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0 _^�RFCYCI;'ppp i UPC 12543 No- 53LOR o��p-T•CONSJ�� HASTINGS, MN 11 2017 11:50AM Tupper Construction Co. 15087785010 page 1 r?St%jTU1MPF. R CONSTRUCTION CO_LLC 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 16 M.TUPPERCO COM Date: 5—//l.// , Town of Barnstable Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry N; This affidavit is to certify that all work completed for permit appti h tion # 7 rn Issued on `j� // 7 - has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Address-,,,, i Richard Tupper License # CS-69058 Town of Barnstable *Permit# Expires 6 month om issue date Regulatory Services � eeS', - • a*axsrnBIX • � MAHB Richard V.Scali,Interim Director '�EDD Building Division DEC 0 Tom Perry,CBO,Building CommissionerTow/v 1 2014 200 Main Street,Hyannis,MA 02601 O�BgRNS www.town.bamstable.ma.us 'I/ Tqe[� Office: 508-862-4038 Fax: 508-790Ti`230 EXPRESS PEPMT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number /'7Y �o 96-6 Property Address ,7 Fop 1-0 1r p 24 Cc�A-V Residential Value of Work$'Y7G Q Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address & d klot? gt-m.ad Lte Le (W 12,4, &,tjlg Contractor's Nam f9 6 �G, _Q Telephone Number Home Improvement Contractor License#(if applicable) &!d � Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [� I have Worker's Compensation Insurance Insurance Company NameI�� Workman's Comp.Policy# GwL°&<�o3z��h S/ao/V 4 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-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side E911Gplacement 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 r aired. SIGNATURE: TAKEVIN D\Building Changes\EXPRESS PERMIT MRESS.doc Revised 061313 •t PaeIofI Details g Licensee Details Demogra hic Information Full Name: RICHARD P. GARNEAU JR Gender: Owner Name: License Address Information Address: Address 2: City: West Barnstable State: MA Zipcode: 02668 Country: United States License Information " License No: CS-009714 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 4/1/2014 Issue Date: Expiration Date: 4/4/2016 License Status: Active Today's Date: 12/1/2014 Secondary License: Doing Business As: Status Change: License Renewal Prerequisite Information No Prerequisite.Information Discipline No Disci line Information Documentum http://elicense.chs.state.ma.us/Verification/T.details.aspx?agen.cy_id=l&license_id=207453& 12/1/2.014 MASS. ,� Town of Barnstable RFD MA'S A Regulatory Services Richard V.Scati,Interim Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby autho ` to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) i — C igna f Owner Date kLt-mni rint me If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. I TAKEVIN MBuilding ChangesEXPRESS PERMIDEXPRESS.doc Revised 061313 The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 svmv mass.gos/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leably Name(%ninewftanization/tndividnal: kp t- £j 2W1 :;9X) Address: City/State/Zip: a Phone# Are you an employer?Check the appropriate box: T of project(required): 4. I am a general contractor and I Yl p I ( � � l.(�.I am a employer with�_ ❑ g 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 8. ❑Demolition w for me in as capacity- employees and have workers' �g Y� tY• [No workers'comp.insurance comp.msurance.I 9. ❑Building addition required. 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions ] officers have exercised their 11. Plumbing airs or additions 3.❑ I am a homeowner doing all work ❑ g rep myself[No workers'comp. rightt of exemption per MGL 12.❑Roof repairs insurance required.]i c. 152,§1(4),and we have no employees.[No workers' 13.[kOther comp.insurance required.] *Any applicant that checks boar#1 mast also fill out the section below showing their wookers'compensation policy information. t Homeowners who submit this at3zdsvir indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such +Contractors that check this boot mast attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the subcontractors base employees,they must provide&err 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 Nam Policy it or Self-ins.Lic.# t)d p (,IWhI)4 a I U Expiration Date: Job Site Address: 0,0 PAi41,0d2lf�& (Aa-[a City/State/Zip: Id 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 certify un the pains and penalties of p irry that the information provided e' frue and correct Si lure: _ �`L�-• Date:/ / Phone 04 Official use only. Do not write in this area,to be completed by city or town official. City or Town: PermivLicense# 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#: 6 � I Business Regulation Office of Consumer Affairs anVow d Bus g 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: Suppllement Card 600 Type: Expiration: 3/26/2015 BAKER & ASSOCIATES INC. RICHARD 521 SHOOTFLYING HILL RD CENTERVILLE, MA 02632 Update Address and return card.m k reason for chsatng ❑ Address ❑ Renewal ptoyrnent ❑ Lo Card SCA 1 Q 20M-OW11 �eamneonuieall� C.�asrac>/eu iRce of Gossamer Affairs&Business Regulation License or registration valid for iedividul use only before the expiration date. If found return to: WR MEIMPROVEMENT CONTRACTORpffiee of consumer A-90irs and Business Regulation M lstration' 182600 Type' 10 Park Plaza-Suite� 170 Expiration: 3/26/2015 Supplement t 3rd Boston,MA 02116 BAKER&ASSOCIATES INC. RICHARD GARNEAU P.O-BOX 923 NotJfiddMwithou ignature CENTERVILLE.MA 02632 Undersecretary Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-009714 RICHARD P.GARNEAU SIR 251 Woodside Rd,' _ West BernstableiNA 0 r commissioner 04/04/2014 I Client#:9742 2BAKERAS ACORD," CERTIFICATE OF LIABILITY INSURANCE DATE 0423/2/23/2D/Y014 4 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil PMONI 508 775-1620 -Ac zt ,No): 5087781218 . A/C No E Insurance Agency E-MAIL ADDRESS: 973 lyannough Rd., PO Box 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURER A:National Grange Mutual Insuranc INSURED INSURER B:Associated Employers Insurance Baker&Associates,lnc.P O Box 923 INSURER C Centerville, MA 02632-0071 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACTOR 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 ADDL SUBR POLICY EFF POLICY EXP LT TYPE OF INSURANCE INSR WVD POLICY NUMBER MW DD/YYYY MMIDD/YYYY LIMITS A GENERAL LIABILITY MPJ7223M 4/19/2014 0,-7/19/2015 EACH OCCURRENCE '$1 OOO OOO X COMMERCIAL GENERAL LIABILITY I DAMA� TO RENTED _ PREMIS S(Ea occurrence) ,1s500,000 CLAIMS-MADE X OCCUR i MED EXP(Any one person) PERSONAL&ADV INJURY 1$10,000 $1,000,000- i I GENERAL AGGREGATE $2,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: I I PRODUCTS-COMP/OP AGG I$2,000,000 POLICY PRO i LOC I $ C I COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident I _ I ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAR OCCUR ! I EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE I AGGREGATE $ DED II RETENTION$ _ _ $ B ;WORKERS COMPENSATION WCC50050024542014A 4/23/2014 04/23/201 X ,-T.o YTAI u"s_I. IER" AND EMPLOYERS'LIABILITY - tANY PROP RI ETOR/PARTNER/EXECUTIVE Y N E.L.EACH ACCIDENT s500,000 I OFFICER/MEMBER EXCLUDED? N NIA - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE s500,000 i If yes.describe under —'' I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT s500,000 i I I I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Barnstable Town Hall, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 367'Main Street, Hyannis, MA. 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S129439/111129438 KKM H Y ©11 �� �0 Town of Barnstable *Permit# Q„ Expires 6 mondtL&om issue date Regulatory Services Fee BARA, ABIXM RR s 1639. Thomas F.Geiler,Director Mfg� Building Division Tom Perry,CBO, Building Commissioner n 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY 00 Not Valid without Red X-Press Imprint Map/parcel Number &6 Property Address atio�Ii tt��e"� Residential Value of Work 3,(�,` Minimum fee of$35.00 for work under$6000.00 Owner's Name&Addressi G� TerC�i O P1 ✓ _ Contractor's Nam . Telephone Numbe O::a a�1,4_<5- Home Improvement Contractor License#(if applicable) /&Gj / 70 Construction Supervisor's License#(if applicable) 7�Y / ^ : PERMIT �workman's Compensation Insurance Check one: ,1'-I ❑ I am a sole proprietor ❑ I 4m the Homeowner TOWN OF BA,RnSTASLE- I have Worker's Compensation Insurance Insurance Company Name a Workman's Comp.Policy# [p "_000 4 s/o 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-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side 1 #of doors Replacement Windows/doors/sliders.U-Value (maximum .35)#of windows *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 re uired. SIGNA C:\Users\decollil:\AppData\Local\Mcrosoft\Windows\Temporary Internet Files\Content Outlook\DDV87AAZ\E.XPRESS.doc Revised 072110 1 lee Coin inoitwealth of Massachusetts� Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, NIA 02111 >vww.ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information A Please Print Leiliblv Name(Business/Organizatio /Individual): Address: &o?t p City/State/Zip: Phone.#: CO 041M d ` - Are you an employer? Check the appropriate box: Type of project(required): 1.[:'I am a employer with 4. ❑ I am a general contractor and 1 6 ❑ New construction employees (full and/or part-time).* have hired the sub-contractors %.❑ i ant a soie proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 1 Zpw f employees. [No workers' � 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. #: bAC �� (�/Q DL� Expiration Date: City/State/Zip.—p Job Site Address: w Attach a copy of the workers' compensation polic eclaration 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 certify under the pains and penalties of perjury that the information provided above is true and correct. rSiQnature:, Date: Phone # L! �GI � � Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License# Issuing .Authority (circle one): 1. Board.of Health ?. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: i Client#:9742 2BAKERAS ACORD,. CERTIFICATE OF LIABILITY INSURANCE Do5(MMIDD i THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Dowling&O'Neil Insurance PHONE 508 775-1620 FAX Agency E-M/CANo Ext: q/C No: 5087781218 ADDRESS: 973 lyannough Rd., PO Box 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURER A:National Grange Mutual Insuranc INSURED INSURER B:Associated Employers Insurance Baker&Associates,lnc.P O Box 923 INSURER CINSURER D Centerville,MA 02632-0071 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LT RR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS INSR WVD POLICY NUMBER MM/DD MM/DD A GENERAL LIABILITY MPJ7223M 4/19/2011 04/19/2012 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $500,000 CLAIMS MADE I OCCUR MED EXP(Any one person) $10,000 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 JE O- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ B WORKERS COMPENSATION WCC5002454012011 4/23/2011 04123/201 X WC STATU- ETH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N _ E.L.EACH ACCIDENT $500 OOO OFFICER/MEMBER EXCLUDED? N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $500 OOO If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT s500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Thomas Perry ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S80402/M80401 LS1 I w '� , ;,` Office of Con_:l-� AM* and Business Regulation lO,Pa..rk Plaza - Suite 5170 -` " Boston, Massachusetts 02116 Home Improvement-:Contractor Registration Registration: 162600 Type: Supplement Card BAKER & ASSOCIATES INC. Expiration: 3/26/2013 BRETT BUSSIERE 521 SHOOTFLYING HILL RD CENTERVILLE, MA 02632 Update Address and return card.Mark reason for cll;m.r A ;,�nl o o-1 rlotzl ♦ ? Address Renewal ', Employment Lost ( a, Oflier of Consumrr Affairs X Business Regulation License or registration valid for individul use only t :.HOME IMPROVEMENT CONTRACTOR before the expiration date. 1f found return to: Registration: 162600 Type: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Expiration: 3/26/2013 Supplement Card Boston,MA 02116 BAKER ASSOCIATES INC. BRETT BUSSIERE P 0 BOX 923 CENTERVILLE. MA 02632 (�ndcrsecretary Not vali without signature `I:t��,Jl Ilv•rtt. Ucl,:Jrtntinl ul Nulllir *,lli'tl tin,t?'ll ii Kutllitn KC�ul:llt�tn� .1110 �Iantlartl� (.i e r .:. 74477 BRETT J BUSSIERE 10 SHEPPARD RD SAGAMORE BEACH, MA 02562 1/6/2013 ---r -- 9228 i ♦ f - of • snRxsTnaLe. Town of Barnstable RFD MA'S A Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us i 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 authorize to to act on my behalf, in all matters relative to work authorized by this building permit application for: o4gbdeA944 W414 (A 1 (Address of Job) Signa e;r Owner Date A U NQrmoh Print NaYhe If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\I.ocal\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 Town of Barnstable *Permit#�11Z6 r r`e t ,�,t.: Expires 6 month,jr m ics ati� e` ufadq Servlees Fee V KAM 200101tm8s F,Ger�Jlvlslon ector t639. 11. Buil ><ng Tom Per CBO 9 _ Perry, Building Commissioner eer'ffptis,MA 02601 Www.town.bamstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION -- RESIDE TIAL ONLY Not Valid without Red X-Press Imprint- Map/parcel Number _ Property Address a opt erc� so Q 3 [if Residential Value of Work no Minimum fee of$25.00 for wc rk under$6000.00 Owner's Name&Address - _ _A__oao( e ` — be r �bbocx Q�9' �hC . Contractor's Nam Telep ne Number 150S_ a __.I lq 1 Home Improvement Contractor License#(if applicable) 1 Construction Supervisor's License#(if applicable) ���"'(�Workman's Compensation Insurance a �y��,�AggO� d] Check one: DEC — 5 2007 ❑ I am a sole proprietor I am the Homeowner TOWN OF BP►RNSTABLE I have Worker's Compensation Insurance Insurance Company Name k40x\e U n t -, A&S, Workman's Comp. Policy#_0 0 c3A�Z Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side [�Replacement Windows/doors/sliders. U-Value 0.3 ` (maximum . •Where required: Issuance of this permit does note mpt compliance with other town department regilations,i.e.Historic-Conservation.etc. ***Note- Pr weer t sign roperty Owner Letter of Perm is 'Dn. c p of the H e Improvement Contractors License is requ d- SIGNATURE: - Q:Forms:buiIdingpermits/express Revise091307 i The Commonwealth of Massachusetts Department of Industrial Accidents Office oflnvestigations 600 Washington Street Boston,MA 02111 U www.mass gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Informa tion 1, - �}, Please Print Le 'b p l Name(Business/Organization/Individval):. 1'CL G I OLS Address:' 0 pX City/State/Zip:C.en�er0 j I:le ffi% o�c 3a Phone.#: _ g� Are an employer Shed the appropriate box: I am a employer with. 4. I am a eneral contractor,andi 1: Q gemployees(full.and/or part time * have hired the sub'connractors 6• ❑New constriction. I am a'sole proprietor or partner- listed on the attached sheet.° 7: E]Remodeling.,'^ -.ship and have no employees. These sub-contractors have 8.' Demolition working for me in any capacity, employees and have workers' - [No workers'comp.insaiianCe comp.insurance.fi 9• ❑Building addition j required:] 5. 0 We are a corporation and;its 10 Electrical repairs or additions 3.❑ I am a homeowner'iloing•all work officers have exercised their m 'self 11 ❑,Plumbiing repairs or.additions y [No workers'`comp. right of exemption per MGL insurance required]fi c:152,§1(4),and we have no 12 Roof repairs'.:. employees.[No workers' 13. OtherrE� ivi O i • : .. ;; �. .�•: . . p. `�Y aPplicant that checks box#L•must also fill out the section below showing thew workers'co ensation ofi :'Homeowners who submit this affidavit indirating @iey m0 . P cY ormation. t are doing all work and then hire.outside contractor,.must so `t a new affidavit indicating:such. xConhactors that check this liox•must attached an additional sheet showing the name of the subcontractors and'sfate ether or not those entities have employees: If the subcontractors have'ein loyees,the}:iiu4ct providb their workers co oli' number. - � �P•P cY� I ani an em.,6 er fhat is providing-•workers'co_M" ' nsakun insurance or m em to 'ees B' "iv is the o and'ob sifP information. f y p y P �'. 7 Insurance Company Name: Policy#or Self:ins.Lic.#: h007' ration DQJob Site Address: bC �BYI L�_�Exp� t /State/Zip. Attach a coP3.of the workers'compensation policy declaration.page(showing,the policy, umber and expiration date).. Failure to secure�overage as required under Section 25A of MGL c. 152 can leid-to the impo lion of criminal penalties of a fine up to$1;500.00 and/or one-year iti r sonment,'as well as civil penalties in the form of a S OP WORK ORDER and'a flue Of up to$250.00 a day against fhe.violator.: dvised that a copy-of this statementmay be fo warded-to the'Office of.. Investi atio e' for insurance v e rificationI do hereby ce pains pen of perjury that the information provided ab ve.is true and correct Si lure:e a Date: il 0— Phone } Offu ial use only. Do not write in this area,to be completed by city or town.officw City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other i Contact Person• Phone#: i r Dater-5/3/2007 Times 3s59 PM Tor M 9,15083626115 bowling 4 O'-Neil Pager 001-002 Client#:9742 2 ERAS ACORD. CERTIFICATE OF LIABILITY INSURA CE csro3ro rYYYi PRODUCER THIS CERTIFICATE IS ISS AS A MATTER OF INFORMATION Dowling&O'Neil Insurance ONLY AND CONFERS NO HTS UPON THE CERTIFICATE Agency HOLDER.THIS CERTIFICA DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE A FORDED BY THE POLICIES BELOW. 973 lyanough Rd., PO Box 1990 Hyannis,MA 02601 INSURERS AFFORDING§RWAC.,E NAIL M INSURED - INSURER A Hari vine r Insurance Co. Baker 8 Associates,lnc. INSURER a Associated E Insurance Compa P 0 Box 923 INSURER C Centerville,MA 02632-0071 INSURER D. INSURER E COVERAGES THE POLICIES OF INSURANCE,LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLIC f PERIOD INDICATED.NOTWITHSTANDING ANY REOUREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T IS 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. IN TYPE OF INSURANCE POI�Y NlA19ER POLICY EFFECTIVE POLICY EJUMATI LIMITS A GENERAL LIABILITY CBMI748 "I9W "1910B EACH OCCURRENCE $1.000.000 X COMMERCWL GENERAL LIABILITY SEA IF.DAMAGE TO RENTED $100 DDD CLAIMS MADE 51 OCCUR MED EXP(Arty one person) $5 000 X PD Ded:250 PERSONAL a ADV INJURY $1 000 000 GENERAL AGGREGATE s2,00000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 000 ON POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per won) $ -HIRED AUTOS BODILY INJURY NON-0WNEO AUTOS (Par awderd) t S PROPERTY DAMAGE $ (Per acodeM) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $'. B WORKERS COMPENSATION AND WCC5002454012007 "23107 04123I06 X WC SI IMf1 DTH- EMPLOYERS'LIABILITY EL.EACH ACCIDENT S100 000 ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICERMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $100.0W If yes,desama under PE OY I E.L.DISEASE-POLICY LIMIT $5OO OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCR RED POLICIES BE CANCELLED BEFORE THE EXPIRATION Town of Barnstable DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL __JJ_ DAYS WRITTEN Thomas Perry NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO 80 SHALL 200 Main Street IMPOSE NO OBLIGATION OR LIASIL11 Y OF ANY RIND UPON THE INSURER.ITS AGENTS OR Hyannis,MA 02M REPRESENTATIVES. AUTHORIZED ESENTATIVE ACORD 25(2001J08)1 of 2 #47454 JV A ACORD CORPORATION 1988 Board of Building Regulations and Standards License oi-re isti alion alid lm ind'1%Idol ust.unk HOME IMPROVEMENT CONTRACTOR before the ex iration date. If found return In: Registration: 118494 Board of Bui ding Regulations and Standards Expiration: 2/1/2009 Tr# 126302 One Ashburtm Place Rm 1301 Boston,Nia. 121108 Type: DBA BAKER CUSTOM ALUM&VINYL INC. 1 MARK BAKER 521 SHOOTFLYING HILL RD. CENTERVILLE, MA 02632 Administrator Not valid without signature Board of Building Regulations an to dards Construction Supervisor cense License: C 74477 Bitilld,a. 1/6/1973 1,1612009 Tr# 8139 BRETT USSIERE:-.;.... ill AREHAM LAKE:_8HCiRfE ST WAREH -AA 02538 .Commission o . F Town of Barnstable NAM• �. • Regulatory Services Tbomas F.Geiler,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 Sect'Dn If Using A Builder 1 , as Owner of the subject property hereby authorize7jS � ' t }�- �.�OG I� 1nC , to act on my behalf, in all matters relative to work authorized by this building permit application f (Address of Job) il F gnature of 46whe Date C A" Print Name Q:Forms:buildingpermits/express Revise091307 f L � ,-r• -r, ,� �� � ,�, �, �4. r '.?•�� t: .tan.-y; ,� ... t; y- _- ��..� °•.w TOWN OF BARNSTABLE BUILDING DEPARTMENT t sas�aT TOWN OFFICE BUILDING out t 39. �� HYANNIS, MASS. 02601 �o r�r�• MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been 'issued for the building authorized by BuildingPer �5.� 9c �7'„ . _ ............................................_......._.._................._..»..».........».......»...»..... »» issued to ........................................................ _......».......... ..»»..»» Please release the performance bond. N. Town of Barnstable Building , This.Card O ThaLMIS Visible From the•Street-Approved Plans Must"be Retained°on Job and this Card`Must be Kept .% " Posted until Finahlnspection Has'Been Made,, • 6�'R� . Where a C�.eft�ficat`�ofOccupancy is Required,such Building-shall Notxbe Occupied:until a Final Inspectiori'has°been made. Permit. . Perrnit No. 13-17-809' Applicant Name: .TUPPER CONSTRUCTION CO,LLC- Approvals Date Issued: '03/30/2017 Current-Use: Structure Permit Type: Building=Insulation-Residential Expiration Date: 09/30/2017 Foundation: Location: 20 PERCHERON WAY,WEST BARNSTABLE� Map/Lot 174-001 056 Z WE ON, y�o_ning District:' RF Sheathing: Owne'r-on Record: HARMON,KATHLEEN 'Contractor Name Richard S Tupper Framing: 1 Address: ' oLcel C -069058. 20 PERCH N r 2 ABLE MA WEST.BARNST 02668' g� � Est Project Cost: $1,732.44 Chimney: Description: INSULATION/WEATHERIZATION P,ermrt Fee:. $85.00 Insulation: Project Review Req: 'INSULATION/WEATHERIZATION Fee�Pa d $85.00 Final: Date 3/30/2017 Plumbing/Gas cial Building Offi o u Rough PI tu bing:. Ell This permit shall be deemed abandoned and invalid unless the work authoraeid by this permit is commenced within siwmonths a er issuance. final-Plumbing: All work authorized by this,permit shall conform to the approved application and the'rapproved construction clocumentffft hii6hAhispermit has-been granted. 'be. � All construction,alterations and changes of use of any building andatruttures shall;be m compliance with the local zoning by laws Rough Gas:and codes. g This permit shall be displayed in a location clearly visible firom access street onroad.and shall be maintained open for public`inspettion for the entire duration of work until the completion of the same. r y Final Gas: The Certificate of Occupancy will not be issued until-all applicable signatures he`BwId'ng and rire;Officials are'p ovided`on this permit. Electrical Minimum of Five Call inspections Required for AllConstruction Service: :1.•Foundation or Footing % 2.Sheathing Inspection � Rough: 3:All Fireplaces must be inspected at the throat level before firest flue lirnI%ilb installed.-MM 4.Wiring&Plumbing Inspections to be.completed prior to Frame Inspection Final: S.Prior to Covering Structural Members(Frame'Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,-Plum bing,.and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the.guarantyfund",(as set forth in MGL•c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: S TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 0 /Map 7 Parcel L Application #r Health Division � k9- �6� Date Issued 3 > / 7 iP/yl Conservation Division c� y0 . Application Fe' d Planning Dept. 0 ��� Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH — Preservation/Hyannis E Project Street Addr ss Village �C1V✓ b Owner L(2ell Address Telephone D Permit Request ') Jk l -C/ . aed 'r a) M nw A A" �y Vex kA:,A: Z2 h 14 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District / Flood Plain Groundwater Overlay Project Valuation / 7 Construction Type Lot Size / Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family a- Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing -,Z 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: M GaS ❑Oil ❑ Electric ❑ Other Central Air: 1311es ❑ 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 Telephone Number L3 X_ 779' D�r Address �/� V11V9& /� License-# ZZ Home Improvement Contractor# < �� Emai /{� Worker's Com ensation #�� p ALL ONSTRUCTION -_ RIS RES TING ROM THIS PRO ECT WILL BETAKEN E TAKEN TO SIGNATURE DATE v �i�/ FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED _ MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION I FRAME U, INSULATION F FIREPLACE ELECTRICAL: ROUGH FINAL *. PLUMBING: ROUGH FINAL - GAS: ROUGH FINAL f`INAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. it i �• > Town of Barnstable Regulatory Services Ricbard V.Scuti,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Tiyannis,MA 02601 www.town.barnstable-ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section h(Usine A Builder I,Kathleen Harmon ,as 0,%mer of the subject p1'q(A'.n. hereby authori7.(!T 1� (� to act on my behalf, in all mama rs relative to work authorized by this building pernvt application for: 20 Percheron Way --- (Address of job) ^ ---- - " 'Pool fences and alarms are the responsibility of the applicant;. Pools are not to be fillets or utilized before:fence is inut:aUed and all find inspections are performed and accepted_ cy,, .*,nAuxejof Owner Signature of.4})pl3cant ILQ�l? e,e n 4'fCLCMfi — -- Print dame Print Name ate • d Q:FORMSONVNIERP RRMISSIONPWLS 27je Commomp"&h o Af j astarhtrseft Dqwftmt 0j1 1Acc1Wexts 1 Congren fit,Suitt 100 B03to6 JVA 02114-2017 N%orkera,Compensx&ata wwanassg0V1Wa LuuraoaAflsdsvit:911111fignX011tiractordFlectddanafflumbem TO BE PMW Wax TUX PSG AUTJIORM. Name(Bndeters/Orgaa{atiMEadivAz0: Tupper Crib sarl Co LLC Hem Print-Uldbly Address: 546A Main Crowell Rd City/Statwzip: West Yarmouth,MA 02873 Phone 608.T/g.p111 #: Are you as eatpi y.?C&gek Ifs appn;.ae bwe 1.1a tam.enWl*ya vvttbL p*0y'=0W aadforXa_dma).a TYPe of"et(rEgallred): 2 a t an a tole t ptilWrarparpt�ah ..d ban o0 7. ❑New cousbuction Say c"Oty.(hie wodoers'env,fostsaaoe ' •workiaa tbrnre ID $ Reluoddlflg reQuLad.] 3.�1 sm a htxaoowaer dolma QI wodc ary.eIL ft wariom,ceop.kM'1 a mWi'&], 9. Demolition 4.01 am a kmsm-and wip be W ft aoaoaetcet to conduce aI wa&oo my icy 1 will 10❑Building addition ntwrethat aD ooaatctoa edw hwa awWe caupsantia o iaannooe cram sole ptopricton with no mpbYWL 11.0 Electrical repda or additions 5C 1 un a Salami oontractw•sad l how hind dw mb.eoatrlmn utord an the attacked si<nt. 12.[3Plumbing re*m or additions These tab eoaesctor.hartr syployga and have workm-coop.kWAMee t 13.ORoof repairs 6.0 we am a caverodon and its onnoem have exemia,d thou fi*of=ar#dm pa uft c. la•[ Outer Wadt10fte110n 1411(4),and we have no smplcpaaa,N w,a q m* camp.intaerox eegaited.] 'Asy aDp>icaet;tat smelts bog 01 man also fill old the anion briar d,oavins tbair wodtm,omaasaaation policy b>lbtmdiam t mama-mm who tttsmk out atlkkM'5&da d'sy am�st damns all Wo*sad thn him on4ida caftufon:oast s d*A a mm apedwit ittdicathia tech. tCcarnolm that d-k this boa suet sbotvina ar aame of the tuib�c aaployea. tf eho Wbcootnepr.hna eastaetow and same wbsd�aaa not rioae srti>ia bars ae�ployees,thrymattp�ovidetheh•vrodtwa'aap.. .. I 1 an M mltat b protaidLe rwrbaa'eoarpaasayF=rises j0P my Qe�o� ad aw Is tilts jW !rr onttotten Io04'� dtt kwumnce Company Now.AMC Policy#or Self-ins.Lit.* WCC50M30120118A 10/3/17 Expiration Dats; Job SiteAddnu: 20 Percheron Wy W Barnstable MA 02668 Attach a copy of the warkwe arnponsatloa pdky daelnrafim q thstetslTp: P�( w�the po*atuuber and w piratlon date). Failure to tleeuro cwvmMc as required holder MOL c.152,§2SA is a criminal violation plmiabable by a fiiae up to$1,500.00 and/or ees ytar imprisot:m=4 ae well se civil penalties in the form of a STOP WORK ORDER and a Otte of up to$250.00 a daY against the vioWw.A copy of this statement may be"m ded to the Offics of Invssdpdm of the DIA for inwranoe coverage verification. I do hazby �qfpedury that the lwjoratesdeft prtoddrl ebom Ii&w and eorrsa 3/16/17 k 508-7784111 Offldd an ono% Do cot WrW in this arse,of bit conplded by*or lather qffleld City or Town: Pe:211JUL;ceose 0 Issdog Aulhority(*do we): 1.Board of Health &Building Department 3.C1tyl1'0wn Clan 4 EkebtW Inspector S.lhunbft Iespeetsr 6.odw Contact Person: P I r �r� ACC)OR CERTIFICATE (bIMIDO/ CATE OF LIABILITY INSURANCE 11 DATE MMMD1YYYY) 16 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 E. Ashley Paiva Southeastern Insurance Agency, Inc. PHONE (508)997-6061 FAX 439 State e,(508)990-2731 ADDRESS:apaiva@southeasternins.cam P.O. Box 7939398 ' INSURERS AFFORDING COVERAGE NAIC 0 North Dartmouth MA 02747 INSURED INSURERAArbella Protection Insurance 41360 Tupper Construction Co I.LC INSURFRaMoston Insurance Brokerage Inc 546A Higgins Crowell Road INsuRERc:INSURERD: - INSURERE: West Yarmouth to 02673 INSURERF: COVERAGES CERTIFICATE NUMBER2016-17 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IJSR LTR TYPEOFINSURANCE POLICY NUAD SUBA MJWRPOLICY PC S COMMERCIAL GENERAL LIABILITY O LIMITS EACH OCCURRENCE S 1,000,000 CLAIMS-MADE I�OCCUR PREMISES E =u a ce S 100,000A 9520045208 11/1/2016 11/1/2017 MED EXP Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,000 �GEIWL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY 0 jPER 4 LOC PRODUCTS-COMP/OP AGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY Ea aedtlem L MI S 1,000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS $ AUTOS 1020009389 12/1/2016 12/1/2017 BODILY INJURY(Per accident) S jX HIRED AUTOS X AUTOS ED O(par ER-Ty��DAMAGE $ urvrmured motmet—s lit umit $ 250,000 UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 11000,000 A EXCESS LIAB CWIMS MADE AGGREGATE S ED I.RETE,.ToNs 4600058368 11/1/2016 11/1/2017 S WORKERS COMPENSATION AND EMPLOYEWLIABILnY YIN OFFICERIMEMBER EXCLUDED? NIA STATUTE ER ANY PROPRIETORrPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 11000,000 B ❑ (Mandatory In NH) wCC5005593012016A 10/3/2016 10/3/2017 E.L.DISEASE-EA EMPLOYE S 1 000 000 II yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,000 1 --T I DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,AddMonal Ramarlls 6ehatlula may be attached If more space to required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Display Purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORUED REPRESENTATIVE Ashley Paiva/AMP ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 rmmaoll f V 7 Wro,m. Office of Consumer 'Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Regismon: 1784u Type: LLC TUPPER CONSTRUCTION CO, LLC. Emit ton: me mole This 41=1 RICHARD TUPPER 546 A HIGGINS CROWALL RD W. YARMOUTH, MA 02673 O POMGflt1 Update Address and return card,bark reason for change. 41 Addrsas `] Renewal 0 BmPloyment [] Lost Card p.• r�//P ernlNNil ltN'►vr�/�L{^l�f;yltlr✓/� S�� oma of Co�aamer Af9kn A gre`a�A goa Liccon or reost ation valid for individual use.only HOME JUPRO1/EIIIW CONTRACTOR before the cspiration data If tband retmp to: Reglatmdon: 178434 Type. Ofliee of Coo9umer Affairs and Business RcgohWon Fxplrallore 4/111=18 LLC 10 -Suite$170 UPPER CONSTRUCTION CO,LLC. fin+ i :ICHARO TOPPER ' 46 A HIGGINS CROWELL RD ✓.YARMOUTH,MA 02673 Uupuy Not ut sigaatun �rnr+r°°a°�+�unai tlor,o 1y4 ate` ae sn5/asis #iNa11QORMANQL* 1Vft my OM �a�st0 ��,aMIC �06ao e Nd BUILDINti PERFORMANCE INS, INC tierate> ,Q �� Llritlbf!- Massachuaetts Department of Public Safety Board of Building Regulations and Standards � �A lfi�af �ti License: CB-069058 + Construction Supervisor 1 MC14ARD S TOPPER 6"A HMINSCROWEL•L�ROAD WEST YARMOUTH MA t1 M: dune ee possess•anent teW an dfltt Isles � Ce1t�a■elhrinlloallatdtl�4let� � f; ' ,s• . ►r=Uoeet &A0NM Wft WM*JAmL$wj" •,=-a•_ Expiration: Commissloner =3 /201e I sessor'�office 1st Floor): As M ( ) rat/' /7 4� /� o!—S SEP71C SYSTEM Assessor's map and lot number -,4ffl — INSTALLED MUS INC` to` Board of Health(3rd floor): � ,�, - ry STALLED IN COlNPL ° Sewat�e Permit number — � 6v L* 'M'- UVI �. '� ENVIRAN TH TITLE 5 t Dsaa9TADLt Engineering Department(3rd floor): ^ JS• r�us H use number ) C ( F ` F J' TOWNEGUL��� Definitive Plan'Approved by Planning Board /19 ,� �� APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only,r '••'�` TOWN OF • B A R N S TABLE P P Otb1 �° R. ° nBUILDING INSPECTR nservto Dc mmjsstoaO APPLICATION FOR PERMIT T CL TYPE OF CONSTRUCTION 19 i : o TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ermit according to the following information: Location z Proposed Use Zoning District Fire District Name of Owner ! dU�� /�-C Address C Name of Builder Address Name of Architect Address Number of Rooms �P Foundation Exterior �/� Roofing Floor �%T "� _ Interior Heating /J `" (J Plumbing �v Fireplace vT/Z Approximate Cost Area �►"- 6-0 Diagram of Lot and Building with Dimensions Fee �1 n\ . r 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 9 7 Construction Supervisor's License QQ Y S L BAYSIDE BUILDING *` No 35934 Permit For Two Story Single Family Dwelling ° Location Lot #148 , 20 Percheron Way o West Barnstable a Owner Bayside Building Type of Construction Frame Plot Lot Permit Granted June 8, (L 93 Date of In4ion�93 Date let 19 cow Cos fn N m C. t 14-9 /-7,3�4 M � 44 I ZIt ni��. so (po•oo e.L '�co pG2�r=zon1 W�Y _Qb'=-.ram �f (a�t��;`fu• . AAll. • CE,2T/�/EO G,LQ7" p,�,q,t/ T/-!,I T T-/,C- A- vxlt>AT�oAJ 1.& s/oE�///� A//o SETBA O.q TE (�•Z 3 ,'C/TS Ltd/T///N Ty�..cLoaa.�G4/.f! 7� q .gAXT•E,?E N BASE"O GN,4if/ �P_EG/S7-E2El� L,c{�c/p SUe!/6yar_� 7T.S s/ygIA141'.Sh/pULI� i J I i C�C-I LL I I i t � I jj t p Cl Cl ! L I 71 i ' LLJ Ll r ' ; t ` ! ; II I h] i � - Lj--4J 1 • t acw I Y i I o � J i ` 1 FE N 10! tj "o ❑ "0 N - -I � � -0 �•. � Z 1J. ..9; j r t r Jr- di J I m � oa1A o Q 1^ i a I W 14 O u a� ' t_I to i ? _► - it r o W it I ` 1 J �• • i to i 4 0`' 212 I I w I FF ��� Iil 8D x � II (� I Cl �o I • ' � I ,I �, 8z � l I L� . iP � I� �� � •. z < I .I I !o i I o0 II 1 3'-!0 /2= o., --12: o.. r S;8•�...,..I8� N 8 Joi srs l I -h fl �;�oca�vK S7.Ei2S C t Z I I •� P I pCo I - �n ► ' t r— ,nil LLJ • I SE CHECK OR MONEY ORDEI LICENSE EXPIRATION DATE. . CONSTR. SUPERVISQ FOR REQUIRED-FEE, 06/30/1993MADE PAYABLEJO RESTRICTIONS ,6 EFFECTIVE DATE UC N0. ...NO 06/ 91"u''-719 005645 "COMMISSIQNE fQ . PUBLICSAFETI c BjT.X y r' A RIAN .T' oACEY ':` ' .. orsEND`�casH�.:. . SS .027-46-5956 62' FERBROOK .LANE CENTERVILL .MA.. 02632 P 'EASE INCREASE PHOTO(WAS"No WA8iN0 OPR ONLYI FEE: ,: .00 E FECTI �I 1 11989 _. ,j +/%r+ ,P,1 '���.%+•.. HEIGHT; NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY :T• �i.4t 1�,Y� a S;,t STAMPED•OR.SgNATURE OF THE COMMISSIONER ,�s x�, � '=;::i•' DOB: • i;t'A••y?�ti vp';'•fTHq DOCUMENT MUST BE D NOT:; DE C K EN'SE.i.STI .�•�., ,;?d. ' ' CARR ED ON iW PERSON Q- ff OF LICENSEE SIGN NAME IN FULL-ABOVE 81GNATURE LINE • �'Y%�''• THE HOLDER WHEN fN0A0• CI OTNERi•RgH��tfit)MB} IMIf 10 IN IN13 OCCUPATION, d*'✓ , COMMISSIONER rti 20CM•247.81429 1 a is Q1 CE!! �L Iti�a•. b _: 'T' rg v C TOWN OF BARNSTABLE, t�'t,,,jrACHUSETTSa ,��►3�� � 1.ul APPLICANT - ADDRESS (NO.) (STREET) (CONTR'S LICENSE) a?dt'._ =2.a :.'. 1' �i .t'.' Ct`v?d .ia.' NUMBER OF PERMIT TO �� �� ( ) STORY J,"-''• DWELLING UNITS '- `(TYPE OF IMPROVEMENT) NO. (PROPOSED USE) AT (LOCATION) 'ZONING - (NO.) (STREET) DISTRICT BETWEEN AND (CROSS STREET) (CROSS STREET) LOT SUBDIVISION LOT BLOCK A SIZE o BUILDING IS TO BE-FT. WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION (TYPE) REMARKS: _ 'AREA OR PERMIT VOLUME ESTIMATED COST $ FEE (CUBIC/SQUARE FEET) � ' OWNER ADDRESS - ) J r•>rii:. - ?] '.t� 'J_`Cij,(; BUILDING DEPT. ' BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF. EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE, MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM 'THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE .NSPECTIONS REQUIRED FOR PERMITS ARE REQUIRED FOR CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN ALL CONSTRUCTION WORK: ELECTRICAL, PLUMBING AND 1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIREO,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN MADE. 3. FINAL INSPECTION BEFORE OCCUPANCY. POST T Holo Bann SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECT9!001 INSPECTION APPROVALS i � t HEATING INSPECTION APPROVALS ENGI ERING EP TMENT / BOARD O EALTH �.. OTHER SITE PLAN REVIEW APPROVAL L CCU G►'l ' ° WORK SHALL NOT PROCEED UNTIL THE(NSPEC- PERMIT 'W!L L BECOME NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF I WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE ARRANGED FOR BY TELEPHONE OR WRITTEN CONSTRUCTION. I PERMIT IS ISSUED AS NOTED ABOVE. NOTIFICATION. ,, ._ r •R i n , . .,-l-,�'LLir .�`,^........T' �.,r"" ...r _ � rfiti. *ME TOWN OF BARNSTABLE Permit No. , 35934 BUILDING DEPARTMENT 4 """ } TOWN OFFICE BUILDING Cash � .Yl yew•�>e x ov► HYANNIS.MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Bayside Buildingg&- Address Lot #148, 20 Percheron Way West Barnstable, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD_ 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. 1 I August 30, 93 .. .. .... ....... ...... .... .. 19................. ..............Bulldi inspector ctor............. .% e a' 1Mf> TOWN OF BARNBTABLENo. ...35934 a Permit ...:......... q BUILDING DEPARTMENT 4 'u"r I TOWN OFFICE BUILDING Cash ■Y� ,610• V HYANNIS.MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY, L Issued to Bayside Building Address Lot #148, 20 Percheron Way West Barnstable, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD_ THIS P£RMIT'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. i August 30, 93 .. ......... .. ... ..... ....... 19................. Building Inspector /b-7 INC- 1 2 1640 �txl 139 .c� l (tip`\ 1� \\ l _- / J l I 1. �%d''1� p.�j! R.I�i 4 Kfr►.e !=QpNi :r+SGS u yb� ,�� S. Q tJ 4O r 2 MutiC-�F'aL tie-'F:C_ l �,--r \ � ►ifs �� � 3 P,K'�, t'!T�+�- t J� itr- �" +_I►.I�Fy_ �EQtaiSE �r�reG. 12co C L}. l_nt! .t_ L�n:IT� L\11�t�/1 �{ tO _ 4 5. Pt :_ ,�rj,r►tt �►!�t. t_ �� MACS W4T�^.T1G- T. 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