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HomeMy WebLinkAbout0050 STETSON STREET SU SYeYso�� ACTIVE �r !t 1 r; ` " Y r al," SS o(!Ic® pfoducis i { T wn df-Barnstable r _ . o eAll, it ' 1 - » �^ - .f ust..b ,K��t ... t. tKls Gard,IVI. h .e tr. v�d..Pians-Musts a Retal �d�r� .Islbi .:F.to .<t e: tl" r10 _ �..., .. .4 ..,,, F :_ � ...: :.. ,✓. .,,_.,, ,,..: :, ,.,, :::t,.,. .,,,, �...,-. „„.� r �'. ,.,. a a, ,, r - .:. is .. •.-. .. ....... ,... ...> _- ^ < , z�n..-. ,,. -<, `£,. as - -' Applicant Name Mike McMahon Approvals PermltNo. B-17 3332 ;: . . pP __._ . _ Date Issued , i0/13/2017 Current Use_ f structure _ ,. .. _ t Permit Type.'Aulldln Insulation-Resldentlal ExpirationDaf f04/13/2018 Foupdation: . g`'-'. Location: .57STETSQN;STREET,HYANNIS ' :: _ Map/Lot 306 057 Zoning Distract: .,R6 :Sheathing: Owner on Record: STURROCK,GUNILLA&SURROCK,JOHN x * Contr ctor.Name MICHAEL T MCMAHON Framing: 1.:: Xa Address: 7 MURiEL DRIVE w Contractor ticense. CS 068111 2 WESTFORD, MA 01886 Est Proi ct Cost: $3,900.00 Chimney: Description: Weatherization,air sealing,weather stripping and blown cellulose Perrnit Fee: $85.00 Insulation: OR Project Review Req: Fee Pald $85.00 fi Dates 10/13/2017, Final: Plumbing/Gas Plumbing: 3 Rough • . Building Official Final Plumbing: E �$�. � ,. This permit shall be deemed abandoned and invalid unless the work autFionied by this permit is commenced.Within si -months affier ssuance. Rough Gas: All work authorized by this.permit shall conform to the approved appl cat on and the approved construction document,&fo.hich this permit has been granted. 34, i Final Gas: All construction,alterations and changes.of use of any building and str,,uctures shall be in compliance with the local zoning by,-laws and codes. Z. This permit shall be displayed in a,location:clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. Electrical r .,� � � Service The Certificate of Occupancy,will,not be:issued until all applicable signatures by the Building a6 Ate Officials areYprovided orxthis permit:.` Minimum of five Call Inspections Required.for All Construction Work ass E u � '' a r Rough. 1.Foundation or Footing h . �.a � 2.Sheathing Inspection Final 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) . 6.Insulation Low Voltage final: 7.Final.Inspection before Occupancy _ Health Where a licable;,aeparate permits are required forElectrical,'Plumbin ;and Mechanical Installations pp g i Work shall;not roceed until the!Ins ector has a proved he various stages.o.fconstruction, --p p . P _.:......... Final Per;� r1s ctin gw Vh d ve':access cgntrac yund�r a setforthln GLcora tors h e a,.. Final: Building plans are'to be available onslte.:' _:. .. All:Permit Cards are the property of the APPLICANT=ISSUED-RECIPIENT �W►Art�► 3£�'T TU PPE R CONSTRUCTION CO.Lac 798 MID-TECH DRIVE,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX, 508-778-5010 WVdW.TUPPERCO-COM Date: `— I, �� - ( ' Town of Barnstable uj r Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 " y, (508) 790-6230 fax o � Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application # Issued on ( ff I has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, T Richard Tupper yar 0 License # CS-69058 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q � Map Parcel App n # Health Division : Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board F Historic - OKH _ Preservation/ Hyannis Project Street Address CO cJ � 0)7 P Village Va, h h is Owner C u l Address S� ✓ l�l f d 1'I �� Telephone Permit Request T4114 CL:7�. I <� h6� us 11 s cc.lak. b4__6k 69 hLeM ed Z Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Toth neon Zoning District Flood Plain Groundwater Overlay112,7 Project Valuation 2-) ��`kConstruction Type co Lot Size a�0 Grandfathered: ❑Yes ❑ No If yes, attach sup orting do.�umation. Dwelling Type: Single Family 22-` Two Family ❑ Multi-Family (# units) q 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 WON ❑ Electric ❑ Other Central Air: ❑Yes 5'l l�o 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) r p Name Telephone Number ��d '" 7 -7 Address License # 14� 17 Home Improvement Contractor# V Worker's Compensation #Q�� ��Sp-�al� ALL CON TRUCTION DEB S ESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 1J,� /J� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED .MAP/PARCEL NO. l ADDRESS VILLAGE OWNER DATE OF INSPECTION: XFO.UNDATIONi_)A-t 1"cl- lul:,4;i: FRAME INSULATION a:,c to->,' F FIREPLACE ELECTRICAL: .. ROUGH FINAL - PLUMBING: ROUGH FINAL G GAS: ROUGH FINAL ` FINAL BUILDING- r { DATE CLOSED OUT ASSOCIATION PLAN NO. y t The Cwnft%P3dSi.'L'18d��€_��I��dfSSff�dBl$S�'t�s OJftt8 of inve4tigC#ious ._ Boston,OVA 02.714-Z.70f s�.>i..c�}rrtc�ss.�oaticiirt ' €a ket. 'Corapensalc16h Insurance. 'f av is Bia dcrs/Cont-act 1zsLFgeAp-plicant Information ��r�ia�>�sl�It���ib�YE Please,Print Lesfbhi Name a3usine5slQtganaz3riot>�Tnl 1-idttali Tuopk r Construction Co. IRS y'dtj,U _ 798 Mid TeehIDrive Citylstate/zip:Wes?Yarmouth MA 02673 _ Plaone �L178�778-C i 11 �vAre you an eanp6o�ca'Check the appropriate bcA T Y of�;ri ject(reg4irea�l. 1 l: i an,:a imp?o ei %vlfl?_ ❑ lam, ;ener t cuitt7 a ur zlt 1 t. ! ciriplotees(fffl ard'oi pert t ruel"`' f�vL tllrerl IItC cvLl LL7i1+s<r,,to2< 6' New cotletrtictioil l am a Sole prolwictor or parlincr., th a.ttft iit tl sheet. 7. [Ti:einntlettlz chic and laavz no clnP yees These sub conh�at tors hAvl� g: UeTnolitlpn torl;rg- for me m any cala att . elllplo� e5 nnc 1ai c TYartPls �: ( Builclin�{tddtinit �. ,lTo sv3rl<ets' cotllp. 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(1: s ` .T P1}ces...Below.isrilepolicv.ttr•rf.j{ih'site :On F7E[dfEtlii. FE . (ilsttl"artce Cllnla�.�3rni ` A_IC P, l,i y 4.>rSeli,ins.Ltc. '. �1JCC 50055030:12007 E\ l31 jobSileAdcire5s .50 Stetson St' H annis `MA 02601 CtL.rr'Stistat�,tp-_ Y _ Attach a ctt:i3r u'tla .v< teas' cua�apiPrStti�aa pfi�licvt3ecEaaatltttt l aic(staoiEtaa? �trEtcy'gtta.a�fi All€�e:�jsiralJon date); {'iitUtZ T SC:Gur ,C i:'C.:it. tli {f ii lCIt3;:JG'4.SOIL !> of i G.L. c:. Ii.Coll.I,Gat'".iQ illr'itripo5ttl0It J.E C {nitral' t.IlcEt::IC?(}f oltc.i tl i, 5 t1,1.0U sin[ r one} gar:it tps!�nril Pont s we L .c:civil pc:n t1 ,,.c ij rho 4o,t x ctt ..5;Ltd atr.E�t't,.O tt z n z u tine t?[•tip TO .7:(1 00 a Clay 41SV(11C ViOlatoi-. .E.c art SSS^Ct thlat'l Uj)U.,Ui t}IiS.ST CE i'riCilt C)aia. tti i'a'i'+i 11 C3CCi`{U ilia;Office tCC(ii�'. 11Lt'' 4ittit7L�a f, the'>�1, i(..r., SUi rce eiiv?i'acc 4r-fiTl.Cattitll.`. 3 t i7eFe Jb L'BI t '1l1 GI" i :�ytldiF ttYrt� of[ {1$. n �fG�l�jm y It tit the info rintd6n prejvlded abotVe IS fr'ue tltPttGt3trPL'F: ' i�ii til \� ia € 12/27/13 7e-011; -- -, 1. J�f fcctz!a�tc tF o. v rte Ilr:this ul•e<i,s ;5s eUFrlpietnd fiV Giay cir f)avij ofi t !. 1 ... .., �14Y231irl�SCf.nSC�'t. 1,. l ---- ff ' 3 uoaa ti s?#altca=it 2.P.U)1dir_g DcPart neuf 3.0tviTchmiClerl, a.Electrical hispector S.plurnWrig Inspector 6'.other Ii Cmilact Person: t Phone* I 1 A /4 COa��M CERTIFICATE OF LI 4BILITY INSURANCE pATIE(MMD°""" 12/03/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION'ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY'AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS,CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE"A CONTRACT BETWEEN THE ISSUING.INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies);must be endorsed. If SUBROGATION IS WAIVED;subject to the terms and conditions of the policy,certain policies may require an,endorsement Aistatementon this certificate:dDes not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CO ACT NAME Lora Lowe Southeastern Insurance Agency, Inc. PHONE -A/C No Ext: CS08)997-6061 FAX 439 State Rdc N,.,.C508)990-2731 EMAIL P.O. Box 79398 ADDRESS: PRODUCER. - -. .. ... N. Dartmouth, MA 62747 'USTOMER 10 go. <. - INSURE INSURED His)AFFORDING COVERAGE ,I NAICp. : - - � -- --. - - INSURERA7 Arbella Protection Insurance Tupper Construction Co LLC INSURER Bc AEIG INSURER6: CNA Surety- --- 27 'Roberta Drive INSURER D: - West Yarmouth, MA 02673 - INSURER E- ' INSURE'RF: _ COVERAGES CERTIFICATE NUMBER: 2013/14/1 REVISION NUMBER THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH'RESPECTTO 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 SEEN REDUCED BY PAID CLAIMS. ILRTSR. ADDL UB - . .... .. TYPEOFINSURANCE - - '...MP^OLIp . M UM17s INSR N/VD POLICY NUMBER LI EFF OOLICY EXP 51_,OOO,OO I GENERAL LIABILITY � - -. �.X COMMERCIAL.GENERACGABILITY' gS0000874 11/0112013 11/01/2014 EACH OCCURRENCE PREMISES Ea occurrence'-.: S 100,00 A �. CLAIMS MADE ;OCCUR MED EXP(Any one person) S S,ON PERSONAL&ADVINJURY $ 1,OOO,.00 _ GENERAL AGGREGATE $ 2,000,00( - GEN'L.AGGREGATELIMITAPPUESPERt PRODUCTS-COMNOPAGd, $ 2,000,00 POLICY JIEC IOC $ AUTomoeiLs uAatlrry ff 5666240000 12101/2013, 12/01 U.12014 COMBINED SINGLE MrT - ANY AUTO t (Ea accident) $ 1,OOO,OO ALL OWNED.AUTOS: 4 BODILY INJURY(Per per son)``.S L BODIYINJURY.(Peracatlent) 5. A X SCHEDULED AUTOS ' X HIRED AUTOS PROPERTY DAMAGE S (Per accident) INC X NON-OWNED AUTOS. - - "" S .. .. UMBRELLA UA13 X OCCUR 460005,.836 11101/201;3 11/01/2014 EACH OCcuRRENCE' $ 1,000,00 A EXCESS UAB CLAIMS-MACE . - DEDUCTIBLE AGGREGATE I:$ 11006,000 RETENTION, S " WORKERS-COMPENSATION ,$ .. .. AND EMPLOYERS'UABIUTY H WCC500559301200 10/03/201� T.3 10103f2014 X '-RRV LIMITS s ATuT X oTH- ANYPROPRIETORIPARTNERIEXECUTNEYI ER B OFFICERIMEMBEREXCLUDED? NIA RICHARD TUPPER I E.L.EACH ACCIDENT $ 1,000,OU U(Mandatory In NH) INCLUDED .FOR WC. COVERAG E.L:;DISEASE•EA EN - s :1,000,00 H yyes,describe under DESCRIPTION OFOPERATION5eelaw E.LDISEASE-.P000YLIMIT:.. $ ,1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Aitacli ACORD 101;Additional Remarks Schedule;if more s aCeag it required) CERTIFICATE HOLDER CANCELLATION_ t a SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE 'THEREOF, NOTICE. WILL BE DELIVERED IN, ACCORDANCE WITH THE.P.OLICY PROVISIONS. "For Information Purposes 661y Tupper Con5traction Co-�LLC ` AUTHORIZED REPRESENTATIVE - .. 27 Roberta Drive W Yarmouth, MA `02673 Lora Lowe ©1988-2009 ACORD CORPORATION. Ail rights reserved_ ACORD 26(2009109) The ACORD name and logo are registered marks of ACORD t�Aiis t�tt§F-1 1Itt :tw Fi" 5tifu3b,INC t Massaehuserfs-Oepartmen'ot.Pu6I lit:SBtEty foriwm Road.Suo ta Board of Scolding Regulations ar►d.$tar�ards M> NY 1 fiw (SM274.127a C: n.lrurtion'lulrvrXils6r www.totom License.CS•069058 y A RlCHA"RD S TUPPER t x . ' 79 8 MCU.-TECH ORV c^ WEST YA.RMOt�t'H73 �d T U Expiration SSU RFARSE SIDI FN DEMNAYMM AND EOWIDtt Wqt ; Ca,naoeas iwr, 12/31/2014 - „�,; tlflire of Coexarnrr,AiTairr b�<t3 �iat�Nt'�ct�lAHrtsr "' b�eagte'Fetpfng Pevpt Build a Safer World'" 3 ,9 -THOME• IMPROVEMENT CONTRACTOR i AYC01>iCP Reyistt�tian: 84B Tow Y MEhM1BER Expiration: 8t2 14 Individual RiCHARO TOPPER $ Richard Tupper {� Tupper Constiuction' RICHARD T PPER: i 29 Amena brave Buildmg:Safety Professi*ona! W C W:'YARMQl3H,MAt32513. 1�nllerxrrrtary. t Mein be # ,81`58319 Exp 4/3pL2014. • OWNER AUTHORIZATION FORM I, AI ,AaA tCGS I-M (Owner's Name) owner of the property located at (Property Address) (Property Address) J Il_J herebyauthorize � S C � a (Subcontractor) r an authorized subcontractor for RISE Eng neering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signat re � O / O / Date f r t t , Town of Barnstable. *Permit X-PRESS PERMIT Expires 6 montlis from issue date SEP 21 2007 Regulatory Services Feed' Thomas F.Geiler,Director TOWN OF BARNSTABLE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number J Property Address S O aL *S C) N S f- / 46-NN> S fR Residential Value of Work 3 d D nO.6 v Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address /V/3/V e v 111 A �A L y Contractor's Name � /1:0 1.� % Telephone Number 6-0 9-- 22 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) e S 01 a V 3 D WWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name CND Workman's Comp.Policy# S 6— 6 ' U 7 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. J7 ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum.44) *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. t .copyo ome Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise061306 r �t The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 , www.mass.gov/dia Workers"Compensation Insurance.Affidavit: Builders/Contractors/Electricians/PIumbers Applicant Information Please Print Lep_ibly Name(Business/Organization/Individual):. - -Address: Ed ,60X (D City/State/Zip: V � y �1NN/�%`S fo A Phone.#:_ Sd 9- �"9?I 3/ Are you an employer? Check the appropriate boa: -Type of project(required):. 1.GWI am a employer with�_ 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 pioprietor,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.:K Roof repairs insurance required.] t c• 152, §1(4),and we have no employees, [No workers' . •13.❑ Other comp.insurance required.] ''Any applicant that checks box A 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. 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 Bove employees,they must providb their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees Below 1s the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: jo 9 U 8 _kl..4 --0 Expiration Date: -�3 lob Site Address: .SCE S A S d N l•{ )//A`'/V/V jS City/State/Zip 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/o 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 days a violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of th 17 or insurance covers a verification, Ido hereby --rdjy nd thep `ns•andpenalties ofperjury that the informadonprovide above is true and correct: Siena - / Z®(/ Date: Phone#: / ®C) . Official use only. Do not write in this area,'tb 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 CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: er �O fHE t )°may Town of Barnstable. Regulatory Services i EABNSUBLE, • MASS. Thomas F. Geller,Director m ]Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 wvt'w.town,b arnstable.ma.us Office: 508-862-4038 Fax: '508=790-6230 Property Owner Must Complete and Sign This Section If Using ABuilder �, �'`/ ►• ` �C'�AU ,as Owner of the subject property . J P P riY herebauthorize y Y 1e1-( C13 PiC14 to act on my behalf, in all matters relative to work authorized by this building permit application for: S"o s 7 r s V sr. h7,4-�w, (Address of Job) 9 , f7--e7 Signature of er Date IVA ti- Q-AL) Print Name Q:FO RM S:OwNFMERMIS S I0N i !C r'G IillllGi � x"'a _ Board of Building Regulations and Standards - i HOME License or registration valid for individul use only _a IMPROVEMENT CONTRACTOR Registrati before the expiration date, if found return to: on: 1 10321 Board of Building Regulations Expiration: 10/20/2008 and Standards One Ashburton Place Rm 1301 - Type: DBA Boston,Ma.02108 CAPRA HOME IMPROVEMENTS FRANK CAPRA ` 40 COPPER LANE L �l CENTERVIL LE,MA 02632 ' 1)epuh Administrator Not valid without signature .U�12C /J007f//lydYGAM,ClIC/L O�,i(�/.2JN.L(./N[OP�A6 BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 012430 Birthdate: 06/16/1940 Expires: 0611 6/2 0 0 8 Tr.no: 24654 Restricted: 00 FRANK G CAPRA 40 COPPER LN CENTERVILLE, MA 02632 Commissioner i I it CNA , WORKERS COMPENSATION AND EMPLOYERS LIABILITY-POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (6S59UB-861 X751-6-07) RENEWAL OF (6S59UB-861X751-6-06) INSURER: CONTINENTAL CASUALTY COMPANY NCCI CO CODE: 80381 1. INSURED: PRODUCER: CAPRA, FRANC G FLAGSHIP INSURAN CE INC DSA.CAPRA HOPS IMPROVE 414 COUNTY ST NEW BEDFORD IAA 02740 PO SOX 664 WEST HYANNISPORT MA 02672 Insured IS AN INDIVIDUAL Other work places and identification numbers are shown in the schedule(s) attached. 2. The policy period is from 03-22-07 to 03-22-08 12:01.A.MI:at the insured's marling address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s)listed here. MA EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in s� item 3.A. The limbs of our liability under Part Two are: Bodily Injury by Accident: $ 1000000 Each Accident Bodily Injury by Disease: $ 1000000 Policy Limit Bodily Injury by Disease: $ 1000000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies to the states, if any,listed here. COVERAGE REPLACED BY ENDORSEMENT -WC 20 03 06A i o��A ,r D. This policy includes these endorsements and schedules: SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications,Oates and Rating Plans. All required information is subject to verification and change by audit to be made ANNUALLY. . DATE OF ISSUE: 02-19-07 WC ST ASSIGN: MA OFFICE: CNA 04d PRODUCER: FLAGSHIP INSURANCE INC 266HG owam .- ;' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 3N9 Parcel r;U�"� Permit# Health Division Date Issued , Conservation Division Fee Tax Collector w_' AllV)PV Treasurer ��(�-�'�r / Planning Dept. ll, I Date Definitive Plan-Approved by Planning Board AI Historic-OKH� A� Preservation/Hyannis Project Street Address 50 1 e\SOk J ��� .Village /� � - Owner N C Address Telephone Permit Request. Rp_ L � � k6� 0. 1lge_4Ac-e_�e,' ) U co -U A Uk q_ o F 0 -T{,TA W�,AP 1Z&1-zTTe,& 1 A4(SC, 1,94 Square et: 1 st floor: existing proposed 2nd floor: existing proposed Total new Valuation O0 �— Zoning District Flood Plain Groundwater Overlay Construction Type vLot 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) Dumber of Baths: Full: existing- new Half: existing new Number of Bedrooms: existing new -11C Total Room Count (not including baths): existing - new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑ Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage: ❑existing ❑new 'size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded Cl Commercial. ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Q Name4-) 1 Telephone Number Addres �)r License# CS a!!��atd A4., Home Improvement Contractor# a c0 q � 7 Worker's Compensation# 0C 6O1 (23q5 ALL CONSTRUCTION DEBRIS RE LILTING FROM THIS PROJECT WILL BE TAKEN TO Oc V1 sz);d SIGNATURE DATE i FOR OFFICIAL USE ONLY - PERMIT NO. DATE ISSUED - ry a MAP/PARCEL NO. ' ADDRESS d VILLAGE - - OWNER DATE OF INSPECTION: � C FOUNDATION FRAME 3 INSULATION FIREPLACE ° • ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL F GAS: ROUGH FINAL �. FINAL BUILDING w DATE CLOSED OUT - ASSOCIATION.PLAN NO. t�ram, -�. ti The Town of Barnstable 'BARMNSTAec.E. 9� MAM 9. - Regulatory Services A • Ec� Thomas F. Geller, Director , Building Division Ralph Crossen, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. � Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but-not more thanfour 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. �6 d -� Type of Work: 1 w t e stimated Cost �( ITkAddress of Work: C) S �S 1 Owner's Name: R&m Date of Application: L 1 y 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 IMPROVEMENT WORK DO NOT HAVE -- -ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: A e_ e. r �y Date Contractor Name Registration No. OR Date Owner's Name q:forms:Affidav r r The Commonwealth of Massachusetts - = ' Department of Industrial Accidents OD/ce of/asesd90 lens _ _ t 600 Washington Street Boston,Mass. 02111 Workers' Com ensation Insurance Affidavit i name: 12\So IJ �T r location• S city nhone# �`' —33,,� 7 ❑ I am a homeo er performing all work myself. ❑ I am a sole pr rietor and have no one workin in ca achy I am an a er providing workers' compensation fo my employees king on �o ::> ................:.::::.::::::.::::::::::.........:::.. ....:::.::::::::::::..::.....::................ .....:...::.:............ :::......:: :::::::.:.......:.: ................. ........ coat an.:.name.<:: .� ... _..... i .. .. . ,:: ; „.. Acld�ss t Y. hone# ;:. ansuraace co. :.: ; ;;t ;> ��:: .::.......... �,�..� b...:.:. .....; all <: .... ❑ I am a sole proprietor,general contractor,or homeowner(circle one)and have hired the contractors listed below who have the followingworkers' compensation polices: com sn name. ::..'.. ::: jd .::.;:.:.:. :.:'.;:: ..j .:::....:..:.::::::::::::. .:.::::::::::..........: ...::::. ... >C......... Xi:•. fy� " �V nh .vAnn>v.w: ..4.v:::::::::• '�: Olt �nratt XX X. ......... atidresss ;.::::' :::.;:.;::.::. "` hon P. 0 Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crLninal penalties of n fine up to understand and/or one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of$100.00 a day against me. I mndeiatand that a copy of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification. I do hereby certi under the enalties of perjury that the information provided above is true and correct Signature Date Print name �✓a7 e r �5`M Phone# official use only do not write in this area to be completed by city or town official city or town: permit/ncense# OBuilding Department OLicensing Board ❑checkif immediate response Is required ❑Selectmen's Office OHealth Department contact person: phone#; ❑Other_ Oevised 9/95 PJA) 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 of hire, express or implied,oral or written. An employer is defined as an individual,partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives;of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required. Additionally,neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority. Applicants Please fill in the workers' compensation affidavit completely,by checking the box that applies to your situation and supplying company names,address and phone numbers along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below.. 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 perinitMcense number which will be used as a reference number. The affidavits maybe reduned 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 Me of Imlesduadons 600 Washington Street Boston,Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 4,y AC RD CERTIFICATE OF LIABILITY INSURANC cSR PG DATE(MM0DNY) YNiE-1 10/06/00 >RODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION )rake,Swan & Crocker Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE %gency, Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR l4 Lot's Hollow Rd. ,PO Box 429 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. )rleans HA 02653-0429 Phone: 508-255-3212 INSURERS AFFORDING COVERAGE NSURED — INSURER A: American States Insurance Co. INSURER B: Le ton Insurance Co Wayne Densmore INSURER C: - ---�— ---—--- P. O. Box 659 INSURERD: S. Yarmouth MA 02664 1 INSURER E: OVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 'S 3SR j -- POLICY E YIVE LICTEXPIRKI ON° -- -- -- -- - - TYPE OF INSURANCE POLICY NUMBER DATE MMIO DATE MID LIMITS GENERAL LIABILITY EACH OCCURRENCE S 300000 A X COMMERCIAL GENERAL LIABILITY O1CD46769780 : 07/07/00 071/07/01 FIRE DAMAGE(Any one fire) IS200000 CLAIMS MADE OCCUR MED EXP(Any one person) IS10000 (X Products & Compl. PERSONAL&ADV INJURY S 300000 i I ° GENERAL AGGREGATE -�$ 600000 FFF G---EIY'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 5 600000 POLICY PRO- LOC -�-- JECT I - AUTOM0131LE LIABILITY COMBINED SINGLE LIMB S ANY AUTO (Ea accident) ALL OWNED AUTOS ' _ I BODILY INJURY 'S SCHEDULED AUTOS (Per person} -- HIRED AUTOS I BODILY INJURY -- ---'-- - NON-OWNED AUTOS (Per accident) 15 PROPERTY DAMAGE S (Per accident) GARAGE LIABILITY, AUTO ONLY-EA ACGDENT S ANY AUTO OTHER THAN EA ACC t g --- I : AUTO ONLY: F --- -— -- AGG R S EXCESS LIABILITY EACH OCCURRENCE 15 ` OCCUR CLAIMS MADE - AGGREGATE - ^_— $ DEDUCTIBLE I S -- RETENTION S 01H- WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS LIABILITY --- B i WC60116345 � ' 09/11/00 09/11/01 E.L.EACH ACCIDENT I S 100000 t E.L.DISEASE_EAEMPLGYEE S i00000 - iIE.L.DISEASE-POLICY LIhr.,T "S 500001) OTHER i `J/fie '(�arwuro�uue�zll� af� jf'nurir.�tiJ�d ' BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 065025 Birthdate:-08/06/1960 111 IiUiiE IPiERUIIEiiE?!i a;f;lRtcCTDR 'EX Tres:x08/06/2G01 P Tr:no: 1718 Restricted To: 00 E i F is d;1 Utl WAYNE R DENSMORE _ PO BOX 659 S YARMOUTH, MA 02664 Administrator DE44`%DRE n PDX 5y4? IIEY PDNt� DR,