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HomeMy WebLinkAbout1545 IYANNOUGH ROAD (5) ,.f ��� �. r3 r ,:, . . .. �, a ;� .. .o z � : . a � - s• - ,. ., ,,, �, ,.�� ., o n ",. � w .� � �. �. ... � � c i o ,. � .. _ i .. i .y _ .. - T w � � .. e 'v �_ - � � ° . � o r .. .� e _ o '._. ., ,: .. .. ., _. .. A.,, .. ' .. TOWN OF BARNSTABLE BUILD NG P APPLICATION Map �53 Parcel 015, c - Application # � V Health Division BUILDIN(3 Dip: Date Date Issued l� Conservation Division Application Fee NOV ! 7 Planning Dept. Permit Fee V TOWN 0� Date Definitive Plan Approve board Historic - OKH _ Preservation/ Hyannis Project8treef7ddres8 Is vs- _z_'YA-,K,1, If f 'Willa ery ' �� 'ov OC-7—It- Owner . V�6 ���1�02_ Address f 9 9k _77-y OLt Ca .� Telephone �9 - 3 V Z TS, 3 3 Permit Re uest )Z7;v- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project�Valuation 000 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 ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER.OR HOMEOWNER) Name" Telephone•Number ��� Address., �.tt>r�Cl�rL � License# OAS 7��� ill tom' � 0" Fd Home Improvement Contractor# Email �Cy rjl,2,c) &JAdCQ2c1Q,9 =_ Worker;'s C6rh endation.# ALCONST//R//UCTIONI,RE/BRLS�RESULTINGwFROM'THISR'PROJEGT,WILL;BE„TAKEN TOE SIGNATURE 0DAT FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. S9 '1 1ILG �VIILI/EVIL/YGWLL/L VJ lI1WJJ Kl./LW J{.LLJ �, Department of Industrial Accidents -- Office of Investigations ` 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): American Construction Corp, Address:54 Oakville Street City/State/Zip:Lynn, MA 01905-2817 Phone #.781-584-6178 Are you an employer? Check the appropriate box: Type of project(required): 1.Z I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.' required.] 5. ❑ 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.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:Liberty Mutual Policy#or Self-ins. Lic. #:WC2-31 S-3801 1 1-022 Expiration Date: 11/09/2016 Job Site Address: lyannough Road City/State/Zip: Hyannis, Ma. Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the A or insur nce coverage v a I do hereby ce afy nder the pdlinsaOpeng ties e . ry that the information provided above is true and correct Signature: - - -- - - - -- � Date: _ Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#• ,acoRo® 'CERTIFICATE OF LIABILITY INSURANCE FDATE(MM/DD"YYY) 10/31/2016 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: Erin Lyons JOHN E. MCLAUGHLIN INSURANCE AGENCY L.P A;"N E , (781)665-2775 FAX A/C No ADDRESS: elyons@mclaughlinins.com 828 LYNN FELLS PARKWAY INSURERS AFFORDING COVERAGE NAIC# MELROSE MA 02176 INSURER A: LM INS CORP 33600 INSURED INSURER B: AMERICAN CONSTRUCTION CORP INSURERC: INSURER D: 54 OAKVILLE STREET INSURER E LYNN MA 01905 INSURER F COVERAGES CERTIFICATE NUMBER: 98927 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 ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDNYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCU DAMAGE TO RRENCE $ RENTED CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION /� STATUTE ER OH AND EMPLOYERS'LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A N/A N/A WC531 S380111026 11/09/2016 11/09/2017 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street AUTHORIZED REPRESENTATIVE �( LLB Hyannis MA 02601 Daniel M.Crow ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AMERI-4 OP ID: EL CERTIFICATE OF LIABILITY INSURANCE FDATE,M1/20 11/0 /20 6 16 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 McLaughlin Insurance Agency NAME: Erin Lyons 828 Lynn Fells Parkway acN; Ell:781-665-2775 aC No: 781-665-0295 Melrose,MA 02176 McLaughlin ADDRESS:elyons@mclaughlininsurance.com John E.McLaughlin Jr. INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Acadia Insurance Company 31325 INSURED American Construction Corp.54 Oakville St. INSURER B:Union Insurance Company 25844 Lynn,MA 01905-2817 INSURER C:Liberty Mutual 24074 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE DDL UBR. POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE OCCUR CPA5040457-15 04/01/2016 04/01/2017 DAMAGESTO ( RENTED PREMISES Ea occurrence) $ 500,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE. $ 2,000,00 POLICY FX] PRJECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1,000,00 B X ANY AUTO MAA5042585-14 04101/2016 04/01/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ f I :NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB CLAIMS-MADE CUA5042733-17 04/01/2016 04/01/2017 AGGREGATE -$ 2,000,00 DED I X I RETENTION$ 10000 $ WORKERS COMPENSATION STATUTE EMPLOYERS'LIABILITY STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N X TO BE ISSUED BY CARRIER 11/09/2016 11/09/2017 E.L.EACH ACCIDENT $- 1,000,000 OFFICER/MEMBER EXCLUDED? ❑N/A _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance CERTIFICATE HOLDER CANCELLATION BARNS02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Building Division ACCORDANCE WITH THE POLICY PROVISIONS. 367 Main Street Hyannis, MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-057683_, Construction.Supervisor � PATRICK M COBURN � 6 PRANKER RD SAUGUS.MA 01,906 o Expiration: Commissioner 08115/2017 r Town of Barnstable Regulatory Services MASS E' * Richard V.Scali,Director i63p- Building Division Paul Roma,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 J i JC) _ ,as Owner of the subject property hereby authorize P"iA 172L G� f ( bc!/Lst9 to act on my behalf, in all matters relative to work authorized by this building pei nit application for. (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. ' S' e of Owner ignature of Applicant V 2�G '-Print Name Print Name Date ,t QTORMS:OWNERPERMISSIONPOOLS f r r G O { T � r z tl fA l� ;x 9 o �6 4.3� i ? p « ; o v� AL at \ f i w w P } 7 6 a t 4r i Af! F ��yyy{1S ' 0 Mass. Corporations, external master page Page 1 of 2 �yl .lO�Sf w v Corporations Division Business Entity Summary ID Number: 203024947 Request certificate New search Summary for: LAKESIDE CENTER, LLC The exact name of the Domestic Limited Liability Company (LLC): LAKESIDE CENTER, LLC Entity type: Domestic Limited Liability Company (LLC) Identification Number: 203024947 Old ID Number: 000899267 u Date of Organization in Massachusetts: 06-24-2005 Last date certain: The location or address where the records are maintained (A PO box is not a valid location or address): Address: 1436 IYANNOUGH ROAD City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and address of the Resident Agent: Name: JOSEPH P. KELLER Address: 1436 IYANNOUGH ROAD City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and business address of each Manager: Title Individual name Address MANAGER JOSEPH`P KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 USA In addition to the manager(s), the name and business address of the person(s) authorized to execute documents to be filed with the Corporations Division: Title Individual name Address SOC SIGNATORY JOSEPH P KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 USA The name and business address of the person(s) authorized to execute, acknowledge, deliver, and record any recordable instrument purporting to affect an interest in real property: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=203024947... 11/17/2016 Mass. Corporations, external master page Page 2 of 2 Title individual name Address REAL PROPERTY JOSEPH P. KELLER 1436 IYANNOUGH ROAD HYANNIS, MA 02601 USA ❑ ❑Confidential ❑Merger ❑ Consent Data Allowed Manufacturing View filings for this business entity: ALL FILINGS Annual Report + Annual Report - Professional Articles of Entity Conversion Certificate of Amendment Lv' View filings Comments or notes associated with this business entity: NewsearchJ , { http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=203024947... 11/17/2016 f Patrick Coburn Four eDEPConfirmation@massmail.state.ma.us Sent: Tuesday, November 15, 2016 6:21 PM To: Patrick Coburn Subject: eDEP Submittal Confirmation for DEP Transaction ID: 881415 Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection.Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for your records. Please do NOT reply to this message,this email address will not receive messages. For assistance with eDEP Online Filing, please email the EEA Help Desk at mailto:EEA.ServiceDesk@State.MA.US or call 617-626-1111. MassDEP is interested in how we can serve you better.To help us make improvements to eDEP, please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/eea/agencies/massdep/service/online/edep-contacts- and-feedback.html. To contact MassDEP Programs, please see http://mass.gov/dep/about/contacts.htm. o�p7 T NOV 7?0� DEP Transaction ID: 881415 ANSTgBCF Date and Time Submitted: 11/15/2016 06:21:20 Form Name:AQ 06-Construction/Demolition Notification Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection.Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for your records. Please do NOT reply to this message,this email address will not receive messages. For assistance with eDEP Online Filing, please email the EEA Help Desk at maiIto:EEA.ServiceDesk@State.MA.US or call 617-626-1111.. MassDEP is interested in how we can serve you better.To help us make improvements to eDEP, please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/eea/agencies/massdep/service/online/edep-contacts- and-feedback.html. To contact MassDEP Programs, please see http://mass.gov/dep/about/contacts.htm. DEP Transaction ID: 881415 Date and Time Submitted: 11/15/2016 06:21:20 1 Form Name: AQ 06,-Construction/Demolition Notification Payment Information DEP coder 133186 Date: 11/15/2016 6:18:16 PM Arneunt($): 100 Payment Detail: COBURN PATRICK--AccountType-- AccountNumber****4006 Confirmation Number: EMAIL ID OF THE USER: pcoburn@amconcorp.com 2 eDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home i Contact i Privacy Policy MassDEP's Online Filing System Usemame:PCOBURN Nickname:PADDYMIKE My eDEP I Forms®1 My Profile® Help I Notifications Receipt 1 Forms Signature Pa meet Receipt Summary/Receipt o print receipt -Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select"My eDEP"to see a list of your transactions. DEP Transaction ID: 881415 Date and Time Submitted: 11/15/2016 6:18:44 PM Other Email : DEP Transaction ID: 881415 Date and Time Submitted: 11/15/2016 6:18:44 PM Other Email : Form Name:AQ 06 -Construction/Demolition Notification Form Name: AQ 06 -Construction/Demolition Notification Payment Information DEP code: 133186 Date: 11/15/2016 6:18:16 PM Amount($): 100 Payment Detail: COBURN PATRICK--AccountType--AccountNumber ****4006 ConfirmationNumber: My eDEP MassDEP Home Contact i Privacy Policy MassDEP's Online Filing System ver.12.27.2.0©2016 MassDEP https:Hedep.dep.mass.gov/Pages/PrintReceipt.aspx 11/15/2016 M75os{ Asbestos Identification Laboratory iBaicn � s t 165 New Boston St., Ste 227 it ,.q Woburn, MA 01801 .. j 781-932-9600 U\IJV Web:www.asbestosidentificationlab.com Email:mikemanning@asbestosidentificationlab.com Lab Code: 200919-0 November 09, 2016 Robert DaPrato Project Number: Commonwealth Asbestos Testing 128 Forest St Project Name:1545 lyannough Rd, Hyannis, MA Medford, MA 02155 Date Sampled: 2016-11-08 Work Received: 2016-11-08 Work Analyzed: 2016-11-09 40//IG Analysis Method: BULK PLM ANALYSIS EPA/600/R-93/116 p,® �FP?, T®w off P1 Dear Robert DaPrato, NOFeAAN STge�� Asbestos Identification Laboratory has completed the analysis of the samples from your office for the above referenced project . The information and analysis contained in this report have been generated using the EPA /600/R-93/116 Method for the Determination of Asbestos in Bulk Building Materials. Materials or products that contain more than 1%7 of any kind or combination of asbestos are considered an asbestos containing building material as determined by the EPA. This Polarized Light Microscope (PLM) technique may be performed either by visual estimation or point counting. Point counting provides a determination of the area percentage of asbestos in a sample. If the asbestos is estimated to be less than 10% by visual estimation of friable material, the determination may be repeated using the point counting technique. The results of the point counting supersede visual PLM results. Results in this report only relate to the items tested. This report may not be used by the customer to claim product endorsement by NVLAP or any other U.S. Government Agency. Laboratory results represent the analysis of samples as submitted by the customer. Information regarding sample location, description, area, volume, etc., was provided by the customer. Asbestos Identification Laboratory is not responsible for sample collection activities or analytical method limitations. Unless notified in writing to return samples, Asbestos Identification Laboratory discards customer samples after 30 days. Samples containing subsamples or layers will be analyzed separately when applicable. Reports are kept at Asbestos Identification Laboratory for three years. This report shall not be reproduced, except in full, without the written consent of Asbestos Identification Laboratory. • NVLAP Lab Code:200919-0 • Massachusetts Certification License:AA000208 • State of Connecticut, Department of Public Health Approved Environmental Laboratory Registration Number:PH-0142 • State of Maine, Department of Environmental Protection Asbestos Analytical Laboratory License Number:LB-0078(Bulk) LA-0087(Air) • State of Rhode Island and Providence Plantations. Department of Health Certification:AAL-121 • State of Vermont, Department of Health Environmental Health License AL934461 Thank you Robert DaPrato for your business. Michael Manning Owner/Director November 09,2016 Robert DaPrato Project Number: Commonwealth'Asbestos Testing Project Name:1545 lyannough Rd, Hyannis, MA '128 Forest St Medford, MA 02155 Date Sampled: 2016-11-08 Work Received: 2016-11-08 Work Analyzed: 2016-11-09 Analysis Method: BULK PLM ANALYSIS EPA/600/R-93/116 ROM Material Location' Color a on-Asbestos'/°: Asbestos LablD 001 Floor Adhesive 2nd Floor Office Space yellow Non-Fibrous 100 None Detected 193482 002 Floor Adhesive 2nd Floor Office Space yellow Non-Fibrous 100 None Detected 193483 003 Floor Adhesive 2nd Floor Office Space yellow Non-Fibrous 100 None Detected 193484 004 Joint Compound 2nd Floor Office Space white _ Non-Fibrous 100 None Detected 193485 005 Joint Compound 2nd Floor Office Space white Non-Fibrous 100 None Detected 193486 006 Joint Compound 2nd Floor Office Space white Non-Fibrous 100 =e Detected 193487 007 Ceiling Tile 2nd Floor Office Space brown Mineral Wool 10 None Detected Cellulose 60 193488 Non-Fibrous 30 008 FCeiIiing Tile 2nd Floor Office Space multi Mineral Wool. to one Detected Cellulose 60 193489 Non-Fibrous 30 009 Tile 2nd Floor Office Space tan Mineral Wool 20 one Detected Cellulose 50 193490 Non-Fibrous 30 Wednesday 09 End-of Report Page 1 of 1 Analyzed by: G2� _ Batch: 17506 / CHAIN OF CUSTODY Client: do MWWILJif EPA/600/R-93/116 Page of Address: /2 �a'£'SG-S'` �lcoro VN nd Time Sample Method Asbestos Identification Lab Hrs UsiBulk - Project Site &#: /��r �.j�/j N �"q h (t� 1656 New Boston St. if A ,,,. ,._.t S Day ®Soil Phone/email address: ✓'�q Suite 227 r ' a 60- 6 6S_-Q � os- - �-�ms �.tc < Woburn, MA 01801y ®Wipe Contact: J ��g�-� lcrysi' �.,cr {781 j932-9600 � '' y point count WWW.asbestosidentificationlab.com Stop on 1st Positive? Yes/No Relinquish by/d a Date Sampled: Notify Method; M Received by/d -M VVE, #of Samples Received: BATCH# Rev 06/16 Anayzed By: 0 Date: Temp in Celsius= Stereo Scope Optical Properties RI Non-Asbestos Percentage(%) 0 Field ID/ c •fl CO (Client v, \ �° ,� Reference) N o Material!Location u' �' N E o G C G 0 O N o N M Q a N O w S: 0 V ° o ° E ,�'� 5 Asbestos o- = rn 12 ° a s ii co) zo °' i` Minerals ` '�' g° m a II ..L o Material Chrysotile d ° 0 z ���ue ii U y (� Amosite Location —6 F,Cau� Crocidolite f C 5 Tremolite Anthophyllite Acti nolite d °? Material F�cxi� Chrysotile Amosite Location `"Q i 6od�Z Crocidolite 1 Tremolite olC� t l Anthophyllite Actinoiite Material (aaR o O 3 Chrysotile £•Sl` e Amosite Crocidolite Location Z No Tremolite atl C� SP/aC£' Anthophyllite Actinolite Page -of Temp in Celcius= Stereo scope Optical Properties RI Non-Asbestos Percentage(%) 0 Field ID/ CO {Client o o v► m Reference) Material/Location C rn o c a ^°o rn ro ,� a o +a O o ut m o vi o o 'o Q o dL0 5 o o Asbestos o = 75 0 nu.a owo tL Minerals ct °a zMaterial �t�� Chrysotile CU w-('c.x -n Amosite f 2-k-1-1> Crocidolite Location F(G-3A Tremolite Q-FfYCr Sf^c f? l� !� Anthophyllite V1&4 l ttT Actinolite Material - i Chrysotile Amosite (� Crocidolite Location Z~�Flao2 Tremolite (J(PC Anthophyllite C/ L Actinolite / d0 Material 3-Or�-- Chrysotile 6 CC5✓h�a4.%� . Amosite Crocidolite Location z,P-a ja( Tremolite Anthophyllite Actinolite Material C�<<<v5 Chrysotile ctAmosite Location Crocidolite 2�p r=-�U6n Tremolite Anthophyllite Material ( . 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N 0 f p 0 lL � N 0 ` 0 O s U O C N 1211 U i ,v Asbestos N `o 42 i c i� Minerals Q w m a it � c c c Material C£f �G Chrysotile -L LL cQ1i z '' O 0 77 C/ Amosite Crocidolite Location 2 Tremolite d��(C Anthophyllite Material SOH�� Actinolite Chrysotile Amosite Crocidolite Location Tremolite Anthophyllite Actinolite Material Chrysotile Amosite Crocidolite Location Tremolite Anthophyllite Actinolite Material Chrysotile Amosite Crocidolite Location Tremolite Anthophyllite Actinolite Material, Chrysotile Amosite Crocidolite Location Tremolite Anthophyllite Actinolite t A 4# ASBESTOS INSPECTION SURVEY Survey Results, Inspection Letter AUGUST 20; 2015 [COMPANY NAME] [Company address] Commonwealth Environmental Testing 128 Forest Street, Medford, MA 02155 Owner: American Construction Corp Representative of Owner, if Applicable: Mr Patrick Coburn Address of Property: 1545 Unit 2b lyannough Rd Hyannis, Ma Definition of ACM (Asbestos Containing Materials) means any material containing more than 1 asbestos. Materials identified as ACM that could be impacted by proposed renovation, demolition, redesign or redevelopment should-be properly removed or abated prior to any of these activities. A Licensed Asbestos Abatement Contractor must conduct abatement work in accordance with all Federal, State and Local Regulations. Asbestos testing performed at: 1545 Unit 2b, Iyannough Rd, Hyannis, Ma. On .November, 4, 2016 , Robert DaPrato, a Massachusetts' Licensed Asbestos Inspector, License p #AI900657 inspected the house at the above address for the presence of asbestos prior to renovation/demolition, per request of the owner. Bulk Samples Were Collected From: Flooring adhesives, Joint Compound and Ceiling Tiles. PHONE: 781-721-4540 www.coreservs.com FAX: 781-938-3933 The 9 samples were delivered to Asbestos Identification Lab, Woburn, MA 01801 for analysis on . The samples were analyzed by the EPA endorsed method of Polarized Light Microscopy with Dispersion Staining (PLM/DS) method. The PLM/DS is a qualitative and quantitative form of analysis that yields the type of asbestos in a sample, if any. The Results of the Bulk Samples are (Negative for asbestos): Description of the Physical Property: Commercial Office Space_ Description of Current and Past Use of Building: Commercial Limitations and Conditions of This Investigation: This NESHAPs survey involved an investigation for ACM in preparation for a specific renovation/ demolition project. Although this investigation involved some exploratory demolition intended to identify and sample inaccessible building materials, the potential remains that concealed ACM may be encountered in the building or at the site. PHONE: 781-721-4 540 www.coreservs.com FAX: 781-938-3933 Inaccessible building areas, building systems, structural components or surfaces which may not have been observed because it was unsafe or impractical to demolish, disassemble or remove systems or coverings, or because a human being can not physically enter or observe the area or component. Unless specifically noted, inaccessible areas may include: ➢ Buried or concealed pipe trenches and utility vaults or utility corridors underground ➢ Buried foundations below gradient ➢ Electrical equipment/wiring non-accessible ➢ Fire door interior with metal wrap exterior ➢ Remnant window and door caulking that have been replaced or in-filled over many years ➢ Concealed mechanical, thermal, surface and miscellaneous areas. �I Commonwealth made every reasonable effort to address these potential ACMs in the building(s). However, potential remains that concealed ACMs could be encountered during any future renovation/demolition project. A Licensed Asbestos Supervisor should always be on site with a water hose during any demolition. This investigation did not include an assessment of air quality or analyses of soil, water or ground water. No attempt has been made to check the compliance of past owners of the site with Federal, State and local authorities. Users of this report are ca utioned autioned that this document is an inspection report, not a project specification, although it is often feasible to use this report, for example, to obtain bids for asbestos and related abatement work, so long as all Federal, State and Local Regulations are followed and all quantities are verified on site by the prospective-:bidders. ' The asbestos containingmaterials that been identified dentified must be remove d by a Massachusetts Licensed Asbestos Abatement Contractor prior to any demolition/renovation. If you should require more information on this matter, please do not hesitate to contact me at 617-605-0405. Total Cost: 580.00 ri Sincerely, Robert DaPrato - Inspector#A1900657 R PHONE: 781-721-4540 www.coreservs.com FAX: 781-938-3933 Shea, Sally From: Patrick Coburn <pcoburn@AmConCorp.com> Sent: Wednesday, November 23, 2016 4:38 PM { To:- Shea, Sally . Cc: Mary Puzio (mary@jkellerco.com) Subject: RE:ViewPermit, Permit No:TB-16-3390 - Hi Sally, . It is actually an extension of an existing office space. The company is called GHD. They are a water service company. They have about 200 offices around the country. - They exist in the existing offices on the right side of the second floor level in this building and are expanding into this space to put a conference room and two small offices. think you could find them on www.GHD.com/usa hope that helps you. Pat JkAm Cfl419fRtflC91�lR Tl�i ' Patrick M. Coburn President i AmConCorp 54 Oakville Street Lynn, MA 01905 Office: 781-584-6178 i Direct: 781-854-6953 Fax: 781 584-6271 [ www.amconcorp.com " From:Shea, Sally.[mailto:Sally.Shea@town.barnstable.ma.us] Sent:Wednesday, November 23,2016 4:06 PM To:Patrick Coburn<pcoburn@AmConCorp.com> Subject:ViewPermit, Permit No:TB-16-3390 Hi Patrick, Can you give us some more information regarding your permit request? What type of office use is this? What is the nature of the business? Thank you. Sally Shea Town of Barnstable Assistant Zoning Admin/Lead Permit Tech. 508-862-4031 1