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Home My WebLink About0007 GLENWOOD AVENUE u, ' Ada• M��•. .��1 ,� y _ .� �r.�.' '�,'., .{� .,"� u�.-37 ,aFi �- ... � 5:r �„ RNI 't+ .� �:.. r:• c TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map v" Parcel ' �all�1 , ; Application # .. O , R STABLE pp Health Division t; Date Issued Conservation Division Application Feet22 Planning Dept. Permit Fee J"57 .0 0 Date Definitive Plan Approved by Planning Board -;;' .' _ ` , Historic - OKH _ Preservation / Hyannis Project Street Address / C, �c c� �'s A7 - Village l:CV4Cri.(l�iL Owner te _ 1 ,", f II-o"v-• Address V1 Telephone -77 1475 75� t Permit Request 1 ��.c rs°zsP•� l a, Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay Project Valuation �w 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 Proposed Use - APPLICANT INFORMATION (BUILDER OR HOMEOWNER) _ Name Mike McCarthy Construction Telephone Number PO Box 52 Address West Dennis, MA 02670 License# Cell (508) 280-6964 CS-F-,-48633 Hgr-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO D%J^,o SIGNATURE DATE 1,2f >� FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCEL NO. a ADDRESS VILLAGE OWNER r DATE OF INSPECTION: FOUNDATION FRAME =` INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING ' DATE CLOSED OUT ASSOCIATION PLAN NO. "r . Town of Barnstable R.egulAtory Services & Richard V.Scali,Director l;atilding)Division Tom Perry,Building CuQunissiouer I 200 Main St:eet, Iyannis,AA 02601 wivw.town.barnstable ma.us Office: 508-862AO38 Fax: 508-r90-6230 Property Own.e r Mus t C;ompletc: and Sign This Section Y II7stn0f A Builder, I, l M Orl4y as'ter €_the sutsject l�roE�tn:yr hereby authoave CQ to act on my behalf.. in all matters relative to-\-,.-ork authorized J.-this bJ--din pernvt applicacic,n fo.r: (,,kddress ofjob). C5Z6 3 ' Pool fences and alarms are the respo sibIty of the applicam-. Pool are not to be filled Ur titiLeti before fence is installed and all'iiz l .ir,,speevons are performed and accepted. Sig;. tore of Ch�ner Siva� tFre of r1plic u'it: 11rintName - - :Ptint:Narm, Date Q;FU12l�lS'O�v A�FRPF.�;.S 1551UNPCH)i.S f t t'_ f i Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-058633 ,r-" IN MICHAEL J MC AR PO BOX 52 W DENNIS MA OM7 o- � Expiration Commissioner "11\ 04/10/2016 �- wl®rwonowlweozlew Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement C6n6actor Registration = Y Registration: 169393 2 r� Type: Individual Expira n: /16/2017 Tr# 264961 MICHAEL'MCCARTHY MICHAEL MCCARTHY j"i � P.O. BOX 52 WEST DENNIS, MA 02670 Update Address and return card.Mark reason for change. Address ❑ Renewal Employment Lost Card 20M-05/11 f The Commonwealth ofMasvachtisetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 y www.mass.gov/din Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED 11r TTI TITS PERMITTING AUTHORITY. Anulicant Information Alike McCalrthV Cons ta- to til'1ilise Print Leeibly Name(Bus iness/Organization/Individu61): P® Box 52 Wiest Dennis, MA 02670 Address: Cell 508 280-696 � ) 4 CSL-58633 HIC-169393 City/State/Zip: Phone#: A71'.m an employer?Check the appropriate box: Type of project(required): 1. a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in- 8. ❑Remodeling any capacity.[No workers'comp.insurance required.) 3. I am a homeowner doing all work myself t 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 El 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.E]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors Iisted on the attached sheet. ) .❑PlumRoof repairs These sub-contractors have employees and have workers'comp.igsurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.dOther 152,§1(4),and we have no employees.[No workers'comp.-insurance required.] Any applicant that checks box tt 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. lContractors 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 flint is provirling lvorkers'compensation insurance for my employees. Below Is the policy and fob site Information. Insurance Company Name: ATM AJJ Try). C_,MiL :X Policy#or Self-ins.Lie.#: Expiration Date: )JL )1j- )/i Job Site Address:- - V 6)e—CA City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER•and a fine of up to$250.00 a day against the violator.A copy of this statement may forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify mr tl at sand allies rjury that the-information provider/above is true 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#: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMA'igQIQ'PAGE A.I.M. Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803-0970 (800)876-2765 NCCI NO26158 POLICY NO. I VWC-100-6017656-201413 PRIOR NO. VWC-100-6017656-2014A ITEM 1. The Insured: Michael McCarthy Construction Inc DBA: Mailing address: P 0 Box 52 FEIN:**-***3862 West Dennis,MA 02670 Legal Entity Type: Corporation Other workplaces not shown above: See Location, 2. The policy period is from 12/15/2014 to 12/15/2015 12:01 a.m. standard time at the insured's mailing address. 3. A. Workers Compensation Insurance:Part One of the policy applies to the Workers Compensation Law of the states listed here: MA B. Employers'Liability Insurance: Part Two of the policy applies to work in each state listed in`item 3.A. The limits of liability under Part Two are: Bodily Injury by Accident $ 500,000.each accident Bodily Injury by Disease $ 500,000 policy limit Bodily Injury by Disease $ 500,000 each employee C. Other States Insurance: Coverage Replaced by Endorsement WC 20 03 06 B D. This Policy includes these Endorsements and Schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules,Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Classifications Premium Basis Rates Code Estimated Per$100 Estimated No. Total Annual Of Annual Remuneration Remuneration Premium INTRA 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 P Y 9 � Y 9 Y 12/15/2014 Authorized Signature Date s Service Office: Bryden& Sullivan Ins Agcy of Dennis Inc 54 Third Avenue PO Box 1497 J Burlington MA 01803 So Dennis, MA 02660 ' 1 ` WC 00 00 01 A(7-11) �� Includes copyrighted material of the National Council on Compensation Insurance, �� used with Its permission. V