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0276 FALMOUTH ROAD/RTE 28 (14)
°M1 i YJ1' 7 j _ �� .' Project Name: o f__ a� J�-IwVN pud ,Address. � ----------- �� Permit#: ------------------------- Permit Date:_ VIM M/P: LARGE ROLLED PLANS ARE IN: BOX: (3� SLOT:_ I Date entered in MAPS on._____� program �utl BY•----------------- Town of Barnstable Building . � sPost�This�Card So�That it�is�Y.�sible From the�Street :Approved laps Must�be Retamed�on ob�and�this�Car Must�be Kept. PosteUntil�Final�l spection Has Been.Made: r , a Permit ;,tee Where a:Gertificate of Occupancy rs�Required such�Bulding�shall Not be Occupied�cn#�I aFinal nspectign as.been;'triade. Permit No. B-16-3607 Applicant Name: GENE A CABRALJR _ Approvals Date Issued: 01/18/2017 Current Use: Structure Permit Type: Building-Alteration INTERIOR Work Only- Expiration Date: 07/18/2017 Foundation: Commercial Map/Lot 293 031 Zoning District: HB Sheathing: Location: 276 FALMOUTH ROAD/RTE 28,HYANNIS L� � , -Contractor Na,'rrae: CHRISTOPHER D RAVINE Framing: 1 Owner on Record: BORNSTU LP ; Contractor Ucerise CS-075373 2 Address: 297 NORTH STREET ' 4 �, Est Project Cost: $200,000.00 Chimney: HYANNIS,MA 02601 k = � $1,955.00 Permit ee: } Insulation: Description: REMODEL OF FLOORING AND DISPLAYS A TREILS WI EBUILT AS A k DISPLAY FOR WEST MARINE Femme aid':' $1,955.00 w Final: t Date 1/18/2017 Project Review Req: REMODEL OF FLOORING AND DISPLAYS,IXTRELLIS WILL BE - BUILT AS A DISPLAY FOR WEST MARINE Plumbing/Gas Rough Plumbing: � k x MEI P 7 Buildin Official g Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authoifzedby this permit is commenced within siz months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and theaapproved construction documents for which i is permit has been granted. All construction,alterations and changes of use of any building and structures�shall be in compliance with the local zoijing by laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street ors road and shall be maintained open forpublic 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 bthe ardFirO ovi xpermit.y Service: Minimum of Five Call Inspections Required for All Construction Work: 1.Foundation or Footing _ Rou h' 2.Sheathing Inspection g . 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.final Inspection before Occupancy tow Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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.142.A). Fire Department Building plans are to be available on site Final: All Permit Cards.are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application V � Health Division � � Date Issued Conservation Division Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board N� Historic - OKH _ Preservation/ Hyannis Project Street Address L o ��1 V-L Village Owner © i Address Telephone 83 7 Permit Request ��In\2 �� C I STOD ..� ft/r�c 1r: Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project 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 ❑ 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 Christopher D Ravine Telephone Number -330-494-1 007 Address. 631 5 Promway Ave NW License # CS-075373 Nor-t-h Cantori, 914 4 4 7 20 Home Improvement Contractor# Email-- chris@frPciol i vi Pri _cnm Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE, — DATE .3" 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 �7 DATE CLOSED OUT ASSOCIATION PLAN NO. P fred olivied construction company March 16,2017 Dear Sir/Madam: I,Timothy L. Feller,an Officer of Fred Olivieri Construction Company,confirm that Christopher Ravine is an employee of Fred Olivier?Construction Company. Sincerely, FRED OLIVIERI CONSTRUCTION COMPANY Timothy L��eller Officer TLF/dw 330.494.1007 ( 6315 Prornway Ave:NW,North Canton,.OH 44720 i www.fredolivieri.com Coverage is Provided In: Policy Number: '0�Liberty West American Insurance Company IXWW(17)56 99 77 89 Mutual. Policy Period: INSURANCE From 11/09/2016 To 11/09/2017 Endorsement,Period: NCCI Co.No. 11576 From To Workers Compensation and 12:01 am StandardTime Employers Liability Insurance Policy at Insured'sMaitingAddress Information Page Named Insured Agent RETAILER FLOORING SOLUTIONS, INC (315) 4884800 IMS GROUP NORTHEAST CORP n EXTENSION OF INFORMATION PAGE ITEM 3 C.Other States Insurance: Part Three of the policy applies to the states, if any, listed here: a All states except North Dakota,Ohio,Washington,Wyoming and states designated in Item 3.A.on s the Information Page. 0 a i N Servicing Office New York -Upstate Countersigned by: and Issue Date 11/21/16 To report a claim, call your Agent or 1-800-362-0000 WC990642A 11/21/16 56997789 N0201736 430 PCAFPPNO AGENT COPY 005184 PAGE. 15 OF 26 I Fred OlIVI8r1 West Marine#1269 276 Falmouth Rd. construction Hyannis, MA 02601 Company Job#17.021 -t-- Start: 3/13/17 Complete: 4/24/17 SUBCONTRACTOR LIST PAINTING King Painting Inc. 50 High St., Suite 22 North Andover,MA 01845 P—978-683-7434 F—978-683-7198 M—978-360-0279 CONTACT: Chris King eking ftinwaintinginc,com FIXTURING I MERCHANDISING - - - Merchco Services Inc. 140 Heimer Road San Antonio,TX 78232 P-210-581-8610 F-888-685-6040 M—954-558-1876 CONTACT: Scott Bouwens sbouwens cDmerchcoservices.com VINYL FLOORING - Retailer Flooring Solutions, Inc. 5611 R Business Ave Cicero, NY 13039 P—315-458-3732 F—315-452-0136 M-N/A CONTACT: Peter Roberts peter(o)retailerfs.com ELECTRICAL Richard J Bisson 331 Cotuit Road Mashpee, MA 02649.. P—774-368-0818 F- NIA CONTACT: Richard Bisson rich ardbisson01yahoo.com 330.494.1007 1 6315 Promway Ave. NW, North Canton, OH 44720 www.fredolivieri.com y ... ..: �?3`S;-p _ .,a'*...,, *-,;:r't� .t- a .r..s'M?+w :J.:.Ite rt..""tr. CJ..t.Corr'Pt'e .Y F;'S:}+tb'`'?C#•".�'11.' °s5.nn°+y"' ?;�..,+...p,c:...6+..,�"ci :{«S .'.. r'l.nv.:.�€A'.c rR�.,'s:A ''h'.`.'i- �5'k`S'' v t -•�3" =��a�''�s ,...:?��ii"2C.a�.�:'�.l:t,. �:��c � �s a Massachusetts Department of Public Safety'All :n Board of Building Regulations and Standards �`'�License• CS-075373 � iP=; ������ CHBISTOPMR,D-"-- r, AZr 6315 PROMW A v--kvt I, gN" orth Canton OIL 44 rs D tw Expiration 4 er - commission q f ti Town of Barnstable Regulatory Services " Richard V. Scali, Director Building Division Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF LICENSED CONSTRUCTION SUPERVISOR ASSUMPTION OF RESPONSIBILITY I, Christopher D Ravine , Construction Supervisor License #t-57�353.73 f� , hereby certify that I have assumed responsibility for the project under construction, as authorized by building permit# g����3Coo�- , issued to (property address) 276 Pal Mouth Rd,1 Henn i -;, Rd on , 201 . The following documents are attached: copy of my Massachusetts State Construction Supervisor's license or Homeowner's License Exemption form (if applicable) copy of my Home Improvement Contractor registration(if applicable) Commonwealth of Massachusetts Workers' Compensation Insurance Affidavit. Road Bond (if applicable) 3-Co- 17 LICENSE HOLDER DATE q/forms/newcontrb , rev:07/18/16 AC40 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 2/15/2017 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 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' NAME CT IMS Group Northeast Corp IMS Group Northeast Corp PHONE AA/C.No (315)488-4800 AN (315)488-5800 4927 W. Genesee Street E-MAIL P.O. BOX 129 INSURERS AFFORDING COVERAGE NAIC# Camillus NY 13031 INSURER AAmerica, Fire and Casualty Cc 24066 INSURED INSURERBOhiO, Security Insurance Co 24082 RETAILER FLOORING SOLUTIONS, INC INSURERCOhio Casualty Insurance Cc 24074 5611 BUSINESS AVE INSURERD: INSURER E: CICERO NY 13039 1 INSURERF: COVERAGES CERTIFICATE NUMBER:CL1721505543 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 ADDL SUER POLICY EFF POLICY EXP POLICY NUMBER MWDD MIDDAN" LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,0001000 A CLAIMS-MADE Fx�OCCUR DAMAGE RENTED- PREMISES(Ea occurrence) $ 300,000 X Y BKA56997789 11/9/2016 11/9/2017 MED EXP(Any one person) $ 15,000 PERSONAL BAOVINJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 21000,000 POLICY JEQ� ElLOC PRODUCTS-COMP/OPAGG $ 2,006,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accide 0 $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ AUTOS SCHEDULED BASS6997789 11/9/2016 11/9/2017 BODILY INJURY(Per $ AUTOS AUTOS X Y ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ Non-owned $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 51000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I X I RETENTION$ 10,000 X Y US056997789 11/9/2016 11/9/2017 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 11000,000 OFFICER/MEMBER EXCLUDED? � NIA C (Mandatory in NH) Y XWN56997789 11/9/2016 11/9/2017 E.L.DISEASE-EA EMPLOYE $ 1,006,000 If yes,describe under D ESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) Fred Olivieri Construction Co., Owner, Architect and their agents, officers, directors and employees are additional insured on all policies on a primary and noncontributory basis (for both ongoing and completed operations for general liability), waiver of subrogation and 30 day notice of cancellation is provided where required by written contract (see endorsements attached) . Porker's Compensation coverage applies to the states shown on the attached Woker!s Compensation policy declarations page. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE -Fred Olivieri Construction Co THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN C�0 SChauEdl' Group, Inc ACCORDANCE WITH THE POLICY PROVISIONS.. ANC W T IONS. 200MarketAve :N A ,ci111 to:l0 0 AUTHORIZED REPRESENTATIVE_ RIZE Canton', OH 44T0:2 Eric Danes/JLJ ' ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025/7nunii r 10 CERTIFICATE OF LIABILITY INSF2/17/D17/IDDIYYYY) �� URANCE2017 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 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 ANTAC. construction Eastern Insurance Group LLC PHONE (800)333-7234 FAx VC Nol: 233 West Central StE-MAIL INSURERS AFFORDING COVERAGE NAIC# Natick MA 01760 INSURERA:Citizens Of America INSURED INSURER B Allmerica Financial Benefits 41840 King Painting Inc INSURERCHanover Insurance Co. 22292 50 High Street, Suite 22 INSURER DAmGuard 42390 INSURER E North Andover MA 01845 INSURER F: COVERAGES CERTIFICATE NUMBER3daster 2016 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY FF POLICY EXP LTR POLICY NUMBER MMIDD MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 A 7 CLAIMS-MADE a OCCUR X Y ZBNA652650 6/16/2016 6/16/2017 MED EXP(Any one person)` $ 5,000 X X,C,U included PERSONAL BADVINJURY $ 11000,000 X Contractual CG0001 04/13 iability Deductible GENERAL AGGREGATE $ 2,600,000 GEN'LAGGREG ATE LIMIT APPLIES PER: $1,000 PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY (Ea accident)SINGLE LIMIT 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED X Y WNA652648 6/16/2016 6/16/2017 BODILY INJURY(Per $ AUTOS AUTOS ( ) X HIRED AUTOS X NONOSWNED PerOPERTYt DAMAGE $ 0 tional bodily in'u $ X UMBRELLAUAB X OCCUR EACH OCCURRENCE $ 5,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DED I I RETENTION R Y L652651 6/16/2016 6/16/2017 $ D WORKERS COMPENSATION Y X ORYSMUTS - OTH- AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,060 OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) KIWC759198 (MA & NH) 6/16/2016 6/16/2017 E.L.DISEASE-EA EMPLOYE $ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A LEASED/RENTED EQUIPMENT BNA652650 6/16/2016 /16/2017 LIMIT $100,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) RE: WEST MARINE#1269 - HYANNIS, MA FRED OLIVIERI CONSTRUCTION CO., OWNER, ARCHITECT AND THEIR AGENTS, OFFICERS AND EMPLOYEES; ARE INCLUDED AS ADDITIONAL INSURED ON A PRIMARY AND NON-CONTRIBUTORY BASIS FOR GENERAL LIABILITY, AUTO LIABILITY AND UMBRELLA LIABILITY WHERE REQUIRED BY WRITTEN CONTRACT. ADDITIONAL INSURED COVERAGE FOR GENERAL LIABILITY AND UMBRELLA LIABILITY INCLUDES COMPLETED OPERATIONS WHERE REQUIRED BY WRITTEN CONTRACT. WAIVER OF SUBROGATION APPLIES IN FAVOR OF ADDITIONAL INSUREDS ON ALL POLICIES WHERE REQUIRED BY WRITTEN CONTRACT. 30 DAY NOTICE OF CANCELLATION APPLIES. 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. '`FRED.QLIVIERI :CQNSTRUCTIONCQ c/o.SCHAUER GROUP, INC AUTHORIZED REPRESENTATIVE 200 'MARKET. AVE N, SUITE: 100 CANTON, OH 44702 John Koegel/PMA ACORD 25(2010/05) ©088-2010 ACORD CORPORATION, All rights reserved. INS025 rgmnnei m Tho ORf1Rrl nama and Innn ara ronletararl marke of ARr1Rr1 i MERSERC OP ID:JR ACG�►RL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) ... ........':::: :::::: 02/17/2017 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 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 endorsements. PRODUCER CONTACT Jennifer Re alado,ACSR Integrity Insurance Agency PHONE FAX 2634 Kerrybrook Ct. o >d.210-593-0820 AIC No): 210-593-0826 San Antonio,TX 78230 noRESs:Jennifer@lnteirityinS.COM Penny A Previtera,CIC INSURERSI AFFORDING COVERAGE NAIC i INSURER A:Allied P&C Ins Co 42579 INSURED Merchco Services,Inc. INSURER B:Technology Insurance Co Inc 140 Helmer Rd.Ste.500 San Antonio,TX 78232-5031 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MMIDDNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE T OCCUR X X ACP 3007494987 01/01/2017 01/01/2018 PREMISES Eaoccurrence) $. 100,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY 1K JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accid.ntl $ 1,000,00 A X ANY AUTO X X ACP 3007494987 01/0112017 01/01/2018 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Peracpident AUTOS AUTOS ( ) $ X .HIREDAUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 7,000,00 A EXCESS LIAB CLAIMS-MADE X X ACID 3007494987 01/01/2017 01/01/2018 AGGREGATE $ 7,000,000 HOED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE ER YIN B ANY PROPRIETORIPARTNERIEXECUTIVE X TWC3602532 01/01/2017 01/01/2018 E.L.EACH ACCIDENT $ 1,000,000 OFFICERNEMBER EXCLUDED? a N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00 If 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) Fred Olivieri Construction Co.owner,Architect&their agents,officers, directors&employees are additional insured on all policies on a primary& noncontributory basis for both ongoing and completed operation on.the general Iiability.Walver of Subrogation is provided and 30 day Notice of cancellation Is provided in favor of the certificate holder. CERTIFICATE HOLDER CANCELLATION - FREOLI2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fred Olivier!Construction Co THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. c/o Schaurer Group,Inc. 200 Market Ave N,Suite 100 AUTHORIZED REPRESENTATIVE Canton,OH 44702 Penny A Previtera,CIC ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD NOTEPAD: HOLDER CODE FREOLI2 MERSERC PAGE 2 • INSUREDS NAME Merciico Services,Inc. OP ID:JR Date 0 2/1 712017 State of MA is included on the Workers Compensation. r WORKERS COMPENSATION.AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 0313 (Ed. ) WAIVER OF OUR RIGHT TO RECOVER:FROM OTHERS ENDORSEMENT We have the right to recover our:payments from-anyone liable for an injury covered by this polloy.Wd"will not titde our right against the person or organization. named in the Sche". (This agreement applies only to the extent that you perform worts under a written contract that requires,you to obtain this agreement from us) `This agreement shall not operate directly or indirectly to benefit anyone not named In the Schadfule. Sdhedule eliairkwt Waiver Person/organiizetioti: Blahket Waiver-Any person or organization far wham ttre bored ln'sured'has agreed by written contract to furnish tf1i5 waiver: Job Description Waiver Premium All MA operations 1,554.00 This endomement d ainges.the 06110y to wI►i it.fs`aitrlched and err efPecWe on the date Issued-unlass othe tivisd staled The information b0low is"Irad only whati this endorsement Is issued subsegeuent to preparation of the policy:)., Endorsement Effective Policy No: I(MCMigs Endorsement No. Insured Premium Insurance Company Countersigned by (Ed,.4-84) �18�5'l�atip�i dl ontraar�peraaliori lRsursnca. f ACCO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 3/8/2017 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 to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONTACT ME: Joanne Bretton A Southeastern Insurance Agency, Inc. PHONE . (508)997-6061 IX4AIC.No No:(508)990-2731 439 State Rd. E-M ess•jbretton@southeasternins.com P.O. BOX 79398 INSURERS AFFORDING COVERAGE NAIC# North Dartmouth MA 02747 INSURER A Merchants Mutual Insurance Com 23329 INSURED INSURER B: Rich Bissoa INSURERC: Dba Rich Bisson Electrician INSURER0: 331 Cotuit Road -INSURER E Mashpee MA 02649-2384 INSURERF: COVERAGES CERTIFICATE NUMBER:2017 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ADD SUER POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MM/DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. A CLAIMS-MADE �OCCUR D M G TO RENTED R MI E Ea occurrence $ 500,000 BOPI046813 3/5/2017 3/5/2018 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 11000,000 GENI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY1:1 PRO. ❑LOC JECT PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY C MBIN D SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS BODILY INJURY(Per accident) $ AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS $ UMBRELLA L AS OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION R STATUTE XI ERH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT_ $ 11000,000 A OFFICER/MEMBER EXCLUDED? FN NIA (Mandatory In NH) TBI 3/8/2017 3/8/2018 E.L.DISEASE-EA EMPLOYEE $ 1,0001000 If yes,describe under owner included DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION luann@fredolivieri.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fred;i01iV1eri :COnStruCtiOn THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 6315 PrOmlaay AVg: NW ACCORDANCE WITH THE POLICY PROVISIONS. .. .. : NorthCanton, OH. AUTHORIZED REPRESENTATIVE Joanne Bretton/JB ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 onl4nit 03/17/2017 10:19 5087756526 PAGE 02/02 330-497-5999 04:51:17 p,m. OH-18-2017 a/2 ToWn of Ramstable D RegalAWY SOx'v MWA*d T.P4 Mmor. ' BvAd?L�Lg Dl�ba �'ettiAama�>3�81tigCamcmlln(aner .. � ��. • 20�btaln 6fba>et; MA.QZ601 `' � W1riT.tb{4n.b8rpQi$b�l.m61� s.; • C#ffic9:,SQB;66Z-4031. Fa= 4790.6nu Propaq Olmer Mist Complete and S%4 This Secdom L Stuart s o r s t�3 i t1 ` ;as Owur.0 o£the subf ecrproprslp i hereby=&*A D Chris Ravine r Fred Olivieri Construction Co.� b J,�dl matte salatfve toc antbc:do�od by t bod{agpe�mit ap�Tirnlioa£c= ; ,t176 Pallmouth Rd.Ste CI Hyannis,M4 02001 • -(Address allob) - - "Pool fences sad.dMM arc tic zMPOlnaN*OHM appu=t,Fools • I a=not to be imed ns+uted barb fence h i atued=a an End 3nV=tlans ate prcfQ=d.and 6ccic WA I t1Lffi of O�vau i• • &tuart Bor_nsteln Chris Ravine Ps3ntNama ��Nasta i , Z000/L000� XVJ "M:8 AL03/81/0 77ze Commornvedrh of Massadrusettr DeDA partirrent of rudush al Accrderrts Offike of lmaestrgadons 600 WasIdwgiou Street Boston,AIA 02111 wrvauitrassgov/dia Workers' Cumpensatian Insurance Affidavit:Builders/C,ontradurslEIectdcians!Plumbers Applicant Inf nmution Please Print Legibly Name(Jus'MetfCkgq zati Co. Address: 6315 Promway Ave NW City/Sate-01r North Canton, OH 44720 Phon04-.'330-494-1007 Are you an employer?Check the appropriate btu: ' Type of project(required}: 1.❑ I am a employer with. 4. ®I am a general contractor and I 6. ❑New construction employees(full andfor pastime).* have hired the sub contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees . These sub-contractors have 8.•❑Demolition fOr e in employees and have avows' ti'�'�u y�'itY- 1 9. ❑Building addition [Na�rg' Comp,iu==e Corny.instuance required.] 5. ❑ We are a corporation and its 10_❑Electrical repairs or adfHtions 3.❑ I ama homeowner doing all work officers have exercised their 1L❑Piumbiagrepairs or additions myself-[No workers'comp. right 2,f exemption L 1?.❑Roofrepairs insurance regained.]Y § (4'and have employees.[No workers' 13-❑Other cow.iasmmce regdred.) *Aqy applicamtthatchedcsbox#1 must also fill out the section below shaving their woikere compensation polkyinfannsfim I Snmeo wrs who submit dds dffidava k&cztm;_q tboy are doing all wa*and then hire outside cortiactars most sohmit a new affidavit indicating sncfi TCoattat t. that cherh this boot mast attached sn.additional sheet dioteing the name of&a suVcamlzsctom sad state whether or not those entities have employees.7f the aubtantzactmbmempployee%&eynnutpravidetheir worken'comp.palicynumber. I man art etnpIoy�ar that is prouidirag tyorkets't otrrpertsation insurance for mp*encploy�ees. Befoiv is lhepvHcy grad job site infornratiom Insurance Company Name:—, Policy it'or Self-ins.LicA�. Expiration Date: Job Site Address: 976 F a l mnu t-h Rd City/State/Zip: Hyannis, MA 02601 Attach s copy of the workers'compensationpolicy-declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MOL a 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andlar one-year imprisonment,as well as civil penalties in the form of a STOP WORE ORDERand a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement mtay.be forwarded to the Office of Investsgatiom ofthe D ins coverage verification. Fdo here c rat the tS rtd psnahYw ofpedu0;thatthe ineformadwi pracidrd abm e i s true and correct Sienature: Date: .3-6- Phone 9- 3S0 — ` 9 T`100 7 OjfciaL nags daily. Do not write in this Area,to be caanpfeted by city ar town of`rciat City or yawn: PermitUcense# inning Antherity(tdrele one): 1.Board of Health Z.Building Department 3.Ci p Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: 6 I lafQrmatzon and lastruefions ' Massaclxusefis Geheaal Laws chVber 152 regmms all=Ploy=to provide workers'compensation for their eMPIOY=- Parsamitto this ,an err ploy=is defined as."_.every person.ia the service of another under any contract of hire, empress or implied,oral or written." An.errzpIoye-is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged is a joint ,and including tine legal representatives of a deceased employes,or the receiver or trustee of en individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling Douse having not more than three apartments and who resides therein,or the occupant of the- dvPeIIing house of another who employs persons to do maiaten ce,construction or repair wow on such dwelling house or on the grounds or building aipurtemant thereto shall not becanse of such employment be deemed to be an empploym" MGL chapter 152,§25C(6)also stains that"every sty or local licensing agency shall withhold hie issuance or renewal of a license or permit to operate a business or to construct buildings in the comm onuvealth for any applicant who has not produced acceptable evidence of commpH=r-a with the Durance.coverage rimed-" Add tionalb,MGM chapter 152,§25C(7)sues"Neither the commonwealth nor Ely ofits political subdivisions shall enter into any contract for the performance ofpubho work until.acceptable evidence of compliancewith the fimn-nce._ reTM emenfs of this chapter have been presented to the contracting authority." APphc - Please fill o-ut the workers'compensation affidavit completely,by checIong the boxes that apply to your situation:aud,if necessary,supply sub-contractor(s)nam e(s), myress(es)and Phone mnnbm(s),along with their cert1cate(s)of ;nn=ce. Lfi itodLiability Companies(LLC)or Limited LiabilityPartr ciships(LLP)withno employees other than the members or partners,are not required to canny workers'compensation insmmce_ If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be mbmitbz;d to the Department of Industrial Accidents for confffmation.of filM C,r,coverage. Also be sure to sign and date the affidavit The affidavit should be-mt mned to ffie city or town that the application for the permit or license is being requested,not the Department of Irnshistlial Accidents. Shouldyou have any questions regatdmg the law or ifyou are required to obtain a workers' compensation policy,please cal the Department at the numzber listed below. Self-insured companies should entDr their self-insurance license number on the appropriate line. City or Town Officials Please be scam that the affidavit is complete and prkited legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigs lions has to coact you regarding the applicant- Please be same to fM,in the penmaWlicemse member which will be used as a reb=mce number. In addition,an applicant that must submit muliiple peen.' -cense applications in any giver year,need only submit one affidavit mdica±i current p olicy iafonnation[if necessary)and ceder`gob Site Address"the applicant should write"all locations in (may 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 fhfur e'perni s or licenses_ A new affidavit must be filled oil each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (ie. a dog license or peunit to burn leaves eto-)said person is NOT ranged to complete this affidavit The Office of Invcstigations would Ike to thank you is advance for your cooperation and should you have any gnesiions, please do not hesitate to give to a call The,Department's address,telephone and fax comber 'fie wealth of Mae chLURCM Deparbnmt of ladistiat Accidents Qf tice,of jxjve& katio-= 600-Waaa$GI,ste'et axeM&oil II ToL 4 617-727-4 ext406 or 1477-MA&RAM Fax 9617-727 7749 Revised 4-24-07 w T_MaSV_gQgfdia FREDOLI-02 SSOKOL ACORO° . DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE- : 12/22/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR.ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S);AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu:of such endorsement(s).: PRODUCER CONTACT - NAME: Schauer Group,Inc. PHONE 200 Market Ave.N (AX,No;EXt):(330)453-7721 (AIc,No):(330)453-4911 Suite 100 EMAIL schauer rou com Canton,OH 44702 ADDRESS:insure @ 9 p• -- - - - - INSURERS AFFORDING COVERAGE ..NAIC# INSURER A:Continental Casual CNA 20443 iNstiRE6 INSURERB:Indian Harbor Insurance Co. Fred Olivieri Construction CO. INSURERC 6315 Promway Ave.NW INSURER D North Canton,OH 44720 - - INSURER.E: INSURER COVERAGES1 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 ADDL SUBR POLICY EFF- POLICY EXP -- LTR TYPE OF INSURANCE 1NSD-WVD POLICY NUMBER MM DDIYYYYI (MM/DDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1;000,000 .. :. . CLAIMS-MADE X OCCUR DAMAGE TO RENTED 5088620661 01/01/2017 01/01/2018, PREMISES Ea occurrence $ 500,000 MED EXP(Any oneperson): $: 15,000 PERSONAL&ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000,000 POLICY JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 11000,000 Ea accident $ X ANY AUTO 5088620630 :. 0110.1/2017: 01/01/2018 BODILY INJURY Perperson) '$ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ AUTOS ONLY.. AUTO ONL� .... .... Perr acctlent DAMAGE $ $ A X UMBRELLA.LIAB X OCCUR :. :. - :.: : :. EACH OCCURRENCE $ 91000,000 EXCESS LIAB CLAIMS-MADE 5088620644 01/01/2017 01/01/2018 AGGREGATE $ 9,000,000 .. DED X RETENTION$: o . A WORKERS COMPENSATION X .PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE 5088620658 :. :: O1/O1/2017. 07/07I2018 E.L:EACH ACCIDENT $ - 1,000,000 OFFICERIMEMBER EXCLUDED? NIA - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Prof/Poll CPL742051802 01/01/2017 01/01/2018 Liability 1000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD101,Additional Remarks Schedule,maybe attached if more space is required) .. .. ... .. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Fred Olivier!Construction CO. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED AN ACCORDANCE WITH THE POLICY PROVISIONS. 6315 Promway Ave.NW North Canton,OH 44720 AUTHORIZED REPRESENTATIVE ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD v � Ohm° Bureau of Workers' 30 W.spring St. Compensation Columbus,OH 43215 Certificate of Ohio Workers' Compensation This certifies that the employer listed below participates in the Ohio State Insurance Fund as required by Iaw.Therefore,the employer is entitled to the rights and benefits of the fund for the period specified.This certificate is only valid if premiums and assessments, including install- ments, are paid by the applicable due date.To verify coverage,.visit www.bwc.ohio.gov, or call 1-800-644-6292. This certificate must be conspicuously posted. Policy number and employer Period specified below 330189-0 07/01/2016 through 06/30/2017 �o 4 FRED OLIVIERI CONSTR CO /' 6315 PROMWAY AVE NW " ' 4 NORTH CANTON, OH 44720-7.61 4 e 4 r X o www.bwc.ohio.gov oo AaAA� Issued by: Acting Administrator/CEO You can reproduce this certificate as needed. ..Ohio Bureau of Workers' Compensation Required Posting Effective.Oct. 13, 2004, Section'`4123.54 of the.Ohio Revised Code requires notice of rebuttable presumption.Rebuttable presumption means an employee may dispute or prove untrue the presumption (or belief) that alcohol or a controlled substance not prescribed by the.employee's physician'is the proximate cause (main reason) of the work-related injury. The burden of,proof is on he employee to prove the presence of alcohol or a controlled substance was.not the proximate cause of thework-related injury.An employee who tests positive or refuses to submit to chemica testing.may be disqualified for compensation and benefits under the Workers' Compensation Act. Oh� Bureau of Workers' l Compensation You must post this language with the Certificate of Ohio Workers'Compensation DP-29 BWC-1629(Rev.April 11,2016) From:William Rex [mailto:wrex@hyannisfire.or j Sent:Thursday December 29, 2016 1:53 PM To:Gene Cabral<Gene.Cabral@Pauldavis.com> Subject: FW: West Marine 276 Falmouth Road Hyannis From:William Rex Sent:Tuesday, December 20, 2016 5:55 PM To: 'Gene.cabral@pauldavis.com'<Gene.cabral@pauldavis.com> . Subject:West Marine 276 Falmouth Road Hyannis We are requesting that pull stations and horn/strobes be added and tied into the fire alarm system in the building. ..The exit signs at the.rear of the store need to be reviewed. Captain Bill ex Hyannis Fire Department 95 High School Road Ext. Hyannis, MA 02601 508-775-1300 i The information contained in this transmission may contain West Marine proprietary, confidential and/or privileged_information. It is intended only for the use of the person(s) named above. If you are not the intended recipient, you are hereby notified.that any review, dissemination, distribution or duplication of this communication is strictly prohibited. If you are not the intended recipient, please contact the sender by reply email and destroy all copies of the original message.,To reply to our email administrator directly, please send an email to netadmin(cr�,westmarine.com. _. 3 . n TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3 O�� c�cS Map Parcel Application l Health Division Date Issued Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis S Project Street Address a7b 1;0&mo�)NN� SZ�e� V�yr Village Owner 'y,) Address a.7(, E!\cba Telephone_ 502) —776- Permit Request x`Cxlw-%o _CJn6 Square feet: 1st floor: existiogproposed 2nd floor: existing proo'se %C, DE-Pot l new Zoning District Flood Plain Groundwater Overlay 2016 Project ValuatioA am oo Construction Type Tptttt\/Vc gABt ISTABLE Lot Size Grandfathered: ❑Yes ❑ No If yes, ac 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: G/Gas ❑ Oil ❑ Electric ❑ Other Central Air: G/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 e2 _ ki\ Proposed Use APPLICANT INFORMATION r (BUILDER OR HOMEOWNER) Name CA aa� � Telephone Number 5Da y3l -3Nd Address 3( C r c'c� kx)P_ License # C`,,-- Cfl600 Da7q 7 Home Improvement Contractor# 16 07` a I � Email Lane, C 0kM\—,Q ccea Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE /�2 %�o T FOR OFFICIAL USE ONLY or APPLICATION # DATE ISSUED MAP/ PARCEL NO. C ADDRESS VILLAGE r i' OWNER DATE OF INSPECTION: FOUNDATION FRAME x , } INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. N 27m Cown-romvealth ofMassadtrtseft VjDepartment cif rni rrstrid Accide ntr f}ffwe of wez6 afia S. 600 WashizWon Mreet Boston,MA 02111 wrtnumassgovfdia Workers' Camrpensaf m Insurance Affidavit:B.uildersiContracturs/E a trivia s(Pl tubers Applicant Informatian Please Print Ad&est.— a`rJ City/statef � Phone-.u-- 606 _ goo Are you an employer?Check the appropriate b T of project r L❑ I am a 1 vd& 4. I am a general contractor and I Y e- 1 (required): �P * liave lvredMe sub-cosadractoss 6. ❑I+Ie�cansi��iog employees(fall aa�for part-time)-* 2.❑ I am a sole proprietor or partner- listed on the attached sheet 'i- ❑Remodeling ship and have no employees Thew sub-contractors have 8. .❑Demolition. worling, forme in•any capac ity- andlsave wor s' 9. Dail addition. INo wod:ers'Comp.insurance Comp_insurano-4 ❑ required-1 . 5. ❑ We are a c orporafifln and its 10❑Electrical repairs cr adds 3-❑ I am a hnmeov=doing all work officers have exercised Breit 1 L❑Plumbing repairs or additions myself[No workers'camp. Tight of egemmgtion per MGL 13.❑Itoofrepai rs. innzance required-]i c.152,§lM audwe have na employees.(NO w0doers' 1.3-❑o&er cow-msuranm required-) '$try Wrx dart cbectsbos l Est also filloutth�sectionheIowshcndng tt�eirwockexs'ca®p��fi++�po&cyinfaamauovL lFlomeowners ,who submit claisstEdasii g-tb_-yaredaiagRUwaairaAtlmbfte contsctumamstsubmit anew zffidaeitmdigti_q;.sacFi -----i(Z6 antxcto[sfist rbEa this box mast xMud ed sa addid— sheet shaamgtisena of the sub caaRcscbo-ts�d state wlii`es armotibme entitieshare.. .,1 �employees.,Ifthesnb=caatau�es�em sapezpI�tbeymustpmsidetL.�r_n�ar�r�'tomp:,galicygimslser_� . I am all emplayw that is pr4n i W markers"eompaisirda s irmiratrce for my earp&n v4 s. Beroov is$re pv cy and jab site information. Insurance Company Name: Policy or Self-ins.Lie_ F_Kpiration Date: Job Site Address: citylStawrp: Attach a copy of the workers'compensation policy declaration page(showing the policy munber and expiration date). Failure to secare coverage as requiredundes Section 25A of MGL c.157 can lead to tfse imposition of criminal penalties of a fine up to$),50t}OU andf'or one-year imprisonment,as well as civil penalties.in the fort of a STOP WORD ORDER a fuse of up to$250-00 a clay against the violator. Be adcdsed that a copy of this statement maybe forwarded to the Office of Investigations of the DIA.ter insumme coverage,+veriScation- I tf0 fserelty uatdsr the and ahies afdt d at floe iuformatimi prm.ided abmw b true w d avrrect Phone ik Ojai uss rusFy. Da ttat a�ri[g ies tFris.crrecy ter be carripletesd by�ar torFn a,,�rcrrit . City or Town: Pern&Ucense f Issning Auflarky(circle one): L.Board of Real& 1 ceding Department 3.fity]Town Clerk 4 Electrical hapector S.Plmmbmg Inspector 6.Other Conbct Person: Phone 9: haformatiou, and Instructions wear- setts Ge tcral Laws ahaproer 152 requaes all eznployeas Yn XaV Ida WorTX&CQmpMSEtion for�Ir P.DIp1Qy�ES. Pm702antib this statatD,an emTLayee is defined m." cveaypersonin i ie service of anothcr under amy contract ofhire, express or impliecL oral or writb=f An employer is defined as"an mdrvidnal,pmtoe shT,association,corporation or other legal entity,or any two or inure of the foregoing=gaged is aloint enterprise,and including the legal Fepresertfafives of a deceased employer,or the receiver or trustee of an individual,pzrft=ship,association or other Iegal eni?ty,employing employees. However ffie owner•of a.dweIrmg horse having not more ffim tbree apazimmts and who resides ffiamin,or the Occpant oftbe _ dweHing house of another who employs persons to do maintManm.cam5fracti on or repair Wa11-.on such dweIImg house urteu�iffI=tn shallnotbecanse of mch employment be deemedt�o be an ezTloy�." or on.the grounds or buzZdmg app . nce MGL cbapt�r I52"§25C(t7 also st tha t at�eve:ry state or local liz sing agency sha l withhold ffie iss or or renewal of a license or permit to operate a businexs or to consiract buildings in commonwealth for an era apPlicantwho has notproduced acceptable evidence of cdm.PE-,nm Wn the insurance coverage requia ed_" Additionally.M(Z chapter 152.§25C(7)stains-N6ithe-the cometa weabh nor ray of its political subdivisions shall ester into any contract for the p erfc=mW ofpubhc work rmbl acceptable evidence of compliance with the msm'ance., requi ements of this chapter have been presmte d in f e;co—*�cting anffIol ity.7 A-Ppikauts ' Please fa obf the wodcess'compensation affidavit completely,by check'ng th a boxes that apply to your situation and,if neCssarL supply s nam. s, e s and a numb s along With then'cedfffi�E(s)of suh-conirac6ar() .e() �S( ) P� �). msmance. Limited Liabiil ty Companies(L LC)or Limited I.iabffi:t,parfneiships.(I.LP)wiffi no=3ployees Other turn thD members or pahtae as,are not read to cagy Woriceas' compensation i usoranoe. If an LLC or LLP does have employees,a policy isregafi-ed. Be advised that f3isaffidayit may br.mbmitftedintheDepartmentoflndnstial Accidents for confamation Of'; ��„rce coverage Also be sure to sign and datethe afdavit The affidavit should be retied to ffi.e city or town that the application for the permit or license is being regaested,not the D eparfine'd of InEncfrial Acad=ts. Should you have any questions regarding the lair or ifyou are req=ed to obtain a wormers' compensaiionpoliey,please call f d Department at fhe number listed below. Self-insmed companies should entL-x their s elf-in.SM73n a license number on the appmpriate line. City or Town O fEl ala Please be sore that the affidavit is complete and priated.Iegffily. The Department has provided a space at.fie bottom of the affidavit for you to iUI out in fie event the Office of Investigaiiaus has to 001¢act you regarding the applicant Please:be sure to fill in the pev�itIlicemse number vthich will be;used as a mfe mce number. In.addition,an applicant fiat must sabmit multiple p=itllicense applications in any gmm year,need only submit one affidavit mEcafmg cuaerlt policy information(if necessary)and under"lob�e Addrese the applicant should wa -"all locations in (may or- town):'A copy of the-affidavit that has bea officially stamped or marked by the city or town maybe provided to the ' ch applicant as proof that a valid affidavit is on file for foiLre.permits or licenses A new affidavit must be filled oizf ati year.Where a home owner or ei�n is obtaining a license or permit not relabEd to any br's�s or commercial veniirre (i.e. a dog license or permit to bum 1mve s etc.)said person is NOT rcgd=d to complete ibis affidavit The Office of Investigaiions would h to thank you is advance for your cooperation and should you have any questions, please do not:hesitafE to give us a call tr4 one and fax timber: The I3epar(menYs eph T1 CGMMMWedth of Massachnsel#s Depaitamt c&Iid=tdd AOCZent-, ' face�Xnn� tio� � E�111 Fax#617`27 7M Revised 4-24-07 g `Ty] Details Page 1 of 1 Licensee Details Demographic Information Full Name: GENE A CABRAL JR Owner Name: License Address Information Ee NORTH DARTMOUTH MA 02747 United States License Information License No: CS-096001 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 7/11/2016 Issue Date: Expiration Date: 8/27/2018 License Status: Active Today's Date: 1/18/2017 Secondary License Type: Doing Business As: [Status Change Reason: License Renewal Trere uisite Information No Prerequisite Information http://elicense.chs.state.ma.us/Verification/Details.aspx?agency_id=1&license_id=284953& 1/18/2017 2016 12-07 12:42 atore1264fax 5t)87753753 >.> P 111.. x'0'ft Of BfarustAbl Replatory Services Ri mrd V.Sahib Director Building Divi$iaxX :taut xom ,:B�dteg comzaitoaer.;. . 200 Fain S{reat;Aymk,MA:02601 ww�v.tawn.bari�stabie,�,au� _ offtcar 509462 4038- fax:`sta&&790 6 3a` Prop"Ov,mex.Must Co pet and Si n Z" i r eclon r c�'. tab . y `"+' tJwoes of the eobjeet o ` ' 1� PAY'•. eteby snthor2e 1r. a� gst oa z b&aZf, iri all tasttrra raistive to woik autho»od,by this building permit aWkab*n£oo» Aro fences and dtanris,are the responsuhtyoftho.applicant Pools ure not to ba fitted or unitized bib fence fi ia� d andsail final: 3,nsjpect�axe . dAna t .S*oaturc of Owner YP , Si aature aE Applicmat , ;. • Print=lVemc, :- .: FrintName _ _: 4:t7on� a s. wrtettsan�sst ems' •' HYANNIS. MASSACHUSE17S r OFFICE LEASE NEWN4 RKET PLACE Aid :: THIS INDENTURE OF LEASE made#his :`l _day of �by and betw en Noi rket Place Ltnuted'Partnershlp,hereinafter referred to as"Landlord" and having a mailing address of 297 North Street, Building One,; Hyannis, Massachusetts 02601, and Nr t :Marine Products, Inc., pd. hereinafter referred to as "T`enant" and hawng an address of 500 Westridge Dri%e. A atsonville_ California 950.76 41Q0 .. HEREBI'WITNESSETH _. - ; ;:ARTICLE I' Prenuses: '" 1 01 Landlords herebj}leases to Tenant,and Tenant hereby leases from Landlord.upon and'subject'to the terms and:provisions of this Lease,units one and two:of the building indicated as 973 Iyannough Road (Also knori as Route 132},H}aiiitis, '1lassaehusetts, sorrietiines hereinafter refeired;to as;ilte "Demised Premises";shot+n;on Exhibit "A"hereto annexed and made a part liereof. Said building is located on a part!of a trnct of land in HS=arm s, Barnstable County Massachusetts sometiines'l�yo��n as ............NaNmarket Place(the"Shopping Centeth more:particularly delineated on Ekhibit"-:". The square footage contained �iithin the:'Demised Premises shall include only the ground floor.square footage contF�iimi[ttithiii the 1 ktntsed Premises,which squara footage shall be measured from the outside of ail} exterior wells contauing the Demised Premises and to the centzr of any demising«ails separatii the Demised Premises froin other,premises in the Shopping Center If the square footage contained sit the Deinised Premises is less than;6613 square feet,then the monthl%::rent setforth in Section 4.0I for yzars 3..10 and Tenants pro;rata share ofRiainteizanco Charges.for the third year of the term and each year .. !}ereafter shall'be rorated to re#leci the actual s uare foots a coizta.iietl within the Demised Premises P :. _ 4 g . :: - aRT)CLE it Term of Lehse . 2.01 ., To have and to Bold the I)ernised I'rein ses:unto Tenant for the term set forth sit Section 2 02 The term of this Lease shall'commence on the:earlier :of(i) store. opening or (ii) 30 dais after (a} s ibstatltial completion of Landlord's t�l'ork(izs in©re f dlhi described in the attached Ex}� bit "B`')and,;(b) Tenant's receipt of the Certifcate of Occupancy or any other goterninental certification requiredfbr Tenant to latrfu)ly use acid occupy the Demised Premises! This..enn shall be. referred to as the"Initial '!'eim" Iit no event shall Tenant's acceptance of the Demised Premises constitute a tvai4 er bti ,Tenant or arelease ofLaiiolord foraiiy latent ar ether defects in the Demised Premises not readih�'ascertaiitablelbti reasonable visual ims tiotz if Landlord is obligated to construct and install antis irnproveinents alters#ions,or additions'#o the Demised Premises prior to the Coinmancemeiit Date("Landlord's«'ork"} Landlord sliall;use:best eRorts to complete Landlord's Work and.detiver possession:of the:Derr iced - Premises to Tenant by Fe tart'"-1-; 94(tile '"Scheduled Coitipletioi� Date") If Landlord ails to substantia[[v vomplete Landlord's Work obtain a certificate of:oecupaney for the Deinised premises :Marc h : 996. -1 _ _ . :::: _ . . __ _ . _ ___.... _ . . ... _ _.. .._..... .. . . .11 1. _ _. . _._...... ..._ .... _ _ ._ . . . WITNESS the execution hereof,under seat,on this:�Jm. 1 day of-t�3eeetsshe ; # 'S, in any number of . oaunterparticopies,each ofAhich counterpart copies sliatt 1. deemed sin original for all purposes,as of the day and year first above i vritteit. Bv: "Tenant" . ;West: ' ar nd Products, Inc.;; . .. I. �.:�::..:...,1.�:I,::.:—:;:;.::-lp:1:1�::..:...:6:�:::---....:-_�:,:—:..:-.-�;::—,:-�::,`1-I::,I:...1, .�.—:::::w..�:I.1,::.....I.::;::::.:1d:p.:..�—'.-:.,,:..I1-.—:::.—.::::.::;�:::�.....:.::..::;."—;p:�,I.Q.:p—...::.�..:.:::;I4w.::�::::.::..::--.::1-:.:!:..::�� ,,.D.I:...:I!..�P...:::-4�p:.!:,1:.:.:;,:�:::....:...::::-1::::.�:::,I:.'—,,....:...::::::.:_:-1:.�...i.:-:.1:-.;:-f.-..::—.::....7�.—II�-:i1:,�;:,:—.::.—::::..:..-:::".:--�,: &.l.;:I I':;.1:,!:!:�.:..:—:1:.;-:.:.::.-.I.,.--:.1..:11..,-:1-::,....—�1:—.w,,;.-;:;:��,,-.—..w.I:::I1:::::..:...:...-..---1-4..:,..I�:...—,: 3 . . B t Its C.O:C ._ . _. .. _ . . . .: ... - . ., . By .! . .! . Bojulie Trlgni . Director of Real Estate , - -. .. ._ .. _ . _. _. „:By "Landlord" :N ew Market;Limited Partnerslyip By: blew Markel Corporation, Corporate General Partner: . 1. 1. B, 1. - stem, pmm ent: . .. .. _ I. _. - .. _ . . . �f . .. .. .. _. ::: .. .:: ... ... -... ,. ::: y .... .'l _':.. f .... ::: .. ... ._.. .. f .. .. ... :. .. .... ...... ::'.; rt. ... .. .... . .. .... , f Mass. Corporations, external master page Page 1 of 2 ✓ K- y Corporations Division Business Entity Summary ID Number: 942374523 Request certificate New search Summary for: WEST MARINE PRODUCTS, INC. The exact name of the Foreign Corporation: WEST MARINE PRODUCTS, INC. Entity type: Foreign Corporation Identification Number: 942374523 Date of Registration in Massachusetts: 06-22-1992 Last date certain: .Organized under the laws of: State: CA Country: USA on: 11-17-1976 Current Fiscal Month/Day: 12/31 Previous Fiscal Month/Day: 00/00 The location of the Principal Office: Address: 500 WESTRIDGE DR. City or town, State, Zip code, WATSONVILLE, CA 95076 USA Country: The location of the Massachusetts office, if any: Address: City or town, State, Zip code, Country: The name and address of the Registered Agent: Name: C T CORPORATION SYSTEM Address: 155 FEDERAL STREET STE 700 City or town, State, Zip code, BOSTON, MA 02110 USA Country:" The Officers and Directors of the Corporation: Title Individual Name Address SECRETARY PAM FIELDS 500 WESTRIDGE DRIVE WATSONVILLE, CA 95076 USA CFO JEFFREY J LASHER 500 WESTRIDGE DR WASTONVILLE, CA 95076 USA PRESIDENT II MATT HYDE 500 WESTRIDGE DR WATSONVILLE, CA CEO 95076 USA http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEIN=942374523&... 12/7/2016 Shea, Sally To: GENE.CABRAL@PAULDAVIS.COM Cc: Lauzon,Jeffrey Subject: ViewPermit, Permit No:TB-16-3607 Hi Gene, We understand the Hyannis Fire Department had some outstanding items which must be resolved prior to their approval of your proposed project. Please contact Captain Bill Rex from at the Hyannis Fire Department to resolve. This approval must be obtained before we can move forward with your permit application. Sincerely, Sally Shea Town of Barnstable Assistant Zoning Admin/Lead Permit Tech. 508-862-4031 i J Shea, Sally From: William Rex <wrex@hyannisfire.org> Sent: Thursday, December 08, 2016 8:40 AM To: Lauzon,Jeffrey; Shea, Sally Cc: Deputy Dean Melanson; Lt.John Cosmo; Kelly Foley Subject: 276 Falmouth Road West Marine Gene Cabral of Paul Davis drop off remodel plans for store. We are requesting that pull stations and horn/strobes be added and tied into the fire alarm system in the building. The exit signs at the rear of the store need to be reviewed. Captain Bill Rex Hyannis Fire Department 95 High School Road Ext. Hyannis, MA 02601 508-775-1300 1 Lauzon, Jeffrey From: William Rex <wrex@hyannisfire.org> Sent: Friday, December 30, 2016 8:15 AM To: Shea, Sally; Lauzon,Jeffrey Cc: Lt.John Cosmo; Melanson, Dean Subject: FW:West Marine 276 Falmouth Road Hyannis Hyannis Fire is all set with permit to be issued Captain Bill Rex Hyannis Fire Department 95 High School Road Ext. Hyannis, MA 02601 508-775-1300 _.._._ . _.... _... . __.._ w._._ From: Gene Cabral [mailto:Gene.Cabral Pauldavis.com] Sent: Friday, December 30, 2016 8:12 AM To:William Rex<wrex@hVannisfire.org> Subject: RE:West Marine 276 Falmouth Road Hyannis Good°Morning I am confirming in this email that Paul Davis Restorations is fully aware of the request that was asked of us to install pull stations and strobes in the proper locations along with an alarm on the rear exit door,of the West Marine at 276 Falmouth rd. Hyannis Ma.We will be removing the exit sign from the storage room to eliminate the need of an alarm in this area. If there is anything else we need to do at this time please contact myself or call our office and I will get back to You as soon as possible. Thank You _...,.. _.._ ....... __..... .. _._... _..,_._, ....m.,__ _...... _ . _.... __._ _. ._.. . From: William Rex[mailto:wrex@hvannisfire.org] Sent:Thursday, December 29, 2016 1:53 PM To: Gene Cabral<Gene.Cabral@Pauldavis.com> Subject: FW: West Marine 276 Falmouth Road Hyannis .. _......_ _._ From:William Rex Sent:Tuesday, December 20, 2016 5:55 PM To: 'Gene.ca bral@pauldavis.com'<Gene.ca bra I@pauldavis.com> Subject:West Marine 276 Falmouth Road Hyannis We'are requesting that pull stations and horn/strobes be added and tied into the fire alarm system in the building. The exit signs at the rear of the store need to be reviewed. Captain.Bill Rex 1 PROJECT NAME: TF-N��Nt' r?T`'Q(t7 U)66--gr "*Jet N6— ADDRESS: 7-1& FA-LM t a PERMIT# let* 67179 _ PERMIT DATE: // ` 2�" M/P: - ! 3 63 LARGE ROLLED PLANS ARE IN: BOX �6 SLOT—A -3 b Data entered in MAPS program on: BY: / �I 7� q/wpfiles/archive f Sign TOWN OFBARNSTABLE Permit * BARNSTABLE, MASS Permit Number. Application Ref: 200800029 20070115 Issue Date: 01/02/08 Applicant: BORNSTU LIMITED PARTNERSHIP Proposed Use:. SHOPPING CENTER- MALL Permit Type: SIGN PERMIT Permit Fee $ 150.00 Location 276 FALMOUTH ROAD/RTE 28 Map Parcel 293031 Town HYANNIS Zoning District H B Contractor PROPERTY OWNER Remarks rEPLACE SIGN FOR 2 UNITS WITH 88.5 SQ WALL SIGN WEST MARINE BLUE & LOGO Owner: BORNSTU LIMITED PARTNERSHIP Address: 297 NORTH ST HYANNIS, MA 02601 Issued By: PC . POST THIS CARD SO THAT IS VISIBLE FROM THE STREET ¢ 1 4., Town of Barnstable SHE Tph�O Regulatory Services Thomas F.Geiler,Director B" MASS. Building Division ^� mQ s639• 'OTE MAC a 0 Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Tax Collector Treasurer o�AUf 666 2.'-) Application for Sign Permit z 2 Applicant: Assessors No. -,:2 �3 Doing Business As: Telephone No. 31 _ 7 to 1. 4 -- Sign Location Street/Road: 2'T(o -FA -LM D I/l n+- R-D. Zoning District: H 6 Old Kings Highway? Yes/No Hyannis Historic District? Yes/No Prope Owner j n r- Name: i'1S` �-�� �1' �etiJIL�� rY1S�InTelephone: Address:r LiQ f 1 ('j Village: ann Sign Contractor Name: 5(67\1) D�Is (&I\i ; I N 0 Telephone: 5-0(� . �� •Db�i�{ Address: ) 22 ld gilRhl -T Village: 69-0C,K tJ.j V/- 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? Y s/No (Note:If yes, a wiring permit is 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: C Date: J. s Size: E Permit Fee: "s c'1 Sign Permit was approved: Disapproved: Signature of Building Official: Date: �=; dL, w M rev.122801 �� 12/20/2007 23:25 50B7756526 HDLLV MGMT PAGE 02/02 ,RORNSTULIMITED PAR TiVERSHIP 297 North Strcct Hyannis,Massachusetts 02601 TEL(508) 775-9316 FAX(508) 775-6526 EMAIL astcin.holly(@verizon_+tet December 19, 2007 Town of Barnstable Building Division 200 Main St Hyannis, MA 02601 To Whom It May Conccrn: I authorize Sign.Design, Inc. to act as our agent For the enclosed sign permit application.. Business Name: West Marine Property Location: 276 Fa.lmouith Rd Building Owner: Bornstu Limited Partnership Phone: (508) 775-9316 Sincerely, Borrt5tu Limited ParLnership by "Bo.instu Corporation, its Corporate General Partner. President 12/21/2007 Signature Title Date By: Stuart A. Bornstein Its: President Town of Barnstable o� Building Department - 200 Main Street BARNSTABLE. * Hyannis, MA 02601 9 MASS (508) 862-4038 RFD MA'S A Certificate of Occupancy Application Number: 200707178 CO Number: 20080023 Parcel ID: 293031 CO Issue Date: 02/01/08 Location: 276 FALMOUTH ROADIRTE 28 Zoning Classification: HIGHWAY BUSINESS DISTRICT Village: HYANNIS Gen Contractor: ROBERTS, MICHAEL Permit Type: 0000 CERTIFICATE OF OCCUPANCY COMM Comments: WEST MARINE C.O. POLIJ �-- ` Building Department Signature Date Signed c` rl r,. "S 1KE TOWN OF BAR STABLE Building d� Application Ref: 200707178 EaRNSTABLE Issue Date: 1It29/07. Permit y MASS. 039• A Applicant: ROBERTS,MICHAEL Permit Number: B 20071950 �FD MA`t Proposed Use: SHOPPING CENTER.-MALL Expiration Date: 951'28108 1-u cation 276 FALMOtiTH ROA.D/.RTE 28 Zoning District HB Permit Type: COMMERCIAL ADDITION ALTERATION Map Parcel 293031 Permit"Pee$ 607.50 Contractor ROBERTS,MICHAEL Village HYANNIS ApP Fee S 100.00 License Num 053861 Est Construction Cost S 75,000 ......._..--- — .-- _ _.__._ ....... ---— -_ Remarks APPROVED PLANS:MUST BE RETAINED ON JOB AND TENANT FIT•OUT FOR WEST MI I RIINE NO STRUCTURAL CHANGES THIS CARD MUST BE KEPT POSTED FUNTH,,FINAL INSPECTION HAS BEEN MADE, WHERE A —' — CERTIFICATE:OF OCCUPANCY IS REQUIRED,SUCH Ow icr on Record: BORNSTU LIMITED PARTNERSHIP BUILDING SMALL NOT BE OCCUPIED UNTIL A FINAL Add ess: 297 NORTH ST INSPECTION HAS BEEN MADE. HYANNIS,MA 02601 Application Inrered by: PR Building Permit Issued By: T}{{sl'PER'M[.T CONVEYSNQ RIGHT TO OCCUPY�ANY STREET:,ALLY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY ORPERMANENTLY. ENC{ROAC;HEM>N'fS ON PUBLIC PROPERTY NOT SPECIFICALLY PERMITTED UNDER THE BUDDING CODE,MUSTBE APPROVED BY THr.JURISDICTION. STR- ET OR ALLY GRADES AS,WELL AS.DEPTH AND LOCATION OF PUBI IQ SEWI RS'vf 1Y BE OBTAINED.FROM THE DEPARTMENT OF PUBLIC WORKS, TI{EISSUANCF..OFTHISPERMITDOES,TiOT`RF FASETHE•APPLICANTrkOA4;'I'14EC6ND{TIONS'OF.ANY'APPI.ib I3LrSStiIBD'IV{SIONRIi0,'T'RICTION MINI 14IUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONTSTRUCTION WORK: 1.FCUNDATION OR FOOTINGS, 2.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 3.WIRIING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 4.PRIOR TO COVERING STRUCTURAL MEMBERS(READY TO LATH). -5.INSULATION. 6.FINAL INSPECTION BEFORE OCCUPANCY. WHERE APPLICABLE,SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL,,PLUMB'ING AND MECHANICAL INSTALLATIONS. WORK SHALL NOT PROCEED UNTIL THE INSPECTOR HAS APPROVED THE VARIOUS STAGES OF CONSTRUCTION. PERMIT♦TILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.I42A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS tq t 3• I He:ttinl;Inspect' Approvals Engineering Dept l C Fire Dept 2 Board of Health • I YOU WISH TO OPEN A'BUSINESS? =Fo, n,frmation: Business certificates (cost$3.0.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in toby M.G.L.-it doesnot dive you permission to ope.rate.) Business Certificates are available at the Town Clerk's Office, to FL(which Hyannis, MA 02601 [Town.Hall) 367 -MA Wgm on Fi!l in t •n: �s:- c, please: f APPJ_lGAlllT S YOUR IVAME: (:&I >°�c(s S,�: BUSINESS YOUR HOME ADDRESS: cdza a'7y'o 1 � rv,`�1 � G TELEPHONE If Home Telephone Number NAME OF NEW.BU54NE3S IS THIS A HOME OQCUPATION? YES NO TYPE OF BUSINESS: � �-- Have you been given approval froTn the buildin :divtsiori? IEEs ADDRESS OF BUSI�VE55 NO 1�S acl A n l S :MAP/PARCEL-NUMBER �- When starting a new business there are several things you must do in order.to be in compliance.with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street). to make sure you have the appropriate permits and licenses-required to legally operate your business in this town. 1. BUILDING'COIVIM ION R'S O IC This inc ividua has' ir►lo d y permit req ui rem en pertain to,this type of business. Authprized Si ture .* COMMENTS: 2. BOARD OF HEALTH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature** COMMENTS: . 3: CONSUMER AFFAIRS[LICENSING AUTHORITY) This individual has been informed of the licensing.requirements that pertain to this type of business. Authorized Signature.* COMMENTS; YJ TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION. Map Parcel 3 Application# ®�� I �� Health Division Date Issued ` 3.: d Conservation Division Application Fee Tax Collector Permit Fee 0 Treasurer Planning Dept. pro 3 �L ON. 48 I Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis Ste' �3 d Project Street Address 21 F914wb 0-�( Qv Village Owner they - S� a L J1 Address -99 7 /0o eT4- S7— Telephone 77,5_- :2 3V! Permit Request J-o-e-4 90 J0o U y -- A,10 Square feet: 1 st floor:existing/lOY 15__0a proposed Id,S' '� 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 2-5i o Construction Type 4_9©& N M L Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) Age of Existing Structure /a S Historic House: ❑Yes iallo On Old King's Highway: ❑Yes No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other NAg- Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing 62 new 1.�_ Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: 0 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 ❑newt size, , Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial)ZII Yes ❑No If yes,site plan review# f Current Use �� �L � Proposed Use �e ; Ga BUILDER INFORMATION Name , , �Ll�eC ` ���,�Z S Telephone Number ,5VeO 96. - Address y0 t? r5,7- License# e-25 0.5-_1 d--!/ , �uiS f�1 Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO l9e6,Z2GJFISi i= SIGNATURE &_-eeDATE -/.7 -D-7 '.4 r t FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: t FOUNDATION 1 FRAME INSULATION t FIREPLACE ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH ° p el FINAL rw i GAS: ROUGH • " cry FINAL FINAL BUILDING ©r • DATE CLOSED OUT ASSOCIATION PLAN NO. ` t , i 03/20/2007 12:21 5037"756526 HOLLY M1JGT PAGE 02/03 DatOt 2/13/2007 Time1 0*42 Ald TO; 6 7,18037756546- DoW11nc E O'NAi1 PA(Eae 002-003 ' Clientd-16170 _!S)FPEWISSETTCO RD, CERTIFICATE OF LIABILITY INSURANCE 21131nvoonYY f) 02/1$!0T ' IrA�0- THIS CERTIFICATE!IS l;SLUED AS A MATTER OF INFORMATION wring O'Nell Insurance ONLYAND CONF6 s i O RIGHTS uPoN THE CERTIFICATE ,encY HOLDER.THIS CER'rIF iI.ATE boos NOT AMEND,E'X76ND OR ALTER THE COVER,4G is AFFORDED SY THE POLICIES BELOW, 222 West plain St PO pox 199Q m- . Hyannis,NIAt D2601 INSURERS AFFORDING E:OVERAGE NAIL 0 wSIIREO iNSURERA; Associated E I'1 Top yens tnsu renc Cbmpa SIpp9Vaissett Cotlstructiun Corp. INSURERS. — &Hard Hat Construction kIMNSUEWREMORCE.- THE29T Notch StreetHyannis,MA 02601COVERAGES POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE NSUREO NAMED ABOVE FOR THE'Pt LICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREUENT,=44 OR CONDITION 01:ANY CONTRACTOR DTHER DOCUMENT WITH KE;PECT 70 WHIC 11 THIS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,TIE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREON IS SV5JECT TO ALL THE 75RI'S.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,AGCREGAT=4IMI116 SHOWN MAY HAVE;BEEN REDUCM BY PAID CLAIMS, TR INSIRI rMe OF INSURANCE POLICY wumegR P IGY EFF@OTiyE PO GY Exl'IBA SON DATE(MMAX)ffn DATE INm1LOD UMrre GENGIZAL IJAHM-Y EA04 OCCURRENCE $ COMMERCIAL GENERAL LIASIL, OAMAGE REPrIEO $ PR CLAIMSMADE OCCUR MCDEXP(Any onop- 1 $ PERSONAL&AOV INJURY $ GENERALAWREUATE $ G6NL 0aPtOATE LIMIT APPLIES PER: PRODUCTS'•COMPIOPAGG S PCLICV 0 713 F1 LDC AUTOMOBILE LIABCRY COMBINED ENSSLELIMIT $ ANYAUTQ (Es aaklonl) ALL CANNED AUTOS BODILY INJURY S SCKOULEDAUT05 (Pwperson) kRED AUTOS ODDLY INJURY NONOWNEDAUTOS (Foruddent) $ NWERTY LAMAGE $ ' (Por x�dce+il GARAGE LUIBILM — AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER TWAN —fl I I --- AUTO ONLY; AGG $ EIiCESSAUMeRELIALIgtfIyTY EACH OCCURRENCE S OCCUR 0 Ci,ANS WADE AGGREGATE $ S OEOUC I LE s ION s _ s A wamas COMPENSATION AND WCC5000549012006 12107106 12107/07 TtWYwe s rAru- OTrI- EMFLAY(RB'L IABLITY ANY PROPRIETCRIPARTNERJUEGUmE r-L•EACH ACCIDENT I$500,000 00FIMINMEMBER EXCLUDED? dowels unCer WE.4 DISEASE-EA EMFtOYE s500 OQ0 'Ial.t�RtfVISI E.L.015FASP-POLICY LIMIT $500.060 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VOWLE5J EXUAISIONS ADDED BY EIIJDGRSEMENT'I 5PECIALLPROVISIONS Insurance coverage is limited to the terms,conditions,exclusions,oilier limitations and endorsements. Nething oontained in the certificate of insurance shall be deemed to have altered,waived.or extended the coverage provided by the policy provislonr. CERTIFICATE HOLDER CAIICEL,LATION _ SHOULD ANY OF THE ABCVE DUS121:1690 POLICIES BE CANCELLED BEFORE TR6 ExPIRATION Suffield Mamt Corp,etal• DATE TNEREOF,THOISSUUIG WSW'EIZVALLENDEAVORTOMAIL 1n DAYSWRIrMN 297 North Str"t 1401144E TO THE CERTIFICATE HI SI.a tR NAMED TONE LEFT,BUT FAILU RE TO 00 SO SHALL Hyannis,MA 02601 IMPOSE NO OBUdATION DR,LIASIb Y OF ANY KIND UPON THE INSURER,R4 AGENTS R RORESEUTATrvE9. AU7VQRQeD R PRE5-1N1AYLv1: ' ACORD 25(2001J08)1 of 2 #46415 . I LS1 Os ACORD CORPORATION 198B s � BOARD OF BUILDING REGULATIONS icense CONSTRU..CTION SUPERVISOR Number. CS 053861 a' �irthdate 02/13/1955 Expires ,02/13/2008 Tr.no: 18454 I 3 � estrictetl Ml -L J ROBERTS 1815 FALMOUTH RD#C6; w. CENTERVILLE, MA 02632 Commissioner tt f a , Massachusetts Department of Environmental Protection ..,.. Bureau of Waste Prevention . Air Quality 1100064220 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition Important: A. Applicability When filling out hh - 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 use the return (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09(2)ten (10) days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. rc�m 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 HYANNIS CROSSING, UNITS 2, 3 &4 Environmental Protection a.Name notification 1276 FALMOUTH ROAD requirements of b.Address 310 CMR 7.09 BARNSTABLE MA 02601 c.Cit /Town d.State e.Zip Code (508)775-9316 f.Tele hone Number area code and extension .E-mail Address lo tional 112,500 1 h.Size of Facility in Square Feet i.Number of Floors j. Was the facility built prior to 1980? [l Yes 0 No k. Describe the current or prior use of the facility: RETAIL STORES _ I. Is the facility a residential facility? [l Yes 2]✓ No —� m. If yes, how many units? o Number of Units �0 3. Facility Owner: �N BORNSTU LP �o a.Name —�0 1297 NORTH STREET b.Address HYANNIS _ MA 02601 _� _0 c.Cit !Town d.State e.Zi Code —�o (508)775-9316 f.Telephone Number area code and extension .E-mail Address o tional _C MICHAEL ROBERTS �Q h.Onsite Manager Name ag06.doc-10/02 BWP AQ 06•Page 1 of 3 Massachusetts Department of Environmental Protection Bureau of Waste Prevention •Air Quality 100064220 BWP AQ 06 Decal Number _ Notification Prior to Construction or Demolition General Description General Pro, ect cont. Statement:If B. J p (cont.) asbestos is found during a Construction or 4. General Contractor: Demolition MICHAEL ROBERTS operation,all responsible parties a.Name must comply with 11815 FALMOUTH ROAD.APT C-6 310 CMR 7.00, b.Address erg1 E of the and Chapter 2 CENTERVILLE MA 02632 Chapter d_ General Laws of c.Cit /Town d.State e.Zi Code the Commonwealth. (508)962-7792 This would include, f.Telephone Number area code and extension .E-mail Address o tional but would not be limited to,filing an IMICHAEL ROBERTS asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of C. General Construction or Demolition Description release of a hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. MICHAEL ROBERTS a.Name _ 1815 FALMOUTH ROAD,APT C-6 b.Address _ CENTERVILLE MA ®�� 02632 c.Cit !Town d.State e.Zip Code (508)962-7792 f.Telephone Number(area code and extension) g.E-mail Address(optional) MICHAEL ROBERTS h.On-site Manager Name 2. On-Site Supervisor: MICHAEL ROBERTS On-Site Supervisor Name 3. Is the entire facility to be demolished? ® Yes Z No �N _0 4. Describe the area(s)to be demolished: s �0 INTERIOR PARTITIONS, NON-STRUCTURAL N =0 =0 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: OPEN FLOOR PLAN, CUSTOM SHELVING �O �Q aq 10/02 BWP AQ 06-Page 2 of 3 �.r LlMassachusetts Department of Environmental Protection ■ Bureau of Waste Prevention • Air Quality 100064220 � 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? c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 11/19/2007 03/31/2008 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 IMICHAEL ROBERTS � =o above and that to the best of my a.Print Name -o knowledge it is true and complete. MICHAEL ROBERTS The signature below subjects the b.Authorized Signature -_N signer to the general statutes PROJECT MANAGER -o regarding a false and misleading c.Position/Title o statement(s). BORNSTU LP d.Representing 11/08/2007 �co e.Date(mm/dd/yyyy) �Q ■ aq 10/02 BWP AQ 06•Page 3 of 3■ f '1 eDEP - Payment Confirmation Page 1 of 1 - y g yy c Payment Confirmation DEP Transaction ID : 155261 Payment Date : 11/8/2007 5:10:29 PM $85.00 has been charged to Credit Card ************7995 Transaction Information DEP Payment Code#27725 Payment Confirmation#23868 Please note that payments received after 3:30 pm will not be posted until the next business day. MassDEP Home o Contacts _ Feedback o Tour Privacy Version: 6.5.11.0 https:Hedep.dep.mass.gov/Restricted/webpages/PaymentConfirmation.aspx 11/8/2007 I DeoartMent of 1naz.,srrzal flmwents 600 Washington Street 41 .� Boston, Mass. 02111 3• ON N Workers' Comyensation Insurance davit T1t7PC�BI CIiI�LutaRFlit�,,,./�� -- -- — name: S I PPEWISSETT CONSTRUC ORL location: 297 North St': City Hyannis MA 02601 phone# ( 508 ) 775- cq)2 , ❑ I am a homeowner perfanning all work myself. ❑ I am a sole proprietor and have no one working i"n any ca achy /g////%//i�///////0%///%////%///////////////////////////////���/%///%%////////////%%/%%////%/%%//%%/////%/I/%/%/%/%%//%/////%%%/////////%%///% %%/////i%��i, ® I am an employer providing workers compensation for my employees working on this job. tom rtnv name: Live w i. address: 2 Strept ...... Hyannis , MA 026"01 phone#: 508 ) 775-9316 nlicy#W.CC 500054901200 -. insurance co. i�/ii�i/ii!!/�iu�ilc%iirr//iiii /// ❑ I am a sole proprietor, general contractor, or homeowner(circle one and have hired the contractors listed below who have the folloiiing workers'compensation polices: eomoanv name: :: >.�.....:.... addr•ras: hone#. r.," ;::K•v;.:•;:: cfty. ..:. '' '• •5:::; Yid•� rollcv insurance cn. comnanv name: address ,: , :. ... /" • ::{;:.,y .}•ray . - :l..i.�:[.]\fi•' ...s... .... •. .y;<;:+i r i%fjr f"Y+ :ilk' inaorancc co. <. �////////�%%// / �,FaBure to secssre coverage as segnired»rsder�eciion 23A of MGL 1S2 can lead"to the impwttion of trlrnind Penalties of a llna rap to 52.500.00 and/or one rears'tmpry cov»ra as welt u dd p da in the torts ora STOP IYORK ORDER and a nne.of S1tt0.00 a day_against sne. I understand that a copy of this statement mar be forwatdat to the O[11ce otlnvest3gations of the DIA for coverage veriIIation. j her ce ify un the d enalti f perju the information pro vidrd above is trti�and concc� Date 11/7/2007 Signature Micha J . Roberts Phone ( 508) 775-9316 Print name .......... . . :... ..;.... .. . . otIIcial ttse only do not write in this area to be completed by city or town ofllcial parraitlilce-we ttiiding Departrnent city or town: Dldcenaing aosrd Melernnen'a Ofnce checks Lf L-=. ediste response b required Q$ealth Dcpar•trnrnt phone{#; DQther __-- contact person a9,95NA) Town.of Barnstable Repl*Ory Services Thomas F.Geiler,Director LA Building 7Divis10n �FnnM'� TomYerry, Buflding Commissioner 200 Main Street, 7lyaaais,MA,02601 www.town barustable;ma.u3 Fax: 508-790-6230 O{�iae; 508-862-4038 . Property 0Wner Must Complete and Sign TMS Section If Using A7Build.eyr by Stuart Bornstein ,as Owner of the subject property M i c Pra e l J. Roberts to•act On my behzff; 'hereby a"thonze: in �.tters relative to work authorized bytlus buMng permit application for. 276 Falmouth Road, Hyannis , MA 02601 11/.7/2007 Signatur of Date Stuart Bornstein Print N=e . . . .. ' . . .. . . I.I. . . " .. . . . . . . . . . ' . . . . . . . . . .. ' .. . . . . . . _ . . .. " . . . . . . . . . . . . . .. .. . . .. .. . . . . , . . . . . . . , . , . . . I. . . . . . . r FCO Letters . . Flat cut out letters for front facade of business .. .. .. . . . . . Logo:38.x 335 " : . . i . . { rt . . 1"thick pvc . O' . . . . .. . . .. . . .. . _ .. . . . . . . . . . . . . . . . . . . . painted to match SW 1812 award blue,'. .0 . . . . . .. ' . . .. .. • . . . . .. .. . . stud"mounted to.building fascia . . . 0 . . secured with silicone' .. .. . . . . . 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Date .. . i . . . . .. ,' Fabrication, 11-27-07 No." j . .. .. . . . . . . 01 . . . . . . . . . . . . ud mounted to building fascia . . . . s . . . . . oose neck li htto the far left is ro o. . . fl _ SeGU t . . W ItI. .. . . . . . . 9 . ght p. p ------ - - _ - - . -- _ , . - : -. _ ti . . . .. .. . . . .. .. cs . o . . [11�UC�"1 t] U r. . .. . . .. .. . . /''� . g t Numb .. "' O .. ojec44428 er a e N/A : . . r c . . . . _ . . . Title: , - i et . ; _ . ,o ., SheFCOletters �,. ` Fr v West Marine:Hyannis.Location . . . . ff6„ ' . . . . . . al . .. I � 1 . Project Developer: Designer: I :. . � � e� . y1-„ �- .,e....rr- ......«,.,,i EY . . . - . . .. .. R. O''Neale DL . _ . . I- . . . . . . . , . . . Sheet Number. . . . . GO1.00 . . . . . . . . ' . . .. . . . . . . . . : . MN Thil tloc.. antl.me desipl!e harem were=Read eapRssly for ibis pml0ct and • . . j .. { . j ( _ remain me,mwly I sq 0 pn Inc.They-may nat be pip M a us a Dr am other pu 1 —wumo w. nn:Coneeat'atebonedte,of Ski Deipn,Inc. " j '. . ____ _ ___..____— T - . . - - ------ _ _- , _ _- -_--- :-__I. . -.- --- - - ----- ____ -- --- ---- - . . � � - - —