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Home My WebLink About3341 MAIN ST./RTE 6A(BARN.) �I rocan &, 01 , R - - . o' . . °' I.I I �1-. . .I I. I.I I I .�II � -I I I I, I I I ,,.-�1 I II��I ,I-� ,1�"�,�,�-, ��. ,�I�,� ,:��,,:,I,, t,� :�� .., "I,,�, ,;.,�I:,I I, I;� ,�, �, j,:�: -,, � I�,,1,:� � :I-�*,I,,,:�.�I?, - " . , j + 4 "a. ,-," .,\� ,��,, ,�,�1-�,',.."I- ,-.,.��,,,', ,,-: ,��,--1"1"�11I � " I , I : " �,",� I I �� : � ,� -1, ,� �:� , I� I , � :, :,I,I I � � -', - , �" , � ,,I, ��;-.�-�',� ��: ,:: �� ,I I . ,,, � �: �� ,�;;�,�,., I, I . I I I I . � ;. � - , � .. ,3 . . -��:�,, I I " , � �I , � . N , , :��, �',, - ,�,,�,,,,��,,��- , A,-,,�,�:�',�" I I "�,�,. I- . �, �, ,,�,:�,,Z�`�, �,� w:,,-,�", :,:�:��..� ��"��:�:� ,�� 'o : � � ; I ,� ,: - , - I;�,��,r 2 �. I.-1 1 :.,I�',,I�.�.,I z�.,�I:I� } fi.��FF'. i f qA I``[ h- k ' ,-"I P . Z}, �.'.6 y:5 r.' ;^:S' r 'f n 1� S ,$,... 1uvt�� F{ I, a Wr ;" 11 V , Y y 4 Y i� H S ` F` : ; I . , : � """,��. �, ,—, - �'�:,�,�� ... � I , 1 71 4, C x C _._. Application number , !�► m Fee ............. ... ✓....�.�!.............. .......... Building Inspectors Initials............. 1639. �� NOV 2 7 2018 cam, TOWN u� �y _ /1 Date Issued........................�..L.�.l �'... .I.U........ TOWN O� bARN51ABLE Map/Parcel..... .... .!/..�.�...................... TOWN OF BARNSTABLE EXPEDITED PERMIT APPLICATION: ROOF/SIDING/WINDO WS/DOORS/TENTS/STOVES/WEATHERIZATION PROPERTY INFORMATION Address of Project: j� V t /"' Q", 5/y", bV ,r145�a �Af NUMBER STREET VILLAGE Owner's Name: -S q tm� P Q(a ►'.� Phone Number l 7 —�j' Email Address: m e-/ _ JaL-C°Cell Phone Number &/ 7 -ey, ? ,V -9�SX 11-1 6 / 7 —?a/ — Project cost$ 0 Check one Residential Commercial OWNER'S AUTHORIZATION As owner of the above property I hhereb authorize PC?M�° l a. �. a to make application f .r a build' g permit in accordance with 780 CMR Owner Signature: - Date: TYPE OF WORK Y�Siding Windows (no header change) # Insulation/Weatherization Doors (no header change) # Commercial Doors require an inspector's review Q Roof(not applying more than 1 layer of shingles) Construction Debris will be going to CONTRACTOR'S INFORMATION Contractor's name 7W Home Improvement Contractors Registration(if applicable)# /f/ (attach copy) Construction Supervisor's License# /t/ (attach copy) Email of Contractor All Phone number ALL PROPERTIES THAT HAVE STRUCTURES OVER 7S YEARS OLD OR/F 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 3 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 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: —5q Telephone Number ,!!�/7 --0 %_5_0 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 edures, specific inspections and documentation required by 780 CMR and the own o arnstable. Signature Date a-, Z 6, Zo 10 F_ A PLICAN GNATURE Signature Date All permit applications are subject to a building official's approval prior to issuance. I_ The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations s 600 Washington Sheet Boston,MA 02111 t www.mass.gov/dia { Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le2ibly _Name.(Business/Organization/Individual): r lM a a I rk Address: `2i z 1 ZnQ( -City/StateZ Phone#:i —rJ 90 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 employees(full and/or part-time).* have hired the sub-contractors 6. El New constriction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity, employees and have workers 9. ❑Building addition [No workers' comp.insurance comp.insurance.: r ed.] . S. ❑ We are a corporation and its 10.❑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.❑Roof repairs insurance required]t c. 152,§1(4),and we have no employees.[No workers' 13.❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their worker;'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. 4Contractors 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 thepolicy 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 hereby certify u th aims andpenalties ofperjury that the information provided above is true and correct. Si ature• Date:= l' � / *.�J _ 1 ___4 Phone#:. .. �o 17 ' 7 Official use only. Do not write in this area,to be completed by city or town official e 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 to this statute,an employee is de ed 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, artnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint en e,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,parts ,association or other legal entity,employing employees. However the owner of a dwelling house having not more three apartments and who resides therein,or the occupant of the dwelling house of another who employs p ons to do maintenance,construction or repair work on dwelling house or on the grounds or building appurtenant th shall not because of such employment be deeme be an employer." MGL chapter 152,§25C(6)also states that" ery state or local licensing agency s/withhhe issuance or renewal of a license or permit to operate a iness or to construct bw7d n in alth for any applicant who has not produced acceptable 'dence of compliance with the inse required"Additionally,MGL chapter 152, §25C( )states either the commonwealth noranysubdivisions shall enter into any contract for the performance of p lic.work until acceptable evidencewith the insurance requirements of this chapter have been presented the contracting authority" Applicants Please fill out the workers' compensation affidavit mpletely,by checking the oxen that apply to your situation and,if necessary,supply sub-contractors)name(s),address s)and phone number(s) ong with their certificates)of insurance. Limited Liability Companies(LLC)or L' 'ted Liability Partin s(LLP)with no employees other than the members or partners,are not required to carry work compensation' . If an LLC or LLP does have employees,a policy is required. Be advised that this davit may be sub to the Department of Industrial Accidents for confirmation of insurance coverage. Als be sure to sign a d date the affidavit. The affidavit should be returned to the city or town that the application for th eniyi or licens is being requested,not the Department of Industrial Accidents. Should you have any questions ding the law o if you are required to obtain a workers' compensation policy,please call the Department at the n ber listed be w. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Ofcials Please be sure that the affidavit is complete and printed legibl . The epartment has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Inv ons has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will b as a reference number. In addition,an applicant that must submit multiple permit/license applications in any giv ear,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"th applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped ked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future p licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or p of related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is OT r to complete this affidavit. The Office of Investigations would like to thank you in adv 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 Commonweal of Massachusetts Department of Iti Accidents Office of am 600 Washii n Street Bostm 02111 Tel.#617-727-4900 ex.406 or 1-877-MASSAM Revised 4-24-07 Fax#617-727-7749 www.m gov/dia r'fp offioe (1st floor): q Assessor's map and lot number .... . 9/... .'% .. ../ -. MUST CONNECT TO TOM SLIER FTNE Q � Board of� Health (3rd floor)-. Sewage Permit number .. y2�1.1..1.... / I&....�� + Z BAR39TABLZ �. Engineering Department (3rd floor): ��p rb 9. House number ...............................4....3.. .1.1...................... EOM a\ P 6(e 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 ....eX.;.51A. )�....!!3'`�j/!l4 tJGe......... TYPE OF CONSTRUCTION .......Fra,M.0 ............................................................................................................. ........... .G+-r 2 f........19.... d' TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ........ s.0....5T.....� 4�.....M.R.,.......4.Z,12IO........................................................................ Proposed Use ...........--u r JGtG. ........R..0.4..i 1........................................................................................................................ .. t...........................Fire District lP,�.Zoning District ................ C�GC-r�1��'„�..., .. .............................................. ...........J................ . Name of Owner W!'J C.t.m.... .'I ..lK.� /�...M.4..hl. ` ......Address ...>3�..y.1...4t t.►la....s .... `�T ? ..... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ........i.........................................................Foundation .....5.fK.6.............................................................. Exlerior ........ fi.j c3........Roofing ......G. -rp.A. t..5.4i.Al.�,s.................................. Floors ......................................................................................Interior .....1AIV. �.Ni/S>(}!e1..................................................... Heating ..................................................................................Plumbing .. ..... Fireplace .................NA........................................................Approximate Cost .........i,.ro v..........................�............... Definitive Plan Approved by Planning Board ________________________________19________ . Area ......... ....................... Diagram of Lot and Building with Dimensions Fee ........�U.r�.�. . . . ................. SUBJECT TO APPROVAL OF BOARD O H AL 12�i N_ j.jr. e�QfiQy� GIALUCI{ id� !V� OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town B rnstable regarding the above construction. Name ..w. ... ...... Construction Supervisor's License ... ............. RING, WILLIAM F. & RI A M. 31725 uild Addition ................. Permit for .................................... k ". Single.. . . ....Fa.m.ilv...d.we.l.l.i.n.9......... .... .. .... .. .... .... .. . .. 3341 Main Street Location ................................................................ Barnstable ............................................................................... Owner ....William...F......&....Rita...M......R.ing ..... .. . .. .... Type of Construction ....F.r.a.m.e......................... ............. ........................................... Plot .............. ............. Lot ................................. y. Permit Granted ......M.ar.c h...2.1..............19 88 .. .... .. .. Date of Inspection ....................................19 Dote Completed ................ ...19 C2 F 16; - C> C'1-32