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HomeMy WebLinkAbout1600 FALMOUTH ROAD/RTE 28 (26) , e F R x j e s r y II Y x d v YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates COST $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town(WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office,'1'' FI., 367 Main St., Hyannis, MA 02601(Lown Hall) and get the Business Certificate that is required by law.. , Fill in please: DATE: 1Z� 'S APPLICANT'S YOUR NAME: ✓j,,r,a�hl �- lrs� BUSINESS YOUR HOME ADDRESS. �IZ�-I Nol rs�z! t?_cx-.mil -9)Z 7-_l?N� /� q V e MA OLs`U y TELEPHONE # Home Telephone Number: 1,7- 13 — NAME OF NEW BUSINESS' � Fan wase� Z �c c- TYPE OF BUSINESS�_ i-I eGit IS THIS A HOME OCCUPATION? YES X NO �-rf cFCib Have you been given approval from the building division? YES _ NO . ADDRESS OF BUSINESS J606 'i,L L O C+7 I &=j46J%((4 A..4o. MAP/PARCEL NUMBER. When starting a" new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You,MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSION ER'S'OFFICE x ; This individual has b informed of any rmit requirements that pertain to this type of business. Authorized Signature** COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. ` Authorized Signature** COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** COMMENTS: Town of Barnstable Building Department - 200 Main.Street �I BARNSfABLE, * Hyannis, MA 02601 9 MASS 1639. . (508) 862-4038 RFD MA'i a Certificate of Occupancy Application Number:, 201003423 CO Number: 20100134 Parcel ID: 209014 CO Issue Date: 08/20/10 Location: 1600 EALMOUTH ROADIRTE 28 Zoning Classification: , SPLIT ZONING w Proposed Use: . SHOPPING CENTER - MALL Village: PoCENTERVILLE Gen Contractor -'ERNEST S VIRGILO Permit Type: CC00 a CERTIFICATE OF OCCUPANCY COMM Comments: liN . .. �% rb B di epartment Signature Date Signed 19 APPROVED TOWN OF BARNSTABLE o , r e r n< I -� r r TOWN OF BARNSTABLE B115'in _ __ g Application Ref:"*� 201003423.. t • �- Permit BARNSTASLE, Issue Date: `'�07/21/10 9 MASS �A 1639• �� Applicant: ERNEST S.VIRGILO rFG �A Permit Number: B 20101429 Proposed Use: SHOPPING CENTER-MALL Expiration Date: 01/18/11 Location 1600 FALMOUTH ROAD/RTE 28Zoning District SPLTPermit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 209014 Permit Fee$ 227.50 Contractor ERNEST S VIRGILO Village CENTERVILLE App Fee$ 100.00 License Num 31105 Est Construction Cost$ 25,000 (Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND REPLACE BATHROOMS IN EXISTING SPACE TO MAKE THIS CARD MUST BE KEPT POSTED UNTIL FINAL l HANDICAP ACCESSIBLE,LIGHTING AND CEILING INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH. Owner on Record: PROPERTY OWNER BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: INSPECTION HAS BEEN MADE. Application Entered by: JL Building Permit Issued By: �® THIS PERMIT CONVEYS NO'RIGHT;TO,OCCUPY,ANY;STREET,ALLYOR SIDEWALK OR A PART H T R TEM YPORARIL OR PERMANENTLY: ENCROACHEIvTENT'S ON PUBLIC PROPERTY;NOT;SP:EGIFICALLY,PERMITTED:UNDER THE BUILDING DE,MUST BE-APPROVED BY THE JURISDICTION. STREET ORALLY GRADES AS WELL.AS DEPTH AND',LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FRONT THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS.PERMIT.DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF-ANY APPLICABL&SUBDIVISION RESTRICTIONS; MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: , 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4,PRIOR�TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5. INSULATION:I 6. F1NALINSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,PLUMBING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(asset forth in MGL c.142A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS rv- ' i x 3 1`-Heating Inspection Appro4is Engineering Dept b T pt G 2, Board of Health 1 TOWN OF BARNSTABLE-BUILPING PERMIT APPLICATION Map Parcel / Application 0 43 r i Health Division C� ' Date Issued 7 Z Conservation Division ��� "" Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address /V/-) 1� Village • -L Owner Z6 Ali/ Address 3a iex, Telephone e / 0 46 (70 Permit Request o3 K rfc Square feet: 1 st floor: existing% d proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation ,_ 7__o Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes 2<o On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 21Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑existing ❑ new size Pool: ❑ existing ❑ new size _ Barm-❑existing r❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: i � t + Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ �t mow" ❑Yes ❑ No if yes, site plan review# ,,* ..,,, ., Commercial r -. _ . -_ Current Use Proposedd-Use-- Tiff 5 APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name SIC Telephone Number 17- .�3 23 2,K- Address Y fv>%'d?G✓)( License # y/YY�'L1 G4� /77 q G 2.6 65/ Home Improvement Contractor .. o Worker's Compensation # 67-z-IJ F3 ! �r'6 7 1_10 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO A/lire 6,AJ SIGNATURE ��� �� DATE /D t ' FOR OFFICIAL USE ONLY J APPLICATION# t DATE ISSUED S , MAP./PARCEL NO. R 4 ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION': FRAME INSULATION . FIREPLACE ELECTRICAL: ROUGH FINAL E ; PLUMBING: ROUGH FINAL ^GAS- * >` ROUGH "" ' - FINAL -JI 'FINAL BU}LDING �► gig. .4�0'' - DATE CLOSED OUT , ASSOCIATION PLAN NO. ' i The Corn rrromvealth of Massachusetts Departrnent of Industrial Accidents Office of Investigations' 600 Washington Street Boston, MA 02111 ,�• www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizationtlndividual): Address Q/�/(/� !J L� LIJr` `'�"7✓ City/State/Zipy. y�d✓f"!A17-11-1- A74- Phone.#: Are y u an employer? Check the appropriate b Type of project(required): 1.VI am a employer with 4. I am a general contractor and I employees (full and/or part tim.e). * have hired the sub-contractors 6. ❑New construction 2.0 I am a sole proprietor or pariiter-' listed on the attached sheet T. [ Remodeling ship and have no employees These sub-contractors have 8. ' Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers'.comp.•insurance comp. insurance.$ required.] 5. 0 We are a corporation and its 10.electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their it.P9 Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t C. 152, §1(4), and we.have no employees. [No workers' 13.❑ Other comp. insurance required_] *Any applicant.that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this aTidavit'indicafing they are doing all work and then hire outside contractors must submit a new affidavit indicating such. XContraetors that check this box must attached an additional sheet showing the name of the sub-contractors and state whahcr or not those a-ntities have employees. if the sub-contractors have cmployces,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: 2(/V/L/� "� ��✓�'�� — Policy#or Self-ins.Lic.#:�0ZZ-A'l C/n`7#007 Expiration Date: &O/Z/;z Jl N Ci /State/Zi Job Site Address: �G Ol� t/J-/lMV V'r�i tY P� ' 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 violator. Be advised that a copy of this statemciit may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do he ertify der the p �n.d penaiti of perjury that the information provided above is true and correct. Siffn, 7 Phon #: - Z Official use.only. Do not write in this area, to be completed by city or town officiaL .City or Town: Permit/Licease # Issuing Authority(circle one): 1.Board of Health '2.Building Department 3. City/Town Clerk 4.EIectrical Inspector 5.Plumbing Inspector 6. Other Information and Instructions Massachusetts General Laws chapter IS2 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 tiustee 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 staee or Iocal 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•accep table.evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,'§25C(7) states"Neither the t:omrrionwealth nor any of its political subdivisions shall . enter into any contract for.the performance of public work until acceptable evidence of compliance v�zth the insurance requirements of this chapter have been presented to the contracting authority.' Applicants Please fill out the workers'compensation affdavit completely,by checking the boxes that apply to your situation and, if necessary, supply sub-contiactor{s)name(s),.address(es)and_phone numbers) along with their crrdficate(s) of insurance. Limited Liability Companies.(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, ate 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 Mll be used as a reference number. In addition, an applicant that must submit multiple permit(licease applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address" f.he applicant should write"all locations is (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 affdavit 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 fo any business or commercial venture (i.e. a dog license or permit to born 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 C6rnm th of Massachusetts 0nweaI Department of ladustri.al Accidents Office of lavestigations• 600 Washlngtoa Street Boston, MA 02111 Tel. # 617-727-4900 ex'406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22.06, www.mass.gov/di a 'ceFr Tows of Bar'nsta.ble Regulatory Services . t Wag. Thomas F. Geiler,Director q� 16fAB9. a�a� Building Division Tom Perry, Building Commissioner 200 Main Street,.Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790. Property Owxier Must Complete and Sign This Section: If Using A Builder as Owner of the subject.property hereby authorize to act on my behalf, is all matters relative to work authorized by this building permit application for: (Address of Tob) . �2D �A,6 Si nature of c vner Date Print Name ` If Property Owner is applying for permit please complete.the Homeowners License Exemption. Form on the reverse side. .I Town of Barnstable o • y � Regulatory Services • f Thomas F. Geller,Director MASS- ,�� Building Division PrfD � Tom Perry, Building Commissioner 200 Mairi.Stm- ._Hy_annis, MA.02601 www.town.b arnstable.ma.as fi c e: 508-862-403 8 Fax: 508-790-6230 Of Ii0AE0WNER LICENSE ExEMPTION Pleare Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state rip code The ctarent exemption for"homeowners"was extended to iiiclude owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. ' DEFUffrrON OF 110lv1EOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside,on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the.Building Official,that he/she shall be responsible for all such work performed under the building permit (Section 109.1.1) T11c undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned "homeowner"certifies that.be/sh.e understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/sbc will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Tltree-family dwellings c*nb ring 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOAJEOwNER'S EXEMPTION .The Code states that: "Any bomcowner performing work for which a building permit is required shall be exempt from the provisions of'this section(Section 1 D9.1.1 -Licensing of cernstruction Supervisors);provided that if the homcowncr errgagcs a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assurning the responsibilities of a supervisor(see Appendix Q, Rules&Regulations far Licensing Construction Supervisors,Section 2.15) This lack of awarmcss bftcn results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unliccnscd person as it would with n licensed Supervisor. The homeowner acting as Supervisor is ultimatt)y responsible. To ensure that the homeowner is fully awerc of his/her responsibilities,many communities sequuc,as part of the permit application, that the homeowner certify that hdshe understands the responsibilities of a Super risor. On the last page of this issue is R.form currently used by several towns. You may care t amend and adopt such a form/ccrtifcation for use in your community. Q:forms:homcczcrnpt f I Mass:achea_setts-Department of Public Safety ' Board of Building Re%ulations and Standardv Cohstructiia Supervisor License License: CS •31105 .- Restricted to: 00 _ ERNEST'S VIRGILIO t . PO BOX 1167; , a _. . MASHPEE;'N1A 02649 . Expiration: 4rurm12 Cumflli�Si.Mirr Tr: 21083 Restricted to: 00 00- Unrestricted 1G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license- Refer Gov/DPS to: W W W.Mass. i R�® 'CERTIFICATE OF LIABILITY INSURANCE OP ID EM DATE(MMIDD/YYYY) 07 08 10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - NAME: PHONE DGP-Miles Insurance Agency,Inc A/C,No Ext: (A/C,No): 3 School Street P.O. Box 1018 ADDRESS: Taunton MA 02780-0957 PRODUCER CUSTOMERID#: JTCCO-1 Phone:508-824-8961 Fax:508-880-2734 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Century Surety "Company JTC Contractors Inc INSURERB: Zurich Insurance Services John Callahan 1 Buttercup Lane INSURERC: South Yarmouth MA 02664 "INSURER D: ' 'INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. " LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE . .$.1000000 A X COMMERCIAL GENERAL LIABILITY CCP643602 04/01/10 04/01/11 PREMISES(Eaocccurrrrence) $ 100000 CLAIMS-MADE OCCUR MED EXP(Any one person) $ 5000 PERSONAL&ADV INJURY $ 1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 1000000 X POLICY PRO LOC $ JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO - - BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ A -UMBRELLALIAB HOCCUR -:- CCP654486 05/13/10 05/01/11 EACH OCCURRENCE $ 1000000 - X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1000000 DEDUCTIBLE $ X RETENTION $ $ B WORKERS COMPENSATION 6ZZUB4197PO7510 04/09/10 04/09/11 X - - AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVr7-1 E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? E] NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Proof of insurance covera a subject to actual policy terms, conditions, limits, exclusions and definitions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EVIDENC THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Evidence Only AUTHORIZED REPRESENTATIVE PRPQRATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are regist ed marks o ACORD I - JTC CONTRACTORS INC SOUTH YARMOUTH MA 617 538 9326 Date 7/7/10 Re. Tenant build out Bell Tower Mall To whom it may concern We have hired Ernie Virgilio for the supervision of the build at the mall he will be an employee of the corporation and covered under the corporations insurance. Should you need any additional information I can be reached at the above number. Thank you Sincerely Pr sident I i Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality 100109137 Decal N.um............._ _ BWP AQ 06 LIZber Notification Prior to Construction or Demolition General Statement: If B. General Project Description (cont.) . asbestos is found during a 4. General Contractor: Construction or Demolition JJTC CONTRACTOR INC operation,all responsible parties a.Name must comply with JONE BUTTERCUP LANE 310 CM 7.00, b.Address and Chapter YARMOUTH MA 02664 Chapterer 21 E of the General Laws of c.Cit /Town d.State e.Zip Code the Commonwealth. 16175389326 ccallahan@globalpdc.com This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an IJOHN CALLAHAN asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. JTC CONTRACTORS INC a.Name ONE BUTTERCUP LANE b.Address YARMOUTH 1MA � 02664 c.Cit /Town d.State e.Zip Code 6175389326 f.Telephone Number(area code and extension) g.E-mail Address(optional) JOHN CALLAHAN h.On-site Manager Name 2. On-Site Supervisor: ERNEST VIRGILLIO On-Site Supervisor Name _ 3. Is the entire facility to be demolished? ® Yes ✓® No MEMOMMOMM N =0 4. Describe the area(s)to be demolished: �0 REMOVE APPROXIMATELY 30FT OF 2X4 SHEETROCK WALLS N -O �p 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: CONSTRUCT NEW NEW WALLS AND BATHROOMS FOR TENANT 0 �0 �d �Q ag06.doc•10/02 BWP AQ 06•Page 2 of 3 l z ti Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 100109137 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition . Important: A. Applicability When filling out pp Y forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-do not (DEP), Bureau of Waste Prevention -Air Quality Control Regulations 310 CMR 7.09. Notification of use the return key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10) days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. re B. General Project Description 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?❑Yes ❑✓ No 1.All sections of b. Provide blanket decal number if applicable: this form must be Blanket Decal Number completed in order to comply with the 2. Facility Information: Department of BELL TOWER MALL Environmental Protection a.Name notification 11600 FALMOUTH RD requirements of b.Address 310 CMR 7,09 I Falmouth MA 02660 c.Cit /Town d.State e.Zip Code 6175389326 f.Tele hone Number area code and extension E-mail Address(optional) 1660 2 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ❑ Yes ❑✓ No k. Describe the current or prior use of the facility: RETAIL SPACE BOTH PRIOR AND CURRENT I. Is the facility a residential facility? ❑ Yes 0 No -o m. If yes, how many units? Number of Units -� 3. Facility Owner: �N BELL TOWER CORPORATION �o a.Name 0 1 BUTTERCUP LANE b.Address SOUTH YARMOUTH CA 02664 o c. it /T wn d.State Zin Code 0 16175389326 f.TT le hone Number area code and extension E-mail Address o ional _Q JOE SOUSA �Q h.Onsite Manager Name ag06.doc•10/02 BWP AQ 06•Page 1 of 3 ti Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention . Air Quality 100109137 O Decal Number BWP A Q 6 Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project, were the structure(s) surveyed for the presence of asbestos containing material (ACM)? ❑ Yes ✓❑ No If yes, who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 7/1/2010 7/30/2010 a.Start Date(mm/dd/yyyy) b.End Date(mm/ddlyyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving ❑ wetting ❑ shrouding b. If other, please specify: ❑✓ covering ❑ other 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? NA a.Name of.DEP Official NA b.Title 7/6/2010 c.Date mm/dd/ of Authorization NA d.DEP Waiver Number D. Certification I certify that I have examined the JOHN CALLAHAN -o above and that to the best of my a.Prin ame -o knowledge it is true and complete. U The signature below subjects the ' b.Authorized Signature �N signer to the general statutes I PRESIDENT =o regarding a false and misleading ; c, Position e �o statement(s). ; JTC CONTRACTORS INC d.Representing 7 : t 6 �o e.D to(mm/dd/yyyy). 0 �O �Q ■ ag06.doc•10/02 BWP AQ 06•Page 3 of 3■ Sign_ TOWN OF BARNSTABLE . Permit * BARNSTASLE, MASS. � i6 ArFG A� Permit Number: Application Ref: 201003577 20070482 Issue Date: 07/15/10 Applicant: PROPERTY OWNER Proposed Use: SHOPPING CENTER- MALL -Permit Type: SIGN PERMIT Permit Fee $ 75.00 Location 1600 FALMOUTH ROAD/RTE 28 Map Parcel 209014 - Town CENTERVILLE Zoning District SPLlT Contractor PROPERTY OWNER Remarks . 26 SQ WALL KOKO FITCLUB Owner:' PROPERTY OWNER �... - Address: , Issued By: P, POST THIS CARD 50 THAT IS VISIBLE 'FROM TT3E STREET r Town of Barnstable Regulatory Services •A Thomas F.Geiler,Director 61¢.+� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862AO38 Fax: 508.-790-6230 Permit# Building Official approving Application for Sign.Permit / APAlicartt: � s� l •�xt�s rav► 5 :Ii' L Assessors No. -20 Doing Business As: Y.aIC-c, AiGi-6 Telephone Nm; &M -Kf 3-: /$Z./ f Sign Location Street/Ito ad: 1lQOa I mw-46 `Z i—L&14- -7 O Zoning District:—Old Kings Highway? Ye o Hyannis Historic.-District;) Y o� ' g c Prope Owner C Vamci 1�}fF�� [[a t f'i ,✓ lephone: : Addressy;6Ud FW AMVVf t /Tp- Villa c:11!f�`'1��1f1�f L L [= } sign Co or _ •�'` � _ `� . Name: �tl�/2 COL2 S'+G I'elcphoue Mailing Address: 1p/1 i'L l��t/.�G- Rp &1,jz/t-e�i f; ) Description` i Please:follow die cover directions.You nitist luive an accm-atc rcaidition of sign t�itli dimetisioiis and location. Is die sign to be electrified? ; Ye io" (Notc.Ifyes,a wii*g jw.mvtis required) Width of building face : L x 10 .2 GO j Check one Reface existing sign` or New Total Sq.FL of proposed sign{s) G S Krou have ae1&ij6nal.s{Vus pk+se attach a shcel hAing each one nidt dimensions if refacing an existing sign please provide a picture of thc.cxisting sign with dimensions: I hereby certify that I am the owner or.that.I have the authority of dre owner to make this application, that the.information is correct and that the use and construction shall conform to the piovisions of §240-59 through§24"9 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent `� Date 7 to, t SIGNS/SIGNREQU t I KELLER"ILLIAMS 7O C�K6-ko FitClub AIL t i tF'�I j(qk. o r' 'I a� 1 Fitclub, �t4711� ��� s GENERAL CEILING NOTES: 1. FRANCHISEE/PREPARER OF PERMIT DOCUMENTS RESPONSIBLE FINISH SELECTION BY l FOR COMPLIANCE WITH ALL APPLICABLE CODES AND LIFE SAFETY O O FRANCHISEE. KOKO _ REQUIREMENTS PER JURISDICTION OF SPECIFIC LOCATION(S). + CB CB ENCOURAGES HIGHEST LEVEL 2. DOCUMENTS REPRESENT DESIGN INTENT AND GENERAL LAYOUT OF FINISH BUDGET WILL TO MEET KOKO FITCLUB DESIGN STANDARDS ONLY. UTILITY CLOSET O O ALLOW-SEE BUILD BOOK FRANCHISEE/PREPARER OF PERMIT DOCUMENTS MUST COORDINATE LIGHTING AND CB CB SECTION 2 LAYOUT AND ALL REQUIREMENTS WITH EXISTING CONDITIONS. FINISH SELECTION CT / 3. FRANCHISEE RESPONSIBLE FOR PROVIDING ENGINEERING AND BY FRANCHISEE. O O CB CB VERIFICATION OF LIGHTING LEVELS, POWER REQUIREMENTS, SWITCHING, AND CIRCUITING TO MEET ALL APPLICABLE CODES.AND REGULATIONS IF REQUIRED. LAYOUT SHOWN IS FOR DESIGN INTENT ONLY. 4. COORDINATE TELEPHONE/DATA REQUIREMENTS AND LOCATIONS. 0CB 1 0CB 0CB 0CB 5. PROVIDE LIGHTING CONTROL PANEL EQUIPPED WITH AUTOMATIC CE LING TitE TIMER CONTROL FO AI W L 6. COORDINATE SECURITY SYSTEM, SECURITY CAMERAS AND CARD SWIPE ACCESS WITH SECURITY PACKAGE PROVIDED UNDER SEPARATE:COVER. PROVIDE CONDUIT DROP AND PULL BOX WITH PULL STRINGS FROM ABOVE'CEILING TO CENTRAL SECURITY SYSTEM CONTROL LOCATION-TBD PER INDIVIDUAL LOCATION. CAMERA POSITIONS SHOWN ARE FOR REFERENCE ONLY CE _9• 4•_9• CE COORDINATE LOCATIONS AND QUANTITIES W/ SECURITY PROVIDER. PAC 7. FRANCHISEE/PREPARER OF PERMIT DOCUMENTS TO COORDINATE 0" SPRINKLER SYSTEM ADJUSTMENTS IN ACCORDANCE WITH CODE (IF REQUIRED) I CA` CA 10. THESE DRAWINGS ARE BASED UPON DIMENSIONS PROVIDED, <)CD ALL DEVIATIONS FROM EXISTING CONDITIONS TO BE COORDINATED BY OTHERS. 11. FRANCHISEE/PREPARER OF PERMIT DOCUMENTS TO COORDINATE ALL FIXTURE AND FINISH SELECTIONS WITH KOKO FITCLUB PROTOTYPE BUILD BOOK. ALL DEVIATIONS MUST BE APPROVED BY KOKO FITCLUB. ' 12. FRANCHISEE/PREPARER OF PERMIT DOCUMENTS RESPONSIBLE CA y` CA FOR PLACEMENT AND SELECTION OF FIXTURES & DOORS TO MEET OCD ALL ACCESSIBILITY REQUIREMENTS. L CF 13. IF CEILING GRID IS TO BE RETAINED, IT MUST BE REPAIRED TO RESULT IN CONTINUOUS CEILING AT ALL AREAS OF DEMOLITION �CD OR PREVIOUS DAMAGE. GRID MUST BE REPLACED BACK TO ADJACENT GRID INTERSECTIONS-NO SPLICE PATCHES OR RIVETING WILL BE ACCEPTED. 14. FRANCHISEE/PREPARER OF PERMIT DOCUMENTS/CONTRACTOR CA CA RESPONSIBLE FOR ANY/ALL UPGRADES OR RELOCATION OF EXISTING HVAC SYSTEMS TO MEET LAYOUT AND ALL APPLICABLE CODES. 15. KOKO SUGGESTS 200 AMP SERVICE TO,MEET POWER NEEDS. (:>CD • EXISITING SPRINKLER CA CA 2 x 2 INDIRECT LIGHT FIXTURE OCE! CA ELEC FIXTURE SCHEDULE 0CB DOWNLIGHT TYPE QUANTITY CA 14 of. T OCC DOWNLIGHT W/ DROPPED LENS CB, 14 CA CA G CC 9 CB (. �• WALLWASH DOWNLIGHT CD CD 6 y. CE 4 _ PENDANT FIXTURE CF - CE BTM. FIXTURE 7 2" AFF m - I n NOTE: LIGHTING FOR UTILITY '_IL- • — \ ROOM NOT INCLUDED IN CA CA - 1y CEILING FAN SCHEDULE 0CB OCD L CF O.: 2 x 2 SPEAKERS - SEE SECTION 6 SECURITY CAMERA 2,-0" 9,-4' CA CA 0 -- --- -- --- - CB 1 K ACT-) AVIULN O b O O -- -- --- -- CC CC CC CC CE OCO :2 -OIL ACT q CEILING TILE T I U —0 AFF CEILING HEIGHT " ' OCC CC CE GREETING SHELF PROVIDE CONDUITS AND PULL BOX WITH PULL �CE CD SEE ELEC KEY, SHEET At STRINGS FOR DATA AND SPEAKERS IN WALL FROM ABOVE CEILING CONNECTING TO CONDUITS O O O FEEDING GREETING STATION AT FLOOR. CEILING PLAN CC CC CC PROVIDE DOOR JAMB STRIP SECURITY 10'-0' CAMERA AT DOOR-COORDINATE WITH SECURITY REQUIREMENTS FOR DESIGN LAYOUT ONLY-NOT FOR CONSTRUCTION Limitations: Franchisee: Timothy Calise These documents provide schematic layout on The ore KOKO O FITCLUB T C L U B DN• Y SITE-FIT LAYOUT 28101d Jail Lane not intended as permit drowings,they provide base Fred l belva v Rom" information from which permit drawings con be developed Franchise Location: Barnstable,MA02630 Koko Approval: Dote: S 25 20t0 530esign Inc. that meet Koko FiICIub design standards.NI code,fie-solely Bell Tower Mall � I.Hancock 5treet,suite 2, and other regulatory requirements ore to be addressed by IVV\Y��' 2010 Project No.09005.26 Quincy,Massachusetts 02169 those c1mlopmg permit documents. Use of these drowings MAY ,. 1600 Falmouth Rd I Drawing No. 2, 617.472.880e signifies acceptance of these limitations. MA 02632 ons. Dole Scale: 1/8•• 1•-0" ,/H\`L/ _ 1 Tt 26'-0' GENERAL PLAN NOTES: 1'-0" 5'-0' 8'-0" 1. FRANCHISEE/PREPARER OF PERMIT DOCUMENTS RESPONSIBLE FOR COMPLIANCE WITH ALL APPLICABLE CODES AND LIFE SAFETY REQUIREMENTS ALL AVAILABLE BATHROOM PER JURISDICTION OF SPECIFIC LOCATION(5). FACILITIES MUST BE COMPLIANT WITH THE 2. DOCUMENTS REPRESENT DESIGN INTENT AND GENERAL LAYOUT TO MEET STORAGE / AMERICANS WITH KOKO FITCLUB DESIGN STANDARDS ONLY. FRANCHISEE/PREPARER OF v \ DISABILITIES ACT (ADA) PERMIT DOCUMENTS MUST COORDINATE LAYOUT AND ALL REQUIREMENTS v ADA N AND ALL APPLICABLE WITH EXISTING CONDITIONS. RESTROOM i p LOCAL CODES AND 3. FRANCHISEE RESPONSIBLE FOR PROVIDING ENGINEERING AND I ORDINANCES. VERIFICATION OF LIGHTING LEVELS. POWER REQUIREMENTS, SWITCHING, AND / LIGHTING AND FINISH CIRCUITING TO MEET ALL APPLICABLE CODES AND REGULATIONS IF UTILITY CLOSET o SELECTION BY FRANCHISEE. REQUIRED. LAYOUT SHOWN IS DESIGN INTENT ONLY. LIGHTING AND 1 KOKO ENCOURAGES 4. COORDINATE TELEPHONE/DATA REQUIREMENTS AND LOCATIONS. FINISH SELECTION HIGHEST LEVEL OF FINISHBUDGET WILL ALLOW-SEE i 5. PROVIDE LIGHTING CONTROL PANEL EQUIPPED WITH AUTOMATIC TIMER BY FRANCHISEE. UTILITY � � BUILD BOOK SECTION 2 CONTROL. \ ADA T' 6. COORDINATE SECURITY SYSTEM, SECURITY CAMERAS AND CARD SWIPE 2' 0" STORAGE RESTROOM 21 n ACCESS WITH SECURITY PACKAGE PROVIDED UNDER SEPARATE COVER. 2'_9 3'-6" 5'-0"PROVIDE CONDUIT DROP AND PULL BOX WITH PULL STRINGS FROM ABOVE1 -6" 2 CEILING TO CENTRAL SECURITY SYSTEM CONTROL LOCATION-TBD PER 1' -0 \ INDIVIDUAL LOCATION. i 7. CAMERA POSITIONS SHOWN ARE FOR REFERENCE ONLY COORDINATE LOCATIONS AND QUANTITIES W/ SECURITY PROVIDER. 9 8. ALL OUTLETS (POWER/DATA) SHOWN FILLED IN:1R 0 12 2 H POWER & DATA & TA PROVIDE MC WIRE STUB-OUTS AND DATA STUB OUTSO POWER DA ORES TO BE 13 3' 0'AFF � 4'-101' AFF INSTALLED ONCE MILLWORK IS IN PLACE. 13'-0" 9. CENTER ALL LIGHTING FIXTURES IN ACT CEILING U.O.N. CORNER F 10. THESE DRAWINGS ARE BASED UPON DIMENSIONS PROVIDED, ALL r— FOCAL WALL �I SMARTRAI 4ER DEVIATIONS FROM EXISTING CONDITIONS TO BE COORDINATED BY OTHERS. CL F ' _ _ o 11. FRANCHISEE/PREPARER OF PERMIT DOCUMENTS TO COORDINATE ALL I . FIXTURE AND FINISH SELECTIONS WITH KOKO FITCLUB PROTOTYPE BUILD If f 1 BOOK. ALL DEVIATIONS MUST BE APPROVED BY KOKO FITCLUB. v 12. FRANCHISSE/PREPARER OF PERMIT DOCUMENTS RESPONSIBLE FOR PLACEMENT AND SELECTION OF FIXTURES & DOORS TO MEET ALL ACCESSIBILITY REQUIREMENTS. I O tt�1I 13. FRANCHISEE/PREPARER OF PERMIT DOCUMENTS/CONTRACTOR CL RESPONSIBLE FOR ANY/ALL UPGRADES OR RELOCATION OF EXISTING HVAC n FUTURE F I m SYSTEMS TO MEET LAYOUT AND ALL APPLICABLE CODES. CORNER OF �� h' CORNER F SMARTRAINER w L CF ABOVE SMARTRAI ER F CASEWORK PACKAGE KEY-BUILD BOOK, SECTION 3 1�' I "' CD GREETING STATION O KOKO SHELF & HOOK I v O ©GREETING WALL O FOCAL WALL o 1 ' I ©GREETING SHELF O FOCAL SHELF O DEFINITION WALL O PLEXI-GLASS DIVIDER CORNER OF I ER F _ SMARTRAINER CORNER RAI ER O DEFINITION SHELF 1 I R STANDARD FINISH KEY-SEE BUILD BOOK, SECTION 4 F O r I n ROOM I O 1 Z3 ROOM NAME AND NUMBER M D I I o j CT—X CEILING FINISH CL F I P-X . C-X WALL FINISH i O II F o RB-X FLOOR FINISH a - CORNER F BASE FINISH F n1 I SMARTRAI IER ELECTRICAL KEY-SEE BUILD BOOK, SECTION 6 " D t it n CWr F ,��h�__N Q 1 A C i L CV ABOVE I O WIREMOLD: SURFACE MOUNTED DUAL COMPARTMENT RACEWAY: MODEL r� I DS4000 SERIES OR EQUAL. RECEPTACLES IN ONE COMPARTMENT DATA CL F I IN THE OTHER. FOR EACH TREADMILL PROVIDE: v I OI CL A-ONE(1) NEMA 120V, 20-AMP 5-20R, SPLIT WIRED/DEDICATED CIRCUIT ^ O O2 O I B-ONE(1) STANDARD 110V RECEPTACLE (FOR VIDEO SCREEN) I . C-ONE (1) DATA JACK (FOR VIDEO SCREEN) v _ DUPEx POWER OUTLET (110 V, UNLESS NOTED OTHERWISE) 1"J 0 _ 1 N POWER OUTLET STUB-OUT (SEE NOTE 7, ABOVE) P Ir TEL/DATA OUTLET (SEE EQUIPMENT FOR TYPE OF CONNECTIONS REO'D) _ CUSTOM WIRE 10 MOLD LENGTH 30" AFF TEL/DATA OUTLET STUB-OUT (SEE NOTE 7, ABOVE) c T3 A A CONDUITS AND PULL BOX W/ PULL STRINGS FOR DATA AND 1 1 1 1 1 SPEAKERS IN WALL FROM ABOVE CEILING CONNECTING TO I 5 I d I N CONDUITS FEEDING GREETING STATION AT FLOOR. v WELCOME 1 J o NOTE: RECEPTACLES MOUNTED 18" AFF TO CL-UNLESS NOTED OTHERWISE POWER/DATA 001 I N STUB OUTS 0 CT-1 PURCHASED EQUIP KEY-SEE BUILD BOOK, SECTION 7 & 8 FLOOR TO FEED P-1 I FUR OUT ALL WIREMOLD C-1 7 6 FLUSH W11H COLUMN C 1 SMARTRAINER 8 STEREO SPEAKERS RB-1 I� i c AND EDGE OF COORDINATE DOOR WIT l� I °D FREETING ALL 2 SMARTSTATION �50" FLAT PANEL TV & BRACKET REQUIREMENS FOR D -_JAMB SECURITY CAMEFLOOR TO 3 TREADMILL W/CARDIO THEATER DEFIBRILLATOR, CABINET&SIGN CARD SWIPE ACCESS I' I CEILING 4 ELLIPTICAL W/CARDIO THEATER 11 LOOSE SEATING I, I B'-0" 5 LAPTOP COMPUTER 12 EQUIPMENT WIPES DISP. FLOOR PLAN o 0 I 1 6 MULTI-FUNCT. COLOR PRINTER 13 WATER COOLER (DScole: 1/8" = 1'-0" N 7 STEREO RECEIVER REPLACE DOUBLE DOORS TH SINGLE DOOR AND SIDELIG T CONDUITS FEEDING POWER/DATA STUB OUTS TO MATCH EXISTt \ GREETING STATION 0 FLOOR TO FEED CONDUIT FOR DESIGN LAYOUT ONLY-NOT FOR CONSTRUCTION J 0 BASE OF WALL TO GREETING STATION Limitations: Franchisee: Timothy IThese documents provide schematic layout only. They ore KOKO FITCLUB not intended as permil drawings,they provide base Fred I bclva SITE-FIT LAYOUT 281 Old Jail Lane v atsc" information from which permit drawings can be developed Approval: Franchise Location: Barnstable,MA 02630 Koko 530esign Inc. that meet Koko Fi1CWb design standards.Al code,ile-solcty Bell Tower Mall Dole: 5/25/2010 1459 Hancock 5treel,Suite 2r and other regulatory requirements ore to be addressed by MAY 2�, 2010 Quincy,Massachusetts 02169 those developing permil documents. Use of these drawings 1600 Falmouth Rd Project No. 09005.26 Drawing No. A 1 617,472.8804 signifies acceptance of thew limitolions. Dote Centerville,MA 02632 scale: ,/a" = 1'-0'� �fi