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0084 WHITE BIRCH WAY
��h,� �. .�.. ,., . r ,.�.._. ,_. ��w� .. , ... �._ ,: ................�.,.., _ �,.....,....,_..._ _ 1 ; i E K • If t 1 1• �. I i u. Y" �•l Q e } •�k 5 �rl (1 �C•t e. l f' q4q a-..�...n� .. ..- R€ _.. _r'�-r.'} '�"-er,t__., _a '--r �:.�-..-.�.m. _ - a; ,-..M,�-�-'�-^-cn �' - -- � - - :. -,M,- .,.�.�R.,,'�L.f• C Cape Save Inc. 7-1) Huntington Avenue South Yarmouth, MA 02664 Tel: 508-398-0398 Fax: 508-398-0399 9/9/16 Thomas Perry CBO Town of Barnstable Building Division BUILDING 200 Main St. Hyannis,MA 02601 SEP 2 7 1016 RE: Insulation Permit 16-2240 TOWN OF�H FAL$L6 Dear Mr. Perry This affidavit is to certify that all work completed for 84 White Birch Way,West Barnstable has been inspected by a third party Certified Building Performance Institute(BPI)Inspector. All work performed meets or exceeds Federal and State Requirements. Sincerely, William McCluskey �-OQ CAX TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Q_—tK&A 1'eN Map a Parcel Application # C� Health Division \���� �0�� Date Issued Conservation Division lie; ��✓� Application Fe Planning Dept. F� Permit Fee �O Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address,, --�II ((U�, Village W e-s4— B�(,6Jfr41e/ Owner l' ►���lT�l 2 Address aFPt Telephone` �'v 5 9 �, Permit Request ASS, 6� �h t-�►� 1,s�,►�, -}-.��r a -)�►e a.-�{ la�a an. (° 1 M Square feet: 1 st floor: existing pro osed 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 Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: 0 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 KNO If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) NameNC14414PTelephone Number Address License #�{' rfv\c 0A 6 6 '[ Home Improvement Contractor# Email Worker's Compensation # Lr AR5 5 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BETAKEN TO 1 a, mA%hA SIGNATURE DATE b FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED I MAP/ PARCEL NO. ADDRESS VILLAGE ,y OWNER DATE OF INSPECTION: a - } FOUNDATION ` FRAME I t INSULATION r FIREPLACE 1�1 ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL Cf GAS: . ROUGH FINAL FINAL BUILDING y DATE'CLOSED'OUT ASSOCIATION PLAN NO. Town of Barnstable Regulatory Services RA g Richard V.Scab,Director Building Division Torn Perry,Building Commissioner 200 Main Street,Hyannis,INLA 02601 www.town.barnstable.rria.us Office: 508-862-4038 Fax: 508-790-6230 Property Owoer iglus t Complete and Simon This Section, If Us inc, Builder 1, _�yI PiICG as C.',ner of.the subject IM-OPOtty hereby authorve...__ . C-tb e e,, S a V e'. t o act on my behalf, in all matter, relauve to cork authorized by this b 11 dine pemit.application for: l_ (Address of Iob) "'`Pool fences and alarms are the rp-spoziblLy of, the applicant. Pools are not to be filled (r ut:iliced before fence is installed and.all final inspections are performed and accepted- K .S -natura of Owner Signature of Applic.u-lt Pnitt Flame Print Name: 22- ) Date Q:FORn9 S:OWNTE.RPFRU,I ISS10N P0ULS .Aco CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD1YYYYI 4`� F4/12/2016 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 poiicy(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 endorsements. PRODUCER NAME: Risk Strategies Company Risk Strategies Company PAHO No,,,,: (781)986-9400 1 FAC No):(781)963-4420 15 Pacella Park Drive ADDRESS:randolphcldprisk—strategies.aom Suite 240 INSURER(S)AFFORDING COVERAGE NAICf Randolph MA 02368 INSURERA:Selective Ins. of America INSURED INSURERS Allmerica. Financial Alliance Ins Cc 10212 Cape Save, Inc INsuRERC:Star Insurance Cc 7 D Huntington Ave INSURER D: INSURER E: South Yarmouth MA 02664 1 INSURERF: COVERAGES CERTIFICATE NUMBER•CL1641211375 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 POLICY NUMBER MMI ICY EFF PO'ICY EXP LIMITS LTR X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DA A CLAIMS-MADE XX OCCUR PREMISES GE Ea occurrence $ 100,000 X B1994480 10/16/2015 10/16/2016 MEDEXP oneperson) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY�PJERCar D LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 B ANY AUTO BODILY INJURY(Per person) $ AALLLOSNE M SCHEDULED AVEA46796600 31/6/2015 11/6/2016 BODILY INJURY(Per axldent) $ X HIREDAUTOS AUTOS PeraC�ddeYrdDAMAGE $ ITOS $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CL41MS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ NIL 1 181994480 10/16/2015 10/16/2016 $ WORKERS COMPENSATION officers Included for X- PER TH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE NIA C Coverage E.L.EACH ACCIDENT $ 500,000 OFFICERlMEMBER EXCLUDED? N❑ (MandatorylnNH) WC085540700 4/9/2016 4/9/2017 E.L.DISEASE-EkEMPLO $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) National Grid Corporate Services LLC d/b/a National Grid, Action Inc, Colonial Gas Company and NStar Electric are all included as Additional Insureds with respects to the General Liability coverage of named insured as required by written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Housing Assistance Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Cape Light Compact ACCORDANCE WITH THE POLICY PROVISIONS. Barnstable County 460 West 14ain Street AUTHORIZED REPRESENTATIVE Hyannis, MA 02601 Michael Christian/CLC '`� 1099-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ,t INS025(zolaol) ' The Commonwealth of Massachusetts Department of Industrial Accidents I Congress S1ree4 Suite 100 Boston,MA 02114-201.7 www massgov/dia R'orkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual):Cape Save Inc Address:7-D Huntington Avenue City/State/Zip:South Yarmouth, MA 02664 Phone#:508-398-0398 Are you an employer?Check the appropriate box: Type of project(required): I. ✓]I am a employer with 15 employees(full and/or part-time).* 7. New construction 2.rl I am a sole proprietor or partnership and have no employees working for me in 8. any capacity.[No workers'comp.insurance required.] 9. Remodeling ❑Demolition 3.M I am a homeowner doing all work myself.[No workers'comp.insurance required.]r 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have workers'compensation insurance or are sole I Ln Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑✓ Other Insulation 152,§1(4),and we have no employees.[No.workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp:policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Star Insurance Co. Policy#or Self-ins.Lic.#: WC085540700 Expiration Date: 4/9/2017 Job Site Address: 84 White Birch Way City/State/Zip:West Barnstable Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sig-nature: Date: 8 4 16 Phone#:508-398-0398 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#: c;� Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration —_ Registration: 171380 - - — Type: Corporation Expiration: 3/14/2018 Tr# 419291 CAPE SAVE INC. WILLIAM McCLUSKEY 7-D HUNTINGTON AVENUE SOUTH=YARMOUTH, MA 02664 , ,. Update Address and return card.Mark reason for change. Address ❑ Renewal ❑ Employment Lost Card SCA 1 0 2OM-05/11 - e er-A airs&Bu iness �igulatira;efla License or registration valid for individul use only _Office of Consumer Affairs&Business Regulation g Y HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 5 Registration:.:-.'171380 Type: Office of Consumer Affairs and Business Regulation Expiration 3/14/2018 Corporation 10 Park Plaza-Suite 5170 ' _ Boston,MA 02116 CAPE SAVE INC. - WILLIAM MCCLUSKEY 7-D HUNTINGTON AVENUE.:' SOUTH YARMOUTH,MA 02664 Undersecretary -Not valid i signature Massachusetts -Department of Public Safety Board of Building Regulations and Standards Cfrir52TiiC`uirn�iinei i isar'anrecialov .cTs License: CSSL-1TI. I WILLIAM J MC CCU 37 NAUSET ROAD I # West Yarmouth NIAENV` `�. Expiration Commissioner 06/28/2017 1 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 2 v �p�plicatiori if Health Division Date Issued -��- Conservation Division ok..'e Application Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board q � - Historic - OKH _ Preservation / Hyannis Project Street Address s q U q TJF- a C� �✓� ( Village B5T1i1; I Owner G&E6+• ArJ9%oQA gVttL.T-0� Address t Telephone 61-7- i4So- Permit Request SST 064, 17-JC-7 Z-X.)62o4N_13 OD VYC � P Square feet: 1 st floor: existing proposed :nd floor: e i in pro osed Total new i � Zoning District Flood Plain roundwater rl ' I Project Valuation 50�DOD Construction Type w nzlj 6 L Lot Size y3 7`b7 Grandfath ed• ❑Yes ❑ No If yes, a supporting documentation. Dwelling Type: Single Family ❑ Two Fami ❑ Multi-Family (# units) o I Age of Existing Structure Histo 'c us ❑Yes ❑ NoZ Old King's Hi,hway: 13?(es No -n 1 Basement Type: ❑ Full ❑ Crawl Walko t ❑ Other 1 Basement Finished Area(sq.ft.) Baseme t finished Area(sq.ft) 1 � �Number of Baths: Full: existing new Half: existing I) new' ; Number of Bedrooms: exist' _ne s Total Room Count (not including baths): existing n First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric er Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing size _ Barn: ❑ existing ❑ new size c Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: 893 5 N Z"1�'trNGA22L. Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ V, b Commercial ❑Yes ❑ No If yes, site plan review # r 1 Current Use Proposed Use 4 s APPLICANT INFORMATION (BUILDER OR HOMEOWNER) �0�71 Name S E G�� C 4ZM_1Z phone muN muN be`r"� Address 202 d�+•�� 61"r"L" ,r2o�D License # Home Improvement Contractor# Worker's Compensation # C-33 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO Sol J �CCd s - 1+ SIGNATURE le DATE d I FOR OFFICIAL USE ONLY APPLICATION# - PATE ISSUED ` MAP/PARCEL N0. } ADDRESS VILLAGE OWNER p `y DATE OF INSPECTION: > FOUNDATION • J FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL i FINAL BUILDING DATE CLOSED OUT _ v ASSOCIATION PLAN NO. c7�5 w _ . I TOWN OF BARNSTABLE Building 201308618 * RAMST"LE, " Issue Date: 11/27/13 Permit 3VIA$S �Art6 3 A�� Applicant: DITTRICH,CHRISTIAN Permit Number: B 20133003 Proposed Use: SINGLE FAMILY HOME Expiration Date: 05/27/14 Location 84 WHITE BIRCH WAY Zoning District RF Permit Type: POOL INGROUND RESIDENTIAL 11 Map Parcel 128028 Permit Fee$ 125.00 Contractor DITTRICH,CH ' TIAN Village WEST BARNSTABLE App Fee$ 50.00 License Num 161240 Est Construction Cost$ 50,000 L Remarks APPROVED/ N UST BE RETAINED O O INSTALL PRIVATE INGROUND POOL,HEATED 18 X 36 WITH ASTM THIS CARD T BE KEPT POSTED UNTIL FII SAFTEY COVER AND 4'NON-CLIMBABLE FENCE INSPEC N HAS BEEN MADE. WHERE A CE FICATE OF OCCUPANCY IS REQUIRED,SUCH Owner on Record: PERPER,EDWARD J&LESLIE A BUILDING SHALL NOT BE OCCUPIED UNTIL A FINAL Address: 84 WHITE BIRCH WAY INSPECTION HAS BEEN MADE. WEST BARNSTABLE,MA 02688 Application Entered by: PF Building Permit Issued By: THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET,ALLEY OR SIDEWALK OR ANY PART THEREOF,EITHER TEMPORARILY OR PERMANENTLY. ENCROACHME SON PUBLIC PROPERTY,NO SPECIFICALLY PERMITTED UNDER THE BUILDING CODE,MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAYBE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM OF FIVE CALL INSPECTIONS REQUIRED FOR ALL CONSTRUCTION WORK: 1.FOUNDATION OR FOOTINGS. 2.SHEATHING INSPECTION 3.ALL FIREPLACES MUST BE INSPECTED AT THE THROAT LEVEL BEFORE FIRST FLUE LINING IS INSTALLED. 4.WIRING&PLUMBING INSPECTIONS TO BE COMPLETED PRIOR TO FRAME INSPECTION. 5.PRIOR TO COVERING STRUCTURAL MEMBERS(FRAME INSPECTION). 6.INSULATION. 7.FINAL INSPECTION BEFORE OCCUPANCY. ' 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. PERMIT WILL BECOME NULL AND VOID IF CONSTRUCTION WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE PERMIT IS ISSUED AS NOTED ABOVE. PERSONS CONTRACTING WITH UNREGISTERED CONTRACTORS DO NOT HAVE ACCESS TO GUARANTY FUND(as set forth in MGL c.142A). THIS , ' TAAT IS VISIBLE FROM THE STREET BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS ELECTRICAL INSPECTION APPROVALS 1 1 1 2 2 2 3 1 Heating Inspection Approvals Engineering Dept Fire Dept 2 Board of Health PROJECT,— NAME: vTtiT1 oen ADDRESS: PERMIT# 1 3 O y PERMIT DATE: ! 1 M/P: ZG r LARGE ROLLED PLANS ARE IN: BOX SLOT Data entered in MAPS program on: BY: q/wpfiles/forms/archive r Tovfi of Barnstable ha *P tm d Regulatory Services Fee �C = aAatBr&BL% = `eg' Thomas F.Geller,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 Property tyAddress lA j lr�Residential Value Value of Work 0(y) Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address Gmarg [A Ct W-% l k", A;�� 19� i^�I,z UAY Contractor's Name D' Telephone Number __j — Home Improvement Contractor License#(if applicable) S l Construction Supervisor's License#(if applicable) 0 I ®Workman's Compensation Insurance Check one: i ❑ I am a sole proprietor SEP 2 2013 ❑ I am the Homeowner I have Worker's Compensation Insurance TOWNJ 0 Insurance Company Name m� l M� 7' Q F—ARNSIMBLEF Workman's Comp.Policy# `7 S Li-X� l l 1`s `7�^' Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Jig Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *Where required Issuance of this permit does not 6=npt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. Aj\copy of the o Improvement Contractors L'' ense&Construction Supervisors License is r6hu—ireddIV SJLGNXI M 7 q � 0AWPMESTORMS7building permit forms\0YRFSS.doe '1 i e l the Comurmnseafth afMassat:husefft Department ofhsustri&Accidmts - (dice ofInvadga#ions 6aO Washington Sfreet Boston,MA 02M wwtt.mass:goyldia Workers'Comyensatinn Insurance Affidavit Builders/C:ouh-actors/ElectricianslPlumbers Applicant Iufm-mation Please Print Ugibly Name ousi �: Mail 0 Address.I 1:�1 LY)1M i Gt�lf�i Ip Q.ty/Statr-z: Q�1j, 0*0 Phone# Pure you an employer?Check the appropriate box: T ; of, o ect r l.. 4_ I era a contractor aid I � � 3 � (required): L M I am a employer with ❑ ti_ [:]New sction. employees(fW1 and/or ).* have hired.the sub-coatcactors 2.❑ I am a sole proprietor or partner- Listed on the attached sheet 7- ❑Remodeling ship and have no employees These sub-oontractorshave g_ ❑Demolition working forme ill any capacity. employees and have workers' 9_ ❑Building addition [NO WOrkUS' Comp-in3U=e Comp.mcnrancr I MT3ired-] 5_❑ We area corporation and its 10-0 Electrical repairs or additions 3_❑ I am a homeowner doing all work officers ha�-e exercised their 11-0 Plumbing repairs or additions myself.[No workers'comp- right of emmption per MGL 120 Itnof iasunmce ]1 c-15Z§1(4),and we hn a no �s 13.❑Other emp -[No workers' comp.insurance requinAl �Aayagp at that checks box#1nattalsofM out tle section belowshovrins8tefrsvadcea'rnaspe napnlicpanf�ti= Homevv�s who sabaut this aiidavft mTLcz&g they set:doing aII wadi sad rhea bide o=nfie contoutors—st sobatit a new affidavit muting Barb- ICon=cMzs thst check this box mint stffiched m additional sheet showing the nine of the s#caatxacmss and state whether ornot those m9i5es hzm employees. If the sub-coatmcims hale empluees,they mast provide their workers'comp policy atnabez I am an employer ihatisproviWftg tvorlsers'comperrsRtfon fr rarrc$for my ert3Plnyext Beloav is t9ie paTicy and job site informadam �—}�— lnserance CompanyName: I r p l r y Policy#or self-ins-Uc.4, (766 ()L( bps Job%fe Addiess -1 kIN`J'e t t F6) kA / CiVIState/ziP:W a S4)jt %M'Pf b (66 5 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration dale). Failure to secure coverage as requiredunder Section 25A o€MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprison,as well as civil penalties in the form of a STOP WORK ORDER and a fine of ups to$250-00 a day against the violator- Be advised that a copy of this statement maybe forwarded to the Office of Iuvestigations of the DIA for- coverage vecification. I do here fy tlr and penatfes ofpedury that the informa#ian provided above' true and correct Date: Phone#: Co , s O#ciai use only: Do not rrrfts in flris area,to be completed by cdy or town offfcfaL City or Tzwn- e# Issuing Auffiar4(circle one): L Board of Health 2.BuRding Department 3.City1rown Clerk 4.Electrical Inspector 5.P#umbing inspector j V Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 Iocal 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 insuranm 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(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 lime. 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 pemuttlicense 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 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 XnnWptions 600 washivou Street Boston,MA 02111 Tel.#617 727-4M W 406 or I 477-MASSAFE Fax#617-727-7749 �J oFEr Town of Barnstable Regulatory Services • snxxsr.�si.E, + . MASS. �, Thomas F.Geiler,Director ' 63g661. Building Division Tom Perry,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.m a.us Officer 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 Il��l Ci�l (� Q VA Cc. to act on ray be3ig in all matters relative to work authorized by this building permit (Address of 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 S' tute of licant Print Name Print Name Tate ' 4� F Town of Barnstable Regulatory Services ♦ ASRT0.^T1Hf_F_ �. Thomas F.Geiler,Director 9`b�Eo;A •�0� Building Division �l Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION Please Print DATE: JOB LOCATION: number street village "HOMEOWNER": name home phone# work phone# CURRENT MAII.ING ADDRESS: 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 hue 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 applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department mini,rum inspection procedures and requirements and that he/she will comply with said procedures and requirements. 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 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 Iast page of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community_ C:\Users\decoUil\AppData\I.ocal\Mcrosoft\Wmdows\Temporary Internet Fdes\ContentOudook\QREaUBNWeRESS.doe Revised 053012 i Massachusetts -Department of'public Safety ? Board of Building Regulations and Standards. . Cimstruction Supen isor License: CS-096986 ANGELO J RO1I�ANU 10 EMERY SxREE, . PEABODY#A 01960 n 1 aC Expiration Commissioner 04/04/2014 I �ie��parrvnao�ziueer</,�.o�C/��.aeaclzccoet�l . Office of Cousumer Affairs&Busi esstRegulatiori <; f WMEIMPROVEMENTCONTkAttok &tratioh::.4648i-4 Type: pirgtion: J.5L2014— "BA. ANGELO J.ROM_AN6 Fl ,Gz • .0 t ANGELO ROMANO`s� 19 BLOOMINGDALE:STREETS CHELSEA, MA 01150 Undersecretary. I ' Massachusetts -Department'of Public Safety Board of Building Regulations and Standards. Construction Supervisor License: CS-096986 a ANGELO J RQNIANO� 10 EMERY STREE PEABODY NjA 0196.0 v-' �- J-•e:..� Expiration F _ Commissioner 04/04/2014 License or registration valid for individul-use only before the expiration date. If found return to: : Office of Consumer Affairs and Business Regulation ( j 10 Park.Plaza-Suite 5170 .t� Boston,MA 02116 Not 'I d wi6o* ut Mgnature V L JPI%O ;d, , hAATMRDWORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY TYPE AR INFORMATION PAGE WC 00 00 01 ( A) POLICY NUMBER: (GS60UB-6605433-0-13) NEW-13 INSURER: HARTFORD UNDERWRITERS INSURANCE COMPANY NCCI CO CODE: 10456 . 1. INSURED: PRODUCER: ROMANO, ANGELO J DBA ANGELO J SAUL FREEDMAN INSURANCE ROMANO ROOFING COMPANY 793 WASHINGTON STREET 19 BLOOMINGDALE STREET NEWTONVILLE MA 02460 CHELSEA MA 02150 Insured Is AN INDIVIDUAL Other work places and Identification numbers are shown in the schedule(s) attached. 2. The policy period is from 06-1 5-13 to 06-15-14 12:01 A.M. at the insured's mailing address. 3. A. WORKERS COMPENSATION INSURANCE: Part One of the policy applies to the Workers Compensation Law of the state(s) listed here: MA �— B. EMPLOYERS LIABILITY INSURANCE: Part Two of the policy applies to work in each state listed in a� item 3.A. The limits of our liability under Part Two are: Bodily Injury by Accident: $ 1000000 Each Accident Bodily Injury by Disease: $ 1000000 Policy Limit Bodily Injury by Disease: $ 1000000 Each Employee C. OTHER STATES INSURANCE: Part Three of the policy applies.to the states, if any, listed here: COVERAGE REPLACED BY ENDORSEMENT WC 20 03 06A o� D. This policy includes these endorsements and schedules: c� SEE LISTING OF ENDORSEMENTS - EXTENSION OF INFO PAGE o�. 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating Plans. All required Information is subject to verification and change by audit to be made ANNUALLY. DATE OF ISSUE: 07-17-13 BB ST ASSIGN: MA I OFFICE: ORLANDO DA HTFD 05G PRODUCER: SAUL FREEDMAN INSURANCE 72WLR 004654 J ANGELO: J. ROMANO ROOFING C0f .z» Residential•Commercial•IndustrialAVC . _. . 19 BLOOMINGDALE STREET CHELSEA;MASSACHUSETTS 02150:` (6$7�.881 4753 Y Date:September.16,2013. To:Greg.Hamilton s, x Subject:84 White.Birch Way;West Barnstable,NIa 02668 :.:. .. .. .:....:. .... s 1).'"Stnp entire roof down to boards :r 2).. Inspect decking and replace,up to 100 Ln ft 'of boarding where needed 3) Install iice and water shiield.to first,3 fc of roof ... ..'.:..'..e F 4): Paper in existing roof area with#15.Ibs`.felt:: - } S) Install aluminum drip edge to.perimeter.edges ' 6) Shingle over underlayment's with CertainTeed Landmark Series shingles s 7) InstallAdge vent across peak:of roof:: 8) Contractor to pull all permits needed, 9)' -Contra'ddeio Ilea l-all debris fromsite':.: 10YAII workmanship warranted-for five-. 11) Roof warranted by CertainTeed Inc.for:.life time.. Furnish all materials and labor for the lump sum' -of$18;000:00 Payments as follows$8,000 deposit upon start$4000 when half-done$4000 balance. . Signature: Date: Signature .. Date: . Assessor's office (1st floor) / % h I Er ` Assessor's map and lot number ...G�!.A/ o� o Board of Health (3rd floor): �Qy' .. 73 Sewage Permit number . !'. '. Z BARNSTABLE, Engineering Department (3rd floor): ,rn ,n oo t6 9. 4 o.Y ' Housenumber ................................... ?..A................................ 'EpYPYd' Definitive Plan Approved by Planning Board ________________________________19 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only \ TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO .G./..........�1. . 9.1. .... ✓Y!.P. :. ...170P!NA4 ........ i� TYPE OF CONSTRUCTION ....G.[�e'V-451....FA1.T yV. .Z ..... f�Q.l..��r�.��..... I /' Z...Lt...........19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: �r(/ h' �q/S rcy �j Je/ xAf , LocationW...!l1 ... I.Y..L ......Jc.�(..�l.�f�!.i .......... Proposed Use ........ . ......�.��...... .......... .................... ' ......� i 1 ?.�� ►.t ....IZ. .S! .t ..P..e Zoning District .�1, .T.................... ...... ......................Fire District .! .�. �.. . ........................... 17, u L p,,Y� ivl if �I�LESCy'/� b0 Srnotz/ l�.ccG�y /S?C'�"Y/'`I�P� /LI . Name of Owner4P54W..J..• .r. .� :' I ...........AddressZ7.. C-�II�1 R<.l1.. ;^Name of Builder /Gl. ....� L.�=5. ! .....Address,.V..0--C� *..... /1� L.P�, 14*0 -i I4 i 4- 2-2. 01 • Name of Architect Mike,-7rI1lt.C IrOAl ......................Address ....!'¢!JP.................. ' Number of Rooms ........... .L.l............ z...S�O .........Foundation ......................... 'Exie for l�f. .j�.�/�s . '' ..)........� .�.,r. .................Roofing .... .p. .. - ............................................... Floors ....1......C. - .e. ' r"'.....................Interior ..L�.�-. .���!s► .&P.....: A.....044.Sl.. A. Heating .1 ....1....... ............................................Plumbing ��!.� . .. ................................................... Fireplace `.f.. i}.lh.l.� � �r!!9.'"'.. �.�Vl./1 ....Approximate Cost ......... .�........�... TArea .................................Flal Diagram of Lot and Building with Dimensions 7 S Fee 3�d... ............................. . �\ 3 C� A� X3,, ` I OCCUPANCY PERMITS REQUIRED FOR N EW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ...... /t��!.....1...�.... �'� Yt ............................ Construction Supervisor's License ... ..... ..91 MERLESENA, �7PAUL qX. & JOHN A=128-028 12, No 32456 Permit for .1 .. Story. Single Family Dwel.linq..............�. Location ...Lot #3 , 84...White...Birch, Wa y West Barnstable ............................................................................... Owner Paul X. & John Merlsena .................................. Type of Construction ......Frame Plot ............................ Lot ................................ Permit Granted ...November 2 2, 19 88 ; Date of Inspection ....................................19 Date Completed ......................................19 r h f 5 C4 TM»o TOWN OF BARNSTABLE �2` -6 PermitNo. ................ BUILDING DEPARTMENT TOWN OFFICE BUILDING Cash 7 .Y• � 6�9• HYANNIS.MASS.02601 Bond X. II CERTIFICATE OF USE AND OCCUPANCY Issued to John Merlesena Address Lot #3, 84 White Birch Way 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. August 24, 19 89 R Building In ector 1 r ..° lay TOWN OF BARNSTABLE BUILDING DEPARTMENT iq _ BAR STA _ TOWN OFFICE BUILDING HYANNIS, MASS. 02601 Y MEMO TO: Town Clerk FROM: Building Department DATE: y— An Occupancy Permit Chas been Lisssued?'for the building authorized by Y' Building Permit $k... A ..1__�>CK"/ !J..._............................................. .... ._..__............... issuedto .......... _ ......T2L&M-a.. ......_................_.... ....__._ a Please release the performance bond. TOWN•OF.BARNSTABLE, MASSACHUSETTS mil A-128-028 DATE November 2L 88 �dj APPLICANT John P. Merlesgna 19 ERMIT N0 NO. 3245 ADDRESS 27 Oldham Road,P Osterville. . 1 1N0.1 (STREET) (CONTR'S LICENSE) PERMIT TO- Build dWelTiriQ (-Li—) STORY Single family dwelling . NUMBER OF (TYPE OF IMPROVEMENT) NO DWELLING.UNITS (PROPOSED USE)- ' AT (LOCATION) lot #1 84 White Birch Way, West Barnstable � � zoNlNc (NO.) (STREET) DISTRICT— rl' BETWEEN (CROSS STREET) AND (CROSS- STREET) 'SUBDIVISION LOT BLOCK LOT SIZE - BUILDING IS FT. WIDE BY,TO.BE - - - .:� '•R. FT. LONG BY FT, IN HEIGHT AND SHALL CONFORM-INCONSTRUCTIO' TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION •'-"REMARKS: (TYPE) Sewaige #88-673 • � i F' AREA OR 3101 u ... BOND VOLUME Q• L t. 235,000 (CUBIC/50uARE FEET) ESTIMATED COST PERMIT :.. FEE..:.' ' OWNER Paul X. &- John P. H;!rlesena ADDRESS Uldliam Roau, VZ:,LUrVjjje, 1 LABUILDING OE PT, �"'° ,` �'•• BY 41 �•,F•R OMITHE DEPARTMENT OF,PU BLIC�WORKSTHE ISSUANCEO F-AT H`ISPERMIT yDOES NOT RELEASE THE APPLICANT FROM ! e r'r OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. ERS M b'e'�utY' IN! OM THE CONDITIO• MINIMUM OF THREE CALL gpPROVED PLANS MUST BE RETAINED ON JOB AND THIS WHERE APPLICABLE SEPARATE INSPECTIONS REQUIRED FOR _ 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 PLUMBING O 2. PRIOR To COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL 3. FINAL INSPECTION BEFORE FINAL INSPECTION HAS BEEN MADE. I OCCUPANCY. ' POST THIS CARD SO IT IS VISIBLE FROM' STREET BUILDING INSPECTION APPROVALS — PLUMBING INSPECTION APPROVALS --- — - — ELECTRICAL INSPECTION APPROVALS 1 fi Jl D/ z /—-- — 3 �.. HEATING INSPECTION APPROVALS ENGINEERING DEPARTMENT I OTHER -- HOARD U) I II AIAI I --� ME WURK SHALL NOT PROCEED UNTIL (HL' INtiPL(: PERMIT RMI T 'd! -- TOR HAS APPROVED THE VARIUUUti SIAGI:ti OF WORK IS NOT STAROTEDME yw1T)iINULL NSDIXVMOONTHS OF ID IF DATETIDE ULL CONSTRUCTION. INSPENGED INDICATED ON THIS(:AR[)CAN PERMIT iS ISSUED AS NOTED ABOVE ARRANGED FOR BY. TELEPHONE OR 4Vf 11 NOTIFICATION. i J m� O 9 n a o I � U i mK � W 6D�IT10�•1 COVG. 864 +' LoT 3 / 4z.,Z 80t 1.01 t ACC F}toP, S x� r' `15 � 9 L 0-r I LOT ? i I JOB # 88-381 CERTIFIED PLOT PLAN PREPARED FOR: LOCATION: ' - LOT 3 WHITE BIRCH WAY W . BARN . SCALE: 1 "=60 ' DATE: 11/17/88 REFERENCE: PB 406 PG 9 JOHN MERLESENA I HEREBY CERTIFY THAT -THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS SHOWN HEREON. • 3�se,µ i;F ly:`y;, 5. S�J"•:L'�' '4l: down cape engineering, inc . o No.3 S02 CIVIL ENGINEERS ii LAND SURVEYORS WAS/88MA ROUTE 6A YARMOUTH MA DATE P"' • RVEYOA W Assessors office (1st floor): I ���� Er Assessor's map and lot number ./. 71 h F—kl FAUST RE Q ` Board of Health (3rd floor): � �"�""" �N . � .. �C , Sewage Permit number GG -� Y r .a��� t 4�1 Z 13AHd9'rADLL, . Engineering Department (3rd floor): p'�;� �0�� n n.J moo �639, e� House number ... .. . . ............ ... .4 . ......... ......... .......... 1'cuilii�v�AEGULATIONS ..,: '°'Fo�av . . . . . . . .. . Definitive Plan Approved by Planning Board __NLr usr____-_26______19 APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00-2:00 P.M. only (,`2l-( TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO 1`l.`�. .Y(!. ........ I .... ✓�!.1.�'.�t ...�Z.��!1!I C......... TYPE OF CONSTRUCTION ....W.. .. . FOR I C x- ........./49 .-.....Z .......'..I ...---..----19. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: W r/� &-otlTri oe, LocationW...! ilt-...1 .ieI4�h....;�.b lilvl..S�.Q! ..1/ lxt'l���f�..'... !!il. le1!.S.!tQ�hie'...P ............. Proposed Use ....5 vV ........Flt-r�—iLy.....�jl`�..m �.......... ..�Z. .�11.~. .� t .�. ..................... .�1 Zoning District F...... .................... .................... ...........Fire Districtl°I. .e 1. . � u L X4 Mar iF4/#1-a-s bO ��v lJ�cLey �,� -'pS7"e.^i.... Name of Owner ,1..J'...M4-7.9 ...........Address-.7.. ...Zd:o... .. ..h-.. ..Y.ill.. ..r'I.`I.• Name of Builderh/11./.v..... .PL ? .....AddressC. ;.1�afR'!...t�yj Name of Architect) l .7" TO. ........................Address ! 'lj. ....�s.rm.. ...koux....1 Number of Rooms ...........�.I............. . . ........Foundation ..D..a`-ed.... .tl.1. .I............................. Exterior (1.!'K .�Q� '�..�....... .�.G.!•,••....................Roofing ... .�1. -..(................................................... Floors 01-e.e.T.....................Interior ..IJ.1-.K.. L '1 ...... 6 ....1...L.1� /.. � 1 Heating �7j}��^.... ....... .H4............................................Plumbing coy.f-m j.pVc................................................... Fireplace 1. 1.J.L.,i&14....Approximate Cost .. ...Z'..7 �.. ............................ � y � Area ......................... ................ Diagram of Lot and Building with Dimensions r ,y 9 9 1� S Fee ...............���/...�..... (1 X3-70 , OCCUPANCY PERMITS REQUIRED FOR NEW DW ELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ..".!�.. ° .... !....�.', . L e r�.. ... .... Construction Supervisor's License .©..I...`7....... '..v.. MERLESENA, PAQL X. & JOHN a No ......... .... Permit for ...... Story............................ Sin le ..P��lp,�j.ing.......... .............. ....... .............. ..... Location .........84 White .Birr a' y .... ...................... ......... ...................West....B a.r.n s.t.a b.1.e...................... ..... .. . .... .. .... .. .... .. . Owner ...X & John..Me.rle.seTi wl er ...... cj .................... ..... ....... ..... .4 Type of Construction ......FTAMe....................... ....................................... ... ....................... PlotLot .................................................. November 22 , 88 Permit Granted .......................... .19 Per Date of Inspection ............................. ......19 Dgte Completed 9C - W ir < 0 1. SME Tn. AS& = The Town of Barnstable .0g AlFDMp'lA Department of Health Safety and Environmental Services Building Division 367 Main Street,Hyannis MA 02601 Office: 508-790-6227' Ralph Crossen Fax: 508-790-6230 Building Commissioner To Whom It May Concern: Please be informed that a Certificate of Occupancy has been issued for The Town of Barnstable has no further interest in any performance bond for this property. Sincerely, bondrele • SENDER: Complete items 1 and 2 when additional services are desired, and complete items 3 and 4. Put your address in the"RETURN TO"Space on the reverse side. Failure to do this will prevent this card from being returned to you.The return recei t fee will provide you the name of the erson delivered to and the date of deliver X. For ad itiona ees t e o owing services are available. onsu t postmaster or tees and check box es or additional service(s).requested. 1. ❑ Show to whom delivered, date, and addressee's address. 2. ❑ Restricted Delivery (Extra charge) (Extra charge) 3. Article Addressed to: 4. Article Number P 650 798 005 Mr. John P. Merlesena Ty a of Service: P. 0 BOX 356 Registered ❑ Insured Hyannis MA 02601 El Certified ❑ coo El Mail ❑ Return Receipt for Merchandise Always obtain signature of addressee or agent and DATE DELIVERED. 5. i at — Alr e ,�t '8.=Addressee's Address (ONLY if X / �� requested and fee paid) 6 igna ure — Argent74 � T X 7. Date of Delivery S PS Form 3811, Apr. 1989 .U.s.c.Po.lsas-23e-a1s DOMESTIC RETURN RECEIPT i I UNITED STATES POSTAL SERVICE OFFICIAL BUSINESS SENDER INSTRUCTIONS Print your name,address and 21P Code in the space below. • Complete items 1,2,3,and 4 on the U, reverse. • Attach to front of article if space -� permits, otherwise affix to back of article. PENALTY FOR PRIVATE • Endorse article "Return Receipt USE, $300 Requested"adjacent to number. RETURN Print Sender's name, address, and ZIP Code in the space below. TO c Mr. Joseph D. DaLuz, Bldg. Commissioner TOWN OF BARNSTABLE 367 Main Street Hyannis, MA 02601 1 P 650�-7,98 005 ,,*Certifikd Mail Receipt No Inst7�anc, Coverage Provided Dtyhot Is ;or International Mail WUrT, TA T ,g (See Reverse) UKRI S,_v Sent to Mr. John P. Merlesena Street&No. P. 0. Box 356 P.O.,State&ZIP Code Hyannis, MA 02601 Postage $ I Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt Showing p) to Whom&Date Delivered tr Return Receipt Showing to Whom, Date,&Address of Delivery TOTAL Postage p &Fees CoPostmark or Date M I_ O LL rn a STICK POSTAGE STAMPS TO ARTICLE TO COVER FIRST CLASS POSTAGE, CERTIFIED MAIL FEE,AND CHARGES FOR ANY SELECTED OPTIONAL SERVICES(see Iront). 1.If you want this receipt postmarked,stick the gummed stub to the right of the return address leaving the receipt attached and present the article at a post office service window or hand it to your rural carrier(no extra charge). ai m 2.If you do not want this receipt postmarked,stick the gummed stub to the right of the return m address of the article,date,detach and retain the receipt,and mail the article. 0 3.If you want a return receipt,write the certified mail number and your name and address!, a rn return receipt card,Form 3811,and attach it to the front of the article by means of the guP.." I, � ends if space permits.Otherwise,affix to the back of article.Endorse front of article RETURN RECEIPT REQUESTED adjacent to the number. 4. If you want delivery restricted to the addressee, or to an authorized agent of the addressee, p endorse RESTRICTED DELIVERY on the front of the article. c+� 5.Enter fees for the services requested in the appropriate spaces on the front of this receipt.If E1 return receipt is requested,check the applicable blocks in item 1 of Form 3811. G7 6.Save this receipt and present it if you make inquiry. ou.S.G.Po.1e90-270-153 0- 4 J C TO The Town of Barnstable 1 fAYt G$.ug•r : Inspection Department . ,, WOR 367 Main Street, Hyannis, MA 02601 508-790-6227. Joseph D.DaLuz Building Coanmissioncr April 23, 1992 Mr. John P. Merlesena P. O. Box 356 Hyannis, MA 02601 RE: A=128 028 ( 84 White Birch Way, West Barnstable; Dear Mr. Merlesena: This office is in receipt of a complaint alleging that you are operating a landscape business from your property located at 84 White Birch Way, West Barnstable. Please contact this office immediately re the above matter. Peace, JJo ph D. Da uz ilding Commissioner JDD/gr Certified mail: P 650 798 005 R.R.R a 4 r . i l G .F t J;[R128 028. ] LOCJ0034 CTY]05 TDS] 500 WB KEYJ 354146 ----MAILING ADDRESS------- FCAJ1011 PCSJ00 YR•J86 PARENT] 69909 MERLESENA, JOHN P 9 MAP] AREAJ83EC JV] . MTGJ2006 MERLESENA, DEBORAH J SP1J SP21 SP3] F 0 BOX 356 UT1J UT2] 1 .00 SQ FTJ 4340 HYANNIS MA 02601 AYB]1989 EYB]19°9 OBS] CONSTJ 0000 LAND 30000 IMP 293200 OTHER ' ----LEGAL DESCRIPTION---- TRUE MITT 323200 REA CLASSIFIED #LAND I 30,000 ASD LND 30000 ASD IMP 293200 •ASD OTH #BLDG(S)-CARD-1 1 293,200 DESCRIPTION TAX YR CURRENT' EXEMPT TAXABLE #PL 84 WHITE BIRCH WAY WB TAX EXEMPT ' #DL LOT ,3 RESIDENT'L • 323200 323200 323200 Lam:. #RR 2138 OPEN SPACE COMMERCIAL INDUSTRIAL EXEMPTIONS SALEJ12188 FRICEJ 1 ORBJ6541/084 AFD] v A j LAST ACTIVITY]04/05/90 PCRJN I N TOWN OF BARNSTABLE BUILDING DEPARTMENT COMPLAINT/INQUIRY REPORT Date Rec'd B Assessor's No. -C�o2 g Last Name First Name ,1�� ORIGINATOR Street Village State Zip Tele hone: Home Work �� Des r' ion• � COMPLAINT INQUIRY Requestor's Signature COMPLAINT Street Address LOCATION Q A= w�do2p OFFICE USE ONLY INSPECTOR'S Date Inspector ACTION/ COMMENTS FOLLOW-UP ACTION ' ADDITIONAL INFO. ATTACHED I COPY DISTRIBUTION: WHITE - DEPARTMENT FILE YELLOW - INSPECTOR PINK - INSPECTOR (RETURN TO OFFICE MGR. ) MISCl 1 "SERVING THE SOUTH SHORE" f-sPhWL7 Ta ^' re& Ho r PINE A R B 0R WOOD PRODUCTS ( X � �s a/k w.0 SANG-LES .Its all about the wood"' (' Aa `r fV 01Z GnRN��S OPTI O W A- - CHATHAM LOFT SHED - 10 x 161 � 31c-C)ClLs ToQ (Elevations - Scale: 1/4" = 1'), LEFT REAR 3-TA OR- #+XC0- 16 VENTS ` 1 x 413 Rgv.E x16 'TTzl M . Iu oPTIa" 4L- it s, � ? f. � V1Nry( 1-I6 o -a. L WINC)O� ,. OPTIONAL N zo e vooR sN 2 GL.E CLRPBOAXAj CpTV FLOOR FRAMING SPECIFICATIONS FRONT (Z,g,�p ^� STEP (2 x 8 Pressure Treated @ 16" o.c.) RIGHT I , 04/26/2017 23:05 5087717070 PINE HARBOR PAGE 03/03 S ,c I- TEC1. P _ �wQ _...,w. .��.WOOD PRODUCTS �...a._.-.,. 259 Queen Anne Road I Harwich MA, 02643 (508)430-2800 1 pineharbor.com I harwichoffice@pineharbor.com Owner's Authorization Form as owner of the property located at 9q -W)4te 3) rcA Wqd Authorize Pine Harbor Wood Products to act on my behalf in all matters relative to work authorized by this building permit application. Owner of property signature Date Pine Harbor Rood Products-259 Queen Anne Road. Harwich MA,02645 f C��s m p�9• i a 0 1. U aoo�r�o.-i �ouc. 41 BGqf . LoT 3 / y3T80t�, i.o i±�♦c� Frc.oF. 9 r . r m� eC �o LoT z JOB # 88-381 CERTIFIED PLOT PLAN LOCATION: LOT 3 WHITE BIRCH WAY W . BARN .PREPARED FOR: .SCALE. 1 "=60 ' DATE: 11/17/88 REFERENCE. PB 406 PG 8 JOHN MERLESENA I HEREBY CERTIFY THAT THE BUILDING SHOWN ON THIS PLAN IS LOCATED ON THE GROUND AS- SHOWN HEREON. down cape engineering, inc . CIVIL ENGINEERS Nc:.33802 a it LAND SURVEYORS ROUTE 6A YARMOUTH MA DATE `RVEYOR , 04/26/2017 23:05 5087717070 PINE HARBOR PAGE 02/03 Town of Barnstable - Regulatory Services - rw=F.G85w,DkecW sun Buildkg Divisiom Tom Perri$DutldMng Conunissioner 200 Main Sftw, uym*MA 02601 www.town ba:`;tstMe-j= n i . Offim: 50"62-4038 Fkc' 508-790- MO PERMMrD REGISTRATION 2W square,beet or lets 64 I, ,, ,6 lam. �- L062tim of shed Nacldross> Vmw Prop=y owri s frame Telepl:ome "'t a ofShed # lun Dift WwWrims RWxiric D;Bbtoet Old Kiag's Highway UbFWTic Distdot Commission jurbdict4m? t.. If over 120 square feat,you must file with Old K7mg'•$ighway 6 Cameervation C mmimdon(ftntum is requlftd) Sigii off hours for Consomdon 8:00-9:30&3:304:30 PLEASE NOTE: IF YOU ARD WrEO N TIE dDRISDIC CON OF ANY OF•TSE ABOVIg COM UMONS;TEMRE MAY BE A REV19W PROCESS AND AP'PucA oN Fn. PLEASE SEE THE AP,FROPRTATE COMMISSION FOR DETAI& ITS FORM MUST BE ACCOMWANIED BY A PLOT PL, AN MV;05201' Town of Barnstable Building t Post This,Cacd So Thai rtis Vble`F£rom the Street-AppcovedhPlans Must be Retained on Job and thisACard Must be;Kept �' * Posted Until Final Inspection Has,�Been Made. y a63p Permit a7. Where aCertificate of'Oecupancy isRegwred;suchBuilding"�shall�Not=be Occupied untiha final�lnspection�harbeen made. ` Permit No. _ B-17-1587 Applicant Name: . Approvals Date Issued: 05/31/2017 Current Use: Structure Permit Type: Building Shed-Residential-200sf and under. Expiration Date: 11/30/2017 Foundation: Location: 84 WHITE BIRCH WAY,WEST BARNSTABLE Map/Lot 128-028 Zoning District: RF Sheathing: Owner on Record: RUFF,MEREDITH _ . g 'C tracts,Name: Framing: 1 Address: 84 WHITE:BIRCH WAY :. � � Contractor License 2 WEST-BARNSTABLE"MA 02668 Est Protect Cost: $0.00 J Chimney: Description: 10x16 Shed Per4mit ee: $'35.00 P Insulation: Project Review Req: 10x16 Shed ° FeegPaid $35.00 Date, 5/31/2017 Final: � _ Rough Plumbing: Building Official final Plumbing: gym . . - �� �� This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six monthvafter,issuance. Rough Gas: All work authorized by this.permit shall conform to-the.approved application and-the approved construction documentgfor.which>thiss permit-has been,granted:AI MOW ll construction,alterations and changes of use of any building and structures�shallbe in compliance with the local zoning by lawsgand codes. Final Gas: I,a� � 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 ofthe .. work"until the completion of-the same. .a x ;g Electrical The Certificate of Occupancy will not be issued until all applicable signatures by;"the Building ano�rire OIt fficials are provideii on permit. z. - Service: Minimum of Five Call Inspections Required for All Construction Work: . 1.Foundation or Footing _ Rough: 2.Sheathing Inspection ' ' = 3.All Fireplaces must be inspected at the 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). Fire Department Building plans are to be available on site Final: All-Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT 7