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0067 BLANTYRE AVENUE
a d TURRE `.' R CONSTRUCTION CO. r_ILc 79B MID-TECH DRIVE,WEST YARMOUTH, MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 WWW.TUPPERGO.COM Date: - r cu Town of Barnstable Thomas Perry CBO ^? 200 Main Street co Hyannis, Ma 02601 _. (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry , This affidavit is to certify that all work completed for permit application # � bl � Issued on S has been inspected by a certified Building Performance Institute (BPI) inspector: All work performed meets or exceeds Federal and State requirements. 9 fo c�c � Sincerely, Richard Tupper License # CS-69058 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel CY Application # jeiy lCO o Health Division Date Issued 3 s `l Ag Conservation Division Application Fee c Planning Dept. Permit Fee y Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village / r r Owner v— fJ / cG� O/ (���� Address Telephone O l Permit Request f Square feet:.1 st floor: existing proposed 2nd floor: existing proposed ' Total new Zoning District Flood Plain Groundwater Overlay Project Valuation- Q Construction Type --�: o Lot Size a Grandfathered: ❑Yes ❑ No If yes, attach $115 orting d6currOtation. Dwelling Type: Single Family U-- Two Family ❑ Multi-Family (# units) 1 0 Age of Existing Structure fz� Historic House: U Yes ❑ No On Old Kings ighway:c:El Yes;❑ No Basement Type: J ull ❑ 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 mil ❑ Electric ❑ Other Central Air: ❑Yes 2,tQo 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: Zonin6 Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name !�% �L��pP,� Telephone Number�5 TV 7 �f—V&Z Address G � 15 // l' ) f F License # � S� Vd �4 /9 U — Home Improvement Contractor# f Worker's Compensation #e C r L CONS RVCON�DLEBR&ISESULTING FROM THIS PROJECT WILL BE TAKEN TO ri �.. O�2&7,5 SIGNATURE DATE ���Y FOR OFFICIAL USE ONLY APPLICATION# - DATE ISSUED a MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION. FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL r GAS: ROUGH FINAL HNAL BUILDING D'A6£CLOSED OUT AS_SQ-IATION PLAN NO. a , j 1 OWNER AUTHORIZATION FORM (Owner's Name) V owner of the property located at 6/ 7 91c t r� -�v (Property-Address) (Property Ad ess) hereby authorize t (Subcontrac ). an authorized subcontractor for Ri E' ngineering,to act on my behalf to obtain a building permit and to.perform work on my property. essma Mmn-jEe5 11,20114y Owner's Signature Date tIN The Commonwealth of Massaehusetts Department of Industrial Accidents Offce of Investigations d I Congress'Street,Suite l00 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/orgamizatiomgndividual): Tupper Construction Address:79B Mid Tech Dr City/State/Zip:West Yarmouth, MA.02673, Phone.#:508-778-0111 Are you an employer?Check the appropriate box: Type of project(required): 1.❑® I am a employer with 4 ❑ I am a general contractor and 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 shipand have no em to ees These sub-contractors have P Y , $. ❑ Demolition. working for me in any capacity. employees and have workers' [No workers_' comp. insurance comp. insurance;, 9. ❑Building addition. 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 rep airs:or;additions myself. [No workers'comp. right of exemption-per MGL 12:❑ Roof'repairs insurance required.] t c. 1.52, §1(4),and.we have,no employees..[No workers" 11E20ther Insulation/ comp. insurance reauired:1 weatherization *.Any applicant that checks box#1 must'also'fill out the section belo�v.showing their.-workers'compensation policy information: t Homeowners who submit this afi,davit 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 additionalsheei showing the name ofthe sub-contractors and state whether or.not those entities.have employees. If the sub_contractors have;employees,theymustprovide'their workers'comp.policy number. I am an employer that is providing workers compensation.insurance for ny employees. Below is the policy and job site information. Insurance Company Name:AE.1G Policy#or Self-ins.Lic.#i WCC5005593012007 Expiration Date: 10/31;4 Job Site Address:= 67 Blantyre Ave City/State/Zip Centerville MA 02632 Attach a'copy of the workers' compensation:-policy declaration page(showing the policy'numher.and.egpiration 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$1,500.00 and/or one-year imprisonment, as<well as civil penalties in the form of a:STOP WORK ORDER.an.0 a fne of up to$250.00 a day against the violator. Be.-advised: a copy of-this statement may be forwarded to the 0 ice of Investigations of the D1A for ins ce coverage Iverification. I do hereby certify under the dyq,dpenalties:ofperjury That the information provided above is true and correct. Si ature: Date: 3/10/14 Phone#: 5087780111 Official use only.. Do not write in this.area,to:be completed by 00.or towir official. City or Town: Permit/License Issuing Authority(circle one): L Board of Health 2-Building Department: 3. City/Town Clerk 4..Electrical Inspector 5.Plumbing Inspector 6.Other' Contact:Person: Phone#• f ACORDa CERTIFICATE OF LIABILITY INSURA6110E ...BATE(MM�pDIYYYY):. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS'UPON THE:CERTIFICATE HQLDIE/0 THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR AL MR THE COVERAGE AFFORDED. THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSU}NG'IN$URER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER." the t0erms and Icondit ons certificate of the odec t Cetta�DnDlolO es ma$IUeRuSre an 9ndB,y fes)mu 11 be Endorsed. ndor 4e n Phis c8rti GAT do IS WAIVED'subject to certificate holder in lieu Of sue endorsement(s). y q es not confer rights to the PRODUCER NAME: Lora Lowe Southeastern Insurance Agency, Inc. P E ac Noy• (508)947-6061FAX No:. 439 State Rd, FAx (SO9)990-2731 P.O. Box 79399 ADDRE FftOR - N. Dartmouth, MA 02747 INSURED INSURERS)A.FFORDlNG GOV17tARE NMI Tupper Construction .CO LLC . INSURER A: Arbella Protection Insurance;., INSURER R k AEIC 27 Roberta Drive INSURER C: CNA Surety West Yarmouth, MA 02673 iNsuRERo: ..._ .. .. .. INSURER:E�.: _ COVERAGES INSURER F CERTIFICATE NUMBER:2013/14/1 REVISION NUAABER THIS IS TO CERTIFYTHATTNE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY:REQUIREMENT,TE 1.Vt OR CONOInON OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS. CERTIFICATE MAY BE ISSUEt)OR MAY:- THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN I$SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS. LTR I TYPE OF INSURANCE AOK SUER - _ INSR NND POLICY NUMBER P L CY M,BI C t.IM1T5`--• IGeNEIutL uA61Lm .81S0000874 11/0112013 11101/201d EnCatoccuRReNC s 1,000,.00 X COMMERCIAL:GENERAL LIAOIL!TY- - CLAIMS 4!ADE �.00G11R PREw- Ea rtenca S IOp e A MED"P(Any;fie p—n) g 5,00 P�RSONALB APV INJURY ...5_ 1;-000'00 --- GENERAL AGGREGATE 8, Z 000 00 CGNPAGQREGAT�UtAIThPPLEgPER' PRCp1JCTS-COpaf3lgI�AGG b 2'000 (IO RR4, t POLICY JECT LOC i f AUTOMBL}IL!^LUABlt,1TY ... 56 - - 9 6624090Q 7?J0v2013 !2/01J201A COh+a1NIzOSINOLSLIMIT ANY AUTO tEeI3eni).� 1'gpO soIDILY INJURY Rer A!:S(9WNkOAUTc]5�. , ♦)s'r@4f1) $. - A X H@OULED AUT09 HQOILY INJURY $ _ X HIRED;AUTOS PRQP_RTY DPMAGE ", _ X NON-OWNFfJAUTCs; (Pcrd Cntj INC UMBRELLA UA$ X 6C UR - 7. B " 46000S8"36 11/01/2613 11I01/2014 eacHoccU!,R�NcE 5; y. Q00 04 CLAIMS=MADE - A' AGGREGATE D€GueTlDLr- s. 1000,00 , R9TVffI0N WORKERR COM NSAT,ON g AND 9WL0YERS'LIAlIILtTr hCC50QS593012Q0 141t)3/2013'10J03/2014 X T Li,lTs ANY PROPRIETORIAARTNERIERECUTIVi Y N RD RICHA e B EE] OFFICERtAt$MQERERCLLrDEt)? NIA TUPPC R I €L€ACtIACCIOENT $ Q INSIuatDrylnNn) I, LUDED FOR WIC COVCRAI5 �a j;:'ltH,tl66rtID8 untie( - F,L DISEASE.FA IRM1kOYE S. R a 00O.,QO sCRI. roN O OPEATIONS peaty L L.f�IASE BOI IhY"LIPdIT ' L> SCRIPTION OF OPERAII0Ii,4 f L4CyT10NSl YE}{I Lt g fAtkaQh kORD lik Ad91ttQnal Rem4As6 g�tledUle lfinof§SpdcC bs rEgUlrsAl CAR fIpICAT-0 h19L0PR CANOELLATI9N _ SHOULD ANY OF THE ABOVE DESCRIBED POUCIE,q`BE CANGELLE.0 a eFORE THE EXPIRATION DATE T#tEREOF, NQ71CF WILL BE DELIVERED 'IN ACCQRpANCE wITH`THE POLICY PROVISIONS, "per nfiormaS19t1 Porposes ottly„ Tupper CansLrslcton Co' LCC`_ Aun,oslzDREPRBssNranvE 27 AcIbeeta Drive W Yar=.Wtrh, MA t)2ti73. Lora t owe IN. tAC9RD25 9 QRATI86 2009At Ali esgtVec(,'. ACQR4 name and logo are registered marks of ACORR o �M l :S Pk!K#-t*fm$kAK;ft JIM t!tut tPt�. ^+ AAassachusett$-Department of PubiiC,Safety W' Road.Sto t o Akk&NY 12M 804rd of Bhilding Reguijitrons and Standa�ls (877327'1-t2?4 � t„n.rru�r.i�rn�upe•r� r�„r. Lkense: Ct4Bgd58 ; RICPlARb S TtIPP£R; 79 B M D-T..Wi DR ": d VEST YA:RMOL[}i A 73 �TES tllPt�" k 't�i' r,Sf)sENEW FOROc'VIUVOt AM$Xh U; nuE ca ,ssi4ner 92f3912014 SEEMLei s fiia �errr+ c . <)trire orConsoma AfTain&.44j css►�,wia#w PeoP[e'Nei�ris�gPeo{�le8uiitl a.5afer�Yar4d�' -440ME IMPROVEMENT CONTRACMR tispfatraHan: .� s Tyo, trIEMBER Expiation: 14 Individual 'RICHARD TUPPER. Richard Tupper Tupper CorlStrtlCtiOn RICHARD Ti)PRER z9 3operia Drive Building Sak*Professional W YARRAfSPTK NIA 02613 t ndrrurre ary Member#.;,8158119 Exp:4'3W014 04/20/2011 15:35 5087785010 TUPPERCO PAGE 01/01 roeS,%) TUPPE CONSTRUC r10rM Fc�ARNSTA LE4 796 MID-TECH DRIVE,WEST YARMOUTH,MA 02673 PHONE; SO T78-0111 FAX:W.TUPPE CO.COM T18 5010 fll MAY e 6 '6 Date 5/6/2013 5A.h,; Town of Barnstable Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application # 201302543 for 67 Blantyre Road, Centerville Issued on 4/23/2013 has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. T pper CS-69058 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION d Map pp Parcel Application Health Division Date Issued �+ 3 Conservation Division Application Fee D° Planning Dept. Permit Fee ,3 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis / V Project Street Address 67 aaa&,e, 7U Village �-w/Z& Owner A&421ui2. `�'12a-Cy Q� Address /o% cai"P. (2ax � Telephone _76 g^ C�2iD - .Permit Request Square feet: .1 st floor: existing proposed 2nd floor: existing proposed Total new -Zoning District Flood Plain Groundwater Overlay. Project Valuation 0� °e 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 C - Basement Finished Area (sq.ft.) Basement Unfinished Area (sq° ) =' Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new , Total Room Count (not including baths): existing new First Floor Root i Count�O N y Heat Type and Fuel: ❑ Gas x0il ❑ Electric ❑ Other '" m Central Air: ❑Yes ❑ No Fireplaces: Existing 2 New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size, Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name ,4,g.6 Telephone Number 77? - OI I Address �9/� �� ,�J .V� License # t4 7 a"Ltn"441 1114 D 24 73 Home Improvement Contractor# Worker's Compensation # WM, ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ZA SIGNATURE DATE �b P h� r t� ` s FOR OFFICIAL USE ONLY ' APPLICATION# _ L DATE ISSUED MAP/PARCELNO. r° ADDRESS VILLAGE i OWNER DATE OF INSPECTION: l.r t. t . ,FOUNDATION �7 FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING 4 i, DATE CLOSED OUT ASSOCIATION PLAN NO. t t ti OWNER AUTHORIZATION FORM (Owners Name) owner of the property located at 6`7 gan ty, f Vtn v� (Prroperty Address) (PropertyAddress) ' hereby authorize (2U (Subcontract an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property- Owner's Signature Z C. 17ci i 3 /( Date _ f rl3UlLa311VLi�' ' hF' t 4 til'1 t t6'C t ivfassachuse#t IeparterTt of Public,Safety 6 ir&of .uiI in.q: e Ula i6ns:a6d Standards Mom,W t2020 <urz4tructi,zra it.leis t zi . (877)274.12'14 License.M069058 www.ios.co { RICHARD S TUPP ER.r g l9 B MtC?=TECH DR w i WEST VARMQLIM 4 �TOW. f" isa AMMSt SIDE FOR DE&MT08 AND MAAT10k �IMT car,rrscsrzcr 121311281+3 f 3j Y 517 6ow, C7Cfice of C"tr►ssuttttr.rifi`atiti&Br�isEa"cap iteiutaktioec .TTV G IMPROVEMENT CONTRA.. W QR y a. z. tdgiSttBtiott218A5 Type: N , r �� F,, r ISA912014 Individual � Explratiots � � f RICtARCf 1UPPIct > r y ' RICHARD'TtJi�P6f2 �� / 'z r 29 Roberta Dove r � , y �_.' a! W.YARMO T H-,MA 026,13 Uliden teretary f 6ec. i9. 2012 4.37PM No. 8524 P. 1/2 _ AGuxu CERTIFICATE OF L IABILITYINSURANCE DATE 19/2�" 12/19/2012 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($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: It the certificate holder Is an ADDITIONAL INSURED,the policy(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 certfiicate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Lora Lowe Southeastern Insurance Agency, Inc, ac.ExN; (S08)997-6061117 No;.(508)990-2731 439 State Rd. . E-MAIL _ _ _ ADDRESS: P.O. Box 79399 CUSTOMS IDS• N. Dartmouth, MA 02747 INSURER(S)AFFORDINGCOVERAGE NAIL! INSURED INSURERA: Arbella Protection Insurance Tupper Construction Co LLE pp INsuRER a: AEIC INSURERCz CNA Surety 27 Roberta Drive iNSURERD: ......... ... West Yarmouth, MA 02613 misuRERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 12/13-2 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE iNSR:WVDPOUGYNUMBER i Npypipvl=•1`F"j"' b�Ep`Flrl'��—� L(MR$ GENERAL LIABILITY .. __. .. - . 850000$743111/01.i2012)11/01t2013 =arr+OCCURRENCE S 1 000 00 X CO MERC,AL GENERAL LIABILITY ! ( ! AI AO T: RENTED ._...:.., - 1 3S pREYk�sS;Ea ecc�r erne) $ '1t�0 0 . I CLAWS 100E -OCCUR i MEG EXP tPnY one Pomp) $ 5 00. A i ERSGNlL a AQv r J $ 1,000,00 GENERAL AGGRE(ATE. $ 2,000,000 GEN'L AGGREGA'E LIWT AGPLiES PER: PRODUCTS-CGMRIOP AGG $ 2,000,000 j POLICY T LOCI 'I ... ... AUTOMOBILE LIABILITY 56662400002 12101/2012 12t0112013 i COMBINED SINGLE LMIT $ (Ea accident) _ 1,000,000_ ANY AUTO 1.BOD LY h I RY,P&r person!�.$ Ali-OWNED AUTOS ;BODILY t:,lt RY(Pa accioeni) A X SCHEOULEC AUTOS 1 PROP RTY OA'AGE i$ X HiREDAUTOa Poraccitle2i) INC X NCNGKINE AU,C5 ! 1 1$ . UA98RELLALlA6 OCCUR EACHOCCJRRENCE I S EXCESS.LIAB .CLAIN�- IAAJE DEDU=TIBL $ woRHERSCOMPEasATION KCSOOSS9301200 1010312012 1010312013. X WC s'X CTR'___. AND EMPLOYERS LIABILnY YIN --- At4Y�RL�PRIETGR�,�RT"aE aEr'I TIvE I RICHARD TOPPER I F. FAC:H ACCIDENT .$ 500,00. B OFF ICERIMEMBLREACLUDED't NIA's — (MarbabryInNHI INCLUDED FOR WC COVERAGEELGiSEASE E;EMIDLO Oc 500,00 es dekn;e u;dor El.DISEASE-PJLMY LIMIT $ 500,000 u(.RPTI'.'.N Gf OFERATIrJNS GGIGr Bond or theft of money Or 1 7106$8130212,812012 02/28t2013 Limit of $1o,000 C property. DESCRIPTI OF OPERATIONS 1 LOCATIONS VEHICLES"chACORD IOI,Additional Remarks Schedule,If more space Is fequlred) ill.juia@csgrp.com CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Conservation Services Group AUTHORIZED REPRESENTATIVE Attn: Bill 3ulio 50 Washington Street We tborough,. MA 01581 Lora Lowe 01988-2008 ACORD CORPORATION. All rights reserved. I ACORD 25(20091.68) The ACORD name and logo are registered marks of ACORD f The,Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www. ass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians[Piumbers Applicant Information Please Print Leeibly Name.(Business;'Organi;,ationr''1.nlividual): Tupper Construction Co. , LLC Address: 79B Mid Tech Drive City/5tatelip: West Yarmouth, MA 02673 Phone#: 508-778-01.11 Are you an employer?Check the appropriate box: Type of project(required): 1.❑X I am,a employer with 4. ❑ 1 am.a general contractor and I. 6. ❑New construction employees(full and/or part-time:):* have hired the sub-contractors 2.0 I am.a sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling ship and have no employees These sub-contractors Have & ❑ Demolition working for me in any capacity. workers'comp.insurance. q, ❑ Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required:] officers have exercised their 10.❑ Electrical repairs or,additions 3.❑ Lam a homeowner doing all work. right of exemption per MGL 1.1.[]Plumbing repairs or additions myself. No workers'comp. c. 152,§1(4),and we have no [ p 1.2,❑Roof repairs insurance required.]t employees. [No workers' comp. insurance required.] 13 ❑Other *Any applicant that checks box rt1.mustalso 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. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy infbraiation. [am an employer that is providing workers''compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: AEIC Poliic #or Self-ins.Lic.>t: WCC 5005593012012 i 10/03/2013 } Expiration Date: . job Site Address: .67 Blantyre Avenue, Centerville City/State/Zip: MA 02.632 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required:tinder Section 25A of MGL c 152 can lead to the imposition of criminal.penalties.o.f a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK.ORDERand a fine of up to$250.0.0 a day against the violator. Be advised that a copy of this statement may be:forwarded to the.Office of Investigations of the DIA for insurance.coverage verification. ...... I do hereby certify:un r t _pains and penall.ies of perjury that the information provided above is true and.correct. Signature: Date: 4 18 2 013 Phone#: _ (508) 78-0111 Official use only. Do not write in this area,to be completed by eiV or town ofjlcial. City or Town: Permit/License# Issuing Authority(circle tine): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 6.Other Contact Person: Phone#: t � � TOWN OF BARNSTABLE Permit No. __-------—--------- I �mn..i Building Inspector Cash 7 YYA ___---_________. _____ 639 0o''tO YPY�\ OCCUPANCY PERMIT Bona ----------____ "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 iilliarr. F. Eldridge, ter: Address �102 F3uckskin Path, Centervil l -•ya `'Y: _ 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. ...................................................... i s.._.._ .................................................................._.................................� Building Inspector � _ � Inc 2,Q,1►.r� f�'_.�-�--...,.: i r tNt l _w CSZT%r-%aC) pL-C:>l r c��zT�i=Y "Ar Ti-AC-- 1::UL) OVAT10Q5"O%AJQ t-�'EIZ�oi�l Gc I�L`!S WIT" T1-IG 5I Vr= U"C-- � � , I `1 i�0 7�' LC>r ?-6 - A► c> SET5AC4 ZZEQUI2CN�c+�cjS a� T" 'To wU of Z ' 4JS 4.FL- fax 23Z ?G LOT fEF, PA- TC,U ' �'� UJ 1 r— S A.XTF--iZ. 111G. tZE:GIS TL.iZcD Y AWID SUQVi*Yorz.S Ti-115 D�.A+-r iS "O"T s,�.S�� v+�-' AW 05TEV-V►L.Lc il4-gr QL)A F-k,4 r' SU2�/E`f ¢ Tian C�F�S�i'S S14otti u> APPLI GAti.I-r �.lbT F6�._use o To o i='TE zM'k4& LO-r t_��CsS `�`-' I c_t.r l�►-� L..I.i�R I PGA se's�or's map and lot`number a ..a4....�^.e?...5:! d;I f' SEPTIC SYSTEM MUST BE P�s ,I1V�STA.LLED IN COMPLIANCE 7� 2 2 7 'WITH ARTICLE II STATE s Sewage Permit number .................................................w, �`` '� 11TARY CODE AND TOWN N) REGULATIONS. t T"Et°�� TOWN- OF 4`BA.RNSTAB-L-E . . Q BARNSTADLE, i BUILDING I N S P E APPROVAL OF 00'FO MPY a,e� ` ' ISLE CONSERVATION f COMMISSION r rr ` C--O v� S t u c� S l ti ................c;v,+1� w t 1,\vt APPLICATION FOR PERMIT TO ...:. ...................................... � . 1/.... .,.,.:..,..........5......... I 1 TYPE OF CONSTRUCTION .......... `!.G)!!� ..... S1-�.0.d ...................... .�:..►.f .......................... t }... ................ .... ...............I qa TO-THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for anpermit according to the following information: Location .....p_l G�n.v1!.Y ............!�'' e...........C '1.\'e�'..v'L\� .......... D .L. 1............. . �^ Proposed Use .........?. .Y .tl-e..r........Fc.i.y'!1IN.......�.�A?:�.��.1!!�.�.................................................... ......................... Zoning District .........t.�.. ..� ...'.........................................Fire District ..�{v� vv.i.�. �' ..:eY�!.!.k�........-.. sfi rr. '' Name of Owner V�!�.�1.1�?.Yr ..F... .�GQ�t.\... '� ..�Sv .....Address Name of Builder .......Address �r � ...Y...a..�t...\N... .LY �tCvv%1� Name of Architect .... �.. �� ve 1\� SSocAddress .. .O... d,).:.. ..............................ow S e��re�S� I�C( Number of Rooms .............D..................................................Foundation .... 04.)c-c ...... �� Exlerior S�\ v���e>.......................................................Roofing .....as..YD. Floors ...�!.l Y O� W©®.4?� ...............................................Interior ....... v ...W-PAI............................................. :rw. Heating...::.Q.1:.L....... ....Wcte`�.................................Plumbing ....C. .�?� .......................................................... Fireplace .... ...................................................Approximate Cost ..... , ..d. ...............................,............. Definitive Plan Approved by Planning Board -------------------------- ------1 9--------. Area ...../Z.. ..�..`. ................. Diagram of Lot and Building with Dimensions Fee . .P. ........ SUBJECT TO APPROVAL OF BOARD OF HEALTH 7 / Cl -1 I I hereby agree to conform to all the Rules and Regulations of t e Town of Barnstable regarding the bove construction. Name .. ...:� ........... .... ............`.... Eldridge, William F. , Jr. two 'story 4 o .29.7.5.9.......P€rmil"for - gle„family dwelling Location ........6.7..Blantyre Avenue .......................C.Q.1?terville............................... ^. Owner ........... jj, :liam..F....Eldridge,...Jr.'. l ry Type of Construction frame r '� - 77 Plot ............................ Lot ................................ r Permit Granted October 27 19 7 Date of Inspection ........ .......... .....:........::19 Date Completed . Q ,o � PERMIT REFUSED - .............. ....... ........... 19 .................... .................................... ..................... 6:2 z Approved ................... : r`' .................. 19 ., . ............................................................................... Assessor's map and lot number ..................:..........:............ . i. 1 t Sewage Permit number 1 P�ofTNEto�� TOWN OF BARNSTABLE BA"STADLE, i "A ` i6}9• BUILDING INSPECTOR pow 9� �. V1 V U C.. �'1.L''L? t'(1 Ui t 1 . A v,r�k \%A C APPLICATION FOR PERMIT TO .......................................................................:..........:....' ................................... TYPE OF CONSTRUCTION ^'''X e'.yY1 f'.- t [ L K3 h Y� �� `1 jj ............... r ......................19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a//��permit according to the following information: Location .....�..I U vt �v v -t / 1 v Q _ ( ••P vt�-f v V 4l 1 '�'_. ��::i tl. ... +... .+.:/,......................................................................... .... .................................... ProposedUse �t �..c. -r_ . -0,m t I\r YD AA,-P.�,. ........ .............................................................................. Zoning District ........B. N-)..�...�..........................................Fire District , tv��tvvt,� Name of Owner s�� tc� .. F �1���.�....:� e; Sr Address �2Q� 1?c,ckgkt.. Y'c� . ......... Name of Builder t��« ....lr v t 4c ... f.:........Address c.'�5��„.. ..��S,C......t..,�, Name of Architect .0.1 av�C. �I e.AI. _„ Address � r..C..v..,Sv „5...t., ........................... Number of Rooms ..................................................................Foundation ... Ca c_a t f L r `tl Exierior �' h.....`......:...........................................................Roofing .....QS.�.................................................................. Floors ...✓�.a` G� UU O Q"�. .Interior ...... � �(7 t ......................................................................... ........... ..................................................................... Heating . � .. .. ........................................Plumbing .......A..`o.! .`............................................................. Fireplace ....1. .. ?r� lc ....................................................Approximate Cost .....co ..0.0. ..................................... Definitive Plan Approved by Planning Board -----------_-------------------19________ . Area .......................�."...'.............. Diagram of Lot and Building with Dimensions Fee 3 '.....:" SUBJECT TO APPROVAL OF BOARD OF HEALTHl � 4� / Tq 7 i . A �f _ ram` �✓ iC I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ............... ............................................................... Eldridge, William F. Jr. A_229-11 20759 F,. two st ry No ................. PermiNor ............ ....... ............... i single family dwelli g Location 67 Blantyre Ave ue ................................................................ , Centerville • ............................................................................... Owner .........William. . . . ..F... ... Eldridge. . . . ., Jr. , .. . . ...... .. .. . ...... . . .... .............. r Type of Construction frame ................................................................................ r Plot ............................ Lot .........#25............... e October 27 78 Permit Granted ........................................19 Date of Inspection ....................................19 i Date Completed 19 PERMIT REFUSED .......... .!�.� .. ./ .�...?�.a�. 19 P,P ...................... .......JJ....`. ..... ..2�............ ............. I n�o /►r et� TP i ti T .. ................................................. ..................... ............................................................................... Approved ................................................ 19 ............................................................................... ...............................................................................