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0118 EISENHOWER DRIVE
---- -- __ : .. � ,. ,y 9 - � W �� �, ,: ,. �. r : - ,. ii - ,:wrap�.. i , I „ j� t. ., � i� ` 1� I ' �. i I,/ Town of Barnstable Building . -: (Post�This Card So That it.is Visible From the Street Approved`Plans<Must be Retained`on:Jobavd this,Card Must be'Kepta ' • W►RNSCABLE, • �`*=';'s'+'s Wit: Y.rttr"� z: {. *,'.� € s-r,<+w�"��.» �; -f`w..: _ y fa,�r. �"*, F .: c .:. _ . �$ ;Posted UntilrFinal-lns ection HasBeen•Made. _� y_. a, fi y 639 \ Ta3'': p i d s" 't xr �� `xi .s c,' � , ..� Permit ' here a Certificate of Occupancy�s Requirucli Bu�ldirig shy a� II Not bcup ed�til aFinal Inspection has been made Permit No. B-18-2531 Applicant Name: CHARLESJ HUNT Approvals Date Issued: 08/21/2018 Current Use: Structure Permit Type: Building-.Addition/Alteration-Residential Expiration Date: 02/21/2019 Foundation: Location: 118 EISENHOWER DRIVE,COTUIT Map/Lot: 039-114 Zoning District:. RF Sheathing: Owner on Record: ANDERSEN, ROGER C&MARIANNE TRS : Contractor Name C&J HUNT CONSTRUCTION Framing: 1 SERVICES LLC Address: 118 EISENHOWER DRIVE 2 .-,. Contractor License 165004 COTUIT, MA 02635 ' Chimney: Description: Install New Front Door and Garage Side Entry Door�No Header -Est Protect Cost: $15,000.00 Changes. t .Permit Fee:. $126.50 Insulation: i (� 2 Remove Wall Paneling from Living Room Install Recess Lighting Final: t Fee Paid: $ 126.50 and Blue Board& Plaster. Dater` 8/21/2018 Project Review Req: � g �a� - Plumbing/Gas . a Rough Plumbing: Final Plumbing: a -11 Building Official Rough Gas: Final Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application_and the approved construction,documents for which this permit has been granted. Electrical FE. .. c All construction,alterations and changes of use of any building and structures shall be m cbmpliance,with the local zoning by-Iawsand codes. This permit shall be displayed in a location clearly visible from access street or road and shall-be maintained open for;p'blic inspection for the entire duration of the Service: work until the completion of the same. Rough: The Certificate of Occupancy will not be issued until all applicable signatures by the Bu d ng and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing Low Voltage Rough: 2.Sheathing Inspection 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed Low Voltage Final' 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Health 6.Insulation 7.Final Inspection before Occupancy Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Town of Barnstable Buildin g . s s Post This -ard 'o-That it is Visible Frorr the Street-Approved Plans`Must=be Retained on'Job and this Card Must bi Kept' g' Posted Until Final Inspection Has Been.Made 'Y = ' a " 1e39 cr :_,. �. .. Permit Where aCertificate of;Occupancy is Require'd;sucFi Buildmg`shall'Not be Occupied until a Final,Inspectionshas been made Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 1 "a fi ,� �`a '° . Town of Barnstable Building _ _ 4 .ng 4 Pos This Card So That it is Visible From the Street .Approved Plans:Must`be Retained on Job'and this.Gard JV16st be*6pt Posted Until Finallnspection Has Been�Ma03 de ` Permit Where aCertifcate of�Occupancy is Required,.'suchBuildingshalLNot be'Occupied until a'Final.Inspection`has-been�made. Permit No. B-18-2531 Applicant Name: CHARLES J HUNT Approvals Date Issued: 08/21/2018 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 02/21/2019 Foundation: Location: 118 EISENHOWER DRIVE,COTUIT Map/Lot: 039-114 Zoning District: RF Sheathing: -». Owner on Record: ANDERSEN, ROGER C&MARIANNE TRS Contractor Name: „ C&J HUNT CONSTRUCTION Framing: 1 Address: 118 EISENHOWER DRIVE SERVICES LLC 2 COTUIT, MA 02635 { °Contractor License 165004 .. � Chimney: . t Description: Install New Front Door and Garage Side Entry Door No Header Est Project Cost: $ 15,000.00 Changes. 8 � Permit Foe: $ 126.50 Insulation: 2 Remove Wall Paneling from Living Room Install Re-cess1ighting ° and Blue Board& Plaster. `�> Fee Pahl: $ 126.50 Final: 7. a " Date: 8/21/2018 Project Review Req: Plumbing/Gas 34 a� Rough Plumbing: f E .' Final Plumbing: s x� Building Official Rough Gas: Final Gas: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afterissuance. All work authorized by this permit shall conform to the approved applicat,on and the'apprrovved on,sttrruction documents for which this permit has been granted. b Electrical All construction,alterations and changes of use of any building and structures shall be-in compliance with the,local zoning by-laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of.the Service: work until the completion of the same. k =. Rough: The Certificate of Occupancy will not be issued until all applicable signatures bythe Bwlding and Fire Officials are provided on this permit. Minimum of Five Call Inspections Required for All Construction Work: Final: 1.Foundation or Footing 2.Sheathing Inspection Low Voltage Rough: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Final: ,5.Prior to Covering Structural Members(Frame Inspection) Health 6.Insulation 7.Final Inspection before Occupancy Final Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Fire Department Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Town of Barnstable Building Post This'Card So That itiswUisible From'the Street ,.Approved Plans Must_be Retained onJobaarid this,Card Must be!Kept z `� Posted Until Final Inspect Has 136i6Made. . a },` µ 6 _ • • Where4a'Certificate,of.Occupancy s.Requiretl,such:Buildirig shall Not.lie:Occupied>until a Fuial lnspection:has been made Permit ililt Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 77 f { E, fig ,y a x , ..} s ..... ....... SZ) ...........Other Fee..... .:..... AUG 67 Mw Fain................. .. .I CQ.. ... . �.... ........... IIN OF B. RNSTASL TOWN OF BARNSTABLL Permit Approval by........................... .On....................... BUII.DINO PERMIT MV..........��J. ...............Pam&.........JZ. ...................... APPLICATION Section I —Owner's Information and Project Location Project Address'P d'1��bC��'� Village C0-&1L Owners Name R° � AY C Owners Legal Address City J State Zip fOS Owners Cell#��6�s�� Ismail C&WA Afe�r Section 2—Use of Structure Use Group*j.'b D ❑ Commercial Structure over 35,000 cubic feet ❑ Commercial Structure.lmder 35,000 cubic feet Single/Two Family Dwelling Section 3—Type of Permit ❑ New Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use ❑ Demo/(entire structure) ❑ Finish Basement ❑ Family/Amnesty ❑ Fire Alarm Rebuild ❑ Deck Apartment Sprinkler System ❑ Addition Retaining wall ❑ Solar i�novation Pool ❑ Insuation l - - Other Specify 4 Section 4-Work Description y q6yf06C ,, 8 VY,�5 Lai s�/l / ss �`7�'( b4xlUlC �BCII� ° J 6 g Yle I LIMA C 3 . Ts,ct m,dnte :2J92018 r Application Number..............................:..................... Section 5—Detail Cost of Proposed Construction j vU r Square Footage of Project_ '7 Age of Structure. Safe Number # Of Bedrooms Existing 3 Total#Of Bedrooms(proposed) ` 110 MPH Wind Zone Compliance Method MA Checklist ❑ WFCM Checklist ❑ Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ' ❑ Masonry Chimney ❑Add/relocate bedroom Water Supply Public ❑ Private Sewage Disposal ❑ Municipal Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: &60 G I am using a crane ❑ Yes No Section 7—Flood Zone Flood Zone Designation Within or adjacent to a wetland,coastal bank? Yes ❑ - No Section 8—Zoning Information ` I 5f1o1 iJ 0 Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units(on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last mdated-2/9/2019 -- ......... 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 (( Please Print Legibly Name(Business/Organization/Individual): Address: ' City/State/Zip: ftp/e-7 Phone#: —CZ Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ 1 am a general contractor and I 6. ❑New construction Fployees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. remodeling 2. I am a sole proprietor or partner-ship and have no employees These sub-contractors have 8. ❑Demolition working forme in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insuranceJ 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its 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#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 r information. Insurance Company Name: Policy#or Self-ins.Lie.#: (�,e ayr3 �f�3�/�_ Expiration Date: Job Site Address: �� 15Y�'ir�W � (l/� t�7Zl�i7' 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 certi th ail an penalties ofperju �that he information provided above is true and correct: Si afore: Date: �� Phone# >V13 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 r Contact Person: Phone#: 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 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-contractors)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 02111 Tel.#617-727-4900 ext 406 or 1-877-MASSAFE Fax#617-727-7749 Revised 4-24-07 v .mass.govfdia ,aco o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 08/03/2018 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 CNTCT NAOME:A Rogers and Gray Processing ROGERS &GRAY INSURANCE AGENCY INC PHONE 508)398-7980 ;uc E-MAIL mail ers ra com ADDRESS: @ro9 9 Y• 434 ROUTE 134 INSURERS AFFORDING COVERAGE NAIClt SOUTH DENNIS MA 02660 INSURERA: ACE AMERICAN INSURANCE CO 22667 INSURED INSURER B: C & J HUNT CONSTRUCTION SERVICES LLC INSURERC: INSURER D: PO BOX 75 INSURER E: FORESLDALE MA 02644 INSURERF: COVERAGES CERTIFICATE NUMBER: 299955 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 SUBR POLICY NUMBER MOM/DD/CY EFF MP�p EXP LIMITS LTRVIrVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP(Any one person) S N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ROT- LOC PRODUCTS-COMP/OP AGG S POLICY❑J OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS L AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER X STATUTE ER TH- AND EMPLOYERS'LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBEREXCLUDED? WA WA WA a 6S62U68H09113418 05/13/2018 05/13/2019 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE,$ 1,000,000 If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Ci & J Hunt Construction Services LLC ACCORDANCE WITH THE POLICY PROVISIONS. P O Box 75 ' AUTHORIZED REPRESENTATIVE Forestdale MA 02644 Daniel M:Crow ey,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 2018-CSL/HIC This Is an ornGat apo auiw of Me Cwuronweaft d Kassachumaf Nate anproveneY . Oma d Conwaxr Aflaln a auflflesi 0.MWatNn �COabaCaDr�° . M _. 1hltolMnvw.mass.eovl {trtto_rMrunwrtraaaoy/�fu(consumer- (htto'llmass.aovt My Registrations Your company Registrations and/or Applications with their statuses are displayed in the list below. , To manage or view any Registration,dick on the appropriate Task button. To register anew company as a Home Improvement Contractor;click the Start New Application button. Start New Application(MIC/Register/Ched"Vcwdr-Wdd=08appf cafiwkt 0) Contractor :HIC RegistrationEBactive •Expiration AppllcaUonApplleaHonCreate m ,Task 6 Name Number;8tatus Oats Date Ty PC Statue Data C&J HUNT ; CONSTRUCTIONIM04 Active 12/16/201712/1512019Renawal Rego n.A1117/2017ManWRegistrafbnUHICdRegWeNRegDeta97conbacbxW=639fi08regL%tmtlmt&. Issued SERVICES LLC , _ C&J HUNT { Registration, CONSTRUCTION t85004:Expired 12116/20151211SQ017 Renewal issued 12/152015.Manage Registration(IHICJRegWwiRegDetmr?cw*actrk=83960®kstratlonld= , . SERVICES LLC i. C&J HUNT CONSTRUCTION,165004 Expired 12H020t31V092015,Renewal. =R� n12MM13Manage,Regisb n atio (miciRegisteriftoetai7cmuaet �ld= ued SERVICES LLC / C&J HUNTPeg. . istrebon' t _ CONSTRUCTION 165004 Expired 12AW011 12/052013 Renewal 12/052011 Manage Registration(IHIC/RegkstedRegDetait? kstrebmrl&= Issued SERVICES LLC C&J HUNT I Initial Registration L` CONSTRUCTION;165004'Expired ty10200912/092011 12/092009 Manage Registration(/HIC/RegfstertRegDetail7eontradadd=680&39regishationid= Application Issued SERVICES LLC i 02018 Commonwealth of Massacrusetts k, Commmnweallh of Massachusetts j Division ofProlessionblt'icensure # ... _. ®1 Board of Building Regulations and Standards Const�.ytiti)n. pyrvisor CS-102829- 1prres.06l26/2019 r CHARLES J INNT � 74 HOLLY RIDGE DRNE SANDWICH MIC9 .F,� Y68� Commissioner V"" t Application Number........................................... Section 9—.Construction Supervisor Name t'i (cS t,- -f Telephone Number �- Address 7V WV/ �i h• City Zu� State 0 r Zip License Number License Type Expiration Date_ Contractors Emailtty� Xt/)C� �i'UC,aco Cell # �� I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the costruction inspection procedures,specific inspections and imm docentation required by and th�ol4am�-- Attach a copy of your license. Signature - Date �L! Section-10—Home Improvement.Contractor Name � -� -�C�.S i ;,,`f, !, Telephone Number Address F o Foe- S City c�eST r- State zip 0,?6Y L-r Registration Number Expiration Date 5 I understand my responsibilities the rules and regulations for Home Improvement COut=tOr3 in accordance with 780 CMR the Massachusetts State ding Code. I understand the nstFuction inspection procedures,specific inspections and documentation required by 7 0 n of Barnstable.Attach a copy of your H.LC... Signature Date Section 11—Home Owners License Exemption Home Owners Name: Telephone Number Cell or Work Number I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation required by 780 CMR and the Town of Barnstable. Signature Date APPLICANT SIGNATURE Signature F Date Print NameCJI�CAW�5 <.J ` � � `' Telephone Number �oy� E-mail permit to: n MnfM 0 - Section 12—Department Sign-Offs _ �! I Health Department ❑ Zoning Board(if required) ❑ Historic District ❑ Site Plan Review(if required ❑ Fire Department ❑ Conservation Joe µ For commercial work,please take your plans directly to the fire deParftnent for approval Section 13—Owner's Authorization as Owner of the subject property hereby authorize to act on my behalf in all matters relative to work authorized by this building permit application for: I �sevike-W-e1Z, P2 �� ��� 8A (Address of job) ' Si a of Owner date a G P�j Lq i Print Name Last 2/92018 ry I av 05 14 01:05p Tupper Com 15087,785010 p.1 Li FD Norm F. u_...._....;... CONSTFRC1CTiQtV Cam_ L�c 546A Higgins Crowell Rd,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 , WWW.TUPPERCO.COM Date: 1 Town of Barnstable Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry This affidavit is to certify that all work completed for permit apple tion q0 (.�q t 60 Issued on � � �� { has been inspected,by certified rn Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. Sincerely, . Permit #: G(� C Address: LOw Richard Tupper License # CS-69058 :. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel I `t' Application dolqowv�� Health Division Date Issued Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address R9 E iSPnVY7t iez br. Village n�-l-i_t_.t� Owner, GC,IQ,YV� /�► G/� /1 Address �Q) � i'1 of Telephone_ © '-in glaq(a Permit Request 44-1 b-A00c 10r) 'n h Int.1) Co l l u acif (al' k_YL h. V'Ma 1 d" 2 rr'i r. Square feet: 1 st floor: existing proposed 2nd floor: existing proposed =TTotVnewan • Zoning District Flood Plain Groundwater Overlay 7 Construction Type Project Valuation O0 e yp fix P-T- Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting cl&ume ation, 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: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing 13 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 ❑ Oil ❑ 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: ❑ 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 k(cha -rd I(Apper Telephone Number Address.,7 1 I ►I(1� — I t h �V License # CAS'�b(r f. 5 0 5} Home Improvement Contractor# 7 Email COm Worker's Compensation #(,cXL&005�5 YOW7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO (YiI 12CN1 (Y) SIGNATURE DATE t e FOR OFFICIAL USE ONLY 3 'APPLICATION# DATE ISSUED MAR/PARCEL NO. y ADDRESS VILLAGE OWNER i r DATE OF INSPECTION: FOUNDATION x FRAME INSULATION FIREPLACE z , '~ ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL Y FINAL BUILDING t DATE,CLOSED OUT R - F k AS ATION.PLAN NO. A r , K The CoMmOnwealth of Massacoseft Department of IndustrialAccidenos Office"of 1n vestigadons 1 Congress Stree4 Siuite 100 Boston,MA 02.114-2017 www,mass gov/dca Workers'Compensation Insurance A#Yidavit BnilderstContractorslElec#ricianslP`lambers Awficant Information Please Print L gibiy Name Business/. Tupper Construction: t Oiganirationtlndrviduai), PPe Address:79B Wald Tech Dr City/Sta'te/Gip:West'Yarri outh, MA 02673 Phone#:5Q8.778=011;1: Are you"an.employer?Chmk the appropriate bog: Type.of projec t{required); ',MEI am a employer with 4. C] I am a general contractor"and I efitp}oyees(full and/or part-tune): have;htred the sub-contractors E New construc ion 2;0 1 am a:sole°proprietor or partner- listed on the attached sheet t 7.: Q:Remodeling ship and have no employees These stib-contractors have: g, Dem©l do i. working for me in any capacity; employees and,have workers'" com insurance . 9. 0 Building addition` [No workers' coinp_:insurance p required.) ;� We are a corpor, Ob and its; 10❑:Electrical repairs"oraddidons. 3 I tun a hgmeowner doing sit]Work officers have exercised their t 1. Plumbing repairs or<additigns❑, myself [No workers' comp, right of ereritipUon per MGI, . insurance real�uired.] 1 and.we have no 12.Q Rgofropalrs c 1�2,§1(4 employees. (No workers' 1lg...6her Weatherizatiori% comp:insurance required:) ns.u: a _ion *Any applicant that checks box#1 must also$II out the section below showing tli it wnrkais oompensahon.pohcv information t Haenwwuers who submit this affidavit indicating they are doing aI1 work and then hire outside contractors must submits new affidavit indcatmgsuch:.- tCotittactors that check this box must attached an addttional,sheet sho ving.tlie name of the sub coiitractors and:state w}iefher or:not those eni7Ues h$ employees. If the sub-contractors have omptoyees,they must provide tlietr"cvvrkt is'comp.policy;oumber: I apt an employer that is providi fg ruorkers'comperes«#ion insurance for my employees Below is the palmy antijob:Site informa#iax Insurance Company Nan e:.AE1C policy l# or Self ins.: l.rc. t WCC5005593612007 (fl/3t14 Expiration Date: Job Site Add ress:-f 0ElmniY Yjit>P, Cty/State/Zip Attat b a copy of the or corripens>>ifion policy declaration page(showing the policy number sad expiration date);; Failure to secure coverage as required under Section 25A..of MG�:c. 152.can Iear;to the'imposition of criminal penalties of fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP 1UORK ORDER aril a fine of tits to$250.00 a:day a e Yrolatat i .Be advised that$co py of dtis statein nt rrtay be f©t warded:;to die Ofrk dr lltr t Stigati ns�l the A tOC IAS "A}1Crw Gd°eC..ge Vert lCBt;pn. I do Itereby`cer u t e S.anilpertalties.dfperjr�ry thus the is{fr rmrat on prov r ed above is hoe 0 correct attire phone#: '5 1`1 Of cial use only. Po n.Wt write'in this:area,to:be completed by:city or, wti;ufftrlal.. City"oir Town: Perinrt/I.icense`# Issuing Authority(cycle one); 1:Board of]EIealth 2.Building{Department.3:City/Town Clerk 4.gleetr cal Inspector 5.Plnmb>ng;Inspector 6-Other, Contact Person: Phone:#: , I s oLqUXNUF�tf#Ht3i{Al1a 1Vl:t nwj i 1 U )asxliusetis tk j partm tarltr.MY lam, of:Public$efety 1 87 tim%.S�wr tt;i Board ct_Butfding Regul ions Sind Standar [ f$TF#2?�►-i2?3 � TtICHARIS TUPPER. 74 8 r,1tD-`rEcm 9R ( WEST YA1�MOVIFH 73: T UPW41 Expiration — (SEENOWE$IeFrip6€SIfi0.A-i1MAN£~ftfi+it.+_� LiXatYkS5iti4et 1W$1/2014 P"*Heipt::g%opie Build a Safer W*rtd- f rcMAt ,g,' , MEMBER i Richard Tupper # Tupper Construction f I • Buiiding Safety Professional . Member'##:81581.19 Exp: 30I2014 ;. Office:of Consumer.affairs&Business Regula((on License or registration:valid for;individul use only `� HOME IMPROVEMENT CONTRACTOR before the espi date. 7f found return to: tegistration 178434, Type:: Office a'irs.and Business:Regulation � Expiration.._4/1fi/201.6` LLC 10 Par aza:-.Sui a 5170 B t t 021 TUPPER CONSTRUCTION CO,LLC: RICHARD TUPPER 79 B MID-TECH DR. W.YARMOUTH,MA 02673 Undersecre.(arr IYo ith'out s-i nature`. , ...ACORN; { ., CERTIFICATE OF LIABILITY INSURANCE 2j63/°2°01 3' j THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND.CONFERSNO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGEAFFORDED BY THE POLICIES BELOW. THIS'CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUINGi .INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. f IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed.:If SUBROGATION IS WAIVED,soubject to the terms and conditions of the policy,certain policies'may rs require an endoement A state ce ment on this rtificatedoes not confer;rights"to'the certificate holder in lieu of such endorsemen,0s)., PRODUCER NCONTACT AME" Lord WOO Southeastern Insurance Agency, Inc. PA"rc°N ; (500997-6061 a�Ne;(508)990-2731, 430 State Rd. - E-MAIL ADDRESS: P.O. BOX 79398 PRODUCER .. CUSTOMER ID;M N. Dartmouth, MA 02747 INSURER(S);AFFORDINGCOVERAGE NAIC'n. ! INSURED - - . INSURERA: Arbell;a: PrOtE'Ct70i1 Insurance j Tupper Construction Co: LLC INSURER AEIC wsuRErt c CNA Surety 27 Roberta Drive West Yarmouth,: NA 02,673; INsuRERE•: ... . . INSURER*:: .. .. COVERAGES CERTIFICATE NUMBER: 2013/14/l.. REVISIONAUMBER: t THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION.OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS j CERTIFICATE MAY BE ISSUED.OR MAY PERTAIN,THE INSURANCE:AFFORDED BY THE POLICIES DESCRIBED.HEREIN-IS SUBJECT TO:ALLTHETERMS EXCLUSIONS AND CONDITIONS OF SU.CH.P.OLICIES,LIMITS SHOWN MAY HAVE:BEEN REDUCED BY PAID CLAIMS. ! INSR. ADDLSUBR POLICY EFF POLICYP, I LTR 9 TYPE OF•INSURANCE INSR WVD POLICY.NUMBER MMIDO MM/D LIMITS GENERAL LIABILITY _ 8S000O874' -1%1IO1/2O1>3 11101I2O14 EACH OCCURRENCE �,$ 1,000'0__ X COMMERCIAL GENERAL LIADILITY ENTED PREMISES Ea oca,rrence CLAIMS-MADE a OCCUR AHED EXP(Any one person) :S,00 A Y_ PE RSONAL&ADV INJURY S _. 1,000306( GENERAL AGGREGATE S 2,000,00 GEN'LAGGREGATELiMITAPPLIE§RER- .PRODUCTS:-COMP/OP._AGG'` S 2,000,00 POLICY PRO- LOG S.... ._ JECT AUTOMOBILE LIABILITY- 56662400002 1-21011201.3 1210,1120149 COMBINED:SINGLE:LIUIT - (Ea ac6denq: 5 1,000,00 ANY AUTO BODILY INJURY(Per person) --,,S ALLOWNEDAUTOS. .BODILY INJURY(Per accident) S A X SCHEDULED AUTOS PROPERTY:DAMAGE $ X HIRED AUTOS r (Per aaxeenf)' INC _. X NON-0WNED AUTOS $ UMBRELUi,LU1B. X :OCCUR 460005836_-111011 0 3 11I0V2014 EACH OCCURRENCE: 5' 1,000,0040 EXCESS LIAR; CLAIMS-MADE AGGREGATE A : 9` 11 OOO,00 DEDUCTIBLE S; RETENTION $ S; WORKERS COMPENSATION WC50 31 ` 10/0312014 TQRYTXAND EMPLOYERS'LIABILITY. Yl N, LIMITS ER ANY PROPRIETORIPARTNERIFXECUTIVE RICHARD TUPPER I E.L EACH ACCIDENT-- $< 1,000,06 B OFFICERIMEMBEREXCLUDED? NIA'.(Mandatory In NH) 0 CLUPED. FOR,WC COVERAGE E.L.DISEASE;c EAEMPLOY_ If yes,describe under DESCRIPTION OF OPERATIONS belo4i - E.L DISEASE-POUCY,GMIT $: 1,060,00( DESCRIPTION OFOPERATIONS 1 LOCATIONS 1 VEHICLES(Aftacb ACORD-.toi,Additional Remaika'Schedufe,if more apace Is re4uireA) CERTIFICATE HOLDER CANCELLATION SHOULD ANY-OF THE ABOVE DESCRIBED LIC POIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE 1.WILL BE DELIVERED' ,IN ACCORDANCEWITH THE POLICTPROVISIONS: "For Information Purposes Only Tupper ..COnstruct on CO LLC ' AUTHORIZED,REPRESENTATIVE 27 Roberta De Ve W. Yarmouth, MA 02613; Lora: Lowe;. . ©198&2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009I0% The ACID RD name and IIogo.are registered`marks of Ad. RO .�ttar► A mass save R _ PERMIT AUTHORIZATION FORM i, Carl C Andersen ,owner of the property located at: (Owner's Name,printed) 118 Eisenhower Dr Cotuit (Property Street Address) (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X ner s Signature 07/19/13 Date FOR CSG OFFia USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Rev. 12132011 - TUPPER CONSTRUCTION CO.LLC 79B 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 r (508) 790-6230 fax Re: Insulation Permits Dear Mr. Perry 0� C:) This affidavit is to certify that all work completed for permit application # 0 / S Issued on has been inspected by a certifaed�► :_ '�' Building Performance Institute (BPI) inspector. All work performed meets or exceeds Federal and State requirements. eIL1�,Iw el T upper : License # CS-69058 w o 16J4113 ' TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application Health Division Date Issued Lb Ct 1 Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village Jr— 27 Owner ?�AZYL. _ az�a�il.Elei Address X a Telephone Permit Request Ct��>i '-� x . Square feet:.1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay a- w Project Valuation l��.p° Construction TypeCDI , Lot Size Grandfathered: ', ❑Yes ❑ No If yes, attach:', porting docur�r` ntation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family (# units) En Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway,❑Ye 0 No Basement Type: ❑ Full ❑ 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: ❑ Gas ❑ Oil ❑ 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: ❑ 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 Wie'34� Telephone Number Address '79 mr-a-1 22a& �)A- License# CO- 06 O g ' (0� UaAm 6 PA Home Improvement Contractor# Worker's Compensation # WeC 5005.59'361.2o,2 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAK TO � GIB SIGNATURE DATE 161h ko FOR OFFICIAL USE ONLY 's tAPPLICATION# &-DATE ISSUED 4 MAP PARCEL NO. r' ADDRESS VILLAGE OWNER �r DATE OF INSPECTION: FRAME INSULATION , < , . FIREPLACE a ELECTRICAL:. ROUGH FINAL PLUMBING: ROUGH FINAL t GAS: ROUGH FINAL �a FINAL BUILDING. r .a DATE CLOSED OUT ASSOCIATION PLAN NO. Ilk mass save PARTICIPATING CONTRACTOR 3iTi 7'ty :t1r'Cv�^G:rt:.!S�1 �7:�t.aREj;, ti*rw+r�' PERMIT AUTHORIZATION FORM I, Carl C Andersen ,owner of the property located at: (Owner's Name,printed) 118 Eisenhower Dr Cotuit (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X 0 ner s Signature 07/19/13 , 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: . Parti p ting Contractor Da e Rev. 12132011 LAMJX►K3 PIENFUNN9011M INZi71TtlTE1 INC Massachusetts-Department of Public Safety 107 Hwm Ro"Suite 110 i Board of Building Regulations and Standards } ' MiRL NY 1.2= Ctimtrurtion Suhcrvisur 4 $, r License: CS-069068 � RICHARD S TUPPER -79 B MID-TECH DR WEST YARMOUTH .,. Richard Ttl {{OR torao�oP+o i �`` RO ONA L `%�4.. &,J(*. ,r r4��; Expiration Comtnissionet 12/31/2014. . (BEE REVERSE SIDE FOR t1ESIfdM OS u1t1 E1f�ATIt111 t1AtESi Oee of Coasntuer Affaln Jc H loess Re�ti4Elor Cr � • Peopte$Hetping P opte Buitd a Safer World'"' 4a HOME IMPROVEMENT CONTRACTOR INTERNATIONAL R"Istmilon: 44 5 Tow. ca�Ecau�ar �� •`;�. �� � . ��.- �� Expirsldon 1a Individuai MEMBER ' , F * ' RI RD TUPPER I , ,Richard Tupper Tupper Consfructlon RICHARD TUPPER r s 29 Roberta Dmre N v-,/`. Building Safety:Piofessio l� W.YARMOUTH.MA tl2i313 ..o VaderwereUry Member#:$1581,1 ,Exp%30/2014�r- �j r " 4 ACO CERTIFICA TE OF LIABILITY INSURANCE DATE(MUMDIYVYY) 10/07/2013 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(Iss)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 NTA T Lora Lowe Southeastern Insurance Agency, Inc. NAME; PAX 8)997-6061; C50 439 State Rd. EMAIL Nd-(508}990-2731 P.O. Box 79398 ADDRESS: PRODUCER N. Dartmouth, MA 02747 CUSTOMER ID INSURED INSURER(S)AFFORDING COVERAGE NAIC 0 INSURE2A: Arbella Protection Insurance Tupper Constriction Co LLC INSURERS: AEIC 27 Roberta ©rive INSURER C: CNA Surety West Yarmouth, NIA 02673 INSURER D: INSURER E; COVERAGES INSURER F: CERTIFICATE NUMBER: 2013/14 REVISION NUMEtER 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, EXCLUSIONSAND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. tlL1RR TYPE OF INSURANCE AD UL INSR VWO POLICY NUMBER INPOUCY EFF jr0ym Y EXP rm LIR1nS GENERAL LIABILITY 8S0000874 11101120121110112013 EACH OCCURRENCE X COMMERCIAL GENERALUABIUTY DAMAE S 1,000,00 NTED 100,00 PREMI Ea omrrsenoe S C AIUS-A1AOE SES OCCUR UED EXP(Any one person) S 5 00 A , PERSONAL&AOV INJURY S 1,000,00 i GENERAL AGGREGATE S 2,000,00 GENLAGGP.EGATE LIMIT APPLIES PER: POLICY ERGO- LOC PRODUCTS-COMPMP AGG S 2,000,00 S AUTOMOBILE LUIBILITY 5666240000 1?J01120t2 12/01/2013!COMBINED SINGLE LIMIT ANY ALTO (Ea acddent) S 1,000,0 ALL OVJNED AUTOS BODILY INJURY(Per person) S A X ISCHED:JLEDAUTOS BODILYI-JURY(Peraecidenq $ X . HIRED AUTOS PROPER-YDAMAGE S (Per accident) - INL X NOIJ-0VVNED AUTOS " 5 S UUBR S A S X oxuR 460005836 031011201311110112013 EACH OCCURRENCE 5 A EXCEss LJas cLAtmS MADE 11000,000 AGGREGATE S 1,000,00 DEDUCIBLE RETENTION S s WORKERS COMPENSATION S AND EMPLOYERS'LIABWTY Y r N WCC500SS930120071010312013 10103/2014 X WC STATU- X OTI+ ANYPRICOPRI=rCRIPARTNER/F.XECUTiVE RICHARD TUPPER I TDRYLIMITS ER B OFFERIMEVEER EXCLUDED? N/A EL EACH ACCIDENT _ OO,00 (Mandatory In NH) I ELIDED FOR WC COVERAGEEL D'SEASE-Eq EMPLOY l.y.QO r OO Iles,DESCRIPTION OF "I OcSCRIPTION OF OPERATIONS below E.L.DISF.s SEQ:'p ,ICY UMIT s 1,QOD.Do C Bon or the t o money & r T106991 02/28/2012 02/28/2013 IJ,'TT t of $ ®I,0 property. � , DESCPoP7IDN OF OPERATIONS I LOCATIONS I VEHICLES(Atiact!ACORD 101,Additional Remand:Schedule,Ir morespace Is requlmd) jpp " w �O CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 1N ACCORDANCE WITH THE POLICY PROVISIONS. "For Information Purposes Only" Tupper Construction Co LLC AUTHORIZED REPRESENTATIVE 27 Roberta Drive W Yarmouth, MA 02673 Lora Lowe ACORD 25 2009109 01988-2009 ACCIRD CORPORATION, All rights reserved. ) The ACORD name and logo are registered marks of ACORD r The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 0211 4-2 01 7 www mass govldia Workers Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le2><bly Name (Businesa/o,,-anization/Individaal): Tupper Construction CO. Inc Address: 79B Mid Tech Drive City/State/Zip:Wl-st Yarmouth, MA 02673 Phone#:(508)778-0111 Are you an employer? Check the appropriate box: ❑ I am a general contractor and I Type of project(required): t.0 I am a employer with 4. 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 S., ❑Demolition working for me in any capacity. employees and have workers' [No workers' cornp. insurance comp. insurance.l 9. ❑Building addition required.] 5. ❑. We area corporation and its 10.❑Electrical repairs or additions 3•❑ I am a homeowner doing all work officers have exercised their 11.E]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.] *Ary applicant that checks box#1 must also rill out the section below showing their workers'compensationpoucy information t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new davit indices gsucb. tCon tractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or qo those entice have cmployees. if the sub-contractors have employees,they must provide their workers'comp.policy number. z 1 am an employer that is provldtng workers'compensation insurance for my employees. Below is"11ze"policy and job��e — inforrnation_ .. Insurance Company Name: ABC o. 4 `~ Policy it or Self-ins-Lic. #: WCC 5005593012007 Expiration Date: 10 3/14 n Job Site Address:&r City!State/ap: 6' J 4 Attach a copy of the workers' compensation policy declaration page (sholving 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 Alt L4 for in coverage verification. �Ido her y certify un� thepairs and penalties Of perjury that the information provided above is true and correct. at e: Date: Phone#: _ 7 7Y ' 0 Official use only. Do not write in this area, to be completed by city or town offwial. Cilh,or Town' PermitlLicense# bisuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical In 6.Other spector 5.Plumbing Inspector Contact Person- Phone 0: r ........ F [ �• ail I 4 ��� �y � � r � + i ` i 1 P� al 07 C u:.R T M a D/ PlD f PLAN i )4W Satl!'9U Mib .» .•tvi jk.�-1 l�J� �!+1�•' 1n. Y, f>LAIO REFERENCE C t C� 4`�I E�'a .�'• ,P 1.1 J ..(_ f q I I a ! ! I CERTIFY THAT THE SHOWN ON MS PLAN IS L.GC+aTEO ON Tl,-),E GEdr'>i RrD E ZONING . LAWS OF I'HE T01074 OF. A a� ;' •'_;;= WHEN.C0bb3U :'Ti �. 1_ I \{/ p,; q 1 5 r 1 DATE i 4: 1 � �r l PETITIONER : REG. i AND SbijfiV�'l4i}c Asse*�r's map, and" lot number ................... ...................... s., y y I SEPTIC -SYSTM�`,1! T . INSTALLED IN C_fi" fi LIAN.CE Sevvage'tPermit..number ............................................ .E.......... .. WITH ARTIC . II'STATE SANITARY CODE AND TO,WIV;, �OF7METD�y, C TOWN " OF BARNST `l ° I HAHHSTIBLE: j d oD.MPY M M B-UILDIHG , INSPECTOR APPLICATION"FOR'PERMIT TO ........ I. .......... ............ ..... ......... .... . .................. TYPE OF CONSTRUCTION ..... � ... �Z. :. !`. .. .. ........................................................... r :... ram`:. ...... ......19 G' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: ........ l f�. .. ..�....... . .V..l�i..........4.��.1..v�..(..............:...................... Location .....0.� . ProposedUse ..... !.. V..I.rr...... '!l..f...'.,�................. ........... ............................:....:.. Zoning District ........................:............................/..................Fire District ( U U..�... Name of Owner (� .:. ..� :....1?- ?..�....� �.......................Address ....Il... ......` .: ..'! .[ ..I .......................... Nameof Builder ....................................................................Address ..................................................................................... Nameof Architect ..................................................................Address ..............................:..................................................... Number of Rooms ....... ...............:..........:.....................Foundation .. �../�.:.. l�fJ t/': :....... d w;C2fy.............. n� Exterior ..... .. 'R...C.. ��. n.......................................Roofing ..:! ... ".... ..................................... Floors .........................................................................Interior .. ..... .. HIF.C./, c . Heating `i I� f' ./ q R ........Plumbing C" .Z ........................... g .....................t.. ... ....................................... ;.. Fireplace ..........Approximate Cost Definitive Plan Approved by Planning Board -----------____---------------19________. Area/ l�lr4.�. ............... do Diagram of Lot and Building with Dimensions Fee .................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable re arding the above construction. 9 � Name ...r�� .. - ..C� ... . ............ .................. W. E. D. Realty 18,160 one story, N ........... Permit-for .................................... Mingle family dwelling . ............................................................................... ; .0. Eisenhower D Irive1 Locatio ................................. ............ Cotuit .........................W................................................... . E. D. Realty Owner-..................................................... 41 /`;I/ '0 frame Typeoof Construction .......................................... ..........*.,./................................................................... ^,,,Plot ............................ Lot .................... ........... e� February 9(,., 76 Permit Grant ........................................19 Date of Inspection ......�719 Date Completed '"'19 in PERMIT REFUSED 40 ... 19 .......................... ................................... . ...................................... .................................... A..................................................... ........ ........... ......................... ............................ .. .................. ............... ............ .................................................. Approved ................................................. 19 .............. ............................................................ ............................................................................... i 3 4� post 4 S T e h s c I I I Step i I ! i I a `e I oS b e s I I , L I - I I I i I i I ! u!6 c I i i I t j I I I ` i I i - i i I I i _.. NOW ; l i j l o C?V11 j �aR•cs- Ga ���cr. iOS7 O,�'- 3-t.A—SS/,Ci-3 US3:-TTS o2113 'ORXEtS COMP ENSA3-IOTI 13�1S�IL4NC£AF�?D �- (i7ccctscrlpctmitzcc) _ -hh s principal pLwxofbusincufTcddcpm:2c 7t C) o kems (c:D ; , do hcrcbyccr66-.undcrthc inssnd (Gut)S ximr: pa pazzltics ofpajar�;t:haa ] l =m an cmploycrproviding the followingworkcrs-comtxnsaricn cov=zc form ,= to ccs uvrk; job_ Y P Y n8 on this 7nsur.2ncc Company Policy Numbu In a solc proarictormnd h2vc nooncworkins for mc- 0 Isms solc proprictor.Zcnc_J contr-aor cr homcowncr(cirdc onc)=d h:vc hifcd the concmczoa isccd bcl ha�c the followiab v orkcs cnmpa=don inn=. cc politics_ - o"' �===x arCoa.:_�or Irsz:---ncc Compaaylt'oiky Nam,bcr Namc ofCon;r--c;or Insurncc Co:Mp:nyPolicy Ncmbcr 11;:zm...c crcor.;__Gor - Inr=rcc Ccrnp:nypoiicyNurnact 4t=1lz.cwo:rrny_dL <-C r__ict< cccltruc.:Cc p <,c•loci--c ti Lc«cc�tl tc�.0 L<�crxc� LGc„ <c ni:L<c<L to lctiLts ce oc tS<£rccrcL=p�tcZ=t t3<rcto tc�c ooc�<ur�j' <r=pk;<rt`Lcr txt7cl -Ce� JCR<CL C]52,«c]($)).n�Fl;ct:ct br s b<lxe••a!�tot a t:<co:< c<p<rraa r.._ cr•il Carar�<crat:cc ACL <C7� v.< �< -<r.c c�)^G� tr; t r / 'O•. «c.Jarz:cc fcr.«—<r�c tc:«c,<c•':1<;:r<cc.r<G vr.lcr.S<C•cr._5/,cf iJ 7 �- t •r.<c�L•�<c:7<Cfi.Cfc:Lc:r .acc�SiLG_CL :Y y``=L���C•��c isctcfc m.c!cSccpt/cckOrlcr= li<cn_cclPcrr.;it;cc Liccn:or�Pcrrairto; Y 6tM dW 33dHSVW HMUSiNINGV Od S311101 8£ 3DUJOH '9 OIAVO 3NI 3NT130003 WO'_S(13 */60M uollPlTdz3 NOI-I HH803 31dAIad edAl 08801T uoT3eajsT6q d013VKNO3 1N3W3A0ddWI 3WOH W—g ail —1 DEPARTMENT OF PUBLIC SAFETY ONE ASHBORTON PLACE BOSTON,MA 02108 LICENSE CONSTR. SUPERVISOR EFFECTIVE DATE LIC-NC. 0 03/31 /1994 050096 DAVID G `N11FNA6EL zo 38 JONES RD z MASNPEE MA 02649 NOT VALID UNTIL SIGNED BY LICENSEE AND OFFICIALLY STAMPED-OR-SIGNATURE OF THE COMMISSIONER l; i SIGNATURE OF LICENSEE . �� � CIONER Assessor's office(1st or' aa9i b '° f�Rr Assessor's map an nu f ' "L �� � e THE Conservation L �®j�(;� ♦w Board a Hea rd floo � ®�� DAUST�DLE Sewage Pe 't umber .O rua Engineering Department(3rd floor): ) c iv House number ` ( � 8 ' ' ��'��UT, as , Definitive Plan Approved by Planning Board 19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2:00 P.M.only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO U U,l L d ' ' 7)&e i<' TYPE OF CONSTRUCTION /y j�r� L /3 19� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location / / b t-u r- ` O u i t_oy I Z) Proposed Use (^_ K- Zoning District Fire District Name of Owner l� R , A H t) e r s e l^ Address Name of Builder UI C"1 V T h 4 q Address_ /� .1 b��.C I`mil �� �Oe Name of Architect —.................. ..... �' Address ~� Number of Rooms Foundation Exterior Roofing Floors Interior Heating Plumbing Fireplace Approximate Cost D oc� Area -52O!D Diagram of Lot and Building with Dimensions L of.�� Fee , ISO Lod 3 NQ , r 47 r � I SNvtirf- �k .196 � Seh h owes —ji r 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 1 =z 41 - Construction Supervisor's License ANDERSON, CARL No Permit For Build Deck i Single Family Dwelling Location Lot ;#12, 118 Eisenhower Drive Cotuit - f Owner ' 'Carl Anderson - t Type of.Construction Frame IL XY Plot - Lot _ Permit G anted April 14 , 19 9 A� Date of Inspection 19 ; Date Completed -19, r , } .; Uq z; a r y y n' a ky.}t {y.l d.3aSa r - �L y t:• - L e''�'�'L s w Its Tv y �rd Z.. n Ja '<i rtlf`-it �k..• Y 4 f 1 r t 1 •t'7Ri 6 r k .`'Y.•� 6 ��-� �,.5 t - � ._ Y r 1 CERTIFIED PLOT PLAN tr LOCATION C.oTV i :T. _ K ., .. r SCALE DATE PLAN REFERENCE `` .11. 5 i-1:C21t�1M �`.� :A,PT is Wa� •T i t -� °`,,,.. \� a r+< I,t „�$'c� '�'�• `�'"-...�,, r��. +�{£1.l_ wt�%,•a��a� fi b ••,�`. x E Y 'r- T<. -S 1.-• � }' �`�it '� 3� js�1���� £„t 1 (� }}^+, � �s�`' �'� } Y 1r � it. \ZJ.5.., }°C I CERTIFY THAT THE TcQNT�iA-TiOk SHOWN ' ri ON THIS PLAN IS LOCATED ON THE ORO1JNa W.E:..L r'# AS SHOWN HEREON AND THAT IT CONFORNLS TO T\ sI r� Y 1E ZONING LAWS OF THE ?OWA1 OF R _ ; X?R.k r w WHEN RIJCTEd N Yrti A 5 5DATE . . �, • e. �I 'PETITIONER : REa. ND- 5 VEYOR.: Assessor's-offlo(1st Floor): /` ,,, SEP`1C SYSTEM, OlUq Asses`sor's map and lot =�.3�� 1�6INSTALLED IN COMP ' Conservation �/ .2 �ET�'61 ° a®�TL� Board of Health / Sewage Permit number �(�^ �� � i E TOWNNVBR® MENT�AL C otz � REGUL��� ,a70. � Engineering Department(3rd floor): House number Definitive Plan Approved by Planning Board 1g, APPLICATIONS PROCESSED 840-9:30 A.M.and 1:00-2-00 P.M.only p TOWN : OF , BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TOf/JG TYPE OF CONSTRUCTION _ �(/O O J� e-yq yy�� 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location l%� ` J-s'�/✓��a w GIs'/ // G ©J U Proposed Use Zoning District— Fire District Cn w/'S-- Name of Owner Address /�� is E�✓�erc� , G Q f v Name of Builder Addresses %���✓��/1� �,t/, `, .S �,U� Name of Architect �' Address Number of Rooms Foundation —5-e-V o Exterior &J G'� ����'� L Roofing -S' ✓��yLT Floors. >,"We D 6 Interior Heating /✓cl Plumbing Fireplace //0 Approximate Cost C�,?, o? 4 d Area /ZP .-- o� Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name -� Construction Supervisor's License 3 J ANDERSON, CARL R� - 't N$ 34802 Permit For BUILD TOOL SHED .Y _ Accessory to Dwelling _ 1 Locatio'- 1-18 Eisenhower Drive i Cotuit , Owner. !C-Li 1 Anderson Type of*Construction Frame Plot ! Lot 1 Permit Granted Jariva y-` 21 , 19 192 s ei i Date of Inspection 19 Date Completed ,L', 19 .. ME 1 �: • ram,,. 1- +: t r r i f 1 .—I S1H!V.e-03 LNI i0 NO tl�OTON 3 tld eivn 1 1110 Y».: %38 1S p N3W(1000 9 , tl StlHip. V• . 1HJ13H a (AINO - c 1 NI1SV}g}LOlOF1d q ;. i pEPA�MEIiT ` {:p , IoA°coMMp0��5' , NOV ;. 31ea rvoueatdic3 :C6 aSl it EFFECTIVE 99 l : OA No owwo� S 8 L� � .. NOT V Afro op -Z F � r r ., yp►AM,9 #� . UST E Assessors offioe (1st floor): Assessor's�m�ap and lot number ...... /��/....�� ....�,� �.., �oF?NEt�� Board of Health (3rd floor): PATH TITLE 5 Sewage Permit number .........76...:-':..3-/. .........:�!--+�'.... �;Rt,(DMMEKTAL CODE AV. Z BAB39TABLE, Engineering Department (3rd floor): =p'cvm REGULATIONS 'oo M639 0� Housenumber ................................A1.1.1.8.......................... o� a� o NC 0 ypY APPLICATIONS PROCESSED. 8:30-9:30 A.M. and 1:00-2:00 P.M. only TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......���S(f'wC�G/ Sf/Q1 ��� °�............................ ..................................... ...................................... TYPEOF CONSTRUCTION ..................................................................................................................................... • n `�.� .....1.�........... ......19.$� TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for/a permit according to the following information: Location ��0 I s Gt A.0.C-4-f. /I d............4fG.��/t�� /s"t c, °..... U ....................... ..... .I .................................................................... 0 Proposed Use �.". ��' �....................... Zoning District J......�............................................Fire District ��°�C�cf7_ d'.` ........................................................... Name of Owner ... ... fir......./9.!A.` 1�4.Address 0�f_ °S'LjQ�j - jj.......... // ® // .......... ................................................ ....... Name of Builder .G(ZVl..... /ta(�(�G✓ /dfJr � 13t✓Jm G�Ylvlar ,J.....A dress ..............I........................��- ...........5. Name of Architect ............................. .........Address Number of Rooms ........................................Foundation .....���?& .......................� S' .....�V&... .,.1/'.��S.S................. // Exlerior .........L.��.Z!.....P^.... '7.'�?}..!. 5...............................Roofing .........�..S�........`.!J!./-............................................. Floors ,,/ �`H� J 1� ........G`""'.. 0�4 ................................................Interior ....... ................ ...Gry l7 Z/ " . ...... . ............................. Heating �U . .........................................................Plumbing ...................d1 (1bZ ....................... Z ................................................ Fireplace .........................Approximate Cost .7 1,.. ,.� Definitive Plan Approved by Planning Board ________________________________19________ . Area ..?........................ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH' f a 1yj 2 Z 1 t 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 .... �.:/...�1 ........... } G Anderson, Mr. & Mrs. Carl , 31215 dd or/to„ No ................. Permit for .......a........P.............. 4 sin le famil dwellin ^ g.......................................g....................... Location 118 Eisenhower_.Drive Vi Cotuit ............................................................................... Mr. & Mrs. Carl Anderson¢ Owner ' Type of Construction ...........frame..................... ................:......................................................... Plot .................... Lot ................................ +,M Permit Granted .........S. tem.b 19 87 Date of Inspection '��c'�/` 3'� .........19 Date Completed ......... ........19 ht /N" � r , t � r . r j ` r Assessor's offioe (1st floor)-"L, j —�71q,�%,/ F /// �FTNET� Assessor's map, and lot number' ............................................ { �♦ Board-'of Health (3rd floor): SEPTIC SYSTE Sewage Permit number �?J....,....,. .F..... a,: a PalSTI•ALLED IN C Engineering Department (3rd floor) `�r WITHTIT4. House number .................................. ............��� �' `�` o�AYa`e0 ENVIRO MENTAL C KID APPLICATIONS PROCESSED 8:30 9:30 A.M. ,and 1:00 ,2:00 P.M.,onlyl ,IDS REGULATIONS TOWN. 'OFBARN-ST-ABLE BUILDING 11S�PECTOR S APPLICATION FOR PERMIT TO N N ... ........... T�. li✓O'.v� �via lrl t YPE OF CONSTRUCTION ........ : ...... ............................................................. .. .............. .......... ... '< ' . .• ..................................................... a fi ✓G VJ TO THE INSPECTOR OF BUILDINGS: ; The undersigned hereby applies for a permit according to the following information: Location ......... .t 0 .i 5'7i ..�!.UG✓ G,l�,. . �l-� `...... .U:!. :......... . ....;.:F.......'................. Proposed Use Jam. hs.2 a rl ,. ......................................................... ......... Zoning District ......... .Fire District Q. _; C I Y .. Name of Owner m�.. .. `��5.... .�^`".�..!.'.�' i'`..Address .,...��.V...L,.�•Si l'j .11. ........... ...... ......s�... ... . . pr:................... Name of Builder ..e !^US .........................Address ..... C/S/- '✓. -i✓ Name- of Architect Address .. ..........:.............. . ................................................................. ./...................................................... Number of Rooms .`........... Foundation ..... �v"`�K .......................................................z�z Exteio. Roofing ........ ..............�. ........................... Floors (/vvzvl.....��G`�..Cr!''� .....4/..* "�� Ok . iy , 's�•Z� F Heating ...Plumbing ..'.:................. ;.. Fireplace .............................................................. ........Approximate Cost a........s . . . ....F'.............. . ............... Definitive Pl6n Approved by Planning Board•-----------------------_._____--19________ . Area ...1=:® ............. - Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ` L�• F� V , . y d 46 Alm C ` 3 • 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 ...v.�..1...1..I Z.......... y ANDERSON, CARL t No,, 30363 Add Garage ..... ........Permit for ..................................... r _ ' w Single 'Family Dwelling ....... . .... ..................................................... Location .. 118,E Eisenhower..Drive Cotuit F ...................................................... ° Owner! Carl Anderson - ............. 4 . ........ Type of Construction .."Frame y .......... I .............................................. .............. ............ ' 1, , // ty 4 .' �.. C ` f , • ..r ` Plot ............ ' ... Lot :.......... r } '� Permit Granted ........ Janua;ry�-;9, 11.9 87 E ! k Date of Inspectionn .. ...... s�- '.19 Date Completed ...... .�� ... 19