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Home My WebLink About0062 SAINT JOSEPH STREET J � Q Assessor's map and lot number .......1.99 ..!........... ../v Sewage Permit number ...... ................................................... SEPTIC SYSTEM MUST B I %T!'.LI ED IN COMPLIANCE �'.ITH fA7T;;^LE it STATE a FTNEtp�� ' TOWN OF BARNST ODE AND TOWN REGULATIONS... . ii i BARNSTABLE, 1639.D N BUILDING INSPECTOR PY p`' APPLICATION FOR PERMIT TO ......... ........ ....... ................................................................................................ TYPE OF CONSTRUCTION ........4.�/. ......................................................................................................... . . .. .. . �r.• d•:..... .,tJ....... ..........19 �.?.. TO THE INSPECTOR OF BUILDINGS: The undersig d hereby applies for a permit according to the following information: Location ....A.... ....... ..................................................... .................................. ProposedUse ....../.... .... .. .............. . .. .............................................I......................... r Zoning District .(id,)rL1!t!l%4 ...............Fire District ... ...... . Name of Owner ...��..C}.. ..............Address ... . . ............. .......... Name of Builder !. .........................Address ......... .�...... .. Name of Architect .....�..c .......................... .................. ...... ....................................................... Number of Rooms .......�.�4.-a�?> ..............................Foundation ��...........CIS?"! ........................................:....... Exlerior ........ -�J—� !!^ ................................... .........................................Roofing ......... ....................................................... Floors ( V. .CX0. .............................................Interior ..... Heating ....,��. ... t...... .c :.......................................Plumbing .le .11..... l ..................................................... Fireplace � ,��1�'./ ...............................................Approximate Cost ... ... ..Qv�, .................................................... ........... .. // ..... Definitive Plan Approved by Planning Board --------------------------------19________. Area ................................f......... SU Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH / 3y� Y Oo r I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. �,, ,; A Name .... . .....4. ... Drouin Corp. 16698 on No ................. Permitfor ---`...=...p...,*x--. { � ! . --................c s......��....c............�...................... ^ | ..St°_ ..St�_________ | ' .. —`' ----.. —.� / ] � -------Hva�?�,��----.............................. ' { Owner ---.��z�.��g��!............................. ' ! - Type of Construction ----.��-----.. ` ' ---------~--------------^—. " ^ ��O � P|c* ---------. Lot -----==--- ` [ October 31 7� i Permit Granted -----_--�.�---.]A ^~ $ ^ ' Date of Inspection'. ..........c�^f�-�� Y�� .�.� � Dote Completedg ` ` J � ' ! PERMIT REFUSED 1 }_ � - ^'----_---.----------.. 19 | / w�^ ---../��'/(J—.----.. ' | ''.--------''�~— ` o � ~'--^---^^~------^--'---~----' ^ ' ^ ----..-------_------.~----~. ^ \ .-----------~-----.------...—. . ` . . Approved ............................................... lg .................... � / ---------------------..---- ^ ` , / ' . Town of Barnstable tHEr � Regulatory Services Thomas F.Geiler,Director " MAR NAN.LE, ` Building Division � ar&639.�Ah Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 0 , www.town.barnstable.ma.us _ Y Office: 508-862-4038 :5 ax: 50W90-62 0 PERMIT Q FEE: $ w Cxr .` co SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less Location of shed(addre s) tillage Property owner's nathe Telephone number Size of Shed Map/Parce S gnature �� Date H is Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:052813 '" Map Page 1 of 1 Town of Barnstable Geographic Information System New Sear Parcel Viewer Custom Map Abutters Map Size ® Zoom Out 11n " Turn p layers n Q ® B=]PG selectingc " h check boxes below r I40. [?.i n Tow Boundaries t e 201r r] Road Names 291212f ti2B1217 ` N71, q 72r" - Voter Precincts P 13 ry I ry J ) a rl Map&Parcel Numbers r Parcels IA 291241 r FEMA Q3 Flood Zones(Current Maps) Not for official Flood hazard determ a # Cl AE(100 yr flood) t, g s" e" E , AO(100 yr flood) r a VE(300 yr Flood w/wave action) oy } xsoo(soo yr flood) 1912131 .q1 d' 191219, w-s I^ rl FEMA Preliminary May 2013 Zones(su Expected Adoption Summer 2014 (; 13 AE-100 year flood .Wp AO-100 year flood i c' + - N VE-Velocity Zone r a 291242 0.2%Annual Chance Flood 4 b �" 'i'I N117 A Open Water r � TW } tea• ' ga ] - �. (, .. e - )'= jvj Neighboring Towns a g G Water r' Streams x E 29i2i4� 23 2912i9 r Jetties +�` - 291240 Cl 0. 0 32 F2et t '"�. $ t �' i d a AN,f r Edge of water (- Marsh Set Scale 1"=32 I Aerial Photos P� I MAP DISCLAIMER Copyright 2005-2010 Town of Barnstable,MA All rights reserved.Send questions or comments to GIS Barnstahle.MA v1.2.4748(Production] is 60 http://66.203.95.236/arcims/appgeoapp/map.aspx?propertyID=291218 10/22/2013 Town of Barnstable Regulatory Services Thomas F.Geiler,Director " '"E„ 'E ' Building Division 1639. iOrEn ,�a`�� Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 0 0 www.town.barnstable.ma.us ca . h-, `a C) Office: 508-862-4038 ax- 50$,,390-( 0 PERMITQ FEE: $ � � rn co SHED REGISTRATION RESIDENTIAL ONLY 200 square feet or less Location of shed(addre s) tillage Property owner's narhe Telephone number Size of Shed Map/Parce S!gna;ture Date Hs Main Street Waterfront Historic District? Old King's Highway Historic District Commission jurisdiction? If over 120 square feet,you must file with Old King's Highway Conservation Commission(signature is required) Sign off hours for Conservation 8:00-9:30&3:30-4:30 PLEASE NOTE: IF YOU ARE WITHIN THE JURISDICTION OF ANY OF THE ABOVE COMMISSIONS,THERE MAY BE A REVIEW PROCESS AND APPLICATION FEE. PLEASE SEE THE APPROPRIATE COMMISSION FOR DETAILS. THIS FORM MUST BE ACCOMPANIED BY A PLOT PLAN Q-forms-shedreg REV:052813 • Town of Barnstable C3 *QrIR24 Expires 6 dote Regulatory Services Fee KAM Thomas F.Geiler,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 Not Valid without Red X-Press Imprint Map/parcel Number O� Property Address to o 3 0 5 10 h ST [;Residential Value of Work Minimum fee of$35.00 for work under$6000.00 .Owner's Name&Address 5e4fc►'U �7rYq r' , Contractor's Name Sprinkle Home Improvement Telephone Number 508 775-1778 Ext. 10 . 103757 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) CS 6643 -PRESS PERMIT Workman's Compensation Insurance S E P 1.3 2012 Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ® I have Worker's Compensation Insurance TOWN OF.BARNSTABLE. Insurance company Name Associated Industries of MA/A.I.M Mutual Insurance Co. Worloman's Comp.Policy# AWC 7004943012012 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, ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) to-side #of doors *Replacemen(W:id:o:w)doors/sliders.,U-Value o (maximum.35)#of windows 1 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 Home Improvement Contractors License&Construction Supervisors License is re t SIGNATURE: C:\Users\decollik\AppDataU,ocal\Microsoft\Window Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 The Commonwealth of Massachusetts Print:_Form Department of Industrial Accidents Office of Investigations 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Sprinkle Home Improvement Address: 199 Bamstable Road City/State/Zip: Hyannis, MA 02601 Phone#: 508 775-177.8 Ext. 10 Are you an employer?Check the appropriate box: Type of project(required): 1.21 I am a employer with 10-12 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp.insurance' comp. insurance. x . 9. ❑ Building addition 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 ,( employees. [No workers' 13-Other n�S SVIAG comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Associated industries of MA./A.I.M Mutual Insurance Co. , Policy,#or Self-ins.Lic.#: 7004943012012 Expiration Date: 01/01/2013 Job Site Address: �o� C t1T" 3oS h � City/State/Zip: a t,v1 i 4- 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 a verification. I do here certi u d enaltles ofperjury that'the information provided above is true and correct !Mature: Date Phone#: 508 775-1778 Ext. 10 OffWal use only. Do not write in this area,to be completed by city or town ofj'iciaL 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#: I Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601. www.town.barustable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must .Complete and'Sign This Section. If Using A Builder I 3�eyl e V-VJ Q , ,as Owner of the subject property hereby authorize Sprinkle Home Improvement to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature o er-. Date i+e I( �r Cc Print Name If Property Owner is applying;for permit,pleasecomplete.tbe Homeowners License Exemption Form on the reverse side. C:\Usen\decoltik\AppDataUAxal\Micmsofk\Windows\Tempomry lntand Files\ContenGOutloor\DDV87AAZ\EXPRESS.doc Cl� Revised 072110 Unrestricted -Buildings of any use group which . contain less than 35.000 cubic feet (991rn)of i Massachusetts -Department of Public Safety enclosed space. Board of Building Regulations and Standards Crrnctrucnnn Supenisor License: CS-006643 BRAD K SPRINKLE . Irk 190 LOTRROPS LANE _ Failure to possess a current edition of the Massachusetts W BARNSTABL.E MA 02'668 j State Building Code is cause for revocation of this license. For DPS Licensing information visit: WWNr.Mass.Gov/DPS JJiStal!or. ' :ommissioner 10/6812013 .. � ��.• T�rirrrrr n•.ii�/I r/ •ILr ,,rr/rrr,..//. - •..- .. _ .. . Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ,--r�.htOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to. 4 gegistration: 103757 Type: Office of Consumer Affairs and Business Regulation Expiration: 7/9/2014 Private Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 SPRINKLE HOME IMPROVEMENT, INC. - +' Brad Sprinkle P . 199 Barnstable Rd. Hyannis, MA 02601 _�_.,_ -- tindersecretary Not valid witho st nature h g r 12/20/2011 9 : 35 : 33 AM 8740 ® 02%09 TE CERTIFICATE OF LIABILITY INSURANCE DA 12/20 20D 11M THIS CERTIFICATE IS ISSUED AS A MATTER Or INFORMATION ONLY AND CONFERS 90 RIORTS UPON THE CERTIFICATE FOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AHED, EXTEND OR ALTER THE COVERAGE AFFORDED BY TEE POLICIES HELOT. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT_HETfiN THE.ISSUING INSURER(9), AUTRORXXED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE SOLDER. IMPORTANT: If the certificate holder 10 an ADDITIONAL INSURED, the policy(ies) must be endorsed. IL 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 bolder in lieu of such endorsement({). PRODUCER CWMACT Bryden 6 Sullivan Ins Agency n" Inc JAIC. a.. fxt), a-Iaa. 88 ralmouth Road R Hyannis, N& 02601 CE{ToaR:a. INSUMIS) arreRPINe Cau""t 031c e IMURBD avm a, A.I.M. Mutual Inssurance Co 33758 Sprinkle HMO Improvement InC Ilallts., 199 Barnstable Road EMUSUMC, Hyannis, bA 02601 Iatwom r: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: un Is ao CNRTa7[Taw You roLrC= or atOamcm LIPTm an&oW NAR ARMS Sasm TO Two aNNrftp xmmo ABOVN fee'LWR POLICY"LWO aDDC1�. aoiWTIWicuum ANY NMQOI:moor, TNNM OR cmmzwm or ANY caswAcw OR o%MNN oocolmT Wrn Rxmrwr TO wow Tara Conn cma May AN ns m as Mpy rSTAs1, TNN musnu O Arromw BY van ROLDCM 005Ciam NossIx ICE XUAM r TO ALL TS TNRIS, Emwzxoss Am CONDITION$ or suco roumcm. Lnwn fNONR May N,Ts ANNE RNDUCND BY RAt9 CLAIMS. - Two a DiaWRANIs POLICY NUMBER r,�� LIIMI S GENERAL LIASZLZW tea oceleaMec { -. ❑COMIRCIAL UNMORAL LIABILITY . .aoQs TO lOYO raOlItEf(Ee..ee.a.w.) • ❑❑CLAIM)"s ❑OCCUR Mom (A"...NMON) e ❑ rsnUnL c.Asa xwww { OL AG"QATI LDIIT APPLIED iRt - - �' ��'AG�GaTi { ❑PORKY ❑PPOJBCT❑MAC MMUCTS-.COI•/OP ago. { a AP1BIId LIABYLITY CeOISKe SINGLE LIMIT - (e�eeolLOq { CAST AUTO - ROBILT IQIOY (p.Anon) { ALL OIWRD AUTOS ❑SCINDOLID AUTOS V _ a®ILT IQIOlIMr ePofY,tl { . rWYTY PROOQ ❑EIRMD AUTOS (P_eoD16-t) { i 0008-01AID AUTOS { . ...A LIAR OCCUR - - SACK OCCIOaOtQ ❑frCBBS LIAR ❑ CLAIq MADE ❑RETEE7I09 t - ` - .oRsas calosNraTmN ® o Am ovwYNNs rsumlTY TRtr LmTT n THE PROPRIETOR/PARTNERS/ - S.L. EACH acCINtaT { 500,000 EXECUTIVE OFFICERS ARE . A R.L. PISSUM -POLICY LIaII { ' 500,000 ® incl ❑ excl 70049d3012012 Ol/Ol/2012 01/01/2013 S.L. PIZZAS -SA nWLMMZ { 500,000 CmwzPYf 1 etfaznlw K arimaTIeaf OR LOCATI6is - - WORKERS COMPENSATION COVERAGE APPLIES TO MASSACHUSETTS EMPLOYEES CERTIFICATE HOLDER CANCELLATION PROOF OF INSURANCE .. suoum ANY Or•mm AB04N OEst?f an rOLDCbi AN BEFORE TNZ EN nannN'DATN WMAW, NOTICE WILL As MMXM= IN ACCORDANCE WITS TAN roLrCY PROVXSXONs. 5289 Bill IncNiryS. NJh Fle Edit Tools Help -Year/Type/Bill No. Customer Account Information History -TTRE R• 26516 _- 380778 Detail Property Information L CAGH L Htc S Parcel ID 291218 %FRYAR,JEFFRE`f Orig Bill -.- ._ _._ __ __:.:_ SAINT JOSEPH STREET 11n _ ._._,__- Alt Parc 62 HYANNIS;MA 02601 , Effective Date t Prop Loc 62 SAINT JOSEPH STREETTC)VVN BLE ;23 Special Conditions/Notes {{ Lien/Sale L I Scan BillInstallment Information Int Dt Billed Abt/Adj Pmt/Crd. - Interest Unpaid bal Quick Entry 08{02{ii 424 89 00 252 04 1.26 -174,11 ~^424,89 � �- 00 00 _3 09 ` 427.98 Utility Acct - - _ _ _ , 441.03 �100 00 3_21 _444,24 Customermm-y4,44.23� OS 0 12 Name ;1 Fees/Pen r 00 15 00 15 00 - - - --I --- --- --- -- i - '00 ' .00 --- Totals. ,83 1,731 1 0 267.04 f 10 77 1,490,56 ,. Parcel -- :i �� ---- __ -------' - - --- — -- Prop Code 1 Notes/Alerts Due 09112j'2012 1,490.56 Bill Dates ; JAN 1 Owner:, SUTTON,JAMES P JR�i _ Per Diem m,, Int Bill Audits r i Paid M 4 - '.r: prier unpaid bf Total Paid . 432,97 ` Bill Events 3 , l • . a Reprint Preferences i Diagnostics _ I, 1_..°€. 1_:..... . . ...: .... �� N _17 Attachments f03 �Display transaction his`ury for the current gill, . f PROJECT � � NAME:._ � ADDRESS: ?j A in it I PERMIT# 00 Q PERMIT DATE: (Q l M/P: LARGE ROLLED PLANS ARE : BOX � tj . SLOT PrIl i Data entered in MAPS program on: tl B Y: - I � > Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services L Fee s� s.aruu : — NAM Thomas F.Geiler,DirectorIL Building Division, ram: I Tom Perry,CBO, Building Commissioner y 200 Main Street,Hyannis,MA 02601 2�7� www.town.bamstable.ma.us. r C : Office: 508-862-4038 9ao��= EXPRESS PERMIT APPLICATION '- RESIDENTIAL ONLY. p Not Valid-without Red X-Press Imprint Map/parcel Number 1 a Property Address (Da sa ✓ k 6 `'} �-Residential Value of Work y �i Minimum'fee of$35.00 for work under$6000.00. Owner's Name&.Address y - � s t� 5, Contractor's Name Sprinkle Home lmpmvement' Telephone Number 508 775-17.78 Home Improvement Contractor License#(if applicable) 103757 a Construction Supervisor's License#(if applicable) (064 R]Workman's Compensation Insurance" °r Check one: ❑ I am a sole proprietor ❑ I am the Homeowner . I have Worker's Compensation Insurance {~ , . Insurance Company Name Aggnc:iated Indll.-,triPS of 'MA Workman's Comp. Policy#AWr`7004943n 12011 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 to ❑Re-roof(hurricane nailed)(not stripping.-Going over existing layers of roof) ❑ Re-side k- replacement #of doors Windows/doors/sliders.U-Value (maximum.35)#of windows "Where required: Issuance of this permit does not exempt coatpliance'with other town department regulations,i.e.Historic,Conservation;'etc. ***Note: Property Owner gn Property Owner Letter of Permission. ; mprovement Contractors.License&Construction Supervi ors License is SIGNATURE: C:\Users\decoliikWppData\L.ocai\Microsoft\Windows\Tempo Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 f � . ' The Commrsonweahk of Massachusetts Dodriminto Industiw►W Accidents Office.of IAvestigotions 600 Washington Street Boston, Mass. 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eec�cians/Ptumbers Appiksnt)(nrormtltion Plisse Print Leglbly Name vidua1y.. . Sprinkle Nome Improvement Address: 199 Barnstable Road Hyannis, MA 02601 -17 '8Ctylsaterzip: on # i. QY I am an employer?wit 9 appropriate dw 4. um a general contractor and 1 b.0 Ne of w construction ,• employees(full and/or part fuse):' have hued the sub-contractors 1. )`Remodeling 2.0 I am a sole propriety or partrter- listed on the attached sheet. .ship and have:no employees These snub-contractors have 8 0 Demolition i worktog for me in any capacity employees and have workers o workers'. 9.�O.Building addition (N comp:.insttraace.; comp. insurance. j required) 5.0 We art a corporation.and its 10. 0 Electrical repairs or additions 3. 0 I am homeowner doing all work officers have exercised their 11. 0 Plumbing repairs or additions' myself [No workers'comp. right of exemption perm MGL . insurance required)t c. 152,§J(4),and we have no . 12. 0 Roof repairs employees.[no workers. 13. O Other comp. insurance required.:) 'Any s/illenot sht cheeks boa$1 one alas 0 opt the ssetim bdww ebswhrt their workers'+aka ales try kde+'w• tB win subsea this afiel.vlr Doting they we doing an wont said them titre ent side e..a,Ear,ona-wbso a ww effid It 1 aeb. teats--that ehuk tbfs bsa ass o sash o ad/Itlmd sheat showh ig the aaame of the ai4o.trutors sad sum whseher or so these addes how eeoyisyem U the .have smeoiryes.dmw mart= olds their warkon'ours.a ft swomber. 1 aw an eaybyrr do ispnvvdawg 'compeasedon twaamfty for my amployem Below is die polley and fob site Wawa"lnatraacx Company Name:Associated Industries of`MA Policy#or Self-ins.Lic.#: AWC 76049430-1 201-r1 1 Expirad.on Date: 01-01-2012 Job Site Address: (01) '1zV1' 03 " 7j se D k St: City/State2io: ttVl� y1 iSE fVll l'4 y Attach a of the w orrkeri'com usatlon SPY Pe poltiy declaration page(showing the policy number and expiration(date)_ Failure to secure coverage as required under Section`25a of MGL 152 can lead to the`ilnposition of criminal'penalties,of a fug up to$1,5W.00 and/or one year' as well as civil penalties in the-form of a STOP WORK ORDER and a fine of S250.00 a day against violator.Be advised that a copy of,this statement maybe forwarded to the Office of Investigations of the DIA for cov ve rification. . 1 efo ktrr6y Pe 4fP 3'than the info►madow provided above is fats and comet . Date: -`$rad Sprinkle Pcrw Name. P pho to#. 508 775-1778 Ext.10 . Do:toot:writs in this area to'be com fated b fist only P y city"or town o,ffisctol City or Town: Permit/Ueense#• Iwttbg Aathorlty(circle one): } I.Board of Beath 2. Bt W"Department 3.CityfTown Clerk 4, Electrical Inspector 5.Plumbing Inspector 6.Other Contact Pam: Phone 0: I . �I,i� ,ei�{ ,}lil•. l�s'j}.tt'tliit'S11 •il f�`a,lrfM nr,.x,, ''; t°-ia ,�r.•�� n r7f�. t'/. rf�[��;.; (rah I�(,un umer A Him, dil"ri%Kegulahon 40 t HOME IMPROVEMENT CONTRACTOR. cotaS:rtr pus,, ee wr ,5oc.• .• r1 r c r Registration; 103757 Type: �rt»++�• CS 6643 �. Expiration; 779t2Q12 °private Coravratic �'• F SPRIv<i HOME IMPROVEMENT INC BRAD K SPRINKLE =1 190 LOTHROPS LANE Srid Sprinkle t W BARNSTABLE, MA 02666 '199 zaarns,a�)Ie aRa Hyorims Ala',0601 1?ndgr rcrc.lar. ..,r r •aus,;r� emr,ri}� .• a 'bit)f7a nrn;r ,u rr't��.tiiitibn valid-l'ur ind0 idul use,ohl; F•ailurc to pore%a current edition of the befuri 11 w c%pu:divn date. If found return to: Mus%achu%ettx Statc Building Caidi�. C,'on.uliu r Affairs and Ku�ne�s Regulutiacl i-i cause for revoca(iun of thisliccn�e„ It, Park 1'Ia a quite,51741 Refer to: WWW Y1aa>.C:o%'JDPS - - \'ri..n1iYt A'ithilut' t;n,tur,, CERTIFICATE OF LIABILITY NSURANC:E' U1TE-}MA14 p,0,') 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 AwwD, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES,BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT OONSTITUTY A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER; AND THE CERTIFICATE HOLDER. + IMPORTANT: If the cartificato holder'ia on ADDITIONAL INSURED.sthe policy( oa) must be endorsed. If'SUBRAGATIOR IS WAIVED, sub7act to the texas and conditions of the policy, certain policies may require an andorsament. A statement on this certificate does not confer rights to the certificate-holder in lieu of such andoreemant(a). Bryden 6 Sullivan Ins Agency vo Inc (A/m r. 1.%)1 ( (A/C, N.it 88 Falmouth Road' 10O1i i Hyannis, MA 02601 CV.TV.A IP•, d MA:C i I INSVAEP(r) A"=WZM NvswWR A';Z.M; MULt1aS_ITIaL]ianca 'Co Sprinkle Homo Improvement Inc i 199 Barnstable Road IMF — 77 Hyannis, MA 02601 t ':■suMra'a i COVERAGES CERTIFICATZ NUMBER: REVISION NUMBER: THIS I! TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BEIAN HAVE SEEM ISSUED TO TNL"INSURYD NAMED ABOVE FOR TIM POLICY PERIOD ZMDICATED, NOTWITUSTAFOING ANY REQUIP2NSNT. TERN OR CONDITION OF ANY CONTRACT OR OTHER DOQlQNT WIT" RESPECT TO WHICM THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, Tat tKSUSANCX ArVOMMO BY THE POLICIES DESCRIBED HEREIN-IS-SUBJECT TO ALL THE TERMS,. CxCLUS201•S`A= CONDITIONS,OF.SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CWNi... w. POLICY EFF 1 POLICY EXD j - _INZTS - - Lv TYPE of IMSURANCI POLICY NU!®ER ria.rnnr 1) ruoa�r.ni II GENERAL LIABILITY' - "CIO OCCURAMOK - t-• . •oCal01LRCIA:: GIliLAAL L;Aa:LST'i - µ .. DANAaE TO.EOTtA - ... rAO/itErlL:.owrr.ra( F - 00".,�E p�tv. El ow EL /AoY .r.pr.onl • a { .aararAL LAIw IMJUai .ooaaAL AaaAwAa / TN K"PIGATE LIMIt APPL:CS INi . D PMCPf2CTr _C90,0!A" F PBLICY PaoatcT Let I..' - AUTOGBILE LIABILITY i� - -�� anas'Also_.L"N,T - 11 {. aaD2LT iM.IV•(Y lY.�rrc.ant ♦' QSCHEDULAG,AUTOS { aDDi LT:[MJIRY Iy.>.nalAr+1 •. ❑i�I PCD iUT4.:F ( (p.>' aar.al � / uNAAeLLA L:Ae oa�uN. {- sAer aeLwrores a� s QOCCIT• L7 AA. ❑ C'.J.:rS sN:=li. _ A0408"n MO MM CONFLNSATIO/ AMD tMPUME! LLABILITY' THE PROPRIETOR/PARTNEAS/ � .s.L,. ahca Acc%um" • 500,000- LXECUT:VE 'OFFICERS ARE _ A a.L, airsass -rcL2cr,urlr • 500,000 ® nci p CXc1 7004,943012011: 01/01i2011 01/01/2012 l c.L. Ol-1 to omto u • 500,000 aa/saNrs ououmm of osssarloss os LorwnaMst - WOPM3RS, CCKMSATION COVZPAGB APPLIES TO MASSACHUSETTS'EKPLOYEE3 CERTIFICATE HOLDER CANCELLATION PROOF'OF INSURANCE .. SHOULD ANY RCt3. OF THE OtscitrwD POLICIES at CALE0 BEFORE THL EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH TIM - . - POLICY PROVISIONS. _ 1 AVTSIOR II®rEPItR1OITAT:t'i .. $ RAWWAKa $ um Town of Barnstable Regulatory Services Thomas F.Geller,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstsble.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I ,as Owner of the subject ro erty P P Sprinkle Home Improvement hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address ofYob) �. g&0fer Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\MicrosoR\Windows\Temporary Intemet Files\Content.OutlookMDV87AAZ\EXPRESS.doc Revised 072110 lime Town of Barnstable *Permit#�� Expires 6 months from issue date Regulatory Services Fee • wtrarwats, X"& Thomas F.Geiler,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 p- Not Valid without Red X-Press Imprint Map/parcel Number 9 1 Property Address ( ttYa to LS 42-Residential Value of WorkS 's YK)b J Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address J�- rv\.¢s `. mC r` a A ru .)L.�n d «� 50seph St Contractor's Name Sprinkle Home Improvement Telephone Number 508 775-1778 Home Improvement Contractor License#(if applicable) 103757 Construction Supervisor's License#(if applicable) S M+ t RlWorkman's Compensation Insurance Check one: �`®�) Q 11, ❑ 1 am a sole proprietor ❑ 1 am the Homeowner i. BARNS-,FABLE I have Worker's Compensation Insurance Insurance Company Name I nf11 tStriPS of MA Workman's Comp.Policy#AWC 700494301?n 11 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 ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders. U-Value (maximum.35)#of windows "Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must Property Owner Letter of Permission. A co provement Contractors License&Construction Supervisors License is e ire SIGNATURE: C:\Users\decollik\AppData\i ocal\Microsoft\Windows\Temporary ternet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 The ConnAonwealth of Massachusetts Departments of Indus&W Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 - www.neassgov/da Workers' Compensation Insurance Affi*davitf Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business organization/Individual): Sprinkle Home.Improvement Address: 199 Barnstable Road City/StateJZdp:Hyannis, MA 02601 Phone#: 508 775-1778 Are you an employer?Check the appropriate box: Type of project(required): 1. OK I am an employer with 9 4. ❑ I am a general contractor and 1 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. . g ship and have'no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building motion [No workers'comp.insurance comp.insurance. t wired] 5.❑ We are a corporation and its 10. O Electrical repairs or additions 3. ❑ 1 am a homeowner doing all work officers have exercised their 11. ❑Plumbing repairs or additions myself [No workers'comp. right of exemption peri n MGL , insurance required]t c. 152,§ 1(4),and we have no 12. ❑Roof repairs employees.[no workers' 13.&Other�f lac comp.insurance required] *Any appHant that cbeeb box MI mast am 80 out the wedon bdow*owing thek workers'compawadon polby loform dm tHonmowners who submit this afildavlt h dica ft they are dot*A work and then hire outride ronbwwn mmt submit a new a®davk brdkatlog snob. Kostacton that cheek tl&bo:mm I attach an 2&Udonal•bet showiag the same of the sub-contractors and state wbether or not than eaddes have employees. U the sub-eontraeton have emsbvem,they mast orovl&thdr worker'coma nolky anmbm I am an anpioyer that is providing workers'compensation insurance for my employees Bdow is the polity and job site information. Insurance company Name:Associated.Industries of MA Policy#or Self-ins.Lic.M AWC 7004943012011 Expiration Date: 01-01-2012 Job Site Address: (oo, :�a�.-J 10 51 e p h I. City/State/Zip: 4U6L vt t4 rz C MA Golfo() 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 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 $250.00 a day against violator.Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverme verificati I do herby r and penaities of perjury that the information provided above is true and corretx Si e: Date: Print Name: Brad Sprinkle phone#. 508 775-1778 Ext.10 o icial use only Do not write in this area to be completed by coy or town o,, ciol" City.or Town• Permit/8cense#• Issuing Anthority(circle one): 1-Board of Heath 2. Building.Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: - Phone#: Town of Barnstable Regulatory Services Thomas F.Geller,DkviWr Building D . ion Thomas Perry,:CBO Bonaiog COoner. 200 Mein Sbut, Hyannis,MA 02601 www.towa.b�aatablema.os Office: 509-8624038 Fax: 509-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Ownu of the subj1ect ProPaY . Eby audwim Sprinkle Home Improvement to act on my.behal f in all matters relative to work authorized by this building permit application for lfzc� CYO ill � C n Y1 ��-✓�.RJI �'lylaelVlt.S (Aiddren of job) Date Print Name If Property owner is aPP MS for Permit,phase complete the Homeownerp License Ez=*&a Fora oa the revere dde. (.`•WiasWeooWldAppDwUacallMimwoB WIMID"TOMPO ey hafad k=V87 Revised 072110 — �1.�".i�Itu•t'!i, ih'13.niintrtt , 1 )'ul�lu: �.it !+ .. �j�°: � ��ccl1 � 1�r ,:u /ac.eCG: Kn:u'�I oil 8111filin I„ uLituua, ui�i �t.,n l.0 d -- lltinrc ul( unaumer:�t�t�rirs dc.ltusincss�tc ulatinn �--' t ons.ruction 5 3flarv+s0r Lc nee 1 HOME IMPROVEMENT CONTRACTOR }; Registration:. 103757 Type: Li,rns,r CS 6643 1 ,; Expiration: 7/9/2012 Private Corporatic SPRINKLE HOME IMPROVEMENT, INC. BRAD K SPRINKLE 190 LOTHROPS LANE ~" * Brad Sprinkle W BARNSTABLE, MA 02668 ^T 199 Barnstable Rd. h Hyannis. Mir,02601 , 1'ndcrsccrchrry F ;p r.w n 10/8i2013 License til- re ictration valid for individul use only editio ol`thr Feilurc ro ussessa current n _ before the expiration ti.uc. If found return to: . Massachusetts State Building Code Office of( onsumer:',ffairs and Business Regulation is cause for revocation of this license. Itl Park I'Lizar-Suite 5 1.70 Boston°.N'1A 02110 Referto: WWW.M%,s.Cor/UPS Not i slid without sign.ture 1 DATE(MMMD/YYY) CERTIFICATE OF LIABILITY INSURANCE 11/24/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTI7:1 DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES,SELOW. THIS CERTIFICAT 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.endoreement(a). PRODUCER CONTACT Bryden & Sullivan Ins Agency NAB` PNOU rAx Inc ( /C. ft. EXs): (A/C. Na) Z-MAIL 88 Falmouth Road 11ODRUS: Hyannis, MA 02601 CUSTOM IDe. INSURLD(S) ArrOHDINO COVERAM NAIL 0 INSUReD 110sumR A: A.I.H. Mutual Insurance CO Sprinkle Home Improvement Inc INSUREI8:. 199 Barnstable Road INBURER C; _ Hyannis, MA 02601 INSURER D: INSUIM INaDRsn r: - COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAND 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. POLICY EFF .POLICY EXP - Lu TYPE OF INSURANCE POLICY NUMBER. NrUaP/YYnL trum/an> LIMITS . GENERAL LIABILITY - EACN occoRANa a MCOIGNERCIAL GENERAL LIABILITY - - DAIaGE TO RZNTZD e - PAEQaEa(L.oaousr I [][]CLAIMS MADE []OCCUR - MZa Ew (Ay—P�raun) 0 ❑ PRUCNAL i ADV INJURY D S GEN'L AGGREGATE LIMIT APPLIES ER: GENERAL AomaOATE � - ❑ JEC POLICY ❑PROT n. /! PRODUCTS -C'OMP/OP AGO e - e AUTOMOBILE LIABILITY - CCMrNZD SINGLE LIMIT ❑ANY AUTO _ (u Aaeidantl 0 BODILY INJURY (Pk 5—M) 0 MALL OWNED AUTOS []SCHEDULED AUTOS BODILY INJUAYIP"a"Idwo 0 []HIRED AUTOS - PROPEA"DANA= []NON-OWNED AUTOS 0 UMBRELLA LIAB M OCCUR - EACH OCCURRENCE 'e []EXCESS LIAB [] CLAIMS MADE AOOAZOATZ e []DEDUCTIBLE - 7 []RETENTION S 0 WORKERS COMPENSATIONyyN- AND EMPLOYEES LIABILITY - rwNr LxWlra as _ THE PROPRIETOR/PARTNERS/ E.L. EACH ACCIDENT 0 500,000 A EXECUTIVE OFFICERS ARE ® incl ❑ excl 7004943012011 O1/O1/2012 Z.L• DI— -DOLICY I'II'IT a 500,000 .O1/Ol/2011 E.L. DISEASE-EA SMPLOYU a 500,000 CarMZN'27 DZZCRIPTTON or OPERATIONS OR IOCATIOws. - - - - WORKERS' COMPENSATION COVERAGE APPLIES TO MASSACHUSETTS EMPLOYEES CERTIFICATE HOLDER CANCELLATION PROOF OF INSURANCE _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ' AUTIIORI ZZD RZPALBZmT'A7IVE