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0946 CRAIGVILLE BEACH ROAD (21)
; . . .� .. . �T- . �, . ,; .fr' �, r . , � � ,� t o ,,� o n �� 11;02'94 17:02 '$8177277122 DEPT IND ACCID Q 00- A. T. = 1�0tiUn.0l2cUPa t`L O �U�6acl.uietb GT ' aUaParfine�ct o�„J'n�u�friaL✓�ccidentl 600 !/ -I nyton Stmet James J.Campbell ��,t, "adccsA 02111 Commissioner Workers' Compensation-Insurance Affidavit 1, -T- t4/V (paensee/pamirr�e) with a principal place of business at: /ZN M4 (Qr/sUWZlP) do hereby certify under the pains and penalties of perjury, that: (� I am an employer providing workers' compensation coverage for my employees working on this job. insurance Company Policy Humber () I am a sole proprietor and have no one working for me in any capacity. (} I am a sole proprietor, general contractor or homeowner (circle one) and have hired the contractors listed below who have the following workers' compensation policies: Contractor Insurance Company/Policy Number Contractor Insurance Company/Policy Number Contractor Insurance Company/Polity Number () I am a homeowner performing all the work myself. I understand that a copy of dais slternent will be fomrzrded to dte Office of Investigations of cite D1A for coverage verification and that failure to secure coverage as recai;ed under Sec ion 25A of MGL 152 can lead to the Imposition of criminal penalties eonsistin¢of a fine of up to S 1,500.00 and/or cn years' imprisonment zz well as civil penalties in the form of a STOP WORK ORDER and a fine of S 100.00 a day against me. Signed this day of 19 nsedP ittee Building Department Licensing Board SeIectmens Office Health Department '5 7 6- q 41 TO VERIFY COVERAGE INFORMATION CALL: 617-727-4900 X403, 404, 405, 409, 375 ti T_ a COMMONWEALTH 'DEPARTMENT OF PUBLIC SAFETY 9 � t�M�BlNI1M� s p�oJ1.f«ti . ONE ASHBORTON PLACE OF I�' - r +�• ' MAggpCHUSETTS _BOSTON,MA 02108 R ClIt C E N S E CAUTION CONSTR. SUPERVISOR '14s EXPIRATION DATE F . T Q 6/0 5/19 9 5 �� t EFFECTIVE DATE LIC N0. RESTRICTIONS " f 06/30/1993 013140 �. NONE ICENSE. JOHN G GUERRA 47 BLUE HjL L AVE BLASTING OPERATORS SS q . 014-44-0499 ° MILTON MA U2187 'm''; MUST INCLUDE PHOTO. jp,,pjG OPA ONLY} F b/�nn //�� r �J U O NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY HEIGHT; STAMPED OR-SIGNATURE OF THE CGMMISS!QNER - DOB: 06/05/1952L � � SIGN"JAA'E IN fU�L APO`fE SIGNATURE LINE THIS DOCUMENT MUST BEA NATURE OF L ENSEE I CARRIEOON THE PERSON OF - THE HOLDER WHEN EN-Aj cmmISS MB PPIN7 GAGEOINIHISOCCUPATION. ,s �ry /7C ,� �-��� �� �J 1 i j ss-ssor's Office ost floor MaD Lot O, !� �,�� Permit# 7 q 9 Conservation Office 4th floor ,✓ �� Date Issued ,- :4oard of Health Ord floor ly b [.n ineerin Dept.Prd floor House# e®� Planning Dept. (1st floor/School Admin.Bldg.): Vift wi- Definitive Plan-Approved by Planning Board 19 r6l ft-V A lic ns rotes 8.30-9:30 a.m.& 1:00-2:00 .m. �� �00.-4 I�crg� ND TOWN OF BARNSTABLE Building Permit Application Prole tre dress ry`• & CgA 16(J!L'L l2-2) Village cls, ,,e ii t Me- Fire District Owner M P K it M SO N) Address 1070 >g zolif f' S)7- / o'eCwe-�m1--e Telephone (1a 0 - 2-18 -5 7 54 0 t Permit Rcquest• ��,?t,a-c r^ C',cDAk SL4 iY C., t--� rD/Y 8 1 Di/VG l-E(� Zoning District Flood Plain Water Protection Lot Size Grandfathered Zoning Board of Appgals Authorization Recorded Current Use Proposed Use Construction Type Existing Information Dwelling Tyne: Single Family Two family Multi-family Age of structure Basement type Historic House Finished Old Kin,p s Highway Unfinished Number of Baths No.of Bedrooms Total Room Count(not including baths) First Floor Heat Type and Fuel Central Air Fireplaces Garage: Detached Other Detached Structures: . Pool Attached Barn None Sheds Other Builder Information Name j O H,/ 01�1 "AedE L4 Telephone number �o f -t S`C� -7 7 Address 1 �?A Lu.4;? Al.4GS y License# 613 M t i�N c�nA e) o C., Home Improvement Contractor# Worker's Compensation # NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Project Cost St lv.SfOOz Od Fee O170 CO SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) BPERM T r 706 FOR OFFICE USE ONLY r'5/•2[9 5 3-T6"9 9 r 226.008.001 ADDRESSv 946- Craigville Beach Road VILLAGE Centerville Mark Ransom OWNER - 1 DATE OF INSPECTION: FOUNDATION^ t + e ! t FRAME INSULATION l t FIREPLACE i ELECTRICAL: ROUGH FINAL - PLUMBING: .-ROUGH FINAL GAS: ROUGH FINAL r - FINAL BUILDING; DATE CLOSED ASSOCIATE PLAN NO" , 1 1 4 Assessor's map and lot number .... ........... ............,.......... .... 'X �oViTHEro� Sewage Permit number .......................................t. ............... Z BARNSTA ILE, i House number .........................................:............ ..........:...... - soo MABa 163q. \0�� V -to YFY A,- TOWN' -OF BARNSTABLE 6URDIHG INSPECTOR S CR 0 APPLICATION FOR PERMIT TO ........... -PY Jl........................... y TYPE OF CONSTRUCTION ....... ........!....... . ................... .. ..... .. ..................................:........... .... ... z 19. a.i:. -_TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ............................................................................. ..1/ .. ...a�'Cal'rf" J....: �T....................Z�................ C%L� �► ProposedUse ........:} ..... .... -:e........................................................................................................................ .... Zoning District ........ ... .... .............. .....Fire District ........................:..... Name of Owner G�,� !t" dress. ...... Name of Builder .........:- '' "''Z'e.............................Address .Name of Architect ..................................................................Address .................................................................................... Number of Rooms ................................... ..............................Foundation Exierior ........ ..Roofing ........� ... ^ ..................... Floors ......................................................Interior ................................... ................................................ Heating ..................................................................................Plumbing ....................................................... Fireplace ..................................................................................Approximate Cost ..................................................................... Definitive Plan Approved by Planning Board ---------------____-----------19_______. Area ..........��(2... ................ Diagram of Lot and Building with Dimensions Fee / A............ ............. .......... SUBJECT TO APPROVAL OF BOARD OF HEALTH \ G ' I. hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re arding°the above'__. construction. �° Name ...(. ..... ........................................ Johnson, Walter & Mary Azoz � ' . ' ' No .. — a�|�� r~ _—..raiee. . , ...........rOOf........................................................... Location l}e Road —~—.—.—...—.--.---------- ~ �, -------'..���u*��x+�+e---------- . Owner ---' .&.�azY.Azoz. Typo of Construction ............Jx.�Pg................... � � +/ - ----.--------.------------. . �- ' _ ' ' Plot ............................ Lot ----------' ~A � n�'eu ..� ��� 2� A} Permit Gro --.r..`� � - [late of Inspection -----------��A ^_ ~ Date Completed -. --~� , —.��— ~- , � ^~ . ^' PERMIT REFUSED «� �� 'lP—.+-----------. ---��,.. -Y .—.��-----------------~ ---.. . ` . , ____________~,_.______.. ' � -----------.-----------.— .��� ---------'^--'-----------''r / r — '' lQ ~`pp/o"c" .�'r_------------ ______`_,________.�____,.___. ' ------------'-------'r^^^^^^—' ~° Assessor's map and lot number . - {'~ Y ...:............................:........ -- �oF THE Sewage Permit number � d � t 33AWSTADLE, i House number ........................................................................ 9� MAM pow t639. \00 fp MPY a' TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............................................................ r TYPEOF CONSTRUCTION .................................... �:.... ?.... .'............ ................................................................ .................................. 'i' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: / Location .....'' ' ` ProposedUse ................................:.. ....5................................................................................................................................ ZoningDistrict Fire District ........�. ' ....... ............................................ Nameof Owner ...............................................:�:.................r Address ....................................................- .........I./................ r Nameof Builder !...................... ................t...........Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ..................................... ........................... ...............'::...:.................:...........Roofing ................................................................................... r 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 i �.r r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. i Name ... ........... ..................................... Johnson, Walter&A Mary Ann, A=226-8� No .... 22939 Permit fur .,/�ear.a a . ......roof ............................................. .........Location q + raigvilad...................... ....... ....... Centervi ............................................................................... Owner ........Walter & Mary Ann Johnson .......................... ............................... Type of Construction frame ............. ........................... ................................................................................ Plot ............................ Lot ................................ Mach 24 RR1 Permit Granted ........................................19 Date of Inspection ...... ...........................19 Date Completed ......................................19 I PENT REFUSED ......................... .................................. 19 ......................... ..................................................... ................................................................................ Approved ................................................ 19 f ............................................................................... 0 c� \ W Centerville-OsteMIle-Marstons MU9 Water Department 0 P.OQ SOS 349.1131 MAIN STREET o OSTMVH-L$NMS'WHUSBT3s"a 0 x aMCe OA WATE R BOARD OF WAYM ODMMCMD 1MS DEBT WMER SUPBIIIIIIUMBR ._. 7E.Na soaaaacMl. RUC No.Sa342&35M o a October 28,2MB 0 i Town of Barnstable Bu3'l ' D t� �ge 367 Main Wed E[yamui%MA 02601 '= F-w Acc.o®t 41326 :-3 NTown�uf B emetable 946 CraiMlle Beach Road -Ceoteiville,MA Gealtemew ~� a x On Friday,October 24.2t108 we ducted the watar service line at the curb stop for the Foperty rDm&mted above at your request.It is am understanding that o thebuilding will be demolished „ If you have any questions,please call our office at 508429-601. very fiulyyours, Craig et Superimendent - --- - - - w------------------------------------------------------------------------------------ o 0 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 101 ma Map Parcel 0 0��O 0 1 7.-Applicatiod #r_�)W� Health Division Date Issued 42ft Conservation Division t/ Application Fee Lis Planning'Dept: -'Permit Fee' Date Definitive,Plan Approved by Planning Board Historic OKH Preservation Hyannis Project Street Address Village CeAe c-v'i k Vt Owner T� 0,,A: ot' Q ac-As IQ h� Address 2-30 %Ife�A Telephone Permit Request To- ®PI tnA y6at 14 QA-'\) SotA Square feet: 1 st floor: existing-proposed 2nd floor: existing-proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuatidin Construction Type Lot Size 2i70 Act-e Grandfathered: J Yes Ll No If yes, attach supporting documentation. Dwelling Type: Single Family L] Two Family L] Multi-Family(# units) hoW Age of Existing Structure 11'150y40-di Historic House: LJYes UN-10 On Old King's Highway: LlYes 6-N-o Basement Type: Ll Full eCrawl LI Walkout U116ther -Slat Basement Finished Area (sq.ft.). Basement Unfinished Area(sq.ft) Number of Baths: Full: existing. new Half: existing -new Number ofBedrooms: existing -new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: U Gas MI-6r,I LJ Electric L3 Other Central Air: LI Yes WrNo Fireplaces: Existing New Existing wood/coal stove: 0 Yes LI No Detached garage: we isting L3 new size , Pool: We-Asti'ng LJ new size Barn: Ll existing LI new size Attached garage: Ll existing Q.new size -Shed: Ll existing L3 new size Other: Zoning Board of Appeals Authorization LJ Appeal # Recorded Ll Commercial L3 Yes U No If yes, site plan review# Current Use -- - P'r_6p6s&d_Use _____ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name I JW AD Pw'(14 C Telephone Number Address 6"MewooC\ CA . License# _33 D t4-t1JP0fA_f 02635 Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO CO- SIGN DATE 0) FOR OFFICIAL USE ONLY S' APPLICATION# DATE ISSUED MAP PARCEL NO. ADDRESS VILLAGE OWNER 6 { DATE OF INSPECTION: i FOUNDATION FRAME INSULATION `t FIREPLACE F ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL f FINAL BUILDING s i DATE CLOSED OUT ASSOCIATION PLAN NO. 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston, MA 02111 www.m ass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization(Individual): No A&<,n 06N i n q '7 1 C Address: x 9 9 City/State/Zip: em I S Yip . Phone.#:_S�09-3 q -'�:tq7 `7 Are you an employer? Check the appropriate box: Type of project(required): 1.❑ I am a employer with . 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. T. ❑Remodeling ship and have no employees These sub-contractors have 8. . emolition workingfor me in an capacity. employees and have workers' Y P h'• # 9. ❑Building addition` [No workers'-comp. insurance comp.insurance. '10. Electrical repairs or additions required.] 5. �e are a corporation and its ❑ eP 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t c. 152,§l(4),and we have no employees. [No workers' 13.❑Other comp.insurance required.] «Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. YContractors 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 subcontractors 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: Policy#or Self-ins.Lic.M 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. 152 can lead to the imposition of criminal penalties of a fine tip 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.3doljitor. Be advis t a copy of this statement may be forwarded to the*Office of Investi ations of the b ms ce cove v cation. I do reby ce ' under t pains pen es of perjury that the information provided ai ve is tru and correct Si a: e Date: Phone#: w ,3 Official use.only. Do not write in this area,to be completed by city or town of xial 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#: 'I Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their.employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or dustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and.phone number(s)along with their certificate(s)of insurance. Limited Liability Companies'(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address" the applicant should write"all locations in (city or town).".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: The Commonwealth o€Massachusetts Department of Industrial Accidents Office of Investigations- 6QQ Washington Street Boston, MA 02111 W. #617-727-49-00 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 i Revised 11-22-06 www.mass-gov/dia II Client#:42270 NORTSEA 4/071 A-0RDTM CERTIFICATE OF LIABILITY INSURANCE M/DDlYYYY) 04/07/09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Rogers&Gray Ins.-So.Dennis ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 434 Route 134 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.0.Box 1601 South Dennis,MA 02660-1601 INSURERS AFFORDING COVERAGE NAIC# INSURED - INSURERA: Acadia Insurance Northern Sealcoating and Paving,Inc. INsuRERB: GUARD Insurance Group 20 Candlewood Lane P.O.Box 995 INSURER C: INSURER D: Dennis Port,MA 02639 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN.MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSIR ADD' LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATIONDATE MM/DD DATE MM/DD LIMITS A GENERAL LIABILITY CLA019849412 10/01/08 10/01/09 EACH OCCURRENCE $1 000 000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEDPREMISES(Ea occurrence) $250 OOO CLAIMS MADE Fx�OCCUR - MED EXP(Any one person) $5 000 PERSONAL&ADV INJURY $1 000 OOO GENERAL AGGREGATE $2 OOO OOO X GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS--COMP/OP AGG s2,000,000 POLICY PRO- JECT FRI LOC A AUTOMOBILE LIABILITY MAA019849512 - 10/01/08 10/01/09 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,OOO,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY. EACH OCCURRENCE $ OCCUR CLAIMS MADE - AGGREGATE $ DEDUCTIBLE RETENTION $ $ B WORKERS COMPENSATION AND NOWC904736 - 04/01/09 04/01/10 X we sTATU- oTH LIM - EMPLOYERS'LIABILITY rR ANY PROPRIETOR/PARTNER/EXECUTIVE - E.L.EACH ACCIDENT - $100,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT s500,000• OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Demolition of former Sun!-Sands Motel. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE - ACORD 25(2001/08)1 of 2 #S43417/M42769 KW © ACORD CORPORATION 1988 ' Town Of Barnstable Barnstable Administrative Services Procurement&Risk Management AUMedcaClty 230 South Street Hyannis,MA 02601 aAMUrAo• ul. s Y , r 1V1AS& www.town.barnstable_ma.us 36 9• A�Eo IV1I+ft h 2007 Johanna F.Boucher Tel 508.862-4741 Purchasing Agent/Contract Compliance Officer Fax 509-862-4717 joh anna,bouchcr®town.bamstable.ma.us April 24,2009 Via Facsimile: 508-394-0955 Northern Sealcoating & Paving, Inc, Raymond Caterino 20 Candlewood Lnae Dennis Port, MA 02639 Subject: Acceptance of Bid; Suni Sands MotelDemolition Project Dear Sir: Congratulations on being•the successful bidder for the subject project, Attached,please find the bid acceptance duly signed by the Barnstable Town Manager, Mr.John C. Kl:imm. The contracts are in the mail for signature. Please sign the acknowledgement portion and fax back to 508-862-4717. Please contact the Property Coordinator(Alisha Stanley) if you have any questions relating to the technical aspects of this project. The actual demolition should be scheduled through her upon the . final signing of the contracts anticipated to be within the next week or so. Time is of the essence for this project. Alisha Stanley,Property Coordinator/Project Coordinator Town of Barnstable 367 Main.Street,Hyannis, MA 02601 Tel 508-862-4749 Please fe ee to contact the undersigned if you have any questions. Reg J h a F. Boucher A. Parker /attachments I 'd 9 'ON 3AIldd1SINIW4b 318d1SN8d8 Wd85 :6 U E 'UV NORTHERN 20 CANDLEWOOD LANE, Box 995, DENNISPORT, MA 02639 (800) 287-9474 . TEL: (508) 398-9474 FAX: (508) 394-0955 May 13, 2009 Town of Barnstable 230 South Street Hyannis, MA 02601 Building Department To Whom It May Concern: Raymond J. Caterino is a full time employee here at Northern Sealcoating and Paving. He is covered under our workers compensation policy which is with Guard Insurance Group, policy#NOWC006637. Ray has permission to pull any and all permits that may be required. Respectfully submitted, Michael C. Collopy General Manager Massachusetts - Department of Pulflic SafetN Board of Buildin Re;;ulations an(I St�tn(Ijlr(Is Construction Supervisor License License: CS 83390 Restricted to: 00 RAYMOND J .CATERINO PC . .., PO BOX 1532 S DENNIS, MA 02660 Expiration: 8/14/2010 ( ranmi�si��ner Tr#: 3139 Restricted to: 00 00- Unrestricted 1H-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS 161 �e�€Il�-e�-lirv;il�lEtarstoua tYli�s �' Wiiter.Department " 7, F0.BOX 369`.1J38 hUM MEST < :: • lT4"Tfl3Elytt.t. M®SS.aiCHi158'f�5&�83 � x 410 t t t 3w' acceoa a C,. BOARD oa warm co�nms s; �ItATe a � 5 A WX7=suvexari MM DEFT r q ►ru sa e.iaatdv.: a. Oc Acr 28,2t S o 2 Town.C&Baaiimble - 8ialdngl)elit �:. _ 36TMsim Street:: Ra.Accarmt�Y.13Zb. Tomi 6fElumgtaM6 946 Ckaigv tle BeuciiRw d Cealewtlfe,MA Oa Friday,Cumber.24,2A0 we disixintea ed the wafzr seaviM line al.t6lo cuili<etap for the gzzvpeity rom'taanexl alxe aA youc rcquast. It is our icnc3eaatxndi8'tltat � t buelding wM be C anoli era if youbavc auy quxstiads;please call ouroffice ai 508-428=0691. Very tnily)yawn _ Cram_ ker, siveriworAcnt. b c� OCT/10/2 .p$/T i1 00:52 �+� C=0 t�IM CATER DEPT. FAX N'O - r P. 002 Account Number 1.32E No. Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION - BARNSTABLE, MASSACHUSETTS aitpoal *paem Cougtructiou Permit Permission is hereby granted to Construct ( e� r ) U ade ) Ab nd n ) System located at 1� and as described in the above Application for Disposal System Construction Permit.The applicant recognizes his/her duty to comply with Title S and the following local provisions or special conditions. Provided: ConsLtny,16on m st be completed within three years of the date of this Date Approved by • L 0 CA T 110 a•�S ����` S -E W A-G E PE RMIT NO. q q raiRVAL P, VILLAGE I N S T A LLER'S NAME i ADDRE'SS. 9 �,, R U I L D E R OR OWNER , A DATE PERMIT ISSUED DATE COMPLIANCE ISSUED 1 L A 25 r . . _. �+� �. ,;:. 3 �/ ��'. i ,O �°�. .. � �` - �ry_ �� r.. .F } { s � � �` ;, _ � j �� ... - - � - r .. �' JUN• 17. 2009 .11 : 51AM NO. 845 P. 2 nationalgrid 44 O GRGU�y 2Q09 Mr,,y�G�M�Nr June 17, 20.09 Attn: Alisha P. Stanley @ Town of Barnstable Re: 946 Crai ville Beach Rd Centerville Ma 02632 This letter is to notify you that the gas service located at 946 Craigville Beach Rd Centerville, Ma was cut off at the main on 6/11/09. If you have any questions, please feel free to contact me 781-907-2921. Regards, Celeste Murphy National Grid 40 Sylvan Rd - E2 Waltham, Ma 02451 781-907-2921-tel# 781-907-5738-fax# i STAR One NSTAR Way EL EC TH/C Westwood,Massachusetts 02090 GAS June 10, 2009 Alisha Stanley Town of Barnstable Barnstable MA RE: Disconnect electric service at 946 Craigville Beach Rd. CentervilleMA STAR w/o#1717139 Dear Alisha, Your request to have the electric service disconnected at 946 Craigville Beach Rd Centerville MA.,has been completed as of 6-11-09. Please call me if you have any questions at 781-441-8311. Sincerely, Kathy white NSTAR Company r May.•13.. 2009; 9.4:9AM No. 0512 P. 2 Town of Barnstable O Aegulatoiy Services �BrAe� a s Thomas F.Geiler,Director o,�a* BuRding Division Tom Perry,Sullding Goixuw*sioner 200 Main.Street,Hyannis,'NIA 02601 www:town.barnstable.ma ms Office: 508-862-403 8 Fax: 508-790-6230 Property der Mils' Complete:axed.Sign.This Section If Using A builder 6.tt � raj ' e-fpWnDHo 'V(''t ) as Owner of the subject property hereby authorize ) VAV}04 T 1(i' to act on,my behalf, in au matters relative to work authorized by this building pemut-application for. v�He &AUA W) CV1 II (Address of job, attire of Owner Date 1 Print Narne If Property Owner is applying for pen-nit please complete the Homeowners License .Exemption Form on the reverse side. Q:FoxMS;0NVNEIt PKM15SIGN L �z w4�,f - Environmental: "Health and Safety is Our Top Priority" : .Response Services,Inc. PO Box 70190,North Dartmouth,MA 02747 Phone(508)998-6229 Fax(508)995-1456 April 15, 2009 Town of Barnstable 367 Main Street �PR 15 ?009 Hyannis,MA 02601 GRp Attn: Alisha Parker wTh 1v;c;NAGEM ENr Re: . Asbestos Abatement Final Completion Report for 946 Craigville Beach Road,Barnstable,MA Dear Alisha: _ s Environmental Response Services,Inc. (ERS), a Massachusetts licensed asbestos contractor(#AC000412),was contracted to remove and dispose of all asbestos containing linoleum,floor tile&mastic and floor leveling.compound at the above d. referenced location. The project was started and completed on February 9,2009. All work was conducted in accordance with local, state and federal regulations. _ Thank you for the opportunity,for ERS.to provide our services: Please do not hesitate to call me at 508-998-6229 if you have any questions. Sincerely, ERS : Gary Pelletier Business Manager Environmental Consulting and Contracting FEB 182009 ENVIROTEST LABORATORY, Inc. 307 Pond Street Westwood,MA .02090 T:781-278-0080 F:7 8 r*-7 NA4M e es!ab.com oyVrao Environmental Response Services 9 Blueberry Lane North Dartmouth,MA 02747 RE:Asbestos Air Testing: . 946 Craigsville Beach Rd. Barnstable,MA PROJECT :42629 To whom this may.concem, Please find enclosed the air results taken on February 91 2009. Envirotest,was contracted to perform. air sampling for airborne fibers at the address cited above. All samples collected,were analyzed by Envirotest Laboratory for the determination of an airborne fiber count. The analysis was performed in accordance with"Phase Contrast Microscopy NIOSH Method,7400." Envirotest Laboratory is accredited under the Proficiency Analytical Testing Program for air analysis by Phase Contrast Microscopy. Envirotest Laboratory is also certified by the State of Massachusetts for analytical Services. If you have any questions concerning your results;this report or the analytical methods employed, please feel free to call me at(781)278-0080. Sincerely, Samuel N. Cohen Industrial Hygienist enc. Envirotest Laboratory Is.Accredited By The Proficiency Analytical Testing Program(AIHA) or . ENVIROTEST LABORATORY, Inc. Q�a� aotv:Iu 307 Pond Street Westwood,MA 020W T:781-278-0080 F:781-278-0090 www.etestlab.Com CEp 1 IM%AMPI ED BY:SMITH D ANALYZED BY:SMITH PROJECT#:42629 ;F PncN' SAMPLE SAMPLE SAMPLE START STOP. TOTAL FLOW VOLUME GRQWTH DATE TYPE . LOCATION TIME M E. MEN. RATE BLANK 1 020909, BLANK XXXX XX)= 300M 3CXDM 300000X BLANK 1. SAME BLANK XXXX XXXXX 300M XXX30C XXX00XX UNIT 2 BATHROOM INSIDE ERS- 1. SAME PCM CONTAINMENT NEXT TO HEPA . 3:05 4:26 80 15/15 1200 UNIT 6 BATHROOM INSIDE ERS-~1 SAME PCM CONTAINMENT NEXT TO HEPA 3:08 4:28 80 15/15 1200 EPA RECOMMENDED RELEASE CRITERION OF 0.01 FIBERSICUBIC CENTII�IEETER OSHA PERMISSIBLE EXPOSURE LIMIT OF 01 FIBERS/CUBIC CENTIIyiETERCONTRACTOR:Environmental Response Service SUMMARY. IFABOVERESULTSAREA O.Ol FIBERSICUBIC CENTIMETER AREA PASSES LOWESTALLOWABLB LIMITS SET BYOSHA AND THE EPA . ' Ffe 1.8 2D49 RO114 wTH Commonwealth of Massachusetts NT 100083973 Asbestos Notification Form ANF-001 Decal Number Imporen tant: nt:ing cut A. Asbestos Abatement Description forms on the 1 a. Is this facility fee exempt city,town district,municipal housing authority,owner-occupied computer,use tY P ' � P 9 tY. P only the tab Ivey residence of four units or.less?- Yes ❑No' to move your cursor-do not b. Provide blanket decal number if applicable Blanket Decal Number use the return key. 2. Facility Location:. SUNI SANDS 946 CRAIGVILLE BEACH ROAD a.Name of Facility b.Street Address BARNSTABLE IMA, 102632 (508)8624782 c.City/Town d.State e.Zip Code f.Telephone Number INSTRUCTIONS 3.'.WOrkSIte.LOCation: t.All sections of this BATHROOM_ F form must be a.Building Name/Building Location, b.Building# c.Wing d.Floor e.Room completed In order to comply with 4. Is the facility occupied? ❑Yes M No: DEP notification requirements of 310.5. Asbestos Contractor. CMR 7.15 and the Division ENVIRONMEN of Occupational TAIL RESPONSE SERVICES INJ 98 CAMBRIDGE STREET Safety(DOS) a.Name b.Address notification . MIDDLEBORO 02346 5089986229 requirements of 453; CMR 5.12 C.Cityrrown d.Zip Code e.Telephone Number . AC000412 . g, Contract Type: Q✓ Written Verbal Y .DOS License Number h.Facility Contact Person I.Contact Person's Title 6 DENNIS E.CHAPLIN SR. ASO40170 a.Name of On-Site Supervisor/Foreman b.Su rvisor/Foreman DOS Certification Number SAM COHEN IAM060787 a.Name of Pro ect Monitor b.Pro ect Monitor DOS Certification Number . EN.VIROTEST AA000128 8' a.Name of Asbestos Analytical Lab b.Asbestos Analvtical tab DOS Certification Number 02/09/2009 02/09/2009 9' a.Project Start Date mm/d b.End Date mm/dd/ 0 18AM-4PM N c.Work hours Mon-Fn. d. ork hours at-Sun. _ 10. a.What type of project is this o ❑ Demolition 0 Renovation Repair Other, please specify: b.Describe 11. a.Check abatement procedures: o Glove bag . . Encapsulation —o. Enclosure Disposal only �LL Cleanup ❑Other, specify: 0 Full.containment b.Describe Commonwealth of Massachusetts -- 100083973 Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cont.) 5. �_�._..._.. ... a.Name of General Contractor b.Address � . c.City/Town d.Zip Code e.Telephone Number area code and extension f.Contractor's Worker's Comp.Insurer g.Policy Number h.Exp.Date mm/dd/ 6. What is the size of this facility? ty a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1.' Transporter of asbestos-containing material from site to temporary storage site(if necessary): ERS,INC. 98 CAMBRIDGE STREET Note:Transfer a.Name of Transporter b.Address Stations must MIDDLEBORO !1 02346 (508)923-1111 7 comply with the c.City/Town d.Zip Code e.Telephone Number Solid Waste,. c Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: ..Regulations 310 ' - CMR 19.000 RED TECHNOLOGIES, LLC 10 NORTHWOOD DRIVE - a.Name of Transporter b.Address BLOOMFIELD 06002 (860)218-2428 c.c Cityrrown d.Zip Code e.Telephone Number .3. J .. a.Refuse Transfer Station and Owner b.Address c.Ci /Town d.Zip Code e.Telephone Number. 4 IMINERVA ENTERPRISES INC a.Final Dis osaI Site Location Name b.Final Disposal Site Location Owner's Name 9000 MINERVA ROAD WAYNESBURG c.Final Dis osal Site Address d.City/Town OH 44688 . e.State f.Zip Code g.Telephone Number. o D. Certification The undersigned hereby states,under the. IGARY PELLETIER penalties of perjury,that he/she has read the a.Name b.Authorked Signature o Commonwealth of Massachusetts regulations JBILISINESS MANAGER � 11128/2009 for the Removal,Containment or c.Positionfritle_ d.Date Imm/dEncapsulation of Asbestos,453 CMR d/yvw) 310 CMR 7.15,and that the information and (508)998-6229^ JERS, INC. contained in this notification is true and correct. e.Telephone Number f.Representing to the best of his/her knowledge and belief. 9 BLUEBERRY LANE MMM- -Io - a.Address DARTMOUTH i 102747' , "•- h.City/Town I.Zlp Code. Commonwealth of Massachusetts ■ Decal Number Asbestos Notification Form'ANF-001 A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed,enclosed,or encaDSSUlated: 0 65 a.Total pipes or ducts(linear otal otner su aces(square c.Boiler,breaching,duct,tank �J d.Insulating cement t_�J surface coatings Lin.ft. S .ft. Lin.ft. S ft. e.Corrugated or layered.paper f.Trowel/Sprayer coatings pipe insulation Lin.ft. S .ft. Lin.ft. Sq.ft. g.Spray-on fireproofing h.Transite board,wall board L__J Lin.ft. .ft. Lin.tt. i.Cloths,woven fabrics J.Other,please specify: n 65 S Lln. S .ft. k.Thermal,solid core pipe VAT$MASTIC insulation Lin.ft. q. 1.Specify _ 14. Describe the decontamination system(s)to be used: THREE STAGE DECON ADJACENT TO WORK AREA :15. Describe the containerization/disposal methods to comply with 310 CMR 7;15 and 453.CMR 6.14(2)( ) WET ACM AND PLACE IN DOUBLE LABELED 6 MIL DISPOSAL BAGS 1.6..For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: a.Name ol DEP Officialb.Title c.Date mm/dd/ of Authorization d.DEP Waiver# e.Name of DOS Official L UU5 Officialitle N g.Date(mm/dd/Yyyy)of Authorization h.DOS Waiver#. 17. Do prevailing wage rates as per M.G.L.c. 149,.§260 27 or 27A—F apply to this project? ❑7 Yes No B. Facility Description N —0 1.. ..Current or prior use of facility: MOTEL 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes .0✓ No TOWN OF BARNSTABLE 1 1367 MAIN STREET . 3' a.Facility Owner Name b.Address ` ._.° HYANNIS 02601 (508)862-4782 o c.Ci /Town d:Zip Code e.Telephone Number area code and extension NA �u 4 massammamma.Name of Facility Owner's On-Site Manager b.On-Site Manager Address FROM :ERS., I NC: FAX NO. 5089230929 Feb. :.04 2009 01:14PM P2 � . , • Commonwealth of Massachusetts _ "`•,,h FEB 4' 2009 I10008397i J v bestos Notification F rmm AAN F-001 Decal Number- ��,....., �ROW1H MANAGEMENT Important:When fllling out A. Asbestos Abatement. Description forms on the computer,use 1. a. Is-this facility fOe exempt-cl town, district, municipal housing authority, d owner-occupie only the tab key residence of four units or less?W Yes . ❑No _ to,move your cursor-do not b.Provide blanket decal number If applicable: .--- —......: •; use the return Blanket Decal Number key: 2. . .Faclllty Location: SUN! SANDS 946 CRAIGVILLE BEACH ROAD e:.�O1113..pt raGlllt � _._ b�Street �_-_ �BARNSTABLE '� 02t332 �5088624782 CitylTown d.Slate -• e•ZI Code p �.T ele hono"N`"" p umber INSTRUCTIONS 3.:: Workslte Location. 1,All sections of this BATHROOM E_� form must be a.BuIlding Name/8ullding Location b.Building# c:Wing �" completed In order Floor a.Room: to comply with 4 Is the facility occupled?. D Yes P/✓ No DF.P notification requirements of 310 CMR 7.1f, 5 Asbestos Contractor. a id the Division of Occupational ENVIRONMENTAL RESPONSE SERVICES IN 98 CAMBRIDGE STREET . Safety(DOS) �� -� notification amo b�Address requlrementeof453 : MIDDLEBORO 02346 r5089986229 — - CMR 8.12 c.Chown I Zf Code e;Telophone Number - rAC000412 a�TcanAe Num er g. Contract Type: �_✓.�Written Verbal :.__. . ac 'ontec or:;on � +� i.Contact Person'R rUo _- DENNIS E,CHAPLIN SR. A 040170 Nam foe on Slle Su ervls M� p oror F°T bbSupetvl�or�Foraman DOS Certlflcotlon.NumYb�er `- �sAM COHEN AM060787M 7• a,Name of Pro,�oMonitor ------,I _ ENVIROTE9T '• b.Pro act Monito os`— ion Numbei ---� .- I—_.. -__Certiflcal 8' n,Name of Asbosto AA000128 r -- a Analvtic9l Lab Asbastoakl; Lab DO 9_ 2/9/2009 I_,_1 $ , ert&c.j9l.QON �� 2/9/2009 ° a.Pro ect�rt�at, mmlga/vriVl b.E �hotjrs' ml ddl N c, or<hours�uTon FN, d.. 3un `""'—'""""��•---- 0 10. e.What type of project is this? - El Demolition �� Renovation Repair .. , Other, please specify b.Describe — - 11. a. Check abetement procedures; o Glove bag []Encapsulation RRRMR� - o Enclosure ❑ Disposal only LL ' Cie anup . �] Other, specify. ra/] Full containment � P I b,Describo - Q 1Z Is the lob being conducted: C]✓ Indoors? El Ootdoorsl .WOO 1ep.doc-10/02 Asbeatos Notification* orrn•Page 1 of 3 FROM,. :EfRS,.,.: INC. FAX NO. .:5089230929 Feb.. 04 2009 01:15PM :P3 Commonwealth of Massachusetts _ _ Asbestos. Notification:Foam ANF.001 5 Ca 1 Number' A. Asbestos Abatement Description (cont.) 13: Total amount of each type of Asbestos Containing Materials (ACM)to be removed, enclosed, or enca,2eulated: 0 65 . a.Total pipes--- or ,uc s near o a o er sur aces square c.roller,breaching,duct,tank surface coatings �In•ry g f` --•' d.insulating cemont �J Tn.ft. K. e.Corrugated or layered paper pipe Insulation Lin,ftt_ . S .ft f•Trowel/Sprayer coatings Lin ft. Sq. t. q,Spray-on flreproonng � � h.Transite board,well board .1 �Lin ft, Sq.ft. in�ft• SgrTf. i.Cloths woven fabrics Olher, E� 165 � Lin,ft. 5q ft• J. please specify: TIL k:Thermal,solid core pipe. IC VAT 8 MA37 insulation �q.ft . - 14. Describe the decontamination systems)to be used:" THREE STAGE DECON ADJACENT TO - - WORK AREA 15. Describe the containerization/disposal methods to:Comply with 310 CMR 7.15 and 453 CM 6.142 ��)s- ` WET ACM AND PLACE IN DOUBLE LABELED'6 MIL DISPOSAL BAGS 77____.___ 16 For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: -P-Uffc all Mr T to c.Dotesm`m/ �of Authorization d.DEP Waiver if a,NamOrr e of DO Official. -- J Ica Tltw N g,Oato(mm%dd%yyyy)of Auttiorizahon -- h.D03 Waiver# ' 0 17. Do prevailing wage rates as per M.G.L. C. 149, §26, 27 or 27A-F ap I to this ro- p Y p ject? [�i Yes Q No ° B. Facility Description N o 1: Current or prior use.of facility MOTEL -_— p. 2 Is the facility.owner-occupied residential with 4 units or less? . El Yes 0,1 No TOWN OF BARNSTABLE 3' a,Faciht -- 367MAIN STREET o Owner -- Namo b•Adair _.. 4 �w ess HYANNIS 02601 -'�`"'"_ o c.City/Town 508 862-a7821. d.Z Code ffTelehone Number a e- —J NA 7' _ r a co e d end oxtenslo' _U. n) a.Name of_�_Faclll O Hors On-She Manager Z. ,____—, b,On-Site MenaOer Address _., �" "."""•'� ;:;]. c,Clty/Town d. e.Telephone Number area code and ext®ne Ion) anfoo1 ap.doc-10/62 Asbestos Notification Form r Page 2 of 3 O FROM ERS,'.. INC. .� FAX'NO.: •:5090230929. Feb. 04 '2009 01:15PM P4 Commonwealth of Massachusetts 00083973 Asbestos Notification f orM ANF-o01 peoalNumber B. Facility Description (cont.) 5 a•Name of�GonerE31 Contractorb.Address Cit /Town d.Zi Code e,Tole hone Number area code and extenslon�_ J f.Contractor'a VVorkor'e Comp.Insurer . Poll Number _ a---`� - h&M.Date(mm/dd/Yyy 6. What is the size of this facility? a.Squaro Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site (if necessary): I Na a of Tr Note Tranefe� anPt)ortor 98 CAMBRIDGE STREET---- __ ........... Stations must MIDDLEBORO b.Address 0234B 508 9231111 -^-�" comply with lho C.Clly/Town _ Solid Waste d.Zip Code e.Telephone Number^ — Division ----- Regulations 310 2 Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: cMR 1s.000 RDCHOLOGIES, LLC a.Name of Tea r0 NORTNWOOp DRIVE �B _.. 8b8.A0d�2d r1a8ssOMFI~LDO µ06 002 c.Cx/ToWn 2�428 .. M_ 3. "_ _Code d Zlu e Tel Number a•Refuse Tronsfer Station and Owner r-----�--., b•Adr_dress _� d Zip Code e•Tele hone Number 4. MNERVA ENTERPRISES INC - -w lnal DI p Slto Locallon Name b.Final DI - ^~ 9000 MINERVA ROAD �"—' sl°$al Slte Locelion Owners Name _ cJF an ►s 0 site ress WAt /TownNES RG I ' ON d,Clt !Town 44688 ---—_. -----------: o_State - f.Zip Code T�--- --- �_ --------- .. g e ephone Number ° D. Certification .r N The undersigned hereby states, under the GARY PELLETIER ��' ' penalties of perjury,that he/she has read the ((`"G'"ARY PELLETIER Y. o Commonwealth of Massachusetts regulations. b,Authorized SI ngnature for the Removal, Containment or BUSINESS MANAGER 01/28/2009 Encapsulation of/lsbestos,453 CMR 6.00 and c.PosltioNTllle ""' --- .- 31t)CMR 7.15,and that the information ; 508 9986229 w.� (ERS INC. contained In this notification is true and correct e.Tele hone Numbo�r_. to the best of his/her knowledge 9 BLUEBE R�resenting' �� and belief, �� RRY LANE Address F1 LL DARTMOUT 0�2747 Z h,Cltyllown "� L____ y� I.ZI Code BEM Q an f001ap.doc 10/02 Asbestos Notifiral.lon'Form page 3 of 3 , Hazardous Materials Inspection Report 946 Ctaig-ille Beach Road Barnstable, Massachusetts Town of Barnstable Barnstable, Massachusetts 6, 2009 E.,:. FUSS�,O'io EI L Disciplines to Deliver Fuss &O'Neill EnviroScience, LLC 50 Redfield Street, Suite 100 r Y Enviroscience. LLC: Di ci drone to Dehijer .January 6,2009 Ms.Alisha L.Parker Town of Barnstable 367 Main St.,.V Floor Hyannis,MA 02601 RE: Hazardous Materials Inspection;Report 946 Craigville Beach Road,Barnstable Massachusetts Fuss.& O'Neill I nv roScience,11 C Project,No.2008081.3-A2F Dear Ms. Parker: Enclosed is the report for the I Iazardous Materials Inspection performed at 946 Craigville Beach Road in Barnstable,Massachusetts. The inspection was per.fo.rmed on October 15,2008 by a Fuss& O'Neill 1~:nviroSc once, LLC licensed inspector. If you have any questions regarding the contents of this.report,please do not hesitate to contact Bob May at 61.7-282-4675,extension 4701. 'Thank you for this opport-Lmity to have served your environmental needs. Sincerely, �'.O 114<311Cidl SUc,Ct ;4!4,. 1001 Robert L. May,Jr. Stephen W. Connelly lstt,t,=t,,,Ul:A Vice President Senior Vice President tl; RLM:adw Enclosure Y:\P2()8\0813\A2Ti\MI7D_94GCriigcilleBeacliltd I-lazimatRpt_20090106.doc. | � G ��� su°un�d�pcxu« � Road - T47wnof BamstableTABLE OF CONTENTS SECTION PAGE 1.0 IND]l[)DDC7l(JN_^_..._ .........^.........'—'...... -- .............................. ~........... ......... 1 1 2]0 ASBESTOS INSPECTION---._-----r ............ — ...................................... ---� 21 Introduction.................................................................................................................... l 2.2 Results ---.--.-------_------------.--_—....._—.-----2 2.3 Discussion............................................................................ ..........................................3 24 Conclusion................. ....................................................................................................4 jD ]JE/\[]-BA8I�l] PAINT '_._.---.--'-----------..4 3.1 Results........... ...... .................... ............ -__—,_...^'..—_—,-_---. 3.2 ........^,_______,_^^__,~~_,~~....... _ .................................. —.5 3.3 Conclusion................. 'r~ ...... —'--.. ` —'�='r '---+ .''-6 4.0 8jklIAb �AN. D NIFfLURY- .^ ..............6 4.1 ``,-__'—.--_' 4 6 � ~ .�'^_-~~,-�'~.�_-_�-'—_--°—.-^^6 ' | 4.3 6 ---''—,~,—,,---_-'—`'r'----'--'—' 4.4 Rcuubo�,.---._.'_.---_...~_^.'".^^—_—_`--.~'�_'-------6 ' � - - APPENDIX A lLICENSFS/CERTIFICATES AP]9ENDC&D ASB�SIl]3 5A]�Pl��lQE3l]I�[8Al�[���B��IN8 (JFCU5T()I�,� � . ^ � � . � � � . � . . � ' . ^ � . ' ' . ^ . - . . � � � o�a^ ' ` ` FUSS&OWEILL Envirokience,u.c 1.0 INTRODUCTION On October 15,2008,Fuss and O' Neill EnviroScicnce,LLC (EnviroScience) Senior Engineer Michael Delaney performed an inspection for hazardous materials at 946 Craigville Beach Road in Barnstable,Mid . Mr. Delaney is a licensed asbestos inspector in the Commonwealth of Massachusetts. Refer to Appendix A for licensing documentation. This inspection was performed for the Town of Barnstable in accordance with our written scope of services dated October 9, 2008. The work included a destructive inspection for asbestos containingmatenals (ACM),limited screening.of painted surfaces for lead and an evaluation of fluorescent light fixtures for PCB ballasts and,light.tubes for mercury. This hazardous building material inspection was performed in responseto the proposed demolition of the building known As the former Suni Sands M6tbl,. 2.0 ASBESTOS INSPECTION 2.1 Introduction During this inspection, suspect.Asbestos-Containing Materials (AG\,L were separated into three USEiA categories. These categories areThermal System Insulation (TSI),Surfacing ACM,and Miscellaneous.ACM. TSI includes all materials used to prevent heat loss or gain or water condensation on mechanical systems. Examples ofTS1 are pipe 'insulation, boiler insulation, duct insulation,and mudded insulation on pipe fittings. Surfacing M-1\4 includes all ACM that is sprayed, troweled,or other wiscapplied to an existing surface. Surfacing ACM is commonly used for fireproofing, decorative,and acoustical applications. Miscellaneous materials include all ACM not listed as thermal or surfacing,such as linoleum,vinyl asbestos flooring,and ceiling tiles. Fuss and O'Neill E n-viroScience sampled all suspect ACM discovered during this destructive survey. Materials that were sampled are analyzed by Polarized Light Microscopy 0LM). During the survey,ACM was quantified in linear and square footage,depending on the nature of the material. Locations,material type,sample identification,and asbestos content.of ACM identified by bulk- sample analysis are given in Table 1 of the Results section. Materials determined.ed to be non-asbestos containing are included:in.Tables 2 of the Rcsult-s section. The Inspectors collected samples"of suspect asbestos:'containing materials in accordance with United States Environmental Protection Agency (USEPA)recommendations and Asbestos Hazard Emergency.Response Act(AHJLRA) protocols.. The protocols included the following: 1 Surfacing Materials (such as plaster,spray-on fireproofing,etc.)were collected in a randomly distributed manner representing each homogenous area based on the overall quantity represented by the sampling as follows: a. Three (3) samples were collected from each homogenous area that is less than or equal to 1,000 square feet. b. Five (5) samples were collected from each homogenous area that is greater than 1,000 square feet but less than or equal to 5,000 square feet. C. Seven (7) samples were collected from each homogenous area that is greater than 5,000 square feet. Y:\I>2008\0813\,NM-*\Ml,'I)�-1)4OCrai,villeBeachRd'F1avA,1atRpt_2(XY)0106.doc f FUSS&OW ILL ` F.nviroseience,w; 2. Thermal System Insulation (such as pipe insulation, tank insulation, etc.) was collected in a randomly distributed manner representing each homogenous area. 'Three (3) samples were collected from each material. Also,a minimum of one(1) sample of any patching materials applied to TSI presun ing the patched area is less than 6 linear or square feet was also collected. 3. Miscellaneous Materials (such as floor tile,construction mastics,etc.)had a minimum of one (1) sample of each homogenous material type. Sampling was conducted in a manner sufficient to determine asbestos content of the homogenous material. In some instances,more than a single sample was collected of miscellaneous materials based on the judgment of the.inspector. Inspector(s) collected samples and prepared proper chain-of-custody forms for. transmission of samples to an accredited laboratory for;analysis,by Polarized Light Microscopy (PALM). 2.2 Results Utilizing the USEPA..protocol and criteria,thc.folloti ii.ng materials that_were sampled during this survey were determined to be ACM`"(Asbestos 1%`or greater): TABLE 1 Asbestos-Containing Materials ACM SAMPLE LOCATION MATERIAL TYPE SAMPLE NO. ASBESTOS CONTENT Unit#2 Bathroom Stone Pattern Linoleum 1015MD-03 5%Ch •sotile 12"x12" Stone pattern 1015MD-09 2 Unit#6 Bathroom Floor'Tile Nlastic. Mastic Io Chrysotile Unit#6 Bathroom Floor Leveler 1015MD-1.7A 7%.Chrysotilc Utilizing the USEPA protocol and critcria,,the following materials were determined to be non- ACM: TABLE 2, . Non-Asbestos Contain Materials `SAMPLE LOCATION MATERIAL.TYPE SAMPLE NO. Throu bout Sheetrock-Walls and C&ilinAs 10151N4D-01A-G Throughout Joint Compound. 1015MD-02A-G' Throughout Ceiln 'Texture; 1015N'ID-03A-E Office Bathroom, l ' ht B1ue'Ilnoleum 1015NID-04A Kitchen ' Light Blue Linoleum 1015MD-04B - Kitchen Adhesive Associated With ldght.Blue 101.5MD-05 I dnoleum Rear Closet 12"x12"Blue Floor Tile 1015MD-06A _ Office Kitchen/Storage 12"x12 Blue Floor Tile 1015MD-06B Unit#4 Bathroom 12"x12 Blue Floor Tile 1015MD-06C Unit#5 Bathroom White Linoleum 1015MD-07 Y:\P2008\0813\A2L\NMI l)_94GCrai}n llcEi�achRd !1vNlatRpt_20090106.doc 2 FUSS.&O'NEILL Envirokience,u.c. SAMPLE LOCATION MATERIAL TYPE SAMPLE NO. Unit#3 Bathroom Bei e 12Y:12 Pattern I noleutn 1015MD-10 Unit#1 Bathroom 9x9 Pattern Linoleum 1015MD-11A Unit#2 Bathroom 9x9 Pattern Linoleum 1015MD-11B Rear Bathroom Beige Linoleum 1015MD-12 Unit#5 Grey w/ Black Floorin 1015MD-13 Unit#5 Grey w/Black Floorin ,Pa er.laver 1015MD-14 Front Bathroom file Grout 1015MD-15 Unit#6 Tan Flooring Adhesive 1015MD-16 Kitchen Floor Leveler 1015MD-17B Exterior Siding Black House Wrap 1015MD-18A-C; Roof Shingle 1015MD-19A-C Garage Exterior Siding Black House Wrap. 1015MD-20A-C Garage Roof Shingle 1015MD-21A-C The results of laboratory,analysis summarized above are located.in Appendix B. 2.3 Discussion The USEPA, Occupational Safety and Health Admiriistration.(OSHA),and the Commonwealth of Massachusetts Division of Occupational Safe y (DOS) defines any material that contains greater than one percent(>19/6) asbestos,utilizing PI.M, as being.an ACM. The Commonwealth of Massachusetts Department of.Environmental Protection (N1ADEP) defines an asbestos-conuw'u'ng material as any material containing equal to or greater than 1% asbestos. Materials that are identified as "none detected" are specified as not containing asbestos. Friable materials that are identified as containing less than ten percent(<109,16) asbestos are recommended to be analyzed further utilizing the point-counting technique to verify asbestos content in accordance with the USE:PA. EnviroScience performed no point counting on any samples collected. Materials that are uniform in color and texture are commonly referred to as "homogeneous". Materials that may become crumbled or reduced to powder by impact or hand pressure are referred to as"friable". The inspection identified non-friable ACM that will be impacted by the proposed demolition. The following list indicates identified ACM in this survey. TABLE 3 Estimated Quantity and:Location of ACM MATERIALS TYPE LOCATIONS QUANTITY SAMPLE NUMBER _ Stone.Pattcrn.Linoleum, Unit,#2.Bathroom 35 Sl" 1015MD-08 12"x12"'Stone pattern Unit#6 Bathroom 30 SF, 1015MD-09 Floor"file Mastic Mastic Floor Leveler Unit#6 Bathroom 30 SF 1015M.L D-17A SF = Square Feet Y:\1'2(M\0813\A213\.\11,'1?_946Craig•ilieBLacliRd i1^aY.MatRpt 20090106.doc 3 FUSS&O'NEILL ____....._ EnvimScience,i.i.c 2.4 Conclusion -`-� "I'he materials determined to contain asbestos that will be impacted by the demolition work . must be abated by a licensed Asbestos Abatement Contractor prior to disturbance in building demolition or renovation. This is a requirement of the Commonwealth of Massachusetts, DOS, DEP and USETA National Emission Standards for Hazardous Air Pollutants r (NESHAP) standards for asbestos abatement. Any suspect material encountered during renovation/demolition that is not identified in this report,as being non-ACM should be..assumed to be ACM unless sample results prove otherwise. 3.0 LEAD-BASED'PAINT'DETERMINATION A lead'based paint deterrzvnation`was performed by Puss&ONT6ll l nviroSaience,,L1,C representative,Michael Delaney,on October .15,2008. .An X-ray fluorescence (h'RI� analyzer was used to perform the lea.4based paint detern ination. A Radiation Monitoring.Device Model l.: A-1,serial number 1015 was utilized for the lead based paint dete:rinination. The instrument was:checked for proper calibration prior,to each use as detailed by the manufacturer and the Performance Characteristic Sheet(PCS) developed for the instrument. For the purpose of this lead based paint determination,various interior and exterior components representing the initial painting history of the building and any building-wide repainting by the owners/managers of the building components were tested. Of course, individual repainting efforts are not discoverable in such a limited program. Lead based paint issues involving properties that are not residential,are regulated to a limited degree to worker protection involving paint disturbing work activities and waste disposal. Worker protection is regulated by'OSHA regulations as well as DOS regulations. These regulations involve air monitoring of workers to determine exposure levels when disturbing lead containing paint. .A lead'based paint determination cannot determine a safe level of lead but is intended to provide.guidance-as to.,the locations of what arc considered industry standards for lead in paint. Contractors may then better determine exposures of workers to air borne lead by understanding die.diff tent c6ncentratidns of head paint"on representative components and surfaces. Air monitoring can then be,performed.during,activities that disturb paint on representative surfaces. The USEPA Resource Conservation and Recovery Act(RCRA)as well as DEP regulate disposal of lead containing waste.- Waste materials containing lead that will be,impacted during renovation or demolition and result in wastee for disposal must be tested using the'Toxicity Characteristic Leachate Procedure(TCLP)-analysis if lead is determined to be present in non- residential buildings. A TCLP sample is a representative sample of the intended waste stream. The,results are compared to the level of greater than 5,0 mg/I,that is considered hazardous lead waste. If the result is below the established level the material is not considered hazardous and may be disposed of as normal construction debris. Y:\P?008\08{3`r12t:\i 91 1)_94G(;raicn itici3caclrltd_Fl v.MatRpt_2(X)9t)10G.doc 4 0nFUSS&O'NEILL ;a. EnviroScience,u.c A level of lead paint exceeding 1.0.milligrams.of lead per square centimeter (nag/cm� is considered toxic or,dangerous f6r compliance vv tla:residcntial,;standards. For purpose of this lead based paint determination the level:i f 1.0 mg/cm'has been utilized as a threshold for areas where possible worker exposures may. occur. 3.1 Results The lead based paint determination indicated consistent painting trends throughout the building interior and exterior. A limited number of exterior painted components were determined to contain levels of lead (greater than 1.0 rng/cm� including the following: TABLE 4 Lead Painted Building Components LOCATION ITEM READING(mg/cm) Exterior Door Trim 7.1 3.2 ' Discussion OSHA published a Lead in Construction Standard(OSHA Lead Standard) 29 CFR 1926.62 in May 1993. The OSHA lead Standard has no set limit for the content of lead in paint below which the standards do not apply: The.QSIIA Lead Standards are task-based and are based on airborne exposure and blood lead levels. The results of this survey are intended to provi le guidance to contractors for occupational exposure control to lead. Building componentscontam.ing lead levels above industry standards may cause exposures to lead above OSHA standards during proposed.demolition. A TCLP sample to characterize the expected waste that will result froth the proposed demolition work is not required due to the limited number of materials containing lead paint. The intent is to fully demolish the structure and the limited amount of lead painted materials will not result in the entire waste stream exceeding hazardous waste limits. EnviroScicnce can collect a sample of proposed demolition waste if requested. 3.3 Conclusion Contractors must be made aware that OSHA has not established a level of lead in a material below which 29 CFR 1926.62 does not apply. Contractors shall comply,.rith exposure assessment criteria,interim worker protection and other requirements of the regulation as necessary to protect workers during any renovation work which will impact lead paint. Disclaimer: The information contained in the sumo y report coneernitig the presence or absence r f leadpaint does Trot constitute a cot*rehensive lead inspection-in accordance with Cormmonwealth of Massad iusetts ngulal ons 105 C NIR 460. The su faces tested represent only a portion of those surfaces that would be tested to(keryminewhether'tbe premises air in corirpkgnce lvith the afgrrmentioned regulations wbich are speck to a child ocerrpied residence,Duly and not applicablc.to cz:br"rilcling of this type and use. Y:\p20ilH\f1813`�:121 1�11'U 99FCraiq�'il]eBcachltd 11a7.Matltpt 2ff)0100.doc 5 FUSS U'NEIL F,nviroScience,4u; 4.0 PCB-CONTAINING FLUORESCENT BALLASTS.AND MERCURY- CONTAINING LAMPS 4.1 PCB-Containing Fluorescent Ballasts On October 15, 2008 EnviroSciencc's representative,Michael Delaney,performed an inspection of representative fluorescent light fixtures to identify possible PCB-containing ballasts. Typical ballasts were examined in-place on ibeir fixtures for evidence of"No PCB"libels or for manufacturer's information that could be used to determine the PCB content. If neither of the above methods.could be used t.o deteimine.the existence of PCBs,.the ballasts were assumed to contain PCBs. 4.2 Results .All light fixtures were identified at continuous electric ballasts or were incandescent fixtures. 4.3 Mercury-Containing Lamps, On October 15,20081~:nviroSciencc's<representative,Michael Delaney,performed an inventory of mercury lamps;therniometers,:and mercury switches. :These,fixtures were inventoried in- Place. 4.4 Results No mercury containing lamps, thermometers or switches were identified during the survey. Report prepared by Senior Engineer I,Michael Delaney. Reviewed by: .f Dr� Robert 1- May,_jr. 5teven'W. Co Vice President stniot vice President 1'\1'2(N)8\0813\A21'\MI D_94GCraigrdleBeacliRd_IIazMatRpt_AW9010&doc 6 r ;a .► FUSS&O'NEILL ` Enviro5cience,LLr. APPENDIX A FUSS & O'NEILL ENVIROSCIENCE LICENSES/CERTIFICATIONS YA112008\081:i\A21i\\fl,'ll_9Q6Ciaig%=illeBeachRa lla MaLRpt_2!)0901(N;.d(w commonwealth of Massachusetts Division of Occupational Safety (aura M.MarGn,Commissioner Asbestos inspector MICHAEL F. DE'LANEY Eff.Date 11/14/07 Exp.Date 11/12108 A1031436 Member of COMES �A HV .„ IIII{N1�1111111iIPll�lll�� EIII�III{IIIIINIIIIIII MVRN x" FUSS&O'NEILL EnviroScience,uc APPENDIX B ASBESTOS SAMPLE RESULTS AND CHAIN OF CUSTODY 1':\112008\0813\A2E\\iG1)_946(.:rai,illeIiuncliRd_Fiat\Tailtpt_2tK)96iO6.doc 4 1 ' EMSL Analytical, Inc. 7 Constitution Way,Suite 107,lftburn, MA 01801 Phone: (781)933-8411 Fax: (781)933-8412 Ennaii:. 6ostr r.laetltj.cdm Attn: Bob.May Customer-lD ENV154C' Fuss&O' Neill EnviroScience, LLC custolrier.po`i. 50 Redfield Street Received-. 10/17/088',00AM Boston, MA 02122 EMSL Order: 130803796 Fax: (413)647-0018 Phone: (617).282-4675 EMSL P Project: 20080813.A2E/Town of Barnstable,Former Suni Sands rot, Motel:946 Cralgvill2 Beach Rd, Analysis Date:, 10/20/2008 Report Date: 10/20/2008 Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized' Light Microscopy Non-Asbestos Asbestos I Sample Location Appearance % Fibrous % Non-Fibrous % Type 1015MD-01A Office,Cig: Whfte/Brown 10% Cellulose 90% Non-fibrous(other) None Detected 1308037964WI Sheetrock Non-Fibrous _ - Heterogeneous 1015MD-01B Office Bdrm,Gig: WhitelBrown 10% Cellulose 90% Non-fibrous(other) None Detected 1308037964002 Sheetrock Non-Fibrous Heterogeneous 1015MD-01C Kitchen.Cig; White/Brown 10% Cellulose 90% Non-fibrous(other) None Detected 130803796-0003 Sheetrock Non-Fibrous, Heterogeneous - 1015MD-61D Middle`Bdrm,Waii: White%Brown' 10°�, Cellulose 90% Non.Abrous,(other) None Detected 130803796-0004 Sheetrock Non-Fibrous. Heterogeneous 1015MD-01E Rear Bedrom,Clg, White/Green 10% Cellulose g0% Non-fibrous(other) None Detected 130803796-0005 Sheetrock Non-Fibrous t Heterogeneous 1015MD-01F Unit#3,Wall: White/Brown 10% Cellulose 90% Non-fibrous(other) None Detected 130803796.0006 Sheetrock Non-Fibrous Heterogeneous 1015MD-01G Unit#1,Wall; WhiteBrown 10% :Cellulose 90% Non-fibrous(other) None Detected 130803796.0007 Sheetrock Non-Fibrous Heterogeneous 1015MD-02A Office,Clg:JC White 100%•Non-fibrous(other) None Detected 130803796-0068 Non-Fibrous - Homogeneous Analyst(S) Dan Williams(51) Renaldo Drakes or otherapproved signatory Due to magnification limitations inherent in PLM.asbestos fibers in dimensions below the resolution capability of PLM may not be detectod.Samples reported as<1`3'a ornone detected" may_tequila additional testing by TEM to confirm as6estos,quantities.Tire abmoeiest report Mates only to the Items tested and may not be repfoouced,in any form without the express written epprd.4 of EMSL-Analytical' MSL-Analytical_tnc.. EMSL'sliability is limited to the cost o.f analysis. EMSL bears no responsibility for sample colledonkgti Mles or analyttal method limitations, Interpretation ariduse of test results-are the responsibility of the clienLSamples receiwd in good condbon unless otherwise noted. NVLAP Lab 6ode'101147-0,AIHA IHLAP5181)179 MA AA060188 PLM-1 _ t 1 EMSL Analytical, Inc. 7 Constitution Way,Suite 107,Woburn, NIA 01801 Phone: 7E1)933.8411 Fax:_(781}#33 8412 Hrnati: Attn: Bob May Customer:ID: ENVI54C Fuss i&O' Neill EnviroScience, LLC Customer PO: 60 Redfield Street Received: 10/17/08 8:00 AM Boston, MA 02122 EMSL Order'. 130803796 Fax: (413)647-0018 Phone: (61.7)"282-4675 j MSL Proj:: Project: 20080813.A2E!Town of.Barnstable,.Former Suni:Sands Analysis Date: 1,012012008 Motel:946 Cralgviile;Beach Rd. Report Date:- 101,20/2008. Asbestos Analysis of Bulk Materials via EPA 600/R•93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Location Appearance % Fibrous % Non-Fibrous % Type 1015MO-02B Office Bdrm,Clg: White 100% Non-fibrous(other) None Detected 130803796-0009 JC Non-Fibrous Homogeneous 1015MD-02C Kitchen,Wall:JC White <1% Glass 1.00% Non-fibrous(other) None Detected 130803796.0010 Non-Fibrous Homogeneous 1015MD-02D Front Bdrm,Wall' White 100% Non-fibrous(other) None Detected 130803796-0011 JC Non-Fibrous. Homogeneous 1015MD-02E Rear Bdrm,Wall: White 100% Non-fibrous(other) None Detected �130803796-00.12 _JC Non-Fibrous. Homogeneous 1015MO-02F Unit#3,Wall:JC White 100% Non-fibrous(other) None Detected 130803796-0013 Non-Fibrous Homogeneous. 1015MD-02G Unit#1,Wall JC White 1,00% Non-fibrous(other) None Detected 130803796.0014 Non-Fibrous, Homogeneous 1015MD-03A Off ce Ktch/Strg: White 100% Non-fibrous(other) None Detected 130803796-0015 Gig Texture Non-Fibrous Homogeneous 1015MD-03B Middle Bdrm:Clg White 100% Non-fibrous(other) None Detected 130803796-0016 Texture , Non-Fibrous Homogeneous Analyst(s)Dan Williams Williams(51) Renaldo Drakes or other approved signatory Due to magnification liimitations inherent in PLM.'asbestos fibers in dimensions below the resolution capability of may not be detected,Samples reported as<1%or none detected may require additional testing by TEM to confirm asbestos quantities.The above test report relates only to the items.tested and may not.be reproduced in any Conn without the express written approval of EMSL Analytical,Inc. EMSL'.s-liability.is limited to the cost Of analysis. EMSL bears no responsibility for sample collection acltwties or analytical method limitations.. interpretation and use of test results are the responsibility of the client.Samples received in good condition unless otherwise noted.: NVLAP Lab Code lot 147-0,AIHA IHLAP 180179,..MA-AA000188 PLM-1 2 EMSL Analytical, Inc. 7 Constitution 11 1/;Suite 167,Woburn, MA'61$01, " Phone: (781)933.8411 Fax: (781)833-8412 t-rlati:,;:bostn 11a Attn: Bob May customerlo: ENV154C, Fuss&O' Neill EnviroScience, LLC Customer Po: 60 Redfield Street Received: 10117/08 8:00 AM Boston, MA 02122 EMSL order: 130803796 Fax (413)647-0018 Phone: (617)282-4675 EMSL Proj: ,t Project: 20080813,A2E ir Town of Barnstable,Former Sun[Sands Analos Date: 10/20/2008 Motel:946 CralgvilieBeach Rd. Report Date: 10l20/2008 r Asbestos Analysis of Bulk Materials via EPA 600/R-93/116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Location Appearance % Fibrous % Non-Fibrous % Type 1015MD-03C Rear Closet:Cig White 100% Non-fibrous(other) None Detected i308037964017 Texture Non-Fibrous; Homogeneous.. 1015MD-030 Rear Bdrm:Cig White 100% Non-fibrous(other) None Detected 1-30803796-0018 Texture Non-Fibrous, Homogeneous o None Detected 1015MD-03E Unit96 Bathroom: White 100k Non-fibrous(other)' 13060379"019 Cig Texture Nori-Fibrous Homogeneous. 1015MD-04A Office Bathroom: White/Blue 10% Cellulose 87% Non-fibrous(other) None Detected 130803796.0020 Lt Blue Lino Fibrous 3% Glass - Heterogeneous 1015MD-04B Kitchen:Lt Blue White/Blue 10% Cellulose 87% Non-fibrous(other) None Detected 13080379"021 Lino Fibrous 3% Glass Heterogeneous 1015MD-05 Kitchen:Lt Blue Yellow 100%Non-fibrous(other) None Detected 130803796-0022 Lino Adh Non-Fibrous - Homogeneous 1015MD-06A Rear Closet: Blue 100% Non-fibrous(other) None Detected 130803796.=3 12xl2 Blue FT Nan-Fibrous Homogeneous 1015MO-06B Office Ktch/Strg: Blue 100% Non-fibrous(other) None Detected 130803796-0024 12x12Blue FT Non-Fibrous Homogeneous: Analyst(s) Renaido Drakes Dan Miami(51) or other approved signatory Due to.magnification limitations inherent in PLM,asbestos fibers in dimensions below the resolution capability of PLM.may not be detected. Samples reported as<1%or crone detected may toga re additional testing by:TEM to confirm asbestos quantities.The above lest report relates only to the items tested and may not be reproduced in any form without the a gxess wnttanapproval of EMSL Analytical,Inc. EMSL•s liability is limited to the cost of analysis. EMSL bears no responsibility for eampla ceUection acbvties or analytical method limitations:. , Interp2tation and use of test results are the responsibility of the client Samples received in good condition unless otherwise noted. NVLAP.Lab Code 101147-0,ANA IHLAP 180179,MA AA000188 - PLM-1 (,3 E IVI aL Analytical, Inc. 7 Constittition Way.Suite 107,Woburn, MA 01801 Phone: (781)933-8411 Fax: (T81)933-8412 Ernail: bos ntah!AnnlsLc-1 Attn: Bob May Customer ID: ENV154C Fuss &O' Neill EnviroScience, LLC Customer PO: 50 Redfield Street Received: 10/17/08 8:00 AM Boston, MA 02122 EMSL Order. 130803796 Fax: (413)647-0018 Phone: (617)282-4675 EMSL Proj: Project: 20080813.A2E/Town of Barnstable,Former Suni Sands Analysis Date: 10/20/2008 Motel:946 Craigvillo Beach Rd. Report Date:. 10/20/2008 Asbestos Analysis of Bulk Materials via EPA SOO/R-93/116 lUlethod using Polarized Light Microscopy NonaAsbestos Asbestos Sample Location Appearance % Fibrous % Non.Fibrous. % Type 1015MD-06C Unit#4 Bthrm: Blue 100% Non-fibrous(other) None Detected 1 30803 79 5.0025 12xl2 Blue FT Non-Fibrous Homogeneous 1015MD-07 Unit#5 Bthrm: WhiteBrown 100% Non-fibrous(other) None Detected M803798-0025 Whl Linoleum Non-Fibrous Heterogeneous 1015MO-08 Unit#2 Bthrm: Gray 95% Non-fibrous(other) 61/6 Chrysotlle 130803795-W27 Stone Pttm Non-Fibrous Linoleum. Heterogeneous Represents:Middle Layer of Linoleum 1015MD-09 FT Unit#6 Bthrm: Gray/Black 100% Non-fibrous(other) None Detected 13080379E-02e 12x12 Stone Pttm Non-Fibrous FT Heterogeneous 1015MD-09 Mastic Unit#6 Bthrm: Black 98% Non-fibrous(other) 2% Chrysotile 130803795-0028A 12xl2 Stone Pttm Non-Fibrous FT Heterogeneous 1015MD-10 Unit#3 Bthrm:Bg Tan 10% Cellulose 90% Non-fibrous(other) None Detected 130803796-0029 12xl2 Pttm Fibrous Linoleum Heterogeneous.: 1015MD-11A Unit#1-Bthrm:9x9 Tan 5% .Cellulose_ 85°>o Non-fibrous(other) None Detected 130803796.0030 Pttrn Lino -Fibrous 100% Glass Heterogeneous 1015MD-1Is Unit#2 Bthnn:9z9 Tan 5% Cellulose 85% Non-fibrous(other) None Detected 130803796-0031 Pttm Lino Fibrous 10% Glass Heterogeneous Dan Williams(51) Renaldo Drakes or other approved signatory Due to magnification limitations inherent in PLM,asbestos fibers in dimensions below the resolution capability of PLM may not be detected.:Samples reported as 0%or none detected may require additional testing by TEM to confine asbestos,quantities.The above test repon relates only to,the items tested and may not be.reproduced in any form without the express written approval of EMSL Analytical.Inc, EMSL's liability is limited to the.cost of analysis.EMSL bears no msponsibility for Sample collectlon,activit es or analytical mettwc limitations: Interpretation and use of test results are the responsibility of the clientSamptesreceived in good condition'untess othonvise noted.. NVLAP Lab Code 101147-0.AIHA IHLAP 180179,MA AA000188 PLM-1 4 EMSL Analytical, Inc. 7 Constitution stay,Suite 167,W6burn,PPA 61801. Phone: (781)833.8411 Fax: (781)933.8412 Email: boft gnikb9_ nsinQn1 Attn: Bob May Customer ID: ENVI54C Fuss&O' Neill EnviroScience, LLC Customer.PO: 60 Redfield Street Received: 10/17168 8:ao Arm Boston, MA 02122 EMSL Order: 130803796 Fax. (413)647-0018 Phone: (617)282-4675 EMSL Proj: Project: 20080813.A2E/Town of Barnstable,Former Suni Sands Analysis Date: 10/20/2008 Motel:946 Craigviile Beach Rd. Report Date: 10120/2008 -Asbestos Analysis of Bulk Materials via EPA 6001R-93/116 Method using Polarized Light Microscopy N n-Asbestos, Asbestos Sample Location Appearance % Fibrous % Non-Fibrous. %. Type. 10151V!D-12 Rear Bthfm:Bg Tan 5°l0;. Cellulose- 90% Non-fibrous(other) None Detected 130803796.0032 Linoleum Non-Fibrous: 5%1.. Synthetic'. Heterogeneous 1015MD-13 Unit#6:Greyw! Tan 10.% Cellulose 9ti% Non-fibrous(other) None Detected 130803796-0033 B1k.Firing, Non-Fibrous - - - Hetero9eneouS 1015MD-14 Unit#5:Sample Black 10% Cellulose 90% Non-fibrous(other) None Detected 130803796-0034 13 Blk Paper Fibrous Heterogeneous t 1015MO-15 Front Bthrrn:Tile Tan 100% Non-fibrous(other) None Detected 130803796-0036 Grout Nan-Fibrous Homogeneous 1015MD-16 Unit#6:Tan Firing Brown 100% Non-fibrous(other) None Detected 13080379"036 Adh Non-Fibrous Homogeneous 10151VID-17A Unit#6:Fir Leveler Tan 93% Non-fibrous(other) 7% Chrysotile 130803796.0037 Fibrous Homogeneous 1015MD-178 Kitchen:Fl Leveler Tan 66% Celluldse 951% Non-fibrous(other) None Detected 13080379"038 Non+Fibrous Heterogeneous::_ . 1015MD-18A Ext Siding:BIk. Black 1'6 'Celjuloser 85%.Non-fibrous(other) None Detected 1308M796-0039 Hose Wrap Fibrous. Homogeneous Analyst(s) r Dan Williams(51) Renaldo Drakes or other approved signatory Due to magnification limitations inherent in PLM,asbestostibers in dimensions below,the resolution capability of PLM may not be detected..Samples reported as<1%or none detected may require additional testing by TEM to confirm asbestos quardities.The above test report relates only to the items tested and may not be reprcduced in any forn without the express written approval of EMSL Analytical.Inc. EMSL's liability is limited to-the cost of analysis, EMSL bears no responsibility for sample collection activities or analytical method limitations. .. Interyreiation and use of test results are the responsibility of the client.Samples received in gcod condition unless otherwise noted. AVLAP Lab Code 101147-0.AIHAJHLAP 180179,.MA AA000188 PLM-1 5 EAVISL Analytical, Inc, 7 Constitution Way,Suite 107,Woburn,MA 01801 Phone: (781)933.8411 Fax: (781)933-8412 Email: bo,�tor.Sa. Attn: Bob May Customer ID: ENVI54C Fuss&O' Neill EnviroScience, LLC Customer PO: 50 Redfield Street Received: 10/17/08 8:00 AM Boston, MA 02122 EMSL Order: 130803796 Fax: (413)647-0018 Phone: (617)282-4675 EMSL Proj: Project: 20080813.A2E/Town of Barnstable,Former Suni Sands Analysis Date: 1 012 0/2 0 08 Motel:946 Craigviile Beach Rd. Report Date: 10l20/2008 Asbestos Analysis of Bulk Materials via EPA 6.QOIR-931116 Method using Polarized Light Microscopy Non-Asbestos Asbestos Sample Location Appearance % Fibrous % Non-Fibrous % Type 1015MD-186 ESQ Siding:Blk Black 25% Cellulose 75% Non-fibrous(other) None Detected 130803796.0040 Hose Wrap Fibrous Homogeneous: 1015MD-18C Ext Siding:Blk Bieck 15% Cellulose 85% Non-fibrous(other) None Detected 130803796-0041 Hose Wrap Fibrous' Homogeneous 1015MD-19A Roof:Asphalt Black 5% Glass 95% Non-fibrous(other) None Detected 130803796,0042 Shingle Fibrous Heterogeneous 1015MD-19B Roof:Asphalt Black 5% Glass 95% Non-fibrous(other) None Detected '2130803796-0043 Shingle Fibrous Heterogeneous 1015MD-19C Roof:Asphalt Black 5% Glass 95% Non-fibrous(other) None Detected 130803 796-004 4 Shingle Fibrous Heterogeneous 1015MD-20A Garage Ext Siding: Black 10% Cellulose 90% Non-fibrous(other) None Detected 1308037961445 Blk Hose Wrap Fibrous. Homogeneous 1015MD-208 Garage Ext Soling: Black: 10% Cellulose. 90% Non-fibrous(other) None Detected 130803796-0046 BIk Hose Wrap. Fibrous Homogeneous 1015MD-20C Garage EA.Siding: Black 10% Cellulose 90%k Non-fibrous.(othei) None Detected 130803 79 6-004 7 Blk Hose Wrap Fibrous Homogeneous Analyst(s) Dan Williams(51) Renaldo Drakes or other approved signatory Due to magnification limitations inherent in PLM,asbestos fibers in dimensions below the resolution capability of PLM may not be detected. Samples reported as 0%or none detected may require additional tasting by TEM to confine asbestos quantities.The above lest report relates only to the items tested and may not be reproduced In any form without the eVress written opproval of EMSL Analytical,Inc.. EMSL's liability Is limited to the cost of analysis. EMSL bears no responsibility for sample collection activities or analytical method limitations, Interpretation and use of test results are the responsibility of the clientSamples received in good condition uniess otherwise noted. NVLAP Lab.Code 101147-0,.AIHA IHLAP 160179,MA AA000168 PLM-1 6 EMSL AnalytiC21, Inc. 7 Constitution Way.Suite 107,Woburn, MA 01801 Phone: i781)933.8411 Fax: (781,193 3-8412 'Ernaii:. Boston ab&e;mL6dm 1 Attn: Bob May Customer ID: ENVI54C Fuss&O' Neill EnviroScience, LLC Customer PO: 50 Redfield Street Received: 10/17/08 8:00 AM Boston, MA 02122 EMSL Order. 130803796 Fa)c (413)647-0018 Phone: (617)2824675 EMSL Prof: Project: 20080813.A2E I Town of Barnstable,Former Suni Sands -Analysis Date: 10/20/2008 Motel:946 Craigville Beach Rd. Report Date: 10120/2008 Asbestos.Analysis of Bulk Ma#eriats:.:via,EPA 600i.R!I0 116 Method using Polarizid Light Microscopy Non-Asbestos. Asbestos Sample Location Appearance. "% Fibrous % Non-Fibrous % Type 1015MD-21A Garage Roof: Black/White 5% Cellulose 85% Non-fibrous(other) None Detected 130803796-0048 Asphalt Shingle Fibrous - 10% :Glass. Heterogeneous 1015MD-21B Garage Roof: Black/Whke 5% Cellulose 85% Non-fibrousJother) None Detected 130803798.0049 Asphalt Shingle Fibrous 10% Glass ' Heterogeneous 1015MD-21C Garage Roof: Black/White 5% -Cellulose 85% Non-fibrous(other) None Detected 136803796-6060 Asphalt Shingle Fibrous 10% Glass Heterogeneous t t t • }�,: ,{ 1 .r �� Analyst(s) `' i ! f*� { Dan,VW1I11amS(51) Renaldo Drakes or other approved signatory We to magnification limitations inherent in PLM,asbestos fibers In dimensions below,the resolution capability of PLM may not be detected. Samples reported as 41%or none detected may require addlUonal testing by TEM to confirm asbestos quantities.The above test report relates only to the items tested and may not be reproduced in any form without the express written approval of EMSL Analytical,Inc. EMSL's liability is limited to the cost of analysis. EMSL hears no responsibility for sample collection activities or analytical method limitations interpretation and use of test results are the responsibility of he crrentSamples received In good condition unless otherwise noted. NVLAP Lab Code 101147.0.AINA IHLAP 180179,MA AA000188 ' a PLM-1 THIS IS THE LAST PAGE OF THE REPORT. 7, 130803796 irx FUSS O'l EIL Lnivirokience',,LLC www.£ando.com 5,0 Redfaeld Street,Saute !OQ Bogto ,lfA 02122 {bl7)282 4675 Fax:(617)282-8253 SAWLE LOG FOR ASSES'TOS BULKS of Sheet rroject Name: lax oL Project No. � wilding Project Nfamger. ], Sample ID Sample Location Material result(0/s) 0[ O ri — .,4 t� �} ou , F CaA a� Alfa Nsie Method: M PLM ❑ Ochs Tumaround Time Based on the turnaround drne indicated above,airalyses we due to EnvimSaencc on or before this:date: Please call the EnvimScience Labomtwy at(SA 953-2700 if analyses vifl be late. Fox Results To. Envirokier ce Consultants,V-LaboxaL at 403 647-001$ Special Instructions: Rja " Samples Gnllecard By: Date: 'Tune ��! a m Samples[Reed](Sent By]:, Date; [ ]( (2 1 Time: 72008 Sattzples Receisvd Bp: Date: Time: Shipped To: QJ'E145L(Scite)_ __.._ ❑ Other 06 Method of Shipmene ❑ Fed Ex ❑LTS Overnight ❑ UPS Ground then 1.�?u3min;FC3R?.iSlAsbrscos$ubm C rwn of Comaw.Bones rep W toe 7130801796 I 1:3080379 . FUSS & O'NEILL EnviroScience, LLc www.findo.com I50 Redfield Street,Suite 100 Boston,IviA 02122 (617�282-4675 Fax.(617)282-8253 SAMPLE LOG FOR ASBESTOS BULBS Sheet of Project Name: ma oC ,Protect No..Q �I- - Building, Project Manager. Sample ID Sam}ple.1.6cation Material Result =-. f I ' r �a atl A (341cr "fA o v Anat"is Methods EgrpLM ❑ Offtac Turnaround.Time r- Based on the tumz:aund time indiceeed above;atsalpses:are dil t, EnviitiScience on orbefose this date: !base caR the EnvifoScience Labo=tary•at(86p)953-2760 sf InIlysm wilt be late. Fax Results To: EavisoErience Cowuitanes nc.,Labotefoty at 413-647-0018 SpedA Instructions- Samples Collected By. Date Samples[Ree'd][Sent Bylt.(. �l j 1 Date_j 1 F 1 Tin1e a �� $ Date: Ttme 3� — Saas Retcived 5`4 Sbipped T. ❑.EMSL{Stoc} ❑ Other I ` Method of Shipment: ❑ Fed Bx ©UPS Ovemight ❑ C1P,Ground ❑ Othe: Y:\Adriim\F0RM81Asbasr0s Bulks ChAin of CusmdF-Baste m ten D Q7:dct r v� •• J& 130803796 1308037 fPFUSS & O'NEILL Envirokience, LLc u wmbndoxom 50 Redfield Street,.Suite 100'Boston MA 021122 {b17) 282.-4675 Fax: (617)282=8253 SAWLE IOG FOR ASBESTOS BULKS Sheet of Project Name - eProjectNo. Builder Project Manager. Sample ID Sample Location Mate" Result(010) als"Le� lax, '0 L2, s � t L x N i Anaipsie m � - 'Pus 0 otblu Tw=rj4%Id r" t Based on the turnaround tit=indicated.above,analyses=..dau to'Enit iroScience on or before this date:_ Plcase can the Enriro5ciencc Laboratory at(8b0)953-2700 if analyses will be late. Fax Resuhut'fo; EmjmSdex�ce Constilrants Inc.Laboratory at413-647.0018 Special Instnactionse Samples Cout!nt:d ay: bate: TV=, Saatplea{Reed)(Sew By];_( . �( I Date: 4 Samglee Reccieed By: Date:' Ttrnc ... Shipped To: ❑ EN4SL(State) ❑:OtE,� Method of Sh pment: ❑ Fed'Ex O':131'S,Overrn ght. 0 UPS Grtittt'id E•Usher, B ;U+? C:4 Y:\Addt n\FORMS\Asbeatna Sulks Chain of C,sstmd-Hey=rev 0407.doe I 1 . 130803796 §OeQ, P a 50 Redfield Street,,Suite 1.00 Boston,MA 02M, (�l t)282-46?5 Fa.v,.a(017) 282 8253 SAMPLE LOG FOR ASBESTOS BULKS Sheet„ .of , Project��zne: ._l.. , -`�� ��Project No. •s'�'. I3�i,1cF>ii PT6)ect Manager. Sample ID Sample Location � Material Resulc(°lob " 3) 17A � µ . 3i, 9 r Based,art cbe tumarwmd Gme indicg%d abovIt,aaafses am.due:to E,)*imt cience ate cr}ieFcre ?is c a c: _:: [?#tsc'c��k the Enisn5:ce tcc.Lbr�tt;zt'. r{rdil 9�3-'�7 :sf sa:3yrs "?�e late. Eax Resubs'to: EiNvin,ieh,ei G ni. -,Iq € ,Y "c a3 az E r}>'{a i i 3,6474)DI Speeiai lnstrt� xoas.. .a .9 Samples r1briccled By" - ie _Tire SamgIes lRec'i1.tI-Sean B}•,l: 1— i,( 1 [l sc 1, I Time Spies Rectir-ed By: 5bipped To: C1 F1.151.;S ate} -- ❑ other r ; Method of Shipment: 0 Fed I x C)UPS Overnig i �`i F+z+cl,"round 'Q other OCT 1 72008 k Y ... ay !w. p�yy wy i 13080379.6 j�A�E Qn. »s FUSS & OINEILL 50 Redfield Street,Suite 110. 021,12 .I"7 2 4�+S Fa�a Sr' PI 'OG VOR ASBISTOS BULKS Sheet :s Of ca' i » ` Neajec:l Na:a1m i Budd: ►-c lariages Sample ID sample 1.4tation Material Result Clo) ' 1 h i r I .rmrtr�n�uxa+- i � e t Analysis Mctbod:.c'!d`PUM ❑ Ocher Iurnactruatl'i'isz�e Baus4 Gsa the t:az=otan Lucae.is)raicaeeci a a e,az a vset sue due,to ErrviroSciance.oi or lsefo clr s eta s: _. Picric Call the E^ cc lc+r,acc Lalx.rv'o ar�W)'953 270Q ifa iyscs VnIl he,late. Fax Results To: Eays :tS,6e:ct Coosa t~as: ,lrc.Ubomtoq at 4134)417.001,8 Specw Insuucdons;_ Samples Gollccteci I}.,, Date-' "z xxe Samples(Rec'd�("�aaa 11�.(: [ � _ ��� l"a?� Sam lc4 Rteei cd By., L?a 1 t P Shipped To; Q EIMSL,(S-tt) sae Method of Shipment; UnJ Qalllc .fw TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map :Q (N Parcel_D0 ,A 00 Permit# C0 r� a47 OF B A R?6TABLE Health Division - ( 7 D,� `�—� = ,'ii ,o r/8h�ate Issued I .J /8 , 63 G Conservation Division . ' �, /n � VsApplication Fee Tax Collector CN,, ��A•-���a�� Permit Fee Li Treasurer �� �.., l iSiOP� SJFPT1>~, t 5d 14 INS Planning Dept. 1" A— 7ALLeD JN CO Sr ae i `� IVY'rt2 r, Ahics Date Definitive Plan Approved by Planning Board /✓ '''� Ee�fs'i< FE H TiTLI 5 ,.s ENTAL CDD Historic-OKH Preservation/Hyannis � � n Aft r Project Street Address L,4_e — Village L —6 y`'6 z V" ] Owner C 61 i0 a S S tj�.- Address Telephone Permit Request -Y G-U I_��v;4-� u N C� � .-�;tics A--x- i iN C ?-�F'c�; �—c. LL " Sq Feet: 1 st floor: existing . proposed 2nd floor: existing proposed Total new ZkioS( 2X169 Zoning District Flood Plain I Groundwater Overlay Project Valuation I` ' Q 0®. ®U Construction Type d6PIV Q 001 E/Z_ Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Ngle Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Struc�tre Historic House: ❑Yes ❑No On Old King's Highway: ❑Yes ❑No 0 Basement Type: ❑Full \0 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 0 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: ❑es ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes,site plan review# Current Use Proposed Use. r. . -BUILDER INFORMATION �5® Name :E[1` aJ ' Telephone Number s 5Y9 &W 7 Address 3�s� C- -� i � n .. License#Y fv 7 Sq Home Improvement Contractor# /3 d OO a Worker's Compensation.# L' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE I v 3 FOR OFFICIAL USE ONLY i PERMIT NO. DATE ISSUED MAP/PARCEC NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION, FIREPLACE ELECTRICAL:, ROUGH FINAL x PLUMBING: - ROUGH FINAL GAS: ROUGH FINAL ' r; FINAL BUILDING f DATE CLOSED OUT ' ►'' ASSOCIATION PLAN NO. r _ The Commonwealth of Massachusetts _ Department of Industrial Accidents office ofinYOS1199afiolls 600.Washington Street Boston,Mass., 02111 Workers' Compensation.Insurance Affidavit _ tJ i✓ 1 S � name: location: � � City � -✓c c e,i� ✓1 phone# �C7�� I am a homeowner performing all work myself. D-k-96 a sole proprietor and have no one working in any capacity I am an employer providing workers' compensation for my employees working on this Job i�`,.,x.yr(4r, �!�".r�,ji pp.�r +Y��•� 'v rt �a3-'f�c9� a. ! r � ::.s.5� � w,'�r _.Yf� r z.; coin an name �,�� .•� �-�� t Y xf. 2- rl^.t3s, t���'� �� �t7x°" ° it .^�'�,�P€ g � ,� � •r� 7r�F � r ° ! -z=':f2�y+,s. -;�J�k ��r ,j,t> G.t* C; t.+' v.-�"• s 4 w yC 1 S s y �' � �� `� rf'°,,�3}3 r4?Z. s r'✓y;,,a y*�.a ^^��. a:i.�Y +z. .h w o r."�= "r v ukc�{s•r fit.. a' � t r 1.�s€� `y"`w:n, �}° s G��` '?T-Y,7T'.�.��#�}y��Y�`s�r�"rn"` �x��°'• � 2 r is Jw�z. �a 5"S {. � r a x rC a 'J1 $�"` �q �^,�. p," ,�` *5. I i t- sole proprie o general contractor,or homeowner(circle one)and have hired the contractors listed below who have —'--'" the following workers' compensation polices {•'tzM3r ^klr sr L t^ '- r > t :c rr�f 1tx canlaairv�nanie 3 _ � � "" 4 arg w w,a^.itwr , msurance,Co�,h Y a'!r t' ...,...'.E OIIC tF.wt'^k .t,..K.�,rt..�..,.s..x..���w_''-•ay "�'"e!°Y4�.:.. +`` }G,.Nt„',�2 t;°•,a*�" 4 r rx` aS: s v z j z': T t :.y r',s 'r,,�7�tt ..J r�..Y ;s'`q s -'°°`. i'� ;f"�T .� v .,a" -'f r a r ?' 1 s`.d8`M.`!: 5; !fi r7 ,t y r F,S- t °}.`r r 1'• '? >Ui ax '^e q..'E�4� 2'• 3Y t� �J''�fl'r�.SS�'�'F�F'4 €•�`7,p.F->£.r'1'"tYG,t Lr .r' r � MkS F•^^-{Y"G,-a r� .: z _. 3V�\ tla d�r y� 'F F .� l,�'>" .Y .dam ; KL 'G-r e�t� 9 ���...,2�'"�'t`-5'�,}'���+''. �'��e35{"�rv.� y,fir.. .��+�. c d 1 i .�,, r. r tt,�� }v?. ss � j.��a �f e rs s �s.d•1, ,.���,;�s`z,��4�`� '�:: hOne a+� tS3 tY..V�e �?q .r�S �'t � �.a.Xy � ♦sf. Y ? �4 fy I r ��a y~f t 5 ro zM � y„�f���s4 ,i-.����s.•r . r �.�W�y'��+,� �"i 'S�i w. ;� ,a 5 .� ',. i s'a, ➢ tr'. ,: �`' h S„ �` � .c S� ..,'"`.'9F.+ :?➢.we,?'j'�"t.�{ry�E�.y. unstiranceco,�...� .. Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to$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 Office of Investigations of the DIA for coverage verification. I do hereby certify under thepains and penalties ofperjury that the information provided above is true and correct. Signature_( t Date .0 ,/p' Print name Y'T�1�"� �� Phone# t7� �T U 1 official use only do not write in this area to be completed by city or town official city or town: permit/license# FIBuilding Department []Licensing Board 0 check if immediate response is required ❑Selectmen's Office Health Department contact person: phone#; I—(Other (revised 9/95 PIA) } r 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 of more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out.in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406 pFZHE 1p�, Town of Barnstable P Regulatory Services s. s �naxsTesi.E Thomas F.Geiler,Director uass. � 1639.�A`'� Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization, conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. Type.of Work: �� c'tL I -�w1C Estimated Cost �- Address of Work: Owner's Name: So /'J f ;;_-7/9-/-//�S �eJ.��c� . �$'d✓. Date of Application:_ ( l5 O I hereby certify that: Registration is not required for the following reason(s): O orexcluded by law ❑Job Under$1,000 59�1ding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permmi'tj as the agent of the owner: � cy 0o Date Contractor Name Registration No. OR Date Owner's Name f1i1f? 1 . -tY 1 1 1 hiP7 isPQ t'i ik: T tie 02 K , 'own cat' Barnstable 1 q Regulatory 1 e ,Il', Director yeas. /di'/� 7't�crn!ig x'. f'e• ►� Tot,}' xry; Builkiftig C.cmmi5Stt1,,cs• 2 0 NIaiti Srrec , N annJ s, 1,rA 0260 OPC�ct:; S08-862-403 Fax 5MS-740-6230 Property O-wiwr Must Comptete and Sign This Secci.ort Tf Ushig A Fuiltir`r £�— - •� • _ v k. -`{ as Nhvnor of the subject t>roptm,' Jax • f ° • heresy autlic-t't2e __C- c2tr r-� :r r r :, ��u VD a,_!" 011 r*'ly hch ]r", in all rn,ILL07s relative to work author 7.cd bv tlu, ,t,uil iirlg pem lt:aP1�Iiratiori for (address ofl )oh) 7�GA i l J (.,�F�L.F�_•.��_.L� Imo.h-1 -1�1,•..)c..k: ( '' � 1.,5 K� i .�C�r�•1j��_ ��V r1 t?4� P--�`�`_;�.(• Jl�tl.�llfC rid �.. �'I1CC t)it:e �y Print None f I .r a �cr>vnarvieuea`l� r�/Gliaeaacleude�d`3 T Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 130009 Expiration: 12/13/03 Type: Individual John Hanson John Hanson 353 Carriageshop Rd. � r 'East Falmouth, MA 02536 t.1-.�i�:ctrnlnr • . . .l{t6 TD0�97/I720OZCUCCLGU2 d�✓�dG�LflQe�b i .4 BOARD OF BUILDING REGULATIONS ' License: CONSTRUCTION SUPERVISOR r� Number: CS 067659 R Birthdate: 12/20/1960 ' •< Expires: 12/20/2003 Tr.no: 12346 ^`a Restricted: 00 JOHN A HANSON r 353 CARRIAGE RDA E FALMOUTH, MA 02536 Administrator { } License or registration valid fond return to expiration da only before the exprte. andards 1 Board of Building R¢gulations and St sbburton Place Rm 1301 One A 02108 Boston, a* 4 • irl tivithr+nt c�anatarP . r 00-35,000 cf enclosed space (MGL CA 12 S.60L) 1A-Masonry only 1 G-1&2 Family Homes t Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. i DIG SAFE CALL CENTER: (888)344-7233 AC®RD,. CERTIFICATE OF LIABILITY INSURANCE 03/12i20 3 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION McCormick & Sons Instirance Age ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 800 West Main Street HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR Avon, MA 02322 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P:508-586-2973 F:508-587-6679 INSURERS AFFORDING COVERAGE INSURED INSURER A: COMMERCIAL GENERAL UNION CAPE MARINE CONTRACTING INSURER B: P. 0. BOX 297 INSURER C: FORESTDALE MA 02644— INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ® COMMERCIAL GENERAL LIABILITY CBJH50751 09/01/2002 09/01/2003 FIRE DAMAGE(Any one fire) $ 50,000 ❑ CLAIMS MADE 9 OCCUR MED EXP(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 ❑ PRO ❑ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ❑ ANY AUTO (Ea accident) ❑ ALL OWNED AUTOS BODILY INJURY❑ SCHEDULED AUTOS (Per person) $ ❑ HIRED AUTOS ° BODILY INJURY $ ❑ NON-OWNED AUTOS (Per accident) ❑ PROPERTY DAMAGE $ ❑ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ❑ ANY AUTO EA ACC $ OTHER THAN ❑ AUTO ONLY: AGG $ EXCESS LIABILITY EACH OCCURRENCE $ ❑ OCCUR [E-11 CLAIMS MADE AGGREGATE $ ❑ DEDUCTIBLE $ ❑ RETENTION $ w $ C STATU- OTH- WORKERS COMPENSATION AND TW RY LI EMPLOYERS'LIABILITY no employees sole owner. E.L.EACH ACCIDENT $ E.L.DISEASE-EA EMPLOYEE$ E.L.DISEASE-POLICY LIMIT,$ OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ❑ ADDITIONAL INSURED;INSURER LETTER:_ CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION SUNI SANDS CONDO ASSOC . DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 010 DAYSWRITTEN C RA I GV I LLE BEACH RD NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL C E NTERV I LLE, MA IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR MA REPRESENTATIVES. AUTHORIZED RSENTAT4VE �� • ACORD 25-S(7/97) ©ACORD CORPORATION 1988 tom-► 96 14 03 FROM INCO SLS-NE WILSON TO 18509280492 _ PAGE•002 APR 8 ' S . • f•M.7t�1./ vl♦ t�1.j-r• 5�1�$Q�tDS' CONDO, y_6.L.YMI 1 v�tl?4D EL- = II.Q• id.G V.� _........_.....�.^ - •j()o YEAR ' i EXISTING BOARaW AL.K PRo�i� 24.. . 4 T KOR. SCALE I•• �4 ao 4• VERT. SCALE I. o• z 4' i PIPE LNG DECK VP.I= I'1 EL. FROM +4'r L i • a 1 t < .a •. LE S VARY IN WIDTH 4• TO 12' . .A 2"Il F- g« a» pOSTs-� g' 0 TYPICAL j 20's Of :S111.1.lYAt�l=� � t!to:29133 At f Dt=CK Fly VARIESS (2) 2x12's (2) L.ED�ERS VARIES 2x4'3 Oft 2X6'a 2x4 POSTS :. ---2x4 CROSS BRACES OA'' T _I TYPICAL SECTION l SCALE r-z i _ _ _ _ ___ _ _ _ _ _ _ _________ _ __ __ ___ _ ___ ____ _ - - _ APR 8 '96 14:03 FROM INCO SLS—NE WILSON TO 18609280492 PAGE.003 �!EVATI�ONS S,45ED ON M. W. = rJ.0 , �� : OPP. ,��� - (C. OBSERVED ) •.2•• P.V.C. LITTLE OR NO WATER _ ` PtPE - Low TIDE e�j _WT i �-- LZ LOCUS. MAP 1.6' .�, SCALE1 : 25,000 SHEET 1 1 OF-2.:_::_ of . .ti o $•o _ f. ; _— cj O �• - 'Y..fa•. �MARSH 1 4• 4 Pt- BK. 3�53 PG. 81 . --- 7 vi -- r c,� MARSH �.. ` a o in 13 of C.S. 6. j ..•• 3. • ..1. ... .. '. yA� VEGETATION ._,............ 2.6' ,4.T .S`__ Orp A ` LAWN STONE IPA � - .. sCA� _r 4O' PARKING IPA LAWN �Y6mac �` PLAN ACCOMPAISYING PETITION 40 20 ' o .40 0 ' SUNI SANDS CONDON INIUM ASSOCIATION To RECONSTRUCT AND I !N AN EXISTING TUSFR goARDwALK AM MOORING PIN IPIT TERVILI-E c'r TFRVft-lzE RIVER, CEN . . �. uw �r,nn tiu.ay I - r * i► r r I'Offil s DEOE Fa•No. ~^• 'o� " roy� (To b•orovno.o cy ME) Commonwealth Cdy.Town Barnstable t� of Massachusetts t a,u,r,ss ! Suhi—sand §..a s Condo Assn. ,, �oa�can� Order of Conditions Mass4chusetts Wetlands Protection Act G.L. c. 131, §40 TOWN OP BAMSTABLE 0RDINMCBS r ARTICT.E XXVZI From Barnstable Conservai ion C/o Nancy Webb To Suni—Sands Condo Assn. Same (Name of Appliccnt (Name of pr:pem, o:`./ner) 107 West Main St.l Address Westboro, MA 01581 Address Map N=ber 226 pare 1 Number 8-2 This Order is issued and delivered a follows: ❑ by hand delivery to applicant orirepresentative on (date) 7� by certified mail, return receipt equested on Au crust 9 1991.{ (date) This project is located at oft Craiqville Beach Rd. , Centerville The property is recorded at the Re 11stry of Deeds in Barnstable• Book page— Certificate (if registered) The Notice of Intent for this projec was filed on June 4 1991 (date) 1 The public hearing was Closed on Jtt t v ?�i (date) i Findings The Barnstablhas reviewed the above-referenced Notice of Intent and plans and has held a pul1lic hearing on the project. Based on the information available to the Commission al this time, the__Csvni s s ion ..._.:has determined that the area on which the proposed w?rk is to be done is significant to the following interests in accordance with the Presumptions of Significance Bet forth in the regulations for each Area Subject to Protection Under the a Act(check as appropriate): Public water supply ® Flood control ❑ t ® ' Land containing shellfish Private water supply Y 1� Storm damage prevention ® Ffshe lns r ❑ Ground water supply I I$ Prevention of pollution 0 Protection of wildlife habitat Total Fling Fee Submitted $25Q•00 State Sharp- $11.2•S0, City/Town Share '7.56 Total Refund pue S (`it lee in excess of S29 r Y/Town Ponion S -_-�_ State Pon,on S ARTICLE 27 onlyr (,A told! ('/i total) Q .Public Trust Righta I ❑ Agriculture [] Erosion Control'.. Q Aquaculture RecreationAl Effective 11/10/89 ❑ Historic i$ Aesthetic APR- ,8 '96 14.04 cp7M c W I L.SL 186 10, a"Z� sQ. t-ouserva�ion.CommLssionn;,reby finds that the following conditions are ;lecessary, in accordance with the Periorrpance Standards set forth in the regulations, to protect those inter• sf g s checked above. The_Q�mmi 4 ion I orders that all work shall be performed in accordance with said conditions and with the Notice of Iiitent referenced above. To the extent that the lot- —4 lowing conditions modify or differ from th plans. specifications or other proposals submitted with the Notice of Intent, the conditions shall control. Genorat Condltlonss 1 . Failure to comply with all conditions stated herein, and with all related statutes and other regulatory mess, ures..shall be deemed cause to revo a or modify this Order. 2. This Order does not grant any prope y rights or any exclusive privileges,.it does not authorize any injury' to private property or Invasion Of prl to rights. 3. This Order does not relieve-the per ittee or any other person of the necessity of complying with all other applicable federal,state or local statutes,ordinances.by-laws or regulations. 4. The work authorized hereunder sha 1 be completed within three years from the date of this Order unless either of the following apply: (a) the work is a maintenance drec ging project as provided for In the Act;or (b) the time for completion.has be n extended to a specified date more than three years. but less than live years, from the date of issuance and both that date and the special circumstances warranting the extended time period are set forth in this Order. 5. This Order may be extended by the Issuing authority for one or more periods of up to three years each upon application to the issuing aut ority at least 30 days prior to the expiration date of the Order. 6. Any fill used in connection with this project shall be clean fill, containing no trash, refuse. rubbish or de• bris, including but not limited to lu er. bricks, plaster,wire,lath, paper, cardboard, pipe, tires, ashes, refrigerators•motor vehicles or pa s of any of the foregoing. 7. No work shalt be undertaken until all administrative appeal periods from this Order have elapsed or, if such an appeal has been filed, untf�all proceedings before the Department have been completed. 8. No work shall be undertaken until t e Final Order has been recorded in the Registry of Oeeds or the Land i Court for the district in which the l4nd is located.within the chain of title of the affected property. In the case of recorded land.the Final O der shall also be noted In the Registry's Grantor Index under the name of the owner of the land upon which the proposed work Is to be done. In the case of registered land, the j Final Order shall also be noted on the Land Court Certificate of Title of the owner of the land upon which the proposed work is to be done. rhe recording information shall be submitted to the Commi a f3 ion _ on the form at the end of this OrdE r prior to commencement of the work. I 8. A sign shall be displayed at the site not less than two square feet or more than three square feet in size bearing the words,"Massachuse is Department of Environmental(Duality Engineering, File Number 10.Where the Department of Environmental Quality Engineering is requested to make a determination and to issue a Superseding Order, the Conservation Commission shall be a party to all agency proceedings and hearings before the Department. 11. Upon completion of the work des ribed herein. the applicant shall forthwith request In writing that a Certificate of Compliance be issued stating that the work hasbeen satisfactorily completed. 12.The work shall conform to the following plans and special conditions: 5.2 I APR 8 '96 14:05 FROM 1NCO 5LS-NE WILSON TO 18609280492 PAGE.O�75 T l SPECIAL CONDITIONS -- Se 3-2264 -- Suni-Sands Condo Assn. Plan of Record: May 8,' 1991 revised, William C.• Nye, RLS. 1 . Due to the shallowness and siltiness of the area, the applicants shall restrict motor boat use to 2 1/2 hours on either side of high tide. At the occasion of next maintenance, the following, conditions shall apply: 2 . No creosote treat d materials shall be used. 3 . Deck plank spacing shall -be no less than one inoh. 4 . No lighting shalllbe installed on the approved pier. S . No piling shall be placed such that they interfere with flow through the aintained ditches. 6 . No railing shall be installed. t ' r k1HE r Town of Barnstable P ti. Regulatory Services « &UMSTABLE, g Y v$ MASS 'OrEo nnvr A Thomas F. Geiler,Director Building Division Tom Perry Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Notice of Building Code Violation and Order to Cease, Desist and Abate: Ms. Joan M. Russo, 50 Central Avenue, Milton MA 02186 and all persons having notice of this order. As owner/occupant of the premises/structure located at 946 Craigville Beach Road;Assessor` Map 2- 26�Pazce1-0.0.8 C 1 y0 ou are hereby notified that you are in violation of the Massachusetts State building code 780 CMR Article(s)421 Section(s) 421.10 and.are ORDERED this date, April 25, 2002, to: 1. CEASE AND DESIST.IM1N4EDIATELY, all functions connected with this violation on or at the above mentioned premises. SUMMARY OF VIOLATION: _780 CMR Article 421 Section 421.10 Enclosures for Private Swimming Pools 2. COMAMNCE immediately, action to abate this violation. SUMMARY OF ACTION TO ABATE: Enclose pool as required per section 42 1.10 subsections 1 through 10 (copy enclosed). And,if aggrieved by this notice and order, to show cause as to why you should not be required to do so,by filing an appeal with the State Building Code Appeals Board (as specified in Article 1, Section_122 of 780 CMR State Building Code) within forty-five (45) days after the service of this notice. By order, Richard Stevens' Local Inspector Certified Mail 7001 1940 0003 9647 2874 R.R.R. Q/FORMS/violate2