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HomeMy WebLinkAbout0091 PARK AVENUE 4 4w9 i�!? !/ o xx UZI •i�."� 4s .? i 1f _ �a H t �+ + :L'�;�_.. �« ,h e e :r� � �' e a�;f: <rk�. .I a �;`^e�a �+x�t' `.r� a$e q 4'; '+'�'�} �y i',.a ,'� a h 1 4 ya{F. F:. .: a A c. +ti •>y t' r tks �' rYz � � )4�F sa 3 '1�<. 1� `,�"8 a�r '� '�7°i P��` `�f �•;{ oi § �� o t,+•� � ,tit � � ,rj+3,�k.4e � F: � � � ���' L- ' ,1 x 4 S 4sl4�� ,. .� e d � V � �}•��+�,� �» kY ;�� a a;�_��' �i+Ic��9P3y�ae� tF p €.":' 4j P`� .... .��„,;, f�,.� a.: l.p , a F M1 - r F ` � t sl , • 1 " n ^ v < TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map. Parcel 006o Application # ; 2ZSO JQ Health Division Date Issued / S Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address Village kc-.2u A( L s Owner rr Address P O• Box i�_ 03 G -1d,ivv4. Telephone /3 — S 3 —J S/8 Permit.Request 12 i2tvv�ov tG eN -4s d- �lac�cL;�, QA^� "�e�wlf nr4�,, 11�rz���x�e�el l=Lvo . N4c.--s cnb �,c IocPsS �/ Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation s q 50 Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ❑ Two Family ❑ Multi-Family(# units) Age of Existing Structure �y2�5. Historic House: ❑Yes XNo On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other 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: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name l�J � �,�.��� �C�,,,,,`,-�-.� Telephone Number Address �P �J.6 fl . License #. ( CU � Home Improvement Contractor# �(0 Email_ 6 l 1 Worker's Compensation # AJC S-- 3/S — 3000 0d ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE q• FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. i ADDRESS VILLAGE . OWNER DATE OF INSPECTION: FOUNDATION FRAME. INSULATION FIREPLACE i ELECTRICAL: ROUGH FINAL C i PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ,s FINAL BUILDING ���U(, DATE CLOSED OUT ASSOCIATION PLAN NO. 1 \ The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www massgov/dia If Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information // Please Print Legibly Name(Business/Organization/In(ividu d): Address:_ 99 S4g-ft- 2c1,. City/State/Zip: f}wl02 ( R.O�S(,�Phone#: SO'd Are you an employer?Check the appropriate box: Type of project(required): 1.91 1 am a employer with C,;�- employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 3:a I am a homeowner doingall work myself 9. ❑Demolition y [No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractomto conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.�Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6_❑We are a corporation and its officers have exercised their right of exemption per MGL C. 14.Q Other 152,§1(4),and we have no 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: Policy#or Self-ins.Lic.#: (AJ C-6­31 S— 'ZN9V oas Expiration Date: Job Site Address: %0AWeq-U I City/State/Zip: C_cL 4� &�J Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pain and penalti s of perjury that the information provided /above is true and correct Signature: �\ n 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#: ® DATE(MMIDDIYYYY) . AC"o CERTIFICATE OF LIABILITY INSURANCE 7/7/2015 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 AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF 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 endorsement(s). PRODUCER DOWLING&O'NEIL INSURANCE AGENCY INC NAME:NTACT - 973 IYANNOUGH RD PHONE FAX PO BOX 1990 IC, MAIL A/C No HYANNIS, MA 02601 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: LM Insurance Corporation 33600 INSURED INSURERB: CAPE& ISLANDS KITCHEN & BATH REMODELING INC 99 STATE ROAD ROUTE 3A INSURERC: SAGAMORE BEACH MA 02562 INSURERD: INSURER E.: INSURER F: COVERAGES CERTIFICATE NUMBER: 25487456 REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM/D MMIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE a OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑ PROECT a LOC PRODUCTS-COMPIOPAGG. $ J OTHER: - $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea a.d.nt ANY AUTO l BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident ' S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ A WORKERS COMPENSATION WC5-31 S-369904-025 7/3/2015 7/3/2016 STATUTE ERH AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EX aN/AECUTIVE YIN E.L.EACH ACCIDENT $. SOOOOO OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500000 If yes,describe under DESCRIPTION OF OPERATIONS below - I E.L.DISEASE-POLICY LIMIT $ 500000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state of MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF BARNSTABLE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED,IN 200 MAIN STREET ACCORDANCE WITH THE POLICY PROVISIONS. HYANNIS MA 02601 AUTHORIZED REPRESENTATIVE n LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 25487456 1 1-369904 1 15-16 WC I Anne Chandler 7/7/2015 12:39:53 PM (EDT) Page 1 of 1 ie�(Jorrunwruuecu�z a�C °cr "aelt' free of Consumer Affairs&Business Regulation License or registration valid for individul use only before the expiration date. If found return to: ME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation egistration 160266 tQ Park Plaza-Suite 5170 Expiration fC&t2046 ' Supt`i Boston,MA 02116 Cape&Islarids KitcherlBsBat$RemQd'eling Inc WILLIAM SCHMITZ 99 State St. y, i Sagamore Beach,MA 02562 V Undersecretary Not valid without signature Massachusetts Depa u a ions and Standards I Board of Building Reg License: CS-076571 I Construction Supervisor I IS WILLIAM L SCHMLq' 66 CARAVEL DRr = I HATCHVILLE M! 0 <r . Expiration: '`•' t 0910912017 Commissioner i od: Maple ize: 2 Color: To be determined. cksplash: • Supply and install subway style pattern. Material- White Carerra • Material allowance per sq. ft. $8.00 • Grout Once Sealer provided. General: • Provide all necessary permits and fees. • Provide proper home protection and dust control.. • Provide trash container on site. • Remove existing cabinets and tops. • Remove existing appliances. • Remove existing kitchen flooring as well as underlayment., • Remove existing baseboard moldings. • Remove existing kitchen window. • Supply and install new Anderson Casement window. • Window allowance: $550.00 with white hardware and screen. • Repair exterior siding to match existing as best possible. • Enlarge existing opening to kitchen as per plans. • Provide structural header as required. • Repair crown molding in other room with chair rail. • Remove existing laminate backsplash and prep for tile. • Remove existing floor vent and relocate under cabinet toe space. • Replace trim on kitchen door. • Remove wallpaper from remaining walls. • Paint walls, ceiling and trim in kitchen. • Paint touch up opposite side wall of kitchen. Touch up wall, crown and chairrail. • Install all owner supplied appliances. • Provide all final inspections. • Provide proper clean up. _ Payment schedule- Deposit required upon signing contract: $5,000.00 Payment required upon completion of demolition: $5,000.00 Payment required upon completion of rough inspections and plaster,repairs: $7,000.00 Final payment due upon completion of work: $20,450.00 We propose to furnish material and labor in accordance with the above specifications-for the.sum of TOTAL OF$20,450.00 q In the event that it is necessary to pursue any legal action to collect any outstanding balance the customer shall be responsible for the total balance plus all legal costs. ACCEPTANCE OF PROP L: SIGNATURE DATE Michael Heinrichs Project Manager 8-12-15 C#774-208-2362 133g' 1 ,i1 3,, 33" 18" 30" 27" 24" . Y 1238" 10, 168" 51 8„ 3 8" 18" 3 15" 36" • ' _ i` 4. } CN I - N N d N 3 W3315246 ✓ O ��� Oy9 ; w N p. -30 RANGE.GAS 1318_RDU2[� _ 1.3/41REP30X90L �; Jj co ;Trim depth of panel to.box 'of refer&trim height. (n ' v W I - 3w N - O FtC 89 minus.3/4"wood flooring = 88-1I4" � 1 c)i i I� (if-they can 9et down to the.same height i. ! 00 6 as h �.' the dining room wood floor) � � � ., Set cabinets::at 87" I; N . i TF3+ 1-1/8";Small Crown to ceiling o >f rn �. w 9 � —1094 97 33 Z" 22.8" 391LGI' 29; 120e 13 . 133 a" All dimensions_size designations ? This is an original design ari.d must Designed: 7/23/2015 given are subject to verification on not be released or:copied.unless Printed: 10/1/2OI:5. job site and adjustment to fit job "�� applicable fee-.has been paid or job conditions. ,}, G. order:placed. (C)Mark Dupont.-2014 ' 4;aPE: ;y^1SLAND . K;tT'C;HENS Deburro Kitchen Tray Base Option FL-PLAN Drawing#: 1 No Scale. 17 —30 lot I 2 �23 j CV) P WD2433L M W3033B 7" Y -N ''ryry I _ W ER B09L SB2 7 d' B T'O T DI S l _ Hw24 . 2 3 R - .®B M M 34.5 33°1 got. 2 2 —.23°° 2 11 - 2.5 2 1°_ 3 3.616 All dimensions_size designations ii This is an original design aiad must Designed: 7/23%20]S, given are subject to verification on i not be released or copied unless Printed: 10/l/201;5 job site and adjustment to ft job x^ + applicable fee has been conditions. i n paid or job order. laced " �< P . (C)'Mark Dupont- 2014 GAPE `' , SLAND OCi-rr Deburro Kitchen Tray Base Option El 1 Drawing #: L. 1Vo Scale., ell - 133$ q 1 ve 3 ie 12.3$a+ ® 4 ev W331524B r— _) W3018B CII W1833L W2733B. WD2433L H:OOO.: F. ( .. 00 F : opT73/4REP30X90L c� 18_RDURANGE GAS 3043DB15 ER36L/33RR ICY,- A" e' 3C] 2 B dimensions_size designations ") This is an original design aril must, Designed:.7/23/20'15, given are subject to verification on k not be released or copied unless job site and adjustment to fit job nY p Printed: 1.0/1/2015 77 J applicable fee has been paid'or job conditions. order„placed. (C)Mark Dupont- 2014 CAPE y-ISL:AND KITCHENS Deb.urro.Kitchen Tray Base Option EI :l Drawing#: 1 No Scale. f �I,WE r Town of Barnstable *Permit#�" �lJ�C��7 s S a,. hs rom 'ssue date Expire nront j °s Regulatory Services Fee BARNSfABLE, : Thomas F. Geiler,Director . erg, Building Division 9/146t ®�i639• ♦ . � '°TEnt�pta P&P;mj Is�7,CBO, Building Commissioner SEP 3 7009 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-861--i'MN OF BARV Fax: 508-790-6230 EXPRESS P lPPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint r Map/parcel Number 00 iv Property Address ` " YC e, ( -V it 4a l t []'`Residential Value of Work ,59S•O o Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address :Yoe h_r1n Contractor's Name ® • Telephone Number 5 0 77� Rome Improvement Contractor License#(if applicable) Q'3 3`"7 S � [12'0orkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner have Worker's Compensation Insurance {�r� Insurance Company Name Workman's Comp.Policy# B ckz .0 -7 (30 4 y o Ob� Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) P Re-roof(stripping old shingles) All construction debris will betaken tom/. ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side Replacement Windows/doors/sliders.U-Value (maximum.44) *Where,required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License.is required. SIGNATURE: Q g AWPFILESTORMMuildin permit forms EXPRESS.doc Revise020108 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organization/Individual): 5 fL -Q.: �3yV1SL T MO oroV.•eYVV_✓-r Address: City/State/Zip: 4y znn t, fy, Liu Phone#: ..,0t- �7 1 S 11 Are ypu an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. El am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet.$ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' & comp. insurance required.] 13.[�Other rdo *Any applicant that checks box#I 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �-1 S50 C. c> en G�.s r ick Policy#or Self-ins.Lic.#: G uX_ 70 ATA 30( -op q Expiration Date: Job Site Address: C. [ P0.*�2�V�Q, A d City/State/Zip: 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 coverage verification. I do hereby n s and penalties of perjury that the information provided above is true and correct. Si ature: Date: 1 Phone#: 5 OS -7 1 5- 8L 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#: OP ID DS DATE(MM/DDIYYYY) ACORD CERTIFICATE OF LIABILITY INSURANCE SPRIN-1 07 08 09 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 A: NGM Insurance Company 14788 INSURER B: Associated Industries of MA Sprinkle Home Improvement ,Inc.- INSURERC: 199 Barnstable Rd INSURER D: . 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 BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATEYMNUDD/YY E PDATE MM/IDD�IYI� LIMITS GENERAL LIABILITY EACH OCCURRENCE $1000000 A X COMMERCIAL GENERAL LIABILITY MSM23519 07/01/09 07/01/10 PREMISES(Ea occurence) S 50000 CLAIMS MADE FXJ OCCUR MED EXP(Any one person) $5000 PERSONAL&ADV INJURY $1 OOOOOO GENERAL AGGREGATE $2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2000000 POLICY PRO LOC Em Ben. none JECT AUTOMOBILE LIABILITY CO a accid D.SINGLE LIMIT $1000000 A ANY AUTO M9M23519 07/27/09 07/27/10 (Eaccieenq ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) X HIREDAUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE' $ f (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $1000000 A X OCCUR CLAIMSMADE CLM23519 07/01/09 07/01/10 AGGREGATE $ RDEDUCTIBLE .� $ X RETENTION $10000 $ WORKERS COMPENSATION AND TORY LIMITS ER EMPLOYERS'LIABILITY B AWC7004943012009 01/01/09 01/01/10 E.I.EACH ACCIDENT $500000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $500000 If Yes,describe under SPECIAL PROVISIONS below. E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT(SPECIAL PROVISIONS Informational purposes only 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 y Inc NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL FaX 8-775-1350 Margoo Mack IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 199 Barnstable Rd. REPRESENTATIVES. Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE Kelley A.Sullivan ACORD 25(2001108) ©ACORD CORPORATION 1988 f' Boar d-ol'Building 'tl5 ` t i � Construction Supervisor License � 7 ' License: CS 6643 Expiration: 10/8/2009 T.r# 0427 Restriction; 00 BRAD K SPRINKLE 190'LOTHRO.PS°LANEr` - '< W BAf IN:;TAF3LE,MA 02b68 (bni'i1111 S A, 00-3.5;000cf enclosed space 1A-Masonry only i 1G- 1 2 Family Homes } Failure to>;po'ssess ascurreut,Wifaon,of of--the Massachusetts-State Building Code +: i is cause for revocmion.of tl is hcer s'e. } � I I �F! 1 c mm J F! x ;tr. r(<3:: Jir i.fice/i2 Board of Building.Regulations and-Stabd:Wds al r 1i ii HOME'iMPROVEMENT'CONTRACTOR r { -'; Registration: 103757 j Expiration: ::7/9/2010 Tip#. 271033 Type: Private-Corporation- SPRINKLE HOME.IMP.,ROVEMENT, ING. Brad:;Sprinkle 199 Barnstable Rd. Hyannis,MA:02601 mrniii strato.r 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 ra�ti Town of Barnstable Regulatory Services �I E Thomas F.Geiler,Director 16 Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.tow n.b arnstab l e.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign Thus Section If Using ABui.lder as Owner of the subject property hereby authorize to act on my behalf, in all inatters relative to work authorized by this building permit application for. .(Address of Job) S' of CW.,ner I D to Print Name If Property Owner is applying for permit please complete the Homeowners License Exemption Porin on the reverse side... Q:FORMS:OWNERPERMISSION