The URL can be used to link to this page

Home My WebLink About1620 FALMOUTH ROAD/RTE 28 (11) ,�� 24 F'cm�U ��°,�" f a �©iGSA s �4 ,� ,.'�''"��.N-�,.."',,,j:0I."�'�I-.��.,-��I��,,'e:"_tT,,�'�;"�,A'.',,'--i.�,.,",1I��,��'I'�'JI I 4.-1,:,'�.,",�'Io�"��1,,,o�.�,,,�-:-�1:1N�"'_,:t_-,-.'�,",1��.0I'��'i---�,�--;"K,"�-.:l,��,�,-��.''v X:�_-:�0',;I"�,."'-_T'R:""'-"I',.,!.l-''A��"�I,,-_��,��-:l-:',,�".--,.��'"',!'�..,1',�v-'��,_1,:I�.I-.t��"�O�'�-�,�'.,�,�":11�:,",.':�"i"�:;�-'��;c o v��'."II''�S"'�'''��-,;-�,I.,4'��,1 i�,,,.:i�'.,."".,��',":�.�--'��,'-A,"'',�-.,',:_��;24�"'A',,x��.'''"�.,1.��'o,'I�f,"',��o,:,�,�'!�"I:W iR�,"p,��_-;'.o�,'-,'�'.1,Jm_FI:,":,�_.;:-"4'..'t,�,I,�I��-,":-"-�,,,-��"��a;,"-I��_��.r�",,�,',_-q 1�%,:'�,o'".,0�_:1.'.,'�''�':��""�,,':,_"—,'I";",�",�t�I,,At',�","r.!'",,.K:-"I',''�'�,�I��':'1_,;-�-;�"I"��'I_"ill�;.'-�'l�'�"��,_"��:,-��i"'1'�"';*7-��,,t�,l nA�,'',,l�'�:.�,�t,a i,I:�-I.��.��o'"",��,�1-!i.Q.�1-.�'-'�-"',:'�-".,�,��',;;:�,"C;.�t".I�t`:��'.':'',t I�-.-�i'%��"."�k.'",I�,,1:��,�I,;."_4-�i.i'�.%,'�1"T"�1',-T-"��:�q1',",',�y-1�."_"'"'Z�.'��,1��I":�',e�,��-'.�1.-,�;�,�,,:',�,'�",I"�,:�,,-�,-!��N��:',1n,-""-�''''',,�;,�..":��,I:''i�I,,_,,'�-01 1��'�'',��.,"I��_iq-;�,'�'�-"!,-I"0,"1��.�.�,-,I,'�'��o.,':,-'-�s�,1 1'p,--'I,�",,'�oJ;,�,i,.'.,",�-',,t;,"'��;i��-'','��'"';�I'"��1 1�,',';''..�,�,w""�I_�A'��o'�,,.e'�_)w,,-7�.3�,,1-,,,I"1—�I,-''1��,"'':''�,�S,""""-"�,"�_��","1�nv,�"4,",�",q';_:,', ';:�''�.',�2!.'*��G_'4-iI��7,.i,,��'I"_;�''"�',�o1��'-��I:�,,'"'',�-v�'.'V"�.:!��'"�,��':�"�A-'-'i�,'_,'��'I,,�-�,.t""�,'-;T-o"I",,e.'t_.''-�"''-'�,;�:.-�'',�,'-�,.','1�"'��:1"A��,',�,�._��-�-_�,�--.�-,-'�"''::I�,'-",J,,1'''��"I:�',,,-,,_'I'��,I''",-'�:,�-"��f',,,�.,��.:'.,i,��'�",I',.,.,--7-2i'�,'�.pI":1'.-o";II'�,"�,�""��:��-�",1"l'�1�","O-�,i I�":'I.,.`�.'�,',,��*"�,,'.�1.:"��'�,1,1I,�,,�;�5.,,.f�-;,:o'�..I�l�I:��"''q i�,"�I'.��':,,-1��_�'�'"..:�.,'-1�1,1 Q,-'.,�,�;'�o�In I.5"'-W S�,-�,".�.�-�'�l':';,-"-�'��.'`�'�!"i,,'�",,'--"�."I', ��.''''"I,,�i;":".�';1::,-..'�"��,I7_i,.-,''�.�io',.,'"�I'&v":,��":,:'.�-',�:,�.�,:.'"I.;�";�.,��"�-1,�,'�t1.:��'�,-I i:''-;��t�-��::'l,�.c'''—""�I�.�o�,.�-'..,,�,x;'��","',"''::�ti"�'-�'!�;,.q"tn.��"I,':�,�I'"4,''��:r".�.I�I,;i-Q I,"".�."�'F�""'�",-n''�,,:�t,Q o'.I,,'"''',�y�n,:,'!v:"�-'��",'I�''�I 1,"'�-"I,".II''",�-,,,I�,'",��'',��J"I,��-Q--a i,'Iy'�I.�,:,. �.4 m',�t11,'I�,��j,,'�;,�"�',-,,""�i;-t,�:,'��",,':�v��I,��.-,--,�I��,4l':;Q,Q��",.��l l.��,I,��:,��vI,�,.""':.N.,-,:'I I�,"WI',,,�"_'��,:I��o ','I0�!4:'e�,0-"�,�,.I,l :I;-��,',.,",s:j&��q I�,�'1��"i.:,,`-,"�'��o:";��I�;,1',t V,�"..'i1,"��_i,,$,'.,.Y".("",_,''"-��4��''-d;"Ii-;�o��'�I��I,�1��_,,,��z_!,�"�:,�V;,,��1n1t_-,�-"I',:�,�tq�A-','I,,,m,�"�,��fAj�',�I."`�'.�';I'�.l T';":��I�y''�',�',�I-'!i'""��'"�:,�'��"m III.oi,-�aQ,�:�'"s�,..,"�'�'�.no�'W,'-I,",i'�-'"'""."""�-�"-"''-,"��1�>"�''-,t�"�w��",_e'%.'"�-_-".V-�,�!,",�p_�",-v--�.I,'�.,",'?�':A i",I',,.",A-�'-n�t",."_-.I"�:,��,:U�_,,�-.,v,�".�'T�,,-��'.,_�-,�,l�-�:I'll��Y��,'_�':��7�,"�,,�:'",�.�,.".,,'wA,'.�".',;!i�_�",."""',i"w:,�;,'-''�,:,�,'�,'",�'��'i�;�",,;I,_"�0,:�-�A�',.W'*,,I�:- �:'%25':'.';�.,.;M�,o-:...,"1."'':�""K�'"':�I..'I1'�t','�.,A'�0�'�"-��,'.K,-�t1��;",�!i �,�W�:�.',��",�i,:�,A"�1,�I:��,"�,.'�'�1�r�:��.I:�,--�".tI-"�§;�','A,_'�1�w''I�,',-�-.��,L-1,"''�':V�!,�,�,",�-,T'-',�'O'-,�*--i-�V,I,I.,�, '�A'�,,.,:'"'I,m".��i�..I 1,"'.n-,�'�',�'.:"'�".��,"7:�;,�'�"�.�'_,1 i_jI�"""y,..'��.,1��'T�..� ",.��"l:"I-.'."1p',,�!,t��,.A��1,�--�v��,�;,*� ,,"':�,.:--"-f��7 t".,'!-��M��`.I�'_11 i�,.,'_0'� gtmJ. ,.. t �.,.. .It. _ :. :.g �(� y �S' :' �cfiU'1 n a- ti x % 5 �; a. { y •// dR1 ✓ ,J' "3.�7.r .,t'16'u,r -„! re L'.a' snt; :xi 9', fX. r`".;., r, t d' _a ,�(`. a f � :�;; �y�,3 a a i,� , '... r, t*a U.av, j S .i,a' -�uI a++ x +r '�. iS ly., x :t f is �"' n \ . k' ` `. : , , f .., , .. .. .. p t ,t L t P; 4+ 4 9''. :,.: ':',1 <� r r.. 1-:.i. ., 1. S'' } t _ Q'r 1 _y4 1! w {fr(' M 1........ .: ......""- Z:. .i....a." ,. . ..., .,. .. ... , 1 .,. 5 Jk 1 ,._...,.:, ...,. F.. 1, C 1 F t Y - r I y a :; Y . . �j; IItI . . r r,: . n , r x n. e ,. ,. i:,.: v 1,,,. , r ., f .c.: n i .v, , •'/.. 5 ` ��(F t - 1�. .P. Y„ ., p'A .1, ,", l,:..., .., ,...n. .,,i m-.zY.. fir 4^ 1 .'[ t '.,,� ,,.. - a t a 4i 1 r cC ..: a 1 t S S S.F a. r '.'.. , � i:. ,1. G _ix k k 1,. l �• t g; ¢ ,1 'J d J f t l 'tZ Y 1 �" b p '4 R 4 1 .f. „ �y . .� .. ..; ,> a .,..., .. 9 ,1 :I.�,'. f J� 7 ,rf- r r ,e. E,... Y _c' r t P. .t Y f L 3 „( M, i':. . ii ' , i •,. ...;.. '-:.�.. ,..E �.. Y ) i s `, t - (` :.1 S t { ,:.5. t ^: t t Y f ; jftf B f 'Ir - } tl -C �} -' N . Town of Barnstable u d 1 `. "'-w• y `. _�" ��a, tt� �" :. yam'.'" x `� � '�, `��^r �, � � � �'i } i ii� HA Post This Card So That rt is Vis�ble'From�theStreet :Approved'Plans iVlust be;'Retamed on Job andxthis Card,Must be Kept +- RNf3'['ABiB. •. 6 PostedUntll Final Inspect�onHas BeenMa , a � ' ° Where a Certificate of Occupanty s Requ�ed,such Buildmg shall Not be Occupied until a Final Insp ct,on„fias been made E Permit ;,, ;.; �,�..._,.�.�......�...�. mr,� ._ .��..�•. �».K.��,...�w.a_.,.,A...�..r�h.-,ter.r_�. �:. n�.-...�...�.�..w,�.;.�.�. �,��.�.,:,�- ;,,��.,..._ �.�,....�;� Permit No. B-17-3114 Applicant Name: Christopher Gacicia Approvals Date Issued: , 10/11/2017 J Current Use: Structure Permit Type: Building-,Siding/Windows/Roof/Doors Expiration Date: 04/11/2018 Foundation: Location: 1620 FALMOUTH ROAD/RTE 28,CENTERVILLE Map/Lot 209-013 Zoning District: SPLIT Sheathing: Owner on Record: POYANT, MARCEL R'" r Contractor;Name: CHRISTOPHER P GACICIA Framing: 1 Address: 20FCAMP OPECHEE RD ContractorL�cense CS 105072 2 CENTERVILLE, MA 02632' ., r 4> # Est Project Cost: $15,000.00 Chimney: Description: remove exitsing windows and doors. install new store front doors Permit Fee: $160.00 Insulation: and windows. repair trim work as necessary r Fee Paid $160.00 Project Review Req: - Date 10/11/2017 Final: PI 1 j Plumbing/Gas <% wt .. Rough Plumbing: .Building Official final Plumbing: This permit shall be deemed abandoned and invalid unless the work authonzed byFthis permit is commenced within six months,.aftergissuance. All work authorized by this permit shall conform to the approved applicatibn aih thefapproved construction documents,for which this permit has been granted. Rough Gas: All construction;alterations and changes of use of any building and stru�c#ures.shai be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspectio f or the entire duration of the Final Gas: work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Off icialsaare provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Service: 1.Foundation or Footing . 2.Sheathing Inspection rr ^^ Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame inspection S.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: - 6.Insulation 7.Final Inspection before Occupancy _ Low Voltage Final: Where applicable,separate permits are required for flectrica1,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as"set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT f Town of Barnstable R�cxEiPT gAWI!'>TABM KAM 200 Main Street;Hyannis MA 02601 508-862-4038 Application for Building Permit Application No: TB-17-3174 Date Recieved: 9/14/2017 Job Location: 1620 FALMOUTH ROAD/RTE 28,CENTERVILLE Permit For' Building-Siding/Windows/RooVDoors Contractor's Name: CHRISTOPHER P GACI CIA State Lic. No: CS-106072 Address: Quincy, MA'02169 Applicant Phone: (617)479-6035 (Home)Own,er's Name: POYANT, MARCEL R Phone:, (000)000-000 (Home)Owner's Address: 20F CAMP OPECHEE RD, CENTERVILLE,MA 02632 Work Description: remove exitsing windows and doors. install new store front doors and windows. repair trim work as necessary Total Value Of Work To Be Performed: $15,000.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation.insurance for every contractor,subcontractor,or other worker before he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required.to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which'is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. - Signed: Christopher Gacicia 9/14/2017 (617)479-6035 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost : $15,000.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $160.00 9/19/2017 $160 00 l visa )CM-)CM- Credit Card X)M 4623 , .._... _....................... Total Permit Fee Paid: $160.00 [12 .. .,, .. � i s , TOWN OF BARNSTABLE BUILDI G PERMff APPLICATION LIT Map 209 Parcel 13 Application # Health Division L� Date Issued (O L3 II(S Conservation Division Application Fee z60 Planning Dept. Permit Fee r Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 1660 Falmouth Road, Village Centerville, MA 02632 Owner MARCEL R. POYANT Address 20F Camp Opechee Rd. CEnterville. MA Telephone 508-775-0079 Permit Request Demolish existing partitions(except small lavatory) . Partition handicapped lavator� sheetrock exterior and install hollow core door. Plumb & electrical & flooring at later date. .Square feet: 1st floor: existing 1,OOOproposed 2nd floor: existing proposed Total new Zoning District xighway Bus Flood Plain NO Groundwater Overlay Project Valuation A"Z® � Construction Type Spec Permit office & retail 1985t Lot Size Grandfathered: X2 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ - Multi-Family (# units) Age of Existing Structure 1985 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Slab on grade Basement Finished Area (sq.ft.) Slab 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: W Gas ❑,Oil ❑ Electric ❑ Other Central Air: 95 Yes ❑ No Fireplaces: Existing New Existing wood/coal stov.,e: O-Yes ❑ No r Detached garage: ❑ existing ❑ new. size Pool: ❑ existing ❑ new size _ Barn!'Q"existing Q ne_ size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ rn Commercial U Yes ❑ No If yes, site plan review # Current Use Office Proposed Use office or retail APPLICANT INFORMATION " -- - --- - --(BUILDER OR HOMEOWNER) Name �e-l C T'D 111J Telephone Number Address 7�D �!'r License# 6_5 - 16cM(66 10w1 Up 9- Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION EBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TOL SIGNATURE DATE S FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER M� r DATE OF INSPECTION: E..-. -FOUNDATION-. FRAME INSULATION _- FIREPLACE , ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL k FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. .T Tdie Commonwealth o,f Massadiusetts Depaphnent ofIndustraal Accidence Offwe of Investigations estigat'ions 600 Washington Street t Boston,MA 02111 a-mv jnas&gvrrJdia Workers' Compensation Insurance davit:Builders/Contractors/Ek-ctricianwThunbers Applicant Information Please Print LezibIy Name{ nurgan ratio - - a'= Address: 1� i�hee a • City/State/Zip: - Phone 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 1 employees(full and/or part-time)-* have hired the sub-conhwtors 6- ❑New con=suuction 2-❑ I am a sole proprietor or partner- listed on the attached sheet. 7_ ❑Remodeling ship and/raise no employees These sob-contactors have 8- ❑Demolition working for me in any capacity- employees and have workers' [No workers' comp.insurance comp.insmanoe.l �_ ❑Building addition required-] .5. ❑ We are a corporation and its M❑Electrical repairs or additions 3,❑ I am a homeowner doing all works officers have exercised their 11_❑Plumbing repairs or additions myself lido workm'comp_ right of exemption per MGL 12_❑Roof repairs insurance required,]I c.152,§1(4),and we.have no y employees-(No workers' 13-0 Other comp-insurance:required.] i Any applicant that checks box if l avast also fill out the section below shoeing their workers'campensation policy information_ t Hameovn ers who submit this of Mmrit indicat ig they are doing all wo*anti then hire outside amtraetors u 3 subs=a new aff d2v t indicates such- 4Conttactors Ghat shad this box must attached an additional sheet showing the time of the sub eontracAoas and state whethu w not those entities hags employees. If the sub-contractois base employees,they must provide their warkM',comp.policy number. lam an empioyw that is pmiding workers compensation insumrtce for my,ernplayem Below is the policy and jab site in formidiosd Insurance Company Name: C E- Policy 4 or Self-ins_Lic-#: (�,5(�. A Expiration Date: Job Site Address: 16!t 2� ��fl`-t O o �i••- D Ci 1Stat&Zip:Ce,N �vZ Attach a copy of the ivorkers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year irnprisoamerdt,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a da ag;iinst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of for ce:coverage verification. 1 do hereby semi aarder the s and penalties of perjrury that the information pro tied nab is and correct Si tore: Date: 6 6-�J� Phone 97, L-12 11 6LA616 lJ,,cid arse only. Do not write in.This area,to be comptded by city or townofficiaL City or Town: JPermit/Ucense# Issuing Authority(circle one): 1.Board of Health,2.Building Department 3.City(fown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Massachusetts-Department of Public Safety .'Board of Building Regulations and Standards Y Construction Supen-isor License: CS-102260 MICHAEL S ME 46fl"I JR ' 97 EMERALD LrtM Marstons 1V u NWR s Expiration Commissioner 11/05i2016 -• ' .. .- - ___ '"�e�Q771A77,(l7LtUEUGL/Z a' -C%I�GCGfJUCl2ctJe� Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR gistration 162938 Type: e� Expiration: 4/27[2015 DBA r MEAGHER BROTHERS CONSTRUCTION MICHAEL MEAGHEWj ,ja 97 EMERALD LN ,k Y, MARSTONSMILL,MA 02648 Undersecretary , ' tip' y t 4 y ; v y Unrestricted-Buildings of any use group which, s ' contain less than 35,000 cubic feet{991m3)of enclosed space. ; f k ' Failure to possess a current edition of the Massachusetts fi State Building Code is cause for revocation of this license. For DPS Licensing information visit www.Mass.Gov/DPS License or;registration valid for individul use only t before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suit 170 Boston,MA 0.11 J No alid rthout signature J CJ '••�-..�.........+..-..+-.vvv.-.....�-.+......r�rr yr u.,vr.m..nvn-v.vv r"w.vv-V.vrvrcraa rvV'nwn a J crrvry me c.�n nr,c,w-rc nvcascn. rnra 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 INSUR�R(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms-and conditions-of the policy,-certain policies may require an endorsement."A statement on this certificate does not confer rights to the certificate holder in lieu of,such endorsement(s). PRODUCER CONTACT Dowling&O'Neil PHONE 508 775-1620 Fax aC No Ext: A/c No: 5087781218 Insurance Agency E-MAIL ADDRESS: 973 lyannough Rd., PO BOX 1990 INSURER(S)AFFORDING COVERAGE NAIL 1< Hyannis, MA 02601 - INSURER A:National Grange Mutual Insuranc INSURED INSURER B:Associated..Employers Insurance Meagher Construction Inc. INSURER C Timothy Meagher INSURER o 772 Main Street Osterville, MA 02655 - INSURER E:. - INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO-WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP - LTR INSR WVD POLICY NUMBER MM/D MM/D LIMITS A GENERAL LABILITY MPT1250G 0/16/2014 10/16t2015 EACH OCCURRENCE $1 000 000 X COMMERCIAL TO COMMERCIALDRENTED L GENERAL LIABILITY PREMISES Ea occurrence $500 000 CLAIMS-MADE Exl OCCUR MED EXP(Any one person) - $1 O 000 PERSONAL&ADV INJURY $1.,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS s2,000,000 COMP/OP AGG POLICY PRO-- DLOG " $ JECTAUTOMOBILE LIABILITY C.OMBIBI ED SINGLE LIMITfE, $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS. AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC50050054422014A 6/23/2014 06/23/201 X WC AND EMPLOYERS'LIABILITY STATU- OTH- ANY PROPRIETOR/PARTNERIEXECUTIVE Y/NCCIDENT $1OO 0OO OFFICER/MEMBER EXCLUDED? �- N/A E.L.E EACH (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained"in the certificate of-insurance shall'be deemed.to have altered,waived,or extended the coverage provided by the policy provisions. h . CERTIFICATE HOLDER CANCELLATION. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE .POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 r ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S140580/M140561 CBD ti Q r= o 3; } r } iQ jl Full ice FLOOR PLAN" APPROVED THIS 26TH DAY OF UARY 1 ' - ) � 2010 21y� n ! Mar el R. Poyant N t , r , t TP LAV C ;I,1 TP LAV B I \ k /.- 3 LAVA_(To belabandonedJ ' Remove fixtures&counter- x Remove all piping&electircal., ' Plug piping as required. I I Remove all partitions. j r I Patch surfaces to match F- I'. adjacent surfaces ON CD FrJ C+7 I IL. I O x f, I 1--------------J I H DRAWING NOTES - LAV B LAV C 1 Wheelchair turning area-60' diarn:.No obstruction 12"above floor. 1-Remove existing water heater&stop basin. . 2 Replace existing lav-too high and obstructed underneath. + 2-Cap off and conceal all waste,vent and supply RESTORATION @STORE NO 10 i Am.Stand o/e: 032T.026 DECLYN Vitreous China w/pop-up drain piping notcompalable with new plumbing fixtures. CENTERVILLE SHOPPING CENTER and paddle handles. Build in wall nounted lav support w/concealed arms. 3-'Furnish and install new wall mold lav as in Lav A lr 60 FALMOIITHI ROAD 3-Relocate existing water closet-Center line must be no closer than 18 inches - Extension arms not required. for from wall. Seat is too high-must be 17 to 19 inches above floor,min. 4-Furnish and install new standard height CADET.,O/E• MARCEL R.PO Y ANT Consult DENMARKS Home Medical Equipment for thicker seat. water closet w/elongated bowl,tank;and white it NE,t".v,ALDa,R Projecr No: AE9610 4- Furnish&install followingSS or chrome plated brass accessories (Ht above floor): open front seat. 38 LEONARD DRIVE Qaa July 26,1996 P OSTERVILLE•M - Grab Bars(2 @ 1-1/4"OD x 42"19)- Ht: 34"-side bar Ht 3"above tank @ rear.5-Furnish&install following SS or CPEr accessories: — M.o,sss.3.I s DWG NO N U!w8<:B;UR3 F. s88+38 230 Mirror (1830)-HC 38"to bottom-Surface mntd - 1630 Mirror over lavatory '�_ � OENERALCON RACrORSNALL Towel Dispenser -Ht' 42"to CL opening-Surface ranted Towel&TP dispensers as in Lav S. `�' VERIFY ALL DIMENSIUSS AND 1 mNon'IDNSON rNEs rE Toilet Paper Dispenser,HE 18"to CL-Surface mntd 6-Patch all scarred surfaces to match existing adjacent. 5-Furnish and install door closer surfaces. Scale: 114"=V-0" PARTIAL BULDING[FLOOR PLAN • 'No.c.HPNGth� ! 1� I. d. / � A PP NfWC Ntr�ryakofl Lo. % I-fo . 4-RP M I C C 1 e C' - -„. ' 7h ZX N� L G �OUND BPT� New Raf t,i t;>c �DIL�(- :r�� PLpN --_ �XI.S(ING C-Nnt r tdN', 1LcO>;.rLL*f-i _ - IYn(nG fG�lMoirf�l E'.G, cc!-r�EY�iu.¢•, me - '. ALL, Dvrl-t�JeIxturc6Al TG Y1ft=`f`rHr'� �E�Jt��MErtfh ... : -'lyaI, It pu - . Yli+'i.MP',,&T- aAMEdrbVAL:ACCE!4" 13oarn ..._. :...�. Modifications to 1660 Falmouth Road, Route 28 N� �� rii�1671N.C, eerir;rTlor,,, : ." a ��°° ..6 NEUJ C.( '.hhlPl,E GILI✓'� Located at the Centerville Shopping Center .. J1$ f Uo ' PLANS pEastv!ew ASSOCIATES ARCHITECTS. '^�.., Centerville; Massachusetts ;. q — -- - errace,Marstons Mills,MA 02648. �+n08-419-121T' 7/z4-/zoi5.. .. 1 of r HARNSTAIRA MAM Town of Barnstable K Regulatory Services Richard V.Scali,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax-: 508-790=6230 Property Owner Must Complete and Sign This Section ` If Using A Builder I, MARCEL R. POYANT ,as Owner of the subject property hereby authorize Me { y( to act on my behalf, in all matters relative to work.authorized by this building permit.application for: i660 Falmouth Road, Centerville, MA 02601 (Address of Job) May 1, 2015 Signa f Owner p, Date MAR L RENE°. POYANT Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN_Muilding ChangesTXPRESS PERMIMXPRESS.doc Revised 061313 I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r• j� � 1 ��`` mil. Map Parcel lJ Application V�� Health Division Date Issued Conservation Division Application Fe Oo Planning Dept. Permit Fee v Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address l / -` 1. Village ` - l(� U ' I Owner �✓� � � Address Telephone WEB 0,pu�l Ile Permit Request w\ o Square feet: 1st floor: existing proposed 2nd floor:,existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation g P00 Construction Type (� "Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ,❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl q Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing b! new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/,coal stove: L Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn:4 existing 0 new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Otheff 1 "_7 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ ty Commercial Yes ❑ y 'No If es site plan review # n Current Use __ i 1 _ _ Proposed Use APPLICANT INFORMATION DC. 6� (W-, Telephone (BUILDER OR HOMEOWNER) gName W" I CC �i{�'I Number , -Lap-r!7 (0 Address � License # 09 qS-Do Home Improvement Contractor# 151 U 5 3 Worker's Compensation # l& ' 00591 ,5-q 6-1 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 1104, 4"ovH LmD i-7 � SIGNATURE DATE (0 J v t FOR OFFICIAL USE ONLY APPLICATION# `y r DATE ISSUED.. r MAP/PARCEL NO. ADDRESS VILLAGE OWNER a DATE OF INSPECTION: 0AFOUNDATION DA - `"°: FRAME - iiINS.ULATION1- , _- FIREPLACE ELECTRICAL: ROUGH FINAL t _ _ PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING -A DATE CLOSED OUT ASSOCIATION PLAN NO. The Conrmonivealth ofhiassachusetts Department of lndustrial Accidents Office of Invessigalions i i 400 Washington Street �rr Boston,.J IA 02111 ivivt4.r a.mgov/dia Workers' Compensation Insurance Affidavit:Builders/ContractorslElectl cians/Plumlbei-s Applicant Information Please Print Le 'b Naatne tBt�ineas�Or aiuzatioa�Iadiv dual): )t'J:{i i L2 ��r d(bov ( 1 l/n ,t (a4 lx . Address. S i i �.I tI Grylsta to/zip M1 > C 2 %�?`a phone Are you an employer?Check the appropriate box: T}'pt of project(required): 1. I am a employer with t�_ 4. ❑ I am a general contractor and I 6. ❑New,constnrction employees(full and/or part-time).* have Hired the sub-contractors 2..❑ I am a sole proprietor or partner listed on the attached sheet. 7. Q Rtmodeliug. ship and have no employees These:sub-contractors have 8. []Demolition. working for me in any capacity. employees and have workers' 9. Building.addition [Nu workers'comp.insurance comp.iasurauce.I required-] 5. Q 'We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11_[]Plumbing:repairs or additions myself [No workers' comp. right of exemption.per MGL 12.Q Roof repairs insurance required.]g c.152,§1(4),and we have no 13.❑Other employees.[No workers' conT.insurance required.r *elny applicant that checks box#1 auut also fill out the section below showing their workers'cottrpensatiou policy information I Homeowners who submit thhis af5d2tdt indicating they are doing all work and then hire outside contractors ttr In submit a new affidavit indicating such !contractors that check this box must attached an additional sheet showing the name of the sub-comttasmrs and state whether or not those entities have emplo}gees. If the sub-coutrecton:have ewtoyees,they must provide their workers'comp.policy number. I ani nit erttpla:ver that is providing tiwrkers'conrperesdtiort ieesurdlrce for rttV employees Below is 610 potiey arrd job site ireforrrlddOI. L Insurance Company !Name: {� Policy;t or Self-ins-Lie.4: �f 4 � }1 �j d '�(�i Expiration Date; ) C ! Job.Site Address: City/state/Zip: JU4 V M, Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failuree to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a five up to$1,500.00 and,''or one-year imprisoument,as well as civil penalties in the fawn of a STOP WORK ORDER and a fine of up to$250.0,0 a day against the violator. Be advised that:a copy of this statement may be forwarded to the Office of Investigations of the DLL for' atnce coverage verification. I do Hereby c rti,fy river thJ efts and penab es of per uty-that die inforination prow ded abotw is true and correct S re: Date: :. phorue 4: . 0 Official rtse©rely; Do not is-rite in this area,to be coetplered by city or toter ofciat City or Tot-m: Permit/License/# Issuing Anthotity(circle one): 1,Board of Health «.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plulalbing Inspector 6.Other Contact Person: Phone#; t /'-taCOq �O ® - A �� DATE(MM/DD ) CERTIFICATE OF LIABILITY INSURANCE 06 24 2015IYYYY 'THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Germani Insurance Agency PHONE 508 428 9194 A/C No: 508 428-3068 908 Main Street E-MAIL Osterville,MA 02655 ADD E s:certs@Qermaniinsurance.com INSURERS AFFORDING COVERAGE NAIC N _ INSURERA:SAFETY INS CO INSURED INSURER B Scott Peacock Building&Remodeling,Inc. INSURER C: P.O.Box 171 Osterville,MA 02655 INSURER D:Commerce&Industry Ins.Co. INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MM/DD A x COMMERCIAL GENERAL LIABILITY BMA0022118 7/5/2015 7/5/2016 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO- � JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident r $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LU\B i I CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ D WORKERS COMPENSATION WC 005-81-5464 6/22/2015 6/22/2016 SPER TATUTE OERH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) t E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 500,000 - 1 - DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) I r f . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Scott Peacock Building&Remodeling,Inc: THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PO Box 171 ACCORDANCE WITH THE POLICY PROVISIONS. Osterville MA 02655 AUTHORIZE TATIVE © -2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are regis ed marks of ACORD J . - r'��r.• \I(•, uiun iur c'rt/f/r�r�/•l. /.pelf rr fJ¢r ra Oflice 01 C.ous„l„er AI-I-a„s& Business Regulation License or registration valid for individul use only j��::�hrIIOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: (f�RRegistration: ..:151853 r tl Type: Office of Consumer Affairs and Business Regulation ge,tl�xpiration: 7/7/2016_, 10 Park Plaza-Suite 5170 - Private Corporation Boston 02116 SCOTT PEACOCK BUILDING&.REMODELING INC JAMES PEACOCK 1046 MAIN STREET SUITE 7 OSTERVILLE,MA 02655 :_ Undcrsccre tit ry — ___.___ _ — — Not vali without signature 1M Massachusetts -Department of Public Safety —1' Board of Buildinc Regulations and Standards ' Cmstrurtiui Supenisu,- License: CS-094500 JAMES S PEACOCK PO BOX 171 Osterville MA 02655 - )I i,6L_X31r Not-1 CViilililsslol,et 07/22/2016 / 1 4-- !i.t.A Of NEU i 1 Yi 1 i �J seY Ili. -O —: 7«.e w/c�psFx, I I i Zx4-rPtMIN6 P w"v.c. q''. .fit_'711 C .C-1 ii_.... T 1=T Nr L�c.c�h5tr�t> TINT- FLcne FiPNxlr ALL w MRc:-r T)4>. 1'G�.+cJrN.E.7�gr+th ;,_ lI-ofl OF 'f11v MG AcUtH£G'(U C-AL PCL6r97 GOGK-� Modifications to 1660 Falmouth Road, Route 28Located at v,c,,__r,;;;r !itit/rl<, c�,:>I„G).,•,, Centerville,the Centerville Shopping Center AKRO ASSOCIATES ARCHITECTS , Massachusetts a 27 Easnlew Terrace,Marstons Mills,MA 02648 Tel.and Fax: 508-419-1217 15 , V. , 1 w - �_—___ {--- t C.v" oY h,bo •I'•i t'�i yi.N i 41 0 CD r , I 131 � T. I a. hi£'.U-.' nCGl•h�lt�ik '�!LE-'{,- FI.COE, �LQMX'i`/T!NG !� fL!`7!/��t,'. �f.lr7t:'r ..t•.P1 , IJ`I - 11 yr AU. Pit?41 7JIXTUiL{-q -16 MEET T)4 {'.G.i..+: OF Modifications to 1660 Falmouth Road, Route 28 Located at the Centerville Shopping Centers 7AKRO ASSOCIATES ARCHITECTS Centerville, Massachusettslew Terrace,Marstons WIs,MA 02648 "Nanax: 508-419-1217 _ 1 • ��TME T�y f i. O.e s�uvsrni3i�. : Town of Barnstable nanss. � p i6z9- ,0 Regulatory Services rFQMAya Thomas F.Geiler,.Director, Building Davislon Thomas Ferry,CBO: Building Commissioner' 20U Main:Street, Hyannts;..N1A 02601 www town.barnstable.ihii Office: S08-862-4038 Fax: .508 790-6230 property,Owner Must Complete-and Sign This Section If us ng A Bt lde'r Il MARCEL .R POYAN,T ,.as Gamerof':thesublect .ro e P P nY herebyauthorize.. SCOTT PEACOCK ,BUILDING & REMODELING INQo:actonmybel alf,. in all matters relative to work authorized by.this builduig permit,application fora m60 Falmouth .Road, C'eriterville: MA::0263'2: (Address of J'ob:) L R. Y 1Q%19/15 Signatttl .,of Qwner Date MARCEL. R. POYANT Pnnt N Q\"PitES\FORMS\building per mu fonns\EXPRESS.doc: RevseQ20108 - ...... :._ ' ,. Town of Barnstable Building I Post This Cartl So That it is Visible Fromthe Street Approved Plans Must be Retametl on Job and this Card Must be Ke�1t BAEH16'TABLE. �. s t..ce.r.uydN} UnNAS9 k^`ysi..a,E i{n,a4.{rn_Y3sy',p etcrt lo..n,§s H1a 1s.,^B.eenuft+rMi'A'pa tl{fe9 :x�t s z et {'d is'4,..c%...t;.�1, 1 Ka dt•t ka xt,ro,,- 4a{t ^u +4` . r.,i°}t J',.-{iz S`St ) �ty;7.,.. i is{"C..{,S.1,rv,yr'� r :....i+5� -fpt i Permit t+bs� Where anCertificate;of�Occupancy is Required,swch Builtl�ng'shall Notrbe;Occupled until a;Fm�al Inspection has been made w;. w Permit NO. B-16-903 Applicant Name: View Point Sign &Awning Map/Lot: 209-013 Date Issued: 04/19/2016 Current Use: Zoning District: SPLIT Permit Type: Sign Expiration Date: 10/19/2016 Contractor Name: View Point Sign&Awning Location: 1620FALMOUTH ROAD/RTE 28,CENTERVILLE Est. Project Cost: $0.00 Contractor License: exempt 16 Owner on Record: POYANT, MARCEL R Permit!Fee: $50.00 ; Address: 20F CAMP OPECHEE RD Fee Paid $50.00 CENTERVILLE, MA 02632 Date 4/19/2016� Description: Reface existing roof sign Dunkin Donuts 11 sq, Project Review Req Building Official This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commencedwithin.six months after issuance. All work authorized by this permit shall conform to the approved application -an d theapproved construction documentsfor which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be m compliance with the-locaI zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road,and shall be maintained open for pb@ic.inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures b the Building and Fire Officials are provided oit.this permit. Minimum of Five Call Inspections Required for All Construction Work:: _ 1.Foundation or Footing 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is.installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection:;:;, 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation 7.Final Inspection before Occupancy Where applicable,separate permits are required for Electrical Plumbing,and Mechanical Installations. PP P P q g, e Work shall not proceed until the inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT . , �3C(t q V I�Wp®IB'�� .March 3i�`-;�2`�016 SIGN Auto AWNING a 7'own of Barnstable 35 Lyman Street Regulatory Services, Building Division Northboro, MA 01532 200 slain Street Hyannis, NA 026o1 508 393-8200 508 393-4244 Fax ,Attention: Robin.Anderson signs@ViewPointSign.com www.ViewPointSign.com Re: Dunkin Donut, 1648,Falmouth Rd INTERIOR/EXTERIOR Hello Robin, SIGNAGE Electric Architectural Encibsedplease find an appCication and associated Dimensional documents to replace the face only on the existing roof Wayfincling sign at the above location. We wid utilize the existing Channel Letters cabinet, there is no change to any square footage. LED/Neon Electronic Message Centers Digital Graphics I have encCoseda check for the fee of$5o.00 basedon the square feet of the sign I have provided a self addressed AWNINGS stamped envelope for the permit once it is issued. Commercial Backlit Canvas 'hank you very much for your help with this project. I Cook Retractable forward to hearing from you. SIGN SERVICE Best Regards, ARCHITECTURAL METAL FABRICATION Sandy uyien VEHICLE GRAPHICS Permit Manager `Viewpoint Sign and.Awning MEMBERS 35 Lyman St Massachusetts Sign Association Northboro, Na. 01532 Rhode Island Sign Association 5o8-393-8200 International Sign Association Sandy@viewyointsign.com Northeast States Sign Association North East Canvas Products Association Industrial Fabrics Association International UL LISTED FABRICATORS OEIHETp own OY•Aarn5labNe O � � Cti111a for ,JfL'.rvic 'S I `(�\AR l3cE. ASS .Ric Ila I-(IV. scali, Interim Director °rFOM,<s Building Division '1'0111.Pcrn', Buddi►i- Commissioner 200 Main Street, Hyannis, N/1A 0260t www.town.barnstahie.ni,I.us . Office.: 508-862-4035 Fax:_ 508-790[6230 A Permit# `, •. , 13nilclitt; C)Ilicirll ;tj�lprcpyiny-- ---------- Application for Signi Pe' rmit - !lpplic:�nt: �e WU��IILl,�—�-' W��2L✓1�---=--------•'1s�cssi>n \c .---, I)o!!!t; I�nsillcs �1{'_c}—�i��i1✓1_�& _------ I'(1c1:1u>lic. Nir. Sign Location S l re.e t/Road: loyU k----__--- "Zoning District:--------- Old Kings f IighlvayP Yes/No Hminis Historic Districts' Wes/No ' Property pert Owner .�-v11---------=-------`------I c1c phc,!!c:_ Acich'c:as:— _�5� =LL ��JIt _ Ca__ \'!Il t;c:— —�lt✓�.IQ/�_vI� G�--- — -- Sign Co' ntrac/tolr Naini: ��L0©► ►'I _ 511 12=—L— l�C l� _----=-----1-(,let) cp: 'Mallilig;lrlilrc:ss��_� �'—� --�f -11LU13��1EJQ►_�0�_��{__�IJ J� = — Description -- -_--------- (/ Please 1,011mv the cover ilireclIons. You ruusL 11:nve an ;rcctu',rle r'errcliliorl of sigr! %with dHI,I(:'usicnis .rrld�b�\•(� location. t Is the silt to be electiiticca' 1'cs/Nu (\arc:1/ rc:; ;r hcirpritrs Width of building I;ace _ v5� Rxl))!A� . Ca l✓1� Check one Reface existing signor New.__ _ 1 otal S(I. rt. of proposed sibnt (s) B rciuIr;ri aclr/iliuua/.cr' rrsIr/c:r+r ali;ii'/r,r.ylice!/r.+lirr crash urrr rri[I1clintr1i.ci(.)11+ If refacing zui existing)sips please provide a picture of tl,e existing signi witli dunensions. ' Itcrchy.cc:rlifv that 1 ;urt flrc owner or(Iml I have the aor ahc ocvnc..r to make this application, thal the i!ll,ornl;H1011 is correct and Ihai the usi� ;uid cousu'rlclimi ,hall miiform to the provisions of §240-.')9 Iltroti,h §2•10-89 of dI(,Towu of Ban IslahluZoui1Ig(.)-diu;liicc:. Signaw.rc of Owner/Ailthonzed Ag°nt: �Qo� f " f�4n`----- I.);i.t.c_3 pl 1, y-- O SIGNS/SIGNREQU `revised 1 10413 Mar30 .602 52p. PoyantR`ealt. �0 77$5688 3: Landlord�AuthoritA f6h. � POint Date. March 30, 2015 SfG1\f allo;AWrVINo To whom it may concern; L, 'r1ARGEL R. -POYANr i �� rl �';,e t,r,, Owner oftFe prope' y located at 1648 Falmouth Road, Cenfervllte,:MA 02632 w. I:uT Rlo;a�exT R�oR Do hereb cgnsent fo allow Sean Danovan:Of VlevrPolnt Sign anal Awmn--to action my SiGNAGE. y behalf pertainjpg t0 permitting and'installatlon of signs an dlgr a�n+riings for the property I rl, rr. balm above, ! D me-, It rul ce'rely A.WhINGS Poyan'C, Ina 20F Camp Ogecliee Rond:f1Ctd(GSS , :SIGN sERucE 508'=775.=007<9 Tele;Phone Al2CHIT�C7URAL hR.t, FAS!OtA 10N po}aritl;@verizon net; Ern all' (Please print carefully}; YEH3C';LE GRAPHfGS Deeded name of Pfoperty< f, 4r Owrne'r: Marcel R:: Yoyamt Centeru111e S,hoppiag ;Center 1620 72 F61, ''t Load:; Cent"-eville, MA :02G32i ' i�yi>ilh l7t;i U tI LV r to�� IQ 117-3/4"Cut Size 115-3/4"V.O.+/- 106-13/16" 15-3/4" 13-3/4" Cut +/- (� n {1 ^ 8"D" 10-1/2" Size +/- I �Op {`JI . . Elevation:(Oty:1)47527 Flat-Cut Polycarbonate Replacement Roof Sign Face 10-1/2'x 106-13/16'=7.78 Sq.Ft.of Graphics 3 Description: (Cty:1)Replacement roof sign face. = -- •Flat-cut White polycarbonate face • First surface aplpied translucent vinyl graphics =Face installed into existing roof sign cabinet62 M' Typeface/Logo:_ P101 W �a��s Art on File D �MN Colors: •Face -White Poly •Vinyl Graphics-DD Orange trans Arlon#3285 -DD Magenta trans Arlon 43284 , -DD Brown trans Arlon#3282 Installation: - .".+ s.+. �• r ,. `t ` a�a- •By ViewPoint - 1 CIA A x fCOMUIS Photo Elevation Views(Proposed&Existing) ^�sa Job: Account Manager: Date: Revisions: Revisions: Customer Approval Acci.Manager Approval Production Approval Dunkin'Donuts Sean Donovan 02.12.16 D.75 03.24.16 D.5 �I��®'�� 1.508.3 93.8 200 tV Location: File: Designer: 1648 Falmouth Rd.,Centerville,MAIDD Centerville 1648Folmouth flat face lb.pltlPeteRivera I I SIGN ANGAWNING FAX 1.508.393.4244 .I z„ =�—_ � — r' ,-;��.a. ``•r s�wt•�„��. � rxa� e.�e wc�.a„ ''��s��Tig,,. 7r�y� ��-.c� f� � ,ay•pd hlNyk .a*�� ii's§�°'''�y s�, tv i��, fiQf'.,�� soy -. �r .",.� fi �L�'.aa, �. r� ,n.. rt tYk'. fs"6•'x "'`Gv ,�'o�` *.. Tc„a'is-,�+. `�'4.�t►_ Ogg -�,% ''! �"4 y��j ,,�yy `Fd'J '� w'f'i�T+�<, f k.-a��r' 'Y°'Y u)�-.�"��'Cx•fz i,.r° r w u4n azv a j Rye' `1'r .•r� a ,,,� f �7a o ki _ 4 M Value Uptton;: NO �,ts•sW V.0 a .; �1;5 3l4 f39/4 i' n7�' ., . t.®� �i S'-iV74 I i (h= -` i �� Glevatain(C!(v,`ti"#7517"Flat;Cut Pntyc 5nnifrr RPtsfOcw' nnrf oCi Sfun Face f0 1/2 x 90 3J16 6 57 Sq.Ft.of Grnplvcs, (bty tl Replace�rert root sgi fnCei ,,^•' - r• w Lli3t cut t'Vhi(v.J>otyoa ulyna!a rare . `. . Ftist surf�.ca;rvplprcM trsr:tugantvinYl gr4Phlc's. . .. -.Face uistailed':mto axsLriy mof sign;cal8nat; •.� -`+ 79•o+;tzcu/Ln�o: 1 1, � I l.)l��t'(', ✓ rrrrlJJ, colds Fact. WNre Pofy �,,,; . - Vinyl C zptira f1f)Or�rx�r tnn Arlon t+32p5; - �' .y ' Y,M �` y }.,' " DD t�fagenla trans-Arlon 1192t3�� : `' -i �„ Db,Bigvm iren�;Argn 43282,; hslaEialrrrr, - r C33; Plrujti Etuahuii Vresrsd?roa�cad a Felsrin9l I "'t ?;n "� � ,� �' lob Atcqunt�Au r Ua'; 6oloq .P,,,er,,on3., k4v,lonn: 3•' - 'y ......,, s,. //�� 5dgi Pu rk n Da u6i Sear.&ono on 02A tb` D7� `. LL////////��/(/ tp� gHq�. C ew to oNom t (>r rpner• G iP � u P.� 16t8 Faeavn>d Cens:.i NJ,DD1Ctiterr?e d4a.4ltra h(m a:e:aiiuh Pete Rn'ero .'�-IIGRI AAIO O .. - _ •. .r r .-. ApprgVed 3/`3 1/1,6 Marc 1 R:: ,oy_ant;: 3/25/2016 Print Page [Print this page • Owner Information -Map/Block/Lot: 209 / 013/ - Use Code: 3230 Owner Map/Block/Lot GIS MAPS 209 /013/ POYANT, MARCEL R Property Address Owner Name as of 1/1/15 20F CAMP OPECHEE RD 1620 FALMOUTH ROAD/RTE 28 CENTERVILLE, MA. 02632 Co-Owner Name Village: Centerville Town Sewer At Address: No GIS Zoning Value: SPLIT RC;HB • Assessed Values 2016 - MapBlock/Lot: 209 / 013/ - Use Code: 3230 -2016 Appraised Value 2016 Assessed Value Past Comparisons Building Value: $ 25475,800 $ 2,475,800 Year Total Assessed Value Extra Features: $ 117,300 $ 117,300 2015 - $ 3,565,200 2014 - $ 3,565,200 Outbuildings: $ 251,100 $ 251,100 2013 - $ 3,565,200 2012 - $ 3414500 $ 1,413,000 $ I,413,000 ' Land Value: 2011 - $ 3,457,600 2010 - $ 3,739,900 2009 - $ 3,920,500 2016 Totals $ 4,2579200 $ 492579200 2008 - $ 45379,600 2007 - $ 4,379,600 • Tax Information 2016 - Map/Block/Lot: 209/ 0131- Use Code: 3230 Taxes C.O.M.M. FD Tax $ (Commercial) 6,768.95 Community Preservation $ Act Tax 1,074.09 Town Tax (Commercial) 35 803.05 Fiscal Year 2016 TAX RATES HERE http://www.townofbarnstable.us/Assessing/print16.asp?ap=Msearchparcel=209013 1/4 3/25/2016 Print Page 43,646.09 • Sales History - Map/Block/Lot: 209/ 013/- Use Code: 3230 History: Owner: Sale Date Book/Page: Sale Price: POYANT, MARCEL R 1993-10-15 C 131734 $1 POYANT, MARCEL R 2072/8 $0 • Photos 209 / 013/ - Use Code: 3230 a �. l " • Sketches - Map/Block/Lot: 209 / 013/ -Use Code: 3230 This property contains multiple sketches. Please use.the navigation,below the sketch to browse sketches. &. .� : Pr xd yb k. nek Additional Sketches 1 2 3 Click Here for print version that displays all sketches at once As Built Cards:elick card#to view: Card #1 I Card #2 Card #3 Card #4 http://www.townofbarnstable.us/Assessing/printl6.asp?ap=0&searchparcel=209013 2/4 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-076718 Construction Supervisor = DAVID J RANDA ri 8 CIDER HILL LANE SHERBORN MA 01770 '` 3 Expiration: Commissioner 03/15/2018 Construction Supervisor Restricted to: Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991 cubic meters)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DIPS Licensing information visit: WWW.MASS.GOV/DPS V AC4 RI® CERTIFICATE OF LIABILITY INSURANCE P ATE`MM'°°"Y'�'' 9/15/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTNAME: Elizabeth BOrtone FM Walley Insurance Agency Inc PHONE (781)326-8383 ac Noll:(781)326-8387 475 High Street E-MAIL Y ADDRESS:ebortone@walle insurance.com P. O. BOX 469 INSURERS AFFORDING COVERAGE NAIC# Dedham MA 02026 --INSURER A:Travelers Indemnity Co of CT 25682 INSURED INSURER B:Charter Oak Fire Insurance Co 25615 Expansion Opportunities Inc INSURERC:The American Insurance Company 21857 DBA ViewPoint Sign & Awning INSURERD:Travelers Casualty & Surety Co 19038 35 Lyman Street INSURERE: Northborough MA 01532 INSURER F: COVERAGES CERTIFICATE NUMBER:2015 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDNYYY) (MMIDONYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 A CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 6305609C939 9/14/2015 9/14/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO ❑ JECT LOC PRODUCTS=COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY EOMaBIINdEeDtSINGLE LIMIT $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BA0123T720 9/14/2015 9/14/2016 BODILY INJURY Per accident AUUTOSS AUTOS ( ) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 C X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 5,000,000 DED RETENTION$ SSE 00048876890 9/14/2015 9/14/2016 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N❑ NIA D (Mandatory in NH) U13-4A698605-15 9/14/2015 9/14/2016 E.L.DISEASE-EA EMPLOYE9$ 1,000,000 H yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION (508)393-4244 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Expansion Opportunities, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN DBA Viewpoint Sign & Awning ACCORDANCE WITH THE POLICY PROVISIONS. 35 Lyman Street NOrthboro, MA 01532 AUTHORIZED REPRESENTATIVE Frank Walley III/BETH ` ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD NS025 omdm i • The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, NIA 02114-2017 �':,,4�'.,.'c 6VWw.lnaSS.aOV/Clla A- orkers' Compensation Insurance Affidavit: Builders/Conti-actors/l lectricians/Plumbers. 'I'0 BF,,FILED 1YITH THIs PERMITTING AUT11012ITY. Auc>Iic:rnt.Information Please Print LejZibly Name (Business/Organization/Indivi(lual):Expansion Opportunities dba Viewpoint Sign and Awning Address:35 Lyman Street City/State/Zip:Northborough, MA 01532 Phone#:508.393.8200 Are you an employer?Check the appropriate box: Type of project(required): LQ I am a employer with 49 employees(full and/or part-time).* 7. O New construction 2.[7 1 am a sole proprietor or partnership and have no employees working for me in S. Remodeling Any capacity.[No workers'comp.insurance"required.] 9. ❑Demolition 3.E-1 1 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 0 Building addition 4-.F�I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 LEJ Electrical repairs or additions proprietors with no employees. 12.0 Plunjbin6 repairs or additions 5.®I am a general contractor and I have hired the sub-contractors l isted on the attached sheet. These sub-contractots have employees and have workers'comp.insurance.t 1.3.❑Roof repairs 6.F� 14.E.]We are a corporation and its officers have exercised their right of exemption per MGL c. Other I 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. .*Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees.,If the sub-contractors have employees,they must provide their workers'comp.policy number: I am an e iployer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site inforMati6n. Insurance Company Name:Travelers Casualty&Surety Co NAIC#19038 Policy#or Self-ins.Lic. #:UB-4A698605-15 Expiration Date:09-14-2016 Job Site",Address: 6City/State/Zip: .e ?,t , b . Attach a copy of the Fv'rlters' compensation poli y declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or.one=year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties perjury that the information provided above is true and correct. Si nature: Date: Phone#:508-393-8200 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: C JSINESS? For Your Information: Bbsiness certificates(cost f -ertificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission t . the necessary signatures on this form at 200 Main St.; Hyannis. Take the completed form to the Town Clerk's,C)M-_, . _ _ :, MA 02601 (Town Hall)-and get the Business Certificate that is required by law. t t. DATE: Fill in lease: APPLICANT'S YOUR NAME/S:7-Eleven, Inc.' Officer:David L. Seltzer. a BUSINESS YOUR HOME ADDRESS: 3200 Hackberry Road, Irving,TX 75063 508-771-1786 3200• Hackberry Rd. Irving; TX 75063 TELEPHONE # Home Telephone Number 972-828-7011 NAME OF CORPORATION:74EIevenj Inc., - NAME OF NEW BUSINESS 7-Eleven 37410H TYPE OF BUSINESS Convenience store. IS THIS A HOME OCCUPATION? YES NO q 2 ADDRESS OF BUSINESS 1638 Falmouth Rd.,Centerville, MA 02632 MAP/PARCEL NUMBER 0� f �✓ (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town"of .Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth . . Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. ` 1. BUILDING COM SION 'S OFFI E This individua ha iMrm of n pe it require ents that pertain to this type of business. uth rized Sign ftape4 •COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the,permie requirements that pertain to this type of business. Authorized Signature* COMMENTS: - 71C k" 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: YOU WISH TO OPEN A BUSINESS? For Your Informiation: Business certificates (cost`fi40.00 for 4 years), A business certificate ONLY REGISTERS YOUR NAME in town (vvhich you !must do by M.G.L.-it does not give you permission to operate.; You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Tale the completed form to the Town Clerk's Office, 1 st FL, 367 Main St., Hyannis,,MA 02601 (Town t iall) and gent the Business Certific::ate that: is required by law. DATE:7/6/15 Fill in please: APPLICANT'S YOUR NAME/S:Jandianne Chamberlin BUSINESS YOUR HOME ADDRESS: 781-878-8210 GrayRobinson PA, 401 East Jackson Street, Tampa, FL 33602 , 43 TELEPHONE # Home Telephone Number 813-273-5029 s NAME OF CORPORATION:TFS Newco LLC NAME OF NEW BUSINESS Tedeschi Food Shops#37410 TYPE OF BUSINESS Grocery Convenience Store IS THIS A HOME OCCUPATION? YES NO XXXX ADDRESS OF BUSINESS 1638 Falmouth Road MAP/PARCEL NUMBER V (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OF ICE This individual has been'.fb�r ed of any p it requirements that pertain to this type of business. , u o ized Signature** r COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: YOU WISH TO OPEN A BUSINESS? For Your Inf orrnation: Business certificates ;cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-- it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Tale the completed form to the Town Clerk's Office, 1 st Fl., 367 Main St., Hyannis,:MA 02601 {Town HUI) and get the Business Certificate that is required by law. DATE:7/6/15 Fill in please: APPLICANT'S YOUR NAME/S:Jandianne Chamberlin BUSINESS YOUR HOME ADDRESS: 781-878-8210 GrayRobinson PA,401 East Jackson Street, Tampa, FL 33602 TELEPHONE # Home Telephone Number 813-273-5029 NAME OF CORPORATION:TFS Newco LLC NAME OF NEW BUSINESS Tedeschi Food Shops#37410 TYPE OF BUSINESS Grocery Convenience Store IS THIS A HOME OCCUPATION? YES NO XXXX ADDRESS OF BUSINESS 1638 Falmouth Road MAP/PARCEL NUMBER Z—(J"� (� (Assessing) , When starting a new business_there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd:& Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING COMMISSIONER'S OF jICE This individualhas been nM ed of any p it requirements that pertain to this type of business. o ¢edSignature tT ** COMMENTS: 2. BOARD OF HEALTH This'individual has been informed of the permit requirements that pertain to this type of business. r 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 PERMIT APPLICATION Map Parcel" 08 Application # Health Division Date Issued 3 Aills"A14 Conservation Division ,-Application Fee Planning'.Dept. 'Permit Fee' Date Definitive:Plan Approved by Planning Board Historic = OKH Preservation Hyannis Project Street Address 1059_ FAIfflow$ ed -X (mozo Tilrp : Village Owner Address Telephone iA Permit Request LJW",0 Fe_,t, oil's Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District: Flood Plain Groundwater Overlay P rp.1'ect Valuation U U Construction Type L6,f,Size 4.1,,El AM,C_> Grandfathere'd: LJ Yes U.No If'yes, attach supporting documentation. Dwelling Type: Single Family -Q Two Family L3 Multi-Family (# units) Age of Existing Structure Historic House: LJ Yes U No On Old King's Highway: U Yes LJ No Basement Type: LJ Full Ll Crawl Ll Walkout Ll Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq-ift)_ Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Roo'n Cou nt-,M Heat Type and Fuel: �Gas LI Oil Ll Electric L] Other Central Air: Yes LJ No Fireplaces: Existing New Existing wood/coal stove:.,El Yre"s LJ No Detached garage: Ll existing Linew size—Pool: LJ existing Unew size Barn: Llexisting Unew size Attached garage: LJ existing Unew size —Shed: LJ existing D new size Other: Zoning Board of Appeals Authorization Ll Appeal # Recorded L3 Commercial No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION JBUILDER OR HOMEOWNER) Name 1-7&06 Telephone Number Addresspn . &Y 191 License # 0&opq Home Improvement Contractor# 151, Worker's Compensation # _Wd 005-91. 59W ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ( Yhf,901tA_ L&"//—_ SIGNATURE DATE Z FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. - ADDRESS VILLAGE ' OWNER DATE OF INSPECTION: FOUNDATION F .. FRAME f INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL " FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I The Conintonwvalth of Massachusetts Department of InditsoialAccidems Office of lnvesdgadons 3 600 Washington Street r l Boston,MA 02111 irrvm.mass govldia 'Workers' Compensation Insurance Affida-vit-Builders/Contractors/Electricians/Plumbers Apifficant Information Please Print Lezibl Name(Busunesw'Organizatiowlud:v dual): Address. I(q0 K 12 City/State/Zip l . N h 02&5�� Phone Aree you an employer?Check the appropriate box: Type of project(required)-. 1. I am a employer with 4. ❑ I am a general contractor and 1 b New employees(full andlor part-lime)." have hued the subcontractors ❑Remodeling g 2-❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remoddeling ship and have no employees These sub-contractors hate 8. ❑Demolition working for me in any capacity. employees and have woskess' 9. ❑Building addition [No workers'comp.insurance. comp.insurance. required.] - 5. ❑ We are a corporation and its 10_❑Electriical repairs or additions I❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself, [No workers'comp. right of exemption per MGL 12. Roof repairs insurance required_]t c-152,§1(4),and we have no }- employees.[No workers' 13_ Other 1 camp-insurance required-] n 'Any applicant that checks boa#1 mnst also fill out the section below showing their workers'compensation policy information. 'Homeowners who submit this affidavit indicatibg they are doing all work and then hire outside contractors mast submit a new affidavit indicating such_ lCuntraciars that check this box must attached an additional sheet showing the name of the sub ctsmitsctars and state whether or not those entities have employees. If the sub-contractors have employees,they taust provide their workers'comp.policy number. I ant art onjpZooyer tliat is pros dixg trrorkers'compertsrrdo)i iiisurnreee for my enrpinyees; Below is the pout y arrd job site inforination. Insurance Company Name: {>, raw U- Policy it or Self-ins-Lic-tk_ �� (�J' `"1 C1/t I Expiration Date. GAG l 6 Job Site Address: ,WAI(MYTI CiW1State/Zip M ( j(. Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required ranter Section 25A of MGL c. 152 can lead to the iulposition of criminal penalties of a fine up to$1,500.00 andior one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250-00 a day against'the.violator- Be advised that a copy of this statement may be forwarded to the Office of Investigations f the DIA for insuranc coverage verification. I do hereby et a the its d penalties of perjury that tie infbrination ptm ded above is tare acid correct tore: � Date: Phone#i_ VJ' - (. 78` 1 Official use only. Do not write lit this area,to be comipktod by city or town oricial, City or.Town: PermitdAceuse# Issuing Authority(circle one): , 1.BoatA of Health 2.Building Department 3.CitylToum Clerk 4.Electrical Inspector .Plumbing Inspector 6.Other Contact Person: Phone#. 6 I I DATE(MM/DD/YYYY) Act CERTIFICATE OF LIABILITY INSURANCE 06/30/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Germani Insurance Agency PHO1AICNE 508 428-9194 Fa Ne: 508 428 3068 908 Main Street E-MAIL Osterville, MA 02655 ADDRESS:certs@qermaniinsurance.com INSURERS AFFORDING COVERAGE NAIC# INSURERA:SAFETY INS CO INSURED - . � INSURER B Scott Peacock Building&Remodeling,Inc. INSURER C: P.O. Box 171 INSURERD:Commerce&Industry Ins.Co. Osterville, MA 02655 INSURER E: INSURER F:- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DD/YYYY MM/DDIYYYY A x COMMERCIAL GENERAL LIABILITY CP00001152 7/5/2014 7/5/2015 EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR DAMAGE ( RENTED PREMISESS Ea occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- 1:1JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ , UMBRELLA LIAB OCCUR - EACH OCCURRENCE $ - EXCESS LIAB CLAIMS-MADE . AGGREGATE $ DED RETENTION$ $ D WORKERS COMPENSATION WC 005-81-5464 6/22/2014 6/22/2015. STATUTE ERH AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N� N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Scott Peacock Building&Remodeling,Inc. AUTHORIZED REPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD �. I \ r f J , ,ems C-�TE l(.(07/.9/L(17/,CUCCECCIC O/J��CLJJ2f�ClJBCtj Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ' -' OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 151053 Type: Office of Consumer Affairs and Business Regulation x7/7/201`6_ Private Corporation 10 Park Plaza-Suite 5170 - tt Boston,MA 0 16 SCOTT PEACOCK Bl1ILDING.:8REMODELING INC 1 c � JAMES PEACOCK It 1046 MAIN STREET SULTE 7r OSTERVILLE,MA 02655" Undersecretary (valid without signature L IM Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction SuperN isor License: CS-094500 JAMES S PEACOCK PO BOX 171 Osterville MA 02655 = t , cJ— '"N - Expiration Commissioner 07/22/2016 �1 j�peTr�s rp/rTown of Barns'tc`li ble 0 Regulatory Services • HARMSTAHLE, w ': z MASS. a Thomas F. Geiler, Director , PTFo r Building Division Thornas Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 wfvw.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 13uildin .Permit Procedure for Commercial Additions/Alterations ❑ Map and Parcel number ❑ Lettcr of Approval from Site Plan Review (if applicable). ❑ Site Plan must also be stibmitted showing the location and setbacks of existing/proposed structures, septic, parking, etc. ❑ t-listoric District at 200 Main Street: Certificate of Appropriateness is required. Old Kings Hig.livray Historic District(north of the Mid Cape Highway) Hyannis Main Street Waterfront Historic District(See map for boundaries) .l-fistoric Preservation(if applicable). ❑ Construction plans-one complete set of fi.di sized plans and one complete set reduced to 1I 'xl7"and frilly dimensionalixed must be submitted with the building permit application. Both sets must have an original architect or engineer's stamp. .Note: The �D srhplicant ncust also submit a set of plans to the appropriate Fire Departnent for review. The �rl application package will not he accepted without prior approval front the 117iu•e Department: i ❑Approval from the following departments, located at 200 Main Street, must be obtained Ell-Tealth Department Hours (8:00-9:30 AYI or 3:30-4:30 PM) ❑Conser ,ation Department 1-fours (8;00- 9:30 AM or 3:30-4:30 PM) ❑Tax Collector. ❑Treasurer ❑ Permit must contain full description of the project, correct square footage,owner's name, address and telephpne number, contractors info nna.tion'and sigriature and dated. ❑ Workers Compensation Insurance Affidavit State form must be cornpleted and a copy of Insurance Coin plianceCertificate must be on file. ❑ A copy of the Construction'Supervisor license is required. Note: Construction Supervisor's license holsters rcre not entitled to supervise construction of a huddiny or an addition (regardless of s ize)to a.building-with a total cubic volume s reater than 35;000 cubic feet. 117 that case, the application must be dc'onipanied by controller) co,irtructi.on doctcment.v-rts indicated in 780 CA4R sections 116&1705. ❑ Check.expirations date, no restrictions ,❑ Controlled Constructior► . If`sprinkler or fire alarm system is required, do not accept application package without prior approval from Tire Department(phone call or in writing) ❑ Have you'subrnitted the AQ 06 form with the State?,www.mass. ov/clep Any question on completing form call 14ler.cxdes Mitchell 617-292=5638 . ANON-REFUNDABLE Application Fee of$100 must be paid'upon receipt of application number, check made payable to the Town of Barnstable. Permits are$9.10 per $1000 of value of work Properly owner must sign Property Owner Letter of Permission. El Projects requiring the use of a crane must complete the forms issued by the Aeronautics Commission Note: No wall is to be covered before wiring, plarribing and frame inspections. Q:rorms/bldg/pcnnits)CADDALT Revised 09/01/08 I Feb 121512:17p Poyant Realty 5087785688 p.1 Feb 11 15 04: 19p _SCOTT PEEK z, 508 ,428 7625 p. 2 Town of Barnstable' . 7 ouaanarw�. i ' r Regulatory Services Eo«ice' Tbomas V.Geller,Director Building Division re 7hamvs Perry,C50 , . Huildin�Gnmrais!tianar b . 200 Main Street, Hyannis,MA 0260 t F- wwwdowabumxGibte.ma.ur: 441 Office: 509462-4038 'Nuz: S08-790-6230 Property Owner Must 'Complete and Sign This Section Ifl Using A.Builder k� MARCEL- R. POYANT ,as Owner or the subject property. hueby lurhorize. a ;to act on MY If, in all matters rcluzive rn work%uthozized by'dis buildia per application for: J oc d (AddrCss of job lub, —T ` . t Y FEBRUARY 12 2015 Y aaturi:cif Owner- Date - Marcel R. Poyant, Owner Centerville Shopping Genter rant NKnIc p'fumtis'builckc�crn�ilslu��+s y Rrvr Vd 123107 YOU WISH 70 OPEN A BUSINESS? `{# For'Your.Information: Business certificates[cost$40.00 for 4 years). A business certificate ONLY REGISTEFlS YOUR NAME in town(which you must do by M.G.L. it does not gibe you permission to operatP.J You must first obtain he necessary.sign,atures othis form at 200 Main'St., Hyannis. Take the completed form'to the Town'Clerk's Office, 1 st Fl. 367 Main St:; Hyannis,MA;02601 (Town.Hall)and get the business Certificate. that is m required:by law.' .o - j _ DATE 12/24/14 Fill in please; r APPLICANT'S YOUR NAME/S,_1'.� d G'c f'� Salt'[Couto " " BUSINESS YOUR HOME ADDRESS: 169 Main Street Stoneham. MA 02180 781-279-0290 . . 7. TLLEPHONE �f Home Telephone Number 781-279-0290' NAME OF CORPORAT1oN,Cape Cod Enterprises, LLC: DBA Dunkin'Donuts NAME OF NEW BUSINESS TYPE OF BUSINESS Retail Operation IS THIS A HOME OCCUPATION? YES. NO X ADDRESS Of BUSINESS 1648 Falmouth Road Centerville, MA 02632 MAP/PARCEL NUMBER, Asse'ssingJ ci aZn��anos E r �D'��ss couth When starting'a new.business there are several things.you must do in order to be.in compliance with the rules an regulations of the Town of ,`Barnstable. This farm is intended to assist you in obtaining the information you may rieed: You MUST GO TO 200 Main St - [eornec:of Yarmouth Rd.& Main Street :to make sure you havethe a ro" riate permits and licenses re uired to le all o.erate,our business In this town.. 3 Y pP -P P a 9 Y. P Y . 1'.• BUILDING CO1 MISSI N R'S.OFFI E This indn!id�ual 6 i Form f y p M1it e irements that pertain to this type of business. COMMEN� Auth r'ze• Signatyc� f 1 • „s 2. BOARD OF HEALTH . . .., This individual has been informed of the permit requirements that pertain to this-type of Business. Authorized Signature** COMM>=NTS: ,y 3. CONSUMER AFFAIRS [LICENSING AUTHORITY) ' This individual has been informed ofthe licensing requirements that,pertain to this type of business. PIP o Authorized Signature*.* COMMENTS::. TOWN OFBARNSTABLE Building 201400074 BARNSTABLE, Issue Date: 02/21/14 Permit MASS. 1639• Applicant: LANDERS MICHAEL Permit Number: B 20140347 Proposed Use: SHOPPING CENTER-MALL Expiration Date: 08/21/14 Location 1620 FALMOUTH ROAD/RTE 28Zoning District SPLTPermit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 209013 Permit Fee$ 2,730.00 Contractor LANDERS,MICHAEL Village CENTERVILLE App Fee$ 100.00 License Num. 086846 Est Construction Cost$ 300,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND INT REM OF TEDESCHI,RELOC OF DELI,NEW W/I COOLER,NEW MANftS CARD MUST BE KEPT POSTED UNTIL FINAL OFF,EXPAN W/I FREEZ,NEW SHELV/DISP,WIND&DR EXP 2/18/15 INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: POYANT,MARCEL R BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 20F CAMP OPECHEE RD INSPECTION HAS BEEN MADE. CENTERVILLE,MA 02632 Application Entered by: JL Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TE ORARILY:O P Y CROACHMENTS ON PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.,STREET OR ALL GRADES,AS LL S DEPTH ND LOCATION;OF PUBLIC SEWERS MAY BE OBTAINED FROM'THE DEPARTMENT OF PUBLIC;WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS: MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. 7.FINAL INSPECTION 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(as set forth in MGL c.142A). BUILDING INSPECTION APPROVALS , PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 t 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health T ed ch food Shops° Date: 7/31/2014 Subject: Permit Extension Yo oa � To Whom It May Concern, �� Tedeschi food Shops would like to ask for an extension on.building permit number B 20140347.The reason that Tedeschi Food Shops are asking for the-.extension is due to equipment delivery delays, and budget cutbacks. If there are any questions please do not hesitate to contact me at 617-799- 4746. � Thank Y 'u, Mike Landers Project Manager - Tedeschi Food Shops, Inc. - 14 Howard Street Rockland, MA. 02370 Office: 781-610-2290 V _ Fax: 781-982-18 Mobile: 617-799-4746 - ` E-Mail; inlanders@tedeschifoodshops.com '; "'' k ' ITS s Nia TOWN OF BARNSTABLEHE Building i2014_00074 EARNSTABLE. Issue Date: 02/21/14 Permit 9 MASS �A 1639• Applicant: .LANDERS MICHAEL tFD �0, Permit Number: B 20140347 Proposed Use: SHOPPING CENTER-MALL Expiration Date: 08/21/14 Location 1620 FALMOUTH ROAD/RTE 28Zoning District SPLTPermit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 209013 Permit Fee$ 2,730.00 Contractor LANDERS,MICHAEL Village CENTERVILLE App Fee$ 100.00. License Num 086846 Est Construction Cost$ 300,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND INT REM OF TEDESCHI,RELOCATION OF DELI,NEW W/I COOLER, NEWHIS CARD MUST BE KEPT POSTED UNTIL FINAL MANAGERS OFF,EXPAN W/I FREEZ,NEW SHELV/DISP,WIND&D ORINSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: POYANT,MARCEL R BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 20F CAMP OPECHEE RD INSPECTION HAS BEEN MADE. CENTERVILLE,MA 02632 Application Entered by: JL Building Permit Issued-By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET ALLEY ORSIDEWALK OR ANYPART THEREOF,'BITHIsR TE RARII.Y -R ENCROACHMENTS ONPUBLIC PROPERTY;NO . _ - SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE`JURISDICTION: STREET.OR ALLEY GRADES A AS D SAND LOCA'r.ION OF�PUBLIC SEWERS-MAYBE BE, - AND FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: " 1.FOUNDATION OR FOOTINGS. r 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. #` . 7.FINAL INSPECTION 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 ISJSSUED AS NOTED ABOVE: PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.I42A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2. '2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health . 4. PROJ NAME:CT ✓� I Ov, �'zy O t ADDRESS: PERMIT# -6 1 U� PERMIT DATE: MIP: � 613 LARGE ROLLED PLANS A.l BOX _ --------------------------------- SJUOT Data entered in NLA_PS program on: . j TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION o 9 3 ��, o� !l��{ iicPaior),H Map Parcel /4.6,-osS�- Co*M F9 pp Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee 7.36 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Ceo ¢rry:1le Village Cf17 fpl-v, Owner ,4 re ®Yy'? Address �0� `Q �4 0404ee I�c� 1 Telephone cn Tay y( 11e, A44 0�b 3 D. Permit Request �t-T h e'-i'or rev-!"Cler C7� r4PE;G4t- re_1Mgf�Cn of oe1- Vl ev✓ �nACR� �r`✓� Y7 Cy✓ IM4 h��Q�.S� ®I��,'ce t P kagv1 S;C7"7 Cal L✓a '�h Pt Pr NKe-ST I�, i,✓ W e►��a�5 �' �oot�.✓er� Square feet: 1 st floor: existing 06 proposed10QL 2nd floor: existing ' proposed `— Total new Zoning District HJ3 Flood Plain Groundwater Overlay Project Valuatiion3 )o,060 Construction Type �� JJ // Lot Size `" k(eS Grandfathered: ❑Yes 3 No .If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure ,S Historic House: ❑YesLU No On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑ Crawl ❑ Walkout ❑ Other JV�n Basement Finished Area (sq.ft.) A®17 t Basement Unfinished Area (sq.ft) "v n Number of Baths: Full: existing new Half: existing new r ' Number of Bedrooms: eA existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: (2 Gas ❑ Oil ❑ Electric ❑ Other Central Air: 52 Yes ❑ No Fireplaces: Existing ` New Existing wood/coal stage: q 'es �No Y, _n ; Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barrf 'd existinga,❑ new size- Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 9 Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ co ram+ Commercial 1P Yes ❑g No' 4 If yes, site plan review # N1A kCurrent.Use ��44 ��a�C '�JTd'�`� Proposed.-Use y nVir1 `Pi CV-1 ' s APPLICANT INFORMATION �� ` ' p. y '�' (BUILDER OR HOMEOWNER 3�S L/4 Name I L 1 ( GC /-S 17 Q ) g��- �a� e d1 P n Telephone Number ' , Address 9 S -90A� ��°�f:e Y, License # IC Home Improvement Contractor# n e..5 Cb 64'. Workers CompensationWm # ALL CONSTRUCTION DC IS SUL•TING FROM THIS PROJECT WIC BETAKEN TO SIGNATURE DATE L U I f3 f 1 FOR OFFICIAL USE ONLY E APPLICATION# ` DATE ISSUED .MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: - o FOUNDATI.ON_u)a- a, 5 , k - FRAME -- t` rINSULATION FIREPLACE F '1 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r , GAS: ROUGH FINAL ' FINAL BUILDING x DATE CLOSED OUT ASSOCIATION PLAN NO. i Jan 08 14 12t18p p,4 KM Town of Barnstable Regulatory ScMces t Rldmrd V.Stalk lnterlm Director Budding Division Thomas Perry,CBO BaVAW Cmmisslonor 200 Main Strock Hyannis.MA 02601 www towabarostabkomas Office: 508-8524038 Fax: SW790-Mo Property Ov mer Must Complete and Sign This Section If Using A Builder r Marcell' ant - °y ,as Owner of the subject Prop" hereby authorize Tedmhi Food Shops to act on my behalf, in all matters relative to work authoxmed by this buddi%permit application foc 1638 1.62 t Falmouth Road•-Centerville;.Ma (Addtees of job) 1/8/14. . Signature of Owner Date Marcel Poyant Print Name f If Property owner 19 aPP1Yla6 for PMA P eamphbe Ube Iff---aers Lieeose ftmapdoa Form on the reverse Q-A poo dt fmm 10 HI I If p a b n rIIetWWmdft Revised OSO412 i Tedescm Food Shops' To: Thomas Perry, CBC) Building Commissioner 200 Main Street Hyannis, MA 02601 Date: January 9, 2014 Re: Michael Landers -TFS Employment Dear Mr. Perry, Michael Landers is rightfully employed by Tedeschi Food Shops, Inc. and is covered under our Workmen's Compensation Insurance. Respectfully, Robert t_:. Tedeschi, 11r. lXecutit'e Vice President l Treasurer 14 1[ox and Street Rockland. MA 02370 Tel. 781.610.2322 14 Howard Street • Rockland, MA 02370 • Telephone 781.878.8210 ® Fax 781.878.0476 • vv\.,,,�,%,.tedeschifoodshops.com Proudly serving our customers since 1923 ' Massachusetts-Department ofPubiic Safety Board of Building Regulations and Standards Construction Supervisor License: CS-086846 NUCHAEL C LANpERS:. ' 1859 SOUTH STREET;� i ' t Bridgewater MA;02324�-; ir, A lit Expiration Commissioner t 03108/2Q15.;. i DATE(MMIDWYYYY) ,��® CERTIFICATE OF LIABILITY INSURANCE 12/26/2013 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 1-800-247-7756 CONTACT NAME: _ Holmes Murphy & Assoc - W'DM PHONE n FAX _(A[C,No.ExO;_._ !(A1C,.!!J0: PO Box 9207 ADDRL ADDRESS: Des Moines, IA 50306-9207 ,_- ___rNSU R(SLFFORDING COVERAGE I NAIC9 IN_5_U_RER.A_: ZURICH AMER INS CO 116535 INSURED INSURER& Tedeschi Food Shops, Inc. INSURER C: 14 Howard Street INSURERD: Rockland, MA 02370 INSURERE: INSURER F: - COVERAGES CERTIFICATE NUMBER_ 37683609 1 1REVISION 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 REQUIREMdENT,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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN A(AY HAVE BEEN REDUCED BY PAID CLAIMV,& INSR ADDL'SUBR I-POLICY EFF" POLICY EXP LTR iYPE OF INSURANCE POLICY NUMBER f 4 51DDlYYYYI`(Mrd10D11'YYYI LIMITS . A GENERAL LIABILITY GL03730935-09 01/01/14 01/01/15. AC OCCURRE CE 51.000,000 x I `o,.rfA�-r�"R nTeO COr.IM=-.RCI.A_ TY I I ;P c., -� 300,000 CLAIMS MADE :.x OCCUR 1 .._,fCO FXP(Any cne Pe,on) t S 5,000 PERSONA! &ADV INJURY IS 1,000,000 iGENERALAGGREGATE 5 2,000,000 GFN'L LIralT A.f`1=S?cR: ?ROD'.CTS-CO',7°iOF AGG-.S 2,000,000 POLICY jc X S t AUTOMOBILE LIABILITY - - COMHME-D SINGLE LI:.11T _ rEa acr�aor+t) c ANY AUTO BODILY INJURY(P(!:person) ALL O'hlNED SCH=_DULED - - AUTOS _AUTOS oOD!!1'INJURY(Pe*ace tlent) S NOK O'M1q=D r.PO° ti i�'DA%',AGc IREDACTOS AUTOS S UMBRELLA LlA6 OCCUREACH OCCURRENCE S EXCESS LIAB CLAISS-MADEI AGGREGATE ' S D=_D RETENTIONS c OTF'= VJORKERS COMPENSATION 'lIC3730938.-09 01/01/14. .01/01/15. } Tory Lt llTy LRT `- AND EMPLOYERS LIABILITY YIN -- �PROPRI�ORPAR XECiTIVE1 ! NIA; - El FEACHACCIDENT S 1,000,000 O IC_Riff Ffi -�EXCLuDcDs (Mandatory in NH) El DISEASE_ EMPLOYE=S 1,000,000 I tes.des�.he un.e:DESCRIPTION OF OPERATIONS bear c DISEASE-POLICY L ItAI, S 1,000,000 ? ,Liquor Liability GLO3730997-02 01/01/14"01/01/15±Each Common Cause 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks ScheduI ,I more space is required) Proof of Insurance / �! r // , CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tedeschi Food Shops, Inc: THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14 Howard Street AUTHORIZED REPRESENTATIVE Rockland, MA 02370 USA + QltI1C r� 41 ©1988-2610 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD bknutsonwdsm 37683609 ATE A�®c CERTIFICATE OF LIABILITY INSURANCE D 12/26NDDY/zo13z/z6 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 1-800-247-7756 CONTACT NAME: Holmes Mushy & Assoc - WDN: PHONE ;FAX DDR PO Box. 9207 ADDRL AESS: Des Moines, IA 50306-9207 _ INSURER(S)AFFORDING COVERAGE NAIC# _ INSURER A: 7URIC_3 AIMMER IBIS CO 16535 INSURED T INSURER B Tedescai Food Shoes, Inc. INSURERC: �4 Howard Street INSURERD: Rockland, N.A 02370 INSURER E: INSURER F: I COVERAGES CERTIFICATE NUMBER: 37683535 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 REOUIREMENT,TEERM 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 CONDITION'S OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR; .ADDLiSUBRi I POLICY EFF I POLICY EXP LTR, TYPE OF INSURANCE POLICY NUMBER 116iMIDD. .IMMtDDIYYYY i LIMITS A. :GENERAL LIABILITY GL03730939-09 I 01/01/14 01/01/15;EACHOCCURR=NCB S 1,000,000 X . i DANdAG=TO RENTED ! CO24UERCIA_GENERAL LIABILITY f PnEMISES(5a nxurre❑ce I S 300,000 I l h ii i 1 1 CLAIMS-MADE �I OCCUR MED E(P(Any ene person) S 5,000 {PERSONAL&AOV INJURY S 1,000,000 _ GENERAL G_c IS2,000,000 _• _ i ,GEN'L AGGREGATE LIMIT APPLIES PER: ' PRODUCTS-COMP/O?AGG is 2,000,000 POLICY I� IF. I X (LOD AUTOMOBILE LIABILITY ! I ;COMBINED SINGLE LIMIT I (Ea a=iden.) I$ +,ANY AUTO ,BODILY INJURY(Per person) IS ALL OWNED SCHEDULED ; BODILY INJURY(Per accident)!S AUTOS AUTOS _ NON-OWNED i PROPERTY DAMAGE S HIRED AUTOS !;AUTOS H {Per arc dent) j5 UMBRELLA LIAB , I OCCUR EACH OCCURRENCE i5 EXCESS UAB I C!AIMS-MADE, :AGGREGATE is D0.D I RETENTIONS I S `WORKERS COMPENSATION ( VVC STATU- LOTH i - AND EMPLOYERS'LIABILITY Y I N i T03Y LIMITS" ? ER I ANY PROPRIE.ORIPARTNERIEXECUTI\c II I E.L.EACH ACCIDENT .�S OF.= I AICERAI-Eh{BER EXCLUDED? N i — �' (Mandatory in NH) f I c.L.DISEASE-EA EMPLOYEE S It ves,cescrbe under DESCRIPTION OF OPERATIONS helm I E.L.DISEASE•POLI„Y LIMIT S 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101.Additional Remarks Schedule,i'More space is required) Proof of _insurance�--- CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Tedeschi Food Shops, Inc. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 14 Howard Street AUTHORIZED REPRESENTATIVE Rockland, MA 02370 USA ©1988.2010 ACORD CORPORATION-All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD bknutsonwdsm 37683539 The Commonwealth of Massachmet& Dgwftent oflndwftitdAccMm& - Offwe of Investigations kv 600 WashhWilan Street Boston,MA 02111 www.mamgov/din Workers' Compensation Insurance Affidavit:Bmlders/ContractorsMectricians/Pimabers Auolie nt Information `` Please Print 1 a Lem'biv Name(B 'dual): wt sc 11 yo sic. -Z 10D:f �. N C._ ,�,�,�,,,,: \ T• Ad&G»I LI City/StMWzip: Phone#: Are Wu an employer. Check the app priate Type of project(required): a 1 4. am a general contractor and I employees(fall and/or pa 4 ime).* have hired the sub-contractors 6. ❑New eanstractim 2.❑ I an a sole proprietor or partner listed on the attached Vie• 7. 6 //eznodeling ship and have no employees These have S. ❑Demolition iforlang for me in any capaoify. employees and have workers' 9. ❑Building addition [NO Workers, comp.insmaumt. requhe&] caw- 5. We are a corporation and its. 10.❑Electrical repairs or additions 3.❑ I an a homeowner doing all work officers have exercised th* I L❑Phunbing repairs or additions sel£ o workers' right of exemption per MGL mY [N emuP• 12. Roof repairs requhv&]t c. 152,§1(4),and we have no employees.[No workers' 13.[1 Other comp.insurance required.] .pny applieeaRas who that checks boot i1 must also m out the section bdow showing thefr workers'w policy ia£omsadm t HomcoaUa submit this affidavit indicating they are doing ell work and then him outside comtactom must submit a new affidavit iad cating such. 3Contraetors that check this boat must attached an additional sheet showing the name of the sub-contractors and.state whether or not those cash ies,have employees. If*.c m o-contus have employees,they most prur&their workers'comp policy rmmber. I an an employer dial fs proyMng workers'compensation Murrance for ney employees: Below is the po&7 mid job infonnadem InsMMM Cody Name• r Policy#or Self-ins.Lie.#: 2, ;�ZOr'3 Expiration Date: Job Site Address: �lv �f rn r,, . ln.A-- City/Stateomp: 0J t 6 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date} Far'hrre to secure coverage as required under Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisommemt,as well as civil penalties in the form of a STOP WORK ORDER and aline of up to$250.00 a day against the violator. Be advised dmt a CDRY ofUhisstatement may be forwarded to the Office of Investigations of the DIA for insina ce verification,"", I do he the p ' p 7.of inforniadon provided above is correct S' . Phone#: z�/ Offudat use only.. Do not write in this area,to be con pteted by city or town o f dd City or Town: Perzuwueense# Issuing Authority(circle one): .. L Board of Health 2.Building Departratnt 3.CitylTown Clerk 4.Electrical Inspector-5.Plumbing Inspector 6.Other Contact Person: Phone M. Massachusetts Department of Environmental Protection __ ■ Bureau of Waste Prevention . Air Quality 1100191774 -1 Ll BWPAQ06Decal Number BWP AQ 06 Notification Prior to Construction or Demolition Whe When fafng out A. Applicability forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor do not return use the return (DEP), Bureau of Waste Prevention -Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10)days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. rd (( � 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 p No 1.All sections of b. Provide blanket decal number if applicable: Blanket Decal Number this form must be completed in order 2 Facility Information: to comply with the y Department of TEDESCHI FOOD SHOPS Environmental Protection a.Name notification 1620 FALMOUTH ROAD requirements of b.Address 310 CMR 7.09 Barnstable IMA 02632 c.Cit /Town d.State e.Zip Code 7818788210 f.Telephone Number(area code and extension) E-mail Address(optional) 3397 1 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? ❑✓ Yes ❑ No k. Describe the current or prior use of the facility: CONVENIENCE STORE WITH A DELI I. Is the facility a residential facility? ❑ Yes ✓❑ No 9�_O m. If yes, how many units? Number of units ' �c) 3. Facility Owner: MARCEL R. POYANT �o a.Name �0 20F CAMP OPECHEE ROAD b.Address CENTERVILLE IMA 02632 �0 c.Cit /Town d:State e.Zip Code 0 15087550079 f.Telephone Number area code and extension .E-mail Address (optional). O MARCELR. POYANT �Q h.Onsite Manager Name ■ ag06.doc•10/02 BWP AQ 06•Page 1 of 3■ Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 1100191774 L BWP AQ 06 Decal Number LNotification Prior to Construction or Demolition' General Statement:If B. General Project Description cont. asbestos is found during a 4. General Contractor. Construction or Demolition MICHAEL LANDERS operation,all a.Name responsible parties must comply with 11859 SOUTH STREET 310 CMR 7.00, b.Address _ and Chapter BRIdG TER MA 02324 Chapterer 21 E of the General Laws of c.Cit /Town d.State e.Zip Code the Commonwealth. 7818788210 This would include, f.Tele hone Number area code and extension) P.E-mail Address(optional) but would not be limited to,filing an IMICHAEL LANDERS asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of C. General Construction or Demolition Description release of a hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. IMICHAEL LANDERS a.Name 1859 SOUTH STREET b.Address BRIDGEWATER MA 02324 c.Ci /Town d.State e.Zip Code 7818788210 f.Telephone Number(area code and extension) E-mail Address(optional) MICHAEL LANDERS h.On-site Manager Name 2. On-Site Supervisor: MICHAEL LANDERS On-Site Supervisor Name 3. Is the entire facility to be demolished? ® Yes ✓� No �N �0 4. Describe the area(s)to be demolished: �o DELI, OFFICE, SALES FLOOR, BACKROOM, WALKIN COOLER �N �0 -0 5.. :If this is a construction project, describe the building(s)or addition(s)to be constructed: �0 DELI, OFFICE, SALES FLOOR, BACKROOM,WALKIN COOLER �o �d �Q � ag06.doc•10/02 BWP AQ 06•Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 100191774 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project, were the structure(s) surveyed for the presence of asbestos containing material (ACM)? ❑ Yes ❑✓ No If yes, who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 2/1/2014 6/1/2014 a.Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving❑ wetting shrouding b. If other, please specify: ❑ ✓❑ covering ❑ other, 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date mm/dd/ .of Authorization d.DEP Waiver Number D. Certification I certify that I have examined the JDAVID KELLEY �o above and that to the best of my a.Print Name �o knowledge it is true and complete. JDavid Kelley The signature below subjects the b.Authorized Signature —�N signer to the general statutes PROJECT MANAGER �o . regarding a false and misleading c. Position e �p statement(s). ITEDESCHI FOOD SHOPS d.Representing 1/10/2014 �co e.Date(mm/dd/yyyy) o Q ag06.doc•10/02 BWP AQ 06•Page 3 of 3 eDEP -MaSS.DEP'S OnlineFiling System Page 1. of 1 MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System U sernam e:M E R LI N S DAD788 Nickname:DAVIDKELLEY My eDEP[Forms cO My Profile® Help I Notifications Receipt Forms Signature Payment Receipt Summary/Receipt print receipt FE11t Your submission is complete. Thank you for using DEP's online reporting system. You_can select"My eDEP"to see a list of your transactions. DEP Transaction ID: 622648 Date and Time Submitted: 1/10/2014 9:22:19 AM Other Email Form Name: AQ 06-Construction/Demolition Notification Payment Information - DEP code: 90932 Date: 1/10/2014 9:21:01 AM Amount ($): 100 Payment Detail: KELLEY DAVID--AccountType--AccountNumber****8162 Confirmation Number: Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab My eDEP MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System ver.12.2.6.0©2013 MassDEP https:Hedep.dep.mass.gov/Pages/PrintReceipt.aspx 1/10/2014