Loading...
HomeMy WebLinkAbout0095 AIRPORT ROAD 9� I A �. k �� I ' � � � ,. � � � � �. � _ _ � � � � .. j � I �' � , , � � � J , � � ( � w g � '~ `� �, I��. _. _�__ ._��. � a '� ..- ........... Parcel: 294-064 Location: 95 AIRPORT ROAD, Hyannis Owner.AMR REAL ESTATE HOLDINGS AIRPORT LLC �k ? Parcel Developer lot: Secondary road 294-064 r z~ Location Road index Interactive map ' 95 AIRPORT ROAD 0010 � i Village Fire district . ___ --- Hyannis Hyannis -� Y Y Town sewer account Sewer connection files Active card 1 ........... V/ Owner: AMR REAL ESTATE HOLDINGS AIRPORT LLC Owner Co-Owner Book page AMR REAL ESTATE HOLDINGS AIRPORT LLC 26982/250 Streetl Street2 425 PROVIDENCE HWY City State Zip Country WESTWOOD MA 02090 V_ Land -.T--- --- - --...._.......................----... ............ ......... ......................-----....... ....... - . ......... ---- Acres Use Zoning Neighborhood 0.64 JOB SHOP(S) B C109 Topography Street factor Town Zone of Contribution Level Paved GP (Groundwater Protection Overlay District) Utilities Location factor State Zone of Contribution All Public Bus. District IN r_ Construction ----- ------- -. _- ----------......... .........................._._._. ......-_.-... I - ......... ..........._ . ......._........ r_ Building 1 of 1 Year built Roof structure _.PS.Heattype. ~., a 2005 Gable/Hip Hot Air Olt Living area Roof cover Heat fuel 5100 Metal/Tin Gas 4 Gross area Exterior wall AC type 5100 Pre-finsh Metl Central Style Interior wall Bedrooms'_ Job Shop(s) Minimum 00 ' Model Interior floor Bath rooms z Ind/Comm Concr Finished 0 Full-0 Half Grade Foundation Total rooms Average AVERAGE Stories i 1 v_ Permit History - — -- - .. Permit Issue Date Purpose Number Amount InspectionDate Comments I 09/19/2011 Commercial 201104534 $200,000 11/28/2011 INTERIOR RENO-DETAILING FACILITY 09/19/2011 Commercial 2011'04708 $19,000 11/28/2011 INTERIOR DEMO-CUT SLAB FOR UNDER GRND PLUMB t i Permit Issue Date Purpose Number Amount InspectionDate Comments 09/06/2011 Commercial 201104762 $14,500 11/28/2011 GAS FURN &AC 1 _ Sale History Line Sale Date Owner Book/Page Sale Price 1 12/26/2012 AMR REAL ESTATE HOLDINGS AIRPORT LLC 26982/250 $830,000 2 07/29/2011 WALL, BRIAN J TR 25590/ 142 $525,000 3 04/10/2009 INDEPENDENCE PARK INC 23602/ 141 $1 4 07/08/2005 BOSTON NOMINEE TRUST 20025/ 1 $206,150 5 07/08/2005 INDEPENDENCE PARK INC 20024/346 $0 6 10/31/2001 ALMEIDA,JULIA MARIA TR 14387/ 157 $201,000 7 06/21/2000 INDEPENDENCE, INC 13084/82 $190,000 ..._..._._.. ......... _ ...... 8 06/27/1974 NAUSET WORKSHOP INC 2062/ 106 $1 v_ Assessment History Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 1 2020..... $344,000 $0 $39,800 $202,800 $586,600 . ......... _ ......... ......... __.. 2 2019 $352,000 $0 $41,600 $202,800 $596,400 3 2018 $346,200 $0 $42,600 $202,800 $591,600 ..................... .......-. ......... _ __ ...... ........... 4 2017 $341,600 $0 $42,800 $202,800 $587,200 5 2016 $341,600 $0 $42,800 $202,800 $587,200 6 2015 $343,400 $0 $40,000 $194,800 $578,200 7 2014 $343,400 $0 $40,800 $194,800 $579,000 8 2013 $343,400 $0 $21,200 $194,800 $559,400 9 2012 $191,600 $0 $7,300 $194,800 $393,700 ........ ......... 10 2011 $118,900 $0 $7,600 $334,000 $460,500 11 2010 $148,400 $0 $8,200 $334,000 $490,600 12 2009 $210,000 $0 $8,500 $310,900 $529,400 13 2008 $326,100 $0 $16,800 $186,500 $529,400 15 2007 $326100 $0 $16,800 $186,500 $529,400 16 2006 $286,700 $0 $7,200 $186,500 $480,400 ....... ......... ......... 17 2005 $221,900 $0 $7,200 $159,900 $389,000 18 2004 $166,200 $0 $7,200 $131,200 $304,600 19 2003 $96,200 $0 $7,200 $113,200 $216,600 20 2002 $96,200 $0 $7,200 $122,200 $225,600 21 2001 $96,200 $0 $7,200 $122,200 $225,600 ......... Save# Year Building Value XF Value OB Value Land Value Total Parcel Value 22h� 2000 � $45,900 $0 � $7,200 $�110,600� $163,700- €' 23 1999 $45,900 $0 $7,200 $110,600 $163,700 r .._.... __ ........ 24 1998 $45,900 $0 $7,200 $110,600 $163,700 ......... ......... 30 1992 $140,300 $0 $0 $114,700 $259,000 ..... ........ ......... 31 1991 $199,600 $0 $0 $163,800 $367,400 36 1986 $0 $0 $0 $0 $0 v Photos �._ . aa ,I: Ey '" s E d�ivar�WaGai�s &t aGd�matG r;,i as rAh P'wa daaa a ,n.`rounmwz a E � ''1� 12aEWiII hE.$'t li ,ri�t^a.+F S(ri.l tx E":Yan,'P e a d 4� E ` i } d E 3 i r� 77, CA i ^ar; S✓ :' •-, ..,� eg.REY `M giyt&M1e.?fit Nf} 'C`vG f (;♦gi IbH ar 2'zwp � �m4 an 1 yak m ¢,�r ` �e " t ( f F a .... ..___ { i,' E Town of Barnstable � Regulatory ServicespR c� Richard V.Scali Interim Director %' A� 039. . Building Division . Tom Perry, Building Commissioner 7 ., 200 Main Street, Hyannis,MA 02601 ��m•„ ,� � www.towa.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 i / Permit# Building Official approving Application for Sign Permit / Applicant: ��1J Assessors No. Doug Business As:,/��f/'� d t e ephone No. t Sign Location Street/Road.- Zoning District: _Old Kings Highway? Yes/No Hyannis Historic District' Yes/No Property Owner 17 Name: y'l / K elephone: Address: .? Village: _ Sign Contractor V Name: Telephone: Mailing Address: Description Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Yes,/No (Note:If<<es,a Kgiirlg pertnitrs re aired) Width of building facelAf ft.x 10= x.10= Check one Reface existing sign or New Total Sq.Ft of proposed sign(s) If you have.additional signs please attach a sheet listing each one with dimensions X If refacing an existing sign please provide a picture of the existing sign with dimensions. 1 v I hereby certify that I am the owner or that I have the authority of the owner to make this:application, that the information is correct and that the use and construction shall conform to the provisions of §240-59 through§240-89 of the Town of B tabVoning Ordinan C. Signature of Owner/Authorized Agent _ Date SIGNS/SIGNREQU revisedl 10413 a ,�. �� 4 � �� ; d ,a z� E� .:, `�� � .�_ . .: --; .� ,; �� .._..��._._.--T--� , .�. .� � ��, . � � Q ��� a � '�� � � i � i o � � P P � � � 1� ..--�7y�o �1. _ { �. a. ;E "� ` � `!,t a pp - t ��P. 'a€ �� wi ,�, �' ■ � „� '( `F ,�� 'ii p 1 ,^ i P .E. } # f ry �. m� �� � . . ,�s .� +' � �i�r �^ � r n�o �, 991 DO 1 t x ' �n y i � ; y t` OP rr 00 7r , - _„ �.-.3c-, � •sue---���,, r ��+.�'n��g - .. x M Ile, Town of Barnstable Building Department - 200 Main Street * sAxxSTABLE, * Hyannis, MA 02601 MASS 0 9. , 1508) 862-4038 RFD MA'S A Certificate of Occupancy Application Number: 201104534 CO Number: 20120150 Parcel ID: 294064 CO Issue Date: 12111/12 Location: 95 AIRPORT ROAD, Zoning Classification: BUSINESS DISTRICT Proposed Use: AUTOMOTIVE SUPPLIES Village: HYANNIS Gen Contractor: ADVANTAGE CONSTRUCTION Permit Type: CC00 CERTIFICATE OF OCCUPANCY COMM Comments: TENANT - A'NGEL'S TOUCH Building Department Signature Date Signed l Town of Barnstable oFt"E' 200 Main Street,Hyannis,Massachusetts 02601 •ARNSPABM = Regulatory Services Thomas F. Geiler, Director Building Division Tom Perry, Building Commissioner '°rFo Mv+ Phone(508)862-4679 Fax(508)862-4725 www.town.barnstable.ma.us October 31, 2011 Mr. Jack Carter c/o Dan Ojala Down Cape Engineering, Inc. 939 Main Street, Route 6A Yarmouth Port, MA 02675 RE: Site Plan Review# 022-11 95 Airport Road—Car Detail Shop 95 Airport Road,_Hyannis_,- 'Map 294, Parcel 064 Proposal: Change of use from All Seasons Laundry to an auto washing and detailing shop. Interior renovations are planned including addition of an oil/water separator and floor drains. Improvements to existing drainage system is proposed. Dear Mr. Ojala: Please be advised that subsequent to Formal Site Plan Review on September 8,2011, the above proposal received an administrative approval subject to the following conditions: • Approval is based upon plan entitled"Site Plan of Land at 95 Airport Road, Hyannis, MA", Scale 1" =20',prepared for Jack Carter by Down Cape Engineering, Yarmouth Port, MA and dated August 31, 2011 with final revision for drainage on October 25, 2011. • Automotive repair of shall not be allowed per the Well Head Protection-Overlay District. • Applicant must obtain all other applicable permits, licenses and approvals required. • Landscaping and site improvements within Airport Road layout shall be immediately removed from the layout if and when requested by the Town. • 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. Sincerely, len M. Swiniarski Site Plan/Regulatory Review Coordinator CC: Tom Perry, Building Commissioner SPR file ~ Sign TOWN OF BARNSTABLE Permit * BARNSTABLE, 9 MASS. i639. Argo�A Permit Number: Application Ref: 201106095 20070669 Issue Date: 11/01/11 Applicant: INDEPENDENCE PARK INC Proposed Use: STORAGE WAREHOUSE & DIST Permit Type: SIGN PERMIT Permit Fee $ 50.00 Location 95 AIRPORT ROAD Map Parcel 294064 Town HYANNIS Zoning District B Contractor PROPERTY OWNER Remarks REFACE EXISTING FREESTND SIGN ANGELS TOUCH AUOT RECONDITION Owner: INDEPENDENCE PARK INC Address: PO BOX 1776 HYANNIS, MA 02601 Issued By: PC POST TINS CARD SO THAT IS VISIBLE;FROM THE ST ET INE ap �, BA MASS LC RFD MAy° ROBIN C.ANDERSON TOWN OF BARNSTABLE Zoning Enforcement Officer 200 Main Street,Hyannis,MA 02601 508-862-4027 Fax 508-790-6230 robin.anderson@town-barnstdble.ma.us �ofTHEra Town of Barnstable . . Regulatory Services � lARNsrAHI.i, 9 MASS �, Thomas F. Geiler, Director °Tfatiu+"�� Buifding Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-623 0 Permit# Building Official approving Application for Sign Permit Applicaiit:_�/�� ���, //�/(�, Assessors No. 2 Douig Business As: Telephone No. Sign Location Street/Road: p Zoning District: / Old Kings HighwayP Ye o Hyannis Historic DistrictP Ye se Property Owner Name. Teleplioiie• I Address: ��� //l _ 7r�� Village: Sign Contract Name: `77/ Y" G Telephone: Sr Mailing Address: `r V. Description Please follow die cover directions. You must have a i accurate renditiou of sigh wide dimensions wid ' location. Is die sign to be electrified? Yes/No (Note.II'yes, a w=)ffpermltisrequired) Width of building face � f� . ft. x 10= x.10= Check one Reface existing s igii—AL or New Total Sq. Ft, of proposed sign (s) " V . 11 you h,?ve addid0JIAl sib7is please attach a sheet listing each ogle with dimensions If refacing an existing sign please provide a picture of the existing sign with dimensions. I hereby certify that I am die owner or that I have die audiority of tic owner to make this application, that tie ihiformation is correct and that tie use and construction shall conform to die proiisions of §240-59 through §240-89 of die Town of Baanhstable in Orduhaihce. Signature of Owner/Authorized Agent:-"`''-- Date 1 ( J f gat �uta Recondition, c Mon - Fri 8 am - 6 pm Saturday 8 am - 1 pm 0 4! t r Town of Barnstable .... �.� ��k� ;a �.� . �.. k � Building s I - Post This Card So That it Visible F oorr to a Street-Approved Plans Must b`e Retained on Job and this Card Must be Kept ana�ssrns,s 'T� Posted Until Final;lns ection,Has Been Made'.``µr ,i63� . pPermit �,uct� . Where a Certificate of Occupancy is Re,:quired,suchulldmgshall Not by a Occupiyed_until auFinal,Inspection hasbeen made ,p Permit NO. B-16-1987 Applicant Name: Map/Lot: 294-064 Date Issued: 07/12/2016 Current Use: Zoning District: B Permit Type: Sign Expiration Date: 01/12/2017 Contractor Name: Cape Cod Signs s Location: 95AIRPORT ROAD, HYANNIS f -__ _ Est. Project Cost: $0.00 Contractor License: 1234 Owner on Record: AMR REAL ESTATE HOLDINGS AIRPORT LLC. Permit Fee 4 $50.00 Address: 425 PROVIDENCE HWY s Fee Paid: WESTWOOD, MA 02090 "" Date:`~ 7/12/2016 Description: Reface freestand sign 18 sq Prime Detail Center of Hyannis i Project Review Req : Reface freestand sign 18 sq Prime i te nter enter of Hyannis j .i Zoning Enforcement Officer f �+ This permit shall be deemed abandoned and invalid unless the work authorized by this,permit is commenced within six-nonths after issuance. All work authorized by this permit shall conform to the approved.application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of anybuilding and structures shall be in compliance with the local zoning by=laws and codes. This permit shall be displayed in a location clearly visible from access street:or"road and shall be maintained open for,public inspection for the entire duration of the work until the completion of the same. The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work' 1.Foundation or Footing g 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed. . 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection " 5.Prior to Covering Structural Members(Frame Inspection) : $, M 6.Insulation .. n 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. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you.must do by M.G.L.-it does not give you permission to operate.) Business Certificates are available at the Town Clerk's Office, 'I"FL., 367 Main Street, Hyannis, MA 02601 (Town Hall) ; ,, ;w •, ^kr ,';- DATE: lD- Fill in please: APPLICANT'S YOUR NAME/S. -e- e, � P P��; BUSINESS YOUR HOME ADDRESS:M DRY. y�'L yy##�Ii�f' ll7 TELEPHONE # Home Telep o er NAME OF CORPORATION: % NAME OF NEW BUSINESS YES NO� TYPE OF BUSINESS c IS THIS A HOME OCCUPATION? ADDRESS OF BUSINESS Jig, or�- MAP/PARCEL NUMBER �� J [Assessing] When-starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. -This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. & Main Street) to malce sure you have the appropriate permits and licenses required to legally operate your business in this town.,{� 1: BUILDING CD 1Zbinfe-r 'S OFF E I " This individ al h �ad an er 't requirements that pertain to this type of business. Auth riz d Signature* COMMENTS: r S 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature** . COMMENTS: l TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Ma � P r I Application # — p ace. Health Division Date Issued Lo.A Conservation-Division Application Feek, Planning Dept. emit Fee !T Date Definitive Plan Approved by Planning Board C�p �C/Ke N Historic - OKH — Preservation /Hyannis Po 9 Z n Project Street Address 9s gljzp, , Village �JAJ/J Owner Address Telephone Permit Request S74 L t. ! OAS- FJeL Cr .1, Klu f) AIX C3)101 �/iSyLtr �1 D J&7 11V 5 14-1,L 2 9gq"S U41 Square feet: 1 st floor: existing proposed @ r 2nd floor: existin roposed Total new Zoning District Flood Plain Groundwater Overlay + Project Valuation v V Construction Type Lot Size .® 3 3 S& F-C Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ N On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl Walkout ❑ Other 4 Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new o�- Half: existing new Number of Bedrooms: existing _new rw C Total Room Count (not including baths): existing new First FloorRoom Comet CD Heat Type and Fuel: A Gas ❑ Oil ❑ Electric ❑ Other r Central Air: )(Yes ❑ No Fireplaces: Existing New Existing wood/coal sQve: bYes ❑ No SV � Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size,= Barn Lb existing- ❑ rpv size— r1 Attached garage: ❑ existing ❑ new size _Shed: ❑ existing 9 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 Is FV7 AlA W Telephone Number � �)i ilk `� ' 5 VV Address _ ca p [. License# CA 11 7-ClU MA 62 Z ( Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE � i r; �r FOR OFFICIAL USE ONLY APPLICATION# t° DATE ISSUED ry MAP/PARCEL NO. -_ S 'h 1 ADDRESS VILLAGE OWNER F Cat Y DATE OF INSPECTION: i " FOUNDATION Y. FRAME INSULATION; FIREPLACE S ELECTRICAL: ROUGH FINAL t , PLUMBING: ROUGH FINAL ;GAS: ts_ - ROUGH t•d t FINAL F , r t .,.FINAL BUILDING J z DATE CLOSED OUT + ASSOCIATION PLAN NO. ' The Commonwealth of Massachusetts Department 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 Please Print LeLribly Name (Business/Organization/Individual): �O �/1- yoolo M V' °a--y+�-17C• Address: City/State/Zip: A M odPhone#: /0 6— O ct�—�S// Are you an employer?Check the appropriate box: Type of project(required): 1.X I am a employer with Q 1;+/ 4. ❑ I am a general contractor and 1 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp,insurance.$ 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other. comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. V 9 V Insurance Company Name: G e v / 1^I d1 �p r -- j-- - Policy#or Self-ins.Lic.#: {�(C a`tom lu�j Expiration Date: I ` t '�/d, ` Job Site Address: %-f frl r Da Z7 City/State/Zip: f �. 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 penalties of perjury that the information provided above rJissttrue and correct. Signature: Date _�'—/' // Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: I; DATE(MM/DD/YY) AC"W CERTIFICATE OF LIABILITY INSURANCE .. 06/17/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS I' 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 I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Aon Risk Services,Inc of Florida Aon Risk Services,Inc of Florida NAME: j 1001 Brickell Bay Drive,Suite#1100 PHONE 800-743-8130 FAX 800-522.7514 A/C No.Ext: A/C,No): Miami,FL 33131-4937 E-MAIL ADP COI-Center@Aon.com ADDRESS: - PRODUCER 10762287 CUSTOMER ID#: INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:New Hampshire Ins Co 23841 ADP TotalSource MI XXX,Inc. INSURER B: 10200 Sunset Drive Miami,FL 33173 INSURER C: ALTERNATE EMPLOYER INSURER D: Cotti-Johnson HVAC,Inc. INSURER E: 80 Cedar St Canton,MA 02021 INSURER F: COVERAGES CERTIFICATE NUMBER: 308176 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. LIMIT'S SiloWN AREAS R!i R1ES"I`I:?. INSR ADDL SUBR POLICY EFFECTIVE POLICY EXPIRATION I LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER DATE(MM/DONYYY) DATE(MMI)DNYYY) LIMITS ' GENERAL LIABILITY EACH OCCURRENCE $ ❑COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ _ 0 CLAIMS MADE ❑OCCUR PREMISES(Ea occurrence) .j IVIED EXP(Any one person) $ !. GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ i ❑ GENERAL AGGREGATE POLICY O PROJECT ❑ LOG $ PRODUCTS-COMP/OPAGG $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ❑ANY AUTO (Ea accident) $ I. " ❑ALL OWIJED AUTOS BODILY INJURY $ � ❑SCHEDULED AUTOS (Per person) i ❑HIRED quros BODILY INJURY $ ❑NON OWNED AUTOS (Per accident) _ PROPERTY DAMAGE $ i (Per accident) ❑ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ I ❑ EXCESS LIAB CLAIMS-MADE AGGREGATE $ ❑ DEDUCTIBLE $ 1 ❑ RETENTION $ $ .' A WORKERS'COMPENSATION AND WC 012438946 MA 07/01/11 07/01/12 ®WC STATU- 0 OTHER EMPLOYERS'LIABILITY TORY LIMITS '4 ANY PROPRIETORIPARTNE-RIEXECUTIVE ❑OFFICER/MEMBER EXCLUDED? NIA E.L.EACH ACCIDENT $ "2,000,000 { (Mandatory in NH) - E.L DISEASE-EA EMPLOYEE If yes.descdbecnder $ 2,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT $ 2,000,000 t' I I: f DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) All worksite employees working for the above named client company,paid under ADP TOTALSOURCE,INC.'s payroll,are covered under the above stated policy. The above named client is an alternate employer under this policy. ik j` a C CERTIFICATE"HOLDER :;;: CANCELLATION „ ..•. ..:: ' •' .;,` f COTTI-JOHNSON HVAC,INC. '`". SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 80 CEDAR ST :i„ THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. fi CANTON,MA 02021 AUTHORIZED REPRESENTATIVE (' on6?Z 9f'eetsize.s, Qncof�f��ticla. I g „ ©1;9882009.;ACORD:CORPORATION All hts:eserved' The ACORD name and logo are registered marks of ACORD (I n p IY: THEr Town of.Barn-stable ` Regulatory Services F I . su►xsx�s[.� .P M.ta9 Thomas F.Geiler,Director 16.19L o Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 509-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I , as Owner of the subject.property here authorize �o � f �S���N S b,� to act on my behalf, in all matters relative to work authorized by this building permit application for: /4--f e7t � (Addr4s of Job) I Al z Signature v er --gate Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RM S:O WNF-U ERMISS)ON Town of Barnstable N� 0 Regulatory Services 8�RNST,BL- 1 Thomas F. Geiler,Director vanes. P ib39 e.,0� Building Division rfOi Tom Perry,Buildfng Commissioner 200 Main-Street,_Hyannis,MA.02601 www.town-barnstable-ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOl%EOV/NER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number strut village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS t city/town state zip code T c 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 supervisor. DE><vNMON OF aar�OWNEx Persons)who owns a parcel of land an which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constrycts more than one home in a two-year period shall not be considered a bomeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building.Official, that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes 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 Building Department •X minim=inspection procedures and requirements and that he/she will comply with said procedures and M requirements. Signature of Homeowner Approval of BuildingOficial 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 perfomung work for which a building permit is required shall be exempt from the provisions of this sectign.(Section 1D9.1.1 -Li=nsifig of otrnstruetion Supcnrisors);provided that if the homeowner engages a persons)for hire to do such work,that s�uCch Homeowner shall act as supervisor. Many homeowners who use this exemption are unaware that they are assuming the responstbilities of a supervisor(see Appendix Q. Ru1cs&Regulations for Licensing Construction Supervisors,Scction 2.15) This lack of awareness often results in serious problcma,particularly when the homeowner hires unlicensed persons. In,this ease,our Board cannot proceed against the unlicensed person as it A ou)d with a liaescd Supervisor. T'hc homeown cr acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her-respormbilides,many communities require,as part of the permit application, that the homcowncr certify that hcJshe understands the responnbilities of a Supervisor. On the last page of this issue is a farm currently used by several towns. You may care t amend and adopt such a fann/certification for use in your community. Q:foT ns:homccxcmpt r. � � � ► a � � a v v a v � v oarb of Rcgiztratton of �jeet �t�cf or erg abiug �ati�fieb tY e re uiremeut� of �� ' j � � c1jT��ett� QbeueLar law, p (C1japter 11.2, *ectiou 237 ttjrougb 251. QW0010th 19zly,1100, Inc i!6 berebp grauteb tbi.5 certificate no. 355 a5 ebibellre to practice aq a *beet 41etal oft tbi!6 911) bap of l.ap 2011 art Teotinioitp Mjereof, i.5 bereunto affixeb tYje natue of Up (Exectttibe,mirector of tYje 38oarb COMMONWEALTH OF IUTASSACFId1�SHEEI META SETTS F A BUSINESS y ISSUES THE ABOVE LICENSE TO CEVI'N L MAIN . OTTI—J0HN8DN HVAC 0 , CEDAR ST tltC M ANT'.DN MA; 02021 0:00 r 05/09/13 99$4 355 � � APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number 7 741 AJdress _ • 4, go V License # l 9 ? 1 ' SO VI-1/ P eAl All Home Improvement Contractor# Worker's Compensation # /)/,)//A ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO L SIGNATURE DATE `Z® TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map -1 Parcels. y Application # ,__�o Health Division Date Issued Conservation Division n�� Application Fee Planning.Dept. Permit Fee [ ® Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation /Hyannis !fy Project Street Address r Q��- �g Ply G,n rt i S fYIASS Village Owner A\qg f RU(A4 141 Address I p Telephone ZZ`f G / /j P \gorf aA hrl� fWA Permit Request (n `J J^S ccow o P—C JP Square feet: 1 st floor: existing SY3R proposed SN9 2nd floor: existing proposed Total new Zoning District \jS 1>ne S S Flood Plain Groundwater Overlay Project Valuation + a O Q-00 0 Construction Type � ��� ;� Lot Size �S� U 3 3 K F Grandfathered: ❑Yes &(No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes M"No On Old King's Highway: ❑Yes U No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Ndr\k Basement Finished Area (sq.ft.) �'� Basement Unfinished Area (sq.ft) I Number of Baths: Full: existing new Half: existing new �- P ; .m 7 Number of Bedrooms: existing _newer Total Room Count (not including baths): existing _ new First Flo(6Room Couht Heat Type and Fuel: Ig Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: : Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: 0 existing, ❑ yi.pw size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial M'Yes ❑ No If yes, site plan review# Current Use Lcw r4rr Proposed Use L f U "lA� A APPLICANT INFORMATION (BUILDER OR HOMEOWNER) CC p Name �\XAW Cjnd�VJ4 100 �In IL Telephone Number (' Address A cQ,xe\\ Q �G L JV t4 License #rh Home Improvement Contractor# t 1' Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE wl i DATE A �I o .r a FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED , 4 i MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME 3 INSULATION s FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f, GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1l�4rPItT1L't8£Of dfZ�BlStt'�Cdd tRCCECd2P2P3` Office of Investigations t 600 Washington Street Boston,AM 02111 www.mass gnv/diva Woriters' Compensation Insurance Afi'idavit: 1$uilders/Contractors/Electricians/Plumbers Appticalnt Information } Please 11ritnt Leeibly Name Husiness/Or anizat on/Individual):— ' `L Lf-iI +� '-1 fr! Address: == �: � C. L �tn j �� City/State/Zip: .e.,; a`�/ ► € t ` Phone#: ;. r Are you an employer?Cheek the appropriate bog: 'Type of.project(required): 1.❑ I am a employer with 4. M Lam a general contractor and I 6. .❑New construction employees(full and/or part-time).* have hired.the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet i 7. Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its !0.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I l.❑Plumbingrepairs or additions myself[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' 13.❑Other comp._insurance required.] *Any applicant that checks bug#1 must also fdl out the section below showing their workers'compensation poll y 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 roust attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information. f am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information i Insurance Company Name: ;€ c`- =` ' 'w=�` i;G i t l )C�t lLA - Policy#of Self-ins. Lie.#: t`7 t`'Pr:Z {��� i Expiration Date:T_41 95 Airport Road Hyannis, MA Job Site Address: City/State/Zip: 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,u¢nder the pains aridpenal es ofperjuty=that the information provided above istrue and correct . Signature: t t ' t f }` Date ' [ ( Phone M 1 ! �1 i+3 f i 9 Qfficial use oky. Do not write in this area,to be completed by city or town official City or ToAi,_d: Permit/Lkense#€. Issuing Authority(circle one) 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector t G.Other Contact Person: Phone#: 1 1 A�® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1 08/30/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Diane Shaw Fred C.Church,Inc. NAME: 41 Wellman Street PHONE g7g 3227272 FAX (g7g)454-1865 Lowell,MA Street A/C No Ext: A/C No Lowe)1,MA 018 E-MAIL dshaw@fredcchurch.com ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: Citation Insurance Company 40274 INSURED INSURER B: National Union Fire Insurance Company of Pittsburgh,PA 19445 Advantage Weatherization,Inc. INSURER C: Navigators Insurance Company 42307 Two Adams Place,Suite 100 Gemini Insurance Company 10833 Quincy,MA 02169 INSURER D: INSURER E: Starr Indemnity&Liability Company 38318 INSURER F COVERAGES CERTIFICATE NUMBER: 18541 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. I�TR TYPE OF INSURANCE ADDL SUER POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X DAMAGE TO RENTED 100,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE rx] OCCUR MED EXP(Any one person) $ 5,000 D VUMA0000890 4/2/2011 4/2/2012 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 MPRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident) $ ANY AUTO BODILY INJURY(Per person) $ A ALL OWNED JX SCHEDULED BBNT98 4/2/2011 4/2/2012 AUTOS AUTOS BODILY INJURY(Per accident) $ XHIRED AUTOSNON-OWNED PROPERTY DAMAGE $ AUT Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5.000,000 E EXCESS LIAB CLAIMS-MADE SISCCCLO1523811 6/20/2011 6/20/2012 AGGREGATE $ 5,000,000 DED I X I RETENTION$0 $ WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I ER 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ B OFFICER/MEMBER EXCLUDED' N/A 006430048 6/20/2011 6/20/2012 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1,000;000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $10,000,000 X of$5,000,000 C Umbrella NY11EXC7111931V 6/20/2011 6/20/2012 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) As required by written Contract,95 Airport Road Realty Trust,RKB Architects&the Town of Barnstable are included as Additional Insured's as their interest may appear. CERTIFICATE HOLDER CANCELLATION Advantage Construction,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Two Adams Place,Suite 100 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Quincy,MA 02169 AUTHORIZED REPRESENTATIVE P lient# Mst# 18541Cert Holder# ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD CERTIFICATEOATE(MMIDD/YYYY ®F LIABILITY' INSURANCE ) 911l2011 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 SELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE.A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED;the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C NTACT NAME: ICAG,LLC PHO • 847-639-1040 EMAIL I NE A N_ 847-639-4950 8715 Cary Algonquin Road AODRESS: certs ice rou ca tive.com Cary,Illinois 60013 1NSURER(S).4FFOROING COVERAGE MAIC q INSURED 1NSURERA: Arch Insurance Company _ 11150 Cape Cod Concrete Cutting INSURERe: Arch Insurance Company 11150 INSURER C; Arch Insurance Company 11150 PO Box 572 INSURER D: West Wareham,MA 02576 INSURERE: COVERAGES - 'INSURER F: CERTIFICATE NUMBER: 106-1-1 Or 2-10 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAWE BEEN ISSUED TO-THE'INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY 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. LT'R TYPE OF INSURANCE D SDY EFF. M Y EXP - . POLICY NUMBER LIMITS.GENERAL LIABILITY gD URRENCE is 1,000,000 X COMMERCIAL GENERAL LIABILITY �ZAGLB9100500 1/28/2011 1/28/2012 0�0fel ce ce s 100,000 CLASIABILIE OCCUR (Arty one person) S 10,000 X XCU LIABILITY A L 8 ADV INJURY S 1 000 000 Limited Pollution Limits $50t1,00 AGGREGATE 3" 2 000,000 GENT AGGREGATE LIMfT APPLIES PER Stop Gap Llablllty(fOr MOrIOpOIIS iC StateS) S-COMP/OP AGG 5 2000000 POUCY PRO LOCSto Ga Limits 1 000 000 Occ r 1 000 0 0 Geri AAUTOMOBILE LIABILITY SiNGLEiiMIT ANY AUTO BODILY INJURY(Per person) S ALLOWNAjSCHEDULEDAUTOSTOSBODILY INJURY(Per aHIREDATOS NED PeOPER�ITUAMAGETOS PHYSIMBRELLerin OCCUR EXCESS LCLAI,MS-MADE NIA EACH OCCURRENCE 5 _ N/A N/A AGGREGATE S" DED RETENTIONS 10,000 'Incidental coverages written on"Claims Made"basis s WORKERS COMPENSATION AND EMPLOYERS'LIABILITY WC STATU OTH- ANYPROPRIETOR/PARTNERrEXECUTIv> YIN ZAWCi919020D 1l28/2011 1/28/2012 C OFFICERIMEMBEREXCLUDE[ Q NIA E.L.EACH ACCIDENT 5 1,000.000 (Mandatory b NH) E.L.DISEASE EA EMPLOYE $ 1,000,0016 IIyeS describe urxler DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 Property/Equipment-DED$1.000 ZAGL89100500 1/28/2011 1/2812012 S 100,000 A Leased/Rented Property and Equip en!fc r vrhi h the insured is'responsibie to InsureiNo Sublimif P r Item S 50l),000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Romanis Schedule,H more space IS required) For All Operations. Advantage Construction,95 Airport Road Realty Trust,RFBcArchitects,Inc.and the Town of Barnstable are named as additional insureds Please refer to the attached Broad Form Named Insured endorsement Architects and Engineers are not included for Professional Liability CERTIFICATE BOLDER CANCELLATION Advantage Construction,Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Two Adams Place Suite 100 ACCORDANCE WITH THE POLICY PROVISIONS. Quincy MA '02169 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION."All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 95 Airport Road Hyannis, MA Subcontractor Address City,State,Zip Selective Demolition Advantage Weatherization, Inc. 2 Adams Place,Suite 100 Quincy, MA 02169 Light Gauge Metal Framing/Drywall Advantage Weatherization,Inc. 2 Adams Place,Suite 100 Quincy, MA 02169 Painting Brothers Painting 145b Barnstable Rd Hyannis, MA 02601 Plumbing Tunney Plumbing&Heating 9 Noel Henry Drive East Sandwich, MA 02537 HVAC Cotti-Johnson HVAC, Inc. 80 Cedar Street . Canton, MA 02021 Electrical&Fire Alarm Hannon Electrical 15R Commerce Way Norton, MA 02766 i Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality,L7 100132041 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition Wlenfafngout 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 unitsTis 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 housir g'autF ority, owner-occupied - Instructions residence of four units or less?❑Yes ❑✓ No 1.All sections of b.Provide blanket decal number if applicable: this form must be Blanket Decal Number completed in order to comply with the 2• Facility Information: Department of DETAIURECON CENTER v Environmental Protection a.Name notification 95 AIRPORT ROAD requirements of b.Address 310 CMR 7.09 H annis - i MA i 102601 . c.Cit own d.State e.Zip Code (781)848-8787 1 Ijkelly@condyne.com f.Tele hone Number area code and extension E-mail Address(optional) 5,000 1 h.Size of Facility in Square Feet i.Number of Floors j.Was the facility built prior to 1980? ❑ Yes ❑✓ No k. Describe the current or prior use of the facility: VACANT I. Is the facility,a residential facility? ❑ Yes ❑✓ No �o m. If yes, how many units? Number of units 3. Facility Owner w -N 95 AIRPORT ROAD REALTY TRUST - -o a.Name 0 95 AIRPORT ROAD b:Address HYANNIS MA 02601 c.Cit own d.State e.Zip Code �o _ f.Tele hone Number area code and extension .E-mail Address o tional C BILL KELLY �Q h.Onsite Manager Name ag06.doc•10/02 BWP AQ 06-Page 1 of 3 f Massachusetts Department of Environmental Protection Bureau of Waste Prevention.•Air.Quality f 100132041 Ll�_);\ Decal BWP, AQ 06 Notification Prior to Gonstructiori or,Deri oliti6h General B, General Project Descri tlon cont x Statement:If J7 p� � � 3 asbestos is found during as Construction or 4. General Contractor Demolition ADVANTAGE"CONSTRUCTION INC operation,all _ ...........- responsible parties a.Name s r cs: must comply with TWO ADAMS PLACE; SUITE 100 , 310 CMR 7.00, b.Address 7.09,7.15,and Chapter 21 E of the QUINCY $ MA s 62169 General Laws of c.Ci /Town '" * 'd;State ^> e:.Zi Code the Commonwealth. 617 237-1840 � 4- ( ) jkelly@condyne.com This would include, f.Tele hone Number area code and extension .E-mail Address o tional but would not be limited to,filing an BILL KELLY asbestos removal h:On-site Manager Name notification with the Department and/or �. a notice of release/threat of C.General Construction oIr Demolition Descri tion L n release of a ¢L p, hazardous substance to the o 1. Construction or demohtion�contractor.., `` : �� •• . . � Department,if q , applicable. ADVANTAGE CONSTRUCTION;;1_INC a.Name TWO ADAMS PLACE; SUITE'10Q.: x b.Address ea QUINCY t MA11 � 02169 c:Ci /Town d:State e.Zip'Code (617)237-1824: &" jkelly@condyne`:corrS ¢" f.Tele hone Number area code and extension E-mail Address'(optional) , BILL'KELLY. y ..........` ^ h. n-site Manager.Name <. �, .r :: 2. On-Site Supervisor: BILL KEL`LY e. ¢ On-Site Supervisor Name o a b 4 t 3. Is the entire_Rfacility-to be'demolished? _.[� Yes ✓[� No -° 4. Describe the areas)to,be:dernolished s" ; o SELECTED DEMO INCLUDING DRYWALL,CMU&CONCRETE Al Ay ° 5: If this Is a construction project describe the building(s)or additions)to be constructed: RENOVATIONS i �Oa ag06.d6c 10/02 BWP AQ 06+Page 2 of 3 Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention •Air Quality 100132041 L7i Decal Number 3. 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)? ❑✓ Yes ❑ No If yes,who conducted the survey? UNIVERSAL ENVIRONMENTAL b.Su[yoyor N me AA000177 c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 08/22/2019 �� 12/31/2011 � a.Start Date(mm/dd/yyyy) b End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate'dust suppression techniques to be used ❑ seeding ❑ paving ❑✓ wetting ❑ shrouding b. If other, please specify: ❑ covering ❑ other 9. For Emergency Demolition Operations;who is the DEP official who evaluated the emergency? NA _ a.Name of DEP Official r NA b.Title . 08/10/2011 c.Date mm/dd/ of Authorization— NA d.DEP Waiver Number D. Certification , M I certify that I have examined the.l IJOHN KELLY =o above and that to tie best of my a.Print Name �o knowledge it is true and complete. JOHN KELLY The signature below subjects the b.Authorized signature - N signer to the general statutes 1PRESIDENT =o regarding a;false and misleading c. Position e _o ' statement(s). JADVANTAGE CONSTRUCTION, INC H d.Re resentin 08/10/2011 �o e.Date(mm/dd/yyyy) 0 �D �Q ag06.doc•10/02 BWP AQ 06•Page 3 of 3 Aug. 19. 2011 9:05AM ORLEANS TOYOTA OFFICE No , 0245 P• 1 own of Barnstable i6S9. Town • lBD Regulatory Services Thomas F. Geilar,Director Building Division Thomas Perry,Cl30 Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town,barnstn We.ma.as Office: 508-862-403 8 Fax: 508-790-623 0 Property Owner Must Complete and Sign This Section If Using A Builder • . T....__r �.. ...--'• ,�-•-:�"""....,�.,.as.4womr of Chi subjectproperry � ---•--'- ... .�_..-- -- -• hercby a oriac F+ lrvt!1 `�Y11��i UY1 to act on my behalf, in all matters relative to work atithorixed by this buildingpextnit application for o cQ (Addreas of f ob) 17 Sigz,atu of er Da Print N e If Property Owner is applying for permit,please completc the Homeowners License gxemption lipr►rt'on the reverse side. I . QAWPFILE9IF0kWS1bm1ding pem%il formslEXPAj5SS.duc kovised 072110 �I 24TVANTAGE Construction,Inca Two Adams Place,Suite 100 Quincy,MA 02169 Phone: (781)848-8787:, Fax: (781)848-3774 August 19, 2011 Tom Perry Town of Barnstable 368 Main Street Hyannis, MA 02601 - Re: Hyannis Toyota 1020 Iyanough Road Hyannis Ma 02601 Dear Tom Perry: Please accept this letter,of notification that William G. Kelly, an employee of Advantage il. Construction, Inc., has been appointed to be our full time Superintendent for the project listed above. If you have any question, please feel free to contact our office at(617)237-1840 Sincerely Advantage Construction, Inc. Jo Q. Kelly Pres'dent — l�lasachir,etis - Dclrrrtrr���nt +,f Boar(I of Buildiri�j Public Safeti RerTul i ( StdrI d,onsruction ` Supervisor License 4 License: CS 19925 2 Restricted - WILLIAM G KELLY PO BOX 395 S DENNIS, MA 02660 �c Expiration: 6/13/2012 ('u nuu i„iutjer Tr#: 27030 Restricted to: 00 00 - Unrestricted x •_ 1 G- 1 2 Family Homes {. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS DVANTAGE ." '. m Construction,Inc.. Two Adams Place,Suite 100 Quincy,MA 02169 Phone: (781),848-8787 Fax: (781)848-3774 August 19,2011 ' - • Y .y,, sty a ', - ` • n•e f Tom Perry Town of Barnstable y. 368 Main Street Hyannis, MA 02601 :# Re: Hyannis Toyota 1020 Iyanough Road Hyannis Ma 02601` Dear Tom Perry K - .k. Please accept this-letter,of notification.that Mark T6bia,:is an employee.of Advantage Construction,-Inc. and will assist William G. Kelly,our,full.time Superintendent for the project listed above. If you have any question,please feel free to contact our office at`(617)237-1840 Sincerely. a } Advantage Construction;;Inc 24 J C. Kelly Pr ident . u A. Pr: •x4 , f BCONSTRUCTION CONTROL AFFIDAVIT Project Name: Interior Renovations Project#: 1144 Project Location: 95 Airport Road Date: 8/17/112011 Hyannis, MA Project Description Interior Renovations for Car Care Center To the building commissioner of the city/town of Hyannis, in accordance with The Massachusetts State Building Code I,Wayne E Benson,Jr., Registration No. 10731, being a registered professional engineer/architect in the following discipline: ARCHITECTURAL ® STRUCTURAL ❑ MECHANICAL ❑ FIRE PROTECTION ❑ ELECTRICAL ❑, OTHER ❑ Hereby certify that I have prepared or directly supervised the preparation of all base building E Architectural Plans, Computations and Specifications for the above named project. 0 u s To the best of my knowledge, information and belief,such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,acceptable engineering practices and applicable laws and ordinances for the proposed use and occupancy. 0 m I further certify that I shall perform the necessary professional services and be present on the Cq construction site on a regular and periodic basis to determine that the work is proceeding in accordance FD with the documents approved for the Building Permit. I shall submit periodically,a progress report 0 together with pertinent data to the Building Commissioner. Upon Completion of the work I shall submit a Final Report as to the satisfactory completion and readiness of the project for occupancy. ®•a CD ✓��-RED AR,, Therefore, I request a Building Permit be issued for the above address. a ,' �� EDSONBF,yT��� Z 's o 0 U) t No. 10731 J E NORTH EASTDN, ro Seal: �0 MA SrGNATLAL OF MPSSP� 6 SS: On this 17 h day of August, 2011 AD before me,the undersigned notary public personally Wayne E. Benson,Jr., proven to me through satisfactory evidence of identification,which were MA State Drivers License,to be the person whose name is signed on the preceding or attached document in my e a presence. E ca V , O " (Wary P blic) M _ a My Commission expires: GI L V Y 2011.08.17 CC Affidavit dnrr TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 104 Map., Parcel 0 ` Application # d �J Health Division Date IssuedCIA °C 1 Conservation Division Application F ly Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board qll qIII W/,9 UrJ Historic - OKH Preservation/ Hyannis o Project Street Address r e EggT' Rol)y Village l S' Owner `�6i A R f o RT )2641-Ty 'TRC167 Address Telephone 7!Y 2 CIO— /-3 Permit Request LA1IR Ri a R McAl S%),-VC y J219L P elieL, fir/ p /9-Zl lYd CUT P,4A 60A rt/t�ic! ' Ufa/ R_ e lz o o ►° z o&R,( AJG Square feet: 1st floor: existing . proposed: IV 2nd floor: existing proposed A_Total new- MP Zoning District 13 ul`s, Flood Plain Groundwater Overlay A10 Project Valuation 00 a Construction Type R'61A101-le Lot Size �2 2' 0 _7> 3 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) 409. Age of Existing Structure © YR Historic House: ❑Yes C7'No On Old King's Highway: ❑Yes ©< Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other 5YA,9 Basement Finished Area(sq.ft.) �✓�� Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new �L Half: existing it/,9L new 2- Number of Bedrooms: /V /9 existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: C�'Gas ❑ Oil ❑ Electric ❑ Other Central Air: Ulles ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: 0 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 yiv o_a Proposed Use 19 y 1-0 n 1? TA APPLICANT INFORMATION (BUILDER OR HOMEOWNER) C `f Name W) it /c el% V Telephone Number 7;7�1 Address Et, Re License# C S 1`j 7 2 6 — & 1 yq, DO"; S AM' 0 1� Home Improvement Contractor.# IV, A Worker's Compensation # >' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE :l✓ 1/ � DATE ' . � FOR OFFICIAL USE ONLY M AP,P,LICATION# l , PATE ISSUED 4P/PARCEL NO, ' i ADDRESS VILLAGE OWNER . DATE OF INSPECTION: , ' FOUNDATION FRAME INSULATION' FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS:- z vi - ROUGH :,,-­ FINAL 'FINAL BUILDING' _ -r . :DATE CLOSED OUT . ASSOCIATION PLAN NO. , r The Commonwealth of Massachusetts Department of1'n Accidents .Office of Investigations. 600 Washington Street Boston,MA 02111 www.mass govldia Workers' Compensation n.snrance Affidavit:Builders/Contractors/Electricians/Piti mberg Apmcant_Information _ Please Print Legibly Name(Business/Organizationnndividual) Address: a, 1 ,A. Cityaate/Zip: 1 0%C 6-aAL1 Phone* Are you an employer?Check the appropriate bog: Type of praject(regnired)t 1.❑ I am a employer with 4. (� ham a general contractor.and I 6.. []New construction employees(fuil.andfor part-time).* have hired the sub-contractors 2.El.I am a sole proprietor or partner listed on the attached sheet x 7. :®Remodeling ship and have no employees These sub-contractors have 8. C]Demolition. working for me in.any capacity. work ers'comp insurance, g, .QBnilding addition [No workers'comp.insurance 5. ❑ We are a corpatinnd its required:] offcers.liave exercised their 1OF1 Electricalrepairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL !t.❑Plumbing repairs or additions. myself.[No workers'comp. c. 1.52,§;1{4);and we have no 12.❑Roof repairs insurance required.]t employees.[No workers' comp.insurance required] 13;❑Other' `Any applicant that checks box fl 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. lContractors that.check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy.information. r am an employer that(Providing-workers'compensadon fnsurwwe for my employees. Below is the policy,and job site information. Insurance'Company G' ` .Policy#of Self-ins: Lie # r"3 L��� t .i� Expiration Date:at 95 Airport Road Hyannis, MA Job Site Address- City/State/Zip:_ _. Attach a copy of the workers'compensation policy declaration page(showing the policy number and:expiration date). Failure to secure coverage as requtred'under Section 25A ofMGL c. 152 can lead to the imposition.of chininal penalties of a fine up to S1,500:00 and%or one-year.impnsonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 a day against'the violator._.Be advised that a copy of this statement may be forwarded to the Office of Investigatiorls.ofthe DIA for insurance coverage verification:. 1 do hereby'certify under the paw and penalties of perjury'that the information provided above is true and correct St ature: �, DaterI-J Phone official use o ly. Do not,write in this area,to be completed by city,or town official City or Permit/License# `Issuing.44hority(circle,-0ne): 1.Board:ofliealth 2.BuildiAgDepartment 3.C tyCTown Clerk: 4.ElectricaCInspector 5 lPlunibing:I6s6eci6e 4.0ther. Contact Person: Phone#: _ 95 Airport Road F; Hyannis, MA Subcontractor Address City,State,Zip Selective Demolition Advantage Weatherization,Inc. 2 Adams Place,Suite 100 Quincy,MA 02169 Light Gauge Metal Framing/Drywall Advantage Weatherization,Inc. 2 Adams Place,Suite 100 Quincy,MA 02169 Painting Brothers Painting 145b Barnstable Rd Hyannis,MA 02601 Plumbing Tunney Plumbing&Heating 9 Noel Henry Drive East Sandwich,MA 02537 HVAC Cotti-Johnson HVAC, Inc. 80 Cedar Street Canton,MA 02021 Electrical&Fire Alarm Hannon Electrical 15R Commerce Way _ Norton,MA 02766 . t 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. IMPOR T: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement..A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Beth Sheehan NAME: AlInslow Warren Insurance Agency PHONE (508)668-1612 FAX No:(SO8)668-79D6 $96 Main $t. E-MAIL ADDRESS:Beth@winslowwarreninsurance.com P. O. Box 71 CRODOUCERUST ER 10 0095093 war le MA 02081 tNSURER S AFFORDING COVERAGE NAIC s INSURED INSURERA:Peerless Insurance 24198 INSURER B Hannon Electric, Inc. INSURER C: 15R ComInerce Way INSURERD: INSURER E: Norton MA 02766 INSURERF• COVERAGE$ CERTIFICATE NUMBER:Ma-terCertifiaate2011 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. LTRR TYPE OF INSURANCE POLICY NUMBER MMWD EFF MWDD EXP LIMITS _ GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED— A CLAIMS MADE E OCCUR X P5274195 /11/2011 /11/2012 PREMISES occurrence $ 100,000 MED EXP(Any one person) $ 15,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 X POLICY JECTPRO LOC S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 ANY AUTO (Ea accident) 274189 BODILY INJURY(Per person) $ A ALL OWNED AUTOS /11/2011 1/11/2012 BODILYINJORY(Per accident) $ X SCHEDULED AUTOS • PROPERTY DAMAGE X HIRED AUTOS - (Per accident) S X NON-OWNED AUTOS PIP-Basic S Aub Extension Endorsement S X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 EXC Ise UAB CLAIMS-MADE - _ AGGREGATE S 1,000,000 DEDUCTIBLE § A X RETENTION S 5 000 822156 /11/2011 /11/2012 S A WORKERS COMPENSATION WC STATU- OTH AND EMPLOYERS'LIABILITY YIN O YER ANY PROPRIETORIPARTNER/EXECUTIVE E.L EACH ACCIDENT $ 500,000 OFFICF_R/MEMBER EXCLUDED'? N I A (Mandatory In NH) 274191 /11/2011 /11/2012 E.L.DISEASE-F-A EMPLOYE $ 500 000 If yes,describe under DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT S 500,000 Business Personal 39,321. A Property ICBP5274195 /11/2011 /11/2012 Deductible 500. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more space Is required) All electrical contracting operations of the insured. 95 Airport Road Realty Trust, RIB Architects, Inc. 6 Town of Barnstable are named as additional insured CERTIFICATE HOLDER CANCELLATION (781)$48-3774 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, .NOTICE WILL BE DELIVERED IN Advantage Construction, Inc. ACCORDANCE VATH THE POLICY PROVISIONS. 2 Adams Place, #100 Quincy, M 02169-7456 AUTHORIZED REPRESENTATIVE Beth E. Sheehan ACORD 25(2009109) 01988-2009 ACORD CORPORATION. All rights reserved. tN$o25(zoosos) The ACORD name and logo are registered marks of.ACORD 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 PRODOCER,AND THE CERTIFICATE HOLDER. .-IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER - CONTACT Diane Shaw Fred C.Church,Inc. NAME: 41 Wellman Street PHONE 978 3227272 FAX (978)454-1865 A/C No Lowell,MA 01851 E-MAIL (800)225-1865 ADDRESS: dshaw@fredcchurch.com INSURE S AFFORDING COVERAGE NAIC# INSURER A: Chartis Property Casualty Company 19402 INSURED INSURER B. Charter Oak Fire Ins.Co. 25615 Advantage Construction,Ina INSURER C: Navigators Insurance Company 41307 Two Adams Place,Suite 100 Travelers Casualty Insurance Company of America 19046 Quincy,MA 02169 INSURER O INSURER E: Starr Indemnity&Liability Company 38318 INSURER F: COVERAGES CERTIFICATE NUMBER: 18537 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. ILTR TYPE OF INSURANCE ADDL U R POLICY NUMBER MMIDDYIYYYY MM/DO EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO R TED 300,000 PREMISES Ea ocaurence $ CLAIMS-MADE M OCCUR MED EXP(Any one person) $ 5,000 B 464DI464 .. 620/2011 620/2012 PERSONAL&ADV INJURY $ 1,000.000 GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2.000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY Ea aBBINED INGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ D ALL OWNED SCHEDULED 810464DI476 6202011 620/2012 BODILY INJURY(Per accident) $ AUTOS AUTOS 'X HIRED AUTOS N NOTOSWNED PROPERTY DAMAGE $ Pe acdde t $ X UMBRELLA LJAB X OCCUR EACH OCCURRENCE $ $5,000,000 E EXCESS LIAB CLAIMS-MADE SISCCCLO1523811 620/2011 620/2012 AGGREGATE $ $5.000.000 DIED X I RETENTION$0 $ WORKERS COMPENSATION VYC STATU- OTH AND EMPLOYERS'LIABILITY IER ANY PROPRIETOR/PARTNERIEXECUTIVE YIN N E.L.EACH ACCIDENT $ 1,000,000 A ❑ N/A 006430048 6/20/201 i 620l2012 OFFICER/MEMBER EXCLUDED? _ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under 1.000 000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ $10,000,000 X of$5,000,000 C Umbrella NY11EXC7111931V 6/20/2011 6202012 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Certificate Is issued as evidence of coverage. CERTIFICATE HOLDER CANCELLATION own or t5amstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1200 Phinneys lane THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Hyannis,MA 02601 - - - AUTHORIZED REPRESENTATIVE -- - -r. P Client# Mat# 18537 Cert Holder# 01988-2010 ACORD CORPORATION. All rights reserved. r ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD . D VANTAGE Construction, 111C. Two Adams Place,Suite 100 Quincy,MA 02169 Phone: (781)848-8787 Fax: (781)848-3774 August 19,2011 Tom Perry Town of Barnstable 368 Main Street Hyannis,MA 02601 Re: Hyannis Toyota 1020 Iyanough Road Hyannis Ma 02601 Dear Tom Perry: Please accept this letter of notification that William G. Kelly, an employee of Advantage Construction,Inc.,has been appointed to be our full time Superintendent for the project listed above. "" If you have any question,please feel free to contact our office at(617)237-1840 Sincerely Advantage Construction, Inc. Jo C. Kelly Pres'7 t '- tVla� achu,ctt� - Dcp.ir-trilciit of Public �Safcti Board of Building] •- R�wlatiuns and Siandar,ds Construction Supervisor License License: Cs 19925 Restricted to: 00 WILLIAM G KELLY PO BOX 395 S DENNIS, MA 02660 Expiration: 6/13/2012 t'ufiuu Tr#: 27030 Restricted to: 00 00- Unrestricted 1 G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WVVW,Mass.Gov/DPS Bureau of Waste Prevention •Air Quality 1100132041 Decal Number �._ 5WP AQ 06 Notification Prior to Construction or.Demolition Important: A. Applicability When filling out pp • y forms on the computer,use - only the tab key A Construction or Demolition operation of an industrial,commercial,or institutional building,or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection -do not use the return (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of use the 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 ❑✓ No 1.All sections of b.Provide blanket decal number if applicable: Blanket Decal Number this form must be completed in the order to comply with 2 Facility Information: Department l Environmental DETAIURECON CENTER ronme Protection a.Name notification 195 AIRPORT ROAD requirements of b.Address 310 CMR 7.09 H annis JIVIA - -� 02601 c.Citvrrown d. te a.Zip Code - (781)848-8787 , ' jkeily@condyne.com r f .E-mail Address(optional) 5,000 11 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: VACANT I. Is the facility a residential facility?. , ❑ Yes ❑✓ No O m. If yes,how many units? Number of units IQ� -° 3. Facility Owner a 95 AIRPORT ROAD REALTY TRUST �O a.Name �° 95 AIRPORT ROAD b.Address HYANNIS MA 02601 m d .State a,Zip Cade O f hoe N mber(area cgda and extension) 'I Address o f a a BILL KELLY �Q h.Onsite Manager Name ag06.doc•10/02 $WP AQ 06•Page 1 of 3 ' t . /h 1 Massachusetts Department of Environmental Protection Bureau of Waste Prevention •Air Quality 100132041 --� 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)? Q Yes ❑ No If yes,who conducted the survey? UNIVERSAL ENVIRONMENTAL b,Surveyor Ngme AA000177 c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 08/22/2011 12/31/2011 a.Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding paving 0 wetting shrouding b. If other, please specify: ❑ covering ❑ other 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? NA a.Name of DEP Official NA b.Title 08/10/2011 c.Date mm/dd/ of Authorization NA d.DEP Waiver Number D. Certification CO I certify that I have examined the IJOHN KELLY =O above and that to the best of my a.Print Name �o knowledge it is true and complete. IJOHN KELLY �— The signature below subjects the b.Authorized Signature signer to the general statutes 112RESIDENT =0 regarding a false and misleading c.Positlont I Itle c statement(s). JADVANTAGE CONSTRUCTION,INC d.Representing 08/10/2011 e.Date(mm/dd/yyyy) 0 �Q agO6.doc•10/02 BWP AQ 06•Page 3 of 3 LlMassachusetts Department of Environmental Protection Bureau of Waste Prevention •Air Quality 1 00132041 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General Statement:If B. General Projectp Description cont. asbestos is found during a 4. General Contractor: Construction or Demolition JADVANTAGE CONSTRUCTION,INC operation,all a.Name responsible parties must comply with ITWO ADAMS PLACE;SUITE 100 310 CMR 7.00, b.Address _ -. 7.09,7.15,and gU1NCY MA 02169 Chapter 21 E of the General Laws of a Cltvfrown d.State e.Zip Code the Commonwealth. (617)237-1840 jkelly@condyne.com This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an JBILL KELLY asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threatof release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor. Department,if . applicable. JADVANTAGE CONSTRUCTION,INC a.Name TWO ADAMS PLACE;SUITE 100 .Address _ QUINCY MA f 02169 c. City/Town d.State e.Zp Code (617)237-1824 1 ljkelly@condyne.com f.Telephone Number area code and extension -mallAddress(optional) BILL KELLY h. n-s a manager Name 2. On-Site Supervisor: BILL KELLY On-Site Supervisor Name 3. Is the entire facility to be demolished? ❑ Yes 0 No N �0 4. Describe the area(s)to be demolished: �o SELECTED DEMO INCLUDING DRYWALL,CMU&CONCRETE N �a 0 5. If this is a construction project,describe the building(s)or addition(s)to be constructed: � RENOVATIONS �0 �C 0 0222 wlmwQ ag06.doc-10102 BWP AQ 06•Page 2 of 3 i of • a, `, � . . «r r,�: { •� b`; _. -s _ . _ a y • i i < l < r re.. • - - ... "�' p ....ice-. .�..r.•. :r - ;.. f s ¢. .� '"� � . r � i-4 lip r CJ t. co { t � ,E'•,� F "c a; �{ Y .a. �.y � '?•. � E�r} m a-n�A j. jL7 AN ja § tt ��pti�-}t� ey E �' g+ { r-rt p f 4 T « All? WS MUM t��4� Rt� . w,e <,•U�,��p ,,.tri}�zt..,SOME Es vh pill -.i< '� �' ? .. . •� - - },'.�E.y _:.a1 -+sue r Town of Barnstable Re ulato Semc es F g rY • to RlVcrl Af.P i ►&Las. Thomas F. Geiler,Director Eon Building Divisfon Tom Perry,Building Commissioner 200 Main 5trcet, Hyamiis,MA 02601 • ww�.to�vn.b arnstab le.ma.us Office: 509-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Us ing A Builder as Owner of the subject.property he y authorize to act oa my behalf, or is all unatteis relative to work authorized by this building permit application for. (Address of Job) ( � I -S A o ate Priat Nacre If Pro pertyOwneris applying for permit please complete.the Homeowners License Exemption FOrm on the reverse side. f T TROY WALL ASSOCIATES WATTORNEYS AND COUNSELLORS AT LAW 111 hr 90 ROUTE 6A SANDWICH, MASSACHUSETTS 02563-1866 T�{� '. �_` s�� ROBERT S. TROY BRIAN J. WALL June 13, 2011 VIA U.S. CERTIFIED MAIL RETURN RECEIPT. REQUESTED Thomas Ferry, Director Building Division Town of Barnstable 200 Main Street Hyannis, MA 02601 Re: Request for Zoning Determination Pursuant to Massachusetts General Laws Chapter 40A, Section 7 Dear Mr. Perry: Please be advised that I represent Jack G. Carter, Jr., the President of Hyannis Enterprises, Inc. and owner of Hyannis Toyota. This serves as a request, pursuant to M.G.L. c. 40A, § 7, for a zoning determination in order to confirm that the property located at,95 Airport Road can be used to wash, wax and detail new and used motor vehicles within the existing building. The subject property consists of, approximately, .64. acres. It is improved with an existing structure with approximately 5,100 square feet of interior space and an asphalt parking lot. The property is situated in a Business Zoning District and within the Groundwater Overlay Protection District. Mr. Carter proposes to use the property at 95 Airport Road to wash, wax and detail new and used cars that are sold through Hyannis Toyota. All the activity will occur within the building. Since the building is connected to the municipal sewer system, all the water used in the business will be discharged into ` the sewer;sewer; the activities in the building will not result in any discharge into the I ground. PHONE: (508) 888-5700 FACSIMILE: (508) 888-5701 June 13, 2011 Page 2 Permitted uses in the Business District include, but are not limited to, the following: 1. Retail and wholesale store/salesroom. 2. Retail trade service or shop. 3. Office and bank. 4. Restaurant and other food establishment. 5. Place of business of baker, barber, blacksmith, builder, carpenter, caterer, clothes cleaner or presser, confectioner, contractor, decorator, dressmaker, dyer, electrician, florist, furrier, hairdresser, hand laundry, manicurist, mason, milliner, news dealer, optician, painter, paper hanger, photographer, plumber, printer, publisher, roofer, shoemaker, shoe repairer, shoe shiner, tailor, tinsmith, telephone exchange, telegraph office, undertaker, upholsterer, wheelwright. 6. Gasoline and oil filling stations and garages. 7. Hotel/motel (subject to certain other provisions of the Zoning Ordinance). 8. Any other ordinary business use of a similar nature. Mr. Carter submits that his proposed use -- washing, waxing and detailing new and used cars —is allowed as-of-right in the Business Zoning District as such use falls within the allowed uses of"retail and wholesale store/salesroom," "retail trade service or shop", "garages," and "any other business uses of a similar nature." The use of"motor vehicle cleaning, service and repair" is prohibited in the I District. See Section 240-35 F 2 m . However, Mr. Groundwater Protection ( )( )( ) Carter will limit the proposed use to the interior of the building. Since the building is connected to the municipal sewer system, the proposed use will have no impact upon the groundwater. Furthermore, the existing use of the property is - r .. June 13, 2011 Page 3 as a laundry and, as such, is presently discharging significant quantities of water into the sewer system. For these reasons, Mr. Carter submits the use should be determined to be allowed. We appreciate your consideration of this matter and respectfully request that you render your decision within fourteen (14) days as specified in M.G.L. c. 40A, § 7. If you agree with our analysis, you can respond to this request by signing the proposed zoning determination set forth below. Thank you. Sincerely, Brian J. Wall Cc: Jack G. Carter, Jr. ZONING DETERMINATION This will confirm my agreement that the use of the property at 95 Airport Road, Hyannis, for washing, waxing and detailing new and used motor vehicles within the existing building is allowed as-of-right and does not require any approval or relief from the Zoning Board of Appeals. j; Dated: OomA' Perry Building Division �, Directo Town of Barnstable TOWN OF BARNSTABLE BUILDINC PERMIT (" PARCEL ID 294 071 GEOBAS ID 20834 .ADDRESS 96.. AIRPORT ROAD - _ <PHONE , IdYANNIS ZIP — LOT BLOCK LOT SIZE x DBA DEVELOPMENT DI.ST ICT NY PERMIT 69053 DESCRIPTION AID OFFICE SPACE INTERIOR WORK' ' PERMIT TYPE BREMODC TITLE COMMERCIAL ALT/CONY CONTRACTORS: MACHEERAS, MICHAEL, IJ�*)'De P artment of ` � "U1Jc,• Regulatory Services ARCHITECTS: TOTAL FEES:. $245.20 BOND $ 00 pF CONSTRUCTION COSTS $32,000-00 437 NONRES./ NHSKP ADD/CO 1 TE aiuwsr�B> , i I s639.:A�� BUILD GQfVISION BY BATE ISSUED 05/28/2003 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO.OCCUPY ANY STREET,.ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY:EN- CROACHMENTS ON PUBLIC PROPERTY,NOT 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 MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE THIS CARD KEPT POSTED UNTIL FINAL INSPECTION 1.FOUNDATIONS OR FOOTINGS PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH-_ (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS.- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4.FINAL INSPECTION BEFORE OCCUPANCY. POST THIS CA o , •, IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 3' 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID.IF CON INSPECTIONS INDICATED,ON.THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK.IS NOT'STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC MONTHS OF.DATE THE PERMIT I.S ISSUED;AS TELEPHONE OR WRITTEN NOTIFICA ... TION. NOTED ABOVE. TION. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 06 1 4 1 f Permit# _ c1 Health Division 0 -1x} `� ° A1'STABLE Date Issued S /o x Conservation Division L55 2P!)tI 7 3: �6 Application Fee Tax Collector Permit Fee 00 TreasurerDIVISION �--� Planning Dept, APPLICANT MUST OBTAIN A SEWER CONNECTION PERMIT FROM TH$ Date Definitive Plan Approved by Planning Board ENGINEERING DIVISION PRIOR TO CONSTRUCTION. Historic-OKH Preservation/Hyannis Project Street Address ao P'T Rb Village Owner YA 04 - '' ,(( , (I'A A • C 6R-A Address 5t9-M/F, 680�c Telephone 609- 7 7 r 91'12Q - ! i;QL 6414129 Permit Request I LNJ rt-6 4 1 -Y e'(6 0?0 AT �V,00-T- *t4n-�fl na . f I Al Square feet: 1 st floo : existing � •i 0 proposed 2nd floor: existing ►� proposed N 1 h�- Total new QijN� Zoning District Flood Plain Groundwater Overlay Projec+;`Valuation j� Construction Type Lot Size 2 S •034 Grandfathered: ❑Yes 21"No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes 26o On Old King's Highway: ❑Yes C'No Basement Type: ❑ Full ❑Crawl ❑Walkout orOther 6W" Basement Finished Area(sq.ft.) m\ i�- Basement Unfinished Area(sq.ft) Number of Baths: Full: existing O 1 new Half: existing of. new Number of Bedrooms: existing new Total Room Count(not including baths): existing 1 f� new _ First Floor Room Count Heat Type and Fuel: YGas ❑Oil ❑ Electric 0 Other Central Air: ❑Yes ❑No Fireplaces: Existing /40 9-A- New Existing wood/coal stove: ❑Yes UdNo Detached garage:❑existing ❑new size Pool: 0 existing ❑new size Barn:❑existing ❑new size - Attached garage:❑existing ❑new size Shed:O existing 0 new sized Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded 0 Commercial 0 Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Telephone NumberJ �D Address Z.?Z duw `'- License# CJ L-Y( / - Lr/, ar Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 6-- S- 0 F FOR OFFICIAL USE ONLY PERMIT NO. DATEJSSUED VAI P/PARCEL NO. 1 ADDRESS VILLAGE DATE OF INSPECTION: .. ' FOUNDATION J ' FRAME W? r INSULATION , FIREPLACE - ELECTRICAL: ROUGH a n-cn c-, FINAL' ;? PLUMBING: ROUGH r FINAL GAS: ROUGH ` FINAL i FINAL BUILDING DATE CLOSED OUT - i ASSOCIATION PLAN NO. - • ' t 7'yje Corrimonwealth of Massachusetts -� =- - Department of Industrial Accidents Me 600 Washington Street Boston,Mass. 02111 `3 Workers' Co m ensation Insurance A�davit lion: Z loco 1 � �2 hone# •Q`` .�.(na. wo=k mysel f. ❑ .I am a homeowner perf'ornung all ❑ I am a sole ro netoz and have no one worlds in ca ac1 ' cam ensation far mV employees working on this job. .,,, ers j. ):J:};r n,x?at}^ :2.w„• :{:f.:>ii•,::T;:kf�:^#;:;�;". �;: 'i::�:;, eI_ rOVl xt•y:•.:•. }:•sS}:•iir! :{F:: 2•:. {?L•Y:•::i:{,•. %k•.: c n.: .. am� � ♦ TS : .. .r:.•;:rr::..}Yi;•yiy::•)}}}:.:{rr n•F.F.}i:C:#`;::'•'}.:}y:.:r.Y•,.}}}:•::•:{2}....:}.:.}... r..:.:::. :..........:::.. ... ..: ,.+ .......Y ....n..• .....,... ........r..r ...r..... .........:... .......... r:......,•r..:..........:::.v:::f.......,............:....r:......::..:..,::.:?:.v?•:•'•-:.:::- •v:h..+:- v:S. ....r.. ...... ..:...... .....u..r$... .u.,.... .........:...................r. :.tr.....r............... ....r.................:..r::.......::..,., ..].;.;:::x•..•*, ....... ........ .....r....• ...r.. .,.. ....... ...:...r.. ....... ..... ......:.... :......n:w:::::...n•:•:•:..:•: v•,n}$:2•;:h`.•::v..:::::::n,h:c;::•2::).:>}:)?;:::r }i..F.v.......v•:,. ........r ......vn•.r....vv.....:::•r.......v::.....w.•.:,:,•.v:,,.,.n.-••••:,.....4•r•::v•.,i.:....v:•. .....n...... .nr .....Sr.:::......... n.. ....... ....... ........... ........r\ ....... ...r........v:::.v.... v....vv r.r.?.;;..v::::.•};•.}}):S::i•:}}:•i•v.,:•:: :?'. ...: .... ...:..r.. ..r...... ...r.. :..:. ...,:....... ,:.::.�.�c:•})]:•::,�fi•T;:.�:::::.:::•�:::::::.�.;;.r:?:.:.t;.;f:{{}n::•T}:;•Y;:;}}:..•: ,........ .:,........ � ..............:•:::::::.�::::::::�::.,•:.,•::.�::{?L?tSS:�::�:::r.�:.:....)r.:.}{::•f?•T:•:a�•::;y�ly,::?Y S::;']:{,::::,. , .} yn.;T•}r•:.]};::R 8t t .......... ....:.... .....:.... .....:.:.....:}:::.:•:•:.... ..:•:::::::..... }T.}.{:;:ny}:•}Y;;:•}rt•:<::s?:r::•.k•::+;;^.t:%:?:;'2::}:;}:;•i}..:•.;Y..:}n.S•i::r ,•:??F•i?:i:ii`t#2`;.2J:•.;{:. .. ..............:v:•:.vrx:::n••}'h::vv:::}:2ih:n•::::v::??•.v::.v.v::•,}}:.v.v:{:.}}.:::... :::n:vir,v:v:::::):^.v.v::::•;. .w:v?v..}{. ... y;?n•{};•, ..............:.• ....n.r..::•:+:..n........•.:.....•:•:+........••:•4........i:.:.A...:....,j::..n.....:..:::::^:}':v v..,.....• v.......rr..:v::::•:}'•}}:F:...L::•..v.;L•^.v;}}:•{.}:{+.::..v.:::h.: .R.�.r .....v::;,:::.,•:::w.v:. .....v w:::•::v:{vw:•}:•:.. r.:::::}:•.:.n:::w•.:v.,.:,.:vr:::r:..-.;•- .,.. ..,. ..... .. r....... ...... $.... .........n:1?4vnv+v.•.vv1.;:{•:}::•v. n. v. .....a r...n.n ...:..... .....:. .,...}....,.. .v..v..... ..{n•:w...n ... ..):. :::{:$'::{)f•; ,.Sv:hQ•:y^j!::t::>}}::S'•..{ .... ......... .......... ........: :....:......... ......r.. r..x...,......?.;Fv::.....:::n.. :...nn. }..Y•v.v:...F.,.A:•:r4.F:.w.......:..v:x::::nr..,:... � .v;22:{.}{;`i:vivt2•{)v'hnK+.•:::y::v}:::::::K• ....:. ....... ........ .......... .:......v:..•.:.:nv:::::,...:::.vv... ..a.nr.. ........."vv:4}:h•:.,•...^ .......Y.•::::.:..: .................... .. ,r. :.... ..:. .... .:. ......... ..:.,...:. '::'t'.•';:}•}r:}::.rJ{2"'v'::T2ti•:%i4•::2i>:}::4C�v'`••:}{.:'.i!'•::iY: .. r........ ...,......... .......,v ...... ...........::`•>i•w;::: {.;;,}.:]:::. .Y ^... ....� ..... ............ .............::::::�::::h:•:?fi:'•:Si}'fi:::v:?w::.v... va••::::.;.. Y::24);.{;.��.,';%},},:x:^'•k.#.• IN ............ ......... .......... .......... n....•... ......:.v:n.....w::.v:.v:::: .....n,......n.....:r:F,.,.•2:;y}�v..}}h::!::iv:ifi:i}.v.v.v:v::<.v•:O:{?•`.7}},•:,: address :.......................:F........,.............::. ,.............:..............v....::. ..:..... :L.::?r.:..........r:..:.;. ..>.................r...................r.....v.::........................... ...n.......r.n n......•+... .........::..........n.. fv..............jj............:......n...+• ':?}):{•]:?{h:;:•:<2i?.•:> .::;{vT:<}'• .... ... .. ........ .......r ...n..... .....}.., r.n.......r.::.,.....: ..r.....n..v....:•;n.,r............}.{:?{:tv:- Q�pw'3I'...:::.vn•}:,v.•.•r,.:.,::....::::•v;... ....... ...:.... .....n... ..}....n..,..• n. .n. ....:.... .:::w::•::::v.,;..,.•• "{.:v;:::.v•r:...;v•f.:{.:r::y::,{•:•:}}t+•::•::}i.,,vv:'{F'•? i.: ..... ...r ...:.... ........ .... ...........v:::::;::::::::.v:::'isST,...v,..::.v;.;v..•i4i:;:O:.v.}:tii:•5:)•...{'}..••v.)::v.•.•:k:..:•.v.,.:..frn:F^::,.v aF?2i.•:•:E'y:i:�}+•Yi y}: ..... ..... .......... ...v: :r::..{v::}:::::::... ,•::n�?{:?•;?+.S is•::::vL{N?v'•::v:SYv::::{•}YY.:tvw:,Lv.F+•.:•,:,...{v,,.:i..;.r.:?':.};n;r.r•: ^•::::fS,:..., fil .............. ....... ...... .--.... ...:v.v; ...... ..... 4:.?2•::•:vnv;:x:•:rrw::::{•:....,:}$:^::.:•:,vJ:�.:':.:..:..... •{{::t. , ..........:... ...... r..:.... ...rr....... .....:..r.r. ..::...n.. ..rl:2i{L4:•:}}:::... .:...:::!w::::Lt±.U............:. .:. .....vx.........n. ..::..w.:.v::L::$G Y.SF�:::F:'••:'Y,:Sa:{:#}"i:?'::!}..:<:.. ...............:v............r.,.....•♦...,.:..rr.•:.;.....r:.::..r.:.:...rr......h.:{......s.:..:::.........:.::••......,......... ,.r.r...::... } all :{.;:•:;yr•.,•.•...i.: :..F•. ,..........:...........::::......:..-:v,..... ,... .:.. .....rv.:...r....f...r....n....:vv....,....•::vv.. .,...:.....:...n,:: .....:•-n•:::........vY.?•.v:::.]^:5:n•n.. : :..... .........v. .f...:r. .rrr. .x...,. ... ...4:•::•.•::}.::.: n.....•...:T.:w x.. . .}.:...r.....y........:.:...r...........:v:; m......•:x.,.....n..:.•.:r.......].:•.:........,v........nr.n•..........:-::�:•..v..r...:.....•, ....;... .,r.:Lt{•::•,:•.:::: ..:•T:y':•}2};;..... .:•:.........:::::....:::v..........:::::.v....:r.,•;..•w:?.......:w:::.:.......:v.vn..,,, ....... ,-.:.:....... ...,••:.:v w:::;::. PER I am a sole proprietor, general contractor, or homeowner(circle one) and have hired the contractors listed below who_ have "-�,' }:•~}:: • lion oliceS: :•:{:2:,, :h>i,:<:<.2w om ensa .:?;h:FY•,• :<.T. ' w rs c <;s T:,, owls thef ,:.,i,:•::n:.:fi:.Y: ::., ....... ;..r..n ....... .....r....... ...r.. .:•:......:•:. r.•........r.:}i::..:..r::::..:.:...v::f{•:{:•i:•}t •::.:??.G.T:•T):6•.';:}: �:{•:••i}::it:•:;.{LT ....n..• ...n........ ....:v.r. .r. ...:.. .. :....... ..,.. ...r. 2.. •'.p•.:<w: .................,rrr.. ,:♦. x....,.:.:.: .. r ♦.,n:•......v: .F.. r: !.fv n.........v:.v.... :: .v.. :: yt:: •5.::.:.:.. .....n•.:r........ ..r v'•Y'>:..2 '::, }f,•?: ??.vi?:?4::v:4:•:S}i::..::v:v..:.:::•. :.....::: :: :::•. .; .}.:rPC-: :v+.• :•:. { .:.. ..fh.v::.. '. ,v,:itiiT::ti f. v....., . . ,. : ..::•:::.::,,,,�:::::. •L::4�r•:{h:?: :2:;;::::::r::r.:: .;,.,.•?:.;::.}>;.v: c••::::i..:,....:;....,. .. ... ::: r ... .r. .. :....::::.::......... .�:r::::::::r:•.,,:..,.,........>...:...:?r•: •:Y.. :)3:.:;:'�'•L)1Y.u;,;y: �•�� .... ..... ...v. .;..r., ...n. .X.}. .:.,..: :.v�,,•n n...•v; m...:?•YF.;:}.};:•,:::r,}}}Ti i:•}+YS•. •n•::.•:.•}::.?• "+-^'rvr•:>'W?#}{%.vf)p{.{.�4'..v'::Ji}::}{'{ • .....................: .. ......... }....{., rr......, .....s,?.... .......),..v......:... .... .:............ „•::,,:•:•}n,.Y::t;w:?::i5:22:'r 2:i?'... ..y �%::�:{+#' ..,...........:......... .:........t. .... ...:....t.....r... r .................>....:... .. ... ........ ...... ,... ... rn. ......r... ....r...:,: ). ...: ........ ...... ..:{.;...:::.::..,,} � ..:5.�:+•r.. .{{}r:.:{.i:f i•;:•+•:?:•T:•:::y.•..�,:y.,:?}`.2.•4#•:fkt ...... .......... ... .... .. .... ni•..:$.F... ...................n..,• ......,...:i..: YR�3• .. .)�•}}:..:^'•::n,^•'ib:.:{.;•;.;{•}:i...t.:.;..,.::5,., ::`{ it-'{ .................:•...........r., r :.:......r.. ...... .... ..n.:........n...... ....:::::::x.v;::::...:.:: ,..},:•:•::' ...Y.v.,• ..i... {:..+.t?.}; •.{S?}.. ........................r.� ... ,... ...., r..... .,.� .... .........r.....,.... ...r.nr.,......r......:.,. r...3....., ..... .........:•�.. .r. .. ..v; ::v..rr.::v.:,..::::::hr;Y....... .::w:n. ,.r.:?,.....>....}..::... ..n..:.;,,v...v;:•`.:?:•:h:'i2•'2�Y::• .n•.,•. . ....... .............. .. . .........:....:.. .::>'•.:... ...:..,...n..:::.:::::::::.{•:;;y;<}}:•}"+;+� ^}:?::.' :f2F:�rFf..;r�.4;2;,(• r:e.aR'����.2�r��:`:':+. a.dF n. r...,..... .. ?n; ?•:{,..:.t•.,..nt?2#'�Fi.}`�}e} {:•.i..i. r..•i,Y.:!•n. fi•n :•}�?•:{�(.�,?Y)'{•:i:+.:}•{.}}i:•i;::::�:. :.i:fi.v.4.::'a:.i:':h'i ......:.{:rnv:::::::•:•.K•i}:r•.v v:+.v::.v:•:{•, ... v::;-•,:vK•::::r::rf{•):::�:+ .,.:{:h:v::�.,.... ,.,,:.:v•r:�:.."....:: ..........:v....,..,•..........n ..:....r.....:.. ...r...... n., ....r...rf...rra:•f.:.v�•Y+.i•>:•.:}.; r.. .{,}::;:T,.�.... r.r:Y.:::.:w. 3ny:4i}:iF,i ..3.;,y,} ....... ....... ......... .... r.r... .n... .. .... { ..... Yi rn.: .. ,...,•�?2:Y•i}Y}}2:^+?::{2•}?TjriY::.:{t;, •,......... n..... ..... .... xn w.... ........... .,. .:r...•:v.n.....•••r_•.r....4.. ..::}::::r v.:"r.,••}:;:•:.:::. ....::.. r..... ... ... ........r... .......:, .. .. .. ... ..r.... ,....... .t........ :•.::?•:..... .,..:.:: : .:. .}v :>Y} F:2#:::•:2:'•::;Ah'•`•{x2:.v'.rs;', ..;::.w.....,•., ....::f.•.: n•:• ... .,.. ,{{�!'i'r,...:x::••. :•• }:...f.:••::::......r•:nv•. ,..,.....,nn:..., •:.?S:v 22{v„ ... .+... .... . - ... :••. r..... .:{:•::.::::. .......... .....:.:♦::::.�::::�::•:{.}•::::::}}:•}s:t+{t:�5:2Y:TT2;�•r.%�:ii:{2?:Y'+.•.`•:is?;;'#>:•.`;::•'.,#>)d:]v'•'`'..,�Tr;wq,3,�::.� ... :..:. ,. .. r.. ... •..•.. ......... .......::::::�:.�:.�...::�•T}5•{.}5:i>:4T:L•r}:25.Y.r:•nv:::•::i+;#F=x9:::..{.}:<•){.:•{:.;,t}•,••,::<r{}.?:::::}:-.s.•'•5.:...:.::.;....: ... ..>. ...........:•::nv:::.v:.;„Tv?r:r.. ...r v:::)v.,v v:...:. ... .......r...:...,v:•::•.vv,4n:!•;J:::.{.n.'ri�::?•.?•::Y,.?.};:;.�••.}:r:v••vtihJIC,:v;:v Ly..:••�:,:•:!<•:; ♦ .r.•:. :r .. ... ..::•..:r::::... .� :..n.,. r....n...... ....:.. ,...,...•.....4...n..r..r:....... ...., ....:,,...........n........... •.y.YhY:}'iv.f;:n:+.Y}•.ii}•#F:lY.+2�;,,?;Y4L:..^.✓a'nv�,yx,r„{{ Nil ... ..:;:•.......:...,nw::. ...{;{:{•........:}:::.::...... ..........r.•::.:............?t ... Y:. •:{L•.,vT....n}•n::v:.......:r...:v.. i..n.....5....r{2••.}y,r.S F.:,. n. �•:, T.=•''v- -.,. ..........:v. :. .....v:.:.x.. :. Kv:n.......:::....r.......v ......:w........•::•.vx•5;v.••r\,.t.:..........:..R. ,..n..: .fit•{::::;•, ...... ..x , ..... .....nn.. .r.... ... ..n ....... ..... ..r .a. }. v.... ....; ..r. ..... ..{.p.;,,- ^:?F.}34..:{ •t�{.::;:}::t% #$;::?'>X4:,�f'f,., •......•:::n... ,:r..v..... ....f......,.;n• r. ...:..n:f..r.}•:r::::..r..:::•:•..r.: n •. .;nJ r...: t....} ..f.{: 'i. ::•i•.,'�;•..v...:?.;:, n•:5....... -......,.... .r... •'if......n• :.n,.......:• r? .. .... ...+:..'r '.: :isF-:::^'r:i;i}:{.'•'C?'•:,Ti ?14:•:{::'},•:?.>'S•nY!+.•'v:::::fi:}.::h ..}. : ::.....;...n::-}:•::-:::.n..:•: :' .;i :.., .;; .. •::.:•....:.v.. Qli .iF(;::#:4::{#2;ii'r'i:v .. .?.. .,+• .: n}}.:•}:. ,sty y.,� :?h :�IId'S1YanC@::CD;?•}. .,'::2i:; ::•:yi'#;'{'•s'<�ix:%=�s:::i ...::::::::::::{•:t•}T:.S::,}:F:•}:;.;:•}:•Y:,.:r:;.}'.:y,:r:::::::•Y::?r•v:w::'•:...:...:.::n. .;.;...•.:5: ....................x... ..................�,...vw..:.. ........v::::i.;..... ,..::;::•:.{•:....}n.1.., •r"{?t`.v.;...:.:...:....{'i?.}•::.Yii'ir...f.ny'{¢::..v: ):3} ..{,Ir..::::}.•:r ..........................r.•..............•::r....... ..............r.r...::::•:,:::::.......:.::::::•::::::::••.....,..........•w::::?<{;::»:}^}i:•.•Uvr•>}:.>>•o}::'r'•i::nr:........... ..}•:)i3>..qqi ...i.... .. ...vnv:::::.•{:•r:••::•:r:v.+.::.::)::r::w:••:.v:x:i::::t+:•.v;:::r..i:,!v::;:::•:..F.:rF.::.:...v::::.v:v:::..:::::n:::.: n:}:•::•:n+•... ............. ..... ..... . .....r...... ...r.... ......... ........ .....,. ......... ......:....:r. >.!•}:S:•:•r: ..........r.:::.:?•:•:•.:....,.:.•n•'•.•::fiv2:;:.:.::?}Kv^'}.:,.n. ....... ....... ......r. ......... .1........r. ....:. ..:....... ....n.. .{....... r:...:,•...1.::•,::v. ..x••::•r:^:•v:vn•.v!::;v:•:iv!+ :{});.,.AT:..;}"v:.}.: :.... .... ...r..).............:••...............n......r...:n.:.,.. :..... n...•.• .....r.....::::•:•.:..:v:r.•............,:•.v:::.v::+.•}:v:::?:::•: ..2,:� �.,4.-4. , �i�2:.:..- ....n......... ...•.........r..r....:.........n........ n....n.•....lv:::::::i::::::........:....i.:..)....na..n. .... .....:.......}:-]:•♦... .nn..•• ..r.. .....r..r.. ...v. ..�.. ..{....... .......... ..... r ...........:•.v:::J:::v•..:..•.:::::::...r.•,i?::{.}}}.:•:.. :^:}2?{:'i•:{2•if:Y•}}'4;+•:•:$:':)v:•.w...n.?^..:''n•}\:... v•...,.:.•::::n,...•v:::.:..n•.v v:.....:.....•:::::.:..«.::::+...,.....n::::..n••:•;::::....••,•.,v...•....::}:,.:v:n.}....5:•nv..........i}.•.:::r.T.......::: ;.., .::..a.... .:•::........:.,.......{:• .h.......:::....{,r......i.:............�.:r....r...... .,•:::.:{?•J:•:,..... r.::.n•:.V:::.:•.....;r::•}:;?•}:•:...... .. r......... ..�..., a.......:.. ::::<. .....:..n•.::::}::. r.f.i h.:::•.}:::::r:•:n•:::.......... :.:.�.�::::•::T?•i+F, .,.•..?r..:}•}.::F+Y}i:^n :t•>„i;•+r:,• .•:•i,••:�: w :n.. .,r•:..vi.4F:.+w:w.y.,,?I7 inw...............r .. ,•.r:rrr v}"ij}::.:....i.. i:w:h•....:....•,• r ...{r.h•:'.^22::• •::}:::r:•v.::.2:. :.f.}}:+.?:J: `}�'?':S'}#. .,. ,...�r.n......:..a........ ....;.........:......i::::)Yvyri}':rF1,...;:.n..;:..?..... \::F•,•:•:.. $h.� ..::.....:..)::"•:.. ....... ..,...:•:^::,•..:•:L;•i.:•...r.. ..,:;:?•}:.;;:;,}:}.}.v.vn};;2:.,.lt rf.:.:,.:v.{v:$.y;i: :•i i;'.: #¢}4t .. .......v.:..... .. .n..,,:... .... ,.(.. ....4:... .......... ........ ...... ..t rr:,:..:::..rr.T.... ,....:tt. :i?r.•:..f•::.:;•^•r.• ... ... ...... .... ....� ...... ...... :..:.. .........,.....:.. ........r...::):•:•:•::rr:.;.;•..T:si:.:4}::.:,•........;:::i�r;r:;r.•)::•T::<Y:::r:•:.:•r.:.,}r{?fd::?.}is?.:'••v{'i:':;7,.:x::Yc {;:::;%2 ..... .......... ..:.......::.......................... ...................:...:...... �:::••: .X. ....... ............ ......... ......... ,..... .,....... ,......... ..:..:L:::•::....:•.::.}}isih:•}::::.:.......:R.....v.•.::'':^.::•:ri1:?•}•?•:.:•t:??•}}:•i:•})::. ,.. ....... ...... ... ....n... r..r. ....... ....:v.:...n..•.v:::......:•. .......+:v v:f.?•.:.x.:.v::.w:::n.:::.:. .; v.:{.Y)l:lv.:::::;::ry:}.,•.; ::+•:::•:::.•.:hr:.:....,..:.v:T...r?..:F•::rT::......:•:::.:!......,...••..r.....:::::.. ::....n;}.;:•..-..n...... OII :...r.....:.. .........r..,.........r.:...........:....r.......:•:r.:...f...:......:. ..,:....... .:..:. ....:•:::f.!•r.:•;::•:r:::::::•.n•.::;.=y '•:::••ti; r. .,...., r........ r.......r..... ...,..r. ..:.:.:{:•::rr::..; ]:{:•;:::.:.. ....,..r...r..:...,•::.!•:..{.,.;.},•.,::..�t•:):•:f::•r..:.,y+:•},.;,,+.•:::::?}x;•}:){.:,::.}-:i:}::;::.: ... .......... .......... :.....r... ...r......,........r .................:::.,.....t... r.;};J:•}:•;:. ...;;..,..::....,::r.::.:i..r.t:2:•+.r,}:;2]^:Sr.•:r•.^.,:;J:;;}}?:Y•}:ry2a ......... .. ......... .. ........ ......r... ........ ................ r.w;v.v:::::v..h+ i.C.}:{•:fi' •'f•::. ..... r... ..... .... .... .n...........v..............•:•:•;:•w::•:v..•...r... ....+,... ,r.•.:.l.?•}Y•}}::;{::••::::• •i::a:?:+}}•.:i,..,..rv{ti{ti':.i:>,:na{•vYi;iri. ...... nv.. ... �.v ........ ........ ..:..... ,r........ ,•x...::r..... nb::::qw:)}:x ....;n.;.....,.F•:nv::v.::v.,•.w:•i::{:6:•:•.. :{.'-::r.•:�r::•::q },b v,�•.., ....... r....... ..... .........r .r..:.:..J... ...fr. ...v..... ....:.. .....:... ..w..:. ....n ,.n.v.,.. rf...n...• ........::::::}.v.T....n v; �j ]� .......:.. .......... .... n.•, ...r-.....r, ....r.....:::: 1........ rl:•:r:w:.......q::nv::v:::• QLiE•'..+:*':^..:::::':•:?•:rF):::i•:......:S:{:•i::.......:.+.v:.v:i::tii^::::•v:•.:F}:•:.:i?>.L::2Fi:•::}:Y... :}.!})Y{4:•:'•:22iti•}}FLS:{::;•r.•:nv.};......r., '•i}Y:i•},;n{..v::•.:i••..v::i,v:.:..:.::.......... n:::n:}•:v.. E�2�SL•2'�12Ce::;G'O$: t#:;`;:E:%::?$`:2{::::;;;)::::;::::.<.:�;:':},5••5:<?.::":::::;;:{?:<:'<;:i:�R:«tt{;•:•>:?i•:?:•::•:::..:.:......... e cd under Section 25,k of MGL 152 canlead to the imposition of erilninal penalties of a Sneup to 51,500.00 and/or one years'imprisonment as well as civil penalties in the form of a STOP WORM ORDVR and St a e of$100.00 a day against me. I mtders{and that a- one to secur overeye is require be forwarded to Copp of this s{atemeatmay the Office of Investigatipns ot the DlAfor coverage verification 1 :- ndert' , airs and penalties-of-perjury thr�-the-information prouidedabvve�slcumsd correct -- I do kereby certifyu ' Date �• L � -- ' Signature 'n-o SS�/� Phone 7 3 0 Prir<t name official use only do not write in this area to be completed by city or town official _ pexmitllicense# C3BulldingDepartment city or town: ❑Licensing Board ❑Selectmen's Office pnone R; Contact person: r r..N...A 9l95 P1A1 •� � • Information and Instructions Massachusetts General Laws chapter�152 section 25 requires all employers to provide workers' compensation for their As quoted from the `law , an employee is.defined as every person in the service of another under nay contract employees. en. of hire,'express or implied, oral or watt association, corporation or other legal entity, or any two or more of An employer is defined as an individual, Partnership, _ the foregoing engaged in a joint enterprise,-and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner.of a .... dwelling house having not more than three apartments and who resides therein;'or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter'152 section 25 also states that every state or local licensing agency shall withhold the isenewal asuancaent who has of a license or permit to operate a business or to construct buildings in the commonwealthy pp .•, not produced acceptable evidence of compliance with the insurance coverage required. Additionally, neither the' commonwealth-nor any of its political subdivisions shall enter into any contract for the performance of public work until coin liance with the insurance requirements of this chapter have been presented to the contracting table evidence of p acc _ autho _ :. .. .. t Applicants " box that applies to your situation and Please fill in the workers' compensation affidavit completely,by checking the b pp Y° Please fill company names, address and phone numbers along with a certificate of insurance as all affidavits may be supplying submitted to the Department.of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and *be returned to the city or town that the application for the permit or license•is date the affidavit. The affidavit sh°uld being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law'.p'r yQu are required,to obtain a workers' cAmpensationpolioy,Please call:ttie Depaitirierit afthe number•listed below:.'•• •. Cityor.Towns '. ::••• Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the you to fill out in event the Office of Investigations has to contact you regarding the applicant. Please affidavit for y . ....,�.,� bet wliich will be used is a refeieaoe numl;er. V6 affi�avits may'be'ie' t�+•. be suie,to fill in tlie.p emirtjl�cerise nwn ,...- ' , `a or FAX unless other arrangements have been made. ' the Department by mail .7. N, v •.F The Office of Investigations would like to thank you in advance for you cooperation and should you have anY9,uestions. please do not hesitate to give us a'calf, _ The Departrnent's address,telephone and fax number: .,... TheCommonwealth Of Massachusetts _Department of Industrial Accidents otflce of I11vestinuons 600 Washington Street , Boston,Ma. 02111 fax#: (617) 727-7749 :: : phone #: (617) 727-4900 eat. 406, 409 or 375 i i i i i i BOARD OF BUILDING REGULATIONS .-icense: CONSTRUCTION SUPERVISOR Number: CS 074174 Birthdate: 12;14,1958 Expires: 12/14/2004 Tr.no: 6441 Restricted: 00 PAULN CROSSEN PO BOX 1114 ( - "� DENNISPORT. NIA 02539 Administrator i i i i i t 1 i i i i j i i i t t I i Town of Barnstable fl�tttt ray �.� Regulatoky Services Thomas F.Gefler,Director 1639• 61 Building Division - Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 office: 508-862-4038 Fax: 508 790-6230 Property Owner Must Complete and Sign This Section If Using A Builder N*3-;*i,In _VA.. ,;m.O�net..of the,subjectpropettp- uthotiz e - � to.act tin my..behalf,. hereby a _ in a m,attets relative to Work authoiize�hp this building•pe=.l-application for: M(:) - OZ601 (Adcdtess of Job) . Sjtlite of et �. Date CAL print Nat�.e COMMERCIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $100.00 Alterations/Renovations $50.00 Building Permit Amendment $50.00 FEE VALUE WORKSHEET NEW BUILDINGS square feet x$140.00/sq.foot= x.0061= ALTERATIONS/RENOVATIONS OF EXISTING SPAC l� 3 square feet X$96/sq.foot= 0, (/ 0 0 X.0061= / o STORAGE BUILDINGS ONLY square feet X$32.00/sq.foot= X.0061 Commprojcost NOTICE NOTICE TO x TO a EMPLOYEES EMPLOYEES r V SV f The Commonwealth of Massachusetts DEPART ENT OF INDUSTRIAL ACCIDENTS 600 Washington Street, Boston, Massachusetts 02111 617-727-4900 As required by Massachusetts General Law, Chapter 152, Sections 21, 22 & 30, this will give you notice that I (we) have provided for payment to our injured employees under the above mentioned chapter by insuring with: THE HANOVER INSURANCE COMPANY NAME OF INSURANCE COMPANY 440 LINCOLN ST,P.O.BOX 15063 WORCESTER,MA 01615 ADDRESS OF INSURANCE COMPANY 09/10103-09/10/04 WHN 7225469 EFFECTIVE DATES POLICY NUMBER 396 MAIN STREET,P.O. BOX 836 508-775-4559 MARSHALL K LOVELETTE INC WEST YARMOUTH,MA 02673 PHONE NAME OF INSURANCE AGENT ADDRESS P.O. BOX 1555 ALL SEASONS LAUNDRY HYANNIS.MA 02601 EMPLOYER ADDRESS DATE EMPLOYER'S WORKER'S COMPENSATION OFFICER(IF ANY) MEDICAL TREATMENT The above named insurer is required in cases of personal injuries arising out of and in the course of u employment to furnish Adequate and reasonable hospital of and medical the First Report ofces Injury must g venit the provisions of the Worke 's Compensation Act. A copy p injured employee. Thee nployee may select his or her own physician. The reasonable cost of the services provided by the treating hysician will be paid by the insurer, if the treatment is necessary and reasonably connected to the work related injury. In cases requiring hospital attention, employees are hereby notified that the insurer has arrar ged for such attention at the BEST AND NEAREST HOSPIT L ADDRESS NAME OF HOSPITAL T BE POSTED BY EMPLOYER WC 7506e (Ed. 1-89) Tr aa 001010 OF GALL Fim " r UO j• � —� wA�iEg— n O �Q RvoK N:- a SM+�LL i R• j I 5 Seni by: ; 5ua (11 niuu; uct-zi -uj il:atsvm; rage jij 7 bAY6S z t3 y w os Wm ��o�OSC--� Gc�N� cT10 N S A S A6 Town of Barnstable IN-) Regulatory Services &OWS A13M ' Thomas F. Geiler,Director 1 MASS. EOM;.�• g Building Division O NO Tom Perry. Building Co mmissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Fax: 508-790-6230 Office: 508-862-4038 April 20, 2004 Anselmo Caldeira All Seasons Laundry 95 Airport Road Hyannis, MA C2601 Re: SPR 093-03 All Seasons Laundry, 95 Airport Rd, Hyannis (R294-064) Proposal: Reconfigure interior space for public use of coin operated machines Dear Mr. Cald ira; Please be advi ed that the Building Commissioner approved your application on April l6, 2004. A signed copy f the proposed plan remains on file. Upon complet on 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 (ZO Section 4-7.8 [71). This documeni shall be submitted prior to the issuance of the final certificate of occupancy. S erely, _ Robin C. Gia gregorio Zoning & Site Plan Review Coordinator ASSESSORS MAP 294 PARCEL 64 C +]` LOT SIZE: 28.031 S.F.t 0.64 AC.t DXrt 7Er __._. O II\ ZONING: B BUSINESS + 5s.00 A� GROUNDWATER PROTECTION OVERLAY DISTRICT a`4 00 OT ENTER SIGNS `• +S.AA O. 3 BWNSI.. TCN[N) EXgn ( - AREA: NO MINIMUM ICIPAL �/ tl V :Ru NEW \ N FRONTAGE: 20 FT MIN. AIRPORT p�r HER Q •;' j•' Q �1 IT CR SIGN �` WIOTH: NO MINIMUM N u5 / �.`f/ TO caOE \J m SETBACKS: 20 FT - FRONT \\\ %'• �' C / s `Od_ s o - _ 0 FT - SIDE �n 0 FT - REAR uHT Ro MAP 294 NO MAXIMUM BUILDING COVERAGE RC�� 15 t t 111 10 FT MAXIMUM BUILDING NFJCHT VER IS(OR 2 STORIES, WHICHE LESSER) /• s o OWNER OF RECORD: 02 cRAss AREA i cHrBaY .� \\ o I N/F JULIA ALMEIDA TR. PENN. NOM. TR. pOLRE 2B 2'CHERRY +5626 �.-""" f_p \ o \ 2 0 BOX 254 HYANNIS, MA 02601 99 /� r.) Oct•\ +\ \.1u� ANSELMO CALDEIRA- APPLICANT / +5•�p�y A y6i O q \C \ • \\ }5595 N P.O.BOX 1555 HYANNIS, MA 02601 LOCUS' MAP PB 267 PC 46. 283/54 '99z dF22 ASSESSORS MAP 294 PARCEL 64 �55 � # s � � FRONTYARO LANDSCAPED SETBACK FROM ROAD LOT LINE: 10' s/ ]O.21+\ .•5 �� / 56— GIRT D # WITH 3•TREES 10'O.C. 02 PARXINC \EXISTING 5175 SF 0• � GP REGULATIONS: EXISTING k PROPOSED " \ 1 \ 1 I SOE MAXIMUM IMPERVIOUS COVERAGE 17,833/28 REPO •• 63.8R(NO CHANGE) $350 '6 METAL BUILDING �[. C I PAVEMENTT REUOVEO 351 SF PAVEMENT PROP05E0 -s `Y". .18 `'] ALL SEASONS LAUNDRY <�\\\ �55A5 6 \ I 1 30%MINIMUM NATURAL STATE: PROPOSED 4400 SF/28.033 SF . 16.0% (NO CHANGE) 066 s +5239 �� /s MAP 294 �1'qq\\ 1 16.29 I (PREVIOUSLY DEVELOPED SITE) 64 ) A 5D-93 \r + Isa R 95 pY +51.59 s - .1. \ 4-2.6 LANDSCAPE REQUIREMENTS FOR PARKING LOTS 'C LANDSCAPE BUFFER FROM LOT LINES TO PARKING LOTS AND DRAINS: \ • \°} .T ( 10' SIDE h 10'REAR REG. / .^Q \y 5605 1 I LANDSCAPE BUFFER FROM BUILDING TO PARKING LOT: 10' RED. 6 1 I EXCEPT AT BUILDING ENTRANCES @ LOADING ZONES- PRE-EXISTING CONDITION P,wN G I ,,. MAP 294 \P _ a I 4-2.7 PARKING IN FRONT k SIDE OF BUILDING ONLY- O.N. I E�,STINc \ ) 76-2 Y U ( SI.NB P TEO --5 �0. iJ R 64 f \\ STRIPING \ A 1600 1qA, 0 <21 SPACES OUTSIDE. 10%INTERIOR LANDSCAPING/tREES NOT REQUIRED. A5 INDICATED `�f�' �' R 4. N 28.033 SF \ 1 +"' ,. � 2 I PARKING CALCULATIONS: E E SA.)[MLNL 56.80 INDUSTRY/STORAGE: SIPS SF(MACHI SS = 6.5 SPACES rR EXIST ABOVE GROUND 11 IAUNOROMAi - 26 MACNINES(1 SPACE/4 MACHINES) = 6.5 SPACES �b,� o NC Ol T K % I TOTAL: 14 SPACES REQUIRED ` N WDN BOLLARDS - ) i 521 CMR 23.2.1 15-25 SPACES: 1 HCP SPACE REQUIRED. 15 PARKING SPACES PROVIDED INCLUDING 1 VAN ACCESSIBLE MCP SPACE R., TO,N FAR PROP. PARKY2G FENCE A)OU.D Iu \ _- --]N— -Ql1�IRIVER J 8354•IQ•E_____ _ GENERAL NOTES: p MANN -- \._._ __-..� I.ME 0 ARON OFPERXIISSTWOG UNDERGROUND UTILITIES�IW SHOWN ON THIS PLANNC -137,0[) _ APPR#WATE. T My EXCAvw I SR. Ex AVA 1 � CONTRACTOR SHALL MAKE THE REQUIRED 72 HOUR NOTIFICATION TO DIG SAFE(I- :�f,V •J.D ESE PAVEMENT ?`� ��SN " BBe- 3.•-)233)AND ANY OTHER UTILITIES WHICH MAY NAVE GABLE.PIPE M NJp APPER uPOLE 1356 5 i EOUIPMENT W THE CONSTRUCTION AREA FOR ARIDCATION OF LOCATIONS. \� P.EO) PANT RD. AND Ca O I 1 2 PpO.[CISWWX THRALL CONFORM CO ONENTS. Of METHOBARNSDS EMPLOYED SUBDIM ON REGULATIONS P SEWER COvfR 40' WIDE P(�NATE WAY I I"TOPCOAT MASS DPw AND\OP THE"ASSACNUSETTS NP.RTUENT OF PUBLIC WMaS STANDARD SPECIFICATIONS II II T0 !•J,• puwFSrt! / ttPE U FOR BRIDLES AND HIGHWAYS IS AMENDED TO PRESENT, lL',I iI 2 4,... • �� 2'BINDER 3.ALL DRAINAGE COMPONENTS MUST BE CAPABLE OF—STANDING M-20 WHEEL LOADS. DRAINAGE REVIEW: 4.VERTICAL DATUM IS NGVD A55UMED FRDM 0.1.5,DATA TOWN WATER AND SEWER, SITE PLAN •' °•°•°•'°° 5 BE PLAN O FOR THE PROPOSED ST WORK ONLY AND SHOULD NOT 4. BUIRA W ANG: !• BE USED FOR PROPERTY LINE STAKING. DRAINAGE AREA.22.234 SF 20 YR STDRY REMOVE TOP k SUBSOIL •O12"PROCESSED RAVEL COMPOSITE. I),BB3 6F.LMYEL/OlAl—).4351 0 SE 20 0 20 40 60 Feet NOW M1.03.1 V18 ROLLER COMPACTED COT-- ETNET -C, 11(I)4.))•31/43W)-/2221•.O.B26 PAVEMENT CROSS SECTION SITE PLAN �4ATONAL )/.%D/SC .08`LEAC)(2221•/N]]60)_T))CES t.)>(A•B G)/.S4PM/SF.1 S64 SF IFALNXNt ARIA REOVA[0, UnL12E EXISTML(4)6'-B'L V LEACH PITS w/4'STORE (A•)SF EA.) SCALE: 1• = 20' NOT TO SCALE TOTAL UACMING AYALABLc VBB SF>1569 Sf O.X. LEGEND: OF LAND IN HYANNIS (BARNSTABLE) MA I I 508-362-454I T A'C iO 508 62-9880 OOM SEWER MANHOLES S� _y1TOrAs-4 WfL �{� � AR EH N PREPARED FOR: EXISTING TREE H C;� ALL SEASONS LAUNDRY INC. down cope engineering, in c. TREE/SHRUB LINE `� �5 OAA No.30792 + 263Aa_ _oR —,o-` #95 AIRPORT ROAD, HYANNIS, MA (Y� f . AN SURVErOR �> UTILITY POLE --ss---- EXISTING CONTOUR R LAND SURVEYORS GATE: 11-9-03 SCALE: t' = 20' 4 9.39 Mob1 Street - yARMOUTHPORT, MASS. O EXISTING CATCH BASIN +61'EO EXISTING SPOT GRADE DJALA PPS, PE Dote: REVISED: 3-30-0. (MOTE HCP SPACE To FRONT ENT ARIA) -03-348 EXISTING FENCE A BUILDING MOUNTED LIGHTS _C. IPl&n in Spy h /L ofVKWE ro Town of Barnstable Regulatory Services snaxMBM v M"S. Thomas F. Geiler,Director i639• �� A a 'Fn3+ Building Division Tom Perry. Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 April 20, 2004 Anselmo Caldeira All Seasons Laundry 95 Airport Road Hyannis, MA 02601 Re: SPR 093-03 All Seasons Laundry, 95 Airport Rd, Hyannis (R294-064) Proposal: Reconfigure interior space for public use of coin operated machines Dear Mr. Caldeira; Please be advised that the Building Commissioner approved your application on April 16, 2004. A signed copy of the proposed plan remains on file. 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(ZO Section 4-7.8 [7]). This document shall be submitted prior to the issuance of the final certificate of occupancy. erely, Robin C. Giangregorio Zoning& Site Plan Review Coordinator I yam\ Oii i:^ Usc Only The Commonwealth of Massachusetts 3 O PV�J ;..r.ic .0. Department of Public Safety c� moss O:.c++Fe*ey S Fee Queked 7i� BOARD OF FIRE PREVENTION REGULATIONS 527 CMR 1200 3/90 (leave blank) Qd APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed In accordance with the Massachusetts Electrical Code, 527 CMR 12:00 (PLEASE PRINT IN INK OR TYPE ALL INFORHATION) Date 11/02/94 \) City or Town of Barnstable To the Inspector of Wires: The undersigned applies for a permit to perform the electrical work described below. Location (Street & Number) 95 Airport Rd. . Hyannis O�-ner or Tenant Mr. Caldeira, All Seasons Laundry_ O,ner's Address same Is this permit in conjunction with a building permit: Yes ❑ No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization NO. Existing Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters New Service Amps / Volts Overhead ❑ Undgrd ❑ No. of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work Wired 2-1 0 washers at 30 amps, 2-3 0 washers) at 30 amps, 2-1 0 dryers at 20 amps, 2-3 0 dryers at 30 amps, & 1-1 $. iron @ 30 amps Total No. of Lighting Outlets No. of Hot Tubs No In- I . of Transformers KVA No. of Lighting Fixtures Swimming Pool grnde❑ grnd. ❑ )Generators KVA No. of Receptacle Outlets No. of Oil Burners No f iBattory Emergency Lighting Units No. of Switch Outlets No. of Gas Burners FIRE ALARMS No. of Zones Total No. of Detection and No. of Ranges No. of Air Cond. tons Initiating Devices Heat Total Total No. of Disposals No. of Pumps Tons KW No. of Sounding Devices No. of Dishwashers S ace/Area Heating KW No. of Self Contained P g Detection/Sounding Devices No. of Dryers Heating Devices KW Local❑ Municipal ❑Other g y Connection No. of Water Heaters KW No, of No. or Low Voltage Si ns Ballasts Wiring No. Hydro Massage Tubs No. of Motors Total HP a \� OTHER: D INSURANCE COVERAGE: Pursuant to the requirements of Massachusetts General Laws I have a current Liability Insurance Policy including Completed Operations Coverage or its substantial equivalent. YES[3 NO ❑ I have submitted valid proof of same to this office. YES® NO ❑ If you have checked YES, please indicate the type of coverage by checking the appropriate box. INSURANCE 0 BOND ❑ OTHER ❑ (Please Specify) 'ContInental 7/1/It' Expiration Date Estimated Value of Electrical Work $ Work to Start Inspection Date Requested: Rough 11/02/94 Final Signed under the penalties of perjury: FIRM NAME LaFleur Electric LIC. NO. A7043 Licensee Raymond E. LaFleur Signatur NO. B el. No. 75-6814 Hyannis, MA Address 30 Perseverance Way, Alt, Tel. No. 01.'I1ER'S INSURANCE WAIVER: I am aware that the Licensee does not have the insurance coverage or its sub- stantial equivalent as required by Massachusetts General Laws, and that ^.y signnt•sre on this permit application waives this requirement. Owner Agent (Please check one) Telephone No. PERMIT FEE $ (Signature of Owner or Agent l TOWN OF BARNSTABLE REPORT $UPPLEM NTARY/CONTINUATION REPORT NAME �MI�DDLE) DIVISION /DHPT �/ NOTE DETAILS 6 OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL $S ETC. oll .40 Ll.Qi { fr K, f w' C / ' xe r SUBMITTED BY PAGE N 1: Crossen Ralph From: McKean Thomas To: Crossen Ralph Cc: Geiler Tom; Jacobs Mary; Rutherford Warren Subject: FW: Laundry in Basement Complaint Date: Tuesday, September 13, 1994 8:51AM Priority: High If you need any assistance with follow-up of the cease and desist order, please give me a call at extension 265. From: Rutherford Warren To: Crossen Ralph; McKean Thomas Cc: Geiler Tom; Jacobs Mary Sub ect: Laundry in Basement Complaint Date: Friday, September 09, 1994 2:02PM I forgot the address, (of course), but have received another complaint that they person is still running his commercial laundry out of his basement. Thought if you wanted to get a breath of fresh air on a Friday, you might visit and review your prior"Cease and Desist"order. Thanks, let me know of results. k R � V V /CPAII N Page 117 4 �-�o TOWN OF BARNSTABLE / f REPORT SUPPLEM NTARY/CONTINUATION REPORT NAME (L,agT, FIRST, MIDDLE) DIVISION /DHPT l . A, Q� NOTE DETAILS d OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL OS ETC. 100, at j i SUBMITTED BY Lf�llz'�7 PAGE/ X", y Y PROJECT/7 NAME: "N �er�vY ADDRESS:/a� rt Tl rW - PERMIT# b20110 PERMIT DATE: / M/P: oa % q LARGE ROLLED PLANS ARE IN: BOX SLOT Data entered in .MAPS on: a�o� program B Y: TOWN OF BARNSTABLE REPORT SUPPLEMENTARY/CONTINUATION REPORT ss ,� NAME (LAST, FIRST, MIDDLE) � DIVISION /DHPT t._,. ,/'�.,4.:.•t��'.L/F /7 f ! -f+-�/-'_�a!�/P�eJ�"�:.�.^' f%..,,;�C....a:.,,.fL NOTE DETAILS 6 OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL RS ETC. r 22L, f 1' +"�?`r i /rf r'? �✓ mar° .�c°i e /mil^!%1 f� �..,�, f. ` -tr jf q,!� ... t .,•d 2�/; ./ � !�!� ;,�.1��'� ( ,/ E�:r•t.,�'"rr'x J" .�6'�Y/rr ;tr>'L_ �'�'ff% .�r 's._s J/'•<+' .� ..w...,w� J / f f f ,"t l.`.,/ f%/ f ��1 'f t7 f / •C„' f-'T f/ ..� 1r� ! e.T,r. J!; 7°.+. a ,p� J I t!'C :e- / 1Y:'>f�'�AC.-L!;-G✓ '� r" i"!../_"s,.. ' /"`,/" ?'�,f(' .f P'.!! «w�.""a"' e !_✓' .l 7 1�� f�J r' � ��fl�./ /f'.�r ✓ f` t ✓ ti. .r9 ? s�tr �It_ /</f �r t /�'�' I /•f'�f� �..-- s''ry 1 frJ�, fJ;, e.£� .�.�-f� � J''.'."y/�.� tr f°!`f ,rf l.� _ _ -yr� �`-.�-+-of _...[. {.' ✓ .�'t� rif/- .fr...•r' .41 14 ;1/ /1' 7` ;.f,/'.l'f.!'7 r'f'��i'P,_,.,.. �J" f� .,✓ ..r^'t' ,?�' F'' n•�. f"'t_....+"..t � ,,,,,�.f.�",.` l / - /1:-r•,"r tf of rr vX � C...�!%! f f .,t� f f +....�.r f4 PAGE Y SUBMITTED BY �f�,r�/r�' f!'1� ref �tY`�-f'•ef't� rt�+..f �, f.!% �. 1 c '. TOWN OF BARNSTABLE REPORT SUPPLEMENTARY/CONTINUATION REPORT F ` / l NAME (LAST, FIRST, MIDDLE) f DIVISION /DBPT NOTE DETAILS 6 OBSERVATIONS-ITEMIZE EVIDENCE, SERIAL RS ETC. r �• y •,� ..�.-.. .�! f i .f ram{°st 1 r'+,, /l` dr ;-� ...!j' � ;! t .�+• ss _ 4w �'i /� .�°-"•if! ,f w� i f t` r{ 1 if r .f�pe -.... AN/ • y' ,,A ` • .Y ! , e {C ' J/ • �F! t'"yr `n r f ! (� III r r r r1 _ r � SUBMITTED BY J�rt , / PAGE Y f R...02 147. LOC 0017 POTTER AVENUE CTY 07 TDS 400 HY KEY 221165 ----MAILING ADDRESS------- PCA 1211 PCs 00 YR 00 PARENT CALDEIRA, ANSELMA MAP AREA WAC jV M-Ir.13 2 1.0 SOUZA, MARIA C fir`I. S1-'2 P 0 BOX 168:3 UT! U-Ir 2 . 22 SO FT 34E-"?-, HYANNIS MA 02601 AYB 1986 EYB 1906 OBS CONST 1683 LAND 24700 IMP 202000 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 226700 REA CLASSIFIED 4ir'L A IN11.1•' i 24, 700 ASO LND 24700 ASD !MP 202000 ASO OTH #BLDG(S) -CARD-1 1 202, 000 ,DESCRIPTibN TAX YR CURRENT EXEMPT TAXABLE #DL LOT 17 LC 9638-A2 TAX EXEMPT #PL 17 POTTER AVE HYANNIS RESIDENT'L 226700 226700 226700 #RR 1304 0080 0455 0080 OPEN SPACE #SR DUMONT DRIVE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE 02/93 PRICE 175000 ORB C129411 AFD V jT L LAST ACTIVITY 11/30/93 PCR Y D. KEY 2271 R 3 OC"; 4 7 F, f3 A I Sl A, L C rf'i L D E J1,R A Al"ISELMA L A INID. BLD/F E PI-INURZE G BUILr' INGS NUMBER' ',"fF' =51PF�.: P1 .24, 7(_)0 2 o 4,, 1 0 1 A_COS­r B ro y E, C Id "Ot"IE I I'l I- IT c A PC A=1211 F'CS=C)O 4C Ju"i-l" VAL L E'v= rl r 1'. F.1-1 R T "r. . T'A y, 1-D'If I" LSOP4' TO tCON I RC)L An'RE.-Al 61AC IR'l.­.ND EXIC'EEDS Sl'Ar�41_11`­IRD "EIGHBORI 100D !_,l^C 1- YANNIIS it P A"R CE t'.-. ICONTROIL_ AREA -r;:*�r­�_M r I L. Ll STANIDAR,,D LAND-MEAN C) rl"I -NEA I r.- ZE 740-3W) I PROVED r FRO)'-14'T---F"I LDE'F"'l"l­.'/ACRES "J'ABLE 02 *it 00% J. I It T L 0 C A 7,1 0 h'--A r.'.j A PrPL Y V AL-SIF I LIMP LA'N'D. ADJS/SB/FEA" STR S"rlR'UClrUlRE ARR All'_-ZEA INOR. 11"10"I"ES T""I 1`56'E NIC E F "K:' F I0 Tk-Li, 'Irl : 1 , : r AE 3 G RR GRAPH .r'l I 1!,j f,..r T(-I h I C U!::,C7 I:R v-, ,a m-r -p w At I I ­ -- -------- —------- --- --- �r u a®= -T - -, ]I�p}�-, � v � V 1-7 L ; � ° i ' j TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 294 071 GEOBAS ID 20834 ADDRESS 96 AIRPORT ROAD. - . _ _ . ._ . _ .PHONE. HYANNIS ZIP — LOT BLOCK LOT SIZE DBA DEVELOPMENT DIST� CT HY PERMIT 69053 DESCRIPTION ADD OFFICE SPACE INTERIOR WORK PERMIT TYPE BREMODC TITLE COMMERCIAL ALT/CONY CONTRACTORS: MACHERAS, MICHAEL ,SkiS IJ ?tr- IJ department of ARCHITECTS: ��G• Regulatory Services TOTAL FEES:. $245.20 BOND $.00 pf tf1E CONSTRUCTION COSTS $32,000.00 437 NONRES./ NHSKP ADD/COIF 1 1 TE T*f 3� Asz.E, Fp Mpl A BUILDING BY DIVISION ._ ICl DATE ISSUED 05/28/2003 EXPIRATION DATE v " e y . +� Y7 4I •� ,95 _.Airport;R ;=� �, ��//�� ,/� 5 t 'HYannis,,XV02601 'S08-771.-81, &'fox h_ 100 Commercioi Unen:Si ervces ri, T :✓' F w� • ; ,<,..,: TOW& OP BA RNSTAB LE B D9(3 PERMIT 11 .. PARCEL,>ID 29'4� 071 GEOBASE ID 20834 ADDR'2SS 99 AIRPORT ROAD PHONE H�YA9'NIS zip LOT a ' , BLOCK; :, 91 J LOT SIZE \DEVELOPMENT DI STI CT. HY PERMIT F69083 DESCRIPT�ON ADD OFFICE SPACE INTERIOR WORK r PERMIT TY E BRE�ODC TITLE COMMERCIAL' ALT/CONY QONTRACTORAxERAs, MICHAEL L . Department of I ARCHITECTS: Regulatory Services TOTAL FEES: - $245.20 •BOND $.00 OIFTHE y a CONSTRUCTION COSTS $32,000.00 437 NONRES./NONHSI ADDjCONV ,1 t� �P tIVATE li MASS. 039. ..I { � BUILD G ISIONBY dl f fi R EISSC3 U 05%28% 003 RXP.IRATIO I DATE THIS-PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY.OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT 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 MAY BE.OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED j FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- ELECTRICAL,PLUMBING AND MECH- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ANICAL INSTALLATIONS. 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. 4:FINAL INSPECTION BEFORE OCCUPANCY. BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS � 1 � 2 2 2 3. 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT f' 2 BOARD OF HEALTH OTHER: SITE PLAN REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL PERMIT WILL BECOME NULL AND VOID IF CON INSPECTIONS INDICATED ON THIS THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. i I �' i 1 r ` � i �Z- , � S/ � +5 ASSESSORS MAP. 294 PARCEL 64 LOT SIZE: 28,033 S.F.f 0.64 AC.f 55.00 ��P�G T L ZONING: B BUSINESS DO OT ENTER SIGNS P�� O GROUNDWATER PROTECTION OVERLAY DISTRICT Q / } 5.44 ?� BARNSTABLE .� HATCHEDEXISiI G AREA: NO- M+N+MUM MUNICIPAL AREA NEW AIRPORT N/ FRONTAGE: 20 FT MIN r( 55.52 PAVEMENT �p HCP SIGN 05 9 - R �� +54 °j WiDTFf N0• MINIMUM- \,�Po 5 7 TO CODE P L US SETBACKS: 20 FT -- FRONT N' W_ 0 FT - SIDE �<y LANT RD GO 0 FT - REAR 5 .5 II ti MA.P-.-&9 NO %4AXIMUNt BUILDING COVERAGE Ur G CHE 15 s'c CAPE COD�`i2 y�0 554 59 ! 30 FT .MAXIMUM BUILDING HEIGHT MALL - � ` 0 �(• `Q � �, � 111 (OR 2 STORIES, WHICHEVER IS LESSER) P � SIGN 54.86 � '�;�.•<'_;S, • \ �9 .02 :...:.'GRASS ..: o OWNER OF RECORD: .:�',,.;.. AR€A 4 CHERRY_ N/F JULIA ALMEIDA TR. PENN. NOM. TR. oDTE 28 Q 1.. CHERRY ::°3' �p Op n n P 0 BOX 264 HYANNIS, MA 02601 OF +56.26 / .. � \ .. .IQ + s. o+ O ANSELMO CALDEIRA- APPLICANT 52. ��'� g '.. •• :.. P.O.BOX 1555 HYANNIS, MA 02601 +54:4 '55.95 LOCUS MAP / 96 �' +s 1i +'.�3/ c+ PLAN REFERENCES: _ - PS 267 PG 46, 283/54 SCALE I" = 2083' s 3 5.55 \ .22 ASSESSORS MAP 294 PARCEL 64 � 3 FRONT ETB YARD' LANDSCAPED SACK FROM ROAD LOT LINE: 10' /� / 6v7 r 45 N GR 54 \ 63 56---`¢ DIRT X X WITH 3" TREES 30' O.C. 50.21 \ RCA 00� \ PARKtNG 1 r ' ` _ i %P F` 54 s 'A\ " --r GP REGULATIONS: EXISTING & PROPOSED 5 oc EXISTING 5175 SF s. o10 I ( I 50% MAXIMUM IMPERVIOUS COVERAGE 17,833/28,033SF = 63.8% (NO CHANGE) 0.50 y 5 0 METAL BUILDING per\\09� J I I PAVEMENT REMOVED 351 SF = PAVEMENT PROPOSED i5 � 1.18 5. ALL SEASONS LAUNDRY S 1.76 0 \ I I PROPOSED 4400 SF 28,033 SF = 16.0% NO CHANGE S o �, 55.I�5 J ( 30%° MINIMUM U NATURAL STATE: PROPOS PREVIOUSLY DEVELOPED SITE ( ) 50.66 IP +52.38 / Op �\ � I ( ) MAP 29464 �6:28 J / 50:93 +5�1915' + 1S pG�� �5 # 9cJ ��� , J �9 55.97 4=2.6 LANDSCAPE REQUIREMENTS FOR PARKING LOTS 30.1' 1 55.8. +56.92 LANDSCAPE BUFFER FROM LOT LINES TO PARKING LOTS AND DRIVES: 10' SIDE & 10' REAR REQ. 6.6 56.05 J LANDSCAPE BUFFER FROM BUILDING TO PARKING LOT: 10' REQ. 0 50 ,0 90. +53.07 \�2� °� DIRT J I EXCEPT AT BUILDINV ENTRANCES & LOADING ZONES- PRE-EXISTING CONDITION / 9i. F 6 PARK G I MAP 294 Co N ( EXISTING \� J W II 76-2 4-2.7 PARKING IN FRONT & SIDE. OF BUILDING ONLY- O.K. II 11 I 51.48 ° PAVED 5• 5 I N # 64 J or- \ � STRIPING \ 5 :00 �� o <21 SPACES OUTSIDE, 10% INTERIOR LANDSCAPING/TREES NOT REQUIRED. TAS INDICAED j \ -28 033 SF .'. o PARKING CALCULA TI N : 0 S �.64 AC.f 10 0 5.78 56 55:86 -k6.80 INDUSTRY/STORAGE: 5175 SF (1/700 SF) 7.4 SPACES EXIST \ EDGE PAMEN I LAUNDROMAT-- 26 MACHINES(1 SPACE/4 MACHINES) = 6.5 SPACES r,Q . ABOVE GROUND J _ ONEACONOIL 'P D TANK J co TOTAL: 14 SPACES REQUIRED \ �G' WITH BOLLARDS 7 I Q 521 CMR 23.2.1 15-25 SPACES: 1 HCP SPACE REQUIRED. \ \ s 48 It fA I o :-15 -PARKING SPACES PROVIDED INCLUDING 1 VAN ACCESSIBLE HCP SPACE .78 I 704.90 56 Sr } J z j 4 DIRT N cpy _'O PARKING FENCE AROUND J w UFFER - DUtPSTER qA�FI 54 _ -- -__ 83.54'10„� -R MANHOLE GENERAL NOTES: 137.00' 1. THE LOCATION OF EXISTING UNDERGROUND UTILITIES SHOWN ON THIS PLAN IS �5 APPROXIMATE. PRIOR TO ANY EXCAVATION ON THIS SITE, THE EXCAVATING CONTRACTOR SHALL MAKE THE REQUIRED 72 HOUR NOTIFICATION TO DIG SAFE (1- 'Q PGg EDGE PAVEMENT 54, ` 888-344-7233) AND ANY OTHER UTILITIES WHICH MAY HAVE CABLE, PIPE OR ,yam s EQUIPMENT IN THE CONSTRUCTION AREA FOR VERIFICATION OF LOCATIONS. APRON UPOLE # 1356/5 (PAVED) O 2. ALL CONSTRUCTION MATERIALS, COMPONENTS, AND METHODS EMPLOYED ON THIS PLA RD* PROJECT WORK SHALL CONFORM TO THE TOWN OF BARNSTABLE SUBDIVISION REGULATIONS TOPCOAT MASS DPW AND\QR_ THE MASSACHUSETTS DEPARTMENT OF PUBLIC WORKS STANDARD SPECIFICATIONS 1 SEWER COVER , 40' WIDE P IVATE WAY " TYPE 11 FOR BRIDGES AND HIGHWAYS AS AMENDED TO PRESENT. DUMPS E 2" BINDER 3. ALL. DRAINAGE COMPONENTS MUST BE CAPABLE OF WITHSTANDING H-20 WHEEL LOADS. APFA 4, VERTICAL DATUM IS NGVD ASSUMED FROM G.I.S. DATA. TOWN WATER AND SEWER. DRAINAGE o°o°o o°o°o°u°o°o o°0 5. THIS PLAN IS FOR THE PROPOSED WORK ONLY AND SHOULD NOT BUILDINGS & PARKING: {_ ♦ SITE PLAN- DRAINAGE o°°o°°o'°o'o'°Oc° o°'$o° BE USED FOR PROPERTY LINE STAKING 0 AREA = 22.234 SF, 20 YR STORMREMOVE TOP & SUBSOIL 12" PROCESSED GRAVEL BLDG/PAVE = 17,883 SF, GRAVEL/DIRT = 4351 SF 20 0 20 40 60 Fee{ MDPW' M1.03.}' VIB. ROLLER COMPACTED COMPOSITE CURVE NO. _ (0.93(17883) + 0.40(4351)) /22234 0.826 RATIONAL METHOD Q=CIA = 0.826(4.2)(22234/43560)= 1.77 CFS PAVEMENT NSITEA 1 J7(448.8)/.5GPM/SF=t 589 SF LEACHING AREA REQUIRED. N UTILIZE EXISTING (4) 6'-8" X 6' LEACH PITS W/ 4' STONE (447 SF EA.) SCALE: T = 20 NOT TO SCALE TOTAL LEACHING AVAILABLE 1788 SF > 1589 SF O.K. LEGEND: _ OF LAND IN HYANNIS (BARNSTABLE) MA off 508-362-4541 �����of rryss C fox 508 362-9880 Q Q ��,Zt+oFr�gssy a� ARNE H yes PREPARED FOR: M SEWER MANHOLES EXISTING TREE ��o� ARN E cy +v11.LA �N INC, �. H. ALL SEASONS LAUNDRY TREE/SHRUB LINE o�ALA down cape en gin eerin g, Inc. No. so7sz #95 AIRPORT ROAD, HYANNIS, MA C/1/lL ENGINEERS �� UTILITY POLE , N 26348 o r � 55 EXISTING CONTOUR / N UR C/E YORS LA O S - - ---- DATE: 1 1-9-03 SCALE: 1 " = 20' 939 Main Street YARMDUTHPORT, MASS. O EXISTING CATCH BASIN +55.00 EXISTING SPOT GRADE OJALA PLS, PE Date: (MOVE HCP SPACE TO FRONT ENT. AREA) REVISED: 3-30-04 x EXISTING FENCE A BUILDING MOUNTED LIGHTS 03-348 L 3-� 27'-7,9947' Storage EXEC Sec HR MGR 1 CFO EtIJ AP 1 AR Purchasing VP--Ml-G Engineering R&D DIR 10 Clean Closet Women's Men 's. Room Room 10 p_ppCL Z r US-MGR Siencetist c 10, E I Main Con-Ferance Room at cc Plan! 'Iffice 91-8.0000, ,T- U In L-Aing Break Room Kitchen Tfl �C MFG MGR 10'-4.0000' Vending Exsisting Exsisting Stair Electrical ROOM Well V-8.-0000- 15' 14'-8.0000' 0000, y. �THIS DCLUIC147 .EMTIAL AND TRADE SECRET INIORNAT". IS 4 k:. 3W SENTINEL PRU WCTS CORP, AND IS GIVEN IU IHE -I vER 7N CONFIDENCE THE. lRECEIVER, BY RECEPTION m :..:"TENT NON OF THE. DDCtWNT + ACCf PIS THE DOCUNLW7 IN -JiFIDENCE AND AGREES THAT, !1 EXCEPT AS AUTFFORTZED IN WWTING BY SENTINEL PRODUCTS CORP- T71 TWIDE USE R TRADDOCUMENT CR M1IN OR CI DISCLOSE � :. - Aw �'' ` f' .'r EUr� OR THE CLMF.IIE NT IAL OR TRADE SEERS TFEORMATTON 7 ; THEREIN, 121 Wr COPY THE DOCUMENT. f3% TO OTHERS EITHER THE DOCtA[NT OR THE COWjSrNTW EIR TRADE SF...RET INFORMATION THEREIN, AND (41 Lh"4 ,' t �CONPLETION OF THE NEED TO RETAM THE DOCUMENT, OR _ _UPON DEMAND. RETURN THE DOCUMENT, ALL COPIES THEREOF. ANO ALL MATERIAL. COPIED THEREritpN. COPYRICNT®SENTINEL PROMF IS CORP.• ALL RIGHTS RESfRVEII } t i z. ?i�1 [`• Y 0 � i\ 1 I I . y i 1 1 1 r 42'-5' { t - -- 37'-10' y0 13'-6' - W 5'-2' ---- 9'-5' 46 s ' --- — ---- 43'- 1' ---- - -�- ---- 21'-3' - - Y -- --- 15'-7' ' 5'-7' 26 0 r � x V endw%g V endwQ F: U -- o, o 9'-8' rn a � X� 13' 6' 1( 30 E O W 1 O y I j or i U { n C � O G. ;U co W t o - s This Drawing isorp 'ential in Des1gn, as dO a �U / IOt Y DpW1,And Invention. It is The Properi�►Df 38' 90 `�_-- ---- ----- SWOrMi Products corp. And May 25'-011 (And Solely For Work Contracted, Or Af 6' used Permission. All Rights Of 27'-8' �, I AepmdUction .4re Reserved. t 25'-7" Li 17'-8' 19, 0 17' 3, U � w J n Z d O f C 1 lL Ct01 ----- - 10 48'-6' -------- --- ------ 10' ---- ' ---- --- 10' ---- ---- 10' ----- �- - 9' 8" 10'_4' 7'-8' 16' 1 ITEM ti PART NO GfTY PART OR MATERIAL DESCRIPi 1 X 91Y WT ' - ---------.----_--._- _ 93'-8' ------- — TD! t-RANCES ARE NOT ADDITIVE '_�tIL'1 i1lJV" iSLf� 70 Air-port Roo -- — - x ;gas ' o jfl) 1 �� I� ;is, �SSO(tMe}�STi w Z kxxx t 30Q i` ( t(7Ll�Un ti rM X. SU E CE RUGHNE S 1 IRAYN IY:BRM DATE 11/27/01 CFN(B BY: FDA T E �, (n 0U MACH N D S. R_F AC IPERNAL T All CLASS UNC 2B UNC 3E APP0 Bt DATE: F i E,TERNAL THREAD CLIPS UNNC 2'A-.�1tYtf _._ Y. _ W \ q I __ X A, Y Y / w1�RK TO DIMENSIONS � � _ DO NOT SCALE DRAWING ;f MOVEE SHARP EDGES SCALE 1/8' = 12' {{ Q (i �Nc DWG NO REV^ Z PLANT LAYOUT (#3) TOP FLOOR 4-100--1182 01