cert Holder named as additional insured.Policies are primary and non contributory.Policies include Waiver of subrogation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE yc'T�te+ e�efa' ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) .1 of 1 The ACORD name and logo are registered marks of ACORD #303267 KMD 2-C CERTIFICATION Client: Turning Mill Consultants, Inc. 68 Tupper Road, Unit 3 Sandwich, MA 02563 Site Name: Hyannis MA SC05 (Candidate: Light Pole Unmarked North) Site Address: North Street at Rotary(across from 776 Main Street) Hyannis, MA 02601 Project#: Type of Survey: X GPS Survey X Ground Survey , Horizontal Datum: NAD83 -expressed in degrees of Latitude and Longitude Vertical Datum: NAVD88 -expressed in feet Above Mean Sea Level(AMSL) Structure Type: Self-Support Tower Monopole Tower Guyed Tower X Wood Pole Water Tank Smoke Stack Roof Top Church Steeple Temporary Site Silo Other Center of Utility Pole: Latitude 41°38' 52.01" N Longitude -70° 17'47.06"W Ground Elevation at Structure: 0' (AGL) 32.7' (AMSL) Top of Structure(Top of Utility Pole): 30.2' (AGL) 62.9' (AMSL) Center Line of Proposed Antenna 36.5' (AGL) 69.2' (AMSL) Top of Proposed Antennas: 38.1' (AGL) 70.8' (AMSL) Overall Height of Structure,Including appurtenances (Top of Proposed Antenna): 38.1' (AGL) 70.8' (AMSL) Certification: I certify that the latitude and the longitude are accurate to within+/-50 feet horizontally,and that the ground elevation is accurate to within+/-20 feet vertically. The horizontal coordinates are based-upon-the North American Datum of 1983 (NAD 83) and are-expressed-in"degrees of Latitude and Longitude.The elevations are based on the North American,Vertical Datum of 1988 and are expressed in feet Above Mean Sea Level ( L) .�- Signature: Bryan p rmenter-- s�` , of sIs, Professional Land Surveyor#48193 BRYAN G. Date: September 1, 2015 00 PNO.48193R' yF,G/STE¢�5�'' "Wl LANO 20 Balch Avenue FFS Groveland,MA 01834 (978)891-5203 AL, www.pfsland.com ven onwireless May 1,2017 Dear Sir/Madam: Re: Kevin Farrell/NEEC Please accept this letter as notification that Keven Farrell working for NEEC, of Kingston, MA has been engaged to perform research on certain properties and real estate including submitting for zoning approval, building permits,and construction for Verizon Wireless'ongoing network enhancement. Keven Farrell / NEEC is authorized to act on Verizon Wireless behalf for the purpose of filing and consummating any zoning and/or building permit applications necessary to obtain approval of the applicable jurisdiction for the installation and/or modification of Verizon Wireless' communication Facilities. Should you have any questions regarding this please contact me at 508-942-7503 or via email at npelletier@trmcom.com. Respec ully, Sean Conway Verizon Wireless Project Mamanger—Real Eastate Vey", ® WJi' 1GSS July2,2015: DearSir%Madam; Re.- TRM, Inc. Flease:accept this letter as not ficatiomfhat TRM,.Inc.;of Foxborough, Massachusetts has-been engaged to perform research on certain ptoperties and real estate including submitting'for zornng:approval, buildirig permits and negotiating real estate agreements.as well as engageJo certain engineering analysis and construction.forVeriion Wireless'.ongoing.network erihancernent. TRM, Inc.,.`is authorized ao act,on Verizon Wireless'behalf for the purpose of filing and consummating,any zoning andlor buftling permit applications necessary.to obtain. approval of the applicable jurisdiction for the installation,and/or modification of Verizon Wireless'.communications facilities: Should yoia have any questions;regarding any TRM,:In;e'sacti�ities;on bahalf of Verizon,UNreless,.feel free to contact me at 508 320=201Tor via email,at ean.conway@yerizonwireless,com Resp tfully, Sean Conway Verizon Wireless Project Manager--Real Estate EVERSA V RCE One word, assa MNBED180 Westirao�,Massachuselts02090 ENERGY D � Q December 1.6,2015 Attention:&ate and Municipal Permitting Authorities MAR 2 2 2017 Re:Initial Authorization for Verizon Wireless to Attach to NSTAR poles To Whom It May Concern: Eversouree Energy d/b/a NSTAR Electric("NSTAR")is aware that Verizon Wireless is in the process of permitting for the.installation of necessary telecommunications equipment and corresponding aerial fiber optic cable in various locations on NSTAR:owned poles throughout our service territory, As part of(lie approval.process,we understand that there is.a requirement for NSTAR to revieww these locations and provide the;TbNvns with confirmation of its approval in advance of Verizon Wireless's-proposed attachment. �I Accordingly;NSTAR hereby submits its initial authorization for Verizon Wireless to install its equipment. and corresponding aerial fiber routes to NSTAR poles in the geographic orations as depicted on the plans. � submitted by Verizdn Wireless and on file with the Towns. The installations on NSTAR poles will be subjectto the underlying terms.and conditions of agreements by and between:NSTAR.and Verizon Wi' less;.as,the sam may be in.effect from time.to time: If themis anything further that I can provide you with for your analysis;please do not.hesitate to contact me.at.508-441-5881. Sincerely, Steven M:Owens Supervisor-Rights,Permits 8c Public Works Eversource Energy,(NSTAR Electric) One NSTAR Way,NWBED180 - Westwood,:NlA 02090 Ph: (508)4.41-5881 FW..(5.08)441-:5842 MAR 2 2 2017 i i 4 i APPENDIX IV Form I APPLICATION AND POLE ATTACHMENT LICENSE Licensee Verizon Wireless Street Address One Verizon Way,Mail Stop 4AW 100 City,State and Zip Basking Ridge,NJ 07920 Date 10/7/15 in accordance with the terms and conditions of the Pole Attachment Agreement,application is hereby made for a license to make 1 antenna,RRIVCabinet and meter attachments to poles and 1 Power Supply(ies)and other attachments located in the municipality of Barnstable in the State of MA This request will be designated Pole Attachment License Application Number Hyann13MASC05-384940 Attached are my power supply specifications if applicable.The cable's strand size is 0.5 and weight per . foot of cable Is 0.2. ❑Communication Snace X Power/Supply Space Licensee's Name(Print)Barbara Kassabian Signature 8c bvwa X V5a&aav NSTAR d/b/a EVERSOURCE Power Company Title Site Acquisition Tel.No. 603-303-8001 Fax No. E-mail bkassabian@trmcom.com *********************For licensor use,do not write below this Pole Attachment License Application Number is hereby granted to make the attachments described in this application to attachments to JOI poles, attachments to F02 poles, attachments to JV poles, Power Supplies and other attachments located in the municipality of in the State of as indicated on the attached Form 3. Licensoes Name(Print) Signature (AGREEMENT ID#) Title 6/D-er U1S h Date Tel.No. The Licensee shall submit an original copy of this application to Verizon New England Inc.and NSTAR Electric Company d/b/a EVERSOURCE ENERGY. Revised 02/23/2015 NSTAR d/b/a EVERSOURCE f Form 2 AUTHORIZATION FOR FIELD SURVEY WORK Licensee: Verizon Wireless In accordance with Article III&Appendix I of the Pole Attachment Agreement, following is a summary of the charges which will apply to complete a field survey covering Pole Attachment License Application Number HyannisMASC05-38490 in the municipality of Barnstable in the State of MA FIELD SURVEY CHARGES Field Survev #Poles Unit Rate Total Field Survey Application Fee 1 pole $139.00 $ 139.00 (includes 1st pole) Field Survey 2-200 Poles $ 1145 per Pole $ Additional Travel Time* $200.00 er Day $ TOTAL Charges $$139.00 *Based on average of 75 poles surveyed per day,add$200.00 travel time for each additional day required to complete survey. Please note,if you calculated the cost incorrectly,your check will be returned and a new check for the correct amount must be received by this office in order to schedule the survey. If you need assistance,please call the HOTLINE on 800-340-9822. The required field survey covering Pole Attachment License Application# HyannisMASCoS-364940 is authorized.I am enclosing an advance payment in the amount of$ 139.00. Licensee's Name(Print)Barbara Kassabian Signature Barb"aXaffab WV Title Site Acquisition Address 16 Chestnut St,Suite 420,Foxboro,MA 02035 Tel.No. 603-303-8001 Date 10/7115 Revised 03/06/2015 Eversource Energy FORM 3—EVERSOURCE rrEMIZED Pole Make-Ready Work Charges PAGE__OF RCE to Complete:Total Poles Surveyed Total Poles Requiring NSTAR Make-Ready AppendixIV Form 3 ;.. :.:�:i:.•FIBLD BURVEY � ''liiAItE:READY WORK FORM"+.•. , . SURVEYORS: DATE OF SURVEY: CWO#: Verizon MWAIC: Barnstable MATE:MA Exch Code: Munic Code: Licensee CraltiCady LICENSEE NAME:Verizon Wireless LICENSEEAPPLICATION#:HyannisMASCOS-394940 EVERSOURCE ELCO KAMM EVERSOURCE NSTAR APPLICATION# i.-''LOCATLON POSE:# ATT OWNERb�HIP•. CHARGE WOItK:DL3CR1PTiON TEL RTE/STREET NAME Tel El F/C J.D. J.U. F.O. YES NO TASK#S / 'Height List one pole per line FS, Tei El Tel EI Tel El REMARKS of Att. ise North St at Rotary(across from 776 N/A N/A Main St) . I W=Ot Height of Attachment Height of Mamma Attachment shall be 40"below SLCO MG enleu otherwise noted here by Verleon and EVERSOURCE surveyor. Revised 03/06/2015 • ti Licensee to complete bold itattelsed areas ont. Provide ownership omwNon It known Revised 03/06/2015 EVERSSURCE - Work Order Application FOR KEN KENDRICK: Customer Request In-Service Date: 1/7n016 WO Received Date: Service Address:Street:North St at rotary(across from 776 Suite:_Town: Barnstable Zip:02061 Main St Customer Of Record: Customer Responsible for Payment of Monthly Electric Bills Name to appear on Monthly Bill:Verizon Wireless DBA—C/O Name: Billing Address: One Verizon Way Mail Stop 4AW100. Basking Ridge, NJ 07920 Telephone: 508-320-2017 Tax ID Number: TBD Existing Account or Meter Number(If applicable): Property Owner Name(if different from above): Owner Address: Owner Phone Number: Party Responsible for Construction costs associated with work order(if different from above) Name:Verizon Wireless Address:400 Friberg Parkway,Westborough,MA 01581 Phone Number: 508-320-2017 Please Note that Articles of Incorporation are required for new commercial EVERSOURCE Customers Type of Service Requested: (Circle Appropriate) X New Service Service Upgrade Service Relocation Temporary Service Pole Relocation Disconnect/Reconnect Service Removal Metering Only OH Service from Pole, Pole#: UG Service from; Riser-Pole#: Padmount#: Customer Loading Brief Description of Work Attach (1) antenna. (1) RRH/Cabinet and (1) Type of Load New Connected Load in KVA meter to the pole. Will require 60 amp single Sin le Phase Three Phase phase service. Lighting Electric heat Air Conditioning Refrigeration Cooking Electric Dryer Water Heater Computer Process Equip. 14.4 Motors/Elevators Miscellaneous Totals 14.4 Number of Meters Required: Residential: Commercial: I Public: Main Switch Voltage: Amperage: Phase: Service Voltage: Amperage: Phase: Facility Type(ie:school,hospital): Telecommunications New Building Square Feet: ALL 480V SERVICES REQUIRE COLD SEQUENCE METERING(DISCONNECT SWITCH ON THE LINE SIDE OF THE METER If more than 1 meter is required, how will meters be labeled?(ie: Unit 1,2,etc,Unit A, B,etc.) Additional Equipment. Generator: KW. Phase: Purpose: Motor(S): Total#: Largest HP: Phase: Locked Rotor AMP: Type of Starting Compensation(choose one): Hard Soft Capacitor VFD *See Article 802 of EVERSOURCE Information and Requirements Book for Maximum LR current and Three Phase Protection* Contact Name(circle appropriate): Customer/Contractor/Consultant:Craig Cody Street Address: 16 Chestnut Street, Suite 420 City, State, Zip: Foxboro, MA 02035 Telephone: 781-831-1281 Best Time to Call: Monday-Friday 9:00 a.m.to 5:00 p.m. Pager: Fax: Cell: Electrician: TBD License Number: Business Name:Verizon Wireless Street Address:400 Friberg Parkway City,State,Zip:Westborough, MA 01581 Telephone: 508-320-2017 Best Time to Call: Pager: Fax: Cell: - Please note that by Interconnecting with the EVERSOURCE Distribution System the Customer of Record acknowledges that they have reviewed and are in compliance with the EVERSOURCE Information & Requirements for Electric Service(Blue Book). For New Commercial Services, New Residential Developments, New 13.8 kv Two Line Station Electric Service, please provide (2) copies of City/Town approved site plans that Illustrates the new facility location and the proposed location of the new utilities(electric,gas,water,sewer,telecommunications)and a One-Line Diagram. For Service Increases at existing facilities,please submit a One-Line Diagram if available. For New Residential Services where a pole must be set,please provide(2)copies of a site plan that illustrates the proposed location of the new facilities. For Temporary Service Requests,please provide(2)copies of a site plan illustrating service location. You may Fax this Form or mail any additional correspondence to: EVERSOURCE ENERGY Electric and Gas One NSTAR Way Westwood,MA,02090 Tel: (781)441—3851 Fax:(781)441-3194 Cell:339-987-7059 H.Kendrick SW340 FOR NSTAR USE ONLY EVERSOURCE Revenue Allowance: EVERSOURCE Rate: KVA or KW rating of Existing Loads(if applicable): Existing Winter Peak Demand: Month/Date/Year: Existing Summer Peak Demand: Month/Date/Year: VIC(FRiYNAP J ` LEASE Po16 EXHIBIT LO ATLON �-5tj5 r HYANNIS MMLSCOS TUANINMII L ' w N0eaP0� uvn toME nsure s,me Tm x•r JV taA%* t 7C If.," KOR7'H eTRYEf®RO7AR` µCOSS FROM vilmAINsjRe ) RARNSTARLE,YAwmt WE.XH.W.T9WRALswna a¢o UNMARKED F AERIAL MAP n 38' 52.01" 17' 47.06" a MADAM s mucW p11p16"`"'�O1C ND1 f°p NITY 8 •. c A Intom wx Fm oxam aoeva IAL MAP unnr uas.xxaa m x oLm•am. L SM RM A nt7aaaa a7Am a me aw ar no"as a xwm at: y� w URn ME toaoaiD wm a mn wAn mom mumr A WOMO aK W. LE-1 7,nuL aOmaWM VA 94= G a,A�a LEASE rou EXHIBIT emnn ew wawaw um maw wow HYANNIS MA SODS ua ta L.T'U"MM.R(cL x41 � �. a A IY 4ra' IYeaI Me111gR. Q omlierEEEr®nbTAn` o ,y I�CR05s F.IIQN 716MAIMMEET) SAWWABLEi MA 0ll001 .e µ91Os1. LEASE EAI05R suelmrus SITE PLAN n i r.wr -t x is m' 4a' a 4y4/a wl.a 4"wl FQOMSW . uxsm ♦ w/IVa aaw lw ala rmm I asses aemW tar N x Ito'WA .0 fac Iaslas aar♦m ax VI Ix°4r W 47" �0 Wo° a� wNUN � •m I►Gas' axes t9� �� as �.� UNMARKED 1.tOrA E♦FPO*"TE aw 41 se'atAl' Caomextes ew yam r ywwlwa pryw I]a WOW /dO 3 M ecaxmlr FOR Iosti Flumes M% / N 41' 38' 52.01" Isalw xor ma ss+ms°aua /aI` W 70' 17' 47.06" A saint I— 4.lCPV. Iam m Coat msa etana /T wuxe♦s clear esv.swwm Ia ac pp°I�• sxm nm L VM PUN a tlEWM Gain aN Se W mw m mau4xlz— SITE& `Nr♦auiNNM ana o x6xu'e,"`maa WM DETAILED EXISTING SITE PLAN n PROPOSED SITE PLAN n SITE PLANS awn Ole-I'd wt sewn Ile-r-a' -� slsxl a LE-2 w�alw LEASE wmmm Ia1a ueC_wa iR R AMQIM ]l1'f AQL fM!'N91 EXHIBIT r4VN1tD YSSQ A� IICMIm 1t34[Atq"[a]f!'a ANL p}.Y/Iatl tr}•N I(Ito•W MOM to= r a11fNY YelrmNo evo� NVANNI"A-SCOS �� tanxe te"R ral a«•a&AL(aram.t rllmcr VIr (+ Q"•r' rfeNe�tam self •:�.-• aJ-vtt w rc wn t U�(U"00 TURMN�fA.L aosmo uwccw r Irlc a a>f A6L (wiser»unm Wu0.YMi11 's`11°twN.Ma C I >R.aur RTNSTREEFOACTAR' UK i I 1ACRO98FROM I A6 MMNSTi[:E11 I °arN°ln°a w% 911RNSTA6LE.MAlJWl NNx R Ieel tm¢ LEASE EKMff SLRNITTALS T twroum reel enuae m ceN.welaU Isle Of MLmMAW raerelmM. MOM=t6= f rpyu an ase rnN1 wu mNeiR t Ir/IW eNO I01 R1O m w�a'.-Q m �Ku awp en u nso>m uaa eNEdm as w I, eeunma alriw rae xwem >a UNLIARKEO ra 1ooy! ulurf 0M.WA�l N Io Val mom OW. .. N ar t.•"0" r>r Ir a.R• mould ura N 41' 38' 52.01" W 70' 17' 47.06" POLE PHOTO 8 CONCEPTUAL UTILITY POLE PNOTO CONCEPTUAL POLE ELEVATION : ELEVATION lGYO MYF ���y NG{4 7/Ir.I'4 J •Ar1T I� LE-3 LEASE EXHIBIT / 11 vv HYANNI9_JNA SCOS r,aosm fxlo"w ua'w w� cTivaRr irs I M WRO fi hoes PO01 MEEFORWAR (46Rbmpao N Pea B ;• �� 776MA1R 91REm n• � BM,NSTMLE;'11A010ot iv a�"r-0o>m ti r' EYR®Lf SUBM,R� PA W= f"�fONkE • M/1Nf 4710 Nf HIO COIIr1B11 D dYW Y11 fi 1 Ot• cwE O W •00[R soc _OII01/D POLL Nukvm 1 — UNMARKED COOO VM NwENe NA DETAIL ENERAL WIR1 ( 1AGRAMRRHDE IL N 41' 38' 52.01" p W 70' 17' 47.06" atntme EQUIPMENT DETAILS Slew lflwe LE-4 r APPLICATION1, POLE-ATTACHMIENT� ICENSE FORIVI Licensee VERIZON WIRELESS Agreement No. AMA140012 Pole Attachment License AMA140012647 Customer License Number H annisMASC05-384940 State of MA IMunicipality IBARNSTABLE Type of Attachment Number of Attachments Billing Description Anchor 0 Antenna 1 MA CAE-ANTENNA-JO Cable/ADSS 0 Cable/Strand 0 Decorative 1 MA CAE-POWER METER- Drop 0 ERUV 0 Misc 1 MA-JOINT OWNED URB7 Overlash 0 Power supply 1 MA-PS URBAN TELECOT Riser 0 Total Attachments 4 Total Attachments Billable 4 Total Attachments-No Bill 0 Licensor's Name(Print) DEBORAH TOBIN Signature Approved by DEBORAH TOBIN on 12/23/2015 Date 12/23/2015 Title SUPERVISOR Phone 617-743-4511 JO �N TELECOM TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION s' Map Parcel 061 - 001 Application # Health Division Date Issued -3 Conservation Division Application Fee 2 Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis 14 yfD ( Wj_,_ Q(,4 Project Street Address rM A Aw Village kAYa► MR. Owner M k k CDC ( Address Telephone $ ^ 7-7S 9 3cn- /� Permit Request � �r 1 ��c� S-�I►.1c lJ)��� it�� a1��c �+9.(� �)ou 2 AMU 0, Gl,& Aed4e 2, T2 JR-C1 S R Ai& cQ �e ��Pi t-T F $ ,�-'TcSL Ic�'L ; R2 (A �!��-1►.�s�h-'t�Llu2 cuM 4i--c�Q Teu►N to c,e Square feet: 1 st floor: existing ZIgLproposed 2nd floor: existing)o proposed Total new X Zoning District Flood Plain 0c) Groundwater Overlay Project Valuation 30,06D. `A" Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. }�Awelling Type: Single Family ❑ Two Family ❑ Multi-Family (# i inits) l Age of Existing Str?FLII re S Historic House: ❑Yes of No On Old King's Highway: ❑Yes 1 Ca o Type:Basement T e: ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) , g� Number of Baths: Full: existing new � Half: existing o`Z new Number of Bedrooms: existing _new /�� \� Total Room Count (not including70il ): existing G new—s��First Floor Room Count Heat Type and F I: ❑ Gas ❑ I yp Electric ❑ Other Central Air: Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes /No p g 9 >(Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn O.existing ❑ new size Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Oh . `V I~l f Ails Zoning Board of A eals Authorization ❑ Appeal # Recorded ❑ BY Commercial 1 Yes ❑ No If yes, site plan review# Current Use oltt C,C° Proposed Use APPLICANT INFORMATION 1 (BUILDER OR HOMEOWNER) Name PAUL MN2_7c � r 6,ET �ul I&IJ Telephone Number ^4,;18 48 34, Address 644 900 QA A i3( 10P All) License # ca(0 4-6 Home Improvement Contractor# 06M-09773'� Email cl�-��u� e�Z(2 NK43 1 . IJQ Worker's Compensation # 4/000?374 ALL CONSTRUCTION DEB ES LTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ` FOR OFFICIAL USE ONLY APPLICATION # . DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Lr r The Commompeah*of assr dense& DelwbmentDt of rtrial�lccid s cff- �a ' gat�ons. 600 Wasbbigion Street _ Boston,CIA 02HI tb+ry masmgavIdia Workers' CompensaflffnInsurance Affidavi-BBmldetslC,ontr=ctnrslnecfririans hers AppEcaut lufmmmfign Please Print Addr. • c�rs�tef s ��� �� -�-9'83�— Are}*o au efaployer?Check the appropriate bum Type of project(req�eq: 1. I am a employer with 4. ❑I am a general coaizsctor and I G. [:]New eonsfrucEiota employees(full andfor part-time)-* fsave 1wed the sub-coatractors 2.❑ I am a sale psoprietar orpartner- listed onthe attached sheet I- ❑"^'-modeUng ship and have no employees. . These smb-confractozs have S. ❑Demolition. wad-ing far me.in any capacity employees and have wodcers' 9. ❑Building addition [No workers'comp,fim�re comp-ksanan�O required-] 5. ❑ We are a�oaloarafioa and its 1 ❑Electrical repairs or aa3tlsf'ions 3.❑ I am a homeowner doing all work officers have exarised their 1 L❑Ffi mbsng repairs or additions M, � [No woxkers' _ � ❑Roof t of ememgfion per M(M repairs insurance required-]i c-152,11(4)6 aadwe have no L. employees.[Nowoders' 13_❑'other cam-insurance required-] *Any app&ctat feat cbeds'bos R mast also M ovtthe sectianbelow shaving deer•a ales'campessa6 peHcy infiEmaf=- #Hammwans who submit dm s$davt la g&ep ne dais.-all wa&sad&=hire autsi&commd=mast submit a new affidda it indi—in sacIL fCaamstos$xtcbecirtluzb=mostattachedasaddiiianalsheetdumiagthen—oftba andstatewhetbmornotthoseemitieshwm ' enplayees.IftLernTi.remt,•sin,�e���a5�'��Y�stFmuid¢'.t3i.�ir warkers'tamP•goIic�a>�lsez I am art euipl er Seat is praucfirrg ovorkets'coat pensrdigrt irisrirartcs for xc earpFa}�ees. $elow is tltepaticy and jabs site trnf ormatiam ! 1 Insurance Company Name: �A�"MF �I�=,C1eAl.)Ce. G Policy-4'er Self-is.Lic-is 000 a 3"/ 4 aZ 16 Job�Address 76 �) Spa o�T t T culls": Attach a.copy of the workers compensationpolicy dedaration page(showing the policy der and ezpiratio0n' date). Failure to secures coverage as under SezHon 25A o€MGL a 152 can lead to the imposition of rdraiaal penalties of a fine up to$1,54D GD r ai r - onmenk as well as chail peuslH is the fame of a STOP WORK ORDER and a fine of up to _00 g against the vio . Be advised flint a copy of this statement may be forwarded to the Office of I4I4eStti�aflo= the DIA coverage L { L4i1 Ido h cam;fp the ands pena&es gfpe�l?'Scatfloe iaf ornuu6oa prmi&d abatis is bus acid c onect Date_ 3 I.S' l(3 Phafle Sb ??G - 44 CM P�v( M4 aO I C�e. t Offikid am and ,Do aot wrife`iit tip area,tfr be evtnpTeted by tafy artown o Lc ial City or Tows: PermftTiicense 9 Lwaing An6wrdy(circle one): L Board of$Atli r.BuffsTmg Degartimeat 3.QtyYrvwn Clerk 4.Electrical Inspector S.Phantibiug Imspectar �.afIter . Contact Person: Phase#- Information and Instrac-ions MasC,r' melt C,=t=al Laws cam'152 regm-m all e�Iapers'fn Provide wa¢$eas'compensation for fbea employees. Ptasaantto this sib,am a Ivyee is defined as_every person m fiie service of aaofi er under any caxtr$ct ofbae, express or imPHOCL Oral or writiM." An e Ivya is detmed as"an incTividual,pa t=MbV,aMDC ffon,corpot�On other legal enemy,or any two or M= of the foregoing engaged is a Joint=bxp ise,and bchhdmg he,Iegal sepresentafivw of a deceased employer,or the receives or trastee of an mctividMl,par ship,associafiion or other Ieg-A eaiiiy,employing cmPmy=s- Howmver the owner of a.dweIrmg house having not more than three apartmerds and who resides therein,or the occ Sant of the - dw5uhg house of another who employs persons to do make,contraction or repay woi on such dwelling house cr on.the grounds or bUi ding appMtnmotj h=tn shallnotbe cause of sack emplaymentbe deemedto be an employer." MGL chapter 152,§25C(6)also states that aevexys&-fa or loczI H=zsk9 agency shall withhold the issaance or renewal of a FceBse or permit to operate a.business or to contract buildings is the commonwealth for any applicantwho has not produced acceptable evidence of compliance with tlxs insurance d- coverage requke A clittonaIly,lVM(Sr1 chapter 152, §25C(7)sues aNehher tine . nor a'ny ofits Political subdivisions shall enter into any contract for thepeafOzmanc6 ofpnblio wmkmnihl acceptable evidence of compliencewifiz fhe insarace._ ems,of this have be:n presented in the oa**r-ram a molit3=" AppJi .. Please fiIl oitt the workers'compensation affidavit completely,by ch=jda.g the boxes 1hat apply to Your situation and,if necessary,amply s nam s , es and a numb s along with their certfficate(s)of sob-canti�Ear() e() ( ) F� �). •1-2.c��rrince_ Limited Liability Compames(LLC)or Limii�dLiabi7it711m-tosbips,(LU)xa&no employees other thm the members or partners,are not rimed to Omy workers' compensation ice_ If an LZC or L.LP does have employees,a policy is requited. Be advisedthd this affidaykmaybe sobmitfc;d tr the Drpa-t<aent of Indu-sirial Accidents for conE atirm of ice coverage. Also be sure to sign and daie�jffie affidavit The affidavit should be retuned to$e city or town that the appfication for the penart or license,is being requested,not the Department of Las dtOl Ac - =:t Kouldyou have any gnast aas regm-ding the law or ifyou ate rcq=rd in obtain a workers' compensation poficy,ple29e call the Departmeot at the number listed below Self-insured companies should emtL then self-;T,sora?,ce license number ao.the appromiata line. City or Town OfElcials - Please be sore that f r.affidavit is comp let-and pried legibly. The Department has provided a space at,tine bottom of the affidavit:for you to till out in the evcat the Office offnvesiigations has to coact ycuregardiag the applicant Please be stye in fi71 m the pe�/Iicense number which wffi be used ss a rofet�ace r<nmbes In addition,an applicant that must submit m_ultPIe penDitllicen se appIi stLc s m any given year,need only sahmit one affidavit indicating==t p.olicv information(if necessary)and under°Job Si A dss dre "t3i a applicant should wrhe"all loc atbns in (c"'Y or town):'A copy of fhe,affidavit that has been officially stamped or mazkrd by the city or town may be provided to the applicant as proofthat a valid affidavit is on file for fattu permits or licenses Anew affidavitm ist be fffie:d ovt mch year.Where a home owner or citizen is obtaining a license or pmmit not relaiod to any business or cometercLd venfr= Cie. a dog license or permit to brum leaves etc-)said person is NOT rmTjhtd to compIete this affidavit The:Office of Investigations would Ire to thank you in advance for your cooperation and ADa.]d yam have any questions, please do not hesbate to give tie a call- The Department's address,telephone and fax mmbm- COMMMweabir of M ssa nmetts ' Depaitnmt of 1ndnsftial Accidents f tc�Of Invegagati=1% Balton.MA 02111 Tel.4 617-' -4,QW'=d 406 or 1-977 MA SSAF Fax It 617-727-7M Revised4-24-07v Massachusetts Department of Environmental Protection Bureau of Waste Prevention•Air Quality BWP A Q OL 100239134 1 Notification Prior to Construction or Demolition Asbestos Project Number# A.Applicability A Construction or Demolition operation of an industrial,commercial,or institutional building,or residential building with 20 or more units is regulated by the Department of Environmental Protection(MassDEP),Bureau of Waste Prevention,Air Quality Division,under Regulations 310 CMR 7.09.Notification of Construction or Demolition operations is required under 310 CMR 7.09(2)ten(10)working days prior to any work being performed.The following information is required pursuant to 310 CMR 7.09.Is this a fee exempt notification(city, town,district,municipal housing authority,state facility,owneroccupied residential property of four units or less)? Is this a fee exempt notification(city,town,district,municipal housing authority,state facility,owner-occupied residential property of four units or less)? FJ Yes r No Type of Notification: Revision of an Existing Formj Cancellation of Project Instructions: 1.Blanket Permit Project Approval,if applicable: Approval ID# 1.All sections of this 2.Non-Traditional Asbestos Abatement Work Practice Approval,if applicable: form must be completed in order to Approval ID# comply with the Department of B. General Project Description Environmental 1.Facility Information: Protection notification GILL DEMNE ATTORNEYS - 776 MAIN STREET requirements of 310 CMR 7.09. Name of facility Street Address HYANNIS MA 026010000 5087759300 2.Submit Original Cityfrown State Zip Code Telephone Fort To: Commonwealth of PAUL MAZZOLA BUILDER Massachusetts Facility Contact Person Contact Person Title P.O.Box 4062 5087764499 GCIBUILDERS@COMCAST.NET Boston,MA 02211 Facility Contact Person Telephone Facility Contact Person Email Facility Size: 2800 1 Square Feet Number of Floors Was the facility built prior to 1980? F-1 Yes ❑No Describe the current or prior use,of the facility: LAW OFFICEANSURANCE OFFICE Is the facility a residential facility? ❑Yes `F No If yes,how many units? 2.Facility Owner: MICHAEL GILL 776 MAIN STREET Facility Owner Name Address HYANNIS MA 026010000 5087759300 City/Town State Zip Code Telephone MICHAEL GILL 776 MAIN STREET On-Site Manager/Owner Representative Address Hyannis MA 02601 5087759300 City/Town State Zip Code Telephone Revised:03/17/2014 Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention•Air Quality BWP AQ 06 100239134 Notification Prior to Construction or Demolition Asbestos Project Number# B.General Project Description(continued) 3.General Contractor: GCI BUILDERS P.O.BOX 509 Name Address MARSTONS MILLS MA 026480000 5084289834 City/Town State Zip Code Telephone PAUL MAZZOLA 5087764499 General Contractor's On-site Manager/Foreman Telephone General C. General Construction or Demolition Description Statement:If asbestos is found 1.Construction or demolition contractor: during a Construction or Demolition GCI BUILDERS P.O.BOX 509 operation,all Contractor Name Address responsible parties must comply with 310 MARSTONS MILLS MA 026480000 5084289834 CMR 7.00,7.09,7.15, City/Town State Zip Code Telephone and Chapter 21 E of PAUL MAZZOLA 5087764499 the General Laws of the Commonwealth. Construction and Demolition On-site Manager Telephone This would include, but would not bw 2.Licensed Contractor Supervisor: limited to,filing an asbestos removal PAUL MAZZOLA GSFA057934 notification with the Department and/or a Supervisor Name License Number notice of release/threat of 3.Is the entire facility to be demolished? ❑Yes IF No release of a hazardous 4.Describe the area(s)to be demolished: substance to the Department,if INTERIOR OFFICE SPACE applicable. MassDEP Use Only 5.If this a construction project,describe the building(s)or addition(s)to be constructed: Date Received FE-TRIM,RE-PAINT,RE-CARPET a '!� 6.If this is a demolition or renovation project,were the structure(s)surveyed ' for the presence of Asbestos-Containing Material(ACM)? G Yes• FYJNo 7.Was asbestos containing material(ACM)found? Yes EJ No If a survey was conducted,who conducted the survey? Name Department of Labor Standards Certification Number Revised:03/17/2014 Page 2 of 3 L71Massachusetts Department of Environmental Protection . Bureau of Waste Prevention •Air Quality BWP AQ 06 100239134 Notification Prior to Construction or Demolition Asbestos Project Number# C.General Construction or Demolition Description(continued) The Asbestos Abatement Notification Number for this address is: This project ry-j Construction Demolition is: 3/25/2016 4/15/2016 Project Start Date(MM/DD/YYYY) Project End Date(MM/DDNYYY) 8.For demolition and construction projects,indicate dust suppression techniques to be used r Seeding ❑ Wetting Covering Pavingj Shrouding Other-Specify: 9.For Emergency Demolition Operations,who is the MassDEP official who evaluated the emergency? Name of MassDEP Official Title Date of Authorization(MM/DD/YYYY) MassDEP Waiver Number D. Certification "I certify that I have personally PAUL MAZZOLA examined the foregoing and am Print Name familiar with the information PAUL MAZZOLA contained in this document and Authorized Signature all attachments and that,based PAUL MAZZOLA on my inquiry of those individuals immediately BUILDnRO responsible for obtaining the BUILDER/OWNER information,I believe that the Representing information is true,accurate,and 3/15/2016 complete. I am aware that there Date(MM/DD/YYYY) are significant penalties for submitting false information, including possible fines and P.E.# imprisonment.The undersigned hereby states,under the penalties of perjury,that I am aware that this permit application or notification shall ' not be deemed valid unless payment of the applicable fee is made." Revised:03/17/2014 Page 3 of 3 I k Massachusetts Department of Environmental Protection Bureau of Waste Prevention•Air Quality s7o BWP AQ 06 ` Notification Prior to Construction or Demolition 01 This is a revision to an existing form. Project ID for existing form to be revised: Ui This job is being conducted under a Blanket Permit MassDEP assigned Blanket Authorization ID: This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: r None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 I Ac R INSURANCE DATE(CERTIFICATE OF LIABILITY `WDDIYYM NCE THIS CERTIFICATE IS ISSUED AS A MATTER OF I 3/9/2016 NFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENDi 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 policypes)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy;certain policies may i 1 Po y require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s): PRODUCER CONTA T The Fair Insurance Agency Inc. NAME: - Kathy Silvia .. PHONE (508)775-3131 FAX 619 Main Street EMAIL A/C No:(508)790-1677. Suite 1 ADDRESS:katnyvthefairagenay.com INSU S AFFORDING COVERAGE NAIC# Centerville MP, 02632 INSURED INSURERAEsseX Insurance Co. The Waquoit Group LLC, DSA.- 'GCI Builders DBA Paul INSURER e:Sa£et ..Insurance Co. 39454 PO BOX 50.9 INSURER C:Savers Property, & Cas.-ARWC 31771 INSURER D INSURER E: Marstons Mills MA 02648_ _.... 7NSURERE: COVERAGES CERTIFICATE NUMBER:CL15101901138 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE'INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, INSR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SH OWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE POUCY NUMBER MM/LIDD EFF MPM/LIDD EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,060,000 A CLAIM84MDE Ex_]OCCUR D GE T R PREMISES Ea occurrence $ 500,000 2CV2830 5/28/2015 5/28/2016 MED EXP(Any one Person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER:POLICY 0 PRI LOC GENERAL AGGREGATE. $ 2,000,00o X OTHER JECT PRODUCTS-COMP/OPAGG $. 2,000,000 : AUTOMOBILE LIABILITYIndividual Risk Mod Prem COMBIN D SINGLE LIMIT Ea accident $ 1,000,060 B ANY AUTO BODILY INJURY(Per person) $ALL OWNED SCHEDULED f AUTOS R AUTOS 5052134 HIRED AU NON-OWNED 6/3/2015 6/3/2016 BODILY INJURY(PeraocideM) $ TOS AUTOS- . PROPERTY DAMAGE •` Per $aceide UM BRELLA LIAB OCCUR Medical payments $ 10,000 -EXCESS LIAS EACH OCCURRENCE $ CLAIMS-MADE. AGGREGATE � DEC) RETENTION$ WORKERS COMPENSATION S AND EMPLOYERS,LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE C OFFICER/MEMBER EXCLUDED? N/A* E.L EACH ACCIDENT $ 100 000 (Mand describe atory in NH)und WC000237d 5/28/2015' 5/28/2016 E.L.DISEASE-EAEMPLOYE $ P DIf ESC TION OF r OPERATIONS below 100,000 E.L.DISEASE.-POLICY LIMIT Is 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I EHICLES(ACORD 101.Additional Remarks Schedule,may be attached B more space Is required) - CERTIFICATE HOLDER. _... CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Michael Gill THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 776 Main Street ACCORDANCE WITH THE.POLICY PROVISIONS. Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE Jackie Stewart/FAIMT1 01988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) 1 �. - - --._ ___._....__.-_ __... ------.-__.._- INE { BAJV&'rAJ= # jM,�r _-- - _ T-own-of Barnstable__ Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 5.08-790-6230 ~ Property Owner Must Complete and Sign This Section, If Using A Builder l 6 ,as Owner of the subject property hereby authorize , /}t!4 / Z70 166 �� to act on my,behal� . in all matters relative to work authorized by this building permit application for: 77� 1441,A1 .STr<<T- (Address of Job) Signature of Owner ' a Print dame If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the, reverse side. QAWPFILESTORMS\building permit forms\EWRESS.doC Revised o4o215 , . j ! Massachusetts-Department of Public Safety. Board of Building Regulations and Standards u17Sttiit`Lk i v-4SIP License: CSFA-057934 ``�.. PAiJL.J MAZZ01X' PO BOX 509 _ di ' Mantoni Mills MW od Expiration 4 Commissioner 06119/2017 " � :'.r- r V/LB�0d17U�72diLUJPCLGGfv G�V/�CC[JJQ.Cil.L6dele. �. _ ' - Office of,Consumer Affairs&Business Regul'at►on • t ' ME IMPROVEMENT'CONTRACTOR egistration Ak253 TYpe• xpiraticrt 8/1tr2� ^:irate Corporation GO BUILDERS INC; i 644 RIVER ROIADe ` j MARSTONS'MILLS",,"'. 34$'la " U,�'• �a y Restricted-One-and two-family dwellings or any accessory building thereto;irrespective of size. . d F 4 i Failure to possess a current edition of the Massachusetts i `: State Building.Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS Grcense or registration valid for individul•use-only before the xpiration date. If found-return to: Office of Consumer Affairs and Business Regulation 10 Park Pl6a=.Suite 5170 Boston,MA 02116 a Not.valid without signature ,t e , i *Permit#: ®® " Town of Barnstab.e yxpi?,es monihsfr issue date ]regulatory Services Fee Thomas F.Geiler,Director �Yi 1Oil Bujiftg D1� s Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 WWo.town.barnstable.ma-us Fax: 508-790-6230 508-862-4038 APPLICATION - RESIDENTIAL ONLY EXPRESS PERMIT Not Valid without Red X--Press Imprint el Number P S Address 7 lential Value of Work 4 ��, Minimum fee of$25.00 for work under S6U00.00 Name&Address et Telephone S4 �8 -�� ;tor's Name Liaprovement Contractor License#(if apPlicable) L. �-ri�cttrse�(�pP�b§e) YT )rlcman's C ensatlo nlnsurance. EIS one: SAY 2007 I am a sole proprietor O� BARNc-TABLE ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance To\N CC), -ance ComP&nY Name Policy# N kma ' Come__ 1 i :y of Insurance Compliance Certificate must be on file. nit Request(check box) old shingles) All construction debris will be taken to -- ❑ Re-roof(stripping Going over existing layers of roof) �y 7pe-side"' To ot stripping gslA. ROT". �p (maximum.44) ❑ R eplacement Windows/doors/sliders. U-Value entre ulztions,i-e.Historic,Conservation,etc. riyThererequired: ldsuance of ' errrvt does mot a mpt compliance with other town departm € owner mus : ign Property Owner Letter of Permission. ***Dote: P Pe of the H e Improvement Contractors i e is required. A copy ;GNATITRE: Forms:expmtrg :vise061306 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111' TTP. wtvw.mass.gov/dia ' Workers}Compensation Insurance Affiidavit: Builders/Contractors/Electricians/Plumbers Applicant Infoxmation .Please Print Legibly Name(Business/Organization/Individual): Co C. QrZA Pc ,� 44Ar2z dL 0q Address: 44 Rev eft �Z'D. �O . t�o�c SOr7 e•e 1 I - 5�8 77G-4 fF9 Ci city/State/ MAR�S?lw dhill Phone.#: Are an enoployerT Check appropriate box. :Type ofpioject(required)-. 1: I am a employer with 4. ❑ I am a general contractor and I have hired the sub-contractors 6. ❑New construction . employees (full and/or part-time).* �, Remodeling 2.❑ I am a'sole proprietor or partner- listed on the'attached sheet ❑ g ship and have no employees These sub-contractors have 8. ❑Demolition iyorking for me in any capacity. employees and have workers' 9 ❑g��g addition [No workers' comp.insurance comp. insurance.$' 5. ❑ We are a corporation and its 10.❑Electricalrepaixs or additions required.] 3. I am a homeowner doing ill-work officers have exercised their 11.❑Plumbing repairs or additions ' • ❑ . myself.[No workers'comp. right of exemption per MGL 12,❑Roof repairs insurance.required.]t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners,who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provides their workers'comp.policy number. jam an employer that is providing workers'compensation insurance for my employees. Below is.the policy and jab site information. Insurance Company Name:�1J•A*11 I: •�Ce_ W Policy#or Self-ins.Lic,#: W OC�/ Expiration Date: 56 ' D Job Site Address: 774 A City/State/Zip' 0 a� Attach a copy of the workers' compensation policy.declaration page'(showing the policy number and expiration date). Pailure.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 no a . Be advised that a copy of this'stateme±maybe forwarded to the.Office of Investigations of IA.for insurance c era e verification. I do hereby n under the pa' and penalties o that the information provided above is true and correct Si tore: Date: _ 774 '4411 FBo only. Do not write in this area, tb.be completed by.crty or town official. n:' ,Permit/License# hority(circle one): Health 2.Building Department 3.City/Tosvn Clerk 4Electrical Inspector 5.Plumbing Inspectorrson: Phone#: nr ati®n ana instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee-of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein;or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house . or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to'operate a business or to construct buildings in the commonwealth Wr 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•af comnplia*withtlie 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 - e s addiegs es and hone number(s)s along with their certificate(s)of, necessary,supply sub coniractor(s)nam ( ), ( ) p r( ) ng LP with no-employees other than the . insurance, Limited Liability Conmpanies*(LLC)or Limited Liability Partnerships(L ) members'or partners, are not required.to carry workers'comp ensation insurance. If an LLC or LLP does have,-. ' ed. advised that:this affidavit may b submitted to the Department of Industrial employees, a policy is required. Ber . ,, Y. ,e� P 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 penmit.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-insmance 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. Anew affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo 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 cio not hesitate to give us a call The Department's address,telephone-and fax number:. °The CCOM.onwW&Qfmassaeldt setts D%Wt Meet of InduWal Maidmts ; O ft" of Inii'estdgat ons i ,` •il ; 0 Stma - BW 'MA02111 - Tel.#617-727-400 ext 40'6 or 1- -MASSAFE Revised 11-22-06 Fax#617- 7-7749 WWW.m. .&Ov'/era °FZHE'°`sti Town of Barnstable. Regulatory Services selusaA ' Thomas F.Geiler,Director 4'ATeD �A'� Building Divisi.on Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 ww ,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, h l ne �` �` , as Owner of the subject property hereby authorize w•C.1 -av,14MS S to act on my behalf, in all matters relative to work authorized by this building permit application for, . MA-iju 14 0941-M./I 1 (Address of jo ) ature of Owner Date Print Name 0Topl,S:OWNER?bRMISSION Boai o Svc ltl�ng Itatxonc ntl Staxtls -_ hTQME'mpROVENI'ENTCONI RACTOR Registratio -,152253 Exprrd ;' $/1.112008 yp PF te_Corporation GCI BUILDERS INC PAUL MAZZOLA 644 RIVER ROAD MA- RSTONS MILLS MA'D264$ Deputy Administrator +, Lcense COI�.STRt1GT40WS;7PE F.kSOFt � ` Nunert,CS v 057934 �x =Mrthatek A1f964�M Expsxes�061f912007 3r np h434fi f Restrartect. n . f 05/10/2007 08:35 FAX 508 790 1677 FAIR INS Q 001 .OBL�►, CERTIFICATE OP LIABILITY LIABILITY INSURANCE 05/1/2� mmwR, (SOS)775-3131 FAX (503)790-1677 THIS CERTIFICATE IS ISSUED AS A M,RTTER OF'INFORMATION The`F'ai r Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O. RoX 430 HOLDER.THIS CERTIFICATE DOES MIDT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED EN THE POLICIES BELOW. 619 Main St. Centerville, NA 02632 INSURERS AFFORDING COVERAGE NAIL# Imsmb The Waquoit Group LLC INWRERA: National Grange - PO BOX 509 INSURER B, Savers Narstons Mills, MA 026" INSURERC: INSURER IN INSURER E: THE PO:JCIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 1141DICAT'ED,NOTWITHSTANDING ANY REQUIREMENT,TERRA 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,EXCLUSION S AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AODLTYPE OF INSURANCE POA,IGY NUAABER POLICY EFFECTIVE POLICY EKPIRAITON r• um(m MNERALLIAMLM MP143707 OS/28/2006 OS/28/2007 EACHOCCURF:E4CE S j 000 X COMMERCIAL GENERAL LIABILITY &i-NW TO M 1,TED CLAIMS MADE rX OCCUR MEp EXP(Any i'pl i1 qwwn) S S10001 A PERSONAL&A 71 IN.IIpRY g 11 000 GENERAL AGGR GATE S 2,000, I T.AGGREGATE LIMIT APPLIES PER PRODUCTS•0114PIOP AGG $ 2,WO, POLICY M JMEl LOC i AUTOYOMI.E LIAMLMY COMBINED SIN1311 LIMIT $ ANY AUTO (Es 6da ICetMJ ALL OWNED AUTOS BODILY IRI IllR) SCHEDULED AUTOS. (P43r P—I S , HIRED AUTOS _ BODILY INJUR`1 $ NON-OWNEDAUTOS (POr 60dd9M' PROPERTY DAI-1,GE S (PeramkmM 3ARAOE LI WUM AUTO ONLY.EA 11CGIDENT i 4 ANY AUTO OTMER THAN T EA ACC $ AUTO ONLY, AGO S L7(GESSNYBRELLALIABLITY EACH OCCURRM ICE 3 OCCUR 0 CLAIMSMADE AGGREGATES S _ $ 1 DEINCTIBLE S RETETrrmN $ $ IMIOF,Ic is COMPENSATION AND W00002374 05/29/2006 05/29/2007 WC 3TATI--I IDTH• FM PrZ PRI UMLFTYTOMPAR E.L EACH ACCI:)I;NT � $ 200 B .ANY PROPRIETORA'ARTNER/EXECUiNE �. OFFFICLWMEMBER EXCLUDED? E.L DISEASE-EP EMPLOYE S 100. 3PECLLL PROVISIONSbelow E.L DISEASE-FC_ICY LItdIT S 500 LAMENT FLOATER OS/29/2006 05/23/2007 TEREX�I1FT TELEHAWLER A SERIALIF�D9664 VALUE 47745 M100 DEDUCTIBLE DESCRIPTi D11 OF OPERATIONS I LOCAMONS I VEHICLES I EXCI I SIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS a CERTIF C TE LD T SHOULD ANY OF THE ABOVE OESORMW POLIMES 1114 CANCELLED BEFORE THE EKRRATION DATE THEREOF.THE ISSUING INSURER V ILL ENDEAVOR TO MAL 15 DAYS WRnY6N NONCE TO THE CEIMP CAI S N W91k MOM TO THE LEFT, Mike Gill BUT FALUM TO MA L SUCH NOTICE SHALL,WPM 110 OIKAAT ION OR LLMLIYY 776 Main Street OFANYKJNO UPON THE INSUREK ITS AGENTS ORF.EamENTATNES. .Hyannis, IAA 02601 AUfI10�REPRESENTAMW ICdt Silva A"S1 !%4frld'— r ACORIO 2S(2001M) 9-4 CORD CORPORATION INS 05/10/2007 08:95 FAX 508 790 1677 FAIR INS IM 002 'IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract betwL,an the issuing insurer(s),authorized representative or producer,and the certificate holder,nor dow; t affirmatively or negatively amend,extend or after the coverage afforded by the policies listed thereon. i ACORD 25(2001M) y _ T t TOWN OF BARNSTABLE SIGN PERMIT PARCEL-It 308 001 001 GEOBASE ID 35205 ADDRESS 776 MAIN STREET (HYANNIS PHONE Hyannis ZIP - LOT 1A BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT 14472 DESCRIPTION DONALD F. HENDERSON, ATTORNEY PERMIT TYPE BSIGN TITLE SIGN PERMIT Department of Health, Safety CONTRACTORS:ARCHITECTS; and Environmental Services � TOTAL FEES: $50.00 1H BOND $.00 CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE ` 1AMSTABLE, ' MASS. OWNER HENDERSON, , DONALD F ADDRESS 776 MAIN ST BUILDIN,�G DIVISIO�v�,r HYANN I S MA DATE ISSUED 04/12/1996 EXPIRATION DATE The Town of i9arnsta no _ Department of Health, Safety and Environmental Semi . , Building Division 367 Main Strxt,Hyanais MA 02601 t . ee M Application for Sign Permit nn / Assessor's no. 3 o 2 ` I- 1 Applicant: /Jc�i a o F N,f„r a .2 s a•� Doing Business As: 47-ru tz : Telephone -7 7 5` /9 a Y Sign Location / street/road: Zoning District—a Old King's Highway District? yes______ n°�-- Property Owner Name: 130 Kq. L fj Telephone 77S Address: 7 G /N i 14 4fy y Village YANK/s Sion Contractor Name: �'o R/J A k 5 6- M12,4 Al v Telephone 7 7 ��a Z u Address: ( o �, I;,�7-CR pa;s (�Q l (A�o 45 Village Description DiLL3am of lot showing location of buildings and existing signs with dimensions, location and size of the ne%v to hp drawn on the reverse side of this application. Is the signto be electrified? yes no (Note: if yes,'a wiring permit is required) —�- I hereby certify that I am the owner or that I have the authority of the owner to make application, that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinances. 1,9 -loc- �zz_ �( b a Date Signature of Owner/AB - Size (sq. ft.) Permit Fee Sign Permit was approved: f disapproved: y8,: I 77 ( �I ,xH? nlF fig" i I� 'I I, I�X�1KD�� I�u I i is i' �yM 116ItI�bAN, SIGN COMPANY DBSICiNERS•MANUFACTURERS•ERECTORS OF ALL T�PES OF SIGNS•WOOD•METAL•P1.Ag'nC Seroing New England Since 1947 1U 111SCR AF.F®. NYANIR%VA Qn" trAl 13\.49aY pN►WI Npi 124% DATE..;"ZN-q,6 - 9GALE ` DESIciNER Z�ft rusT9►eER _i voJq,� 812 MAIN ST. 3 "ST MA T S OSTERVILLE, MASS. 02655 pi (508) 428-9131 LOCUS N CERTIFICATION: Y CERIFICATION LO 0TARA RESORT i i g NC GOLF COURSE 5 TH BE LOCUS MAP EN SCALE: 1" = 2.,000' ASSESSORS MAP 308 PARCEL 1-1 Y p MAP 7.90 PARCEL 149 C POS v G D Z&NA F. r� ✓ �`'� �oC ��oo��J � I 92.E OG. NO AREA RE:QUIRFMENT YY �h� V \�' 50 ?.0' FRONTAGE REQUIRED „r� �6I/ �Qa�JQr `'V `gl Pj/� W C.B.MISSING C.B.SET. i1r 1 LOT 1 B ?115 sq. ft. 'O 5�o p0 �95 6o VI1 I C.B. MISSING h 2h�ti0 !17 h Sy2/ �v N "111 J S Ct Q� I 0�1 O / e ��0• P C.B. MISSING \ LOT 3 L.C.C. #9010D C.B. FND. HIT OFF c / DONALD F. HENDERSON BACK OF SIDELINE /�-1�6\ CTF. 103378 / 0.13' 1 B.R.B. FND. UNDER PAVEMENT�0-00l-_ LOT I 15,665 eq.fl.' ro / qro W FND. // p9 5 a 0 30 s h 1.S O.R.B. FND. UNDER PAVEMENT t� 0a(;"G SET "At's \� •.O N �\ 10 - 8.�.1 lVI O In B.R.B. FND. UNDER PAVEMENT PPo Ro Tel ALL BUILDING TIES 1 \ T TO BRICK 5' HIGH L��3643`0>>60216.29` \\ 0O 00, �pPRo m4*-I \� SrAr N 4.0 C AT I o 6.4 a gLF VARI f HIGtIWAY 11\ I C.B. FND. 1.15' S13'19'4 (pieO h QS ld d S f 4 n! j� wI prH IN STREET CERTIFY THAT THE CONDITIONS ON THE 'f�Jy �t :Rf1IINi1 AAC TWC CAMC NIM.1 At' „AT riir �1,/rf�7j�� \ 0 TOWN OF BA.RNSTABLE ' ' t SIGN PERMIT PARCEL ID 308 001 001 GEOBASE ID 35205 r. ADDRESS 776 MAIN STREET (HYANNIS PHONE l HYANNIS ZIP 1 M LOT 1A BLOCK LOT SIZE i DBA DEVELOPMENT DISTRICT HY PERMIT 77090 DESCRIPTION 5.3 SQ FT PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of ARCHITECTS: Regulatory Services TOTAL FEES: $25.00 BOND $.00 plfr Tt1E CONSTRUCTION COSTS $.00 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE BARN3IASLE, MASS. � 16,3 1 ArFD MP'�A t BUILDI D WISION BY /� DATE ISSUED 06/07/2004 EXPIRATION DATE / `t" Town of Barnstable Ft"E r Regulatory Services do Thomas F.Geiler,DirectorTOW} l OF BARNSTABLE + UMMSfABLE, 9 MASS. $ Building Division 039. 39.t Aim Tom Perry, Building CommissjZM JUN -3 AMU: 11 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 . Fax: 508-790-6230 Tax Collector T ✓f� Treasurer Application for Sign Permit Applicant: Assessors No. 3 An., Doing Business As: �ro /� /1� /% . f' Telephone No. Sign Location Street/Road �a =1144-1 Zoning District: Old Kings Highway? Ye /No Hyannis Historic District? YeQ o Property Owner Name: �- �� �Gt,�� /Qn� �e-� � Telephoner ' �`% rJ�� r . Address: Sri.�.� Village: ����r�of P/�y Sign Contractor ,..✓ �'°r�Name: 6 �—?C Telephone: 'Yo�;2- c� d Address:— �: /-t�+2 0�� . Village: "I P� Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions,location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes/No (Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the authority of the owner to make this application,that the information is correct and that the use and construction shall conform to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent k-� I Hate: " � �p0 Size: Permit Fee: p4�- Sign Permit was approved: Disapproved: Signature of Building Official: � f) Date: 6 y 6 Signl.doc rev.122801 �Y � q 4�l,Jts,. �,.• q q.f, �irsj akr�n�, G tar wn i Est J bA.kw,L; pl Appraisal and = 1 — Real Estaie Seniors i 11 4'w++•5 ,�{may.�4�4 �t. � � � _ �, �, � < yr' �-"'}k�. a"`�'{� A A i ol .sz!V".` .3 y1 1 46. ccm'e : z .� .......:g gag, ; - 3'S MOP ��,,.. �t�-a 3,_s+• t 6,u.�,1-'"w�,"""�'w. -- �- �"�"•.„y�,.;,,, � ,�,-may�',..'" Nr ^s. � _ a�,�Assessor's offioe Ost floor): AAt E 1 Assessor's map and lot number N t � uF a Board of Health (3rd floor): -40.j�v � Se4,gge Permit number .................................................... i BASII9TSDLL .� 8 Engineering Department (3rd floor): �� v1,�n�� °o,�1639- MAG&p�e� Hduse number ..:......................:............ <// 0 APPLICATIONS PROCESSED 8:30-9:30 A.M, and 1:00 200 P.M. only up,! TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ....d.....(/ " ` ��v1Z�� /.....f..`. ............................................................................................... TYPEOF CONSTRUCTION /��U�...................................................................................................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies four a permit according to the following information: Location .. t` .......#941st)......<..:a� ..... ..... ....................................................... .. ....................... Proposed Use (� ....��.� .....� lil.�Zr4. C '. !..........................................................:......................................... Zoning District u-���� ...........................Fire District................:.................... ........... .. ................................................... Name of Ownerjx Nl`.V-.�...t... ........Address .�.1.........6........�1._.1..AU(f, `!�'�,f..r`��N'r�� ` I Name of Builder0 ......Address m . Nameof Architect .......................•..........................................Address ...........................................................................r......... 1 / KJ/ r Number of Rooms .......................!..........................................Foundation ...�.../� aG ....................:.... �,c..�taUG� gdil/cr( i Exterior ............., Roofin UL�F'/L ! '......................... �. V Floors !... y..................................Interior l7UC..........: ,...................................................... Heating . � `�.'�/.a•r'.` .........................Plumbing ................... Fireplace .........^........................................................................Approximate Cost .........�Q/. dU Definitive Plan Approved by Planning Board --------------------------------19-------- . Area ..... 5��, � . . .......... Diagram of Lot and Building with Dimensions Fee �I!. .............................. SUBJECT TO APPROVAL OF BOARD OF HEALTH • r t r ' l r OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. y ` Name . ..:.. �r....... .. Construction Supervisor's license 4� ' Henderson, Donald F. A=308-001 a61 "10224';-� add to No .........*....... Permit for .................... ....... ....... commercial building Location 776 Main Street ............................................................... Hyannis ............................................................................... Owner .........Donald F. Henderson ........................................................ Type of Construction frame Plot ............................ Lot ................................ Permit Granted .......NQV.embe.r...25.........19 86 Date of Inspection ....................................19 Date Completed ..............................:.......19 ill gc 1 � AssgskK,s--4ffioe (1st floor): O / pFTHET� Assessor's map 'and lot number .............:............................./ Q.. 1 �♦ Board of Health (3rd floor): <1 � �� '�/i Sew �%w pge Permit number ..... .'.?`...... Engineering Department (3rd floor): �� 7� �n�f� � '°o Nb& Husenumber .......:........................./........../..../......................... oya9- APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO C�� ` v� v �v I.................................................... ......................................:.. � ry1 TYPEOF CONSTRUCTION ....... ..eXl..... ............. .... ........................................................................................... �� .../.... 19 - TO THE .INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..�T%o.......10!7 4 ....5.7(�.........W-y-opov-4--�. .......................................................................................... Proposed Use / cS.d.......�J..I.U�Z..... .Ni41v�. /.................................................................................................... Zoning District ............14..�-!!S....�eS-s Fire District ........... ....zo ................................................... r Name of Owner kuW�125.4?!q........Address ..71 ....�.�... .. '... t.. 0 O - 1 Name of Builder(? ' :........ ..........Address o,3..... Nameof Architect ................ .........................................Address ............................................................................ Number of Rooms ` ................................Foundation���'� � �J''Q .................................. ,................................... ..... ........ ........................ Exterior ..l �v ... Roofing ! . ' .. '/���l t .... 61C ... 460 ................. Floors '{� �".................................................................Interior C�C .. .. `Lk`G '!. !�.......................... �, �-. Heating .........................Plumbing Fireplace ..................................................................................Approximate Cost ..... ..... .. it Definitive Plan Approved by Planning Board ------------------------_-------19________ . Area ..1���`q�a..�......................... Diagram of Lot and Building with Dimensions Fee .... ../U.U............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable rega ding the above construction. Name ... ...... .. .............................. Construction Supervisor's License ..a.. .2.. . ........ Henderson, Donald F. No .....354..M PEirmit for .......add...to................ -commercial building........................ k ................................................ Location ................Z 7.6...Main....Street................ .. . ........ . .......................Hyannis................................. Owner Donald F. Henderson .............................................. Type of`Construction .............. raw.................. ............. ............... J- Plot ............................ Lot ................................ Permit Granted ........... .....19 86 Date of Anspection ....................................19 Date C6mpleted ......... L4 7- A - '2 VL et• Q ' �9 4 '� q /Ny 7,6 NN ry n �,J: JkN OFGEORCGE df1s , J. 15 w Q� LANIDES N No. 22723 rim tis a �JT c- ca O� o GEOFtGE. -Z� N y LANIDES -31 i e No. 7987 \,ANAL r4/C �rp�e� 1 S�oc�/n 4I� �,�i�s1,6/q� /S ho7'� NUD C'e���mun��I Pane% zSoo�!— Uoo G e coh foPm nXe ' a1�o. d , e 73wr>: f Bar�nafQ6/c. h Cen,s�rac�F� 1P.L67' �'.0 •� A/ ZA.�V } i/v lYy',4 AI All S lY), Ae6Par6D BU//-DI"G ADD/ 7'/D,Y 12e f Brent y 7.7G /y�>,��� .v T :fie 7 �Ccnd. C wrl� o WNeD ,8y CeW 33e43 ,�0GD 1.` #,ENDzt:PS6Al �1��? 9o/a. sca4r 1 y o' Slav, 26 /FdG Plcn arC W f7, Q3 4 8 JEPWH h /,y. W ARA/60r/f P.eA Town of Barnstable *Permit# �� 6 4 Expires 6 months from date TUR A IRMN M i Regulatory Services Fee MASS. r� 1639. ,0$ Thomas F.Geiler,Director Building Division Tom Perry, Building Commissioner X PRESS PERMIT 200 Main Street, Hyannis,MA 02601 I Office: 508-862-4038 Fax: 508-790-6230 SEp 1 8 2003 EXPRESS PERMIT APPLICATION - RESIDENTIAL pF BARNSTALE / Not Valid without Red X-Press Imprint Map/parcel Number 30 goo I co I w lA Property Address 774 �aihr 7 &afiniS, / 411021 o � ❑ Y/�Residential Value of Work 102.00 6 T , Owner's Name&Address lJnt1m-�� 1�ePoic(e _Sm Contractor's Name j• 0 c/ Telephone Number_ 5-0 3�a2yo� Home Improvement Contractor License#(if applicable) �Y./0 Cgjkstruction Supervisor's License#(if applicable) �77 97 04,vt Ln Workman's Compensation Insurance tjp g Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance Insurance Company Name 1<//L Workman's Comp.Policy# UI CC 50© O y Y 3 0 1 a 0 0 a— Permit Request(check box) •�Re-roof * (stripping old shingles) All construction debris will be taken to sd��'xCo ��ei�T FRe-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *where required: Issu ce of this p ' does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property er must sign Property Owner Letter of Permission. provement Contractors License is required. Signature Q:Forms:expmtrg Revise053003 °FINKS � Town of Barnstable Regulatory Services r r 1A MASS. ' Thomas F.Geiler,Director y Mass. $ �A ;63q. rfD MA'I A 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 as Owner of the subject property hereby authorize v 1 L to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job Signature of Owner Date Print Name Q:FORM&OWNERPERMISS ION Results Page 1 of 1 Home Improvement Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City,Name, or License number Select Search type: r, AND r OR Search Search Results Reg. No. Applicant Street City jEjjje Zip Name Title Expirat J. 2 O'Loughlin, 100398 O'LOUGHLIN, Harold Harwichport MA 02646 President/Treasurer 6/16/20 INC. St Joseph Total of 1 ' Records matched. Back to Home Page BBRS Privacy Statement http://db.state.ma.us/bbrs/hic.pl 9/18/2003 i .... -- BOAR F DING LAT S i I License CONSTRUCTION SUPERVISOR S Number§'C� 074187 I Bir�th�tat 0212011960 Tr.no: 8859 I� Restras�d,��00 s, vk" ; JOHN C LONEFA!`i PO BOX 2046 Administrator EAST DENNFS, MA 021741 TGWN `-CF BARNSTABLE 4 SI6+ PERMIT PARCEL, ID 308 001 001 GEOBASE ID 35205 ADDRESS 776 MAIN STREET (HYANNIS PHONE HYANNIS ZIP - 'LOT 1A BLOCK LOT SIZE 'DBA DEVELOPMENT DISTRICT HY PERMIT 45694 DESCRIPTION "FIRST AMERICAN TITLE INSURANCE CO. 6 SQ. PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $25.00 BOND $.00 O�THE CONSTRUCTION COSTS $.00 I 753 MISC. NOT CODED ELSEWHERE 1 PRIVATE PE E, ; * fARN3fABLE + MASS. 1639. A� � � FD MI�►I � RUILDI DIVISION/� DATE ISSUED 04/26/2000 EXPIRATION DATE T4 Town of Barnstable (�9 t t Department of iiealtlP, Safety and Environmental Services Building Division F V 367 Main Street,Hyannis MA 02601 e ,� ,��r , et Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 C, 1 rd4gQ10 Building Commissioner Tax Collector 7� Treasurer Application for Sign Permit " Applicant: Assessors No. O Doing Business As: 1 Ns OA-ft-NifF COQ�,4 /UV Telephone No. Sign Location Street/Road: 7 7& lam)f>J R. _ate Zo District: Old Kings Highway? Yes&Hyannis Historic Distric ?�D Yes Property Own Name: &Z�'2 Telephone• Address: Village: Sign Contractor JORDAN SIGN CO. Name: 103 ENTERPRISE ROAD Telephone: 7�71`' IfW Address: Village: Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location and size of the-new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes (Note:If yes, a wiring permit is required) I hereby certify that I am the owner or that I have the.authority of the owner to make this application, that the information is corre;bt and that the use and construction shall conform. to the provisions of Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authori ed Age Date:`/ S®O Size: Permit Fee: W-6� Sign Permit was approved: Disapproved: , t Signature of Building Offici Signl.doc rev.8/31/98 - r r 91 "INS 0 on low IV IL il c to A "® SB 4/Pp Ao r AO f Tr aa ' ' e - .. > r [ .. fi. •6 . x�F.� .. �« Day } - • John A.Drew,Realtor Appraisal and Real Estate Services Donald F.Henderson Attorney at Law 081,90413058" m — - VICINITY MAP . . '1 LEA POLE 77- } � 4 E r ~ • EXHIBIT $ke I'T I LOCATION ` ; ` III' �� li`+ r EXISTING POLE O a TAG. ,. sRE . 7l a� � m t HYMIVIS M 5 "Al A E FIRM t i i- ,. t. a e EXISTING PALE 14;r�ra. .; a : F - d "- CONSULTANTS,INC. .,. , G&VE Co. :�, m ..z,� s . I " LOCUS POLE. .� ,,,� `DEVELOPERS,ENGINEERS AND' #31 x4—Y F * NO TAG a r coNsrxucrloxhi<+xAceRs w,,. ti N 41* .38' 62.0 n t - _ 68 TUPPER ROAD,UNITE OX1159•SANDIM H16A 02563 r w �0 17 4zDs" DR T IL(5081868-0 83'-FAX tarts. 88-0246 - " �F -�i" • ' ♦ -'" ,s�" pp .,: ,n,w.Nrn ngrtn0 nsu8an,s.wm - u { q SITE.ADDRESS: • a�i NORTH� .STREET @ ROTARY � I CROSS FROM ilt. It ��i i � 776 MAIN STREET) r HYANNIS,MA 02601 3 EASE EXHIBIT, S L •ra � `'� ' � � ;,,�� � . � , : � �•,. .. ,�_ ` ' ��`��' UBMITTA S s a D 02/13/17 REVISE VILLAGE CALLOUT i ttT -6 08/29/16 CHG.-ADDRESS nd : a d, 09/30/15 3 _ .:A. 09 14/15 ISSUED S / FOR REVIEW x� r v � II DRAWN BY: SS E x' "5 a r v CHECKED BY: MFJ'- POLE NUMBER: A a i i s _ ., a a a� •� ' � s UNMARKED � . _ a F aF ,. r .- COORDINATES: N 41 ° 38" •52.01 „ AERIAL MAP , W . 70` .1.7' . 47.06„ SCALE: NONE LE-1 NOTES: r°- 1. NORTH. IS APPROXIMATE. 2. STRUOC IPME ANALYSIS N ANpNDESOIGNNTATION PENDING SHEET'TITLE: 3. THIS DOCUMENT FOR LEASING PURPOSES ONLY. NOT FOR CONSTRUCTION. VICINITY` f�,� '`^ 4. POWER .& TELCO TO COME FROM EXISTING OVERHEAD AERIAL MAP UTILITY LINES. SERVICE TO BE DETERMINED, f 5. SITE PLAN &: ELEVATIONS BASED ON SITE VISIT BY TURNING MILL CONSULTANTS, INC.. . — . 5'NEET NUMBER:_ 6. UTILITY POLE COORDINATES BASED ON FIELD MEASUREMENTS UTILIZING A HANDHELD GPS. UNIT. � ® 7. AERIAL PHOTOGRAPH VIA GOOGLE. , V4V95.f�9 LEASE EXHIBIT. EXISTING OVERHEAD WIRES 4'f - SITE OHW OHW EXISTING POLE PARTIAL TAG R 73 t Y. HYANNIS_MA_SC05 1 A&E FIRM EXISTING.POLE c&vE co. TURNING MILL i #31X4-Y CONSULTANTS,INC. I r' - DEVELOPFRS,ENGINEERS AND I LOCUS. POLE _ - CONST 20N bwNAGERS - .- NO TAG - - 6B lUPPER ROAD.UNR 3 .. - N 41' 38' S2.D1" - - - _ PO box 1159.SANDWICH,MA 02563 - • TEL:(508)8BB-0383-FAX:(608)888-0246 W 70' 17' 47.06" t mrningmu�onsunam:.00m West M .. ._ ally StSITE ADDRESS: - > `a NORTH STREET @ ROTARY (ACROSS FROM 4 0 776 MAIN STREET) HYANNIS, MA 02601 • r `G Maur S{ j LEASE EXHIBIT SUBMITTALS I SITE PLAN' 1. SCALE: 1" = 40'- LE-2 -- - - - - - 0 23' 20' - - 40' - - - D 02/13/17 REVISE VILLAGE CALLOUT ' - - C• 08/29/16 CHG. ADDRESS B 09/30/15 CHG. DISC. SWITCH PROPOSEN PROPOSED LESSEE A 09/14/15 ISSUED FOR REVIEW LESSEE 4. X 12.0 DIA DRAWN BY: SS f LOCUS POLE EXISTINGCHECKED BY: MFJ NO TAG s . EXISTING ..OVERHEADPOLE'NUMBER:N 41' 38' 52.01° OVERHEAD WIRES W 70' 17' 47.06" WIRES NOTES: LOCUS'POLEUNMARKED OHW1. NORTH IS APPROXIMATE. NO TAGOHWN 41' 38' 52-01COORDINATES:2. EQUIPMENT MOUNTING AND ORIENTATION PENDINGW 70' 17':47.06"STRUCTURAL ANALYSIS AND. DESIGN. Q3. THIS DOCUMENT FOR LEASING PURPOSES ONLY. STREETEXISTINGLIGHTN 41 ' 38' 52.01EXISTING 4oPOWERT FOR C&NTELCOT70 COME FROM EXISTINGW 70' 1 7' 47.06" 1 STREET LIGHT p� OVERHEAD UTILITY LINES. SERVICE'�TO BE 6 , DETERMINED'. SHEET TITLE: 6 5. SITE PLAN & ELEVATIONS BASED ON'SITE VISIT BY TURNING MILL CONSULTANTS, INC. SITE & 6. UTILITY POLE COORDINATES BASED ON FIELD MEASUREMENTS.UTILIZING A HANDHELD GPS UNIT. DETAILED I ' 6 EXISTING SITE PLAN 2 PROPOSED SITE PLAN 3 SITE PLANS SCALE: 1/4" 1'-0" LE-2 SCALE: 1/4" = 1'-0" LE-2 1 ^ SHEEP NUMBER: i 0 2 4 8 ., .0 2.. 4 $' , LE-2 LEASE t EXHIBIT PROPOSED LESSEE ANTENNA TOP OF ANTENNA CAD 38.1't A.G.L. (70.8' AMSL) PROPOSED LESSEE ANTENNA _PROPOSED LESSEE ANTENNA ® 36.5'f A.G.L .(69,2' AMSL) 38.7" H X 12.0" DIA — SITE PROPOSED LESSEE 4' ANTENNA MOUNTING BRACKET HYANNIS MA SCO5 EXISTING. EXISTING TOP OF POLE © 30.2± A.G.L. (62.9'A.G.L.) STREET . L PROPOSED LIGHT • 0 LESSEE COAX z II 2)-1/2"0 IN A&E FIRM v 2" .U—GUARD (FARSIDE) III - a» , III ULL SCONSULTANT ,INC. . PROPOSED LESSEE'POWER TAP DEVELOPERS,ENGINEERS AND -I-RUCTION MANAGERS CONS SECONDARY LINE'®: 25.7f A.G.L. (SUBJECT TO UTILITY COMP 68 PO'0 X 11)59.SANDWICH NMA 02563: TEL:(508)888-0303 FAX:5887888-0246 vnrw.turningmilkonsuttents.com SITE ADDRESS: I NORTH STREET @ ROTARY MIN II LI (ACROSS FROM: 776 MAIN STREET) _ ~ PROPOSED_LESSEE 026 y SAR-O.MOUNTED TO HYANNIS, MA 0 if I K OF RRH r z - - PROPOSED LESSEE LEASE EXHIBIT SUBMITTALS y R •' �, .- - PROPOSED:LESSEE: •II RRH2X60 sr POWER CONDUIT 1. ?: PROPOSED LESSEE - FIBER DEMARC BY DC CONVERTER ,, • _ FIBER PROVIDER D 02/13/17 .REVISE VILLAGE-CALLOUT - FI 1R PROVIDER PROPOSED LESSEE. 60 AMP DISC: SIN C 08/29/16 CHG. ADDRESS . - .. E 8 09/30/15 CHG. DISC. SWITCH PROPOSED LESSEE + •gam a = i POWER CONDUIT PROPOSED LESSEE � A os/1a/1s ISSUED FOR REVIEW ✓Ph• ;< FIBER' IN. 2" U—GUARD I PROPOSED LESSEE DRAWN BY: SS v _. UTILITY METER �1 r; w xra PROPOSED. LESSEE CHECKED BY: MFJ EQUIPMENT'GROUNID POLE NUMBER: t , � • i 7' OR; UNMARKED PER h 3f, I UTILITY COORDINATES: e LOCUS POLE 7 COMP. . ROM'fS rr nNiD41,38' s2D1" N 41 ' 38' 52.01 W 70• 17' 47 O6" GROUND LEVEL 1 7' 47 6"" �r �r . � _ PROPOSED LESSEE.:...... ' SHEET TITLE: _ GROUND RODS � �• ` POLE PHOTO:_ � CONCEPTUAL UTILITY POLE PHOTO ; CONCEPTUAL POLE ELEVATION 2 ELEVATION SCALE: NONE LE-3 SCALE: 3/16" = 1'-0" LE-3 SHEET, NUMBER: 0 2 4 8 j LE®3 vW 15,169 a LEASE _EXHIBIT 11" REF + SITE - HYANNIS MA_SC05 PROPOSED ANTENNA:, 12.0""DIA • � A&E FIRM :: ATILL III UhTANTS,INC.- DEVEL.OPER.S;ENGINE-ERS,AND CONSTRUCTION MANAGERS 6 E PP D,UNIT3 eOX tt 9 6ANOWiCH.NIA02563 3$.7' =" *s - " 7eL:(508)88SA383 FAX:508).88BA246 — SECONDARY rcnv.Nmu gm ucgnsuRams.com N SITE ADDRESS: ry - z FIBER NORTH STREET @ ROTARY PROPOSED _ GND (ACROSS FROM b FIBER� ) FRONTHAUL _ - o, 776 MAIN STREET) x � o a HYANNIS,MA 02601 BACKHAUL -. 37" - uO o o T PROPSED IN R_EF' � S N� • � �_, � � , � � LEASE EXHIBIT SUBMITTALS PROPOSED "5 _4 RRH J _ - -PROPOSED - D 02/13/17 REVISE VILLAGE CALLOUT AC/DC -' - - C 08/29/16 CHG. ADDRESS ` CONVERTER 09 30 15 CHG DISC. SWITCH 0 ". A 09/14/15 ISSUEDI FOR REVIEW „ DRAWN BY: SS 30A SERVICE EQUIPMENT T CHECKED BY: MFJ METER GROUND POLE NUMBER: SOCKET 5 , UNMARKED COORDINATES ANTENNA DETAIL , RRH DETAIL 2 - GENERAL ��. Al8' ' 52.01 WIRING DIi4CaR�4iVl 7 SCALE: NONE. LE-4 SCALE: NONE LE-4, f SCALE: NONE LE-4 N L) 1 17' 47 06.,, • W 7 0' SHEET TITLE:' < EQUIPMENT DETAILS I . SHEET NUMBER: y L1..,�' -" • .� , ynvl5.iss