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Home My WebLink About0078 HIGHLAND STREET �/ 4 r ` II I SMEAD No. 10339 smead.com Made in USA �cvaeo� e oA�ST-CON`'J� o Town of Barnstable *Permit# Expires 6 months from issue date Regulatory Services Fee --? * Richard V.Scali,Interim Director T TOVV STABLE _ Building Division Tom Perry,CBO,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.bamstable.ma.us Office: 508-862-4038 Fax:508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number �� / Property Address 77E 1 k'N C) 3 F 4 Residential Value of rk$ q�0� O C Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address ! T Jtj ky-5 Contractor's Name h e t_�_C C)`(t) \40rl Telephone Number 1150 toy 779 V48K Home Improvement Contractor License#(if applicable) �� f� dl� Email: ) l H /''l f-g ,"- ►sie o r� Construction Supervisor's License#(if applicable) Q—Co- �0?4kn ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor I am the Homeowner I have Worker's Compensation Insurance Insurance Company Name P . Workman's Comp.Policy# �1.� 1 Copy of Insurance Compliance Certificate must accompany each permit. Permit Rest(check box) Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to—al,- Nk1 Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum.35)#of windows #of doors: ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Elec al&Fire Permits required. *Where required: Issu a of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: I er must sign Property Owner Letter of Permission. Home Improvement Contractors License&Construction Supervisors License is SIGNATURE: / TAKEVIN D\Buil.ng Changes XPRE PERNIMEXPRESS.doc Revised 061313 - Ilk WANStnats. 639. Town of Barnstable Regulatory Services Richard V.Scali,Interim 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 �Y Prop a Owner Must Complete and Sign This Section If Using A Builder 010 e fq\1-5 as Owner of the subject property hereby authorize-�m At to act on my behalf, in all matters relative to work authorized by this building permit application for: (Address of Job) Signature of Owner Date Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. TAKEVIN Muilding ChangesTXPRESS PER rEXPRESS.doc Revised 061313 Client#:16665 2MEAGHERC0 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) F612912015 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 endorsemengs). PRODUCER CONTACT Dowling&O'Neil PH"N ,508 7754620 AfC,N.:5087781218 Insurance Agency EMAIL ADDREss 973 lyannough Rd., PO Box 1990 . Hyannis,MA 02601 INSURER(S)AFFORDING COVERAGE NAIL II INSURER A:National Grange Mutual Insuranc INSURED INSURER B:Associated Employers Insurance Meagher Construction Inc. Timothy Meagher INSURER c: 776 Main Street INSURER D' Osterville,MA 02655 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. ILNTSRR TYPE OF INSURANCE ADD UB POLICcY EFF POLLI�CY EXP INSR POLICY NUMBER MIDDNyynMIDD LIMITS A GENE LIABILITY MPT125OG 1011612014 1011612015 EACH OCCURRENCE $1 000 000 X COMMERCIAL GENERAL LIABILITY DAMAGE jO�tENTED R MI E Lao occugence $50O 000 CLAIMS-MADE 51 OCCUR MED EXP(Any one person) $1 O 000 PERSONAL&ADV INJURY $1 0009000 GENERAL AGGREGATE $2,000,000 GEN`L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED - PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY WCC5050054422015A 0612312015 06123/201 X WC STATM"TU OT}I ANY PROPRIETOR/PARTNER/EXECUTIVE YIN E.L.EACH ACCIDENT $100 000 OFFICER/MEMBER EXCLUDED? a NIA (Mandatory in NH) E.L DISEASE-EA EMPLOYEE $100 000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 7TT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the coverage provided by the policy provisions. CERTIFICATE HOLDER 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 Met ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 1 The ACORD name and logo are registered marks of ACORD #S153340/M153339 CBD t. . The Cou nromwealth of Massachusefts Departownt of Industrial Accidents Office of Investigations 600 Washington Street ,1 Boston,M4 02111 tvmnrnass.govldia Workers' Compensation Insurance Affidavit HmlderslContractorslEIectricianslPlumbers Applicant Information Please Print Lembly Name MusmessfOrganizatimUdivedad):_ Address: City/State/hp: \ Phone i# -�- Are you an employer?Check the appropriate box: Type of project(required): 1.41 am a employer with ,?) 4. ❑ I am a general contractor and I employees(full aadlorpart-xime)_ : have hired the sub-contractors 6. ❑New conduction. 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 working for me in any capacity. employees and have workers' [Na workers'comp_incii►a'nce comp.iusurance. 2 9. ❑Building addition required-] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 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 mod)I c.152,§1(4),and we have no employees-[No workers' 13_❑Other comp.insurance required-] _Any applicant that checks bm*1 moot also fill out the section below showing their workers'compensation policy informstion Homeowners who submit this affidsn-ir mdirating they are doing all wo*and then hire outside contractors mmst submit a new affidark indicatimg sash. =Contractors that check this boa must attached an additional sheet showing,the name of the subtonuactors and state whether or not those entities have employees. Ifthe sub-contractors have employees,they must provide their workers'comp.policy m®ber. I.am an employer that is providbW workers'compensation insurance for ut<y enrpinyeesL Below is thepoticy and job site iriformadon Insurance Company Name: )�jL'� Policy#or Self-ins-Lic_ ,�, Facpiration Date: ess (;Job Site Addr 1 t S'I t L Ntl �y'� City/State/Zip: V_/U Ay TV 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up#o$1,500.00 and/or one-year imprisonment as well as civil penalties in the forth 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-fyr insurance coverage verification. d do hereby ce fy tin ere pains and penalties of perjrrr}thattlre infomtation prorRded o �e i true artd correct Signature- Date: f Phone#: Official use only. Do not write in this area,to be completed by cif,or town o f'rciat City or Town: PermiitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.CitytTown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 9 Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-102260 MICHAEL S MEAtFllk— 97 EMERALD LANE14 Marstons Mills MA 028 ' i )rW Expiration Commissioner 11/05/2016 ,A �e �oancnyaMacaeall�a�C�/l/luaJac�uaetGt Office of Consumer Affairs&•Business Regulation t . YOME IMPROVEMENT CONTRACTOR registration 162938 Type: Expiration:: 4/_27/207L DBA t MEAGHER BROTHERS CONSTRUCTION k MICHAEL MEAGHER,-JR x�€ . 97 EMERALD LN MARSTONSMILL,MA 02648 Undersecretary 4. 0 use op�y f `va`��a�tnto• �t`op ' e�`StCat`o aatealava�vs vess�e� se of C i<at�0 `eev a" 1� tb o 5 s b f 0 a � 00Qeatkyta��'L ;6 tk Unrestricted-Buildings of any use group which contain less than 35,000 cubic feet(991M )of enclosed space. 1 " i. i r Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. t www.Mass.Gov/DPs For DPS Licensing information visit: