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Home My WebLink About0026 SECOND AVENUE (HYANNIS) co 5 e c��n c�_ ►'�ire, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel ymrl OF B R SIT L F Application Health Division Date Issued � �i ,j Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board ' (# Historic - OKH _ Preservation / Hyannis Project Street Address � vt i Village Owner Svs... �� Address S«` Telephoned Permit Request 7 Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation (g Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting documentation. Dwelling Type: Single Family GY 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 ❑ 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 ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) - Name Mine McCarthy Construction Telephone Number ox Address West Dennis, MA 02670 License # Cell (508) 280-6964 CSL-58633 HIC-169393 Home Improvement.Contractor# Email Worker's Compensation # ALL CONSTRUCTION DETIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO � SIGNATURE DATE 4 FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. F ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. z� of roy� Tdwn of Baraastable o� Regulatory Serynces s�exstnut� Richard V.ScAi,Director ,r Building Division Tom Perry,Building Commissioner 200 Main Street,Ilywun s,-NIA 02601 w►r•w.town.barnstabte.m ms Office: 508-862-4.038 par.: 508-790-6230 Property Owner Must Complete and Sign This Section If Usino, AABuilder jCA,t A. UdVtC— L4k as Omler:of the siibject property hereby authorize, _ cas+l-tj S�Yv -to act;ou mybebalf, in all matters relati!c to work autl,onze y this building pemut application for: (A.ddress ofjab), i Pool fMeeS and alarms are.the iesponsibilkyof the applicant. P001s are not to be filled or uul ed bef ore"fence is lmtalled and all f nJ impecti ns me performed and accepted._ a Signatur 0,9;mer Signature of Applicant g unt Name Print Narxu Date � I E• Q:FORMS:ONt')QFRPF-R IJ5Sl0.NPOOLS I :7 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCC �R PO BOX 52 s W DENNIS MA t 67 Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Buslness Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C6ntfactor Registration —' Registration: 169393 -- Type.- Individual Expiration- 6/16/20 7 Tr# 264961 MICHAEL MCCARTHY rr = MICHAEL MCCARTHY P.O. BOX 52 - WEST DENNIS, MA 02670 -- ''s r` — - Update Address and return card.Mark reason for change. - Address ❑ Renewal Employment ❑ Lost Card 20M-05/11 The Commonwealth ofMassachiisetts Department oflndustrialAccidents I Congress Street,Srrite 100 Boston,MA 02114-2017 www tnass.gov/tliq Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Phimbers. TO BE FILED WITH TILE PERMITTING AUTHORITY. Applicant Information Mike ,.T_e -4e..__ Go etion-Please Print Leeibly Name (Business/Organization/Individual): PO Boxj2 Address: West Dennis, MA 02670 City/State/Zip: CST.-580A a PIC-169393 Are ym an employer?Check thew propriate box: Type of project(required): I. m e 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.] 9. 0 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10❑'Building addition 4Q 1 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 I L❑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. 13.[]ROOF repairs These sub-contractors have employees and have workers'comp.insurance.t 6.O We are a corporation and its officers have exercised their right of exemption per MGL c. 14.dOther 152,§1(4),and we have no employees.[No workers'comp.,insurance required.] •Any applicant that checks box#1 must also fill out thesection 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. lContractors 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-contractors have employees,they must provide Their workers'comp,policy number. I am an employer that isproviding workers'compensation insitrance for my employees. Below is the policy and job site Information.Insurance Company Name: A-I/ rp� M, 4"( T"'. Policy#or Self-ins.Lie.#: V�L'bo'6�i 7�s6' 1`( � Expiration Date: h� A 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 requited under MGL e. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,asmell 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 rto hereby certify un t/ al snail pities rjury that thei informntion providers abo a ii true and correct. Si nature: Date: 7/I 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATTIIIQ'PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800.)876-2765 NC61 NO 26158 POLICY NO. I VWC-100-6017656-2014B PRIOR NO. I VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P 0 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, includingall endorsements is hereby countersigned b �— � � Y 9 Y 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, used with Its nermission.