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Home My WebLink About0178 WALNUT STREET (HYANNIS) �-7 't THE r Town of Barnstable *Permit# M�c �P�pF 0 Expires 6 months from issue dater/ r • Regulatory •Services Fee • r • BARNSTABLE, " v� 74�� '4 Thomas F. Geiler,Director prE0 MPt PERMIT JUL -� � Z009 Building Division Tom Perry,CBO, Building Commissioner 200 Main Street, Hyannis, MA 02601 TOWN OF SARNSTASt�E 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.___ 0 1 3 Property Address l `hLj � �l�f av Aks Zesidential Value of Wort. 1 Minimum fee of$25.00 for work under$6000.00 Owner's Name& Address O� L-3COVI S-�. f�va✓�tn�S (Y1n oa�o Contractor'sName. r"ndef Fmz G�1C17\Q✓LT Telephone Number I lone Improvement Contractor License# (if applicable) I 0 3-7 ;5 7 Construction Supervisor's License# (ifapplicable) CS (OLD S�3) Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner [ I have Worker's Compensation Insurance 1 Insurance/Company Name Workman's Comp. Policy# q Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to ❑ Re-roof(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders. U-Value (maximum .44.) *Where required: Issuance ofthis permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. 'Note: Pro e caner ign Property Owner Letter of Permission. copy e Improvement Contractors License is required. SIGNATURE: Q:`.WI'1=1LF.S\k•0RMS\building permit forms\EXPRESS.doc Revised 100608 . F f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): r ' A 'e rY1 ' D r Address: 9 City/State/Zip: IL CL A L. t Phone#: JU'S " .T�S" Are an employer. Check the appropriate box: Type of project(required): 1.I� 1 am a employer with q 4. ❑-I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working forme in any capacity. employees and have workers' insurance.$ 9. ❑Building addition [No workers pomp.comp..insurance P• required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 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 13.[ 'Ether �✓� 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 anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub=c6ntractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am`an employer that is providing workers'compensation insurance for my employees. Below is the.policy'and job site. information. Insurance Company Name:A-550(-1a In ALA-4 t C.'9 0 lMf Policy#or Self-ins'.Lic.#:Al)C 7Z(X 1�A 36 1a Qdc( Expiration Date: r Job Site Address: WCJ n A St. City/State/Zip:.. �C Ark cS 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.ofthis statement may be forwarded to the Office of Investigations of the D r ins coverage verification. I do hereb e e and penalties of perjury that the information provided above is true and correct Si afore: Date: 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#: HOME IMPROVEM ENT SWCE 1946-PROINKI F SPRINKLE HOME IMPROVEMENT,INC. Celebrating 63 Years in Business! 199 Barnstable Road•Hyannis,MA 02601 .508 775-1778.800 244-1778•Fax 508 775-1350 Email—sprink@comcast.net Website address: www.sprinklehome.com Property Owner Must Complete and Sign This Section I, CSZ.., �m� '� as Owner of the subject property �CT , hereby authorize Sprinkle Home Improvement to act on my behalf, in all matters relative to work being done on my property (i.e. permits, applications, etc.) if necessary. Address of Job A10 I Signature of Owner Date Print Name 1- =IIIIt :� � $�'1��1►1.��S:Ululilul�.11 r T .•- 12/31/2008 14: 18 Bryden & Sullivan Insurance Donna Seviour-*Margo 112 . P ID DS DATE(MMrDO/YYYY) AC CERTIFICATE OF LIABILITY INSURANCE OP 12/31/08 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 MA 02601 Phone: 508-775-6060 Fax: 508-790-1414 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER Associated Industries of HA INSURER M Sprinkle Home Improvement Inc. INSURERC: 199 Barnstable Rd 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. I POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MMIOD/YY) DATE(MM/DD/YY - LIMITS GqNEKAL LIABILITY EACH OCCURRENCE S COMMERCIAL GENERAL LIABILITY PREMISES E.occurence S CLAIMS MADE a OCCUR MEO EXP(Any one person) 4 PERSONAL R AOV INJURY S GENERAL AGGREGATE S GEN'LAGOREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO S POUCY j Oa LOC - AUTOMOBILE LIABILITY COMBINED SINGLE OMIT $ ANYAUTO (Ea accident) _ ALL OWNED AUTOS BODILY INUURY $ SCHEDULED AUTOS - (Per person) . HIRED AUTOS - . E1004Y InLURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE S _ e (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHER THAN EAACC S AUTO ONLY. AGO S EXCESSAIMBRELA LIABILITY EACH OCCURRENCE $ i OCCUR E1 CLAIMS MADE AGGREGATE S 4 DEDUCTIBLE RETENTION $ S T WORKERS COMPENSATION AND TORYS OMIATTSLL OERH- EMPLOYERB'LIABILITY A ANY PR06RIETORIPARTREROXCUTrVE AWC7004943012009 01/01/09 01/01/10 E.L.EACH ACCIDENT $500000 OFFICERIMEMBER EXCLUDED? - - _ E.L.DISEASE-EA EMPLOYEE $ 500000 B Y,es,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY UTAT $ 500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDEO BY ENDORSEMENT/SPECIAL PROVIEI049 CERTIFICATE HOLDER CANCELLATION SpRNMO 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 80 SWILL Fax #508-775-1350 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Margo Mack 199 'Barnstable Rd. REPRESENTATIVES. Hyannis MA 02601 AUTHORIZED REPRESENTATIVE Kelle A.Sullivan ACORD 25(2001/08) O ACORD CORPORATION 1988 • � do ii d nl'Buldint,12Ggul�Uuns rind St,i;ndtir-rls ' Construction-SupervisorLicens.e Lrc:em" C:S 6643 Exp n:aratto 1:0/8/2009 TO9427 Restriction; 00 BRAD-It SPRINKLI- 190 LOT'HROPS LANE i W BA'RNSTAK-E,MA-02668 coiimlkssWher __ ... N. c Nr 0:0 35,Q00 cf enclasedspace 1=A-1VYasonry on yy -: t 1G 1 ..2"l arnIlly oVes j Failure to p'u$sess•a current edtbton.oi`fhe MuSsachusetts SMte Buiiding Code i IFF is cause for revocation of'ifhts Itcens:e: fI .q ` Board-ofBdildingd2egulatio/ns afid:`Stan.dards HOME IMPROVEMENT CONTRACTOR s4` 1F ; Registration: 103757 Ezp➢faUon .7/9/2010 Trt# 27103`3 Type:: Private Corporation SPIINKLEHOME IMPROVEMENT, INC. Bfad: Sprinkle 199'Barnstable Rd. Hy6rinis. MA 02601 Administrafoi 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 Rrn 1301 Boston,Ma.02108 Not valid wit out Sig ture — TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 3 _ Q Map -3�y Parcel Permit# �� I Health Division _A1 r2�� C� - Date Issued Conservation Division 2 4 � Fee Tax Collector , Treasurer UU, *PRLiCp Mpgp p EWER t3TAW Ab CONNECTION PSRMT PROM THE Planning Dept. ENGINEERING DlYt810D!PRIOR TO CC?lODi Date Definitive Plan Approved by Planning Board Jkj 'I Historic-OKH Preservation/Hyannis Project Street Address i 7 9 J zf4,) % . Village l �✓� r1 Owner �j d �'< Styr )/ Address ! L W,11) Ll�/ S l Telephone Permit Request Square feet: 1 st floor:existing �proposed 2nd floor: existing proposed Total new/63 Estimated Project Cost Z300�' Zoning District Flood Plain Groundwater Overlay Construction Type Lot Size Grandfathered: ❑Yes ❑No If yes, attach supporting documentation. Dwelling Type: Fi g Family Q Two Family ❑ Multi-Family(#units) Age of Existing Structure Historic House: ❑Yes U No On Old King's Highway: ❑Yes ®'No Basement Type: eeFull ❑Crawl ❑Walkout ❑Other /SroyY�' Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full: existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths): existing new First Floor Room Count ' Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool: ❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:dexisting ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes Er"N"o If yes,site plan review# Current Use Proposed Use BUILDER INFORMATION Nam� 6- r&�tzc A Telephone Number Y?0 2_ff(5r5' Address Z.S QuegV ",V �►(Z/� . License# 0Y!rl-3 F'x�s/a/T Home Improvement Contractor# /o 3 Y Worker's Compensation# ,//20 3-0 l ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO �X/® b_,55 C'vT' SIGNATUR DATE FOR OFFICIAL USE ONLY k 5 PERMIT NO. . DATE ISSUED MAP/PARCEL NO. ADDRESS ` VILLAGE #T OWNER . . r• - _ .. , DATE OF INSPECTION: 4. . r FOUNDATION FRAME INSULATION } FIREPLACE ELECTRICAL: ROUGH FINAL ;r ` PLUMBING: ROUGH FINAL GAS- ROUGH FINAL FINAL BUILDING ?; k DATE CLOSED OUT *r 5 ASSOCIATION PLAN NO. n �ri r t T . OWNER: Map Lot !�. DATE: .The Commonwealth of Massachusetts Department of Industrial Accidents ��- ; — 0!llfca ollovestlgatloos 600r Washington Street Boston,Mass. 02111 �— Workers' Compensation Insurance Affidavit 41ZL locatim city nhgne# I am a homeowner performing all work myself. ❑ I am a sole proprietor and have no one working in any capacity [ am an employer providing workers' compensation for my employees working on this jobD8li BeG Cvr . Poe JG, address: 34/,Y r U1qo d C/ nhone N• 1 [ • * CJ 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: cornpirly phone H- ___-- policy tt nddr «• city phone f$- insurance co. nolicv u Fnilure to secure coverage as required under Section 25A of MGL 152 can Ind to the imposition of criminal pen■Itirs of,fin.upi"l.300.00sad/or one vcam'imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine ofS100.00 a day against me. I uoderstaad that a copy of this statement be forwarded to the Office of lnvesdgarions of the DIA for covcnge verificadon. l do hereby certify u de t p ' a d zRics of perjury that the information provided above is true and comet Signature / Date Print narnC J GI'1'1 P S (�L V r_Q f r Phone Al ofricial use only do not write in this arcs to be completed by city or town ofricial city nr town: - permit/license$0 MBuilding Department Licensing Board check if immediate response is required (:]Selectmen's OMCC. 0Hnith Department __ ohone p: ( 508 ) Mother ____ ;" G-- �2� . 1 74F 171 DEPARTMENT OF PUBLIC SAFETY 0 a) ON- ASHBURTON PLACE, RM 1?01 BO'.ITON.., M, 0'C.'108-1618, CONSTRUCTION SUPERVI'dOR LICENSE; Number : EXP i.t Birthdate: .,C 04 513 5/1 21t-'000 05/12/1944 Re i ,:P -D� l - ,301N E 5 L'i ilC:C3RAIH PO 8 0 x R, .......... S DENNIS, MA 02660 Keep, top for recei n. ,)f address noi R, 0 ? ';7 Mmoll HOME, IM T IT RR --`,,EME�,'i R 'A-T T, `rnq A. �t - :, e94,�, k4 'M Board of f,3 tone S . -e ac, 'd A 'h Boston , h' --H*E IMPROVEMENTA TOR R e q ip,t-r, t < n 109374 0 Mi� Type PR ATE QQ -�Q.O. 'PINE HARBOR .BU.I;L-01NG C, JAME ".. D 'cGR'ATH 259 QUEENANNE .PD' "'HARWICH .MA 02645 1ME A The Town of Barnstable snxxsrnaM • ' : �0� Department of Health Safety and Environmental Services rFc 39 a Building Division 367 Main Street,Hyannis MA 02601 Office: 508-862-4038 Ralph Crossen Fax: 508-790-6230 Building Commissioner 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: x- S O a g5Le Estimated Cos .2 Address of Work: / 7 -R 5- Owner's Name: Date of Application: 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 ZOwner 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 I hereby apply for a permit as the agent of the owner: Date Contractor Name Registration No. . a nl 97 OR C C Date Owner's Name g1onns:Affidav AM �W. 14 '77 BLOCK: Ll I" Pima ko 'Bokp'D, i I fhb VjOob JS FV L.L ZXT fZA r 1+6CE CiQ D ,P)rL4" :e Lnrbr Ss H-aw u6 _� x Tv p Pi�r� 40us ptyyjDacl J�o 1 1�5 777 JF7 71- .-P LOT L`OT 1S .oo- S45 57'30"W SHED 10. 00' ti 1.5' OVER— _—___ HANG / y NI LOT 3 RES. ZONE.- 'RE" This MORTGAGE INSPECTION Plan is For FLOOD ZONE.• "C" Bank Use Only TOWN: _&YA4Y_MZ--------_______ REGISTRY OWNER: BOYCE Q. _Bc JUDY E._ SMIT I---------- DATE: REF: _Z6_�5,11_4 ----------BUYER: _��'FIN1N_C -------------------------------- DATE: _1�8�9Z_______________ PLAN REF: 155 -------------SCALE:1"= 30' FT. I HEREBY CERTIFY TO �6PE_�QI1_861YK_9LV11________ TRUST CO_ __ ___THAT THE BUILDING WN `�N OF MqS YANKEE SURVEY SHO ON THIS PLAN IS LOCATED ON THE GROUND AS CONSULTANTS SHOWN AND THAT ITS POSITION DOES ___ CONFORM PAUL TO THE ZONING LAW SETBACK REQUIREMENTS OF THE A. 40B (SUITE 1) ME RITHE TOWN OF _ $��MsTABLE-------------AND THAT q No. 32098 Ei e INDUSTRY ROAD IT DOES_ NOT__ LIE WITHIN THE SPECIAL FLOOD HAZARD �� q p �� MARSTONS MILLS, MA. 02648 AREA AS SHOWN ON THE H.U.D. MAP DATED_$,/. /_65 _ ��soEC�STER�S�Q� TEL: 428-0055 Co unit - ,250001 0005 C NA( IANC FAX: 420-5553 _ THIS PLAN NOT MADE FROM AN INSTRUMENT PAUL A. ME ITH ply ----- SURVEY NOT TO BE USED FOR FENCES ETC. 13240 DPG