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f 1p 11 1412:46p Tupper Com 15087785010 p.1
CONSTRUCTION CO. LLC
79B MID-TECH DRIVE,WEST YARMOUTH, MA 02673
PHONE: 508-178-011.1 FAX: 508-778 5010
MAW.TUPPERCO.COM
Date:
Town of Bamstable
Thomas Perry CBO o
200 Main Street
Hyannis, Ma 02601
(508) 790-6230,fax
Re: Insulation Permits
Dear Mr. Perry'
This affidavit is to certify that all work completed for permit application
Issued on has been inspected by a certified
Building Performance Institute (BPI) inspector. All work performed meets
or exceeds Federal and-State requirements.
Sincerely, Permit
Address: � 7 G� n
Richard Tupper
License # CS-69058
.'4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map Parcel v Application # 41 g 6 S 1 9
Health Division Date Issued ��IJ� y
Conservation Division Application Fee S
Planning Dept. Permit Fee
Date Definitive Plan Approved by.Planning Board
Historic - OKH _ Preservation/ Hyannis
Project S7671664111C
t Address
Village ,
Owner � DCf7 D Address -i(,0�9 Z;✓�s /D
Telephone `7` 01 -`7`
Permit Request /d'.lQ /IGi'. /�7JAalM f�lG'wx W 2Z Gax rel%ldde �77 G7�7 G 1�ylxG
'oCA_jjle�'r In m4r haf s �al-110d
fig
Square feet: 1 st floor: existing proposed 2nd floor: existing propose�Tot� never
erg F
Zoning District Flood Plain Groundwater Overlay � i
ra
Project Valuation 5 9, Construction Type ;
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting ocurrtatior.
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: 91/Full ❑ Crawl ❑Walkout ❑ Other
Basement Finished Area(sq.ft.) Basement Unfinished Area (sq.ft) 117 ,5
S�
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 mil ❑ Electric ❑Other
Central Air: ❑Yes L'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:
1
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 Telephone Number �J y0 ' 77F-0111
Address 7M M;o License # C f- 0&l a�_
./
(/V 0�W7 Home Improvement Contractor# l7Q J
Email 627��M� Worker's Compensation #h gV55-!!& 0
ALL CONSTRUCTION DEBRIS R SULTING FROM THIS PROJECT WILL BE TAKEN TO ��� h7Q)
)/-.
SIGNATURE DATE
.j
t
4
} FOR OFFICIAL USE ONLY
E �w
t
APPLICATION#
DATE ISSUED
F MAP/PARCEL NO.
p ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
FOUNDATION
4 FRAME
INSULATION
FIREPLACE
t ELECTRICAL: ROUGH FINAL
PLUMBING: ROUGH FINAL
i GAS: ROUGH FINAL
FINAL BUILDING y
t
DATE CLOSED OUT
ASSOCIATION PLAN NO.
i
T'he -01AI .Onwealth ofMassachusetts
Oepar ftwnt;ofI"dusl'rialAteekletats
Office of-Tnvesiigations
1 Congress Street,.Strafe 100
BOstola 1 M4 02114-2017
wwwmass gov/ tra
Workers'"Compensatio-4 Insurance davit:Baiilders/Contractors/Eleetiaisians,/Plumbers
Applicant. nformation Please P>rS»t Lftibi
Name(BusineWOrganiaationlindit-idual); TUPPer Construction
Address:70$'Mid Tech Dr'
City,/State/Zip-West Yarmouth,MA 02673 Phone#:508-77MI—I 1
Are you an employer?Cheek;the appropriate box: — —
1.Q 1 am a employer with. 4. [] 1 am a.general tontrac#or and l
Type of project{required)'::
employees(full anc'Vbr part-ume)�,- eve hired the suti coribactors Q evv construction:
2_ 1 am a sole<prctprietor or:partnei•_. listed on:the attached sheet. 1. Q Remodeling
ship and have-no employees These sob-contractors:have Demolition
working :for me in any capacitj. employees and have'Workers'
Q:B.uilding addition
[No vvorkets' comp-insurance comp.insurancs.<
required.] I.[] We are a corporation and its 1'0.[�Electrical repaTtS or additions
I❑ f am a homeovw'ner:doing ail wort: officers have exercised theirmbut�re r,or adficions
rlaht ti o p`m�=self. [Nis workers' coo p. 5 t e empiian per i�llGL j ❑' oofrepairs
irstirattcerequited.l=r. c. .152;ys1(4),andwehavenO i3.�C3thzr Wea.t$erizat`iolz/
employees. [ha workers
comp_.insurance required 1
nsu a ion.
*Any applivantthat checks boy#]must also fill Out fh1L. fIPnbtIom showing th6riiorkers'compensittion puliey.intbMutiIn.t 1 Tom tvnex,who submit this afiidnviriiidicatzn thev a dpi�gatl work and theft lute ours.e contactors mWt'submit aaeNN,afftlavit indi;a,tin such.
#Gontractorsthat chccl.this bob must attached an additional sheet shuning[tic natrie orthe sub-contractors and state«heiher or not those entities have.
employees. if the sub-ccmttacrors have employees.they?nustpioride Their %voftrs'comp.pzilicy nuin6erc
i am an emplWr i/tut is prolidin. Vorklers.rntripe�rs�rar�ansurance�nr,np e►trplouees: Below is the palicly a#d job site
information. a
;insurance Colnpaity blame:AEiC'
PolicY#of Self-iris Lie.n`WCC5005693012067 10/3I1,
Expiration. ate:"
Job Site Address:, �0 hn&rS. ../�
CityrStato; ip: (��10��
Attach a Copp of the worker: eom}reusaiibtt pgliry declaration.page(showing the tttrgycg number and.expiration date)-
Failure to secure coverage a>t flu yeti utt er SeI n ZSA of i�lGl t. 152 can lend to the imposition of criminal penalties of a:
one up to S1,500:.0�and/or Otte-year impnsotiment:as welt as civil penalties in the form afa ST P WORT:QRi ER and a:fine
of up to 2St�.00 a day against the:violaior: He advised that,a copy.of. his ststemet t t>3Ay be for sattt eel to t]g Cif icr of
Invesdgat ons of tttr iasttrance cover4�6 a ific-ition.
Ila lt>sreh rt' ;u e zlac pants:uQiJpenadiies ofper,nn.that Ili infor�ottttiatt lrrevi ri uve is trite.rand correct.
SiA!attune;
Phone#: $087 801
Official r use brtJ4. Bn n write tt flris:area;:to be completes by city or tuwrz u ffclttl..
Permi#/Licease##
Usuing Authority(cirele one);
t:l3oia of lge3tlth 2.Building I9¢partrraeat 3.amity/Towsi Clerk 4.. tectricai Tasgector S:Phambittg ia�specfar
h.Other
Contract Persotalsrne#e .. _._
r
OWNER AUTHORIZATION FORM
(Owner's Name)
owner of the property located at
p 7..
(Property Address)
0
ry
(Property Addre s)
hereby authorize 1 ► (J
� C. ;
(Subcont ctor)
an authorized subcontractor.for RISE.Engineering, to act on my behalf to obtain a building
permit and to perform work on my property.
Q finer' Signature
Date
ACORD,
CERTIFICATE OF LIABILITYINSURANCE DATE(MWDDAYYYYI
12/m3/2013
t THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION.ONLY-AND CONFERS NO. 16HTS UPON THE;CERTIFI.CATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE HOES NOT CONSTITUTE:A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(tes).must he endorsed. If SUBROGATION IS WAIVED,subject to
the tonne and conditions of the poitcy;curtain policies nay require an andorsement. A statement orrthis certificate sloes not Confer rights to the
certificate holder in lieu of such endorsernent(s).
PRODUCER - ;CONTACT
NAME:; Lora a Lowe
Southeastern Insurance Agency., Inc. PAN�°NN<EN: {�0$)997`=6462 (508)990-2731
439 State Rd`. E-MAI
ADDRESS.
P.O. Box 79399 PRooucEr:
'..:CUSTOMER ID#-
.. ....
N. Dartmouth, MA 02741 INSUREMS)AFFORO1NGC OVER AGE NAIC1
INSURED iNSURekv Arbe3la Protection Insurar to
Tupper. Construction Co. !LC INSURERS: A(EIC f
'INSURERC;: CNA Surety
27 Roberta Drive. INSURERo':
West Yarmouth, NIA 02673 INSURER;E c
INSURER F: ... ... .. .. . .
COVERAGES CERTIFICATE NUMBER- 201.3/14/1 REVISION:NUMBER:.
THIS IS TO CERTIFY THATTHE POLICIES OF.INSURANC€LISTED BELOW HAVE BEEN ISSUED TOTHE kNSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT;TERM OR totg I nON OF ANY CONTRACT OR OTHER DOCUMEN-T WtR T H RESPECT TO M—IICH.THiS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN;-THE INSURANCE AFFORDED BY THE POLICIES'DESCRIBEO HEREIN FS SUWECTTO ALL THE TERMS
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS_SHOWN MAY HAVE BEEN REDUCED By PAID CLAIMS
INSR ADOL BRPOLICY EFFPOLICY EXP - --
LTR. TYPE OF INSURANCE ' UMfTS
.. lNSR.WYD POLICY NllMBER MM/DD MWDD .
GENERAL LtAWLITY.. - &SOOOO&74 -1110112013 11101120141 EACH OCCURRENCE
1,0�00,00
:COMMERCIAL GENERAL LIABILITY00,OQ
PREMISE {Eaocr.rrenee
cLallas-DACE n OCCUR I Ma
D EXP(Any one person) f S S,00(
A t PERSONAL&ADVINJURY 1 S 1,000,00
GENERAL AGGREGATE S
GEN`LL AGGREGATE L1ksr APPLIES PER* � PRODUCTS-=A?JOPAGG;S 2,000,0
POLICY JECT —,_Lo-- - S
AUTOMOBILE LIABILITY i r 666240000 9 210112013, 12/0112014 i COMBINED St GLEE LIMIT '
acddent) - 4 1,00 ?o
ANY AUTOS - -- -
`BODt1Y INJURY(Per person).15 -
ACt:OWNED-AUT ,
- I.BOt)iLV INJURY(Pzraaident). 5
A X SCHEDULED AUTOS PROPERTY DAMAGE 3
X MRED AUTOS (Pereaident) C
X NON"OVmEDAUTOS'
UMBRELLA,LJAB` X OCCUR - - 4600OS836 11/0112013.11101/2014 EA.CH.:000URRENCE ;5 I,006-,00
A EXCESS UAB Cj gtR15 9ADE AGGREGATE S 1,000,00(
DEDUCTIBLE
RETENTION, 5 - `. _ .. ...i S
WORKERS COMPENSATION - ,I AND EMPLOYERS LIABILITY YIN . '.. (Ca`50055930]:200JI:1010312013 10/0312014 X ;o�RYunnrUrsR[. .. .
X
ANY FROPRIETORAPARTNERIEXECUTIVE RICHARD TUPPER IS E.L EACH ACCIQENT _ 3
OFtCEFUMEMBER EXCLU Q.Nt.A
(Mandatary in NH) . . I LUOED' OR-WC COVERAGE E.L DISEASE-EA EMPLOY S .1,000,0
If yes,describe under
OESCRIPTFON OF OPERATIONS betav E.L-DISEASE-POLICY LIMIT S 1,000,00
f
DESCRIPTION OF OPERATIONS I WCATIONS IVEHICLtS'(Attach ACORD 11011 Additions(RemuftSchedule,if more space is required)
CERTIFICATE HOMER _ CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES.BE`CANCELLED BEFORE
THE EXPIRATION DATE THEREOF; NOTICE WILL SE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
"Far Information Purposes Only''
Tupper Construction Co LLC AU
THOR�EO REPRESENYATIV�
4
Z7 Roberta Drive
W Yarmouth, NA 02673 Lora. Lowe
O 1988-2009 ACORD CORPORATION: Alt rights reserved:.
ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD
f
E3L381L9 it 6 E�ioi�1 i lit C: lf� tt`i tl l ,tad€: . iassacha�setrs-4 pa me e F ��t e 5a;
136arc#zi#Sbiidinj Rb- '-I Hoes and Srardare:s
f274-12 x C'3}n.ttutiii:n Supsi.i�t:F
+�u vi.ipa.ro n. s_ie-ense:CS-46"58
-
RICil!'iRDSTUPYER
79.ig MID-YTECHDR x
WtST YARrti'IOrPT€i A''_tD2S73
ffichardlupper
iSfftEaESiG�fC4RDt6kAT[6NSkPd�EiRATitINfFATES;:. g v �lfn[sst`as�e> 113{d2(i94
4
!.%iiafavrrHtoirerratrlj a1rt Lrtrr ctG
Offic¢,of Cnnsu'wei,Affaiax License or registration gelid for individuf dse only
OME IMPROVEMENT-C.C)MTRAC'fOR before YG�expe rlaie. If fottnd'ret�srsa fo:
egistrat4on: 978434 Type Ofliice of C f zors and$usiness R�ulaaon
, Expiration: 411612616 LLC 1(3Pa ,aza Su' 1
70
'UPPER CONSTRUCTION GQ
RICHARD TOPPER r I
1913 MID-TECH DR-
�.
W.YA,RMC?UT ..MA 62673 lindessexretar5 Rio atia�ttit sagnat�ec�
t
6£hDKcRETtRlft}UE
peOpW Helping Pto*0d a Saferlfiiatl
icon
WEMSER
,
Richard Tupper.
Ttipper Cpnstructiori
9uiidingSafety Professional
tu#emtier# $1 8i 19 Exp;4/301201
i
9))4104
of Town of Barnstable *permit# 9.1--10
O� Expires 6 months rom issue date
> ABLA . Regulatory Services Fee
MASS.
%6 q. `0� Thomas F.Geiler,Director
�EDNp Building Division
Tom Perry, Building Commissioner �����
200 Main Street, Hyannis,MA 02601
Office: 508-862-4038 S E P 7
Fax! 508-790-6230 �004
EXPRESS PERMIT APPLICATION - RESIDENTIAL OF BARNS-CA_,_�;
Not Valid without Red X-Press Imprint
Sap/parcel Number (J� 0,3 o'er
�i
roperty Address U /�S � r Vf IleCIO
residential Value of Work I7W,7- Minimum fee of$25.00 for work under$6000.00 /
)wner's Name&Address u SCL A , .be=TZ
/S ! Vim &'4fi,00L, D ahD
.ontractor's Name Telephone Number
come Improvement Contractor License#(if applicable)
;onstruction Supervisor's License#(if applicable)
]Warkman's Compensation Insurance
Check Kla
ne•
❑ ole proprietor
Homeowner
❑ I have Worker's Compensation Insurance
mwmce Company Name
Vorkman's Comp.Policy#
,opy of Insurance Compliance Certificate'must be on file.
'ermit Request(check box)
❑ Re-roof(stripping old shingles) All construction debris will be taken to
Uile"-roof(not stripping. Going over / existing layers of roof)
❑ Re-side
❑ Replacement Windows. U-Value (maximum.44)
*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.
Home Imp ,ementt Contractors License is required.
>ignature
2Tdrms:expmtrg
Levisc063004