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Home My WebLink About0065 BLACKBERRY LANE L-axio- aq9 - oga Application nu((mber................................................ Fee �J ... ................. ..... NAM y Building Inspectors Initials......... . .................. 9 6�Date Issued: ...Map/Parcel . ................ni J _ S 4BLF �............... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: S ��. �crf. L ,,_ NUMBER nn TREET VILLAGE Owner's Name: �I-�,._ 1��r. Phone Number_() ►— ciC5 r Email Address: Cell Phone Number -, Project cost$ 9��"' Check one Residential= Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize to make application for a building permit in accordance with 780 CMR Owner Signature: Date: TYPE OF WORK ❑ Siding ❑ Windows (no header change)# Insulation/Weatherization ❑ Doors(no header change)# Commercial Doors require an inspector's review ❑ Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name Mike McCarthy ConSStr aeti6ti, We t,Dennis NMA 02670 Home Improvement Contractors Registration(if applicable (attach copy) CSLI-58633', CHIC-169393 Construction Supervisor's License# (attach copy) Email of Contractor Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 75 YEARS OLD OR/F THE SUBJECT PROPERTY IS IN • u�r��iw n�e�rn�i+r vim&I•w#8rr AnrA IAA uww^F214+ w nnnn2 iw I nrrr+nr w nrn■A1r,0-w a nr orro ir_m APPLICATION NUMBER *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 . {5 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.-F 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 4 ICANT'S SIGNATURE Signature .. , �. Date jd/X)/ All permit applications are subject to a building official's approval prior to issuance. DocuSign Envelope ID:F561D9EF-51064C62-880A-16A17DAECF79 �.� ZbG Town of Barnstable Building Department Services AA Brian Florence,CBO •iit��, •off Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, Shawn Brown , as Owner of the subject property r hereby authorize ��,�1- �- to act on my behalf, in all matters relative to work authorized by this building permit application for: 65 Blackberry Lane Hyannis (Address of Job) Docu��SSiiggnned by: E55 DocuSigned by: j r i � -_� EDRArrIM9519eoE 6 D253949E... Signature Do3E 6wner Signature of Applicant DocuSigned by: DocuSigned by: Print Name Print Name 8/22/2019 6:32 PM EDT Date Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvem06t�ntractor Registration Type: Individual Registration: 169393 MICHAEL MCCARTHY Expiration: 06/15/2021 P.O.BOX 52 WEST DENNIS,MA 02670- Update Address and Return Card. SCA 1 is 2OM-05/17 .'moo �zrnaivano ✓��aa.�u�sel 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: Rggistiration Expiration Office of Consumer Affairs and Business Regulation 169393 06/15/2021 1000 Washington Street -.Suite 710 MICHAEL MCCARFk3Y Boston MA 02118 MICHAEL F.MCCARTH1r 6 RANGLEY LN. tf a SOUTH DENNIS,MA`02660 undersecretary =. Not valfdv�41- out signature Coftirtionweath of Massachusetts ivfBfon II of Professional Licenstfre michaet 100 My Boa o u ding RegWauons and Standards; ]I ConsMipte Cons;ri� tS; yisor Has ec� tF ! ft NtalnW Flbler C"58633 ' �litdOse tt�irtNlg 0 � �tpic� 041'f01�:0;�(j , ° Y0f AiaPet ZQ11 �M//I��G L J iV C PC ROX 62 i 4 WEST DENNIS J NATaANAL F{Bf3R 1gladyl�ffieaMlbOtled - -w.we..e.rc.,.....F_..e. - COMMIS slOher ' • 491ifittt�,�n,... - - OSHA 001558712 Us DeParfinent of Labor aft O=OaftWSafety and health Administration h, Michael M-Carthp ' i+es +oc +rrcor *fee a to neu►oofa,paGoaarsaTeH and i feaN, roa+sarr,� ,. : . Trahsing CisUr&e fn F 3�tiolns Health41 ,r efffiss� 1>�rsorl�el�:fhde N The Commonwealth of Massachusetts r Department of1'ndustrialAccidents j Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia I-Vorlcers'Compensation Insurance Affidavit:Builders/Contractors/El;lectricians/Plumbers. TO BE FILED WITH THE PEPAMING AUTHORITY. Applicant Information Please Print Le ibly Name{Business/Organization/Individual): Mchael McCarthy Address: PO Box 52 City/State/Zip: St Dranil one Are you an employer?Check the appropriate box: Type of project('required)' LE3 I am it employer with Ir employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor of partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required]. 3.[]l am a homeowner doing all work myself.[No workers'comp.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❑Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am,a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑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 �r)J��f+•., 152,§1(4),and we have no employees.(No workers'comp,insurance requir d J *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 e'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.lam an employer that is providingworkers'compensation insurance for my employees. Below is the policy and job site Information: 1 Insurance Company Name: �T Q^ J Li c�; i�-i + f i,rc Z'nc Policy#or Self-ins.Lic.#: V Expiration Date: �'a- ►S�I Job Site Address: City/State&ip: 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 cerhJy and t e ins enaides of perjury that the information provided above is true and correct. Si ature: Date: I)- IfI I Phone#: rSc.0 �-h-6 SG y Official use only. Do not write in this area,to he completed by city or town offfcfaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector fPliumbing 6.Other Contact Person: Phone#: