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0065 INDEPENDENCE DRIVE (6)
KOHL-'-INDEPENDENCE D I &too x 1; I.......... WAS%Now WE XTIT allm who lama I too,",WPA IIon, WK Tv"S soon MAO All now ZMAMP goo,Mu"sum-PNMAW W_Ywo"" IIWW,It goo, gJ-1- Ilk IMa 01 , --gw W 20 FAItoo,OREM k toe---jr-, MAI A ones go W MERV MORMS Ram--OOZY, Von I, got ?Wn ............. .- Sign TOWN OF BARNSTABLE Permit * BARNSTABLE, MASS. 9� s6 '0?Fp 39. A Permit Number: Application Ref: 201304156 20070873 Issue Date: 06/21/13 Applicant: OCW RETAIL HYANNIS LLC Proposed Use: SHOPPING CENTER- MALL Permit Type: SIGN PERMIT Permit Fee $ 200.00 Location 65 INDEPENDENCE DRIVE Map Parcel 295015X01 Town BARNSTABLE Zoning District SPLT Contractor PROPERTY OWNER Remarks 192 SQ FT KOHLS Owner: OCW RETAIL HYANNIS LLC Address: ATTN: STEPHANIE WARD 800 BOYLSTON ST STE 1300 BOSTON, MA 02199 Issued By: SS POST THIS CARDSO THAT IS VISIBLE FROM THE S BEET - r Town of Barnstable Regulatory Services * anxi�sraszz:, � $ omas F.Geiler,Director 1639. ,� ` n ram' Building Division Tom Perry, BuRding Commissioner 200 Main Street, Hyannis,MA 02601 ww.to*mbarnstable.maxs Offic: : :0:.-862-4038 Fax 508-790-6230 Permit Building Official approving.,-- .''Lpplication for Sign Permit Applicant (; _.-...� Assessors Doing Business As: Telephone Pao,'- Sign Location Street/Road: �� ytiC`tL, ►7-CJls e�k�JeQ `�.C2i V _ a. Zoning Distdcf: Old Sing Hghway? Ye,S .yaInis IEstor;c.;)istrictP Y Iioperty Owner .,rame. 1:1 -�14- - . Telephoner zkq %ldress � /? /V �/'�"� �7`: / 'Village:--������•'--�� d Sign; Contractor i Co Telephone:— gob-;3 6- Mailing Address: 0 G(D � l��C - S�, L�/`�Z. AAA- i Description • ::tease follow the cover directions.Yn-u must have an accurate rendition of sign with,dimensions and 1c cation. l LLI:e sign to be electrified? Yes (Note:Ifyes;a yniingpermitisreryuiredJ Width of binding face ft.z .0? Uto o x.10� 200� t. � (Merli o-ae Reface egg sign cr :Vew� Total Sq.Ft.of proposed:-�r � .l s) Yyou gave additional vgns please=ci1 a sheetlis g each one wl b dimPn '0125 If refacing an existing sign:please provic i; a picture of the existi sign with dime::":ions.. I hereby certify that I am the owner or t:at I have the authority of the owner to this application, '. iat 6 e information is correct and that t:_e use and constriction shall conform.tr, provisions of 3240-59 throug�§240-$9 of the Town c f Barnstable Zo ' ce. Si_nature of Owner/art cified Agrz# ) PRE-FINISH BLACK/"TrE S" .063"ALUMINUM RETURNS, ,y{pI (WHREIN6IDE) �- THE IE DRAWINGfS) SVIEWED AND REALIZE AT CEPT ANY THE DRAWINGS)AS SHOWN.10.EA112E THAT ANY .125-ALUMINUM GUSSETS CHANGES TO THESE DESIGNS MADE BEFORE OR m AFTER PRODUCTION MAY ALTER THE CONTRACT 1/2'ALUM NUT PRICE ALL CHANGES MUST BE IN WRITING AND WELDED TO SUPPORT 4° m S APPROVED BY BOTH PARTIES PRIOR TO PRODUCTION. (TYP,) .125-ALUMINUM BACKS,PAINTED 'TAP WHITENINSIDE),SATIN FINISH BLACK(OUTSIDE) SIGNATURE 8 DATE - MOUNTLNO HARDWARE WALLOUPA - q THE CUSTOM ARTWORKOEPICTED HEREIN IS LETTER CLIP 8 FOR REPRESENTATIONAL PURPOSES ONLY 33'3" B AND MAY NOT EKACTIY MATCH THE COLORS OF THE MATERIALS PROPOSED FOR USAGE ELECTRIC SIGNS PRODUCED AT LISLE.POWERSUPPLY 11� IMAGE WORKS CONFORM TO UL dB �\ ffi STANDARDS AND DISPLAY THE / J\ UNDERWRITERS LABORATORIES LABEL' e I1\ ALL ONSITE PRIMARY ELECTRICAL CONNECTIONS BY OTHERS. tlE ACRYLIC L IC OLITE FACES P.0.9 REVISE PIACEIMENTOMPROR OLHOND WHSEAMS,ONE FACES (NO SEAMS,ONE PIECE) P - WAM p 4,17.13 REVISEDSIZE DM INTERNALLY ILLUMINATED CHANNEL LETTER ELEVATION 3ne°>=1'-O" NOTE REAL ALL PENETRATIONS i6 WITH CLEAR SILICONE SPIRANT P. 1 SO SO.FT. USLED THE POINI•WHITE MODULES p (1)OF(2)SETS REQUIRED II;yLL 41/2• 12'NSTAL TTTE CONDUIT p' DISCONNECT SWITCH Q BY INSTALL PRIM ARYELECTRIC IR`WHIPS a MOUNTING HALL CUP A OUT OFLETTER,9 WIRE,I2 GAUGE 34•K LETTER CLIP C y§FINISH AINE BLAC F l PAINTED SATIN FNISH BLACK � S CUSTOM WALL ANOLE 1/4'WEEP HOLE,LOW OOPS PAINTED SATIN SECTIONS OF LETTER, FINISH BLACK (2)PER LETTER LETTER SECTION DETAIL EQ 33'3° EQ y 11046 LIA086TTER ROAD ASHLAND,VA 23(105 '^ PHONE804.798.5553 FAX:604.798.3502 V KOHLS OIFNT HYANNIS MA y IOOIGM 8 DrRRIF.IONEa y LtBIL11GFRlRINf §6 WAM 13113 W NVAMR MBAtFO 3 NOTED 96 w¢ KOHLS-HYANNIS-01 OPT2 --wwRrS OL 1 R2 FRONT ELEVATION SHOWS PROPOSED SIGNAGE 3/32"=1'-0° ouRPwIPB GrA OP , ;g N.. TOP Of PMPP � �'4 ;4. lie Tt 1.EXISTING FRONT ELEVATION(EAST) S JJ IL' 1171J�� � {" a JO�J2�2B �12�]�!"IS�T-TTT B�r"1.�- ' ' •:,.un•. Efa t view+ a 1.FRONT ELEVATION(EAST) EO. 48'-0 EO. EO. 79'-B' [JJ T> 25 TS Ie ZS 3] Jt 1B 18 Jt 27 TB22 9 2) 24 ( « L 1 Y I' ) x HARDSCAPE PLAN TOP or PxxnPEr ,t - EL rDP or _ �L I 24r-0 ' I E NH a°DR NR f 2.EXISTING RIGHT SIDE ELEVATION(NORTH) TOP w rnxNlNc `$ Tov oc lffll . Fx{rsH 7LWR a9eBP 2.RIGHT SIDE ELEVATION(NORTH) JD - ,�` °° —MON} O COIORI SYSTEM WITH1143 OTTER BROOK DIUM SAND FINISH. E.I.FS.SYSTEM© COATING.COLOR:TH SMOOTH"LIMESTONE'STO NNAIO-0056'OUIET HIDEAWAY' UPPER: METAL O UPP R GLIDDEN PR AND OFESSIONAL A1756'PEPPER SPICE'E,PAINTED © COLORMETAL GKYNARSERRA TANUTTER& UTS.PREFINISHED. zz RECYCLING TRASH RECEPTICAL 2 'PEPPER TO MATCH:A7756 'PEPPERSPICE' MASONRY:PAINT GLIDDEN PROFESSIONAL OA1756 E.LF.S.SYSTEM WITH STO,MEDIUM SAND FINISH. LOWER:GLIDDEN PROFESSIONAL A1BC4'BROWN BAG' 5'-0'x 09'4'LIGHTED BUILDING SIGNAGE BY 2J TRASH RECEPTICAL E.I.F.S.REVEAL COLOR TO MATCH: 0 'PEPPER SPICE' COLOR:STO.#NA10-0067-SANDLEWOOD BEIGE'. ALUMINUM STOREFRONT I CURTAIN WALL,PREFINISHED. Q OTHERS OVER FINISHED WALL SURFACE.WALL ® ftA16D4'SROWN BAG' COLOR:KYNAR'BONE WHITE' FINISH CONTINUES BEHIND SIGNAGE. Q BIKE RACK 0 NEW STING STRUCTURE VERSTUD OVER J MASONRY:PAINT GLIDDEN PROFESSIONAL gA1804 E.I.F.S.SYSTEM WITH STO.MEDIUM SAND FINISH. CONCRETE WALLA WITH MEDIUM Q PLANTING AREA'BROWN BAG' OB CoLOR:STO.#NA10L068'SUPER WHITE'. Q METAL COPING,PREFINISHED.COLOR KYNAR'MEDIUM BRONZE' BROOM FINISH.NATURAL COLOR O MASONRY:PAINT GLIDDEN zB SMOKERS POST z E.I.F.S.REVEAL COLOR TO MATCH: PROFE SSIONAL'KOHLS CANVAS' O E.LF.S.SYSTEM WITH STO.MEDIUM SAND FINISH. 19 STEEL EYEBROW(ABOVE( O O A7.S.REVEAL BAG' COLOR:STO.#NAIO.0064*CANVAS'. 0 METAL COPING.PREFINISHED.COLOR:KYNAR*SIERRA TAN' , 5 COLD:STD.ACCENT BANG TUBE STEEL'EYEBROW'WITH POLYUREA COATING SYSTEM.COLOR 20 ROOF LINE BEYOND 0 BUILDING UP LIGHT Q BUS STOP COLOR:$T0.#NA70-0064'CANVAS'. PROTECTIVE COATING SOLUTIONS#PCSE45'OUIET HIDEAWAY' Q METAL COPING,PREFINISHED.COLOR:KYNAR'ALMONO' ze NOT USED ILA Q CHAIN LINK FENCE Q NOT USED O 10' ZV HYANN IS, MA DESIGN ELEVATION-FOR PRESENTATION ONLY NOT FOR CONSTRUCTION q�M4� ^ > DATE:NO ROVED:OB,2012 PAGE 1 STORE N0.:11506 KCHUS DLO LORD 30 42 LAND LORO APPROVED'. SSK-T.O. ax4 APPRov6D: 1� N l TOP OF BLOCK � _ �� a .'S`e^Po" .. ��r`A }ae^& ,Y' � � ,L,4 �.;..;..p t ��.•� ,s"'��Ar�: >.}.,' ,. 0 fL too^o - 3.EXISTING LEFT SIDE ELEVATION(SOUTH) 2 1♦ J Oil- 20 .A� - J2•1)J0 JO Re 5 9 0 Top of RLOLx T� fLP 12F iwVn rvC .,,FlNaN DODR MortgN RNBED Putty 3.LEFT SIDE ELEVATION(SOUTH) aK v 1 -- - �.1� I }---.. --- emAcfNT — _ 'I�. IF 4.EXISTING REAR ELEVATION(WEST) 3 2 •.iv�' r _ ..y a 3 �2 mM m• OHL'0. � l 4 TOP OF BLIN:k - - 4901 E. 15t u, tR51�: Rat 4.EXISTING REAR ELEVATION(WEST) DDCN ADDMON 0 COLOR TOSYSTEM CIp 1743O.OTTUM SAND ER ROOKINISH. E.I.F.S.SYSTEM WITH Q COATING.COLOR:STO#NA1H0.MQUIETHIDEAWAY'D'LOTUSM!' METAL DOOR AND t0i UPPER:G GLIDDEN PROESSIIONAL NA1766"PEPPERSPICE'E,PAINTED © METAL GUTTER&COLOR:KYNAR*SIERRA TAN'. RECYCLING zz RECYCLING TRASH RECEPTICAL 0 PI-1, COLOR EPPER SPICE' MATCH:gA1756 MASONRY:PAINT GLIDDEN PROFESSIONAL#A1758 E.I.F.S.SYSTEM WITH STD.MEDIUM SAND FINISH. LOWER:GLIDDEN PROFESSIONAL#Al 804'BROWN RAG' 5'-0•K 39'-0'LIGHTED BUILDING SIGAGE BY v TRASH RECEPTICAL E.I.F.S.REVEAL COLOR TO MATCH: '+ OTHERS OVER FINISHED WALL SURFACE. 0 pA1804'BROWN RAG 0 'PEPPER SPICE' 0 COLOR:STD.#NA106067'SANDLEWOODBEIGE. COLOR:KMNAR'BONE WHITE'STOREFRONT I VARIANCE WALL,PRE FINISHED. 0 yARIANCE REQUIRED FOR 5'0'SIZE 0 BIKE RACK O NEW EIFS OVER STUD OVER O AOWNRAGPAINT GLIDDEN PROFESSIONAL#A1804 O• SYSTEM STO. MEDIUM PER SAND FINISH. a CONCRETE WALK WITH MEDIUM zs PLANTING AREA E.ISTINGSTRR000G�RE TO MATCH: 0 Q METAL COPING,PREFINISHED.COLOR KYNAR'MEDIUM BRONZE' 0 ERGOM FINISH.NATURAL COLOR 0 SMOKERS POST 3R #A.F.S.REVEAL BAG' MASONRY:PAINT GLIDDEN E.I.F.S.SYSTEM WITH STO.MEDIUM SAND FINISH,PROFESSIONAL*KO HUS CANVAS' COLOR:STD.71NA10-0064'CANVAS*, Q METAL COPING,PREFINISHED.COLOR:KYNAR'SIERRA TAN' Q STEEL EYEBROW(ASOVE( EIFS COLOR AND PATTERN TO » DEMO EXISTING DRY DOCK CCENT BAND T ROOF NE MATCH ISTING LINEAR WALL WASH 0 COLORASTO.NA10-0064'CANVAS'. OD pROT CTTVE COATI G SOLUTIONS#PEL"EYEBROVr WITH RCS645 QUIET HEA COATING IDEAWAW LOR O METAL COPING,PREFINISHED.COLOR:KYNAR'ALMOND' O CHAIN LINK FENCED z# EXISTING BRICK RICK UTILITY BRICK 0 PR POGSSNNAGE TOMATCHT 0 10' 2D• HYAN N IS 1 MA DESIGN ELEVATION P00.PRESENTATION ONLY NOT FOR CONSTRUCTION �.r..a Now umu DATE:NOVOVED:O8,2012 PAGE STOREN0.:11506 LAND 3I 42 lANO LORD APPROVED: SSK-T.O. AHJ APPROVED: 1� lyl •' PRE-FINISH BLACK/WHITE B. .OB3•ALUMINUM RETURNS, (WHRE INSIDE) B THE DRq INO I AS SHOWNEFLUY REVIEWED. HEREBYND REALIZE THAT ANY .t25•ALUMINUM GUSSETS y CHANGES TO THESE DESIGNS MADE BEFORE OR "a AFTER PRODUCTION MAY ALTER THE CONTRACT 1/2•ALUM.NUT x7. '� PRICE ALL CHANGES MUST BE IN WRITING AND WELDED TO SUPPORT q' W 8 APPROVED BY BOTH PARTIES PRIOR TO PRODUCTION. .125•ALUMINUM BACKS,PAINTED 2AP WHITE'INSIDE),SATIN FINISH BUCK(OUTSIDE) SIGNATURE 8 DATE MOUNTING HARDWARE 36'-61/2' WALL CLIP 2 THE CUSTOM ARTWORK DEPICTED HEREIN IS LETTER CLIP B FOR REPRESENTATIONAL PURPOSES ONLY >! AND MAY NOT EXACTLY MATCH THE COLORS ^ g OF THE MATERIALS PROPOSED FOR USAGE EL "C SIGN KS S PRODUCED AT USLED POWER SUPPLY 5' u� IMWR AGF-OR. NFORM TO Ul 48 STAND AND DISPLAY THE in o IAJDERITEARDS RATORlES LABEL. ALL 01817E PRIMARY ELECTRICAL CONNECTIONS BY OTHERS. N24d]PLASKOIITE 'g DATE RETISION OEffBPIION DESIGNER WHITE ACRYLIC FACES 4(NO SEAMS,ONE PIECE) 2.5.13 REVISE PLACEMENT WANT 6.11.19 REVISE QUANTITY WANT INTERNALLY ILLUMINATED CHANNEL LETTER ELEVATION a1s=t'-O' NOTE SEAL ALL PENETRATIONS WITH CLEAR MUCONE SEALANT 3 192.7 SQ.FT. (1)REQUIRED USLED'THE POINT`WHITE MOWLES 2 3 4 U2' 1/2'LIWID TTTE CONDUIT 8' ECT SWITCH BY INSTALLER DISCONNECT F. PRIMARY ELECTRIC IZ WHIPS MOUNTING HARDWARE OUT OF LETTER-3 WIRE,I2 GAUGE 8 WALL CLIP A LETTER CLIP C 14'X 1•I'RETAIIIII 3 PANTED SATIN FW ISH BIApC W L >r a CUSTOMWALLANGLE s 1/4•WEEP HOLE,LOW CLIPS PAINTED SATIN SECTIONS OF LETTER, FINISH BLACK (2)PER LETTER fr LETTER SECTION DETAIL $'s a Y EQ 36'-61/2' EQ s � 7n ® 11048 LEADBETTER ROAD ASHLAND.VA 23005 p PHONE:SM.798.SS33 FAX:B04.798.5582 EN KOHLS 1uNr HYANNIS MA 8 WTIW FS• f1FRRIF JC1NF$ _ ABAVtl3RD F y WAM M9GMx 18113 MrErxvMD NOTED Ilillll 1TAD 0°II KOHLS-HYANNIS-01 rw[Gn FRONT ELEVATION SHOWS PROPOSED SIGNAGE 3/32•=t'-O' s CL 1 R2 roAnxclRwlwu mx NONE- BAXTER NYE ENGINEERING& SURVEYING Registered Professional Engineers and Land Surveyors 78 North Street,31 Floor,Hyannis,MA 02601 TQWN %l AQ$-E7TAW 2 Fax: (508)771-7622 � OCT 181M 1 1; 0 September 27,2013 Mr.Thomas Perry Barnstable Building Commissioner 200 Main Street, I IS l Hyannis,MA 02601 CIVIL SITE PLAN SITE CERTIFICATION PROJECT: Kohl's Department Store,Southwind Plaza,65 Independence Drive,Hyannis,MA Barnstable Site Plan Review#035-12 RE: Civil Engineer-Site Plan Certification I, Matthew Eddy, being a registered Professional Civil Engineer with the firm of BAXTER NYE ENGINEERING & SURVEYING, Registered Professional. Engineers and Land Surveyors, hereby certify that I have supervised the preparation of the Civil Engineering Site Plans and specifications for the above named project and that,to the best of my knowledge,information and belief,such Civil Engineering Site plans and specifications meet the applicable provisions of the Massachusetts Building Code as relevant to the site design, and generally accepted.standards of Civil Engineering practice in effect at the time of performance. As of the.date of this Certification,to the best of my knowledge, information and belief,the work has been substantially performed and completed,with the exceptions noted below,in general accordance with the Site Plan as Approved by the Barnstable Site Plan.Review Committee. This certification is for the purpose of checking for conformance with the design concept and general compliance with the information given in the Approved Civil Engineering Site Plans. It is not to be considered a field control as=built of vertical and horizontal information shown on the Approved Site Plans nor is it to imply daily inspections of site plan related work. The following exceptions.to the Approved Site Plan are noted: 1. One bike rack was installed at the northeasterly corner of the building. The plans noted two bike racks. SH OF Af4 Name Matthew Eddy,P.E. `S7C Registration No.: moo`' MATTHEW yGu, W a Seal E�DDLIVIY n Signature No.43183 SGISTS � S/ONAL Cc: File 0:\2012\2012-030\ADMIN\LETTERS\2012-030 Kohls Site Certification letter.docx Page 1 Land Surveys • Subdivisions • Septic Design • Wetland Filings • Site Design BAXTER NYE ENGINEERING & SURVEYING Registered Professional Engineers and Land Surveyo,, � o 78 North Street,3rd Floor,Hyannis, MA 02601 Tel:(508)771-7502 Fla:(508)771e�P22 September 27 2013 �? Mr.Thomas Perry Barnstable Building Commissioner C" 200 Main Street, r� Hyannis, NIA 02601 CIVIL SITE PLAN SITE CERTIFICATION PROJECT: Kohl's Department Store,Southwind Plaza,65 Independence Drive,Hyannis,NiA Barnstable Site Plan Review#035-12 RE: Civil Engineer—Site Plan Certification 1, Matthew Eddy, being a registered Professional Civil Engineer with the firm of BAXTER NYE ENGINEERING & SURVEYING, Registered Professional Engineers and Land Surveyors, hereby certify that I have supervised the preparation of the Civil Engineering Site Plans and specifications for the above named project and that,to the best of my knowledge, information and belief,such Civil Engineering Site plans and specifications meet the applicable provisions of the ivlassachusetts Building Code as relevant to the site design, and generally accepted standards of Civil Engineering practice in effect at the time.of performance. h As of the date of this Certification,to the best of my knowledge, information and belief,the work has been substantially I performed and completed, with the exceptions noted below, in general accordance with the Site Plan as Approved by the Barnstable Site Plan Review Committee. This certification is for the purpose of checking for confornnance with the design concept and general compliance with the information given in the Approved Civil Engineering Site Plans. It is not to be considered a field control as-built of vertical and horizontal information shown on the Approved Site Plans nor is it to imply daily inspections of site plan related work. The following exceptions to the Approved Site Plan are noted: l. One bike rack was installed at the northeasterly corner of the building. The plans noted two bike racks. ESN OF&N Name Matthew Eddy,P.E. Registration No.: MATTHEW tiGN W. a Seal 4Di COI I� N Signature No.43183 GISTfs��O��� �s$�ONAL Cc: File 0:12012t2012-0301ADrviliN LETrERS12012-030 Kohls Site Certification lettecdoc, Page l Land Surveys e Subdivisions o Septic Design m Wetland Filings e Site Design i PROJECT NAME: ADDRESS: (o,5 PERMIT# 0 6 PERMIT DATE: 3 D 6 Z WP: -D Gl �-- 6 l Spa 1 LARGE ROLLED PLANS ARE IN: BOX ` _ SLOT Data entered in MAPS program on: t 10 BY: q/wpfiles/forms/archive Town of Barnstable Building Department - 200 Main Street * B&ARMW , • Hyannis, MA 02601 MASS 1639. (508) 862-4038 RFD MA'I A Certificate of Occupancy Application Number: 201207070 CO Number: 20130101 Parcel ID: 295015XO2 CO Issue Date: 09/13113 Location: 65 INDEPENDENCE DRIVE Zoning Classification: SPLIT ZONING Proposed Use: SHOPPING CENTER - MALL Village: HYANNIS Gen Contractor: SCHIMENTI CONSTRUCTION COMPANY Permit Type: CC00 CERTIFICATE OF OCCUPANCY COMM Comments: V� Building Department Signature Date Signed TOWN OF BARNSTABLE soft on.. e O� �� .. 200MA 2 0'70;*' 7U U buttaing * Issue Date: 11/27/12 V i 9 MASS. 16 Applicant i°T�p A Permit Number: B 20122886 Proposed Use: SHOPPING CENTER MAIL { _ Expiration Date: 05/27/13 Location 65 INDEPENDENCE DRIVE Zoning District SPLTPermit Type: SPECIAL PROJECT ADD/ALTER.COMM Map Parcel 295015X02 Permit Fee$ 30,030.00 Contractor SCHIMENTI CONSTRUCTION COMPANY'. Village- HYANNIS App Fee$ 100.00 License Num 048064 Est Construction Cost$ 3,300,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND TENANT IMPROVEMENT.FOR A DEPARTMENT STORE(KOHL'S) THIS CARD MUST BE KEPT POSTED UNTIL FINAL A LOADING DOCK ADDIITON-REFERENCE SKEET TI INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH .- . Owner on Record: OCW RETAIL HYANNIS LLC BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: ATTN: STEPHANIE WARD INSPECTION HAS BEEN MADE. 'a 800 BOYLSTON ST,STE 1300 BOSTON,MA 02199 Application Entered by. PF Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY SIREEr,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PELIMANENTLY. FNCROA ON PUBLIC PROPERTY,N SPECIFICALLY PERMITTED UNDER THE BUILDING CODE MUST BE APPROVED BY THE JURISDICTION. STREET OF ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE 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 FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6-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.I42A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPRJVALS ELECTRICAL R SPEC i ION APPROVALS 21 2 Z 3. 1 Heating Inspection Approvals Engineering Dept Fire Dept AntAlm'RUQ— 2 Board of Health l-7� --1 � t TOWN OF BARNSTABLE Building " 201302673 BARNS'PABLE, I Issue Date: 05/01/13 Permit 9 MASS. 16 N19.P't A�� Applicant: S&B MECHANICAL Permit Number: B 20130961 Proposed Use: SHOPPING CENTER-MALL Expiration Date: [Location 65 INDEPENDENCE DRIVE Zoning District SPLTPennit Type: SHEET METAL COMMERCIAL Map Parcel 295015X02 Permit Fee$ 160.00 Contractor S&B MECHANICAL Village HYANNIS App Fee$ License Num 2714 Est Construction Cost$ 120,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND FURNISH AND INSTALL 6 FULL SHEET METAL DUCT SYSTEM WITH THIS CARD MUST BE KEPT POSTED UNTIL FINAL FINISHED REGISTERS,INSTALL 4 EXHAUST FANS WITH DUCT WORK INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: OCW RETAIL HYANNIS LLG BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: ATTN: STEPHANIE WARD INSPECTION EN MADE. 800 BO STE 1300 BOSTON,MA MA 0219199 Lic G� Application Entered by: PF Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY.,ENCROACHMENTS ON PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE'BUILDING CODE,MUST BE.APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION'OF PUBLIC SEWERS MAYBE 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). 141 yys 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 TOWN OF-BAR[ Zj!k@LE fiduBu' ng ®� 01300574 I1MNS-14,13M Issue Date: OV25/13 Permo MASS. 9. Applicant: SCHIMENTI CONSTRUCTION COMPANY Permit Number:- B 20130200 Proposed Use: SHOPPING CENTER-MALL Expiration Date: 07/25II3 [Location 65 INDEPENDENCE DRIVE Zoning District SPLTPennit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 295015%02 Permit Fee$ .00 Contractor SCHIMENTI CONSTRUCTION COMPANY Village HYANNIIS App Fee$ 100.00 License Num 048064 Est Construction Cost$ 0 Remarks 1i APPROVED PLAINS[!LUST BE RETAINED ON,JOB AND INTERIOR DEMO PERMIT,PARTITIONS AND CEILING DEMOLITION T�i�BARD ivt[�g-r BE KEPT PcysTEiy UNT q� ►L TO ACCOMPANY PERMIT 201207070 _ _ J INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record OCIN RETAIL HYANNIS LLC BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: ATTN: STEPHANIE WARD INSPECTION HAS BEEN MADE. 800 BOYLSTON ST,STE 13DO BOSTON,lei 02199 / Application Entered by. TP Building Permit Issued By: -..-- THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF.ETHER TEMPORARILY OR PFRMANUTTLY. ENCROACt MEM O_N PUBLIC PROPERTY,NO SPECEFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WEL.LAS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THEDEPARTMBffOF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOTRELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS, MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). 5.INSULATION. 6.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. PERWI`WILL BECOME NULL AND VOID IF CONSTRUCTION WORD IS NOT STARTED VMIHN 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). y s s tfi r rr sky xtc $-:r x�; r' Itxi 14( •+ a� c r is ert 9 + n.II BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 �v�G ff Ul�"Ja�eG'Rvvlo, s`/> 13 I ��(JZr/f 60" / S C G 3 1 Heating Inspection Approvals Engineering Dept fiw*I' 06 Fire Dept 2 Board of Health Town of Barnstable Building Department - 200 Main Street * , STABLE. * Hyannis, MA 02601 MASS s639- . (508) 862-4038 Certificate of Occupancy Temporary Application 201207070 CO Number: 20130087 Parcel ID: 295015X02 CO Issue Date: 08/15/13 Location: 65 INDEPENDENCE DRIVE Zoning Classification: SPLIT ZONING Owner: ,- OCW RETAIL HYANNIS LLC Proposed Use: SHOPPING CENTER - MALL ATTN: STEPHANIE WARD 800 BOYLSTON ST, STE 1300 Village: HYANNIS BOSTON, MA 02199 Gen Contractor: SCHIMENTI CONSTRUCTION COMPANY Permit Type: CTCO COMM TEMPORARY CO Comments: TEMP C.O. FOR MERCHANDISE ONLY 30 DAYS ONLY EXPIRES 9115/2013 Building Department Sig/ature Date Signed Expiration Date PROJECT II ww c NAlY1E: •�.Y)I ADDRESS: �b4A-VXvj L5 PERAgT# d laC7�0�C7 PERMIT DATE: l M/P: CD (�� �Z : LARGE ROLLED PLANS ARE IN: ]BOX SLOT Data entered in MAPS program On: BY: AA),vi S Commonwealth of Massachusetts q�� VA heetMetal Permit Ma Parcel , Date: Permit it 40 l� I Estimated Job Cost: $ Permit Fee: $ ®~� Plans Submitted: YES ���Xo Plans Reviewed: YES NO Business License# Applicant License Business Information: Property Owner/Job Location Information: Name: �� � /�A�' �ICa � Name: Street: L j�tF lANO, I Street: o City/Town: �Bn _ 14 City/Town: IT�1r) Telephone: _ (q 7q 06 01; Telephone: how, 7 Photo I.D. required/Copy of Photo I.D. attached: YESNO J-1/M-1-unrestricted license J-2/M-2-restricted to dwelling; 3-stories or less and commercial up to 10,000*1q.4 Residential: 1-2 family Multi-family Condo/Townhouses ANl 9 � - y X3 Commercial: Offic Retail-L industrial Edu ational - 'r6W O 9 Fire Dept. A r X Institational_ Other 4RNSTABLE Square Footage: under 10,000 sq. ft. over 10,000 sq. ft umber of Stories: Sheet metal work to be completed: New Work: Renovation: HVAC Metal Watershed Roofing Kitchen Exhaust System Metal Chimney/Vents Air Balancing' Provide detailed description of work to be done: - t "� in \ �41 f S�� A tv� �:� .. c NSURANCE COVERAGE: have a current liability insurance policy or its equivalent which meets the requirements of M.G.L. Ch. 112 Yes do ❑ f you have checked Yes, indicate the'type of coverage by checking the appropriate box below: k liability insurance policy � Other type of indemnity ❑ Bond 0 )WNER'S INSURANCE WAIVER:1 am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Assachusetts General Laws,and that my signature on this permit application waives this requirement ' Check One Only Owner ❑ Agent ❑ Signature of Owner or Owner's Agent y checking this box[:], I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and ccurate to the best of my knowledge and that all sheet metal work and installations performed under the pe`mit issued for this application will be i compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prioi to insulation installation: YES NO Progress IIlSDections Date Comments t Final Inspection Date -Comments Type of License: Master f le ❑ Master-Restricted y/Town ❑Joumeyperson ` Signature of Licensee rmit# ❑Joumeyperson-Restricted License Number. 271Y Check at www.mass.0ov1dp1 pector Signature of Permit Approval Fully Insured o S&B MECHANICAL 110 Elm Street, Unit#1 Lic. No. 21268 Bridgewater, MA 02324 Tel: 508-279-0606 • Fax: 508-279-0607 www.sbhvac.com COMMONWEALTH OF MASSACHUSETTs COIViMONWEALTH OF MASSACHUSETTS' SHEET VETAL VIORKERS AS A QSINF ;S SHEET METAL WORKERS ;SSilESTHE ABOVE[!CENSE TO: AS A MASTER-UNRESTRICTED ISSUES THE ABOVE LICENSE TO: pAUL C BOWEti - IPAUL C 'BOWES . S AND B. MEC4ANICAL.. , 110 ELM ST J. UNIT 1... 14 :FIRST AVE BRIDGEWATER MA 02324-000'0 LAKEVILLE MA 02347,.2324 510 03/23/ 4 159002 2714 03/28/14 141362 1 } Ss�B MECHANICAL Fully Insured = =; � aA Heating Air Conditioning Sheet Metal Systems Service & Maintenance r� HE ' Town of Barnstable } ; Reg Moir Services t HAR1VrTARTP ♦ ✓ �+ �PAAFM Thomas F.Gefier,Director i639. �4+� p Building Division Tom Perry,Binding Commissioner 200 Main Street;Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Usifig A.Builder as et of the subject ptopetty heteby authorize ( "FEC to act on mp behalf, in all matters telatLV'e to work atffiadzed by this building permit, - - (ICJ �h��e e�1��✓t C � ��` _ (A.ddtess of Job) **Pool fences and alatms are the responsibili f the tY o e applicant. Pools are not-to be filled-before fence is installed and pools are not to be Utilized until all ftnl inspections are performed and accepted.. S e CvnerSignature of Applicant hs Print Name Print Name � z/O � � ate Q:FORM5:0 WNEPJ E RMMSIONPOOLS . II . . ..E Town of Barnstable ti Regulatory Services AAANRTAA7_,Y. . Thomas F.Gefler,Director Hal 16 3i",�� Building Division Tom Perry,Balding Commissioner 200 Main Street, Hyannis,Na 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE:- JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAII.WG ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as suiperyisor. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling,attached or detached structures accessory to such use and/or fame structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a fowl acceptable to the Building Official,that he/she shall be responsible for 0 such work pefformed under the birildina permit (Section 109.1.1) The undersigned"homeowner"assinnes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner'certifies that he/she understands the Town of Barnstable Balding Department •mini�1m inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner i Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction ControL , HOMEOWNER'S EXEMPTION The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,'that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q, Rules&Regulations for Licensing Construction Supervisors,Section 2.15).This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her rrsponsrbt7ities,many communities require,as part of the permit application, that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may cars t amend and adopt such a foma/eerfification for use in your corrnnunity. Q:forms_ham=crrrpt Tie Commonwealth o.f Massachusefts Departmemf of-TndusMd A=denis Q ffice of Invesfigations- •600 Washington Street, Boston,MA 02111 www-M=s-gov/dia Workers' Compensation hLmrknce Affidavit; Buffders/Contmztors/Electricians/Plumbers A-ppIicant Information Please Print Le�bly Name( s/Orm*+/F�iyi�+a�: ��t� •�,c� �' Address: 1I� �( s� uA ! Cr1Y/Sta#eJZip: �►f� ia/ M��32y Phone.#: .; -CY0,-06 i7eaan employer? Check file appropn�bay hype� ect(requtz e 1. a employer with -4. [] I am a general c�ctar a d I � employees(fan and/or part tie).* have hired the sob=cnxftachms 6 ew csrstrnciion . 2.❑ I am a'sole gioprietar orpariner- listed on the-aftached sheet 7. []R.emodelmg ship and have no employees 'These sub-cam have g Demolitim Wanking far me iff any capacity, employe6s•and have Warms' t�,,,��;. [Na workers' Comp,inenranrF. Cam•Inset- ce,$ 9. S addition regained.] 5. []'We are a carporattnn andifs 10.0 Electrical repairs cc adTrtions 3.❑ I am a homeowner doing in•Work officers have em=isea their 11.❑Phmi:drg repairs a' addiLm myself [No workers' comp. right of exemption per M L 12 Roofrepairs fim once regciLed.J t c.152, §1(4), and we have no . employees. [No Wa:3a a' 13.[] Other M=-in�regmred.J *Amy applic�t timt chinks bar#1 must also M oat the section below showing fei v aacas' Policy t Homeawness who snbmit�is aindavit' ca�� ��' are doing all work and tten hum oaLside contractors mastsuba�anew afdavitindimittog such. $Centactms flat check this bar=st attached sa additional sheet showIDg the name of the sub-contractors and sty whether ornot those eatitia have employ— g f--b-Wntracfnrs have-33pky-s,fCP maztFovidr&es wort='c¢mp.poll ynnmbM : I am an employer that is pro`;du g'workers'compensation insurance for my employees Below is tke policy and job site inform adore. InsIzza P Campany Name: ca ---------------- Policy#ar Self-.ins.Lic.# qo..q`T" -dam Expaad=Date: Job Site Address: C!1 CAY/St&&#: t -ial:ll a copy of the workers' compensation policy declara an page'(showiug the policy number and ezpa•alion date). FaEnn.to.secum covemp as regmrednnder Sectim25A ofMQ,G. 152 can lead to the ' ositian of�ua1 fete up is $1,500.00 and/or one- ar p � . penalties of'a ye =q= m =4 as wen as civ11 malfi:s in the�of a STOP WORK ORDER and a fm of'up to S250.00 a day against th;violafoz Be advised tip a copy of this sf t=mm t map be Erwarded to the C)fEice of hmesti>?3fiagas of the WA for inssn=ce ye[ifrrai;r,r, I do hereby e e pairs-and penalties of'perjwy that the information prgvided aiiove is Prue aril correct Date: Phone#` — p �:d use on£y, Do not write pc tlza a1 ea, tb be Iefed by city or town affzriaL ' City or Town: , PerMWLicense# •Iss�g Ai:dhadty(c rde one): L Board of Health.2.Buffdiiig Department 3.Chy/Town C3erk 4.Electrical Inspector 5.Plmnbing Inspector 6.Other Cont act Person: Phone A { 04/25/2013 11 : 41 : 40 AM 507-455-5200 Page 4 I �1 A� CERTIFICATE F LIABILITY N �� 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 lueu of such endorsement(s), PRODUCERh2h'EAcl CLIENT CONTACT CENTER FEDERATED MUTUAL INSURANCE COMPANY �{o HOME OFFICE:P.O.BOX 328 IUCN xt: -333-494 07-446-4664 OWATONNA,MN 55060 E- I •CLIENTCONTACTCENTER FEDIN .0 M INSURER(S)AFFORDING INSURERA:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 290-918-2 INSURER B: S&B MECHANICAL INSURER C: 110 ELM ST#1 BRIDGEWATER,MA 02324 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:152 REVISION NUMBER:0 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. 29- TYPE OF INSURANCE D POLICY NUMBER (AWFni M&M LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $� RE IS Ea ccur CLAIMS-MADE X OCCUR MED EXP(Any one person) A X BUSINESS OWNER'S LIABILITY N N 9392612 06/01/2012 06/01/2013 PERSONAL&ADV INJURY $1,000,000 GENERALAGGREGATE $2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PROT LOG AUTOMOBILE LIABILITY MBINE0 SINGLE LIMIT $1,000,000 acc ANY AUTO BODILY INJURY(Per person) ALL OWNED AO N N 9392613 06/01/2012 06/01/2013 BODILY INJURY(Per accident) X HIRED AUTOS X NON-OWNED DAMAGE AUTOS a acci X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $5,000.000 A EXCESS LIAR CLAIMS-MADE N N 9392615 06/0112012 06/01/2013 AGGREGATE $5,000.000 DIED I I RETENTION gg H WORKERS COMPENSATION X C TATU. OER AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE E.L.EACH ACCIDENT SK0,000 A OFFICER/MEMBER EXCLUDED? N I N 9392614 06/01/2012 06/01/2013 E.L.DISEASE-EA EMPLOYEE (Mandalory in NH) $500.000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L DISEASE-POLICY LIMIT $500,000 DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(Attach ACORD 10f,Additional Remarks Schedule,it more space Is required) CERTIFICATE HOLDER CANCELLATION 290-918-2 1520 CITY OF HYANNIS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 367 MAIN ST. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HYANNIS,MA 02601-3919 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988.2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 6 7 Parcel Application # Health Division Date Issued Conservation Division Application Fee y Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address bg Tn�wen�tnc,& DrI V6 , hhoofs )AA 02-60 I Village 800 L'�.oy��n S+ree,-f Suc+e, 1300, Owner h& (A )w Com gams Address r3os60. AAA 07-0q Telephone C' .17� _.�I 7- C1200 Permit Request Daw 4lon Pe rn4f, i4er for PoL4410 n S an .1 1 i A �Jp-mo 5539` Square feet: 1 st floor: existing proposed 1.5Z4 2nd floor. existing proposed A Total new 56 I 54-,R Zoning District SPLIT IN ID-1 146' Flood Plain Groundwater Overlay Project Valuation 1)du&v)in Construction Type C0rbrne('G1'a �P/)era ,� nq trnni� Lot Size �.S �4�re.5 Grandfathered: ❑Yes No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) 17 Historic House: Y N N n 1 Kin Highway: ❑Y ® N Age of Existing Structure r H sto c ouse es o 0 Old g ses o 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: A Gas ❑ Oil fA Electric ❑ Other Central Air: A 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 Sob;o_4i Ccn54r-uc,+io() CO. Telephone Number (91A� ?-A 0hoo Address (050 anbur RoosA License # C S - © '9CrO nn iCJ 0foj`7-7 Home Improvement Contractor# 16 Worker's Compensation # VT ROO Q-BZOSA 7-9-0-12 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 01 JZ14 A0I S r } FOR OFFICIAL USE ONLY 'APPLICATION# ( DATE ISSUED 1 MAP/PARCEL NO. r' , ADDRESS VILLAGE.- OWNER ` DATE OF INSPECTION: T FOUNDATION FRAME INSULATION FIREPLACE r ELECTRICAL: ROUGH - FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` � l FINAL BUILDING r s , s DATE CLOSED OUT ASSOCIATION PLAN NO. ': Massachusetts Department of Environmental Protection Bureau of Waste"Prevention . Air Quality 100164113 Decal Number Notification Prior to Construction or Demolition lWhen filli�ngout 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-donor 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. 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?. N Yes r_ i No I.Al!sections of b. Provide blanket decal number.if applicable:this form must be Blanket Decal Number .�. _..� completed in order to comply vAth the 2. Facility Information: Department of . ....... Environmental KOHL'S DEPARTMENT STORE#11506 Protection a.Name notification 165 INDEPENDENCE DRIVE requirements of i '�"" "- b.Address 310 CMR 7.09 ....__._...,....�.-....__.____. _ , . .. :..��._._., :Hyannis WA 102601 d.State._ _ e_Z l(262)703.0000 9.Telephone Number{area,code and extension) Mpw E mail.Address optional) 55,386 ! 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: PRIOR USE -STOP &SHOP GROCERY..,_........ s RY STORE f. Is.the facility a residential facility? Yes E✓? No ,, m. If yes, how many units? Number of Units 3. Facility Owner: THE WILDER COMPANY l a.Name 1800 BOYLSON STREET, SUITE 1300 b.Address _........ ..__.___„ .__:._.._ ..,,......M,. BOSTON _ i MA 021.99 _., 1(617)247 9200 f.Telephone Number_{area code and extensionf,_„ grF,ma�l Address optionalt_ ___ .__„ _ _ E SANDY LAGREGA ® F h.pnsite Manager Name ag06.doc 10102 BWP AQ 06•Page.1 of 3 Massachusetts Department of Environmental Protection R Bureau of Waste Prevention - Air Quality 1100164113 Decal Number Notification Prior to Construction or Demolition General Statement:If B. General Project Description (cont. asbestosis found during a 4, General Contractor: Construction or Demolition 1SCHIMENTI CONSTRUCTION COMPANY operation,all responsible_parties ?.Name .. ... :_ must comply with 1650 DANBURY ROAD b.Address 7.09,7.15,and _ Chapter 21E of the aRIDGEFIELD W._. _____...,,.__..� ,GT �) 106877 General Laws of C.Citvfrown ,__ ___,_--_-._._ d State _ e Zip Code the Commonwealth. (914)244 9100 ___ i gcolonnese@schtmentt com This would include, ne - -. �._..__..._.. but would not be f.Telephone Number(area code and extension _ q.E-mail Address_ optional) limited to,filing an ;JOHN COLONNESE asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. 1SCHIMENTI CONSTRUCTION COMPANY a.Name 1650 DANBURY ROAD .i b.Address RIDGEFIELD __ ._ [06877 c CtylTown _ d State e Zip Code [(914)244-9100 tshockley@schimentt com _._ E f.7e�hone Number(area code and extension) g E maU Address(optional _. ITHOMAS SHOCK,LEY 'h.On-site Manager Name "-—" 2. On-Site Supervisor: ITHOMAS SHOCKLEY ___.._....._,.. _............... ..._..__._.......__-__ __ __,._... _.. On-Site Supervisor Name 3. Is the entire facility to be demolished? E Yes ✓✓ No ® 4. Describe the area(s)to be,demolished: ._.. z_ INTERIOR PARTITIONS AND CEILING DEMOLITION I 5. If this is a construction project, describe the building(s) or addition(s)to be constructed: ;ADDITION OF A 1524 SQ FT LOADING DOCK l l 0 .-......_........ _tea...,.« ...... ..-......�_....._._-_.........._,—•—__—�—....-r-r+ ..-,..„„„..,,nr n.n.ro-.... __—....�.�...................-.....>,.,,., ..........f.� ag06.doc•10/02 BWP AO 06-Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality (1U0164113 i � Decal Number BWVVP 06 Notification Prior to Construction or Demolition C. General Construction or Demolition Description (coat.) 6.. a. If this is a demolition project, were the structure(s)surveyed for the presence of asbestos containing material(ACM)? I Yes ✓j No If yes, who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: ?0311512013 — 0910112013�_.. a,Start Date'(mmlddlyyyy) b.End Date(mmJddlyyyy) S. a. For demolition and construction projects, indicate dust suppression techniques to be used: ing aving wetting ,J shrouding b. If other, leasespecify: ^^_ { P covering i✓f other NA-[NTERlOR DEMO ONLY 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? _.._ a.Name of DEP Official'---- b.Title c.Date(Ei d/vyy}of Authorization - _ d.DEP Waiver Number i D. Certification I certify that I have examined the JOHN J COLONNESE . above and that to the best of my a.Print Name knowledge it is true and complete. ® The signature-below subjects the 6.Auit,oiized signature ® signer to the general statutes PROJECT EXECUTIVE regarding afalse and misleading g 9 9 c:Positii?ii)•I`rt�e•"_.__._ _. ®o statement(s). SCHIMENTI CONSTRUCTION COMPANY ® d.Representing 1�o S- e:Date(mmidd%.._.'.._ ....___W:.� -.._....._ : YYYY) ®r-x ®m® ag06.doc-10/02 BWP AQ 06•Page 3.of 3 eDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact i Feedback I Tour i Privacy Policy MassDEP's Online Filing System Usemame:SCHIMENTICT Nickname:SCHIMENTW My eDEP Forms sm My Profile lm'Help [Receipt Forms Signature Receipt Summary/Receipt 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: 519574 Date and Time Submitted: 11/13/2012 9:42:19 AM Other Email : Form Name: AQ 06-Construction/Demolition Notification Payment Information DEP code: 76261 Date: 11/13/2012 9:41:39 AM Amount($): 85 Payment Detail: COLONNESE JOHN—AccountType—AccountNumber '1148 ConfirmationNumber: Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab My eDEP MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.11.9.0.00 2011 MassDEP httns://eden.den.macs_gnv/Pagec/PrintRereint.ncny 11 A Page 1 of 2 Kristen Corbi From: John Colonnese Sent: Thursday,January 24,2013 11:00 AM To: Kristen Corbi Cc: Patrick Moughty Subject: FW:Hyannis-Demolition permit Follow Up Flag:Follow up Flag Status: Red Kristen, Here is your approval for the demo permit check. John Colonnese,Project Executive CORPORATE HEADQUARTERS 650 Danbury Road Ridgefield,Connecticut 06877 t 336.859.9802 1 f 336.859.05T 720 Fifth Avenue New York,New York 10019 t 212.246.9100 I f 212.246.91 C3 This email and its attachments may be confidential and are intended soley for the use of the individual to whom it is addressed.Any views Schimenti Construction Company.If you are not the intended recipient of this email and its attachments,you must take no action based up, you have received this email in error. .._..............__._................__.............._._...._........................__...............__...._.................._......................................._.._........................................................................................:........._.......................................................... From:Gary Bohn[mailto:gary.bohn@koh[s.com] Sent:Thursday,January 24,2013 10:48 AM To:John Colonnese Subject:Re: Hyannis-Demolition permit Buy it. From:John Colonnese[mailto:]Colonnese(o)schimenti.com] Sent:Thursday,January 24,2013 10:20 AM To:'Gary Bohn'<gary.bohn(d)kohls.com> Subject: Hyannis-Demolition permit Gary, The Town of Barnstable is asking for a separate demo permit for the Hyannis project. The fee is$100.00. Can you confirm that we can pay this fee, and submit for reimbursement for this cost. Thank you, John John Colonnese, Project Executive CORPORATE HEADQUARTERS 650 Danbury Road XI Ridgefield,Connecticut 06877 t 336.859.9802 1 f 336.859.0576 720 Fifth Avenue New York,New York 10019 t 212.246.9100 1 f 212246.9103 - 1/24/2013 LETTER OF TRANSMITTAL consiraction Company TO: Town of Barnstable JOB NUMBER DATE Building Division 13-021 �24 January, 2013 200 Main Street ATTENTION Hyannis, Massachusetts 02601 Building Division Re: Kohl's Department Stores, Inc. #13-021 Hyannis ,MA Take Over WE ARE SENDING you the following items: ❑Shop Drawings 0 Prints ❑� Plans ❑Samples ❑Under separate cover via: ❑Copy of letter ❑Change Order ❑Specifications ❑Other •0 ® e".g 1 1/24/2013 Town of Barnstable Building Permit Application -Demolition 1 1/24/2013 Massachusetts Department of Environmental Protection BWP AQ 06 1 1/24/2012 Check for$100.00 Demolition Permit Fee ❑For your approval ❑Approved as submitted ❑Resubmit ❑Copies for approval I For your use ❑Approved as noted ❑Submit ❑Copies for distribution ❑As requested ❑Returned for corrections ❑Return ❑Corrected prints ❑For review/Comment ❑Other REMARKS: N/A Thank you, Kristen Corbi Project Coordinator kcorbi _schimenti.com 650 Danbury Road Ridgefield, CT 06877 914-244-9100 *914-244-9103 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION DLOP Map Parcel Application # Health Division ^ IZ Date Issued �� 1 �— Conservation Division0 ®� Application Fee P Planning Dept. Permit Fee.3 030 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address lw2 0 Village Owner CQA*PA+V�( Address Y99 NbyL5z001 S7, StAkrF— /,31D0 Telephone fv 1`7 - Z LI-7 41Z,00 Permit Request T IF54A., I-r f A4P2oV?---Mrr,117 F;PkZ A, srr,o i,.�i 7�-t g4. Lc /�/!�+ DtyC.K ADP-1 riaNJ , C, aG soye-r Square feet: 1 st floor: existing s' $proposed 56 3 2nd floor: existing 0/^-proposed A Total new i�SZL?SF Zoning District 14 P Flood Plain G Groundwater Overlay Project Valuation,3'3� Construction Type Lot Size 5,`4 � x� �`� Grandfathered: ❑Yes �No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ;KNo On Old King's Highway: ❑Yes YNo Basement Type: 36 Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.)ph" Basement Unfinished Area(sq.ft) �Ja 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 �"o Fireplaces: Existing New Existing wood/ oal stove-❑es ❑ No --a UJ Detached garage: Ll existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑mew,"size_ 'Ili m 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 M-rAI Proposed Use Aa^1 R r--1A1 L APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name SCh r M E,41 Cow,i T �~ Telephone Number a6 3- Address !o Sa !fie-j u-�, License# C-S Sc -T IJ cl T 66 c Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE Ail& DATE 10, 0 Ia E FOR OFFICIAL USE ONLY ,APPLICATION# - DATE ISSUED MAP/PARCEL NO. t ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f DATE CLOSED OUT ASSOCIATION PLAN NO. s Departmext of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information n PIease Print Legibly Name(Business/Organization/tn&vidua): :5 C}1 1 W f a t 1 C O N b;2uc►/o.J ..Address: '0 .f) City/State/Zip: �I�G4FI .?�. .Gr D(�S`1 Phone.#: Lil ``��. Are you an employer? Check-the appropriate box: :Type of project(required);- 1.❑ I am a e to er with' 4. I am a general contt actor and I mP ;Y _ 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 g• ❑Demolition worldng for me in any P ca acn3'• employees and have workers' $. 9. ❑Building addition [No workers' comp. insurance camp.insurance. required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am i homeowner doing all work officers have exercised their M❑Plumbing repairs or additions myself, [No workers'comp. right of exemption,per MGL 12.❑Roof repairs insurance:required.]t C. 152, §1(4),and we have no employees.[No workers' 13.❑ Other comp•insurance required.]----------------- - *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation,policy information. t Homeowners who submit this 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.poIicy number. I am an employer that is providing workers'compensation insurance far my employees. Below is thepolicy and job site information. Insurance Company Name: / p 11 2� a 'Z C ! qi 3 Policy#or Self ins.Lic V# V Z,.K V 3 � ?�' 1 Expiration Date: z Job Site Address: blr City/State/Zip;�AVA-1 AJ15 r o �O 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 DIA for insurance coverage verification- I do hereby certify under the pains•and:pe es of erjury that the information provided above is true and correct Si afore: Date: Phone# Official use only. Do not write in this area,to be completed by;city or town ofj`-trial 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#: M AC" CERTIFICATE OF LIABILITY INSURANCE D /DD/YYYY) 11/5/i5i2o12 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). CONT PRODUCER IAMP CT Robert Kesten Kesten-Brown Insurance, LLC IM .PHONNo.E ,C No: 277 Fairfield Ave - 3rd FL E-MAI ADLDRESS:RKesten@kbiins.com INSURERS AFFORDING COVERAGE NAIC# Bridgeport CT 06604 INSURERA:Travelers P & C Co of America 25674 INSURED INSURER B RLI Insurance Company 13056 Schimenti Construction Company, LLC INSURERC:Charter Oak Fire Insurance Co 25615 650 Danbury Road INSURER D:St. Paul Fire & Marine Ins Co. 47 67 Ridgefield CT 06877 INSURERE:Travelers Indemnity Co of 5666 :J (914)244-9100 1 INSURERF: COVERAGES CERTIFICATE NUMBER:6/29/12-13 Master Renewal 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 I TYPE OF INSURANCE ADDL SUBR POLICPOLICY NUMBER MM DDY/YYYY MM/DD/YYYY LIMITS LTR N GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 300 000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ A CLAIMS-MADE OCCUR C2J-CO-8205A277-TIL-12 6/29/2012 6/29/2013 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY EOMa.,d.nl)BINED SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED SCHEDULED J-CAP-8205A308-TIL-12 6/29/2012 6/29/2013 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident i INY Motor veh law enforcement $ B UMBRELLA LIAB I X OCCUR (Lead) RXL0261632 6/29/2012 6/29/2013 EACH OCCURRENCE $ 5,000,000 D tl) CESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 RETENTION$ (Excess)ZUP-10S8350912NF 6/29/2012 6/29/2013 Each Loss/Agg. $ $5MM/$5MM C WORKERS COMPENSATION ROUB-8205A29-0-12 6/29/2012 6/29/2013 X WC STATUS OTH- AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE NIA (NY, & NJ) E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? C2HUB-8205A28-9-12 6/29/2012 6/29/2013 I (Mandatory in NH) E.L.DISEASE-EA EMPLOYEq $ 1,000,000 If yes,describe under (Other States) E.L.DISEASE-POLICY LIMIT 1 $ 1,000,000 DESCRIPTION OF OPERATIONS below A Contractors Leased/Rented T-660-222D4267-TIL-12 6/29/2012 6/29/2013 $150,000 Per Item Limit/ Equipment/Statutory NYDBL First Rehab-NY DBL #93586 /1/2012 12/31/2012 Max Total$500,000,$,1000Ded DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: Job #13-003, Kohl's New Store, 65 Independence Drive, Hyannis, MA 02601, Town of Barnstable is included as additional insured with respect to General Liability as required by written contract. I 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. Town of Barnstable 200 Main Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 Robert Kesten/JPP ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. IN9025 r?ntnnsi ni Tha Arr on nnmc nnA Innn arc rania+—A mar4c of Ar_n0r`1 Schiff][MMI&I Construction Company Town of Barnstable Building Division of the Regulatory Services Department 200 Main Street Hyannis,Massachusetts 02601 Attention: Thomas Perry RE: Building Department General Liability Insurance Subcontractor Contact List To Whom It May Concern, Enclosed please find the Building Department General Liability Insurance for the ground up Kohl's Department Store that will be located at 650 Independence Drive in Hyannis, Massachusetts. Construction is tentatively scheduled to begin in mid March of 2013. As construction is currently four months from commencement, Subcontractors have not yet been selected. As soon as all trades have been selected the required list of subcontractors along with their contact.information will be forwarded to your office as well as the Department of Industrial Accidents, Office of Investigations. Any questions or concerns regarding the Kohl's Department Store project in Hyannis, MA can be directed to the Senior Project Manager,John Colonnese. His contact information is as follows; IColonnese@Schimenti.com (336) 959-9802(Office) (914)755-0495 (Cell) Regards, Kristen L. Corbi Project Coordinator 650 Danbury Road,Ridgefield,Connecticut 06877,914-244-9100;914-244-9104 fax f^ Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 10016411Ll BWP AQ 06 Decal Number Notification Prior to Construction or Demolition Important: A. Applicability When filling out `r 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 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. 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?0 Yes Z No i 1.All sections of b. Provide blanket decal number if applicable: E _.a this form must be Blanket Decal Number completed in order to comply with the 2. Facility Information: Department of KOHL'S DEPARTMENT STORE#11506 Environmental _ Protection a.Name notification 651NDEPENDENCE DRIVE requirements of b.Address 310 CMR 7.09 H annis _ w MA 02601 j c.Cit /Town d.State e.Zip Code (262) 703-0000 I f.T ele hone Number area code and extension .E-mail Address o tional 53861.1 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? Yes [V] No k. Describe the current or prior use of the facility: PRIOR USE -STOP &SHOP GROCERY STORE I. Is the facility a residential facility? 12 Yes EVj No �. m. If yes, how many units? Number of Units e� 3. Facility Owner: ® THE WILDER COMPANY ._....._.__. ...._.____..._..._.�_.�.. ... .........��.. _._�..__ ..._..............., a.Name _ 800 BOYLSON STREET, SUITE 1300 w mm ~ +WT w ® b.Address BOSTON �� MA � 02199 =®^ c. i /Town (617)247-9200 _ f.Tele hone Number(area code and extension __..._ ._ _.... , _-_�_,_,__ r a.E mail Address o tp iona� e,_ ANDY LAGREGA_ h.Onsite Manager Name ® ag06.doc•10/02 BWP AQ 06•Page 1 of 3 Massachusetts Department of Environmental Protection Ll 100164113Bureau of Waste Prevention • Air Quality ____�Decal Number BWP AQ 06 ......_... Notification Prior to Construction or Demolition General B. General Project Description (cont.)Statement: If � p ( asbestos is found during a Construction or 4. General Contractor: Demolition SCHIMENTI CONSTRUCTION COMPANY j operation,all responsible parties a.Name must comply with 1650 DANBURY ROAD 310 CMR 7.00, b.Address 7.09,7:15,and RIDGEFIELD � � CT 0687 Chapter 21 E of the General Laws of c.Cit./Town d.State e.Zip Code the Commonwealth. (914) 244-9100 jcolonnese@schimenti.com This would include, but would not be f.Tele hone Number area code and extension_ E-mail Address o tional limited to,filing an IJOHN COLONNESE asbestos removal h.On-site Manager Name ® notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. SCHIMENTI CONSTRUCTION COMPANY m. a.Name 650 DANBURY ROAD � � b.Address - RIDGEFIELD �� ACT� ��� 06877 __ j c.Cit /Town d.State e._Zip Code (914)244-9100 itshockley@schimenti.com Telephone Number(area code and extension) g�_E m-mail Address(optional) C THOMAS SHOCKLEY � h.On-site ManagerName _.-._.._..-, 2. On-Site Supervisor: THOMAS SHOCKLEY On-Site Supervisor Name 3. Is the entire facility to be demolished? Yes No o�. 4. Describe the area(s)to be demolished: rINTERIOR PARTITIONS AND CEILING DEMOLITION -0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: e� s ADDITION OF A 1524 SQ FT LOADING DOCK fir" s �v ag06.doc•10/02 BWP AQ 06•Page 2 of 3 Massachusetts Department of Environmental Protection ■ i Bureau of Waste Prevention . Air Quality iloo1sa113 _J Decal Number BWP AQ 06 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)? 10 Yes ✓[ No If yes, who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 3/15/2013 _ 0/01/2013 0 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: E] seeding paving El wetting shrouding b. If other, please specify: E] covering other INA-INTERIOR DEMO ONLY 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Da Authorization_ y y d.DEP Waiver D. Certification I certify that I have examined the �JOHN J�(:OLONNESE �......_... ,__.__._.. _._ __._.___._ _.__.._.._ _..... _.� .. a ® above and that to the best of my a.Print Name knowledge it is true and complete. ® The signature below subjects the b.Authorized Signature___ signer to the general statutes PROJECT EXECUTIVE regarding a false and misleading 'c7 pos-; off ;{ "- - - -- - --- ��� statement(s). ISCHIMENTI CONSTRUCTION COMPANY ® d.Re resentin e.Date(mm/dd%yyyy) -nr ag06.doc•10/02 BWP AQ 06•Page 3 of 3 l , eDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact i Feedback I Tour I Privacy Policy MassDEP'S Online Filing System Usemame:SCHIMENTICT Nickname:SCHIMENTIMA My eDEP; Forms . My Profile_ Help Receipt Forms Signature Receipt Summary/Receipt print receipt FE,xit j 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: 519574 Date and Time Submitted: 11/13/2012 9:42:19 AM Other Email Form Name: AQ 06- Construction/Demolition Notification Payment Information DEP code: 76261 Date: 11/13/2012 9:41:39 AM Amount($): 85 Payment Detail: COLONNESE JOHN --AccountType--AccountNumber ****1148 ConfirmationNumber: Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab eDEP MassDEP Home I Contact Feedback ( Tour Privacy Policy MassDEP'S Online Filing System ver.11.9.0.0©2011 MassDEP https://edep.dep.mass.gov/Pages/Pr,intReceiDt.asDx 11/13/201.2 i From: John Colonnese Sent: Wednesday, November 14, 2012 01:50 PM To: David Carlson Subject: FW: Kohl's Hyannis - Bldg Permit Submittal Dave Way at the bottom of this chain. .From: HenryKurasaki [m itt :Henry.Kurasaki@MulvannyG2,com] Sent: Sunday, November 04, 2012 3:30 AM To: John Colonnese Cc: 'Gary Bohn'; 'Trevor Wright(trevor.wright@kohls.com)'; Crystal Ng; 'Justin Crable (jcrable@atwell group.com)'; Troy Paionk(tpaionk@atwell-group.com); 'Eric Borkenhagen' Subject: RE: Kohl's Hyannis - Bldg Permit Submittal Importance: High John, I spoke with the fire official (Dave McCurdy) last week and we already have Fire Department acceptance, we just need to have them sign-off on the permit application. Also no fire protection documents required at time of submittal, it will be deferred like we typically do. And the pre-construction meeting occurs when our set has gone through plan review. When you get out there, you can coordinate further with the building commissioner (Tom Perry). Also as I've been reminding you for several weeks, there is a process to the permit submittal. You'll need to walk to all the departments (Health Dept., Conservation Dept.)to get sign-off before you do your final submittal to the building department. You'll also need all the forms with you (e.g. Workers Compensation Insurance, Construction Supervisor license, AQ 06 form, Application Fee ($100), and the appropriate Form 7460 and Form E-10 for Crane operation(I believe this can be submitted later). We anticipate shipping the complete permit set with permit application on Nov 7th so you can submit on Nov 81h. Please confirm the address to ship to so we can address it accurately. Let me know if you have any further questions. Thanks! Henry Kurasaki, AIA, LEED AP BD+C Associate 1 MulvannyG2 Architecture 1 425.463.1368 From: John Colonnese [mailto:]Colonnese@schimenti.com] Sent: Thursday, October 18, 2012 1:10 PM To: Henry Kurasaki; 'Justin Crable (jcrable@atwell-group.com)'; 'Eric Borkenhagen' Cc: 'Gary Bohn'; 'Trevor Wright(trevor.wright@kohis.com)'; Crystal Ng Subject: RE:Kohl's Hyannis - Bldg Permit Submittal r Henry, The permit procedure form indicates that we need Fire Department approval before we can submit the application package to the town. Have you talked to anyone at the fire department to see what they need for their review.Do we need to get a sprinkler sub on board and provide drawings. Do you know if the pre-construction meeting should be held prior to submitting the drawings, or can the meeting and plan submission be performed at the same time. Thank you, John From: Henry Kurasaki [mailto:Henry.Kurasaki@MulvannyG2.com] Sent: Thursday, October 18, 2012 1:12 PM To: Justin Crable acrable@atwell-group.com); John Colonnese; Eric Borkenhagen Cc: Gary Bohn; Trevor Wright (trevor.wright@kohls.com); Crystal Ng Subject: FW: Kohl's Hyannis - Bldg Permit Submittal Justin, Looks like we can submit bldg. permit without site plan approval. Please coordinate with the Town on the next Formal Site Plan Technical meeting. Keep me in the loop on the schedule. Thanks! Eric, For our permit application, we'll need the owner to give permission for this permit. I've attached the form. Can you please coordinate with the owner to get this signed and return to me. I'd like to have this by next week(10/24/12). John, I'm working on the permit application and will send the whole package the week of the Nov 5th. In the interim, please review attached permit submittal procedure and note the GC requirements. Also ensure you have the Insurance Affidavit filled out and Certificate on file. And lastly please review the email below from the Town as they would like to have a Pre-Construction Meeting. Please review and let me know if you have any questions. Thanks! Henr y Kura saki, AIA, LEED AP BD+C I Associate MulvannyG3 Architecture 425.463.1368 From: Perry, Tom [mailto:Tom.Perry@town.barnstable.ma.us] Sent: Thursday, October 18, 2012 5:57 AM To: Henry Kurasaki Cc: Barrows, Debi; Buntich, JoAnne; Swiniarski, Ellen Subject: RE: Kohl's Hyannis - Bldg Permit Submittal Henry, Yes you could submit the Building permit prior to Site plan approval.There are no Zoning issues for this project to proceed forward (one of the reasons to have an approved site plan) but there are changes to the parking lot proposed and that's the reason for the necessity for Site Plan review.With winter fast approaching (ugh)the site probably won't be finished till next spring so there should be time to work out the details of this aspect of the project. Also at that time we'll need all the construction control documentation necessary under 107.6 of the Massachusetts amendments. In preparing these plans make sure you review the Massachusetts Amendments to 2009 I.B.0 since Chapter 9 especially--fire protection--is heavily amended. Once the GC is chosen I would like to have a pre-construction meeting so details of inspections,submittals etc.can be worked out. I am in Portland next week at the ICC conference so I'll be out of touch if you need something from me.My staff can help with answers if there are any questions that may come up. Look forward to this project TP ----Original Message---- From: Henry Kurasaki [mailto:Henry.Kurasaki@MulvannyG2.com] Sent: Wednesday, October 17, 2012 5:25 PM To: Perry,Tom Cc: Justin Crable Ucrable@atwell-group.com) Subject: Kohl's Hyannis - Bldg Permit Submittal Mr. Perry, This is a follow-up to a voicemail message I left you today. It is my understanding that the Formal site plan meeting (technical meeting) on October 251h was canceled. We are anticipated to submit for building permit on November 8th and our hope was that we would receive Site Plan approval. such that we could include the approval letter with our Building Permit Submittal Since that meeting has been canceled, we are in a little dilemma regarding our schedule. I was wondering if it would be possible to submit for building permit.(11/8) in anticipation of site plan approval. And I would understand a permit would not be issued prior to site plan approval. I would appreciate your consideration and please let me know if you have any additional questions. Thank you! Mahafo, Henry Kurasaki, AIA, LEED AP BD+C I Associate Creating Business Value Through Inspired Design MulvannyG2 Architecture 1110 112th Ave NE I Suite 500 I Bellevue, WA 98004 D: 425.463.1368 T: 425.463.2000 F: 425.463.2199 E: henry.kurasaki@muIvannyg2.com W: www.mulvannyg2.com Celebrating 40 years of DESIGN AT WORK Bellevue, WA I Portland;.OR i. Irvine, CA I Washington, DC I Shanghai, China - ThF s al-xwa.Sf You aM nmt 4i''- .�.t, ,J 9 'a, 6 � b i3x, <5.:3 .t, �,�ukt>Z.;�.^,�3 ,.J E.,�S�i.k 57..?'k&..,n,.t i,?�t�.f f ¢6i�. �i „... _,.... , . . . ,pG . -, _pf rx Please consider the environment before printing this email. kv�- of@%vGs�}m�s - eepa my Pu s p and Sb�,ds �almma eee�r C-048A4 . . mOl%USao/ £Y�~x \ 2 7 AMtyl« ABIN§T N� k31, / \ j %�q4 Town of Barnstable z Regulatory Services ' neea 16omae F.Gdier,Dbvcinr BuRdiong Mbion Tom Perry,BeBdfng Commimioner 200 Mats Sfree%Hyannis,MA 02601 wvvw:towa.barnstablemaus ' Office: 508-962 4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder L OGGJ =. yahA r S. L C C- m Omner of the subject pmpeq hCSCby 9uthOliZe Kohl's Illinois, Inc. and their agents, including Schimehti _Construction Company to act an= is in mattes relative to work authorized by this building pemit♦ WSJ e (�C� it ee o u� e- (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 ?Vectio#�s are performed and accepted. OCw Reta 1-Hyan s, LLC By: OCw New Eng nd Retail Holdings, LLC By: TA Eng an , LLC Manager BY* David J. M Manager S*Uture D pplu ant Print Name Print Name It- 1Y- 12r Date Q•FORM .- . 6012 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 1 of 2 The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth,Corporations Division 4 I One Ashburton Place, 17th floor Boston,MA 02108-1512 Telephone: (617)727-9640 TAD NEW ENGLAND LLC Summary Screen Help with this form F Request a Certificate, The exact name of the Domestic Limited Liability Company(LLC): TAD NEW ENGLAND LLC Entity Type: Domestic Limited Liabilijy Company(LLC) Identification Number: 208915866 Old Federal Employer Identification Number(Old FEIN): 000949238 Date of Organization in Massachusetts: 04/12/2007 The location of its principal office: No. and Street: 800 BOYLSTON ST., SUITE 1300 C/O THE WILDER COMPANIES City or Town: BOSTON State: MA Zip: 02199 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: DAVID J. MALLEN No. and Street: 800 BOYLSTON ST., SUITE 1300 C/O THE WILDER COMPANIES City or Town: BOSTON State: MA Zip: 02199 Country: USA The name and business address of each manager: Title Individual Name Address (no PO Box) First,Middle,Last,.Suffix ,_ Address,City or Town,State,Zip Code MANAGER DAVIDJ.'_MALLEN..— »--- _ 800 BOYLSTON ST.,SUITE 1300 BOSTON,MA 02199 USA The name and business address of the person in addition to the manager,who is authorized to execute documents to be filed with the Corporations Division. Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code SOC SIGNATORY DAVID J.MALLEN 800 BOYLSTON ST.,SUITE 1300 BOSTON,MA 02199 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/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 11/14/2012 i The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 2 of 2 Title Individual Name Address (no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY DAVID J.MALLEN 800 BOYLSTON ST.,SUITE 1300 BOSTON,MA 02199 USA Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership X Resident Agent _ For Profit _ Merger Allowed Select a-type of filing from below to view this business entity filings: ALL FILINGS Annual Report I Annual Report-Professional Articles of Entity Conversion4�( Certificate of Amendment View Fllings';R a. New,;Search Comments O 2001-2012 Commonwealth of MassachL setts All Rights Reserved Help http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 11/14/2012 The Commonwealth of Massachusetts William Francis Galvin - Public Browse and Search Page 1 of 2 The Commonwealth of Massachusetts J William Francis Galvin Secretary of the Commonwealth,Corporations Division - One Ashburton Place, 17th floor Boston,MA 02108-1512 Telephone: (617)727-9640 OCW RETAIL-HYANNIS, LLC Summary Screen Help with this form FiequL`esta Gertificate :,� The exact name of the Foreign Limited Liability Company(LLC): OCW RETAIL-HYANNIS,LLC Entity Type: Foreign Limited Liability Compaa(LLC) Identification Number: 208944693 Old Federal Employer Identification Number(Old FEIN): 000950048 Date of Registration in Massachusetts: 04/24/2007 The is organized under the laws of: State: DE Country: USA on: 04/04/2007 The location of its principal office: No. and Street: 535 MADISON AVENUE City or Town: NEW YORK State:NY Zip: 10022 Country: USA The location of its Massachusetts office, if any: No. and Street: City or Town: State: Zip: Country: The name and address of the Resident Agent: Name: C T CORPORATION SYSTEM No. and Street: 155 FEDERAL ST., STE. 700 City or Town: BOSTON State: MA Zip: 02199 Country: USA The name and business address of each manager: Title Individual Name Address (no Po Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code MANAGER TAD NEW ENGLAND LLC 535 MADISON AVENUE NEW YORK,NY 10022 USA MANAGER OCW NEW ENGLAND RETAIL HOLDINGS,LLC 535 MADISON AVENUE NEW YORK,NY 10022 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 Title Individual Name Address (no Po Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code REAL PROPERTY ANNE MEYER 120 SOUTH CENTRAL AVENUE CLAYTON,MO 63105 USA REAL PROPERTY THOMAS E.QUINN 535 MADISON AVENUE http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 11/14/2012 The Commonwealth of Massachusetts William Francis Galvin- Public Browse and Search Page 2 of 2 I I ( NEW YORK,NY 10022 USA I Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership _ Resident Agent _ For Profit _ Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS i-'I Annual Report Annual Report-Professional z? f Application For Registration Certificate of Amendment s. ° ` View Flhngs' T�_ N w Search ° : Comments 4 O 2001-2012 Commonwealth of Massachusetts All Rights Reserved Helo http://corp.sec.state.ma.us/ccrp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 11/14/2012 Schirnehti Construction Company November 12, 2012 Town of Barnstable 200 Main Street Hyannis, MA 03601 I hereby authorize our superintendent Thomas Shockley of Schimenti Construction Company as the Construction Supervisor for the Kohl's remodel construction project at: 65 Independence Drive Hyannis, Massachussetts Tom's license number is C-048064, expiring in 02/03/2014. This authorization is valid until further written notice from Schimenti Construction. Sincer J i i Matt ew Schimen i Presi ent F 650 Danbury Road,Ridgefield,Connecticut 06877,914-244-9100;914-244-9104 fax C�==_ y,M CORPORATION x978.4 0.1017 Specialty ContractorsZ fax 978.470.1017 April 18, 2013 Town of Barnstable 200 Main Street Hyannis, MA 02601 RE: Southwind Plaza, 65 Independence Drive,Hyannis,MA 02601 (Former Stop & Shop) Dear Sir or Madam: ; Please be advised that Dec-Tam Corporation will be performing an asbestos abatement projects at the above referenced locations. This work had been scheduled for May 06, 2013 thru May 07,20 f 3. All applicable local, state and federal agencies have been notified of this work. Please let me know if you have any questions. Sincerest regards, v David Patti Sales Estimator DP/cam D3 Enclosure a w Environmental Remediation Services • Surface Preparation • Facilities Services 50 Concord Street • North Reading, MA 01864 9 www.dectam.com • solutions@dectam.com I Commonwealth of Massachusetts L 100175897 ' Asbestos Notification Form ANF-001 Decal Number Important: When filling out A. Asbestos Abatement Description forms on the ` computer,use 1. a. Is this facility fee exempt-city, town, district,municipal housing authority,owner-occupied only the tab key residence of four units or less?❑Yes 2]No to move your cursor-do not b. Provide blanket decal number if applicable:. Blanket Decal Number use the return key. 2. Facility Location: SOUTHWIND PLAZA 65 INDEPENDENCE DRIVE a.Name of Facility b.Street Address Flyannis MA 1 102601 (617)896-4932 _ c.City/Town d.State e.Zip Code f.Telephone Number f INSTRUCTIONS 3. Worksite Location: 1.All sections of this FRMR STOP &SHOP EXT form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room completed in order to comply with 4. Is the facility occupied? Z Yes ❑No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: and the Division of Occupational DEC-TAM CORPORATION 50 CONCORD STREET Safety(DOS) a.Name b.Address notification NORTH READING -� 018641 19784702860 requirements of 453 CMR 6.12 c.City/Town d.Zip Code e.Telephone Number AC000035 f.DOS License Number g. Contract Type: ✓]Written ❑Verbal DAVID PATTI » SALES h.Facility Contact Person i.Contact Person's Title 6' GEORGE A. PAGE I JAS071933 a.Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number RIA AA000028 7' a.Name of Project Monitor b.Project Monitor DOS Certification Number RIA AA000028 8' a.Name of Asbestos Analytical Lab b.Asbestos Analytical Lab DOS Certification Number _ �0 9. 05/06/2013 1 105107/2013 a.Project Start Date mm/dd/ b.End Date mm/dd 0 7A-4P �N c.Work hours Mon-Fri. d.Work hours Sat-Sun. �o 10. a. What type of project is this? =O ❑Demolition Q Renovation Repair (]Other, please specify: b.Describe e 11. a. Check abatement procedures: ° ❑Glove bag (] Encapsulation _ o ❑Enclosure ❑ Disposal only ❑Cleanup R Other, specify: REMOTE DECON, POLY ON GROUND, CAUTI ❑Full containment b.Describe Z =Q 12. Is the job being conducted: ❑ Indoors? ✓Q Outdoors? , ® anf001 ap.doc•10/02 Asbestos Notification Form•Page 1 of 3 I r� Commonwealth of Massachusetts 100175897 Asbestos Notification Form ANF-001 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or encapsulated: [0 750 a.Total pipes or ducts(linear ft) 0.71 otal o er su—fr aces square c.Boiler,breaching,duct,tank d.Insulating cement �-- surface coatings Lin.ft. Sq.ft. Lin.ft. (Sq.ft. e.Corrugated or layered paper E= f.Trowel/Sprayer coatings C pipe insulation Lin.ft. (Sq_ft. Lin.ft. Sq.ft. g.Spray-on fireproofing Lin Sq.ft—J h.Transite board,wall board Lin.` ft.—� i.Cloths,woven fabrics tJ j Other,please specify: L� 750 Lin.ft. S .ft. Lin.ft. So.ft. k.Thermal,solid core pipe MASTIC insulation Lin.ft. Sq.ft. 1.Specify 14. Describe the decontamination system(s)to be used: THREE STAGE 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(9): MATERIAL WILL BE WETTED AND PLACED IN PRELABELED BAGS FOR DISPOSAL 16. For Emergency Asbestos Operations, the DEP and DOS officials who evaluated the emergency: a.Name of DEP Official b.Title I c.Date(mm/dd/ )of Authorization (d.DEP �Waiver# e.Name of DOS Official T.DOS Official Tittle g.Date(mm/dd/yyyv)of Authorization h.DOS Waiver# �N �0 17. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A—F apply to this project? ❑Yes ✓0 No B. Facility Description �N RETAIL �o 1. Current or prior use of facility: �o 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes ✓ No r THE WILDER COMPANIES 800 BOYLSTON`ST,SUITE 1300 s� 3' a.Facility Owner Name b.Address o IBOSTON 1 102199 1 161 7-896-4932 o c.City/Town d.Zip Code e.Telephone Number area code and extension 4 SEAN HENDRIC<SON ISAME AS#3 a.Name of Facility Owner's On-Site Manager b.On-Site Manager Address �Q c.City/Town d.Zip Code e.Telephone Number(area code and extension) anf001 ap.doc-10/02 Asbestos Notification Form-Pa e 2 of 3 Commonwealth of Massachusetts L;L-I 100175897Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cont.) 5' a.Name of General Contractor _ b.Address c.City/Town d.Zip Code e.Telephone Number area code and extension GREAT DIVIDE WCA153726610 1 112128/2013 f.Contractor's.Worker's Comp.Insurer g.Policy Number h.Exp.Date mm/dd/ 6. What is the size Of this facility? 3200 1a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site(if necessary): Note:Transfer a.Name of Transporter � L� b.Address Stations must comply with the c.City/Town d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 SERVICE TRANSPORT 58 PYLES LANE a.Name of Transporter b.Address NEWCASTLE 19720 (877)999-9559 c.Cityrrown d.Zip Code e.Telephone Number 3. a.Refuse Transfer Station and Owner b.Address c.City/Town d.Zip Code e.Telephone Number Lj 4. IMINERVA ENTERPRISES INC a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name 9000 MINERVA ROAD I IWAYNESBURG c.Final Disposal Site Address d.Ci /Town OH' 44688 ®C9 e.State f.Zip Code g.Telephone Number �o D. Certification �N The undersigned hereby states,under the =PATTI �0 penalties of perjury, that he/she has read the a.Name b.Authorized Signature -o Commonwealth of Massachusetts regulations ISALES 1 14/16/2013 for the Removal,Containment or c.Position/Title _ d.Date(mm/dd/ww) Encapsulation.of Asbestos,453 CMR 6.00 and 1(978 470-2860 ('D�EC�-TAM 310 CMR 7.15, and that the information It ) I I contained in this notification is true and correct e.Telephone Number f.Representing o to the best of his/her knowledge and belief. 50 CONCORD ST o Q.Address N READING 01864 u_ Z h.Citylfown i.Zip Code ® anf001 ap.doc•10/02 Asbestos Notification Form•Page 3 of 3 A of ZNE Town of Barnstable 200 Main Street,Hyannis,Massachusetts 02601 ► BARNSrABLB• + . AS& iro�,,pr► Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner Phone(508)862-4679 Fax(508)862-4725 www.town.barnstable.ma.us November 16, 2012 Kohl's Department Stores,Inc. C/O Mr. Eric Borkenhagen, Agent 7800 North 1113 Street Milwaukee, WI 53244 RE: Site Plan Review#035-12 tKohl's Department Storks, Inc.�`-ti 65'Independence Drive, Hya nis Map 295, Parcels 015-XO1 and 015-XO2 Proposal: Renovation of the Super Stop and Shop in the Southwind Plaza shopping center to provide space for Kohl's Department Store as anew tenant. The-renovation will include the removal of the mezzanines within the existing building as well as the dock appendages along the rear of the building. The renovation will include a new receiving dock appendage at the southwest corner of the building, as well as a new store front. The parking lot will be renovated with new pavement as well as ADA compliant parking spaces. Dear Mr. Borkenhagen: Please be advised that at the Formal Site Plan Review meeting held November 15, 2012, the above- referenced proposal was approved subject to the following: • Approval is based upon and must be substantially constructed in accordance with plans entitled "Proposed Kohl's.Department Store, Southwind Plaza, 65 Independence Drive, Hyannis, MA, Preliminary Engineering Plans", 16 Sheets, dated October 8, 2012 with final revisions November 6, 2012,prepared by Baxter Nye Engineering & Surveying, Hyannis, for Kohl's Department Stores, Inc.; floor plans dated 11/6/12 and design elevation plans prepared by Mulvanny Architects G2 of Bellevue, WA. • Areas proposed to use bark mulch, as depicted on Landscaping Plan, Sheet L1.0 by Baxter Nye Engineering, will be planted with grass.instead. • Delivery schedule as set forth in October 18, 2012 letter from Mr. Justin P. Crable, PLS, Project Coordinator, Atwell LLC. (attached) • Applicant must obtain all other applicable permits, licenses and approvals. Upon completion of all work, a registered engineer or land surveyor shall submit a letter of certification, made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan(Zoning Section 240-105 (G). This document shall be submitted prior to the issuance of the final certificate of occupancy. A copy of the approved site plans will be retained on file. Sincerely, Ellen M. Swiniarski Site Plan/Regulatory Review Coordinator Attachment: Letter from J.P. Crable to Town of Barnstable, 10/18/12 ----------------- CC: CIQPITerry, Building Commissioner Justin Crable, PLSPLS, Atwell LLC Matt Eddy, Baxter,Nye Engineering & Surveying f 4 ATWELL October 18, 2012 Town of Barnstable - . Attn:,Thomas Perry 200. Main Street Hyannis, MA 02601 Atwell, LLC Project No. 12000779 RE: Southwind Plaza, 65 Independence Drive,Hyannis, MA 02601 Kohl's Department Store Site Plan Submittal Dear Mr. Perry: Please find enclosed our formal site plan submittal package for the above mentioned project. Upon your receipt and review,please advise if there is any additional information that you will require or are need of to process our application. Separately, during our site plan preapplication meeting, Town staff requested that we include a narrative with our application describing the anticipated product delivery schedule for the Kohl's store. We anticipate one (1)to two (2) deliveries per week from January thorugh October and four (4) .to five (5) deliveries per week during the months of November and December. The time of the delivieries typically occur during the early morning hours from 7:00 a.m. to 9:00 a.m. or in the evening hours between 8:00 p.m. to 10:00 p.m. As discussed at our preapplication meeting,there is typically one trailer in the dock at all times: When a new delivery is made, the semi-truck cab will drop a trailer full of product and pick up the empty trailer that is in the dock and return back to the distribution center. We look forward to working with the Town on this project and await your response. Sincerely, ATWELL Justin P. Crable, PLS Project Coordinator 1'245 East Diehl Road,Suite 100 1 Naperville,IL 60563- 1 630.577.0800 Tel 630.577.0900 Fax www.atwell-group.com qiv .- . �I"E'" � Town of Barnstable 200 Main Street Hyannis,Massachusetts 02601 BMWErrABLE, ' yann ' Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner Phone(508)862-4679 Fax(508)862-4725 www.town.barnstable.ma.us November 16, 2012 Kohl's Department Stores, Inc. C/O Mr. Eric Borkenhagen, Agent 7800 North 113 Street Milwaukee, WI 53244 RE: Site Plan Review#035-12 Kohl's Department Stores, Inc. 65 Independence Drive, Hyannis Map 295, Parcels 015-XO1 and 015-X02 Proposal: Renovation of the Super Stop and Shop in the Southwind Plaza shopping center to provide space for Kohl's Department Store as a new tenant. The renovation will include the removal of the mezzanines within the existing building as well as the dock appendages along the rear of the building. The renovation will include a new receiving dock appendage at the southwest corner of the building, as well as a new store front. The parking lot will be renovated with new pavement as well as ADA compliant parking spaces. Dear Mr. Borkenhagen: Please be advised that at the Formal Site Plan Review meeting held November 15, 2012, the above- referenced proposal was approved subject to the following: • Approval is based upon and must be substantially constructed in accordance with plans entitled "Proposed Kohl's Department Store, Southwind Plaza, 65 Independence Drive, Hyannis, MA, Preliminary Engineering Plans", 16 Sheets, dated October 8, 2012 with final revisions November 6, 2012, prepared by Baxter Nye Engineering & Surveying, Hyannis, for Kohl's Department Stores, Inc.; floor plans dated 11/6/12 and design elevation plans prepared by Mulvanny Architects G2 of Bellevue, WA. • Areas proposed to use bark mulch, as depicted on Landscaping Plan, Sheet L1.0 by Baxter Nye Engineering, will be planted with grass instead. • Delivery schedule as set forth in October 18, 2012 letter from Mr. Justin P. Crable, PLS,Project Coordinator, Atwell LLC. (attached) • Applicant must obtain all other applicable permits, licenses and approvals. Upon completion of all work, a registered engineer or land surveyor shall submit a letter of certification, made upon knowledge and belief in accordance with professional standards that all work has been done in substantial compliance with the approved site plan (Zoning Section 240-105 (G). This document shall be submitted prior to the issuance of the final certificate of occupancy. A copy of the approved site plans will be retained on file. Sincerely, r Ellen M. Swiniarski Site Plan/Regulatory Review Coordinator Attachment: Letter from J.P. Crable to Town of Barnstable, 10/18/12 CC: Tom Perry, Building Commissioner Justin Crable, PLS, Atwell LLC Matt Eddy, Baxter,Nye Engineering & Surveying S _ ATWELL October 18, 2012 .Town of Barnstable Attn: Thomas Perry 200 Main Street Hyannis, MA 02601 Atwell,LLC Project No. 12000779 RE: Southwind Plaza, 65 Independence Drive, Hyannis,MA 02601 Kohl's Department Store Site Plan Submittal Dear Mr. Perry: Please find enclosed our formal site plan submittal package for the above mentioned project. Upon your receipt and review,please advise if there is any additional information that you will require or are need of to process our application. Separately, during our site plan preapplication meeting,Town staff requested that we include a narrative with our application describing the anticipated product delivery schedule for the Kohl's store. We anticipate one (1) to two (2) deliveries per week from January thorugh October and four(4) to five (5)deliveries per week during the months of November and December. The time of the delivieries typically occur during the early morning hours from 7:00 a.m. to 9:00 a.m. or in the i. evening hours between 8:00 p.m. to.10:00 p.m. As discussed at our,preapplication meeting, there is typically one trailer in the dock at all times. .When a new delivery is made,the semi-truck cab will drop a trailer full of product and pick up the empty trailer that is in the dock and return back to the distribution center. We look forward to working with the Town on this project and await your response'. Sincerely, ATWELL Justin P. Crable,PLS Project Coordinator 1.245 East Diehl Road,Suite 100 Naperville,IL 60563 630.577.0800 Tel 630.577.0900.Fax www.atwell=group.com