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HomeMy WebLinkAbout0039 TOWER HILL ROAD (30) e ��� �- ISM _ �, - _ � _ - - _ ,, _ . �. - � ! f ',� y �, t ' � a 'V SO TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # ��1 d S S Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Feem � Date Definitive Plan Approved by Planning Board (p Historic - OKH Preservation/ Hyannis Project Street Address 3 9 I ow 6r I F55 t Village' OE&exv Owner A_ 11_,V) 'a I) Address Telephone .Permit Request (�l S Square feet:.1 st floor: existing - proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation2-Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach sWporting dodum(i ation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) CD _ �= Age of Existing Structure Historic House: ❑Yes ❑ No On Old Kings Fighwaya ]Yes❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ? Basement Finished Area (sq.ft.) Basement Unfinished Area (sq. Number of Baths: Full: existing new Half: existing new Number of Bedrooms: 441 existing —new Total Room Count (not including baths): existing �_new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil )4Electric ❑Other Central Air: '` I Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name"f1! Telephone Number F,�017i Address4� A I License # ( i��n(�q65 (A r�l 7�) Home Improvement Contractor# l G Email Worker's Compensation #(X 66A 2) ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE ( DATE " l f .. - f i FOR OFFICIAL USE ONLY t APPLICATION# DATE ISSUED A MAP/PARCEL NO. M: ADDRESS VILLAGE OWNER DATE OF INSPECTION: 'a FOUNDATION 4, 'r -FRAME INSULATION ,T FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH- FINAL FINAL BUILDING DATE4CLOSED OUT - AS@1D,MATION PLAN NO. OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at q To cy4&( �4 r l I fat.. (Property Address) A/A v 2-6 , (Propeo Address) -� -I 9 � hereby authorize L� `� S�Ct) '� j01j , (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signatur Date i . u Tlie Comnionwealfl: of Massachusetts Department of Industrial Accidents Office of Investigations 600)Washington Street Boston,NA 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumblers ApiaGcant Information Please Priait Legibiy Name(Business/organization<tndividuai): .Tupper -Construction_. Co. , LLC Address: 546A Higgins Crowell Rd City/State/Zip: West Yarmouth, MA 02673 Phone#. 50 8--7 7 8-O'11:1 Are you an employer?Check_ the Appropriate box: Type'of project(required): 1.[]X 1 am a employer with 4. ❑ 1 am`a general contractor and 1, 6. 'Q New.construction employees(full and/or part-time).' have hired the sub-contractors 2. 7. Remodeling [] l am. sole proprietor or parmer listed on the attached sheet.;t a ,ship and have no employees These sub-contractors have S: Q Demolition working,for me in any capacity. workers'comp,insumnee, 9. C]Building addition [No workers'comp.:tnsurance S. ,Q We are a corpdratioi and its required.] officers have exercised their 10: ]Electrical repairs or additions 3,n ] am a homeowner doing all work right of exemption per MG`L I LF1.Plumbing repairs or additions myself.,(No workers'comp' c.,1 523§l(4),,and we have no 12.E Roof repairs insurance required.]- employees, (No workers't 13.[J Oche"rVVeattierizafior comp:Insurance mquired] °AiV applicant that checks box 41 must also rill out the section below showing their workers'compensation policy information. t.Womeowners who submit this affidavit indicating they arc doing all work and then him outside contmctots must submit a new'affidavit indicating such. tCoutractors that check this box must attached an additional sheet showing the name of the sub-coittractors and their workers'oomp.policy information. I ant at e>ployer that is providing workers'compensation insurance for niy emiloyee& Below is tyre policy aid job site information. Insurance Company Name: AEIC Policy#or Self-ins.Lic.#: WCC 5005593012014A _ Expiration Date: 10/3/15 Job Site Address., 1 City/State/zip:u oa(p Attach a copy of the workers'compensation policy declaration page(shoving the policy number and expiration date). 'Foilum to secure coverage as required tinder Section 25A of MOO 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 OPlice of investigations of the D]A for insurance coveitge verification, I do hereby certify under the poins4 1 penalties of perjury that the information provided above/s true and correct. A Sit nmature: °� � � Date: Phone#: (5 0 8) 7 7 8-0111 Official use only. Do not write in thlr area,to be completed by city or town ojj7cial. 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 b.Other Contact Person: Phone#: i , a ' 1 ® DATE(MMIDDNYYY) AcoR,v , CERTIFICATE OF LIABILITY INSURANCE: �..� 12112014 THIS CERTIFICATE IS ISSUED AS-A MATTER OF INFORMATION ONLY'AND CONFERS NO,RIGHTS UPON THE CERTIFICATE HOLDER.,THIS CERTIFICATE DOES'NOT.AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND,OR ALTER THE COVERAGE�AFFORDED:BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE 'A CONTRACT BETWEEN'THE ISSUING INSURER(S)` AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the,pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to, the terms and conditions of the policy,certain policies may require an endorsomont. A statamont on this corti icata doe's not confer rights to the certificate holder in lieu of such endorsomont s PRODUCER OrCTLora FitzGerald', Southeastern Insurance Agency' PHONE' KII, (508)997-6061 FAX, (508)990-2731 439 'State Rd. I ,lfitz@southeasternin6.com' P.O. 'Box 79398 INSURERS AFFORDING COVERAGE NAIC0 North Dartmouth 'MA 02747 IN Aibel'la Protectfon.,Insurance 1360 INSURED, INSURER13Assooiated' Em lCr ers 'Insr. �Co.- Tupper' Construction •Co LLC ugER,c. ' 79 Mid ,Tech Drive, INSURE D:- Unit 'B INSURER E: _ West Yarmouth.. MA 02673 INSURE F: COVERAGES CERTIFICATE NUMBER:201S-1. REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF,INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ASOVE.FOR THE POLICY,PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,,TERM OR CONDITION OF ANY CONYRACT-OR OTHER DOCUMENT WITH RESPECLTO WHICH;THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,:THE INSURANCE'AFFORDED'9Y,THE POLICIES DESCRIBED.HEREIN 1S,SUBJECT TO ALL THE'TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN R60UCED BY PAID CLAIMS., SR TYPE OF INSURANCE pp pp MAN viva POLICY NUMBER' M D D LIMITS; GENERAL LIABILITY' EACH OCCURRENCE S' l;000;O06 X COMMERCIAL GENERAL LIABILITY MG T ATE S' 100",000 A CLAtM6•MADEOCCUR 9500008743 1/1/201q 1/1/2015 �MEDEXP(An tine Bison 8 5400' PERSONAL6AOVINJURY, S, 1i000,000 GENERAL'AGGREGATE S 2',000 `000 GEN•LAGGREGATE LIMIT APPLIES PER:"! PRODUCTS-COMPIOPAGG" S Z,000 000 X POLICY PR JFrO• ' LOC $ AUTOMOBILE LIABILITY a COMSI de SI S 1 '000 000 ANY AUTO BODILY INJURY(Per person) S A ALL OWNED SCHEDULED 020009389 2/1/2014 2/1/2015 AUTOS X AUTOS BODILY INJURY(Pet accident) S X HIRED AUTOS X NON—OWNED PROPERTY AUTOS I DAMAO S c' n1 suredmotod 181 splitllmil S 250.000 UMBRELLA UAB OCCUR EACH OCCURRENCE S A EXCESS LIAR CLAIMS MADE AGGREGATE 5 DIED RETENTIONS P600058368 11/1/2014 1/1/2015 S B WORKERS COMPENSATION I WCYSTATU _1OTH AND EMPLOYERS'LIABILITY Y I NLIM ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT S,. 1,000,000 OFFICERIMEMBER EXCLUDF[Y) NIA (Mandatory In NH) WCCSOOS593012014A 0/3/2614 0/3/201S E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It e$,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE:POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101.Additional Remarks Schedule,it morn space Is repulred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN INFORMATION PURPOSES ONLY ACCORDANCE WITH THE POLICY PROVISIONS. TUPPER CONSTRUCTION CO LLC 546 A HIGGINS CROWELL ROAD AUTHORIZED REPRESENTATIVE WEST YARMOUTH, MA 02673 Lora FitzGerald/LHL ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025nrimmin1 Thn a( non nnma and Inr.n am►ar.icfararl mnrkc of Af npn j Y t ,, �,�QP 'N/1Ut'IM14vrli'�ry ey'"�liJwift�Ih,Pllt .,��U111M ofCmisaater Af'INi1��`111tsineS';Itcftnlallim hiccnso er ivipislrgtioe vaUd 1\r itidivtAul use otiiy to: OW IR4�R0V6A4l;Nr CONTRACTOR Wore the ex i date, If tellod rctnrn } Idtfettonc 110434 Yypa; Uf6eu of u�tttlti� f hirs an11 t3uciness ltiguLNioa I ftptraNnn; 4l16f�plfi 1.1,C 10 Pod. xn d Sol a 513n ^� opttl)t�A1a111Zf�1� f;it;WAt3C? `fU>i1�ti> W,YARMOUTH,MA 02613 tladcltcerclu+w .. �.Nn kY FitLuut si0nahlrc a l bolti�IP 'PF.R*OWANCE INSTIY6M_ JUC. ' .•�� � e s-. t ) Majamahtisatte•Department of Public Safety ,30?Nafmdad Road,Sutle ho + Gonfd of Suilding Ragulations and Standards Wilk NY t3t>: Gun►Iructiun,upet,i�al (01 A<id>fVd t�ve,Hpi,cen� �,{copse;C5�6f�tl3a Richard S Tupper Sod A t`i!}0m Crwtie Wem YdWttOuth M!1 Richard Tupper bf�110Y�9tM•,nsl ' ` •'s;`� �1�t'�I�I,'+.��4' 1as> ttcgss taflo utaNsatatxa� , �' , '° Coltim;Ssioner 12I31=6 21 lai�pfe tltilaing Peale BuHd aSafrt Warid"' . MEMBER Richard Tupper Tupper Construction 8uilding Safety Poetesslonet ti Member,#:g158119. -':Exp:413012015 I THE VILLAGE SQUARE NORTH CONDOMINIUMS .1046 Main St.Suite 11 Telephone:508420-0299 Osterville,MA 02655 Fax:508-420-0789 January 26, 2015 Town of Barnstable Building Department 200 Main Street Hyannis, MA 02601 To Whom It May Concern; We-hereby authorize Tupper Construction of Yarmouth. MA to perform work at Unit#150 at Village Square North Condominiums, 39 Tower Hill Road, Osterville, MA. This work was reviewed by the Board of Trustees and approved. Sincerely, ,Aot? v Andrew Witter ARM,AMS, CMCA President, First Property Management AWlaons T/T'd 0TOS8LLBOST:01 68L002t7BOS SUNUTA Ai83d08d 1S8IJ:W02ld 81:60 ST02-92-NUr TU RIPER _ .:. CONSTRUCTION CO_��c 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 WWW.TUPPERCO.COM Date: �7 �� Gtv, + 5O --• � to �_ Town of Barnstable Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 C (508) 790-6230 fax (y� 1Cp p Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application # �— 0 1 * 4)5 E Issued onl / has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Permit #: Address: Richard Tupper C License # CS-69058 t