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0395 WEST MAIN STREET (2)
Ova I �F 1 1 0 (HE fpy_ `' y ..k ..nSa" yx,r�y - c `IIyiy � '6 � �, � "� � F�nnted�On�fi Case#: C-19-634 Address: 395 WEST MAIN STREET, Date: 7/31/2019 HYANNIS Owner Info: Property Info: CUMBERLAND FARMS INC MBL:, 165 FLANDERS ROAD 269-116 WESTBOROUGH MA 01581 Owner Notified?: r Complaint Details: Type of Complaint Classification,of Complaint Method of Complaint Zoning, Building Code, Medium Priority t Phone Complaint Summary: Report of dedicated areas created for new smoke shop regulations. No permits pulled to create areas inside that require separate entrances. Reported that all Cumberland Farms in Barnstable have created this. No building permits on record. Action History: Action Taken Date Description Fee Inspector Close Case 8/1/2019 $0.00 mckechnr Inspector Assigned to Complaint: mckechnr Filed by: sheas Comments: Comment Date Commenter Comment 8/1/2019 mckechnr Area created by moving display.racks, making walls. No building permit is required at present time 8/1/2019 mckechnr Area created by moving display racks, making walls. No building permit is required at present time 8/1/2019 mckechnr• Area created by moving display racks, making walls. No building permit is required at present.time Alcry Rf5 - ��®ate ®r 0 f.�es Maly) curnWdard F A R M S June 26,2019 VIA ELECTRONIC MAIL AND CERTIFIED MAIL NO. 7013 2250 0002 0835 8668 Thomas McKean Director of Public Health Town of Barnstable 367 Main Street Hyannis MA 02601 Re: Adult-Only Retail Tobacco Stores Mr. McKean, As you know, Cumberland Farms, Inc. (CFI)has recently inquired as to the newly-enacted Board of Health tobacco regulations, and is actively exploring all available avenues to continue serving our adult tobacco customers in Barnstable. I appreciate your time in discussing one of those potential.paths forward: obtaining and operating under an"adult-only retail tobacco store"permit at our current retail establishments. From the text of the regulation,my meeting with you and your colleagues on June 13,our subsequent emails, and your phone call on June 19, CFI's current understanding of the situation is as follows: • In the event that demand for adult-only permits exceeds supply,CFI will now be considered first in line and will have the right of first refusal when such permits become available under the new regulations. • However,the requisites and overall process for obtaining adult-only is not well defined among the various Town stakeholders involved here—including,to my surprise,the Board of Health itself,which adopted these new regulations to begin with. • CFI has provided three different draft plans for purposes of discussing an acceptable adult-only store model.There is still no consensus on how these proposals will be handled by the Town internally,or whether they will be approved. CUMBERLAND FARMS,INC. 165 FLANDERS ROAD,WESTBOROUGH,MA 01S81 W W W.CUMBERLANDFARMS.COM • You have contacted representatives of the Massachusetts Association of Health Boards (MAHB)and the Cape Cod Regional Tobacco Control Program(CCRTCP)seeking their review of CFI's plans.You have received direction from Ms. Sbarra of MAHB,which you have not shared with CFI but which you have shared with town counsel. You have not yet received a response from town counsel,or from Mr. Collett of CCRTCP. This matter remains a very important issue for CFI, and time is of the essence in light of.the new regulation's imminent effective date. Please keep me informed of any new developments as soon as possible. Finally,as I am sure you are aware,private entities like MAHB and county programs like CCRTCP have no regulatory authority over CFI in matters of retail permitting and local rulemaking. Accordingly,please be advised that CFI reserves all rights and remedies to challenge any adverse action in this matter, including without limitation any condition or denial attributable to the involvement of such third-party organizations. Best Regards, g rds, CUMBERLAND FARMS, INC. omas Cacciola Vice President of Real Estate and Construction Email: tcacciola@cumberlandfarms.com Phone: 1 (508)270-4414 Cc: Brian Florence Building Commissioner Town of Barnstable Robert McKechnie Building Inspector Town of Barnstable Robin Anderson Zoning Enforcement Officer Town of Barnstable Ruth J. Weil, Esq. Town Counsel Town of Barnstable i .a. �� i �, Vl2✓C� ��� 3 �s- � �31 j Do :.�•:,;23k3 s S7' Q 1 2":4 20- $=3+5 TOWQ Of,BdhAB.LE; ;LAND COURT REGISTRY t .,.. � ; <Zontng'Board of;'A.pPeals: 4 + Decision and Notice Special.Per 'it No.20 3-070--Cumberland Farms,Inc.-- i Section 24043(B)&240.94; Alteration of Preexisting:Nonconforming Use:in WP` Section 240.2SM--Conditional Use,Special Permit Section 240-93(Bj Alteration of a Pre-existing.Nonconforming:Structure To;demolish arid,rebwld a preexisting nonconformmng gas station. Summary:: r, Graritfed:with;Conditions. Fifil�'i+iS��F`�3*:i l.ERl Peti0oner•;` Cumberland Farms;,lnc 100 Crossinoul g Bevard,F ramingham,MA i+�!1;:• D :;$ FPt ;35 Property Address: x 395-WeA Main Street,`.Hyannis Assessor's M*Parcel 269/116` Zoning: Highway Business DiArict,:Wellhead Protection:,Oxerlay�istnct: Hearing Date: December 11;2813 Recording Information: Me& Certificate!No.,,89626 o . Plan.; Plan No'113285,Sheet`2 Background' The subject property is a 0 60•acre:pareel.located--at the,corner of West Main Street and>Suomi'.Road in Hyannis: The parcelis currently.irriprovedwith six:fuel dispensers(twelve;pumps);a 50 ftx-90 ft gas station canopy and;;an approximately 800;sq:ft,convenience.storeJkiosk. :A,separate freestanding~multi-tenant`.bwldug;of approximately' 4,450 sq.ft'sits behind the.gas station This buildng;is curreritly:vacant. The parcel'is located entirely wrthintlie. Highway Business`Districtand VUellhead'Peotecti9 Overlay Disfnct.•The property is;;6ounded to the:north,and eastby 1"ots`used'for.storage of.:used cars., ., The%property has:been owner by-Cumbed d,Farms since 1982 According o'the Appirrant,'a°Speedy Way,"` station operated'atahe site pnor.to;their pumas'ari1.d.redevelopment and uI.se'of,the propertyloe a gasoline filling. station dates'to.as.early as 1958,Aas evidenced bya fueLstorage license: The use-of the property as a;gas.station` thus predates the adoption of the Groundwater Protection 'Cwerlay< Districts m 7987. ;The ezisting `site: configuration was:establisled in 198271983 . The multi-tenant`Wilding-to the rear has three,, ' ant.spaces A'LCurn erland:Farms;sign is d splayed:'above-one space,but it appears to be'largelyvacant;_us. perhaps for storage In 3002;the Boar&issued i Conditional Use Special Pemmit to 'Sassy,,:Nails' for 'use;'of<a tenant-space for,::a,manicurist shop.: That use has•since been: abandoned. Cumberladd:Tafms Inc.`is seeking to"deinoUsh;all existing structures:and redevelop"t'li site;with a new:gas station and'mnvenience store To accomplish this;the Applicant has made three Special.Permit requests. The'. A'"licant sou t io`alter:a reexistin �nonconformin 'PP p g g gasoline filling station.use in the Wellhead:;Protiection; Overlay District, a Conditional Use Special Permit forretail:sales;in'the;Highway Business.District,and'a Special Permit for,alteration of.pn�existing nonconforming structures;that do not meet setback'requirements in :the High wayBusiness District: } Procedurall"I Hearing Summary. Special Permit No=201.3.070,a request by Cumberland Farms for Special P6iihii to demolish an existing gasoline fillirig station antl:multi-Tenant building arid.rebuild.a:new 4,426 sgA convenience atore�and, gasoline pumps w'ith..canopy was fled:acthe Town;Clerk's:C►ffice and the Zoning;Board:of App,,eals office on November.8,T 2013 A public heanng before:the Zoning Board of Appeals:Was'.duly advertised and notice sent°to'all abutters, accordance:with. MdL Chapter,40A. The hearing was`opened;:December 11;.2013;'at which time.the Board' found to:,grant the';requests 5ubjed to conditions: Board members ded. ing,`this.appeal;were Craig,;G:.Larson;; rt. Brian Florence Alex M.,Rodolakis William H Newton and GeorgeT.,Zevitas ,. Attorney)ames�Veara represented' he Apphcan8 before the Board f Martin.R.Donoghue fromtoastal Engneering:Company,Inc:.was,.also present. Attu,mey V.eara reviewed the existing site :conditions and bneflj! Tdwn ofBarhstable ZAniagBoa>ad ofAppeals=Derision andNot+ce $pedal Permit No'2013-070: Cumberlaad Firms Preeg+stuig Naacoafoswug Use&Stnutures,C6ndirioaal Use,... presented the proposed new construction. He reviewed•the relief requested,staring with'the alterthe gas station use in the WP Overlay District,explaining,there would be no intensification of;the use,,improveiments.in safety., and stormwater management,and an increase in;impenrious surface area. Ne reviewed the request fora Conditional Use special Permit,noting,approval from the Site Plan Review-,Committee had been received. He: discussed the request for alteration-of pn ex+st+n&nonconforming<structure,noting the improvements to:s'etbacks . along West'Main,Street;the reduced buildng'coverage, add ition"of landscaped areas,and reduction+n:::curb cuts. He stated.the proposal compl*ed'.with the"local'rehensive plan In response to questions:from the Board,the Applicant reviewed the loading areas;and number and location.of parking spaces.. The outdoor seating area'was discus sed;;inciudng concems out(aitering,during hours when= the store is closed and the Applicant agreed to,secure ttie•area with a fence gate or chain: Existing and proposed setbacks were discussed. The Boardnoted that the Applicar►t's.proposal was a substantial'improvement over, existing bonditions. Traffic circulation and curb cuts were.' iewed. Public`commentwas re uested and no•one spoke::,,' Findings of Fad; At the December 11,2013:hearing,the Boardvnanirnously made the following findirigs of fact.for ilppeal 2013; 070; a request by'Cumberland Farms; Inc, to demolish existing•structures and rebuild a convenience store"and: ' °nonconforming gas,statton at 395';Wesf Ma+n Street,Hyannis: 1.: Cumberland Farmsinc.petitioned for a Special.Pem its to completely,demolish an;.existing multi-tenant building,.con .en+enee`.stoi�iosk.canopy and six'fuel dispensers and reconstruct anew 4,426 square foot convenience store;a;canopy°(seduced m area):`and:three fuel dispensers. 2. :The subbed property is:located at 395 Wesf-Main Street,Hyannis,MA as shown on;;Assessor's'tilap 269 as., Parcel`116 It i5+n theHighway Business Zoning District and;INellhead Protection Cwerlay`bistriet 3,. Cumberland Farms,.lnc.+s requestmg Special.Perm+ts`under Sect+orw'44 -93B and 240-94 for alteration of a preexisting nonconfomi+ng use housed+n a preexisting nonconforming structure The Applpnt seeks to'° alter and continue the gasoline,filling station use m the Wellhead Protect ion;'District.. 4.` The proposed alterat+6ns are not substantially more'detr+rrienta)to`the surrounding neighborhood:There will• increase'in hazardous materials or fuel storage,.the number of fuel pumps will be reduced to,ihree,. safety and stormwater,i MOD vemeFOwill be.ma ,and there will beta,decrease in the toial';imperious . surface area.: S. The.proposed:use and-expansiom+s on`;the same Iot;as occupied by ie nonconforming use on the date+a became nonconforming. The'nonconforming!irse is,ma+ntained on Lots 3,•4and 34 as shown on LandyCourt Plan No 11328B:,: 6; The proposed:use+s oat expanded beyond the zoning d+strid+n existence,onahedate rt fiecarne: . nonconforming. T1ie entire parcel has been zoned WP smce.1987: Hi waY Business Distr+d . e A PPicant+s p ro Pos+ ' :ft -25erm7:_ Cumberand Farmsis rquestigaCio fo f ttia C ilsale +n he T l 4 t vemence,store.n anew.426 s con ... A, 8.. The proposed retail use well not substandally:adversely. affect the.pmlik health,safety,welfare;comfort or convenience ofahe community The proposal adequately addresses;parking :access;: and5eap+ng,,and , utfl+t+es and will be substantial+rnprovement'over existing;eond+tions 9 ':Cumberland Farms+s requesting a Special Permm pursuant to 5ect+on,`240=93B for alteration Of preexrsttng nonconforming structures The existing and proposedstru res do not confon�i.to.:front<and "rear yard . setback requirements in ih&HB D+strirx .The proposed setback of the new canopy:and convenience store.are 17 feet'and 22 feet:from Suomi Road;:;regxxpvely: Th'e proposed.rear`f;i ilding'setback+s 6 O feet.; ; 10 The proposed alterations are not sub' irally-more detrimental"to the surrounding neighborhood :The proposal+mpr6ves the'overall:condition of the-site,including appearance; MWest Main Street; number:of curb'cuts,and pervious area and landscaping: 11 A7he Site Pian:Rev+ew Committee approved the proposed development on-December:10,2013 d. .. 7" TTbft?of Bamstable Zoning:Board of Appeals—Decision acid Notice. Special Permit No 2013-060—:Cvmbeslaad:Fauns. :Pteemsting Nanconfomo ng Use&'Strnctuaes,Conduranal:ITse 121..After an evaluation o€.all the evidence:presented,the proposat fulfillsahe'spirit and intent oflhe.Zoning; Ordinance and would not represent a ubstantial detriment to the.publ'ic.good or the neighborhood affected: The proposal:will improve`tfie.appearance of the property,bring the canopy;and pumps_into'greater compliance with setback riequirements on West Main`Street'and add:landscaptng aril other aesthexe functional,and safety improvements: The vote to accept the findings was: AYE:: Craig G:1.a"rson;Brian.Florence,Alex M:Radolakis,W:Iliim H':Nev 6ton,:George T , itas NAY:. None" Decisiom Based-on the findings of:fact, a motion eras duty made`and seconded to grant Special°;Permit;No ZQ13-070ao -Cumberland Farms,;:Inc.subject to:tefollowing conditions. 1. Special;Permit'No.201."70 is granted to Cumberland Farms;Inc.forthe redevelopment of ttie existing.gas station and convenience fore.at 395 West Mai ri Street, Hyannis. ;Relief is granted`as;follows:. a. Special Perrrrits under Sections 240-93B and 240-94 for alteration of a preexisting nonconforming use; housed in;a preexisting nonconforming structure;'to alter..and continue use of a gasolinp filling station:use in`the.Wd.1head'Protecti6n:District. b A Conditional Special,-Permit-'pursuant to 240-25(Q,or retail.:sales'in the Nighwaya3usiness:Distr4t, .•p - nce store: s ecifically the operatjon:bf`a 4,426 square foot;convenie r c. A Special.Pemiit;for alteration of preexisting nonconforming structures,to allow,the setback of the new canopy and conv6n!ence-stdre to;be'l 7.feet and�22 feet from Suomi:Road,..respectively and the:proposes;. rear building setback to be 6.0 fit: . 2. The redevelopment shall be m substantial,compliance'.with the plans entitled'Proposed Site Red eve{opment -Cumberland farms,lnc°drawn and stamped by Coastal Engineering Company,lnc.and dated December` 10,2013,and the building elevations entitled`Cumberland Farms Extenor:Elevations'drawn byAhevato: Architects, Inc.;dated October 7,,2013; 3. . Landscaping shall be installed and mamtained.in s'bstantiaFtonfomr ance with the pEan entitled "Cumber[and Farms, lnc Planting Ptan'drawn and stamped by Hawk Design, lnc 'dated December 9,2013, 4.: 'The redevelopment shall be.inconformance with°all:conditions,-co ntained:irr.the Site Plan.Review Committee's'approyal;letter•dated:December 70,20]`3. 5::: For the purposes of improved pedestrian safety,the s foot concrete sdewaltcon Suomi Road shall.be; extended north:_to"meet the walkw ay,:fin front;of the.buitding sip' sh' be externally illurrrinated.- 'din;corripliance,with the Sign Code as determined by,the Building. .;Commissioner:" .. 7. 'The redevelopment shall be in'aomplance with all Board of;Healtti,;regulations or with any;yarrapce issued;_` by`theBoarii. 8.; The redevetopment'sh'11 be.in`compliance.with;allfjre codes:And requirefnents of the Hyannis..F.ire' De partmenC 9. `The site shall be connected to:sanitary sewer and all necessary permits shall'be obtained from the; Department:of.PublicWorks. 10. The deeasion shall,be:recorded'at the;Bainstable County Registry of Deeds and copies of the record decision shall:be submitted to"the Zoning Board of Appeals:Office and the;Building`Droisron prior fa issuance.of,buildrng or demolition permits..;The ngtts authorized by this special permit must be exercised' r _. wcthin awo y.,ears,unless extended : . 11.;The fenoed-m seating'area on ice easterly srde of the�bwtding`shal1:be closed-off with a gate orcha n,during hours.when tifieatore is ctos 'L 3 TdWn of Batnsta_4'Zoning Bond of Appeals'—Deustaa and Notuoc S eaal P. Pemnit No.2013-070 C=,& ' Fames' Pee�stu►gNo�acossf Use.&`Stni. ,• ,,. . : o�ag . , ,ctures,Caadittonal TJsz The vote was:.. AYE: Craig,G. Larson, Brian Florence,Alex M:Rodofakis,Wil}am H Ney.Fo Barge T Zevrtas NAY: None. Ordered Special Permit No.2013-070 to allow Cumberland Farms;inc.to:comp[etely demo lish'an existing mutt enan# building,convenience store/kiosk canopy and s!x fuel dispensers�and reconstruct a new.4,42b,squareI 't convenience storey a canopy,and three fuel dispensers has been'grant "subiect to conditions This decision -must be recorded atthe Barnstable itegistry of Deeds.f&h:to begin effect`and,notice'of.that recordingsubmitted• , to the.Zoning Board of Appeals CMce .Th"e relig:"t thorized by.this dec sion.must be exercised within iwo years unless extended Appeals:of this decision': any,shall I<e'made pursuanrto.MGL Chapter 40A,:Section;1 T; within twenty{20)days after the of the fil►ng of this deciston;t.a copy.of which must be filed in tF►e.office of the Barnstable Town.CCerk CLN raig G."Larson,'Chair Oate ignedtr- 'W ' I,Ann uirk Clerk of the.7own,of_:Bamstabie Barnstable:.Coun Massachusetts`'hereb"certi tha>rcenty )'Q tY,< , y fY +� days have elapsed since the Zoning Board'of Appeals filed this decision and that no,appeal of the ° ' been filed in the office of the Town`.Clerk:"` Signed and sealed his day of under the pawns and:penalties of perjury,,,, .. .0 ► r.11.�1�:� Ann,Qwrk;:;Town,Clerk Town of Barnstable Assessing Division 367:Main Street,Hyannis Mkbuof' . vvww tovDbarnstablema.as , Office. 508-8b244Z2 J'efferyA.Rudd*,MAAi. FAX: 508-86Tr4922; Diredorof Assessing ABUTTERS LISTCERIVICATION hlovernber 22,2013. RE:. Adjacent Abutters List For Parcels) : 2fi9-1.16 39.5 West Main St - Hyannis, MA 0260'I As requested, I,herebycertify`the.names°and.addresses assubmitted'on the,:: attached sheet(s):;as"required under.,Chapter40A Section 'II of the; Massachusetts General Laws,for the;ab. ye referenced parcels as hey,appear on the most;recent tax Itst with:mailing addresses supplied'... ` Boats of Assessors. Tovm,of Barnstable. Attachment: Zoping Board of Appeals (ZBA) Abutter List Ifor Map Parcel(§): '269116' Parties of irftrest ace dose dicectiy opposite subieet lot on.,any public or prlvate's�treet or:W,ay, and abutters 6o abutters.Notification of all.properties within 300 feet ring i$ttie:•subjecE lot : ('Total Count.-59, CI F Maili Map&Parcel Ownerl Oweer2 Addressi, Address ng 2., Country Deed Cit1'SYdteL'P OUEIE269031 . FAIRH°VE GERTRUDE 7 b27 M 22688/24419 ; OUb 269032 HASSISTANCE CORP. 460 W"MAIN ST. HYANNIS,MA., 12588J335 02601 269033 HOUSING WANNIS,MA 460 W MAIN ST ASSLSTANCE'CORP 02601 269049 NACAR,JANICE E CJO.FORD-BEXLtY, 10 PEM LANE MASHPEE,MAi' 3486/24: �ANICE E 026491 C ARD ARELI ,jOHN WEST L ANC WEST 111HO ARN269050 FTR LDER ABiF 11203REALTYTRUST MA 0ztss .. 26905100A GAGOSIAN, %GAGOSIAN, GAGOSIAN.REALTY 555'HIGH MEDFORD,MA'. 6872/i95; WARREN E. `WARREN E TR TRUST STREET 02155 SORCENELI, 492,0- N GLIS AN. PORTLAND_OR:2690SIODB ST4I9 97213SHAWN D APT 20098/.093, MONAGHAN, 351:N SIERRA` LAS'ANGELFS;. 26905100C BRENDAN 7 8<LTAM 2042A/003, P. BONITAAVE.,#14" CA`90036.:• 398 WEST MAIN,ST HYANNIS,MA`. 26905100D "S,BRENDA'A ' „ 23303/8 _... UNIT.1D 164 BLUEBERRY HILL HYANNIS,MA, 26905100E. MIRANDA,RUI A'. - 15671/042 RD t:• 02601; WEST-: .26905100F SILVA CRLSTLIME, 7 t SIERRA WAY YARMOUTH,MA: 17432/236, 02613: C/O FITZGERA ,. DA sILVA, . . : WEST 26905100E LD 11 SIERRA WAY. YARMOUTH,MA; 1]296%231 •CRISfiANE MAURA. CRISTIANE 02673: 6 C/O HYANNISi HYANNIS,MA 26905100H BURCH,DONALD M 775`WEST MAIN;ST' 3437/191 PACKAGE"STORE. 0201 KARUKAS; 398'w MAIN ST,,. HYANNIS,MA 2690$100I' _ 24512/110 GREGORY Tr uNIT 3A_. 02601;', 398 WEST MAIN`ST HYANNIS,MA^ 26905100J LETSCH;DEAN. 2i224/020 ' sUNIT 3B.0 -. ..:._ BREW 26905100K`' CARVER,LYNN 106 HENRY'S,ROAD - ,24077/300:, STER,MA „ .. ,02631: FOIIYLER,FRANCIS 398 VILEST MAIN'ST HYAhNIS MA' 269,OS1001:° 20892/229 02501 FREEMAN;KENNETH HYANNI5,MA: 26905100M 59 WAt)fUT,Sfi2EET: :235.65[170,' CO 3EANNE..MARIE 02601 26905100N ,LLDYD,PETER A TR ADLi=R RFt1LTY TRUST.' SIASC�NSET BOURNE,MA 26971/296 DRWE ,02%Z DEMORACSKI, 76 PARTRIDGE'" WEST". 269051000 . MARK A&AL3CE LANE SPRINGFIELD, 24176/72, VOGE4. _ . . MA:01089` 398"WEST MAIN'ST HYANNiS MA; 26905100P MCGOWAN,PAtIL M 4D 02fi01_- 10081J164 269p5.t00Q`. CHIRMAN,"JOANIB C/O:DEROSA']OAN B?•=P0'BOX'.1252. HYANNIS,MA; 10985/0i5 0260Y{. BERGERON, http:/L66:203 95 236/arciuLsJagipgeoapp%AbutteiReport.aspx'?type=ZBA: 11/8CZ413 ROBERT&' 4/oSfRGERON, 396'WEST:MAIN : HYANNIS,MA` 269051DOR` -230971137 'HOLBROOK,DENISE ROBERT: ST `UNFf'SB, GLOVER,WILLIAM R 1555 ORLFAPLS; EAST HARWICH,; 26905100S - 23886J176 III ROAD `: MA 02645.: FAULKNER, 398,WEST MAIN ST HYANNIS,MA 26905100T .. 12455/278 PATRICIA. UNTr 5D; 02601 GRIFhTfH;:RICHARD COUNTRY GARDEN 153 HOIJ.IDGE HILL. MARSTONS, 269052 MILLS,;MA, 466WJ145 W]R TRS REALTY TRUST' ME 02648 FOWLER 7AME.S:A 46FOWLER,]AMES A '`358"WEST MAIN_ : HYANNIS,MA .269053 STREET 02601 _ 13785/134 1R&GERALDINE:A., III,&i c*RLES W VALENTINE, RGO 23WOODLAND MA HYANN]S,, 269054 MA 23353/148 ` E :.AVENUE' . 02601 ASACK,]OSEPH,G& C/O KHOURIS HYANNIS,MA 369097 KHOURI,MARION. . '. 347 WEST MAIN ST 11438%253 TRS ORIENTAL RUG CO.' 02601 ' KOPPEN RICHARD-L 365 Wl3T MAIN' - HYANNIS,'MA 269098 , 13713%271 ESTATE OF STREET 02601'. ' 269099 DIPRErE,HENRY_:A 2022 MICANOPY:; "NOKOMIS;FL C103355 &ANNE;I 7RAIt.: ° 34275r. BUTLER,KAREN L B' MISAIQ REALTY 379 WEST MAIN ST HYANNIS;MA'. 26910000A EORDEKIAN, 22838/225 :' WENt)Y.LTRS TRUST , UNIr.1' 02601 379WESTMAIN.`. HYANNLS 269100008 KIEFFER,SCOTr L ' *84/157 5r-;UNIT=:2, 02601 379 WEST MAIN'`,' HYANNIS,MA 26910060C' ' KIEFFE 02601"R SCOTT L 18864/157 _ . ' �MARSTONS � <: 26910009D ANDREENKO.ZLHTA. : '155 SPUR LANE MILLS,-.MA.' 02648` " HYORA THEODORE HYANNIS;MA 269101 P, 20 SUOMIRD- _ 0260L' C159952 ]ATOM,70HN;R& `166 REDBERRY ONS 269102ILLS,'MA; C194730 HEATHER LANE.w •02648`. .. ,. ALARIO,ROBERT C CALVIN SOMERO R E; NEW IPSWICH;, 269103. &SPINELL I KAREN` 53 WHEELER ROAD Ci99248 IRREV TRUSY NH 03071 ALARIO,ROBERT C CALVIN SOMERO R ; NEW IPSWICH;; 269104• &SPINELLI,`KAREN . 53 WHEELER ROAD C199248 TRS,: IRREV TRUST NH 03071 LEMMER,. HYANNIS,MA. - 269105 CHRISTOPHER& SO SUOMI RD CI71051- , MONIQUE 02601 WEIPITRAUB. 8 RUE HE 269106, 75020,PARIS FRANGE, C181700 LOUI$E A POINCARE• HYANNIS 269115. FERGUSON; 4f SUt)MI ROAD., , C1774fi4. ELIZABETH CUMBERLAND'? 100 CROSSING FRAMINGHAM,: 269116 4044i692 BLVD,"V0742 MA 01702 GDODWIN ROBERT,MURKY'WATER HYANNIS,MA ; 269117 ,.. PO BOX 977 EALTY'tRUST 24930/114, H TR :;' :,R : 026U1 CALLAHAN,, %RAF REAL ESTATE STONEHAM,:MA` C188053 269118 4 VI'RGINIA LANE. RICHARD PTR•: cENTERPRLSES,LLC 02180`; -- EMERALD SERVICES' HYANNIS,MA 269119, 433 WEST.MAIN Sr C159f39 269120 433 WEST MAIN HYANN C1 IS,MA' ' ST' 699D6 STREET LLC ,433 WEST MAIN; 02601 httpJ/66 203 95:236/azcuns/appgeoapp/AbutterReport.aspx?type=ZBA l l/8% 013 w ; ravuuccu t, ;Page 3 of PHU.TAI THO& `IiYANNIS,MA . 269128 51 SHADY.LN ,C107388 HONG DU Q2601- 269129001 EVANS,IM M %zuBOV,UM& <67 KENWOOD .;: 'BROOKuxE,MA' ,c1728S4 DMITRIY'. STREET 02446`1 NOTHACKER;_ :6.326 NORTH PHILAD,ELPHIA, *- 269129002' RAINER E&PAMELA C188608 H FAIRHILL STREET PA 19126 CELESTE AND SONS' HYANNIS MA 269130; CELESTE,ALTR 60 SHADY LANE, ` C108546 REALTY TR 02601 GOLLIFF,SHAUtU►L HYANNIS,MA. 269131 54 SHADY'LANE: C167163 &MARCY LYNN,. 02601: HOLMES,LLNDA, BUFFALO,NY' 269132001 rv;144 HAMLIN RD. C15Q026 . RUSSELL. 14208 `. .http//06 201: 5 36/- bluaPpgeoapplAbutterReport.aspx?type=ZBA; 11/8/2013'_ Page 4"of:4: Z09132003 -GA4j .JOSEPH G. HYANtUS lR PO BOX,613' r 1 o2so Clti7229' 269,155. ScmvO,.WIi LmM „ "'W..SHADY LANE YANNtS,MA; . - C115545, 0260f; 2691S6 COSTA,'CWLYN C 45 SHADY LA. HYANNLS,MA; C160239,. 02601.. 269181 CAWAREW1:30HN WE$T.MAIIVSTNOM F TR ; R ST, 111 HOLDER LN BARNSTABtF, 915$J212 MA 02668, 269196 CLASSIC CAR , AS W MAIN, HYANN SERVICES INC MA J. , STitEFT IS,. C1"62529: 02601 269197 GOODWIN;ROB MURKY WATER . H JR-TR REALTY TRUE PO BOX.97Z "HYANNLS,MA C193472` . 02601. This Est bf!itself does NOT,constitute a certifr�Gst of abuftm and is.provided ony as an aid to the detemanatfon'ofabutters tf a. certified Gat of abutters is required,Pon fact me Assessing.Dlvision to have Uiis flat cer6Qed.the owner and addn.ss`data on this iist'is!{om the Tam of BamstWe Assessors database as of'11/8/ZD1$°: r. t 1 http203.95 236larciulsJappgeoagp/AbutterReportaspx?type=ZBA 11/8/2013 �ISO.7 24 cc) all m FONTIAC Sr p t >o Fi iQ a\ a WOODLAND� Rl fli � \ 1♦,♦ A ���; �fQ �!1'.. t ; rr `�ZiL-♦♦ ♦�\` rlivrf :J, Gp.�. \.. r ` l i r I , St �`. 5:1`3.ti\1�.4;`(2;•r,• A v\.\,., •'' 7.\;tir ^..1\t� \ .k ` .• p= , , e r.r \ aW�h�•�!`v♦�:': .y�t�rS� ,\'\\ , �Ys� lC'•.1..� �tir7n r Sk .,� p XW \ �a\\s S \�i; \ =zS �'r\Ft�' r cc 71`' `�a'v `A\ e �{ �,b . .`L.. \\tip \ .�'} irx ti�iM vRta,.�C 1\in•�,�f' m �'�,p' ,Tr}. •. '? 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I,:.W-c - 92, N .:.:\ \ 1 �v♦ �\\\. �a\ ♦ v v 1'••v ♦ •i `.Cy�:y \} V� ,[�V V y� .� ♦\ nbyh fD r.\� r n�.,h� v v♦♦ r Y •.av♦�J,,\• tr `e; n . .. ��...��' -25� f -��s "`h. :4 ` t�ti''fi \: •S.C� ♦data_ `\•''�:\ ♦\\ \ � `ZZ�\" ♦ '.�, .. ge, � _ Ok �S r J Y ♦ :\ti;.t:';i:'F �M7 \ �` � ?Srx•�e v 7.i ��♦ � ♦h�� •� t o�'�•6, _ {{�V .� `'g W J vh,•.\\� '"1?Yd � t't �T`'��?\�'� CCF,r, \\�\\y ••♦� �"'��>,.•••,'`,c {�.�m 'S P), p`•f�� ' �ey`p�'�♦ •.,1�n ,: .��,•}♦1\vv: ,♦^f�c 4a•, �Z�T '..R1 N.. � ��.O.ise• I E ,� :�# 'Ft7"'���`.r \�(v t� \:S\,ti�,a\j,.•`e" \,;♦ •:Tip}\.a��\ � - i! e e mSe o .,`ti. � \ ;�\� ♦ vt�'K•x\'\fir\' • ::'� ''' m g s°��(y�o 73 1 gm mlb , ik c # ggeag` E ;� a� STRp/GN1'fNAY Roma, Paul To: mbrook@bohlereng.com Subject: cumberland farms/w. main st. Hi.-Matt, Let's;keep this proposal as simple as it is.The information supplied is perfectly adequate for the project. Thanks,., Paul 4 . jV �. TM 352 Turnpike Road 0H L E Southborough, MA 0HONE PHONE E N G I N E E R I N G FAX 508.480.9080 June 2,2017 Town of Barnstable Building Department 200 Main Street Hyannis,MA.02601 Attn: Paul Roma, Re: Cumberland Farms West Main Street Dear. Mr. Roma, r `� Enclosed, please find two drawings detailing a proposed "air tower" (air machine for tires)..I recently spoke with someone in your office about adding this to the Cumberland Farms at�95 West``MairiEffl Street,,and I was advised to send these drawings to your attention, either for sign-off or to determme-'if W additional information is required. The included SK drawings show the proposed location of the air-�towemr_ on the existing site,as well as details of the air tower itself. Since many customers have been requesting. the air machine at this particular,store, we are hoping this can be added with your approval of same. Once you have had a chance to review, please feel free to call me at(508)480-9900 or you can email me . at mbrook@bohlereng.com. Sincerely, BOHLER ENGINEERING Matt Brook CIVIL AND CONSULTING ENGINEERS• PROJECT MANAGERS• SURVEYORS• ENVIRONMENTAL CONSULTANTS• LANDSCAPE ARCHITECTS Serving the East Coast • www.BohlerEngineering.com PLAN REFERENCES: DATUM NOTE: o z ASSESSORS MAP 269, PARCEL 116 ELEVATIONS SHOWN HEREON � ARE BASED ON THE NORTH LAND COURT PLAN 11328-8 AMERICAN VERTICAL DATUM 1988 (NAVD 1988) v� ZONING DISTRICT: HB WEST OVERLAY DISTRICT: WP (WELLHEAD PROTECTION) LEGEND MAIN ST k AS BUILT PLAN FOR 395 WEST MAIN STREET SUOMI BARNSTABLE (HYANNIS), MA EXISTING PREPARED FOR: CUMBERLAND FARMS, INC. PREPARED BY.-COASTAL ENGINEERING CO., INC. ® CATCH BASIN DATE: DECEMBER 16, 2016 — —10— — CONTOUR :!�A LOCUS LIGHTPOST KEY MAP BARNSTABLE, MA UTILITY NOTE VGG VERTICAL GRANITE CURB LOCATION OF WATER, SEWER, TELEPHONE, ELECTRIC, AND GAS LINES ARE APPROXIMATE AND FOR PROpRY Ll REFERENCE ONLY. CONTRACTOR SHALL SITE AND FOLLOW ALL ALL DIG SAFE MARKINGS. CONTRACTOR _\ SHALL NOTIFY DIGSAFE (1-888-344-7233) AND U ALL UTILITIES PRIOR TO EXCAVATION. PROPOSED ELECTRIC SERVICE (TO BE INSTALLED IN 1 \ /ACCORDANCE W///MA ELECTRIC CODE)/ / \ CONVENIENCE STORE a P� \' \ TIMBER (CUMBERLAND FARMS) RET. WALL 41415t S.F. aP EDGE OF PAVEMENT \ REMOVE VGC AND INSTALL 1 % CONCRETE SLAB FLUSH WITH/ I _ EXISTING STING PAVEMENT GRADE / I i PROPOSED FINISHED FLOOR , a UNDERGROUND EL.=39.5t VENT PIPE ' CURB I PROP SED AIR TOWER `�) I PROPOSED 'f . R P ° �� �.._ .� / " `�CONCRETE © I SLAB F0 0j EXISTING �i BUILDING i A / AREA �\ °O. ° �_ _ ® � f PROPOSED -- — -- I) 26,737 S.F.f ---- j.�L _ .._ BOLLARD (0.61 AC.t) ®... .. ®� \ .Iui j Z EXI NG<� . CONCRETE PAD \\� PROPOSED ui PLAN PARKING STRI IS l as i I ui PAINTED WHITE \ ' ®CAL` ® 1 o STRIPING SCALE: 1 — 20 UNDERGROUND (� -----�•-- FUEL LINES I ® i DRAWN BY:MJB Coastal Engineering Co.,Inc. c 2017 (TYP.) I� C17871.00.dwg COASTAL CUMBERLAND FARMS, INC. SHEET NO. PROJECT NO. C17871.00 engineering co. SKETCH PLAN SHOWING SKC-1 SCALE AS NOTED 260 Cranberry Hwy.Orleans.MA 02553 PROPOSED AIR TOWER DATE 508.255.65U P 508.255.6700 F 395 WEST MAIN ST. BARNSTABLE(HYANNIS),MA 05-30-2017 CFI AIR MACHINE DETAIL NOT TO SCALE WHITE PVC BOLLARD COVER v 9 d PROPOSED 6" W. 6" DIA. STEEL BOLLARD ° o VERTICAL CURB FILLED W/CONCRETE d d v EXISTING AIR MACHINE BASE SIKAFLEX 1C SL d VERTICAL (Excel Tire Gauge, (SELF— LEVELING) GRANITE CURB Model: SC09) CAULKING OR EQUAL o d 4'-0" 1" FILLER ROPE d o 2'-0" 2'-0" BACKER ROD a d CONC. SIDEWALK y d Q � ELECTRICAL---___r.' . d s ° d ° o CONDUIT FLUSH ° a° CL ° 4 ° o o � CONCRETE 4 a a 4 (3) 8" DIA. 8" PVC SLEEVE c ' d CONCRETE FILLED a PROPOSED 6" W. SAND ti BOLLARDS. VERTICAL CURB '0 d SEE DETAILS FOR MORE INFO. EXIST. 6" W. CONCRETE 4' VERTICAL CURB DETAIL A PROPOSED PAINTED WHITE STRIPING AI R PLAN VIEW O 6" W. VERTICAL CURB, SEE VERTICAL GRANITE WHITE PVC BOLLARD COVER W/ GREEN CURB DETAIL FOR (PMS #376) REFLECTOR TAPE 4" CONCRETE CL MORE INFO. (SUPPLIED BY C.F.I.) ® TOP, PAD ATTACHED TO PIPE WITH SILICONE ADHESIVE. BOLLARDS SHALL BE PLACED AS SHOWN ON PLAN �00 r� b ✓p. GREEN 'REFLECTOR TAPE A 2'-0' 2'-0" CONC. PAC 4"-0' BOLLARD COVER FRONT ELEVATION VIEW DRAWN BY:MJB Coastal Engineering Co.,Inc.@ 2017 C17871.00.dwg COASTAL CUMBERLAND FARMS, INC. SHEET NO. PROJECT NO. C17871.00 engineering co. SKETCH PLAN SHOWING SKC-2 SCALE AS NOTED Mw� MA CM9 PROPOSED AIR TOWER DETAILS 508255.65ll P 508.255.6700 F DATE 395 WEST MAIN ST. BARNSTABLE(HYANNIS),MA 05-30-2017 f Town of Barnstable DIME Regulatory Services do Richard V. Scali,Director STAB Building Division BARNSTABLE BAMswesr •cFmrani:t•mwr.xruuis MA93 -. nwsc¢rus.psmnue•w�rerxv.�� - 16 39. Paul Roma, 1639_2014 • ♦ a '°rEo +A Building Commissioner - '200 Main Street, Hyannis,MA 02601 - _..._. www.town.barnstable.mams January 23, 2017 -- — •—= ----- -- — To Whom It May Concern: Please be informed that the Town of-Barnstable has no further,interest in the street permit bond/policy#106337107 for the property'located at 395 West Main Street, Hyannis. Sincerely, Debi Barrows ` Office Manager . 4 F A R W S January 18, 2017 ti ATTN: Debbie Barrows _ Town of Barnstable Building Division ? .200 Main Street Hyannis;MA 02601 RE: CUMBERLAND FARMS #V0990/2326/2142 ; 395 West Main Street Hyannis,MA 02601 Dear Ms: Barrows; In reference to the above-mentioned location,please be advised that all outstanding construction items have been completed. Therefore, we would like to request the release'of performance bond#106337107 in the amount of$1,272.80.4 have attached a copy of the bond here for your reference. This bond was submitted at the time that we submitted for the building permit for the Raze& Rebuild project. Please let me know if there:is anything else needed in order'to have this released. Please send the original bond back to my:attention at the address below. Thank you for your assistance in this matter. Sincerely yours, CUMBERLAND FARMS; INC. Leah Crisostamo. Senior Project Coordinator,Construction&Planning 165 Flanders Rd. Curnb&, Ad Westborough, MA 01581. Phone: 508-270-1429' - - Page 1 of 1 CUMBERLAND FARMS,:INC. 165 FLANDERS ROAD,WESTBOROUGH,MA:01581 AM TRAVELERSJ BOND (License or Permit -Deffnite Tenn) Bond No. 10633'm KNOW ALL MEN BY THESE PRESENTS: THAT WE, Cumberland Farms.Inc- as Principal, and Travelers cask„and Surety Company ofAmeriea a corporation duly incorporated under the laws of the State of Connecticut and authorized to do business_ in the state of MWIA.setts _ as Surety, are held and firmly bound unto Town of narnstable , as Obligee, in the penal sum of One Tbansaed Two Hm'adred Seamy-Twn and Nym f 51.272M ). Dollars, for the payment of which we hereby bind ourselves, our heirs, executors and administrators, jointly and severally, firmly by these presents. , WHEREAS, the Principal has obtained or is about to obtain a license or permit for Raze&ItebWN Prolect at 30 West Male Street'Hyannis,MA as at forth In 4e mans by Mmto Arebite0&Coastal Znalwaep*ftm Inc NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION ARE SUCH, that if the Principal shall faithfully comply with all applicable laws, statutes, ordinances, rules or regulations, pertaining to the license or permit issued, then this obligation shall be null and .void; otherwise to'rernain' in full force and effect. This bond is for a definite term beginning imois , and ending 3/13M17 and may be continued at the option of the Surety by Continuation,Certificate: PROVIDED, that regardless of the number of years this bond is in force, the Surety shall not be liable - hereunder for a larger amount, in the aggregate, than the penal sum listed above. PROVIDED FURTHER,-that the:Surety may terminate its liability hereunder as to future acts of the Principal at any time by giving thirty (30)days written notice of such termination to the Obligee. SIGNED, SEALED AND DATED'this 1218n015 Cumberland Fatom Inc. . . a Ma G: Howard, Secretary� Principal, _Travelers and jM Cam ofAmeilen ime l Attorney-in-Fact `. Project Name_: Hyannis. MA R&R Project No. V0990J2326/2142 + ` S2151B(6110) WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER TRAVELERS,J� POWER of AMRNEY Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Su ety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company �y 1.91 Attorney-In Fact No. 23(XM4 Certificate No. 006521215 KNOW ALL MEN BY TEIESE PRESENTS:That Farmington Casualty Company,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the. laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Mark P.Herendeen,Kevin A.White,lem Correia.Maria Chaves,Themsan E.Rowedder,Jane Gilson,Bryan Huft,and Gregory].Steele of the Cityof Boston Massachusetts ,State of ,their true and lawful Attorneys)-in-Fad, each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,tecognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies in their business of guaranteeing the fidelity of persons;guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitted in any actions or proceedings allowed by law. if 15th IN WIT OI ff WfREOF,the CompI61 have caused this instrument to be signed and tlicir corporate seals to be hereto affixed,this cto5 day of t Farmington Casualty Company y 'r`� w,, St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company . Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul.Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company 4w- �Y�GS State of Connecticut By City of Hartford ss. - Robert L.Raney,rentar Vice President T 2015 On this the 15th day of October ,before me personally appeared Robert L.Raney,who acknowledged himself to be the Senior Vice President of Farmington Casualty Company, Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,and that be,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by signing on behalf of the corporations by himself as a duly authorized officer. In Witness Whereof,I hereunto set my hand and official seal. * �+ - C . My Commission expires the 30th day of June,2016. L�6 Marie C.'tetreault,Notary Public 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVALID WrrHOUT THE RED BORDER R WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER This Power of Attomey is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: e�P� RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional and of said officers or the Board of Directors at time may remove an such appointee and revoke the undertaking,and any any Y Y �� power given him or her,and it is FURTEUM RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature_of a bond:recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority;and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President, any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the future with respect to any bond or understanding to which it is attached. I,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companies;'which ism'foil force and effect and has not been revoked. x,�` , IN TESTIMONY WHEREOF,I have hereunto set my hand and affixed the seals of said Companies this day of_ C�:G�f� � 20 L� All 45. • .' - c -" Kevin E.Hughes,Assistant SeAtary �0 0 - To verify the authenticity of this Power of Auorney,call 1-800-421-3880 or contact us at www.travelersbondmin.Please refer to the Attomey-In-Fact number,the above-named individuals and the details of the bond to which the power is attached. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUTTHE RED BORDER _ „ ... . . Town of Barnstable a Building Department-200 Main Street OrEONAM tee Hyannis, MA 02601 .` Tel._(508) 862-4038 Certificate -Of Occupancy Permit Number, B-16-1496 CO Issue Date:: :12/28L2016 Parcel ID: 269-116 Zoning Classification: HB Location: 395 WEST MAIN STREET, Proposed Use: HYANNIS - Gen Contractor: WAYNE J SILVIA Permit Type: Commercial - Business Comments: Building Official Date: COAST L engineering co. - December 27, 2016 C17871.00 r r x Paul Roma Town of Barnstable Building Commissioner Building Division 200 Main Street Hyannis, MA 02601 ' RE: Cumberland Farms21Z- 395 West Main Street Hyannis,MA j { Dear Mr. Roma: UZI } As stated in our letter dated December 16, 2016,,Coastal Engineering Co.,"Inc. performed periodic inspections,of the site work at the above referenced property throughout the project and found the site work construction to be in substantial compliance with the approved plans.The post-construction site conditions are shown on an"As- Built Plan" dated 12-16-16, which I understand was submitted to.you with the letter. Please do not.hesitate to contact.me if you`should have any questions or require additional information.- Very truly yours, 4� �JV1 OFJf4s9cti s COASTAL ENGINEERING CO.;,INC. DAVId J. cN o MICHNIEWICZ CIVIL , �. 31 9 David J. MlchniewIcz,.P "� _oN N�'�� Principal-in-Charge - DJM.-.. - ccs Aaron Amara, Cumberland.Farms,,Inc. Tarja McGrail,Coastal Engineering Co., Inc. D:\DOC1C17800\17871\Correspondencet2016-12 27 CO Letterdoc .::Orleans I Sandwich 1 Nantucket .- T a_ ,3. —.r��° iCOASTAL engineering co December 16, 2016 C17871.00 Paul Roma Town of Barnstable Building Commissioner Building Division 200 Main Street Hyannis, MA 02601 RE: Application for Certificate of Occupancy t Cumberland Farms, Inc. 395 West Main Street' Hyannis, MA _ Dear Mr. Roma: : r Attached please find two (2) copies of the existing conditions"As- Built plan showing the site of the redeveloped Cumberland Farms store at 395 West Main Street, During construction, Coastal Engineering performed periodic inspections of the site work construction:and has found the work completed to be in substantial compliance with the approved plans. Please contact me if you should have any questions or require additional information. - k } COASTAL ENGINEERING CO., INC. I X Tarja L. McGrail, P.E. . TLMAvp Enclosures: as stated `' cc: Aaron Amara, CF, by email x Joseph Apruzzese, D.F. Prays D-\DOC\C17800\17871\Correspondence\CO Ur 2016-12-16•doc .n Orleans t 5atidiAch ttNantuekek 3 � r Final Construction Control Document w To be submitted at completion of construction by a R Registered Design Professional ,c for work per the 8th edition of the SYe Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Cumberland Farms Date:12/08/2016. Permit No. Property Address: 395 West Main St.Hyannis,MA 02601 Project: Check(x)one or both as applicable: X New construction Existing Construction Project description:.New 4380 SF mercantile building I Alexander Ryazanov MA Registration Number: 42758, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans computations andspecifications concerning: Architectural Structural Mechanical Fire Protection X Electrical&FA Other:Describe for the above named project. I,or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge,information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents.. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the a construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or electronic signature and seal: E7GAA DER L. RYAe'.AQI 17r L �+ T Phone number: 617-577-9900 Email: aryazanov@syska.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 i Final Construction Control Document u To be submitted at completion of construction by a Registered Design Professional Je�ed for work per the 811,edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Cumberland Farms Date:12/08/2016 Permit No. Property Address: 395 West Main St.Hyannis,MA 02601 Project: Check(x)one or both as applicable: X New construction Existing Construction Project description:New 4380 SF mercantile building I Myles Vance,MA Registration Number: 51278,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Architectural Structural • X Mechanical Fire Protection Electrical&FA X Other: Plumbing for the above named project. I,or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis.To the best of my knowledge,information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or electronic signature and seal: Of 44 ti Phone number: 617-577-9900 Email: mvance@syska.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 I Final Construction Control. Document To be submitted at completion of construction by a Registered Design Professional ems' for work per the 86' edition of the JO J Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Cumberland Farms Retail Building(Excludes Gas Canopy)' Date:12/13/16 Permit No. Property Address: 395 West Main Street,Hyannis,MA 02601 Project: Check(x)one or both as applicable:X New construction Existing Construction Project description:New 4,380 SF, single story building,Mercantle Occupancy,Construction Type 5B, slab on grade, Non-sprinklered 1,James Owens,AIA,NCARB,MA Registration Number: 20329 Expiration date: 08/31/17 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: X Architectural Structural Mechanical Fire Protection Electrical Other: Describe for the above named project. I,or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis..To the best of my knowledge, information, and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: , 1. Have reviewed, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. ED Aqc Enter in the space to the right a"wet"or �,� �5 01y����O electronic signature and seal: o. 3 BOSTON , MA G Of µ ASSP Digitally signed by James Owens,AIA,NCARB Phone number: 508-528-0770 Email:james.owens@hfa-ae.com Date:2016.12.1314:41:58-05'00' Building Official Use Only. Building Official Name: Permit No.: Date: Version 06_11_2013 Final Construction Control Document To be submitted at completion of construction by a Registered Design Professional for work per the 8th edition of the' Y Massachusetts State Building Code, 780 CMR, Section 107.6.4 Project Title:Cumberland Farms Date:November 16,2016 Property Address: 396 West Main Street, Hyannis,MA 02601 Project: Check(x)one or both as applicable:X New construction Existing Construction Project description: New single story,wood frame,slab on grade,Type 513 construction; mercantile occupancy. I Robert R. Chartrand MA Registration Number:32109 Expiration date:0613612018,am a registered design professional, and I hereby certify,to the best of my knowledge,information and belief, that 1 have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Entire Project Architectural X Structural Mechanical Fire Protection Electrical Other: for the above named project.I certify that 1,or my designee,have performed the necessary professional services,in accordance with the Professional Standard of Care,and was present at the construction site on a regular and periodic basis to determine that the work proceeded in accordance with the requirements of 780 CMR and the design documents prepared by me and approved as part of the building permit and the I or my designee: 1. Have reviewed,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents.. Such review shall not diminish or relieve the Contractor of its submittal and other responsibilities. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. The Contractor is responsible for performing the work in accordance with the contract documents and shall be exclusively responsible for its construction means,methods,sequences and procedures,and for construction .safety. tiZN b 41 Enter in the space to the right a"wet"or electronic signature and seal: Rt3ERT R'., s CHARTRAND r" Digitally i reed-byP Ab6rl Chartrand STRUCTU.fl€L � Com I b� . n com tty w l V� No.3Z109 Da 2016.1.1.16 13:19:57-05'00' o IS T-s Phone number:508 384-0163 Email bob@rreengineering.com. �SSfQNAIL�N� Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. RRC Engineering,LLC 60 Man Mar Drive Unit 2 Plainville.itilA 02762 tel 508 384 0163 rrc:engineering.com on z Electrical Contractors Inc. 752 Bark Street Swansea, MA 02777 The fire alarm at the new Cumberland Farms ( 395 W. Main St., Hyannis )was installed by John A. Moniz Electrical Contractors Inc. in accordance to the NFPA 72 National Fire Alarm and Signaling Code. red Moniz i I .A, *Poniz Electrical Contractors Inc. 752 Bark Street Swansea, MA 02777 Cumberland Farms 395 W. Main St. Hyannis, MA Fire Alarm Points List 1. Duct Smoke—RTU #1 Shutdown 2. Duct Smoke—RTU #2 Shutdown 3. Pull Station Side Entrance 4. Smoke Detector Side Entrance 5. Smoke Detector Retail Sales 6. Pull Station Front Entrance 7. Smoke Detector Retail Sales 8. Smoke Detector Retail Sales 9. Smoke Detector Retail Sales 10. Smoke Detector Cooler Access 11. Pull Station Rear Door 12. Smoke Detector Corridor 13. Smoke Detector Men's Restroom 14. Smoke Detector Woman's Restroom 15. Smoke Detector Receiving 16. Smoke Detector F.A.C.P 17. Smoke Detector Alcove 18. Smoke Detector Outside Managers Office 19. Smoke Detector Managers Office 20. Heat Detector Attic 21. Heat Detector Attic 22. Heat Detector Attic 23. Pressure Switch Suppression 24. Pump Shutdown f FIRE ALARM AND EMERGENCY COMMUNICATION SYSTEM RECORD OF COMPLETION To be completed by the system installation contractor at the time of system acceptance and approval. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets,data,or calculations as necessary to provide a complete record. 1. PROPERTY INFORMATION Name of property: CUMBERLAND FARMS Address: HYANNIS,MA Description of property: RETAIL Occupancy type: Name of property representative: Address: Phone: Fax: E-mail: Authority having jurisdiction over this property: HYANNIS/BARNSTABLE FD Phone: Fax: E-mail: 2. INSTALLATION, SERVICE,AND TESTING CONTRACTOR INFORMATION Installation contractor for this equipment: JOHN A.MONIZ ELECTRICAL Address: 752 BARK STREET,SWANSEA,MA License or certification number: Al663 Phone: 508-324-9669 Fax: E-mail: john@monizelectrical,com Service organization for this equipment: Address: License or certification number: Phone: Fax: E-mail: A contract for test and inspection in accordance with NFPA standards is in effect as of: Contracted testing company: Address: Phone: Fax: E-mail: Contract expires: Contract number: Frequency of routine inspections: 3. DESCRIPTION OF SYSTEM OR SERVICE ®Fire alarm system(nonvoice) ❑Fire alarm with in-building fire emergency voice alarm communication system(EVACS) ❑Mass notification system(MNS) ❑Combination system,with the following components: ❑Fire alarm ❑EVACS ❑MNS ❑Two-way,in-building,emergency communication system ❑Other(specify): NFPA 72, Fig. 10.18,2.1.1 (p. 1 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. f — 3. DESCRIPTION OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2010 Additional description of system(s): 3.1 Control Unit Manufacturer: FIRELITE Model number: MS92000DLS 3.2 Mass Notification System ®This system does not incorporate an MNS 3.2.1 System Type: ❑In-building MNS—combination ❑In-building MNS—stand-alone ❑Wide-area MNS ❑Distributed recipient MNS ❑Other(specify): 3.2.2 System Features: ❑Combination fire alarm/MNS ❑MNS autonomous control unit ❑Wide-area MNS to regional national alerting interface ❑Local operating console(LOC) ❑Direct recipient MNS(DRMNS) ❑Wide-area MNS to DRMNS interface ❑Wide-area MNS to high-power speaker array(HPSA)interface ❑In-building MNS to wide-area MNS interface ❑Other(specify): 3.3 System Documentation ®An owner's manual,a copy of the manufacturer's instructions,a written sequence of operation,and a copy of the numbered record drawings are stored on site. Location: AT SITE WITH OWNER 3.4 System Software ❑This system does not have alterable site-specific software. Operating system(executive)software revision level: 4.0 Site-specific software revision date: 12/16/16 — _ — _ Revision completed by: GARY J.EMOND SET ❑A copy of the site-specific software is stored on site. Location: 3.5 Off-Premises Signal Transmission ❑This system does not have off-premises transmission. Name of organization receiving alarm signals with phone numbers: Alarm: Phone: Supervisory: Phone: Trouble: Phone: Entity to which alarms are retransmitted: Phone: Method of retransmission: UL LISTED CENTRAL STATION VIA INTERNAL DACT If Chapter 26,specify the means of transmission from the protected premises to the supervising station: DACT If Chapter 27,specify the type of auxiliary alarm system: ❑Local energy ❑Shunt ❑Wired ❑Wireless NFPA 72, Fig. 10.18.2.1.1 (p. 2 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 4. CIRCUITS.AND PATHWAYS 4.1 Signaling Line Pathways 4.1.1 Pathways Class Designations and Survivability Pathways class: A Survivability level: 0 _ Quantity: 1 (See NFPA 72,Sections 12.3 and 12.4) 4.1.2 Pathways Utilizing Two or More Media Quantity: Description: 4.1.3 Device Power Pathways ®No separate power pathways from the signaling line pathway ❑Power pathways are separate but of the same pathway classification as the signaling line pathway ❑Power pathways are separate and different classification from the signaling line pathway 4.1.4 Isolation Modules Quantity: 0 4.2 Alarm Initiating Device Pathways 4.2.1 Pathways Class Designations and Survivability Pathways class: Survivability level: _ Quantity: (See NFPA 72,Sections 12.3 and 12.4) 4.2.2 Pathways Utilizing Two or More Media Quantity: Description: _ 4.2.3 Device Power Pathways ®No separate power pathways from the initiating device pathway ❑Power pathways are separate but of the same pathway classification as the initiating device pathway ❑Power pathways are separate and different classification from the initiating device pathway 4.3 Non-Voice Audible System Pathways 4.3.1 Pathways Class Designations and Survivability Pathways class: A Survivability level: 0 Quantity: 2 (See NFPA 72,Sections 12.3 and 12.4) -— --- ------ - —----------- 4.3.2 Pathways Utilizing Two or More Media Quantity: _ Description: 4.3.3 Appliance Power Pathways ®No separate power pathways from the notification appliance pathway ❑Power pathways are separate but of the same pathway classification as the notification appliance pathway ❑Power pathways are separate and different classification from the notification appliance pathway NFPA 72, Fig. 10.18.2.1.1 (p. 3 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 5. ALARM INITIATING DEVICES 5.1 Manual Initiating Devices 5.1.1 Manual Fire Alarm Boxes ❑This system does not have manual fire alarm boxes. Type and number of devices: Addressable: 3 Conventional: Coded: Transmitter: Other(specify): 5.1.2 Other Alarm Boxes ®This system does not have other alarm boxes. Description: Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other(specify): 5.2 Automatic Initiating Devices 5.2.1 Smoke Detectors ❑This system does not have smoke detectors. Type and number of devices: Addressable: 8 Conventional: Other(specify): _ Type of coverage: ®Complete area ❑Partial area ❑Nonrequired partial area Other(specify): Type of smoke detector sensing technology: ❑Ionization ®Photoelectric ❑Multicriteria ❑Aspirating ❑Beam Other(specify): - — ----- -- - - 5.2.2 Duct Smoke Detectors ®This system does not have alarm-causing duct smoke detectors. Type and number of devices: Addressable: Conventional: Other(specify): Type of coverage: Type of smoke detector sensing technology: ❑Ionization ®Photoelectric ❑Aspirating . ❑Beam 5.2.3 Radiant Energy(Flame)Detectors ®This system does not have radiant energy detectors. Type and number of devices: Addressable: Conventional: Other(specify): Type of coverage: 5.2.4 Gas Detectors ®This system does not have gas detectors. Type of detector(s): Number of devices: Addressable: Conventional: Type of coverage: 5.2.5 Heat Detectors ❑This system does not have heat detectors. Type and number of devices: Addressable: 6 Conventional: 0 Type of coverage: ®Complete area ❑Partial area ❑Nonrequired partial area ❑Linear ®Spot Type of heat detector sensing technology: ®Fixed temperature ❑Rate-of-rise ❑Rate compensated NFPA 72, Fig. 10.18.2.1.1 (p.4 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 5. ALARM INITIATING DEVICES (continued) 5.2.6 Addressable Monitoring Modules ®This system does not have monitoring modules. Number of devices: 5.2.7 Watertlow Alarm Devices ®This system does not have waterflow alarm devices. Type and number of devices: Addressable: Conventional: Coded: Transmitter: 5.2.8 Alarm Verification ®This system does not incorporate alarm verification. Number of devices subject to alarm verification: Alarm verification set for seconds 5.2.9 Presignal ®This system does not incorporate pre-signal. Number of devices subject to presignal: Describe presignal functions: 5.2.10 Positive Alarm Sequence(PAS) ®This system does not incorporate PAS. Describe PAS: 5.2.11 Other Initiating Devices ®This system does not have other initiating devices. Describe: 6. SUPERVISORY SIGNAL-INITIATING DEVICES 6.1 Sprinkler System Supervisory Devices ®This system does not have sprinkler supervisory devices. Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other(specify): 6.2 Fire Pump Description and Supervisory Devices ®This system does not have a fire pump. Type fire pump: ❑Electric pump ❑Engine Type and number of devices: Addressable: Conventional: Coded: Transmitter: Other(specify): 6.2.1 Fire Pump Functions Supervised ❑Power ❑Running ❑Phase reversal []Selector switch not in auto ❑Engine or control panel trouble ❑Low fuel Other(specify): 6.3 Duct Smoke Detectors(DSDs) ❑This system does not have DSDs causing supervisory signals. Type and number of devices: Addressable: 2 Conventional: Other(specify): Type of coverage: FULL PER NFPA Type of smoke detector sensing technology: ❑Ionization ❑Photoelectric ❑Aspirating ❑Beam 6.4 Other Supervisory Devices ®This system does not have other supervisory devices. Describe: NFPA 72, Fig. 10.18.2.1.1 (p. 5 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 7. MONITORED SYSTEMS 7.1 Engine-Driven Generator ®This system does not have a generator. 7.1.1 Generator Functions Supervised ❑Engine or control panel trouble ❑Generator running ❑ Selector switch not in auto ❑Low fuel ❑Other(specify): 7.2 Special Hazard Suppression Systems ®This system does not monitor special hazard systems. Description of special hazard system(s): 7.3 Other Monitoring Systems ®This system does not monitor other systems. Description of special hazard system(s): S. ANNUNCIATORS ❑This system does not have annunciators. 8.1 Location and Description of Annunciators Location 1: FRONT MAIN ENTRANCE Location 2: Location 3: 9. ALARM NOTIFICATION APPLIANCES 9.1 In-Building Fire Emergency Voice Alarm Communication System ®This system does not have an EVACS. Number of single voice alarm channels: Number of multiple voice alarm channels: Number of speakers: Number of speaker circuits: Location of amplification and sound-processing equipment: Location of paging microphone stations: Location 1: Location 2: Location 3: 9.2 Nonvoice Notification Appliances ❑This system does not have nonvoice notification appliances. Horns: With visible: 6 Bells: With visible: Chimes: With visible: Visible only: 3 Other(describe): ONE EXTERIOR RED STROBE 9.3 Notification Appliance Power Extender Panels ®This system does not have power extender panels. Quantity: Locations: NFPA 72, Fig. 10.18.2.1.1 (p. 6 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 10. MASS NOTIFICATION CONTROLS,APPLIANCES, AND CIRCUITS ®This system does not have an MNS. 10.1 MNS Local Operating Consoles Location 1: Location 2: Location 3: 10.2 High-Power Speaker Arrays Number of HPSA speaker initiation zones: Location l: Location 2: Location 3: 10.3 Mass Notification Devices Combination fire alarm/MNS visible appliances: MNS-only visible appliances: Textual signs: Other(describe): Supervision class: 10.3.1 Special Hazard Notification ❑This system does not have special suppression predischarge notification. ❑MNS systems DO NOT override notification appliances required.to provide special suppression predischarge notification. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS 11.1 Telephone System ®This system does not have a two-way telephone system. Number of telephone jacks installed: Number of warden stations installed: Number of telephone handsets stored on site: Type of telephone system installed: ❑Electrically powered ❑Sound powered 11.2 Two-Way Radio Communications Enhancement System ❑This system does not have a two-way radio communications enhancement system. Percentage of area covered by two-way radio service: Critical areas: % General building areas: % Amplification component locations: Inbound signal strength: i^ dBm Outbound signal strength: _ dBm Donor antenna isolation is: __ _v _ dB above the signal booster gain Radio frequencies covered: Radio system monitor panel location: NFPA 72, Fig. 10.18.2.1.1 (p. 7 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 11. TWO-WAY EMERGENCY COMMUNICATION SYSTEMS (continued) 11.3 Area of Refuge(Area of Rescue Assistance)Emergency Communications Systems ®This system does not have an area of refuge(area of rescue assistance)emergency communications system. Number of stations: Location of central controlpoint: Days and hours when central control point is attended: Location of alternate control point: Days'and hours when alternate control point is attended: 11.4 Elevator Emergency Communications Systems ®This system does not have an elevator emergency communications system. Number of elevators with stations: Location of central control point: Days and hours when central control point is attended: Location of alternate control point: Days and hours when alternate control point is attended: 11.5 Other Two-Way Communication Systems Describe: 12. CONTROL FUNCTIONS This system activates the following control fuctions: ❑Hold-open door releasing devices ❑Smoke management ®HVAC shutdown ❑F/S dampers ❑Door unlocking ❑Elevator recall ❑Fuel source shutdown ❑Extinguishing agent release ❑Elevator shunt trip ❑Mass notification system override of fire alarm notification appliances Other(specify): 12.1 Addressable Control Modules ❑This system does not have control modules. Number of devices: Other(specify): ADDRESSABLE RELAY MODULES FOR HVAC SHUTDOWN BASED ON DUCT DETECTOR INTIATING,GAS PUMP SHUTDOWN 13. SYSTEM POWER 13.1 Control Unit 13.1.1 Primary Power Input voltage of controlpanel: 120 Control panel amps: 6 Overcurrent protection: Type: CB Amps: 20 Location(of primary supply panel board): MAIN ELECTRIC ROOM Disconnecting means location: 13.1.2 Engine-Driven Generator ®This system does not have a generator. Location of generator: Location of fuel storage: _ - Type of fuel: NFPA 72, Fig. 10.18.2.1.1 (p. 8 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 13. SYSTEM POWER (continued) 13.1.3 Uninterruptible Power System ®This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): 13.1.4 Batteries Location: Type: Nominal voltage: __ __ Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): ❑Batteries are marked with date of manufacture ❑Battery calculations are attached 13.2 In-Building Fire Emergency Voice Alarm Communication System or Mass Notification System ❑This system does not have an EVACS or MNS system. 13.2.1 Primary Power. Input voltage of EVACS or MNS panel: EVACS or MNS panel amps: Overcurrent protection: Type: __ Amps: Location(of primary supply panel board): Disconnecting means location: 13.2.2 Engine-Driven Generator ❑This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 13.2.3 Uninterruptible Power System ❑This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): 13.2.4 Batteries Location: Type: Nominal voltage: _T_ Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): ❑Batteries are marked with date of manufacture ❑Battery calculations are attached NFPA 72, Fig. 10.18.2.1.1 (p. 9 of 12) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 13. SYSTEM POWER (continued) 13.3 Notification Appliance Power Extender Panels ®This system does not have power extender panels. 13.3.1 Primary Power Input voltage of power extender panel(s): Power extender panel amps: Overcurrent protection: Type: Amps: Location(of primary supply panel board): Disconnecting means location: 13.3.2 Engine-Driven Generator ®This system does not have a generator. Location of generator: Location of fuel storage: i Type of fuel: 13.3.3 Uninterruptible.Power System ®This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): 13.3.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours)`. In alarm mode(minutes): ❑Batteries are marked with date of manufacture ❑Battery calculations are attached 14. RECORD OF SYSTEM INSTALLATION Fill out after all installation is complete and wiring has been checked for opens,shorts,ground faults,and improper branching,but before conducting operational acceptance tests. This is a: ®New system ❑Modification to an existing system Permit number: The system has been installed in accordance with the following requirements: (Note any or all that apply.) ®NFPA 72,Edition: 2010 ®NFPA 70,National Electrical Code, Article 760,Edition: 2014 ®Manufacturer's published instructions Other(specify): _ T System deviations from referenced NFPA standards: Signed: Printed name: Date: Organization: Title: Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 10 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 15. RECORD OF SYSTEM OPERATIONAL ACCEPTANCE TEST ®New system All operational features and functions of this system were tested by, or in the presence of, the signer shown below,on the date shown below,and were found to be operating properly in accordance with the requirements for the following: ❑Modifications to an existing system All newly modified operational features and functions of the system were tested by, or in the presence of, the signer shown below,on the date shown below,and were found to be operating properly in accordance with the requirements of the following: ®NFPA 72,Edition: 2010 ®NFPA 70,National Electrical Code, Article 760,Edition: 2014 ®Manufacturer's published instructions Other(specify): ❑Individual device testing documentation[Inspection and Testing Form(Figure 14.6.2.4)is attached] Signed: Printed name: Date: Organization: Title: Phone: 16. CERTIFICATIONS AND APPROVALS 16.1 System Installation Contractor: This system,as specified herein,has been installed and tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 16.2 System Service Contractor: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: Date: Organization: Title: Phone: 16.3 Supervising Station: This system,as specified herein,will be monitored according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: NFPA 72, Fig. 10.18.2.1.1 (p. 11 of 12) Copyright 0 2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. f 16. CERTIFICATIONS AND APPROVALS(continued) 16.4 Property or Owner Representative: I accept this system as having been installed and tested to its specifications and all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 16.5 Authority Having Jurisdiction: I have witnessed a satisfactory acceptance test of this system and find it to be installed and operating properly in accordance with its approved plans and specifications,with its approved sequence of operations,and with all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: I NFPA 72, Fig. 10.18.2.1.1 (p. 12 of 12) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. A FIRE ALARM AND EMERGENCY'COMMUNICATION SYSTEM INSPECTION AND TESTING FORM To be completed by the system inspector or tester at the time of the inspection or test. It shall be permitted to modify this form as needed to provide a more complete and/or clear record. Insert N/A in all unused lines. Attach additional sheets,data,or calculations as necessary to provide a complete record. Date of this inspection or test: 6/13/1612/16/16 Time of inspection or test: 5:OOPM 1. PROPERTY INFORMATION Name of property: CUMBERLAND FARMS Address: HYANNIS, MA Description of property: RETAIL Occupancy type: Name of property representative: Address: Phone: Fax: E-mail: Authority having jurisdiction over this property: HYANNIS/BARNSTABLE Phone: Fax: E-mail: 2. INSTALLATION,SERVICE, AND TESTING CONTRACTOR INFORMATION Service and/or testing organization for this equipment: Address: Phone: Fax: E-mail: Service technician or tester: Qualifications of technician or tester: A contract for test and inspection in accordance with NFPA standards is in effect as of: The contract expires: Contract number: Frequency of tests and inspections: Monitoring organization for this equipment: Address: Phone: Fax: E-mail: Entity to which alarms are retransmitted: Phone: 3. TYPE OF SYSTEM OR SERVICE ®Fire alarm system(nonvoice) ❑Fire alarm with in-building fire emergency voice alarm communication system(EVACS) ❑Mass notification system(MNS) ❑Combination system,with the following components: ❑Fire alarm ❑EVACS ❑MNS ❑Two-way,in-building,emergency communication system ❑Other(specify): NFPA 72, Fig. 14.6.2.4(p. 1 of 11) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 3. TYPE OF SYSTEM OR SERVICE (continued) NFPA 72 edition: 2014 _ Additional description of system(s): 3.1 Control Unit Manufacturer: FIRELITE Model number: MS92000DLS 3.2 Mass Notification System ®This system does not incorporate an MNS. 3.2.1 System Type: ❑In-building MNS—combination ❑In-building MNS—stand-alone ❑Wide-area MNS ❑Distributed recipient MNS ❑Other(specify): 3.2.2 System Features: ❑Combination fire alarm/MNS ❑MNS ACU only ❑Wide-area MNS to regional national alerting interface ❑Local operating console(LOC) ❑Direct recipient MNS(DRMNS) ❑Wide-area MNS to DRMNS interface ❑Wide-area MNS to high-power speaker array(HPSA)interface ❑In-building MNS to wide-area MNS interface ❑Other(specify): 3.3 System Documentation ®An owner's manual,a copy of the manufacturer's instructions,a written sequence of operation,and a copy of the record record drawings are stored on site. Location: AT FACP 3.4 System Software ❑This system does not have alterable site-specific software. Software revision number: 4.0 Software last updated on: 12/16/16 ❑A copy of the site-specific software is stored on site. Location: 4. SYSTEM POWER 4.1 Control Unit 4.1.1 Primary Power Input voltage of control panel: 120VAC Control panel amps: 6.0 4.1.2 Engine-Driven Generator ®This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 4.1.3 Uninterruptible Power System ®This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): NFPA 72, Fig. 14.6.2.4(p. 2 of 11) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 4. SYSTEM POWER (continued) 4.1.4 Batteries Location: FACP Type: SLA Nominal voltage: 24VDC Amp/hour rating: 7 Calculated capacity of batteries to drive the system: In standby mode(hours): 24 In alarm mode(minutes): 5 ❑Batteries are marked with date of manufacture. 4.2 In-Building Fire Emergency Voice Alarm Communication System or Mass Notification System ®This system does not have an EVACS or MNS: 4.2.1 Primary Power Input voltage of EVACS or MNS panel: EVACS or MNS panel amps: 4.2.2 Engine-Driven Generator ❑This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 4.2.3 Uninterruptible Power System ❑This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): 4.2.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): ❑Batteries are marked with date of manufacture. 4.3 Notification Appliance Power Extender Panels ®This system does not have power extender panels. 4.3.1 Primary Power Input voltage of power extender panel(s): Power extender panel amps: 4.3.2 Engine-Driven Generator ®This system does not have a generator. Location of generator: Location of fuel storage: Type of fuel: 4.3.3 Uninterruptible Power System ®This system does not have a UPS. Equipment powered by a UPS system: Location of UPS system: Calculated capacity of UPS batteries to drive the system components connected to it: In standby mode(hours): In alarm mode(minutes): NFPA 72, Fig. 14.6.2.4(p. 3 of 11) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 4. SYSTEM POWER (continued) 4.3.4 Batteries Location: Type: Nominal voltage: Amp/hour rating: Calculated capacity of batteries to drive the system: In standby mode(hours): In alarm mode(minutes): ❑Batteries are marked with date of manufacture. 5. ANNUNCIATORS ❑This system does not have annunciators. 5.1 Location and Description of Annunciators Annunciator 1: MAIN FRONT ENTRANCE Annunciator 2: Annunciator 3: 6. NOTIFICATIONS MADE PRIOR TO TESTING Monitoring organization Contact: NA Time: 8:OOAM Building management Contact: YES Time: Building occupants Contact: YES Time: Authority having jurisdiction Contact: NA Time: Other,if required Contact: Time: 7. TESTING RESULTS 7.1 Control Unit and Related Equipment Visual Functional Description Inspection Test Comments Control unit Lam s/LEDs/LCDs Fuses Trouble signals Disconnect switches Ground-fault monitoring Supervision Local annunciator Remote annunciators Power extender panels ❑ ❑ Isolation modules ❑ ❑ Other(specify) NFPA 72, Fig. 14.6.2.4(p. 4 of 11) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 7. TESTING RESULTS (continued) 7.2 Control Unit Power Supplies Visual Functional Description Inspection Test Comments 120-volt power Generator or UPS Battery condition Load voltage Discharge test Charger test Other(specify) ❑ ❑ 7.3 In-Building Fire Emergency Voice Alarm Communications Equipment Visual Functional Description Inspection Test Comments Control unit ❑ ❑ Lam s/LEDs/LCDs ❑ ❑ Fuses ❑ ❑ Primary ower supply ❑ ❑ Secondary power supply ❑ ❑ Trouble signals ❑ ❑ Disconnect switches ❑ ❑ Ground-fault monitoring ❑ ❑ Panel supervision ❑ ❑ System performance ❑ ❑ Sound pressure levels ❑ ❑ Occupied ❑Yes ❑No Ambient dBA Alarm -- dBA (attach report with locations,values, and weather conditions) System intelligibility ❑ ❑ ❑CSI ❑STI (attach report with locations,values, and weather conditions) Other(specify) ❑ ❑ NFPA 72, Fig. 14.6.2.4 (p. 5 of 11) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 7. TESTING RESULTS (continued) 7.4 Notification Appliance Power Extender Panels Visual Functional Description Inspection Test Comments Lam s/LEDs/L,CDs ❑ ❑ Fuses ❑ ❑ Primary power supply ❑ ❑ Secondary power supply ❑ ❑ Trouble signals ❑ ❑ -- - — -- - - -- - --- - ---_ Ground-fault monitoring ❑ ❑ Panel supervision ❑ ❑ Other(specify) ❑ ❑ 7.5 Mass Notification Equipment Visual Functional Description Inspection Test Comments Functional test ❑ ❑ Reset/power down test ❑ ❑ Fuses ❑ ❑ Primary power supply ❑ ❑ UPS power test ❑ ❑ Trouble signals ❑ ❑ Disconnect switches ❑ ❑ Ground-fault monitorin ❑ ❑ CCU security mechanism ❑ ❑ Prerecorded message content ❑ ❑ Prerecorded message activation ❑ ❑ Software backup performed ❑ ❑ Test backup software ❑ ❑ Fire alarm to MNS interface ❑ ❑ MNS to fire alarm interface ❑ ❑ In-building MNS to wide-area ❑ ❑ MNS NFPA 72, Fig. 14.6.2.4(p. 6 of 11) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 7..TESTING RESULTS (continued) 7.5 Mass Notification Equipment(continued) Visual Functional Description Inspection Test Comments MNS to direct recipient MNS ❑ ❑ Sound pressure levels ❑ ❑ Occupied ❑Yes ❑No Ambient dBA Alarm dBA (attach report with locations,values, and weather conditions) System intelligibility ❑ ❑ ❑CSI ❑STI (attach report with locations,values, and weather conditions) Other(specify) ❑ ❑ 7.6 Two-Way Communications Equipment Visual Functional Description Inspection Test Comments Phone handsets ❑ ❑ Phone jacks ❑ ❑ Off-hook indicator ❑ ❑ Call-in signal ❑ ❑ System performance ❑ ❑ System audibility ❑ ❑ System intelligibilit ❑ ❑ Radio communications ❑ ❑ enhancements stem Area of refuge communication ❑ ❑ system Elevator emergency ❑ ❑ communications system Other(specify) ❑ ❑ NFPA 72, Fig. 14.6.2.4(p. 7 of 11) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 7. TESTING RESULTS (continued) 7.7 Combination Systems Visual Functional Description Inspection Test Comments Fire extinguishing monitoring ❑ ❑ devices/system Carbon monoxide detector/system ❑ ❑ Combination fire/security system ❑ ❑ Other(specify) ❑ ❑ 7.8 Special Hazard Systems Visual Functional Description(specify) Inspection Test Comments El El ❑ ❑ 7.9 Emergency Communications System ❑ Visual ❑ Functional ❑ Simulated operation ❑ Ensure predischarge notification appliances of special hazard systems are not overridden by the MNS. See NFPA 72,24.4.1.7.1. 7.10 Monitored Systems Visual Functional Description(specify) Inspection Test Comments En ine-driven enerator ❑ ❑ Fire pum ❑ ❑ Special suppression systems ❑ ❑ Other(specify) ❑ ❑ NFPA 72, Fig. 14.6.2.4(p. 8 of 11) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 7. TESTING RESULTS (continued) 7.11 Auxiliary Functions Visual Functional Description Inspection Test Comments Door-releasing devices ❑ ❑ Fan shutdown Smoke management/smoke control ❑ ❑ Smoke damper operation ❑ ❑ Smoke shutter release ❑ ❑ Door unlocking ❑ ❑ Elevator recall ❑ ❑ Elevator shunt tri ❑ ❑ MNS override of FA signals ❑ ❑ Other(specify) ❑ ❑ 7.12 Alarm Initiating Device ® Device test results sheet attached listing all devices tested and the results of the testing 7.13 Supervisory Alarm Initiating Device ® Device test results sheet attached listing all devices tested and the results of the testing 7.14 Alarm Notification Appliances ® Appliance test results sheet attached listing all appliances tested and the results of the testing 7.15 Supervisory Station Monitoring Description Yes No Time Comments Alarm signal ® ❑ 9:OOAM Alarm restoration ® ❑ Trouble signal ® ❑ Trouble restoration ® ❑ Supervisory signal ® ❑ Supervisory restoration ® ❑ NFPA 72, Fig. 14.6.2.4 (p. 9 of 11) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. 8. NOTIFICATIONS THAT TESTING IS COMPLETE Monitoring organization Contact: YES Time: 10:OOAM Building management Contact: YES Time: Building occupants Contact: YES Time: Authority having jurisdiction Contact: NA — Time: Other,if required Contact: Time: 9. SYSTEM RESTORED TO NORMAL OPERATION Date: 12/16/16 Time: 10:OOAM 10. CERTIFICATION 10.1 Inspector Certification: This system,as specified herein,has been inspected and tested according to all NFPA standards cited herein. Signed: Printed name: Date: Organization: Title: Phone: 10.2 Acceptance by Owner.or Owner's Representative: The undersigned has a service contract for this system in effect as of the date shown below. Signed: Printed name: Date: Organization: Title: Phone: NFPA 72, Fig. 14.6.2.4 (p. 10 of 11) Copyright©2009 National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. DEVICE TEST RESULTS (Attach additional sheets if required) Device Type Address Location Test Results - - -- -- --- --- - ----------- NFPA 72, Fig. 14.6.2.4 (p. 11 of 11) Copyright©2009'National Fire Protection Association.This form may be copied for individual use other than for resale.It may not be copied for commercial sale or distribution. Town of Barnstable Building ,.. � - . Post This Care!So:That it;is Visible From<ahe Street`-Approved Plans Must�be.Retained on,Job and this G d Must be Kept Posted Until Finallnspection Has Been:Made' , ` _ z >. , Q Where a�Certificate of:0ccu anc is,Re" urred;such`Buildin` shall;Notabe Occu red until a,Flna'I lns ection.has'been'made ermi P y' a g p p Permit No. B-16-3399 Applicant Name: Bohler Eng Approvals Date Issued: 11/21/2016 Current Use: Structure Permit Type: Building-Sign Expiration Date: 05/21/2017 Foundation: Location: 395 WEST MAIN STREET, HYANNIS Map/Lot: 269 116 Zoning District: HB Sheathing: Owner on Record:- CUMBERLAND FARMS, INC �Contractor Name: Framing: 1 Address: 100 CROSSING B'LVD Contractor License\ 2 FRAMINGHAM, MA 01702 -Project Cost: $0.00 Chimney: Description: 32.5 sq freestanding monument sign &35 scl wall sign with logo i Pe rim,it,;Fee: $ 150.00 Insulation: Cumberland farms a Fee Paid $ 150.00 Project Review Req: 32.5 sq freestanding monument.sign&k35 sq wall sign with logo Date:-� 11/21/2016 Final: Cumberland Farms 7777777 J(yduun�_ Plumbing/Gas w � . " Rough Plumbing: `Zoning Enforcement Officer Final Plumbing: This permit shall be'deemed abandoned and invalid unless the work authorized by this permit is commenced within months after'issuance. _ g All work authorized by this permit shall conform to the approved applicationand the'approved construction documents for.`which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws'and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for,public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work ) 1.Foundation or Footing Rough: 2.Sheathing Inspection 3.All fireplaces must be inspected at the throat level before firest flue lining is installed Final 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the inspector has approved the various stages of construction. Final' "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT - BOHLER ENGINEERING MA, LLC V PLEASE DETACH AND RETAIN FOR YOUR RECORDS V Nm m F M BOHLER JOB# W151640 SIGN PERMIT FEE $150.00 �VE Town of Barnstable 1� Regulatory Services / Richard V. Scali,Director 05 Building Division . Paul Roma,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 t Permit# Building Official approving Application for Sign Permit Applicant: Matthew Brook Assessors No. Map#269 Parcel#116 Doing Business As:Cumberland Farms convenience store Telephone No. 508-480-9900 Sign Location Street/Road: 395 West Main Street Zoning District: yg Old Kings Highway? Ye Hyannis Historic District? Ye No Property Owner Name: Cumberland Farms, Inc. Telephonei 509-270-1400 Address:,100 Crossing Boulevard Village: Framingham Sign Contractor Name: Poyant Signs Telephone: 800-544-0961 Mailing Address: 125 Samuel Barnet Blvd New Bedford MA 62745 Description Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Yes (Note:If yes, a wiring permit is required) Width of building face 72.99 ft.x 10= 729.9 x.10 72.99 Check one Reface existing sign or New X ' Total Sq.Ft. of proposed sign(s) 34.89 If you have additional signs please attach a sheet listing each one with dimensions 'If refacing an existing sign please provide a picture of the existing sign with dimensions. 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 §240-59 through §240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent: _ Date /i signs/signrequ&aPP revised: 06/20/16 Town of Barnstable Regulatory Services �axsrns�.: KAMRichard V.Scall,Director Building Division Paul Roma,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# Building Official approving Application for Sign Permit Applicant: Matthew Brook Assessors No. Map#269 Parcel#116 Doing Business As:Cumberland Farms convenience store Telephone No. 508-480-9900 ~ . Sign Location , Street/Road: 395 West Main Street Zoning District: HB Old IGngs Highway? Yes o Hyannis Historic.District? YesS Property Owner Name: Cumberland Farms,Inc. Telephone' 509-270-1400 Address:.loo Crossing Boulevard Village: Framingham Sign Contractor Name: Poyant Signs Telephone:-800-544=0961 Mailing Address: 125 Samuel Barnet Blvd.,New Bedford MA 02745 Description Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Ye!@ (Note:If yes, a wiring permit is required) Width of building face 72.99 ft.x 10= 729.9 x.r0 72.99 Check one Reface existing sign or New X Total Sq.Ft. of proposed sign(s) 32.50 . If you have additional signs please attach a sheet listing each one with dimensions If refacing an existing sign please provide a picture of the existing sign with dimensions. 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 §240-59 through §240-89 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent:. Date iF i signs/signrequ&app revised: 06/20/16 CF-MID-MON-517T,SYS-CUSTOM 1 6FT MONUMENT SIGN SYSTEM OVERVIEW - ***STONE VENEER TO BE INSTALLED BY OTHERS;.AFTER CABINETS HAVE BEEN INSTALLED*** PRODUCTION Total Square Ft= 32.5 Sq Ft -Gooseneck•lights prepped by Pro Sign in shop _ -Installed in field by.GC 5'-01/z Between Blockwork 5' 0"Cabinet Wi th Precast Concrete 4'-9'/2,M. Cap By.Others" (20;n) Templates &anchor (Centered on top of Pier) bolts for.MID.signs _ 2,_6„H x 5'-0"W x 20 to be supplied by - - pp (wain ID Cabinet material supplier. . 12.5 Sq.Ft Rev Cumberland "" Consistent to Remain � � Consistent 11/a" - - �, F R M 5 �Ms Throughout"Sign - A - 4) d _.. Cultured Stone Veneer LL — l!I'.;j li ��_ I Over Post Shrouds �. I b By Others >. _ so e7 INSTALLED AFTER CABINETS O O a - - - 4'-0"h x 5'-0"w x 20„ o �` - o R l i 2-Product,Skyline Scroller Price _ 'v et Cabl�. —" n Supplied By Others) - `- s r o 20 Sq Ft -Electric1al stub out (distance:from top of planter cap) erland - - Cumb R A F M S FT - - •W - _i - ' -Cabinet to house.20"x 14".x.7"Skyline'Control Box - 3M vm sM rFens wny� Cabinet to also be used as access panel for electrical wiring ®ieoci ®assasa - _,L - Gerenium ReE Certllnel ReE x Grade Side View Front View Ii I Elec.By Others 8'-81/2"Planter Planter t- - O-1 Main ID Overview • -. MAR F- �F. - Scale 1 Y4"=V-0" DESIGN ' WACumbedand Fanns\Sites\ ° - •' MA\hlyannis\005421\Design\ 005421.cdr 251 Boot Road Cumbedand"Farms Copyright;Pro Sign Company,2016 " IaEv Design Pen By ACT ID1005421 P 0 Downingtown PA TMIgGR^»uGR�LGOE�GAT^TMAT�FR�RRIE^" 6 EMA CPI EMA QN �9097 g INFORMATION OF PRO SIGN OOMFANY,rr SI-L NOT IIE USED, OUFUGTEOOROISOLOSEOWWNOIE ORR FORANY .TEL THI 610.518.5881 FUFMIE OTHER THAN TO EVALUATE MIS FROFOS4L.IF FAX-I 610.5,8.5244 395 West.Main cSt. oRW MAWAFIOED O� MFReMs R nAw"o�'anL OF changed Id p WWW info@prosign.riet .FiyanfliS,MA:O2601 MFE FEE S NAVE THE RIGHT TO USE OR DISCLOSE THE height CBIIOUt3. Date Page www,pr9sign,net DATA TO THE EVENT FRONOEO IN THE RESULTING CAM(NOT.' 11 .15.16 1 of 36" D/F MID CABINET'S OVERVIEW OTY. 1 PRODUCTION .125 Aluminum Face Silicone Adhesive �« 5'-0"Cabinet Width : w/Mechanical I Dash lines denote mounting Fasteners area for gooseneck lights cc � co 3/<"Clear ' Acrylic t ��°ao 4�i Copy. 10 C C o° Cabinet:color`&finish io Cumberland to snatch N N F A. , R M 5 Alcoa Shell white Side View. Front View ' -Router Cut 1/8"Cumberland Farms White Aluminum Face 0-1 I.Cabinef Scaling SGaie l i2"=,1-0 -3/4"Clear Acrylic Push Thru(%":Exposed)"Cumberland Farms" Text&Logo Attached with Fasteners mounted to Rear.of Aluminum Face -Main Text("Cumberland")to be Laminated w/3MTM ScotchcalTm Translucent Graphic Film 3630-97 Bristol Blue Custom,1/8"Aluminum ' -Arch,Logo&Sub Text("Farms")to be Laminated w/3MTM ScotchcalTM ` Cabinet Cumberland Farms Translucent Graphic Film 3.630-106 Brilliant Green White Formula(300G B-10,..1g B-44) , 5:-0"Cabinet Width• � Cumberland F A R M S ®3M vnN 3M Trens Vinyl .Gemniu ReE ®Cor38 CI4n RaE 3M Vlnvl ®3M VinN . •. - O RAW BAW eGereon 29 Per Face. White Black 0 O - Sloan 8OW 58 Total Power Supply ' e Black' _ 1� (CIS OO ow.,`viwrruEnurm, O CM PRODUTION W:\Cumbertand Farms\Sites\ ' ` - MA\Hyannis\005421\Production\ ' - 4005421_CAD.at „— 005421 BrllGantGreen_Plotai _ _ DESIGN • W:\Cumbedand Farms\Sites\ 0-1 Illumination Details MA\Hyannis\005421\Design\ 005421.cdr scale i 314"=1'-0" Sloan VL Plus white long REV Design PM By ACT ID1005421 2s1 Boot Cumberland Farms Copyright;Pro Sign Company,2016 6 EMA CPI' EMA M THIS a MMNGaICAUaE50NTA,H,TSFnpPR1ET,ViVQN I9097 DOWningtOwn PA 19335 wFGnnwnoN OF vao slGNcwFaNv,rtsHnu NOT aE usEn, - - OUFura OT W—NTO Va TES 8 FnmF IFTEL 81O.51B.5881 PUMP 9EOTHFA H OTO1SFftETHIaFPOF09AXTO 395 West Main.S't. RINCOGfECTION EaTOT SUBMSION OF9 DATLTOF -chars edhel ht FAX- infoO 8 sign. oRwOONNEcrroNWITHT N HTTueSIONOFrwsGargTHE g g Date Page WVJVJ info®prosigri.net Hyannis,MA:02601 OEFEREE SHPIL HRVE THE WGHT TEU SULMG0OaE THE ( CBIIGUtS www.proslgn.nel GATR TO HE E%ERPRONDEOIN MERESUI MG CON MCT. r l__ ._� 11 .15.16 2 of 5 36" D/F MID CABINET.1 CROSS SECTION PRODUCTION V-8"Total 3"Top hinge pop riveted 1"x 1"S tube ~ &plug welded to extrusion Square 0-1 Cross.Section Detail &11/2"angle Scale 11riz,_1_o- -- 2"x 2"Angle. i '• 1/8"Aluminum 5"x 5"Angle for LED mounting 1/8"Aluminum � �� Sloan White VLPlus Long ,..� '� .� face versBlocked �'ty to extrusion r Cumberland .11/2"x.11/i'Angle= 1".x'1"Square tube F A R M S - '�� Z 3M VInNyl. 3M Trans Vinyl 3M VInN 3M VinN "" •I 3Bri.W III.. ®B63 Bnnft.Green rt Pop rivet u Silicone adhesive w/ 3/a"x 3/a"Angle mechanical fasteners 5"x 5"Angle _ ,for support DESIGN WACumbedand Fanns\Sites\ MA\Hyannis\005421\Design\ 005421.cdr 25t Boot Road Copyright;Pro Sign Company,2016 - -REV Design PM� �By ACT I D1005421 P 0 Downingtown PA 1933s Cumberland Farms ,„g � 6 EMA CPI EMA g INFORMATION OF PRO SIGN COMPANY.n SHALL ROT aE UBFD. QN 19097 OUP"nl)OR OE;OLOSEDINWF tZORPARTFgtANY TEL 1610.518.5881 FURigBE OTHER TO Rw IATE TRIa FFOFOBAL.IF .FAX 610.518.5244 395 W6St.M81n-QSt. OR OONNEEMION�mTR1TReM°su OFi�aA,THE ' Date Page -WWW info®prosign.net .HyanfllS,MA,OZ6O1: OEFEREE ERAIL HN THE RKiHT TO USE OR O10(% ETHE g OATH TO THE EMNT RRONOEO IN THE RESULTING CONrf .. www.prg5ign.net 11 .15.16 3 of 5 CUSTOM-CHLTR-18 CHANNEL LETTERS-.SMALL OVERVIEW OTY 1 PRODUCTION. i� 8'-5' "/2 Total Overall Width poi.50) I I, 5„ i i i�--- 2'-2":(26;R) —Aii4l c - ---- O a. ci o p O L i 0) - 0 as Cu (� p� as b { 0 ,. � �� 59/1 1/4"Stand-off 5'-91im"(69.6675in) �- Front View • Side View CI ffib&c 11d F A R M S 0-1 Finished Letters Overview. ®sMvl ®sMrenswnN ... - Scale I%.="1'-o" .Gerenium R.tl Co3�a ReE MCI 3M Ynyy����gg . -. 38r6LatNBtu. ®B 3leaniGreen New.Set of Externally Illuminated.Channel Letters/Logo-34.89 sq.ft. area -Aluminum fabricated letter/logo cans.Returns painted to match Blue PMS 301c&Green PMS 376c: — 3/16"White acrylic faces with 1"blue&green Jewelite trimcap. -"Cumberland"text to receive blue translucent vinyl overlay-3M Bristol Blue#3630-97.., "Logo&FARMS"to receive green translucent vinyl overlay-3M Brilliant Green#3630-106: �oTM -Letters mounted to clapboard siding with non-corrosive hardware/1/4"stand-offs. -Access behind fascia system required for secondary sign wiring: -All holes and seams to.be caulked and sealed. PRODUCTION ' WACumbedand Farms\Sites\ MA\Hyannis\005421\Production\ " - -005421_CUSTOM_35sgfL.Letters-CAD.al DESIGN WACumbedand Farrns\S tes\ MA\Hyannis\005421\Design\ . 005421.cdr REV Design PM By ACT ID1005421 261 soot Road Cumberland Farms Copyright,Pro Sign Company,tots 6 EMA CPI EMA �,^�+ THIS DMWIrvO MCLUDE9 DATq THAT 6 PRDPRIETARY' JI 1 O Downingtown PA 19335. - IRro UIOATEDOADEOLSEDWIINHO RFAFFTTeeuseD. - ON 9097 �V IIIJJJ DUPucAreDDRTHANTD° TET ISF`RO SR.IF ���� a. TEL 1610.518.524 s 'PURPOSE OTHERIWIN TD EVALFA OS6PRDPD6AL.JLTO VfI.' 395 West.Main St. D°""""'�ION FIF°'°TM°"'�°'ER'TARIMT&TH changed to 181 FAX in o.516.5ign onw OOrvrvECTI I vET THE THE FIGHT R THIS aATa HE 9 WWW -.info®prosign.net - .Hyannis,MA.026O1 DATA TO HE EXTENT EDIN T°U6E°IVIING 6E THE non gable i Date Page www.proslgn.nel DATA TO NEE%EMPRO 0EOIN THE REfiUUMOrANRWC. v , 11.15.16 4 of 5 CF-MID-MON-5FT CBX2016FTCONTROL BOX:CABINET OVERVIEW OTY. 1 PRODUCTION 5'-0"Cabinet Width 2"4P '-4"42'' 1 T/4"Recessed- —4'-91/2"Face Width 11/4"Recessed o -1/8"White aluminum - o Side View 11/4"Recessed Front View Custom 1/8"Aluminum Cabinet Cumberland Farms 0-1 I finished Cabinet Overview White Formula(309G B-10,.1g B-44): Scaled i=1'4' Cabinet color&finish to match ' Alcoa Shell white. —4'-91/2 Face Width { � Side -CumberlandView :1/8 White aluminum Front View F A R M S 0-21 Flat Trans Face , Scale I'3/4"=1'-0" - - Pentorre PaMone . PantoTre PaMone 3116 _ ®1� m Process BleCk x �a N � Aluminum ' 1/a"Brake.Formed Aluminum II J7. Zee" T I�1'/4+I 0-31 Cabinet Components • Scale f 3"=V-0" DESIGN - _ MCumbedand Fwms\Sites\ MAViyannis\005421\Design\ - - 005421.cdr REV Design, PM By ACT ID1005421 251 Boot Road Cumberland Farms Copyright,Pro Sign Company,2016, 6 EMA THIS DRAWING IN-5OATH THAT I6 PROPRIETARY CPI EMA I,JJI I O Downingtown PA19335 - INFORMAIWNOFFROSIGNCOMPA ITSNALL NOT BEUSEO. QN 9097 ' I✓A IJ i TEL I 610.518.5881 OU u TEDOROISCLOSEOINWIOEORPARTFORANY' PURPO6E OTH6RTHANTOEYAIFFIOP SERASARESUI FA ` FAX 610.518.5244 395 West Main St.. OR�EC;�YA TT ESUBN Nfiw OF THIS DATA.NE 5 I �j wwVv into®prosign.r et Hyannis,MA-OZ6O1 DEFEREE BI—HANS HE NIGHT TO USE OR DISCLO8E THE , Dat{e Page www.prosign.net DATA TO HE"NT PRONGED IN THE RESULTWGCAN MCi 11 .15.16 5of5 ' F , TM 352 Turnpike Road BOHLER Southborough, 01772 PHONE 508.4.480.99009900 E N G I N E E R I N G FAX 508.480.9080 November 16,2016 Town of Barnstable Building Division 200 Main Street Hyannis,MA 02601 Attn: Robin Anderson = ^ Re: Cumberland Farms y 395 West Main Street Hyannis,MA t� Dear Ms. Anderson, Enclosed, please find revised signage information for Cumberland Farms on West Main Street. Per your most recent comments,the wall sign has been replaced with a sign having a total boxed area of 34.89 SF. Additionally,the detail for the freestanding sign has been clarified, as requested,to show the appropriate dimensions of the Cumberland Farms sign panel, and confirming its previously stated area of 32.5 SF. Please let me know if the enclosed drawings are sufficient for approval of the proposed signage. If you have any questions, please do not hesitate to contact me. Sincerely, BOHLER ENGINEERING atthew�DBrook CIVIL AND CONSULTING ENGINEERS• PROJECT MANAGERS• SURVEYORS• ENVIRONMENTAL CONSULTANTS• LANDSCAPE ARCHITECTS Serving the East Coast• www.BohterEngineering.com Final Construction Control Document a To be submitted at completion of construction by a Registered Design Professional for work per the 8th edition of the oT* . Massachusetts State Building Code, 780,CMR, Section 107.6.4 Project Title: Cumberland farms Date:November 16,2016 Property Address: 395 West Main Street, Hyannis,MA.02601. Project: Check(x)one-or both as applicable:X New construction Existing Construction Project description: New single story,wood frame,slab on grade,Type 5B construction;mercantile occupancy. I Robert R. Chartrand MA Registration Number:32109 Expiration date:06/3012018,am a registered design professional, and I hereby certify,to the best of my knowledge,information and belief, that 1 have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Entire Project Architectural X Structural Mechanical Fire Protection Electrical Other: for the above named project.I certify that 1,or my designee,have performed the necessary professional services,in accordance with the Professional Standard of Care,and was present at the construction site on a regular and periodic basis to determine that the work proceeded in accordance with the requirements of 780 CMR and the design documents prepared by me and approved as part of the building permit and the I or my designee: 1. Have reviewed,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. Such review shall not diminish or relieve the Contractor of its submittal and other responsibilities. 2. Have performed the duties for registered design.professionals in 780 CMR Chapter 17,as applicable.. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. The Contractor is responsible for performing the work in accordance with the contract documents. and shall be exclusively responsible for its construction means,methods,sequences and procedures,and for construction safety. Enter in the space to the right a"wet"or tia`4 `S9e electronic signature and seal: o R 'BERi"R. �G s CHARTRAND Digitally ig ed.bybert c Chartrand —i Conta 1bb rce e. ri com STRl1CTURRL t„ ��� Nq,d210rJ D .1.161319:57-05'00' o p Q7• Phone number:508 384-0163 Email:bob@rrcengineering.com FS�!orant�N� Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised:If`other' is chosen, provide a description. RRC Engineering,LLC 60 Man Mar Drive Unit 2 Plainville,MA 02762 tel 508 384 0163 rrcengineering.com AGMBALANCEO 00. Company Name Cape Cod Insulation Phone Number 508-775-1214 Applicator Name 9 .� Installation Date 10-17-2016 Jobsite Address 95 W. Main St. Hyannis Ma. A-Side Lot #'s PA86001543 Permit Number B-Side Lot #'s P3037313116 �oTaO U3�Ma0�c " ' apprO�oru Tc 50' FL Walls /Gable 5.5" R-24 300 Attic g" R-40 3825 0Rwflnw@fit C @dUng MCI Lo @TWn Blaze Lok Thermal Barrior Attic Roof Line & Gable Walls 23 Mils Wet wwwMemilec.com DEMILEC AGRI BALANCE oo DEMILEC Agribalance°is a two component,open cell,spray applied,semi-rigid polyurethane foam system that contains more than 20%renewable agricultural based materials(refined vegetable oils).This product is a fully water blown foam system having a low in-place density with excellent adhesion to various substrates and to itself.Agribalance incorporates the single phase solution technology developed by Demilec for excellent shelf life and consistent processing.Agribalance complies with the intent of the International Code Council's residential and commercial building codes for spray polyurethane foam plastic insulation.Agribalance meets the USDA guidelines for incidental food contact. ASTM D 1622 Density 0.6-0.8 Ib/ft3 9.6-12.8 kg/m3 ASTM C 518 Aged Thermal Resistance(R-value @ 1 inch) 4.45 ft2h°F/BTU 0.78 Km2/W Air Permeance @ 75 Pa @ 3.5"(75 Pa=25 mph wind) < 0.02 L/sm2 Air Permeance @ 500 Pa @ 3.5" 0.003 L/sm2 ASTM E 283 Air Permeance @ 1000 Pa @ 3.5" 0.006 L/sm2 Air Permeance @ 1500 Pa @ 3.5" 0.011 L/sm2 Air Permeance @ 2000 Pa @ 3.5" 0.018 L/sm2 ASTM E 96 Water Vapor Permeance @ 5" 4.95 perms 283 ng/Pa•s•m2 ASTM D 2126 Dimensional Stability @ 1580F(70°C)97%R.H.(28 days) 3.16(%volume change) ASTM D 1621 Compressive Strength 1.86 psi 12.82 kPa ASTM D 1623 Tensile Strength 3.87 psi 26.68 kPa Surface Burning Characteristics,5.5"thick Class I ASTM E 84 Flame Spread Index 15-20 Smoke Developed 400 Ignition Barrier-Compliant with 2006,2009&2012 IBC and IRC,and ICC-ES AC-377 Appendix X,for use in attics and crawl spaces with: NFPA 286 BlazelokT"I134 at 5 mils dry film thickness,9 mils wet film thickness,or Pass No Burn Plus XD at 6 mils dry film thickness,10 mils wet film thickness,or Heatlok Soy at 2"thick NFPA 286 Thermal Barrier-Compliant with the 2006,2009&2012 IBC and IRC,as an interior finish Pass without a 15 rn'nute thermal barrier with BlazelokT"TBX at 15 mils dry film thickness. ASTM D 1929 Ignition Properties(spontaneous ignition temperature) 968°F(520°C) PROPERTY" 'A-PMDI ISOCYANATE, .a. � ,. - w , AGRIBALANCE RESIN ' Color Brown Amber Viscosity @ 77°F(25°C) 180-220 cps 250-450 cps Specific Gravity 1.24 1.08-1.12 Shelf Life of unopened drum properly stored 12 months 12 months Storage Temperature 50-100OF(10-38°C) 50-100-F(10-38°C) Mixing Ratio(volume) 1:1 1:1 `See SDS for more information. l . . Cream Time Gel Time Tack Free Time End of Rise 1 -2 seconds 3-4 seconds 6-7 seconds 6-7 seconds 3315 E.Division Street,Arlington,TX 76011 Agribalance Technical Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 9-22-16 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 1 of 2 AGRIBALANGEO 00. Initial Recirculating Setpoint Temperature 80-85°F 27-30°C Initial.Primary Heater Setpoint Temperature 120°F 49°C Initial Hose Heat Setpoint Temperature 120°F 49°C Initial Processing Setpoint Pressure 1300 psi 8963 kPa Substrate&Ambient Temperature >50°F >10°C Moisture Content of Substrate 1519% 519% Moisture Content of Concrete Concrete must be cured,dry and free of dust and form release agents. *Foam application temperatures and pressures can vary widely depending on temperature,humidity,elevation,substrate,equipment and other factors.While processing,the applicator must continuously observe the characteristics of the sprayed foam and adjust processing temperatures and pressures to maintain proper cell structure,adhesion,cohesion and general foam quality.It is the sole responsibility of the applicator to process and apply Agribalance within specification. General Requirements:Equipment must be capable of delivering the proper ratio(1:1 by volume)of polymeric isocyanate(PMDI)and polyol blend at adequate temperatures and spray pressures.Substrate must be at least 5 degrees above dew point,with best processing results when ambient humidity is below 80%.Substrate must also be free of moisture(dew or frost),grease,oil,solvents and other materials that would adversely affect adhesion of the polyurethane foam. Agribalance must be separated from the interior of the building by an approved thermal barrier or an approved finish material equivalent to a thermal barrier in accordance with applicable codes.Agribalance must be sprayed at a minimum thickness of 3"per pass.This product must not be used when the continuous service temperature of the substrate or foam is below-60°F(-51°C)or above 180°F(82°C).Agribalance should not be used in contact with bulk water,below grade or to cover flexible ductwork. Disclaimer:The information herein is to assist customers in determining whether our products are suitable for their applications.We request that customers inspect and test our products before use and satisfy themselves as to contents and suitability. Nothing herein shall constitute a warranty,expressed or implied,including any warranty of merchantability or fitness,nor is protection from any law or patent inferred.All patent rights are reserved.The foam product is combustible and must be protected in accordance with applicable codes. Protect from direct flame and spark contact,around hot work for example.The exclusive remedy for all proven claims is replacement of our materials. `NtERrejcBAAPPROV.. INSPECTION TESTIe C us GREENp ERTTIP CATION ' +re �TM APPROVED �M �,a<5,� C E 3315 E.Division Street,Arlington,TX 76011 Agribalance Technical Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 9-22-16 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 2 of 2 is A AGRI BALANCE8 00. DEMILEC e DATA SIB RNSHED FOAM --• . r • Manufacturer of Chemical Components Product Demilec Trade Name: Agribalance@ 3315 E.Division Street,Arlington,TX 76011 Chemical Name: Semi-rigid Urethane Foam Plastic Phone:817-640-4900/Fax:817-633-2000 Chemical Family: Urethane E-mail: Info@Demilec.com/Website:www.Demilec.com . Emergency Telephone:1-877-DEMILEC(336-4532)or CHEMTREC 800-424-9300 or CANUTEC 613-996-6666 Physical State/Odor Semi-rigid open cellular plastic/Neutral .. m EMERGENCY OVERVIEW/.WARNING - &` Routes of Entry Skin contact,inhalation(only if dust is created during cutting). Eye Contact May cause mechanical irritation to eyes. Skin Contact May cause mechanical irritation to skin. Dust Inhalation May cause mechanical irritation to respiratory system. Dust Ingestion May cause choking if swallowed. Urethane Plastics 9009-54-5 100 Eye Contact Flush with water for 15 minutes. Skin Contact Wash with soap and water thoroughly. Inhalation Remove to fresh air if effects occur.If not breathing,give artificial respiration.If breathing is difficult,assist with oxygen.Consult a physician. Ingestion No adverse effects anticipated by this route. • • r Auto-Ignition Temperature 968°F(520°C)per ASTM D 1929 Flash Ignition Temperature 896°F(480°C)per ASTM D 1929 Suitable Extinguishing Media Use water,dry chemical,carbon dioxide or chemical foam. Hazardous Decomposition Under fire conditions,carbon monoxide,carbon dioxide,hydrogen products halides and nitrogen oxides. Special Fire Fighting Because fire may produce toxic thermal decomposition products,wear a self-contained breathing apparatus Procedures with positive pressure. Gib- - - --- No information available.Refer to Section 13. Eye Protection Safety glasses during cutting. Skin Protection Protective clothing to minimize skin exposure. Respiratory Protection Dust mask during cutting. Ventilation Use sufficient ventilation to keep exposure to dust at a minimum(below 5 mg/m'breathable nuisance dust). 3315 E.Division Street,Arlington,TX 76011 Agribalance Foam Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 1 of 3 ;EXPOSURE LIMIT VALUES _ $ For Product OSHA PEL(TWA)-8 hr WEEL(AIHA)(TWA)-8 hr Urethane Plastics N/A N/A Appearance Semi-rigid open cellular plastic Odor Neutral Density 0.60-0.80 Ib/ft3 Auto-Ignition Temperature 968°F(520°C)per ASTM D 1929 Melting Point N/A,Thermoset Decomposition Temperature >260OF(127°C) Maximum Service 180°F(82°C) Temperature Solubility in Water None 01 + Stability This product is considered stable under normal conditions. Incompatibility None known Hazardous Decomposition Under fire conditions,carbon monoxide,carbon dioxide,hydrogen products halides and nitrogen oxides. Hazardous Polymerization None Corrosive Properties None Oxidizer Properties None Stable in the presence of most solvents found in binders,bituminous materials,wood preservatives and Chemical Resistance sealers.Resistant to facers containing plasticizer,fuel,mineral oil,weak acids and weak bases. Resistant to fungi and microbes.UV rays cause a darkening of the foam surface and with time will degrade the surface. OICHWAUNIA POTENTIAL ACUTE HEALTH.EFFECTS Eye Contact May cause mechanical irritation to eyes. Skin Contact May cause mechanical irritation to skin. Dust Inhalation May cause mechanical irritation to respiratory system. Dust Ingestion May cause choking if swallowed. `POTENTIAL CHRONIC HEALTH EFF.ECTSfi h ` Sensitization Not known or reported. Carcinogenic Effects The components of this product are not listed by NTP,IARC or regulated as a carcinogen by OSHA. Mutagenic Effects No known significant effects or critical hazards. Reproductive Effects No known significant effects or critical hazards. Developmental Effects No known significant effects or critical hazards. $AQUATIC TOXICITY,{DATA FOR.-COMPONENTS TOXI64Y - a Urethane Plastics No data on product itself. .• • _ -- Waste Disposal Method The generation of waste should be avoided or minimized whenever possible.Waste must be disposed of in compliance with federal,state,provincial and local environmental control regulations. Demilec has no control over the management practices or manufacturing processes of parties handling or using this material. 3315 E.Division Street,Arlington,TX 76011 Agribalance Foam Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 2 of 3 is 1��M i ' J Technical Shipping Name Agribalance Primary Hazard Class N/A Secondary Hazard Class N/A Label Required None Placard Required None Poison Constituent N/A LIN Code N/A EPA Registration# N/A TDG Classification Non-regulated WHMIS Classification Non-regulated No information available. • a This product does not contain nor is it manufactured with ozone depleting substances. Notice:The information herein is presented in good faith and believed to be accurate as of the effective date shown below.However,no warranty expressed or implied is given.Regulatory requirements are subject to change and may differ from one location to another;it is the user's responsibility to ensure that its activities comply with country,state,provincial and local laws.This product may present hazards and should be used with caution.While certain hazards are described in this publication,no guarantee is made that these are the only hazards that exist.Hazards,toxicity and behavior of the products may differ when used with other materials and are dependent upon manufacturing circumstances or other processes.Such hazards,toxicity and behavior should be determined by the user and made known to handlers, processors and end users. Prepared By Demilec-EHS Group Current Issue Date February,2015 3315 E.Division Street,Arlington,TX 76011 Agribalance Foam Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 3 of 3 Y � r AGRI BALANCE oo DEMILEC :SECTION 1:`PROD6CT&COMPANY INFORMATION E 3 R .. z. Manufacturer of Chemical Components Product Demilec Trade Name: Agribalance@ B-side 3315 E.Division Street,Arlington,TX 76011 Chemical Name: Polyurethane Resin/B-side Phone:817-640-4900/Fax:817-633-2000 Chemical Family: Polyether Resin Blend E-mail:Info@Demilec.com/Website:www.Demilec.com Product Use: Component of a Polyurethane System Emergency Telephone:1-877-DEMILEC(336-4532)or CHEMTREC 800-424-9300 or CANUTEC 613-996-6666 SECTION 2:•HAZARDS IDENTIFICATION ` _ a Physical State/Color/Odor Liquid/Amber/Faint EMERGENCY OVERVIEW/,WARNING p. 1 �• OSHA/HCS Status This material is classified hazardous under OSHA Hazard Communication Standard (29 CFR 1910.1200). Physical/Chemical Hazards Acute Health Hazard/Chronic Health Hazard/Fire Hazard Toxic vapors may be released during burning or thermal decomposition. Routes of Entry Eye contact,skin contact,inhalation,ingestion. Eye Contact Product liquids,aerosols or vapors are irritating.Vapors may cause a transient condition known as glaucopsia, resulting in blurred vision and appearance of halos around bright objects. Skin Contact May cause irritation and dermatitis. Inhalation May cause headaches,dizziness,drowsiness and other central nervous system effects. Ingestion May cause irritation to throat,esophagus and stomach(nausea,abdominal pains,vomiting and diarrhea). Carcinogenicity The components of this product are not listed by NTP,IARC or regulated as a carcinogen by OSHA. - SECTION 3:COMPOSITION/INFORMATION ON INGREDIENTS = - INGREDIENTS _ CAS# % Polyether Polyol Trade secret 20-30 Agricultural Based Polyol Trade secret 15-30 Tris-iso-chloropropyl Phosphate 13674-84-5 15-40 Surfactant 1 Trade secret 5-20 Surfactant 2 Trade secret 0-1 Tertiary Amine Catalyst Trade secret 1-5 Water 7732-18-5 1-20 SECTION 4:FIRST AID MEASURES Eye Contact Immediately flush eyes with running water for a minimum of 15 minutes.Hold eyelids open during flushing. Obtain medical attention immediately. In case of contact,immediately remove contaminated clothing and shoes.Immediately flush skin with plenty Skin Contact of soap and cold water.Do not use hot water.Wash contaminated clothing and shoes thoroughly before reuse.For severe exposures,immediately get under safety shower and start rinsing. If irritation develops, obtain medical attention. Move exposed person to fresh air.Keep person warm and at rest.If not breathing,breathing irregularly,or if respiratory arrest occurs,provide artificial respiration or oxygen by trained personnel.Obtain medical Inhalation attention if adverse health effects persist.If unconscious,place in recovery position and get medical ,attention immediately.Maintain an open airway.Loosen tight clothing such as collar,tie,belt or waistband.If-- thermal decomposition products are inhaled during a fire,symptoms may be delayed.The exposed person, may need to be kept under medical surveillance for 48 hours. 3315 E.Division Street,Arlington,TX 76011 Agribalance B-side Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 1 of 5 Wash out mouth with water.Move exposed person to fresh air.Keep person warm and at rest.If material has been swallowed and the exposed person is conscious,give small quantities of water(250 ml).Stop if the exposed person feels sick,as vomiting may be dangerous.Obtain medical attention if symptoms occur.DO Ingestion NOT induce vomiting unless directed to do so by medical personnel.If vomiting occurs,the head should be kept low so that vomit does not enter lungs.Get immediate medical attention if adverse health effects persist or are severe.Never give anything by mouth to an unconscious person.If unconscious,place in recovery position and get medical attention immediately.Maintain an open airway.Loosen tight clothing such as collar,tie,belt or waistband. No action shall be taken involving any personal risk or without suitable training.If it is suspected that fumes Protection of First-aiders are still present,the rescuer should wear an appropriate mask or self-contained breathing apparatus.It may be dangerous to the person providing aid to give mouth-to-mouth resuscitation. Notes to Physician Following severe exposure the patient should be kept under medical review for at least 48 hours. SECTION 5:FIRE FIGHTING MEASURES , _ <r4 A Flash Point >200°F(93°C) Auto-Ignition Temperature N/A Upper Flammable Limit(%vol.) N/A Lower Flammable Limit(%vol.) N/A Suitable Extinguishing Media Dry chemical,carbon dioxide(CO2),foam,water spray for large fires. Hazardous Products of Combustion products may include carbon monoxide,carbon dioxide,nitrogen oxides,halogenated Thermal Decomposition compounds,traces of ammonia vapors,aldehydes and ketones,low molecular weight organic products. Firefighter should be equipped with self-contained breathing apparatus(SCBA)with a full face-piece Special Fire Fighting operated in positive pressure mode to protect against potentially toxic and irritating fumes generated by Procedures thermal decomposition or combustion during a fire.They should wear appropriate protective equipment such as PVC boots,gloves,safety helmet and protective clothing.Material supports combustion. IN "SECTION 6:ACCIDENTAL RELEASE- EASURES,a, :: :• n ' ' Personal Precautions Avoid breathing vapors or mist.Provide adequate ventilation.Use suitable protective equipment. Environmental Precautions Avoid spreading of spilled material,runoff and contact with soil,waterways,drains and sewers. Inform the relevant authorities if the product has caused environmental pollution. Move containers from spill area.Approach release from upwind.Contain to prevent spread into drains, sewers,water supplies or soil by creating a dike or trench.For minor spills,spread sawdust or other absorbent material over the spill area and allow at least 30 minutes to absorb as much of the remaining Methods for Cleaning-up product as possible.Shovel into suitable metal containers for waste disposal.Contaminated absorbent material may pose the same hazard as the spilled product.Dispose via a licensed waste disposal contractor. The spill area should then be washed down with soap and warm water to dilute and remove remaining traces of material.Ventilate area to remove the remaining vapors.For major spills,released material may be pumped into containers for disposal.Wear suitable personal protective equipment. .;SECTION 7:-HANDLIN,G&STORAGE Irz-: 4 " Storage Temperature 50-100°F(10-38°C) Storage Life 12 months Do not inhale vapor/spray.Avoid contact with skin and eyes.Put on appropriate personal protective equipment(see Section 8).Eating,drinking and smoking should be prohibited in areas where this material is Handling handled,stored and processed.Workers should wash hands and face before eating,drinking and smoking. Use only with adequate ventilation.Wear appropriate respirator when ventilation is inadequate. Keep in the original container or an approved alternative made from a compatible material;keep tightly closed and sealed until ready for use. Store in tightly closed containers in a cool,dry and ventilated place away from incompatible materials and food Storage and drink.Store away from ignition sources.Protect containers against physical damage.Containers that have been opened must be carefully resealed and kept upright to prevent leakage.Do not store in unlabeled containers.Use appropriate containment to avoid environmental contamination. Precautions If contamination with isocyanates is suspected,do not reseal containers.Employee education and training in safe handling of this product are required under the OSHA Hazard Communication Standard. Packaging Containers Original container 3315 E.Division Street,Arlington,TX 76011 Agribalance B-side Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 2 of 5 SECTION 8:.EXPOSURE CONTROL/,PERSONAL PROTECTION EXPOSURE LIMIT,VALUES For Product N/A For Ingredients ACGIH-TWA(8 hrs,40 hrs/week) ACGIH-STEL OSHA,PEL-TWA Polyether Polyol N/A N/A N/A Agricultural Based Polyol N/A N/A N/A Tris-iso-chloropropyl N/A N/A N/A Phosphate Surfactant 1 N/A N/A N/A Tertiary Amine Catalyst 0.05 ppm 0.15 ppm N/A PERSONAL--PROTECTIVE EQUIPMENT Conditions of use,adequacy of engineering or other control measures,and actual exposures will dictate the Preventive Measures need for specific protective devices at your workplace. Establish a safety zone to keep out nonessential personnel.When spraying outdoors,protect people,cars,etc.against airborne overspray. Eye Protection Eye protection is required when directly handling liquid product.Use appropriate chemical goggles,face shields or full-faced respirator.Persons who work with this product should not wear contact lenses. Use long-sleeve protective clothing impervious to chemicals,boots and chemical-resistant gloves such as nitrile/butadiene rubber("nitrile"or"NBR"),butyl rubber,polyvinyl chloride("PVC"or"vinyl"), Skin Protection polychloroprene(neoprene).Protective gloves and clothing should be worn when handling freshly made polyurethane products to avoid contact with trace residual materials that may be hazardous in contact with skin.Wash hands,forearms and face thoroughly after handling chemical products,before eating,drinking, smoking,using the lavatory and at the end of the working period. Spraying in open-air well ventilated area:Use a properly fitted full-face air purifying respirator with organic cartridges complying with an approved standard if a risk assessment indicates this is necessary.Spraying in Respiratory Protection enclosed areas:Fresh air-line respirators or self-contained breathing apparatus should be used in areas with concentrations above the TLV.Respirator selection must be based on known or anticipated exposure levels, the hazards of the product and the safe working limits of the selected respirator. Environmental Exposure Use local exhaust ventilation to maintain airborne concentrations below the TLV.Ventilation is not required Controls/Ventilation when spraying outdoors.Suitable respiratory equipment should be used in cases of insufficient ventilation or Requirements where operational procedures demand it.For guidance on engineering control measures refer to publications such as the ACGIH current edition of"Industrial Ventilation,a Manual of Recommended Practice". Additional Protective Measures Safety showers and eye wash stations should be easily accessible to the work area. °SECTION 9:PHYSICAL&CHEMICALPROPERTIES 5 ¥¥ Appearance Amber liquid Odor Faint Viscosity @ 77°F(25°C) 250-450 cps Specific Gravity @ 77°F(25°C) 1.08-1.12 Flash Point >200°F(93°C) Auto-Ignition Temperature N/A Boiling Point N/A Freezing/Melting Point N/A Vapor Pressure N/A Vapor Density(Air=1) N/A Solubility in Water Soluble SECTION 10:STABILITY&REACTIVITY z" ' s- r, ng P Stability This product is considered stable under normal and anticipated storage and handling conditions. Conditions to Avoid Avoid exposure to moisture and high temperatures to protect product quality.Avoid open flame. Strong oxidizing and reducing agents:strong acids,strong alkalis,alkaline earth metals(aluminum,zinc, Materials to Avoid copper,etc.),phosphorus and phosphorus-containing compounds.Avoid unintended contact with isocyanates. Hazardous Polymerization Will not occur Hazardous Products of Combustion products may include carbon monoxide,carbon dioxide,nitrogen oxides,halogenated Thermal Decomposition compounds,traces of ammonia vapors,aldehydes and ketones,low molecular weight organic products. Decomposition Temperature N/A 3315 E.Division Street,Arlington,TX 76011 Agribalance B-side Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 3 of 5 SECTION 11:TOXICOLOGICAL INFORMATION Acute Oral Toxicity, Acute InhalationToxicity, Acute DermalToxicity, Repeated Dose Toxicity{ LD50(Rat) LC50(Rat) LD50(Rabbit) (Rat) Polyether Polyol >5,000 mg/kg >200 mg/I(1 hr) >2,000 mg/kg N/A Agricultural Based Polyol N/A N/A N/A N/A Tris-iso-chloropropyl <2000 mg/kg >4.6 mg/l,aerosol(4 hrs) >2,000 mg/kg(24 hrs) 90 Days,oral:NOAEL: Phosphate 36 mg/kg Surfactant 1 3310 mg/kg N/A >2,000 mg/kg N/A Tertiary Amine Catalyst 1070 mg/kg 4 mg/I(4 hr) >250 mg/kg N/A Tertiary Amine Catalyst can cause severe eye and skin irritation;prolonged contact may result in chemical burns and permanent damage of liver,stomach and lungs. POTENTIAL ACUTE HEALTH"EFFECTS Eye Contact Product liquids,aerosols or vapors are irritating.Vapors may cause a transient condition known as glaucopsia, resulting in blurred vision and appearance of halos around bright objects. Skin Contact May cause irritation and dermatitis. Inhalation May cause headaches,dizziness,drowsiness and other central nervous system effects. Ingestion May cause irritation to throat,esophagus and stomach(nausea,abdominal pains,vomiting and diarrhea). POTENTIAL CHRONIC HEALTH EFFECTS . t Sensitization Not known or reported. Carcinogenic Effects The components of this product are not listed by NTP,IARC or regulated as a carcinogen by OSHA. Mutagenic Effects No known significant effects or critical hazards. Reproductive Effects No known significant effects or critical hazards. Developmental Effects No known significant effects or critical hazards. SECTION 12:ECOLOGICAL INFORMATION a z; Ecological testing has not been conducted for this product.Available toxicological data for individual ingredients are summarized below. AQUATIC TOXICITY DATA FOR,rCOMRONENTS:TOXI CIT.Y. _, e aM. h. Polyether Polyol N/A Agricultural Based Polyol N/A Tris-iso-chloropropyl LC50:51 mg/I(96 hrs)(fathead minnow);180 mg/I (96 hrs)(bluegill sunfish); Phosphate 131 mg/I (96 hrs)(daphnia magna) Surfactant 1 LC50:1-10 mg/I(96 hrs)(fish) Toxic to aquatic organisms,may cause long term adverse effects in the aquatic environment. Tertiary Amine Catalyst N/A SECTION 13:DISPOSAL CONSIDERATION The generation of waste should be avoided or minimized whenever possible.Waste must be disposed`of in Waste Disposal Method compliance with federal,state,provincial and local environmental control regulations.Dispose of surplus . and non-recyclable products via licensed waste disposal contractor.Incineration is the preferred method.If incinerated,toxic and corrosive combustion gases must be properly handled. Empty containers retain product residue and can be dangerous.Do not pressurize,cut,weld,braze,solder, Empty Container drill,grind or expose such containers to heat,flame,sparks,static electricity,or other sources of ignition.All Precautions containers should be disposed of in an environmentally safe manner and in accordance with governmental regulations. Demilec has no control over the management practices or manufacturing processes of parties handling or using this material.The information presented here pertains only to the product as shipped in its original condition as described in SIDS Section 3(Ingredients). SECTION-14:TRANSPORTATION INFORMATION k ' Technical Shipping Name Agribalance B-side Land Transport/DOT Classification Non-regulated Sea Transport/IMDG Classification Non-regulated Air Transport/ICAO/IATA Classification Non-regulated TDG Classification Non-regulated Emergency Telephone Number 1-877-DEMILEC(336-4532)or CHEMTREC 800-424-9300 or CANUTEC 613-996-6666 3315 E.Division Street,Arlington,TX 76011 Agribalance B-side Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 4 of 5 SECTION IS:REGULATORY INFORMATION 4T 1p, U.S.FEDERAL REGULATIONS t e, OSHA Hazcom Standard Rating This material is classified hazardous under OSHA Hazard Communication Standard (29 CFR 1910,1200). HSC Classification Irritant U.S.Toxic Substances Control Act TSCA All ingredients are listed on the TSCA Inventory. U.S.EPA CERCLA Hazardous Substances(40 CFR 302) Non-regulated SARA Section 311/312 Hazard Categories Acute Health Hazard;Chronic Health Hazard;Fire Hazard U.S.EPA EPCRA SARA Title III Section 302 Extremely Hazardous Substance Non-regulated (40 CFR 355,Appendix A) U.S.EPA EPCRA SARA Title III Section 313 Toxic Chemicals(40 CFR 372.65)- Non-regulated Supplier Notification Required U.S.EPA RCRA Composite List of If discarded in its purchased form,this product will not be a hazardous waste either by listing or Hazardous Wastes and Appendix Vill by characteristic.However,under RCRA,it is responsibility of the product user to determine at Hazardous Constituents(40 CFR 261) the time of disposal,whether a material containing the product or derived from the product should be classified as a hazardous waste(40 CFR 261.20-24). State Regulations Check individual state requirements. CANADA t WHMIS B/Material causing other toxic effects(toxic) CEPA(DSQ All components are listed or exempted. so SECTION 16:OTHER INFORMATION A-1 2 HMIS Rating 0-Minimal;1-Slight;2-Moderate;3-Serious;4-Severe ,Reactivity 0 Health Hazard:2 NFPA Rating 0-Insignificant;I-Slight;2-Moderate;3-High;4-Extreme Flammability Hazard:I Instability Hazard:0 This product does not contain nor is it manufactured with ozone depleting substances. Notice:The information herein is presented in good faith and believed to be accurate as of the effective date shown below.However,no warranty expressed or implied is given.Regulatory requirements are subject to change and may differ from one location to another;it is the user's responsibility to ensure that its activities comply with country,state,provincial and local laws.This product may present hazards and should be used with caution.While certain hazards are described in this publication,no guarantee is made that these are the only hazards that exist. Hazards,toxicity and behavior of the products may differ when used with other materials and are dependent upon manufacturing circumstances or other processes.Such hazards,toxicity and behavior should be determined by the user and made known to handlers, processors and end users. Prepared By Demilec-EHS Group Current Issue Date February,2015 3315 E.Division Street,Arlington,TX 76011 Agribalance B-side Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Cemilec.com Page 5 of 5 5 A= PM I C8 DEMILEC L*FM DATAI _,SECTION,1:PRODUCT&COMPANY,INFORMATION >. �: Distributed By Product Demilec Trade Name: A-PMDI 3315 E.Division Street,Arlington,TX 76011 Chemical Name: Diphenylmethane Diisocyanate(MDI) Phone:817-640-4900/Fax:817-633-2000 Chemical Family: Aromatic Isocyanate Email:Info@Demilec.com/Website:www.Demilec.com Product Use: Component of a Polyurethane System Emergency Telephone:1-877-DEMILEC(336-4532)or CHEMTREC 800-424-9300 or CANUTEC 613-996-6666 a SECTION 2:HAZARDS IDENTIFICATION , ' � `° � ' f. Physical State/Color/Odor Liquid/Brown/Slightly musty .EMERGENCY OVERVIEW/WARNING; P Y t OSHA/HCS Status This material is classified hazardous under OSHA > < Hazard Communication Standard(29 CFR 1910.1200). Toxic vapors may be released during burning or thermal decomposition.Closed container may forcibly Physical/Chemical Hazards rupture under extreme heat or when contents have been contaminated with water.Use cold water spray to cool fire exposed containers to minimize the risk of rupture. Harmful by inhalation.Irritating to eyes,respiratory system and skin.May cause sensitization by inhalation and skin contact.This product is respiratory irritant and potential respiratory sensitizer:repeated inhalation Human Health Hazard of vapor or aerosol at levels above the occupational exposure limit could cause respiratory sensitization.A hyper reactive response to even minimal concentrations of MDI may develop in sensitized persons.The onset of the respiratory symptoms may be delayed for several hours after exposure.Lung damage and respiratory sensitization may be permanent. SECTION 3:COMPOSITION/INFORMATION ON INGREDIENTS INGREDIENTS, .: r, ,. _ ;. , `CAS."# k µ %• .: a Polymeric Diphenylmethane Diisocyanate(PMDI) 9016-87-9 50-60 4,4'Diphenylmethane Diisocyanate(MDI) 101-68-8 35-45 2,4'Diphenylmethane Diisocyanate(MDI) 5873-54-1 1-5 :SECTION 4:FIRST AID-MEASURES y a ` Eye Contact Immediately flush eyes with running water for a minimum of 15 minutes.Use lukewarm water if possible. Hold eyelids open during flushing.Obtain medical attention immediately. In case of contact,immediately remove contaminated clothing and shoes.Immediately flush skin with soap Skin Contact and water.Use lukewarm water if possible.Wash contaminated clothing and shoes thoroughly before reuse. For severe exposures,immediately get under safety shower and start rinsing.If the irritation develops, obtain medical attention. Move to an area free from further exposure.Obtain medical attention immediately.If breathing is difficult, Inhalation qualified personnel should administer artificial respiration or oxygen.Asthmatic symptoms may develop and may be immediate or delayed up to several hours.Extreme asthmatic reactions can be life threatening. Ingestion DO NOT induce vomiting unless directed to do so by medical personnel.Never give anything by mouth to an unconscious person.If patient is conscious,wash out mouth with water.Get immediate medical attention. No action shall be taken involving any personal risk or without suitable training.If it is suspected that fumes Protection of First-aiders are still present,the rescuer should wear an appropriate mask or self-contained breathing apparatus. It may be dangerous to the person providing aid to give mouth-to-mouth resuscitation. Eyes:Stain for evidence of corneal injury. If cornea is burned,instill antibiotic/steroid preparation as needed. Workplace vapors could produce reversible corneal epithelial edema impairing vision.Skin:this compound is a skin sensitizer.Treat symptomatically as for contact dermatitis or thermal burn.Ingestion:treat ` Notes to Physician symptomatically.There is no specific antidote.Inducing vomiting is contraindicated because of the irritating., nature of compound.Inhalation:treatment is essentially symptomatic.An individual having a dermal or pulmonary sensitization reaction to this material should be removed from further exposure to any diisocyanate.Following severe exposure the patient should be kept under medical review for at least 48 hours. 3315 E.Division Street,Arlington,TX 76011 A-PMDI Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 3-11-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 1 of 6 SECTIONS:FIRE FIGHTING MEASURES Suitable Extinguishing Media Dry chemical,carbon dioxide(CO2),foam,water spray for large fires. Hazardous Products of Combustion products may include carbon monoxide,carbon dioxide,nitrogen oxides,hydrocarbons and Thermal Decomposition HCN. Firefighter should be equipped with self-contained breathing apparatus(SCBA)with a full face-piece Special Fire Fighting operated in positive pressure mode to protect against potentially toxic and irritating fumes generated by Procedures thermal decomposition or combustion during a fire.They should wear appropriate protective equipment such as PVC boots,gloves,safety helmet and protective clothing.Avoid contact with product.Exposure to heated diisocyanate can be extremely dangerous.Decontaminate equipment and clothing prior to reuse. A hazardous pressure buildup could result due to reaction with water producing CO2 gas if contaminated Unusual Fire/Explosion containers are resealed.Containers may burst if overheated.Use cold water spray to cool fire exposed Hazards containers to minimize the risk of rupture.Large fires can be extinguished with large volumes of water applied from a safe distance,since reaction between water and hot diisocyanate can be vigorous. SECTION 6:ACCIDENTACRELEASE MEASURES Evacuate all non-emergency personnel.Isolate the area and prevent access.Eliminate all sources of ignition. Spill and Leak Procedures Notify management.Use protective equipment.Control sources of the leak.Ventilate.Clean-up should be performed by trained personnel. Environmental Precautions:Contain the spill to prevent spread into drains,sewers,water supplies,or soil. Major Spill or Leak:Released material may be pumped into closed,but not sealed metal containers for disposal.Process can generate heat. People dealing with major spillage should wear full protective clothing including respiratory protection.Use suitable protective equipment.Minor Spill or Leak:Cover spill area with Methods for Cleaning-up sand,earth or any suitable absorbent material.Saturate absorbent material with neutralization solution and mix.Wait 15 minutes.Collect material in open-head metal containers.Repeat applications of decontamination solution,with scrubbing,followed by absorbent until the surface is decontaminated.Check for residual surface contamination.Swipe@ test kits have been used for this purpose.Apply lid loosely and allow containers to vent for 72 hours to let carbon dioxide to escape.Wash the spillage area with water. Test atmosphere for MIDI vapor. • a mixture of 75%water,20%non-ionic surfactant and 5%n-propanol Neutralization Solutions 0 a mixture of 80%water with 20%non-ionic surfactant • a mixture of 90%water,3-8%ammonium hydroxide or concentrated ammonia and 2%detergent SECTION'.7:.HANDLING&STORAGE? .•E v Storage Temperature 50-100°F(10-38°C) Storage Life 12 months Do not breathe vapor,mists or dusts.Avoid contact with skin and eyes.Use adequate ventilation to keep airborne isocyanate levels below the exposure limits.The efficiency of the ventilation system must be monitored regularly because of the possibility of blockage.When the product is sprayed,heated,or used in confined space,suitable respiratory protection equipment with positive air supply is required. Keep equipment clean.This material can produce asthmatic sensitization upon either single inhalation exposure to Handling a relatively high concentration or upon repeated inhalation exposures to lower concentrations.Individuals with lung or breathing problems or prior allergic reactions to isocyanates must not be exposed to vapors and mist.Do not breathe smoke and gases created by overheating or burning this material.Decomposition products can be highly toxic and irritating.Keep stocks of decontaminant readily available.Employee education and training in the safe use and handling of this product are required under the OSHA Hazard Communication Standard 29 CFR 1910.1200. Store in tightly closed containers to prevent moisture contamination.Due to reaction with water producing Storage CO2 gas,a hazardous build up of pressure could result if contaminated containers are resealed.Do not reseal container if contamination is suspected.Uncontaminated containers,free of moisture,may be resealed only after placing under a nitrogen blanket. Packaging Containers Suitable:steel,stainless steel.Unsuitable:copper,copper alloys or galvanized surfaces. SECTION 8:EXPOSURE CONTROL/PERSONAL PROTECTION: ; Ingredient Name 4,4'Diphenylmethane Diisocyanate OCCUPATIONAL EXPOSURE-LIMITS r US.ACGIH Threshold Limit Values:TWA:0.005 ppm US.OSHA Table Z-1 Limits for Air Contaminants(29 CFR 1910.1000):Ceiling Limit Value:0.02 ppm,0.2 mg/m3 US. NIOSH:Pocket Guide to Chemical Hazards:Recommended Exposure Limit REL/TWA:0.005 ppm,0.05 mg/m3(10 hour,40 hrs/week) Ceiling Limit Value and Time Period(if specified):0.020 ppm,0.2 mg/m3(10 min) a.ENV1RONMENTAL CONTROLS Provide exhaust ventilation or other engineering controls to keep the airborne vapors concentrations below their respective occupational exposure limits.Standard reference sources regarding industrial ventilation Occupational Exposure (e.g.ACGIH Industrial Ventilation Manual)should be used as a guide about adequate ventilation.To ensure Controls that published exposure limits have not been exceeded,monitoring for airborne diisocyanate should become part of the overall employee exposure characterization program.NIOSH and OSHA have developed sampling and analytical methods and they are available upon request. MDI can only be smelled if the occupational exposure limit has been exceeded considerably. 3315 E.Division Street,Arlington,TX 76011 A-PMDI Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 3-11-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 2 of 6 Environmental Exposure Emissions from ventilation or work process equipment should be checked to ensure compliance with the Controls requirements of environmental protection legislation.In some cases,fume scrubbers,filters or engineering modifications to the process equipment will be necessary to reduce emissions to acceptable levels. PERSONAL PROTECTIVE EOUIPMENTv , ,.0 •¢;.. Eye protection is required when directly handling liquid product.Safety eyewear such as chemical safety Eye Protection goggles or 8"face shield should be used when there is a greater risk of liquid splash.Contact lenses should not be worn when working with this chemical. Avoid all contact with skin.Cover exposed skin area with appropriate clothing to prevent skin contact.Use chemical resistant gloves such as nitrile/butadiene rubber("nitrile"or"NBR"),butyl rubber,polyvinyl chloride("PVC"or"vinyl"),polychloroprene(neoprene).Protective gloves should be worn when handling freshly made polyurethane products to avoid contact with trace residual materials that may be hazardous in Skin Protection contact with skin.Wash hands,forearms and face thoroughly after handling chemical products,before eating,smoking and using the lavatory and at the end of the working period.Appropriate techniques should be used to remove potentially contaminated clothing.Wash contaminated clothing before reusing.Animal tests and other research indicate that skin contact with MDI can play a role in causing isocyanate sensitization and respiratory reaction. Airborne MDI concentrations greater than the ACGIH TLV-TWA(TWA)or OSHA PEL-C(PEL)can occur in inadequately ventilated environments when MDI is sprayed,aerosolized or heated.In such cases,respiratory protection must be worn.The type of protection selected must comply with the requirements set forth in OSHA's Respiratory Protection Standard(29 CFR 1910.134).The type of available protection include:1)an atmosphere-supplying respirator such as a self-contained breathing apparatus(SCBA)or a supplied air Respiratory Protection respirator(SAR)in the positive pressure or continuous flow mode,or 2)an air purifying respirator(APR).If an APR is selected then:a)cartridge must be equipped with an end-of-service life indicator(ESLI)certified by NIOSH,or(b)a change out of schedule,based on objective information or data that will ensure that the cartridges are changed out before the end of their service life,must be developed and implemented.The basis for the change out of schedule must be described in the written respirator program.Further,if an APR is selected,the airborne diisocyanate concentration must be no greater than 10 times the TLV or PEL.The recommended APR cartridge is an organic vapor/particulate filter combination cartridge(OV/P100). All applicants assigned to an isocyanate work area should undergo a pre-placement medical evaluation.A history of asthma,bronchitis,eczema or respiratory allergies such as hay fever,are possible reasons for Medical Surveillance medical exclusion from isocyanate areas.Once a worker has been diagnosed as sensitized to any isocyanate,no further exposure can be permitted.The Occupational Exposure Limits do not apply to previously sensitized individuals.A comprehensive annual medical surveillance program should be instituted for all employees who are potentially exposed to diisocyanates. Additional Protective Measures Ensure that eyewash stations and safety showers are close to the workstation.Educate and train employees in the safe use and handling of this product.Follow all label instructions. SECTION 9:PHYSICAL&CHEMICAL-PROPERTIES t , # #'. •. M '$" $ Physical State Brown liquid Odor Slightly musty Viscosity @ 77°F(25°C) 180-220 cps Specific Gravity @ 77°F(25°C) 1.24 Flash Point >388*F(198°C)by ASTM D 93 Auto-Ignition Temperature >1112°F(600°C) Boiling Point -406-F (208°C) Bulk Density 1.234 kg/m3 . PH N/A Vapor Pressure <0.0001 mmHg @ 77°F(25°C)(MDI) Vapor Density(Air=1) 8.5 for MDI Solubility in Water Insoluble.Reacts slowly with water to liberate COz SECTION 10:STABILITY(&REACTIVITY p' - u, a o rat Stable at room temperature.This product will react and release heat with any materials containing active hydrogen.The reaction is accelerated and can be violent at higher temperatures if the miscibility of the Incompatibility ' reaction partners is good or is supported by stirring or by the presence of solvents.MDI is insoluble with and heavier than water and sinks to the bottom,but reacts slowly at the interface.A solid water-insoluble layer of polyurea is formed at the interface by liberating CO2. Conditions/Materials to Avoid Avoid high temperatures.Avoid water,alcohols,amines,bases,copper alloys Hazardous Polymerization May occur at elevated temperatures(350°F(177°C)),in the presence of alkalies,tertiary amines and metal compounds. Hazardous Products of Isocyanate vapors and other irritating,highly toxic gases such as carbon dioxide,carbon monoxide,nitrogen Decomposition oxides,hydrocarbons and HCN. 3315 E.Division Street,Arlington,TX 76011 A-PMDI Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 3-11-15 . Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 3 of 6 SECTION 11:TOXICOLOGICAL INFORMATION Acute Oral Toxicity, Acute Inhalation Acute Dermal Toxicity, Repeated Dose Toxicity(Rat) LD50(Rat) Toxicity,LC50(Rat) LD50(Rabbit) A-PMDI 90 days,inhalation:NOAEL: (data based on >2000 mg/kg 490 mg/m3(4 hr) slightly irritating 1 mg/m3(6 hrs/day 5 days/week) comparable products) Irritation to lungs&nasal cavities 4,4'Diphenylmethane 369 mg/m3(4 hr) 90 days,inhalation:NOAEL: Diisocyanate N/A >2240 mg/m3(1 hr) >10,000 mg/kg 0.3 mg/m3(18 hrs/day 5 days/week) Irritation to lungs&nasal cavities POTENTIAL ACUTE HEALTH EFFECTS :, Eye Contact Irritating to eyes Skin Contact Irritating to skin.May cause sensitization by skin contact. Product is a respiratory irritant and potential respiratory sensitizer.Repeated inhalation of vapors or aerosols at levels above the occupational exposure limit could cause respiratory sensitization.Symptoms Inhalation may include irritation to eyes,nose,throat and lungs,possibly combined with dryness of the throat, tightness of chest and difficulty in breathing.The onset of the respiratory symptoms may be delayed for several hours after exposure.A hyper-reactive response to even minimal concentrations of MDI may develop in sensitized persons. Ingestion Low oral toxicity.Ingestion may cause irritation of gastrointestinal tract. POTENTIAL CHRONIC HEALTH EFFECTS Target Organs Lungs,upper respiratory tract,skin A study was conducted where groups of rats were exposed for 2 years to a respirable polymeric MDI aerosol at concentrations of 0,0.2,1 or 6 mg/m3.No adverse effects were observed at 0.2 mg/m3..At the 1 mg/m3,minimal nasal and lung irritant effects were seen.Only at the top concentration(6 mg/m3)there was an increased incidence of benign tumor of the lung.One malignant pulmonary tumor was seen in the 6 Carcinogenic Effects mg/m3 group.MDI administration to rats in this study did not change the distribution and incidence of tumors from those seen in control animals.The increased incidence of lung tumors is associated with prolonged respiratory irritation and the concurrent accumulation of yellow material in the lung.In the absence of prolonged exposure to high concentrations leading to chronic irritation and lung damage,it is highly unlikely that tumor formation will occur. Mutagenic Effects There is no substantial evidence of mutagenic potential. No adverse reproductive effects are anticipated.No birth defects were seen in two independent animal(rat) Reproductive Effects studies.Fetotoxicity was observed at doses that were extremely toxic(including lethal)to the mother. Fetotoxicity was not observed at doses that were not maternally toxic.The doses used in these studies were maximal respirable concentrations well in excess of the defined occupational exposure limits. .SECTION 12:ECOLOGICAL INFORMATION AQUATIC TOXICITY DATA FOR COMPONENTS TOXICITY I Biodegradation:0%,not degradable(exposure time 28 days) Bioaccumulation:does not accumulate(112 days)(rainbow trout) A-PMDI Acute&Prolonged Toxicity to Fish:LC50:>1,000 mg/I(96 hrs)(zebra fish) (data based on LC50: >3,000 mg/I(96 hrs)(orange-red killifish) comparable products) Acute&Prolonged Toxicity to Invertebrates: EC50: >1,000 mg/I(24 hrs)(daphnia magna) Toxicity to Aquatic Plants:NOEC:1,640 mg/I(72 hrs)(green algae) Toxicity to Microorganisms:EC50:>100 mg/I (3 hrs)(activated sludge) 4,4'Diphenylmethane Acute&Prolonged Toxicity to Fish:LC50:>500 mg/I(24 hrs)(zebra fish) Diisocyanate Acute&Prolonged Toxicity to Invertebrates:EC50: >500 mg/I(24 hrs)(daphnia magna) By considering the production and use of substance,it is unlikely that significant environmental exposure in the air or water will arise.Immiscible with water but will react and produce inert and non-biodegradable Mobility solids.Conversion to soluble products,including diamino-diphenylmethane(MDA)is very low under the optimal laboratory conditions of good dispersion and low concentration. In air,the predominant degradation process is predicted to be relatively rapid OH attack,by calculation and by analogy with related diisocyanates. By comparison with an analogous product,the following values are anticipated.The measured ecotoxiety,i*s that of the hydrolyzed product,generally under conditions maximizing production of soluble species.Even Other Adverse Effects so,the observed ecotoxicity is low/very low.A pond study showed gross contamination caused no significant toxic effects on a wide variety of flora in all tophic levels(including fish),no detectable diamino- diphenylmethane(MDA),and no evidence of bioaccumulation of MIDI or MDA. SECTION TVDISPOSAL CONSIDERATIONS l The generation of waste should be avoided or minimized whenever possible.Waste must be disposed of in Waste Disposal Method compliance with federal,state,provincial and local environmental control regulations.Dispose of surplus and non- recyclable products via licensed waste disposal contractor.Incineration is the preferred method.If incinerated, toxic and corrosive combustion gases must be properly handled. 3315 E.Division Street,Arlington,TX 76011 A-PMDI Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 3-11-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 4 of 6 I Empty containers retain product residue(liquid and/or vapor)and can be dangerous.Do not pressurize,cut,weld, Empty Container braze,solder,drill,grind or expose such containers to heat,flame,sparks,static electricity,or other sources of Precautions ignition.All containers should be disposed of in an environmentally safe manner and in accordance with governmental regulations. Demilec has no control over the management practices or manufacturing processes of parties handling or using this material.The information presented here pertains only to the product as shipped in its original condition as described in SDS Section 3(Ingredients). SECTION 14:TRANSPORTATION INFORMATION ' ;• " ' ' Technical Shipping Name A-PMDI Land Transport/DOT Classification Non-regulated 4,4'Diphenylmethane Diisocyanate RSPA/DOT Regulated Components Reportable Quantity(RQ)for 4,4 MDI:Single containers with >_5,000 Ibs Reportable Quantity(RQ)for A-PMDI:Single containers with >_11,905 Ibs Additional Transport Information In individual containers of less than the Reportable Quantity,material ships as non-regulated. Sea Transport/IMDG Classification Non-regulated Air Transport/ICAO/IATA Classification Non-regulated TDG Classification Non-regulated Emergency Telephone Number 1-877-DEMILEC(336-4532)or CHEMTREC 800-424-9300 or CANUTEC 613-996-6666 ISECTION 15:yREGULATOR*INFORMATION ,U.S.FEDERAL REGULATIONS t OSHA Hazcom Standard Rating This material is classified as hazardous under OSHA Hazard Communication Standard (29 CFR 1910.1200) HSC Classification Toxic/Irritant/Sensitizer US.Toxic Substances Control Act/TSCA All ingredients are listed on the TSCA Inventory US. EPA CERCLA Hazardous Substances 4,4'Diphenylmethane Diisocyanate(CAS 101-68-8)has a 5,000 Ibs RQ.Any spill or release (40 CFR 302) above the RQ must be reported to the National Response Center(800-424-8802). SARA Section 311/312 Hazard Categories Acute Health Hazard,Chronic Health Hazard US. EPA EPCRA SARA Title III Section 302 Extremely Hazardous Substance Non-regulated (40 CFR 355,Appendix A) US. EPA EPCRA SARA Title III Section 313 Components:Polymeric Diphenylmethane Diisocyanate(pMDI):50-60% Toxic Chemicals(40 CFR 372.65)- 4,4'Diphenylmethane Diisocyanate:35-45% Supplier Notification Required US. EPA RCRA Composite List of If discarded in its purchased form,this product will not be a hazardous waste either by listing or Hazardous Wastes and Appendix VIII by characteristic.However,under RCRA,it is the responsibility of the product user to determine` Hazardous Constituents(40 CFR 261) at the time of disposal,whether a material containing the product or derived from the product'- should be classified as a hazardous waste(40 CFR 261.20-24). The following chemicals are specifically listed by individual states;other product specific health State Regulations and safety data in other sections of the SDS may also be applicable to state requirements.For details on your regulatory requirements you should contact appropriate agency in your state. California Prop.65 No ingredients listed COMPONENTS 4 „ CAS# � e_ ;, , ;WEIGHT'% w Massachusetts,New Jersey or Pennsylvania Polymeric Diphenylmethane Diisocyanate(pMDI) 9016-87-9 50-60 Right to Know Substances Lists 4,4'Diphenylmethane Diisocyanate(MDI) 101-68-8 35-45 2,4'Diphenylmethane Diisocyanate(MDI) 5873-54-1 1-5 New Jersey Environmental Hazardous COMPONENTS, CAS# -WEIGHTr% Substances List and/or New Jersey RTK Polymeric Diphenylmethane Diisocyanate(pMDI) 9016-87-9 40-55 Special Hazardous Substances Lists 4,4'Diphenylmethane Diisocyanate(MDI) 101-68-8 35-45 CANADA Class D-1A/Material causing immediate and serious toxic effects(very toxic) WHMIS Class D-2A/Material causing other toxic effects(very toxic) Class D-213/Material causing other toxic effects(toxic) CEPA(DSL) Canada Inventory:All components are listed or exempted. 3315 E.Division Street,Arlington,TX 76011 A-PMDI Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 3-11-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 5 of 6 SECTION 16:OTHER INFORMATION 2 HMIS Rating 0-Minimal;1-Slight;2-Moderate;3-Serious;4-Severe Reactivity " ' 1 Health Hazard:2 NFPA Rating 0-Insignificant;1-Slight;2-Moderate;3 High;4-Extreme Flammability Hazard:1 Instability Hazard:1 This product does not contain nor is it manufactured with ozone depleting substances. Notice:The information herein is presented in good faith and believed to be accurate as of the effective date shown below.However,no warranty expressed or implied is given.Regulatory requirements are subject to change and may differ from one location to another;it is the user's responsibility to ensure that its activities comply with country,state,provincial and local laws.This product may present hazards and should be used with caution.While certain hazards are described in this publication,no guarantee is made that these are the only hazards that exist.Hazards,toxicity and behavior of the products may differ when used with other materials and are dependent upon manufacturing circumstances or other processes.Such hazards,toxicity and behavior should be determined by the user and made known to handlers, processors and end users. Prepared By Demilec-EHS Group Current Issue Date March,2015 3315 E.Division Street,Arlington,TX 76011 A-PMDI Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 - Last Revision 3-11-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.coni Page 6 of 6 B LAZE LO K- `60 TBX DEMILEC DATA 1� Blazelok-TBX is a water based,fire protection,intumescent coating.11 dry mils of Blazelok TBX applied over Heatlok Soy',Demilec APXT" or Sealection®500,or 15 dry mils over Agribalance®meets building code requirements as an interior finish tested in accordance with NFPA 286. The use of Blazelok TBX omits the code prescribed thermal barrier over these products.Blazelok TBX meets the USDA guidelines for incidental food contact when dry. ASTM E 84 Test Results Flame Spread<25,Smoke Developed<50 Protective Properties Compliant with the 2006 IBC Section 803.2,the 2009&2012 IBC Section 803.1.2.1 and the NFPA 101 (per NFPA 286) paragraph 10.2.3.7.2 as an interior finish for use without a prescriptive thermal barrier. Volatility/VOC <50 g/I-Complies with LEED,AQMD and EPA VOC requirements Solvents Water Based-Caution:Do not thin this material. Toxicity Non-Toxic Weight per Gallon 11.2-11.8 lbs. Solids by Volume 58-62% Color White/Gray Heatlok Soy-17 mils wet dries to 11 mils dry film thickness(DFT),nominal. Wet Film/Coat to DFT Demilec APX-17 mils wet dries to 11 mils dry film thickness(DFT),nominal. Sealection 500-17 mils wet dries to 11 mils dry film thickness(DFT),nominal. Agribalance-23 mils wet dries to 15 mils dry film thickness(DFT),nominal. Heatlok Soy-11 mils to comply with the 2006,2009&2012 IBC and IRC. Recommended Final DFT Demilec APX-11 mils to comply with the 2006,2009&2012 IBC and IRC. Sealection 500-11 mils to comply with the 2006,2009&2012 IBC and IRC. Agribalance-15 mils to comply with the 2006,2009&2012 IBC and IRC. Foam Cure Time Prior to 1.5 hours.Use a brush to touch up the coating in the unlikely event the foam sets back from the substrate Application of Coating after the coating is applied.This setback could potentially cause the coating to develop a crack a few mils wide intermittently along the foam's edge. Dry Times Dry to touch-2 to 3 hours depending on humidity/temperature.Humidity above 50%RH has a significant impact on drying time.Thicker than recommended wet thicknesses will adversely affect the drying time. Graco®695/ASM 2100 3300 psi with spray gun tip model number RAC 525,LTX 525 or larger. Recommended Equipment Hose size:use 1/4"dia.last 50'to gun,additional lengths of hose use minimum 3/8"dia.to minimize pressure loss.Remove pump and gun filters prior to spraying. Up to 92 ftZ/gal at 11 mils DFT over Heatlok Soy Coverage Up to 85 ft2/gal at 11 mils DFT over Demilec APX and Sealection 500 Up to 83 ft/gal at 15 mils DFT over Agribalance Coverage rates will be reduced on foam with large undulations or rough surfaces. Minimum Temperatures Storage Temperature=45OF(7°C)/Application Temperature=70OF(21°C) Use infrared gun to confirm temps. Fungus/Mold Resistance No mold growth per ASTM D 3273 test. High Humidity Environments Contact Demilec's Building Science Department for technical assistance. Note:Please contact your local Demilec Technical Service Representative for assistance regarding the installation of this product. Disclaimer:The information herein is to assist customers in determining whether our products are suitable for their applications.We request'- that customers inspect and test our products before use and satisfy themselves as to contents and suitability.Nothing herein shall constitute a warranty,expressed or implied,including any warranty of merchantability or fitness,nor is protection from any law or patent inferred.All patent rights are reserved.The foam product is combustible and must be protected in accordance with applicable codes. Protect from direct flame and spark contact,around hot work for example.The exclusive remedy for all proven claims is replacement of our materials. Fire Wnalogy To A Higher Power 3315 E.Division Street,Arlington,TX 76011 Blazelok TBX Technical Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 1 of 1 B LAZE LO K'- Go TBX DEMILEC tCCI DATA 1 g g Manufactured For Product Demilec Trade Name: BlazelokT'TBX 3315 E.Division Street,Arlington,TX 76011 Chemical Name: Intumescent Coating Phone:817-640-4900/Fax:817-633-2000 E-mail: Info@Demilec.com/Website:www.Demilec.com Emergency Telephone:1-877-DEMILEC(336-4532)or CHEMTREC 800-424-9300 or CANUTEC 613-996-6666 Physical State/Color Liquid/White-Gray EMERGENCY OVERVIEW/WARNING Physical/Chemical Hazards Acute Health Hazard Routes of Entry Eye contact,skin contact,inhalation,ingestion. Eye Contact Direct contact may cause irritation,redness and/or swelling. Skin Contact Direct contact may cause irritation. Inhalation May cause headaches. Ingestion May cause gastrointestinal irritation. Carcinogenicity The components of this product are not listed by NTP,IARC or regulated as a carcinogen by OSHA. No reportable quantities of hazardous ingredients are present. Eye Contact Immediately flush eyes with running water for a minimum of 15 minutes. Skin Contact Thoroughly wash the affected area with soap and water.Remove contaminated clothing. Inhalation Move exposed person to fresh air.If breathing is difficult,administer oxygen. If breathing has stopped,give artificial respiration and seek medical attention. Ingestion If material has been swallowed and the exposed person is conscious,give small quantities of water. Notes to Physician Severe exposure may cause dermatitis and/or a respiratory tract infection. Flash Point N/A Upper Flammable Limit(%vol.) N/A Lower Flammable Limit(%vol.) N/A Suitable Extinguishing Media N/A Explosion Hazards Closed containers may rupture when exposed to extreme heat. Hazardous Products of Thermal Decomposition Carbon monoxide and/or carbon dioxide may be released when exposed to high temperatures. Special Fire Fighting Firefighter should be equipped with self-contained breathing apparatus(SCBA)with a full face-piece Procedures operated in positive pressure mode to protect against potentially toxic and irritating fumes generated by thermal decomposition or combustion during a fire. 3315 E.Division Street,Arlington,TX 76011 Blazelok TBX Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 1 of 3 Personal Precautions Avoid breathing vapors or mist. Provide adequate ventilation.Use suitable protective equipment. Environmental Precautions Avoid spreading of spilled material,runoff and contact with soil,waterways,drains and sewers. Inform the relevant authorities if the product has caused environmental pollution. Methods for Cleaning Up Contain the spill area,cover with an inert absorbent material,and remove to disposal container. Mop with mild detergent or cleaning solution.Observe all federal,state and local laws. Storage Temperature >451E(71C) Storage Life 12 months Storage Precautions Closed containers may rupture when exposed to extreme heat. EXPOSURE LIMIT VALUES -• J, For Product N/A PERSONAL PROTECTIVEtClUIPMENT _0 Eye Protection Eye protection is required during application.Use appropriate chemical goggles with splash guards or side shields or use a full-faced respirator. Use long sleeve protective clothing and rubber/latex gloves.Wash hands,forearms and face thoroughly Skin Protection after handling chemical products,before eating,drinking,smoking,using the lavatory and at the end of the working period. Respiratory Protection Always use safety goggles and a mask with NIOSH approved organic vapor filter. Environmental Exposure Local exhaust as required by job conditions to keep TLV below acceptable limits. Controls/Ventilation Refer to OSHA regulations 29 CFR Part 1910.94. Requirements Additional Protective Measures Safety showers and eye wash stations should be easily accessible to the work area. Appearance White/Gray liquid Flash Point N/A Boiling Point N/A Vapor Density Heavier than air Evaporation Rate Slower than butyl acetate VOC/Volatility <50 g/I-Complies with AQMD and EPA requirements Weight per Gallon 11.2-11.8 lbs. Stability This product is considered stable under normal and anticipated storage and handling conditions. Conditions to Avoid Avoid exposure to extreme heat.Closed containers may rupture when exposed to extreme heat. Materials to Avoid Avoid contact with oxidizing materials. Hazardous Polymerization Will not occur Hazardous Products of Carbon monoxide and/or carbon dioxide may be released when exposed to high temperatures. Thermal Decomposition Decomposition Temperature N/A g POTENTIAL'ACUTE HEALTH'rEFFECTS Eye Contact Direct contact may cause irritation,redness and/or swelling. Skin Contact Direct contact may cause irritation. Inhalation May cause headaches. Ingestion May cause gastrointestinal irritation. POTENTIAL CHRONIC HEALTWEFFECTS F f,. Carcinogenicity The components of this product are not listed by NTP,IARC or regulated as a carcinogen by OSHA. 3315 E.Division Street,Arlington,TX 76011 Blazelok TBX Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 2 of 3 No information available. Waste must be disposed of in compliance with federal,state,provincial and local environmental control Waste Disposal Method regulations.Dispose of surplus and non-recyclable products via licensed waste disposal contractor. Incineration is the preferred method.If incinerated,toxic and corrosive combustion gases must be properly handled.DO NOT incinerate closed containers. Demilec has no control over the management practices or manufacturing processes of parties handling or using this material. The information presented here pertains only to the product as shipped in its original condition. . , Technical Shipping Name Blazelok TBX Land Transport/DOT Classification Non-regulated Sea Transport/IMDG Classification Non-regulated Air Transport/ICAO/IATA Classification Non-regulated TDG Classification Non-regulated WHMIS Classification Non-regulated Emergency Telephone Number 1-877-DEMILEC(336-4532)or CHEMTREC(800)424-9300 or CANUTEC(613)996-6666 U.S.EPA EPCRA SARA Title III Section 313 None Toxic Chemicals(40 CFR 372.65) State Regulations Check individual state requirements. Notice:The information herein is presented in good faith and believed to be accurate as of the effective date shown below.However,no warranty expressed or implied is given.Regulatory requirements are subject to change and may differ from one location to another;it is the user's responsibility to ensure that its activities comply with country,state,provincial and local laws.This product may present hazards and should be used with caution.While certain hazards are described in this publication,no guarantee is made that these are the only hazards that exist.Hazards,toxicity and behavior of the products may differ when used with other materials and are dependent upon manufacturing circumstances or other processes.Such hazards,toxicity and behavior should be determined by the user and made known to handlers, processors and end users. Prepared By Demilec-EHS Group Current Issue Date February,2015 3315 E.Division Street,Arlington,TX 76011 Blazelok TBX Safety Data Sheet Phone(817)640-4900,Toll Free(877)336-4532 Last Revision 2-16-15 Fax(817)633-2000,Info@Demilec.com,www.Demilec.com Page 3 of 3 i r� NOR � 'ti.. r� a e ca � l a R4 s t a 74 4�`��x'". >a�, w,, ,,d,',. ,I ,. x '�#•��"� t+;�"x��'""k� &s -0a�?Y r'„��w''Y� � �rt*_: �" 3r . r t a: 2 . DIVISION: 07 00 00—THERMAL AND MOISTURE PROTECTION SECTION: 07 2100-THERMAL INSULATION REPORT HOLDER: ,;. DEMILEC (USA) 1NC. 3315'EAST DIVISION STREET ARLINGTON,TEXAS76011 EVALUATION SUBJECT: SEALECTION® 500 SPRAY-APPLIED POLYURETHANE FOAM-INSULATION ICC ICC ICC c PMG LISTED Look for the trusted marks of Conformity! "2014 Recipient of Prestigious Western States Seismic Policy Council (WSSPQ Award in Excellence" A Subsidiary of CODEc uNc ICC-ES Evaluation Reports are not to be construed as representing aesthetics or any other attributes not S"` '"d specifically addressed, nor are they to be construed as an endorsement of the subject of the report or a f recommendation for its use. There is no warranty.by ICC Evaluation Service, LLC, express`or implied, as P G!D to any finding or other matter in this report, or as to any product covered by the report. PRooWf M" n«roaeaea+ Copyright © 2016 ICC Evaluation Service, LLC. All rights reserved. f IMES Evaluation Report ESR-1172 Reissued February 2016 This report is subject to renewal February 2017. www.icc-es.org 1 (800)423-6587 i (562) 699-0543 A Subsidiary of the International Code Council® DIVISION:07 00 00—THERMAL AND MOISTURE material in Type I, II, III, IV and Type V construction under PROTECTION the IBC and in dwellings under the IRC. The insulation is Section:07 21 00—Thermal Insulation for use in wall cavities, floor/ceiling assemblies, or attics and crawl spaces when installed in accordance with REPORT HOLDER: Section 4.0. Under the IRC and the 2015 IBC, the insulation may be used as air-impermeable insulation DEMILEC(USA)INC. when installed in accordance with Section 3.4. The 3315 EAST DIVISION STREET insulation may be used in nonload-bearing,fire-resistance- ARLINGTON,TEXAS 76011 rated walls when construction is in accordance with (817)640-4900 Section 4.5. www.demilecusa.com info(&demilecusa.com The attributes of the insulation have been verified as conforming to the provisions of ICC 700-2008 Section EVALUATION SUBJECT: 703.2.1.1.1(c) as an air impermeable insulation. Note that decisions on compliance for those areas rest with the user SEALECTION® 500 SPRAY-APPLIED POLYURETHANE of this report. The user is advised of the project-specific FOAM INSULATION provisions that may be contingent upon meeting specific conditions, and the verification of those conditions is 1.0 EVALUATION SCOPE outside the scope of this report.These codes or standards 1.1 Compliance with the following codes: often provide supplemental information as guidance. ■ 2015,2012 and 2009 International Building Code®(IBC) 3.0 DESCRIPTION ■ 2015, 2012 and 2009 International Residential Code® 3.1 Materials: (IRC) SEALECTION® 500 spray-applied foam insulation is ■ 2015, 2012 and 2009 International Energy Conservation semirigid, low-density, polyurethane foam plastic that is Code®(IECC) installed as a component of floor/ceiling and wall ■ 2013 Abu Dhabi International Building Code(ADIBC)t assemblies.The insulation is a two-component spray foam plastic with a nominal in-place density of 0.5 pcf(8 kg/m ). (The ADIBC is based on the 2009 IBC.2009 IBC code sections referenced The insulation is produced in the field by combining a in this report are the same sections in the ADIBC. ■ Other Codes see Section 8.0 polymeric isocyanate (A-PMDI component, A-Side ISO) ( ) with a polymeric resin (SEALECTION 500 B-Side Properties evaluated: component).The insulation liquid components are supplied ■ Surface-burningcharacteristics in 55-gallon (208 L)drums and/or 250-gallon (946 L)totes and must be stored at temperatures between 50OF (10°C) ■ Physical properties and 100°F (380C). The liquid components have a shelf life ■ Thermal resistance of one year when stored in factory-sealed containers at ■ Attic and crawl space installation these temperatures. ■ Air permeability 3.2 Surface-burning Characteristics: ■ Fire-resistance-rated construction The insulation, at a maximum thickness of 6 inches (152 mm)and a nominal density of 0.5 pcf(8 kg/m3), has a ■ Exterior walls in Type I through IV construction flame-spread index of 25 or less and a smoke-developed 1.2 Evaluation to the following green green standard: index of 450 or less when tested in accordance with ASTM ■ 2008 ICC 700 National Green Building StandardTm (ICC E84. Greater thicknesses are recognized as described in 700-2008) Sections 4.3 and 4.4. SEALECTIONO 500 thickness is not limited when separated from the interior of the building by Attributes verified: a prescriptive thermal barrier as complying with the IBC or ■ See Section 2.0 IRC and as described in Section 4.3.1. 2.0 USES 3.3 Thermal Resistance,R-values: SEALECTION® 500 spray-applied polyurethane foam The insulation has thermal resistance (R-value)at a mean insulation is used as a nonstructural thermal insulating temperature of 75°F(24°C)as shown in Table 1. ICC-ES Evaluation Reports are not to be construed as representing aesthetics or any other attributes not specifically addressed,nor are they to be construed as an endorsement of the subject of the report or a recommendation for its use.There is no warranty by!CC Evaluation Service,LLC express or implied,as dui to any finding or other matter in this report,or as to any product covered by the report, imrux Copyright©2016 ICC Evaluation Service,LLC. All rights reserved. Page 1 of 5 1� f ESR-1172 1 Most Widely Accepted and Trusted Page 2 of 5 3.4 Air Permeability: identified in the Demilec application guide. The insulation SEALECTION® 500 spray-applied polyurethane foam must be applied when the ambient temperature is greater insulation, at a minimum thickness of 3.0 inches (76 mm), than 23°F (-5°C).The insulation must not be used in areas is considered air-impermeable insulation in accordance that have a maximum in-service temperature greater than with 2015 and 2012 IRC Section R806.5 (2009 IRC 180°F (82°C). The foam plastic must not be used in Section R806.4) and 2015 IBC Section 1203.3, based on electrical outlet or junction boxes or in contact with water, testing in accordance with ASTM E2178. rain or soil. The foam plastic must not be sprayed onto a substrate that is wet, or covered with frost or ice, loose 3.5 BlazelokTm 1134 Intumescent Coating: scales, rust, oil, or grease. The insulation must be BlazelokTm 1134 intumescent coating, manufactured by protected from the weather during and after application. TPR2 Corporation, is a one-component, water-based liquid The insulation may be applied to the maximum thickness coating with specific gravity of 1.3. BlazelokTm I134 is in a single pass. Where insulation is used as an air- supplied in 5-gallon (19 L) pails and/or 55-gallon (208 L) impermeable insulation, such as in unvented attic drums and has a shelf life of one year when stored in assemblies under 2015 and 2012 IRC Section R806.5 factory-sealed containers at temperatures between 45°F (2009 IRC Section R806.4) or 2015 IBC Section 1203.3, (7°C)and 90°F(32°C). the insulation must be installed at a minimum thickness of 3.6 BlazelokTm TB Intumescent Coating: 3.0 inches(76 mm). BlazelokTm TB intumescent coating, manufactured by TPR2 4.3 Thermal Barrier: Corporation, is a one-component, water-based liquid 4.3.1 Application with a Prescriptive Thermal Barrier: coating with specific gravity of 1.3. BlazelokTm TB is SEALECTION® 500 spray foam insulation must be supplied in 5-gallon (19 L) pails and/or 55-gallon (208 L) separated from the interior of the building by an approved drums and has a shelf life of one year when stored in thermal barrier of 1/2-inch-thick (12.7 mm) gypsum factory-sealed containers'at temperatures between 45°F wallboard or an equivalent 15-minute thermal barrier (7°C)and 90°F(320C). complying with, and installed in accordance with, IBC 3.7 BlazelokTm TBX Intumescent Coating: Section 2603.4 or IRC Section R316.4, as applicable, BlazelokTm TBX intumescent coating, manufactured by except where insulation is in an attic ®r crawl space as 2 described in Section 4.4. SEALECTION 500 thickness is TPR Corporation, is aone-component, water-based liquid not limited when separated from the interior of the building coating with specific gravity of 1.4. BlazelokTm TBX is by a prescriptive thermal barrier as complying with the IBC supplied in 5-gallon (19 L) pails and/or 55-gallon (208 L) or IRC. drums and has a shelf life of one year when stored in factory-sealed containers at temperatures between 45°F 4.3.2 Application without a Prescriptive Thermal (7°C)and 90°F(32(1C). Barrier:The prescriptive 15-minute thermal barrier may be 3.8 Andek Firegard Intumescent Coating: omitted when installation is i®accordance with this section and Table 2. SEALECTION 500 spray foam insulation Andek Firegard intumescent coating, manufactured by and BlazelokTm TB, BlazelokTm TBX or DC 315 Andek Corporation, is a one-component, water-based intumescent coating may be spray-applied to the interior coating with specific gravity of 1.37. Andek Firegard is facing of walls, the underside of roof sheathing or roof supplied in 5-gallon (19 L) pails and has a shelf life of one rafters, and in crawl spaces, and may be left exposed as year when stored in factory-sealed containers at an interior finish without a prescribed 15-minute thermal temperatures between 45°F(7°C)and 90°F(320C). barrier or ignition barrier. The foam plastic insulation 3.9 No-Burn®Plus XD Intumescent Coating: thickness must not exceed thicknesses stated in Table 2. No-Burn® Plus XD intumescent coating, manufactured by All foam surfaces must be covered with intumescent No-Burn, Inc., is a translucent aqueous liquid in 1- and coating, described in Section 3.6, at the minimum 5-gallon 3.8 and 18.8 L thicknesses stated in Table 2. The intumescent coating g ( ) pails and 5hrgallon (208 L) must be spray-applied over the insulation in accordance drums. The coating has a shelf life of three years when with the coating manufacturer's instructions and this report stored in a factory-sealed container at temperatures at a rate stated in Table 2 to obtain the recommended between 40°F(4.5°C)and 90°F(32°C). minimum dry film thickness noted in this section. 3.10 DC 315 Fireproof Paint: 4.4 Ignition Barrier-Attics and Crawl Spaces: DC 315, manufactured by International Fireproof Technology, Inc., is a one-component, water-based, liquid 4.4.1 Application with a Prescriptive Ignition Barrier: coating with a specific gravity of 1.3. DC 315 is supplied in When SEALECTION® 500 spray foam insulation is 5-gallon (19 L) pails and/or 55-gallon drums and has a installed within attics or crawl spaces where entry is made shelf life of one year when stored in unopened factory- only for service of utilities, an ignition barrier must be sealed containers between 50°F(10°C)to 80°F(27°C). installed in accordance with IBC Section 2603.4.1.6 or IRC 4.0 INSTALLATION Section R316.5.3 or R316.5.4, as applicable. The ignition barrier must be consistent with the requirements for the 4.1 General: type of construction required by the applicable code, and SEALECTION®500 spray-applied foam insulation must be must be installed in a manner so thefoam plastic installed in accordance with the Center for Polyurethane insulation is not exposed. SEALECTION® 500 spray- -Industries Guidance on Best Practices for the Installation of applied foam insulation as described in this section may be Spray Polyurethane Foam, the manufacturer's published installed in unvented attics in accordance with 2015 IBC technical data sheet and product application guide and this Section 1203.3 or 2015 and 2012 IRC Section R806.5 report. A copy of each document must be available at all (2009 IRC Section R806.4). times on the jobsite during installation. 4.4.2 Application without a Prescriptive Ignition 4.2 Application: Barrier: The SEALECTION®500 insulation is spray-applied on the 4.4.2.1 General: SEALECTION® 500 spray-applied foam jobsite using a volumetric positive displacement pump as insulation may be installed in attics and crawl spaces, ESR-1172 1 Most Widely Accepted and Trusted Page 3 of 5 without a prescriptive ignition barrier as described in IBC comply with Section 2603.5 of the IBC at a maximum Section 2603.4.1.6 and IRC Sections R316.5.3 and thickness of 35/8 inches (92 mm), when installed per the R316.5.4, in accordance with Section 4.4.2.2, 4.4.2.3, manufacturer's published product application guide and 4.4.2.4, or 4.4.2.5, when all of the following conditions this section. The potential heat of Demilec SEALECTION® apply: 500 spray polyurethane foam insulation is 496 Btu/ft2 a. Entry to the attic or crawl space is only to service (5.6 MJ/mz) per inch of thickness when tested in utilities,and no storage is permitted. accordance with NFPA 259. b. There are no interconnected attic or crawl space 4.6.1 Nonload-bearing NFPA 285-tested Wall areas. Assembly: c. Air in the attic or crawl space is not circulated to other 4.6.1.1 Interior Face: One layer of 5/8-inch-thick parts of the building. (16 mm), Type X gypsum wallboard complying with ASTM C36 or ASTM C1396 is installed with the long dimension d. Under-floor(crawl space)ventilation is provided when perpendicular to 35/8-inch-deep (92 mm), 20 gage steel required by 2015 IBC Section 1203.4 (2012 and 2009 studs spaced a maximum of 24 inches (609 mm) on IBC Section 1203.3) or IRC Section R408.1, as center. The wallboard is attached with 11/4-inch-long applicable. (31.8 mm), bugle head screws located 8 inches (203 mm) e. Attic ventilation is provided when required by IBC on center along the perimeter and 12 inches on center Section 1203.2 or IRC Section R806, except when air- (305 mm) in the field of the wallboard. Wallboard joints impermeable insulation is permitted in unvented attics in must be taped and treated with joint compound in accordance with 2015 IBC Section 1203.3 or 2015 and accordance with ASTM C840 or GA-216. Fastener heads 2012 IRC Section R806.5(2009 IRC Section R806.4). must also be treated with joint compound in accordance with ASTM C840 or GA-216. f. Combustion air is provided in accordance with IMC 4.6.1.2 Stud Cavity: SEALECTION®500 foam insulation, (International Mechanical Code )Section 701. in a maximum thickness of 35/8 inches (92 mm), is spray- 4.4.2.2 The insulation must be covered on all surfaces applied in all stud cavities. with a fire protective coating at the minimum thickness set 4.6.1.3 Exterior Face: One layer of 5/8-inch-thick forth in Table 3. (16 mm�GP DensGlasso sheathing attached to steel studs 4.4.2.3 The maximum installed thickness of the insulation using 1 /4-inch-long(31.8 mm), self-tapping screws spaced must not exceed the thicknesses set forth in Table 3. 8 inches (203 mm) on center along the perimeter and 4.4.2.4 The coating must be applied over the insulation in 12 inches on center(305 mm)in the field of the sheathing. accordance with the coating manufacturer's instructions Details of the exterior wall covering must be provided by and this report. the report holder, designer or specifier to the code official, with a fire engineering analysis demonstrating that the 4.4.2.5 Use on Attic Floors: SEALECTION® 500 spray- addition of the wall covering will not negatively affect applied foam insulation may be installed at a maximum conformance of the assembly with the requirements of IBC thickness between and over the joists in attic floors as set Section 2603.5. forth in Table 3.All exposed foam plastic surfaces must be 5.0 CONDITIONS OF USE covered with a minimum nominal thickness of the fire protective coatings as set forth in Table 3.The intumescent SEALECTION®500 spray foam insulation described in this coatings must be applied over the insulation in accordance report complies with, or is a suitable alternative to what is with the coating manufacturer's instructions and this report. specified in,those codes listed in Section 1.0 of this report, 4.5 One-hour Fire-resistance-rated Wall Assemblies subject to the following conditions: (Nonload-bearing): 5.1 The products must be installed in accordance with the SEALECTION® 500 foam insulation may be used as a Center for Polyurethane Industries"Guidance on Best component of a one-hour fire-resistance-rated, nonload- Practices for the Installation of Spray Polyurethane bearing wall assembly as described in this section Foam", the manufacturer's published technical data (Section 4.5). sheet and product application guide, this evaluation report and the applicable code. If there are any 4.5.1 Interior and Exterior Face: One layer of 5/8-inch- conflicts between the manufacturer's published li thick (16 mm), Type X gypsum wallboard complying with installation instructions and this report, this report ASTM C36 or ASTM C1396 is installed on the interior and governs. exterior side of nominally 2-by-6, No. 1, Southern yellow 5.2 The insulation must be separated from the interior of pine wood studs spaced 16 inches (406 mm) on center. the building by an approved 15-minute thermal The wallboard is attached with 15/8-inch-long (41 mm), installation is as described in t when barrier, except coarse-thread drywall screws located 8 inches (203 mm) Sections xcep or when through 4.4.2.5. on center along the perimeter and 12 inches on center (305 mm) in the field of the wallboard. Wallboard joints 5.3 The insulation must not exceed the thicknesses noted must be taped and treated with joint compound in in Sections 3.2,4.2,4.3,4.4,4.5,and 4.6. accordance with ASTM C840 or GA-216. Fastener heads 5.4 The insulation must be protected from exposure to must also be treated with joint compound in accordance weather during and after application. with ASTM C840 or GA-216. 4.5.2 Stud Cavity: A nominally 51/2-inch (140 mm) 5.5 The insulation must be applied by contractors thickness of SEALECTION® 500 foam insulation is spray- authorized by Demilec(USA)Inc. applied in all stud cavities. 5.6 Use of the insulation in areas where the probability of 4.6 Exterior Walls of Type I,II,III and IV Construction: termite infestation is "very heavy" must be in accordance with IRC Section R318.4 or 2015 and When used on exterior walls of Type I, II, III and IV 2009 IBC Section 2603.8 (2012 IBC Section 2603.9), construction, the SEALECTION®500 foam insulation must as applicable. ESR-1172 1 Most Widely Accepted and Trusted Page 4 of 5 5.7 When use is on exterior walls of buildings of Type I, II, 8.0 OTHER CODES III, and IV, construction must be as described in 8.1 Evaluation Scope: Section 4.6. 5.8 See Section 4.5 for the fire-resistance-rated wall In addition to the codes referenced in Section 1.0, the assemblies. products recognized in this report have also been evaluated in accordance with the following codes: 5.9 Jobsite certification and labeling of the insulation must ■ 2006 International Building Code®(2006 IBC) comply with 2015 IRC Section N1101.10, 2012 IRC Section N1101.14, 2015 or 2012 IECC Sections ■ 2006 International Residential Code®(2006 IRC) C303.1, R303.1 and R401.3 [2009 IECC Section ■ 2006 International Energy Conservation Code® 303.1 and 401.3],as applicable. (2006 IECC) 5.10 The insulation is produced in Arlington, Texas, ■ 2003 International Building Code®(2003 IBC) under a quality-control program with inspections by [CC-ES. ■ 2003 International Residential Code®(2003 IRC) 6.0 EVIDENCE SUBMITTED ■ 2003 International Energy Conservation Code® 6.1 Data in accordance with the ICC-ES Acceptance (2003 IECC) Criteria for Spray-applied Foam Plastic Insulation 8.2 Uses: (AC377),dated May 2015, including reports of tests in The products comply with the above-mentioned codes as accordance with Appendix X. described in Sections 2.0 through 7.0 of this report except 6.2 Reports of fire propagation characteristics tests in as noted below: accordance with NFPA 285. ■ Application with a Prescriptive Thermal Barrier: See 6.3 Reports of air leakage testing in accordance with Section 4.3.1, except the approved thermal barrier must ASTM E283. be installed in accordance with Section R314.4 of the 6.4 Reports of air permeance tests in accordance with 2006 IRC or Section R314.1.12 of the 2003 IRC. ASTM E2178. ■ Application without a Prescriptive Thermal Barrier: 6.5 Reports of room corner tests in accordance with See Section 4.3.2. NFPA 286. ■ Application with a Prescriptive Ignition Barrier: See 6.6 Reports of tests in accordance with ASTM El19. Section 4.4.1, except attics must be vented in accordance with Section 1203.2 of the 2006 and 2003 6.7 Reports of potential heat tests in accordance with IBC or Section R806 of the 2003 IRC, and crawl space NFPA 259. ventilation must be in accordance with IBC Section 7.0 IDENTIFICATION 1203.3 of the 2006 and 2003 IBC or IRC Section R408, as applicable. Additionally, an ignition barrier must be Components of the spray foam insulation are identified installed in accordance with Sections R314.5.3 or with the manufacturers name (Demilec (USA) Inc.), R314.5.3 of the 2006 IRC or Section R314.2.3 of the address and telephone number; the product name 2003 IRC,as applicable. (SEALECTION® A-PMDI or SEALECTION® 500 B- 0 Application without a Prescriptive Ignition Barrier: Side); use instructions; the density; the flame-spread and See Section 4.4.2, except attics must be vented in smoke-developed indices; the date of manufacture; accordance with Section 1203.2 of the 2006 and 2003 thermal resistance values; the evaluation report number IBC or Section R806 of the IRC, and crawl space (ESR-1172); and the name of the inspection agency ventilation must be in accordance with Section 1203.3 of (Intertek Testing Services NA). the 2006 and 2003 IBC or IRC Section R408, as Each pail of the BlazelokTM 1134 and the Blazelok rm TB or applicable. BlazelokT"^ TBX intumescent coating is labeled with the manufacturer's name (TPR2 Corporation), the product • Protection against Termites: See Section 5.6, except name, and use instructions. Each pail of Andek use of the insulation in areas where the probability of Corporations Firegard intumescent coating is labeled with termite infestation is "very heavy" must be in the manufacturers name(Andek Corporation)and address, accordance with Section R320.5 of the 2006 IRC or the product trade name, and use instructions. Section R320.4 of the 2003 IRC. No-Burn® Plus XD intumescent coating is identified with •Jobsite Certification and Labeling: See Section 5.9, the manufacturer's name (No-Burn, Inc) and address, the except jobsite certification and labeling must comply product trade name,and use instructions. with Sections 102.1.1 and 102.1.11, as applicable, of the 2006 IECC. Each pail of DC315 is labeled with the manufacturer's name (International Fireproof Technology Inc.), address, product trade name and use instructions. i ESR-1172 I Most Widely Accepted and Trusted Page 5 of 5 TABLE 1—THERMAL RESISTANCE(R-VALUES) THICKNESS(inches) R-VALUE(°F.ft2 h/Btu) 1 3.8 3.5 13 4 15 5.5 21 7 27 9.5 36 10 38 11.5 44 14 52 For SI: 1 inch=25.4 mm;1 °F.ft2.hBtu=0.176 110°K.m2/W. 'R-values are calculated based on tested K-values at 1-and 4-inch thicknesses. TABLE 2—USE OF INSULATION WITHOUT A PRESCRIPTIVE THERMAL BARRIER Maximum Insulation Maximum Insulation Fire Protective CoatingA lied to all Foam Surfaces Coating Thickness(i Thickness(in.) Minimum Coating Dry Minimum Coating Wet Minimum Vertical Surfaces s Ceiling Surfaces Film Thickness mils Film Thickness mils Application Rate Blazelok TB 5/2 10 14 25 1 al/82 ft Blazelok TBX 7/2 102 11 17 1 al/85 ft DC315 7/2 11 /2 12 18 1 al/90 ft For SI: 1 inch=25.4 mm;1 gal=3.785 L;1 ft2=0.093 m2. TABLE 3—ATTIC OR CRAWL SPACE ASSEMBLIES WITHOUT A PRESCRIPTIVE IGNITION BARRIER Maximum Insulation Maximum Insulation Fire Protective Coating Coating Thickness(in.) Thickness(in.) (Applied to all Foam Surfaces Vertical Surfaces and CeilingSurf Minimum Coating Dry Minimum Coating Minimum Attic Floors aces Film Thickness Wet Film Thickness Application Rate Blazelok 164 9/a 11 /a 5 9 1 al/175 Andek Fire and 9/2 11 /2 10 20 1 al/l00 ff No-Burn Plus XD 9/2 11 /2 6 10 1 al/l60 DC 315 7/2 1172 3 4 1 al/??ft For SI: 1 inch=25.4 mm;1 gal=3.785 L;1 ft2=0.093 m2. c TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION rA,) ,2LOf�o Map2,u Parcel l Application'# `� Health Division Date Issued 9' / Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis ��� S Project Street Address 3 I�eSt /LlGiir�S//C�f . : Village W ,/ 0wner���,�J6.0, r jet" � r,.-"S Address �►/ ,� ray SSIn,a Telephone G G1 51** Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation a 000 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new -Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) _ Name yfG e_SG0 PfJfte f i /D Telephone Number 7�� �'g� O•Z00 Address- ag& License # CS! —Q Z�2E 3 7 19, tz X AV/V" 11 Home Improvement Contractor# Email V�n,izo� ✓��Worker's Compensation # A/� 3 OD 'ITI � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO AzSIGNATUR DATE FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED �► MAP/ PARCEL NO. ADDRESS VILLAGE OWNER 1 DATE OF INSPECTION: FOUNDATION i FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL I GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. t The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 1.00- Boston, "-02114-101"Y www mass gov%dig 1t otleers'Co_mpensation Insurance Atfidavifc Btulders/ContractorsZElectricianslPlu�nbers TO.BE FILLED WITH THE PERMI.rrtNG AUTHORITY. Apulicant Infortnadon PleasePririt Le tjibly Name(Business/Organizaiiodandividuat)-. ha eo Address:: G LStatelZi ,(, t 1 tY p J 'hone 'Are-you Dyer'Check e:appropri. box Type of prolecf.(regmredj': It tamacalpi9ye sNltan part ?. {{----��`New,Construction O ._ _- 2:❑fain a.sole pioprietor or paitnetship and have no iinptoyees working;forme in. $ .�`Remodeling. any capacity.[No.workers'comp insurance required) 3.Q1 ara a homeowner doing all work myself:'[No workers comp.tsurance regwred]" 9. ❑DemoliEion. 10[]:Buildtng addition 4; 1 am a homeowner and willbe luring contractors to conduct 0 work on my'property..l witi a:eosure thatall.contractors eAff have workers'compensation insurance-or are sole:' ILC]:1 lectricaf-repairs:or additions proprietors with no,employees. 12[:]Plumbing:repaits_or addition"s. 5^l am a general conttaetor and t'have.himditlie sub contractors listed•omthe atta_ched sheet: 13. Roof r 2tt5 S. . : . . Thesesub-contractors'have,employees:andhave,workers:comp insurance,.. :14110ther -_ 6. 14e;ait:a'corporationand its officers lCaveexercised tteeu:tigtif of exemption per iti1GE.c: ` 152,§1(4),and4e.Mire noemployees:[No workers'comp.insurance repaired] *Any_applicant that checks liox z#1 must also-fill out the section below showing their workers eompensanon policy mtormatioh. t Homeowners who submit this affidavit.indicating they.,are;doing all work and then hire outside'oontractdAs fiiust submita new affidavit indicating such:, 'Contractors that eheckthis box trust:attached an additional:s`hezishowing then Ae of the:sub•contiactor`s.and:state whether or not those entities have _ -- . employees-I.fthe:sub-con�otshaveemploypps,they.must,prgvride their workers'cotnp..policynumber. l am ail employer that.is providing woekers'.ronipe»sation insurance for my employees., Below.is the:policy.andjobsite. f rnforrahoit. TU Insurance Company..ame._ W Policy#or;Self ins.Li'C #. i t l Expirat on'Date: C�:' r City/StatclZ Job Sife Address C ''Attach a copy-of the wor-ken!.cmpenation:policy declaration,pag� hwgeph ndexii"tiondato( Failure to secure coverage a§regutred under MGL c 152 §-75A`is a criminal volatton;puntshable:'by,"a fine up tot$1 50Q:00 and/or'one year impnsottmp%as well as civil penalties in the forcri of a STOP WORK�MMER and a.ftne:of t(p. to S250 OO a dayagamst the violator-,.A.A copy of thtss_tatemerit may be forty_azded to the Office of Inxesttgations of the:DIA foc insurance # coverage verification;. t I do Hereby cePhfy under lhe:ruins and penalties of er:uty that•the injorntalion provided above is"true:anrl;correcG Signature: - ;Date: Phone#. Of jRa!a use::onlyi:Do nol:►vrite ui this,red,to 6e completed by ctfy'or to"ofcraL City or Town; Permttll icens' # Is uing.Authortty,(circle one).: ;1.;Board:oflElealth 2 li;uilding,Department 3 (6t TowwClerk :4.Electr cahInspector: 5.Piunibing-inspector. 6..Other ' Contact Person:. Phone#r I E Eno '°'�9D200 FRANCESCO DEMOLITION, INC. I DEMOLITIONP 0. 86*1915- I Duzburv.MA 02331 10, .781.585.0200 1 F. 781,934.9.191 July, 28; 2D16. Town:of`Barnstable: Building; nspector ToW.h..Hall Hyannis, MA 02601 I i ' RE . 395 (Nest Main. Street, Hyannis MA - This is to certify that'=at I'Frank Durante President.and Owner of Francesco Demolition,, Inc hereby authorize Francesca 'WaddelI the Account Manager:of' Francesco Demolition; Inc;. ,(CS 75537.) to pull the:demolition permit for the said project, l f i Sincerely.,. Francesco Demolition;: Inc: Frank Durante President E. t t - - i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Canso ui`u0i�Supervisor +rs� License: CS-075537 FRANCESCA M VJ�AD 25 MARLYMAC WA� ¢ PEMBROKE MX---023bMffj Ns Expiration Commissioner 05/25/2017 S . ....-_ MA �5. --' 11 A 'if lvlasszmhuseits.Departtn�nt of EAvironmental P;rotecttor, Ismot,mon Copy Hire:is-the:file you requested fofyour records:: To retain a copy of N file:you.must Sage and/or o int, Usiinarne: .FRANCEWO 7ransacion ID' 838546 dttll7lc(ft At106. ConstructionlDemohi-lan Notificaiion &Ze.of 5ifi2;; 100.88K Status of TransactWP'._ In Process Dade ard;Tiin .Cteat?tl`; 61912016 1 i:43"-52 AWI: Note.This Be only ncludes cormstn3t.3rve n pafi'ofyour transactiomas of the date and time inuica ed above. if you:need a more current copy of your transaction;cetum to eCEP and select to''Download a Copy frorn the Current.Submit ais page_. DI ) } VJ LlMassachusetts Department of Environmental Protection Bdreau of Waste Prevention• Air Quality BWP AQ 06 1°ozaas6l Notification Prior to Construction or Demolition Asbestos Project Number iii 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 CbiR 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)" r Yes F No Type of Notification: r Revision of an Existing Form r Cancellation of Project Instructions: 1.Blanket Pennit Project Approval,if applicable: ` Approval ID# 1.All sections of this 2.von-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 CUMBERLAND FARMS 395 WEST MAIN STREET requirements of 310 CMR 7.09. Name of facility Street Address HYANNIS MA 026010000 5082701400 2.Submit Original City/Town State Zip Code Telephone Form To: Commonwealth of LEAHCRISOSTAMO REPRESENTATIVE Massachusetts Facility Contact Person Contact Person Title P.O.Box 4062 Boston,MA 02211 5082701400 Icrisostamo@cumbedandfarms.com Facility Contact Person Telephone Facility Contact Person Email Facility Size: 5230 1 Square Feet Number of Floors Was the facility built prior to 1930? F Yes r No Describe the current or prior use of the facility: VACANT CUMERLAND FARMS STORE Is the facility a residential facility? r Yes No If yes,how many units? 2. Facility Owner: CUMBERLAND FARMS 100 CROSSING BOULEVARD Facility Owner Name Address FRAMINGHAM MA 017020000 5082701400 City/Town State Zip Code Telephone WAYNE SILVA 25 ANTHONY STREET On-Site Manager/Owner Representative Address Seekonk MA 02771 5083363366 City/Town State Zip Code Telephone Revised:03/172014 Page I of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality BWP AQ 06 100244861 Notification Prior to Construction or Demolition Asbestos Project Number B.General Project Description(continued) 3.General Contractor: DF PRAY 25 ANTHONY STREET Name Address SEEKONK MA 027710000 5083363366 City/Town State Zp Code Telephone WAYNE SILVA 7749011137 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 FRANCESCO DEMOLITION,INC. 107 OAK STREET operation,all Contractor Name Address responsible parties must comply with 310 DUXBURY MA 023320000 7815850200 CM 7.00,7.09,7.15, City/Town State Zip Code Telephone and Chapter 21Eof the General Laws of ANTHONY DURANTE 7815850200 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 FRANCESCA WADDELL CS-075537 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 r No release of a hazardous 4. Describe the area(s)to be demolished: substance to the Department,if ENTIRE STRUCTURE applicable. MassDEP Use Only 5. If this a construction project,describe the buildings)or addition(s)to be constructed: Date Received N/A _ 6. If this is a demolition or renovation project, were the structure(s)surveyed for the presence of Asbestos-Containing Material(ACM)? F Yes r No 7. Was asbestos containing material(ACM) founO � Yes r No If a survey was conducted,who conducted the survey? KLEINFELDER&SMITH&WESSEL SWA 16137 Name Department of Labor Standards Certification Number Revised:03/17,2014 Page 2 of 3 i Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality BWP AQ 06 100244861 I - Notification Prior to Construction or Demolition Asbestos Project Number# C.General Construction or Demolition Description(continued) The Asbestos Abatement Notification Number for this UNKNOWN address is: This project r- Construction Fv- Demolition is: 6/23/2016 8131/2016 Project Start Date(MM/DD/YYYY) Project End Date(MM/DD/YYYY) 8. For demolition and construction projects, indicate dust suppression techniques to be used (- Seeding fv— Wetting r Covering (— Paving j-" Shrouding I— Other-Specify: 9. For Emergency Demolition Operations,who is the klassDEP official who evaluated the emergency? Name of MassDEP Official Tide Date of Authorization(MM/DD/YYYY) MassDEP Waiver Number D. Certification "I certify that I have personally FRANCESCA WADDELL examined the foregoing and am Print Name familiar with the information FRANCESCA WADDELL contained in this document and Authorized Signature all attachments and that. based Ian on my inquiry of those individuals immediately Position/Tide responsible for obtaining the FRANCESCO DEMOLITION INC information, I believe that the Representing information is true,accurate,and 6/9/2016 complete. I am aware that there Date(MMIDD/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 f i Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality BWP AQ 06 Notification Prior to Construction or Demolition t ----._. _ .._ f•This is a revision to an existing form. Project ID for existing form to be revised: — • This job is being conducted under a Blanket Permit MassDEP assigned Blanket Authorization ID: I • This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization 1D: f,—, None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of t EASEMENT FOR ELECTRIC SERVICE WO#01983415—Pdmnt Xfrmr-10782/010 395 West Main Street-Hyannis KNOW ALL MEN BY THESE PRESENTS,that: CUMBERLAND FARMS INC, a Delaware corporation,successor by merger to VHS Realty, Inc., having its principal place of business at 100 Crossing Boulevard,Framingham,MA 01702, hereinafter referred to as the Grantor,for consideration of One Dollar($1.00), grants to NSTAR ELECTRIC COMPANY d/b/a EVERSOURCE ENERGY, a Massachusetts corporation, having its principal place of business at 800 Boylston Street,Boston,Massachusetts 02199,its successors, assigns and licensees,hereinafter referred to as the Grantee, with quitclaim covenants,the right and easements(as more particularly described below)for underground lines for distribution of electricity,and lines for control,relay and communication purposes over, across,upon and under a certain parcel of land owned by Grantor(the"Premises") located at 395 West Main Street,Hyannis,Massachusetts. Said Premises and all boundaries are determined by the Court to be located as shown on subdivision plan 11328-B(sheet 2)dated October 1928,drawn by George F. Clements,Engineer, and filed in the Land Registration Office at Boston, a copy of which is filed in Barnstable County Registry of Deeds in Land Registration Book 9 Page 74 with Certificate of Title No. 1972 and said land is shown thereon as Lots 3,4 and 34 The easement rights granted herein are more particularly described as the right,from time to time and within the Premises,to install, construct,reconstruct, alter, extend,operate,inspect, maintain, repair,replace and remove (a)underground buried cables,wires, conduits,pipes, splice boxes,manholes,hand-holes,wire distributing facilities, fixtures,appurtenances,service and lamp connections,with the wires and cables therein, and all necessary foundations, anchors, and other supporting appurtenances deemed necessary by Grantee for the purposes specified above; (b)above-ground pedestals, concrete pads,transformers; switchgear and apparatus cabinets with the necessary wires, cables,terminals,fixtures and appurtenances deemed necessary by Grantee for the purposes specified above(hereinafter(a)and(b) are collectively referred to as "Equipment"), and (c)together with the right and easement to enter upon the Premises, including vehicular access for construction and maintenance purposes,as may be necessary from time to time for all of the foregoing purposes,utilizing existing paved ways and parking areas on the Premises to the extent practicable. All Equipment shall be installed in conformance with Grantee's"Information &Requirements for Electric Service,"as issued by Grantee from time to time. Any Equipment installed by the 1 Grantor shall be maintained by the Grantor,and if Grantor fails to repair or maintain such Equipment, Grantee reserves the right to do so at Grantor's sole cost and expense. All Equipment shall be installed in locations mutually agreed upon by Grantor and Grantee, and shall initially be approximately as shown on a sketch dated 03/27/14 which is attached hereto and incorporated herein as Exhibit A. To the extent that no location is determined in advance,the location of the easement shall be fixed by the actual installation of the Equipment, and,unless specified otherwise, shall be 15 feet in width,centered on the Equipment as installed. Grantor may at any time,at its sole cost and expense,prepare and submit to Grantee for review and approval an"as built"plan of the Equipment in recordable form. Upon approval of such plan,and concurrently with the recording of such plan,the parties shall execute and record an amendment to this instrument, fixing the location of the easements granted hereunder to the locations and dimensions shown on such plan;provided,that Grantee shall have the right of access over the remainder of the Premises for all purposes contemplated by this agreement. Grantor will not erect or permit any structures or obstructions which in the reasonable judgment of the Grantee might interfere with the safe operation and maintenance of the Equipment. Grantee shall have the right to cut down and keep trimmed all trees,bushes,underbrush and growth as the Grantee may from time to time deem reasonably necessary for the safe operation and maintenance of the Equipment. All work by Grantor or Grantee under this Easement shall be done in a good and workmanlike manner by competent personnel or contractors, in conformity with all applicable permits, licenses, ordinances,laws and regulations, and free from any liens for labor or materials. The party performing the work shall be responsible for obtaining all applicable permits. Except in the event of emergency,prior to commencing any work at the Premises, Grantee shall endeavor to provide Grantor with such notice as may be practicable under the circumstances, which may consist of telephone or other verbal notification. The Grantee shall restore the surface of the Premises(by grading,paving or reseeding)wherever damaged by the Grantee by reason of its work as closely as reasonably practicable to the condition of such surface before such work. In the conduct of all work,neither party shall unreasonably interfere with the business,operations or access of the other party,its employees,invitees or contractors,or any other person having an interest in the Premises. Grantee shall have the right to connect the Equipment with its facilities located or which may be placed in private or public ways adjacent to the Premises. Grantee shall have the right to extend the lines from time to time, and the right to use the Equipment,to serve other customers of Grantee who may conveniently be served thereby. 2 • NSTAR Electric Service Address: City: Page Number. "h.No. Work Order Number. 395 WEST MAIN ST. HYANNIS 1 1 1983415 a—.f..vayss Customer's Name/Title: Prepared by: . Date CUMBERLAND FARMS 508 271 6624 CHRIS MURPHY 03/27/14 Sales Representative: ANDY WINTERS NEW CirauitNumber: 80B 523 Electrician. RICK LINDSEY 413 575 9320 SERVICE TLM: 404704 switch size: 600 AMP Secondary Sheet Number. RUN # 10782 1519/1 4791P1A IS NOT IN FIELD FOR RECORDS 39/66-5 39/66 39/65 39/64 9/63 39/62 39/61 / nC51 - 1299/ '� 3-1 ACSR g 405 79/P1 A 'GCB 6' R 39/62- NSTAR CON"fINUED 411 OTH .. CB, 'INSTALL THREE PHASE PM XFMR150 KVA 22.81201208 395 i MAKE ALL CONNECTIONS CUSTOMER TO SUPPLY SEC CONNECTORS R INSTALL 3-110 URD 25 KV CABLES FROM POLE 47912.5 TC 150 KVA PM XFMR 22.8 1201208 r� •47912.5 MAKE THREE PHASE RISER CJ jTLM 404704 79 47912. ...._.. _...... ... ........_._.._ — NSTAR TO 10792/01 VERIZON TO 'REMOVE SINGLE PHASE PRIMARY FROM POLE 39164 TO 47913 '47911 REPLACE 1975 40'JO WITH 45'CL1 JO RAKED BACK FOR 360'#4 CU+1- 1-11 LACK OF PROPER GUYING 'REMOVE 360'+/-4X110 AC FROM POLE 39/63 TO BUILDING#395 'INSTALL 45'CL1 JO AT LOT CORNER WITH BACK A&S 47912.5 VIA POLES 47911 47912 CUSTOMER TO *39163 REMOVE THREE PHASE BANK XFMRS&C10 22.81201208 'SUPPLY AND INSTALL THREE PHASE VAULT FOR XFMR BASE(NE13A) 37.3 KVA •47.5 REPLACE POLE TO POLE GUY TO POLE 39/63 *INSTALL 2.4'SCHD 40 PVC DUCTS WITH STEEL RISER PIPES AND SWEEPS ALL TO NSTAR STANDARDS ''39/64 REPAIR BACK GUY ADJUST TENSION FOR NEW THREE PHASE 9/3 *INSTALL 110 ACSR FROM POLE 39164 TO POLE 47912.5 THREE PHASES *INSTALL A PIECE OF 4 CU FROM POLE TO GROUND RING PM BASE 23W+I- VIA 47911 CONTINUE SINGLE PHASE TO POLE 47913 130'+/- "' "" *INSTALL,SECONDARY WIRE FOR NEW SERVICE ALSO SUPPLY CONNECTORS FOR NSTAR TO MAKE CONNECTIONS 'INSTALL 3X 110 ACSR TRIPLEX CABLE 479M TO 479/3 VIA 479/2.5 280'+/-INSTALL 3X2 TO 47912 FOR HOUSE SERV►CES100'+/- eDEP - MassDEP's OnlineFiling System- Page 1 of 1 MassDEP Home Contact I Privacy Policy MassDEP's Online Filing System Username:FRANCESCO Nickname:DEMOLITION I 0 E P Fn ',I Prob' tom HaipI NOLI�tcat ,',ns L Receipt J Forms Signature Payment Receipt Summary/Receipt print receipt Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select "My eDEP" to see a list of your transactions. DEP Transaction ID: 838546 Date and Time Submitted: 6/9/2016 11:42:31 AM Other Email : DEP Transaction ID: 838546 Date and Time Submitted: 6/9/2016 11:42:31 AM Other Email : Form Name: AQ 06 - Construction/Demolition Notification Form Name: AQ 06 _ Construction/Demolition Notification Payment Information . DEP code: 125322 Date: 6/9/2016 11 :42:21.AM Amount ($): 100 Payment Detail: WADDELL FRANCESCA --AccountType - - AccountNumber ****8599 Confirmation Number: My eDEP MassDEP Home Contact Privacy Policy MassDEP's Online Filing System ver.12.23.4.00 2016 MassDEP https://edev.dej).mass.;zov/Pap-es/PrintP,eceii)t.as-ox 6/9/2016 f - Shea, Sally From: Deputy Dean Melanson <dmelanson@hyannisfire.org> Sent: Thursday, September 08, 2016 8:12 AM To: Shea, Sally; Lauzon,Jeffrey; Roma, Paul; Franey, Patrick; Barrows, Debi; Lt.John Cosmo; William Rex Cc: Joseph Apruzzese Subject: Cumberland Farms, 395 West Main Street We are Ok for a demo permit fro the front gas station area building and canopy being taken down. Deputy Chief Dean L. Melanson Office 508-775-1300 Fax 508-778-6448 dmelanson@hyannisfire.org X r r 1 ik d8 O '1 fill<E' ��9C'#`I„i;� Re:Cumberland Farms 395 W MAIN Hyannis, MA,02601 To whom it may concern, This letter is to serve as a notice of removal for the telephone lines at the Cumberland Farms at 395 W MAIN Hyannis, MA,02601. Effective 9/6/2016 the telephone lines and demark for this location have been moved from the building to the telephone pole. Thank you Sincerely, Demetra Rosen Senior Premier Account Analyst 617-837-4290 100 Newport Ave Ext Quincy, MA 02171 n ti � 'a on algrc June 30,2016 Matt Brook 352 Turnpike Rd. Southborough,MA 01772 To Whom It May Concern RE:395 W.Main St,Hyannis This letter is to confirm that we have verified that there is no natural gas,service on the property named _ above. I can be reached directly at 508-760-7484 should there be any further questions. Patti Weldon nationalgrid Sr.Sales Rep:—.Complex Gas Connections 127 White's Path S.Yarmouth,MA. 02664 508-760-7484 desk 508400-5051-cell 508-394-1109-fax Oitricia.weldone?natiohal d com_. r oOHE r, Department of Public Works 47 Old Yarmouth Rd. 326 Water Supply Division Box Hyyaa MA.nnis, MA. * BARNSTABLE, « 02601-0326 9 MAC i639. TEL:508-775-0063 `0� �6Ar�o Hyannis Water System Operations FAX:508-790-1313 July 27, 2016 Town of Barnstable Building Inspector Town Hall Hyannis, MA 02601 Re: 395 West Main Street—Acct# 601416-Map/Parcel# 269-143 Dear Sir: Please be advised that the above water service was shut off at the curb stopand meter removed on July 27, 2016. The owner has informed us that they are demolishing the building. If you have any questions,please call the office at(508) 775-0063. Sincerely; • .. .. .. ' ayne Starck Hyannis Water System . v r \ f Town of Barnstable Department of Public Works BARMABM ; 382 Falmouth Road ; Hyannis , MA 02601 ��63* www.engineering@town.barnstable.ma.us Office : 508—862 -4090 Fax : 508—862 -4711 July 27 , 2016 al sewer of Subject : Disconnection partial from municipal J � p ) p 395 West Main Street ; Hyannis Map & Parcel 269 - 116 Dear Sirs This is to notify you that the office building area of the property at 395 West Main Street ( Map & Parcel 269 - 116 ) , in Hyannis village, Mass. was disconnected from municipal sewer on July 27th , 2016. The partial disconnection was inspected and accepted by the Construction Projects Inspector from the Town of Barnstable DPW—Admin & Tech Support. A sewer compliance record and a record drawing will be completed and filed in the Admin & Tech Support office. An additional disconnection, for the remainder of the property, is scheduled for a later date. If you have any questions, or need additional information, please call Dave Anderson at 508 — 790 - 6244. Sincerely ; David J nd rson ; Construction Projects Inspector Town o Barnstable DPW - Admin & Tech Support SMITH & WESSEL ASSOCIATES, INC. HAZARDOUS BUILDING MATERIALS AND AIR QUALITY SPECIALISTS September 9, 2016 Ms. Emily Straley . Kleinfelder, Inc. =� , Project Managerr. 1 Speen Street, Suite 200 Framingham, MA 01701 RE: Post-Abatement visual and air clearance, 395 West Main Street,Hyannis,MA Dear Ms. Straley: Kleinfelder,Inc: retained Smith&Wessel Associates, Inc. (SWA)to perform a post- abatement visual clearance at the Cumberland Farms located at the above referenced address. The areas abated consisted of approximately 750 square feet of asbestos containing floor file from within the gas station and 350 sf of roof tar flashing from the perimeter of the gas station roof. The work was conducted by Banner Environmental 'Services, Inc. (Banner)of Avon,Massachusetts, was the Massachusetts licensed Asbestos Abatement Contractor who performed the work. SWA's Massachusetts licensed Project Monitor Asa Fayard was on site to conduct the post abatement visual inspection and air testing following abatement activities on September 81 2016. He was not on site during actual abatement work. Banner contained the interior of the gas station space by sealing all critical barriers with 6 mil polyethylene sheeting. All walls were covered with 2 layers of 4 mil polyethylene sheeting and the ceiling a single layer. A three chambered personal decontamination facility was constructed contiguous with the work area as the only means of entrance and egress by qualified personnel only. Negative air pressure was established in the work area relative to adjacent spaces by installing air filtration devices equipped with high w efficiency particulate air filters(HEPA's). The black tar flashing reportedly was removed using hand scrapers as was the floor tile. Upon completion of all asbestos removal and fine cleaning in the work areas, SWA's Project Monitor visually inspected the tar flashing and the floor file and no suspect debri_s remained. Following the successful visual inspection in the gas station containment, SWA's Project Monitor collected post-abatement air samples. The air samples were collected and analyzed on-site utilizing phase contrast microscopy(PCM). The air test results were compared to the post-abatement clearance requirements of the Massachusetts Labor Standards (MA DLS)of less than or equal to 0.010 fibers per cubic centimeter of 188 GREENVILLE STREET` TELEPHONE:(978)346-4800 SPENCER,MA 01:562 FAX:.(978)346-7265 J air(f/cc)for all samples. All post-abatement air samples met the MA DLS criteria(See attached results). Because successful visual inspection and air test results were obtained,the work areas were cleared for re-occupancy by all personnel. The project should not be considered complete,however,until the Owner receives the Waste Shipment Records(WSR) from Banner documenting the proper disposal of all asbestos waste. If you have any questions regarding this report, please.do not hesitate to call me at your earliest convenience. Respectfully submitted, Stith& Wessel Associates,Inc. for Asa Fayard Enclosure 5WTM&WCML MZOMMM INC SWA 16330 Page 2 9/9/16 APPENDIX A PCM Air Sample Results SWM 8 WCUM ASWCUM%INC SWA 16330 9/9/16 Air Monitorin"g:Results for.TotalFiber Concentration 395'West M-C Street Hyannis, Massachusetts Sample Sampling Volume Result No. Date Period (liters) Description/Location (fibers/cc) 1. 9/8/16 NA NA Blank Quality Control Sample 0/100 2. 9/8/16 12:20 p.m. 1,220 Post-abatement air sample,rear of <0.004 to gas station following floor tile 2:22 p.m. abatement 3. 9/8/16 12:22 p.m, 1,220 Post-abatement air sample, <0.004 to northwest side of gas station near 2:24 p.m. entrance following floor tile abatement Note:All samples were analyzed according to NIOSH 7400 Method. Analyst:Asa Fayard saem&Wessel.Amomcm,INc SWA 16330 9/9/16 APPENDIX B Daily Construction Reports Searata&Wessa;a.AssomA sa,Imc SWA 16330 9/9/16 Smith & 'Wessel Darly Construction Report Associates, Inc. Page-L of 1 sitQ: ,Pro ed#: Project Monitor. Asa Fa ard-_`_- - Client: Contact: Date Contractor: e CONSTR�U�1'i N;N-6 S 1 t r or: io _ - oAOw A6J , . .:_ .� .. P O� c O %L! Summery of'abatement_work:accomplished,`including type and-quantity of ACM abated m each work area; 6: f'w S,t we_ Y E t1S�U� E Everwu=Energy SURC � one NSTAR Way,Westwad,Massachuwas 02090-Mo NERG September 9,2016 Cumberland Farms 100 Crossing Blvd Framingham,MA 01702 RE: 395 WMain St,Hyannis,MA To Whom It May Concern: At Eversource,we're committed to delivering great service. This letter serves as confirmation that,,as.of September 9,2016 the electric service to the Cumberland i Farms store with the address listed above has been disconnected. ') If you have any questions,please contact me at(781)441-3206 Sincerely, John Daly, Senior Account Executive-Eastern MA Eversource Energy 1 NSTAR Way Westwood, MA 02090 (781)441-3206 A(781)441-8721 ®iohn.dale.ir@eversource.com._ '.`y ili ... z r �Via Department of Public Works 47 Old Yarmouth Rd. Water Supply Division P.O. Box 326 pp y Hyannis,MA. « # 02601-0326 * BARNSTABLE, y MASS. TEL:508-775-0063 1639. Hyannis Water System Operations FAX:508-790-1313 September 9, 2016 Town of Barnstable Building Inspector Town Hall Hyannis, MA 02601 , Re: 395 West Main Street—Acct# 601415—Map/Parcel# 269-142 Dear Sir: ° Please be advised that the above water service was shut off at the curb stop and meter removed on September 9, 2016.. The owner has informed us that they are demolishing the building. If you have any questions,please call the office at (508) 775-0063. Sincerely, J e Starck Hyannis Water System . n Town of Barnstable Regulatory Services reeea Richard V.Scali,Director t6yq. ` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I Cumberland Farms,inc. ,as Owner of the subject property hereby authorize eF Pray == to act on my behalf, in all matters relative to work authorized by this building permit application for. 395 West AAain Street (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Cumberland Farms, Inc. BY:Kt�a/1��etL L4• �1,r�sdt.✓' Signature of Owner Signature of Applicant Sr. Pipeline Mgr_ hArA Print Name Print Name r Date F- A R M S hECMTARY'S CERTMCATIE I Mark G.Howard,hereby cer f that I am duly elected Secretary of Cumberland Farms,Inc.,a Delaware eogmdion,having a usual place of business in Framingham, Middlesex County,Massachusetts and hereby certify that the following:is a true copy of a record of vote passed at a mewing of the Board of Directors of said cozporation which was held the I Oth day of February 2016 at which time a majority of the Dkeetozs were Pm. To authorize Ketlileaa A. Sousa,Senior Pipeline Nk nager,Real Estate,.to sign and execute on behalf of the Company any easements,licenses,right of way agreements,permits.or applications therefore,which may be required in the ordinary course of busirmns pertaining to real estate owned by the Company and to exec.M whatever docu may be appropriate in eom.w. cation therewith, I further certify that this vote has not been rescinded and is still in force and effect. A:Tnie Copy Attest Dated at Framingham,Massachusetts this 12th day of February 2016. . :: �n - - Mark .Howard, ecnry. Cumberland Farms,Inc. 100 Crossing.Boulavard, Framingham,MA 01702 5W270-1400 www.cumberiandfarms.com CERTIFICATE OF VOTE I,Mark G.Howard, hereby certify that I am duly elected Secretary of Cumberland Farms, Inc., a Delaware corporation,having a usual place of business in Framingham,Middlesex County,Massachusetts, and hereby certify that the following is a true copy of a record of vote passed at a meeting of the Board of Directors of said corporation which m was held the 12 day of August,2014,. at which time a majority of Directors were present. VOTED: To authorize the following persons,individually,to sign and execute on behalf of the Company any easements;:licenses,right of way agreements,permits or applications therefore,which may be required in the ordinary course of business pertaining to real estate owned by the Company and to execute whatever documents maybe appropriate in connection therewith. Persons so authorized: Ari N. Haseotes, Chief Executive Officer,President and COO Mark G. Howard,Esq.,Secretary Diane M.Boissonneault,Assistant Secretary Dino M. DeThomas, SVP &Chief Real Estate Officer Mark L.Russell,Director of Real Estate:Administration Kathleen A. Sousa, Senior Pipeline Manager,Real Estate. I further certify that this vote has not been rescinded and is still:in force and effect: A True Copy Attest Dated at Framingham,Massachusetts This 5th day of January 2016qp Mark . Howard . Seer r Grantee shall.indemnify,defend and hold harmless the Grantor,its successors and assigns, from and against any claim, cost, loss oar liability incurred by Grantor for physical damage or injury resulting from the negligence or willful misconduct of the Grantee,its employees, agents and contractors in the conduct of the work at the.Premises pursuant to this easement.Nothing herein shall be construed to impose on the Grantee any liability for indirect,consequential,punitive or other special damages. Grantor may request that Grantee relocate any of the Equipment installed by the Grantee to another location on the Premises acceptable to the:Grantee. Such relocation shall be at the sole cost and expense of the Grantor. Grantor shall have the right to use the Premises,and the right to grant to others the right to use e Premises, for all purposes that do not unreasonably interfere with the rights granted to the Grantee hereby. All Equipment installed within the Premises pursuant to this easement shall remain the property of the Grantee and Grantee shall pay all taxes assessed thereon This easement is executed pursuant to,and shall be subject to, the Grantee's Terms and Conditions of Service,as filed with and approved by the Massachusetts Department of Telecommunications and Energy from time to time. For Grantors.title see Certificate of Title No.89626. _. tw EXECUTED as an instrument under seal this I Y day of .. JIB. ,2016: CLIMBERLAND FARMS INC. B (IU R ARI N.HASEOTES-Press d CEO i . DINO M.DETHOMAS=Senior VP of Real Estate COMMONWEALTH OF MASSACHUSETTS On this�day of�,ht , 2016,before me,the undersigned notary public, personally appeared u6`i�, ins 1'YL DEnImp,%proved to me through satisfactory evidence of identification,which was C. V II dZ4,4CLL to be the P erson s Whose name is signed:on.the preceding document, and acknowledged to me thatS& signed it voluntarily for its stated purpose,.as an office@ of Cumberland Farms Inc: CON:NFE M. SYREK Notary Public, Notary Public 00MMONVPI91 n OF MA3WMUMM My Coemnlasion Expires January 21, 2022 r My Commission Expires:\ An 11 U2-Z, i 4 r Charles D.Baker,Governor Karyn E. Polito, Lieutenant Governor ��� Stephanie:Pollack,Secretary&CEO DOT Jeffrey DeCarlo,Administrator Massachusetts oepartmentof Transportation Aeronautics Division April 15, 2016 Mr.Matthew Brook Bohler Engineering 352 Turnpike Road Southborough, MA 61772 Re: MassDOT File# 16-HYA-0075-02 Temporary Crane for Construction of Gas Station Hyannis, Massachusetts Dear Mr. Brook: Enclosed is a copy of the final determination by the Massachusetts Department of Transportation (MassDOT) Aeronautics Division on your Requestfo�Airspacei?euiewsof _.. the above referenced projects. The Aeronautics Division's assistance is offered pursuant to the aviation law requirements of the Commonwealth. Please note that although the projects is not subject to further action required by the Aeronautics Division's laws or regulations,this office may offer additional comments a*fter considering FAA's determination of Its impact to a public use airport or NAVAID facility through the aeronautical study process. you have any questions, please feel free to contact me. : . Sincerely,. lam: Thomas F. Ma ion E Director of Airport Engineering MassDOT Aeronautics Division Phone: 617.412.3678 Email: thomas.mahoney@state.ma.us Enclosed: Airspace Review:Form cc: K. Servis Assistant Airport Manager file rn:\airport-projects\hya-barnstable\airspace reviews\2016\permit not required 16-hya-02 04152016,doc lug Logan Office Center,One Harborside Drive,Suite 205N East Boston,MA 02:128 Tel:61741 Z-3680,TTY:857-368-0655 Leading the Nation in Transportation Excellence :. www.rhass.gov/massdoIt Massachusetts Department of Transportation For Office use only AIR— AERONAUTICS DIVISION AlrspaceAnarysls� _. ,• ' El Comments Received REQUEST FOR AIRSPACE REVIEW. ❑ AIR-Port updated MassUUT File No.: i 2016=HYA-00075-2 FAA File No.: (For reference only) Notice is required by.780 CMR(Code of Massachusetts Regulatlons)111.7,Hazards to Air Navigation..Pursuant to Massachusetts:General Law(MGL) Chapter 90,Section.35B,the MassDOT Aeronautics Division agrees to perform an AIRSPACE ANALYSIS:and render a determination for the project listed below. IMPORTANT:All shaded areas must be completed. Sponsor(include name,:address,telephone number): Sponsor Representative(same data if applicable): Last Name Suffix:- First Name ::. .Last Name ::. Suffix i Mrst Name Cumberland Farms Matt Brook .. .. . ,Bohier Engineering Company .. Telephone :-. , ?company. : ;Telephone ... . '(508)270-140.0:: (508)480-9900 . r- . `Addross City -. ,State. Zip Code - , ''Address ... .: . City. °'State:.:'ZipCode. . 100 Crossing Blvd. Framingham i MA. i 61702 i 352 Turnpike Red tSouthborough 'MA i 0772 EmaO:. { I a Email a. mat mbrook@bohleng.com 'mbrook@bbhfereng.com 1 Project Description(please type or print clearly):: Location,Height,Elevation Data: Cumberland Farms gas station ? Nearest City,State: Barnstable Project involves the construction of a Cumberland Farms gas station and Degrees Minutes Seconds convenience store at 395 West Main St in Barnstable(Hyannis).There will be a gas; canopy with an overall height of 20-ft,a main building with a height of 29-ft and 8 Latitude I 41 38 55 ;Parking lot lights with overall heights of 15-ft each.Lastly,cranes will be used at various points during construction including Installation of the roof trusses,and i Longitude. ` 70 t 18 f 40 'installation of the gas canopy.The maitlmum height of the cranes Is:75-ft,and !typical on-site time frame for the cranes is 1 week. Datum El NAD 83 ❑ NAD 27 Site elevation above MSL ft): 39 msl p. Maximum height above ground(ft): 75 agl Maximum elevation above MSL(ft): 114 msl ❑ RMUIRED:Attach a 112 r<11 Inch map(e.g.USW clued SheeS)rdiwAng tocatlan of project. Nearest Public-Use Aviation Facility::: Barnstable Municipal Airport 'Print or type,below,the name of person filing this request for review' _. Signature - : i Date - t 777 DO:NOT WRITE BELOW THIS LINE-FOR Aeronautics OFFICE USE ONLY AIRSPACE ANALYSIS concludes the following:: Closest Runway: _ . :06/24 Distance,from RW end: 9898:ft Offset from RW CL: 298 ft. p Left El Right . ❑Project violates MGL Ch.90,35B.by 0 ft. [Runway Horizontal Plane-3,000'x 2 Statute Miles,150'above RWj . ❑Project violates MGL Ch..90,358 by 0 ft. [Runway Approach Plane-3,000'x 3,000' 20:1 slope] Project violates 702 CMR,5.03(1)(a)by 0 ft. [Runway Approach Plane/Land 500'x 10,000'@ 20:1 slope] . ... ... . _. ❑Project.violates 702 CMR,5.03(2)(a)by 0 ft. [Runway Approach Plane/Water-500'x 10,000'.@ 20:1 slope] 0 Project does not violate Aeronautics-Division Airspace Laws or Regs. DETERMINATION: Permit.is.required pursuant to MGL.Ch.90,358,for ❑Runway Horizontal Plane p Runway Approach Plane p Permit is not required pursuant to MGL Ch.90,35B D No violations of Laws or.Regs. ❑Ch.90 violation=30'agl ❑Permit is required pursuant to 702 CMR, 0 Permit is not.required pursuant to 702.CMR,50.3: ❑Additional concerns: : ❑FAA Standards . ❑Noise . . .. ❑Traffic Pattern... p Wildlife ❑VFR Route p Other This.determination is based on the foregoing description of the proposed project including the location,height and elevation data provided by the Sponsor.Any changes in the data provided to the Aeronautics Division from that which is shown herein will render this determination null and V 'd a d will necessitate a new request for review. MassDOT-A8r0 Title: l : Flinn E-10 Last Revised 0912014 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map .2 G% Parcel G A �� Application # o- Health Division 2 Z Date Issued AwConservation Division Grp Oo Application Fee Planning Dept. 92 Permit Fee - N Date Definitive Plan Approved by Planning Board j Historic - OKH Preservation/ Hyannis Project Street Address Aden .SY' Village WV. Owner�,�� ��� 1z� Address Telephone Ma-a .2 s--cy7a -.;2- Permit Request Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District �r Flood Plain Groundwater Overlay Project Valuatiofi'a y�Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing U. new .size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # . t Current Use Proposed Use APPLICANT INFORMATION fra 17 r eseo -�s (BUILDER OR HOMEOWNER) -1e2L Name FrGti'11e ��(/a el� Telephone Number x1 S ©�a0 Address �d� eje .!;tle of License # C- 0 75337 0U,Yh(Z", A4 Home Improvement Contractor# Email ,t2!2 Q cam, `>A lly%i Worker's Compensation #. XAP)0, ?061y3_7 ALL CONSTRUCTION DEB S ULTING FRO l S ID J C ILL BE TAKEN TO /_� SIGNATURE 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 t GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r MA SOC Filing Number: 201680267710 Date: 4/15/2016 3:23:00 PM The Commonwealth of Massachusetts Minimum Fee:$100.00 I William Francis Galvin Secretary of the Commonwealth Corporations Division t r One Ashburton Place, 17th floor Boston,MA 021084512 Telephone: (617)727-9640 Identification Number: 043276899 1. Exact name of the corporation: FRANCESCO DEMOLITION,INC. i 2.Jurisdiction of Incorporation: State: MA Country: 3,4. Street address of the corporation registered office in the commonwealth and the name of the registered agent at that office: Name: FRANK DURANT No. and Street: 107 OAK ST. City or Town: DUXBURY - State: MA Zip: 02332 Country:USA t 5. Street address of the corporation's principal office: No. and Street: 107 OAK STREET sl City or Town: DUXBURY State: MA Zip: 02332 Country:USA 6. Provide the name and addresses of the corporation's board of directors and its president, treasurer, secretary, and if different, its chief executive officer'and chief financial officer. Title "Individual Name Address.(no Po Box) First,Middle,Last,Suffix Address,City or Town State,Zip Code PRESIDENT FRANK_DURANTE 107 OAK STREET M .xv. DUXBURY,MA 02332 USA PRESIDENT FRANK DURANTE e' 107 OAK STREET DUXBURY,MA 02332 USA a PRESIDENT FRANK DURANTE �107 OAK STREET t DUXBURY,MA 02332 USA PRESIDENT FRANK.DURANTE 107 OAK STREET ' DUXBURY,MA 02332 USA PRESIDENT FRANK DURANTE 107 OAK STREET € DUXBURY,MA 02332 USA �� t PRESIDENT FRANK DURANTE 107 OAK STREET DUXBURY,MA 02332 USA f t PRESIDENT FRANK DURANTE 107 OAK STREET DUXBURY,MA 02332 USA PRESIDENT FRANK DURANTE 107 OAK STREET 'DUXBURY,MA 02332 USA l PRESIDENT FRANK DURANTE 107 OAK STREET DUXBURY,MA 02332 USA PRESIDENT FRANK DURANTE 107 OAK STREET DUXBURY,'MA 02332 USA . TREASURER FRANKDURANTE 107 OAK STREET DUXBURY,MA 02332 USA ' r SECRETARY FRANK DURANTE 107 OAK STREET DUXBURY,MA 02332 USA PRESIDEMT FRANK DURANTE 107 OAK STREET DUXBURY,MA 02332 USA PRESIDENT FRANK DURANTE 107 OAK STREET' DUXBURY,MA 02332 USA DIRECTOR FRANK DURANTE 107 OAK STREET DUXBURY,MA 02332 USA 7. Briefly describe the business of the corporation: DEMOLITION CONTRACTOR 8. Capital stock of each class and series`: t i Par Value Per Share Total Authorized by Articles Total Issued Class of Stock Enter 0 if no Par of Organization or Amendments and Outstanding Num of Shares Total Par Value Num of Shares CNP $0.00000 10,000 $0.00 100 CNP $0.00000 0 $0.00 0 9. Check here if the stock of the corporation is publicly traded: { 10. Report is filed for fiscal year ending: 12/31/2015 Signed by FRANK DURANTE , its PRESIDENT on this 15 Day of April,2016 ©2001 •2016 Commonwealth of Massachusetts All Rights Reserved G , _ NSTAR Electric Service Address: City: Page Number. Auth.No. Work Order Number. 395 WEST MAIN ST. HYANNIS 1 1 ®� 1983415 Customer's Name11'itle: Prepared by: Date CUMBERLAND FARMS 508 271 6624 CHRIS MURPHY 03/27/14 Sates Representative: ANDY WINTERS NEW Circuit Number: 8013 523 Electrician: RICK L.INDSEY 413 575 9320 SERVICE TLM: 404704 switch size: 600 AMP Secondary Sheet Number. RUN # 10782 1519/1 479IP1A IS NOT IN FIELD FOR RECORDS 39166-5 39/66 39/65 39/64 9/63 39/62� 39/61 f f '1 f � E 1299/ r s CB 3-11 ACSR 1 g 408 79/P1 A '�� ass` R 411 39/62- NSTAR CONTINUED OTH ... Cf3 . O •INSTALL THREE PHASE PM XFMR1SO KVA22.81201208 395 1 MAKE ALL CONNECTIONS CUSTOMER TO SUPPLY SEC CONNECTORS *INSTALL 3-110 URD 25 KV CABLES FROM POLE 47912.5 TC 150 KVA PM XFMR 22A 1201208 *47912.5 MAKE THREE PHASE RISER C_TLM 404704 479/2. 79 _..... _ NSTAR TO 10782/01 VERIZON TO •REMOVE SINGLE PHASE PRIMARY FROM POLE 391"TO 47913 *47911 REPLACE 1975 40'JO WITH 43'CL1 JO RAKED BACK FOR 360'#4 CU+1 1-1 L LACK OF PROPER GUYING •REMOVE 360'+/.4X110 AC FROM POLE 39163 TO BUILDING#398 'INSTALL 4S'CL1 JO AT LOT CORNER WITH BACK A&S 4791Z.5 VIA POLES 47911 47912 CUSTOMER TO 39163 REMOVE THREE PHASE BANK XFMRS&CIO 22.81201208 •SUPPLY AND INSTALL THREE PHASE VAULT FOR XFMR BASE(NE13A) 37.5 KVA *47W1 REPLACE POLE TO POLE GUY TO POLE 39163 *INSTALL 2.4'SCHD 40 PVC DUCTS WITH STEEL RISER PIPES 39164 REPAIR BACK GUY ADJUST TENSION FOR NEW THREE PHASE 9/3 AND SWEEPS ALL TO NSTAR STANDARDS *INSTALL 110 ACSR FROM POLE 39164 TO POLE 47912.E THREE PHASES 'INSTALL A PIECE OF#4 CU FROM POLE TO GROUND RING @ PM BASE 230'+/ VIA 47911 CONTINUE SINGLE PHASE TO POLE 47913 130'+/- *INSTALL SECONDARY WIRE FOR NEW SERVICE ALSO SUPPLY CONNECTORS FOR NSTAR TO MAKE CONNECTIONS INSTALL 3X 110 ACSR TRIPLEX CABLE 47911 TO 47913 VIA 479f2.5 260'+1.INSTALL 3X2 TO 47912 FOR HOUSE SERVICES100'+I. � too F A R M S SECRETARY'S CERTIFICATE I,Mark G.Howard,hereby certify that I am duly elected Secretary of Cumberland Farms,Inc.,a Delaware corporation,having a usual place of business in Framingham, Middlesex County,Massachusetts and hereby certify that the following is a true copy of a record of vote passed at a meeting of the Board of Directors of said corporation which was held the 1 Oth day of February 2016 at which time a majority of the Directors were present VOTED: To authorize Kathleen A. Sousa,Senior Pipeline Manager,Real Estate,to sign and execute on behalf of the Company any easements,licenses,right of way agreements,permits or applications therefore,which may be required in the ordinary course of busies pertaining to real estate owned by the Company and to execute whatever documents may be appropriate in connection therewith. I further certify that this vote has not been rescinded and is still in force and effect. A True Copy Attest Dated at Framingham,Massachusetts this 12th day of Febnwy 2016. are Mark .Howard, ecretary Cumberland Farms,Inc. 100 Crossing Boulevard,Framingham,MA 01702 508 270-1400 www.cumberiandfarms.com t My Commission Expires:= 4 SMITH & WESSEL ASSOCIATES, INC. HAZARDOUS BUILDING MATERIALS AND AIR QUALITY SPECIALISTS Y July 26, 2016 r, 4, Ms. Emily Straley Kleinfelder,Inc. Project Manager 1 Speen Street, Suite 200 Framingham, MA 01701 RE: Post-Abatement visual clearance, 395 West Main Street, Hyannis, MA Dear Ms. Straley: Kleinfelder, Inc. retained Smith& Wessel Associates,Inc. (SWA) to perform a post- abatement visual clearance at the Cumberland Farms located at the above referenced address. The area abated consisted of approximately 620 square feet of asbestos- containing black tar flashing on the roof of the strip mall building. SWA's Massachusetts licensed Project Monitor,Gary Buda,was on site to conduct the post abatement visual clearance following abatement activities on July 26,2016. The black tar flashing reportedly was removed using hand scrapers and the mastic adhesive via chemical removers and hand grinders. Upon completion of all asbestos removal and fine cleaning in the work areas, SWA's Project Monitor visual inspection indicated no suspect debris remained. Because successful visual inspection results were obtained,the work area was cleared for re-occupancy by all personnel. The project should not be considered complete,however_, until the Owner receives the Waste Shipment Records (WSR) from the abatement contractor documenting the proper disposal of all asbestos waste. If you have any questions regarding this report,please do not hesitate to call me at your earliest convenience. Respectfully submitted, Smith & Wessel Associates,Inc. w Project Manager Enclosure 188 GREENVILLE STREET TELEPHONE: (978)-346-4800 SPENCER,MA 01562 FAX: (978)346-7265 APPENDIX A Daily Construction Reports SMPrH&WESSEL ASSOcings,Mc SWA 16330 7/26/16 Smith & Wessel Daily Construction Report Associates, Inc. Project Desc. Project No. 3h5 67,4 �J.c,.. S � �Y�ii�l�s 4 /633® Client felAr Project monitor: PM Cert.#: Date: 7 24 G Contractor: Supervisor TEKE CONSTRUCTION NOTES lXt tar jai e w�! U G!� Gf�f� So S�✓JQ Summary of abatement work accomplished, including type and quantity of ACM abated in each work area: Pale of / . The Commonwealth of Massachusetts = Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, MA 021.14-2017 wM SVey' www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/individuai): Address: I� Oqk i ee4- City/State/Zip:1 k, Phone#: ' Are you a employer?Check appropriate b .: Type of project(required): 1. am a employer with employees(full and/or part-time).* 7. F1 New construction '❑l am a sole proprietor or partnership and have no employees working for me in 8. any capacity.(No workers'comp.insurance required.) . Remodeling 9 3.D t am a homeowner doing all work myself.(No workers'comp.insurance required.]' ❑Demolition 4. f am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 I.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5M 1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.❑ROOf repairs CS These sub-contractors have employees and have workers'comp.insurance. We are a corporation and its officers have exercised their right of exemption per�IGL c. 14.❑Other 6.r 152,$1(4),and we have no employees.(No workers'comp.insurance required.] *Any applicant that checks box Ill must also fill out the section below showing their workers'compensation policy information 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 workers'comp.policy number. !am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 1 f 1 Expiration Date: J' Job Site Address�_;TJ-5 W?11 NIAA �4 City/State/Zip: nt MA Attach a copy of the workers' compensation policy declaration page(showing the policy numb r and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. !do hereby certify uAder the pains`and pe !ties of-- jury that the information provided hove is true and correct a Signature: Date: Phone#: ----- — --- ✓v ..^ Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person:. Phone#: P78I.S.15 ENO Ai88 _ FRANCESCO DEMOLITION, INC. DEMOLITION P.O. Box 1915 I Duxburv. MA 02331 1 0: 781.585.0200 1 F: 781.934.9193 July 27, 2016 Town of Barnstable Building Inspector. Town Hall Hyannis, MA 02601 RE: 395 West Main Street, Hyannis MA. This letter is to certify that I Frank Durante President and Owner of Francesco Demolition, Inc., hereby authorize Francesca Waddell (CS 75537) to pull the demolition permit for the said project. Sincerely, Francesco Demolition, Inc. - Frank Durante President nationalg ri d. July 25,2016 Bohler Engineering 352 Turnpike Rd. Southborough, MA 01772 To Whom It May Concern RE:Cumberland Farms-395 West Main St(Rear),.Hyannis This letter is to confirm that we have cut/capped the gas services(only)at property named above.. I can be reached directly at 508-760-7484 should there be:any further questions. Patti Weldon nationalgrid Sr.Sales Rep.—Complex Gas Cpnnections 127 White's Path S.Yarmouth,MA. 02664 S 508-760-7484 desk & . �i 50R9,406L 051 —cell 5094 faxv - .- at_fir nAii4nal d d \. � kn r o Town of Barnstable Department of Public Works w rAxsrAet.E 382 Falmouth Road ; Hyannis , MA 02601 MASS www.engineering@town.barnstable.ma.us 1639, b M1� Office : 508 — 862 - 4090 Fax : 508—862 - 4711 July 27 , 2016 Subject : Disconnection ( partial ) from municipal sewer of 395 West Main Street ; Hyannis Map & Parcel 269 - 116 Dear Sirs ; This is to notify you that the office building area of the property at 395 West Main Street ( Map & Parcel 269 - 116 ) , in Hyannis village, Mass. was disconnected from municipal sewer on July 27th , 2016. The partial disconnection was inspected and accepted by the Construction Projects Inspector from the Town of Barnstable DPW—Admin & Tech Support. A sewer compliance record and a record drawing will be completed and filed in the Admin & Tech Support office. fdf� An additional disconnection, for the remainder of the property, is scheduled for a later date. If you have any questions, or need additional information, please call Dave Anderson at 508 — 790 - 6244. Sincerely ; David J nd rson ; Construction Projects Inspector Town o Barnstable DPW - Admin & Tech Support r of IME r Department o p rtment of Public Works 47 Old Yarmouth Rd. Water Supply Division P.O.Box 326Hyannis,MA. * BARNSTABLE, *' 02601-0326 9 MAC �' TEL: 508-775-0063 `bAr 1639. 186 Hyannis Water System Operations FAX:508-790-1313 ED MA'S July 27, 2016 Town of Barnstable Building Inspector Town Hall Hyannis, MA 02601 Re: 395 West Main Street—Acct# 601416—Map/Parcel# 269-143 Dear Sir: Please be advised that the above water service was shut off at the curb stop and meter removed on July 27, 2016. The owner has informed us that they are demolishing the building. If you have any questions,please call the office at(508) 775-0063. Sincerely, ayne Starck Hyannis Water System EVERSSURCE Eversource Energy One NSTAR Way,Westwood,,Massachusetts 02090-9230 ENERGY July 27,2016 Cumberland Farms 100 Crossing Blvd Framingham,MA 01702 RE: 389 W-Main St,Hyannis,MA , To Whom It May Concern: r At Eversource,we're committed to delivering great service. This letter serves as confirmation that;as of July 27,2016 the underground electric service to the tear building(Cumberland Farms-meters 5098324,2295426,and 5098769)of the address listed above has been disconnected. a If you have any questions,please contact me at(781)441-3367 Sincerely, {r J John Daly, Senior Account Executive Eastern MA Eversource Energy . 1 NSTAR Way Westwood, MA 02090 r n(781)441.-3206 & (781)441-8721 ®john.daly.ir a(�euersourse.com lugCharles D. Baker,Governor Karyn E. Polito, Lieutenant,Secrtar Governor OT Stephanie Pollack,Secretary&CEO Jeffrey DeCarlo,Administrator MassachLsetts Department of Transportation Aeronautics Division April 15, 2016 Mr. Matthew Brook Bohler Engineering 352 Turnpike Road Southborough,MA 01772 Re: MassDOT File# 16-HYA-CO75-02 Temporary Crane for Construction of Gas Station Hyannis, Massachusetts Dear Mr. Brook.~ Enclosed is a copy of the final determination by the Massachusetts Department of Transportation (MassDOT) Aeronautics Division on your Request forAirspace Reviews of the above referenced projects. The Aeronautics Division's assistance is offered pursuant to the aviation law requirements of the Commonwealth. Please note that although the projects is not subject to further action required by the Aeronautics Division's laws or regulations, this office may offer additional comments after considering FAA's determination of its impact to a public use airport or NAVAID facility through the aeronautical study process. If you have any questions, please feel free to contact me. Sincerely, Z-vl Thomas F. Mahon E Director of Airport Engineering MassDOT Aeronautics Division Phone: 617.412.3678 Email: thomas.mahoney@state.ma.us Enclosed: Airspace Review Form cc: K. Servis,Assistant Airport Manager file m:\airport-projects\hya-barnstable\airspace reviews\2016\permit not required 16-hya-02 04152016.doc Logan Office Center,One Harborside Drive,Suite 205N r East Boston,MA 02128 Tel:617-412-3680,TTY:857-368-0655 Leading the Nation in Transportation Excellence www.mass.gov/massdot Massachusetts Department of Transportation For office Use only AIR- AERONAUTICS DIVISION f AlrspaceAnalysis - ❑ Comments Received REQUEST FOR AIRSPACE REVIEW ❑ AIR-Port Updated MassDOT File No.: i 2016-H1i4-00075.2 FAA File No.: - (For reference only) Notice is required by 780 CMR(Code of Massachusetts Regulations)111.7,Hazards to Air Navigatlon.Pursuant to Massachusetts General Law(MGL) Chapter 90,Section 35B,the MassDOT Aeronautics Division agrees to perform an AIRSPAC E ANALYSIS and render a determination for the project listed below. IMPORTANT:All shaded areas must be completed. Sponsor(include name,address,telephone number): Sponsor Representative(same data If applicable): Laet Nema Suffix First Name Mist Name _ Suffix r First Name - T_ Cumberland Farms Matt Brock - BBohler Engineering N Company t Telephone .Company - (5_8)270-1400 -� r µ _ Y - - _ i 508)480-9900 �Addross t ty - State 71 Coda Addreae - _ C ty— ----1 State' Zip Code _ 100 Crossing Blvd. Framingham I MA i 01702 I 352 Turnpike Red Southborough '•,MA 01772 t Email - Email .. - mbrook@bohlereng.com' - Imbrook@bohbarengcom Project Description(please type or print clearly): Location,Height,Elevation Data: Cumberland Farms gas station _ - Nearest City,State: Bamstable 1 Project involves the construction of a Cumberland Farms gas station and -� Degrees Minutes T �Seconds €convenience store at 395 West Mein St in Barnstable(Hyannis). r s.. The e.w(i tre_ I ago --.- -. - can i f o with an overall height i 0-ft main building' )canopy g ,a u ding with a height of 29 ft and 6 Latitude 1 41 j � 38 � 55 t parking lot lights with overall heights of 15•ft each.Lastly,cranes will be used at t. _ various points during construction Including Installation of the roof trusses,and Longitude - '70 - 18 ] 40 Installation of the gas canopy.The maximum height of the cranes is 75-ft,and F_ _ i I typical on-site time frame for the,cranes is 1 week. Datum 0 NAD 83 ❑ NAD 27 t Site elevation above MSL(ft.): 39 msl Maximum height above ground(ft): 75 agl _ _ f Maximum elevation above MSL(ft): 114 msl ❑`REDUIREM Atlach s 112 x 11 lath map(e.g.USGS clued sheet)dwwing location of project. 1 Nearest Public-Use Aviation Facility: Barnstable Municipal Airport ;Pdnt or type,bebw,the name of person filing this request for review I Signature !Date r DO NOT WRITE BELOW THIS LINE-FOR Aeronautics OFFICE USE ONLY AIRSPACE ANALYSIS concludes the following: Closest Runway: 06/24 Distance from RW end: 9898 ft. Offset from RW CL: 298 ft. p Left ❑Right ❑Project violates MGL Ch.90,35B by _ 0 _ ft. [Runway Horizontal Plane-3,000'x 2 Statute Miles,150'above RW] ❑Project violates MGL Ch.90,35B by 0 _ ft. [Runway Approach Plane-3,000'x 3,000'@ 20:1 slope] ❑Project violates 702 CMR,5.03(1)(a)by 0 ft. [Runway Approach Plane/Land-500'x 10,000'@ 20:1 slope] ❑Project violates 702 CMR,5.03(2)(a)by 0 ft. [Runway Approach Plane/Water-500'x 10,000'@ 20:1 slope] p Project does not violate Aeronautics Division Airspace Laws or Regs. DETERMINATION: ❑Permit is required"pursuant to MGL Ch.90,35B,for ❑Runway Horizontal Plane ❑Runway Approach Plane O Permit is not required pursuant to MGL Ch.90,35B L7 No violations of Laws or Regs. ❑Ch.90 violation=30'agl ❑Permit is required pursuant to 702 CMR,50.3 Permit is not required pursuant to 702 CMR,50.3 ❑Additional concerns: ❑FAA Standards ❑Noise ❑Traffic Pattern ❑Wildlife t ❑VFR Route ❑Other t This determination is based on the foregoing description of the proposed project including the location, height and elevation data provided by the Sponsor.Any changes in the data provided to the:Aeronautics Division from that which is shown herein will render this determination null and v 'd a d will necessitate a new request for review. /► MassDOT-Aer4z .W1.1 . . Title: /f, By �jt Date � �a Forth E-10 [ Last Revised 0912014 A VERIZON ENGINEERING 385 MYLES STANDISH DR TAUNTON, MA 02780 f Z.O. f:.:. MATTHEW I(IRRANE TEL#508-884-4945 7/27/1 6 TO WHOM IT MAY CONCERN ALL VERIZON SERVICES HAVE BEEN DISCONNECTED TO THE SHED &REAR BLDG LOCATED .@395 W MAIN ST., HYANNIS., MA. YOU'MAY PROCEED WITH YOUR DEMO. Thanks, Matthew Kirrane 'Matthew Kirrane Date 7/27/16 Nl- U Massachusetts - Department of Public Safety Board of Building Regulations and Standards ! 1.1111\LI U1.L11/11 JUIICI Y111/1 �� License: CS-075537 ': _ Y I FRANCESCA M 25 MARLYMAC OVA If 1 PEMBROKE MA- Expiration f Commissioner 05/25/2017 ire 1 R , EASEMENT FOR ELECTRIC SERVICE WO#01983415—Pdmnt Xfrmr-10782/010 395 West Main Street-Hyannis KNOW ALL MEN BY THESE PRESENTS,that: CUMBERLAND FARMS INC, a Delaware corporation,successor by merger to VHS Realty, Inc.,having its principal place of business at 100 Crossing Boulevard,Framingham,MA 01702, hereinafter referred to as the Grantor,for consideration of One Dollar($1.00),grants to NSTAR ELECTRIC COMPANY d/b/a EVERSOURCE ENERGY, a Massachusetts corporation, having its principal place of business at 800 Boylston Street,Boston,Massachusetts 02199,its successors, assigns and licensees,hereinafter referred to as the Grantee, with quitclaim covenants,the right and easements(as more particularly described below)for underground lines for distribution of electricity,and lines for control,relay and communication purposes over, across,upon and under a certain parcel of land owned by Grantor(the"Premises") located at 395 West Main Street,Hyannis, Massachusetts. Said Premises and all boundaries are determined by the Court to be located as shown on subdivision plan I I328-B(sheet 2)dated October 1928,drawn by George F. Clements,Engineer, and filed in the Land Registration Office at Boston, a copy of which is filed in Barnstable County Registry of Deeds in Land Registration Book 9 Page 74 with Certificate of Title No. 1972 and said land is shown thereon as Lots 3, 4 and 34 The easement rights granted herein are more particularly described as the right,from time to time and within the Premises,to install, construct,reconstruct, alter,extend,operate,inspect, maintain,repair,replace and remove (a)underground buried cables,wires, conduits,pipes, splice boxes,manholes,hand-holes,wire distributing facilities, fixtures,appurtenances,service and lamp connections,with the wires and cables therein, and all necessary foundations, anchors, and other supporting appurtenances deemed necessary by Grantee for the purposes specified above; (b) above-ground pedestals, concrete pads, transformers, switchgear and apparatus cabinets with the necessary wires, cables,terminals,fixtures and appurtenances deemed necessary by Grantee for the purposes specified above(hereinafter(a)and(b)are collectively referred to as "Equipment"), and(c)together with the right and easement to enter upon the Premises, including vehicular access for construction and maintenance purposes, as may be necessary from time to time for all of the foregoing purposes,utilizing existing paved ways and parking areas on the Premises to the extent practicable. All Equipment shall be installed in conformance with Grantee's "Information &Requirements for Electric Service,"as issued by Grantee from time to time. Any Equipment installed by the 1 Grantor shall be maintained by the Grantor, and if Grantor fails to repair or maintain such Equipment, Grantee reserves the right to do so at Grantor's sole cost and expense. All Equipment shall be installed in locations mutually agreed upon by Grantor and Grantee, and shall initially be approximately as shown on a sketch dated 03/27/14 which is attached hereto and incorporated herein as Exhibit A. To the extent that no location is determined in advance,the location of the easement shall be fixed by the actual installation of the Equipment,and,unless specified otherwise, shall be 15 feet in width,centered on the Equipment as installed Grantor may at any time,at its sole cost and expense,prepare and submit to Grantee for review and approval an"as built"plan of the Equipment in recordable form. Upon approval of such plan, and concurrently with the recording of such plan,the parties shall execute and record an amendment to this instrument, fixing the location of the easements granted hereunder to the locations and dimensions shown on such plan;provided,that Grantee shall have the right of access over the remainder of the Premises for all purposes contemplated by this agreement. Grantor will not erect or permit any structures or obstructions which in the reasonable judgment of the Grantee might interfere with the safe operation and maintenance of the.Equipment. Grantee shall have the right to cut down and keep trimmed all trees,bushes,underbrush and growth as the Grantee may from time to time deem reasonably necessary for the safe operation and maintenance of the Equipment. All work by Grantor or Grantee under this Easement shall be done in a good and workmanlike manner by competent personnel or contractors, in conformity with all applicable permits, licenses,ordinances,laws and regulations, and free from any liens for labor or materials.The party performing the work shall be responsible for obtaining all applicable permits. Except in the event of emergency,prior to commencing any work at the Premises, Grantee shall endeavor to provide Grantor with such notice as may be practicable under the circumstances, which may consist of telephone or other verbal notification. The Grantee shall restore the surface of the Premises(by grading,paving or reseeding)wherever damaged by the Grantee by reason of its work as closely as reasonably practicable to the condition of such surface before such work. In the conduct of all work,neither party shall unreasonably interfere with the business,operations or access of the other party, its employees, invitees or contractors,or any other person having an interest in the Premises. Grantee shall have the right to connect the Equipment with its facilities located or which may be placed in private or public ways adjacent to the Premises. Grantee shall have the right to extend the lines from time to time, and the right to use the Equipment,to serve other customers of Grantee who may conveniently be served thereby. 2 5 � y a nn iS M A Massachusetts Department of Environmental Protection -� eDFEEP Transaction Copy Here is the file you requested for your records. To retain a copy of this file you must save and/or print. Username: FRANCESCO Transaction ID: 838546 Document: AQ 06- Construction/Demolition Notification Size of File: 100.88K Status of Transaction: In Process Date and Time Created: 6/9/2016:11:43:52 AM Note: This file only includes forms that were part of your transaction as of the date and time indicated above. If you need a more current copy of your transaction, return to eDEP and select to "Download a Copy" from the Current Submittals page. G� 41 i . ' ZnJ <so Massachusetts Department of Environmental Protection Bureau of Waste Prevention• Air Quality I, BWP AQ 06 1oo2a4861 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)? f Yes F No Type of Notification: l— Revision of an Existing Fonn F- Cancellation of Project Instructions: 1.Blanket Permit Project Approval,if applicable: Approval ID# 1.All sections of this I.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 t. Facility Information: Protection notification CUMBERLAND FARMS 395 WEST MAIN STREET requirements of 310 CMR 7.09. Name of facility Street Address HYANNS MA 026010000 5082701400 2.Submit Original City/Town State Zip Code Telephone Form To: Commonwealth of LEAHCRISOSTAMO REPRESENTATIVE Massachusetts Facility Contact Person Contact Person Title P.O.Box 4062 5082701400 Icrisostamo@cumberlandfarms.com Boston,MA 02211 Facility Contact Person Telephone Facility Contact Person Email Facility Size: 5230 1 Square Feet Number of Floors Was the facility built prior to 1930? (", Yes r No Describe the current or prior use of the facility: VACANT CUMERLAND FARMS STORE Is the facility a residential facility? r yes r No If yes,how many units? 2. Facility Owner: CUMBERLAND FARMS 100 CROSSING BOULEVARD Facility Owner Name Address FRAMINGHAM MA 017020000 5082701400 City/Town State Zip Code Telephone WAYNE SILVA 25 ANTHONY STREET On-Site Manager/Owner Representative Address Seekonk MA 02771 5083363366 City/Town State Zip Code Telephone Revised:03/17/2014 Page I of 3 "71 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality BWP AQ 06 100244861 Notification Prior to Construction or Demolition Asbestos Project Number# B.General Project Description(continued) 3. General Contractor: OF PRAY 25 ANTHONY STREET Name Address SEEKONK MA 027710000 5083363366 City/Town State Zip Code Telephone WAYNE SILVA 7749011137 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 FRANCESCO DEMOLITION,INC. 107 OAK STREET operation,all Contractor Name Address responsible parties must comply with 310 DUXBURY MA 023320000 7815850200 ' CMR 7.00,7.09,7.15, City/Town State Zip Code Telephone and Chapter 21 E of ANTHONY DURANTE 7815850200 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 FRANCESCA WADDELL CS-075537 notification with the Department and/or a Supervisor Name License Number notice of releaselthreat of 3. Is the entire facility to be demolished? (✓Yes r No release of a hazardous 4. Describe the area(s)to be demolished: substance to the Department,if ENTIRE STRUCTURE applicable. MassDEP Use Only 5. If this a construction project,describe the building(s)or addition(s)to be constructed: Date Received N/A a 6. If this is a demolition or renovation project, were the structure(s)surveyed for the presence of Asbestos-Containing Material(ACM)? Yes r No 7. Was asbestos containing material(ACM) found? I1-1 Yes F No If a survey was conducted,who conducted the survey? KLEINFELDER&SMITH&WESSEL SWA 16137 Name Department of Labor Standards Certification Number Revised:03/17/2014 Page 2 of 3 `71 Massachusetts Department of Environmental Protection Bureau of Waste Prevention• Air Quality BWP AQ 06 100244861 Notification Prior to Construction or Demolition Asbestos Project Number# C.General Construction or Demolition Description(continued) The Asbestos Abatement Notification Number for this UNKNOWN address is: This project r Construction F,, Demolition is: 6/23/2016 8/31/2016 Project Start Date(MM/DD/YYYY) Project End Date(MM/DD/YYYY) 8. For demolition and construction projects, indicate dust suppression techniques to be used r Seeding r Wetting r" Covering r Paving r Shrouding r 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 1 certify that I have personally FRANCESCA WADDELL examined the foregoing and am Print Name familiar with the information FRANCESCA WADDELL contained in this document and Authorized Signature all attachments and that, based FM on my inquiry of those individuals immediately ' Position/ C FRANCESC responsible for obtaining the O DEMOLITION INC information,I believe that the Representing information is true,accurate,and 6/9/2016 complete.11 am aware that there Date(MM/DD/YY`(Y) 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/N14 Page 3 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention• Air Quality BWP AQ 06 l ! Notification Prior to Construction or Demolition • This is a revision to an existing form. Project ID for existing form to be revised: • This job is being conducted under a Blanket Permit MassDEP assigned Blanket Authorization ID: I f•This job is being conducted under a Non Traditional Abatement Work Practice Permit. MassDEP assigned Non Traditional Work Practice Authorization ID: • None of the above conditions apply,generate a new form. Revised: 11/13/2013 Page 1 of 1 Town of Barnstable Regulatory Services WAS& Richard V.scall,Director ' ¢ Building Division , Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601. www.town.barnstable.maxs Office: 508-862-4038 Fax: 508-790-6230 , a . Property Owner Must Complete and Sign This Section If Using A Builder r I Cumberland Farms,Inc. as Owner of the subject property ,. hereby authorize jkrencesoo oemolitlon to act on my behalf, in all matters relative to work authorized by this building permit application for: ' 395 West Main Street (Address of Job) ` **Pool fences.and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all filial ` inspections are performed and accepted. Cumberland Farms, Inc Signature of Owner Signature of Applicant Sr. Pipeline Mgr. - Kathleen Sousa Print Name Print Name July 27, 2016 Date I Town of Barnstable Regulatory Services RAWWesasaM + Richard V.Scali,Director ¢ Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder l Cumberland Fames,Inc as Owner of the subject property hereby authorize lFrancesco Demolition to act on my behalf, in all matters relative to work authorized by this building permit application for: 395 West Main street (Address of Job) 4 **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accep n. Cumberland Farms, Inc. By [fit y s e�gllL1<�oL1_ _ Signature of Owner a of App cant Sr. Pipeline Mgr. Kathleen Sousa )ell Print Name Print Name July 27, 2016 Date CERTIFICATE OF VOTE I,Mark G. Howard, hereby certify that I am duly elected Secretary of Cumberland Farms, Inc., a Delaware corporation,having a usual place of business in Framingham,Middlesex County,Massachusetts, and hereby certify that the following is a true copy of a record of vote passed at a meeting of the Board of Directors of said corporation which was held the 12`h day of August, 2014, at which time a majority of Directors were present. VOTED: To authorize the following persons,individually, to sign and execute on behalf of the Company any easements,licenses, right of way agreements,permits or applications therefore,which may be required in the ordinary course of business pertaining to real estate owned by the Company and to execute whatever documents may be appropriate in connection therewith. Persons so authorized: Ari N. Haseotes, Chief Executive Officer,President and COO Mark G. Howard, Esq., Secretary Diane M. Boissonneault,Assistant Secretary Dino M. DeThomas, SVP &Chief Real Estate Officer Mark L. Russell,Director of Real Estate Administration Kathleen A. Sousa, Senior Pipeline Manager, Real Estate I further certify that this vote has not been rescinded and is still in force and effect. A True Copy Attest Dated at Framingham,Massachusetts This 5th day of January 2016 Mark . Howard Seer Grantee shall indemnify,defend and hold harmless the Grantor,its successors and assigns, from and against any claim,cost, loss or liability incurred by Grantor for physical damage or injury resulting from the negligence or willful misconduct of the Grantee,its employees, agents and contractors in the conduct of the work at the Premises pursuant to this easement.Nothing herein shall be construed to impose on the Grantee any liability for indirect,consequential,punitive or other special damages. Grantor may request that Grantee relocate any of the Equipment installed by the Grantee to another location on the Premises acceptable to the Grantee. Such relocation shall be at the sole cost and expense of the Grantor. Grantor shall have the right to use the Premises,and the right to grant to others the right to use the Premis es, for all purposes that do not unreasonably interfere with the rights granted to the Grantee hereby. All Equipment installed within the Premises pursuant to this easement shall remain the property of the Grantee and Grantee shall pay all taxes assessed thereon. This easement is executed pursuant to,and shall be subject to,the Grantee's Terms and Conditions of Service,as filed with and approved by the Massachusetts Department of Telecommunications and Energy from time to time. For Grantors title see Certificate of Title No.89626. EXECUTED as an instrument under seal this IF day of 12016. CLIMBERLAND FARMS INC. By: ARI N.HASEOTES-rPrreess d CEO By. DINO M.DETHOMAS-Senior VP of Real Estate COMMONWEALTH OF MASSACHUSETTS On this L6day of3UALJ , 2016,before me,the undersigned notary public, personally appearedPtj Nkseu S bn M DEXhQkqd&proved to me through satisfactory evidence of identification, which was GLI tjl(�4 , to be the person so whose name is signed on the preceding document, and acknowledged to me that she signed it voluntarily for its stated purpose, as an officez@ of Cumberland Farms Inc. $S, tV E+M. SYR E K _ k o!nI_.P) d Y L Notary Public Notary Public COMMONWEALTH OF MASWHUSErTS My Commission Expires January 21, 20222 3 8 FRANCt' DEMOLITION, INC P.O. Box 191'5 I Duxburv.MA 02331 1 0: 781.585.0200 I F:781.934.9193' DEMOLITION July 28, 2016 Town of'Barnstable Building Inspector ' Town Hall. Hyannis., MA 02601 t RE: 305 West.Main Street;.Hyannis MA This is to certify'that at I Frank Durante President:and. Owner of Francesco Demolition., Inc.,, hereby authorize, Francesca. Waddell the Account Manager. of Francesco "Demolition, Inc_ (CS775537),to pull,the demolition permit for the said project., Sincerely, Francesco 'D.e.m`olltion, Inc j Frank Du:rante President ° A } The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite oo, Bosto "A 02114-20X 7 www.mass gov/dia workers'Compensation Insurance Affidavit:Builder s)Contract ors7Electriciaris/Plumbers: TO BE FILED WITH•THE PERV11TT.ING AUTHORITY: APRlicantInformation Please"Print Le'ibL Name(Business!Organizaton[Individiial) �(•tf� �?jC {%� (` j� "( Address: City/State/Zi 57 AreyogAuemployer?.heck aappropriabox: Type of projeCt:(reCluired): /I Ie�I am a employer with t�-✓ employees(full an Votpah-time),* 7• NeW CoriStrUCtiOn' ❑ tr . 2. {am a sole proprietor or"partnership and have no employees working for'.me:in ❑ 8. ❑Remodeling any capacity [No,workers'comp.insurance,required.] 3•�[am a homeownerdoing•all work myself[No workers'comp;insurance required*]' 9: ❑Demolitiort.- 4 M:I.ain:a;homeowner.acid will be'hiring contractors,to condo,*al!work"on,my property 1 wilh to[� Building addition ensurethat.all contractors either have workers'compensatimi insuraoceor are sole I LE]Electrical repairs.or additions Proprietors with'no'employees.: 11[]Plumbing repairs or additions 5:Q I am a.general contractor uid t;have,hiredtlie sub-contrnuors'.Lsted on the attached;sheeG rliesesob-contractors have employees and have workers.comp..insurance.. )3.❑Roof iep8h 3 6.F�We are,a corporation,and its officers have:exeteisedflieiriight:ofexemption:per"MGtrc: a4:❑:QthCl 152;§I(4),and we have na"employees:[No workers '-comp insurance required;] "Any applicant that checks box,41 musralso egout the section below'showing their workers compensation policy infoiit anon: t Homeowntis who.subuiit this"affndavit indicating they are doing all,work and ttibn;hire outside'contractors must submifa'new affidavit indicating such. *Contractors that check this box must attached.an;additionalsheet showing the•name of the sub-contractors and state whether or not ahose entifi tfave eiiiplayees. If tile sub-contractors have;emptoyees,they must provide their workers'comp.?policy number. l ant an employer that is providing workers'conipensadon insurance for my einployees Below is,the policy and job site; iiiforination.' 106 Insurance Company Name: �LMLC (WUl Policy or Self-ins.Lic.#: V\Af I � "[ - Expiration Date: . CJ(( t Job Site Address: W �'h City/State%Zip: ,Attach a copy of the:workers"compensation;'.poticy-declaration page'(showing'the policy nuiit sand expiration date)._ Failure.to.secure cgyoage as"requned`undeilvGL c. 152,§25A:is a,criminal violation puriishable:by a fine'up to$I,SU0.001, and/or`one year imprisonment;4s well:as ci'vil,penalttes:in the form of.a STOP'WORK ORDER ant(a fine.of up to>$250.0'O:a day against the violator: A copy of thisstatement may'b'forwarded to the Office of.Investigations,of the DIA for insurance coverage verification. l do hereby cerdfy,uniler fhe pains and pe/naaldes-of perjury that the it>formation:pravided aboxe,is.true and.correct, Si nature: Date; ' 1 Phone#: Dffcial use only: Do not'write i t this area,:to be cornpleted.by city or town,offidal. City or Town. :P,.ermit/Lcense#" ,Issuin -Authors g ty:(clrcle one);: • !.`Board of Health: 2 Building Department 3.Cify/Town Clerk :4.Etectrical Inspector:5.Plambfng Inspector 6.Other 9. ;Contact:Person* Phone#'- l . E1lERSSURCE' EVersource;Ener9Y ENERGY One NSTAR Way;Westwood;Wssachusetts;0208MiM � - r July 28,2016 Cumberland Farms 100.Crossing Blvd Framingham,MA 01702 RE; 395 W-Main St,,Hyannis,MA f To,Whom'It May Concerni x AtE.versource,we're committed to delivering great service: This letter serves as confirtnation'that,as:of July 28,2016.the,underground electric service to the rear building(Cumberland Farms-meters 5098324;.2295426;and 5098769)of the address-listed above has been disconnected. If you.have any questions,please.contact me at(7:81)441;3206 Sincerely,: tj1 4 47 John Daly;:Senior Account Executive-Eastern MA Eversource Energy 1 NSTAR Way Westwood, MA.02090 �T(781)441 3206 ! (781)441-8721 .. . _ ®iohn daly>ir@everaource.;cont: I a i U TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map es Parcel 16,6 Application Health Division Date Issued Conservation Division j Application Fee Planning Dept. Permit Fee LA Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ HyannisK ^��r Project Street Address Village Ick4&,1Nw S Owner QAeA9,fR1 Wb,. Address dot? GP,&56i Pr 615.1� Telephone �4 ._777OT a Permit Request Cm —►g clot 1 r,� 1� ,3 rp .6= Square feet: 1 st floor: existing ,o95 proposed 2nd floor: existing �proposed �Total newQ Zoning District Flood Plain Zoa4. f— Groundwater Overlay +�Projec� Valuation, Z 00 }.7 Construction Type Lot Size ,?37 Grandfathered: XYes ❑ 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 ffi No Basement Type: ❑ Full ❑ Crawl ❑Walkout AOther ylA Basement Finished Area (sq.ft.) N14, Basement Unfinished Area (sq.ft)_ ArIA Number of Baths: Full: existing new Half: existing new 2- Number of Bedrooms: o existing a new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: NdGas ❑ Oil ❑ Electric ❑ Other Central Air: Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: O'existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization Id Appeal # 0`70 Recorded:9 Commercial Yes ❑ No If yes, site plan review # �3D—t3 Current UseC= m g t s {'64S S�a� &) Proposed Use Xtb+j APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Namel owfte- Telephone Number .? y '" Address License # 0 S 0 I33 A 1J ink - Home Improvement Contractor# Emai69 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4 - SIGNATURE DATE rt FOR OFFICIAL USE ONLY APPLICATION# I DATE ISSUED 0 MAP/PARCEL NO. ADDRESS VILLAGE OWNER p. DATE OF INSPECTION: FOUNDATION i FRAME INSULATION Q! D O FIREPLACE ELECTRICAL: ROUGH FINAL- . PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING E DATE CLOSED OUT ASSOCIATION PLAN NO. x ® DATE(MM/DDIYYYY) A�DP CERTIFICATEcOF LIABILITY INSURANCE TEMMI 016 DIYY 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 Willie of Massachusetts, Inc. NAME: c/o 26 Century Blvd - PHONE FAX •1-877-945-7378 A/C No:1-888-467-2378 P.O. Box 305191 EMAIL Nashville, TN 372305191 USA ADDRESS:certificates@willis.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:Valley Forge Insurance Company 20508 INSUREDD.F. Pray, Inc. INSURERB:Continental Insurance Company -35289 25 Anthony Street INSURER C:National Union Fire Insurance Company of Pitt 19445 Seekonk, MA 02771 -INSURER D:Continental Casualty Company 20443 INSURERE:Illinois Union Insurance Company 27960 INSURER F: COVERAGES CERTIFICATE NUMBER:W1527472 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR - POLICY EFF POLICY EXP - LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 10,006 X Contractual Liability , 6024546250 07/01/2016 07/01/2017 PERSONAL BADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY II PRO � LOC , .PRODUCTS-COMP/OPAGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY Ee eBINEDISINGLE LIMIT g 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ B ALL OS SCHEDULED 6024546264 07/01/2016 07/01/2017 BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS f Per accident $ $ C X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE' BE 023014156 07/01/2016 07/01/2017 AGGREGATE $ 5,000,000 DED I X I RETENTION$5 000 $ WORKERS COMPENSATION € X PER OTH. AND EMPLOYERS'LIABILITY Y/N STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � N/A 6024546278 07/01/2016 07/01/2017 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.0 DISEASE-POLICY LIMIT $ 1,000,000 E Contractor's Pollution Liab :'C00'G2736956A 004 07/01/2016 07/01/2017 Each Claim 5,000,000 11 Claims 5,000,000 - DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Evidence of Coverage 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 D. F. Pray,, Inc. - - - - - -25 Anthony Street - - eekonk, MA 02771 / ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD SR ID:12463408 BATCH:Batch #: 236196 �ZNE Town of Barnstable $ Regulatory Services . MASS I'='� Richard V.5cali,Interim Director - i639• �e Nua" Building Division, Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must _ Complete and Sign This Section If Using A Builder I, Cumberland Farms, ;Inc. as Owner of the ro subject _ l property herebyauthorize__DF�Pray/Wayne Silvia to act on my behalf, in all matters relative to work authorized by this building permit 395' Main - Street (Address of Job) ' Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final ; inspections are performed and accepted. Cumberland Farms, Inc. .; By Signature of Owner igna o Applicant E Kathleen Sousa Senior Pipeline Mgr. iA V CJ k Print Name Print Nari t June '30, 2016 Date Q:FORMS:OWNERPERMLSSIONPOOLS 10/13 r 'TRAVELERSJ BOND (License or Permit - Definite Tenn) Bond No. 106337107 KNOW ALL MEN BY THESE PRESENTS: THAT WE, Cumberland Farms,Inc. as Principal, and Travelers Casualty and Surety CompanIy of America , a corporation duly incorporated under the laws of the State of Connecticut and authorized to do business in the state of Massachusetts , as Surety, are held and firmly bound unto Town of Barnstable , as Obligee, in the penal SUM of one Thousand Two Hundred Seventy-Two and 80/100 $1,272.86 Dollars, for the payment of which we hereby bind ourselves, our heirs, executors and administrators, jointly and severally, firmly by these presents. WHEREAS, the Principal has obtained or is about to obtain a license or permit for Raze&Rebuild Proiect at 399 West Main Street,Hyannis,MA as set forth in the plans by Allevato Architects&Coastal Eneineerina,Inc. NOW, THEREFORE, THE CONDITIONS OF THIS OBLIGATION ARE SUCH, that if the Principal shall faithfully comply with all applicable laws, statutes, ordinances, rules or regulations, pertaining to the license or permit issued, then this obligation shall be null and void; otherwise to remain in full force and effect. This bond is for a definite term beginning 12/8/2015 , and ending 3/13/2017 , and may be continued at the option of the Surety by Continuation Certificate. PROVIDED, that regardless of the number of years this bond is in force, the Surety shall not be liable hereunder for a larger amount, in the aggregate, than the penal sum.iisted above. PROVIDED FURTHER, that the Surety may terminate its liability hereunder as to future acts of the Principal at any time by giving thirty (30) days written notice of such termination to the Obligee. SIGNED, SEALED AND DATED this 12/8/2015 Cumberland F Inc. By: Mar G. Howard, Secretary Principal Travelers&sualty and Surety Company of America By: Jane Attorney-in-Fact Project Name: Hyannis, MA R&R Project No. : V0990/2326/2142 S-2151 B(6/10) WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER ' e F ,C,1 POWER OF ATTORNEY T'`R^V`LE•`R�� Farmington Casualty Company St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company Fidelity and Guaranty Insurance Underwriters,Inc. Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul Guardian Insurance Company Attorney-In Fact No. 230044 Certificate No. 006521215 KNOW ALL MEN BY THESE PRESENTS: That Farmington Casualty Company, St. Paul Fire and Marine Insurance Company, St. Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company are corporations duly organized under the laws of the State of Connecticut,that Fidelity and Guaranty Insurance Company is a corporation duly organized under the laws of the State of Iowa,and that Fidelity and Guaranty Insurance Underwriters,Inc.,is a corporation duly organized under the laws of the State of Wisconsin(herein collectively called the"Companies"),and that the Companies do hereby make,constitute and appoint Mark P.Herendeen,Kevin A. White,Jean Correia,Maria Chaves,Theresan E.Rowedder,Jane Gilson,Bryan Huft,and Gregory J.Steele of the City of Boston State of Massachusetts their true and lawful Attome s-m-Fact, YO each in their separate capacity if more than one is named above,to sign,execute,seal and acknowledge any and all bonds,recognizances,conditional undertakings and other writings obligatory in the nature thereof on behalf of the Companies-in their business of guaranteeing the fidelity of persons,guaranteeing the performance of contracts and executing or guaranteeing bonds and undertakings required or permitt&in any acfions or proceedings allowed by law. � 1 sin IN WITNESS 7REOF,the Compar dj leave caused this instrum�ttVo be slgned,and their rporate seals to be hereto affixed,this UctODer J day of [� Farmington Casualty Corn pany [� F , I St.Paul Mercury Insurance Company Fidelity and Guaranty Insurance Company Travelers Casualty and Surety Company .Fidelity and Guaranty Insurance Underwriters,Inc.., Travelers Casualty and Surety Company of America St.Paul Fire and Marine Insurance Company United States Fidelity and Guaranty Company St.Paul'Guardian Insurance Company 02r�L �pt�•• �"F10.E6 .IN1,G9.. j}J+C�INSU C irnRou,Fq�o ®4cj -!P$ �`pR PORA �i .. Q. 'hf�` C 1982�'O �d IHCp�pppp h ip �! TF� 3W �pRPORAT� I 00 a HARTF N. t H4RiF6H0. ..a k� �.SEA .SEAL 3°' ........... �, CCHH.- o od s �aPr \ .f u o:'•.. :d� 61•y� �H - .I.. � �QRnx^ � State of Connecticut By: City of Hartford ss. _ Robert L.Raney,Kior Vice President 15th October 2015 Orr this the - day of before_me personally appeared Robert L.Raney,who.acknowledged himself to be.the,Senior Vice President of Farmington Casualty Company,.Fidehty and Guaranty-Insurarice Company,Fidelity and Guaranty Insurance Underwriters;Inc.;St:Paul :Fire and Marine Insurance Company,St.Paul Guardian Insurance Company St.,Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and'.Guaranty-Company,and that he,as such,being authorized so to do,executed the foregoing instrument for the purposes therein contained by-signing on behalf of the corporations by himself as a duly authorized officer. G.Tp'T In Witness Whereof,I hereunto set my hand and official seal. M Commission expires h y. t e 30th day of June,2016. � G # Marie CT etreault,Notary Public. 58440-8-12 Printed in U.S.A. WARNING:THIS POWER OF ATTORNEY IS INVAUb'WITHOUT THE RED BORDER WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER � 4 This Power of Attorney is granted under and by the authority of the following resolutions adopted by the Boards of Directors of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance, Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and United States Fidelity and Guaranty Company,which resolutions are now in full force and effect,reading as follows: RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President,any Vice President,any Second Vice President,the Treasurer,any Assistant Treasurer;the Corporate Secretary or any Assistant Secretary may appoint Attorneys-in-Fact and Agents to act for and on behalf of the Company and may give such appointee such authority as his or her certificate of authority may prescribe to sign with the Company's name and seal with the Company's seal bonds,recognizances,contracts of indemnity,and other writings obligatory in the nature of a bond,recognizance,or conditional undertaking,and any of said officers or the Board of Directors at any time may remove any such appointee and revoke the power given him or her;and it is FURTHER RESOLVED,that the Chairman,the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President may delegate all or any part of the foregoing authority to one or more officers or employees of this Company,provided that each such delegation is in writing and a copy thereof is filed in the office of the Secretary;and it is FURTHER RESOLVED,that any bond,recognizance,contract of indemnity,or writing obligatory in the nature of a bond,recognizance,or conditional undertaking shall be valid and binding upon the Company when(a)signed by the President,any Vice Chairman,any Executive Vice President,any Senior Vice President or any Vice President,any Second Vice President,`the Treasurer,any Assistant Treasurer,the Corporate Secretary or any Assistant Secretary and duly attested and sealed with the Company's seal by a Secretary or Assistant Secretary;or(b)duly executed(under seal,if required)by one or more Attorneys-in-Fact and Agents pursuant to the power prescribed,in his or her certificate or their certificates of authority or by one or more Company officers pursuant to a written delegation of authority; and it is FURTHER RESOLVED,that the signature of each of the following officers:President,any Executive Vice President,any Senior Vice President,any Vice President, any Assistant Vice President,any Secretary,any Assistant Secretary,and the seal of the Company'may be affixed by facsimile to any Power of Attorney or to any certificate relating thereto appointing Resident Vice Presidents,Resident Assistant Secretaries or Attorneys-in-Fact for purposes only of executing and attesting bonds and undertakings and other.writings obligatory in the nature thereof,and any such Power of Attorney or certificate bearing such facsimile signature or facsimile seal shall be valid and binding upon the Company and any such power so executed and certified by such facsimile signature and facsimile seal shall be valid and binding on the Company in the futuie with respect to any bond or understanding to which it is attached. I,Kevin E.Hughes,the undersigned,Assistant Secretary,of Farmington Casualty Company,Fidelity and Guaranty Insurance Company,Fidelity and Guaranty Insurance Underwriters,Inc.,St.Paul Fire and Marine Insurance Company,St.Paul Guardian Insurance Company,St.Paul Mercury Insurance Company,Travelers Casualty and Surety Company,Travelers Casualty and Surety Company of America,and Unite�dd States Fidelity and Guaranty q Company do hereby certify that the above and foregoing is a true and correct copy of the Power of Attorney executed by said Companie'�bwhich is infll force and effect and has not been revoked. IN TESTIMONY WHEREOF,I have hereunto'set my hand an y�ed the,seals of said`Companies this day of L/GcTi` b&r, 20 Leo 0WV "Kevin E.Hughes,Assistant Sec tary G (6FN �Mf IN •'VttY ANp POR ¢ NARTFORD� 'o CONN. nVV.3 S$AL x�a� 1S...A1�J �5,....... Pd 61 �N • 'O "//Itttt To verify the authenticity of this Power of Attorney,call 1-800-421-3880 or contact us at www.travelersbond.com.Please refer to the Attorney-In-Fact number,the above-named individuals and the details of the bond to which the power is attached. WARNING:THIS POWER OF ATTORNEY IS INVALID WITHOUT THE RED BORDER CERTIFICATE OF VOTE I,Mark G.Howard,hereby'certify that I ani duly elected Secretary of Cumberland Farms,Inc., a Delaware corporation,having a usual place of business in Framingham;Middlesex County,Massachusetts, and hereby certify that the following is a true copy of a record of vote passed at a meeting of the Board of Directors of said corporation which was held the 12te day of August,2014, at which time a majority of Directors were present. VOTED: To authorize the following persons,individually,to sign and execute on behalf of the Company any easements,licenses,right of way agreements,permits or applications therefore,which may be required in the ordinary course of business pertaining to real estate owned by the Company and to execute whatever documents may be appropriate in connection therewith. Persons so authorized: Ari N. Haseote§, Chief Executive Officer-,President and COO Mark G.Howard, Esq., Secretary Diane M. Boissonneault,Assistant Secretary .Dino M. DeThomas, SVP &Chief Real Estate Officer Mark L. Russell,Director of Real Estate Administration Kathleen A. Sousa,'Senior Pipeline Manager,Real Estate I further certify that this vote has not been rescinded and is still in force and effect. A True Copy Attest Dated at Framingham,Massachusetts This 5th day of January' 2016 Mark . Howard Secr ary ZISSON & VEARA, P.C. ATTORNEYS AT LAW 828 MAIN STREET DENNIS, MASSACHUSETTS 02638 TELEPHONE (508) 385-603I FAX (508) 385-6914 MAILING ADDRESS: P.O. BOX 2031, DENNIS, MA 02638-0043 E. JAMES VEARA RICHARD L. ZISSON PAUL V. BENATTI (1942-2006) CHRISTOPHER A. VEARA EDWARD E. VEARA RETIRED October 20, 2015 VIA FIRST CLASS MAIL Elizabeth Jenkins,.AICP Principal Planner Growth Management Department Town of Barnstable 200 Main Street Hyannis,VIA 02601 Re: 395 West Main Street, Hyannis LSp iil`PermitiNo 22013=070"-Cllmberland'FarmS;In Dear Ms. Jenkins, Enclosed please find an as-recorded copy of the one year extension for the above referenced Special Permit issued to Cumberland Farms, Inc. Thank you for your attention to this matter. Col Tally E. James Veara EJV/lmW Enclosure Ec: Kathie Sousa(Cumberland Farms) John Marth(Cumberland Farms) Da-=: It 260. 495"-1-Q_-2i�- 2J315 12:01 BBARNSTABLE LAND 6r3CtFrT REGISTRY j Town of Barnstable - - -- - - - �` ';;;•,r . Zoning Board of Appeals Notice of 1 Year Extension , f Extension of Special Permit No. 201�3-07_0—Cumberland Farms, Inc. Summary: i Year Extension Granted Petitioner: Cumberland Farms, Inc. Property Address: 395 West Main Street, Hyannis, MA Assessor's Map/Parcel: 269/116 Recording Information: Special Permit 2013.035: Document No. 1238757 Deed: Certificate No.89626 Plan: 11328-B, Sheet 2 (Lots 3, 4, 34); Background & Procedural Summary By a letter dated July 29, 2015, E,James Veara, Esq.,as representative for Cumberland Farms, Inc., requested a one year extension of Appeal No. 2013-070, a special permit to demolish and rebuild a pre-existing nonconforming gas station. The Board voted to grant the Special Permit on December 11, 2013. The decision was filed with the Town Clerk on December 18, 2013 and recorded at the Barnstable County Land Court Registry as Document No.1238757: Section 240-125(C)(3) of the Town Code authorizes the Board to allow an extension of the time to exercise a Special Permit for a period not to exceed a total of one-year upon a showing of good cause. Attorney E.James Veara,on behalf of the Petitioners, presented the*extension request to the Zoning Board of Appeals at their August 26, 2015 regularly scheduled meeting. Motion At the regularly scheduled meeting of the Zoning Board of Appeals on August 26,2015, a motion was duly made and seconded to grant a one-year extension of Specia[Permit No. 2013-070. The validity of the Special Permit shall be extended from December 18, 2015 to December 18, 2016. The vote was as follows: AYE: Brian Florence,Alex Rodolakis, George Zevitas, Herbert K. Bodensiek, Robin Young NAY: None - Ordered Special Permit No. 2015-070 has been granted a one-year extension to December 18, 2016. This extension must be recorded at the Land Court Registry for it to be in effect. Brian Florence, Chair Date Signed 1,Ann Quirk, Clerk of the Town of Barnstable, Barnstable County, Massachusetts, hereby certify the filing of this extension in the office of the Town Clerk. - Signed and sealed this /!� day of � under the p�ai i�,<an��MA s of ,. f: perjury. co To Ann Quirk- Clef 4, ; :: i D Town of Barnstable fO M� Zoning Board of Appeals Addendum to Notice of 1 Year Extension Extension of Special Permit No. 2013-070--Cumberland Farms, Inc. Summary: 1 Year Extension Granted Petitioner: Cumberland Farms, Inc. Property Address: 395 West Main Street, Hyannis, MA Assessor's Map/Parcel: 269/116 Date filed with Town Clerk: September 9, 2015 Recording Information: Special Permit.2013-035: Document No. 1238757 Deed: Certificate No. 89626 Plan: 11328-B,Sheet 2 (Lots 3, 4, 34) I,Ann Quirk,Clerk of the Town of Barnstable, Barnstable County,Massachusetts,hereby certifh� ipt (20)days have elapsed since the Zoning Board of Appeals filed this decision and that no aPSPq:0R11�! •e••••••a+;-�. 1.)s1 decision has been filed in the office of the Town Clerk. yy ',t. :�; JF Signed and sealed this t' day of under the pains and ena*if r � � • .J� �• V' -fir`-`,ra F :° Ann Quirk,Town Clerk �' SN. z . d °. Town of Barnstable EARiCSTAELE TOkqq t;LEI�,K, 6a61A , .•` Zoning Board of Appeals 2015OCT 16Ph1:25 Error in Script As related to the decision rendered for: Extension of Special Permit No. 2013-070—Cumberland Farms, Inc. An error in script was identified in the Notice of One-Year Extension for Special Permit No.2013-070, along with the associated addendum,issued to Cumberland Farms,Inc.for property addressed 395 West Main Street,Hyannis. The notice was filed Hrith the Town Clerk on September 9,2015 and the Town Clerk signed the addendum on October 7,2015. The error is found in the summary portion of the Decision and Addendum. Under`Recording Information'an incorrect permit number is referenced. The Notice for Extension of Special Permit No.2013-070 and associated addendum are corrected to read as follows: Recording Information: Special Permit 2013-070: Document No. 1238757 Deed: Certificate No. 89626 Plan: l 1328-13,Sheet 2 (Lots 3,4,34), Respectfully Submitted, Eliz ethdS., e kins,P incipalPlanner Oa 2015 Page 1 of 1 r Town of,BaftP. "ABLE. LAND., .COURT. REGISTRY ! . t bnIing':,Board of-Appeals 77 .Qecision':.and Nofice: Special Permit No.2613-070-Cuhibeflarid Farms,Inc.- Section 240.93(8)&240.94-Alteration of Pre-existing`Nonconforming Use.in WP: Section'240-2S(C)=Conditional Use.Special Permit `Section 240-93(8)—Alterat ion=of,a-Pre-existing Nonconforming 5tructu're To;demolish`and rebuild'a preexisting nonconforming gas,statidn Summary:: Granted with;Conditions. �jSTi €i1+ll�!Cl.ERI' Petitioner: Cumberland Farms,'Inc: 100 Crossing Boulevard,Framingham,.ivtA 2kr1;, 8 � . Fii3i35; Property Address: 395 West Main'Street Hyannis . . Assessor's Map/Parcel: ;269/1 i 6 Zoning: Highway.Business District,,,Wellhead::Protection,Overlay District: Hearing Date: December 11;,2013 Recording information: Deed: . Certificate No.-.89626 `Plan: °Plan No:'11.3286;Sheet'2 (Lots3,4 .34)' 'Background The subject property is a 0.60 acre.parcel located'at the corner of West Main Street and Suomi'Road in Hyannis. The parcel is currently improved with six'.fuel dispensers(twelve puinps),.a 50 ft'x 90 ft gas station canopy and.an approximately 800 sq.ft convenience storeJkiosk._:A separate.freestanding multi-tenant:44ildirig:of approximately 4,450 sq.ft sits behind the gas station. Th s buildingI currendy.,vacant. The parcel is lacated`endrely within-the Highway Business'District and:Wellhead Nptediort Cweclay;Dis€rict ,The property is bound.0 to.thIe north;and' east by lots used for storage of used cars The property has:been owned'by--Cumberiand:.Fasins since T982. According to:the Applicants'a"Speedy Way station operated at the site prior to'their purchase and redevelopment and use of the pr1.operty fora gasoline filling station dates to as early as 1958;r.as ev. enced,by a fuel storage license. The use of the:property as a;gas station thus predates the adoption of the Groundwater Protection.Overlay, Districts in :1987: The. existing site configuration was'established in-1982-1943 The.multi-tenant building to the rear has three tenant.spaces. A'Cumberland,Farms sign is:displayed above one space,but it appears to be aargely.vacan used perhaps;for storage. ,In'2002,the Board`.issued`a Conditional'Use; Special Permit ,to`°Sassy,'Hail s"'for;use'of a'..tenant:;space for. a manicuristrshop. That use has;'since been abandoned. Cumberland Farms, Inc: is seeking'16 demolish'all existing structtires',and 'redevelop the site with a new.gas station and,convenience.store.. To accomplish,this,the'Applicant has made three Special Permit requests. The Applicant sought to..alter a preexistmg`:nonconforming gasoline filling,;station use in,the Wellhead:Protection; Overlay District, a Conditional Use Special Permit for retail: etail sales.in the.Highway Business.Distnc��,"and a Special Permit for alteration of preexisting nonconforming structures'that do:not:meet Setback`requirements!in the:, Highway Business.District: Procedural&.Hearing Summary: Special Permit No.:2013-070,a-request;by Cumberland Farms for Special Permit to demolish:an existing gasoline: filling station and multi-tenant building and,rebuild:a,new 4;426 sq.ft;con" venience store and gasoline pumps: with canopy was<filed at;the Town:Clerk's,Ctffice'.and die Zoning.Board of Appeals office on November 8,2013. A public hearing before."the Zoning Board of,Appeais.:was :duly advertised<and notice sent-to all abutters in accordance with :MGL Chapter 40A --The-hear ng was opened.December 11,..2013; at which time;the Board found Wgrant the requests subject to conditions. ,Boar&members deciding this appeal •were Craig,G. Lar$on, Brian Florence,Alex M. Rodolakis,William H..NgWn and George T.-Zevitas Attorney James,Veara.represented'theApplicants beforethe Board. lvMartin R.Qanoghuefrom Coastal' y " Engineering Company;Inc.was,also present. Attorney Veara reviewed the existing site.conditions and briefly Town of Bamstable.Zoning.Boazd ofAppeals,-Decision aadNotice Special Permit No:2013-07U-Cumberland Farms T*ee s Nonconforming Use&Sttucsures,Comditioual Uw Presented,the proposed new construction..,He reviewed the relief requested,staring with'the aiter:the gas station use in the WP Overlay District.ex. l.a.i_nin. 1f.i.e re.wo Id be no:intensification ofdte.:u i se, mprovements'.m safety: and atormwater management,aric an increase in'impervious surface area.:.He reviewed the request for a Conditional Use Special Permit,;noting approval from'the.Site plan Review Committee had been received. He< discussed the request for alteration of preexisting,nonconforming structure,noting the'improvements to::setbacks along West Main,Street,the reduced building coverage, addition of landscaped areas,and.reduction;in curb;euts: He stated the proposal complied with;the] comprehensive pian. In responseao questions.from the.Board;aheApplicant reviewed the loading areas and number and location of parking spaces: The outdoor seating.area.was discussed,:including concems about loitering,during hours when the store is closed and the Applicant agreed�to secure the area with a fence gate or chain. Existing and proposed setbacks were discussed: The Board noted.that the Applicant's proposal:was a substantial i%mprovement over e existing conditions. Traffic circulation and cueb.cuts were'revieweci.. Public comment was requested.and no,.one spoke.. Findings of fact At December`Yl,201 Yhearing,the'Board"unanimously made,the4ollowing''findings of fact forAppeal`201''3= 070, a request by`Cumberland Farms; Inc.to demolish existingspvctures and rebuilds convenience_store;and nonconforming gas.station at 395 West Main Street, Hyannis:.: I. Cumberiand.Farms,Inc petitioned fora Special Permits to completely demolish an ezisting'muSti=tenant ' building,..:convenience store/kiosk;canopy and six fuel dispensers and reconstruct a new 4 426aquare foot convenience store,a canopy(reduced in area); and three fuel dispensers: 2. The subject property is located`at 395 West Main Street,Hyannis,"MA shown on Assessor's Map:269,as Parcel 116. It;is in'the:Highway Business Zoning District and:Wellhead Protection`0veri4y`District 3. Cumberland:>Farms;_Inc:is requesting,Specia!'Permits,:under„Sections'240-93B,and 240a4:for alteration of a', preexisting nonconforming::-use housed in a preexisting nonconforming structure. Tle Applicant seeks,to . alter and continue the gasoline:filling station use in:the Wellhead::Protection,District:", 4 The Proposed'alterations.arepot-substantially more detrimental to the surrounding peighb6thood..There will' be no:increase in hazardous materials or_fuel storage,the number of•fuel pumps will be reduced to: ree,: safety and stormwater improvements will be.ffi d andl there will b"Aecrease in:the total`:impervious surface area: 5: The proposed use and expansion is,onthe'same tot';as occupied by tiie nonconforming"u`se on the.date in became nonconforming. The,nonconforming;use is maintained on Lots 3,4 and 34.as:shown on Lan&Court Plan No. 1.1:328B.. 6. The proposed use is not expanded beyond the zoningdistrict in existence,onahe date itbecame':;- nonconforming:.The entire parse{tins beenzoned WP since:1987 7. Cumberland Farms is.requesting a Conditional Use Special Permit pursuant:to;240-25(Q for:retail sales in'.il e. Highway,.Business pistrict. The Applicant is.,proposing a new 4,426 sq.ft convenience store; 8. The proposed retail use will not substaniiallyadversely.affedffie public health;saf y,welfare;comfort;or M convenience,of the community The proposal adequately addresses;parlung access, landscapmg,.and:. utilities and will be Substantial improvementover existing conditions 9. Cumberland Farms is requesting a Special Permit.pursu' t to Section 240=9.36 for alteration of preexisting nonconforming structures The existing and.,proposed structures do;not conform.to..front`and rearyard" setback requirements in the MB District The proposed setback.of the new gm9pyand converne'nce store are 17 feet and 22 feetfrom Suomi Road,'respectvely. The proposed rear buildingsetback is 6Q feet. 10 The proposed alterations are not substantiallymore detrimental.to thesurrounding neighborhood. The proposal improves the overall condition of the site, including appearance,setbacks from West Main Street, number of:curb cuts and pervious area and landscaping: 11'.The.Site Plan,Review.Committee approved tfie proposed development on,i?ecember.l0,'2Q.13 2 Town of Barnstable Zoning Board of.Appeab Decis oa and Notice Special Permit No.2013-070—,Cximbeslaad .=Pteesistm$!Nonconfoiming Use&Structures,ibmdirioaal Use 12.After an evaluation of all the evidence presented,.the;proposal fulfllsthesp.irit and intent ofthe.Zoning Ordinance and would not represent substantial detriment to ttle.publ.'ic good or the neighborhood affected, The proposal will improve the appearance of the.property;bring the canopy and pumps.nto greater compliance with setback requirements on West Main Street;and add landscaping and other aesthetic, functional,-and safety improvements. The vote to accept the findings was: AYE: Craig G.Larson,Brian Florence;:Aiex.M:Rodolakis,William H.Newton,George T.Zevitas NAY: None Decision Based on the:findings of fact, a:motion was duly made`and seconded_'to grant;Special.;Permit No:20)3-07Q'to Cumberland Farms,Inc.subject to the following conditions 1. Special perinif No.2013-070'is granted to Cumberland Farms;Inc.`forthe.redevelopment ofahe:ex sting,gas stationandconvenience store at 395'West Main Street, Hyannis. Relief is granted as follows:; a. Special,Permits,under Sections 240-93B-a6d 240-94 foralteration of a preexisting nonconforming use housed in a preexisting nonconforming structureto alter:and continue use of a,gasoline filling station use. in the Wellhead Protection District. b. A Conditional:Use Special.Permit`pursuant to 240-25(0 for retail sales iii the Highway Business;District, specifically the operation:of a 4,426 square foot convenience;stores c. A Special.Perrnitfor alteration of preexisting nonconforming structures to.allowthe setback of the new, canopy and conveniencestore to'be,17feet and 22 feet':fr=Suomi Road,:respectivelyand the proposed> rear building setback to be 6.0feet:. -2. The'redevelopment shall be in substantial,compliance with;theplans entitled"Proposed Site Redevelopment:. Cumberland"Farms,anco drawn-and`stamped by Coastal Engineering Company, Inc:and dated,December• 10,2013 and the building elevat ons.entitled'Cumberland Farms Exterior Elevations..".drawn by Allevato'. Architects,Inc.dated Od6ber7,201;3: 3. Landscaping shall be-installed.and maintained in substantial'..conformance with the plan.entitled "Cumberland Farms,inc.Planfing Plan°drawn and stamped by Hawk Design, Inc dated.December 9,2013. 4. The redevelopmentshall.be in conformance with:all'conditions contained:in the Site Plan Review. Committee's approval letter.dawd.December 10;2013:.. 5. For the purposes of improved pedestrian safety,the foot concrete sidewalk-on Suomi Road shall:be extended.north to.meet the walkway in front_of the building,: _ 6. Signage shall be extemally:iliu.rninated and incompliance with the'Sign Code as determined by.the Building.. Commissioner. 7. 'The.redevelopment s:ha be incompliance w th,all Board of.Health regulations or with any:variance,issued; by the Board. 8. The redevelopmentshall.be in.'compliance,with,aII fire:codes and reguirernents:of th Hyannis Fire' Department: _ 9. The site shall be connected io:sanimr sewer+;and all necessary permits shall^be obtained from the: Department of Public Works:. 10, Ttie decision shall tie':recorded at,the'Bamstable'County Registry of Deeds and;copies 'f,th recorded decision shall be submitted to;the Zoning Board of Appeals:Office and'the.Building Divislon prior'to issuance of building ordemolifion permits. The rights authorized bythis special permit must be exercised within two years, unless extended:: =1.1. The fenced-in seating`area on the"easterly side ofthe'building shall'be closed-off with a gate or chain during hour`s'when the:store inclosed. •L 3 Town of Barnstable Zoning$oatd;of Appeals T7 idsion sud Notice Special Permit No:2013-070'—Cumbedaad Films.-P eeaistiugNonconfo=ing Use&°structures,Conditional Use The vote was: AYE: Craig G,1.arson, Brian Florence,'Alex M Rc dolal'is;William H.Newton;;George T.Zevitas NAY: None` Ordered Special Permit No.2013-070 to allow Cumberland Farms,lnc,to'completely demolish an extsting,multi errant building;convenience store/kiosk;canopy:and six.fuel dispensers:and'reconstruct`a new4;426 square foot convenience store,a canopy,and threefuel dispensers has been'grantedsubjectto conditions. This decision must be recorded at the Barnstable,Registry.of Deeds 1.for itto be in effed:and',notice of at recording submitted' to the Zoning Board of Appeals Office. The relief,authorfzed.by this decision.must.be exercised within two.years unless extended. Appeals of this decision, if•any,shall.be made;pursuant to MGL Chp; r.40A,:Sediow17; within twenty(20)days after r the of the filing of this decision;a copy of which must beefed in the offce;of the Barnstable Town Clerk. Craig G. Larson,Chair Date` igned: A_.` "j •� Z' I,.Ann:Quirk,Clerk of the Town of:Barnstable;,Barnstable County,:Massachusetts,:hereby certify thagt�ocert ) ti .u, days have elapsed since the Zonin Board of A P g ppeals filed this decision and that no appeal of the deec�rt.has been filed in the office of the Town Clerk.: ,.d� •.�p�. t f�f�1 t:�lflf�ff.' Signed and sealed this day of under the`pains and penalties of,perjury., AAnn;QuiricJown Clerk 4_ Town of Barnstable . aenwes�a F 200 Main Street,Hyannis,Massachusetts 02601 rnsa i6;� Regulatory Services Richard Scali, Interim Director Building Division Tom Perry,Building Commissioner Phone(508)862-4679 Fax(508)862-4725 www.town.bamstable.mam December 10,2013 Cumberland Farms, Inc. c/o Attorney E.James Veara Zisson&Veara 828 Main Street Dennis,MA 02638 RE: Sim lan,Review#_03-0 13' umberland_Farms 395 West Main Street,Hyannis Map 269,Parcel 116 Proposal: Raze existing 4,095 st building to the rear of the site formerly used as a division office as well as additional tenant units;the 792 s.f.convenience store/kiosk and the gas canopy of 4,550 s.f. A colonial style building of 4,426 st is proposed to be constructed to be used solely as a convenience store. Six fuel dispensers will be replaced with three fuel n storage tanks to remain. Parkin will be redesigned dispensers with existing underground sto ag g g and landscaping will be enhanced. Dear Attorney Veara: Please be advised that subsequent to the formal site plan review meeting held October 17, 2013,revised plans for the above project were found to be approvable subject to the following: • Approval is based upon and must be substantially constructed in accordance with the following plans entitled: "Cumberland Farms,Inc.,Barnstable—Proposed Site Redevelopment Plans",8 Sheets,Scale 1"=20',prepared by Coastal Engineering Company,Inc.,Orleans,MA for Cumberland Farms, Inc,dated October 4,2013 with final revision to sheets CFG3.0 through CFG9.0 December 10,2013;Landscape Plans,3 Sheets,prepared by Hawk Design,Inc.,Scale 1"=10',dated October 7,2013,revised December 9,2013;Lighting Plans with photometric, dated October 3,2013. • Relief must be granted from the Zoning Board of Appeals for setbacks,alteration of nonconforming use&structure as well as a conditional use special permit for retail sales in the HB District. • ADA detectable panels shall be dark grey in color as depicted on the plan. • Dumpsters must be setback 10 from the property line. Applicant has the option to apply to the Board of Health to seek a setback variance. • Detailed floor plans will need to be provided and approved by the Health Department at the building permit stage. • A 1000 gallon grease trap must be installed as shown on the proposed plan. • A Common Victualler License is required for proposed outside seating. Contact: Christine Ade,Administrative Assistant,Licensing Authority 508-8624774. • Water service must be installed in accordance with the Hyannis Water Department requirements. Old water service must be cut and capped off at the main. Contact: Hans Keijser,Supervisor, Hyannis Water 508-778-9617 Ext 3502. • Sewer connection:rust be installed in accordance with the Town of Barnstable Public Works Water Pollution Control Division Regulations. Contact: David Anderson, Construction Project Inspector,DPW 508-790-6244. • Consultation and approval from Hyannis Fire Department is required. Filing and approval from the State Fire Marshall's Office for new self-serve dispensers and fire suppression system is also required prior the issuance of a building permit. Contact: Deputy Chief Dean Melanson, Hyannis Fire Department 508-775-1300. • A road excavation permit must be obtained from DPW prior to construction in the road layout. • Applicant must obtain all other applicable permits,licenses and approvals. • Upon completion of all work,a registered engineer or land surveyor shall submit a letter of certification,made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan(Zoning Section 240- 105(G). In addition to letter of certification,an as-built of the driveway entrances including elevations verifying that the stormwater will remain onsite is requested. This document shall be submitted prior to the issuance of the final certificate of occupancy. A copy of the approved site plans will be retained on file. Sincerely, Ellen M. Swiniarski Site Plan/Regulatory Review Coordinator CC: Tom Perry,Building Commissioner SPR File ZBA File Hyannis Fire Department Licensing Authority Health Dept. Mail Processing Center Aeronautical Study No. Federal Aviation Administration 2016-ANE-714-OE Southwest Regional Office Obstruction Evaluation Group 10101 Hillwood Parkway Fort Worth, TX 76177 Issued Date: 04/27/2016 Matt Brook, Bohler Engineering Cumberland Farms, Inc. c/o Bohler Engineering 352 Turnpike Rad Southborough,MA 01772 717) **DETERMINATION OF N.O HAZARD TQAIR_NAVIGATION ** The Federal Aviation Administration has conducted an aeronautical study under the provisions of 49 U.S.C., Section 44718 and if applicable Title 14 of the Code of Federal Regulations,part 77, concerning: Structure: Building Cumberland Farms Building Location: Barnstable MA Latitude: 41-38-55.25N NAD 83 Longitude: 70-18-40.50W Heights: 4 g 0 feet site elevation(SE) 29 feet above ground level(AGL) 69 feet above mean sea level(AMSL) This aeronautical study revealed that the structure does not exceed obstruction standards and would not be a hazard to air navigation provided the following condition(s), if any, is(are)met: It is required that FAA Form 7460-2,Notice of Actual Construction or Alteration,be e-filed any time the project is abandoned or: At least 10 days prior to start of construction(7460-2, Part 1) _X_Within 5 days after the construction reaches its greatest height(7460-2, Part 2) Based on this evaluation, marking and lighting are not necessary for aviation safety. However, if marking/ lighting are accomplished on a voluntary basis,we recommend it be installed and maintained in accordance with FAA Advisory circular 70/7460-1 L. The structure considered under this study lies in proximity to an airport and occupants may be subjected to noise from aircraft operating to and from the airport. This determination expires on 10/27/2017 unless: (a) the construction is started(not necessarily completed) and FAA Form 7460-2,Notice of Actual Construction or Alteration,is received by this office. (b) extended,revised, or terminated by the issuing office. (c) the construction is subject to the licensing authority of the Federal Communications Commission (FCC)and an application for a construction permit has been filed,as required by the FCC, within Page 1 of 4 i 6 months of the date of this determination. In such case, the determination expires on the date prescribed by the FCC for completion of construction, or the date the FCC denies the application. NOTE: REQUEST FOR EXTENSION OF THE EFFECTIVE PERIOD OF THIS DETERMINATION MUST BE E-FILED AT LEAST 15 DAYS PRIOR TO THE EXPIRATION DATE.AFTER RE-EVALUATION OF CURRENT OPERATIONS IN THE AREA OF THE STRUCTURE TO DETERMINE THAT NO SIGNIFICANT AERONAUTICAL CHANGES HAVE OCCURRED, YOUR DETERMINATION MAY BE ELIGIBLE FOR ONE EXTENSION OF THE EFFECTIVE PERIOD. This determination is based, in part,on the foregoing description which includes specific coordinates ,heights, frequency(ies)and power. Any changes in coordinates , heights, and frequencies or use of greater power will void this determination. Any fixture construction or alteration, including increase to heights,power, or the addition of other transmitters,requires separate notice to the FAA. This determination does include temporary construction equipment such as cranes, derricks, etc.,which may be used during actual construction of the structure. However, this equipment shall not exceed the overall heights as indicated above. Equipment which has a height greater than the studied structure requires separate notice to the FAA. This determination concerns the effect of this structure on the safe and efficient use of navigable airspace by aircraft and does not relieve the sponsor of compliance responsibilities relating to any law,ordinance, or regulation of any Federal, State, or local government body. Any failure or malfunction that lasts more than thirty(30)minutes and affects a top light or flashing obstruction light,regardless of its position, should be reported immediately to (877)487-6867 so a Notice to Airmen (NOTAM) can be issued. As soon as the normal operation is restored, notify the same number. If we can be of further assistance,please contact our office at(404) 305-6531. On any future correspondence concerning this matter,please refer to Aeronautical Study Number 2016-ANE-714-OE. Signature Control No: 286324358-290156889 (DNE) Darin Clipper Specialist Attachment(s) Case Description Map(s) Page 2 of 4 Case Description for ASN 2016-ANE-714-OE Construction of a 4,380 SF Cumberland Farms gas station and convenience store on the referenced property. Page 3 of 4 TOPO Map for ASN 2016-ANE-714-OE �' �� ''fin. •`t-J 1' t 5 J 1 t4tP ., I • ,t f s+`i.'�.+i`'r.r�sP l ua.s, i,/J•vr � s'J�' y � .s X'y7�^,- v f. < 1 ,,Y ! �.PF' )rs. �--t�.yr it 'L. /'�� r'' 'd"i'��_2�`�r�"�Z' �•`- l� � ` '�.ir"Vf p -4+ A .ti -Y Y �4 A T Y l t:fi x rz- "'^b � LLLL�'G''f x s'e�'i3 t �%A � • r •t.. 1 '�Y:: ���r_,�' �i.�Bk � *Shy �`�,....r'"�1✓. -�...3�' '1 _' ,.GrM+z 1`i. ,�-r—'ter--z {,r'. � .t v$ r � a� y � ;rr '� I ^� 1:+.'t..G"� ? �,.,,� ro �� 'r Ftr3 -�. *qa t rot ..>. 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Page 4 of 4 i Mail Processing Center Aeronautical Study No. Federal Aviation Administration 2016-ANE-718-OE Southwest Regional Office Obstruction Evaluation Group 10101 Hillwood Parkway Fort Worth, TX 76177 Issued Date: 05/03/2016 Matt Brook, Bohler Engineering Cumberland Farms, Inc. c/o Bohler Engineering 352 Turnpike Rad Southborough,MA 01772 **DETERMINATION OF NO HAZARD TO AIR NAVIGATION ** The Federal Aviation Administration has conducted an aeronautical study under the provisions of 49 U.S.C., Section 44718 and if applicable Title 14 of the Code of Federal Regulations,part 77, concerning: Structure: Building Cumberland Farms Gas Canopy Location: Barnstable,MA Latitude: 41-38-56.00N NAD 83 Longitude: 70-18-40.15 W Heights: 38 feet site elevation(SE) 20 feet above ground level(AGL) 58 feet above mean.sea level(AMSL) This aeronautical study revealed that the structure does not exceed obstruction standards and would not be a hazard to air navigation provided the following condition(s), if any, is(are)met: It is required that FAA Form 7460-2,Notice of Actual Construction or Alteration,be e-filed any time the project is abandoned or: At least 10 days prior to start of construction(7460-2, Part 1) _X_Within 5 days after the construction reaches its greatest height(7460-2,Part 2) Based on this evaluation,marking and lighting are not necessary for aviation safety. However, if marking/ lighting are accomplished on a voluntary basis,we recommend it be installed and maintained in accordance with FAA Advisory circular 70/7460-1 L. The structure considered under this study lies in proximity to an airport and occupants may be subjected to noise from aircraft operating to and from the airport. This determination expires on 11/03/2017 unless: (a) the construction is started(not necessarily completed)and FAA Form 7460-2,Notice of Actual Construction or Alteration,is received by this office. (b) extended, revised, or terminated by the issuing office. (c) the construction is subject to the licensing authority of the Federal Communications Commission (FCC)and an application for a construction permit has been filed,as required by the FCC,within Page 1 of 4 6 months of the date of this determination. In such case,the determination expires on the date prescribed by the FCC for completion of construction, or the date the FCC denies the application. NOTE: REQUEST FOR EXTENSION OF THE EFFECTIVE PERIOD OF THIS DETERMINATION MUST BE E-FILED AT LEAST 15 DAYS PRIOR TO THE EXPIRATION DATE. AFTER RE-EVALUATION OF CURRENT OPERATIONS IN THE AREA OF THE STRUCTURE TO DETERMINE THAT NO SIGNIFICANT AERONAUTICAL CHANGES HAVE OCCURRED,YOUR DETERMINATION MAY BE ELIGIBLE FOR ONE EXTENSION OF THE EFFECTIVE PERIOD. This determination is based,in part,on the foregoing description which includes specific coordinates ,heights, frequency(ies)and power. Any changes in coordinates ,heights, and frequencies or use of greater power will void this determination. Any future construction or alteration; including increase to heights,power,or the addition of other transmitters,requires separate notice to the FAA. This determination does include temporary construction equipment such as cranes, derricks, etc.,which may be used during actual construction of the structure. However,this equipment shall not exceed the overall heights as indicated above. Equipment which has a height greater than the studied structure requires separate notice to the FAA. This determination concerns the effect of this structure on the safe and efficient use of navigable airspace by aircraft and does not relieve the sponsor of compliance responsibilities relating to any law, ordinance, or regulation of any Federal, State, or local government body. Any failure or malfunction that lasts more than thirty(30)minutes and affects a top light or flashing obstruction light,regardless of its position, should be reported immediately to (877)487-6867 so a Notice to Airmen (NOTAM)can be issued. As soon as the normal operation is restored, notify the same number.. If we can be of further assistance,please contact our office at(404) 305-6531. On any future correspondence concerning this matter,please refer to Aeronautical Study Number 2016-ANE-718-OE. Signature Control No: 286442653-290811449 (DNE) Darin Clipper Specialist Attachment(s) Case Description Map(s) y Page 2 of 4 Case Description for ASN 2016-ANE-718-OE Construction of a gas station canopy associated with the proposed Cumberland Farms gas station and convenience store on the referenced property. Page 3 of 4 TOPO Map for ASN 2016-ANE-718-OE 7l 1 1 { s���������A �� cw(L� r ��4 •.,. t� .: stfr �'"' LL 'y,�- t,X 4 a��`�0��� ��� .° '..'y "�'�� `�',��".�� ':J',.��� w���a' ..� i �'r-• ',r %1. �'�- •� :5(�` � "_�cr°J,;>Pr �y � S. 9 w r _� t?�!2�-.1 /,E ' +c� _ � •�.4 'c � T ,f� r .s _ �,.t Y �s3 ��/t {1f/ .�r'- �•1��SsY-¢,'�--rx�--_Y• E-S � /; ` �r t ! •,. ,r �: -r .��f i�iX�"a -•`. "°! of r.: ,;s� z' yt -:r.G,h ✓: _ .h `�" c x r7 r+l..l ;\ �rs�i ;;« I'fxi - � �+xJ.,f..*t.a:t !;'� �' ./ •'-... a :� Pr�h' XS� 84.E n� � l'3 ^'l$ ..•1 ! _ +;+ :5 t -^•,?.tf" 12�,! 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As a condition to this determination,the temporary structure must be lowered to the ground when not in use and during the hours between sunset and sunrise. This determination expires on 12/31/2016 unless extended,revised, or terminated by the issuing office. It is required that FAA Form 7460-2,Notice of Actual Construction or Alteration,be e-filed within 5 days after the temporary structure is dismantled. NOTE: REQUEST FOR EXTENSION OF THE EFFECTIVE PERIOD OF THIS DETERMINATION MUST BE E-FILED AT LEAST 15 DAYS PRIOR TO THE EXPIRATION DATE. AFTER RE-EVALUATION OF CURRENT OPERATIONS IN THE AREA OF THE STRUCTURE TO DETERMINE THAT NO SIGNIFICANT AERONAUTICAL CHANGES HAVE OCCURRED,YOUR DETERMINATION MAY BE ELIGIBLE FOR ONE EXTENSION OF THE EFFECTIVE PERIOD. This determination is based,in part,on the foregoing description which includes specific coordinates and heights. Any changes in coordinates and/or heights will void this determination. Any future construction or alteration, including increase to heights,requires separate notice to the FAA. Page 1 of 4 This determination does include temporary construction equipment such as cranes, derricks, etc.,which may be used during actual construction of a structure. However,this equipment shall not exceed the overall heights as indicated above. Equipment which has a height greater than the studied structure requires separate notice to the FAA. This determination concerns the effect of this temporary structure on the safe and efficient use of navigable airspace by aircraft and does not relieve the sponsor of compliance responsibilities relating to any law, ordinance, or regulation of any Federal, State, or local government body. Any failure or malfunction that lasts more than thirty(30)minutes and affects a top light or flashing obstruction light,regardless of its position, should be reported immediately to (877) 487-6867 so a Notice to Airmen (NOTAM)can be issued. As soon as the normal operation is restored,notify the same number. A copy of this determination will be forwarded to the Federal Aviation Administration Flight Procedures Office if the structure is subject to the issuance of a Notice To Airman(NOTAM). If you have any questions,please contact our office at(404) 305-6531. On any future correspondence concerning this matter,please refer to Aeronautical Study Number 2016-ANE-719-OE Signature Control No: 286442789-290159761 (TMP) Darin Clipper Specialist Attachment(s) Case Description Map(s) Page 2 of 4 I Case Description for ASN 2016-ANE-719-OE Use of a crane for installation of roof trusses associated with the construction of a Cumberland Farms gas station and convenience store at the referenced ro e P P rtY- Page 3 of 4 TOPO Map for ASN 2016-ANE-719-OE '�°7^�-i' `�'' � �''�r nA t"' �r � � � ✓ter j o. .�`' "r C' c`J4^� � rt`'���a:tt,�, '�r�� z sn � tir �usr � `•n_"— s r�� r >Y*11 , A' .� .,"x,Y t�, � t PER", +>> ��A�� s�*.4��� s, „ .A i ' j� Rr t w ti:. � -f \ ems• nc+e n � r' n"r� ME /3 , -r _ f . s j:� �`v �xu� ��«� �y� i`i'�, #�.,x 3'�s..� n3 `4. � ;,� Z', i �. r�+ �1��'1✓`• `�"3� e � Z ''-a er �ys� r4 i3 s5.3" s E,i S. i ,t7+'• ° sr x P fi"", e ,� }•.� sI .t d''^t S 'e '�•3. ,� �. � '�< 1 P Aitr3'S �"d`J � F• :. �' y'�.'c Jv ( u. 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K-S ,w m� fin• ,r zs s. ;- .�';«' ^w Y 9 r 'q 6 x ,axdb ' an .sxy y r r F r r X1 7 z y F F 4 x M5, f � ��tl"'..j c"E.."i�'w -a'z'%n�.'�i a` ^� c:G, ��� ".:Y a •b t "J'...�5f .,�tr s Jam; °i' r`a r 'r }.1� Y7 f ; 5 ✓� -F` �.,,v,;- ,. '''�t.-y<5 � ,�� �zc.'�..a'X ef�'•���5'" Z' ��l�r'Sh r� x'��":p.,SSQ�`'Y.sj„�tiL �.�'�lr+f� ��y i�rq � At"A`t�ii^ �'S''..�����,�t Y .��,��;F �1 �' 'u.:t� yt .-,, �.�v',"'^ f qy.�� r '�`�,.,� �.� .W�C�.,av a �a ...� ;ri'l•.s•�` w `41v � r ..%sr .s ���7'<'�;ls r •.,rt�,c `tA`Y.• jz^ .:�»z'1 a p s f�a,.:-�^��-•s?• � -y,.,.ua,.-,.�`.^'i°'"s"r�S� `' a r ;. '� �:''a—"'t Q�, M r .� r rr� �5..'�""J-r,.•.}:,'.^L 2>'A"3�t.�+a,.�x��E..,:;t.?;�e^,�,rai.'.�� :�.tiv"sx'c�.'`5t�''{Pb����t1...4`•AL�,�'..z't'�.r�E''�'�v�f6..�.X ��vt":.r.�, � 1u'."'�..vr � '� -�� 3 .r`��^r's r�`� �n fink <rsM jai..¢t? �aS...MSc ,.,•,__K.:. ,-r;...ra,E.. ,,.,�.<:.,,,w.ausN.id..., Y...;3,`r<'a�..;w,<7�,£r,.E,.a z1$t=�< Page 4 of 4 f Mail Processing Center Aeronautical Study No. Federal Aviation Administration 2016-ANE-715-OE Southwest Regional Office Obstruction Evaluation Group 10101 Hillwood Parkway Fort Worth, TX 76177 Issued Date: 04/27/2016 Matt Brook, Bohler Engineering Cumberland Farms, Inc. c/o Bohler Engineering 352 Turnpike Rad Southborough,MA 01772 "DETERMINATION OF NO HAZARD TO AIR NAVIGATION FOR TEMPORARY STRUCTURE" The Federal Aviation Administration has conducted an aeronautical study under the provisions of 49 U.S.C., Section 44718 and if applicable Title 14 of the Code of Federal Regulations,part 77, concerning: Structure: Crane crane 2 -canopy work Location: Barnstable,MA Latitude: 41-38-55.00N NAD 83 Longitude: 70-18-40.00 W Heights: 38 feet site elevation(SE) 35 feet above ground level(AGL) 73 feet above mean sea level(AMSL) This aeronautical study revealed that the temporary structure does not exceed obstruction standards and would not be a hazard to air navigation provided the following condition(s), if any, is(are)met: As a condition to this Determination,the structure is marked/lighted in accordance with FAA Advisory circular 70/7460-1 L,Obstruction Marking and Lighting, flags/red lights- Chapters 3(Marked),4,5(Red),&12. As a condition to this determination,the temporary structure must be lowered to the ground when not in use and during the hours between sunset and sunrise. Any height exceeding 35 feet above ground level(73 feet above mean sea level),will result in a substantial adverse effect and would warrant a Determination of Hazard to Air Navigation. This determination expires on 12/31/2016 unless extended,revised, or terminated by the issuing office. It is required that FAA Form 7460-2,Notice of Actual Construction or Alteration,be a-filed within 5 days after the temporary structure is dismantled. NOTE: REQUEST FOR EXTENSION OF THE EFFECTIVE PERIOD OF THIS DETERMINATION MUST BE E-FILED AT LEAST 15 DAYS PRIOR TO THE EXPIRATION DATE. AFTER RE-EVALUATION OF CURRENT OPERATIONS IN THE AREA OF THE STRUCTURE TO DETERMINE THAT NO SIGNIFICANT AERONAUTICAL CHANGES HAVE OCCURRED, YOUR DETERMINATION MAY BE ELIGIBLE FOR ONE EXTENSION OF THE EFFECTIVE PERIOD. Page 1 of 4 f This determination is based, in part,on the foregoing description which includes specific coordinates and heights. Any changes in coordinates and/or heights will void this determination. Any future construction or alteration, including increase to heights,requires separate notice to the FAA. This determination does include temporary construction equipment such as cranes, derricks, etc., which may be used during actual construction of a structure. However, this equipment shall not exceed the overall heights as indicated above. Equipment which has a height greater than the studied structure requires separate notice to the FAA. This determination concerns the effect of this temporary structure on the safe and efficient use of navigable airspace by aircraft and does not relieve the sponsor of compliance responsibilities relating to any law, ordinance,or regulation of any Federal, State, or local government body. Any failure or malfunction that lasts more than thirty(30)minutes and affects a top light or flashing obstruction light,regardless of its position, should be reported immediately to(877)487-6867 so a Notice to Airmen (NOTAM) can be issued.As soon as the normal operation is restored,notify the same number. A copy of this determination will be forwarded to the Federal Aviation Administration Flight Procedures Office if the structure is subject to the issuance of a Notice To Airman(NOTAM). If you have any questions,please contact our office at(404) 305-6531. On any future correspondence concerning this matter,please refer to Aeronautical Study Number 2016-ANE-715-OE Signature Control No: 286354744-290157511 (TMP ) Darin Clipper Specialist Attachment(s) Case Description Map(s) Page 2 of 4 r Case Description for ASN 2016-ANE-715-OE Use of a crane for installation of gas canopy associated with the construction of a Cumberland Farms gas station and convenience store at the referenced property. 1 Page 3 of 4 r TOPO Map for ASN 2016-ANE-715-OE �'.. "._r�E_k�'y,t�'�'�"-�".�'�. t"'•p � � �� � � .,uiS� � 3 � R roar'"..a S�?Yy'c".}G`s�I d M !x •. ' K� r °' SL�r�a�z�•r �r .�e� '-c.�'-� '� �' r y i,.'�s� `s:" jf „w� �t ; �` '�� r f - 1. - � i a. �' •' � �� � �"' Mgt V w;.� ,,� F•b�'; 5" xx ~ b� f\t w r r"'�` zQ d'� u:4t rr,„{,.&..x �_�' y '0 / J,__ k �r g�sa,,•`r �e t; t, Y �t .. ..r r �,� '3�� P -r_ � a s7s� t.S��.�; sr air � 3 �c9�i s5 js ..� :_`p,�`T•.', a "a +e ��. 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Jr n� `.�� .� �r� +.::�is't f''!�� ,�.SS-'`� ^� �, i'�f �2 � � r >rt`.�sEr3 'r �44 ��+.'� � �✓ r � .v .., a �e�cc�� 4 l7` ��,�f 5�..�5 �st3;.7Prs�y.�.1✓ .i�!�.FAF f tx ¢�i5r�x;Ft r�''�w �,��rr, �y s� l�'�.f� r r ir;: ��,�y5'f..''.e' �- tf���rd � S `��' tt�3j �� v 5�x S'J 4" �s r� e:+r 7 � �..(` i .y- C+ l rV ✓- .� ,�.^ n ft1'"�,-S �,'�.r��"ur 'C��' '�"$� a> .,� ik.�.. 1»"'�f x ti .cs y}ti•s„ ^.: � g �, .K ,JG .X..d ,+ ✓y. ri r 3 . ill'£�'5�..9 'S -a3'?3z,r`t.2's l � 32 a ,rk�,L ✓' .c: ��x �f�,;�, ✓H,� �� w � l„�r ��r?�,�Tf c`.I'°sus �s-r�","`z' a � w Ox.,� �� l �rx i�^t'.Y��."t•��a .�,+ ., '���,."� �� ,��-.xb �^ a,'"Fh�• �hr.ca'k•x �� } t b'�p�'yr .+r h`� r'�r i�t c1.r�t y,.fi {y r ' � s,. � "f. �.-. •r >s"l � r >' s'F' �"`Lt,:l+.�'� {,( ns R�r1k£r �m.+ ?�J,�' P, ��rr... ,� �,."mot,S �lrc i"�ti�.c` ��z 'S` '!r � F r`L ,�a /•"`�' �,F,u-",�,.t ''{�'r'c� l 5 :.�..5` .t,r fi'.n'' . a G. 4 t 17S 5� �i.. a r f 2� '*a �.lc. J�� t � �r�� r^x* 'h.Y ��,��d { t y`'{ r�y Fl� jt. L� �� �� S°S r 5' 'V•y1 y„'N c�.Ec �F,. .*Y' yr� f s`.v, f n �a +r 15 kt ;.iagsy x`3LMi v�S kv3 Z,h:Y T 5 41 � m ' ter k r.F Y��. k � .,r +r3 �G e< "i 2 ..u' .x:�•�,..,., .... ... ..•-.s:.s..w...... ...�,,...0 ,.. .✓.......... .r.ar.4r�.x��w•.s,xw aTamaTn. .,. 2 `-', ..s. Page 4 of 4 Charles D Baker Governor Karyn E Polito .Lieutenant Governor ssDo Stephanie Pollack,Secretary.&CEO Massac[nu3em Department o1F iransportatlon Jeffrey DeCarlo;Administrator lug Aeronautics Division April 15, 2016 Mr. Matthew Brook Bohler Engineering 352 Turnpike Road Southborough, MA 01772 Re: MassDOT File# 16-HYA{075-02 Temporary Crane for Construction of Gas Station Hyannis, Massachusetts Dear Mr. Brook: Enclosed is a copy of the final determination by the Massachusetts Department of Transportation (MassDOT) Aeronautics Division on your Request forAirspace Reviews of the above referenced projects. The Aeronautics Division's assistance is offered pursuant to the aviation law requirements of the Commonwealth. Please note that although the projects is not subject to further action required by the Aeronautics Division's laws or regulations, this office may offer additional comments after considering FAA's determination of its impact to a public use airport or NAVAID facility through the aeronautical study process. If you have any questions, please feel free to contact me. Sincerely, --�I Thomas F. M-ahon E Director of Airport Engineering MassDOT-Aeronautics Division Phone: 617.412.3678 Email: thomas.mahoney@state.ma.us Enclosed: Airspace Review Form cc: K. Servis,Assistant Airport Manager file m:\airport-projects\hya-barnstable\airspace reviews\2016\permit not required 16-hya-02 04152016.doc Logan Office Center,One Harborside Drive,Suite 205N East Boston,MA 02128 Tel:617-412-3680,TTY:857-368-0655 Leading the Nation in Transportation Excellence www.mss.gov/massdot I Massachusetts Department of Transportation For Office use Only AIR— O i) Airspace Analysis AERONAUTICS DIVISION I ❑ Comments Received REQUEST FOR AIRSPACE REVIEW 1 ❑ AIR-Port Updated MassDOT File No.: 2016-HYA-CO075-2 FAA File No.: I (For reference only) Notice is required by 780 CMR(Code of Massachusetts Regulations)111.7,Hazards to Air Navigation.Pursuant to Massachusetts General Law(MGL) Chapter 90,Section 35B,the MassDOT Aeronautics Division agrees to perform an AIRSPACE ANALYSIS and render a determination for the project listed below. IMPORTANT:All shaded areas must be completed. Sponsor(include name,address,telephone number): Sponsor Representative(same data if applicable): Last Name suffix First Name Last Name Suffix First Name Cumberland Farms Matt Brook Bohler Engineering Company Telephone Company Telephone (508)270-1400 (508)480-9900 Address city I state I Zip Code Address City State Zip Code 100 Crossing Blvd. r Framingham IMA 101702 352 Turnpike Rad Southborough MA 01772 Email.,..- Email mbrook@bohlereng.com mbrook@bohlereng.com Project Description(please type or print clearly): Location,Height,Elevation Data: Cumberland Farms gas station Nearest City,State: Bamstable Project involves the construction of a Cumberland Farms gas station and Degrees Minutes Seconds convenience store at 395 West Main St in Barnstable(Hyannis).There will be a gas canopy with an overall height of 20-ft,a main building with a height of 29-ft and 6 Latitude 41 38 55 parking lot lights with overall heights of 15-ft each.Lastly,cranes will be used at various points during Construction including installation of the roof trusses,and Longitude 70 18 40 installation of the gas canopy.The maximum height of the cranes is 75-ft,and typical on-site time frame for the cranes is 1 week. Datum [j] NAD 83 ❑ NAD 27 Site elevation above MSL ft): 39 msl Maximum height above ground(ft): 75 agl Maximum elevation above MSL(ft): 114 msl ❑, REQUIRED Attach 81/2 XL 11 Inch map(a`.'0 USG§Qued'Sheet)showing location 61 pnojeW, Nearest Public-Use Aviation Facility: Barnstable Municipal Airport Print or type,below,the name of person filing this request for review Signature Date �e <. "*""*'****'*•*DO NOT WRITE BELOW THIS LINE-FOR Aeronautics.OFFICE USE ONLY AIRSPACE ANALYSIS concludes the following: Closest Runway: 06/24 Distance from RW end: 9898 ft. Offset from RW CL: 298 ft. p Left ❑Right ❑Project violates MGL Ch.90,35B by 0 ft. [Runway Horizontal Plane-3,000'x 2 Statute Miles,150'above RW] ❑Project violates MGL Ch.90,35B by 0 ft. [Runway Approach Plane-3,000'x 3,000'@ 20:1 slope] ❑Project violates 702 CMR,5.03(1)(a)by 0 ft. [Runway Approach Plane/Land-500'x 10,000'@ 20:1 slope] Project violates 702 CMR,5.03(2)(a)by 0 ft. [Runway Approach Plane/Water-500'x 10,000'@ 20:1 slope] p Project does not violate Aeronautics Division Airspace Laws or Regs. DETERMINATION: ❑Permit is required`pursuant to MGL Ch.90,35B,for ❑Runway Horizontal Plane ❑Runway Approach Plane N Permit is not required pursuant to MGL Ch.90,35B p No violations of Laws or Regs. ❑Ch.90 violation=30'agl p Permit is required pursuant to 702 CMR,50.3 0 Permit is not required pursuant to 702 CMR,50.3 ❑Additional concerns: ❑FAA Standards ❑Noise ❑Traffic Patter ❑Wildlife p VFR Route ❑Other This determination is based on the foregoing description of the proposed project including the location,height and elevation data provided by the Sponsor.Any changes in the data provided to the Aeronautics Division from that which is shown herein will render this determination null and v 'I a d will necessitate a new request for review: MassDOT-Aero /i Title: /��1) Date 7 - Form E-10 �� � Last Revised 09/2014 i P x Massachusetts Department of Public Safety Board of Building Regulations and Standards License: S Constructionn Supervisor WAYNE J SILVIA 71 TWIN BROOK LANE 9 TAUNTON MA 02780 M1, LA- Expiration;; Commissioner 03/08/2018 r r 'y The Commonwealth of Massachusetts Department of Industrial Accidents Office'of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applieant Information _ r__ Ptease Print Legibly Name (Business/Organization/Individual) t Address4-�'10f�1A City Phone# � Ct /State/Zip Are you an employer?Check the appropriate box: Type of project(required): l. I am a employer with 4. I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. New construction 2: 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have Workers' 3 insurance.+ 9. Building addition comp.[No workers' comp. insurance p. required.] 5. We area corporation and its 10. Electrical repairs or additions 1. I am a homeowner doing all work officers have exercised their L 1. Plumbing repairs or additions myself. o workers' comp. right of exemption per MGL y � k ' ti p p 12. Roof repairs insurance required.] t c. 152,§1(4),and we have no employees. [No workers' i 13. Other comp. insurance required.] "Any applicant that checks box#1 must also till out the section.belo�v'showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are d'omgttll".work anA:,Ehen.hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional 3heetsli0ktng thr'nvn�`,;of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees-they must provide their workers'comp.policy.number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and-job site information. 4 Insurance Company Name: r - M Policy.#or Self-ins Lie.#: ,vJ _�.Q' I-Exptration Date Job Site Address `' %� ,A' ° e r ^Ctty/State/Zip:,' T` t _`4, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition.of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for:insurance coverage verification. I do hereby certr J;;under the pains:and penalties of perjury that the information provided.ab'ov"is de'and correct. J. $I ature c c Pl'nne.#. N �� ` a e: t Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: _ Phone Initial Construction Control Document = To be submitted with the building permit application by a Registered Design Professional for work per the 81h edition of the yVe�y Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Cumberland Farms Date:9/09/15 Property Address: 395 West Main St.,Hyannis,MA.02601 Project: Check(x)one or both as applicable:X New construction Existing Construction Project description:New 4380 SF mercantile building I Alexander Ryazanov,MA Registration Number: 42758,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning' Architectural Structural Mechanical Fire Protection X Electrical Other: for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents.' 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code: Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a`Final Construction Control Document'. ' OF Enter in the space to the right a"wet"or electronic signature and seal: Phone number: 617-577-9400 Email: ayazanov@syska.com Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide a description. Version 06 11 2013 Final Construction Control Document To be submitted at completion of construction by a ° Registered Design Professional ey� for work per the 8th edition of the s°v Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Cumberland Farms Date:9/09/2015 Permit No. Property Address: 395 West Main St.,Hyannis,MA 02601. Project: Check(x)one or both as applicable: X New construction Existing Construction Project description:New 4,380 SF mercantile building I William P. O'Keefe MA Registration Number: 36480, am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Architectural Structural X Mechanical Fire Protection Electrical&FA Other:Describe for the above named project. I, or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis. To the best of my knowledge, information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept,shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or electronic signature and sea]: F AIq" WILLI '? o O.K:E F A. ICAL cn 0.,36480. O� FG/STEQ'� ASS/ANAL EN'\ Phone number: 617-577-9900 ' Email: wokeefe@syska.com Building Official Use Only Building Official Name: Permit No.: Dater Version 06 11 2013 f Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 8th edition of the Jev�� Massachusetts State Building Code, 780 CMR, Section 107 Project Title:Cumberland Farms Retail Building(Excludes Gas Canopy) Date:09/09/2015 Property Address: 395 West Main Street, Hyannis,MA 02601 Project: X New construction Project description:New 4,380 SF,single story building,Mercantle Occupancy,Construction Type 5B, slab on grade, Non-sprinklered I,James Owens, MA Registration Number: 20329 Expiration date:08/31/2016,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': X Architectural for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,(780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee)shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept,shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work,I shall submit to the building official a`Final Construction Control Document'.. Enter in'the space to the right a"wet"or ,� tEO Aqc electronic signature and seal: p�`' @.Oyu P1o.20329 BOST • Jy 4� Phone number: 508-528-0770 Email:james@allevatoarchitects.com H 0f A�Sya Building Official Use Only - Building Official Name: Permit No.: Date: Allevato Architects Inc 31 Hayward Street Franklin,MA 02038 tel 508 528 0770 fax 508 528 9454 allevatoarchitects.com Generated by COMcheck-Web Software Envelope Compliance Certificate 2012 IECC Section 1: Project Information - Project Type:New Construction Project Title:Cumberland Farms-Hyannis,MA-4380 SF Construction Site: Owner/Agent: Designer/Contractor: 395 West Main Street John Martin James Owens Hyannis,Massachusetts 02601 Cumberland Gulf Group of Companies Allevato Architects,Inc. 100 Crossing Boulevard 31 Hayward Street Framingham,Massachusetts 01702 Franklin,Massachusetts 02038 508-270-1400 508-528-0770• james@allevatoarch itects.coni Additional Efficiency Package: Reduced interior lighting power.Requirements are implicitly enforced within interior lighting allowance calculations. Section 2: General Information Building Location(for weather data): Bellingham,Massachusetts . Climate Zone: 5a Building Space Conditioning Type(s): Nonresidential Vertical Glazing/Wall Area Pct.: 14% Building Type Floor Area Retail 4956 Section 3: Envelope Assemblies Envelope PASSES:Design 0.1 1/o better than code. Climate-Specific Requirements: Component Name/Description Gross Cavity Cont. Proposed Budget Area or R-Value R.-Value U-Factor U-Factorial Perimeter Roof-Flat:Insulation Entirely Above Deck 2092 --- 25.0 0.039 0.039 Roof-Attic:Attic Roof,Wood Joists 2288 38.0 0.0 0.027 0.027 Floor:Unheated Slab-On-Grade,Vertical 2 ft. 4380 10.0 Ext.Wall-Front:Wood-Framed, 16in.o.c. 581 21.0 0.0 0.062 0.064 Window:,Perf.Specs.:Other testing/cert.nfrc,SHGC 0.35,PF 237 --- --- 0.430 0.380 0.50(b) Door:,Perf.Specs.:Other testing/cert.nfrc,SHGC 0.25,PF 0.50 43 --- • --- 0:670 0.770 (b) Ext.Wall-Rear:Wood-Framed,16in.o.c. 818 21.0 0.0 0.062 0.064 Door-Rear:Insulated Metal,Swinging 48 --- --- 0.130 0.370 Ext.Wall-Side:Wood-Framed,16in.o.c. 717 21.0 0.0 0.062 0.064 Ext.Wall-Side:Wood-Framed,16in.o.c. 599 21.0 0.0 0.062 0.064 Window:Metal Frame,Perf.Specs.:Other testing/cert.nfrc,SHGC 44 --- 0.430 0.380 0.35(b) Window:Metal Frame,Perf.Specs.:Other testing/cert.nfrc,SHGC 44 --- --- 0.430 0.380 0.35(b) Transom:Metal Frame,Perf.Specs.:Other testing/cert.nfrc,SHGC 7 --- --- 0.430 0.380 0.35(b) Door-Side: ,Perf.Specs.:Other testing/cert.nfrc,SHGC 0.25(b) 23 --- --- 0.670 0.770 Project Title:Cumberland Farms-Hyannis, MA-4380 SF Report date:09/04/15 Data filename: Page 1 of 2 (a)Budget LI-factors are used for software baseline calculations ONLY,and are not code requirements. (b)Fenestrations product performance must be certfied in accordance with NFRC and requires supporting documentation. Section 4: Compliance Statement Compliance Statement: The proposed envelope design represented in this document is consistent with the building plans,specifications and other calculations submitted with this permit application.The proposed envelope system has been designed to meet the 2012 IECC requirements in COMcheck-Web and to comply with the mandatory requirements in the Requirements Checklist. James Owens, RA, NCARB Qriruo- 09/09/15 Name-Title Date Project Title:Cumberland Farms-Hyannis, MA-4380 SF Report date:09/04/15 Data filename: Page 2 of 2 i COMcheck Software Version. 4.9.3 Inspection Checklist Energy Code: 2012 IECC Requirements: 100.0%were addressed directly in the COMcheck software Text in the "Comments/Assumptions" column is provided by the user in the COMcheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. 1 High Impact(Tier 1) _ 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Cumberland Farms-.Hyannis, MA-4380 SF Report date: 09/04/1, Data Page 1 of 7 2y0121EcC �lanReeWn e : omplies? � -;�„ Comments/Assumptions" q $ A f A it e, a,4Y 10 A fp t C103.2 ;Plans and/or specifications provide all ;❑Complies ;Requirement will be met. [PR111 information with which compliance :❑Does Not can be determined for the building Location on plans/spec:A4.0 I envelope and document where UNot Observable I :exceptions to the standard are ;❑Not Applicable ; :claimed. C406 ;Plans, specifications, and/or ;❑Complies ;Requirement will be met. [PR9]1 calculations provide all information :❑Does Not with which compliance can be determined for the additional energy :❑Not Observable efficiency package options. ;❑Not Applicable C402.3.1 ;Vertical fenestration area <= 30 ;❑Complies ;Requirement will be met. [PR10]1 :percent of the gross above-grade wall :❑Does Not area. Location on plans/spec:A2.1 :[:]Not Observable; ❑Not Applicable C402.3.1 ;Skylight area <=3 percent of the ;❑Complies Requirement will be met. [PR11]1 :gross roof area. ;❑Does Not ❑Not Observable;Location on plans/spec: NA ❑Not Applicable C402.3.2 In enclosed spaces > 10,000 ft2 ;❑Complies (Exception: Requirement does not apply. [PR14]1 ;directly under a roof with.ceiling T❑Does Not heights>15 ft.and used as an office; : i Location on plans/spec: NA ;lobby, atrium, concourse, corridor, ;❑Not Observable :storage, gymnasium/exercise center, ❑Not Applicable ;convention center,.automotive ; ;service, manufacturing, non- , refrigerated warehouse, retail store, ;distribution/sorting.area, ;transportation, or workshop,the ,following requirements apply: (a)the ;daylight zone under skylights is>_ ; half the floor area; (b)the skylight :area to daylight zone is>= 3 percent ; 1 with a skylight VT>= 0.40; or a minimum skylight effective aperture >= 1 percent. C402.3.2. ;Areas with obstructions that block ;❑Complies ;,Exception: Skylights designed to exclude direct sunlight 2 ;direct beam sunlight on >= 1/2 of the ;❑Does Not :entering the occupied space by the use of fixed or automated [PR15]1 ;roof over the enclosed area for more ; �baffles. ;than 1,500 daytime hours per year :❑Not Observable between 8 am and 4 pm. ;❑Not Applicable ;Location on plans/spec: NA Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Cumberland Farms- Hyannis, MA-4380 SF Report date: 09/04/1 Data Page 2 of 7 Section Footing/Foundation- Pla s Verified'' Field Ver fied V' a &}Re ID . Anspectioh - A* Value '"` " Value' " Complies? CommentslA5sum tions p &A W� . .A 6 . lC402.2.6 Slab edge insulation R-value. R- , ; R- ;❑Complies ;See the Envelope Assemblies [F03]2 ;❑ Unheated ;❑ Unheated ;❑Does Not table for values. Heated ❑ Heated ❑Not Observable ❑Not Applicable C303.2 Slab edge insulation installed per 4p,&❑Complies ;Requirement will be met. [F04]2 manufacturer's instructions. . ❑Does Not ❑Not Observable Location on plans/spec: �. ❑Not Applicable. A4.1 IC402.2.6 Slab edge insulation ; ft ft ;❑Complies ;See the Envelope Assemblies (F05]2 depth/length.Slab insulation ;❑Does Not ;table for values. extending away from building is covered by pavement or>= 10 ;❑Not Observable i inches of soil. ;❑Not Applicable C403.2.7, :Exterior insulation protected - ❑Complies ;Requirement will be met.*4 1 C408.2.8, :against damage, sunlight, ❑Does Not C404.5 moisture,wind, landscaping and - (F0611 ;equipment maintenance ❑Not Observable activities. ❑Not Applicable C402.2.8 Bottom surface of floor structures mow% ' tk' [F012]3 incorporating radi inant heat ❑Complies ;Exception:,Requirement insulated to>=R-3.5. g []Does Not does not apply. . ❑Not Observable I See the Envelope Assemblies []Not Applicable ;table for values. Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Cumberland Farms- Hyannis, MA-4380 SF Report date: 09/04/1 Data Page 3 of 7 4Section . s ; Plans',Verified : 0 Field Verified; '91 #I �* Framing/Ro.,Fh.ln Inspection Complies? Comments/Assumptions.; & Req:ID , ` , Value Value m V -- C402.4.1, ;The building envelope contains a - ❑Complies ;Requirement will be meta C402.4.2 i continuous air barrier that is ❑Does Not [FR16]1 sealed in an approved manner w 'Location on plans/spec: and either constructed or tested []Not Observable ❑Not A licable A4.0 in an approved manner.Air .� F ,�, PP barrier penetrations are sealed in an approved manner. 10s C402.4.3, Factory-built fenestration and m. ❑Complies :Requirement will be met. C402.4.4 doors are labeled as meeting air ❑Does Not [FR18]3 leakage requirements. 5 ❑Not Observable Ip a- t# 0 4 0 4 ❑Not Applicable C402.4.7 Vestibules are installed on all ' .„ k 0 ❑Complies ,Exception: Requirement [FR17]3 building entrances. Doors have , ❑Does Not :does not apply. self-closing devices. ❑Not Observable ; Location_ on plans/spec: ' ❑Not Applicable ;NA u _ _ C402.3.3, :Vertical fenestration U-Factor. U- U- ;❑Complies ;see the Envelope assemblies C402.3.4 T❑Does Not 'table for values. [FR8]1 ;❑Not Observable ❑Not Applicable C402.3.3 ;Vertical fenestration SHGC value. SHGC: ; SHGC: ;❑Complies ;See the Envelope Assemblies [FR10]1 I ;❑Does Not I table for values. ; ;❑Not Observable ❑Not Applicable C303.1.3 Fenestration products rated in ❑Complies :Requirement will be met. [FR12]2 accordance with NFRC. ❑Does Not " ;Location on plans/spec: ❑Not Observable Spec Section 088000 ❑Not Applicable C303.1.3 ;Fenestration products are ❑Complies :Requirement will be met. [FR13]1 :certified as to performance labels Tie ❑Does.Not or certificates provided. ` ;Location on plans/spec: ❑Not Observable Spec Section 088000 F ❑Not Applicable ; C402.2.7 U-factor of opaque doors ; U U- ;❑Complies ;See the Envelope Assemblies ![FR14]2 associated with the building El Swinging Swinging ;❑Does Not :table for values. thermal envelope meets ❑ Nonswinging ❑ Nonswinging requirements. ;❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 1 Medium Impact(Tier 2) 3 'Low impact.(Tier 3) - Project Cumberland Farms- Hyannis, MA-4380 SF "Report date: 09/04/1 Data Page 4 of 7 2012 IECC Mechanical`Rough-In Inspection Complies? Comments/Assumptions , „ :;a. . - ' Fi +*%'.-�s ix# C402.4.5. Stair and elevator shaft vents have ,[]Complies ;Exception: Requirement does not apply. 1 motorized dampers that automatically ElDoes Not [ME3]3 I close. 'Location on plans/spec: NA ❑Not Observable ❑Not Applicable C402.4.5. Outdoor air and exhaust systems have;❑Complies Exception: Requirement does not apply. 2 motorized dampers that automatically:[]Does Not [ME58]3 shut when not in use and meet ;❑Not Observable Location on plans/spec:NA maximum leakage rates. Check gravity dampers where allowed. E]Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Cumberland Farms- Hyannis, MA-4380 SF Report date: 09/04/1 Data Page 5 of 7 .section _ ' Insulation 1„sp ct on Plans Ver�f�ed. *Field Verified` Complies? Comments/Assumptions<. 4 Value =Value �. µ C402.4.1. ;All sources of air leakage in the ❑Complies ;Requirement will be met. 1 ;building thermal envelope are ❑Does Not [IN111 ;sealed, caulked, gasketed, 4 cation on plans/spec: weather stripped'or wrapped with []Not Observable :Lo Lo 0 moisture vapor permeable '. ❑Not Applicable ;wrapping material to minimize air o'er leakage. ; C402.4.2. ,Roof R-value. For some ceiling R- R- ;❑Complies ;See the Envelope Assemblies 1 !systems, verification may need to.❑ Above deck ..;❑ Above deck ;❑Does Not ;table for values. [IN2]1 'occur during Framing Inspection. ❑ Metal ❑ Metal' ❑Not Observable ❑ Attic 1❑ Attic ;❑Not Applicable 1 j f 1 1 I C303.2 ;Roof insulation installed per , ❑Complies ;Requirement will be met. [IN3]1 ;manufacturer's instructions. ; ❑Does Not Blown or poured loose-fill :Location on plans/spec: ',insulation is installed only where °' 4 []Not Observable 1A4.1 !the roof slope is <=3 in 12. 4 16 []Not Applicable ' I C303.2 Above-grade wall insulation ❑Complies Requirement will be met. [IN7]1 :installed per manufacturer's ❑Does Not instructions. ' Location on plans/spec: l ❑Not Observable A4.0 ❑Not Applicable IC402.2.5 Floor insulation R-value. ; R-• R- ;❑Complies ;See the Envelope Assemblies I[IN8]2 ;❑ Mass ;❑ Mass :❑Does Not !table for values. ❑ Steel ;❑ Steel ;❑Not Observable ' ❑ Wood ❑ Wood ;❑Not Applicable �C303.1 Building envelope insulation is - ❑ p Q Com lies ;Re uirement will be met. �[IN101z labeled with R-value or insulation V certificate providing R=value and ❑Does Not ` other relevant data. ❑Not Observable .. ❑Not Applicable C303.2.1 Exterior insulation is protected - ❑Complies :Requirement will be met. I[IN14]2 from damage with a protective ❑Does Not material.Verification for exposed - :Location on plans/spec: foundation insulation may need. []Not Observable A4.0 to occur during Foundation ❑Not Applicable Inspection. C402.2.1 Insulation intended to meet the VI Y ❑Complies ;Requirement will be met. [IN17]3 roof insulation requirements - sAS VP& ❑Does Not ! cannot be installed on top of a !Location on plans/spec: suspended ceiling.Mark this M1 ❑Not Observable :Location requirement compliant if ❑Not Applicable 1 I insulation is installed accordingly. . . Additional Comments/Assumptions: f 1 High Impact(Tier 1) 11 2 1 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Cumberland Farms- Hyannis, MA-4380 SF Report date: 09/04/1 Data Page 6 of 7 '� -,,:._ 2012 I+f CC ¢ 0, OtFinarii;isoectlion T� Complies7 �Co menu/ss mp io s , A W C402.4.6 ;Weatherseals installed on all loading ;❑Complies :Exception: Requirement does not apply. [F137]1 dock cargo doors. :❑Does Not ❑Not Observable;Location on plans/spec: NA ❑Not Applicable C402.4.8 Recessed luminaires in thermal ;❑Complies ;Requirement will be met. [F126]3 envelope to limit infiltration and be IC :❑Does Not rated and labeled.Seal between ;Location on plans/spec: Electrical Specifications interior finish and luminaire housing. UNot Observable ',[]Not Applicable ; C406 ;,Efficient HVAC performance, efficient ;❑Complies ;Requirement will be met. [F[34]1 :lighting system,or on-site supply of :❑Does Not renewable energy consistent with ;what is shown the approved plans. :❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1. High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Cumberland Farms- Hyannis, MA-4380 SF Report 09/04/15 Data Page 7 of 7 i COMcheck Software Version 4.0.0 Interior Lighting Compliance Certificate Project Information Energy Code: 2012 IECC Project Title: Cumberland Farms Project Type: New Construction Construction Site: Owner/Agent: Designer/Contractor: 395 West Main St Hyannis, MA 02601 Additional Efficiency Package Reduced interior lighting power.Requirements are implicitly enforced within interior lighting allowance calculations. Allowed Interior Lighting Power A B C D Area Category floor Area Allowed Allowed Watts (ft2) Wafts/ft2 (B X C) 1-Interior(Retail) 4380 1 .30 5694 Total Allowed Watts= 5694 Proposed Interior Lighting Power A B, C D E Fixture ID: Description/Lamp/Wattage Per Lamp/Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. 1-Interior(Retail) LED 2:A:2x4 LED Troffer:LED Panel 40W: 1 10 40 400 LED 3:B:2x2 LED Troffer:LED Panel 33W: 1 45 32 1440 LED 4:C:LED Downlight:LED Other Fixture Unit 40W: 1 43 39 1677 LED 5:Cl:LED Downlight insulated ceiling:LED Other Fixture Unit 40W: 1 6 20 120 LED 6:E:Cooler and Freezer Lighting:Other: 1 7 64 448 LED 1:H:Cooler and Freezer Doors:LED Other Fixture Unit 40W: 1 23 39• 897 LED 7:N:Bathroom and attic light:LED Panel 44W: 1 7 44 308 Total Proposed Watts= 5290 Interior Lighting PASSES: Design 7% better than code Interior Lighting Compliance Statement Compliance Statement: The proposed interior Fighting design represented in this document is consistent with the building plans, specifications, and other calculations submitted with this permit application.The proposed interior lighting systems have been designed to meet the 2012 IECC requirements in COMcheck Version 4.0.0 and to comply with the mandatory requirements listed in the inspection Checklist. Christopher Eng - Electrical Engineer 09.09.2015 Name-Title Signature' Date Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 1 of 8 COMcheck Software Version 4.0.0 Exterior Lighting Compliance Certificate Project Information Energy Code: 2012 IECC Project Title: Cumberland•Farms Project Type: New Construction Exterior Lighting Zone 2(Neighborhood business district) Construction Site: `Owner/Agent: Designer/Contractor: 395 West Main St Hyannis, MA 02601 Allowed Exterior Lighting Power A B C D E Area/Surface Category Quantity Allowed Tradable Allowed Watts Watts/Unit Wattage (B X C) Parking lot(Parking area) 14000 ft2 0.06 Yes 840 Gas Station(Free standing/attached sales canopy) 2100 ft2 0.6 Yes 1260 Building Entrance Canopy(Main entry) 8 ft of door 20 Yes 160 Perimeter Canopy Lighting(Walkway<10 feet wide) 225 ft of 0.7 Yes 158 Patio Seating(Outdoor sales area/lot) 325 ft2 0.25 Yes 81 Total Tradable Watts(a)= 2499 Total Allowed Watts= 2499 Total Allowed Supplemental Watts(b)= 600 (a)Wattage tradeoffs are only allowed between tradable areas/surfaces. (b)A supplemental allowance equal to 600 watts may be applied toward compliance.of both non-tradable and-tradable areas/surfaces. Proposed Exterior Lighting Power A B C D E Fixture ID : Description/Lamp/Wattage Per Lamp/Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. Parking lot(Parking area 14000 ft2):Tradable Wattage LED 6:A:Pole Fixture Parking Area:Other: 1 5 130 650 LED 8:B:Pole Fixture Parking Area:Other: 1 1 130 130 Gas Station(Free standing/attached sales canopy 2100 ft2):Tradable Wattage LED 3:C:Gas Pump Canopy:Other: 1 6 130 780 LED 9:Cl:Gas Pump Canopy:Other: 1 6 130 780 Building Entrance Canopy(Main entry 8 ft of door width):Tradable Wattage LED 2:Cl:Exterior Downlight:LED PAR 20W: 1 10 18 180 Perimeter Canopy Lighting(Walkway< 10 feet wide 225 ft of walkway length):Tradable Wattage LED 1:Cl:Exterior Downlight:LED PAR 20W: 1 16 18 288 Patio Seating(Outdoor sales area/lot 325 ft2):Tradable Wattage LED 7:M:Patio Light:LED Other Fixture Unit 80W: 1 3 92 276, Total Tradable Proposed Watts 3084 Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 2 of 8 Exterior Lighting • • Design 0.5% better than code Exterior Lighting Compliance Statement Compliance Statement: The proposed exterior lighting design represented in this document is consistent with the building plans, specifications, and other calculations submitted with this permit application.The proposed exterior lighting systems have been designed to meet the 2012 IiECC requirements in COMcheck Version 4.0.0 and to comply with the mandatory requirements listed in the Inspection Checklist. Christopher Eng - Electrical Engineer 09.09.2015 Name-Title Signature Date Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 3 of 8 COMcheck Software Version 4.0.0 Inspection. Checklist Energy Code: 2012 IECC Requirements: 23.0% were addressed directly in the COMcheck software Text in the "Comments/Assumptions" column is provided by the user in the COMcheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. W I A-0-9 4 '_ ..A V I"' ; ' ^` 1 2012 IECC PIangReview Complies , Comments/Assum tions a • - � ;r ;— - C103.2 :Plans, specifications, and/or ;❑Complies ;Requirement will be met. [PR4)1 calculations provide all information :❑Does Not ;with which compliance can be determined for the interior lighting :❑Not Observable :and electrical systems and equipment :❑Not Applicable ;and document where exceptions to ;the standard are claimed. Information :provided should include interior :lighting power calculations, wattage of ;bulbs and ballasts,transformers and ; :control devices. : C103.2 ;Plans,specifications, and/or ❑Complies ;Requirement will be met. [PR8)1 calculations provide all information ❑Does Not :with which compliance can be ;determined for the exterior lighting :[]Not Observable and electrical systems and equipment :❑Not Applicable ;and document where exceptions to ;the standard are claimed. Information provided should include exterior. ,lighting power calculations,wattage of; bulbs and ballasts,transformers and control devices. C406 ;Plans,specifications, and/or ;❑Complies [PR9)1 calculations provide all information ❑Does Not ;with which compliance can be ;determined for the additional energy ❑Not Observable; efficiency package options. ;❑Not Applicable Additional Comments/Assumptions: 1 IHigh Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 4 of 8 i 2O121ECC Rough-In,Electrical Inspection :complies? el Comments/Assumptions C405.2.2. Automatic controls to shut off all ;❑Complies Requirement will be met. 1 building lighting installed in all ;❑Does Not [EL22]2 buildings. '❑Not Observable ❑Not Applicable C405.2.1. Independent lighting controls installed ;❑Complies Requirement will be met. 1 per approved lighting plans and all ElDoes Not [EL23]2 manual controls readily accessible and; visible to occupants. ❑Not Observable: ❑Not Applicable C405.2.1. :Lighting controls installed to uniformly;❑Complies :Exception:Areas that are controlled by an occupancy sensor. 2 !reduce the lighting load by at least I❑Does Not [EL15]1 ;50%. ❑Not Observable; ❑Not Applicable C405.2.2. Daylight zones provided with ;❑Complies Exception: Requirement does not apply. 3 individual controls that control the ❑Does Not [EL16]2 lights independent of general area lighting. :❑Not Observable I❑Not Applicable C405.2.3 Sleeping units have at least one ;❑Complies ;Exception: Requirement does not apply. [EL17]3 master switch at the main entry door ;❑Does Not that controls wired luminaires and. switched receptacles. :❑Not Observable ;❑Not Applicable C405.2.2. .;Occupancy sensors installed in ❑Complies ;Requirement will be met. 2 required spaces. ;❑Does Not [EL1811 :oNot Observable ❑Not Applicable C405.2.2. ;Primary sidelighted areas are ❑Complies, ;Exception: Requirement does not apply. 3 :equipped with required lighting :j❑Does Not [EL20]1 controls. . :[:]Not Observable! ❑Not Applicable C405.2.2. ;Enclosed spaces with daylight area ;❑Complies Exception: Requirement does not apply. 3 under skylights and rooftop monitors ❑Does Not [EL21]1 :are equipped with required lighting controls. q 9 g ;❑Not Observable ❑Not Applicable %C405.2.4 Automatic lighting controls for exterior;❑Complies ;Requirement will be met. [EL25]2 lighting installed. ;❑Does Not ;❑Not Observable: . ❑Not Applicable C405.2.3 :Separate lighting control devices for ;[ Complies :Requirement will be met. [EL411 :specific uses installed per approved :❑Does Not ;lighting plans. ;❑Not Observable.; :,[]Not Applicable C405.3 Fluorescent luminaires with odd ;❑Complies ;Exception: Requirement does not apply. [EL19]3 numbered lamp configurations that :❑Does Not are with 10 feet center to center(if recess mounted) or are within 1 foot ❑Not Observable: edge to edge (if pendant or surface ;❑Not Applicable mounted) shall be tandem wired. C405.4 Exit signs do not exceed 5 watts per ;❑Complies ;Requirement will be met. [EL611 !face. ❑Does Not ❑Not Observable; ❑Not Applicable 1 High Impact(Tier 1) 2 J Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP—E\CMB10059-Hyannis—MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 5 of 8 20'12 IECC *Rough-In'Electrical Inspection., complies? ,.„ sComments/Assumptions 9 'a . y a A� V C405.6 ;Exterior grounds lighting over 100 W ;❑Complies ;Requirement will be met. [EL24]1 provides>60 Im/W unless on motion :❑Does Not ;sensor or fixture is exempt from scope ;of code or from external LPD. ,❑Not Observable ❑Not Applicable C405.2.3 ;Additional interior lighting power ;❑Complies ;Requirement will be met. [EL8]1 :allowed for special functions per the ❑Does Not approved 9 li htin plans and is 9 automatically controlled and ❑Not Observable: separated from general lighting. ;❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 6 of 8 i Y'aZti " ; , 2012 IECC nl Inspecon Complies. Comments/Assumptions ; , C408.2.5. I Furnished as-built drawings for ;❑Complies _ 3 1 electric power systems within 30 days :❑Does Not [F116]3 of system acceptance. ;❑Not Observable: ❑Not Applicable C303.3,C4 Furnished O&M instructions for ;❑Complies ; 08.2.5.2 systems and equipment to the UDoes Not [F117]3 building owner or designated representative. :❑Not Observable ;❑Not Applicable . C405.5.2 ;.Interior installed lamp and fixture ;❑Complies ;See the Interior Lighting fixture schedule for values. [F118]1 :lighting power is consistent with what :❑Does Not is shown on the approved lighting ;plans, demonstrating proposed watts :❑Not Observable are less than or equal to allowed ❑Not Applicable watts. C405.6.2 ;Exterior lighting power is consistent ;❑Complies ;See the Exterior Lighting fixture schedule for values. [FI19]1 with what is shown on the approved :❑Does Not ;lighting plans, demonstrating ;proposed watts are less than or equal :❑Not Observable to allowed watts. ;❑Not Applicable C408.3 Lighting systems have been tested to ;❑Complies [FI3311 ensure proper calibration, adjustment, FlDoes Not ;programming, and operation. ❑Not Observable; ❑Not Applicable C408.3 Lighting systems have been tested to ❑Complies [FI48]1 ensure proper calibration, adjustment, :❑Does Not ;programming, and operation. ❑Not Observable; ❑Not Applicable C406 ;Efficient HVAC performance, efficient ;❑Complies [F13411 :lighting system, or on-site supply of, :❑Does Not ;renewable energy consistent with ;what is shown the approved plans. ;❑Not Observable ❑Not Applicable ; Additional Comments/Assumptions: 1 JHigh Impact(Tier 1) L 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 7 of 8 Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 8 of 8 COMcheck Software Version 4.0.0 Mechanical Compliance Certificate Project Information Energy Code: 2012 IECC Project Title: Cumberland Farms Location: Hyannis,Massachusetts Climate Zone: 5a Project Type: New Construction Construction Site: Owner/Agent: Designer/Contractor: 395 West Main St Hyannis, MA 02601 Additional Efficiency Package Reduced interior lighting power.Requirements are implicitly enforced within interior lighting allowance calculations. Mechanical Systems List Quantity System Type&Description 1 HVAC System 1 (Single Zone): Heating: 1 each-Duct Furnace,Gas,Capacity=60 kBtu/h Proposed Efficiency=80.00%Ec,Required Efficiency=80.00%Ec Cooling:1 each-Single Package DX Unit,Capacity=38 kBtu/h,Air-Cooled Condenser,Air Economizer Proposed Efficiency=15.00 SEER,Required Efficiency=13.00 SEER Fan System: FAN SYSTEM 11 Back of house--Compliance(Motor nameplate HP method):Passes Fans: FAN 1 Supply,Constant Volume, 1200 CFM,0.9 motor nameplate hp 1 HVAC System 2(Single Zone): Heating: 1 each-Duct Furnace,Gas,Capacity=150 kBtu/h Proposed Efficiency=80:00%Ec,Required Efficiency=80.00%Ec Cooling:Leach-Single Package DX Unit,Capacity=71 kBtu/h,Air-Cooled Condenser,Air Economizer Proposed Efficiency=12.60 EER,Required Efficiency=11.00 EER Fan System: FAN SYSTEM 2 1 Retail--Compliance(Motor nameplate HP method):Passes Fans: FAN 2 Supply,Constant Volume,2540 CFM,2.0 motor nameplate hp 1 Water Heater 1: Electric Storage Water Heater,Capacity:40 gallons w/Circulation Pump Proposed Efficiency:0.92 EF,Required Efficiency:0.88 EF Mechanical Compliance Statement Compliance Statement. The proposed mechanical design represented in this document is consistent with the building plans, specifications, and other calculations submitted with this permit application.The proposed mechanical systems have been designed to meet the 2012 IECC requirements in COMcheck Version 4.0.0 and to comply with the mandatory requirements listed in the Inspection Checklist. Name-Title Signature Date Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 1 of 9 COMcheck Software Version 4.0.0 Inspection Checklist Energy Code: 2012 IECC Requirements: 23.0% were addressed directly in the COMcheck software Text in the "Comments/Assumptions" column is provided by the user in the COMcheck Requirements screen. For each requirement, the user certifies that a code requirement will be met and how that is documented, or that an exception is being claimed. Where compliance is itemized in a separate table, a reference to that table is provided. 2012 IECC Plan Review„ , a Cpmpllle a U Comments/Assumption's 9 0-4 M, f . , C103.2 ;Plans, specifications, and/or ;❑Complies [PR2]1 :calculations provide all information :❑Does Not ;with which compliance can be determined for the mechanical ❑Not Observable I systems and equipment and ;❑Not Applicable document where exceptions to the ;standard are claimed. Load :calculations per acceptable ;engineering standards and ; handbooks. 1 C103.2 'Plans,specifications, and/or ;❑Complies [PR3)1 icalculations provide all information ElDoes Not ;with which compliance can be determined for the service water :❑Not Observable heating systems and equipment and ;❑Not Applicable , ;document where exceptions to the ,standard are claimed. Hot water :system sized per manufacturer's ;sizing guide. C406 ;.Plans, specifications, and/or ;❑Complies [PR9)1 calculations provide all information :❑Does Not ;with which compliance can be determined for the additional energy :[-]Not Observable; efficiency package options. ;E]Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) ' 3 1 Low Impact(Tier 3) Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 2 of 9 2012 IECC Footing/Foundation;inssp tion Complies /Comments/Ass mptio s " -�. C403.2.4. JFreeze protection and snow/ice ;❑Complies 5 melting system sensors for future :❑Does Not [FO9]3 connection to controls. ❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 JHigh Impact(Tier 1) 112 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 3 of 9 a 3a .' ' ° 2012'IECC Plumbing`Rough-in"inspection Complies Comments/Assumptions, C404.3 Temperature controls installed on ;❑Complies [PL5]3 service water heating systems(110 QF :❑Does Not for dwelling units and lavatories in public restrooms and 90°F for other :❑Not Observable occupancies.) ;❑Not Applicable C404.4 ;Automatic time switches installed to ;❑Complies [PL3]1 ;automatically switch off the :❑Does Not recirculating hot-water system or heat ;trace. :❑Not Observable ❑Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 1[2]Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 4 of 9 0 Section - .;1 A. V Al qi . - . .'° x .. Mechanical Rou hln Plans Verified a Field Verified P` # g =,*Complies? Comments/Assumptions ' Inspection Value Value' C403.2.3 HVAC equipment efficiency Efficiency: ; Efficiency: ;❑Complies ;See the Mechanical Systems list [ME55]z verified. ; ; ;❑ ;for values. Does Not ❑Not Observable ❑Not Applicable C403.2.5. ;Demand control ventilation F❑Complies 1 :provided for spaces>500 ft2 and ❑Does Not [ME59]1 :1>25 people/1000 ft2 occupant ;density and served by systems [-]Not Observable ; with air side economizer, auto If, ❑Not Applicable ;modulating outside air damper ;control, or design airflow>3,000 cfm. a ._ . ,,C403.2.7 HVAC ducts and plenums R- R- ;❑Complies [ME60]2 insulated.Where ducts or ;❑Does Not plenums are installed in or under ; a slab,verification may need to ; ❑Not Observable occur during Foundation ; ;❑Not Applicable Inspection. C403.2.8 Thermally ineffective panel J ❑Complies ; [ME41]3 surfaces of sensible heating E ❑Does Not panels have insulation >= R-3.5. P U6 V 0 ' # ❑Not Observable - ❑Not Applicable C403.2.7 Ducts and plenums sealed based # ❑Complies [ME1011 on static pressure and location. ❑Does Not V to T ❑Not Observable ' ❑Not Applicable ; C403.2.7. Ductwork operating >3 in.water ❑Complies 1.3 column requires air leakage ❑Does Not [ME11]3 testing. ❑Not Observable . ❑Not Applicable C403.2.7. Ductwork operating >3 in.water ❑Complies 1.3 column requires air leakage ❑Does Not [ME11]3 testing. ❑Not Observable Tts q ❑Not Applicable C403.3.1, ;Air economizers provided where } " ❑Complies C403.3.1. :required, meet the requirements ❑hoes Not 1 ;for design capacity, control j IME6211 ;signal,ventilation controls, high- " ❑Not Observable limit shut-off, integrated []Not Applicable ;economizer control,and provide , a means to relieve excess s ; outside air during operation. C403.3.1, ;Air economizers provided where e , ❑Complies C403.3.1. :required, meet the requirements ❑Does Not 1 :for design capacity, control [ME6211 ;signal,ventilation controls, high- � ❑Not Observable limit shut-off,integrated ❑Not Applicable economizer control,and provide a means to relieve excess 0 10 0 6. " outside air during operation. - C408.2.2. Air outlets and zone terminal ly, , . ❑Complies 1 devices have means for air ❑Does Not [1iVIE53]3 balancing, ' ❑Not Observable ; v. ❑Not Applicable 1 High Impact(Tier 1) j 2 Medium Impact(Tier 2) ; 3 Low Impact(Tier 3) Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 5 of 9 1 Section Mechanical Rough-In t PlansWerified Field Verified 4 z ` Complies? p Comments/Assum tions• & Req:I1T :Inspection T • i value , ,1 Values' s a C403.4.2 VAV fan motors>=7.5 hp to be ;❑ VSD" ? _ VSD ;❑Complies [ME66]2 driven by variable speed drive, ❑ Vane axial ❑ Vane axial T❑Does Not have a vane axial fan with fan fan Does Observable variable pitch blades,or have ❑ Other ❑ Other controls to limit fan motor ;❑Not Applicable ; demand. 1 C403.4.2 VAV fan motors>=7.5 hp to be ;❑ VSD ❑ VSD ;[]Complies [ME6612 driven by variable speed drive, ❑ Vane axial ❑ Vane axial ❑Does Not have a vane-axial fan with fan fan variable pitch blades, or have ❑,Other Other ❑Not Observable controls to limit fan motor ;❑ ;❑Not Applicable demand. C403.4.2 VAV fan motors>=7.5 hp to be ;❑ VSD ❑ VSD ;❑Complies [ME66]2 driven by variable speed drive, ❑ Vane axial ❑ Vane axial :❑Does Not have avane-axial fan with fan fan variable pitch blades, or have ;❑.Other ❑ Other :❑Not Observable controls to limit fan motor ;❑Not Applicable i demand. C403.2.6 ;Exhaust air energy recovery on r ❑Complies . 10 [ME57]1 'systems meeting Table C403.2.6 IV ? ° ❑Does Not y ❑Not Observable ❑Not Applicable C403.2.11 Unen.closed spaces that are 0 JElcomplies ![ME71]2 heated use only radiant heat. 04 04 0 , ❑Does Not x 4 ❑Not Observable 4, ❑Not Applicable C403.4.7 ;Hot gas bypass limited to: <=240 ❑Complies [ME35]1 kBtu/h-50%>240 kBtu/h-25% ❑Does Not ❑Not Observable -00 ❑Not Applicable C403.4.7 Hot gas bypass limited to: <=240 ❑Complies [ME3511 IkBtu/h-50%>240 kBtu/h-25% ❑Does Not ❑Not Observable jr,]E]Not Applicable Additional Comments/Assumptions: 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) Ji 3 1 Low Impact(Tier 3) Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 6 of 9 i ,n` � 4' 2012IECC Final Complies Comments/Assumptions, Y � � C403.2.4. Heating and cooling to each zone is ;❑Complies 2 controlled by a thermostat control. :E]Does Not [F147]3 Minimum one humidity control device per installed ;❑Not Observable humidification/dehumidification ;❑Not Applicable system. C403.2.4. Heating and cooling to each zone is ;❑Complies 2 controlled by a thermostat control. ❑Does Not [FI47]3 Minimum one humidity control device per installed ❑Not Observable humidification/dehumidification ;❑Not Applicable system. C403.2.4. Thermostatic controls have a 5 °F ;❑Complies 2 deadband. ❑Does Not [F138]3 ❑Not Observable: ❑Not Applicable C403.2.4. Temperature controls have setpoint ;❑Complies 2 overlap restrictions. ;❑Does Not [FI20]3 ;❑Not Observable: ❑Not Applicable C403.2.4. Each zone equipped with setback ;❑Complies 3 controls using automatic time clock or :❑Does Not [F139]3 programmable control system. '❑Not Observable ❑Not.Applicable C403.2.4. Automatic Controls: Setback to 55°F ;❑Complies ; 1 (heat) and 85°F (cool);7=day clock, 2- UDoes Not [F140]3 hour occupant override, 10-hour backup ;❑Not Observable; ❑Not Applicable C403.2.4. Systems include optimum start ;❑Complies 3.3 controls. U [FI41]3 Does Not ❑Not Observable ❑Not Applicable C403.2.4. Systems include optimum start ;❑Complies 3.3 controls. :ODoes Not [F141]3 :[:]Not Observable ;❑Not Applicable C408.2.5. Furnished HVAC as-built drawings ;❑Complies 1 submitted within 90 days of system :❑Does Not [F17]3 acceptance. ❑Not Observable; ❑Not Applicable C303.3,C4 Furnished 0&M manuals for HVAC ❑Complies ; 08.2.5.2 systems within 90 days of system :❑Does Not [FI8]3 acceptance. ❑Not Observable ❑Not Applicable C408.2.5. ;An air and/or hydronic system ;❑Complies ; 3 .'balancing report is provided for HVAC :[]Does Not [F[43]1 ;systems. ;❑Not Observable; " ❑Not Applicable C408.2.3. HVAC control systems have been ;❑Complies 2 :tested to ensure proper operation, :❑Does Not [FI10]1 ;calibration and adjustment of.controls. ❑Not Observable ❑Not Applicable 1 High Impact(Tier 1) 2 Medium Impact(Tier 2) 3 1 Low Impact(Tier 3) Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 7 of 9 2012'IECC Final Inspection," Comphes� Comments/Assumptions) % C404.3 Public lavatory faucet water ;❑Complies [Fill]3 temperature<=110°F. ;❑Does Not ❑Not Observable: ❑Not Applicable C404.5 JAI[piping in circulating system ;❑Complies (F125]2 insulated ;❑Does Not ❑Not Observable; ❑Not Applicable C404.6 Controls are installed that limit the ;❑Complies [F112]3 operation of a recirculation pump :,❑Does Not installed to maintain temperature of a storage tank. ,❑Not Observable ;❑Not Applicable C403.2.2 HVAC systems and equipment ;❑Complies [F127]3 capacity does not exceed calculated :❑Does Not loads. ❑Not Observable: ❑Not Applicable C408.2.1 ;Commissioning plan developed by ;❑Complies [FI28]1 :registered design professional or :❑Does Not ;approved agency.. ; ❑Not Observable; ;❑Not Applicable C408.2.4 ;Preliminary commissioning report ;❑Complies [FI29]1 :completed and certified by registered UDoes Not ;design professional or approved agency. ,❑Not Observable ;❑Not Applicable C408.2.5. ;.Final commissioning report due to ;❑Complies 4 :building owner within 90 days of ;❑Does Not [FI30]1 ;receipt of certificate of occupancy. ❑Not Observable:, ;❑Not Applicable C408.2.3. ;HVAC equipment has been tested to ;❑Complies 1 :ensure proper operation. ;❑Does Not [F131]1 ; ;❑Not Observable :,[]Not Applicable C408.2.3. ;Economizers have been tested to ❑Complies 3 :ensure proper operation.. :❑Does Not [F132]1 ;[]Not Observable ❑Not Applicable C406 :Efficient HVAC performance, efficient ;❑Complies (FI34]1 :lighting system, or on-site supply of :❑Does Not :renewable energy consistent with ;what is shown the approved plans. :❑Not Observable ❑Not Applicable ;. Additional Comments/Assumptions: 1 High Impact(Tier 1) j 2 Medium Impact(Tier 2) 3 Low Impact(Tier 3) Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 8 of 9 Project Title: Cumberland Farms Report date: 09/09/15 Data filename: P:\NEO\MEP_E\CMB10059-Hyannis_MA(Suomi)\Project Engineering\Comcheck Hyannis MA.cck. Page 9 of 9 i . The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t; Boston;MA 02111 www.mass.gov/_dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers lieatrt It�fgrmatign; Please Print te 'bl., Name (Business/organization/Individual) Address., City/State/Zip: Phone #: `Qg- "�( - 3►�StpO Are you an employer? Check the appropriate bqA: Type of project(required): 1.❑ 1 am a employer with 4. V1 am a general contractor and I 6, [ 1ew construction. employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached slie'et 7• ❑Remodeling ship and have no employees These sub-contractors have 8. Demolition i working for me in any capacity, workers'comp. insurance. 9. ❑Building addition [No workers comp. insurance 5: Q.We:are.a corporation and its required.] officers have exercised their 10.:0 Electrical repairs or additions 3.❑ I am a homcowner doing all work right of exemption,per MGL 1:1.[] Plumbing repairs or additions myself. [No workers' comp; c.152, §1(4),and we have no 12 [] Roof repairs insurance required.] t employees. [No workers' 13:[] Other comp insurance required.] *Any applicant that: box#1 must also fill out the section below showingfheir workers compensation policy information. t Homeowners who submit this affidavit indicatingthey:pre doing all work an :then hire.outside contractors must submit a new affidavit indicating such. tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and theirworkers'comp.policy information. I am an,employer that is providing workers':compensaiion:insurance for:my employees. Below is the policy and job site information. Insurance Company Name: G Policy#or Self-ins. Lie.#:; .00 4[,� "' Expiration Date. Job Site Address!-City/State/Zip: Attach,a copy of the workers compensation policy declaration page:(showing.the policy number:and expiration date). Failure to secure coverage as required under Section 25A of MGL c. .1.52 can le.ad.to the imposition of criminal penalties Oka: fine up to:$1,500.00 and/or one-.year imprtsoriment;as well as'civil.penalties in the form of a STOP WORK ORDER:and a fine, of up to$250.00 a day against the violator. Be:advised that a copy of this statement maybe forwarded:to:the Office of. investigations of the DIA for insurance coverage verification. I du hereby.. wti rider the pains and; englitt s of perjury that the information provided above is true and correct Si nature, ' Date; . ` Phone°#: _. . •� Official use only. Do not write in this area,to be completed by city or town official City or Town:, Permit/License#. Issuing Authority(circle one): 1. Board of Health 2..Building Department 3.:City/Tow.n::Clerk 4...EI:ectrical Inspector 5.Plumbing Inspector 6.Other... Contact Person:. Phone#: 1 ZISSON & VEARAP. C. ATTORNEYS AT LA I£� n= 828 MAIN STREET �� r'S /;� ��BR�� } DENNIS, MASSACHUSETTSl�O�26�111$ TELEPHONE (508) 385-6031 L�2 FAX (508) 385-6914 MAILING ADDRESS: P.O. BOX 2031, DEN 1S, I A-92,638-0043 .!V 4 , E. JAMES VEARA RICHARD L. ZISSON PAUL V. BENATTI (1942-2006) CHRISTOPHER A. VEARA EDWARD E. VEARA RETIRED July 1, 2016 VIA FIRST CLASS MAIL Paul Roma, Building Commissioner Town of Barnstable 200 Main Street Hyannis, MA 02601 RE: 395 West Main Street,Hyannis Cumberland Farms,Inc. Dear Mr.Roma, ,I-am writing to you in connection with the redevelopment proposed by Cumberland Farms at the property located at 395 West Main Street, Hyannis. I have enclosed materials from the project's architect explaining the discrepancy in the square footage calculation on submitted plans. After reviewing the enclosed, could either you or someone from the Building Department please contact me concerning whether or not there is, in fact, an issue going forward based on the discrepancy notwithstanding the fact that the overall dimensions of the building have not changed. Thank you. Cordially, 0 E. James Veara EJV/lmw Enclosure Cc: Elizabeth Jenkins, Principal Planner(via first class mail) (via email only): Kathie Sousa—Cumberland Farms Robert Polo-Cumberland Farms James Owens -Allevato HFAIALLEVATO Creative Solutions-Mtanlngful Places June 30,2016 Paul Roma, Building Commissioner Town of Barnstable 200 Main Street . Hyannis, MA 02601 Regarding: Cumberland Farms—Building Square Foot Discrepancy 395 West Main Street, Hyannis, MA' Architects Project Number:41-13-00240 Dear Mr. Roma; It has come to our attention that there is a building square footage discrepancy indicated for the above listed project. This was as a result of how the square footage was calculated during the regulatory approval process. The building square footage on A1.1 dated October 13, 2013 as submitted during the Planning& Zoning review process indicated 4, 426 SF as calculated to the outside face of finish.The building square footage on A1.1 dated September 9,2015 as submitted for Building Permit indicated 4,380 Sf as calculated to the outside face of sheathing.' The overall.dimensions of the building have NOT changed.Both the A1.1 dated October 13,2013 and the A1.1 dated September 9, 2015 indicated overall building dimensions of 60'-7 5/8" (finish-to-finish) by 72'-11 7/8" (finish-to- finish). We apologize for any confusion regarding this matter. Please let me know if further clarification'is needed. Sincerely, HFA I ALLEVATO z' No.20329 James Owens,AIA, NCARB " ; Program Manager/Project Architect BOSTON 4 . y� MA. �J cc: Robert Schuler—Cumberland Farms Inc. Fqt pr OF Robert Polo—Cumberland Farms Inc. James Veara—Zisson&-Veara HFA ALLEVATO www.hfa-ae.com » 31 Hayward Street,Franklin,ytA 02038 P 508.528.0770 .f 509.528.9454 New Conswcdon: ioro• a x/e-n rvmn m straw¢ .. •• mx....rxace w¢osuxe ....._ _... .. .. _ /���T,,,,�,,,,,� ______ ==o =_ _�.. .. O .o _. ._.. ... o. .O Pl.W1tJ1;11011U_ j 5t«e#nD Prop YTBD N iF i; 395 Wag Main Street _ i tl J. WALK—IN STORAGE I FREEZER �,� z �.I c , IandF—,I.. x aW . N RECEIVING/ d OM M I UTILITY t I ALLLVATO Uy All...I,Architects I a ___ r�B I x, N ALCOVE CORRIDOR x a�aa ii --- —o a� I tl � \ I I JAW / r___7 10 o OI �h ' CASHIER.AREA �'k 11 I I .:��tTc I I ' �Y •.y. 54 I � \ § I I 6 � N II PATIO N I i TOTAL BUILDING AREA=4.426 SO.FT. .I L------'I TOTAL SO.FT. r� 1/'�\t tl./ CUMBERLAND ' FREEZER - Y is = - N........: aoml � I I sw VT. ...:..... _ .,... N ® ' -p ®-® :: Q © _.._... .. FL00RPLAN Q Q..... Q . 0 . . S ux e o — e I •�u.v =I—o J PLAN A1.1 nalz�xw 1300.29 Ao,slr�. 1 TY _ A9.• r 5/o Aa.f a•-u v.• :u9•rnr. 7 HSFE m I0.5 nn 11LLMfS.It®m.•iMm 50fAFE _W row i Rlm m.l.s Inx tagmx a.°\ P�•'�•p R M s'� x- VS1e s2326 '"°v L-o K _ Orate Mg0990 _ IlM1omoe S�IE Is¢ Ines) 1 Ilxv fact _ 9'ti• { 395 west Man s—, zt xr•"�.ru oz551 m. D -—-I—1• - --- -- - - - -—- - - -—-—- -—- emI„nen�5�xa va,"n,m°. �v v lano xuuE I WD I Y . v w um u: , -- - I EImF.l lll I b I I1• Y I u.1 WALK—IN QSETDRAG 'IEN u� r I f � fuEn mi�I I IPIIJII� II i \��P I TT I ®GES IRI•Ef,AF Ef E m ya _ � ALLEVATO A I-alu Arrnmeces m<RRR C NNG . l O , I La I I - "soa sia oim"=lasams9 urlun luE PuamL wls) I -IZ I,O I1 Adf 4 •1 1I I a+c�ru 0'I a. I • WALK—INCOOLER I 40 '>� M....a 1 II 1 0+ ® ® I ITslm-II inwMalu tt2•IwY/3 ALCOVE u --a n�ur I —_.II! }®(l _ O_.® i j I•` i swE.y .�\ _ _ _ _ Y\ �5 _ __ _ _ __ __ __� •1 III. w +OO ... .. ...._ p Qt Ara I r • - I I I h je I Aai O 't 7.e �BMGR q r-0• II .T. u Ael � 5� �FFlCE` • AS' O14M6®m•a ltv. eIS� A W[FS IS¢/61) I a �. l B fY-0'CIEA I O ;'. r CASHIER AREA J I I _• 1 \! `1 P��f/� a J.111i1 N.° p IO el Halo.. - j _ I i o EI I ? m v luF.f µ 5 Aa.o 4 e 1 I I HA I SALES AR A WALK-IN FREEZER ' { CUMBERLAND 4 i . 1 .FARMS lu xal II .i ' I ! ~ ° $ AS_l av v/xluE 4,3 0 SF f ^ 14 cwxlw U 19.5' FLOOR PLAN t �.;a s � >E-0 I\/r � i \ Ir •.m \ � � i � ~ � 5r,I/5• - -,5 >;�B I __————__ _I _ f I I :. __:—_—_— m RL+°IRm muulE 5EE•5°I tslF I . A - w.9 mx must_ 1 I L 'J .,, .. -0 r/e. -n/Y io s _•.__J � Ire xa f6-0 5/e• - Aaa Aan 1 Aa.a. a AaaFLOOR PLAN Al.i j• Az, ra xo. 13o°.za Town of Barnstable Regulatory Services Richard V.Scali, Director ' =6 Building Division Paul Roma,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PLEASE FORWARD THE ATTACHED PAGE(S) TO: TO: ATTN: S� S v 6A P-6Q- FAX NO: FROM: PAUL �- DATE: _ PAGE(S): Q:forms/faxcover Rev.07/06/16 Town of Barnstable Regulatory Services Richard V. Scali, Director � szAB Building.Division BARNSTABLE 9 MASS BS0.NSTFBtE•:JlFhV:I •T,T:1R•MYFM?IIS i639• Paul K. Roma "'°""' 1639F201 4Y'$`"�' prFD"" A Building Commissioner 573 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 July 8, 2016 Mr. James Veara Zisson and Veara, P.C. 828 Main Street P.O. Box 2031 Dennis, MA 02638-0043 Re: 395 West Main Street, Hyannis, MA Cumberland Farms, Inc. Dear Mr. Veara, The purpose of this letter is to confirm today's phone conversation with your office regarding the above referenced address. Mr. Owens' explanation of minimal discrepancies between the plans dated October 13, 2013 and those dated September 9, 2015 are understandable and cause no concerns with the overall project. Thank you and Mr. Owens for addressing and clarifying this issue. Sincerely, Paul Roma Building Commissioner P. 1 Communication Result Report ( Jul. 8, 2016 9:59AM ) 2) Date/Time: Jul, 8. 2016 A: 59AM r File Page No, Mode Destination Pg (s) Result Not Sent 8397 Memory TX 915083856914 P. 2 OK- ` Reason for error E. 1) Hang up or line fail E. 2) Busy E. 3) No answer E. 4) No facsimile connection E. 5) Exceeded max. E—mail size E. 6) Destination does not support IP—Fax Town of Barnstable l E Regulatory Services a ea HB3ard V.soak oh-Aor ... Building Diviaion PaW Etaea,Hnmmg Commledaav 2W Matt same,HY—%MA OMI u OIDoc 509-862403E F=508-790-MO- PLEASE FORWARD THE ATTACHED PAGE(S)TO: FAX No; SD$— —6`J/`t IW:-. c u Da LA K-b Fg'Li�,S 9 t-�. 1weFiKNy FROM DATE: PAWS): a Ha.OINN16 - - �IMME' Town of Barnstable 200 Main Street,Hyannis,Massachusetts 02601 �nxxsreate. '�Fu ti9. Regulatory Services Richard Scali, Interim Director Building Division Tom Perry, Building Commissioner Phone(508)862-4679 Fax(508)862-4725 www.town.barnstable.ma.us December 10, 2013 Cumberland Farms, Inc. c/o Attorney E. James Veara Zisson & Veara 828 Main Street Dennis, MA 02638 RE: Site Phan Review-# 030-13—Cutuberland Farms 3-95—W-_est_Main_Street,_Hyann-i Chap.2Z69;Parrccell;l l 6 Proposal: Raze existing 4,095 s.f. building to the rear of the site formerly used as a division office as well as additional tenant units; the 792 s.f. convenience store/kiosk and the gas canopy of 4,550 s.f. A colonial style building of 4,426 s.f. is proposed to be constructed to be used solely as a convenience store. Six fuel dispensers will be replaced with three fuel dispensers with existing underground storage tanks to remain. Parking will be redesigned and landscaping will be enhanced. Dear Attorney Veara: Please be advised that subsequent to the formal site plan review meeting held October 17, 2013, revised plans for the above project were found to be approvable subject to the following: • Approval is based upon and must be substantially constructed in accordance with the following plans entitled: "Cumberland Farms, Inc., Barnstable—Proposed Site Redevelopment Plans", 8 Sheets, Scale 1"=20',prepared by Coastal Engineering Company, Inc., Orleans, MA for Cumberland Farms, Inc, dated October 4, 2013 with final revision to sheets CFG3.0 through CFG9.0 December 10, 2013; Landscape Plans, 3 Sheets,prepared by Hawk Design, Inc., Scale 1"=10', dated October 7, 2013, revised December 9, 2013; Lighting Plans with photometric, dated October 3, 2013. • Relief must be granted from the Zoning Board of Appeals for setbacks, alteration of nonconforming use & structure as well as a conditional use special permit for retail sales in the HB District. • ADA detectable panels shall be dark grey in color as depicted on the plan. - - 4. • Dumpsters must be setback 10 from the property line. Applicant has the option to apply to the Board of Health to seek a setback variance. • Detailed floor plans will need to be provided and approved by the Health Department at the building permit stage. • A 1000 gallon grease trap must be installed as shown on the proposed plan. • A Common Victualler License is required for proposed outside seating. Contact: Christine Ade, Administrative Assistant,Licensing Authority 508-862-4774. • Water service must be installed in accordance with the Hyannis Water Department requirements. Old water service must be cut and capped off at the main. Contact: Hans Keijser, Supervisor, Hyannis Water 508-778-9617 Ext 3502. • Sewer connection must be installed in accordance with the Town of Barnstable Public Works Water Pollution Control Division Regulations. Contact: David Anderson, Construction Project Inspector, DPW 508-790-6244. • Consultation and approval from Hyannis'Fire Department is required. Filing and approval from the State Fire Marshall's Office for new self-serve dispensers and fire suppression system is also required prior the issuance of a building permit. Contact: Deputy Chief Dean Melanson, Hyannis Fire Department 508-775-1300. • A road excavation permit must be obtained from DPW prior to construction in the road layout. • Applicant must obtain all other applicable permits, licenses and approvals. • Upon completion of all work, a registered engineer or land surveyor shall submit a letter of certification, made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan (Zoning Section 240- 105 (G). In addition to letter of certification,an as-built of the driveway entrances including elevations verifying that the stormwater will remain onsite is requested.. This document shall be submitted prior to the issuance of the final certificate of occupancy. A copy of the approved site plans will be retained on file. Sincerely, Ellen M. Swiniarski Site Plan/Regulatory Review Coordinator CC: fTom'.Per y Building-Commissioner SPR File ZBA File Hyannis Fire Department Licensing Authority Health Dept. ° VHWWE Town of Barnstable 200 Main Street Hyannis,Massachusetts 02601 ax swsrABM ' AM en ram' Regulatory Services Richard Scali, Interim Director Building Division Tom Perry, Building Commissioner Phone(508)862-4679 Fax(508)862-4725 www.town.barnstable.ma us December 10, 2013 Cumberland Farms, Inc. c/o Attorney E. James Veara Zisson&Veara 828 Main Street Dennis, MA 02638 RE: Site Plan Review# 030-13 Cumberland Farms 9S!West Main Street;H y— InnLsJ Map 269, Parcel 116 Proposal: Raze existing 4,095 s.f. building to the rear of the site formerly used as a division office as well as additional tenant units; the 792 s.f. convenience store/kiosk and the gas canopy of 4,550 s.f. A colonial style building of 4,426 s.f. is proposed to be constructed to be used solely as a convenience store. Six fuel dispensers will be replaced with three fuel dispensers with existing underground storage tanks to remain. Parking will be redesigned and landscaping will be enhanced. Dear Attorney Veara: Please be advised that subsequent to the formal site plan review meeting held October 17, 2013, revised plans for the above project were found to.be approvable subject to the following: • Approval is based upon and must be substantially constructed in accordance with the following plans entitled: "Cumberland Farms,Inc., Barnstable—Proposed Site Redevelopment Plans", 8 Sheets, Scale 1"=20',prepared by Coastal Engineering Company, Inc., Orleans, MA for Cumberland Farms, Inc, dated October 4, 2013 with final revision to sheets CFG3.0 through CFG9.0 December 10, 2013; Landscape Plans, 3 Sheets,prepared by Hawk Design, Inc., Scale 1"=10', dated October 7, 2013, revised December 9, 2013; Lighting Plans with photometric, 'dated October 3, 2013. • Relief must be granted from the Zoning Board of Appeals for setbacks, alteration of nonconforming use & structure as well as a conditional use special permit for retail sales in the HB District. • ADA detectable panels shall be dark grey in color as depicted on the plan. • A variance must be granted by the Board of Health for dumpsters set back less than 10 feet from property line. • Detailed floor plans will need to be provided and approved by the Health Department at the building permit stage. • A 1000 gallon grease trap must be installed as shown on the proposed plan. • A Common Victualler License is required for proposed outside seating. Contact: Christine Ade, Administrative Assistant, Licensing Authority 508-862-4774: • Water service must be installed in accordance with the Hyannis Water Department requirements. Old water service must be cut and capped off at the main. Contact: Hans Keij ser, Supervisor, Hyannis Water 508-778-9617 Ext 3502. • Sewer connection must be installed in accordance with the Town of Barnstable Public Works Water Pollution Control Division Regulations. Contact: David Anderson, Construction Project Inspector, DPW 508-790-6244. • Consultation and approval from Hyannis Fire Department is required. Filing and approval from the State Fire Marshall's Office for new self-serve dispensers and fire suppression system is also required prior the issuance of a building permit. Contact: Deputy Chief Dean Melanson, Hyannis Fire Department 508-775-1300. • A road excavation permit must be obtained from DPW prior to construction in the road layout. • Applicant must obtain all other applicable permits, licenses and approvals. • Upon completion of all work, a registered engineer or land surveyor shall submit a letter of certification,made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan (Zoning Section 240- 105 (G). In addition to letter of certification, an as-built of the driveway entrances including elevations verifying that the stormwater will remain onsite is requested. This document shall"be submitted prior to the issuance of the final certificate of occupancy. A copy of the approved site plans will be retained on file. Sincerely, Ellen M. Swiniarski Site Plan/Regulatory Review Coordinator CC: Tom Perry_;Bu_i1�g-Commissioner SPR File ZBA File Hyannis Fire Department Licensing Authority Health Dept. ,(HE Sign TOWN BARNSTABLE Permit BARNSTAsIE. MASS. 9� 16,59. Permit Number: Application Ref: 201200237 20070698 Issue Date:`- 01/17/12 Applicant: CUMBERLAND FARMS, INC Proposed Use: FUEL SERVICE AREAS Permit Type:. SIGN PERMIT Permit Fee $ 50.00 Location 395 WEST MAIN STREET . Map Parcel 269116 Town HYANNIS Zoning District H B Contractor PROPERTY OWNER Remarks REPLACE EXISTING PRICE SIGN CUMBERLAND FARMS 24 SQ RELOCATE'EXISITNG cf PANEL TO ABOVE PRICE SIGN Owner: CUMBERLAND FARMS, INC Address: 100 CROSSING BLVD., V0742 FRAMINGHAM, MA 01702 Issued By: pC POST THIS CARD SO THAT IS VISIBLE FROM THE ST „T CARDLTH,Ao PARKER December 22,2011 Town of Barnstable 200 Main Street Hyannis,MA 02601 Attn: Mr.Thomas Perry. Cumberland Farms . Building Commissioner V0990 395 West Main Street Hyannis,MA 02601 Delivery:Regular mail Dear Mr.Perry,. Enclosed please find(1)one Application fora Sign Permit,(I)one photo of the existing pylon sign with scope and(1)one detail of the Scroller price panel by Skyline Products for the proposed pylon modifications for the sign located at 395 West Main Street Hyannis,MA. Cumberland Farms,the. owner of the property wishes to remove the 4'x 6' price sign,relocate the 2'-0"x 6'-0"Cumberland Farms panel to the top position and install a new 4' x 6' "Scroller"style price changer. The footings, location and square footage of the pylon sign will remain the same as will the internal illumination. The contractor for the project is Poyant Sign Inc.,125 Samuel Barnet Blvd,New Bedford,MA a copy of their Worker's Compensation Insurance is enclosed.Also enclosed please find an Agent for Owner Authorization letter allowing me to obtain the permits on behalf of Cumberland Farms.An electrical permit will be obtained by a licensed electrician prior to the Scroller price panel installation: Lastly,I have enclosed check# 1793 in the amount of$50.00 for the permit fee.Please.review the enclosed permit package and if you find everything is in order please return the permits to me in the enclosed self-addressed stamped envelope.If you have anyquestions or require additional information please call me at(774)239-2781.Thank you in advance for your time in helping to expedite this matter. Sincerely,: Carolyn A. rker Cc: Cumberland Farms File SPECIALIZING IN THE PETROLEUM INDUSTRY Project Management,Permit Expediting,Drafting Fire Suppression Plan 3 Lorion.Avenue,Worcester, MA 01.606 t Tel: 508-853-1167-,Fax: 508-853-1176 •.Cell:774-239-2781 •.capconsulting@averizon.net Town of Barnstable Regulatory Services i s , AM' Thomas F.Geiler,Director, 1639. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit Building Official approving Application for Sign Permit Applicant 6RW-04W /�/9i�� CG / sessors No 9:26 7 Doing Business As: C�/�,�iE/1? i'1,10 �W,01? tSTelephone No.�7 a �497V Sign Location J�� Street/Road: &96 Gt W T w.,9-11<1 &re.y;,z,- _ . Zoning District Old Kings Highway? Yes/No Hyannis Historic District? Yes/No Property Owner Name: 'Telephone:. —o��l '� c�® Address:/W Village � - 1-219lfi� i �3VIV,1V Sign Contractor Name: ap6l! /ee ///VG Telephone: -- 3 Mailing Address: "Illvylez 49�10(!Wl�T AV yl.� /W Description Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified?=((Ye /No (Note:Ifyes,a winngpermitisregriired) Width of building face �V W ' ft.x 10=�x.10 A�6 Check one Reface existing sign or New Total Sq.Ft.of proposed sign(s) If-you have additional si�is please attach a sheet listing each one with&mensiolls -) If refacing an existing sign please provide a picture of the existing sign with dimensions. - 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 tlieprovisions of §240-59 through§240-89 of the Town arnstable Zoning Ordinance. Signature of Owner/Authorized Age t Date SIGNS/SIGNREQU revised 12110 f t s 4F` 17 .a� a BP 1, 2 11V71 OvoV VIVI 1,VWI� Ste' "SIGN SPECIFICATION&CUT-SHEET" N • O � v • N i 3E p Qd �a O 0 us 24" 6-0 211 1611 2" Q LL. TRANSLUCENT BACKGROUND (Max. Pole) o NON-ILLUMINATED ZQ .. :BLUE'3M#3630-97 WHITE COPY _] U TRANSLUCENT WHITE COPY, LU 211 EXHAUST VENTS —4- m g 1 u 21' DO NOT BLOCK 5" IXi�YA1 p � ¢ 9" W 0 OZ N 2 1/2"CONDUIT a 2 4'-0" NIPPLE,CABLE S 32" .. ' PASS THROUGH 9, - - - - - 34" 2M DELTA DRIVE L392-3921-3M RADO SPRINGS, .. 910'1112 9„ ssoas 511 REMOVABLE U( FACE RETAINERS m p w y Z u Ir 32"CHANGEABLE NUMERALS J w N— CABINET PAINTED TRANSLUCENT WHITE COPY }n _j Lu w "MAP WHITE" OPAQUE BLUE(3630-97)BKGND Y C Z Q U J J A [O W 0 M w co O 3 8 PROPOSAL DRAWING SPECIFICATIONS $ S r DRAWING NUMBER:CUMB2203-040711-01 REV: A r g i g -2-u � C C m Flourescent Interlor Illumination: REVISION DATE: 04/08/2011 HP-2-Ha ,_ y Q„o g a T-12-800 H.O. CATALOG NUMBER: PCS-32SPDFITG F42T12/CW/HO,qty 6 � Magnetic Ballast: 2 MUSTED 82.2 348 DR,qty 2 ELECTRIC 0LEASE SIGN OR INITIAL IF RAWING IS APPROVED 8 APPROVED: DATE: -E o 9 r-o€ Input Voltage:120 VAC �e SIGNS 2 F 9901057 1.09. m. TOTAL=3 Amps *SIGN TOLERANCES:+1/8 -1/2" CONFORMS TOUL STD 48 N z 2-3 aa'aaa0A v - • Client#:122772, POYANTSIGNI ACORD,. CERTIFICATE OF LIABILITY INSURANCE ' DATE 0712°IYYYI) 09/07f2011 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 NAME: HUB International New England PHONE 978857-5100 9789880038 AIC.No.Ext: AIC.No: 222 Milliken Blvd E-MAIL ADDRESS: Fall River,MA '02722 INSURER(S)AFFORDING COVERAGE NAIL# 508 235-2200 INSURER A:Valley Forge 20508 INSURED INSURER B:Continental Casualty Company 20443 Poyant Signs,Inc. INSURERC:National Fire Ins Co of Hartfor 20478 125 Samuel Barnet Blvd. INSURER 0:Continental Insurance Co 35289 New Bedford,MA 02745 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. TSR R TYPE OF INSURANCE ASOL SU U DY M�IDYEXPMMDY POLICYNUMBER YYYMD - LIMITS - - A GENERAL LIABILITY C1077924068 9/04/2011 09/0412012 EACH OCCURRENCE RENTED.",;.) OECCCURRENCE $1 00O 000 COMMERCIAL GENERAL LIABILITY PREMISES Eaocre $100 000 _ CLAIMS-MADE I �I OCCUR - MEDEXP(Any one person) $5 000 ' - PERSONAL&.ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES-PER: - _ . .. - PRODUCTS-COMP/OP AGG $1,000,000 POLICY DX PECf IF X 11 L 0 C $ C AUTOMOBILE LIABILITY 20954906ti1 9/04/2011 09/041201 COMBINED SINGLE LIMIT Eaaccident 1,000,000 D X ANY AUTO C1077924040 9/04/2011 09/04/2012 BODILY INJURY(Per person) $ ALL OWNED rx SCHEDULEDBODILY INJURY(Per acddent) $ AUTOS AUTOS - X HIREDAUTOS NON-OWNED r F - PROPERTY DAMAGE $ - ,- - AUTOS - , Per.cadent X rive Oth Car $ B X UMBRELLA LIAB OCCUR C1077924054 9/04/2011 09/04/2012 EACH OCCURRENCE $5 000 000 EXCESS LIAR HCLAIMS-MADE AGGREGATE $5 000 000 DED I X.I RETENTION$10000 - $ - A WORKERS COMPENSATION WC182091627 9/04/2011 09/04/201 X WC sTAru- H- UT EMPLOYERS'LIABILITYTQR ANY PROPRIETORIPARTNER/EXECUTIVE YIN _ - E.L.EACH ACCIDENT $1 OOO OOO OFFICER/MEMBER EXCLUDED? I NIA. (Mandatory In NH) - - E.L.DISEASE-EA.EMPLOYEE $1 000000 .. if yes,desc'nbe-affde,`-.__ - _.,. - +:. _ DESCRIPTION OF OPERATIONS below - E.L.DISEASE—POLICY LIMIT $1-000;O0D� -" ''•" DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) - **Auto Liability Information D C1077924040 Eff Date:09/04/2011 Exp Date:09/04/2012 Auto Liability:Any Auto,Hired Auto,Non-owned Auto Liability:Drive Other Car . (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE r` Poyant Signs,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 125 Samuel Barnet Blvd - ACCORDANCE WITH THE POLICY PROVISIONS. New Bedford,MA 02745-0000 AUTHORIZED REPRESENTATIVE ftr4Il .9E 0406--- ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 2 The ACORD name and logo are registered marks of ACORD #S587112/M586927 MM007 �= a Ms July 15 2010 To Whom It May Concern: Cumberland Farms, Inc., with a usual place of business in Framingham, Massachusetts, does hereby authorize CAROLYN A. PARKER CONSULTING to apply for and represent Cumberland Farms, Inc. in filing of any applications for required permits and/or approvals for the LED PRICE PANELS at our store/self-service gas station including, but not limited to, appearing before any governmental agency at general meetings or public hearing addressing such construction/improvement of Cumberland Farms retail facilities. Cumberland Farms Gulf Group of Companies, Manny Paiva Planning Department Manager COMMONWEALTH OF MASSACHUSETTS MIDDLESEX COUNTY Subscribed and sworn to before me this 9 5t' day of July 2010 by Manny Paiva who is personally known to me. MAURE DICKSoN Wotary Pubnc (CD> OHWEAL7H OF aAssAcHuars Notary PubtAv1i!l,rn R,Y Harm 15 n e�puee My Commission Expires: I .2013 s . Cumberland Gulf Group of Companies . 100 Crossing Boulevard,Framingham,MA 01702 508-270-1400 �tHE Sign BARNSTABLE Permit BARNSTABLE, TOWN OF MASS. 1639..�Ae� Permit Number. Application Ref: 20064866 20060066 Issue Date: 11/28/06 Applicant: Proposed Use: IND/COMM Permit Type: SIGN PERMIT Permit Fee $ 25.00 Location 395 WEST MAIN STREET Map Parcel 269116 Town HYANNIS Zoning District H g Contractor PROPERTY OWNER Remarks NEW WALL SIGN 12 SF CUMBERLAND FARMS Owner: V S H REALTY INC Address: 777 DEDHAM ST V0990 CANTON, MA 02021 Issued By: PC POST THIS CARD SO THAT IS VISIBLE FROM THE STREET Town of Barnstable Regulatory Services Thomas F.Geiler,Director y snwvsTnBr.>:, MASS. Building Division i639' Fo►ui � Thomas Perry,CBO Building Commissioner 200 Main,Street, Hyannis,MA 02601 www.town.barnstab le.ma.0 s Office: 508-862-4038 Fax: 508-790-6230 Permit# Application for Sign Permit Applicant: Cumberland Farms, Inc. Map&Parcel# 269-116 Doing Business As: Cumberland Farms Telephone No. 781-828-4900 (wall) Sign Location 395 West Main Road @. Suomi Road Street/Road-.— Zoning District: HB Old Kings Highway? )r�s/No Hyannis Historic District? Ngfs/No Property Owner `�"� Name: Cumberland Farms, Inc. Telephone: 781-828-4900 Address: 777 Dedham Street Village: Canton, MA 02021 Sign Contractor Name: Image Plus Telephone: 860-487-1000 Mailing Address: P 0 Box 172, Ashford, CT 06278 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/'PA (Note:If yes;a wiring permit is required) C�r Width of building face ft.X 10= a.10= S+Ft.of proposed sign 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§240-59 through§240-89 of the Town of Barnstable Zoning Ordinance. Cumberland. Farms, Inc. Signature of Owner/Authorized Agent:By ac, j Date: i 1 Z-4 Permit Fee: Sign Permit was approved: Disapproved: Signature of Building Official: Date: In order to process application without delays all sections must be completed. Rev. 9/12/06 r 2 t s, INS ` ul. x t g s v R� .a L 4 .• ;BankofAmerc' R 1 Ctm�ber�'�r farms „2 j7 D�-GSFAM STREET a(p" �•. , A. .. CANTQP1s(5!(ISSAGHUSETTS Ej �32131 $ •• • AMOUN PAY EXACTLY216 # #?4### #st • z '' � i ' NOT VALID AFTER'%'Y DAYS . fq /r T E Y afN i S TOWS a _"7 R i➢ 3 mr au 20.. 15/ " AMOUNTS OVER:00,000.00REQUl TWO(2)•SIGNAT.URES "NO 2800 2 1 r,V 1:0 1 1 20 1 5 3 91: 0000130 2 4 1 3 1 311' i 5 � mot , Sign , TOWN OF BARNSTABLE Permit * BARNSTABLE, ' MASS. 9�Ar�0 9.a Permit Number.- Application Ref: 20064862 20060065 Issue Date: 11/28/06 Applicant: V S H REALTY INC Proposed Use: IND/COMM Permit Type: SIGN PERMIT Permit Fee $ 25.00 Location 395 WEST MAIN STREET Map Parcel 269116 Town HYANNIS Zoning District HB Contractor PROPERTY OWNER Remarks REPL EXIST GAS SIGN- TOTAL 22.5 SQ ADJUSTABLE PRICE SIGN CUMBERLAND FARMS Owner: V S H REALTY INC Address: 777 DEDHAM ST V0990 CANTON, MA 02021 Issued By: pC {�( . PAST TICS CARD SO TIIAT IS VISIBLE FROM TM- STREET Town of Barnstable T"E Regulatory Services Thomas F.Geiler,Director y saxxsTnsre. Building Division t63o. �® "rFcnm Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax 508-790-6230 Permit# Application for Sign Permit Applicant: Cumberland Farms, Inca Map&Parcel# 269-116 Doing Business As: Cumberland Farms Telephone No. 781-828-4900 Sign Location West Main Road S m' Road /J66� Street/Road. 395 @ uo i O� Zoning District: HB Old Kings Highway? �4s/No Hyannis Historic District? i ^o Property Owner Name: Cumberland Farms, Inc. Telephone: 781-828-4900 Address: 777 Dedham Street Village: Canton, MA 02021 Sign Contractor Name: Image Plus Telephone: 860-487-1000 Mailing Address: `P 0 Box 172 Ashford CT 06278 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) Width of building face ft.x 10= x.10= Sq.Ft.of proposed sign _ 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§240-59 through§240-89 of the Town of Barnstable Zoning Ordinance. Cumberland Farms, Inc. Signature of Owner/Authorized Agent:.By -----� )— Date: 0 1 Z. `r Permit Fee.- Sign Permit was approved: Disapproved: Signature of Building Official: Date.- In order to process application without delays all sections must be completed. Rev. 9/12/06 s. w `a r t , J yy� rP .a•+jai � u d� py E =a x n , 10 TOWN OF BARNBTABLE ' 7 Permit 24449 No - ------ Bnildiag Inspector , ._ .. t Cash _ e 3 L �t Bond R OCCUPANCY PERMIT - -- 1- , Issued to V, $, H, Realty, Tnc , 9ddTess ,`175west rlaiiillft Wiring Inspector S' J, Inspection date /�/�.. may/ . . Plumbing Inspecto1 .r 1' (' 1 Inspection date Gas Inspector t jam. _ 'ok Inspection date / �r.•l�e 1 iaF: q� v Engineering;D tm eparent Inspection date% • jBoa7ia o Health r %�3 � ° �j f�' y �� Inspection date1011 � ,THIS PERMIT WILL-'NOT,BE -VALID, AND THE BUILDING,SHALL: NOT BE 7OCCUPIED %;UNTIL.zr_, SIGNED BY THE-BUILDING INSPECTOR+ UPON.- SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS' AND DY ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING--CODE. _._.......__. _ __. 19_ _,. ...._............ Building 'Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT t asaaSrAIM : TOWN OFFICE BUILDING rua .6 q g�ar�r►,� HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorized by BuildingPermit #....... . ................ ............................................................................................................................. issuedto ........................................................................._............._...._.... �.. Please release the performance bond. FROM - TOWN OF BARNSTABLE Mrs.,Muriel White BUILDING DEPARTMERT- Construction Department 367 MAIN STREET HYANNIS, MA 026M V. S. A. Realty 777 Dedham Street Phone: 775-1120 I Canton, MA 02021 SUBJECT: Building Permit #24449 dated October 12, 1982 FOLD HERE -DATE - February 4 1985 M E'S S A G E I An "occupancy permit has not been issued under the above building permit because the stores at the rear of the Cumberland Farms store have not, as of this date,, been' cdmpleted (wiring, plumbing, etc.). Please be advised that.the building numbers have not been affixed on the buildings and this is also a regeiirement for an occupancy permit. If you have any further questions please contact my office. Elv-�"t, eph"D.. DaLu , Building Commission DATE REPLY i .• .. .SIGNED Ne7-RM1 RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW,COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. V.S.H. REALTY DIVISION OF CUMBERLAND FARMS, INC. January 24, 1985' Mr. Joseph Daluz Building Department . Barnstable Town Hall 367 Main Street Hyannis, MA 02601 RE: CUMBERLAND FARMS STORE WEST MAIN STREET @ SUMOI ROAD f HYANNIS, MASSACHUSETTS Dear Mr. Daluz: Enclosed you will find a copy of a letter forwarded to your department . in March of 1984 and July of 1984 requesting the release .of- a Per formance Bond in the amount of $1,000.00, a' copy of which I have en- closed for your records. Since the issuance of this bond, all work has been completed and the store has been opened. I would like to request "the release and return of this bond to my personal attention. If you have any questions concerning this matter, please do not hes- , itate .to contact me at-your convenience. Very truly yours,. V.S.H. REALTY, INC. Muriel White (Mrs.) Construction Department. maw Enc. CERTIFIED MAIL RETURN RECEIPT REQUESTED'•#P 361 792 435 777 DEDHAM STREET, CANTON, MASSACHUSETTS 02021 617-828-7790 d <!ti t Y ,IRII ilf - 111./1 It/111/I.1(,/11/t 111\,/III1 J1�1 Jyll.�./yl 11 ll rl 11 :•1!/1 I JCIL!1�11 r 7 f!�h ,�Ir ..�. d�y��-' ,, i •. . _ �-. .. _. _... . _ . ..-..v. <,.,-._ -. .,. .-.�e•.:-mlr�`I�:V-titlr[Sll R71•n111i mI IC II'tt rl . rl3 t n-R 1 t r - Jr.N� .l. Mc.04 ,17- A C COMPANY F. C KEENE NEBi. HAMPSHIRE 03431 � I.I CENSE Olt 1'I:ItM lT ROND - KNOW ALL ME"'T BY THESE PRESENTS, That We, V.-S.H. Rea l't_y'lli<.. ;.. 777 De01 ii^ Street, Canton, M ssac::usetts 02.021 `~ IQ r_s Principal, and PEERLESS INSURANCE COMPANY, a New Hampshire corporation, and having pri iple office in the c.:`v of .Keene, New Hampshire. as Surety, are held and firmlv w u-rtc `1e `Ccrc--r, of 'Barnstable, t�sc;acfntst.t_cs hereinafter cal+ed the Obligee, in the penal sum of- thoura d a _ - - - u; DOLLARS ($ 1,0_)0.00 Ir. lawful money of- the United States of America to be paid to said Obligee, For wt; n �y payment well and truly to be made, we bind ourselves, our heirs, executors, administra- R: tors, successors and assigns, jointly and severally, firmly by these prase-nts. 1 1 t. l: Signed with our hands and sealed with our seals this 27th day of A.2. 19 3_r-'_ WHEREAS, a LICENSE or PERMIT has been granted by + he Obli��e to th- ,ove Principa' .nithorizing said Princi al to i)<i li T / inden P c-ci: .i.r.ltc-t :1 ,,u f, locrl�.e>_ ur. Now, therefore, the Condition a- f this Ubligati.or. is such, that if t..� said ' trincipal shall faithfully observe the provisions of the Laws, Ordinances, and r ` I .:.olutions, governing the issuanc-a of this License or Permit, then this- Oaliaf r.. to +~ shall be null and void, otherwise to remain in full force and effect. tticl�LF:�`.ri ` ;abCr3v s1i�11{1 d 5i><ii�td;:tiSjc:�:fi:th X°:` X X;Wy,ain X X XZ; - - jI � 3�iw,,ufi'1;���i;�:�Yd,..bl�litYX�X�t(G1�D�►7:��' �'0 <r"'.. ^r.•� S�'- The Surety may cancel this bond at any time by filing with the Obligee thi-v-y (30) S� days written notice of its desire to be relieved of liability. The Surety shall not 51 [- he discharged from any linbi.lity already accrued under this bond, `or wh}t.n qha' 1 zee rue its rounder hc`foro the expirat ion of the t.hirtv y3ay period. Dr..B. Haseotes 1 ` Chief Executive Officer PEERLESS INSURANCE COMPANY f / BY: Ba a,-a .J. chards, Attorney-ir-k'�:ct 1 �c PSIS-226 IE� 346-110(5/II2) i rwllt 11..:1,1 11 u)=11,t111riL11 _..__ _.._.—_--- - —• IM lt- ;i It//1LIt�W111:it7:r 11:IC111t11Lti"l2 t 1.t(�13f ll.t.iL`- -i tL�t(il. ....1Ci1�L'1�L1�.1:.�... .1�..- cc.hv .-i;,,c..�• -' IF PS- E / i V.S.H. REALTY, INC. 777 DEDHAM STREET CANTON. MASSACHUSETTS 02021 617-926-7790 March 21, 1984 Mr. Joseph Daluz Building Department Barnstable Town Hall 367 Main Street Hyannis, MA 02601 RE: BOND #S-03-97-28 CUMBERLAND FARMS STORE WEST MAIN STREET @ SUMOI ROAD HYANNIS, MASSACHUSETTS Dear Mr. Dalzu: In reference to the above-mentioned men coned bond and our u store located on West Main Street, Hyannis, this bond was presented to the Town of Barnstable in October of 1982 for work to be done parallel to the street frontage as a requirement for the building permit. Since that time, all work has been completed and I would like to request the release of this bond. I have also enclosed a copy of this bond for your review. If you find everything is in order, I would appreciate having this bond forwarded to my personal attention. If you have any questions, please do not hesitate to contact me. Very truly yours, V.S.H. REALTY, INC. Muriel ite (Mrs.) Construction Department maw Enc. yy..� ;` �`.�+.'•.�y .T?� �'�� j'^���"'t✓' a� +&�*�`7��.�� '�{:�'��a�' .��w.y�� tY`�k y;+y�'�:. � �y;; ,:�-� ,yJ��YSi�:.;..� _;S.-S,..y�;.._. ��.Y} 5 t ,1 : I1R t ,.. m 1+'! +\1i'I\+ I\ iLJI7\lit1^I ' `:•i ,..-:v. -_�a��:.-.•ii+_ ..-'.v.•:•....� �.v.r.6..�i.ti ..'.. ti.•.. e�'v- V .lt`Ni`ILI1 IC71i ( i,.ti-.r •-�V- w^-'v-'%i✓-_•y. .tir:�.. ;i . - --' - - -- 1. a ; ` •, PEERLESS r+d' 113URANCE COMPANY f� KEENE NEv, HAMPSHIRE 03431 ; j A f1� —€ � - Bernd No. S-V' -;7-"'' IA CENSE' Olt PI(RM IT -BOND KNOW ALL MEN BY THESE PRESENTS, That We, �'•'S.}1. Ye^1ty,Ini:, ' 777 DedEiFn Street, :Canton, }•it ssachusett.s 02021 ea Principal, 1 and PEERLESS INSURANCE COMPANY, 'a New Hampshire corporation, and havingri . .i le P P ! ; office in the City of .Keene, New Hampshire, as Surety, are held and firmly unto 'lie Town of Barnstable, }•I^ssachusetts ' hereinafter called the Obligee, in the penal sum of- '-rife thousand an 00/i;: i - - - - - - - - - - DOLL 5 .y - - - - - - - - - DOLLARS ($ 1,000.'00 lawful money of the United States of America to be paid to said Obligee, for wh;,_n C. i payment well and truly to be made, we bind ourselves, our heirs, executors, administra- tors, successors and .ass' ns, jointly and,severall firmly b these } }g J y Y. y y presents. r Signed with our hands and .sealed with our. seals this 27th day of J1,11V •A.L'. 1 g -WHEREAS, a LICENSE or PERMIT has been granted by the Obligee to the above snden � . j Princ-ipal authorizing said Principal to con,;"truct a ouilding loc:te(' r _- i,!;t. , '.;, �k7 St.:l'eet and S .-.io4., Barnst;lble, .Mass.-chus:_:i:ts:, . 1 .Now, therefore, the Condition of this Ubl"igatioi� is\such, that if tl-._• said Id Principal shall. faithfully observe the provisions of the Laws, Ordinances, and T.F volutions, governing the issuance of this License or Permit, then this= shall be null and void, otherwise to remain in full force and effect. .cxxxx;,x:. y, xbJndXXXX= v x,_-d,4D a ity,.xyY. lwidK iTiEX The Surety may cancel this bond at. any .time by filing with the"Obligee >fhi<rstj i130) , � � days written notice of its desire to be relieved of liability. The Suret 'not be discharged from any liability already accrued under this bond, or whi".:7i saa,~ I '}c)i'.rue r, ' licreunder before the expiration of .the thirt2/v daY period. y' y 4 ,t �i' t - 10 �, IL 4 (, D.B. ..Haseotes (Princri pa"�'�.) ►:ti;,> ,} , Chief" Executive Officer I t , PEERLESS INSURANCE COMPANY 'hr BY: 1 Ba aYa, ,}, icflards, Attorni y-ir=}':ctr 5 1 PSN-2.26j. #i i _ 346-110(5/82) ; �� litlill[1L'.ist.'[Z11/lfit[lIJ[.��itC11;1L11.t111:1C�1:1f�S:ICa,':il::ll.1LIL1L'!!).1:I[1TIIll:IC]IIlL1li1Lll++ .113E.1/1Lt:11' V.S.H. REALTY, INC. 777 DEDHAM STREET CANTON, MASSACHUSETTS 02021 - 617-828-7790 r June 2, 1983 Mr.. Joseph DaLuz Building Department Barnstable Town Hall 367 Main Street Hyannis, MA 02601 RE: WEST MAIN STREET @ SUOMI ROAD HYANNIS, MASSACHUSETTS Dear Mr. DaLuz : Please be advised that the V.S.H. Realty, Inca does intend to install the necessary granite curbing at the above-mentioned address and intends on having this work completed within the next thirty days. We appreciate your cooperation in allowing this amount of time in order to fulfill this requirement. Very truly yours, V.S. R LT , INC f f�- alb Richard L. L ngton Vice-President, Cc truction maw cc: Gerry Butterfield V.S.H. REALTY. INC. 777 OtONAM STRUNT CANTON,MASSACMYStTTS Omit S/7WF77SS Y March 21, 1984 a Mr. Joseph Dalzz Building Department Barnstable Town Hall 367 Main Street Hyannis, MA 02601 RE: BOND #S-03-97-28 CUMBERIAND FARMS STORE WEST MAIN STREET @ SU DI ROAD HYAMIS, MASSACHUSEITS Dear Mr. Dalzu: In reference to the above-mentioned bond and our store located on West Main Street, Hyannis, this bond was presented to the Town of Barnstable. in October of 1982 for work to be done parallel to the street frontage as a requirement for the building permit. Since that time, all work has been ccnpleted and I would like to request the release of this bond. I have also enclosed a copy of this bond for your review. If you find everything is in order, I would appreciate having this bond forwarded to my personal attertion. If you have any questions, please do not hesitate to contact me. iY Very truly yours, V.S.H. REALTY, INC. 0 Le Construction Department maw, COPY 7/10/84 t W i _ a, S y s:. P _RLESS INSURANCE COMPANY' ' Eez r +r' _ .. ..:W'nL i Y.Y. r•-ilir:` - .�• -"Jf.1Lt- •.'!.{!�i' -"1L•.ie � .. C KEENE NEW HAMPSHIRE 03431 . Bond No. I.I CI':NSE OR I' -IRM I.T I3UNU KNOW ALL 14F.", BY THESE PRESENTS, That We, V.-S.11. Re-1.ty,In,- 10 V, e r 777 Dcc71 1t^ Str, et, Canton, T .^ss.oc;,,-_setts 02021 <:s Principal, and PEERLESS INSURANCE COMPANY, a New Hampshire corporation, and having pri. iple - '; office in the (': `v of .Keene, New Hampshire. as Suretv, are held and firtnl,i i)(* unto -.:1e To,` i of ;3arustable, - hereinafter ca'led the Obligee, in the penal sum of- -k't:e thousand and 0`),'1::_i- __ - DOLLARS ($ 1,ilJ;).tl J ) fit:•,; k i? i:_t:ful money of the United States of America to be paid to said Obligee, for wh •. n. 5= payment well and truly to be made, we bind ourselves, our heirs, executors, administra- tors, successors and assigns, jointly and severally, firmly by these presents. 1 . tc Signed with our hands and sealed with our seals this 2.7th day of 1117 A..;. 19 S _ WHEREAS, a LICENSE or PERMIT has been granted by the Obli-ee to thy above :inden `` 5 Principa' authorizing said Principal to cc•,r, .i:r-itct :i ' ui;-d big loc;�t.t 3arnFtr'. l e Mf is: iius: Now, therefore, the Condition of this Obligation, is such, that if 0-:1• said ; I Principal shall. faithfully observe the provisions of the Laws, Ordinances, and F.--solutions, governing the- issuanc•a of this License or Pernit, then thi: 001igr r. on ?= shall be null and void, otherwise to remain in full force.and effect. fL�L','' y�Y,C 7y Y�tYdY,S.Zi3T'�{� sw�iV`ate:1•�{1bfn,t:�.tY1LLX,:.,..'it):tp �etC,XiXa�fXr{:�� r�1:X.`l.! �1:�X��F� if;•. • X10,Xxxx;,,,,d a{: txO ayxliu-4aifU d4aM�ia�vtbi25NdbV*X,.3 MXA,S .>a,.�KbIMJIXXX XnnW�,iJ�Ay�,A, h4k�.rtx' r:a obo",M, 2:71 The Suretv may cancel .this bond, at- any time by filing with the-Obligee days written notice of its desire to be-relieved of liability. The Suretx','shali. not"-, he discharged from any liability already accrued under this bond, or wh _ :Vn-ph��1 a *.rue' hereunder before the expiration of the thirt�yy dayy peri.[Ici. 4R 4 R �� t• �, ', Ni ;�. V.S.It. (}Ft Iv = D.B. Haseotes (Pr Chief Executive Officer t ,/ PEERLESS INSURANCE. COMPANY BY: - it n Ba ara J. cFiirds, Attorney-i>ti Vki:t 1 ; PSB-226 _ ' 346-110(5/82) -a}. ..�, .n.=; .,c.r.�� �, -�' �. -�...� - .. :. -.,-; �.�.nc-_-.�.- . a,.r �cav, SltL�l.tllll.t:t;[ !'t1�LiLll.tLif,tll[''Fn,:t/lt:lllLtL�l�tLl1'� iIL.ICILIL.IL'1L11:ti1rIL11:ILfLlIJL11,!iJJL]l1IL.1:iL' �i 1.[iil.L.:.ILii.lillrL�1:1.:'. ..:L.L.-t .)_t/lLiLu:![itiSC,:.tI�il:J. . �1� �OF t0 � g Assessor's map and lots number THE r Q �5ewage Permit number 4- �g¢ • F'�'1c Sy STEM SUS u_ u..IFrA ASdg9aTSHLE, • r House 'number .:........:................. 114 T�4LLE® IN C01l�P a , .... .............................. t LIA z639•a0\0� 1 /IThi TITLE 0�pY -.aTOWY. -OF BARN ' _ C06EAND yr+ t� EMULATIONS *.'F PULDING,- INSPECTOR °+ APPLICATION.FOR PERMIT TO ........................r� �... R�I.417 A I,...S7 O� ff 1-66 S....0 Vrl lr7 � ....................... TYPE OF CONSTRUCTION °4,5 fd N! ....... � . ........ ................ ......................... v:..:..Y y.. ..9.4... ....19014� TO THE INSPECTOR OFM BUILDINGS: M ' The undersigned hereby applies for a permit according to the following information: Location ... Of.. . ...... .>�.!XY. . �.� .....Gt� ....c .u .�'..:.: :........... ........................................................ Proposed Use ?... Al�. ... A A/C/./...Y ...�'f f�0 T,4.A ...:r:TO..... ..../..V.44 vs Zoning District .:: .....................................`.....:...............:Fire District .............................. Name of Owner YX/.Z.....f. X 14� y..1 j��.... ..../.? .a. ..�J......6,4 �/1'1✓ /�'! . .Address �. ' Name of Builder- ..... .....s A... i'. ................. ..................Address ......` ... �. .-�... '. - ®,.....�. Name of Architect ..................................... ............Address ................................. .. .... Number of Rooms ..... ....... .....Foundation d�Pi ............................................. ^^�--.............................................................................. Exterior /!'J/ 'd/1/ ?l ...................................................Roofing ..1... 6.....t...Q/ /g. '. '.................................. Floors :.�. :.......:.:.Interior .......................................................................... Heating ....17a�.:A.T.... ...../..:.c.l......:........................Plumbing ...................... ........................................ Fireplace ....... ..............................................:....................Approximate.Cost .................................................... - !Definitive Plan Approved b Plannin Board ______________________________19________ aO �' pp Y 9 Area �...p..................1l. ............. Diagram of Lot and Building with Dimensions Fee U ......-.. ............. SUBJECT TO APPROVAL OF BOARD OF HEALTH s S� fp2, 0 . f OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ' I. hereby agree to conform to al;l the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam, ,C ,r� s ......... .. ................. y, 777H �REALTY INC. No',24449• Build Commercial ' Permit for .s. ^r = t ? J/Rental +Stores t ............................................. West Main Street/Corner SJomi Rd. Loc tion Hyannis e ' Owner VSH Realty...Inc....:...:.... .......... Frame Type of Construction ..............................::......... ..... Plot.:..u................... .. Lot . .. ....... ... .......... } Permit;Granted ..QQ.t�....2:..................19 82 Date of Inspection `��' .19 ' Date Completed 9 Assessor's map and lot number .................. !zhv............. THE Sewage Permit number ........................................................ B98d9T11DLE House number ........................................................................ Kim& 2 '39- TOWN OFBARNSTABLE • BVILDING INSPECTOR _D6 xi F_ APPLICATION FOR PERMIT TO .............................. .... .... ........................................ TYPE OF CONSTRUCTION I Aj. T...A4,o i A/ T.+ SUOMI 960 Yy ) ........................�n...7. ......19 12-- TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 4 ........Location ......... ..... ....... ............ .. ....V ......................................................................... ProposedUse ..................................................I............................................................... ZoningDistrict ................... :............................................Fire District ........... .... .......................................... Name of Owner ................... h)......................................:.Address ........... Name of Builder. ............ .........Address .... ...................................... ...................................... ....aqiov,... Name of Architect .................. ..............................................Address .................................................................................... Number of Rooms ....................\ .............................................Foundation .............................................................................. Exierior .............................................N.....................................Roofing .................................................................................... Floors ..... ..............................................�v ..................................Interior .................................................................................... Heating ....................................z................................... -.Plumbing............... ................................................................................ Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board ---------------—--—----------- Area .......................................... Diagram of Lot and Building with Dimensions Fee .. .. ............................. ..... 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 regarding the above construction. 3 Name ..W........1................ ............... .......;.............................. V I S 1 QMO, l24,rS V. S . H.. REALTY TR A=r�- 143 � ISI 24448 No .................. Permit for D ISH................................... Building ........... .......................................... �4:......................... t Suomi Rd. Location Yest Maini.§...t...re...e..../ ......................... .................... ............ .. .............../........................ . .. ....... .. .... h OOw V. S. H�- Realty Trust wner ...................;,................. ......................... Type of Constructin Frame(I y ........................................... po ............................. ....................................;.......... Plot .................... ..... Lot .............................. Permit Granted'- .....Oct t .......... .19 82 19 Date of Inspection .................................... Date Completed ............I................ ....19 Assessor's map and lot number �,. _ ?HE 1-57 Sewage Permit number �� ` Sri.-!`� d.. ...,�.+nre",. Z NA"STADLE. i House number 1. b a ,.....'..............�...... 9��o YA9 TOWN - OF BARNSTABLE f . BUILDING IINSPECTOR -- APPLICATION FOR PERMIT'TO�'d {' ......v... '....... �G if.�✓./ f�� S'T O.A6 1 � �a t4,�' 0 v'��!',a ....................................... ............................. TYPE OF CONSTRUCTION ..................... ,........... ......... ................................ U �` .19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: LocationAl,J'..: f..... : ... �.f ..... . ....:. .��1. ...... 1. ...................................................................... Proposed Use,.b?..:r.�Q�`t.� � �`�/V�J�;�... ...�.�,4OT�4 #4 �..:�'�aa/e S7-aa Zoning District .....F�..... . ........... ............ ........... ..........Fire District ................' �1t... 2t........................ /,� . Name of Owner rA,... .?.. .�✓ .JAJC.................Address .7.7..? �? �` ....5 ...� ,+� I - ' Name of Builder' ............ ........... .........................................Address �O Nameof Architect ..................................................................Address .................................. ............................................. CYO✓ Numberof Rooms ....-4 ........................................................Foundation ........................................................................:....... Exterior .:! de't✓A. .................................... ............Roofing .L�° .�..... ... i / .:.... Floors ........ N.............-............................................................ Interior .................................................................................... .... Heating !! ..f........�.�,Vr .J,...............................Plumbing ......... ............................... /f Fireplace ...... ....�:...,A............................................................Approximate Cost .................................................................. Definitive Plan Approved by Planning Board ----------------__-----------19_______. Area �p;.. '`'' .................. Diagram of Lot and Building with Dimensions � " 3 Fee .......... .... SUBJECT TO APPROVAL OF BOARD OF HEALTH P � , o g 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. Name ............................ , . ..... :�� VSH REALTY INC. A=269-142"143 0-o mct)-01) 24449 Build Commercial No ................. Permit'for .................................... i . ....... ...S.t.or.e.s.................... Location Aggl..Min.. ......Suomi Rd. .................HY.arm s.......:.......................:........... Owner ....Yqf!..A9A!tY...1.11.Q.................... Type of Construction .....Fr=e........................ .................................:............................................. Plot ............................ Lot ................................ Permit Granted .......Oct......1.2...............19 82 Date of Inspection ....................................19 Date Completed ......................................19 tv" r Assessor's map and lot-number .,.........:�.. .. ....`....... F _ i QyO�THE Tp�y 4 Sewage :Permit number ......`..................................:......:.....:.s } Z H9Sd9TODLE ti i House number .....................:................................................ 90p M6 a ♦�. 39' C NP.t TOWN iOF BARNSTABLE BUILDING : INSPECTOR APPLICATION FOR PERMIT TO �.® �'i. S r' �.. ..!./..° G-. t' f v`r 0) .. .................. ........ . ... ... ...... .... ....... .. TYPE OF CONSTRUCTION V).�:J,. S "l.l ur;� .S..... . .L. �8... �.. ............................... .................................,...7 ......19........ TO THE INSPECTOR OF BUILDINGS: 1 The undersigned hereby applies for a permit according to the following information: Location ........ .. .. .r ...1.1..: .........4 .......PLA .......4.9 d..... ...................................................................... ProposedUse ................ .........................................................................................: ........................................................ Zoning District ................... :.......................Fire Districtj�! .. . . . Name of Owner ill! .... . .Address Name of Builder' ...... ..... Address .....,...... '° ...................................... Nameof Architect ............................ ............. ................Address ...............:................................... ............................. Numberof Rooms ..................................................................Foundation ..............:............................................................... Exierior ....................................................................................Roofing ...............................................................................:.... Floors ......................................................................................Interior Heating ............. ......Plumbing Fireplace ..................................................................................Approximate Cost .................................................................... Definitive Plan Approved by Planning Board -----------____------------19_______. Area .......................................... Diagram of Lot and Building with Dimensions Fee. ......................................::..... 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 regarding the above construction. Name ... .. . ......................... ..... { H.-,`REALTY TRUST 1i No -: 24448 s Demolish Permit for . . ........................... tt p. Building r -- 6 ..r. ... ................................................................ '4est Main Street Suomi Rc . Location i " Hyannis • .......... ................................................................ Owner�.....V'.,,S. H' Realty. Trust Type of Construction ..,,_Frame........................ -- - .................... .... . ............................................ Plot ......................... Lot ................. r ^� October 12�, 82 Permit Granted .........................................19- s ; • Date of Ins ection ...... .. . F19, - '7 Dote Completed .. .......19a. . r. r F-eb 17 04 11 : 45a p. l h_ it M$ Nis i I Date: To: From Darrell Chaloult Sub.co.ntractor stripin== proiect for Cumberland Farms Subject St in io'ect consist ofa 9"decal that is 6" blue& 3" orange that sits on the lower:tnm=as shown below.' It has rio::advertising in it and its sole purpose is to accent the new Cunnbetland Farms Colonjal°loot. If you any questions please call rr1e, if this all right. please sign the Approval Form and return via fax(860)g29-0599: Thank you;for your assistance regaMing this issue. II w w Our Experience is Your Advantage PO Box 409-Willington, CT 06279-Phone(860)487-1000/Fax (860)429-0599 F..ieb 17 04 11 : 45a p. 2 .i i APPROVAL FORM : i ' Site Street Address: Site City&State: f4 i 7 Contractor: .l.,r. 0 3 A, /'/r.s .Z �! �% Pw,!/��'- �� (o+'�.i.'f•.dP?rr.� t'�'!.v'k t {- YJ�Vs �'J�_1. !�%�'.(� The striping project for Cumberland Farms, Inc. on the above site does not require any permitting other than the following Z - C,/1) Date: (p 2 3!: ��'✓e fi?y �� Signed by Toxvn/City Official Building inspector/Zoning Enforcement Officer plan;iinc� Department -- f ' ` TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 269 113 GEOBASE ID 17507 ADDRESS 395 WEST MAIN STREET PHONE Hyannis ZIP - LOT 3 4 & 3 BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT HY PERMIT TYPE BSIGN DESCRIPTION SIGNEPERRMIITET (24 SQ.FT. ) CONTRACTORS: i : Department of Health, Safety ARCHITECTS i and Env ronmental Services TOTAL FEES: $25,00 BOND Tt1E .00 CONSTRUCTION COSTS $.00 Qi► 753 MISC. NOT CODED ELSEWHERE * STABLE, • MAS& OWNER V, S H REALTY INC 1639. Ae� ADDRESS 777 DEDHAM ST V0990 ED M1� CANTON MA - BU�LDING DIMS, ON BY .d. DATE ISSUED 01/02/1997 EXPIRATION DATE The Town of Barnstable IL a artment of Health, Safety and Environmental Services � 1 Department p Building Division 367 Main Street,Hyannis MA 02601 _ Ralph Cmssen Office: 508-790-6227 Building Commissioner Fax: 508 790-6230 Application for Sign Permit Applicant A ' G S Assessors No. Doing Business As: h n ce 5 Telephone No. Sign Location Street/Road: (�2 (19) p )h 3� S ' • r"Zoning District: - • tc Old Kings Highway? YOOO Property Owner II Name: �v m�e �c�1�A �c�f n� S Telephone: Address:�.uL? �t' Village: Sign Contractor Telephone: O� 22 - Name: � -� Address: • ' �' Village: Description lot showing location of buildings and existing signs with dimensions, Please draw a diagram of g location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? YesCo (Note:Kieii a wyiDffPM7ZZ t is requkeO I hereby certify that I am the owner or that I have the authority of the owner to make this the application, that the information is correct and that the use and construction shall provisions of Section 43 of the Town of B_ le Zo ' Ordinance. n -Date: Signature of Owner/Authorized Age Size: Permit Fee: o�•� �� Sign Permit was approved Disapproved: of Buildin Offs Date: Signature g Jr 00' MIT �o �o 0-� 00 1 �1 k� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION / ? Map Parcel �( � Permit# 7 Health Division 51 ao' �Q/L� Date Issued "• 17 Pt = 1 ;; Application Fee Conservation Division pp Tax Collector Dom? �c I_— /5 /t73 Permit Fee Treasurer �- ' ' ;VfIOhT7�____ MMCAM MtTST OBTAII�1 A SEVOEIt Planning Dept. CONNECTION PERMIT FROM THE ENGINEERING DIVISION PRIOR To Date Definitive Plan Approved _by!Planning Board P CONSTRUCTION Historic-OKH \y ` Preservation/Hyannis P"'" Project Street Address Village - Owner Address Telephone1 �1500 Permit Request OAP --r—��/� �. _ o hOtt S� P r L � Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new '\j Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type ` Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family Cl 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 2 Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other 4 Central Air: 0 Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes,- 0 No Detached garage:0 existing ❑new size Pool: 0 existing ❑new size Barn:0 existing ❑new size Attached garage:❑existing O new size Shed:0 existing ❑new size Other: Zoning Board of Appeals Authorization Cl Appeal# Recorded 0 Commercial ❑Yes O No If yes,site plan review# { =Current Use .,_t__ Proposed Use BUILDER INFORMATION ,, ��y ✓ ` Name �/�-o Telephone NumberPUE?)— &-,) ��X �0 Address O o _cam re. License# ®� Home Improvement Contractor#, Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE i a FOR OFFICIAL USE ONLY .a PERMIT NO. DATE ISSUED "+ MAP/PARCEL NO. ADDRESS VILLAGE OWNER r DATE OF INSPECTION'-. FOUNDATION FRAME _ 4`�`/2lyt �� !� /yi d,h INSULATION w � FIREPLACE ELECTRICAL: ROUGH FINAL -� PLUMBING: ROUGH FINAL J GAS: ROUGH FINAL -.F FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f R 09/15/03 ,10:39 FAX 1 781 344 9674 CYN ENVIRONMENTAL T&D 0002 Z0,30dd -11diol ** 0 Town of]Barnstable a : Regulatory Services ThomesF,Gebr,Dkeetor, sO1g. BUH&Uig DiVid1DU 0 Tom Perry, BundiagCatmdW10mr 200 Main SUM HyaaaiS.UA 02601 Office: 508-862-403$ Pax: 508 7'40-6230 ' I Propetty Owner Must . Complete and Sign This Section If using A Builder as OcPacstt of the subject pxgperep_ hereby av�horizc Ely ©hyY! f!`I ca act ca zay behalf,. is all matters retie to v"k suthotized by this buaftS pmmit applk%t n fog (Address of Job) � Date Friat Name R Q: s: >�ssiot� SEP 15 '63 08:21 1 781 344 9674 PAGE.02 C7ho+7hCTP)-T m gsCF. SLS T8L -blN8WN06InN3 lid BS:80 20, SL d3S SEP 15 103 10:55 1 781 344 9674 PAGE.02 r,f sz �. Ljcpns Pa. T LC,u-suP R gp. _ 4 Tr.no. 24469 R L7 THOMAS S LON .i Wrj;� 7 GRPSS4Y BEAR WEST MA 04%�'� Ad 4n nfstrator Y S t The Commonwealth of Massachusetts - ,. = ' Department of Industrial Accidents =_ = Off CIV oflnyestfgatlaos _ 660 Washington Street = Boston,Mass. 02111 Workers' Com ensation Insurance davit DAM Cyn Environmental_ ('c�r�ra*rein d/b/a Cvn Fnvi } I S location 100 Tosca Drive ci Stoughton MA 02072 hone# 781- - ❑ I am a homeowner performing all work myself. 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'�A. -r.. yxam a to secure coverage as regrdred mtder Section 35A of MGL 152 csa lead to the imposition of O Sloal peJoaltin of a me. to derst.o0 and/or .one y�,imprisonment as rreIl as dvII penalties in of a STOP WORK ORDER and a IIae of S100.00 a day against me: Imttderstaad that a copy of this statement may be forwarded ffice of Inv ations of the DIA for coverage verification I da hereby certify under t pai»s and enalti o Perjury that the information provided above is Tr�uej an cair�e Date / / - Signature / /I Print nan Phone# , ofgcial.use o y do notwrite in this area to be completed by city or town oiBcial perndtllicense It ___(]Building Department city or town: ❑Licensing Board ❑selecimews Office ❑eheckif Immediate response is required ❑Health Department phone it; — Other contact person: Man (ccvised 9793 PJIa Information and Instructions . F, Massachusetts General Laws chapter152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the `lawl, an employee is defined as every person in the service of another under any contract of}ire, 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 siUL on and supplying company names,�address and phone numbers along with a certificate-of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and r 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'.compensations policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits maybe retame in_ 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 Once of Investlgations 600'Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 nhone#: (617) 727-4900 ext. 406, 409 or 375 . �i•� - TOWN OF I3ARNSTABLE BUILDING PERMIT APPLICATION � �v Ma)i- y Parcel _ Permit# Health Division }eta l� Date Issued M)6 Conservation Division o J, Application Fee 5 0. y Tax Collector Permit Fee Treasurer o Planning Dept. Date Definitive Plan Approved by Planning Board. istoric-OKH Preservation/Hyannis <<wProject Street Address Village (A-.#-\, M� Owner . �.M ��^ <<MS - Address �cAh(,.,,Si- . Cck b` Ma (1Z�' 1 Telephone Permit Requests�� - C1<ls� - Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1 a, 8'0 0 . 0 0 Construction Type Lot Size Grandfathered: ❑Yes O No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: O Yes ❑No On Old King's Highway: ❑Yes ❑No Bas-ement Type: O Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:exis�iag new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric O Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing O new size Pool:O existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:O existing O new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded O Commercial ❑Yes ❑No If yes,site plan review# Current Use Pr000sed Use Project Street Address6w (A'�Y� �T Village. MA— --- Owner w.M �A� ���5 �C- Address 7� �h��..�S�• C�l�,�� t^1�4 UZaZ Telephone SS a� ' o-0 Permit Request �� �1�� 5��c.- :S� CA`�G�c�MA� ^ k Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No Basement Type: ❑Full O Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use rr BUILDER INFORMATION Name � .� C l l-� Telephone Number (110 5\vi - S Cl 1 Address ��U Qa c .mac„ (), License# CS 0`�X 1`f 13-2- Home Improvement Contractor# Worker's Compensation# WU L 01-3 � ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO NI --- SIGNATURE DATE � r �(� C\ i � � � �� 1 - The Commonwealth ofMassachusetis Department of Industrial Accidents Office 0117yeslMgafial's - 600 Washington Street ,y Boston,Mass. 02111 Workers' Compensation.Insurance Affidavit nfo lea ifiI - name: (A- location: hone# c'ty all work myself. ' El I am a homeowner performing Eli I am a sole proprietor and have no one working in any capacity workers' compensation for my employees working on this job. _ an em foyer providing _ �am p " y- ��'--cyf .. -,er--it v:. a�,o- .,.:i!�•fr �.F- 3 i�•T 3}��.� �c r e - .rc S ,s.. ..: fC0 .r<^� .:::. - ;e„- tiSdr �- ,� +"'o2y.i. Fxs3s,,�� _< K" t �-}• r,. '± - P-4 •�-y-a;.'" ^-`..^.-roe.-i-taS f rG- .�.^�.� _ s ..a v^�.•. '1w Fo1�-;��f T..•Ll� .�' ift�. -4._ 4 ♦ ii'�isn +1L�..� � .,-+-�•a f y�� hones# :f tart . 1r Z"' rw I am a sole proprietor,general contractor,or homeowner(circle one) and have hired the contractors listed below who I have e following workers' compensation polices:_ .{cr. 4' = .��` „1,i^`c-F'rar�y'° �-r�{.a'• ""� `�3 '•3.- t-.,�,-a'��i+ c -w za ;-s ' "`V--•r'-'�^.'N r1-+'i l..fN wit z £ .1.�i '�.. �. f _ ^. WE y F` r^z '� �x Srti`j-'�`•��?.t`_+�,. ,�c �l •r r! -a�� �.r-+`1" q 4` "•y3• `�+y`G'8 !! MR N y � �.�+�� rV .?r �"•rq `-�- �e-�-.�r 7 T ,f."sYi^��.i .. a a �Y!:w � � z 'e-� "z � €'33�y, xi�r a.•�-;-e""' Per �' c�''�`�,•.��q�' ,a 1 YA 'c..,,,, _•'C:_ -a' "' �s�.lh#-.�,,g^�ai +Z sY t -" •z� lfs3-� .�rf -t'�•Trs "# _ �, -x „x�- r•.Lx -s� - - r��' '' r. - _ K ��..._..�s'a c ��c•��� L�_���y 4- _,rK� z�•.�'� }lOne'��'.��•'��`T s rX+r � y-,��Y-'�� _ � •A�i �i F•3s�.L -"C-�'�.�-�cu.;^.P�'.�.h�a'^"- 2,� '1 7 '.i J-.✓ �..s,{,- r �fiF��rc � . _ix.c `t no3-5� '� `16- •et`"„ c�s�+ `..RAN '�'Y � aj "'A +T+r SeI�.!".-y"LF�' ."L "'y�LS t^'4sT_`�f_.�� Jy.,y'?� e�- ¢ Y rS."`C.'`fc'•-- - _ a� .^. Y CSI-. .-. s�SN�� 2' _ � Ry�-'_x_ ]:.. ti-.�.- �...- 0.?�v3 �- om an rri'am . .� - - ,���`' �Y '�05Feiffi ��, s _�a ''.-ems.,`"tij,"' s �"€fi.-5"•y,.�'+' `, ��e +-�+v ems - ��- - --1r2 �"` Ibne ' �,Y z +fit L t a 4 s 1 �?3� z ��-"J} 'E. � v '.'�-c � n�z�•-^+.t_ r,..5"`�.,���`+"�yi r, '"��.yit�y;-�"`'�.�'�ti'-r +. .... .� �r y� c.•1 '+�..7z= .,x' , � �•.r a:-�c-��L, �a�, K c-r�Uc,�.�s.-� �!'r- 3v�t1.rM•t.. �.3� 'x'.r. �iri3urance>co�=r..=:� �_ ..-c.. - _ .�-. •- - . Failure tiD secure coverage as required under Scctioa 25A of MGL 152 can lead to the imposition o[criminal penalties of a fine np to S1,500.00 and/or that a one years'lmprtsoament ascellforwarded A d d two the��mof Investigations of the DIA four co a ge verificaSti°a.AO aday against me. I understand copy of this statement may b I do hereby c under thepains and p cities of perjury that the information provided above is(tr'ue and correct V. Date Signature 17-1 0/s oS ` . Lkb YIh�S Phone# Print name official use only'; =d°not write in this area to be completed by city or town official permitAicense# r]Building Department city or town• [-]Licensing Board []Selectmen's Office 0 check if immediate response is required QHealth Department phone#; (-10ther contact person• OP ID CS DATE(MM.mO/YYYYI ACORD_ CERTIFICATE OF LIABILITY INSURANCE STEEL-4 I 06 13 03 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION rRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Merritt McKenzie,Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 200 Galleria Suite 600 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 200 Galleria Parkway N.W. Atlan-ta GA 30339 NAIC#t Phone: 404-266-7160 Fax: 404-266-7199 INSURERS AFFORDING COVERAGE INSURED ------ wq�RER A ATTCOmp, Inc J�INSkj-PCP B AIG Steeltec, LLC C Steeltec Construction Mgmt LLC 210 Pauldingg LaneDallas GA 30132 RER E. COVERAGES THE POLICIES OF INSURANCE LISTED'�BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POUCY EFFECmE roucr E%PIRATION FOUCY NUMBER DATE DDIYY DATE FA�OD/YY LIMITS Ml LTR NSRD TYPE OF INSURANCE EACH OCCURRENCE $ GENERAL LIABILITY PREMISES(Ea acuence) S COMMERCIAL GENERAL UABq_R v MED EXP(Ary are person) f CLAIMS MADE ED OCCUR PERSONAL E ADY NNRY f GENERALAGGREGATE S PRODUCTS-COMPIOP AGG S GENL.AGGREGATE LIMIT APPLES PER PR6 El LOC POLICY J£CT AUTOMOBLLE L111BRJTY COM8NE0 SINL;IE LIMIT S (Ea attlOalp AN(AJTO BpOLY NNRY f ALL OWNED AUTOS (Per person) SCHEOULEO AUTOS BODILY[1AAtY S HIRED AUTOS (Per accofft) NON.DVAF_D AUTOS PROPERTY DAMAGE S (Per accwm) AUTO OILY-EA ACCIDENT S CARAGE LIABILITY EA ACC S OTHER THAN ANY AUTO - AUTO OILY. AGG S EACH OCCURRENCE f EXCESSNMBRELLA LIABILITY S `' AGGREGATE OCCUR ❑CLAMS MADE f S DEDUCTIBLE << S RETENTION S WC STATU- OIK g TORYLMTS ER WORKERS COMPENSATION Arm s 11000,00( A EMPLOYL:RS'UABIUTY WCV4131360 04/07/03 04/07/04 EL.EACHACCDENT ANY pROPRETOR/PARTNER.oECUnvE EL oGEASE-EA EMPLOYEE $ 1,000,00( OFFICERNIEMBT-'R OCUJMD7 ���crbe�� eL.olSFasE-POUCYl1.YT $ 1 000 00' SPECAL u w Deww OTHER B Pollution Llab Cp01958994 07/01/02 07/01/03 ea is/ag $ 2M .. Deduct $10 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CANCELLATION CERTIFICATE HOLDER RE�REN =TZ !! @AC F THE ABOVE OESCRIBEO PotutEs LN:CANCELED BEFORE TLl ,THE Lsu1aIG INs11RER wR.l EaroFwvoa T'O u11a CEM*XATE HOLDER NAMED To THE LEFT.BUT FAILURE TOReference Only UGATWN Oft LNBRlTY OF ANY KIND UPON THE LNSURER ITS VES.PRESE ©ACO ACORD 25(20011UU) BOARO OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR AJINumber: CS O48148 Expires: 10/18/2003 Tr.no: 16180 Restricted: 00 MICHAEL R DEUBEL 1446 ECHO MILL DR � POWDER SPRINGS, GA 30127 a� Administrator r� i ' ._3T,» .�:�-`;�: _ ��e � „�4"i' «� �• � CiFfyf�425..iT,. T�`� -_ ilpr COPYRIGHTED MATERIAL 7HESEPLANSARESUBJEC770FEOERALCOPYRIGHiLAWS ANYUSEOFSAMEWIYHOUTTHEEXPRESSW RI77EN PERMISSION OFSTEEL7EC,LLC.ISPROHIBITE D •FASCIASYS7EMPR07ECTE DUN OE RUSPATENTN 0.0 457,857 GEL 8120103 ISSUE DESCRIPTION DRAWNBY CHECKED BY DATE STEELTEC CONSTRUCTION MANAGEMENT, LLC 210 PAULDINGLANE,DALLAS,GEORGIA 30132 (770)-505-5917 SITE FOR TITLE HYANNIS JOB# DWG.# 2236 HYANNIS MA BLDG FRONT 2003-451 z� • , .a.,.... - "'� +tom'_ .. do t a ♦ SS . .�.. ..,;r. 4ar,•ti�,� .i .�C: ♦,� ��,.,, .. "'Cu r "'y •r*�.n `�: 49'}er., .�, ;+, .. v�• .iiR� a �"3.',_' „w, � _ ., . �• � � � d� p ..+, nF .M' n - :J - r a•w.g? nk' �: •`i� «. a'ar d'�l' S wjSA �' �' +a fir.+ "!�. .T*+.-±• 'f ._`'..C�.a .afi.•+ �."..;.#+ AAA— r ..ry r, s w x � � ` AI wayC� + yVq n... •x _ jr�� � y� . ' fir, , ^ - ..�. , � ,� :=t= =• .yam COPYRIGHTED MATERIAL , THESEPLANSARES UBJEC770FE DERALC OPYRIG H7LAWS i -rr�a y{R Cr. 1. ANYUSEOFSAM EWITH O U77 HE EXPR ES SWR17TEN PERMISSION OFS7E ELTEC,LLC.ISPROHI BI7ED 'FASCIASYS7EMPRO7ECTEDUN DERUSPA7ENTN0.D057,BS7 GEL 1 8120103 ISSUE DESCRIPTION DRAWNBY CHECKED BY IDATE STEELTEC CONSTRUCTION MANAGEMENT, LLC 210 PAULDINGLANE,DALLAS,GEORGIA 30132 (770)-505-5917 SITE FOR TITLE DEEP RIVER JOB# DWG.# 4565 DEEP RIVER CT BLDG LEFT 2003-449 r ' COMMERCIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $100.00 Alterations/Renovations $50.00 S O. O 0 Building Permit Amendment $50.00 FEE VALUE WORKSHEET NEW BUILDINGS square feet x$140.00/sq.foot= x.0061= ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet X$96/sq.foot= ��� S-00 ' °© X.0061= 6.^ Commprojcost - STEELTEC, LLC LETTER OF TRANSMITTAL 210 Paulding Lane Dallas, Georgia 30132 DATE: AUGUST25,2003 �JOBNO. CF#2326 Phone: (770)505-5917 Fax: (770)445-4789 ATTENTION: BLDG.DIVISION 508-862-4038 RE:395 WEST MAIN STREET TO: TOWN OF BARNSTABLE 200 MAIN STREET t. HYANNIS,MA 02601 WE ARE SENDING THE FOLLOWING ITEMS: []PLANS []PRINTS []SAMPLES ATTACHED VIA UNDER SEPARATE COVER VIA COPIES DATE NO. DESCRIPTION 1 BUILDING PERMIT APPLICATION 1 BUILDING PERMIT APPLICATION FEE 1 WORKER'S COMPENSATION INSURANCE AFFIDAVIT 1 WORKER'S COMPENSATION INSURANCE CERTIFICATE 1 CONSTRUCTION SUPERVISOR LICENSE 1 SET PHOTO LAY-OUT 1 FASCIA SECTION DETAIL THESE ARE TRANSMITTED AS CHECKED BELOW: ®FOR APPROVAL []FOR YOUR USE DAPPROVED AS SUBMITTED []AS REQUESTED []FOR BIDS DUE ,1999 APPROVED AS NOTED []FOR REVIEW&COMMENT []PRINTS RETURNED AFTER LOAN TO US RETURNED FOR CORRECTIONS El REMARKS SIGNED: MAI IF ENCLOSURES ARE NOT AS NOTED,PLEASE NOTIFY US AT ONCE The Commonwealth of Massachusetts :..T 1~. -- - = Department of Industrial Accidents Office ofinrestigaffons . - T" 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit name location city _//�i�AJiQ' �� phone# 45; ❑ I am a homeowner performing all work myself. ❑ I am a Sole r rietor and have no one workin in an apacity l ❑ I am an employer providing workers' compensation for my employees working,on this job.,.. . tompanv name <: - - atldf city phone. :::.;::: oli d enSifiri e.co. ....:. ❑ I am a sole proprietor general contractor r homeowner(circle one)and have hired.the contractors listed below who have the following workers'compensation polices: Xx camnanv s n ine^ ' .::..:::::::::.:::::::..........:.:.::::::::.. address:::::;:: :. ..... ......::•...:::::::::::.;:. ..................... .::; :: tip � opt~'# > > < > > >>> >i<>s:>::> <:>>:`:<>? ::>: >`>>``>«€»< ....::.:..:::: ::.::>..... .;:.;.::.::::.: c an n m ;. address ;:. h ................. nsurauce.tMix..::::::..;:«. _.:.::.::.:.._ . :,._ Faihrre to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal.penalties of a fine up to$1,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I understand that a copy of this statement may be forwarded to the Offlee of Investigations of the DIA for coverage verification I do hereby certilk under the pains penalties of perjury that the information provided above is true rued correct Signature Date Print name 49(,�2 Phone# 0000 official use only do not write in this area to be completed by city or town official city or town: permit/lieense# ❑Building Department ❑Licensing Board X. and ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other &Yiscd 9/95.PJA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the"law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a . dwelling house having not more than three apartments and who resides therein, or the'occupant of flie'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 acceptable table evidence of compliance with the insurance coverage required. Additionally,neither the P P 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 and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents,: Should you have any.questions regarding the"law"or if you are required to obtain'a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of itie affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may b.d retuioneil 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 Me 01 Inllesduatlons 600 Washington Street Boston, Ma. 02111 faa#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 ✓lze �amwmaru�reai o�✓�aaaac�ucaetta BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR ,I Number ,CS;; 066428 i Expired U5/,09/2003 Tr.no: 9399 Restricted Ta DAVID"E AUDETI E 401 KING RDA_ / TIVERTON, RI 02878 Administrator r r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION s � t Map 26� Parcel oF Permit# Health Division � u✓� ` ,mac BARTr��I.E Date IssuedA_40_�2 Conservation Division 5- MZ- 06- PM 2' 54 Application Fee Tax Collector GA`MMOIR 'ASEWER Permit Fee CONNECTION PERMIT FROM TIiT��, ©mil 1 �� ENGINEERING M c�-. VV Treasurer ULM,0*1 1'10� P� Planning Dept. Date Definitive Plan Approved by Planning Board 1`" Historic-OKH Preservation/Hyannis Project St reet Address i v o 04 Village OwnerrX61��2.�A 1J �A(Lmc Twc Address 717 >eAwv, St, Lww 0 % M4 Telephone Permit Request a45 Cww6p j Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuati n ,O Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Cl No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded Q Commercial O Yes ❑No If yes,site plan review# �� SP� EL_ �� tw`Zl 'CurrentUse . sq -� �' -- __ Proposed Use s 4 me (06614--o Sians ui�i" T BUILDER INFORMATIO Lg01 Ll8-(o C) IL/ Name UAOA e `tZC7Y''��e,'Z��►�� 412_ Telephone Number 9C_b-5;?1J-( -P1 6�. V33 / Address , A AIXe W_S Avg License# h 6 G 4 8 '�2bU)de w Ge_ ) 1ZZ 629 01_ Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE C! FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED } - MAP/PARCEL NO. ADDRESS - VILLAGE OWNER DATE OF INSPECTION: , FOUNDATION 7 'I FRAME INSULATION - FIREPLACE ELECTRICAL: ROUGH 1,.,FINAL PLUMBING: ROUGH FINAL _ GAS: ROUGH -' FINAL r} FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. f. QUERY PERMITS : QUERY END QUERY PERMITS PENTAMATION---------------------------------------------------------- _- 02/10/03 PERMIT NUMBER 66523 PARCEL ID 269 116 395 WEST MAIN STREET PERMIT TYPE BSIGN SIGN PERMIT DESCRIPTION 26X120 = 20 SQ FT SIGN FOR SASSY NAILS { CONTRACTOR PERMIT FEE 25 . 00 VARIANCE STATUS A ACTIVE CONSTRUCTION TYPE 753 GROUP TYPE 1 APPLICATION O1/22/2003 EXPIRATION VALUATION 0 . 00 DATE ISSUED O1/22/2003 COMPLETED DEPARTMENT-----STATUS---DATE-----DEPARTMENT-----STATUS---DATE---- (N) EXT/ (P) REVIOUS/ (C) ONTRACTORS/ PR(0) PERTY/ (I)NSPECTIONS/ (H) ISTORY/ (F) EES/ (A) RCHITECTS/ (V) IOLATION/ (E)XIT f w west gain S tru t Rou te 28 SuomiRoad 94DEX OF Hy am 990 QBAWM BY [-WG A10. t3TK1 Q AM Store# . MMAM BY MALTLAND FARMS . PROPOSED SITE PLAN il�rc - R Db-02-02 a i. LS1 H�llSTR1ES Gas S ta ton 852,142 _ FARMS W. CANOPY ELEVATION i - LIt iT#Att; SAL 04-25-02 R 04-23-M STE-7EC, LLC -{ _ FRAMM PLAN & UVATIONS (sht E1 of 13-R.04-22-02 FRAMM PLAN & ELEVATIONS Wt F1 of-1-R 04-23-02 V,Fw—R uu T' US-,E D . May 2-7t .. 2A P RV 0 fy APT FOR' C a.S RUC T A N K D E T. A I L S - FROFM 2r x 9'CMIXTE PAD . - PPOUM 3.DSACTM TDBE W/ZY+�22 VALVE ASS-aPW 28-W W/&ikl8:I1taAT 01BffLL Ple* LiM _ VALVE MV SUM 0 VAPDR'I�CDVEfM 40 9 .. ., C FU liM W/CPW 81•T4' o O P AM W/VAM SFX."11"4.MIT FLL CO N) . FRMW MI GMTA'M W ktkW%L tom. F1F08E0 SL60664LE KKK W/LW DETECTOR - FEWASET-Li IpR38PaM8i 4T1 4FJWiLLIAtri A. R t D sasFaeu Mf.Ws BY ErWIN l� -now"lDe�DDq�autoN Iry x m'-w�.(smErn _ ,ui.ahSpCtS s,um r/U7C6. MOM reaAN, earra°FA T"IS 11'-0`IEU i - tAT TD SCALE . 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Ir $ b b b f bA ggg, w, , T b W b 6' Pa b* b 91 s y b b 91 b b b b b b F- FIj b b b b b b b o b b b b b b g' b b 6 g". b b bbb b b� } p1 b b b bs pa b b b pv be b ba bas 91b b p* b b 9 1 91 b, b b p1 b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b b. b -4 / ob , b Pb 91 91 y 91 bb b b / b bb b b b 91 b bb 91 bio' C o 91 91 91 91 b 91 91 o 91 91 o b oi b b b b 91 b b bb 9' -bb' b! b b bI bbbb 91 91. bb b b b > b bbb b. g. g. b g, g. b 9e o' bi b y b b b 91 b e1 b 91 b 9 1b bn > b b av b b b1 b, b b dr b bi b t y S ip PAOD h .O Rif b, o" � y y p b b e . _ - - .- • ' - .. .. -, ., 1 % T. ,a l BUILDING I I FFT - - i �, a - i V dl1 McTDNERD-�IV!•TB(e lw:,0fiA GAL,ICCNT.At TOP) ! _ •lI•Dn aWAT•m m DTRmO[ - _ . W.EAO NOTED OTNERNDE. r ll0¢t14 DAI.V,"M BRAclf Ml BRACE GR095E3EAM AT S LOCATE AT EACH P Ihl AND PAIbM I¢ OIITR✓DOl(2)CENTER PURLIN9 _ ' TO HEADT R, ' WITH FULL DEPTH --------- ----- _--------- ------------------- 6TIFFENER _________ _____ _ ____________ __ _ __ __ a § yI•�• ! - .B.er i a e.re ar._..v.fMROf6R HRfuD m.e Q \aFO•1'.8"ocfrTnx/ t - D 1` D D D D A PA A 11)4.1VI• 1 . TEC a Tm1e t m •IA.ve•LAP 1 - MULLION TEKD a rK I , _ xv OUTRIOOeR i Y — r Teo D•oa I ne•-e• Nv A• !4 • - e•-o• - la•-r• ll,� 2V-0- O.m• _ 1 SECTION ! FRAMING PLAN rw B El . 18)Ober COLODDAL by ow]�Mz 1 I D'•Pve Oe,Newe ekayaro 7 - - hI hI I"1 eT SMELTeC IIII III I - - IIII HIDN rN1w OP wive i " r—V--1 r—u—•T r—''J-1 1' � r—V-1 _ - FRONT ELEVATION CATsoK AND EF=TlO or,T T,,RAL 6MEL W CONFORTT TO rNe LAM5T Alx - IDNe,oeelal.PABRICATN AND SRECTM O COLD P D DTIEL WCTI DMALL C.OISOFr'+TO - Nel ePe—ATI & C REAM CROD&BEA`I GR? M CROeDBeAM #•we 8TfiR1Epe - MATERIf�e, E eeOTNRd.aem aD»aRADe em ny.&m KDU - - " A FOR PERMITS LRf- 1 4/22/02 NANQLD.ADm ADD(1�I as KeN .. tWiAL 62.TIOND fTUBEI•aem Ae *RAM D ITy•AD lr&11 •m Aae rry.ye Neu - .. g ISSUE DESCRIPTION I BY 1 tHK. GATE . Ef0.t8 A ssin9 40 fly.10 KDI;OALVAWSID f060)yrtH BIXCD @IMBL ID110N NI6N �•A-ale DOLTD A10 N!1'D .. I•a-9tD pppLLTn 0.`0 NIrO �•.e•.811•BPI.KE PLATE 18•AD]Tbb aye(Py.M NDU 1I PER CGNiECT1CTU fA Pea cwcTNEO PIy1LN pUIyD1 REVIs10Ns: _ OP&TialCl�•AL DTEDL tNALL 0C IN ACCORDY OW LATEDT ANDI I ALB DU fWT ff O TeA LaW2HNCE R PILON,F@ DIMAPLEVIETY bRWE STEELTE.C, LLC -- P etmLLVILLB,NY BBa D 6RALLTED ee BOLTED CDALL USE D D1EDe�CPWLTS.D DN S 8A 1.. ' L1CeNDe• ` IVRAL BOLTED CON•@cilplD BNALL USE ABm AalS BOLTS.BOLTS DNALL BE TIGHTENED BT iHe NIT METNOD Ae PUL T fPER Alx DPecETCAnGNDA II A eHALL DE BRnnwr TO A eNu tIGHTNEDD,wsDreD AD TTIE TIGHntE&e ATTaNED By THE RLL y,.TOP PLATE II• 210 PAULDING LANE " a MAN IlalN6 AN DIyDNART MID hi 8E T/ TD N tH CLNyeeTNTT BIaLL THEN BE TKIITENED ADDRIONLLLT 6T A IIJT OR BOLT QJ1aTKN PVFLN ' - D!ND ROTATlp1 OF iN8 PART NOT TUFwED BT THE WyENGUOr Tkle FOLLOWNQn C0.Vf,1 - M UP TO AND N=DNG I DIAMETERS•ID TURN N O�R I AND LBDD TMAH D DIN• MT •N NRN ;•A-D1D EOLTD ANb RTTe - DAL1,AS;GEORGIA 30132 (770)-505-5917 STEEL SHALL BE DROP=AMD WTN A RED-ONIDE RUST NH 5B PRIMER FIELD TOUCHUP fa PER CON•8!cTION/ ' ,AND MANTENANCE SHALL 58 THE REWP FBLITT 6 THE O (WLEeS OTHE W �� - -' . OADD&HALL MEET fAe A M ilM ?ALL LOCAL W1LDND CODE RSWIMP I)IM, I Y G 9 AM O I G I LL1LS r' CROSSBEAM TO COLUMN CONNECT ON �TYP BAR SPL GE CONK TION - DAD. amreP ° D CU IDES RLAt M D FROAD ARMS STORE 02142 eknyl WAD Dim LOAD 'Oao1°i•DP Hl'ANN I S, MA THESE PLANS ARE SUBJECT TO " D FOR: CUMB.FARM .JOB N0. lOr&r - nPH yevo ePeeD 1AeGE T.ea•¢1fPOBUFE•c•I - •FEDERAL COPYRIGHT lA155• I reRnla.Tre-DPNW _ ! EXPRESS WRITTEN PERMISSION F ANY USE VF SAME WITH=THE - TylAIQ-L .51-0° X 92'-O°. 2P0ta(.o6 �I l FRAMINCs PLAN To 1D P'LP?PER OEeVJO - - _ DELEVATIONS El OF I- GTZ L-eW W STEELTEC•U.C.TLC.M PROHIBITED - _ - . BUILDING EXISTING a .MI FOOT S 17, L Tj L ..I t t - V i rT � f T -1 rT 'I rT1 L EXISTING ANCHOR BOLTS AND FOOTERS TO BE USED. SINCE FOOTINGS AND ANCHOR BOLTS WILL NOT BE FULLY EXPOSED, NEITHER STEELTEC, LLC NOR LAWRENCE R. PILON, PE ASSUMES LIABILITY FOR THE STRUCTURAL INITEGRITY OF THE EXISTING ANCHOR BOLTS OR FOOTINGS. II 0. T3 b• 41-0• - - zg'-b• Q•-o• • OWNER SHALL BE RESPONSIBLE FOR - - VERIFYING STRUCTURAL ADEQUACY OF EXISTING ANCHOR BOLTS AND-FOOTINGS TO SUPPORT NEW CANOPY STRUCTURE. NOTE: NEW STRUCTURE AND FASCIA WILL BE FouNDArioN PLAN SAME SIZE AS EXISTING STRUCTURE. '"*'.''0° THEREFORE, THERE SHOULD BE NO 6.6• SIGNIFICANT INCREASE IN LOADS ON EXISTING j ANCHOR BOLTS OR FOOTINGS. AB.PLAN (4 BOLTS) . • II'SQUARE BOLT PATTERN D°o PvC DOUNSPOUf!INSIDE SHROUD) (EXISTN4 I-V4'DIAMETER) BY STEELTEC SHROUD NOT SWMN FOR CLARITY _ .. MP.R DRIB - . OPTIONAL —— — ISLAND C-AN4PY _ _ ELEV.�0'-0• TOPS OF ALL FnlJTPKaB - FM.DRIVE .THIS SAME ELEV. _ ROUGH GRADE _ i 8•PROD_ — A FOR PERMITS LRP 4/23102 EXISTING FOOTING'EURr .. ISSUE DESCRIPTION - .BY CHIC. DATE DIMENSION TO BE FRONDED - _ I )•GROUT(BY.GOJ REV610N5: PRIOR TO CANOPY FABRICATION lq z - - - LAUIRECE N R.PILON,PE - SF'EPBVEILVLLW° 5= STEELTEC LLC LICENSE• ' - I 210 PAULDING LANE ir DALLAS,GEORGIA 30132 (770)-50575917 EXISTR•Yn UNDISTURBED SOIL - - . (SEE NOTE Q) - SQARE SITE:CUMSERLAND FARMS STORE 02142 389 WEST MAIN ROAD HYANNIS,MA FOOTING DETAIL F THESE PIANs aRE SUBJECT ro u FDR: CUMB.FARM JOB NO. . NO SCALE-(8)FOOTMGS REQUIRED . a'' 10a I n_ '_ a - FEDERAL coarwart uws. ,- BI 0 x 92 0 02CPD066 ANY USE OF SAME WITHOUT THE F.oNAL c EXPRESS WRITTEN PERMISSION OF �) p TITLE:.FOUNDATION PLAN M'•No' . STEELTEC,U.C.IS PROHIBITED -� AND ELEVATIONS FI OF l oAP m it g fE ��Y ' Will, ORR .1E r-- i N Sx - e W-lr T-V 4 � Ci U O ._ W-W T-W febstlnp MdiD of all tM N . - .1 CATOX PAD SNGTNNG Sro•OSB WITH.TAR 2•e8'RAi7ERS O 16.O.C.WITH . �^ .3.5•KRAFT FACED(R 11) - w PAPER YEAR HALT S OIGLES - .. : CARBON '2•s6••RAFTERS O 16•"O.C.1KTN s .� .. • y _ "-NSIMTON EL - 3.5 KRAFT FACED(R-11) - ) WASULAT10N .. Yee•STUDS 16'O.C. , vE 11E1G1tT 0' 3.5'KKK AFT EAVE tEt(Jrt 10' 0- ... BLOW -R tt NSUTA7IDN ° "RITERIOM 51EAlItaK' PACKAGE 1�•�. -. " . KQERIOR SIEA _ _ �•" - __ EXTERIOR SMEATIMO EXTERIOR SNEA»maG - - - - ., .. - .23.5 KRlF7 FACEOO.C.. - (R-11)N4AATION . 2N'PRESSURE-TREATED SILL PLATES LAGGED TO CONCRETE FLOOR DOUBLE DOORS "6'.CONCRETE FLOOR SLAB RATED" " .. .. _ - 3.000 PSI 1KTN /4 REBAR.O-12.0. I '�10'-0•. j _ .. ` - NC1 6•COMPACTED 0-0' . .. '.OUTSIDE rRAl" .. SUBGRADE FLOOR PLAN WALL SECTION ..: WALL SECTION. - a No. Re.iim- Dole . .. - Otr - umber�end Forms 777 DeMom"Street - ContoR. Massachusetts ELECTA x. CAWO (6 en i DOM ooa. 412 CFI # 2. • 395.West .Main St. fH onnis. Mossochusetts OWL= �e ' Remediotion Shed rlo-o � a'-D'�. Design o-� SOUTH'ELEVATION EAST ELEVATION WEST ELEVATION � D.ESPr oAtAXGrTeT RAMONALENCH ayo re 0 NSR t�s E I �© MNGEO 2 SHALL BE iNREE FEET rnDE "93'Stott Rd. eT EttaGN. tttu BE OF 2 tNCN BT Sogomore Btoch, AAossocnu tts _ A 1NCN TRIDER CONSTRUCTKfN.ArID mu BE 51EATNEO (508) 888 3900 0 1KTN Sro-IJCN TEXrtIRE T-,-1 f PLTR00p. NS�LT ON.AMID T1E M T TeE p0ort5 ". SHEET ROCK�L BE RE M11i EXISTING 012 x I"TOPSEAL TEKS TOP CAP SPACING 21" X 2" X 20 GA. CONT. + 110 x f" TEKS ANGLE STD. BA a 4'-0" SPACING 2" X 2" X 18 GA. V EXISTING SHINGLES (2 PER LOCATION) ANGLE TO BE REMOVED AT IS GA. TRIM �22x ©TO PACING SEAL EKS AREA OF NEW SUPPORTS TOP TRIM _ _ \ \ & BRACKET >=LASHING= "8 X 2" PAN HEAD TEKS a2'-ro SPACING MAX. -- MT32 CROWN 1114 x g" LAPTEKS EXISTING STORE MOULDING / a 2'-0 SPACING ; STRUCTURE L/ MF-f EXISTING PLYWOOD \ 2" X2" XISGA. ANGLE \ 2" X 2" XIS GA. ANGLE FIELD \ FABRICATE — — OUTRIGGERS a 2'-8" O.G. I" SUBGIRT SG I \ FASCIA CLIPS EXISTING STORE REQ,D. FOR 60" \ STRUCTURE OR HIGHER IS GA. COVERUP FASCIA W/ 3" BLUE DECAL ABOVE / ro" ORANGE DECAL 2" X 2" X IS GA. / "8 X 2" PAN HEAD TEKS ANGLE — a2'-& SPACING MAX. — — — IS GA. BRACKET / EXISTING f=,4eG I ,4 SEC,1 I ON - XMT34 IS GA. BASE MOULDING E 1 #10 x 2""TEKS 1110 x I" TEKS a 2'-0" SPACING SSLE OE96IIPDDN RY CW. DATE a 4'-0" SPACING REV5gN5: (2 PER LOCATION) S8 X 21,, PAN HEAD TEKS STEELTEC, LLC STEEL POP RIVETS a2'-6 SPACING MAX. 30" O.G. MAX. •omnxber of the (TOUCH UP) IMAGE RESOURCE GROUP Z0 PAULDlKG LANE T�T'F. NEW FA&GIA SECTION DAIS64,GEORGIA 3013E(/70}505-5917 E 1 9r w. n►Q:,� THESE PIPNS ARE SUBJECT TO FOR JOB NO •FEDERAL COPYRIGHT LAWS• �� ANY USE OF SAME WITHWT THE OPASCUSYSTEM PR07VCTIM E%PRESS WRITTEN PEWSSION OF 'E EXISTING BLJI DING ' UNDER US PA'IWIT NO.D457,S57 STEELTEC.LLC.IS PROHIS ED E I OF 1 WITH MANSARD ti i 4z - FILENAME LEGEND: Uj ' ...... ... Approximate Property Line Storm Sewer line Water Line Cori E. Mueler Wayne Zerris: Natural Gas Line i Residential Vacant ® Cotchb6sin Proposed SVE Well Shod 65 l . RESIDENCE Shady Utility Pole wj proposed AS Well 22 Suomi Rd. (80.01) 9 & Monitoring Well _y Se Figures 4 through 7 for it Sporge Well e h A (AS)177 E ipment, Electrical and Shed Details ' 0 .Soil Vapor Extraction:Well.(SVE) Thoedore Hyoro • Soil Boring, ® ECS .Soil Boring_' Residential CUMBERLAND _ (80.31) Groundwater,£levotion See Figure 2 for Well DetailsVACANT VACANT 9 .. 18-20 Suomi Rd. a: REGIONAL WEST MAIN Groundwater, FARMS Flow Direction � \Infe�,ecl 1 OF ii FICE , AUTO ra General Notes- a Site pion prepared from a Town of .Hyannis Assessors Mop, Site Pion by ECS, n R. and Site Reconnossoince by ENS See Figure 3 for Trench Details �. All locations, dimensions,` and property lines .. P P Y depicted on this pion are approximate. This a DD pion should,not be"used for construction or land.conveyance purposes c� ,-5 Horizontal, and vertical .locations of wells, and l✓ Cornelius Hickey CB n USTS selected site .features determined through . measurements mode b re resentatives of ENSR. l Commercial f AS-1 MW-3 V I NT - O MP � 8 (80.31) .. ) CLE ..-- 80.32 80�8 :. /' ( ) CANOPY MM-2 . CumberY<Dnd Farms L 1 1 379 W. Main St. + MW-7 ® k 777 Dedham Street lCB ---- — - -- Canton, Massachusetts . 1 SVE-1 .3 Alfred and Leoh Zerris I PUMP I T TITLE ,_ € I PROJECT P F PUMP f { FOOD I 405 WEST MAIN- CFI. # 4 STORE I AUTO 1 395 West Main Street C (80. ) 1(�44) f ISLANDS ISLANDS s �, . . Hyannis, Massachusetts (, ` J FIGURE TITLE / (80.64)i sign _ _1 SVE stem AS ' Sy De J ^ice APPROVED BY REVIEWED RY. _ CGM' DTM P, DRAWN SfAI f. Jv RPM 1,_40, v WEST MAIN , . Route 28 STREET J06 NUMBER I 2140-251 12/9/02 Richard Griffin Number Capacity Tank Tank Installation Removal Pork Place Fish and Lobster ENS R Ions Construction Contents Dote Date COUNTRY R 95 . S t d t e Street 1 5.000 N/A Gasoline N/A 11/82 Condos John F. Cordorelli Trust GORDEN NURSERY SagOt710fe,. MassOchusetts f -2,OOD N/A Gasoline N/A 11/82 _ 398 West Main Street, 406.. West 'Main Street (.508) $.$8-3900 1 2.000 N/A Diesel -N/A 11/82 •, . Notes: o %",• 1 8.000 Fiberglass Gosolne 12/82 M Use 1. All locations and dimensions of site and near vicinity FIGURE features ore approximate only. 1 8,000 fiberglass Diesel 12/82 In Use 2. All wells were surveyed by GTI p p Q Notes: 3. Groundwater contours are interpolated between data points 0 40 60 80 SHEET. This information was compiled based on available and interred in other areas 0 Nondex of N.E Inc. records and local records. 4. Figure dernved from "Site Information c Mo 8 Groundwater N/A.a Mlornglion was not ovoibbla Technology. Inc. Norwood, Mo. October 5.pi992 Scale In feet EETt �� SH � y 0 -c► - � ..a 8 z Z - COASTAL engineering - co , wET M NO[ra�Y WW Orkar■.MA 02653 A 1 N S E E T 508.255.65'11 P" F 508.255.6700 Suo mi I as A OCUS ASSESSORS M P269 PARCEL 196 ASSESSORS MAP 269 PARCEL 102 _ BARNS » TABLE MA STONE: FENCE ENCLOSURE LINE OF CONCRETE BLOCK CONCRE TE S 70.04 20 E EAVES RETAINING WALL PAD AREA WiC 02 TANK F135.40' CANOPY HEDGE - KEY MA P , RIP RAP EDGE OF PAVEMENT ' I N0 SCALE • • • • ...i X 4 LAW N ` o .. 1 1 AREA :PLAN REFERENCES. _ 1 F REN CES. CONCRETE PAD .. .o � FENCE 1 I ELECTRIC ROOF . I I ASSESSORS ENa SSESSOR MAP 269 OSURE u PARCEL TANSFORME R DRAIN MPSTERS L 116 z ( TYP. v O � _ w LAND COURT.PLAN 11328 B / 1 28 1 » GA GA I TE 1 N 19.55 40 E ASSESSORS MAP 269 39.3 �•, i LAWN cRETE r APRON 50 1 _ ZONING DISTRICT. PARCEL 101 EXr is HB S AREA TI N i G 38.5 2 EMPL OV ERLAY DIST RICT: WP (W ELLHEAD WELLH AD PROTECTION) LD N G TION ►7 - - .PAR KI �E N SP' S 9 At2_$ 1 55 40 W TIMBER 1 CONVENIENCE STORE RETAINING N 50 , 1 I �Cn SE CONNECTIONS SEWER E TIONS 0 AS SHOWN ARE'TAKE CU MBERLANO FARMS . 4 ® vs N d WALL - FROM SEWER E INFORMATION TI IN� ) PROVID D BY 1 . E 4 415f S:F. I 1 . 1 THE TOWN OF' A NS B R TABLE DEPARTMENT � I rvEDGE 0 OF >. F PAVEMENT I < I (I a • a PUBLIC WORK S, DATED 2 I 3 I 10 1 16 v 1 I • us i _ • - - - - SURFACE MA NHOLE NH COVERS AND M A O ; OLE RIMS RE 8 . �, .:.SHOWN ASBUILT: UNDERGROUND v . I U RGROUN STRUCTURE FINISH D Fi00 SHOWN IN R 'f+�. WN DASHED LINE RE •8 S A FROM: I II .�7 EL.=39.5t ': CONSTRUCTION TI ES S AND ARE ,: r E FOR STRUCTURE 1 RE FERENCE ONLY. a _ t I. 315 5 EIfE ALK CR W G , r--L 1 I 1:. 38.5 I I 3 39.5 d _ 38.9n 38 I 1 7�38. 4 . r -I x _ ® . FLOOD NO TE. - _ EXISTING 1 u► DscAPE i 1_ J EX S11N BUILDING I ND i EGU LA i d ® FLOOD ZONE C AS SHOWN ON FE MA FIRM 9 m v N o � `PANEL 25000 1 0008 D REVISED EVI DULY 2 9 1 92 I TYP. _ • x . z .9/ L s I 36.8 X -AREA EaL 37:D I I 7 � z 3 .1 X 38.2 _ _- .1 _ DATUM 0 , x . i r 26 77 S.F.S F.- C�1 ETE PAD. i ( BITUMINOUS / w �I I T7 I _ t os ` c. i l 1A PR IUM CONCRETE ) I» \ ( ELEVATI ONS SHOWN 1 : II HEREON ARE BASED S 19 55 40 W 3s.2 I I ASSESSOR MAP 269 AVEMENT I- +-I X S ON THE NORTH AMER C iz i A VERTICAL N X I N N CAL U D GROU D 110.Q0 UNDERGROUND PARCEL 100 r l l I - .` -Is,, 1 • DATUM 1988 NA CANOPY VD 1988 EL LINES_ FUEL I _. _•_ TYP. / _ t _ I I 36.6 I II ASSESSORS A r X 38.2 X SSE MAP 269 I , / 37.5 `PARCEL 117 d / I t! I L a • I; I . I I FULL i ► I DISPENSER' _ s I 1 0 _ . r s. • X 37.5 3a� X .3 1 I ( ► i d X 1---1 - � 1 37s N 19 55 40 E d I ► d J 1 17 t - 7747 150.00 .1 v I I : CONCRETE PAD . I LEGEND _ I I v _ a 37.7 1 3s.2 _ I ► I ■ ► BOUND I ► 1 1 1 _ - .5 - -IL J - � C I X 37.8 n I ► 1 ® CATCH BASIN W I a l #� 4 - - 1 D d _ _ RAIN M 1 _ _ \ ® ® ANHO LE sv � _ I 1 SCA ,I LAND PE -- -� S JJ _ __ SEWER MANHO LE ISLAND _ 3 SPACES _- ---- M _ TYP. _- __ 38.6 � 38 EDGE of CLEAN OUT 38.6 i LAWN TYP. WN FUEL EA � •. BEN ® VENT r BENCHMARK: �• 7�38.3 I. BITUMINOUS R 40.00 36. aY- TOP.OF CON BOUi�en CONCRETE v \� CONCRETE _ .-. CUMBER NO MANHOLE CU : / / ELEV. 40.20 (NA VD-: PAVEMENT w es . < 9 FARMS SIGN 3 CONC ETE WALK MONITORING d R WELL v X ol�rW v a OH w oriW �yA. DE CT TE ABLE E CONCR TE WALK v WARNING P STORMWA R A AQ. 0o TE VALVE VGC 95.40 _ __ V'GC i TYP. EP ❑ ELECTRIC NE s s s s s s PANEL s ` ,; s s s s MM ELECTRIC METER TR S PUL L BOX WEST .MAIN MEET: W 5 IMDE PUBLIC WAY. ® GAS METER UGHTPOST MISC. SIGN v� ASSESSORS MAP 269' ASSESSORS MAP 269 _ P AR 052 PARCEL 1 O POST PARCEL EL 05 - T1UTY-0- POLE E~ -� GUY WIRE` o ` 3 MISC..TREE �, ra i _ M i �o l,A . o -.� SC N �. ALE CHAIN LINK FENCE N NE A NOTED S NO D DRAWING FILE STOCKADE FENCE WIN. 1 8 1-A -B C 7 7 S UII.,T.dw g DATE _ PICKET , C ET FENCE I _ 12 16 16 - DRAWN BY HEREBY oHw E CERTIFY..THAT THE CONDITION S OVERHEAD UTILITY ac .......PLAN D UTY LINE. 1 0 SH WN HEREON ARE LOCA TED AS THE Y WAT ER.LINE Cr•� B EXISTED ON THE GROUND AS OF 2 CKED Y 0 6 0 1 7 16. 20 10 0 2 I , 38 _ CONTOUR �o l 2 � l L T R � e DATE .•� QQ N Y x37.8 SP OT T GRADE h h s A 1-inch 20 ft.'. P.L. VERTICAL GRANT CUR B RB •eq. h JOH N I sJ 0 C� M c E:L WE :ABoi ` eu N 3 -. 3 6 02 0 O 9 SS N y �q O S E fYi V UR • `W 1 1. OF .SHEETS FR O N,rEcr o. C17871 00 i i I 3 I (EXISTING) 105'-11" EXISTING 2.0"X6'_0 EXISTING 2'-0"X6'-0" FUTURE TENANT 2'-0"X6'-0" INTERNALLY ILLUMINATED BELT SIGN INTERNALLY ILLUMINATED BELT SIGN INTERNALLY ILLUMINATED BELT SIGN (12 SO. FT.) (12 SO. FT.) (12 SQ. FT.) SASSY NAILS G' riJR eoant-aeee X w 1. - - ' EXISTINGFRONT ELEVATION SIGN CHART- EXISTING BUILDING SI GNAGS CUMBERLAND FARMS - 2 X6 =12 SO-FT - A X TENANT. .SASSY NAILS 2 6 12 SQ.FT . PROPOSEDBUILDINGG p S I NAGE _ -TENANT- FUTURE SIGN 2'X6' ,= 12 SQ.FT _ TOTAL 36 SQ.FT 369 West Main Street-Route- REVISIONS V# 0990 a eet Route 28 <P--, Suomi Road DATE REV. BY: 0MCRIPTION 26.735 sq.ft YANNIS MASSACHUSETTS ; SCALE; 1/4' = T-00 .61 ACRES DATE. Sept. 14, 2006 r_ FILE: V0900:0/master.dr> STORE # 2326 ` +C ► ? DRAWN BY: TRG GAS STATION# 852142 777 Dedham Street Canton, Massachusetts 02021 CHECKED BY: 1596-1421 FRONT ELEVAT 10N i i i �. EXISTING 3'-O"X5'-O" INTERNALLY Vl fi C�C�nO{ ILLUMINATED SIGN , „ 15 SO. FT. r iln EXISTING T-0"X5'-0" INTERNALLY ILLUMINATED SIGN (TO BE REFACED) 1 15 SO. FT. trtY tt- '?4< i t • ' a 22.5 S0. FT. TOTAL 75 $O FT ti r PROPOSED 1'-6"X5'-0" INTERNALLY ILLUMINATED r CUMBERLAND FARMS SIGN. i «0 1 �p GRADE GRADE . I EXISTING- PROPOS, D- I - , SCALE* 112" = 1'-0" SCALE 1/2„ _ 1,-011 REVISIONS V# 990 359 west Main Street - Route 28 G Suomi Road DATE REV. BY. DESCRIPTION HYANNIS MASSACHUSETTS { SCALE: as noted �® DATE: Sept. 14,2006 FILE: colonlal.db/master.dr` DRAWN BY: TRG 777 Dedham Street Canton. Massachusetts 02021 CHECKED BY* existing/proposed, sign , r Project Title 1 3 3.2 4 4. 1 5.3 7 New Construction: NOTE T r, - -REFER TO ELEC DWG DETAILS FOR WIRING INFORMATION NARROW INFRARED FOODWARMER HATCO MODEL #GRN-18 - Cum erland 16 GENERAL NOTES F A R M 5 SNEEZEGUARD (SUPPLIED & INSTALLED 1) O SEE SHEET A1.5a FOR EQUIPMENT SCHEDULE. Store #2326 — -- -- BY MILLWORK VENDOR) 16 2) Q SEE SHEET A8.1 FOR ACCESSORY SCHEDULE. I VSH #V0990 SUPPORTS (SUPPLIED & INSTALLED BY MILLWORK VENDOR) Oracle #MAO99O F1 DUAL INFRARED FOODWARMER HATCO MODEL #GRAIHL-18 ROLLERGRILL & BUN WARMER 395 West Main Street Co2 Hyannis, MA 02601 TANK 18'-7" REEZER _ (DID I OUT TQ OUT Owner HEATED SHELF U � ■ Cumberland Farms, Inc. HATCO MODEL #GRS-18-1 — — — — — — — -- — — — — — - - — - — — — D 100 Crossing Blvd C - - - CC - - - C C - - - C 07_1 I% 11 - gam, ■ 1 F ■ Framingham, MA 01702 \ / W TER HEATER J`` - — — — Js Js Js Js J5 2" MIN. tel 508 270 1400 MILLWORK (SUPPLIED & INSTALLED / \ P AIRSPACE �� / ABOVE 13 L = BY MILLWORK VENDOR) / \ / �� o_ N Architect `O WO EN - ME 1 C)f CD w HARRISON FRENCH H1 SEE a WALK-IN STORAGE A8.1 J5 � \ 0 C: I A T F. ` , 1, T n JS J5 SEE 3 , co R FR EZER M x 3111a,a.atdSttcct 3 WARMING RACK ELEVATION - A81 J5 A1.5 SCALE: NO SCALE _ CES� � ( ° 1 „ Frviklin,\4:\(1203R 12 t 504.529.077n f 508.528.9454 ��1���.hfa-aexom 0 0 0 0 CORRIDO - 0 / I I 0 _ -7 3/4 Js Js Js = Stipulation for Reuse THIS DRAWING WAS PREPARED FOR USE ON A SPECIFIC _ J5 SITE AT CITY, ST, CONTEMPORANEOUSLY WITH IT` ISSUE M w > e I (_ J t. L s �'• J6 J6 6 J6 DATE ON O4/22/16 AND IT IS NOT SUITABLE FOp USE 0 \. . J5 J5 O J1 A V / ON A DIFFERENT PROJECT SITE OR AT A LATER TIME. 15 J6 J6 z / / » „ I USE OF THIS DRAWING FOR REFERENCE OR EXAMPLE ABV O O O o _ - 25 9 1 COOLER e w ON ANOTHER PROJECT REQUIRES THE SERVIC S OF LL I` _ 7�T7� PROPERLY LICENSED ARCHITECTS AND ENGINEERS. —V V I TO OUT , O REPRODUCTION OF THIS DRAWING FOR REUSE ON ANOTHER PROJECT IS NOT AUTHORIZED AND MAY RE 68 JS = 3 1/4" /? wp J6 CONTRARY TO THE LAW. 9'-6" Js I I I 14'-5 1/8" R.O. z COOLER Seal Q EQ. EQ. _ - -- RECEIVING(UTILITY - - - ALCOVE �F - - - - -�� -- - - - - - - - ---_-- - A� €�o C USTOM PANEL CUSTOM PANEL B7 I � All ` / - _— — — — tip.20 ooe z � 4'-7" SEE a¢ • ,0 8.1 3 Js Js 4'-11" ■ �, O cD / — — AB 4 A�E -- MS co J6 /(��Of 1�1A��� A11 04/22/16 7 0 % \ ca Es Fz c8 \ S J^ II Cons nt II -- SEE - A V. A8.1 4 N J i i/\\ - -� \ H9 BV. M9 \\ r o A11 CPI co J8 w ° o v w - / \ �.:; O. AB) vow ,o cz '� -' I E7 G1 I \ O � AAi��� MGR 'I' \ 14 i J7 � o / \ �� H6 A\ vv OFFICE I o � — — — F3 \�� C9 C7 \ o J8 fV l Q-- _- U�dBRELIA1 7 _ — ---- — ---CF37 f . J �' STAND TO CONCRETE I „ = PATIO WITH 4 I i 4'-1 3 4 3'-0 7 8" cs H2 I 3 H2 2 MIN. is n O / » / L 3'-2 7/8" — ----- J7 -- - AIRSPACE = ANCHORS, TYP. FOR L , ---- -- ------ --- o_ W _- — — Revisions z I I _ H3 O = _ � pp LJ J8 5 -1 in / \\ // \ .� F4 �- — -� � G1 BELOW D5 DS D7 D8 -- M I _ d / f ca ixLOW A No. Date Issued for _ I j F3 1 0 Iy t K5 B��OW I - - - - ' ° � I O - 01/23/14 90/o CLIENT REVIEW --_- F34XA 11 =_ Q 1 �� G3 o = �07/16/15 90%CLIENT REVIEW n o G4 , �� �9 �_- _ 1 � I I � o ? '1? 4' Ka `o � Js �09/09/15 100%CDs 00 4'-10 1/8" , — - F3 x \) // Irc K1 Kt K1 04/22/16 BULLETIN #01 (Full Re Issue) I •i7 � � � \ K2 K2 K2 0 - z —_ J - -- A / - — - i m Fa 1 III F� 00 i I � ---_----_ -- .i - I w o PATIO --- ---- z I I - Q \ J5 - - --- -- -- / K7 H1 (00 �, F9 m w n O 0 f I I z - O LLJ H4 Ln a \ /G5 i I 0 - ---_ --- a i LL 1 I T F O = w \ �\/% 10 — 15 � ¢ C t 0 -- cD a ---- co I 0 I � / \ O N o o / 4 -10 1/8" - O ------- - -- 6 J5 - - ` ' � - � RETAIL ' o zCkf /� y / o --- - - — --- ICD - i I B6 ,°, A ES AREA: O _ N =1 WALK IN - W FREEZER J6 � --- - - - - - \ o � 2 -- � � Key Plan - --- 1 USTOM PANEL 3'-0" �? - ci, O FURNISH GATE LATCH A1 .5 L Js - I� O AT TOP RAIL TO 9'-6" O —= TO OF LIGHT OL N JS SECURE GATE IN \ - OPEN POSITION, TYP. GAT TO SWING 180' 12'-0" (AS HOWN TYP. 1 F O O FE 0 ` FE _ II -1 ; ■ — I - -- - - F - - — - --_ - — --- -- -- _- ---- - Title -- ------- - -- U ♦ — - ----- (F5 _. EQUIPMENT PLAN � < Q 0 _ ^1 CV Q ! _ 9'-11 5 8" OUT TO OUT �0_ C - I Date: 04/22/16 3'-0" K1'n ) Drawing No. _ 1 1 .5 �� �.7 Pot MERCH PLAN DATE: 09/ 10/ 15 2 ENLARGED EQUIP. PLAN COFFEE BAR 1 EQUIPMENT PLAN ■ A1.5 SCALE: 1/2"= 1'-0" A1.5 SCALE: 1/4" = 1'-0" Project No, 1300_29 ------------ BUILDING I I _TF s MOx12 WOX12 WIOx12 6 WIOx12 ,�iP! V WIOxi2 WIOX12 CROSSBEAM A a _ #. STIFFENERS WI0xl2 W W1Oxl2 WI0x12 5 5 5 5 EI El E1 El PURLIN @ Q ( ALL, A 24 FASTENERS AND/OR AT EA.OU RKoGER 2"x2"x20 GA GAILY.(CON[.AT TOP) r p S A AT unOxt2 = � unmxl2 UNLESS NOTED OTHERWISE, BRACE GRO SBE M ►� 2"x2"x20GA GALV, KNEE BRACE("I k LOCATE AT EACH PURLIN AND FASTEN (2) CENTER PURLINS `^ 1 TO NEAREST OUTRGGER WITH FULL 1pEPTN ----- ———————————--- ——————————————————— r--—————————————————————--L————— ———— — STIFFENER. ---------- ---- — ------------ -------------------- -- ----- — ------ r ? x2"x ER — —— ———— — 18 GA GALV,CUTRIGG 'OR2 w 2'-8" O,C(MAX) WW10RI2 lOxt2 WIOx11 p 5 TY . C;R0655EAM f3RAQE DETAIL EI � � I FASCIA b D 9 6 St (2)012 x 1 1/4" Wi0x12 E1 Wax El I El 014x VS LAP MULLION TEKS 3 PER OUTRIGGER W10x12 W10x12 WI0x12 Ni � 0 � z z X x WIOx12 WI0x12 WI0xI2 ELEV, 44' 6" CONT, SILICONE CAULK �^ 0141/6 LAP TEKS Q • 12" O.G, I'LICE _6" TSKICE „ " 1 SECTION 12 -0 23'-6 21-0 23'-6 12 -0 '' _ @ EI BCALE� P - I'-O- FRaMlNG PLAN z SCALE, 3/I6" a 3 I. El El EI El � I in , (6)GREY COLONIAL II II SHROUDS BY STEELTEC II II II II II � I 3 0 PVC D.S. INSIDE SHROUD In, BY STEELTEC u lul InnI InI ii n n HIGH POINT OF DRIVE Ali I Iiil liil Iiil III I ii u n A I"I I"I Idl lyl ELEV,0'-O" I f I I I i I I I----J L _J 1-----1 L--- 1 FRONT ELEVATION SCALE 3/16' • I'-0' i y 't I r STEEL NOTES I. DESIGN,FABRICATION AND ERECTION OF STRUCTURAL STEEL SHALL CONFORM TO THE LATEST AISC SPECIFICATIONS. DE516N,FABRICATION AND ERECTION OF COLD FORMED STEEL SECTIONS SHALL CONFORM TO THE LATEST AISI SPECIFICATIONS, CROSSBEAM CROSSBEAM CROSSBEAM CRO555EAM " WEB STIFFENERS 2. STRUCTURAL MATERIALS: (N,S, t FS,) WIDE FLANGE SECTIONS A$TM A512 GRADE 5O(Fy 50 K5U FOR P�IR1'1175 L 'P �/22/>a2 ANGLES)CHANNELS - ASTM A36 (N - 36 K51) HOLLOW STRUCTURAL SECTIONS(TUBE) - ASTM A500 GRADE B(Fy ■ 46 KSU ISSUE DESCRIPTION BY CHK. DATE PLATE- ASTM A36 (Fy - 36 KSI) " " n ROOF DECK ASTM A653,GRADE 40 (Fy ■ 40 K51),GALVANIZED (G60)WITH BAKED ENAMEL FINISH IN " A-325 MOLTS AND NUTS � x 8 x 8� SPLICE PLATE �" A-326 BOLTS AND NUTS REVISIONS: STRUCTURAL BOLTS - ASTM A325 PURL (4 PER CONNECTION) (4 PER.CONNECTION) PURLIN ANCHOR BOLTS - ASTM A3(o (Fy - 36 KSU PURLIN 3.WELDING OF STRUCTURAL STEEL SHALL BE IN ACCORDANCE WITH LATEST ANSI /AW9 DLi (WITH E10XX 51 MAPLCE R.PILON, PE 1;51 MAPLEVIEW DRIVE ELECTRODES). I PENNELLVILLE,NY 13132 4,FIELD CONNECTIONS SHALL BE BOLTED CONNECTIONS UNLESS SPECIFIED ON DRAWING, 5.ALL STRUCTURAL BOLTED CONNECTIONS SHALL USE ASTM A325 BOLTS. BOLTS SHALL BE TIGHTENED BY THE (I • �LICEN5E v DW32 STEELTEC LLC TURN-OF-THE NUT METHOD AS FOLLOWS(PER A15C SPECIFICATIONS): A,ALL BOLTS SHALL BE BROUGHT TO A SNUG TIGHTNESS, DEFINED AS THE TIGHTNESS ATTAINED BY THE FULL II � EFFORT OF A MAN U51NG AN ORDINARY SPUD WRENCH. 3/4" TOP PLATE II • B.ALL BOLTS IN THE CONNECTION SHALL THEN BE TIGHTENED ADDITIONALLY BY A NUT OR BOLT ROTATION FURL INzzgl--- 210 PAULDING LANE (THERE SHALL BE NO ROTATION OF THE PART NOT TURNED BY THE WRENCH)OF THE FOLLOWING: co BOLT LENGTH UPTO"AND INCLUDING 4 DIAMETERS - 1/3 TURN " A-325 BOLTS AND NUTS DALLAS, GEORGIA 30132 �r�./! !��-5�5"5�1!ry BOLT LENGTH OVER 4 AND LESS THAN 8 DIAMETERS - In TURN 6. STRUCTURAL STEEL SHALL BE SHOP COATED WITH A RED-OXIDE RU5T INHIBITIVE PRIMER. FIELD TOUCH-UP, (3 PER CONNECTION) FINISH PAINTING,AND MAINTENANCE SHALL BE THE RESPONSIBILITY OF THE OWNER(UNLESS OTHERWISE SPECIFIED), 4 TY . C OSS AM TO U IN CONN CTION 3 TY C OSS AM TO COLUMN CONN CTION 2 TY SN A S IC CONN CTION GUr'IB RL.,4ND ,4RM5 ��I-0� 2��2 1, DESIGN LOADS SHALL MEET (AS A MINIMUM)ALL LOCAL BUILDING CODE REOUIREMENTS. SITE El EI EI : # ROOF LIVE LOAD 30 PSF ����'(H OF MgSs4cyG FLAT ROOF 5NOW LOAD - 0 PeF LAWR NCE R. HYANN1 M,4 389 WEST MAIN RD�AD BASED ON ROUND SNOW LOAD 30 PSF ;a WIND LOADS: r' ` U Cl S1RU URAL v' JOB NO. LATERAL - 30 PSF FOR: � �.� RGJ TE4 GUMS. F,4Ri"I I1 UPLIFT 20 PSF THESE PLANS ARE SUBJECT TO � N�. $soa !�¢� _ FEDERAL COPYRIGHT LAWS 0 E, 1 O> x e2 -O, 02 GF00(o(o BASED ON SO MPH WIND SPEED (ASCE 1-88 - EXPOSURE "C") SIONAI ANY USE OF SAME WITHOUT THE DEAD LOADS: DECK/GUTTER /LIGHTS 5 PSF EXPRESS WRITTEN PERMISSION OF �/�" L �'� TITLE: R 3 pI /� DWG. N0, FASCIA - 5 TO 15 PLF (PER DESIGN) I\�M 1NI.:F FLAN STRUCTURAL STEEL - SELF WT : STEELTEC, LLC. IS PROHIBITED CONCRETE 145 PCF AND ELEV�4TIDN5 1=1 OF 1 BUILDING EXISTING N FOOTINGS I I- -1 (- L _l L LJ 1 i i I I d j u,. 0 O 61 i I I I � L J L J L J 1- -� I I EXISTING ANCHOR 5OL T5 ,AND FOOTS R5 TO 5E U5E D. SINCE FOOT INC;s AND ANCHOR BOLTS WILL NOT 8E FULL"r EXPOSED, � NC E NEITHER 5TEELTEC LLC NOS' LAWRE I�. THE , SSUi` 'f ,�B L R , f L ON P� ,� �c, L I EXISTING STRUCTURALSTRUCTURALf N�"EC�RI�"lI' OF THE E ANCHOR 5OLT5 0�' FOOT INC;5, 21 _ „ 23' 6�� ,2'_�„ OWNER &HALL 5E REST='ON515LE FOFOR12 -(d 23 -fo P) Lo VERIF*'riNG 5T'RUC;TURAL ADEQUAG)' O E X I ST"INC; ANCHOR BOL T5 ,AND FOOTINGS TO SUPPORT NEW CANOF%r STRUCTURE. NOTE NEW 5TRUC;TURE ,AND FASCIA WILL BE FOUN[)ATION PLAN 5 1~'I 5 f ZE AS EXISTING STR.UGTURE. SCALE: 3/16" = I'-C" THEREFORE, THERE 5HOULD 5E NO SIGNIFICANT INCREA5E IN L0AD5 ON EXISTING ANCHOR 5OL T6 OR FOOTINGS. A.5. PLAN (4 BOLTS) 12" SQUARE BOLT PATTERN 3"o PVC DotLN6POUT (INSIDE SHROUD) (EXISTING 1-1/4" DIAMETER) BY STEELTEC. SHROUD NOT SHOGUN FOR CLARITY H.P. OF DRIVE ISLAND OPTIONAL UNDER CANOPY ELEV. 40 .011 TOPS OF ALL FOOTINGS FIN. DRIVE v THIS SAME ELEV. ROUGH GRADE PROD. A FOR PERMITS LRP 4/23/02 - ISSUE DESCRIPTION BY CHK. DATE D MENSIOEXISTING N TOTBPROVIDED 2" GROUT (BY: G.CJ PRIOR TO CANOPY REVISIONS: FABRICATION LAWRENCE R. PILON, PE c PENNELLVILLEDRI 13132 x STEELTEC, LLC. w LICENSE " 9193 210 PAULDING LANE IM tt� DALLAS, GEORGIA 30132 (770)-505-5917 EXISTING UNDISTURBED SOIL (SEE NOTE 02) SITE: GUMBI✓RLAND FART"ICJ STORY 02142 SQUARE 389 WE&T M,41N ROOD �.��OF MgSS4 kF' ti I ' M /� cad LAWRENCE R. GJ, 1"'1 CNN 15 I I f-t FOOTING DETAIL A � LON FI THESE PLANS'ARE SUBJECT TO N. 39URAL FOR: CUMS. FARM JOB N0. No SCALE (8) FOOTINGS REQUIRED e FEDERAL COPYRIGHT,LAWS a �' '�c►stEa a�� j�, _ u X 92 '_0" 02GP00(o(O ANY USE OF SAME WITHOUT THE F IONA1. EXPRESS WRITTEN PERMISSION OF TITLE: FOUNDATION PLAN DWG. NO, STEELTEC, LLC. IS PROHIBITED AND ELEVATIONS F1 I - - - -