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3845 MAIN STREET
�65 N ®ll }!{}i]L� I y� �l )f ® ` �fTl�� r0 1` 12 r'r1r It! i l ',4( r' »07716 SSLL�IY �4 I i 'tti, Ir --,l i cF - A ��1 1" 6 # 4 T 1 �r! j ,�# , 4, �y;e F �i� `' E" �' � ad+ C�J d l t ,� 1�� � II ,Y� �'�''•� � ' Ka.SI?J� � � ' a,,► �;,,i:1 �A;f���� ;��d�� � ����. ��i � 1�, � � � ��� �, „ n �� ���� ������ ���.��.�`y' . ���� � � � ' .#+ �����'"j�k����� � ��11����������41d 1�1' •`� k � �� ���• I. � r1 �, '# .� ,' 1 �11 , a1 , 1- 4 , iHui IL. I • ,l . tl , 1. , 7+ ..: � s �rr' .,.` 1 � '#i �r.. .. '. + .� :.: eEy, ".;. ,��r•1 ..1 lv.:� r �r»"' 'F "s / . , 'd '1 15� till a i �� �.'�il '. �I� �e�l� + dary f g 1 1 p, �''4e 1 F» .u' i �.I;. .4 b d _ -1 �' j '( si, ri1, F 'i ,,{{t ��� � ii.,.�J,1�{{q{jj� `i�• r�: �� d; r »4 1 �1't �' Y �kf{ !1 { rilir, r it 1 i rp .,W »(, - - W. � 1 dF' Ail �'�1L11, . i..t ,t1 ,,I NI ' 11 y, l y. A, ,SS , o ! il' n i, t{� ! �'. s�, 8 ,�tr,»6 s. �.{"S, �, ,F' .na 9 .", ',i, Ja t { di.•" f + »�s1 re}i, d, r F. µ 1 y i5�' �, s •i�r 'r,. ,.r + �. ., ,i ,i' yl /sli °1t, p'Id..,, .#{. _,c "j >» ,T � y 1�r ;" / w 4 l .. .t rv.. i' •`iu • 1 n I• a k. '' 1 1! »» '.r' B 1„ ,.T '•d.. , 1+'� .,5,. tt- {f • . A r "• ./: it µ;'..1 i. [ ? ✓ - �V ., ... •f.. ,,F x N 1 S, U k-; , p A'!' ,' ‘, i' .r,. .' `' ; ,ji, •° • n y Frx '.rr: ...•.,�a. .,.,i r d. .;,•.... F ,',: 1, , �,., •.;" ,.. »:..: .:�, : . , �.»1' a :j,-. �- brit :: �1,,-- '! jj OFF 4, t 1 +1.1 7. U !• 4 n' r• • ' ., - .: •'� 14 .';,�� ... 1 1, ,r{ , , .;, V "ir.< 1+y ::.a.. { ..'�, 4k- �, 'mil`- �,. 1' .. it _!'r, ! _N... »t ,y.. S ,Ir•1 . ''+ �t�' ., ,n N "yye• i{ W .0 '. ... !f- if •' ,x .. r,r ., .I+• Y4. .. s: r 1 ;�. r, ..' s ,.J s�. q• r,», „. ,� 'it `�'i^,k t, .a .. �, IA �•r e 4, ) a .j 'k i.:. r I.•.{l •»' Y F r4 6 {!' y.yt' i� .4` t Ib� , 1'' '4* •1( .. 'tS' 6 1 v. Ilya .+,( '''. 'lo. , '' F' '' , " 1 / � 1 �/ d f n s , lJa: ,„a.,2 ,:'t,�r ._:..> .,F.• .,.y ",d, , ,,r� -. ,.^ , _ .... .. _ .� ,. .. __. _ a ., ..,� .. u � yk, - -,� Barrows, Debi From: Randall Swetish <rgswetish@comcast.net> Sent: Saturday,June 12, 2021 7:34 PM To: Barrows, Debi Subject: Permit extension for permit#TB-20-3408 Att: Debi Barrows BUILDING DEPT To: Building Commissioner JUN 14`2021 Town of Barnstable TOWN OF BARNSTABLE Due to professional and personal reasons, I have been unable to start the deck work described permit#TB-20-3408 at 3845 Main St. 6A Barnstable. I would like to extend the permit for another start period. I anticipate a start date in the late summer or early fall. Thank you, RG Swetish CS-010219 CAUTION:This email originated from outside of the Town of Barnstable! Do not click links, open attachments or reply, unless you recognize the sender's email address and know the content is safe! 1 foor Application numberTIE ki►�r� Qa ®15' E ` is Fee MASEaR' T�18I$ i .JUl... 16 2019 Building Inspectors Initials 41 s659.mis�1` Date Issued 1.1.1 .. Map/Parcel...1 .5 00.Q.I............... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/IWINDOWS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: 3 0 fS— IT:, c1- NUMBER STREET VILLAGE Owner's Name: ( v'7 5 /5,4^.",3 Phone Number No - 5C -4/L c(. Email Address: Cell Phone Number Project cost$ ) Check one Residential `' Commercial OWNER'S AUTHORIZATION As owner of the above property I hereby authorize C( IL_( (`v -- to make application for a building permit in accordance with 780 CMR Owner Signature: Aell-k a, Date: TYPE OF WORK © Siding El Windows (no header change)# "Insulation/Weatherization El Doors (no header change)# Commercial Doors require an inspector's review El Roof(not applying more than 1 layer of shin es) Construction Debris will be going to err- td CONTRACTOR'S INFORMATION Mike McCarthy Construction Contractor's name PO Box 52 West Dennis, MA 02670 Home Improvement Contractors Registration(if applicable)# 4ch copy) CSL-58633 HIC-169393 Construction Supervisor's License# (attach copy) Email of Contractor (1-)Ptelc C c r¢'L- 5d Q c a , 1. C�� Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER75 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 the tent have sides?Yes Noyesplease attach floorplan with exits marked) (If 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 PLI ANT'S SIGNATURE Signature Date 71161 All permit application are subject to a building official's approval prior to issuance. -_-, ..., ,677e FO- 0-/-10-eadel 0/- Aq,c)-eleic}1-e/4- Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 02118 Home Improvement Contractor Registration ....._.._..: :4-•:-•, :7.-... ,,, Type: Individual ; r,,,,,ai,k.„:,74..'tfii.,, Registration: 169393 MICHAEL MCCARTHY Expiration: 06/15/2021 P.O.BOX 52 i!',. .•.:-7i:::-,-.,.I: -:-..-,-;_i.,::::: i,-_,', WEST DENNIS,MA 02670 i',..`,:, i:-:----..:-..--..-.::,'.. •,.,..:,,:,,.. ,,,„::?, ; .- -,74:-,,•:-,--:::-.1,-,-;...7i. ., :• --:"' . '•:"::',:..-.....i . ,,.: . . Update Address and Return Card. - ..... SCA 1 Ca 20M-05/17 •Kv)2/,24210ear‘441Za&ac./LJel4 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: Registration Expiration Office of Consumer Affairs and Business Regulation 4.69393:4-7 06/15/2021 1000 Washington Street -Suite 710 i-----..17-:;.......-, --MICHAEL MCC Boston,MA 0211.8 , , / -- 4 ./....MCCARTHY.4:,,t," .-:-41,- .'''f`7-a•I'---7,3:?j 7,-;.-11:.:.; -..:i,:_,-,,,3:,-- '•'',!.-.-.7.--77.,1,:, MICHAEL F.MCCiNFit-14Kz1;:r.." iwavxdie a.ga4,4,- ,(/ / I / 6 RANGLEY LN. -'• •-,,,:-2,4-- .--, ',' ...,SOUTH DENNIS,MA-62860 Undersecretary Not valiciAfittliOut signature, &• of Massachusetts i • Board of eg,Ulations and Standards . 1 DiVision ot Professional Licensure Cons • Michael McCarthy , rifecarthy countryman , ...- ! CS.058633 tskictiOditiViftvisor Has esscestsidly Seinpleted OW National Fiber' -.: i - Z4C-- Wires:0411012020 Woks*tralning course ,,k,,.- lt...i.:-", 4- . : taid aye/04ot 2011 . MICHAEL J NICCIOCM .tt . 1 •!_..-":''. „.!---_?,•mr,01 , ....., 40010F , ;. .. '''' • . . - ,... - - WEST DENNIS mA .,-:• . , rat:dninwge_altith gankteratSalau asiatiebabott.FI-DER i. Not mad uniessemboasad • .......................,,....., . a. 41..... - - - -. , com...... , , . , . y„„„........ , ._., _ . • : ,...... . . .,:,,......,,.. ..„.:.. ..... :.„.„. ... ,,,_ ,;..-lta.fr .-`:* OSHA :0 01 5.5i8712 ,..;* -. --,... --. ... sh....„,,,-...........0.,..., - -,-;:--:.„, ,-• ,.::.,. ; ; ca0astawfar..htticcatagitt Ca:Whines :-..: -7.-c- .4-. l''.'- :i U.S.Department of Labor , OccupalionatSalety and Health AdminIstratitin MichaelMcCarthy ..: , , ,,, ,-., ..:.• ,-,-,..,e.„,.;',:::A-,..,:,-.:.,:.,- ' c ..„.......,,.. .... ,‘::. : :,..--- -:,:: :-.i7J-7.... ., .;!..,,,,.;.-,,,_ : =m•N:-:-,..,IMNPRItiOiggifffetitataned. ... :, g: !: ':....: .,,,,'-.., .--'; "COI.r(r.lkt444.!0 ;*..-rcioWeitnifStitY . 41.14 *1(c.cf. *044000.0:10410or 005iir°,"4,i0d"41111 . :- :.; ..f•-.:'., 7"'.- . :i::-.-.:••• . 'Coiklie- : L ::;,:"itE:.IT:: :I. IfoTJAiotriass'mho and a bolt ofteltiunte r. . :.:,„:.::':!s..-:-...:,;:'..•.,,Z 4iiitetiAittgilth.:,:.,.. . ; I:- ::::.:fs,.. ...:: . ::: ''.7:'• ;.:... ..;i: ..'i. ?" ,‘,4'4.?. , 2 ..'!:....'. .., '. , .• '•:'.'.:,.:,', ''':,i'7, 410M••••-• :,:-.': '':....:,..-;- ''----p.,..:,--- 1;;$4,-.;,..,---,---,- • - " " — • mato . . - .- , - • . • • The Commonwealth of Massachusetts • 1 t Department of Industrial Accidents • Viiiiii=='Eff 1 Congress Street,Suite 100 11=• Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. • TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): Michael McCarthy Address: PO Box 52 City/State/Zip: • WCS� Phone • if: Are you an employer?Check the appropriate box: Type of project(required)' 1.Q I am a employer with �. employees(full and/or part-time).* 7. ❑New construction 2.0 I am a sole proprietor of partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.). • • 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required]t 9. ❑Demolition 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will - • • ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.t • 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other .i.- l 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 providing workers'compensation insurance for my employees. Below is the policy and job site - information. 11 Insurance Company Name: Nc_'�t'c.r.�I f...i r:,&;1 i 47 + "Ft-it -re,c• Policy#or Self-ins.Lic.#: Vk/C 3-`I 3 571 Expiration Date: I' .)►f)/• 7 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 bya 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 J%',enalties of perjury that the information provided above is true and correct. Signature: Date: I)-)if1I i ' ' Phone#: (5'6t0 2 fi ci-G s6 y Official use only. Do not write in this area,to le 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#: n Envelope ID:E50DSF2E-D53B-4E36-9586-7F9B644E1F7B o `1 c,q . ••o (-1-NHE py do Town of Barnstable Ceti— s� Cs&_(o �—Zz i fARNSTAHGE,I: ! Building Department Services MAss. 0 Brian Florence,CBO 9�pA 1639. �Q� rFb MO d' 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, JAMES A BURROWS , as Owner of the subject property hereby authorize P`C,�4-1_- (- .- -- .to act on my behalf, in all matters relative to work authorized by this building permit application for: 1 3845 Main Street Barnstable (Address of Job) 1DocuSigncd by: •14. L 4.YVOU)5 .igmtifirb`fFOwner Signature of Applicant James Burrows Print Name Print Name 7/11/2019 1 5:08 PM EDT Date ci---,,E,„„,,) Town of Barnstable ig � ,; -�. "�t `:' �. � � y� ,':..� N .'':f � a ...� f ,:r �'���'. r� ,.tP �,. ':.x��s�ate.,:, ;.x � .. t * :i. a,`A =PstThis Car So Tht ibis„ViiblFrom th StreetApproved PlanMust be:`.-Retined=on Job and thi Card Must b Keptr 6" Poed Until Finl InspectionHastBee Made �, #ssa , erea Certificate''=of Occu anc` !,.:Re "uird,such.Buildrn shll Not::be Occu ied°until:a Final Ins' ection h been made er It � Whe .....,,.,,. �..,R,,�. .. ��.�,M ...,.,gip�.,,Y� .q.. ' z>,�>�z:�..:yAg�x. � ,<6� � �,.,;...p�E. .,. z7.. �,.. ,�..�p ,. ,.- .a� � Y ��E .§..' Permit No. B-18-2770 . Applicant Name: RANDALL G SWETISH BUILDER Approvals Date Issued: 10/05/2018 Current Use: Structure Permit Type: Building-Deck Expiration Date: 04/05/2019 Foundation: Location: 3845 MAIN ST./RTE 6A(BARN.),BARNSTABLE Map/Lot:, 335,-008-001 Zoning District: RF-2 Sheathing: Owner on Record: BURROWS,JAMES A Contractor Name RANDALL G SWETISH Framing: 1 Address: P 0 BOX 322 Contractor,License CS-010219 2 CUMMAQUID, MA 02637 - ,Est Project Cost: $25,000.00 Chimney: Description: Build New Exterior Deck as Described in attached Drawings(about Permit Fee: $ 110.00 500 sq.ft. of deck area). Insulation: Fee Paid: S 110.00 Project Review Req: Date 10/5/2018 Final: ?- TeS1-0 Plumbing/Gas Rough Plumbing: Building Official Final Plumbing: Rough Gas: This permit shall be deemed abandoned and invalid unless the work authorized by tfiis permit is commenced within six months after issuance. All work authorized by this permit shall conform to the approved application and theapproved construction documents for which this permit has been granted. Final Gas: All construction,alterations and changes of use of any building and structures=shall be in compliance with the local zoning 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 work until the completion of the same. Electrical .:::3::'-,(,. Service: 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: Rough: 1.Foundation or Footing 2.Sheathing Inspection Final: 3.All Fireplaces must be inspected at the throat level before firest flue lining is installed 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection Low Voltage Rough: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Final: 7.Final Inspection before Occupancy Health Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Final: Work shall not proceed until the Inspector has approved the various stages of construction. " contractingwith unregistered contractors do not have access to the guarantyfund" (as set forth in MGL c.142A . Fire Department P�rSOnS g ) Final: Building plans are to be available on site All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT ApplicationNumber6- .,, . • . • BARN 4STABLE, IF Permit Fee Other Fee .f1,...:1..646514:, • 0#51 -1°—° • Total Fee Paid , TOWN OF BARNSTABLE Permit Approval by.EX csiL..1.d..-5:18' BUILDING PERMIT m4,24.02.1C.6.12..d. . APPLICATION • - Section I— Owner's Information and Project Location Project Address gg46 4MritifSr74:. Village Xe44144.44 -`7:1 Eil r•-•!..?1 Owners Name .37/4144/41, Z:a4P-42-0 9 4 rsri ---1 -- —rt - Owners Legal Address g$6K 72160.Zt., ,57 -. . 1 :i. -,--- : ' cil City RoMAA. State 'W —. . . Zip I — ----, .. :a. . • . - r-- Owners Cell# 5g) 4475 20,14 . E_T„A .3 Pt4 4 ileau_0403g) ,A,Piee&66)-(44 Section 2—Use of Structure Use Group . 0 Commercial Structure over 35,000 cubic feet El Commercial Structure under 35,000 cubic feet V SinOe/Two Family Dwelling Section 3—Type of Permit 0 New Construction 1:1 Move/Relocate El Accessory Structure ID Change of use 0 Demo/(entire structure) 11 Finish Basement 0 Family/Amnesty CI Fire Alarm Rebuild al Deck Apartment - D Sprinkler System Li Addition 0 Retaining wall 0 Solar 0 Renovation El Pool 0 Insulation Other-Specify Section 4 -Work Description aj/49 A/-&-re --,,crviecort_ 6A— At 46655e4:figeb .0`... zeikuteile_60 ekzikA.)-eiz. 3 (14 iyett3i- -57,0 tit 66 zeeda.. awc,‘.... ) T Jut I/minted!2/9/2018 Application Number Section 5—Detail Cost of Proposed Construction coc vw Square Footage of Project . 1"7 Age of Stricture - Dig Safe Number #Of Bedrooms Existing Total#Of Bedrooms(proposed) 110 MPH Wind Zone Compliance Method ❑ MA Checklist ❑ WFCM Checklist 0 Design Section 6—Project Specifics ❑ Wiring ❑ Oil Tank Storage ❑ Smoke Detectors ❑ Plumbing [] Gas .❑ Fire Suppression 0 Heating System 0 Masonry Chimney 0 Add/relocate bedroom Water Supply , ❑ Public 0 Private Sewage Disposal El Municipal -❑ On Site Historic District ❑ Hyannis Historic District ❑ Old Kings Highway Debris Disposal Facility: I am using a crane 0 Yes © No Section 7—Flood Zone Flood Zone Designation ti Within or adjacent to a wetland,coastal bank? Yes P2 No 0 Section 8—Zoning Information Zoning District Proposed Use Lot Area Sq.Ft. Total Frontage Percentage of Lot Coverage #of Dwelling Units (on site) Setbacks Front Yard Required Proposed f • Rear Yard . Required Proposed 7 t (.- ti -"4 Side Yard Required Y Proposed 4� Has this property had relief from the Zoning Board in the past? ❑ Yes 0 No Last updated:2J92018 6 • Application Number Section 9—.Construction Supervisor Name PAIUtP ' Telephone Number t5e2r 8" S 2 Address /0 Gkeae4.- /212 City Ashur..-Il 14/4-- Tap eP2-eldr License Number d5 evCR.64 License Type (') Expiration Date 3/20Z° • r 4441- Contractors P.mail 1 -C` ,4 r ## 61=W 3?7/Off 5- 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 documentati required by 780 an wn of .1e.Attach a copy of your license. Signature , DateWci,e3",e Section-10 —Home Improvement Contractor Name - �f� 4J ��( �‘ Telephone Number • 4Z8-8-6-2( Address/61 i eJeit ` City'1i l litre& State elk(, Zip 6-2...'1 Registration Number 4L 70 Expiration Date erfrev I understand my responsibilities under the roles and regulations for Home Improvement Contactors in accordance with 780 CMR the Massachusetts State Building Code. I understand the construction inspection procedures,specific inspections and docum • . d by 780 and the Town of Barnstable.Attach a copy of your H.LC... Signature Date geAgfrr Section 11—Home Owners License Exemption Home Owners 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 APPLICANT SIGNATURE Signature 07{ Date _4143A Print Name /z O gee Telephone Number 6-68? 12S Eref-2-1 E-mail permit to: 2 sre. 44e Appia&Rez- . 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 approval Section 13—Owner's Authorization I, Jam e s a. i rr-()LAD s , as Owner of the-subject property hereby authorize Rci,-,clei l I S w e-fi' . to act on my behalf, in all matters relative to work authorized by this building permit application for: 304 5 P?qiii Str e 7' T3 Ns- ) J:2/9 c,Z O (Address of job) 1 S 'ature of Owner date 1 J,9/re s 4: i, ti/L1U�I S ... ,. • I Print Name . , . .• . '' - . 1 i J. i 1 '' • Last wd :2/9rz018 vc.1 Commonwealth of Massachusetts Division of Professional Licensure -.- Board of Building Regulations and Standards • .1,,t_1 IA il•--- • COnStrt4:4110n J pervisor / CS-010219 -4,- •/6 I• *Wires: 02/13/2020 ,,,, ... — 4,t,i I, 1:!-S, •-:: '0:;:'41.7,1:.t:145,70 _ RANDALL G SWETIS11111: p , *... 10 WHEELER ..-.-:* ;- MARSTONS MILbS MA'02648 07--N-7- -)icsmIL 4 4,--- Commissioner CeL e-iieW A 122/122071,122eal 2,C/Q,1424dadt2deeed Office - registration, • of Consumer Affairs&Business Regulation 1 License ot7valid•fOr individual use only ' ., •••• - . HOME IMPROVEMENT CONTRACTOR . ,. . : -1,. . before the'expiration date.:If found return to : ,., _ 1:7 •:.: • ,.., .,. ' :- Registration: 109470 Type: , :i Office of Consumer Agairq'atiOBlisiness:RegulatiOn",i: .•••• Expiration:-H-.491-101201i8 DBA • . r 10 Park Plaza:-Suite 5170 "Q"-_,---i---r="1--_;___,:_'• , 0,-..\•_, '''';-- t-----47-----"rn . Boston,MA 02116 • RANDALL G SWET,ISKSqILDER3" • . i•;:.1 V-ggr- -1,5::,,;::-.2,1,r...\ , , ? 'c. RANDALL SWETISH:=':'.:E:•.-A‘,,,-,:',-, ":-••• • ' 4.• '",-AK_-,---T-,' •'•7 ' 10 WHEELER ROAD '7'',' '''=-7;--t:ftu.'-:•.%l" . , . '• `-'-i,-,-,-„7•:=•-- ,.•:,-':' ',. MARSTONS MILLS, MA 02648- Undersecretary Not valid without gnature • • :...• • l . . • . , ' 1 . . . , , • , I 1 N. . . . '' t . .. 1 . i --,.. -"'"-- , . • . . „,..,.... Bun,k .Dt,Jos , , ... 1 (..-,• \15717),- LA- o,t.-.,....„: ,- „ • .n . . ,...> . • , _ . • . . .,, 4,:-. liflAyk)ii.;I- , . ' ----- .. . • _ „....... „. - .„ I • • . . , 1 8 r-Cop ,.....—,...,-,..---,-,i • . . . 1:.: • r .,,..... ,,,.. I , „ .•..„.. . • ,...- . . -. . . ..,-. . • (.... . . 1 ......._ . ..____,,, • . ...., , ......__..._... .......,,,, . , ‘ rat' ' • . • .15,„(.(,-,>()€..,---.D ' -• . . . '_ • . - i . . . . , oc--0F.3. 92. 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( •••• 6*,...• ...,•••^',, ' ,c P A J t . • .N a ,,,,/ -/ "ir_ ...=5>f_er. ,... ‘ 7-,, f L.--- , j i 6 I, . .. . r 4<stii . BUILDING DEPT DEC 9 4 2018 ,... 1 - • /— i / I/e (' ...-.,- ,,o A 4,,1:.... ....... . 1 / ,r- I-1-twN''''dF BARINSTABLE ....., „ ""---4 - ___ • • f' g 11i- `--� ' "" chi CsC),-�� �. _7 aJ /, .ci/E. ,„6,e4/1\,44,44.y— - . , • • • :: • • • f, ,} • • • .. 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P 014 1_ . / . w� i . . i,• ' 4ikia, . . ,.. : _ __. . . . 1 . 0, i! . . . . 1-1 i IA - I T' i .,2 }j> r . 1. `: , e o x� til. I . , r-7-7-4. . . . �(Q� 4 '.t'Y �+ 1 4 - - , _ . cf got • ' 1 1 ehttiii _-__-_-_------. kg 141 . li . - dkitAtaitti -. ._! - i . .: . i! a A - -- 'w • s„E ro Town of Barnstable is O Conservation Commission . = ADMINISTRATIVE REVIEW FORM ADM18- rEDmoo. Fee $25.00 Fee Paid Address/location of proposed project: �jl Street: 3 6- 6y� ✓f�T7�� Village: }-L/ 7��L Map:33 r Parce1:OC 0 Owner/Applicant: A e''�li�/�� L Mailing address: `) R -4 4 e(a C,E' , //1& Phone/cell: 3/b ' k'. �� Email: j! 14 AG(&t oc05( 'tp4in9:LG6'21•f Fax: Contractor/Agent: i74 P6 /� �C tJ�'7/7 Address: /0 ()6,7t' l:E� /�Y /01 1 / at Phone/cell: JrZe //03.5 Email: f2-67 5CLF J!5 e e il6 2 t, Associated File# Project description: Attach additional sheet if necessary,along with photos and a site plan if available(include distant from resource). A-e-tc �(�lC I�ll .c.6_ �.Iv 4..{:- 4-e- ( 7`1 k-e1/1 1. Will the proposed work take place within any of the following resource areas? (If`yes,"please check the following resource areas). I) C/ ❑ Town coastal bank; ❑ State coastal bank; ❑ 100-year flood plain(land subject to coastal storm flowage); ❑ Salt marsh; ❑Beach; ❑Dune; ❑Vegetated wetland; ❑Lake; ❑ Pond; ❑ Stream; ❑ Intermittent stream; ❑Estuary; ❑ Ocean; ❑ Land under said waters. 2. Will the proposed work take place within 50-feet of any of the above resource areas? _ A/O_ 3. Is excavation by machinery required? 1.L6/' -5 iJ QC' ("Ai 9/ 4. Is foundation work proposed? ArQ 5. Is removal of vegetation proposed? /" Understory ❑Groundcover ❑shrubs 6: Is regrading proposed,either /the ao,fkition or removal of soil? A/C 7. Is tree removal proposed? /" If so,why? ❑Water view Aesthetics Safe issue Y ❑ ❑ h' Are trees: ❑living ❑ dead [] dying(please supply photos) 8. Is planting proposed? !" v If so,please supply a plan which includes species. 9. Is removal of poison ivy proposed,or other invasive species removal/control proposed? (V If"Yes,"please explain on additional sheet. /� 10. Is the use of herbicides proposed? " Applicant signature: ""-7 Date: / / Reviewed by: Date: gr.-Ai/2 ' Q\regulations\admin policies procedures\adminreviewform 7/1/2017 The Commonwealth of Massachusetts Department of Industrial Accidents !Yj' 10r fl Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information "J Please Print Legibly Name(Business/Organization/Individual): 2� £ ( 4 _ Address: /0 // City/State/Zip: Phone#: Ore` 24 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. 0 New construction 2.1employees(full and/or part-time).* have hired the sub-contractors I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have 8. 0 Demolition working for me in any capacity. employees and have workers' 9. El Building addition [No workers' comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.0 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 12.0 Roof repairs r insurance required.]t c. 152,§1(4),and we have no 'W U A „r to employees. [No workers' 13. Other_ (eitigueiL 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: 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 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 here ' under the p u a 1 pen .ties of rj that the information provided above is true and correct. Signature: Date: *3 Phone#: 6771C � 1-1 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#: r • 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(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 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 that 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 Boston,MA 02111 Tel.#617-727-4900 ext 406 or 1-477-MASSAFB Revised 4-24-07 Fax#617-727-7749 www.mass.govfdia do '7O&ICc° �oFtt•+e t04�4 TownofBarnstable *Permit# Expir�Jmo it/i om issue date ,psi', �� c ado/ Regulatory Services F:; : : �o x MAS3��/ p i O 9 Thomas F. Geiler,Director s7-A I Building Division Tom Perry, CBO, Building Commissioner . 200 Main Street,Hyannis,MA 02601 • www.town.barnstable.ma.us Office: 508=862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY c Not Valid without Red X-Press Imprint Map/parcel Number j 7 S- - CO O - 30 k Property Address '3?4J 1r2X4 c-V 0 ce it(A2 1A4i 12esidential Value of Work - Minimum fee of$25.00 for work under$6000.00 Owner's Name &Address c L -Z- 0 2v2_ ,VekL Lift • Contractor's Name p W , `J 4 e Telephone Number cot. 3‘e3-" /97 Home Improvement Contractor License#(if applicable) l 6 uS 1`l Construction Supervisor's License#(if applicable) . i'4.3 M 4 i ❑Workman's Compensation Insurance I Check one: [l I am a sole proprietor ❑ I am the Homeowner ❑ 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) k‘.._ . Re-roof(stripping old shingles)) All construction debris will be taken to \ �!�^OL gles ❑ Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side . #of doors [� Replacement Windows/doors/sliders.U-Value U (maximum .44)#of windows Gt :aoc trig J -we J v.Deot - -C - b.- 'al Itk, - *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Pr.. y Owner must sign Property Owner Letter of Permission. A •'y A, the Home Improvement Contractors License & Construction Supervisors License is SIGNATURE: Q:\WPFILES\FO S\building permit forms\EXPRESS.doc , Revised 090809 1 • , The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations • - h '. I' '� • 600 Washington Street ;i Boston, MA 02111 t•vyvw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Geat ��I� Address: RC, CI('°L 22)(13 City/State/Zip S�Z-�� �2�3o Phone ti: 5-& 3 2- 't ( 7? Are you an employer? Check the appropriate box: Type of project (required): 1.❑ 1 a employer with 4, [ I am a general contractor and I mployees (full and/or part-time).* have hired the sub contractors 6. ❑ New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. n Remodeling ship and have no employees These sub contractors have g. Demolition working for me in any capacity. employees and have workers' 9. C Building addition [No workers' comp. insurance comp. insurance. required.] 5. [ We are a corporation and its 10.E Electrical repairs or addition 3.❑ I am a homeowner doingall work officers have exercised their 1 1.� Plumbing repairs or addition right of exemptionper MGL myself. [No workers' comp. g p 12.E Roof repairs c. we have no • insurance required.]t 152, §1(4), and 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, 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 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 imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fin of up to$250.00 a day ag.' .t the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the D e .r insurance coverage verification. I do hereby certify un'ems%e p' ?i .enalties of perjury that the information providedAA above is true and correct. Signature: / Date: /02-`f"-° PhoneU-1 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 Nh`s statute, an employee is defined as "...every person in the.service of another under any contract of hire, • express or implied;'orai or written." • • An employer is defined as"an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing erg ged in a joint enterprise, and including the legal representatives of a deceased employer, or the receiver or trustee of a individual, partnership, association or other legal entity, employing employees. However the owner of a dwelling hou having not more than three apartments and who resides therein, or the occupant of the dwelling house of another o employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building purtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also st. es that"every state or local licensing age cy shall withhold the issuance or renewal of a license or permit to op:rate a business or to construct buil.' igs in the commonwealth for any applicant who has not produced acce able evidence of compliance wi the insurance coverage required." Additionally,MGL chapter 152, §25C(7) ates "Neither the commonwe: th nor any of its political subdivisions shall enter into any contract for the performance o- public work until accept,.le evidence of compliance with the insurance requirements of this chapter have been present:. to the contracting a 'hority." Applicants Please fill out the workers' compensation affidavit corn. etely .y checking the boxes that apply to your situation and, if necessary,supply sub-contractor(s) name(s), address(es)an .done number(s)along with their certificate(s) of insurance. Limited Liability Companies (LLC)or Limited L'a,ility Partnerships(LLP) with no employees other than the members or partners, are not required to carry workers' co r,pens- ion insurance. If an LLC or LLP does have employees, a policy is required. Be.advised that this affidavit may :-submitted to the Department of Industrial Accidents for confirmation of insurance coverage., Also:.e sure to si_• and date the affidavit. The affidavit should be returned to the city or town that the application for th; permit or licens- •s being requested,not the Department of Industrial Accidents. Should you have any questions r=:arding the law or if •.0 are required to obtain a workers' compensation policy,please call the Department at th- number listed below. S-'. -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 pri r ted legibly. The Department has pro•ided a space at the bottom of the affidavit for you to fill out in the event the • fice of Investigations has to contact,yot,regarding the applicant. Please be sure to fill in the permit/license number vhich will be used as a.reference number, n addition, an applicant that must submit multiple permit/license applica ons in any given year, need only submit one ffidavit indicating current policy information(if necessary)and under"Jou Site Address" the applicant should write"all los tions in (city or town)."A copy of the affidavit that has been o Fl icially stamped or marked by the city or town may se provided to the applicant as proof that a valid affidavit is on fi e 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 co ercial 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 than you in advance for your cooperation and should you have a 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 Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 4-24-07 www.mass.gov/dia Cr. Al HE(HEro Town of Barnstabley� f<; Regulatory Services • ' $" ' ' ' Thomas F. Geller,Director � 1639. /5 D b',�� 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 Property Owner Must Complete and Sign This Section If Using A Builder , as Owner of the subject property LA my , herebyauthorize � to act on behalf, 1 in all matters relative to work authorized by this building permit application for. 31-qc itegt. (Address of Job) • / AIM a. igi ature of •' er Date "."-POL6-1>ei•(4`7,&*--c_ Print Name • If Property Owner is applying for permit please complete the Homeowners License Exemption Form on the reverse side.