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HomeMy WebLinkAbout0127 PITCHER'S WAY �i � `�► -f- c h e is C-c� 4� 31 1 ,-,Assgssor's map and lot number ...--,-11.,4F,,5�....-.A/..a:... { �0*T E R � Q Sewage Permit number ... ��. .. .. ............................. �a �y gg / h7"PT1C -SYSTEMi BaEB9TaBLE, i House number pp���o�p. ................f............................ ....,......:.............., v �1tlSY ,fie gip. 4iG=39• �0� - o mac. ALLC® IN COi�,s! TOWN . OF BAR NSA 7 T � �L �Dr� # EGULATION . BUILDING INSPECTOR APPLICATION FOR PERMIT TO .. ..t.s.�.T ..... �.! .�-..`. .. z� ��-�. ....................................:.......... TYPE OF CONSTRUCTION .............�..V.P.7........::..��?�.�.�.................................................................. 3 ......... ... ............192.3... TO THE INSPECTOR OF- BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... .L)t. ......7........ ................. .S................................................. Proposed Use ....... �... ,. ..................Fire District ................................. Zoning District .................:.......................... .... �... Name of Owner ................Address ..... L>S� ..�!2 w)- %A-1..��C��.. .........Q L(ate!7 Name of Builder' luko........ !4�?\.5.....................Address .`� ... f 1�?S...l. ..... `YY...�C5 .. Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ...............IS...............................................Foundation ........ ��.��.�.��� v ( � Exterior ... T>..........a�^?? � "� Roofing ,�..5..�.h. .�. .'...... ............. ............... �� .Interior �. G Floors ......�C'�..-.5..�..:......................................................... .................�... �.............�.5?...�-...................... ,Fieat g ..`............. ,...................' ............... .. _.:`M':......-.. f' Fireplace ......X-9--s-..............................................................Approximate Cost ...........�.��j. .................................... �. Definitive Plan Approved by Planning Board ----------------------_---------19________, Area (� (,�...:.- :...:..-.. /" Diagram of Lot and Building with Dimensions Fee ���S ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH 'So f J 4D // l� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. e Name ........ ...'*X. .. .... .�.1's��............ Do i Ste'/ WILLIAM B. . No �- 15.2O.4.. Permit for _l;5..Stma............ ` f ' .........sS iog l . .. `�..Ir aod' ..DvveIli�/I__._.. �ot �7 I27 ` Location ------..u--_—..�������4���'���� � � —+.--.—�.a. ............................................... Owner —..V�il.li��\_Il�.� ______ Type of Construction -�]�����--------- ^, '--.��—..;,.—.--.---.-----.--.---.. ` - p�� — ....................... �� ^ —'--------- Pe!mit Granted ....�—i,ln—5.—^----]n 83 --.� —. � - Date of Inspection ------------l9 � , . . � --- --''r— �D ^ � . � - . ` ~ ` . ` `^ ;7 { � 4 ` ra. � 25284 @„�•�; TOWN OF BARNSTABLE Permit No. -------------------------------- STABuilding Inspector' s "L Cash °virf OCCUPANCY PERMIT Bond --------------- Issued to Witt ialn R. Davi-6 Address tot 07 127 P.iteh".6 Way, Hyttrtvt,us Wiring Inspector Inspection date Plumbing Inspector, x ! Inspection date Gas Inspector � Inspection date ,.Engineering Department � � � � Inspection date.j/—'moo ,,Board of Health r ;� �C }ff' ��;� Inspection date fG� �rl THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR- UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. p ..... .. _ ........ . .. .... ... `� Building` Inspector l FROM may, a TOWN OF BARNSTABLE ` BUILDING DEPARTMENT Mr. Francis Irahteine 367 MAIN STREET HYANNIS, MA 02801 Town Clerk " ""` "' "y.,"` Phone: 775-1120 SUBJECT: FOLD HERE - - DATE - - MESSAGE. has been r j, t tun er Pmd #25284 William R. Davis). Please release Bcnd.. sy.+,:p.a.4.Pat►t:...w...r+•w.row*•.M.q..r.wK-.�e.w+a.aF a.+..:.a,fi<eP^s rw A!b �] ��,,jj �(:�//"'.'�.,!! - SIGNED i DATE REPLY, SIGNED N87.RMI - RECIPIENT: RETAIN WHITE-COPY RETURN PINK COPY ' - - - -PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND FINK COPIES WITH CARBON INTACT. - - P - FROM TOWN OF BARNSTABLEE BUILDING-DEPARTMENT MY, F' lC5 I.ahirie 38� MAIN STREET HYANNIS, MA:' 0213tM tClerk ..�.d #� .v�����„t.�� , � w Phone. 775-1120 SUBJECT: .� FOLD HERE' 'M'.f. DATE - 1 - - 1 R , - Work has been caimpleted =ter PerA„ 25Z84 j ?1l14 n R��Davis�. Please release Bcnd. � M;d9'C�Y''fi'�'R'O:}W'9�.R�'Yh i��'.i fF44.•.2!�!!iWftiv jk S�W'Y..�'(!vM#K`�17 f-�94'#M YR.� . - SIGNED _ .. DATE - REPLY SIGNED - N87-RMI •- - RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY PRINTED IN U.S.A. A SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. "D ► eE AS s rFov-rt-+ orrl pca�o pia+: p� 39 i.lar L�r s.,et�cr 4 kDook . 23 s`Pv 4� 'A A/ 3 y aY / -� il!�3Cg © LOT / L4cs¢ 1 Q � { ,.3.T, f,:'.` �:G. v Y !'1 •� � .fir O. Hps 6 S ooQw►L Y . 2 ( 1 'Y'II N C �xn^Nst►a�(. t � i t � . t f `I cP�Fr nD/,ssLIA fE a T.P E s.ti1. L_- Cl Al OF �/F E��SwvRTt-! ALBER .` ZCtirC_ u, cs No.1U951 F w,DT'H A p� 0�� FS,f3: 20' 9a 'tSTE FSS�ONA�� �� a+•.RSSunE� PRc'r>✓criot� urP6E= AR-nct$ZS.z. :° FA f LEGEND ; '; t�OF, EXISTING SPOT ELEYATI.ON -Ox0 � .. • CERTIFIED PLOT PLAN EXISTING CONTOUR --- 0 FINISHED SPOT ELEVATION .. �, LET 7 ?i Tc H /�s �! FINISHED CONTOUR - O�-�- s i�-�l n/I✓/S ., . IN APPROVED BOARD OF HEADSAAR. e DATE AGENT ;'" SCALE, / � = 30 ` DATE, LDREDGE ENG/NEER/NG CQ� CLIENT.. 1 CERTIFY THAT THE PROP08ED EaISTERE REGISTMEQ ,fOB . D. p,., BUILDING SHOWN Old THIS PLAN CIVIL LAND CONFORMS TO THE ZONIN,9. LAMB : E QI EImov 3R-8 '� Q:R 9ARNSTA: E, ASS. Ed'3 712. MAI N'.`STREET GN. BYE . SHEE"f... :.Oft DATE ©. LAND SURVEYOR ' Qcrt-f� 51 f7t c.+i.►E Qeco Q-o OrA r.l ,, i PGfi1v Gook 85 A 39 tiIF I E`M pLE 1�oTL' L.T \ 70 1%,8 Tower d Qto LcT C7 TAriucn PL ! P6 . 4"7. !� /V 8 7'' S S Z D isi,-7 v i � 4 L-D T 7 M ►� o t o � 6 3 �� Q� ►I � v,.! F tea- SS N 43,03 ul u/F EE LL�3 Wo�L"n-1 ap, lo , o0o s. F Imo• w1Drl4 'k I F. S. !3 �4 1�S5uNtED PP-orEcrn�-j t-wjOGe AP-T TLC, I i cf-1/kP?, � , G-�-E .�Q A►.i�F�'�`rFE� G.L°tt15E•, �o CERTIFIED PLOT PLAN %/?C 1--v,9 y xm IN su 3 ` B S'� A S L as bl ASS*, �o m SCALE: . / „=3 0' DATE, 0 GE ENG EER/NG COIN HA6,IK_ I CERTIFY THAT THE TUUNDA"> l U n/ CLIENT PA SHOWN ON THIS PLAN IS LOCATED i E818TERE0 REGISTERED JOB NO. g.� ON THE GROUND AS INDICATED AND CIVIL LAND' , CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR. 'g OF BARNSTA E , ASS. Eicc�Ar i � c1.R.E . A:,uoTa�D 712 MAIN ST. CH.BY 6 2► 93 �- HYANNIS, MASS. SHEET OF � � DATE G. LAND SURVEYOR Assessor's map and lot number .... r' [C .. .... oFTHEtO � � Sewage Permit number ....,.....�'...............s............................. Z BARNSTABLE. i House number ........................................................................ 9�0 MAST e00 �aMPYa` TOWN OF BARNSTABLE BUILDING INSPECTOR ...... ► x— APPLICATION FOR PERMIT TO .......:.......................... ....................: TYPE OF CONSTRUCTION ............l.2P.ca�....... ...u .-................................................................... .r.......... .................19 .}... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ (a} .* ?......... �.-- :. r� � 4.,c.° .Y!..�.. Proposed Use � ..'—" Zoning District Fire District ``�? �1 �'ti ``. Name of Owner .. �'�.!`�......��' kt P.Cap-AYZ -.............Address . ..... �.......k,<<+� �Kw e< a��t 1 0 ..... �.._ .............�..................... Name of Builder" ....... ......................Address Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ............... ............................................Foundation .........'°. ?u G tT ...................(................. Exterior ...�P. ........'g1�? ``` C ....................Roofing .................;e<.. ..tra � ...................................... Floors ......�,?_4:_3�r. ....................................................Interior .. � Heating F�\%-� -~C3 t ..Plumbing .... ........... ....... ....................................................... 11 Fireplace ..... ... .. ....-- ............... ,:...............................Approwmate Cost ..:...... .. o. ?.d.c'.........................:.'.. r Definitive Plan Approved by Planning Board -----------__ -__--__19_-_-____. Area .'` .... .. . ------ - ? ... ... cps— Diagram of Lot and Building with Dimensions Fee `'��'7. ....................... ......... SUBJECT TO APPROVAL OF BOARD OF HEALTH OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS 1 hereby agree to conform to all the Rules and'Regulations of the Town of Barnstable regarding the above construction. +, T e Name . ....J X?�. ''�;... U- ::......!..... f DAVIS, WILLIAM R. A=289-16 No . 25284 Permit for .....1 z Story - 'S_inq.le.„..F...ar mi ly Dwellin Location of ......127 Pitcfi e ...................... ................Hyar}nis........................ Owner ...Wi.1.1am..R.. Davis„ ` Type of Construction ...k:rAMe............. ................................................................................ Plot ............................ Lot ................................ Permit Granted ...July 5, 19 83 Date of Inspection ....................................19 Date Completed ......................................19 a Ly e /S � '� f� L 'jL f., V oF1Ht:ram, TOWIl Of Barnstable *Permit#r 010� C �`� Expires 6 onlhs from issue dale S G Regulatory Services Fee r r BARNSTABLE, ZOO9 MASS. AUG 2 0 Thomas F. Geiler,Director t63q. AIf0 MPt A OWN OF BARNSTABLE Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 www.town.barnstable.ma.us 01'fice: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number_IA! l(PC) �( Property Address t �Che�S � CT C�►1✓��S Q��� [DAle's—i Value of Work �/ Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address os r6,/,,6 `. Pose- Am 20 l f j'0 6 Largo 50ryie-'S 1J i. 1 O LY Contractor's Name4i, n U �6m �+Jti(1dLN2 tYk- Telephone Number.�jU�S' "1�' f 7-1 t� biome Improvement Contractor License# (if applicable) LO 3 -7 .7 Construction Supervisor's License# (if applicable) (PG q3 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ 1 am the Homeowner g I have Worker's Compensation Insurance Insurance Company Name Ps_smt< L✓\-A, Workman's Comp. Policy # 7w4 Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ,� . LKRe-roof(stripping old shingles) All construction debris will be taken to Qrr'YtG• 1 0,to slw, ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders. 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 must sign Property Owner Letter of Permission. A co y of the Home Improvement Contractors License is required. SIGNATURE: 1:`.411'FILt{S\I(7RMS\huilding permit forms\EXPRESS. oc Revised 100608 B i,d of B3 iilding Regal�tions and Stirnd ii(Is �l�;fi•. C,onstruetaon Supervisor License• P 1� r L:ic'ense. 03 6,643 Exparatron, 1018/2009 Tr#' 9427 Restriction; 00 BRAJ:K SPRINKLE 190 LOTHROPS LANE W BARNSTABILE,MA 02668 Conpn)issuii er I. t 0;0 3 ,Q0;0 cf,eaclosedsp Ace ' IA Masonry only 1G-1 .2 Family:Hom'es t F Failure topossess a curreti[t edrbionio-1"th`e 1Nassach.usetts State Buildilug Code t ` is cause fo'r revo'c:a'tton of his hc.ens:e; 'F <Board of:BuildingRegulations antiStanda'i r " HOME IMPROVEMENT CONTRACTOR Registration: 103757 �t?f� Expiration: 7/9/2010 Tr# 271033 Type:: private-C'orpo.ration SPRINKLE HOME IMPROVEMENT; INC. Bract..Sprinkle 1994arnstabtb Rd. Hyannis-MA:02601 Admmistra-foie .._......._.. - ---- 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.02108 Not valid wit out sig ture ti 1. h� f ��rr-.r i- �:DI:Zi '�:����•: Im���:[:lul�:ui�:i:� 1 T ,.�- 1.2/31/2008 14:18 Bryden & Sullivan Insurance Donna Seviour-►Margo 1/2 ACORD CERTIFICATE OF LIABILITY INSURANCE o SPRINPID - OATF(MINDO1 12/31/0/08 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 MA 02601 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER Associated Industries of HA INSURER B Spprinkle Home Improvement Inc. INSURER C: 1H9 Barnstable Rd INSURER0: 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. INSK 4DO-LPOLICY EFFECTIVE POLICY EXPIRATION LTR' N5RD TYPE OF INSURANCE POLICY NUMBER DATE MWDOfYY DATE(MIAMONY) LIMITS GF,NERAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL.LIABIUTY PREMISES Es occurence S CLAIMS MADE ❑OCCUR HIED EXP(Any one person) S PERSONAL&AOV INJURY S GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGO S POLICY PERCOT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) S ANY AUTO ALL OWNED AUTOS - BODILY INJURY S SCMEOULED AUTOS (Per person) HIRED AUTOS BODILYINJURY $ NON•OWNEDAUTOS (Per accident) PROPERTYOAMAGE S (Per accident) GARAGE LIABILITY AUTO ONLY-FAACCIOENT S ANYAUTO OTHER THAN EAACC S AUTOONLY:. AGO S FXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S i OCCUR El CLAIMS MADE AGGREGATE S S DEDUCTIBLE S RETENTION S - 3 WC STATU• 11TH• WORKERS COMPENSATION AND TORYUMITS ER EMPLOYERS'UABILRY A ANY PROPRIETOR/PARTNERlFXEWTNE AWC7004943012009 O1/01/09 01/01/10 E.L.EACHACGOENT $ 500000 OFFX:ERIMEMBER EXCLUDED? E.L.DISEASE•FA EMPLOYEE S 500000 e yes,descnbe under SPECIAL PROVISIONS below E.L.DISEASE•POLICY UMT S 500000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT I 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 OSUGATION OR LIABILITY OF ANY KIND UPON THE WSURER,ITS AGENTS OR Margo Mack 199 :Barnstable Rd. REPRESENTATIVES. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE lKelley A.Sullivan ACORD 25(2001108) O ACORD CORPORATION 1988 AGREED CONDITIONS 1. Homeowner agrees that payment will be made in,accordance with the terms specified herein. 2. Overdue balances will bear interest at the rate of 1.5%per month(Annual percentage rate) 3. Homeowner will pay lawful collection expenses, including reasonable legal fees incurred by the Contractor as a result of the Homeowner's failure to comply with payment terms. 4. Contractor is not responsible for existing conditions of residence. 5. Contractor is not responsible for damage to such items as, but not limited to: sidewalks; driveways; patios; lawns; shrubs; sprinklers; and other such appurtenances. However, reasonable care will be taken.. 6. All agreements are contingent upon strikes, accidents, or delays beyond Contractor's control. 7. Homeowner is to carry fire, and other necessary insurance. Contractor's workers are fully covered by Worker's Compensation Insurance. 8. 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. _ 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 may be required to register or mail in a warranty card or other evidence bf 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 performed on this job (i.e. permits, applications etc.) if i I� �01 Joe a Ann Trovato Date Brad K. Sprinkle Date I 5. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): r i le m rbyernetJ Address: 99 . City/State/Zip: 44OLVIn ry\P, oa (j� Phone#: 50�S." 5" Are you an employer. Check the appropriate box: Type of project(required): 1.LY I am a employer with . 1 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. 0 Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑Building addition [No workers'comp.insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their I L Plumbing repairs or additions 3.❑ I am.a homeowner doing all work ❑ g p myself. [No workers' comp. right of exemption per MGL 12. oof repairs insurance required.]t c. 152,§1(4),and we have no employees.[No workers' 13.❑ Other comp.insurance required.] ;Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub=cdntractors 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: �a50 C_, Policy#or Self ins.Lic.#:_A- `7C) J� 04 1 36 l a (�5 Expiration Date: Job Site Address: o�� Pc ,r5 Ljav City%State/Zip:.. &aAA S (Y1A ©a(o0 Attach a copy of the workers'compensation i0licy 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 cerd u e ns d penalties of perjury that the information provided above is true and correct Sip-nature: Date: v v Phone#: Official use only. Do•not write in this.area,to be completed by city or town official City or.Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: TOWN OF BARNSTABLE Town of Barnsta BUG 17 RM 9 13 _r aFt"E raw. Regulatory Services Thomas F.Geiler,Director '" MASS. . " Building Division v�AT i639. � Tom Perry,Building Commissioner ED MA a 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 PERMIT# 4077dl® 0 1 �&/ FEE: $ ' SHED REGISTRATION 120 square feet or less I a-7 PiTc+6x wA A VA)J Location of shed(address) Village Jos Ep�i TR6YATo 1?w fik.J 2bLt i tb 6�6-369-$76 1 Property owner's name Telephone number `Q` �C oT -i gni7i 6 Size of Shed Map/Parcel# I o Sie re Date Hyannis Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? Conservation Commission(signature is required) Siga-off-hours for Conservation 8 00'9 30r&3:30=4:30~- 1 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. \A) PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. C\" V THIS FORM MUST BE ACCOMPANIED BY A f,,,f PLOT PLAN Q-forms-shedreg REV:042506 K� PC&?,j P.,�4 85 �AC,1 39 ti t 1= I 1=M p LC Oc,7 Lc+T �v(3Jt P r-T -to IRfoB Tower Qc�PI� Ti4 KluL, U �L 23S N �7 5-S 2_v � C7 J �I LOT 7 ,M Q � �5 o 6 3 E Ct �`..1 �l y i _ 44- i 4q: 03 . 40 �t L on" V\)ID T�-1 10' c �llr-P+ T . OF CERTIFIED PLOT PLAN pg� c L r7-r -7 j/-7 c=/y c_ : .-T M y A �'� "✓ Gm M IN �o su SCALEc . / „_ 30 ®ATE c� �z:,,r�ur 3 wl— L® .DGE' ENGINEERING. CO.IN ���' A�V,s a CERTIFY THAT THE �v�„r���,0 IV CLIE6dT SHOWN ON THIS PLAID, IS LOCATED _-- lj0BfNO. ,....- ON THE GROUND AS INDICATE® AND rsnMFORMS..TO THE ZONING LAWS � t D t y L � f�,�p�-- � �� ,. : ,� YN � •� r Town of Barnstable *Permit#a O'a6Z0 X-PRESS PERMIT >Xpires¢monthsfrom issue date Regulatory Services Fee ate. JUL 2 5 2006 Thomas F.Geiler,Director TOWN OF BARNSTABLE 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 �� Not Valid without Red X-Press Imprint Map/parcel Number Property Address 1 09-? �ckkv s QY &&AAiS .. nia C )u o t Residential Value of Work 0 /1 Q( Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address -7p� E bsanr g l r 14' Contractor's Name�;81( Q Lvtn(J✓G�L�A Telephone Number 6� Home Improvement Contractor License#(if applicable) C d 3 7 5 7 Construction Supervisor's License#(if applicable) CS O y ( & T 3 #KVorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's ✓✓��Compensation .insurance Insurance Company Name fT,L!1 1 1�f Wt'f�t.�Lt .1-✓l S Workman's Comp.Policy# _?ovy 1 `l 301 a M(Q Copy of Insurance Compliance Certificate must be on file. 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 o 3Z(maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: pe r must sign Property Owner Letter of Permission. rovement Contractors License is required. SIGNATURE: � rI Q:Forms:expmtrg Revise071405 The Commonwealth of Massachusetts'. Department-of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organization/Individual): Address: 119 1�arn5-�-�bt� ROJ City/State/Zip: can r�i f 1'lA O d Ce o f Phone#: ,50V- 7 IS- `i-1-1 r Are you an employer?.Check the-appropriate box: Type of project(required): 1.0-1..am a employer with__y____ 4• ❑ I am a general contractor and.I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 7. Remodeling 2.❑ 1 am a:sole proprietor or partner- listed on the attached sheet t ship and have no employees These sub-contractors have 8. ❑ Demolition working forme in any capacity. workers' comp.insurance. 9• ❑ Building addition [No workers' comp.,insurance 5• ❑ We are a corporation and its 10.❑ Electrical repairs or additions required] officers have eicercised their ri t of ex ti er MGL ME] Phunbing repairs or additions 3.El am a homeowner doing all work emPon p myself. [No workers' comp. c. 152,§1(4),and we have no. 12.❑ Roof repairs insurance required.]t . employees.[No workers' 13.❑ Other comp.insurance required.]- •Any applicant that checks:box#1 must also fill out the section below showing their workers'compensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tcontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'camp.policy infosTnation. I am an.employer that is providing workers compensation insurance for my.employees. Below is the policy and job site information. _ Insurance Company Name:. Alin Lgs. Policy#or Self-ins.Lic.#: Expiration'Date: .5 - (3 0 7 r , (�,�s�:V S cr y tt`c._v\ll�S City/State/Zip:& n.�-i T 1P17 Da dab 'Job Site Address:1.� 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 gfMGL 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby erti airs and penalties of perjury that the information provided above is true and correct: Si a e: Date: ( U Phone# S 6 �? Official use only. Do not write in this area,to be completed by city or town offleial City or Town: Permit/LIcense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Board of Building Regulations and Standards ' W HOME IMPROVEMENT CONTRACTOR i Registration 103757 4 S Expiration 7/9/2008 vi s Type Pn 4 e Corporation SPRINKLE HOME IM£PROVEMENT;`INC. Brad .Sprinkle 199 Barnstable Rd. j Hyannis,MA 02601 Deputy Administrator I /4. 7 I BOARD'OF BUILDING REGULATIONS License CONSTRUCTION.SUPERVISOR .• � u ry Number CS 006643: Bithdateo ,10/08/1955 Expires 10/08/2007 Tr. no: 66380 j Coh!W661:16-n CS li Restricted 00 BRADX SPRINKLE 190 LOTHROPS LANE / :- ,R W BARNSTABLE, MA 02668 C /� Commissioner- I w HOMEOWNER: DO NOT SIGN.THIS CONTRACT IF THERE ARE ANY BLANK SPACES 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. ate.. Ow er signature Contractor Signature .z. Date Date �s. A Al A Ya d 01 '! $ sx „ice e V^. yE a = �' 4 MAY, 23. 2006 ?0:26AM ASS OC1AIELD 1NSURANC: _ NO, 7283 r, 2%2 F, CERTIFICATE OF INSURANCE � IbSUBDATE(MM/DO/YY) PRONXER TM tERTIFICATE 18 200 AS A MATTER OF IRF0 AFN O LY AHD COMPS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE B:yden&Sullivan Ins Agr ncy DONS NOT AMEND,EXTEND OR ALTER THE CON'ERAGE AF60RDED BY THE Inc PnI.ICISS BEkOw, 88 Falmouth Road COMPANIES AFFORDING COVERAGE Hyannis, Ma 02601 ""• -- --- ••-••_..___ INSURED Sprinkle Home Improvement Inc PM Y A A.I.M. Mutual Insu:arce Co 199 Barnstable Road Hyninis,MA 02601 I I COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF IN5U'R tNCE LISTED BELOW HAVE R88N 1SSUfiD TO THE JNSUR&D N'LMID ABOVE 1 OR T4L POLi0 PEit1UD INDICAIU,NOTWrrHSTANDING ANY REQ1j-IREM2XT,TERM OR CONDrrioN OF ANY coNTRACT OR OTHER DOCUME..NT WITH RESPECTTO WHICH THIS CERTIFICATE MAYBE ISSWED OR MAY PERTAIN,THE 14SURANCE AFFORDED 3'V THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIDN3 OF SUCH P01,)=. LIMITS SHOWN MAY I{AVE BEEN REDUCED BY PAID CLAiYIS. CO POLICYCFFECTIVE EXPLIL%T1011 LTA TYTZ OF INSURANa P(ILICY NUMAIR LIMITS -- DATB(MWDD'YYI DME(AIM/DWYY) OWUKALLIANUTY ENERnLAGGREGATE S CUNMEP.CIALGBNGRALUABILI Y RODUC'"-QOMP1QPAGO.I -mMADB�-CUR i SKSON'AL&AUV.INJURY I y —'•._._V_..:,.., _... 'OWNER'S 11 CONTRACf01:S P1111. :ACH OCCURRENCE ! $ ! IRE DAMAGE(Any ow fire) $ R ev.EXPANSE:(Any ont Prim) I S LAUTOMOsas L1AElUTY ONiIN6D SING1$ ANY AUTO i IMIT = I I ALLOWNED AUTOS I 60VILYINIURY i RULED AUTOS I I I(Pot pu�wi4 MIRED AUTOS --- �2ODMYINIURY ••.•"^• ON-OWNED AUTOS i I PC�iCclOtw) S ARAOB UABILITY I +— ROPC7RTY DAAIAGC I S I RXCFASTJAIIII,'TV EACHOCCURPGNCG S MIRFLLA FORM AGOWA75 $ TI IGR THAN UMDULLA FORM WORKIER'S COMPENSATION AND N. - XQTH : EMPLOYEkS'L1AKITY I TRY Derr I 7004941 PAFTNDP9IIKECCTIVE o120QRi Oi117/20pti 105/1312007 s_ A TIILPROPRIETOR,' �{ IM1iCL I ! - LDISEASB..POLI LIMIT S 50C,000 OFFICBRSARB C ! i 15' S •• f 8 S SOO Oq0 IOTTILK DESCRIPTION OF OPF.AATTONS20G.�TRON5NEHtCLEWSCIAL'ITZXS CERTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE I*KE EXPIRATION DATE TIARRE071, THR ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NO TICE TO TI18 CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR Brad Sprinkle LIABILITY OF ANY KIND UPON THE COMPANY, ITS AGENTS OR REPRESI:NT'ATI%W, 199 Barnstable Rd. AU THOR.17,PD REPRPSINTATNT.. Hyannis, MA 02.601