Loading...
HomeMy WebLinkAbout0245 OCEAN VIEW AVENUE p- ;;,)Li c5 j J . f Massachusetts Department of Environmental Protection Bureau of Resource Protection - Waterways Regulation Program X280443 Chapter 91 Waterways License Application - 310 cnnR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment G. Municipal Zoning Certificate Richard K. Bendetson Name of Applicant 245 Ocean View Avenue Cotuit Bay Cotuit Project street address Waterway City/Town Description of use or change in use: To relocate and maintain existing.pier with proposed ramp,float and tie off piles.. To be completed by municipal clerk or appropriate municipal official: "I hereby certify that the project described above and more fully detailed in the applicant's waterways license application and plans is not in violation of local zoning ordinances and bylaws." Printed Name of Municipal Official Date Signature of Munic pal Official Title City/Town CH91App.doc•Rev.03/17 Page 6 of 13 ' 3 Massachusetts Department of Environmental Protection -au o'l urce Protection—tltFaterwayS - latron-Pr6gram x280443 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment Important:When filling out forms A. Application Information (Check one) on the computer, NOTE: For Chapter use only the tab 91 Simplified License application form and information see the Self Licensing key to move your Package for BRP WW06. cursor-do not use the return Name(Complete Application Sections) Check One Fee Application# key. WATER-DEPENDENT- reb General(A-H) ® Residential with <4 units $215.00 BRP WW01a B " ❑ Other $330.0 0 ,BRP WW01 b For assistance ❑ Extended Term $3,350.00 BRP WW01c incompleting this .-..-----------------------------•-------------------------------------------------------------------------------•--••-------------------------..-..---------- application,please Amendment(A-H) ❑ Residential with<4 units $100.00 BRP WW03a see the — "Instructions". ❑ Other $125.00 BRP WW03b NONWATER-DEPENDENT- Full (A-H) ❑ Residential with <4 units $665.00 BRP WW15a ❑ Other �,$•2t,005.00 ;=BRP -*I5b �r _-Z ❑ Extended Term $'1, �350.00 --BRP N15c -----------------------------•--•--------------------.._..-------------..-..-..--------------------.-..-..-.7 ---------------°--------::- ............. Partial (A-H) El Residential with<4 units $6t65.00 BRP MN14a ❑ Other $2,005.00 . BRP 1�V1114b r— ❑ Extended Term $3,350.00 BRP NWW14c Municipal Harbor Plan(A-H) ❑ Residential with <4 units $665.00 BRP WW16a ❑ Other $2,005.00 BRP WW16b ❑ Extended Term $3,350.00 BRP WW16c ---------.-.._..----------------..-..-------------------.._.._.--------------------------------------..-..-------------------................................ Joint MEPA/EIR(A-H) ❑ Residential with<4 units $665.00 BRP WW17a ❑ Other $2,005.00 BRP WW17b ❑ Extended Term $3,350.00 BRP WW17c Amendment(A-H) ❑ Residential with<4 units $530.00 BRP WW03c El Other $1,000.00 BRP WW03d ❑ Extended Term $1,335.00 BRP WW03e CH91App.doc•Rev.03/17 Page 1 of 13 3 Massachusetts Department of Environmental Protection Dureaa-of Resource-Protection=Waterways-Regdati on-Program—T2-80443 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment B. Applicant Information Proposed Project/Use Information 1. Applicant: Richard K. Bendetson w , Name E-mail Address 63 Atlantic Avenue Mailing Address Note:Please refer Boston MA to the"Instructions 02110 City/Town State Zip Code E-7-7 FETED Telephone Number Fax Number 2. Authorized Agent(if any): John O'Dea john@sullivanengin.com Name E-mail Address P.O. Box 659 Mailing Address Osterville MA 02655 City/Town State Zip Code 5084283344 5084289617 Telephone Number Fax Number C. Proposed Project/Use Information 1. Property Information(all information must be provided): Owner Name(if different from applicant) 033 019-001 41.607408 -70.437556 Tax Assessor's Map and Parcel Numbers Latitude Longitude 245 Ocean View Avenue, Cotuit MA 02635 Street Address and City/Town State Zip Code 2. Registered Land ® Yes ❑ No 3. Name of the water body where the project site is located: Cotuit Bay 4. Description of the water body in which the project site is located (check all that apply): Type Nature Designation ❑ Nontidal river/stream ® Natural ❑Area of Critical Environmental Concern ® Flowed tidelands ❑ Enlarged/dammed ❑ Designated Port Area ❑ Filled tidelands ❑ Uncertain ❑ Ocean Sanctuary ❑ Great Pond ® Uncertain ❑ Uncertain CH91App.doc•Rev.03/17 Page 2 of 13 r 3 Massachusetts Department of Environmental Protection Sureau-of- esource Protection— Wain Y-280443 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment C. Proposed Project/Use Information (cont.) Select use(s)from Project Type Table 5. Proposed Use/Activity description on pg.2 of the "Instructions" To relocate and maintain existing pier with proposed ramp,float and tie off piles. 6. What is the estimated total cost of proposed work(including materials &labor)? $40,000 7. List the name&complete mailing address of each abutter(attach additional sheets, if necessary).An abutter is defined as the owner of land that shares a common boundary with the project site, as well as the owner of land that lies within 50' across a waterbody from the project. Scott A. & Laurie Blizard 1286 Main Street, Cotuit, MA 02635 Name Address David J. Der Hagopian, Jr. 300 S/Interlachen Ave., #204,Winter Park, FL 32789 Name Address Name Address D. Project Plans 1. I have attached plans for my project in accordance with the instructions contained in (check one): ® Appendix A(License plan) ❑ Appendix B (Permit plan) 2. Other State and Local Approvals/Certifications ❑401 Water Quality Certificate Date of Issuance ®Wetlands SE3-5535 File Number ❑ Jurisdictional Determination JD- File Number ❑ MEPA File Number ❑ EOEA Secretary Certificate Date ❑ 21 E Waste Site Cleanup RTN Number CH91App.doc•Rev.03/17 Page 3 of 13 r 3 Massachusetts Department of Environmental Protection reau-of-Resource-Protection atervvays R-agulatb -Program-2-$o443 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal No. Water-Dependent, Nonwater-Dependent,Amendment. E. Certification All applicants, property owners and authorized agents must sign this page.All future application correspondence may be signed by the authorized agent alone. "I hereby make application for a permit or license to authorize the activities I have described herein. Upon my signature, I agree to allow the duly authorized representatives of the Massachusetts Department of Environmental Protection and the Massachusetts Coastal Zone Management Program to enter upon the premises of the project site at reasonable times for the purpose of inspection." "I hereby certify that the information submitted in this application is true and accurate to the best of my knowledge." Applicant's signature Date Property Owner's signature(if different than applicant) Date 5111V� Agent's signature(if applicable) Date CH91App.doc•Rev.03/17 Page 4 of 13 f 3 Massachusetts Department of Environmental Protection B�xreamof R�eso=6-Prote�cfrori—1 terwaq�RtgulatirnrPr6gram X2�o443 Chapter 91 Waterways License Application -310 CMR 9.00 Transmittal"°. Water-Dependent, Nonwater-Dependent,Amendment F. Waterways Dredging Addendum 1. Provide a description of the dredging project ❑ Maintenance Dredging (include last dredge date& permit no.) ❑ Improvement Dredging Purpose of Dredging 2. What is the volume(cubic yards)of material to be dredged? 3. What method will be used to dredge? ❑ Hydraulic ❑ Mechanical ❑ Other 4. Describe disposal method and provide disposal location(include separate disposal site location map) 5. Provide copy of grain size analysis. If grain size is compatible for beach nourishment purposes, the Department recommends that the dredged material be used as beach nourishment for public beaches. Note: In the event beach nourishment is proposed.for private property, pursuant to.310 CMR 9.40(4)(a)1, public access easements below the existing high water mark shall be secured by applicant and submitted to the Department. CH91Adoc•Rev. pp e .03/17 Page 5 of 13 f r -=C"y. ,�♦ Jyy,+7ear '� ;vf� , `""" {� -,t , r- r . t o `\�j��_ Vj • pp �.. k1�`.� rLi 1 Ablan ( g� ng ^"1�. •tia�t• -O`er.,,, ',~ d OGa ,..al\�o�•� `� 4la U .#, rt} R� w h18rySt` wrd to P i i p s Ve. ,� t Al , e• �>tilA_ � Cy i b. fr,. 'O tF+�,,..-...�� �'1. �� L� 1 • { y_� f g� Ei t t �. .T105 �fr. �Q . ,b4 .� ► �� , ♦ V"'. •�1 �i is a��r� ., � A °~�,,..�• � Hand{ �.,r, 1 ��� �, `Bach,�'��:� • �> E g • •1a .,�.,,,''s t � -�Y Noisy, 0?2,i d 'r a s• �;' �.� ���' o (k�� Landing e,� �"" (r� � s � 'fir •�* s � � , �: r :� . � � •• A4 ! :...a ,r L�4 V ':J^ � � U �1, �' • ,4,' `s�} F� a•h; .:n.. r 4 etc» ,� ♦'{.+ n o tr,'• a't , •Y D c :'." F' .y4'� �yt4 - 3� • �Os'r`� 3 , tt t nt12 . e a O > Pt TMe Q ' •�_ t' y " € r R ¢ fI ,•- � '. � 7 r t K y w. s_ a r- } � s'f:. .0'!5 � a��+1 � s...sr� .� ..f: . .�• f �: �1 _ .� }�� � cw ``�Pi p'�'�f�.j�. ,.�}[i�#�4 } 'O � SE • ;1 `.r0 ` t r� }�"§� rY1p$Af�.4. ... ��, n �� � ,,1 .`_ � 4�jv�a w• • } 1.4r - '• ��� r �. �.� .�* !;w E$�r�ld r pP.�'� g � �•$Q �..�e� Y� I' ijAV LAM R r a � � ta#wl 3 •Light I lab,2000 , /� �.Cc_-0�0' {{��/^� ^ -k ..fir."- a, rt •s a. > a r` E xa T s: m t`o��Y a • f` t 2VL� �,, "` O. ..1 DOV y'a:21/V M O 40OA I a r • �. v oil DIRECTIONS: FROM HYANNIS — FOLLOW ROUTE 28 TOWARDS SHEET 1 OF 4 COTUIT,•TAKE A LEFT AT LIGHTS ONTO PUTNAM AVENUE AND RICHARD K. BENDETSON FOLLOW TO END; TAKE A LEFT ONTO MAIN STREET, AND THEN A TO RELOCATE & MAINTAIN EXISTING LEFT ONTO OCEAN VIEW AVENUE; SITE IS ON THE LEFT, #245. PIER WI TH PROPOSED RAMP, ASSESSORS. MAP 033 PARCEL 019-001 FLOAT & TIE OFF PILES IN NANTUCKET SOUND LATITUDE: 413625" AT 245 OCEAN VIEW AVENUE LONGITUDE. 70 26'12" CO TUI T MA UTM: 380288E 4607134N APRIL 2.3, 2078 SULLIVAN ENGINEERING & CONSULTING, INC. OSTERVILLE, MA COTUIT BAY 0�011 II ' 3 D 67 EXISTING LCP 1 UNPERMITTED MOORING DECK CH.91- DPW LIC.#3027 "1947" MAINTAIN A CONCRETE CAP ON A STONE JETTY AND A PILE AND TIMBER PIER. EXISTING STONE GROIN EXISTING 'M4 w(0.0) PIER ACCESS DEED CERTIFICATE#192778 PLAN LCP 6713—D s , STAIRS BEACH GRASS MHW (2.8 LOT 14 OF1{:.5., Q ci `i W J o NIF SLY Z Q o cd DAVID J DER HAGOPIAN TURSTEE DAVID J DER HAGOPIAN TRUST 41 0 co w Q � ACCFs.4 ir) RgMp N o ``' Q LOT 14 rn OVERALL EXISTING PLAN VIEW M CIA � SCALE. 1" = 40' t^ 20 0 10 20 40 ao to 114.23 N16' 23100"E SHEET 2 OF 4 RICHARD K. BENDETSON AVENUE TO RELOCATE & MAINTAIN EXISTING VIEW PIER WITH PROPOSED RAMP, OCEAN FLOAT & TIE OFF PILES IN NANTUCKET SOUND AT 245 OCEAN VIEW AVENUE COTUIT MA APRIL 23, 2018 SULLIVAN ENGINEERING & CONSULTING, INC. OSTERVILLE, MA S x-6.2 x-1.9 x-1.7 x-2.5 x-0.9 x-4.1 x 2.1 x-10.3 V) x-3.2 Q = x x-�:2.4 x-7.9 x-13.1 x-0.4 52' _ 4: .4 O x-10.4 m 18' _ -8.2 12^ TIE OFF g x PILES (2) 2.t7_ x 2.6 ^� .5 d NEB F_a'__� 1_1-_ -_ ------- - _2� 8'x18' 10 P _ ' x � BOARDWALK FLOAT RAMP _ ACCESS _ c-3 x STAIRS STONE -15 ro GROIN D m x- .7-9.4 EXISTING PIER �3 TO BE x_1.8 -3.5 REMOVED x-6.4 x-5.9 x-9.3 x-3.2 o o x-1.9 3: x-6.1 x-3.0 DETAIL PLAN VIEW SCALE. 1 = 20' 20 0 10 20 40 �;, f' oil;I C. <n SHEET 3 OF 4 A RICHARD K. BENDETSON TO RELOCATE & MAINTAIN EXISTING ' PIER WITH PROPOSED RAMP, FLOAT & TIE OFF PILES f 'IN NANTUCKET SOUND A T 245 OCEAN VIEW AVENUE COTUIT MA Ll I APRIL 23, 2018 SULLIVAN ENGINEERING & CONSULTING, INC. OSTERVILLE, MA EXISTING PIER & PROPOSED CONSTRUCTION BOARDWALK PER DPW 52' CH91 LIC.# 3027 102'± ELL 13' M.H.W. 2.8 ...................................................... ............................................................................................... ... ............. .. ............ .. ............. .. . . 0.0 PIER PROFILE SCALE. 1" = 10' 4 0 2 4 2" X 6" MIN. DECKING (TYP.), 4 0' ---�714" MIN. SPACING DRY 18' . 9.0, 9.0, EL. 4.8 3" X 8" FOR 0) ALL STRUCTURAL MEMBERS M.H.W. 2.8 M.H.W. 2.8 F : --- ��WATER AND ELECTRIC TYP. Z M.L.W. 0.0 Nj r---I rri r-:-o ::Io(3— Z rr, (3 C)C) CROSS BRACING p C) ;I\-:Z M.L.W. 0.0 IV IV C/)r-rl 0 rr, QD rrl ELL PROFILE ----i rr, ---j�,�� rrl CCA-TREATED PILING AND STRUCTURAL TIMBER N.)Q:z C) �70 (GREATER THAN THREE [3] INCHES THICK) ARE -XI (3 it SCALE. 1" 10' (A '-rr'-0)� ALLOWED. OTHERWISE, NO CCA-TREATED OR -co 12" PILE- CREOSOTE-TREATED MATERAILS SHALL BE USED. (3 rri 0 N)cS r1l -q cn Z--rl (TYP.) 10 0 5 10 20 (j)-q r', Z3 FOR PIER — 0 rz)-rri PIER SECTION CIO Q:p z--4 Z r-::o (/) SCALE: 1 4' Z 1.rri 0 rrl Cf) 4 0 2 4 8 PROJrE NAME:1. ADDRESS: PERMIT# PERMIT DATE: .LARGE ROLLED PLANS ARE IN: BOA SLOT Data entered in MAPS program on BY: oo t., to k"5 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION oil Map Parcel ® Application # Health Division Date Issued Conservation Division �1 Application Fee Pw Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board f Historic - OKH _ Preservation/ Hyannis Project Street Address Village Owner ;�'�( '�- _� Address `{ V�e w W?C\1X Telephone U?1-7 Permit Request Nk4ps\<, i � 1?�cop 0 wad C r� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay o Project Valuation OUO Construction Type a Lot Size Grandfathered: ❑Yes ❑ No If yes, attach s pporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway:110 Yeses❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeal!:;�o Ath rization ❑ Appeal # Recorded ❑ Commercial ❑Yes If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Aa 64 C1iST&T_ Telephone Number (Vq0 Address PSff- '_ License # 0-5 r793SB ® Home Improvement Contractor# 1 I Worker's Compensation # WL (0,3 © 3 ALL CONSTRUCTION D BRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO e SIGNATURE DATE /60 ,F FOR OFFICIAL USE ONLY APPLICATION# IIATE ISSUED i MAP/PARCEL NO. 4 , ADDRESS VILLAGE OWNER T 1 i E DATE OF INSPECTION: t C FOUNDATION 4 - FRAME ti ` INSULATION FIREPLACE A t 4 ELECTRICAL: ROUGH `' FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL' : ' FINAL BUILDING A 13 E DATE CLOSED OUT 1 ASSOCIATION PLAN NO. r ` The Commonwealth of Massachusetts Department of Industrial Accidents I Office of Investigations 600 Washington Street 'r Boston' MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Address: L9 City/State/Zip:C Phone #: W . 9-OY 8 Are eyyou an employer? Check the appropriate box: Type of project(required): 1.'CJ I am a employer.with 5 4. ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- Misted on the attached sheet. 7. [] Remodeling ship and have no employees These sub-contractors have S.- ❑ Demolition working for me many capacity. employees and have workers' - [No workers' comp. insurance comp, insurance. 9. :0 Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE] Plumbing repairs or additions myself No workers' com right of exemption per MGL Y [ P• 12.0 Roof.repairs 'insurance required.] t c. 152, §1(4), and we have no 13.[ Otfier 0 1, � . • . ' employees. [No workers' _��a�' .j -�. comp. insurance required.] *Any applicant that checks box#I 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. tContractors 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. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: W to :30 Expiration Date: Zz / Job Site Address: •44 ocec l�2Yn/ City/State/Zip: �3s Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form'of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage.,verification. I do hereby certify under,the ains and penalti o perjury that the information provided above is true and correct. Signature: l Date: 3 A/// Phone#: (9 Official use only. Do not write in this area, to be completed hy•city or town of City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department' 3. City/Town Clerk 4..Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: I Information and 'Instructions. Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, constniction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP) with no employees other than the . members or partners, are not required to.carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation.of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pen-nit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one`affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of.Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel-,4,617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia Workers Compensation and ST-A- -R Employers Liability Insurance Policy i N s u R A N c E 26255 American Drive c 'o M P A N Y Aruem Information PageberofMeadotubrooh®InsuranceGroup - Southfield, Michigan 48034-6112 Policy Number Renewal Of Policy Period Agency WC0632030 New 03/01/2011 to 03/01/2012 0000750 Item Named Insured and Address Agent 1. Macallister Building, LLC Renaissance Insurance Agency,Inc. 64 Ebenezer Road 981 Worcester Street Osterville, MA 02655 Wellesley, MA 02482 FED ID Number: 025687813 NCCI Carrier Code No.: 24562 Risk ID No.: 0196263 Other workplaces not shown above:None. Entity: (LLC) Limited Liability Company 2. Policy Period: 03/01/2011 to 03/01/201212:01 am standard time at the insured's mailing address. 3A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation law and any occupational disease law of each of the states listed here: MA 3B. Employers Liability Insurance: Part Two of the policy applies to Employers Liability Insurance for work in each state listed in Item 3A. The Limits of Liability are: Bodily Injury by Accident $100,000 Each Accident Bodily Injury by Disease $500,000 Policy Limit Bodily Injury by Disease $100,000 Each Employee 3C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All states except ND, OH, WA, WV, WY and states designated in Item 3A of the Information Page. 3D. This policy includes these endorsements and schedules: See attached schedule. 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rates , and Rating Plans. All Information below is subject to verification and change by audit. Adjustment of premium shall be made at: Policy Expiration Classification of Operations: See attached schedule Minimum Premium. Expense Constant: Deposit Premium: Total Estimated Annual Premium: Countersigned 03/10/2011 By- DATE Authorized Agent This Information Page with the Workers Compensation and Employers Liability Insurance Policy and Endorsements, if any, issued to forma part thereof, completes the above number policy. Date of Issue:03/09/2011 Insured'Coov RENCE1 WC 00 00 01 (12/98) BAWMASIX �;M t>,� Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street,,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section I£Using A Builder as Owner of the subject property hereby authorize 4 c r'`�'S Ve- L L L LL to act on mybehalf, in all matters relative to work authorized by this building permit application for: �- (Address of J Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\MicrosoftlWindows\Temporary Intemet Files\Content 0ut1ook\DDV87AAZ\EXPRESS doc Revised 072110 Depa►-tment of Publil'SJCt) - Board of Building Regulations and Standards Construction Supervisor License License: CS 79358 e MARK A MACALLISTER ; 64 EBENEZER RD OSTERVILL"E, MA )2655 Expiration 8/12/2012 ('n nnn issiune r Tr#: 907 ✓�te,T�omvnzartwea��•.�✓�adQc�c�iuGvlt¢ � Office of�onsumcr,Affa�rs& use»ess Regu'at111 L,icense or registration valid for indi:i, ''use only. ~HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to � .� �I Office of Consumer Affairs and Business Reguiat► — Registrtinn:, +493374a 10 Park Plaza-Suite 5170 - Expiratwm' 8/3{/2011 Tr# 28724; ' . Type �DBA Boston,MA 02116 N#,-'ALLISTER BUILDING;'r��k� �s MARK MACALLIb DER T _t , 64 EBENEZR ROADS OSTERVILLE,.MA�02655' , ' Undersccretarys� Not valid without signatur j Existing Flo t I t \ I )6x18' ! I \ Pro ert: Line r i I O O t 7' Existing Lk \ 4` I { I8' \ , \ 6IStin Pier \ s le 1"=10' 1 ' • ` Exiting Flo lit )6x18' \ \ 7 1 Pro ert Line t o I 1 , \ \ { 1 I Pr ! osedl DolpF(i Pil s \ }\ ; Existing Dech \ \ ' to be \ \; Re Al ved 1, 1 \ \ Prop sed Float i 1 6x18 \Proposed �� ` 1 i ; ! 4'�' Wide Pier I !1 + ProDpose I ''eeck 1 \ ` 1 17• 1 -1 Proposed Pier O Lion 1 I 9' Scale 1= . 1 II I • � !. � i I 1 (._G G(ZL \'-9 aT Z s 1 i t i Existing Flo t I I I I - fix18' ` Pro ert Line t t I Prop��osed I bolphibi Piles \ ' Exi tin D ck �to be \ I F7�moved ( ! \ ti \ Proposed-Floatl ! 1 \ , Pro Tat form\ & Eonr \ Px18 �t•. 47 ' ( ! \\ ` , Proposed \ t ` \4' Wide Pier ( I I 1 11 Pr osed { { 0 Proposer. oat, I I Proposed Pier(Option 2) \ + ' ax14'`� 1 1 I I \ Scale 11=10'. i 1 I i TITLE PREPARED BY. PREPARED FOR: N I LD I N G D EP Sketch Pier Plans ��J 9.q5 M4 Ocean View Ave. ' 1U&1e11ng& Richard K. Betidetson 2 Barnstable (cctuit) Mass. Sullivan ConSUIting,IIlG 63 Atlantic Avenue (-MmQ&M"•R0.BMW. ��W4�1k.VAMM Boston MA 02110 OCT 13 2017 - ..�y,lllvan.apnam•vr.uwltisrrytneom � - Draft: CTR O DATE: August 3, 2017 SCALE 1 = 1D' JOD 40 o Za 40 ©1AIA1/1F BA�'1NST/1BLE a Pro/eet%2700, 8A1V�llf