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Home My WebLink About0189 GUILDFORD ROAD 'ate. `Y;'x `ti�1*' � n�v •t s F� '� � �' - �,. �.�,*45xy. �� RI'„ � �,�, �'k,� � �'�'� " "al:. q{ � 1,,, . ,. � F � «„�,:o� •�u �' ^"''a -.. ..., .Y.. .� i� �:, _ .. ,�'4 �t htu � :E �-. � �� x ��.,.;� �.v�3;1 .�r, a .�•i�} ,�rwr � r � y ',. - ��YR rx � �.� ,. - � -. �4 v r�" ` .. �. ., -� I �- .. ..- _. c - .. 3 . o. ,. - ` t _ - - � .� - r« i ,i .�.. �- -. r. : ,- .. .. '' . :;, ,:f _ r t�'� r s �� ' d a � v � 3P.)� 'y E� C �A t kR4 C �. ., . � :� � • :, a�+ � i ,_ .°� _,., � .- �., �� - t .�. ,.,; r b ,,, ,a o y. - - F \ ... .:4 t .., •, _, .._: .,: } - rF�.r r`, r � � ... � _ .. - '1.:� .�� .`� _ F �f .. ..� ... .. ` o �. _� ., .. . . ..< ,,, � '. _ t �, of BarnsTown (S(0 table >Permft' # Ew&a6manAUrfmn Jaw date f . Regulatory Seit ces Fee `= Thomas F.Geller,Director Building Division 11)26I1 z- Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 www.towa.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION RESIDENTIAL ONLY 7 Not Vaffd wMaru Red X-Press lnvdw Map/parcel Number I y$ l t �i�Address I `� -� t d`t u A GC o Aff �Q�kL U • I-e. Residential Value of Work 3. V(o a'" Minimum fee of S35.00 for,work under$6000.00 Owner's Name 8t Address Qp -em u Contractor's Name Sprinkle Home Improvement Telephone Number 508 775-1778 Ext..10 Home Improvement Contractor License#(if applicab103757 le) �. Construction Supervisor's License#(if applicable) CS 6W -PRESS PERMIT KWorlmlan's Compensation Insurance Check one: NOV. - 9 2012 ❑ I an a sole proprietor ❑ I am the Homeowner ® I have Worker's Compensation Insurance TOWN OF 0ARN$TABLE Insurance Company Name Associated industries of MA/ A.I.M Mutual.insurance Co. Workman's Comp.policy# AWC 7004943012012 Copy of Insurance Compliance Certificate most 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 JIL : (maximum.35)#ofwindows 3 - 'Where required: issuance of this permit does not exempt compliance with other wwn deparm=regulations,i.e.Historic.Consetvadoa etc. 'r4�N'oe: Property owner most sign Property Owner Letter of Permission., A copy of the Rom provement Contractors.License di Construction Supervisors License is SIGNATURE: G:1UsasWccopilc\AppDatall,oca(1i�dicrosog\WiodowslT Internet Files\ConunL0Wook0DV87MZ1F MS.doc Revised 072110 f The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations �- I.Congress Stree>y Suite 100. Boston, MA 02114-201.7 www.massgov/dia Workers' Compensation:Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aaulicant Information Please Print Legibly Name (Business/Organization/Individual): Sprinkle:Home improvement Address: 199 Bamstable Road . City/State/Zip: Hyannis, MA 02601 Phone#: 508 775-1778 Ext. 10 Are you an employer?,-Checkthe appropriate do am'a: ere ' Type of-project(required): l.0 1 am,a employerwith1&-12 g . raLcontractor-and 1 employees(full and/or part-time).* -have hired the sub-contractors 2 6. 0 New.construction .0'_1 am a sole proprietor or:partner- listed on the attached sheet. _ 7: 0 Remodeling- ship and have no employees These sub-contractors have 8; 0 Demolition- workingfor me in an capacity. employees and have workers' Y P tY• 9 0 Building addition. [No.workers'.comp..insurance :comp.:insurance: S. We are a corporation and its. .l0.O.Electrici repairs or additions required.] ❑,eq red.J � 3.0 l am a homeowner-doing all.work officers have exercised.their 11:0 Plumbing repairs-or-additions myself o workers' com right of exemptiowper MGL Y lI`I P 12:0 Roof repairs insurance required.]t c.�152,§1(4.).and we have no employees:[No workers' 13MOther t.t)I*A c�OL S 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether of not those entities have employees. If the sub-contracwrs.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: 00490102 01/01/2013Policy#or Se£ns.Lic.#: xpraton: ae Job Site Address: UC-4 QC�. City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the,policy number and expirstion.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 DIA for insu v rage verification. I do hereb certify. ai enaltles ofperjury that the Informado&provided above is true and correct. Phone#: 508 775-1778 Ext..10 Official-use only. Do not write 1n this area;to be.completed by city or town official City or-Town: PermittLicense# Issuing Authority(circle one): I.Board of Health 2. Building Department 3.City/Town-Clerk 4..Electrical Inspector 5.Plumbiag.Inspector 6.Other Contact Person: Phone#:. P : RAWMAKA $ 'm ,j Town of Barnstable Regulatory Services,' Thomas F.Geller,Director Building Division Thomas Perry,CBO Bullding 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 as Owner of the subject property , hereby authorize Sprinkle Home Improvement hereby on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date osc-- G � Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Usersldecollik\AppDataU.ocal\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 { r Unrestricted - Buildings of any use group which` contain less than 35;000 cubicfeet.(99 I'm').Of Massacn'usetts -'Departnient of Puotic Safety enclosed.space. Board of Building.Regulations.and Standards ( ��n.trurtu�n Sul,rn't.��r —cense CS=006643 BRAD K SPRINKLE 190 LOTHROPS LANE ^� Failure to possess a current edition of the Massachusetts W:BARNSTABLE MA.0�6 State Building Code is cause for revocation of this.license. . t. For DPS licensing information visit: wwa:Mass:Gov/DPS 10/08/2013 /L. 'r Office of Consumer Affairs&Business-Regulation• License or'registration valid for individul use only HOME IMPROVEMENT CONTRACTOR. before the expiration date. If found return o: ; Registration:. 103757 Type: Office.of Consumer.Affairs and Business Regulation. °Expiration: 7/9/29-14 Private Corporatior• -10 Park Pla7a-,Suite.5170 , Boston;MA 02116' SPRINKLE HOME IMPROVEMENT, INC. Brad Sprinkle 199 Barnstable Rd. Hyannis,MA 02601 . i Undersecretary Not valid.witho signature a 12/20/2011 9 : 35 : 33 AM i 8740 ® 02/09 DATE(bDVDDdYY1) .,CERTIFICATE OF LIABILITY INSURANCE 12t20/201.1 TRIO CERTIVICATi-Is Unm AB A K TTER or,XOTORKMON' OXIM Am CONVERB so RIOETB upon.TUN CERTzrzCATE ROLDER. TEIB CEATZVZCATE DoEB"NOT AVVZRRATZVNLT OR EEOATIVELT ]NOSED, EMEND".OR.AMM TEE COVERAGE-AV VMM:RV TEE P"ZCZZB EELOW.. TRIG CENTIVICATE Of zNBDRAECE.DOES EOT'COEETZTRTE A CONTRACT RCTMN-TEE z8euxua-IEBOAER(S). AOTRORZSED,REVRSBEETArzVE-OR.BRODIICSR, mm Tim CERTIVZCams SOLDER. - znPORT terms It the certificate holder IS an ADDITIONAL INBORED,. the polioy(ies) must be"endorsed. it BORROoaTZOE IB WAIVED, sub3act 1 to the and aonditinns of the policy, aertain policiee'msy require;an endorsmeut. n•'statiaent on this.Certillcate des■ not aonler rights to.the aertiiloote.holdas in lieu off suoh eDdorseaeat(s). ' ra"LAMS Clew BIyden & Sullivan tna Agency SIGN. Inc we'..a.. m 1: wa ■.,r ■a.n 88 ftl=Uth Road Hyannis, M 02601 wnem■:... asaum[P1 arnom esWWs■ o[c. n{oaao mrs"a�sprinkle HC�e Zaprowe®ent isle A:I.M. Mutual Insurance Co 33758 ; " • 199 Barnstable Road - Hyaaais, bA 02601 . aa■■R s: COVERAGES amfirimm-NGMSER: REVISION NMCBZR: TNzs Is To QwzvR NO TRR ROLICZRE ot OA.ai =Orm MEW RAVE Room lisom W TQ asosso m RssmD aDLCAIIM , RORWi1Wi-.ND=G.aWY RNpWasl�t, "Ns N s oR ComiTZON or.ARV COVIRMW on OTRRE DoQ U=tiWWT To W=WIN COMWZ M,MT W.ssiom at My RisTat♦, TIM zogumu CR AVlOmm RT US ROO.ICM RNi*a Is x"Jum so ALL-TRs"Mal tCWsMUS an=MMWM or.XUC•-RO.==. =KM sRORi ma[Rath SEER Rm m RT Van CLUM. `-'- ROLMM NUMBER va=cY NRr Ioum @ UNIT■ ; �- TWE or asDRANCE ,■ww++n aPUW/a,r, f . (:]CQv"=A .GxuPA0 LL BmITI" .0ae1Ge TO mTW . .OQCLAIM'/YO{. "0OCC01k - "IO M.MINIMAL�OM' I■uR' MssA.1 { A80'L AOW■OATf LDIIT.AMISS{P,• OV061".or00J{CT 0z.,w awzomn=LIARZtSTV -. - _ __ - 'COZW■0I■0L■LDIIT. 0—Arro _ 11OCWPmdD A0T00 - w{LI"nYe10As APOart1 .{ BW ❑■0-arro AMCM s 4 ee■nSA L LA0 a m W .. - ■{OI■CA, Ci { .f 02=00'LLAO 0 C[ADO PAD{ - � • .. RaaRa■OOIQERSMOR 'SM M PROPRIEI'OR/PAiCMN/ - '■'.L'.-oaANIMIST - { 500;000mcccurm-o"Icm ME -0 incl 0. excl 7004943012012 ■.L. .[is■{■ asueT[an:" �. 500;000. Ol/Ol/2012. 01/01/2013 3' B.L. DIU&W-samLs■I,■. {` 500„000 WORKERS COMPENSATION CCVERAGWAPPLIES:?0.MhSSA=U9 rS'EWLOYEES, - I MW IFICAM HOLDM CMCEIJ AT20N .PROOF-OF INSURANCE' RNo=ANY or TRR Mon ohm YCL=ai uN'CUCCUM RRRoii RNs saaATLON cam TRmEOr,.N01'1'L7 WM'RE.MUM= IN ACOOmi=WITS M . roLlar rioRsmis. L t 5289 0 0/c, > Town of Barnstable *Permit# Q, Expires 6 months from issue date Regulatory Services Fee 3 s— * IARNSPABLE, MASS9c , Thomas F.Geiler,Director ®PRESS PER Building Division �0� Tom Perry,CBO, Building Commissioner. 200 Main Street,Hyannis,MA 02601 APR 12 2012 www.town.bamstable.ma.us Office: 508-86274038 08-790-6230 MI EXPRESS PERT APPLICATION ; RESIDENTLALLWO�1`I, IYANSTABLE Not Valid without Red X-Press Imprint Map/parcel Number VF Q l Property Address V (ter 0'Residential Value of Work . �t 00 C Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address �� ✓i L-7 e.G I CJ l y��f��'C.0 l�.O[ Cer1 �c►'�, ��t f��} �r263� - Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) e-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to —To WA o-( h k ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑Fence over 6' #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 sign Property:Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors LLicense is , req red. SIGNATURE: Q:IWPFILES�FORMS u riding ermit formsTYPRESS.doc Revised 051811 Town of Barnstable Regulatory Services 9�^BtEg' Thomas F.Geiler,Director Building Division _Tom.Perry,Building Commissioner ` 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 (� f HOMEOWNER LICENSE EXEMPTION DATE: 1 I Please Print JOB LOCATION: 81 bull ford CtAtcy-VII(C number street village "HOMEOWNER": 14A I `iL,. 70�' 68I --M4 name // home phone#. work phone# CURRENT MAILING ADDRESS: t 89 city/town state " zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow p homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. s DEFINITION OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building permit. (Section - 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and.other applicable codes, bylaw ,rules and regulations. The ersigned"homeowner"certifies that he/she understands the Town of Barnstable-Building Department minimum inspection proce es and rMunts and that he/she will comply with said procedures and requirements. Sign"owner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control. ' ' - HOMEOWNER'S EXEMPTION The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt ..from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors); provided that if the homeowner engages a person(s).for hire to do such work,that such Homeowner shall act as"supervisor." Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules &Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious.prob'lems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc Revised 051811 dF� ^ • anffivsr M, • MASS, 'Town of Barnstable 4 �pIED INA'�� Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.nia.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 property hereby authorize to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date - Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. 0 QAWPFLESTORMS\building permit formsTNPRESS.doc Revised 051811 „ . The Commonwealth of Massachusetts .UfDepartment of Industrial Accidents Office of Investigations = 600 Washington Street - Boston,MA 02111 www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Infonnation Please Print Le b Name(Busims Organization/Individuat): Address: )4UD City/State/Zip: L LCrIVI-APhone.#: 5� 6 . Are yqu an employer?Check the appropriate box; Type of project • (required):: 1.0 I am a employer with -4• [❑ I am a general contractor and I . * have hired the sub=contractors 6.'.❑New construction . employees(full and/or part timel. . 2.❑ I am a'sole proprietor or partner- listed on the-attached sheet 7. Remodeling. J ship and have no employees These sub-contractors have g. Ej Demolition working for me in any capacity. employees and have workers' "[No workers' camp.insurance comp.mcrrrance.� 9 addition . required,] 5. 0 We are a corporation and its 10.7 Electrical repairs or additions 3 am a homeowner doing iZ work officers have exercised their 11.[]Pltnnbing repairs or additions ep ysel£ [No workers' comp. right of exemption per MGL 12.❑Roof repairs brurance required-]t c. 152, §1(4),and we have no . employees. [No workers' i3•❑ Other Pomp.irmn-ance required.] 'Any applicant that checks box#1 must also fill out the section below showing thee•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. $Cantiactu s that check this box must attached an additional sheet showing the name of the sub-contractors and state whether ar not those entities have employees. If the sub-contractors have employees,they umstprovide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.# Expiration Date: lob Site Address: Gay/State/Zip: Attach a copy of the workers' compensation policy declara$on 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 c»al penalties of a fine up to$1,500.00 and/or one-year imprisomnent, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a da�t against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the ILIA for i surance coverage verification. I do hereby certify untr the pains-and penalties ofperjury that the information provided ab vg is it and correct, Signature: . Date: Phone# Official use onl . Do figit write in this area, tb be completed by city or town official City or Town:: �l Permitucense# 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#: