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HomeMy WebLinkAbout2506 MEETINGHOUSE WAY/RTE 149 0 2 UPC 12543 NA$T1MGS. UN Town of Barnstable Building Post This Card So That it is Visible From the Street-Approved Plans Must be Retained on Job and this Card Must be Kept BAPOWAffiZ °SAE& Posted Until Final Inspection Has Been Made. ^� �� Where a Certificate of Occupancy is Required,such Building shall Not be Occupied until a Final Inspection has been made. Permit No. B-20-1237 Applicant Name: Michael Tomlinson Approvals Date Issued: 05/15/2020 Current Use: Structure Permit Type: Building-Siding/Windows/Roof/Doors Expiration Date: 11/15/2020 Foundation: Location: 2506 MEETINGHOUSE WAY/RTE 149,WEST Map/Lot: 155-025 _ Zoning District: WBVBD Sheathing: . Owner on Record: SCHULMAN,STUART D& Contractor Name Framing: 1 Address: 2506 MEETINGHOUSE WAY Contractor License: 2 WEST BARNSTABLE, MA 02668 Est. Project Cost: $9,800.00 Chimney: Description: Reroof Permit Fee: $49.98 Insulation: Fee Paid: $49.98 Project Review Req: Date: 5/15/2020 Final: _ Plumbing/Gas � ` Rough Plumbing: ��Building Official Final Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afte�,issuance. All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. Rough 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 Itreet or road and shall be maintained open for public inspection for the entire duration of the Final Gas: work until the completion of the same. + y � s � Electrical The Certificate of Occupancy will not be issued until all applicable signatures by the Building and Fire Officials are provided on this pe;rmit. Minimum of Five Call Inspections Required for All Construction Work:y Service: 1.Foundation or Footing 1} 2.Sheathing Inspection Rough: 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 Final: 5.Prior to Covering Structural Members(Frame Inspection) 6.Insulation Low Voltage Rough: 7.Final Inspection before Occupancy Low Voltage Final: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Health Work shall not proceed until the Inspector has approved the various stages of construction. "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT �� „E Final: ; ,. w Ba ble BU11C�1 . T n r ' g. k o rns a • Post�This CardSo That it�s Visible fromnfhe Street ApprovedPlans Must°be Retained onJ.ob and thisCard Must.;be Kept uursrwsuR A.. � • Mesa Posted UntilFlnal.Inspection HasBeenMade. ri I'er'n1�t Where a ertifi�cate of Occupancy is Req dire,such Buil �g=,,snaalF.of be.Qccupied until<a Final Inspectio,`n as been made Permit No. B-18-252 Applicant Name: Approvals Date Issued: 02/23/2018 Current Use: Structure Permit Type: Building-Insulation-Residential Expiration Date: 08/23/2018 Foundation: . Location: 2506 MEETINGHOUSE WAY/RTE 149,WEST Map�/Lot 155 025 Zoning District: WBVBD, Sheathing: •i Ek -Owner on Record: SCHULMAN,STUART D& Contra=t Name HENRY E..CASSIDY , Framing: 1 , oAddress: 2506 MEETINGHOUSE WAY . Ctr�actoUcenseCS 100988 2 WEST BAR NSTABLE, MA'02668 E§VtPrdjbct Cost: $0:00 Chimney:, vy%�� . Description: INSULATION-air sealing Permit-:Fee: : $85.00 i § Insulation: Project Review Req: Fee Paid: $85.00 Da a 2/23/2018 Final: i�- Plumbing/Gas _. Rough Plumbing: ��.. .��� q v% Building Official � Final-Plumbing: This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months afteri h Gas: ssuance. Rough a , ,y ?;, All work authorized by this permit shall conform-to the approved appli¢ationand=tapproved construction documents for which this permit has been granted. All construction,alterations and changes of use of,any building and structuresahallibe in compliance with the local zoning by laws:and codes. Final Gas: € <, K� This permit shall be displayed:in a location clearly visible from access street�or road_and shall be maintained n for the entire duration of the r work until the completion of the same. -Electrical v Service: The Certificate of Occupancy will not be issued until all applicable signatures by the Building andaFire40ffiaals 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 tow Voltage Final: 7.Final Inspection before Occupancy 'Health Where applicable,separate permits are required for Electrical,.Plumbing,and Mechanical Installations. Work shall not proceed until the Inspector has approved the various stages of construction. Final" "Persons contracting with unregistered contractors do not have access to'the guaranty fund (as set forth in MGL c.142A). Fire Department Building plans are to be available on site Final: �� All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application# Health Division Date Issued .2 Conservation Division Application Fee J . Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board BUILDING APT_ Amnalf A Historic.- OKH Preservation / Hyannis JAN 2 5 2018 Project Street Address '12)�6I0 Yz -),e_. TOWN OF BARIVSTASLE Village (/lGix -uJ Owner Address Telephone Permit Request �� l l/ ; I IA-,CGl Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type_ /U47 Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family ] Two Family ❑ Multi-Family (# units) Age of Existing Structure / Historic House: ❑Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing _new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric 0 Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size—Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial 0-Yes )(No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name11�12r, Telephone Number C"�� 7 ✓'f� ,2 Address4 ! License # / (�/� ,� CL Home Improvement Contractor# 22 1-027 Email orker's Compensation # Ir ALL CONSTRUCTION DEB IS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE lI FOR OFFICIAL USE ONLY, APPLICATION # Y ' J DATE ISSUED € MAP/PARCEL NO. � i , ADDRESS VILLAGE OWNER f, DATE OF INSPECTION: w N FOUNDATION „ FRAME f INSULATION FIREPLACE t ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL f GAS: ROUGH FINAL 1 is FINAL BUILDING y DATE CLOSED OUT ASSOCIATION PLAN NO. CAPECOD-27 KDOYLE CERTIFICATE OF LIABILITY INSURANCE DATE(MMIOD/YYYY) rlal"2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED.BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE.BY AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)must have ADDITIONALJNSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsements . PRODUCER C TACT Rogers&Gray Insurance Agency,Inc. PHONE 434 Rte 134 ac No,EXl; FAX No: 877)816-2156 South Dennis,MA 02660 E- At ,mall rogersciray.corn NSURER S AFFORDING COVERAGE NAIC q INSURER :Peerless Insurance Company 24198 INSURED INSURER B:Sclfet Insurance Company 39454 Cape Cod Insulation,Inc. INSURE C:Endurance American Specialty Insurance Company 41718 18 Reardon Circle South Yarmouth,MA 02664 IN RERD:Atlantic Charter Insurance Company 44326 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUBR LTR TYPE OF INSURANCE ffia POLICY NUMBER POLICY EFF POLICY EXP A LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR EACH OCCURRENCE 1,000,000 CBP8263063 04/01/2017 04/01/2018 DAMAGE TO RENTED 100,000 PREMISES(Faoccurrence) MED EXP(Any one arson 5,000 PERS NAL&AD INJURY 1,000,000 GEN'L AGGRE ATE LIMIT APPLIES PER: GENERAL AGGREGATE 2,000,000 X POLICY JECT LOG OTHER: 2000 PRODUCTS-COMP OP AGG 2,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT(Ea accidenu 1,000,000 ANY9UT0 6232707 COM 02 0UTOS ONLY X SCHEDULED 04/01/2017 04/01/201 B BODILY INJURY Per arson IRE AUUTTOSSWNEpILY X AUTOS ONLY X AUTOS ONLY gROOPER or RTYU AMAGE ccldent Per accident S C. 1 UMBRELLA LIAB X OCCUR EACH OCCURRENCE n2,000,000 X EXCESS LIAR CLAIMS-MADE EXC10006636002 04/01/2017 04/01/2018 AG RE ATE DIED RETENTION 5 D WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X PER OTH. ANY PROPRIETOR/PARTNER/EXECUTIVE YIN R/O WCE00431902 06/30/2017 •b6/30/2018 ISTATUTF ER 1,000 FFICER/MEMg��EXCLUDED? ] NIA E.L.EACH ACCIDENT 000 (DMandatory In NH) It yes,describe under E.L.DISEASE•EA EMPLOYEE 1,000,000 DESCRIPTION F OPERATIONS below 1,000,000 E.L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more a Workers Compensation Includes Officers or Proprietors, pace Is required) Additional Insured status Is provided under the General Liability and Auto Liability when required by written contract or agreement with the Certificate Holder, CERTIFICATE H LD8R CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE ACORD 25 12016/031 0 1oaa-�niG er•non nnoonoATrn&r All.;.,• .,. , Commonwealth of Massachusetts l�J Division of Professional Llcensure .Board of Building Re ulations and Standards Cons �fit�.�lttpprvIsor CS•100988 y' t °. '; ? PIres; 11/11/201.9 r ^ � ..^ +; HENRY 8 SHED E CAS-SIDY,`t;; '��y,: 1 ROW WEST YARMOG, T Commissloner C ------------------------ � 6 Office of Consumer Affairs and Business Regulation 10 Park Plaza - SUite 5170 Boston, Ma ;°�bUsetts 02116 Home Im prove me.-K-P0.o•• tractor Registration Type; Corporation ( / Reglstratlon: 153567 Cape Cod Insulation Inc � 18 Reardon Circle w Expiration: 12/14/2018 So, Yarmouth, MA 02664 ,'fi `' a' ;•tl.'.::... Uzi• l�iGY+d Co 20M•06/11 Update Address and return card, Mark reason for change, _ c __.......... vT/as�o��+mta�atuar��t�o�C�/��rt4Jrr•o�udel2d . Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only Type: Corporation before the expiration date. If foun urn to; c.......g16tratlon Ex [ration Office of Consumer Affairs end sl ss Regulation s i! jl 7 12/14/2018 10 Park Plaza'. a 5170 "i Boston,MA 0 Cape Cod Insulatl A J'ol` HenryCassid 18 Reardon Clrcl�''Q,: CCQir So,Yarmouth,MAQ'2�§g:i:.' C� Underseoretary t al hout si atu The Commonwealth of Massachusetts Department of Xndustrdal Accidents b 1 Congress Street, Suite 100 Boston, MA 02114-2017 www,mass,gov/dla llrorkers' Compensation Insurance Affldavltt Builders/Contractors/Electricians/Plumbers, TO BE FILED WITH THE PERMITTING AUTHORITY, Apnlicaat Information Please Print Leeibly Name (Business/OrganizatioOndlvidual): Cape Cod Insulation Address: 18 Reardon Circle City/State/Zip: South Yarmouth,MA 02664 Phone#: 508-775-1214 Are you an employer?Check the appropriate box: Type of project (required): I.r,-/l I am a employer with 48 employees(full and/or part-time),* 7. ❑ New construction 171 am a sole proprietor or partnership and have no employees working for me In $, ❑ Remodeling any capacity,(No workers'oomp,insurance required,) 3.❑1 am a homeowner doing all work myself..(No workers'comp.Insurance required,)t 9. ❑ Demolition 4.❑I am a homeowner and will be hiring contractors to conduct ell work on mI will 10 ❑ Building addition ensure that all oonuictors either have workers'compensation insurance or are sol property. I,❑ Electrical repairs or additions proprietors with no employees, . Plumbing repairs or additions ❑ 5.❑1 am a general contractor and I have hired the sub-contractors listed on the attached shoot. 112.❑Roof repairs These subcontractors have employees and have workers'comp.Insurance.t 6.❑We are a corporation and Its officers have exercised their right of exemption per MdL o, 14, ✓❑Other Weatherization 152,§1(4),and we have no employees. (No workers'comp, Insumnoe required.) *Any applicant that checks box N 1 must also fill out the section below showing their workers'compensWon policy Information. t Homeowners who submit thle tsffidavit Indicating they are doing all work and than hire outside eontraotots must submit a new affidavit indloating such. tContraotors that check this box must attached an additional sheet showing the name bf the sub-oontraotois and state whether or not those entitles have employees. If the subcontractors have employees,they must provide their workers'oomp,policy number. ._ I am.an employer that Is providing workers'compensation Insurance for my employees. Below is the policy and fob site Information. Insurance Company Name: Atlantic Charter Policy#or Self-Ins.Lio.#: WCE00431902 Expiration Date- 06/30/2018 Job Site Address: 26 0i'd City/S tat e/zip:1.V ,� k 1 le, Attach a copy of the workers' compensati. policy declaration age(showing the olio is ( g policy number and expiration date), Failure to secure coverage as required under MOL 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$250,00 a day against1he violator,A copy of this statement may be forwarded to the Office of Investigations of the DIA for Insurance coverage verificatlon, 1 do hereby certify under the pains and penalties of perjury that the Information provided Bove is true and correct aignate; Hen ryCassid Y o...,rr„�•„.m J n #: 508-775-1214 Official use only, Do not write In this area, to be completed by city or town offlclal, City or Town; Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3, City/Town Clerk 4, Electrical Inspector.5► Plumbing Inspector 6, Other Contact Person: Phone#i Town,of... artab , 1 Rdgu'latoes Ri ard,V.,9C$ Bulldtg'Drvsianr ;sAUIAOMA.C. :•);:: '�:, ..�. :►:. .,. ....,. t;. .. . :7, . . .:Bu�7d�ing•�itymatiis�•ibder� ''� • . �;:: . .. • . , . . .. .J Street,Hyannis,lVIA'020, www.town.barnstable.ma.us OffYc ,5' 6*461403$ ..;,'!'. .. .. . ).). . . . . . Fax,. 508-1904230 :Prope wnear must Complete and ign,Tlii Section l ..`'7t.. . I MELISSAAVERINOS; .:i= as Owner-.-of the Subjectrprbpefty t hereby authorize ;: • .�,, �,� to act on my behh alf, in all matter's'rtlati.v)e to:workiavthorized-by.,th s building.permit:application:rfot:'::: r :r .: t 1 2.506..Meetinghouse.Way West.Barnstable, MA 02668.. . . . . (Address of Job) 1 Signatur caner Date Print Name; rt . •Ji ..:o:.r�s';i1 yi�. .. � 't '' fi: :1_+ +i�, 'a.• 7�. .. . . .: . ... If Property Owner is applying for permit,please complete the Homeowners License Exemption Form. T C:1UsersldecolliklAppData\IAMllMierosoft\WindowsUNetCachelCon4ten'r Outlook\L7U69LF2\EXPRESS(2).doc 01/25/17 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map l Parcel Application # Health Division Date Issued t Conservation Division Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ®� Historic - OKH _ Preservation / Hyannis Project Street Address 9L �.., Village W Owner n• A✓ccv^.., Address S�nL Telephone 737-11Si Permit Request r: E t1 Square feet: 1st floor: existing proposed 2nd floor: existing proposed _Total new a C4 Zoning District Flood Plain Groundwater Overlay C)I ' v . .Project Valuation 16Z" — Construction Type ' Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docu.rient5don. Cn Dwelling Type: Single Family. p/ Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: 0 Yes ❑ No On Old King's Highway: ❑Yes ❑ No Basement Type: ❑ Full ❑ Crawl 0 Walkout ❑ Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # \ 1 Recorded ❑ V ; l Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mire McCarthy Construction Telephone Number PO Box 52 Address west Dennis,MA 02670 License # Cell (508) 280-6964 C-S;l_58633 H1C-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � Jti kz, SIGNATURE DATE I° /I rf FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED � MAP./PARCEL N0: ADDRESS VILLAGE OWNER DATE OF INSPECTION: s FOUNDATIONS I' FRAME r INSULATION FIREPLACE 'v ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. 1� OWNER AUTHORIZATION FORM y � l - (Owner's Name) owner of the property located at R (64, 014 � (property, dress) Z 6C / &4- (Property Address) ,r herebyauthorize `t C1 , (Subcontractor) an authorized subcontractor for RISE Engineering, act on my behalf to obtain a building permit and to perrorm work on my property. Owner's S1§nd1v4 Date £'d ££6T89S80ST:01 6090BLL80ST M30IONEW3 030NdnGU:W0NJ 20:60 OT02-T-100 . Massachusetts -Department of Public Safety Board of Building Regulations and Standards C'nnxtrurtian Super�itiur License: CS-058633 MICHAELJMCCJAR PO BOX 52 W DENNIS MA 6267 � " lit Expiration Commissioner 04/10/2016 XIM wowtwoo~ada VcAmdadmielff1j. _ Office of Consumer Affairs and Business Regulation _— 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiration: 6/16/2015 Tr# 238121 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 — WEST DENNIS MA 02670 Update Address and return-card.Mark reason for change. Address Renewal [:]"Employment ❑ Lost Card SCA 1 C� 20M-05/11 El 1 The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 wily p mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ` Applicant Information Please Print Le ' I Mike c arthy Construction Name(Business/Organlzagon/Individual): PO Box 52 Address: West Dennis, AIA 02670 City/State/Zip: CSIpMQ3 HIC-169393 Aretlrn an employer?Citeck the appropriate box: Type of project(required): 1.. a employer with y 4. ❑ I am a general contractor and I --+-- 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole propridtor or partner- listed on the attached sheet:t 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity, worlmrs'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I I.❑Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),'and we have no 12.❑R of repairs ran lusuce required.]t employees.[No workers' • I3.Q'�ther comp.insurance required.] *Any applicant that thirds box#1 mast also fill out the section below showing their wodmW compensation policy kdbrmadoa t Homeowners v&o submit this affidavit indicating they am doing all work and thin hire outside contractors most submit a new affidavit Indicating such. 1Contractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy Ifftnatiom lam an employer tltat Is providing workers'compensation Insurance for my employees ,Below is the policy and Job slle information. Insurance Company Name: a•n. Policy#or Self-ins.Lic.#; VW(r Ica-�0116V_- _')°HA Expiration Date: Job Site Address: SZ4C_> City/State/Zlp; Attach a copy of the workers'compensation policy declaratio page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c.152 can lead to the imposition ofcriminal penalties of a fino 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 cerl6 N e pa a enaUles ofperjury that the b;formadon provided above Is true and correct S ture' Date:* '�S II Phone P Offlelal use only. Do not wrUe In this area,to be completed by city or lown offklaL t Permit/License 0 City or Town: i Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CItylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector j 6.Other - Contact Person: Phone#: i r ® DATE(MWDDIYYYY) ACC)o CERTIFICATE OF LIABILITY INSURANCE 07/1012014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01962-001 RaUJACT Bryden&Sullivan Ins Agcy of Dennis Inc A/C.No.Ext: (508)398-6060 ,No.: (508)394-2267 PO Box 1497 So Dennis,MA 02660 — ESIS).AEEOBDJbO E0YEFAG.E ALCM SERA: A.I.M.Mutual Insurance Company _ _ 26158 _ INSURED Michael McCarthy Constmcdon Inc 9_ - AuBEs_ P 0 Box 52 SUB West Dennis,MA 02670 s.LIB�B_ -- COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHCR DCCUMCNT WITH RESPECT TO V61-IICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. lop TYPE OF INSURANCE I yp�^ws POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE s COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED S xmncel CLAIMS.MADE OCCUR MED EXP(Arty one person) i PERSONAL S ADV INJURY s GENERAL AGGREGATE S GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ �OLICY IUE�T DOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) s AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE S _ AUTOS _ S UMBRELLA LIAB OCCUR EACH OCCURRENCE s EXCESS LIAB CLAIMS MADE AGGREGATE $ y—DEERDg CAM R�EgTpETN�TIIONN $ yy�gTp� TH $ AND EqM�PPLRO�iErETrpiSR�pLIqARB�INLIETRY� X TV6$ L II N Ti s CER- _ A OFFICER/MEFABER EXCLUDED ECUTrVE1 NIA VWC-100-6017656-2014A 7/17/2014 7/17/2015 E.L.EACH ACCIDENT $ 500,000.00 (Mandatory In NH) ar E.L.DISEASE-EA EMPLOYEE s 500,000.00 D�SGRM% OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,G00.00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Workers Compensation Coverage applies to MA employees only. CERTIFICATE HOLDER CANCELLATION Thlelsch Engineering 195 Francis Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cranston,RI 02910 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I f Town of Barnstable *Permit# r r Regulatory Services Expires ee�. s%ooze'* RMWSTABLB, r 3 Thomas F.Geller,Director X-P R ES S PERMIT A Building Division Tom Perry,CBO, Building Commissioner JUN — 6 2012 V 200 Main Street,Hyannis,MA 02601 n www.town.bamstable.ma.us (� .Office: 508-862-4038 TOWN OF RffitffAbLE EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprin[ Map/parcel Number Property Address 1 \ 1 ` esidential Value of Work t 11 bCv .C/v Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address � ,�'G 6) .\ MC ��� tom-- 1— �i W� G� Oct Contractor's Name Telephone Number.^ � _ 1 Home.Improvement Contractor License#(if applicable) =an's on Supervisor's License#(if applicable) Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I the Homeowner have Worker's Compensation Insurance Insurance Company Name r Workman's Comp.Policy# o S ` S.!V C( / Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) Ke-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ra � (_ (A QS� ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors' ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is r SIGNATURE: C:\Users\decollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 f _ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): maid— L A nyin Address: City/State/Zip: � � Phone#: 5��- �� i �V0 Are yo n employer?Check the appropriate box: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I employees(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. ❑Remodeling ship and have no employees These sub-contractors have g. ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• 9. ❑Building addition [No workers' comp.insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their l LE]Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL l2•[EHKoof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 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. +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.#: S t ! v O Expiration Date: Job Site Address: �'O —C 1 City/State/Zip: 1 � Attach a copy of the workers' compensation policy declaration page(s owing 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. 1 do hereby cert' under the pains and penalties of perjury that the information provided above is true and correct. Si atur Date: dLJ Phone#: 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#: aF� snxxsrnBLK ,� Town of Barnstable DN1`�p Regulatory Services g rY Thomas F.Geiler,Director Building Division Thomas Perry,CBO 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, as Owner of the subject property hereby authorize.—_ ��,� -- � to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) • *Signa' Oix;t�er a Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollikWppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 DATE A� CERTIFICATE OF LIABILITY INSURANCEF5/29/012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Cristina NAME: T. Edmund Garrity 6 Co. , Inc. P"D"E (617)354-4640 � U .Le171354-5e2e 545 Concord Ave. aonRE s:cristina@garrity-insurance.com _ ..... . . INSURE S AFFORDING COVERAGE .._ ..._ _-- NAIC# Cambridge MA 02138 INSURERA:SCOttsdale Insurance INSURED INSURER B-CITATION 40274 Mark Lemon, DBA: ML and Son Construction INSURERC:The Hartford 490 Pitchers Way INSURERD: PO BOX 423 INSURERE: West Hyannisport MA 02672 INSURERF: COVERAGES CERTIFICATE NUMBER3Kaster COI 2012 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR _ ._ ,,,TYPE OF INSURANCE ._ POLICY NUMBER ,MM/DD MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE To RENTED X COMMERCIAL GENERAL LIABILITY PREMISES E.occurrence $ 50,000 A CLAIMS-MADE a OCCUR CPS1399527 /7/2012 /7/2013 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GE N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICY JECT PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 ANY AUTO BODILY INJURY(Per person) $ B ALL OWNED SCHEDULED STLT 6/14/2012 6/14/201'3 AUTOS X AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per.cadent UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ C WORKERS COMPENSATION C WC SLIMIT OTH- AND EMPLOYERS'LIABILITY ANY OFFlCER/MEMBER/EXCLUER/EDED ECUTIVE� N/A EL.EACH ACCIDENT $ 100,000 (Mandatory In NH) 0515N280 /18/2012 /18/2013 E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below F E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate Holder is named additional insured for general liability if so required by written contract as it relates to named insured's operations. CERTIFICATE HOLDER CANCELLATION ml_sonconstruction@ comcast SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF;*NOTICE WILL BE DELIVERED IN Town of Barnstable ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE W Garrity/CRISTI ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 rgmnnsi nt Thn Arr1Rr1 nmmn 2nA Innn nm rnniafnrori morke of Arr1Rr1 -/ ��+e�wieall/c o� VOfticeof ConsumerAffairs&B sines�R gui�n�a License or registration valid for individul useHOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to only Registration:,-1436160 Expiration: =6/19/2014 Type: Office of Consumer Affairs and Business Regulation Individual10 Park Plaza-Suite 5170 MON _ Boston,MA 02116 MARK LEMON == 490 PITCHERS WA`i'�E= HYANNIS, MA 02601 �._-- Undersecretary Not valid without signature Depa tment Of Public Safety Massachusetts' ulations and Standards Board of Building Reg Specialty Construction Supen'isor License: C$SL-jp0207 M IVIARK J LENIIB � ��' PO BOX 423% ' ' '026*e RT WEST BY J �!• �� ion Ex 0�412014 041 Commissioner __