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TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
�J 1
Map /4r, Parcel 0 2 Application # CPO.1 �-6 yo t
Health Division Date Issued A th'ah N
Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH Preservation/ Hyannis
Project Street Address I
Village .�,1/I����t� l l e,
Owner 1 km Address 110 &L)+�Vohaw Dr.
Telephone —10 10
Permit Request
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new
,Zoning District Flood Plain Groundwater Overlay
Project Valuationf2506 go 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: X Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) I tU
Number of Baths: Full: existing new Half: existing new
Number of Bedrooms: existing _new
Total Room Count (not including baths): existing U new First Floor Room Count
Heat Type and Fuel: A 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 _ Othenz
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ M`~ C)
Commercial ❑Yes ❑ No If yes, site plan review#
Current Use Proposed Use
air
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)- . -
Name l I� :rUPT Telephone Number
Address I'OsCauA1 License# CJ Q 0 D 5 9
AMHome Improvement Contractor#
Email Worker's Compensation #�J)1 FY_Y1h_6q;ij1 11MA4
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PRO ECT WILL BE TAKEN TO
_ J ,
SIGNATURE DATE 104M
FOR OFFICIAL USE ONLY
APPLICATION#
,k DATE ISSUED
r o
MAP/PARCEL NO.
ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
4
GAS: ROUGH FINAL
;F FINAL BUILDING
DAT&CLOSED OUT
ASS
QgjATION PLAN NO.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www mass.gov/dia
Workers' Compensation Insurance davit.•Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name(Business/Organization/Indi.vidual); Tupper Construction' Co. j. LLC
Address: 546A Higgins Crowell Rd
City/State/Zip: West Yarmouth, MA 02613 Phone-#. 508-778-0`111
you an employer?Gheck the appropriate bog:
Are YType of project(required):
I-M I am a employer with 4- ❑ Ir am a general contractor and I 6. FIL New construction
employees(full and/or part-time).* have hired the sub-contractors
2.El I am a sole proprietor'or partner listed onthe attached sheet.. ❑Remodeling
ship and have no employees These sub-contractors have 8; � Demolition
working for mein any capacity. workers' COMPL.r insurance 9. Building addition
[No workers'comp.insurance 5. ❑ We ate a corporation and its
required.] officers have exercised their
10. Electrical repairs.oradditions
3.❑I am a homeowner doing all,work right of exemption per M L 11.0 Plumbing repairs or additions
myself. [No workers';comp. c. 152; §1(4),and we hav�no 120 Roof repairs
insurance required:]t employees. [No workers' "
comp.insurance required.] 13.El Other Weathefization
*Any applicant that checks box 41 must also;fill out the section below showing their workers'wmpensation: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 their workers'comp.policy information:
I am an employer that is providing workers compensation insurance for my emp loyee&L Below is thepolicy and job site
information. f
Insurance Company Name:_ AEIC'
Policy#or Self-ins..Lic.#:. WCC 5 0 0 5 5 9 3 012 014A.. Expiration D,ate:' 1%0/3/15
' Job Site Address: 96. � C.jty/State/Zipoto
Attach a copy:of the workers' compens on policy.declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of IvIGL c. 152 can lead tor 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.ORDE.R 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 yerification.
I do hereby certify under the pa n penalties of perjury that the i.forination provided above is'true and correct:
.
_. Date:
I LPhone#: (5 0 8) 7 7 8-0`111
Official use only. Do not write in this area,to be completed by city or townof)`iciaL
City or Town: Permit/License#
Issuing Authority-(circle-one):
1.Board of Health 2.Building;Department 3.City/Town Clerk 4.ElectricalInspector 5..,Plumbing Inspector
6.Other
Contact Person: Phone#:
r
I / r
,sae CERTIFICATE +�F -LIABIL.IT IN U . NCEt DATE(�IM,D�Y14
ll7 f 29/2014
THIS CERTIFICATE IS ISSUED AS'A MATTER OF INFORMATION ONLY AND.CONFERS NO RIGHTS:UPON'THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFRRMATIVELY 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 poky(iesymust be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may"wre an en orse0lenL_A statement on this certificate does not confer rights to the '
certificate holder in lieu of such endorsement(sf.
CONTACT
PRODUCER NAME Lora F1tZPerald
Southeastern Insurance Agency PHONE ;508)997-6061 AfC rdD.:(508)990-2731
439 State Rd,. E-MAL' lfitz@southeastarnins_com
DD ESS:
P.O. Box 79398 INSURER(S)AFroizOli+ocovERAGE NAic�
North Dartmouth MA 02747 IrisuRERA Arhe11a Protection. I>zsurance' 1360
INSURED INSURERB:Boston Insiarahce Brokerage Inc
Tupper Constract:ion :Co hLC INsuRERc: .
27 Roberta- Dr:ive INSURER o:
aINSURER E
West Yarmouth MA 02673 I.INSURERFi
COVERAGES CERTIFICATE NUMBER:2015: 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.rALL THE TERMS, ;
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES:LIMITS:SHOWAN MAY HAVE BEEN`REDUCED BY PAID CLAIMS.
INSR - :.POLICYEFF POLICYEKP.: LIMITS
TYPE OF INSURANCE, POLICY NUMBER MIO MMID
GENERAL LIABILITY EACH OCCURRENCE S 1.,000,000
'DAMAGE TO RENTED .. 100 0O0
X COMMERCIAL GENERALUABILITY 'PREMISES o e ca 5
A CLAIMS-MADE X OCCUR 500008743: 1/1/2014 1/112015 MEDEXP(Anyoneperson) g. 5,000:
.. ..
PERSONAL BAOVINJURY :S 1,000,000`
GENERAL AGGREGATE S' .2,000,000
GENIL AGGREGATE LIMIT APPUES PER: PRODUCTS-COMPIOP AGG S 2:i.000 i 000
POLICY PRO
X LOC .-. ... :S
AUTOMOBILE URBILriY' - - - G06a8lNED SING-LE:UMIT
Eaavxitien: S 1:-000 000-.
A14Y AUTO BODILY INJURY(Pet person) S
A ALLOVVNED X SCHEDULED 020009389; 2/1/2013 /1/20I4 BOD)LYINJURY(Per:aaiciaM) S
XAUTO H REDS AUTOS
AUTOS X NON-0VtiMED PROPERTY DAMAGE .5.
AUTOS Waraccidant
Uninsured motwofii- tknit 250 000
8. UMBRELLA LIAB OCCUR EACH'OC CUR RENCE s
IS
A r EXCESS:LIAB : CI;AIMS-IAADE AGGREGATE.S
DED RETENTIONS .. - 600058368. 1/1/2014 '1/1/2015 S
$ WORKERS COMPENSATION x :WC STATU
AND EMPLOYERS'LIABILITY y,l N',"
ANY PROPRIETORIPARTNERIEXECUTIVE F.L.EACH ACCIDENT S 1 :000 00D
OFFICERIMEMBEREXCLUDED? N NJ,a CC500$$93012D14;> 0/312014 OJ3/2fli5
(Mandatory_inNH) ❑',�. ELDISEASEL-EA:EMPLOYE S.. 1 ,DOQ 000
liyas.d1P 10 eunder.. ._ EL;DISEASE-POLICYLIMR `S -1,t000 000 DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS/LOCAT7UN51 VEHICLES(iltlaU.:ACORb i07.3ltltlidOrlal RemaNts ScheOule,it mo+e spate is repaired)'
1
CERTIFICATE HOLDER. CANCELLATION
HOULD ANY OF Tikk ABOVE DESCRIBED POLICIES BE CANCELLED.BEFORE
THE.E7(PIRATION''DATE 'THEREOF; NOTICE' WILL ;BE DELIVERED_ IN
ACCORDANCE WITH THE.POUCY PROVISIONS:
SNMRMATION PURPOSES ONLY
TUPPER 'CONSTRUCTION CO LLC
546 A HIGGINS CROWELL ROAD AUTHORIZED REPRESENTATIVE
WEST YARMOUTH,, lak 02673
Lora ritzGerald/)sHL;
ACORD 25(2010105) 01989-2010 ACORD CORPORATION. Alt rights Teserved.
WSO25minnva ni - Th.Ar.nPn aril:1,n—am rwesicl—e4—4—of Ar`nRrk
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PERMIT AUTHORIZATION FORM
I, AUGUST VIEKMAN ,owner of the property located at:
(owner's Name,printed)
170 Nottingham Dr CENTERVILLE
(Property Street Address) (city)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
X
Owne's Si ure
Date
FOR CSG OFFICE USE ONLY
Conservation Services Group has assigned the following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
Participating Contractor Date
C]sfC!]
�i
for Office Use Only
Rev. 12132011
f
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,Parcel Detail Page 1 of 3
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Logged In As: Parcel Detail Monday, November 17 2014
Parcel Lookup
Parcel Info
Parcel ID 172-022 I developer I LOT 12
Lot
Location 1 170 NOTTINGHAM DRIVE I Pri Frontage 1131
Sec Road I Sec I
Frontage E
Village CENTERVILLE I Fire District C-O-MM
Town sewer exists at this address I No I Road Index 1104
"` T-
Asbuilt Septic Scan: � � x �
172022 1 Interactive
1rt
#�
Map I
172022_2
Owner Info
Owner ITOVET, MADELINE M ( Co-Owner i%VIEKMAN,AUGUST K I
Street! 170 NOTTINGHAM DRIVE Street2l
City ICENTERVILLE I StateFm—Al zip 02632 I Country
Land Info
Acres 0.34 use Single Fam MDL-01 I Zoning RC I Nghbd,010
Topography FLevel ( Road!Paved
Utilities Septic,Gas,Public Water ( Location I I
Construction Info
Building 1 of 1
Year 1972 I Roof Gable/Hip Ext*ood Shingle
Built Struct..._ Wall —
Living Cover Roof AC
Area 1196 I Asph/F GIs/Cmp� ype!Central
style Ranch wau!Dry��___.__,.- ( Rooms,�Bedrooms
� LLw- VI !l N �
� I Int Bed
Bath
Model Residential Floor I Carpet Rooms 11 Full + 1 H t
_
I
Grade Average I Heat Hot Air �I Total I6 Rooms
b '
Type Rooms r
Stories 1 Story Heat Fuel Gas (Fund- LL
ation,Poured Conc. I
Gross[2968 _ _I
Area
Permit History
http://issgl2/intranet/propdata/ParcelDetail.aspx?ID=11770 11/17/2014 .
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FRIEDLINE&CARTER ADJUSTMENT, INC i �.
436 Main Street, P. O. Box 338 $�
Hyannis, Massachusetts 02601 N €f,f 2' 01
Tel.- (508) 771-3232
FAV(508) 790-2344
INTSION
TO: ( Building Commissioner or Inspector of Buildings
( ) Board of Health or Board of Selectmen
( ) Fire Department
TOWN OF Barnstable
TOWN HALL
Barnstable, MA
RE: Insured: HAVERSTOCK, Madeline
Property Address: 170 Nottingham Drive
Centerville, MA
Policy Number: 31-12O029598
Type of Loss: Fire
Date of Loss: 1111612010
File#: 111994
Claim has been made involving loss, damage or destruction of the above captioned property,
which may either exceed $1,000.00 or cause Mass. General Laws, Chapter 143, Section 6 to
be applicable. If any notice under MGL, Ch. 139, Sec. 3B is appropriate, please direct it to the
attention of this writer and include a reference to the captioned insured, location, policy
number, date of loss and file number.
On this date, I caused copies of this notice to be sent to the persons`named above at the
addresses indicated above by First Class Mail
ti
N. LAGUE
Adjuster
11/22/2010
Assessor's Office(1st floor) Map /7 Z LotAc / ol c Permit# 2 7
Conservation Office 4th floor `� 93_zO TM Date Issued
O r�-s ' o VL
Board of Health 3rd floor iPtw PLAN a—i Z7167M
---,q 5)/0`S 3 pRVIE
Engineering Dept. Ord floor) House# /7 0 F-J.3_ = �
Planning Dept. (1st floor/School Admin.Bldg.): K i
Definitive Plan Approved by Planning Board 19 •e» ,,�'�
(Applications processed 8:30-9:30 a.m.& 1:00-2:00 p.m.)
TOWN OF BARNSTABLE
Building Permit Application,
Project Street Address P 70 /Vo T r1 M c-,q!gM PR i V6— {-OT Lam,
Village �j CFI�'C=R t/tL Fire District "
Owner Address
_ Telephone ZIA0-- ik-'5-
Permit Request: G'ON5` 2?L/G T— �X /,`L ° 7TD0L Sf�E®
Zoning District Flood Plain Water Protection
Lot Size - Grandfathered
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Existing Information
Dwelling Type: Single Family Two family Multi-family
Age of structure Basement type
Historic House Finished
Old Kings Highway Unfinished
Number of Baths No. of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name 5-1-V/aR"T 1!�119-l-A4117 Telephone number
Address __ 02 0 f "/— —yo tJ f,-u AV License#
Home Improvement Contractor#
Worker's Compensation #
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN (AS BUILT) SHOWING EXISTING, AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO (�
Project Cost I Y cc�
Fee
SIGNATURE G ` DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
BPERM T
HAVERSTOCK, MADELINE T. i
FOR OFFICE USE ONLY
1-.22
4
ADDRESS 170 NOTTINGHAM DRIVE, CENTERVILLE VILLAGE
OWNER MADELINE M. T. HAVERSTOCK. _
DATE OF INSPECTION:
FOUNDATION
FRAME
INSULATION -
FIREPLACE
ELECTRICAL: ROUGH FINAL
' } �
PLUMBING: ROUGH FINAL
GAS: ROUGH FINAL
FINAL BUILDING: J
� F '
DATE CLOSED OUT: { "
ASSOCIATE PLAN NO. �
I
HOME OWNER' S EXEMPTION
The code state that: "Any Home Owner performing work for which a building
permit is required shall be .exempt from the provisions of this section
(Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that, if
Home Owner engages a person(s) for hire to do such work, that such Home Owner
shall act as supervisor. "
Many Home Owners who use this exemption are unaware that they are assuming
the responsibilities of a supervisor (see Appendix Q, Rules and Regulations
for . licensing Construction Supervisors, Section 2. 15) . ..This_ .lack of awarenes
often results in serious problems, particularly when the Home Owner hires
unlicensed persons. In this case our Board cannot proceed against the
inlicensed person as it would with licensed_ Supervisor. The. Home"64rier-actin
as supervisor is ultimately responsible.
To ensure that the Home Owner is fully aware of his/her; responsipilities,�. man
communities require, as part of the permit application, that the Home -Owner
certify that he/she understands the responsibilities of a supervisor. On the
last page of this issue is a form currently used by several towns. You may
care to amend and adopt such a form/certification for use in your community.
<.7
• TOWN OF BARNSTABLE
BUILDING DEPARTMENT
HOMEOWNER LICENSE EXEMPTION
Please print. ..
DATE C�c1-,4697V
JOB. LOCATION /. G
Number Street ,address ==;Section of:aown,
HOMEOWNER„
Name
Home phone Work phone
PRESENT MAILING ADDRESS Sal
City town State Zip code
The current exemption for "homeowners" was extended to include owner-occupied
dwellings of six units or less and to allow such homeowners to engage an in-
dividual for hire who does not possess a license, Iprovided that the owner
acts as su ervisor
DEFINITION OF HOMEOWNER:
Person(s)' who owns a parcel of land on which he/she resides or intends to. re-
side, on which there is, or is intended to be, a one to six family dwelling,
attached or detached structures accessory to such use and/or farm structures.
A person who constructs more than one home in a two-year period shall not be
considered a homeowner. Such "homeowner"- shall submit to the Building Official
on a form acceptable to the Building Official, that he/she shall be responsible
for all such work performed under the building permit. (Section 109. 1. 1)
The undersigned "homeowner" assumes responsibility for compliance with the Stat
Building Code -and other applicable codes, by-laws, rules and regulations.
The undersigned "homeowner" certifies that he/she understands the Town of
Barnstable Building Department minimum inspection procedures and requirements
and that he/she will comply with said procedures and requirements.
HOMEOWNER'S SIGNATURE l
APPROVAL OF BUILDING OFFICIAL
Note: Three family dwellings 35,000 cubic feet, or larger, will be required
to comply with State Building Code Section 127. 0, Construction Control.
THE CLASSIC POST & BEAM GARDEN SHED EVELAND CONSTRUCTION
209 Iyanough Road
Hyannis, MA 02601
(508) 778-5667
FRAME - ALL LUMBER TO BE FULL DIMENSIONAL PINE
2 X 6 FLOOR JOISTS, RAFTERS, COLLAR TIES. @ 24" O.C. -
4 X 4 CORNER POSTS
2 X 4 STUDS AND PURLINS
IX VARIOUS WIDTH DECK, ROOF BOARDS & SIDING
ALL VERTICAL SIDING TO HAVE 1/2" X 2" BATTONS @SEAMS
OTHER SPECS
SOLID CONCRETE BLOCK FOOTINGS (POURED WHERE REQUIRED)
ALUMINUM GABLE VENTS
ALUMINUM PLINTH POST FEET
ASPHALT ROOF SHINGLES, UNLESS OTHERWISE SPECIFIED
1 X 8 RAKE BOARDS; 1 X 6 FACIA; 6" TEE HINGES; LOCKING HASP
.ALL HEIGHT DIMENSIONS APPROXIMATE y r
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