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HomeMy WebLinkAbout0790 IYANNOUGH ROAD/RTE132 - FIVE BELOW `�fii�' i 90 lyannough Rd, Hyannis 5/14/14 - - AL - - - - _ _ kill U J , q y n h • S , V � v �F y a Y r Q *� wow +w' `{ '7:r, �,.^ n,...' .'-t '•:'� x «�F• r ^-.'.fig.r',. .,.... I ' win• M+r Y s • r anm w ~Jriw. �rrn� , C7 1 +-S �s i tw A r 4, p j1} Fpr T y. tip: s 4 .. .-..•-.-+� :�`is.�.`r��--�� �`+s.'w� �"^�+�--^.,..Mr'�--/Yyc-. ...........� is �*'+ � ram... 7,Z 10 ■ � f wall" .000 'Ilk a Vie f,�fnort- 3,3 a Zoning District: Yes/No Hyannis Histori( Property Owner Name: Address: I am applying for the following: (Please check all that apply) Trade Flag (not to be used in conjunction with c Symbol) Business Trade figure or Symbol(not to be user trade flag). Open/Closed Sign(not to be used with a trade f Hardship Location Sign if this box is checked at', from property owner giving expressed permission for x property. Please attach graphic or photo of proposed with dime I hereby certify that I am the owner or that I have the that the information is correct and that the use and co §240-59 through §240-89 of the Town.of Barnstable Signature of Owner: Q:\WPFILES\FOR.N4S\SipsinHyannis.DOC mot , Sign " . : TOWN OF BARNSTABLE Permit 9 MASS. 1639. �� ' �F A Permit Number. Application Ref: 201401770 20070967 Issue Date: 03/25/14 Applicant: Proposed Use: SHOPPING CENTER- MALL Permit Type: SIGN PERMIT Permit Fee $ 200.00 Location 790 IYANNOUGH ROAD/RTE132 Map Parcel 311092 Town HYANNIS Zoning District SPLT Contractor PROPERTY OWNER Remarks 69 SQ. FT. WALL SIGN FOR FIVE BELOW Owner: PROPERTY OWNER Address: HYANNIS, MA 02601 Issued By: PC . PAST THIS CARD SQ THAT IS VISIBLE FROM THE S ;BEET I ,„E, Town of Barnstable Regulatory Services HAM Metre. ' Thomas F.Geller,,Director MASS. . 9`bA 039. Building Division TFD MA'S A g Tom Perry, Building,Commissioner 200 Main Street, Hyannis,MA 02601 wwwaown.barnstable.ma.us Office: 508-862-4638 Fax: 508-790.6230 Pcrmit# Building Official approving Application for Sign Permit l /� Anchor. Me Sin Inc. an Stariiek-contact Assessors No.�./I-0�j_ Applicant;-- --- g , (Megan: — Doing Busuiess As: Anchor Sign,Inc. Telephone No. (843),576-3255 Sign Location Strect/Road:_ Ca etown Plaza,790 Lyannough Road,Hyannis,MA 02601 • .. - . . Zoning District: 3230. Old Kings Highway? Yes V,�o Hyannis Historic District? YeAr' Property Owner Nanhe:Gape Harbor Associates c/o S R Weiner&Assoc.,.Inc. Telephone:__(617)046-3272 Adch-e-ss:__M 7901yanriough Road/RTE 1322-_ Village:_Cape Town Plaza Sign Contractor 1 80 213.3331� Namc Anchor Sign,1nc.�_ ___ .._TciC)hoiic. �0)_ M<uling Adch-ess:__ __ 2200 Discher Avenue,.Charleston,SC 29405 Description Please follow the cover directions.You must have an accurate te-ndition of sign with dimensions wid location. Is the sign to be elcclrifie:d? 'cs t� Width of building face r69'-2" fLx:10- x,.10 _ Check one Reface existing sign or New Total Sq.Ft of proposed sign(s) 68.89 If�•ou h��i e aclditio//al sigh/s please att<�cJi a sbeefL'stu each oue wid)dimensions if refacing an existing sign please provide a picture of the existing sign with dimensions. I thereby certi6,that I ani the o`Aii&or that I have tie authont}r of the owner to make this.application; that tie information is correct aiid that the use and construction shall conform to die provisions of §24�0-59 tlhr6ugh§240-89 of die Town.of B ►isl<tl of}❑ 9rdimu►ce, Signature.of Owner/Authorized Agenti' / Date_ 3/6/14_ SIGNS/SIGNREQU revisedl2110. �\� PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 03/25/14 TIME: 11 :05 -----------------TOTALS—,--------------- PERMIT $ PAID 150.00 AMT TENDERED: 150.00 CHANGEPLIED: 150.00 APPLICATION NUMBER: PAYMENT METH: CHECK T PAYMENT REF: 0172573 5 'a PERMIT PAYMENT RECEIPT TOWN OF BARNSTABLE BUILDING DEPARTMENT 200 MAIN STREET HYANNIS, MA 02601 DATE: 03/25/14 TIME: 11 :08 -----------------TOTALS----------------- PERMIT $ PAID 50.00 AMT TENDERED: 50.00 AMT APPLIED: 50.00 CHANGE: .00 APPLICATION NUMBER: PAYMENT METH: CHECK PAYMENT REF: 0172573 r»: SIGN A 33 Five Below- - .. Sign Type: Individual Front Lit Channel Letters - &Halo Lit Backer Panel - Internally Illuminated LED 68.89 Top of Sign To Grade=1T-4" • Bottom of Sign To Grade=13'-9" '- 69'-2"Lease Dimension EQ 20'-8" EQ 19'-51/2" I i !: _ .. -_ I If Bit o I TF TV IT T1 ff.IT 11 - - it N J ALL sarnti i z Front Elevation (West) Scale: 3/32"=1'-0" 69.20 - Formula: 1:1 - 68.69 Client: Five Below • 03/06/2014 Permit Rendering JD This rendering is the Pmpeny of Anchor 03/18/2014 Revise Sign A dimensions and allowable s .ft. JD sign,Inc.It is for the exdesile use of anchor sign.Inc.end the Pony which Site#: FB-A15835 s en JJ��� O P,e sn d engine erem�:g It to be , 1FOUS S��N Address: 790 Lyannough Road r YY distributed, re0ruduced o exhibitetl Hyannis,MA 02601 without the consent of Anchorrnanaq Sign.Inc. Please comact your accroun t er - Capetown Plaza with queettens rcgertling this statement • (IF - } 69'-2"Lease Dimesion ' i m Perspective Elevation (West) Scale: 1/16"=1'-0" Client: Five Below • 03/06/2014 Permit Rendering JD This rendering is d,e property of Anchor Site* FB-A15635 03/18/2014 Revise Sian A dimensions and allowable s .at. JD Sign,Inc.It Is for the e.dus,e use et quested,theMCh.1 Sign,la—ad derng. I party a ! NUB ���� Address: 790 Lyannough Road • unpublished original drawing not to ce (r t distributed, reproduced or exhibited Hyannis,MA 02601 without the consent of Anrhor Sign.Inc. Please contact your tmecant m nager Capetown Plaza with questions regarding this statement. I,F r� 20'-8" 20'-0„ SIGN A 33"Five Below Sign Type: Individual Front Lit Channel Letters 19'-5 112" 8 Halo Lit Backer Panel Internally Illuminated LED .. .. 6889 Top of Sign To Grade=17'-4" Bottom of Sign To Grade=13'-9" Sign Layout Detail Scale: 1/4"=1'-0" 5" 1 112" 1 1/2" 1 I 1 Electrical 1 I Detail: •- • • • • .�" I 1 I I AGILIGHT WHITE TUFFRAYZ LED 1.Existing Facade:Clapboard Siding/Plywood/Metal Studs (5)Xitanium 60 WATT transformers 2..040 Aluminum letter returns painted to match silver @.85 AMPS EA, total amps=4.25 O (1)120v/20 amp circuit required �L tuho 3..125'x 1"trim cap to match silver 4.3mm Signabond Lite composite backs 1 I I (interior of sign can painted white for maximum illumination) 5.White LEDs This sign is to be installed in accordance with 6.3/16"White Acrylic faces the requirements of Article 600 of the National 7.Waterproof disconnect switch per NEC 600-6 _ Electrical Code. 8.Primary electrical feed 9.Transformers 1)Grounded and bonded per NEC 600.7/NEC 250 10.Mounting Hardware;1 1/2"Sleeve spacers(ptm facade)w/3/8"thru bolts w/1 5/8"x 1 5/8" 2)Existing branch circuit in compliance with 12 gauge uni-strut Drain holes at bottom NEC 600.5,not to exceed 20 amps 11..125"Aluminum Face and.065"Returns Painted to match SW#6959 Blue with bottom of letter cans 3)Sign is to be UL listed per NEC 600.3 (2)per letter 4)UL disconnect switch per NEC 600.6-required per White Border for Background Pan sign component before leaving manufacturer' 12.0.75"x 0.0625"Aluminum angle pop-riveted to backs attached to returns via#8 Pan-head screws Section Thru Sign 'For multiple signs,a disconnect is permitted but 13.3/16"Clear lexan backs not required for each section. 14.#12 x 1"TEC screws with 1 1/4"fender washers Scale:N.T.S. Client: Five Below . 03/06/2014 Permit Rendering JD 'm1,rendering is the property of An 03/18/2014 Revise Sign A dimensions and allowable s .ft. JD Sign,Inc.ft is for the e„dusive use of O Site#: FB-A15835 Anchor Sign.Inc.and the party which ���� ���_••_ unpublished the rendering. n is {l\Y�![l]Y// Address: 790 Lyannough Road • distributed, eproduetl drawingo no,1. our o Hyannis,MA 02601 pleasetihe,ao`' Ancno`Si—go, your accoun Capetown Plaza wim yuescons regabmg his swtement. kr F4 .� F ��. Capetown Plaza SIGN A 33"Five Below Sign Type: Individual Front Lit Channel Letters &Halo Lit Backer Panel - _ Internally Illuminated LED - 68.89 Top of Sign To-Grade=17'-4" Bottom of Sign To Grade=13'-9" POND \ • �� ��y�.rcnctcsli°r � I �� s �w� -7 Z + \ of 44 is I t z TX r, 'fit t t!f`Fr G.7 rtih"P•17(t l� 191!'rle+trl llnt rlli•` !i4 u.f xthf(1 I f I•ItYl1+4'tA l'frnf( t !lr.ice• 3 � i'� IYANNOUGH'ROAD C (RTE.,:1:32) CAPE COD FMALL Client: Five Below • 03/06/2014 Permit Rendering JD rhis rendering ie me property of Anchor ch Site#: FB-A15835 03/18/2014 Revise Si n A dimensions and allowable s .ft. Jp sign,Ina It is ncho,Sign, c me e.cwswe use of 17�� �\�Aq� Aquesled In. rendering. It is which f�► �O 6I V Address: 790 Lyannough Road • unpublished original drawing not to be [[!! Hyannis,MA02601 distributed. rep—ced or exnimlod without the consent of Aerhor Sign,Inc. 1 y Please contact your account manager Capetown Plaza with questions regm,ing this c otement. (qAnchowSign. Sign Permit Request March 6, 2014 Town of Barnstable, MA / w Attn.: Robin Anderson Town of Barnstable 367 Main St. Hyannis, MA 02601 �\ Phone: (508) 862-4027 Dear Robin: This sign permit request is in regards to: Five Below(FB-A15835) 790 Iyannough Road' Hyannis, MA 02601 Enclosed,please find a check in the amount of$200.00 for the sign permit fee, a completed sign permit application, a Letter of Authorization from the Landlord/Owner, (1) set of detailed plans, a copy of the property information listing and a self-addressed stamped envelope for the return of the permits for above-mentioned location. I have included what I believe to be the complete requirements needed to obtain this permit. If I have failed to send any important information or if any other fees are due, please contact me as soon as possible so that I may get it to you. I appreciate your time and efforts. Thank you. Please do not hesitate to call if you should have any questions. Sincerely, _ n 6J Megan tarric Permit Coordinator Toll-Free: (800) 213-3331 Direct: (843)576-3255 Fax: (843) 576-7255 Email: mstarrick@anchorsign.comuD P.O. Box 22737•Charleston, SC 29413 �M Charleston 843.747.5901•Toll Free 1.800.213.3331•Fax 843.747.5907 � a www.AnchorSign.com l '/l� �tHME, Town of Barnstable Regulatory BMWSTABLE, ' Thomas F.Geiler,Director 0.39..,a Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-7 0-6230 Permit# Building Official appro�ring_ Application for Sign Permit Applicant: Anchor Sign,Inc. (Megan Starrick-contact) Assessors No. Doing Business As: Anchor Sign,Inc._ __Telephone No. (8 3)576-3255 Sign Location Street/Road: Capetown Plaza,790 Lyannough Road,Hyannis,MA 601 Zoning District:_ 3230 _Old Kings Highway? Yes'q Hyannis His c District? Yes Property Owner Na►ne:Cape Harbor Associates c/o S R Weiner&Assoc.,Inc_Telep one:_�617)646-3272 _ Address: 790 Iyannough Road/RTE 132 __V; age:___Cane Town Plaza Sign Contractor Name:_ Anchor Simon,Inc._ Telephone:__ (800)213-3331 Mailing Address:_ 2200 Discher Avenue harleston, SC 29405__ /NT escripti n Please follow the:cover directionst have an ccurate rendition of sign with dimensions and location. Is the sign to be electrified? Width of building face 69'-2" x.10= Check one Reface existing signw_ Total Sq.Ft of proposed sign (s) 80_03 If you have additionalsigns plea sheet listing each one with dimensions If refacing an existing sign please picture"of the existing sign with dimensions. I hereby certify that I am the ow, I have the authority of the owner to make this application, that the information is correct id that the use and cons ction shall conform.to the provision_s of §240-59 through§240-89 of e Town of armstabl o ui g Ordinan e. Signature of Owner/Au rued Agent: Date 3/6/14 SIGNS/SIGNREQU revised12110 p o.. ............ ... .......__........_.__........_......._ .... _..... ._..... . ...._._ . .... ... _ .. ......... ...-_.... _._......_...._ __.... ---__...._._ ::-._-_ -.....__._.._ _..._.._........ --_... .... .. .. _. ... .... ....... .. -. .........._. _.........__. ___........... . ._.--.........._ ............_..._..... . .. . .._.. ._........._ .. .._......_.. . - ..... .. .... .__................_.....:... ....._._.._ .__.. .. ... __ _ _. _... _. ... . .. ... ......__._. _...__...... _. .... ,.... __._.... .......__. . ...._. _.........__...... _._. _ ..__.-........ .. �_.. .. ..._. .. .___ .. ._.. .........................__.._._...... .......__._.....I...__.. ....._........ ......._.. ._. ....._.. _. ... ...._ ...... ..._ _. ._. .. .._.. .. _. ......_.__.. ...:... .. ... .._.....1.... ................... ....... _._:.._...... ........_. ..... ......_....._ .__. _ .:: : .: _ I. Capetown Plaza LLC F11 ebruary 13,2014 : Town of Barnstable,MA . 367 Main Street . - :_._ _Hyannis;MA Q2601 _ _ _ - Re. Five Below(FB-A15835) 71. LyaI - . Road Hyannis,MA 02b01' To Whom If May Concern . . . _ _ : , . _ Tlvs letter authonzes Anchor S gn,l'Inc to bean authorized agent of the property owner, - - enabling them to obtain permits and perform sign installations at the;project;,add, fisted Above; Thank you,. _ .. .. :--.1-.IwI:.—.:�-I1l�:-:::I-:I—:::.d--.I:-:..:�:-.-.:.I:1:...::..�:I:.-p.:;....::.::::;:,:...�...1.:1:::*::.::::---q—:::.:m:.1:.::.:,..::.:d:---I�i.:..:...*:.:-.,:-1.::,,:.:::-.�:,:..:..:....—:::P:.::..�;..::::.:1:.:.*-..:�:.:�::.�m---i—.:.:1..-:.::—::1.:.::—:b.::;.,—.M-..:..:I m:-..�1d:.—�_..:,:..:—,.::I:.:�:�...m.--...�.1I::::�:':I.----.II::.n.:,:I:--:—':..,.-:-:'I l.::-:.:.-:—::,:::I-..:':�:-:.::—-:-:-..-.:.:..:.:.-�:--:-,--.1,-..,.!.--..:-:—::...:I.��I:..—,—...—:.-.�:..:-1..�—:I�,..'....-...-..::,.::;::m::�..—I:.-;:.:'.,,.....-..�::-..!,--.*-.I..:—..--..:,:..,,...p—:.--.-.::1,:::—:..:.—..—.�1.:...,;.:..::.::.:::...1:..,::.::.;,..d:,:.:.....-:;:.::,:,:,q.-...-1�:--.�;—:,.,.:�:.:,-.—...—:.1:::1 f�:.:,—;::..-,...::..I:.�:.:;,,-q-.7:.:�I.-.1.�.],:-,—:--.—.-..:�:I,.:-1:—:�-::.:�.-:-:::-:I:,.-.�:I.:�:::.::,...:.-1.,:I-..;�--:.::.::::...:::.:.,.::�:.:.�—:I.:.::-:�.:-.-:I.:.�:----�.;:':.-:.�::.::.:-:':.::::-,.:.:-.:.l:.:--:::::.:d.-.:-:-:--:1-.I.:l:.:—:::.:-.b.::.:::f,:".�.,.:::Id.!.:..:::..::::::-:::::,. - . : :. .. . -- sign a_ e :. .: ,+ 9 ., Pn ted Name : . .. cv� I L , 1330 Boylston Street Chestnut Hill', MA 02467 _ _ ._ _ .. .. _ .. _. .... Town of Barnstable Building Department - 200 Main Street ASTABLE, MA 02601 MAC. �, Hyannis, - 9� 16gq (508) 862-4038 RFD�A Certificate of Occupancy . Application Number: 201309393 CO Number: 20140029 Parcel ID: 311092 CO Issue Date: 05101114 Location: .790 IYANNOUGH ROADIRTE132 Zoning Classification: SPLIT ZONING Proposed Use: SHOPPING CENTER - MALL Village: HYANNIS Gen Contractor: SADLER, GARY Permit Type: CC00 CERTIFICATE OF OCCUPANCY COMM Comments: FIVE BELOW Building Department Signature Date Signed 4 V TOWN OF BARNSTABLE �� '�-ding 201309�93Permit • BARNSTABLE, +` Issue Date: O1/02/14 MASS, A i639• �� Applicant: SADLER�GARY rF0 MAC A Permit Number: B 20140001 Proposed Use: SHOPPING CENTER-MALL Expiration Date: 07/02/14 Location 790 IYANNOUGH ROAD/RTE132?oning District SPLTPermit Type: COMMERCIAL ADDITION ALTERATION„ Map Parcel 311092 Permit Fee$ 4,550.00 Contractor SADLER,GARY Village HYANNIS App Fee$ 100.00 License Num Est Construction Cost$ 500,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND LANDLORD WORK FOR 2 RETAIL TEN FIT-UPS IN EXIST PLAZA,IN T THIS CARD MUST BE KEPT POSTED UNTIL FINAL CONST,TOILET ROOMS, STOREFRONT,ROOFWORK, INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: PROPERTY OVUNEP, BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: HYANNIS,MA 02601 INSPECTION HAS BEEN MADE. Application Entered by: PF Building Permit Issued By; THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY:"ENCROACHMENTS X PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,.MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY,GRADES,AS WELL AS DEPTH AND LOCATION rPUBLIC.SEWERS MAY BE. OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF TMS•PERMtr DOES NOT REL EASE'THE APPLICANT FROM THE CONDITIONS OF ANY,APPLICABLE SUBDIVISION. RESTRICTIONS. °' s K MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED.. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. * 7.FINAL INSPECTION BEFORE OCCUPANCY. 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. PERMIT WILL BECOME NULL AND VOID-IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. , PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 fe lei ' � - - DIV 3 1 Heating Inspection Approvals Engineering Dept Co A S Fire Dept Z,1� e�1� 2- try �� Board of,Health 41 �iN•t L I Final Construction Control Document H, W To be submitted at completion of construction,by a W a Registered Design Professional for work per the Wh edition of the Massachusetts.State Building.Code, 780 CMR, Section 107 Project. Title:5 Below Date:4-4-14 Permit No. Property Address: 790 Iyannough Road Project: Check(x)one or both as applicable; New construction X Existing Construction Project description: Landlord work for 2 tenant "fit ups" for mercantile space in an existing plaza building. Scope consist of interior construction toilet rooms, storefront; roof work and limited facade construction, ' 1,Dan Rhodes MA Registration Number: 39320 Expiration date: 6-3044; am u registered design Professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Architectural Structural Mechanical Fire Protection :Electrical X Other: Fire.Alarm for the above named project: I,-or my designee; have performed the necessary professional services and was present at the. construction site on a regular and periodic basis.To the best of my knowledge, information, and belief the work- proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: l: Have re.viewed,for conformance to this code and the design concept,shop drawings; samples and other submittals by the contractor in accordance,with the requirements of the construction documents.. 2. Have performed the deities for registered design professionals in 780 CM:R Chapter 17;gas applicable. 3. Have been present at intervals appropriate-to.the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in it manner consistent with the construction documents and this code. Nothing in this document relieves the,contractor of its responsibility regarding the provisions of 780 CM.R 107. F A. S Enter in the space to the right a'"wet"or e electronic signature and seal: pA N �. n►AooEs ; cj ELECTFtICA� N. � No. 39320 Phone number 614-322400 Email:Dan@aegltd.com FSStpNpl E�� f Bt iilding Official Use Only Building Ofifieial (Name: Permit No; Date: Version 06 1 12013 Final Construction Control Document H To be submitted at completion of construction by a Registered Design Professional for work per the 8t"edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Capetown Plaza 5 Below fit out Date:4.08.14 Permit No. Property Address: 790 Iyannough Road,Hyannis,MA 02601 Project: Check(x)one or both as applicable: New construction x Existing Construction Project description: Landlord work for 2 tenant"fit ups"for mercantile space in an existing plaza building. Scope consist of interior construction toilet rooms, storefront,roof work and limited facade construction. I Carmine Guarracino MA Registration Number: 40104 Expiration date: 06-2014 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: Architectural x Structural Mechanical Fire Protection Electrical Other: Describe for the above named project. .1,or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis.To the best of my knowledge, information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as part of the building permit and that I or my designee: 1. Have reviewed,for conformance to this code and the design concept,shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its res onsibility regarding the provisions of 780 CMR 107. Zti.QE A14—, Enter in the space to the right a"wet"or CAPOAIvE. ` electronic signature and seal: / NO) ( OR RAU Phone number: 617.628.170 Emad ng.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 Final Construction Control Document _ To be submitted at completion of construction by a oil Registered Design Professional for work per the 8th edition of the Y Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Capetown Plaza 5 Below fit out Date:4.08.14 Permit No. Property Address: 790 Iyannough Road Hyannis,MA 02601 Project: Check(x)one or both as applicable: New construction x Existing Construction Project description:Landlord work for 2 tenant"fit ups" for mercantile space in an existing plaza building. Scope consist of interior construction toilet rooms, storefront,roof work and limited facade construction. I Gary Sadler MA Registration Number: 20054 Expiration date:09-31-14 ,am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning: x Architectural Structural Mechanical Fire Protection Electrical Other: Describe for the above named project. 1,or my designee,have performed the necessary professional services and was present at the construction site on a regular and periodic basis.To the best of my knowledge, information,and belief the work proceeded in accordance with the requirements of 780 CMR and the design documents approved as-part of the building permit and that I or my designee: - 1. Have reviewed,for conformance to this code and the design concept, shop drawings,samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Have performed the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Have been present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work was performed in a manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. Enter in the space to the right a"wet"or electronic signature and seal: ' %v A5S. Phone number: 774.430.3390 Email: gsadler@55upland.com Building Official Use Only Building Official Name: Permit No.: Date: Version 06 11 2013 P Final Construction Control Document N r To be submitted at:completion of construction by a aRegistered Design Professional for work per the 8"' edition-of the Massachusetts State Building Code,780.CMR, Section 107 Project Title: Five Below Capetown Plaza Date4-17-14 Permit.No. Property Address: 790.Iyannough Road Hyannis,MA 02601. Project: Check(x) one or both as applicable: New construction X Existing Construction Project description: Landlord work for 2.tenant"fit ups"for merchantile space in an existing plaza building. Scope consists of interior construction toilet rooms, storefront, roof work and limited facade construction. I, Dan Rhodes,MA Registration Number: 39320 Expiration date: 6-30-.2014,am a registered design:profe.0ional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning: Architectural Structural. X Mechanical Fire Protection X Electrical X Other: Plumbing for the above named project. I, or my designee,have pet formed the necessary professional'services and was present at the construction site on a regular:and periodic basis.To the best of my knowledge, information, and belief:the work proceeded in accordance with the requirements of 780 CMR and the design documents approved,as part of the building permit and that I or my designee: I, Have reviewed,for conformance to this code and the des'ign.concept,:shop drawings, samples'and other submittals by the contractor in accordance with the requirements of the construction documents.. 2. Have performed the duties for registered design professionals in 180 CMR Chapter 17,as applicable: 3. Have been present.at intervals appropriate to.the stage of construction to:become generally familiar with the progress and quality of the work and to determine if the work was performed in a-manner consistent with the construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions-of'780 CMR ]:07. qN. F Enter in the space to the "right a "wet"or electron ic.signatu re and seal: o N R. �. g m: RHODES o ELECTRICAL , No. 39320 Phoiie.num belt; 614-322-70'50 Email: dan@ crs ;aealtd.coni '7 '¢ � �`Ssror�A1.E`�> Building:Official Use Only Building official -`lame:- Permit No;; Date: Version 06 i 12013 i TESTING . ���` A A CING, INC. 151 State Rd,Westport,MA 02790 Phone (508) 730-1010 Fax (508) 730-1020 TwinTechTAB.com TEST AND BALANCE REPORT PROJECT: Five Below LOCATION: 796 Iyannough Road Hyannis,MA 02661 DATE: 4/10/14 PROJECT#: TT-14-38-1571 ARCHITECT: ENGINEER: Upland Architects NA 250 E.Main Street Suite 13 Norton,MA 02766 GENERAL CONTRACTOR: MECHANICAL CONTRACTOR: Pivotal Builders Kermit B Schulz&Sons 31 Parsons Drive 39 Norfolk Road Swampscott,MA 01907 Millis,MA 02054 4 1 Twin Tech Form 2012 TESTING A A CING, INC. 151 State Rd,Westport, MA 02790 Phone (508) 730-1010 Fax(508) 730-1020 TwinTechTAB.com TEST AND BALANCE REPORT CERTIFICATION SHEET PROJECT: Five Below LOCATION: 796 Iyannough Road Hyannis,MA 02661 DATE: 4/10/14 PROJECT#: TT-14-38-1571 This is to certify that Twin Tech Testing and Balancing,Inc.,has balanced the systems described herein according to their design specifications.Furthermore,the testing and balancing has been performed in compliance with the requirements and procedures of the Testing,Adjusting and Balancing Bureau,and the results of these test are recorded in this report. rod . �ItliI ,. m etkT-. ., IT U 2 Twin Tech Form 2012 I PROJECT: Five Below C—j itADDRESS: 796 Iyannough Road TESTING AL IA CING, INC. Hyannis,MA 02661 DATE: 4/10/14 PROD.#: TT-14-38-1571 REPORT INDEX TITLE Page # Cover Page 1 Certification Page 2 Index Page 3 Instrument Sheet Page 4 Symbol Sheet Page 5 Report Summary Page 6 RTUs data sheets Pages 7-11 EFs data sheet Page 12 3 Twin Tech Form 2012 PROJECT: Five Below ADDRESS: 796 lyannough Road TESTING ALA CING, INC. Hyannis,MA 02661 DATE: 4/10/14 PROJ.#: TT-14-38-1571 INSTRUMENT CALIBRATION SHEET THIS IS A LIST OF INSTRUMENTATION THAT WILL BE USED ON THIS PROJECT MANUFACTURER CALIBRATION CALIBRATION MODEL# TYPE OR DESCRIPTION DATE DUE DATE ADM-880C Shortridge Multimeter 2/1/2014 2/1/2015 HDM-250 Hydrodata Multimeter 2/1/2014 2/1/2015 CFM-886 Shortridge Flowhood 2/1/2014 2/1/2015 Fluke 971 Temperture/Humidity Meter 2/1/2014 2/1/2015 Fluke 365 Tru-RMS AC/DC Meter 2/1/2014 2/1/2015 RV801 TSI Vane Anemometer 2/1/2014 2/1/2015 ALL INSTRUMENTS ARE CALIBRATED USING AN INDEPENDENT TESTING FACILITY TECHNICIAN: Peter Medeiros NOTES: 4 Twin Tech Form 2012 PROJECT: Five Below TWI " C 3 ADDRESS: 796 Iyannough Road TESTING A A CING, INC. Hyannis,MA 02661 DATE: 4/10/14 PRO .#: TT-14-38-1571 SYMBOL LEGEND AHU Air Handling Unit L.D. Linear Supply Diffuser AC or ACU Air Conditioner Unit LPS Low Pressure Steam ACCU Air Cooled Condensing Unit L.T. Light Troffer ADJ P.D. Adjusted Pitch Diameter LWG Low Wall Grille AMP Amperage LWT Leaving Water Temperature AVG Average MAU/MUA Make Up Air Unit A.D. Air Density MBH ' 1,000 BTU's per Hour B.H.P. Brake Horsepower N.A. Not Accessible C.D. Ceiling Diffuser N.I. Not Installed CFM Cubic Feet Per Minute N.L. Not listed C.E. Ceiling Exhaust N/A Not Applicable/No Access CH Chiller N.Z. Nozzle CHWR Chilled Water Return O.D. Outside Diameter CHW or CHWS Chilled Water Supply O/A Min Outside Air Minimum C.R. Ceiling Return OAT Outside Air Temperture CP Circulating Pump PF Power Factor CC Cooling Coil PHC Preheat Coil CT Cooling Tower PH Phase(s) CWR Condenser Water Return PMP Circulating Pump CW or CWS Condenser Water Supply P.P. Perforated Plate DB Dry Bulb PSI Pounds Per Square Inch D.D. Direct Drive P.T. Pitot Traverse DIA Diameter RA Return Air EAT Entering Air Temperature RF Return Air Fan EDC Electric Duct Coil R.G. Return Grille EDH Electric Duct Heater RHC Reheat Coil EF Exhaust Fan RPM Revolutions per Minute EMCS Energy Mgt Control Systems RTU Roof Top Unit EWT Entering Water Temperature SA Supply Air FCU Fan Coil Unit SAT Supply Air Temperature FH Fume Hood S.D. Supply Diffuser FG Floor Grille SEF Smoke Exhaust Fan F.E. Floor Exhaust or Return SF(AIR) Supply fan F.L.A. Full Load Amperage S.F.(Elect) Service Factors FPB Fan Powered Box SHC Steam Heating Coil FPM Feet Per Minute S.P."W.C." Static Pressure in Water Column F.S. Floor Supply S.W.E. Sidewall Exhaust F.S.R. Floor Supply Register S.W.R. Sidewall Return FT.HD. Feet of Head S.W.S. Sidewall Supply FTU Fan Terminal Unit TAB Testing,Adjusting,and Balancing GPM Gallons Per Minute TSP Total Static Pressure HC Heating Coil UH Unit Heater HEATER O.L. Thermal Overload for Motors V Volts HEPA High Efficiency Particulate Arrestance VAV Variable Air Volume H.F. HEPA Filter VD Volume Damper HOA Hand/off/Auto Switch VFD Variable Frequency Drive H.P. Horsepower VP Velocity Pressure HPS High Pressure Steam W Watts HRC Heat(Recovery or Recliam)Coil WB Wet Bulb HVAC Heating,Ventilation&Air Conditioning W.D. Water Density HWR Hot Water Return W.G. Water Guage HWS Hot Water Supply W.V. Wind Vane Anometer HX Heat Exchanger F Degrees Fahrenheit I.D. Inside Diameter AP Differential(Delta)Pressure LAT Leaving Air Temperature AT Differential(Delta)Temperature, 5 Twin Tech Form 2012 I PROJECT: Five Below ILY TW �� U ADDRESS: 796 Iyannough Road TESTING = A A CING, INC. Hyannis,MA 02661 DATE: 4/10/14 PRO .#: TT-14-38-1571 REPORT SUMMARY All systems are balanced within designspecifications. RTU-4 is for future use,unit set up high to accommodate addition ductwork. Nick Cifelli Peter Medeiros TABB Su ervisor TABB Technician 6 Twin Tech Form 2012 A I PROJECT: Five Below YLT ADDRESS: 796 Iyannough Road TESTING A A CING, INC. Hyannis,MA 02661 DATE: 4/10/14 PRO ECT#: TT-14-38-1571 FAN DATA SYSTEM FAN NO.RTU-1 FAN NO.RTU-2 LOCATION Roof Roof SERVES Sales Sales MANUFACTURER York York MODEL NO. ZH120N15T4AAA6A ZH120N15T4AAA6A SERIAL NO. NIB4475842 NIB4475841 MOTOR DATA SPECIFIED TESTED SPECIFIED TESTED MANAFACTURER NL Century NL Century FRAME SIZE NL 56HZ NL 56HZ HORSEPOWER NL 3 NL 3 BRAKE HP NL 2.74 NL 2.79 SAFETY FACTOR NL 1.15 NL 1.15 VOLTS PHASE 460 3 460 3 460 3 460 3 MOTOR AMPERAGE 4.7 4.2 4.4 4.3 4.7 4.3 4.3 4.4 MOTOR RPM 1725 1725 1725 1725 SPEED VFD SETTING 1 1 1 1 HEATER SIZE NL CB NL CB HEATERAMPS NL CB NL CB FAN SPECIFIED TESTED SPECIFIED TESTED SUPPLY CFM 4,000 3,991 4,000 4,016 RETURN CFM 3,250 3,271 3,250 3,287 EXHAUST CFM NA NA NA NA OUTSIDE AIR CFM 750 738 750 741 SUCTION PRESSURE NL -0.51 NL -0.53 DISCHARGE PRESSURE NL 0.31 NL 0.3 FAN STATIC PRESSURE NL 0.82 NL 0.83 EXTERNAL PRESSURE 1 0.54 1 0.55 0 A DAMPER POSITION NL 10% NL 10% SHEAVE RPM SPECIFIED TESTED SPECIFIED TESTED FAN RPM NL 1239 NL 1244 MOTOR SHEAVE BORE NL 1VP50-7 8 NL 1VP50-7 8 FAN SHEAVE BORE NL AK70-15 16 NL AK70-15 16 BELT SIZE/NO.OF BELTS NL A54-1 NL A54-1 SHAFT CENTER LINE NL 19 NL 19 SHEAVE TURNS OPEN NL 2 NL 2 NOTES: 7 Twin Tech Form 2012 f f PROJECT: Five Below ADDRESS: 796 Iyannough Road TESTING A A CING, INC. Hyannis,MA 02661 DATE: 4/10/14 PRO .#: TT-14-38-1571 AIR DISTRUBITION SYSTEM: RTU-1 SUPPLY RETURN 0 EXHAUST ROOM OUTLET UNIT AREA/AK DESIGN I ACTUAL I DESIGN I ACTUAL LOCATION NUMBER SIZE/TYPEJ or F.H. I FPM FPM CFM CFM NOTES Supply Supply Sales 1 44x4 1.20 820 825 1,000 1,007 Supply Sales 2 44x4 1.20 820 797 1,000 972 Suppiv Sales 3 44x4 1.20 820 836 1,000 1,020 Supply Sales 4 44x4 1.20 820 813 1,000 992 Totals 4,000 3,991 Return Return Sales 1 40x28 7.77 418 421 3,250 3,271 NOTES: 8 Twin Tech Form 2012 I PROJECT: Five Below I � 1 ADDRESS: 796 Iyannough Road TESTING A A ` CING, INC. Hyannis,MA 02661 DATE: 4/10/14 PRO .#: TT-14-38-1571 AIR DISTRUBITION SYSTEM: RTU-2 SUPPLY RETURN EXHAUST ROOM OUTLET UNIT AREA/AK DESIGN ACTUAL DESIGN ACTUAL LOCATION NUMBER SIZE TYPE or F.H. FPM FPM CFM CFM NOTES Supply Supply Sales 1 44x4 1.20 820 825 1,000 1,016 Supply Sales 2 44x4 1.20 820 797 1,000 973 Supply Sales 3 44x4 1.20 820 836 1,000 1,031 Supply Sales 4 44x4 1.20 820 813 1,000 996 Totals 4,000 4,016 Return Return Sales 1 40x28 7.77 418 423 3,250 3,287 NOTES: 9 Twin Tech Form 2012 I PROJECT: Five Below ADDRESS: -796 Iyannough Road TESTING A A` CING, INC. Hyannis,MA 02661 DATE: 4/10/14 PROJECT#: TT-14-38-1571 FAN DATA SYSTEM FAN NO.RTU-3 FAN NO.RTU-4 LOCATION Roof Roof SERVES Stock Room Toilets Open Area MANUFACTURER York York MODEL NO. 2H061NO7F4AAA6A ZH061N07F4AAA6A SERIAL NO. NIB4475838 NIB4475837 MOTOR DATA SPECIFIED TESTED SPECIFIED TESTED MANAFACTURER NL Marathon NL Marathon FRAME SIZE NL 56HZ NL 56HZ HORSEPOWER NL 1 NL 1 BRAKE HP NL 0.807 NL 0.846 SAFETY FACTOR NL 1.15 NL 1.15 VOLTS PHASE 460 3 460 3 460 3 460 .3 MOTOR AMPERAGE 2.6 2.1 2.2 2.1 2.6 2.2 2.2 2.1 MOTOR RPM 1725 1725 1725 1725 SPEED VFD SETTING 1 1 1 1 HEATER SIZE NL CB NL CB HEATER AMPS NL CB NL CB FAN SPECIFIED TESTED SPECIFIED TESTED SUPPLY CFM 2,000 2,095 2,000 2,417 RETURN CFM 1,600 1,638 1,600 2,005 EXHAUST CFM NA NA NA NA OUTSIDE AIR CFM 400 427 400 412 SUCTION PRESSURE NL -0.47 NL -0.32 DISCHARGE PRESSURE NL 0.26 NL 0.14 FAN STATIC PRESSURE NL 0.73 NL 0.46 EXTERNAL PRESSURE 1 0.44 1 0.34 0 A DAMPER POSITION NL 10% NL 10% SHEAVE RPM SPECIFIED TESTED SPECIFIED TESTED FAN RPM NL 1241 NL 1233 MOTOR SHEAVE BORE NL 1VP40-7 8 NL 1VP40-7 8 FAN SHEAVE BORE NL AK56-15 16 NL AK56-15 16 BELT SIZE/NO.OF BELTS NL A47-1 NL A47-1 SHAFT CENTER LINE NL 17±1/2 NL 171 2 SHEAVE TURNS OPEN NL NL 1 NOTES: 10 Twin Tech Form 2012 Y PROJECT: Five Below ADDRESS: 796 Iyannough Road TESTING i ALA , CING, INC. Hyannis,MA 02661 DATE: 4/10/14 PRO .#: TT-14-38-1571 AIR DISTRUBITION SYSTEM: RTU-3 SUPPLY RETURN X EXHAUST ROOM OUTLET UNIT AREA/AK . DESIGN ACTUAL DESIGN ACTUAL LOCATION NUMBER SIZE TYPE or F.H. FPM FPM CFM CFM NOTES supply Managers Rm 1 12x12 FH NL NL 150 155 Stock Rm 2 12x6 0.353 1,133 1,189 400 420 Stock Rm 3 12x6 0.353 1,133 1,204 400 425 Stock Rm 4 12x6 0.353 1,062 1,106 375 390 Stock Rm 5 12x6 0.353 1,062 1,093 375 386 Corr 6 12x12 FH NL NL 200 213 Men's 7 12x12 FH NL NL 50 54 Women's 8 12x12 FH NL NL 50 52 Totals 2,000 2,095 Return Stock RM 1 14x22 2.13 751 769 1,600 1,638 NOTES: 11 Twin Tech Form 2012 I_ r PROJECT: Five Below ADDRESS: 796 Iyannough'Road TESTING A A CING, INC. Hyannis,MA 02661 DATE: 4/10/14 PROD.#: TT-14-38-1571 AIR DISTRUBITION SYSTEM: RTU-3 = SUPPLY j X 11 RETURN IL =X===TFE--XHAUSTjj ROOM OUTLET UNIT AREA/AK DESIGN ACTUAL DESIGN ACTUAL LOCATION NUMBER SIZE TYPE or F.H. FPM FPM CFM CFM NOTES Supply Managers Rm 1 2406 6.00 NL NL 2,000 2,417 Return Stock RM 1 2402 5.33 751 769 1,600 2,005 NOTES: *1 Unit is for future use,no ductwork attached to unit. 12 Twin Tech Form 2012 I { PROJECT: Five Below ADDRESS: 796 Iyannough Road TESTING A A CING, INC. Hyannis,MA 02661 DATE: 4/10/14 PRO I.# TT-14-38-1571 INLINE FAN SYSTEM: EF's SUPPLY E� RETURN �j EXHAUST ROOM FAN FAN VOLTS FAN TESTED DESIGN TESTED LOCATION NUMBER HP PHASE I AMPS AMPS CFM CFM NOTES Men's 1 NL 115 1 0.7 0.7 75 82 Women's 2 NL 115 1 0.7 0.7 75 79 NOTES: i 13 Twin Tech Form 2012 YOU WISH TO OPEN A BUSINESS? For Your Information: Business certificates(cost$40.00 far 4 years). A business certificate ONLS'REGISTERS res YOUR NAME Z� Main St., Hyh you annis. . must do by M.G.L.-it does not give you permission to operate.) You-must first obtain the ne Y Take the completed form to the Town Clerk's Office, 1st F1. 367 Main St., Hyannis, fv1A 02G01 (town Hall) and get the Business Certificate that is required bylaw. DATE: y�zz !y Fill in please: l� t� YOUR NAME S: �nr� 1' Qrt, e GeN+n,' -- � � Y, m APPLICANT'S / r . k� -1 L,� 2 NO YOUR HOME ADDRESS: Mt BUSINESS : c d _ TELEPHONE#. Home Telephone Number ��► _ S y6 -7�A5 �"� D7 I NAE OF CORPORATION 1-" l 10 M 2 o, ��� TYPE OF'BUSINESS a� � NAME OF NEW BUSINESS , — IS THIS A HOME OCCUPATIONS YES O r2�� l sz� MAP/PARCEL NUMBER ses ADDRESS OF_BUSINESS When starting a new business there are several things you must do in order o o maincompliance You MUST GO TO 200 regulations inartns(corn of Ya mouth Barnstable. This form is intended to assist you in obtaining the information y y iate permits and licenses required to legally operate your business in this town Rd. &Main Street) to make sure you have the appropr :1. BUILDING COM74ep R'S OFF E This individu I infer o an pe t requir merits that pertain to this type of business: zed�Signa COMMENTS: ' 2. BOARD OF HEALTH This individual ha bee for 'e ..of the permit requirements that pertain to this type of business: I py�thori dSignaure* PiroCOMMENTS: J (rd J I 3. CONSUMER AFFAIRS(LICENSING AUTHORITY) type of business. This individual has been informed;.of the licensing requirements that pertain to this Authorized Signature* COMMENTS: TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ' Parcel C� l `� Application A. r 3 _/J PF Health Division � Date Issued q` Conservation Division Application Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street /Address 990 I-MA n a?,cgh Roo-J. Village / J nn il5 Owner c)5 Z�yelgymw4 4sna `r. ," Address A$W/ .MR 00246=7_ Telephone /0/ a- Permit Request 'rC,OAA-h UQ�Tfi mc-LuctU\ q4i)I 190,6 (J� I qC 1n+( 126Cta 9 All t^1441R e,, un'ITSnQ Square feet: 1 st floor: existin �/93 proposed 2nd floor: existing proposed Total new Zoning District L. Flood Plain Groundwater Overlay Project Valuation Construction Type'1-P) 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.) rr t k Basement Unfinished Area (sq.ft) N4, Number of Baths: Full: existing NI(V new Half: existing WIC new Number of Bedrooms: N 1 ft existing —new Total Room Count (not including baths): existing w �4 new First Floor Room Count Heat Type and Fuel: �Gas ❑ Oil ❑ Electric ❑ Other Co Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood%coal stovq: ❑ebbs ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn:'0 a Asting ❑ ne 3 size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial dYes ❑ No If yes, site plan review# Current Use p44AU-CAA-),& Proposed Use Mj- IIdQrCov APPLICANT INFORMATION (BUILDER OR HOMEOWNER) q01 '73Z- ?jZc11) Name v Telephone Number Address License # C-S 902 76 /Z,.e,l.. d'6-TTt, 62,;7 6 ] I Home Improvement Contractor# � EvWorker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATUREf/-;�' ATE ���� FOR OFFICIAL USE ONLY — • �r { APPLICATION# DATE ISSUED MAP/PARCEL NO. 'q ADDRESS ; VILLAGE { OWNER } 4 4 DATE OF INSPECTION: viF.OUNDATIONit1 ,, 4,,.. FRAME INSULATION,,!- FIREPLACE , • ELECTRICAL: ROUGH FINAL d PLUMBING: ROUGH FINAL - #: 5 GAS: ROUGH FINAL FINAL BUILDING s. ' DATE CLOSED OUT ASSOCIATION PLAN NO. h The Commonwealth of Massachusetts y Department of IndustrialAccidents Office of Invesdgations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information / Please Print Legibly Name(Business/Organization/Individual):_ Address: City/State/Zip: o2761 Phone#: 6160 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. []New construction - eployees(full and/or part-time).* have hired the sub-contractors 2.[�]'�am Oa sole proprietor or partner- listed on the attached sheet. 7. Fg'�emodeling ship and have no employees These sub-contractors have g. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp. insurance comp.insurance# required.] 5. ❑ We are a corporation and its ME]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 repairs -- insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.❑ Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy.information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $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: / i'✓L VT oh Policy#or Self-ins.Lic.#: W C G s S o Il 6 t)L4 Z O /3 Oq Expiration Date: z Job Site Address: D l% NN O L led City/State/Zip: - (7 �` �iKl 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 certi under the pains and penalties ofperjury that the information provided above is true and correct Signature: ;04� Date: G Phone#: yd) 732 Z� Official use only. Do not write in this area,to be completed by city or town officiaC 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 issuance.or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25CO states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance: 'If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call.the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Depariment of Industrial Accidents Office of Investigations 600 Washington Street Boston,,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASWE Revised 4-24-07 Fax#617-727-7749 www.mass.gov/dia f OP ID:MS I, CERTIFICATE OF LIABILITY INSURANCE DA 12J301"YYY' 12/30/13 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements, PRODUCER 508-669-6762 NGOAME cT F.J.TORRES INSURANCE ACY INC PHONE FAx P 0 BOX 165 /vc No DIGHTON,MA 02715 EMAIL ADDRESS: PRODUCER CT MER ID g:ELLSM-I INSURERS)AFFORDING COVERAGE Nw# INSURED MICHAEL ELLS INsuRERA:A I M MUTUAL INS COMPANY 53 FRANCIS ST INSURERS: REHOBOTH,MA 02769 INSURERC: INSURER 0 INSURER E• INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE-AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 1NSR TYPE OF INSURANCE POLICY EFF POLIO EX L POLICY NUMBER MW MMID LIMITS GENERAL LLABLITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PREMISES Ea aaxarence S CLAIMS-MAOE OCCUR MED EXP(Arty one person) S PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S POLICY PRO-FQT El LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO BODILY INJURY(Per person) S ALL OWNED AUTOS . BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) r NON-OWNED AUTOS $ $ UMBRELLALL4B OCCUR EACH OCCURRENCE S EXCESS LIAe HCLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION 1NC STATU OTH- AND EMPLOYERS'L1ABILnY ANY PROPRIETORIPARTNER/EXECUTTVE YIN CC-500-5011804-2013A. 0211213 02/12114 E.L.EACH ACCIDENT $ 50Q,D0 OFFICEMEMBER EXCLUDED? F N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 U yca,deseriDe under DESCRIPTION U0 OPERATIONS below I E.L.DISEASE-POLICY LIMIT S 100,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(AttaCh ACORD 101,Addrdonal Remarks Schedute,N more space Is required) CERTIFICATE HOLDER CANCELLATION TOWNBAI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF BARNSTABLE ACCORDANCE WITH THE POLICY PROVISIONS. BUILDING DEPARTMENT 200 MAIN ST. AUTHORIZED MWRESENTA HYANNIS,MA 02601 ©1 -2009 ACORD COP OF6PON. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered 49iks of ACORD b,nt eet-e, i 13W i61 Town of Barnstabae� Regulatory Services _f , .,___. - VVis-T Richard V.S6oli,Interim Director Building Division Thomas Perry.C130 Building Commissioner 200 NMiin Street, Hyannis,MA 02601 www.town.barnstable,ma.us Office: 505-962-4038 Pax, 506-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder 1 Richard A. Marks as(Nvtmr of the subject rrc)perty hereby auchori�e M,i w ��� to act on Ply behalf, in all matters relative to work authorized by this bu8dingpcnrut application fat; P c.A A. 7 fV z Y'A. Q b (Address of Job) ' �/V.4k „�.s, Ati P. le.7 x v d i • �J�- / / Sig Tatum of Owner Ustre Richard A. Marks fruit Name If Property Owner Is appLying for permit,please complete the Homeowners License Exemption Form on Lire reverse side. TAKL•VIN_MuildmsChangceltiaPRls4SP kMIhlXpRISS.Jac Rtviscd 061313 Massachusetts -Department of Public Safety Board of Building Regulations and Standards'. .. Construction Supers isor - License: CS-098276 y ``v Is MICHAEL E ELL I 53 FRANCIS ST REHOBOTH M.4F 02761 t721 Expiration Commissioner 03129/2015 t. Mass. Corporations, external master page Page 1 of 2 rE William Francis Galvin Secretary of the Commonwealth of Massachusetts ri HOME DIRECTIONS CONTACT US Isearch sec state.ma us Search Corporations Division Business Entity Summary ID Number:001053027 Request certificate New search Summary for: CAPE TOWN PLAZA LLC The exact name of the Foreign Limited Liability Company(LLC): CAPE TOWN PLAZA LLC Entity type: Foreign Limited Liability Company(LLC) Identification Number: 001053027 Old ID Number: Date of Registration in Massachusetts: 05-13-2011 Last date certain: Organized under the laws of:State: DE Country: USA on: 10-15-2010 The location of the Principal Office: Address: 1330 BOYLSTON ST., SUITE 212 City or town,State,Zip code,Country: CHESTNUT HILL, MA 02467 USA The location of the Massachusetts office,if any: Address: City or town,State, Zip code,Country: The name and address of the Resident Agent: Name: S.R. WEINER&ASSOCIATES,INC. Address: 1330 BOYLSTON ST., SUITE 212 City or town,State, Zip code,Country: CHESTNUT HILL, MA 02467 USA The name and business address of each Manager: Title Individual name Address MANAGER WS CAPE TOWN LLC 1330 BOYLSTON ST.,STE 212 CHESTNUT HILL; MA 02467 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver,and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address REAL PROPERTY RICHARD A. MARKS 1330 BOYLSTON ST., SUITE 212 CHESTNUT HILL, MA 02467 USA REAL PROPERTY JEREMY M. SCLAR 1330 BOYLSTON ST., SUITE 212 CHESTNUT HILL, MA 02467 USA REAL PROPERTY THOMAS J. DESIMONE 1330 BOYLSTON ST.,SUITE 212 CHESTNUT HILL, MA 02467 USA REAL PROPERTY DEIRDRE A. GEOGHEGAN 1330 BOYLSTON ST., SUITE 212 CHESTNUT HILL, MA 02467 USA r Consent r Confidential Data r Merger Allowed r Manufacturing View filings for this business entity: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary... 12/31/2013 i PROJECT . 1VAIVIE: Lv� ADDRESS: PERMIT# PERMIT DATE: M/P:_ ( 1 2 LARGE ROLL D PLANS ARE L%T: BOX 1: � SLOT Data entered in MAPS program on: B Y: PRQJC� NAIYlE: ADDRESS: -Q�� �� Gk- � PERMIT# -24�)1 �G1 PERM-IT DATB: MIP, LARGE ROLLED PLANSARE IN: Bay j SLOT - Data entered in MAPS program on:. �. Z BY (� &YAAAf ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Cm (/ Applical . n# Health Division Date Issued 2 Conservation Division �' Application Fee Planning Dept. Permit Fee 5 ,50 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address IM® i � Q&t)64+ Village Owner V S DO"Lla�Ot° -- ,3'i—A A155, Address 'e",N1E-6>°rW i w MPS 07-46-f Telephone `:NA --fermit Request LA+JDLM 1r'a -y— fioR_ 2. R e NP-tL �1v A+f I_ If--IT- 095 i r-J A, f=1Xi57'>Nt9 °PLA-2,61 8121 L0,Q&_ i TDILE7"fLo bM:5, 571)HEE�0nj R oD F INa 1'L,iL A ►� L 1"� i 1�0 5�1 I-(=�,2 e Gd �'�T 11A_�v Square feet: 1 st floor: existingg►proposed 2nd floor: existing proposed Total new Zoning District s� Flood Plain Groundwater Overlay Project ValuAbn _'%001 060 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.) WIA Basement Unfinished Area (sq.ft) Number of Baths: Full: existing N�la� new Half: existing A, new Number of Bedrooms: WIA, 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 ')d Yes ❑ No If yes, site plan review# Q Current Use t� RL= LL- Proposed Use VA- ��IECu-P 1;r7 APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) c3 game AVL S4LQL,-QNA4J1D Telephone Number -114-- Address 01T pff wo. 27'. ScuI t&1 License # 12:00154 ND(LTDiJ .P/�A b 2114 Home Improvement Contractor# 014, EP� L� gSaofe����1/p�lch� C®I'1 Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �/�s-r� M A tJ�r✓��� SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# ` DATE,ISSUED MAP/PARCEL N0. ' i k ADDRESS VILLAGE OWNER 4 i , a DATE OF INSPECTION: FRAME - t x INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL P+` PLUMBING: ROUGH FINAL GAS: __ ROUGH FINAL FINAL BUILDING • ti ' r; DATE CLOSED OUT t ASSOCIATION PLAN NO. f j , Page 1 of 1 Franey, Patrick From: Deputy Dean Melanson [dmelanson@hyannisfire.org] Sent: Tuesday, December 31, 2013 3:14 PM To: Perry, Tom; Dianne Cook Cc: Barrows, Debi,; Shea, Sally; Franey, Patrick; Lt. John Cosmo; Spanky Sylvester; dwarren@sargarch.com; akjackovic@jackovic-construction.com Subject: 5 Below Store, Hyannis Cape Town Plaza Tom, I have spoken with those involved in this project about the Demo Permit and the Building Permit requests. The summary is that WS Development(the owners) are responsible for the initial demo and the basic building permits, not the tenant(5 Below) or their GC (Jackovic Const). When the building construction/renovations, and the associated life safety issues are complete, 5 Below's general contractor(Jackovic Construction)will come in for a permit for the fit out. It is expected the 5 Below will receive the space on or before April 1 st. WS Development (Diane Cook) is aware of our concerns and issues regarding fire alarm and sprinkler for this building. I have worked with Diane.in the past and she is familiar with the basic set of requirements from the previous renovations in this building (OLd Navy). As Hyannis Fire is OK for a demolition permit to be granted for this space. I would expect that you will see their general contractor coming in an applying for the permit next week some time. Hyannis Fire will meet/talk with the GC and WS Development during demolition to firm up sprinkler and fire alarm plans sufficiently for us to approve a building permit application. Deputy Chief Dean L. Melanson Office 508-775-1300 Fax 508-778-6448 dmelanson@hyannisfire.org 12/31/2013 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): V PLAtyQ A2.1v �-1 r- 0 4, Address: Ail City/State/Zip: 1 Phone#: .-114 _4 30-3310 Are you an employer?Check the appropriate box: Type of project(required): L 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. IRRemodeling ship and have no employees These sub-contractors have g. QDemolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp. insurance comp.insurance.t' 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 I LEJ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.N Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TCoutractors 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: CROSS NJSUIZAN&E —P�A- 20 Policy#or Self-ins.Lie.#: &TA=9M 5 01455 3! k Expiration Date: (0— 1 Job Site Address: 150 L 1 A P O O &.A City/State/Zip: WA-P1 J 63 MAr 67,b I 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 un er the pains and penalties of perjury that the information provided above is true and correct Sig-nature: -^ Date: Phone Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 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 issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit(license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would lice to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts r Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-MASWE Revised 4-24-07 Fax#617-727-7749 wWv.mass.govfdia DATE(MMIDDNYYY) .a► oRv = CERTIFICATE OF LIABILITY INSURANCE 12/17/2013 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.OE INSURANCE.DOES.NOT CONSTITUTE A CONTRACT BETWEEN:THE.ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER., IMPORTANT: If the certificate holder is.an ADDITIONAL INSURED,the.policy(les)_must be endorsed. If SUBROGATION IS WAIVED,subject to . the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does.not confer rights to the certificate holder in lieu of such.endorsement(s):. . PRODUCER. . TA Lauren. Goldman NA T ren. Cross Insurance-Peabody PHONE F (9'78)532-5445 c9ie>s3z-znr AX. 139 Lynnfield Street ADDRAIESS:14oldman@crossagen.cy.com INSURERS.AFFORDING COVERAGE NAIC# Peabody MA ,01960 INSURERA:Peerless Ind :Ins Co 18333 INSURED INSURERB:Peerless Insurance 'Com an . Upland Architects Inc"` INSURER C.Continental Casualty COm an 250 .E Main .St INSURER D:- Ste 13 INSURERE: Norton MA 02766 INSURERF, COVERAGES CERTIFICATE NUMBER:CL13121298556 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY IREQUIREMENT,.TERM OR CONDITION.OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS. CERTIFICATE-MAY BE ISSUED:OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN. IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS, INSR LTR TYPE OF INSURANCE POLICY NUMBER MIAIU LICYEXP DDY EFF POMI LIMITS GENERAL LIABILITY EACH-0CCURRENCE $. : 1,.000,000 X COMMERCIAL GENERAL LIABILITY PREMISES $ 50 OOO A CLAIMS-MADE'❑X OCCUR OP1016580: 4 MED EXP,Any one arson) $ 8,000 6/19/2013 /19/ZOl PERSONAL 8 ADV INJURY $ 1,000,000. . .GENERAL AGGREGATE: $ 21000,000 GEN'L AGGREGATE LIMIT APPLIES PER: g PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY ' PR0 LOC $ , COMBIN SINME LIMIT AUTOMOBILE LIABILITY Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ' BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED. PROPERTY DAMAGE $•, HIRED AUTOS' AUTOS Per accident)- X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAR CLAIMS MP.DE AGGREGATE $: 1,000,000 DED. : RETENTION LB694966 6/19/2013 6/19/2014 $ C WORKERS COMPENSATION 'LIABILITY AND EMPLOYERS . ' WC STATU- E.L.EACH ACCIDENT $ 500 000 /PARTNER/EXEC YIN. ANY PROPRIETOR UTIVE❑ N/A OFFICERIMEMBER EXCLUDED? 094853712 - 1/14/2013 1/.14/2014 E.L.DISEASE-EA EMPLOYE $ 500 000 (Mandatory in NH)' If es,describe under E.L.DISEASE.-POLICYiIM1T $ 500`060 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required), Refer to policy.for exclusionary endorsements;and special provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED'POLICIES BE CANCELLED BEFORE THE EXPIRATION. DATE THEREOF, NOTICE WILL''BE DELIVERED IN. ACCORDANCE WITH THE POLICY PROVISIONS For Insureds purpose AUTHORIZED REPRESENTATIVE Timothy.Tiamonte/NID1 ACORD 25(2010/05) -©198 010 ACORD CORPORATION..All rights reserved. 82 , INS025 oninnsi rrf Thrs Arr)Rn n2mo.zinrl•Innn 2m r�cnic mrorl m. an of n92 • • I to] ' • Lei 0 I -,t r 7 m o. l CONTROL # :J 53 5 0.7 IMPORTANT v If your license is lost,`damaged or destroyed; is inaccurate;or needs to be corrected,visit our web site at mass.gov/dpl for instructions to ensure the proper,mailing of your Renewal Application and,any other correspondence. This license is subject to Massachusetts General Laws and regulations.Your license is a privilege,and cannot be lent or assigned to any person or entity under'penalty of law.Keep this license on your person or posted as required by law and/or, . regulations. - eDEP - MassDEP's OnlineFiling System Page 1 of 1 MassDEP Nome ( Contact I Privacy Policy MassDEP's Online Filing System Usemame:MCB99D Nickname:RED BARRON My eDEP; Forms". My Profile= Help Notifications LReceipt - a: Forms Signature Payment Receipt Summary/Receipt print receipt;:,, Exlt ;; Your submission is complete. Thank you for using DEP's online reporting system. You can select"My eDEP" to see a list of your transactions. DEP Transaction ID: 618635 Date and Time Submitted: 12/18/2013 1:20:16 PM Other Email : Form Name:AQ 06 -Construction/Demolition Notification Payment Information DEP code: 90516 Date: 12/18/2013 1:19:29 PM Amount($): 100 Payment Detail: BARRON MICHAEL--AccountType--AccountNumber ****5416 Confirmation Number: Contractor Contractor Number Name Address, , Supervisor Project Monitor Lab My eDEP MassDEP Home I Contact I Privacy Policy MassDEP's Online Filing System ver.12.2.6.00 2013 MassDEP https:Hedep.dep.mass.gov/Pages%PrintReceipt.aspx 12/18/2013 Massachusetts Department of Environmental Protection Bureau of Waste Prevention • Air Quality 1100190894 Decal Number Ll BWP AQ 06 Notification Prior to Construction or Demolition Important: When Ifng out A. Applicability forms on the computer,use only the tab key A Construction or Demolition operation-of an industrial, commercial, or institutional building, or to move your residential building with 20 or more units is regulated by the Department of Environmental Protection cursor-donot use the return (DEP), Bureau of Waste Prevention-Air Quality Control Regulations 310 CMR 7.09. Notification of key. Construction or Demolition operations is required under 310 CMR 7.09 (2)ten (10)days prior to any work being performed. The following information is required pursuant to 310 CMR 7.09. B. General Project Description 1. a. Is this facility fee exempt-city, town, district, municipal housing authority, owner-occupied Instructions residence of four units or less?❑Yes ❑✓ No 1.All sections of b. Provide blanket decal number if applicable:this form must be Blanket Decal Number completed in order to comply with the 2. Facility Information: Department of CAPETOWN PLAZA Environmental Protection a.Name notification 1790 IYANNOUGH ROAD requirements of b.Address 310 CMR 7.09 Barnstable MA 02601 c. ow 7744303390 f TeleDhone Number(area code.and extension) .E-mail Address(optional) 8127 1 h.Size of Facility in Square Feet i.'Number of Floors j. Was the facility built prior to 1980? ❑✓ Yes ❑ No k. Describe the current or prior use of the facility: MERCANTILE I. Is the facility a residential facility? ❑ Yes Q No �o m. If yes, how many units? Number of Units -� 3. Facility Owner: �N CAPETOWN PLAZA LLC o a.Name -0 11330 BOYLSTON STREET, SUITE 212 b.Address CHESTNUT HILL MA 02467 � c.Cityrrown tate e.Zio �0 16172328900 f.Telephone Number r n E-mail Address O NEALCANNON �Q 'h.Onsite Manager Name ag06.doc•10/02 BWP AQ 06•Page 1 of 3 Massachusetts Department of Environmental Protection ,N-1-1 Bureau of Waste Prevention • Air Quality 1100196894 BWP AQ 06 Decal Number Notification Prior to Construction or Demolition General B. General Project Description (cont.)Statement:If � p � asbestos is found duringa construction or 4. General Contractor: C Demolition TBD operation,all a.Name responsible parties must comply with TBD 31,0 CMR 7.00, b.Address e r 2 and Chapter 1 E of the TBD MA 00000 General Laws of c.City/Town d.State e.Zip Code the Commonwealth. 10000000000 This would include,but would not be f.Tele hone Number area code and extension E-mail Address(optional) limited to,filing an JTBD asbestos removal h.On-site Manager Name notification with the Department and/or a notice of release/threat of release of a C. General Construction or Demolition Description hazardous substance to the 1. Construction or demolition contractor: Department,if applicable. TBD a.Name TBD b.Address TBD MA 100000 c.Ci /Town d.State e.Zip Code 0000000000 J. f.Telephone Number area code and extension) g.E-mail Address(optional) TBD h.On-site Manager Name 2. On-Site Supervisor: TBD On-Site Supervisor Name 3. Is the entire facility to be demolished? ❑ Yes 0 No �N �0 4. Describe the area(s)to be demolished: -0 PORTIONS ROOFING, STOREFRONT, INTERIORS _N �O �0 5. If this is a construction project, describe the building(s) or addition(s)to be constructed: PORTIONS ROOFING, STOREFRONT, INTERIORS HVAC UNITS �0 , 0 �d �Q ag06.doc• 10/02 BWP AQ 06•Page 2 of 3 I Massachusetts Department of Environmental Protection ■ Bureau of Waste Prevention • Air Quality 100190894 Decal Number BWP AQ 06 Notification Prior to Construction or Demolition C. General Construction or Demolition Description (cont.) 6. a. If this is a demolition project, were the structure(s) surveyed for the presence of asbestos containing material (ACM)?. ❑ Yes ❑✓ No If yes,who conducted the survey? b.Survevor Name c.Division of Occupational Safety Certification Number 7.. Construction or Demolition: 1/10/2013 4/10/2013 a.Start Date(mmlddlyyyy) b.End Date(mm/dd/yyyy) 8. a. For demolition and construction projects, indicate dust suppression techniques to be used: ❑ seeding ❑ paving El wetting ❑ shrouding b. If other, please specify: ❑✓ covering ❑ other 9. For Emergency Demolition Operations, who is the DEP official who evaluated the emergency? NA a.Name of DEP Official NA b.Title 12/18/2013 c.Date mm/dd/ of Authorization 00 d.DEP Waiver Number D. Certification I certify that I have examined the IGARY J SADLER -o above and that to the best of my a.Print Name �o knowledge it is true and complete. JGary J Sadler The signature below subjects the b.Authorized Signature �N signer to the general statutes ARCHITECT =o regarding a false and misleading c. Position e �o statement(s). JUPLAND ARCHITECTS d.Representing 12/18/2013 e.Date(mm/dd/yyyy) �O �Q ■ ag06.doc•10/02 BWP AQ 06•Page 3 of 3■ 12/19/13 Upland Architects Mail-eDEP Submittal Confirmationfor DEP Transaction ID:618639 PLA ►N AITE � Michael Barron <rnikebcz 55upiar�d.cotn> eDEP Submittal Confirmationfor DEP Transaction ID: 618639 eDEPConfirmation@massmail.state.ma.us Thu, Dec 19, 2013 at 10:38 <eDEPConfirmation@massmai1.state.ma.us> AM To: mikeb@55upland.com Cc: gsadler@55upland.com Thank you for using eDEP Online Filing from the Massachusetts Department of Environmental Protection. Your transaction is complete and has been submitted to MassDEP. This email is your receipt for the eDEP Online Filing transaction described below. Please review it and keep a copy for your records. Please do NOT reply to this message, this email address will not receive messages.For assistance with eDEP Online Filing, please email the EEA Help Desk at mailto:helpdesk:eea@massmai1.state.ma.us or call 617-626- 1111. MassDEP is interested in how we can serve you better. To help us make improvements to.eDEP, please take a minute to complete our eDEP Online Filing Survey at http://www.mass.gov/eea%agencies/massdep/service/ online/edep-contacts-and-feedback.html. To contact MassDEP Programs, please see http://mass.gov/dep/about/contacts.htm. DEP Transaction ID: 618639 Date and Time Submitted: 12/18/2013 01:33:47 " Form Name: AQ 06 - Construction/Demolition Notification Payment Information bEP code: 90518 Date: 12/18/2013 1:33:24 PM Amount ($): 100 Payment Detail: BARRON MICHAEL -AccountType — AccountNumber****5416 ConfirmationNumber: Contractor Contractor Number Name Address Supervisor Project Monitor Lab https://mall.g oog le.corrVrnai l/u/0/?ui=2&i Ir 9f3al46240&vievr pt&search=inbox&msg=1430b823cfaa2728 112 ' ..' Town of Barnstable Regulatory Services n Thomas F. Geller,Dlreatar - r Building Division Tom Perry,BuDdIng Commissioner 200 Main Street,Hyannis,MA 02601 wtinv,towiL ba rn sta b l e,m a.us Office: 509-862-4038 t i Paz`508-790 6230� ' Property Owner`Must f. Complete and Signt'rhis Section Zf U§ice A Builder as Owner of the subject property hereby authorize VPLA,OQ a(TEC mT5 ' to act on ury belraIf, in all tnnttx'.rs '('JPdvc to wort authorized by t'ais bw1ding lac emit '- U (Address A(lb) ,k **Pool fences and alarms are the responsibility of the applicant.,Pools are not to be fiIled or utilized before fence is installed and all final, inspections,are performed and accepted. '' K Signature-of Owner '. Si e of Applicant . Ta ' t Name Priut Name Q:FOKMS OWNF.W'MtivifSSIONPooLS U2012 Mass. Corporations, external master page Page 1 of 2 William Francis Galvin Secretary of the Commonwealth of Massachusetts HOME DIRECTIONS CONTACT US Search sec state.ma us Search Corporations Division Business Entity Summary ID Number:001053027 Request certificate New search Summary for: CAPE TOWN PLAZA LLC — _.._....._.._...-...............-- _ ----- The exact name of the Foreign Limited Liability Company(LLC): CAPE TOWN PLAZA LLC Entity type: Foreign Limited Liability Company(LLC) Identification Number:001053027 Old ID Number: Date of Registration in Massachusetts: 05-13-2011 Last date certain: Organized under the laws of:State: DE Country: USA on: 10-15-2010 The location of the Principal Office: Address: 1330 BOYLSTON ST.,SUITE 212 City or town,State,Zip code,Country: CHESTNUT HILL, MA 02467 USA The location of the Massachusetts office,if any: Address: City or town,State, Zip code,Country: The name and address of the Resident Agent: Name: S.R.WEINER&ASSOCIATES,INC. Address: 1330 BOYLSTON ST., SUITE 212 City or town,State, Zip code,Country: CHESTNUT HILL, MA 02467 USA The name and business address of each Manager: Title Individual name Address MANAGER WS CAPE TOWN LLC 1330 BOYLSTON ST., STE 212 CHESTNUT HILL, MA 02467 USA The name and business address of the person(s)authorized to execute,acknowledge,deliver,and record any recordable instrument purporting to affect an interest in real property: Title Individual name Address REAL PROPERTY RICHARD A. MARKS 1330 BOYLSTON ST., SUITE 212 CHESTNUT HILL, MA 02467 USA REAL PROPERTY JEREMY M.SCLAR 1330 BOYLSTON ST., SUITE 212 CHESTNUT HILL, MA 02467 USA REAL PROPERTY THOMAS J. DESIMONE 1330 BOYLSTON ST.,SUITE 212 CHESTNUT HILL, MA 02467 USA REAL PROPERTY DEIRDRE A. GEOGHEGAN 1330 BOYLSTON ST., SUITE 212 CHESTNUT HILL, MA 02467 USA r Consent Confidential Data r Merger Allowed r Manufacturing View filings for this business entity: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary... 12/18/2013 Mass. Corporations, external master page Page 2 of 2 � pg ,ALL FILINGS Annual Report Annual Report-Professional z Application For Registration Certificate of Amendment View filings Comments or notes associated with this business entity: j New search William Francis Galvin,Secretary of the Commonwealth of Massachusetts Terms and Conditions 1 http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary... 12/18/2013 Initial Construction� Contry ' ol Document H To be submitted with the building permit application by a Registered Design Professional for work per the 8th edition of the SVeve; ., Massachusetts State Building Code; 780 CMR, Section 107 Project Title: Capetown Plaza Date:12-04-13 Property Address: 790 Iyannough Road Hyannis,MA 02601 Project: Check(x)one or both as applicable: New construction .x Existing Construction Project description: Landlord,Work for 2 tenant "fit ups for,mercantile space in an existing plaza building. Scope consist of interior construction toilet rooms, storefront,roof work and limited facade construction. I Gary Sadler MA Registration Number: 20054 Expiration date: 09,-31-14 , am a"registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerningl: x Architectural Structural Mechanical Fire Protection Electrical Other: J for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code,,(780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. .Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official, I shall submit field/progress reports(see item 3.)together,with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Control Document'. ED ARC Enter in the space to the right a"wet"or ��\ y Sq0 electronic signature and seal: �� F� �► No. 20054 cl, ATTLEBORO, M S. - Phone number: 774.430.3390 Email: gsadler@55upland.com Ina Building Official Use Only Building Official Name: Permit No.: Date: Note 1.Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised.If`other'is chosen, provide-a description. Version 06_11_2013 Initial Construction Control Document To be submitted with the building permit application by a Registered Design Professional for work per the 81h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Capetown Plaza Date:12-04-13 Property Address: 790 Iyannough Road Hyannis,MA 02601 Project: Check(x)one or both as applicable: New construction x Existing Construction Project description: Landlord work for 2 tenant "fit ups" for mercantile space in an existing plaza building. Scope consist of interior construction toilet rooms, storefront,roof work and limited facade construction. I Carmine Guarracino MA Registration Number: 40104 Expiration date: 06-2014 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans, computations and specifications concerning': Architectural x Structural Mechanical Fire Protection Electrical Other: for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR),and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review, for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17,as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required-by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a`Final Construction Control Document'. Enter in the space to the right a"wet"or electronic signature and seal: CART°;E o GUARRAC1.4O STRUCTUr2AL "' f No.40104 ` Phone number: 617.6280.1700 Email: guarracino@rgeng.com o�c`.p� i="�,•f,��, F L Building Official Use Only Building Official Name: Permit No.; Date: Version 06 11 2013 i Initial Construction Control Document 4 To be submitted with the building permit application by a M Registered Design Professional for work per the 8`h edition of the Massachusetts State Building Code, 780 CMR, Section 107 Project Title: Capetown Plaza Date:12-04-13 Property Address: 790 Iyannough Road Hyannis,MA 02601 Project: Check(x) one or both as applicable: New construction x Existing Construction Project description: Landlord work for 2 tenant "fit ups" for mercantile space in an existing plaza building. Scope consist of interior construction toilet rooms, storefront,roof work and limited facade construction. I Dan R.Rhodes MA Registration Number: 39320 Expiration date: 6-30-2014 , am a registered design professional, and I have prepared or directly supervised the preparation of all design plans,computations and specifications concerning': Architectural Structural X Mechanical Fire Protection X Electrical Other: X Plumbing for the above named project and that to the best of my knowledge, information,and belief such plans,computations and specifications meet the applicable provisions of the Massachusetts State Building Code, (780 CMR), and accepted engineering practices for the proposed project. I understand and agree that I(or my designee) shall perform the necessary professional services and be present on the construction site on a regular and periodic basis to: 1. Review,for conformance to this code and the design concept, shop drawings, samples and other submittals by the contractor in accordance with the requirements of the construction documents. 2. Perform the duties for registered design professionals in 780 CMR Chapter 17, as applicable. 3. Be present at intervals appropriate to the stage of construction to become generally familiar with the progress and quality of the work and to determine if the work is being performed in a manner consistent with the approved construction documents and this code. Nothing in this document relieves the contractor of its responsibility regarding the provisions of 780 CMR 107. When required by the building official,I shall submit field/progress reports(see item 3.)together with pertinent comments, in a form acceptable to the building official. Upon completion of the work, I shall submit to the building official a `Final Construction Contro nt'. Sqc y �. Enter in the space to the right a"wet"or N • NODES electronic signature and seal: o ELECTRICAL No. 33320 A9�� Is Phone number: 614-322-7050 Email: dan@aegltd.com Building Official Use Only Building Official Name: Permit No.: Date: Note 1. Indicate with an`x'project design plans,computations and specifications that you prepared or directly supervised. If`other' is chosen, provide a description. Version 06 11 2013 COMcheck Software Version 3.9.2 Interior Lighting Compliance Certificate 2009 IECC Section 1: Project Information Project Type:Alteration Project Title:5 Below Construction Site: Owner/Agent: Designer/Contractor: Capetown Plaza Applied Engineering Group,LTD 768 lyannough Road 7402 East Broad St. Hyannis,MA 02601 Blacklick,OH 43004 614-322-7050 Section 2: Interior Lighting and Power Calculation A B C D Area Category Floor Area Allowed Allowed Watts (ft2) Watts/ft2 (B x C) Retail 9897 1.5 14846 Total Allowed Wafts= 14846 Section 3: Interior Lighting Fixture Schedule A B C D E Fixture ID:Description/Lamp I Wattage Per Lamp/Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. Ret a I(9897 sq ft) � F a Linear Fluorescent 4.A.48"T8 28W(Super T8).Electronic: 2 3 56 168 Linear Fluorescent 1:Al:Other:Electronic: 6 99 84 8316 Linear Fluorescent 2:A1.1:48"T8 28W(Super T8):Electronic: 3 8 84 672 Linear Fluorescent 3:A2:96"T8 ES 60W:Electronic: 4 7 120 840 Total Proposed Wafts= 9996 Section 4: Requirements Checklist Lighting Wattage: 1. Total proposed wafts must be less than or equal to total allowed wafts. Allowed Watts Proposed Watts Complies 14846 9996 Passes Controls, Switching,and Wiring: Ll 2. Daylight zones under skylights more than 15 feet from the perimeter have lighting controls separate from daylight zones adjacent to vertical fenestration. Ej 3. Daylight zones have individual lighting controls independent from that of the general area lighting. Exceptions: Contiguous daylight zones spanning no more than two orientations are allowed to be controlled by a single controlling device. Daylight spaces enclosed by walls or ceiling height partitions and containing two or fewer light fixtures are not required to have a i separate switch for general area lighting. 4. Independent controls for each space(switch/occupancy sensor). Project Title: 5 Below Report date: 12/03/13 Data filename:W:\AEGPROJECTS\2013\13164\13164 Five Below- 12-02-13.cck Page 1 of 2 Exceptions: Areas designated as security or emergency areas that must be continuously illuminated. ❑ Lighting in stairways or corridors that are elements of the means of egress. 5. Master switch at entry to hotel/motel guest room. 6. Individual dwelling units separately metered. 0 7. Medical task lighting or art/history display lighting claimed to be exempt from compliance has a control device independent of the control of the nonexempt lighting. O 8. Each space required to have a manual control also allows for reducing the connected lighting load by at least 50 percent by either controlling all luminaires,dual switching of alternate rows of luminaires,alternate luminaires,or alternate lamps,switching the middle _ lamp luminaires independently of other lamps,or switching each luminaire or each lamp. Exceptions: Only one luminaire in space. ❑ An occupant-sensing device controls the area. ❑ The area is a corridor,storeroom,restroom,public lobby or sleeping unit. ❑ Areas that use less than 0.6 Watts/sq.ft. 9. Automatic lighting shutoff control in buildings larger than 5,000 sq.ft. Exceptions: LJ Sleeping units,patient care areas;and spaces where automatic shutoff would endanger safety or security. 10.Photocell/astronomical time switch on exterior lights. Exceptions: Lighting intended for 24 hour use. 11.Tandem wired one-lamp and three-lamp ballasted luminaires(No single-lamp ballasts). Exceptions: ❑ Electronic high-frequency ballasts;Luminaires on emergency circuits or with no available pair. Section 5: Compliance Statement Compliance Statement: The proposed lighting alteration project represented in this document is consistent with the building plans, specifications and other calculations submitted with this permit application.The proposed lighting alteration project has been designed to meet the 2009 IECC,Chapter 8,requirements in COMcheck Version 3.9.2 and to comply with the mandatory requirements in the Requirements Checklist. bw Name-Title Signature Date Project Title: 5 Below Report date: 12/03/13 Data filename:W:\AEGPROJECTS\2013\13164\13164 Five Below-12-02-13.cck Page 2 of 2 i COMcheck Software Version 3.9.2 Interior Lighting Compliance Certificate 2009 IECC Section 1: Project Information Project Type:Alteration Project Title:5 Below Construction Site: Owner/Agent: Designer/Contractor: Capetown Plaza Applied Engineering Group,LTD 768 lyannough Road 7402 East Broad St. Hyannis,MA 02601 Blacklick,OH 43004 614-322-7050 Section 2: Interior Lighting and Power Calculation A B C D Area Category Floor Area Allowed Allowed Watts (ft2) Watts/ft2 (B x C) Retail 9897 1.5 14846 Total Allowed Watts= 14846 Section 3: Interior Lighting Fixture Schedule A B C D E Fixture ID:Description/Lamp/Wattage Per Lamp I Ballast Lamps/ #of Fixture (C X D) Fixture Fixtures Watt. ya ..... .... . .. Linear Fluorescent 4:A:48"T8 28W(Super T8):Electronic: 2 3 56 168 Linear Fluorescent 1:Al:Other:Electronic: 6 99 84 8316 Linear Fluorescent 2:Al.1:48"T8 28W(Super T8):Electronic: 3 8 84 672 Linear Fluorescent 3:A2:96"T8 ES 60W:Electronic: 4 7 120 840 Total Proposed Watts= 9996 Section 4: Requirements Checklist Lighting Wattage: 1. Total proposed watts must be less than or equal to total allowed watts. Allowed Watts Proposed Watts Complies 14846 9996 Passes Controls, Switching, and Wiring: 2. Daylight zones under skylights more than 15 feet from the perimeter have lighting controls separate from daylight zones adjacent to vertical fenestration. Lj 3. Daylight zones have individual lighting controls independent from that of the general area lighting. Exceptions: Contiguous daylight zones spanning no more than two orientations are allowed to be controlled by a single controlling device. EJ Daylight spaces enclosed by walls or ceiling height partitions and containing two or fewer light fixtures are not required to have a separate switch for general area lighting. 4. Independent controls for each space(switch/occupancy sensor). Project Title: 5 Below Report date: 12/03/13 Data filename:W:WEGPROJECTS\2013\13164\13164 Five Below-12-02-13.cck Page 1 of 2 Exceptions: ❑ Areas designated as security or emergency areas that must be continuously illuminated. ❑ Lighting in stairways or corridors that are elements of the means of egress. ❑ 5. Master switch at entry to hotel/motel guest room. ❑ 6. Individual dwelling units separately metered. ❑ 7. Medical task lighting or art/history display lighting claimed to be exempt from compliance has a control device independent of the control of the nonexempt lighting. ❑ 8. Each space required to have a manual control also allows for reducing the connected lighting load by at least 50 percent by either controlling all luminaires,dual switching of alternate rows of luminaires,alternate luminaires,or alternate lamps,switching the middle lamp luminaires independently of other lamps,or switching each luminaire or each lamp. Exceptions: ❑ Only one luminaire in space. ❑ An occupant-sensing device controls the area. ❑ The area is a corridor,storeroom,restroom,public lobby or sleeping unit. ❑ Areas that use less than 0.6 Watts/sq.ft. ❑ 9. Automatic lighting shutoff control in buildings larger than 5,000 sq.ft. Exceptions: ❑ Sleeping units,patient care areas;and spaces where automatic shutoff would endanger safety or security. ❑ 10.Photocell/astronomical time switch on exterior lights. Exceptions: ❑ Lighting intended for 24 hour use. ❑ 11.Tandem wired one-lamp and three-lamp ballasted luminaires(No single-lamp ballasts). Exceptions: ❑ Electronic high-frequency ballasts;Luminaires on emergency circuits or with no available pair. Section 5: Compliance Statement Compliance Statement: The proposed lighting alteration project represented in this document is consistent with the building plans, specifications and other calculations submitted with this permit application.The proposed lighting alteration project has been designed to meet the 2009 IECC,Chapter 8,requirements in COMcheck Version 3.9.2 and to comply with the mandatory requirements in the Requirements Checklist. Name-Title Signature Date Project Title: 5 Below Report date: 12/03/13 1 P Data filename:W:WEGPROJECTS\2013\13164\13164 Five Below-12-02-13.cck Page 2 of 2 Mass. Corporations, external master page Page 1 of 2 S William i FrancisSecretary � b oftheCommonwealth ofMassachusetts sf w `�g� HOME DIRECTIONS CONTACT US Search sec state ma.us ; Search Corporations Division Business Entity Summary ID Number: 271927566 Request certificate New search Summary for: UPLAND ARCHITECTS,INC. The exact name of the Domestic Profit Corporation: UPLAND ARCHITECTS,INC. Entity type: Domestic Profit Corporation Identification Number: 271927566 Date of Organization in Massachusetts: 04-05-2010 Last date certain: Current Fiscal Month/Day: 12/31 The location of the Principal Office: Address: 250 E MAIN STREET UNIT 13 City or town,State,Zip code,Country: NORTON, MA 02766 USA The name and address of the Registered Agent: Name: GARY SADLER Address: 250 E MAIN STREET UNIT 13 City or town,State,Zip code,Country: NORTON, MA 02703 USA The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT GARY SADLER 34 UPLAND ROAD ATTLEBORO, MA 02703 USA TREASURER GARY SADLER 34 UPLAND ROAD ATTLEBORO, MA 02703 USA SECRETARY GARY SADLER 34 UPLAND ROAD ATTLEBORO, MA 02703 USA DIRECTOR GARY SADLER 34 UPLAND ROAD ATTLEBORO, MA 02703 USA Business entity stock is publicly traded: I" The total number of shares and the par value,if any,of each class of stock which this business entity is authorized to issue: Class of Stock Par value per share Total Authorized Total issued and outstanding No.of shares Total par value No.of shares CWP $0.01 200,000 $2000.00 0 Q Consent [d Confidential Data r Merger Allowed r Manufacturing View filings for this business entity: ALL FILINGS Administrative Dissolution Annual Report4 Application For Revival Articles of Amendment View filings Comments or notes associated with this business entity: http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary... 12/19/2013 i Mass. Corporations, external master page Page 2 of 2 New search William Francis Galvin,Secretary of the Commonwealth of Massachusetts Terms and Conditions http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary... 12/19/2013 16YNq�=,,76