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Home My WebLink About0077 BURSLEY PATH L ' a i � Q NO. 152 1/3 ORA ESSELTE 10% , .. ..�+r,�•T,,!rt�n�w�.+...,.,, ....R • �--.•'+�.,..r.�....v..ti.....� e. ..,......_.�-_�.�. ...,._ .R�.iiK�r.�-.-�a��_......�..�.e-�rr..r....-�.F^a.. ,r...,....s-.--er...- �..�r.r�.r,•:•,.,.,�•�.....s�,-_.�+�-�--.�,..,..rn,,,,•�...-...:,�: i • Town of Barnstable *Permit Expires 6 months rom issue date :z Regulatory Services Fee XMIL .�stvau►ws Thomas F.Geiler,Director MKt� Building Division �FJI Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number w/ nos � Property Address 1 �'e,j b k VJ e T j Q�✓1 S Y�� (OResidential Value of Work oft 1 5 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1`ey In 5 � y �� S ZD Contractor's Name Sprinkle Home Improvement Telephone Number 508 775-1778 Home Improvement Contractor License#(if applicable) 103757 Construction Supervisor's License#(if applicable) C,5 (06�{ ZWorkman's Compensation Insurance �� PERMIT Check one: El am-a sole proprietor ❑ 1 am the Homeowner 1 have Worker's Compensation Insurance MAR 2 9 2012 Insurance Company Name AsgnrintPtl IndltStriPS of MA Workman's Comp.Policy# AWC; M049430 1?n 1 TOWN OF BARNSTABLE Copy of Insurance Compliance Certificate must accompany each permit. ll Permit Request(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will betaken to %Lc mo t,1 h \fcxy\S 3f /❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum.35)#of windows "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 copy of thicHalyie Improvement Contractors License&Construction Supervisors License is equ' SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 The Commonwealth of Massachusetts Print Form _ Department of Industrial Accidents Office of Investigations ' I Congress Street,Suite 100 Boston,AM 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Sprinkle Home Improvement Address: 199 Barnstable Road City/State/Zip: Hyannis, MA 02601 Phone #: 508 775-1778 Ext. 10 Are you an employer?Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 10-12 4. ❑ I am a general contractor and I 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 ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof 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 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. =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 provide 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: Associated Industries of MA./A.I.M Mutual Insurance Co. Policy#or Self-ins.Lic.#: 7004943012012 Expiration Date: 01/01/2013 Job Site Address: -7-7 City/State/Zip:_Wesl S vflyaue foN4 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 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 hereb certify ug4=1egal ddpenalties ofperjury that the information provided above is true and correct Sip-nature: --- Phone#: 508 775-1778 Ext. 10 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: WL Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Stwt, 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 I, Y ex l n L, on 5 ,as Owner of the subject property hereby authorize Sprinkle Home Improvement to act on my behalf, in all matters relative to work authorized by this building permit application for: 9 `7 ?)LAY�s t4 Pa% u&)ds 2ca,-asWe- (Addre s of Job) - a 3 Signature o Owner Date Kez'A �-�OVA S Print Name If?Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the. reverse side. C:\Usen\demilik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\ContmLGudook\DDV87AAZ\EXPRESS.doc Revised 072110 12/20/2011 9 : 35 : 33 AM 8740 m 02/09 CERTIFICATE OF LIABILITY INSURANCE D"'�iv o 2001i'1' TNIs CZRTIFICATR Is ISSUED As A RATru or INr0IN"xoN OILY AID Comas so RIon" OPo■ Tax CERTIFICATE ROLDER. TQs CRRTI►ICAT= D0R9,NOT ArFIMWXVRLY OR NEGATIVELY AMEND, XXTRED OR ALTIM TOR COVRRAGR AFrORDRD BY THE POLICS=s aRL01. TEX8 CERTIFICATE Or Iss0s"CR D0=8 NOT CONSTITUTE A CONTRACT RE �TI TIR ISSUING IIRORRR(s)I AUTIORIIM REPR=BEETATIVZ OR PRODUCER, AND TS Cx=ICATE ROLX&R. IMPORTANT: If the Certificate holder is an ADDITIONAL INSUSED, the pollcy(los) Must be endorsed. If SURR0GATI0N I8 VANED, 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 andorsement(a). Bryden i Sullivan Ins Agency gym' Nave rat IIIC A/C. a.. Mal. 1MC. E.): E 88 ftlmouth Road ASE, ...v= Hyannis, bA 02601 aysrWas Iw. I•[I)a als) wre"Ma cmamx YIC a Sprinkle Home zmproVement Inc as sst A, A.I.M. Mutual Insurance Cc 33758 Sprinkle nrwm B, 199 Barnstable Road INS11WR C. Hyannis, ba 02601 IaiEo B, IrsEn s: mEm E, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: win I$ TO CN%Wv'lr>ms RS ROLE= Or xxxm lQ Lts'is RQ,om sAva am Is io Ta amosND NAEsm ARMS FOR sa VOL3Y FaIOD X10=210. sofor va'AUiF=ANY RNnUtamf . SOON an coSlTms or ANY coma@ OR own DOCMs v= Mawr so wlCK Vanesrzr=m EwY as I1s0m OR MY Fst2a2;, SS asRaAmv&wF aY va mOL=UX DiiCaaID SaN2s Is mcsaNer to ALL 7S Taos, ma"Zolm AND OORDIr=" or mOCR FOLICM. LnEm Aa0a7 11"lava INNER REDUCED By van CLAM. az� FOI.rLY lgita mOLICY ar F06DCY m LZlDlrm ►� was or 1EXU1ANCs truwiaTn lruaaReYn) Ginza"I'ZA&ZLM saa BCClmaacl { OCCEs[RCLAL GENERAL LIABILITY BlEMaE Ta EIIVY • OCLIIe WED■ OOCCDR tef @ IA17. B.s..a) • ❑❑ •aa•ol c Rev New= { GErL AGGREGATE LD11T uaL:sa u, •ssaaL ao•am•ars { OMiICT OFTAXICT OLOC .IIGEVCTs- caw/w a•• • { AOl IIi LIaaII1TY Cem Dma sIMLE LDIiv DART AUTO L.—id..%) MILT DQIQ (Nr P.—I • ALL CORD AUTOS OsCIIDe.[D AUTOS SMILE 1141RIMr—I"t) { OEIRID AUTO! •aGEaaT!Bm�i • (B.I.toiy,y OIDs-OWED AUTO{ O { OMRILLA LIAR1:1 OCCUR RACE OCCEa21001R • OIIC[ss LiAB O CLADC HAD• apalmGaTE • D[DOCTIM • OR[TIETIOE 1 { Rolms OOrSAA'rrol aTtF AND NIL0'1m1 LIARII,ITI[ TRUE LUM p THE PROPRICTon/PAR7MR3/ R.L. R&M aeealn { 500,000 A EXECUTING 0rrICGR9 ARIA ® incl ❑ excl 7004943012012 I.L. BIOAQ -nLICT LDnr { 500,000 01/Ol/2012 01/Ol/2013 N.L. BIZARRE -sA meLGas { 500,000 ceamT aaIQIDVIAa II WERATIon Is LBCATIN, W0RMS' COMPENSATION COVERAGE APPLIES TO MASSIACHUSETPS EMPLOYEES CERTIFICATE HOLDER CANCELLATION PROOF OP INSURANCE 1110IILD ANY or TOM AROVN DUCLUM 90=C=s in CARCaum aa'Oas IS @nzai= Dam lmNOF, wor=W= an=a4mov Is A0oosun s till is FOIJ=FA0V28I011m. avTE�Im R:BalasTnlvs 5289 �I.I��.lillll•ill• Ilill•IIIIIWIfI -•I P1IIII,, ,III I. I{n.u'11 ttt liuilllul_ I<r_ul.ut, n• ,ul l �I,IritLltrl• (1(ticsnf(onsumerAtrtralrsg-lvsiness guI "on Construction Sut)t r,,Is0r ,:cc r,st Tl, HOME IMPROVEMENT CONTRACTOR s'f Registration: 103757 Type: Llt.cl ,t, levy Expiration: 7/9/2012 Private Corporatic - Y.4 BRAD K SPRINKLE SPRINKLE HOME IMPROVEMENT,INC. • 190 LOTHROPS LANE WE Brad Sprinkle W BARNSTABLE, MA 02668 199 Barnstable Rd. _ Hyannis. MA 02601 Undersecretary U:rG_ s 10/&2013 6004 License or registration valid for individul use only Failure to possess a current edition of the before the expiration date. If found return to: Massachusetts State Building Code Office of(•onsumer Affairs and Business Regulation is cause far revocation of this license. I 10 Park Plaza-Suite 5170 Refer to: WWW.Mass.Gov/DPS Koston.VIA 02116 Not %alid without sign ore i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I b Parcel /U a/5 Permit# Health Division — `� !��`� �� fBsyN 0 IF BARNS FABLE Date Issued C' /7 03 Conservation Division � � � 20,93 JUN j ' at-j 9• �� Fe / D � 1 / 1 Tax Collector L �,Cl//_ SST Treasurer _ _ ED INCOMPLIANCE Planning Dept. L''VISION , �r VIITH TITLE 5 ENVIRONPAEPITAL CODm ANL Date Definitive Plan Approved by Planning Board TOIT01 REOULP TfO.�S - - •. • Historic-OKH t4 �It5Pr1eso3ervation/Hyannis - Project Street AddressWWI Village' I Pit &rn s iz„6 U_ Owner P,U t �. f--LI on's Address 29 '31,1r,51ey Telephone 5 U$-- 3 2 J " 10.10 Permit Request I (D' X I(.o ' �SCre ev) C1Urog l U i i-In TX X /L/ V an 1- 'p )Yc,11 Square feet: 1 st floor: exists g proposed 2nd floor: existing proposed Total new, Valuation�'� I�� IUD Zoning District Flood Plain Groundwater Overlay Construction Type Wo rl A- Lot Size (3 . 85 Grandfathered: O Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family O Multi-Family(#units) Age of Existing Structure to N e5 Historic House: ❑Yes Cl No On Old King's Highway: ❑Yes O No Basement Type: ($Full ❑Crawl O Walkout O Other ' Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing o new Half: existing I new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count Heat Type and Fuel: YGas ❑Oil ❑ Electric O Other Central Air: O Yes ❑ No Fireplaces: Existing '-e,,3 New Existing wood/coal stove: O Yes O No Detached garage:O existing O new size Pool: O existing O new size Barn:O existing O new size . Attached garage:9-6isting ❑new size Shed:O existing O new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded O Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use i BUILDER INFORMATION Name o� � �yxc�� s �, f u W i nc, f�i-m6eJ 6!T, � Telephone Number 56 9417 -3 a ¢S ,w Address I Sh License# �3 Home Improvement Contractor# /U o� 69 3 btu&i s sce n e�- Wo er s Compensation# 10C 0 0 6 10� f ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN T,:& SIGNATURE DATE ( o?�/, 00- FOR OFFICIAL USE ONLYt PERMITNO. y DATE ISSUED MAP/PARCEL NO. ADDRESS' VILLAGE J OWNER V - DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL a L , PLUMBING: ROUGH' FINAL GAS: ROUGH-' ' FINAL FINAL BUILDING 6510N NA PO/63 DATE-CLOSED OUT ASSOCIATION PLAN NO. Application to BA T�u��T` 4 CLERK .g'# �igbWap Regional �isstorlC Migtri>rt QCDrr><PAW ABLE ��00. In the Town of Barnstable 2103 JUN 12 PN1 2: 0 6 CERTIFICATE OF APPROPRIATENESS ppiication is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under Section of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described.below and on plans, rawings, or photographs accompanying this application for: :HECK CATEGORIES THAT APPLY: Exterior building construction: ❑ New ❑ Addition ❑ Alteration Indicate type of building: ❑ El � House Garage Commercial Other !" Exterior Painting: ❑ -- Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Rep,�aain�tintg Existing S�n Structure: ❑ Fence El Wall ❑ Flagpole Ia th 'YPE ORPRINT LEGIBLY: DATE (o CU ESS OF PROPOSED WORK �J/6 f ASSESSOR'S MAP NO�DDR SED � n . J )WNER ASSESSOR'S LOT NO. "Z TOME ADDRESS 7 f TELEPHONE NO.,5222- ,.2S'/0016 =ULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any iublic street or way. (Attach additional s et if necessary.) D ILA AGENT OR CONTRACTOR �� L TELEPHONE NO.( �/ - y ADDRESS DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done, including materials to be used. Please include locations of proposed signs. i x/ Signed Owner-Contrac4 t For Committee Use Only � . This Certificate is hereby_WMOVEDate 0 Approve ied Committee Members' Signatures: . Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION 7-IZ9 SIDING TYPE ?�/51"i126 CHIMNEY TYPE /1��Q� COLOR ROOF MATERIAL / 5��OLOR PITCH /Z WINDOWS COLOR SIZE TRIM COLOR �� C7 DOORS COLORS SHUTTERS COLORS GUTTERS �� E� COLORS DECKS /� I-7XI(-::;' MATERIALS DLO GARAGE DOORS / �— COLORS SKYLIGHTS SIZE COLORS SIGNS ' COLORS FENCE . COLOR -All NOTES: Pi out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when applicable. Fitzpatrick Home 04.10856.....page &ad .......... ......3C5.. ............. ........ ........ Land Court Cootlikato No.................in Book................Pop a............IBarnstable Re 16t of .............. Inc. ggftol� pja,-JAQ;�Jp..Barnstable bv to of Plan Ray:...I an.-.,.15!...1991 ... Do ......I ...... .... .. j,.8 rnstabi ltg4,try ?!�n. ............. Book... .... Filed Plan Me. .............................. MORTGAGE INSPECTION PLAN MACNEILL 6 FITCH R-4732-2 Kevin P. Lyons Low No. 77 Burslay Path, Barnstable Lot 4A r c6q.V. V jm� (grit," BURSLEY PATH • Oct. 29, 1997 JN 63756 .......... THIS PLAN IS f=0R MORT0AGEE. PURPOSE--S ONI.-", CERTIFY'rHAT 7II:5 P:.AN WAS PREPARI:D IN ACCORDANCE WIT'i THE COMMONWEALT11 OF 41ASSACHUSEfTS PROCEDURAL AND TECHNICAL STANDARDS FOR THE PRACTICE OF LAND SURVEYING M CM-11 6.0%AND V-14 THE SPECW CATICII SHEET ATTACHED HE.fifiTO. a. 4NDIRSON Ift WM of THE 1A `� •/j•°� . The Town of Barnstable HAS& g Regulatory Services �p i639• Geller,Director rfo,u,� Thomas F. . Building Division Peter F. DiNlatteo, Building Commissioner 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation.repair.modernization,conversion, improvement.removal.demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors.with certain exceptions,along with other requirements. Type of Work: `X ,Sc✓e timated Cost ifo D Address of Work: Bur s i q Owner's Name: n Date of Application: I hereby certify that: Registration is not required for the following reason(s): 0Work excluded by law ❑Job Under$1,000 Mudding not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED. CONTRACTORS APPLICABLEFOR W ORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner. Date CdAtractor Name Registration No. OR Date Owner's Name q:forms:Affidav:rev-070G01 "' �_ The Commonwealth o Massachusetts l — f • - Department of Industrial Accidents ' Ofl/ce ol/arest/Aal/oos , 600 Washington Street Boston,Mass 02111 Workers' Compensation Insurance Affidavit name: T, m� �i ��cw 1«ation City UJAS� '&M Sftlol e phone# SOY 7 7 -1ALY r ❑ I am a homeowner performing all work myself: ❑. I am a sole or and have no one worldng in aci I am an 1 workers'�� on for 1 this Job.'P mY�p�worlang NX im :on';ist;:;::�F: :;:;<F::::; ::F��::::�::;:::;:>::2::::::�:�:`�>:.r:}F}i;;-:: T••`•>:."' 2::r<::2:i2 . ;name:: f' �#r::.:.:::.>.::; .. .. .:::i:.: t' Yt cum amr .�•.....�:.�:. 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M Bgthdate i,1130/1959 I Expiration: 7i2/2004 T n0 3952 Type: DFA Expires 1t1/30/2004 r. �3 GRAY BUILDING&REM Restricted:'1G 1 � raY ! TIMOTHY GRAY 51 15 TOBISSET ST ,may-�,., MASHPEE, MA 02649 Administrator. 4A 02649 i ti RESIDENTIAL BUILDING PERMIT FEES APPLICATION FEE New Buildings,.Additions $50.00 Alterations/Renovations $25.00 Building Permit Amendment $25.00 FEE VALUE WORKSHEET NEW LIVING SPACE 9� square feet x$96/sq.foot= 911 6 1� x.0031= plus from below(if applicable) ALTERATIONS/RENOVATIONS OF EXISTING SPACE square feet x$64/sq.foot= x.0031= plus from below(if applicable) GARAGES(attached&detached) square feet x$32/sq. ft.= x.0031= ACCESSORY STRUCTURE>120 sq.ft. >120 sf-500 sf $ 35.00 >500 sf-750 sf 50.00 >750 sf- 1000 sf 75.00 >1000 sf- 1500 sf 100.00 >1500 sf-Same as new building permit: square feet x$96/sq.foot= x.0031= STAND ALONE PERMITS Open Porch 1, x$30.00= 30 (number) Deck x$30.00= (number) Fireplace/Chimney x$25.00= (number) Inground Swimming Pool $60.00 Above Ground Swimming Pool $25.00 Relocation/Moving $150.00 (plus above if applicable) Permit Fee �u�° r 0 A5 Engineering Dept.(3rd floor) Map /ld Parcel O;OZ, Permit# House# ate Issued ' Z3 Board of Health(3rd floor)(8:15 -9:30/1:00-4:30) Conservation'Office(4th floor)(8:30- 9:30/1:00-2:00) c 3 � Planning Dept. (1st floor/School Admin. Bldg.) 11 MUST ME De ' n Approved by Planning Board 19Cqs � TOWN dRANST to dry�L Building Permit Application J — Project Street Address Q U rs(e Village Owner J r0 l o.n� ► ? '1[. Address Telephone - 6� 4 Permit Request cr►S-(- 2Z S be e �G..� ►e W 14 6 (,'cr- p rt Ua (Nlivrr 6arlc to First Floor Z-.7.7 ; square feet Second Floor / 6 square feet Construction Type4/&46./ _fv�i4k Estimated Project Cost $ 4k f,2�2, GW Zoning District Flood Plain AID Water Protection Lot Size �_ 6 Y Grandfathered 3Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure C1 Historic House ❑Yes No On Old King's Highway 39 Yes ❑No Basement Type: 34 Full ❑Crawl ❑Walkout ❑Other c vt Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 23b Number of Baths: Full: Existing New Half: Existing New No. of Bedrooms: Existing New I Total Room Count(not including baths): Existing New First Floor Room Count Heat Type and Fuel: Gas ❑Oil ❑Electric ❑Other Central Air ❑Yes 21 No Fireplaces: Existing New —L Existing wood/coal stove ❑Yes ❑No Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) f Attached(size) f2A�ge (b' ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ `Commercial ❑Yes U No If yes, site plan review# Current Use Z A Proposed Use �ltv�fe- Builder Information Name Z -�k'� e v, Co Telephone Number Address�� 1S� License# 9r,,G&+J,51 MA e20 ! Home Improvement Contractor# Worker's Compensation# Gov C r' Q a 5 g a NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS PROPOSED STRUCTURES ON THE LOT. ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �l1Uf/ L.�RnID t /� SIGNATURE 4�112 A!!!!�"A DATE BUILDING PERMIT NIED F R THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY PERMIT No. G DATE ISSUED ` MAP/PARCEL NO. 6 ADDRESS , A_ VILLAGE i -OWNER DATE OF INSPECTION. / y FOUNDATION FRAME. < � INSULATION, "1 FIREPLACE . !"!3 ��'�' R65 ELECTRICAL: RO GI FINAL " PLUMBING:;, fROU;GI- FINAL 9 GAS: fi % FINAL FINAL BUILDI �V' 'd 241 DATE CLOSED WE ` ASSOCIATION TOWN OF BARNSTABLE CERTIFICATE OF OCCUPANCY PARCEL ID 110 025 002 GEOBASE ID 37060 ADDRESS 77 BURSLEY PATH PHONE I W ..BARNSTABLE ZIP - LOT 4 BLOCK LOT ;SIZE _ DBA DEVELOPMENT DISTRICT WB PERMIT 26659 DESCRIPTION SINGLE FAMILY DWELLING (PMT.`#24598) PERMIT TYPE BCOO TITLE CERTIFICATE. OF OCCUPANCY :CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: Ox BOND $.00 . 4y�' CONSTRUCTION COSTS $.00 �T 756 CERTIFICATE OF OCCUPANCY ` BARNSTABLE. • (, MASS. 039. IN1�►� BUILDI G DIVI. O BY DATE ISSUED 10/29/1997 EXPIRATION DATE 's ..�'' �',31�'•CS '4'r w.. ♦ �.yy� r r� " -:.��r�-ar.wM..Z7J,� 'iL_� ...a�wdw liti:.�.1...3�.rr..r Y..e.. jv,..F�i_.r: •c.� w�.ti..c:.�w..w+ �.,..�.arro.. ..ate..1+_�.w�..1i j...... - TOWN OF BARNSTABLE BUILDING PERMIT PARCEL ID 110 025 002 GEOBASE ID 37060 ADDRESS 77 BURSLEY PATH PHONE ' W.. Barnstable T `LIP :LOT 4 - BLOCK LOT SIZE DBA DEVELOPMENT DISTRICT WB PERMIT 2459B DESCRIPTION 3BR/2.5 BATH 2 STORY COLONIAL/2CAR GAR_ 'UNDI PERMIT 'TYPE, BUILD TITLE NEVRESIDENTIAL BLDG PMT CONTRACTORS: FI`1'ZPATRICK HOMEBUILDING CO. , INC. Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: $372._00 ME BOND $.00 Oxt CONSTRUCTION COSTS $120"000.00 101. SINGLE FAM HOME DETACHED 1 PRIVATE Pi,; ?E�' ; * BARNSTABLE, • MASS. OWNED FITZPATRICK HOME BUILDERS, _ i3 ADDRESS PO BOX 154 Ep MA'S FORESTDALE, MA. BUILDING DIVISION BY .�. ` DATE ISSUED 67/23/1997 EXPIRATION DATE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY.EN- CROACHMENTS ON PUBLIC PROPERTY,NOT SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION.STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS.THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FOUR CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: APPROVED PLANS MUST BE RETAINED ON JOB AND WHERE APPLICABLE, SEPARATE 1.FOUNDATIONS OR FOOTINGS THIS CARD KEPT POSTED UNTIL FINAL INSPECTION PERMITS ARE REQUIRED FOR 2. PRIOR TO COVERING STRUCTURAL MEMBERS HAS BEEN MADE.WHERE A CERTIFICATE OF OCCU- (READY TO LATH). PANCY IS REQUIRED,SUCH BUILDING SHALL NOT BE ELECTRICAL,PLUMBING AND MECH- 3.INSULATION. OCCUPIED UNTIL FINAL INSPECTION HAS BEEN MADE. ANICAL INSTALLATIONS. 4.FINAL INSPECTION BEFORE OCCUPANCY. VISIBLEPOST THIS CARD SO IT IS BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL(INSPECTION APPROVALS N` O� l � C �' IIV�1A/IQrd1��C!LIVv 3 1 HEATIN SPECTION APPROVALS ENGINEERING DEPARTMENT µ.S o 2 N0 .nkrx� 9- BOARD OF HE9//iG 2, I I OTHER: SITE P44 REVIEW APPROVAL WORK SHALL NOT PROCEED UNTIL - PERMIT WILL BECOME NULL AND VOID IF CON- INSPECTIONS INDICATED ON THIS ' THE INSPECTOR HAS APPROVED THE STRUCTION WORK IS NOT STARTED WITHIN SIX CARD CAN BE ARRANGED FOR BY VARIOUS STAGES OF CONSTRUC- MONTHS OF DATE THE PERMIT IS ISSUED AS TELEPHONE OR WRITTEN NOTIFICA- TION. NOTED ABOVE. TION. - ; • c � , i BU. ILDING PERM .IT. ♦ r The Commonwealth of Atassach uscas • _._. ):_ Dcpurtruurt ojlurlustrial.4ccrrlurts Office 8//nyes#92flaw �;`\_�j•', :.r' I'' 600 !f ashbirron Strict �a :Oil. ' Boston.'A1u.ys. 02111 Workers' Compensation Insurance Affidavit i li :iri irif�rrn i n. --_ ._.. r�--•�, -�. - .....�.._.r..—..d_.._... ...,,._.� - _.__ --- - m f e v �/l • Incntion a — d IfoV / J /I/Id CJ7 1 nhonc it I am a homeowner performing all work myself. I am a sole proprietor and have no one workina in anv capacity [) I am an emplover providing workers' compensation for my employees working on this job. comnanv name: address: city: Phnne#• insurance cn. pplicv# I am a sole proprietor: general contractor, or homeowner(circle one) and have hired the contractors listed below who have ihe roHowing workers' compensation polices: �� company name: 1d O • `�.�►�- address: 1 O 6J, �1 city'&,s+ Phone#• s-o /.—z d — ,00')30 — insurance co &e—/I/`�/Q✓�lp die- L/V c l 03,5 I gq — • ..; .::..-.... V.!^.._..-..._ : '�•:t ._:'-•�::- �r^.�.:�"�L iT"f^.wwsi♦ �1r•t'.. 'i'L _ comnan-• nnmc: nddresc: rite: nhonc#- insurance co nolicy# .Attach addititinal sheet if neccssary� i r•+_ - !i' =:T •�� -��^^�"^44o" __ .. _-_.... - JS/... �1I �- "_�.•a"�:_ �.rnW�� - 1:'W!'iwl►�iE•.Wci:rlL Failure to secure coverage as required under Section:SA of MGL 152 can lead to the imposition of criminal penalties of a line up to SI.500.U0 andior unc wears' imprisonment:is well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a cope of this statement mad be forwarded to the Office of investigations of the DIA for coverage verification. 1 do herehr certify a er th•pains and penalties ojperjuty that the information prorided above is true and orre t. Signature / Date 7 �� Print name — 6 ,4G't rtCk Phone# -f ` 6 7) ' official use unly do not write in this area to be completed by tiny or town official city or town: permit/license# r'Itiuilding Department C]Liccnsing Board I] check if immediate response is required aseleetmen's Office [311callh Department ` contact person: phone#: rl0thcr S: r Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for the: employees. As quoted from the "law". an eniplm?ee is dcfincd as every person in the service of another under any contract of hire,express or implied. oral or written. An einp/urer is defined as an individual. partnership, association. corporation 6r other legal enfit\: or ail-,, two or mor, the foregoing engaged in a.joint enterprise, and including the legal representatives of a deceased employer, or the rccei%,er or trustee of an individual , partnership. association or other legal entity, employing employees. However tilt owner of a dwelling house haying not more than three apartments and'who resides therein. or the occupant-of the dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling ho, or of the _rounds or building appurtenant thereto shall not because of such employment be deemed to be an employe: MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant m.-ho has not produced acceptable evidence of compliance with the insurance coverage required. Additionally. neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter I-. been presented to the contracting authority. 7.7777 Applicants Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and supplying company names. address and phone numbers as all affidavits may be submitted to the Department of Industrial Accidents foi• confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested. not the Department of Industrial Accidents. Should you have any questions regarding the "law'' or if you are requires to obtain a workers* compensation policy. please call the Department at the number listed below. Citv or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at tite bottom o. tite affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Plea be sure to fill in the permit/license number which will be used as a reference number. The at may be returned the Department by mail or FAX unless other arrangements have been made., The Office of lnvestiaations would like to thank"you in advance for you cooperation and should you have any questior please do not hesitate to give us a call. , • .,.�.�,.... ..__,.............,.,_. .. ..., ,- one-R--„-....._,•.o...w._- The Department's address. telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Office of Investigations - 600 «'ashington Street Boston,Ma. 02111 fax #: (617) 727-7749 phone #: (617) 727-4900 ext. 406, 409 or 375 .I r.;il . _ ?'_+ AN Ett={NKEir:': BAGEL = 1 _5 6 1 , 1 1 F' Gi,1 t I • I _ •.6 w; rs�Ei`a:'•��nt3L'+x?vb`als�s."�Aailxw�ets+n��uov.i�.v......- . ..........:......-,<•»,�;.rc.��•�.r:s�:,.n..p.,as.�.�_� �. SC'S:tgt {'{4ti 100 S 2 xx �,rf i il Fit It}tv,.1 ,.,�..wy ��5L.11.!t:� 1'C„ �� .` ,w " :�� t�loot�_� ?i _�..f_= a ;L?IM77G f�l�._(.� . +�'c ' +. '• - i i S• ' i t , I t. % i , `4 ' �i l:'•Ili Till iiil lj�i it • ( li : I . iL I I 1 is I ! j I I ,�►'► i + I !III I F dill I �y jai, j I I it � 'I '�I I ; � ► -- ,�,,� � it 11 !!II I '�, � `i jllll�y 'II� �II�� I � ,p_ a � �� i 1 • _ �IIII ! IIII!Ilii� !I' � j II T l i i 41 j D irL j �e fFlie- 54 ir- Q � 6 1 I C _ I O 4ii .I � 4�o•td it i � . L a N i • L ^ � �e E - P c•a • g ' 9 K R z! I I ° i J r K • - L � li iI it � � I _I i H L L t Tv R � . 9 -1 it ;Ip F-lit I L �I i / Il; l jllf Il,li!Ilhl III! Jill zz- 71�1 � �,_,._... � �" II ice: ,� :. ..__.; ' 9 .'-a---- ..---' I� '•--� 1 i��a� ' 81= �� --- - ----,..�i�-, i �( � � � t��Ii� .i i �i 1 i a, �-) �. 1 � i � .� L —.� �, i � i F= -�— `�•� '�p: `� I1� i lil ��,�I� I II,r / � I I� .I � I i � � � f��• i� � I � � ��I�i � l I:. � ,�__, ; , 1 t E � / , , I, i j i I; , ; yr -F+ _ - � � i � �I� � l r I I�' lam' "�� I i � ___— i �` �� I i 1� � � i `i i l' 1 \� i i � i I ��-L�wl i' I �� ,; � �: , ;� �. j; I c '' ' i� �',, � i ,� I ,I I � I I� 4 � I ; .�I� � � � � T`�� 1 ��- - I �. � I i �'4il��l Il�lrl�l,l '��I��II��il I�� , � � � ��'1 9 c i i !4 7 i ILL C \ a I r s C r i 4 1 4 � o �pill P �� E• ti .il I1 N n�� C Hit R 7 /�yle _ -- - -- ------ --- 171, 1 ,P=3 aZ.,,-8. LoT IVo -4 = iZ7,ss-, -77 o I� � iN b N N r IN 1 m -tea . �1 Z yE,eEBY GEeT/fy Ti�1.9T Tf�� fit'/.{7"/�+/emu�r, i; - s�j, )6�01cz-ao CAr Lor NO. ¢A 2KtJG9T/o�vCS' OP T1�� Z4Nl�G �BYGAhIS 0-` Try- �7�� Of BA,�/sl-98L� ��Fi�� Fav�uo•�Tio�/PCAN3 SO, OF Mgsf "AS-C3[//LT" JOHN gCyG P. Fes' DOYLE,Ilf H i N o.33889 lgNo SUR STI �/,(..LEX /oATti �� BA2�S>fi'BGE.MiI. i O Application to 4; 9�? 127 .yp�pHS C P�S V i4N M SE p'h ps Old Kings Highway Regional Historic District Committee in the T6W i of Barnstable for a CERTIFICATE OF APPROPRIATENESS Application is hereby made, id triplicate, for the issuance of a Certificate of Appropriateness under Section 6 of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, drawings or photographs accompanying this application for: CHECK CATEGORIES THAT APPLY: 1. Exterior Building Construction: ® New Building ❑ Addition ❑ Alteration Indicate type of building: ® House ❑ Garage ❑ Commercial ❑ Other 2. Exterior Painting: ®. 3. Signs or Billboards: ❑ New sign ❑ Existing sign ❑ Repainting existing sign 4. Structure: ❑ Fence ❑ Wall ❑ Flagpole ❑ Other (Please read other side for explanation and requirements). TYPE OR PRINT LEGIBLY DATE ADDRESS OF PROPOSED WORK Z GUL (aY 612-4 LJ rr,- ASSESSORS MAP NO. OWNER Z��T-R'�� / `�'�n�i► ' IJ/^r 4< - - ASSESSORS LOT NO.4�` � J HOME ADDRESS 1 06 1 S`( 44, ly �"y o�c:��l TEL. NO. .J FULL NAMES AND ADDRESSES OF ABUTTING OWNERS. Include name of adjacent property owners across any public street or way. (Attach additional sheet if necessary). / fro,ncrt LlWr 12). ('crn3-�� i (A.. l3?U TorPC4-d, Z aa� 6,-V# AGENT OR CONTRACTOR �'i � c .,-7 TEL. NO. ADDRESS 66 00 DETAILED DESCRIPTION OF PROPOSED WORK: Give all particulars of work to be done (see No. 8, other side), including materials to be used, if specifications do not accompany plans. In the case of signs, give locations of existing signs and proposed locations of new signs. (Attach additional sheet, if necessary). CC9 /ll v d� C 0l o/er Gj'CJ'r_Se Signed Awner-Con tractor-Agen t Space below line for Committee use. Receved_by H.D.C. tificate 'Ch reby Da �° v i Tlr0_ 5 RK r OSARIN LD KING'S HIGHWAY �� r1 IMPORT If Certi ate is approved, aenroval is subject to the 10 day appeal period i 1 Town of Barnstable n 's %t� Old Kig Highway Historic District Committee r SPEC SHEET CHIMNEY TYPE /�� U � � COLOR_ �e ROOF MATERIAL �f COLOR lZ PITCH <� WINDOW SIZE 0 TRIM COLOR C1�N�i SCE , DOORS e, . / COLORj_ ,/ SHUTTERS N`A COLOR GUTTERS , — ( i o", DECK01 GARAGE DOORS �,�� S� l� /1� COLOR SIGNS COLORS SIGNS /✓� �� COLORS SIGNS N�� .� a ,COLORS FENCE COLOR v NOTES: Fill out completely, including measurements and materials/colors to be used. Three copies of this form are required for submittal of an application, along with three copies each of the plot plan, landscape plan and elevation plans, when applicable. Plot plan need not be . "Certified" except for new homes, but should show all structures on the lot to scale. SPECSHT SAVERS Workers Compensation and PROPERTY Employers Liability Insurance Policy r CASUALTY INSURANCE 10985 ( 135 COMPANY Information Page Overland Park, Kans,. 224 AmmM cf We drnbry ks lns-Goat' Policy Number Renewal Of Policy Period WC0001031 WC0001031 10/15/2002 to 10/15/2003 _ I Item Named Insured and Address Agent 1. Tim Gray Building & Remodeling, Inc Renaissance Insurance Agency, Inc. 15 Tobisset Street 981 Worcester Street 4 j Mashpee, MA 02649 Wellesley, MA 02482 3, FED ID Number: 04-3559727 NCCI Carrier Code No.: 31771 Risk ID No.: Other workplaces not shown above: None Entity: Corporation 2. Policy Period: 10/15/2002 to 10/15/2003 12:01 am standard time at the insured's mailing a_ 3A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensat any occupational disease law of each of the states listed here: MA 3B. Employers Liability Insurance: Part Two of the policy applies to Employers Liability Insuranc each state listed in Item 3A. The Limits of Liability are: Bodily Injury by Accident $100,000 Each Employee . Bodily Injury by Disease $500,000 Policy Limit 3 Bodily Injury by Disease $100,000 Each Accident t 3C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: All .)t ND, OH, WA, WV, WY and states designated in Item 3A of the Information Page. 3D. This policy includes these endorsements and schedules: See attached schedule. j '. 4. The premium for this policy will be determined by our Manual of Rules, Classifications, Rate and Rating Plans. All Information below is subject to verification and change by audit. Adjustment of premium shall be made at: Policy Expiration I Classification of Operations: See attached schedule Minimum Premium: $500 Expense Constant: Deposit Premium: $3,521 Total Estimated Annual Premium: i Countersigned 09/30/2002 By DATE Authorized Agen. This Information Page with the Workers Compensation and Employers Liability Insurance I Endorsements, if any, issued to form a part thereof, completes the above number po Date of Issue: 09/30/2002 Insured Copy REr; 01 SV (12/! z s • � � N.em�.riC�iLC,. 9TAIL . , SAVE: .2Xa'o A W D.C. W PLY.%*ATWNG W/C SOLES TYP.BEAD.BOARD TYP,iX4 MWs.DECKING TYPI SCREENTNCs' " 3?Xi0'e PT 2XiO �J !1�s PT, "O.G. 6X6 PT . TYP.CB66 BASE ro I . TYf'.MkNOERS... fol. LsADE I vd.foo i 4Xk0 RIDS. . 12 oJc: 2X6 So ASPWA1•TflAP1R . .. , SPWALt 8W�I1�taLEB `2X9 RAF SO'A U2"PLY:3WEA'�INds - 4� �-0� aSPWALT PAPI R ASPWALT SWINGLEB . P 4X$PLATE ikb Os s 2 2XIs WDR. E9/B":8 t�ILDCs. .: WRAP 4X4 PT*: y - Po t4 O ORE µ , ---��-. 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