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Home My WebLink About0129 SIXTH AVENUE (HYANNIS) 1415 06:57a Tupper Com - ` 15087785010 p.1 ..... CONSTRUCTION CO.,LL-c 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 V*VW.TUPPERCO.COM Date: �' 1411 S Town of Barnstable Thomas Perry CBO 200 Main Street 4 ° Hyannis, Ma 02601 S.d (508) 790-6230 fax Re: Insulation Permits {; M Dear Mr. Perry i This affidavit is to certify that all work completed for permit application # � Issued on has been inspected by a certi lied- _ Building Performance Institute (BPI) inspector. Ail work performed megts or exceeds Federal and State requirements. I Sincerely, Permit #: r � 2 S • C` J `� f • Address: I Richard Tupper License # CS-69058 " +. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION OF SPARNSTABLE Map 1 Parcel y D � Application Health Division rLa � Date Issued 2 /' Conservation Division Application Fee S Permit F� ��""�"' e Planning Dept. T, lot e Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 4 Village I Owner OLAu re, �ra�—,1 c Address 0 � � Q� Telephone 56 S--7-7 Permit Request o 9-3� ciflulo-,:�-e- , (Pynl vilQ (-m C:f�r Uaw in</5'�(A r \ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project ValuationO Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure 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_ 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: AYes ❑ 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: I Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Nam 1JTelephone Number Address6_�A License# Nc> �� r Home Improvement Contractor# Worker's Compensation PA50515 ,5D(B144 'ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO 5 4(p A �r SIGNATURE DATE k FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER t DATE OF INSPECTION: zFO.UNDAT,I.ON:i R,u: _. JUA*L. FRAME INSULATION..; s F FIREPLACE ,t ELECTRICAL: . ROUGH FINAL PLUMBING: ROUGH • FINAL GAS: ROUGH FINAL FINAL BUILDING_ = DATE CLOSED OUT ASSOCIATION PLAN NO: L� HOME OWNER WEATHERIZATION WORK PERMIT: PLEASE COMPLETE AND SIGN THIS FORM AS THE APPLICANT HOMEOWNER. hereby consent to and agree that weatherization work may be done by the Weatherization Program of Housing Assistance Corporation on the property located at: The weatherization work done will be based on programmatic priorities and availability of funding and it may include all or some of the following measures: Weather stripping; air sealing; attic & basement insulation; exterior wall insulation; ventilation measures In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to Housing Assistance Corporation the property with such equipment and materials as may be necessary to perform weatherization. 2. The Housing Assistance Corporation reserves the right to inspect the fuel or utility bill for the weatherized unit on an ongoing basis for no more than five (5) years after the weatherization work is completed. I have read the provisions of this agreement and give my consent. Home Owner(signature) = �` -i �L�%), �( Home Owner email: Date: Agent:(signature) Date: 1 � 5� 4�'i .3 Weatherization Contra ors: Adam T Inc Cape Save All Cape Energy Frontier Energy Solutions Alternative Weatherization, Lohr Home Improvement Building Science Construction Resolution Energy Cape Cod Insulation Tupper Construction 'I I The Commonwealth of lW assacflusetts Department of Industrial Accidents Office o,f'Investigations No 600 Washington Street Boston, MA 02-1.11 svww.mass.gov1 dia Workers' Compensations Insurance Affidavit: Builders/�Contractors/Electri€fans/Pltimbers Applicant Information Please Print if,egibiy 'Name(QusinessiOrganization/Individual): Sul laer Construction Co. , LLC Address:�546A H ins Crowell Rd City/State/zip: West Yarmouth, MA 02673 Phone#: 508--778-0111 i' Are you an employer?Check the appropriate box: Type of protect(required) I am a employer with 4. [] 7 am a general contractor and I employees(full and/or part-time).* have hired the sus,-contractors v. New construction 2.E] .l am a sole proprietor or partner- listed on the attached sheit. t 7. Remodeling ship and have no employees These sub-contractors have 9. []Demolition working for me in any capacity. workers'comp. insurance, g Building addition (No workers' comp.insurance 5- Q We are a cot poration and its required.] officers have exercised their 10.�:Electrical repairs or additions 3.❑ I-am a homeowner doing all work right of exemption per MGL I l.® Plumbing repairs or additions myself'. [No workers'comp. c. 152,§1.(4),and we have no 12.M Roof repairs insurance required.]I employees.[No workers'` comp.insurance required.] l'.[�Other eat>herization 4Any applicant that checks boa 91 must also fill out the section below showing their workers'compensation policy infbrmation. f HomeoNvners who submit this affidavit indicating they are doing all%vork and then hire outside contractor,must submit a rtevv afflidavit indicating such. �Contracmon;that check this box must attached an additional sheet slwWing the name of the sub-contractors and flicii cYorkcrs'comp.poiicy information. I am an emplkver that is providing workers'compensation insurance for my employees Below is the policy anal jab site fgforja�utioat. Insurauce Company Name:_AEI C Policy#or Self.-ins. Uc,#: WCC 5 0 0 S 5 9 3 012 014A Expiration Date: 10/3/15 Ic;b Site Address- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expi ation date). Failure to secure coverage as required under Section 25A.ofMOL.c. 152 can lead to the imposition of criminal penalties of a fine up to`31,500.00 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 Ul_A for insurance coverage verification. I do hereby cert?ft under the pains'and penalties of perjury that the infornuition provided above is true and correct. Si*nature: ' Date: Phone#: (5 0 8) 7 7 8-0 1 Official use only. Do navy write im this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3.City/Town Clerk .4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: CERTIFICATE F /+ DATE JMIVVDD/YYYY) LIABILITY INSURANCE 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 CONTACT Lora FitzGerald An4E: Southeastern Insurance Agency PH°Ns {508)997-6061 r- -- PAx �5 �- ! C No:l 08)990-2131 P.O. Box 79398 1 State Rd. EDDALC8S,IPitzOSOUtheasternins.com P.O North Dartmouth MA 02797 __ INSURER{S)AFFORDING COVERAGE NAIC 4 "--�� ---------- ----- INSURER AArbella_Protection Insurance 41360 INSURro 1NSURER,8Associated Employers Ins Co. i_v!Tupper Construction Co LLC INSURER C: ! 79 Mid Tech Drive - — -•------111 INSURER.D !unit B - —_-_--- West Yarmouth- MA 02673 INSURER E: '— IN SURER F: COVERAGES CERTIFICATE NUMBER-2015-1 REVISION NUMBER: THIS IS TO CERTIPY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 'rO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 1N01CATED. NOTWITHSTANDING ANY REQUIREMENT. TERNS 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.UN/lITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A�iL sua t !_TR INSR! TYPE OF INSURANCE_ i - POLICY EFF ' POLICY EXP .POLICY NUMBER CAM/ODryYYY I MCNDDIYYYY i LIMITS j GENERAL LIABILITY - I ' I EACH OCCUR4 PCLE ,000,000 -X !COM1?ER IAL Gi"NERAL UABILITY ki H A I ' I PR M1ii lc u er Cel 5 100,00 CI.AINTS.MADE D OCCUR 6500008743 11/1/2014 1/1/2015 I RAFQ CAP tnq One Derserti c 5,000 -v— - I PERS-UNAl&ADV ir!URY S 1,000,000 C Irl AGGRLr'l(cUt!;t lFP: o-. I I GENERAL AGGREGATE (-�. 2-,_000,000 t'G _ ES.Ell , P.ODUCTS-COMPIOP AGG 13_ 2,000,000 _ � 5 I AUTOA013ILELIABILITY i i - ...-.: ___ I ! I COMO !EQ SINGLE UC1iT I ANY�; tE if [y'rlkRil -_� 1 '000 000 ��J 1L OWNED }}S ` I fiocii/wjuRY(Pe person} A AUTOS X tAUTO)S EO �3020009369 12/1/2014 12 1/2015 / BODILY INJURY - X R.I .r d0 -OWNED I L _� f_ , QGERT 04 1AGE s r f - _._ - __. ! Llrnsa;eti C^gtor t8l ctl!r in. ' UMBRELLA LlAO - ..250 000 - Occur ECLA�!MSAAOE tEXCESS LIA8 NGE_ c GATE oEo IR>reNnONs 4600059368 11/1/zo1� z1/1/2o1s `� — T,j 4YORKER.S COMPENSATIUN - -- - - AND EMPLOYERS'LIABILITY A STATIU t 10TYiNti- - -- LJNr PROP CRUZ O ICERPoEt RER XCLUDC _ ....._ NIA ; !{10/ E.L.E LEACH CCIDENT I 000 000 i(P{andatory n NH) I CC5005593012014A I3/2014 J10/3/20X5 p I.DISEt Sr EA=+9 :OY=_E S u 1 000 000 ! r3 6Ls 7N[f r 4c CIrz�6 PT[ON O, OPERATIONS Nr±144v ._. � ' 1 I - v-:_._t•._._;.-s - - { ._._.___.�F. DGEASE-POLICY VAIT S _ 1 000,000 j_ I DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Ahach ACORD 1e1,Additioru l R—Writs Schedu(e,it more space is required) - CERTIFICATE HOLDER - CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN IN-FORMATION .PURPOSES ONLY ACCORDANCE WITH THE POLICY PROVISIONS. TIPPER CONSTRUCTION CO 'LLC 546 A HIGGINS CROWELL ROAD AUTHORIZED REPRESENTATIVE WEST YARMOUTH, MA 02673 t1 Lora FitzGerald/LRL I ACORD 25(2010/05) Th.Arllgrl v 1988-2010 ACORD CORPORATION. All rights reserved. iI+15025r�n(nnttlit r+amn.ar,rC ir,nn o.n rnnlcrnrnrimar4a of GC.rI!]rl �., Ctttsi�01 i n�Tsiih it:�n1trS,s iiti.l=Tiittte+,0ati eta Uon.ss ur r nisrc'ativci v;,iid for indwidi:t use wity IMPROVEMENT CtJNTRAC-OP. ireiurc Jtic e lst�tdtQasdaic s9'fa,iiiyai i ,s;r)L) 4 ftisttratEQ:t '�q?i `+ lie: i3f ica=s=t t x{�urnsFla�f.Tirs:Ttcti tart t<,Lxs fii it.:ctiu:3 iUG%DE XNF,':tat.,C i t0,W irtj.:_t.C . t' k..'A10"^+71H Div, in4u>ai:rc.,it:" 'ti6[Ta=�1',�itt7,�ct:,4�s3itit,ei "�°+11�.$.1�•f�.S7§-.�"'��i.3t��s�t.Jf�x`tt.a I�.j�z�s�tY,y., �}- �.: �•• ^.•�- .:. 1 P785 -CttilbettY-OnF i ,it"ESt ot Public s ta.} l-tfh•,.h l 3i? itti Co.r.T.�}a^.iti 7r, �L,•.{tilZiiC}#-,anc 3l i die;`"�a rA..;i:`y f�.ti L�i,tµ'e.P it L3Nai tHt41 i•Tt i?2=r . lit;A?ail:t:im wraaWt Me '� �brrBr YSrYtYigtiil3 i�:� � � y Paapie KIVing People Build G Saftsr World" cm, Mt Richard Tipper Tupper 0:oiiStruction $1{!�i1iPtG Saf2iy�f:7tY'.S9=Qi a�i Member r:8158119 Ew 4130!2015 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map '- `J� Parcel O Permit# b 60 Health Division 9'7 ---14, -3 � 5 3 o3 T0 "If 0t 0A IRNS)TA8LE`:� Date Issued s—D--� Conservation Division A, ��/��•�. f yy { j Application Fee Tax Collector dDo� ��— "'" �/ m?fD3 -.Permit Fee Treasurer R L-- Sf�°?'0 3 .. _�_ ��C SYSTEM MUST BE T; E i C INSTALLED IN COMPLIANCE Planning Dept. VM TITLE S Date Definitive Plan Approved by Planning Board EWRONMENTAL CODE ARIL Historic-OKH Preservation/Hyannis TOE REGULATIONS Project Street Address /o�` � i4yr Village Owner t1 .ter � �� Address ✓� �.� Telephone `�� 57 Permit Request Square feet: 1 st floor: existing proposed 2nd floor:existing o q g p p proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation � a� ,--- Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(#units) v Age of Existing Structure Historic House: 0 Yes ❑No On Old King's Highway: ❑Yes Cl No O Basement Type: ❑Full ❑Crawl ❑Walkout O 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 2 Meat Type and Fuel: Cl Gas ❑Oil ❑ Electric' ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:O 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 ' BUILDER INFORMATION Name Telephone Number 6—a' L // 7 Address License# 00 Ll,:� 7 6 6 Home Improvement Contractor# O Worker's Compensation# ,WC/ 31.E•,3 7.34 o-0 a. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 0 FOR OFFICIAL USE ONLY17 PERMIT NO. r DATE ISSUED f4 MAP/PARCEL NO. ' , ADDRESS VILLAGE OWNER DATE OF INSPECTION: FTION /2 OUNDA 1 FRAME /f INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL if PLUMBING: ROUGH P FINAL ' GAS: ROUGH _ . t = FINAL f 1 FINAL BUILDING 7/ t o ? DATVLOSED OUT ASSOCIATION PLAN.NO. ' ♦ A The Commonwealth of Massachusetts Department of Industrial Accidents =-� = Ol�ca o/Ioses�gst�oos < 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance davit name: � �� /�-1 U�G. �� •�i d �! ��' �'. location city phone# ) ❑ I am a homeowner performing all work myself. I am a sole netor and have no one workin in ca aci ' ob. El �•n for e 1 ees workln . this ensaim ]rkers co g wo mP o3'ovldm mY 1 r I am an em o g mP ..........................::::::::::::..:::::::::::::.:�::::::.:::..�::>;':::;:.}}}:.;:;.}:.}}:<.:;.:.;:::;:<.:<.;:;.}:;.Y}}:.;.<::;}<:>>:;>;:>::<:�>:::>::�:>;:«:r;�»>» :cam anv<nam > :''•5 :•:: ';:•.•:?>{:}j^:�i:;:�:�':j ti;:Y.'•:yt't:;T ?i :.';;i'?::�ii:Y'':`:::J:^j'r,:::;''i:'�iii$:•: .:::>i:;'s. :<;l:::'M1?v'�i:^;":::• :isj::;ij;isti;:•,:}::::`::: ........................................::•.::::::::::::::::::::::::::;:.:o}:::;•>:•}::;•::•}»:•:•:<:•}}:•}:•}:•}::•: ::;::;}:•:r::ir}:.}:::•Y::•}}}}}:•>}:•:•:;•:}:-:•>}::::::.�::::}:;•::::.�:•;•.:••.:.4':,}:.�:•}}.•: 'p Lion etw" i fF }"`serarce ❑ I am a sole proprietor,general contractor, or homeowner(circle one)and have hired the contractors listed below who have llowin workers' co ensation polices; the g ..mP....................:..::.�:::::::::::.:::.:.................::.:::::. .. man :name::•::::':::;<:::<:::;:};:::;:>:<::::;:>:>::>:;�:<•>.:..::;:::;.}�:.;}}:...::.}:.;,,;:;<;::::::;:::::::.:.. ..,.::. ::: :{::i'::}'.�}{i;'r:;,ri;::'v::?:::L�:j.?:, ::'rtf i:}:i':iiL:i:}:;:�:�ii'<i�::iyi::y:?i:!t:'i::}}::::;i:}}:�:�::?;:;i:}}ii::;i:.�:;`•;:>:j::::;'r:: :::iitiC: .:.:2..:.x• .•f Y:;'::;T};;+}:;Y}::i;;}};}.}: .�ii;;:•}::..{.:;�{{•}:3:•}}?:}:::ry:;:::.;v;.:•.•v::.:i:::::!•:`y.}i::n:;:r::�::•::::........:..r:n;..:......::...::.. .,..;:.:.,...:..:•}::.:�:::: .:................::�:� :a a .,•;;;:�;.:;;}:�:•ss< :•::..................:•......................:::::. :::.::::.... ......... ..... ... ......... ............................. .........................:::.:::...v.::::::::::.::::::::::::::.v::G;:::.�::::n:::.v-v;{:::.,•:x:.}}}:•}i:, :.. y :::}}:•}F•. 21 :Lto�•ii,yv �+�.r;:{:::::::::.}l:::::;:i:.::.:�}i}}}}:i�:�}?}}_}i:4:+j.i}:::i:.•i}i}}}}.i; •:::•Y::::.;;::i:i'-}:::v:::.;v:::::::;.:�:::::.�:v:.;.}.:::ii�::.:................ r n,:.•j Yi�iutarteexot<:;:: ::::;:;•;;;:>;::::;:Y<:,>:<::;;;:;:r;,z:;:;.}:.:;.>•.}:;::::<;.;-.:<.,.::::..:::..:.:..::::..:::::::,,.::.::.............. ... . . .. .4. :j;:;:;{}is} '::;:'Y�ii:v/':::iti':�:'ji}iii:i{:'i::i:!:ii::::!;iiiiiv i'r:i::�i::i::i{;$i:iy:iiiiiii:�+:t:;:{ i:y;j;�i:;{:;v:i:y::�:}:i'i�i:>:}%:�:;:j?<:!}::;:::v:iii:::}}'':v'::':i}•i�:}}:•:;:}:ii:':•}:•}:•}}:::.;?:�'8:•}ii:;:�:•}';}}}:}:;:r.J}::?'•}:.:.�...::.:::i:i}}:v:.•r..v...v .:+.!;;.::0}y}..:i,+.ti;i:•}:?:i:i•i:i:j;:i;:ij;?::•:?y;:•i;:};;.;}�:?;;::;:;:•:;{.}Sjj•.�::.:}: `.'�:`�';:'`.�:::�:is�`ti::::::;:::'::;`:>;:::'i:`;:R:::>:::`<:;'';: <:�<:'<::;�;;: %;:;:::i::�:<":?:;:2;:;;:::::2';::.;;;;>::::::'•:Y::?%SSr:%><>.'>`:6:; :::::`:a::::::;::;:t:::;:�:%YY:::�:ii:::5:t�:;::'LS`:�fr•<}:+�:}:�}:;!};}�'•�;c:c;:•}:•r:;::::•.;}::t:•}:•}`••• ........sitiC!ii•:!isv:ii:}:4}:i•i':•Y:•:•:•:C:?:{:$.ti;'i:':::::;:.:>.?}ii;:;i.:}i:}:}'n:....:....':;{:':j$' an :i:'t:;�%:::::; :•'::3: -.',Q�;}:n�rjjii�3 .`''<`Si��.�i�? `#'� 2•i. {i?:::i�i:;%ii�:iii:iSit?``:�.:::;>i`-:i�;i:: :::[>;:....::.�:? i : n�'nrnm gaame to secure coverage as required under Section 25A of MGL 152 can lead to the imposftloa of crlminal penalties of a fine up to S1,5 00.00 and/or one years,imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of 3100.00 a day against ma I underatad that a copy of this statement may be forwarded to the Office of investigations of the DIA for coverage verification. I do hereby certify under the pairs and pen of perjury that the information provided above is trr�and carted signature Date Print name tU U Phone# �'� (contact fficial use only do not write in this area to be completed by city or town ofScial ty or town• permit/license# ❑Building Department ❑Licensing Board ❑checkif immediate response is required ❑Selectmen's Office ❑Health Department person: phone#; ❑Other (�cvised 9/95 YJA) 1 . Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract r implied,of hire, expresso p d, oral or written. e entity,An employer is defined as an individual,partnership, association, corporation or other legal al �'° or any two or more of o or the receiver or 1er the foregoing engaged in a joint enterprise, and including the Legal representatives of a deceased employer,y , 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 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 applicantthe o has evidence of compliance with the insurance coverage required. Additionally,neither evi . not produced acceptableP visions shall enter into an contract for the performance of public work until commonwealth nor any of its political subdivisions Y acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants a o affidavit completely,by checking the box that applies to your situation and Please fill in the workers' compensation supplying company names, address and phone numbers along with a certificate of insurance as all affidavits may be w: submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign an .;. - date the affidavit. The affidavit should be returaed to the city or town that the application for the permit or license is of Industrial Accidents. Should you have any questions regarding the"law"or if you being requested, not the Department policy,please call the Department at the number listed below. are required to obtain a workers' compensation City or Towns 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 permrtllicense number which will be used as a reference number. The affidavits may be rctarned 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 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 investigsuons 600 Washington Street Boston, Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 �oFiHe, � Town of Barnstable Regulatory Services MASS Thomas F.Geller,Director i nsAss. 39. a g�� Buildin Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-403 8 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 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: Estimated Cost 3 o-&- Address of Work: /oo ' Owner's Name: ��2e/A-A Date of Application: I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 (]Building 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 MROVEMMNT 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: Da e Con ac or Name Registration No. OR Date Owner's Name i i I �;�i BOO ASRDeOO�BUII!LDMd,,G REGULATIONS License STRU,ffTWf N SUP€-RdVhSOR MiurnbesC: 004276 B''i idate J�p t 03�� Tr.ne: 12063 ART"U L DOL � P j ` ; 1S9�MCC<;i2+M'I'CK'DR�� z y� ��'•c-9. _, 1N BA�RNST�ABLE; MA fl2668 Adm'nistrator i � �1ie �omvireaiuuea�/ o�.�aoac�u�aet� ' Board of Building Regulations and Standards HOME IMP ZOVEMENT CONTRACTOR Re�istrat�b� 104499 Ekpjration 714 2004 _PnVAte Corporation ART DOLGOFF BtJI{�iNG7EI�tQ j 1 Ar�uu�^Do)off i �ti ,of f19 McCormick Dr. : € W.Barnstable MA 02668 Administrator I j i I1-111.31kl Y _ _ E Axis _ +.w�..w..::..+..ee.+e.+.....r.. ...�..�-..ew:w....s..-+.am.ve-�-�w...+.,.•.+.+..:...e . ov _ i� 97�' OFIKE T Town of Barnstable Regulatory Services safuvsras[.s, 9� Mass. Thomas F.Geiler,Director 16Sq. �0 AIEDMA'IA Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I , as Owner of the subject ro e p p riY hereby authorize o act on my behalf, in all matters relative to work authorized by this building permit application for: e- L is c 0� (Address of Job) Signature of Owner Date Print Name ( :TORMS:OWNERPERMISSION / 'Engineering Dept.(3rd floor) Map (:;; j Parcel_. �4� e'er--hermit# J Y 7 7 House# Date Issue f d 1 _ - Fee a5 �iME and 19 MAqq TOWN OF, BARNSTABLE Building P it Application Project Street Address /� t Village Owner �� o�, `�� Address Telephone Permit Request First Floor square feet Second Floor square feet Construction Type Estimated Project Cost $ 02JS - 6-2) i Zoning District �,� Flood Plain Water Protection Lot Size Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure 4K�_ 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 New Half: Existing New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: aOil ❑Electric ❑Other _ 4J Central Air ❑Yes A�oFireplaces: Existing g ❑New Existing wood/coal stove Yes No —� Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) ❑Attached(size) ❑Barn(size) O None Shed(size) X /I--- ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use Builder Information Name_ Telephone Number Address License# Home Improvement Contractor# 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 SIGNATURE . DATE BUILDING PERMIT DENIED THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY • h F � � , PERMIT NO. P DATE-ISSUED ' MAP/,PARCEL NO: :. ADDRESS- 41 VILLAGE OWNER S �j I ' a DATEOF INSPECTION: FOUNDATION rM- I � FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. Dc part»uttt of ludustrial Accidelits plfcc-O"Mestf9waffs 600 if&sltittl;ton Street Boston.Alas 02111 Workers' Compensation Insurance'Afridavit Please PRINT - •Aj1t111C-�ni inw�m�auprrt�t' s- 12,90 1 am a homeol#cr performing all work•myselE I am a sole proprietor and have no one working in any capacity 1 am an employer providing workers' compensation for my employees working on this job. n v Idr t • ' c:.... Phone#• ina►r-ince co nolicv# 1 am a sole proprietor. nener21 contracto meowner c le one)and have hired the contractors listed below who have the following workers' compensation polices: m anv name: •eddre cirn phone#• insur•tncc co nolicv# - .. _... _. y!•If•' � .71�OR_-..�.:•-•Tft-«c-+:^... �:---air--...vl�.-�-S7`.�)r..��sl•,r.-... _.^��!�wno,.-T�e:�..•�-z- cnm an-name: nddre cr rip Phone#• iicurince en policy 0 .Attach additional sheet if tieeessa + - ,..•s��;'<"'c'-..:. :.'.:.'. ...r..•...`•; _ .. Failure to secure coverage as required under Section 25A of 51GL 1S2 can lead to the imposition of criminal penalties of a fine up to S1S00.00 andmr- une years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of S100.00 a day against me. I understand that cope of this statement may be forwarded to the OMce of Investigations of the DIA for coverage verification. ' I do herebt•certif nd• e pains and pe of peduq•that the information provided above is true and come q/ Si_natutr Date9/ — Print name Phone# ~official use unit' do not write in this area to be completed by city or town official . ciq or town: permit/license q rIBuilding Department C3Uccnsing Board check if immediate response is required 13Seleetmen's Office C)Iiealth Department coataec person: Phone ft riOther iTwued3,1)I P1At t , Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for employees. As quoted loom the "law",an enzplt ti ee is defined as every person in the service of another under an\ contract of hire, express or implied, oral or written. An cmplorcr is defined as an individual, partnership, association. corporation or other legal entity, or an-two or r the foreamila, enuaaed 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. Howeve: owner of a dwellin- house having not more than three apartments and who resides therein. or the occupant of the dwcllim, house of another who employs persons to do maintenance, construction or repair work on such dwelling or on the ;_rounds or building appurtenant thereto shall not because of such employment be deemed to be an empic MGL chapter 152 section 25 also states that avery state or local licensing agency sliall withhold the issuance of renei.al of a license or permit to operate a business or to construct buiidings 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 chant, been presented to the contracting authority. 77.7 77 Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation ar 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,tli;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 requi to obtain a workers' compensation policy, please call the Department at the number listed below. Cin• or'I'o�,%•ns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottorr the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. P be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returne 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 should you have any questi 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 600 Washington Street Boston,Ma. 02111 °F WE A Tha Town of Barnstable M � Department of Health Safety and Environmental Services ` 10 59. Building Division 367 Main Street,Hyannis MA 02601 Ralph Crossen Office: 508-790-6227 Building Commissioner Fax: 508-790-6230 For office use only Permit no. Date AFFIDAVIT HOME IMyROVEMENT 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 r to owner occupied building adjacent containing su h aresidence or building be done by registered least one but not more than four Iling units contractors, with structures which are adjacent to s certain exceptions,along with other requirements. 0// t.Cost Type of Work: / Address of Work: o? Owner's Name �-�— Date of Permit Application: z D "r I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. 'lding not owner-occupied � Owner pulling own permit Notice is hereby given that: UNREGISTERED OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH CONTRACTORS FOR APPLICABLE PPLICAB � RNT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM GUARANTY FUND DER MGL 14A SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. .Date Contractor Name Registration No. OR ...... • t � ' TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB LOCATION /� f W - Number Street address 4Se�dtion of wn "HOMEOWNER" Name Home phone Work phone PRESENT MAILING ADDRESS City town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervis-or. DEFINITION OF HOMEOWNER: Persons) who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Officia_on a form acceptable to the Building Official, that he/she shall be responsiblE for all such work performed under the building permit. (Section 109. 1. 1) The undersigned "homeowner" assumes ..responsibility for compliance with the Stat ' Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply wip said p edures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which a -building permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Ownez shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations for licensing Construction Supervisors, Section 2. 15) . This lack of awarene; often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Board cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home "dwner, actii as supervisor is ultimately responsible. . To ensure that the Home Owner is fully aware of his/her responsibilities, mar. communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. ssessor's office(1st Floor): Assessor's map and lot numb 4, S B' ,.• c. THE T ✓Conservation(4th Floor): 1%LLE01N C C 21."i. 1,r;� Board of Health(3rd flo - T WITH�`�`L O = sAassT�ait Sewage Permit number �'�—' ��j 3�� a u �xlr�. °� ,`' rua engineering Department(3rd floor)' ,�i 1c'_ House number 1639. E '" �" Definitive Plan Approved by Planning Board ' 19 APPLICATIONS PROCESSED118:30-9:30 A.M`and 1:00-2:00 P.M.only ! TOWN OF BARNSTABLE `BUILDING INSPECTOR APPLICATION FOR PERMIT TO L TYPE OF.CONSTRUCTION W pd& Co r-.&}C cjr,lo(N s-1 � - 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the foil ing information:r `� p / Location Ave- n(1 k's Proposed Zoning District S�4��`i�` E� Fire District U 1 Name of Owner Address "I t/e� S Z� n Name of Builder Address Name of Architect Address ` Number of Rooms Foundation G ". S6r�k_ Ty,pt?C Exterior Roofing Floors Interior Heating Plumbing / �^ Fireplace Approximate Cost Area �Pd Diagram of Lot and Building with Dimensions Fee ��o� C� / jo,sks G z- 1vbeS 3 Z" �elt9w GT�.�.e eve 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 Construction SEEpervisoes License "eA)iU t°1 — z �. ,. FRASER, ROBERT 4� A=245 63 No Permit For ADD DECK TO _ DWELLING Location -12 9 Sixth Avenue r ; West Hyannisport _ rl Owner'Robert Fraser J Type of Construction YR .-, Plot J Lot ' •fir c'' f . -Permit Granted � • May 20 - 19- 94 Date of Inspection: , F Frame Insulation Fireplace 19 Date Completed 1-9 • y. ' , ..� - .per , I _ y . TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. o DATE � � ✓ . 9 J `(' JOB LOCATION Number Street Street Address Section Of Town HOMEOWNER" ee�bt:k-_T 1 Name Home Phone Work Phone PRESENTMAILING ADDRESS jK4► AX) c& _ 0.-47, City/Town State Zip Code The current exemption for "homeowners" was extended to include owner- occupied dwellings of six units or less and to allow such homeowners to engage an individual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(s) who owns a parcel of land on which he/she resides or intends to reside, . on which there is, or is intended to be, a one to six family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Official on a form acceptable to the Building Official., that he/she shall be responsible for all such work performed under the building Permit. (Section 109. 1. 1) The undersigned "homeowner" assumes responsibility for compliance with the State Building Code and other applicable codes, by-laws, rules and regulations. r The undersigned ."homeowner" certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35,000 cubic feet, or larger, will be �. required to comply with State Building Code Section 127 .0, Construction Control. xiscs HOME OWNER'S EXEMPTION The code states that: "Any Home Owner performing work for which a building permit is required shall be exempt, from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person(s) for hire to do such work, that such Home Owner shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, . Rules and Regulations for Licensing Construction Supervisors, Section 2. 15) . ' Thi's lack of awareness often ,results in serious problems, particularly when the Home Owner hires unlicensed this persons. In t 'P s case our Board cannot proceed against the unlicensed .person as P it would with licensed supervisor. Home Owner acting as supervisor is ultimately .,responsible.pervisor. The To ensure that the Home Owner is fully aware of his/her responsibilities, many communities require, as part of the permit application, that the Home owner 'certify that he/she 'understands the responsibilities of a supervisor. On the, list page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. f �- BARNSTABLE NOTBTOKETCH SCAGE P11VE ST Ir e tn ROAD LOT HSE LINE ILLS EACHYANNISPORT CRAIG V GOLF CLUB LOCUS ASSESSORS SIXTH A VE LOT 245/61 ASSESSORS p LOT 245/64 CENTER VILLE HARBOR 100. 00 LOCUS MAP PLAN REF 34/23 ZONING. "RB" DEED: 12511209 O """"' ASSESSORS MAP 245/63 SHEDQi -,,,,,, 0 Q CONC. ti PAD ti;;;;;;;;; ' 26 8 PLOT PLAN OF LAND ,,,, LOCATED AT (� """""'' ' ' 129 SIXTH AVENUE J,j� 18. 8' HYANNISP0RT, MA. ,. �� ' /� E L PREPARED FOR: O �. o "�'ti N , CLA IRE FRASER ASSESSORS ' p G ~' f MAY 05,2003 LOT 245/62 cl. ASSESSORS O LOT 245/63 �O GRAPHIC SCALE PAULA.sq`y' AREA=8000.tS.F Zo o ,o zo <o eo MERITHEVV e-.= _ �` 100. 00 - ( IN FEET ) ///4.�11...SUP. O `�� 1 inch = 20 ft. FO RES T S TREE T I CERTIFY THAT THIS SURVEY AND PLAN WERE MADE IN ACCORDANCE WITH THE PROCEDURAL AND TECHNICAL STANDARDS FOR THE PRACTICE OF LAND SURVEYING IN T"MMONWEALTH OF MASSACHUSE 0� TEL. 428-0055 FAX 420-5553 408 JF PA UL A. MERITHEW, P.L S. ATE J# 53