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0516 BEARSE'S WAY
l NO z Message Page 1 of 1 Anderson, Robin From: Jeffrey Ford Uford21@verizon.net] Sent: Wednesday, August 15, 2012 3:48 PM To: Anderson, Robin Subject: RE: Car Wash HI Robin, Thanks for the heads up on this. I just spoke with our client and they have indicated that the open signs and flags will be removed immediately. If you hear anything differently just let me know, but I know the owners have instructed this be taken care of right away. Thanks as always& have a great afternoon, Jeff LAW OFFICE OF MICHAEL FORD JEFFREY M.FORD, ESQ. 72 MAIN STREET, P.O.BOX 485 WEST HARWICH, MA 02671 TEL. (508)430-1900 FAX(508)430-9979 EMAIL:iford2l(c)verizon.net From: Anderson, Robin [mailto:Robin.Anderson@town.barnstable.ma.us] Sent: Wednesday, August 15, 2012 2:42 PM To: jford2l@verizon.net Subject: Car Wash Hi Jeff, Please instruct your client at the car wash to remove all un-permitted signage. In addition to the open signs they now have portable flags flapping in the wind. This action violates the sign code on more than one level. Could could contact them and confirm their intention to comply in order to avoid citations? Thanks so much for your assistance with this matter. &bin Robin C Anderson o / Zoning Enforcement Officer C 7aivn of Barnsta6Ce 200 'Main Street -•� ,� Hyannis, M-21 026oi 5o8-862-4027 �J- V-) 8/15/2012 l AC® D /DD/Y CERTIFICATE OF LIABILITY INSURANCE 221//21/2012 �- 2 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 Lauren Deluca NAME: QUINCY INSURANCE AGENCY, INC. RHONE (781)431-9600 FAX No (781)431-9595 At L 144 Gould Street ADMDRESS:ldeluca@quincyinsurance.net Suite 152 INSUREfl S AFFORDING COVERAGE NAIC 9 Needham MA 02494-2337 INSURERaThe Travelers Indemnity Co. .INSURED INSURER BCharter Oak Fire Insurance Co. Breen & Sullivan Mechanical Services INSURERc:Fireman's Fund 7 Healy COUrt INSURER D: INSURER E Danvers MA 01923 INSURERF: COVERAGES CERTIFICATE NUMBER:2011-2012 LLD Master REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED: NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR P OLICY POLICY EX LTR TYPEOFINSURANCE - - POLICY NUMBER MIDD/ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 1 X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccunence $ 300,000 A CLAIMS-MADE OCCUR X XCO- 570M822A-IND - 11, 2/22/2012 MED EXP(Anyoneperson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER* PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE IMI Ea acddent 11000,000 B ANY AUTO BODILY INJURY(Per person) $ 20 000 ALL OWNED X SCHEDULED X X 810-2031XI62-COF-11 2/22/2011 2/22/2012 BODILY INJURY(Per accident) $ AUTOS AUTOS 40,000 HIRED X X NON-OWNED PROPERTY $ AUTOS 5 000 Medical payments $ 5 000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 5,000,000 C X EXCESS LIAB CLAIMS-MADE - AGGREGATE $ 5,000,000 DED I X I RETENTION$ 0 X X SUO 00073509796 2/22/2011 12/22/2012 $ B WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED?- � N/A (Mandatory In NH) B-56SM9863-COF-11 2/22/2011 2/22/2012 E.L.DISEASE-EA EMPLOYE $ 1,000,000 11 yyes describe under DESCtRIPTION OF OPERATIONS below X E.L.DISEASE-POLICY LIMIT it 11000,000 A Installation Floater O- 570MB221-IND-11 12/22/2011 2/22/2012 Job Site 100,000 Temp.Storage&Transit 75,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Operations: Plumbing, Heating, Air Conditioning and Sprinkler Service and Installation. Job location: 516 Bearse Way,t 5�7 Corporation Street, Hyann� s,_MA__---J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Barnstable ' ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA AUTHORIZED REPRESENTATIVE Lauren Deluca/LLD ACORD 25(2010/05) 01988-2010 ACORD CORPORATION. All rights reserved. INS025(201005).ot The ACORD name and logo are registered marks of ACORD �t Sign TOWN OF BARNSTABLE Permit * BARNSTABLE, MASS. 16 39. Permit Number: Application Ref: 201201021 20070714 Issue Date: 02/23/12 Applicant: 516 BEARSES WAY LLC Proposed Use:, PARKING LOT Permit Type: SIGN PERMIT Permit Fee $ 200.00 Location 516 BEARSE'S WAY Map Parcel 293009 ` Town HYANNIS Zoning District SPLT Contractor PROPERTY OWNER Remarks NISSAN SIGNS 86 SQ FREESTND/LOGOA AND 2 WALL Owner: 516 BEARSES WAY LLC Address: 1102 RIVERDALE STREET WEST SPRINGFIELD, MA 01089 Issued By: POST THIS CARD SO TI3AT IS yTSIBLE FROM THE STREET PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE; 02/23/12 TIME`: 09:19 t ----E------------TOTALS----------------- PERMIT $ PAID 200.00 i AMT ,TENDERED: 200.00 AMT CHANAEPLIED: 200.00 APPLPICATION NUMBER: PAYMENT METH: CHECK PAYMENT REF: 9619 °FT► ,�,, Town of Barnstable Regulatory Services i « ' BARNSTABLE. ` Thomas F. Geiler, Director Y MASS. 1639.,p``� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Q www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# Building 011icial approving------------ Q Application for Sign Permit q Applicant:_1�_ _ tS S(AV\.J [� �( a -++----------!-----(---------ff------Assessors No.--------------- + V 1 DoingBusiness As: � 1^ + cj)., _c+C_�c9�t _`ts^ 'l ele hone No._5og"4 20=_19 00 _ i f - - --`�--- p Sign Location 3�ia h7oc�7 IS� 5 6, I Strect/Road: ------------------- - - ------- - _�e1 ---� Zoning District:WL __Old Kings Highway? Yes Io Hyannis Historic District? Yes�1Vo� Property Owner ff t�� II j �G Name:_ - 411 1iTL`tiS_A51 T ���—-----1 elephone:-59t ------------ - Address: 1 -- � r4c' ----------------Village:_W—5 �� T+'�1� 7A4 ow, -r Sign Contractor Name:-P --------------------------------------- Telephone: 9S4' 1471 ---,9 0(3 Mailing Address:o��� _1e ruiT�QdV�, __p(Cit U ff'e�t ►�i+ti PEW%C� _ Description Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. aa 13w+��t��a N�its�� ��rrfni Is the sit,�l to be electrified? Ye /No (Note:Il:pes, a tf ig-permit rs iegtrirerl) d' 7.741 Width of building face—1 U 0 _ft. x 10=_��OM x.10=_10�___ (�w i 14 i�� ( p +i Check one Reface existing sign__—or New_ V Total Sq. Ft. of proposed sign(s) 6 L)'► W i a SZ lr►� Il you have additional,signs please attach a sheet listing eacli one Tiitli dimensions If refacing an existing sign please provide a picture of the existing sign with dimensions. al yj lam I hereby certify that I a1n 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 o1' Sr §- 240;59 through §240-89 of the'1 own of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agen 1k Aik.fj' _ Date a 3 j 0 / U '9 If vvwc'i SIGNS/SIGNREQU revised]21 10 NISSAN NORTH AMERICA, INC. Nissan Retail Environment Design Initiative Sign Program 11.SITE PLAN AND COLOR RENDERINGS The following provide a visual representation of the prepared solution. NSF PAUL A.S.O MJU R.M RELOCATE r x,V NISSAN � 22 r/NISSA NEW 1 ry OTjt M12 W 5,ss;ro .1 or P R R 1 17 Fl FUMNTUR T E FOR \ O -� E 5 90E.— ElECMCAL CKARW1O SfARON OBAl.1SE NISSAN o o�8 N EW � 18,3g1 SF �a�Ao am •' GF E7LLS11NG o�, ! 29 '�111'1 ' 5,663 SF (G REtdNN SDI\ •1 d 11�EW P"MEEG ' gt1Rp1N�A 1.4 5"AN1POS ' 32 m>A�1 SEN`��EF N s / uN 1 ,a oNu Ery 'E 7 3 E 9 A FIECROCAL QVOCH G ^.��,..y..aa��nnON , 1 SEAIRN J"— NEW I 13 p NEW Balise Nissan of Cape Cod(3816) Occ/2011 ' Rev.z Hyannis,MA Page 4 12/09/2011 Rev.3_02/22/2012 1 NISSAN NORTH AMERICA, INC. Nissan Retail Environment Design Initiative Sign Program SITE BEFORE NEW CONSTRUCTION NISSAN _ III E PROPOSED BUILDING AND SIGNAGE i 75' 5' ±43'7" 5' -NISSAW- HER.a I --- B:24" NWM Channel Letters C: 18" DNL Channel Letters F: 60"Entry Element Balise Nissan of (3816 Cod Cape oct/2011 P ) Rev.2 Hyannis,MA Page 5 12/09/2011 Rev.3 02/22/2012 NISSAN NORTH AMERICA, INC. Nissan Retail Environment Design Initiative Sign Program SITE BEFORE NEW CONSTRUCTION PROPOSED BUILDING AND SIGNAGE b In D: 15"Service Channel Letters Balise Nissan of Cape Cod(3816) ocv201 1 Hyannis,MA Rev.2 12/09/2011 Page 6 Rev.3 02/22/2012 NISSAN NORTH AMERICA, INC. Nissan Retail Environment Design Initiative Sign Program III.SCHEDULE OF SIGNS 13' -19 9/32" 24II" l� A Nissan Word Mark Channel Letters 24" Channel Letters(Total of 1) 27.71 sq.ft. NEW 8'-5" 18" Dealer Name Letters 18" Channel Letters (Total of 1) 12.8 sq.ft. NEW 7' -7 9/16" t1 Service Channel Letters 15" Channel Letters (Total of 2) 9.53 sq.ft. NEW Balise Nissan of Cape Cod(3816) ocv2011 Rev.2 Hyannis,MA 12/00/2011 Page 7 Rev.302/22/2012 NISSAN NORTH AMERICA, INC. Nissan Retail Environment Design Initiative Sign Program III.SCHEDULE OF SIGNS CONTINUED T 2" 4 9 F I i !-NISSAN 0 i 0 T I 4 Custom MBS-18 Pylon 18 Sq. Ft. Main Brand Sign (Total of 1) 10" OAH RELOCATE 711 5' - 10" 5' - 011 NISSA iI. GEntrV Element-60" 26.75 Sq. Ft. Main Brand Sign (Total of 1)60' OAH NEW Balise Nissan of Cape Cod(3816) oet/2011 Rev.2 Hyannis,MA 12/09/2011 Page 8 Rev.302/22/2012 Town of Barnstable Geographic Information System February 23, 2012 293060 293026 *47 #58 293030 #32 293027 293011 #32 293007 #45 #648 293038 293031 #306 m #276 293008 x #628 p @� N n 1f< 9,ps� 0 293028 p s, q #20 sL O 70 9`' ® 293010 #322 4 293009 Z #516 293001 #382 fAtiM�V7N RO�RT6 28 292137 #0 292287 #307 292005 #317 029230 292077 #489 Z<� DISCLAIMERS:This map is for planning purposes only. It Is not adequate for legal Map:293 Parcel:010 a Selected Parcel boundary determination or regulatory Interpretation. Enlargements beyond a scale of Owner:BALISE AUTOMOTIVE REALTY LP Total Assessed Value:$1002000 1"=100'may not meet established map accuracy standards. The parcel lines on this map _E are only graphic representations of Assessor's tax parcels. They are not true property Co-Owner: Acreage:0.67 acres Abutters boundaries and do not represent accurate relationships to physical features on the map Location:322 FALMOUTH ROAD/RTE 28 or W such as building locations. Buffer +' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel , Application # 14 \LD Health Division Date Issuedot5 Z_ Conservation Division Application Feel G� Planning Dept. Permit Fee = U Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis 1 Project Street Address rrIIe Village 11 _419b Owner 1'Id'l l�Dlf��L1�1�5 Address Telephone �� ✓mil k� ill S Permit Request Lymio 1 //A� ,:01 T Uf'/�.�/odf /djb- ThIl ilW dIS�D� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ' Project.Valuation�'-S 0 D n Construction Type ~` c Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) vM 3 Age of Existing Structure Historic House: ❑Yes 5/No On Old King's Highway: 0 Yes No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: d � existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other / Central Air: El Yes dNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes Q No Detached garage: ❑ existing 0 new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial O Yes ❑ No If yes, site plan review# _Cur_r_ent_Use _N(��(�II' Proposed Use uIA tl� i ��� 1►QL' APPLICANT INFORMATION } (BUILDER OR HOMEOWNER) Name A-406(y*d 6aitd' r � Telephone Number Wl3 �Ja 31-72 - Address - 3b a A-I b� ls�T' License# V b a SpF�I) �. 01105 Home Improvement Contractor# Worker's Compensation # _D `'ze. ALL CONSTRUCTION DEBRIS RES LTING FROM THIS PROJECT WILL BETAKEN TO' N5614 W%k , 1 ,SIGNATURE-. DATE r• FOR OFFICIAL USE ONLY APPLICATION# t SQATE ISSUED f }r}�AAP/PARCEL-NO. t - r rADDRESS_i• VILLAGE OWNER t DATE OF INSPECTION: ��:3 FO _._... _ ..._._' UNDATION �=' x f . FRAME -'-- :�eJINSULATIONA_. l t+ ,� 3 .- •� C� r FIREPLACE } ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL - GAS i ROUGH FINAL 1--1,1 4NAUBUILD.INGiV 1tRoGt. x :I d-�7ECLOSED OUT:,�=Ltm ASSOCIATION PLAN NO. APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name AwewW 0,1tdlh cft,3 Telephone Number Address 35'd License # 060 3g� SpFta �^1�i, 0!!OS Home Improvement Contractor# Worker's Compensation # P(ell2e- w(Nnt.'e- � ALL CONSTRUCTIONDEBRIS RE S LTING FROM THIS PROJECT WILL BE TAKEN TO CG � 5Q(( M C 3 6 ,+l oor&. ! k/!i 1�iat�i pill MC U q a q(7 SIGNATURE DATE 0-0-to 7-to TOWN OF BARNSTABLE_BUILDING PERMIT APPLICATION Map Parcel 'Application # la Health Division Date Issued k Conservation Division Application Fee Planning Dept. Permit Fee < � Date Definitive Plan Approved by Planning Board Historic - OKH _Preservation / Hyannis Project Street Address rI N Village �l��dY7d) Owner ll� DUIdfDK��VE Address , &ll'ff� 6 A1Lrt aD1D�� Telephone 118"✓L kr Permit Request L tny ll h milrr 9r Kam- -rnI aC#211//�2_2 difJH d�*IS .Ty anonok f)c111 o Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay ' Project:Valuation:°,S 0 D o Construction Type ^' c v Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. ( Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) = U3 // NO Age of Existing Structure Historic House: ❑Yes O'No On Old King's Highway: O,,Yes N'+ No 4J c i Basement Type: ❑ Full ❑Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑ Other / Central Air: ❑Yes 4No Fireplaces: Existing New Existing wood/coal stove: ❑Yes Q No Detached garage: ❑ existing 0 new size—Pool: ❑existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial iYes ❑ No If yes, site plan review# Current.Use_ N �(� _ Proposed Use OIA APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Na A55 411111h +� APROJECTWILL um er Ad re s // ri i�/cl�� D �1r' .� prove ent Contractor# Com ensation # rQ 11�� � (t ALL CONS UCTION DEB IS RESULTING F OWILL E TAKENTO L I�SQ I, . �1—&l 1 Purl ilk W : _ J41) wSIGNATURE G, DATE d P t F }r} 1 r 5} FOR OFFICIAL USE ONLY APPLICATION# 4 L'SUATE ISSUED_i"Ez :f_)) -'r J.; ' F 4� �lIAR/PARCEL NO. a f z '._ADDRESS_,, VILLAGE ` 4 OWNER 1 I. Y i DATE OF INSPECTION: _ LD'FOUNDATION ';l FRAME .AINSULATION t 41 ,' ' '.` ' -;,, .. 4 FIREPLACE s '` y ELECTRICAL: ROUGH FINAL {� PLUMBING: ROUGH FINAL - f AS H ;L4 ROUGH FINAL _. ' t t s f { ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department oflndustrialAccident`s Office of Investigations 600 Washington Street c� Boston, MA 02111 yy www,mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): 52-2 Address: City/State/Zip: f �/� �1��� Phone #: 4M /� �If Are you an employer? Ch lk the appropriate box: Type of project(required): ]. I am a employer with t/' 4. ❑ I am a general contractor and I 6: ❑ New construction employees(full and/of part-time).* have hired the sub-contractors.. . _ _. - __ -.....___.._-__ -......_ . 2-❑ I alri a sole proprietor-or partner- listed on the attached sheet. 7. V,.Remodc;ling ship and have no employees These sub-contractors have g, emolition working for mein any capacity. employees and have workers' 9 ❑ Building addition No workers' comp. insurance comp, insurance.$ required.) 5. ❑ We.are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a bomeowner,doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself, [No workers' comp. right of exemption per MGL 12.❑Roof repairs required.] t c. 152, §1(4), and we have no insurance re q employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#J must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must anchcd 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. Tarn an employer that is providing workers' compensation insurance for my employees. Below is thepolicy al djob site inforinatiom Insurance Company Name: �J�� � ��/ILY� � J� Policy# or Self-ins. Lic.#: �0"/ �f'Y'�� Expiration Date: Job Site Address:�I /Ar ��U�� 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, Ldo hereby eertify�uAAnder the,Qp�a�ilns and penalties ofperjury that the information provided above is true and correct. Signature: UPI, �fX� Date: 10 2 / 0/0 Phone# '� �� Official itse 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#: Massachusetts Department of Environmental Protection 0 Bureau of Waste Prevention . Air Quality 1100113240 _ M BWP AQ 06 Decal Number Notification Prior to Construction or Demolition Important: Applicability When filling out A. 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 cursor-do not (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of use the return key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10)days prior to any �---h 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?❑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 Environmental vacant structure Protection a.Name notification 516 Bearses Way requirements of b.Address 310 CMR 7.09 ("--------- H annis MA I 02601 c.Cit own d.State e.Zio Code f.Tele hone Number area code and extension .E-mail Address(optional) 6,120 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: former car wash I. Is the facility a residential facility? ❑ Yes ❑✓ No �O m. If yes, how many units? Number of Units —�° 3. Facility Owner: —N Balise Motor Sales �° a.Name Doty Circle b.Address West Springfield MA 01089 c.Citv/Townd. t t e.Zi ode ° (413)348-8689 � 1 f TeleDhone Number de gnd exignsion) .E-mail Addr ti nal D Jim Demas �Q h.Onsite Manager Name ag06.doc•10/02 BWP AQ 06-Page 1 of 3 I Massachusetts Department of Environmental Protection _ Bureau of Waste Prevention • Air Quality 1100113240 i'--, Decal Number BWP AQ 06 Notification Prior to Construction or Demolition General Statement:If B. General Project Description Cont. asbestos is found during a 4. General Contractor: Construction or Demolition Associated Building Wreckers, Inc. operation,all a.Name responsible parties must comply with 1352 Albany St. 310 CMR 7.00, b.Address Chap 7. and S rin field MA 01105 Chapterer 21 21 E of the General Laws of c.Cit /Town d.State e.Zip Code the Commonwealth. (413)732-3179 This would include, f.Tele hone Number area code and extension :E-mail Address o tional but would not be limited to,filing an Andrew Mirkin asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. Associated Building Wreckers, Inc. a.Name 352 Albany St. b.Address S rin field MA 01105 c.Cit /Town d.State e.Zip Code (413)732-3179 f.Telephone Number area code and extension .E-mail Address(optional) Fred VanDerhoof h.On-site Manager Name 2. On-Site Supervisor: William Babcock On-Site Supervisor Name 3. Is the entire facility to be demolished? ✓❑ Yes ® No �N _0 4. Describe the area(s)to be demolished: _o Entire existing structure. �N �O 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: n/a -( �o �D �Q ag06.doc•10/02 BWP AQ 06•Page 2 of 3 t,� 1Massachusetts Department of Environmental Protection 17� Bureau of Waste Prevention • Air Quality BWP AQ 06 Decal Number Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project,were the structure(s)surveyed for the presence of asbestos containing material (ACM)? ❑✓ Yes ❑ No If yes,who conducted the survey? ADAM LESKO AI073071 c.Division of Occupational Safety Certification Number 11/01/2010 7. Construction or Demolition: 01/28/2011 __ a.Start Date(mm/dd/yyyy) b.End Date(mm/ddlyyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving❑✓ wetting shrouding b. If other, please specify: ❑ ❑ covering ❑ other 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization d.DEP Waiver Number _ D. Certification I certify that I have examined the FRED V%NDERHOOF o above and that to the best of my a.Print Name O knowledge it is true and complete. The signature below subjects the b.Authorized Signature -N signer to the general statutes PROJECT MANAGER �o regarding a false and misleading c. osi on e �o statement(s). ASSOCIATED BUILDING WRECKERS, INC. d.Re resentin � e.Date(mm/dd/yyyy) � o �Q aq 10/02 BWPAQ06•Page 3of3 � , ' C The Commonwealth of Massachusetts t Department of Industrial Accidents Office of Investigations 600 Washington Street � iiilu � Boston, MA 02111 www.mass.gov/dia ; Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hued the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7. ❑'Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing a]I-work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12.❑ Roof repairs insurance required.] t 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below,is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: Expiration Date: 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 under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: Official use only. .Do not write in this area,to be completed by city or town official _City.or Town: Permit/License# Issuing.Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every erson in the service of another under an contract of hire p Y , express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual, partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, 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, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in_(city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,' please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-OS Fax # 617-727-7749 www.mass.gov/dia The Commonwealth of Massachusetts William Francis Galvin - Public Browse and Search Page 1 of 2 The Commonwealth of Massachusetts William Francis Galvin Secretary of the Commonwealth,Corporations Division One Ashburton Place, 17th floor \\� Boston MA 02108-1512 Sill Telephone: (617) 727-9640 ASSOCIATED BUILDING WRECKERS, INC. Summary Screen Help with this form Request a Certificate The exact name of the Domestic Profit Corporation: ASSOCIATED BUILDING WRECKERS, INC. Mergered with ASSOCIATED BUILDING WRECKERS TRUST on 5/13/2009 Entity Type: Domestic Profit Corporation Identification Number: 042052737 Date of Organization in Massachusetts: 12/30/1947 Current Fiscal Month/Day: 12/31 Previous Fiscal Month/Day: 00/00 The location of its principal office: No. and Street: 352 ALBANY ST City or Town: SPRINGFIELD State: MA Zip: 01105 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country: Name and address of the Registered Agent: Name: ANDREW MIRKMN No. and Street: 352 ALBANY STREET City or Town: SPRINGFIELD State: MA Zip: 01105 Country: USA The officers and all of the directors of the corporation: Title Individual Name Address(no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code PRESIDENT ANDREW MIRKIN 299 TANGLEWOOD DR., LONGMEADOW,MA 01106 USA TREASURER ZANE L.MIRKIN 347 ARDSLEY ROAD LONGMEADOW,MA 01106 USA SECRETARY VIRGINIA ST.ONGE 69 POCHASSIC ST., WESTFIELD,MA USA CFO ZANE L.MIRKIN 347 ARDSLEY ROAD LONGMEADOW,MA 01106 USA DIRECTOR FRANCIS MIRKIN MR 72 BROOKSIDE DRIVE LONGMEADOW,MA 01106 USA DIRECTOR ANDREW MIRKIN 299 TANGLEWOOD DR., LONGMEADOW,MA 01106 USA DIRECTOR ZANE L.MIRKIN 347 ARDSLEY ROAD LONGMEADOW,MA 01106 USA http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 12/16/2010 The Commonwealth of Massachusetts William Francis Galvin - Public Browse and Search Page 2 of 2 business entity stock is publicly traded: _ The total number of shares and par value, if any,of each class of stock which the business entity is authorized to issue: Par Value Per Share Total Authorized by Articles Total Issued Class of Stock Enter 0 if no Par of Organization or Amendments and Outstanding Num of Shares Total Par Value Num of Shares No Stock Information available online. Prior to August 27, 2001, records can be obtained on microfilm. Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership _ Resident Agent _ For Profit _ Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS Administrative Dissolution Annual Report Application For Revival Articles of Amendment View Filings New Search Comments ©2001-2010 Commonwealth of Massachusetts All Rights Reserved Helo http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 12/16/2010 li assachusetts Department Of Public Safety Board of Build Regulation and Standa.rtls ccnstuCiu Supervigor License License: GS 62382 Restricted to: QQ NDREW ` ts. 299 TA�VC } 0� -� R LON'OM'EA r 06 c,, ,,.a.. Expiration: 10/31*/2011 C'ommis�ioner Tr#: 6802 i DIG SAFE SYSTEM, INC. - Renew Existing Ticket Page 1 of 1 Request Number: 20104902811 Date 11/30/2010 Time 09:55 Latitude: Longitude: State: MASSACHUSETTS Municipality: BARNSTABLE Address/Intersection:516 BEARSES WAY Nearest Cross Street 1: FALMOUTH RD Nearest Cross Street 2: PITCHERS WAY Additional Information: DEMOLITION OF STRUCTURE Nature Of Work: DEMOLITION OF STRUCTURE Area Of Work: PRIVATE PROPERTY Area Is Premarked:Y Start Date: 12/03/2010 Start Time: 10:00 Caller:JOANIE SAVAGE Title: DEMO CO ORDIN Return Call: BEF 430PM Phone#: 413-732-3179 Fax#: 413-734-6224 Alt.Phone#: Email Address:ABW_INC@COMCAST.NET Contractor:ASSOCIATED BUILDING WRECKERS Address: 352 ALBANY ST City:SPRINGFIELD State: MA Zip: 01105 Excavator Doing Work:ASSOCIATED BUILDING WRECKERS,INC. Member Utility List Code Abbreviation11 Name BW HYANWT HYANNIS WATER SYSTEM CH NGRDGS NATIONAL GRID GAS-COLONIAL CL NSTREL NSTAR ELECTRIC-COM CW VERIZN VERIZON HK COMCAS COMCAST-PEMBROKE ON ONTARG ON TARGET LOCATING RJ IDM INNOVATIVE DATA MANAGEMENT . There may be non-member utilities in the area that you need to notify. . Electric and other companies may not mark lines they don't own or maintain. You may want to contact them for more information. . The excavator is responsible to maintain markings placed by member utilities... DIG SAFE ENCOURAGES A COPY OF THIS ELECTRONIC TICKET ON SITE AT ALL TIMES. Renew,Another;Tlcket ;Print Ticket ; Return To Menu Return:To Home http://digsafefonn.digsafe.com/cgi-bin/dwcgi.exe I 1/30/2010 r Sep 16 10 08: 30a Balise 4137814270 p. l AL F 352 Albany Street,Springfield,Massachusetts 01105 Tel:(413)732-3179/(800)448-2822 Fax(413)734-6224 y, www.buildingwreckemeom d.�J(l�6Ul TI b1 Ail ftCfi�ly September 1 S,2010 V aRI P a Jim Demas Facilities Director BALISE MOTOR SALES 122 Doty Circle West Springfield,Massachusetts 01089 Thank you for the award of this contract. we agree to abate and demolish the two buildings located aE MCand 528 Bearses Way Hyannis,Massachusetts. Associated Jim ldinx Wreckers work includes: 1) Demolition of buildings and removal of all debris to an approved facility,including slabs and foundations. 2) Removal and disposal of any miscellaneous concrete pads and walls on property. 3) Removal and disposal of wooden stockade fencing,vacuum bases,shed and concrete wall at rear of carwash. 4) Removal and disposal of concrete retaining wall and chainlink fencing between carwash and Balise Ford dealership. S) Notifying Dig Safe and arranging for the disconnection of services. 6) Taking out the demolition permits and furnishing a certificate for demolition general liability and workers compensation insurance,upon request. 7) Leaving the site rough graded with soil on premises. 8) Using water for dust control,as needed,via a garden hose hookup at Balise Ford. 9) Asbestos removal per survey by Green Environmental dated February 16,2010 meeting all current EPA,DLl,DEP and OSHA requirements for asbestos abatement. 10) Hirin and paying for a third party Industrial Hygienist to do the required air clearance testing. 11) Removal and disposal of any mercury bulbs,switches,or PCB containing light ballasts prior to demolition. Balise Motor 1ALes will be responsible for. 1) Any service disconnection charges,if any. 2) Obtaining any historical permits or special notifications,if required. 3) Any repair to grass,asphalt,landscaping or ntonitor wells (mark out by Owner) damaged during demolition in the work area. 4) Any damage to underground services that Dig Safe and/or Balise Motor Sales has not made us aware of(including,but not limited to,underground sprinklers,roof drains and septic systems). 5) Cost associated with any hazardous materials found at the site,other than specified above. 6) Marking out the septic tank and/or well with stakes prior to demolition,if applicable. 7) Marking the property for Dig Safe. 8) Making job accessible to work. 9) Any underground tanks,if any. I 0) Any backfill. M\MswondNnrMo_crm-2mols2s_Bea m_way-NrmiLKA Sep 16 10 08: 31a Balise 4137814270 p. 2 Jim Deillas September 15,2010 Page 2 of'? 11) Any Freon recovery from RTU's,lvindow utlits,or refrigerated items,as required,prior to dettiolition. 12) Making payment in full upon completion NVithitt thirty (30) days. Any balance that beconles past due for a►1y reason will be charged a service charge of I.;i`,5 per month, 18%annually. If it should become necessary to turn this account over for collection, the billed party agrees to pay all collection costs plus reasonable attorney's fees incurred. Balise Motor Sales is unaware of any haiardous materials or wastes on the property and knows of no legal reason,regulation,or other circumstances,which might prevent or ill any Nvay interfere with the right or ability of Associated building Wreckers. I11c. to perform the above work if any hidden conditions do exist oil this job,they arc the owner's responsibility. Sincerely, A s6ociated Buildin Wreckers, Iric. A4reed and Accepted: By: l a Andrew Mirkin, President I 11e 'Title Date Balise Motor sales Form Letters 1 r Town of Barnstable Department of Public Works BARN'!3'1'AOLM 230 South Street, Hyannis MA 02601 MAWwww.engineering@town.barnstable.ma.us Mark S. Ells , Director Office : 508— 862 -4090 Fax : 508—862 4711 December 13 , 2010 PKM Contractors East Dennis , Mass - - Balise Auto Group Springfield, Mass Subject Disconnection .from municipal sewer of 516 Bearses Way , Hyannis ; M&P 293 09 Dear Sirs - This is to notify you that the commercial building at.516 Bearses Way ( Map & Parcel 293 - 09 ) , in Hyannis village, Mass was disconnected from municipal sewer on December 13th 2010. The disconnection was inspected and accepted by the Construction Projects Inspector from the Town of Barnstable DPW —Admin & Tech Support. A sewer compliance record and a record drawing will be completed and filed in the Admin & Tech Support office. If you have any questions, or need additional information, please call Dave Anderson at 508 — 790 - 6244. Sincerely ; avid nderson ; Construction Projects Inspector Town of Barnstable DPWAdmin & Tech Support Client#:27633 ASSBUI ACORD. CERTIFICATE OF LIABILITY INSURANCE 9DATE(MM1DD /15/2010mm PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Chittenden Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1391 Main Street,3rd Floor HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Springfield,MA 01101 413 781-6871 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Steadfast Insurance Co Associated Building Wreckers,INC INSURER B: American International 352 Albany ST INSURER C: Springfield,MA 01105 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DDT TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE M D DATE MM/DD LIMITS A GENERAL LIABILITY GLOS86686405 03/15/10 03/15/11 EACH OCCURRENCE $1 00O 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $1 OO OOO REMCLAIMS MADE a OCCUR MED EXP(Any one person) $1 O 000 X PC Ded:10,000 PERSONAL&ADV INJURY $1 000 000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY X jEQ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY SE0903618303 03/15/10' 03/15/11 EACH OCCURRENCE s5,000,000 OCCUR X❑CLAIMS MADE AGGREGATE s5,000,000 DEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND 6894471 02/01/10 02/01/11 X WC SLIMIT OTH- ER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1 00O 000 OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1 000 000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POI CY IMIT 1.1,000,000 A OTHER Pollution CPL903860902 03/15/10 03/15/11 1,000,000 each claim 2,000,000 aggregate 10,000 ded. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE:516&528 Bearses Way,Hyannis,MA Certificate Holder and Town of Hyannis are named as Additional Insureds under General Liability as required by written contract for work performed by insured subject to terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Balise Motor Sales DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _3p_ DAYS WRITTEN 122 Doty Circle NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL W.Springfield,MA 01089 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S79232/M69633 JMG 0 ACORD CORPORATION 1988 r IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this.certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(2001/08) 2 of 2 #S79232/M69633 TEr Town of Barnstable ` Regulatory Services t aAxxsrAs[.� v MAM g Thomas F. Geiler,Director ` BuiIding Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: S08-862-4038 Fax: S08-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, J*m mu Ii, �a'f1�P, , as Owner of the subject property hereby authorize pCIC�1 � fll l `/� C� C to act on my behalf, in all matters relative to work authorized by this building permit application for: �J c)t #Ildfi,1/s (Addres of Jo ) Signature of N er Date L�emc J Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FO RMS.M WNERPERMISSION a . Town of Barnstable sae TKE Tp�y ytv O Regulatory Services ts-rAB Thomas F. Geiler,Director Building Division PrEDy Tom Perry, Building Commissioner 200 Mairi.Street,._Hyannis,MA..02601 www.town.barnstable-ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOlydEOWWER LICENSE EXEMPTION 9 Please Print DATE: JOB LOCATION: number street village "HOMEOWNER': name home phone# work phone# CURRENT MAILING ADDRESS:- city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor_ DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which be/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached si ucttrres 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 homeowner. 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.be/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S ExEMrzTON The Code states that: "Any homcowncr performing work for which a building pemvt is required shall be exempt from the provisions Of this seetion,(Section I D9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such wofk,that such Homeowner shall act as supervisor." Many homcowneas who use this exemption are unaware that they arc assuming the responsibilities of a supervisor(see Appendix Q, Ruics&Rcgvladons for Licensing Construction Supervisors,Scction 2.15) This lack of awareness often results in serious problems,particularly when the homcowncr hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responstble. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application., that the homeowner certify that he/she understands the msponsibilitics of a Supervisor. On the Last page of this issue is a form currently.used by several towns. You may care t amend and adopt such a form/ccrtification for use in your community, Q:forms:homccxcmpt I MAR 25 19% 03:34 FR TO 14137814270 P.01i01 s September 14,2010 This is to verify that the telephone equipment providing service to 516 and 528 Hearses Way,Hyannis,Ma has been removed This work was verified on September 10,2010. Yours truly, April Clarke-Local Manager 16 Hinckley Road,Hyannis,Ma TOTAL PAGE.01 ** t:�G. �'� �1;0' i.39P N'TAR-S'JM^W No, 330''5 P, ONSTAR :One NSTAR Wsy;:OW40 &L G?rRpC Westwood.MA 02090.9230 GA PhonalFAX761-dg1-33M justin.reihtQns(ar,tcm October 6, 2010 Balise Motor Sales 1102 Riverdale St, W. Springfield MA 010€39 RE: 528 Bearses Way Hyannis—WO#01792688 516 Bearses gray Hyannis—WO#01792692 To Thorn It May Concern:: At NSTAR, we're committed to delivering groat service. This letter serves as,.confirmation tat, as of October 6, 2010, the electric service to both 516 and 528 Bearses Way, Hyannis, has been removed'. ;Based on this information,there.is no electric power at this address and you may proceed with the demolition. If you have any questions,please;contact meat (781)4 1-3334. Sincerely, Justin Deihl New Customer Connects r Oet '6: 2010 1.:39PM N.ST.AR-SUMSW3 No, 3308 P. 2 ONSTAR Ono STAR Waj,sir,VO eE L C 77�>C Westwood,IAA 02090-9230 0A 8Phone/FAX 781411-3334 jus ltn.reihi( nstar: rrt. October 6,2010 Salise Motor Sales 1 102 Riverdale St. W, Springfield MA 01089 RE: 528 Searsas 1P►fay 9�yar nis—W0#01792688 546... fuses Way Hyannis- 'WO#01,792692 To Whom it May Gonc rn At NSTAR,46're comrMbad to delivering great service. This letter serves as canfemat on#hat; as of October 6,20'1.0, the electric service to both 516 arfd 528 Bearses`VVay, Myannls, has been rerrwved. Based 00 t4is information, there is na electric power at this address and you may.prcce►ed with (he'demolition,emolition, lf`yvu have a€�y.4uestions, please odntact mo:at(781)44'I 3334. Sincerely, Jasfiry Reihl New Customer Connects ..- - _._ _.._. ._W._W;. ;.__ __.__.. ......_..... . _....m._ SEP-27-2010 10:52 KEYSPAN: 718 403 65% P.01/02 ti nationalgred September 27,2010 Balise Motor Sales Attn: Jim Demos This letter is to ramify you that the gas service located at 516 Beerses Way,Hyannis, Ma was cut and tapped on property on 9/23/10. If you have any questions,please feel free to contact ma '781- D7-2930 Sincerely, Diane L.Stevenin Customer Driven Construction diane.stevenin@us.ng6d.com 781-907.2930' 781-522.1056 fax 40 Sylvan Road S=2 Waltham,Ma 02451 I .. national rood �J Request for Service Cut-Off and Demo Slgn-off The following information is necessary before National Grid can initiate a service cut-off or can provide a gas utility sign- off for a demolition request. Please provide the information listed below. You will be notified by mall or fax if the building Identified does not have a gas service. if the building identified has a gas service,the gas service will be cut-off. Once the service is cut-off you will be noted by mail or fax. The notice may be used to satisfy the demolition permit requirement for gas utility sign-off purposes.If you have any questions or would like to speak to a company representative regarding this matter,please call(781)907-3960,and leave your name and phone number. Requests can be faxed to (781)522-1056 or mailed to: ; National Grid 40 Sylvan Road Waltham,MA 02451 Attn:Sales Fulfillment Company Name(if applicable) '3A L S.SE MQ Zjj,Q sA Name of Contact Person `f�/)1 J7EInl4 S Mailing Address ,BA2TSE — ��Oa /Gl (�E/Q�f� Sj ujE-sr seer .Fx Phone Number of Contact Person Y1, 7 3SS/003 Fax Number of Contact Person Earliest cut-off date:(see Note) 00E&�A (NOTE.Because National Lind may need to oatain a permit approval for any excavation work required,the requested cut- off,may require up to 30 days)' Address of demolition and/or service cut-off V clty/Town d tleq A)A)r.S Is the service cut-off request due to a demolition?(Circle One) YES i NO Y Is this the only building located at this address?(Circle One) YES NO �Y`7 If there is more than one building at this address,please provide a sketch below clearly in icating all NO an_�draw an W in the box that pertains to the request. SKETCH: GA The lead4ime required for installation of a gas service is typically 6 to 8 weeks. If it is anticipated that gas is to be used at this location in the future,the owner must notify Sales Fulfillment group(781-907-2921)as soon as possible to make arrangements for gas service installation. Please note that the customer will assume the cost of service reconnection or service installation. By signing below,I certify that I am the owner of the property or that I have been authorized by the owner of the property to act as the owner's agent in requesting this curt-off. If it is determined that I was not,in fact,authorized to request this cut-off,i shall defend,indemnify,and hold Boston Gas Company d/b/a National Grid,Colonial Gas Company d/b/a National Grid and Essex Gas Company d/b/a National Grid(National Grid)harmless against any costs and liabilities arising out of or related to this cut-off request,including,without limitation,reimbursing National Grid for its costs related to cutting off and reinstating service." Owner/Agent Signature: Date: a Nationalgrid Supv Signature: Cut off Date: I i I FROM :HYANNIS WATER SYSTEM FAX NO. :508 790 1313 Nov. 30 2010 04:22PM P1i4 •�e E r Department of Public Works Y , Q, Water Supply Division f � J Y BAMSTABLE, ^ I a, Hyannis Water System Operations i November 30, 2010 'own of Barnstable Building Inspector Town Hall Hyawmis,MA 02601 RF: 516 Bearses Way.-#604107 Dear Sir: Please be advised that the above water service was shut off and the meter removed on 10/27/10. At that time;the water service was cut and capped by PKM Construction. The owner has informed us of plans for demolishion of the building. Sincerely, 0, ayn Starck. Hyannis Water System Green Environmental Consulting, LLC 296 Sylvester Road • Florence, MA, 01062 • Tel/Fax (413) 341-3418 February 16, 2010 Jim Demas Facilities Director Balise Motor Sales 122 Doty Circle West Springfield, MA 01089 Re: Pre-demolition Asbestos Survey 516 Bearses Way Hyannis, MA Dear Mr. Demas: At your request, Green Environmental Consulting, LLC (GEC) performed an asbestos inspection of the building located at 516 Bearses Way in Hyannis, Massachusetts (hereafter referenced as "building"). Fieldwork associated with the inspection was performed on February 1, 2010. Background The building consists of one-story former carwash with a flat roof. Interior finish materials include floor tiles, ceiling tiles, linoleum and sheetrockAoint compound wall and ceiling systems. Exterior finish materials include vinyl siding and rubber roofing. GEC understands that above-referenced building is scheduled for demolition. In accordance with state and federal asbestos regulations, asbestos-containing materials (ACM's) in the building are required to be identified and removed prior to any activity that would disturb the material. Sampling/Results Seventeen (17) samples of suspect asbestos-containing materials (ACM's) were collected and submitted to an accredited laboratory for analysis using Polarized Light Microscopy with Dispersion Staining (PLM/DS). Materials found to contain greater than one percent asbestos by weight are considered to be asbestos-containing materials (ACM's). Refer to Attachment No. 1 for laboratory results, including detailed description of sampling locations, as well as chain-of custody records for samples collected. GreenEnvironmentalConsulting.com Y Pre-demolition Asbestos Survey 576 Bearses Way. Hyannis, MA Page 2 No asbestos-containing materials (ACM's) were identified during GEC's inspection The following materials were sampled and determined not to be asbestos-containing materials (less than one-percent asbestos by weight): Material Location(s) Representative Sample(s) White Linoleum Office 00212E-01A & 01B Sheetrock Office (walls and ceiling) 00212B-02A& 02B Joint Compound Office (walls and ceiling) 00212B-03A & 03B 12" White Floor Tile Front Reception 00212E-04A & 04B 12" White Floor Tile Mastic Front Reception 00212E-05A & 05B 2'x4' White Ceiling Tile Front Reception 00212E-06A& 06B 12" Brown Self-Adhesive Floor Tile Bathroom 002126-07 Felt Paper on Foam Roof 00212B-08A & 08B Black Seam Sealant Roof 00212E-08A & 08B Limitations This report is intended for the sole use of Balise Motor Sales. This report is not intended to serve as a bidding document nor as a project specification and actual site conditions and quantities should be field-verified. The scope of services performed in execution of this evaluation may not be appropriate to satisfy the needs of other users, and use or re-use of this document, the findings, conclusions, or recommendations is at the risk of said user. Although a reasonable attempt has been made to locate suspect asbestos-containing materials (ACM's) in the areas identified, the inspection techniques used are inherently limited in the sense that only full demolition procedures will reveal all building materials of a structure and, therefore, all areas of potential ACM. Estimated quantities of ACM are based on professional judgment and practicality. Other unidentified ACM's may be located within walls, ceiling cavities, below flooring or grade, and other non-accessible areas. Caution should be used during any renovation/demolition activities. GEC's asbestos inspection was limited to accessible areas on the interior of the building. It was not within the scope of this survey to fully inspect areas requiring demolition or areas deemed unsafe by GEC's inspector. In addition, electrical systems and/or components were not included in GEC's survey due to the safety issues inherent with sampling such systems. Interior components of mechanical equipment in the carwash, including the boiler and hot water heater were not sampled. The Massachusetts Department of Environmental Protection (DEP), as well as the U.S. Environmental Protection Agency (EPA) currently recognize Polarized Light Microscopy (PLM) analysis as an acceptable analytical method for determining the Asbestos content in non-friable, organically bound (NOB) materials. However, comparative studies between PLM analysis and Transmission Electron Microscopy (TEM) analysis have shown that PLM analysis may yield false negative analytical results for NOB's such as floor tiles. I I Pre-demolition Asbestos Survey 516 Bearses Wayy, Hyannis MA Page 3 GEC recommends that, prior to demolition activities, one sample from each homogeneous area of mastic and other non-friable organically bound (NOB) materials that originally tested negative by PLM undergo confirmatory analysis by TEM, utilizing ELAP-198.4 TEM Method for Identifying and Quantifying Asbestos in NOB bulk samples. Conclusions/Recommendations No asbestos-containing material (ACM's) were identified during GEC's inspection. Any suspect asbestos-containing material that is discovered during building renovation/demolition that is not included in this report should be assumed to contain asbestos until further bulk sampling and analysis is performed. If you have any questions regarding this survey or the sampling and/or analytical techniques employed, please contact us at (413) 341-3418. Sincerely, Green Environmental Consulting, LLC Adam Lesko MA Inspector Lic #A1073071 f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street x Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A / Please Print Legibly Name (Business/Organization/Individual): wX/N Address: AM Ad City/State/Zip: f , ME Phone #: °18 Ix-6,11q Are�you an employer? C ck the appropriate box: Type of project(required): 1.ru¢� I am a employer with .M t�- 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Eemodeling 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 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself ' . right of exemption per MGL y �o workers comp. 12.❑ Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.❑ Other employees. [No workers' comp. insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins. Lic. #: 'T/I Expiration Date: Job Site Address: J�(Y Adnz wal City/State/Zip: ITLILI����, 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 f the DIA for inAurance coverage verification. I do hereby c r r the p i s and penalties of perjury that the information provided aboveis true and correct. Si nature: - 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): I 1.Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: r LOCATION SEWAGE PERMIT NO. - VILLAGE . I �� � ; ,� ��3 -• ova � , IN. STA LLERIS NAME A ADDRESS BUItK LDER OR OWNER _- -- 0% Y-YCf Y- .DATE PERMIT ISSUED DATE COMPLIANCE ISSUED i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 77 Map Parcel. S � Application # ��`( �01 Health Division /L I� Date Issued -1 Conservation Division Application Fee �--P Planning Dept. 'Permit Fee -6 IWO Date Definitive'Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address � VT. S Li/ Village Owner uC.l�/. �Ul r ��llf�� Address/0—fi✓/l//1,Y ri)1 Telephone Permit Request _I�Q,r�Pkft) l�O(A0 //.f M W d H -,5 Square feet: 1 st floor: existing proposed `2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 0 0 v Construction Type Lot Size Grandfathered: 0 Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes N(No On Old King's Highway: ❑Yes Q No r Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas 0 Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove:..0 Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑_new -size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: {.y Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial i(Yes- 0 No If p ,es site Ian review# Y Current Use Proposed Use O/A. APPLICANT INFORMATION '- -(BUILDER OR HOMEOWNER) Name _ 4%61 046d 6JAI fyMk'23 Telephone Number 1 73 a 309 Address 3 �T License# 01 ��,, 10S r Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RE ULTING FROM THIS PROJECT WILL BE TAKEN TO C0,5ed'i _ C� bkms 38 Al� fol'/rk, P,�w �f dye SIGNATURE' DATE 12--(7-to 4 3 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. } ADDRESS VILLAGE OWNER DATE OF INSPECTION: k FOUNDATION i FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t , PLUMBING: ROUGH FINAL GAS: ROUGH FINAL C FINAL BUILDING DATE CLOSED OUT ' ASSOCIATION PLAN NO. I I s _ N. APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name A 55pua4d 6J b JYtycpar Telephone Number 13 73 a 3175 Address 3 S�. M bafoy S'r License # 0 6 d 3 g aZ qf)! (S fend 0 mti. 0I10S Home Improvement Contractor# Worker's Compensation # `&M. f)--Aaw ALL CONSTRUCTION DEBRIS RE ULTING FROM THIS PROJECT WILL BE TAKEN TO C�c,gecf�- �k-m 3g Al fo��� P.& i'ew, fir✓ �ayv SIGNATURE DATE I2-�c7-�� TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel.,.:.-.,/ 2� - ------ Application # Health -Division _ V Date Issued ' Conservation Division Application Fee Planning Dept. ,.,Perm it Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation Hyan his Project Street Address -W VOW 41r)IN6 Village Owner A d d ress//Pvw�x Telephone M/) 0a Permit Request ov Y/Lfaw 91 a rX1111)P/_J Sqbare feet: 1 st floor: existing proposed '2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation I'D 10 0 0 —Construction Type Lot Size Grandfathered: Ll Yes LJ No If yes, attach supporting documentation. Dwelling Type: Single Family LJ Two Family LJ Multi-Family (# units) Age of Existing Structure Historic House: Ll Yes S(No On Old King's Highway: LJ Yes YNo Basement Type: U Full U Crawl Ll Walkout L11 Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: LJ Gas L3 Oil LJ Electric Ll Other Central Air: Ll Yes Ll No Fireplaces: Existing New Existing wood/cFoal stove:__LJ Yes-;-U No Detached garage: L] existing LJ new size—Pool: LJ existing D new size Barn: LJ existing J_Qew -size Attached garage: Ll existing LJ new size —Shed: LJ existing Ll new size Other: Zoning Board of Appeals Authorization 0 Appeal # Recorded LJ Commercial N(Yes- L] No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Telephone Number V 1n.A 1w Add s w , ense omo Impr vement Contr for# 2111T Worker's Com ensation 191111Y ff*6_�, C,(111,(d ALL CONSTRUCT-11 N DEBRIS ESULTING F M THIS PROJECT WILL TAKE TO PCLY /H t b -2�SIGNATURE DATE 1 a C t FOR OFFICIAL USE ONLY f APPLICATION# ' - DATE ISSUED r �4 MAP/PARCEL NO, ADDRESS VILLAGE OWNER Y s DATE OF INSPECTION: FOUNDATION _ FRAME s . INSULATION I FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL 1 GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT ? ASSOCIATION PLAN NO. �F r J a 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 ,l //�^/ /�j d�J,_p ,y�/ Please Print Le2ribly Name(Business/Organization/Individual): -A.55ocy(UfXC/ �I�1L.Jilli hI LMr-S,_�. Address: JbJ City/State/Zip: �/n/ l� Dlla� Phone.#: 4 Ar�you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with � f - 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction .2.❑ I am a sole proprietor or partner-' 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' # 9. ❑Building addition [No workers'-comp.insurance comp. insurance. 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ p 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site information. um 1 �, j/(Q Insurance Company Name: 4nt'J�ILIV� �:lyo VC11/ �Q_ oo Policy#or Self-ins. Lic. #: [l 7'7`7 Expiration Date: Job Site Address: 0 l drz ( 1 City/State/Zip:M._LS/ M WIN.- 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 violator. Be advised that a copy of this statement may be forwarded to the Office of Investi ations the DIA for' ce covers e verification. I do hereby ce under the p and penalties of perjury that the information provided above is true and correct Sit3rtature: Date: IL11 '//1/ _ Phone#: 1 15 / A �"� 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#: • P ( t Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house employment e to or on the grounds or building appurtenant thereto shall not because of suchbe deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit tooperate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall . r a enter into any contract for,the performance of public work unto acceptable evidence of compliance azth the insurance . requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and, if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies.(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete-and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town),".A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations. 600 Washington Street Boston, MA 02111 TO. #617-727-4900 ext 406 or 1-877-MASSAFE Fax# 617-727-7749 Revised 11-22-06 www.mass.gov/dia I Client#:27633 ASSBUI ACORD- CERTIFICATE OF LIABILITY INSURANCE 9DATE /15/2010nvvY> PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Chittenden Insurance Agency ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 1391 Main Street,3rd Floor HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Springfield,MA 01101 413 781-6871 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Steadfast Insurance Co Associated Building Wreckers,INC INSURER B: American International 352 Albany ST INSURER C: Springfield,MA 01105 INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSR DATE MWDD/Y DATE MM/DD/YY A GENERAL LIABILITY GL0586686405 03/15/10 03/15/11 EACH OCCURRENCE $j 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED_2REMISES(Ea occurrence) $1 OO OOO CLAIMS MADE 7 OCCUR MED EXP(Any one person) $1 O 000 X PC Ded:10,000 PERSONAL&ADV INJURY $1 OOO O00 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG s2,000,000 POLICY X PRO- LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY SE0903618303 03/15/10 03/15/11 EACH OCCURRENCE s5,000,000 OCCUR 50 CLAIMS MADE AGGREGATE s5,000,000 RDEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND [6894471 02/01/10 02/01/11 X WCSTATUS OTH- EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000 000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $1 000000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A OTHER Pollution 860902 03/15/10 03/15/11 1,000,000 each claim 2,000,000 aggregate 10,000 ded. DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE:516&528 Bearses Way,Hyannis,MA Certificate Holder and Town of Hyannis are named as Additional Insureds under General Liability as required by written contract for work performed by insured subject to terms and conditions of the policy. CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION Ballse Motor Sales DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS WRITTEN 122 Doty Circle NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL W.Springfield, MA 01089 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S79232/M69633 JMG 0 ACORD CORPORATION 1988 ��- 3 ..__. �•< � - _ �.-,. � ��#, ,��' � �;� - /_ �` _. � ,� / � " .. "� s � e. a �.� "..� �. AsBuilt Page 1 of 1 LOCATION SEWAGE P VILLAGE ICI INSTA LLER'S NAME 0DRESS� � I e U l L D E R OR OWNER cl, to DATE PERMIT ISSUED DATE COMPLIANCE ISSUED q I I t Y`7w1`,� ti 1 � l J http://issgl2/intranet/propdata/prebuilt.aspx?mappar=293008&seq=1 12/16/2010 " Town of Barnstable - �► Department of Public Works DAWMABLI& 230 South Street, Hyannis MA 02601 www.engineering@town.barnstable.ma.us Mark S. Ells , Director Office : 508-862 -4090 Fax : 508—862 -4711 December 13 , 2010 PKM Contractors East Dennis , Mass Balise Auto Group Springfield , Mass Subject Disconnection from municipal sewer of 528 Bearses Way Hyannis ; M&P 293 - 08 Dear Sirs ;. This is to notify you that the commercial building at 528 Bearses Way ( Map & Parcel 293 - 08 ) , in Hyannis village, Mass was disconnected from municipal sewer on December 13th , 2010. The disconnection was inspected and accepted by the Construction Projects Inspector from the Town of Barnstable DPW —Admin & Tech Support. A sewer compliance record and a record drawing will be completed and filed in the Admin & Tech Support office. If you have any questions, or need additional information, please call Dave Anderson at 508 - 790 - 6244. Sincerely ; David 3 A derson ; Construction Projects Inspector Town of Barnstable DPW Admin & Tech Support The CorhmonWealth of Massachusetts William Francis Galvin - Public Browse and Search Page 1 of 2 The Commonwealth of Massachusetts _ William Francis Galvin Secretary of the Commonwealth, Corporations Division One Ashburton Place, 17th floor Boston, MA 02108-1512 Telephone: (617) 727-9640 ASSOCIATED BUILDING.WRECKERS, INC. Summary Screen ,� Help with this form ;Requests Certificate The exact name of the Domestic Profit Corporation::.ASSOCIATED BUILDING WRECKERS, INC. Mergered with ASSOCIATED BUILDING WRECKERS TRUST on 5/13/2009 Entity Type: Domestic Profit Corporation Identification Number: 042052737 Date of Organization in Massachusetts: 12/30/1947 Current Fiscal Month/Day: 12/31 Previous Fiscal Month/Day: 00/00 The location of its principal office: No. and Street: 352 ALBANY ST City or Town: SPRINGFIELD State: MA Zip: 01 105 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country: Name and address of the Registered Agent: Name: ANDREW MIRKIN No. and Street: 352 ALBANY STREET City or Town: SPRINGFIELD State: MA Zip: 01105 Country:USA The officers and all of the directors of the corporation: Title Individual Name Address (no Po Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code PRESIDENT ANDREW MIRKIN 299 TANGLEWOOD DR., LONGMEADOW,MA 01106 USA TREASURER ZANE L.MIRKIN 347 ARDSLEY ROAD LONGMEADOW,MA 01106 USA SECRETARY VIRGINIA ST.ONGE 69 POCHASSIC ST., WESTFIELD,MA USA CFO ZANE L.MIRKIN 347 ARDSLEY ROAD LONGMEADOW,MA 01106 USA DIRECTOR FRANCIS MIRKIN MR 72 BROOKSIDE DRIVE LONGMEADOW,MA 01106 USA DIRECTOR ANDREW MIRKIN 299 TANGLEWOOD DR:, LONGMEADOW.MA 01106 USA DIRECTOR ZANE L.MIRKIN 347 ARDSLEY ROAD LONGMEADOW,MA 01106 USA http://corp.sec.state.m a.us/corp/corpsearch/CorpS earchSummary.asp?ReadFromDB=True... 12/7/2010 I The Common*ealth of Massachusetts William Francis Galvin - Public Browse and Search Page 2 of 2 e _ business entity stock is publicly traded: The total number of shares and par value, if any,of each class of stock which the business entity is authorized to issue: Par Value Per Share Total Authorized by Articles Total Issued Class of Stock Enter 0 if no Par of Organization or Amendments and Outstanding Num of Shares Total Par Value Num of Shares No Stock Information available online. Prior to August 27,2001, records can be obtained on microfilm. _ Consent _ Manufacturer _ Confidential Data _ Does Not Require Annual Report Partnership _ Resident Agent _ For Profit _ Merger Allowed . Select a type of filing from below to view this business entity filings: ALL FILINGS Administrative Dissolution Annual Report Application For Revival Articles of Amendment Comments O 2001-2010 Commonwealth of Massachusetts All Rights Reserved Help http://corp,sec.state.ma.us/corp/corpsearch/CorpSearchS ummary.asp?ReadFromDB=True... 12/7/2010 I THE rati Town of Barnstable Regulatory Services u2x6r�sr.e, y MAss. Thomas F. Geiler,Director 16 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 Property Owner Must Complete and Sign This Section If Using A Builder I JmLs AA—y , as Owner of the subject property hereby authorize A� 0(1()t LW /�I O .C'keds_Z�C. to act on my behalf, v in all matters relative to work authorized by this building permit application for. INA (Address of Job) )SnakLf Owner L Date Print Name If Property Owner is applying for permit please complete.the Homeowners License Exemption Form on the reverse side. Q:F0WS:0 WNERPERMISS)0N Town of Barnstable Regulatory Services aaxxsr,►s>.e Thomas F. Geiler,Director MASS. Building Division lED MA't a Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA.026.01 www.town.barnstable.ma.us Officer 508-862-4038 Fax: 508-790-6230 HOTtTEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)who owns a parcel of land on which he/she resides or intends to reside, on which there is, or is intended to be, a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constrtlets 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.be/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION .The Code states that "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section.(Section ID9.1.1 -Licensing of construction Supervisors);provided that if the homeowner engages a parson(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q. Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application., that the homeowner certify that hdshe understands the responsibilities of a Supervisor. On the last page of this issue is a.form currently used by several towns. You may care t amend and adopt such a fom•✓certification for use in your community. Q:forms:homoexcmpt L pep 16 10 08: 30a Balise 4137814270 P. 1 352 Albany Street,Springfield,Massachusetts 01105 Tel:(413)732-3179/(800)448-2822 Fax.(413)734-6224 ,,��'',,,,-• / www.buildingwreckemcom CIYA�� U f(( tS�ifC�fU)V September 15,2010 VWf 0 Is to, DDT.6b Jim.Demers Facilities Director BALISE MOTOR SALES 122 Doty Circle West Springfield,Massachusetts 01089 Thank you for the award of this contract. we agree to abate and demolish the two buildings located at 516 and 528 Bearses Wav,Hyannis,Massachusetts. _Associated Building Wreckers work includes. 1) Demolition of buildings and removal of all debris to an approved facility,including slabs and foundations. 2) Removal and disposal of any miscellaneous concrete pads and walls on property. 3) Removal and disposal of wooden stockade fencing,vacuum bases,shed and concrete wall at rear of carwash. 4) Removal and disposal of concrete retaining wall and chainlink fencing between carwash and Balise Ford dealership. 5) Notifying Dig Safe and arranging for the disconnection of services. 6) Taking out the demolition permits and furnishing a certificate for demolition general liability and workers compensation insurance,upon request. 7) Leaving the site rough graded with soil on premises. 8) Using water for dust control,as needed,via a garden hose hookup at Balise Ford. 9) Asbestos removal per survey by Green Environmental dated February 16,2010 meeting all current EPA,DLI,DEP and OSHA requirements for asbestos abatement. 10) Hiring and paying for a third party Industrial Hygienist to do the required air clearance testing. 11) Removal and disposal of any mercury bulbs,switches,or PCB containing light ballasts prior to demolition. _Balise Motor Sales will be responsible for: 1) Any service disconnection charges,if any. 2) Obtaining any historical permits or special notifications,if required. 3) Any repair to grass,asphalt,landscaping or monitor wells (mark out by Owner) damaged during demolition in the work area. t 4) Any damage to underground services that Dig Safe and/or Balise Motor Sales has not made us aware of(including,but not limited to,underground sprinklers,roof drains and septic systems). 5) Cost associated with any hazardous materials found at the site,other than specified above. 6) Marling out the septic tank and/or well with stakes prior to demolition,if applicable. 7) Marking the property for Dig Safe. 8) Making job accessible to work. 9) Any underground tanks,if any. i 10) Any backfill. { r M\MawondNVEMo_CM 2010X529-,BM —Wa9.JbMMdVMAdw � Q Sep is 10 08: 31a 8a1ise 4137814270 p. 2 Jim Demas September I 5,20I0 Page 2 of 2 11) Any Freon recovery from RTU's,window units,or refrigerated items,as required,prior t0 deltlolltion. 12) Making payment in ftlll upon completion xvithin thirty (30) days. Any balance that becomes past due for any reason will be charged a service charge of I.-.-)%per 111011th, 18% annually. If it should become necessary to ttirlt this account over for collection, the billed party agrees to pay all collection costs plus reasonable. attornev's tees incurred. Galise Motor Sales is imaivare of ally hazardous materials or wastes on the property and knows of no legal reason,regulation,or other circumstances,which might prevent or in any«'ay interfere with the right or ability of Associated Building Wreckers. Inc. to perform the above work if any hidden Conditions CIO exist 011 this Job,they arc the ow'11Cr s responsibility. Sincerely. i AQociated ruildin Wreckers, Inc. Agreed :lt1d r\cceptcd Andrew Mirk-in, Fresident 1 the '1'it[e Date Balise Motor Sales i { i I i f r i i t i i I I i I i i i 3 E ' I corn] Letters t l i y' . assachusett Department of Pubt c Safety oarcf of Building Regulations anti Standit.rds : ... Construction Supervisor Licehse License: CS' 62382 z Restricted to 1 ANDREW Hii, ikRk"-- ; 299 TANG'' C� LONG MEAD ` . ; .01 ��� ........ .._ _. _...• Expiration: 10/3172011 C onunissioner T #: 6802 r w Massachusetts Department of Environmental Protection _ Bureau of Waste Prevention . Air Quality 100113241 BWP AQ OO Decal Number 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 use the return is regulated by the Department of Environmental Protection cursor- not (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. OkA B. General Project Description 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?❑Yes ❑✓ 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 vacant structure Environmental Protection a.Name notification 528 Bearses Way requirements of b.Address 310 CMR 7.09 H annis MA � 02601 �� c.Cit own d.State e.ZiQ Code f.Tele hone Number area code and extension .E-mail Address o tional 6,384 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 commercial structure I. Is the facility a residential facility? ❑ Yes ❑✓ No a--o m. If yes, how many units? Number of Units �° 3. Facility Owner: -N Balise Motor Sales �o a.Name �0 122 Doty Circle b.Address West Springfield MA � c.Citv/Town d.State e.ZiD Cod �o (413)348-8689 f.TeleDhon- a Qgde and gxtgnsion) E-mail Address o do I D Jim Demas �Q h.Onsite Manager Name ag06.doc•10/02 BWP AQ 06•Page 1 of 3 I I Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality 100113241 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General Statement:If B. General Project Description cont. asbestos is found during a Construction or 4. General Contractor: Demolition Associated Building Wreckers, Inc. operation,all responsible parties a.Name must comply with 1352 Albany St. 310 CMR 7.00, b.Address and Chapter S rin field MA � 01105 Chapterer 21 E of the General Laws of c.City/Town d.State e.ZiD Code the Commonwealth. (413)732-3179 This would include, f.Tele hone Number area code and extension .E-mail Address(optional) but would not be limited to,filing an Andrew Mirkin asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. Associated Building Wreckers, Inc. a.Name 352 Albany St. b.Address S rin field JIVIA J 01105 c.Cit /Town d.State e.Zip Code (413)732-3179 f.Telephone Number area code and extension .E-mail Address(optional) Fred VanDerhoof h.On-site Manager Name 2. On-Site Supervisor: William Babcock On-Site Supervisor Name 3. Is the entire facility to be demolished? ✓D Yes ® No �N �0 4. Describe the area(s)to be demolished: _o Entire existing structure �N �O �O 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: n/a �Q ag06.doc•10/02 BWP AQ 06-Page 2 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 100113241 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)? ❑✓ Yes ❑ No If yes,who conducted the survey? Adam Lesko b.Survevor Name AI073071 c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 11/01/2010 �� 01/28/2011 � 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 b. If other, please specify: ❑✓ wetting ❑ shrouding ❑ covering ❑ other 9. For Emergency Demolition Operations,who is the DEP official who evaluated the emergency? a.Name of DEP Official b.Title c.Date mm/dd/ of Authorization d.DEP Waiver Number D. Certification I certify that I have examined the Fre:VanDerhoof =o above and that to the best of my a.Print Name _o knowledge it is true and complete. The signature below subjects the b.Authorized Signature- signer signer to the general statutes Project Manager =o regarding a false and misleading c. Position e �o statement(s). JAssociated Building Wreckers, Inc. d.Representing e.Date(mmlddlyyyy) �c �C) �Q ag06.doc•10/02 BWP AQ 06•Page 3 of 3 I ' DJG SAFE SYSTEM, INC. - Renew Existing Ticket Page 1 of 1 Request Number: 20104902786 Date 11/30/2010 Time 09:46 Latitude: Longitude: State: MASSACHUSETTS Municipality: BARNSTABLE Address/Intersection: 528 BEARSES WAY Nearest Cross Street 1: Nearest Cross Street 2: Additional Information: Nature Of Work: DEMOLITION OF STRUCTURE Area Of Work: PRIVATE PROPERTY Area Is Premarked: Y Start Date: 12/03/2010 Start Time: 10:00 Caller: JOANIE SAVAGE Title: DEMO CO ORDIN Return Call: BEF 430PM Phone#: 413-732-3179 Fax#: 413-734-6224 Alt.Phone#: Email Address:ABW_INC@COMCAST.NET Contractor:ASSOCIATED BUILDING WRECKERS Address: 352 ALBANY ST City: SPRINGFIELD State: MA Zip: 01105 Excavator Doing Work:ASSOCIATED BUILDING WRECKERS,INC. Member Utility List Code Abbreviation Name BW HYANWT HYANNIS WATER SYSTEM CH NGRDGS NATIONAL GRID GAS-COLONIAL CL NSTREL NSTAR ELECTRIC-COM CW VERIZN VERIZON HK COMCAS COMCAST-PEMBROKE ON ONTARG ON TARGET LOCATING RJ IDM INNOVATIVE DATA MANAGEMENT . There may be non-member utilities in the area that you need to notify. e Electric and other companies may not mark lines they don't own or maintain. You may want to contact them for more information. . The excavator is responsible to maintain markings placed by member utilities... DIG SAFE ENCOURAGES A COPY OF THIS ELECTRONIC TICKET ON SITE AT ALL TIMES. w,,, Renew Another k%71 Return To Menu Return To Home http://digsafefonn.digsafe.com/cgi-bin/dwcgi.exe 11/30/2010 Massachusetts Department of Environmental Protection 1100113195, Bureau of Waste Prevention —Air Quality Decal Number Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 Important: A.facilityLocation When filling out forms on the COMMERCIAL STRUCTURE computer,use only the tab key 1.Name of Facility to move your 1528 BEARSES WAY cursor-do not 2.Street Address use the return key. JHYANNIS MA i 3.City 4.State 5.Zip Code rd 6.Telephone Number INSTRUCTIONS B. Project Cancelled 1. This form is only available for Check here if this project is/was cancelled. online filing of project date revisions. 2. Enter al number. C. Project Dates decal number. 3. validate that g/30/2010 10/8/2010 the project location is correct 1.Ori inal Start Date mm/dd/ 2.Ori final End Date mm/dd/ for the entered decal. 3.Latest Revised Start Date(mm/dd/yyyy) 4.Latest Revised End Date(mm/dd/yyyy) 4. Enter your new project dates. 5. Certify your notification. D. Revised Project Dates Submit date c6anges. 10/4/2010 10/12/2010 1.Revised Start Date(mm/dd/yyyy) 2.Revised End Date Date(mm/dd/yyyy) E. Other Project Revisions I i i F. Revision History EDEP: 09/16/2010 08:00:28 AM OTHERPROREV: ITEM A.13.L. IS REVISED TO ADD ONE 1'X1' ` BOX OF VERMICULITE 3 anf06pdrn.doc•rev.2/5/04 Massachusetts Department of Environmental Protection 1100113195 Bureau of Waste Prevention —Air Quality Decal Number Ll Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 G. Certification The undersigned hereby states,under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts regulations for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. JAMES BEAUDRY IJAMES BEAUDRY 1. Name Authorized Si nature PROJECT MANAGER 1 19/29/2010 I 2. Position/Title 3. Date mm/dd/ BAYSTATE CONTRACTING SERVICES,INC. 1 14137810821 I 4. Representing 5. Telephone 352 AALBANY STREET 6. Address SPRINGFIELD 101105 7. City/Town 8. Zip Code anf06pdrn.doc•rev.2/5/04 IeDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home i Contact Feedback i Tour i Privacy Policy MassDEP's Online Filing System Usemame:BAYCON352 Nickname:JOANIE My eDEP Forms im. My Profile fa Help Receipt i Forms Signature Receipt Summary/Receipt print receipt Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select"My eDEP"to see a list of your transactions. DEP Transaction ID: 338516 Date and Time Submitted: 9/29/2010 6:35:42 AM Other Email : Form Name: Project Date Revision Notification DECAL#and Facility information Form Name: ANF001 DECAL#: 100113195 Facility Name: COMMERCIAL STRUCTURE Address: 528 BEARSES WAY, HYANNIS, MA Original Project Dates Start Date: 9/30/2010- End Date: 10/8/2010 Revised Project Dates Start Date- End Date My eDEP MassDEP Home I Contact Feedback Tour Privacy Policy MassDEP's Online Filing System ver.9.8.5.1©2010 MassDEP https://edep.dep.mass.gov/Pages/PrintReceipt.aspx 9/29/2010 Massachusetts Department of Environmental Protection 1100113195 � Bureau of Waste Prevention —Air Quality Decal Number Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 Important: A. FacilityLocation When filling out forms on the computer,use COMMERCIAL STRUCTURE only the tab key 1.Name of Facility to move your 528 BEARSES WAY cursor-do not 2,Street Address use the return key. HYANNIS MA � � 3.City 4.State 5.Zip Code rg5 6.Telephone Number INSTRUCTIONS B. Project Cancelled 1. This form is only available for ®Check here if this project is/was cancelled. online filing of project date revisions. 2. Enter project decal number. C. Project Dates 3. Validate that the project 09/30/2010 10/08/2010 the location is correct 1.original Start Date mm/dd/ 2.Ori inal End Date mm/dd/ for the entered decal. 3.Latest Revised Start Date mm/dd/( yyyy) 4.Latest Revised End Date(mm/dd/yyyy) 4. Enter your new project dates. 5. Certify your notification. D. Revised Project Dates Submit date changes. 1.Revised Start Date(mm/dd/yyyy) 2.Revised End Date Date(mm/dd/yyyy) E. Other Project Revisions Item A.13.1. is revised to add one 1'x1' box of vermiculite F. Revision History anf06pdrn.doc•rev.2/5/04 Massachusetts Department of Environmental Protection 1100113195 � Bureau of Waste Prevention —Air Quality Decal Number Project Revision Notification For Asbestos Notification ANF-001 and AQ 06 G. Certification The undersigned hereby states, under the penalties of perjury,that he/she has read the Commonwealth of Massachusetts regulations for the Removal,Containment or Encapsulation of Asbestos,453 CMR 6.00 and 310 CMR 7.15,and that the information contained in this notification is true and correct to the best of his/her knowledge and belief. Fran Mason 1. Name Authorized Signature Project Supervisor 2. Position/Title 3. Date mm/dd/ Baystate Contracting Services, Inc. 1 1(413)781-0820 4. Representing 5. Telephone 352 Albany St. 6. Address Springfield 01105 7. City/Town 8. Zip Code anf06pdrn.doc•rev.2/5/04 f eDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home I Contact Feedback I Tour I Privacy Policy MassDEP's Online Filing System Username:BAYCON352 Nickname:JOANIE My eDEP! Forms . My Profile . Help Receipt Forms Siqnature Receipt Summary/Receipt pant receipt, Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select"My eDEP"to see a list of your transactions. DEP Transaction ID: 335071 Date and Time Submitted: 9/16/2010 7:40:32 AM Other Email : Form Name: Project Date Revision Notification DECAL#and Facility information Form Name:ANF001 DECAL# : 100113195 Facility Name: COMMERCIAL STRUCTURE Address: 528 BEARSES WAY, HYANNIS, MA Original Project Dates Start Date: 9/30/2010- End Date: 10/8/2010 Revised Project Dates Start Date- End Date My eDEP MassDEP Home ( Contact I Feedback Tour ( Privacy Policy MassDEP's Online Filing System ver.9.8.5.1©2010 MassDEP https://edpp.dep.mass.gov/Pages/PrintReceipt.aspx 09/16/2010 i Commonwealth of Massachusetts ■ v` 100113195 Asbestos Notification Form ANF-001 Decal Number L r Important:When filling out A. Asbestos Abatement Description forms on the computer,use 1. a. Is this facility fee exempt-city,town, district, municipal housing authority, owner-occupied only the tab key residence of four units or less?❑Yes ❑✓ No to move your cursor-do not b. Provide blanket decal number if applicable: Blanket Decal Number use the return key. 2. Facility Location: COMMERCIAL STRUCTURE 528 BEARSES WAY a.Name of Facility b.Street Address Hyannis MA 02601 c.City/Town d.State e.Zip Code f.Telephone Number INSTRUCTIONS 3. Worksite Location: 1.All sections of this Commercial Structure throughout form must be a.Building Name/Building Location b.Building# c.Wing d.Floor e.Room completed in order to comply with 4. Is the facility occupied? ❑Yes ❑✓, No DEP notification requirements of 310 CMR 7.15 5. Asbestos Contractor: and the Division of Occupational IBAYSTATE CONTRACTING SERVICE 1352 ALBANY STREET Safety(DOS) a.Name _ b.Address SPRINGFIELD �� 01005 � 413-781-0821 notification requirements of 453 CMR 6.12 c.City/Town d.Zip Code e.Telephone Number f.ADO License Number g. Contract Type: ❑✓ Written ❑Verbal Jim Demas, Balise Facilities Director h.Facility Contact Person i.Contact Person's Title 6' FRANCIS C MASON I JAS070548 a.Name of On-Site Supervisor/Foreman b.Supervisor/Foreman DOS Certification Number Unknown at this time n/a 7' a.Name of Project Monitor b.Project Monitor DOS Certification Number Unknown at this time n/a 8' a.Name of Asbestos Analytical Lab b.Asbestos Analvtical Lab DOS Certification Number =0 9. 09/30/2010 10/08/2010 a.Project Start Date mm/dd/ b.End Date mm/dd/ =0 7-4p None �N c.Work hours Mon-Fri. d.Work hours Sat-Sun. 0c 10. a.What type of project is this? =o ❑✓ Demolition ❑ Renovation ❑ Repair ❑ Other, please specify: b.Describe 11. a. Check abatement procedures: o ❑Glove bag ❑ Encapsulation o ❑ Enclosure ❑ Disposal only W--itL ❑Cleanup ❑Other, specify: ❑✓ Full containment b.Describe. �z -Q 12. Is the job being conducted: ❑✓ Indoors? ❑Outdoors? , ■ anf001ap.doc•10/02 Asbestos Notification Form•Page 1 of 3■ r Commonwealth of Massachusetts ■ "`�- 100113195 �j Asbestos Notification Form ANF-001 Decal Number A. Asbestos Abatement Description (cont.) 13. Total amount of each type of Asbestos Containing Materials(ACM)to be removed, enclosed, or encapsulated: 14 1500 � a. I otal pipes or ducts(linear ft) —b.I otaloother surfaces square-ftj c.Boiler,breaching,duct,tank d.Insulating cement surface coatings Lin.ft. Sq.ft. Lin.ft. Sq.ft. e.Corrugated or layered paper pipe insulation Lin.ft. Sq.ft. f.Trowel/Sprayer coatings Linft.� Sq.ft. g.Spray-on fireproofing I h.Transite board,wall board Lin.ft. Sq.ft. Lin.ft. Sq.ft. i.Cloths,woven fabrics I j.Other,please specify: 14 500 Lin.ft. S .ft. Lin.ft. S .ft. k.Thermal,solid core pipe I flr the/clk insulation Lin.ft. Sq.ft. I.Specify 14. Describe the decontamination system(s)to be used: Standard and remote decon. 15. Describe the containerization/disposal methods to comply with 310 CMR 7.15 and 453 CMR 6.14(2)(g): To be thoroughly wetted, double bagged, labeled and properly disposed. 16. For Emergency Asbestos Operations,the DEP and DOS officials who evaluated the emergency: a.Name of DEP Official b.Title c.Date(mm/dd/yy y)of Authorization d.DEP Waiver# e.Name of DOS Official f.D S Official Title N g.Date(mm/dd/yyyy)of Authorization h.DOS Waiver# 0 17. Do prevailing wage rates as per M.G.L. c. 149, §26, 27 or 27A—F apply to this project? Yes No B. Facility Description i-N vacant commercial structure —o 1. Current or prior use of facility: —o 2. Is the facility owner-occupied residential with 4 units or less? ❑Yes [Z] No Balise Motor Sales 122 Doty Circle 3' a.Facility Owner Name _ _ b.Address �o West Springfield i 01089 �� o c.Cit /Town d.ZipCode e.Tele hone Number area code and extension _� Balise Motor Sales 122 Doty Circle _ 4' a.Name of Facility Owner's On-Site Manager b.On-Site Manager Address Z West Springfield 101089 �Q c.City/Town d.Zip Code e.Telephone Number(area code and extension) ■ anf001ap.doc•10/02 Asbestos Notification Form•Page 2 of 3■ i Commonwealth of Massachusetts ��""� 100113195 Asbestos Notification Form ANF-001 Decal Number B. Facility Description (cont.) Baystate Contracting Services, Inc. 352 Albany St. 5' a.Name of General Contractor b.Address Springfield 01105 1 14137810820 c.City/Town d.Zip Code e.Telephone Number area code and extension Steadfast Insurance WC654902701 �� 07/21/2011 —�— f.Contractor's Worker's Comp.Insurer g.Policy Number h.Exp.Date(mm/d 3600 d/ 6. What is the size of this facility. ••••••••••••••••••••••••••••--•-••-•••— a.Square Feet b.Number of floors C. Asbestos Transportation and Disposal 1. Transporter of asbestos-containing material from site to temporary storage site (if necessary): Baystate Contracting Services, Inc. 352 Albany St. Note:Transfer a.Name of Transporter b.Address Stations must Springfield 01105 413 781-0820 comply with the � ( ) p y c.City/Town d.Zip Code e.Telephone Number Solid Waste Division 2. Transporter of asbestos-containing waste material from removal/temporary site to final disposal site: Regulations 310 CMR 19.000 Red Technologies 110 Northwood Blvd. a.Name of Transporter b.Address Bloomfield 06002 1 1(860)218-2428 c.City/Town d.Zip Code e.Telephone Number 3. JCharles M Gordon &Sons IL03 Pickering St. a.Refuse Transfer Station and Owner b.Address Portland � 06480 1 1(860)342-1022 c.City/Town d.Zip Code e.Telephone Number 4. IMINERVA ENTERPRISES INC lPermit#54288 a.Final Disposal Site Location Name b.Final Disposal Site Location Owner's Name 9000 MINERVA ROAD I IWAYNESBURG c.Final Disposal Site Address d.City/Town OH 44688•,•:•.••••.•.:_� (330)866-3435 �M e.State f.Zip Code g.Telephone Number �o D. Certification i_N The undersigned hereby states, under the Fran Mason �� �o penalties of perjury,that he/she has read the a.Name b.Authorized Signature �o Commonwealth of Massachusetts regulations project Supervisor �� for the Removal, Containment or c Position/Title d.Date(mm/dd/vyyy) 310 C Encapsulation of Asbestos, CMR 6.00 and (413)781-0820 � Baystate Contracting MR 7.15,and that the information contained in this notification is true and correct e.Telephone Number f.Re resentin O to the best of his/her knowledge and belief. 352 Albany St. o q.Address Z_—LL ISpringfield 101105 h.City/Town i.Zip Code �Z anf001ap.doc•10/02 Asbestos Notification Form•Page 3 of 3 I (DEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Home i Contact Feedback i Tour i Privacy Policy MassDEP's Online Filing System Username:BAYCON352 Nickname:JOANIE My eDEP1 Forms= My Profilecd Help LReceipt i Forms Signature Payment Receipt Summary/Receipt ° print receipt J Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select"My eDEP"to see a list of your transactions. DEP Transaction ID: 334831 Date and Time Submitted: 9/15/2010 2:39:43 PM Other Email : Form Name: AQ 04-Asbestos Removal Notification Form ANF-001 Payment Information DEP code: 48574 Date: 9/15/2010 2:37:47 PM Amount($): 85 Billing Info: SAVAGE JOHANNA--AccountType--AccountNumber****1200 Confirmation N u m ber: Contractor Contractor Number:AC000021 Name: BAYSTATE CONTRACTING SERVICES INC Address: 352 ALBANY STREET, SPRINGFIELD, MA 01005 413-781-0821 Supervisor FRANCIS C MASON Project Monitor Lab Location COMMERCIAL STRUCTURE Project Start Date 9/30/2010 My eDEP MassDEP Home i Contact i Feedback ) Tour i Privacy Policy MassDEP's Online Filing System ver.9.8.5.1©2010 MassDEP https:Hedep.dep.mass.gov/Pages/PrintReceipt.aspx 09/15/2010 FROM :HYANNIS WATER SYSTEM FAX NO. :50B 790 1313 Nov. 30 2010 04:23PM P3/4 ,H rod Department of public Works Q► Water Supply Division lA$NSPASLl, � ° 6;9: a, Hyannis Water System Operations tEp�y .. i November 30, 2010 Town of Banistable B wilding luspector Town Hall Hyannis,MA 02601 RE: 528 Bearses Way-#604106 Dear Sir; Please be advised that the above water service was shut off and the meter removed on 10/27/1.0. At that time the water service was out and capped by PKM Construction. The owner has informed us of plans for denmolishion of the building. j Sincerely, ?yln��Z'k Hyannis Water System ....._........ ... . f (0Q. 6. 2010 1 :3.9PM NS?AR-SUMSW3 N0. 3308 P. 2 64PJSTj4R fine NSTAR Ww..SVVPO kc re rRvc westwow.Ma 0209 .9230 Phone 1w,7814414334 juetin.rer�tt�nst8r.�tca October 6,2010 Ballse Motor Sales 1102 Riverdale St. W, Springfield MA 01089 RE: 528 Bearses Way Hyannis i WO#01792666 516 Bearses Way Hyannis—WO#01792692 To Whom It May Concern: At N STAR,<wi64 cornmitted4o delivering great service. This letter serves as can irrrat'sr n that, as tit October 8; 2O1a,the electric service to both 516 and.528 Beetses Way, Hyannis.j.has been removed. Bawd on this information, there is rto el®ctric power at this address and you may proceed with the demolitioh. If yo.0 have any quostiohs,please+c act rho at(781)441-3334. Sincerely, / Rel*hl New Customer Connects i Sep. 61 [uIu Y:)fRlr - "N R One NSTAR Way E1 ECTR Westwood,Massachusetts 02090 AS i REQUEST FOR SHUTOFF AND REMOVAL OF SERVICE i I t we,_(13�q LT�SE JVM> < 294_ -,, property ownerts of: S/lo M -- So�� �l�Ei1RS 's /,r�A��1 _ � �Al Z'� A Hereby request removal of the overhead 1 underground(please drde ate)from the home for purpose of demolition or renovation. D f 37 Z/,:f 0 a i Accounts# 4�/ 9_�-,70 7 Pole or Underground pad# Meter# IZT&5c%k If available The first date that NSTAR can remove servlce'is: (Allow uo to 10 worklnadays from this date for the rob to be comoletedl Please provide the following information so we can get a confirmation letter to you. Your current mailing address: //Oa` O�AEVAAL 9' �,(� SAtZ7X),,: Current Phone number: /0 /be ;2 Please fax confirmation to: �b712� �� d� Z bEwa s Other instructions: wner's signature Owner's signature If you have any further questions,please call our office at 1-888-633-3797 Please complete and return to NSTAR. NSTAR Fax 1-781.441.11 Attention: Eileen Gurska q41. 3 3 SEP-27-2010 10:52 KEYSPAN 718 403 69% P.02102 { nationalgrold September 27, 2010 Balise Motor Sales Attn: Jim Demos eea l .HMOL 03 62 1 This letter.is to not'� you that:the located at 52$Bsersea Way,Hyannis, Ma Was Cut and capped at valve on.property on 9123/1.0. If you have any questions,please feel free to contact me @ 789 7-2930 Sincerely, Diem L.Stevenin Customer Driven Construction dione.stevonin@ua.ngrid.com 781-907-2930 78i-522-iON fox 40 Sylvan.Road to-2 Waltham,Alta 02451 TQTPL P.02 nationalgr'd as ios� Request for Service Cut-Off and Demo Signoff ?g The following information is necessary before National Grid can initiate a service cut-off or can provide a gas utility sign- off for a demolition request. Please provide the information Wed below. You will be notified by mail or fax if the building Identified does not have a gas service. If the building identified has a gas service,the gas service will be cut-off: Once the service is cut-off you will be notified by mail or fax. The notice may be used to satisfy the demolition permit requirement for gas utility sign-off purposes.If you have any questions or would like to speak to a company representative regarding this matter,please call(781)907-3960,and leave your name and phone number. Requests can be faxed to (781)522-1056 or mailed to: National Grid 40 Sylvan Road Waltham,MA 02451 Attn:Sales Fulfillment Company Name(if applicable) AL r F M07DA s-L,49Z<. Name of Contact Person s2zm MalingAddress�4ZSE - 110Q 92N�r��� 1 �P,��-,� ����, ink Phone Number of Contact Person��3-2j5./D0� Fax Number of Contact Person y� ^2��- yd7� o/O 89 Earliest cut-off date:(see Note) g//3 4a (NOTE.Because National Grid may heed roblatain a permit approval for any excavation work required,the requested cut- off may require up to 30 days.) Address of demolition and/or service cutoff City/rown / Is the service cutoff request due to a demolition?(Circle One) YES NO Y Is this the only building located at this address?(Circle One) YES Y NO CD If there is more than one building at this address,please provide a sketch below clearly indicating all buildings and draw an W in the box that pertains to the request. SKETCH: The lead4ime required for installation of a gas service Is typically 6 to 8 weeks. If it is anticipated that gas is.to be used at this location in the future,the owner must notify Sales Fulfillment group(781-907-2921)as soon as possible to make arrangements for gas service installation. Please note that the customer will assume the cost of service reconnection or service installation. By signing below,I certify that I am the owner of the property or that I have been authorized by the owner of the property to act as the owner's agent In requesting this cutoff. If it is determined that I was not,in fact,authorized to request this cutoff,I shall defend,indemnify,and hold Boston Gas Company d/b/a National Grid,Colonial Gas Company d/b/a National Grid and Essex Gas Company d/b/a National Grid(National Grid)harmless against any costs and liabilities arising out of or related to this cutoff request,including,without limitation,reimbursing National Grid for its costs related to cutting off and reinstating service." Owner/Agent Signature: G� �� .� , „ Q Date: Nationalgrid Supv Signature: Cut off Date: I r Green Environmental Consulting, LLC 296 Sylvester Road • Florence, MA, 01062 • Tel/Fax (413) 341-3418 AF February 16, 2010 Jim Demas Facilities Director Balise Motor Sales 122 Doty Circle West Springfielq,_�-4.A-01-08,9-- ....,;;,-._,- Re: Pre-demolition Asbestos Survey 528 Bearses Way. , -�" Hyannis, MA (�U� " r Dear Mr. Demas: At your request, Green Environmental Consulting, LLC (GEC) performed an asbestos inspection of the building located at 528 Bearses Way in Hyannis, Massachusetts (hereafter referenced as "building"). Fieldwork associated with the inspection was performed on February 1, 2010. Background The building consists generally of a one-story former car electronics/auto detailing building with a pitched roof. Interior finish materials include floor tiles, ceiling tiles, carpeting, textured wall and ceiling material and sheetrock/joint compound wall and ceiling systems. Exterior finish materials include concrete block walls and asphalt-based roofing shingles. GEC understands that above-referenced building is scheduled for demolition. In accordance with state and federal asbestos regulations, asbestos-containing materials (ACM's) in the building are required to be identified and removed prior to any activity that would disturb the material. Sampling/Results Twenty-five (25) samples of suspect asbestos-containing materials (ACM's) were collected and submitted to an accredited laboratory for analysis using Polarized Light Microscopy g with Dispersion Staining (PLM/DS). Materials found to contain greater than one percent asbestos by weight are +" considered to be asbestos-containing materials (ACM's). Refer to Attachment No. 1 for laboratory results, including detailed description of sampling locations, as well as chain-of custody records for samples collected. Green EnvironmentolConsulting.com f .Pre-demolition Asbestos Survey 528 Bearses Way. Hyannis, MA Page 2 The following materials were determined to be asbestos-containing materials (ACM's): Asbestos-Containing Materials (ACM's) Material Location Estimated Reference Notes Quantity Sample Number (s) 9" Red Floor Tile Showroom and 500 Square 00212A-07A & under Waiting Room Feet 07B carpeting in q.F X• some areas y White Caulk Front Showroom 14 Linear Feet 00212A-14 metal door Door Vermiculite Attic 1 Box Assumed "Grainger" box The following materials were sampled and determined not to be asbestos-containing materials (less than one-percent asbestos by weight): Material Location(s) Representative Sample(s) Sheetrock Throughout 00212A-01A & 01B Joint Compound Throughout 00212A-02A & 02B Metal Window Glaze Garage Bay and North Side of 00212A-03A & 03B Building °. Roofing Shingle Roof 00212A-04A & 04B Roofing Paper Roof 00212A-05A & 05B Duct Tape Attic 00212A-06 Black Floor Tile Mastic Showroom and Waiting Room 00212A-08A & 08B Chimney Mud Attic-on Chimney 00212A-09 Carpet Mastic Front Rooms 00212A-10A& 10B 1'xl' Ceiling Tile Front Rooms 00212A-11A& 11B Ceiling Texture Front Rooms 00212A-12A & 12B White Gasket Mechanical Room on "Thermo" 00212A-13 Ventilator i5; f Pre-demolition Asbestos Survey 528 Bearses Way, Hyannis, MA Page 3 Limitations This report is intended for the sole use of Balise Motor Sales. This report is not intended to serve as a bidding document nor as a project specification and actual site conditions and quantities should be field-verified. The scope of services performed in execution of this evaluation may not be appropriate to satisfy the needs of other users, and use or re-use of this document, the findings, conclusions, or recommendations is at the risk of said user. Although a reasonable attempt has been made to locate suspect asbestos-containing materials (ACM's) in the areas identified, the inspection techniques used are inherently limited in the sense that only full demolition procedures will reveal all building materials of a structure and, therefore, all areas of potential ACM. Estimated quantities of ACM are based on professional judgment and practicality. Other unidentified ACM's may be located within walls, ceiling cavities, below flooring or grade, and other non-accessible areas. Caution should be used during any renovation/demolition activities. GEC's asbestos inspection was limited to accessible areas on the interior of the building. It was not within the scope of this survey to fully inspect areas requiring demolition or areas deemed unsafe by GEC's inspector. In addition, electrical systems and/or components were not included in GEC's survey due to the safety issues inherent with sampling such systems. The Massachusetts Department of Environmental Protection (DEP), as well as the U.S. Environmental Protection Agency (EPA) currently recognize Polarized Light Microscopy (PLM) analysis as an acceptable analytical method for determining the Asbestos content in non-friable, organically bound (NOB) materials. However, comparative studies between PLM analysis and Transmission Electron Microscopy (TEM) analysis have shown that PLM analysis may yield false negative analytical results for NOB's such as floor tiles. `„ GEC recommends that, prior to demolition activities, one sample from each homogeneous area of �A mastic and other non-friable organically bound (NOB) materials that originally tested negative by PLM undergo confirmatory analysis by TEM, utilizing'ELAP-198.4 TEM Method for Identifying and Quantifying Asbestos in NOB bulk samples. I r .a ti Pre-demolition Asbestos Survey 528 Bearses Way. Hyannis, MA Pane 4 Conclusions/Recommendations Asbestos-containing materials (ACM's) were identified during GEC's inspection. Identified ACM's should be removed, handled, and disposed of properly, in accordance with applicable state and federal regulations prior to any activity that may disturb them. Any suspect asbestos-containing material that is discovered during building renovation/demolition that is not included in this report should be assumed to contain asbestos until further bulk sampling and analysis is performed. If you have any questions regarding this survey or the sampling and/or analytical techniques employed, please contact us at (413) 341-3418. Sincerely, Green Environmental Consulting, L,LC Adam Lesko MA Inspector Lic #A1073071 t MAR 25 19% 03:34 FR TO 14137814270 P.01i01 Warr". September 14,2010 This is to verify that the telephone equipment providing service to S 16 and 528 Hearses Way,Hyannis,Ma has been removed. This work was verified on September 10,2010. i Yours truly, April Clarke-Local Manager 16 Hinckley Road,Hyannis,Ma TOTAL PAGE.01 * f s.�v 't F y,di} 4{k ( i E Town of Barnstable 1 � 08 �,, F T"E' 200 Main Street,Hyannis,Massachusetts 02601 } "If, ' 1AENSPABLE. i Growth Management Department JoAnne Buntich,Director 16 9, ATFD" a 367 Main Street,Hyannis,Massachusetts 02601 Phone(508)862-4679 Fax(508)862-4725 www.town.barnstable.ma.us June 9, 2010 Balise Automotive Group c/o Attys Michael D. &Jeffery Ford 72 Main Street P. O. Box 485 West Harwich, MA 02671 Reference: Balise Automotive Group Vehicle Display Portion-of_Application SPR 014-10 516 & 528 Bearse's-Way,,Hyannis e Proposal: Demolition of existing 6,139 s.E car wash & 3,297 s.f. commercial building at 516 & 528 Bearse's Way and redevelopement of these parcels for vehicle display area for Balise Ford dealership. Dear Attorney Ford: Please be advised that subsequent to Formal Site Plan Review meeting held May 13, 2010,the vehicle display portion of the above application received an administrative approval at a staff meeting held June 8, 2010 subject to the following conditions: • Approval is based upon revised plans entitled"Balise Automotive Group"prepared for Balise Automotive Realty, Limited Partnership, C-1 through C-9.2 dated May 6, 2010 with final revisions May 24, 2010 to Sheets C-1, 4, 5, 6, 7, 8, 9& 9.1 for plans related to vehicle,display area, Scale 1"=40',prepared by Baxter Nye Engineering& Surveying, Hyannis, MA. • The recording of a 5 ft. sidewalk easement to the Commonwealth of Massachusetts along Route 28. • Placement of a sign"Authorized Vehicles Only" at the Bearse's Way entrance to the vehicle display lot. • Tree depicted at the edge of sidewalk easement area on the corner of Route 28 and Bearse's Way to be moved northward out of the easement area. • Landscaping to be protected by placing fencing between the vehicle display area along the perimeter of display area abutting the planted areas. There is to be no parking of display vehicles on the green/landscaped areas. • Lighting of the lot shall conform to the Lighting Standards of the Cape Cod Commission. The height of the light standards shall not exceed 26 feet. All lighting shall be shielded and shall not glare onto abutting properties or onto surrounding public ways. • No part of the site shall be used as a parking lot for the general public unless the site is changed to comply with zoning requirements for parking lots. Staff comments provided by Steven Seymour, Growth Management Engineer, in attached e-mail dated June 9,2010 as they relate to the vehicle display lot. • Applicant must obtain all other applicable permits, licenses and approvals required including,but not limited to,the granting from the Zoning Board of Appeals of a conditional use special permit for retail sales in the Highway Business District and a special permit for a non-conforming structure. • 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 240-104 (G). This document shall be submitted prior to the issuance of the final certificate of occupancy. Sincerely, 4 r 4,c � Ellen M. Swiniarski Site Plan Review/Regulatory Review Coordinator CC: Tom Perry,Building Commissioner SPR file ZBA file Attachment: 6/9/10 e-mail Steve Seymour Swiniarski, Ellen From: Seymour, Steve Sent: Wednesday, June 09, 2010 1:35 PM To: Swiniarski, Ellen; Perry, Tom Subject: Balise Ford Tom and Ellen A few additional comments that I would send on to Matt Eddy if you concur: We normally place a minimum of 1-1/2 inches of top course due to the aggregate size and need for pavement integrity. Plans show 1". Increase to 1-1/2". Show fire truck turning maneuvers on a copy of the plan. Call out ADA approved slopes at curb openings on Bearse's Way. Provide copy of most recent drainage area calculation map. Provide photometric plan for lighting. Pavement markings are not showing on plans. Recommend my sitting down with Matt Eddy to briefly discuss drainage, lighting, and pavement markings. Steve Stephen Seymour, P.E. Special Projects Manager Growth Management Department 367 Main Street Hyannis, MA steve.seymour@town.barnstable.ma.us Office: 508-862-4086 Fax: 508-862-4782 _ 1 Town of Barnstable Geographic Information System New Search H --1 F Parcel Viewer Custom Map Abutters I Map Size Zoom Out nflflnfln a I flIn wee KA 14, K hr X JPG Map: 293 Parcel: 009 k R"1 293026 Location: 516 BEARSE'S WAY Li 293060 "Al Owner: 516 BEARSES WAY LLC 47 2 293007 93011 kJ293027 N 648 46 N 32 Age [Location Information Map &Parcel 293009 293038 All T Location 516 BEARSE'S WAY n' 7� N306 Acreage 0.77 acres -J- 3r "I A 628r" lCurrent Owner Mailing Address 516 BEARSES WAY LLC 293028 N 20 1102 RIVERDALE STREET 14 iS 29301 WEST SPRINGFIELD, MA 01089 9 -7 293009 —, 293001 0382 N322'- tiv 6iff 14 �4— Appraised Value (FY 2009) Extra Features $0 A� 'j Out Buildings $17,600 Land $351,700 Buildings $248,100 Total Appraised $617,400 292287 N307 lAssessed Value (FY 2009) l4kvlR'Tr 292006 Extra Features $0 N317 3 ee ,2,2,77 Out Buildings $17,600 � t N 489 Land $351,700 N 489 Buildings $248,100 Total Assessed $617,400 Set Scale 1" = 138 I Aerial PhotosMAP DISCLAIMER Copyright 2005-2008 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS BarnstableMA v1.2.3357 [Production] http://www.town.bamstable.ma.us/arcims/appgeoapp/map.aspx?propertylD=293009 3/13/2009 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map '+ 293 Parcel 009 Permit# 8s t 7—y C/ Health Division 10 o5 lc� Date Issued f f- �Conservation Division 3; �- Application Fee Tax Collector Permit Fee Treasurer CONNECT95A�ryt. Planning Dept. v Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address�'1._ =�6 �Bearse's way �3 �e�5"L1q; Village Hyannis MA Owner Edgar H. Levesque Living Trust Address Telephone (508) 778-6766 Permit Request Renovate approximately 960 square feet of existing building as shown by attached sketch. �G .✓�yle G2� / G�r}�h 77f9 �`P//P !,Z CQ renovation Square feet: 1 st floor: existing proposed 2nd floor: existing N/A proposed N/A Total new 0 Zoning District - $ Flood Plain No Groundwater Overlay No Project Valuation 10,000 Construction Type L:"> Lot Size 0.77 Grandfathered: W Yes ❑ No- If yes, attach supporting, ,ument�tCon. 4.:. � Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) C) W. Age of Existing Structure `/0 years Historic House: ❑Yes Q No On Old King's High ay: ❑%s No Basement Type: ❑Full 11 Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) None Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 1 new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: i7 Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes 4 No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size 4ached garage:Cl existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# None Recorded❑ Commercial ®Yes ❑No If yes,site plan review# Current Use Car wash Proposed Use Detail Shop BUILDER INFORMATION Name HPritagP Custom Building Telephone Number (5os) 778-47o0 Address 72 Pine Street Hyannis MA 02601 License# 008124 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO BET Container 0 SIGNATURE /x DATE �- FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED 'MAP/PARCEL NO. r , ADDRESS VILLAGE I: . OWNER r DATE OF INSPECTION: FOUNDATION FRAME I�, INSULATION FIREPLACE A ELECTRICAL: ROUGI FINAL m PLUMBING: ROUGH FINAL GAS: ROUGHpj FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Town of Bamstable Re"tory Services ' T F.GeOw,Diredar ftfl ug Dillon Tomra".13ww $.Comn1etoner 200 Main 9keA $yen*MA 0M601 eww.tiownbarnetablema.ut Offiew. 508-8624039 , Fax: 508-790-6230 i Property OwiierMust Complete and sign This. Section If Using ABuilder Edgar H. Levesque as.Owner of the subied PrOPM hereby authorize : Heritage Custom•Building, Inc-. to act on zaybehalf, in all matoers Mative to work authorized b7da binding Pena&OPPECOlim for 506Ra&rqa'p1Wav Hyannis MA 0 60 (Ad�hC38 of job) ft/ �g�- ZxAk" s4ma6m of Owner ate P Qom. f, } i _ f • t. , EE n54�r} jQQ .I t 'Ll2%.I NG REGULATIONS 1 I k( ✓1ze Vo�n�nti�r�r °� r sG BOARD OS ERUCT ON SUPERVISOR } 14 i k r ta, a E f f License CONSTRUCTION O I Number.CS 008124 . I'1ti Frl Birthdat 0811371953 I N 1701.0 f + Tres. 08I1372007 IT no: ti � I 00� Li f u' � t Restricted i t till A DOUGL LE �- k F f} 632 ner 5 HAYWARD RD i s j 1• Commissio CENTERVILLE, MA 02 I t �r i { $ a _ - t 11 t I: E , - 7 y S t r f COMMERCIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $150.00 Alterations/Renovations $100.00 $100 Building Permit Amendment $50.00 FEE VALUE WORKSHEET NEW BUILDINGS square feet x$140.00/sq.foot= x.0081= ALTERATIONS(RENOVATIONS OF EXISTING SPACE 960 square feet X$96/sq.foot= 92,160 X.0081= 746.496 STORAGE BUILDINGS ONLY square feet X$32.00/sq.foot= X.0081 Commprojcost Rev:063004 V SKELETON SPECIFICATIONS HYANNIS CAR WASH HAND WASH BAYS Scope of Work The two hand car wash bays are to be converted to one auto interior cleaning bay and one customer waiting area, including a toilet, sink and employee lounge. No structural elements of the two bays will be disturbed. The westerly bay will be closed to the weather by adding new overhead garage doors at the entry and exit. The easterly bay will be renovated to accommodate a customer waiting area, a toilet, and an employee lounge. Materials A) Cleaning Bay 1) Exterior Two new overhead doors 2) Interior a) Floor- Existing floor to remain.. b) Walls & ceiling -New 5/8" Water resistant sheet rock B) Office Bay 1) Floor a) Seal Existing Catch Basin b) Remove existing floor and install a new concrete floor 2) Walls a) Frame partitions with 2 X 4 wood studs b) Install 5/8" Sheet rock all areas Use double on party walls between cleaning bay and wash bay. Use single on all interior partitions. 3) Ceiling Install 5/8" suspended accoustical ceilings all areas 4. Doors a) Exterior- See Plan b) To cleaning bay 1 3/4" -Hinged solid core wood doors c) Interior- 1 3/8" hinged, hollow core wood i 5. Finishes 1. Paint all walls and sheetrock, ceiling, doors and trim 2. Install vinyl tile on customer and employee area floors 6. General Install thermal insulation to code Mechanical and Electrical A) Plumbing 1) Rough plumbing a) Use PVC waist piping sized to code b) Use copper water piping sized to code 2) Equipment a) Install a 30 gallon hot water heater 3) Fixtures Install all new standard fixtures Note: Waste to be connected to existing sewer pipe B) H.V.A.C. 1) Heat- Install electric baseboard heat 2) Ventilation-Install adequate exhaust from the lounge and toilet C) Electrical 1) Utilize existing electrical service 2) Wire all outlets, lights, and equipment using copper romex properly sized 3) All lights to be 2'X 2' fluorescent 4) Alarms - all fire alarms per Hyannis Fire Department regulations Site Work A. Site Utility To be designed by Baxter&Nye Note: See attached plans for window and door schedules ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��Parcel Z�W, Permit# �l d Oilt'N OF DA,;�iiS f.ABLE Health Division Date Issued Conservation Division �3 j ` PH 2: 1¢ Application Fee Tax Collector" Permit Fee Cl� Treasurer __- I_3; 10H Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Project Street Address ���,, �,�r� Village r- Owner Address Telephone Permit Request Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation , QUd Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑No On Old King's Highway: Cl Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use - — - -- -- Proposed Use /y BUILDER INFORMATION Name__�,Q,� / �T� � �,,�/� �; �, r_Telephone Number Z: Ty -'/f7� Address_ A:U/ / , eW off �s� �� License# Home Improvement Contractor# Worker's Compensation# _�7S'✓GC/� R.?�/jaw 67�' ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE d r' FOR OFFICIAL USE ONLY PERMIT NO. b rf DATE ISSUED ti MAP/PARCEL NO. f , ADDRESS VILLAGE OWNER 4 DATE OF INSPECTION: FOUNDATION + FRAME '. INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL. . ' r PLUMBING: ROUGH FINAL 1 i GAS: ROUGH FINAL t " ..r ol FINAL BUILDING DATE CLOSED OUT' ASSOCIATION PLAN NO. r �- The Commonwealth of Massachusetts dustrial Accidents Department of In - OflfcE OflQYesti9affons 600 waslsington Street Boston,Mass. 02111 -' � Workers' Com ensatian Insurance Affidavit / /VM FRI,ell 014 _Y i name: � location "r hone# C. ; er erforming all work myself ❑ I am a hom P ca aci ❑ I am a sole rietor and have no one worlQn es working on this job, %%//%%%%//////%/%/ o ensation for mp ems ayer,,n};.>}:?3Ef.Yh; 4Y r�. .3v: .{{. }x.::.fY1.n)a'E;)w4 4 // (� orkers c f 4y. 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W. ,r}::3;•:'�;,f}t;•S•:•:,`•i'.:A'Y':::%`•efo'i'<'s«2>i•.'•r:�:Mn::#e�:}'t.7�S}'•,iti,,• �f$r?:;>C%<•;)i;: !•3..j;;:yYr?, rrlfF3,;r,.ki;gSa'r: v v:S:::xi'Syh$.:.{:,.h'tc..... ri]tiFauCe:c6f:.r .. :. ........... enalffn of a iineQp to 51,500.00 md/ar Fie aecme eoversgeas ui1ed,under8ection25Ao[MGL 152 eanle�to the imp : inn of crinsinal p enaltin in the form of a STOP WORK ORDER and a fine of 5100.00 day against me• I Qnder'tmd that a im risonrnent as wdl as civil P ations of the DIA for coverage veriscation. one pears P be foz'Rai'ded to the Ot8•ce otInvestlg copy of this statement na3' _ p uns dpenalties ofpedury that the information provided above is iru�and tarred I do hereby certify Date Signature Thane# Print name.. '��� �'✓ �� . ita in this area to be completed by dty or town official ofIIdal Use only do not Ynitr- t/ucense ❑Building Department pe ❑Licensing Board dty or town' (]5dectinea's Office nse rzgnirzd. ❑Health Department (] check if inunediate rdFo "" �Other phone#; contact person: (fs'risad 9195 PIS r Information and Instructions sachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for Lei Mai defined as eve person in the service of another y quoted from the `law an employee� every ct employees. As quot � P . of hire, express or implied., oral or written. association co oration or other legal entity, or any two or more of an individ utnership, � rP fined as ual, � . de An employer is ' the foregoing engaged in a1oint 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 haves not more than three apartments and who resides therein, or the occupant of the dwelling house of enance construction or repair work on such dwelling house or on the grounds or anothe r who employs Persons to do mainf , 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 issuance or renewal of a license or permit to operate a business or to construct.buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neitherthe commonwealth nor any of its'political subdivisions shall enter into any contract for the performance of public work until he contracting acceptable evidence of compliance with the insurance requirements of this chapter have been presented to t authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies es a all s be tilation and supplying company names, address and phone numbers along with a certificate'of ins ran_ y submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should ygu have any questions regarding the"law"or if you are re quired to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the perrnit/license number which will.be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. Ems The Department's address,telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents amce of fnvesdgauuns 600 Washington Street Boston,Ma, 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �TI D,ITE IMWDWYY) i �M— CERTIFICATE OF LIABILITY INSURANCE _ lisizao3 .I PRODUCER ^THIS CISRTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Mc Shea Insurance AgenCy, InC. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 749 Fain Street, Suite#H ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. i Oaterville, Ma. 02655 INSURERS AFFORDING C=OVERAGE — �-508-420 90.11 _ --- — �f (INSURED paul J Cazoault & gong Roofing Inc. INSURER A wasters exit a Ing- Co. _ 1,,sunERB Trav+glera Ins i�v.. C .I.11ivsii_ 1031 Main Street NSUREn c OBterville, Ma 02655 NSURER D 19DD-69B—'S569 INSVH!:PE COVERAGES -- I THE POLICIES OF INSURANCE LISTED BILLOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NDrwffIiSTAD o ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE: ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR Y EFFECTIVE POLICY EXPIRATION LIMITS LTRTYPE OF INSURANCE POLICY NUMBER TE MW I E MMrOD/Y _ OENERAL LIABILITY EACH OCCUPA;NICE E 0OQ 4 x COMMERCIAL Ut NFRAL LIABILITY I i"IRE DAMAGE(A v 1-17 S CLAIMS MADE I OCCUR i MED EXP(Any ore peaon) 5 A _ SCP0467325 '04/30/03 I04/30/04 PtHSONALSAUVINJURY $'L.000 i I I GENERAL AGGREGATE T$.3.000,00g— OEN'L AGGREUAI!LIMIT APPLIES PER.I PRODUCT$ COMP/OP Af.,G £ I POLICYEl JC 0 LOC AUTOMOBILE LIABILITY COMBINED 31NOLE LIMIT (Es accldonl) $ ANY AUTO ALL OWNED AUTOS I BODILY INJURY £. SCHEDULED AUTOS (Per Person) HIRED AUTOS - BODILY INJURY £ NON-OWNED AUT03 _ i (Par act:dent) I - PROPERTY DAMAGC £ (Per accident) [EN ITY AUTO ONLY EA ACCIDENT £ OTHER THAN EA ACC S AUTO ONLY, AGG S TY LACHOCCURRENCE CLAIMS MADE AGGREGATELE WORKERS COMPENSATION AND x v RY LIMITS ER _ EMPLOYERS'LIABILITY 77PJUB-922X653-502 .08/10/03 108/10/04 IE.L.EACH ACCIDENT } 100.000 H I EL DISEASE CAEMPLOYLE 1100 O.00 ._ E L DISEASE POI ICY LIMIT 1: OTHER I —' DESCRIPTION OF OPE RAT IONSILOCATIONSIVEHICL ES/EXCLUSIONS ADDED BY ENDOAGEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER ADDITIONAL INSURED;INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIDED POLICIES ME CANCELLED BEFORE THE EXPIRATION TOWn Of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 3.0_ DAYS WRITTEN I NOTICE TO THE CERTIFICATE HOLDER NAMED TO TIIE LEFT.BUT FAILURE TO DO SO SHALL f Harnetable, MA 02630 IMPOSE NO OBLIGATION OR LIABILITY Of ANY KIND ON THE INSURER,ITS AGENTS OR REPnERENTA I IFS. r �i 508 420 4555 inUTH 1 OR!zEDR RE T ACORD 25-S(7/97) ti ACORD COEIPORATION 1988 PROPERTY OWNER MUST COMPLETE A '1D SIGN THIS SECTION IF USING A B UI L,DER as Owner of the subject property Hereby authorize Paul J. Cazeault & Sons Roofing. To act on my behalf, in all matters relative to work authorized by this building Permit application for (address of Job) Sign ure of w ate 6� Print Name (Please return this form to Cazeault Roofers with your signed proposal/corttract) a A i 0/ Board of Building Rc Ltla ions and Standards One Ashburton {'lace - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Reg]strat ion Registration: 103714 Type: Private Corporation Expiration: 7/9/2004 PAUL J. CAZEAULT & SONS, INC. Paul Cazeault P.O. Box 2781 Orleans, MA 02653 Update Address and return card. R7ark reason for chanl,c. Address Rcuew::l ". I-:mploynicn( Los[ Board of Building Regulations and Standards License or registraliou valid for individul use only I p HOME IMPROVEMENT CONTRACTOR Before the expiration date. If found return io: r Registration: 103714 Board of Building Regulations and standards Expiration: 7/9/2004 One Ashburton Place Itin 1301 A Type: Private Corporation Boston, la.02108 PAUL J.CAZEAULT&SONS, INC. Paul Cazeault 22 Giddiah Rd. Orleans, MA 02653 Administrator N��' ., BOARD OF BUILDING REGULATIONS License: -,ONSTRUCTION SUPERVISOR Number CS 026325 Ea Blrthdate: 10/20/1959 .`• '.t Expires: 10/201.'003 Tr.nu: 7310 Restrictec : 00 PAULJ CAZEAULT 1585 MAIN ST OSTERVILLE, MA 026`,5 ( Administrator Board of Buildingg Re Cg�ulations One Ashburton Prace, Rm 1301 Boston, Ma 02108-1618 License: CONSTRUCTION SUPERVISOR LICENSE Birthdatc: 10/20/1959 Number: CS 026325 Expires: 10/20/2003 Restricted To : 00 PAUL J CAZEAULT 1535 MAIN ST _ OSTERVILLE, MA 02655 Tr. no: 7310 Keep top for receipt and change of address notification. i The Commonwealth of Massachusetts Department of industrial Accidents Mca ifMMMPffM 600 TVashin;ton Street Boston,Muss- 02111 Workers' Compensadon Insurance Affidavit General Busin es � e, ife °' e�Uustom Buil 'r�tag, • • - � • ' 72 Pine Street 0 2 6 01 H anni state: MA zi bane — address 506 Bearses Wa H a_na s e Retail❑RestaurantBarBat ng Establishment I am a sole proprietor and have no one Business Type; ❑Office[]Sales(including Real Estate,Antos etc,) yi orking iu any capacity. I am an em toyer with elu Ioyees(full& art tin . ❑ � / // /��/// /////��/////%i�// //%/lr� / ensation for'my employees�'vorlflng on this job. an emplay�providing viprkers' comp I am ;,, r is -i:;' :" •.:r :! •.'.. : ,t..r4 ` }'�:'•Y'•�:Yi •• i... 'r .� �t 'x' � i' :,t,�'t.r•-` •ilti::°'r.. i .•. t,i: �aII Aflm°� •r. ii. .t:. r•,j•.` ,. ' .�' ~ ' ��: r;. ..' ;�� 'r��,(��f',,•'�''', . ,;,� : ..y r�C 1-•. .r' � '''•t •�+ .. f. .9�:.a'• .�• ri.`.i:?5 i:^•'.,.t''•': .:.y., t 11'd'869r f.. .:i:r-, .t, r' :'7, '.• ^• �t, J, ,t .t. �N,ru '!. .;r _ ,': `'':,.,t:, ,�; •t.e. bone#••� •' ,:t., t. 'i •1.•. ''r11�:.� �LZ C.'•# •t`''.: r ..s• ///,/',////• •/* •�/ p•, rance.Cu.'r �' ' 'j j %/ gyvorkers' . I am a sole proprietor and have hired the independent contractors listed below who have the followin �}ensation polices: `. t`.• , , ;) P, 1C¢g�'� CLhSZOFii,'BRt'1�d121; t0 en DflM] y .+..: ^�rl:.: .,n:.f. Vie: is t•' 7•"'r `u: ,!:a: '� i.•r,•r•,i••�i < 'i '�i>i: ..2 2i36,e : •r .r:v. ! -'oi, '�~••i• ' •r, 't'C 'ad ¢ss;: ,.• �.'f „., r ;y :t� 4.r ,.t. rri ]0$ t °:'�' nn2s' hone '' t a .,. •F..,,.t,.u. •'f�•{��:•�:'I.4'• 'e'(•r' •'�'a.:- �r• •1;i•ji}' 't-.';Y•t'+ •t• siltance ��� •�f! },'a 't .-, .F...:R : it.1-t .,Ts Ny•',' '(5•l y t /�/ 1 {...'_.: �.'.1•.ti. {''!,t• i L• .r `r•1. .:'� r',: .7J•' •'r•' ��r`�`hi'Fti€1,��mc•I.Il',r�tt..s2��6�.�'1+Qrt�'S'' r,• ' - i' . CO an, trey address: }i� .•( $yanti-is; OII .••<t..�•', rr nr'' —.k., ... ":r,• .i t. {,. .b?t•' .,tr':u.•.' t�J, ••t�.'�.t• ,. ;:r •i �aN!f4'�.'�? �> 3137icvo 6 CQ[kl piox lisuranc�r //.� e to secure coverage as required under Section 25A of Mi STOFWORIS ORDER 152 cati-Irad to the and a fine ofiS100.00ea d y again? mi n0FBI IBM derotand.that Fall , r),ontaentaswellasciygpenaltiesintheform one years imp be.forwarded to the Office of Investigations of the DIA for coverage verification copy,of this statement may do hereby certify under the pain ndpenaft M0. u tt the tnf arm atian provided above is true d oorr r Zr Date Phone# _• Print name e -�- ^x r ' ter <v ��' '�} � x• ' J ¢- do not write in this area to be completed by city or town official of l,Cial Use only permitlliceate it C]Building Department city or town: ❑Licensing Board ❑Selectmen's Office IR �cheek it immediate response is regvlred C]HealthDepartment' , ❑Other phone nl -' coataetperson: (tevf:ed 9ep�2003) 16 _ - a low— b � Town of Barnstable ` Regulatory Services BAMSPABL& ' Thomas F.Geiler,Director M.L% 9 079 10� g Buildin Division �prfD Myr A Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Building Permit Procedures for New Commercial Building 1. Letter of Approval from Site Plan Review. 2. If Zoning Board of Appeals relief is required for the project,a copy of the decision with proof of recording from the Registry of Deeds must accompany the application. 3. Plot Plan(Plan of Record)recorded at the Registry of Deeds showing the date the lot was established,its area and boundaries. Site Plan must also be submitted showing the location and setbacks of existing/proposed structures, septic,parking,etc. Copy of deed. 4. Historic District Commission,200 Main Street,approval required prior to construction/demolition for any properties located in a Historic Old Kings Highway Historic District(north of the Mid Cape Highway) Hyannis Main Street Waterfront Historic District(See map for boundaries) 5. Construction plans-one complete set of full sized plans and one.complete set reduced to 11"x 17"fully dimensionalized must be submitted with the building permit application. Both sets must be stamped by either an architect or an engineer. NOTE: The applicant must also submit a set of full sized plans to the appropriate Fire Department for review.The application package will not be accepted without prior approval from the Fire Department. 6. The following departments,located at 200 Main Street,must sign off on the building permit application: Engineering Department Health Department Hours 8:00-9:30 AM or 1:00-2:00 PM Tax Collector Conservation Department 8:30—9:30 AM or 1:00-2:00 PM Planning Department Treasurer 7. Workers Compensation Insurance Affidavit-State Form. Copy of Insurance Compliance Certificate - must be on file. 8. Construction Supervisor's License-A copy of the Construction Supervisor license is required. Note: Construction Supervisor's license holders are not entitled to supervise construction of a building or an addition(regardless of size)to a building with a total cubic volume greater than 35,000 cubic feet. In that case,the application must be accompanied by controlled construction documents as indicated in 780 CMR sections 116 &1705. 9. Performance Bond($4.00 per foot of road frontage)must be submitted with permit application.. 10. Property owner must sign Property Owner Letter of Permission. 11. Application fee: Must be paid when application package is submitted. Checks made payable to the Town of Barnstable. Q:bldg/wpfiles/forms KNEW REV:063004 Employee Lounge & Equipment Room Supply Storage Office 30' 0 Automobile Interior Cleaning Processing Area Customer Waiting Area 32' t - z�oan WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S60UB-985X456-8-05) RENEWAL OF (6S60UB-985X456-8-04) INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY NCCI CO CODE: 80411 1. INSURED: PRODUCER: HERITAGE CUSTOM BUILDING INC & GOLDMAN & ASSOC INS FIN P 0 BOX 170 933 FALMOUTH RD WEST HYANNISPORT MA 02672 RTE 28 HYANNIS MA 02601 -2319 Insured is A CORPORATION Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 01 -04-05 to 01 -04-06 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA a— B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in m item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 100000 Each Accident Bodily Injury by Disease: $ 500000 Policy Limit 0 Bodily Injury by Disease: $ 100000 Each Employee �= C. OTHER STATES INSURANCE: Part Three of the policy applies to.the states, if any, listed here: SEE ENDORSEMENT WC 20 03 06 D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 0 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 12-23-04 WC ST ASSIGN: MA OFFICE: ORLANDO DA HTFD 05G PRODUCER: GOLDMAN & ASSOC INS FIN 28HPP 028342 I The Commonwealth of Massachusetts __ -- Department of Industrial Accidents 600 Washington Street Boston,mass, 02111 'W'orkers3 Con pensadon Insurance Af idavft�/e���Fusin / if erltae�G�ustom TBuil v awe g• • 72 Pine Street address: H anni sta te: MA zi : 02601 hone# — address: 506 Bearses Wa �Hannis work site location h — etail[]Restaurant/Bar/Eating Fstablishment I am a sole proprietor and have no one Business`�'p : Office[]Sales(including Real Estate,Antos etc,) working in any capacity. I'�an em Toyer with eii 1 ees(full& art tine. ❑Other / /�%//%/%%//%� on/o/T////��p/ es worldng on this job. I am an empleyer providing-workers compens; Y, > cam any Aflrne: ;.•: ,.. _,•.: .,�+ ;:'ti'.r'r, i �. • .a +'` .'�\i?•t' ' 'h' •T'�:• 'ter/,..�• ...r ja... ,>,r:'r M1.r •r;;•• i' addrE55" .t, t'' r'+t'', i'F`,'�••'t,C �t. :;•'.w rt. •r. ,i ;>.. X. bone# ' r . . . , rF•". �• city: •t. ..,,, i',l' r ': :. ••. •' 771 insui ance.co:w'•'. `"" - jr '//// /l/// ///%//////y/// //o/ -workers' ` /l/ ll eve the fo g / / contractors kilted below who h � I am a sole proprietor and have hired the independent corn�ensationpolices: ' .•, 't:., :•fl�� .C�ge'�'C.it�t:oht.'�•ilt3.in' . . ;�,,,...,, •• • COInLan nflIDe, t .�. ..rt;'•'..�. nr:,� n:,f•'�e:��:�.. t•''r t +.'• hose '' "t• T. :i'�;r.:•t` ,'. ' Clty:. il;:':'I?`' 'e'f.r' '" ,',',.. nt'� :�.;. + �'• 's / � ...'„' 't.:-'•�1•:.�'r. •+ •':•,,i rAtr:;—','�+ ,•_„i,. r,. r 011Cy:#} • '% _ fnsurence co. y�/:!/ .� t. r1; .".'S.tT.. tis '.-.f�. .r •�',t.!'f. rydr ii•'j.: ^�„�. •1... ai7.., :1:•.. l:;.:..�e' -A. '}%`jrii..V� am2L2T.' "r 6:(7C' +'A't9'S• .i+.r .. - 'i�' COM tin. MM oddness: r' i r rY.a'nhis; ,.02COir; : M hone#' �+ t .?�ct y . -r7, ., "'[ .tir'r+,fir .ti,r.'� ' u,'r:x 1• /M alties n of F 2 Lad to inipos allure to secure coverage asFEW required Hader Section 25A of MG STOP WORIS 0 ER and a rjne ofi5140.0 a osias�m I°n8 otoana.thatp one years'Imprisontaent y wall as forw&IIarded to the ff the form of e �opyvi'thl5statementmsybeEarwardedtotheOff�caofIavestlgatioasa{the'DlAfvrcoverageYeri[ication. • 1-1;7 Ida hereby certify under the pain nd penalties; uryt the Inform anon provided above,is true d cart �L Data Phone# Print name � ,.�• official use only do not write in this area to be completed by city or town official permit/lieease# ❑Building Department -� city or town: OLlceasiag Board ❑Selectmen's Ofrice NK ❑checklf immediateresponse is required ❑HeaithDepattment i phone�; ❑other contaetpersonn 3 y MV Pv � ; c ,r f L IN _ 1 i • d 'I Employee Lounge & Equipment Room , : Supply Storage Office 30' Automobile Interior Cleaning . Processing Area ng Customer Waite Area it 6 ' fi I ., . . . . I .. _ ". r,: , . .. ., . t I I" ; y'.f F j 2 s i r a !! 9 t st}F 11j1[1 .. - Illnf�ki;ylCp a `IF Pik t ! R tl 1 - / > - .. - �, // 11 S,. .'.,,,,//� n.LOI//Y/nW�^AnA' I y1 {,y y, ; BOARD OF BUILDING REGULATIONS ,y n R t f; License: CONSTRUCTION SUPERVISOR .',lI.1:.-,,�;...!�..I�.�-.%'.,�:.�-�1::..:��;:;:.I�I��.;-.'�.,-�;�11i-,!!�'!��'..,�,..-�1�i;:iii...�!.�;:I��.;1�:.I,���.�-'..'��'�"'.',,.!.—',��:i'.j'i"1"�..;��-��:i�'!�-;4%,��.,,t'..�:"i',.,.'�'i�'''".I!i'.l,;"!"''-"'..�..i1:�;�!.;i;:l����i1!j.""�"�,,.'::"1..:'�.p�..,5:,;i:r;"�.'�,.7'i�'�:�i';H,!�;.."—_ r�f y d.a F jl ` 'frh'I t ' 1.. Number .CS 008124 ! Y (rL I ; 4 �. #�i .I 4;t `t F Birthdate: 0811311 . - ,Irj` •fj I (' . � Tr.no: 1701.0 Ex pires 08/1312007 C I fE . !a'I;s `_ RestrFcted 00 �..I ( }' + +k,l l pOUGLAS W LEBEL / c� . a C,,G�,. // 1 5 HAYWARD RD 02632` + {f!£:E f't�i 1'1 - I ii CENTERVILLE, MA Commissioner I.St t r , j.l .. J { i t .,: .. (.I , ! I i t' - .. lt. t.A , . .. it. 7 .t1 . . - t y 1 ' - S 4 1 I. F, I+ - .. ! :. .. !it - .. - c ,: t t -- r . .. . i. . y i f,Y ' i i tt b i .. .. ! t y i1 III ,. L. - � - " • . 1 " - f f - .. t 1, !1F . i ` . t 7t . . . T ' .a _ ! I - ! 1 + . ( 1 . . . li r y .. - .- .. ' `: -. - .. - — - .. _ — ;1( i t - ,.. . r --.. .. ' ., r _ - ,:.. . t --;.. T , yt..: , -. - .... . d. - . ! .- _ s :}. Iu Ft i . . .t + - 4 i i " - to �.. f v 1 k >: .-. - t t. +. .. • _ . ` 1. p .. - f - - - - f i a - ! 1 I I tI! t .a r .. 1 't t .. t f'._ - } 1 .i > - .. ..r i _ .. .. lz. _. t - f I t _t. .. t - f - . f Y .: ,�+. .. ...e .... I. .., ..y 1 I I t - , } - ..: 1 t .: I 1 - - .. • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 293 Parcel 009 Permit# Health Division Date Issued Conservation Division Application Fee Tax Collector Permit Fee Treasurer Planning Dept, Date Definitive Plan Approved by Planning Board Historic-OKH " Preservation/Hyannis Project Street Address , 506 Bearse's Way Village Hyannis MA Owner Edgar H. Levesque Living Trust Address Telephone (508) 778-6766 Permit Request Renovate approximately 960 square feet of existing building as shown by attached sketch. Square feet: 1st floor: existing renovation proposed 2nd floor: existing N/A proposed N/A Total newer Zoning District 13 Flood Plain No Groundwater Overlay No Project Valuation 10,000 Construction Type Lot Size 0.77 Grandfathered: W Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure 30 years Historic House: ❑Yes Q No On Old King's Highway: ❑Yes M No Basement Type: ❑Full X]Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) None Basement Unfinished Area(sq.ft) Number of Baths: Full: existing 1 new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: D Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes Cl No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# None Recorded❑ Commercial 3 Yes ❑ No If yes,site plan review# Current Use car waGh Proposed Use Detail Shop BUILDER INFORMATION Name Heritage CnGtom Biii 1 cling Telephone Number (5m) 778-4700 Address 72 Pine Street Hyannis MA 02601 License# 008124 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO BFT Container SIGNATURE DATE Scope of Work 506 Bearse's Way Hyannis MA 02601 Demolition • Remove existing concrete slab. Re-pour slab Doors • Install two new garage door units Roof None Electrical • Wire office, lounge, waiting room and cleaning area Exterior Siding None Plumbint • Construct new employee bathroom Insulation • Insulate where needed Kitchen Cabinets None Sheetrock • Re-sheetrock'as shown on sketch plan Page Two 506 Bearse's Way Hyannis MA Flooring • Office, storage, employee lounge, and equipment room • Customer waiting area Septic • No changes to current system - hooked up to town sewer Landscaping None f COMMERCIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,Additions $150.00 Alterations/Renovations $100.00 $100 Building Permit Amendment $50.00 FEE VALUE WORKSHEET NEW BUILDINGS square feet x$140.00/sq.foot= x.0081= ALTERATIONS/RENOVATIONS OF EXISTING SPACE 960 square feet X$96/sq.foot= 92,160 X.0081= 746.496 STORAGE BUILDINGS ONLY square feet X$32.00/sq. foot= X.0081 Commprojcost Rev:063004 °fTM�,ati Town of Barnstable --- '� Regulatory Services LE, ' Thomas F.Geller,Director 9`b1639. a`0� 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 ' Property Owner Must Complete and Sign This Section If Using A Builder I ,as Owner of the subject property. 'hereby authorize. -Heritage Custom-Building, Inc. to act on my behalf, � in all matters relative to work authorized by this building permit application for: 506 Bearse's Way Hyannis MA 02601 (Address of Job) Signature of Owner Date Print Name Q:FORMS:OwNER MUMSI0N Barnstable Assessing Search Results Page 1 of 2 iN r p at -., J>j Home: Departments:Assessors Division:: Property Assessment Search sults /,S/ «back to search 516 PARSES" 14 u Owner: / !/ / r 7 LEVESQUE, EDGAR H TR Property Sketch Lege d Map/Parcel/Parcel Extension 293 /009/ �3" Mailing Address is e LEVESQUE, EDGAR H TR - ff �,1' EDGAR H LEVESQUE LIVING TRUST 7743 EAST NEVILLE AVE % m MESA,AZ.85208 ]+j HL3 Assessed Values: P Appraised Value Assessed Value %j3,3 rift 3 ��133 �,- Building Value: $ 124,900 $ 124,900 Extra Features: $0 $0 Outbuildings: $7,400 $7,400 Land Value: $268,200 $268,200 Interactive Property Map: Ma requires Piu Totals:$400,500 $400,500 1 have visited the maps before Show Me The Map April 2001 photos available Sales History: Owner: Sale Date Book/Page: Sale Price: LEVESQUE, EDGAR H C66339 $0 LEVESQUE, EDGAR H TR 2/5/1998 11208/137 $ 10 Tax Information: Tax Rates: (per$1,000 of valuation) Town Tax $3,764.70 Town Fire District Rates Other Rates 9.40 Barnstable - 2.88 Land Bank 3%of Town Tax Hyannis FD Tax $ 1,157.45 C.O.M.M. 1.54 Cotuit 1.88 Land Bank Tax $ 112.94 Hyannis 2.89 Y� 5/Q West Barnstable 1.96 http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 3/19/2003 r Barnstable Assessing Search Results Page 2 of 2 Total: $5,035.09 Due to rounding differences these values may vary Land and Building Information Land Building Lot Size(Acres) 0.77 Year Built 1949 Appraised Value $268,200 Living Area 4749 Assessed Value $268,200 Replacement Cost$244,854 Depreciation 30 Building Value 124,900 Construction Details Style Car Wash Interior Floors Concr-Finished Model Ind/Comm Interior Walls Minimum Grade Average Grade Heat Fuel Gas Stories 1 Story Heat Type Hot Air Exterior Walls Concr/Cinder AC Type None Roof Structure Flat Bedrooms Zero Bedrooms Roof Cover Rolled Compos Bathrooms Zero Bathrms Total Rooms 1 Room Extra Building Features Code Description Units/SQ ft Appraised Value Assessed Value PAV1 PAVING-ASPHALT 16500 $7,400 $7,400 Property Sketch Legend BAS First Floor, Living Area FST Utility Area (Finished Interior) UAT Attic Area(Unfinished) BMT Basement Area(Unfinished) FTS Third Story Living Area(Finished) UHS Half Story(Unfinished) CAN Canopy FUS Second Story Living Area (Finished) UST Utility Area(Unfinished) FAT Attic Area(Finished) GAR Garage UTQ Three Quarters Story(Unfinished) FCP Carport GRN Greenhouse UUA Unfinished Utility Attic FEP Enclosed Porch PTO Patio UUS Full Upper 2nd Story(Unfinished) FHS Half Story(Finished) SFB Semi Finished Living Area WDK Wood Deck FOP Open or Screened in Porch TQS Three Quarters Story(Finished) t http://www.town.bamstable.ma.us/tob02/Depts/AdministrativeServices/Finance/Assessing/... 3/19/2003 i Scope of Work 506 Bearse's Way Hyannis MA 02601 Demolition • Remove existing concrete slab. Re-pour slab Doors • Install two new garage door units Roof None Electrical • Wire office, lounge, waiting room and cleaning area Exterior Siding • Vinyl patch where needed Plumbing • Construct new employee bathroom with toilet and sink Insulation • Insulatiion where needed for exterior walls Kitchen Cabinets None Sheetrock • Re-sheetrock interior partitions as shown by Plan Page Two 506 Bearse's Way Hyannis MA Flooring • Office, storage, employee lounge, and equipment room and customer waiting area shall be tile or vinyl Septic • No changes to current system- new bathroom to be hooked up to existing town sewer Landscaping None i �jo. wp overhead.door Employee Lounge & Equipment Room 30' 0 Office Automobile Interior Cleaning Processing Area Customer Waiting Area overhead door 32' r Andonucio Antonio Goncalves ~74 Windshore Dr. Hyannis, MA 02601 March 11, 1999 Town of Barnstable Hyannis, MA 02601 Dear Sirs: This letter will confirm my desire to open an auto detailing business, Andonucio A. Goncalves, d/b/a Rainbow Auto Detailing at 31 Thornton Dr., Hyannis, MA. As auto washing is not allowed on Thornton Dr., we will be washing cars at the Hyannis Car Wash on 506 Bearse's Way, Hyannis. At the Thornton Drive location, we will be doing auto detailing only -vacuuming and cleaning automobile interiors and polishing and waxing of the exterior. Andonucio A. Goncalves Barnstable, SS March 11, 1999 Then personally appeared before me the above named Andonucio A. Goncalves and acknowledged the foregoing instrument to be his free act and deed, before me. l 4athleen M. Milholo Notary Public My commission expires May 4, 2001 SKELETON SPECIFICATIONS HYANNIS CAR WASH HAND WASH BAYS Scope of Work The two hand car wash bays are to be converted to one auto interior cleaning bay and one customer waiting area, including a toilet, sink and employee lounge. No structural elements of the two bays will be disturbed. The westerly bay will be closed to the weather by adding new overhead garage doors at the entry and exit. The easterly bay will be renovated to accommodate a customer waiting area, a toilet, and an employee lounge. Materials A) Cleaning Bay 1) Exterior Two new overhead doors 2) Interior a) Floor- Existing floor to remain. b) Walls & ceiling -New 5/8" Water resistant sheet rock B) Office Bay 1) Floor a) Seal Existing Catch Basin b) Remove existing floor and install a new concrete floor 2) Walls a) Frame partitions with 2 X 4 wood studs b) Install 5/8" Sheet rock all areas Use double on party walls between cleaning bay and wash bay. Use single on all interior partitions. 3) Ceiling ~' Install 5/8" suspended accoustical ceilings all areas 4. Doors a) Exterior- See Plan b) To cleaning bay 1 3/4" -Hinged solid core wood doors c) Interior- 1 3/8" hinged, hollow core wood Cy ti 5. Finishes 1. Paint all walls and sheetrock, ceiling, doors and trim 2. Install vinyl tile on customer and employee area floors 6. General Install thermal insulation to code Mechanical and Electrical A) Plumbing 1) Rough plumbing a) Use PVC waist piping sized to code b) Use copper water piping sized to code 2) Equipment a) Install a 30 gallon hot water heater 3) Fixtures Install all new standard fixtures Note: Waste to be connected to existing sewer pipe B) H.V.A.C. 1) Heat - Install electric baseboard heat 2) Ventilation- Install adequate exhaust from the lounge and toilet C) Electrical 1) Utilize existing electrical service 2 Wire all outlets, lights, and equipment using copper romex properly sized 3) All lights to be 2' X 2' fluorescent 4) Alarms - all fire alarms per Hyannis Fire Department regulations Site Work A. Site Utility To be designed by Baxter&Nye Note: See attached plans for window and door schedules I SKELETON SPECIFICATIONS HYANNIS CAR WASH HAND WASH BAYS Scope of Work The two hand car wash bays are to be converted to one auto interior cleaning bay and one customer waiting area, including a toilet, sink and employee lounge. No structural elements of the two bays will be disturbed. The westerly bay will be closed to the weather by adding new overhead garage doors at the entry and exit. The easterly bay will be renovated to accommodate a customer waiting area, a toilet, and an employee lounge. Materials A) Cleaning Bay 1) Exterior Two new overhead doors 2) Interior a) Floor- Existing floor to remain b) Walls & ceiling -New 5/8" Water resistant sheet rock B) Office Bay 1) Floor a) Seal Existing Catch Basin b)Remove existing floor and install a new concrete floor 2) Walls a)Frame partitions with 2 X 4 wood studs b) Install 5/8" Sheet rock all areas Use double on party walls between cleaning bay and wash bay. Use single on all interior partitions. 3) Ceiling Install 5/8" suspended accoustical ceilings all areas 4. Doors a) Exterior- See Plan b) To cleaning bay 1 3/4" -Hinged solid core wood doors c) Interior- 1 3/8 hinged,hollow core wood i 5. Finishes 1. Paint all walls and sheetrock, ceiling, doors and trim 2. Install vinyl tile on customer and employee area floors 6. General - Install thermal insulation to code Mechanical and Electrical A) Plumbing 1) Rough plumbing a)Use PVC waist piping sized to code b)Use copper water piping sized to code 2) Equipment a) Install a 30 gallon hot water heater 3) Fixtures Install all new standard fixtures Note: Waste to be connected to existing sewer pipe B) H.V.A.C. 1) Heat - Install electric baseboard heat 2) Ventilation- Install adequate exhaust from the lounge and toilet C) Electrical 1) Utilize existing electrical service 2) Wire all outlets, lights, and equipment using copper romex properly sized 3) All lights to be 2' X 2' fluorescent 4) Alarms - all fire alarms per Hyannis Fire Department regulations Site Work A. Site Utility To be designed by Baxter&Nye Note: See attached plans for window and door schedules f SKELETON SPECIFICATIONS HYANNIS CAR WASH HAND WASH BAYS Scope of Work The two hand car wash bays are to be converted to one auto interior cleaning bay and one customer waiting area, including a toilet, sink and employee lounge. No structural elements of the two bays will be disturbed. The westerly bay will be closed to the weather by adding new overhead garage doors at the entry and exit. The easterly bay will be renovated to accommodate a customer waiting area, a toilet, and an employee lounge. Materials A) Cleaning Bay 1) Exterior Two new overhead doors 2) Interior a) Floor- Existing floor to remain b) Walls & ceiling-New 5/8" Water resistant sheet rock B) Office Bay 1) Floor a) Seal Existing Catch Basin b) Remove existing floor and install a new concrete floor 2) Walls a)Frame partitions with 2 X 4 wood studs b) Install 5/8" Sheet rock all areas Use double on party walls between cleaning bay and wash bay. Use single on all interior partitions. 3) Ceiling Install 5/8" suspended accoustical ceilings all areas 4. Doors a) Exterior b)To cleaning bay 1 3/4" -Hinged solid core wood doors c) Interior- 1 3/8" hinged,hollow core wood I 5. Finishes 1. Paint all walls and sheetrock, ceiling, doors and trim 2. Install vinyl tile on customer and employee area floors 6. General Install thermal insulation to code Mechanical and Electrical A) Plumbing 1) Rough plumbing a)Use PVC waist piping sized to code b)Use copper water piping sized to code 2) Equipment a) Install a 30 gallon hot water heater 3) Fixtures U�6k;s;'Lt t� Install all new standard fixtures B) H.V.A.C. 1) Heat - Install electric baseboard heat 2) Ventilation- Install adequate exhaust from the lounge and toilet C) Electrical 1) Utilize existing electrical service 2) Wire all outlets, lights, and equipment using copper romex properly sized 3) All lights to be 2'X 2' fluorescent 4) Alarms - all fire alarms per Hyannis Fire Department regulations Site Work A. Site Utility To be designed by Baxter&Nye Note: See attached plans for window and door schedules ry d� AIai II 5 d 1 1• eowc;e--e)&-z) 7-6 61vs' Avl-o ��a2 Y .ry it �1 { � / sq y d � 'ev + 2) 400 Ils9y X�4L IAII�2�0161 Z;Fervo e. t y .�t f-. /a,OS f o Z'7E ir4vc l c 41, A- /4-vx-Ra e � i r 1 A51M; C-O G�IZ � �1L /ZO LS'�G t7lZ�� rf 51 - �� - I.t �t - ,r 1 . r{ t 4 i{ J - Engineering Dept.(3rd floor) Map C , Parcel Permit#_�g House# �'�� Date Issued oard of Health Ord floor)(8:15 -9:30,/1:00-4:30) Fee Conservaho ice(4th floor)(8:30- 9:30/1:00-2:00) Planning Dept.(1st floor of Admm. Bldg.) 1HE rq Defini ' an Approved by Planning 19 MIAMI TOWN OF BARNSTABLE Building Permit Application Project Street Address Avdcp, v Village Owner A?C,10J Address XW�P� Telephone 0' /r/ �77 Permit Request ua ;� First Floor square feet Second Floor square feet Construction Type S&6c-e I<Ael! - 4�lC 4114e/ zl�k .lpcll Estimated Project Cost $ d-ao . ob Zoning District Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House ❑Yes f�No On Old King's Highway ❑Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other oOPte— Basement Finished Area(sq.ft.) il/�,ryF- Basement Unfinished Area(sq.ft) 114 Number of Baths: Full: Existing New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing oZ New First Floor Room Count Heat Type and Fuel: etas ❑Oil ❑Electric ❑Other Central Air ❑Yes ZNo Fireplaces: Existing 414 -New Existing wood/coal stove ❑Yes Ulo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) ❑None ` C(Shed(size) moo© �. ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ 'Commercial AYes ❑No If yes, site plan review# Current Use e4- Proposed Use Builder Information ? r� ✓ Name Telephone Number ,//Address �ce e# �.� 039 .3.33 ome Improvement Contractor#7 116> 94 4 Worker's Compensation#_ NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT) SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTIO DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ` BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED i MAP/PARCEL NO. t' ADDRESS VILLAGE .' OWNER DATE OF INSPECTION: .. s FOUNDATION ' FRAME 1 INSULATION ' FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL f GAS: ROUGH FINAL y FINAL"BUILDING -� DATE CLOSED OUT ASSOCIATION PLAN NO. 5 r The Commonwealth ojAtassachusetty Department of lttdttstrial Accidents ' office SMWest/gaUoes 600 11 avitial tun Street Boston,Mau. (12111 Workers' Compensation Insurance Afftdayit �p;+hcant Information• Please MINT'ledj�jy name: Incition- city phone# I am a homeowner performing all work myself. Q j1 am a sole proprietor and have no one working In any capacity ~�m tployer roviding work om nv ers' compensation for my employees working on this job. name• •tdt r y t #• VZ in. an co. lieu# I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comimm• name: iddress• - city phone#• insurance co nelicv# �- . - _... �+c7tt::- +..-nac-=-�^r..:1»ea-ec--,:as^`._ _"race•±�.���-�iT�;rrr+wwyq'•+cr:_r."�"�'�4"�_':`i.�""..=�,'."'—',-_�'..".�' company name* - address- City phone#: ingur-ince co policy# Attach additional sheef if tiecessary�•: i�:-v_^!:_"^tI rac:xe _ -_•-_._ : a:.�..� __•"�r,._`++•.;: �+�++t ^' A �� Failure to secure an crags as required under Section 25A of MGL 152 can lead to the imposition of criminal penalties of a fine up to 51.500.00 andiur one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of 5100.00 a day against me. I understand that a copy of this statement may be forwarded to the Office of Investigations of the D1A for coverage verification. ' !d t'erebr certi tinder the pains and penalties of perjun•that the information prorided above is true and correct. Si_natun � Date ✓ `L O 7 ��y rint name f � ®� Phone#AJ 7 official uscnh do not write in this area to be completed by city or town official - city or town: permit/license# t�Building Department C3Liccnsing Board I]check if immediate response is required ❑Selectmen's Office C311calth Department contact person: phone Miller smised;;9s rtAt information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers'compensation for the employees. As quoted tom the "law", an enrP1({ree is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An eiyrphor r is defined as an individual. partnership, association. corporation or other legal entit}, or any two or mo: 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 tl-. owner of a dwellina, house having not more than three apartments and who resides therein, or the occupant of the dwellin'�, house of another who employs persons to do maintenance , construction or repair work on such dwelling, he or on the ,rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe MGL chapter 152 section 25 also states that even• state or local licensing agenc,% shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant %vho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into anv contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should vdti have any questions regarding the "law" or if you are require: to obtain a workers* compensation policy, please call the Department at the number listed below. .. -•--- .. ::..,...5':M: ... .. 'lam+.:. •J: .Few� '�'• Cin• or,towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom c tite affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Pie: be sure to fill in tite permit/license number which will be used as a reference number. The affidavits may be returned ; the Department by mail or FAX unless other arrangements have been made. Tile Office of Investigations would like to thank you in advance for you cooperation and should you have any question. please do not hesitate to give us a call. The Department's address. telephone and fax number. The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Ma. 02111 fax #: (617) 727-7749 nhnnp 14- (617) 727-4900 ext. 406. 409 or 37-5 Scope of Work 506 Bearse's Way Hyannis MA 02601 Demolition • Remove existing concrete slab. Re-pour slab Doors • Install two new garage door units Roof None Electrical • Wire office, lounge, waiting room and cleaning area Exterior Siding • Vinyl patch where needed Plumbing • Construct new employee bathroom with toilet and sink Insulation • Insulatiion where needed for exterior walls Kitchen Cabinets None Sheetrock • Re-sheetrock interior partitions as shown by Plan Page Two 506 Bearse's Way Hyannis MA Flooring • Office, storage, employee lounge, and equipment room and customer waiting area shall be tile or vinyl Septic • No changes to current system-new bathroom to be hooked up to existing town sewer Landscaping None Assessor's office(1st Floor): {} ! Assessor's map and lot number �7"3 0 0,F C,iwGt1: c oJ� Board of Health (3rd floor):( ' n 'r ^��. Sewage Permit number No r�� tioda� BA�'S ,���-0Lc- 11 Z 33AHd3TADLL i Engineering Department(3rd,floor): KAss House number i639• \®�' Definitive Plan Approved by Planning Board 19 ���►r APPLICATIONS PROCESSED'8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO E F 6 T `r 6/4tf 6 P/ 00r 6 fX/s 7X/V G /WD WySN BAyS h2XyWOi7rke TYPE OF CONSTRUCTION WK L S �' 401,/DBL oC Lf STFNL Bt A tij wPoo FRI,�ryE oN PVS71A,G /0"AIR,:p Fv&1(,A4r1v,f/ Tuzy 3 19 / TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Proposed Use PROUC6i11V T fuOL10 A111FIV 14/ASNlrr(r- 411)? Oclt-4/ )I- N1NGF f Zoning District Fire District Name of Owner 06, /7 ' L t Vks Q tj Address ���/1/�'� S PAT�� 16W 4'/1//S' 6/1\ y- f v Name of Builder BRIA ,v �,1 U ZO AlAddress a a Y�1,� /RC L I �NUJ/+S R% ` &/t , Name of Architect � Address Number of Rooms Foundation �U !! Pd y�'�� L &A1 FN r° 0 FF Z-Al ViN y b 7-0 Exterior MALT H PEST/l1/G O PP WySN -aNRoofing Floors POv "CD P r t Interior f 1l 01 7 OFF f 1-,C1e ll- -,414f' Heating1"X/Sy 16 Riy0/44/t— Me AT Ty rUylF Plumbing 2\Al fT/&rr /V'/1 Approximate Cost ? �00 0-4Fireplace pp Area 9 Diagram of Lot and Building with Dimensions Fee 1<0 m OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �%W�fI� v v Construction Supervisor's License LEVESQUE, EDGAR H. A=293-009 No 3 310 0 ' Permit For B I d Roc)f nx7ar Exi-sting Wash bays (Car -Wash) 51(p Location Bearses Way Hyannis Owner Edgar H Levesque Type of Construction Frame Plot Lot Permit Granted July 25, 19 89 Date of Inspection 19 Date Completed 19 } 7//j/ Assessor's office(1st Floor): p .Assessor's map and lot number �!`3 O a 9 r moo*TWE to` . Board of Health(3rd floor): Sewage Permit number . NO A24:�-�'oAat BAYS T- Z BA"STABLL i Engineering Department(3rd floor): raea House number s C SY.�bM MU� 16 aY•a�ei' Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only @NSTALWO INS 5U WM TOWN O F B A R N S CODE AND MOVIN Q LAMONS BUILDING . INSPECTOR APPLICATION FOR PERMIT TO '�R� ! " (�f/ry r! oI/EV TX 15 r N 6 rwD �FI�F fF�l/F w,�S/� 9111 ' 1i 2 X ► oaDd- TYPE OF CONSTRUCTION WKLS= eve/DBaco Cf44('Y = STFFL 6r�M d�- Wool)Fp,4RF dy PVSr1A1& /0"AV9k-P fovNDAr111'f1 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the ollowing information: Location Proposed Use PR 1!t'Nio ES' Zoning District )_/ Fire District Name of Owner LJ0614 !7 ' ��Vtf Q U k Address Name of Builder BRIE Al �,4 V zo Address o1a ri4 L l /�C L Name of Architect A Iq Address Number of Rooms A11A Foundation 1:-140,=n OFF T-A/ 1//M Y G t b Exterior /t?/a r( & PA/S T//1/G C N R ��l sN &O ioofing S1 I'F G , �F1/`I AeVO _Aq/N 6= Floors I&IR ED OVAIC R F`l't Interior 17A C`,6�n OFF L/11' Heating X(Sl �i�)O/�4/VT Y A r'�i /-2 0vff Plumbing t\K/f Fireplace N�H Approximate Cost 6-000, Area 4Fr• 0 Diagram of Lot and Building with Dimensions Fee A©©°- - I _ f CS Cz 571 Oa -u C 4 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ' Construction Supervisor's License LEVESQUE, EDGAR H. f 4. No. 33100 Permit For Bld. Roof ove Existing Wash Ra�zs/ Car Wash I� 1 Location 506 Bearses Wad , -Hyannis s Ed Owner gar H. LevesgiiP 't _ Type of Construction Frame Plot Lot Permit Granted July 25, - 19 89 Date of Inspection 19 Date Completed �' " 19 } co _ IR F -3 0 V ------------- Employee attl, by Tony Lucero,editor,Michigan Carn ID you ever wonder why some tral or holl customers will just hand you steers off q money and not say a word or it or not,t, lY. ook you m the eye when you fastereratt oath them in their car? eA Ing Fact, t least some of the tim reflec Bng make then. hat they arb',Simply B.._ 4 � - i �: W e °� ��� � � _ , �„ � � : ,a ,_ , ¢ � � ���.. . �;3 �. ``�� IHE'O'y� The Town of Barnstable BARNSTABLE. ' Department of Health Safety and Environmental Services MASS. a 9 16)9 `eo �PrEUM0a• Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 PLAN REVIEW Owner: Map/Parcel: a D Project Address: Cale tl�s/'IBuilder: The following items were noted on reviewing: C o 1v 7"-AC 7- 4 % J7�,/ C1,yF '/ei''-Y Reviewed by: Date: q:building:forms:review TOWN OF BARNSTABLE SIGN PERMIT PARCEL ID 293 009 GEOBASE ID 20512 ADDRESS 516 BEARSE'S WAY PHONE HYANNIS ZIP -- LOT 1 & 2 BLOCK LOT SIZE � DBA DEVELOPMENT DISTRICT HY N. PERMIT 29744 DESCRIPTION HYANNIS CAR WASH(48 SQ.FT. ) PERMIT TYPE BSIGN TITLE SIGN PERMIT CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services A TOTAL FEES: $50.00 ptr THE BOND $.00 -- ---- ----,v - ry . - CONSTRUCTION COSTS,-- .----- --_.. $.._OOv 753 MISC, NOT CODED ELSEWHER 1ARN3fASLE. •' MASS. �► 1639. ♦� B ILDIN DIVISO/ DATE ISSUED 03/30/1998 EXPIRATION DATE 1 � F � The Town of Barnstable • Department of Health, Safety and Environmental Services * &UMSrnaLE, MAWBuilding Division AlFD MA'�A 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Application for Sign Permit Applicant:— = /�-G'iJR( u� _ —Assessors No.—vZ y 00 Doing Business As: 10 � --- `� ' ---Telephone No._ 7�^/���/ Sign Location / Street/Road: :4 �'�S ---- - ----------- __ a Zoning District:--- --— Kings Highway? Yes(90 Property Owner r Name:-------- Ln --------------------------Telephone:_—v�>W<---=— — Address: ---Village: Sign Contractor 7_ Name:— — — _—_--- Village:_— Description Please draw a diagram of lot showing location of buildings and existing signs with dimensions, location and size of the new sign. This should be drawn on the reverse side of this application. Is the sign to be electrified? Yes o (Note:Ifyes, a wiringpermitis required) 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 Section 4-3 of the Town of Barnstable Zoning Ordinance. Signature of Owner/Authorized Agent:—, �1', �= Date:---- Size: Permit Fee:____ Sign Permit was approved:_ ---------- Disapproved:---------------- Signature of Building O cial:_ tee_ _ _ — _Date:07 �� J - � 3 , i i � O i I s 1 1 � SK S � 1 a E+ �' _ . r ��C�A M�SR � I• . i ,' ���, M V 1J736tJ , 8,:42 FnlARnin � �°i ►• , �p'S fie)�' �=%� €'4 a � a , i�- r 4 .. v, 1. _ r � i i { i — I � r - - - I . wf wi 1 I Eli , � r r , - i; m7 71- -77 : i Q X, ..� O ou ,I ti c cA as - �— 14 r , i T.; t7N ........... ----------- t j t -- I , I { 1 _ , -77 -41 - fir?� e , , r r i r _ , _ .. y .. . . . . •.. _ --.. _ . � „ _.. -., � ,. ....._ ..,.,.. � -.ter. ry -.>r. >,,.3_-. s_. ..: a-.-.. �r _-.. �...y..r}•-erg.>.. P•w w ;Y. 'a... - — -_ - .. ..-:: .. .: ... _ _•.a+ ......:-`.r >� . -..•`Cy-.!..mot.- l�.w ... _.: 3.. - _ r F 44n:..r:... •.-�«.. ....:. a,-._: .. r a .:;..tia-- ..... :• T _�,!^n' L.`. 1 . 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