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HomeMy WebLinkAbout51 MAIN STREET (HYANNIS) i i 1 ' r f TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �l2 Parcel ;'Application #/� Health Division Date Issued �. Conservation Division Application Fee I Planning Dept. Permit Fee ` Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address � Village U, vt c (2 Owner . 0 Address . 0� A,� AAis 12,u0 r.®De Telephone A- b2 0✓ Permit Request 1 0 ®4/ o h I" Square feet: 1 st floor: existing &b0 proposed b 2nd floor: existing ® proposed 0 Total new L Op Zoning Distric Flood Plain Groundwater Overlay Project Valuati n L 0 DD 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 S Historic House: ❑Yes XNo On Old King's Highway: ❑Yes A No Basement Type: ❑ Full ❑ Crawl ❑Walkout Other Basement Finished Area (sq.ft.) tl!�> Basement Unfinished.Area (sq.ft) e-n> Number of Baths: Full: existing Z7> new Half: existing new n 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 N0 Detached garage: ❑ existing ❑ new size—Pool: ❑existing ❑ new size _ Barn: ❑ existing newjsize_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial YYes ❑ No If yes, site plan review# Current Use 0!5?Ii3C46 Proposed Use ., G✓t APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name' Telephone Number in &(�q 4 qK .fV1 M 1A4 Address License # 5 !7 l 4Home Improvement Contractor# --' Worker's Compensation # A CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO iWIV /1J SIGNATUREA444 DATE iz z��� y c` FOR OFFICIAL USE ONLY ` APPLICATION# DATE ISSUED MAP,/PARCEL NO.; ADDRESS. VILLAGE - r , OWNER DATE OF INSPECTION: l , _FOUNDATION_i_ : y i FRAME 1; INSULATION ' ' FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL GAS: CRIA :" +ROUGH 3'�'s° gF; FINAL -i' FINAL BUILDING .:,f� � - t K: DATE CLOSED OUT 1 ASSOCIATION PLAN NO. E . } Page 1 of 1 Shea, Sally From: Lt. Don Chase [dchase@hyannisfire.org] Sent: Thursday, December 23, 2010 4:53 PM To: 'Brent Heinzer' Cc: Shea, Sally; Perry, Tom Subject: RE: Quest Diagnostics - 51 Main Street Hyannis Brent, Plans look ok.There looks to be two horn strobes added on the proposed drawing—A101. A permit will be needed for changes to the fire system. Reading the General Notes on page A101 (item #25) states sprinkler to be provided and installed. Is this planned or just"boiler plate" notes? Have a nice holiday. Thanks, Don Lt. Don Chase,Jr., FPO Fire Prevention Officer Hyannis Fire Department 95 High School Rd. Ext. Hyannis, MA 02601 (c)508-648-5806 (w)508-775-1300 x106 From: Brent Heinzer [mailto:bheinzer@bthassoc.com] Sent: Wednesday, December 22, 2010 11:40 AM To: dchase@hyannisfire.org Subject: Quest Diagnostices - 51 Main Street Hyannis Don, Attached please find a PDF file of construction documents, for your review and approval,for the above mentioned project. If you have any question please give me a call. Regards, Brent Brent T. Heinzer, R.A. President B. Thomas Heinzer Associates, Inc. 975 Merriam Avenue, Suite 201 Leominster, MA 01453 (p) 978.466.6560 (f) 978.466.6565 www.bthassoc.com e 12/29/2010 � T/x De gn Smd:'o of H' ' B. Thomas Heinzer Associates, Inc. _BT Architects December 2 1 , 2010 Town of Barnstable 200 Main Street Hyannis, MA 02GO RE: I I G.0 SIGN-CN: DTI -7G8 Quest Diagnostics 5 1 Main Street, Unit#G Hyann15, MA 02GO I Building Comm1551oner In accordance with Section I I G.0 of the Massachusetts State Building Code, I, Brent T. Heinzer, Registration No 2058 1 being a registered profe55ional architect, representing B. Thomas Heinzer A5500atC5, Inc., hereby certify that I have reviewed, annotated and directly 51-lpervi5ed the preparation of all de51gn plans, computations and 5pecification5 concerning: ENTIRE PROJECT ® ARCHITECTURAL ® STRUCTURAL ❑ FIRE PROTECTION ❑ MECHANICAL ❑ HVAC ❑ ELECTRICAL ❑ CIVIL/SITE ❑ OTHER(Specify) For the above named project and that, to the best of my knowledge, such plans, computations and 5pecification5 shall meet the applicable provisions of the Massachusetts State Building Code, all acceptable architectural and engineering practices and all applicable laws and ordinances for the proposed use and occupancy. I further certify that I shall perform the necessary profe55ional 5ervice5 and be present on the construction Bite on a regular and periodic basis to determine that the work 15 proceeding in accordance with the documents approved for the building permit and shall be re5pon5lble for the following a5 Specified in Section I I G.2.2: I . Review of shop drawings, samples and other materials of the contractor a5 required by the construction contract documents as submitted for building permit, and approval for conformance to the design concept: 2. Review and approval of the quality,control procedures for all code required controlled materials. 3. Special architectural or engineerinq professional inspection of critical construction component requiring controlled materials or construction specified in the accepted engineering practice standards. Pursuant to Section I I G.2.3, I shall submit periodically, a progress report together with pertinent comments to the local Building Official, a5 required. Upon completion of the work, I shall Submit a final report a5 to the satisfactory completion and readiness of the project for occupancy. y ��RED ARC HFf� C� Yr � m4� �� Subscribed and sworn to before me this 4-1/ day of 20L0. rD _ ~ WE MI R Notary Public State T y F My Commission EShA T. xpires Da e1 U lf Notary Public Brent T. Heinzer, Architect Commonwealth of Massaehu: B. Thomas flemzer Associates, Inc. My Commission Expi April 13,2012 9'7„ 5 Merr.lam Avenue , Suite 201 , Leominster , MA 01453 ( P ) 9 7 8 - 4 6 6 - 6 5 6 0 ( F ) 978 - 466 - 6565 www . bthassoc . coin be `X�e'guI , :or `: r vtc•es: Ttia"m es:F..Gea D?re0or ". Bta ldin' } J 'isron r. . BO t�uilrlmg C�min:iss�On�r 200 Main{Streat; 14yannis. MA- 2-60 t w►r'iY:'town,tan�nst�rtitck.�a•.rrs ._ C?fFrcc. 30.5=&b2- O B E>. .. t .. Ft+ S(3 =7,90-tiZJO e.rey. O rict l ils.:' . b _r- Cotnpllat. av id'S(gp.T,I(a:i{g S e c�.on � 51a7[.5.1 g^I �l F � �.:4'h:.;;{r.k .. - r 4 i i V##�. ,�`Ca`,��•: ` -.k. c_"Su.x )ecOi 4 .. roper, + h ere sy,a=ukS7artzc- � ueaDmiattcrs It -bite awork:alathQrtcit� �y.t} s,bv�lding.parmit"2p 6tabon:f6`r . (Address:;raC�`ab Ab Sigtians€c ofwzser ISte f`FPoprtyo : e Oplyir gorpmVsceompla eF rngr� er ws4p $ reverse tide'. ���'�i'�tLf�FC'> tb�:(tding��rmit farmsCfXft2�S$d4z Revjsrft 0721 10 The'Commonwealth of Massachusetts William Francis Galvin - Public Browse and Search Page 1 of 2 The Commonwealth of Massachusetts William Francis Galvin w Secretary of the Commonwealth,Corporations Division =y One Ashburton Place, 17th floor Boston,MA 02108-1512 Telephone: (617) 727-9640 B. THOMAS HEINZER ASSOCIATES, INC. Summary Screen Help with this form Request a Certificate The exact name of the Domestic Profit Corporation: B. THOMAS HEINZER ASSOCIATES,INC. Entity Type: Domestic Profit Corporation Identification Number: 000887356 Date of Organization in Massachusetts: 02/02/2005 Current Fiscal Month/Day: 12/31 The location of its principal office: No. and Street: 154 BARTHRICK RD. City or Town: WESTMINSTER State: MA Zip: 01473 Country: USA If the business entity is organized wholly to do business outside Massachusetts,the location of that office: No. and Street: City or Town: State: Zip: Country: Name and address of the Registered Agent: Name: BRENT THOMAS HEINZER No. and Street: 154 BARTHRICK RD. City or Town: WESTMINSTER State: MA Zip: 01473 Country: USA The officers and all of the directors of the corporation: Title Individual Name Address(no PO Box) First,Middle,Last,Suffix Address,City or Town,State,Zip Code PRESIDENT BRENT THOMAS HEINZER 154 BARTHRICK RD. WESTMINSTER,MA 01473 USA TREASURER BRENT THOMAS HEINZER 154 BARTHRICK RD. WESTMINSTER,MA 01473 USA SECRETARY BRENT THOMAS HEINZER 154 BARTHRICK RD. WESTMINSTER,MA 01473 USA DIRECTOR BRENT THOMAS HEINZER 154 BARTHRICK RD. WESTMINSTER,MA 01473 USA business entity stock is publicly traded: _ The total number of shares and par value, if any,of each class of stock which the business entity is authorized to issue: Par Value Per Share Total Issued Class of Stock Enter 0 if i Par Total Authorized by Articles and Outstanding http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 12/29/2010 The Commonwealth of Massachusetts William Francis Galvin - Public Browse and Search Page 2 of 2 of Organization or Amendments Num of Shares Num of Shares Total Par Value CNP $0.00000 10,000 $0.00 0 Consent Manufacturer _ Confidential.Data _ Does Not Require Annual Report Partnership _ Resident Agent For Profit _ Merger Allowed Select a type of filing from below to view this business entity filings: ALL FILINGS Administrative Dissolution f Annual Report Application For Revival Articles of Amendment View Filings I New Search Comments ©2001-1010 Commonwealth of Massachusetts All Rights Reserved Helo 4 http://corp.sec.state.ma.us/corp/corpsearch/CorpSearchSummary.asp?ReadFromDB=True... 12/29/2010 f ACORD,w CERTIFICATE OF LIABILITY INSURANCE °A 12121 0 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION DeCarolis Insurance Agency, In ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 146 North Main Street ALTER THE COVERAGE:AFFORDED BY THE POLICIES BELOW. Leominster, MA 01453 INSURERS AFFORDING COVERAGE NAIC# - - ..._.._...-- .._._._.....--...--........_........_..........--- ..:...... ----........._........_.---.._._.. .._.._..__...... --._..._...._...— - ---.._..--------... INSURED i INSURER A-Norfolk.&-Dedham-Insurance__Co..i_--------_-.-.------------ B Thomas Heinzer Associates In INSURERS: Insurance Compan _ - 975 Merriam Ave, Suite 201 INSURERc:_...__--......_......._.._.—_...___-- ..._............ - : ........... Leominster, MA 01453 .......................... INSURER D: INSURER E COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. -- -- __ _.-........._-- �.._..-. -......-----.--..._..._._.__ ... ..............._.. ... _..._. POLICY Mite; t POLICY EXPIRATION - INR ApD'L POLICYNUMBER D DATE LIMITS TYPE ! GENERAL LIABILITY .EACH OCCURRENCE............. $_ _1,000,000...... ----I j i pAMAGETORENTED -�COMMERCIAL GENERAL LIABILITY t LFR_6y!.SE$(Eaaerce) . ..j$ ............. I A ; CLAIMS MADE :OCCUR 1R0645264A 1/28/10 1/2E3/11, MEDEXP(Anycr�apersm) .$. 5,000 FERSONAL8ADVNJURY is 1,000,000 i GENE RALAGGRFGATE_..._.... .$..._2,O00,OOO PRODUCTS COMP�OPAGG !$ GEN'LAGGREGATE LIMIT APPLIES PER: i i -----..._... .. -.—._......-............._.......__. j I i POLICY I PRO- 4 !LOC j AJTOMOBILEUASIUTY COMBINEDSNGLEUMIT '$ (Ea amdert) •ANYAUTO ........,...t._..........._...., I !ALL OVMED AUTOS BO DI LY N JURY !$ i L........I i (Per person) I I SCHEDULED AUTOS L_..........._...._......_.. ............ i ' ! HIREDAUTOS ' i BODILYNJURY $ (Per a0d Cat) ' I NOWOMED AUTOS —..._............_ -- -- L PR CP ERTY DAMAGE is I ' (Per aca dai t) I ! I !GAR AGELIABIU7Y I AU TO0NLY•EAACCDENT 'S ..._...---....._...--.__-.. L ANYAUTO ! I OTHER THAN EA ACC-i$........_...._._. ...... - ... } I i AUTO ONLY: AGG ;$ i 3 IXCESSNMBRELLALWBILITY EACH-OCCURRENCE $............._._.._._...-.............__..._. NC E 1 OCCUR CLAIMS MADE i `AGGREGPSE..................... .�..$ .................._....... ..._..- $ DEDUCTIBLE { ! $ .._... ...— RETENTION $ I m STATU !OTH WORKERS COMPENSATION AND i I ----;TQRY LIMBS EMPLOYERS LIABILITY I E L EAC H AC CIDE NT $_....._........100,000 -- MYPROPRIETORIPARTNERrEXECUTNE ( .._..._....-....----......._..---------..... Aj OFFICER/MEMBEREXCLUDED? WE083237A 8/16/10; B/16/11E EL05EASE-EAEMPLOfEE t$ 100...000 I Ifye6dW—P'i6a 1SK i ELDISEASE-POUCYLMIT $ 500,000 i SPECIAL PROVISIONS talaru I OTHER B iProfessional Liability AEL1003223 9/7/10 9/7/111$ 1,000,000 i DESCRIPTION OF OPERATIONS/LOCATIONS I VEH ICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPERAT0M TOWN OF BARNSTABILE DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN 200 RAIN ST. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL HYANNIS, MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR L-MseREWNTATIVES. AUTH RRED RE ACORD 25(2001108) © CORD C ORATION 1988 f I. Massachusetts- Department 0 Public afe Board of Building Regulations and �tatel`4 ix Construction Supervisor License License: CS 74213 Re"stticted to., 00 BRENT T HEdNZER 975 MERRY AVE#2Q1 LEOMINSTER, MA O'1453 Expiration: 2J22/2011 ('ummivionrr i The Commonwealth of Massachusetts Department of Industrial Accidents — l Office of Investigations 600 Washington Street ! Boston, MA 02111 www.tnass.go v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name (Business/Organization/Individual): QQ Address116 fACiPLA AVE, �20 jl.tZ_-Oi City/State/Zip: Ito Phone #.. ko(pa fpS�Q Are you an employer? Check the appropriate box: Type of project(required): 10 am a employer with_9- 4. [] I am a general contractor and,I / * have hired the sub-contractors 6. ❑ New construction employees(full and/or part-time). 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have S. :Demolition Workingfor me in an capacity. employees and have workers' Y9, E]Building addition [No workers' comp. insurance comp. insurance.t required.] 5. We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their. 11.0 Plumbing repairs or additions myself. [No workers'comp. right of exemption per MGL 12 ❑Roof repairs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13.0Other comP• insurance required.] ] *Any applicant that checks box#1 must also fill out the section below showing their workers compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name.of the sub-contractors and state whether or not those entities have . employees. if the sub-contractors have,employees,they must provide their workers'comp.policy number. I am an employer fhat is providing workers'compensation insurance for my employees. Below it the policy andjob sr'le information. 11// Insurance Company Name: 0_ 0(J J_121- ,�; �Q Policy#or Self-ins. Lic: #: r 01piration Date: /(e VV Job Site Address:o mlkw 4f City//S.tate/Zi 1A.A1 MA 6p1 Attach a copy of the workers' compensation policy declaration page(showing the policy nu ber and expiration date). Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. ]1do hereby certify u der e ins andpenalties ofperjury that the information provided above is true and correct.natur Date: `Z ZI Za�� Phone#: Official use only. Do not write in this area, to be completed by city or town official { City or Town: Permit/License# Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: 'Information and Instructions 4,f , Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as "...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling.house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."' • s MGL chapter 152, §25C(6)also states that"every state 6r'local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings.in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill out the workers'compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s)name(s), address(es)and phone number(s) along with their certificates)of insurance. Limited Liability Companies (LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has,to contact you regarding the applicant. Please be sure to fill in the permit/license'number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current policy information (if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia r Massachusetts Department of Environmental Protection Bureau of Waste Prevention - Air Quality J100118757 I • �.l; BWP AQ 06 Decal Number, Notification Prior to Construction or Demolition Important: A. Applicability When filling out pp y forms on the computer,use only the tab key A Construction or Demolition operation of an industrial, commercial, or institutional building,or to move your residential building with 20 or more units 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 s� work being performed. The following information is required pursuant to 310 CMR 7.09. (� B. General Project Description 1. a.Is this facility fee exempt-city,town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?❑Yes ❑✓ No -- 1.All sections of b. Provide blanket decal number if applicable: Blanket Decal Number this form must be completed in order 2 Facility Information: to comply with the ty Department of Environmental Protection a.Name notification 51 Main Street requirements of b.Address 310 CMR 7.09 H annis MA —j 102601 c.Ci /Town d.State e.Zip Code I f.Telephone Number area code and extension E-mail Address(optional) 1,200 1 h.Size of Facility in Square Feet i.Number of Floors j.Was the facility built prior to 1980? ❑ Yes ✓❑ No k. Describe the current or prior use of the facility: Multi-Tenant Office Building I. Is the facility a residential facility? ❑ Yes ✓❑ No .- m. If es, how man units? �p y y Number of Units 3. Facility Owner: N J R Fennell Realty Trust 1994 -- o a.Name 0 1501 Mass Ave,2nd Floor �..�� b.Address 02139 Cambrid e _ c0 c.Citvrrown d State e.Zip Code 5=9901=0 (617)876-8800 1 lkfennell@odypartners.com --� f.Tele hone Number area code and extension .E-mail Address(optional) s(7 Simon 11�� 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 100118757 �._ Decal Number I� BWP AQ 06 Notification Prior to Construction or Demolition General B. General Project Description (cont. Statement:If p asbestos is found during a Construction or 4. General Contractor: _.._.,�_ Demolition *con Construction Group operation,all responsible parties a.Name — --- must comply with 1767 Central Park Ave 310 CMR 7.00, b.Address _ 7.09,7.15,and Yonkers NY 10710 --� Chapter 21 E of the General Laws of c.Ci (Town d.State e.Zip Code the Commonwealth. (914)787-8176 1 Inyconl23@aol.com This would include, f.Tele hone Number area code and extension) q._E-mail Address(optional) _ but would not be limited to,filing an Claude Beauboin asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threatof C. General Construction or Demolition Description release of a hazardous substance to the 1. Construction or demolition contractor: Department,if --- applicable. �Nycon Construction Group — a.Name 1767 Central park Ave i b.Address Yonkers NY 10710 C.City/Town _ d.State e.Zip Code _ (914)787-8176 --� nycon123@aol.com -� J - f.Telephone Number(area code and extension) g.E-mailAddress(optional) Claude Beauboin h.On-site Manager Name 2. On-Site Supervisor: Claude Beauboin On-Site Supervisor Name 3. Is the entire facility to be demolished? Yes [✓j No N �0 4. Describe the area(s)to be demolished: 0 3 Interior partitions&flooring c) 5. If this is a construction project, describe the building(s)or addition(s)to be constructed: 3 Interior partitions&Flooring } o -tea 0 ag06.doc•10/02 BWP AQ 06•Page 2 of 3 I Massachusetts Department of Environmental Protection Bureau of Waste Prevention . Air Quality 1100118757 j1 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 U No If yes,who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7. Construction or Demolition: 01/24/2011 —� 03/01/2011 a.Start Date(mm/dd/yyyy) b.End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving b. If other, please specify: ❑ wetting ❑ shrouding — ❑ covering ,_✓n, other 1131astic dust barriers and floor protection 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 BLrent T. Heinzer _ =1111=111111110 above and that to the best of my a.Print Name �o knowledge it is true and complete. Brent T. Heinzer The signature below subjects the b.Authorized Signature —� signer to the general statutes Architect o regarding a false and misleading c. Position/I me�— �o statement(s). JB.Thomas Heinzer Associates, Inc. d.Representing .._.__.--.- ��T 12/29/2010 — �p e.Date(mm/dd/yyyy) �Q ag06.doc•10/02 BWP AQ 06•Page 3 of 3 euLr- massurr*s ununertimg aystem rage 1 or i MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System Usemame:BTHASSOC Nickname:BTHEINZER My eDEP Forms Q My Profile CA Help Transaction OvervieW Trans#357797 ID#1001 18757 AQ 06-Construction/Demolition Notification ` Forms Signature Payment Submit G Payment print Exit Payment Confirmation Thank you.Your payment has been received. Note:Payment received after 3:30pm will not be posted until the next business day. MassDEP Home I Contact Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.9.9.9.0©2010 MassDEP MassDEP Home I Contact I Feedback I Tour I Privacy Policy MassDEP's Online Filing System Usemame:BTHASSOC Nickname:BTHEINZER My eDEP Forms 0 My Profile ExHelp ( Receipt Forms Signature Payment Receipt Summary/Receipt print receipt Exit Your submission is complete. Thank you for using DEP's online reporting system. You can select"My eDEP"to see a list of your transactions. DEP Transaction ID: 357797 Date and Time Submitted: 12/29/2010 10:51:35 AM Other Email : Form Name: AQ 06-Construction/Demolition Notification Payment Information DEP code: 51702 Date: 12/29/2010 10:48:47 AM Amount($): 85 Payment Detail: HEINZER BRENT--AccountType--AccountNumber****0483 Confirmation Number: Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab My eDEP MassDEP Home I Contact Feedback I Tour I Privacy Policy MassDEP's Online Filing System ver.9.9.9.0©2010 MassDEP 1 The Uerep Svudeo of B. Thomas Heinzer Associates, Inc. Ti B Architects June 3, 201 1 Town of Barnstable 200 Main Street cI w Hyannis, MA 02GO I , RE: I I G.0 SIGN-ON: 5TH-7G8 Quest ov Diagnostics 5 f Main Street, Unit #G r Hyannis, MA 02GO I Building Commissioner In accordance with Section I I G.0 of the Massachusetts State Building Code, I; Brent T. Heinzer, Registration # 20581 being a registered professional architect, representing B. Thomas Heinzer Associates, Inc., hereby certify that the above referenced building project has been constructed in accordance with the applicable provi5ion5 of the Massachusetts State Binding Code, all acceptable architectural and engineering practices and all applicable laws and ordinances for the proposed use and occupancy. USE: B - Business (Phlebotomy Center) TYPE OF CONSTRUCTION: 5b, Unprotected OCCUPANCY LOAD: 43 SPRINKLERS: No FIRE ALARM: Yes ERED Al co �A m � / o No.20581 Subscribed and sworn to before me th15 (o day of 20 1C WESTMI T R M Notary.Public State My CommI551on Expires `3• /-z Dat DIANE T. HUBIAK Brent T. Heinzer, Architect Notary Public B. Thomas Heiner Associates, Inc. Commonwealth of Massachusetts My Commission Expires April 13,2012 975 Merriam Avenue , Suite 201 , Leominster , MA 01453 ( P ) 9 7 8 - 4 6 6 - 6 5 6 0 ( F ) 9 7 8 - 4 6 6 - 6 5 6 5 www . bthassoc . com PROJECT_j NAME: ADDRESS: PERMIT# PERMIT DATE: ` l M/P: URGE.ROLLED PLANS ARE IN: Y Box l SLOT C% Data entered in MAPS program on: C BY: _