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0800 BEARSE'S WAY (36)
i }, Town of Barnstable ild 1� ..Bui ing eaIik .eeLE ,j' Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept Posted Until Final Inspection Has Been Made. Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit Permit NO. B-17-3700 Applicant Name: WILLIAM W CROSTON JR Approvals Date Issued: 11/06/2017 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 05/06/2018 Foundation: Commercial Map/Lot: 294-061-OOM Zoning District: Sheathing: Location: 800 COMMON AREA BEARSE"S WAY, HYANNIS .Contractor Name: WILLIAM W CROSTON JR Framing: 1 Owner on Record: MCNAMARA,WILLIAM 1 JR TR Contractor License: CS-014112 2 Address: 37 WHITMAR ROAD Est. Project Cost: $ 14,980.00 Chimney: MARSTONS MILLS, MA 02648 Permit Fee: $236.32 Description: Replace Insulation and Drywall in Masterbedroom area Unit SEE Insulation: .Fee Paid: $ 236.32 and Ceiling of Electrical Room in Building 5 All Insulation to match Final: or exceed Existing. Date: 11/6/2017 Project Review Req: REPLACEMENT ONLY y Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: ,5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: E All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION eMpirX, Map JL �?Lf Parcel win Application Health Division Date Issued 7 Conservation Division Application Fee Planning Dept. Permit Fee 4�0 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Tv Project Street Address itkrl6 tA.- SwS 61.1 �vc.� Village W&C,fill �S Owner 4A^ Cows5 rY.-A 6o.1 da~•w v10g 3 Address FOP 6f4J-,S.-s Telephone '�7� 7J PL Permit Request Pla, T y3ol At ee � Square feet: 1stlfloor: existing proposed 2n?floor: existing proposed Total new Zoning District ,i Flood Plain A/0 Groundwater Overlay Project Valuation "/� � Construction Type "Pa L Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# +} �� Age of Existing Structure Historic House: ❑Yes 2'ao Id King's Highway: ❑Yes M17o YP Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other �2 52017 l OF Basement Finished Area (sq.ft.) Basement Unfinished RAaftms`. Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing&' new Total Room Count (not including baths): existing !Y new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil (flectric ❑ Other Central Air: ❑Yes Flo 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 ���r���dti` �H�� Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name IJt�� CYuwSlykL Telephone Number Tvk Address 6C all," ow License # ®Al`f 2- &uysrd's py'.f- OT6011 Home Improvement Contractor# Email Cy `P�Vq aL,S 44 ' 40o Worker's Compensation # ��� 11 ALL CONSTRUCTION DEBRIS RESULTING FROM/THIS PROJECT WILL BE TAKEN TO r' SIGNATURE DATE w FOR OFFICIAL USE ONLY ,c J APPLICATION# DATE ISSUED h MAP/PARCEL NO. ADDRESS VILLAGE OWNER '. DATE OF INSPECTION: FOUNDATION L. FRAME i INSULATION r - j FIREPLACE c r ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 1 DATE CLOSED OUT ASSOCIATION PLAN NO. i m a v .w� L r. x i ':.� '� -,;� .' •:9 a _,.�• . ,.,, t. :, F s`�,. ^. �6 r r �.0 �` •`r� �v b $ +mot ,�'r;' 411 Or y�.�/H `�a�y n k� n �.a lk "rr' fo 14 n c t a a"x c A NK "`fry}1" If, I All Al .+ ,e q - ,. c 'i€-� _ `' ry 4 - y ? •fi .�x ds .t a+�gs �x '� « „ ' a z -c { ...*-,. -� >f=� t .� f• ..}�' � r'�'°,:.' J - � .y,. 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Y�. i,X � +'E ry � � �.. tom: - ,. 2,,. ... -� � •- .,�M _ ��, e y r a r a •a, , Department oflnduri idAcd&7z& Office o0zVerfigafions 600 Washington Street Boston,AKA 02M . www.muss gnvldia Yorkers' Compensation Insurance Affidavit Builders!ContractorsMectdcians/Plmnber .Auplica ut Information Please Prat s Legibly' Address: .0, City Zip: �$ P!t.t dI' PhDne#: ok 771 63j-1/ Are you an employer?Check the appropriate box: Typa of ro'ect .1.[�'�am a emphryer wish 4. ❑I am a general contractor and I P J (fired): employees(EM and/or put thne).* have hired the sob-contractors 6. ❑New conshvcfion 2.❑ I am a sole proprietor or partner- listed on the attached sheet [7. [�J o odehng ship and have no employees n=e actors have 8. []Demolition worlang for me in any opacity employees and have workers' g. Bud ' addition [No workers'comp,insin:ance comp.inst ranca t 5. We are a corporati=and its 10.❑Blectricalrepairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Pbmb" repairs or additions myself [No wo11ars'comp. 4&of exemption per MGL Ing insurance required.]t c,IA§1(4),and we have no 12-El Roof repairs employees.[No wouk=' 13.❑Other cMMP•rise wed] *Any appHcmattbat check box#I amst also ill ontthe section below sfiawmgtltdswo J='eomp=38fioa poIicy mbnnxtirrn t Ho==m=who submit this aT3davit indicating they are doing zU wade and thm hind outddo=&actm nmst submit anew afsdxrh iadieatmg melt TCouhart=that eheckft box nmst attached sn addhbnal shed showiugthe name of the and state whether or ant those mdffim have employers.If the sub-its have emPmy_..g-9=mt Mwida fficir wmk_,__P.Policy=mba Pam an employer that is pruphEng workere conVemadon huurau=for my euployem Belmv is fhe poHq and job site . informaSon. ' Insurance Company Name: 194 �.. /�. / i v' Co�✓, Policy#or Self-ins.Lic.#: .yam 2// j of e, 2.12 19 ExpirationDatcx / Job Site Address:_ & ^Ji't d City/St wzip: Attach a copy of the workers'compensation policy declaration pa (show ing the policy number and expiration date). Failtae to secmt-e coverage as required nader Section25A of MGL c.152 can lead to the imposition of criminal penalties of a tine up to$1,5W.00 and/or one-year impriso=crit;as vmZ as civil pen Ifies in the foam 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 forwm-ded to the Office of Investigations of the DIA for human=coverage veaficaiion. I do hereby catyouLw thj!PaY9md.PZnaWeY ofPe7m7'that the infortru dou provided above is&Ue and correct S' Date- Phone# Official use only. Do not write in this are%to be completed by city or 15nm o xIaL City or Town: Tssd g Amthority(circle one): L Board ofElealth.2.. . Department 3. - _ Building p CrtyfTown Clerk 4,EIotrioY Tnspeetor 5.Plumbing Inspector 6 Other Contact Person: 'Phone#: Information and Instructions . 7yfxzcca_j=etts Ger<eral Laws chapter 152 reds all employers to provide worker'compensation fur-their employees. po¢� sue ,I this s ,an employee is defined as .every person in the service of another under any cordract of hire, express or implied,oraI or WhEEL" An employer is defined as"an individual,partnership,association,crnporation or offer legal entdy,or any two or more of the foregoing engaged is a joint eot mpdse1 and including the legal represeafa&=of a deceased employer,or the receiver or trustee of an individnal,partnership,association or other Iegal 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 - dwellmg house of another who employs persons to do maintenance,coushuction or repair work on such dwelling house deemed to be an employer." or on the grounds or building app thereto shall not because of Bach employment be deem emp y MGL chapter 152,§25C(t7 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 applicantwho has not produced acceptable evidence of compliance with the insurance,coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor;iny of its political subdivisions shall enter info any contract for the performance ofpublic work untrl acceptable evidence of compliance with the insurance., requirements of this chapterhave been presented to the contracting audhoiity." Applies Please fill out the wodsers'compensation affidavit completely,by chw1c ng the boxes that apply to your situation and,if necessary,supply sub-conf actor(s)nam e(s), address(es)and phone numbers)along with their cartificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)withno employees other than the members or partners,are not required to carry workers'compensation in er=ce. If an LLC or LLP does have employees,apolicy is required. Be advised that this affidavitmaybe submitted to the Departnent of Industrial Accidents for conformation ofmsurarce coverage. Also be sure to sign and date the affidavit The affidavit should be relined to the city or town that the application fin 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 eater their self-insurance license number on the appropriate lime. 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 f M in the permit/licrose number which will be used as a reference number. In addition,an applicant that must submit multiple permit/Ecense applications in any given year,need only submit one affidavit indicating rrmrnt 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 fle for R&n permits or licenses. A new affidavit must be filled out each year.When:e a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (ie. a dog license or permit to bum leaves etc.)said person is NOT regrind to complete this affidavit The Of of Investigations would Iike to thank you in advance for your cooperation and should you have any questions, please do not hesiiste to give us a call. The Department's address,telephone and fax number. -Tha CommmwwIth of MassachuseM Depart ment of Ind 1 Accidents mice of)tv'eWPUD= 600-WashiVG3:L.StMd Bastou,MA 02111 Ta#617 727-4900 cat 4€6 or 1-977 MASSAFE Fax#617-727 7744 Revised 4-24-07 .masggavIdia 1 ®AcoRo CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 1 10/05/2017 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(les) must be endorsed. If SUBROGATION IS WAIVED,subject o the terms:and conditions of the policy,certain policies may:reciuire an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Christine Davies DOWLING & O'NEIL.INSURANCE AGENCY PHc"o E (508 775-1620 arc Nu: ADORess: cdavies@doins.com 973 IYANNOUGH RD INSURERS AFFORDING COVERAGE NAIC# HYANNIS MA 02601 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: WILLIAM W CROSTON INSURERC; WILLIAM W CROSTON BUILDINGCONTRACTOR INSURERD: P O BOX 138 INSURER E: OSTERVILLE MA 02655 INSURER F: COVERAGES CERTIFICATE:NUMBER: 199.138 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES..LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL$UBR POLICY NUMBER MMIDDY EFF IYYYY MMLDD/YICY YYY LIMITS f-TR COMMERCIAL GEN ERAL•LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE.F-1 OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) S N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRO- POLICY EJECT ❑LOC - : PRODUCTS-'COMP/OP AGG $ ROTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS :Per accident $ "A UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 4EXCESS LIAB CLAIMS-MADE N/A. - AGGREGATE :$ DED I I RETENTION$ $ WORKERS COMPENSATION X SEATUTEJT ERH AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? N/A N/A. N/A AWC40070134192017A. 09/08/2017 09/08/2018 (Mandatory in NH) ET.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $. 1,000,000 N/A :DESCRIPTION OF OPERATIONS/LOCATIONS/:VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims:for benefits to employees in states other than Massachusetts if the insured hires,or:has hired those employees'outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification:Search tool at www.mass.gov/lwd/workers-compensation/investigations/. Sole proprietor has not elected coverage. Continuation of above Named Insured:WILLIAM W CR08TON BUILDING CONTRACTO CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Whitten Landscaping 45 Commercial Street AUTHORIZED REPRESENTATIVE South Yarmouth MA 02664 Daniel M.CroWl'ey,CPCU,Vice President—Residual Market—WCRIBMA @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The:ACORD name:and logo are registered:marks of ACORD BILL CROSTON BUILDING CONTRACTOR BOX 138—OSTERVILLE,MA.02655—(508) 428-8657 1-800-924-1073 MA LIC.#014112 MA REG. #100023 October 8, 2017. Cape Crossroads Condominiums c/o American Properties T eam 500 West Cummings Park Suite 6050 Woburn, Ma 01.801 Re: Unit 5EE and electrical room Proposal We hereby:submit specifications and estimates for supplying the labor and materials to repair the fire and water damage in the master bedroom and bathroom and the first floor electrical room. This will entailing replacing the straping in the bathroom and inspecting and repairing as necessary any damage to the roof trusses. We will then vent the bathroom fan to be supplied and wired by others to the exterior. We will then check the insulation under the bathroom and bedroom floors. If.this insulation is wet there will be a up charge to replace it. The attic framing above the master bath will then be sealed for odor control. We will then replace the ceiling.and all damaged sections of the:walls using5/8 inch gypsum board. The new drywall and all repaired areas will then be completely taped and prime painted. After the drywall is completed we will install sixteen inches of blown cellulose insulation in the,attic space. In the electrical room we will install fiberglass batt insulation in the ceiling and 5/8 gypsum board on the ceiling. The gypsum board will be completely taped and the ceiling finish painted. All work areas will be cleaned on compleation and all construction debris will be cleaned up and removed from the site. Please Note: If the insulation between the second and third floors under the bathroom and bedroom is wet and needs to be replaced the additional cost for this work will be 1,000.00 We propose hereby to furnish material and labor complete in accordance with the above specifications for.the sum of': Fourteen thousand nine.hundred eighty and no/I00 141980.00 A deposit of 1/3 will be due on acceptance, with the balance:due on.completion. Bill Croston Building.Contractor By Bill Croston Acceptance of of Proposal The above prices,specifications are satisfac e a at°hereby accepted.Y u are authorized to do the work as specified. Payment.will be madc.as outlined - N -' Date of Acceptance_•�� 'si'gnat �f License or registration valid for individual use only Offce of Consumer Affairs&Business Regul a before the expiration date. If found return to: HOME IMPROVEMENT-CONTRACTOR Office of Consumer Affairs and Business Regulation r Registration P, r 100023_ Type: 10 Park Plaza-Suite 5170 Expiration 6187201,8 DBA ` Boston,MA 02116 BILL CROSTON BUILD CONTRACTOR r- WILLIAM CROSTONr 155 SUOMI RD A t HYANNIS,MA 02601 —� Undersecretary Not valid without signature w Massachusetts Department of Public Safety 3�! Board of Building Regulations and Standards License: CS-014112 g F Construction Supervisor WILLIAM W CkOSTON JR 55 SUOMI RD HYANNIS MA 02601 nn II , Expiration: Commissioner 04/26/2018 . j rZ Lj J o t� 2 r P a G "6 '-1 1y t� ��` �, �� N J TPJWN OF BARNSTABLE BUILDING PERMIT APPLICATION — 1� Map V Parcel VG ARNSTABLE Application Health Division g _ `' #i Date Issued ,: Conservation Division Application Fee Planning Dept. Permit Fee ;rs'tffFr�i+,f1 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis pit ProjeetyStreet Address Villages . ���Y 1 Own�� M1 � �l r� Address Telephone--6P— /77S — 7-7 ,P_e tmirRequest`� 03 U'i 4,TxTLoxt . C ILL fii 5 , I'�r` rr�y� r�C Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay _ . P,coj c^ t Valuation ® Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing U new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) ' "e��s� "1 ��o ` �� �lelephone:Number3 1. /7- / ' 7l 3-� Address.,.3 �- S' , 7z ) License # C S "1 Q 3 t l l Z(� lie, U d y J^� Home Improvement Contractor# /6 V-! 3e Email `I A ✓SS �►� �Q Worker's Compensation # 7116 P/OO q ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO gvurp) e /1 vm Z ` . SIGNATURE 10ktt—f 7 o?l, (7 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED -MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL ,PLUMBING: ROUGH FINAL GAS: ROUGH FINAL . 'FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. wig C�rmmcynrea &f A&ssadirmettv '• � r��erzte�,� s15ia��tcc�tic�rrts . ` ;forte afbn-wz69at€O=- BaS&II,MA 02HI �4��vxuma-m ldia , Wtrkers CmmpsIIiiffi6ILIIISUrmc$A.fffdaPIb� {i@I51��5f f'r`frrr��nrlP �e� .N-arae' - -F 1� .� SGV'y►�GS `� Are as a Lployer?Meck.the apprap iafe bu .L[�"I a�a 1 -Pi fi 4_ ❑I a�a gaerai coaful for anc€I T 'of pra�ect(reqused�_ P � 6. New consfiaclioa • emplopees(fizTlandfofpatt-ffme�.* Ira�el�fhe suF��oa�a�s ❑ • .❑ I am a sale prc�gdtof arpartaes rLted nafhe attached sheet 'I- ❑Remode-hug s and have as I s Trees sub-corlrad�ors have �P ��. . . $ ❑Demolifiog w0diag,form=Manir g es emAopeaardhavewor !rre $ . - 3. 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E ME.IMPROVEM NT CONTRACTOR f R%Registratlon 1,6438 TYPe , { Expiration 7�23{2G18 Suppiemerit Card , z �I A R S SERVICES INC 'ARS RESTORATION 5PE ALlSTS i. # f. .; JASON FREITAS 1 38 CRAFT ST ii NEWTON,MA 02458 Uudersecre'tary l�r i is f i 1 I i Construction Supervisor Restrtctedao: " f Unrestricted-Buildings of.any use group which contain ..*I less than 35,000'pubic feet(991 cubic meters)of enclosed.space: - � Failure to possess a current edition';of the Massachusetts State Building Code,is cause for revocation of this license. . DP.S Licensing information visit:WWW;MASS.GOWDft . validfor individuai use onlg istration License or reg ala;ion before'-the expiration date. If found return to: v s er Affairs and Business Reg pff�ce of Consum �; y 10 ParkPlaza`�Suite S170 Boston, 116 MA:02 d.witl►out s►g store # ..,;:,...m-� _;:.._ _ n. . .,._ :. _�.._.�:,: __,�.,�.�, �..�.�:�..- � �--ter----.mod..•-.�.-,,..,.-,.�.. Main Level 13'7" 6 Bath Bedroom —9'3" 4' EBathroom Storage �., Clst Hall O° M 00 Bedroom 2 b Kitchen �o 7 1 , 9'8"- 1 F--6'4" 00 Living/Dining Room - 20' LN - 20'8" Main Level RCON-5EE 7/21/2017 Page: 5 I Operator: PBARTON Type of Estimate: <NONE> Date Entered: 7/21/2017 Date Assigned: Price List: MAB08X fUL17 Labor Efficiency: Restoration/Service/Remodel Estimate: RCON-5EE Grand Total Areas: 2,316.44 SF Walls 686.75 SF Ceiling 3,003.19 SF Walls and Ceiling 686.75 SF Floor 76.31 SY Flooring 288.50 LF Floor Perimeter 0.00 SF Long Wall 0.00 SF Short Wall 294.83 LF Ceil.Perimeter 686.75 Floor Area 755.78 Total Area 2,316.44 Interior Wall Area 1,032.00 Exterior Wall Area 114.67 Exterior Perimeter of Walls 0.00 Surface Area 0.00 Number of Squares 0.00 Total Perimeter Length 0.00 Total Ridge Length 0.00 Total Hip Length ii ARSSE-1 OP ID:SH CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDONYYY) 0619 6l2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND'CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS i CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND`OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. } IMPORTANT. If the certificate holder is an ADDITIONAL INSURED,the policy()es)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and condition's of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the 1 certificate holder in lieu of such endorsement(s). PRODUCER CO A Rodman Insurance Agency,Inc. NAME: 145 Rosemary St.,Bldg.A arc N :781-247-7800 FA IX Nc;781-444-0090 Needham,MA 02494-3238 E-MAIL t Evan Tobasky ADDRESS:. INSURER(S)AFFORDING COVERAGE NAIL I } I ER NSURER A:The Hartford#30104 INSURED AIRS Services Inc INsuRB:Beacon Mutual Insurance#24017 ARS Restoration Specialists 38 Crafts St j INSURERC: Newton,MA�02456 INSURER6: INSURER E': I INSURER F: i COVERAGES { CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD POLICY NUMBER MM/LDID EF MMILDIDrYYYY LIMITS COMMERCIAL GENERAL LIABILITY I 3 i EACH OCCURRENCE CLAIMSMADE ; OCCUR A A- 1 PREMISES Ea occurrence $ { ' MED EXP(Any one person) $ i PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ( GENERAL AGGREGATE $ POLICY❑JECO`f LOC PRODUCTS-COMPIOP AG $ OTHER- AUTOMOBILE LIABILITY i CON43INED SINGLE LIMIT $ 11( Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOSULED BODILY IN INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $HIRED AUTOS 1 AUTOS Par acc d=n i $ UMBRELLA LIAB I OCCUR EACH OCCURRENCE $ EXCESS LIAB I CLAIMS-MADE AGGREGATE $ DED RETENTION'S $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY i YIN g STATUTE ANY OFFICEOPRIETOR EXCLUUE�CUTIVE 0 NIA 7H684009(MA) 09/24/2016 09/24/2017 1 E.L.EACH ACCIDENT $ 1,000,000 B (Mandatory In NH) i 0000064630(RI 09/24/2016 09/24/2017 E.1:D15EASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS belrav E.L.DISEASE-POLICY LIMIT $ 1,000,00 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached''more space Is required) CT Work Comp w/The Hartford #9972M310 9/24/16-17 lmil/imil/imil PH Work Comp w/NCCII#NHARP300503 9/24/16-17 lmil/lmil/imil i { i f CERTIFICATE HOLDER I CANCELLATION ARS-- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ARS Services Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. dba ARS Restoration Specialists LLC 38 Crafts St i AUTHORIZED REPRESENTATIVE Newton,MA 02456 1 j O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) ( The ACORD name and logo are registered marks of ACORD i To Wn of Barnstable Regulatory Services M' Richard V.Scali,Director Building Division. Paul Roma,Bmldnag Commissioner 200 Mara Street,Hy�,MA 02601 ww w.town.barnstable.ma.us Office: 508-862-4,j-138 Fay 508-790-6230 = Property Owner Must Complete and Sign.This Section If Using A Builder Q- Z I V10 V - ,as Ownet of the subject ptop=ty hereby zrAmrize R S P.0► CPis V TC . to•act on my behA in 2R To2. tdatim to work authorized.by this budding pe=ffi application.fot: (Address o Job) **Pool fences mid alarms ase the tesponsibility of the applicant Pools ate not to be filed or utilized before fence is instaDed and all final inspections ate pedotmed and accepted. o Ckmer SLmt=e ofAppli� nmitry Z-klo 0 V11" f Print N AL P to q:FoxMs:ov��ooLs - . American Properties Team, Inc. June 16,2017 Mr. Paul Roma Building Commissioner 200 Main Street,Hyannis,MA. 02601 Re: Cape Crossroads Condominium,Units SEE&SEC Authorization for ARS Services to Perform Asbestos Abatement Dear Commissioner Roma: This letter is to confirm that Cape Crossroad Condominium Trust has hired ARS Services to perform all necessary asbestos abatement at The Cape Cross Roads Condominium located at 800 Bearses Way,Hyannis, MA in units SEE and SEC. Please accept my sincere apology the permit was not pulled in advanced. I was under the impression it was done. ARS has previously obtained the approvals from the Department of Environmental Protection(DEP) and is overseeing the project on behalf of the Trust. If you have any questions or concerns please do not hesitate to contact me directly at 781-258-7077., Sincerely, 4 Anthony Colletti,RPA,FMA,LEED Green Associate Portfolio Manager American Properties Team, Inc. As Agent for Cape Crossroads Condominium CC: Board of Trustees 600 WEST CUMMINGS PARK•SUITE 6050• WOB RN •MA U 01801.781-932-9229 -FAX 781-935-4289 i MLCHELE�CUi31.0$ PE. Consulting Sit ructuraI Engineer 123 Cottonwood Lane•Centerville,Massachusetts 026324919•(508)711-7601: mcu.dil.o@.comcas.t.net k f� Fk ( STRUCTURAL REPORT . CAPE CROSSROADS BUILDING S.UNIT SEE . 800 8EARSES WAY,HYANNIS,MA s . I t i FOR: Mr.,Peter Barton # ' ARS RESTORATION SPECIALISTS 110018 Townhouse Rd. 56._Yarmouth,MA t)2664. ,MICHELE WOO. SjFi0CTURAL m No 34"4 10, SSlONAL DATE:` DULY,2017 x 3 i i t e ICHELE CUDILO P.E. Consulting Structural Engineer 123 Cottonwood Lane•Centerville,Massachusetts 02632-1979 (508)771-7601•mcudilo@comcast.net July,2017 Mr. Peter Barton ARS RESTORATION SPECIALISTS f i. 110 Old Townhouse Rd. So,Yarmouth,MA 02664 ' { RE: STRUCTURAL REPORT CAPE.CROSSROADS=B.UILDING S UNIT SEE 800 BEARSES WAY,HYANNIS,MA Dear Mr.Barton, At your prior request,I met with your representative,Bill Reis.of ARS,at the above captioned_residential apartment on July 10,2017 for the purpose of addressing the structural integrity of one of the:building's iy residential wood framed building,in particular as related to the recent fire damage,which occurred after.the electrical fire in the top floor of the building ceiling wiring, The.purpose of this repor .is to list the structural:issues of concern with regard:to the observed conditions,especially as to Remedy.The purpose of this report is to list the structural issues of.concern with regard to the existing building: [: Architectural items and other issues are not covered herein. f°I 1.0 BackRround and Observations • The site fronts Bearses Way in Hyannis on.Cape Cod,MA,;and this building is set back; This site:is in an apartment complex f . - # with multiple buildings,within which are multiple.attached apartment units. This Unit in Building 5,Unit SEE,is in the op rig floor of a three story building. It faces the East,Le.Unit-SE East.' r It is understood that recently there was.an electrical fire in the roof trusses to the building.f The origin.was at the first and. ; second truss parallel to the left most concrete block demising wall,mid-way within the 3`d floor bedroom toward the east of the building.The trusses and ceiling strapping were charred. [See Photos and SIV following this report.] Of note is that the hree-story structure was constructed in 1974;prior to the 2008 building cotle changes for high wind construction: At the time of observation,the superstructure roof 1niss framing and bathroom partition wail;. were damaged by..a fire resulting from an:electrical fire. The damage.is confined to.-the upper unit only,and the two left roof bays at the:origin.of the fire in parttcular.. The. roof framing to the right side do not show effects. There.is some bathroom partition wall stud fire damage. [See . t SK's following this report.]` Continued STRUCTURALREPORT CAPE CROSSROADS BUILDING 5 UNIT SEE 800 BEARSES WAY,HYANNIS,MA Page 2 2.0 Wood Framed Superstructure The center of the Master Bedroom in the building truss bottom chord and diagonals were'impacted,and the fire 4 spread and impacted the adjacent bay,and did not spread.to the opposite side unit bay or exterior walls. This bay section of roof exhibits char through a portion the bottom truss chord and diagonal chord system;trusses span between exterior front wall and.a.demising rear wall. Repair requires removal and replacement of the charred sections between truss steel press plates of the bottom chord and diagonals between press plates only. The t' partition wall framing that was affected requires removal and replacement. The fire did not appear to penetrate the walls to lower floor levels. t f The framing consists of wood trusses,2x6@24"o/c top chords,with 2x4 bottom chord ceiling and diagonals,onto timber 2x4 bearing walls. The wood walls at the.right side of-:this area are in generally good condition. p, 3.0 Conclusions and Recommendations The above information provides you with the minimum requirements for maintenance of the structural integrity of # ` above captioned residential apartment structure,namely reconstruction of the wood framed superstructure truss, t bays indicated on the SK's.Consult with a licensed contractor,such as one you,may find in the Blue Book of Building and Construction,.is recommended to perform the scope of work to rebuild and repairthe superstructure } truss framing;the scope of work is.to repair the woad framing. I trust the content of this report meets your needs at this time.. Please do not hesitate to call should;there be any further question or need. i ,Sincere) t. Y I Michele Cudilo,P.E. /2017-174 1N OF MAg P . , MtCHELE ��cN CUDILO STRUCTURAL NO 34774" /STEp`���� k: 1 /pNAL I t ` { I i 7J18J17 1:51 PM Print Page ~=�fFrinta�►is-page • Owner Information -Map/Block/Lot: 294/0.61/ODY - Use Code: 10.20 Owner <:: MapBlock/Lot Ire De 294/061/ODY ZINOV,°DMITRY TR property Address PO BOX 2546 Owner Name as of 1/1/16 800 BEAR.SE.S WAY HYANNIS.,MA.02601 Co-Owner Name . MIHANAZ REALTY TRUST Village: Hyannis Town Sewer.At Address: Yes GIS Zoning`.Value: SPLMHB. _. . o Assessed Values 2017 - Map/Block/Lot: 294/061/ODY Use Code: 1020 2017.Appraised Value 2017 Assessed Value Past Comparisons Building Value: " $"81-,900 7t81,900 °- 'ear` Asse, ed-Value Extra Features $ 0 $.O 2016 - $ 81,900 Outbuildings: $ 0 $0 2015 - $70;200` - Land Value: $ 0 $ 0 2014 - $70,200 $ 819�00 2013 $ 82000 2012 -:$ 85,600 2011 - $ 114,100 2017 Totals $8 i 00 1010- $ 116,800 .. ., 2009 - $ 150,100 $ 165,000 2007 - $ 175;OOOa o Tax Information 2017 Map/Block/I;ot; 294 1061i ODY'- Use Code: 1020 x Taxes Hyannis FD Tax (Residential) >$ 20066 Community Preservation Act tax: $ 23.44 http://www.townofbarnstable.us/Assessingiprintl7.asp?ip-O&searchparcei=2940610DY Page l of Prlr►i Page 7/18/ 7 1:51 PM Town Tax ltesdental) 343 Fiscal Fear 2017 o Sales History- Map/Block/Lot: 294/061/ODY - Use Code: 1020 History: Owner: Sale Date Book/Page: Sale Price: _ ZINOV,DMITRY TR 2010-04-20 C33-5EE $80000 EQUITY TRUST COMPANY TR 2008-02-26 C33-5EE , $90000 BANK OF NEW YORK TRUST COMPANY 2008-02-07 C33-5EE $140250 SILVA,EDNA R 2003-11-21 C33-5EE $1 SILVA,EDNA R &PEREIRA,CLAYTON D 2001-06-05 C33-5EE $94900 PARKER,TINA M 1999-06-01 C33-5EE $61900 PATTERSON,JAMES L 1989-05-15 C33-50 $0 PATTERSON,JAMES L & C33-50 $0 e Photos 294!061/ODY Use Code: 1020 There are not any photos for this parcel e Sketches- MapBlock/Lot::294/061/ODY- Use Code: 1020 i' As-Built Card N/A o Constructions Details- Map/Block/Lot 294/061/ODY Use Code: 1020 http://www.townofbarnstable.us/AssessingJprintI7.asp?ap=0&searchparcel=29406100Y Page 2 of 4 Prik Page 7/18/17 1:51 PM Building Details Land Building value $81,900 Bedrooms 2 Bedrooms USE CODE 1020 Replacement Cost. $102,324 Bathrooms 2 Full-0 Half Lot Size (Acres) 0 Model Res Condo Total Rooms 4 Rooms Appraised Value $ 0 Style Condominium. Heat Fuel Electric Assessed Value $0 Grade Average Heat Type Elec Baseboard 4 Year Built 1974 AC Type. None Effective depreciation 20 Interior Floors Carpet Stories 1 Story Interior Walls :Drywall Living Area sq/ft 845 Exterior Walls Vinyl Siding Gross Area sq/ft 845 Roof Structure Gable/1-1ip Roof Cover Asph/F Gls/Cmp o Outbuildings.& Extra Features- Map/Block/Lot: 294/061/0DY•Use Code: 1020 There are not any extra:building features on record at this time. _.. © Sketch Legend Property Sketch.Legend B2N Barn-any:2nd story area FPC. OPen Porch Concrete Floor REF Reference Only BAS First Floor, Living Area FTS Third Story Living Area(Finished) SOL Solarium BMT Basement Area(Unfinished), FUS Second Ztorv.Living Area(Finished)SPE Pool Enclosure BRN Barn GAR Garage TO$ Three Quarters Story(Finished) CAN Canopy GAZ Gazebo. UAT Attic Area:(Unfinished) CLP Loading Platform GRIN Greenhouse UHS -Half Story_(Unfinished) FAT Attic Area(Finished) GXT Garage Extension Front. UST Utility Area(Unfinished) FCP Carport KEN, Kennel. UTQ Three Quarters Story (Unfinished) FEP Enclosed Porch MZ1 Mezzanine, Unfinished UUA Unfinished Utility;Attic FHS Half Story(Finished)- PRG. Pergola UUS Full Upper;2nd Story (Unfinished) FOP Open ed) x: or Screened in Porch PRT Portico WpK Wood Deck PTO Patio Microsoft VBScript runtime error'800a01a8' http://www.townofbarnstable.us/Assessing/print17.asp?ap=0&searchparcel-29406100Y Page 3 of 4 OF Mil Sgcy o MiCNEL GN CUDiL o StRUCTUI ALbffi No 347 4 o Q 9ForstE -41 I D U - v: 3 �t Al" � ktZ- Zit SS off=►� =T`tp�tts 'I" - tZ-p tom: : = .� ..� y $ r s �� n - k w Y' REPAIRS TO UNIT 5EE MICHELE ;Ct1DIL0, P.E. Ca`nsutting Structural En sneer BUILDING 5 cememita-Messachusatte 0202 197g sas rnasol Drawn By: MC Date: 01/18/17 800 BEARSES SPAY ' - D-Y'awlllg- Scale: AS .NOTED Rev. 0 HYANNIS, MA S K- 10 0 File NameiARS Project No.2017-17 i aS`�iAM vu 0E $N4CKW � .... h - Y ��apf MASSq�,yG UFO N o SOU �ZA v 1.90 4Q JL �sstot�a/t� Q _ REPAIRS TO UNIT :5EE MCHELE CUDILO, P.E. Consuitif Structurbi En ineer z BUILDING. 5 CenteKiue, Massachusetts0as32-1979 500 771= 501 1 raven By. MC Date: 07/18/17 800 BEARSES WAY s D `aWI�1: le; =AS NOTM Rev. 0 HYAINNIS, MA S K- 1. f File Noma.ARS Project No.2017-t kJi� ."7russ TEST ��Ttvss T i h f t - l'IRE, MOD.QUEEN ; i 'Job Reference fontwWll "Urilveise%C«nponeru com.,eie,�tcrd,cr.o6aos;neanc vasywe _.___._._ _ 8.010 a aa�r 2016 MMek Industries,tncnc'.Wed 3w 19,1 MQ6 eon Pa4e lb:DbS4Wb5H651ZZ3g9VOjfMRzZnTk-pLysGrh6RvjM311UWr1ZVU5UgVgM2BOT'?OCL OZR 84-3 r3411-7 3&S13 - - � Scala=1:77A ` 6x8 4.00 12 a 40 { 4 4x4 8x8 U- 6x8 2 .--' �- .. 6 Wa W6 W4 r t W3� .: W3 -w1 f1L . .` 1 T7 ` W,1 Tx -�V� • � 4x6 __.. 14 1316 12 k17 11 � 18 10 19 9� � �. g 4x6 44 3x6- 34=' 3x8- 3x8 w 3x8 3x6=% 4x4 2398 360 3T-1fii 2348 2 3A8.10 43-4-0 4&50-0 Plate-Offs®ts(X,Y [7 0 2 6 Ed9el i 81 (6:0-0-0 0 4 8]•[7 0 2.6Ed9a1 LOADING{psi} t SPACING- 2-0-0 cS1. j DEFL. In (loc) Well Udµy PLATES GRIP , TCLL 25.0 Plate Grip DOL 1.15 TC 0.44 Vert(LL) -0.30 11-14 >814 240 l MT20• : 1471144 TCDL . 10.0 Lumber DOl 1.15 BC 0.78 Vert(7L) 0.651'I-14 >371 180 SCLL 0.0 ' Rep Stress Incr YES WB 0.84 Horz(TL) 0.02 8 rds nla BCDL�$10.0��" m Code IRC20061TP12002 a Matnx R_ j Weight 209lb FT=0% LUMBER- BRACING- TOP CHORD 2x6 SPF No.2 TOP CHORD Structural wood sheathing dlMcxfy.appfied or 6A-0 oc purtins. BOT CHORD 20 SPF No.2 BOT CHORD Rigid ceiling directly applied or 6-0-0 oc bracing, WEBS 2x4 SPF`No.2 WEBS., 1 Row at mldpt 3-11,4-11,5-11 f MTek recommends that Stabilizers and reguired cross bracing be. installed during truss erectlon in accordance.wittv Stabtzzei 0, REACTIONS. All bearings 0-3-8 except(jt=length).11=0-44(input 038);19=0.4-a(Input:0-3-8). (tb)- Max Horc15=78(LC 3) Max Uplift:Alt uplift 100 lb or less at joints)11 except 15=-126(LC 3).8=-143(LC 4) ,r OF MBA Max Grav Afi reactions 250 ib or less at joints)except 11=2708(LC 1),11=2708(Lq 1),15=977(LC 9), 8=977(LC 10) a� t � c+N FORCES. (lb)-Max.ComplMax.Ten.-All forces 250(lb)or less except when shown.TOP CHORD M �( F,P� OT CHORD 1 15=-60612246,14 698R44 13-14=-288/4 76,13.6t—881 76,112-6-2881176, 12-17=2881176,11-17=-288/176,11-18=288/176;10 18=28f3lfi76,1( 19=288/176;. 9-19=-2881176,8-9=501744,18=6061945 ,o AE(#t51�Q WEBS. 2-14=-3641151,3-10,01614,3-11=-1039H59,4-11-1155/106;5-11=-1039/155, 5.9=01614 6.9=3641143,2-15=•1558f308,6-8 -15581342 NOTES- 1)Unbalanced roof live toads havebeen considered for this design. - l 2)Wind:ASCE 7-05;90mph;TCDL=BApsf BCDL=6.0*,h=25it;.Cat.11;Exp;B;enclosed.MWfRS to rise)gable end zone.canttiavecfeR and right exposed;end vertical left and righ(':axposed;';Lumber DOL=1.33'p4te grip 001-0.33 3)This truss has been designed fora 16.0 psf boftom chord five load nonconrwrrent With any other live loads. 4) This truss:has been designed for:a live bad of 20.Opsf on the bottom chord in all areas where a_rectangle:3 6 0 tail by 1 0 0 wife will fit between the bottom chord and arty other members;with BCDL=ii!14 9. 5)WARNING;:Required bearing size at joint(s)11,11 greater thin input bearing size:. 6)Provide mechanical connection(by others).of truss to bearing plate capable of withstanding 100lb uplift at joint(s)11 except(jt=1b)15=125; 8=143. 7)This truss:is designed in accordance with the 2006 International Residential Cade sections R502.11.land R802;10 2 and referenced standard:ANSIlTPl1. ( ; LOAD CASE(S) .); 1)Dead+Roof Live(balanced)+lJriinhab.Attic Storage;Lumber increase=115,Plate Increase=l.1 S Uniform Loads(plfj Vert:1-16=20.16.17=.60,17A8=20,18;19--60,7-19-r20.1-0-70,4-7=-70 .: 2)Dead+Uninhabitablb Attic Without Storage:Lurtiber Increase=125,Plate Increase=l 25 Uniform Loads(pif) Vert.1-7=•40,1-4-20,4.7=-20 Continued on page 2 4 tL {1 SS0 r I V. Symbols Numbering System General Safety Notes PLATE LOCATION.AND ORIENTATION " Center plaid on joint unless x;y 6.4-8 dimensions shown to ft-in-sixteenths Failure to Follow Could Cause Property —► 4 (Drawings not to scale) offsdts are.indicated. � Damage or Personal Injury Dimensions are in ft-in-sixteenths. Apply plates to both sides of truss 1 2 3 1: Additional stability tracing for was system,e.g. and fully embed teeth. diagonal or X-bracing,is always required. see BCSI. - TOP CHORDS - �. c+ C24 2. Truss bracing must be designed by an engineer.For 4 wide truss spacing,Individual lateral braces themselves WEBS Sx, may require bracing,or attemstive Tor I v y plz n9 bracing should be considered. ' 0 •+ 0 3. Never exceed the design load! shown and never O: U stack materials on inadequately braced trusses. p 4. Provide copies of this truss design to the building For 4 x 2 orientation,locate BOTTOM CHORDS designer, ther erection supervisor, per s� petty owner and plates Q- Nil from outside. edge of truss. 8 7 6 5 5. Cut members to bear lightly against each other. 8. Place.plates on each face of truss at each This symbol indicates the JOINTS ARE GENERALLY NUMBERED/LETTERED CLOCKWISE joint and embed fully.Knots and wane at joint requirdd direction of slots in AROUND THE TRUSS STARTING AT THE JOINT FARTHEST TO toeauons are regulated by ANs1/rPl 1. connector _!ales; THE LEFT. P 7. Design assumes hisses will be suitably protected from 'Plaid location deta)Is available in MiTek 20/20 CHORDS'AND WEBS AREtDENTiFIED 13Y END JOINT the environment In accord with ANSMI 1 software or upon request. NUMBERSlLETTERS. 8. Unless otherwise noted,moisture content of lumber shall not exceed 19%at time of fabrication: PRODUCT CODE APPROVALS 9. Unless expressly noted,Oft design Is not applicable for PLATE SIZE IGC-ES Reports: use with fire retardant.preservative treated,or green lumber. The first dimension is the plate 10.Camber is a non-stnidural.consideration and is the A width measured perpendicular ESR-1311 ES11-1352,ESR1988 responsibility of truss fabricator.General practice is to X.4 to slots.Second dimension is ER-390T,ESR-2362,ESR=1397,ESR-3282 camber for dead load deflection. the length parallel to slots. i 1,Plate type,size,odentatlgn and location dimensions indicated are minimum plating requiiements. LATERAL BRACING LOCATION 12:lumber used shop be of the species and size,and in all respects,equal to or better than that Ili dicated by symbol:shown and/or Trusses are designed for wind.loads in the plane of the specified. by text in the bracing section of the truss unless otherwise shown. 13.Top chords must be sheathed or purlins provided at output. Use T Or 1 bracing spacing indicated on design. if Indicated.. Lumber design values are in accordance with ANSl/TPi t 1a 9ottom chords require lateral bracing at 10 ft.spacing.SeCtidrl 8,3 These';ittlss designs rely an lumber values or less,tt no ceiling is installed,urdess otherwise noted. BEARING established by others. 15.Connections not shown are the responsibility of others. Indicates location where bearings 15.Oo not out or alter truss member or plate without prior (supports)occur. icons vary but I reaction section Indicates joint 0 2012 MTeW All Rights Reserved approve of an engineer: number where bearings 0�66r. 17.install and load vertically unless indicated otherwiso. Min size shown is'for crushing only. 18,Use of green or treated lumber may pose unacceptable environmental,health or performance risks.Consult with Industry Standards: project engineer before use. ANSI1TPi1: National Design Specification for Metal 19.Review all portions of this design(front,back,words Plate Connected.Wood Truss Construction. and pictures)before use.Reviewing pictures alone DSB-89: Standard for.Bracing. - b not sufficient. 'D Design e t i SCSI: Building Component Safe Information, B p 20.Design assumes manufacture In accordance with Guide to Good Practice for Handling. ANSIfrPi I duality criteria. Installing$Bracing of Metal Plate Connected Wood Trusses. MiTek Engineering Reference sheet MII4473 rev.101OY2015 I 7 Town Of Barnstable RECEIPT A 200 Main Street, Hyannis MA 02601 508-862-4038 6'""�`R Application for Building Permit PP g Application No: TB-17-1963 Date Recieved: 6/21/2017 Job Location: 800 UNIT 5EE BEARSE'S WAY,HYANNIS Permit For: Building-Alteration INTERIOR Work Only-Commercial Contractor's Name: JASON R FREITAS State Lic. No: CS-103111 Address: Taunton,-MA 02780 Applicant Phone: (Home)Owner's Name: ZINOV,DMITRY TR Phone: (Home)Owner's Address: PO BOX 2546, HYANNIS,MA 02601 Work Description: Drywall demolition,200 sf ceiling . Total Value Of Work To Be Performed: $11,712.00 Structure Size: 0.00 0.00 0.00 Width Depth Total Area I hereby swear and attest that I will require proof of workers'compensation insurance for every contractor,subcontractor,or other worker before 'he/she engages in work on the above property in accordance with the Workers' Compensation Act(Chapter 568). I understand that pursuant to 31-275 C.G.S.,officers of a corporation and partners in a partnership may elect to be excluded from coverage by filing a waiver with the appropriate District Office;and that a sole proprietor of a business is not required to have coverage unless he files his intent to accept coverage. I hereby certify that I am the owner of the property which is the subject of this application or the authorized agent of the property owner and have been authorized to make this application. I understand that when a permit is issued,it is a permit to proceed and grants no right to violate the Massachusetts State Building Code or any other code,ordinance or statute,regardless of what might be shown or omitted on the submitted plans and specifications. All information contained within is true and accurate to the best of my knowledge and belief. All permits approved are subject to inspections performed by a representative of this office. Requests for inspections must be made at least 24 hours in advance. Signed: JASON R FREITAS 6/21/2017 Applicant Date Telephone No. Estimated Construction Costs/Permit Fees Total Project Cost: $11,712.00 Date Paid Amount Paid Check#or CC# Pay Type Total Permit Fee: $206.58 6/21/2017 $206.58 Cash 1..............._. ......................-__..................... ......... ._....... Total Permit Fee Paid: $206.58 .J TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map � CI D ParcelOL)y T(°,����:.� OF �R�,R�j�')iAlEApplication # Health Division Date Issued IS 7 Conservation Division Application Fee c! Planning Dept. Permit Fee 0� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street{{Address C GA 2SE� UDAY H Village OwnerGw�6Address ON LT- EE �} ter-' Permit Request t -17 -r .S l:Qd r' `7 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay _Project Valuation 11 710 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ,❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use - — -- APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name AEf3SQ-" ( IncTelephone Number S(0,:�a Address ( 0 d Te License # � r'1 S PA Homee lmpro7�en1 Contractor# D(0 I"1 Email D Worker's Compensation # 7 � LGtdQ� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE C,Aa 19 FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER All DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL j FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. r _ NJjr oQ Cv El ❑ p� " p � n T bdo Kn PA zb �+ ki- ON ormation a)EI Baal I;ales ofh , pmsaa to this Sttnin,as=ElFayr=is defined as¢. YP��m$�e srav�cc of �� esPtess ar i=2lieC%oral orvuit� POIB"On n CM ofher Iegal entity,or ay two°�[mcnr eris ddned as saainal,Pig e4 or the Aa r =agedin.a3ai:d dives ofa decEas p $� office of as ink Pam.�o�—or affi=Igal may, g o afti�c- x areti2aMtbI=ap��andvho x�sidas e bansc.bayingaotm - ®. d�ffnghocs owner ofa.d�eITmg ,a atrvr� g Tense of and�er��ys P��to do ma�•�, � �F �ie�eto dnnx ntb=m=of Mch en&ym= the d=medt3 be ao.�aploY • or on.fhe gra�d�ar bM7dm9 . s a±0 ar Iocal Ti=Ldnff a=Cy shaRW!fhha a ffie issaaucc�or MG`L r�ptec L52,§25g6)also sfatts f Et h,tiic earmo.o-nfealth for any reQ�aj of a jf=n=or pe rM o in oP�e a hgsmess or to constmIt LM co Pottage retjo n ed-" applicaat�Iio has�not'prDcluced acceptable evil=ce of cnncPTzancevPi Z poIifiir l sab isians shall ri-,tionallsrY.MGI.chagt=L52,§25CM states-ffeithmf r, -nwmaM of ii43iemsm��•, eft into any cone t$ep o�nbfia�eaairmubZ accrptable eyid�ace �Of rhap(Pa hays T�ee�piese�ed fn the a a�omty-'_ - AI,PIiEcan-[s ' _ gaeba=�applyt7DYDUrsitnai ate,i Please frII a at Elie�ozl�s'come nn ai davit come Y.by �b�{) ong thc"ir��s)of _ �, �,,,L�s)name(s),address( ) Ph= s al no otbe[f3�iiie necessary s�PIY Lia7?i]tEymmes(LIiC)ar 1iinds.")with no �bce. Lmmt to�y��,�ensaf=a=m1= ffijTrCarF.I.P doeshaQe ins P arenot " be saw err tTicDcpaL-bnent of Tndnstiial y a oIi is Be advisedtbatfl¢saY¢�Y andda-f3-the�davit. aslioald Aceide�s far oo�m ofinsar- � - Also a sore to sig�x notthe Dearfineaf of be rein is r$e czfy or tnvvnthd fiie appbcatina far ff=p�or license is being r ues', to obiaia a.v ullc[s' T�e �rA - Shonldyonbavz any gnnst�.ans gihe Iavt orifycu an: - rmrrp®saffan.Porrcy,P e caIlt DePatimeotatfh.L=b=Iis�bejovT �rif msat yes should r�`ntt3�eir s eIf-iIIsm T.tcnasc nOmb=on the aFF� line City ar Tnvva - - jeg�fy_ 'I7ieDe�admeniha•SPL°��asgaceaf;f3�botimn mtjc= Please be smc the wit is eample#c andpt - has to cotdactyoa� tho applicant cfthr-affida�ffir yov.in ja ar3t intbo evr�ttbe Office bctsed as a �Mimbcc 7n addition,an aFP Pl=se•bcsorclnffiImthcpc�itllicease�beT _� Y� � mama$davit � t�must=±aZ jL mvi2iple p�icaase ap=-Tobrons �aIL Iocatiu-ns m__(�y or p olicv j]: a ti m C¢nax&atg)and nndcd`doh t ki ss the sLt ctl be vidcd to the - . ed�camada:dbYtjie city artnvznmaY PrO or fivsc A nv affida4it�sst be f1Iled ant each town)='A copy of-[he•atTdavitt�has bra offi - s� �ereia].�z • applicant as_prooftbat a valid affidavit is on file far f:tne p year.'Whe�e ahnmeownet or is obfaiamg aliceasc orpr.�¢notre7aird a LybD:s�m=Or �ie.a dng lirxase'orp�¢t o bmn 1=7y s ei--)s-dd pew jg XOT x���t O °cmP veoIIldl�toi�kym-aa&==foryu rcoapedionaod'-sbavldgonbavzaaY4 � 'ITic O$�e afTnv��s • please do nothrsda�b givm-M a call- Tbr-Dr-pEctn=i's adft=s�tt-jcphone and fmMz3lbc= Fag a'-7T-' �tHE Town of Barnstable Regulatory Services Richard V.Scab,Director 1 M Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Usinsr A Builder I, re,HA -7- r t O V ,as Owner of the subject property hereby authorize c kxy l C_,Q_ to act on my behalf, . in all matters relative to work authorized by this building pertnit application for: (Address of Job) *'Pool fences and nlamns are the responsibility of the applicant Pools are not to b ed or utilized before £ is ins ed and all final ins perfomded and acc [Signature o er Signature of Applicant —��'�V ESE•�:� 2 Pnrit Name Print Name Date Q:F0RMS:0V9MPM0SI0N?00I S ARSSE-1 OP ID:SH ,a►�O" CERTIFICATE OF LIABILITY INSURANCE DAT 06N 612 11612 Y017 7 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 pollcy(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 Ileu of such endorsement(s). PRODUCER NAME Rodman Insurance Agency,Inc. PHONE 781-247-7800 145 Rosemary St.,Bldg.A AIC No E Arc Noy 781-444-0090 Needham,MA 02494-3238 Fz hMAIL Evan Tobasky ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC i INSURER A:The Hartford#30104 INSURED ARS Services Inc INSURERB:BeaconMutualInsurance#24017 ARS Restoration Specialists 38 Crafts St INSURER C Newton,MA 02456 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MMIODIYYYY LIMA COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS MADE OCCUR DAMAGE TO RENTEIY PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO- JECT LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per..:dent $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED i RETENTION$ $ WORKERS COMPENSATION X STATUTE ER F� PER 77TH- AND EMPLOYERS'LIABILITY A ANY PROPRIEfORIPARTNERICUTIVE YIN 7H684009(MA) 09/24/2016 09/24/2017 E.L.EACH ACCIDENT $ 1,000,00 OFFICERIMEMBER EXCLUDED? ® N I A B (Mandatory in NH) 0000064630(RI 09/24/2016 09/24/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,00 It yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CT Work Comp w/The Hartford #9972M310 9/24/16-17 lmil/lmil/lmil NH Work Comp w/NCCI #NHARP300503 9/24/16-17 lmil/lmil/lmil CERTIFICATE HOLDER CANCELLATION ARS-- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ARS Services Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN dba ARS Restoration ACCORDANCE WITH THE POLICY PROVISIONS. Specialists LLC AUTHORIZED REPRESENTATIVE 38 Crafts St Newton,MA 02456 ae6 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD + 9 ARSSERV-02 CWOObSIDE '4�i [7" CERTIFICATE OF LIABILITY INSURANCE DAT12212DIY6 9I2212016 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 BYTHEPOLICIES 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(les)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 IIBU of such endorsements. PRODUCER License#1780862 NAcr NAME,COr Paul Ruozzi _ HUB International New England PHONE' 781 792-3285 T 600 Longwater Drive -tA�AAIL " t ) tAJC Nu): Norwell,MA 02061.9146 ADDRE — u aooRess:pawl.ruozzi@hubinkernationai,com kRR _ INSVRER(S)AFFORDING COVERAGE NAIC 0 _ INSURER A;Nautilus Insurance Company 17370 INSURED INSURERB;Commerce Insurance Company 34754 A.R.S.Services,Inc, INSURERC;Hartford Fire Insurance Company 19682 38 Crafts Street INSURER D: Newton,MA 02468 INSURERE; _ INS UHER P: Y....- �.. J.� COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OP INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, INSR PCLICYEFF POLICY I-TR TYPE OFINSURANCE INSD D POLICYNUMBER MAIIDDIYYYY MMMIUYYYY LIMITS A X COMMERCIAL GENERALLIA13U.ITY EACHOCCURRENCE_ $ 2,000,000 cwMs MADE OCCUR X X ECP0153768716 0912412016 0912412017 s' p, noe S 100,000 X BIIPD Ded;$10,000 - _MEU EXP An one Qerson) S 5,000 X PDIIUtiOn Liab CPL _ PERSONAL&ADVfNJURY 3 2,000,OOD GEN'LAGGREGATE LIMrr APPLIES PER; GENERALAGGREGATE S 2,000,0() POLICY(]JECT 1:1I.00 PRODUCTS-COMPIOPAGG $ _ 2,000,000 OTHER: AUTOMOER.ELIA°lt1TY D EDS G LIMIT Eaaccldent $ 1,D00,00 13 X ANYAUTO X X 15MMC13GBJWM 09124/2016 09124/2017 BODILY INJURY(Per person) S X A HIREDAUTOS LLOWNED _ ASV SCHEDULED BODILY INJURY(Per aaldenl) $ NON-OWNED X X AUTOS PenaoEefde DAMAGE 3 S X UMBRELLALIAB X OCCUR EACH OCCURRENCE _ $ 6,000,000 AEXCESS LIAR CIAIMS-MADE X X FFX163788816 09/24/2016 09/2412017 AGGREGATE - S 610001000 DED I I RETENTION$ WORKERS COMPENSATION - PER OTH- ANDEMPLOYERS'LIABILITY YIN ST/1TUTE ER ANY PROPRIETORIPARTNEWEX[CUTIVE E.L.EACH ACCIDENT S OFFICERIMEMBER EXCLUDED? NIA .-.-..- (Mandatory inNH) E.L.DISEASE-EA EMPLOYE S If yes,dascAbo under ...-.,- - DESCRIPTION OFOPE RATIONS below _ E.L.DISEASE-POLICY LIMIT S C Property(Ballment) DBUUMR06539 09/24/2016 09124/2017 $959,000 Blanket DESCRIPTION OF OPERATIONS LOCATIONS/VEHICLES(ACORD 161,Addpinnal Remal$s Schedute,maybe attached if more spaaels required) f CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE A.R.S.Services,Inc THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN (Evidence of Coverage Only) ACCORDANCE WITH THE POLICY PROVISIONS. 38 Crafts Street Newton,MA 02458 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 00141011 Thxi a nr)t?n n�mo—i L—Oro. laf—A—1—,.s A rnorT s C� C� c ' I p. ;j Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS403111 Construction Supervisor 3 JASON R FREITAS 5 MC INTOSH DRIVE, c' y TAUNTON MA 02780 ' Expiration " Commissioner 05l13/2018 ,. ,y�,� Elie su aC�/�creorrcdetb `r ice of:Consumee AtTa�rsi&.Business Regulation ME.IMPROVE MENT CONTRACTOR Registration 06438TYpe Ezpir t�9n (231O�B Supplement Ca A R S'SERVICE8"IN `ARS RESTORATIOtJSREGt LI JASON"FREITAS CRAFT ST NEWTOK MA 02458 Uudersecretprg . a .5 1 E Construction Supervisor Restricted to: ! Unrestricted-Buildings of any use group which:contain less than 35,000 cubic feet(901 cubic meters)of f enclosed space. i of g Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS.Licensing.informationvisit:WWW;MASS.GOV/DPS ense or registration al' tf found return to.only l L'c rcat�on date latiorr tiefore the 0 usiness Regu _. Office of Consumer Af{airs and B i .10 YArk�laza>-Suite 5170 Mp 02116 , Boston, - � - i lid*without sag attire; I American Properties Team, Inc. oa 0 June 16,2017 Mr. Paul Roma Building Commissioner 200 Main Street,Hyannis,MA. 02601 Re: Cape Crossroads Condominium,Units SEE&SEC Authorization for ARS Services to Perform Asbestos Abatement Dear Commissioner Roma: This letter is to confirm that Cape Crossroad Condominium Trust has hired ARS Services to perform all necessary asbestos abatement at The Cape Cross Roads Condominium located at 800 Bearses Way, Hyannis, MA in units SEE and SEC. Please accept my sincere apology the permit was not pulled in advanced. I was under the impression it was done. ARS has previously obtained the approvals from the Department of Environmental Protection(DEP) and is overseeing the project on behalf of the Trust. If you have any questions or concerns please do not hesitate to contact me directly at 781-258-7077. Sincerely, Anthony Colletti,RPA, FMA,LEED Green Associate Portfolio Manager American Properties Team,Inc. As Agent for Cape Crossroads Condominium CC: Board of Trustees 500 WEST CUMMINGS PARK•SUITE 6050• WOBURN •MA •01801.781-932-9229 •FAX 781-935-4289 f iM a i g C0NSULT1` fG April.7,2017 i Mr.Peter Barton ARS Restoration Specialists t 14 0 Old Town House Road t South Yarmouth,Massachusetts 02664 } Subject: Asbestos Sampling Report i 800 Beai ses'Way ` t Unit 5EE i Hyannis,Massachusetts 02601 s Hillmann ProjectNo. M34020 Dear Mr. Barton: The ose of this letter is to present the laboratory results of.the as bulk sampling conducted by Hillmahti Consulting,LLB(Mllmann) at the above-referenced location. Mr. Jef rey Bedard of Hillmann(MA license A1900673 2) conducted a site inspection.on April 4, 2017. The purpose of. the visit was to collect samples of suspect asbestos containing materi l s that were impacted by afire. The suspect asbestos samples were collected from the Bedroom Ceiling of Unit 5EE. A copy of Mr.Bedar&s credentials is attached. j As--bestps E The following suspect asbestos containing materials(AGMs)were identified and sampled: ® White Popcorn'Ceiling Coating(2%,Chrysotile,.Bedroom) A total` of three (3) suspect asbestos bulk samples were collected. The samples were transported under proper chain of custody to Hillmann�Consulting;LLC laboratory in Union, New Jersey (Iv1A Licenser A_A000183). The method of analysis was Polarized Light Microscopy (PLM) with dispersion .staining,. as recommended by the United States Environmental Protection Agency (USEPA). Materials having asbestos concentrations greater than or equal to one percent (> 1%) are considered by the USEPA to be asbestos- contatnihb materials. Sample results are as follows . The White Popcorn Ceiling Coating was determined to contain asbestos. (2°10 Chrysotile,approximately 150.SF of in the B droom of Unit 5EE), i Your Prc� e ty. fur a-to it�7 F.\riddlesle.Turnjiike,-Midmg'A,Suite lla0$edrord Maachusrtts0t SO(•Pij 3Y ,r�S:Fae(.>,7 5 .4`7ffi.Qfficc lggatEuns.1_+v 1_,act:;(,crpcarute.flea)irta 1°nrk,Virymtu,.C'eu n+yli v ia,i lortlt C:arolira,(al:rornia LnginezringDioi;:ion:her.frrme+• �;�•sv.�-tilirla�n�onsulrin .com ti Y s L' { t Hillmann ConsultingLLC I l � E The biilk sample results are attached.to this letter. As the,asbestos containirig White Popcorn Ceiling;Compound is physically adhered to the ceiling wallboard,both components are considered Lobe asbestos containing. Removal of the ACM as recommended if this area is to be disturbed by future renovation and should be removed by a.licensed asbestos abatement contractor rn accordance with.all federal, state and local laws governing g b asbestos. This will require a ten day notification to the.Massachusetts Department of Environmental Protection (MassDER) :by .the abatement contractor.. Third party oversight and.air quality monitoring are also required. If additional impacted suspect AGMs are discovered°during renovations for which there are no sample documentation/results.Hillmann recommetcis additional sampling, E. Results:of this inspection.should not be extrapolated to other uninspected areas or materials. 1 f If you have any questions or require further information,_please contact the.undersigned at 781-533-:7758. g I Sincerely, Hilisnann Consulting,,Ir LC i Jeffrey Bedard ��• .: . r= . harry Rockefeller, C1H Environmental Scientist Regional Manager } Attachments: Inspector Credentials;Photograpwc,Docurnentahoi; Laboratory Analytical Report i 4 i i S i f asbestos Sampling Repo 1 2 F M3-1020 ARS—800 Bear ses JVgy, Unit,5•EE, Hyannis, Massa0huset.a w` a�oer �� ��ro a�� � -•fit � � � ` � �v j �s. or ,a=;� ct � �• o Lu c3 o gCIL y Hillniann Consultingac Photographlic Documentation ( E �t f (r♦ jai ry $ ': ?b- `°: 't s 4 a -.V-as '� � •� +��.: �,. .; ae,., =tir s . View of fire damaged ceiling In the bedroom of Unit SEE with asbestos containing Popcorn Ceiling Coat-n 2%C ,White g( hrysotile approximately 150 SF) i 4 t , asbestos.Sampling Report. ARS 806 Bearres WaY, Unit 5EE,Hyannis. Massaelauskts 1�13 40?© r � z i Date of Sampling: f 04/0412017 Job#: M3 4020 Date of Sample Receipt: 041051201-7 Order#: 041.7049 b.��g . Client: AR5 RESTORATION SPECIALISTS 4 110 OLD TOWNHOUSE ROAD SOUTH YARMOUTH,MA 02664 3 HILLMANN CONSULTING,L.L.C. j ENVIRONMENTAL CONSULTING,LAB SERVICES Attn: PETER BARTON a 1600 ROUTE 22 EAST Location: 800 BEARSES WAY/HYANNIS/MA P.O.BOX 1597 UNION,NEW JERSEY 07083=1597 PHONE:(908)688-7800 FAX:(908).686-2636 Field Technician: Jeffrey Bedard x www.hilimannconsulting.com Date of Analysis: 04/05/2017 t s: Date of issue: '04/05/2017 BULK SAMPLE CERTIFICATE OF ANALYSIS Staining ;ethod: EPA/60(3/�ri4-82-d20 per 40GFR PLMI;with Dispersion Staining Asbestos f Asbestos Non-Asbestos LAB ID# Location Detected? ` Constituerrts Conslituerrts Sample Description (Yes/No)I VV201262 01/Bedroom/Ceiling^ Popcorn Ceiling,Homogeneous Yes YChrysotile 2% __-- o I _s Non-Fibrous.Material 981a W201263 02/Bedroom/Ceiling Popcom Ceilin i Homogeneous � °g o9 Yes rcChrysotile 2/° Non-Fibrous Material 98°t° i �. W201264 03/Bedroo mf Ceiling Pop*om Ceiling,homogeneous Yes t 'Ch rysotile 2.% Non-Fibrous Material 98?t° 3 i s This report relates only io the materials tested and may not be duplicated in partwithoutwritten permission by Hillmann Consulting. Samples are analyzed'according to the EPA Test Method and are subject to the inherent_:limitations of Polarized Light Microscopy and interference of matrix components:This report must not be used to claim product endorsement by NVLAP`or any`agency of the US government. This report:is not complete without the chain of custody,which contains the time of sample collection.The.laboratory is not.responsible for time of sample collection.which is on non-laboratory personnel,if it is aot provides+. ( { i , I i , , Signature � r � - >� Rocco Rapuano Senior Analyst TESTING PAGE_ 1 of 2 r Lab Code 101421-0 - I i BULK SAMPLE RESULTS Enclosed please find the Certificates of Analysis for bulk samples analyzed for asbestos content by Hilimann Consulting,LLC. All fibrous components including-type and percentage of.asbestos,of present,are reported. Percentages given are visual estimates under microscopiat observation,unless otherwise indicated bycodes. This test report only relates to items tested. F The method of analysis used.is Polarized Light Microscop y py PLM)analysis with dispersion staining: Hillmans follows the EPA and the National Voluntary Laboratory Accreditation Program (NVLAP)recammended method of anslysis.EPA 600iPV14$2-020 Interim AAefliod for the Determination of Rst e Eos,it Bulk Insulation Samples and&A 600IR-93I116 published July 1993 is also used for guidance- i 01/02109). organically tiound(NOB)sample results reported as negative(less than I t asbestos)must be considered Inconclusive(ELAP.)tem i98.6, 01/02/09). +� Polarized-light microscopy is not consistently reliable in de asbestos in floor coverings and similar non-friable.organically bound materials. Quantitative transmission electron microscopy is currently the.only method that.can be used to determine if this material can be considered or.treated as non-asbestos containing(ELAP Item 198.6,01/02L09). All analysis and certifies &Y certificates of analysis shaft meet all requirements of the most Handbook 150-2006 Edition. ¢urcent I cl AC`Siardards,.t+3YECAP Regulations;and NVLAP MIST This report cannot be used to claim product endorsement by NVLAP or anyagency of the U.S.Government. The National Institute of Standards and TechnologyAccredrtatton'requirements;mandatesthat this report must not he rep duLed ex report maycontain specific data not covered'by NVLAP,ELAP,or NELAC accreditation` respectively,if so identified in the notes. NY ELAP Item 198.E does not remove vermiculite and may underestimate the level of jsbLtos present in a sample containin `{ 9 9 realer.titan 10%:vermiculite. Listed below are explanations of notes and or sample descriptions contained within certificates of analysis. -Homogeneous.-Sample is composed of a uniformed material,and analyzed as such-Non-homogenous- All components were analyzed as discreet layers. The results reported indicated the contents of the sample as a whole: Results of each layer available upon request by the client } € -Recommended TEM Polarized Light Microscopy is not consistently reliable in detecting asbestos in floor coverings and similar non-friable organically bound materials. Quantitative transmission electron microscopy.is currentiythe only method that can be used to determine if this material can be considered or treated as non-asbestos containing. (NY FLAP Regulation Item 1 J8.6,1Ii i/05). eg PointFeder Counting- 'Sample was determined less than i0%positive by visual estimation. Sample was point counted as specified_.in NESHAPS regulations Federal Registration Vol.55,,No.224,November 20,199.0,EPA to verrf�r asbestos content quantification. -:Stratified Point Counting- Point Counting Criterlaforfriable bulk sample as dictated by NY ELAP Regulation Item 198.1,1/11105. Gravimetric Reduction Sample has been heated,and undergone acid digestion to4educe interfering substances before analysis.(Item.199.6 Of NY ELAP Manual(NOB by PLM)) -Final%Inorganic<1=f The percentage of Inorganic material is less than 1,resulting inthe sample being Non-ACM. (NY ELAP Regulation Item 198.6,1/11/05).; r - S F Hil►mann'siaboratory A�treditations- ELAP#10926 NJ NELAC#20037 NVLAP#101421 0 VA#3333 000203 MA#.AA000183 TX#300405 s WV#,LT000427 PA#68-00774 A CA#2924 ' RI#AAL-128 i CT#PH-0797 i ME#-LB-0084 1 Philadelphia#ALL15-000003 x f , j i i Signature f k V( J j Lf 3 Rocco Rapuano Senior-AnalystJJ �! \„EJJ �1NGj:r--+T PAGE: 2' of 2 Lab Code 101421-0 t f BULK SAMPLE iDENT0N FORIt1i ��/ L`�hr,3'' G o N.U t:lr►'M Cs DATE:_� PI_M COC, Versi6n:3.3 Environmental Consulting&Lab Services,:1000 Route 22 Fast,Unlon,NJ 07QQ3 (908)6884800 Fax,(308)G86-2636 email: JOB#:r am-L1( ain _ C�it611mann8roup.cot►t C) t''OSl;I-IVi-STOP ON ALL.1aOMOG..SAMPLES TAT for f PL Ni 3•tilers Q•�@2hrs 24hrs 481irta 72hrs .6•7day LOCATION ION � tJEhttb6� R TAT for TEM 9• s 8»121irs 24brs 4Qhrs I?Itrr, ti Yriay TAf_for__•80F;V_.:.1wk-2wif _ 6aNALYz :AL I NIBS As INDICATED BY__ ;, M :� . - LAE3 instrtic:tiori: : oAtV 1LYZE 13OT1 OM/INN f l7 LAYERS FIRS, A6 INDICATI AMC'(�BY GBJ�1+IVEI VIA F POSITIVE OSITIVE STCfp ON TEM ONLY��� Sane Ie fl D•. HEN STOP ANALYSIS Of OTHER LAYERS Honig. iD Lab Floor/Ro.om Location Descriplon� Material Description Catt�itttity Cond �----- - Color ----- lime Sample. ----~--- -M- • in SIJVV? Friable? NOB Collected t.at'Results 7 a r '(� N --� —1 l G-• .�^.-..- .�,,.,.., C l•1� a1A1 7. 114 CHAIN OF CUSTODY �_.SAMPLED f3Y: _ .. T13ANSPORTED BY- PYint RECEIVED BY: ANALYZED By. spacers occupied? Sign M._ .•„ ,, i Spaces Operating? ate Pdettirint Corios _ AcoessIssues? AP=acouslica.l plaster,SCpbroVrn coat,pF=base flashing,SUR=bulit•up roofing,CEi=covo.base,CAM=cove tins : _padding mastic,CP1=carpel tile mastic,CT=cei - e mastic,GP curly pashi linrj file,C'm=cl r I ng,CF3=ceramic r�asl c,CUNT=ceramic Wall tile,F134reproonng,JC=Joint compoinul,JT=)oint tape,6C=Iovnp r ltio,CM= rpof mastic,cPM=carpet PPUd parapet wall flashing,RFP=re•Iirforced fiberglass pinet SP=soundproofing,7P=tar paper,VA-vappr barrier,VCT=vinyl(ip P np compound, Pt.=plaster;PP=pitch,pocket, VUPA=w°:t�ll:paper adf7eslve,P1=pipe insulation,PP1=pipe filling Insulation,t=G:=Fiberglass Nno ALG,OTFIt ft I SCRIPTIONB MUST BFM;:WRITTEN mastic VSF:=v1nA siieet flooring,Wflliwlalftard,. I i a 1 iy T3 !� r 16ot.R0LrrE 22 KA.si'-Ro.90X 537 3�, L =Sj:F A.NI 14 tJi$�ofl.1'�.3.a�9�315�? i C:0 N l;U�. r# TELEPHONE sae sas sii0-Fax-goa-sss-zca's E ARS Restoration Specialists 1.10 Old Town Hou'S'e Road 100111E DATE; 0411.1./17 South Yarmouth, Wife 0 lnvoJ e No- 245 4 2 8 ,U J08 � I IBER. M34020 Peter Barton ; PURCHASE ORDER. lmVbICE T0TA'L; $714.00 DUE UPON RECEIPT 8GG'Bearses Way.Unit 5EE:Hyannis,MA-Asbestos Sampling. DATE Cl3Ll_ T�;,1tA161E T 414/201.7 Asbestos Investigator 9UAl�TiT�f TOTAL 414f20 7 Asbestos'l'ro ect Management rnt 720.00 Shift 0.50 M0,00 ! 9 1OQ.00 Hour 0�0 414120/7 bulk Analysis(FLlttl) a.50.00 4/71201 r7 Asbestos Letter Report 8.00 Sample 3;00 $54:00 3 25D.00 Fiat 1..00 �26Q.0fl t0ta1 this,Invoice $ } f t l { i . } } 3 { i .. j R k f Please Remit To Hillmann Consulting,4-LC: Accounts ReceNoble €�G PDX .597,Union, 07088-1597 Federal Tax iD#27-1'.592684 Visit our Website at inimi.hilimannconsulting,com 1 Massachusetts Department of Environmental Protection 10U2tti561R1 BWP AQ 04 (ANF-001) _ ,. Asbestos Project# j Project Revision.Notification 1. W Project Revision 4 T r' Project Cancellation A. Asbestos Abatement Description I 1.Facility Location: 1 CAPE CROSSROADS CONDOMINIUMS 800 BEARSES WAY Instructions 1.1AI1 a.Name of Facility t b.Street Address sections of this form HYANNIS fviA OZ601 0000000000 must be completed in order to comply with C.CitylTown d.State e.Zip Code - f.Telephone MassDEP notification NA requirements of 310 ; NA CMR 7.15 and g•Facility Contact Person Name h.Facility.Contact Person Title Department of Labor Worksite Location: BUILDING#5 UNITS C& E Standards(DLS) i.Building N g notification g Name,Wing,Floor,Room,etc. requirements of 453 2.Blanket Permit Project Approval,.if applicable CMR6.12 -Approval to# 3.Non-Traditional Asbestos Abatement Work Practice Approval,SNTi7035 MassDEP Use O'niy if applicable: p Approval ID# Date Received ' 6/14/2017 6/16/2017 a.Project Start Date(MM/DDNYYY) b.End Date(MMIDD/YYYY) 2.Submit Original 8AM-4PM NA Form To: I c.Work Hours-Monday Through Friday d.Work.Hours-Saturday&Sunday Commonwealth of Massachusetts P.Boson,MA MA 02211 B. Other Project Revisions: i I k Note:Temporary,', storage of Asbestos containing waste' 1 material is only allowed at the place of business of a DLS licensed Asbesto's contractor or a transfer station that is perrllttad by MassDEP and i operated in i compliance with Solld Waste Regulations 310 CMR 19.006 1 i i I Revised: 11/13/20 t 3 Page ] of 2 n t - I i j a Massachusetts Department of Environmental Protection - -- - - -- �•� i ;1OU266561R1 t BWP AQ 04 (ANF-001) Asbestos Project# Project Revision Notification 'FF Project Revision f— Project Cancellation. C. Certification f GARY PELLETIER GARY PELLETIER Note:Contractor must "I certify that 1 have personally 1.Name 8 2.Authorized.Signature sign this form for;DLS examined the foregoing and am BUSINESS MANAGER 6/1212017 notification purposes familiar with the information contained in this document and 3.Position/Ti le" 4.Date(MM/DD/YYYY) all attachments and that,based 5089986229 1, ERS,INC. on my inquiry of those 5.Telephone ;y, 6.Representing individuals immediately 9BLUEBERRY,LANE DARTMOUTH responsible for obtaining the 7.Address 8.CityrFown i information,f believe that the f Information is true,accurate;and 1 02747 complete.I am aware that there 9-State 10.Zip Code are significant penalties for submitting false information, including possible fines and imprisonment.The undersigned hereby states that I have read the Commonwealth of Massachusetts.regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor Standards and 310 CM 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not be deemed valid unless payment of the applicable fee is made." I I I t i F _ i f� i I j1 Revised: 11/13/2013 Page 2 062 r F s F Massachusetts Department of Environmental Protection r--- '100266561 } BWPAQ 04 (AeF-001� X Asbestos Project# Asbestos Notification Form 1— Project Revision Project Cancellation A. Asbestos Abatement Description; 1.Facility Location: CAPE CROSSROADS CONDOMINIUMS 800 BEARSES WAY Instructions 1.1All a..Name of Facility b.Street Address. sections of this form HYANNI$ must be completed in MA 4 02601 0000000000 order to comply with c.CitylTown d.State e.Zip Code I.Telephone MassDEP notification NA NA requirements of 310 il CMR 7.15 and 9•Facility Contact Person Name h.Facility Contact Person Title Department of Labor Worksite Location: BUILDING#15 UNITS C& E Standards(DLS) notification I.Building Name,Wing,Floor,Room,etc. requirements of 453 2. Is the facility occupied?�-a.Yes b.No CMR 6.12 3. Is this a fee exempt notification(city,town district,municipal housing authority,state facility,or owner-occupied residential property of four units or less)? I-" a.Yes W' b.No MassDEP Use Only 4.Blanket Permit Project Approval,if applicable: Date Received Approval ID# 5.Non-Traditional Asbestos Abatement.Work Practide Approval,SNT17035 2.Submit Original if applicable:Form To: Approval ID# Commonwealth of Massachusetts 6.Asbestos Contractor: P.O.Box 4062 s Boston,MA 02211 ENVIRONMENTAL RESPONSE SERVICES INC ? 98 GAMBRIDGE STREET a.Name b.Address MIDDLEBORO MA '; 02346 5089231111 { c.City/Town d.State e.Zip Code f:Telephone i AC000412 h.Contract Type: IV 1.Written r 2.Verbal g.DLS License# 7 RAFAEL DIAZ AS902311 a.Name of Contractor's On-Site Supervisor/Foreman b.DLS Certification# NA f 8. a.Name of Project.Monitor b:DLS Certification ft 9 FLI ENVIRONMENTAL INC € AA000144 a.Name of Asbestos Analytical Lab ' b.DLS Certification# ' 10. 6/1312017 6/1612017 j a.Project Start Date.(MM/DD/YYYY) b.End Date(MM/DD/YYYY) 6AM-4PM NA c.Work Hours-Monday Through Friday d.Work Hours-Saturday&Sunday I t.What type of project is this? j 1 a:Demolition W b.Renovation r- c.Repair,' d.Other-Please Specify: Revised: 11/13/2013 Page 1 of 4 Massachusetts Department of Environmental Protection — ----- ---- -; BWP AQ 04 (ANF-001) i 100266561____ Asbestos Project# d Asbestos Notification Form f- Project Revision R : ' Project Cancellation -- i A.Asbestos Abatement Description (cont.) 1.2.Abatement procedures.(check all that apply) r a.Glove Bag! b.Encapsulation c Enclosure 1` d. Disposal Only TV e.Cleanup i !v f.Full Containment iv g.Other-Please Specify: EXTERIOR i 13.lob is being conducted: Iv a.Indoors fV3, b.Outdoors I l4 a.Total amounrof each type-of asbestos Contaming_materials(ACM)to be removed,enclosed,or } encapsulated: 220 I 1.Linear Feet(Lin.Ft.) 2.Square Feet(Sq.Ft.) b.Boiler.Breaching,Duct, c.;1°ransite Pipe ! Tank Surface Coatings 1.Lin.FL 2.Sq—Ft. 1.Lin.FL 2.Sq.Ft. d.Pipe Insulation c.Transite Shingles 1.Lin.Ft. 2.Sq.FL 1.Lin.FL 2.Sq.FL f.Spray-On Fireproofing g.Transile Panels t 1.Lin.Ft. Z Sq.Ft. f1.Lin.Ft. 2.Sq.Ft. h.Cloths,Woven Fabrics i..Other-Please Specify: P. fy: 1:Lin.Ft. 2.Sq.Ft. j.Insulating Cement # CEIUNG,CONTAM.MATERIAL 220 1.Lin.Ft 2.Sq.Ft. 1.Lin.Ft. 2.Sq.Ft. i f 15.Describe the decontamination system(s)to be used: i THREE STAGE DECON ADJACENT TO WORK AREA 16.Describe the containerization/disposal methods to comply with 310 CIIR 7.15 and 453 CMR 6.14(2) WET ACM AND PLACE IN LABELED,DOUBLE 6 MIL DISPOSAL BAGS 1 17.For Emergency Asbestos Operations,the MassDEP and DLS officials who evaluated the emergency: JEFFREY FINNEGAN INSPECTOR a.Name of MassDEP Official i b.Tille,Of MassDEP Official 6/612017 SAW-17-213 c.Date of Authorization(MM/DDNYYY) ) d.Waiver# DLS COMPUTER e.Name of DLS Official '=f.Title of DLS Official l 6/8/2017 19583-2017 g.Date of Authorization(MM/DD/YYYY) h.Waiver# 18.Do prevailing,wage rates as per.M.G.L.c. 149,§426,27 or 27A—F apply to this r a Yes 1v b.No project? Revised: 11/13/2013 Page 2 of 4 I W , Massachusetts Department of Environmental Protection - -- --- i BWI'AQ 04 (ANF-001) 100266561 I Asbestos Projeet# Asbestos Notification Form r Project Revision f` Project Cancellation i { t f B. Facility Description 1.Current or prior use of.facility: RESIDENTIAL 2.Is the facility owner-occupied residential with 4 units or less?.r a.Yes f✓ b.No 1 3 CAPE CROSSROADS CONDOMINIUMTRUST 800 BEARSES WAY a.Facility Owner Name b.Address IJ HYANNIS MA 02601 0060000000 C.Cityfrown d.Stale'J e.Zip Code f.Telephone 4 NA NA 4 a.Name of Facility Ownei's.On-Site Manager s b.Address j4 HYANNIS a MA k02601 0000000000 t a City/Town d.State,,' e:.Zip Code f.Telephone f ENVIRONMENTAL RESPONSE SERVICES 5 9 BLUEBERRY LANE a.Name of General Contractor j b.Address j DARTMOUTH 5089986229 I MA 02747 C.Cityfrown d.State e.Zip Co f.Telephone 1 TRAVELERS j g.Contractor's Worker's Compensation Insurer 3 6HUB0623N7 1 1 6/12/2017 h.Policy# F I.Expiration Date(MM/DD/YYYY) 6.What is the size of this facility? 10000 2 a.Square Feet b,#of Floors i 1 Ce Asbestos Transportation&Disposal i 1.Transporter of asbestos-containing waste material fi-bm site.of.generation. r a.Directly to Landfill or f✓ b.To Temporary'Storage LocatioiVTransfer Station ! ENVIRONMENTAL.RESPONSESERVICES 9 BLUEBERRY LANE c.Name of Transporter d.Address Note:Temporary k storage of Asbestos j DARTMOUTH MA 02747 5089986229 containing waste i L.Uty/Town material is only f.State. g.Zip Code h.Telephone allowed at the place of business of a DLS licensed Asbestos 2.If a temporary storage.location/transfer station is used,Fist name of transporter of asbestos containing conlractor or a transfer waste material from temporary storage location/transfer station to final disposal site: station that is i permitted by RED TECHNOLOGIES,LLC MassDEP and 70 NORTHWOOD DRIVEa.Name of Transporter operated in i ti.Address compliance with Solid BLOOMFIELD Cr 06002 Waste Regulations 8602182428 ` 310 CMR t9.000 C.City/Town d.State e.Zip-Co Zip CCode f.Telephone I f Revised: 11/13/20.13 Page 3 of 4 j r •t it " Massachusetts Department of Environmental Protection r A 00266561 BWP AQ 04 (ANF-001) - -- Asbestos Project# Asbestos Notification Form { I Project Revision --- F Project Cancellation s C.Asbestos Transportation&Disposal:(cont.), 3.Name and address of temporary storage location/transfer station for the asbestos containing waste material: ENVIRONMENTAL RESPONSE SERVICES 98 CAMBRIDGE STREET a.Temporary Storage Location Name b.Address MIDDLEBORO MA 02346 5089231111 C.Gttyffown d.State e.Zip Code f.Telephone 4.Name and location of final disposal site(asbestos landfill): MNERVA ENTERPRISES diIINERVA ENTERPRISES a.Final Disposal Site Name b.Final Disposal Site Owner Name 9000 MINERVA ROAD q j i c.Address WAYNESBURG i CH �44688 3308663435 d.City/Town e.Siate Zip Code g.Tefeph me } A Certification {{{t GARY PELLEf1ER "1 certify that 1 have personally GARYPELLETIER 1.Name l 2.Authorized Signature examined the foregoing and am familiar with the information BUSINESS MANAGER 6/8/2017 Note:Contractor must contained in this document and 3.Position�tfe s TO—ate(MWDD/YYYY) sign this form for D,LS all attachments and that,based 5089986229, ERS,INC. notification purposes on my inquiry of those 5.Telephone 6.Representing individu als immediately 9 BLUEBERRY LANE DARTMOtJf}i ( responsible for obtaining the 7.Address J information,I believe that theMA t &.City/Town information is true,accurate,and 02747 complete.I am aware that there 9•State 10..Zip Code I are significant penalties for submitting false information, x including possible fines and imprisonment.The undersigned i hereby states that I have read the Commonwealth of i Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by j the Department of Labor Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection); and that I am aware that this permit application or notification shall not be deemed valid unless payment.of the applicable.fee is made." I Revised:11/13/2013 Page 4 of 4 i f ,Massachusetts Department of Environmental Protection i 110026656I_R2 a . BWP AQ 04 (ANF-001) Asbestos Project# Project Revision.Notification g 3v Project Revision Project Cancellation a A. Asbestos Abatement Description 1.Facility Louition: CAPE CROSSROADS CONDOMINIUMS : 800 BEARSES WAY Instructions 1.All a.Name of Facility b.Street Address sections of this form HYANNIS must be completed in MA 02601 00.00000000 order to comply with c.Cityrrown d.State e.Zip Code f.Telephone MassDEP notification NA ►.Iq requirements of 310 CMR 7.15and 9•Facility Contact Person Name h..Facility Contact Person Title Department of Labor Worksite,Location: BUILDING#5 UNITS C& E Standards(DLS)1 notification j i.Building Name,Wing,Floor,Room,etc. requirements of 453 2.Blanket Permit Project Approval,if applicable CMR 6.12 1 Approval ID# 3.Non-Traditional.Asbestos Abatement Work.Practice Approval,SNT17035 MassDEP Use Only ifapplicable: Approval ID# Date Received ! 6/14/2017 6123/2017 1` a.Project Start Date(MM/DD/YYYY) b.End Date(MM/DD/YYYY) l 4PM 2.Submit Original 8AM- NA Form To: c.Work.Hours Monday Through Friday d.Work Hours-Saturday&Sunday Commonwealth of Massachusetts P.O.Box4062 ( B. Other Project Revisions: Bostonon,,MAA02211 1 i = i Note:Temporary i storage.of Asbestos containing waste material is only f allowed at the place of business of a DLS licensed Asbestos contractor or a transfer station that is permitted by MassDEP and operated in compliance withS.oltd Waste Regulation's 310 CMR 19.000 F i I I : l I # Revised: 11/13/2013 Page I of j i f f I ri U { 7 ` Massachusetts Department of Environmental Protection -- '`� l 100266561R2 _I { BWP AQ 04 (ANF-001) ____. Asbestos Project# Project Revision Notification 6 FV Project Revision 4 T— Project Cancellation. i j C.Certification k GARY PELLETIER GARY PELLETIER "1 certify that I have personally Note:Contractor must p Y 1.Name 2.Authorized Signature sign this form for DLS examined the foregoing and am 9 BUSINESS MANAGER 6116/2017 notification purposes familiar with the information I contained in this document and 3.Positionmtle .4.Date(MMIDD/YYYY) all attachments and that,based 5089986229 ERS,INC I on my inquiry of those 5.Telephone'. 6.Representing 1 individuals immediately 9BLUEBERRYLANE DARWOUTH responsible for obtaining the 7.Address 8.Citylfown information,1 believe that the 02747 information is true,accurate,and complete.I am aware that there 9•State 10.Zip Code are significant penalties for submitting false information, } including possible fines and imprisonment.The undersigned i r i hereby states that I have read the Commonwealth of } Massachusetts regulations governing asbestos abatement (453 CMR 6.00 promulgated by the Department of Labor 1 t Standards and 310 CMR 7.15 promulgated by the Department of Environmental Protection), and that I am aware that this permit application or notification shall not:be deemed valid unless payment of the # applicable fee is made." I I i i I i I n I Revised: 1 1/13/201.3 a Page 2 of 2 I t I I