HomeMy WebLinkAbout3420 MAIN ST./RTE 6A(BARN.) (3) r'�
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phone: 1-866-756-4676
UNV12305
MADE IN CHINA
TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION
Map l Parcel Application #.�dl iJol7��
Health Division Date Issued Ple
'Conservation Division Application Fee
Planning Dept. Permit Fee
Date Definitive Plan Approved by Planning Board
Historic - OKH _ Preservation / Hyannis
Project Street Address g) Ma 'in
Village
Ownerl�, l I Address
Telephone 7
Permit Request a!�75
a,�a�em_h) (�Owl&w Waj( af6l.
Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new,
Zoning District Flood Plain Groundwater Overlay
Project Valuation Construction Type
Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation.
Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units)
Age of Existing Structure 12 S 0 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 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 dNo Fireplaces: Existing New Existing wood/coal stove'' ❑Yes ❑ No
Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn ❑,`existing ❑;new �Isize_
._J
Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other:
-� 0
Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑
Commercial ❑Yes ❑ No If yes, site plan review #
J
Current Use Proposed Use
APPLICANT INFORMATION
(BUILDER OR HOMEOWNER)
Name 4 Telephone Number
Address t l A License # (i-./
Home Improvement Contractor#
Worker's Compensation #Wmzb9515j 1 _30/
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PRO ECT WILL BE TAKEN TO
0.
54�A I FA, W I' , . -- I ABn A 69(al
SIGNATURE DATE ['I Z I
FOR OFFICIAL USE ONLY
APPLICATION#
DATE ISSUED
MAP/PARCEL NO.
r<. ADDRESS VILLAGE
OWNER
DATE OF INSPECTION:
jAFOUNDATI.ON1
FRAME
{iINSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL
s
PLUMBING: ROUGH FINAL
k. GAS: ROUGH FINAL
FINAL BUILDING
-DATE CLOSED OUT
ASSOCIATION PLAN NO.
. cow
y '
Bacon Farm Condominium Trust
3420 Main Street
P.O. Box 230
Barnstable, MA 02630
April 21,2015
To Whore It May Concern:
This letter authorizes Tupper Construction to act on our behalf in matters authorized by
the building permit. r
Ilona Kelly
Trustee
6'd 0969-ZW-909 jngpv we1i!!M d Lt l0 9l bZ ady
Town of Barnstable
Regulatory Services
'r r�wrctirea
RicLxrd V.Scali,Director
►„ ° Building Division
['om Perryt Building Commissioner.
2001vlain Street11yan ais,:Ak 02601
m—mtown.ba rnstable-mams
Office-. 508-€62-:408 'Fax: -508-790-6230
Property der Must
Complete and Sign This Sccti:on
ff q!` J-ncr A Builder
as Owner of.he subject prop,.--tvy
_—` l t
Hereby authorise.— _ I f 4I to nt on,m j*a ehalf,
in-A xtatters mlitive to wok. = tborized by d is ba, no perm t applic €ion.for_
Pool fences and alarm are dle espons Itv of the appl ca .Pools
are not to be fined or utilized before fence is iastalkd and all.'U al
inspections are performed and accepted-
Signature of C)vm--r Si It-ure of 1 ppkant
P
I
I?rint Name I'rir�t Name
Date
QzF0RA7$:o�4;��RY;��,id61;S3gA1PLH�::.�i \
i
The Commonwealth of 11?'assachusetts
Department o,f 7r:dustrial Accidents
Office of Investigations
' 600 Washington Street
Boston, M4 02111
WWW.m,ass govldiai
Workers' Compensation Insurance-Affidavit: Builders/Coiitractors/Electricians/Pluanbers,
Applicant Information Please Print Lei h '
Name(Business/OrganizationRadividuai): Tupper Construction Co. ; LLC
Address 546A Higgins Crowell Rd
City/State/Zip: West Yarmouth, MA 02673 Phone#: 508-778-0111
Are your an employer; Check the appropriate box: Type of project(required):
L.M 1 am a employer with 10 4. ❑ 1 am a general contractor and 6. M New construction
employees(full and/or part-time).* have hired the sub-contractors
2. 1 am a sole proprietor or partner- listed on the attached sheet.'t 7 El Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
workingfor in an capacity. workers'com0-insurance:
Y p 9. Building addition
[No workers'comp.insurance 5. We area corporation and its
required.] officers have exercised their if?.❑Electrical repairs or additions
3.❑ 1 am a hom.eowner doing all work right of exemption per MGL 1 LE] Plumbing repairs.or additions
myself. [No workers' comp: c. 152 §l(4),and we have no 1?.❑Roof repairs
insurance required.]t employees. [No workers' 13.11 Other�p( alllet jza#inn
comp.insurance required.]`
`any applicant-that checks s box#1 must also fill out the section Wow showing their workers'compensation policy inibmation.
s nomeoevnets who submit this affidavit indicating they are doing all-work and then hire outside contsactors,must submit a new affidavit indicating,such.
Contractors that check this box.must attached an additional,sheet showing the oame ofthe sub-contractors and their workers'comp,policy;information_
lam an employer that is providing workers'compensation insurance for my employees Below is the policy aped job site:
iffyort ation.
Insurance Company Name: AEI C
P olicy 4 or Self.-ins- Lic.9- WCC 5005593012014A Expiration Date: 10/3/15
Job Site Address: V1 city/State/Zip (�
Attach a.copy of the workers'compensation policy declaration gage(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 ofcr criminal penalties of a
ftne.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 maybe forwarded to the Office of
I W sfigations of the°DIA for insurance coverage verification.
I do.Hereby cerlily_under the pants:s Me Oelaalties o.f perjUry that the information provided above is true and correct
SitFnature:
Phone#:.
(508) 778-Q111—
7Fssu
e araly. 190 not write in this area,to Be cUmpleted by city or town offciat
wn: Permit/License#
Authority(circle one);
t.Board of Health 2.Building Department 3.City/Town Clerk, 4.Electrical Inspector S.PlumbingInspector6.Othe>r
Contact;Person: Pho>$e#
ACORO
CERTIFICATE OF LIABILITYINSURANCE
DATE(MWDMYYY;
�I11a��JEtl4�sE 12/1/2014
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 zTHE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERT FICATE:HOLDER:
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poli.cy{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 FitZCseTa1C1 -
PAE
Southeastern Insurance Agency PHONE {50B)997-6461 FAx
_.:' �;(SOB)990-2T31
439 State Rd. £ARIL A(.SS.Uitz0southeasternins.com
P.O. Box 79399 INSURER S AFFORDING COVERAGE NAIC
North Dartmouth MA 027 ? WSURERAArhella Protection Insuranae I4136C
tkSURED
INSURERBAssociated Employers ers Ins. Co.
Tupper Construction Co LLC INSURER 79 Mid Tech Drive, I INSURERD -.
Unit B
INSURER E
West Yarmouth MA 0267.3 1NsuRERp:
COVERAGES CERTIFICATE NUMBER:2915-1 REVISION NUMBER:,
THIS fS 70 CEffrIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO.THE INSURED NAMED ABOVE FOR THE POLIO PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT,OR OTHER DOCUMENT V41TH 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 PAIDCLAIMS.
1NSR, ADDL S118R _ .
1-TR+ TYPE OF INSURANCE INSR a POLICY NUPAaER. POLICY EFF POLICY EXP -
.,GENERAL UABILITY - -
yEACHOCCURKEICE S 1,000,000'
X I COMMERCIAL GENERAL LIABILITY I DAMAGE O
PREMISES Ica accic acre) 5 100,600
A pi 'LPJMF,-WADE OCCUR 8500008743 1F:/1/2014 _1/1/2015 'MEOEXP(Any rnat3ersar,) c_ $,Q(jO
PERSOiNAL&ADVINJURY S 10 000,000
E4 j d GEP4EEL;L AGGREGATE 15 2,000,00
.
'GEN'L ACs'CREGATE U&M APPLES PER..
! PRO 1 ! I PRODS'PRODS'-0011PIOP AGu{:S 2 j 000 j OOb
i_X POLICY LDCt..S
AUTOMOBILE LIABILITY ` .. .. - .G-n1Eli+lED 5t�lGLE UCAIT I
E88ir1[itvv[: S 1 -00�0 000:
A ANY;AUTO i BODILY INJURY(Per¢srsonl �,S
ALL SCHEDULED � 020009384 12/1/2014 2/1/2015
80O , N.URY(F eGdek) 5
1 X NON-04aNED
I. HiREw AUTOS AUTOS. f ILSR_OPTR I�I-AMAG.- S
) 2SD 000
UedteRELLA uka I )�� �
f1 u,�+sl:rea>reta:siea�luthraw '-
j EhCH CG;U*HRENCE S
A 'EX LIAB CLAIMS-)AADE J
I OED RETECNTION§ 460005e368, 1/1/2014 { 1/1/2015 AGGREGATE
COMPENSATION S
:AND EMPLOYERT LIA81yTY I'APC STAT E- jVIM-
WORKERS - -
( ANY PROPRIETORIPARTNEW.CECUTIVE YIN j ^l I ER
!( OFRCER1M1 EAa9ER£XCLUD(ED? ❑ N l A. I E.L.EACH ACCIDENT 5 1 Q 00 000
.:OffxysdG9=,bet er CC5005S930120i4A - 0/3/20I4 0/3/2015 I("E', DISEASE EAEMP'OY5 S 1 000,000
FSCi2PFTtON OF OPGRAT•.t"j{d5 t1&I— I F L DISEASE POLICY Imr, $ 1 00{1 000
__. -
DESCRIPPON OF OPERATIOi�IS 1 LOCA'.O.S 1 VEHICLES(AtEaCt1 ACORD 01,kddi#iartai RamarksSehedule,.ef wsaese spate isre u(red) - - -
CERTIFICATE.HOLDER
CANCELLATION
1.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
' THE EXPIRATION -DATE THEREOF, NOTICE WILL BE DELIVERED' IN
INFFORMATIOA: PURPOSES ONLY ACCORDANCE WITH THE POLICY PROVISIONS.
TUPPER CONSTRU6TT0X CO LLC
548 A HIGGIN§ CROWELL ROAD AUTHORIZED'REPRESENTATIVE
WEST' YARMOUTH, MA 02673
Lora F taGerald/LHL.
ACORD 25(2010/05) (D 1988-2010 ACORD CORPORATION.-All rights reserved.
INS025r�nynnsin� Th.arrlon.,�..,o of.a a..,..aka rnnicrnrn.�mar4c i f a(,ni2n
Oma,91-C:31i1sww 1,(fairs Ok aillfli,�'S dC€•..fit,a�tj t,•., dice_w or a i0m';on u9iie for intlividut usr ubty
ftfE kOVFIS��R2 W4TAAi"Fi# It f«rt cite xlEt elrs cf ttt. if found rrt€a ):
w t€at§ml a¢ xu _. BD icon t seta PyAf iv,"and attsr;sew
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TUPPER
CONSTRUCTION CO. L-Lc
546A Higgins Crowell Rd,WEST YARMOUTH, MA 02673
PHONE: 508-778-0111 FAX: 508-778-5010
VWVW.TUPPERCO.COM
r3
Date: �J
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 application
Issued on ��(p l �� has been inspected by a certified
Building Performance Institute (BPI) inspector. All work performed meets
or exceeds Federal and State requirements.
Sincerely, Permit #: ';�-0 j 60g4-51
i
i��u f
Address: 3 (n �l ,
Richard Tupper D I
License # CS-69058