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HomeMy WebLinkAbout0015 MASA'S PLACE �. J 5 h1 asct's `�i �i��� }F ''�- __ - 23 2016 09:54AM Tupper Construction Co. 15087785010 page 1 T UP P Fm R CONSTRUCTION CO.LLc 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 506-778-5010 VMW TUPPERCO.COM aa - 3 Date: : Town of Barnstable ' Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax X= i Re: Insulation Permits Dear Mr. Pent' This affidavit is to certify that all work completed for permit application # 6-/4o - 19'10 Issued on l Q 1711�0 has been inspected by a certified Building Performance Insti ute.(BPI) inspector. All work performed meets or exceeds Federal and S ate requirements. ,Sincerely, Address: • Richard Tupper License # CS-69058 �o Q 10 -7--ao/ h TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q^A i l-d Map Parcel v / 7 Application NN cation # C� " Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee ` Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis 06 Project Ste t Address Village Owner_joS@�O t'1 _ Address d'ncl Telephone -';� .�- bi~' �� /V Vo o® Per it Request f << � � e / If Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValuatiorIR & -7° � Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ET Two Family ❑ Multi-Family (# units) Age of Existing Structure /q 79 Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: CffFull ❑ 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: d Gas ❑ Oil ❑ Electric ❑ Other E ' Central Air: ❑Yes 21(�o Fireplaces: Existing New Existing wood/coal stove'❑Y s ❑ 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) - 0 Name G�tsC� � Telephone Number e ALense Address � # �L' � 7 tea �-v l Home Improvement Contractor# I Email ram{)"Oi� hV',0ee C.�') �/i'✓� Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ze-A 1 S mt r- ml SIGNATU DATE FOR OFFICIAL USE ONLY -s APPLICATION# DATE ISSUED MAP/PARCELNO. ADDRESS VILLAGE OWNER S DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 4 Town of Barnstable Reguhitory Services MAn Riebard V.Scali;Director i639. Building Division 'tom Perry,Budding Conunissiouer 200 Main Street,Hyannis."ALL 02601 m,NvwAown-barn-stable.ma.0 s Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section Yf Using. ABuilder as Owner of dic suhjecr propert:y- hereby authorize t�!7}?�.� (� to act on my behalf, in all matters relative to work authorized by this building pernik application for. --_- C,s �� '�- ` (Address ofjob) Pool fences and alarms are the responsibi] ty of the applicant. Perils are not to be filled or utilised before fence is installed aud aU fur,:;l inspections are'performed and accepted. Ana of Owner Signature of Applicuit Print Name Print Narm Dat I i Q:FOnIS:OlVN$.RPERI.tISS1ONFOOL4 t The Commonwealth of Massaehuselts ` f Deparftwt of InduoialAcchfents Office of Investigations I CongressStree4 Suite 100 Boston,MA 02I14-2017 www mampy1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly Name(Business/Organizatiowbdi«dual): TUPPER CONSTRUCTION Address-546A HIGGINS CROWELL RD City/State/lip-WEST YARMOUTH MA 02673 ph(me#:508-778-0#1 i Are you an employer?Check the appropriate box: Type of project(rewired): 1.© i am a employer with 10 4. 0 1 am a general contractor and I employees(full and/or em to * have hired the sub-contractors b• ❑New construction p 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, 0 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 I0.❑ Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11. Plumbing re❑ S pairs or additions myself. [No workers' comp. right of exemption per MGL 12_❑Roof repairs insurance required.] t c. 152,§l(4),and we have no employees. [No workers' 13.®Other yl/EA7HER#ZATIOId comp.insurance required.] "Any applicant that checks box 01 must also fill am the section below showing their vvarkers'compensation policy information. t Homeowners who submit this affidavit indicating they ate 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 same of the sub-contractors and state whether ornot those entities have employees. If the sub-c AVactors have umplotiees,they must provide their work='comp.policy number. f y mployeez Below Is the policy and job site I ant an enrployer.that is providi�tg workers'ro+�nsaliox insurance or� e information. Insurance Company Name*AEIC Policy#or Self-ins.•Lic.#:WCC5005593012015A ExpZratiam Date:10/3l16 Job Site Address: 15 Masas PI city/State/Zip; Hyannis MA 02601 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 imprisoioment,as well as civil penaltie&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 biatement may be forwarded to the Office of Investigations of the DIA f e coverage verification. I do hereby cer11 jy der,th pains an penalties of perjury that the info madon provided above Is true and correct. Signature- Date: 9/19/16 Phone#: 508-778-01 Offacial use only. Da not write in this area,to be completed by city or town ofj'iclal City or Town: Pertnit/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. Pltoae li, AcoR[� DATE(MWDDM-M CERTIFICATE OF LIABILITY INSURANCE 12/1/2015 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 Lora Fit&Gerald Southeastern Insurance Agency, Inc. PHONE (508)997-6061 4C pj:(508)990-2731 439 State Rd. E-MAIL Ifitz@southeastern:Lns.com P.O. Box 79398 INSU S AFFORDING COVERAGE 1 NAIC# North Dartmouth 1+A 02747 INSURERA Arbolla Protection Insurance 141360 INSURED INSURER B Ba9tOn Insurance Brokera a Inc Tupper Construction Co LLC INSURereC: 546A Higgins Crowell Road INSURER0. I INSURER E: west Yarmouth MA 02673 INSURERF: COVERAGES CERTIFICATE NUMBER203.5-2016-1 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. I R IUBR LT TYPE OF INSURANCE A POLICY NUMBER LILY E i LICY P LIMITS I R COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE 8 1,000,000 A ± DAMAGE TO RENTED: CLAIMS-MADE �% OOGLiR j PREMISES(Es ocau►encef `S 100,000 fI 9520045208 11/1/2015 11/1/2016 MEOEXp(Anyo,spe,sc„) IS 5,000 l 1 PERSONAL&ADV INJURY IS 11000,000 GENLAGGRE(GGAAT"E LIMIT APPLIES PER: IIII� GENERAL AGGREGATE S 2,000,000 X POLICY L-1 JECT 0 LOC I PRODUCTS 1 5 2,000,000 OTHER: i� 'S }AUTOMOBILE LIABILITY i COMB aBINED SINGLE 1 S 1,000,00 LJESA ANY AUTO f (BODILY INJURY(Per Person) IS AUTOS OWNED SCHEDULED 1020009389 12/1/2015 12/1/2026 BODILY INJURY(Per accidem)lS 3C HIRED AUTO L��R f}�!� EO # } PPROPERTY Dall_AMAGE is r f unSnsured st®1 iI Lim t i S 250,000 UMBRELLA UAB 'OCCUR f - {—EACH OCCURRENCE s A i EXCESS LIAO I ^CLAIMS-MADE AGGREGATE Is DED RETENTIONS l :4600058368 11/1/2015 11/1/2016 g WORKERS COMPENSATION } i I I TAWS i I ER AND EMPLOYERS'LIABILITY YIN i I ANY PROPRIETORIPARTNERlEXECUTIVE } EL EACH ACCIDENT $ 1 000 OFFICENMEMBER EXCLUDED? i N t A I 000 I 8 (Mandatory in NH) 1 WC5005593012015A 10/3/2015 10/3/2016 ,E.LDISEASE_EAEMPLOYE $ l,_000'000- It yae.describe under I DESCRIPTION OF OPERATIONS bebw f # 1 E.L.DISEASE-POLICY LIMIT S 1 000 000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 161,Additional Rems"Schedule,may be mooned U.more'"aco Is regetrod) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For informational purposes Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tupper Construction Co.,I= ACCORDANCE WITH THE POLICY PROVISIONS. 546A Higgins Crowell Road W Yarmouth, MA 02673 AUTHORIZED REPRESENTATIVE Lora FitzGerald/MEN( ®1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS026 r20tame 1. f , �� i � C.1I>?.•?l`2Qlxll �'-t�f?. t� -• ��Gf�`.�,if�'•t'f�rGl.�f.'��.}• Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 r Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 178434 Type: LLC Expiration: 4/16/2018 Trtl 410201 TUPPER CONSTRUCTION CO, LLC. RICHARD TUPPER 546 A HIGGINS CROWALL RD - - --W. YARMOUTH, MA 02673 Update Address and return card.Mark ressoa for change. 2oae os»i Addrm :`-, Renewal ['I Employment L bast Card sCA 1 0 %�� f:rgirHrnnwii/// ./'�/r<r,.•:rr�a� //. «�. Offlee of Consumer Afhdrs&BoAaess Regaledon License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 178434 Type: Office of Consumer Affairs and.Business Regulation v- Expiration: 411&2018LZ-,(ryC: lop -Suit*' N' yyTUPPER CONSTRUCTION CO,LLC. RICHARD TUPPER 546A HIGGINS CROWELL RDW.YARlutOUTH,MA 02673 UP= Nat without signature- - BUILDING PERFORMANCE INSTWM, INC 107 Hennes Road,Suite 210 Matta,NY 12020 1077)274-1274 www.bpl.org E Richard Tu per Bw,ow. W R VEM SIDS FOR 0M. NATIONS AND,7lPUfATlON DATES) Massachusetts-Department of Public Safety Unrestricted-Buddinge of any use group which Board of Building Regulations and standards contain less than 35,000 cubic fee.(991m)of C41 witruction sulwal iiui enclosed space. License:CS449M Rlaw d S Tupper 546 A s crow Wert Yarmouth NA OftiM W } S Failure to possess a curmn edition of the Massachuwm State 6uiiding Code is cause for revocation of this Dense. J„�.,,.dr.,6�tg�. 1 i1i° expiration For CPS Uaauing tnform;t,on visit; warw.Mms.GotirJDPS Commissioner 12031#2016 X-PRESS PERMIT OCT 3 0 2013 ' ,> Town of Barnstable *Permit Rhlfi�►et..:: g I.3, Expires 6 nn ribs from issre Re ulato _Services; Fee BARN MASS 163 Thomas F.Geiler,Director ..Building Division. Tom Perry;CBO,' Building Commissioner, .. „ ` 200 Main Street,Hyannis;MA 02601 www.town.banistable.ma.us.. Office: 508-862-4038i' y Fax: 508-790-6230 EXPRESS'PERNIIT APPLICATION: RESIDENTIAL ONLY ? —7 Not Valid withourRed X Press Imprint Map/parcel Number o�o� 3 Property Address `rnczS S �il:li5 Residential • eValue of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1Derkar 0-r '51 g _Fa nd c� ree `� k n! lD Sphnk a ome mprovement Contractor's Name 199 Barnstable Road; Hyannis MA 02601 Telephone;Number 508 775-1778 Ext. 10 - a Home Improvement Contractor License'#(if applicable) 103757 Construction Supervisor's License#(if Applicable) ;CS-006643 6Workman's Compensation Insurance Check one:. ❑ I-am a sole proprietor ❑ I am the Homeowner �] I have Worker's Compensation-Insurance Insurance Company Name. A.i.M Mutual Insurance Co . workman's Comp.Policy# 7004943012013 ' Copy of Insurance Compliance Certificate'must accompany eacliyermit.; Permit Request(check box). Yarmouth Transfer Station . El Re-roof(hurricane nailed)(stripping,old.shingles) All construction debris will>be taken.to ❑Re-roof(Hurricane nailed)(not'stripping., Going over. . existinglayers of roof) ❑ Re-side _ #of doors Replacement Windows/doors/sliders:U-Value e S _(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 Leuer of Permission. iw Improvement Contractors License&Construction Supervisors 1icense.is SIGNATURE: C:\Users\decollikWppDataU,ocal\Microsoft\Windows\Tern rary Internet Files\Content.Outlook\QRE6ZUBN\EXPRESS.doe Revised 053012 Unrestricted- Buildings of any use group which f.: cmmin less than 35.000 cubic feet (99•1m1)of 1 Massachusetts -Department of Public Safety enclosed spaCe Board of Building Regulations and.Standares {.'.<,�lv(:vc.nnn Super}1.�i>!^ �.„•_ „�„-. License: .CS4)06W. l ' BRAD K SPRDUC� 190 L YMOPS Failure to possess a current edition of the Massachusetts W BARNSTABLE State Building Code is cause for revocation:of this license. far DPS licensing information visit. www.Mass.Gov/DVS �I tip' i to Expp!rafion Ce�emn;sseortee 10/08/2015 Office of Consumer Affairs&Business Re-ulation License or registration valid for individul use only. ,�`KOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Istration: Type: Office of Consumer Affairs and Business Regulation, •e9 103757 .. b°� ,410 Park Plaza-Suite 5170 Expiration:` 7/9/2014 Private Corporator Boston,MA 02116 SPRINKLE HOME IMPROVEMENT INC Brad Sprinkle ' 199 Barnstable Rd Hyannis,MA 02601 Undersecretary Not valid witho signature r ram. SPRIN-1 OP ID:DS ACORD" DATE(MM/DD/YYYY) CERTIFICATE-,OF LIABILITY INSURANCE 12121/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),_AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies:may require an endorsement. A,statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(a). PRODUCER Phone:508-775-6060 CONTACT NAB: Bryden&Sullivan Ins Agency PHONE Fax Fax:5 8-79 -1414 a 0 0 88 Falmouth Road ac o Ert: (AIC.No):' Hyannis,MA 02601 E-MAIL -- Kelley A.Sullivan ADDRESS: -- INSURER(S)AFFORDING COVERAGE NAIC 0 _ INsuRERA:Associated Industries of MA' INSURED Sprinkle Home Improvement Inc. INSURERS 199 Barnstable Rd Hyannis,MA 02601 Ir9suRERc< ---- — _ INSURER D: ---j----� ,, .. INSURER EL: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY.PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE POLICY NUMBER MMID EFF Y EXP + LIMITS — GENERAL LIABILITY a EACH OCCURRENCE. $ DAMAGE TO RFNTFU COMMERCIAL GENERAL LIABILITY I { -PREMISES(Ea oeaxrence� CLAIMS-MADE ( Y OCCUR An i MED EXP one Person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ _ �GEN'L AGGREGATE LIMIT APPLIES PER: _ I i PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC. I I$ AUTOMOBILE LIABILITY I (Ea ax�dem) t I S ANY AUTO ! j BODILY INJURY(Per person) ($ ^ALL OWNED SCHEDULED ( ) i BODILY INJURY(Per accident) S AUTOS NO NON-OWNED I PROPERTYDAMAGE -- HIRED AUTOS AUTOS I Per accident 1$ is UMBRELLA LIAR OCCUR i EACH OCCURRENCE 1$ _ EXCESS LIABLAIMS-MADE ` AGGREGATE $ — DED RETENTION$ 1 S WORKERS COMPENSATION ITORY LIMITS WC STATU- TH- AND EMPLOYERS LIABILITY IN A ANY PROPRIETOR/PARTNER/EXECUTIVE❑ NIA AWC7004943012013 ° 01/01/13 i 01/01/14 E.L.-.L.EACH $ 500,_00 OFFICER/MEMBER EXCLUDED? i I 111 (Mandatoy in NH) f E.L.DISEASE-EA EMPLOYE S 500.00 If yes.desc ibe under 1 ` - DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 500,00 1 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule.N mom apace Is required) CERTIFICATE HOLDER CANCELLATION SPRNKHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sprinkle Home Improvement Inc ACCORDANCE WITH THE POLICY PROVISIONS. Margo Mack 199 Barnstable Rd. AUTHORIZED REPRESENTATIVE Hyannis,MA 02601 Kelley A.Sullivan ©19884010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD { s' T,E, Town .of~Barnstable . 0 Regulatory Services vMAS& Thonas F.Geiler,'Dir'ector o '' - Building Division Toni Perry,Building Commissioner 200 Main Street, Hyannis,MA-02601 ' www.town.barnstableana.us . I Office:, 508-8624038 Fax: 508-790 6230 � - Properly-Owe erMust., omplete and S C 1gn This Section If IJstn A Builder r I, 0 'e 1 -9 I)oil\0 - , as Owuei•of the"subject property here by,authorize t"o°act on ny behalf, in all matters relative to work authorized by this building permit application for. 1S (Addre''s of Job) J - Z V.- S' lure of Owner ate ,EQ t ) o Print Name If Property Owner isapplying for permit please, complete the Homeowners License'-Exeinption Form on t-he reverse side, ' Q:FORMS:OWNERFERMISSION I The Commonwealth•of Massachusetts Department of Industrial Accidents Office of Investigations 000 Washington Street .' Boston, MA 02111 www.mass.gov/dia Workers' Compensation.Insurance.Affidavit:*-Builders/Contractors/Electricians/Plumbe'rs Applicant Information Please Print Ecidbly Name(Bus►ness/organization/Ifidividual): Sprinkle Home.Improvement address: 199 Barnstable Road: City/State/zip: Hyannis, MA 02601 Phone #: 508 775-1778 Ext.10 Are you an employer?Check the appropriate box: Type of project(required): 1 I am a employer with 10-12 4. ❑ I.am a general contractor and I 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, ❑Demolition workingfor me in an ca aci employees and have'workers' Y P h 9: ❑ Building addition [No workers' comp. insurance comp.insurance.* required.] 5. ❑ We are a corporation and its - '10.❑ Electrical repairs or additions 3.0 i am a homeowner doing all work officers have exercised-their i I.[] 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 employees. [No workers'. 13.❑ Other comp. insurance te4uired.] *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 anew.affidavit indicating such. Tcontractors 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. lam an employer that is providing.workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A.I.M Mutual Insurance Co. Policy#or Self-ins. Lic.#: 7004943012013 * Expiration Dater 1/01/2014 Job Site Address: S mQSG S f R City/State/Zip: 14_,X�Cl5 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 c ins and penalties of perjury that the information provided above is true and correct. Si nature: i Date: Phone#: 508 775=1778 Ext. 10 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 2. Building Department 3.City/Town Clerk 4.1 Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: " .e TOWN OF BARNSTABLE Permit No. ------------------- i Vmn,K Building Inspector cash OCCUPANCY PERMIT Bond __X_________ "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector." Issued to Address Wiring Inspector Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department 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. ...................................................... 19......__ ............................................................................................. Building Inspector l y �c - 4 r s or's map and lot num ram.... '". -�, ,.L--. I� SEPTIC .SYSTEM MUST BE C�THE TO INSTALLED 1N COMPLIANC Sewage Permit number ...................`................................... WITH ARTICLE II STATE ro SANITARY CODE AND TO House number / ...... '° REGULATIONS. MAR s L i639 C� 9�r q� �j 'FO MPT a' y TOWN OF BARNSTABLE BUI.LDIN6 ,- IN,S}PECTOR ��. `— APPLICATIONFOR PERMIT TO ...............::....:.........................................._.................................................:.......:.. TYPE OF CONSTRUCTION ...............� L............................................................:............................................ ............-- }� ..............19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereb applies for a rmit according to the following information: ,,//ff 6 Location ..............�......Y'. /J.... ..... . ........ ....................................................................................................... } �...� .- ProposedUse ..............:............................. .............................................................................................................................. Zoning District .................. ... ........................ .....................Fire District .............................................................................. . Name of Owner ....... .. . .. ....................................................Address ........... ................... — ............................. Name of Builder .............. Address ................!.a.....................i..'...................................... a t ; � Nameof Architect :::..................Address........ .................... .............................. ............................. Numberof Rooms ... ..........:-r,?...............................................Foundation .............................................................................. Exierior Roofing ........................... .......... ..................................... Floors �'� ............Interior �.,.,........................................... .................................. �................ � _f Heating ........................... .. !....�........................Plumbing ................. .. ............. :............. Fireplace ..:................... Approximate Cost ..............1 :�c- ... .. Definitive Plan Approved by Planning Board ----------- � ..5. .:.... ------ - 19 ----. Area ...., Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH 4rqq2 �b I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ... ............................................................ Bassett, J. A. B 20846 one story j o ................. Permit for ...........;........................ single family dwelling `• ' ............................................................................... 15 Masa's. Place ' Location ........... Hyannis Owner J. A. Bassett Type of Construction frame ....................... ............................................... PIf ........... Lot ..............#14........... Permit Granted ........Ng.Vember 21 .78 !' dte of Inspection ..., �e .l....7�..........19 s Date-Completed ......................................19 d LZ?/71 PERMIT REFUSED ...... _ ................................................ 19 f ................................. ........................................... s . ................................................................................ " ......... ............................................................. - ...... . ................. ........................................ Approved ................................................ 19 ....................... ........................................................ ............................................................................... a - . - `�»\ r^��- Assessor's mop and � -l il..�-,J.,� .J_i__��/ Sewage Ponni� number -\��.-.�^^----------- ��~ »y^� Houue num6eSTABLE � -------.`--,=---'-----_-` 1639 | ` / ` MA��^ TOWNy������T��' ���� �� � �� ��T�� r�� � ��-� �� � �� |"� � ��� ��� �� �� |"� �� ]� �� �� ���� ' -BUILDING � N N �� � �� INSPECTOR �� 0NNN� N0N ��N�� �� �� = ���� mmn �� APPLICATION FOR PERMIT TO --..�-� ---------.----~-'--'------~--'- . ' TYPE OF CONSTRUCTION ................ --.--.----------...--.--.------~--. � � -....z��\�J��......-.-.l9.{. K � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby appliesfor accordingt6 fo|�vv information:' . ^ Location -----... ~,- ~ .L�� ..----------------.--,.-......-.....---_.. .^, Proposed Use --- ���?��~°�/����� , -.-..------------.---..--------.------.--. Zoning District --. ---.-..Rve District ------------..�--.------____ |�� �� . 1 � Name of Owner ...... ..--------..A66res ---.��T�_�.-.. ----------. v / / ' �l ' ^ ` ' ' y ^ Nome of Builder ----'`-��-��-`-^�-----------.Address -------------.-..-.---------... , Nome of Architect ....... .�. -------A66res -------------------_----____ Number of Rooms ...................../- -----Foundohon ---'...............----..�'��`------____ Exterior ---�� ----.RooGng ---' ^° �_-________,.. Floors -----.` /' ' ----|n�,�r ---'`�>.��..� ~--.. Heating ----'L.!....-1-........................--------P|umbing ----- Fiep|oce '-----..`-..........................................................Approximate Cost ...............:L _______,_ Definitive Plan Approved by Planning 800v6 lV----. Area -.. -.^�'�---. - Diagram of Lot and Building with Dimensions Fee ....... � SUBJECT TO APPROVAL OF BOARD OF HEALTH - . � . r / . , / - / . ~ , . . ^ . | . ' � | � - � ` \` ' . . | hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nome ....... ....................................... __-- | � / / Bassett, J. A: ,7' A=292-317 - No 20846Permit for .,,, one sto y singleckmi family dwelling ............................................................................... 1,' Masa's Place Location ..z............................................................. Hyannis ............................................................................... Owner J. A. Bassett .................................................................. Type of Construction ............frame Plot Lot .... �14 )........... Permit Granted ....... Qv-Qjmbgr...21.........19 78 Date of Inspection ........../........................19 Date Completed I .� l PERMI REFUSED .................................. ................. ............. 19 ....� .. .. ..... ........................ . ........ ............... j. � ............. ............... � ............ ................. Approved ................................................ 19 ............................................................................... ............................................................................... o, o $OIL LO• / X1 id a> ray y (l 2':.PLASTONE LOAM B FILL 12 MAR. 0 p m T- 6� SU1aJ l '�iif 00 411 IC. I. DIST. /p ,�° o BOX a n• o ° n p $ "•M� Test !o �� 0 �I � pp 29"MIN. D .,S/G i C r0 S A IOOO �I n D, o ° 1000— GAL. o OI SEPTIC I D n PRECAST OR d °D a I "'o'►�� �"�` +��i y� L TANK 6 lee, °,a BLOCK °D D o 5•t•c.a5 D SEEPAGE PIT o 9t�7 4'mj Sides•- 186 SF. o Or I C.,p.•r a G Rmup 0 — -- 20' MINIMUM I/ou°•, oo lQ1c�1_ 2eCJ7 �z'c .vb 9?i ` FOUNDATION I %z I WASHED STONE ELEVATION SKETCH lo Pane. RATE SCALE I' = 4' TEST BY TOWN INSPECTOR r'��G �s-,�•.�.r°-►y BACKHOE OPERATOR -.l A. 5s • l7. .�_ TEST MADE ON : .30 -17A. z- 1-1E,e-1,5 Y CE/QT/ c,v TNAT 1 rMF -r7V uC 7-r-'X E _5&*W�✓ fislrf2i uN iYA� LoG AT1.'��j /Al /o L x L I �".�++£ x���o c1•,e a CT lea i�7!g , — beadi Mark To c 8. vExp. Q Irv=�Q3.St fMOO �. fMItE LAPSLEY .A , '2597 O C ID SU(ZVE ♦ �' n/. b 7oP Q � a 0 9 V 71t NHS/" �'/' 3S� ' G �. _...•.�. cl1 _. �Y n CrI * riJ �- ,�. t.)ESfim�7��CJdd�/yt�'/aw��b,drnvn4)=3?�C}gPd�No g3rbaycgr1ir.;ler) Lo-T G .) x•�!/ow�bl� ;�/��/ ikw ArAl system ' r�lewd/�s ' 186 sFx 2.50yf'rlf = 470 qpo dap tw ELEVATION SCHEDULE_ • PROPOSED SITE PLAN I INV. AT FOUNDATION e 2 INV. INTO SEPTIC TANK = 1 7l� ,y SEWAGE SYSTEM DESIGN IN 3. 1 NV. OUT OF SEPTIC TANK = 102,4U a 4. INV INTO DISTRIBUTION BOX = 10 51`LEII,2Q �. Ig�� N. �� 5 INV OUT OF DISTRIBUTION BOX IO2.1 C—lo OF Af4X s 6. INV INTO SEEPAGE PIT = Q CASE COD SURVEY CONSULTANTSQ r Ow A rn ROUTE 132 McKECbINIE 7. BOTTOM OF PIT = 96.00 HYANNIS, MASS. .SS No. 14n4 etc A DIVISION BOSTON SURVEY CONSULTANTS, INC. jj '�, G!1CY'� /t1�• 8 BOTTOM OF STONE LAYER