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0028 FARM HILL ROAD
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CO_ LLc 79B MID-TECH DRIVE,WEST YARMOUTH, MA 02673 PHONE: 508-778-0111 FA X 508-778-5 010 WWNl.TUPPERCO.COM Date: Town of Barnstable C Thomas Perry CBO 200 Main Street Hyannis, Ma 02601 (508) 790-6230 fax %Ij o, 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 #: -a 013 Y 7 sr Address: Richard Tupper License # CS-69058 ,r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION �� g 33 Map Parcel C� `' HPPIi�at o Health Division Date Issued J Conservation Division Application Fee r PlanningPermit Fe Dept.p e Date Definitive Plan Approved by Planning Board I)Zz�j- Historic - OKH _ Preservation/ Hyannis Project Street Addrreess/5r d Fax/" // Village Owner dlto '6e � Addresso�� Telephone 5 7-J M q Permit Request f(.L l epe-r Square feet: 1 st floor: existing ffieproposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay tJ Project Valuation Construction a Construction Typ ✓lt' 1-6FnCb Lot Size_ a 0 Grandfathered: ❑Yes ❑ No If yes, attach suu:p'porting documtation. w Dwelling Type: Single Family 0--' Two Family ❑ Multi-Family (# units) _ Age of Existing Structure LJ g g ( %� Historic House: ❑Yes ❑ No On Old King's(Highway ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other w ''- 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: U-G//as ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes Flo 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 \ r GhG/2,A L(.P f� Q(--.. Telephone Number 7�' Address /-� /`�/ �(� �! License # C'�_Y 0� � o6y v L1 A Home Improvement Contractor# �/ Ste' Worker's Compensation # 1it�('CSUU�S' 30/ ALL CONSe- ATRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ��,� A/Y1 L . V'� - ,5 SIGNATURE DATE FOR OFFICIAL USE ONLY r r APPLICATION# =" 4 DATEISSUED t MAP/PARCEL NO. aADDRESS VILLAGE i . f OWNER 4€ t ' DATE OF INSPECTION: t);FO_UNDATION:-t_AF!iVx iWillML A•r.;;= FRAME -- I A 1INSULATION ' x. ti FIREPLACE R L ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING C p ' DATE CLOSED OUT ASSOCIATION PLAN NO. •4 [F. I v ASS save FERMI AUTHORIZ T0O FOR owner of the property located at: (Owners Name, printed) r r. (Property Street Address) (City/Town) 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. #,, 71 Owners Signa tud-11 l 91&113 Date FOR CS.G OFFICE USE ONLY Conservation Services Group has-assigned the following Mass Save Home:En er y Services:: Partici rastor to the above eference project: Participatin C .ntractor Date Rev. 12132011 I The Coninton wealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street,Suite 100 �¢ Boston,lllA 0.2114-201'7� www mass.govld a Workers'Compensation InsuraneeAffidavit:JBuildszrs/Co>ntracitors/Electricians/JPlurnbe' rs` Applicant:Information Please Print Le gibiy Name (Business organizat om'fndividua[): TuppOr Cohstrubtion CO. Inc Address: 79B Mid Tech Drive City/State/Zip:West Yarmouth, MA<02673 Phone# (508)778-0111 Are you an employer?Check the appropriate box: 1.noI am a employer with 4. []1 am ageneral contractor and'.1, Ty at:project(required): employees (full and/or pa have have hired the sub-contractors �' ❑New construction ?.❑ 1 am a sole proprietor or partner listed onthe attached sheet; 7. []Remodeling ship and have no employees These sub-conti actor s..have g_ Demolition working forme In any capacity. employees and..have workers.' [No workers' comp. insurance comp_msuratice:' 9• [:Building addition required.] 5. [}We are a corporation and its 10.[]Electrical repairs or additions 3.❑ 1 am a homco%mer doing all work officers have exercised their ] l Q Pltunbirig repairs or additions myself: [No workers' comp. right of exemption per-NIGL. insurance required.] c. 152, 1(4),and we Have no 12.❑RoofrepairS employees. [No workers' 3.E].Other comp.insurance required:] *:\ny applicant(hat checks box N l must also fill out the section below showing their woi ers'-`compensatiortpolicy information. t'Homeowners who submit this affidavit indicatingthey:arc tang all work and then hire outside contractors mustsubmit.a ne«r affid8vitintlicatingsuc$: +Contractors that check this box rnust attached an additional sheet.showing.the name of the -contractors and'sia e tewhcther or notthosc entities have employees: l)ifie sub�on(ractors have,employees;they-must provide their h.,orkers'comp.policy number: I ail,all employer that is providing workers'c.onlpensatiominsurance for my eltlployees_ Below. true policy andjob siti information. Insurance Company Name: AEIC Policy#or Self-ins.Lic.#: WCC 50055930120.07 10/3/14 Expiration Date: Job Site Address: 28 Farm Hill Rd CityfState%Zip:,.Centerville MA 02632 Attach a copy of the workers' corn peusation policy declaration page(showing the policy number and expiration dafe) Failure to secure coverage as required under:Section 25A of Ty1GL e. 152 can lead to the im 0, it on of criminal penalties.of a Fine up to$:1,500.00 and/or one-year.,imprisonment;as well as civiLpcnaltics in the m for of a STOP WORK ORDER and':a fine' of up to$250.00 a day against the tnolator; Be advised that a.copy of this statement may be forixafdcd to the Office of Investigations of the D for insurance coverage verification;_ - I do heI' C2ify under ;patns;alld penalties of perjury that the information provided above is true;and cor^reeL r . Sieriature. _: l l/8/13 Phone#: 5.0.8 7.7;8 0111. Offueal use Drily. Do not write In this area,to be completed by city or town official. City or Town Permit/License Issuing Authority(circle one): L6. .Board of Health 2.Building Department 3.City/Town Cleric 4-Electrical Inspector 5.Plumbing Inspector Otherr ontacf Person: Phone#: ACORL , CERTIFICATE OF LIABILITY INSURANCE DATE 10/31/2013 31/2013 _ , 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Lora Lowe NAME: Southeastern Insurance Agency, Inc. HONE 508)997-6061 FAXac No (508)990-2731 439 State Rd. E-MAIL ADDRESS: P.O. Box 79398 PRODUCER CUSTO ER ID#: N. Dartmouth, MA 02747 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA: Arbella Protection Insurance Tupper Construction Co LLC INSURERB: AEIC INSURERC: CNA Surety 27 Roberta Drive INSURER West Yarmouth, MA 02673 INSURERE: INSURER F: - COVERAGES CERTIFICATE NUMBER: 2013/14/1 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE ANSR SWVR POLICY NUMBER POLICY EFF POLICY EXP LIMITS MWDD MM/DD GENERAL LIABILITY 8SO0008743 11/01/2013 11,10112014 EACH OCCURRENCE $ 1,000,00 X COMMERCIAL GENERAL LIABILITY —DAMAGE TO RENTED .PREMISES Ea occurrence) ceuence $ 100,00( CLAIMS-MADE FX1 OCCUR MED EXP(Any one person) S 5,00( A PERSONAL&ADV INJURY $ 11000,00( GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,00( POLICY PRO- JECT M LOC $ AUTOMOBILE LIABILITY - 56662400002 12/01/2012 12101/2013 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 1,000,00( ALL OWNED AUTOS BODILY INJURY(Per person) S BODILY INJURY(Per accident) $ A X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) INC X NON-OWNED AUTOS $ $ UMBRELLA LIAB X OCCUR 460005936 11/01/2013 11/01/2014 EACH OCCURRENCE $ 1,000,000 A EXCESS UAB CLAIMS-MADE AGGREGATE $ 1,000,000 DEDUCTIBLE $ RETENTION S $ AND REMPLOYERS LIABILITY YIN ERS COMPENSATION WCC5005 59301200 10/03/2013 10/03/2014 X TOR L M TS X °TH- ER B ANFICER/RIE ERPEXCLUD tE ECUTIVE❑ NIA RICHARD TUPPER I E.L EACH ACCIDENT $ 1,000,00 (Mandatory In NH) I LUDED FOR WC COVERAGE E.L.DISEASE-EA EMPLOYEE S 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. "For Information Purposes Only" Tupper Construction Co LLC AUTHORIZED REPRESENTATIVE 27 Roberta Drive W Yarmouth, MA 02673 Lora Lowe ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD 1 t31ltL1J Nt�i i't�iF i#ItJ G t t13!#Ti ;dt 4 t fassa F�seits -p partmt n#_of Public Safety i07 0�Rpm, 110 m"NY 12t}Z0 . „ ',� $aarci o Build►.ng Regu#atians artc#$ da'tanrtEs ' ;, (SM 274-1274 ililt n ko'r` www.bpi.wm LFce"L-:CS-069058 ` h WHA:RtD S TUPP£R. 79 B MID-TECIfi i0t2 W EST YARIZOl3''rEi M' 2 73' V NNAJ Expiration -_- &{SREVFRTifSiREFORRt^itUTIDgSk{DE#fiNkATKtNOATES; '' COitNti155�Pft8TZI$1/204. v ti Office of Consumtr Affairs B iatss Re�td�do�a Qy Peppie Helping Peopte Build a Sate"World"° #CME IMPROVEMENT COPITRACTtDR C1gQ ®, iC�Eete �Rsgistrtlon4 845 'ripe, k Expiration 8fi2 i4 individual MEMBER R HARbTUPPER< t 4 .'Richard Tupper Tupper Construction ' RICH TUPPER 4 � 29 Roberta 06ve Building S2fety Professional g, W.YARMOUTH,Mk026i3 t,ndrisecreta,�y Member# 81581 i9 ` Exp`: 410/2014 - ' � S f *Permit pCVE ri Town of Barnstable Expires.6monthrfrom issue date Regulatory Services Feeoc h� H sti �-- PERMIT Thomas F. Geller,Director ` �prFDMA'�a` CT - 2 2007 Building DivisioIl Tom Perry, Building Commissioner TOWN Orr- BARNSTABLE 2p0 Main Street, Hyannis,MA 02601 Office: 508-862-403$ Fax: 508-790-6230 ExpRESS PRRlVIIT APPLICATION - RESIDENTIAL ONLY Not valid without Red X-Press Impnnt Map/parcel Number v�Lf 7 l Property Address e rc.T�v� Value of Work 7 ❑Residential Owner's Name&Address JpS�' 2 O Cn 331i o✓i Sc�. C Telephone Number y Contractors Name, �'� ( g Home Improvement Contractor License# if a licable). >£ 2,63 0 Construction Supervisor' 's License#_( applicable)) ❑Workmen's Compensation Insurance Check one: I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name �Cct_A f e - . Workman's Comp.Policy# Permit Request(check box) gRe-roof(stripping Old shingles) All construction debris will be taken to ✓� . Going over existing layers of roof) []Re-roof(not stripping• ❑ Re-side [] Replacement Windows: U-Value (maximum.44) ❑ Other(specify) department regulations,i.e.Historic,Conservation,etc. *Where required: Issuance of this permit does not exempt compliance with other town Signature Q:Forms:expmtrg ve �aar�iom V V �ofzHE, � 'down of Barnstable,. Regulatory Services + 3ARNMBLE. y MASS. $ Thomas F. Geiler,Director idg9• ,� Building Division �lED MP•i A Tom Perry, 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 as Owner of the subject property herebyauthorize (�✓'lS•1(-(J G ` r o � to act on my behalf, in all matters relative to work authorized bythis building permit application for (Address of Job) t na} e of(Mer" Date Print Name Q TO RM S:O W NERP ERMIS S I ON l The Commonwealth ofMassachusetts Deparfinent of IndustrialAccidents Office oflnvestigations ; 600 K'ashington Street Boston,M4 02111 www.m ass.gov/dia Workers"Compensation lnsurgnce.Affidavit;.Builders/Contractors/Electricians/PIumbers Applicant Information / �J Please Print Le 'bI g ) �4 IoJICI(CQ�t�7i� .L/'/G. Name usiness/Or anization/Individual '. � O Address: 6s/ /29 f/�Ct/s /6nS City/State/Zip: Phone.#: Ar you an employer?•Check the appropriate box: Type of project(required):, 1.[ 1 am a employer with � 4. [] I am.a general contractor and I 6• New construction . employees(full and/or part-time).* have hired the vu,b'contractors 2.❑ 1 am a'sole proprietor or partner- listed on the-attached sheet. 7. ❑Remodeling. ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. 1W employees and have workers' 9 Building addition [No workers' comp.insurance comp.insurance.$ required.] 5..0 We are a corporation and its MO Electrical repairs or additions officers have exercised their 3.ElI am a homeowner doing all work 11,[]Plumbing repairs or additions myself [No workers'comp. right of exemption MGL 12.�TRoof 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 belowshowing 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 providb 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: Policy#or Self-ins.Lic.#: I3 X 7 6 q - Expiration Date:- i i ' lob Site Address: (1��f✓''` ! t 1 L J2A City/State/Zip: Attach a copy of the workers' compensation policy declaration page(shoving 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 vp 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 IDIA for insurance coverage verification. Ido hereby certify under the pains-and p nalties of perjury that the information provided above is true and correct Signature. �z f� 41 Date: /O . Z 0 _ Phone#: FOther only. Do not write in this area,Yb be completed by city or.town official n: Permit/License hority(circle one): Health 2.Buildi-ngDepartment 3. City/Town CIerk 4.Electrical inspector S.Plumbing inspector son: Phone#: Results Page 1 of 1 Home Improvement Contractor Look Up Enter Search terms separated by spaces. Search terms can be Town/City, Name, or License number Select Search type: (i, AND (7) OR Searar h Search Results Reg. No. Applicant Street City State Zip Name Title Expiration 135592 M.L. CONSTRUCTION CO, 651 RIVER MARSTON 02648FMICHAEL_ PRE 4/22/2008 Total of 1 Records matched. Back to Home Page BBRS Privacy Statement http://db.state.ma.us/bbrs/hic.pl 10/2/2007 < Board of Building Vf 'k I g Rcgnlohor'and cta� � 3�� HOMEIMPROV' ENTCl 4tRACTO " }te #1,cen'e Eres�stranon.vaildfonndiv+du!neeon1. i y Registration r 1 fO �xP� hon date. If found retu�u to o59Z �narJ ref fS\ilding Regulations and Standrrds :! Expiration +2/200b' a i r 1ne ASWinon Place Rm 1301 TYPe F+rvaleGrpomhor Joston'�1a°02108 CONSTRUCTION f ' CO INC PoUCHAEL L EARY1z�. E r RIVER RD {� I aRSTONMILLS MA 02648 1-it valid without -.axY .a4r,=�v a Board of Building Regulations and;:Standards f' Construction Supervisor Llceriso 1 . License: CS 8g386 to Birthdete 7/17/1967 4 � Pi!tlon /7 1j7/2009 -Tr# 17470 q �, I Restriction 00, tJ MICHAEL P LEARY ' 651RIVER'RD �2 MARSTONS MILLS,MA 02648 l ommisAoner , & ram Z a r Board of Building Rtgula� ::—�--t=— . g Rcgulanor:anU Cta+ ;�rr �rk���TN' •; � - } f HOME IMPROV' t r xr ccn e i rpgistrauon-valid.for mdrvidu+ase onk s a ENT Cf YTRACT0 m; Registration 5592 fO�e; expiration date if found return to : a t ro: tildmg Regulations and Staiiil Ards Expiration '%r+y2006 5- C1reAsh - f, c:, T ,�,.�, .;t.. rton Place Rm 1301 YPe FrvateC rporauor 3oston-iV1a02108 ML CONSTRUCTIOt C tt r' O INC ' �� - NVCHAEL LEARY + 1°51 RIVER RD �Ic aRSTONMILLS 4' x 02648 tvand.without 1I Vilardre Z. ,{ Board of Building Reguladons a UStandards Construction Supervisor License ' Lice se CS l 3 Blrthdate, 80386 ( i I .. 7/17/1967 aC 1 ' Expl cn 7/1T/2009 Tr# 17470 lP 1 � rRestrictlon 00 r. l MICHAELP LEARY�� ' ; +. 651 RIVER RD MARSTONS MIL - —� LS,MA 0264 8 Commissioner � ' Joy~ �aor ��� Board of Building HOME IMPROV' reststrauon valid for mdrvtJu'use only ENT Cf YTRACTC t: e j r / fo e t� cxptration date. If found return to Regtstretton 5592 ] } nardiif IrJdin Ite ulations and Standrrds Expiration _s,y200b � line Ast �`ton Place R.1301 p ype E. VSte G.: rpoialtor u.. �=ioston�l`iu02108 1 M L.CONSTRUCTIOt 4UCFAEL LEARY..•- " 4 51 RIVER RD c tc gRSTONMILLS MA 02648 r�ithou urc - - _ --'^•`.� __ ..�[::t i o�u.-tea' �..'��- .'� Board ofBuildin R g egulations ai d&Standards_ �.' Construction Supervisor License .0 Lice se Cs 80386 I' Bl date. /17/1967 y# � stE i yen 7/1112009 nt 17470 (� ` tRestiiction 00 MICHAELP LEAD, v - fj 651 RIVERRb MARSTONS MILLS,MA o1648 Commissioner S s