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PLC 798 MID-TECH DRIVE,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 WWW.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 pei mit application # 52 Issued on 7// has been ins cted by, a certified Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements_ Sincerely, Permit#: Address: �017 Richard Tupper License # CS-69058 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION TOWN OF BARNSTABLE l-I/ Lf Map Parcel (`)La 0 Application I lJ Health Division 7014 JUL ^ PH 1� �3 Date Issued � l� Conservation Division Application F Planning Dept. RI9 .. Permit Fee 1.� � � Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis. Project Street Address /0/7 l ff � �T Village cinz, yi m1 Owner ., L Q Address /0/`7 Ld M01 tl J111_ Telephone Jp-tv , 116; Permit Request _.r-nd_a- 11 /�(l� /(Y4 f,���l Aey 75/��1'����J �J'C� S , /abw late- we-"7 a -/� %ps i/ ke'hIdl00 f I n r /,e7 4 i- Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1 60, 5 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 7"U Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: Gull ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) e 60 Basement Unfinished Area (sq.ft) &D Number of Baths: Full: existing '1Z 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 &61 ❑ 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:CKexisting ❑ 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 C� Telephone Number Address /�� �,e _.I��, License # C� O&A) Valt2?2 7 V S Ua Home Improvement Contractor# T`3 Email(��/v►�rl �� oky l Worker's Compensation ALL CONSTRUCTION BRIS ES LTING FROM THIS PROJECT WILL BE TAKEN TO -7�� �U 0,Q&7 SIGNATURE DATE 71- FOR OFFICIAL USE ONLY i i� APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE ` OWNER 'I DATE OF INSPECTION: FOUNDATION is FRAME INSULATION �C �.` FIREPLACE !+° ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING L _ r ' DATE CLOSED OUT ' ASSOCIATION PLAN NO. The Commonwealth ofMassachuseus Department of Industrial.Aceidents` Offtee of In vestigations 1 Congress.Street,Suite 100 Boston,MA 0.2314-2017 >ivsvw mass gov1d a Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le6ibly Name(Business/Organization/Individual): Tupper Construction Address:79B Mid Tech.Dr City/State/Zip:West Yarmouth, MA 02673 Phone#:508-77&011.1 Are you an employer?Check the appropriate box Type of project(required): 1. I am a employer with 4. Q I am a general contractor and 1 employees(full and/or part-time).* have hired the sub-contractors 6. E--ew>construction 2.Q I am a sole proprietor or partner-. listed on the attached sheet. 7. 0 kemodeling ship and have no employees These sub-contractors have; g. Q Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance comp. insurance.l 9. ❑Building addition required.] 5.Q We are a corporation and its 10.❑;Electrical repairs or additions 3.Q 1 am a homeowner doing all tX)oti officers have exercised their 117❑ Plumbuig repairs oradditions myself,: [No workers' comp. right:of exemption per MGL. 12.Q Roofrepa rs insurance required.] ' a. I52.§1(4).and we have no ypairs 7i n employees. [No.workers' 1-g 9ther. . 0 j comp.insurance required:] lea alie'Riat i c n Any applicant that checks box 01 must also fill out the section below.showing their workers'compensation policy information. t Homeowners tivho submit this afndavitindicating they are doing all x%brk and 6 hire outside contractors must submit;a new affidavit lard eating such; tContracuirs that check this box must attached an additional sheet Sho"ing 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 Nvorkcrs'cornp:poi cy:nurriber: 1 am an employer that is providing workers'compenjidran insuran a far my employees. Below Is the policy rind job.site. information. Insurance Company Name:AEIC Policy#or Self-ins, Lic.#:WCG5005593012007 Expiration Date:i©13l14 Job Site Address: 1017 West Main St City/State/Zi.p; Centerville MA 02632 Attach a copy of th or erscompensation policy declaration page(shoW. the policy number and ex Failure to secure v piration date). < e as required under Section 25A of MGL c. 152'can lead to the imposition of criminal penalties of a fine up to$1,50 0 and/ none-ye#imprisonment,as well as civil penalties in the form of a STOP VUCRI�QRDEIt and a_fine of up to$250; a day ag inst the v'olatzai. Be advised that a copy of this statetnenf anay;be.fotwvarrled,:to the.Office of nvestigations fthe Di for ins rlr Ce coverage veriticPtion; 1 r1t,}rerehy rtify etnrf" the pain arrrlp�rrraltics dfperjrtry t/ra7tt/ee infr�rmatinn prnvirled above is true t7ntl correct.` Sirytiature ate:' 71214 1?hone#:_5 778 - Official'UseL.0 _ut write:n this:ttrea,to be completed ihysc�ity oraotvn:uffttial. City or Town: Permit/Lieense'#' , 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#: OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at be, DDuz,-� (Property Address) (Property Address) hereby authorize l C Ctl } O J, , (Subco ) an authorized subcontractor fo RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. Owner's Signature Date S ' Ptio—u"MAW.;k Iftifil Wit.IPN; * At�t�Chu3etts_EJtpirtmrnt of Public Safety '� I 107c3 F'tM&Su4 t'0 K:ft MY 120� Board of Building Reguiatians and Standards t$7T;fly-t?as K:., `. t=•naruart��n�u}�.•i•�.i.,,r «wwt tz.e s _scense:CS-469056 E2ICHARp S TUPPERIT »& 79 B Mfl)-TECH DR WESTY'Al2m0L•'7H& 73 Ffichad TUPW _xpiration " (ski Owa 8,oi:CAR WWWATCMumrav>a,uiczrra=f rvrasstorrei 9,.2131/2014 4 PeoPte l44ing peoPte BuiW aSafer Wot'W- j 'MEMBER Richard Tupper Tupper Construction Building Sarety Proressibnai Member#:8'158119 Exp::4f3012014 .. ,�-4.... �'l�C U[•1>rltri=iKG[[itrlr"t/•e!'-sf'r/lldil7Clrrrar?r�. ._ ��.�-. •. Wee of Consumer affairs&Business Regulation License or registration-valid for individul use only „ r.70ME IMPROVEMENT CONTRACTOR before the epi date if found return to. �9 #2egi-ration: 178434 Type:; Office of C ffairs and Business Regulation' 9P'�Ex iration: .4/16/2016 LLC 10 Par aza-,Su' a 5170 Bo tb1A 021 TUPPER CONSTRUCTION CO,LLC: RICHARD TUPPER t 79B MID-TECH DR. W.YARMOUTH,MA 02673 Undersecretary No tthout signature i I i A CORD ra DATE[MMIDD/YYYr) CERTIFICATE OF LIABILITY INSURANCE 12/03/2013 t 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 i BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the'poilcy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to j the terms and conditions of,the policy,certain policies may require an endorsement. A statement on this certificate does not:confer rights to the j certificate holder in lieu of such endorsement(s): PRODUCER >CONTACT NAME: LOrd, Lowe } Southeastern Insurance' Agency, Inc. A",�"N;�: (508)997=6061 ax N,:(508)990-2731 ( 439 State Rd. E-MAIL ADDRESS: P.U. BOX 79398 PRODUCER CUSTOMER ID#; N. Dartmouth, MA 02747 INSURER(S)AFFORDING CoVERAaE NAIC# } INSURED i INSURER:A:i Arbel.la PPOt;eCtiOtt Insurance Tupper Construction Co LLC INSURER B.: AEIC 1 INSURER : CNA Surety 27 Roberta Drive wsURERDE West Yarmouth, MA 02673 _ INSURER E i i 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 IS1.SUBJECT TO ALL THE TERMS, :EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED.BY PAID;CLAIMS. INSR ADD SUB POLICY EFF POLICY EXP LTR TYPEOFINSURANCE :INSR WVD POLICY NUMBER MM/DD MMIDD LIMITS. GENERAL LIABILITY. 8500068743 1110112013 1110112014 EACH OCCURRENCE $ 1 000,00 X COMMERCIAL GENERAL LIABILITY DAMAGE RENTED S -100 OO -PREMISE Ea occurrence CLAIMS-MADE OCCUR MED EXP(Arty one Person) S_ 5,00( A - 'PERSONAL 8'ADV INJURY S 1,000,00( GENERAL AGGREGATE S 2,000,00 GEMLAGGREGATELIMITAPPUESPER: PRODUCTS--COMPlOP.AGG- S 2,000,00 POLICY. PERQ .. LOC _. S.... AUTOMOBILE LIABILITY S6662400002 1.21011201312/01/2014 COMBINED SINGLE,LIMIT (Ea accident), S 1 i 000,00 ANY AUTO 'BODILY INJURY(Per person).-..S ALL OWNED AUTOS fBODILYINJURY(Peraccideny S A X SCHEDULED AUTOS • .PROPERTY DAMAGE - $X HIRED AUTOS (Per accident) INC X NON-OWNED AUTOS $ S UMBRELLA LIAS X <OCCUR 4600058368/1/0112013 11/01/2014 EACH OCCURRENCE 5 1,000,00 A EXCESSLIAB CLAIMS-MADE AGGREGATE. S 1,'000900 DEDUCTIBLE S RETENTION WORKERS COMPENSATION WCCS00SS9301200 /010312013 1,010312014 X TDRY_IMI_TS Xs �ER AND-EMPLOYERS'LIABILITY. YjN ANY PROPRIETORIPARTNER/EXECUTIVE RICHARD TUPPERIS E.L. EACHA.MDENT S� 1,600,000 B OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) I LUDED FOR WC COVERAGE E.L.DISEASE,-EA EMPLOYEE S. 1,000,000 'If yes,describe under - - - DESCRIPTION OF OPERATIONS below E.L.DISEASE:-POLICY LIMB $' 1,000,00 DESCRIPTION OF OPERATIONS I LoCAitoNS/VEHICLES(Attach ACORD-101,Additional Remadcs Schedule;If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBEDPOLICIES 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 AGORD 1 • Health Complaints 12-Aug-99 Time: 1:20:00 PM Date: 8/11/99 Complaint Number: 2015 Referred To: BUILDING DEPT Taken By: EDWARD BARRY Complaint Type: ZONING ILLEGAL APT BASEMENT Article X Detail: Business Name: Number: 1017 Street: W MAIN ST Village: IS&r;�L Assessors Map_Parcel: 229-060 Complainant's Name: GUS AUBREY NEIGHBOR Address: Telephone Number: 771-3324 Complaint Description: ILLEGAL APT IN BASEMENT , KITCHEN PLUS, ENTRANCE THRU SIDE OF HOUSE THAT FACES POND Actions Taken/Results: Investigation Date: Investigation Time: 10 .30 \./c SxT ! ST'aV-L; W o�n�a"L S C�W 1�1.E2S ST1-T/Z TV1{'1 Ca"7Ck JrJ A-% CC V4FcS \,X(kEN, tit / t�uYclna&@ v lbrL14_10 L3T_ . GBNlTpr 4.v S L_J2, l l3 P,Tt ( - / \z4o2K,Rn 01,4 / G U L-S'T Ida r . '['h eta. LS rr e z� CSrtAa L%. )\t PAY S �LL__� C'zrx-,L_► , S J f- iL-P__'Fe_ , i 2eh�� r1 C, 3S i 1_�10 n ah -_1 us" rq-4g, P_f- E5 w h = 1 aA9 -060 The Town of Barnstable oR tt+E Permit* ? Massachusetts 11AA MIZ ; Date 9 ' 9 KAM SOLID FUEL STOVE PERMIT 1659. Fee 4,5 , a This constitutes an official stove permit after inspection and approval by the building inspector. Owner--I�R-yj�j 7oGts yGAJANT" Telephone no. '71/ — 034 / Address of Property, /p/ W. A(9,4/ -�MEE-,- Village CEnJ�R-j/ic�c_(5' Location and Stove Type Date: Building Inspector The solid fuel burning stove at the above location passed: failed: inspection. Town of Barnstable Building Department ComplainVInquiry Report Date: JO Rec'd by: Assessor's No.: Complaint Name: cu./e�L2r C Location J Address:_ fG 17 �d ' M/P Originator Naine: Street:__�� �✓ Village: State: Zip: Telephone: D/E Complaint Description: Inquiry 0 Description: For Office Use Only Inspector's Action/Comments Date: Inspector. Follow-up Action Additional Info. Attached Copy Distribution: VUlite-Department File 3 ellow-Inspector Pink-Inspector(Retum to Office:banger) P.229 060. A P P R A I SAL DATA KEY 141377 TOUSIGNANT, HENRY I LAND BLD/FEATURES BUILDINGS NUMBER ZN/FL=RD- 1 75,000 74,500 1 A-COST 149,500 B-MKT 145,500 BY 00/ BY /00 C-INCOME PCA=1011 PCS=00 SIZE= 960 JUST-VAL 149,500 LEV=300 CONST-C 0 ----COMPARISON TO CONTROL AREA 49WB -- TREND EXCEEDS STANDARD NEIGHBORHOOD 49WB CENTERVILLE PARCEL CONTROL AREA TREND STANDARD 15] 15 LAND-TYPE 75000] LAND-MEAN +0% 149500] 168000 IMPROVED-MEAN -56% 25% FRONT-FT 100 DEPTH/ACRES TABLE 02 100%] LOCATION-ADJ APPLY-VAL-STAT 1 LNR]LAND LFT/IMP]ADJS/SB/FEAT STR]STRUCTURE ARR]AREA-MEASUREMENTS NOR]NOTES COM]MARKET INC]INCOME PMR]PERMITS GRR)GRAPHIC FUNCTION-[ ] STRUCTURE-CARD NO-[000] DATA-[ ] XMT[?] ,R229, 060. P E R M I T [PMT] ACTION[R] CARD[000] KEY 141377 00000000] PERMIT-NO MO YR TYPE VALUE CK-BY MO YR %CMP 'NEW/DEMO COMMENT [ J [ ] [ ] [ ] ] [ ) [ ] [ ] [ l [ J [ ] [ ?J t- ]JR229 060. ] .IOC11017 WEST MAIN STREET CTY] 10 TDS] 300 CO KEY] 141377 ----MAILING ADDRESS------- PCA] 1011 PCS]00 YR]00 PARENT] 0 TOUSIGNANT, HENRY I MAP] AREA]49WB JV1345353 MTG]0000 TOUSIGNANT, CLAIRE M SP1] SP2] SP3] 1017 W MAIN ST UT1] UT2] .50 SQ FT] 960 CENTERVILLE MA 02632 AYB] 1963 EYB] 1975 OBS] CONST] 0000 LAND 75000 IMP 74500 OTHER ----LEGAL DESCRIPTION---- TRUE MKT 149500 REA CLASSIFIED #LAND 1 75,000 ASD LND 75000 ASD IMP 74500 ASD OTH #BLDG(S) -CARD-1 1 74,500 DESCRIPTION TAX YR CURRENT EXEMPT TAXABLE #PL 1017 W MAIN ST CENT TAX EXEMPT #DL LOT 8 RESIDENT'L 149500 149500 149500 #RR 1813 0125 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALE]00/00 PRICE] ORB] 1846/247 AFD] LAST ACTIVITY]08/12/93 PCR]Y