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0073 FOX RUN
4��se, h L ///n) .. ,. .. .._� r n _ .:. x �l .. ill{... r F :. � O _ Town of Barnstable n _. _ _ . Building unxresrns Post This Card So That it is Visible FromtFie Street-Approved PlansMust be'.Retaired on Job and this Card Must be'KeptY `" 6� ��$ Until Final Inspection Has Been Made. ��� �� _ ._ rus . Whe"re a Certificate of Occupancy is Required,such.Buildmg shalLNotaie Occup d until'a«Final,lnspection'has been made• _ i t ..su . it _.. .,. l . ,b . Permit NO. B-20-1573 Applicant Name: Rechelle Bryan Approvals Date issued: 06/25/2020 Current Use Structure Permit Type: Building-Insulation-Residential Expiration Date: 12/25/2020 Foundation: Location: 73 FOX RUN,CENTERVILLE _ Map/Lot: 227-155 Zoning District: RC Sheathing: Owner on Record: KATCHPOLE,JOSEPH&ELIZABETH TRS .f Contractor.Nae Framing: 1 Address: 73 FOX RUN �� Contractor License:, 2 a.J CENTERVILLE, MA 02632 Est. Project Cost: $3,400,00 .. .lR �..,._. Chimney: Description: Weatherization and Air Sealing work with the.Mass Save Program- Permit Fee: $85.00 No structural changes. _ Insulation: -Fee Paid: $85.00 Project Review Req: Date: 6/25/2020 Final: ?aa Plumbing/Gas . Rough Plumbing: al This permit shall be deemed abandoned and invalid unless the work authorized by this permit is commenced within six months after issuance. Final Plumbing: All work authorized by this permit shall conform to the approved application and the approved construction documents for which this permit has been granted. All construction,alterations and changes of use of any building and structures shall be in compliance with the local zoning by-laws and codes. Rough Gas: This permit shall be displayed in a location clearly visible from access street or road and shall be maintained open for public inspection for the entire duration of the work until the completion of the same. ) _ Final Gas: _ _ The Certificate of Occupancy will not be issued until all applicablesigna tures by the Building.and Fire vOfficials are provided on this permit. Electrical Minimum of Five Call Inspections Required for All Construction Work:, 1.Foundation or Footing Service: 2.Sheathing Inspection i 3.All Fireplaces must be inspected at the throat level before firest flue:lining is installed - _ _ Rough: 4.Wiring&Plumbing Inspections to be completed prior to Frame Inspection 5.Prior to Covering Structural Members(Frame Inspection) - Final: 6.Insulation 7.Final Inspection before Occupancy Low Voltage Rough: Where applicable,separate permits are required for Electrical,Plumbing,and Mechanical Installations. Low Voltage Final: Work shall not proceed until the Inspector has approved the various stages of construction. Health "Persons contracting with unregistered contractors do not have access to the guaranty fund" (as set forth in MGL c.142A). Final: Building plans are to be available on site Fire Department All Permit Cards are the property of the APPLICANT-ISSUED RECIPIENT / Final: �7� 4 �MCCARTHX o � RUCT-ION ;C ,6 . z SJ. Dual and Commercial 97 .RI7ATI(1N�J�'PECIALYS�' i \ --4 ,..., ..tea March 15, 2014 .r E :-gip Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Street Hyannis, MA 02601 RE: Insulation Permits \ Dear Mr. Perry, This affidavit is to certify that all work completed for permit application#201200453; Status A; Parcel 227155 at 73 Fox Run, Centerville, MA; Permit Type RADD and issued on 12:00:00 AM has been inspected by a certified Building Performance Institute(BPI) inspector.All work performed meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION /,2 Map Parcel TO WIN OF PAR TAAp�lication l a_u& �N�) Health Division >(j ► p �:Date Issued Conservation Division Application Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis CP_r_oject;Street-Addresses `7 3 �e�x �e�,v Village -., Cri V-7-M L LS.. c0wwner-, 76Srtf 1-4 ,ate I-I POLF4 Tele hone.7:�_ _5708 790 :3()9 2- Permit Request 1 S c_ orb 6j LA 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: r Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use T_ Proposed Use APPLICANT INFORMATION (BUILDER OR-HOMEOWNER) Name= 5 '�� i�i��G�-�- Telephones°Numbed /,90 36,9 Z Address- ? 3 roll_ ,v License# V 7 9P V I LI-E j 6 2 Home Improvement Contractor# ` Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGMATURE- - �-- /!C� ��� 1- r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL `t PLUMBING: ROUGH FINAL F GAS: ROUGH FINAL FINAL BUILDING ldli iZ .i ` DATE CLOSED OUT s ASSOCIATION PLAN NO. 4 mble Regulatory.Services * MAS& E 4 Thomas K Geiler, Director P� 1639. preor •+" Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 www:town.ba rnsta ble.m a.us Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF LICENSED CONSTRUCTION SUPERVISOR ASSUMPTION OF RESPONSIBILITY 'Pro I, 70 S�P4 KA CFI i"d�� true # lk hereby.certify that I have assumed responsibility for the project under, construction, as authorized by building permit# (� , issued to (property address) on , 2010— " The following documents:are attached: .. copy,of my Massachusetts State Construction Supervisor's license or Homeowner's License.Exemption form (if applicable) copy of my Home Improvement Contractor registration (if applicable) Commonwealth of Massachusetts Workers' Compensation Insurance Affidavit. Road Bond(if applicable) It6 2z. Z LI ER DATE 11 �CY q/forms/newcontrb rev:1 10410 Town of Barn-stahle Regulatory Services vBA NSTABLF- Thomas F. Geiler, Director EnMc+A�� Building Division Tom Perry, Building Commissioner 200 Main Street, Hyannis, MA 02601 Office: 508-862-4038 Fax: 508-790-6230 NOTICE TO THE BUILDING DIVISION OF CHANGE OF LICENSED CONSTRUCTION SUPERVISOR I, �eS$4 Jea r C tI 160Z , owner of property located at Uk. `►�T- �1 )'� I , hereby certify that is no longer Construction Supervisor listed on the application for the project under construction as authorized by building permit #�dJo�� , issued on 201 I understand that the project under construction must cease until a successor licensed° Construction Supervisor, is submitted on the records of the Building Division. RO RTY OWNER DATE q/forms/newcontr reference R-5 780 CMR rev:1104 10 oFtl , Town of Barnstable Regulatory Services , 11MMSTAaLE, Thomas F.Geiler,Director y�A1MA3S' ,0g TEn 39. 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 HOMEOWNER LICENSE EXEMPTION Please Print DATE:._lC1/(1�� 1 U� -2-0 ]� JOB LOCATION: 7-3 F©}C Q)rJ Al a�Ar.—It R V]L-LIF number street village "HOMEOWNER": J oSrTk 1C A T!.14 PO L rz_ _-soe' •790 �`�9 Z 6 17 710 V Z.6 2— name home phone# rco►r'phone# CURRENT MAILING ADDRESS: _,;A,^C AS J D � L-�j�,h i ICON 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. DEFINITION 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 permit (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. 4 igna re of omeowner 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 of this issue is a form currently used by several towns. You may care t amend and adopt such a form/certification for use in your community.- Q:forms:homeexempt pUIME 1p Town of Barnstable ° - °� Regulatory Services RARNSTABLF4 M Thomas F.Geiler,Director 1659. �Fo +a 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 to act on my behalf, in all matters relative to work authorized by this building permit. (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. Signature of Owner Signature of Applicant Print Name Print Name Date Q:FORM&OWNERPERMISSIONPOOLS 6/2012 The Commonwealth ofMassachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street _ Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lp:,b �Nam� --e(Business/OTganizationadividual):. ;��1.$�iP'{ ���-T�1 t - �Addr�' es— 7-3 car f�y n.l City/State/Zjp:1 �/v`T�R��r r vz ' LPhone.#: .;� 79 03692 � Are you an employer? Check the appropriate box: Type of project(required):_ 1.0 I am a employer with . 4. .E] I am a general contractor and I employees(full and/or part time). * have hired the sub-contractors 6. 0 New construction 2.❑ I am a•sole proprietor or partner- listed on the'attached sheet.. 7. ❑Remodeling ship and have no employees These sub-contractors have ' g. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance, comp.insur nceJ r ed , I am .] 5. 0 We are a corporation and its 10.0 Electrical repairs or additions 3. a homeowner doing allwork officers have exercised their .. 11.0 Plumbing repairs or additions . myself. [No workers' comp. right of exemption per MGL . 12.0 Roof repairs c. 4 insurance required.]t � 152' §1O'and we have no ❑ .' employees. [No workers' 13. Other comp.insurance required.] *Any applicant that checks box#1 must also fin 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. QContractors$i'check this.box must atlach'ed�—additional sheet showing the name of the sub contractais and state whether or not tliose entities-have employees—If the subZcont actors have omployees;they must provide t rir_worlcers'c policy numb 'lam an employer that is providing workers'compensation insurance for my 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 Section25A 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 staternmit may be forwarded to the Office of InvestiRations of the DIA for insurance coverkze verification .Ido-herebycerhify under the pains•andpenalties ofperjury that the information provided above is true and correct Phone#: 790 3 6,9 7 . v 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): I,.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5:Plumbing Inspector 6. Other Contact Pelson: Phone#: Town of Barnstable Regulatory Services THE t Thomas F.Geiler,Director Building Division w ■ARNSTABLE, ; Tom Perry,Building Commissioner r 1639. 200 Main Street,Hyannis,MA 02601 ��FD MA'S A Office: 508-862-4038 Fax: 508-790-6230 August 2, 2012 Matthew Scavarelli 181 Captain Lijah's Rd Centerville, Ma. 02632 RE: 73 Fox Run, Centerville, Map: 227 Parcel: 155 Dear Mr. Scavarelli: This letter is to notify you that a frame inspection was conducted at the above referenced address for permit application number 201203185 and the following deficiencies were found: 1) Deck supporting beams are over span based on prescriptive residential deck construction guide. You must correct the above deficiencies and arrange for a new inspection. Thank you for your immediate attention in this matter and do not hesitate to call this office with any questions. Respectfully, WeLzon Local Inspector (508) 862-4034 Q:zoning5 4 TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map_ Parcels t Application PF t. F A R�q E ,�y Health Division Date Issued Conservation Division 11 Application Fe Planning Dept. Permit Fee Date Definitive Plan Approved b Planning Board ` f / pp Y 9 Historic - OKH _Preservation / Hyannis Project Street Address -2- Ap-,,c Village ✓JLcd— Owner K#T-e_,fYAOLe Address Telephone /7 - 7/(D O 2k-2— Permit Request l oo Godv S 774,t4X--lam A J)A.< k UJ L- fi /'�/�e9'�G1L7-/c�eJ ;+�" ll-V Gr h/r���,C1'f M t�4 4 cep d✓1i 8'��-/ 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: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review # Current Use 3 = ---- - ___ Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name �� '�� t r�/Lc��-r Telephone Number 77(. - 26 9f- Address &fit eM a L i t,3 License # CS ft/® q amam P - V t 4-u, A44- 6 3 Home Improvement Contractor# 13 7&F'f# Worker's Compensation # �62 ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE - L DATE r FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP PARCEL NO. S i ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION FRAME rQ, INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL S PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT t _ ASSOCIATION PLAN NO. t The Commonwealth of Massachusetts . Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dim Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):__ *7477— c.��rtt-cam► AC-m0LD".,✓cT Address:_ l b'1 C/ '�q,� 4 r of-ffrr Ro dtc3z j-POO City/State/Zip: c�rz�a/ r c_t_cf Xsf- Phone.#: Y-d F — 77 6. •- F6 FC- Aree you an employer?Check the appropriate bog: a of ro ect(required).:. 4. I am a general �P P ) 1.❑ I am a employer with ❑ . g ral contractor and I employees(full and/or part time).* have hired the stab-contractors 6 ❑New construction 2. I am a sole proprietor or partner- listed on the-attached sheet: 7. ❑Remodeling. ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers'` co insurance.t 9• ❑Building addition o workers' co � -[N comp.insurance. . . � mP• required_] 5. ❑ We are a corporation and its 10.0-Electrical repairs or additions 3.❑ I am a homeowner doingall work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. - right of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152,§1(4),and we have no 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. t Homeowners who submit this affidavit indicating they are doing all work and then 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 am an employer that is providing workers compensation insurance for my employees. Below is the policy and job site information . Insurance Company Name: 6(-'P T•Y /�txrLtAL- �,use3te Policy#or Self-ins.Lic.#:_ �C -- ?!,S' V/ O// Expiration Date: Job Site Address:_ 7 3 City/State/Zip: G XW VrC.C&-1.14 p 3 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$1,50000 and/or one-year imprisomnent, 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 forwarded to the Office of Investi.gations of the DIA for insurance coverage verification I do hereby certify under the pains dpenalties ofpperjury.that the information provided above is true and correct Signature: / - Date Phone#: SU F .. 7 2 G FOther only. Do not write in this area,to be completed by city or town offu iaL n: Permit/License# hority{circle one); Health.2.Building Department 3.City/Town Clerk 4.Electrical Inspector &Plumbing Inspector son: . . Phone#• . Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity, employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or Iocal licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGI:'ehapter 152, §25C( )states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for,the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented'to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contiactor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete'and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Sile Address"the applicant should write"all-locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid:affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to.thank you in advance for your.cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone-and fax number: Tlie-Commonwealth of Ma=Qh=tts Department of FndusWal A ooidems Qfflee of fuvestipt ohs 600 Washing S.treiet Boston,MA 02111 Tel.##617-727 49Q4 W 406 or I 477 MASSAFE Fax##617-727-7`�49 Revised 11-22-06 • www.mass.gov/dia I rr . ltuss<achusctts - Dclru tmcnt of Public Safct% y �o.ard of Building Regulations and Standards Construction Supervisor License License: CS 81091 I MATTHEW M SCAVARELLI , a 181 CAPTAIN LIJAHS RD CENTERV!LLE, MA 02632 y i c7— Expiration: 5/11/2013 ('nuiui i iccr Tr#: 14816 I J _ om� office of Consumer Affairs&B siness:Re PER :HOME IMPROVEMENT CONTRAC70R T ,� i' YPe_ )� � Registration ,A 3*4 Expiration 1J6/2013 Individual t° IVIA EW SCAVARELLI IVi.ATTHEW SCAVAREL r 181 CAPTAIN.LIJAHS RD s CENTERVILLE,MA 02632�A y Undersecretary arts i r License or registration val►d for ind►viduf use only { before.the expiration date.. 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Manholes 227701 Satellite Dish #,,327 Utility Poles- + signs Fuel Tanks Water Tanks ........ Flagpoles Utility Boxes 7-157 �27-p 0 Posts 0 Pilings i inch=40jeet N Data source Human-made features, Disclaimer This map is for planning p—�.— ly. It's Feet Town of Barnstable s map are only graphic not adequate for legal boundary determination -- hydrography,topography,and vegetation were Parcel lines on this t Conservation Division interpreted from 2008 aerial photographs and representations of Assessor's tax Parcels.They or regulatory interpretation.This map does no 0 10 20 40 60 80 W t represent an on-the-ground survey. may have been updated from more current are not true propertyboundaries and do.no f J. ACORDL CERTIFICATE OF LIABILITY INSURANCE GATE(MMIDDJYYtf1� ; PRODUCER THIS CERTIFICATE IS ISSUED AS A*MATTER'IOF.INFORMATIONS Rogers&Gray Insurance Agency Inc ONLY AND CONFERS NO RIGHTS.,;UP,OWXHE °CERTIFICATE2 HOLDER. THIS CERTIFICATE DOES NOT./AMEND TEND PO Sox 1601 ALTER THE COVERAGE AFFORDED'BY THE IDUcIESIBEL W -U- S Dennis, MA 02660 { INSURERS AFFORDING COVERAGE NAIC# `" INSURED INSURERA: National Grange Mutual Matthew Scavarelli dba Matt Scavarelli Carpentry P IY INSURERS: Liberty Mutual Insurance 181 Li•Captain ahs.Road INSURERC f: P t : Centerville, MA 02632 INSURERD: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED!NOTWTHSTANDIN- ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE:'�MAY�BE'ISSUED O,, f MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF8UCH ` POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICYEFFECTIVE POUCYEXPIRATION s n 7R S P O C POLICY NUMBER :LIMITS'`" GENERAL LIABILITY EACH OCCURRENCE r' $'''-r F1iQ.QU�000 COMMERCIAL GENERAL LIABI LITY - PREMISES.Ea $" '00o r nw i CLAIMS MADE FZ OCCUR MEDIXP(Anyone arson). $` ` 'A',O,0QO MP067477 6/13/11 6/13/12 PERSONAL BADVINJURY s tl" �1;0001000: �r, GENERAL AGGREGATE $ " � 2;p0.MQQO G/EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS' PIOPAGG' $'T 2;000,0.00 .Rq yJ POLICYFI PRO- LOC N� AUTOMOBILE LIABILITY ': } COMBINED SINGLE LIMIT $ i ANY AUTO (Ea accident) I ALLOWNEDAUTOS j s BODILYINJURY SCHEDULEDAUTOS (Per Person) $ ' HIREDAUTOS a{ ) BODILYINJURY $ + NON-OWNED AUTOS (Peraccident) F PROPERTY DAMAGE (Peraccident)" GARAGELIABILITY AUTO ONLY-EAACCIDENT $ Y.•' ANYAUTO EA ACC' $ OTHERTHAN AUTO ONLY: AGO $ # EXCESSIUMBRELLA LIABILITY - EACHOCCURRENCE 71OCCUR CLAIMS MADE AGGREGATE $ 1,000;000 CU067477 6/13/11 6/13/12 DEDUCTIBLE { RETENTION $10,000 $ WC STATU- ti WORKERS COMPENSATION AND OTH EP,APLOYERS'LIkBiUiY - y E.L.EACH ACCIDENT $ `.50U,000. � ANY PROPRIETOR/PARTNEWEXECUTiVE WCZ-31S-329141-011 7/12/11 7/12/12 �•" OFFICERWEMBER EXCLUDED? - ^.•, If yes describe under E.L.DISEASE-EA EMPLOYEE $ 500,000 SPECIAL PROVISIONS below. E.L.DISEASE ''S00-POLICYLIMR $ OTHER f 1� DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICL_ES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION � • to SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 13E CANCELLED BEFORE THE EXPSiAT10N 1:v DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL DAYS?WRRTENb� t' j `e NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT,FAILURE TO DO 80'SNALLt A k IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS.AGENTS OR>' REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) ©ACORD CORPORATION 1988x ' I) JS 06 t E E M`l I/z DES/G/V OA rA l0 X fzT CrA La Alt C-k 113 -5 r I,oE ER SULLIVAN ,ric fss�IIA 0NO. 29733 W f, •t �l 6 6Ae a tR s i p� 'm pr o No.c4048 T�S`l' Z• �5.8 tea' :. S, �D�o BOX /NV. 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MATT SCAVARELLI REMOLDING AND FINISH CARPENTRY LLC 181 Captain Lijahs Road Centerville,Ma. 02632 Ce11508-776-9698 Fax 508-775-4699 Deck Contract To: Joe Katchpole Date:May 21,2012 73 Foxrun Centerville,Ma 02632 Phone: j Cell: 617-710-0282 Email:jkatchpole@msn.com Re: To construct the framing required to meet customer drawing of deck and to be code complaint Specifications: Deck size 8' x 44' with a triangle shape projection of 8' x16',framing made of pressure treated wood Tx 8"in size,concrete.footing(10"x 4')placed at perimeter of deck @ 8' spacing to allow for proper support,decking and railing material to be provided by contractor at contractor cost plus 5%,decking and railing to be installed by.customer Work to be performed: As stated on Deck Quote dated May 16,2012 Framing material&labor ....................... $8310.00 Total ...............................................$8310.00 Payment Schedule: Deposit.....................,. .... 20% G Start of project ..................25% After footing .................... 35% At Completion ..................20% Note: Contract terms are to be approved by customer.. Start of project can't begin without the issuing of a building permit.The customer is responsible for complete payment in the event of a change or cancellation. Contractor is responsible for providing all labor and material to complete the framing of the deck as stated for this project and obtaining a building permit.All scheduled payments are to be paid in full within 5 working days of request. Approval: q 4 (Cu�om�er-. J Katchpole" Contractor:Matt Scavarelli f l f ..... ... ...- -..-..... ... � $fit.�...� t Zw E wa { rj r' E 3 Y. t s e1} s i toy"' F 91 7 y j q .„ >� 9 spo /- oc , 4 C l'!EGG ,�°Cra�' e;7)t ~ 7 ' �r' :.���. .'nl� ..6•.. .ww..rv-...nw ,.....,.n.,L..r H:.w,,..,.n a.u ...... ,w ,,....,.,. .:�e,., .1.1.1..11 f;4>l�t,��� .:�/i✓i/�'r, � ,.,/ �� r. i,F� ;e � '"�` .t'?-'• r�`�wK®+.i':�u:) �d ," �.- � '�`f i' ,r'' � g; .u. � �. s �..:C•. 1 :'�'"e �� t� 2•�.d J. F° � 4 F;i'} r �«.�9 ' � �. � � � � G� cs<:'f� F ..a.` •.gib' J �('�y .,A::r �l�<2,��(�c=at� �',. ��'��r�,;,� ' S G�`rL L'. 6i ?� s i a C^, - - i � f THE � TOWN OF BARNSTABLE Permit No. ... $l $..... BUILDING DEPARTMENT 00 TOWN OFFICE BUILDING Cash ?....). (}qj i6;q• .... ttt �ouY HYANNIS,MASS.02601 Bond ................ CERTIFICATE OF USE AND OCCUPANCY Issued to Joan Doherty & Paul Caggiano Address Lot #8, 73 Fox Run Centerville, i4a.s.5achusetts USE GROUP FIRE GRADING OCCUPANCY LOAD THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS AND IN ACCORDANCE WITH SECTION 119.0 OF THE MASSACHUSETTS STATE BUILDING CODE. d Building Inspector TOWN OF BARNSTABLE, MASSACHUSETTS Am227-155 PERM .. �... JOB WEATH��$ C.A.R,Ds�oo•-popp. July 11 85 l��' r~rO�vu APPLICANT Michael- R. Shay •DATE (Brews er, P1ERMIT NO. >:�''• U ADDRESS 1lAA (N0.)_ (STREET) (CONTR'S LICENSE) Build dwelling & swminn �Tn1 Si ;l' faIIily dwelling OF TO p� Sn0 n$ 1 (TYPE OF IMPROVEMENT) NO. DWELLING UNITS (PROPOSED USE) AT (LOCATION) of VT Fox (tun, Centerville ZONING RC (N0.) (STREET) DISTRICT- BETWEEN AND (CROSS STREET) (CROSS STREET) SUBDIVISION LOT BLOCK sLOT ize BUILDING IS TO BE FT, WIDE BY FT. LONG BY FT. IN HEIGHT AND SHALL CONFORM IN CONSTRUCTION TO TYPE USE GROUP BASEMENT WALLS OR FOUNDATION Sewage #85-519, (TYPE). REMARKS: (Hichael R. Shay) 132.00 . AREA OR 1924 sq. ft. 135,000 13G.75 VOLUME ESTIMATED COST PE (CUBIC/SQUARE FEET) E Joan Doherty & Paul Caggiano ;1 OWNER , ADDRESS BUILDING OEPT. BY THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEWALK OR ANY PART THEREOF, EITHER TEMPORARILY OR' PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALLY PERMITTED UNDER THE BUILDING MUST BE AP- PROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF.PUBLIC SEWERS MAY BE OBTAINED CODE, FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE T.HE'APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS.. ...... MINIMUM OF THREE CALL INSPECTIONS REQUIRED FOR APPROVED PLANS MUST BE RETAINED ON JOB.AND THIS WHERE APPLICABLE SEPARATE ALL CONSTRUCTION WORKS CARD KEPT POSTED UNTIL FINAL INSPECTION HAS BEEN PERMITS ARE REQUIRED FOR ELECTR CAL1. FOUNDATIONS OR FOOTINGS. MADE. WHERE A CERTIFICATE OF OCCUPANCY IS RE- MECHANICAL�INPLUMBING ' STALLATIONS.D 2. PRIOR TO COVERING STRUCTURAL QUIRED,SUCH BUILDING SHALL NOT BE OCCUPIED UNTIL MINAL INSPECTION TI TO LATHE FINAL INSPECTION HAS BEEN,MADE.. 3, FINAL INSPECTION BEFORE OCCUPANCY. IS VISIBLE FRO) STREET POST THIS CARD SO IT , . BUILDING INSPECTION APPROVALS PLUMBING INSPECTION APPROVALS _ ELECTRICAL INSPECTION APPROVALS 1 a / )J r 2 2 /mil `G/ l / 2 y_ . gyp® opt a I—, EAL 3 HEATING INSPECTING APPROVALS REFRIGERATION INSPECTION APPROVALS I I I I i / 2 C)G '+VCRK S.ALL NCT PROCEED UNTIL THE PERMIT WILL BECOME PULL AND VOID IF CONSTRUCTION INSPECTIONS INDi'..pr 0 ,NSPECTOR -!AS APPROVED 74E VAA CUS 6� STAGES OF CONSTRUCTION. WORK IS NOT STARTED WITHIN SIX MONTHS OF DATE THE CaN eE ARaaNcr0 •,)O ON THIS-CARD PERMIT IS ISSUED AS NOTED ABOVE... OR WRITTEN NOTIF• $TI ON. TELEPHONE 1. . .. . . . JOSEK+H D. DALUZ TELEPHONE: 775.1120 Building Commitaioner EXT. 107 TOWN OF' BARNSTABLE BUILDING INSPECTOR TOWN OFFICE BUILDING HYANNIS, MASS. 02601 February 27, 1986 Ms. Joan C. Doherty 3207 Eight Street Charlestown, ' MA 02129 RE: 73 Fox Run, Centerville A=227-155 Dear Ms. Doherty: Please be advised of ARTICLE XI. SWIMMING POOLS of the General By-Laws of the Town of Barnstable which reads: "Private Swimming Pools shall be suitably fenced to a minimum height of four (4) feet. Public and semi-public swimming pools shall be suitably fenced to a minimum height of .six (6) feet. Such fence shall be constructed so as to prohibit unauthorized access." Your swimming pool located at 73 Fox Run, Centerville contains water and is unfenced. A suitable fence must be erected immediately to prohibit un- authorized access to the pool. Failure to comply with this order will result in further action by this office. Peace, f ' JdSeph D. Da luz Building Commissioner JDD/gr cc: Michael B. Shay. G. , ' % ��� (����l/ — v r c 7/` ��� FROM TOWN OF BARNSTABLE Mr: Michael Shay 13UIL.DING DEPARTMENT Brewster, MA 367 MAIN STREET HYANNIS, MA 02601 Phone:775-1120 SUBJECT: Building Permit #28188 Doherty/Caggiano FOLD HERE j' t DATE - November 13., 1985 MESSAGE Please contact this office immediately re the unfenced swimming pool located at 73 Fox Run, Centerville. SIGNED Richard R. Be arse DATE REPLY A;30� U SIGNED N87.RM1 - RECIPIENT:RETAIN WHITE COPY,RETURN PINK COPY SENDER:SNAP OUT YELLOW COPY ONLY.SEND WHITE AND PINK COPIES WITH CARBON INTACT. - e f.0 X IG 'O �aaravN�P... IS :;nIP� nNe 1 Ct 2eV J .! S'•+-� !�-� � i r � � _I t + �.. `I t i.:.�i--�' � ! �.. 1 1 I .I._ i �` i .I '..�.I }P �I`��" i i -'':�'�-� ��''.:`Y �3 ,f x}ri^t., � r.. t,' f Y f .. :. } .. .} r t a: r ! � + -l # � t TJI {' „v�r �i• ; h�''_` _fit _I .._ �.. .s }. r I.t I-:- ! I , I � -{••-� { I t _� r - T+-; , �� � .-T--.r-_--� .~!} ��` ' is ,•. a'� a �, :t 1 I ; t r j I 4 iii--- _. ..t I t I - ,[.t ( r i d {• t F T 'A^' , 1. � f 4� , I,,- _"I ' T .Ili ! I 1 1- 1 r I � � �•1 �{� ( l } ,. i f//�w�./1� j - I '7— >, i } j t I� I I S � ! Y I � �.I + I I , ,t 7_ I �• JI� -Nr a • 1,`4 } t. j t I { �1 � t � t Y t h '` � �•. , ,.� ! I ! 1f T � � t 1 �"� -`1 � {-•'�1 F"j� a. I � �/- I M r I 1 I ! Y ( r ! f7 I, t i. „» + i 1 I- e f 1 s i 'I - � 3• i. r �,- { , ! : { I_ � h F ' �� i S �r '� r I � , .I..!iy , {.„{ ' I i' I ' ✓._ I a d I # /.. 1 I...j 1 - 1 ! i ' t {° "gar r i J, r + i. r ;i Tt 4 f - - 4-i r i v 1 I"'t i t .t„ r ' i , .� 1 i ;f.--i � *`r - �� �. �� t i - { I «, 1 t , t i. .. �- A— t , ' t I �tcNP�- , � ff_. may. C twa t � J -7 1. } i..?' ..E... .BARTER j, w, f + f i� (� rrt �Q r K I LL-- I .1 '.f f .I :1 t : � ! 1- { 1'tT �� ' 7 0� r• � r._�. " � r 1 � I r � t --� :+,.) ! , t " ! t.:- ' i._y L I�_ � }.-1 7} � +-+_t 1 ., +.f• t •.-tom I i'-, t }��=1 ��:->_- I t-T CE,2 T%F r..-A, { -•-h-,�.....i- r-f'+-' `r. -( ! -i. I �7{ 'I-. -bw+-aE,. 4- .I E p..., r / cE.eT/may rAIAT.TNE� _ _ •7a / , ` { I. I -- L. N t {s'f,%OWN f/E�EGL(/C'GLyI.oL YSr W/Tf/ SCA L ,eE4v�.eEME4rs="oF._TNT ,COCAT,�'O iS//A/ .�LOGiaPG4/if! F ,OA l,. _ ; ew-,4 /NSre!/�Ft/T,StieYEY� Th�� QSTE.21�/.C.C�a MASS. :`: 0�,45'ETS S v[X> SOT g� APF'/./e-AIVT � ('—,Q GG/d�.f0 r., -� � I �✓1-F t��1 2.�Z TLIs) : ASF 102•o l o0 �?1" / (o V— N ioi •5 do ` D2.p 1.GhLti 102.3' V�ti OFAf i J py TFR t `� p ARD 7b� SL)LL)kI.AD3 �`j: A Na: 291�3 BAXTER � �11N► o `s N 24046 /OfNA I +��.� �VV /ss t4ssessar's pnap and�lot nu;ber .......................... ................. - SEPTIC -SYSTEM �' ;oFTHE,ro (3 ', IST IN ALLED IN Sewage Permit number. ....... ........ ..................:. WITH TITL �'N�,dIRONKENTAL C� EdHB5T11DLE, House number ....... .. . ..... ........................................_ 1'J 9� NAM ..... E ULATyJ°''�Fo�ara� TOG N OF BAR.NSTABLE .. C w BUILDING INSPECTOR APPLICATION FOR PERMIT TO �vNS�R�-�C`......� Si /Ji�..%C POOL— APPLICATION ..... .. .. .. .... TYPE OF CONSTRUCTION D0b rRA.H.E ' P����P►CR ...............W...................... ... ...... .......................... ................................................... ......................ca,E....6.............198-T.. TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location E�o- 15 VOX Una 1 Lhi'PE V t U L ............................................ Pro osed Use....... 2Si 6F-10*riAL r...................................... ................................................................................. P ............................. ............... Zoning District ...................Fire District C` ° Name of Owner .,—YpAtJ...-.oN. ~R;Y PC Address ...... ARLEa s� ........................................... ... .... .......... A..... ........�....... . Name of Builder HICNAi✓L- k 314AI Address .......�R�Gtt<S`fEQQ �-� ...................'.1....�............................................... Nameof Architect ..................................................................Address ................................i..................................................... Number of Rooms Foundation ..pOupt� `-'` ocAr.'ic ................................................. ................. .............................................. Exlerior /2 Cb.y- f UbAR Ge A.P.Ab.a f�G `..fz U X 1 s.sPNAL-r .......................... .......................................................................Roofing ............................ .................. ..... iuooD GRPi~7- ) RPVwALL. pilJE Floors ....................................................Interior ................................. .. ................................................. Heating �/ g `,OPP�Q �P�� ..............................................................Plumbin................... ................. ....................... Fireplace j' ......................................Approximate. Cost ! .. Definitive Plan Approved by Planning Board ---------19 Area ... 1�......�.......... E 745 Diagram of Lot and Building with Dimensions SE A°TrAckiEb Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH Vs 2 119?41& S7- a OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Tjon.. of Barnstable regarding the above construction. Name ........ ............... . .........I................................. a Construction Supervisor's License ...C.QQ+74—n............ DOHERTY, JOAN & A=227-155 CAGGIANO, PAUL 28188 Permit for ...fAM i I'V•..... dwell in�;..��..:RWirrimingool ..... ........... Location ...LotJ 8 73 Fox Run -7 .................................................. Centerville .......................................................................... Owmer ...Joan..Doherty. ..&--Paul--Gagglan-o Type of Construction .....frame.......................... . ................................................................................. Plot .....................:...... Lot ................................ W7 < Permit_Granted ............... .......19 85 Date of Inspection ...................................7-19 Date Completed ......11...... ......................:71 7_� IXI k: r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map -'7 Parcel ISS Application #o?0 0 06 41 S�3 Health Division Date Issued Z t Z_ Conservation Division Application Fee Planning Dept Permit Fee Date Definitive Plan Approved by Planning Board C alb 112 Historic - OKH _ Preservation/ Hyannis Project Street Address �� }�-oA Village CCv clr_,A c Owner . -,-t\rJs e )CG-'C_A.R-)� Address S, c Telephone 7 Permit Request )6oV 51_ �� �� CCIIJIa4i 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 M/ 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 d/coal eve:-Q Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ BA: ❑ existing LIN w size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ 0 1 - � � r Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ -a Commercial ❑Yes ❑ No If yes, site plan review# s .__ �-- 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(508)280-6%4 !" -SL-58633 H C=1f9393`"`" ? Home Improvement Contractor# Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE~ IL; Al > FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. 10 ADDRESS VILLAGE + _ OWNER " � k4 DATE OF INSPECTION: "Ni FOUNDATION FRAME f INSULATION c r FIREPLACE I ELECTRICAL: ROUGH FINAL y PLUMBING: ROUGH FINAL k GAS: ROUGH FINAL FINAL BUILDING t DATE CLOSED,OUT ASSOCIATION PLAN NO. r, The Commonwealth:of hfassachusert. Department of Industrial Accider r , Office of Investigations 600 Washington Street Boston, MA 02.111 www.mass.gov/din Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pllzmbers Applicant Information Please Print Leibly Name (gnsiness/Organizationllndividnao: MCC erthV Construetien Address: P.O. Box 52 West De City/State/Zip: Phone F-U re you an employer? Check the appropriate box; 4. I am a Type of project(required): . ❑ I mm a employer with ❑ general contractor and Iemployees(full and/or part-time).*. have hind the sub-contractors 5. []New construction . I am a sole proprietor or partner- listed on the attached sheet., : 7. .E]Remodeling ship and have no employees These sub-contractors have , g, 0 Demolition Working for me in any capacity, employees and have`workers'. [No workers'comp.mmrranrte comp.insurance., 9. ❑Building addition. required.] 5. El. We.are a corporation and its -10.❑Electrical repairs or additions 3.❑-I am a homeowner doing all work officers'have.exercised their 11.[]Plumbing repairs or additions myself [No workers' comp. right of exemption per MGL - insurance required.]t c. 152, §1(4), and we have no . 12.0 oof mpairs employees. [No workers' 13. Other comp.insurance required.] 'fwy applicant that checks box 91 must also fill out the section below showing their workers,compensation policy information. t Homeowners who submit this affidavit indicating they are doing an work and then hire outside contractors must submit a now affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-mutictOM and state whether or not those entities have employees. If the sub-contractors have employees,they most provide their workers'comp,policy number. I am an employer that is providing workers compensation insurance for my'employees. Below is the po&cy and job site information. Insurance Company Name: Policy#or Self-ins.Lc. 4-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 o required under Section 25A of MGL C. 152 can lead to the imposition of cimminal penalties of a fine up to$1,500.00 and/or one-year imprisonment, as WeE as civil penalties in.the foul of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy"af this statement maybe forwarded to the Office of Investigations of the D4 fo ce coverage verification I do hereby certify e ains an es of perjury that the information provided above is true and correct Phone O, Icial use,only. Do not write in this area, to be completed by city or town ofj"zcial City or Town:' Permitlhicense# Issuing use (circle one): 1.Board of Health"2.Building Department .3. City/To own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone.#:" f/1(ifi IG�� - W Office of Consumer Affairs and' .usiness Regulation 10 Park Plaza = Suite 5170 Boston, Massachusetts 02116 a Home Improvement Contractor Registration -� Registration: 169393; = r?i Type: Individual Expiration: 6/16/2013 Tr# 213517 'MIGHAEL MCCARTHY r MICHAEL.MCCART Y ^� ���� --- y J P.O. BOX 52 WEST DENNIS MA 02670 1 27 Update Address and return card.Mark reason for change. U Address Renewal E mployment Q Lost Card DPS-CAI 0 50M-04/04-G101216 - ,p� ✓fie T�G'a�tin2amcaeal� a��/L�(,CadQac�iuQel7a _ - \ Office of Consumer Affairs&B siness Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration.,,-1.69393 Type: Office of Consumer Affairs and Business Regulation TMIAEL 10 Park Plaza-Suite 5170 Expiration 6/16/2013 IndividualBoston,MA 0211t;MCCARTHYzF y a a } 'M' ... . MICHAEL MCCARTHY ' 6.RANGLEY LN. j g. SOUTH DENNIS, MA 02660= Undersecretary '; t valid without signature / _ IVlassachusetts- Department of Public SufetN Board of Building Regulations xntl St.uttl:u tlti Construction Supervisor License j t License: CS 58633 ,�r Restricted to: 00 }l MICHAEL J MCCARTHY PO BOX 52 W DENNIS, MA 02670 OWNER AUTHORIZATION FORM _ ( 'I ner's Name) owner of the property located at 6ZZ (P.rope (y Address) (Property Address) 1c- hereby autho Oize , 'f �ti �. li" 6 ubcontractor) , an authorized subcontractor for RISE Engineering, to act on:my behalf to obtain a building permit and to perform work on my property. .�.. . ?wnes' Signatur Date V M