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Home My WebLink About0053 WEBSTER ROAD Town of Barnstable *Permit# oFt� - _ Expires 6 monthsf issue date Regulatory Services Fee HARNBrASI t' M" '$ Thomas F.Geiler,'Director r:n IfDMPt-.: ' p. 1r Building Division � E ?. Tom Perry,CBO, Building Commissioner . DEC' 1 8 2009 200 Main Street,Hyannis,MA 02601 TO 1 www.town.batmstable.ma.us �° OF BARNSTABLE Office: 508-8624038 'Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number Property Address V e-b e4ar RDaJ 3 M aI m-4zas !mil,l 1 s AAA Da 6 W Residential Value of Work e 4 J Minimum fee of$25.00 for work under$6000.00 � II Owner's Name&Address pot e_r--� lV I CXeXS o n 53 W S jtr Roo,, i . %MCLegL0 S ILL///s; MA 6, _a—L& Contractor's Name '5 Ot,;n K LP_ Borne_ -Telephone Number 5OV- -7 -7 S-11 '18 .Home Improvement Contractor License#(if applicable) 1 0 3 7 5 Construction Supervisor's License#(if applicable) CPCO`( [6orkman's Compensation Insurance. Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑-have Worker's Compensation Insurance Insurance Company Name 0S5t � Z O c ✓,&Lks I-� e-.S rn A Workman's Comp.Policy# P l>JC —]Cab`A 9 `1 3 CO 1.2_0y 7 Copy of Insurance Compliance Certificate must accompany each permit. r ; Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑Re-roof(not stripping. Going over existing layers of roof) .❑ Re-side #of doors Replacement Windows/doors/sliders.U-Value 3 ` (maximum.44)#of windows 9 '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. A co oft a Improvement Contractors License&Construction Supervisors License is. eq SIGNATURE: QAWPFILESTORWbuilding permit forms\EXPRESS.d Revised 090809 Massachusetts- Department of Public Safgy Board of Building Regulations and Standards Construction Supervisor License 4ic ense: CS 6643 Restricted to: 00 • I BRAD K SPRINKLE I 190 LOTHROPS LANE W BARNSTABLE, MA 02668 Expiration: 10/8/2011• i Commissioner Tr#: 5478 Restricted to: 00 00- Unrestricted ;i 1G-1 2 Family Homes i Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Refer to: WWW.Mass-Gov/DPS ' �/ee�oomimanwealdi o��/�aaaa�uaell2 i -Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Reglst �1►� 103757 , 9/2010 Tr# 271033 _ to Corporotrcn. ' • SI�F�ifi�iCL••E HO ;IIVC. E3rafi1 SpiNWe J 5 —.• y'atrnis f�A02�Ofi_t.. iu r,. � -. L dense .r regis r# ?: before the eYpi'ratioii date.'.If found return:to: •. oard-of-9 g.iRegulatfons and Standards ; -.bne atisbburton: Pjace'Rnt:1301 sto 02i:08' •ter. - • tare Not watil wit out sg * d:I: i�[. R Yiii�`1�:��►1:uaa:��l:�:ol�:u T I �rrsL�� ya R •#'12/31/2008 14:18 Bryden & Sullivan Insurance Donna Sevlour->Margo 1/2 ACORo SPR CERTIFICATE OF LIABILITY INSURANCE OP °ATlm2/3 /IN-1 12 3108 PRODUCER THIS CERTIFICATE IS ISSUED AS'A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden Q Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis MA 02601 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURW INSURERA: Associated Industries of MA INSURER ET Sprinkle Home Improvement Inc. INSURER C: 199 Barnstable Rd INSURER O: Hyannis MA 02601 wsuREa e COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEENREDUCED BY PAID CLAIMS. LNSR POLICY NUMBER ►DULY lfFECTIV)E POLICY EXPIRATION UNITE LTR SRD TYPE OF INSURANCE DATE MMrDO/YY DATE MMJDD/Y GENERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GEN IABI ERAL LLITY PREMISES Es Occurgnce f CLAW MADE OCCUR NEO W(Any One Permn) S PERSONAL d ADV INJURY S GENERAL AGGREGATE S N CENL AGGREGATE LSAT APPLIES PER PRODUCTS•COMP/OP A00 f PRO POULY JECT lAC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (EP atcldent) S ANY AUTO ALL DMEDAUTOS BODILYBNIURY - (Per Perm) S SCHEDULED AUTOS HIRED AUTOS BODILY WVRY ' S (Per accidenq NON•OWNEDAUTOS PROPERTYDAMAGE f (Per acc10anf) GARAGE LIABILITY AUTO ONLY•EA ACCIDENT S iANYAU70 OTHER THAN EA ACC S AUTOON.Y. AGO f I EXCEStAIMIBRELLA LIABILITY EACH OCCURRENCE $ I OCCUR D CLAMS MADE AGGREGATE S r , S OEOLC71BL.E f RETENTION f S WC TLL I JOIN. WORKERS COMPENSATION AND TORYLLMITS ER EMPLOYOW LIABILITY AAIMPROORIETOR/PARTNER/EXECU7?VE AWC7004943012009 01/01/09 01/01/10 Ei.EACH ACCIDENT s 500000 OFFICER/MEMBER DCLUDED7 E.L.DISEASE•EA EMPLOYEE s 500000 i !YC3.deaCllOe under SPECIAL PROVISIONS DNdr E.L.DISEASE•POUCYUNi S 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY 6NDORIS MENT/SPECIAL►ROVIs10NB CERTIFICATE HOLDER CANCELLATION SPRNKHO ImOMLD ANY OF THe ABOVE DEscRIBE)►Oucizs Be CANCELLED BEFORE THE EXPIRATION • DATE THEREOF,THE I96VING INSVRER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Sprinkle Home Improvement, Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO BO SWILL Fax #508-775-1350 IMPOSE NO OBUGATIOHOR LIABRITY OF ANY WND UPON THE INSURER,ITS AGENTS OR Margo Mack I 199 •B'irnstable Rd. RIPRESENTATIVES. Hyannis MA 02601 AUTHOMED REPRESENTATIVE Kelley A.Sullivan ACORD 25(2001/08) 0 ACORD CORPORATION 1988 r 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):—,,�F�ab t1UVY%_ ImpaN2'Wle_A Address: 1.019 .?Sm.r ac,- City/State/Zip: &.n h LS NIA nt t Phone#: 5QX- 1-7 S l l Areeyy u an employer?Check the appropriate box: Type of project(required): 1.LJ I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. # 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9, ❑ Building addition [No workers'comp.insurance 5• ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL I L❑ Plumbing repairs or additions myself..[No workers'comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees.[No workers' 13.0 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 1 Insurance Company Name: SSOC; Sv`�l►.�T f C's Policy#or Self-ins.Lic.#: G QC_ 7M 99 %A 301 J-60( Expiration Date: Job Site Address: 5 ))S" E%Y K I. �'I YS-61S M i�I e, City/State/Zip: MA. �a6 q� Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Fa lure 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 ce 'y e p enalties of perjory'ihat the information provided above is true and correct. Si ature: Date: ,Z'1 0 Phone#: 5 0 0 - -7 IS- - I Off E only. Do not write in this area,to be completed by city or town official, n: Permit/License# hority(circle one): Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector son: Phone#: ST Town of Barnstable r "a Regulatory Services ` Thomas F.Geiler,Director $qev16�� Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02.601 w`vw.town.b arnstable.ma.us Office: 508-862-4038 Fax: 5.08-79M230 Property Owner Must Complete and Sign This Section If Using A Builder I, Bob Nickerson as Owner of the subject property herebyauthorize SPRINKLE HOME IMPROVEMENT, INC. to act on my behalf, in all matters relative to.work authorized by this building permit application for. 53 Webster Road, Marstons Mills, MA (Add-Tess of Job) 'Joe Signature f Owner Oate Bob Nickerson Print Name If Property Owner is applying.for permit please complete the Homeowners License Exemption Form on the reverse side. Q:FORMS:OVJNERPERMISSION i 4 s 10 k/0 tib 6� i. .00, 00., LOT 72: sO' I x y� • �6.s S41°10'00"E .9 WEBSTER ROAD 184.46' - I 55 Webster Road scale 1"-40' Deed: Book 1341 Page 303 , Plan: Book 157 Page 97 "I CERTIFY THAT THE BUILDING SHOWN ON THIS 'PLAN IS AS IT ACTUALLY EXISTS AND THAT IT CONFORMS TO THE TOWN OF 'BARNSTABLE ZONING REGULATIONS. I FURTHER CERTIFY ' _ PLOT PLAN OF• .LAND THAT THE SUBJECT PROPERTY SHOWN located .-in HEREON DOES NOT LIE WITHIN THE BAR�I.STA$L` a; MA 100 YEAR FLOOD PLAIN" prepared---for i DATE Jame 15,1986 ��tK of Mqs� Robert Nickerson & Ann Oliver-Nicker GREOGE 4 Esc .E. - LOMURno H $ SANITARY Ujineern 9 Flood Zone Information from 'PF O ti Dated Community5 p : 250001 0015 C Nsr ENG�,�`�� 24 Forsyth Ave., S. 'Yarnxouth, MA%' Assessor's office (1st floor): /U 3- 03 C�� aEc S � Assessor's map and lot number ........ ................................... � r -�, . Board of Health (3rd floor): r /,, / 'fO Sewage Permit number ..... .. .��.lY..3C ....tolabo �'�� L B , Engineering Department (3rd' floor): .53 �JS E��i°ar° ` = -s' 6C. '.aRraed ABd9TABL i639' House number ....:................................................................... TOWN RECA r a 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 � '0� � L L TYPE OF CONSTRUCTION .........:..... ��v.. .....T.... lL ...... �LC/NCB ....................... .............�. ...�. ................19. � TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies fora permit according to the following information: Location .. .....��! ?... .:...... � ...... ..�.1 ...... ...... .. .....f Proposed Use ...... 1. �i ..................... Zoning District f.•).4?J Q ......C.'f 14.4 S...................Fire District .. ..... .......................................... Name of Owner ......Address .. ?.. .... ......1,0 !Mt.hk 0/a yra.......Jd.NNSa Name of Builder . ...........................Address ..........: Name of Architect .............. .. .... ....Address ..;7 ..... p.... ..5.� �D1�1/�.C4,_,, .vas Number of Rooms ..... .......... :..................Foundation ...... .D!�G '......w.?!.'.�....�6..�'dlll�/v�� Exterior D.:.�.1 � ✓ .Cz�..................................Roofing .../ Sl..... '..QLI Floors1..1. ...........................................Interior ...G D/z) ... ........................... ................ Heating ..... /�/..��.Y..:.�.L.U..U�................................Plumbing .......�1/./. ...... ................................................ Fireplace ...........................................:......................................Approximate Cost ................Sf ......................:........ Area .... ... �.. � Diagram of Lot and Building with Dimensions Fee .............. 5..... 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 i construction. t;e Name / Construction Supervisor's License ✓ ..r .................. f NICKERSON, ROBERT P. ti No ...32.37.'2. Permit for ...A ID...T.Q................. r' .......$.i.n9.1e...F.aznUY...dwell.i.n.g......... Location ......5.3...Webster..Ro.aci................... ....................Max 5t.Q.ns...Mi.11.s...................... Owner ... ...... ......... Type of Construction .......Fra e...................... . ............................................................................... Plot ............................ Lot .....#7 2.................... Permit Granted ....Rc.tab�x...2.0.,,..`:..:19 88 Date of Inspection ../. .. .....19 Date Completed ........ `19 M t ' - •t .. -