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HomeMy WebLinkAbout0224 PATRIOT WAY .� r. i �. a }u � it e - � ,. .. �. �. r i o � _ y 4 o W TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map _ Parcel 620-3 Application# Health Division Date Issued Conservation Division Application.Fee Planning.Dept. Permit Fee Date Definitive Plan Approved by Planning Board IZZVi3 Historic - OKH _ Preservation / Hyannis. . Project Street Address Village e ./��I/e, Owner ��, ��/ �i Yj'1 JG � Address-,� 610el r r/ r�/e. Telephone �oo a 7 � 16-7 Permit Request &( ! , tAV-17 le/ zat-A!w 1/4 w Square feet: 1 st floor: existing/S� proposed 2nd floor: existing _proposed;; Total newer+ Zoning District Flood Plain Groundwater Overlay Project Valuation 6136 Construction Type Lot Size 5 Grandfathered: ❑Yes ❑ No If yes, attach supporting k6,curmentation. Dwelling Type: Single Family Q--'p Two Family ❑ Multi-Family (# units) Age of Existing Structure , f Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑-FGII ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) 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 Count Heat Type and Fuel: ❑ Gas O'bil ❑ Electric ❑ Other Central Air: ❑Yes R No Fireplaces: Existing/New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION r (BUILDER OR HOMEOWNER) Name Telephone Number) 060— 728'a11 Address -NB A 4 �(�Gl ��. License # eLf Home Improvement Contractor# Worker's Compensation ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO i SIGNATURE DATE �//e113 FOR OFFICIAL USE ONLY _ tY a APPLICATION# DATE ISSUED �t MAP/PARCEL NO. F ADDRESS VILLAGE OWNER �4 4 . DATE OF INSPECTION: i l 'i Y FRAME - - -- - - `- INSULATION;' FIREPLACE ELECTRICAL: ROUGH FINAL r PLUMBING: ROUGH FINAL - � GAS: ROUGH FINAL I FINAL BUILDING, b. 'f DATE CLOSED OUT ASSOCIATION PLAN NO. TheEommonwealth of Massachusetts'. i Department of Industrial Accidents ro Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance.Affidavit.- Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LepibIy Name (Business/Organization/Individual)' TUpper COI1StrUCtl011 CO. Inc. Address: 79B Mid Tech Drive City/State/Zip:West Yarmouth, MA,026173 Phone#:(508)778-0111 Are you an employer?Check the appropriate-box: Type of project(required); 1.KI I am a employer with 4. ❑ Lain a general contractor and I 6 New constructions 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._ ❑Remodeling' shipand have employees These sub-contractors.have 8.. ❑Demolition working for me in any capacity.. employees and have workers' coin insurance. 9. ❑ Building addition [No workers' 'comp. insurance P 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 1. E Plumbing repairs;or.additions. myself. [No workers' comp right of exemption per MGL insurance required.] c. i 52, §1(4),and we have:no 12..R Roofrepaiis employees. [No workers' 13.❑Other comp. insurance required.] *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 anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of.the sub-contractors and'state whether of not those entities'have employees. If the sub-contractors have employees,they must provide their workers'comp.,:policynumber_, I amp an employer that is providing workers'compensation insurance foz n:y employees: Below is the policy and job site information Insurance Company Name; AEIG _ Policy:#or Self ins. Lic.#: WCC 5005593012007 Expiration Date: 10/3/14 Job Site Address ul� City/State/Zip1w Attach a copy of the workers' compensatio olcydeciaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A.of MGL c: 1.52 can.lead to the:imposition of criminal penalties of a fine up to$1.,SOO.00 and/or one-year:imprisonxnent; as.well as.ci.v l 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 forwarded.to the Office of Investigations of the DIA for insurance coverage verification. I do hereby ce u r�he pains.and penalties of perjury that the information provided above is true and:correct. Sianature: at [ /� :Phone#: 508-778-0111 Official use only. Do notwrite in this area,to be.completed by city or town official. City Or Town: Permit/License Issuing Authority(circle?one): - L..Board of Health 2..Building.Department 3.Ciity/Town Clerk 4.Electrical Inspector 5.Plumbing:Inspector 6. t O her Contact Persons Phone#: ACORD.. CERTIFICATE OF LIABILITY INSURANCE UAT 10/31/2013) 31/2013 , THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIF=ATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Lora Lowe Southeastern Insurance Agency, Inc. A N : (508)997-6061 FAX (508)990-2731 A!C No 439 State Rd. E-MAIL ADDRESS: P.O. BOX 79398 PRODUCER GUSTO ER ID#: N. Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURERA: Arbella Protection Insurance Tupper Construction Co LLC INSURERB: AEIC INSURERC: CNA Surety 27 Roberta Drive INSURERD: West Yarmouth, MA 02673 INSURERE: 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 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. ILTR TYPE OF INSURANCE ANSft SWVD POLICY NUMBER POLICY EFF POLICY EXP - LIMITS MMIDD MMIDD GENERAL LIABILITY 8500008743 11101/2013 11/01/2014 EACH OCCURRENCE $ 1,000,00( X COMMERCIAL GENERAL LIABILITY DAMA R NT S 10O 00 PREMISES Ea occurrence � CLAIMS-MADE [X]OCCUR MED EXP(Any one person) S S,00( A PERSONAL&ADV INJURY $ 1,000,00( GENERAL AGGREGATE $ 2,000,00( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,000 POLICY IECT PRO LOC $ PRO- AUTOMOBILE LIABILITY 56662400002 12/01/2012 12/01/2013 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,000 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) S A X SCHEDULED AUTOS PROPERTY DAMAGE X HIREDAUTOS (Per accident) S INC X NON-OWNED AUTOS ` $ UMBRELLA LIAB X OCCUR 460005936 11/01/2013 11/0112014 EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ RETENTION $ $ A DRKERS EMPLOYERV COMPENSATION YIN WCC500559301200 10/03/2013 10/03/2014 X ORY WCS TATU X OTH- ER B ANY FICER/RI BERPEXCLUD tE ECUTIVE� NIA RICHARD TUPPER I E.L EACH ACCIDENT $ 1,000,00 (Mandatory In NH) I LUDED FOR WC COVERAGE E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more 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 Only" Tupper Construction Co LLC AUTHORIZED REPRESENTATIVE 27 Roberta Drive W Yarmouth, MA 02673 Lora Lowe ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD BUILU1Nta PEF K)KMANLE 1hl-b ITUTE., INC Massachusetts -Department of Public Safety: 107 Hetmes Road,Suite 110: Board of Building Regulationsand Standards E Ma t8,NY 12020. 1 (877)274-1274. � Cnn�rructi��rrSuP�r-v�e,ir License: CS-069058 RICHARD S TUPI?ER 79.B MID-TECH DR s I WEST YARMOLVI'H r 02 73 1 Rkhard Tu pIf f peer BPI W 5040940 4. f CERTI IEDPROFESSIONAL :. `i<•6«� JJ � '` Ex iratiI rr (SEE REVERSE SIDE FN DENWIDWS AND EXPIRAt0N D*fEs►. Commiss r 12/31/2014 Office of Consumir Affairs dk B 4iaeas Regulation I .> + ! � �#:ria4#elfWp e* HOME IMPROVEMENT Wme, c �`� � Registratio 5GO R Type CONTRACTOR ,. fxpiratl 9%20 Individual - Psa , RI RDTUPP ►j -teasez } pr'� 4 U t�E1P ;M t RICHARD f OftS�t'!d all ` " 29 Roberta Drlve y W.YARMOUTH. 026,13.E U dersecretary. , ��d1t1�3tifetjr l�rotelsbi�ii."�•'` � � ,,,. a � a - r OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) z�3 2 (Propefty Address) ' hereby authorize 7v—PA✓L CwStR.tee rI pA7 CO. C (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner' Signature (0000 Date r YUPPER CONSTRUCTION CO.LJLc 79B MID-TECH DRIVE,WEST YARMOUTH,MA 02673 PHONE: 508-778-0 1 11 FAX: 508-778-5010 WWW.TUPPERCO-COM Date: 4L f 1 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 applicationFri 33 issued on has been inspected.by a certified Building Performance Institute (BPI) inspector.( All work performed meets or exceeds Federal and State requirements. in er Richard Tupper. License # CS-69058 „o,• },,� TOWN OF BARNSTABLE Permit No. .920 Inspector cash $960.00 7 �YL OCCUPANCY PERMIT Bond ---------------------- "No building nor structure shall be erected, and no land, building or structure shall be used for a new, different, changed, or enlarged use without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has been issued by the Building Inspector.” Issued to Suffolk Realty Address Box 308, Centerville, MA 02632 Wiring Inspector l/ ��,.�,.,/ Inspection date Plumbing Inspector Inspection date Gas Inspector Inspection date Engineering Department f,,� ,�,,,y/� , i Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. ......................................:.............. 19......__ ............................................................................................................» Building Inspector Asse sor's map and lot number SEPTIC SYSTEM MUST BE �+ c:: � (�'� INSTALLED IN' COMPLIANCE Sewage"Oermit number ..... .................................................. WITH ARTICLE 11 STATE SANITARY CODE AND TOM HETO�f r. TOWN OF . -BARNST _ BAS$STADLE; . UUt DING.F INSPECTOR AlE p NpY h•. i c�i t"• APPLICATION FOR PERMIT TO ......aillg7;:e...f.cliT1ilY...1 QSIdeXlt"Ll.. :.................................................. TYPE OF CONSTRUCTION ..............WQ.od... z. .e.............................................. ..................-........................... :. aro .......................... ..................19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location Lot...#..2 Patriots Way.............Centerville.................:.................................................................. Proposed Use .sin.le..family..residental............................................................................................................ ...... ..........l Zoning District .... ....................................................Fire District ....Cent OSt Name of Owner Suffolk Realty...............................„Address ...1P.,....Q.t...BoX„ 08,,,Centerville ........ ........... Nameof Builder ...same......................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ....Seven.................................................Foundation ..........8.-L.Q.•.......................................................... Exterior ...Cedax...5.11ilagl.eS............................................Roofing ...a.,90 al.t...5.Y1.].I7.giI-5....................................... Floors ...PQWl.ed..(7.RXIQ.r.Qte...........................................Interior ...pla star...walls............................................... Heatingf.hW...by....0 . 1......................................................Plumbing ......pvc.................................................................... Fireplace ...aZld...ba.OQX.........................................Approximate Cost .....$3.5.1.0Q............................................ Definitive Plan Approved by Planning Board ________________________________19________. Area �.89�.S..f.................... Diagram of Lot and Building with Dimensions Fee .......� ..7— ........... ....... SUBJECT TO APPROVAL OF BOARD OF HEALTH l�(Q���a' a a� C6 �}. 4) L ' off I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Nam l.. .C.t4-TV .... U .. ^ ' ^ , . . . , . / . .` ` ^ . ' ' � . . . t � ' . . . ` . ` ' / - ' . . ^ , Suffolk Realty 20259 one story single'family dwelling Location 224 Patriots Way Centerville PERMIT REFUSED � lg ^� .—.....~.....---..�..-----./ . . —'~—^—'----�'------~---``11 ^ | .—.,^..^...~.......—....~^'---.. —^—.—^—.---.----.--.---.... ° ' ^ Approved ' ^ . ^ ' � . ................................................ lg � . ------'—~-----~^^^^—^^^---^—'' ' ----------.---.-----...~---- . ` � | I Ail '57- e 4l L©i9 SFA�ivp • ,.moo � f c�0�� . i 9.5cA`,S /3'` ! � t �r/�}T�� �'"Ne'o C/.tJ''",�i�'�,D p E 2 T O t,/IV R EC0)e DS -y6 ��.. 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