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HomeMy WebLinkAbout0201 FIVE CORNERS ROAD CO La a u n e Y o V Town Of Barnstable g 8 RegWatory Sete FM > 6 � d 0 ?E&I , lot Tom Pe OC 1 20o Main Street,Hyannis;MA 42601 0P �� WWw.town bamstable ma ms 4%,Offlct;: 508-862-4E)38 4 " -508=790-6230 . LESS A���cATION v RES T � �Y iVotVaW [&Redx-tress rmprar t 11/iaprgarcel Numbers—p�„9__ • Property Address o2oi i't�C Flrr►e(-g fP�'1/ E Residential Value of Work 3 ' --�-- -Maaira�rm fee of$35.0D for work amder 60Df#• � 0D Owner's NMD&Address o�Q� - Fi✓G Cnr/1P% s ` �on'forytl(P tMA ©Lto '2- Contractor'sName -7ii�o-� Te lep r� honeNumher Home Improvement Contract License#(if applicable) k gjY3 Email_ Construction Supervisor's Lieense#(ifapplieable)�gC}�6�- Worlaman's Compensation Insurance Check one: ❑ I am a sole propnietoF ❑ I am the Homeowner . I have Wo&ees Compensation insurance Tnsuuance Comp y N9�` an Name ��e� ��� . Workman's comp.Polic, Copy of hL4wanee Connphance Cext Meate must accomgaatp each peeimtt' Permit Request(checkbox) -' ❑ Re-roof(hw7leme nsaed)(sir*g old shingles)All construction debris will be taken to ❑Re-roof(hnr ieme,maned)(not strippin . Going over existing layers ofmop El side Replacement Windowsldoorslsliders,.Z7 Value 3 0 (maximum 35)#of windows , #of doors: ..❑ Sanoke/Carbon Monoxide detectors 4 floor plans marked wade red Sand kispeMons requ raL " Separate Elecaicai&ire Perm&regoked. �hererequited 7s'm=ofttspe®itdaesn' tmemptc evdkoB�ertmm ie gmrnie.Coasavaden,eir_ Note: Propg er sign Property Owner Ire a0er dnion. A 0f Improvtmtemt Conhwla s lucem&Const mchon Sapervnm lt�se is reala�ged. SIGNATURE: T:\KEVIN D'SuRding ChaagesMM 1iHS5 dnc Revised 061313 , Home Depot Contractor License Numbers: MA Home Improvement Contractor Reg. # 126893 © , Salesperson Name and Registration Number: Christopher Plourde : R-1-128533-15-00239 Home Improvement Agreement THD AT- HOME SERVICES, INC ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: marylou pierozzi [T756668 First Name Last Name Branch Name Lead# 201 five corners road CENTERVILLE MA 02632 Customer Address City State Zip (978) 502-1158 Home Phone# Work Phone# Cell Phone# 1ppmlp40@yahoo.com Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY ' AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR.MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASFISIGN BE W TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN'ORAL AND W ITTANTICF OF YO IGHT TO CANCEL. Ackr 5wledg b X 09/26/2016 C�'stomer's SIg Date 1 Distribution: White-Home Depot Yellow-Customer Copy .% -At z Massachusetts-Department of Public Safety Board of Building Regulations and Standards Su-rsei i i.twi Srseciui% - License: CSSL-099162 ri_ti 4� ' TIMOTHY PH" -�� 4 CIRCLE DRIVE` . q'0 War&am MA 0871 Expiration Commissioner 061OW2017 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:-Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/oraoanizafionqndividual) / / P Address: C i f`cJe--- /S r/U e— �~ City/State/Zi : e-h Qry-�, M 0L-- 0aS71 Phone#: 6r0 8"— C162— 6, Are you an employer?Check the appropriate box: 1.❑ 1 am a employer with 4. ❑ I am a general contractor and I Type of project(required): 2. J employees(full and/or part-time).* have hired the sub-contractors . 6. ❑New construction am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g_ ❑Demolition working for me in any capacity. employees and have workers' [No workers'comp,insurance comp.insuranCeJ 9. (3 Building addition required:] 5. ® We area corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their . I L[I Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no 3a.❑ I am a homeowner acting as a employees. [No workers' 13.❑Other general contractor(refer to#4) comp.insurance required.] °Any applicant that checks box#1 mast also fill out the section below showing their workers'compensaticoolicy information- *Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating such. ZContractom that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy oli number. I am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information n Insurance Company Name: bn) (1�! g(.LMA Al /n tj Policy#or Self-ins.Lic.#: Expiration Date: _ Job Site Address: 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/or one-year imprisonment;as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi under th pains and enalties of perjury that the inforrnatton provided above is true and correct Si ature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: PermitUcense# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town CIerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#• t (p 0 dY w,t o 24> lJe4 9"�T/ Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home ImprovernentContractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2018 THD AT HOME SERVICES, INC ANDREW SWEET 2455 PACES FERRY ROAD, HSC1C 11 $. ATLANTA, GA 30339 Update Address and return card.Mark reason for change. I-] Address F-1 Renewal ] Employment i� Lost Card sc:a ._, ?ann-osrri . f %/lY Yt r•Trkl�f/.i(r1r:(YI/./!L t f�"�l.q rLrll.IL.tE:��F .. Rice of Consumer Affairs R Business Regulation License or registration valid for.,individual use only .Ii before the expiration date. If found return to: OMEIMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation x x, Registration 126893 Type: 10 Park Plaza=Suite 5170 Expiration 8/3/2616; Supplement Card Roston,MA 02116 THD AT HOME SERVICES INC.' THE HOME DEPOT AT HOME.SERVICES ANDREW SWEET '` 2455 PACES FERRY ROAD,HSC AALANTA,GA 30339 Undersecretary Not v with ut signature The Commonwealth of Massachusetts _ Department of Industrial Accidents = � Office of Investigations I Congress Stree4 Suite 100 ` Boston,MA 02114-2017 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Anolicant Information Please Print Legibly Name (Business/Organization/Individual): The Home Depot At-Home Services Address:908 Boston Tpk City/State/Zip:Shrewsbury,MA 01545 Phone#:508-962-6942 Are you an employer?Check the appropriate bog: Type of project(required): 1.0 I am a employer with 200" 4. E] I am a general contractor and I 6 []New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. EJ Remodeling ship and have no employees These sub-contractors have 8. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp. insurance comp. insurance.-' required.] ' 5. Q We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs required.] t c. 152, §1(4),and we have no insurance re q ] employees. [No workers' 13.[v/Othet��o oa r 'comp.insurance required.] de 0(4ce,-n *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Belmv is the policy and job site information. Insurance Company Name: New Hampshire Insurance Company y WC 015519215 Expiration Date:311 2017 Polic #or Self-ins. Lic.#: xP Job Site Address: 201 r�✓e__ 0ArAP,^ 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/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 D fkInsurance coverage verification. i I do hereby certify u#er Vw pains and penalties of perjury that the information provided above is true and correct Si mature- Date: Phone#: 401-714-6 FEOther only. Do not write in this area,to be completed by city or town official. n- Permit/License# - hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing.Inspector son• Phone#• DATE(MMIDD/YYYY) AC R CERTIFICATE OF LIABILITY.INSURANCE oylal2ols THIS CERTIFICATE IS ISSUED AS TIVELY MATTER OR NEGATIVELY AMENDTION , EXTEND OR ALTER THE COVERAGE AFFORDED CERTIFICATE BY THE POLICIES CERTIFICATE DOES NOT AFFIRMATIVE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. endorsed. If SUBROGATION IS WAIVED,subject to the olic ies must be IMPORTANT: ff the certificate holder is an ADDITIONAL INSURED, p Yl ) 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). CONTACT PRODUCER NAME: FAX MARSH USA,INC. PHONE A/C No)* TWO ALLIANCE CENTER EMAIL 3560 LENOX ROAD,SUITE 2400 ADDRES ATLANTA,GA 30326 INSURE S AFFORDING COVERAGE NAIC# Steadfast Insurance Company 26387 100492-HomeD-GAW-16-17 INSURER A: 16535 IN a:Zurich American Insurance Co INSURED 23841 THD AT-HOME SERVICES,INC. INSURER C:New Hampshire Ins Co DBA THE HOME DEPOT AT-HOME SERVICES Illinois National Insurance Company 23817 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003746646-14 REVISION NUMBER:8 ED ABOVE FOR THE ITHIS IS TO I HAT THENDICATED.CERTIFY NOTWITHSTANDING ANYI ES REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCCOF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED UMENT WITH RESPECT TOLICY WHICH PERIOD WHICH CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY HE POLICIES DESCRIBED;_HEREIN IS SUBJECT TO ALL THE TERMS, MAY HAVE BEEN RE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN OLICY EFF PPOUCYAEXPs LIMITS INSRLTR ADDL UBR POLICY NUMBER MM/DD/YYYY MM/DD TYPE OF INSURANCE 9,000,000 A X COMMERCIAL GENERAL LIABILITY GL04867714 06 0310112016 0310112017 DAMAGE TO REN ED $ PREMISE a occurrence) $ 1,000,000 CLAIMS-MADEM OCCUR EXCLUDED LIMITS OF POLICY XS MED EXP one person) $ OF SIR:$1M PER OCC PERSONAL&ADV INJURY $ 9,000,000 GENERAL AGGREGATE $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $ 9,000,000 X POLICY 7 JECT LOC $ OTHER: 03/01/2016 03/0112017 COMBINED SINGLE LIMIT $ 1,000,000 B AUTOMOBILE LIABILITY BAP 293886313 Ea t BODILY LY INJURY(Per person) $ X ANY.AUTO BODILY INJURY(Per accidenq $ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG PROPERTY DAMAGE AUTOS AUTOS - $ NON-OWNED Per accident HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAB OCCUR $ AGGREGATE EXCESS LIAB CLAIMS-MADE $ DED RETENTION$ WC015519215(AO 03I0112016 03101I2017 X PTATUTE ERER H C WORKERS COMPENSATION 03/01/2016 03/01/2017 1,000,000 C AND EMPLOYERS'LIABILITYY TY WC015519217(AK,KY,NH,NJ,Vn E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE a NIA 03/01/2016 03/01/2017 E.L.DISEASE-EA EMPLOYE $ 1,000,000 D OFFICER/MEMBER EXCLUDED?- WC015519216(FL) 1,000,000 (Mandatory In NH) E.L.DISEASE-POLICY LIMIT $ If yes,describe under Conitnued on Additional Page DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more apace is required) EVIDENCE OF INSURANCE CANCELLATION CERTIFICATE HOLDER 77 THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES HE EXPIRATION DATE THEREOF, NOTICE .WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE i of Marsh USA Inc. Manashi Mukherjee ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD a TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Z Health Division Date Issued l Conservation Division Application Fee Planning Dept. Permit Fee 4 ` Date Definitive Plan Approved by Planning Board c6i�) A-hq Historic - OKH _ Preservation / Hyannis Project Stree Address �0/ Fi Y� ® ��' f� Villa ed, 9 Owner Mat LOLL i Address o7o {'iIle (,mvexs Telephone Permit Request ! .Square feet: 1 st floor: existing ' proposed 2nd floor: existing proposed Total new Zoning District Flood Plain /—Groundwater Overlay Project Valuation S F(A 'X6 Construction Type r&,1A Lot Size Size ® 3 7 Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family 61-' Two Family ❑ Multi-Family (# units) Age of Existing Structure 70 Historic House: ❑Yes ❑ No On Old King-sjHighway ❑Y ❑ No Basement Type: 0 Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area's ft. Basement Unfinished Area Number of Baths: Full: existing `2— new Half: existing new Number of Bedrooms: - existing new Total Room Count (not including baths): existing new First Floor Room Counts ' Heat Type and Fuel: a'Gas ❑ Oil ❑ Electric ❑ Other Central Air: Lames ❑ 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: Q, xisting ❑ 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)OV - � p Named ��� Telephone Number Sd ` 7 7!f `Q// Address //, ��� /' License# Home Improvement Contractor# Worker's Compensation #44C9V6.S93 ,- ALL CONSTRUCTION DEBRIS RESULT G FROM THIS PROJECT WILL BE TAKEN TO 7�K /21/�- SIGNATURE DATE f s FOR OFFICIAL USE ONLY t XPPLICATION# __DATE ISSUED MAP/PARCEL NO. r ADDRESS VILLAGE OWNER DATE OF INSPECTION: �tFOUNDATI.ON�ti�•;�•;.{t��t.���!�tFr�ti��-�i. - FRAME — - — ,;INSULATION, Y s } FIREPLACE ELECTRICAL:. ROUGH FINAL + PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING` • 4 t. DATE CLOSED OUT ASSOCIATION PLAN NO. yyL A_ lipdtAXh0 i' t3KttM1A#vl:t IftIllUII-,INC Massachusetts-Department of Public Satsty Momllrt.NY i2�0 ... v: 107 HVIRI s Road.Suft I 10 Board of Building Regulations.and StAndargS On 274.1274 (", �•irucipin%%ujrerN i.ur www:gpCpm ., : License: CS-088058 RJCHARD S TUPPER '79 B MID-TECH AR WEST YARMOUTH " . (secx -s FOR ius+srowrror Aa n€ ,ror,n►rF .�.�... .1�'�. Expiration Comrxssioner 12/31/2014 4 , Orrice of Coesunier Afmin&BuYia:t6 ftalad" PeopleNelpIng People Build a Safer Wiirid"' THOME IMPROVEMENT CONTRACTOR Rapiatration: g Type: Mt01�pi8C('Co Expimlon: GQ 14 individual RICHARD TUPPER Richard Tupper Y TUpp ;C6nstruction RICHARD TUPPER 2$Rwerta Drive +' gem Bwidutg Safety Feofessionai W,YARMOUTH,MA WSiS tlndsrserretary Memt er# 81581419 ��Exp 4/3df2Q14 , , ACORN, CERTIFICATE-OF.LIABILITY INSURANCE nATE(MMM°YYYY) 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 CON TRACT 8 REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ETWEEN THE ISSUING INSURER(S),AUTHORIZED IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(tes)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 endorsomen s). PRODUCER Southeastern Insurance A enc ME: Lora Lowe 9 Y Inc. ac No Ext: (508)997-b061 439 State Rd. EnaAI Arc Nc:(SO8)990-2731 P.O. Box 79398 ADDRESS: . PRODUCER N. Dartmouth, MA 02747 ME INSURED _ INSURER( AFFORDING COVERAGE NAIL p INSURER A. Arbella Protection Insurance Tupper Construction Co LLC - ittsuREa e_ AEIC INSURERC: CNA Surety 27 Roberta Drive West Yarmouth, MA.02673. INsuRERo: - - INSURER E: - INSURER F 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 CONTRACT OR OTHER DOCUMENT.WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. IL TYPE OF INSURANCE.. AD L SUB - - . INSR WVD POLICY NUMBER M�ar/OD EFF MM/oU EXP LIMITS GENERA(LIABILITY. SSOOOO874 11/0112013 11101/2014 EACH OCCURRENCE S 1'000,00 I X COMMERCIAL GENERAL LIABILITY- • A - CLAIMS_AAOE �X .00CUR. . . . : . . PREMISE (Ea occurrence) .S 10010 A MED EXP(Any one person) S S,:OO PERSONAL&ADV INJURY S 11000,000 t GENERAL AGGREGATE $ 2,000,00( - - GEN'LAGGREGATE LIMIT APPLIES PER:. - -- - -- POLICY j�T. LOC _ _ PRODUCTS-COMPrOPAGG 8: 2,000, s AuroMoslLE uAeeurY 5666240000 12101/2013 12 O112014 COMBINED SINGLE LIMIT ANY AUTO - . . . - : . - (Ea accident) .S 1,000,O ALL OWNED AUTOS- - - - - - - - BODILY INJURY(Par person) S - A X SCHEDULED AUTOS - _ _ ', BODICYINJURY(Paracaderlt) S. - - X HIRED AUTOS PROPERTY DAMAGE S (Peracadent) . INC X NON-OWNED AUTOS - - _ - 5 UMBRELLA LIAR X. OCCUR -- 46000S836 11/01/2013 11/01/ 0014 EACH OCCURRENCE. S 1 A EXCESS LIAB CLAIMS-MADE ,000 00 AGGREGATE S 1,000,00 DEDUCTIBLE RETENTION. S. $ T RKERS COMPENSATION . . . . - . . . . . . $ 1. EMPLOYERS,LIABILITY - - YIN WCCSOOSS9301200 10/03/2013 1O/O3/2014 X, T �LIMITTs X Ulm- AND ...ANY PROPRIETORIPARTNERtEXECUTNE RICHARD TUPPER I _ . 1,000,00( ' ICERIt9EM8EREXCLUDED? N!A 6.L.EACNACCIOENT y.i. s,deorys&m TIN) I ELIDED FOR WC COVERAG E.L.DISEASE.EA EMPLOYEs 1,000 00 a,desathe kinder °.CRIPTION OF OPERATIONS below . : :: - . . . . . -. - . . . . - . . . . . jDESwC1RIPTIoN,GF E.L.DISEASE-POLICY LIMIT :S - 1 000 00 OPERATIONS I LOCATIONS INEHICLM.(Attach ACORD 101,Additional Remarks Schedule,it roore 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 ACCORDANCE WITH THE POLICY PROVISIONS. "For Information Purposes Oely" -Tupper Construction-Co LLC - - AUTHORIZED REPRESENTATIVE 27 Roberta Drive W Yarnwuth, MA 02673 Lora Lowe ACORD 26 2009109 ®1988-2009 ACORD CORPORATION. All rights reserved. ( The ACORD name and logo are registered marks of ACORD f The.Commanwet ld,of Alassr chusetts De artinent of liidl, Trial 4rciclents Ri Office Of IPnveStigations . + � I CO3I J-ass Street,Snite 1 oo ©v dirt Workers,Compensation Insurance Affidavit: DuflderslConti'aetol-s/Electt'itians/Plumbers A licant Information Please PEW Legibly Name(13usiness,Organiaat;oa,'Intlividtiall: Tupper Construction Co'.Inc Address: 79B Mid Tech Drive C'i ty'/State/7_ip:West Yarmouth, MA,02673 Plione r:(608}77$-011.�i-- - -� 1 . .ire you an employer`'Check the 2pprr7pe ate:boa I ain•t employer with - . 1 am a geneml contractor and 1 j;vl>e of project(required): i ;;inployees (full and/or part-tune).`' havc hired the sub cons ae furs 6. ❑New construction <•❑ 1 am a sole proprietor or partner listed on 111.e attached sheet. 7 Q Rennodeling, ship and haye.no.employees Tltase sub-cr>titractors.ha've 8.: Detltoliti�tl tisorkirg for mein any capacity. employ-ee5 and ha�--e ,vorkers' i Wo workers'"comp. insurance carnp::insurance. {]Buildiii addition i r <fuired.j 5"0 w are a corporation rind its 10.0 Electric.a!iepairs or"additions 3.0 1 ani a homeowner doing alI-.work' officers have exareised their ) 1.[] Plumbing repairs an additions. myself �)11U�10rlCCI'J' comp. ri=lit of%;Xctmnion per Nl(GL. . 1 insurai.cc.required.]'' c 15,21,§1(4).and have no 17.0 P,00frepairs. ctnpayees. (Nn,, oikers' . i' other` -- cnnip. insurance required_) 1 Afil A)IiClttT[bht ehecks box-sin nin-,t also--f ile uut'thes etan bcin.t ,It�it�iuy illCnrwOrk"i� CU7t;(7Cr,8iiti-0R pO1tCV1n1'bn-I�tiOn. J T bldtnwtyners.:hv subinit this uftidat it ird ca ing the.v ark!doing rll wc%rit aIld ilicn hire ouui&contractors niust submit tt ncty tilrldavi,indu itiyg such: t:4ttti tuUrs That Check III isout box utasr•ttt.tCf.Cit an adtlufol.atl sh"t 6110tYiI19 rite ttaim:of Lite sub-contractor,and state whether or not those antitrec have- . mplcye :. 1J:the stib-contracutr,,:havc uusplayccs.titcy mitit provide their workers-'citttip.Policy number. P am an ernplat'ej tJtat is pro t4ding:riorless'Eo;itpatJJ.s[JtioJt insurance for ntf+elnr*ryecs. Belvw is t3reP/ilizy cand jt;b site 787f/1?71tUtTOJt. (nsul•ance Company i\smz: AEIC " poliev.f or Sets-ins..Lit,. WCC 50055930 i 2007 E.. Ftiratioii Date. .'rub Sife Addrt,s: 201. Five Corners Rd city/StateeGi Centerville MA 02632 Attach,z copy of tlQe workers' compensation policy declaration page(Sho+y°tug tite policy number and ekpiranon�date). E iiltnc.to scwre cove.i-e.as required tinder.Section 25A of.M61-c:.l 52 can-tczid to the imposition of criminal penalties"of a" )tttt: UP fit S1,aut).Oo ttnCUUr one year imprisonment.as woll as civil renalti,N in the;nets Ufa 5TOTI WORK.ORDER x,ia? of up to S250.00 a day-against thca=i:.lator. .Be advised that a copy.of this satem 'gat' ant maybe oraardGd to The Office of ;c�reta;ev ixicat�n.nveti i f n I do bereby certify Jurd=.tlJept7rj8S QJ1[lpenaltles 0 'Pe)fln, Pit[ft floe TJaforrjrrxtivjt provided above js,tit[e[tJtd.ca nreri." Sitnature: 11 13 — � Phone r: .508-778 011 Of finial usr oJJly,_Do ilot rttite M.ikis area;to be cvruplete[l ly city or town official. _ lasuhw Authority(eircte one): 1.Board of;health 2.Building Department 3.Citti•/'fawn Cl 6:{ether eri 4.EBectricai Tnspcctor S.Plumbing"Inspector Contact Person: phoneM. f -nip. r PERMIT AUTHORIZATION FORM �. Mary Lou Pierozzi l owner of the property located at: (Ownees Name,printed) 201 Five Corners 'Rd • Centerville MA 02632 . '(Property Street Address) {City�Town) ` hereby authorize the Mass Save Home Energy Services Program assigned Participating--- Contractorlisted below to act on my behalf and obtain.a building permit to perform insulation and/orweatherization work on my property. _ Date t FOR CSG OFFICE USE ONLY _ Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: y Participating Contractor - Date Rev.1213201 S r= v 05 14 10:56a TupperCom 15087785010 p.1 Is�ly G� CONSTRUCTION CO.ric 79B MID TECH DRIVE,WEST YARMOUTH,MA 02673 PHONE 508-778-0111 FAX: 508-778-501.0 WWW.TUPPERCO.COM Date: ^ , Town of Barnstable Thomas Perry CB4 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax t Y=° TH Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application # i �o� �; � Issued on has been Y- inspected b a certified Building .Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Richard Tupper License # CS-69058 C L I E TOWN OF BARNSTABLE 33ARNSTABL o"039Ann 1 .Ar. BUILDING INSPECTOR m APPLICATION FOR PERMIT TO Ayu,.� . ..... ...,Dt . .. ...... TYPE OF CONSTRUCTION ......... ....................................................................... . .. ........ .........................19.10 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies-for 'a permit according to the following information: Location ......../A ..... Z, ... . .. ........e ....... ...................................................................... Proposed Use ....OK . Zoning District ........ .......... ..................................................................................... A:-,... .................................................. ......... ..................................Fire District llm 4A.. Name of Owner & ....... Address ...............V?! ..f-4 7;. . ........ ..... Name of ......Address .......................... ....... .................................................. Name of Architect .. ... ......................................Address .................................................................................... . Number of Rooms ...... X...............................................Foundation R4. ..............L Exterior ....9-414.40 .........&/.3- ......0......Roofing..... ..... . .. Floors .............................................................. Interior ......04 . ... ... LVI Heating ............ ... ...............................Plumbing ...Z�4........L,.t,.......;2 ....... ..... .... ................ Fireplace ......... ..................................................................Approximate Cost......... .........d..................... Diagram of Lot and-Building with Dimensions 41e, 0 NSN _3 1 /11*1 M 0 V) 0 U) (f) I E Z < > Lij LIA < .................................... LJ > 7 X n 0 /4 V) .7�-jllzl OJT a: C1- ci- �A W -7) < C) 171, � I, F-- (n U) LLJ �Ld LLJ �j 2: 2� U) Cry 0 < n <A cc 0 U) < n < LLJ F-- Lij i-- -17 LLJ S fit ' !r) ............. I hereby agree ro—con—form to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..................... ................... Nozmeat Development Corp. ��m�� ` 8�0�u� �� No —. . Permit for ---��o.. —. ' �Y. .......................... | � �� }�l�m Road Locohon =—.----..���������--------'' � ` - ntille ����������...::��.......:'.............................. Owner ........ , Type of Construction .........fX-.4XV-------. _____.,_____________'_______ ! ��l � Plot ��----�-----' —'�—'.���'----'' | � ' { -' AugLiot 17 �O �~ Permit Granted -------------]g |^ � Date of Inspection lP ------------ � | �� Dote Completed —�,����.�.��--.=—]o��^° , PERMIT REFUSED � � ^ . . —~ ' —.. . lV |—.. .. — — .. . --------.-- ------^-------------------.. . —_-----.-.~--------.-----.--. � . | —.------~----------.~—.~..—.—.. . | � ------------.------.—..~---... ` . ' ` � . . Approved ---------------- lV � � ^ -------''—'-----~^—^^-----^--'' t q � -------.---.-------.—~........ k Assessor's map= and lot numiser..... : SEPTIC: �Y yoFTHETo�. ' STEIN fWU H Sewage Permit number.�?,o.. , ' INSTALL SYSTEM IN COMPI IAWIT C' ENVIRONMENTAL � H TITLE L Z BAR3STA ILE, i House number ....:.:.................................°....................:... ....,.. 1V►/I#i� 9lioiENT COS 9 AL E rasa e:-.�0 t639. �00� TOWN REGULATION, Y TOWN OF BARNSTAIRLE f BALDING � I �P� TO APPLICATION FOR PERMIT TO ...... . .-' ......:..... . .�..l.v................. ......................... TYPE OF CONSTRUCTION .................... .. ......L a.vsL- .. ............................................. .............. .............19.t...Z k TO THE INSPECTOR OF BUILDINGS: _ w The undersigned hereby applies for a permit according to ollowing information: Location` ...4=. ,z..V1.l... ...r....... ............ ........ Proposed Use ...................................................................:....................................:.......................................:......................... ..... 'Zoning District Fire District u ZO 1l°°y c /t- Name of Owner ......... ... Q.............'?�.....Addres5 ......................... :.. ..... ..... . .. ................ Name of Builder" ..... "� 65'J!�,�...... ^....°&M..°Address #Z/ '............ . ..� Name of Architect Address ...........:............:....................................:...................... Numberof Rooms ..................1.............................................Foundation .,................... ...... ................`. Exterior .............. ........................Roofing .............. i!.Y ✓ Floorst'" D /:.1. •J..^�.4�. .........................Interior :................................................................................... Heating ...... ..7-....... ...... / 1...,...... �./..Plumbing Fireplace ...............................................::.................................Approximate Cost ..................6.°......°°.°................................. Definitive Plan Approved by Planning Board ________________________________19________. Area ..........F Diagram of .Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH �9 o Imo--- 4- a 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 .`.... .......... ....................... ........... CH. 'MOUZON,--,' 23919 No ................. Permit for ...TO ......................... Single Family Dwell ' ........................................................�Uxg............... Location Kive...C.O?Zn.er.s...RgAd........ . .. . ..... .. .. .. .... .. ......... Centervi.11p................... ..................................... ...... .............. Owner ......H. Mouzon ............................................................ Type of Construction .........Fr.amp...........I.......... ................................................................................. Plot ..... ......... Lot ............................ 82 Permit Granted ..... ............19 D�te of.Inspection ....................................19 Date Completed ........ ... .....19 ff 77 7