Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
0670 OCEAN STREET
ll ll/ /V r �P I I I� L I:- Town of Barnstable Building � xi d• .,' .w � � .,c ra, ,�s_ ;e .s�4e—�� aa-'sp��:` ' -",i r '�'a'&. �." w � �� k � 1"�°'-;:'. � � �;.`?-�� ' z �� Post This Cant rd So Thatrt is;Visible,,From She Street Approved Plans Must beRetamed on J,ob and,#his Card Must'beKept �nxrii3►wsue � Poosted Uil Final Inspection Has Been Made a � '� L rf x Permit • �Whece a Certificate ofYOccupancytiis Required,such Buildm�g shall Not be Occupied until a Ftnal Inspection;hasebeen made Permit No. B-18-669 Applicant Name: RICH A BURRIDGE Approvals Date Issued: 04/19/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Commercial Expiration Date: 10/19/2018 Foundation: Location: 670 OCEAN STREET, HYANNIS Map/Lot: 324-041 Zoning District: RB Sheathing:. Owner on Record: BARNSTABLE,TOWN OF(BCH) "`' Contractor Name:, ;RICH A BURRIDGE Framing: 1 Address: 367 MAIN STREET Contractor License,. —7,097595 2 HYANNIS, MA 02601 - Est Project Cost: $ 12,500.00 Chimney: Description: PROPOSED INSTALLATION OF(1)SMALL CELL:ANTENNA_AND Permit Fee: $ 263.75 ASSOCIATED Insulation: EQUIPMENT ON AN EXISTING EVERSOURCE UTILITY POSE POLE#55. Fee Paid $263J5 1st Extension to expire 4/19/2019. Date 4/19/2018 Final Plumbing/Gas Project Review Req: ��, ,;jyY-- Rough Plumbing: Building Official Final Plumbing: r Rough Gas: " 2, Final Gas: y.This permit shall be deemed abandoned and invalid unless the work aorized by this permit is commenced within six mo uth nthsafterassuance. All work authorized by this permit shall conform to the approved application and the approved,construction documents,for which this permit has been granted. Electrical All construction,alterations and changes of use of any building and structures,shall be in compliance with the local5zomng by lawsa'nd codes. This permit shall be displayed in a location clearly visible from access street or road and shall be�,mamtained oper for public inspection for the entire duration of the Service: work until the completion of the same. Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Health 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department 1` ork shall not proceed until the Inspector has approved the various stages of construction. Final: Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Z �:9 (c� TRM BlJ[LDlbC Convergent(Network Solutions October 18, 2018 OCT 18 2018 TOWN OF BAR[V8-,,A4:;_. Mr. Brian Florence Town of Barnstable ov-..,* Building Department 200 Main Street, Hyannis, MA. 02601 Subject: Building Permit Extension Barnstable_SC20_MA Dear Mr. Florence; Verizon Wireless requests to extend an existing building permit(BP# B-18-669)that was approved on April 19, 2018.The permit allows for the installation of one (1) small cell antenna and ancillary equipment on an existing Eversource utility pole located near 670 Ocean Street, Hyannis, MA 02601. Construction was setback due to a delay in make ready work by the utility company.A six-month extension should provide Verizon and its General Contractor enough time to complete construction.The permit is set to expire on October 19, 2018. Should you have any questions or concerns, please do not hesitate to contact me via phone or email.. Regards, William Perry Site Acquisition Specialist Tower Resource Management, Inc. 750 West Center St. Suite 301 West Bridgewater, MA 02379 Cell: (401) 528-9721 1. Town of Barnstable Post This Card:So That it is Visible From the Street:-Approved Plans Must be.Retained.on Job and,this Card Must be Kept Posted. Until Final Inspection Has Been Made. er it +� Where.a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been.made. Permit NO. B-18-669 Applicant Name: RICH A BURRIDGE Approvals Date Issued: 04/19/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Commercial Expiration Date: 10/19/2018 Foundation: Location: 670 OCEAN STREET,HYANNIS Map/Lot: 324-041 Zoning District: RB Sheathing: Owner on Record: BARNSTABLE,TOWN OF(BCH) Contractor Name: RICH A BURRIDGE Framing: 1 Address: 367 MAIN STREET Contractor License: CS=097595 2 HYANNIS, MA 02601 Est. Project Cost: $ 12,500.00 Chimney: 4 Description: PROPOSED INSTALLATION OF(1)SMALL CELL ANTENNA AND +}} Permit Fee: $213.75 ASSOCIATED Insulation: EQUIPMENT ON AN EXISTING EVERSOURCE UTILITY POSE POLE#55 Fee Paid:. $213.75 Date: 4/19/2018 Final: Project Review Req: Plumbing/Gas Rough Plumbing: f91- -- uilding Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the wor0authorized by this permit is commenced within six months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved application and the approved construction documents for whichithis permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local`zoning by-laws and codes. Final Gas: This permit shall be displayed in a location clearly visible from access street or roadand 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 by the Building and Fire Officials are provided on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work-: r Rough: 1.Foundation or Footing _ - ---. _•- �^^-^� 2.Sheathing Inspection Final 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department c, Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �l Town of Barnstable Building wrrrxrees•.e�. • W�br+ttez: Cahi st r'r E& P n t�dF 6 'dPos .i f�:inScaoa ltTelnht'o sapfi4 eOrtc�c;tciys�ro u'`�U n�i�a s H�nbacls e;;B i,IF„ser�'e�oR�n mea M:,tu,-wfih air�re tl e•eStl t�"r se�ue�cth k%B Au PiPl,d rotn�v„e.sdh Pa;m,,�I l al nN�s o Mt bues�t,O bcecuR e�it eadm.uendt iol na;JFoinbaal�nl nds the��cst Cioatn..r;dh§,aMramsu'b sete bne rnKae dP�' Permit a....K,:; az t�, %_' ' .,man_-,. . �;.e p`.3,..a«.�:..£a4�_���-�:"�z,A .,��:. •,,. �k:':�ts�g :,`�.. 6. .-;"'�i.' ,�u p;y^` '.,:�.,,, ah,r w,.:'.sw f.,.�_��...s.m:.».��,a,�...>>f m c�8:::� ��. _. Permit No. B-18-669 Applicant Name: RICH A BURRIDGE Approvals Date Issued: 04/19/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Commercial Expiration Date: 10/19/2018 Foundation: Location: 670 OCEAN STREET, HYANNIS Map/Lot 324-041 Zoning District: RB Sheathing: Owner on Record: BARNSTABLE,TOWN OF(BCH) r Contractor Name RICH A BURRIDGE Framing: 1 Address: 367 MAIN STREET AContrt r License; CS-097595 2 HYANNIS, MA 02601 Est Project Cost: $ 12,500.00 Chimney: Description: PROPOSED INSTALLATION OF(1)SMALL CELL ANTENNA AND Permit Fee: $213.75 ASSOCIATED Insulation: EQUIPMENT ON AN EXISTING EVERSOURCE UTILsITY�POSE POLE#55FeePaid $213.75 ��,� �Date 4/19/2018 Final: Project Review Req: Plumbing/Gas j k y ry ts `� � � ✓ Rough Plumbing: f ' .Building Official ti Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorJied1by�this permit is commenced within six mo hs aIdA ssuance. Rough Gas: e All work authorized by this permit shall conform to the approved applicationand theapproved construction documents forwhich this permit has been granted. ' x Final Gas: All construction,alterations and changes of use of any building and str6cturesshall1be in compliance with the local zomng�by laws,'and codes. This permit shall be displayed in a location clearly visible from access stet or oad and shall be maintained open for pub inspection for the entire duration of the work until the completion of the same. �� ` , Electrical Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials arekprowdedgon this permit. Minimum of Five Call Inspections Required for All Construction Work Rough: 1.Foundation or Footing •, ; ,, .. • g 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION ftiLA2Lr<,S.�r Map Parcel ©� Il° A polication #. CJ Health Divisions Date Issued y 9 /� Conservation Division TO M4R os? Applicati 0 Planning Dept. ©, 13�R Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Af ��-- Village Owner Address agg, way Telephone So& - Permit Request cvl4cek„�. V ASS uc;alr�A 2cri.'.,r�.,,,a-�- ot., .i,,, `G�-.'�, �✓ei-Se..X-Cp c J^�;i i�-f � I P Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 12, soo. oo Construction Type Lot Size LAJ l da Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units)j4/_'/W Age of Existing Structure Historic House: ❑Yes Ulo On Old King's Highway: ❑Yes rlao Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other 411,4-- Basement Finished Area (sq.ft.) ✓l ./ Basement Unfinished Area (sq.ft) Number of Baths: Full: existing / ZA: new Half: existing new Number of Bedrooms: &/lq- existing _new �y Total Room Count (not including baths): existing a VIA_ new VVIk- First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other_. Central Air: ❑Yes ❑ No Fireplaces: Existing New 04 - Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing U new size _Shed: ❑existing ❑ new size _ Other: All/A Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use U4; )1 Proposed Use Lo--. �_4i APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name -fin 2,�r�P Telephone Number 1S s� Sq7- /33o Address 2-90 Wc4r_� + License # C S 09 7 5`!5— �.-ti���1�e , I1� Home Improvement Contractor# Email Worker's Compensation # SLRn3 Z��o ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE 2 FOR OFFICIAL USE ONLY t APPLICATION # DATE ISSUED MAP/,PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION 1 FIREPLACE ELECTRICAL: ROUGH FINAL I PLUMBING: ROUGH FINAL G GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT '; •ASSOCIATION PLAN NO. w x w c � p � i. � t SA r t els Al A, .0 GE a ry.8r r x Uzi r � � - e, e 3 i '7V r'' U a RRID $ � ro :, , 9 WAFER STREET---, , s n " r y a _ g u ^ � � � � � w ., nn ry � ,� s. - ,3h, wnI x� �rtrr�oiw�i�� Nei u:S+wm.v� �uh�n4 � ,m_ ,�,� ..,�m. W �u�mnm'+��,•w S^ p i. b: i ssio, �w P i a �.x S E m� s w vY ... .e' .•.. ..: t....\a".F, :::t... ., r.._.+. �.. ..r ....ix': ..$. .. \ L 3+c..�._. �.:4C.. ..'p-�°i �..:"� `....:?.. ,�-v.�,`,. \i:..��a �{� :\:� �a, ��� o�., � �. ,;� ,�� ,. � n„;�, e o,�a . :. � a ,•b�.� ^.ate..-. M�rr� r, . ,, �: ^ �,, v �,� ��� �I ,^ +,'.: rY °'..� �,�" " � u��" ° � ��y .. ._� " �.: MIN, . , " '.. &MOM .3 - . y The Commonwealth of Massachusetts W Department oflndustrialAccidents e I Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual):J Lee Associates LLC Address:420 Northborough Road Central City/State/Zip: Marlborough, MA 01752 Phone#:508-597-1330 Are you an employer?Check the appropriate box: Type of project(required): 1.[D I am a employer with 40 employees(full and/or part-time).* 7. ❑New construction 2.F�I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.F�I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 [:]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.M I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. ROOF repairs These sub-contractors have employees and have workers'comp.insurance.- p 6.R We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other Telecommunications 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. -Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name:Federal Insurance Company Policy#or Self-ins.Lic.#:54303256 Expiration Date:10/1/2018 Job Site Address:670 Ocean Street City/State/Zip:Barnstable, MA 02601 Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: 1/25/2017 Phone#:508-597-1330 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#: l"lwireless March 1,2018 Dear Sir/Madam: RE: Rich Burridge Please accept this letter as notification that Rich Burridge working for J Lee Associates, of Marlborough, MA has been engaged to perform research on certain properties and real estate including submitting for zoning approval, building permits,and construction of Verizon Wireless ongoing network enhancement. Rich Burridge/J Lee Associates are is authorized to act on Verizon Wireless behalf for the purpose of filling and consummating any zoning and/or building permit applications necessary to obtain approval of the applicable jurisdiction for the installation and/or modification of Verizon Wireless communication Facilities. Should you have any questions regarding any TRM, Inc's activities on behalf of Verizon Wireless,feel free to contact me at 508-320-2017 or via email sean.conwav@verizionwireless.com Respectfully, �GGL�G�J Sean Conway v Verizon Wireless Project Manager—Real Estate f VerlZia?wireless March 1,2018 Dear Sir/Madam: RE: Rich Burridge Please accept this letter as notification that Rich Burridge working for J Lee Associates,of Marlborough, MA has been engaged to perform research on certain properties and real estate including submitting for zoning approval, building permits,and construction of Verizon Wireless ongoing network enhancement. Rich Burridge/J Lee Associates are is authorized to act on Verizon Wireless behalf for the purpose of filling and consummating any zoning and/or building permit applications necessary to obtain approval of the applicable jurisdiction for the installation and/or modification of Verizon Wireless communication Facilities. Should you have any questions regarding any TRM, Inc's activities on behalf of Verizon Wireless,feel free to contact me at 508-320-2017 or via email sean.conwav@verizionwireless.com Respectfully, y�GGh� Sean Conway Verizon Wireless Project Manager—Real Estate f _ .rk Mail Processing Center Aeronautical Study No. Federal Aviation Administration 2018-ANE-2112-0E Southwest Regional Office Obstruction Evaluation Group 10101 Hillwood Parkway Fort Worth, TX 76177 Issued Date: 04/17/2018 1 , Nicole Pelletier r TRM 16 Chestnut St. Foxboro, MA 02035 en ** DETERMINATION OF NO HAZARD TO AIR NAVIGATION 32 rz, The Federal Aviation Administration has conducted an aeronautical study under the provisions of 45(J.S.C., Section 44718 and if applicable Title 14 of the Code of Federal Regulations,part 77, concerning: Structure: Barnstable_MA_SC20 Location: Hyannis, MA Latitude: 41-38-09.15N NAD 83 Longitude: 70-16-50.99W Heights: 4 feet site elevation (SE) 33 feet above ground level (AGL) 37 feet above mean sea level (AMSL) This aeronautical study revealed that the structure does not exceed obstruction standards and would not be a hazard to air navigation provided the following condition(s), if any, is(are)met: It is required that FAA Form 7460-2,Notice of Actual Construction or Alteration,be e-filed any time the project is abandoned or: At least 10 days prior to start of construction (7460-2,Part 1) _X_Within 5 days after the construction reaches its greatest height(7460-2, Part 2) Based on this evaluation, marking and lighting are not necessary for aviation safety. However, if marking/ lighting are accomplished on a voluntary basis, we recommend it be installed in accordance with FAA Advisory circular 70/7460-1 L Change 1. This determination expires on 10/17/2019 unless: (a) the construction is started (not necessarily completed) and FAA Form 7460-2,Notice of Actual Construction or Alteration, is received by this office. (b) extended, revised, or terminated by the issuing office. (c) the construction is subject to the licensing authority of the Federal Communications Commission (FCC) and an application for a construction permit has been filed, as required by the FCC, within 6 months of the date of this determination. In such case, the determination expires on the date prescribed by the FCC for completion of construction, or the date the FCC denies the application. Page 1 of 3 NOTE: REQUEST FOR EXTENSION OF THE EFFECTIVE PERIOD OF THIS DETERMINATION MUST BE E-FILED AT LEAST 15 DAYS PRIOR TO THE EXPIRATION DATE. AFTER RE-EVALUATION OF CURRENT OPERATIONS IN THE AREA OF THE STRUCTURE TO DETERMINE THAT NO SIGNIFICANT AERONAUTICAL CHANGES HAVE OCCURRED, YOUR DETERMINATION MAY BE ELIGIBLE FOR ONE EXTENSION OF THE EFFECTIVE PERIOD. This determination is based, in part, on the foregoing description which includes specific coordinates, heights, frequency(ies) and power. Any changes in coordinates, heights, and frequencies or use of greater power, except those frequencies specified in the Colo Void Clause Coalition; Antenna System Co-Location; Voluntary Best Practices, effective 21 Nov 2007,will void this determination. Any future construction or alteration, including increase to heights,power, or the addition of other transmitters, requires separate notice to the FAA.This determination includes all previously filed frequencies and power for this structure. If construction or alteration is dismantled or destroyed, you must submit notice to the FAA within 5 days after the construction or alteration is dismantled or destroyed. This determination does include temporary construction equipment such as cranes, derricks, etc., which may be used during actual construction of the structure. However,this equipment shall not exceed the overall heights as indicated above. Equipment which has a height greater than the studied structure requires separate notice to the FAA. This determination concerns the effect of this structure on the safe and efficient use of navigable airspace by aircraft and does not relieve.the sponsor of compliance responsibilities relating to any law, ordinance, or regulation of any Federal, State, or local government body. A copy of this determination will be forwarded to the Federal Communications Commission (FCC) because the structure is subject to their licensing authority. If we can be of further assistance,please contact our office at(817) 222-5922, or debbie.cardenas@.faa.gov. On any future correspondence concerning this matter,please refer to Aeronautical Study Number 2018-ANE-2112- OE. Signature Control No: 360380875-362815972 (DNE) Debbie Cardenas Technician Attachmerit(s) Frequency Data cc: FCC ' I Page 2 of 3 Frequency Data for ASN 2018-ANE-2112-OE LOW HIGH FREQUENCY ERP FREQUENCY FREQUENCY UNIT ERP UNIT 1710 2130 MHz 460.25 W Page 3 of 3 TOWN-OF BARNSTABLE BUILDING PERMIT APPLICATION ' 3a�- T 'v�]N OF BARNSTABLE Map Parcel Application # /��6 5c� (f l Health Division ; ' ` '" "' 'J Date Issued G O b ,i y:3' .. ,. Conservation Division Application Fee Planning Dept. Permit Fee 01 VIS10N1 � Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 6 ccc-a Village / Gl �►hf S Owner �h B ����` Address Telephone Permit Request dZ le 146 0 Ci F P0Q a-, ?` G` C� rv► k Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �U6 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 des ❑ No If yes, site plan review # 'Vurrent Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name A4�4rl C'�2tt,o (49' Telephone Number `re / N Address ( � J C6lr rr.T' /c( License # /O y 3 1q 3 PX-6vv)Ile, Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO VC,r r-d SIGNATURE DATE U U �J ` FOR OFFICIAL USE ONLY APPLICATION# ` DATE ISSUED MAP/PARCEL NO. F` ADDRESS VILLAGE J OWNER ;r DATE OF INSPECTION: 'E' �r�FOUNDA-T_ION€��-+j, A�k,, F-=::•i:1t�_;�-�,,., �, c� 'FRAME ,,.INSULATION . ,-F FIREPLACE t' ELECTRICAL:: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING _ ' DATE CLOSED OUT ASSOCIATION PLAN NO. BARIMAILE, MASS Town of Barnstable Regulatory Services Thomas F:Geller,Director Building Division Thomas Perry.CBO Building Commissioner -200 Main Street; Hyannis,MA 02601 \ • WWW.t()WntlTArn CtAIIIP._MgV-Vic Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If UsinLr A Builder I -STFs�h° ,v ✓. s vtl E mac/ ,-as Owner of the subject property r hereby authorize // to act on my behalf, I in all matters relative to work-authorized by this building permit application for-20 5r (Address of Job) Signatur of er 16ate I Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollWl AppDauUAxatUcamo}tlWMows\Temporary Intemet Files\ContentOutlook\QRE6ZUBN\EXPgESS.doc. Revised 053012 _ The Commonwealth of Massachusetts i Department of InduytrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: City/State/Zip: ��� yr Phone#: Are you an employer?Check the appropriate bog: Type of project(required): 1.09f m a general contractor and I am a employer with 4. ❑ I a employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity, employees and have workers' [No workers'comp. insurance comp.insurance.: 9. Building addition required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof rep ' insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other P D comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp,policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: d ( �— d Expiration Date: Job Site Address:�� ocC�+` S�_ City/State/Zip: G Z Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a. fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator: Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under e p#ns and penalud of ury that the information provided 9above is true and correct; Si afore: Date: Phone#: `"�d-V 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#: f Ace" - CERTIFICATE 4F LiA81LtTY INSURANCE �...r - 31' M5 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((es)must be endorsed. 9 SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endortgment. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CONMNPAS:cr pwkley Assigned RISK SerVIOBS . McShea Insurance PHONE E BW 634-4589 wr-Ne k 866 215-8118 1550 Falmouth Rd RT 28 Ste 2 ADMRESS: POf1 - rvlces erkLyft aom Centerville,MA 0202 ' ----- 'INSURER(S)AFFORDING COVERAGE NAICO INSURER A Ar2dia Insurance Co INSURED .INSURER-9: Richard Caaeault Jr - INSURER c 198 Five Comers Road 11emER a Centerville,MA 02632 INSURER E INSUfRt32F: - COVERAGES . CERT�iCATE NUMBER: REVISION RLMSER. 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 OONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE D UBR POLICYNUtdI R PO ICYE YEXP LIMITS INSR WVD MWDDI RMIDD/YY O ENERAL LIABRJTY AUTOMOBILE LIABILITY - $ WORKERS COMPENSATION - WCSTATII- - OTM- _ AND EMPLOYERS'LIABILITY YIN TRY LHBTS EAR ANY PROPRIETORIPARTNERIEXECUTIVE y A OFIcEmEMBER EXCLUDED? NIA WC-20-2"03093-03 02/042015 mm42016 mL Enc1R ACCIDENT $-500;t�0 (Mandatory In NH) - I yea.describe under PLOYS DESCRIPTION OF OPERATIONS below D -P 1 I R +�D DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Add-dional Ramarb Schedule,y more space IsrequieM Election CateWy Elect.Stag Name Cove Stat>°(S) All Entities/Locations Sole Froprie w 6odude Rid>ard Mutt 3r MA Cazeautt Jr 198_Five Corrters_RoadC�terv�i:[lQ f CERTIFICATE HOLDER ANCELLATION `SICOULD ANY OF THE ABOVE DE&Q2I EDPOLICIESBECANCELLEDSORE THE EXPI RATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PEDVISIONS. Town of Barnstable AUTHORIZED REPRI°SENTATIVE Building Dept 200 Main St Hyarmis,MA 02601 Signature: g _ �✓�" ACORD 25(2010105) .8RAC 3139 r Offrce of CoasntQer A & t� } • HOME IMNitOVIrMEE[ILT ; ` eg noa Lccem or registration>vaTid for mdmdalnse odijr G _- Re9tistratton �+£CDR before:Ehe expiration date: If foand return - 1S86Q7 Expiration812017 YRe` E3ilfce of Consumer Af€airs and Basrnt RIai3eiB Irtdtvtdyai _ 16 °:I'iaia : nrte' I70 RICHARD P CAZ,,e AbE J[i Bostoi 021I6 RICHARD:CAZE - L' �n 19.8 F1UE.(:URNf=RS RCS _ VENTERt�fLLE.MA�L[73Z -,.- •c �: t�- � .�/ ' Undersecretary _ t �Ilit�a�ctwrttio.Rf`ugnat •-=-----_ gC- aitraent of Pu27 r _Cansrrnchon Snp� sor se-°CS-900M : P [i S RICHARD P.C 199 FWe Corners Ron CenterviIle 1YIA Dam. on • # - �;. - 8T$rlIS5lUr1FF_ .a 7��a,��-_ • 1 I Page 1 of 1._ PC 72 uslu ; 20' _ _ _ 20 20 10 10 Open ea'` 4 24 13;20 2' 10 '42 10 AS 34 34 - U 30 12 28 30 28 , • http://townofbamstable.us/sketchesl5/26858 27853.jpg 6/l/201'5 Soccer Resort 201-683-4794 p.2 The Town of Barnstable Barnstable Office of the Town Manager IF, 367 Main Street, Hy.annis MA 02601 aAxvsrwBt.g. : www.town.bamstable.ma.us Office: 508-862-4610 Fax: 508-740-6226 � ►ze►ss. f ,. APPLICATION FORM USE OF PROPERTY,PARADES,MARATHONS,TRIATHLONS,ROAD RACES 2007 The approved application must be on file in the Town Manager's Office at least thirty(30)days prior to event. ParadefRoad Race applications must be received ninety 90 days prior to scheduled date. Date of application: Fee amount: S43.00 per request!:Total paid: YES(ck OR cash) NO *Each request means each event such as a parade,followed by an event on the Town Green,for example. This application must be complete/all signatures prior to submitting to the Town Manager for final approval. You may be required to leave application at various Departments'to wait for appropriate signature. t. CALL TOWN MANAGER'S OFFICE TO TENTATWELY RESERVE DATE OF EVENT-CHECK AVAILABILITY R.-quest for: Hyannis Village Green Asehon Park —Parade- Benefit Run/Walk MarathorvTriathlonOther(please specify):— Certain facilities may require additional fees for services by DPW depending on location,use of staff size of event. The fees will be determined by DPW and paid directly to that department 2. Name of Event Day/Date of Event: ft r rp Rain date: tAA. 1p 3. Name of Sponsoring Organization: \ e_e5r Mailing and physical address: "120 movapf S I 1 1 DT 4. Contact person: N�P14 SVYA Phone: gj_�_`GI U� 3. Person in charge DAY OF EVENT: Cell phone: 6. Setup time: Actual event start and end time: SI(V\ Clean up time: 7, Estimated number of volunteersiparticipants: Estimated number of spectators: >>POLICE DEPT will determine if extra-detail necessary. 8. Admission fee/registration charged to participants? 3 No Cfy s: .Amount: Will there be food or craft vendors at event? Ye No -- e gip►INDA >>If yes, indicate the number of vendors and type(food/merchandise/etc): l C c(c 2uat: »R'ill thcrc be merchandise available for sale? Yes No NIA Vendors need to complete application for special licenses ai the Licensing Division-200 Main Street,Hyannis. 9. Map attached(REQUIRED)for road race/parade eve >>Are street closures required: Yes No »Detail of route and rest stops attach edhndicated on map. 10. Food preparcd/scrvcd at cvcnt? —Yes No »If yes,will there be cooking/hraiing involved? Yes No f , Soccer Resort 201-683-4794 p.3 TENTS.STRUCTURES. ENTERTAINMENT DEVICES*Attach map for layout of event including structure placement TENTS REQUIRE ADDITIONAL PERMIT FROM BLDG DEPT. Structures& Grounds have designated tent friendly zones. Should you require tent elsewhere other than these zones, location needs to first be cleared with Structures&Grounds. >>No open flames in tents or propane storage use.without a fire permit. 11. Are you installing or constructing any structur including buildings,climbing structures,etc? _Yes 12. Are you installing any tents or canopies? No `! Quantity and size: S�4-44- Own or rent?1,07.1D Rental com any: Tel 4 13. Do you plan to have any sound amp' cation? Yea No Music _Other(ple11 e describe) 14. Is electrical power required? Ye No (for sound amplification(PA system), lighting,popcorn machine,etc) >>If yes,circle: will you provide portable generator? OR will you require TOB temporary service? >>List maximum wattage required and location for hook-up: If more than'usual'hookups, please note there will be overtime costs if Town Electrician setting up and removing "A-frame"or dropping service before/after event outside of business hours. !CONES.BARRIERS. � 15.Do you have need for barricades/cones? Yes No >>If yes,describe for what use: DEPOSITS: S5.00 each cone. $50.00 each/barricades(quantitiesldeposits arranged through DPW). 16. Will you require access to the town building? Yes No >>If yes,describe for what use: VEHICLES 17.Do you plan to drive vehicles onto property? If yes,provide details: w )-TIA ;1 Specific loading zones to be reviewed with DPWiStructures&Grounds. (' Organization will be liable for any damages vehicles may cause the ground. COMFORT STATIONS. PORTABLE TOILETS AND HAND WASHING SINKS 18. Do you plan to provide portable toilets andlor hand washing sinks atyour event? _Yes No >>If yes: # of regular toilets 4 of handicap accessible toilets #of hand washing sinks Public Comfort Stations located at Town Hall Parking Lot North Street and Barnstable Village Fire Station are open from 9AM to 9PM,daily. If event absolutely re uiies early open, it must be reviewed with DPW. GARBAGE AND RECYCLING SERVICES 19. Trash pick up is the responsibility of the organization requesting this permit. Please provide your plan for the cleanup and removal of garbage and recyclables during and after your event: wr,�(,t.sil'u, 0 cm--,l?f' Number of recycling containers: Number of garbage receptacles: A one lime disposal fee for use of Town containers may be assessed. Any fee will be determined and rollected by DPW. The cost is based on size of event. SECURITY;SAFETY 20.Will there be demos,displays,materials that are potentially hazardous/impact public safety?_Yes >>If yes,describe: 21.Have you made any provision for on-site security? Yes 22.Have you made any provi5ion for on-site medical services? Yes ' No PARKING 23. Please provide description of your parking plans(where event attendees will park): 0:3 t /V`CT f(Z ',,6 >>Plans for disabled parking: >>Plan for emergency vehicle access: >>Please describe your plans to notify residents,businesses impacted by this event: SIGNS/ADVERTISING 24.%till the event be advertised? If yes,where: L-o >>Do you plan to distribute flyers or ads before or during this event? Y' No >>Do you plan to place any signs or banners or other advertisement at the event site? _Yes N >>If yes,please indicate where: >>Provide sign/banner detail and dimensions and method of attachment or support: i i Soccer Resort 201-683-4794 p.4 r (Signage may require additional permits). I have read, understand and agree to abide b each numbered it «Y ern on the attached _ and Regulations for Use of Village Green and other Town 'Property" // "Rules and Regulations for Parades, Walkathons, Road Races" agent for the sponsoring organization, agree to abide by said rules and any er sp is conditions (letter e attached)established for this particular event. Signature of sponsoring agentDate Printed Name: ,, OWN" #a##k########k#+!#####rt#xxs�x#kk####,#####�c.F##i#y4####kF#ask#4##*#x#k%+kk##t#xt k#K#k##+###4#x#kt#k##t##tt APPROVED BY: CHIEF OF POLICE DATE: (Barnstable Police Department, 1200 Phinney's Lane,Hyannis 508-778-3805) CHIEF OF FIRE DEPT(S) DATE: (Village Fire Department,Addresses vary) RECREATION E• (,Hyannis Youth&Community Center, 141 Basset Lane,Hyannis 508-790-DA DATT • PUBLIC WORKS DATE: (382 Falmouth Rd.Hyannis 509-790-6400) REGULATORY SERVICES DATE: (200 Main Street,Hyannis 508-862-4674) BOARD OF HEALTH DATE: (N/A for Parade/Race permits unless serving food.508-8624644) BUILDING DEPT �{ l��n �� DATE: / S (N/A for Parade/Race permits unless erecting tents. 508-862-4038) TOWN MANAGER DATE: (Town Hall,367 Main Street,2" floor,Hyannis 508-862-4610) SPECIAL CONDITIONS and ANY FEES(As determined by Department's above) DETAILED AS FOLLOWS: a � Soccer Resort 201-683-4794 p.1 i a.�es-slal . Soccer Resort 720 Monroe Street,C411 Hoboken, NJ 07030 To:Barnstable Building Department Fax:508-790-6230 .tune 1, 2015 Dear Building Department Chief, I hope this letter finds you well. I represent the Soccer Resort,a soccer tournament organization,and we are in the approval process for running an Adult and Youth Beach Soccer tournament at Kalmus Beach on August 8&9 2015, in conjunction with the recreation department and local community soccer organizers.This event was submitted to the Council Meeting in January and is currently subject to approval by the Town Manager. j Patti Machado,the Leisure Services Director for the Town of Barnstable Recreation asked that I send over the application to you so you can view our application form. As this is an event in its infancy,I hope we can discuss any thoughts and questions you might have.Once all department head have faxed us back their submitted approval sheets,we hope to submit to the Town Manager for final approval. We were asked to run this event by Patti Lloyd of the Cape Cod Chamber of Commerce. We are a national organization who has been running unnin tournaments in the U.S.,Canada and Europe for 12 years and we work with local Barnstable community organizers to run this fun, small tournament for families on August 8 &9,which will partially raise awareness for charitable works. Again, please let me know if you have any questions.If not our address is listed above to mail or email back your approval signature to nswan soccerresort.com finally:We are very excited to be playing beach soccer in Cape Cod.We hope to run an event that is loved in the local community,enjoyed by participants and fits in well as a local event that reflects the community spirit of Barnstable and Cape Cod. Many Thanks Niall Swan Soccer Resort 'I Phone:718-433-245t A TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION oiL4 o Map Parcel placation # Health Division Date Issued ,5- Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address -e—e__rO-Y'N Y-1 \ Village Owner Address Telephone CZ- —it Request 10 G- C,__tS '�C (3 .rN ` 3 O+- S 1 Inca r r`d � ' Square feet: 1 st floor: existing p sed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, aftach5bporting2Dcur�ntation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) C) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King'snHighway❑Yet ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ OtherT? ;p Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.f) ' Y"1`o 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 �� C� Telephone Number [ s oLl �� U Address M a`C License # Home Improvement Contractor# Email %\-k CO�_, G O vY 1 Worker's Compensation # © I�JCOO Co ALL CONSTR ION DEBRIS SULTING FROM THIS PROJECT WILL BE TAKEN TO )C&A `§ o7 �2 r-S SIGNATURE DATE 1 14 f ` FOR OFFICIAL USE ONLY APPLICATION# ' DATE ISSUED MAP/PARCEL NO. , r ADDRESS VILLAGE f OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION ' l FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING k a t DATE CLOSED OUT A!�.—SOGION PLAN NO. r The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www mass.gw/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. Applicant Information Please Print Legibly Name(Business/Organization/ladividual): --�L C N Address: (0 (_Oo City/State/Zip: a hone#: o you an employer?Check the appropriate boa: Type of project(required): 1.N I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* 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 g, ❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp.ins,ranCe comp.insurance.# required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their. 11.0 Plumbing repairs or additions Myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]t a 152,.§1(4),and we have no employees.[No workers' 13.�Other comp,insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hue 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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sature,__ Date Phone#: em a �;C9—t (oC1 00 Official use only. Do not write in this area to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle.one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every 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." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the.issnance 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 numbers)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC'or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one,affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for yourcooperation 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-MASSAFB Fax#617-727-7749 . Revised 4-24-07 vww.mass.gov/dia CERTIFICATE OF LIABILITY INSURANCE DATE(2foN/A/2D 4 Producer THIS.CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE Cove Risk Services,LLC CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT Braintree,MAA 02185 Box 859 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY Br21 THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# Insured INSURER A: MA Retail Merchants WC Group Inc. Parry Cape Cod,Inc. - INSURER B: 660 Mac Arthur Blvd. Pocasset,MA 02559 INSURER C: INSURER D:. INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBEDHEREIN IS SUBJECTTO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAYHAVE BEEN REDUCED BYPAIDCLAIMS. POLICY .. - ADUL EFFECTIVE DATE POLICY EXPIRATION 1NSR LTR iNSRD TYPE OF INSURANCE POLICY NUMBER MM/DD DATE MM/DD LIMITS' GENERAL.LIABILITY .EACH OCCURRENCE $ - - COMMERCIAL GENERAL LIABILITY - - FIRE DAMAGE(Any one fire) $ - CLAIMS MADE = OCCUR - _ MED EXP(Any one person) $ PERSONAL&ADV INJURY GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: - - .PRODUCTS—.COMP/OP AGG PRO- POLICY JECT - AUTOMOBILE LIABILITY. . - COMBINED SINGLE LIMIT ANY AUTO _ - . . - (Ea accident) - $ ALL OWNED AUTOS - BODILY INJURY _ 'SCHEDULED AUTOS - (Per person) - $ - HIRED AUTOS - BODILY INJURY $ - NON-OWNED AUTOS - (Per accident) - PROPERTY DAMAGE $ - - - (Per accident) - GARAGE LIABILITY - - AUTO ONLY—EA ACCIDENT $ ANY AUTO _OTHER THAN, EA ACC. -$ - AUTO ONLY AGG. $ 'EXCESS LIABILITY - - EACH OCCURRENCE $ OCCUR- ❑ CLAIMS MADE - _ _ _ _ AGGREGATE_ $ DEDUCTIBLE - $ RETENTION S - $ WORKERS COMPENSATION AND WC STATU- OTH- - - - - EMPLOYERS LIABILITY - - X TORY LIMITS ER _ ANY PROPRIETER/PARTNER/EXECUTIVE E.L.EACH ACCIDENT /fl OFFICER/MEMBER EXCLUDED? - $ 100,000 .. „ If yes,describe under NO 014000500406114 1/01/14 1/01/15 E.L.DISEASE-EA EMPLOYEE SPECIAL PROVISIONS below - - - $ 100,000� - E.L.DISEASE—POLICYLIMIT $. 500,000 OTHER - - i DESCRIPTION OF OPERATION&LOCATIONS!VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS - - CERTIFICATE HOLDER ADDITIONAL INSURED:INSURER LETTER: CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO ATTN:Building Department MAIL 35 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED 200 Main Street TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR Hyannis,MA 02601 LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE i IMPORTANT DOCUMENT Certificate of Flame W§s&tance ISSUED BY Date of Shipment 06/04/10 CNRegistration Number -a F-12110 1;:1NDUSTRIES ING.R Ten t Identification 14870560 EVANSVILLE, INDIANA 47725 MANUFACTURERS OF THE FINISHED TENT PRODUCTS DESCRIBED HEREIN This is to certify that the materials described have been flame-retardant treated (or are inherently noninflammable)and were supplied to: PARTY CAPE COD 660 MACARTHUR BLVD POCASSET, MA 025592230 ♦ TES N Certification is hereby made that: The articles described on this Certificate have been treated with a flame-retardant approved chemical and that the application of said chemical was done in conformance with California Fire Marshall Code. AH fabric has been tested and passes NFPA 701, CPAI 84. Serial# 8106200(8) Description of item certified: 20'X30' WHITE FRAME TENT Flame Retardant Process Used Will Not Be Removed By Washing And is Effective For The Life Of The Fabric TRIVANTAGE STATESVILLE NC Name of Applicator of Flame Resistant Finish Signed: HC C AN OR INDUSTRIES INC� 05/14/2014 12:28 FAX 508 790 622.6 T01M1N HANAGER. 01005 The Town of Barnstable Barnstable Office of Town Manager +caCRY NAM 367 Main Street, Hyannis MA 02601 www.towu.bqmstjb_Ie-ma.us �,,�y�► ww.town.bamsfjble.ma.us 2007 Office: 508-962-4610 Fax: 5DS-790-6226 Email: tom.lynch(n@,town.bam,,table.ma.us 'Thomas K. Lynch,Town Manager February 6, 2014 WALK-A-THON PERMIT Subject to the approval of the Chief of Police, the Town Manager hereby grants perrnissicn for a walk-a-thon to be held in the Village of Hyannis on S uraday,May 19, 2014, for the benefit of the Cystic Fibrosis Foundation. Said 5-mile walk will commence at 12:00PM at Veteaan's Beach on Ocean Street; straight onto Gosnold Street; left onto Ocean Avenue; left onto Hyannis Avenue; following Wachusett Ave. into Hyannisport; up Irving Ave.towards Hyaruaisport Golf Club;left down Dale.Ave_;right on to Irving; left onto Iyanough Ave.;to Hyannis Ave;right onto Ocean Ave.; right onto Gosuold Street and back to Veteran`s Beach,where it will encl. Thomas K. Lyzach,x'own Manager cc: Chief Paul MacDonald,Bmstable Police Dept, Chief Harold Brunelle,Hyannis Fire Dept. PAID: $43.00 �I .w t t - � - ,. .61 121 Cystic Fibrosis Foundation 321 Sperry Tent(White or Blue with Stars) Veteran's Memorial Park Hyannis or May 20,2012 20 x 30 a Spay Tent(white) 05/14/2014 12:27 FAX 508 790 6226 TOWN MANAGER 1�002 -;, . Bamstoble ..: ' atECe" 671,�ni Str.'d,ilymnis MA.02t 01 s atttrr � .-'dVAS lst6&m&W Otbice: 508-862-461011ace$05-790-6226 q ITON FORM USED?PR0PElfi TYj,?AM-DFSa MARATHOM,TMA.TFII.i NS,ROAD RAUS The aappravea3 aplrl *ilan''Mml beon the is the T"m Manaileet ice st tesatithirty(30)dayo prior to event. parads/iad'R ab aDPtl 'cs rdijivbe`r4elved nFaety f90).dsy_,p to�cheaulla�d Dade Ofapplicstio4 �' Fab ea�noutrt; $'}3.flD per e4 BotHl paid; raOt! ( on cash) No ' *Eachiagaast-aicaz each,evertsrrc4•assparada,followed hi'an tbeTWMIG=ar.,forWemmple. , This applica45n mukU complex, eigfieturss prior to sub- nq to+ho Tcrwr,Manapr for final appmv�6. You may be mquired to lure,appticatton of l+etioua Departments'to wail to appropriate signature. I. CAL TOWN MANAGER'$OFTFICE TO;IEIvTATiWEJ,Y RES1gItYE DATE®71wdLhT-C Ft$CK AYAILA$I�IRY rR. . Rcgmmt.for, Iyannls Willpgc Caftan AseJQoi�Rsrk ' Persia —,yr� �OufitkunlWr]k _ -Marath6.a/THotb.igU Othq plwt•s wify):�E Gef'tnln%W itias mqy require additional fees for tjer+ ms by DPW depending on lacstlon,tab trot staff&alas event The fees will bra d'eormfnad by DF'W and pall diret;tay to that departntalt, .2, 'Nam :ofEYCntr R d fr 1 l Dayl Dstr of 3vent: daw', — 3, Aleine of Sponsoring Organization:CY25 f1le F'f 'ft O % Q1�t1 '7�/tJ It ► g_— r laSling and phy�cal xddt so ! , • 414j 4. Ckta�pawn,l r�,r1Cr�r eff'a ►11 .��r iS i'I 9Li c� Phoaec'z�' =_ rac>�,a'` 5. Ptnmia charge DAY OF L'VST17 t i R _Cell phvne:_ e/0 9 6- SeLuptisno: � 'Act4aJ event start atttl eildttr$C: p _Clean upMANO tirais' �" ' - 7. Estirti nusflser ofvohmrst�porr3cipents L�,�; • PM - • ---- riiummr of—i fs;�.-�--�-- ---- �� »POLIC$IAPT wifi&ftrnsino Ift'eat dota_il .k. Admia.�iort f.elregistradon ohar�d tv pardCipanta7 .,No tfyct�; aa� _� ' 'Will there bb fb6d or ere wWors a2 cventl Yes No- >-�,ryes,intdimjs thet tuber of vendors and We{fowhln �i qt*' ;,>W ti there be mardiimdiso AVailabit fur Bete? Yt R MD vendors nand to oo.,Tletn application far specie]flea d ei the Licensing DivWon-200 Main street,Hvw ig. 9. Mep attached(REQURILM)for rorA rwUpaMe event: >>Are stmat clost>rm rtupiircd: Yes Aiu >>De I of roue mrWrest stops sttrackodind icated om m3p. 10. Food prepauedl fd cvoriv Yyas _o. iU v, r' !} »If y*S,will there•b_o�klnotsattng involved? ales�No -�7��//11�e ?A�i ��}� � '' 05;14!2014 12:28 FAX 508 790 6226 TOWN MANAGER 001 TENn.upUCTi1REB.ENTxPTk0,;f MNP DEVICES"Aaao,r map rrW tayout'af ev�l�t lnoludirgstrvLTureFiucem is t� TENTS REQl7M AIDDI7'ONdkD P$ILMIT FROM BLDG DBPT,� Structurea A Grodind9 hive deilpatw teat*101161y zones.. Should you require trafdsmhbre over tiTgn these rams?Io�t oD.nacds W flrsrha cleared with Sbuatures 8C C�rpt+ids. >>No open Barnes W tents'or propose storage use without a fire permit, I I. Areyou bismilitcg or constructing any shsotures,Including bullMings,eilm6ing.strltchza,etc? _Yea *0 12. Are you installing any tents or canopies?,'Pot -No Quantlty are,sine: On or r r RORW cDTnpmy- I4# O J 19, Do you plan tohavc any mund.ampli6cetlon, ,\Jes-.. No Music . Iwodescribe)�� .4. Is electrical power required? es.•_No (for WU3 4•amplification(PA syskm),lighting,popcom matbina ez} »Ifyea,.circle; will yD®proyidc poA-able generator? OR vdll.you regoireTOB teaWmry sc:wioc? >>Ust rnwftum wattage required and la:$tion for hook-up:drAlWay it 04. Ai-� ram.`#Or 1�r4_fL If mere than`usuar hookups,please note dwre*l be viveititne coats it Town IiWrlcdan setting up and ramoving _°A-%, Friu"crcr drupphlo service beforo/afteT event outside of bttsijeaa tnura, . ! GDNES.I1AIdRLERS: .__ • — �� 15.Do you have need for Wmicadeslconcs? Yes o >>IfM dexilbcfor Wbat DEPOSITS; S5.00 each eerie- $50,00_ach/baTrIWes(givan iciesrdeposits arranged wot gh DPv. ' I6,WI{l yov;tquirc access to the town bu]14t,ng7 V Yes No >>VVW,describc fur what uao:. t VE fe 6ARi?Aa ol_ FP R-6 VEMCLES' - 17,Do you plan to dT;ve vehicles Onus pmprrty? If yos,.provide details; Spealfio loading zones to be rcvicwcd W th DPW/SIructuras dt[bounds. Qrgpnization will be liable for any dcmeg=vableles wey cause the ground, ��R ow COMPOR asrT T GNS. �OUABLE T.CA TS AND Nolan WAsz-iNG 8DM3 18. Do you plan to proviWo portable toile ,aodlor hard washing sinks at your*visit?.,Yes No of regular toilets •#ofltaadicap acooasfble Wilds __j orhsnd Wkshing shirr Public ewort&tatlor.,located at'fuwn clad Parking l.at,North Street and Sarststablo V.9age We Station are gp n born CAM In 9PM�daily. If argent abzR& negulm oa0y upon.k mat be re%iowed with DPW._ GARDAt3E ANZD M''YCLINO 5ERVICP,S - - --� 'I Trash.p7ck'up Is the reWonsibllhy of the arpsnlzatlon requesting 1pl3 penni4. Plows Provide'Your plan for c cicaniTp ana t enTovall of sarbage and reFyrl {ss du''+g and aflei Your cvanC�Q _ �d.S f/! / — Numacr of rmycilrcg,c TaWnors' D ura rrcc , _ A :me tine:di wid tW for-use of Town conwi-mm may be.wOAvC Ace}+feb tvlll tie dabsenimi and ooltected by DYA The cost is based on aloe of evert ECUFJTY/SAFE?Y - 20,W'W inert bra demos, SY Ys di le< +rrmleiia9+.het M potcntislly htr dous/lmpW public We tp7 'Yes No >>If yes,dasmibt: 21.Haveyou made my provision for on-w. sewm Yes--No 27 ade Have 3u m _awy Lxovislon far on-the medical sesylowa_ Yet Nt PAPJUNO 23.Pletuto Ptcvidt dwalption of ym+;r parking plar,a'(®hltnre event slgtode�widl pork)' _Y AR � 0—t >>Pim for disabled.pst'idag; r J Y w »Pins for emergcccy-Ycbkle acerw,. _ >'-Picaso desmlbe your plans to natify residents,businesses impwtrd by this oymt; j ar`1G�18f1117�'EA'I'IslD1r} . 24,W:11 the evcrn be advertised? Byes,where; »DO you plait tD dlSt iWiz By;n Or xds b£forc OT luting this eYOW Yes No >>Do run plea to Plate cr y signs UT banners or other sdverdsortatnt ar tH5 event site? ,k!Yes_—No »Ityes,plaaftse indicate where: _ »Provide h !banner dctak and dimawa mW gcthod of attachment or support: 05/14/2U14 1.2,28 FAX 508 790 6226 MTN MANAGER Q.o o 4 02/05.2014 7:57 M FAX 50$7909279 BARNSTABLE REC/IYCC 1002/0A02 02A14/2014 14-,08 IP X 606 T80 6226 TOWN MANAGER H RECREATION �aOu2 Vaal. La• aver I r y4'Ienkou" I ' �• i.>' . •• 1 onto • CAN airI'M.&a,• � � � �� 6vAf�ra•i,60M•• Mi41RM� Q �'���- , • n ' + b�' •n4.swc s � •' r. rr ' b sia - N�6A ; A p,��,y, ♦ 'V,�1G a •ri WOr!•6 • 1f'ur4�►i1 d ikY�$I7 r t • 1 - 1 •1 .d . e r yr e y "d• � r het yYiv:a.\� a - /., e • ♦'r•. ..f� p• ,tI h n,• I•et� Ga- v��a* i♦e 1, � . ,, • a a • \ yd 1 m m ulowgl:i 01840 'dtu;-)Kj$ 8Z,11107 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40,00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. -it does not give you permission to operate.) You must first obtain the necessary signatures on this forni'at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI., 367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: Fill in please: APPLICANT'S YOUR NAME/S: Jj2dr&kv s` BUSINESS YOUR HOME ADDRESS: U + h TELEPHONE # Home Telephone Number z NAME OF CORPORATION- NAME OF NEW BUSINESS TYPE OF BUSINESS IS THIS A HOME OCCUPATION?. _ YES NO k: ADDRESS OF BUSINESS' MAP/PARCEL NUMBER O [Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to legally operate your business in this town. 1. BUILDING CO ISSIO ER' OFF�jE _ This individual e n i o ed"o any p r r quirem nts that pe ain to this type of business. riz rratu e* COMMENT m 6� 2. BOARD OF HEALTH This individual has been or ed of the permit requirements that pertain to this type of business. ' L r\+n q,uthhcize Si�nat re** l COMMENTS: I���GfS >''C!tYd IDS I211IVVltOL ir�0"I I 3. CONSUMER AFFAIRS(LICENSINP AUTHORITY) This individual has ti inf the licensing requirements that pertain to this type of business. Aut,orized Signa re** t / COMMENTS: YV Sign * aAMSTABLE. * TOWN OF BARNSTABLE Permit MASS. 6� 9.iArFA Permit Number: Application Ref: 201203090 20070756 Issue Date: 05/24/12 Applicant: Proposed Use: MUNICIPAL IMPROVED Permit Type: SIGN PERMIT Permit Fee $ 50.00 Location 670 OCEAN STREET Map Parcel 324041 Town HYANNIS Zoning District RB Contractor PROPERTY OWNER Remarks TWO WALL SIGNS 8 SQ EACH SNACK BAR @ KALMUS BEACH Owner: BARNSTABLE, TOWN OF (BCH) Address: 367 MAIN STREET HYANNIS, MA 02601 Issued By: pC POST THIS CAM SO THAT IS VISIBLE FROM TIDE ST ET A �IMME Town of Barnstable Regulatory Services ' BAmerABLEThomas F.Geiler,Director 96 . Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Permit# Building Official approving n Application for Sign Permit Applicant i�✓ �/� Assessors No. v� ?4 I Doing Business As: A U � ld��� �'U�( ��Telephone No. Sign Location Street/Road: Zoning District: Old Kings Highway? Ye No Hyannis Historic District? Yes Property Name: i� � Telephone: —4P662 Address: Village: �;44415bV• Sign Contractor - ,Q� Name:__ is Telephoner U '711 ifFD h Mailing Address: 2.4 Q Descripti . Please follow the cover directions.You must have an accurate rendition of sign with dimensions and location. Is the sign to be electrified? Y s/No (Dote:Ifyes,a wiringpermitis required) Width of building face—4�—ft'x 10- x - M.-Check one Reface existing sign or New Total Sq.Ft of proposed sign(s) Ifyou have additional signs please attach a sheetlisdng each one with dimensions If refacing an existing sign please provide a picture of the sign with dimensions. . I hereby certify that I am the owner or that I have th a on of the owner to make this application, that the information is correct and that the use an co tructi n sb all conform to the provisions of §240-59 through§240-89 of the Town of B ble onin Or �nce. 1 Signature of Owner/Authorized Agent: Date SIGNS/SIGNREQU revised12110 • t1 .r a � r�s YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L. -it does not give you permission to operate.) You must first obtain [lie necessary signatures on this form at 200 Nlain St., Hyannis. Take the completed form to the Town Clerk's Office, "I st FI., 367 Main St., Hyannis, NIA 0260.1 (Town Hall) and get the Business Certificate that is rcKquirecl by law. as DATE: Fill in please: APPLICANT'S YOUR NAME/S: ,� f BUSI SS YOUR HOME ADDRESS: TELEPHONE # Home Telephone Number NAME OF CORPORATION: NAME OF NEW BUSINESS Q TYPE OF BUSINESS IS THIS A HOME OCCUPAT NO o ff�� / ADDRESS OF BUSINESSr i& MAP/PARCEL NUMBER ���C �V�l (Assessing) 0/ 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 COM SIO R'S OFFIC This individua en informe o an per it r it me hat pertain to this type of business. Aut orized Signature* 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: i j YOU WISH TO OPEN A BUSINESS? For Your Information: Business Certificates cost $30.00 for 4 years. A Business Certificate ONLY REGISTERS YOUR NAME in the Town (WHICH YOU MUST DO BY M.G.L. - it does not give you permission to operate). You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Cleric's Office, 11" F1:, 367 Main St., Hyannis, MA 02601(Town Hall) and get the Business Certificate that is required by law. DATE: V2_7 Fill in please: APPLICANT'S YOUR NAME: ��� / � <�7 oZZ. BUSINESS YOUR HOME ADDRESS: Z24 e le— �rr.7 2— TELEPHONE # Home Telephone Number: NAME OF NEW BUSINESS s A,,v t, 57AIAr-4 At- TYPE OF BUSINESS 5,t1", /9147,- Cav,c.cc s5/* IS THIS A HOME OCCUPATION? YES NO o/ Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS L20 (G�.F-40_j S��f , ,5 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 1need. 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 CO MISSIO ER'S OFFI This individual Nas e in� d fanyer it requirements that pertain to this type of business. VV ' Aut orized Signature** COMMENTS J 2. BOARD OF HEALTH This individual h s bee med 0 e rmi equirements that pertain to this type of business. Auth rized g ture** COMMENTS: �. ( C2f4Gl_q K IV�Q(i�-T y _ A 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) This individual has been informed of the licensing requirements that pertain to this type of business:. Authorized Signature** COMMENTS: i l TO ALL N W USINESS OWNERS DATE: O 2 ran WIM � Fill in ple se: offimmefflin APPLICANT'S YOUR NAME:Z-C/N//2 �D E V Zq La,P6= S' BUSINESS YOUR HOME ADDRESS:q09 t9/_Z-441ZrZ (f/K S, ylq e o TELEPHONE Fr— Tele h ne Number Home 08= NAME OF NEW BUSINESS M094,1k O TYPE OF BUSINESS -max �o IS THIS A HOME OCCUPATION? YES NO Have you been given approval from the building division? YES NO ADDRESS OF BUSINESS E MAP/PARCEL NUMBER -V O 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. Once you have obtained the required signatures, listed below, you may apply for a business certificate at the Town Clerk's Office (Ist floor Town Hall) or if you get the business certificate first you MUST go to the following office to make sure you have all the required permits and licenses.. GO TO 200 Main St. — (corner of Yarmouth Rd. & Main Street) and you will find the following offices: 1. BUILDING COMMISSIONER'S OFFICE This individual h nforme f any permit requirements that pertain to this type of business. uthorized Signature** COMMENTS: 0 *Ir /O-Z-- 2. BOARD OF HEAL This individual has b Wormed f th Or t quirem nts hat pertain to this type of business. �Iw AA Aut orized 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: Business certificates (cost $20.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in the town (which you must do by M.G.L. - it does not give you permission to operate -you must get that through completion of the processes from the various departments involved. "SIGNIFIES APPROVAL FOR A BUSINESS CERTIFICATE ONLY. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION; Map t Parcel V Permit# Health Division. / ��5 ILZ- 3av=-0/e Date Issuedf�7�� Conservation Division ' Fee Tax Collector Treasurer AMICANT MOST OBTAIN A SEWER Planning Dept. CONNECTION PERMIT FROM THE ENGINEERING DIVISION PRIOR TO Date Definitive Plan Approved by Planning Board " ` gCTIODT Historic-OKH Preservation/Hyannis Project Street Addr ss Village Owner Address .✓ Telephone Permit Re uest . o7— uS �— Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Estimated Project Cost Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ `Two Family ❑ Multi-Family(#units) ` s-c Age of Existing Structure /!�t'y0 s Historic House: ❑Yes *No On Old King's Highway: ❑Yes 12ft Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other �-�- Basement Finished Area(sq.ft.) e 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 eat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No o� Detached garage:❑existing ❑new size Pool:❑existing ❑new msize- Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded U Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION b Name_5;,/�, C',s Telephone Number Address ees G o .I,,W 5� License# ' Home Improvement Contractor# Worker's Compensation# ALL CO TR CTION DEBRIS R SULTIN PROJECT WILL BETAKEN TO 2Faay,16- 4C SIGN rR/_ DATE FOR OFFICIAL•USE ONLY _ � ♦ F f _ ' 11 £•` F • .. " r t t< 4 r. PF�RMIT:NO. DATE ISSUED h MAP/PARCEL NO' ADDRESS r " ' VILLAGE r ' }. • ^OWNER ^ `` , ..� _' �� • `', ` •� t. 14 17 DATE OF INSPECTION: Y` FOUNDATION FRAME z yr - ' - a`. , - -r "�• .-._ �+ INSULATION � •.`'� _ ',;�-"; � , ° f , .' - i •, . FIREPLACE ' r `f ELECTRICAL: ROUGH '`FINAL PLUMBING: ROUGH FINAL w GAS: w ROUGH <cr ;? FINAL � . FINAL BUILDING 3 t. Y' DATE CLOSED OUT ASSOCIATION PLAN NO. '._,�,; �le �iamvinoouoea� o�✓�aaaac�ureelta _ BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number=CS. 047226 Birthdate 0 0/1956 Expires 06/29=01 Tr..no: 10927 Restricted To: 1 G JOSEPH C SLOMINSKI 6 BRALEY JENKINS RD CENTERVILLE, MA 02632 Administrator Kalmus Beach House Renovation Project Permits 300 Demolition -dump fees 500 Wall Construction - materials/rough carpentry 500 Windows 500 Electrical Rough-in - materials 1000 Plumbing Rough-in 2000 Ventilation 1700 Wall Finish - Green board & FRB panels 6000 Ceiling 2000 Lighting 3000 Interior Doors &Trim 1000 Entry Doors 1800 Finish Plumbing 5000 Ansul - relocation of existing 500 Flooring - material 5,000 Commercial floor installer 9,000 Countertop 1000 Interior painting - material 500 • Roof- materials 1500 Misc. &Tools 1200 Total 44000 -aft 324041 mappar owner addr1 city state landacres gis_acres landvalue bldgvalu_e total_appraised total assessed 324041 LE, TOWNMAIN STR EH YANNIS MA 48.06 50.3304 9630000 363100 _" 9993100 9993100 (1 row(s) ,�� vs �v,L�,✓T �� 343 lie Page 1 L. _$- r'l,� Pa. ald� �✓�aaaar/u�aelta BOARD OF BUILDING REGULATIONS ' License: CONSTRUCTION SUPERVISOR . Number..CS 032127 j Blrthdate:.0221/1943 i Expires:0221/2062 Tr.no: 17150 Restricted To: 00 ROBERT A BURGMANN PO BOX 634 "�'. : EAST SANDWICH, MA 02537 Administrator -TOWN OF BARNSTABLE'BUILDING PER_MIT.APPLICATION Map Parcel ». ,, Permit# Health Division /�� — /_L- 2:7 N� 1NS7,4 septic��SMA4 E°��! I ued r LLE®IN Coiap�, � , Conservation Division ZNIVIR� "i7'I-I 77TT - Tax Collector ' , 7V -Treasurer f ` 1 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH , Preservation/Hyannis _ Project Street Address LaQ O C 0-0, ST ` Village 1 Owner K ) c' tW i *6 Lb: Address _ Telephone ' �39 Permit Request T`C'2�-1- Q Square feet: 1st floor: existing proposed 2nd floor:existing proposed Total new Estimated Project Cost -Zoning District Flood Plain Groundwater Overlay • Construction Type Lot Size Grandfathered: ❑Yes O No If yes,attach supporting documentation.. Dwelling Type: Single Family 0 Two Family ❑ Multi-Family(#units) _ ,Age of Existing Structure Historic House: ❑-Yes- 0 No On Old King's Highway: 0 Yes . O No Basement Type: ❑Full ❑Crawl 0 Walkout 0 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:0 existing ❑new size " Pool:0 existing ❑new size Barn:O existing 0 new size Attached garage:0 existing ❑new size Shed:0 existing ❑new size' Other:. Zoning Board of Appeals Authorization ❑ Appeal# Recorded 0 Commercial ❑Yes ❑No If yes,site plan review# , Current Use Proposed Use ' BUILDER INFORMATION ' ' Name Telephone Number Address License# Home Improvement Contractor# Worker's Compensation` ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE* ✓�C �Y(a ,�i� DATE ;. FOR OFFICIAL'USE"ONLY PERMIT NO. 1 DATE ISSUED MAP/PARCEL NO., ADDRESS ' VILLAGE . OWNER - DATE OF INSPECTION: FOUNDATION FRAME INSULATION - Z. t FIREPLACES yt , ELECTRICALS r ROUGH FINAL d t r PLUMBING:` ..ROUGH i FINAL GAS: 'ROUGH FINAL • t FINAL BUILDING i t DATE CLOSED OUT ` , r ASSOCIATION PLAN NO.' ' N�- of .�. ° r` k `ref r �Iglt., r�;..a?\!;_�i:?� ) i I.tE�'lM3r:' F�` ^�Y�? :,t.i•�t,:.. t�i•',C.. _.. NEW `,':..,;h??�' f?�j` � M,AY ail rd'e zu'i.< a This t, €Aroctuc:t$hemkr,, have b""mc+ragalase¢urees from rttateri tti itt9vaen0y fidme retardant as here after dh material supplier NAME,: i CertltlE4dBrea l : .r�z6&rs� sa : r ys .l s., .3;,��a v'>. ?4-,: �`s'4I :it^ Ili t�:' ;1,,� '-'-",IYILI S:'(lilt i'r.t"• V)tIY!: ltl ri"'tf'1''(�'J(':i SI;�#YY')c:. a,:df a.'�76.nilt• l..�it?i i'1�:35 !t"i ,.i.)3:n 111:c�i1:.!" t ��l: ,!S'tl;;.i :r .. ..".;f>: 'i. 'ro .. f`r (-••i �:�) b -9 JISt1 •,L� , '�1;"%� M i (��` •?i��• Lf`:'�,:'SlpS S't�i3�i;C� .i;i£'bt')f Fa`S!!('s�i) i ic•'t'l !(�','�i rt(;(!f'�.:i•.F,s ti. C'f0<';rRTriIi2(r.; t s• •�+„1 i n>5 rsc�. i.r �� (? C� si:?�;i11C;iid'..iai?r. t;� I�li�l, _�".,••'i�?{;Oi7r.'. 4 1 with tt}<; FExft,;:z, .,I' .i".:':., .i')a. 1a`t'ti�c'v1 -rVL- cal.,r ca_t,l w tu31E ><i��b>h�3t; 3..`.i �;?aJ+fly3 .... kJ.>,t'W w, ;_..�.;c,:',.r.i;t__ _— ^.w ._ - w. �......._...._ M.. ... ......... Y j ...,�__.w'....w._...,....�.,..,,n.uyu�M,.o. .......:•-.. .-.... ....--.._::..�,.ar.ww,», r"...",...u.M wr.v ..�.,�_.,+r••u».....n.nn. wu�.n..,......--._.-:—, ....^�_...r....,..»..,...,..,,. .- —ryj f � (Jc�scri�iotr r<�1;8!'y3 i�i�dd > wr, r •, `.� ._,it �t�..,,..w. .._..-......�..._. , -�.....................,..,,:_.,.:. ._.._..—� Flan,14 Kc--tior- t Proce" Usert ids H4 Mast 5e Rcrm ved Sy W I'f`eing .And is Elfectwe For The Life Of The Fabric t.�.......'..._....,.._.,,1. ...,..._.-,—___.w..,.._.`.....,,,,,,._.. ,...._.,....,....,,.......,..,.,..aS {CNY FPAF(TM EN',.lr:IFIN ON'8i7ORI.I=xV�,vINF A.-;�30ctA.'V%—.INC: ,�- .,, �R'Bt�I.°.2xt%31sY¢3l'S,. '�L4't4!F'��ltu�9'(�iratlf' 9(1 i_.s�1tY9lf4cvA3fp� � ' i fn q f9 1f yr LI) Lo LO ..3x I p m CD /w�` 'oaf{=i ;i :�c: i`:iS a::. t=ae:• li: � '�;: _r...� � ..�j MIN Ln O ,.�f��};'' jot �9 � yt�f• 9{� [�a� a _ k9 ' � � CD Q !► t ., ir46a� ¢C 4a' h � e•f �•'.,'X :F3{: :; e l b! :.iiE #i tri. •. 3{i EJ �a[ �� k•+<:, ct ifs . ..sit. ifs: },a,: [• �:�. �- q '�')T,;"Alt.:'+ �3t'ff ':3 :ts$1; fi.i� , s�j�a }:si �:'i�:� •'r�� •�t:�f :-; � �+ L';.i�' t 2•• �{; .'t .. 4.y . � � c••3Si :;�4?%!f ,) ���i =K3" £ii Y `alt •.; �I•_ t'K `�t,i° w a¢i It; 1Lt s o •fs% }" 3 • 'tl �*3f: :sic` aiir 3Ft }T' SFa >gfi?. }a' )- �t't a .£` i i i,5i��_ •;!5.•a I; iy. 'f " }¢sa `F::f ?zE ,. � � -�s ��:y: .sgt{ •�•'i�t� �t�iai.;. ys. �s,': M /a,i-� -'ttcf "R�' Si1i� �I �y �0<1^d ,�.� r! �kft� ,i41' 1:3�' ,i2gYY' "F /'� :i V• :. .{:[-.:: � L. �i �<: wi: •� rt: '�, z�s ft-i"` t a•.. .i'-f. :l:i": .•s -.. •:3 � ,t•. ef[-t ?"t'•� ±A '°. � '� �H �: r,. ':�Y� ��;-.IY t y.i �<i< = a :,:�....; 'v: ••t:':iSv::i ,t� � �(� '•.�O r`� i..'`i`-'�: t:€ <:•n fr'_:4•. 3}�:t: rt€ :'£;:..F":: Q iy En %�� it� ,i. :tk•k �fsr. `.a- .2. .,F•7� - t `:F. �..:. �S —E r.7 a�.itrj:t it�S: j` i ->•' _.; :av ;� �" 03 G 7f •[s:t }r:;.: (g�{ti <�-�)- lfa ±a,:: _"{ .Lk Sa�aD N` m r! A :dr t:•:; zs.<•:d' err: :,:!,,. 4:', a' � �[;.} ��':i>• ,.i:h�;;y.:;'. -z-ti, g:ib. �Z:a; �'?f:'. � _ t3,.yi ..e:�:ar. � G ot p t.••�R:.� �{Sexi: .a�,G :..y(, �i�(i..- 2ifc: �. Z: d+,a: '3 �.i;i:[. y;;f9 )s', :Z; ,r±,t` ."iw:• '{1'.:' ..-ft � si'+:. , :..� W,id.� g'Y T.4 f y :cxLcs a{",':". t[-j.'•: q5 .tyij ,.• Q �• a3i ff"` °;:Z•<'> `aas6�. jE�R": f7 tt� f�f_s": -:, ..�'iv,r�i�i ,. ;° i — '> i'- d ' {; f >, Fri� ; UQ o r.7 6. .43 �{• .•, E f:s t'���Yzif�<;i o133i_ Y.•. LEASE EXHIBIT: THIS LEASE IS SCHEMATIC IN NATURE .. �. §` x , • .Y ', r � =a i :�: r - s AND IS INTENDED TO PROVIDE • . °_ - K ca � GENERAL INFORMATION REGARDING THE - . ` .. LOCATION AND SIZE OF THE PROPOSED ` � , . g 1 e � `„ �p Z WIRELESS COMMUNICATION FACILITY, li cc THE SITE LAYOUT'WILL BE FINALIZED in CID UPON COMPLETION OF THE SITE ° ' F f SURVEY AND_FACILITY DESIGN. � � ` � _ .`�; � �_ �- - _~�� � .' �� �e � � . -,4 . STRUCTURAL NOTE: 3 " Oki -14 O A STRUCTURAL ANALYSIS SHALL BE fKc PERFORMED ON EXISTING UTILITY POLE PRIOR TO CONSTRUCTION AND SHALL k � • r • �1 BE THE RESPONSIBILITY OF UTILITY CO. 1 . v n "u inn �, „. � �• -. � INSTALLATION NOTE: INSTALL ALL EQUIPMENT, MOUNTING BRACKETS AND HARDWARE IN ` ACCORDANCE WITH MANUFACTURER'S � •� t RECOMMENDATIONS ' ry y1 w ELECTRICAL NOTE: r `f • �� ` GENERAL WIRING DIAGRAM AND NOTES TAKEN FROM E—MEMO BY • " " „ ' ` '` ` JAMES F. GVAZDAUSKAS, P.E. t DATED JANUARY 12 2017 $ may s. *t a COORDINATED NOTE: COORDINATES AND AMSL ELEVATION '. orBASED FROM FIELD SURVEY DATED xc .' a ,�r .. ter...}; - 04/03/2017. A METES AND. BOUNDS _. �. a ^ s SURVEY WAS NOT CONDUCE 3^" T$„ r ki. .fie �`` �R, g S` .d iRTu 9� OF Itcorr It r .. - •a f^ ^- ° S ...,' •*� a-" ft � �,w 'u '° .�'t' `aC" {�:.:r � i. :. " ' `' ' it a � No,40M qr T LEGEND - v � .„ a (F) = FUTURE (BLACK) - n a (E) = EXISTING (YELLOW) APPROX. LOCATION �) UTILITY POLE _ (P) = PROPOSED (BLACK) NOTE• (AGL) = ABOVE GROUND LEVEL E TRUE NORTH SUBJECT POLE FALLS WITHIN TOWN'S (AMSL) = ABOVE MEAN SEA LEVEL NAD 83 LATITUDE: 41' 38' 09.15" 1 SITE PLAN RIGHT—OF—WAY. N.T.S. = NOT TO SCALE NAD 83 LONGITUDE: —70' 16' 50.99" 0 25' 50' 100, MASSDOT HIGHWAY LAYOUT PLAN (WHITE) LE-1 SCALE: 1"=50 GROUND ELEVATION: 4.4' AMSL BARNSTABLE SC20 MA LEASE EXHIBIT DATE: 10/23/2017 fAVADVANCED veri onwireless DRAWN BY: SMB ENGINEERING GROUP, P.C. DRAWING NUMBER REVISION CHECKED BY: SNA Civil Engineering-Site Development VERIZON WIRELESS 670 OCEAN ST. SCALE: 1 =50' Surveying-Telecommunications 400 FRIBERG PARKWAY BARNSTABLE, MA 02601 BARNSTABLE SC20 MA 2 WESTBOROUGH, MA 01581 SHEET: 1 OF 6 (P) 12.0.0 X 38.7'H NH360QM—DG-2XR TOP (P) ANTENNA ANTENNA MOUNTED ON TOP (E) UTILITY ELEV. = 32.8't AGL.(37.2'± AMSL) POLE (P) ANTENNA GROUND WIRE � OF (P) ANTENNA � �—(P) 12.0'0 X 38.TH (P) ANTENNA MOUNTING BRACKET — /, 31.1'f (35.5't AMSL) G NH360QM—DG-2XR ELEV. IN (P) COAX CABLES (TOTAL OF 2) ANTENNA MOUNTED ON TOP (E) UTILITY POLE & (1) RET CABLE IN 2' U—GUARD P � P TO (P) ANTENNA TOP (E) UTILITY POLE ELEV. = 28.5S t AGL (32.9 t AMSL) (P) POWER WEATHERHEAD i (P) RRH'S (TOTAL OF 2), (2)(P) — MTM a �t— DIPLIXERS, & (2)(P) DELTA (P) RRH'S (TOTAL OF 2), (2)(P) AC/DC CONVERTERS MOUNTED DIPLEXERS, & (2)(P) DELTA TO (E) UTILITY POLE AC/DC CONVERTERS MOUNTED (P) FIBER. 2' U—GUARD TO (P) SAR-0 TO (E) UTILITY POLE a } }(P) SAR-0 (P) SAR-0 I � BOTTOM OF (P) RRH (P) Xz' COAX CABLES (TOTAL OF 4) TO DIPLIXERS ELEV. 12.5'± AGL (16.9'f AMSL) ° �,-- �r�' (P) ELEC. RGS CONDUIT TO (P) METER 60A-2 POLE DISCONNECT SWITCH FUSED WITH (3)-20A CIRCUIT BREAKERS & METER SOCKET I °D 60A-2 POLE DISCONNECT SWITCH FUSED WITH (3)-20A CIRCUIT BREAKERS & METER E GROUND LEVEL gh SOCKED ELEV. = 0 t AGL 4.4 t AMSI (P) GROUND WIRE FROM (P) I `i� I - METER TO (P) GROUND ROD i SCO T r2 PHOTO ELEVATION L J AVAUs LE-2 SCALE: 1'=10' Im C LEGEND t11tl. (F) = FUTURE (BLACK) 1 E L E VAT I O N ° iT INSTALLATION NOTE: UCTURAL NOTE: (E) = EASTING (GREY) �`�sOIdAL INSTALL ALL EQUIPMENT, MOUNTING A RSTRUCTURAL ANALYSIS SHALL BE (P) = PROPOSED (BLACK) LE-2 SCALE: 1 =10 BRACKETS AND HARDWARE IN PERFORMED ON EXISTING UTILITY POLE (AGL) = ABOVE GROUND LEVEL 0 5' 10' 20' ACCORDANCE WITH MANUFACTURER'S PRIOR TO CONSTRUCTION AND SHALL (AMSL) = ABOVE MEAN SEA LEVEL RECOMMENDATIONS BE THE RESPONSIBILITY OF UTILITY CO.' N.T.S. = NOT TO SCALE BARNSTABLE SC20 MA LEASE EXHIBIT DATE: 10/23/2017 DRAWN BY: SMB ADVANCED yeti onwireless DRAWING NUMBER REVISION CHECKED BY: SNA ENGINEERING GROUP, P.C. 670 OCEAN ST. Civil Engineering-Site Development VERIZON WIRELESS BARNSTABLE, MA 02601 SCALE: AS NOTED Surveying-Telecommunications 400 FRIBERG PARKWAY BARNSTABLE SC20 MA 2 WESTBOROUGH, MA 01581 SHEET: 2 OF 6 INSTALLATION NOTE: (p) 112.0"0 X 38.7"H INSTALL ALL EQUIPMENT, MOUNTING NH360QM-DG-2XR ANTENNA (P) AWS RRH, (P) PCS RRH, (P) AC/DC BRACKETS AND HARDWARE IN MOUNTED TO (E) UTILITY POLE CONVERTER; (2)(P) DELTA AC/DC CONVERTERS, ACCORDANCE WITH MANUFACTURER'S (2)(P) DIPLEXERS, 60 AMP METER SOCKET " (35' RECOMMENDATIONS ( TALL POLE *� W/DISCONNECT MOUNTED TO (P) UTILITY POLE NH)360QM-DG 2XR ANTENNA TOTAL LENGTH) �\ 3.0' MOUNTED TO (P) UTILITY POLE STRUCTURAL NOTE: o A STRUCTURAL ANALYSIS SHALL BE m PERFORMED ON EXISTING UTILITY POLE z PRIOR TO CONSTRUCTION AND SHALL r (P) ANTENNA MOUNTING BRACKET BE THE RESPONSIBILITY OF UTILITY CO. PER MANUFACTURERS SPECS (P) SAR-0 (E) OVERHEAD WIRES ' (E) 28.5' TALL POLE i (35' TOTAL LENGTH) SCOTTPE ADAMIS TRUE NORTH cab 4 ANTENNA PLAN 5 ANTENNA MOUNTING DETAIL LE-3 SCALE: 1"=4' LE-3 SCALE: 1"=4' 12.0" - e e 2 7.3" cv N COMMSCOPE NH360QM-OG-2XR o � DIMENSIONS: 12.0"0 x 38.7" e e o o e e WEIGHT: 33.7 LBS TOP FRONT SIDE :® PCS RRH WOGM: 55.0 LBS. - �e " a ,. M 7.6' a4 o e W,...- eeee °e v°D,, ooee D N ooee e o FRONT JIVL 0000 0 e°eo ee � eeee oe TMn! e e e o e e WIRELESS CONSTRUCTION. INC. v eeee e e POLE/WALL MOUNT FOR DUAL DIPLEXER RADIO BRACKET FRONT ITEM DESCRIPTION OTY. DIMENSIONS: 7.6"H x 7.3"W x 3.2"D LEGEND AWS 90W RRH 2 PCS RRH RACK W/ DOUBLE MOUNT 2 WEIGHT: 6.6 LBS UNIT WEIGHT 67.0 LBS SUPPLIED HARDWARE (F) = FUTURE (BLACK) 3 SUPP RRH RACK LIED HARDWARE T NOTE: MOUNT DIPLEXERS TO BACKSIDE (E) = EXISTING (GREY) OF DBL-MNT BRKT (P) = PROPOSED (BLACK) , ANTENNA DETAIL 2 RRH DETAILS 3 DIPLEXER DETAIL (AGL) = ABOVE GROUND LEVEL LE-3 SCALE: N.T.S. LE-3 SCALE: N.T.S. (AMSL) = ABOVE MEAN SEA LEVEL LE-3 SCALE: N.T.S. N.T.S. = NOT TO SCALE ^A BARNSTABLE SC20 MA LEASE EXHIBIT DATE: 10/23/2017 ADVANCED veri�onwireless DRAWN BY: SMB ENGINEERING GROUP, P.C. DRAWING NUMBER REVISION CHECKED BY: SNA Civil Engineering-Site Development VERIZON WIRELESS 670 OCEAN ST. SCALE: AS NOTED Surveying-Telecommunications 400 FRIBERG PARKWAY BARNSTABLE, MA 02601 BARNSTABLE SC20 MA 2 WESTBOROUGH, MA 01581 SHEET: 3 OF 6 PROPOSED ANTENNA ANTENNA MOUNT/BRACKET ANTENNA GROUNDING (2) 1/2" COAX CABLES & (1) REf (DEPENDING ON ANTENNA CABLE IN 2" W RATED U—GUARDS MODEL) SECONDARY LINES $ +N WEATHER HEAD (LEAVE 10' CONDUCTORS FOR UTILITY CO. TIE INS) FIBER FRONTHAUL & BACKHAUL IT FIBER DEMARC ON POLE (2) DIPLEXER FIBER JUMPERS IN 1-1/2" W (4) 1/2" COAX RATED U—GUARD IF LENGTH CABLES EXCEEDS 4' �� AWS RRH PCS (3)#6 AWG WIRE IN FIBER JUMPER (TYP.) RRH 1-1/4" W RATED PVC DC POWER #2 AWG COPPER GROUND DELTA AC/DC CONVERTER (TYP.) (TYP. OF 2) WEATHER PROOF SQUARE D CAT OF AC POWER NOTE: USE PROVIDED DELTA NO.: SDSA1175 SECONDARY SURGE MANUFACTURERS WIRING HARNESS ARRESTOR ON 20A 2P CIRCUIT BREAKER SCOTT fd. #2 AWG COPPER AMOMIMAMMS SQUARE D QO-100A, 8 SPACE, 16 CIR OUTDOOR GROUND IN 1/2" Cm MAIN LOAD CENTER WITH COVER. 60A 2P MAIN UV—RATED PVC , CIRCUIT BREAKER WITH (3) 20A, 2P BRANCH CIRCUIT BREAKERS (1 FOR SURGE ARRESTOR & (1) PER RRH) MILBANK CAT NO.: ��P�r�t L a U2272—RL-5T9—BL SINGLE LEVER 120/24OV, 1+ 3W 125A METER 3/4"000' COPPER .�•'' CLAD GROUND ROD NOTES: 1. 120/24OV, 1—PHASE, 3 WIRE: USE MILBANK MODEL #U5818—RL-200S METER SOCKET ELECTRICAL NOTE: GENERAL WIRING DIAGRAM AND 2. 120/208V, 1 PHASE, 3—WIRE: 1 GENERAL WIRING DIAGRAM NOTES TAKEN FROM E—MEMO BY USE MILBANK MODEL #U5818—RL-200S METER. SOCKET JAMES F. GVAZDAUSKAS, P.E. WITH FIFTH TERMINAL KIT K5T LE-4 SCALE: N.T.S. . DATED JANUARY 12, 2017 BA R N STA B LE SC20 MA LEASE EXHIBIT DATE: 10/23/2017 I DRAWN BY: SMB ADVANCED verfZ nwireless ENGINEERING GROUP, P.C. DRAWING NUMBER REVISION CHECKED BY: SNA 670 OCEAN ST. Civil Engineering-Site Development VERIZON WIRELESS BARNSTABLE, MA 02601 SCALE: AS NOTED Surveying-Telecommunications 400 FRIBERG PARKWAY BARNSTABLE SC20 MA 2 WESTBOROUGH, MA 01581 SHEET: 4 OF 6 • 4y GENERAL NOTES ELECTRICAL AND GROUNDING NOTES STRUCTURAL NOTES: 1' �ileooYO e°aaiaN�as iNo iwwNc N�ooa�afa 1. w�c a�wi� E��am 1' DENIM W BsalloM M�MENR U� MWO m"sl/ v e�/M-m-o L UNUIP NOMIXIN NO MV M(AS MR10Nq N s BE w.MINED 0 Use AM PROVEN M s O swL VEW AIL oNeiNNN Iwo aNaiaN N=ran�lO�No MLIM OF AW xOMIL MT NNINK OaORII I SOL BE FlOINm 10 7NE AIFDNDN OF 1NE tCxNRDORON xANANEt 3 NML sNR161F AID IDIINID NICIEIS l0 FWREWE Q ACCBS N FCLE CIaa1 AND OOIBNlfBDN GF SINNUML UK 31KL GIOINWII W IN MaNN1 NNINIE W MR aaMlMaalal =aBNONNN N UM100 MCBDL NNN 10 FORCE ONREIE W9PNR AND WBCwCNION Par I E OEM wNIMOINCN AND lSa,7DN OF NMIOMML SM FOR NAIaNOS: SN AAN1l �R 16NN1 NIN IS119t N AOOaNNI:E/N �VV=NN�L NIaL l QNW GMT awL RC M FIN FBW AD 0 FANGIN E RN 4. SNRWROL AND INCNIMNNI6 NIS awL OaNONN 10 ANY AM NMORN AL MR NNMS ONENNME NONyOBL L 000020 NO®RIC Q11W PA ING IDr FPRIONND A 301=w.AVERM N GDNRID SND PBNDS AND NNapISNaI GN' L sna PK awL OONr 10 ON Mw%M -MM wash s S man VSNNN NNL NMN:IINIL 7~. WE DIRID PIE 10 dar w AmNI1L WON HIDE A.at ANY A03 PFE ME IL NMM ISO IMF-OM n C-ON=NUM AIO SeNNESS WFE E CR S,aM0[L L BBMR L ARI IM NRO GNINM A M AN 0 lO WNNW BIU PFE 1M MOM ME NNDw.ACx1K 01100E 10MIBN D WHEN, N N�!WIS GAN1w®NNO!�OOMAR N SCNDINE NI PIR(11C PBNNIM a/ AN WNNe NBNB®N IIOIO WNf FGNlOA[xt7K al a NOMA L aaMsa CN Nua OU BE NO fl a Nua paeM TIM NO 0CW=10 WN AM IM NONwNalls NNBONI S POR SnaCRNML JM%NCUDIO.aAONNE WIN MO RAN NN aNaer.ALL 100 awl BE L NI®0000f awl NE 17MUE 40 PVL Wr ML=L % HE MRWK NOW awL K 0MR NN TOE MR MR at SO MIUML 7. ALL NBE.NIt1NSMB awL WE ONNwNBO AM FINICNION N ACWIONNE WM ANN M23 IM OW-W GMLIMN®)OOAMIOS ON SON MO NIEL FROOIICIS".MEW 0a1MSE NMM6 L NNI BOWL 0MNF N CINE IaWENI ILICNCK UM MUNCHI 1, PqM MD FFMW t CU S E FPC M NOaND GN=NNRINL L ALL BOL14 MPIIONS MO INCNl1ANNtIS NNtDWAE awl BE Qw N ACCaONCE WM MIN M53-AM-OMM PONCE ML WON PAL NOPL GpaNwE NOWIN I NN UMN 000PW Off NI M AND MR NMN Pw.IMFa 000N E NNO6 L NIN I=NOW tN ONIE IMISM188M K YNNR 111MMDN PINK NO L Pan WNOS.BULL NMEr SNP CM MO ALL CNUNBI GwNANIID=n=NMLL NE NNIWBI INN AN tN>DIaN 211C PNOAST�M CBL NE NDD Oa1Q AIO NIS ON•Q A6 MNOIIBI fN OW NIiNN PART OOIFLI'l10 WIN NIUMENS W ANN A711L ONNNrOO P®MR wRT 9101E WE 0 PE CNIF nO N NNONL PONCE RRL IN NI PNL NWE AND G ONME 0001E 1EVINN WE WENT.2NC N VMN GUN IM wM Mw FIaRRI N NtONI GN IENNN.IMCMN7N8 M MID WOMBS N IEIIi NNNtliB1 IM aaMN NWwN PPNF SKL NE NN NCR U:D IIUN 4 COW((i110 101E 1N CRr NININ 000 WM A NEWLINO OCINIO 11 VA E MM NEWEEI NS AIO 11F N VqQ NNIUMM M ANN M23 GN Mw AS NWUML PRCMT GNINR ML aE NDO MACE GNNQ ANE NOBNNIAO IRE W,IaNNNE IL 0040 IA M AU=FLY WIN IN APP S OWE FOR PROCFnINe. FMMCE AND AWAY WWEDS.MO FOR MOH006 N aONDIN ANIE 1E tR01ND PmNI N 1�aaDIRS awL N PIAC OIMAL IN®N OONINS,INO MONO.ALL IBM Me W]ONq awl NE G WWW IN ACCONNICE WM INS 11. ALL BMW Low aOINE DIaL NNE NM a BOONAE 'sNaONO OVUM=ROC EIN M ALL WSMO 11101E BE NNE IDIq Elaol NDCIIIOOQ NO WEAI/awl 1L FPO 9A'PIM N FpaT tRWR OONFOMI 10 ANC MO ML WIDE Mw w WED NNE ME NCR 110%FUME 1FE MOWN atE Fm wai&4 IN 1NE MSC VINK OF ORR OONI MIC10.SIN EONIaI Il 0101000 awl CCURY Nx NM ML UL ADDIONIY BAND AND UNNBO P1�101 awl K NNE N ANCUM ON T E w SR 11. NOONMONx FFNNONBA ON Olt OBa�M0000 q MaN t NI OINN NE O mane at OaN10N VI LL GRINND alNd MWINN PNCR W�ON OCRIMM AOWL ANY SM AOMN AU HICU E 14, GRIND ODNIK MU SMUN MORN IS NNN BM INN NNNNCRAB 1 M DINE GRINNNID NM V"=ff PN w GNNL IL INNNMIR ML M rONal INK 6V NL MINT MU N AN NNNA 011 IN UORMT OW.INK IN aR 1L IIs< aNwD®WE Nx NRIMMI foR ASOE tRILtE WP�SM N�S awl BE I N1�dM G�/3M2%NI=aREAaNE NM%AND awL BE NDr-W aKMt1® 'WE a sOl VUL DRE aarPa eNN to WM MMCN AMOS MU aa1NDF aP 11r NNNEtNN sNM�N MR ANCM 000 WRI N=a INSIM AN wR NEON GRINpD/e t0 N NwOr NWAOIID OaPN®dal 1lrE OOMNLWN NIE N W INNINBI NNEIF•A 8CN®I 11AW MO A EPW MIWL 11E MPCNONNO BMW awl E INE W-4ff W-20 16 ML GRIND M/BNMD GR aNlao ODNBIIC SBOr DD IDF AUa sIIE asps WE W a N aaNaar MO aR Nr--10 NNBIS UO NB M UK)OR ENONE IS AP NCM ECRA WM 4-11r 1NL EMIUM IDEM NN Gw1w®N�. 14. MN-M" sous 9M CONFURM 10 rmelK 9160 CNDN PP-$-=%MW N,npE 4,aM N NO NO(MU N 17. NINE 41101NB10 tWaICIRD RIND 11E aNRSNF AND NANNNNlF wax OR APNM WJL 00NaU1C0 awl BE N A000101M WIN I E NNIPOPAaC'S NeooNNaDUM N NNM MIILF MNl1lE AF I1Od0®`DiN 1t�wNNA us°N os GyaNE°feea°BQIR r aem�T aMLL a nNNNe MN GNE Iwr(31//�1 NCI SL a eNBt eoNiaelr aR GyiNB°Er° GRa°B�°DN GR Naa a a W IL G RAIL sue M AD aoNa V E Nw1 SE PtACNN ANNNF NRDIN 011 90 . >d ONNRE7MD lD NNoao eND RMLL w IwE nI Wo xouE aalsPl®NON IL aalloE FOR M E NO a UNME 31ff F aMLL NE 3010 M AN BWAW(49-00 N=K WENa aaf M IIPi OWrat uNs APRY tIIOE NRNN OOIi01110 W AlL IOFIaNNR V. ALL tMSF N RICE=0ffE 3ML NE NDPN MO PWM N AC00 NNCE WIN 11E N CAMON Ns N►AN 318 MO IL NND ANIBIN tNINDD N CaNL GNNE tRIAO D4 AR1 MMI1 R/BD AM 31A. R M NNl I E ANBIN AAPPLY q�NINlDN OaFNAO A ALL aaNI�I T1PE aIIAO aa1NIM01R IN, 11E POUANq MOWNOONCI6IE OWOPBt ItWiORCIp NFS MU ME AS FOlNAMB INNESS 1101®O11a1W9Ek 00000 E aW AONASF E M-3 MCM " 21. Q MD MOM 001 NBNa1K 9EaNODC YNINrt 5118�1 aONQaE E1M00N 10 DNM on UPON �au PROIGNAR Baal GEDIAO N0p AN NNDID FOIE WJ�I E4NIN 10NAi/ MO LJONN MO S ° ES GRAND NID AN IWDINER RDIIND Nli MIRM 1 1 D NONE= TT im. 2L aalNMaolt RILL IN OOI/AEl®/NI10 NNIN AN RM00 03000 Fan ALL E7QONBI EMNS 91NL BE FlO1A0®WM A 314W4'ONNP6t WESS NO11n NIINwRE. PMiBT am-off OOINNOaML S NAN NOMN 0010I11E MONK ADAMS 2A OMDN70R awl A D UN MMMASI AND NNQNCE 1L UNNat SM OOWLY WM 11E NBIRaB1B OF 1 E MGEIICAN MIME OF 1N�t OOINNMICNON MO IN N=K 10-Rw �C low w=F0.4 FFMN cm off. FwW FMVJCIS ANNOaNIM IWICIML CENMN W�IyODN FOR NO OOINIMICINL ALL UNER OU NE cc AND WU K S N 8MAL QMOE NIX 2 OR BEREL PNESaNE 11FI0® TE °�!(} BARNSTABLE SC20 MA LEASE EXHIBIT DATE So/23/Zo» W- DVANCED verffOnwireiess DRAWN BY: S DRAWING NUMBER REVISION CHECKED BY: SNA NA ENGINEERING GROUP, P.C. 670 OCEAN ST. Civil Engineering-Site Development VERIZON WIRELESS BARNSTABLE, l 02fi0) SCALE: AS NOTED Surveying-Telecommunications 400 FRIBERG PARKWAY BARNSTABLE SC20 MA 2 WESTBOROUGH, MA 01581 SHEET: 5 OF .6-