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0041 OLD TOLL ROAD
f 02dord NO. 152 1/3 ORA ESSELTE 10% f i M n 1 _ � � �� ���� u( � i ��' S `�- c�� � ��� y j, . , � �� w 1 . 'UPPER :.... CONSTRUCTION CO_ ut-c 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508 M-0111 FAX: 508-778-5010 bVWW.TUPPERCO.COM i Date: �l �1 a 2 • o t ry -+•fa Town of Barnstable `! Thomas Perry CBO ' 200 Main Street Hyannis, Ma 02601 M (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application # '� 0 f 600 69 �;'- Issued on has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Permit* � ( 000 5 ve rt Address: Richard Tupper License # CS-69058 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel pplication Health Division Date Issued 'Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis (J�/ Project Street Address Village Owner r I Address P r�lm� Telephone Permit Request T 6 - StA GQSS I jl( I V)CA , i ins 1 - s I oid -41 ar�� he w a A4J Q C CAD L i V1 Gf 'Au cf s Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type _ Lot Size Grandfathered: ❑Yes El No If yes, attach u orting dQcumebtation. S i¢J Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) r -� Age of Existing Structure - l Historic House: ❑Yes ❑ No On Old King's ' ighwayT❑YqT ❑ No U Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other w --i en Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 1-;7 m Number of Baths: Full: existing new Half: existing new Number of Bedrooms: J existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: XGas ❑ Oil ❑ Electric ❑ Other Central Air: )4 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) rr Name Telephone Number 'J� AddressEj&A (�M�JC[If?j • License # Home Improvement Contractor# Worker's Compensation #�,Y_� ,r�5q_,3)1g06A ALL CONSTRUCTION DEBRIS RESULTING FRO T IS PROJECT WILL B AKEN TO 5�F ° s0a ou& I .� SIGNATURE DATE JJ "� R FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER r„ DATE OF INSPECTION: -),PFOUNDA;TIOMu�t�+i FRAME 8 INSULATION.,L,,i nt . FIREPLACE ELECTRICAL: . ROUGH FINAL F PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING:- _ DATE CLOSED OUT ASSOCIATION PLAN NO. ;,, 155520 OWNER AUTHORIZATION FORM ( wner's Name) owner of the property located at �4 2� (Property Addre s) (Property Address) Chereby authorize \ ` , (Subco r or) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Ow is Sig at re l lLl Date The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Apulicant Information Please Print Legibly Name(Business/Organization/lndividual): Tupper Construction Co. , LLC Address: 546A Higgins Crowell Rd City/State/Zip: West Yarmouth, MA 02673 Phone#: 508-778-0111 Are you an employer?Check the appropriate box: Type of project(required): 1.0 1.am a employer with 4. ❑ 1 am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 7. ❑Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp.insurance; g_ ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions right of exemption per MGL l Ln Plumbing repairs or additions 3.El 1.am a homeowner doing all work myself. [No workers' comp. c. 152, §l.(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.[3 Other Weatherization comp. insurance required.) *Any applicant that checks box#1 must also fill out the section below sbo-,,dng their workers'compensation policy information. r homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, hContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers`comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: AEIC Policy#or Self-ins.Lic.#: WCC 5 0 0 5 5 9 3 012 014A Expiration Date: 10/3/15 ,a1 Job Site Address:11 Ojai _� City/State/Zip: naiG(L [ lr It Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civi I penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains:andp'enalties ofperjury that the information provided above " true and correct Signature: 11 Date: .5 Phone#: (508) 778-0111 #� Ofcial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#• ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM7DD1YYYn 12/1/2014 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 CAOMTACT Lora Fit2Gerald. Southeastern Insurance Agency PHONE FAX (508)997-6061 arc (508)990-2731 P.O. Box 79398 439 State Rd. ADDRESS;lfitz@southeasternins.com INSURER S)AFFORDING COVERAGE NAICZ North Dartmouth MA 027tl7 INSURERAArbella Protection Insurance 41360 INSURED INSURER BAssociated Employers Ins. Co. Tupper Construction Co LLC INSURERC: 79 Mid Tech Drive INSURER D: Unit B INSURER E: West Yarmouth MA 02673 INSURER.F: COVERAGES CERTIFICATE NUMBER.2015-1 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEO TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIRFMENT,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 t A DL SUe LTR1 TYPE OFINSURANCE POLICY NUMBER MM 1 YEFF MMIDD� LEirTS GENERAL UABIUTY rNSR EACH OCCURRENCE ; 1,000,0001 X COMMERCIAL GENERAL LIABILITY ; A e PREMISES Eecccwrerce s 100;000 A CLAIMS-MADE El OCCUR B500008743 1/l/2014 1/1/2015 MEOEXP(Any cneperson) 5,000 I PERSONAL 3ADVINJURY S 1,000,000 GENERAL AGGREGATE I S 2,.000,000 GEMLAGGREGATE'I APPLIES PER j PRODUCTS•.COMPAGG�S 2,000,000 X POLICY PRO- LOC ROS AUTOMOBILE UMUTY fE88 emsIRGLEUor!T S 1,000,000 ANY AUTO A 80DILY INJURY(Per person) S ALLOWNEO X SCHEDULED 02000 12/1/2014 2/1/2015 AUTOS 9399 AUTOS BODILY INJURY(P0:acaderx) S X HIRED AUTOS X NON-S TYDAfsO'NNED AUTO PROPER S I Uninst red rn0torist M sort ftin S 250,000 UMBRELLA LIAB i OCCUR EACH OCCURRENCE S A EXCESS UA8 CLAIMS-tAAOE t AGGREGATE S DED RETENTIONS 4600058368 11/1/2014 1/1/2015 $ WORKERS COMPENSATION SOTH- AND EMPLOYERS•LIABJUTY YIN i ANY PROPRIETORIPARTNERIEXECUTIVE OFFIC—EMBER EXCWDED7 NIA E.L.EACH ACCIDENT s 1,000,000 (Mandatory in NH) WCC50OSS93012014A 0/3/2014 0/3/2015 1(yes,d25ai0eunder 1 E.L.DISEASE•EA EMPLOYSe S 1,000,000 DESCRIPTION OF OPERATIONS bet— _ r L p{EAse.POSY LIMIT I s 11000.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Addnlonal Remarks Schedule,If more spa"is required) 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 REPRESENTAMtE WEST YARMOUTH, MA 02673 Lora FitzGerald/LHL ACORD 25(2010J05} ©1988-2010 ACORD CORPORATION. All rights reserved. INS025onirnsinl TO—drnon name anrt Innn am ronicinin,l mar4c of A(,r)pn r ' 1 t u i t ''.7,3p fir;•ua:a+r rf�i•.J if J j a Ir..i �r OfficP Ol t:Oid Wrier A(taln d RllsIRtt itr•'nlatiUu Liccrst or renistrition valid for individid ust only OA9i 1iMlC'ROd IL�t IttT GC�+Y f2A 7 12 hefur't.(lie.cxflcytthx Hate, if fou:td ertin•l UN Type: Llf€ir nt C tf�wxa iirtiiti wid RuAtim ft0_ntstion ~' dr"`: kpiration' 6116r:01: LLG R1Ci u+ii� TUPPOI 7a s itk nzv—cH CDR. ? '�N_' V4.Y SRMVUT•n,MA 0Y73 131�3tYd i'f' fi� tAf NGE.-INST4 W%-,t:'-� ^•••�-••�,� :a,�vt.r. ..-.-:.-r„>A >~...,....-r.:+f�i S \7ass�Chuaetts-fle�ar`h?exit a P:ub I =diN.7 hAn1w s skw.8we me t1:+'� e'� �'f?ii; � f�i,t\"af SUt'.11i2ll�ilfi•!'S"tltip +1��iiiii:�ra, t:icefi�e'C�•91o�Jil;'� Richord S'Ytippt r 546 A Hiram ,C.u se W W64YatlhbUth.MLA 11r ey � �l�i9ci'G lil�7jl�fi t -, dJ•S;P �y i try DIM .ts rkacC z+s iGaa6 wrtcia. u,-:.'�'� y 1 s�jAMfS r �� cF.rsta.:.�YytiL•lAttM..�} - YC People Helping People"it'd a safer Worldi J �ttlF<d4f►]eW can-ccsautr MFM85R Richard 4l'pper cupeEr Construction: uoldinU Safety Protessionig Member#:8.158119 ExpA/30/2015 o�VE rqk, Town.of Barnstable *Permit# 6 Expires 6 months from issue date Regulatory Services Fee S snxtvsTna�, KAM $ Richard V.Scali,Director 16'9 CFO MA'S p Building Division .X-PR PERMIT Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 AUG 2 7 2014 www.town.barnstable.ma.us Office: 508-862-4038 ax $-790-6230 EXPRESS PERMIT APPLICATION - Not Valid without Red X-Press Imprint Map/parcel Number �U � � �/ Property Address Yf OLL7 n L.0 t�--D- V✓• ,/,304117AJ51 Z,677 XA,4 Residential Value of Work$ S,sL5b . O 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address t L t— P 77Y Y S� Contractor's Name �- (�(/c_r7'3i'� Telephone Number Home Improvement Contractor License#(if applicable) /9 746 G Email: �HK/�-T3�3 e�Q/yll•�i�L., ceA. , Construction Supervisor's License#(if applicable) O 41� /;�_`j ❑Workman's Compensation Insurance Check one: am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp. Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) 0,**-Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. / SIGNATURE: Q-Z�0 Q:\WPFILESTORMS\building permit forms\EXPRESS.doc Revised 061313 � Print For" m � The Commonwealth of Massachusetts Department of Industrial Accidents V_ Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/orgamzation/Individual): Address: 1 466, )e y/ / City/State/Zi : r L M,9 S'3 Phone#: -50(9 "Zo V/— 331;p- Are you an employer?Check the appropriate bo T31)e of project(required): 1.❑ I am a employer with 4. E I am a general contractor and I p - 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling slip and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity. employees and have workers' � Building addition [No workers' comp.insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions ❑ officers have exercised their 11. Plumbing repairs or additions .3. I am a homeowner doing all work p myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: 0-/ i o" i D t�,A D City/State/Zip:LJ, MMSl Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce r rder tlre. sins and coral 'es c�rjury that the information provided above is true and correct. Signature* - Date:-- -- - -- — ----- Phone# Official use only. Do not write in this area, to be completed by city or town official City or Tomm: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector i.Plumbing Inspector 6. Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employee. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permittlicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA G2114-2017 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 7-2010 Fax# 617-727-7749 www.mass.gov/dia I UVOKERSCOIVIPEIVSATION�ANDrEIUIPLOYERS'LIABILITY INSURAICE`POLICY� 'rp" �z � �} •{� �' z ;. Info�matiorx Page ' ':r ';'x �� V11C 0n 00 01 F @ Atlantic Charter Insurance Company VDAC NCCI Co. No.:29211 Policy Number: WCV01168000 1. INSURED: Prior Policy Number: New Robert F. Tyndall Producer: 80 Brigantine Avenue O'Briens Centerville Insurance I Osterville, MA 02655 Federal ID Number:174560293 Agency, Inc. Risk ID Number: PO Box 610 Centerville, MA 02632 Business Type: Individual SIC:9999 NONCLASSIFIABLE ESTABLISHMENTS Other Named Insured:See WCE106 Other Work Places: See WCE107 2. POLICY PERIOD: The Policy Period Is From: 7/11/2014 To 7/11/2015 12:01 A.M. Standard Time at The Insured Mailing Address 3. COVERAGES: A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee C. Other States Insured: Part Three of the policy applies to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06B D. This policy includes these endorsements and schedules: See WCE105 4. COVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates & Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications No Estimated Annual $100 of Annual Remuneration Remuneration Premium See WC 00 00 01 Minimum Premium: Deposit Premium: $500 $500 Interim Adjustment: Annually Servicing Office: Estimated Premium (Minimum Premium) $500 25 New Chardon Street Boston, MA 02114-4721 Issue Date 07/01/2014 Countersigned By:_ � Copyright 198 NNational Council on Compensation Insurance Form: 100mv Unrestricted -Buildings of any use group which ' contain.less than 35,000 cubic feet (99Irn )of enclosed space. Failure to possess a current edition of the'Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-046189 DAVIDHWEBB 24 MEADOW VIEW DR E FALMOUTH A 02536 MA Expiration Commissioner 10129/2014 Ce ePomunaarzcue��C/z d�Caac�iu�eG i' -— _—_...:...... ......... . Office of Consumer Affairs&Business Regulation License or registration valid.for individul use only OME IMPROVEMENT CONTRACTOR. before the expiration date. If found return to: egistration: '' '9166 Type: Office of Consumer Affairs and Business Regulation laza-Suite 5170 Expiration:E 81-2812-045i DBA. 10.Park P Boston A 0211r 1 WE68 CRAFT DESIGN�-�}'.��� . JAI �A DAVID WEBB 25 MEADOW VIEW DR ;` EAST FALMOUTH,MA G2536 Undersecretary !� Not valid without signature g 1 t �pF IKErOy, BARNSrABLE, " Town of Barnstable 1639• Regulatory Services. Thomas F. Geiler,Director. . Building Division Thomas Perry,CBO Building Commissioner .. 200 Main:Street,, Hyann►s,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 . w&f ; as Owner of the subject property hereby authorize li✓ 61—ll to act on my behalf, in all matters relative to work authorized by this building permit application for: 10 (Address of Job) Signature of. wner Date I Print Name If Property Owner is applying.for permit, please complete the Homeowners License Exemption Form on;the reverse side CONSTRUCTION CO. LLC 79B MID-TECH DRIVE,WEST YARMOUTH, MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 VJWW.TUPPERCO.COM Date: Town of Barnstable Thomas Perry CBO E 200 Main Street C3 oz-w- Hyannis, Ma 02601 (508) 790-6230 fax ca N T"` � R7 Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application Issued on 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 License # CS-69058 e TOWN OF BARNSTABI:E BUILDING PERMIT APPLICATION / TOWN OF PARNST��rE � Map . / O Parcel 07Z �In V Health Division ��� I f H g; 0 Date Issued Conservation Division Application Fee Planning Dept. ISIO;J Permit Fee - Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address 01(:2 L Village Owner � Address , Telephone �7 � '" G ZX -77 S— .Permits Request le`2 -d 8A,2Lt t 4nl IDA)6 M L-11).kd Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay 'Project Valuatio ss/& Construction Type Lot Size / Grandfathered: ❑Yes El No If yes, attach supporting documentation. Dwelling Type: Single Family Q- Two Family ❑ Multi-Family (# units) Age of Existing Structure ) Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: Full 0 Crawl ❑Walkout ❑ Other / Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) l Number of Baths: Full: existing new Half: existing new Number of Bedrooms: N-1 � existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: Gas ❑ Oil ❑ Electric ❑ Other Central Air: es ❑ 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 /� �\ Tele hone Number Address 7 1=��/J/ ��,lJ� License # c s Wva Home Improvement Contractor# Email ��/? (& l�90C.C.o, Worker's Compensation # WW3 ALL CONS/T,R CTIO EB RESULTING FROM THIS PROJECT WILL BE TAKEN TOZ'/W /�//�1 Z�&i SIGNATURE DATE V r FOR OFFICIAL USE ONLY APPLICATION# y , F DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER 5 DATE OF INSPECTION: I r . 1 FOUNDATION f; FRAME INSULATION . FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DAFCLOSED OUT ASSRpATION PLAN NO. The Commonwealth of Maysaellusetis Department of IndustrialAccidents Office of Invesligations I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print:LyWbly Name(Business/OrganirationAndividual): Tupper Construction Address:79B Mid Tech Or City/state/Zip:West Yarmouth, MA 02673 508-778.0111 � Phone#: Are you an employer?Check the appropriate box: 1.❑� 1 am a employer with 4. ❑ 1 am a general contractor and I Type of project(required): employees(full and/or part-time)." have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. 0 Demolition working forme in any capacity, employees and have workers' comp. 9• ❑Building addition [No workers'comp. insurance p. insurance.t required.] 5. 0 We are a corporation and its 10.11:Electrical repairs or additions 3.❑ 1 am a homeowner doing all wolf officers have exercised their I I.[]Plumbing repairs oradditions myself [No workers= comp. right of exemption per MGL 12.[]Roof repairs .insurance required.]" o. 152,§1(4),and we have no employees. (No workers' 13.90ther Weatherization/ comp.insurance required.] nsu a ion Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such. `lContracton;that check this box must attached an additional sheet showing tic name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. l ani an employer that L-providiug workers'compensation insurance for my employees. Below is the policy and job site utformation. Insurance Company Name:AEIC Policy#or Self-ins. Lic.#:WCC5005593012007 Expiration Date:10/3/14 Job Site Address: 41 Old Toll Rd W Barnstable MA 02668 City/State/Zip: . Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage ired under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties,of a fine up to$1,300.00 or one-y ar imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and afine of up to$250.00 a y Against thte ' ator. .Be advised that a copy of this statement may be for"rded to the Office of ilavestigations of a DIA for ins, a fledge verification. 1 d'U Hereby ce 6 and t e pa and penalties of perjury that Ilia h ornmtlon provlded ahI'ls true and rreCt St us e: .phone#: 508 Official use only. Do not write in IM area,to be completed by city or town ofJlelal. City.or Town: Permit/License.# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: NClwi�liMAiM�:�t IlVtalll41 t:,IN V Massachusdris•Oapmment of Public Safety IOT11Mrtlsl 'SuM 110 Board of Building Regulations and Standards �.NY 1 _ (u11HP1111IU1,UlA'1'�NtP 1d77!c�T4.1QT! wwwoy►.con+ License; C3-060088 RICHARD S TUPPER "BAlin-TECH nit " WESY YARMOUN- RICh"Ttppor - - —•� .A, Expirimon (CltelvlxteSmPOn6t8+CIaYs idARO1)( ift(14to CWnnkgslUPisf 12131/2014 i Peopts 1`1410118 Paople Build a Safer World- . uut � f MEMBER i Richard Tupper Tupper Constfuctl0r1 Building 840y pmfdaslan®I Member*8158119 Rxp;4/30/2014 .. .... _.._._!01r�ni���i�c,i��ura//�e�'C-lli�,l.fnc/ndc/la ....... _ . . .�.._. �_,.__ _ �....._.... _....._...._ . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only C gOME IMPROVEMENT CONTRACTOR before the expi Idate. If found return to: tegistration: 176434 Type:. Office of C ffairs and Business Regulation �,yfrxpiration: 4/16/2016 LLC 10 Par ara.Su'a 5170 Bo ,MA 021 TUPPER CONSTRUCTION CO,LLC. RICHARD TUPPER 79 8 MID-TECH DR. W.YARMOUTH,MA 02673 Undersecretary o tthbut signature ACORL , CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD/YYYY) 12/03/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to j the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the I certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Lora Lowe Southeastern Insurance Agency, Inc. N Nc . (508)997-6061 Fn Nc:(508)990-2731 439 State Rd. E-MAIL ADDRESS: P.O. BOX 79398 PRODUCER CUSTOMER ID#: N. Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Arbella Protection Insurance Tupper Construction Co LLC INSURERB: AEIC INSURERC: CNA Surety 27 Roberta Drive INSURERD. West Yarmouth, MA 02673 INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 2013/14/1 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. ILTR TYPE OF INSURANCE ANSR SWYD POLICY NUMBER POLICY EFF POLICY EXP LIMITS MMIDDfYYYY MM/DD GENERAL LIABILITY 850000874 11/01/2013 11/01/2014 EACH OCCURRENCE S 11000100 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTEIT___ PREMISESEa occu e e S 100,001 CLAIMS-MADE rX]OCCUR MED EXP(Any one person) S 5,00( A PERSONAL&ADV INJURY S 11 000,00 GENERAL AGGREGATE S 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,00 POLICY JECT 171 LOC S AUTOMOBILE LIABILITY 5666240000 12/01/2013 12/01/2014 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) S 1,000,000 BODILY INJURY(Per person) S ALL OWNED AUTOS BODILY INJURY(Per aWdent) S A X SCHEDULED AUTOS PROPERTY DAMAGE $X HIRED AUTOS (Per seddent) INC X NON-OWNED AUTOS S a UMBRELLA UAB X OCCUR 460005836 1110112013 1110112014 EACH OCCURRENCE $ 11 000,00 A EXCESS UAB CLAIMS-MADE AGGREGATE S 1,000,000 DEDUCTIBLE S RETENTION S S WORKERS COMPENSATION WCCSOOSS93012007 10/0312013 10103/2014 X X AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVEYIN RICHARD TUPPER IS LE.LEACHACCIDENT S 1,000,000 B OFFICER/MEMBER EXCLUDED? N I A (Mandatory In NH) I LUDED FOR WC COVERAGE EL.DISEASE-EAEMPLOYE $ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below F.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remaft Schedule,U more apace is(squired) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. "For Information Purposes Only" AUTHORIZED REPRESENTATNE Tupper Construction Co LLC 27 Roberta Drive W Yarmouth, MA 02673 Lora Lowe 01988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD f i OWNER AUTHORIZATION FORM I, 0- �� (Owner's Nam owner of the.property located at 0 -/ T 1 a (Property Address) (Property Address) hereby authorize U Ccvl S J 1 v ✓O x J (Subcontr t r an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Signature ChMI Br wn(May 15.2014) Owner's Signature Date —&—,— 'own of Barnstable *Permit#a'3U 0�1 nt rom issue date SS PERMIT a . � Expires6mo � . Rebulato Services Fee anrtxs A"BL4 MASI 19 2Q13 Thomas F. Geiler,Director . 1639. �0 ' ATfD MA't A Building Division �C . . TQWN ®F BARdST4StPer�,CBO Building Commissioner 200 Maine Street,Hyannis,MA 02601 D wwwaown.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 L� V �D e l p r ° .�hk lq esidential Value of Work �i 50 190 Minimum fee of$35:00 for work under$6000.00 Owner's Name&Address )f g R Y L J n d Contractor's Name L a L— Telephone Number S iW— ZG— 3-2;?F Home Improvement Contractor License#(if applicable) Construction Supervisor's License'#(if applicable) ( Y6 / 7 ❑Workman's Compensation Insurance Check one: I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp:Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) VRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping: Going over existing layers.of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows ❑ 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: I Massachusetts -Department of Public Safety Board of Building Regulations'and Standa rds Construction Supe-isor License: CS-046189 DAVID H WEBB ; 24 MEADOW VIEW D EFALMOUTM�� � 5'4— ~` Expiration COmmission'er M/29/2014 i Office of�onome Wffa'irs u�ness egu a oon� t License or registration valid for individul use�only HOME IMPROVEMENT CONTRACTOR i before the expiration date. If found return to: Registration: A 19766 Type: j Office of Consumer Affairs and Business Regulation Expiration: $/28/2013 DBA 10 Park Plaza-Suite 5170 F--=- - Boston MA 02116 . W CRAFT DESIGN::- lil = i, I DAVID WEBB k 1 • 25 MEADOW VIEW. EAST FALMOUTH, MA;0253fi. Undersecreta o :.r ry ` Not valid without signature i The Commonwealth of Massachusetts Deparhnent of Indusfi7ial Accidents Office of Investigations 600 Washington Street Boston AIA 02111 " wrvw.mas&grv/dia Worriers' Compensation Insurance Affidavit- Builders/Contractors/E.lecfricians/Phunbers Applicant Information Please Print Legibly- Name(Business/organ t owhifividual):- XA_1L� Address: NL L -r �✓ V t L� 1�2° City/State/zip: = ,4-` IV14 tea 36 Phone:4- 50� - �G 1� Are you an employer?Check the appropriate box: Type of p'. ro,iett(re quired): 1.El am a employer with 4_ X�l am a general contractor and I 6- ❑New construction employees(full and/orpart-.time)-* havetired the sub-contractors I El am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling ship.and have no employees These sob-contractors have g_ ❑Demolition employees and have wodcets' working for me in any capacity. � 7� 9. ❑Building addition jNo workers' comp_insurance comp-mama l required.] 5- ❑ We are a corporation and-its 10.❑Electrical repairs or additions I❑ I am a.homeowner doing all work officers have exercised their 11-❑Plumbing repairs or additions mysself. [No workers'comp- right of exemption per 1Y1GL 12.❑Roof repairs insurance rewired.]r c. 152, $1(4),and we have no employees.[No workers' 13.❑ Other comp.insurance required.} 'Any applicant that checks box#1:must also fill out the section below shawm.g their wmkes'compensation policy information 1 Homeowners who submit this affidavit indicating they are-doing allwal and then hue outside cofactors utast submit a new affidavit indicating such FContracmrs-that check this boat must attached an additional sheet showing the name of the sub-contractors and stare whether or not fose entities have employees. Ifthe sub-conimaors have employees,they mustpmvide their vAwkers'comp.policy number. -- - — -- --- I am an employer that iss providing workers'cornpensahon insurance for grey amployem Bdow is fire policy and job site information Insurance Company Name: Policy 4 or.Self=ins_Lie.9: Expiration Date: Job Site Address#7 / 0Lb LL AD City/State/Zip:W Attach a 1copy of the workers''compensation policy declaration page(showing the policy number and expiration.date). Failure to secure coverage as required under Section 25A of MGL c_ 152 can lead to the imposition of criminal penalties of a fine-up to$1,500-OG and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORIIER and a ime of up to$250.00 a day against the violator. Be-advised that a copy of this statement maybe forwarded to the Office of Investigations of the.DIA for insurance coverage verff=tion. I do hereby ceoftuler the,pains andpeaabyes f icry that the information provided above is trine and correct Si tare: l� J Date: 7 — Phone#: Official use only. Do not write in this area,to be couapleted by do.or town official City or Town: PermitUceme# )issn.ine Authority(circle one): 1..Board.of Heaht 2..Budding Department 3.Cityfrown Cleric 4.Electrical Inspector 5.Plumbing.Inspector 6:Other � �,IO R,''-RS" COIVIPE''1 NATION AND EMPLOYERS L IA131LITY Ii $:URANCE POLICY Information Wage WC, 00 00 01 -I zzuardic Charter Insurance Company VDAC ;. Co No.:29211 Policy Number: WCV00730206 7tv SiU. ED. Prior Policy Number: WCV00730205 -i ynoail Roofing, LLC Producer: I 80 Brigantine Avenue Fredericks Insurance Agency, j Ostervil}e, NIA 02655 Federal ID Number.204616445 Inc. Risk ID Number: PO Box 427 Osterville, MA 02655 usl.ness Type; , - Limited Liability SIC-9999 NONCLASSIFIABL•E-ESTABLISHMENTS i Named Insured: Other Work Places: _. 4�Y PE�"IOD: The Policy Period Is From: 7/'11/2012 To 7/11/2013 12:01 A.M. Standard Time at The Insured Mailing Address VJorke s Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed, here: IVI ; I Employers Liability Insurance: Pali Two of the policy applies to work in each state listed in item 3A. The limits of our j liability under Part Two are: Bodily Injury by Accident $ 100,000 each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 100,000 each employee j L.. Other States Insured: Part Three of the policy applies to the states, if any, listed here: 1 COVERAGE REPLACED by ENDORSEI''EN f WC 20 03 06A D. his policy includes these endorsements and schedules.- See WCE105 C-OVERAGES: The premium for this policy will be determined by our Manual of Rules, Classifications, Rates & Rating Plans. All information required below is subject to verification and change by audit. Code Premium Basis Total Rate Per Estimated Classifications Estimated Annual $100 of Annual NO. Remuneration Remuneration Premium See WC 00 00 01 -------------- -- Minimum Premium: Deposit Premium: $500 $500 Interim Adjustment: Annually Estimated Premium (Minimum Premium) $500 Servicing Office: 25 New Chardon Street ! Boston, MA 02114-4721 11 issue Date 06/14/2012 Countersigned By: � DateUN ` 101 ' _•yrgnt 198 National Council on Compensation Insurance Form: 700mv Yrti Town of Barnstable T Regulatory Services SiRNSTABL= v uLRa P, Thornas F. Ceder,Director �Eo wilding Division Tom Perry, Building Commissioner 200.Main Street, Hyannis,MA 02601 ����.totivn.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This. Section 1f Using A.Builder as Owner of the subject_property hereby auLhoiize LwaL3to act on my behalf, in all matters relative to work authom—ld by this bu.ildi.ng permit application for. 2� (.address of job) Sig tur of Owner LD �e- PrIDt Name /74 If Pro erty Owner is a 1 "n P pp g forperrrutplease complete. the Homeowners License Exemption .dorm on the reverse side. Engineering Dept. (3rd floor) Map 10g( Parcel !Zrl 1 Permit# a-4 gCe House# "'t I eo , Date Issued Board of Health(3rd floor)(8:15•- 9:30/1:00-4:30) Z� e '5,2) Conservation Office(4th floor)(8:30- 9:30/1:00- 2:00) 1,J cn `�,`1 `(�1ts6 ffWA9�7-:;-— Planning Dept. (1st floor/School Admin. Bldg.) SEPTIC► W11ONS ST BE �� LIAAIGE Definitive Plan Approved by Planning Board 19 ENI"000EANC TOWN OF BARNSTABLE *TWO. Building Permit Application Project Street Address -&-o / /T-b A0 0 0 . Village Owner ,Ed T_���5 Address o-2- (_P4 Telephone _��oa� KPI-G, Permit Request !-iJ✓qi& First Floor F, square feet Second Floor square feet Construction Type rz ram e-- Estimated Project Cost $ Zoning-District Flood Plain Water Protection Lot Size 12-Z $.}-. Grandfathered ❑Yes ❑No Dwelling Type: Single Family �r Two Family ❑ Multi-Family(#units) Age of Existing Structure Z Historic House ❑Yes �Q No On Old King's Highway Yes ❑No Basement Type: P Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) a 7P 5, Basement Unfinished Area(sq.ft) Number of Baths: Full: Existing L New�_ Half: Existing New No.of Bedrooms: Existing _? New 8 Total Room Count(not including baths): Existing Cp New f w .First Floor Room Count 1 -A -'ed Heat Type and Fuel: ❑Gas JdOil ❑Electric ❑Other Central Air ❑Yes j -90 Fireplaces: Existing JNew _0 Existing wood/coal stove ❑Yes JANo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) 0% (Attached(size) a 4 X aS -new ❑Barn(size) n,/��� �,,� ❑None ❑Shed(size) ;�'°I �' ❑Other(size) oning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes %'No If yes, site plan review# r . Current Use Proposed Use Qe kol.e--- Builder Information Name Telephone Number 2. Address a_ -y- License# ©gyp One Home Improvement Contractor# f���5'49 Worker's Compensation# NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 9 . SIGNATURE DATE BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) � i FOR OFFICIAL USE ONLY PERMIT NO. ' DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: r . FOUNDATION FRAME y INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: :r, Rl ll (;iH FINAL FINAL BUILHIN DATE CLOSi6,1 ASSOCIATION a. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��� Parcel Permit# (� Health Division Date Issued Conservation Division D Fee 45- ©D Tax Collector ' / 1 SEPTIC SYSTEM MUST BE Treasurer I,ya-e �IZ�JLD�� INSTALLED IN COMPLIANd- WITH TITLE 5 Planning Dept. ENVIRONMENTAL CODE AND Date Definitive Plan Approved by Planning Board _ TOWN REGULATIONS w e eanHistoric-OKHOk AO'c"PIN Prvtio /HAn ' /�` Project Street Address (D Village Owner �U�'�`�h 10 G 5�7yt k 6 v e1 v Address 4 (d f-V ea_ W Telephone In �0 0 ci Permit Request r`�iM � a PPro X f "40l �-� S Sq, `� �� 3 h b CA of,45. w4k,- vty wwl4d 0-vO . P40 �I,k� IG .Bl efi(Stiw 14/44 Vl>! vlevL10v�c1 Square feet: 1st floor: existing proposed 2nd floor: existing I proposed Total new Valuation 95-D Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfatliered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family Cl Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: Cull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other ..Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes,site plan review# Current Use Proposed Use I BUILDER INFORMATION Name 064( &JO-vi &A Telephone Number 4 z Address Po Go( 394 License# ©q 7 ��I o5 Et at 114, WA d1-U Home Improvement Contractor# Worker's Compensation# W(-C:;-(91—�Li ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 3w/Irf 5J'U t/wp SIGNATURE ` DATE f FOR OFFICIAL USE ONLY PERMIT NO. - DATE ISSUED - MAP/PARCEL NO. ADDRESS > VILLAGE OWNER x ,� r DATE OF INSPECTION 1- r FOUNDATION L' FRAME INSULATION FIREPLACE ' ELECTRICAL: ROUGH' FINAL , PLUMBING: ROUGHS FINAL ~ GAS: ROUGH'. FINAL r FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. { �t The Commonwealth of Massachusetts Departure of Industrial Accidents "`'E'_ goes ala -SM0,atioos 600 yyashington Street Boston,Mass: 02111 Workers' Compensation Insurance davit „ ••O name. 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J.,.:....,�.}:Cry.±n.}:�:•:}±.. .. ..... ..... .... ...... ........ A.C..r. :...... .............................. ........... :::S::rr:: >it}:iM:::':r?S'2>i;;y±:::;:[iT:::':?;•:r:4i:c:%:r;is�;:%2Si;:k;:>;>:0:•:9::;:::::::•:}.....:.::.�..... S v:: a a a r es . ...:.:...... ti�S: ........ .v: ...>M...+a?,.... :. ::.....r.C�:&ar.rraf1:r;r.:•:::r.,:::,::.:::. :...;•:::.,::::;::.�:.�::::::::::::::::.:�:............ c ............:.,.............4}.?., at..r:.. .....� .. .,2 }.::• ............. 2^inrance ce<'`:>::<:::::;:::>::::;:<:?:>;:;s:::.<::?::w.±}:•±}:::,.:.N.v:•:,.::::. M to S2,500.00 and/or of cdminsl penalties of a tine ap Faitnre to aeettte roVe==Ee as required tinder Seetlan2SA of MGL LU tsm had t§o!be y gainst me. I understand that a as wa as chn pawtLes in the form of a stop WOGS ORDER and a Ste of S10o.00 a da a one years'imprisonment of the DL►for coverage veriScatton. cop'of this statement rosy be forwarded to the OIDce oflttv�L� under the p ' and atalties° pC1l�'that the iafarniation Pr°'3ded about it trot and corrcd I do hereby certifyLti �' 2 f Q l O/J -- � Date / 1y signature 4� —44 21 Print name b�l�l �/� _... _._ . Phone� oi$dpl w o111da1e only do not write in this area to be completed by city or town Department �Nicense ft ❑Building o city or town: ❑Licensing,Offi ❑Selectmen ce ❑check if immediate response is required ❑Health Department pb�W, - Other contact person: -•ram 9195 r1�11 Information and Instructions ' S provide workers' compensation " ter 152 section 25 requires all employers top tion for th contract Massachusetts General Laws chap is defined as every pro,in the service of another under any employees. As quoted from the"law",an emp, y ce of hire, express or implied, oral or written. vi ip� association, corporation or other legal entity, or any two or more of An employer is defined as an individual,P the legal representatives-of a deceased employer, or the receiver or the foregoing engaged'in a joint enterprise, and including loving employees. However the owner of a trustee of as individual, partnership,association or other legal entity, emP m the occupant of the dwelling house of dwelling house having not more than three apartments.and who resides therein, � house or on the grounds or construction or repair work on such dwelling another who employs.persons to do maintenance be to building appurtenant thereto shall not because of such employment be deemed to an�P 3'�• the state or local licensing agency shall withhold the issuance or renewal MGL chapter 152 section 25 also states every in the commonwealth for any applicant who has . of a Iicense or permit to operate a business or to construct budding coverage required. Additionally,neither not produced acceptable evidence of compliance'wifhthe msU>z'an public work until of its olitical subdivisions shall enter info any contract forthe performance of p commonwealth nor any P of this chapter have been presented to the cunt" '" �r`acceptable evidence of compliance with the msu-Jncereq-0kenicrits authority. L ff :applicants and Please fill in the workers' WMPensatEM a��Camp ' checiang the boat that applies to your situation namabes along with a certificate of insurance as all affidavits maybe sapnitring company names,address and pbaac . of inm a� • Also be sure to sign and submitted to,the.D artmen#of-.Industit Acecd� tlint licatim for the ermit or license is should be to the�y or town . aPP P date the affidavit. The affidavit Accidents. Shanld you have regarding the"law"or if you b e^ing requested,not the Department of Inds meat at the member listed below. a workers'•camP policy,P call the Department are required to obtain City or Towns • Department has provided a space at the bottom of the is - lm and I * ' .has to ca daat you regarding the applicant. Please Pl..ase be sure that the affidavit� camp affidavit for you to fM out in the event the Office of � number. The affidavits may be retuzned t^ be sure to fill in the pie nnnber wbtch wffibe used`as a reference the Department by mail or FAX Unless other arrangements bave been made. would .tom�in advance{�you cooperation and should you have any questions. Th.- Office of Investigations please do not hesitate to give us a ca1L Mom ����EW Tne Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Dince of Nvesugations 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 7274900 eat. 406, 409 or 375 The Town of Barnstable • aARNSrABLE. Regulatory Services l><n Nu•+° Thomas F. Geiler, Director Building Division Ralph Crossen, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW. SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied build ing;containing=at-4east�one;but,not,more..than.four dwelling units or to structures which are adjacent to _u such residence or building be done by registered contractors,with certain exceptions,along with other requirements. �. Type of Work: �iv =�O Estimated Cost 6 a Address of Work: 4' 01J TO11 k Owner's Name: 104 a Date of Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Mob Under$1,000 ffBuilding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE - - ---.- _�- ACCESS TO THE-ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: z ((9 0 Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav ��; '" ONE INPROVENENT�CONTRRCTOR �*w�`��. z Registration $ �� • ��� Exp ri atiiin:�lI/12/Ol a...�j�;�, Type DBR t xsfi< f N 'lir* Nall ICHAEl7J 6ARDNER BUILDER 1C M1• G�ca��o �sN GREEN -�,I;ADMINISWTQR tQSTERVILIE BOARD OF BUILDING REGULATIONS i Ucense:,CONSTRUCTION SUPERVISOR Number:-:CS;=a 047291 Birthdate. 02=1964 Up k s:.02/2'L2002 Tr.no: 18719 g Restricted To,. '1 G' MICHAEL J GARDNEk'_ PO BOX 334 OSTERVILLE, MA 02655 Administrator i - i i The Commonwealth of Afassac•husetts Department of Industrial Accidents Office ol/oyestigat/ons It.'; ',`'' h110 11'a.vithr tots Slrcet ` .+;:-.- IN .'-Boston, Alas. 02111 Workers' Compensation Insurance Affidavit It an inf rm i n: PI P m • loc•ttion' 11Z cio. I am a homeowner performing all work myself. e ❑ 1 am a sole proprietor and have no one working; in any capacity _ .. � _.y.-_..r.. .-a-.—'� w+."'sw_tfr•r.�ur•.^ffS.?.r�:,.??nr".*�.+_..w..a!•�•�.-an�,++..:.werA�^..+. ,..•..r.+... r�r...-.y.. ... ..'.',.-�..-........ ._ ._..... L'� ._.....w..:..:.s:.. ..9.. ...ate... - '•.ir' :"r.. ..�.:.:t_.w�..i.:,..�::_�.,.... .�..�t.-- -�..��.-:.,__�.__�_ II am an emplover providing workers' compensation for my ewplows working on this)ob. , SGc$ CBSc7*14C7V;- company name address: city: LEI �/ �/!J) � � nhone#- instirince cn 8242 k&JIM polia# 4o I am a sole proprietor, beneral contractor,or homeowner(circle one) and have hired the contractors listed below who have the followin; workers' compensation polices: comCinv n•tme• address: cirv: phone 0: incur,ince co policy# ._ILL:.+.+.>.i.+.��_ui'..-a1�.�LrJIr'.rr.l raai�.rai.. -:I _.r�l-:.-ib.Yi••: L—�_G coniyiny nime• address: city: phone#: insurance co nolicy# :Attach additional sheet if necessary �•: "^- : `_�' � �^ f,;7; '°"-' • .�"Jr':it��...►-._.�_:r�u..hL�J��•�--`�J. ._�_�.�_...v..�._'r'�r'..- Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a tine up to S1.500.00 and/or one years' imprisonment as well as civil penalties in the form of a STOP NVORK.ORDER and a fine of S100.00 a day against me. 1 understand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. 1 rlo berebt•certifi'under the pants and pet ies of perjure'that the information provided above is true and correct. Signature Date AAA Print name /t/� N 21z_ Phone k �0C7_g 2, official use onh do not syritc in this area to be completed by cih or to syn official city or tnsyn: permiUlicense# OBuilding Department C]Liccnsing Board ❑check if immediate response is required ❑Selectmen's Office I [3I1calth Department contact person: phone#; r'tO1hcr tro,sed 3:nc IVAI Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "la\%•", an entphwee is defined as every person in the service of another-under any contract of hire, express or impiied. oral or written. An enrphn'Ver is dcf incd as an individual, partnership, association. corporation or other legal entity. or any, two or more of the fore�,oing engaged in a joint enterprise, and including the le-al 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 ,rounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally, 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 in the workers- compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you Dave any questions regarding the "law" or if you are required to obtain a workers' compensation police, please call the Department at the number listed below. 77 Citv or -howns Please be sure that the affidavit is complete and printed legibly. The Department ltas provided a space at the bottom of the affidavit for you to fill out in the event the Office of investigations leas to contact you regarding the applicant. Please be sure to fill in the permit/license number wliich will be used as a reference number. The affidavits may be returned to the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and sliould you have any questions, please do not hesitate to give us a call. -.,y..,..t+.._,..: _...-.,.�..^v:.-..•_ .---w.:.r•.r....:n�.:-..v.r '•,ew.,....-..�..+rare.++,•-:..�'. ..nv-�...�R.,.,,�...�.-- vn+-�w....�._-.•..n.. The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents „n Office of Investigations 600 NVashington Street Boston, Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 erne r� • snatvsrABIE • The Town of Barnstable 9 16 9. ,0�' Department of Health Safety and Environmental Services Eat' Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissior For office use only Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL,c. 142A requires that the "reconstruction, alterations, renovation, repair, modernization, conversion, improvement, removal, demolition, or construction of an addition to any pre-existing owner occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors, with certain exceptions,along with other requirements. Type of Work: Est. Cost �%�� Address of Work: / Ol Z-2 Owner's Name Date of Permit Application: I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under S1,000. _Building not owner-occupied _Owner puffing own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the g nt of the O3� Date Contractor Name Registration No. OR ,y S • o � t: d � , �,s,gC 'a N � am ��.• o o�� C � ��L�� sL _ 22 m";`a� ®, � fit. ^i�ft y .��;'• _ M M � Q �L ��'r" � iV � v (�^ �'�c�-+ N ii a:`�• �11 ti1�+:..�&�,` f% F' =�i�'�a`�''d ¢�JwP v,� � . z ,. c� By..-MT..........DATE-1 SUBJECT.- � ot4..! tLfj, 21 ��q � . _ . ._._ ___. CHKD. BY...........DATE +" -t------ JOB NO...... -- T1�i�Zf�.. R-#�_M1N1� R1 .:� , l P Fl,00 J o t ITS F SaiivT-e;; 2 x 'b @ " o,c, COhlT"t�41 1otjS 2x b SLc(-,r`d�46 2Ln FL, . I � I t , Z x j�AIL� C2� /211LTS C 5- o O,G. -rq off' 2- I/z" Sa.T•5 CAP 11s"y --��j- rr d�- I �O 1%0071 - x 2'- kX I �- - t { x 1 2 �oTr� H&TSt;2i E;sTF, , vVK4H- sr t_ TO 56 A-S i M A S c.o, s140P ?1410WD wl rv;T )OWI&T1va OA111 Z;OLTS To SE }} sTh'� ft 307 (GF�L�.)°�`t�z,"� C��►,ls�Uf-I -1YP� X c}�M,�1 To Co r 4 J O s i 1 TJ i > of Sri= ¢1-JD MASS Gabrg� LATE" bDrT1o� �EQVIP�=1e�1 A�,t- WeLDS ;5-Ie�-T2oDEs . SAP Wet.D Ckf hp4D tASP', 's 'n `5, G��.�ItJRr� A1,1. D<t-��}JS1or�S v� I� �RL�-1 IT�LN��- 1�RvJ►NVS� }}+J� Fl�v'� MICHELE C . T'UDOR , P. E . ���`` MICHELE gcti� Consulting Structural Engineer sTNo.Ru347 AL N 123 Cottonwood Lone 9 Centerville.Massachusetts 02632•(508)771-7601 Q®9�.�F9�STER�G��>��`� �. Application to <PW�HS Old Kings Highway Regional Historic District Committee in the Town of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, iri triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts,•1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ❑ New Building JT�r Addition. Q Alteration Indicate type of building: (House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: Z�' 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). p TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK 41Y)�Z&!e&re—l"LXASSESSORS MAP NO. OWNER LX ASSESSORS 44OT NO. (s5�h) 3fo z—P SuS HOME ADDRESS 34" ��- CLxU����i�SiD�G%� TEL. NOCiL60) FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public s et or way. (Attach additional sheet if necessary). 27 Ce—j /oL.�L— r6 w 13. Lam% 74— AGENT OR CONTRACTOR TEL. NO. ?2 ADDRESS qcl�/� NU Z:M. © 2! 73 DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). 40,0 a, Fuct, 34'y)� La/.c•�s��y� a rim FQrh.1, 9a0 s. F� To Tfj� iQl6 Signed Owner-Contractor-Agent space below line for Committee use. n Received 1p H:D.6 I� LID Date The Certificat is hereby 6(49C1 ✓eJ Date u L2 -J%WTime /K ____0 TOtAI�J OF I:iAPi'iS7{481.E Approved ❑ IMPORTANT: If Certificate is approved, approval is subject to the 10 day appeal period provided in the Act. Disapproved ❑ Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION Di /1L'Ls�i9�1/' p SIDING TYPE �i DO'S d-�/�C�-�• C� Suliyl•�1c�COLOR Nj�/rQL CHIMNEY TYPE ^C F /S >�COLOR�� 7 ROOF MATERIAL 3 Tl .� COLOR 13 po J� PITCH )Z� 2_ i- e,Yc IF- TOP wlNDow OV 4 SIZE TRIM COLOR DOORS ('o COLOR SHUTTERS COLOR_ jQj&2BjQ 2� GUTTERS (AA" PIX C'"p DECK /SfS - -�_ziz� !-!�/d� IIP GARAGE DOORS T"!547 f r91:g o ST9F_/__ COLOR SIGNS, �� COLORS FENCE COLOR ;v • NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. Plot plan need not be "Certified" except for new homes, but should show all structures on the lot to scale. SPECSHT RE 00 00 PROPOSED FRONT ELEVATION ® o o ® ® BE EH ®® Mil ® ® ® m ul m (30 PROPOSED REAR ELEVATION NEAL A. PRATT WARREN JOHNSON RESIDENCE DATE 10-10-9b PAGE:2 of 1 BUILDER/DESIGNER42 CH SEROAD PROPOSED ELEVATIONS SCALE None E. SANDWICH, MA 02537 BY: NAP PHONE: (508) 888-3206 4^00 7WMLe , q7 RECEIVE® JAN 4 1997 VVEST BARNSTABLE FIRE DEPARTMENT 130 a� PI U z 2 LEFT ELEVATION REAR ELEVATION `d. Barnstable Fire be It REVIEWED I Location Number Bsmt f st Floor Z ® � Znd Floor F111 .40THer — Total Notes: t42 ® ®® ® ® ®® ® ® �� It ®® ®® j Reviewed ® FRONT ELEVATION NEAL A. PRATT WARREN JOHNSON. RESIDENCE DATE: 10-10=96 PAGE:1 ,DF4 RIGHT ELEVATION BUILDER/DESIGNER EXISTING ELEVATIONS SCALE: None Al E. SANDWICH, MA 02.537 BY: NAP PHONE: (508) 888-3206 19' 1 EXIS NEW FULL PW&. CELLARCELLAR 0 GARAGE 21'- 1/2' f . 19, CELLAR PLAN -- ------ -- -7 NEW FULL CELLAR FLOOR �, / EXISTING CELLAR / GARAGQ 8'.oil I / Notes / —— — ———— J 16'+8'keyed Footing-#MD test 24'- 1/,- B'walls-0300D test/gored to a+s;slN fandotbn / 4'wqn 12 9 ` J / FOUNDATION PLAN NEAL A. PRATT JOHNSON RESIDENCE DATE: 11-20-96 PAGE:4 of 4 BUI DEIR SEE IGNEROAD FOUNDATION PLAN SCALE: NONE E. SANDWICH, MA 02537 BY: NAP PHONE: (508) 888-3206 4 19, 1 OFT LINE rI ,j EXIXTING HOME } + LO FT G��/✓/�/) JA V S GARAGE II''�` ❑ ATTIC 24'- 112' t ' PROPOSED 2ND FLOOR PLAN IT d' FAMILY ROOM oFt Ine ' ec ' EXIXTING HOME �0 ?([ TLLJJTge- w GARAGE D 2<'- Ile Public Health Division 7 1 oot line above Town of Barnstable PO Box534 PROPOSED 1ST FLOOR PLAN Hyannis,Massachusetts 02601 Fax(508)775-3344 Phone(508)790-6265 NEAL A. PRATT WARREN JOHNSON. RESIDENCE DATE: 10-10-96 PAGE: 3 of 4 -1--,, e�')e r e Jowl A0 u,t,'- BUILDER/DESIGNER SCALE None 42 CHASE ROAD PROPOSED ADDITION BY: NAP �� E. SANDWICH, MA 02537 p iv �j�¢t/,�. 4 ,�jpJi ' PHONE: (508) 888-3206 /��t�'C2� i Asphalt singles over Felt 2x10 rafters 16'U. \ 1/2'CDX sheatNng Rag fbergloss nsuiolion Ix3 strapping 1/2' ,rawinrtl ontl plaster Asphalt sN.0 s over Fell ue600/ \ 1/2'COX sheothng 2x8 rafters 16'6C. 20 collar Ue5 16'6C. //// ¢-� r►D I I 1 Ridge and soffit vent Ridge and soffit vent 2x I/_ m I VNte cedar shngles over fell / !� �@ {v 5 � 1/2'CDX sheatNig it) 2x6 studs 16'QC. Vr R19 Fbergloss nstaotion 3/4'i6G subfloor I l(p 404 L. 1/2'biueboard and piaster 2s10 floor joists 16'0.C. Vhlte cedar shingles over typar Ile CDX Flash floor 1,1 studs 16'O.C. r3/4'i&G sub Floor P.i.Sat piote II 2x8 Joists 16'D.C. I R19 fiberglass sheatNng 8' c'eto call se 2 / 4'xe'forting 'reinforced concrete floor B'concrete vdi wx16'fooling 3'concrete floor of ,�qc 0� MICHELE yG g C. TUDOR N No.34774 STRUCTURAL 'tcISTER�`���a`��`� FSS/ONAL —97 NEAL A. PRATT WARREN JOHNSON RESIDENCE DATE. 10-10-96 PAGE.5 of5 BUILDER/DESIGNER CROSS SECTIONS SCALE None E. SANDWICH, MA 02537 BY; NAP A 5 PHONE: (508) 888-3206 �//%% �e !L� �r L ����t;. �'�:J':..:;[ 4ti• '�;*Z: "N:.�' ,��.L v � S+`_`�p+5, ; v tl L•;a�'�.") �yr~T" i'G. Ur',+4^,S;��r' 77775 _ c " _ .. .. '' �� • :^fin�-•_ 't'. J; tZZ L v T J��p N mD/? rA 7aiV h Na --- G ��-r/� • F - .. low TQ L L Tz Ufl. P,owrza.i � CERTIFIED PLOT PLAN . S•?� i yr. LOT . 7.5' OL G o:. R09ERT , NEW CONSTRUCTION ONLY �. _ � �' BRUCE � WE T 13 A isl5, .': ELDRED TOP OF FOUNDATION IS FEET % `' J IN ABOVE LOW POINT OF ADJACENT.: £ ROAD. jj roa su�� - AS$* :�.w . . SCALE / - 40 DATE GE ENGINES !NG :, :. "ngc�Eow fo����,T,�� ✓ "��' '' ;'' 1 CERTIFY. THAT THE CLIENTS ; - EGISTERED REAIBTERED ;a; "' �'='."83 z g g SHOWN ON TN1S PLAN 13 LOCATED" CIVIL LAND: �_. JOS N0. ON. THE GROUND AS INDICATED AND : _-- . ..' A n I /`_f%UWilkOfVQ• 1'A Tut mr0% aan I 1WQ•::' ryC�+;gay _ . - f7 TOWN OF BARNSTABLE permit No. __.--_---259------------------__,--- Building Inspector t NAWWAn _ Cash X. OCCUPANCY PERMIT Bond ____ •G�j/ ' �� 'warren Johnson Issued to Address lot #75 41 Old Toll Road, West Barnstable Wiring.Inspector Inspection date fc - -- Plumbing Inspector i ,rXM 34 - ` Inspection date Gas Inspector In ; A � _e«j6�' Inspection date .� , � Y4 t�". k'Engineering Department Inspection date Board of Health . F1 _�• r, Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. f' f . ......................................................... _�. .._._...... Building Inspector Assessor's map and lot number . ..."1......-..../,/.......... THE Sewage Permit number '... �P Q BAUSTADLE, i q MML House number ....:.................................................................... co i639, ♦� e 0 YPY Or TOWN .OF BARNSTABLE BUILDING INSPECTOR �2 y Ca IJ "(R�CT" �IJc ��� 1�GU �1,/6JCq . APPLICATION FOR PERMIT TO .....................................................>:...................................................................... TYPE OF, CONSTRUCTION ..................................................................................................................................... ............. � .. < C ..`:.......19.3. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to ,thle following information: rs Location ......L-T R ar.... 5 C�t� IvI` .L. s�......Z}�t �C ProposedUse ...... AaMt. ..(.........Z..�.�1,scF; .......................... ................................................... Zoning District ....t`.A................................................................Fire District ........N�.'�..��!�!...s................................... Name of Owner -.1,...................................................Address ......�.��..��..'..��� c.. PT..MI�P.SF : Name of Builder Sa4al� � ' c- .or.9 1 (5 ....................................................................Address .................................................................................... Name of Architect ..................... �S ....Address ��c��.�c�� 4 l�J �bc .n.............. gri Numberof Rooms .......5/457......................................................Foundation .............................................................................. Exterior1F� ............................Roofing ....pl� .-,�,tnT............. ........................................ v tit�'��zl� M� t `( Floors ,: wpph �} Y . Interior ...CAt?1 C- y-......... `... :a. ... .............. ........................................... HeatingI/ .......�I ...... .......................... Plumbing .. ��T 1iz-�FtnJ.............................................: .... Fireplace ...... .................... ....................................................Approximate.'Cost ..:..ram..® ........................ ................. Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ...�.?:.�� .: ..................... Diagram of Lot and Building with Dimensions Fee... ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 4 1 '.4 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations-of the Town of Barnstable regarding the above construction. Name ...... ........ . .... ... .C. D�...................... J 0 is9f Construction Supervisor's License .................................... JOHNSON, WARREN A=109-71 25979 1�2- No ................. Permit for ...........Story ......................... Single Family Dwellin(j............... .............................................................. Location .....Lot...7.5.........4.1...Old...T.O.1.1...Road . .. ..... .. W., Barnstable ............................................................................... Owner ......Wa.r.re.n...J.oh.n.so.n............................ .. .... .. .. .... .. .... .. Type of Construction ......F.r.ame......................... .. ....... ............................................. .......................I........... Plot ......................... Lot................................. January 18, 84 Termit Granted .....................................19 Date of Inspection ....................................19 Dote Completed ................. .................19 70' • Assessor's map and lot number .. ..... ........... yofteeTo` 41 � C SYSTE Sewage Permit number 1, ....C,�l'...21................. S�.�'�6 o� $"STALLED IN C ;1?s � • .,per • House number .................7....... ............................... �4ITN1•TOTL MAO t639. „!`,VRONG1 ENTAL a TOWN OF. ,, BARNSTABL^E�A f°= ' T 10 N BUILDING"" INSPECTOR APPLICATION FOR PERMIT TO ..... ......�A� ... � t`. �� .� �F........... . ...... ....... . TYPE OF CONSTRUCTION .................. ............................. .............. T..` ......19 3 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ..... T.... .................................ft......0®...........��G.�..1.............................d.�........................................... Proposed Use .. eMCAe.....FA:`!4A�<..........R-P-SkDR �................... ............ Zoning District ....!4 ... .............."..6 . Fire Distri r4.421 . . Ica Name of Owner ... �lb -��---- � ............................Address ...............................`..............................:...................... Name of -Builder .......................Address 14�. I.'�✓�LwN.. �.. aQ�1`1e Name of Architect .tom+^ .............. .......s� � 5.................Address ���... ......`y`�.:.. � ga Numberof Rooms .......&......................................................Foundation .............................................................................. ExteriorW .� GE��Q- 115F��5 Roofing . 1�4�1AUT.......................................................................... .... . .. . . . ............................................................. y - Floors ..........................r 4 v�a�-rzl .. �.... . �N3E:0� '�Y�'� ....Interior ....C.#!f?i�.. .:�'l�?�(,� Heating / 'G gG tii .. . .......Q/...................................Plumbing ... �H" ............:................................ Fireplace ' ...Approximate Cost �... ............ ........ I Definitive Plan Approved by Planning Board -----------_______-----------19_______. Area ... .. . .... Diagram of Lot and Building with Dimensions Fee �/. .................... .................... SUBJECT TO APPROVAL OF BOARD OF HEALTH (��- OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... . .6....... G.[1` !7......... ......... Construction Supervisor's License ..... JOHN-SON, WARREN 25979.- 12 Story No ................. Permit for .................................... F.ami.1Y..Dwellz.ng................. '4- Lot - r Location o ...75 ^ a i --� F...4.1..Q1d...Toll...Road. `. .............. .. Vas.t..B,arns;tabl,e...................... 31 Owner ....Warxem...J.Ohn.sian.......................... Type of Construction Exame.............................. al ................................................................................. 1.71 vd, i 'Plot .::. . ................... Lot ................................ g Y � r�7 3 G. 'Pe�rmit Granted Ja uarY...l$.�.--...r.19 84 Date of Inspection/.-:!�!,/- 41.........:..........l`9 Date omelet d ....................... 19 ` 7 1 s t V1 1 5 vv Iv ( Lar-75 (13(- j z � L 0-T —7 f s' Z—v7- � 6 N 6 - G t----- j -C—— 62 1 3 i •fl �'G�TC M � 4e • f �� �i+'� rLt�rT/k L U G� `� La.ei /� /► �pf,J�or>rya". -�'Lq 7Lls,+oJ ZQ wli..:G CERTIFIED PLOT PLAN Mom'„ s :di's :? NEW CONSTRUCTION ONLY : �st<uct_ ° Wl �a7T C �, ;^�,*'a^psi p? � TOP OF FOUNDATION IS-- FEET _:` IN ABOVE LOW POINT OF ADJACENT >. ,fi` . s'7E���� .8A J1 S"fA .ROAD. SCALES / " _10' DATE 1110%4 Q /AGE ENGINEOING C4.1N /`�����p'�/ I CERTIFY THAT THE F&'d/`2/"9�"t SHOWN ON THIS PLAN IS LOCATIED �'^'' E0ISTERED� REOISTERED CLIENT 8 S '. CIVIL LAND JOB NO. ON THE GROUND AS INDICATED AN�O�', s: ENGINEER SURVEYOR DR.BYl A '�, CONFORMS TO THE ZONING LAWS OF BARNSTABL , MASS . 712 MAIN STREET — CM.BYE T. _ / i gy H YA N I.I S, MASS. SHEET / OF DATE REG. LAND SURVEYOR ' 6 TOWN OF BARNSTABLE 25979 �( Permit No. - - - - - --------- { 3 3 Building Inspector ` cash +M°w .. r 1016. OCCUPANCY PERMIT Bond �__445 Warren Johnson Issued to Address lot #75 41 Old Toll, Road, West Barnstable Wiring Inspector �'/ -G Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date - J Engineering�Department ,' f R Inspection date Board of Health ^ . p'T• �f Inspection date y THIS PERMIT WILL NOT BE VALID; AND THE`BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE -BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF.THE MASSACHUSETTS STATE BUILDING CODE. 6,491 63 ,lam .................................... ... ls......� _ .......... _... ...... Building Inspector FROM TOWN OF BAR'NSTABLE Mr. Francis Lahteine BUILDING DEPARTMENT Ttown Clerk �367 MAIN STREET HYANNIS, MA 02WI � yr4MMar.�P 2N`rl.ww♦�.Yad4PlF Phone; 775-1120 SUBJECT: FOLD HERE t DATE February•19, 1985 M E S S A G E' Work has �8em Meted under Pemit t25979 Warren Johnson) • ♦n-a.Y 1e.b ♦*,11'Y`:#aiT,F#`s y.w�4+..#•il.Ji-wsw�il,a"w �t♦W`4,►4Y*-•aYyt-x 4•4+t-s•-tea �vuM♦•os iL w�.•` Please release Bond. „t'B!sw Part!•..e.nrt•�'4rcs7`eFwaawaw•►'O`�V.wewiN ar.,YiVa+kM'.✓•r41^ /A Y SIGN D DATE - REPLY Vt SIGNED .. ,. ►.. Nei-RMI RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. fFROM TOWN OF BARNSTABLE BUILDING DEPARTMENT Mr. John C. McKean 145 Great Marsh Road 367 MAIN STREET HYANNIS, MA 02M Centerville, MA Phone: 775-1120 SUBJECT: Lot #75 Old Toll Road, West Barnstable FOLD HERE DATE October 31, 198. MESSAGE A Foundation Permit will be issued upon approval of the Historical Commission. SIGNED DATE J REPLY SIGNED N87.RMI RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. Ilk •'•.•.. Remember Luj can Printing for all your printing needs! 428-8700 0 4507 Falmouth Road (Route z8),Cotuit TO TIME- DAT E ZC VIH�LE Y '_�:JWEREOQuRGE:1T Q relephosea M. Q Retrrmed ��Q{alleV to ywrc ccHi � . see pcu OF s pc PHONE Wrll ctlll1'ou'p c ain q • � 9�� ' �t know�U MESSAGE OPERATOR: 7 23-024-400 SETS 23-027-200 SETS