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0027 FOSTER ROAD
5 - � j , of Town Of Barnstable *Permit# � " 11 7 Expires 6 months from issue date Regulatory Services Fee go • ,axxsrne,�, • a» Richard V.Scali,Director 35.00 6796 Building Division o Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 iv MqR 02 www.town.bamstable.ma.us ®� 10,� Office: 508-862-4038 OF8 118-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL OrABLC Not Valid without Red X-Press Imprint Map/parcel Number 3Cl'r7 Property Address 27 Foster Road, Hyannis, MA 02601 Residential Value of Work$ 5,575.00 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Paul Arnold 27 Foster Road;.Hyannis, MA 02601 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: ❑ I am a sole proprietor' ❑ I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name AIM Mutual Insurance Co. Workman's Comp.Policy# AWC400700943 " Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Re-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 Iof roof) ❑ Re-side El 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 the Hoy rovement Contractors License&Construction Supervisors License is r ired. SIGNATURE: a C:\Users\Decollik\AppData\Local\Microsoft\Windows\Tempo I temet Files\Content Outlook\2PIOlDHR\EXPRESS.doc, T Revised 040215 6. For inside remodels (i.e. additions, kitchen &bath, basements, etc.), we will take reasonable care to keep construction related dust and dirt to a minimum, however, homeowner will be responsible for their own house cleaning at end of project. 7. All agreements are contingent upon strikes, accidents, or delays beyond Contractor's control. Should a contract be terminated or cancelled after the mandatory rescission period, contractor will recover costs including all time related to this job with a reasonable fee (including profit) for all completed work and materials purchased or ordered. 8. Homeowner is to carry fire, and other necessary insurance. Contractor's workers are fully covered by Worker's Compensation Insurance. 9. Fencing, carpentry, painting, plumbing, electrical, dry wells, etc., and all other work necessary that is not contained in this contract, shall be the responsibility'of the Homeowner. 10. For roofing, the above pricing is based on a single layer strip unless otherwise specified. Should there be an additional layer or layers of roofing they will be removed and disposed of at an additional cost. Re-leading of the chimney is not included in quote unless specified and will be bill additional, if required. 11. For Window installation, contractor is not responsible for removal or reinstallation of window treatments. 12. Contracts not fully executed within thirty days of contract date are subject.,to pricing adjustment if applicable. RIGHTS TO CANCEL The Owner may cancel this Agreement if it has been signed by the Owner at a place other than the address of the Contractor, which may be his main office or branch thereof, provided that the Owner notifies the Contractor in writing at his main office, or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Agreement. WARRANTIES The Contractor warrants that the work furnished hereunder shall be free from defects in workmanship for a period of two (2) years following,completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship, or damage caused by the Contractor, his subcontractors, employees or agents, . is discovered within two years after completion of any job, including clean-up, the Contractor shall, at his own expense, forthwith remedy, repair, correct, replace, or cause to be remedied, repaired, or replaced such damage or such defect in workmanship as long as the owner has paid their agreed contract in full. The foregoing warranties shall survive any inspection performed in connection with the agreed upon work. All warranties for product supplied by the Contractor under this Agreement shall be those given by the manufacturers of such product, which shall be and hereby passed directly to the Owner. Such manufacturer's warranties, the Owner maybe required to-register or mail in a warranty card,or other evidence of ownership and use of such product in order to activate such warranties. The Owner's failure to send in or register such ' . documentation, which failure voids that manufacturer's warranty, shall not create any responsibility for the Contractor to warranty such product. Note: Any changes in the:contract during the duration of the project which results in additional monies due will be paid in full to the contractor at the time of the change. I authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be o ed n thi ob (i.e. permits appli ations etc.) if oi;eowner Signature Da a Contractor Signature Date Registration number: 103757 F i r-._�.__..._.._ ..__._,.._ __....,,:._�...�,•z+�..�.�-........Esc:^-�"""_,....d..�..._....J.__.�.._.._..._..�_� _...u�,�- _._.....M.._�......e_�..�..Y._�..____�'� l J ` 1 1 I The Commonwalth of Massachusetts Departme7it of In dustrial.Acc-ideilts Office oflnvestigadons. ' 60©Washington Street ` Boston,JVU 02111 ivwos.ntass:gm din Workers'.Compensation Insurance davit:Rudders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibh� Name(susrnewOrganizatiowla&,ideal): Sprinkle Home improvement Address: 199 Barnstable Road QWStat Zip: Hyannis, MA 02601 Phone.# 508-775-1778 Aree you an employer?Check the appropriate.box: Type of project(required): 1. I am a.employer with 10 4..0 I am a general contractor and I employees(fir11 and'or part-time).* have:hired the sub-contractors 6. ❑Nevi.construction 2.❑ I am a sole proprietor or partner listed on the attached sheet y- ❑Remodeling ship and have no employees These sub-contractors have 8 ❑Demolition, working for me in any capacity.ci employees and have workers— [No INQ workers'comp.1nCAHRf1Ce, comp.m31]['BnCE..T 9. ❑Building addition _ .•- 5.❑ LX4 are a corporation and-its. .10.❑_Electrical.repairs car additions mod) officers have exercised their 11. Plumbing airs or additions 3.❑ I am a homeowner doing all v�rork ❑ &�p , 1£ o workers' right of exemption per:MGL myself � c�P• la:WRoofnepaks insurance required.]F c.152,§1(4X and we have no. employees.[No workers'. 13.0 Other comp.insurance required.] •Any applicant that checks boa#1 must also fill out the section below showing their workere,compensation policy information Homeowners who submit this affidavit indicating they are doing all weak and then hire outside contractors must submit anew affidavit indicating sack (Contractors that check this boa must attached an additional sheet showing the name of the sub-cantractars and state whether or not those entities bare° employees. If the sub-contractots have employees,they must provide their workers'comp.policy number.: I ant an ernplocer that isprmiding iiwrkers'congmtisatiort.iiisnrartce for nty eniplo Eves. Below is titer polio,and job site,. information. Insurance CompanyNlame_ AIM Mutual Insurance Policy 0or Self--ms.Lie.#:' AWC40070049432016A Expiration:Date:, 1/1/2017 ' Job.SiteAddress: 27 Foster Road city.+EtawZip: Hyannis. MA 02601 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 ci,.rilpeualties in the form of a STOP IttORK ORDER and a,fine of up to$250.00 a day.against the-violator. Be advised that a copy.of this sta#emeat.may be forwarded tolhe Office of Investigations:of the DIA for insurance co-u•erage verification.. I do hereby ce n and pant alties.0 psrjrrrt�flint the inforruation prmdded above is Mie and correct Si tore: Date: 2/16/2016 Phone#: 508-775-1778 Official use only. Do not wi ite rn-tlds area,to be completed.by city'or7mm.ofiletal City or Town: PermitlLicense:A ' Issuing Authority(circle one): 1.Board of Health I Building Department 3.CitylTown Clerk 4..Electrical Inspector. S.Plumbing Inspector . . 6.Other Contact.Person: Phone#: 6 SPRIN-1 OP ID: DS DATE(MM/DD/YYYY) ACORO' CERTIFICATE OF LIABILITY INSURANCE �..�" 01108/2016 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(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 NAME: Kelley A.Sullivan Bryden&Sullivan Ins Agency PHONE 508-775-6060 FAX No:508-790-1414 88 Falmouth Road Alc No Ext Hyannis,MA 02601 ADDRIESS: Kelley A.Sullivan INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: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. INSR TYPE OF INSURANCE POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE CLAIMS-MADE OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY - $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JECT PRO ❑LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED r SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED - PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y AWC40070049432016A 01/01/2016 01/01/2017 E.L.EACH ACCIDENT $ 500,000 ❑NIA OFFICERIMEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,00 (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) c 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 J SPRIN-1 OP ID: DS ,4,�C0RLX CERTIFICATE OF LIABILITY INSURANCE DA07/10/2015TE Y) 07/10/2015 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 Bryden&Sullivan Ins Agency PHONE Donna M.Souza Fax 88 Falmouth Road A/c No Ell:508-775-6060 A/c No,508-790-1414 Hyannis,MA 02601 E-MAIL Kelley A.Sullivan ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURER A:Associated International Ins INSURED Sprinkle Home Improvement Inc. INSURER B:Western World Hy Barnstable Rd INSURER Insurance Company 34754 Hyannis,MA 02601 � Y 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. LTRR TYPE OF INSURANCE POLICY NUMBER M�pY EFF MMIDD EXP LIMITS B X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE X OCCUR NPP1403909 07/01/2015 07/01/2016 DAMAGESE TO RENTEIT ce - $ 100,00 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 X POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: JEmp Ben. $ non AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT , Ea accident $ 1,000,00 C ANY AUTO BDYYVG 07/27/2016 07/27/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ ALTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESSUA13 CLAIMS-MADE CUBW5902215 07/01/2015 07/01/2016 AGGREGATE $ 1,000,00 DED I X I RETENTION$ 10000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE '❑NIA - E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ K yes,descries under DESCRIPTION OF OPERATIONS betow E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ' Operations performed by the named insured as provided for by the terms and conditions in the policy. 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. # , 199 Barnstable Rd. Hyannis,MA 02601 - AUTHORIZED REPRESENTATIVE Kelley A.Sullivan ©1988-2014 ACORD CORPORATION.,All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD F Massachusetts Department of.Public , Board of Building'Regulations.and Standards' License: CS-006643: Construction Supervisor t BRAD K SPRINKLE"' F 199 BARNSTABLE ;HYANNIS.MA OZ601, x. .Expiration .Commissioner 10/0872017,' �� QJlteeoCca�amer�t�aira�'Baune�R�alrtion`F. CONTRACrOR Wom 103757 'type: . raHan- 7ptf s Prty�a CRorporetb � , SPRtdKL HQIiAE'iNAPIRtAIlI=NT,,INC, Br8d.8pifdkia. a, :,.. l SH988�tabie Ad. ` . Hy mlk MA 02601. . ._ VnAerseo�ewr�r. Unrestricted-Buildings of any use group which contain less than 35,000 cubic feat("I M )of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is Cause for revocation of this license. , For DPS tioensins information visit: www.Mass.Gov/OPS t LASNOfMP400aftevdM for b&*W�� 41111111110 WQNO P AdkAm no ggmkm goillWhave N realplimm-soft fli7r gym.NA Ull K Nat VIM swcets4a_SPRINKI F ; 199 Barnstable Road: Hyannis;MA 02601- (508)775-1718 Fax(508)7754350.: Email'-"sprink@comcast.net Website address:wwwsarinklebome.com PcIul.Arnold 27 .Foster. Road. . Hyannis, MA 0260:1 : 508-534 9453 :January 20 20.16 Re Roof CONTRACT.WORK.,ORDER JO.B :#131590 Work:-Scheduled,by: . :Ftoor.:protection . �,o,,Dust:.c.ur.tai:n. o. Wo.rk.order.reviewed Description Of Work To to Done Roofing • Strip and *.disoof. ll menero :a of :s . Apply CertainTeed"Winter Guard .Ice Dam.protection to: leading edge of roof aswell as all suspect areas(valleys chimney etc). • Apply. CertainTeed"Roofers Select Fiberglast Shingle. Underlayment over existing plywood • Supply and :install CertainTeed Landmark.Pro roof"shingles`in choicer-of color from samples provided: • . Cut in and install Air:Vent Shingle Vent. lI.ridge Venting and .cap with Hip and Ridge. • Install all new drip edge and vent boots, Page 1 of 2 07 FIRE r Town of Barnstable *Permit# �j Expires 6 months from iss a f Regulatory Services Fee BARNSTABLE, MASS. Thomas F. Geiler, Director i6M ♦� AlFD A't A Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.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 _ 1 �(� ('rope y Address _ =�5 2 ( 00JC n 4l lano 1 Residential Value of-Wort. 1 �7 V Minimum fee of$25.00 for work under$6000.00 Owncr's Name& Address Contractor's Name�nf l' 0 Zhye Telephone Number I lome Improvement.Contractor License# (if applicable) V �C)�jZS Construction Supervisor's License#-(if•applicable) ❑Workman's Compensation Insurance ®PRESS PERMIT Check one: ❑ I am a sole proprietor APR 2 2009 ❑ 1 am the Homeowner I have Worker's Compensation Insurance TOWN 0F BP►RNSTRBLE Insurance Company Name Workman's Comp. Policy # w` �V C6py of Insurance Compliance Certificate must be on fil . Permit Request(check box) ❑ Re-roof(stripping old shingles). All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/ liders. U. -Value _ ` (maximum .44) — l(1L2 (I 11L__ . *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner` gn Property Owner Letter of Permission. Le� e Improvement Contractors License is required. SIGNATLRE: ():`\k Pl II.I.S\I ORMS\building permit forms\EXPRE:SS.doc Revised 100608 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations, 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Ledbly Name(Business/Organization/Individual): Address: City/Sta /Zip: Uhno Phone.#: y J� Are yo an employer?Check the appropriate box: Type of project(required):a employer with 1. am _ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors ..2:❑ I am a sole proprietor or partner-' listed on the attached sheet 7. .❑Remodeling ship and have no employees These sub-contractors have 8.'❑Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers'-comp.-insurance comp.insurance.$ required] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I LE]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 �,�g �` employees.[No workers' 1310 Other cJ1 V- 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 subcontractors and state whether or not those entities have employees. If the subcontractors 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: ~ Policy#or Self-ins.Lic.M 0-0.(ACA W �J I' C Expiration Date: 1 Job Site Address-Q IC(Jl�tl�� City/State/Zip: CA, fit)MkL 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 tip 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 insuranc vera a verification. I do hereby certi 1, 4—<e ai nd penalties of perjury that the information provided above is true and correct. "Signature: Date: 4, _ Phone#: 6 OK-_72S-- l Official use only. Do not write in this area,to be completed by city or town official, City or Town: Permit/License# r 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#: - iIrllli "3�: Ei 12/31/2008 14: 18 Bryden & Sullivan Insurance Donna Seviour4Margo 1/2 ACORD CERTIFICATE OF LIABILITY INSURANCE oP OATS SPRIN-1 12/3/31/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Bryden & Sullivan Ins Agency HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 88 Falmouth Road ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Hyannis HA 02601 - Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A Associated Industries Of HA INSURER B: Spprinkle Home Improvement Inc. INSURERC 199 Barnstable R9 INSURER o: Hyannis MA 02601 INSURER 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. 1 SR D - POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMrDO/YY) DATE(MMIOD/YY) LIMITS GENERAL LIABILITY y - - EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY - PREMISES Ea dccurence S CLAMS MADE a OCCUR' - MEO EXP(Any one person) S PERSONAL C AOV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT PLIES PER: PRODUCTS•COMP/OP AGO S POLICY JRDT17 LOC, AUTOMOBILE LIABIUTY .. COMBINED SINGLE LIMIT S ANYAUTO _ (Ea accident) _ ALL OWNED AUTOS - BODILY INJURY SCHEDULEDAUTOS - (Per person) S - HIRED AUTOS - BODILY INJURY ' (Per accident) S NON-OWNED AUTOS ,. � - _ PROPEP.TYDAMAGE 3 . (Per accident) GARAGE LIABILITY AUTO ONLY•EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGO S E%CESS/UMBRELLALIABILITY - EACH OCCURRENCE .S ? OCCUR a CLAIMSMADE AGGREGATE S DEDUCTIBLE - 4 RETENTION S _ $ WC STATII OTH WORKERS COMPENSATION AND - TORYUMITS ER EMPLOYERS'LIABILITY - A ANY PRCPRIETORIPARTNER/EXECUTNE AWC7004943012009 01/01/09 01/01/10 E.L:EACH ACCIDENT. S 500000 OFFICERIMEMBER EXCLUDED'! E.L.DISEASE•EA EMPLOYEE S 500000 It yes,describe under ` SPECV+L PROVISIONS below E.L.DISEASE•POLICY UMIT S 500000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT SPECIAL PROVISIONS - CERTIFICATE HOLDER CANCELLATION . SPRNKHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Sprinkle Home Improvement, Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Fax #508-775-1350 IMPOSE NO OSLIGA'nON.OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Margo Mack 199 'Barnstable Rd. REPRESENTATIVES. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE lKelley A.Sullivan ACORD 25(2001/08) 0 ACORD CORPORATION 1988 '_ l�o t:nd Q,t(341111titlg IZLglllit(IOItS sr'tYd Siand:ui ds Construet'rom Super-vlsor Li'c'en5:e F Licem'se. 05 5'643' Exprra{io.n 101872009 Tr#` 427 Restncti;o:n: 00 BRAD-k SPRINKLE rr / 190 LOTH ROPS LANE c:• j t w BARNSTABL•E,.MA n -02668 cat: ssidircr I 0'.0—3 9040 encldseelsp,ac:e' I 1-A-Mascn ry only t + 1G- 1 ..2 Family pI"owes , , •�' Fa-,ilure ta'p'o�sess.a current�ii►ticacll oaf Elie , R ,; Massachuseats State Buliding at I is cause for itevacatto-n of thTs�0C.Onns;e: t 1 k /Fir ( ,rre r rucera�f. XIiJ,nrXre}Blo' Boa`rd=of-BuildingR. gutatiBns a'nJ Sfan,dards �' > ; HOME IMPROVEMENT CONTRACTOR AM; �, f Registration 103757 Expiration 7/9/2010 Tr# 271033 Type. I?fivate Corporation i SP47INk�LE HOME iMPf0VEMEN:T,INO B:tad. ..Sp;rhki:e ,. 199 Barnstable•^Rd: �ti-`. '. ya Hnnis MA 0260:1 Admtrtrsf�aioi y _License or registration valid for individul use only before the expiration date. If found return to: t Board of Building Regulations and Standards One Ashburton Place Rm 1301 Boston,.Ma.02108 Not valid without Sig ture zT�ti Town of:Barn:stable Regulatory Services qusrr S. Thomas F.Geller,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize QAG to act on`mybehalf, in all matters relative to work authorized by this building permit application for. a-Y (Address of Job) o'9' S. ture of Owner _ Date -6d Print_Name F If•Property. Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side. n-FOR MR-OWNFRPERMIRSION ninee s' ap Parcel : L S y Permit# 3 O �- House# Date Iss b d Y I i g �+G.. i;z m Board of Health(3rd floor)(8:15=9:30/1:00- ee d - �, Conservation Office(4th floor)(8:30- 9:30/1:00-.2:00) F + �'LICANT'jKUS .. . ColfNECTION 1 EWER ENGIN E BAR bpTnoa 19 aONSTRUCTIO ' R TTO NSTABLE. MASS P + t6sQ. tFD DAA�° TOWN OF BARNSTABLE, r Building Permit Application 1' Project Street Address >J- j Village t- a3r)I_S t✓1 8" b 1 h Owner •1L I csq Ait Ft S> :::ZY is Address e� ��_ t/l" n?a Y✓!�- Telephone ia, b d 16 ! O r Permit Request vtF . �m4� mac.it>� p��i� g�iF j7� I��. 13 C_t J ti 44 s,c .ray `z3 r'-�rrAty gi- f3t4SFrvl E�1 - First Floor '7/ square feet Second Floor (�� square feet Construction Type Q ate -s=xA %F r Estimated Project Cost $ Zoning District , Flood Plain Water Protection Lot Size 9000 Grandfathered ❑Yes ❑No Dwelling Type: Single Family Two Family ❑ Multi-Family(#units) Age of Existing Structure '?P5_ Historic House ❑Yes No On Old King's Highway ❑Yes ❑No Basement Type: Apull ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) 4 Basement Unfinished Area(sq.ft) 53 Z_ Number of Baths: Full: Existing�_ New�_ Half: Existing 1 New No.of Bedrooms: Existing New Total Room Count(not including baths): Existing 6 New First Floor Room Count 4- Heat Type and Fuel: ❑Gas nOil ❑Electric ❑Other Central Air ❑-Yes f)a No , Fireplaces: Existing 1 New Existing wood/coal stove ❑Yes XNo Garage: ❑Detached(size) Other Detached Structures: ❑Pool(size) XAttached(size) °-}-O ❑Barn(size) ❑None ❑Shed(size) ❑Other(size) Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes A No If yes, site plan review# Current Use Tim ICE/ tft&4 Proposed Use 5>411l(T Builder Information Name Icq*icp -r- jS> ZT-1e_ Telephone Number �5�a8 2-7 / -?o 30 Address 2 License#_��,,..t�o f..,,,c?(,g: .,== 1 6 -4d. 1 Home Improvement Contractor# Worker's Compensation# 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 wl Lol �t c+� L.A SIGNATURE ���� DATE 4_ i 3�aifti BUILDING PERMIT DENIE FO . TH OLLOW REASONS) r Y :yP r FOR OFFICIAL USE ONLY -PERMIT NO. DATE ISSUED ` Va MAP/PARCEL NO ADDRESS VILLAGE OWNER — ,�� •• ' .. - l i - ' � t s '' ' �. .w ' c •,« e j Ems• r i t r DATE OF$NSPECTION: • ' `s - L- �. FOUNDATION bllclll- FRAME t 4.5t INSULATION-.--. FIREPLACE s ELECTRICAL: ROUGH FINAL All s PLUMBING: ROUGH FINAL _ GAS: ROUGH FINAL y fi FINAL BUILDING ce + f DATE CLOSED OU�c% '. ASSOCIATION PLAMNO. { 3 fi t °f THE r The,,To'". :ofBarnstable 9e�A � 10�' Department of Health Safety and Environmental Services rEcr " Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227 Ralph Crossen Fax: 508-790-6230 Building Commissioner For office use only ; 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: �'.t ol�sA't e�� Est. Cost#�;-6.CC)n Address of Work: Zi"? ter' w— ►21;> 14 VA-4 Owner's Name P_t r-t4A-L_> Date of Permit Application:_ 4 1 9 I hereby certify that: Registration is not required for the following reason(s): Work excluded by law Job under$1,000. Building not owner-occupied Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A SIGNED UNDER PENALTIES OF PERJURY 1 hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. OR Date' I Owner's Name r The Commonwealth of Massachusetts .._ 1, •:— <�__= -- ��-=_ � Department of Industrial Accidents �` Office of/nsestig,9011S 600 Washington Street Boston,Mass. 02111 name' location Z'z - ci i p d hone# 5Q 6 I am a homeowner performing all work myself. ❑ I am a sole Pro netor and have no one working in any capacity ❑ I am an employer providing workers' compensation for my employees working on this job. _. comaanv name address: W. city:,: tihone#: ... . .. insurance co. policy# ❑ I am a sole proprietor, general contractor, or homeowner(circle one)and have hired the contractors listed below who have the following workers' compensation polices: comaanv name• address: city -phone#: ;. oltcv#' insurance co ,� /,/G/%% 'cam any name: X. address city phone#i insurance co. olicv# Failure to secure coverage as required under Section 25A of MGL 152 can lead to the imposition of crhninal penalties of a One up to 51,500.00 andlor one years'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a One of 5100.00 a day against me. I understand that a i copy of this statement may be fot�varded to the Office of Investigations of the DIA for coverage veriflcation. I do hereby certify der the pains and penalties of perjury that the information provided above is true and correct �vL Signature ' Date Print name 4I n 0 tl.d TO ta.I it i SSN -�` Phone# 2 71 -N3 D official use only do not write in this area to be completed by city or town official city or town: permit/license# ❑Building Department ❑Licensing Board ❑check if immediate response is required ❑Selectmen's Office ❑Health Department contact person: phone#; ❑Other (moved 9/95 PIA) Information and Instructions Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their employees. As quoted from the "law", an employee is defined as every person in the service of another under any contract of hire, express or implied, oral or written. An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having 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 house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer. 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 who 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 have been presented to the contracting authority. 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 along with a certificate of insurance as all affidavits may be submitted to the Department of Industrial Accidents for 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 required to obtain a workers' compensation policy,please call the Department at the number listed below. City or Towns Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the pi number which will be used as a reference number. The affidavits may be mbirned io the Department by mail or FAX unless other arrangements have been made. The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth Of Massachusetts Department of Industrial Accidents Imce of Imlesduatioas 600 Washington Street Boston;Ma. 02111 fax#: (617) 727-7749 phone#: (617) 727-4900 ext. 406, 409 or 375 7 CU9App@adkJ Table Jl=b(toatfoned) ?i cm pdre FaelcaM for Oae and Tw&Fan*Realdentbal Bolldinp Heated witb Foad Fads MAXIMUM MINIMUM GlazingQg Glazing Gelb Wall Floor I Elm Slab �C00�g Arm'(%) U-value= &vdue' It value' &value° Wall 4 p� Effiamcy' p � &vdue' &vdue� 5"1 to 6500 Headng Degree Days' Q 121E 0.40 1 38, 13 19 10 6 Normal R 121E 032 30 19 19 10 6 Normal S 12-A 0.30 3E 13 19 10 6 95 AFUE T 131G 036 3E 13 13 WA WA Nomml U 131E 0.46 3E 19 19 10 6 Nord V 131E 0.44 3E 13 23 WA WA ACE W 13% OM 30 19 19 10 6 115 AFUE X 18% 032 3E 13 2S WA WA Normal Y 12% 0.42 3E 19 23 WA WA Normal Z 18% M42 3E 13 19 10 6 90 AFUE AA Ism. 0.50 30 19 19 10 6 90AFUE 1. ADDRESS OF PROPERTY: 1-7 fi! ' c_ 2. SQUARE FOOTAGE OF ALL EXTERIOR WALLS: 4.Do 3. SQUARE FOOTAGE OF ALL GLAZING: ift +0 4. %GLAZING AREA(#3 DIVIDED BY#2): o (10 5. SELECT PACKAGE(Q—AA-see chart above): METHODS OF DETERMINING Y RE UIREMENTS NOTE: OTHER MORE INVOLVED ENERGY Q ARE AVAILABLE. ASK US FOR THIS INFORMATION. BUILDING INSPECTOR APPROVAL: YES: NO: q-forms-080303a 780 CMR Appendix J Footnotes to Table J5.2.1 b: ' Glazing area is the ratio of the area of the glazing assemblies (including sliding-glass doors,,skylights, and basement windows if located in walls that enclose conditioned space, but excluding opaque doors)to the gross wall area,expressed as a percentage. Up to 1%of the total glazing area may be excluded from the U-value requirement. For example,3 ft of decorative glass may be excluded from a building design with 300 ft of glazing area. 2 After January 1, 1999, glazing U-values must be tested and documented by the manufacturer in accordance with the National Fenestration Rating Council (NFRC) test procedure, or taken from Table J1.5.3a. U-values are for whole units:center-of-glass U-values cannot be used. ' The ceiling R-values do not assume a raised or oversized truss construction. If the insulation achieves the full insulation thickness over the exterior walls without compression, R-30 insulation may be substituted for R-38 insulation and R-38 insulation may be substituted for R-49 insulation. Ceiling R-values represent the sum of cavity insulation phis insulating sheathing (if used). For ventilated ceilings, insulating sheathing must be placed between the conditioned space and the ventilated portion of the roof. 'Wall R-values represent the stun of the wall cavity insulation plus insulating sheathing (if used). Do not include exterior siding, structural sheathing, and interior drywall. For example, an R-19 requirement could be met EITHER by R-19 cavity insulation OR R-13 cavity insulation plus R-6 insulating sheathing. Wall requirements apply to wood-flame or mass(concrete,masonry,log)wall constructions, but do not apply to metal-frame construction. 'The floor requirements apply to floors over unconditioned spaces (such as unconditioned crawlspaces, basements, or garages).Floors over outside air must meet the ceiling requirements. `The entire opaque portion of any individual basement wall with an average depth less than 50%below grade must meet the same R-value requirement as above-grade walls. Windows and sliding glass doors of conditioned basements must be included with the other glazing. Basement doors must meet the door U-value requirement described in Note b. _ d 'The R-value requirements are for unheated slabs.Add an additional R-2 for heated slabs. ' If the building utilizes electric resistance heating use compliance approach 3, 4, or 5. If you plan to install more than one piece of heating equipment or more than one piece of cooling equipment, the equipment with the lowest efficiency must meet or exceed the efficiency required by the selected package. 'For Heating Degree Day requirements of the closest city or town see Table J5.2.1 a NOTES: a)Glazing areas and U-values are maximum acceptable levels. Insulation R-values are minimum acceptable levels. R-value requirements are for insulation only and do not include structural components. b)Opaque doors in the building envelope must have a U-value no greater than 0.35. Door U-values must be tested and documented by the manufacturer in accordance with the NFRC test procedure or taken from the door U-value in Table J1.5.3b. If a door contains glass and an aggregate U-value rating for that door is not available, include the glass area of the door with your windows and use the opaque door U-value to determine compliance of the door. One door may be excluded from this requirement(i.e.,may have a U-value greater than 0.35). c)If a ceiling, wall, floor, basement wall,slab-edge, or crawl space wall component includes two or more areas with different insulation levels, the component complies if the area-weighted average R-value is greater than or equal to the R-value requirement for that component. Glazing or door components comply if the area-weighted average U- value of all windows or doors is less than or equal to the U-value requirement(0.35 for doors). •__ }g;fig..: . Ili TOWN OF BARNSTABLE BUILDING DEPARTMENT HOMEOWNER LICENSE EXEMPTION Please print. DATE JOB. LOCATION Number Street address Section of town "HOMEOWNER" icvt A+�s7 T 0 C=t : `70 3p _ Name Home phone Work phone . PRESENT MAILING ADDRESS 1-�v AnY��� �1/f�. O�� g 1 • City/town State Zip code The current exemption for "homeowners" was extended to include owner-occupied dwellings of six units or less and to allow such homeowners to engage an in- dividual for hire who does not possess a license, provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER: Person(sJ who owns a parcel of land on which he/she resides or intends to re- side, on which there is, or is intended to be, a one or two family dwelling, attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such "homeowner" shall submit to the Building Officia: on' a form acceptable to the Building Official, that he/she shall be responsibl for all such work performed under the building-permit. (Section 109. 1. 1) The undersigned "homeowner" assumes . responsibility for compliance with the Sta= Building Code and other applicable codes, by-laws, rules and regulations. The undersigned "homeowner" certifies that he/she understands . the Town of Barnstable Building Department inimum inspection procedures and requirements and that he/she will comply its said procedures and requirements. HOMEOWNER'S SIGNATURE APPROVAL OF BUILDING OFFICIAL Note: Three family dwellings 35, 000 cubic feet, or larger, will be required to comply with State Building Code Section 127. 0, Construction Control. HOME OWNER'S EXEMPTION The code state that: "Any Home Owner performing work for which aKbuilding permit is required shall be exempt from the provisions of this section (Section 109. 1. 1 - Licensing of Construction Supervisors) ; provided that if Home Owner engages a person (s) for hire to do such work, that such Home Owne.- shall act as supervisor. " Many Home Owners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q, Rules and Regulations;, for licensing Construction Supervisors, Section 2. 15) . This lack of awarene; often results in serious problems, particularly when the Home Owner hires unlicensed persons. In this case our Hoard cannot proceed against the inlicensed person as it would with licensed Supervisor. The Home " wner actin as supervisor is ultimately responsible. To ensure that the Home Owner is fully aware of his/tier responsibilities, mar communities require, as part of the permit application, that the Home Owner certify that he/she understands the responsibilities of a supervisor. On the last page of this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. .: Lot .16 NSA.fYA, q a ' 1^ram Uv*[tS:+�n�b- •' '� � - t .- _ _a Yi ..-. �Na�'i2�E1?O.C. 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