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HomeMy WebLinkAbout0020 MILL LANE �y Oxford NO. 152 1/3 ORA ESSELTE 10% © o o TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map I Parcel V 6 I - 00 I TO Health Division �wDate Issu�d i.7 Conservation Division „Application Fee Planning Dept. ...�� Permit Fee -oc) 1 ON Date Definitive Plan Approved by Planning Board D Historic - OKH _ Preservation/ Hyannis Project Street Address c% J /.If! L.L Village Wei- IJ•,,l-�►� Owner �C..LY, kc LJ 4L k f_Y%_ Address 5..�1 Telephone 3► 1=3-0C Permit Request 1,�lT��l..c �,�, ) o" Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District r Flood Plain Groundwater Overlay Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family �_ir/ Two Family ❑ Multi-Family (# units) Age of Existing Structure I 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 ❑ 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: ,l Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name Telephone Number Address P® Box 52 License # West ennis, Celli (508) 280-6964 Home Improvement Contractor# CSL-58633 HIC-169393 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO .4 Y, �f 01 M162 1 SIGNATURE DATE 1 FOR OFFICIAL USE ONLY APPLICATION# s DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE i OWNER R. .K DATE OF INSPECTION: FOUNDATION ' FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL . PLUMBING: ROUGH FINAL GAS: ROUGH FINAL -� FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. ,e YJ Town of Barnstable °4 Regulatory Services YUkhard V.ScA Djredo: Tom Perry,Btulding Commissioner 2DOW6kStreet Syands,MA.02601 www town bamstable nza as Offtce: 508-W4038 Fax: 508-790-6230 PWpe1tY 0W,= USt Couykft and$igu This Section If WmAbuider i; as ow=of the.st b ect property herb xmhorize004�,S OA) ro ad:on ntybeW in-An==xdaxive to vmrkautho- tbis bonding permnt application for: krypve- Address df fo'l "`Pohl fences and alarm are the responwb&yof the aiplicant Poch are nest to be:jMed or Zed-befone fence is insmted and at final im pecuots are peafAuned awl aeceptect AS of Owner &jmim of Applicam Pnnt Name Name lJ Daze Q•.F0tuns0W9aWi xU4ssVMK*1S I cT Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor ; License: CS-058633 MICHAEL J MCC�AR PO BOX 52 lei W DENNIS MA 0267 b Expiration Commissioner 04110/2016 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiratio /2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY i -- P.O. BOX 52 _ — - WEST DENNIS, MA 02670 - »'.j.`4f.-...J Update Ad ess and return card.Mark reason for change. 20M-05/11 Address Renewal �:i Employment [] Lost Card ,per The Commottrvealth ofMassachttsetts Department of Indrlstrial.Acchlents 1 Congress Street,Srtite 100 Boston,MA.02114-2017 wwminass.govIt is Workers'Compensation Insurance Affidavit:R►tiIders/Contractors/Electricians/Pltimbers. TO BE FILED WITH ME P)'Rh1fiTT1NG AUTHORITY. Applicant information Mike McCarthy lease Print Le ibl Name (Business/Organization/Individual): Address: West Dennis, MA 02670 e - City/State/Zip: r L-38Wn3#: HIC-169393 Are you an employer?Check theapropriate box: Type of projecf(required): 1. 1 am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in $, Remodeling any capacity.[No workers'comp.insurance required.] 3.❑i am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9• ❑Demolition 4. lam a homeowner and will be hiring contractors to conduct all work on m 10❑Building addition ❑ g y property. 1 will ensure that all contractors either have workers'compensation insurance or are sole I i.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. These sub-conlractors have employees and have workers'comp.insurance./ 13.❑Roof repairs 6.❑we are a corporation and its officers have exercised[heir right of exemption per MGL c. 14.90ther 152,§1(4),and we have no employees.[No workers'comp:insurance required.] 'Any applicant that checks box 41 must also fill out(lie section below showing their workers'compensation policy information. t Homeowners who submit(his 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 bn additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. if the sub-conlractors have employees,they must provide their workers'comp.policy number. fain an employer flint is prowling ivorkers'cotnpensation insrrrance for my employees. Below Is the policy and f ob site Information. p� Insurance Company Name: T/ ' Policy#or Self-ins.Lie.#: V�L�ioa'�ui ?656=-an]y Ij Expiration Date: ),;L 1 - ri Job Site Address: �-G �;�t �-�.� City/State/Zip: d^/gt I,- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine tip 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 aWflal and allies rF ry that theinformation provider/above is trite and correct. Si nature: Date Phone#: Official rise only. Do not write in tlds 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.Citylrown Clerk 4.Electrical Inspector 5.Plumbing Inspector " 6.Other Contact Person: Phone#: i WORKERS COMPENSATION AND EMPLOYERS-LIABILITY INSURANCE POLICY INFORMPAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800) 876-2765 NCCI NO 26158 POLICY NO. I VWC-100-6017656-20146 PRIOR NO. I VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P O Box 52 FEIN:**-***3862 West Dennis, MA 02670 Legal Entity Type: Corporation Other workplaces not shown above: See Location 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m.standard time at the insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000:.each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease. $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 0712979 INTER SEE CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $29,332 GOV GOV Deposit Premium $7,748 STATE CLASS MA 5479 State Assessments/Surcharges $28,601.00 x 5.8000% $1,659 This policy, including all endorsements,is hereby countersigned by 12/15/2014 Authorized Signature Date Service Office: Bryden&Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 Burlington MA 01803 So Dennis, MA 02660 � , ` / WC 00 00 01 A(7-11) �� Includes copyrighted material of the National Council on Compensation Insurance, \�� imad with itc narmiccinn v N _�,L _ ,p� Assessor's office (1st floor). J7` �y � HE Assessor's map and lot number.�....................J Board of Health (3rd floor): Sewage Permit number e. .g� Engineering Department (3rd floor): TALLED IN C House number ................ .....................C91, ........................ ;`MITI o war a� TITL Definitive Plan Approved by Planning Board -------- 7-----------1 ./V ;:�; APPLICATIONS PROCESSED 8:30-9:30 A.M. and 1:00 2:00 P.M. only TOWN REGULATiOIVS TOWN OF BARNSTABLE z BUILDING INSPECTOR APPLICATION FOR PERMIT TO .......�!.... � lr'L'.................................. ......................1..... ............... 1� . TYPE OF CONSTRUCTION ........../-R.67 .. ................................................................................................... .................. 0............ ..�. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for as permit according to the following information: Location rG7 ICM. ►'4.1.�...u44. ................w.: . ........................................................ ProposedUse ... .. 1t � �.................................................................................................................................. Zoning District ..... .......................................................Fire District ...V...... /. , Name of Owner ..Fo!ymto...C7..C. . . ...L/.r4-,10...............Addressf<!1fH�f .LL . . i Name of Builder ......X'-t/iC? f".X0.............Address Nameof Architect ..................................................................Address .................................................................................... Number of Rooms ..................................................................Foundation ...( J17.. ...6 Ci<.................................. Exlerior ...... ....................................................Roofing ... ....................................................... Floors .....wQOk1../....G1n.aT........................................Interior ................................................... 'cleating ..........................Plumbing .....C.0?.Pop�r........................................................ Fireplace .....�. ........................................ ..............................Approximate Cost ...3 .......................... ................. Area .. � .. .................... Diagram of Lot and Building with Di t sions N 4 Fee 1 3 + G� 6fee OCCUPANCY PERMITS. ZEQUIRED FOR NEW DWELLINGow I hereby agree to co nf rm to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. . Construction Supervisor's License .00 241............ SCANZILLO, RONALD No -...3.2:.5..6.8.. Permit for ..Remodel .................................. Sihcrle Family ...................................... ...pw .1.1.i.ng........ Location ....Lot... ......2.0...Mill Lane..... West Barnstable ........................ .................................. Owner ...Ronald Scanzillo .......................................................... Type of Construction ....Frame.......................... .... ....... . ............................................................................... Plot ............................. Lot ................................ �Permit Granted ...... 1.7f .19 89 Date of Inspection ..............19 Date Completed ....... ......................19 1 ,14i Assessor's office (1st floor): Assessor's map and lot number ....... ......... ........ , .. I E���� Q Board of Health (3rd floor): Sewage Permit number ......................................... eAs39zsnta. 0 Engineering Department (3rd floor): +oo MAB1639. House number ......... . ... �0 MAY a' Definitive Plan Approved by Planning Board _ _____.___ _.._.__-____ 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 .... TYPE OF CONSTRUCTION .......... .........s' r ...................�! [i:... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ...... ......°.. .... ' .:........................................................... ................ ProposedUse ... °...... : .................................................................................................................................. i Zoning District .....i ..............................................................Fire District . o Name of Owner ...............Address .... % '.....� Name of Builder ...,:i.�!.:.'�.....,.:: .....: . . ...'..: _ .............Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Number of Rooms Foundation ..... � ' '�........................................................... Exlerior .. ....................................................Roofing ...�.?.. . Floors .%.... .... .,....... ........... .........................................Interior ..... .............................................................. Heating ::.:...............................................................Plumbing ;c;:,, , Fireplace ..................................................................................Approximate Cost ... ...` . .'::.:. :. ........................... ................ Area ` :................... Diagram of Lot and Building with Dimensions Fee OCCUPANCY PERMITS_ R'EOUIRED FOR NEW DWELLINGS,' 1 hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name :.. Construction Supervisor's License ..>: ,............. SCANVILLO, RONALD A=156/— Ol Remodel No ..........325.68...... Permit for .......................Sin cfle, Family Dwelling ........... .............:............................................. Location ..Lbt #1 , 20 Mill Lane ........................................................... West Barnstable ............................................................................... Owner . o .Rnald Scanzillo ................................................................ Type of Construction .Frame...........I............................. ............................................................................... Plot ............................. Lot ........................ Permit Granted 1.7..........19 89 Date of Inspection ...................................19 Date Completed ......................................19. q 004 �00 � ol