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Home My WebLink About0077 BREZNER LANE `ay�.FS •• .� � i''77" irk+z� y�� '`�i �� ,.�/y 5 �� s�.Ye'L..Y1�K—'t.,,7A1,.,.�. .�(�1 G� _ u ...c�� ,� � ' wat l �. l+A �, r' -'�Ad :� rid 3 '� t'`�, . ��;�.x � t^',� 'P". r'd u � r x. , ,.. ,. ,�...�� .. r; a�,ni ..' �. -', a�,.,5.u'' ..:. ` �x- v � .n..., a ,�„}i 7.. ,;�x ..�:r [.;n ,p ,;.:�.... � - t� '.r.. '. .gip.y.�, ., ". ..y .�. ._ N. �: �d y,..a_.:. .n. �. Y: ':X' - C., ^tic.' t. 1 u �, - r p4. .t t, ��^w ,,t.�<�.��IIyy�i w 7 '-r� �.'44:'ar. -(° t. r a1 cte, `: .. ,� .!?'$' +4. '•..c F� - � ^t1n, :...+Fr 3 t" L ^'iF:', l .Y��. � ;/l .I:r. .�.` ei�Y.C/ '"iSk�.r tdadfr W. W .l 1.�n� fl r 4k".s',.�li�e o-'. f.y7.i�? y1 ,y� q A ak a �, � � rR .. i L X • � dro � m' �: ,. .. .. ' - .. .i �p o Y y � ' �' ,{ _. � _ - �- a" -., e -.r � Yi>: �� ,i i. �. _ .<, ,. r � .. ,. � .. t .. ... .. .. ', ;, ,. .. � - a ,r w � - �_ ".. � � , .. P .. .. . � ; .. - .r ." y . .o a .- .. s ,. � ., V ' ,a. � r, TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map a Parcel. -1 Application # D 011.1 N.3 Health Division Date Issued Conservation Division Application Fee so Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board �-- Historic - OKH _ Preservation/ Hyannis Project Street Address -re 7-Inl-c y— Lcr, Village c c J k- Owner Q�� 1 w�S Address 5- Telephone L I- )77� Permit Request �1►�t�fit�,�. .l- jo', ce Square feet: 1 st floor: existing proposed 2nd floor: existing proposed ._Totalnew Zoning District Flood Plain Groundwater Overlay �. Project Valuation )2w Construction Type r Lot Size Grandfathered: ❑Yes ❑ No If yes, attachsupporting documentation. Dwelling Type: Single Family O' 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 A$II4-_e _eCn_rth3r Constniction -Telephone Number P® Box 52 Address West D,.nni A4A 02 670 License # Cell (508) 280-6964 CSL-58633 11IC_169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE 7 A J1, FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ti 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. f 57 It Town.-of Barnstal* tegulaory S:ervices nsnss �• • Richard,V'.Scab;Director ' ;, Bt ildi ft Division. Tom Perky,Building.Commissioner 200 Maiu Street;Hyannis;.MA:o2601 ,vvw.w t6wn.barnstabIc_m2 us: Office: 50.8=802-403$ Pax: 508-790-6230 Property Owner Must Cblrxrnplete'�and 5igz�` 'his Sec�:on m If Usu� ABuider; L 6- U�J 5 ,as Q�vner of;rlie Sribjeq propeny liexebyautlzoii �C o � co act,on.'nybehag, in all matters relative to work authonzed-bythis budding permit application for. 77 %3iQZ/ll��, Gi9N� �..C�6r►llc�.�ff.LLtc (Address af`,f _v s "-I'oolfences and ihums'are the fespons bi]ityof the::appli-6mt: Pools are not:to be,fiilee�'orutilized fiefore fence�s xnsalled`.and alltfial ixlspecpons are_pezfo mei ,and:accepte . Signature f Qoener, s Signature of-Appkant A Trint;Name Print..Nam- # 7 l Date f t t QM MS,01MF.,kiPERM SSI.ON?OOLS_. I ' r q�l aT Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 MICHAEL J MCC}kR PO BOX 52 W DENNIS MA 0267 o-� Expiration Commissioner 04/10/2016 Office of Consumer Affairs and Business Regulation - - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 169393 Type: Individual Expiratio /2017 Tr# 264961 MICHAEL MCCARTHY � MICHAEL MCCARTHY ri P.O. BOX 52 — —--- WEST DENNIS; MA 02670 �' ---- --- Update Ad ess and return card.Mark reason for change. 20M-05n1 El Address Renewal —j Employment Lost Card of = — The Commonwealth ofMassaclrusetts Department of Inrlitstrial.Accitlents - I Congress Street,Suite 100 Boston,MA.02114-2017 wwif mass.govAlla Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Pltiuibers. TO BE FILED WITII ME P)RNIMING AUTHORITY. Applicant Information lease Print Le ibl Mike McCarthy Name(Business/Organization/Individual): PO B9x52 Address: West Dennis, MA 02670 e - 964 L-5$1�13#: HIC-169393 Are yol,an employer?Check then opriate box: Lr570'/ Type of project(required): 1. 1'. a employer with employees(full and/or part-time).* 7. (]New construction 2.E]1 am a sole proprietor or partnership and have no employees working for me in $, ❑Remodeling capacity.[No workers'comp.insurance required.] 3. 1 am a homeowner all work myself 1 9. ❑Demolition ❑ g y [No workers'comp.insurance required.] 4.❑1 am a homeowner and will be hiring 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 I I.[]Electrical repairs or additions proprietors with no employees. 12. Plumbing repairs or additions 5.❑1 am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.t 1 1 13.❑Roof repairs 6.a we are a corporation and its officers have exercised their right of exemption per MGL c. 14.90ther 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 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 lm 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 member. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and Job site information. Insurance Company Name: ATM / i,,l 1-ny, Policy#or Self-ins.Lic.#: V�(��)c�c�— Cri 7C� ad)Y '' Expiration Date: Job Site Address:_ 777 �ZZrY �..�� 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 un t! al s and allies rjury that the-information provided above is trite and correct. Si nature: Date: 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: J .. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORM 'PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO 26158 POLICY NO. VWC-100-6017656-2014B PRIOR NO. 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 riot 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 GOV GOV Deposit Premium $7,748 STATE CLASS MA 5479 State Assessments/Surcharges $28,601.00 x 5.8000% $1,659 This policy, including all endorsements,is hereby countersigned b ��'�` �� 9 Y 12/15/2014 Authorized Signature Date Service Office: Bryden&Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 J Burlington MA 01803 So Dennis, MA 02660 / WC 00 00 01 A(7 11)- Includes copyrighted material of the National Council on Compensationi Insurance, used with its nermissinn.