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Town of Barnstable *Permit#CZ/a 4 7)39
Expires 6 months o 'sue dqk
` Regulatory Services Fee
• L+sNsr�.t, • .
MASS
3 Thomas F.Geiler,Director,
/J .11L
Building Division
Tom Perry,CBO, Building Commissioner.
200 Main Street,Hyannis,MA 02601
www.town.barnstable.ma.us
Office: 508-862-403:8 Fax: 508-790-6230 =
EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY'
Not Valid without Red X-Press Imprint
Map/parcel Number 1 9 y 06-
Property Address F ljD-D &t `S (
[Residential Value of Work (o� Minimum fee of$35.00 for work under$6000.00
Owner's Name&Address- V L C1 c1 o i(e K-P a
Sprinkle Home Im rovement
Contractor's Name S P P Telephone Number 508,775-1778 Ext. 10
103757 +�
Home Improvement Contractor License#(if applicable)
%JOP lip
Construction Supervisor's License#(if applicable) CS 6643
NOV ,
XWorkman s Compensation Insurance 2 Y 2012
Check one: T
❑ I am a sole proprietor ®!�I//V OF SA
❑ I am the HomeownerR
® I have.Worker's Compensation Insurance NSTABLE
Insurance Company Name Associated Industries of MA/ A.1 M Mutual Insurance'Co.
workman's Comp.Policy# AWC 700494301.2012. .
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 Windoaa�s/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 sign Property Owner Letter of Permission. ,
A co� e avement Contractors License&Construction Supervisors License is,,
7
SIGNATURE:
I
C.\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Interne iles\Content Outlook\DDV87AAZ\EXPRESS.doc
Revised 072110
j,
$ aruasraes $
Town of Barnstable
Regulatory Services
Thomas F.Geller,Director
Building Division
Thomas Perry,CBO
Building Commissioner
200 Main Street, Hyannis.MA 02601
www.town.barnstable.ma.us
Office: 508-862-4038 Fax: 508-790-6230
Property Owner Must
Complete and Sign This Section
If Using A Builder
1, lam L' o9— QA a f e- as,Owner of the subject property
hereby authorize Sprinkles Home Improvement to act on my behalf,
in all matters relative to work authorized by this building permit application for:
Address of Job)
11 112,_
SignaWe of Owner v Date
)Ay<D �D 'ilk
Print Name
If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the
reverse side.
C:\Uwm\decollikWppDataU,ocal\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc
Revised 072110
i
The Commonwealth of Massachusetts Pnnt:Forrn ,
Department of Industrial Accidents
Office of Investigations
' I 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
N1YTle (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):
1. ✓❑ 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.❑ 1 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' 9 ❑ Building addition
[No workers' comp. insurance comp. insurance.:
required.] 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their I I.❑ 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. ther S(
comp. insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Y 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: C, CROP a :Sac"S R64 City/State/Zip: 01-P, IIY1{�
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 coy5rage verification.
I do hereby certi u dpenalties o er'u that the in ormation provided above is true and correct
Si ature: L ____ _ 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#:
Unrestricted -Buildings of am• use group-which
cnntam less.than 35.000:cubie.fect499 M Iof i `A assachusetts Department .3t �-�o, c gate:,
enclosed space Board o1.3u:iarng �eguratrons Ina StanCar(IS
y se CS-006643.. . .
BRAD SPRINKLE
I"LOTHROPS LANE
Far+ure co.possess a current edition of the Massachusetts . w ARNSTABLE MA fb
%fate Building Code is cause for revocation of this license
!ro i P',U[ensong,nfamabon visit WW*!Mass.G0VDPS
10/0812013
Office of Consumer Affairs yc Business Regulation License or registration valid for individul use only
HOME IMPROVEMENT.CONTRACTOR• . before the expiration date. If found.return to:
,t;Registration; 103757 Type: Office of Consutner.Aflairs and Business Regulation
LL Expiration: 7/9/2014.. Prroate.C.orporatior. 10 Park Plaza Suite 5170.
Boston:MA 02116
SPRINKLE"HOME IMPROVEMENT "INC
3r0d Sprinkle
+99 Barnstable Rd
+yanms.MA 0260Y
t ndersecretar) -Not valid with signature
. 2/20/2011 9 : 35 : 33 JAM 8740 0 02/09 _
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5289
LAW OFFICE
JAMES H. QUIRK, P.G.
ATTORNEY-AT-LAW
JAMES H.QSTIRH GOB.RTE.26&POND ST. TELEPHONE(617)398-6969
JAMES H.QUIRK,JR. 398-6980
P.O.Box:547
SOUTH YARMOUTH,MASS.02664
April 27 , 1988
Joseph Daluz , Building Inspector
Town of Barnstable
397 Main Street
Hyannis , MA 02601
Re: Copies .of .Building Permit, Inspection Reports
and Occupancy Permit - Lot 15 Captain Lijah ' s Road
Dear Mr. Daluz : -
In furtherance of my letter to you of March 31, 1988 , a copy
of which is enclosed, I am enclosing a copy of the portion of the
subdivision plan showing Lot 15 , Cap'n Lijah' s Road. The building
permit which you forwarded to me was for another Lot 15 on another
Capt. Lijah' s Road. I understand that after the Smith subdivision
was approved, the name of the road was changed to Capt. Jack ' s Road.
If you have any questions , please do not hesitate to contact
me. I will appreciate your forwarding the above referenced docu-
mentation.
ery truly. yours,
MES H. QU RK, R.
JHQ/mre
}{ LAW OFFICE.
�. JAMES H'QUIRI P
r e •a ( ,Z s. :. .:. " ,^ ..8 9 .t a d y �,,: !3 l+:, � i � .,�+.c s. x
- ATTORNEY AT LAW '
• T. F ADDRESS ALL-MAIL TO::,•`
JAMES H.QUIRK .-. = COR.RTE.28&POND ST. P
P.O.Box 547 ;
.`O.Box 547
JAMES H.QUIRK,JR. - - SOUTH YARMOUTH,'MA 02664
SOUTH YARMOUTH,MA 02664
(617)398-6969
March 310 1988
Joseph Daluz, Building Inspector `
Town of Barnstable
397 Pain Street
Hyannis, Massachusetts 02601
Re: Copies of. Building Permit, Inspection, Reports
and Occupancy Permit - Lot 15 Captain' Lijah's Road
Dear Mr. Daluz:
Please be advised that this office represents Marion McCarthy who ..
was to purchase the above -captioned 'propertylb I: have been able
to reconstiuct the information to know that the building permit,
was probably obtained in August of 1984. The property was sold
by James K. Smith, Trustee of. J.K.S. Trust to David B. Reid. and
Claire R. Xander, recorded in Barnstable County Registry .of Deeds
Book 4529 Page 334 dated May 13, 1985.
Please. rewiew your file and advise whether you have a ropy of the
Building Permit and the Building Permit Application, the various
:inspection reports and Occupancy Permit. I would greatly appre-
ciate your (raking copies of same and forwarding them to my office.
Very truly yours,
JAMES H. QUIRK, JR.
�_,;W rnr e
bc: Marion McCarthy
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�0 0 . Acp• L` N
r t' o�� TOWN OF BARNSTABLE permit No. ._ -------------_-------------_
Building Inspector
Cash --------------------- ---
�A
OCCUPANCY PERMIT Bond
Issued to Address
Wiring Inspector Inspection date
Plumbing Inspector Inspection date
Gas Inspector Inspection date
ifs
Engineering Department Inspection date
Board of Health Inspection date
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.
( ...... ..- ,v �- r.-y---
Buildinb Inspector
• - - FROM _ _ -
vv
_
TOWN OF. BARNSTABLE
BUILDING DEPARTMENT
W. Francis seine
Tom Clerk - � _�� MAIN STREET HYAPEldtS, HAA 026M
Phone. 7754 O
SUBJECT:.
FOLD HERE
DATE _ - -
MESSAGf
-
- - _ rrswEe..a yl•fe iKvFr N�iS a"4'�`T^+� . .. _ - _ -
Work- has b9en under Permit'426776 James K. Smith) . "
Please rel a-Bond-
- - +.,meA:Mr a��r=e,«wn-,#sm,e�+�-•s a+�w:w .
_ SIGNED
DATE
REPLY
SIGNED - -
. y r
N87•Rml , RECIPIENT: RETAIN WHITE COPY,RETURN PINK COPY.
'PRINTED IN U.S.A., '
SENDER: SNAP OUT.YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT.'
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GE2TIFICp PLoT PLA1-1
PROFILE ,1 L06b'-TIoN v
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LOCp.TED WITNI►J rTHE GLObD PLAIN
I o,�..�- �� � _::�gAxTEtZe-.1�.1`{_E_I.N�• I.:
REGIS�>G2E.�'I.AwDSu4vC-y6t5
Tu►5 pLe.�.l is KAOrT g.'�Sc o►d A dSTE2VILL� - MASS:
1�STRu1'�6"T 1;u2vr--Y -T NE n_ ►= SETS Suou�
^I/.tv-- L. �_ IK_lE�j APPLICP.►,IT
Asiessdef-map.and lot number, . �^
/�i�✓I.... ..
�OF THE t0
6 Sewage PermitLQumber !?...L��C?..<......... d�Q
M MUST
INSTALLEDIN
I- ':House number ........... ................................... 90
WITH
YPY p'.
MA
TORN OF ' BARNS � ,? , ¢ jTt. �. r
I � fk� VR
B,UILD`IHG INSPECTOR
-' Construct Dwelling r4
/ ........'�' `APPLICATION FOR PERMIT TO:.....:........... ...... .....: ..........................� � .. .................................... 44
TYPE OF CONSTRUCTION ..............................wood frame '
f ° ........ :.......
. �. .. . . Aug. 2 � 84
............... .............................19........
TO THE INSPECTOR'OF BUILDINGS:
The undersigned hereby 'applies for a permit'according to .the following information:
Lot 15 Cat Li'ah's Road Centerville
Location ...................... .k?.. ................ .........s........................ ........... ...... ........ .. ......... ...........................
Proposed Use Single: family... ... ...... ....... ........ ... ...: ...............:....................:..
i , ,
Residential Cent,09t„
.Zoning District ....... : ...... ..... ........Fire District ..... ... .....................................................
Name of Owner' James K. Smith . Barnstable ;
......................... ............ ...... Address ..................................... .....
i
Name of Builder ...:..James K.. Smith
............................Address .....................................................................................
Name of .Architect :...........Address '..:..:..........
.................................................. .....................................................................
r
Number of Rooms ................`...........................:...:.................Foundation ........P.ourPd...qor1:YrPtP......................................
Exterior .........clapboard...&.X.c..s..............4....................:.Roofing ..............a5p.11alt..................................................
...... ,
Floors .':.......hardwood....................................>..:. ....Intenor dXy.wall............:..........................................
Heating .....gas.:. ?arm..A:KT..�.................................................Plumbing .............2..baths.........................................................
65,000
...........:...................:............:.. ate. Cost ...... . ..Fireplace ... ...one... ...................APProxim ...............
Definitive Plan,Approved by'Planning Board'--,-'_____________________------19 Area .'7.........� ................... "
Diagram of Lot and Building' with Dimensions ' Fee
SUBJECT TO APPROVAL OF BOARD OF HEALTH r
2 8x50
2—car .garage under
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.
M1 Name `1........ .......................................
j
#5190
w° Construction Supervisor's License .........
SMITH, JAMES K,,, _
A
N.o 26776 Permit for l'AO Y... .:... .. •; - -
�� sia le fame l dwel l �n x• 2+ � • ." •� `,. r � � �• � �
.. 9 Y........... ... ..................
9
Location' 19- .1.5.$.. .'s.:Rd.
.. Generv:i ] Je ... r f
,,. ner James K :S i'th r �_
Ow .
TYPe^nof. Construction ........F.Comq.........
Plot .. Lot..................................
t
Permit Granted Au9Y5A,...Z.............19 84
Date-of Inspection h .............19 . r
Date Comp leted0...:..iT9
c Fir 1' �t `•'
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