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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # CDO I S b IJ Health Division Date Issued Conservation Division Application Fee $ ' Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Ci l Owner Address Telephone ' ', Permit Request `f1' (240,,5s] Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation •609'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 161 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: VGas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes YNo Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Att,,�ched 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 p (BUILDER OR HOMEOWNER)-` Named Telephone Number Address 5 License# f ''s '0 b W /',f Y(Vloo Home Improvement Contractor# J Worker's Compensation #Aal"61� ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO j SIGNATURE DATE 5 f FOR OFFICIAL USE ONLY S ,APPLICATION# ,! DATE ISSUED { MAP/PARCEL NO. F t ADDRESS VILLAGE OWNER DATE OF INSPECTION: s FRAME s INSULATION&-; �s_ � t FIREPLACE ELECTRICAL: ROUGH FINAL '+ PLUMBING: ROUGH FINAL ili�r GAS: ROUGH FINAL FINAL BUILDING.: f DATE CLOSED OUT ASSOCIATION PLAN NO. P �, a . . • .. -ENCINEEBhrC E OWNER AUTHOMZAT�ON 'FORM".- Owner's Name ; owner of the property located at: - (Property Address} - (Property A(Tdress) hereby authorize 1 f vp c ' p - (Subcortrac car} 11 an:authorized subcontractor for RISE..Engineering;to act on'my behalffo obtain.-a building permit:and to perform work on`my property. This form is.only valid with a signed contract., r _. Owner's S' nature3 / /S - , Date RISE Engineer[ng 6 Dupont.Avenue South Yarmouth, MA 02664 1 J + The C®tat oi� enit o,f insac i e;is Dcpsnerat ofYustialccae�zts Of.fa Investigations 66 as#inV9n Street www nat s:gov1diq. : u ds/C tee6 s E eetricans/Pui bersVork2rs' Compensation Insurance o } Ap®lieant Information Please Print Legibl NaMe(Business/organization/iidividual) .. Tupper Construction Co' :Lt r Address: 540A Higgins Crowell Rd City/State/Zip: West Yarmouth, MA 0.2-6 7 3.4Phone#;: 509 Are;you an employer?Check the appropriate box' Type.of ro ect re *red .... 4 yp p .14 ( �.. ) 1.Q l am a employer,with 4 ;I am a_genera}.contractor and 1` 6 New construction employees(full and/or part-t ine); have hired tbe:sub-contractors Remodelin 2.❑ 1 am a sole.proprietor or partner.: hsted,on the attached sheet. 7,# E g - ship and have no employees These.sub-contractors.have; 8 .[]y:Demoliiion working for tm in any capacity, «workers'comp insurance;: p `` 9 []Bullding'addition [No workers.'. corP. r ❑ Weare aori paration and its' I 10.0 Electrical repairs or dffltions required.] officers have exercised their' 3.E i am a homeowner doing_al}work rigfit:of exemption per MG 11.j Plumbing repairs.or:,additions myself. [No workers'comp: c 152;§10),and we:have pc ;I2 0 Roof repairs ` insurance required.]' employees.[No workers' 13_ Ot]ier eomp.:insurance required.], Ieath'erizatin *Any applicant that ehecks bax#1 must also fill outttie section,fie}ow 09No jng their workers'comFeasatian polacs information:. "r Homeawmers who submit this affidavit indicating they are doing ail�vvYk aad ti�en hire outside contractors,bust submit.' " anew affidavit Indicating such; 'Contractors that check this box must attached an additional sheetshowing tN narne of the sub-contractors ant.their wprkers'clomp;policy information: f am an.employer that is providbw workers'competuaadoiz.itivurcatice for.tray employees. Belrtw is;tiae policy ad ob site; informalion. Insurance Com"panyName:, .AEIC Pokey#or Self ins;lit. WCC 5 60 5,55 3 6120 Expiration Date. t O/3I�5 . . . .... Job Site Address . Mil -�Z4 - n "��r�� Gty(5tatelZi D Attach.a e'ogsy of the workers'.cortapensation policy declaration ;page(:slzoevitag the:poliey nuaaalaer and expiration;iate); Failure to secure coverage as required under 8octi6r 3A ofMG'I c 152:.caitlead to the'imposition of c 7mihai penaljies.af=a. fine tip to$1;SOO.00 andlpr one year ftt onment,as well as.civi.i pens}ties in:the form of a STOP WORIt ORDER and a fine ofup t0.$250:00 a day against the violator: .Rd advisedtha a copofhtm fy i d Jf µ. Investigations of theDlA for insurance coverage verification: - 1110,hereby,certify;0.7dd r tie pcatttsr Q het€altaes of per�ar lhat the ati rtartatanrt gravid,d c'bdve is tare crud coarect.' Sitmature; A � .. 'bate• 112, ' ,f r (508}'778-Q111 ciat use drily. D6noi write ire tkis area,to:Be ccrrriv eted ty city.or.towra o caa!' Ulf Oty.or Town, I'eatnat/L:tense;#,.. .. _. .. .,.. Iss6ing Authority(circle one): 1.Board:of.Milth 2.wilding:,$9epartiifient 3:Cityff.owaa Clerk 4 Electri.-.,L%pert�r �.IPIt>uzbiag Yuspector 6.Other Cmntact Persoat.. f AC Rb® CER0-IFI' A. . 4 DATEIMPMDDIYYYY) . ,. TF OF LIABILITY INSURANCE 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 Oft ALTER.THE COVERAGE.AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT;CONSTITUTE A CONTRACT:BETWEEN THE SSSUING 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 aei endorsement- A statement on this certificate does not confer rights to be certificate holder in lieu of such:endorsemen r }• . ' PRODUCER :-. .... ... ._ ... .CONTACT SAE: LOr2 FitzGerald Southeastern Insurance Agency PHONE x t508);997-Si061 t5Dei9�a-2lal 939 State Rd; � ' `. � ;E.MAIL :lfitz@southeasternins.com n DDRE P.O. $DX 79398 SNSURERtSI AFFORDINGCOVERAGE North Dartmouth. :NIA 02747 * . � -Area INSURED INSURERAArbella Protection Insurance i41360 - INSURERB:Associated Employers. ins. Tupper Constriction Co LLG • ..., „ :INSURER ... _. . - 79 Mid- Tech brve � _' •,; ' _ . . . ,... :INSURERD:::.. - unit s _ . INSURER E - • , .West Yarmouth --SURER F .COVERAGES CERTIFICATE NUMBER 2f315-1 REVISION NUMBER. Tfils iS'roCERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW NAVE BEEN ISSUED TO-,THE INSt1RE0 NAI4{EO ABOVE FOR THE POLICY P£RSOa", INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR..CONDITION O.F ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO.1V iCI11`HIS CERTIFICATE mAY BE ISSUED OR MAY PERTAIN;THE INSURANCE AFFORDED BY THE-POLICIES DESCRIBED HEREIN iS-SUBJECT TO ALL T E TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES:-LIMITS SHOWN MAY`HAVE BEEN REDUCED BY.PAiQ CLAIMS;INSR ADDL _LTR TYPE OF 1-SURANCE,. INSRL POLICY.-UMBER:' mwaoryyyy POLICY EFF POLtCY EXP - GENERAL LIABIUTY - _-_.. .... �ERCHOCCURRcP.t ;;, 1;.000,000. I X GOA9MERCIAL GENERAL UABIJTY A A 0 _ I``I 'f 2armSES Eaceaxrer,* I S, 100,000 A CLAWS-MADE OCCUR !8500008743 11/iJ201a 7/1/2Oi5 IMEDEXP{Avy one oerc=J y S;;OQp I #P RSOi-L&ADVINJUPY {s 1r000,000:: _ r }} C;Enc:R�;L..AGGREdAfi= .� f S 2-;�000,000- GrI+PLRGuRE"nA7 US«TAPPLFES'r^=_F� � •_ PRO. LOC :j 1 PRO0UCr5•COM01OP k- 5 2,000,00-0 X POLICY - - AUTOMOBILE LIABIUYY I " G ;UMt'x (� N9BlNED 5+h LE EaxLrilen, 5: l Q00.000 A ANY AUTO, I • :• BOOILY't J3URY(FecPer�art S Au DINNED EX SCHEDULED 020009389� .12�.7.. �^�1{AUTOS AUTOS � - / /2014 '2/1/2015 80DILY.INJURYPor' HI FO AUTOS ...r AUTOS.. y (UMBRELLA LIAR F I tPr, n«;aQ ar I {Ltn.t sur 3 meta st E4 entr+k as *' 250 000 EXCESS LIAR OCCUR _ EACH Oq.. RRENC'E S: ^ p AGGREGATE Dt;D RETENTIONS 600058368 1/1/2014 111/1/2025 B. W9MRS COMPENSATION AND EMPLOYERS'LIABILfTY Y/,N �G 1T jr OTIi ANY PROPRIETOPIPARTNER c/'XEC[ITIVE _ jj ` `'�"'�1' - OFFICERIMU.46ER EXCLURED? "N i A - '# E L.EACK ACCIDE'JT .3' 3.;000 00 0' (MandatMinNH) t CC5D0559301201.4A 013/2014 10/3/201S' tEL.i115Er4e• Itgges,tr scrgai-i der Ij _ EAw1API Y_ S 1 :000.000 OESCiiiPTiONOFOPErIRATIONSbaWs Cx&EA..E-POLICY+SATE S: 1„000 `000 DESCRIPTION OF9PERATIONSt LOCATIONS:VEHICLES(Atiicfi ACORDtpt;Additional-Remarks Schedule,aaia6e� ece'is - _ 7 CERTIFICATE HOLDER_ _. .. . CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES$E CANCELLED BEFORE '' i • THE EXPIRATION GATE THEREOF, 'NOTICE VVILL BE 'DELIVER£33 IN , i INFORMATION PIIRPOSES :ONLY _ ,p c. ACCORDAtIG..WITH THE.POLICY PROVISIONS. TUPPER CONSTRtICT201d co: IZ,G_ _... 546; A .HIGGIPIS C120FiE# ROAD auTHORlzsoaEaREtFNTnnvE E-:S.T. ,YARM010 . MA, 026.73' __ Lora Fitz.Gerald/L3L ACORD 25(2010/05) 41988-2010 ACORO CORPORATION. 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LLc 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-776-5010 WWVV.TUPPERCO.COM Date: -. j Town of Barnstable hht v 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 Issued on / /I has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Permit #: �� I 1 � 1 . Address: � V- Richard Tupper License 9 CS-69058 � � 'W .r..i• -.....�..L7 .,.�':.. .:r.'x,; r ,..!•;S .�K�ry,»>v�,.... ta:. a �:.+'...+,m....+...x. ,. :F+.-,.v =x.cr. y...-..»v _ r - ems Assessor's map and ,lot;number 2.,�....�....... �(� ��� ,%' f -7 J Sewage Permit numberr......... .... ....!......................,........... 7NE.T°�°,� TOWN OF BARNSTABLE Z 33MOSTULL i M6 9. .e�� BUILDING INSPECTOR 0 MAI a• J APPLICATIONFOR PERMIT TO ........A... —...................................................................................................... TYPE OF CONSTRUCTION ............ r..1r.. ' ...................................................................................................... ................... ...........19... 7 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a�pJermit according to the following i nformation:, Location ....................:...... ..... ................... ................................................'.::...:.-..�...`. Proposed Use ......... .... 4 ........................................................................ .......... ....................................C ZoningDistrict`..................:.":.................................................Fire District .............................................................................. l �g ,.,��lXo �1� ....:.Address ....! "..�'-......�..3.�::.............�� Name of Owner -...nc:...................................�...� ..�.............. ( x Nameof Builder ....................................................................Address .................................................................................... t ` l ` Nameof Architect ...................................... ........Address S .............. ...............-- .......--............ern--.............:.................... Numberof Rooms ..................................................................FFoou__ndation ......................................................................... Exieriori... I r� V..................... ................c.v..:.......................................................... Floors .......................................Interior ........ ..... ............................................ Heating ..........................r .. < ....................................Plumbing -�� U .... ..V.ly............................................................. Fireplace ........................... ......................................Approximate Cost ................i... ........ Definitive Plan Approved by Planning Board ......19_ __.1 Area ,' ...,.. ..w e -Diagram of Lot and Building with Dimensions Fee ..................................... SUBJECT TO APPROVAL OF BOARD OF HEALTH -)IIhs N do 0 C I hereby agree to conform to all the Rules and Regulations of the'Town of Barnstable regarding the above construction. D Name ... ^^...!... ...... ....................... Danielle Construction Co. A=190-217 No 17804 permit for .,,,1 1/2 story, ...... ........ single/family dwelling Location3��Great Marsh Road Centerville ............................................................................... OvAer Danielle Construction . ...........................................................Co....... Type of Construction fr ....................ame...................... ................................................................................ Plot ........................ Lot .....A ...................... Permit Granted .........Tld.ly...9...................19 75 Date of Inspection ............................:........19 Date Completed .........................71..........19 PERMIT RE USED ...................................... ...................... 19 ................................... ........................................... ............................... ................................................. ......eU .................................. lib Approved ................................................ 19 ............................................................................... ............................................................................... �. / D ' 2/ �....... 7— !- 7v— As ?ss l reap and lot'number ..... SEPTIC CY8-T I Sewage Permlt number ..�...'............... INSTALLI D IN CUMPLIAI WITH ARMLE II STA"M yo�THE TOWN OF 'BARN SE Z B9HBSTOBLE, � "6 9 BUILDING INSPECTOR ,' ��YPY h• _ APPLICATIONFOR PERMIT TO ........1 ...2........................................................................................................ TYPEOF CONSTRUCTION ............ ..J^.. ..e................................................................................................ ..2 ......19.. .S TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for permit according to the following information. Location �0 3 ProposedUse ......... ............ ... ... .............. .............................................................................I......................... Zoning District 2 �..........................................Fire District ............................................................................... Name of Owner . . ... ...... ........ ......Address ....�.c �-:....1. . 3. �- ............ ... . Nameof Builder ....................................................................Address .................................................................................... L. Nameof Architect ..................................... Address .................................................................................... Numberof Rooms ............................... ................................Foundation . ........................:..... .I........ ( � I �Roofin ......Interior Floors .........................C/�L�fl -............................ ........,����. .............. Heating ..........................r.. .. .. ..................Plumbing ................ ... ......... ....... ..Y................................... Fireplace .......................... ...................................:Approximate Cost ...............;r................................................... Definitive Plan Approved by Planning Board _t'_ ___J!_�_______19_ __ .T Area ..... ..... �..� ..� Diagram of Lot and Building with Dimensions Fee ..............®........................... SUBJECT TO APPROVALOF BOARD OF HEALTH b � I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......... ........:......................A.......................... ' Danielle Construction Co. 4' 17804 Permit for 1 1/2 story, • ............... single family dwelling .... y.............................................................. y Great Marsh Road Location ................................................................ Centerville ............................................................................... Danielle Construction Co. t Owner .................................................................. frame Type of Construction .......................................... ................................................................................ f #3 3 _ sPlot ............................ Lot ................................ Permit Granted ..........July..!............. 19 75 L - Date of Inspection / 17................................... J Date Completed ....f '.1 /?��... t PERMIT REFUSED ................................................................ 19 ............................................................................... ................................................................................ ............................................................................... ............................................................................... Approved ................................................ 19 ............................................................................... Ste fry era v� lr�+a „tea+ t CEQTt5 Y TO A, r T45' FOUMtoAVION 4N 'rWS GRouto© A5 SHOWN ,HEREOW 6i aNp COMP':Y5 W17l i 7±4F ZONING �? ' LAWS OF -rP E -T O W M atr DA.Ts Co'lS�r7 L rr- 3 _ 11 74N Q ti rl N r7�IV _ _ ... ob I- r pV k L0 P 1 .ar tr,A. Sc.Q.�.E. i i N = 4o t~ r 24W D C ' gy�Q� � sum RZGl5TE�Ze; LAND 5v2VEYORS Pi-a � ; +z8 �� ' .© 5'i" ►2 v l t� NE A S . f