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HomeMy WebLinkAbout0118 WAYLAND ROAD n � Town of Barnstable *permit# Expires 6 months jr� a date j .. Regulatory Services FeePE RMIT . 'Tho g s F:Gei1e Director JAN 2 5 2007 11u lding Division T0Vj1Aj J .` Tom Perry,CBO Building Commissioner OF BARNSTAB ,.8... . . ...200 Main Street,Hyannis,MA 02601 www,town-barnstable.ma.us.. :... ...... Office: 508-8624038' ' ` Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - .RESIDENTIAL ONLY Not Valid without Red X-Press Imprint Map/parcel Number 40 Property Address f V wC- L& "d "�n [/Residential Value of Work iniffQrn.fee of$25.00 for work under$6000.00 Owner's Name&Address &r U D—(2,- Contractor's Name Telephone Number T E* Home Improvement Contractor License#(if appli )__� 1 I`•� Construction Supervisor's License#(if applicable) __ ❑Workman's Compensation Insurance 94 one: M I am a sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must be Permit Request(check box) [E/Re-roof(stripping old shingles) All contraction debris will be taken to ICL ❑Re-roof(not stripping. Going over existing layers of roof) ❑ Re-side ❑ Replacement Windows. U-Value (maximum.44) *Where required: issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property er must sign Property Owner Letter of Permission. Hom pr emen. on ctors License is required. SIGNATURE: Q:Fonm:expmtrg Revise071405 °pIHE roy, Town of Barnstable a regulatory Services $nxraASS. nsnss. t Thomas F.Geiler,Director v �+. �A i639. �0 p 039. � Building Division. Tom Perry, Building'Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable..ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must 'Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize U� LQ to act on . Y m behalf, in all matters relative to work authorized by this building permit application for. dress of Job) Signature of Own r 'Date ��:r�1 f 1YW QQd Print Name Q TORMS:OWNERPERMISRON r . Board of Buildin g Regulations and Standards HOME IM License or registration valid for in ' P,ROVEMENT CON License Reglstratio efore the expiration date. If found use only tEat ]Board of Buildin d return to: l= 4 007 g Re ul •I„ �.�'� - ;� One Ashburton Place ations and Standards Y' �Mdual -�' B Rm 1301 Ames Cu —�^ I oston,Ma.02108 rley s Imes CurleyG" ?% 17 Fuller Rd. >\ - mterville,MA 02632~ + a �-- Administrator Not valid without signa ure 1 i r r �\ 1 he u-ommonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations, ' a 600 Washington Street Boston'.M4 02111 www.mas&gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legjbly Name (Business/Organization/Individual): qvml-s Address: City/State/Zip: VfF olzu 0 I Phone#: Are you an employer? heck the appropriate box: Type of project(required): 1.❑�Zi:yete:e (oyerawndi'/hor l 4. ❑ I am a general contractor and I 6. .❑ New constriction part-time).* have hired the sub-contractors 2. I am a sole proprietor or partner- listed on the attached sheet. t ❑ Remodeling ship and have no employees These sub-contractors have Sm. ❑ Demolition working for me in any capacity. workers' comp,insurance. 9, ❑ Building addition [No workers' romp.insurance 5• ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself.(No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. (No workers' 13.❑ Other comp:insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: j t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their worker;'comp,policy information. I am an employer that is providing workers compensation insurance for any employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. #: Expiration Date: 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Offree of Investigations of the DIA for insurance coverage verification. I do hereby certify under a ains and penalties of per ury that the.information provided a ove as true and correct Signature: Date` Phone#: f Official use only. Do not write in this area,to be completed by city or town officinal. City or Town: FermBit/License;#. Issuing Authority (circle one): F 1.Board of Health 2.Building Department 3.City/Town Clerk e.Electrical inspector 5.Flumbina Inspector 6. Other i Contact Person: Fhone#: w Town of Barnstable *Permit# �.� Regulatory Services >Fees6monthsfr sue DAMSMBGE, ' 7 y MASS. Richard V.Scali,Dir r qje i639• f� lEv t�xl' Building DiTsg� fd'1 , Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA CY 120 H www.town.bam A a.us Office: 508-862-4038 ��� - Fax: 508;790-6230 EXPRESS PERMIT APPLICATION - RESIaf _NLY Not Valid without Red X-Press Imprint r Map/parcel Number � - � Property Address Residential Value of Work$ ^], boo Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 1,1. P\ Contractor's Name .�L dIy J 61AJ Yom F 'T M n Telephone Number �0 �/ 5 0� S � 7 S 2 Home Improvement Contractor License#(if applicable) f O 01 Email: Construction Supervisor's License#(if applicable) d ? s 3 ❑Workman's Compensation Insurance Check one: I am a.sole proprietor ❑ I am the Homeowner ❑ I have Worker's Compensation Insurance Insurance Company Name Workman's Comp.Policy# Copy of Insurance Compliance Certificate must accompany each permit. Permit Request(check box) ❑ Re-roof(hurricane nailed)(stripping old shingles) All construction debris will be taken to ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ® Re-side Replacement Windows/doors/sliders.U-Value ( (maximum.32)#of windows #of doors: �. *Where required: Issuance of this permit does not exempt compliance with other town department regulations,i.e.Historic,Conservation,etc. ***Note: Property Owner must sign Property Owner Letter of Permission. A copy of the Home Improvement Contractors License&Construction Supervisors License is required. SIGNATURE: Q:\WPFILES\FORMS\building permit forms\EXPRESS.doc 01/25/17 Th�Cmmorrfvealth ofMarsadr=effy ; 600 Mashhwwn&reel _ Bastin,M4 02HI impm- me mgop/dfra . Workers' C<Qnxpensaf itm Ins=ce Affidwvit Raft& (Cunt2ctFrSM ' "�ombers AppUcan#1TEfQ=2f DU Please Prfid Ad&e= 3" CA J 6,1�11 w d�C Are you an employer?:Meck.the appropriate bom Type of PM'ect(requireo- L❑ I am:a employes wffi 4 ❑I am a geu-erd coLtmctor and I 6. ❑ldew conztwfon employees(fall andfor par-ime)* 1mvehiredifie sdb"camhactars 2.f�-I am a sole propa-etor orp= tm r- 1 sfed On the attadted sheet 7- ❑Remodeling, ship and have no employees These mb-cantractam have g_ ❑Demolition' wad3ag for me in any rapacity_ employees and1=e wadmrs' 9..L]Rut3diag addition o searbers'canzp_ t< camp-n, .�„ # -1 5.❑ We are a coaporaftan and ifs 10.❑Electrical repairs or a,dddians 3-❑ I am homeowner doing&U wm k cffcers have exel-cTsed their ' ILL]Plnmbimgrepaim or addifiaas , a wadmrs' of em=pfiaa per IMGL �€[No - c. i sudwefia�ema l� Loaf • istsam=regaired-1 i �' § M 13.0 Other ea4doyem[Na cam.in=ance require al 'Asp8pgg&csmtfi%attbedsb=#lmastalsoMcati esectianbeLawshavdag►`he¢u;aderecmqpemuLf,:•peyegiafnsms6mL #ff�meovra� o s iris�a >a cz g 6�ey sa±aaio�age i&�ea}�Se c �cma submit saewaffi 1=ft;m sudL $ztA-V 1h[s bmx mast— mr.addifimW sheet d=d=g the aameof the zd stMEMwhether anwtlhuse emi ieshm eaxgl es.Iftlses&t sha�e�pIoy�s,tfieY� psavidethek W0d—'CMZp•PQRqam3bex. lam an eaiFIa�sr flint u prvuiriirrg tverkers'caaa�erasrdtora g�suraz3ca jnr�;�emPfn3�ees; $�Inav is�TtaPa�cF rusd job she ��ormatr'nu. ' TrsumamCa pzayName: " Policy Al'cr Self-ins.Zic.4k F�piratiauDafe: Job Sif�Address: CifylSfaterzip: AEfach a-mpy of the workers'comzpensatianpoUcg decIaratiant page(showing the policy nzmber and emphation date). Failure to secure coverage as required uader Sec€i n 25A of MjGI.a I5Z caa lead to the imposition Qf MM;,nal peua*es of a fine up to$L540 OU asdfor osia-yearimpFisonnent as well as civil,peaalges is the fnm of a STOP WORK ORDEIRand a fine of nplo MM a day against the violat=- Se advised ffiat. a copy of this sent snag be fozwarded to the Of5m of lwvestegaiaians office DIA far finurance coverage sum.. Ida leretry cedf#ywu1zrdwpdhsandp&naW=afrer,jurp thattfis rqfbr=mEivupmi&dabvm is tram and em7ed Date- Ph=ik- �C)� � � Y Qffdd use a* Do rust wi&in f b mm-4 to be txneip&Mff by eiip arrtairn ojorerat City or Town: PrrrrcitlTar.•crce A u�v ci rJe Ong Iss�g �� 1= L Board of$eat MBuffirmg Depart ma d I Eff jf Town Clerk 4.Electrical Inspector S.Pl mbing Emspector 6.Other ckm act Person: Phame#: t ormation and Tastruction.s ��sa•- *�e#�s Goal Ia4es chapter 7�Z rega�es all m�e��compCQSZ"M fs$i - ea employees - P l im stat2t"as mgr&gyw u defied as= `T,.�,CMev=y"�•",`person" m$le scrvi.m of anatl=der eay c��t of3aae, =q rCM or fiaP3ie4 Oral or wIft=" errgslayer is de=fined as"aa fiexvic!nA per,assodBtion;cmPOon m affier legal=± ar gay twom of the fOregniag���aJ� �������� - of a drxeased eatplopr� x eceivm Qr tras of an indrvidnal,per.msociaiion ar ofher legal eatty,employing Ca33ploYer- Hawever ffie owner of a.dweMEghausD bzvingnotmorm tban Ib lee apmtac ts Eadwho resdesth orthc occapa33t oftbe- dweMng house of der who emgIops Peasoas to do maims cc,camshudioa or teFair wadr-on such dweMag hamm 5ierein sbaHnotbecm=of sash emplaymcatbe deemedto be an employe-" or oa t�grounds or b¢n7dmg appurtua� • 25 also stdzs d3±¢every sf tin or Ioca.I�at e ShaII withhold ffie issues ce or MCA cUsptPa I3Z,§ C{6) renew j of a license or permit to operate a bashLem or to const mrt bmZdfags is ffie Comm anwealffi for any applicant-who has notprocl=ed acmptable eviidenca of cnmpH=mwim ffm hsurance.covexzge regal �7donanV,MGI,cbaptsr L52,§25CM states=T�ffie _ nrlr 9[y ofitspol al subfflvisiOas shall enf�r inn any comfnact for the perfomnce;ofpnblio wcaim n a.c=ptable evld==of compliance with.fie msnraa= regrza-eo=L s of this chap e:rhave beenp=CEtE'dtn ffie eonractmg az OzhY a Applicants ' Please fili oA f3j-,wod=s'compeasatinn affidavit completely,bychocj3ngt=bo=that apply tO your sitak=and,if necessary,supply s)name(s), adtiress(es)�phanernmber(s) alongwrt ffiC r=tifac�(s)of msn¢izce. Limit$d Liao t Compames gj-C)or LimibedLbbiiMT1"exi ships(LLP)�eifb nw empInyecs oti�r than tha menbers Or posy are uat req�ed to�y waxlcc&camrpensafiau-�"g7Ce If as T LC or P.LP does have employees,apoliey is regaiit4 Be advisedth ttbis affi,daVkmaybe mbmatndtn tbaDepmfmcat of Iudas[rial A.ccid= s for confnznafnn of insarm=coverage. Also be sore to sign and date the af-xdaYit 'Ilse aidavit should beretunedtoibecityortown•ffid the apPlicafan for ffiepem35Eorlicenseis being requested,not ffieDepart edof IndastaBI 14 Daid�- Shaddyou bave any gaesdOns rega�g th a law or$you are regairedtn obtaiiL a worio�s' =MpensationpDHCq;please call ffie,Depmtncm±attberarmberhst:dbe.Io'w. Self-msmedcampanimshaalctmterthair self b sar—.ce Hc=se number on the 2q p Tine. City or Town Offidais _ Pleasebesore theaffidavitis comple#eandpii�dle : TheDe-parhncmthaspm4idcd2.sPace atthebottom of the affidavit fur you to fib out is ffie eyeat the Offi=of Invcsd9afl=has to comdac-byamreg-rdmg tILM applicant_ Pleasebeszsefflfllintlicpe lliceasemnnberwhichwdlbeusedasareax==nomber. Iu-addidon,anapplicM± ffiat must sabnt mulple paat[Ti muse applitafiams is auy given.yea need only sabot one affidavit Md3r atmg eaa�t policy mfo mation Cnf n=s-sny)and undea-lob Site 1s�i Jim applieartst shovId vrd=6aII.l mbOns in-(cry or town)„A copy of thoeffidavit at has been offficially stamped er mazes--d by fie cry cr tO may be providcd to&e ' applicant as prop-ftlnat a valid affidavit is on file for Rdnx pmmiI3 or Hc=m A new affidavitmusb be fiIled ovb each year.*Where ahome owner or ciCumis obiai sing alicense or perm.itnatrelatedin mybusin=or commezcial Cie.a dog ROM=orpe®.it to bum leaves ef�--_)said pemon is NOT=gairedto anmplefe ffiis affidavit The Office ofInveslig wouLilx�to�kyoumadvm=foryour coopeaaiianand sbotzlldyoathave anyquesttOas, please do not hesitate to give us a eaIL Thy DI epattmeat's ad&css,tnlepb=EEad f3zrmmbez - . . • _ � of jt�-c1� . - . ant ciflud>�ialAts • Ta#617- -4 = 4Q6 or 14 MAMPE Fax#617 727-7749 Revised 4-z4--0T - gu--gam r ToWn of Barnstable Regulatory Services VIAM Richard V.Scab,Director - '� Building Division. Paul Roma,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.mans Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder as Owner of the subject property hereby authorize `_L. to act on my behalf in all matters relative to work authorized by this building permit application for l� CA,14 y 1-A'J D (Address of Job) **Pool fences and alarms are the responsibility of the applicant Pools are not to be filled or utilized before fence is.installed and all final inspections are performed and accepted. S ture-of Owner... Signature of Applicant Print Name 5L* q5q,�q Print Name 1 Date QFORMS:OWNERPERWSSIONPW S Town of Barnstable Regulatory Services Richard V.Scab,Director Building Division n- � Paul Roma,Building Commissioner sA ¢ a�� 200-Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 HOMEOWNER LICENSE F.XEMPnON Please Print DATE: .JOB LOCATION: number street village "HOMEOWNER": - name home phone# work phone# CURRENT MAILING ADDRESS: city/town state zip code The current exemption for"homeowners"was extended to include owner-occupied dwellings of six units or less and to allow homeowners to engage an individual for hire who does not possess a license,provided that the owner acts as supervisor. DEFINMON OF HOMEOWNER Person(s)who owns a parcel of land on which he/she resides or intends to reside,on which there is,or is intended to be,a one or two- family dwelling,attached or detached structures accessory to such use and/or farm structures. A person who constructs more than one home in a two-year period shall not be considered a homeowner. Such"homeowner"shall submit to the Building Official on a form acceptable to the Building Official,that he/she shall be responsible for all such work performed under the building hermit. (Section 109.1.1) The undersigned"homeowner"assumes responsibility for compliance with the State Building Code and other applicable codes, bylaws,rules and regulations. The undersigned"homeowner"certifies that he/she understands the Town of Barnstable Building Department minimum inspection procedures and requirements and that he/she will comply with said procedures and requirements. Signature of Homeowner Approval of Building Official Note: Three-family dwellings containing 35,000 cubic feet or larger will be required to comply with the State Building Code Section 127.0 Construction Control` \ 'HOMEOWNER'S EXEMPTION ` The Code states that: "Any homeowner performing work for which a building permit is required shall be exempt from the provisions of this section(Section 109.1.1-Licensing of construction Supervisors);provided that if the homeowner engages a person(s)for hire to do such work,that such Homeowner shall-act as supervisor." . Many homeowners who use this exemption are unaware that they are assuming the responsibilities of a supervisor (see Appendix Q,Rules&Regulations for Licensing Construction Supervisors,Section 2.15) This lack of awareness often results in serious problems,particularly when the homeowner hires unlicensed persons. In this case,our Board cannot proceed against the unlicensed person as it would with a licensed Supervisor. The homeowner acting as Supervisor is ultimately responsible. To ensure that the homeowner is fully aware of his/her responsibilities,many communities require,as part of the permit application,that the homeowner certify that he/she understands the responsibilities of a Supervisor. On the last page this issue is a form currently used by several towns. You may care to amend and adopt such a form/certification for use in your community. Q:\WPFILES\FORMS\building p=it fomms\WRESS.doc 0620/16 Office of Consumer Affairs &Business Regulation-Mass.Gov Page 1 of 1 The Official Website of the Office of Consumer Affairs&Business Regulation(OCABR) Consumer Affairs and Business Regulation ' Home Consumer Rights and Resources Home Improvement Contracting HIC Registration Complaints z I, Registration# 168027 Home Improvement Contractor KENNETH KENDALL Registration Home Pape Registrant DBA CLEARVIEW HOME IMPROVEMENTS r Name KENNETH KENDALL Address 5 WELDEN PL. City, State Zip FAIRHAVEN., MA 02719 = Massachusetts Department of Public Safety Expiration Date 12/06/2018 t Board of Building Regulations and Standards License: CS-075153 Construction Supervisor KENNETH D KENDALL Complaints Walls 5 WEE'_tWPLACE " 1s- FAIRH• EN MA 02719r .: ' No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. �� �y, � Back To Search Commissio er Expiration: 01M2/2019 ©2012 Commonwealth of Massachusetts. Mass.Gov®is a registered service mark of the Commonwealth of Massachusetts. �l e�am�rraa�a�ueu`G�o��i�oac���eCt Office of Consumer Affairs&Business Regulatioa Registration valid for individual use only HOME IMPROVEMENT CONTRACTOR ::Type: Individual before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration Expiration 10 Park Plaza-Suite 5170 _ ;± !- =a68027 12/06/2016 i Boston,MA 02116 Kenneth Kendall=,- ;•:-_ = D/B/A Clearview Horne � ��D� �: Improvements Kenneth Kendall .k_.. 5 Welden PI. Undersecretary Not valid without signature Fairhaven,MA 02719 1kttn z-//qP,r,;r.Pcnra..state.ma.us/hic/licdetails.asl)x?txtSearchLN=69873 4/11/2017 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map Parcel 26 2 Application # . 3S QQ Health Division Date Issued 1 Z ? JY2 Conservation Division Application Fee Q Planning Dept. Permit Fee a .� Date Definitive Plan Approved by Planning Board G!� Historic - OKH _ Preservation/Hyannis A=-L S 6��' Project Street Address Village Owner �',�� �..r.� Address s r-� Telephone Permit Request k ` ca1-r'-,� aFi c �vY r�-I Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation Cam`' 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 Are (sq.ft) Number of Baths: Full: existingnew Half: existing UkD�e s g Number of Bedrooms: existing _new Noy 3 02016 Total Room Count (not including baths): existing new Firsloltrpraoom Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑Other 8AA1VSTA13, 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 0 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 Telephone Number Mae c a . Address PO Box 52 License # Nest Dennis, Cell (508) 280-6964 Home Improvement Contractor# CSL-5S633 Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO �j�rS �xc t SIGNATURE DATE I Ind t(, FOR OFFICIAL USE ONLY 'APPLICATION # DATE ISSUED MAP/ PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: t FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING f, DATE CLOSED OUT i ASSOCIATION PLAN NO. Arast e O~a •a., 02601 5-0 ro lice; r:. is A mattM ie1a .-ve-i o work adhot �Yffiis bici�g.pem� c{v sr p "r'' CtC)10E ES 3J1EY1Sla� tAl€'Y $ 7't .uat t Y. }ate Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 - Boston, Massachusetts 02.116 ..: . ..:. . . Home Improvement Cbntractor Registration —- - �M� Registration: 169393 Type: Individual Expiration: 6/16/2017 Tr# 264961 MICHAEL MCCARTHY MICHAEL MCCARTHY ,1 P.O. BOX 52 WEST DENNIS, MA 02670 4 4j, Q;4 Update Address and return card.Mark reason for change. -SCA 1 20M-OS/17 Address ❑ Renewal El Employment ❑ Lost Card io 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: <::1'69393 Type: Office of Consumer Affairs and Business Regulation Expiration.-__6TtQ 1-7 Individual 10 Park Plaza-Suite 5170 t a Boston,MA 02116 MICHAEL MCCARTHY._--.-- MICHAEL MCCARTHY ; NNotLNfidwith 6 RANGLEY LN.SOUTH DENNIS, UndersecretarY t signature Massachusetts Department of Public Safety �± Board of Building Regulations and Standards License: CS-058633 „• 4 Construction Supervisor MICHAEL J MCCARTHX a ' P.O.BOX 52 * WEST DENNIS MA 0267a0 ^^^ v�-- Expiration: commissioner 04/10/2018 The Commonwealth of Massachusetts Department of lndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-20I7 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant information Please Print Le ibly Name (Business/Organization/Individual): Mire McCarthy Construction OX 52 Address: West Dennis, MA 02670 City/State/Zip: Ce11 08)#280-6964 _ "IC-169393 Are you an employer?Check the appropriate box: Type of project(required): l.Plam a employer with 5— employees(full and/or part-lime).i [7. New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in S. 0 Remodeling any capacity.[No workers'comp.insurance required.] 3.E)I am a homeowner doing all work myself.[No workers'comp.insurance required.)1 9• El Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 O Building addition ensure that all contractors either have workers'compensation insurance or are sole I LE]Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.Q 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.= 13.0� Roof repairs 6,n We arc a corporation and its officers have exercised their right of exemption per MGL c. 14.13/Otber l✓C.f 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy informalion. ' t Homeowners who submit Ibis affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors-and stale 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. Insurance Company Name: 1 Q Policy#or Self-ins.Lic.#: Expiration Date: 11 4- 1 1( 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 t a' s enalties ofperjury that the information provided above is true and correct Si ature: Date: Phone#: LS-(,o 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#: s 5 DATE(MMIDDIYYYY) AC< E0 CERTIFICATE OF LIABILITY INSURANCE 12/07/2015 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(ies)must be endorsed. If..SUBRO.GATION.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 endorsement(s). PRODUCER 01962-001 CNI��ACT Bryden&Sullivan Ins Agcy of Dennis Inc e•E,d; (508)398-6060 m.No,: (508)394-2267 PO Box 1497 IMSs: So Dennis,MA 02660 INSURER AFFORDING COVERAGE NAIC q INSURER A• A.I.M.Mutual Insurance Company INSURED INSURER B: Michael McCarthy Construction Inc IN RER C P 0 Box 52 IN RER D West Dennis, MA 02670 INSURER E 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. y D Iv TYPE OF INSURANCE I SR POLICY NUMBER Mf ly ID NINI/D[j LIMITS 1 GENERAL LIABILITY EACH OCCURRENCE $ DAGERD COMMERCIAL GENERAL LIABILITY PREMI ET EaENTErrence $ CLAIMS-MADE1-1 OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ ENI AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ OLICY ECT OC AUTOMOBILE LIABILITY COMBINED acci 8D SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accidentl $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ '�'r�d���IP��i� s€Ct�A'�RgT' x Y ZN -S °��' NyPR�p��E7oR/pqRTNER/EX YIN E.L.EACH ACCIDENT $ 1,000,000.00 A oFFICERIMEMBER EXCLUDED ECUTNE� NIA VWC-100-6017656-2015A 12/15/2015 12/16/2016 (Mandatory OF in NCH)) E.L.DISEASE-EA EMPLOYEE $ 1,000,000.00 UrCRIFTION 9PERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 PROYISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD C. p l .ram ..n...e .. A OF Mks f o L ti i . 9874 o /3TE�yp� Q j No sua��' 4 3. o p 1 A ab ,�� �X X io ; .IILo11 titi �C, a L9>, °ti 20/4L N N a : . ; �� 46 47 s, F- NEE 12g . oM ioC-)cc .5.F. D-1 H : ioo ' 20 F.s. B . OWNS CERTIFIED PLOT PLAN 70 PFvvN>> Tr a fv/ ` L..D 7' 47 141,A yL r N`,� rev, I I3 e9 -7-/1 SCALE: � =30 ' DATE / /92--��5' LDREDGE ENGINEERING COIN F",Q,,,vco I CERTIFY THAT THEF�v.w.4?run/ CLIENT SHOWN ON THIS PLAN IS LOCATED EGISTERED REGISTERED JOB NO.,L?-l) r ON THE GROUND AS INDICATED AND CIVIL I LAND CONFORMS TO THE ZONING LAWS ENGINEER SURVEYOR DR.BY' '4:� '4 ' OF 5AP_-,jsTABi...0 , MASS. 712 MAIN ST. CH.BY= J, �• oi. B. 2 ,��c-- .--- HYANNJS, MASS. SHEET I Of L DATE R I LAND SURVEYOR 1 _ '==AkgVsor's map and lot number/2 °� ...... PyOF TH E Sewage Permit number .... /...... 2.2......................... d� o� I EMSTADLE, i House number .............................. .L.!. ...................... ro MAea DISC p 1639. \00 { 0 MAI a' TOWN OF -BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO n +xi?,+t... �.?����..f'...Fs'�L�7.ltr•Elora 11.ngr ..................................... TYPE OF CONSTRUCTION ...W1pd... :ame....................................................................................................... ............Lz". ... �.5....1913 TO THE INSPECTOR OF BUILDINGS: The, undersigned hereby applies for a permit according to the following information: Location . ....?.�....t� -1 1?:........ ..n ................................................................................ ................................... A Prdposed;Use ...................................................................... ... ........................................................................I......................... Zoning District ..R.B.............................................................Fire District ..... YArm.IU...................................................... Name of Owner @;Dricorn .I'�eS:;tY...T.rMPt..............Address 7.65...F� 1f!?Qt�t�..Rt?��.1...���xllzll�:��.............. Name of BuilderFranco. Real...EState DeV.. cO.Address .76�y Falco®uth„ 2®air Hv„ar�xi s.............. Inc. Nameof Architect ..................................................................Address .................................................................................... Numberof Rooms .S X........................................................Foundation ... .o.C.................................................................... Exterior .... IPPbPArd...@n,d, Qr...ahln.gal e.S..............Roofing AF4.1091A...SM-.11;ErleS.......................................... Floors .....Cc3Y'Ae. .Interior ...S�:le,, TO,� ,, •,.„ ................................................................ ........ ............................................. HeatingGa:s........F.r.W.`.Aa.................................................Plumbing ................................................. Fireplace E' ..............................Approximate Cost A.4- Only .0.0.................. Definitive Plan Approved by Planning Board ________________________________19________. Area .:456:iq...,...:'.t .......... Diagram of Lot and Building with Dimensions Fee `r } ." SUBJECT TO APPROVAL OF BOARD OF HEALTH { I \� 3 ti I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name . r!' ..:.I� ............ ..: • CAPRItREALTY TRUST A=271-47 23755 One Stor Nq ................. Permit for .................................... Single Family Dwelling ............................................................................... Location I,ot...4.47,,, 11,$„Wayland,,,Road ...............AY..r.lai S..........................::................. Owner .,Capricorn Realty,,,Trust ........ ...... Type of Construction ..F.r.aMe........................... ..........................................................."................... Plot ............................ Lot ................................ Permit Granted ...;January 13, 19 32 Date of Inspection ....................................19 Date Completed ......................................19 t PERMIT REFUSED ........................................................ 19 ................................ ........ ............... _ /;;;I ............... . .. . . ............................................... ................................................................................ ............................................................................... Approved ................................................ 19 ............................................................................... .................... ......................................................... *ramzs,w..- a..a-.,.^'y,"."- t^14.i: -�... "^r,.' �-, aR+<r Cs4 � z��.. �a--tr`s+,, �. .t �.• ( .w^',* r�+r�� ,�,c., 'uep-`3V�� �•"P' 5� :.. .- .. , m.....,:U x c. ...,x r 1,.m •:..x. -.. L..4e "1 {YtlfT t,e '.TOWN'.OFBARNSTABLEh 3755 PermitNo - Bllll(LiIIg I11SPeCtOI , susnPm _E' 2 f �X OCCUPANCY PERMIT_.; sk Bond �x "1No' building„nor' strueture shall be-erected, and�no land, building or structure sliall be used fora new, different, changed,',or enlarged h use's without" `a Building Permit tfieiefor�: t ,'first having'been obtained from 'the Building,Inspectors No building shah`.;be occupied.unt�l a certificate of occupancy has.been issued.by ti-e Building Inspector " �� w ' ° " y i Issued ito C 1y r] QY I2 Rema l y Trizb Address LGt . 4 7 1�1$ Uara nQ Roatx ,"$= ynna s Wiring 7iispector' t R1 r y z Inspection date ', /, E ac -- / Plumbing Inspector $ t Inspection date ' Gas'Inspector e � �, �f t Y Inspection date ��• Engineering Department�� �r t t Inspection date}.�; f, r K•h a /iy3 r. '. . Vn THIS PERMIT WILL NOT-BE VALID, AND'THE"BUILDING SHALL.NOTEBE OCCUPIED-'UNTIL -.. $IGIVED BY THE=BUILDING, INSPECTOR',;UPON: SATISFACTORY COMPLIANCE WITH ;TOWN_REQUIREME'�TT:3 ,• '�" � ' Buil_dmg Inspector f u. �- f.•..Yip.! _ e , _ - •.'� _ i^ .._ -i.:'tnA:, -t ? '• . .. ar.� .' .._k._. .. _. ..,.;{.. sor's map and lot number ............... .......`!� ...... . ./.. wC � 'T `� .. .. qu y�f? E / -2 INSTALLED IN COMPLIANCE Q � g ? Sewage Permit number .... ..... .... ........................., w`� ��++pp�� ®�//gg ��qq g�am®o��',,Ipp°�appt y�TIT�L�s 5 qq+�� .....{!t C d�1 Y®�iJ5Y8491E@`TAL CODE AND : BABaSTADLE, i House number .............I......... . .............................. yo Mnea p cd C £ a A,- • t-z TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO ...Faz_,a.,y...pwe.1.1 ng....................................... TYPE OF CONSTRUCTION ...Wo.od.,Frame............................... .......................� ....19........ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies?for a permit according to the following information; Location . . ..... �� .1. .............................................................:................................................... ProposedUse ............................................................................................................................................................................. ZoningDistrict ..R.,B.............................................................Fire District .....H,yannir;...................................................... Name of Ownerca:p.:icorn„Realty,., rust..............Address .7. 5...Fa. .IC1Q.lit ...RQ C1a...1Ya 17J.S.............. Name of BuilderFranco Real Estate Dev. Co.Address .7. 5. Falmouth Roads H�rann .............. ..................... ........................... Inc. Nameof Architect ..................................................................Address .......................................................:............................ Numberof Rooms .SIX.........................................................Foundation ..P. C.r...................................I.............................. Exterior .... ..........Roofing As.pklalt...Sk1ingle.S......................................... Floors ...... arp.e.t.................................................................Interior ...Sheet...rOCk .............................................................. Heating -...F.^. Wr.A...r..................................................Plumbing tW ...-...C.QpP.er................................................. Fireplace .NQX1Q......................................................................Approximate Cost ... Da.�O.Q...O.Q..:.............. ..................... �3G Definitive Plan Approved by Planning Board ________________________________19________. Area ....f.t............ Diagram of Lot and Building with Dimensions Fee 7�............................... SUBJECT TO APPROVAL OF BOARD OF HEALTH6�yQ . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .. ... .:.. .... . ............. ....... .r f CAPRICORN REALTY TRUST 23755 One . ................. Permit for ..............S t ry ........ Single Family Dwellin ............................................................................... Location .,Lot #47 ....1;�� and Rd..NAyl . ..................... ................... J�y an ........... . n.i.s............................................. Owner ..Capricorn Realty Trust ............ ........................................ Type of Construction .Frame...... .................... .. ....... ..............n.......................................................... Plot ............ .......... Lot ................................ January. 13, 82 Permit Grantqd ........................................19 Date of rAp ......................19 TT Date'Complete .................. ...19 r PERMIT REFUSED ......... ...................................................... 19 ............................................................................... ...............................................................I................ ................................................................i.......... ............................................................. ................. Approved ................................................ 19 ............................................................................... -d