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Home My WebLink About0100 WIANNO AVENUE e o e a � e o �I p �� , ;� �, �� y 0 �i 0 ;� if a ,� i Ir '� i i u 1 1 i o � 1 a i a c � i � oo,� rn�I-�-��1� �oQd�s 7'�rc� j I - Application numb��ecc ...................................... ........ Fee .....� ................. ................ sucar�sz . Building Inspectors Initials...b................... I M0� Date Issued.:...1..-.a .l. JUL 22 2019 1* 1 - 45 MapParcel.............:................................................... TOWN O� B-�,I�NSfABLE TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: l0U �J v c r,►-r- ,L NUMBER STREET VILLAGE Owner's Name: ��ee r��*S �ua. +- Phone Number Email Address: �'' Cell Phone Number Project cost$ Check one Residential v Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMnR r Owner Signature: Date: TYPE OF WORK Siding 13 Windows(no header change)# 12(Insulation/Weatherization Doors(no header change)# Commercial Doors require an inspector's review 0 Roof(not applying more than 1 layer of shingles Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Mike McCarthy Construction PO Box 52 Home Improvement Contractors Registration(if applicMil .Dennis; MA 02670(attach copy) e Construction Supervisor's License# CSL=58633 rAch copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR IF THE SUBJECT PROPERTY.IS IN A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN BE ISSUED. ti APPLICATION.NUMBER......................................................... r *For Tents Only* Date Tent(s)will be erected Removed on ,_ number of tents total Does the tent have sides?Yes No ' (If yes please attach floor plan with exits marked) Dimensions of each Tent X X X Additional tent dimensions can be attached on a separate piece of paper. Purpose of Event Check one: this event is a: for profit non-profit event Check one: Food served Yes No Flame Spread Sheet of each tent must be attached. Provide a site plan with the location(s) of each tent Fuel source being used LP tank 20 lbs. or> Yes No , if yes, a gas permit is required. Natural Gas Yes No , if yes, a gas permit is required. If food is being served at.your event please obtain a Health Department approval between the hours of 8:00am-9:30 am or 3::30 pm-4:30pm. Commercial events may require Fire Department approval, *WOOD/COAL/PELLET STOVES Manufacturer# Model/I.D. Fuel Type Testing Lab Offsets from combustibles: front back left side right side HOMEOWNER'S LICENSE EXEMPTION Homeowner's Name: Telephone Number Cell or Work number 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 required by 780 CMR and the Town of Barnstable. Signature Date APP ICANT'S SIGNATURE Signature DateLJ f All permit applicati s are subject to a building official's approval prior to issuance. Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home ImprovementContractor Registration Type: Individual MICHAEL MCCARTHY ' Registration: 169393 ' Expiration: 06/15/2021 P.O.BOX 52 -_ WEST DENNIS,MA 02670 Update Address and Return Card. SCA 1 0 20M-05/17 .�'� �inr�2oivaeal/r'a�'✓�a�1o�We%1� Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: Regist_ate Expiration Office of Consumer Affairs and Business Regulation 469393_ -- 06/15/2021 1000 Washington Street -Suite 710 - -= Boston,MA.02118' MICHAEL MCGARTHY - :+, MICHAEL F.MCCART-H` 6 RANGLEY W. SOUTH DENNIS,MA`02660 Undersecretary Not valfcLAll0ut signature i cortiittonyteerltA of Massaehuseffs f)iviston of Professional:�iee..nsilre Board of Building ReguiatiQns and Standards; illlikae�l Mciy 1y Co'nsr �}; visor Has s��S6OOrnpPstlsl doNO ltMI Fiber CS'-t)58.fi33 grey Theft GE ume � � � �t�'ID.�;.0;1f 2300 diky of AtIlUst M I MICFW1rk J CIkR `s PO BOX52 S WEST D NNtS,- ••I�,Nitera�FiOer �� '�%7,w�:E_��?;d� OOrn-ft siotter /+ 4vt1.1-MtQQP,..,� o A 001.5-50 2113*4 .. Us.Department of tabor OuvpationakSalety qm Mealth AomiNstrallon :_,. ;• McCarth '�+o?as i!syciar!vte.._...ofia,►ooc ac[ova►safer!:anp;Freafu+ 4,?lit�!la ra. ofirSeteEy IT 7'krie : iaift;haitaot8i�a?tfinn .? ?: The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia I-Vor leers'Compensation Insurance Affidavit:Builders/Contractors/I;lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ��s , *� Please Print Le ibiy Name{Business/Organizadon/Individual): Mchael McCarthy. (Gr.S'�'r�.c�'vu� Address: PO Box 52 St vVinil.MA 02671 ' City/State/Zip: Phone Are you an employer?Check the appropriate box- Type of project(•required): l.Q I am a employer with employees(full and/or part-time).* 7. 0 New construction 2.❑I am d sole proprietor or partnership and have no employees working forme in 8. Remodeling any capacity.[No workers'camp.insurance required.]. 1[]I am a homeowner doing all work myself.[No workers'camp.insurance required]t 9. El Demolition 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 I.E]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.Q I am•a general contractor and I have hired the sub-contractors listed on the attached sheet These13.❑Roof repairs sub-contractors have employees and have workers'comp.insurance t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 1►'�>/�•/+..� 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 anew 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. ' F lam an employer that is providingworkers'compensation insurance for my employees Below is the policy and fob site Information'. Insurance Company Name: N�'F t'�r\� L J,;I I I i + 1 i f'c- Trc Policy#or Self-ins.Lie.#: V 1 k/Ley 4 57 A/ Expiration Date: I'a-I 15- I I 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 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 and t e ins enalties of perjury that the information provided above is true and correct Si ature: Date: 11-1'f1I F Phone#: CS--k) etc;-G Tic b i Official use only. Do not write In this area,to he 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 Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: Qt L( QF THE.TQ� �wpy N yo� Town of Barnstable oA�v�r� Building Department Services 1 MASS. 000 Brian Florence,CBO �prFo MA�a� Building Commissioner 200 Main Street,Hyannis,MA 02601 YS' www.town.barnstable.ma.us (Z G+'q Z S� ' 2-t G Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, MARGARETTA J SWIFT , as Owner of the subject property hereby authorize ,� 1.� CC to act on my behalf, in all matters relative to work authorized by this building permit application for: 100 Wianno Avenue Osterville (Address of Job) i Sign re of Own4 Signature of Applicant r Print Name Print Name //16 Date