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HomeMy WebLinkAbout0060 SECURITY STREET Cow,� S e c�-� � �5►f--- - _. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 7'� Map. Parcel if q q Application # Health Division Date Issued '7 L-7h 6 Conservation Division Application Fee Planning Dept. Permit Fee U� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis r/►"'�/�T� S C�T Project Street Address Village Owner �,J. eft Address Telephone Permit Request -)o ��9��1��.� caw I S4 r r µ-' C' Square feet: 1st floor: existing proposed 2nd floor: existing proposed TotafPew Zoning District Flood Plain Groundwater Overlay N' ' Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach suppprting docurn tion. CD Dwelling Type: Single Family 211' Two Family ❑ Multi-Family (# units) `' m 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) 'F Name Telephone Number i e c a y Construction Address PO Box 52 License # West Dennis, MA 02670 Cell (508) 280-6964 Home Improvement Contractor# CSL-58633 HIC-169393 Email G Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE ! b-i ��t FOR OFFICIAL USE ONLY, APPLICATION # DATE ISSUED. MAP/ PARCEL NO. 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. -tn �V'4, I Town of Barnstable. Regulatory Services " Richard V.Scali,Director Building Division Tom Perry,Building Commissioner s 200 Main Street,H)wnis,NLk 02601 «�w.to�vo.barnstable.ma.us . Y Office: 508-862-4038 Pax: 508-790-6230 property Owner Miz t Complete and Sign This Section. if Usn�ABuilder I, t 1 I(•0 VY L �.6 V ,as Owner of the subject propty hereby authorize nQAw to act on mybehA in all.matters relative to work authorized by this building permit application for. (Address of job)'. , Q �,G 0 ""Pool fences and alarms arie the, responsI l Ly of the applicant. Pools are not to be filled or utilir_ed before fence is installed and all fina1. ' inspections are performed and accepted- MIJL,7�- X, CZL S'i of Owner gnatiue Signature of AppLcant L Co fit: Print Name Print Name Date Q:F0nIS:0NNW FR1d1SS10NP001S Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C r ctor Registration -—= Registration: 169393 _ Type: Individual Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 - — WEST DENNIS, MA 02670rt 11 '_-;•,;:' Update Address and return card.Mark reason for change. -- Address Renewal U Employment Lost Card SCA 1 Ca20M-05/11 (9.71 TparyrUl9?.a9?1WeC11 i2 6197r/.CIgJCLCtL meted Office of Consumer Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: ;x9393 Type: Office of Consumer Affairs and Business Regulation Individual 10 Park Plaza-Suite 5170 iratio 6�1�6/2U17 � r Boston,MA 02116 MICHAEL MCCARTHY =i ': c MICHAEL MCCARTHY ` �� 6 RANGLEY LN. SOUTH DENNIS,MA 02�60 Undersecretary Not id with t signature Massachusetts Department of Public Safety ` r Board of Building Regulations and Standards License: CS-058633 Construction Supervisor MICHAEL J MCCARTHY,_ ? P.O.BOX 62 WEST DENNIS MA 026,70 j. /(^^^ v�— Expiration: Commissioner 04/10/2018 r Tire Commonwealth of Massachusetts Department oflndustrialAccidents - 1 Congress Street,Suite 100 Boston,MA 021141-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNIITTING.AUTHORITY..., .. ApplicantInformation Please Print Le ibly Name(Business/Organization/fndividual): Mike McCarthy Construetion- ox 52. Address: Went Dennis, MA 02670 City/State/Zip: Cell 08)#280-696393 Are you an employer?Check the appropriate box: Type of project(required): l.�am a employer with !�_ employees(full and/or part-time). 2, ❑New construction l I 2. am a sole proprietor or partnership and have no employees working forme in ❑ i 8. Remodeling any capacity.[No workus'comp.insurance required.] El Demolition 3.❑I am a homeowner doing all work myself.(1•Io workers'comp.insurance required.]r 9. • 4.❑I am a homeowner and will be Airing contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 LE]Electrical repairs or additions proprietors with no employees. 12.E]Plumbing repairs or additions S.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These13 ❑Roof repairs sub-contractors have employees and have workers'comp.insurance. .�-�/ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.D Other 152,§1(4),and we have no employees.(No workers'comp.insurance required.) *Any applicant that checks box ill must also fill out the seclion.below showing their workers'compensation policy information. t Homeowners who subunit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. 1Contractors that check This box must allachcd 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. Belonv is the policy and job site information. ._Insurance Company Name: AM •/ t •>�c,� T,,� p Policy#or Self-ins.Lic.#: V1,✓L—7011-GG 190t Expiration Dater )2 )ir '1 C 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 MGL 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 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 under i a' s enalties ofperjury that the information provided above is true and correct Si ature: Date- Phone#: U-21 D,�Q^6 S C 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#: AC p�> CERTIFICATE OF LIABILITY INSURANCE DATE 121071DD/YYYY) 2/07/2015 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 condition!;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 JWCT Bryden&Sullivan Ins Agcy of Dennis Inc o ; (508)398-6060 No,; (508)394-2267 PO Box 1497 % SS, So Dennis,MA 02660 INSURER RDING COVERAGE NAIC III INSURER A: A.I.M.Mutual Insurance Company 33758 INSURED INSURER B• Michael McCarthy Construction Inc INSURER P O Box 52 INSURER West Dennis, MA 02670 INSURER 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 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. ILTR TYPE OF INSURANCE 1 SR POLICY NUMBER MM/D (ANSYN% LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TSIFO RENTED $ P MIS CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ OLICY E�- OC COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Me $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) UMBRELLA LIAS OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ �'I�d �i���C ll4f4 X -IAMA,S OR R Y/N E.L.EACH ACCIDENT $ 1,000,000.00 A AONYIPROPRIETOR/PARTNEWECUTWEa N/A VWC-100-6017666-2016A 12/16/2015 12/15/2016 E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 (Mandatory in NH) t�� DESCRIPTION I&ERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION Cape Light Compact PO Box 427 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Barnstable,MA 02630 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 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Zee Parcel ( T7 Application # 0)0 /S_0 -3 y Health Division Date Issued — I Conservation Division Application Fee Planning Dept. Permit Fee '00 Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address K0 Village Owner Address c Telephone !SZi— 770-1*7 Permit Request vj.e -I— (d,, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Construction Type 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 ❑ 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:_%I = Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# :Z G� CAD Current Use Proposed Use ICU APPLICANT INFORMATION - -- (BUILDER OR HOMEOWNER) Name _ 4ike A4„Car-t y Const-nneflon Telephone Number PO Box 52 Address M 2670 License # West Dennis,Cell (508) 280-6964 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE C Ir A T_ FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ?R ADDRESS VILLAGE OWNER DATE OF INSPECTION: 4~ FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. I i Stla-7SG-�y t7 Town of Barnstable Regulatory Services WASS Richard V.Scali,Director ' 63 Building Division Tom Perry,HuBding Commissioner 200 Main Street,Hyannis,VIA 02601 www.town.barnstableina.us Office: 508-862AO38 ' Pax: 508-790-6230 Property Owner Must C;ompletc and Sign This Scction If Usimg.A Builder 1,lt//1, Ila04 a L-- as(hurter of the subject property hereby authorize. I GrA to act on my behalf, in all matters relative to work autho l by this building perniit application for: R --sT ,9q_ty,5 1,271a 55 G AP L r / (Address of Job) *;'Pool fences and akims are the responsibility of the applicant. Pools -,are not to be filled oruLdized before fence is installed and all final inspections are performed and accepted. a Si�,nature of weer Signature of Applicant Print Name Print Name Date Q:FORMS-OvvNTRP£RMISSIONPWLS •Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 ' MICHAEL J MCC_AR PO BOX 52 W DENNIS MA 8267 ilk Expiration Commissioner 04/10/2016 i Office of Consuiner Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration:, 169393 Type: Individual ExpJ ration: 6/16/ 017 Tr# 264961 MICHAEL MCCARTHY # 43f MICHAEL MCCARTHY P.O. BOX 52 / WEST DENNIS, MA 02670 f Update Address and return card.Mark reason for change. Address �� Renewal , Employment '� Lost Card 20M-05/11 The Commonwealth ofMassachnsetts Department of InllustrialAccirlents I Congress Street,Suite 100 Boston,AfA 02114-2017 w►vlv.mass.gov/dia. Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pitimbers. TO BE FILED WITH TILE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/individual): Mike McCarty Construction Address: Nest Dennis, MA 02670 Cell (5 City/State/Zip: CST.- S: HIC-169393 Are yo, an employer?Check the a propriate box: Type of project(required): l.7m a employer with F employees(full and/or part-time).* 7. New construction In 1 am a sole proprietor or partnership and have no employees working for me in $, E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp,insurance required.]t 4.0 1 am a homeowner and will be hiring contractors to conduct all work on my property. (will 1.0 E Building addition ensure that all contractors either have workers'compensation insurance or are sole I I.Q Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.F]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 13.❑Roof repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.dOlher 152,§1(4),and we have no employees.[No workers'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. tContractors that check this box must attached Im 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. Inman employer that is provl(ling)porkers'compensation insurance for my employees. Ilelop Is the policy and Job site information. Insurance Company Name: br m MJ4.1,l Tn3l own Policy#or Self-ins.Lic.#: V�L�bo-6oi 7�s6�. ly Expiration Date: 1.;L Ill' )/i Job Site Address: KG 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 MGL 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 against the violator.A copy of this statement may forwarded to the Office of Investigations of the DiA for insurance coverage verification. I do hereby certify un tl a1 sand allies rjnry that the-information provider)above is tare and correct. Si nature: AV Date: (, /1— 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 ffealth 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMAT1fl1Q'PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 800 876-276.5 NCCI 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 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 INTEA 0712979 INTER SEE CLASS CODE SCHEDU E Minimum Premium $550 Total Estimated Annual Premium $29,332 IGOV GOV Deposit Premium $7,748 STATEICLASS 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 C�� WC 00 00 01 A(7-11)Includes copyrighted material of the National Council on CompensationInsurance, used with Its nermission.