HomeMy WebLinkAbout0007 VINE AVENUE t -
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Application number-.:�
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$ Al 22 2019 Fee ...... l...:.®U........................................
• (OWN 0 MRNSIAB
Building Inspectors Initials......... t..................
l639� A�
Date Issued:..... ..�`.�....!..�.........................
Map/Parcel....... Q
TOWN OF BARNSTABLE
EXPEDITED PERMIT APPLICATION:
ROOF/SIDINGAVINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION
PROPERTY`INFORMATION
Address of Project: / U�nc ��t �V c��v,
NUMBER STREET VILLAGE
Owner's Name: Phone Number
Email Address: Cell Phone Number
Project cost$ w'" Check one Residential Commercial
OWNER'S AUTHORIZATION
As owner of the above property I hereby authorize -A k c Q
to make application for a building permit in accordance with 780 CMR
Owner Signature: - Date:
TYPE OF WORK
❑ Siding ❑ Windows (no header change)# Ez sulation/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 K r c
CONTRACTOR'S INFORMATION
Contractor's name Mike McCarthy Constructiotl
PO Box 52
Home Improvement Contractors Registration(if applicably st Dennis, lVdA 0267�ttach copy)
--'4•CSL-58633 HIC-16�393
Construction Supervisor's License# (attachcopy
Email of Contractor ��1`� C(',Lr!L @ Phone number
ALL PROPERTIES THAT H VE STRUCTURES OV 75 YEARS OLD OR IF THE SUBJECT PROPERTY.IS IN
A HISTORIC DISTRICT. YOU MUST OBTAIN HISTORIC APPROVAL BEFORE A PERMIT CAN'BE ISSUED.
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
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 F a '' 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
PLICANT'S SIGNATURE
Signature Date 7 c i c
All permit applications are subject to a building offcal's approval prior to issuance.
4
DocuSign Envelope ID: 19F13DE3-19CE-4BEB-8DF7-A02C64B8554D 3
�pyOF SHE T O�yO
Town of Barnstable
RARr-STARLE,
Building Department Services
90o May; ��m Brian Florence,CBO
n Building Commissioner GCO��
200 Main Street, Hyannis,MA 02601 r�
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, NANCY W HANSEN , as Owner of the subject property •
hereby authorize < <,r l: civ` �'- to act on my behalf,
in all matters relative to work authorized by this building permit application for:
7 Vine Avenue Craigville
(Address of Job)
RDoc
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Signncnd by:
IIDA
1FE1a ureW O
� wner Signature of Applicant
Roger Hansen
Print Name Print Name
7/18/2019 17:48 AM PDT
Date
Office of Consumer.Affairs and Business Regulation
1000 Washington Street - Suite 710
Boston, Massachusetts 02118
Home ImprovementContractor Registration
Type: Individual
Registration: 169393
MICHAEL MCCARTHY i ' Expiration: 06/15/2021
P.O.BOX 52 �,'
WEST DENNIS,MA 02670
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Update Address and Return Card.
SCA 1 v 20M-05/17
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Office of Consumer Affairs&Business Regulation
HOME IMPROVEMENT CONTRACTOR p Registration valid for individual use only
TYPE:Individual before the expiration date. If found return to:
Reglstiition Expiration Office of Consumer Affairs and Business Regulation
a69393— 06/15/2021 1000 Washington Street -Suite 710
MICHAEL MCOAi Boston,MA,021E
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MICHAEL F.MCCAR-0.
6 RANGLEY LN.
SOUTH DENNIS,MA`026fi0 Undersecretary Not valfdWAK ut signature
CormOnWealth of Massachuse#ts
Div gull of Professional'Licenstire
,8h89�MCC Board of Bt,ilding R:egwations and S#aMdards
Consl r };
May colesael isor
Has sum fi t OOrn~elie JWWW Fiber
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2 dW of PAIOUM 2041 MIGHAIsk J C �
PO BOX AR
4 WEST DENNIS
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NAT�ONAL F18lBR ; -
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oSMA 00J558712 *;
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Us.Department of Labor -
O=vationalSalety qnd He8411 Adminlslraion h, •':.
Mchae-I McCarthy
+?oe�fi+�y`4lorstpletetl8.1011QttrOtxupeti0n8tSare(y�nd,}{eaph T ' -,. �`�"� �dWs!{wf�;�� - .,
TfainTng Cifimle in •$afety
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The Commonwealth of Massachusetts
Department of InndustrialAccidents
I Congress Street,Suite 100
Boston,MA 02114--2017
www mass gov/rlia
lirorkers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information *�= Please Print Legibly
Name{Business/Organization/Individual): Nehael MCCal'thVa,• . Gr.t'�'r�.��'v�>. r,C.
Address: PO Box 52
City/State/Zip: Phone
Are you an employer?Check the appropriate box: Type of project(required)'
LE3I am a employer with �. employees(full and/or part-time).* y. New construction
2.❑lam a Sole proprietor of partnership and have no employees working for me in 8. Remodeling
any capacity.[No workers'comp.insurance required.].
In I 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 Q Building addition
ensure that all contractors either have workers'compensation insurance or are sole 11.[:]Electrical repairs or additions
proprietors with no employees.
12.El 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 t
6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other
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.
I am an employer that is providingworkers'compensation insurance for my employees Below is lire policy and job site
Information: 11
Insurance Company Name: Nam' ,,.,1, Lib.;11 4-i + '1:7►,r'c Tit
Policy#or Self-ins.Lic.#:_ V 5),/C-:�,►-4 57 y Expiration Date:_ �'a- t Sf!1
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 enaides of perjury that the information provided above is true and correct
Signature: Date: I1 �rff!tF
Phone#: �R.0 �-h--6 T6 b
Official use only. Do not write in this area,to ke 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 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Assessor's Office(1st floor) Map 'Lot U�� �N Permit#
Conservation Office(4th floor) { Date Issued
Board of Health(3rd floor)(8:30-9:30/'1:00-2:00) Fee- �
/Engineering Dept.,(3rd floor) House#1 Z&2 z
Planning Dept.(1st floor/School Admin. Bldg.) _
BARNSTABLE.
Definit' an Approved by Planning Board 19 e a .�
TOWN OF-BARNSTABLE'
Building Permit Application
Proj eet Address
Village � 0-Y �Ni,I�J UrGL�' i
Owner D, DOn,�rAl4 Address
Telephone '�SD�� 77.E Sao 0 7
Permit Request
S
Total 1 Story Area(include 1 story garages&decks) square feet ��1�; a, S40 Sa . .
Total 2 Story Area(total of 1st&2nd stories) square feet
Estimated Project Cost $
Zoning District Flood Plain Water Protection
Lot Size Grandfathered?
Zoning Board of Appeals Authorization Recorded
Current Use Proposed Use
Construction Type
Commercial Residential
Dwelling Type: Single Family Two Family Multi-Family
Age of Existing Structure Basement Type: Finished
Historic House Unfinished
Old King's Highway
Number of Baths No.of Bedrooms
Total Room Count(not including baths) First Floor
Heat Type and Fuel Central Air Fireplaces
Garage: Detached Other Detached Structures: Pool
Attached Barn
None Sheds
Other
Builder Information
Name p//I � . • ./r ,►�1 Telephone Number &64t�7 ZZ-77/,,�
Address ,�� ,[ �_ ,��,,,� - License#
_ iv►�n�-� �.�"i, /'�1� Home Improvement Contractor#
Worker's Compensation#
NEW CONSTRUCTION OR ADDITIONS REQUIRE A SITE PLAN(AS BUILT)SHOWING EXISTING,AS WELL AS
PROPOSED STRUCTURES ON THE LOT.
ALL CONSTRUCTION DEBRIS RESULTING FROM THIS-PROJECT-WILL BE TAKEN TO
SIGNATURE DATE
BUILDING PERMIT DENIED FOR THE FOLLOWING REASON(S)
FOR OFFICIAL USE ONLY — -
PERMIT NO. '
DATE ISSUED +
MAP/PARCEL NO. ;
ADDRESS - VILLAGE
OWNER
DATE OF INSPECTION: y 1
FOUNDATION t
FRAME
1 . .- • , � - } 1 r jai i
INSULATION
FIREPLACE
ELECTRICAL: ROUGH FINAL .<
PLUMBING: ROUGH FINAL
zc
GAS: r ROUGH FINAL
FINAL BUILDING s -
DATE CLOSED OUT- ' '
ASSOCIATION PLAN NO. '
y.
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HOME:73MPROVE: ENT XONTRACTORS REGISTRATION Y �r�
.Board.:of '.Sui� ding RegulationsrEnd Standards i g 3f � ,° '
b RI
ne 'As =ton .Rlace Room 130.1 �
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3 er�f9{ 0.:�..�' g�.-��„+-,�� . •yam �� kY.�
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7.,=:F�TeISs$ Se ty.rttJ �2108 w i t
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a�.+ �xu�ii.� 1F.. au y^ '- ..�_ ,t+".. •r a 1+ �' -3 �ii. c G*` '+-.
OME ;ZMPROWEMENT., ACTOR
egistration 10891 xpt 'iofi -08/"2'7/96 .
YP S a t u Y c+f 5 POo0T1r�»"r�oew{u�A��la ^ /�J�e��
1u} ,1�,•Y' Q v R .A ,3�.i4- -.':+ d'Z•,} V....p y k —L• .fr , � I .... ye �1�1�RO.rttMt CONTRACTOR.
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THEODORE L H TCHCOCI< t r a get T�rpenG614� ,,,s
THE:ODORE L. --,H .T.CHGOCK z s� ira ioe 'OB/27/.96
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.65 .LISA LN/PO 80X .211
ABLE. IAA 02668.
W BARNST
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1�is�n�o ��Dv y
BARNSiAMZ MA 42668
r ti ti TORt: h , k
The Town of Barnstable
NAM $ Department of Health Safety and Environmental Services
Building Division
367 Main Street Hyannis MA 02601
Office: 508 790-6n7 Ralph Croce
F= 508 775-33" Building Commission:
For office use only
Permit no.
Date IQ 6.0
.Zq,5- AFFIDAVIT
HOME nUROVEMENT CONTRACTOR LAW
SUPPLEMENT TO PERMIT APPLICATION
MGL c. 142A requires that the"reconstruction,alterations,renovation,rqx&,moderairation,conversion,
improvement,,remrnal, demolition, or construction of an addition to any pre-adsting owner occuPied
building containing at least one but not more than four dwelling units or to sttucttuns which are adjacent
to such residence or building be done by registered contractors,with certain asceptions, along with other
tequirrmeats.
Type of Work: �%5I _/ a F Est Cost
Address of Work: 33 / m A) Si
Ow•ner.Name• E/„ ;''e
Date of Permit Application:
I hereb}•certify that:
Registration is not required for the following reason(s):
Work c eluded by law
Job under SI,000
Building not owner pied
Owner pulling own permit
Notice is hereby green that:
OWNERS PULLING THER OWN PERMIT OR DEALING WITH L�NREGISiERED CONTRACTORS
FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS M 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 Wner:
30
Dat Contractor name Registration No.
OR
The Commonwealth of Massachusetts '
Dcpartlneiit of Industrial Accidents
\,: 600 Ti'as MI'lon Street
Boston,A1ass. 02111
Workers' Compensation Insurance Affidavit
,elipllCant�nfnrmatinne - - PIeABe PRiNTI bL(y,� - '
name:
location:
city Phonc#
CJ I am a homeowner performing all work myself.
-(� I am a sole proprietor and have no one working in any capacity
(�] lam an employer providing workers' compensation for my employees working on this job.
company name:
address: f./) . LgD_X O yl. 15- bSA AA�P -
city: �.0 �ATA15T.9-bar° /Y� O�6 phone#: •�sQ�`) 7,5- _ 776
insurance co. 7�e polio•$$ 7.
0 1 am a sole proprietor, general contractor,or homeowner(circle one)and have hired the contractors listed below who have
the following workers' compensation polices:
company name-
address:
city: phone#:
insurnnce co. policy#
j. -'4.. _.r.:' - = - yCF[!:/.-r,-�:_"�.7A`ten—a�.1"y'%.;"_'Tq.Y, •'} _','c!"a .P ::R3".M�' `?r!"�?[.!:^' '"•:-?iS
compam•name•
address:
city: phone#•
insurnnce co. policy#
Atiachadditional'she'etifnecess_� �:�. ,w s �,;: ,w'~r.f;�x ;_act- +u_ •'`t£s' ^^
Failure io secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminai penalties of a fine up to S1,500.00 and/or
one years'imprisonment as well as civil penalties in the form of a STOP NVORK ORDER and a fine of S100.00 a day against me. I understand that a
cope of this statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
1 do hereby rd under the errjun•that the information provided above is true and correct.
Signature Date A�9S
Print nameD�D k- tti7�.di�Dc'.C. Phone#/.�/11�1 7 7s— 7 7/D3
official use only do not write in this area to be completed by city or town official
city or town: permit/license# nBuilding Department
OLicensing Board
O check if immediate response is required OSelectmen's Office
011calth Department
contact person: phone#; nOther
(revised 3,95 PJA)