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HomeMy WebLinkAbout0068 WHITMAR ROAD J , i 1 � \\ I� it I 0 ol� `I�I`� TU PPE R 31Z CONSTRUCTION CO. LLC 79B MID-TECH DRIVE,WEST YARMOUTH,MA 02673 PHONE: 508-778-0111 FAX: 508-778-5010 WWUV.TUPPERCO.COM Date: /`f o Town of Barnstable C Thomas Perry CBO i z 200 Main Street Y , 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#: ,4 r Address: Richard Tupper oTv r License # CS-69058 70-7 Q. ' Assessor's office''(1st floor): 1`�' F THE r Assessors map and lot number Q y Board of Health (3rd floor): Sewage Permit number "�.... '� >; 339HBSTADLE, Engineering Department (3rd floor): J I� C '°o 163 MA51 `House number .. �4 A ..... 0 MAI a�6 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 .Art*).....C'01 j!;1 :.�...............:............................................. TYPE OF CONSTRUCTION ......LV...Djy ........................ .`..... ..............19.._ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information- LLocation I W�#rt'!"t'Yl YZ 0 CC7�V i i" ..... /q ocation ........... .......................................... .................................. ....... ......................................................l............................. �5:! �4't,...A0'l�i;�...................... t . Proposed Use ............... : � � : : Zoning District ...............................................Fire District Name of Owner .P.�!.A 'W49.i'Y�if t!4 ..rnr'U.1�.r .........Address �✓ �1 � ... ...� `�•� �/1 .............it. -............. e......................Ails a Name of Builder ).(, ..... ....................... a. .a , "Name of Architect .5 �'Vl�f if'1QU15 r.................Address .................................................................................... �r Number of Rooms ..................................................................Foundation ......:........ Exterior ..CL 1d?ar D.....................................................Roofing ..../ .... UfTF•............................................... Floors .. / /I �YYh.CO , ...............................Interior ............. ............. Heating '(Al q!t%...........................................Plumbing 2 �1z 0t-- 5- Fireplace .. ...................:.............................................Approximate Cost ....... . . !.°v....................................... Definitive Plan Approved by Planning Board ______________ 19-------- . Area .......................................... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH i 1 OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS R I I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...,....v. .... ............ .... — — ..-............... � Construction Supervisor's License ...�91` 6--*1"...... TUPELO WHITMAR TRUST AT7=8 �7 y�C3 I No ...2937'... Permit for „Two Story ...................... Single Family Dwelling ............................................................................... Location .... ... Lot #.13. , 68...Whitm.ar. ..Road. . ..... ...... . . ............. .......... . .. .... . .. . Cotuit .................................................................I............. Owner Tupelo'Whitmar Trust .................................................................. Type of Construction Frame ................................................. .............................. Plot ............................ Lot ................................ Permit Granted .........Mai' 21 .........19 86 Date of.Inspection ....................................19 Date Completed ......................................19 g� 70 //g, SST Alb 6xiadaz. , YU r / //�a Tel o F • Assessor's office (1st floor): _ 1' t�' SY TEM MUST BE N 4/ 7 � / . SEPTIC c�THE Toy Assessor's map and lot number ..... .... ......... .....................p.. INSTALLED IN COMPLIAN =-Board-of Health (3rd floor): WITH TITLE 5 fO�P ♦� Sewage Permit number .. . E-MVIRONMENTAL CODELE, Engineering Department (3rd floor): ,{� : `T(DA A'1 r�+l:r.1l;I__�TIMJ S 'oo�Mb39• 1I ouse number . 'of .......... ..... p MAY a 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 ......:�,'L4.....�%0��[�"v� 2 ...................... TYPE OF CONSTRUCTION .......tv. DD..... f... ..................................................................................... .............. .. .46. .r TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location .... .l... .3.......... !#!r1"Cd4at? ....1'?- ..........r—�N T..�...1 ...................................................................... I �Q ProposedUse ...... ............................................................................................:.......................... 1 Zoning District ............... ..... ............................Fire District ........, �.`I...U.` Name of Owner ..'. ... . .................�17.........Address �j �r�... �'� �1/ !fry .. .m` _ 014A.) 1 ?A­rtt((_1A LAB 0?W-tl1tW49-a ✓kA Name of Builder :.Address --f 4 .. ................... Name of Architect ��(a✓VlA9 n'Iawt-S r..................Address .................................................................................... ............ Number of Rooms ................. ............ .....................Foundation ............... � Exterior ..C! �� ......................................................Roofing .... ..t...f6a�....> ...:........................................... Floors +T!L...Alww ................................... .Interior .. Pwrf-le (-Se " )........................ ............. 2 � Heating P� ...............Plumbing ............Z � s Fireplace .1341(jr .................................................. . .... ......Approximate Cost .......1.•.! .. . ....................... ........ Definitive Plan Approved by Planning Board ________________ o ____19 Area ....Xff® ...... ........ Diagram of Lot and Building with Dimensions Fee �l �......... ..... ..... SUBJECT TO APPROVAL OF BOARD OF HEALTH i 1131 ` 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. 4 Name . ........... ...... . ..... Construction Supervisor's License .................................... ,.M. M. E. TRUST R 29377 Two Story No ................. Permit for .................................... Single Family Dwelling - r r Lot #13 68 Whitmar Road Location Cotuit O...wner• .........'' hTu elo Witmar Trust................ - J _ a� - f - ................................................................... w T e of Construction Frame YP ........ ............... ........................................... ... ✓ �' Plot- ...... ............... Lot ................................. _ k May 21, - 86 Permit Granted ........................................19• Date of Inspection rye-. 19 Date C pleted ...... < " - - ...................19 s ©( - _ Y M _ - n t 3S, �41 w�yc s� �y Qe• ldgSs, yl �. . . - - D M ,,moo I W 1 C A Y it.E ._. N At } �. ;P No. 19334 Q b jc- CERTIFIED PLOT PLAN '- LOCATION CERTIFY THAT THE .HOWN' HEREON COMPLYS WITH SCALE / DATE HE--;SIDELINE AND SETBACK :E_ REMENTS OF THE TOWN OF PLAN REFERENCE -S. AND IS .00ATED. WITHIN !THE FLOODPLAIN. ,AT, � BAXTER I✓ NYE, INC. 'HIS-PLAN IS NOT BASED ON AK,,- -- REGISTERED- LAND -SURVEYORS HS-70RUMENT SURVEY AND THE OSTERVILLE^- MASS. )FFSETS SHOWN SHOULD NOT BE TG ���-- ISED TO DETERMINE LOT LINES, APPLICANT A m 7T, }qp In- -A-KCrIi4�L'PAt 7' T• 9' t r �t..,.r E 3h F �i;.;F'r jnr(Qj7 t�` ' y„i+j •.'., f.�.?�'�•, 't `�e l I rKT r� `>�!i=!�1 , �iQpY .t ., i i'C.p� ) r` t �. � 1 a'1 :!a � y■ ', t7 � t� +If}� Ea9A c 1 ' tTaYvN O'F�AR�$TABLE; MASSACHUSETTS ,.. PE tMIY - , " C7 p VALIDATION:. DATE. 19 PERMIT NO ,E `May 21:y 86 'HarS.i mr APPLCANT ADDRESS' P (N0.) TP1 A� " t LICENSE) .f t I♦a - 1 1�-. PERMIT TORttdld 'llerol'Ldno NUMBER OF ',y •' ( LI STORY le Faar�,ly- 811fA$— OWELL,ING UNFTS •(7YPE•OF IMPROVEME„ I NO. '(PROPOS USE t . . ( t• �4 AI C,LOCAT(AN) T'At �t�� iiR itmarg Rnae'�`�(��Tuit ''. ON ; DDy�e � (STREET)'. r s _ J � *k BETWEEN_ „- AND, r, r(CROSS STREET) ` (CROSS STREET r LOB. ` SUB01 Nd0►L LOT BLOCK _ IZE �i. J r' 5 BUILDING t9.X818F' f FT .WIDE BY FT. LONG BY FT ;IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION REMARKS Q IP�6�11.: C- r. `+ F (TYPE) Ji T r' ;. F t �t• t r` BOIAd..' AREA OR p r 1 VOLt►MQ F a©1�7 BQi... .ft• ESTIMATEO:COST 9 140,000� FEEMIT 1oItI��Q' j(CUSICFSOUARE.FEET) OWNHq 7Xii4C�gl4fC> i1XxU[l6CC`M M E TRUST z� ADDRESS 38�.kilmo th .Road'.'M8YSCO2T9 Mj l'B BUI.LDJNG DE PT,. . . t BY Y J • / x J ALL CONS?RU�C'1TUty'n(lF[K. ' ....a.nu .��.'•� '... l • �y°� 'i,) t.:.✓.f••"�i.•✓'•'...+fl I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICAtE OF"(7ti"i,l ttit3GT Izi KC= MItC•HAg1C,A, INSTALLATIONS. 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL) MINAL INSPECTION TI TO BEFORE FINAL INSPECTION HAS BEEN MADE. II 3. FINAL INSPECTION BEFORE • . 00CUPANCY. POST THIS CARD' SO IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 2 2 2 ( �- cl0 3 A S HEATING INSPECTION APPROVALS ENGINEERING DEPART ENT OTHER 2 BOARD OF HEALTH WORK SHALL NOT PROCEED UNTIL THE INSPEC- PERMIT WILL.BECOME.NULL AND VOID IF CONSTRUCTION INSPECTIONS INDICATED ON THIS CARD CAN BE TOR HAS APPROVED THE VARIODUS STAGES OF WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CONSTRUCTION:_ PERMIT IS ISSUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITTEN NOTIFICATION. { TOWN OF BARNSTABLE 2 7...... � .Permit No. . BUILDING DEPARTMENT • P """ I TOWN OFFICE BUILDING Cash .Yl ou+ HYANNIS,MASS.02601 Bond x....44. CERTIFICATE OF USE AND OCCUPANCY Issued to M. M. E. TRUST Address Lot #13, 68 Whitmar Road Cotuit, Massachusetts USE GROUP r-- FIRE GRADING OCCUPANCY LOAD E THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ......... Build' g Inspector ..� °�. TOWN OF BARNSTABLE BUILDING DEPARTMENT 2 Bs M IL = TOWN OFFICE BUILDING 9 HYANNIS, MASS. 02601 .MEMO TO: Town Clerk FROM: Building Department DATE: An Occupancy Permit has been issued for the building authorizer by BuildingPermit #........ 9.q,322......................................................................................................_...._................. . ..... . issued to ......l �! :.. �1..:. ...... ...................................................................._.............................. .� Please release the performance bond. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION r Map �J 7 Parcel - pP A lication q_)01 6 �✓ Health Division Date Issued K Conservation Division Application Fee Planning Dept. Permit Fee L Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address f Village / Owner Address �f� ( 7 Telephone �© �� 0- Permit Request /'I G� �/ S^ Z2JP Cbl_�U69 AkA Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning Distri t Flood Plain Ground ater Overlay r Project Valuati nT34� Construction Type . V �V. d v Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family d' Two Family ❑ Multi-Family(# units) Age of Existing Structure Lff( Historic House: ❑Yes ❑ No On Old King's;Highway: ©;Yes ,-.C] No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other .. =j C ) Basement Finishdd Area (sq.ft.) Basement Unfinished Area (sq.ft)=' J Number of Baths: Full: existing o2- new Half: existing new _ Number of Bedrooms: existing _new Total Room Count (not inc Type ding baths): existing new First Floor Room Count Heat T e and Fuel: "Gas ❑ Oil ❑ Electric ❑ Other Central Air: 0-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: M9xisting ❑ 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 Telephone Number ✓ rT i� (( l Address /O License # Home Improvement Contractor# ��lS Worker's CompensationC3� ALL CONSTRUCTION DEESU TING FROM TH S PROJECT WILL BE TAKEN TO SIGNATURE DATE / i FOR OFFICIAL USE ONLY APPLICATION# DATE.ISSUED_ MAP/PARCEL N0. �- c r l ADDRESS VILLAGE OWNER "4 DATE OF INSPECTION: FRAME - — -- -- — — — INSULATIONr r-� x : L >. FIREPLACE ELECTRICAL: ROUGH FINAL - E f PLUMBING: ROUGH FINAL { GAS: ROUGH FINAL FINAL BUILDING t DATE CLOSED OUT. ASSOCIATION PLAN NO. r • The Commonwealth ofMassacl:usetts . Department of IndustrialAccidents Office.of Investigations 1 Congress Sireet;Suite 100 Boston,A"0211:4-20.17. www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizationftndividual):. Tupper Construction Address:79B Mid Tech Dr City/State/Zip.west Yarmouth, MA 02673 Phone#:50$-778-0111 Are you an employer? ._Check the appropriate box: Lam a eneral contractor and i Type of project(required).. I�■ I am a employer:with 4.. �. g . 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 shipand have no employees These.sub-contractors have 8. Q Demolition working for me many capacity. , employees and have-workers'. coin insurancea 0. 0 Building addition [No workers' comp.-insurance_ l?a required:) 5• `We are a corporatiorrand its '1.0.E Electrical-repairs or additions officers have exercised their 3.❑ I am a homeowner doing all work: 1.iEj Plumbmg repairs or additions myself. [No workers' comp. right of.exemption.per MGL.. 12. insurance required.] . 152, §1(4),and we have no goof repairs Q employees. [No workers' 3.[ Other =sulation/ 1. comp,insurance required. Weather zation Any applicant that.checks box#1 must also fill out the section below showing their workers'compensation policy inforrriation. 4 Homeowners who submit this affidavit indicating they are.doing all work and then hire outside contractors must submit a new affidavit indicating such. tConttactors 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.polk:y.and job site. information. Insurance Company Name:AEIC . Policy#.or Self.ins::Lic.#:.1NCG500559301200Z Expiration:Date:10/3114 Job Site Address: 68 Whitmar Rd Cotuit MA.02635. 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 afine of up to$250.00 a day against the violator.. Be advised that a copy of this statement may be forwarded to-the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify:under the.Pains and penalties ofperjury that the information provided above is true and correct Siarlature: Date 2/7 414 Phone#:. 5087780111 Official use only.,Do not write in this area,io be completedby city or town official City or Town:. . : Permit/License# 3 Issuing Authority(circle one): Ulf 1.Board of Health 2.Building Department 3. City/Town Clerk . 4.Electrical Inspector S.Plumbing Inspector. 6.Other Contact Person: Phone#: diR£1�t1Vt3 NtHt-v"l WfWt ITtIIIUit,tNL Massachusetts.-Department f01•i KMN Aw.Surw rtp a{public sa y • 0 May&air 12M F Board of Building Re gulstrona end Stannarda ism274.72?i. � : . . . : . : . . - �.�,h•Iru�i)'!ll.SilItvi'S.f,uC WwytCp Corn treensa:C5�068Qb8 ` RICHARD S IlIPP£R 79 B MJD-TECH DR WEST YARIIOUTH �. .�J ..R Exptratton °tsgF7FfKE5,6gFORUE6+GtuT urG£xPratr rrrF�3, Comr�ssioner .12/31/2014 i�M �iOUMMl�f�1 oOv,. t ; peoPte 1.1eiPii►g PeOPle 8nild a Safer Warn!=" ••: nmee 4('0e3nmcr aAnin 4 B int+r R4040" HOME IMPROVEMENT CONTRACTOR. `:ReQt�tn6on: q g '1'YPe:. bIEMBER .EYpintion::. �4 MOWU21 :R{CHARD TUPPER ..J� Richard Tupper Tupper Construction RICHARD TUPPER $wtd'mg safety Professional W.UR#A66Tii MA i2&i$ Member#:-.8158119 4130/2t}14 a natr Ku.y ACORD CERTIFICATE'OF LIABILITY.INSURANCE :120 THIS CERTIFICATE IS ISSUED AS:A MATTEit OF INFORMATION ONLY-AND CONFERS NO RIGHTS UPON THE CER t1FICATE HO ER fWIS � CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND;EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TNIS:CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONS RACT BETWEEN THE ISSUING INSURER{$),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER: IMPORTANT: If the Certmcate holder is an ADDMONpL INSURED,the pblicy(tes)must be endorsed.the temas and candlti rsed. If SUBROGATION 13 ohs of the policy.Conain:poticles WAIVED,subject to. ce►tificate holder in I"of such endomement(t;). �Y require an endorsement.A.statement on this certtfineate does not cord"rights to the PRoouCER Southeastern Insurance Agency, Inc. E Lora Lowe 439 Sta#e.LW. ac IEal L : 000997-6061'. • np;(508)990-2T31 P.O. BOX" 79398: . . . AD DUCE N Dartmouth, .MA, 02747 INSURED INSURE AFFORDING COVERAG RIS) E NAiCs INsuRERA: - Arbei7a .Protection-Insurance Tupper Construction Co LLC IaSi1RERa AEIC ' -- - INSURERC:' C" SUret - - . 27 Roberta Drive y . . . West Yartrouth; MA 02673 INSURER O -. COVERAGES.' INSURERF: CERTIFICATE NUMBER.2013/14 1 REVISION NUMt3ER THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVl BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POUCY PERIOD INDICATED. NOTVNTHSTANDINGAAIY REQUIREMENT,TERM OR CONDITION OF ANY CONMRACT:OR OTHER DOCUMENT WITH RESPECT WHICH THIS - CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POUCiES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADS L GENFim U e V fT INSURANCE POU"NUNuR LMJTS 850000874 11101./2013 1 141i2014 EACH O��R s i 800,0 COMMERCIAL GENERAL UAWLITY - t -- w PREIAS oRCC S - 1.CLAIR7SAM1ADE'�OCCUR'. . OOs.11-Fll MEDEXP(MyonePin) 5PERSONALAAOVINJURY S _:1 000 0 AOOR$GATE UNTAPPUES PER GENERAL AGGREGATE EOUCS 7 LOC: t PRCMXTS:COMRrpPAGG $. 21 OQO�. AUTOMODU tJAHIL(rY. - - - g 5665240000 7a1o112013 12/07IM4 �MaNEDs,r L,IrsrT Arn Auro : . (ES 000 _ .. '. ALL AWNf?I)AUTOS - 00D&Yif"wRY.tperp@I A �IceaULeP AUT00 # * II005ILY INJURY tPet Atr i) S X MIREDAtIrOS 4 PROKRTYDAMA E X NONi>3NFIEOAUTO$. (Ppr dons) I$: 1NCL V7SaRE14A LiAe X OCCUR 460005$36 1q/01t2093 11/09l2894 EAcrioccuRREnC> g 1 OD(I . . A e%CFSSUAb - CLArMS.e9ADE � - � � � .AGGREGATE ---�•••.~-S.:� 100( 1. UOO OO -. . APO UNn(rMS,MADI� WCCS00559301200 9014&2013 9Q/03I2014 X T L s X s AryYPROMIETBRIAARTNEItIEXF 1PiVEY{N = a B .(1}1 6NWINEREXCLURED4 !( `!) N/A Z RICHARD '111PPER I L.EAOHACSIDEM. 8 O00 00 ea cep der f'L:UDED.FOR WC.cOvt RAC .. E.L.OieEASE Far�.ov� 2"000 00 scRl Toro OPEtiATIONS tIa POId4,f Utah 1,DOQ 00 . . AE8CRIrsRpNOFt?pERdiTIQN61L4CATlON$lvE11tCLCg(AttaNIAGOR440t,AdgfgonslReglq191sllct�d........ lmrasAaceNIRQUII�) CRTIF1� TP M®jR CANCEL L;ATi 9HCUL19 ANY 9F THE ABOVE DESCRIBEiJ P.OLIC►E,$B@ CANC6LI.ED BERORE A�G4XPIRATIAN RATE.THER F�IE 'WILL N DELIY R0:IN RDANCE WITH THE ROLL PR IS 'tF(1rflfArRk�ts�$fl PNI'RASE9 QOy., hipperIs.tptlst9ono: LL,C. . ausrioRlt�41RItrS1sNYATIVE r 27- Roblsrto 0rivld " ;. . 1V 7. Yar•IRdutrhl Mp.Q2S73 . - Lora L owe "CORD,26 _ W 10b&2008 ACQR � p®fQ�? . _ The ACQRQ name and l D COLiPORATI�pN: A r BhIN r rvOd ego are regisierQtl rna�of pGQR[� . ,. N OWNER AUTHORIZATION FORM 1, S (Owner's Name) owner of the property located at - (Property Address) (Property Address) n _ 1 hereby authorize �U c (Subcontractor) j ( � an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. O ne ' ignat6re l , Date " .. ... .CFI ie it 44 L!1 2 � i Town of Barnstable *Permit# ;;�6 (o X-P I®C Vce P E R 7: ' Expires 6 months from issue date MAY 31 200egulatory Services Fee o 0 omas F.Geiler,Director -:TOWN OF SARNSTAINUUding Division Tom Perry,CBO, Building Conunissioner 200 Main Street,Hyannis,MA 02601 �r www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERIVIIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number t L Property Address %Residential Value of Work 10, fhZ� Minimum fee of$25.00 for workl under$6000.00 Owner's Name&Address _ �%oo iJ�.J cS l kq-wk5 Contractor's Name_ Telephone Number -a,\- Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ®Worlcman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name Cn(f` !/ Workman's Comp.Policy# 7 9 X /9 X/0 , i Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) Re-roof(stripping old shingles) All construction debris will be taken to C t ❑Re-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. ove t ontractors License is required. SIGNATURE: Q:Forms:expmtrg / Kevise071405 May, 31. 2 IV 2 9rNi 16: 0?L4 P. 1 v <: v �l: s2. t �; c3 � fr�i „�.> J SK'r 8) 3fY'r<' "':»��'•:.> . n>`>: \�®® FIN `v6®) 4sis �� ti n )J�ddv 4° fX)N i',,ia w�ui PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AMU CONFERS NO RIGHTS UPON THE CERTIFICATE WISE & QUINN INS AGCY HOLDER. THIS CERTIFICATE DOLES NOT AMEND MEND OR 449 PLEASANT ST ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. COMPANIES AFFORDING COVERAGE RROCKTON MA 02301 GOMFANY V 24WCR A HARTFO D ER' INSURANCE COMPANY INSURED COMPANY PRASER CONSTRUCTION CO S 71 TARRAGON CIRCLE COMPANY COTUIT MA 02635 C _ COMPANY r.•l�:o:,• � rz : r.�,s { ...r > is. nv ':. <, ti> i:• fAx ) .>,. >✓ i a.fi'>t� i ! K ) f`': s < >. >.`i. i;�3�.9.1 ... :?;<.'.., r... ....... .....,,,., .:.,..',..,.. ....,..,..r t�iw,t.., ....k,.or� :<.x ,....1..'',. .. .. 2 r�... lfr:vnrr.Al,: s4.... ohss.... ..rls ..G.. THIS IS TO CERTIFY THAT THE POLICIES OP INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDFF ION OF ANY CONTRACT OR CTHER DOCUMENT WITH RESPECT TO WHICH THIS 1 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS ANC CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIM& CO POLICY EFFECTIVE POLICY EXPIRATION LIMITS, LTA TYPE OF INSURANCE POLICY NUMBER DATE(MMTI11YV) DATE(ALM',DD1YY) OCNIERAL LIABILITY --- GENERAL AGGREGATE 8 �ROOUCT-S-COMPICP AGG. ' L'OMMERCIAL GENERAL LIABILITY "ate PERSONAL d AOV.INJURY );r CiJAfMS MADE k OCCUR.. Jh $ OWNER'S 8 C3N7RACTOR'S PROT. !EACH OCCURRENCE $ I PIKE DAMAGE(Any one fire) E —� MEN.�XPEN8c(Any one person) $ OOM9INED 81NOLE AUTOWIOBI E LIABILITY ANY AU70 . .. LIMIT S ALL OWNED AUTOS II I HOOILY!NJURY 8CHEDULE;DAJT08 (Per Pereen) HIRED AUTOS BO?ILY INJURY I S NCN-OWNED AU'06 ` (Ptt Acaidmni) i PROPERTYOAMAGE $ I GARAGE t ABIUTY AUTO ONLY EA ACCIDENT 1111 I ANY AUTO - OTHER THAN AUTOON'.Y: Via,t•s < kr'�S,,r}:`:'i<< EACH ACCIDENT 6 __ -- - AGGREGATE E$ EXCESS LIABILITY EACH OCCURRENCE $. UMERE_LAFORM A6GREtlATE OTHER THAN UMBRELLA FORM A WORKER'S COMPENSATION AND - I BTATUTOR'r LIMITS '7; •1, ,1'L "")'"' I MPLOVER'S LIABILITY 09-26-06 t'UR-794X619-1-05} 09-26 C5 I EACH ACCIDENT 6 THE PROPRIETOR' ^'. INCL ' - DISEASE-FOLSOYLIMIT $ FARYNER8IEXECUITIVE I OFFICER8ARE: ExCL DISEASE-EACH EMPLOYEE $ I OTHER. E � DESCRIPTION OF OPERAI10H$iLOCATIONSIVEHICLESIRESTRICTIONSISPECIAL ITEMS _ _--- THIS—REPLACES-'ANY PRIOR CERTIFrCATE ISSUED 70-THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. :iyl„� '. :;{1, III ! -'.i7 p�` .}: ':VK<t $S: "�•'Y4, t'S94))' I Silt t{k)t4X•�i�}>t tl2K!ln�t><>k ,typ.r va'�. .<, u!�• o-L...s.>............. ..4+..h 5,,. ... '.S.'.? �.:9'.ghq.o->..;;g:j•.R..., ..r.. .r'.:4t{ib,P2... 1.d.....,,1 :'.'•.in.N+.'.:.....s.«r )!l�',::;ia ,.,.::..: 'i4S...:. d, < SHOULD ANY Of THE ABOVE DESCRIBED POLICIES BE CANOULED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING COMPANYWiLL ENDEAVOR TO RAIL 10 DAY WRITTEN.NOTICE TO THE CERTIFICATE HOLDER RAME®TO THE FRASER CONSTRUCTION'CO. LEFT, BUT PAILURE TO MAIL SUCH NOTCE SHALL IMPOSE NO OBLIGATION OR 71 TARRAGON CIRCLE LIA9IUTY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR NMFSEHTATIVES. CUTUITT MA 02653 AUTHORIZED REPRESENTATIVE � �.......... ................ ........ ...: ....... ... ......... ............. Department oflndustrial Accidents Office of Investigations 600 Washington Street ' Boston, MA 02111 TOMmassgov/dia• Workers' Compensation Insurance Affidavit:Binders/Contractors/Electiicians/Plwmbers A plicant Information Please Print Leg1bIy Name pushess/Organizatioonllad Adu4:_ c)2Aw. Address: City/state/Zip: • C-6 /14,4, ' Phone#: � Are you an employer? Check the•appropriate box: Type of project(required): 1,5I am a employer with_ -,� 4. ❑I am.a general contractor and I 6. ❑New construction employees(M and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor ar partner- listed on 1he attached sheet, t 7. ❑Remodeling ship and have no employees These sub-contractors have 8, ❑ Demolition working for mein any capacity.. workers' comp.insurance, 9. ❑ Ehii1ding addition [No workers' romp,in=mce• 5. ❑We are a corMation and its required.] officers have exercised their I O.❑ Electrical repass or additions 3.❑ I am a hanieownea doing aU work right of exemption per MGL I I.❑ Pbnt mg repairs or additions myself:[No-workers' comp, c. 152,$1(4),and we have no 12.(Z Roof repairs i'nsur=ce,required.]t employees.[No workers' 43.❑ C!ther ems.insurance required.] Any applionat that check;box#1 must also fill out the section below ahowing their workers'compensation policyiafarrae#oa Homeowners who submit this affidavit indicating they are doing at work andiben hire outside c=tmctosa must submit a new affidavit indicating'eruch. onhactors that check We boat must attadhed an additional cheat showing the mare of to sub-coatraatars and their wcikere comp,policy information, am an employer that Is providing workers'compensation Insurance for.my employees Below Is the policy and job site information. ���� . . : '•�. aneo b mpmyName: v�y#or S��s.Lie.� ' �9x`Yl� /l��—� �a#�: ' •lJ ��, ; Job Site Adckess:_ !)0 - City/statezipi: G lz..� Attach a copy of the workers' compensation policy declaration page(showing the policy number and W.iration date). Failure to secorc-coverage as required undei Section 25A of MGL c. 152 rmi lead to the imposition of crffiiaal penalties of a fie up to$1,5001.00 and/or one-year b4rdsomnent,as well as civil penalties m the•fa m 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 eer i at en a 'ury that the information provided above is true and correcit i tare: Date: l City or Town: I�ermitti,icense# I Issuing Autharity(circle one): 1.Bo2*d of#iesith 2.Building(Department 3.Cityl—I own Clerk 4.Electrical inspector 5.Plumbing Inspefnkor• � l 6.Other Co-ataet Person: 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: (F> AND (7) OR °Search Search Results Reg. No. F Applicant Street City State Zip Name Title Expiration FRASER 71 FRASER, 112536 CONSTRUCTION TARRAGON COTUIT MA 02635 DEAN OWNER 3/23/2007 co CIR Total of 1 Records matched. Back to Home Page tS�iri c ent p a Z v c� D �U\ o m a: N _ http://db.state.ma.us/bbrs/hic.pl 5/31/2006 Fraser Construction Roofing & Siding Specialists Payable immediately upon completion NO MONEY DOWN NO Payment at the start or part way thru Payments accepted are: CASH - CHECK - MASTERCARD - VISA- AMERICAN EXPRESS Possible Extra -After the shingles are removed from the roof, we will lift one sheet of plywood to make sure that the insulation be not up against the plywood sheathing, preventing ventilation from the eaves to the ridge. If it is, ventilation panels will be installed by; removing the plywood sheathing, installing the panels, turning the plywood over and then re-installing the plywood. If needed, this would be charged for as an extra at the rate of$4.00 per panel including Materials &Labor. There are 6 panels per sheet of plywood. Possible Extra-Any rotted or otherwise deteriorated trim boards, plywood sheathing, lead flashing, or other carpentry needing replacement will be done and charged for as an extra at the rate of$45.00 per hour, plus materials, plus 20%overhead mark-up on total extras. FRASER CONSTRUCTION Warranties the labor for 10 years FRASER CONSTRUCTION Warranties the shingles against Blow-Offs for 10 years. CERTAINTEED Warranties the shingles and labor 100%for the first 10 years, and then on a pro rated basis for the Lifetime if the shingles become defective. CERTAINTEED Warranties the shingles to be ALGAE resistant for a full 10 years. Any deviation or alteration from above specification will be executed upon written orders and will become an extra charge over and above the estimate. All agreements contingent upon strikes, accidents or delays are beyond our control. Owner should carry fire, tornado and other necessary insurance upon the above work. We, if not accepted within thirty days may withdraw this proposal. FRASER CONSTRUCTION: Carries Workman's Compensation and Public Liability Insurance on the above work. DATE OF ACCEPTANCE: SUBMITTED BY: owner ., rase ction