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HomeMy WebLinkAbout0115 PINEY ROAD Ag L:✓1��� � " . - - .: (� ..y4 Z,---TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION- 0 i�OW�`� OF �i STABLE Ma OZ Parcels U p � Application # 6 J Health Division i-il ICI,,, ? I J 4ilj 9: 1 p Date Issued 2. Conservation Division Application Fee Planning Dept. _ Permit Fee 510 . 0 6 Date Definitive Plan Approved by Planning Board JON Historic - OKH _ Preservation / Hyannis Project Street Address ��5� /�/L� t2D . Village Owner�jJG� I d(� �Tf2Q��� Address J3Qg 7q S- b Telephone 1)077 To VE, dYl(A- oZG 3 1, ,Permit Request 12feYj1e_ IATT/t./oe_ �16e 12 1:?AW ft� 7 1A11 trl dw S — 112 .f'ii wa f t -�n !� B&nC: 11 di Z? F� 6 ICkJ 6KA D) Square feet: 1 st floor: existing_5�:�Oproposed — 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type_ Lot Size . ) Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure //S� Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: W Full I Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) ZG U Number of Baths: Full: existing / new Half: existing new Number of Bedrooms: 2— existing _new Total Room Count (not including baths): existing S_ new First Floor Room Count cS� Heat Type and Fuel: ;&Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ONo Fireplaces: Existing — New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes 4(N6 If yes, site plan review# Current Use a:afi�em_&e Proposed Use wZ S4"_ APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Af i r_kL Z_jtg jj L S Telephone Number Address ymy k=/j/T Gil./ License # Ci S —01 z&SL3 C0 10 1 Z 01 tt Q2,4 3 Home Improvement Contractor# Email (o tit (IV��a) I(/f% Worker's Compensation # �aAI) D,� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 4(e SIGNATURE DATE `�'d FOR OFFICIAL USE ONLY APPLICATION# -,f DATE ISSUED MAP/PARCEL NO. 1 ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME �'�4I14 2 Pjl i INSULATION FIREPLACE z ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ` FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I. The Cornmor wealth ofMassadiusetts Departmuit of Industrial Acciderits ! Oflice oflniwtigadons 600 Washington Street Bostoirr,AA 02111 MM -true&got,1dh7 Workers' Compensation Insurance Affidavit: BtdIders/ n4ractorsMediicianslPlnmbers Applicant Information ( r Please Print Leali Name(Ilcsiessi(kga dzat o dal): A-bl mo* IV KC, Address: 17 IIIlollIC.hd I_ll• - City/stateizi, CU%,T- N�r oz6!5 phone z_ pj—% Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with—/jQ 4. ❑ I am a general contractor and i employees(full andlor part-time}* have hits the sub-contractors 6- ❑'New v construction 2.❑ I am a sale proprietor or partner- listed on the attached sheet. 7. [3'Remodeling ship and have no employees. These sub-contractors have S. ❑Demolition working for the in any cWcity. employees and have workers' 9. ❑Building addition [No workers',comp.insurance: comp.insurance.I - required.] 5. ❑ We are a corporation and its 1{l.El Electrical repairs or additions 3.❑ I am homeowner doing all.work officers.hav-e exercised their I LEJ Plumbing repairs or additions ngself[No workers'camp. tight of exemption per MGL 12•❑Roofr+epairs insurance required.]I c.152,§1(4),and we have no employees.[No workers' 13.❑'Other comp.insurance required.] *Any.appiicant ghat checks box#1 mast also fill out the section below showing ffi&workers'compensation policy inform2tirn. I Homeowners who submit this affidavit indicating they are doing all vial and then hire oubide contractors mast submit a new affidavit indicating sack. tContractors that clink this box.must attached an additional sheet showing the name of the sub-conftactars and date whether air not those entities have employees. Ifthe sub-contractars have employees,they must pmvide their workers',comp.policy number. ' Iam raft employer t➢iat is,prof�i ttorke rs'conrpi7asatiort insumance for my enwto'ees. IIdosr is cute pot'l7 and ob su`e it forrfarafion. Insurance_CompanyName: CO N-n-a y (1m-e, :a&&A H,(.1"U , Policy#or Self-ins.Lie. 6,1 —U 3 Expiration hate: l L 1 Job Site Address: hPc1 Md' CityoS:tate/Zip: K(J Ik1I Attach a copy of the workers'compensation policy declaration page(shoring 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 ciAl penalties in the form of a STOP WORK ORDER.and a fine of up to$250.00 a clay against the violator. Be advised that a copy of this statement may be faswarded to the Office of Investigations:of the DIA for ur�ance coverage verification. -- - - - ------ .. -- _.... Ihodeaebycrfr . andp nadties ofpeduty that tiro inforuaa on pmIdedabot, is into and correct Date: I �(/•.e. Phone#: J�i �Z�'i— at z Official use only. Do not write in this area,to be completed by city otrtopim officiaL City or Town: Per€uuitUcense 9 Issuing Author'(circle one): 1.Board of Health 2.Building Department 3.Cityffonu Clerk 4.Electrical Inspector 5.Plumbing Empector 6.Other , Contact Person: Phone 0: = Office of Consumer Affairs and Business regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 104804 Type: Private Corporation Expiration: 7/15/2016 Tr# 255509 LAGADINOS BUILDING & DESIGN, I,NC Nicholas Lagadinos 13 Thankful Lane Cotuit, MA 02635 Update Address and return card.Mark reason for change. Address Renewal F-� Employment 7 ]Lost Card SCA 1 L; 2OM-05/11 ' V/'LB�QO�J19i7YL092tl182L[�Z O�C%/�CILdOQ.CfZCC4�J• Office of Consumer Affairs&Business Regulation license or registration valid for individul use only i�OME IMPROVEMENT CONTRACTOR before the expiration,date. if found return to: egistration:. 104804 Type: Office of Consumer Affairs and]Business Regulation ,expiration: >:7/15/20.16: Private Corporation 10)Park Plaza-Suite 5170 ]Boston,MA 02116 LAGADINOS BUILDING:&DESIGN,:-INC Nicholas Lagadinos 13 Thankful Lane Cotuit, MA 02635 Undersecretary Mot valiYwhh o t ignature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-012653 Construction Supervisor NICHOLAS A LAGADINOS, s 13 THANKFUL LANE, O COTUIT MA 02635 i T l Expiration: Commissioner 07/16/2017 of 1NE rp� '""SS. 1639• A Town of Barnstable ♦0 ATEp�,� Regulatory Services Richard V.Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, �A)1�'L( V}CC� GIV1 �� , as Owner of the subject property hereby authorize /yl P.fL Ll�}Li�7�1V1(�.S to act on my behalf, in all matters relative to work authorized by this building permit application for: (Addre s of Job) 0 Signature of Owner Date w�u�-cam ���✓t��' Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\Decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\2PIOlDHR\EXPRESS.doc Revised 040215 DATE(MMIDDIYYM ACCO CERTIFICATE OF LIABILITY INSURANCE 1/20/2016 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 NAME:CONTACT Ashley. Clark .. Leonard Insurance Agency, Inc PHONE (508)428-6921 FAX (508)420-5406 A/C No 683 Main Street ADDRESS:Ashley@leonardagency.com Spite B INSURE S AFFORDING COVERAGE NAIC# Osterville MA 02655 INSURER APPli6a UW Captive Risks. - AUC001 INSURED - - - "INSURER B Lagadinos Building & Design, Inc.. INSURERC: . INSURER D 13 Thankful Lane INSURER E: Cotuit MA. 02635 INSURERF: COVERAGES CERTIFICATE NUMBER:WC Master"2016 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 - ADDL SUBR POLICY-EFF POLICY EXP - LIMITS LTR POLICY NUMBER - MM/DD MMIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -DAMAGE TED CLAIMS-MADE OCCUR PREM SESOEa occu ence $ ' MED EXP(Any one person). $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO JECT ElLOC PRODUCTS-COMP/OP AGG $ . OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY(Per person) $ " ANY AUTO .. x" � .. .� _ .. : ALL OWNED: SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $' HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB 1 CLAIMS-MADE AGGREGATE $ DED RETENTION$ $- WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE - - E.L.EACH ACCIDENT $ 500,000 :Pa OFFICER/MEMBER EXCLUDED? - N/A - . (Mandatory In NH) 46-880906-01-03 •1/2/2016 1/2/2019 E.L.DISEASE-EA EMPLOYE $: 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $. 560,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule;may be attached if more space is required) , Builder in Massachusetts. CERTIFICATE HOLDER. " CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Barnstable. THE EXPIRATION DATE THEREOF, NOTICE WILL' BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis, MA 02601 . .. AUTHORIZED REPRESENTATIVE .. -. D Flett/LEODFI ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS0251201461) z- yf. 01 / 13 J M17F. �yp`y'F REScheck Software Version 4.6.2 Compliance Certificate Project Wallace Grove Energy Code: 2012 1ECC. . . . Location: Cotuit, Massachusetts Construction Type: Single-family Project Type: Alteration Climate Zone:, 5 (6137 HDD) Permit Date: Permit Number: Construction Site: Owner/Agent: Designer/Contractor: 115 Piney Rd. Nick Lagadinos Nick Lagadinos Cotuit, MA 02635 Lagadinos Building and Design Inc. _ -. Lagadinos Building and Design Inc: 13 Thankful Lane 13 Thankful Lane 13 Thankful Lane Cotuit, MA 02635 Cotuit, MA 02635 508-428-4097 508-428-4097 lagcon@capecod.net lagcon@capecod.net' Compliance: Fails Maximum UA: 91 Your UA: 103 Envelope Assemblies Gross Area Cavity Cont. Perimeter Ceiling 1: Flat Ceiling or Scissor Truss 536 38.0 : 0.0 0.030 16 Wall li Wood Frame, 16"o.c. 800 15.0 0.0. 0.077 53 , Window 1:Wood Frame:Double Pane with Low-E: 72 0.300 22 - Door 1: Solid 37, 0.250 9 Floor T:All-Wood Joist/Truss:Over Unconditioned Space 100 30.0 0.0 0.033 3 Mechanical Equipment Description Fueltype Efficiency Other(Except Gas-Fired Steam) Gas 95 AFUE Project Title::Wallace Grove Report date: 01/20/16 Data filename: FAResCheck 2014\Grove Piney Rd Cotuit.rck Page 1 of 1 2012 IECC Energy Efficiency Certificate Insulation Rating R-Value Above-Grade,Wall 15.00 Below-Grade Wall 0.00 Floor 30.00 Ceiling/ Roof 38.00 Ductwork(unconditioned spaces): Glass&Door Rating U-Factor SHGC Window 0.30 Door 0.25 Heating&Cooling Equipment Efficiency Other Gas-Fired Steam (Except ) 95 AFUE Cooling System: Water Heater: Name: Date: Comments �t r Town.of Barnstable *Permit#ab �` 0(0 1 P� ae Expires 6 months from issue date Regulatory Services Fee 9.v� 1 , Richard V.Scali,Director ArED µp`l A Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION = RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number _. Property Address T -� ,- P l t �S" �►-w� ff Residential Value of Work$ (Q® " Minimum fee of$35.00 for work under$6000.00 -. _-----.-nnnn - .... -- _ ...... Owner's Name&Address Contractor's Name L Telephone Number- Home Improvement Contractor License#(if applicable) /0�6 �� Email: S W A bi( Cie Construction Supervisor's License#(if applicable) �' pC/ �F® orkman's Compensation Insurance Check one: FM e ❑. I am a sole proprietorKhESSIV IT ❑ I the Homeowner - have Worker's Compensation Insurance OCT 2 2�11• Insurance Company Name J:� • TOWN n� BARNSTABLE Workman's Comp.Policy# Luce �0 0 7;�b X 01 A0 f Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping.old shingles) All construction debris will be taken to ❑Re- oof(hurricane nailed)(not stripping. Going over existing layers of roof), Re-side ❑ Replacement Windows/doors/sliders..U-Value (ma)imum.35)#of windows #of doors: ' El Smoke/Carbon Monoxide detectors 4 floor plans marked with.red S and inspections required. Separate Electrical&Fire Permits required. *Where required; Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home.Improvement Contractors License&.Construction Supervisors License is required. SIGNATURE: QAWPFILES\FORMS\building permit forms\EXPRESS.doc Revised 061313 oFztiE r� * BASNSTABL IE, �$ 16 9. ,�� Town of Barnstable pTED��jy Regulatory Services Richard V. Scali,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,.MA 02601 www.town.barnstable.ma.us Office: 508-862-4038' Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder �q-(!:;>�� ,as Owner of the subject property hereby authorize (ag�f-CiC5 � b� to act on my behalf, . in all matters relative to work authorized by this building permit application for: (Addy ss of Job) SignatIte of Owner ate Print Name If Property Owner is applying for permit,.please complete the Homeowners License Exemption Form on the reverse side. Q:\WPKLES\FORMS\building permit forrm\EXPR-SS.dbc Revised 061313 .. . Town of Barnstable Regulatory Services Ftt�r Richard V.Scali Director o ok, Building Division * BAaNSTTAELK <` Tom Perry,Building Commissioner 9� 200 Main Street, Hyannis,MA 02601 'OTEo r'tp'1 a www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: . JOB LOCATION: number street, village "HOMEOWNER": name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. - The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 0613.13 t!e C`t�m�aopn€ t�o��ass�c��s� � rti�t o�'�aulr�.si `�4Ec,�dexr;Es -- - Owe ofliions Mmkinglon Street Bostox;,MA 02ILT wr4•w.masy-gorld 'Workers.' Compensatiuxt InsuranceAffidavit-B.nilders/Contract-or MecctricianMumbers rpplkaut Information pease Print Legibly Name Ukuiwwasl tiunffiffvidual): -,�,u Addr 1 �. Ci {5tat-ejZ C'�ec.�o°� y phone ire y4n ag employer"Check appropnat�box:- T u#}u°sect(r nixed �-�- - ...-_.._ ❑ construction. �t�'1�a employer wrfh �� 4_ ❑ T am a general ctrnfracEor and I 6_ New employzes{fu11 agdtorpart e _* have-hired-the sub-contractors. listed on the at#whed sheet, 7_ ❑Re=de-liag 2-❑ I am a sole propfietor or partner These snb contrartats haue ship and have no employees $_ ❑Demolition w for me in any c ci �_ employees and have workers' o>�ng y � � 4_ ❑Building addition worker",cainp_iu airanre comp_insuranize.1 - 5_❑ We am a corporation and ifs lf}_.❑Electrical repairs or additions 3_❑ I am a homeowner diving all work offir ets h um exercised fhear 11-0 Plumbing repairs or additions Myself [No workm,comp- right of e2mm ficn per MGL 12_❑Roof repairs xn�tirs�e regnirEd]l c-152, §1(#},and we ha m-rso employees-Wo`wa&ers- I3_❑fliiaer comp_insurance required:] flay wpliciait d=t checks box fl umst also fill oit the section below stowing iheu leis'compensation gorLT arm d o- #Flammwnets wbo submit this affidxvif ind rxtEag they use Aomgr elf wa l[and thenhiie outside contractors mast submit a new afgdnk intricatk rn =Goatmcina thst rhxic this box must attached ma xdditionxl sheet sjb —the name of the sx*-- s and state whether orngt Lhasa entifies have anpluyees. If the mb-contmctms:h.m emplaces,they Est pzuvide their warkers'comp-policgnumber_ I am an.empZqyer Mat is prmiding workers'competzsrrdoa Lr=rance}ar nzy empfayem .Hei a is the pa9c}anal job sitar iat_forn�mtian_ qq - Insurance comparryN=e- R k 1 + t 1,0 HU g or Self iris I.if;5-`_ (,0 CC -0 U 7 7410 1 a6 JJ6 Expiration.Date: Job Site Address t uw^b Cityr'StatelZip= co 41 Arch a copy of the workers'compensation policy derl iration page(showing the policy number and ecpiration.date). Failure to secure covtsage as required under Section 25 q_of ML c. M can lead to the impositim of mminai pmalties of a fine up to S1,500.6a andlor one-yearin3pawnment as well as civil penalties in the form of a STOP WORK ORDER-and a fine afup to$250-00 a,day against the violator_ Be advised tbat a copy of this stat uneat maybe forwarded to-the Office of InvesEigatioris of the DIA fbr instirance coverage vacation_ Ida hereby a erhfy under tt7w per6is and penaWas aaf`perluty thatths irra{orrizatian priwided abmre css riw mid correct Date- 7///!i� � cial use only. Da not write in tidy area,ta be compi`etad by city,or town a ciaL CRY or Town::" PermitUcense# Issuing Anthoritlt{circle one}: 1.Board of Health 2.Building Departmeeut 3.City-IT,own Clerk 4.Electrical BL;pec#or 5_Plumbb*Tbspecter 6.Other Informations and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuautto this statute, an employee is defined as"--every person in the service of another under any contract of hire, express or implied, oral or written_" An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,-or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three aparhnents and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or 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 numbers)along with their ceutifi=-le(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation inssurance- If an LLC or LLP does have, employees, a policy is required_ D e 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 affrd2vit The aflidaS2t should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the Iaw or if ,a workers' you are required to ob�i -` compensation policy,please call the Department at the number listed below. Seii insured companies should enter the' u self-insurance license number on the appropriate line. City or Town Officials. Please be sure that the affidavit is complete and printed legibly. The Department has.provided a space at the bottom of the affidavit for you to fill out in the event the Office ofIuvestigations has to contact you regarding the applicant_ Please be sure to Ell in the permit/license 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 a,�davit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all,locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be gilled 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 Ieaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you is advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and fax number. The Commonwealth of Massachusetts Deparimttt of Indusb�jal Accidents Gffice of fvestiotiom 600 Washingau S`trcat Rnstoio MA 02111 Tel.A 617, -49-00 at4-06 or 1-9. I ASWE Revised 4-24 07 Fax#617--727-�4r VjWW_Ma.Si gmuddi i CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 01/27/2014 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Blackstone Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE P.O: Box 3144 i HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Worcester, MA 01613 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A- Utica First Insurance Lambros Construction- INSURERS: A.E.I.C. � 3 Tabor Road INSURER C: Forestdate, MA 02644 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. LTR IRSRO TYPE OF INS URANCE POLICY NUMBER" DATE D E M/DD! LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO R N D 100,000 A CLAIMS MADE R] OCCUR ART 8139422 1/10/2014 1/10/2015 PREMISES(Ea occurence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PROJECT LOC AUTOMOBILE LIABILITY e ANY AUTO COMBINED SINGLE LIMIT $ (Ea accident) ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ (Per person) HIRED AUTOS NON-OWNED AUTOS BODILY INJURY $ (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY B ANY PROPRIETOR/PARTNER/EXECUTIVE WCC5007862012014 1/13/2014 1/13/2015 E.L.EACH ACCIDENT $ 100,000 OFFICER/MEMBER EXCLUDED? Has,describe under E. DISEASE-EA EMPLOYEE $ 100.000 SCIAL PROVISIONS below E.L.DISEASE-POLICY LIMI $ 500.000 OTHER George Lambros is covered by the workers compensation policy. CERTIFICATE HOLDER CANCELLATION E.J. Jaxtimer SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 48 RSOry Lane DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 15 DAYS WRITTEN Hyannis, MA 02601 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE No OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) ©ACORD CORPORATION 1988 v,ieanvrraaizcue�cCC/d�� d'uO�ccrettJ j. License or registration valid for individul use only g I before the expiration date. If found return to: Office of Consumer Affairs&Business Regulation i ME IMPROVEMENT CONTRACTOR .Type Office of Consumer Affairs and Business Regulation egistration v1463 10 Park Plaza-Suite 5170 i ratio n 5I1012016; DBA i Boston,MA 02116 LAMBROS CONSTRUCTION £ E r- �-•: `a 3 ? GEORGE LAMBROS ' 3 TABOR RD 4 Not valid without signature FORESTDALE,MA 02644 r Undersecretary n. . . . Massachusetts Department of Public Safety Boardbf.Buildin_. g Regulafions an& tandards: Construction Supersisor License: CS-042403 �- GEORGE L LAMB'YtOS 3 TABOR RD i FORESTDALE MA 02154 Expiration Commissioner '` 01/11/2016; i Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services ee 4 Thomas F.Geiler,Director X-P '`,' Building Division AUG 10 2005 Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 TOWN OF 8ARNSTAK . www.town.bamstable.ma.us E Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number ® Property Address J/ -- Pip.a;t i}C (_._. [Residential Value of Work Z o Minimum fee of$25.60 for work under$6000.00 Owner's Name&Address Contractor's Name C�,eA=%4 Telephone Number �,,E Home Improvement Contractor License#(if applicable)_ of l Construction Supervisor's License#(if applicable) 2<orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I gm the Homeowner have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# W C' 7 6 D Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) gTie-roof(stripping old shingles) All construction debris will be taken to_/ ❑Re-roof(not stripping. Going over existing layers of roof) Q Re-side Replacement Windows. U-Value (maximum.44) *Where required: Issuance'of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. /Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 Town of Barnstable Regulatory Services i r ' SAMSUBLr. ' Thomas F,Geiler,Director 9 9 HAS: 0A Fc 3 A�. Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorizes to act on my behalf, in all matters relative to work authorized bythis building permit application for. ace - n oargS (Address of Job -A . — � 8 Siinature of Owner a e l�ci�I'S-•��-l�r�V� v Print Name QTORMS:OWNERPERMISSION f i ' a v r . /f �T .77tv, ✓fze �omvmaruuea�� �� � � µ { � � . s��ttl of gt3dii Regulations and St4 d r 'v I ° A Ir tise�or rs �C kOME IM Q"JEP�iERIT GQ�iTftACTOR T v�el*bf���l�in4g egu[ations and S a�u a R �$t +a�• 121463 "One AUburton Place Rm 1301 _f/2006 Boston,lVla 0210$ !Xx�V1PR6S CON \ `JRGE LAMB c I STD E,MA 0?fG4 _ A _1tand without s!gnatu .� , a ° wog 6u1 m soul e6e nnnnnn jau-podadeb@uob6el,liewa 9ioz`oz8nuop°xupsaupaM 60LZ-8Zti=805 Xel L60b-8ZV-8,OS'lad �riO Ep ILu.�a` @A0J S£9Z0,VjN plo aue'1 1nAUe41£G_ :xg Noma : r OZ w. W 41 ' 0 a >' 1-41 0- oz. F- UJI,ix *� ` ,.. as � 411 W + W - � . m °s s R., 1J �• DECK 251 sq ft N _ ♦. -. �' �" - r m y KITCHEN/DINING' 3'-4 x T-11 .M F {. 1} k BATH, 6'-11"x.4'-5 M we Door , ao .2/6 L:6 , v - ♦ N wlo door KITCHEN/DINT G .co.BEDROOM, .. - 9-5"x 8'-1... - : - 87 sqR. - aa• Remove Chimney Remove Wall a, y s x 'LIVING , - 125 sgft ,+ DR t, � e1 i+ B O M rn k ..+ •4 � Y `W n �—in L-+6 1ftg Eft• na Ha9e9z s _ 1 'O -• #.. PORCH , K.. ,�` - 1• lbasq a r. a , .LIVING AREA w a ' uj : ` , .tie i 4 ob C,0 N (0 o O CD p X M m ' •Y �` cc Cu ._;O 0 -6"-H * rnrn U 00 -CU j N O U LO - t J'a P : �y f` t � S ` - � ��,.k�� ��', �•`-a �. �,.. w 'I Tax "t �_� ' - ��-'��- � ... - .- - '�c- u - .r t w . x, i' .:. .:..-.t ..... �`vy:,. k,...✓ i� -v. .. .YNs�vh ,.-.... ,r.,.. r_ m. ._..,. :, u 4 � .,�' � - - s,,. . +�,^.��., a ,,,. �«�: �;. s B .�. G .„ a s:'. a ..n'.,: •�.. .: � •.. _ ..wr ,- '�" , a .,. a.,,,.,� +, . .�. .� x �P�r rah:. � hemwp HE OR cl �3 r yS•v'"6" ��{� ��I F� v h x fit, co . cz Right Front Elevation CC •, v t:` a O t a ' a ` * N � U O C Moo U — f ' JN � Q' CD X M CO r •rV (n • ` 4' cu co 1:t Cu v , s .._ t e - • - M .. .. F W .i A a ib{+ LO • i �^ 1I - p e �, 4—J _ vs w n • s .w .-. I :. a �'- •. '.. rT L . s v s La s t � t Y } rv^. :t a 's r '•' • '. - J. ' Left Rear tl rt . Elevation ' , CD �.. 40'- _ - , w - • y OU i O 6' - 13'-31/16" 34' C'V ti C.M 00 � C f �-C) X V m s ' - - .1 s x — U s —I M Uco 1. — -- -- — — \ � N o _ — I � I : I• o z / I. FT I' •r. 12'-0 11/16" - .. t• ..\\ m / v 2'-10 5/8" 5'-2 5/8"11 Hill 12'-11 9/16" — , r Y I \ I I I \ $ I I + (5N- r = I — x a f m \ m O 2'-2, - QI v O i - ` IF - „ w 4 r x . .l Lj Roof Framin N y �. g b cz f • co W , u - !' 'EA tin and New " Framing Existing!2k6 Roof Rafters t New 2x6 CeilingJoists 16 O.C. - o New Window-and Door Headers 2` 2x8 N R-15 Wall nsurance °. New' 1/2:CDX.•Sheathing as needed �` �'�n �. o. - - JNCD a' R-38 Ceiling: Insulation Floor joists - o X New Fl is as.needed'2 2x6 r. Y m R-19 Basement Ceiling Insulation - 0 r L_� O U:ca r M;O 00 UC14 - J CU " 4-1 „ t , r y. x ,.. � „ ,;., , , ..., x.� �:.,. ;. �"�. �. ,� ,ems. '".C�•: a :�� � - .. � - x. «r I t E a i s{ g { I' Y d � { 5 j I r t 1 j t I — P�r v : : , $ a� n 1{ a + ' • w. p 1 R I - • eplace Damaged studs and sheath i n this s area: cz pq