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0223 STEVENS STREET (3)
op ::? S'tev�s a . ` Town of Barnstable BUlldlii Post3Th�ssCard,So Thatrt is VlsibfeFrom the`Street ,A "roved:PlansMustsbe Retained on Job and th�s,Card Must beKe t + fARNtT[ABi.lT. • ,.�,�•' t �.., =3�. ��,�. 3� ,,,: � fpp�s �� �� �� a�r �". ,'� �s 4� � •P z�.. Permit Where a CeFrticateof Occupancy_s Required,such�Bu�ildmgs NbeOup�ed unt�ha allnsp o hasbeen made Permit No. B-18-1952 Applicant Name: DOMENIC JOSEPH VENTURELLI,SR. Approvals Date Issued: 07/10/2018 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 01/10/2019 Foundation: Commercial Map/Lot 308 258 Zoning District: OM Sheathing: Location: 223 STEVENS STREET,HYANNISAl z t Contrai tor'Name: DOMENICJOSEPH VENTURELLI, Framing: 1 Owner on Record: VILLAGE MARKETPLACE LLC r �; " kSR. 2 Address: P O BOX 1562 Contractor License C8E107219 d'3 Chimney: HYANNIS, MA 02601 h Est Project Cost:• $20,000.00 Description: Multiple Address: Permit Fee: $282.00 Insulation: 269 Stevens Street Unit E Bldg#5 Fee Paid: $282.00 Final: Demo Removal of flooring cabinetry and some walls,partition (light Date 7/10/2018 metal framing). Plumbing/Gas *New Tenant to pull building permit for fit-out Rough Plumbing: r ��.x Building Official ` Final Plumbin Project Review Req: %, g Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents'or whic this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures sh6l'Fbe in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or roadnd shall be maintained open for public inspection for the entire duration of the work until the completion of the same. s R` Electrical Service: The Certificate of Occupancy will not be issued until all applicable signaturesby the Bwldmg and Fire Officials are provided on his 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 priorto 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. Final: Work shall not proceed until the Inspector has approved the various stages of construction. Fire Department "Persons contirpcUnEg with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: rr Building plans are to be available on site c� All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ,. rt .,,.- .1.. �..... .... ................... c AFplic�tion xumber BAMMAEM . D MA88. Peffiit Fee.......................................Othea Fee........................ TotalFee Paid........ ` .......................................... , TOWN OF BARNSTABLE Pe71&ApproVal>y...../..ei?:j.`. :.:....oa..:Zz e_ BUILDING PERMIT .� . Mai... ..................Parc ......... . .. el...... APPLICATION Section I — Owner's Information and Project.Location i' Project Address a(P E 5 k\ie_ ,3 S btO Vflli age 4 Q n n 1 S Owners Name �`�I1CcgQ Mares}�ccc�, C:L� Owners Legal Address aa3 5e-vens SWt& Me-A City y State Zip Woo ) —� J Owners Cell# E-mail Section 2—Use of Structure Use Group Commercial Structure over 35,000'6"bic feet ❑ Commercial Structure under 35,000,cubic feel o ❑ Single/Two Family Dwelling Section 3—Type of Permit ❑ New Construction ❑ move/Relocate ❑ Accessory Structure . ❑ Chalge of use, r ❑ Demo/(entire structm) ' ❑ Finish Basement ❑ Family/Amnesty ElFire Alarm Rebuild ❑ Deck Apartment a Sprinkler System ❑ Addition ❑ Retaining wall. ❑ Solar Renovation ❑ Pool ❑ Insulation Other—Specify I Section 4-Work Description _ 7v c\ QT cx�r< k� -t �nl �-tu Ipf�nrt W m 9.,it 3Poera�� ecrt t�C �Ou.�►c��. T act nndadpd-2J92018 Application Number.................................................... Section 5—Detail Cost of Proposed Construction V0.1000.00 Square Footage of Project Age of Structure 3 Dig Safe Number # Of Bedrooms Existing C>' Total#Of Bedrooms(proposed) C7 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist ❑ Design Section 6—,Project Specifics i ❑ VVin g [] Oil Tank Storage ❑ Smoke Detectors Plumbing ❑ Gas = .❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑Add/relocate bedroom — Water Supply Public El Private Sewage Disposal Municipal ❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes �No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No Section 8—Zoning Information Zoning District C>M Proposed Use Lot Area Sq.Ft. C�7 CQf3 Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard- Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No bast imdated:2/9/2018 ` Application Number................................. Section 9—.Construction Supervisor Name Telephone Number Address Sa6 City i��irro� State AP, Tip Oa36o License Number C s -lo'7 9,i 9 License Type. ,c--c�,tr:,�,.Expiradon Date Contractors Email dve Fr, a PSI; ;LI,G �ca;11; Cell# 5 -afio ��3 t � I understand my responsibilities under the rales and regulations for Licensed Contraction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the contraction inspection procedures,specific inspections and documentation by 7 0 CMR and the Town of Barnstable.Attach a copy of your license. e Signature Date 6�%b I go it Section-10—Home Improvement Conti actor Name Telephone Number Address City State zip N Registration Number Expiration Date I understand my responsibilities under the rales and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Budding Code. I understand the construction inspection procedures,specific inspection and documentation required by 780 CMR and the Town of Barnstable.Attach a copy of your IUC... Signature Date v r Section 11—Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulation for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature Date l $ 1 o t Print Name i .; �/e�j �j(; Telephone Number E-mail permit to: f.i'."6 , (OM T e..�.....i..a-.i.•lmnmo A Section 12—Department Sign-Offs Health Department ❑ Zoning Board Cif required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ r For commercial work;please take your plans directly to the fire deparonentfor approval Section 13—Owner's Authorization H as Owner of the subject property hereby authorize - to act on my behalf in all x� matters relative to work authorized by this building permit application for: (Address of job) ' Signature of Owner date i Print Name 4 Lest=dated:2J92018 Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Constr.-'iori�SbPervisor f CS-107219 Eires: 07/19/2019 DOMENIC JOSEPH VENTURELLI, � S R —J ? _ 626 LUNNS W%kX X C = PLYMOUTH MA�02360 `. + Commissioner Construction Supervisor Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. . • old a r ;} r Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For information about this license Call(617)727-3200 or visit www.mass.gov/dpl , The Commonwealth'bf Massa6huse& Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Bulders/Contractors/Electricians/Plumbers Applicant Information Please PrintLesibly Name(Business/organizatimv ndMdual): LSMIQYVL�, J�►jk Chy►QC.UiV►Y�, Address: I'(LQ 01 (ow6)w sy lZwCC 1 Wes V \hnwx ,� 0.- UA Od U City/Stat zip: �- C)(ou Phone#: 5?) ^301y--3b VY Are you an employer?Check the appropriate box: 'Type of projecf(required): 1. I am a employer with 4 4. ❑1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction l 2.Elm I a a sole proprietor or partner- listed on time attached sheet �• ❑Remodeling ship and have no employees These sub-contractors have g• E'Demolition working for me in any caPa•citY• employees and have workers', 9. ❑Building addition [No workers'comp.insurance comp.msm-ance.$ 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 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.] *Airy 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 am 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-contactors and state vyhetber or not those entities have employees. If the sub-contractors have employers,they must provide their workers'comp,policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. _ Insurance Company Name: ro"Rn SI-eAR5 ''such u Policy#or Self-ins.Lie. ow I LPG Expiration Date: fi I Job Site Address: o7UCIE 54, em SkTw City/Sinte/Zip: q j OdU0 I Attach a co of the workers'compensation olio declaration age showing the policy nuu�fber and expiration date). PY P policy P ( Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to time 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 DIA for insurance coverage verification. I do hereby certi=thep=analties of perjury that the informationprovided,^above is true and correct: Sinature: Date: Phone#.- 56Y- 394- 3( Yq official use only. Do not write in this area,to be completed by city or town official City or Town: PermitlLicense# Issuing Authority(circle one): 1.Board of Health Z.Building Department 3.City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector-. 6.Other Contact Person: Phone#: WILLI-3 OP ID: EST ,d►co 9 CERTIFICATE OF LIABILITY INSURANCE DA 0 6/1 812 0 1 Y) 06/18/2018 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 Eastern States Insurance NAME: HONE ency,IrtC. AICC, EXt:781-642-9000 0A/� No:781-647-3670 Prospect Street E-MAIL Waltham,MA 02453 ADDREss:certificaterequest@esia.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Selective Insurance Company 19259 INSURED Williams Building Company, - INSURER B: Inc. 196 Old Townhouse Road INSURERC: West Yarmouth,MA 02673 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVVITHSTANDING 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 D UBR - POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MMIDDIYYYY MM/DD/YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR S2332498 01/01/2018 01/01/2019 DAMAGETO RENTED 500,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ 15,00 PERSONAL BADVINJURY $ . 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ]JE C LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT Ea d.m $ 1,000,000 acc A X ANY AUTO A9105499 01/01/2018 01/01/2019 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 A EXCESS CLAIMS-MADE S2332498 01/01/2018 01/01/2019 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION - X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC9058165 01/01/2018 01/01/2019 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? NIA - (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 A Equipment Floater S2332498 01/01/2018 01/01/2019 Scheduled 534,45 DEDUCTIBLE:$1,000 Leas/Rent 300,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101I,Additional Remarks Schedule,may be attached if more space is required) RE:269 E Stevens Street,Hyannis,MA 02601 CERTIFICATE HOLDER CANCELLATION HYAHYA1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town Of Hyannis THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y ACCORDANCE WITH THE POLICY PROVISIONS. 356 South Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Mass. Corporations, external master page Page I of 2 ze M: us s ly ark Corporations Division Business Entity Summary ID Number: 001259843 Request certificate I ;New 11 search Summary for: VILLAGE MARKETPLACE, LLC The exact name of the Domestic Limited Liability Company (LLC): VILLAGE MARKETPLACE, LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 001259843 Date of Organization in Massachusetts: 02-08-2017 Last date certain: The location or address where the records are maintained (A PO box is not a valid location or address): Address: 255 STEVENS STREET City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and address of the Resident Agent: Name. TIMOTHY C. WILLIAMS v Address: City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and business address of each Manager: Title name Address MANAGER TIMOTHY C. WILLIAMS 255 STEVENS STREET HYANNIS, MA.02601 SA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Title Individual name Address The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001259843&... 6/18/2018 Mass. Corporations, external master page Page 2 of 2 _REAL PROPERTY TIMOTHY C. WILLIAMS 255 STEVENS STREET HYANNIS, MA 02601 USA JI ❑ ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Annual Report ^ Annual Report - Professional 'I Articles of Entity Conversion v'� Certificate of Amendment . !View filings Comments or notes associated with this business entity: t New search http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=001259843&... 6/18/2018 Parcel Lookup Page 1 of 1 1 H ,Ip a�.�hlid.RSTah(Fl.,t,.�'+j, .ao �� 3"'•.^^^^ '�"¢.a,«. Logged In As: Pa r'CO I Lookup kU p Monday,June 18 2018 Road Lookup Condo Lookup Multiple Address Lookup Reports Search Options Search By Street Street# .,.` . .._. Street Name Stevens Street Village Hyannis Search <Prev Next> Page 7 of 11 IM Rows/Page: Flo 771. Parcel Location Owner Village Index Map . 223 STEVENS STREET- Multiple 308-258 Address VILLAGE MARKETPLACE HYAN 1535 308258 (265 STEVENS STREET Unit A-D LLC - BLDG#5 APARTMENTS) 223 STEVENS STREET Multiple Address VILLAGE MARKETPLACE 308-258 (267 STEVENS STREET HYAN 1535 308258 BLDG#5 SCANDINAVIAN DESIGN LLC (BLDG 5)) 223 STEVENS STREETw= Multiple 308-258 ddress VILLAGE MARKETPLACE HYAN 1535 308258 269 STEVENS STREET Unit A-D LLC BLDG#5 APARTMENTS) " 308-023 232 STEVENS STREET BORNSTEIN, STUART A&JAMILA HYAN 1535 308023 ' 308-018 248 STEVENS STREET WEST BAY PROPERTIESINC HYAN 1535 308 018-a; 268 STEVENS STREET 308-017 268 STEVENS STREET LLC HYAN 1535 308017 STAFFORDSHIRE 308-006 294 STEVENS STREET HYAN 1535 308006 - LIMITED PARTNERSHIP STAFFORDSHIRE 308-005 300 STEVENS STREET HYAN 1535 308005 F _ LIMITED PARTNERSHIP 308-045 309 STEVENS STREET FREEFALL LLC HYAN 1535 308045 308- 320 STEVENS STREET#A1 BARNSTABLE HOUSING HYAN 1535 30800400A 004-OOA AUTHORITY http://issgl2/intranet/propdata/lookup.aspx 6/18/2018 r PROJECT �. NAME: . p`v�✓«S. ADDRESS: PERMIT# PERMIT DATE: I LP MiP: O a , LARGE ROLLED PLANS ARE IN: BOX Z cam. SLOT Data entered in MAPS program on: � S j BY: q/wpfiles/formshrchive. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel _ Application!# 17 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 S Village -Vl� Owner now h / �1 G-_ p Address o? �CJ42 �5 T a/ Telephone' 7 2-5— q-3& Permit Request ei P�v�,�� v; /,Qo 7,— TueQ.0 V /-V Square feet: 1st floor:existing h1a a�ap 2nd floor:existing - proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 6, D o o Construction Type: �` 1 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 ,,mow Heat Type and Fuel: A-Gas ❑Oil ❑ Electric ❑Other Central Air: 3kYes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes c0 No CA) Detached garage:❑existing ❑new size/U Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: y, r Zoning Board of Appeals Authorization 0 Appeal# Recorded❑ CommercialYes ' O`No If yes, site`plan review`# .LLM Current Use &61&,4•L �z e Proposed Use C sw j BUILDER INFORMATION Name Telephone Number Address �? A)0-e7—# �% License# CS O�` 3 e�/ _USA t//-S Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO LZi,-._Q �a -e- SIGNATURE DATE FOR OFFICIAL USE ONLY ` x r s APPCItATION# zD kZ ;SUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER i DATE OF INSPECTION: FOUNDATION FRAME (I((�, D INSULATION S ✓��` V FIREPLACE ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. J r y y 1 Y I�ANNIS FIRE DEPARTMENT :) 95HIG.H.SCHOOL RID EXT. HYANNIS, MA.02601 HAROLD S. BRUNELL€; CHIEF` FFIiltTht£� - - $-,-, APEME,i OF'FIHE ECVCATION IvIRE PREVENTI :N.BUREAU �1 BUSINESS'PHON,E:(50$)7757-1800 FACSIMILE PHONE:(508)778-6448 LT.b0Na1LD I3: CIMS,E;JR.;CFI LT. ERIC F.xUBLER, CFI FIEF PREVENTION-OFFICE FIRE PREVENTION OFFICER B�!(IrDINO= G.00E COMPLIANCE FORM THIS"FIREPREVENTION fUREAU.HAS REV[EUVEC�THE PLANS DATED :.: . . FOR THE PROP R-ry:LQCATED A7" ALSO KNOU`JN �S V AMj .. C St3 l THE CHART BELOW INPICATES: THE STATUS OF OUR REVIEW: TYRhF:G(�NmUC LION DOCUIfEI f ;N/A.. RECEIVED REVIEWED COMPLIES 1� tARRA;T)t/E1iE0.�Jf T 2 FIRE FIGHTlJ`dCY�RESQX ACCESS 3`HYDRANT LO,CATI©N/VYA°TAR SIJPPLIf.: 4 SPRINKLER SXSI IMS SPRINKLER CONTROL EQUIPMENT ` >��`; `6-5TANDPIpE SYSTEMS c 7 STANDPIPE 1fALVE LOCATIONS 8 E.DEPARTMENTCOf�INCTt�N. . 9 F(RE.PRgTE>✓TIVE SIGNAL ING SYST &ANNUNCIATOR LOCATION {.. 11=SMOKE CDNTROL%EXHAUST r. 12-SMOKE.GONTROL EQUIP LOCATION _ w .. 13-L1FE S�1FET.Y SYSTEM FEATURES >- . 14 FIRE EXTINGUISHI(`JG SYSTEMS s 15- F.ES. CONT�ibL-mEQUIP LOCATION 17 FIRE PRQTECTION EfUIPJCNAE .`.. .1BLARM`:TRANSMISSOI�}METHOC�" --- `° 19 SE.QUENCE QF OPERATIO:N�iEPORT { r 2i3 ACCEPTRNCfT.TET{N r✓RiT1=RlA sELfVE TkiE [ OGUMEN7S TO BE COMPLETE AND.COMPLIANT FOR THE 1SSUA(dCE OF A BUILDING PERUIIT: WE HAVE COMPLETED THE'AGCEPTANCE TESTING FOR THE OCCUPANCY PERMIT AND BELIEVE THAT WITHIN THE SCOPE OF THE BUILDING PERMIT;THE'A r VE ISSUES ARE IN COMPLIANCE. BOARD OF BUILDING REGULATIONS fi icense: C.ONSTRU.C.TION SUPERVISOR, 3 Number CS 053861 f 1 irthdate 02/13/1,955 Expires;:,02/13/2Q08 Tr.no: 18454 _ - MI�pItJ_L J ROBERTS x 1815 FALMOUTH R6`#662 C { w CENTERVILLE, MA 02632 commissioner' Massachusetts Department of Environmental Protection Bureau of Waste Prevention •Air Quality . A 100064223 BWP 0 Decal Number Notification Prior to Construction or Demolition Important:Mn 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 b the Department of Environmental Protection cursor-do not g 9 Y p 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. 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?n Yes ✓(] No 1.All sections of b. Provide blanket decal number if applicable- this . this form must be Blanket Decal Number ®� completed in order to comply with the 2. Facility Information: Department of Environmental VI LLAGE MARKET PLACE Protection a.Name notification [UNITS AND 241-E STEVENS STREET " ._. .� requirements of b.Address - 310 CMR 7.09 L ' RNSTABLE � Mq 02601 c Citv/Town _ d.State e.Zip_ f.Telephone Number area code and extension E-mail Address o tional 18,000 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? R1 Yes ❑ No k. Describe the current or prior use of the facility: COMMERCIAL/RETAIL SPACE �� ���? I. Is the facility a residential facility? Yes ✓] No -'° m. If yes, how many units? Number of Units —° 3. Facility Owner: �N ONE VILLAGE MARKET PLACE LP i s° a.Name �° 1297 NORTH STREET s b.Address _ [HYANNIS _� AMA _._.�... � 02601 0 C.Cit frown d.State e.Zip Code (508)775-9316 _ f.Tele hone Number area code and extension ,, _�q E-mail Address" tional o j -- D MICHAEL ROBERTS �Q h.Onsite Manager Name ® ag06.doc-10/02 BWP AQ 06•Page 1 of 3 . f . Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention . Air Quality l000sa223 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General Statement:If B. General Project Description (cont.) - asbestos is found during a 4. General Contractor: Construction or Demolition IMICHAEL ROBERTS operation,all responsible parties a.Name must comply with 11815 FALMOUTH ROAD,APT C-6 310 CMR 7.00, b.Address _ 7.09,7.15,and Chapter 21 E of the CENTERVILLE MA 02632 General Laws of c.Cit /Town d.State e.Zip Code the Commonwealth. (508)962-7792 This would include,but would not be f.Telephone Number area code and extension .E-mail Address(optional) limited to,filing an IMICHAEL ROBERTS 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. MICHAEL ROBERTS a.Name 1815 FALMOUTH ROAD,APT C-6 b.Address CENTERVILLE M . A� 02632 c.Cit /Town d.State e.Zip Code (508)962-7792 —- f.Telephone Number(area code and extension) g.E-mail Address(optional) MICHAEL ROBERTS h.On-site Manager Name 2. On-Site Supervisor: MICHAEL ROBERTS On-Site Supervisor Name' 3. Is the entire facility to be demolished? ® Yes [7j No N =0 4. Describe the area(s)to be demolished: �0 INTERIOR PARTITIONS. NOTHING STRUCTURAL. �N ' 0 5. If this is,a construction project, describe the building(s)or addition(s)to be constructed: OFFICE SPACE. -0 0 �o �Q ■ ag06.doc-10/02 BWP AQ 06•Page 2 of 3■ r , 4 Massachusetts Department of Environmental Protection _a_ ■ Bureau of Waste Prevention • Air Quality l000sa223 BWP AQ 0 w{V� 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)? C] Yes 0 No If yes,who conducted the survey? ..S.urvevor Name c.Division of Occupational Safety Certification Number 03/31/2008 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:. E seeding ❑ paving b. If other, please specify: [✓_] wetting ❑ shrouding E] covering other 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title s c.Date mm/dd/ of Authorization d.DEP Waiver Number D. Certification I certify that I have examined the MICHAEL'ROBERTS =o above and that to the best of my a.Print Name o knowledge it is true and complete. IMICHAEL ROBERTS The signature below subjects the b.Authorized Signature —�N signer to the general statutes _ PROJECT MANAGER =o regarding a false and misleading O statement(s). ONE VILLAGE MARKETPLACE LP d.Re resentin — 11/08/2007 e.Date(mm/dd/yyyy) o C3 Q ' ■ ag06.doc•10/02 BWP AQ 06•Page 3 of 3■ e�)EP - Payment Confirmation Page 1 of 1 y � �� Payment Confirmation DEP Transaction ID : 155271 - Payment Date : 11/8/2007 4:49:30 PM $85.00 has been charged to Credit Card ************7995 Transaction Information DEP Payment Code#27724 Payment Confirmation#23867 Please note that payments received after 3:30 pm will not be posted until the next business day. Mass DEP Horne Contacts ..M, Feedback o' Tour Privacy Version: 6.5.11.0 s - https://edep.dep.mass.gov/restricted/webpages/PaymentConfirmation.aspx 11/8/2007 C;OI „ REF Ti�I ATE OF L.Ua►MLI I r IF40UMM111%. , Ulf "w THIS CERTIFICATE IIS II.SUED AS A AlIAT7ER OF INFdRMATION PrsoDDCOt AT ONLY AND CONFEF9 T 4 RIGHT S UPON THE CERTIFICATErF Nb OR •wlitlg&O'Nell Insurance HOLDER.THIS CER of CATS DOES NOT AMEND, Lei ALTER THE COvER,4G-AFFORDED BY THE P OUCIES BELOW: 222 West Main fit PO Box 1990 NAIL X Hyannis,iUW I�2Rq!-= INSURERS AFFbI✓tDING t OVERAGE ,N5IJF A; A.sscciatecl Nf lo�yer3 Insurance Compa ttlSUREfi - Sippewissett Construction CorP- INSU H: &Hard Hat Construction o; 29T North Street INSURER 0' Hyannis,MA 02601 1NsuREFz E .� COVERAGESFol SUED TO T14F INSURF- THE PO POLICIES OF Han OR CON�DRgONOaF HANYEGONT�RACT OR DTHan AOCUMENTT WITH��CT TO Vy"10 I�g CER71 IM M MANY BE ISSUED ORNDING ANYMAY PER REMTAIN,TiE INS'JPANGE APFOPrPI�BY THE POLICES DSVS RIBBD Hl3 N IS SU6JECT TO ALL TFIE TE Rt'S.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGGREGA r!S L>MfTS SHOW74 MAY NAVE BEEN REDUGM BY PAID GLAIM8' EFfECT1VE P G•EM IMP ri UNIRE off YYP6 OF INSURANCE POLICY NUNtgER - DATE kanlon DAIS FmNIaO TR EACH OCCURRENCE . ii GENERALUAWW" DAMAGE RENTED S CWWRCIAL GENERAL UARU n1' Ik&O EXP An, CUKIMSMAMCl CC" PERSOWLI,AMINIW @ GRhLAGflREG4TE i PRODUCTG•COMMOPAGG f GL*X AGOREOATELIMTAPPLIES PM POLICY rrr LOC AUTomoa E UAIMM �0[d)WOLE OMIT S ANY AUTO BODILY URY S ALL DINNED AIJTCS BO�ony SCIAOULEOAUTOS 6001LY BRED AUTOS er .4 3 (P aedeent) NON-0WEDAUTOS "OPER'TyCANAGE S _ (Par acddR+1I I AUTc ONLY-EAACCIDENT $ GARAGE 1-1411"rIl OTHER THAN EA ACC S . ANY AUTO AUTO GN6Y; AGG E PACK OCCURRENCE S 0CESSAIMBRELIALIAMIUTY AGG"WE S OCCUR 0 pAIMS MADE S DEDUCPBLE S ICIN $ C5600549012QDB 12107105 1?JOTdO — we 5 A NSATonAm WC rATuD-E NT oTH- 500otEr ,008 04PLOYOW UMIL TY E,L DISEASE• OWFFIG6 EA EM OYEE$No 000 RMEMPE)X=OED?�NE EJ_GSnA51°-POLICY LIMIT SEi00.000 I1 oe•[As MOV e OTHER OESCR TION OP O Id6 PERATIQ (LOCATIONS J VHIICLES!DCl7.U51D AODEB e7 ENDGRSEMEa t SpEpALpKOVISIONS Insurance coverage is IlmKed to the terms,conditions,exclusions,oftr rtif limitations and endorSAments. Nothing contained in the`e ndedate of Insurance shall be deemed to have altered,vliaived,or extended the coverage provided by the policy provislons CANCELLATION CEfTIFICATE HOLDER 6MODU1 ANY OF THE ABOVE DF:SCI 70E0 ppLgl@S BE CANCELLED HEFORE THE exPIRATION Suffield hfigmt Corp,stal•. DATE THEREOF,THg$$We105'J1ERvILLENGEAVORToMAIL 10 DAYS WRfTTEN St Z9T NOrtFt reet GTWr;TO THE CERTIF'IGATE in�w IR NAMED TO THE t EFT,SLIT FAIw RE T6 00 5o SHALL Hyannis, St Ot IMPOSE NO OGUGATION OR UAHILI'Y OF ANY N.THE INSURER,ITS AGENTS OR REPRE6ENTATNES. ,� --- AMMORRED PRESCINFIAT i� LS1 0 ACORD CORPORATION 198E ACORD 25(2001109)1--uf 2 #46415 r Town.of Barnstable , oFTME rOktio . Regaiatory Services • g Thomas F. Geiler,Director . BUS&�'� Build ug Division 9� sd3q. Ati� . CEO i TomYerry, Building Commissioner . 200 Main Street; Hyannis,MA 02601 w,,,yw.town.barustable;maxs Fax: 508-790-6230 Offioe: 508.86214038 Property Owner Must Complete aad Sign This Section If Using ABuildeir by S t u a r t Bornstein ,as Owner of the subject property hM i c rra e l J. Rob-e i t s to•act on my behalf; ' 'hereby a'rthonze tri relative to work authorized bytes building Permit application for, atters in all ' 233.. E .. Stevens Street , Hyannis.,._ MA 02601 11/.7/2.007 Date Slgnatur of � � Stuart Bornstein • Print Dame � - _ Departrngnt of ind4,strial Acc.,aents 600 Washington Street �w ��•s r.3� .. Boston, Mass. 02111 . Wor'ers Corn/nsation insurance davit NOUN/= film name: S I PPEWISSETT CONSTRIiC location' 297 North St Hyannis MA 02601 ohoneff ( 508 ) 775- g-� , ti ❑ I am a homeowner performing all work myself. Cl I am a sole proprietor and have no one workin in any capacity, /////%%%////%/%//%/%//%/////////////% %%/% ///%%///%�%%//MM///% ® .I am an employer providing workers* compensation for my employees working on this job. com nnv name: S i ew i. . address: rth Hyannis , MA 026-01 phone A- (508_) -775-9316 cirr- olicvAW.CC 500.054901200 ' insu/Uii.U//cc CIL //a�ai/�ii�rri/iivi�✓%��c/�ir /i/�da//r�/ //i / Uiii//i/////�/i�i/////�/i//io/%�// //ii /�/�/iil�/// /i��/iiU/i,U//,%///i./////✓�//// �iiz or homeowner(circle one)and have hired the contractors listed'below who ❑ I am a sole proprietor,general contractor, have the follox%ing workers'compcnsation polices: comaanv name. address: -. :: '• '.•:..- .:.. .vi 1: Y�.. •:'},:. 7\wY'P 4v +� ..•.. ' ,;• .. - done#' r.•1n,..:- ':+' -' > insornnce crt. eamnanv name- address• _ • city- .,'.::•. ,:.;::>y;:.:; .E:o:C>::`.-.yr'ii%:,;::o.'!.... ..•.).j::>t',L''::''i::=i=i•' -;�c%%.ir•' .. Insurance co. sor MG Faffnsr to secure corersge>,segniscd under�cction 25A MGY.1S2 can lead-to the imposition of criminal penalties of:tine:up to 51.500.Oo and/or one years' secuLmpre coo sent a re as aril p�dp the form or a STOP WORK ORDER and a flue of 5100.00•a day.stainst me. l undesstand that s copy of this statement mar be forwanitd to the Oinct of"Yestigations of the DIA for rnrmte reriIIotion. I her ce ijy un the d enalti jperju the injosmativn provided above is truce and correct: Date 11/7/2007 Signature Micha J . Roberts 1'hone ( 508) 775-9316 Print name ojudai use only do not write in this area to be completed by city or town of nci2l persni0cense r3 ❑Btlldlnt Depattr.1 nt city or tovm: (311censing Board E]Selestmen's Ofncc (� check if L-=edinte Mponse!s rt lth gWred ORea Departrnrl phone# [Other -- corlmn person: , nyca 9,95 PJIAI v EXHIBIT "A" �, , �` �. SITE PLAN \\ w o 30 -so so too ISO G. 3 I ;; GRAPHIC SCALE -•- 1 r t k y, I , za V 1 1 aLAJ r ac BLD'G. l L r- r, lS f r —.... �-- S drive d• _.... r I•v e Z I ----------- STEVENS STREET ' _ _. i r w i � � i r �� P I i a a . y .�. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 308 Parcel 258 Permit# C>)w aI 7 6 Health Division Date Issued Conservation Division Application Fee Tax Collector Permit Fee - Qr Treasurer Planning Dept. Date Definitive Plan Approved by Planning Board L Historic-OKH Preservation/Hyannis Project Street Address 20 Stevens Street -fi r :Village Hyannis Owner Stuart Bornstein Address 297 North Street Hyannis Telephone 508-775-9316 Permit Request Create New Offices for Bank and Two Handicap Lays t Square feet: 1 st floor: existing 1,500 proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay r� Project Valuation 200,000 Construction Type g Lot Size 3.86 Acres Grandfathered:, ❑Yes ❑No' If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 25 Years Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other N/A 1 Basement Finished Area(sq.ft.), N/A Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing one (1) new Two (2) Han icap Number of Bedrooms: existing N/A new Total Room Count(not including baths): existing, new i First Floor Room Count Seven (7) Heat Type and Fuel: ❑Gas ❑Oil X Electric ❑Other Central Ai`r: &Yes ❑ No Fireplaces: Existing NSA 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:O existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial LA Yes ❑No If yes, site plan review# Unknown Corm:erciai Banking Current Use ---- _Proposed:Use BUILDER INFORMATION Arthur P Vidal Jr 508-548-3710 Name Telephone Number Address 205 Worcester Court License# 010514 Falmouth MA Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO x Bourn a dfiii SIGNATURE DATE 77 - r2_0 6 FOR OFFICIAL USE ONLY i . PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: i; FOUNDATION FRAME ® I� r INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDINGak, DATE CLOSED OUT 3 ASSOCIATION PLAN NO. sr } 4 AFFIDAVIT ARCHITECTURAL DESIGN AND INSPECTION To: Paul Roma, Building Inspector Hyannis, Massachusetts Re: The Community Bank Hyannis Office 259 Stevens Street BKA Ref. No. 205088 In conformance with Section 116.0, Construction Control, of the Massachusetts State Building Code, I certify that to the best of my knowledge, information and belief, the plans and computations for the captioned building were designed in accordance with the requirements of the Massachusetts State Building Code and all other pertinent laws and ordinances. I also certify that 1, or my authorized representative, will inspect the work during construction. This will include the inspection and review responsibilities outlined in Section 116.2.2: Upon completion of the construction, a final inspection affidavit indicating that the .building is satisfactory, complete and ready for occupancy will be issued. Barry Koretz -No. 3962 Architect - MA Reg. No. BKA Architects, Inc. �`siEREo �� Company F .j R; �lF mQ 142 Crescent Street, Brockton, MA ® 2 Address CKTON. . O M SS. J� (508) 583-5603 10F Telephone ` May 24, 2006 Date I Frdav,June 02,2008 6;OB PM Ken Swartz 508 457 7832 p.02 To,ym of Barnstable Aeg*atnry Selrvit-es � *rhomw F.Geller,Director Bmldim Division 'Famp�xrY� �� Comm�esiax�er . 2%Mais5tx)o#, $y=vs,MA 02601 v"Aawn.barestable.,,ma.ua U �ioe: 5L18�8�2-4035 - F'ax: SQ8 99Q-623iS - Ptope-4 der Must Co mplete sLAd Sign This Seetioii If Using ABuider I, Stuart B o r n a t :i n ,7s O=er of the subjact prc7par> r hereb7lut$Qri2�_., ' V CkitlntruCLionjArthur P V.id.aa -- to Act onmytxh�"t�, in 4 matte r%l tjvc to V jrk.authorized bytl is buil'c�'ng Pernik appEe ion tar. 2afi :��c?e�ib SKroet, T1p�riniL , (.Ad(l2es s d j 0b� d,--- r fr l ure fl IIeY a Date n.enDAt�•PSWt,TF12 qAR MlC�FI 7 Z0lZ0 7a-d i9NW A110H 9Z599LL80'S 5Z ;50 900Z/90/90 06/22/2006 10.20 FAX 508 790 1077 FAIR INS I10U1 _.... ®ATE&mfo Timid CERTIFICATE OF LIABILITY INSURANCE 06/22/2006 F%00u m+ 5 8 775-3131 FAX (508)790-1677 THIS CERTIFICATE IS ISSUED AS A MAT-MR OF INFORMATION The Fair Insurance Agency, Inc ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER,THIS CERTIFICATE DOES NOT AMEND,EXTEND OR P.O. Box 430 0 E AFFORDED BY THE P ICIIES BELOW. 619 main St. Centerville. MA 02632 INISLIRERS AFFORDING COVERAGE NAIL S INSURED 'V V 5nrtruction Co. nC. INSURERA! US LIABILITY 205 Worcester Court A6 INSURER B; AIM E. Falwouth, MA 02536 IrmAERC: GREAT AMERICAN INSURER D. IN8URER E; THE POLICIES OF INSURANCE LISTED BELOVJ HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONCITION 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 CON0ITIJNS OF SUCH. POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY P'40 CLAIMS. INSRkQD'L TifPGOP IN$URANCE POLICY NUNSER POLIOY EFFECTIVE POLICY EXPIRATION UMITS i OBNERAL LIABILITY CLIL120758 10/22/2005 10/22/2006 EACHOCCURR6NCE v i s 1,000,0i�C X COMMERCIAL GWrRAL LIABILITY f DAMAGE TO RENTED 50,0Il CLAIMS MADE OGGUR IIAED EXP(Any ono Person) S _ 00 A PERSONAL&ADV INJURY b 11000,000 QEN$RALAGGREGATE 3 1 000 CO OEN'L AGGREGATE LIMITAPPLIES r'cR: PRODUCTS-COMPfOP AGO $ 2,Q®B i 06I) POLICY LOG AUTOMOBILE LABIL17Y - -- COMBINED aCcidmd)SINGLE LIMIT s ANY AUTO (E ALL OWNED AUTOS BODILY INJURY pluacrY} SCHEDULED AUTOS � ` (px i HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per awdant) PROPERTY DAMAGE $ (Per eottdent) j GARA6HLIABRJTY AUTO ONLY-EA ACCIDENT i _ ANY AUTO OTw6R THAN EA ACC 9 AUTO ONLY: AGO $ £xCE981UM8RELLA LIABILITY EAGM OCGURReNCe 9 OCCUR a CLAIMS MADE AOOASGATE S DEDUCTIBLE d i RETENTION $ 4 wORKER9 SwcoNPEN mAND AWC7007352012003 11/16/2005 11/16/2006 wcsrATu-TORY LIM" orl+ EMPLOYER$'LIABILITY E.L.EACH ACCIDENT 4 100 00 ANY PROPRIMS R FXtILUDP atSC 1TIV2 a E.L DISEASE-EA EMPLOYE, s 10(I,Q OFF10ER/MEe under XCLUDEFi? If;Ie9,describe I.tMar 00 6PP,.GIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT 5 500.000 IOTHiR II pE§t:'�ON OF OPERATIONS i LO,-,LT90Nr,i VENICLLS 1 OWLEIMONS ADDED BY ENOCsRS£HiI ENT 1 SPECIAL PROVISIONS - j iCERTIEIC'ATF_HOLDER PANCELLATION 1 SHOULD ANY OF THE ABOVE DESI,?RIBED F%ICAE6 BE GMOELLED BEFORE THE i e EXPIRATION DATE THEREOF,THE ISIS0 41NSUPAR WILL.RMEAVOR TO MAIL TOWN OF BARNSTABLi` 2_DAYS tYRITfEN NOTICE TO THE CENTIRCATE N41 AER NA81E0 TO THE LEPi, BUTL INC BE" bur IIAILURL TO MAIL SUCH NOTICE SHALL.IMPOSE NO OBLIGATION OR LIANLITf 200 MAIN ST OF ANY XINO UPON THE INSURER,ITS AGENTS OR REFRESENTAMES H ANNIS, MA 02601 Au THORIi5OR6PR&SOYAnVF. lKathy Silviat FAITU7. d� ACORD 25(20011D0) CAGORD CORPORATION 11988 r _—Workers' The Commonwealth of 1Vlassachus etts Department ofIndustrial Accidents Office otlnvestigatfons 600 Washington Street, 7h Floor Boston,Mass. 02111 Compensation Insurance Affidavit:Buildin lumbin /Electrical Contractors name: V & V Construction ` address: 205 Worcester Court ci Falmouth state MAziv 02536 vhone# 508-548-3710 work site location full address): 259 Stevens Street ❑ I am a homeowner performing all work myself. Project Type: ❑New Construction Remodel ❑ I am a sole roprietor and have no one working in any capacity. ❑Building Addition ® I am an em loser rovidin workers'compensation for my,employees working on this job. lA:Yr ';+}wt-;:,,�. ant-_ '',�•�:'• ';'., �' ^: s.r •.,'S,a.,"='sN",:}:> ^.=•'lib e'v_,f "i '�Sy':S. .,+.`-kS.,a r:�r?';Sal".%�:o�ax L;r':,. ,�r,iCYee�.i".��,�..+`,.'�,.x,?}.::;i,'`�'::. .':.', •' �r:�;',•:. ' .,. ' 4 4Ft 1 F:^• �'+.T. .,Y''C:�.Y.1:1 S \ -i,a:'..:„ r V ;c ?mg�iiL�il'��''F,A'?`9ra�A�..�""s. •s,. .•� k,•�,�,•;R, c.;:;...�,'f,vr :;♦:.'�a":;C::<,•..�s.:• ';�.,•i•"::,,:_••i• 4-4 :,.i•• qq��' ♦:ram;.Y;fY :?: . `_," '� '�v��; A. •' i< �.`4,.:4.p'j:: "�', <. ..�.� •'•'t�Ci r::4' ..r. `>`• KJ��� .v%i'• •":f:" '-t",,L x,uc �'l".`i^.•,,:: t V„ ��7i �.:i:;iii�'':, '�_'t <2"'Ts' -t )'�;�'^� '�:>4°.{•'��,;a...:ai::t`^n`i��pi} .8•. :iy�:.� ,v"i`a:�ip':�'. .. •1� "!'�''�• 1`'t�3rt;�s„ '� '>s' (•'• •:q 3+y' +�"'. 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I understand that a copy of this statement may be forwarded to the Office of Iuvestigatio of th DIA for coverage verification, I do hereby certify u er the pains and pe a ' opf ner'ury A a in rmation provided above is true and correct Signature096 T / A Date June 22, 2006 Print name Arthur P Vidal Jr Phone# 508-548-3710 official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department' ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑health Department contact person: phone#; ❑Other (rovised Sept 2003) 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 applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,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 in the workers' compensation affidavit completely,by checking the box that applies to your situation. Please supply company name,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 permittlicense number which will be used as a reference number. The affidavits maybe 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, 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,7"'Floor Boston,Ma. 02111 fax#: (617)727-7749 phone#: (617)727-4900 ext. 406 r REGULAIO DING BOARD OF BULL ON SUPERVISOR License: CONSTR UC Y Number;`_, , 010514 " Birthdafe k3911EYF1935. 4818.0 j 0g110J2007 Tr.no: Restricted ARTHUR P VIDA���' PO BOX 127 025 — --. E FALMOUTH, MA Commissioner i i — f I S' TI�TIS FIRE DEPARTMENT �YAriYu/5: 95.HIGH.SCHOOL RD. EXT. HYANNIS, MA.02601 HAROLD S. BRUNELLE, CHIEF �`�'�SGAKETM� ETYDEMT AWANENEfi•DFFINE EOYCA710X VIRE PREYENTI :N BUREAU 8uslNESS7PHONE: 50$ 775-i300 FACSIMILE PHONE:(508)778-6448 LT,1<ON—ALP R. CHASE;11L. CFI LT. ERIC F.lIUBLER,CFI FII>`E REVICN TION OFFICER. FIRE PRE'VEN nON OFFICER BUILDING--. COP.. COMPLIANCE FORM THIS'FIRE PREVENTION B'UREAU.HAS REVIEWED THE PLAN DATED ( G FOR THE PROPER A'- LOCATED AT _�� �� 4 ALSO FCNUV`Jfv AS _ � M`^�/l t �{ . THE .CHART BELOW INDICATES THE STATUS OF OUR REVIEW. t.. ,TYPOF CONSTRLIC fO1�1 DZ�CUf1AENT N/A RECEIVED REVIEWED COMPLIES ro; RRATIVE FEPpFIF s:' 2 .FIRE FIGI•fTl1`d J HESCI?E,•ACCESS 3 F-fYDRAN7 LC~CATIONI WATER SiJPPL.If.` ,.�/.:; _ 4 SPRLNKLER f 5 SpR1NKLER CONTROL EQUIPMENT 6 STAN0.41PE SYSTEMS :. 7 �TANI�PIPE VALVE LOGATI01�1S.. ,. 8`avfRE DEPARTMENTT,CC3NN,�GTION 9 FIRE PROTECTIVE SI.GNALlIVG SYST �5, 1.0=F P o:S. &ANNUNCIATO.R LOCAT101V,'` - 1.1=SMOKE CONTROL%Ex!MUST 12-SMOKE CONTROL EQUIP,LOCATION 13 LIFE SAFETY SYSTEM FEATURES . A � =FIf�E EXTINGUfSHIPJG SSTEMSY 15-F E S.'CONTROL EQUIP LOCATION i Ez FIRE PEtOTECTIOIV RO©N}S 17-FIRE PIQTECTION EQUIP SfGNA;G.E 1I3 RLARM'TAANSMISSION NIETEOD' --- - x 19 SEQUENCE OI= OPERATIO:N IEI?.ORI' . 2D-ACCEPTANCE TEST{NG CRiTER1A . - WE BEE1 VE THE DOCUM CO PLETE AND.COMPLIANT FOR THE ISSUANCE OF A BUILDING PE 4IVE HAVE COMPLETED TH CCEPTANCE ESTING FOR THE OCCUPANCY PERMIT AND BELIEVE THAT WITHIN THE SCgPE OF THE$UILDING PERMIT;THE ABOVE ISSUES ARE IN COMPLIANCE. Remove all walls, doors, etc. NI R 6•-0" .. 10-7" 10'-7" TOILET Remove wall &.Sink q Remove office walls, doors & sink TOILET Remove all cabiletry counter & sink U z = STAIRWELL STAIRWELL S 1 � CLOSET y� ' CLOSET CLOSET ` ®4 1 q Remove closet,.sink & counter. Plumbing rough-in to remain for CLOSET installation of juice bar sink by STAIRWELL Remove Cabinetry STAIRWELL tenant at tenant expense z surrounding g column x ; U CLOSET m Co Remove all'floor finishes co in entire space. Tenant to -� provide new flooring at Remove office tenant expense g walls & door 36-5l j� 10.-7„ 10.-7. K i. f BUILDING 5-EXISTING CONDITION Remove all walls, Barnstable Bldg. Dept. doors, etc. SCALE:1/8"=IV' t Approved by: "Permit #: REVISION DATE DRAWING TITLE PROJECT TITLE I/8"=I'-0" DRAWING NUMBER. BUILDING 5 DATE: II/I3Z/I7 FLOOR PLAN DEMOLITION PLAN FOR t � DRAWN BY:DTS A— 1 . O WOMENS WORKOUT SHEET I OF I . - - 4HUnrsg�tenpnn/}:Ant-: 1 l