The URL can be used to link to this page

Home My WebLink About0092 STRAIGHTWAY qa S`Fe-a.i�h-Fww� U -- - - — -- � a Town of Barnstable F *Permits# VC✓ 6�(Gi' tr Expires 6 n onMs from' re date Regulatory Services Fee B tt63 JP Thomas F.Geiler,Director 6 �� Mld 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 DGI III Property Address Ira 3 t 0i g y4 lo-a Ayd,r\A l 5 [Residential Value of Work - 1 25 0 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address M2 �( a c�i4h�t c�v i!J .hv\�S Contractor's Name Sprinkle Home Improvement Telephone Number 508 775-1778 Ext. 1-0 103757 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) CS 6643 --RESS PERM XWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor MAY —4 2012 ❑ I am the Homeowner (�Q I have Worker's Compensation Insurance Insurance Company Name Associated Industries of MA/A.I.M M_UJP 9r H WFAB � workman's Comp.Policy# AWC 7004943012012 Copy.of Insurance Compliance Certific ate.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 .3 o? , (maximum.35)#of windows _ *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. } Improvement Contractors-License&Construction Supervisors License:is uir SIGNATURE: C:\Users\decollik\AppData\Local\Microsofft\windows\Tempo Vary Internet Files\ContentAudook\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.mass.gov%dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Hanle (Business/Organization/Individual): Sprinkle Home Improvement Address: 199 Barnstable Road City/State/Zip: Hyannis, MA 02601 Phone #: 508 775-1778 Ext. 10 Are you an employer?Check the appropriate box: Type of project(required): L Z I am a employer with- 10-12 4. ❑ I am a general contractor and 1 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 workingfor me in an capacity. employees and have workers' y, p n` 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 l EJ°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 13 thetC��rrou) RpOlaCt?�fI employees. [No workers' comp. insurance required.] •Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. =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: City/State/Zip: tt_�r Gt v�rl i3 , NSA Qa(oo i 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 imp w risonment,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 coy age verification. I do hereby certi un a penalties ofperjury that the inform n provided above is true and correct Signature: Date Phone#: 508 775=1778 Ext. 10 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: a : : eg l t ry,Servrcesr �nxrs=^ar^ Thomas,-F.Geiler,D;irectar " uAss Tmiq]Per rSr,I3i�il irng'Gn irnisc cuter;. - 200 Main 9treet,.Hy-aauis,MA a2601:. www town.barnstab[e.ma:us Qfiicq: 508-862.4038 Fax:: 508-71 0 6230 PIO ? I L WIlGf7S CaI• plete and Sign flus�.Sedan„' � Y' IIn f Builder- US" c F r �: I5 1 P P as.C3wz�er of tb.e.sub"eci ro ert hereby authorise SPRINKLE:HOME IMPROVEMENT,.INC._ f t�act on my�ebalf; in aTir atters mla&e to work.authorized bythis building permit application for t . S P ture of G'�uxa.Pr _ Date Pnnt .' e If P 'oveffty C wme is apply ji ;fgr Peirn�I j��e�s� �: rnple�e e Homeowners Llc nse .Exem Exemption o.'zx ,o— 4 ' revers si e. Q`raRI�',s:OF;NER-T'.EiPAISSIO.N 12/20/2011 9 : 35 : 33 AM 8740 02/09 DATE(BIMMDrfM CERTIFICATE OF LIABILITY INSURANCE 12/20/201 1 Me cmrzyICATt Is I009M As A r LMM or IsrowaviON ONLY An CONnRs ■O axern r➢ON Tss aRTIricivi nouns. TNIs czarr CATn DOtB ■a3 ArrIRN7►TIVRLY OR NteAszVow.Y A�D, =WNW OR AIMM Tit COVRRAss ArrORDsa BY TES YOLICIRs BWAW. Ttls CNRTI➢ICATs Or INsvaAYCt Data NOT ConsTITum R CONTsaCT aximoN in Issaln0 INsumm(s), ArTNORIiw mp nst7TATIVt OR ➢RODIICER, AND in CNRTIFICATt NOLOSR. - IWORTANT: If the certificate holder is an ADDITIONAL IXGVMD, the policy(lee) Must be endorsed. If saNROOa?IO■ Is narilm, subject to the teas and Conditions of the policy, certain policies my require an andoreement. x statement on this certificate does not confer rights to the Certificate holder in lieu of nub endorsesiant(s). Datatow Bryden 6 Sullivan Ins Agency •'• .r{ss ras Inc la/C. e.. oa1: a-tata 88 Falmouth Road a...�: Hyannis, M 02601Inow CesTw It.. IZnlm([)aresoms Cans - nIC a Spzinkle Home Zmprcwemeat Inc- - mum a, A.I..M. Mutual Insurance Co 33758 Spr : � 199 Barnstable Road MMem C. Hyannis, M 02601 nuvm r: - COVERAGES CIRTIFICATZ NOMER: RIVISION NQISER: less Is TO Cox TMw INS VOL== Or asOsawn Luvab 7Q,Os Rirn snow SiWD 5'sow ass, — vainS News ran us 9*6=WORLOD Z�ICAZID. - soiRasRR�N asx Ypaaslvr, 7m as COWITrON or ANY counam an O'isstl DOCUMENT Nrss ssarNcr 10 mm wn c1M%w=xMs Mr BE Issvm on mix row'istl, '�alsasANW arraN BY era rOLICIai rowaNO NONE• Is srsiNLT To ALL as vases, NLCfmass aso OONDITMM or sacs rOL=s. LM" seven am OtR stow MGM By ram mum. , t� ""cr err rOL=M �r swN or asoRANcs raslex sorRse LIowTs OOowaL Ln1RII— - - Rani DCetaae[s- - , . rOIIQ{le...Owss•.a.l - t DDCLAIM NMI DOCCOP - - m MID tam Oimmm L c ry XMIUM[ $ O. mssal Aa�sars s 0{['L AWa{YAT[LDAMISSIIS At tP: - DPICT DPPQIICT DLOc ant , AUTOMOBILE LZNBZL Tr - CaMata[a{Ii1a LIMIT Dan 0 _ 1•...ot4wt) - • DILL 001D.AOTW - - - _ aOPILT IQIe! (P.r P.a.•wl t i D[CREDO,[D AUM MWILT I>OnrlP.r.mlawt) t D{IPtD AUTO3 lYrwry shies , OWN-OWED ADT00 t Oea6LA LLa OCC DP _ so= aCClemR { D[LC{n LIAO D CZ1n0 MADE SOf�s OalrowrATn!/ O11F , ArD N1I0xO II'r➢r s LIiR - W—taaT/ pl - 7M MOPRICIOWPAMM/ A s CXLCUME Orr ICE" ARE - .. C.L. CAM acelner 500,000 ® incl Q excl 7004943012012 01/01/2012 01/01/2013 S.L. P:nAn -"Ll"L�T ' 500,000 - X.L. amass -sa=M0JMs t 500,000 Camrs nsnlnits tr WNRUIm IM LOCATIONS, MORKERS' COImENSATION COVERUM APPLIES TO MASSACHOSL"MS IMPLOYEES 1 1 i i CERTIFICATE HOLDER CANCELLATION PROOF OF INSGRANCI ssoOLD my or twx man assCRrino ro&==z is CABCatam agoss zss MZRATION Dads TRowsOr, Nw=W= Ns DNLIMM Is ACCOAM Cs tls9'low rcL=fiorlsmNs. - _ arTMYIm rises miss[v{ 5289 r ._.•1` �l.r.�.l (111. 'll. II a .. ,(ti. i �t I nnr - .._ I . eri� / I•i IMarrsIMYII[[I f;n.11'rl t liull;lln_ I� _LIi.IIL:u Iu ! ;1 Oflirt unsum & t�f+ia %Kexulahon :onstructlon > ,;,• >, +?t, HOME IMPROVEMENT CONTRACTOR I , r Registration: 103757 Type: .s 6643 r' Expiration: 7/9/2012 € Private Corporatic SPRINKLE HOME IMPROVEMENT.INC BRAD K SPRINKLE 190 LOTHROPS LANE Brad Spnnkle- W BARNSTABLE, MA 02668 199 Barnstable Rd Pw -- Hyannis'MA.02601 pr 4,t z I ndersecretan `ram` 10;8,201.3 6004 Licivrse(rr registration valid for individul use on)% Failure to possess a current edition of the before the expiration date. If found return to: Massachusetts Statc Building;Code Office of Consumrr Affairs and Business Regulation is cause for revocation of this license_ III.N»r 6 Nl:iza-luite;S170 f Koaon, Refcrto: WWW.Mass.Guv/DPS NIA 02116 \ot %slid without sign` ore Assessor's ma and lot number ....... . ....' �./ v p ` szi'T[C u1�1SiEM ��••iU5 �Vf �' BE "v Sewage Permit number .......... `;:s`�' �.' i�: II SI!;'t E Sri`sI TA?Y CODE AND T®VliN *TNETp� TOWN O BA A LE 01 89HBSTABLE. i _ KABB. Dun INSPLECT01% 'Fa MPY d- APPLICATION FOR PERMIT TO ... 'IC.IaJ. ..... .r..eJ.er!!/........J..c.r..G ................................................... TYPE OF CONSTRUCTION ...........Z2e.W-4? ;,........ .............................. ........... ................19.2-3 TO THE INSPECTOR OF BUILDINGS: The undersigned-hereby'applies for a permit according to the following information: a r Location ........../... ........ fft9(.9. �:y....................................................................:..............:.................................... ProposedUse ............................./...............................................................................................................................................:. Zoning District ....f.l. r..�l. .�..................................Fire District ................. ............ ......................................... Name of Owner ............................Address ..... .4r ..........................c........... Name of Builder ..K.irn%'..h./Ch.,r........ �1. ..................Address .. .................. ........ ............. Nameof Architect :.................................................................Address .................................................................................... Numberof Rooms ...........C../.. ^4—.........................................Foundation .............................................................................. fir, ./.i Exterior ........�.9..�.��...J,`i•I.�.r�'.. ..�.,f.......................................Roofing .......- ............................................................. �' .Interior Floors ..........C....�f.'7!(��............................................. .................................................................................... Heating ..................................................................................Plumbing .................................................................................. Fireplace ..................................................................................Approximate Cost ....... ..4.;.2.a..q............................................ Definitive Plan Approved by Planning Board -------------------_-----------19________ . Area .......................................... Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name. . .. ..- ................................. Human, Mr. C. a 16846 enclose porch No ................. Permit for .................................... . .................... .q �. ............................... ...... 'WStraightway I Location ......... ....................................... ...... ..... i .........................Hyannis Xr. C. Human Owner .................................................................. Type of Construction ...............frame ........................... ................................................................................ Plot ............................ Lot ................................ ,! 1 Permit Granted ........ ?.. .ry.22..........19 74 Date of Inspection . .l. ..� �� Date Completed 19 �. �1 r PERMIT REFUSED i 19 i ................................................................................ f. a ............................................................................... f ............................................................................... Approved ................................................ 19 ' t ............................................................................... ............................................................................... _ J