Loading...
HomeMy WebLinkAbout0037 SIMMONS POND CIRCLE t i a- r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel Application # ' Health Division Date IssuedA �`��/7Conservation Division �, Application Planning Dept. tw iPermit Fee Date Definitive Plan Approved by Planning Board , ®�� ®� ' Historic - OKH _ Preservation/HyaWiis ' ®� gP Project Street Address C, 4"49 JR Cr I C Village Owner V/01L% Address 5� � Telephone 77c, _G C Z Permit Request J&/f st S.1 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 LY'_ 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 Mike McCarthy Construction Telephone Number po Box 52 Address West Dennis, MA 02670 License# Cell (568) 280-6964 CS1,_�9633 HIC-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �- Y, c v SIGNATURE DATE II I j FOR OFFICIAL USE ONLY APPLICATION # DATE ISSUED i, } 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. 0� RISC ENGINEERING OWNER AVTHORIZAT8ON FORM I, Z �11 t- /'Z GJ.Sa r,j (Ownees'Name) ' d owner of the property located at. �j <<YIN10et/ Ocn% . C�2C (Property Address) ' Nis . NA ol (Property Address) ' hereby authorize (Subcontractor) ' an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. Owne s tigna, e , ' Date 1 I RISE.Engineering 6 Dupont Avenue South Yarmouth, MA 02664 f f Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 } i Type: Individual 'Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY " MICHAEL MCCARTHY - P.O. BOX 52 WEST DENNIS, MA 02670 Update Address and return card.Mark reason for change. scni 0 20rn-05m Address Renewal 0 Employmentj Lost Card _______..----------_.------------- --- . 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: UEVRegistration: ;.`16 9393 Type: Office of Consumer Affairs and Business Regulation xpiration`-=_6I312047 Individual Boston,MA 02116 10 Park Plaza-Suite 5170 MICHAEL MCCARTHY_- ., MICHAEL MCCARTHY = �( - F 6 RANGLEY LN. SOUTH DENNIS,MA 02660' Undersecretary Not lid with t signature e Massachusetts Department of Public Safety ®" Board of Building Regulations and Standards License: CS-058633 Construction Supervisor + 4 MICHAEL J MCCARTHY:: P.O.BOX 62 WEST DENNIS MA 026T0 # aSIR 1 ^^^ Expiration: `ommissioner 04/10/2018 The Commonwealth of Massachusetts, = r' Department oflndustrialAccidents • I Congress Street,Suite 100 Boston,MA 02I14-2017 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. t T.O,BE FILED WITH THE PERMITTING AUTHORITY.. Applicant Information Please Print Legibly Name (Business/Organizatiodfndividual): Mike McCarthy Construction Po Box 52 Address: West Dennis, MA 02670 City/State/Zip: Cell 08)#280-6964 AV SIC-169-393 Are you an employer?Check the appropriate box: Type of project(required): 1.�am a cmployerwkh employees(full and/or part-limc).O 7. New construction 2.❑I am a sole'propricior or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 3.OI am a homeowner doing all work myself.[No workcrs'comp.insurance required.)t 9• ❑Demolition 4.❑I am a homeownerand will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers"compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 5.❑i am a general contractor and T have hired the sub-contractors listed on the attached shut. 12.E]Plumbing repairs or additions These sub-contractors have employees and have workers'comp.Insurance.$ 13.❑-/Roof repairs 6.❑We arc a corporation and its officershave,exercised lhcirrightof exemption perMGLc.. 14.1_�JOtber �✓C.f1�,,«/1,` 152.§1(4),and we have no employees.(No workers'comp.insurance required.) •Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy informalion. t Homeowners who submit Ibis affidavit indicating they are doing all work and[hen 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 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. � .M Insurance Company Name: Aj / 1 ,,A— ,i --i,,� o Policy#or Self-ins.Lie.#: ( G V761Sb -D`'ui6-A Expiration Date: )2 '1h- '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 Ofice of Investigations of the DIA for insurance coverage verification. I do hereby certify under t a' s enalties ofperjury that the information provided above is true and correct Si ature: Date: Phone#: L:sc k) mac -C VC Official use only. Do not write in this area,to be completed by city or town officfat 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#: l MCCART9. OP ID: KS ACORO° DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1 12/20/2016 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 endorsements. PRODUCER CONTACT Dennis Office Bryden&Sullivan Ins Agency PHONE FAX of Dennis Inc. c .508-398-6060INC. NC No): 508-394-2267 485 Route 134,PO Box 1497 E-MAIL So. Dennis,MA 02660 ADDRESS: Dennis Office INSURERS AFFORDING COVERAGE - NAIC# INSURER A:National Liabilit &Fire Ins INSURED Michael McCarthy INSURERB: Construction Inc , PO BOX 52 INSURER C West Dennis,MA 02670 INSURERD: F INSURERE: INSURERF: 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. INSR TYPE OF ADDL SUER _ POLICY EFF POLICY EXP - `,.LIMITS LTR POLICYNUMBER MMIDD MMIDD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREMISES Ea occurrence $ -DAMAGE TO REN D MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: ; GENERAL AGGREGATE $ PO- POLICY JET a LOC . :PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT- $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALLOWNED AUTOS AUTOS SCHEDULED BODILY INJURY(Per accident) ,$ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ - $ WORKERS COMPENSATION X I PER STATUTE OTH AND EMPLOYERS'LIABILITY ER A ANY PROPRIETOR/PARTNER/EXECUTNE Y/N V9WC747574 12/15/2016 12/15/2017 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? Y❑ NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMB $ •1,000,00 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Michael McCarthy has Opted to Exclude himself for Workers Compensation benefits. CERTIFICATE HOLDER CANCELLATION CAPELIG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, ,NOTICE WILL BE DELIVERED IN Cape Light Com pact ACCORDANCE WITH THE POLICY PROVISIONS. Box 427 Barnstable,MA 02630 AUTHORIZED REPRESENTATIVE �� Q ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD l P�oFt rOw� Town of Barnstable *Permit# Expires 6 months from issue date snaxsrnBi.E. : Regulatory Services Fee v� , ,. ,0� Thomas F.Geiler,Director A'EDN1A`p Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis,MA 02601 Office: 508-8624038 - Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number_ 1 Property Address . 3 q S o-r-ra .Residential Value of Work or6000 Owner's Name&Address Kl CA"CQ Contractor's Name !4 Ckl✓ Pl� Telephone Number Home Improvement Contractor License#(if applicable) Construction Supervisor's License#(if applicable) Q M.Workman's Compensation Insurance c p ' Check one: y� PQ�SS ❑ I am a sole proprietor ❑ I am the Homeowner �.I have Worker's Compensation Insurance cj-( . OwN�� BARN Insurance Company Name ` Workman's Comp.Policy# ! X��12 Z Permit Request(check box) '$ , �Re-roof(stripping old shingles) All construction debris will be taken.to_ l ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) ❑ Other(specify) 'Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. Signatur (�Q Q:Forms:expmtrg Revised121901 I be C) Assessor's map and lot nu'm, A 77� THE Ole zac Sewa*NPermit number .............. ................................ 33AUSTAIL H61use number .................. ................................... MASIL t639- a MIAR TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ............. ... ........................ ................................. TYPEOF CONST Zic,—T i V..................... ................................................................................ -/..........19..0. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:;;, Location ..... ........................ ....... x .. ...... Proposed Use ............. .................. Zoning District .......... ....................................Fire .1............................................................................. .. ..... ........... .......... ... ......................................Fire District ......... �/z .... .............................................. 7 C��Acldress ...1K.', 1 6 Name of Owner ......... r--,C,.- ........ Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ...................*,"**"",*,*,"***,*","*"'I.................Foundation .............R.............................................................. .Exterior ..............4-J1. .....cc� ..............................................Roofing ................1?,(A-,;7 ......... ............ 4r4Floors ............K7. .................................................Interior .......................-).......... ............... Heating ............ .............................:.......................Plumbing /............... ................... ................. Fireplace ..................... 76 0:�2...e.........................................Approximate. Cost .......................... .................... Definitive Plan Approved by Planning Board --------------------------------19--------- Area C,............. Diagram of Lot and Building with Dimensions Fee ............................................. SUBJECT TO APPROVAL OF BOARD OF HEALTH ,tir3 7 e, OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. ,............... Construction Supervisor's License NICKULAS, LARRY A= O 7 y No f One Story Permit for ............................. ...... Story . .......... ons and Circle ..... .. ............................................Family Dwelling ........... Location .... ..... ns ond CircIe ...... ............... 00 ...................�jyc_1]��s.......... ............... Owner ....Lari..y.jNickulas................................... ......... Type of Construction F.rame............................... .. ........ ............................................................................... Plot ............................. Lot ................................ Permit Granted .....Jan ry.. qj..........19 85 Date of Inspection ....................................19 Date Completed ......................................19 aw i a ors" Ti, � Assessor's map and lot'number ......... ..... ........... F THE T Ar.- p,� �t 5t3 G �O l 73 oaf Sewage Permit number .... -�� _ � �� SYSTEN's ................................ STALLED � Of•" IN Z BARBSTABLE, i House number .................. ..................................... _. . WITH TIYLE 9 NAB& . 0 L�= �lVIRO MENTA. d °moo 039'a.0 TOWN OF B-ARNSMA, #LK BUILDING 11SPECTOR _ APPLICATION FOR.PERMIT TO ............ V!/i./l. � ............ .. ./..� .......... TYPEOF CONSTRUCTION ..........:.........A.�. .... ................................................................................ ..7........ZZ......... 19.. y TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a ermit according to the following informat' � Location ..... ��.... ..... .... ..........v��. rl�d ?..Gl ?../....... ......T . ....... .. n ... C .. ProposedUse ............c.,�� ........... �!!'?z�........ ....................................... ^ ..................................... Zoning District .............�1.... ....................................Fire District ........ ..................... Name of Owner ......... Address ... e.x...s? ...............' ........ .... . � Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms ................. -..................................Foundation ........... .............................................................. Exterior ...............<N/�r...............................................Roofing ................ w. ... ... ...✓••. . .................. Q .�.- .Interior ..................... G.. ���� Floors ..�................................................ ..... ..�.�.�`C�G.(��................ r r s Heating .........�c, r—s.:.......... .......Plumbing ................... --4— ................. Fireplace ................... .......................................Approximate. Cost ...............07.6.0.0.0.................... Definitive Plan Approved by Planning Board -------------------_-----------19________. �Area ... ............... Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH j yd 3 LI OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. .... ... ......0........Nam Construction Supervisor's License aI�.z..Z.�a's.. NICKULAS, LARRY Cam` • No ..27478 or ...gPf�..�itgrY............. ............... Permit f ..Single.. Family Dwelling ...................... Location ......LOt..la.......3.7...,9lRums..PoncL.Cir(_-le ..................!Y.Clr ................................... Owner' ..... ............................. Type of Construction Fxam............................. / J .................................................................................... Plot ..................... ...... Lot ................................ L Permit Granted ......19 85 -Date of Inspection ....................................19 Date Completed Z-- 19 A - o 00 , o. M : ., , s+ 0 3 40 T� N (V'� -4.` S� M,onrs �^ CERTIFIED PLOT PLAN y F f Qom , 'ROEF4d! vj� L o r H YA NN I &f2t3 'E p w * a t v €LDRcD :v.t IN F'k 1 n u SCALES+'/'�-40' 0ATE,' l/z/��. ' GEE GI EE lNG°C .! ' /Y/cic�u+ s °_. ra CLIENT_..,, ,; 1 CERTIFYg THAT THE 96��o� x F At�:19TERE0 REOISTEREQ ;;$MOWN ON';'TN;19: PLAN .IS LOCATED h : { d0>3Y N0 ",W THE GROUND, AS INDICATED h,; CIVIL i' LAND CONFORMS;`kT.O: THE ZONING L'A E y ., ENGINEER SURVEYOR OR.Sir "/G ' pF BARNSTA®L , MA88 ' A �Yf 712 'M A I N S T R E ET CK 8Y!.,.�,.,�..,.�,� ,� �ELT °Y SHE `'��� .. z: ?� "6r. ;. .� +,•q+r s r,`• ,E a t .�, ,t sta �..t f �^� r �P° `•e TOWN OF BARNSTABLE " BUILDING DEPARTMENT 'r 2 saaa�r : TOWN OFFICE BUILDING 039. HYANNIS, MASS. 02601 �o r�r►• e MEMO TO: Town Clerk . I FROM: Building Department DATE An Occupancy Permit has been i ssued for the building authorized by "r '� f, ` Building Permit. $k........._„....... .....�...�........_..,__... .............................._.....,..w.._......._..»......�...�.....».�....._.. issued to ............ t „..... ............. Please release the performance bond. ' t •TOWN: OF. BARNSTABLE ' Permit No' 2.747$ Building Inspector Cash `. OCCUPANCY PERMIT I ------- -- Bond Issued'to Address Larry Nic'ul.as` ,Lot,rl $,� -3,? Siminoms'-pond Circle,' .Hji riinis Wiring'Inspector ,.ii ,�."'a..,-�.:'' Inspection date g Plumbing Inspector :% �"'~ j\��y : Inspection date Z Gas Inspector s 9 r.�e '�.� Y-. Innspection date y A 11C.cS S..®-n--,rr •t1i1 r X Engineering•Departm"ent ,* ° y�r�' s a: Inspection date' j mod. �. t'#:,. �yr�/. s.v'" �. Board' of Health /"' }` '�. t/v+r{�liv Inspection date -`p THIS.'PERMIT WILL NOT BE VALID, AND;THE BUILDING SHALL NOT :BE OCCUPIED UNTIL .SIGNED BY;THE 9 BUILDING• INSPECTOR. UPON.. SATISFACTORY.,COMPLIANCE^WITH TOWN.• REQUIREMENTS;AND IN -ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUS,ETTS"STATE-,," BUILDING CODE. 9' Building...Inspector