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0055 WATERFIELD ROAD
Lt�a.� -ieloC o�d4 -� .` .. .. �..«►T--'^-^-w+.r+.e,.�-...n�-�+^r!r^ww^.; .��;-,w.^..a--.-ram._►--...-+.-,.-�----�-......�.�__-_y+•.-.... .�... ..�.....+....w.r.^..•' ^"*- oFtKE,gk, Town of Barnstable *Permit#- C Ex�rres 6 months from issue date Regulatory Services Fee •AxxsrAsi e " y MASS. ��, Richard V.Scali,Director ° !" C�4�4 1639. Building Division J f Paul Roma,Building C�ommissione��'V 200 Main Street,Hyannis,-MAj02601 www.town.barnstable.ma.us � � „ - Office: 508=862 4038 - ' —F65C 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL'ONLY --.-- - Not-Valid-withoutRed.X-Press-Imprint--__.--------.-----------_------- _ Map/parcel Number Property Address /A) a: r 0C V '1 Residential Value of Work$ '7 000. O O Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address S,l e V Contractor's Name Cr (o P Telephone Number S O 7 7 C a2 4 0 0 Home Improvement Contractor License#(if applicable) 0/ Email: c O re V a!d COre�, r 00ar'SQ0NQ,1 Construction Supervisor's License#(if applicable) _SS L —.j o 6Q ,?/ ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [�I have Worker's Compensation Insurance p Insurance Company Name 4r(�p 0. 6 r O le C O f? r/1.1 LW Q14 t✓ Workman's Comp.Policy# -S-0 O -- SC)Ls o 9 — .? O/ 6 Copy of Insurance Compliance Certificate must accompany each permit. Permit Req est(check box)Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to �u PP g gLarwo(44- kVF_ ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required: *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property OwAler must sign Property Owner Letter of Permission. A co f t Home Improvement Contractors License&Construction Supervisors License is requi d SIGNAT ' Q:\WPFILES\FO S\building permit fo s XVESS.doc 06/20/16 The Commonwealth of Massachusetts Department of Industrial Accidents t_. Office of Investigations 4 ,;- ',..� 600 Washington Street Boston,MA 02111 ._4 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lejdbly Name(Business/Organization/Individual):/ r G s a Co " -Co r t Yt:h /` � e,f Address: -7 Is,41, ` City/State/Zip: Phone#: -S-(:)9 7 7 C oZ ?7 0 0 Are ou an employer?Check the appropriate box: Type of project(required): l.( I am a employer with C 4• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity.. employees and have workers' 9. Building addition [No workers'comp.insurance comp.insurance) g required.] 5. ❑ We are a corporation and its ME]Electrical repairs or additions 3.❑ 1 am a homeowner doingall work officers have exercised their I I. Plumbing re❑ g pairs 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-oontractors 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:X r t o I/tom Pro le C 1*o 17 �n S•c z r cZn Policy#or Self-ins.Lic.#: WCC .SO® --Sp jS® !Z j a O 1('X Expiration Date: 7 Job Site Address: Q,i r yt�e-J City/State/Zip: �S�e rV 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" ce coverage verification. I do hereby ce fy de(tkpzi penalties of perjury that the information provided above is true and correct Si ature: Date: Phone#: 7 74r—a2 9 Y0 D 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): J.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i ACO 0® DATE(MMIDD/YYYY) �� CERTIFICATE OF LIABILITY INSURANCE 9/16/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Ashley Paiva Southeastern Insurance Agency, Inc. PHONE (508)997-6061 F� No:(508)990-2731 439 State Rd. E-MADDRESS:apaiva@southeasternins.com P.O. BOX 79398 INSURERS AFFORDING COVERAGE NAIC II North Dartmouth MA 02747 INSURERAArbella Protection Insurance 41360 INSURED INSURER B AEIC Armen Safaryan, DBA: Corey and Corey INSURER C: 67 Sea Street INSURER D: Unit A4 INSURER E: Hyannis MA 02601 INSURERF: COVERAGES CERTIFICATE NUMBER:2016-17 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF'INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADD S BR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MMIDD MMIDD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PREMISES Ea occurrence $ 100,000 9520046441 9/18/2016 9/18/2017 MED EXP(Any one person $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN1-AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY JET LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: Employee Benefits $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 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 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION I PER OTH- AND EMPLOYERS'LIABILITY STATUTE 0U ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N/A E.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? Li B (Mandatory In NH) WCC-500-5015091-2016A 9/18/2016 9/18/2017 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 8 yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 1,00 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Display Purpose Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ashley Paiva/AMP ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 oniantt I . i -- rGUSMID 411 RQM •� C [J1Y�[OI� i �13if3135S1�03tB? ; • Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 183202 Type:. DBA Expiration: 9/14/2017 Tr# 270482 COREY AND COREY ! iy ARMEN SAFARYAN 67 SEA ST APT A4 ' HYANNIS, MA 02601 �4 Update Address and return card.Mark reason for change. .E1 Address Renewal Ej Employment ❑ Lost Card SCA 1 % 20M-05/11 . COREY & COREY "THE ROOFERS" ROOFING,SIDING& MORE 67 SEA STREET#A4, HYANNIS, MA 02601 PHONE: (508) 776-2900 CERTAINTEED LANDMARK LIFETIME-ALGAE RESISTANT ARCHITECTURAL STYLE RE-ROOFING PROPOSAL October 4,2016 STEVE LYMNEOS 55 WATERFIELD EM: info@lymneos.com OSTERVILLE,MA TEL: 617-327-3870 COREY & COREY will perform the following services in a neat and professional manner and in accordance with the manufacturer's specifications and local building codes. Remove and Haul Away All of the Old Asphalt Roofing Shingles from the Main House Only.Re Nail All Plywood Sheathing as needed. Supply and Install CERTAINTEED LANDMARK AR: LIFETIME WARRANTY, 10 YEAR SURE START PROTECTION, CLASS A FIRE RATED, COPPER/CERAMIC STONES for a FULL 10 YEAR WARRANTY AGAINST ALGAE CONTAMINENT,240 POUND, EXTRA HEAVY WEIGHT, 130 MPH WIND WARRANTY, CATEGORY III HURRICANE STORM/HURICANE NAILED (6 NAILS PER SHINGLE),MULTI-LAYERED, LAMINATED 'ARCHITECTURAL-STYLE,FIBERGLASS.BASED.ASPH_ALT SHINGLES. COLOR: WEATHERED WOOD Supply and Install CERTAINTEED WINTER-GUARD (Ice & Water) WATERPROOF UNDERLAYMENT SYSTEM on Roof Eaves, Under Step flashings 100% Coverage on the Shallow Pitched Roof Areas,Valleys,Chimneys and Skylights Supply and Install #15 BLACK SATURATED FELT ROOFING PAPER Supply and Install HICK'S VENTED DRIP EDGE on the Roof Eaves Supply and Install AIR VENT SHINGLE VENT II RIDGE VENT on The Main Ridge Supply and Install ALUMINUM& NEOPRENE SOIL PIPE FLASHINGS Clean and Remove the Debris from work area after job is completed. TOTAL INVESTMENT---------------------- $79000.00 JAI OREY &COREY "THE ROOFERS" ROOFING,SIDING& MORE 67 SEA STREET#A4, HYANNIS, MA 02601 PHONE: (508) 776-2900 CERTAINTEED LANDMARK LIFETIME-ALGAE RESISTANT ARCHITECTURAL STYLE RE-ROOFING PROPOSAL EACH SHEET OF PLYWOOD WILL BE REPLACED AT THE RATE OFF-------$50.00. POSSIBLE EXTRA CARPENTRY: Any Rotted or otherwise Deteriorated Trim Boards,Plywood Sheathing,Missing Metal Flashing, Side Walling or Any other Carpentry Needing Replacement Will be Done and Charged for as an Extra: Materials Plus Labor at the Rate of$40 per Hour (per person). PAYMENT SCHEDULE: A Deposit of One Half is due at the Signing of this Proposal and the Final Payment for the Balance is Due Immediately Upon Completion. WORK SCHEDULE: All of The Work is Normally Scheduled for Completion Within 60 Days of Acceptance. Please Make Checks Payable to: ARMEN SAFARYAN or COREY & COREY COREY & COREY Warranties the Shingles and Labor for 5 years CERTAINTEED Warranties the shingles and labor 100%for the First 10 years and the Shingles your LIFETIME if the shingles become defective CERTAINTEED-Warranties the Shingles up to a - CATEGORY III HURRICANE-130 MPH WIND WARRANRY COREY & COREY Carries Workman's Compensation and Public Liability Insurance on the Above Work DATE OF ACCEPTANCE:> SUBMITTED rmen Safaryan ACCEPTED BY: STEVE LY �IEOS- S`� IVII COREY &Co OMEOWNER Ad I � ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION, Map //de.- PP sParcel Application Health Division Date Issued Conservation Division Application Fee5g�� Tax Collector Permit Fee Treasurer 3-10 9� Planning Dept. Date Definitive Plan Approved by Planning Board �Gm Historic-OKH AJ A- Preservation/Hyannis N 4 Project Street Address Village esne VI L-Le— Owner rAlOL. LV14lJ E�D_5 Address 1Ct� Telephone ��/C101 �5 ✓�� �?� L/��S' Permit Request ffi tYQ/C- Z)AAW -G E� C36&P&_ kr Square feet: 1 st floor:existing proposed 2nd floor:existing d proposed,! T&?n aI ne f• � C•� O C Zoning District Flood Plain 4-- Groundwater Overlay N '^ Project Valuation Construction Type . !/4)x'-> F F_�, Lot Size - Grandfathered: ❑Yes ❑No If yes, attach supportin documegtion.>i- M r Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) O M Age of Existing Structure /4`�i Historic House: ❑Yes *o On Old King's Highway: ❑Yes )<o Basement Type: kFull X Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) f� Basement Unfinished Area(sq.ft) AF-0 Number of Baths: Full:existing / new 29 Half:existing / new <f:) Number of Bedrooms: existing-1-8 new 1�y i Total Room Count(not including baths):existing lt�2 new ep First Floor Room Count Heat Type and Fuel: ❑Gas *Oil ❑ Electric ❑Other Central Air: ❑Yes ANo Fireplaces: Existing _ New ZA—Barn: iwood/coal stove: ❑Yes -No Detached garage:❑existing ❑new size Pool:❑existing ❑new size . ❑existing ❑new size 04L Attached garage:❑existing Elnew size Shed:❑existing ❑new sizethey: 7 Zoning Board of Appeals Authorization ❑ Appeal# i 4-- Recorded❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use Jeer4 2 , II BUILDER INFORMATION Name ND / 6 Telephone Number Address e �. License# 0/ -R'�S^� Home Improvement Contractor# /0 2 Worker's Compensation# MG-4 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATU DATE V oZ D FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL N0. ts. � r ADDRESS VILLAGE OWNER ' DATE OF INSPECTION: w I FOUNDATION FRAME INSULATION E FIREPLACE R ELECTRICAL`. ROUGH FINAL �s PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING C& DATE CLOSED OUT ASSOCIATION PLAN NO. i ra oawnzanu a a ,cra,ac�uiaeLta i ,Board of Building Regulations and Standards j Construction Supervisor License z•r 1 'j License: CS .15851 iBirthdate:.-.9/28/1953 Ex-oration 9/28/2009 Tr# 2366 i Res4nction -00. CRAIG N ASHWORTH -385 SEA STREET HYANNIS,MA 02601 ✓ Commissioner I ✓fze L�orvrrvh2suea�fa c�✓ as¢c�ucaela Board of Building Regulations and Standards License or registration valid for individul use only — HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 102014 Board of Building Regulations and Standards Ex pi One Ashburton Place Rm 1301 P _6/30/2010 Tr# 268470 Boston,Ma.02108 a _P-rivate Corporation .: - . i poration ERNEST B. NORRIS:'&'SON INC'-' 1 Craig Ashworth 138 Osterville W.Barnstable rd.- � r z — Osterville, MA 02655 Administrator Not valid without signature Client#:646400 2NORRISEB ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYI). 115/2112009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR-----` ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.- ..,,. 973 lyannough Rd., PO Box 1990 E Hyannis,MA 02601 INSURERS AFFORDING COVERAGE NAIC# ^' INSURED INSURERA: Acadia Insurance E.B.Norris&Son.,Inc. INSURER B: 138 Osterville-West Barnstable Road INSURERC: Osterville,MA 02655 INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MM/DD DATE(MMIDDIYYI LIMITS A GENERAL LIABILITY CPA005234520 05/03/09 05/03/10 EACH OCCURRENCE $1 00O 000_ X COMMERCIAL GENERAL LIABILITY DAMAGEPREMISe TO RENTED occurrencel $250 OOO CLAIMS MADE OCCUR MED EXP(Any one person) $S 000 'oly'YY.)..- PERSONAL&ADV INJURY $1 000 000..:._.-_ -• GENERAL AGGREGATE $2 000 OQO. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 OOO 000,..,:. ;. POLICY JET LOC A AUTOMOBILE LIABILITY MAA005233820 05/03/09 05/03/10 COMBINED SINGLE LIMIT `•'- ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY $1,000,000 X SCHEDULED AUTOS (Per parson) X HIRED AUTOS BODILY INJURY $1,000,000 • X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE(Per accident) $500,000 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ - ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ TH A WORKERS COMPENSATION AND WCA021246412 05/03/09 05/03/10 X CRY LIMIT FR :; u EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT s500,000 O OFFICER/MEMBER EXCLUDED? NO It E.L.DISEASE-EA EMPLOYEE $SOO,000 y y SPes•describe under ECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $500,000 •' ': OTHER DESCRIPTION F OPERATIONS LOCATIONS VEHICLES C ON 0 OPE 0 S/ / E CLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Officers are included under the workers compensation policy. Insurance coverage is limited to the terms,conditions,exclusions,other - limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the F coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRE.TLQ_ Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL In DAYS W TTEN;:; 200 Main Street NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO_$HALI_ 1, Hyannis,MA 02601 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGEµJS,O$: REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 #S57998/M57992 LS1 © ACORD CORPORATION,19.,8 t ,per The Commonwealth of Massachusetts �\ Department of Industrial Accidents Office of Investigations _ 600 Washington Street Boston,MA 02111' wtvw.mass.gov/dia ' Workers'Compensation Insurance Affiddvit: Builders/Contractors/Eleetricians/Plumbers Applicant Information Please Print Le bl �tQ(,3 NG NalI18(BusinessJOro ni�ation/Individual): � .B� �/1-10 - � ' f •Address: `� ��TERylG �, .s A-11ZX �3 ' City/State/Zip: ®o�j i/e ��� 49 hone-#: Are you an employer?Check the appropriate bog: :Type of project(required):. 1• I am a e to er with 4. ❑ I am a general contractor and I mP Y 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. ElRemodeling ship and have no employees These sub-contractors have g• ❑Demolition �Vorkin for me in an capacity. employees 3 and have workers' g Y P t3' t• 9. ❑Building addition [No workers' comp.insurance comp.insurance. 10. •Electrical repairs or additions required.] 5. ❑ We are a corporation and its ❑ '3.❑ I am a homeowner doing ill-work . officers have exercised their 11.❑Plumbing repairs or additions ' myself.[No workers'comp. right bf exemption per MGL 12.❑Roof repairs insurance.re4e ] t c. 152, §1(4),and we have no d- 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 ttien hire outside contractors must submit a new affidavit indicating'such. tcontnactors that check this box mutt attached an additional sheet showing the name of the sub-contractors and state whether ornot those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that isproviding workers'compensation insurance for my employees. Below is.thepolicy and job site information. Insurance Company Name: ���—Y7/ A ca Policy#or Self-ins.Lic.# 6�4 Q 2-1 2Z 4 66 &l Z- Expiration Date: v Job Site Address: �Cy,�� l�ev �� Gity/StateJZipOs�1Li�� Attach a copy of the workers'compensation policy declaration page'(sliovving 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 1)IA for insurance coverage verification I do hereby certi er the i penal ' f perjury that the information provided aboove ' true an correct Si afore: 2t" t Date; a, ; _ Phone# � Official use only. Do not write in this area, tb be completed by city or town off ciai 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#: Town of Barnstable Regubtory Services Thomas F.Qefter,Mreetor Building Division Tom Perry, Banding Commisdoner 200 Ma{n Street, RY=mb,MA 02601 www.townbarnstable.ma.ns )Moe: 508-862-4038 . Fax: 508-790-6230 property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject pxopezty ' f . I bete authos3ze ic3 G to act on mY behalf; in all=afts relative to work autho:dzed by this building petmit applkcadon£or. (Address of job) mar o� G+ Sigustne of Date Pont Name Be SE" Double 1-3/4" x 7-1/4" VERSA-LAM® 2.0 3100 SIR Floor Beam\F1301 BC CALL®2.0 Design Report-US 3 spans I No cantilevers 1 0/12 slope Thursday,August 20,2009 13:06 Build 285 File Name: BC CALC Project Job Name: Description: FB01 Address: Specifier: Joe Madera City, State,Zip:, Designer: Customer: Company: Shepley Wood Products Code reports: ESR-1040 Misc: 10-00-00 -- - - 1 0-00-00 - 10-00-00 BO,3-1/2" B1,3-1/2" B2,3-1/2" B3,3-1/2" LL 1,853 Ibs LL 4,734 Ibs - LL 4,734 Ibs LL 1,853 Ibs DL 441 Ibs DL 1,166 Ibs DL 1,166 Ibs DL 441 Ibs Total Horizontal Product Length=30-00-00 Load Summary Live Dead Snow Wind Roof Live Tag Description Load Type Ref. Start End 100% 90% 115% 133% 125% Trib. 1 Standard Load Unf. Area(psf) Left 00-00-00 30-00-00 40 10 10-00-00 Controls Summary Value %Allowable Duration case Span Disclosure Pos. Moment 4,677 ft-Ibs 55.8% 100% 14 3- Internal Completeness and accuracy of input must Neg. Moment -5,584 ft-Ibs 66.7% 100% 18 1 - Right be verified by anyone who would rely on End Shear 1,840 Ibs 38.2% 100% 14 1 -Left output as evidence of suitability for Cont. Shear 2,669 Ibs 55.4% 100% 18 1 - Right particular application.Output here based Total Load Defl. U352(0.333") 68.2% 14 1 properties building and code-accepted d design Live Load Defl. U416 0.282" 86.6% properties and analysis methods. ( ) 14 1 Installation of BOISE engineered wood Total Neg. Deft. -0.176" 35.2% 14 2 products must be in accordance with Max Defl. 0.333" 33.3% 14 1 current Installation Guide and applicable Span/Depth 16.2 n/a 1 building codes.To obtain Installation Guide or ask questions,please call %Allow %Allow (800)232-0788 before installation. Bearing Supports Dim.(L x W) Value Support Member Material BC CALCO,BC FRAMER®,AJS- BO Post 3-1/2"x 3-1/2" 2,294 Ibs n/a 25.0% Unspecified ALLJOISTO,BC RIM BOARD-,BCI®, B1 Post 3-1/2"x 3-1/2" 5,901 Ibs n/a 64.2% Unspecified BOISE GLULAM- SIMPLE FRAMING B2 Post 3-1/2"x 3-1/2" 5,901 Ibs n/a 64.2% Unspecified SYSTEM®,VERSA-LAM®,VERSA-RIM B3 Post 3-1/2"x 3-1/2" 2,294 Ibs n/a 25.0% Unspecified PLUS®,VERSA-RIM®, VERSA-STRAND®,VERSA-STUD®are trademarks of Boise Wood Products, Notes L.L.C. Design meets Code minimum(U240)Total load deflection criteria. Design meets Code minimum(U360) Live load deflection criteria. Design meets arbitrary(1") Maximum load deflection criteria. Connection Diagram b d a • �• • c •4 • a minimum=2" c=3-1/4" b minimum=3" d= 12" Member has no side loads. Connectors are: 16d Common Nails Page 1 of 1 9'-4 1/16" fi POST POST DOWN DOWN (2)1-3/4"x 7-1/4"LVL CONTINUOUS 30' 28'-0" 9-4 1/16" PO ST OST DOWN DOWN (2)1-3/4"x 7-1/4'LVL CONTINUOUS 30' 9'-3 13/16" 101-0" 1 01-o" 1 01-o" 30*-0" w ; i ve � y 3 ;.iN Akk py i .✓ 'may - - - ..�._ ���-� - .�'�"""rr.,, •r "'`" .. AIMw e•�y f y Assessor's map and lot number ......... �� Sewage Permit number ......:.. fly �/ ?!f J ...!. . r r Z BARNSTADLE, i House number ............................................................................ 9c rasa s • o�'airar a�e0 TOWN OF BARNI STABLE w BUILDING INSPECTOR v APPLICATION FOR' PERMIT TO .... ............................: ..... l ?..`........................................... & i';, a TYPE OF CONSTRUCTION ...........�'l�I D ;?!/1, ✓,;;�;24 ...:; v .. ......................... .� .:..:.../.. .........,9.f TO THE INSPECTOR OF BUILDINGS: i. The undersigned hereby Japplies sffor a permit according to the following information: ti Location .... ..<,.5...... ................................................................ ........................... .. v Proposed Use ........g .......................................................................Fire District .... Zonin District P....�t.-::1......... Name of Owner .z%.,,ate....... ?�-P.< 7...............Address ........5r� r/I� v. a� G.� L(-f24 /...... Name of Builder ., = 7. * r! ....� �J !?!. :::..............Address /�,/,,.. ... � CJ!%. CI ! �r.>r;L•... �R Address .. ..... ..`�. .. _ .. ............................................ x Name of Architect ..............................-..-:............................'-----� ...... f Number of Rooms ..................................Foundation .............................................................................. Exterior ....... ......................Roofing ......!% '`r4'�? !'�r.?_6._........................................... :L Floors .:....................Interior .......r.'"7�: .................................................... s Heating .....: ............................................:..........Plumbing ............ Fireplace ��'J. n ?'!. ...............................................Approximate Cost ......... ..Q .!........................................... ti ........... .... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ........................ ................. `' OV Diagram of Lot and Building with Dimensions Fee / SUBJECT TO APPROVAL OF BOARD OF HEALTH- LJ 1 i 1 2- I hereby agree to conform to all the.Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....................... ................ ...... Lymneos, PaU!' A=118-38 21209 No ................. Permit for .......Add...P.Wch..rdbs ............................................................................... Location .............55..Wate .... ......... ............ ...........................Oster...........YUIQ.............................. Owner ..............Paul LyMnVQ.$.......................... ........... Type of Construction .......frame........................ ......................................... .........................:........... Plot ............................ Lot ................................ Permit Granted ...................Apri.. .!18.............19 79 Date of Inspection ............. ......................19 Date Completed ........... .......................... PERMIT REFUSED .... ........ . ..................... ................................ . . ..... 19 .............. ..... . ..... .. ..... .... .. ................................................................................ ............................................................................... ............................................................................... Approved ................................................... 19 ............................................................................... .............. ............................................................. Assessor's map and lot number ...�/..-*i. ...�.�'�..) �C• 0� "�'�� 79 Bpi 7F1 E T�� ro�'P o Sewage Permit number ........�1- ''2 ..... .�...... .. �J SEPTIC SYSTEM MUST BE 1`r INSTALLED IN COMPLIANC • WITH ARTICLE : BAHBSTODLE. House number .......................................................................... E 11 STATE 90 rae SAIL ITAPY CO . DE AND TOWN 9 � oYFYa`�� REGULATIO S TOWN OF BARNSTARLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .... ............ ............. . .... . ................................. TYPE OF CONSTRUCTION ...........(!!/. .... ........... . ... . ............................... � ../.. ..........19 za TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... s..... . ... .... r.. .... ..... ...................................................:........:.......................................... ProposedUse ..... ... .................................................................................................................................... ZoningDistrict ........................................................................Fire District ..... .. .. . ........ .... .............C� ... Name of Owner ... .. ... ...............Address �.7 �(/ Name of Builder . ........ . .. . . ...... .. .... ... .................Address J.....5�: Nameof Architect ....................:...............Address ................................................................................... ------------ Numberof Rooms ..................................................................Foundation .............................................................................. Exterior ........--21�D'3't. .......................................................Roofing ...... ........ ...... ......... ..:. ........................................... Floors .Interior Heating ....... ...........................Plumbing ...... ... .. .. ............................................................... Fireplace ..:.... .... .. ... ....... ... ................................................Approximate Cost ........ � Q.!........................................... Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ........ . ................... Diagram of Lot and Building with Dimensions Fee �� ............. ............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH Q G> I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ....................... ... ........ .......... ....... | Lyonmoo, Paul No —. Permit for -- P-- R� � ——of ---------------------.-----. � Location .........55. ..Boad_____ � --------0="er'====----------. � � Owner ........... ........ � � ^ ' Type of Construction --..--Yram�-----.. � .......... ---------------------' ^' Plot ............................ Lot ----------' � ' ' ~ � - �y T 18 79 Panni�Gron � --- �� � ��� -----� ..]g � � Doteof]nspec�on ...................................' lV � , ��r ��� Do�e (�xno|a�e6 ---._—,�,�.,�^�--l9 ^o/� � . . , ' � PERMIT REFUSED l�----.---------------.. ---------------._—_------- / .------~' ...................................................... . ' � . . ..------.----------.~-----.—, ~v-----._'--.—..------------'—' . . .'-------- lg ` Approved —_-----. ` ^ ' -------..---..---...-----.--.---. ' ------'---------------.--.— ` ---�� _ Assessor's map and lot number Sewage Permit number ........ ........ z.................. Soft SVSTEM MUS ARSSTABLE, NAM House number ......................................................................... IN com t639- TRLE SPU - F011 Of ODE AND TOWN OF B A R N S�5'=,NGIWATIONS BUILDING JINSPECTOR .. .... ..................................... APPLICATION FOR PERMIT TO ......... ............. ... TYPE OF CONSTRUCTION ................ �. .)...... .................................................................. . ........... ..........19-79 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ......... ........ ........... . ...................... ProposedUse ..... . ....................................................................................................................... ZoningDistrict ........................................................................Fire District .............................................................................. Name of Owner ...4axa. ........Address ...... Name of Builder .. . ..........Address ... 1-1AZ ......�. Name of Architect ......... .....................................................Address .................... .................... ... ..................................... Number of Rooms ...........*................................................Foundation ........ cl-lv:neka............ Exierior ......... ....................................................Roofing ..............k--t 4. -L"z&...................................... Floors ........... .........................................................Interior .......... ................................ Heating .......... f...................................................Plumbing 111164&- ...!A—..&.1.5.z.;OeZ4..................... r ................................................Approxim Fireplace .................. 2 ate Cost .......... .... DefinitivePlan Approved by Planning Board ---------------------------- Area .......8............. ,00 Diagram of Lot and Building with Dimensions Fee ........ ...................... SUBJECT TO APPROVAL OF BOARD OF HE ,�LTH �2 ly I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .....A ...... � - 21439 Lymeos, Paul No ...... Permit for ..Add..t0.. ' ' ' --------------------------' Location ..�.5.Waterf ield--Rd-;......................... ` � ------'0s.t=rvzlze...................................... � _ Owner ........Poul.. ymeos............................... � ' . Type of Construction .......^f.ragae...................... ' � _-----------------.-.------. . . Plot ............................ Lot ----------' � . � Permit Granted .........July....9................ , Date of Inspection --------. ---lV � . ��� Dote Completed -.-- lq �`� ' ' � ' . ERMIT REFUSED ' ' nwp ....................... . ' ' - ----. . ' ' . � ----. ----' C) '� lA "pp "`=" m�'�_.�-----------' .................. ............................................................ - � --------.------------....--.. ' ' � Assessors map and lot number Sewage Permit number �' ° q .� P Z BAS39TABLE, i House number y t6 aY 9 Y a•0 , TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. .... ....... TYPE OF CONSTRUCTION ................... ..................... ..................................................................................... ........ :� .......!!lam. 9. ......9..r TO THE INSPECTOR OF BUILDINGS: The undersigned herreby applies fora permit according to the following iinforrm--a�tion:// Location .........�'.`?..........�?,..� ,(p,,.;?. "!/.P%1.•Gi ............ //I '/ !<li-/YF�,O. ; .2i, i .............. ... ..fi_ /r � ......... ................. ...................................../.........................Proposed Use .. ZoningDistrict .......�.................................................................Fire District ...........................�...../............................................. Name of Owner . i1, /4Q.k..... ..........Address .......:5�.� ... �/,•,,f e.{.K !� h / ; .1 �7 Name of Builder ... G.!�t .c(: -* ... .�,?,...�� {/..............Address ... ��.�........ .i?fit l....:•........ ..... .2(./i �..,. Name of Architect "' �'.-`.....................Address Number of Rooms .......... ...........................................:.....Foundation ........ P.wr?Pam? ....,/.0,0�.:�-�.A14............. Exterior .......... .............`.....................................................Roofing .............. ................................... i. Floors /............................................................Interior ....... ....._......... �. ................................ Heating .......... � i.:...................................................Plumbing ! / �� . Fireplace ..................Ij- ..................................................Approximate Cost ......... :... .:. ..................... v Definitive Plan Approved by Planning Board -----------_______-----------19_______ . Area ...................Q................... f Diagram -of Lot and Building with Dimensions Fee —.-.. . SUBJECT TO APPROVAL OF BOARD OF HEALTH fy tA FI I hereby agree to conform to all i he Rules and Regulations of the Town of Barnstable regarding the above . construction. Name ........... �- .. ;� ....................../ � 71439Lymeos . . , Paul � � No '.214-39-. Permit for f � _____________________^____.. � w- ' - ' Location ......55. . Rda,...... ' � .................................Oacezzzille--------. . - ` - Owner ..........j?:nl_J437jilrie.02__________ ' Type of Construction .........zxma-------' ' . - ' ` ` � Plot ux / . � \ Permit Granted � � � . ` Date of ".^p=`."". � ' up,e Completed t»« � � � ~ PERMIT~ REFUSED J___--_---' .. lg r�A � ----. .�r ------ -.-.----..--,----.-----------.. ^ � ----.----_--.-----...------. � ---------..-----~-------.-.- Approved --_----------,-.. ]g � � '--..---..|---------.--------.. � � ^ � � ` ........................................................... . � ' � ' Assessor's office(1st Floor): , Assessor's map and lot number 3 � sEFne EYS1'E�t'u�� OF T�E TO Board of Health(3rd floor): 7 \ � Vz7A ;Lq A g w Sewage Permit number S— y�o �I.JJ � � ��1�" Engineering Department(3rd floor): G !�! f CjODE�® = BaBa9feDLL Fss` ~�ti�e�t0 House number LATIONS 9- s � �0 Definitive Plan Approved by Planning Board 1fo �o ypY d APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 12--AL TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a,.pe�rmit according to the following information: t �• Location V�i�`��i`1 \t A V%kA V`��4 a w— - Proposed Use 5e2z<� y r�e�2-Ae-L Zoning District Fire District ns-T r V A k Name of Owner Pdj LV IH1w4as Address 5-S W<�e-` `l Name of Builder Rsb Address 2Ay� Name of Architect Address u lt � Nle s Lt/�pJ Number of Rooms 1 Foundation l� y-yg�C.X !VA • Exterior W_C' InC�PA Roofing ���-T Floors Interior Heating lj b N Plumbing ti0 mo, Fireplace AJ4 ti e Approximate Cost Area Diagram of Lot and Building with Dimensions Fee O o OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable egardin above construction. Name Construct, Supervisor's License LYMNEOS, PAUL No 33102 permit For ADDITION 4 k' Single Family Dwelling Location 55 Waterfield Road Osterville Owner' Paul Lymneos Type Frame T e of Construction Plot Lot N Permit Granted July 27 , 19 89 Date(f Inspection 19 ! 19 s Date Completed_ 0 all M 2IR " F. e• � �Q ti i. !,.:�'- t.r• .�..�^rY-. S'L...�Ol r5,•LM -''�vy. •�y1 f . ...44 ` • � .,,, *, 'N !•�' " tj-'w'k „i.:�• 'y. Assessor's office(1 st Floor): Assessor's map and lot number Board of Health(3rd floor): Sewage'Permit number_ S— 7y�i*A� Z BAHd97'GDLL,'i Engineering Department(3rd floor): F�S, rasa House number. °° i639• \ae' Definitive Plan Approved by Planning Board 19 �Fo rav a' APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BNRNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO Ccmz 1y j N�A-Lcm S L �5�-•� �"C ��� TYPE OF CONSTRUCTION W� "fa L•e • ''1 �'S 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a_p'e'r�m'it according to the following information: I I Location `���'T f� Proposed Use 21 J RIC— Fire District C'�ST�t y�l� € +4oning District �f� t - Name of Owner TGi_�, 6..�d�+tY1l','� Address Name of Builder 03Uk5 ?aku- ,Q_ 't-�. C_ Address 2-4 �/ �. �� 'd \!k v4- •- l Name of Architect Address Number of Rooms ,r, 1 Foundation two featr °'` - A« Exterior wdz)G " eAVK\, W �' S A`tnCkIIA Roofing Floors Interior � '� �r�� hiV`4 Heating N d N Plumbing Aid � . � Fireplace A.1Q ti e— Approximate Cost r • � Area 0 Diagram of Lot and Building with Dimensions . Fee �Q may. tl d y OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS ] I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable egarding^ •e above construction. Name Construct•' Supervisor's License O 3 O LYMNEOS, PAUL A=118=038 - . _ No 33102 Permit For ADDITION Single Family Dwelling Location 55 Waterfield Road Osterville Owner Paul Lymneos Type of Construction Frame Plot Lot Permit Granted July 27, 19 89 Date of Inspection . 19 Date Completed 19 ............................ ............................................................................................................... ............ ... .. ......................................... ....................... ............................. ............................. ....... ............................ .......................:.............. .................................................................................m.......................................... .............. .......................... ....................................... .......................................... ........................................... ....................................... ........ 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