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0007 PHEASANT WAY WEST
��'��1�s . .. � r � � . � �� . � . � ,_ ,�. _ o a�� �; - � � . .. . �. �• ��� ,, ,.. "< � , ,. .: c - -- - ,,.' :.' .. � ,. _ - 4 .. .. � � � .,. 4 - �, ;: ., ., C A. _ __ y 14 14"09:57a Tupper Co 15087785010 p.1 IrU RRE R CONSTRUCTION CO. LLC 79B MID-TECH DRIVE,WEST YARMOUTH, MA 02673 PHONE_ 508-778-0111 FAX: 5OB-778-5010 VVWW.TUPPERCO.COM D ate: Town of Barnstable Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 --a (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit application Jssued on �'�5(/ has been inspected by a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, Permit #: Address: - Richard Tupper License # CS-69058 i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map' Q Parcel p�C plication # Health Division Date Issued 3)2s)1fi Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Stree Address [iv Village l�le_ Owner ad Address Telephone l Permit Request �� N a J. Co 03 „Square feet: 1 st floor: existing proposed 2nd floor: existing proposed �'"� TotlRew _ :Zoning District Flood Plain Groundwater Overlay u ..Project Valuation s 3 Construction Type i N Cot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. .. Dwelling Type: Single Family 3--' Two Family ❑ Multi-Family (# units) Age of Existing Structure g g Historic House: ❑Yes ❑-No On Old King's Highway: ❑Yes ❑ No Basement Type: Chi u l ❑ 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: w ❑ Oil ❑ Electric ❑Other Central Air: ❑Yes Qlo 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 (BUILDER OR HOMEOWNER) Name G140 Telephone Number y l� �� '" 1/ Address77�74 C:�4 hr License # � '7e 7 Home Improvement Contractor# Email /f'1/fl Gl eV Mo Worker's Compensation #At ���r�/����uo'� ALL CONSTRUCTION DEBRIS RESU TING FROM T I PROJECT WILL BE TAKEN TO SIGNATURE DATE C FOR OFFICIAL USE ONLY APPLICATION# "DATE'ISSUED MAP/PARCEL NO. t ADDRESS VILLAGE OWNER DATE OF INSPECTION: i FOUNDATION j FRAME INSULATION FIREPLACE F ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DA tCLOSED OUT AS-,$OTION PLAN NO. 4 w The Commonwealth of Massachusetts Department of IndustrialAccidents r Office of Investigations - a a I Congress Street,Suite l00 Boston,AL4 02114-2017 - www massgov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):. Tupper Construction - Aadress.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) I.Q I am a e.mployer:with 4. ❑ I am a general contractor and[. 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 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:insurance.x ❑Building addition 9. required.] 5. ❑ We are a corporation and its 1.0..❑Electrical repairs or additions 3.❑.I am a homeowner doingall work officers have exercised their l LEI Plumbing repairs or,additions myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.] t c. 152, §](4),and we have no Insulation% employees. [No workers' 13.[ Other comp. insurance required.]. Weatherization pny:applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r Homeowners who submit ibis 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,the must provide their worker s'comp.policy number. I.am an employer that is providing workers compensation insurance for my employees..Below is the policy and job site" nformadon. Insurance Company Name:AEIC Policy,#or.Self ins. Lid.#..WCC5005593012007 Expiration Date: 10/3/14 . 7. Pheasant'Wa West Sob Site Address: Y City/State/Zip: Centerville MA .0 2 6 3 2 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 viola ie advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for ins!Lan±cover a verification. I do hereby.certify.under the pain a e Ides of perjury that the information provided above is true and correct.. Signature: Date: 3/18/14 Phone#: 5087780111 Official use only. Do not write in this area,to be completed by city or town official. City or.Town:. . t/Lt Perrni .cense#� .. . ... . . . , . . 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#:' L. �y PAMPAIEP n mass save. CONI MB PERMIT AUTHORIZATION FORM /1 I� /� /-3�:` �� v y ;owner of the property located at. (Owner's Name, printed) 7 e �a , �?- LAP ' >,� k�o U. /1 l% Qr�S r �t� Y �1 1l � � , (Property Street Address) (City/Town) hereby authorize the-Vass Save Home Energy Services Program assigned.Participating Contractor listed below to act on my behalf and obtain a building permit to perform]nsulation andlor weathenzation work on my property. Owner's 1 gnat 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; Y—A 17 di bib f Participating Contractor Date f Rev:12132011 ACOR4� CERTIFICATE OF LIABILITY INSURANCE TH1S CERTIFCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.�THISOI3 CERTIFICATE DOES NOT AFFlRAAgTIVE4 AFFIRMATIVELY OR AIIAEIVD,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE OELOYV. THIS CERTIFICATE Of INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSU POLICIES ING INSURER{gl,AUTHORITIES REPRESDIMATiVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTAN : If ilia Ceritt CM hotder is an ADDITIONAL INSURED„the pollCygeS)must 6e enQorsed. It SUBROGATION IS WAIVED,suDjticf to the terms and ler in lieu of die po1ICY,certaiemenri poitctes may require an Wtdoesernartt A statament on this cemfteta does not comes rights to.the . eeRlfsCdt9 holder In Ilea of such endorse I, PRODUC€R Southeastern Insurance Agency. Inc: 1°A"4E Ion Lome 439 State Rd. a am (SO8)99T-606I H,:(508�990-2T31 P.Q. Box 79399 A° N. Dartmouth, NA,02747 . . INSUREO ^INSU AFFORDINGCOrERAGE PtAfCS TapPer Construction Co LLC A: Arbe117a Protection Insurance tNsulzERe: AEIC 27 Roberta fOrive INSURERC: CNA Surety West Yarmouth. NW 02673 +NEURERD. COVERAGES. CERTIFICATE NUMBER.2023/I4/It uRERF: THIS TO CERTIFYTHATTHE PDLtCtES OF INSURAPICE LISTED SELOWHAVE BEEN ISSUED TO THE INSURED REVISION N��UF�MBER POLICY PERIOD PERIOQ. INDICATED. NOTUVITttSTANDmNGANY REOmJIREMEptT,TEtuuIOR CQNDMON OF ANY CONTRACT OR OTHER OQCUMENF►A1TH RESflTHE ECTTO WHICH CERTIFICATE MAY LIE ISSUED Ott MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 11AIT ECF TO ALL THE WHICH THIS. EXCLUSIONSAND CONOM,oNS OF.SUCH POLICIES.LINiiFS SI IOVrN MAY HAVE BEEN REDUCED BESCRI DESCRIBED HE t I TYPE OftNStwaNRE Im v N - POLICY µOUC w aP teat u alaerLtTr SS0000874 1110t2013 11/01/2014 Lam 1 i X 6OMWRCIALOfNE.RALLfAWUTY EACHOOCUwzEum 1 000 i ceUh>S ktkOE OCOIR s 100, A M@DExP(ftwwPw=) S- S Pc;RSONALBADVINIURY t 1 000 GRNLAQQW.UAYLf:IMITAWLIFS _ t NBRAIA6GRECuITfi- S a 000 0 aQucr dRoauCTs.crirm�ai�aca s 2�000 00 aVtamatmmLsraau�ITr S 24000027T10I1rAMg 1710K12014 +almvEoscresmdLla! 7 aNrTtj : . . s - tea a�eemtp g m ALLpwNeoay-T(ts 1 000 0 @OOtC,Ytl�tµRY(RerPCr�n} 'g A X SCHE®Slti tt AUT4S SMI6Y INJURY(Per ar iie S. X HMO AUTOS I(y'RCP£ftiY DAJMHf X. NOk.OvVNlet3AUTOS .. Ir�c S utrsR>AuauAs X gcctlR 4600OS836 11f01i2013 t9f01i20ta FACnoxuRr � g: A ems mlaa 1 Mot cMaLE AGGREGATE RETeMON 8 s 1'ON 00 „ - A � LOYt�S'(,��ttNzr rr �tGC5005s9301200 90/0312093 10f09t2014 X E .. g e to rvs �>( u Nia RICHARD TUPPER " . I k.UM,FOR we CO _. 161tn c to I" YCItAG �6,fA6F1A4CmmiRNT g e,L t MME.OA k1dRS6VB t ODQ� + H ti S 1 000 00 CL�IgeAss .POMoyUMIT s 1 ON 0 �CRIPTI�HQB(IFERI#RONStl�A1l4N$fVlft(l$I�S I�htEhACCR544t,A8glt4tndiRamirltsa`1re�duts,Uttmiaz:pMCtJCCQWiINj ; CERTIf-ie TE MO�I CANC@LIJs TtgN SHOUL4 ANY 9F THE%DOVE DES.CRmpeD POUC1E3 OR CANCELLED NEFORE THE EXPIRATION. PATE THERgOF,.NOTICE wILL .s6 DltLIVLR4=0:iN ACCORDANCE MTM THE POLICY PROVISIONS. �*FQP 1n'�OrmAti9n:PUr`pOses QRIy" Tupper CensGructioel;Co LLB. quTnaR<zsD�wisswrrAmlE- 27. R�rta Drive IV mrmouth, MA 82073 Lora LotTe AGORA fi{2IIfl>f109) The ACORD name and 1 o are 1A13&304g ROf�RD COR TlrJM A l f g r�orVed. og reglstereflt m4 t�of ACORA . ��r�titcf- ti fYi�itlt�tf:,fl�K: m"Sachusetts- 107 Department of Public S�:.Stwr tp Y Afi"NY 12m Board at Building ReQWations.and Standards tsm 274-1274 t.,Warn.ru+n�ui►�rti�..�r w License:CSr0 W58 TUMARDS TUPPjjR - . 79 S MW-TECH DR } WEST YARMOU'fN t ExpiiutOn - •t5f:RVEnESW FOR Di6"TiMAMEmullouwa Cwrurassionmr 12/34/2014' } r w/k 4;ft(NiR1.tl0if/1(fir i If(i 1Q�IGi or6rc of Consamer Affain 4 4 sluts d%%,#jg iaa� �"Peapte Helping Peogte Build a SaferWoriB�` �T� NOME UNpROVEMEHT CONTRACTORI. Expirstian: to inoividual R{CHARD TUPPER Richard Tupper. f . Tupper Construction RIChtARD (UPPER 2$R000ris wive 80ding Safety Profassionat UV .VdRMpUYW.MA 0261$. Member#:$15$119 Vaderwrairy :. e lWxp:4/30JZ094 ' y. OF P-ARNSTABi LE CONSTRUCTION CO. LLC 546A Higgins Crowell Rd,WEST YARMOUTH,MA C2673 PHONE: 508-778-0111 FAX: 508-778-5010 9 UWVW.TUPPERCO.COM Date: 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 # 90 [40. 1 9- Issued on 50 hasbeen inspected by a certified Building Performance Institute (BPI).inspector. All work performed meets or exceeds Federal and State requirements. Sincerely; Permit #:. ` Address: 61 L°GS Q. 1 G'Ua VV I Richard Tupper. I License # CS-69058 oF� r Town of Barnstable *Permit#t� d6 l Expires mo n r is ue date Regulatory Services Fee iARNSTASLE Thomas F. Geiler, Director b 9RES r ITBuilding Division Tom Perry, CBO, Building Commissioner SEP 1 1 2008 200 Main Street, Hyannis,MA 02601 TOWN ® B�R S�f B�, wwW.town.barnstabie.ma.us Office: 508-862-4038' Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY Not Valid without Red X-Press linprint Map/parcel NumberX� Property Address L 1 2JV` lit VY V if 1 esidential Value of Work �' Minirrium fee of$25.00 for work under$6000.00 Owner's Name &Address I CAContractor's Name ; Alt! _ Telephone..Number Home Improvement Contractor License# (if applicable) Wo an's Compensation Insurance Check one: a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name �' - Workman's Comp. Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) - e-roof(stripping old shingles) All construction debris will be taken to Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value (maximum..44) *Where required: issuance of this permit does not exempt compliance with,other town department regulations,i.e.Historic,Conservation,etc. ***iVote: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License, is required, SIGNATURE:, li'-- QAVRP ILESTOR-MS\building permit foms\EXPPESS.doc I I � � 51F&� _0V( 3 Oe 67�. David Sawyer Construction 318 Meiggs Backus Road Qom "/ Sandwich,MA 02563 508-539-1992 Date 0'� Proposal Submitted To Work Place: C'ea �,���tI h 2-- STRIP AND REMOVE OLD ROOF SHINGLES. --20: SUPPLY AND INSTALL: COLOR: f ,92[: e ( I PLC A. aA- Ku_k(_L Y t�WA_, e-1,C [Ij U'G cl L�_ Vtk dyt b C' ._U(a v �. , Vim- d- y �ti�► ; �Ln cA tr ?cu (-elm L Ac CLEAN&REMOVE ALL DEBRIS FROM WORK PLACE AFTER JOB IS COMPLETED. ALL DEBRIS TO LANDFILL. r �� TOTAL INVESTMENT FOR MATERIAL& LABOR:$ , All materials guaranteed to be as specified,and work to be performed in the accordance with the specifications submitted for the above work and completed in /i a substantial workmanhke.manner. Payments to be made as follows ru G��g /<1l 4 LI/( f( Any alteration or deviation from,tM work specifications involving extra costs�e executed only upon written order,and will become an extra charge over and above the estimate. All agreements contingent upon strikes,accidents or delays beyond our control.Please remove and/or secure any fragile household items. Not responsible for broken or damage household items. Five-Year LABOR WARRANTY/PLUS MANUFACTURES SHINGLE WARRANTY. We may yvithdraw this�ro�osal if not Accepted ccepted - within 30 days. Respectfully submitted f/C. ACCEPTANCE OF PRO OSAL The above prices, specifications and conditions are satisfactory and are hereby accepted..You are authorized to do the work as spe ified. Payments will be made as outlined above/ / Date* /_ l d :Signature ": -J' 4 , The Commomvealth of Massachusetts Department of Industrial Accidents Office cf rn-Vestigations 600 Washington'Street Boston, AL4 02111 . �- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Build ers/ContractorsTlectricians/Plumbers Applicant wormation r Ple e Print Le 'bl Dame (Business/Orgaiuzefion/Individual�: JJ,,, ,�,, n Address: City/State ne.# /Zip: Pho : 0 'r )� 2 Are you an employer? Check the appropriate boa: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a gene contractor and 1 6. ❑N"ew construction employees(trill and/or part-time).* have hired the shb-contractors ❑ 2. am a'solc proprietor or partner- listed on the attached sheet 7. Remodeling shy and have no employees These sub-contractors have g; ❑ Demolition employees and have workers' working for IDe in any capacity. $ 9. ❑ Building addition [No workers' cow).m�tT�nr_e COS'tnrLLr3IIGe' 10. "Electrical rc airs or additions rtquircd] S. ❑ We arc a corporation and its ❑ p officers have exercised their I LE]Plumbing repairs or additions 3.❑ I am a homeowner doing all wank myself: [No workers' comp. right 6f exemption per MGL 12 ❑Roof repairs t c. 152, §1(4), and we have no rrn incnee required.] employees. [No workers' 13 comp. bim rancc required-] `Any applicant that ehceSs box#1 roust also fill out the section below showing thcirworl=rs'eornputsation Policy information. t HmT=wnas who submit this affidr6t indicating they are doing sll work and then hire outside contractors must submit anew aEd-avit uidimting such. lCzyntraetars that ebmk this box rr x t attached an additions]shoot showing the name of the sub-contractors and state whether or not titoso entities have employers. If the sub-eontract o s lave employees,they trust providt their wvrT: ,camp.pobuy number. l aic an employer thud is providing workers'compensation insurarcce for my employees. Helow is the policy and job site information Ins-u ancc Company Name: n Policy#,"•or Sclf--ins.Lic. #: Expiration Datc: lob Site Address: City/State/Zip: Attach;,.copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to sccurc coverage as required under Section 25A of MGL c. 152 can lca:d to the imposition of rriniDial penalties of a. finc;rip to S 1,500.00 and/or one-year imprisonment, as we11 as civil penalties in.the form of a STOP WORK ORDER and a fir of up to $250.00 a day against the violator. Be advised that a copy of this statcmcrit may be forwarded to tha Office of Investi tions c)fthpfDEA for incrrranr_e cover& c cation. I dv hereby.certi under the gins- pen of perjury that the information provided above is true and correct Si c: C Datn: — Phonc# O fzciul use only. Do not write in this'area, tb be completed by city or Lawn official City or Town.: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Departroent 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other r + *vo Phone#'; ra Board of Building Regulat ons and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 134313 Type: DBA Expiration: 10/24/2009 Tr# 259907 DAVID SAWYER CONSTRUCTION DAVID SAWYER 318 MEIGGS BACKUS RD. SANDWICH, MA 02563 Update A dress and ret rn ca ark ason for change Address n Renewal Employment Lost Card 'S-CAI it 50M-05106-PC8490 Board of Building Regulat ons and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 134313 Type: DBA Expiration: 10/24/2009 Tr# 259907 DAVID SAWYER CONSTRUCTION DAVID SAWYER 318 MEIGGS BACKUS RD. SANDWICH, MA 02563 Update ddress and retur W ard.M k reason for change. Is-CA1 0 5OM-05/06-PC8490 E] Address Ej Renewal Employment Lost Card lias>achusctt• - I)Clt:trtritcnt fit' Public tial'ct� t3nartl nt' IDuiltlim Reutilatinns anti `tantlartls ' - -_i_i pF=:`!!5'�� License: CS SL 98859 Restricted to: RF,WS DAVID SAWYER 318 MEIGGS BACKUS ROAD SANDWICH, MA 02563 Expiration: 1/27/2011 ( inn,i••incr Tr--: 98859 V Restricted to: RF,WS IA- Masonry only . RF- Roof Covering WS-Windows and Siding SF- Solid Fuel Burning Devices DIVA-Demolition only Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass.Gov/DPS j TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel %�7 Application# Health Division Conservation Division Permit# Tax Collector Date Issued _ ) O Treasurer Application Fee " Planning Dept. Permit Fee �(o / 7o Date Definitive Plan Approved by Planning Board D s�I3al Historic-OKH Preservation/Hyannis Project Street Address ea.san E Village VI //e Owner T6,44 Address Telephone 7- 9 - 4<Z8 Z (C e_f/ Permit Request 3 S4P_aS0fJ roams JC I g m /ace. d P '"f9h gQ dirt: We ' T' 1 � a Aor?.. l���ii�� 5&6ec , Square feet: 1 st floor:existing proposed � 2nd floor:existing ��� proposed ^, Total new. Zoning District Flood Plain Groundwater OverlayCIO .-Project Valuation / a-d"0-- - ��_ Z _ Construction Type n 2 w Lot Size A?J/O Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. M 4)welling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes ,VNo On Old King's Highway: ❑Yes ;kNo Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) "/ / 4 Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new orV119 Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new Ad f4 First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other -A Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No WADetached garage:❑existing ❑new size Pool:O existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: .Zoning.Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes W/No If yes, site plan review# Current Use S/V?11 l 7° �:M ��i dy-ye �"7-7i Proposed Use BUILDER INFORMATION Name �� .j °g, Telephone Number -fig- 77 s " 28/S. Address ZY 1+Ai0 t 6 f/ License# O!c 91 Z- Home Improvement Contractor# /l8 7 90 Worker's Compensation# 4 Ef S77 b 9 ALL CONSTRU TION DEBRIS RESULTING ULTING FROM THIS PROJECT WILL BE TAKEN TO A Jay)-[r P t 5I t Se�liS%Pry ,cI V l two o r U— ��T IJ al p �adP� 'UCI - S SIGNATURE DATE 2 O - _ 1 FOR OFFICIAL USE ONLY PERMIT NO. r• DATEI ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION 65) 500oS FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH ]cc// FINAL FINAL BUILDING �l! 0 SKc.�T/67J DATE CLOSED OUT ' r' ASSOCIATION PLAN NO. The' Insurance Agency THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONn/u, of Cape Cod, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 480 Route 6A, p O Box 960 HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR East Sandwich MA 02537 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Phone: 508-888-2766 INSURED INSURERS AFFORDING COVERAGE INSURER A. ! NAIC$ AIG American International Co s Home Improvement Specialist INSURERS: Harle sville Worceste of Cape Cod Inc. INSURER C: r Ins Co P O Box 1224 Hyannis MA 02601 INSURER 0: CO RAG INSURER E: ------------- I 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR INSR TYPE OF INSURANCE POLICY NUMBER GENERAL LIABILITY DATE NM/D GATE MMlpp/YY LIMITS B I COMMERCIAL GENERAL LIABILITY 5,T4134 EACH OCCURRENCE $ 1000000 i CLAIMS MADE a OCCUR PREMISES(Ea o=rence) $ 10 0000 X Business Owners MEDEXP(Arty onaperson) $5000 ---- -0-S< QZ/-05- 02-/Q:6- -PERSONAE'S-ADVINJURv_ _ - -- s 1000000 GEN°L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2000 000 X POLICY JECT LOC PRODUCTS-COMP/OP AGG $2 Q Q O O Q O AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT I ALL OWNED AUTOS (Ea accident) $ Y HIRED AUTOS (Per person) $ NON-OWNED AUTOS BODILY INJURY (Per accident) 1 S t PROPERTY DAMAGE I I GARAGE UAMUTY (Per accident) $ ANY AUTO AUTO ONLY•EA ACCIDENT S f I OTHER THAN EA ACC $ EXCESSIUM13RELLA LIABILITY AUTO ONLY: AGG $ OCCUR ❑ CLAIMS MADE EACH OCCURRENCE $ ttF--- AGGREGATE $I DEDUCTIBLE RETENTION $ WORKERS COMPENSATION AND I $ A EMPLOYERS'LIABILITY I ANYPROPRIETOR/PARTNERIEXECUTNE WC6815769 X TORY LIMITS ER i Oyes.deonbeunREXCLUDED? 09/15/05 09/15/06 E.L.EACH ACCIOENT It yes,desuibe under $ 10 0 0 0 0 SPECIAL PROVISIONS below. E.L.DISEASE-EA EMPLOYE S 100000 OTHER EL DISEASE-POLICYLIMIT I$500000 ' Ii TIONS/VEHICLES/ PROPERTY 95000 DESCRIPTION OF OPERATIONS/LOCA DCCLUSK)NS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Home improvement and remodeling CERTIFICATE HOLDER CANCELLATION 4TO1 SHOUZ ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATEISSUING INSURER WILL ENDEAVOR TO MAIL 2 O �LCG� DAYS WRITTEN—`-� NOTIFlCATE HOLDER NAMED TO TH E LEFT,BIJT FAILURE TO 00 SO SHALL• IMPON OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR / 7 REPR ACORD 25(2001/08) - The Insurance A en r ©ACORD CORPORATION 1988 RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings $100.00 Residential Addition $ 50.00 jft Alterations/Renovations $ 50.00 Change of Contractor/Builder $ 25.00 FEE VALUE WORKSHEET NEW LIVING SPACE square feet x$96/sq.foot= x .0041= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE o?SR square feet x$64/sq.foot= I /a$ fZ x .0041= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq. ft.= x.0041= ACCESSORY STRUCTURE>120 sq.t't. >120 sf-500 sf $ 35,00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 s u+psi: >1500 sf-Same as new building permit: square feet x$96/sq.foot- x .0041= STAND ALONE PERMITS Open Porch x$30.00= (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= � (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee �Z Projcost Rev:063004 r °FINE►� Town of Barnstable Regulatory Services MAC I'E� Thomas F.Geiler,Director Building it fp Mpt u d g Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. / Type.of Work:_ f Qj�i¢i'�-i Estimated Cost Address of Work: f- he�4.d1� �/V �2Y1�-�I'yl Ile- Owner's Name: Tdm /'//U r Date of Application: 0 l2 f I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000 ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the o er: Date Contractor Name Registration No. OR Date Owner's Name Q:forms:homeaffidav /re Vfc»�r�na�luJe¢lt�• oP_ auacluaelt BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR _. -Number: CS 069152 ., V f Birthdate: 12/11/1962 1� Expires: 12/11/2006 Tr.no:. 6328.0 ■ Restricted: 00 JOHN M FALACCI PO BOX 1224/1441 RT 132 G of HYANNIS, MA 02601 Commissioner `,p. ✓IP. tr'O'JiPIJlGJlfGo2(.�i� C�✓'�(4:1:1fZCIfI:SE�.1 Board of Building Regulations and Standards I HOME IMPROVEMENT CONTRACTOR. - . _ Registration: 148770 __- -. . Expiration: 10/25/2007 Type: Private Corporation HOME IMPROVEMENT SPECIALIST OF CAPE COD JOHN FALACCI 25 IYANNOUGH RD HYANNIS,MA 02601 Administrator Pv°FINE Tp�y Town of Bainstable Regulatory Services 9 Mass, Thomas F.Geller,Director �'°Peo rA�m Building Division. Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.b arnstabl e.m a.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder • . .. I Om as Owner of the subject property hereby authorize I , S C . to act on my behalf, " in 0 matters relative to work authorized by this building permit application for. V � (Address of Job) Signature of Owner Date Print Name Q TORMS:OWNERPERMISSION . 2 N 4 q M ; .CJ /WA NIN dart low qF Lop Ti--.%AT The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.maugov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electridans/Plumbers Applicant Information Please Print Legibly Name (Business/organizatiowbaviduan; l I y"C 1 0-d Vem e t&I Y4,P-C-1a_1/TAr Address: o?3- yA-A/o GL6 M 4� 47 _Z . City/State/Zip: -14Y� f lS O-L6 0 1 Phone#: !�;V- '7•7-S- - 28 t S e you an employer? Check the-appropriate bog: Type of project(regaired): 1I am a employer with 4. ❑ I am a general contractor and I 6. employees (full and/or part time).* have hired the sub-contractors ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet t �� Remodeling o . . ship and have no employees '� These sub-contractors have 8'. htlon working for me in any capacity. E workers' comp.insurance, g 2PBt addition [No workers' comp.insurance S. ❑.We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.[No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.]t . employees. [No workers' 13,❑ C►ther comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation polieyinforrnation' `. t Homeowners who submit Phis affidavit indicating they are doing all work end then hire outside contractors must submit a new affidavit indicating such tCoatractors that check this box must attached an additional aheet showing the name ofthe subcontractors and their workers'comp,policy information. e ram an employer that lsproviding workers'compensation Insurance for.my employees Below Is thepolicy and liob sits information. Insurance Company Name; & h�GC v�y,Ge 10 C . Policy#or Self-inn.Lie.4: OcI/f `7!a 9 Bxp rat on D:az6: Job Site Address: u-S e o (mot/ City/State/Zip: &1711P_eV, �fe 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$1,300,.90 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 m2y4be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby ce u er A sin nd penalties of perjury that the information provided above is true and correc4 Si ature: Date: Phone#: \t Official use oMy. Do nag vrki in this area,to be completed by city of town offiicUL ' City or Town: P ermit/Li cease# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Cityrfown.Clerk 4.Electrical Inspector 5.Piurnbina Inspector 6. Other Contact Person: Phone#: I� Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute employee is defined as"...every person in The service of another under any contract of hire, _ an em P Y express or implied,.offal or written." _ 'du gmen ' association, oration or other legal entity, or any two r more An employer is defined as• an mdm ale p , hip: �P of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer 'r the . receiver or trustee of an individual,parmeisbip, association or other legal entity, employing employVbem ' ever the owner of a dwelling house having not more than three apar nients and who resides therein, or the o the dwelling house of another who employs persons to do maintenance,construction or repair work onling house e grounds Or building appurtenant thereto shall not because of such employment bemmployer." or on the gr � ate or local licensing en ld the issuance or MGL chapter 152, §ZSC(�also states that every•st g agency onwealth for ana business or to constract buildin siY renevyal of'a.license or permit to operate g•k „ a licant whohas not produced acceptable evidence of compliance with the inerage required.Fpical subdivisions shall Additionally,MGLchapter 152,§25 C(7)states Neither the commonwealth nor aenter into any contract for the performance ofpublic Work u�acceptable evidennce with the insurance requirements of this chapter have been presented to the tracting authority." Applicants Please a out the workers'compensation affidavit comple by checking a boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and p e numb s)along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liab P ' s(LLP)with no employees other than the members or partners,are not required to carry workers' compensa'on' ante. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure t gn and date the affidavit. The-affidavit should be returned to the city or town that the application for the permit li a is being requested, not the Deparf rent of Industrial Accidents. Should you have any questions re gar ' e law if you are required to obtain a workers' compensation policy,please call the Department at the numb listedbel Self-insured companies should enter their self-insurance license number on-the RE2&te line. City or Town Officials . Please be sure that the affidavit is complete and prin legibly: The Departm t has provided a space at the bottom. of the affidavit for you to fill out in the event the ce of Investigations has to tact you regarding the applicant. - Please be sure to fill in the permit/license numb hick willbe used as a refer a member. Iu addition;an applicant that must submit multiple permiAicense appli ions m any given year,need onl bmit one affidavit indicating current policy information(if necessary)and under" ob.Site Address"the applicant ahoul, write"all locations in • • (city or town)."A copy of the affidavit that has be officially stamped or marked by the ci or town may be provided to the applicant as proof that.a valid affidavit is file for fature permits or licenses. A n affidavit must be filled out each year.Where a&me owner or citizen is raining a license or permit not related to business or commercial venture (i.e. a dog license or permit to bum le es etc.)said person is NOT required to compl a this affidavit The Office of Investigations wool a to thank you m advance for your cooperation d should you have any questions, please do not hesitate to give us all. The Department's address,tel one and fax number: The Commonwealth of—MuSaCh-usetts Department of Industrial Accidents Office d lnytsoga4m 600 Washington Street Boston, MA 02111 Tel. #11 617-727-49 00 ext 406 or 1-10177-MASSAFE Far.; 617-72.7-7749 Revised 5-26-05 v,Tww.inas5.aov/dia i I I Existing house I I \\ I I / I I t , 14'[0- I _ I I I O X I' n l vOi Ch I / l lD --- - - - -- 14-0" Floor Plan 1/4" = 1'-01.1 ' Home Improvement Specialists • Tom&Beverly Murray Date:8/25/2006 25 Iyannough Road 7 Pheasant Way Hyannis,Ma.026oi Page: i Centerville,MA. 5o8-775-2815 , . i Houu lull basement \ ,. \\\ Db/2xJOPT join i2x1OPTjoists @ 16'o.c. ' A 2-2x8PTptt Inch 12' a dla.cmCmIc Bona-tube 9 pars to 48'below pead Oral Ste. 5'B" 5=8• Dbl2xI0Pr box Floor Frame 1/411 = 1 1_011 1 Home Improvement Specialists n Date:8 2 2006 Tom&Beverly Murray � 25 Iyannough Road Y Y • Hyannis,Ma:o26oi 7 Pheasant Way „ 508-775=2815 Centerville MA. Page 2 r � 0 C N M N r \ N R W bjD ce Tempered single - glass - panels m - Fo c .c i~a Tempered N single glass a panels o $ 0 o L Ei cz O O U' N f _ �•�1 wry co O N x . x 2x10 Rafters @ 16" g o.c. w/ 1/2" CDX Ply sheathing CO • A 2 - 13/4x14LVL Hip beam Roof Frame � V1 cis 2x10 Rafters @ 16" o.c. w/ 1/2" CDX Ply sheathing TTTT_F ii I LFLF" xi N U O O C Cross Section cl 14'0 UD 0 N x I I , AA it 27 f I l .0 J qF i I GE,07 /EO ILO? f�L4�c/ I T/-,,47- 7-/-/2--- LaG47-/OA/ �v1J]DgT1MJ 6ENTF2M Wiv yE,eEO�C/COyI.aL YS /,r//Ty it/Z SETB.4 CK .�EQU/.C�/t'/E�/TS O� Tf-��' 7`OWii/�F ...F,.C.�� .. �E��,eE�/�•E- 0 C.4 T,ELD jam//T////✓ o BA XT,E.CPE B-QSE"o Get/,Q�{/ _ � i2EG/STE-2E1� L.4it/� SU.�l�6 O,�,rs'ETS Syolt/,�/Sf•/DUL.a �STE.21//.G:C�a �fQSS. . -/l/�C/� S 1 T Assessor's office(1st Floor): �f� Assessor's map and lot n m /� C EM MUST B o�INC ro Conservation ��$L� r� e� Board of Health(3rd floor): 5 Sewage Permit number DENVIRONMENTAL CODE AND { "D` • Engineering Department 3rd floor): House number P ( ) q . J� TOWN REGULATIONS e•'�o e►r Definitive Plan Approved by Planning Board 4- APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1,00-2:00 P. .on y voFA&u,SjW&i TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO �. TYPE OF CONSTRUCTION _ L/� GNU�l ✓ZO✓Yd°�, / 19---�_ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: 01 Location Proposed Use Zoning District—A C Fire District Name of Owner✓& G &e62 �y�d4/�' Address C A yr •� Name of Builder Address Name of Architect Address Number of Rooms Foundation 7 �Jr�� Exterior ? Roofing dE-1�6a,& Floors G/ if'� ` Interior Heating � Ll de 6 Plumbing Fireplace L �� � / �` Y` ��%� Approximate Cost Area ��15 Diagram of Lot and Building with Dimensions Fee /O ±S 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 Construction Supervisor's License C-)V5 6 Vs— BAYSIDE BUILDING CO. , INC. No 35900 Permit For One Story Single Family. DweYling Location -'L�o't"�# P:h:easart='inlay_: '. Centerville -: � �r �� _ � �; r ' i. _ .• � ,�'`,:' - Owner 1 Bays'ide Building Co. ,I Inc. Type of Construction .,-Frame �" �` ; �' E- Plof Lot Permit Grant cl May 251 19 9 3 j ' , ' !i ! Ck Date of;Inspection 19 , Dat le omp A19' � /�jf/SvL' �q�J? � i �t t _ � � _ _ k' v 4 '.,z .• 4 cr t., -,2• ti� F t I � a � i t Q*TMf>, TOWN OF BARNSTABLE ` 35900 Permit No. . BUILDING DEPARTMENT I ""'r ! TOWN OFFICE BUILDING Cash YL �� 6TV• X �ovT� HYANNIS.MASS.02601 Bond CERTIFICATE OF USE AND OCCUPANCY Issued to BAYSIDE BUILDING COMPANY, INC. Address Lot #1 7 Pheasant Way, Centerville USE GROUP FIRE GRADING OCCUPANCY LOAD 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 AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. { September 21 19 . ..... ................. ............ Building Inspector THE FOLLOWING IS/ARE THE BEST IMAGES FROM POOR QUALITY ORIGINAL (S) A �CM LI DATA 't 7 i . >s S � w , r � Y T. . 1. `9 Y N►, Ixt `{ gl ! N t w r tr 4 t \ i. , Ya ;f a`, a R 4>Rrla A�.Kk Ii, t ti' z, -K, ,. r ' S e \ l 1 v •Jti �( M`S 1��{,r aYya,i )1 .u c 7 };' a gyp/79�,.;g`� r i`ap+��,.., y' '`! r.r.:. J' t 1 7 i vRx 5 .vw. tt jD Ql �a o, `` :t A' .: , lk. e a .6 � +y J' ft^s a�, .[A- A.' ar'••!' • , -. .F a..".J,• 1 - rrt. a 9. \ W L ; l '�i al ti' { I�},. r°<. � t• T ! Ij,if•a y' f�a� atiN2),�,,��a�r0�'�• \ .'�. �,, ! R e`Y 1tt! ,, } ro .. ♦"+ t i3Y 3 Wl •a r. $ / �.3 .1::`�, \J-. -4 a v t xtti.ya`++ Jt,R1ti 4:1.�" a�,,� ,' i. ;. J4 . ., , ! 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