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HomeMy WebLinkAbout0039 MEADOW LANE 0 r �I/II __� `�RECYCIfppo OO z rur - UPC 12543 No. 53LOR o�OpST.CoNJ�p HASTINGS, MN n. - - iiii __ (IN - Town of e Barnstabl Building Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept I i63p 163 $ Posted Until Final Inspection Has Been Made. . �0 taro•<° Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit - Permit No. B-20-1714 Applicant Name: JOHN A LEBOEUF Approvals Date Issued: 08/05/2020 Current Use: Structure Permit Type: Building-Addition/Alteration-Residential Expiration Date: 02/05/2021 Foundation: Location: 39 MEADOW LANE,WEST BARNSTABLE Map/Lot: 133-005-003 Zoning District: RF Sheathing: Owner on Record: CHAPMAN,WILLIAM G&MONTHIAN Contractor Name: JOHN A LEBOEUF Framing: 1 4 Address: 39 MEADOW LANE Contractor License: CS-010161 2 WEST BARNSTABLE, MA 02668 I Est. Project Cost: $50,000.00 Chimney: Y Description: Build New 8+18-6 Mud Room 1 Permit Fee: $305.00 y Insulation: REVIEWER'S NOTE:Actual dimension shown on plan is 8 by 18'6". Fee Paid: $305.00 RMCK �� Date: 8/5/2020 Final: Project Review Req: wl Plumbing/Gas Rough Plumbing: '.Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within'six months after issuance. All work authorized by this permit shall conform to the approved application and the'approved construction documents for which this permit has been granted. Rough Gas: All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoriing 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 inspection for the entire duration of the Final Gas: work until the completion of the same. f j Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this,permit. Minimum of Five Call Inspections Required for All Construction Work:f Service: 1.Foundation or Footing 2.Sheathing Inspection _ Y Rough: 3.All Fireplaces must be inspected atthe throat level before firest flue lining is installed Final: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) Low Voltage Rough: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health 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). fi Fire Department Building plans are to be available on site '� All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT Final: R- z®� pf tHE tp Application Number.... ............� l ....1.................................. BARNSrABLE. * ` /I Y O�•Q O 1asAes. V Permit Fee.................................Zoning District........................ �n 111 039. ��FO MA'S A TotalFee Paid ........................................................... .. ...... �DS yp�O TOWNOF BARNSTABLE Permit Approval by....R.'........................on.... ...... ............. BUILDING PERMIT _ Map.....1 r.3.3`y...........................Parcel...fl® ................................... APPLICATION Section 1 — Owner's Information and Project Location Project Address 3!2 Village Ajea 4,,A/c /t-Hill- Owners Name i/da 4, a& Owners Legal Address 6 Q-AAIS Ia- b 1� City-jk) , .ys�l fig State 4404 Zip D.266-F— Owners Cell # - E-mail Q '� Section 2 -Use of Structure . Use Group ❑ Commercial Structure over 35,000 cubic feet . _:. �` ❑ Commercial Structure under 35,000 cubic feet esingle/Two Family Dwelling Section 3 - Type of Permit ❑ New'Construction ❑ Move/Relocate ❑ Accessory Structure ❑ Change of use El Demo/ (entire structure; ElFinish Basement ElFamily/Amnesty ❑ Fire Alarm ebuild ❑ Deck Apartment ❑ Sprinkler System. Addition ❑ Retaining wall 0 Solar ❑ Renovation El Pool ❑ Foundation Only Other-Specify Section 4 - Work Description 122 61�6 1?06 ��_ Last updated: 1/31/2020 Application Number.................................................... Section 5—Detail l Cost of Proposed Construction ® 0 Square Footage of Project f�� Age of Structure 31 (4iAte5*. Dig Safe Number g4l q # Of Bedrooms Existing Total # Of Bedrooms (proposed) 0 110 MPH Wind Zorie Compliance Method Ev/MA Checklist ❑ WFCM Checklist ❑ Design Section 6— Project Specifics • 4 . ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors j ❑ Plumbing ❑ Gas ❑ Fire Suppression ❑ Heating System ❑ Masonry Chimney ❑ Add/relocate bedroom Water Supply ❑ Public Private Sewage Disposal ❑ Municipal ❑ On Site Historic District ❑ Hyannis Historic District IV/ Old Kings Highway Debris Disposal Facility: I am using a crane ❑ Yes 2 No Section 7 — Flood Zone a Flood Zone Designation Within or adjacent to a wetland, coastal bank? Yes ❑ No j Section 8 — Zoning Information Zoning District Proposed Use/22t,14 O°D/X--' Lot Area Sq. Ft. 13, -7o 6 Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed Rear Yard Required Proposed Side Yard Required Proposed Has this property had relief from the Zoning Board in the past? ❑ Yes ❑ No Last updated: 1/31/2020 Application Number........................................... Section 9— Construction Supervisor Name Telephone Number Address �; d . City ��/!/�i'I//�£ State�>4.Zip � �-- License Number (3101 License Type (J rf xpiration Date qf�0 a Contractors Email F� L- /I�A�� ' Cell # F I understand my responsibilities under the rules and regulations for Licensed Construction Supervisor in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation requlwfd by 780 CMR an the Town of Barnstable.Attach a copy of your license. Signature Date Section 10 —Home Improvement Contractor Name 1 its L Telephone Number Address State Zip Registration Number 779 7,� Expiration Date I understand my responsibilities under the rules and regulations for Home Improvement Contractors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and documentation quired by 780 CM Rand the Town of Barnstable.Attach a copy of your H.I.C... i Signature Date FL/ tion 11 — Home Owners nse Exemption Home Owners Name: Telepho m er Cell or Wor ber 1 nderstand my responsibilities under the rules and regulations for Licensed Construe ' Supervisor in accordance with 780 CMR the Massachusetts to a Bu�lUing_Code_._I understand the construction-inspection proc ores,specific inspections and documentation required by 780 CMR and the Town of Barnstable. ' Signature Date APPLICANT SIGNATURE Signature Date C) 01Q0 LL I - __ 0 g� 4// �) Print Name GUa'�1� Telephone Number Og �' E-mail permit to: o"F® 611,9,0;1, Cam Last updated: 1/31/2020 Section 12 — Department Sign-Offs Health Department ❑ Zoning Board (if required) ❑ Historic District ❑ Site Plan Review(if required) ❑ Fire Department ❑ Conservation ❑ For commercial work,please take your plans directly to the fire department for approvak Section 13 — Owner's Authorization 15 �- as Owner of the subject property hereby authorize to act on my behalf, in all matters r tive to work authorized y this building permit application for: (Address of job) Az Signature of Owner date Print Name Last updated: 1/31/2020 The Commonwealth of Massachusetts Department of IndustridAcci&nts Office of InvaWgations 600 Washington Street Boston,MA 02111 www.mass govIt a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Organ mWon/Individual)' Zac Address: eff. Fe.? �1 City/State/Zip: s ' Phone M Are you a-n employer?Check the appropriate box: Type of project(required): 1.❑ ;Tployees a employer with 4. ❑ I am a general contractor and I (full and/or part-time).* have hired the sub-contractors 2. ❑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 working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers'comp.insurance comp'msurance.t 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions requured] officers have exercised their 11. Plumb' repairs or additions 3.❑ I am a homeowner doing all work ❑ � myself.[No workers'comp. right of exemption per MGL 12.❑Roof repairs insurance ]t C. 152,§1(4),and we have no employees.[No workers' 13.E]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 contactors must submit a new affidavit indicating such. tr—ontractors 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 sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is p oviding workers'compensation insurance for my employees Below ' poli'cy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: City/StatelZip: Attach a copy of the workers'come on policy declaration p showing the policy number and expiration date). Failure to secure coverage as under Section 25A of MGL c. 152 to the imposition of criminal penalties of a fine up to$1,500.00 one-year imprisonment,as well as civil penalties in the of a STOP WORK ORDER and a fine of up to$250.0 y against the violator. Be advised that a copy of this statement may b arded to the Office of Investii0o of the DIA for insurance coverage verification. I do hereby ceW and the pains and p of perjury that the information provided above is due and lcorrect. Si store: Date: �e �e,G� Phone#: d 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#: 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 requirements 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-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLQ or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation irouance. 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 retuned 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 brat 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 may be 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 like 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 Bastion,MA 02111 Tel.#617-727-4900 ext 406 or 1-877-141ASSAFE Revised 4-24-07 Fax#617-727-7749 www;maw.gov/dia i FC-l lia �SN ci o cam ) ; IN tt ICJ �I�y�'s*�. 2,15 in 1 � ) ��.a:.�•f�� ils�v�k`�;.,�.��•as=a� _.4StY. "�.d� iC�r4� " b fP .qp ml .Y(,ipom +A '1 W j IS R N F''i�x/1 o �ry�L+a3t�s �5, ` ,. r �r O s� T�• Ar W >� �f y � N^ IN y .,- ,»i ; k - _ -g*R`R€��n^,+C+:. ',rony 'kte3*•vh* p 'X.` '�. 5 t w r Set,' I atiiuf` ': COnsRrUctlOn'SUpervlSOr �89�',�.� +r< .a ti } `&' ._ 'y..�� y' ,, '�• "^ �- linrestncted4-Buildings of any-use qrq.yP whiehbcontain{ } S r°S ddp.t hF�' +' ,}3} he, 'r1'R .Gi�•`2Y kw�, Mess than 3b,000cublc•feet(99.1•cubic'meters'of enclosed;" ,�r�� :� � space. s %Registration valid forsindlvlduat u oA, ° n � k2betorelthe expiFetlon date ,If found reurnrtozk ' � ?,� ^"'��� r' � � Offi`ce�of Con9umer Affairs andf�usarless'Regul'at�on�'�`� ; �� AOOWWashlrtgton Street. Stilt®;710 e9ostOh, trM f t !r 3 1 �: Failure to possess,a current edition of the Massachusetts ' r,1� a a �:•State BuildinCode is cause:for revocationjot this lice'rise IN )UNSlld�wlth0u9 ` ,r r or itit+ormaRion abouf ti iltense s����x�,, ,,Csl�,�617)�,7$7 3200 orvisit vvwvv7my�ap�ss:gov/dpl� k '�i� F s , � `•+-� "` `'' ' '� tkGl �,w'&:es�?�`x.A,�ss'�;�t:�a' i�c`'�4 �'1''�r�z,��,s�,`, i°��t3`` �'�-a�x.�,�-, �.b y,:'�,�t REScheck Software Version 4.6.5 Compliance Certificate Project Addition Energy Code: 780 CMR 51.00: Massachusetts Residential Code, 9th Edition, Energy Efficiency Location: West Barnstable, Massachusetts Construction Type: Single-family Project Type: Addition Climate Zone: 5 (6137 HDD) Permit Date: Permit Number: Construction Site: Owner/Agent: Designer/Contractor: 39 Meadow Ln. Jack Leboeuf W. Barnstable, MA 02668 P.O. Box 21 Centerville, MA 02632 Compliance: trade-off Compliance: 4.7%Better Than Code Maximum UA: 43 Your UA: 41 The%Better or Worse Than Code Index reflects how close to compliance the house is based on code trade-off rules. It DOES NOT provide an estimate of energy use or cost relative to a minimum-code home. Envelope Assemblies Gross Area Assembly or Cavity Cont. U-Factor UA Ceiling 1:Cathedral Ceiling 160 38.0 0.0 0.027 4 Wall 1:Wood Frame, 16"D.C. 270 21.0 0.0 0.057 11 Window 1:Vinyl/Fiberglass Frame:Double Pane with Low-E 54 0.300 16 Door'1:Solid 20 0.270 5 `floor 1:All-Wood Joist/Truss:Over Unconditioned Space 150 30.0 0.0 0.033 5 Compliance Statement: The proposed building design described here is consistent with the building plans,specifications, and other calculations submitted with the permit application.The proposed building has been designed to meet the 780 CMR 51.00: Massachusetts Residential Code,9th Edition, Energy Efficiency requir �eZnttn RESchec rsion 4.6.5 and to comply with the mandatory requirements listed in the REScheck Inspection Checklist G-Ja__ Ack Name-Title Signa re v Date Project Title: Addition Report date: 06/24/20 Data filename: Untitled.rck Page 1 of10 TOWN OF BARNSTABLE PERMIT CHECKLIST Sip off hours for Health and Con-scrvation are 8-9:30 a.m. and 3:30-4:30 p.m, A compkkpetwit Wftadon fndudesJUling al&WdOns 1-13 1. NEW STRUCTURES/REMODELING/RENOVATION/ADDITIONS Site Plan showing setbacks of proposed and existing structures -gTommercial-One complete set of full sized plans one reduced 11"xl7" (plans may require a stamp by an architect or engineer). ❑ Residential - 5 Sets of floor plans no larger than 11"x 17" smoke/co detectors marked ,0' orker's Comp.Affidavit and policy(if required) Res Check or COM check from the 2015 International Energy Cod Council(IECC) -9-Letter of financial Interest for new houses only(not required for rebuild after teardown) -®-Performance bond made out for$4.00/foot of road frontage(new construction only) 2. DEMOLTION OF A BUILDING (NOT PARITIAL) ❑ Everything above plus shut off letters from following utility companies: D Gas ❑ Electrical ❑ Water ❑ Sewer(if required) 3. DECKS/PORCHES/GAZEEBOS/INSULATION/SOLAR/POOLS/SHEDS ❑ Site Plan:showing proposed location ❑ Construction plans showing framing detail(if new framing), ❑ Pools-Barrier details, pool specs(engineers design) ❑ Workman's Comp Affidavit and policy(if required) FAMILY APARTMENTS ❑ Section 1 Plus: ❑ Family Apartments are subject to approval from the Building Commissioner. Agreement must be signed, notarized and recorded at the Registry of Deeds and returned to the Building Department. n P J a i bq �. w tz 9 P, w � c � I I j -- lam- i I j I �I 1 i h v r h � - I 1 j I j a T I i a t o x 0 h � � I I �i � I M M x o F a �c 0 lz H k \� E .N C� 0 cl-A A e� 14 3 a y y IfY o �-. SL s Q• p,� � �,� �' O C'y p h e g ZIP ca O �l : �21.z1' I a R L o"r 4 43,post s F i.. o � _ 57.01- -- — - 60, f �cv i4ct Nn o in e it o G �N r r 126.02' _ — �.. 58.01' " LA��C JOB 89-204 CERTIFIED PLOT PLAN PREPARED FOR; LOCATION. MEADOW LN. W. BARN. SCALE: 1"=50 ' DATE: 12/4/89 REFERENCE. L-4 PB 446 PG 47 DAN WEATH:ERBEE I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. �is� r. o JWN a. down cape engineering, inc . o tACLU4EE CIVIL ENGINEERS U !` 33: 2 H r LAND SURVEYORS �c�ga� I. ROUTE 6A YARMOUTH MA DATE Rk4- - RVEYOR of 39 M��s�ow L�rJ *EST 19ARNSTeA FEE FBAt TECTORS REVIEWED ROOM G D DATE FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED POR PERlAITTINO IICG DCM 0 0 0 0 LT14'�`IJN) e 0 KITC HEN 5�o2AGF �ComPvTER REQUIRED G M INTO T O — STATE SUILDOrG CODE REpUIRES THE UPGRADING OF fJS I N ADE SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN BE U 1plw M S7A1R S T o ONE OR MORE SLEEPING AREAS ARE ADDED OR CREATED. S�CUND NOTE: A SEPARATE PEFW IS REQUIRED FOR THE INSTALLATION OF SMOLT DETECTORS-THE ELECTRICAL FLOOR PERMIT QQEt=SATW-y THIS REQUIREMENT. UNI)NIG ROOM l=Row7 DOO P FIRST FLOOR. 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IQ rJ1Pp 7 I w ip Erg m o z so.0 1p TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map ��eso' Parcel � Permit# �f`& 4-4-7 Health Division _ � 'a✓ S Date Issued Conservation Division o f EXISTING C SYSTEM F MITED TO`�' �� OF BEDROOM ee � Tax Collector d Treasurer D 0 Planning Dept. Checked in By Date Definitive Plan Approved by Planning Board Approved By Historic-OKH Preservation/Hyannis Project Street Address 3011 M EADOVS1 LA(-J E . Village \4551 ( ANS;`'tABLE "A 02GGS Owner RtCATkbO Q i4-L-LA r\l!c Address 3(1 M eftow L"E W B AQNSTAR LE-mA Telephone SOS 3CoZ-8 3C,0 1 Permit Request V '((� �C,� �� r f- Square feet: 1 st floor: existing proposed 0 2nd floor: existing proposed Total;new ' C) ! Valuation Zoning District Flood Plain Groun ater Overlay - Construction Type T'_0Jnr) eA 0 G, Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family Two Family O Multi-Family(#units) Age of Existing Structure VC-AM Historic House: El Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: LH Full ❑Crawl ❑Walkout O Other Basement Finished Area(sq.ft.) NJ A Basement Unfinished Area(sq.ft) M/A U Number of Baths: Full: existing new Rl Half:existing Cr new Number of Bedrooms: existing 2 new Total Room Count(not including baths): existing new_ First Floor Room Count S Heat Type and Fuel: 0 Gas . Oil O Electric D Other Central Air: ❑Yes 5kNo Fireplaces: Existing 1 Newer Existing wood/coal stove: O Yes 19 No Detached garage:❑existing ❑new sized Pool:0 existing ❑new size 0 Barn:O existing Cl new size Attached garage:Cl existing ❑new size _Q Shed:O existing O new size 0 Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial. ❑Yes .9 No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 'Rl(',dMPO A D�AZ Att3 & Tele phone Number 608 Address Z 9 Ke",�%Ww License# \ VJ • Q,,PaO SIA 0� , lk (0 ZGGe Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE , IBC L DATE n?j 2 S_l Q ,- FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF�INSPE URION: FOUNDATIOP) s. FRAME OIINSULATION „ 0 FIREPLACE N tr = ' ELECTRICAL ROUGH FINAL; PLUMBING: N ROUGH FINAL` GAS: ROUGH FINAL- FINAL BUILDING DATE-CLOSED OUT ` ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department oflridustrial Accidents Office of Investigations : 600 Washington Street Boston,MA 02111 •''� _ www mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plunabers pplicant Information Please Print Legibly Name (Business/organization/lndividual): _ 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 (fu1T and/or part time):* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet# ❑ Remodeling ship and have no employees These sub-contractors have 8. .❑ Demolition kuired.) rkin for me in an 'ca aci workers' comp.insurance. 9 g any'cap ty. ❑ Building addition workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or.additions officers have exercised their 3. m a homeowner doitg all work right of exemption per MGL ILL] Plumbing repairs or additions self.-[No workers' comp. c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]t employees. [No workers` 13.[3 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 anew affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub contractors and their workers,comp-,Policy information I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site. information. - Insurance-Company Name: 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$.1,500•.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 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. do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. atare: Date Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: I 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��`:`44 m�4ll . Wegtip,:association,Forporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise, and inchiding the legal represeniaiives of a deceased employer,or the receiver or trustee of an individual,pa rtnership, association or other legal entity, employing employees. Howt=ver:ibe owner of a dwelling house having not more than three aparbnents and who resides therein, or the occapant of the dwelling house of another who employs persons to do maintenance, construction or repair woiYtin 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.". ter 152, 25C 7 states `Neither the commonwealth nor any of its-political subdivisions shall Additionally,MGL chap § ( ) enter into any contract for the performance of public work until acceptable.'evidence of compliance with the insurance requirements 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 certificates)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 maybe 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' ationpolicy,please call compens 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 providedga 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 permitlhcense 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 necessary)and under"Job Site Address"*tlie applicant should write"all locations in (city or policy information(if town)."A copy of the.ainda�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' kenses..A new affidavitmust 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 bum leaves etc.)said person is NOT required to complete this affidavit The Office of Investigations would like to thank you in advance for your cogpe'ration 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 : . .. .. s ..Office of jnvestigations 600-Washington Street . 'Boston,MA 02.111. Tel. #617-7-27-4900 ext 40.6 or'1nM-MASSAFE Fax#617-7274749 Revised 5-26-05 y�r�yw,mass.gov/dia r �oF ME ra,� Town of Barnstable yP °� .Regulatory Services WIMSTABLF. = Thomas F.Geiler,Director KAs8. g Building Division Tom Perry,Building Commissioner 200 Main Street; Hyannis,MA 02601 Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions, along with other requirements. _ IWI't_RNDZ WORK Ot4L4 - RCSiOEIV'CIAI. KrAOiJWOG Estimated Cost A000-o - .- Type of Work: : .. � � . Address of Work: 2,c1 M E A(J0\tJ LAW e VW , VoNR N S-TABLE , MA 0 2L 68 Owner's Name: P%I C A41,00 A• b 1A Z-LA,4ff Date of Application: oe 2-5� 105 I hereby certify that: Registration is not required for the following reason(s): ❑Work excluded by law ❑Job Under$1,000. []Building not owner-occupied ELOwner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c.142A. SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: > Date ' Contractor Name Registration No. 08l 2s I.o s zi `' 91 Qoa p;R►Z—La0� . .� Date Owner's Name Qlforms:homeaffrdav r Town of Barnstable �OfTltE)p�,_O + Regulatory Services • Thomas F.Geiler,Director • snxxsrnez$, ►�0� Building Division rf0 � Tom Perry,Building Commissioner 200 Maia Street, Hyannis,MA 02601 www.town.barnstable.ma.us ice: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE.- JOB LOCATION: MCA�OW �q�i✓ 1N�S`C BAi�,f`1S��giL number street village ,1HOMEOwNER RiCAWAO DiAZAAi\)e SO€ -M.2-83W Nf� name home pbone# work phone# CURRENT MAHMG ADDRESS: 21 C( M 9A D O W I_A c G VQ• BA9.113STAq E 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 homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINITION OF HOMEOWNER Persons)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 j applicable codes,bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 'GAA1_ Signature of Homeowner 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 ttates 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 problems,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/ber 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 cormnunity. n•f,...,,c•h,m,.nrvn,,,t . -�9 M P AC)CM LArJ WC-sT B'�4RNSTd�BCE SMOKE DETECTORS REVIEWED v ROOM BA A GO DATE FIRE DEPARTMENT DATE BOTH SIGNATURES ARE REQUIRED POR PERMITTINQ BACK/ S SIDE DOOR KI-TC HEN S ► o R,AGE l corn? )Tm ovy--ice REQUIRED $U-1 N G M AD G INTO STATE BUILDING CODE REQUIRES THE UPGRADING OF p R� SMOKE E SLEEPING AREAS ARE ADDED OR CREATED. ' THE ENTIRE DWELLING WHEN S i AIR MORE S 'TO ONE OR MORE SS Sr` N NOTE, A INSNS SEPARATE Pg�IT IS REQUIRED FOR THE TALLATION OF SMOKE DETECTORS-THE ELECTRICAL FLOOR, PERMIT QQE6 NM SATISFY THIS REQUIREMENT. LI\MIG ROOM • g 1ROtJT DOOR T-I R ST FLOOR, PL.AIJ I wn of Barnstable *Permit kk Bu' mg Department Services 1'es6ntoWeUefr OCT 2 O 2017 Brian Florence,CBO 0 L Building Commissioner �i°rEp 1�I r 8N H N S A BLOVMain Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number (�(i° UC)____�: Property Address .3� /yle�Q�d�.ri /�� /��zzi2&=s-,/,fp ❑Residential Value of Work$ Q2—3Q2106, Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address JZ,4,� r Contractor's Name—� ���J�l/P_�t'/ Telephone Number 0 -_5_9 r,92 Home Improvement Contractor License#(if applicable) Email: Construction Supervisor's License#(if applicable) ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor am the Homeowner ff—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) f&Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to �UhiLi sS�r9?i ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.32)#of windows #of doors: *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 License is required.. SIGNATURE:/,�/,�_ QAWPFILESTORNIMbuilding permit forms\EXPRESS.doc 08/16/17 bar The Commomveakh ofMassadliusetts Department of1ndreshiat Accident& Offwe ofJ£nvstigadons ' 600 Washineon&met Boston,CIA 02111 mt ntamas&gnv1dfa Workers' Compensation Insurance,Affidavit Bmdlders/ContractorsMec icianslPhimbers Applicant Informatsan Please Prints Name AddFe= 39 i2rrcz�✓� / 42 Oa .P City/Stater: Phone Are you an employer?Check the appropriate box: T of project r 4. I am a general contractor and I � P ] ( eclnu�etl}: I.❑ I am a employe-with ❑ g 6. ❑New construction employees(full and/or pmt-ime)s have hired the sabr cont actass 2.❑ I am a sale proprietor or partner- listed on the attached sheet 7- ❑wog ship and have no.employees These sob-com2xacto:s have S.,❑Demolition woni-ing far rrne in any capacity employees and have wodwo- 9. ❑B,uildmg addition. [No upr1mrs'comp.insurance comp-tnsuranmi requked-] 5. ❑ We are a corporation and its 10❑Electrical repairs or ad iaas 3-Jkj am.a homeowner doing all work officers have exercised their 1L❑Plumbingrepairs or additions. myself [N°wo6mrs'camp. right of won per MGL 12-❑Roof repairs insurance requited.]F c.152,§1(4h and we have no employees.[No word& 13.❑Other cam-insurance .] 'LlayWffcm&batchedabox�lnmstalsoffi wi outthesecdonbelowshaagilieirwa&eiea=pensad parieyinfonaEim T ffnmeawners who submit rhis aftida[ft ivrting they are doing all waal agd&en hire outside contictats=3A mtn=a new 2Mdzek indicating scicli iC d=ctmm fft=r'hP,t this bans mint atn&ched=additional shRei showing the nine of fe su►-ca�tscm�and state whelhet of not those enfities have employees.Ifthe sub-c�have employees,they==pmvide their workers'ramp.policy w eL lam an entnplayer fhat isproviding workers'eampmsdian insurance for uzy enrplio ees Selow is thepaUcy and job sHe information. Insurance Company Name: 'Po icy 4L or Expiration Date: Job Site Address= ' lrP1JL�isYiJ C'..JS �� CityJState/7.rg:In Attach a copy of the workers'compensationpolicydeclaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A o€MGL a 152 can lead to the imposition of criminal penalties of a fine up to$L500 00 and/or one-year imprisonmenk as well as civil penalties.in the fom 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 maybe forwarded to the Office of Investigations oftne DIA for insurance coverage verifica3ionn- f do ho-aby coth,under the pains and penalties afp&,Pt y that the inforruadm provided abmv i true and correct Si i`�� -�� / Date .D / 1. Phone i€ e. SSA— 09,;?— 3 10 7 O,o'rciat use enFy. Do not w ite in this area,fa be completed by city artorrn oficiai. City or Tawa• Permiff cease;ff Leg Authority(circle onee): L Board of Health Z,Building Department 3.fftyi town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other C©act Person: phone* - - - 6 nformation. and Instructions Massachusetts Ge'neaal Laws chapter 152 requires all employ=to provide workers'compensation for their employees. pmmuan±to this sty,an Employme is defined as.`°_.eveay p=son in the service of anofher under amy contract of hire, express or implied,oral or written." arts association,amporatfon or other legal errtrty, or any two or more An err�Layer is defined as"air indrvidual,p ersh�, of the foregoing engaged is a Joint eoteaprise,and including the legal reps eolatives 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 dweIling house having not more than three apartments and who resides therein,or the occipant of the - dweIlmg house of anofer who employs persons to do mai abmancc,contraction or repair work an such dwelling house or on the grounds or bmIdmg app thereto,shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also stems that"every stain or Iocal lisp agency shall withhoId ffie issuance or renewal of a license or permit to operate a business or to construct bufldiugs in the commonwealth for any applicantwho has not produced acceptable evidence of complianeewith the iIIsarancr_coveragerequited." Additionally,MGI.chapter 152,§25C( )slates"Neither the conoa awealth nor;Ly ofits political subdivisions shall ester into any contract for the perbonD.aace ofpublic work until acceptable evidcace of compliance with the fimm7mlce.. ,Txl ents of this chaptes.have I;een piesented to the contacting autho&y." Applica.rrb PIease,fM out the workers'compensation affidavit completely;by checking the boxes that apply to your sitnation and,if necessary,supply sob�ontcactor(s)name(s), address(es)and phone numbers)along with their certificate(s)of insurance. Limited Liability Compames(LLC)or LimitedLiabs-lityParfner O4s(LLP)withno employees ofhe ffim the members or partnea-s,are not rega kmd.to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidayk maybe submitlEd to the Department of Industrial Accident$for confimation of insmance coveaage Also be sure to sign and date the affi—davit The affidavit should beret need to the city or fawn that the application fur the pe=it or license is being requested,not the Department of Industrial Accidents. Should you have any questions regardm,g the law or ifyou are required to obtain a woikers' compensation policy,please call the Department at the number listed below. Self-msred companies should enter their self—insurance,license numlber on the appropriate line. City or Town Officials f - Please be sore that the affidavit is complete and primed 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 regmdmg the applicant Please be sure to fill in the penmit/license number which will be used as.a refcrauce n=ber. In addition,an applicant that must submit multiple pexinit/license applications in any given year,need only submit one affidavit indicating current policy information(if necemary)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 maimed by the city or town may be provided to the - applicant as proof that a valid affidavit is on file for fbtm:e'pezm s or licenses A new affidavit must be filled oil each year.'Where a home owner or citizen is obtaining a license or permit not related fn any businrss or commercial vemttae (Le. a dog license orpermrt to buns leaves etc.)said person is NOT required to complete this affidavit The Office of Iuvestigafions would hike to thank you i a advance for your cooperation and should you have any questions, please do not hcsifate to give us a call. The Depmrtm enf's address,telephone and fax number: ThL_ T�ealft of massachnsem Depaxbnmt Gf Tndilsh ial ACCZenft Qface of Jxmestgatio= �4�a�bing�n Str>�t os M&oil 11 Ta 4 617 -49W CXt 4-06 Qr 1- 77 MASSAFE Fax#617'27'74 Revised 424-07 i Town of Barnstable Building Department Services Brian Florence,CBO ' Building Commissioner 200 Main Street, Hyannis,MA 02601 a&IxarwmU MAW www.town.barmtable.ma.us Office: 508-862-403 8 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: eP o?d// JOB LOCATION: .11 GJl number stet village "HOMEOWNER": `��`G L,b_n, ,�/2li/., ��2 ��rx�i»l' L? - S '�3F�7-'v7/D"y name home phant# work phone# CURRENT MAHING ADDRESS: 45M42C ,4.3d f� city/town f state up code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINPPION 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, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements d that he/she will comply with said procedures and requirements. rgnatune o om er 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 problems,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 this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFUM\FORMS\building permit forms\EXPRESS.doc 08/16/17 ��++E Town of Barnstable Building Department Services ` A ` Brian Florence,CBO 1659. ►`� Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section - If Using A Builder L 4.f G:L .`� � .� ,,�� ,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 o(Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORMS:OWNWERMISSIONPOOIS Rev:09/16/17 Meadow Lane West Barnstable, MA October 30, 2016 Carrie Bearse, Chair Town of Barnstable Old Kings Highway Historic District Committee 200 Main Street Hyannis, MA 02601 Paul Roma, Building Commissioner Town of Barnstable Building Division 200 Main Street Hyannis, MA 02601 Re: 39 Meadow Lane West Barnstable, MA Dear Ms. Bearse and Mr. Roma, We drive by number 39 as we live towards the end of Meadow Lane. Last week we were shocked by a large building/structure which was erected at 39 Meadow Lane with an opening which appears to a garage? To be honest we've never seen anything like it and don't know what to call it. It's huge, unattractive, inappropriate and must certainly be a flagrant violation of the rules and regulations of The Old King's Highway Historic District. We hope you can look at it at your earliest convenience and if needed, educate the owner as to the rules and regulations he/she bought into as the property recently changed hands. Thank you the work you do and your attention to this matter. tr• ems'-ti�a._�t� ,.,x. .. Ra... / / _,f1.*.r 1.....3 u `t � .v�`3.S? 5.1 Yaw �.� a00 Paiii ,3AavN • I'/ 1 ,! ,fir!' i���� t , �r�:e��i's ''...�.C:_;;_' • �`'�97'Y' !i j'.fl�� f!i! 11�11 ��f f il�i kill .�.� '- �' S `�,� 1 •� rya .44; ' 'r• f '�;' � ` 'r •` •-f 40 13 '�+ 1,�j ,i,. .,t � ; -•z'y{h•t k� X*.SI � ;,y 44 k:+Q�. .. '�v t. `� .�/y - • CN jr i 12 CIO _ .~ l .fir :•„ 1 - r a � ��,� lab u r _ 39 Meadow Lane, West Barnstable a Mckechnie, Robert N From: Roma, Paul Sent: Friday, November 04, 2016 8:19 AMb�� To: Mckechnie, Robert Subject: FW: 39 Meadow Lane,WB - Garage! 0 Attachments: section 3.pdf -----Original Message----- From: Fair, Marylou Sent:Thursday, November 3, 2016 4:31 PM To: Roma, Paul;Jenkins, Elizabeth Subject: FW: 39 Meadow Lane,WB-Garage! Paul, Further to our conversation yesterday, I received the e-mail below today regarding the "garage" at 39 Meadow Lane. I did forward the written complaint we received in yesterday's mail along with the photograph you provide to the Chair. She believes that these types of"structures" are not appropriate in the district as defined in the OKH Bulletin, Section 3- Definitions and does not qualify as an exclusion or exempt feature as defined in 3:03(d) Let me know what steps the OKH should take next—Thank you! Marylou -----Original Message----- From: suemazou@vahoo.com [mailto:suemazou@yahoo.com] Sent:Thursday, November 03, 2016 9:33 AM To: Fair, Marylou Subject: 39 Meadow Lane,WB-Garage! I'm really sorry to bother you again Marylou but can you ask someone to check out the "garage"which went up one day last week? It's a real eyesore :( Thanks again,Susan -------------------------------------------- On Thu, 9/22/16, Fair, Marylou<Marylou.Fair@town.barnstable.ma.us>wrote: Subject: RE: 39 Meadow Lane,WB- Rock wall of boulders/construction debris being constructed To: suemazou@vahoo.com Date:Thursday,September 22, 2016,8:32 AM Thank you, Susan. The Inspector was able to visit yesterday and spoke to the owner and informed them that they need to file with the OKH as the stone wall is over 30" (he estimates approx 36"). He did tell me it is made of large natural stones. If you are an abutter,you will receive an abutter notice when the application is filed so that you can be made aware of when the hearing will be held if you wish to attend or submit any comment. i . i Marylou -----Original Message----- From:suemazou@vahoo.com [mailto:suemazou@yahoo.coml Sent:Wednesday, September 21, 2016 4:37 PM To: Fair, Marylou Subject: RE: 39 Meadow Lane,WB- Rock wall of boulders/construction debris being constructed Thank you so much Mary Lou for your much appreciated update. Fieldstone walls are gorgeous but this one is not fieldstone. Instead the oversized boulders have an unfriendly,almost threatening(commercial)feel on a residential lane north of 6A. It's my opinion it's not in keeping however all I ask is the Chair be made aware to make a final determination. I have great respect for the Town of Barnstable's OKH committee and all you do. It really does show:) -------------------------------------------- On Wed, 9/21/16, Fair, Marylou<Marylou.Fair@town.barnstable.ma.us> wrote: Subject: RE: 39 Meadow Lane, WB- Rock wall of boulders/construction debris being constructed To: suemazou@vahoo.com Date:Wednesday,September 21, 2016, 11:40 AM The inspector was by yesterday and did take photos, but with the rain,the photos did not clearly show the wall so he will be returning again today. Hopefully, he will also be able to chat with the owners for a clearer understanding of what is being done.. I will then forward the photos to the Chair for her determination. -----Original Message----- From: suemazou@vahoo.com [mailto:suemazou@vahoo.com] Sent:Wednesday,September 21, 201611:16 AM To: Fair, Marylou Subject: RE: 39 Meadow Lane,WB- Rock wall of boulders/construction debris being constructed Not to be an itch but when is the inspector going over. Work is in progress and it's NOT fieldstone per OKH regs. Is hewaiting until it's too late to take down or does he have a conflict of interest? 2 , I think he should be taking photos for you and the board to see. Thanks! -------------------------------------------- On Tue, 9/20/16, Fair, Marylou<Marylou.Fair@town.barnstable.ma.us> wrote: Subject: RE: 39 Meadow Lane, WB- Rock wall of boulders/construction debris being constructed To:suemazou@vahoo.com Date:Tuesday,September 20, 2016, 8:49 AM Hi Susan, . will have the building inspector stop by and see what is going on^ . It may require a filing with the Old King's Highway. Marylou -----Original Message----- From: suemazou@vahoo.com [mailto:suemazou@yahoo.com] Sent: Monday,September 19, 2016 7:59 AM To: Fair, Marylou Subject: 39 Meadow Lane,WB- Rock wall of boulders/construction debris being constructed Dear Marylou, A LARGE rock wall is going up at 39 Meadow Lane I made of oversized boulders and construction debris. 3 Please send someone out to look at it ASAP as it's not made of natural fieldstone and may exceed 30". Thanks, Susan 4 _ a �7 .T Ar OF ` ay. -16 �. afar _ ,• ,� ' b, ' _F � - 3 %mve NMI e 4w r + •1p r, r Ar Jr • r aP AM- At r - I f ... 4�' *#i IWO ox, F. + ` _ j q7i.. - .. 1 4 PF Ak ir _ + ` s dr , s z , w • +"io Of P ! 46 if41 lamp , rh , •� w fir, +a:_ = /C,>��lb 7 r 4r lk 0 Ir to wk 41 N I c a 4 i r N Y M EE H !! 44 1 ,fir- � ;• 4' � s' � '� �•�T � T s L : Alb Aft— EA-�- \JJF �� 3 s R t R dF oil iw ,r t6t b :-�" ,fix -*-•�:� a /j9 n F*L T - F ♦ TA -1 ` kE b - �a 1 Vo w APIO Irk VF ik +J� - _ � lop air �-. .,�. L { � _ s •� _ _ ter: �� '� �+1 �_'#'i;' _ w _ a ar- l � � !l� f�f/v �T �� ���o ��� 10 At '•�` ,�,� . All s R4 ems- 'tt 'fk •13 Idw _ -10 a• AF r r a� - IVA - 6.w lk QMF a Awk IL! 'tea �� � ��� �� �� ,�/o y/�� f f ' 1 t dF ZnA po 1 r BIL nM a +�• '�''.f _e'7r _ -+e r {.r'i'- fk .e Pow Jv �� � 3 � �vlc���ti Lw� � a � u��a � C,� � ,ilo�� l b i 4 u � � � vet 'i+�' ,� �,r.+ _ :.,_ • ,. tk • . AM w _ s le_ _..,�� � . � — .-- '-ham fi. . , t ,�",�"•� _ ,: pw- � _ r F' S _ ._���-ter,=-,�-•-ra��-•... ...•_ t aa� F �7 3 /l.t.- �-� �v 5 T ��'Z3 �����1� Mckechnie, Robert From: Fair, Marylou Sent: Thursday, November 05, 2015 2:46 PM To: Mckechnie, Robert Subject: FW: 39 Meadow Lane Bob, FYI -----Original Message----- From: suemazou@yahoo.com [mailto:suemazou@yahoo.com] Sent: Thursday, November 05, 2015 2:31 PM To: Fair, Marylou Subject: 39 Meadow Lane Hello MaryLou, You or someone from your department (building inspector?) should drive by the above address soon. Driving down the street, one can see under active construction a new dormer across the rear. Thank you. Susan 1 -Town of Barnstable ermlt: Regulate q,, fi'ABLE ate: 8/m . .. .. Richard V.Scab,Interim Director Buildi ig Division A;1 9: 2 8 ee.L35,081.. RAWWABIA ` Tom Perry, Building Commissioner %639.� 200 Main Street, Hyannis,MA 02601 www.town.barnstable. a u DIVISION Office: 508-8624038 Fax: 508-790-6230 TOWN OF BARNSTABLE SOLID FUEL STOVE PERMIT Owner: >� c j:�p i Phone: V ��a ' ��' / Install at: Sq M e,4_L',0rJ C. /- Village: �. -'� -� e Map/Parcel: Date: ' o'� I ! 5- Stove Ne Used B. Type: Radiant irculatin C. Manufacturer: e N)C- Lab.No. V L 1-) 7 7 IBC- I-q' D. Model No.: "X Q V On P''l Chi ey /Existing (If existing,please note date of last cleaning B. Flue Size Cam"' Rc�--Ng S4,per,s ►(ns5 5-�ce,l C. Are other appliances attached to Flue? tv0 D. Pre-fab Type and Manufacturer N f A E. Masonry: ine nlined Hearth A. Materials: M Aso r-,Z y '2' B. Sub Floor Construction: l�ao p11-�F Installer Name: OF' To }f C �,f^N e y Address: l N h�c•GL� G►� Phone: — L-'�6 a- 4-1 I Location of Installation: 3 ►'l F. l� ' ,41z N, H.I.0 Registration# Construction Supervisor# CL OR check_Homeowner Installing,no license red LICENSED INSTALLERS SIGN "1-1�- APPLICANTS SIGNATURE: APPROVED BY: /IJ100F F— v .f Please make checks payable to the Town o Barnstable *This constitutes an official stove permit after inspection,photographed, and approved by the Building Inspector Q:forms:stove { Rev HAW � The Commonwealth of Massachusetts Department of Industrial Accidents = Office of Investigations . 600 Washington Street Boston, MA 02111 www.mass.gov/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual):-T-G,P 'GO Stt y- ce Address-. City/State/Zip: VARI."af k .{- 0-^"�71hone #: Are ou an employer? Check the appropriate box:RType of project(required): 1 I am a employer with 4. ❑ I am a general contractor and I employees(full and/or time). have hired the sub-contractors 6. ❑ New construction - 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. Demolition workingfor me in an capacity. employees and have workers' y p tY� [No workers' comp. insurance comp. insurance.$ 9. ❑ Building addition 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.❑ 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A SSOC, t vZ-:4. es cr� N1s+SS Policy#or Self-ins. Lic. #: A t,' G 5 f Expiration Date: Job Site Address: City/State/Zip: Ga 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 2cetun=eren s of perjury that the information provided above is true and correct Si nature: Date: Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation. 10 ParkPlaza-Suite 5170 Boston, 02116 I i t valid wkhout signature 1 Restricted To'CSSL-SF-Solid Fuel Burning Device Failure.to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/DPS L— i t r 1 Massachusetts -Cee-irtmen "of Public t'r' X� Board of Building Regulations and Standards. Construction Supen-isor SPccialtl� License: CSSL-099371 �. DOUGLAS D Sfdov ' ' 18 PM NACLE LANE YARMOUTHFORT MA`.s;02675 Expiration. Commissioner 1108120i5 " ��r, �cnr�,ro,uoerrll����;-llr�Jrrc�rr�ef(1 Office of Consumer Affairs&BusinessRegulation a — OME IMPROVEMENT CONTRACTOR — egistration: 164686 Type: - Nation: .10/30/2015 Private Corporatio: I. TOP TO BOTTOM CHIMN..EY,.INC.. DOUGLAS SHERMAN I 18 PINNACLE LN.. YARMOUTH,MA 02675 zRir Undersecretary I 1 ; TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION gDa`Z ttJJi �i .�1��3 Map I 3 Parcel yC ,/00-3 Application# Health Division 3) U=: 2 F;i j : 16 Conservation Division Permit# Tax Collector ~�TUi U`i�itsfz Date Issued Treasurer Application F Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Ok Historic-OKH Preservation/Hyannis 9 5'07 Project Street Address 35 m ems®L3 L-1ri P_ Village LJe-ST Owner. t- ;G(,' r&) ID La e— Address 31 o'er Lav-,� w. Cki��dale Telephone SOFs - 3La - '33t 1 Permit Request Reran a n Co �-r G' ° ' ©" c4-CCA(— 0a5 rcnIGuCSL me_r� 41 I Vt SGRhrA' PoICcN Square feet: 1 st floor:existing proposed 2nd floor:existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation 6 d 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: O'Yes ❑No Basement Type: ❑Full ❑Crawl ❑Walkout ❑Other Basement Finished Area(sq.ft.) Basement Unfinished Area(sq.ft) Number of Baths: Full:existing new Half:existing new Number of Bedrooms: existing new Total Room Count(not including baths):existing new First Floor Room Count Heat Type and Fuel: ❑Gas ❑Oil ❑Electric ❑Other Central Air: ❑Yes ❑No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑No Detached garage:❑existing ❑new size Pool:❑existing ❑new size Barn:❑existing ❑new size Attached garage:❑existing ❑new size Shed:❑existing ❑new size Other: Zoning Board of Appeals Authorization ❑ Appeal# Recorded❑ Commercial ❑Yes ❑No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name Q Telephone Number Jam`0$ Address 9 T ?.�_IV��Tb��. �a License# d 6 (1(�P'c Home Improvement Contractor# Worker's Compensation# Tj 94 3 0� Zoo`7 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO z tx SIGNATURE DATE g h � I-"z,7 FOR OFFICIAL USE ONLY PERMIT NO. DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE 4` I OWNER �I DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT 6" '. ASSOCIATION PLAN'NO: r 7 Z Application to ®tbi Ring,ys T�tgbbjap Regional 3�isstoriC �DisstriLt Committee In the Town of Barnstable CERTIFICATE OF APPROPRIATENESS pplication is hereby made, with four complete sets, for the issuance of a Certificate of Appropriateness under Section of Chapter 470, Acts and Resolves of Massachusetts, 1973, for proposed work as described below and on plans, •awings, or photographs accompanying this application for. HECK CATEGORIES THAT APPLY: Exterior building construction: ❑ New ❑ Addition Alteration Indicate type of building: ❑ House ❑ Garage ❑ Commercial ❑ Other Exterior Painting: ❑ oT> Signs or Billboards: ❑ New Sign ❑ Existing Sign ❑ Repainting Existing Sign Structure: ❑ Fence ElWall ElFlagpole ❑ Other 'YPE OR PRINT LEGIBLY: DATE ,DDRESS OF PROPOSEDWORK � �O'Le.3 cf ._ ASSESSOR'S MAP NO. I )WNER K4 t-(zLc�0 i C.,_- - ASSESSOR'S LOT NO. IOME ADDRESS 3�1 ��lEc a',<: ��:�d �, ,^�S4c 1 tTi TELEPHONE NO. :ULL NAMES AND ADDRESSES OF ABUTTING OWNERS, including those of adjacent property owners across any iublic street orway. (Attach additional sheet if necessary.) kGENT OR CONTRACTOR ,:�kA, � VWI, , •J u�a�t�or_. TELEPHONE N0. 1rJ' - 77.E 177 - NDDRESS 1� 9 6:v1y1 LS DESCRIPTION OF PROPOSED WORK: Give particulars of work to be done., including materials to be used. Please nclude locations of proposed signs. Dn � Signed Owner-Con act r-Agent For Gommittee Use Only CD y Q:q LP ~� This Certificate is hereby Date Approved enied UL 6 2007 Committee Members' Sign res: T OwrJ OF QARNST M "111C FRESER�ABL ATlO, Town of Barnstable Old King's Highway Historic District Committee SPEC SHEET FOUNDATION iJ ;00 C.n_S A SIDING TYPE COLOR CHIMNEY TYPE /VlA COLOR ROOF MATERIAL COLOR PITCH WINDOWS LCOLOR SIZE TRIM COLOR DOORS COLORS SHUTTERS d COLORS GUTTERS COLORS DECKS- (0+ Q O - MATERIALS 1"" 1 GARAGE DOORS At COLORS SKYLIGHTS AjJA SIZE COLORS SIGNS COLORS IHISTORiG T' IFv: _ li l_Y i.V JU FENCE 2007 .i -J L -4r� I PRESERVN i QN1 NOTES: Fill out completely, including measurements and materials/colors to be used. Four copies of this form are required for submittal of an application, along with Four copies of the plot plan, landscape plan and elevation plans, when applicable. SPECSHT d�rrranusea� ���as�ua�a . i Board of Building Regulations and Standards _ — I HOME IMPROVEMENT CONTRACTOR `I Regstr-ati6n: 1 Q3757 Expiration 7/972008 zj -t� 1 i Ty, e.. Prl��a4e Corporation - SPRINKLE HOME I:MPROVEMENT,'INC. Brad Sprinkle M' - .> 199 Barnstable Hyannis, MA 02601 Deputy Administrator _ BOARD OF B.UILDING;REG.U,LATIONS License: CONSTRUCTION:SUPERVISO.R Number CS 006643 Birthdate 10/08/1955 F k Experes 10/Q8/2007 Tr.-no: 6638;0 xi Construction 'CS, ricted 00. Rest t BRAD K SPRINKLE s 190 LOTHROPS LANEr ;'': W BARNSTABLE, MA.:02668 Commissioner I I '. ' CERTIFY.CATE O�F INSURANCE ISSUE DATE 0512112007 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND Bryden&Sullivan Ins Agency CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE Inc POLICIES BELOW. 88 Falmouth Road - ------- Hyannis,MA 02601 COMPANIES AFFORDING COVERAGE — INSURED Sprinkle Home Improvement Inc 99 Barnstiable'RUAd"" COMPANY A A.I.M.Mutual Insurance:-Co ... ... Hyannis,MA 02601 LETTER <CO�ERAGES ., 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. — CO TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS I,TR DATE(MM/DD/YY) DATE(MMIDD/YY) GENERAL LIABILITY GENERAL AGGREGATE PRODUCTS-COMP/OP AGG. COMMERCIAL GENERAL LIABILITY PERSONAL&ADV.INJURY =CLAIMS MADE Q OCCUR EACH OCCURRENCE OWNER'S&CONTRACTOR'S PROT. FIRE DAMAGE(Anyone lire) MED.EXPENSE(Anyone person) AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO BODILY INJURY ALL OWNED AUTOS (Per person) SCHEDULED AUTOS HIRED AUTOS ..... JTO.S BODILY INJURY --- GARAGE.LIABILITY _ PROPERTY DAMAGE EXCESS -- -----.---- EXCESS LIABILITY EACH OCCURRENCE UMBRELLA FORM AGGREGATE OTHER THAN UMBRELLA FORM „ WORKERS COMPENSATION AND STATUTORY LIMITS OTHER EMPLOYERS LIABILITY X HE PROPRIETOR/ EL EACH ACCIDENT 500,000 A PARNERSIEXECUTIVE FFICIERS ARE: 7004943012007 05/13/2007 05/13/2008 EL DISEASE--POLICY LIMIT S 500,000 INCL EXCL , ' EL DISEASE--EACH 500,000 EMPLOYEE COMMENTS/DESCRIPI'ION OF-OPERATIONS OR LOCATIONS: C 3=� ✓�� tYr �.,�,, °� °.`. ,<<e+p .3"'s�"' CANCN.LLAI iOl\ 4 1`��.tt��� `� .��+�:. �'+�,» s~�a'�«... , SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE.EXPIRATION DATE BRAD SPRINKLE HEREOF,THE ISSUING COMPANY WILL ENDEAVOR TO MAIL 10 WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,ITS AGENTS OR REPRESENTATIVES. 199 BARNSTABLE ROAD FIVANNIS,MA 02601 JAUT14ORIZEDREPRESENTATIVE dPb otth�, Town of Barnstable Regulatory Services _ ► = Thomas F.Geller,Director ' as�ss, Building Division. Tom Perry, Bunding Commissioner 200 Main Street, TJysmis,MA b2601 www-town.b arnstabl e.ma.us )ffice: 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 o �bact on my behalf, in all matters relative to work authorized bythis building perrait application for. (Address of Job) Signature of Owner Date R1Can 01 I.0Iz Print Name Q:FORMS:OWNERPERMISSION I r 8 HOMEOWNER: DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLAND SPACES ;I authorize Sprinkle Home Improvement to act on my behalf in all matters relative to the work to be performed on this job (i.e. permits, applications etc.) if necessary. Ricardo or Therese Lane-Diaz Brad Sprinide Date Date = The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations h 600 Washington Street Boston,MA 02111 _ www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print LeObly Name(Business/Organization/Iudividual): 'S'i:)R 1toy-,LEA 1� �l� _1- {Y1 n R�� I�fl2 N Z N`C Address: vCfr�� City/State/Zip: v � ' Phone#: O`6 7 77. :5— (..2 'Are.you an employer?Check the appropriate box: Type of project(required) 1.U 1 am a employer with `I. 0 I am a general contractor and I 6. ❑New construction s:(full and/or pact-time)..*. have hired.the sub-contractors ;.employee : - listed on the attached sheet.. 7. 2.0 I am a sole proprietor or partner [y'I�enlodeling :.ship and have no employees, These sub-contractors have .g,. Q Demolition. working for me in an capacity, employees and have workers' Y ca P Y 9. ❑Building addition . [No workers' corilp.insurance comp.insurance.-- required.] 5. We are a corporation and its . 1.O.Q.Electrical repair$or.additions 3.❑.I arri a homeoevner doing all��,ork officers have.exercised their :.'1 I:Q Plumli:ing re pairs'oriadditions No workers' coin light of exemption per MGL 12. Roof-repairs- myself . [ P � . ihsurance required.]t 51 1(4),and we have no c. 152, employees:[No. workers' comp.insurance required] 'Any applicanf 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 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 isproviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Coinpaay Name: _� U 1 l) 0. = iJ cS W\Q M" Policy#or Self ins.Lie.#: 6.b.'1 c(. '�O 1 a OD r/ Expiration Date: `5 13 Job Site AddresS:,,� I rn , ��t— City/State/Zip:L�)_ rnS� I.� :A Oa b(o . Attach a copy.gllthe 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 D1AfbYjnsuiazeeTVrage verification. I do Hereby ce u e at nd penalties of perjury that the information provided above is true and correct Si attire: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# V iIssuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: °FTHE r° Town of Barnstable Regulatory Services sa MASS. Thomas F.Geiler,Director y tKnss. g � i6g9• ♦0 �616319'la 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 Permit no. Date AFFIDAVIT HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal, demolition,or construction of an addition to any pre-existing owner-occupied building containing at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. Type of Work: Estimated Cos S UV Address of Work: 1J�1 ��szo, � � C - ►.��n b�'d�Q>� Owner's Name: cx-k� —ii-, Date of Application: I hereby certify that: Registration is not required for the following reason(s): []Work excluded by law ❑Job Under$1,000", ❑Building not owner-occupied ❑Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. SIG TIES OF PERJURY I hereby apply for a permit as ent o e o� <6 Date Contractor Sign ture Registration No. OR . Date t Owner',s Signature Q:wpfiles.forms:homeaffidav Rev: 060606 ti♦ .t ,,,.,, ,;�; 4�,•�, �"-:, �^S1'ti.��`a�v ,.c�,�'c �,+ r3`�„l.E� '4 f�.�i � � �'� ,g,jy��„� ���,�.,�lj�{..•�.. {,tr: •t ,s t N .-. A� . s ;!+� .,�x y..`.�#,.T t �x 7.��'Y+..�.y�i �� e.. t 1 F. a •t. r •!�ji r s. I��t rA tsi -Sal I ` 7.7 I _ I .z• .._.� ._.. 9 1 : -- �. .. - ......._„ -;r-- �.-----'---_-: - :=fir:._... ;`!•,-=- t - is rr � { iV i. 1 i• Ij; t _.... - ,;_, \F` 1 1• Y { '1 lr> . 1 r ti l A 43 -70�+ F Ate-' / N ' 01 I 1 i n Couc , •FOU V.;lj. e I o r ' 0 G 0) r r 12Ei.B2' se.oz j06 # B9-204 it CF_RTIFIED PLOT PLAN pREpAPED FOR: LOCATION: MEADOW LN . W . BARN . `•'1 SCALE: 1 =50 DATE: 12/4/89 it REFERENCE: DAN WEATHERBEE L-4 PB 446 PG 47 I HEREBY CERTIFY THAT THE STRUCTURE jSHOWN ON THIS PLAN IS LOCATED ON THE } GROUND AS .SHOWN HEREON. 4;S t^c�Ufd+-E t, down cape engineering, inc . � � j;,..���Y�? CIVIL ENGINEERS � LA ____ � -•r ND SURVEYORS "T_ _ {f •RVEYOR . II DATE o - ,t•rc�' ROUTE 6A YARMOUTH MAlow — r -777 .777777 up r Assessors office(1st Floor): Assessor's map and lot number�!\ y G Q Q•"3 Tw c toy e Board of Health(3rd floor): • Sewage Permit number ° i BAHl9TOBLL J Engineering Department(3rd floor).; ,! recta ,House number 1' °o t639• Definitive Plan Approved by Planning.Board /, K 1 -PI12A,1 , .19 APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00-2/Mrr .M.only TOWN - OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO TYPE OF CONSTRUCTION 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location -1G/ r- V , k� /:TjL,cr -✓�yv v C I Proposed Use �. ®• Zoning District �- ' Fire District �•- ��+�-�+-� -� Name of Owner ,�L 1c T Address Q l4'//�.+-l.//�_ ..r�, f � n�✓!$ Name of Builder /Q %{r. �. � . . Address Yam'/� ...�� ,��- � /o -a-,►�.�®-� Name of Architect A Q li �.l . Addressi.��.,�a.,y1� Number of Rooms Foundation cl=a �.-o J/ . v � r Exterior �' z Roofing ��-� Floors �� � Interior Heating �� ��T�� " P Plumbing � ��/ 4:gd Fireplace Approximate Cost ��D, d-�'D•ea Area Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform.to all'the Rules and Regulations of the Town of Barnstable regarding the above construction. Name �z.. Construction Supervisor's License d 0 9 MEADOW LANE REALTY TRUST ��,3 ohs a �� .. ` . • No 33400 Permit For 12 Story Single -Family Dwelling Location Lot #4 , 39 Meadow Lane West Barnstable Owner Meadow Lane Realty Trust . Type of Construction - Frame i i F .d Plot Lot Permit Granted December 5 , 19 85 Date of Inspection 19 I - Date Completed 19 a f 1 PERMIT COMPLETED 1/1/-q.L ,Assessors office(1st Floor): p / 3.� r%n r THE Assessor's ma and lot number 0 b o� To Board of Health(3rd floor): �— Sewage Permit number (��� A E-I f;,iD 1 E`� i Engineering Department(3rd floor): _,±���: " fir,++ � Wb° •ad'3� BAS3StdDLL House'number 'L�J`tYt�6 REGULAMONG i639• \ei' Definitive Plan.Approved by Planning Board APPLICATIONS PROCESSED 8:30-9:30 A.M.and 1:00- M.only TOWN - OF BARNS ABLE BUILDING INSPECTOR ,. APPLICATION FOR PERMIT TO -/Sfd /jN4 TYPE OF CONSTRUCTION - / ��/�`P CJ w e'LL-i,v`J - 19 TO THE INSPECTOR OF BUILDINGS: The undersigned ddphereby applies for a permit according to the following information: Location �Jl "' Al %en _.146m S4: i Proposed Use Zoning District K'F Fire District1�� ��� - Name of Ownergjd g n.A•.-r4k I.P�T.�,� Address I'f Name of Builder�� e�.ia� Address /,'� 6 ,��1,,Z ,. o.„���1�_ Name of Architect Addresso Number of Rooms Foundation Exterior /�° �' Roofing � � -��� Floors Interior Heating- eatin VjL � "'��- Plumbing Fireplace Approximate Cost Area Slog / 9 Diagram of Lot and Building with Dimensions Fee ` O !• U ' li3 1 ' i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name 0,4a4 - Construction Supervisor's License 9 /� .1/*jgFe13 �9, MEADOW LANE REALTY TRUST E No 33400 Permit For 1 z' Stork - Single Family Dwelling a Location Lo L #4 39 Meadow T,ane West Barnstable a ". Owner Meadow Lane Real t-�Z TrnSf. Type of Construction Frame Plot Lot r Permit Granted December 5; 19 89 Date.of Inspection L�-19 ` .' Date Completed - �// 19 - t T" 57.01' �. \r'A 0 43,-70c �,. �.� al 57.01• 4z f ! i n o � G o,N r r . �— 126:82• �� 51).01'. 9 . U05 # 89-204. CERTIFIED PLOT PLAN a PREPARED FOR: LOCATION. MEADOW LN . W . BARN . SCALE: 1 "=50 ' DATE: 12/4/89 REFERENCE: s --- L-4 PB 446 PG 47 DAN WEATH:ERBEE I HEREBY CERTIFY THAT THE STRUCTURE _. SHOWN ON THIS PLAN IS LOCATED ON THE -.. GROUND AS SHOWN HEREON. OC 4L .. JOt'iN down cape engineering, inc . CIVIL ENGINEERS LAND SURVEYORS . 4 s, RVEYOR ROUTE 6A YARMOUTH MA DATE ; � I i i T \ t a5 L ,•1 PH F j 1 p r ? .. r s z L � s • t ' t I I i I m in ®fI � Rr04 lr4 cpxD . � Nzz o 0Fl i - ---- - ----- -- - - 3 190 .mac o Z I r e I n o�iA is s < P ) 6 rt 1 ° �� h r i m. Z Z a� k (y Mi^4TP1 I- i p 0 r Ii:F z,.z ° • p _ n2 00^ C£ >t ,,1sc a j.n r A 1�11 'nz D� Z a n< 0,410a Q� dIH Ol)m D i O Al p1� o i 1 Z E vl.p jr a o• o r o 341X i I a- Y o�rc x 0� gym ® ° PPI r 0' `o o o . b� fE or PI P. I Z _� Z j P •Z� p °i•9 : P0 0. ' v� li °Lp Try . C- Z-. I po •A I o r o OQ O I O p laa t7f • y p p y sf 0 L9 ^;^ .� p• . = .Z . o j ..n) u bS-� o A� Pad 0 P aZ� t o. g° k °i/ °2 `r ijj" #•"oE p NE ° r f r f °0/ '1 yt °i! "err, �R `` e� I �� kD� f r Z'• C �S0, '1 r p 3 o f A f s p• I0� oa 'A Z , s a z Z Z N N N k Z a p F 16"� 4-.-kl— c_ z4 ' 01 ! tp tV + 1'� m r a Z L E:43n a 0N 0 l0 { T T Q i N� A �Z m_!N� a_• ✓_��s4 s_�o_ `\ �t Alf f� Z Z r OD e V �y 0 0 A F 14 vp��7` o 0 0 0 o A c v T r L Z �.. 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O I o� 3o TtiA )10 = 00 fi 0 p '94 w c D 49 1 i•u nZ P - i �. •� ..h• .A�.. .! oP - = OBI Z �r_ �•_r_ !` -TO.WN OF BARNSTABLE, MASSACHUSETTS BU TDINu �• DATE �. .:,'••,,�;)• : - APPLICANT r'i:::'..._ :� I - ' 19 PERMIT NO i\Tt+ M4.00 ADDRESS i:.: L j• r'. ��-'1'i- itll�!}C?')7IN0.1 (STREET) (CONTR'S LICENSE) PERMIT TO L'U.-lI. lhJ 4_ i(' ( .L :1 STORY ` NUMBER OF (TYPE OF IMPROVEMENT) NO. ;DWELLING UNITS IPR OP05ED VSE) AT (LOCATION) �•.� r ' - __ ZONING (NO.) (STREET) '— -"-- - DISTRICT_ BETWEEN (CROSS STREET) AND (CROSS STREET) 11: SUBDIVISION LOT —_ l0T_ BLOCK _— SIZF. BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP - BASEMENT WALLS OR FOUNDATION ' REMARKS: .sew::':,•r.: "Q (TYPE) AREA OR VOLUME 1.3 6`t ;:�, 1 ESTIMATED COST "i I" PERMIT ' • (, (CUBIC/SQUARE FEET) �•/ 1" FEE $ 1�0.`1 U� OWNER :1f+Un(.)t'i ADDRESS �' U• i1 66!? F l:Si.c�:i�i'.':•.,I,�.�.�_ •. f: BUILDING DEPT• ` �'�/ BY / OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE— ` ALL CONSTRUCTION WORK: CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR I. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL INSTALLATIONS. PLUMBING AND 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MEMBERS(READY TO LATH). 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. OCCUPANCY. POST THIS CARD SO IT IS VISIBLE FROM STREET ' BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 2 -- <__: -- _---- -- cl, ` �J HEATING INSP TION APPROVALS ENGINEERING OEPAR MENT 1 OTHER _ --------.....-------'------- BOARD Of-HEALTH - - v WORK SHALL NOT PROCEED UNTIL THE INSPEC. PERMIT W! TOR HAS APPROVED THE VARIOI STAGES OF WORK IS NOT BECOME ARTEDNWITHINULL NSI,'MONTHS OfOID IF CON SDATE THE INSPECTIONS INDICATED ON THIS CARD CAN BE TRUCTION CONSTRUCTION PERMIT I$ )$SUED AS NOTED ABOVE. ARRANGED FOR BY TELEPHONE OR WRITTEN NOTIFICATION. 0 tiZ. 4,1- ' �e�vEeiGK T ou►�c��. r G d21-07'rE DULIGdN N � tp 0 � r t _ t O i 43` L� \ UP iD ' �- ._ ----- 155�------_- "'' --DWELL ► i i w Sal II 5.Ci5P �. i I �o� �+�s-�o►��G . Sq - Z o4 rod ; LOc�4T/O,v: M>cbb�w Sri:w, sbz+s�rdQL� pbNa. .wE4T4E25—Ef-= .eEFE,eC�c/cE: 4-7 OF o!� ARNE wn c4PIP"S s' oJALA N C/�//L EIC/G/�llEEG3 ,fr '9f(,r� 2ocJTE Gq��geMovrs-�, M�i53, a r—rJ ,ems. � ,va sc���r�rot tr TOWN OF BARNSTABLE .Permit No. ..334.0.0...1 BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash ................ • 7 .Y� t619. /! p 9�ror6r HYANNIS.MASS.02601 Bond .......... v c CERTIFICATE OF USE AND OCCUPANCY , Issued to Meadow Lane Realtv Trust Address f' Lot #4, 3 9 ideadow Lane West Barnstable Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED.UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. ......June 11........... 19.....90........ ...... �! 4... ....................... i Buil ing Inspector t iJ. °�. TOWN OF BARNSTABLE BUILDING DEPARTMENT st TOWN OFFICE BUILDING / t HYANNIS, MASS. 02601 MEMO TO: Town Clerk FROM: Building Department r DATE: An Occupancy Permit has been /issued for the building authorized by Building Permit #� oT„� _ _.._...... . ..............:__.... ......»._ . .__. issuedto . ..Y..... _ ...�.._.... - ... �!��..... �... . .. ��......�......._�.............._ ... ...... Please release the performance bond. [� - ,;.r,mat,,�;:..,.�"'-,.•.x'+7r.ra�",y�'+� +,r.. _ _ _ .'"•�'r"fR"''"'`"r1`,✓"'"`�`y�r_+^'rY.`vk--µ"�.r•�'S7-.r..f�..�,.,,y_,.�->•-*��'^ '.rt'*Yry'ti.�...,��'+y't-�..1�`r4. Y TOWN OF BARNSTABLE Permit too. .. BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash .N� � 6 p HYANNIS,MASS.02601 Bond .......... t • CERTIFICATE OF USE AND OCCUPANCY Issued to Meadow Lane Realty Trust Address Lot #4, 39 Meadow Lane West Barnstable, Mass. USE GROUP FIRE GRADING OCCUPANCY LOAD r THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND.IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. :Buil ng Inspector clop \ot oe �0 H sk"i J i 1 _ =� \ ' I M i J" i I• � I � i 0 0 � h o Q Is t V '•� S i� , o i , • E i i - r i Ij I 1 i y C'�- bo -a e � f � � x W bl V� ..cam 4r VS, q o 1 J � � I e I i .k o � � • 7 Oct Od \ �I J g � . ow3 b v { f6 � . I Qi tv) 4 Lo O �1 CY moo Ac- loom Y1 ' o �o o - S its, ' AWL q �- JwNIL i t i Q L 4 0 -ros+ s 57.01 1 1 1 7 � O '37iCU '� I j 0 o G � ON r r 126.82' - 58.01, 9 ii r Boa # 89-204 CERTIFIED PLOT PLAN PREPARED FOR: _ -- LOCATION. MEADOW LN . W . BARN . SCALE: 1 " =50 ' DATE. 12/4/89 REFERENCE. L-4 PB 446 PG 47 DAN WEATH:ERBEE I HEREBY CERTIFY THAT THE STRUCTURE SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. K'Of bf4,t r t�;, down cape eng-aneer i ng, inc . o hictUiLE `;� CIVIL ENGINEERS LAND SURVEYORS . ROUTE 6A YARMOUTH MA DATE RVEYOR ___. j *CS- 2YAgNG7A Fk-C SMOKE DETECTORS REl]EE &AS_,M 12 7v00G D FIRE DEPARTMENT TE BOTM S/GRI,4TURES ARE REQUIRED POR L0a x���1 0 0 b ® K TC HEN los REQUIRED 9E-:1 r1 G MAi)e 1.. NTo STATE BUU)M CODE RECKJIRES THE UPGRADING OF SMOKE DETECTORS FOR THE ENTIRE DWELLING WHEN S iAIRS TO ONE OR MORE g �LEEP AREAS ARE ADDED OR CREATED. SCE N IME: A SEPARATE PEA IS REQUIRED FOR THE INSTALLATION OF SMOKE DETECTORS - THE ELECTRICAL FL�QR, PERW QQffLMUSATISFY THIS REQUIREMENT. lRo rl l boo t l �_T FLO OR, PLA j w d 0 la OOOO 01 �� r ` Q• J t � � p J�r � l " s s _ O � 4 0 O - � �_ �. 1 3y 31 V�i ';�-F----r FFa 04 0 a it 0 m 1L z = > u _0 F tl < 1 ♦ O -� -d m O �l t4N Q h0m IDrg ? ` • y 3f� Ut s0 Y Mrk9 a X Y a �v sit + Q V4 -Q� f4F ? 18d r .Qi?� s 4 Igo J J J Z N =O [0 '°Y[y p ` µ p�-p O p a0 Q r or J � 1 0 0 3 3° i ya �> v °� • 1 1 1 Q rI04 IP G pQ rr o '�� �U I, W j ®��o� d aQ /Zd o- r Kz •o 0 4 �. _ t- y 0 t 1 - o � Z o 41 o a o°��t 'm .0 r r3 ; a to ma" 'x a@a Q coo F Z 2 .o sm �+ 0 - —�Tt — -4 >3T Aw pr Y W@N �0 -+ ►nN r $ 10 8 • s s' O - 3(0 des 81 r ; 13 Y1 ° `u d U0 H�� bf ulr 7 . . �dol� Zgg. d ' � a-.j}�L ►4inv�K � i � 1 j .07 D C B ci 0 � L_ I j u r .r a ..I -- ' x AG L, qD IL CP _ -t --TJ - `.. � r _ l.. .�`�•- - - �- . � -Y • ram`'` . � =� _ — �. 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