The URL can be used to link to this page

Home My WebLink About0039 WEST TERRACE 9 T��s�- -7�`�r�-. , � ;� .� f „ .. o' .� ;; v ,• ,. ., m. eb 09 1511:17a Tupper Com 15087785010 p.1 a , CONSTRUCTION CO. LLc 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 WWW.TUPPERGO.GOM Date: Town of Barnstable Thomas Perry CBQ !$ 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax 43 Re: Insulation Permits �- N) M Dear Mr. Perry This affidavit is to certify that all work completed for permit application Issued on j ��i g lj 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 w License # CS-69058 F ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application #ac)141) Health Division Date Issued �l y Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address Village Owner Address f2q Uk�?±TeX C Telephone [ I I— 1-7 1- P34—/o q I Permit Request -"o-z `Visa 111-f-i'm_ 9 r �o se rz \f mii [a-Ro,in ol eoJ n idft 17,Va-PM± -�balm l 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 ,Jd Two Family ❑ Multi-Family(# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ,Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq - Number'of Baths: Full: existing_ new Half: existing s newt T Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Roo Count-.., 53. Heat Type and Fuel: /Gas ❑ Oil ❑ Electric ❑ Other �y Central Air: ❑Yes J'No Fireplaces: Existing New Existing wood/coal stove: ❑ems ❑ 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) N m �/� Telephone a ' hon p e Address License #ylalrn (11 Home Improvement Contractor# ` Email Worker's Compensation #� ° ,5M 65-I;)Q u w'7 tI ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PRO) CT WILL BE TAKEN TO 'Pi4b-A 4ian 1' :5 anN&I a),�mnnow% wA D2:io-3 SIGNATURE DATE t FOR OFFICIAL USE ONLY r APPLICATION# DATE ISSUED r I MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL t PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING _ . .. c DAFF&CLOSED OUT ASSTION PLAN NO. _ - i 1ng 1 1.^ffrS Assi e C _ CorporationCape Cad . HOME OWNER WEATHERIZATION WORK PERMIT&FUEL RELEASE: PLEASE FELL OUT AND SIGN THIS FORM IFYOU ARE THE APPLICANT HOMEOWNER. hereby consent to and agree that weatherization work maybe done b} the Weatherization Program of Housing Assistance Corporation (hereinafter referred as "Agency")on the property looted at: Theweatherization work done will be based on programmatic priorities and availability offunding and it may indude all or some of the following measures Weather-stripping& caulking of windows and doors, insulation of attics, sidewalls& basements, attic and other ventilation measures and possibly replacene t of badly deteriorated windows. In consideration of the weatherization work to be done at my home I agree to the following: 1. I give permission to the"Agency" its agents and employeesto travel onto or across said property with such equipment and materials as may be necessary to perform weatherization work on said property. 2. The H ousing Assistance Corporation resevestheright to inspect thefuel or utility bill for the weatherized unit on an ongoing basisfor no morethan five(5) years after the weatherization work is completed. I have read the provisions of is ream - listed and freely ' e my consent. F _ Home Owner: (Signature) r} Date t Agent: (signature) a'' ` Date HAC approved Weatherization Company : 0 000 live learn work grow 460 West Main St. Hyannis, MA 02601. hac@haconcapecod.org 508-771-5400 tax: 508-775-7434 The ComMonwealth of Massachusetts Department:of Industrial'Accidents TkIOffice of Investigationston 640 Washing Street Boston, MA 021,11 i www.massgov%dia Workers' Compensation Insurance davit,: Builders/Contractors/ElectricianslPlumbers Applicant Information Please Print Legibly Name(Business/Qrganization/Individual),:; Tupper Construct-ion Co. , LLC Address: 546A Higgins Crowell Rd City/State/Zip: West Yarmouth, MA 02673 Phone:#: 508-778-0111 Are you an employer?Cheek the appropriate box: Type of project(required): I.0X I am a employer with 4. 0 I am a;general contractor.and I 6. ❑New construction employees(full and/or part—time).* have hired the sub-contractors 2.❑ I am a sole proprietor or.partner listed on the attached sheelt. 1. E]Remodeling ship and have no employees These sub-contractors have 8. [] Demolition working for in any capacity. workers' comp.insurance} 5. M8uilding addition [No workers' comp:.insurance 5.: Q We area corporation and its' required.] officers have,exercised th6ir 10.❑ Electrical repairs:oradditions 3.❑ I am a homeowner,doing all:work right of exemption per.MT'no: L 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and Web 12.,�Roof repairs insurance required.1f employees. [No workers' 1JvQ Other Vi/egtheflzatiOrl comp,insurance required.] 'Any applicant that.checks box 41 must also fill out the section below.showing their.workers'e.ompensation;nolicy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating"such. :Contractors that check this box must attached'an.additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance.for invent Below is the pol/cy and job site information. Insurance Company Name: AE I C Policy:#or Self ins.:Lic.#;: WCC. 5 0 05 5 5 3 0,12 0;14A: Expiration Date: 10/3/15 Job Site Address: )LfA h oar cae, City/State/Zip: ( OP& 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 t6 the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment;as well as civ.Apenalfies 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,be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pams,&nd enaldes'of perjury that the informotion provided abo a is true and correct si ature: Date: I� Phone#: (508) 778-011.1 Ojfieial use only. Do not write M.thik area,to be completed by city:or town offaciat City:or Town: Permit/Licenset Issuing,Authorty(circle one) 1.Board;of Health 2.Building Department 3..CityTrawn Clerk 4.Electrical Inspector 5.Plumbing Inspector *.:Other, Contact:Person : . Phone,# a a Ac CERTIFICATE<0F LIABILITY- INSURANCE DATE l0/2912014i� THIS CERTIFICATE IS ISSUED AS A MATTER OF iNFORMATION':ONLY AND CONFERS NO RIGHTS UPON THE CEl;T1FIGATE HOLDHR.THI ND S CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTE OR ALTER'THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS.CERTIFICATE OF wSURANCE"DOES NOT COP9STITUTE;A CONTRACT BEIIIYEEN THE ISSI)ING tNSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THEZERTIFICATE 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 certficato does-not confer rights to the certificate holder in lieu of such endorsement(s): PRODUCER :,CNAOME:NTACT Lora F3,tZra .Geld '. .." ..... Southeastern Insurance Agency PHONE {508)997=6061 Fax NO_,(508)49D-2731 439 State Rd. E-ADMAID lfitz@Southeasterruns_com SS: P.O. Box 79398 INSURERS AFFORDING COVERAGE.' 14AIC 4 North"Dartmouth MA 02747 irisuRERAArbellai Protection. Insurance 41360 INSURED INSURER B-Boston i lnSurance .Brokerage .Inc Tupper Construction Co LLC INISURERCi 27 Roberta Drive INSURERD: INSURER E Worst Yarmouth MA 02673 INSURER F,:-, COVERAGES CERTIFICATE NUMBER2015 REVISION NUMBER THIS 1S 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 VM--H RESPECT TO WHICH THIS CERTIFICATE'MAY 13E';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 UB POLICY EFF:.POLICY EXP LTR POLICY NUMBER MMIO MM/D GENERAL LIA81tJTY EACH OCCURRENCE S. l:i 000/000 X COMMERCIAL GENERAL LIA.B UTY DAMAGE TO RENTED 100 000 MI o c / `( 5 A CLAIMS-MADE ❑X OCCUR 50000B7.43: 1JIJ2019 1'itl%2015 MED EXP Any on e p ersonj 5,000 PERSONALB'ADV INJURY 5 1'i 000,000 GENERAL AGGREGATE $ 2-,000,000 GEN'L AGGREGATE UMIT APPLIES PER: 'PRODUCTS-COMP/OP AGG 'S Zo':000.000 -.X PRO, POLICY .� -7AUTOMOBILE UABILVTY .. :... .. ,.. .. . COMBINED SINGLE.UMIT - - aaaadent vS t.:00U 000 ANY AUTO .BODILY INdUwperpersonj 3 A ALLOWNED SCHEDULED 0200t39389' 2ll/2013 /1J2O14 80DILYJNJURY(PeraoddeM S: AUTOS X AUTOS- PROPERTY DAMAGE NUTOS 7dED PeracciEent -S X HIRED-AUTOS X AUTOS - - - Uninsured motanst Hl fumft':s. 250 000 X. UMBRELLA LIAR OCCUR EACH OCCURRENCE .A EXCESS.UAB CLAIMS-MADE - AGGREGATE _..........._ S OED-: RETENTIONS ;_.600058368 i/ (201A ` 1/1/2025 15 - WORKERS COMPENSATION g ;WL-STATU X OTH AND EMPLOYERS'LIABILITY Yt N RY LIFJJ ANY PROPRIETOR/PARTNERIFXECUTNE JE.L.EACH ACgDENT S" _ I:,OOO 000 OFFICERIMEMBER EXCLUDED? N N t A CC500559301014A 0J312014 '0/312015 (Mandatory in NH) 2 ❑ ..., - E.LDISEASEl,EA'EMPLO 'S 1.000 000 It y05,d=sct 6e Onder DESCRIPTION OF OPERATIONS Neiow. _. E.L OISEASE-POLICY LIMIT.::5 l O00 000 DESCRIPTION f7F OPEftA71QNS/LOCAl70N5/VEHICLES IA1teGiACORD.101,AQCftiartal Remanps.SMeaule,ittnore spaceis repulreO)- CERTIFICATE HOLDER CANCELLATION SIiOULD ANYOF tt4E ASQVg DESCRIBED POUCIES'BE CANCELLED BEFORE THE' EXPIRATION: DATE THEREOF;..,NO TICE' WILL BE DELIVERED to INFORMATION PURPOSES ONLY ACCORDANCE WITH THE POLICY PROVISIONS:. TUPPER CONSTRUCTION CO -mr- 546 A'HIGGINS CROVELL ROAD AUTHORIYED REPRESENTATFVE WEST YARMOUTH, MA 02673 Lora' FitzGerald/LH IACORD 2S(201OA); 01988-2010 ACORD CORPORATION, All rights reserved: eN$L1'a~S.MMinR-m nT.. T4io�r:C1Rr'1 n�ma meael inrtn m-ranecfieemr8 martic:nf Ar`ARr1; . , .� �*,. Y:.ems-as-.�� ,..s+><•w...�rau..E;-:w,r�n�e. ,.•v.�.-tea. - �:s..KB.t'd�4 •LiT' -'r _ ."'f ' x._ ,.. .1:...a - r Z •� "� �� Vic" ...•z :Tir•� ....,:rr41r 4i� �?..(f,L ra i� i�72�1 s CCtl<: tY�'t."i P 4 ;.t 4U ��i` x.l. S- csi5!: s xiTCYES Stet Qs1`FL2 $.'1'<•,:a'4.�1._s `-r. ss.`3'�:�: �m.;?:xE'�.,,.,v`t; `4��;:T°s��a�4.�SaH:c�'c 42;,°,.-y, _ .-: 0,60 t i3Pk^..Li make aameTj}^•`.Gi �f3a:.i - .-- .. •car•,... .;:v" ter- sn;m'a�._,� ...... .. .. :.. .. i€ r Town of Barnstable *Permit# C Expires 6 months from issue date Regulatory Services Fee BAMSTAB ` W MAC' Richard V.Scali, Director 1639. "rEnl,�rA Building Division ®CT'l 4 201 Tom Perry,CBO,Building Commissioner® 4 200 Main Street,Hyannis,MA 02601 t u ®F�A R►V S�A p C www.town.barnstable.ma.us DLC Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY ,r�D� Not Valid without Red X-Press Imprint Map/parcel Number Lk,`L Property Address ye'r.V 1 (residential Value of Work$ jFc? n� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address InCf�n n ' eell 1-r S Contractor's Name (��k__rtom'e1 ;?jptV(,e1n e_i-�- Telephone Number S-e5r S(,Co 0cl7 �{ Home Improvement Contractor License#(if applicable) ./-W Email:C �.-LtQwt �jDr�G�I/ylea� lc �G q Construction Supervisor's License#(if applicable) VS3 tca � I [ Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ` ❑ I am the Homeowner �QQ ,I have Worker's Compensation Insurance 4 Insurance Company Name 11c6d j eA Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Re est(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is SIGNATURE: W-6--1 Q:\WPFILES\FORMS\building permit form XPRESS.doc Revised 061313 :y} r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street 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): Address: a Z b-V-z-17 . ��c - City/State/Zip:)`-6,wW5r- 1 Phone#: 07 7V u_ - Are you an employer?Check the appropriate box: Type of project(required): I ;I am a employer with C 4. ❑ I am a general contractor and I have hired the sub-contractors 6. New construction employees(full and/or part-time).* - _ 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling h b These sub-contractors have ship and have no employees T 8. ❑Demolition and have workers'to . working forme in any capacity. employees y 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ 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 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 ❑ p employees. [No workers' 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 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,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: AC-AA-I Gt Policy#or Self-ins.Lic.#: ( �C o-t t lid® j��5 Expiration Date: 5 B S Job Site Address: )C-5-r 1 L°r-nae_e City/State/Zip: 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 violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided above is true and correct Si igr ahue Date: Phone#: S�a& S(Uo 047-7`t Official use only. Do not write in this area,to be completed by city or town official City or Town: _- �Permii/License#V___ 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#: 1 Information and Instructions E 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 in the 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 with the 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 your situation and,if necessary,supply sub-contractor(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 to any business or commercial venture (i.e. a dog license or permit to burn 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 Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 0211.1 Tel. #617-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax# 617-727-7749 www.mass.gov/dia 639. Town of Barnstable Regulatory Services Richard Scah,Director 'Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,-MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 } Property Owner Must Complete and Sign This Section If Using A Builder I ,as Owner of the subject property hereby au nze to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) ' l ignatur f Owner Date 1l ,/ Print N e If Property Owner is applying for permit;please complete the Homeowners License Exemption Form on the reverse side. QAWPHLESTORWbuilding permit formAsmokecarbondetectors.doc r Revised 050412 Town of Barnstable ; Regulatory Services pF Richard V.Scali, Director Building Division t 11AMMA33M t Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION r Please Print DATE: /011 5 C JOB LOCATION: 1 �, T Tie P-ra e. n`nu e nnff street village "HOMEOWNER 70 Iame me pho e�##I / work phone# CURRENT MAILING ADDRESS orks- d If.- L/ city/town stki zip c e The current exemption for"homeowners"was extended to include owne occu ied dwellings of six units or less and to allow homeowners to engage an individual.for hire who does not po ess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two-family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building_permit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department imam inspection procedures and requirements and that he/she will comply with said procedures and re tir ements. tALf ding Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall act as supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor(see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require, as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. i 1 j r , ACORU � CERTIFICATE OF LIABILITY INSU RANCE D52B/2D,4 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 endorsemen s. PRODUCER CONTACTErica H O'Co_nnor HART INSURANCE AGENCY,INC. N-OE:- -- 243 MAIN STREET PHONE 508-759-7326 x205 508-759-7366 PO BOX 700 E LLB: BUZZARDS BAY,MA 025320700 ADDRE — INSURER(8)AFFORDING CMV RAGE NAIL R -- -- INSURERA:.PENN-AMERICA INS CO 32859 INSURED Scott Lohr dba Lohr Home Improvement INSURER a:_ACADIA INSURANCE COMPANY 31325 23 Grand Oak Rd — Forestdale,MA 02644 !NLWERc - - • wsuNSEa o:--__ • INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADOL POLICY Ei* MPOLICY EXP - � L. POLICY NUMBER A GENERl0.LIABILITY PAV0027252 0511512014.05/152015 EACH OCCURRENCE $ 1,000,000 DAMA(�aE T R NTE COMMERCIAL GENERAL LIABILITY ( i $ S 50,000 CLAIMS-MADE ,�OCCUR I .+ MED EXP(AM wre $ 5,000 INJURY $ 1.000,000 i ! GENERAL AGGREGATE S 2.000,000 GEML AGGREGATE LIMIT APPLIES PER: PRTS-COMP/OPAGG S 1,0()0,0()0 f?ODUC POLICY PRO- LOC S AUTOMOBILE LIABILITY COMBINED I LE UMIr i I, .SE3eccideA.Jy. ANY AUTO I I BODILY INJURY(Per pmw) S ALL OWNED -' SCHEDULED AUTOS _ AUTOS I BODILY INJURY(Per aaoiderrt) S NON-0WNED i I PROPERTY'-DAMAGE S HIRED AUTOS AUTOS I f $ .UMBRELLA LIAa OCCUR { i EACH OCCURRENCE S EXCESS LIAR L1CLAIMS-MADE I I. I _AGGREGATE S DED RETENTION E ` - B wORKERS COMPENSATION WC202000536000 05/15/2014 05/15/2015 j WC TATU- OTH t AND EMPLOYERS'LIABILnV YIN I - ANY PROPRIETOR/PARTNERIFXECUTIVE E.L.EACH ACGDENi S SOO,000 OFFICERIMEMBER EXCLUDED? N NIA .— R yeses.dascnbe NH)ndatory In IfI I i E.L DISEASE-EA EMPLOYEE S 50D,006 DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT S 500,OOD DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,U more space Is required) ERTIFICATE HOLDER CANCELLATION Fax#:(508)775-3344 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF 13ARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 236 SOUTH STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS,MA 02601 AUTNORIZEO REPRESENTATIVE !' ZZ- 0 1 988-201 0 ACORD CORPORATION. All rights reserved. CORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Su Pcr�'isor License: CS-053961 , �,'.% r" SCOTT A LOUR 23 GRAND OAK'ItD - FORESTDALE NIA �� Expiration -� 0 logf2015 Commissioner tr � {o�anvnzoruairs& �t�au�� License or registration valid for individul use only Office of Consumer Affairs&B smess Regulation g _ HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 5 Registration: .,;172172 Type: Office of Consumer Affairs and Business Regulation x Expiration: 4/31/2016 DBA 10 Park Plaza-Suite 5170 -- - Boston,MA 02116 LO HOME IMPROVFMW' SCOTT LOHR 23 GRAND OAK RD FOREST DALE,MA 02644 d.::.G Undersecretary Not valid without signature '= , i 1o ..�� .Assessor's map and lot number : r Q� �/ �'�f TOE♦ THE Sewage Permit number /,I/Os .0. ..' �G I }. SEPTIC SYSTEM MU { �. STABLE i r House number lt �, N Dy p 39- WITH TITLE 5 r TOWN 'OFBARN 1 � AN "* TOWN BUILDIN G .INSPECTOR; APPLICATION FOR PERMIT TO ".'.......... /' !Gl::.. ��... C'.A........................... TYPE OF CONSTRUCTION ........... �,r�•Ile•01,��....:.../. ': .- ?1 ! .......lQ./...z......................................... u „£ ..... �.......19�.... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for'a permit according to the following information: Location ..........g.R...... ..... � �,6�:C:�G........................... .� ��L.k:Kv4?- ............................. P ProposedUse ....... � i;/........... ,j . .....L �l�Z ..... ............................................................... ZoningDistrict .......................:.................................................Fire District .............................................................................. Name of Owner ...AQ—el: !t/. Address ....,.... ................ Name of Builder' . . .IQ�.1!'eG,.... � .lG'Lc.Gl�.Address,... .L �.I I'Ll...Aor .....�li, �� e✓Y/.. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..Foundation ..... ... Exterior ��k� �e� Roofing .........:..f .p u?�..f�lr.�L Floorsl.�?.1!�uv.:6h ....................................Interior .................................:....................:............................. Heating. '.................................................................. :..... .Plumbing :,1�!b �l' ,?��ov ................................. Fireplace Approximate Cost(( 6 0, v� ..................................................... :l.Jr. ..: ...................... ..... ... .... :... pp Y g //0/—,Definitive Plan Approved b Planning Board ____________________________19,____ . Area Diagram of Lot and Building with Dimensions .. J� gg - � Fee J............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH r I � 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. N �� ' ................................... CUSACK, HELEN No 24275 Permit for ..tZemodel Base :rat r , `....S.in.S1e...Fami.lY,..Dwe,lling.... ... t , r+ Location 3.9..Wq.S ...TerrAG.e... .. r. a - .... ...... .. � i� xY .�..�. ......... ........... i Owner ............................... Type.of J• .r� `1 � j , Construction ...Frame......................... Plot ............ .... Lot .,............................... ar� -Au ust 10., 82 Permit"Granted ..; s; Date'oflpectinrP`7e5' ........`.:'.....-19 `. . .. , r,• '_ /� 7 1f9Daa Completed ...... . 2 ..... t ` ! CN e g /- -Assessor's map and lot number .. /. ..././.. �lr,X..... �pFTHEtO� ........... b Z Sewage Permit number /A.ax."cS:�?*.!!lJ.•i.P.•fl�!<<.+1��.:. . Z BAWSTADLE{ i House number ........................................................................ 9 rasa �p 03q. TOWN OF BARNSTABLE BUILDING I H S FEcC T O-R ..____��•. h APPLICATION FOR PERMIT TO .........rrr�..:. .�f ./`�1 '. ............:...................................:.. TYPE OF CONSTRUCTION ...... ..... ..................................... .. ... ??......19 �.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby_applies for a permit according to the following information: Location ........ ..-i;'4 .&..;4,7.... . :'.. .. G Z y/'.' . .............................. F � Proposed Use ........ /it lil i............. ..... `.r:?........................................................................... ZoningDistrict ............. ............................................................Fire District .............................................................................. Name of Owner ....t..?. r ! ..... .lr..t� ..C.., C.............Address ....,..� / :. ..... �✓r`� ................ Name of Builder' Cy"'``��. 5�. /'4-1_.:"c1dress ....�'�:.. ' i",. ! .....11 yf� ..... �. / Sk' f t Nameof Architect ...........................:......................................Address .................................................................................... Number of Rooms ....................�...........................................Foundation ........� je.;O ,,� . ..... ..... r � � Exterior ................ ze.� ��..�eC..........................................Roofing ..........fir <rro, f",�y G`?...................................... Floors ......... ,.Al..�i!7..r .l�.u.�r.. ..........................................Interior .................................................... Heating ..................................................................................Plumbing / '/*'.?`.;rr fi`? ..................................... Fireplace ..................................................................................Approximate Cost !rf � Definitive Plan Approved by Planning Board ------------_____—-----------19_____--• Area /.1.lir5._54..�� L" Diagram of Lot and Building with Dimensions Fee ., ........ SUBJECT TO APPROVAL OF BOARD OF HEALTH 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. Naae , 4. 1 ? ..................................... • 5i. � USACK, HELEN A=207-114, 24275 Remodel Basement No ................. Permit for ...................... ............. Single...FgjAj jy ..A �].J.�, g............. Location . .Xx . ................... .................. ......... . .................... Owner .....Helen G.lAs�,G}5,..................:.......... Type of Construction ..F.rame......... ............. Plot ..... Lot .... ....................... Y .. .. ... . .. . .. .. Permit ranted ugus t 0 , 19 82 Date of Inspection ... ................. ..............19 Date C pleted ....... ................ ...........19 {6D "+':