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0006 MINTON LANE
®� 152 1/3 ORA ESSELTE 10% o r r7121116 Town of Barnstable *Permit ` III' Fapires 6 months o 's at y7 n�,r r e'rr Regulatory Services Fee aAnrr AJ" Richard V.Scali,Director Building Division 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 Map/parcel Number rr 1 p�� /`�� Not Valid without Red X--Press Imprint Property Address (D f1 1 (/-) (n �, i M/A UaCe(p *esidential Value of Work$ S 6 oL') — Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address c )tz P—V i L u -� 0"'A Contractor's Name Sprinkle Home Improvement Telephone Number 508-775-1778 Home Improvement Contractor License#(if applicable) CS-006643 Email: sprink comcast.net Construction Supervisor's License#(if applicable) 103757 JZWorkman's Compensation Insurance Check one: X0 ❑ I am a sole proprietor ❑ I am the Homeowner JUL 1 91016 W I have Worker's Compensation Insurance Insurance Company Name AIM Mutual Insurance Co. TOWN OF BARNSTABLE Workman's Comp.Policy# AWC400700943 Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) WRe-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to Town of Yarmouth Disposal ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .32)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 t e Improvement Contractors License&Construction Supervisors License is re SIGNATURE: C:\Users\Decwllik\AppData\Local\Microsoft\Windows emporary Inte et Files\Content.Outlook\2PIOIDHR\EXPRESS.doc Revised 040215 u� �4 r 5 S i l l U o _r� i� 1 i { t } 1 0 } i a s--.- -�.--_,_____ �__ _. - . _ - - � ' I r• �\ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 < Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print.Leeibly Name(Business/Organization/Individual):SPRINKLE HOME IMPROVEMENT, INC. Address: 199 Bamstable Rd. City/State/Zip: Hyannis, MA 02601 Phone#:508 775-1778 Are you an employer?Check the appropriate box: Type of project(required): 1.Q I am a employer with 10 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3.❑I am a homeowner doin all work myself t 9. ❑Demolition g y [No workers'comp:insurance required.] 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.[]1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13 oof repairs These sub-contractors have employees and have workers'comp.insurance.I p 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 152,§1(4),and we have no employees.[No workers'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 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: A.I.M.Mutual Policy#or Self-ins.Lic.#:AWC40070049432016A Expiration Date: 1/1/2017 Job Site Address:� L/4,12 City/State/Zip: W. � 6-1 -4A Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c t ins and penalties of perjury that the information provided above is true and correct Sig nature: Date: Phone#: 508 775-1778 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 &.Other Contact Person: Phone#: SPRIN-1 OP ID: DS CERTIFICATE OF LIABILITY INSURANCE DA011081201TE Y) 01/08/2016 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(les)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 endorsemen s). PRODUCER CONTACT Bryden&Sullivan Ins Agency PNAMNE Kelley A.Sullivan FAx 88 Falmouth Road c .508-775-6060 Ac No:508-790-1414 Hyannis,MA 02601 E-MAIL Kelley A.Sullivan ADDRESS: INSURE S AFFORDING COVERAGE NAIC p INSURERA:Associated Industries of MA INSURED Sprinkle Home Improvement Inc. ' INSURER B: 199 Barnstable Rd Hyannis,MA 02601 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. �TRR TYPE OF INSURANCE POLICY NUMBER MIOWOD EFF IPA YNYYYI EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEITL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECTT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIREDAUTOS NON-OWNED PROPER DAMAG $ ALTOS Per accident UMBRELLALUIB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION R AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTNE YIN NIA AWC40070049432016A 01/01/,2016 01/01/2017 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SPRNKHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sprinkle Home Improvement,Inc ACCORDANCE WITH THE POLICY PROVISIONS. Margo Mack 199 Barnstable Rd. AUTHORIZED REPRESENTATIVE Hyannis,MA 02601 Kelley A.Sullivan ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD c�/�_ Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,Massachus.etts 02116 'A'•• Home Improvement Co0"r Registration Re ion: 103767 Type: fNivate comommn 1:- -'`' c-- +x'• Expim9on: 7411 8 7d1 41'dQ91 01 SPRINKLE HOME IMPROVEMENT,r'ItV_ ='Y.::: -� Brad Sprinkle °:� ,? . _... .. _ Y.- Hyannis,MA 02601 - -- ':�. Address aad return caM.Mork reason for diange. Address L.l Renewal Ll Employment l.1 last Card _172m �,,,,,,,,,,. ,/�'+ G,a,�En4,r.,�i1 License or realsasnoo valid for Individual one onry pf t.of Cowaenter Affairs A Ruslueu ReOolati- bdbre the expiration dote. If found"turn ta: mE UAPROVEMENT CONTRACTOR office of Conwmer A fMrs and Bugituss Reguladon ott :�1GCfyS7 Type' 10 Park Plaza-Sake 5170 Expuadcn:.,i 68, Prival*CorPOrOWn Boggy IAA 02116 SPRINKLE HOME If,IPAy ;`:11VC. Brad Sprinkle 199 BamtMM Rd — HyaMft MAOZ801 �UD&.get retary Not validwithoat turn TOO/ 100'd LZLS# eTXUTadS OS£TSLLBOS 6Z:ZT 910Z'61"I ®� Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-006643 Construction Supervisor BRAD K SPRINKLE' f x� 119 BARNSTABIIE HYANN IS:MA 02601:* r--j l.Jl..� Expiration: Commissioner 10/08/2017 '�/f1 (/ •II/I/II•IIIINYIIIII f� �(�(�,II�II.M'II. Umeeorcon.wMerAmteaB ftdo a.ReXmnon APROVEMMCOMMtrM ittora {03?87 Type; bcpTraIIon: 7 p16 Private ft=ralio -A'M1v SPRINKL12 HOLM 1".Rd YEMENT,INC. Bred Sprir>kta 108mnstabb Rd. Hymcmta,AAA 02601 tJnderse•�ry unrestricted-Buddwgs of any use gawp which contain less than 35,000 cubic feat(991tn3)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code Is Cause for revocation of this license. For DVS Ucwdsint information visit: www.Mass.Gov/DPS or P40WO&O wAt fW tffmilkift! -*a Wokman dmL EF`g Vemm OL oleo 4fC4m=WA so"wSNOWe M Na!l`-Salle 5118 Spa►rA 011K Pht sari wi�at � i ADDENDUM TO CONTRACT breakable If contract calls for sidingand trim, or roofing; we recommend you remove any items hanging on walls until job completion. NOT INCLUDED IN CONTRACT PRICE ❑ Painting or staining around wed oft n reveals weathering, as well as areas.that may Removal of existing doors and windows not be previously stained or painted. As noted, Contractor will not be responsible for or may p painting or staining these areas. ❑ Ad'ustments or Reattachments retractor will not assume responsibility for removal, re-attachments, or re-positioning ra of Co drapery rods, window shades, blinds and/or mini blinds, and correspondinga RIGHTS TO CANCEL cancel this Agreement if it has been signed by the Owner at a place other The Owner may provided than the address of the Contractor,which may be his main office or or b h b e ordinary mail Y that the Owner notifies the Contractor. in writing hang midnight of of the third business day posted, by telegram sent or by delivery, not late following the signing of this Agreement. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES I/we accept this contract in its entirety and Uwe authorize Sprinklome improvement to act on my behalf in all matters relative to the work to be performedthisJob (i.e permits, applications etc.) if necessary. Contractor Signatu Date omeowner Signature Date tration# 103757 Jim Keville Brad Sprinkle - R gis 6 Minton Lane,W.Barnstable,MA 02668 Homeowner Signature Date patti Keville 6 Minton Lane,W.Barnstable,MA 02668 Town of Barnstable *Permit# ' Erphw 6 nronds r Lrsue da • Regulatory Services Fee -6 HARNSUIBIA t639. Richard V.Seal%Interim Director Building Division " Tom Perry,CBO,Building Commissioner u � 200 Main Street,Hyannis,MA 02601 APR 24 2015 www.town.barnstable.ma.us Office: 508-862-4038 0 k. ' ' ; " T 'Fait?SSQ'8 7,9,Uy6230 t: - EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid wohout Red X-Press Imprint M1, )*eel Number O 0 Property Address 6 P"6fi9"� Residential Value of Work$ �[� Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address fl-l'7't ��Ew a4 3> '6r;�6/e- 04 o Z66 9 Contractor's Name S o CAA� P/'N u_F-. V V(l J 1p)S NNI O Telephone Number !b f—Z.2-8' I 00,00 Home Improvement Contractor License#(if applicable) c�1732`f JL Email: Construction Supervisor's License#(if applicable) D /67o 7 XWorkinari's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ' I have Worker's Compensation Insurance Insurance Company Name A /Ua7 Workman's Comp.Policy# WC Copy of Insurance Compliance Certificate must accompany each permit. DR =-� Permit Re�t(check box) w� Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to `,:2 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side 2 Replacement Windows/doors/sliders.U-Value 3 (maximum.35)#of windows #of doors: •.0 Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required: Issuance of this permit does not exempt oomphanm with other town depam=teguhdmm,i.e.Historic,ConsavabM etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. t SIGNATURE• TAKEVIN D\BuRding ChangeAWRESS PERMI'AMRESS.doc Revised 061313 i i JCI 6 n u� .a.iv vrn.rrrcvr Alhmn Rom,•.7�stmia Ri M91Z tt,trsMatisr Pt�o»ri 5Ss.2 � :i0lA6MM Sratlteto.�ieto�stvd• LiCd/>Sla IbeMwal 6y 1lndarzan cf SaaEker>N.tagimad CU9MMWIN-DOYVAND DOOR RMODEMNGAMERIMMr ( WD Id n;4-i - q/607/,qd� w es IS.r•,v,$ t A , b ,..r, &rye0r] to purcham the przhwb atrdlcjw--Wucs of Soudmtn AW En&4 sd'VVE do UJC d/b/a Rfes+al. hi'Andersen of Soudwm\Tsw Ba-tomd{"der"',;o axe wdfi dw temlo and.coodWwas deparftd an 1U facer cowl ate,ferule of diir aFManrnt aria on der athudtea= +.Arft P)fMiltcii-Ay,lhit 1%g. M=� .J. O iUS do G Condo E iROAT Topfjo{bAar ftMWrdU&ft0= Medtodo lfftyu SCsedr cm h a ;; Depwk keosved PM-- W �^'� Cr+.dti fatal aro saeptrd tord�asotor+l,/-tin Jl3 of ate SrtaerOt tE Strrt or laD 1737Lr—JJ2 7 �dnatcl Go�tetla�ta,� F. oaw Pi=e let Corm Catdlb{� QI soft 0* A ree m&yoamdvwMe*Vd=ate&&MMatOtto(gobvWd%e BAnce at Subsuniti 7 M j`w Kt 8*=r at �tilzt S- rGa w 40 job 4atbe=Q*by well GM#Won al)ah(179t). �. `77 ard and after be care elr Panne dsed<ft* or rWL Ruyev(s)ads and aulerstawds that thls AgAeawat oanstitatunc tie cadre aadaroandtag btweea&e pantos,and t u &now avn•n varbal®drrstaadiings d=Vbng any of for terms of this Agieenseas:Bbyr-*)achnamilodgps t%zt'8wyq (s) (1)Lie vend the Agrecmeat,ceders- In the tams of Ais Ag,ecm-4,and bas veceima a CaMWA.1M%:igeed�cad A. copy of ddsAgreemeat,inu it ng the two atta died Matite s airCareenadion,an ib a datefvrst.w+�ritten:above and(2)vvas orally huroemedot ayer'srit dI*cancel flitsAgttcemest.DO.NOMONTMS COVIMAOMTKIMEAREAVYBIANKSPACE& (Rhode Isfaerd Snk*Only)Nos oe toBsye=(t)Donot sign tbisABreement if a"of the spaceshrtend4d far the agreed terots to the extent of then avama.ble infortnatloe ate leftblapelL(2)Too era emitted to a copy of this A3reefinent.at the lute you siga W(3)Tor may at say+base,pay oaf dbe flit aspaid babtsee dne rtalee tlir A�:wmtate sad in.so dote you many be eadded tr receive R partial ret►ate of*.$*anto cad iasarance s"tgto-(4)The s4.11et leas Ao rnoer yozrr premises or ermeQit say ha*uh of,the peace to x"waseas goods perehased smdere thIs Ag—eat.($)You may ctoaeli tkisA gesat If it has.not bees signed.as the mnm ofrEe or a.brad&date of the!9e ltr,provided you notify tLr seller at his or her wan office or branch office shows in theAgreerneat by re listened oeeerdfsed mma,`&kb shauu be pestedimot htee thad wider., of the third calendar day after ibe day on wAdch the buyer aim the Agreement.. sin"y aid nay befidy an suiuel rebates mail deU erimat,s not made�.See the aeoeinpanying notice of eamed"on f WM.lar as expinamtkaof bayed tWns. DayerlaJ mv6Td die corimmer education niateri;ab p vided bg thr Wade Mmdl Ckxmmors Riosmdon Rua #6rr31 Renewal by Aadersen of Southern New Bagla Bettye.(*) sp: ivre 4r 5 ` ! S` �' J6*,0reS 71 CV# Ilk i Pr`vrt hlmnrl or 14vdstct R91ff Pthu Nwis. �nax YOU, THE 1111 ejE (9); MAY CANCM THIS Tt34ItlSkcrz0N AT Aw Ti.MB PRIOR To mus?%vJOH'f, OR.TM BusimS DAY AMR TITE DATxern is3TRAN&#tcnow.SHE Tm A.x KOT1t',�ElFI`d1KCKUATtoi roRm FOR AN 'ATIO\OFTWS RIGHT. >K- - NOTICE Of - - - - �--- -- - - - - -= - CEAN-CANCIEL- - --- �LATION Bate of 1t lion You islets®steer Dal.t�'1Fansae4lon + t Ytru ertal► this transaedout4 without p6Mft eW obligatj*4%wit#ttri this trxa,saCtIory Vfl* urt p or OU three business days from Ott abaro date.if you cancel,any *%ree business days from file above date.if you caroee%a property traded irb any payments made by you under the i pwpergr eroded�arty paymen nudt by .under the Contract or Sales and arty n e bwerurroent executed I Cont Aft ur Sate,ww n acts egOtkMa it buinent executed by you willbe returned wWWn ten business dys fa owing l by you.Ell be reunited�tltin ten business days fallowing neveipt by the.Seller of:your cancellation noose,and any i "ce;Vt b7 tfrs 5atio.of your caneenatkn neadete,,and'aril Security interest aritartg L oaf; of the tramacgon.%Ql be society kWha vst arising out of the tnarnacdon tt W be canceled.if you�tseel,yauu eruct make a.aitabie oo cite S!Uer I mneeled.,lf you canal must rester avmlab%to theSefler at your rosiderrce,in•subsmrttially as good Condition as when t at your resider %in�as good'. elan as when received,any goods del hrered to you under this Contract ew t received,aryl goods delh%red to you under Oft Contract cw SateF orou y n %if you wish,Comply weeh life inst rottlots of.t ISaltr or you rnaA if you%idk clanp?y.vial the moons of the Soler regarding the Meeur"shiprnerrt.of tfto goods attire the Seller regardirs Eire return shlpenatt of the goods at ow S lleh expense and risk:If yap do rrralar the foods avarksMe � Sellerus bai nse and t leyou do make the araohme � Seller and the Seller does not'pidr thorn u{p within to file S�Cr and tine Secllor dons not pktk try iitirWO ewetttlr days of the date of cancellation,you mug mtstin or t twenty dabs-of flee date of ca nceilatiorq you.sneer retch or- dispose of the goads;wkhoue any flirt her ablipdom if yott 1',dispose of the Rands Without arty fifrtlter o wgatiiom if you fail to make the goods available to the Seller,or if you agree 1 tad tO maim the goods tsstaflabie to rho Seller,or If you agree to retJt the goods to late Seller and fail to do so,then you I to Fetter tote> to the Seller and,fill to do so,ihoar yogi rer►utiri troth for performance of all v6liZations under tiro remain 11aNe per4orrnanee of all obi ut%U r the Contraet<Th ca soO this transactlotq mail or dH'i+ct a sighed 1 Cone aet'.To m vod tliir, onytvtar7 or dei�"irer a sd and elated copy of teat eaeuezllapon rtotice or airy Diller i " datod uopy of Otis canodsaeion.node-or any wPittfinnotice,orsendate rumto by.Andersenof I wrktxtrtnallne,or.senda ioltenavrai Mderstrrof Soutshem New England at AIM=Ro S. a Southern New' and at 26 man BL02S6S� NOT)IAMM THAN MIDNiGNT Oi s NOT(Daft) LATER THAN 1+WHIC NT OF I HEEREBY CANCEL TtiiSynANsAcroK 1 If HE t MY CANCELTHaTRANSAC1 OK �r.rL nta,rt t a+r• >010DAM /riurt3rsr . p.t.. RM tv CW VWft loco 0wr•ydow fDgW C-Mr ft* i Southern New England Windows d.b.a Massachusetts-Department of Public Safety Board of Building Regulations and Standards i j' Construction Superni%or License. CS-095707 BRIAN D DENNLSON 7 LAMBS POND,>EIItC Charlton MA OM r �i� "'�� Expiration Commissioner._ 0910N/2016 I I Office of Consumer Affairs 6d Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 173245 Type: Supplement Card SOUTHERN NEW ENGLAND WINDOWS LL Expiration: 9/19/2016 DENNISON BRIAN 26 ALBION RD LINCOLN, RI 02865 Update Address and return card.islark reason for change. sCA? 0 20;:4-05/11 (—j Address C Renewal ❑ Employment f—I Lost.Card "' Jac U'our�rraxcactrll�z o�r(�l�i;;rrc�rcc(/� . OfTice of Consumer Affairs&Business.Regulation License or registration valid for individul use only before the expiration date. If found return to: 2 MEIMPROVEMENTCONTRACTOR P Office of Consumer Affairs and Business Regulation �y Registration: 173245 Type 10 Park Plaza-Suite 5170 Expiration: 9/19/2016 Supplement•;ard Boston,MA 02116 SOUTHERN NEW ENGLAND WINDOWS LLC. RENEWAL BY ANDERSON DENNISON BRIAN 26 ALBION RD LINCOLN.RI 02865 Undersecretary Not va� ithout signature �^7 0 A�® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 08/12/2014 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 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 Willis of New Jersey, Inc. NAME: c/o 26 Century Blvd PHONE FAX •1-877-945-7378 A/C No:1-888-467-2378 P.O. Boa 305191 E-MAIL Nashville, TN 372305191 USA ADDRESS:certificatesowillis.cam INSURE S AFFORDING COVERAGE NAIC a INSURER A:Selective Insurance Company of SE 39926 INSUREDSouthern New England Windows LLC INSURERB:The Beacon Mutual Insurance Company 24017 D/B/A Renewal by Andersen INSURER C:Argonaut Insurance Co=anv 19801 26 Albion Road Lincoln, RI 02865 INSURERD: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:W529169 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MM/DD/YYYY MM/DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,0D0,000 CLAIMS-MADE �OCCUR DAMAGE TO RENTED PREMISES Ea occunence $ 100,000 A Y MED EXP(Any one person) $ 10,000 S 2029459 08/10/2014 08/10/2015 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 POLICY RQ a LOC PRODUCTS-COMP/OPAGG $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY EO aBBIINdED SINGLE LIMIT $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ A ALL O SCHEDULED AUUTOSS AUTOS S 2029459 08/10/2014 08/10/2015 BODILY INJURY(Pe raccident) $ X HIREDAIIiOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE S 2029459 08/10/2014 08/10/2015 AGGREGATE $ 5,000-,000 DED I I RETENTION$ $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER B ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � NIA 0000068028 08/21/201% 08/21/2015 E.L.EACH ACCIDENT $ 11000,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 1,000,000 C Work Comp/EL Covg: KC927938352394 08/21/2014 08/21/2015 E.L Ea. Accident - $1,000,000 Statutory Limits - WC S.L. Disease Policy Lmt - $1,000,000 .L Disease Ea. Employee - $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is requlred) own of Nattapoisett is included as an Additional Insured as respects to General Liability when required by written contract/agreement as per policy orm. 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. AUTHORIZED REPRESENTATIVE Town of Mattapoiaett 16 Main St ttapoisett, MA 02739-0000 "7L ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of.ACORD SR ID:6629625 BATCH:Batch $: 79627 The Commonwealth of Massachusetts E RE Deparbnent of IndusbW Accidents Office oflnveMgations IF 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information PIease Print Legibly Name (BushmsmMnization/mviduat): 5&,0 Address: o-)L 4-1A-". J ioa:;o City/StateMp: L/ C=0 n! - t���6s Phone#: Are you an employer?Check the appropriate box: Type of project(required): -1.`�am a employer with 9-0 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 forme in any capacity. employees and have workers' 9. Building addition [No workers'comp.insurance comp.msnrance•t ❑ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 L❑Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12.❑Roofrepairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13. OtherWIN40LAD comp,insurance required.] *Any applicant that checks bar#1 must also fill out the section below showing the r wa dons'compensation policy. oa t Iiomeownets who submit this affidavit indicating they are doing all work and then hire outside conttact=must submit a new affidavit indicating su& iContzartors that check this boa must attached an additional sheet showing the name of the sub-conhactats and state whe&cr or not those entities have employees. If the sub-coahactars have employees,they must provide their watiosm'comp.policy member. I am an employer that isprovi ejn workers'compensation insurance for my employees Below is the policy and job site information. /Y Insurance Company Name Policy#or Self-ins.Lic.M W ' L.21 7 ,j P j S-::;:R 3 ` Expiration Date: L454 i /.5" Job Site Address: 1� City/State/Zip:W'1*/�'j�k f /lot 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 hereby e . pains and penalties of perjury that the information provided ab a isfuFed correct c Signafore: Date: Phone#: O �" Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/P_,icense# _ Issuing Authority(circle one): g.Board of Health 2.Building(Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector GOther 9/zA V oQ To,,ti Town of Barnstable *Permit# 90 >e Fspires 6 months from ism date Z autrrsr�re, _ Regulatory Services Fee Thomas F.Geller,Director i639• � A,ED1V1°`' Building Division . . Tom Perry, Building Commissioner X-PRESS P,., 20.0 Main street, Hyannis,MA 02601 AUG .) 1 200 Office: 508-862-4038 Fax: 508-790-6230 TOWN OF 13ARI',' EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red%Press Imprint Map/parcel Number 11400 7064 3 ' Property Address m nT0n CZV\.R- t.�?• &r eis611e- GQt&Ce Residential Value of Work 4 l ff). Owner's Name&Address Sir P �• lC.e lc �n Mi 1161 La v1f-_ t,J Q a✓✓t S t- 4-� Contractor's Nameja f 1'n ILA e Telephone Number., CAS 7 7 S- I7-7 Ff Home Improvement Contractor License#(if applicable) CLS-7,'S-7 Construction Supervisor's License#(if applicable) Sao6 U 4 3 3, 19orlanan's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner R5,-Mave Worker's Compensation Insurance Insurance Company Name 14.TVn / Ul-Ual Workman's Comp.Policy# 70Oy J 4361 91 CW 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' ❑ 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 Wt sign Property Owner Letter of Permission. ovement Contractors License is required. Signature Q:Forms:egmtrg Revise053003 mow- --�-_ I authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be performed on this job (i.e. permits, applications etc.) if necessary. HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY ]BLANK SPACES a 49: ner signature Contractor Signature Date k CERTIFICA►.TE OF WSURANCE ISSUBDATB(MM/DD/YY) PRODUCERt SON NO RRGHTB UPON THE CERTIFICATE IFICATE HOLDItR. 'PILLS CER7 YFiCAT51 Brydea&Sullivan Ins Agency DOESNOTAMM E�►"iENM OR ALTER THE COVERAGE An"ORDED.BY THE Inc' POLICIE88 Falmouth Road COMPANIES AFFORDING COV MUGE Hyannis.MA 02601 mvRkD SpriWde Home Improvement Inc COMPANY LETTER A A.I.M, Mutual Insurance CO 199 Barnstable Road Hyannis,MA 02601 COVERAGES THIS JS TO CERTIFY THAT THE POLICIES OF INPURANCB LISTED BELOW HAVE BEEN ISSUED TO THE INSU1tBD NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NO'rwrIHSTANDINQ ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTM DOCUMENT WMI RWPECTTO WHICH THIS CBRTMCATE MAY BE ISSUED OR MAY PERTAIN,,THE INSURANCE AFFORDED BY THE POLICMS DESCRIBED HERRIN 13 SUBJECT TO ALL TIC TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LINM MOWN MAY HAVE BUN I=UCED BY PAZ CLAIMS. CO TM Of VSULLNCE POLICY I11=r6Ti POLICY f:.i�T,CTIYB POLICY 8"1"[i LII0TS L DATa(MMND/YY) aAt&(MMIDD/YY) GENERALLIAIDMnY pNBRALAGGREOATa S MM XL4L GENERAL LIADR IPY DU&M-COWMF AGG. S WS MADE OUWAL a ADY.INIURY OwN6R'9 A C0WRACI'OR'S KQT. ' CH OCCURRENCE S , tUDAMAGS("mfire) S 6A EXPEN96(Am'oro pones) S ALPIW ODR.4 LLtAILif1c MD WDD SINGLE ANY AUTO Likirr S L OWNDD A(lTOs BODILY D'WRY CICD=D AUTOS ( ( Pam AUTOS ormy DUUAY Auras 00A" 1 GARAGE LIABILITY ROPERTY DAMAGE f ZxCWLIANL= SAO OCCURRENCb s WAA FORM AQOREOAT[ f ER THAN UMDRSLLA POEM Y6A8L)ASPPINLf�AY ON AND 6MP X .W I A TIID PROPNETORr 7004N3012004 0314=04 05/13/2005 FIJAMAIWIDENTf PARTNDR&4VQCLnM X INCL J&DISUM11,POLICY 1AMIT If OM Bs S L DTSBASS P OTIS►A EtiL-RWrION OB OPhTATIONSILOCA4I0N61VBf[fOLSWRECLU,rrms CGRTUWAT'B HOLDER CAIWELLATION " SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BMAR THE Proof OP IIISI imuce WMATION DATF% TIIE3 OP, TUB ISSUING COMPANY WILL ENDEAVOR TO MAIL'10 DAYB WjtrITBN NOTICE TO THE CERTIFICATE HOLDER NAMED TO TIM LEFT,BUT FAILUU TO MAIL SUCH NOTICE SHALL IMPOSE NO ORMATION OR LIABILITY OP ANY KIND UPON THS COMPANY, ITS A4BNT5 OR RBPRESENTAT'NE.R. _._. Atl'It1ORIWD REP43SENPATIVE F� ?71,e V699GiI/.li•�IUJeILLU !1`�.''!��(LJOI.L(.l2[ldead .. BOARD OF BUILDING REGULATIONS License:.CONSTRUCTION SUPERVISOR I Z�r 4 i 7t{° i Number.::..CS 006643 y. Birt ... tidate:::1:0(.08/1:955 f Explres::.1Q/Q012005 Tr.no: 5711 • y • Rest�Icted:::00� . BRAD K SPRINKLE 190.LOTHROPS LANE W BARNSTABLE, MA`02668 Administrator / �e -Vominzaneuea,�l�x a�../�avatcc�ie�.aP,lla y Board of Building Regulations and Standards - HOME IMPROVEMENT CONTRACTOR =' Registration:. 103757 _ - Ezpirations_�.T192006 T"--:_:Private Corporation SPRINKLE HOME.`.!MPROUEMENT:,INC. Brad Sprinkle 199 Bamstable Rd. Hyannis,MA 02601 Administrator 00-35,0o0 cf endosed space a , (MGL C.112 S.60L) 1 A-Masonry only 1 1G-1&2 Fatuity Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. 3 y9 , " DIG SAFE CALL CENTER: (888)344-72'33 tit. { License or registration valid for individul use only before the expiration date. If found return to: Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,Ma.02109 Not valid without signet re APR- 17-97 THII 08 :50 DOWN CAPE ENGINEEPING 508 362 9880 P- 01 I lip�, 6- 0 /-- 1> AF S LOT 4 43,606 sf 1.0 acres LOT 3 O O' CONC LOT S NUN6, a8.3,f � b ae.s ?p 5 co 101.75- —..... 11.6g�` -�— 99•20' UTILITY ANb LOT 10 ACCESS EASEMENT JOB # 96-423 CER TIFIED Pl. o T PLA N LOCATION SERVICE RD. WEST .BARNSTABLE, MA SCALE : 1" = 60- DATE APRIL 13, 1997 PREPARED FOR: REFERENCE LOT 4 PB 528 PC 84 PRES'TICE PROPEI?TIES I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE CROUND AS SHOWN HEREON. �M Of A� fl SW 4i-oeeo a- W � MNE � oe i o cepo 4gweelhng, Inc.LAND SURVirvvna4 �b i --( ——--- � s� w TOWN OF BARNSTABLE PARCEL ID 000 000 081 GEOBASE tID ADDRESS' ' 6 MINTON LANE PHONE (508)771-0008 WEST BARNSTABLE' MA ZIP,-. 02668- LOT 4 BLOCK LOT. SIZE. DBA ' DEVELOPMENT DISTRICT PERMIT 24529 DESCRIPTION CERTIFICATE OF OCCUPANCY] PERMIT TYPE BC00 TITLE' CERTIFICATE OF OCCUPANCY ►. CONTRACTORS: Department of Health, Safety ARCHITECTS: and Environmental Services TOTAL FEES: CIE.~� BOND $ 00 CONSTRUCTION COSTS $.00 101 SINGLE FAM HOME DETACHED 1 PRIVATE P;..41 -- * BARNSr'ABM ; MA83. OWNER . PRESTIGE PROPERTIES, INC. , 1639' A�O� ED MA'S ADDRESS 1645 FALMOUTH ROAD " BUILD Il��/D VISION CENTERV I LLE, MA ��. BY i DATE ISSUED 07/21/1997 EXPIRATION. DATE e PARCEL. JD 000 GEOBASE ID ADDRESS 1645 SERVICE ROAD PHONE (508)771-0003 WEST BARNSTABLE, MA - ZIP 02668-- LOT 4 BLOCK LOT SIZE DI3A J DEVELOPMENT DISTRICT PERMIT 21916 DESCRIPTION_ NEW SINGLE FAMILY DWELLING PERMIT TYPE " BUILD TITLE NEW RESIDENTIAL BLDG PMT GONTRACT.ORS: KENNETIL Department`of Health,:Safety; ARCHITECTS: - and Environmental Services TOTAL FEES_ $279.00 tk BOND $"00 .. ., CONSTRUCTION COSTS $90,000-.00 101 SINGLE FAM HOME DETACHED 1 PRIVATE P , , • `+ * BARNSTABLF, • ` - 1MAS.S. OWNER PREST39 IGE PRO:PER7.IES; INC. , . ADDRESS 1646 FALMOUTH ROAD BUILDINGoDIVISION-2- _ CENTERVI LLE, MA. DATE ISSUED 03/20/1997 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. OST THIS , • IT IS VISIBLE FROM STREET BUILDING INSPECTION APPROVALS PLUMPING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS i Pod -:- 'Y/z��7 ems-►�•,�1 `�� . •�� -3-0197 .ems � VdVL 7- zt -•57 � 3 1 HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT 2.1 G� BOARD F H T _ 4 A `mil M -21- 92 OTHER: /`C SITE PLAN 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. t �o s' 4 1 I 1 r' n t ' Engineering Dept. (3rd floor) Map . Parcel it# House# 16 Scf1« Date Issued 3 Q2-7 97 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 3 f Z.S" y j�y>ra-i Planning Dept. (1st floor/School Admin. Bldg.) He TBE D 'v Plan Approved by Planning Board 19 INSTAt,LE CE TOWN OF BARNSTAMETU E DE AND Building Permit Application TOWN REGULATIONS rI't"' t Address c'a % ,/ Se. ;c P iZ u-1�✓ Vill age w Owner Lr�4 r. zr 6•f-c-S Address /G �� 'uco✓�� • Telephone -7-1 /- 6ZO 3 - Permit Request C6-k5 d w. First Floor 9 3 L square feet Second Floor 9 a square feet Construction Type w°U Estimated Project Cost $ 9�E Zoning District /z Flood Plain c Water Protection Lot Size y 3, Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure ^'�,° Historic House ❑Yes ❑'No On Old King's Highway ❑Yes dj No Basement Type: Of Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) 9 3 Number of Baths: Full: Existing NP New Z Half: Existing ''/'' New 6 No. of Bedrooms: Existing ^'/A New 3 Total Room Count(not including baths): Existing t✓IA New First Floor Room Count Heat Type and Fuel: dGas ❑Oil ❑Electric ❑Other Central Air ❑Yes L?[No Fireplaces: Existing ^1/A New 0 Existing wood/coal stove ❑Yes dNo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) LifAttached(size) /y X 0-7- ❑Barn(size) ~�P ❑None ❑Shed(size) N//' ❑Other(size) NAP Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes YNo If yes, site plan review# - Current Use ROW Proposed Use 5-11V&CLY, Z5,141 L� Builder Information Name ��S ' e o .e i , t.s Telephone Number 7-7! - dP 3 Address It,yr a t1-40 d F License# 0 -2d v Rid 0 a 3 Home Improvement Contractor# Worker's Compensation# 6y c V 00 a-a 77 L? 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 BETAKEN TO �� c SIGNATURE DATE 3 ' Z' 1-7 J BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S) FOR OFFICIAL USE ONLY f PERMIT NO. ' DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION f FRAME INSULATION FIREPLACE = L t ELECTRICAL: ROUGH FINAL . PLUMBING: fm GH FINAL GAS: r FINAL cc FINAL BUILDING'N DATE CLOSED OUTS go r co ASSOCIATION PL � m m o CF IME tp� * * * * * BARNSTABM • MASS. 1639. - Town of Barnstable Department of Public Works 367 Main Street, Hyannis MA 02601 Office: 508-790-6300 Thomas J. Mullen Fax: 508-790-6400 Superintendent i To: William O'Brien Prestige Properties From: Robert A. Burgmann, P.E., Town Engineer Subject: Address Changes Date: June 26,1997 Dear Mr. O'Brien, Contact from the West Barnstable Fire Dept. indicates an address problem exists for lots 3 thru 8 on Service Rd. as shown on a subdivision plan for Heman Fish Realty Trust, Christopher P. Kuhn Trustee, dated September 12,1996, Rev. September 30,1996 and signed by Barnstable Planning Board as Approval Not Required and recorded at the Barnstable County Registry of Deeds as Plan Book 528 Page 84. Addresses were assigned where the plan showed road frontage, however, an alternate access was provided by easement to the lots from the end of Minton Lane. This makes locating the properties very difficult.New addresses will be provided on a temporary basis as follows: Lot Number Formerly "Service Rd." Now"Minton Lane" #3 # 1625 Service Rd. # 7 Minton Ln. #4 # 1645 Service Rd. # 6 Minton Ln. #5 # 165.5 Service Rd. # 5 Minton Ln. #6 # 1675 Service Rd. #4 Minton Ln. #7 # 1695 Service Rd. # 3 Minton Ln. #8 # 1705 Service Rd. #2 Minton Ln. It is my understanding that a new subdivision is being proposed'in the area of the current access easement. This may affect the appearance of the access provided to the above listed properties. In the event this plan does get approved and constructed, new addresses will be reassigned to these lots. Ji f� It is also necessary to provide a sign at the end of Minton Lane at the entrance to this area that indicates that this easement is a"private driveway" along with the assigned house numbers as defined in the "Rules and Regulations for Numbering of Buildings for the Town of Barnstable", since this access has no road status and will not be plowed or . maintained by the Town of Barnstable. It is also necessary to permanently close the access entrance for this area on Service Rd. to prevent using this as an alternate access until a new subdivision is approved. Closing this access is required since a curb cut was riot obtained from the Department of Public Works and can carry a fine of$200.00 per day. Should this access be opened for use without proper permits, new addresses may be reissued for Service Rd. and the fine be imposed. CC: W.Barn. Fire Dept., Barn. Police Dept, Building-15ept., Planning Dept., U.S. Post Office, E-911 Data Mgmt.,Nynex, Comm. Elec, Col. Gas Co. I �{y�''�'�T'��f`e;��� a;'". .,''.i.i-►:"�,,,'�,�r.,�s."1"'R i'TG'"�t i�r..v r�'1,.,.e•r�.r.."s}' .•-ft.i+--'raYf'�-'�isti`F::•r.�f y:'w�',y s,ny' v�-., The Town of Barnstable f : ,STABL E• Department of Health Safety and Environmental Services 1619• Building Division 367 Main Street,Hyannis, MA 02601 Office: -508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner Inspection Correction Notice Type of Inspection ✓1 vim---- Location 10-r- P r2 yc,.- -e 2 Permit Number Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: 1 /1 jPn r�)2 -Fr JCL 44:6-1911, 0 -1144 5 0", go VL- tl t-PAI�e A.- n -P AZ- A- r S o.Cj 1 d�I /rf•�-ur.•r 2 s. o� S r.� �. �,T-c �.o�'l.R..P21 n9p t IvPPd( Z C P44 4wkt - A"gQVA � u oo- -IIJ �'LT' C_ ' 2. l 7�5 d. s,- e Cp�7 Please call: 508-790-6227 for re-inspection. 1 Inspected by Date s �� i To `—� Date Time WH E YOU WERE OUT M of Phone Area Code Number Extension TELEPHONED PLEASE CALL CALLED TO SEE YOU WILL CALL AGAIN WANTS TO SEE YOU URGENT RETURNED YOUR CALL Message A Operator AMPAD �_ EFFICIEN ��00S ..ovrv�eaa _1 TOWN OF BARNSTABLE .;j 'r BUILDING PERMIT PARCEL ID 000 000 081 * GEOBASE ID NADDRESS: (� �tP/„vy—a� C�1� PHONE. (508)771-0003 WEST BARNSTABLE, MA ZIP' 02668 '�tf �`> f � yi .. ,4 BLOCK LOT :SIZE ''.. .DEVELOPMENT DISTRICT... ' > PERMIT 21916 DESCRIPTION NEW SINGLE FAMILY DWELLING y t PERMIT:;-TYPE :'BUILD TITLR`. NEW. RESI DENT IAL..BLDG ,�MT t.. t "rig" •J'.CONTRACTORS,:"? KENNETH B SADLER Department of Health ' Safety `ARCHITECTS , and Environmental Services"' TOTAL-',FEES,:", $279.00 . BOND ... T11E °, �.: ' F ;CONSTRUCT•ION .COSTS { ��1r .00 Ox , y $90,000.00 , r rsj�us SINGLE FAM HOME`_DETACHED 1 PRIVATE p � : till n� Ft1 OWNER PRESTIGE PROPERTIES, INC. , i639• ADDRESS 1645 FALMOUTH ROAD MK'� :•'::�`'.�,,:r.�tF,• CENTERVILLE,,.. :MA BUILDI v I tBY `� DATB ISSUED 03/20/1997' EXPIRATION DATE ff ' ttf, ,N , e•1;:t '�' � { } '1 ,R r .t �S. f a } } I �,A+v�.k�r�.=+►�-+'�`�'r.haw...�.�.�-.`tom ..-.rT.. ?�'i.1w....e-v , ,�„+-.., ,... .. "'-'hr-�+'•'.�. .S..r!- �M.-,-.-�., .i•-rit• `� .✓`1/r.,,.,�n^"n,+l""`*�.--,. .. �11KEr The Town of Barnstable o� �Ae.MASS. Department of Health Safety and Environmental Services 1639. �0 �Fo,u+a Building Division 367 Main Street,Hyannis,MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 - Building Commissioner Inspection Correction Notice Type of Inspection . Location /0-r- P iZ�O Permit Number I ( (e e i Owner Builder One notice to remain on jobsite, one notice on file in Building Department. The following items need correcting: 1ti4,a'I I n.r U S a AC I by d. C'-P 1AdL S 1-X i rr � 1 Lr� i e- G Ar-Al i Please call: 508-790-622(7"f)or re-inspection. Inspected by ��� \ '` -� Date "7 /D fq N CV O) a w a; o m a C . G W V d c.a m u � m • ,o t' up e►• a y o~ ca � as r-• m -Of o� W N � m ppy di m • - v a-r �• v� '� 6' .o ppipp a a.m. "°oi m > y o, N '• N ti OOWGG. �.'6�.•� LPL � •- mV Ei.:, = .. VJ AM, O ff y •` ,U 3C V.06 S v c n ---' ae i--------- __-- o ------------------ �___J �_-____-__— -_____ w ` , , • ' ---------------------------------------------------------- ' A w..w r..f..w 1.,•N6,�WOr.Mw. ...� o E r'wmd.hw.Plwn POUNVAT WN PLAN AlOO 7 ��i co cl •CO3 '' v�t w , W I b•o o..�.� s 3 _..,... p - Fit E i J }► `I PI�Jr PR.00Ft PLILN SHfRnIAM/f�OO I c Cos Ln 'c co i a a m N am :E .9 •� is � �`. ,�I� l�0 L V 'CD V + A— cO . ' c a • �---- ------------4----- ------------ --- ---L________ ---_-------_ --___------- �- 6 E :' + >..::.e• i ® -- i ............... ....may..... ...,.- -------... ........ o •� .a= "R 2133 . i ............. - ........... 77 .. ..... - .............- - ..........:::: .L S fall ; mUl i xn- auorr Flacr Pl.n -A P-Loay-PLAN ' A000 GJLP�i: ��y.� �•_0� JM[R wUw[C A 17OO g ftj i Y r,t•coa�Iv...,.i....hw.t.y�.r %Oa, ro•r6r.l�.w.r.w+.F+o�rN 4� � ........-.r....•r.,.. .n r..w.r.o.<.r,r r,.•ten.....w�,r.r. n.r.....•.r-.,ch•N � _`�is-'_ i,. eo.rlyw.r.w.w rAN � .i,.•wo.nw..r...Fi>rhN � .,.•i.K.rlrr.N..M... � v Si ..rort...la•. ro•.� ..to.w.l.�...ra.... ..a-r . .� c��.. 'Y .�a e•r.r.,..nrw.r.w..r..rhN ..ems•,,s v..o•"r•w.r.t...w. — �a€li ci DMMMG M,: A VZ UCAING xGTl,04 ouuny o.W on A400 f I Ell .00 I I I I I I I I I I I r--------------------- ------=-----------------------------------'----------- ------------------------------------------------------------- -- -; fLIGHr eievaTlON ��.F-P-oNr MCyArloN ° rl 3F < segx ® om 00 Nil U I I I I I I I I I I I I I I ' _________—J I f—__________—__________—______—__—�i DMMIND ITlE i ----------- _____J -----—__—---------- t.____! �Cr-r eievarlau �R �s 6�•,F---aF-ei.evp.rloN _ ISSU E D A :....................................................:.::::.:.:.:::.:::.:.::.::.::::::::::::::::::::::::.:......:.......::..::..::...:::::.:::::: 1. 6 96 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE JOHN MCALPINE INS . AGCY. DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE ONE CENTER PLACE POLICIES BELOW. CENTERVILLE, MA 02632 COMPANIES AFFORDING COVERAGE CODE SUB-CODE COMPAN LETTER Y A EASTERN CASUALTY COMPANY B INSURED LETTER — PRESTIGE PROPERTIES, INC. COMPANY LETTER C 1645 FALMOUTH ROAD COMPANY LETTER D STE E-1 CENTERVILLE, MA 02632 COMPANTTERY .E ::.::.:.:..:.:......G............:.:.:.:.: ..................:.�:.......................................:..:...........:.:........ .....�.....:.::..:.:.....:.:.:.:.:.:....:.:.:.:.: .......: ...................................................... . ::: ::.:. .� . THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L1STEDBELOW HAVE ......................................... BEEN ISSUED THE INSURED NAMED ABOVE 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 TIIE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EEFECIIVR POLICY EXPIRATIO LTR TYPE OF INSURANCE POLICY NUMBER LIMITS DATE(MM/DD/YY) DATE(MM/DD/YY) GENERAL LIABILITY GENERAL AGGREGATE s COMMERCIAL GEN.LIABILITY PRODUCTS-COMP/OP AGG. s CLAIMS MADE ❑OCCUR. , PERSONAL&ADV.INJURY s OWNER'S&CONTRACTOR'S PROT. EACH OCCURRENCE s FIRE DAMAGE(Any one fire) s MED.IXPENSE(Any one person) s AUTOMOBILE LIABILITY COMBINED SINGLE ANY AUTO LIMIT s ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) s HIRED AUTOS BODILY INJURY NON-OWNED AUTOS (Per Accident) s GARAGE LIABILITY PROPERTY DAMAGE s EXCESS LIABILITY • EACH OCCURRENCE s UMBRELLA FORM AGGREGATE s OTHE R THAN UMBRELLA FORM STATUTORY LIMITS .....'. : A WORICBR'S COMPENSATIONWC V O O 2 2 7 6 H 0 6-21-9 6 0 6-21-9 7 EACH ACCIDENT •:...............1.0.0.., 0.0•• AND EMPLOYERS'LIABILITY DISEASE-POLICY LIMIT s 5 0 0, O O DISEASE-EACH EMPLOYEE s 100, 00C OTHER DESCRIPTION OF OPERATIONS/LOCATIONSNEIIICLES/SPECIAL ITEMS IOht........................ ................. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE TOWN OF BARNSTABLE EXPIRATION DATE THEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO FINANCE DEPARTMENT MAIL10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE 230 SOUTH STREET LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRISENTATN-S. HYANN I S, MA 02601 plm10R1ZEU REPRESENT ,�• #11332-2* ............. .............:::::.::. (k. Cf1...;'0................... . :. o o ?'4 0 RTE. 6 t LOCUS RD. � /qB�F oP� SIC ",y �U?, 70 U l�? Ir . o0 I \ FOR REGISTRY USE ONLY LOCUS MAP SCALE 1" = 2000' , CO �z6 BARNSTABLE ASSESSORS MAP 174 PCLS. 6, a \ 2) 7.XO2, 7-3 & 7-4 m g� 141 N PLAN REFERENCE: PLAN BOOK 528 PG 84 LOT 1 .� LOT 2 \ p X = 910317.84 I HEREBY CERTIFY THAT THE PROPERTY 43,724 s.f. J LINES SHOWN ON THIS PLAN ARE THE LINES Y = 251625.86 DIVIDING EXISTING OWNERSHIPS, AND THE (1.00 ac.) \m\ v MHB FND LINES OF THE STREETS AND WAYS SHOWN ARE THOSE OF PUBLIC OR PRIVATE STREETS OR WAYS ALREADY ESTABLISHED, AND THAT \ NO NEW LINES FOR DIVISION OF EXISTING o � OWNERSHIP OR FOR NEW WAYS ARE SHOWN. \� -c \ \ LOT 3 ►� —_ —— — — — —224.24 ! \ 43,765f s.f. 7 p — — — _ _ ! (1.00 ac.) l h S 83 31'27" E — _ — 18.45 DATE ARNE H. OJA P.L.S. UTILITY/ACCESS 242.69 — �— — ^ --\ 226.71 EASEMENT o \N N 83 31'27" W N ' a, I CERTIFY THAT THIS PLAN WAS MADE IN ACCORDANCE WITH REGISTRY OF DEEDS RULES AND REGULATIONS �X = 910118.13 EFFECTIVE JANUARY 1, 1976. Y = 251541.40 CB FND � cn EDWARD B. HUTCHINSON JR. " et ux m � - RICHARD T. FARLEI' JR. et ux LOT 4 1 DB 4362 PG 187 43,606E s.f. DB 5255 PG 295 w aD ^? '{ ^ J� �7 M 1 m rn Z n DATE ARNE H...OJALA P.L.S. 1 N \ -A 1 p�. cn N tv LOT 5 m o •hp EASEMENT PLAN OF LAND IN I (WEST) BARNSTABLE, MASS. SAND HILL R0.1:D A PREPARED FOR (UNDEFINED TRAVELED WAY AND 40' PRIMATE WAY AS SHOWN ON SUBDIVISION PLAN RECORDED IN PB 175 PG 115.) PRESTIGE PROPERTIES I L?9�t s ,oUTILITY/ACCESS1. C,, �7� 44�sa EASEMENT o I \Syc>s F ' H I S 83 04'22" E 40 0 40 80 120 Ft. j i 26f 5 � - -_ __101._75 065. ___ I OWNER OF RECORD I I 77f ---___5 99.20 11.95 down cape engineering, in( LANE � I N 8304'22" W n � GE PROPERTIES � MjNTON TE) I I 1 CIVIL ENGINEERS SCALE 1 = 40 JANUARY 15, 1997 PRESTIGE VA REVISED: FEBRUARY 28, 1997 1645 FALMOUTH ROAD (50' PRE ` 1 UTILITY ACCESS EASEMENT IAND SURVEYORS REVISED: MARCH 26 1997 CENTERVILLE, MASS. 02632 , � � (PLAN BK. 528 PG. 84) 1 - i 939 main st. 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WITHIN g' OF FIN. GRADE r , t x bIINiMtJ61 .75 OF,COVER OVER PR ,� , I . q ECAST 2X SLOPE REQU]RED OVER SYSTEM . s v o .G ,t' WITNESS: , -�_��•-�I..! Cx � . . I r -a i- _ . J . N 2' DOUBLE WASHED PEASTONE DATE. , . RU PIPE LEVEL . . s FOR FlRST 2 �, a 9 •S. RAT r✓ti t .. . \ PERC. E PROPOSED Sao : , 3 MAX. �_ ~' , -.-. , . . GALLON SEPTIC - . , �' �____ 'is . - - � CLASS ..G SOILS P#: ._.. f � •0 TANK (H-_lo ) GA$ r'r . 7v. S3 - . .•d . - , 5 . q2.a - - o , X SLOPE 6'' RUSHED`STONE OR MECNANiCAL• ( ) �__ c - . s COLaPAC1TON. (15.22] [2]) 2 c 1 ELEV. - o � 4. . ; , . ___._-- q .o DEPTH OF FLOW ..�� X SLOP 9rL _ .. . . 3 4 TO 1 1 2- DOUBLE WASHED STONE TEE SIZES. / / . . . DEPTH _ o . . LNLET ..�_ �,, . � L. oLmET DEPTH t9 : LOCATION MAP.' SCALE:: ;I-:,,9 1-.,L I. 1 , a ..f, Gi7-• . . '-, L . .h.cam." �,. - LEACHING to lc, 3 FOUNDATION SEPTIC TANK D BOX -;- . ASSESSORS;MAP 7`} PARCEL' � -" FACILITY 0.0 , - & : "' ` t,-,.5 , ,, , " - - : ,,�, : ZONING DISTRICT: ,A / I\l YARD SETBACKS:. ; 4 . o c FRONT - z . , G . ` , - o� : , . E ti, - SIDE :' _ i5 ` To 1/ .-, .. �. *f fI� I P�o.o 8 r h . S• e- '� M� `REAR M ,� a . �. r E _'I5 . Q „ vSg PLAN 'R F o >=t nl E. >f �� t� . - =' . 1 I � FLOOD ,,ZONE: Zi �� . - ! R G,,e%,.t <_ . . . .t,ro • - ,.o T too' ___• , tl . InTES. , ,4, v.r dT f-a- r-vJ Q 0 4. b ' t >. - ,, SEPTIC DESIGNS (GARBAGE DISPOSER IS` µo A-,.pssp ) 1. DATUM IS *'tom - 0,4- n . ___-_ _.. _- ✓� G� N, DESIGN FLOW: BEDROOM Ito GPD = 3aGPD 2. MUNICIPAL WATER t5 -� kLd-tom U ) !�, / - - ` �O USE A 11-0 GPD 'DESIGN FLOW - 3. MINIMUM PIPE PITCH TO BE `1 8` PER FOOT. ` a y '4. DESIGN LOADING FOR ALL PRECAST UNITS` TO BE AASHO H--, I i., _ /90 SEPTIC TANK. ,?,3 p GPD (___) G'�o k_ 5. ;PIPE .JOINTS TO BE MADE WATERTIGHT. .. t . b r USE A 1500 GALLON SEPTIC TANK i \ --I - : 6.' CONSTRUCTION DETAILS TO BE IN ACCORDANCE WTrH MASS. LEACHING ENVIRONMENTAL CODE TITLE>V. ._ _ J SIDE5:. -- 7. THIS PLAN IS FOR` PROPOSED WORK •ONLY AND NOT`TO BE ,,/ USED `FOR' LOT"LINE STAKING. _ II . ', 9 2J os E30T70M: :1s , ,24 .r ' ?- 8 PIPE FOR SEPTIC SYSTEM TO .SCH. 40--4 PVC. II J 1 \ . • Q 1 TOTAL: 41" - S.F. 5+YGPD 9. COMPONENTS NOT 'TO BE BACKFILLED OR CONCEALED WITHOUT . ,' : , . TH AND PERMISSION OBTAINED .INSPECTION BY BOARD OF HEAL b, -rth C.Is �a��"I%_-(--�-__.10_1r-.ice- ---- FROM BOARD OF HEALTH. ►� . _._� r 1 ` / . ! . bt . f0 , 0 . tf --� ,� LEGEND / SI TE AND SEWAGE PLAN . f / ,_ . , 100.0 PROPOSED SPOT ELEVATION . ►o_It. ► y OF. I . r - 1 • t�` s - A t7 � 100x0 X LNG P T ATI N , E IST . . : .'.: S 0 ELEV 0 P p.- 01 q IN THE TOWN OF: 6-4 . Y , 100 .. . ,. ROPO ED CONTOUR , {7. P S . . .I -' .. , .. , 48 0 '; i � W "� p- G> a-r L-E 1 . . . 1 . 100 _ _ EXISTING CONTOUR I ;- PREPARED`FOR: 2 • 9 f 2 r t {fTf li : e (del; , . gt o.I _ , - - a o _ , / . ea ., L►�AIYE- ,Oct '1b 9y - 1 _ . 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