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HomeMy WebLinkAbout0057 WATERSIDE DRIVE 6,7L-40 «(e �• ? ,w a6/cD o6* o Of Town of Barnstable *Permit# °� Regulatory Service's FX-PR r� r s 1 ESS PER Tmas F Geile.r;Director JAN ;6 2012 . Building Division JAN - 6 2012 Tom Perry,CBO,,Building Commissioner< 200 Main Street,Hyannis, MA 02601 TOWN'OF BP.RNSTABLE- Office: 508 �WM80F BARNSTABLffww town:barnstable.ma us Fax: 508-790-6230. , EXPRESS PERMIT APPLICATION - �RESIDENTTAL ONLY Not Valid wit&oud.Red X-Press-lmprint Map/parcel Number - �' � • NF. ti F Property Address Residential Value of Work ® � Minimum fee of$35.00 for work under$6000.00 Owner's-Name&Addresses �� R Contractor's Name Telephone Number .iome Improvement Contractor License#(if applicable)_�, 24 { ,. �onstru • coon Supervisor's License#(if applicable) Workman's Compensation Insurance ` Check one: ❑ I am a sole proprietor ❑ I am the Homeowner 19 I have Worker's Compensation surance tsurarice Company Name: 'orkman's Camp. Policy# 0® 7 �<'9 opy of Insurance Compliance.Certificate must accompany each permit. ; .rmit Request(check box) ❑ Re-roof(stripping.old shingles) All construction debris will betaken to '. ❑Re-roof(not stripping. Going-over existing layers of roof) }. ❑ Re-side. :< " #of doors .r Replacement Windows/doors/sliders. U-Value J (maximum.44)#ofwindo _ .*Where re u' suance o permit oes not e=pt compliance with other town department n guiations,i.c.Historic,Conservation,etc, Prope Own must sign Property Owner Letter of Permission. A c y of the ome Improvement Contractors License& Construction Supervisors License is r uired. NATURE: The Commonwealth of Massachusetts . Department of Industrial Accidents W Office of Investigations d 600 Washington Street Boston,MA 02111 ,�•�'W. www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le gib Name(Business/Organization/Individual): Address: City/State/Zip: L/"3, Y�¢�O­t-' +Phone.#: Z< (o Are you an employer? Check the appropriate box: Type of project(required):.' 1 I am a employer with 4. EJ I am a generalcontractorand I employees(full and/or part-time).*_-- have hired the sub-contractors 6. New constriction 2.❑ I am a sole proprietor or partner- listed on the:attached sheet. T.Remodeling ship and have no employees These sub-contractors have g, Demolition workingfor me in an capacity. employees and have workers' Y P tY 9, ❑Building addition [No workers'comp.insurance comp.insurance.# required.] 5. 0 We are a corporation and its 10.0 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 12.0 Roof repairs insurance required.]t c. 152, §1(4),and we haire no' 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. $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 r- 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. Below is the policy and job site J1 .; information. a Insurance Company Name: Polic #or Self-ins.Lic.#: �� y 2�� Expiration Date: ' r Job Site Address: / : (/C/ ��' City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number.and expiration date). Failure.to secure uired under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to 00.00 d/or one-I imprisonment;`as well as civil penalties in the form of a STOP WORK.ORDER and a fine of up 2 . a day ainst thlator. Be advised that a copy of this statement may be forwarded to the Office of Inv • ations of the for insce coverage verification. I hereby cent' under the pai sand penalties of perjury that the information provided abo a is trfre and correct. SiNaaftir, e: Date: 14 Z Phone Official use only. Do not write in this area,to be completed by city or town officiat City or Town: Permit/License# Issuing Authority(circle one): A.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: C . Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute,an employee is defined as"...every person.inthe service of another under any contract of hire, express or implied, oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,.and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced.acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for.the performance of public work until acceptable evidence of compliance withthe insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to yourr situation and,if necessary,supply sub-contcactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all-locations in (city.or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related fo any business or commercial venture (i.e. a dog license or permit to bum leaves,etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any.questions, please do not hesitate to give us a call. The Department's address,telephone.and,fax number.. The Commonwealth of Massachusetts Department of lndustrial Accidents Office of Investigatio>ats 600 Wasliingtoh Street Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-977-MASSAFE Revised 11-22-06 Fax#617-727-7749 www.mass..gov/dia I TUOPER CONSTRUCTION CO_t t r 79B Mid-Tech Drive West Yarmouth, MA 02673 Phone 508-778-0111 Fax 508-778-5010 Registration#121845 License#069058 Date: 11/08/11 Attn:Building Department I hereby authorize Tupper Construction Co.,LLC to pull the permits necessary to complete the project described on the attached permit application form. Thank.you, Owners' Signatures Print Owners'Names: t(,I K cu(� Street Address: aZ(�3 z ACORD,M CERTIFICATE OF LIABILITY INSURANCE UATE(MM/DD/YYYY) 11/09/2011 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 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: . Karen Bernier Southeastern Insurance Agency, Inc. HONK Ext. (508)997-6061 Fax (508)990-2731 439 State Rd. E-MAIL A/C No: P.O. BOX 79398 PRODUCER CUSTOMER ID#: N. Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER Ai Arbella Protection Insurance Tupper Construction Co LLC INSURERS: AEIC INSURERC: CNA Surety 27 Roberta Drive INSURERD: West Yarmouth, MA '02673 INsuRER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 11/12 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS GENERAL LIABILITY 850000874311/01/2011 11/01/2012 EACH OCCURRENCE $ 1,000,0( X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISE Ea occurrence $ 100,0( CLAIMS-MADE FK OCCUR MED EXP(Any one person) $ S,0( A PERSONAL&ADV INJURY $ 1',000,O( GENERAL AGGREGATE $ 2,000,0( GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP%OP AGG $.. 2 OOO, 0( POLICY PRO- ! ' JECT LOC $ AUTOMOBILE LIABILITY S6662400002 12/01/2011 12/01/2012• COMBINED SINGLE LIMIT ANY AUTO (Ea accldenU.. . _...._ .$ BODILY INJURY(Per person) $ ALL OWNED AUTOS A X SCHEDULED AUTOS BODILY INJURY(Per accident) $ PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) . IN( X NON-OWNED AUTOS $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DEDUCTIBLE J $ RETENTION $ $ WORKEP.SCOMPENSATION WCCSOOSS9.3012007 10/03/2011 1O/03/2012 X' WCSTA U- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE RICHARD TUPPER I E.L.EACH ACCIDENT $ SOO,OO B OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) INC LUDED FOR WC COVERAG E.L.DISEASE-EA EMPLOYEE $ SOQ QO if yes,describe under r DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ SOO;00 C and for theft of money & r 71068813 02/26/2011 02/28/2012 Limit of $10,000 . roperty. . DESCRIPTION OF OPERATIONS/LOCATIONS/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. AUTHORIZED REPRESENTATIVE "F r Information Only" I Karen Ber ©1988-20 ACORD CORPORATION. AI rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of A ORD µ Massachusetts- Departnient of Public Safety Board of_Buildin,_, Re�_uiations and Standards _ `I Construction Supervisor License N� License: CS 69058 RICHARD S TUPPER 79 B MID-TECH DR WEST YARMOUTH,.MA 02673 Expiration: 1 2/31 1201 2 III TrN: 8340 (ommissinner M - I Office`61�o11ts0 `Sj1� � License or registration valid for individu[use only `I before the expiration date. If found return to HOME IMPROVEMENT CONTRACTOR II Registration: 121845 Type: Office of Consumer Affairs and Business Regulation Expiration: 6/19/2012 Individual 10 Par l a 5170 ;R 'B-ost ,MA 02116 ' D TUPPER ! RICHARD TUPPER '� ! << 29 Roberta Drive 21 W.YARMOUTH,MA.02643 Undersecretary Not valid witho signature i f0 J! °!fin � ! I TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map o� rcel'" / Application # Health Division Date Issued Conservation Di '''on Application Fee Planning Dept. Permit Fee ` Date Definitive Plan Approved by Planning Board Historic - OKH Pre servation/Hyannis Project Street Address .:�'7 A✓ -�,� si �R , Village /9• O Owner,�jv�/� /hs�l�iE*ELLY L'.4iPs? t- ZW 6" ddress �Z wi9 ,2s'in .�R Telephone Permit Re ue Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 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: 1;9 Full ❑ Crawl Nr,,30 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: 4 Gas ❑ Oil ❑ Electric ❑ Other Central Air: AYes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ANo Detached garage: ❑existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: ZZO , Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use 5;E` Proposed Use 5/5- w APPLICANT INFORMATION _ (BUILDER OR HOMEOWNER) Name L.LC Telephone Number e. 2 ,P 6 -Address ` 9.9 M CI-Z-C-1-i License # C S' ,, 9OS e \/ ,, O UT1f, M)19 QQg 73 Home Improvement Contractor# Worker's Compensation #,h/ec 3D®S: 2_007 'T ALL CO T CT ND B RES LTING FROM THIS cPROJECT WILL BETAKEN TO �. SIGNATURE A DATE FOR OFFICIAL USE ONLY " APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME `l o r INSULATION CAD lhi r b FIREPLACE ELECTRICAL: ROUGH FINAL es _ PLUMBING: ROUGH FINAL GAS: ROUGH. FINAL FINAL BUILDING .:2 DATE CLOSED OUT ASSOCIATION PLAN NO. .. • is The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street t Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /I Please Print Legibly Name (Business/Organization/Individual): 71'-IDp&2 j!!f s26nz�r7-ion� YJ. LL Address: f>. 173 City/State/Zip: Phone M &Z5f'-aFO-/Z S;1'0 Are you an employer? Check the appropriate box: Type of project(required): 1.L?7 1 am a employer with 4. ❑ I am a general contractor and I 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 workingfor me in an capacity. employees and have workers' y p y• 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.0 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 insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#I 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. tContractors 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. Below is the policy and job site information. Insurance Company Name: -C Policy#or Self-ins. Lic.#: WC6 Expiration Date: /Q / Job Site Address:J-7 /r✓A7 iPS/L) City/State/Zip43&!2�V A-- Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure cov as ired under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,50 0 and/or one-ye r imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up t , 50 0 a aga' he olator. Be advised that a copy of this statement may be forwarded to the Office of Inves igatio s of th I for in r ce coverage verification. I do h eby r rfy under p in and penalties of perjury that the information provided abo a is ue and correct. Si ature: Date: 0 Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: f '� �lns.achusrtt. - Departtucttt of Puhlic �atctN Board of Builtlim� Rc�uJatinn. rnd Stand:u d. Construction Supervisor -License License: CS 69058 Restricted to: 00 RICHARD S TUPPER 79 B MID-TECH DR WEST YARMOUTH, MA 02673 Expiration: 12/31/2010 ('uuw ix�i nw' Tr,: 7545 ,per ✓lie TOamirrco�ru.�rea.�li o�✓l/�avacl �\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 121845 Expiration: 6/19/2010 Tr# 268787 Type: Individual -� RICHARD'TUPPER RICHAR ER 29 Reeerta Drive W:YARMOUTH,MA 613 Administrator i' I DATE(MMIDD/YYYY) ACORN.' CERTIFICATE OF LIABILITY INSURANCE 11/24/2009 PRODUCER (508)997-6061 FAX (508)990-2731 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION- Southeastern Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 439 State Rd. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 79398 N. Dartmouth, MA 02747 INSURERS AFFORDING COVERAGE NAIC# INSURED Tupper Construction Co LLC INSURERA: Arbella Protection Insurance INSURER B: AEIC 27 Roberta Drive INSURER C: - West Yarmouth, MA 02673 INSURERD: INSURER E: - COVERAGES 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. INSR DD' TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR NSR DATE MM/DD/YYYY DATE MMIDD/YYYY LIMITS _ GENERAL LIABILITY 8S00008743 11/01/2009 11/01/2010 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 100,000 _ CLAIMS MADE FR]OCCUR MED EXP(Any one person) $ - 5,000 A PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY 7 PRO LOC JECT AUTOMOBILE LIABILITY 56662400002 12/01/2009 12/01/2010 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) A X HIREDAUTOS - - - BODILY INJURY $ X NON-OWNEDAUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) INCL. GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE- $ _ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WCC5005593012007 10/03/2009 10/03/2010 X AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y RICHARD TUPPER IS ' E.L.EACH ACCIDENT $ 500,000 B OFFICER/MEMBER EXCLUDED? Lip` (Mandatory in NH) LUDED FOR WC COVERAGE E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under ° SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. For Informational Purposes Only. AUTHORIZED REPRESENTATIVE 11(rista Hartford ACORD 25(2009101) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD i TU PPE R CONSTRUCTION CO.LLc 79B Mid-Tech Drive West Yarmouth, MA 02673 Phone 508-778-0111 Fax 508-778-5010 Registration#121845 License#069058 Date: November 25,2009 Town of Barnstable Attn: Building Department I hereby authorize Tupper Construction Co.,LLC to pull the permits necessary to complete the project described on the attached permit application form. Thank you, L_ Owners' Signatures Print Owners'Names: Ian Carr&Anne Marie Kelly Carr Street Address: 57 Waterside Dr.,Centerville,MA 02632 f t , if I , • i ` f , i � 1 jll 1 r , 441 t_ 1 1 { , I f t • i i i I , ) , tom—' t I 1 f i r pp y f I i i l I i , r t t 1 1 I , a r ' f r t — ' ' a --------------------------------$L6'Lx3�6-------------------------}4r"x-3�Y-------------? 6 x3=9-------------------'.4---------------- � 4• v• o v' 4• v• v• d v• t 1 4 1 -C . ------ • ° 1 1 1 V 1 p 1 l� 1 1 1 1 1 D•. 1 � 1 1 t 1 0 1 1 1 4 1 1 1 774 Proposed Basement = a--- ---------- I 1 11 1 I 1 1-� 1 I 1 1 °• 1 I 1 1 1 by 1 I .,°• 1 1 1 1 I 4 , - -------- 1 1 1 1 I 1 I D 1 11 1 1 oI 1 ---- Q 31-4 1 D t- 1 ' 1 -------- 1 1 111 I 1 I ! I 1 1 ' 1 p , 1 Dv 1 I i ° a------ ------------------------------------------------------------------ 0- , D , .a v �0 v v �4 v - v �4 0 - v o4 v o � � .° .0 o p 4 G VQ 4 0 ; a . n o . � n a n n a a----------------------------------------------------- - I II 1 Ian ann Marie Car r 51 Waterside Dr. Centerville SCALE 3/1ro" = 11 APPROVED DRAWN BY t<I G DATE December 11, 2 01B REVISED Proposed Basement Remodel DRAWING NUMBER Assessor's map and lot number �.`..,1.4 ...... ; of IN r o�y P SEPTIC Sewage Permit number .................. .......... .f'4.�.......�........ e��sTMUST ,q® @ED IN House number ...... ..`��.....7...................................:.... M639 e� WITH TITLE 5 °o ENVIRONMENTAL rr-,7;. . r oYAYa\ { TOWN OF BARNSTAIRLE-� V r' ,; DUI.LDIHG INSPECTOR. APPLICATION FOR PERMIT TO ....Construct„•Single Family,. pwell.ing................... TYPE OF CONSTRUCTION ............Wo.o d...Fr.z me.............................................................................................. ...............19.... 5 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .....Z0.t...# 8................ ' ............................................... ProposedUse ..........................................................................................................................:.................................................. Zoning District. RC '.............Fire District Centerville. Osterville ........................................................... ............................ Name of Owner ..Anchor Building CO . ....Address ...1. ...� 4 uth Rd . Hyannis, MA 02601. .......... ..... ..... ........ Name of Builder F.ranr,.O..R.eal...Es.tr'a,t.e.—Dev....C:O,.Address S.amle.......................................................................... Nameof Architect ...............:..................................................Address .................................................................................... Number of Rooms Eight Foundation P•.. ........... ........................................ .............................................................................. Exterior Clapj oardlShin;;les Roofing .....As.Phalt„Shin.l.es ....................................... Floors ..•.,Sheetrock......................................... Heating_,lraS�-F .W..A:r.....................:........................:......Plumbing ....I'W0-00�? ?er......................::............................ Fireplace ............ s...............................................................Approximate. Cost ........$.. ............................... Definitive Plan Approved by Planning Board ______________________________19• ______. Area rr .q,... ........�- Diagram of Lot and.Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH OjU� 1 �ry 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 .. 111.�.CI.>��1....... ANCHOR BUILDING- CO. f lei, ' � .No ..2 7 9 4 9, 'Permit for .,Two...S t r .......... } Single. Family...Dweluag. - Location .... ..8,......5.7....W..4teAZ5.ide—.Drive ......................Ce.11ae.K V;L.7.1e............................. An hor B i ` Owner ...........G..............>�..�. g...CA............. Type of Construction, k'.r.aMe............................. ' ............................................................:................... Plot .....................:...... Lot ................................ � May 31, 85 Permit Granted ........................................19 Date of Inspection Date Completed p d. L..........19 d' _ d i Coy 3 � 0 3 33 3 kg$ Z Sao 47— °$ --� _r $ G 7�• 7 ' L o r. 7 L N � a 39 '� O /s4 I� 2W 461 o P/[oPoSE� �' /o' �jC/ST7•�G - —=' 36 �5 f �I t - _ AA - 76 b 60 r- (Aj r 'DTN CERTIFIED PLOT PLAN OF Mgsf /47 8 WATE/C5/ DE �Jelr/E ?K r✓07 �I S SUS 0'D r•a7" P/Ld7LGT7o�1 �� ROBERT • C /fT�TZ.t�/C LE EFz.:./�,".-i'Jam, ELDREDGE, y — ��Wnl /�'�Cf9WSo No. 19367 ,+� g IN 9FCIST ER �'S` U A S Y CALE+ "= 30/ DATE , GE �E'NGI EE ING W I r' :-&A-Nc.� I CERTIFY THAT THE F°viva rr v r✓ CLIENT SHOWN ON THIS PLAN IS LOCATED EGISTERED REGISTERED �q.�Z.Z JOB N0. � ON THE GROUND AS INDICATED AND j CIVi� LAND - CONFORMS TO THE ZONING LAWS ` ENOIPlEER 8URVEYOR DR.'®Ys . . OF_.BARNSTAB E AMASS. , j 712 MAIN STREET CH.GYM . HYANRI.St MASS: SHEET�,OF A t E REG. LAND SURVEYOR a3 �°°9' � w �, $. �� //� (�/h r � � /+ /e /l L G�-C .��1�""L �,.,� Y�'Zrt - G[,�.G�Ir�C. �� `'I�...Q_��\ .. - 27949 • TOWN OF BARNSTABLE Permit No. -------------------------------- { _ Building Inspector ITAU cash -------------------- � or.Y' OCCUPANCY PERMIT Bond issued to Anchor Building Co.. Address. lot #8 5� Wate?rsidd Drive, Centerville Wiring Inspector A Inspection date .- EnAe ;Plumbing Inspector / �y . �+r Inspection date �� Gas Inspector I ' O a r ,�,A;- Inspection date �� ��A 14 [,,Engineering Department Inspection date Board of Health „ t 31 f t v Inspection date 71.6 L,les" 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. �i' �►,,.�'' ....... ..... ................ 19��� A r �..1.�.-a�:. ..,..� le .f�... Buildinn, Inspector TOWN OF BARNSTABLE BUILDING DEPARTMENT t saaasr : TOWN OFFICE BUILDING �� 6 9• �� HYANNIS, MASS.-02601 A i MEMO TO: Town Clerk ju FROM: Building Department ` DATE: An Occupancy Permit has been issued for the building authorized by Building Permit #._ l .........•.............. ../� ....... _. .. _. ...... _ . issuedto .................. �...................... .. ...._..............�.................. ......(�//................._......... Please release the performance bond. Assessor's ma q and lot number .. .' .:... /... ..../ . of TNs To Sewage Permit number ................ �.:....................`....... G e Z BA"STADLE, i i House number .......... `-�.. 7......................................... rp rasa ' p i639 `e00 11 NO ' = TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ,.Construct Siac1.e Family, Swellin .. TYPE OF CONSTRUCTION ......11, rkood :x:amP....... .................... .. ................... ......... .. ....... ................ ...1G ..................19... .� ...............,..... . TO THE INSPECTOR OF BUILDINGS: t The undersigned hereby applies for a permit according to the following information: Location ..... c,. ...: .. :............... atE:r .i c... C?ritex v.... ... 'a....,0 26C 2,......................................................... .... t ProposedUse .................:............:...............?..........................:................................................................................................... Zoning District {C.........................................................Fire District Cer�ter'VilJ 8 OsterVil?e ............... .............................................................................. Name of Owner anchor .BUi 1..d1...... Co....................Address ...r�65..,;'alnouth 1:d. . H;rannis,...M-4 02601. ............................................... Name of Builder Address ; a,iC1P................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms • ............................................Foundation P.C. Roofing ::.r s .hhlt Shi.n�le5.................................... Exterior C3 abt?az;d Shinl�es p Floors ParUet/hardwood/tile/slate ". Sheetrock ......:..............................................................................Interior .................................................................................... Heating a..D..-..........'t.�...F.E.D.........................................................Plumbing ' .. ................................................. Fireplace ............`.__.................................................................Approximate Cost ........s..qo.®oQ.:�.CO............................... Definitive Plan Approved by Planning Board ________________________________19________. Area So. ..a...:.. .............. Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I � 1 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. Construction Supervisor's License .. .� ��. . ' .? ...... ANCHOR BUILDING CO. A=227- 74 /7c/ Aw 707 No .27.949... Permit for Two Story Single Family Dwelling ................... Location ...Lot...§,{....... 7._.Waterside Drive Centerville ............ .I. .............................................................. .. Owner Anchor Buildin Co ..................................... .................. Type of Construction ... rame ............................. ............................................................................... Plot ............................ Lot ................................ Permit Granted .....Mai'....3.1,...................19 85 Date of Inspection ....................................19 Date Completed ......................................19 l