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0032 OAK NECK ROAD
�3d, OeK NBC ��G Town of BarnstableBuilding PostThls,Card So That�t,is1/is�bleFromyhe Street Approved-Plans Must beRetamed on,lob andthis CardMustabe Kept �—S ::.'�`Y'$ t s a`w.,�'` ;,,�a Z l. s 3 . anwss �" Posted Until;Final Inspect�on,Has Been Made ,, ,: � ' - °. Where a Certitficate of Occupancyi11 uired,such Burldmg shall Not be Occupied until a Final,lnspect�on has been made it Permit No. B-18-209 Applicant Name: HENRY E CASSIDY Ap provals Date issued: 02/07/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 08/07/2018 Foundation: Location: 323 OAK NECK ROAD, HYANNIS Map/Lot 307 198 Zoning District: RB Sheathing: Owner on Record: DEIN.EY,JACOB T I �% h '.ContractorNarrie: CAPE COD INSULATION, INC Framing: 1 M i Address: P O BOX 614 `_ ctor Contra License 153567 2 HYANNISPORT, MA 02647 Est Project Cost: $9,000.00 Chimney: Description: R-38 FGB to 1152 sq Kneewalls 6mil poly to 1152 Open Grown Permit F0.e: $95.90 Crawlspace; R-19 to 1152sq Ft. Crawlspace Ceiling 12%Hours Air Insulation: Fe„e�Pald:' $95.90 Sealing. Final: ` Date` 2/7/2018 Project Review Req: i. a f' Plumbing/Gas Rough Plumbing: 3 Building Official . Final Plumbing: S, This permit shall be deemed abandoned and invalid unless the work author1ized by this permit is commenced within siz months after issuance. Rough Gas: All work authorized by this permit shall conform to the approved applicatiorrand the'approved construction documents;for which this permit has been granted. Final Gas: " All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by laws and codes. This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public mspeetion for the entire duration of the work until the completion of the same. Electrical c The Certificate of Occupancy will not be issued until all applicable signatures by theBuilding and Fire Officials are provided,on this permit. Service: Minimum of Five Call Inspections Required for All Construction Work: Rough: 1.Foundation or Footing ..m. ,... ..'x. _ ... 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final: "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT i TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map �J© Parcel Application . Health Division Date Issued —247IJ Conservation Division Application Fee ,fyzn Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address , . Village Owner Address Telephone Permit Request bmi kit/.4-0 hr v v P(�,t4 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 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 / Historic House: ❑Yes ❑ No 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 BUILDING D lCentral Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal is ove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing , ❑ new size J R.1 ting ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new siz��� Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION /(BUILDER OR HOMEOWNER) ,r C/ Name �S�(�' Telephone Number s ��U 121/ Addressd_ �gLicense # 1 � soAa-- Home Improvement Contractor# Email d Col Worker's Compensation # ALL CONSTRUCTION EBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ! 2 3 ti _. FOR OFFICIAL USE ONLY t� APPLICATION # t DATE ISSUED r MAP/ PARCEL NO. ADDRESS VILLAGE OWNER r �F DATE OF INSPECTION: k FOUNDATION e FRAME INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. n� 460 West Main Street I-Ir�tt it7g � _ Hyannis,MA 02601-3698 Tel:(508)771-54001=ax(508)790-2425 TTY on all lines Chpe cc-d rep Weatherizatio'n 1. c Your tenant has requested and is eligible for weatherization of your rental home through.the Weatherization program at Housing Assistance Corporation. An average weatherizatiO job is worth $4,500 and these-services are provided at no cost to you. The following weatherization measures are applied to the typical job: air sealing in the attic and basement, insulation in the attic; basement and walls, weather-stripping doors. Bath fans may be installed if necessary. We will test the efficiency of the refrigerator. All work is professionally done by licensed and experienced contractors. HAC will conduct a final inspection to make sure that all work is completed in compliance with quality work standards. Prior to the work being done you will receive a letter from HAC showing the actual measures that will be installed and the total dollar value to the-work. To confirm your ownership of the property, we will pull the appropriate town assessor's report. If necessary, we may ask for a copy of your tax bill or deed to prove ownership. " The work on your rental property will begin when we receive -the signed copy of the attached Agreement. If we do not receive the Agreement, HAC will conduct an energy audit but no weatherization work can be done without the signed Agreement. During the energy audit we will install energy,efficient light bulbs and will test the efficiency"of the refrigerator. If you have any questions-please contact Suzanne Smith at 508-771-5400, ext. 123 or ssmith@haconcapecod.org LANDLORD: ,L- ' gje, TENANT: Inn ,/� ����'�nc� Ida+t R i A - �1Q D�.0�� �S4��t � lam_ VCD/ email: 1 4. '^�C��,µ o•ti l d n emaill: PHONE:(home) PHONE:(home) (Call) q3 �(� (Geri) ��P 3 .2 557 ;L 14. The Parties acknowledge that this Agreement is under seal. It Is-intended by the Parties that the Tenant or any successor Tenant is the intended beneficiary of the-Agreement andishail have a right of enforcement. Property Owner's Signature: Date /2 Phone: �1�` . . i.. Address: ?? �e s Tenant Signature Date Agency Approved Weatherizabon Company Adam T. Inco orated / All Cape Energy ! Altemative Weatherization �Ca �Cod ! I • . Cape Save 1 Cazeautt Frontier Energy Solutions ! tohr Home Improvement / Tupper Construction Agency Signature Date Section 9: Debris Disposal/Workers Compensation Affidavit DEMOLITION SITE ADDRESS DISPOSAL/DUMPSTER FIRM APPLICANT'S SIGNATURE DATE t'orkcrs'Compensation [..nsur inc.eAf'fidm its Builde:rs1cont�ract rs/Electr1dans/Plumbers r� Iicti.n.t infr?rmxfi,itttt Plc i.e Pt nt Uce.fbly Na[ttt?.�Itns nEaxpr�r 'ratiart'Fnditticlual3: � l V i l/ Mdress: L Pltcr►te ff: Ark,Vou all eniplo•cer'.Chcci,t t npp:roprinte Utrxt Type arprt7Jctt.(tcgellrvd}: l ( t ant a emplc,}Er tt:itit 4. 0 I art,a gcncral contractor and I �tnplc�} cs Y tu11 anJ ter p t rt-tithe ha c])!red 41y2�uU cxttttr.tctcrta t' ��ctt r�'n�txttcti�n 2 [);l ant tt sa1.proprietor or,pArtitet. listed ott the+ttl toltcd ltecl., 9, ©:IYsnrtvdelin�_ sltlp tula have rco ertiltioy to i'!rt r vui ,vontnnt tort It+tve $ [�fJcnu�lltin.n: working fortrnti n.my;:unpw.ity. e.ttiploy2esnttdlta-eworkers, [NO 1Ppr.ke. carry,rater?ncc coltap.ratsurune.c.t 9+ 0 Buildin({.orldititm tr�uilYcf•� S 0:We nru a ctttnortiinn anct its 10.0 Electrical repairs or udditions 3.❑ {am rt bol oWly-T&itt,-till.work o(liccrs(lave aaerc:lsetl their l t.[ Plumbing,rv.pairs or additiotis. to}Self:[A!ctrs orikr?rs'cc ttti. rt.�ht of csetttption.lxr NIOL ursutnnc:eroquired.�' I:S , l.(•l) attttthehave.nv li[ Rttnrrt'paita e1uployccs.[No woAvrs' l:i+( cnher � {, camp.histrtuncanccgttirtr3.) tn�::ptairnrttthat<uatxivx.al'm,r,ttA'nrill Vat Eherrcttantul,rt•alrxvipgtheiratiaLcts'enni(entstitn3.�1ick inrw�int.icxl. t i l�n.4�,ty±r.ut5a submte t7�is atli lrri ct tniti��citr�sttr�•aa thin$ntt rtnrl,,o:l.ill�r itire.but+;tciot�rntn�tvrx u)u�+;ubnut n naty ntl:<fns-irin,lf„rcinlsuctt. _'l.•c,ntrir:mr,chat rti�^ek tlut ixs:mu�l nit,�:�,.�cl ur t�;lJctirn�3 5k�ct.slck�r+l m,�life rl;m.c c7r tice rcilr��nn:u:tai�tutJ:sL�rr�ttaztlt;K i�r nut ityrisrt enrcpri ls��•c .n1D1?itrs'. 1fk11csuirrc�crrei�r�ht+n emtifo}rws,rli;�•rrr;crtyti�eirtachcir avrkrt�'ecrnla t+ulir,yitnnthrr Irrtre fill r�rll�dc�t Alta(( lrrrrt(rlirr?'+t4nrfkt'r€ cY�art rrrrf(r?rtrrcat>rttrrc far 1tlrPrrir(eYc'�t, rlatrisa(icr�rra(Icarurrr(jtibsllc infvrnref(nrr• Insurantcv Company`anti+,��.� 9Lob -� 9tl Polr }rk:nr5etf-ius tic. :—a- (f �2 �? � 11� Job Site Ad3ress: ✓�� r�G � Ci.t rSlutrt' s ir,NC y I tl+ ,(,�7 9 Atitic6.n copy rtl'the-workers"cutnpeusrtilofrpollcyiltrlatKt[rinfrhtr(sirt,tihigihr3ti>lic, a.uaibc tdesltiratfo�e). roilure to svettrs coverarc as retluired.under Section:2Srl.,L)fNIG1.v+152 ra.n ic.14 to the nti;Itwition t1:LI'imirull.penaltivi of 11 line up to S(. t)t1„(}t),util"grunt }'ear 11,1tl,risan>rt;ttt,as XMI its civil pepitlties it)file:riarrtt.t?ta$TOP AVORK ORDER wid it€ute art up to .,its tltI,.a•iQtalor, 11L ndt ised tlt:at a eopY Of this$441 110111 j,11V IV lonvuriltxl to Ott E}ITic4 Of. lttW56=41ti0M Of ilw IDS. tr utsurattv4 tow .rai y vtct itictiti.�t1 ��1»!u!rehl +. i.+ rrrdw rhu�,i i„x or,rfl+.+,ralr}nc n rnx l� +rr+.ifiral.tli w irrjnra,nli for rnrYilnil nint•�e i.Urr ns,rr.rnrrnni:.yr laltrtne A^ I f)jfrc(irl tr nu(t: .;t)a fast.ante Irr:rlrl.,r rrrc�n,..fn be'rtun p(elerl ht`�(tk nr trier+rr rr,(�'icirrl. City orTown: 1!ern.rltlf Crcnxc tJ tcsuin .ilrthur(t}{i(t wax:one): 3...13afiatl orl exlth : ..13U.11 IngDepnrintent 3.Ciit•f1'0ts'n C':lerlt 4,1 leeirlcrtl lnsrectoA` i.l'lurnt�.ln In4pector 6+l).tlter ti;untitct Pea•�on': Plrotte fs: : I -�� CAPECOD-27 POYL '4�oRoQ CERTIFICATE OF LIABILITY INSURANCE [70A (MM/001YYYY)TE 6/30/2017 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(les)must have ADDITIONAL-:INSURED provisions or 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 endorsements . PRODUCER 22NIACT Rogers&Gray Insurance Agency,Inc. PHONE FAX 434 Rte 134 (A/C,No,Ext): A/C,No:(877)816-2156 South Dennis,MA 02660 E-MAILADDRESS•mail ro ers ra ,corn INSURERS AFFORDING COVERAGE NAIC# INsuRERa;Peerless Insurance Com an 24198 INSURED -LNSURERB:SafGty Insurance Company 39454 Cape Cod Insulation,Inc. INSURER C;Endurance American Specialty Insurance Company 41718 18 Reardon Circle INSURERD:Atlantic Charter Insurance Company 44326 South Yarmouth,MA 02664 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ CLAIMS-MADE a OCCUR CBP8263063 04/01I2017 04/01/2018 DAMAGE TO RENTED 100,000 MED EXP(Any one erson 5,000 PERSONAL&ADV INJURY 1 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY a ppej LOC COMP/OP AGG 21000,000 PRODU TS- OTHER: - B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1.000,000 ANY.ED 6232707 COM 02 04/0112017 04/01/2018 BODILY INJURY Per person)OWNED SCHEDULED p o l AUTOS ONLY X AUTOS BODILY BODILY INJURY Per accident X AUTOS ONLY X N OS ONLY PRROPERTY AMAGE Peracadent C UMBRELLALIAB [I OCCUR EACH OCCURRENCE 1 21000,000 X EXCESS LIAB CLAIMS-MADE EXCI0006636002 04/0112017 04/01/2018 AGGREGATE 2,000 D ,0000 ED RETENTION$ D WORKERS COMPENSATION PER TUTFOTH- ANDEMPLOYERS'LIABILITY ER YIN X OFFICEANY RMREIMTgOER/EXCLUDED?ECUTIVE a NIA �OWCE0043190206/30/2017 b6/3012018 E.L.EACH ACCIDENT 1,000,000 (Mandatory In NH) If yes,describe under E.L.DISEASE•EA EMPLOYEE 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addltlonal Remarks Schedule,may be attached If more apace is required) Workers Compensation includes Officers or Proprietors. Additional insured status is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 251201RI031 y Commonwealth of Massachusetts Division of Professional licensure Board of sion O ^" g.Regulatio'ns and Standards C0ns�r tff �;Nb- Pprvisor CS-100988 IN E ires: 11/11/2019 HENRY E CA'UlDy 8 SHED ROW.RMO WEST YA r tjT M. 6,73O Commissioner Office of Consumer Affairs and Busin ess Regulation • 10 Park Plaza v Suite 5170 Boston, Ma a'( usetts 02116 Home Improve mar�t .oractor Reg istration e C �z r Type; Corporatlon Cap Cod Insulation, InC Registration; 153567 18 Reardon Circle n .)_ f.;r :tyr Expiration; 12/1 4/2018 SO, Yarmouth Y. ;CA_+)^20M.05/11 Update Address and return card. Mark reason for change, ro�va-nvrvzarzrue�clf�oy�C�/C�udouc�tteeGto '4'�—�F;�R1C1�1:7�rk--1,�-�.ta.S#r.Flr�...__........_ Office of consumer Affelrs&Business Regulatlon HOME IMPROVEMENT CONTRACTOR T`ype.; Corporation Registration valid for Individual use only s lstratlon before the expiration date, If foun w >._:. EXplratlon Office of Consumer Affairs and urn to; �` sl 12/14/2018 10 Park Plaza• sl ss Regulation ,`::` 4� `= (a'r� Boston,MA 11 a 5170 Cape Cod Insulin W Henry Cassidy : n 18 Reardon Circl$ . So,Yarmouth;MA.QZi4�/%' 'S,'•• Undersecretary t al hout si atuy _-�-ta - I3 t �// 2 r Town of Barnstabk f *Permit vth3s Expires 6 mo h f m mft, r • .Regulatory Services Fee w BARNSPABLE,MASS. Thomas F.Geiler,Director 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 -3 Q Property Address _ _-3 Q c)cw>Z Q RJR a �lA [residential Value of Work b 4M . 3 C7 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 5 c0,1 0 a VA �► 17 0 Contractor's Name Sprinkle Home Improvement Telephone Number 508 775-1778 Home Improvement Contractor License#-(if applicable) 103757 Construction Supervisor's License#(if applicable). XWorkman's Compensation Insurance AR-PRESS PERMIT Check one:" MIT ❑ I am a sole proprietor ❑ I am the Homeowner JUL 12 2013, I have Worker's Compensation Insurance Insurance Company Name Associated:Ind l lStrmeS of MA TOWN OR Rod ea le,TA®LE Workman's Comp.Policy#AWC 7004943012011 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)' [EIRe-side Y #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 Rome Improvement Contractors License&Construction Supervisors License is SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Conteni.0Utlook\DDV87AAZ\EXPRESS.doC Revised 072.110 Unrestricted-Build• contain less than 35,E of any use group which cubic feet(991ln )of Massachusetts Department of Public Safety enclosedspace. Board of Building Regulations and Standards Clinstruction Supeni%nr ' License: CS41106643 BRAD K SPRINKU Failure to possess a current edition LOTHROPS ion of the Massachusetts W BARNSTABLNE E MA. State Building Code is cause for revocation of this license. P For DPS Licensing information visit: www-Masskov/OP5 J.L. �.6t�. =zairatior. Commissioner 10/08/2013 Office of Consumer Affairs&Busitreas Regulation License or registration valid for individul use only 9 r V=&Won MPROVEMENT CONTRACTOR before the expiration date. If found return to: 103757 Type: Olftce of Consumer Affairs and Business Regulation : tcpiradon: 7/9/2014 Private 10 Park Plaza-Suite 5170 Corporation Boston.MA 02116 SPRINKLE HOME IMPROVEMENT,INC. Brad Sprinkle 199 Barnstable Rd. Hyannis.MA 02601 a Undersecretary 3 Not valid with signature- - .. .. 4 i CF THE Tp� r • * BAMSrABLE, MASS. 1639. Town of Barnstable ♦� arEO��s Regulatory Services Thomas F.Geiler,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 as Owner of the subject property hereby authorize 111 act on my behalf, in all matters relative to work authorized by this building permit application for: 3 (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. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\8R76BDVA\EXPRESS.doc Revised 061313 SPRIN-1 OP ID:DS ACORO` DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 12121/12 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(les)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 endoreemen s. CONTACT PRODUCER Phone:508-775-6060 NAME: Bryden&Sullivan Ins Agency pH Fax 88 Falmouth Road Fax:608-7904414 Hyannis,MA 02601 ADDRESS: E LL AIC No Kelley A.Sullivan INSU 8 AFFORDING COVERAGE NAIC S NSURER A:Associated Industries of MA INSURED Spprinkle Home Improvement Inc. INSURERe IA Barnstable Rd Hyannis,MA 02601 INSURER C: INSURER D: INSURER E: . INSURER F: COVERAGES CERTIFICATE NUMBER: 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. L R TYPE OF INSURANCE POLICY NUMBER MMID - LIMITS GENERAL LIABILITYEACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Me omurence $ CLAIMS-MADE a OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ a AOS OWNED SCHAUTOS SDULED BODILY INJURY(Per accident) $ NON-OWNED PROPERTY $ HIRED AUTOS AUTOS Peraoddent $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAS CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ LIM WORKERS COMPENSATION STATU- TH- AND EMPLOYERS'LIABILITYTS A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N WC7004943012013 01/01113 01101114 E.L.EACH ACCIDENT $ 500,00 OFFICERIMEMBER EXCLUDED? N I A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00( DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES"ch ACORD 101,Additional Remarks Schedule,if more space Is required) CERTIFICATE HOLDER CANCELLATION SPRNKHO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sprinkle Home Improvement,Inc ACCORDANCE WITH THE POLICY PROVISIONS. Margo Mack 199 Barnstable Rd. AUTHORNZED REPRESENTATIVE Hyannis,MA 02601 Kelley A.Sullivan 01988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010105) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts, j 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): Sprinkle Home Improvement r Address: 199 Barnstable Road s City/State/Zip: Hyannis, MA 02601 Phone#: 508 775--1778 Ext.10 Are you an employer?Check the appropriate box: r Type of project(required): i.[XI am a employer with 10-12 .4. 1 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 g• Demolition workingfor me in an capacity. employees and have workers' Y P tY• $ '9. 0 Building addition [No workers' comp.insurance comp. insurance. required.] 5. E We are a corporation and its '10.0 Electrical repairs or additions ` 3.❑ I am a homeowner doing all work ; officers have exercised their 11.❑Plumbing repairs or additions myself.[No workers'comp.' right of exemption per MGL 12.0 Roof repairs- . insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13.0.Other comp.insurance required.] . *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 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. y. Insurance Company Name:, A.I.M Mutual Insurance Co. Policy#or Self ins.Lic.#: .7004943012013 Expiration Date: 1/O1/2014 Job Site Address: �6- City/State/Zip: 14\1 a_hVV',._6 . M A . ~ 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 ins ce coverage verification: I do hereby c un airs and penalties of perjury that the information provided above is true and correct Si afore: Date: 3f '. 508 775-1778 Ext. 10 Phone#: F 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 q Contact Person: Phone#: �. Town of Barnstable *Permit# Fapires 6 months from issue date BARMADM Regulatory Services Feebulft � Thomas F.Geiler,Director ®PRESS PERMIT �A el/B Building Division Tom Perry,CBO, Building Commissioner MAY - 2 2012 200 Main Street,Hyannis,MA 02601 www.town.batmstable.ma.us Office: 508-862-4038 1 TOWN OF BA �1 4230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number AA- 20 Property Address_ axL a J� &aia At [Residential Value of Work AA 7 Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Lo ryy s aa� !fit i rv�i n k�ct w� MA 61-1 o Contractor's Name Sprinkle Home Improvement Telephone Number 508 775-1778 EXt. 10 103757 Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) CS 6643. KWorkman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ lam the Homeowner I have Worker's Compensation Insurance Insurance Company Name Associated Industries of MA / A.I.M Mutual Insurance Co. Workman's Comp.Policy it AWC 7004943012012 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 Windows/doors/sliders.U-Value ', (maximum.35)#of windows *Where requited: 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 the m provement Contractors License&Construction Supervisors.License is equire . SIGNATURE: I C:\Users\decollik\AppDataU:ocal\MicrosoMWindows\Temporary Internet Files\Content Oudook\DDV87AAZ\EXPRESS.doc Revised 072110 ,,. The Commonwealth of Massachusetts Print Form Department of Industrial Accidents ' Office of.lnvestigations 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 Lezibly Name (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): I.❑✓ 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.❑ 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 ty• 9. ❑ Building addition [No workers' comp. insurance comp•insurance.' required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions officers have exercised their I I.❑ Plumbing 3.❑ 1 am a homeowner doing all work g repairs or additions myself. [No workers' comp. right of exemption per MGL .12 ❑ Roof repairs insurance required.]t c. 152,§1(4),and we have4no _I _ employees. [No workers' 13,�Other ids !l(]GW LJ 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. xContractors 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. 7004943012012 01/01/2013 Policy#or Self_ins.Lic. #: Expiration Date: Job Site Address: f Iec) KooA City/State/Zip: AAA cacouk 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 certt s and penalties o er'u that the information provided above is true and correct Si ature: 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#: I ro,,ti Town of Barnstable Regulatory Services 6, 'M Thomas F.Geiler,Director Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 Property Owner Must Complete and:Sign This Section If Using A Builder as Owner of the,subject property hPrebyauthorize SPRINKLE HOME IMPROVEMENT, INC. to act on my behalf, in all matters relative to work authorized by this building permit application for. (Address of Job) C � QA A1Z Signature of Owner Date Print Nacre I•f Pro'erty-.Owner is applying for permit please complete the .Homeowners-License Exemption Form on the reverse side. Q:FORMS.0-WNERPERTe[IBSION . f 12/20/2011 9 : 35 : 33 AM 8740 02/09 CERTIFICATE OF LIABILITY INSURANCE D"�12/20/2011 THIS CNRTIPICATE Is IOSUm As A MATTER Or INr0RAO1TION ONLY AND CONMRE 20 MOETO UPON TRE CERTIFICATE ROLM&. fag CERTIrICATE DOM NOT AFFIRAWXVELT on NESATIVELY AJOeND, EIITEND OR ALTER Tax COvsaaw Arrow= sy THE POLICIEs azLow. Tals CERTIFICATE Ol INSURANCE DOES NOT CONSTITUTE A CONTRACT ASTWEEN THE Iss0IN0 INSUREA(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND TEE i CiRTIfICATE WLDEi. IMPORTANT: If the 0rtiflcate holder is an ADDITIONAL IESURED, the poliey(Ses) Mist he endorsed. If SUBROONTION IS WAIVED, subject to the terse and conditions of the policy, certain policies Ray require an endorsement. A statement on this certificate does not confer rights_to the certificate holder in lieu of such andorseaent(s). PaODutaR Bryden 6 Sullivan Ins Agency Oleo Inc (VC. S.. sm): 88 Falmouth Road naauw Hyannis, MK 02601 Penn I•• Imam mSEColman"(P) wr{eame Caan" safe{ Sprinkle Home ImQraVemDnt Inc mPm a, A.I.X. Mutual Insurance Cc 33758 mum a, 199 Barnstable Road Inownss C. Hyannis, DA 02601 ISt11EY., ISSUES&S: mum r: COVERAGES CERTIFICATE NOMER: REVISION NW®ER: Tail IN TO COMMY 1MM TOM ROLZCZfi Or IfNORaNCS LZi7EL MILOW NAVE BEER ==M TD TER ZEN a am NOW TER POLMVT Pam ZEUM=700. i0'afTlli=MM Nat NNgazzoNsar, Tam OR COmrvzon Or Any corn Qr on Ozone DOcoosm WME zxx c TO aaa Tits ealase m Ely Y zssva0 an MAY . REM=, INS asrialC'i AfrOM ay TER POS.ICas DaiCiam aNRsa Is SUMMICT To ALL la leaf, McLUSIOEs AND OONDITMONS Of SUCi roL=Zu. LZKM faOWe MAX gave era REDUCED ER PAID CLU001. w POLICY NUMBER of rozj'y as LZEZTf { was Or INSOiAUCE ,rAa(rren -uwwaerten i OaaAL LZAZZLM - - sea oecueEPcs { - DeoP(rRCAL wnnAt LAPnirt Ramos To mm {; { PmiYf IS....wa..w) 00CLAIM7 McDi DOCCDR - m m MAY—P.s..a) { ws'L AG"ZO►TS LIMIT►PPLiSS IR: - - �a•I'E••SU•�s { D►CLICT DPAMCT pLOC - PUMIX_ Car/O ADS AUTCU eIIi LaaZLITIi Ce Mb{IMP A LIMIT 0Ar7 AUTO D ALL CtalD AUTOS - SwILY IS7M (P.t P---) { i DPCI<DO.tD►PCM .. .. e.. ROILY Ia7aI(a.r. IA. t) { D EIPtD AVIO! _ PaariRPr Ramie { (Pa.miMt) DaDE-OIOID AUTO{ { OORELLA LLa «CDI sea SCNiTiC[ { 1:19=933 LAa D CLADO M►De - A9SiiERTi { DIDUCTI tLt { DRMOTiOa t a0itaf O _ _ Poor LamOTM- AND■fLOYNER LIABILITY n TIE: PRO1?RI6'P0R/PARITILR!/ - t%LCIIPIVE O[fICOW Suet E.L. sAo(.eema.r { 500,000 A ® incl O excl 7004943012012 t.l. .IfViE -POLICY Lou? 500,000 01/01/2012 Ol/Ol/2013 S.L. PI{sats -RA metUM { 500,000 teamr{I MSMZ"lw er OPERATIONS OR LECAriO, i,)OBETRS' CCWCNSATION COVERAGE APPLIES TO MASSACHUSETTS UMLOYEE3 • lli _ I CERTIFICATE HOLDER CANCELLATION PROOF-Or INSURANCE saoULO ANY OF TER ABOVE OMORM in Rol== AN CAMCMZJM MWORa lER . EXPIRATION DASE TaisOV, NOT Ies WILL ERN DELIVERED IN AOCORMCs'M M - ' VOL=PROM2002. EmlMsalso RssRsssrnrn 5289 �l.l\\,11111♦ 'Il� 11, 'III. :t I•n f't,, , ::1 1{ull:lul•_ K. ••uI.111.,11, � c)flirruA'(in sumer.iimtrs staess ekuahoa -onstructlon > • !� HOME IMPROVEMENT CONTRACTOR + Registration: 103757 T Ype: 6643 Expiration: 7/9/2012 Private Corporatic 4 k' SPRINKLE HOME IMPROVEMENT. INC BRAD K SPRINKLE 190 LOTHROPS LANE Brad Sprinkle W BARNSTABLE, MA 02668 199 Barnstable Rd Hyannis MA 02601 1 ndersecretan- Y.c 10a62013 6004 I.Iccn.c ur registration %slid for individul use onh r Failure to possess a current edition of the heforr the expiration date. If found return to: ' isMassachusetts re State Building Code Office of('onsuruer Affairs and Business Regulation. is cause for revocation of this license. 10 Pail. Plaza-Suite 5170 fio.ton. NIA 02116 Referto: WWW.Mass.Cov/DPS v Not %alid without sign ore , ti r N6l -Al -N- 9• 13. 46 P 1`� 6• BH o O h XIST R=28. 92' EOUNOIN EXISTING • R N 2' 0g RESIDENCE g6•Al OAK � • 8, 674. 51 SF+\- NECK 0. 20 AC+\- ROAD o' N74 °19 ' 20"'W 8. 45 90. 00 ' 69,84' S83 °09' 00 W ����..ri OFSsq CERTIFIED FOUNDATION PLAN �o��VMICHAEL cyGN LOCUS:. 32 OAK NECK ROAD, HYANNIS, MA S. PREPARED FOR: SPRINKLE HOME IMPROVEMENT LADUE LADUE LAND SURVEYING DATE: 5/6/11 No. 37550 MICHAEL S. LADUE, P. L. S. SCALE: 1"=20 ' ��F a`� 51 CAPTAINS VILLAGE LANE -ss\o BREWSTER, MA 02631 av�'�° 508-896-6707 I HEREBY CERTIFY THAT THE FOUNDATION SHOWN ON THIS PLAN EXISTS ON THE GROUND AS SHOWN HEREON. NOTE: FENCES THAT EXIST ON OR ADJACENT TO LOT LINES ARE NOT DEPICTED ON THIS PLAN. M TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION i Map 3® Parcel Application #` IA G Health Division Date Issued 4 7� l Conservation Division 0k_ 7-,Application Fee Planning Dept. `Permit Fee q Date Definitive Plan Approved by Planning Board D �! Historic ' OKH _ Preservation/Hyannis V Project Street Address Q Village AYGLV1►1k,5 Owner _xyArc_ LaL N 0.M S Address _I oQ Frc(m i Telephone (o(-7 - 733 7c�%53' Permit Request C:0n Pc-,CA 0)01 O� X I("a, 0 � a����an 1"-,� " 4,O` Crate I S�CSC AC Square feet: 1 st floor: existing proposed 3A2Z 2nd Ilf xisting proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 1 , ova Construction Type C6n uen ' e7a)1y Lot Size o, g Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family ❑ Multi-Family (# units) Age of Existing Structure BuriF 0557 Historic House: ❑Yes A No 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 I F..II Half: existing 0 c:7° new(4--a Number of Bedrooms: 2 existing l new -� Total Room Count (not including baths): existing y new I First Floor Room Count, Heat Type and Fuel: ❑ Gas Oil ❑ Electric ❑ Other v Central Air: ❑Yes XNo Fireplaces: Existing New Existing wood%coal stove: ❑Yes ❑ No Detac#/Wgarage: ❑ existing ❑ new size_Pool: ❑existing ❑ new size _ Barn: ❑ existing C] nevus size_ Attached *e: ❑ 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 `nrn Proposed Used Kuhl IV APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name '5:0' rL'AkJe Telephone Number `-50%- 7'7 5 - I�1� Address V MiNCLECWK r1wU IE License # (n(ay3 NrainK MA 0260 Home Improvement Contractor# 103 75 7 Worker's Compensation # y9 y 301a20 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO I✓ahS L SIGNATURE DATE J. r FOR OFFICIAL USE ONLY z� APPLICATION# N '7 DATE ISSUED - MAP/PARCEL NO. co A ADDRESS VILLAGE •- OWNER DATE OF INSPECTION: _ FOUNDATION g FRAME INSULATION -7 ►��li FIREPLACE s ELECTRICAL: ROUGH FINAL a PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r :a DATE CLOSED.OUT ASSOCIATION PLAN NO. i The Commonwealth oj'Mussac'husetts Department oj'lndustrial Accidents 1 Ofj1C4'Oj'lnvestigations ,. 600 Washington Street Boston, Mass. 02111 st10111.ntuss.guv/diu ' Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information T Please Print Legibly !dame 1}3ttsiness:th�utization lnairidual): —Sprinkle HOITIe Improvement Address: 199 Barnstable Road City/State/Zip: Hyannis, MA 02601 Pbone#: 508 775-1778 FAre you an employer:' Check the appropriate box: T'wpe of project(required): I. I ant an employer with 4. 1 ain a .,cncral contractor and I ! � 6. ew construction m m employees (full an(Yor part tie).' have hired the sub-cuntt actors r 7. Remodeling I ant a sole proprietor or partner Itsteoi on the attached sheet. ship and have na emplovecs I hcsc ,ul?-couu;tctors h tvc (. Demolitiolt witrking for nic ill any capacity. enaplo\ccs and have workers' ( I I workers' comp. utsurance Dump, nlsurancc. + '7. k�uildin�a addition [No recluircdl �. We are It ct rpor ttton and its 10, h.lectrical repairs or additions I am a homeow ncr doing all �k ork officers h.tvc exercised their 1 I. P i myself [Nu �workct, comp. rt�ht ai cxcinphitn peens \1G1.. I lambing repairs or additions insurance reyuimdI t C. Ii2, § I(+). and we have no 112.. Roof repairs _ cvnployccz. [no workers' ! 1 Other ! camp. insurance rcdinrcd.) - -- Any applicant that checks box#I must also fill otu.the section hclow showing their workers'contpensa(ion police information. —� {'Homeowners who submit this affidavit indicatiur'they:are doing;all work and then hire outside contractors muss subati't a new affidavit indicating;such. Contactors that check this box must attach an additional sheet showing,the name of the sub-contractors and state whether or not those entities have employees. II' th m e sub-contractors have eployees,they must provide their workers'cmp.policy number. I ant an employer that isproviding workers'conywnsation ntsurance fir nt1 employees. Below is the policy and job site information. Insurance Company Name: Associated. Industries.of MA. Policy rr or.Sell=ins. Lic _ AWC 7004943012011 Expiration Date: pf C.tl - 20& Job Site Address: 3a �_� _�pOl r_� ( itviStatcl%ip: y_Gi.N_I.L1tS_�_i��_ (2y�= Attach a copy of the workers' compensation policy declaration page (showing;the policy number and expiration (date). Fallllt'C to secure coverage as recjuircd ttndu Section 251--1 of MGL 152 can lead to the imposition of criminal penalties of a fine LIP to S 1,500.00 and/or one year,.inlprisottnlent its \wel.1 as civil penalties in the form of a STOP WORK ORDER and a (Vine of S250.00 a day against violator. Be advised that<I copy of this statement tn;lybe forwarded to the Office of Investigations ofthe DIA fir eovera-e verification. /do herb 1"utr Ic pu is and penalties of peijury that the infarntation provided above is true and correct. Print Nam.. Brad Sprinkle /'/tone 508 775-1778 Official use onitt Do not wrile in this area to be completed by city or torten ojjic'ial City or'fo��n: Permit/license#: r i Issuing Authority(circle one): I r /.Board of Heath 2. Building; Department 3. Citv/Town Clerk 4. Electrical Inspector 5. Plumbing; inspector i 6. Other i I 1 Contact person: Phone#: 1 .CERTIFICATE OF LIABILITY INSURANCE DATE11/2/2010Y) 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 CONTACT Bryden & Sullivan Ins Agency P"�E FAX Inc (A/C. No. Eat): (A/C. No): E-MAIL 88 Falmouth Road ADDRESS: PRODUCER Hyannis, MA 02601 CUSTOMER IDe. INSURED(S) AFFORDING COVERAGE HAIC INSURED INSURER A: A.I.M. Mutual Insurance Co Sprinkle Home Improvement Inc INSURER B: 199 Barnstable Road INSURER C: Hyannis, MA 02601 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. POLICY NUMBER POLICY EFF POLICY EXP LIMITS LO` TYPE OF INSURANCE (aN/DD/YYYY) (Mf/OD/YYYY) GENERAL LIABILITY EACH OCCVMNCE $ ❑COMM.RCIAL GENERAL LIABILITY DMAGE TOERENTED A urrence) $ ❑❑CLAIMS MADE Flo- - MED EXP (Any one person) $ OPERSONAL L ADV INJURY $ ❑ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES ER: aPOLICY PROJECT ❑LOC PRODUCTS - CCHP/OPAGG S $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (ea accident) ❑ANY AUTO -- -- -- BODILY INJURY (per person) $ ❑ALL OWNED AUTOS ❑SCHEDULED AUTOS BODILY INJURY(per accident) $ PROPERTY DAMAGE HIRED AUTOS (per accident) $ NON-OWNED AUTOS $ EJ g ❑UMBRELLA LIAB ❑ OCCUR EACH OCCURRENCE $ EXCESS LIAR ❑ CLAIMS MADE AGGREGATE $ ❑DEDUCTIBLE $ ElRETENTION $ $ WORKERS COMPENSATION ® uc DTATU- OTH- AND EMPLOYEES LIABILITY roux LIMITSy THE PROPRIETOR/PARTNERS/ EXECUTIVE OFFICERS ARE E.L. EACH ACCIDENT g 500,000 A E.L. DISEASE -POLICY LIMIT ® incl ❑ excl 7004943012011 01/01/2011 01/01/2012 $ 500,000 E.L. DISEASE -EA EMPLOYEE $ 500,000 COMMENTS /DESCRIPTION OF OPERATIONS OR LOCATIONS: CERTIFICATE HOLDER CANCELLATION EFI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 40 WASHINGTON ST POLICY PROVISIONS. SUITE 2000 WESTBOROUGH, MA 01581 AUTHORIZED REPRESENTATIVEG2 '\ iiu,,achtl�rt[� I)rl>.rrunrnr ++i 1'111tlic �nfrt� v �.. 1J6%lLJIL(J•I-.U,BCLG i2• !y..,1'G wGG!'1G[cfxcu PJ i �A Board of 13tnitiitt•� Rc�•_ulati++tte and `tattlLtt't°s � Office�ot�ConsumerAf`t{airs&B Siness egulahon Construction Supervisor License `� <<HOME IMPROVEMENT CONTRACTOR Registration: 103757 Type: License: CS 6643 - rUff r , Expiration: 7/9/2012 Private Corporatic Restricted to: 00 " SPk NKLE HOME IMPROVEMENT, INC. BRAD K SPRINKLEt'w ; t 190 LOTHROPS LANE "' ` ��„ Brad Sprinkle W BARNSTABLE, MA 02668 4. ' 199 Barnstable Rd: a,ti����G3__. Hyannis, MA 02601 Undersecretary �-�— Expiration: 10/8/2011 -- ( „n,ui•.i„m•r Ti 5478 Restricted to: 00 License or registration valid for individul use only 00- Unrestricted before the expiration date. If found return to: 1G-1 2 Family Homes Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 + Boston,MA 02116 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. Not valid without sign ture Refer to: WWW.Mass.Gov/DPS g y� 7th Edition Massachusetts Building Code � �._4 Mass. Version of the WFCM 110 MPH Exposure B.Checklist IvlCKf Nl I`E Summary of Construction Requirements' ENGINEERING CONSULTANTS Project: Williams Addition, 32 Oak Neck Rd. Hyannis structural•civil"environmental • Per review of location, site is Exposure B • The Mass Checklist has been satisfied for the proposed addition. m Standard framing connection requirements: y Table 2 from WFCM manual Anchor Bolt Requirements: 5/8"bolts spaced 71 o/c with minimum embedment of 7" into concrete. Additionally, a bolt must be placed between 6" and 12" of each corner. All sill plates to be connected using 3"x3"x l/4" square plate washers Floor Construction Requirements: First two joist bays of the floor framing to be blocked with 2x lumber 4' on center for the length of the joist. Sheathing to"be nailed in accordance with Table 2 (8d nails,_6 �n f spacing at the edges and 12 inch.spacing in the field). • Exterior Wall Requirements: ` f�. ;; All exterior wall.studs to be 2x4 or 2x6 16" on center. Note that since the addition has a cathedral ceiling, the gable end wall requires full height 2x6 studs at 16" o/c running 7Y 4W �'x >afrom the floor box up to the under side of the roof rafters with double top plates. The s, double top plates on the exterior walls to have a splice length of 2 feet and splices are to be nailed with 6— 16d nails in accordance with Table 6 in the WFCM 110/B booklet. Nailing of plates to studs to be with 2- 16d nails. The bottom plate to floor box nailing his 3- 16d nails per foot for walls on all elevations. K jY For all door and window openings, multiple king studs are required. For openings up to *'= 4 feet wide, 2 king studs are required, for.opening 5 feet to 9 feet wide, 3 kings studs are required, and for openings 10-12 feet wide, 4 king studs are required. For shear and uplift connection of the sheathing, the sheathing is to be nailed 6"on center at the edges and.12" for all elevations. All nails are to be 8d or equivalent gun nails (A 1 x 2 '/2")., In order to eliminate the need for steel strap ties and hold downs per.-the WFCM manual, sheathing must be installed and nailed in accordance with Note 4 on the Mass Checklist. This includes using full sheets of sheathing running from the PT.plate at the foundation up to the top plate of the walls (Note 4 Sheet attached). 1.279 Millstone Road Brewster,MA 02631 t 774.353.2144 f 774.353.2142 www.mckengineers.com Roof Framing Requirements: Roof rafter connection to the.top plate requires Simpson H2.5A hurricane clips with 2x blocking between rafter bays toe nailed to the rafters with 4- 1 Od nails per side. If blocking is not desired, Simpson H-10 or H-14 hurricane clips can be substituted and installed on every rafter. All clips to be installed in accordance with Simpson requirements. Roof sheathing to be nailed using;8d or equivalent nails 6 on center at the edges, 6"on center in the field. The first two bays between rafters are required to be blocked 4 feet on center at all gable ends per the WFCM. Limitations and Contractor Responsibilities The contractor must refer to the Tables and Figures within the WFCM 110 MPH Exposure B booklet for illustrations and requirements discussed within this summary. All connections and nailing must meet the requirements herein and as illustrated in the booklet in order to be in compliance with the building code. The contractor is responsible to ensure all connections, nailing, and anchor bolts are visible to the inspector at the time of the framing inspection/foundation inspection. The contractor must reference the Simpson Strong Tie C-2009 catalogue for all strap, hangar, and tie installation requirements and limitations. This document and the attachments as well as a copy of the WFCM booklet must accompany all sets of plans submitted to the building department and issued to the contractor/subcontractors unless the plans are updated with notes and details that reflect the requirements stated in this document and _. attachments. This review was completed on_plans by Betsy Laughton dated 3-17-11 and was based on the floor plans and elevations provided. Any changes to these plans or field changes made may render the requirements outlined in this document null and void and could result in non-compliance with the,requirements of the wind design. H OF CIVIL Mark A. ( , Pres., Mn� Consultants, Inc. Atch: Mass. Checklist �a��oNnt E�°�� AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 Gtl I!I iQv►+-s Add►' 3 20 axc Me-r,L QIL gy aM1 i S Check 1.1 SCOPE Compliance Wind Speed (3-sec. gust)........................................... ...................... .................................................110 mph Wind Exposure Category.................................................................. ............... .................B _ice 1.2 APPLICABILITY Number of Stories(a roof which exceeds 8 in 12 slope shall be considered a story) / stories s 2 stories ✓ RoofPitch ..........................................................................(Fig 2) .............. (�'.�z 5 12:12 ` Mean Roof Height .............................................. (Fig 2)......... ............411 :580' ft s 33' v Building Width,W ......................................:..,..,....:............(Fig 3)................ ............................... ft s 80' Building Length, L .....................................:........ ......:........(Fig 3 ....................... �c ( 9 ) .........................._ v Building Aspect Ratio(LAM .........................:....................(Fig 4)................................................. • :1 5 3:1 v Nominal Height of Tallest Opening2 .:.................................(Fig 4)..................................................1�s 6'8" 1.3 FRAMING CONNECTIONS General compliance with framing connections...................(Table 2)..... 2.1 FOUNDATION Foundation Walls meeting requirements of 780 CMR 5404.1 Concrete...................:.........................................:....................:....................... (/�.................... Concrete Masonry ................................................ A/& 2.2 ANCHORAGE TO FOUNDATION'-' 5/8"Anchor Bolts imbedded or 5/8"Proprietary Mechanical Anchors as an alternative in concrete only Bolt Spacing-general ................................. ........(Table 4)............................................... in. Bolt Spacing from end/joint of plate ............................(Fig 5)....................................T in.s 6"-12" . �C Bolt Embedment-concrete...........................:.............(Fig 5).................................................._2 in. >_7" ✓' Bolt Embedment-masonry............................:............(Fig 5)........................I.................... in.a 15" K/A Plate Washer........... ....................................................(Fig 5).......................: z 3"x 3"x'/" f" 3.1 FLOORS Floor framing member spans checked ...............................(per 780 CMR Chapter 55)................:.................. Maximum Floor Opening Dimension........................... .. ....(Fig 6).._.............. ft:5 12' -� . . ............................:.... Full Height Wall Studs at Floor Openings less than 2'from Exterior Wall(Fig 6)...................... Maximum Floor Joist Setbacks """" " Supporting Loadbearing Walls or Shearwall ............(Fig 7).......... ............................. ......a ft s d Maximum Cantilevered Floor Joists Supporting Loadbearing Walls or Shearwall................(Fig 8).................................................... Oft 5 d (� Floor Bracing at Endwalls...................................................(Fig 9)...... -�- .. Floor Sheathing Type .......:.....................:.:..'.....................(per 780 CMR Chapter 55)......�'�t!O!yr ...... Ci Floor Sheathing Thickness ... .... ... .......(per 780 CMR Chapter 55)................... in. �- Floor Sheathing Fastening .:.. "" (Table 2).. nails at_(e in edge/,[�in field 4.1 WALLS Wall Height Loadbearing walls....................:......:............................(Fig 10 and Table 5)........................... ft :510, I/ Non-Loadbearing walls................ ....... .......................(Fig 10 and Table 5)............... Wall Stud Spacing ................................ .......................(Fig 10 and Table 5)...................u2 in.5 24"o.c. t7` Wall Story Offsets .... ............(Figs 7&.8).................... . .........,�ft s d 4.2 EXTERIOR WALLS' Wood Studs Loadbearing walls..... ...........(Table 5)..............................2x ft in. Non-Loadbearing walls......... ....` ...:.................:.(Table 5)..............................2x�-�ft in. Gable End Wall Bracing' -� !� Full Height Endwall Studs............................................(Fig 10)........ WSP Attic Floor Length.................... ........................(Fig ft zW/3 d� ( 9 11)........ Gypsum Ceiling Length(if WSP not used)..................(Fig 11)........ ....:... ......... ft z 0.9W NA and 2 x 4 Continuous Lateral Brace @ 6 ft.o.c. .. (Fig 11).............. or 1 x 3 ceiling furring strips @ 16"spacing min.with 2 x 4 blocking @ 4 ft.spacing in end joist or truss bays PVA Double Top Plate - / Splice Length . ......... .......................(Fig 13 and Table 6)..................................... ft D' Splice Connection (no of 16d common nails).............(Table 6)................ .. .......— "v AWC Guide to Wood Construction in High Wind Areas: 110 mph Wind Zone Massachusetts Checklist for Compliance(780 CMR 5301.2.1.1)1 Loadbearing Wall Connections Lateral (no. of 16d common nails).....:...:.......:..... . .....(Tables 7)................:............... . Non-Loadbearing Wall Connections t� Lateral(no.of 16d common nails)............::. ............ (Table 8)......................... y f Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) Header Spans (Table 9)....: ...:.....:...........:.... ft b in. 5 11'Sill Plate Spans (Table 9)....: .:.. .. �.. ft in.s 11' .� Full Height Studs (no.of studs) ...., a � ���•'�"" (T,ble 9) .:.:.................:......... Non-Load Bearing Wall Openings(record largest opening but check all openings for compliance to Table 9) ,Header Spans.................... ....:......(Table 9)............_.......: ..... ......s�ft. D in. s 12' ✓� • Sill Plate Spans........:....................:. ....(Table 9)..... ...: — Full Height Studs(no.of studs)....:... """ ft(�in.5 12- 1. ....:........(Table 9)................ 1C Exterior Wall Sheathing to Resist Uplift and Shear'Simultaneously4 - Minimum Building Dimension, W Nominal Height of Tallest Opening2 .....:....:.......:....:......_.....:. ...................................... Type........................ . G 85 6'8- Sheathing t/ . ...............:...:(note 4)............. . � Edge Nail Spacing ................:......................�� 9 .......................... . (Table 10 or note 4 if less)........................Ja_in. � .. ............ Field Nail Spacing..........................................(Table 10)..:..............................................�in. Shear Connection(no. of 16d common nails)(Table 10)...................................:................... V, Percent Full-Height Sheathing....................:..(Table 10)........................... . . 5%Additional Sheathing for Wall with Opening>6'8"(Design Concepts)........... Maximum Building Dimension, L �A- Nominal Height of Tallest Openins2.:.:........... ......................:........:......................!!L�8 s 6'8" t/ Sheathing Type................................:..:.....:....(note 4)...........:.......................................... Edge Nail Spacing..........................:. •••,•••......(Table 11 or note 4 if less)........................�i_in. t Field Nail Spacing................................... .....(Table 11) Shear Connection (no.of 16d common nails """"-� ' in )(Table 11).......:............................................... Percent Full-Height Sheathing.........::............(Table 11)............. . . ... . _e 5%Additional Sheathing for Wall.with Opening>6'8"(Design Concepts)............. t� Wall Cladding ......o Rated for Wind Speed?.......... �l 6.1 ROOFS Roof framing member spans checked?.......: .. .:.....(For Rafters use AWC Span Tool, see BBRS Website) Roof Overhang ...... ........(Figure 19)..............__L ft s smaller of 2'or U3 Truss or Rafter Connections at Loadbearing Walls Proprietary Connectors Uplift . .......:..,*. (Table 12):.... U=B&pif Lateral (Table 12)..._: .... .........L=��Plf Shear :: ......:(Table 12).............................................S=_ pi f V Ridge Strap Connections, if collar ties not used per page 21... (Table 13 .42 Gable Rake Outlooker...,... ) ............ . ..........T=.LZL�PIf c_- .•..*. ........(Figure 20).. .......... O ft:5 smaller of 2'or U2 ✓Truss or Rafter Connections at Non-Loadbearing Walls . Proprietary Connectors Uplift........: ....................U=4 ....... .(Table 14)..:.................. .. Lateral(no. of 16d comrimon nails)...(Table 14)......................... .. Z.� ...........L= lb. Roof Sheathing Type.............:...........:.......:.: *" .........(per 780 CMR Chapters 58 and 59 Roof Sheathing Thickness..... ,� ) .Z 7M! p .... .................................... Roof Sheathing Fastening..... (Table 2).................: Notes: ............................................... . t� 1. This checklist shall be met in its entirety, excluding the specific exception noted in 2,to comply with the requirements of 780 CMR 5301.2.1.1 Item 1. If the checklist is met in its entirety then the following metal straps and hold downs are not required per the WFCM 110 mph Guide: - a. Steel Straps per Figure 5 b. 20 Gage Straps per Figure 11 C. Uplift Straps per Figure 14 d. All Straps per Figure 17 e. Corner Stud Hold Downs per Figure 18a and Figure 18b 2. Exception:Opening heights of up to 8 ft. shall be permitted when 5%is added to the percent full-height sheathing requirements shown in Tables 10 and 11. 3. The bottom sill plate in exterior walls shall be a minimum 2 in. nominal thickness pressure treated#2-grade. > � Town of Barnstable Regulatory Services ! Thomas F.Geller,Director MAB& ► E 16 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 Property Owner Must Complete and Sign This Section If Using ABuilder I, ,V-GL a INkS ,as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized by this binding permit application for.. .(Address of Job) signature of Owner i?ate \ Print'Name If Property er is applying for permit please complete the Homeowners License Exemption Form on the reverse side. f1•.Ff1RMC•f1WNARPF.R1yfT.CC1f�N . 1 r , 1 -N N6� g.�_ 13. 46 ' OS _ NN ,, 6H O �o 5p ' �O.�jA 40 EXISTING R 2' A=16. 00 51' P RESIDENCE g0 OAK R=28. 9 . NECK - 0 4. 20AC+ SF+\- \ ROAD 90. 000 N� 8. 45 ' 4 19 '20„W 69,84' S83-09' 00°W CERTIFIED PLOT PLAN LOCUS: 32 OAK NECK ROAD, HYANNIS, MA MicSAEL yGs �. r PREPARED FOR: SPRINKLE HOME IMPROVEMENT LAoUE LADUE LAND SURVEYING���'. DATE: 10/8/10 No. 3 7 560V MICHAEL S. LADUE, P. L.S. SCALE: 1"=20 ' \ yy. 51 CAPTAINS VILLAGE LANE BREWSTER, MA 02631 I HEREBY CERTIFY THAT THE STRUCTURES SHOWN ON tC1 �rI (G 508-896-6707 THIS PLAN IST ON THE GROUND AS SHOWN HEREON. TE: NCES A EXIST 1. S . LINESARENOTDEPICTEDR N LOT ON THIS Town of Barnstable � ���— Expires 6 months frou 'ssue date Regulatory Services Fee Thomas F.Geiler,Director Building Division Tom Perry,CBO, Building Commissioner . 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us --Office: 508-8624038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number .3 0 Property Address c3c �. N L-e-� 1'(�Cid } a✓1 A (V\P` cR to o l 1�J Residential Value of Work' Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address S,�-, ✓X A V-C ) It ,6 V-y C Contractor's Name Ot i A Ic I C6►'1'1e X✓►\prGV-e mP_rj Telephone Number '507� S-11 118 Home Improvement Contractor License#(if applicable) 10315 7 Construction Supervisor's License#(if applicable) XPRE Vorkman's Compensation Insurance - S Check one: . RMIT ❑ I am a sole proprietor JUL 2010 ❑ I am the Homeowner -15 9,1have Worker's Compensation Insurance TOWN OF BARNSTABLE Insurance Company Name Q,-�—nac+ajtA Zv1&LLS4-r-,,e S 4 Workman's Comp.Policy# II.J(— 700 49 4 301 oZ00fi Copy of Insurance Compliance Certificate must accompany each permit. . . 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 _ #of doors - 0 Replacement Windows/doors/sliders.U-Value 3S (maximum.44)#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 me Improvement Contractors License&Construction Supervisors License is re SIGNATURE: Q:\WPFflM\FORMS\building permit fonns\EXPRESS.doc Revised 090809 The Commonwealth of Massachusetts Department of Industrial Accidents Off lce of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ayulicant Information Please Print Legibly Name(Business/Organ ization/Individual):S ll r;y)Ide— A w T'rY%n roVe.tnPn� Address:— City/State/,Zip: 4VIA6 MA od(001 Phone#: _66,�- 7 7.5 - l-77 3 Are you an employer?Check the appropriate box: Type of project(required): E ey 1. i am a employer with _ 4• ❑ 1 am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 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 m working for e in any capacity. employees and have workers' g ❑Building addition [No workers'comp.insurance comp.insurance.t 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 11.❑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.❑OthetQeP 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. tContnactors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors 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: })SSOC. Policy#or Self-ins. Lic.#:A LAJC Zoo q 9 q 3Cb(ab ll7 Expiration Date: Ol _ Job Site Address: 3 Oi L M"94- City/State/Zip:_Hyo✓Iyl CQ(Qc}' 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 Investi ations of the DIA r insuLaacVZoverage verification. 1 do hereby ce nd a td penalties of perjury that the information provided above yis true and correct Si nature: Date' `Z G` t a Phone #: �' 7 -)h 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#: ero�� Town of Barnstable ° Regulatory Services Thomas F.Geller,Director ' y Building Division Tom Perry,Building Commissioner G 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 a Property Owner Must Complete and Sign This Section If UsinLy ABuilder as Owner of the subject property hereby authorize to act on my behalf, in all matters relative to work authorized b)fthis binding permit application for. d MA .(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. n-PnRMCd1WNFRPFRwY.C.ginw ` = Ro® CERTIFICATE OF LIABILITY INSURANCE OP ID Ds FDATE(MMIDDlYYYY) SPRIN-1 01/05 10 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 I Phone: 508-775-6060 Fax:508-790-1414 41NSURER INSURERSAFFORDINGCOVERAGEINSURED - A: Associated Industries of MA^ `INSURER B: -� Sprinkle Home Improvement' Inc. INSURER 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 SE 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 �pAp�EOMM/EDDnYYY DATE MM/ODIYY VIE POLICY YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY _;,' I PREMISES Ea occurence $ _ CLAIMS MADE OCCUR I MED EXP(Any one person) $ II—PERSONAL&ADV INJURY $ GENERAL AGGREGATE --�—$— GEN'L AGGREGATE LIMIT APPLIES PER: i PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC j t JECT AUTOMOBILE LIABILITY j - COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO ALL OWNED AUTOS T i BODILY INJURY I$ SCHEDULED AUTOS I •^ (Per person) I HIREDAUTOS j I BODILY INJURY NON-OWNED AUTOS J(Per accident) $ _ PROPERTY DAMAGE - - I (Per accident) _ I$ GARAGE LIABILITY i AUTO ONLY EA ACCIDENT $ — ANY AUTO OTHER THAN EA ACC $ _i. AUTO ONLY: AGG $ EXCESS I UMBRELLA LIABILITY ' I EACH OCCURRENCE $ OCCUR CLAIMS MADE' AGGREGATE $ $ = DEDUCTIBLE III $ RETENTION $ — WORKERS COMPENSATION AND EMPLOYERS'UABIUTY TORY LIMITS ER A ANY PROPRIETOR/PARTNERIEXECUTIVEt—] AWC7004943012010 Ol/Oi/10 I 01/01/11 E.L.EACH ACCIDENT $500000 OFFICERIMEMBER EXCLUDED? -- (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $500000 It yes,describe under SPECIAL PROVISIONS)elow E.L.DISEASE-POLICY LIMIT $500000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE"HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION SPRNKHO DATE THEREOF,,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE To THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Sprinkle Home Improvement, Inc IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR Fax #508-775-1350 REPRESENTATIVES. Margo Mack AUTHORIZED REPRESENTATIVE 199 Bar st Ole Rd Kelley A.Sullivan gyannis ACORD 25(2009/01) ©1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 10o7iv� smess cgu a on Y Of e.ot`Consume arr V x g License or registration valid;for individul use onl HOME IMPROVENII=NT CONTRACTOR before the expiration date. If found return to: Registration: t)3757 Type Office of Consumer Affairs and Business Regulation Expiration: 12 Private Corporati(1 c� 10 Park Plaza Suite.5170 --—- Boston,MA 02116: S KLE MOM 'jNC. 1 "W �` Brad Sprilkie 199 Barnstable#Zcl Hyanrtis;`Mk 020Ji L Ub'd rsecretaiy Not valid Without-sign.tu:re M�tssilchusetts- Department of Public,:$1tfet}' Restricted to: OO Board of Buildim, Re;ulations an(I S#xn(f<trds Construction Supervisor License i 00- Unrestricted 1G-1 2 Family Homes License: CS 6643 Restricted to: 00 . / /f�l'i BRAD K SPRINKLE�; ;�,. I Failure to,possess a current edition of the I 160 LOTN'ROPS LAN f< i Massachusetts State Building Code I is cause for revocation of this license. 1N BARNSQBLE, MA 02668 Refer to! WWW.Mass.Gov/DPS i Expiration: 10/8/2011 ('unimiaiunrr Tr#: 5478 Town of Barnstable *Permit# Expires 6 months from issue date �1• ulatory Services Fee e9.' Director JUL 3 V u�'ji ryding fi� asion 1'O� T m Perry, , Building Commissioner O C� N �r2GR ee Hyannis,MA 02601 .to table.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 Property Address `50 Residential Value of Work c�k� Minimum fee of$25.00 for work under$6000.00 Owner's Name&Address �CltsL �. Contractor's Name Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be on file. Permit Request(check box) ❑ Re-roof(stripping old shingles) All construction debris will be taken to Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. \\Home Improvement Contractors License is required. SIGNATURE: Q:Forms:expmtrg Revise071405 77 �S 1 ne L ommonweacrn uj lvlu�surnuseua Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plu>il fibers A_ pplicant Information Please Print Legibly Name (Business/organization/Individual): c c�rC�� 'r � Address: City/State/Zip: Phone Are you an employer? Check the-appropriate box: Type of project(required): 1.❑ I am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contracto$ Remodeling 2.El am a sole proprietor or partner- listed on the attached sheet 7. ship and have no employees These sub-contractors.have 8. ❑ Demolition working for mein any capacity. workers' comp.insurance. g, ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 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' 1.3.7 Other 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. lContractom that check this box must attached an additional sheet showing the name of the sub-contractors sad their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andjo,4 site information. Insurance Comp any Name: Policy#or Self-ins.Lic. #: Expiration Date: Job Site Address: 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$1,50Q.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 certify under the pains and penalties of perjury that the information provided above is true and correct Signature: �ls°` .. � Date: Phone Official use only. Do not write in this area, to be completed by city or town official. 1 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 1 6.Other Contact Person: Phone#: Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." An employer is defined as "an individual,partnership, association, corporation or other legal.entity, or any two or more of the.foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the ' dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or . renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the Insurance coverage required." Additionally,MGL chapter 152, §25C(7)states`Neither the commonwealth nor any of its political subdivisions. shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance reg,-djements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials . Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom. of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would hike to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 w 1-8077-MA SSAFE. pax# 617-727-7749 Revised 5-26-05 wv.mass.izov/c"iia GO N STRU GTI O N TO`GO N FORM TO THE ---------------- ---- -- ---------- -- - -------- i WFGM 110 MPH EXP05URE B MANUAL -------------- - NOTE5: 20'-ADDITION 1 c All construction to conform to E .o' 780 GMR MA State Building E 10' o w SPRINKLE HOME IMPROVEMENT Code,lth Edition S �� DETECTORS REVIE 199 Barnstable Rd. x z/aw>s (2�1 �x II h°bE eey o-� All sheets of ply sheathing Mal Hyannis, MA 02601 to be installed vertically,or ry Jv horizontally with blocking at BARNSTABLE BUILDING DEPT. DATE 1 e3 4'b" edges,3"edge/12"field nailing _��� gy m I I BEDROOM v �o I clipped ceiling in Follow all manufs specs for I I 3 installation of all Sim son FIRE DEPARTMENT DATE; „3 v p 2 b 16'-3 1/2" components p BOTH SIGNATURES ARE REQUIRED FOR PERM I ,W-5 17 — I BUILT-IN SHE ING � J all trim, rake, fascia s c_mD p ® o 2x10s @ 16 oc and soffit to match existing IMPORTANT- UPGRADE REQUIRE .- size and location o o R-35 ins. �\ I3/4IC II'le t.w.s Cont. ridge vent ENTRY 1 no to te:RIDGE o J STATE BUILDING CODE REQUIRES T F Q I 51b" COX ply sheathing SMOKE DETECTORS FOR THE ENTIRE D N structural ridge 15# felt ONE OR MORE SLEEPING AREAS ARE ADD OR CREA� OEMj propa-vent between rafters W 2x6 collar ties @ 16 oc NOTE: A SEPARATE PERMIT IS RE U RED - IN10 (2) Simpson H2.5 hurricane i °a BATH - o�i '� clips at all rafter ends 6:12 pitch INSTALLATION OF SMOKE DETECTORS-T E ELERI AL �, I x PERMIT DOES NOT SATISFY THIS REO IR MENT-. 30-year laminated roofing � c U) tlJ cased opening @ 4-6 x 3-0 shower sink vanity i Q existing door with seat w/extended stack N QO vent I ! 16 counter Cont. soffit 61 6 31 -6^ „ 2 1/2" Colonial trim, �� m I existing a, existing BEDROOM 2x4s @ 16 or, casing, baseboard ry u 2x10s @ 12 or-OR :? LIVING ROOM to match existin 0 2x12s 16" OG OR remove/relocate 1/2' ply sheathing 9 @ X n (2)existing window I R-19 ins L1/Ls per man ufs specs o vinyl clapboard walls to be bluebd I I R-30 ins. o and plaster . �I box sills and bridging E g 3/4 T&G, subfloor E 0 2x6 PT sill w/sealer and j ca v anchor bolts install anchor bolts at ,. N I 4b" max. w/Simpson © S� y X BPS bearing plates 8 ( o.Ui place bolts w/in 6"-15" of each corner and to 20, b" min. depth j ! i ! 8" conc. fnd. wall on -s U) existing existing BEDROOM 1 1 16"xb" deep Cont. KITCHEN o conc. ftgs. @ 4-0 1 Date: I below grade 1-16-11 - f SECTION CAS PROP05ED ADDITION scale: 1/4"=1'-0 existing BATH 1 j Revisions and �NOF Final Plans: - 22511 -- �-.. i 3 2-.11 MARK A. ` ZIE I �� �Q/S T EKE��►� 32' �sS1ONAl.�a6 FLOOR PLAN scale:3/16=1'-0" I BUILDER TO CONFIRM ALL CONDITIONS • 673P4 'v n�� AND DIMEN51ON5 ON 51TE 1 �