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0700 YARMOUTH ROAD
yob y --Rd, -I E —ram. -ri /' —_ 1 e "'�'�- �M1 _.. �� i 7 � - --« 2»� , � - \� .- ^�� `9 T«° » TOWN Of BARNSTABLE 1019 FEB 28 AN & 57 DIVISION h 7 a i r TOWN OF BARNSTABLE 1119 FEB 28 I-M 8* 57 DIVISION ;� t Y `�� '� ., TOWN OF BARNSTABLE 57 ,tl,1 -SION �r� ' _ _ �, � y �:r C � I i i I � -f_-� !' i� 4 i 'r ;�^ TOWN OF BARNSTABLE 57 INa i TOWN OF BARNSTABIE 7019 FEB 28 ►.N S 57 11IVtS[ON Q YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You musffirst obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: - 1 Fill in please:- APPLICANT'S YOUR NAME/S: Cx7 r c+' r BUSINESS YOUR HOME ADDRESS: 4� TELEPHONE # Home Telephone Number Lt 10 ak NAME OF CORPORATION: _row 51'4-c NAME OF NEW BUSINESS fYl T TYPE OF BUSINESS IS THIS A HOME OCCUP TION? YES NO x ADDRESS OF BUSINESS' a) IA Mo 'US W O2C�30 MAP/PARCEL NUMBER 3 S Cal W3 (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMIS I R'S OFFICE This individual ha b i e4ot y r quire e jsth t pertain to this type of business. ut o i ed i natu COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: C� Anderson, Robin To: Hartsgrove, Elizabeth Subject: RE: 711 { Liz, I was unable to reach anybody at the store so I called Angelo of Charles White Property Management (617-320-1744) and.explained to him about the sign ordinance and reports of at least 5 feather flags. I advised that if true, that is a $500.00 a day fine and I thought we wouldn't want to get off on •the wrong foot as. they are advertising a grand opening. He said he would run down there and explain it to them and that ". . .one way or the other those flags will be down today". Robin Robin C. Anderson Zoning Enforcement Officer 200 Main Street Hyannis, MA 02601 508-862-4027 " -----Original Message----- From: Hartsgrove, Elizabeth Sent: Thursday, July 07, 2016 4:49 PM To: Anderson, Robin Subject: 711 Robin, the 7-Eleven opening up on Yarmouth Road has about four or five feathered flags advertising the grand opening. I'm not' sure if they have frugal from you or, Paul. Liz Sent from my iPhone J a 1 • •r FEIN#:75-1085131 Email:jandianne.chamberlin@gray-robinson.com YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates [cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. " DATE: —" Fill in please: APPLICANT'S YOUR NAME/S:Richard Blau-Attorney-in-fact f. BUSINESS YOUR HOME ADDRESS: 978-345-0083 GrayRobinson PA 401 East Jackson Street, Tampa, FL 33602 TELEPHONE # Home Telephone Number 813-273-5029 NAME OF CORPORATION:7-Eleven, Inc. _ NAME OF NEW BUSINESS 7-Eleven#37425H TYPE OF-BUSINESS Grocery Convenience Store IS THIS A HOME OCCUPATION? YES NO XXXX ADDRESS OF BUSINESSAWYarmouth, Hyannis, MA 02601 MAP/PARCEL NUMBER _ '45 6 1 d 003 (Assessing) . °70 When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST'GO TO 200 Main St. — (corner of Yarmouth Rd.&Main Street) to make sureyou have the appropriate permits and licenses required to legally operate your business in this town.. 1. BUILDING COMM1 SS IONER'S OFFICE/'' This individual as b n i orm d c�knyCer r qu ents tha pertain to this type of business. KILA th riz Sign ture*d * . - COMMENTS: I ,► w 2. BOARD OF HEALTH - This individual has been informed of the permit requirements that pertain to this type of business.' Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. ;I Authorized Signature* COMMENTS: t Sign TOWN OF BARNSTABLE Permit * BARNSTABLE. MASS i6 9. A Permit Number: Application Ref: 201506045 20071141 Issue Date: 09/16/15 Applicant: Proposed Use: RETAIL & SERVICE STORE SMALL Permit Type: r SIGN PERMIT Permit Fee $ 125.00 Location 700 YARMOUTH ROAD Map Parcel 345010003 Town HYANNIS Zoning District g r Contractor PROPERTY OWNER Remarks REFACE EXISTING SIGNS 40 SQ WALL & 8 SQ TENANT PANEL 7-ELEVEN Owner: ROSARIO, EDWARD A 8t JOHN J JR TRS Address: 12 LONGVIEW DR CENTERVILLE, MA 02632 Issued By: PC _ POST THIS CARD SO THAT IS VTSTBLE FRAM TIDE S .'BEET PEROIIT PAYMENT RECEIPT 'TOWN-OF BARNSTABLE " ^� BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601, DATE: 09/16/15 TIME: 09:43 - ------- - --TOTALS- '= --- - PERMIT $'PAID 125 00� y' AMT TENDERED: 125.00-1. AHANGEPLIED: 125.00' APPLICATION NUMBER: PAYMENT METH: CHECK . " PAYMENT REF: 4740 .......... . _ _........ . i t C 041—Ue 06. -o2 y_o :�:A N- . 1 3 II Town U Barnstable ~° Regulatory Services `] RNSTA21 E s t � r s Thomas F.Geiler,Director 63 Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601ar www.town.barnstable.ma.us r. 1sio Office: 508-862-4038 Fax: 508-790-6230 Permit# Building Official approving �( Application for Sign Permit Applicant NA notiA(. S16,N C0ZP0e4'rkX4 Assessors No. 3y5 O10 003 1• I l SrrYFty ECEVG N O Doing Business As. Telephone No. Sign Location ` Street/Road:. '700�r41eN10Lt rH0.4p (dba'a` 1a9� Zoning District: Old Kings Highway? Ye4/�Hyannis Historic District? Ye923 Property Owner C HAPMS 14U M MCo'r, '1-e 1 CO. " 12 8 3 Name: INC�N1G • Telephone: Address: 215 M 1 O Ta,14 I�M. ' _ Village:W•�Ae Mgt a /44 0208 Sign Contractor 3 �1 Cv� C0t�"Tt pN G1p Cgs) g ,?3 Z- �t Name: I' Telephone: Mailing Address:-1 ep ' .. Roo nu. �mt LWti CT 01431 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 o (Note.Ifyes,a wiringpermitis required)S1415-T1 * Width of building face 0 ft x 10= 40 0 x.10= 10 Check one-Reface xisting sign or New Total Sq.Ft of proposed sign(s)Team wr 24NEL WMA 51(fN: y0 SQ PT- B you have additional si�1s 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 o s Ile in O Hance. Signature of Owner/Authorized Agent -Date Cc�Qµ�-�,oN� � � w.. ,� _ _ _ M�-oc�os�(5oe_�35tP:�33Z�--hdhc��x;�, . Sign Permit Couwita= SIGNS/SIGNREQU HAI woonaePI revised12110 5�.oa HEA—IRER HOPWIS DUDKO 2 Phoebe Nry - phom Pax 50 7332 MA 01505 hwondhopldnspchana.n: LETTER OF AUTHORIZATION PURPOSE:By authorising this letter, the Landlord/Property Owner/Authorized Agent,respectfully approves the proposed sfgnage and gives authorization to the contractor/authorizing agent to act on your behalf throughout the presentation/permit process submittals required by neighborhood and/or city officials. Pate: To Whom it May Concern: I sprint name}: J 7 the{circle one of the following}: Landlord/Propedy OwnerlAuthodzed Agent for the Tedeschi at:696 YARMOUTH LOA%HYANNIS,MA 02601,do hereby authorize,approve,consent and give permission for Hazel Wood Hopkins, as the authorizing agent to obtain all necessary municipality approvals&secure sign permits to erect sfgnage at the property referenced above. 2!244 P1 Gn" an roperty Owner/Agent Signature int Name HIS - Date 40 lo 42 ZAA t ?,all, A, Telephone No. Email A dress Mallin6Address of Landlord/Property 0 ner/Authorized Agent J "-PEA,4CC CXj 5T l N(: '4N-r ;4NLL, 8'-4"CABINET ¢ -.tom :,a - .ff•',,. d �L E L E Ie7 E n® f ff4 �� � Ilw+ K :MnLL�i.ERM'1► z 88 * L.ir�l�.114�t��WVVI�ldIM �r� �i�.t6►��r Wariras q _ _ m BUT m° VD's; OI I.Tl S TOYS soy '4°EXISTING CABINET: qb r 6'-o°cursizE11 OFFICE.B RETAIL foF,LEASE � " 71.9,U YD QFFICE$.RETAIL SPACE far LEAS soe ssysast ? O + u ACRVL CTFACE it 0 LDq ;� r � � �x •ems,�{ Y EXISTiNG WILLOW PACKAGE TENANT PANELS MANUFACTURE&SHIP TWO(2)CUSTOM MAIN-ID TENANT PANELS FOR AN EXISTING MULTI-TENANT aa. 74. MONUMENT SIGN CABINET. 3/16"THICK FLAT WHITE ACRYLIC FACE W/TRANSLUCENT VINYL GRAPHICS APPLIED FIRST SURFACE. 7-ELEVEN VINYL SPECS: ^' 3M 3630-44 ORANGE, 3M 3630-33 RED, 7£LEVEN LOGO 3M 3630-26 GREEN DIMENSIONS: ,,,.: • ``` '•- OAH: 10" NOTE:REMOVE&DISPOSE OF EXISTING TEDESCHI TENANT PANELS. oAL: 55%° EXISTING CONDITION:52.7 SO FT PROPOSED ELEVATION:52.7 SO FT Front Elevation&Side Detail-Custom Replacement Tenant Panels-Sign A , Z Photo Overlay-PYLON STRUCTURE-Sign A " 1'-0" Display Square Footage(V.O.):8.i NTS harbinger. palls oD ongP co c.pEmn_' Salesperson:rg PM:DD Designer:mh Page:2 7•Eleven#37425 �® oU4 zDl5 I-Reel ea/ rtssl 2iv RI 1 p_eninRl n91^�__.___ m^� PMETR� rsAr, xn.B7 69a Yarmouth Road -- - -- , sign of the future e� Hyannls.Massachusetts — _ _ E<�yy�n 02601 __��_�____ THE SIGN SON THESE PAGES HAVEBEEN DESIGNED 530011//Roaa,3aCRSOrn1119.FL 11111•904.26B.4aal �J7 F:\CustOmers\7 EIEVen\Art TO MEET OR EXCEED ALL APPLICABLE CODES OR \S E4417-RI#37425.cdr __ customer royal date: OUREMENrs OF THE NEo20R AND OR 2301 Ohio Dr.Pla^0.TX.32257•97L905,"50 "'— — app THE 2010 FBC AND OR THE 2007 SFBC THIS DESIGN IS iOR THE SOLE PURPOSE OF ILLUSTRATION 6 CONCEPT DESIGN THIS FILE IS NOT TO BE USED FOR PRODUCTION AND/OR FABRICATION.THIS DESIGN IS THE SOLE PROPERTY OF HARBINGER AND MAY NOT BE USED 01 DUPLICATED IN ANY FORM WITHOUT 71HE E%PRESS WRITTEN PERMISSION OF HARBINGER. '' 1 v�r� V -. ���� . �� Sim � 13'-3"EXISTING CABINET J �/' p 13'-2h'CUT SIZE L�\• 12'-10"V.O. ✓V' ' ~re - -3/4"CABINE SH—i/B° V-W CUT SIZE MV_ Ed 1 EVE BOL N d -FLAT 3116' ACRYLIC FACE y� FLUORESCENT LAMP LL ¢ . :.;I � w.'i n.+r. En ® U;-t� _ 1'RETAINER FLAT .. ,: • ACRYLIC FACE MANUFACTURE&SHIP ONE(1)CUSTOM REPLACEMENT MAIN-ID FACE FOR AN EXISTING S/F WALL SIGN CABINET. INSTALL ONE(1)STANDARD INTERNALLY ILLUMINATED S/F WINDOW SIGN.3/16"THICK FLAT WHITE 3/16"THICK FLAT WHITE ACRYLIC FACE W/TRANSLUCENT VINYL GRAPHICS APPLIED FIRST SURFACE. ACRYLIC FACE W/TRANSLUCENT VINYL GRAPHICS APPLIED FIRST SURFACE.CABINET TO BE ' 7-ELEVEN VINYL SPECS: INTERNALLY ILLUMINATED W/T-8 H.O.FLUORESCENT LAMPS.51/6"DEEP ALUM.CABINET& 3M 363D44 ORANGE, 1"RETAINERS ALL PAINTED BLACK.SIGN TO HANG INSIDE THE STORE BEHIND GLASS AS INDICATED 3M 3630-33 RED, IN PHOTO OVERLAY WITH EYE BOLTS. 3M 3630_26 GREEN F77ELEVEN LOGO DIMENSIONS: VINYL SPECS:3M 3630-157 BLUE, 3M 3630.33 RED,3M 3630.126 GREEN NOTE: REMOVE&DISPOSE OF EXISTING TEDESCHI FACE. OAII: 23'/." NOTE: EXISTING CABINET TO BE RETRO-FITTED WITH NEW INTERNAL LED ILLUMINATION. DAL: 131 W NOTE:ATM SIGN TO BE FABRICATED&PROVIDED BY OTHERSI 4 Front Elevation&Side Detail-Custom Replacement Face-Sign B 5 Front Elevation&Side MountingDetail-Standard ATM S/F Window Sign-Sign C _ /"=1"0" Display Square Footage(Existing Cabinet):39.7 1•=1'-0" Display Square Footage(Cabinet):3.2 NOTE: REMOVE&DISPOSE OF EXISTING TEDESCHI FACE. NOTE: EXISTING CABINET TO BE RETRO-FITTED WITH NEW INTERNAL LED ILLUMINATION. 1 4 �-ELEVEIIP �- ^'' -` yy«.�.e4'Ur„• .tS,.,:. M4._�...Lt .9 >� - ,�:-. r 1..4" `: �J-Jt-.:, 141 4 N Y' EXISTING CONDITION:39.7 SO FT PROPOSED ELEVATIOIN.. b Photo Overlay-Storefront-NORTHEAST ELEVATION-Signs 8,C PUTS NDreo asi9= ..mn..n harbinger. a oeal�qo gtl.9 IC9 eR1 _— mh__ Salesperson rq PM bb Designer mh Page 3 uL ax 7-Eleven#37425 0�2015 i Revlpge('I qa I9 B I ojEsglg gtn n MET can c==x u�.3D7 696 Yarmouth Road sign of the future Hyannis,Massachusetts -- '•-------- ---- -- EL YEO 02601 THE SIGNS DN TNESE PAGES HAVE DEER DESIGNED i F:\Customers\7 Eleven\Art TO MEET OR EXCEED ALL APPIICABLE'ODES on 5300 Shad Road,JacksO 11I..FL.32257.904.268.4681 ,SVE4417•RI#37425.cdf cUStOmer�prOV81 date: RTHOE�M TScr THE ANDOR NEC 300]SroFBCR 2301 Ohio Or.Piano.TX.32257•972.905,9450 -- - TXIS DESIGN IS FOR THE SOLE PURPOSE OF ILLUSTRATION B CONCEPT DESIGN THIS FILE IS Nor TO BE USED FOR FROM ON AND70R FABRICATION THIS DESIGN IS THE SOLE PROPERTY OF HARBINGER AND MAY NOT BE USED OR DUPLICATED IN ANY FORM WRHOUT THE E%PRESS WRITTEN PERMISSION OF HARBINGER. NATIS-04CL SRUTKAUSKI ACORO" DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 111312015 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 NAMECT Corrine Sternberg Smith Brothers Insurance,LLC. PHcO NEo 68 National Drive,Suite 2 AN Ext:(g60)652-3235 a No; (860)652-3236 Glastonbury,CT 06033 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Valley Forge Insurance Company 20508 INSURED INSURER B:State Auto Mutual Insurance Companies 25135 National Sign Corporation INSURERC:St. Paul Fire&Marine 24767 780 Four Rod Road INSURER D:National Fire Ins Co of Htfd 20478 Berlin,CT 06037 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL UBR POLICY EFFrMMIJD.D� EXP LIMITS LTR POLICY NUMBER MM/DD/YYYYA X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR X 5095051353 01/19/2015 /2016 DAMMIS RENTED 300,000 PREMISES Ea occurrence $ MED EXP(Any one person) $ 6,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY a PECOT- LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 100000 Ea accident) > > B ANY AUTO BAP241771400 01/19/2015 01/19/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PRO PERTY DAMAGE $ X HIRED AUTOS X AUTOS a d ent X UMBRELLA DAB X OCCUR EACH OCCURRENCE $ 5,000,00 C EXCESS LIAR CLAIMS-MADE ZUP-14P21895-14-NF 01/19/2015 01/19/2016 AGGREGATE $ 5,000,00 DEC) I X I RETENTION$ 10,000 S WORKERSCOMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N❑N N/A X 5095051305 01/19/2015 01/19/2016 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 { I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 70 / - �f 0, 1 CDvYI 0 d�y� t� -.� � i � � i \ 1 ti �. �, � � t e `"ET°�ti Town of Barnstable MAE& Building Department-200 Main Street a¢ °rFOMAN Hyannis, MA 02601 Tel. (508) 862-4038 Certificate Of Occupancy Permit Number: B-2015-06826 CO Issue Date: 2/24/2016, ,Parcel ID: 345_010_003 Zoning Classification B Location: 700 YARMOUTH ROAD, Proposed Use: 3250 HYANNIS Gen Contractor: GARY SADLER Permit Type: Addition/Alteration - Commercial i Comments: 7 ELEVEN G 2/24/2016 9:09:16 AM Building Official Date: �s xta TOWN OF BARN STAB LE .' Building 201506826 - BARiMSTABLE, Issue Date: 1247/15 Per it MASS. 9$A i639• Applicant: rFD .1 A Permit Number:r B 20153698 Proposed Use: RETAIL&SERVICE STORE SMALL Expiration Date! 06/15/16 Location 700 YARMOUTH ROAD Zoning District B Permit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 345010003 Permit Fee$ 1,365.00 Contractor GARY SADLER Village HYANNIS App Fee$ 100.00 License Num 20054 Est Construction Cost$ 150,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND �7ELEVEN OR REMODEL OF CONVENIENCE STORE CONVERT TO THIS CARD MUST BE KEPT POSTED UNTIL FINAL DEMO WALLS AND FIXTURES DOORS INSPECTION HAS BEEN MADE. WHERE A `.,,..�M. CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: ROSARIO,EDWARD A&JOHN 9 JR TRS 1 BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 12 LONGVIEW DR •' ° INSPECTION HAS BEEN MADE. CENTERVILLE,MA 02632 ` ..'-Application Entered by: PF Building Permit Issued By: :. K THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART:THEREOF,EITHER TEMPORARILY.OR PE NENTLY; ENCROACHMENTS;ON PUBLI 'PROPERTY;NO ' SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET,OR ALLEYtGRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT,FROM, CONDITIONS OF ANY APPLICABLE SUBDNISION, ^* RESTRICTIONS ;zz.' c ly1INIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 31.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. _ 41.WIRING&PLUMBING INSPECTIONS TOBE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL_MEMBERS(FRAME INSPECTION). fi.INSULATION. FINAL INSPECTION BEFORE OCCUPANCY. ' WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. 1 1 r" WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. , a. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS.OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). r p ,+, M C »rx ® RR nn 55 '; __Warf MR BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 16 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Wr- Fire Dept 2 Fgoal th f 116,� — �-F- _- --34( -Cominonwealth of.Magsachus.ettg - ShmM.Aal Permit Map Parcel, Date: '�-� ® 1C oermit# S FEB 25 2ntg Estimated Job Cost,$ b 0 o Peribit OF AHIV �q� Plans Submitted: YES; NO b� P`la�seviewed. YES, NO Business.License#. Applicant License.#: Business Information: Property Owner/Job Location Information: Name: h e tr r. �' a.'A Street: 3 G r�� v� Street: r ✓ o � City/Town: s n Ci !Town: 51`�l f �` (�.ty a Telephone: 7 r S,-q,r 5 Y Telephone: Photo I:D:required/Co` of Photo I.D. attached: YES'. Jstricted license I J-2, -2-restricted to:dwellirigs 3=stones,or less and commercial up:to:I0,000 sq ft:/2-stones or'le. Residential 1 2'family° Multi family` . Condo/Townhouses Other 1 Comimerciali Office Retail :Industrial Educational 1 F reADept:Approval Institutional. Square Footage.: under 10,000 sq„ft over 10,000 sq ft.: Number of Stories Sheet nnetal work to be to mph ti ;& New Work. Renovation.. HVAC IVletal Watershed Roofing: Kitchen Exhaust;System:.. Metal Chimney I vents.. ikirl Balancing <= Y Provide detailed"description of workto Gas h10, INSURANCE COVERAGE I have.a current jiability insurance policy or' equivalentwh�ch meets the requirements-of M.G L Ch°112' Yes j No If you have checked indicate the. a of.covers-e b :che'kin ithe a�orb prate box tielow y tYP 9 y 9 I?p P } A liability insurance pci icy [ 'Other type:-of indemnity OWNER'S INSURANCE WAIVER:1.am awareahat the,iicensee does not have the.myrance coverage required by.Chapter 112 of ttze . Massachusetts General Laws,and that my,signature on this.:permit application waives this requirement Check One.Ohly. _ Qwner"Q y Agent< J �. i Signature ofOwneror Owners Agent 1 By.checking th[s boxM,_.l hereby cerb 6mi all of the details and infonnation 1 havesubmitted(or entered)tegardmgthis applfcatiori`aie true and' accurate to the.best of Fny knowledge and that ail sheetmetal work and installations performed under the permit issued for this application wit be in=compliance with all pertinentprovlslon of the Massachusetts.:Buildmg Code and Chapter 1;42 of the deneral Laws:; Duct inspection required prior to,insulation installation YES. NO Fro_ _U,$Iia ons' Date Coniments� t . Fp21S1 In eChaJII ° Date -.Comments. Type oflacense' Master_ Pile ❑Master Restricted` QJoumeypersom _ SighatUre d Licensee �emiit ©Journeyperson-Restricted Cleanse Number a- `� , :ee. Check at www.ma;;Laavldal } nspector Signature of Penmt Approval Y ! — _ COMMONWEALTH.OF:MASSACR ET-: .a.............. SHEET N4ETAL WORKERS ISSUES THE FOLLOWING LICtNSE MASTER UNRESTRICTED 3 ,�` a s L a`� JOSEPH F FRANEY x ABINGTON,MA 02351 228� 2 r t � ' -• • • as f � e -- _— _ _ E I LICEUSA Of Std _ MA =NONE t G� c� 3�Obe �4 .15 SEX-i e 50KIMBER CIRCLE ' • BINGTON MA 023512281: '` '` .5 DO 01.12-2015 Rmr 0-15.7005 � "CO MMONWEALTH OF MASS"QHUS5 s M. mile F= EEQAR!D QI: Y`�� 4P r }�F'SIiEET°METAL WORKERS ISSUES THE FOLLOWING LICENSE AS A , 1t�lA5TER-UNRESTRICTED €'+��°�JOSEPH F FRANEY 3 `� L �. °� � �— 1 • ER •�`t 5.3r+a.P.sS s �"4s1^we�C`F�,3-�"�35� `,� `"`, ,,, a W 50 K, B 2A N,INGTO � 0.0375AB T1a2 822280s11,8;264 01 \�s, ;eA _ r Me Commonw 'of Mdssachuselts ' I?epdrtment oflt4dustraal rtcaidenits ., of 1 adgadons` 600 W_tUhO9Vn Street` Boston,MA 02111 wruiy.massgov/dia ,._ ; .. k• Workers'Compensation Insurance Affidavit:Builders/Contractors/Electriciaus/Plaza rs Aj)pIicant Information Please Print;Le I' Name(Business aVmizationllndiv*d) rt r 94 dQ e •e A+ i e r'. eon z'./'•a+„�-� .5 Address.: I I ( i <- - • City/State/Zip; Are on an employer?Check the appropriate';boz a of ro ect< r 4. eral:contractor and:I Type P I { egeiired) 1: I am a employer wig G ❑ I am a:m ernployees'(full and/or patttmse) s have hired the:`sub-conhac6as 6 [] ew construction;.. 2.El am a'sole proprietor or,partner- hated on Xhe'attached sheek` 7. ( RRemodelirig.. sbi and have no employees '' eaub-contractors:have. g ❑ D.emolrtton wozhng;for me tm; ny capacity:; employees and hav I.e workers' IV 9: B adchtlori: [No workers'comp,insurance;: °0 - °e, required.] 5. We:are a eoiporatton and.:its 10[]Blectncal<iepazrs or additions: .3:❑ I:am a homeowner,,doin ail work officers have.exbicistid then: ;1'i ❑Plumbing repans`:.gr additions myself [No workers'comp: right of exexuptzon per MGL ,IZ c.152 1 and we have n o: ❑Roof repairs , msun=e required j t § (. employees.[No workers'- " . 13.D Otber " comp;`insta'ance regiured:] - _: - , Any applicant that cb box#1 mustalso fill out the section below showing then wotkers co• mpensation pokey mfororatioa t Hoareownets who suhmffthis affidavit indicxking they are doing all work and then hue outside contracmrs must submit anew affidayst indicating such.. tCon#ractots that check this boz.musi attached as additi&ial sheet showing the name of the sub-conhacmrs mad aKatc whether or not t2 ose cutities have. employees, if the sub-=traam have employees,they must prowdt their worlds'comb:policy nar5ber 3 I am an;emptoye-rthat is praviding workers'concpensadon:insurance for._my employees__Below s the policy acid ob site information. J Insurance Company Name r P ram_-M U l`ilea Pohcy#ot:Self ins Lic # �( 4t/S ���� S� 'l/�� ,L C ERgiz ation:Date: lob Site Address. °��/►1Ov/ /� C4tylStatelZip: q! 11 z� . . l Attach:a copy of the workers'"compensation golicy declaration;gage{showvng the policy number and�e$pu atop date): Faz7ure,to secure coverage.as iequired under Section 25A of MGL c, l52 can lead to the natpositio�a'of trial penalties of a flue up to$1,500.00 antiior one-yeaz imprisonment,as weir as d"il;penalt es in flie form of a STOP'WORK ORDBk"and a-fine of up to.$250.00 a>day against the nolatoz,;Be advised that a.copy,of this statement may be foravarded the Office of ; , , Investigations of the.DlA for insurance,coverage verification I do hereby certify:under the pains andp .. of penury that"the information provided above is true and correct. Si ature: Date _ Phone I—IF 7 F. f y Ufficral«se:only. Donot write ut thtF area,to.be completed by city or-town of`rcral City or,Town: - _ Pe mit/ iceiise#: Issnutg Authority(circle one): 1 Board of Health 2-Building Department:I City/Town Clerk CllectricalTns*' for S:;Plumbing,Insgector kviv Contact Person; :Phone#:; ` •- J r Workers Compensation And Employers aLiability Insurance Policy' WC 00 00 01 A Coverage Is Provided In: Policy Number. • Liberty Ohio Securltv Insurance Comaanv 1XWS(17)57 08 22 21 Mutual® (Prior NPoli y Number. INSURANCE NCCI Co.No. IL9991 - MA Risk ID 000033332 Workers Compensation and , Employers Liability, Insurance Policy Information Page ITEM 1:The Insured&Mailing Address Agent Mailing Address&Phone No. FRANEY REFRIGERATION.AND AIR CONDITIONING INC. s (508) 676-0309 131R CENTRE AVE VIVEIROS INSURANCE AGENCY INC ABINGTON, MA 02351 . 375 AIRPORT RD FALL RIVER, ^MA;02720-4702 , N _Individual_Partnership T . X Corporation or fEIN:042644629 NAICS238210 Other workplaces not shown above: ITEM 2 The policy period is from 01/01/2016 to 01/01/2017• 12:01 am StandardTimeat the insured'smailingaddress. ITEM 3 A.Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA ' B.Employers Liability Insurance: Part Two of the policy applies to work in each state listed in Item 3.A. The limits of our liability under, Part Two are: Bodily Injury by Accident $500,000 each accident Bodily injury by Disease $500,000 `policy limit - Bodily Injury by Disease $500,000 each employee C.Other States Insurance: Part Three of the policy applies to,the states, if any,listed here:`See Extension of Information' Page D.This policy includes these endorsements and schedules:..See Policy Forms and Endorsements Summary ITEM 4 ,The premium for this policy will be determined by our Manuals.of Rules, Classifications, Rates and Rating Pians. All information. required beloW.is subject to verification and change by audit. Classifications Code Premium Basis-Total Rate per Estimated, s No. Estimated Annual $100 of Annual Remuneration Remuneration' Premium See Extension of Information Page(s) _4 N Total Estimated Annual Premium $14,833.00 Total Surcharges and Assessments $838.00 Minimum Premium $355.00„ _ MA Total Estimated Cost'. $15,671.00 If indicated below, interim adjustments of premiums shall be made. Deposit Premium $15,671•.00 Servicing Office Mass/Connecticut/Rhode Island Countersigned by: and Issue Date 01/05/16 To report a claim, call your Agent or 1-800-362-0000 WC 00 00 01 A(WC'30 10.E) ' © 1987 National Council on£Compensation Insurance, Inc. 01/05/16 57082221 N0220374 450 PCAOPPNO 'AGENT COPY 006913 PAGE 3 OF 22 PROJECT ADDRESS: PERMM DATE: LARGE ROLLED PLANS Data entered m MAPS program— on i / files/fomishdchtve:. q wP. t. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ' Map �� Parcel ®10' 003 Application # Health Division Date Issued r/Z`f7 Conservation Division Application Fee .y oor Planning Dept. Permit Date Definitive Plan Approved by Planning Board ri Historic - OKH _ Preservation / Hyannis , n Project Street Address Village 4,)cwts a i V 4U ©26o1 `M' Owner cNIMM&D&ILAddress 0 COMMUX&MAn Telephone (1 (1 2_6Q!2 � OZ 1 j(Y) Permit Request Ll.nc, Pec_0n< F F'n-t6 s P-0 woo& �ne�P,l Plc lrxa Square feet: 1 st floor: existingaa.proposed232L 2nd floor: existing 0 proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1 5(� f�0 Construction Type �R Lot Size 0 7 6 &. Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure 2-77 Vr. Historic House: ❑Yes 2fNo On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Na- Basement Unfinished Area (sq.ft) kJA Number of Baths: Full: existing new -27 Half: existing 2 new ", Number of Bedrooms: 0 existing _new Total Room Count (not including baths): existing _ new First Floor Room Count Heat Type and Fuel: C- bas ❑Oil ❑ Electric ❑ Other Central Air: W"rYes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes La 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 61 X � � ��C� ��Telephone Number -7 71 ��6 3� �--_ I2 Address G_ Oon N License # 2o Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE�� FOR OFFICIAL USE ONLY 1 APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: IA FOUNDATION FRAME INSULATION y s • t FIREPLACE ELECTRICAL: ROUGH FINAL 1 PLUMBING: ROUGH FINAL `GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT SSOCIATION PLAN NO. The Commonwealth of Md� sachusetts. Department ofIndttstridlA.ccidents ' I Congress Street,Suite 100 Boston,MA 02114-2017" www mass-gov/dia Workers'Compensation Insurance.Affidivit:General Businesses. TO BE FILED WiTH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name:._ �W' Address: "r; - mom , City/State/Zip: l 2(.'A Phone'#. Are you an employer?Check th appropriate box: Business Type(required): 1.❑ I am a employer with employees(fiill and/ 5• ❑Retail or part-time).* 6. ❑RestaurantBar/Eating Establishment 2.M I am a sole proprietor or partnership and have no , 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity: [No workers'comp.insurance tequired] 8• ❑Non-profit; 3.❑ We are a corporation and its officers have exercised 9.,❑Entertainment their right of exemption per c. 152, §l(4),.and we ttave 10.❑Manufacturing no employees. [No workers'comp. insurance required]* 4.❑ We are a non-profit organization,staffed by volunteers, 11 [a Hcatfh Care with no employees. [No workers'comp:insurance req.] 1 12.0 Other *Any applicant that checks box 91 must also fill out the section beiow showing their workers'compcnsatio f policy infarrnation. "if the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box 41: ' I am an employer that is providing workers'cotnpetssation insurance for my employees. Below is policy i�tformatiun. Insurance Company Name:.-. RRi&4t S tr Insurer's Address: y. . City/State/Zip: . �� C.1; JS j - F Policy#or Self-ins.Lc..4 {- �� Expiration Date: 0 I l .,. Attach a copy of the workers'compenNation;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 S 1,500.00 and/or one-year imprisonment,-as well"as.civil penalties in.thc form of a STOP WORK ORDER and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of-the DIA for insurance coverage verification. I do hereby certify, trn the pains and penalties ofperjury that thejnformationprovided above is true and correct. Si nature ,. Date- Phone 4: r. Official use only. Do not write in this area,to be completed by city or town"official. " City or Town; Perm_it]License# Issuing Authority(circle one): 1. Board of Health :2.Building Department 3.City/Towti Clerk 4. Licensing 6.Other Board S:Selectmen's Office Contact Person: Phone#: www.mass.gov/dia + AI CORD® r DATE(MMIDDIYYYY) ,ems; CERTIFICATE OF LIABILITY- INSURANCE " 10/5/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND; EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement:;A statement on this certificate''does not confer rights to the certificate holder in lieu of such endorsement(s). - a PRODUCER CONTACT. r. NAME: RJ Mackintire; Jr. Mackintire Insurance Agency Inc OEEE>s1. (5.08)366-6161 l ke1 '(568)3ee-5202 11 West Main StreetDDRIESS:rjm@mackintire.com INSURERS AFFORDING COVERAGE NAICv Westborough MA 01581-1931 , INSURERAiSelectiye Ins: Co. of-America: 12572 INSURED INSURERaiGuard`Insurance Group f Pary Inc INSURER C 9 Totman St. INSURERD: INSU0ER,E Quincy MA 02169 .. INSURE R-F. COVERAGES CERTIFICATE NUMBER Master,2015-2616 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 POLICY EFF POLICY EXP LTR _ TYPE OF INSURANCE t POLICY NUMBER.. MOLICTYYY MM/DD/YYYY LIMITS'.. X ,COMMERCIAL GENERAL LIABILITY tt " 1 EACH-OCCURRENCE IS 1,000;000 A CLAIMS-MADE OCCUR -DAMAGE S-O FiEN ED- —t-'� 100 000 PREMISES Ea occurrence} S S 11889709 6/5/2015 .6/5/2016' MED EXP(Any one person) S' S,000 i n { w t` PERSONAL B_ADV INJURY S S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:. , GENERAL AGGREGATE' S 2,000,000 X POLICY 1 E PRO, JECT LOC' PRODUCTS-COMP/OP AGG S 2;000,000 .OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT �I I Ea acudent S 1,000,000 A ANY AUTO f BODILY INJURY(Per person) S AUTOS X SCHEDULED A9094920 6/22/2015 6/22/2016 'BODILYINJURY(Peraccident)iS AUTOS AUTOS . X NON-OWNED _ HIRED AUTOS X t PROPERTY.DAMAGE AUTOS ( {Per PERT nl) S - I Uninsured motorist at s`lit lima S _ 100,000 UMBRELLA LIAR i OCCUR =-I r EACH OCCURRENCE 15. EXCESS,LIA$ CLAIMS-MADE ,AGGREGATE '. IL DED 'I RETENTIONS ] p $ - WORKERS COMPENSATION t "' ANY PROMEMBER EXCLUDED?ECUTIVE, YlN.;NlA �. 1 ,E:.L4 EACH.ACCIDEN7 OTH. AND EMPLOYERS'LIABILITY I TUTE � ER. OFF _.. �5_ 100,000. B .(Mandatory In and + TSD.: lb/1/2pS5 10/1/2016 E.L.DISEASE EA EMPLOYE S I.yes;describe under � 100 000 DESCRIPTION OF OPERATIONS below ; A E.L.DISEASE-,POLICY LIMIT S 500 -000, DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES'(ACORD 101,Additional Remaiks Schedule,may benattached'If morespaca Is required)' ` Job Site: 656 Yarmouth Rd, Hyannis MA 0260.1 CERTIFICATE HOLDER ,f CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED,BEFORE Tawas of Hyannis THE EXPIRATION PATE JHEREOF,.,.NOTICE.WILL BE:. DELIVERED 1N ACCORDANCE WITH THE.POLICY'PROVISIONS. AUTHORIZED REPRESENTATIVE a. Connor M 0 jTE2AGX, ©1088-2014 ACORD CORPORATION: All rights reserved. ACORD 25(2014/01) -The ACORD name and I.ogo are registered marks of ACORD ` INS025t�osenl f _ x NWOEFs Omine Filing Sjstiam Its- Copy d RE3colttl", ;� Submission Receipt Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental,Protection.Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for your records. Please do NOT reply to this message,this email address will not receive messages. For assistance with eDEP Online Filing,please email the EEA Help Desk at mailto:EEA.ServiceDesk@State.MA.US or call 617-626-1111. MassDEP is interested in how we can serve you better. To help us make improvements to eDEP,please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/eea/agencies/massdep/service/online/edep-contacts-and-feedback.htnil. To contact MassDEP Programs,please see http://mass.gov/dep/about/contacts.htm.• DEP Transaction ID: 778468 Date and Time Submitted: 10/09/2015 04:02:26 Form Name: AQ 06:Construction/Demolition Notification Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection_ .Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for your records. Please do NOT reply to this message,this email address will not receive messages. For assistance with eDEP Online Filing,please email the EEA Help Desk at mailto:EEA.ServiceDesk@State.MA.US or call 617-626-1111. MassDEP is interested in how we can serve.you better.To help us make improvements to,eDEP,please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/eea/agencies/massdep/service/online/edep-contacts-and-feedback.httnl. To contact MassDEP Programs,please see http://mass.gov/dep/about/contacts.htm. DEP Transaction ID: 778468 Date and Time Submitted: 10/09/2015 04:02:26 Form Name: AQ 06-Construction/Demolition Notification Payment Information DEP code: 115113 Date: 10/9/2015 3:59:20 PM Amount($): 100 .•.J..........v.�... ..vu.a....r.... iaw..w..:)t... vv ..v v......aa..�.�.v.... v�... �k�k�k�k�k�k�k�k:k�k'k#�k�k�k**$#�k�:�k###:k�k*�k�k�k+k�k�k�k�k#:k�k�k�k�k�k�k�k�k*�k%k�k�k�k*�k*�k###�k�k�k�k�kik�k�k�k�k�lt�k�k�&�k�k�k�k#�k�k#�k+k�k�k�k r t. r - �l �qsA 3 OWNER'S AUTHORIZATION LETTER Dater - d- �U Property Address: I hereby certify that 1 am the owner(i)of the above mentioned property. I hereby authorize the Applicant listed below;to act on my behalf in matters related to applying for and obtaining a building permit for the work proposed at the I 9 above mentioned property. . 7 Eleven Inc. 1722 Routh St.Dallas Texas,has authorized"and engaged Royston LLC 1SS6 Old Eibert Rd a Royston,Georgia and Upland Architects 250 E.Main St Norton Ma to conduct all matters regarding remodel work and related permitting services and activities. i Authorized Applicant: Gary Sadler Upland Architects,Inc. 250 E.Main Street Norton,MA 02766 Owner: _ Name:��e�n('-Aros Company: — �.�Q Address:_S 3 �'csm �� @ \ (� 5�Cz M6 Phone: \7 Signature: 11041ele Ylze Coma ompealth ofMassadiusetts n Deputment afrndu_ctrial AcdderEts - Offl-ce of inve 6ga1ilI7Is. ;y 600 Washington Street -- , Boston,MA 621I1 nwin fi1asmgOvIdia Workers' Campensatian Insurance Affidavit Buitden/Cuntracturs/Elect icians/Phmihers Applicant Infarm3tian Please Print LedWy A—dd-ress: - city-/S atel V Plldnc-, ' Ar . uVr. Check the apprapriate z: Type of project(required): I. am 4. I am a general contractor and I emplo 11 andfor * ave hired the sub-contractors 6 ❑Ides con�rucfioa 2.❑ I am a sole proprietor arparfner listed on.the attached sheets. 7+- Remodeling r slip and have do employees. These sub-cantractors have g_ ❑Demolition, working forme in any capacity- employees and have woikers' [No`corkers' comp.insurance~ comp-insurance-1 9. ❑Building addition. required] 5- ❑ We are a corporation and its 16-❑Electrical repairs or additions, 3.❑ I am.a homeouner doing all work officers have-exercised their 11-❑Plumbing repairs or additions m)'set � �F-€ o warkecs' fight12.0 IZoa of exempfiou per MGL ' frepairs insurance required-]Y c.152,§1(4h and we have no employees-[No warkers' 13-0 other comp-insurance required-1 'AELY appPiczoftbat checks box rl anise aLsa fll outthe sectionbeTowshncsing theuwoaere campensatinu palicg infbm=don_ t H.ameownu s who submit Fbdr�dfidavu infficadng&--y are doing zU wa I aid dL=hire outside cont mctorsnmst submit a new affidavilt indica4ng sac7L rQn= tars$ut check this box must attached as additional sheet showing the name of the sub-camtwctua snd staff whether or not tbnse entitieshave employees.Ifthemb-contactorshaveempIofees,thepmustpmvide-their uvrkers'tamp.polky.number- I ant an euipkpyer that ik pratzditrg workers'congm-L ditarc iimirancafor my enrplayem•H. 47iv is Ma paTicy fmd joh s&e in farmalinn Insurance Company Name:__t Poficg or Self-ins.Lis_ l�pisatioaI3ate: ® 1 f Job Site Address V Md ` "CttylStaf �tp: Attach 2 copy of the workers'comErpensationp.olicy declaration page((showing the policy uttm er and expiration date): Faiinm to secure coverage as required under Section 25A of MGL c, 1:572 can lead to tine iffipasition of criminal penalties of a fine up to$1,50a 0U andl'or one-3tearimprisormenty as well as c vi1 penalties in the form of a STOP WORK ORDERand a Eme' of up to$250.00 a day against the violator. Be sd,,dsed that a copy of this statement man be forwarded to the Office of Imvestegatiom ofihe DIA for insurance coverage izzific a ion Ida kerzby catlifjt rzatdt<r tttepairts aced perta]ties of"gei:f ry tTiat f is infornza€mi prates abmrs fs bug aced correct Sittature:- 2 Date: 12, Phone ikJ �(/ 6,oWid use zcrt£� �Do not atrrke En dais arslc,to be caimpWad by city artoirn afrciat - City or Town: Permiffkeziie Issuiug Antharity(drde oz w): , L Board of$ealtk 2.RuiITag Department 3.CitylTotea Olerh 4.Electrical Inspector's.Plumbing Inspector &Other Come kct Person: Phone#: laformation and 11ast`ncfions : . . Massacltaseffs GehPaal Laws chapter I52 requires aII employer's to provide 4vorkers'cou�ensation far theiF employees. p }n this ,an anFIvye=is defined as."Levery person in the service of another under any Contract ofhire, express or implied,oral or written.-" An e2rPIvye2 is defined as`Qaa individual,parinersb�p,associafian,corporation or other legal entity,or any two or more of the foregoing engaged in a1oint and including the legal=preseniatives of a deceased employer,or the receiver or trustees of an individual,Partnership,association or other Iegal entity,employing emploYees- However the owner of a.dwelling horse having not more than tlr as apartments and-Who resides therein,or the occupant of the:- dweIIiag house of another who employs persons to do Mai atenan ce,conshuction or repair worm.on such dweIling house or on isle grounds or bm1dmg appurtenaritlhamto shall not bmause of s=h employment be deemed to be an employer." MGL chapter 152,§25C(6)also siafes that every state or local licensing agency shall withhold$ze issuance or renewal of a liceme or permit to operate a rat buskess or to construct bmldb:gs is the commonwealth for arrp plicant as n ap Who hotproduced acceptable evidence of complian—%With the amurance.cove ee ragrgnired-" Additionally,MGL chapter 152, §25C(7)stairs'Neither the con onweatth nor arty of ifs political subdivisions shall enter into any contract for the,perfu ance ofpublicwoikumtll acceptable evidence of compliance with the insurance.. r ems of this chapter have been presented to the contracting ardhorafy_" �m AgpIicauts ' Please frill out the WD&erb, compensation affidavit completely,by checlT the boxes that apply to your sitnation and,if necessary:supply sub-contracto�) •s nam� )'_ ( )s address es and phone numbers) along with their certfficate(s)of . mnran I p �thno Icce. Limited Liability Companies(LLC)or LimitedLiabfiityPartnerships,(L ) empo Yees other than the members or partners,are not rbquimd to catty workers'compensation msarance If an LLC or LLP does have employees,a policy is rcgokL-d. Be advised that this a$da-vrtmaybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage_ Also be sure to sign and datethe afdavit. The affidavit should be retrmmed to the city or town that the application fur the permit or license is being regaest not the Department of Tn rho cfir i al Accidents. Should you have auy questions regazdmg the law or if you are required to obtain a workers' comp=sationpolicy,plmsecaIltheDeparimentatthr-numberlisindbelow. Self-insUredcompaniesshouIdenterthetc s eIf-m s�c.5 license number on the,appropriate line. City or Town Offfcclals Pl.asebe sale that the affidavit is complete andpriniedleg�Iy. TheDepartmenthas 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 peniirllicense number which will be used as a reference number. In addition,an applicant that must sabmit multiple pennitllicensa applications m any given year,need only submit one affidavit indicating dent policy infounation(if necessmy)and under°Job Site A d 1drese the applicant should Write"all locaisuns in (�Y al town)-'A copy of the-affidavit that has be n officially stamped or madced by the city or town may be provided to the _ applicant as proofthat a valid affidavit is on file for foizz<e.pemifs or licenses_`A new affidavitmust be fmcd out da.cTh year.glhere a home owner or citizen is obiaiIIing a license or permit not related to any business or commercial veufi� (Le. a dog license:or permit to burn leaves et--)said person is NOT ruqaiiad to complete this affidavit The Office of Investigations would ae;to thank you in aiivaace for your cooperation and should you have any questions, please do not hesii to gim us a call- Me, one and fax number: The I?epariment's address,telephone -Th,_-CGM -ij of I u&ets ' Department of lriciustdal Agents QM=Of lave&tigatio= , �Q4�a�am.�tQn Strut . Badon�MA 02111 Tf,,L 617- 7-4 'Qxt 406 or 1-&77-MA.SSAFF Fax 617-727-7M Revised 4-24-07g� UPLAND- ARCHITECTS U PLAN DARCHITECTS.COM 10-9-15 Notification of Plumbing Variance: Attn: Barnstable Building,Department 7-Eleven # 36425 696 Yarmouth Rd Hyannis ma Dear Sir, The following is a breakdown of project cost for the above referenced project: 1. General construction $100,000 . 2. Electrical $ 30,000 3. Plumbing $ 20,000 Total Cost $150,000 Sincerely, Mike Coste Upland Architects, Inc. 250 E. Main Street#13 Norton, MA 02766 mikec(�55upland.com phone: 1-774-430-3390 www.UplandArchitects.com 250 E:•MAIN STREET _SUITE�A- NORTON, MA 02766 1 -774-430-3390 Mass. Corporations, external master page Page 1 of 2 s° s Corporations Division Business Entity Summary ID Number: 042839205 iRequestcertificate New search Summary for: PARY, INC. The exact name of the Domestic Profit Corporation: PARY, INC. Entity type: Domestic Profit Corporation Identification Number: 042839205 Old ID Number: 000206586 Date of Organization in Massachusetts:, 04-26-1984 Last date certain: Current Fiscal Month/Day: 06/30 Previous Fiscal Month/Day: 00/00 The location of the Principal Office: Address: 9 TOTMAN ST.::::::::::::, ` City or town, State, Zip code, QUINCY, MA 02169 USA Country: The name and address of the Registered Agent: Name: CYNTHIA GACICIA Address: 9 TOTMAN ST City or town, State, Zip code, QUINCY, MA 02169 USA Country: The Officers and Directors of the Corporation: w Title Individual Name Address PRESIDENT CHRISTOPHER'P GACICIA;MR':i 2_.RUSTLEWOOD DR.-CANTON,MA-02190 'USAD PRESIDENT CHRISTOPHER P GACICIA MR 2 RUSTLEWOOD DR. CANTON, MA 02190 USA TREASURER CYNTHIA POMEROY GACICIA 24 ADRIA WAY WEYMOUTH, MA 02190 MS USA SECRETARY LISA J GEORGE MRS 14 KETCHAM LANE WEYMOUTH, MA 02190 USA DIRECTOR CHRISTOPHER P GACICIA MR 2 RUSTLEWOOD DR CANTON, MA 02021 USA Business entity stock is publicly traded: ❑ http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=042839205... .12/10/2015 Mass. Corporations, external master page Page 2 of 2 The total number of shares and the par value, if any,.of each class of stock which this business entity is authorized to issue: Total Authorized Total issued and outstanding Class of Stock Par value per share No.of shares ` Total par No.of shares value CNP $ 0.00 15,000 $ 0.00 1 ❑ ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing Note:.Additional information that is not available on this system is located in the Card File. View filings for this business entity: ALL FILINGS ,. Administrative Dissolution Annual Report , Application For Revival Articles of Amendment A _1__ _L View filings Comments or notes associated with this business entity: New search http://corp.sec.state.ma.us/Corp Web/Corp Search/CorpSumm.ary.aspx?FEIN=042 83 9205... 12/10/2015 YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS THE BUSINESS NAME in town (which you must do by M.G.L.- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 15t FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law., Fill in please: Date: 8 0 tea ` x APPLICANT'S NAME: TGn�eS [}< it S �G(2r YOUR HOME ADDRESS: �1 dli-� Cyr Y4"-Ov r� MFi 02�'7 q BUSINESS TELEPHONE # HOME TELELPHONE #: NAME OF CORPORATION: TL0 5F_vuj RQN�,ap .J�)L, �y NAME OF NEW BUSINESS NA, Tc&sct( , ',S __)c�"Z14 TYPE Of BUSINESS.- IS THIS A HOME OCCUPATION? YES ✓ NO ADDRESS OF,BUSINESS fl aa-,M v+�, MAP/PARCEL NUMBER" ss ng) When starting a new business tfibre are veral t ings you must do to be in compliance with the rules and regulations of the Town of Barnstable. This form is to assist you in obtaining the information you may need. You MUST GO TO 200 Main St.`(corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in town. 1. BUILDING COMMISSIONER'S OFF IC This individual has been for ed f n permit requirements that pertain to this type of business. Y p q p Yp Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual en inf te=rTit regGi a ents that pertain to this type of business. Authorized 911 Kanatuye** COMMENTS: C� 141 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual h een ipfo d of the ns�irements that pertain to this type of business. Authorized Signature** COMMENTS: YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$30.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. - it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 1s' FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) DATE: [fig- 01.. b sI am..V Fill in please: 1 APPLICANT'S YOURNAME: BUSINESS YOUR HOME ADDRESS: A gas ar' n S a9 r e, TELEPHONE # Home Telephone Number !o !a NAME OF NEW BUSINESS G-R ESGIf FOOR HoP : . TYPE OF BUSINESS. IS THIS A.HOME OCCUPATION? YES NO Have you been given appro I fro 'the buildrng division? YES; NO ADDRESS OF BUSINESS MAPTARCEL NUMBER . v� ��� Oa3 When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St.—(corner of Yarmouth Rd. & Main Street) to make sure you hav a ppropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISS NER'S FFIC This individual h be i orme f erm' it ents at pertain to this type of business. 1 A r z Signature COMMENTS: 2. BOARD OF HEALTH This individual has n informed of the permit requirements that pertain to this type of business. uthorized Sign ure** COMMENTS: 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual ha on infouvedof he ' e sin er, ements that pertain to this type of business. ri a gnature** S COMMENT N 9J3 1 j / V�A 1, S-C 6 Q Wt g • TO ALL NEW BUSINESS OWNERS DATE: .. 03 Fill in please: all APPLICANT'S r `� YOUR NAME: n/1 iciara� 1 '�. VSa: .BUSINESS ;. YOUR HOME ADDRESS: qa ti'-1A`9 F-A Wt IL TELEPHONE ?' Telephone Number Home o539q-,1) 19-7 NAME OF NEW BUSINESS.S 1 l- CC vuC jbq -dab,Escd% Fov�sNoe1#314TYPE OF BUSINESS RVrA+t- IS THIS A HOME OCCUPATION? YES I ::j_NO Have you been given approval from the building division? YES= NO ADDRESS OF BUSINESS ro1� ` AfL-ou- H (ZJ., Ar01� , YnA MAP/PARCEL NUMBER When starting a new business there are several things you must do in order.to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor- Town Hall) or if you get the business certificate first.you MUST go to the following office to make sure yo.! have G" the required permits and licenses.. GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER'S OFFICE This individual has been inform any permit requirements that pertain to this type of business. Authorized Signature*" COMMENTS: 2. BOARD OF HEALTH This individual has been dmedyf t p rmit r nts that pertain to this type of business. Authoriz ignature" - COMMENTS: ` 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Business certificates (cost $20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must g do by M.G.L. - It does not give you permission to operate - you must get that throu 'i completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. -it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Tale the completed forn-, to the Town Clerk's Office, 1st Fl., 367 ,N-1ain St., Hyannis; MA 02601 (Town Hall) and fret the Business Certificate that is required by law. x f� DATE: Fill in please: k APPLICANT'S YOUR NAME/S: Jandianne Chamberlin c/o GrayRobinson BUSINESS YOUR HOME ADDRESS: GrayRobinson PS,.401 East Jackson Street„ Tampa, FL, 33602 p_ 781-878-8210 TELEPHONE # Home Telephone Number 813-273-5029 NAME OF CORPORATION: ,TFS Newco LLC NAME OF NEW BUSINESS Tedeschi Food shops#37425 TYPE OF BUSINESS Grocery Convenience store IS THIS A HOME OCCUPATION? YES NO X L/ /�j ADDRESS OF BUSINESS l59&Yarmouth Road Hyannis, MA 026.01 MAP/PARCEL NUMBER l 0- 1 0 —corissessing) .7OO When starting anew business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S O CE This individual has been i r ed of a yyermit requirements that pertain to this type of business. An zed Signature** COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: / YOU WISH TO OPEN A BUSINESS? !=-or Your info n-nation: Business certificates ,cost$ 0.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town(which you must do by.M.G.L.-it does not give you permission to operate.) You must first:obtain the necessary Signatures on this form at 200 Main St., Hyannis.,. .. y� Take the completed fora to t:he Town Clerk's Office, ist Fl., 367 r`lain St., Hyannis, N11A 02601 (,Town Hall', and get the Business Certificate that is required by law. DATE: Fill in please: - APPLICANT'S YOUR NAME/S: Jandianne Chamberlin c/o GrayRobinson BUSINESS YOUR HOME ADDRESS: GrayRobinson PS, 401 East Jackson Street„ Tampa, FL, 33602 781-878-8210 - TELEPHONE # Home Telephone Number.813-273-5029 NAME OF CORPORATION: TFS Newco LLC NAME OF NEW BUSINESS Tedeschi Food shops#37425 TYPE OF BUSINESS Grocery Convenience store IS THIS A HOME OCCUPATION? YES NO . X 2 ��y� ADDRESS.OF BUSINESS 69a Yarmouth Road Hyannis, MA 02601 MAP/PARCEL NUMBER ( l/! W, ( ssessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'SYFCE This individualhas been i d of a y ermit requirements that pertain to this type of business. A zed Signature* COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permitrequirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: r TOWN OF BARNST ABLE BUILDING PERMIT APPLICATION Map .3�� Parcel 0/400.3 z Application � U I t Health Division Date Issued !!�� Conservation Division Application Fee C) Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address 0 ���2hoOtlT �� Village Owner 6P R45421 O o %70-4Q Qi Address lea YoW1-1t7 A0 ,Avgy t//S Telephone JJ_.0e _ 36 4/- DSO;r Permit Request /&S7AcW-A FRAffsH 69W-1— Square feet: 1�Vloor: existing proposed 2nd floor: existing proposed Total new Zoning Pstricr Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size �' Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. U_ Dwelling9pe: §ingle Family ❑ Two Family ❑ Multi-Family (# units) In Age of Ez sting Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No fP 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 ?W10 AEpRAp-O -fPVc1v S'1b4 Ce?W.15f_ Telephone Number 77 6-94" 79(19� Address ie"9 416fS y License # GS Home Improvement Contractor# /3CE&14 Worker's Compensation # S6a A7rACH60 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ' ("� DATE �7 >� FOR'OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. s ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL j PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING • a r DATE CLOSED'OUT ,. ASSOCIATION PLAN NO. t THE r � Town of Barnstable ` Regulatory Services Thomas F. Geiler,Director B ail ding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstab le.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property C)wrierMust Complete and Sign This Section If Usinz A.Builder LLI-j -C �.C6Z-- / �' , as Owner of the subject ro e 7 P P y hereby authorize �ayIZ2 �6-kZAe0 to act on mybebalf, in all matters relative to work authorized by this bdc iag permit application for. (Address of Job) Signature of Owner Date , (� eL r- S Gtl'/0Print Name If Property Owner is. applying for permit please complete.the Homeowners License Exemption Form on the reverse side. The Commonwealth of Massachusetts _ -Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): MARV45 Y5#A C V1447-,eVG 7%ON SOL-07-10NS Address: /&19 Z4,50a y pARKC ,J Y (60S MAI OFF/C-6) City/State/Zip: WRYI.100TN MA Phone #: -7 F/' 3 3 V'- 6 0/Z Are you an employer?Check the appropriate box: Type of project(required): 5 1. I am a employer with .50f 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.$ 9. Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. No workers' coin right of exemption per MGL Y [ P• 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out%the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Q Z Policy#or Self-ins.Lic.#: A l G w°f 17 9 110 3 Expiration Date:1&01 Z. Job Site Address: 60& YAt4AlOa7h' RVA,0 City/State/Zip: /1y,4AyN/S 0 lyA Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that.a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains y4penalties of perjury that the information provided above is true and correct. Si ature: Date: 0 -3 11 Phone#: -77 tb " . 7 y,O) 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#: Massachusetts- Department of Public S Board of Building Re,�ulutions and Standards Construction Supervisor License License: CS 66183 DAVID A FERRARO L]n 17 WOODSBURY RD ROCKLAND, MA 02370Expiration: 6/9/2Tr#: 1657 1 i i /�1Er�Et/5'H�4 Co�rsTievG�o� s s �PEv/S�NG � rS GU,Q,Qt��iv T AO -d G %d �EFt.�L7 N i4D CSS L -'q Fi�e4Oq G9� j 1�1Fl t�Y/c fo 0, -7? 4- 619 o 71°17 Menemsha Tom-of mmiSTABLE SOS ANGELES 60STON TON 27 RA 3- 21 June 27, 2011 Town of Barnstable ' Building Division 200 Main Street Hyannis, MA. 02601 RE: Tedeschi Foods Shops 700 Yarmouth Road To Whom it May Concern, Please accept this letter as our verification that David Ferraro is an employee of Menemsha Construction Solutions and is therefore authorized under our Workers Compensation insurance. If you should have any further questions, please do of hesitate to contact me at 781.337.9012, Thank you for your cooperation. Sincerely Jim Talbert Vice President Construction Operations . r ui MENEMSHA ACORV CERTIFICATE OF LIABILITY INSURANCE DAT3/29/2011 /DD/YYYY) ��. 3/29 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 Commercial Lines-(310)543-9995 NAME: PHONE FAX Wells Fargo Insurance Services USA,Inc.-CA Lic#:OD08408 E-MAIL ac No 21250 Hawthorne Boulevard,Suite 600 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Torrance,CA 90503-5519 INSURER A: Old Republic Insurance Company 24147 INSURED Menemsha Development Group Inc. INSURER B: American Guarantee and Liability Insurance Com 26247 4950 West 145th Street INSURER C: INSURER D: INSURER E Hawthorne,CA 90250 INSURER F: COVERAGES CERTIFICATE NUMBER: 2548314 REVISION NUMBER: See below 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 CY EFF POLICY EXP LTR TYPE OF INSURANCE ma&WVD SUER POLICY NUMBER MM/POLID/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY AICG91791100 4/1/2011 4/1/2012 DAMAGE AMAGETOCH RENTE $ 1,000,000 X DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 CLAIMS-MADE I X1 OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO JEcLOC $ A AUTOMOBILE LIABILITY Al CA91791101 4/1/2011 4/1/2012 COMBINED SINGLE LIMIT 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ B X UMBRELLA LIAB X OCCUR AUC488700801 4/1/2011 4/1/2012 EACH OCCURRENCE $ 9,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $ 9,000,000 DED RETENTION $ WORKERS COMPENSATION X WC STATU- OTH- A AND EMPLOYERS'LIABILITY Y/N AlCW91791103 4/1/2011 4/1/2012 ".ITS ANY PROPRIETORMARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Evidence of coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Menemsha Development Group,Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 4950 West 145th St. ACCORDANCE WITH THE POLICY PROVISIONS. Hawthorne,CA 90250 AUTHORIZED REPRESENTATIVE The ACORD name and logo are registered marks of ACORD ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 100127452 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition �E'VISt(7•, Important: A. Applicability When filling out PP y forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-do return not use the ret (DEP) Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10)days prior to any work being performed.The following information is required pursuant to 310 CMR 7.09. B. General Project Description 1. a. Is this facility fee exempt-cit ,town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?y[]Yes ❑✓ No 1.All sections of b. Provide blanket decal number if applicable: this form must be Blanket Decal Number completed in order 2 Facilit Information: to comply with the y Department of TEDESCHI FOOD SHOPS Environmental Protection a.Name notification ARMOUTH ROAD 760 Z4ieHo0rit QO�D requirements of b.Address 310 CMR 7.09 F � � annis MA 62601 5087752002 Number r E-mail Address(optional) 1 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ❑ Yes ❑✓ No k. Describe the current or prior use of the facility: I. Is the facility a residential facility? ❑ Yes C]✓ No o m. If yes, how many units? Number of Units �c? 3. Facility Owner: N JOAQUIM PROPERTY MANAGEMENT LLC o a.Name .0 700 YARMOUTH ROAD --�� b.Address HYANNIS 1 102601 (D c.City)Town d,State e.Zit)Code =o 15087711093 f Teleohone Number(area code and extension) E-mail A r i C EDWARD ROSARIO �Q h.Onsite Manager Name ag06.doc•10/02 BWP AQ 06•Page 1 of 3 Massachusetts Department of Environmental Protection _— Bureau of Waste Prevention • Air Quality 100127452 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General Statement:If B. General Project Description (cont. asbestos is found during a 4. General Contractor: Construction or Demolition IMENEMSHA CONSTRUCTION SOLUTIONS operation,all responsible parties a.Name must comply with 1169 LIBBEY.PARKWAY 310 CMR 7.00, b.Address er 2 and Chapter 1 E of the WEYMOUTH I MA I OF2189 General Laws of c.Cit /Town d.State e.Zip Code the Commonwealth. 17813379012 This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an JDAVEFERRARO asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. MENEMSHA CONSTRUCTION SOLUTIONS a.Name 169 LIBBEY PARKWAY b.Address __ _ WEYMOUTH MA 22189 -1 c.City/Town d.State e.Zip Code 7813379012 f.Telephone Number area code and extension .E-mail Address(optional) DAVE FERRARO h.On-site Manager Name 2. On-Site Supervisor: DAVE FERRARO On-Site Supervisor Name 3. Is the entire facility to be demolished? ❑ Yes ✓❑ No N _0 4. Describe the area(s)to be demolished: 0 SAWCUTTING FOR FLOOR TRENCH N :..�.O 0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: � NO NEW CONSTRUCTION. MINOR REMODEL ONLY. 0 0 ag06.doc•10/02 BWP AQ 06•Page 2 of 3 Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention • Air Quality 100127452 It Decal Number BWP AQ 06 Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project, were the structure(s)surveyed for the presence of asbestos containing material (ACM)? ❑✓ Yes ❑ No If yes,who conducted the survey? RICK BOWEN b.Survevor Name A1061044 c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 6/20/2011 1 7/31/2011 a.Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving ❑ wetting ❑✓ shrouding b. If other, please specify: ❑ covering ❑ other 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization d.DEP Waiver Number t D. Certification co I certify that I have examined the JPHIL WOODYATT --o above and that to the best of my a.Print Name �O knowledge it is true and complete. JPhiI Woodyatt The signature below subjects the b.Authorized Signature —N signer to the general statutes ISENIOR PROGRAM MANAGER o regarding a false and misleading c. Position/Title o statement(s). JIVIENEIVISHA CONSTRUCTION SOLUTIONS d.Representing 6/3/2011 o e.Date(mm/dd/yyyy) �Q ■ ag06.doc•10/02 BWP AQ 06•Page 3 of 3■ r 40•-7 tn' 11- 5' 111n - Project Owner: 4' •-01n•r 1 - 1a-s- 1 - 1rs^ B•-10 1rs- r-x 1rs- r • d 9HELVBlG C Tedeati 1 �MEN'S B' COMPRESSOR FOOD SHOPS c ESTROOM BACKROOM ROOM 14 HOWARD ST.ROCKLAND MA M70 103 105 - c7nl ma n:1D FAX(780878-0 76 9 '-101n^ 9.9112^ 23'A' OMEN' RESTROO s I RACKING RACKING RACKO G —KWG RACKNG Consultant: c 102 7 WALK IN COOLER 104 I I Aenemsha - FT:.. � R --- ---- mnawcdon aoa.uona ' p NEWT-3 oaRr I II f MULTI DECK I •n Plann4g.CMG Consw .B.-13 W B_LASE- _ .Bo lm.Lw Angeba FREZ-5 v Y T.1.FV4M W.bMANAGEMENT 5 ST. 0 7 HAWTHwrNDRNE.a 9ozso vd,.:31oaa3a43o LL Faa:3f03413131 r-w SHLF-1 SHLF-1 SH F-1 SHLF-1 - •- aw,m...m.n r v1aAa,maw.awanouon,.amal.a, LL w a.a.apa.0 nw wnfaMYp a raa w -a dr aaama.q `> I I I I I I sny an e. am.a an a.191na1 my�. N I1I1 '1 1 6•-51n^ FII � lrn LrLn I $s•41rsH- K aw Tidm.aLDan mFMo.u•r>au.nm'dla 91aa r nan ard dmd.a a.doxrt.av=oa>e9g.a Nnr.e a Maro9..wd Merlems6a Campardea. 11 \ I ul I I I W L- - - Project Address: 11 I SHLF-1 SHLF-1 SHLF-1 SH F-1 0 FI- i1 I I 3 �� TEDESCHI'S FOOD u I cnrlD-s I "- __ STORE#314 , " r 696 YARMOUTH RD. woo � I I I II I I I HYANNIS,MA02601 I I 4•-:1112^I II m fi 1 I F�+# 'm 3•at •fi- s• O I I I z Stamp: NBW I II N II Cl i "1.9 J I S. a'L`Sl_J-W-D I I I M I"r IJI 4 I \�/ I FRES�vuE _u S r- w w _ m I I I to IjE-1u�7 r �1 SHLF-1 SHLF-1 L SH,IFd wo �Lzaa��� SALES 100 O ti, No. Date Description �J -D \Duos _ DONUT BULL n SECURITY _ HER HEV O sP COUNTER 2 H ', avz rs CHECKOUT r-9- rB rs^ j - 101 Sheet Title: USH 41 4' 4' UFP t� FLOOR PLAN, 4•-S 1rs' x'•1' NT - RE/E UIPME FURNITU Q FINISH DIMENSIO CODE NS 4' ! 3B•_,,,rs- PLAN ITEM MANUFACTURER PRODUCT NUMBER (WIDTH X DEPTH X HEIGHT) REMARKS -- t CASE-1 ISLAND FRESH CASE ARNEG LACOLLE C45 60 1/4"X 96"X 51 3/4" FLOOR PLAN SCALE: q 1/4-1•-0.. J CASE-3 DAIRY MULTI DECK HILL PHOENIX ON5DM 75"X 36'X 83 5/8" '.t APPROVALS REVIEWED BY:FM 1O MAIN ENTRANCE SO MOP SINK O RELOCATED FIXTURE DRAWN BY: JF SHLF•1 WIRE SHELVING MICRO-WIRE WIRE 32"X 15 3/4"X 59 3/4" END CAP DISPLAY 1 VP SALES AND MARKETING SHLF-2 WIRE SHELVING MICRO-WIRE WIRE 76-X 32-X 59 3/4" O COUNTER 6O "ASTING FIXTURES TO BE RELOCATED EVP OPERATIONS DWG.DATE: 05/04/11 SVP LOSS PREVENTION SCALE:AS NOTED SHLF-3 WIRE SHELVING MICRO-WIRE WIRE 113.5"X 32"X 59 3/4" O 1'X1'VCT TILE O MEW FIXTURES VP STORE DEVELOPMENT PROJECT NUMBER:16978 COND-2 MIRCO/CONDIMENT ROYSTON 2'-6"X 3' - COUNTER qO REACH IN FREEZER gO FASTING FIXTURES TO BE REMOVED VP CFO SHEET: FREZ-5 FROZEN FOOD CASE ZERO ZONE 5 DOOR 153 3/8"X 37"81 318' 5 DOOR PRESIDENT CEO A 111 EQUIPMENT SCHEDULE KEYNOTES 1 k