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HomeMy WebLinkAbout0078 THIRD AVENUE (HYANNIS) Town of Barnstable Building Department - 200 Main Street RAPNSTABLE, * Hyannis, MA 02601 - �$ 1639. ��' - (508) 862-4038 RFD Mfg A ., _ Certificate of _ Application Number: 201408685 CO Number: 20150199 Parcel ID: 246089 CO Issue Date: 09129115_>'. Location: 78 THIRD AVE (HYANNIS) Zoning Classification: RESIDENCE B DISTRICT Proposed Use:. _ SINGLE FAMILY 'HOME Village: HYANNIS Gen Contractor:' TYLER, SANFORD Permit Type .'-'-R000 .CERTIFICATE OF OCCUPANCY RES Comments: �° Building Department Signature Date Signed " , TOWN OF BARNSTABLE,, Puffla rig" 2J""u1408685 . BARNSTABLE, Issue Date: 1 12/17/14 Per m i t y MASS. 1639. Applicant: TYLER�SANFORD Permit Number: B 20143417 , Proposed Use: SINGLE FAMILY HOME Expiration Date: 06/16/15 Location 78 THIRD AVE (HYANNIS) Zoning District RB Permit Type: RESIDENTIAL ADDITION/ALTERATIO Map Parcel 246089 . Permit Fee$ 688.50 Contractor- TYLER, SANFORD Village HYANNIS App Fee..$ 50.00 License Num 060982 Est Construction Cost$ 135,000 Remarks APPROVED PLANS MUST BE RETAINED ON JOB AND 16X20 ADDITION CONSISTING OF BEDROOM,BATH,CLOSET&RE OFMS CARD MUST BE KEPT POSTED UNTIL FINAL KITCHEN&BATH INSPECTION HAS BEEN MADE. WHERE A CERTIFICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: DECOSTA,ELEANOR M BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: BOX 173 INSPECTION HAS BEEN'MADE. WEST HYANNISPORT,MA 02672 Application Entered by: PF Building PernTit Issued By: � THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET ALLEY OR SIDEWALK:OR'ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY:ENCROACHMENTS ON Pup&PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUQ.DING CODE;MUST BE APPROVED BY THEJURISDICTION? STREET OR ALLEY'GRADESAS WELLAS-DEPTH AND LOCATION OF-PUBLIC SEWERS MAY BE - OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT.DOES NOT'RELEASE THE APPLICANT,FROM THE,CONDITIONS OF ANY APPLICABLE SUBDIVISION- RESTRICTIONS M 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 UNREGISTEREDCONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.I42A). BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS ,—_. 3 D C C/_l� 1 Heating Inspection Approvals Engineering Dept r FiCre D t(�.�.�..:-9�...� 2 Board of Heal L �. � gar � (�l fi1 [as I IS 3--13 --iS7 r�lp a� Commonwealth of Massachusetts Sheet Metal Permit Map Parcel_� , Date: 3) �`� � S XOPR PERMIT: Permit# Coln 1 Estimated Job Cost: $ i I I�900_.' MAR 0 9 2015 Permit-Fee: $ Plans Submitted: YES e�N OF AR N STAB LSE Reviewed: YES NO Business License# C22�$ Applicant License# V 13 Business Information: Property Owner/Job Location Information: Nonz.: kXP,I,1r,o - -0 8 W 1 Name: e41 �.�may-C I,n Gh ce-e+5 Name: l .�Le �- Tra y u c�� Street: ?-z' &x aLi7 Sizeet`. n City/Town: grn�� ohh M4 a'i�)3 City/Town:W 4n a QX ,m Telephone: 5 4>`6 LI 9$ 94%5 . Telephone: Photo I.D.required/Copy of Photo I.D. attached: YES `� NO Staff Initial J-1 M-1- estricted license J"-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10,000 sq. ft./2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other i Commercial: Office Retail Industrial Educational Fire Dept. Approval Institutional_ Other Square Footage: under 10,000 sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metalwork to be completed: New Work: '''' Renovation: HVAC ✓ Metal Watershed Roofing. Kitchen Exhaust System Metal Chimney/Vents Air Balancing Provide detailed description of work to be done: _1 A r+y1 C�( y t IG cs— i� c7 t�y ) ) l� 4,0 mom i i r INSURANCE COVERAGE: I have a current liability insurance policy orb equivalent which meets the requirements of M.G.L.Ch.112 Yes 2N'oEl I If you have checked Y_q§,indicate the type of coverage by checking the appropriate box below: A liability insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my signature on this permit application waives this requirement. Check One Only Owner ❑ Agent ❑ Signature of Owner or Owners Agent By checking this boxE],I hereby certify that all of the details and information I have submitted(or entered)regarding this application are true and accurate to the best of my knowledge and that all sheet metal work and installations performed under the permit issued for this application will be in compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Ductinspection required prior to insulation installation:YES NO Progress Inspections Date Comments Finial Insuection Date Comments t f i Type of License: 3Y ❑ Master title ❑Master-Restricted '.itylTown ❑Joumeyperso'n . Signature of Licensee permit# ❑Joumeyperson-Restricted License Number:. `) 3 �^ =ee$ Q Check at www,mass.ggvldnl nspector Signature of Permit Approval i G o The G`z7.mmanrve�l&of Massachuseffs . eparhnent of iuk3a ul Accidents - - R 0 zCe of rmles�e`afic rs 600 Washington Street $aslanr 1 0-2111 '' wtt.�fil Jti(�SS.�ai�l�lll Worlcers' CompensatiolaTnsurance 4-fidavi-:Builders/Contra:ctorsfMechicianslPlumbers Applicant Information Please Print Legibly Namc(BU6W.sS/0!Zani7a onlf idi;rzdmQ-M v/)'L; I g 1 ►c;�o 1)9 ,9 4'e s+- cal Adress: P.6, G. x a 4') w. Vr,,r VY,- m-A ci fs$3� - W• Ct r y Phone:r_ � ' �- v ��► -� soy- y9t yug � Are you an employer? Check the appropriate box T of ect_ c=tzactor and I 1 01 {r egmred}: 4 1_❑ I am a employer with ❑ I am � 6- ❑New�sEnYr�;io-a loyees{full andlorpazfime}_ * have hired the sub--contrwims. 7_ I.am a sole prapr%etor or partner- listed on�e attached sheet7- ❑IZrmodeling ship and haze no employees 11 snl� coutrar#ors have g- ❑Demolition waddng for me.is any � �r.c cz employees and have workers' !I- ❑13uiltiing addition ¢�ira [No workers' comp_7nnce comp-inset-anc l :required-] 5_❑ We are a cotporation and ifs 10_[]Elerhical repairs or additions �_❑ I PM a homeowner doing all wrork officers hnm exercised(heir 12_0 Plumbing repairs or additions, Myself [No workers'camp_ right of eazemption per MGL 12-0 Roof ;mmnmnre c c_152, §1(4} and wehneno ram' 1 13_❑Other employees-[No workers' comp-iaccrranrr..required-I '_�Aay anpUc=t that checks boa fl must also fll out iLee section bgovc shawl their odccss�conmeusatio�gpiicF i t Hamenwners vrho summit ibis afn- s m cstmg try are daing all wmic and Shea bn-L amsid COat IUM must Stahmit a ae affidavit incurs snrl Zcbntmctors that check this box musrt sttsche3 six idditinn sheet sham-mg the name of the sab- 3 and ststr vrhetisec ncaat abase mai£ies Is.-va �.Inyees_ If'the sob-cauihacems bare ea�Ioy�s,t$2y must pruc�de their'works°comp-Policy awnhez lam art errrpbr ihrrt igra�iditrg ttrorke-rs'conrpnrtsxrttA.n aztrttrrtrtce far rrz}r exTo1 cze� BelatF is thegr�Ticy rutd job site %��atmtziiAn Insurance CompanyN=e: Pol:cy fr or Self-ins-Lic-4: ExpisationDate: Job Site_Address: CityfState/2 p: Attach a tops-of the workers'compensatims policy deZaration page(sh�the policy number and expiration date). Failure to secure coverage as requireduirdcr Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00,andlor one year impIIS t,as wen as civil peaahies 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 cry of this statement maybe farwarded to the Of m of Im7egti�tirs o€tiie DIA for in%t-ance coverage-eriEcation- I d4 here fy tL t)ts i en dies DAP tYtaffhe irzforraa#r¢n pratzdgd ubrrFre is h rte array correct: Siena I3aEe: 3 1 L I ) S Phone 4: QA5wiat use anly. Da not mite in this area.,to bs completed by city ar town ofciaL Cites or Town: PaudtUcense# Issuing r'inthority(drde one): 1.Board of HeaIth 2.Buil in„Department I Gityll`owa Cleric 4.Electrical Inspector 5.Plumbing In -tor 6.Other Contact Person- Phone#: 6 Information and Instructions r Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute, an employee is defined as"___every person in the service of another under any contract of hire, express or implie-A oral or written.." An employer is defined as"an individual,partnership,association,corporation or other legal entity, or amy two or more of the foregoing engaged in a joint enterprise,and including the Iegal 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 occJDant 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 as employer." 52 25C also state "e c' MGL chapter I , § (� o s that very state or local licensing agency shaII withhold the issuance or renewal of a License or permit to operate a business or to construct buildings in the comrnonvrea it1h for alay 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-contactor(s)name(s), addresses) and phone number(s) along with their cerr.":ficait(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnershi-ps(LLP)vwT'ua: o 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 Depa--traent of indust-Tial Accidents for conf=ation of insurance coverage_ AIso be sure to sign and date the affidavit 'llit affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Dcpar'inent of Industrial Accidents_ Should you have any questions regarding the law or if you are required io obt^m�a arorkers' compensation policy,please call the Department at the number listed below. Sel insured companies should enter their self-in=aauce license number oa the appropriate at. Cityor 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 rill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to all in the perroitllicense 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 gown may be provided to the applicant as proof that a valid affidavit is oa file for futme 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 venue (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this af adav-it 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: nt-Comiaaaw-ean of Massachusetts Depattine�nt of Indust dal Accidents Qf ke az 7avestigatcaus GGG Washington S &ostoz,IAA Q21 11 TtL A 617-72 -4 W 406 or I-977-MASSAFE Revised 4-24-07 Fax IF' 6I `27-T.1-49 i 0 lie Town of Barnstable Regulatory Services • aaaTvsrea[Z. MAs9. Thomas F.Geiler,Director 1659 ` Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner bust Complete and Sign This Section If Using A Builder I, G V-) r Le'� ,as Owner of the subject pro l Pert7 hereby authorize U n z�o G (�t,�'1 n C� -� to act an mp behalf; in all matters relative to work authorized by this building permit (Address of job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized until all final inspections are performed and accepted. �l S Signature of Owner Signatur fApplicant Print Name Print Name , Date Q;FORMS:OWNERPERMISSIONPOOLS 1 r caC Z_c�ng5 ST 1®u y 10 07 Ins f j. �..�.-..-.*+—.,�e�....->.,•.n-- � i - ,1 w.nr�ama<navesnv.n+a.ovu.s®•Q.Ba.....czm.......�.wr .-.a Y F ..� .-..:rfq-r+':'ik!�-.-..,� i.. »-...,s-.. _-..-.� V a� i6 r its �P ;$ COMMONWEALTH OF M*AI SSACHUSETCS: AS1SFACH��S�ETTJS� D/R�VER'E,'�`�'"" SHEET .Mf:TAL', WORKERS ,n gun„`y ��88 rx,+t�, >a 9a END'^ 40 NUMBER ISSUES THE" FOLL"OWING; LICENSE , 043020 '4 NON,",WS531628©8 ;! AS A MASTER1NRISTR I CTED 3�ooaLfl li.f ;,. n� 4 :..N j r_ r f SEA 78 SE7G�N� k ps NONE \\�; a_ s �IUNZ t 0. L� NAPOL I TANG `;•� t�J� cr E - �{ eNy sy 1 u i)�U�\.I 91a tl 15 �`1 S 7& C AMP S� _ W YARMOUTH MA:02673 r�A o2673 3207' j';1 � U 0�2D14Re R 11�7 %j1i/ W YAFIOUTH= _ 8 UD OS - v07'951009 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION G Map 0 Parcel Application #_OZ) S Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Feed°. Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 71? 70 i4)\ AIVI Village WeS (_n' Owner A)e Address �3 eeS 3 ®7 Telephone Pe it Request .5/-O� / AA. lc D.v �v �� �0 'v v �5 Square feet: 1 st floor: existing proposed cylo 2nd floor: existing prop ed Total new er Zoning District /9 Flood Plain A b Groundwater Overla• 672 = Project Valuation DD® Construction Type Lot Size_ %02, 900 SSA Grandfathered: ❑Yes ?KNo If yes,Tattahporting c�cumentation. Dwelling Type: Single Family )d Two Family ❑ Multi-Family (# unitsIN Age of Existing Structure Historic House: ❑Yes ❑ No On ighwayg]Yes ❑ No Basement Type: A Full 'Crawl Walkout ❑ Other AN Basement Finished Area (sq.ft.) / Basement Unfinished Area (sq.ft)__,,5 cW Number of Baths: Full: existing / new Half: existing new Number of Bedrooms: existing /new / Total Room Count (not including baths): existing j® new l First Floor Room Count Heat Type and Fuel: W'G' as ❑ Oil ❑ Electric ❑Other Central Air: 2'Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes;X'No Detached garage: existing ❑ new sLO 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 ❑lY/s L No If yes, site plan review# Current Use Proposed Use '-54 M APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) - - Name �UI/O............. f Telephone NumberZZV Address 01 6: License # ��r- /1/1,6 o Home Improvement Contractor# /77 I� Email 1.U0 Worker's Compensation # ��0�0 '0?0 -DD������� 0 ALL CONSTRUCTION DE RIS RESULTING F OM T©S PROJECT WILL BE TAKEN TO SIGNATUR �`l DATE r = FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER f t DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL - FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. i The ComwompeaM o,f Massacbus Departinwt offnibu&ialAccidents - [ire of a tiga ions 600 Marhangton Sty eet Bostarr,.MA 02111 -:. wr��tv:rxtuss:gav�rlirr Workers' Compenzsatiun Insurance Affiidavit:Buillders/ContractorsMectrieianslPlumbers Appficant Information Please Print Legibly Name aWsi wOrpmzatio�: /� / Ad& < c v . o� City/Stat&aip: 01. VO` 4. Phone 47- Are you an emplayer?CheqL the appropriate boz �- !Z T of O'ect r 4. I srrr a contractor and ����� L M I am a employer with 1 6- Q New mployees{full a ndlorpm time}* have hired the sib-contradDrs 2_❑ I am a sole proprietor orparner- listed on the attached sheet 7- KLRemodeling strip and have no employees These sub-contractors have: 8. ❑Demolition and have workers' �vorlting forme in any capacstY- employees 9_ §4Buildmg addition [NO workers.' comp_insurance comp_rnm=nc l ] 5_❑ We are a corporationand its 10. ,ectrical repairs or additions required_Q I am a homeowner doing all work oftYc•ers ha��e exercised weir I I-.Plumbing repairs or additions ' myself[No warba s'camp- right of exemption per MGL 12.❑hoof insurance regnired_]I c.15Z§I(4} and we IIHIM no employees-[No warimrs' 1 _0 O.iher COMP-insurance required.] tllny aggti t th=t cbe�s boa-91 nmst also M out the sesfian below dwwin rhos woAen-mrTm don poULT i&m S Homeowners.b.submit this sfadivit hxUc xftg they aye damg aIIvre*and da n hide outside contracmrs—St snhmit a seer off idavit md3rs#iog rnrF �C.cart®cma thst cliecY this box must attached sa additional sheet shaming the name of the s�m�rxmss and staff tchethe[orncut tluise 1•isve employ-- If the sobs-coot-ctcus lm-—Pl0)2sy they M-St p-vAe tbeir work-s'romp.policy numb- I am aaz employer that isprm idittg workers'cot gwnsation insurance far my employees. Beraw is tho poFicp artd job silt inf ot�ttativan_ / ' Insurance Company Name: �Lr°. ss% /�'�/� ,�s,� Y-4,4111, ee.;> Policy#or Self ins Lim# ©® Fxpiiatian Date: �7 �- -�� Job SrbeAddress: 7 91 t�SP CityrtatelZip: µ,tJI_Sj0& -1' A Attach a of the workers'cam ensatitmpolicydeclaration (shoving the numb and bton dates . sog P P�( '' policy } Failure to secure coverage as mpiredtinder Sectim SA ofMUL c. 152 can lead to the imposition of"ciiminai penalties of a fine up to$1.50D 00 and/or tme-yearimprisa— as well as civil penalties m the.fbrm of a STOP WORK ORDER-and a fine of up to S250-00 a day against the violator_ Be advised that a copy of this statement maybe forwarded to the Office of hnniestigations of the DIA for i ce coverage y cation I do hereby c . ' under parrs and enabies a.fpcdw 'thatfhe infor ration prini&d a is and correct Simature Bate: t 0 phone#: lWzcial use only. Do not wriffi in this area,to be campieted by cav ar town ofJiciaL City or Town•. Pertnit License# Issuing Autharity( rCk One}: L Board of Health 2.Biding Department fifyjfowa.Clerk 4.Electrical Inspector 5.Plumbing hmpector 6.Other. Contact Person: Phtrne#: 6 Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. pursuantto this statute, an anployee is.defined as"._.every person in the service of another under any contract ofbire, 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 stars that"every state or Iocal 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 ceraficafe(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with Do employees other than the members or partners, are not required to cant'workers' compensation ins -ance_ 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 retained to the cityor town that the application for the permit or license is being requested,not the Department of Should you have an questions re the law or if you are r uired to obtain a workers' Industrial Accidents.ty y qu regarding y eq compensation policy,please call the Department at the number listed below. Self-insured companies should enter their i 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 ill out in the event the Office of Investgafions has to contact you regarding the applicant Please be sure,to fill in the permit/licease number which will be used as a reference number. In addition,an applicant that must submit multiple permitllicense 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 of 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 Comma iyemg h of Massaehusetts Depaiinent cif Industrial Acckdmts Office ofkveWotions 600 Washington Street Basin=MA G21.II Tel#6I 7-727-49-GO ext 406 or.14 MASWE Fax#6I7-127-7749 Revised 4-24-07 www.ma.s�- ovfciia BTS FAX 4/25/2014 1:55:59 PM PAGE 2/002 Fax Server I CERTIFICATE OF LIABILITY INSURANCE DA7£(NM/DO//YYY) _.. 4/2512014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO.RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certlllcate does not confer rights to the certificate holder In lieu of such endorsements. PRODUCER CONTACT Beffley Assioned Risk Services McShea Insurance FAX 800634-4589 Arc.Na: 866 215-8118 1550.Falmouth Rd RT 28 Ste 2 AD(1REs3 PolicySerAcP.s@berkleyrisk.com Centerville,MA 02632 NS ER S AFTORDMG COVERAGE LA)CM IN R INSURED INS U tR B: Tyler and Traywick Building Company LLC INSURER C. PO BOX 216 INSIRERo West Hyannisport,MA 02672 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NLNBER: THIS IS TO CERTIFY THAT THE POLICES 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 MAYHAVE.BEEN REDUCED BY PAD CLAIMS. LTR TYPE OF INSURANCE INSRAUUL WVD POLI CY NUMBER MMIDD/YYY MMID O/YVYV LIMITS GENER LRBILITY L AUTOMO VILE LIAVILITYIAYU S WORKERS CONPeWATION »,N TORY LIMITS LJ ER AND EMPLOYERS'LIABILITY ANY P ROPRIETORIPARTNE RIEXE C UTIVE © E"L EACH ACCIDENT $100,000 A OFFICEINIENISER EXCLUDED? NIA C WC-20-2D•005315-00 /19/2014 04/19/2,015 (Mend story in NH) $ 100,000 If yea,d under DE SCRIPTgeacdbeN OF OPERATIO NS below 500,000 OESCRIPTION OF OPERATIONS 1 LOCATIONS VEHICLES(Attach ACORD 101.Addilionnl Remark.Schedule,r mare apace iarequied) Coverage Becbon Category Elect.Status Name States) All Entities/Locations Officer include Sam Traywick MA Tyler and Traywick Building Company LLC Officer include Tyler Sanford 648 Craigville Beach Rd West Hyannisport,AAA 02672 CERTIFICATE HOIDER CANCELLATION SHDULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF.NOTICE WILL BE DELIVERED IN ACCORDANCE WITHTHE POLICY PROVISIONS. George&Athansia Papademetriou 21 Lantern Rd ,. Needham,MA 02492 rgnature: ACORD 25(2010105) BRAC 3139 019/18/2C04 3:39PM FAX Qj0001/0001 NEW ENGLAND LAND SURVEY MORTGAGE INSPECTION PLAN �I Professional Land Surveyors NAME PAUL CHAMBRE � 25 SUTTON AVENUE T Oxford, MA 01540 LOCATION 78 THIRD AVENUE PHONE: (508) 987-0025 HYANNIS, MA ' FAX: (508) 234-7723 REGISTRY BARNSTABLE SCALE 1"=40' DATE 9/18/2014 f BASED UPON DOCUMENTATION PROVIDED, REQUIRED MEASUREMENTS WERE CERTIFY TO:---- l MADE OF THE FRONTAGE AND BUILDING(S) SHM ON THIS MORTGAGE �� OF �Ec INSPECTION PLAN, IN OUR JUDGEMENT ALL VEIBLE EASEMENTS ARE 0EE0 REFERENCE: 2782/246 SHOWN AND.THERE ARE NO VIOLATIONS.OF ZONING REQUIREMENTS DEED REGARDING DWELLING STRUCTURES TO PROPERTY LINE OFFSETS (UNLESS PA {;K PLAN REFERENCE ZOS�601 OTHERWISE NOTED IN DRAWING BELOW). NOTE: NOT DEFINED ARE ABOVc GROUND POOL$, DRIVEWAYS, OR SHEDS WITH NO FOUNDATION$, ETC. THIS IS A MORTGAGE INSPECTION PLAN; NOT AN INSTRUMENT SURVEY, N0. 51 WE CERTIFY THAT THE BUQDiNG(S)ARE NOT WITHIN THE SPECK 00 NOT USE TO ERECT FENCES, OTHER BOUNDARY STRUCTURES, OR TO FLOOD RUMD AREA SEE FIR4t PLANT SHRUBS. LOCATION OF THE STRUCTURE(S) SHOWN HEREON IS 9FCISTER�O EITHER IN COMPLIANCE WITH LOCAL ZONING FOR PROPERTY LINE OFFSET " 25001 CO564J um 7 16 14 REQUIREMENTS, OR IS DIEW FROM VIOLATION ENFORCEMENT ACTION �E LA� UNDER MASS, G.L TITLE Mi. CHAP. 40A, SEC, 7, UNLESS OTHERWISE FLOOD HAZARD ZONE WAS BEEN MI MJNED BY SCALE AND IS NOTED- THIS CERTIFICATION IS NON-TRANSFERABLE. THE ABOVE NOT NECESSARILY ACCURATE, UNTIL DEFlNRNE PLANS ARE ISSUED CERTIFICATIONS ARE MADE WITH THE PROVISION THAT THE INFORMATION BY HUD AND/OR A VERTICAL CONTROL SURVEY IS PERFORMED. PROVDEO IS ACCURATE AND THAT THE MEASUREMENTS USED ARE PRECISE ELEVATIONS CANNOT BE OETERMNED. ACCURATELY LOCATED IN RELATION TO THE PROPERTY LINES. 100' GAR LOTS 167, 169 & 171 -� 12,000 SF+ ( o ITl 178 100' � ca PINE WAY ' f m R_ m 0' 20' 40, 60' BO' 120' REQUESTED BY: STAN NOWAK DRAWN BY: CSC M CHECKED BY: GES SCALE: T'�40' FILE: 14MIP9364 W x Zo' q-9191 I i O n� r rr (zo o .> :`"i 7 Qi . `� f �>; U✓ 0 YA-Kf u P S o 2 Nl A' A'FVC Guide to Wood Comst'ru_ctioti an High MwdAt eas:116 wh aF zffd Zoize M-ass'achuSCbts Checklist for Compliance(780 cm-R 53ou.i.o' Ea Check Compliance 1.1 SCOPE Wind Speed(3-sea-gust)....--- ------- .-....._........................................................ ..............__............110 mph WindExposure Category..............._..................................................................................................-.......8 1.2 APPLICABILITY Number of Stories ...............4......_...-:.:_..............(Fig 2)-=-------- -------_. stories <_`2 stories RoofPitch ........._....._.........._............................-............(Fig 2)-......;-.............................- :51212 _ Mean Roof Height--------..................--.......__..._.._.,..-_-(Fig 2).......................:............... .,.Aft :r.33' Building Width.W............:....................... ........... (Fig 3) ,. �ft <807 � Building Length,L .........._............._.................... Fig 3) _.- Zo ft 5.80' Building-Aspect Ratio(L/W) ........................................__(Fig ....._.___--=.�_:[�L,r s 311 Nominal Height of Tallest Openings _...........-(Fig 4)... ......................_... :•;........_ <_6'8" 4.3 FRAMING CONNECTIONS' General compliance with framing connections_....:.........•-•-(Table 2).--_--_--_--.---........__-._._-..,_._.:-.:......_....._... 21 FOUNDATION. Foundation Walls meeting requirements of780 CMR 5404.1;. _ Concrete.. .......... -•....... ......... ......... ......_......... ................ Concrete Masonry. - - .. 2:2 ANCHORAGE TO FOUNDATION'a W Anchor Bolts imbedded-or 5V Proprietary Mechanical Anchors_as an alternative in concrete only Bott Spacing-general............._............... (tab4e4}_ 3� in 7 Bolt Spacing from endloint ofplate (Fig 5) __ m.:5 6°-12' [� Bolt Embedment' concx2fe:...........:.:. F in.z T C 1 _.......-.........( tj 5)-........._....- Soft Embedment-masonry (Fig 5).--. :-.-__-_____----.-__ in.'-,15' Plate Washer_......................................._...................(FU 5).._•............................_.........>3°x 3°x%" 1771 3.1 FLOORS Flaor'fiamirig member spans checked (per 786 C'M?Chapter 55) _. .....�. M*hurrr Floor O nin Dimension ...:.. _.__...(Fig6 ......... ft s 12'&1/2'br Wl2 tiff Pe g . -• )-.:.__ Full Height Wail Studs at-.Floor Openings Jess.than T from EideriorWall(Fug 6).............:......................... Maximum Floor Joist.Setbacks Supporting rtin Loadbearing Walls or SheaiwalL....,.- :..* ._(Fig ......................._::_........ ft s d Maximutn Cantilevered Floor Joists PIM g Loadbeanng Walls or Shearwall (Erg t3)...-._' ft 5 d Floor&tang atEndwalis (Ful 9)_.-- 17-171 - FloorSheathingType . GDY- (per780 CMR Chapter 55)............ Floor Sheathing Thickness._....._.: ...._�.: r�._ pt 5}.._ .. ....... ._g _ __._....{per780:CMR=:Cha Floor Sheathing Fastening. .....:................................(Table 2)-.•mod nails at n:edge.1.12'in field )� 1:WAU-S Walf.Height Loadbearir>q walls: (Fig 10 and Table'5)...........:. ft S:1p' Non-Loadbewing-w21Ls (Frg10'andTable5)__._.__. eft s20' Wall Strid Spacing _--_-_-(F'ryq 10 and table 5)................... I(, in;:52,f o.a Wall.Story.Offsets : _ ._....__. „. _ _..:..(Fgs.7&8)::_�.............. ..... _ft s d _ 4:2 EXTERIOR VdALJ_$3 :_ Wood Scuds Loadbearing walls_ {fable 5):. Zx ft v in_ Non-Loadbeari waits...............-----:..--...----. -._ �.ttg (Table 5)-.:. 2x� I G ft in: Gable End Wall Bracing' FulLHeight EndvtiraUStittls:... (Fig 10).: W P.AtticFtoortength;..w.: u ,__ (Figi1). fitZW , G Ceti Le � P not .., ypsum rng ngth( WS prised) o:9W I� 2-x 4 Continuous Lateral Srace @ fi ft o p,„(Fri 11)._.. .. Double Top-Plate ; Spice Length -- (Fig 13 arm Table&) ..... Z ft Splice Connection.(no.of 16d common nags)......,-..___.(Tabie a)_........... _........................ 8 �' Z A FVC Gidde to FFood Construction in I i f_6i'JT`ind Areas:110 niph Find Zone Massachusetts Checklist for .'CNIR 5301-2 t.1 j' Loadbearing Wail Connections Lateral(no.of endnaled 16d common nits)__. L .(Table7}_ ._......_..._.._..__..._.�.... :�-.-_---2 �j Non-Loadbearing Wall Connections 2 Lateral(no_of endnailed 16d common nails) (Table 8)..........-...... __.___--_�,____._.._.__ [� Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans ...._....___...... ft in-s 11'' ry Sill Plate Spans -----_...-._-:-----_•--_--.--•�---.-�:._=(Table 9)_-�._._�__.__�-_._i o ft in:51'1 Full Height Studs(no.of studs).--." (Table 9)..._.-_-.------------------------------_�_..�_ Q Non-Load BearingWall Openings record largest ( rg opening but check all openings for compliance to Table 9)Header Spans.............._._.._._._-....................-_,(Table 9}_.------•--•.----•---.-_-.- 6 ft 8 in.<12' Sill Plate Spans_-:........................................ 9 in.<_12' Full Height Studs(no.of studs)-------- ..,_:(Table 9)......_................... .. - - - Exterior Wall Sheathing to Resist Uplift and Shear Simdltaneously4 Minimum Building Dimension;W Nominal Height of Tallest Opening2 --------- . --------- ---.G p X ; Sheathing Type------_-----_ C.Q X_..yZ_........(note 4)......................._.. _ -_ - 0 Q Edge Nail Spacing........................_.._. ..._._.(T able 10 or note 4 if less)....._ in_ . Q Feld Nail Spacing. _._ _..__...._-_-___.__{Table 10)...... ....____......... v_._..:_ �_in. Q Shear Connection(no-of 16d common nails)(Table.l0)_........._....................... ------ Percent Full-Height Sheathing' ........................... __ _._ 5%Additional Sheathing for Wall wi#h.Opening>6'8"(Design-Conoepts)-..._.-_._.--_- Maximum Building Dimension,L Nominal Height ofTaltest Opening _ ----.-•-:._... ---• -- ' 56W Q Sheathing Type-- --•-- (note 4)-------------------•--.. ._:G41r.:,� Q Edge Nail Spacing-----_-•-...___.__._._..____.(fable 11 or note 4 if legs).._._., ..-�.�=in Q Field Nail Spacing_.,,__.._----•---.---•.----_....(Table 12• in- Q Shear-Connection no.of 16d coininon nails(" )(Table 11) .. _� �_--_-� . �✓- Percent Full-Height Sheathing._._.. ,. (fable 11)..�_.:_ _.,_ .__.� �%. Q 5%Additional Sheathing for Wall-with Opening>TW(Design Concepts) ..A Wall Cladding.'_ Ratedfor Wind Speed?....................--------------,----- - ---------.-._ ._ .._-----_.... _...I-— :-:_... Q 6.1 ROOFS Roof framing member spans checked? ..._. _._....(For-Rafters use-AWC.Span TOQL see. BBRS Webs�e Roof-Overhang .................._._..:.............._. ._.-.(Figure 19)_...:...:_:?_. ft s smatler.of 2'or tJ3 Truss or Rafter Connections at Loadbearing Walls_: - Proprietary Connectors (Table'.12); U=-203 plf Q Lateral j2 pif177 .:: Shear............... (Table 12) S- .5y tl= r . Ridge Strap Connections,if collarties not used per page 21:.__(Table Gable Rake Outiooker.....:...........:...::::.. Fi ure 20 ft s smallerof 2 oriJ2 Tnrss'or RafterConnections`at NonmLoadbearing Walls A( Proprietary Connectors•' Uplift..... ..... ........ .......(Table 14) Lateral(no of 16d common nails) •(fable l4}.....:... L 2S3 lb Roof Sheathing Type.:- .,.... (per 780 CMR Chapters.58 and 9) � �. _ RaofSheathing Thickness...-.... - �8+ _ kf Z t WSP . __ S Roof Sheath' Fasfening ....:..:_ �..-� ._E. m9- - - (Table 2)- - Notes `_ + 1--This checldist must be met in its entirety,excluding the specific exception.noted in 2,to compiywith the requirements of 780 CMR 5301 71-1 Item 1-Ifthe-checklist is met in its entiretythen the following metal straps and hoiddawns.are_rr t_ required per the WFCM 110 mph Guide: •. a Steel S6aps per Figure 5. b. 20 Gage Straps per Figure 11 C. UpGft Straps per Figure 14 d. Af Straps per Figure 17 Comer:Stud Hold'Downs per Fwrire 18a 2 Except(on Opening•heights of up to•8 ft.shall be pe'"iMed:wheo 5%is.added to the'percen#fiitf-hetghl sheattung ::..:r+�quiremeirts s"liowrrm Tables l0 arrd.'lL. . , . .: .. 3•"Tbe bottom sill plate fn ekteriorwaits•shall W a minrmum'2 in.nominal thidaiess_pn sure freafed# -grade. 6 e a'41,41 o/Ib W al C//?/M/j ot& = Office of Consumer Affairs and Business Regulation, — 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 177365 Type: LLC Expiration: 1112512015 Tr# 247073 F .; p TYLER AND TRAYWiCK BUILDING,GQ:;LI_;C.:,r- SANFORD TYLER i 1 , -— P.O. BOX 216 i WEST HYANNISPORT, MA 02672 5; 'Update Address and return card.Mark reason for change. SCA 1 2UM•OS/ti Address L_l Renewal ❑ Employment Lost Card t� ' &2ea��c.�aatraetaltle a�C/�?ludfac�tcvelb Office of Consumer Affairs&.Business Regulation License or registration valid for individul use only " before the expiration date. If found return to: - =:OME IMPROVEMENT CONTRACTOR _ gistration 177365 Type: Office of Consumer Affairs and Business Regulation expiration 11t'�12Q15 LLC lU ParlcP}aza-Suite 5170 Boston,NIA 02116 TYLER AND TRAYW1 K::B:UILDIi' GO LLC SANFORD TYLER l 67 CRANBERRY LANE c� _ WEST HYANNISPORT,MA'02672 Undersecretary. Not valid ithout signature a Massachusetts -Department of Public Safety Board of Building Regulations and Standards i Construction Supers-isor License: CS-060982 _ r SANFORD R TYL$R PO BOX 80 W HYANNISPOI€T b: �` Expiration Commissioner 10/12/2016 'I i �- c itata:at°€ k!' eabj(n;t rirtr.thrector `3'homas'Perry,C110 2. t3uTttaa;°Cvaaatnasserni 00�1�i�i�� c,_ t ty t rra},`�f�W.,661 tvrv�>_tntti ar.'}ar°tr sir ttt�.rraa,tas (Afice: 508 862-4 1 a `. 5£3+-7`3Q- ?"sCl comploc id Si. h T. Uon If a s:u A Builder htreovauthori rrlTehai r tra=t1?. matto-s rt iaTaT:c ti, s cjr:?' arixeci r this bwits"ua p arrxzi app jrz"irsca ! ° � e (Ad&es's ofjo ) are t vet Owner E Print Narn-c If PrOP rty Owner is applying for permit piarast carn)pIcte the,l�r�natcar�°�arr�1<t�era�� <�c prinn `orb)ran the reverse side. T AUVINN •}ami tiro t3,�€a c k. £�ttf;?S;T tt 1Tt €dc3 S:uu Rs;vlkd O6131:3 «r oFtN r Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee C:9 �- 1ARNMrABLE, 9� Mom' Richard V.Scali,Interim Director 1659. �0 ArED MAC s Building Division IffJORESS PE OT Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 NOV 19 2014 www.town.barnstable.ma.us Office: 508-862-4038 T®WNta'z:'508r�i 'Q�` °3 ABEE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 246-089 Property Address 78 Third Avenue Wets Hyannisport0 X Residential Value of Work$ 52,3000 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address CHAMBRE, PAUL A&CHRISTINE A 1066 NORTH WATERWAY DRIVE FORT MEYERS, FL 33919 Contractor's Name Tyler and Traywick Building Co LLC Telephone Number 774-487-9082 Home Improvement Contractor License#(if applicable)_l77365_ Email: styler@tylerandtraywick.com Construction Supervisor's License#(if applicable)_CS-060982 /- orkman's Compensation Insurance Check one: I am a sole proprietor V❑❑ 1 m the Homeowner ave Worker's Compensation Insurance Insurance Company Name_Berkley Assigned Risk Services Workman's Comp.Policy#_WC 20-20-005315-00 Copy of Insurance Compliance Certificate must accompany each permit. Permit R;'Re-roof t(check box) (hurricane nailed)(stripping old shingles) All construction debris will be taken to—Macomber Sanitary Refuse ❑ roof(hurricane nailed)(not stripping. Going over existing layers of roof) [t Re-side eplacement Windows/doors/sliders.U-Value o (maximum.35)#of windows #of doors:—13— ❑ 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 Owner must sign Property Owner Letter of Permission. Ajcopy of the Home Im ment Contractors License&Construction Supervisors License is SIGNATURE: ��-- T:\KEVIN Mudding Changes\ P ESS PERMIT\EXP SS.doc Revised 061313 �asraai•� ` wit Towit of Barnstable Richard (r:Nri€a tArector Building':DivAim uiltltaal; ;e sa€€aaia s";. fjfJ l tir;Srr€^cS, T°lyaaa 02601 ca^w��'PaD�r€a.if aa•€asa:af�tc.ca€€r.tt to c t- v orn and Sign Thi c i0.11 �s�...._,.....,._...,._—..,,.-.»......__._..._ __........_..:.�.................: _._. ..........._..,.m...........x t�" . a *e;z; aaclaaDrarc �'l�l ...:...7`_ :,.. /S� L [!/fie cD<a:i,a on mv lvch at:l". sst d m4rrcrs re Pa'rivc t.O autficnized,hv thIF build'.. r RCT tApPlIcat,a=ra zaar;. gg (Address,ofJob) a zwa C.ot hvner 4� .9 Ai 1'ra41t 'a.anc. if Property Owner is applying ing for per"ait,please taaanla et€ the 116sreaecaFaT€rc 'a i<ireaasa Ext rnls can F€araaa aaaa the reverse side. -evised 61 11 The Commoms ealth of Massachusetts .-- Department of ludastrial Accidents Office of Investigations t 600 Washington Street Boston,MA 07111 •• nmv.mas&gvv1dia Workers' Compensation.Insurance Affidavit.: Builders/Contractors/EIecti icians/P'lumbers Applicant Information M2se Print biv Name(Busineimorgmizatio�tllntlividual). i Address: .2/& Citylstatetzip: Phone 4-. 7 � 4(LJO 94�1- Are ou-au employer?Check We appropriafte bGX T of project r a employer with 1, '1- am a general contractor and 1 1I� e ] iced}'= y : have hired the sub-con ctors 6- ❑I3eu construction .<- Pemployees(full.arxdior�)_ 7. Rernodelin 7.❑ I am a sole proprietor or partner- listed on the attached sheet- ❑ g ship and have no employees These sub-contractors have g- ❑Demolition working for me m any capacity- employees and have workers' 9- ❑Building addition jNo workers'camp-insurance comp-insurance.) required-] 5. ❑ Lie are a corporation and its 10.❑:Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I L E]Plumbing repairs:or additions myself o workers' - right of exemption per MGL IL..❑Roof repairs insurance required.]t c.152,§1(4),and we:have no r employees.[No workers' 13. i�i G#1 P L,0&4- d comp-insurance required-] ;Any apphcM that checks boys#1 mast a1w till out the section below showing their workers'compensation police infornwiaa. Homeowners who sob=this affrdma bulicatihg they are dttmg all work and then hire aumde contractors m=subinu a new affidavit m1cl catiag such. koatractors that check this box mmst attached an additional sheet showing the aame of the sub-cout'racton and state whether or not those endues have employees. If the sub-coutraetois have employees,they must.)mvule their workers'comp.policy number. I am are employer that isproviding trorl£ers'compensatian insurance for my employees. Belrnv is the policy and job,site information. Insurance Company Name: A Policy#or Self u&Laic- ®0 Expiration Bate: G d Job Sit�eAddress: �� fide /r�P ���5 (l4c� cityfStaterZtp: 1c3� ���`,Q Attach a copy of the workers'compensation policy: eclarati page:(showing the policy number and)expiration date). Failure to secure coverage as required uncles Section 25A of MGL c. 152 can.lead to the imposition of criminal penalties of a fine up to S 1,500-00 anchor one-yam imprisonment,as well as civil penalties in.the form of a STOP WORK(ORDER and a fine of up to$7250.00 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 cerf • the pains a a s ref parjarry� at fire inrformation prosided abm his truer nd correct Signature: t_- Date. t� Phone#: "' s Official use only. Do not write in this area,to be completed by citp or totwi official. City or Town: PermitUcense Issuing Authority(circle one): 1.Board)of Health 2.Building Department: 3.CitylTcsunn Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.(Other Contact Person: Phone#a 6 CERTIFICATE OF LIABILITY INSURANCE F—DAMIDD—) TE(M /20/2014 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 NAME: PAUL SCHLEGEL SCHLEGEL INSURANCE BROKERS PHONE 508-771-8381 FAX 508-771-0663 (A/C,No,Ext): (A/C,No). 34 MAIN STREET E-MAIL ADDRESS: SCHLEGELINSURANCE@GMAIL.COM WEST YARMOUTH MA 02673 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:TRAVELERS INSURED INSURERB:NGM INSURANCE COMPNAY 14788 Silas Desouza INSURER C: 34 Lumberjack Trail INSURER D INSURER E: West Yarmouth, MA 02673 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR rypE OF INSURANCE - POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) B GENERAL LIABILITY MPT1035P 06/20/2014 06/20/2015 EACH OCCURRENCE $ 2,000,000 R COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 500,000 CLAIMS-MADE Fx-1 OCCUR MED EXP(Any one person) $ 10,000 I PERSONAL&ADV INJURY $ 1,000,000 I J I GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO- LOC $ _--_ JECT 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) UMBRELLA LAB OCCUR EACH OCCURRENCE $ H EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION 6HUB-5B714 / .97-7-13 11 20/201411/20/2015 WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS _ ER ANY PROPRIETOR/PARTNER/EXECUTIVE ^ - - E.L.EACH ACCIDENT $ 100,000 . OFFICER/MEMBER EXCLUDED? ;L.JI N/A (Mandatory in NH) - rE. .L.DISEASE-EA EMPLOYEE $ 100,000 DESCRIPTION OF OPERATIONS below If yes,describe under L.DISEASE-POLICY LIMIT $ 500,000 I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) SILAS DESOUZA HAS ELECTED NOT TO BE COVERED UNDER HIS CURRENT WORKERS COMPENSATION POLICY CERTIFICATE HOLDER CANCELLATION TYLER TRAYWICK P 1 78 THIRD AVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN WEST YARMOUTH MA 02673 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE HAND DEL VERED 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD � G!2� Office of Consumer Affairs and Business Regulation. 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration i Registration: 177365 Type: LLC Expiration: 11/25/2015 Tr# 247073- TYLER AND TRAYWICK BUILDING SANFORD TYLER �. P.O. BOX 216tl WEST HYANNISPORT, MA 02672 Update Address and return card.Mark reason for change. SCA 1 ij 20M-05/11 Address 0 Renewal Q Employment Lost Card 6 �8 lQb�l'b97243LLU8CLGClZ �V��C[dJC4GiZLLJ2CGJ- Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: g i st ration: 177365 Type: Office of Consumer Affairs and Business Regulation xpiration: :::_:_ltl2.5%2.015, LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 TYLER AND TRAYWICK BlJIL41NG'CO LLC SANFORD TYLER C—�J 67 CRANBERRY LANE:-'-'-, WEST HYANNISPORT, MA'02672 Undersecretary. Not valid ithout signature L I Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-060982 \\ 1 111 UF. •. i SANFORD R TYL$R - PO BOX 80 W HYANNISPOI€T Expiration Commissioner 10/12/2016 �� .._. .. f.: BTS FAX 4/25/2014 1 :55:59 PM PAGE 2/002 Fax Server DATE(MM/DOM CERTIFICATE OF LIABILITY INSURANCE 41252014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO.RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT'BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(les)must be endorsed.If SUBROGATION 1S 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 cON Acr Beddey Assigned Risk Services McShea Insurance 800 634.4589 aC.N J866 215-8118 1550.Falmouth Rd RT 28 Ste 2 ADDRESS: PolicySeMces@berkieyrisk.com Centerville,MA 026.32 INSURER S AFFORDNG COVERAGE NAlCN INS LR R INSURED INS U2ER B: Tyler and Traywick Building Company LLC INSU rR C: PO BOX 216 INS URERD West Hyannisport,MA 02672 INS UZER E: INS MER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT,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 HEWN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES.LMRS SHOWN MAY HAVE.BEEN REDUCED BY PAD CLAIMS. INSR LTR TYPE OF tNSU IiANC,E INSRAUUL WVD POLL CY HUMBER MM/DD/YYY MM1DD/YYYY UNITS GENE LLABL AUTOMOBILE LIABILITY $ WORKERS COMPENSATION TORWIAW ER LJ AND EMPLOYERS'LIAOILITY YIN ANY PROPRIETOR/PARTNER/EXECU7IVE O E.L EACH ACCIDENT $100,000 A OFFICE/MFMB6t EXCLUDED? NIAC31 WC-20-20'005315-00r/1912014 041IM015 (Mandatory In NH) $ 100,000 If yes,descdh—der DESCRIPTION OF OPERATIONS6a1aw F500,000 DESCRIPION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Ad iUonsl Ramarks Schedule,r mom space israqured) Coverage Section Category Elect.Status Name Stat (s) All EntitieS/LOCationS Ot1-7cer Include Sam Traywick MA Tyler and Traywick Building Company LLC Officer include Tyler Sanford 648 Craigvilie Beach Rd West Hyannisport,MA 02672 I CERTIFICATF-WIDER CANCELMION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCOFIDANCE WTTHTHE POLICY PROVISIONS. George&Athansia Papademetriou 21 Lantern Rd > Needham,MA 02492 ignature: ACORD 26(2010105) BRAC 3139 Parcel Detail Page 1 of 5 pt €! i fiAZ'e5T:lt�L'-rcF. // tea; vQ 1 ;9. r � ` Logged In As: Parcel Detail Thursday, November 20 2014 Parcel Lookup Parcel Info Parcel`246-089 - I DeveloperLOTS 167&169& 171 _ ID Lot ---_._.. --- - Pri Location.78 THIRD AVENUE(HYANNIS) ( Frontage�120 Sec-PINE WAY -.._ -- - -- -- Sec .1..00 _..___.. Road Frontage ..... ....... Fire .... Village'HYANNIS (HYANNIS District Town sewer exists at this Road 709 -- -- .......... . ......- (1709 address 'No , Index 1 Interactive M a p Owner Info --- _. ---........._ _- -._._........ _-, _ Co- Owner IDECOSTA, ELEANOR M f Owner'/oCHAMBRE, PAUL A&CHRISTIN E A 1 Streetl 11066 NORTH WATERWAY DRIVE Street2 CItyIFORTMEYERS State;FL ZIp;33919 Country[ Land Info Acres Use iSingle Fam MDL-01 1 Zoning•RB Nghbd 10107 Topography,Level Road'Paved Utilities [Septic,Gas,Public Water Location Construction Info Building 1 of 1 YearE1900 ROOflGambrel Ext Wood Shingle Built Struct Wall— Living 1249 � Roof,Asph/F GIs/Cmp AC;None... Area Cover' Type Style Colonial NW8 l IDrywall � Rooms 4 Bedrooms Intf Bath Model Residential FIOOr'Hardwood ROOmS'1 Full+1H J Heat Total http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=17173 11/20/2014 NEW E,NGLAND LAND SURVEY MORTOAQE INSPECTION PLAN Profmnionml L—d eue.eyo,-m NAME PAWL CHAMBRE _ Oxford,, MA AVENUE IACATION 78 THIRD AVENUE KE DETECTORS REVIEWED GABBON MONOXIDE ALARMS PRONE: (508) 987-0025 HYANNIS, MA - - WINDOW 5GN&DOLE EA7C: (508) 234-r729 --- �f MUST BE INSTALLED PER SCALE 1"'40' DATE 9718/2014 MASSAOHUSETTS BUILD",CODE ZE(uoNWAL) fA41PAAATIVE A46¢IU LN N0. REGISTRY BARNSTABLE -- ---- -""-' 5PM6ol `rYvk sl wu a�mr mo00O"w.x'N°`um euiorKtsl mmnu xewxw.mtxls eae M 0 174 2=6. 4'-6" WVA 2442 „^ u^ a r o®�pat�r,2782/246 BARNSTABLE BUIL ING DEPT. DATE °°" srwwrwnmrmn Fa sNmca "" - xrrurxce zos sot f vH 2 4 +4'-0" W0H 24310no an.:onworncsmunuvun sw.x wrccx mAWNING 2C0`c 2'O° Al ZI i m m�u awcr w,v uzu mxrc�m ra�wum�n nL� 25001 C0564J wtw wvsr'e�ma M ouv:we�.r.`u.rss mxsawst nam w�zrmm xm aw arorrwo n wu.m m xortm wa uxircnnox a mmtinwwmrwc ar.avx im c wxm.aM1 rmmmr nxw rn m.ao maiamxs"rc mwe wn rxr rvanoa our nr"vaxm.w n mm amvr"wwrr:mmma wrm m amamra� o m 1a u x'W°nupx ro."gar'`r�wnswr rmar mrwnma arm K arwna FIRE DEPARTMENT DATE -L'° 23' p' SRO' BOTH SIGNATURES ARE REQUIRED FOR PERMIT/NG -�- 1� 0 Da _ LOTS 167, 169&171 ---�IE I v--AFWLo I NEW 9EG4t. I a pl a OHALF o, IOU 4 lie O 'y. - Zo=o" PINE WAY __T1EYf. 0wr1614 Rd C9 EN O � G N © O O -.5`0'--1 DfV- 1 - exo4F SELOW1 0 0 0 a h O j O 4 '� 246e fAi9 I I O n II �� IIATA O C i C III:p".F Y. �.L- 116LL r r Za4$ U`1tNG RoON O CpIMNEY \J 1 A) _ LOW WALL p YG FNTiGY: nFFIGU 4L. Gy. -no O � O O O O ® L-:/ A nN ! I y3'-4" 33 4" -- �� 5F—GQ1�1D FLOOR- PLAN FIRST FLOOR PLAN General Notes: ` i.All work to be performed in uccurdunce with Massachusetts State Building Code,780 CMR, Eighth Edition,IBC 1009,mid applicable codes included by reference.Framing to be in accordance with the American Wood Council Wood Frame Construction Manual,110 MP11 Zone.All work to be as approved or directed by local authorities having jurisdiction. 2.Contractor to secure all permits,and to arrange for inspections by local authorities having jurisdiction,as may be required. aEVLSEp. 12-10-t4 3 Work to be left in clean condition,ready for use and occupancy.All debris to be disposed off AI1dI'Cl S R.Stf1k1S site in a legal manner. Architect - 4.Conti to install or upgrade all plumbing,electrical,heating and venting systems as 85 R—View Lone,Centerville,MA 02632 Teleplwme:(509)790.MO required,per code.Install and upgrade all Fire protection systems per applicable codes,or as may Floor Plan with New Addition be required by local authorities having jurisdiction,including smoke and carbon monoxide - detectors. A 1 78 3'Avenue,West Hyannisport,MA ��h-o� 12-o4•i4 A¢5 --urw--"ViTiot, _Zwl3m rL 1L=SE-2EMOVAT" VIP- PL:P:N 1=1 Mll ILE I I 14::3fl4AlI-..SMlN4LE5.. TY f•/L imiLl Fool ` - ..SGrvstiD FLoO2 — I� ❑ ❑ ❑ 1 SHM4L4 SlDu34�,TYP O "�1RST 1 1 I 7�s",s�xnrY+soT i i - L� 1 LEFT 51P_E YA fl9N Z- "—T rL�YA710t 1 s, I r�--- ---- ' - - �_ ------------------------ scams L / .I o C _ L1 ❑ �� ❑ ❑— SEW.. SLi6[R _...__ — Q� ' ,❑ ❑ II7LLllllp dLJI --—- l� uEVst.-aEt :_ G�J NEW.gE[k ' LIE -pcccss rcuE.c-rn ucw._ I T_ � I c¢�wL sfau zt•.Ic" I ��AI- _Sl1?ELFYATION n' E l __ A� LVATION I w/aiLRccw vxxx 1 {LEV4Sfdls_-.12 (O-l4 Andrejs R.StriUs Architect 85 Ri—View[my Ccnt—lk,MA 02632-Teleph—:(508)790-MO Elevations 78 3-'Avenue,West Hyannisport,MA A2, yt'�I'-cC 12-oa-14 PRS =AZ3&tfFtaTE F4AMINL�_ � (OLSIT_ GA MERtI S'PuRLINS� ' -__.- -:-fiR1L'SiFrE?t, U,°Q�• �g�COKAY-TRf'.- _ t -X- 1 - o I 0 _"OF-S"*MN,t.6 � -- m -fLBEIAATfG-N•T.s ��. � � - :MenWin_ar iXj"VA!7 10 FSIC- VIE 1df lk"V•AE AT EWES- _ Fr& S."l COws'LRUGTLGAL_.yO1NTf - t YPStiM._WAU.IOMD4 • �S1xMIF�G A'T �0]= #r�cca �«s t-p•• 1nHNFCrm iztr Ib=o" j 16WLE--CDLLAk-TIE AEfENT) f•F17T 4.:Tumixi!i --��-py� �{` FV. .bATN. ELOSFT U7t.-`HALL° 2xL tL`Q•G �. 1 I I a it°ae. I 1 gXlSrldG-FDUb O�noN 7x34 __ TCa'LI itiftlLAT1Or1 I 1 ; 1 :IHTERIptG:7ALrl1'N rsutL a) I o - :� :.eyR'IrtION Id"x-IL"Art335 �(mtg II I I o _. .- LGDO,t 5111N4LFf UYE2. I 1 A�O+ I g'o". s I I fG�DCTIiIE 0 -73L1f-3ffiATAlAfe.:. N - '� N I 'IL I i I I peL-_lo urs ETE,::FollNOA'fION WAU-S ' s/a na ARGNOg SPLTS B wNc, -0 -3•r 3'PLATE. WASN.ER-.-_._f" .fUDP1Ob[ •eE CJK,T£G -'Q Id, b GLutQ ANO NAILED I - -FkOM CVkNEki..r?Q n.r.AAIN. I I 44- I P=t or�ugM t� Timl%T'11]BR.c OWNER't Orrickh-r -.. R�11z-ttaL__ - P�aee.�6srut �ttsCc — 1 I I (, IE4312ps CW N -PLA1 _ g. I!o„ Lb-Q1�_EBIaMLI1fx_.PL9�L ;—� - _ - JJ L io!1m-fQN2 TLLft,-rust, 1ED4EF AS WkLL , vas An 19.�tp j1 I _ G EtIL PDL.Y574tYLrcN6 flLN o 0 2x-919_1f".4i c:- - I I Z-z ai 1 ,. HDtEi-.-7:1ISME'L.ft, -- ------ -ZEYI S E D: I2-IO-Ik EGIC_F1�7t(J[Lt1-Ci — A� I An reds R.Strikis 5C?LbPI HI ADD121D� fcaLk- -_1-a" Architect 85 Rive,View Lane,Carterville,MA 02612-Teleph=:(508)790-0920 Sections and Details 78 3"Avenue,West Hyannisport,MA AJ AS NOTED IYoh•14 ' i i I w i i N I e•o" �,4„ I. 5! Go4JD LOOP— Platt SEWER OUTL 4- (� 1M5wSV4T pl—P a Ell G6cK �F (l —T. -all. iJciarll GPwcE� 7knY I ' I _ , 'FIRST FL002 F'LAI� - #"_,=b,. Andrejs R.Strikis Architect 33,-4" 85 Rim View lane,Cm wrville,MA 02632•Telephone:(508)790-0920 Existing Floor Plans 1 78 3-'Avenue,West Hyannisporl,MA' 1 �'/4�L��o 12•o4c14. El FIDI 'L �1111 it a� I m Andrejs R.Strikis Architect 83 River View Lme MA 02672-T 3M)190-0920 Existing Elevations, 78 3rd Avenue,West Hyannisport,NM X2 y4�i'o' i2-o4-14 "� - - _.---