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HomeMy WebLinkAbout0993 SHOOTFLYING HILL RD r� t,. gat 5°4A t ,,,,����',•its � x " ;�14 +'. 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Y, - .. [, , .. l '1 .'`4 , 4„ f i -x f k T.; j��h -k 1t 7 i �: ,.: _ " x 4 {}t J $ r -^ _ " t s rr .. ..- 4'�.:. .. J- .. - .. „ ,.} r ,,r . -, .. -,, , ,....... -" , .: , h ,� i :., . ...,,, „ , • ,,, ra 1 Y -', r,. ,- r; , kY ,. .. ,: , v rt. , ,A/. Assessor's ma and lot number l/ 77 ) P . . .. ......./....'yl...`�....✓O� �p/c f��e,. �b-lf' S� D�TNETO Sewage Permit number .......... ... .............. - Z BARNSTABLE, i MABa House number .............................. . ............... 'oo i639 e00 up"i TOWN OF BARNSTABLE BUILDING `INSPECTOR APPLICATION FOR PERMIT TO �f t ................................. ..... .... ......... TYPE OF=CONSTRUCTION ....... A ..-e............................................... ........................ TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according t e following ` formatio Alte Location .c .. ..� .. c�C� ..... .. . .. ... Cf(..F... � .............................. ProposedUse ....... �.f .. .. l' t�Y1�./ .................................. ................................... ......................... Zoning District . .;. .. .. ............. ..............791'�3 ..Fire District .... Z ..................... ..... Name of Owner .... ?+� ...r.Address � r tl Nameof Builder .....................................................................Address ...................................................................................: Nameof Architect ..................................................................Address ............................................................:....................... Number of Rooms .................... Foundation .. (,� (�.G!1 ,�`-�............. . ° .. g ... ...... ....Exterior .....��/..�,.17..(./'7. ��,�. �� � Roofing s'�� �C.t .���...-.................... P f Floors ...... .��` .. ....................Interior .....6,1 Heating .. .. . ....r 5....... ..........Plumbing .......4.��. ..... . .................................... V Fireplace .......... ................................................................Approximate. Cost .........................,L• �,�.�.��..' .. ................ --1 9- ------`. Area Definitive Plan Approved by Planning Board ___ ------ = _ _---- ��J.. . ........ ..... � Diagram of Lot and Building with Dimensions Fee �. ........ .. SUBJECT TO APPROVAL OF BOARD OF HEALTH` ("j `i 0 fig i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name .............................�............. .::........ ............................ Construction Supervisor's License ........ C-RIEENBRIER CORP. 27 13-2 Story No ...... �e'rm Permit 'for .................................... FamilySingle Dwelling ...................... Location ..... ................. ........ ....... r Owner Greenbrier ............................... Type of Construction ......FrIdWe........... Y .............. .. ................................................................................ Plot ............................. Lot:7.'.-.;.............................. Permit Granted .....October..18 .... ..........19 84 "A" .... ........ .... .... . . Date of Inspection ........... 19 ,!r _ 1 J,t v - "„ Date Completed .19............. it r A, Assessor's :map,and lot number,,, * :jt....�.... ... .�7 J!� O�is e �' y..... THE Sewage Permit number .7. d.... ...... ..�..�............... 4 ` HAUSTADLE. r Z i House number l-3� '4.4..' ` ruse 90 p 039. \0� E TOWN OF BARNSTABLE BUILDING INSPECTOR APPLICATION FOR PERMIT TO . .. .. � TYPE,OF CONSTRUCTION .......!! :/... r?1 ..��................................................ ........................ .. /a. 19 TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit accord'ng t• t e�following '.reformation: Location �� ..................... /• / . ..<<-�.. .. .... Z 1�1. ................................... ... ProposedUse � f..... L•Z. .............................................................................•......................... Zoning District ... ........ ..........................................................Fire District ............. (../........................ ............................ '� I ��7Jf// Name of Owner ....�.y Q�� D�/ W- v-:-�.Acldress �....�... ...,r.. .. !� . �C./....... Nameof Builder ....................................................................Address .................................................................................... Nameof Architect ..................................................................Address .................................................................................,... Number of Rooms ....................e..12......................................Foundation Exterior .....� � (.•....Y ..,1.176.�� ✓ ....Roofing ... ...... 4/. . .. ��./ � ....................Inte rior .... ?. ?.`. .T...r... C��.........................Floors Heating p��- ....�1 '...C.:• c: ............... .Plumbing .......�. /., ...........:....:................... . ...... ..... �J ��ll k Fireplace .........'...r..v..........................................................Approximate Cost ....................... ................. Definitive Plan Approved by Planning Board - 11 19 Area .......................................... Diagram of Lot and Building with Dimensions /'/L,f Fee ............................ ..... SUBJECT TO APPROVAL OF BOARD OF HEALTH �f Z tt � i OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations�:of the Town of Barnstable regarding the above construction. Name ..................................................................................• Construction Supervisor's License ........ ....................... ... G GI /"o --.-��... r�,mxfor —��:.�.���*----- � ---������.��ou��,..uwe��zz�9.—.----- Locohon 150.. ..Hill..Road � —__—_ Y.K]� .80��1�, �"�°~---------'r M. Owner ' .Cg�PA---------. Type ofConstruction —..J��4W......................... ' ` ---------'----------------- plot ------....-- Lot ..---------- . ' ' OotcU�*r 18—���— � ' Permit �ronxa6 -------- —.l0 8 - . Date of |nopechon------------lg Dote Completed ..................... ' / J-0 yw�� . 2 --�� -7 -- 8- - . . ' ~ ` . ' / . .. / ' � . ' '. ' ^/ � ^ ' .� ' ' TOWN OF BARNSTABLE Permit No. __------------------------- 4An Building Inspector cash -_---------_--___--- uua - OCCUPANCY PERMIT Bond ----_____-_� O Issued to Address lot #lb sJO great Hill Road, Centerville Wiring Inspector fib•" '- Inspection date Plumbing Inspector , Inspection date Gas Inspector r Inspection date _ Engineering Department i '/ �_ Inspection date Board of Health Inspection date 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. Building Inspector FROM TOWN OF BARNSTA13LE (Ei ' t.. T«� 13UI .DING DEPARTMENT a: ( mr. cis �jt i sr'NF 'tlF!F b'A' Mtn Clerk Vw .�, •� ,� ,1�7 MAIN STREET H ANNIS, Mid 02 t - t...i�,rV 4Y i�.•4 in.Et lF^'v'W!•1@.4E!n'F..�at ym'. i Prone: 775-1120 SUBJECT: FOLD HERE- - - DATE - - - i • - Decxn lI 1984 MESSAGE r. Work has been coupieted under Permit Please reZea ,&rtdr 4 ww44 How�R�-v-Aow-* ". . IGNED DATE REPLY ' . .- SIGNED AN87-RMI ,• - ' RECIPIENT:RETAIN WHIT e .. U E C OPY RETURN PINK COPV ' PRINTED IN U.S.A. SENDER: SNAP OUT YELLOW COPY ONLY.SEND WHITE.AND PINK COPIES WITH CARBON INTACT. s 1 ` t V �N V t wk 4 q r G i k l t 4 � GS3S�F Q T f t. �a3 "CERTIFIED PLOT PLAN uµ OF M,qs ROPE 17�lI/��I I TRUCE ELDRC• �E 4 1N k ds �n DATE t /a ` F G. W i V l e arc5s afi�� t CII�IENTx x ! �` "I'CE:RTIFaY THAT THE ;Ot 9,1P E D � ;RGOISt EREO Y k y° : 8H01AIAI�h ON TMIB• PLAN, 19 LOCAT9 T. a :. 4 n A ;�Q,l Ip3Qro�TE13ROUNQ,A A9 INOICATED:jA .!r''�Dka� .'�2� � �ENQINEER W , :8URVEYOR � � _CONFO,RM;%.IT � THE .10NING , 0 Q ` A R N STA 9. E k'A;88. kD .v r 5 ...v a 1::p'+. {S .. {1 t.y; #' :i••'nth'. e'a t ° aft 4- ,,. �' 4t�"3C?��P st y..i_ c. .Etnx �',�8+ A�dirn: .M������ °2`��,�ad' �.�2„•ri 73' =.s *r�.`' ys m.`1��{f rl«T- a " '°4 , HfA NA ,r ? '.d*.-"x e. .e',^•- . .. L:'''4.., 1,a;+�a` ;y�^;i", ,f',� ,Lr;+5;33' "�S �{ s. '. Ai '{E� 'k '�, i7• 9 l�-AND a,..., .,.w.:,�., .H :.,..,..ws� �„ _,.x:^ .+�.,,,'.vim.. m.V, t.,. :•.: �:..,_a�..�w.�..... ... .. ........ s se URV�YQR�. x oo (� , // 4/1 i ; fig L o r 0-7 J �. oil 4.3 07, t ct " i s. �'pf�e vN.T'K G ` ' 1 fir! �tNOF,A14 CERTIFIED PL®�' PLAN AL 407 s'c Rb$fRT � C IV R V/i_L E o . SE y p �3RUCE:` NO 10951 Qr pp E?LDRE V'0 f N . .rr . . rFSSlONA1.�a 7E �a4 9 A A h :, I-A �3 ,l ` �, ;° SCALES / " -.S�DD�TE � �'" z /sue . RE'DGE ZOV CLIENT.�; i CERTIFY THAT THE PROP®S at .s ;P rr Er JQ®-, No., A ON THIS P'.ANBUILDINGSHOWNEG6ST V6ACV? CONFORMS O ..THE ZONIN{j� r EP84iPE OF AaE LE MASS r" /p9�iX(g}S®�®'_M�y K$n�Nky �'`y � VIi�� � ^`� � /,2�j '�( � ✓ �L ��•-,--�-�r r• t`,y i! +a^'r.t .. 1 Ii 1W FY I+l7I . 1�'MIJ��/M �� I ^F '; f+ ' h.:��L,. :`,, (ar </ -, .L�- r:. •T•.•.s..OF' DA E Kr_V. LAAI-D SURVE:YOAt. TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 191 Parcel 0.31 Application #cQ6 1 q 6 33D b Health Division Date Issued _ Conservation Division Application Fee C Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address 77 3 Village Owner T-19-el � Address Telephone Permit Request is Square feet. 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay2 R CD Project Valuation Construction Typep;Q Q p~.:JJ _n Lot Size Grandfathered: ❑Yes ❑ No If yes, attach su porting 4;urr e@Ptation. Dwelling Type: Single Family O' Two Family ❑ Multi-Family (# units) = ' Age of Existing Structure Historic House: ❑Yes ❑ g g Y No On Old Kin 's NHi hwa :`_]Ye, ❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other ti T• M 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 Wext peunim;; MA 02670 License# Cell (508) 280-6964 CSL 58633 UIC-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO ' SIGNATURE DATE ��� /1Y r : • FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP,/PARCEL NO. ADDRESS VILLAGE OWNER �. .A1 r". Y8y bir _6 W DATE OF INSPECTION: ` FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL M PLUMBING: ROUGH FINAL GAS: ROUGH FINAL ,a FINAL BUILDING. c - . e DATE,CLOSED OUT ASSOCIATION PLAN NO. The Commonwealth of Massachusetts Department of IndusftialAccidenhs Office of Investigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Busness/orgmizatioa/individuai): Mike McCarthy Construction PO Box 5 2 - _ Address: West Dennis, MA'02670 Cell (508) 280-6964 City/State/Zip: CSL-586Une1ftC-169393 Arzoam an employer?Check theappropriate box: Type of project(required): a employer with 4. I am a general contractor and I employees(felt and/or part-time)-* have hired the sub-contractors 6 ❑New conshuction 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, E]Demolition working for me in any capacity. employees and have workers' 9 Buildin addition [No workers'comp. insurance comp.insurance.1 ❑ g required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3•❑ I am a homeowner doing all work officers have exercised their 11.[]Plmnbing repairs or additions • t of exemption e myself o workers comp. p per MGL Y � P 12_0 Roof repairs - insurance required_]t c. 152, §1(4),and we have no employees. [No workers' 13 �Otlier comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing then-workers'compensaiion 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 snb-contractors and state whether or not those entities have employees. If the sub-cofactors have employees,they nmst provide then"workers'comp.policy number. Lam an employer that is providing workers'compensation insurance far my employees• Below is the policy and job site information. _}� Insurance Company Name: � � / �,66 17 Policy#or Self-ins•Lic.#: 'V VAC I Expiration Date: 7 l i Job Site Address: 3 1- ( 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 e. 152 can lead to the imposition of criminal penalties of a fine up to$1,50D.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 Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under e p ns and penalties of perjury that the information provided/abovee is true and correct Signature: Date: /�3//y Phone#: Of use only. Do not write in this area, to be completed by city or town official City or Town: PermiflLicense# 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#: -Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto 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 Iegal entity,employing employees. However the owner of a dwelling house having not more'fhan three apartaient"s and who resides therein,or the occupant of the - dwelling house of another who employs persons to`do mamtenancekconstruction or repair work on such dwelling house or on the grounds or building appurtenant thereto shfal�l not'because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states'tliai"everystate or local 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,MGL chapter 152, §25C(7)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 irisl rancd requirements of this chapter have been presented to the cont-acting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s), address(es)and phone number(s)along with their certificate(s)of irmirance. 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 lime. 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 Site 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 bum 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. The Commonwealth of Massachusetts Department of Indust ual Accidents Mace of flavestigatiow 600 washfivou Street Boston,MA 02111 TO.#617-727-4900 ext 406 or 1-977-MASSAFE Fax#617-727-7749 Revised 4-24-07 w w.mass_govldia AC R`" CERTIFICATE OF LIABILITY INSURANCE DATE(MM,DD/YYYY) �:✓` i 10/16/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. .IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER 01962-001 CONTACT j NAME: Bryden&Sullivan Ins Agcy of Dennis Inc PHO fAA/ ._NNE o__Ext); (508)398-6060 !FAX (508)394-2267 — _-- PO BOX 1497 1 EMAIL So Dennis,MA 02660 1 ADDRESS:_ __-NAIC# _'tNsuRER A__A.I.M.Mutual Insurance Company 33758 INSURED Michael McCarthy Construction Inc INSURER a _ _........... INSURER C-'--------- ---------'- O Box 52 West Dennis,MA 02670 - INSURER E-____ IINSURER F 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 CONDITICIvS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BELINI REDUCED BY PAID CLA:NIS. IN SR �_.- ..-- LTR TYPE OF INSURANCE lIIN- I WVBD I POLICY NUMBER T POLICY EFF�POLICY EXP -- - lMM/DD/YlYYi1 MM/DD/YYYY)i_ _ I LIMITS GENERAL LIABILITY i - EACH OCCURRENCE $ i I COMMERCIAL GENERAL LIABILITY I DAMAGE TO RENTED --- - I ' ;CLAIMS-MADE OCCUR MED EXP(Any one person) :$ PERSONAL&ADV INJURY $ --- - i I GENERAL AGGREGATE i s ;GEN'L AGGREGATE LIMIT APPLIES PER: --- ---- ---- j PRODUCTS-COMP/OP AGG is POLICY JE i_..- LOC j ---- ------ ------..._ -- - - - i -COMBINED SINGLE LIMIT T! CT AUTOMOBILE LIABILITY , I ---- -'- - --- - . ANY AUTO jI BODILY INJURY(Per person) $ ALL OWNED I SCHEDULED AUTOS AUTOS I BODILY INJURY(Per accident) $ HIRED AUTOS AON O WNED I PROPERTY DAMAGE ' ( , 4_(Per accident)_ UMBRELLA LIAB OCCUR i - - -- ----+— --- ---- — --- -- ----�-- ---- - - EACH OCCURRENCE $ CLAIMS MADE I I EXCESS LIAB I - - -'-- --' - -- i AGGREGATE DED i RETENTION $ ! ' , I � $ WORKERS C,QMPENSATION I X i WC STATLI OTH AND EMPLOrrERS'LIABILITY _ TORY LIMITS_ ER — ANY PROPRIETOR/PARTNER/EXECUTIVE�i N ' I I E.L EACH ACCIDENT $A OFFICE R/MEMBEREXCLUDED? Y I'N/AI VWC-100-6017656-2013A 7/17/2013 7/17/2014 ! -- - _—"— ---500,000.00I (PAandator,in NH) -- E.L.DISEASE EA EMPLOYEE! $ 500,000.00 If s ddescribe and r j -- - _ _ DeSCRIPTION OF PbPERATIONS below - " - E_L.DISEASE POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF SANDWICH Attention:BLDG DEPT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN HALL ANNEX THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Sandwich,MA 02563 ACCORDANCE WITH THE POLICY PROVISIONS. i. AUTHORIZED REPRESENTATIVE {, ©1988-2010 ACORD CORPORATION.All rights reserved. �,ORD 25(2010/05) ' The ACORD name and logo are registered marks of ACORD Massachusetts - Department of Public Safety Board of Building Regulations and Standards ^ Y C'on.struction Supervisor License: CS-058633 Ar MICHAEL J MCCAR PO BOX 52 W DENNIs MA 6267 -1 - 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 Expiration: 6/16/2015 Tr# 238121 ..MICHAEL MCCARTHY MICHAEL MCCARTHY P.O. BOX 52 — WEST DENNIS, MA 02670 Update Address and return card.Mark reason for change. SCA 1 Li 20M-05/11 Address ❑ Renewal 0 Employment ❑ Lost Card ` -7- 430 154543 OWNER AUTHORIZATION FORM u-k Qx3 (Owner's Name) . < owner of the property located at A x . 1�11C13 5v� �� ' ( n (Property Addre ) (Property Address) , hereby.authorize Ci 'f . COV\ 04110 1 (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property: Owne s Signature Date' �1 ! —17 ill k 4, ell s M * C + RUCTION CO:� w r � `°sldktial and on, Builder ys� - 5 Y i 1y CCARTHYC' Gt { 46 -JOVE&' WWW. October 21,2014 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Stret Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, , This affidavit is to certify that all work completed for permit application#0 at 993 SHOOYFL ING mu W Y has been inspected by a certified Building Performance Institute(BPI) inspector.All work p, rformed4� v= meets or exceed Federal and State requirements Sincerely, Michael McCarthy McCarthy Construction Certio"21 .:�� 0 Cobb Real Estate 1550 Falmouth Road, Route 28 Centerville, Massachusetts 02632 Business(508)775-2121 Fax(508)771-8089 www.century2lcobbrealestate.com October 8, 2013 To whom this may concern, In reference to 993 Shootflying Hill Road, Centerville, MA 02632: According to the Town of Barnstable by-laws, the owner of 993 Shootflying Hill Road, Centerville, MA 02632 can rebuild on the current foot print if home is destroyed by fire or any other natural disaster. Regards,ds e a g , Thomas Perry (/ Building Inspector Town of Barnstable _ I II a® nii�s® Each Office is Independently Owned And Operated Town of Barnstable *P it#l�O z . Regulatory Services EV 6 hssue dme • sARNsh+sLB. _ °�' $ Thomas F.Geiler,Director 6 ,0 X.PRESS PERMIT Building DIVISIon Tom Perry,CBO, Building Commissioner 200 Main Street,Hyannis,MA 02601 MAR 2 6 2012 www.town.bamstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION - RESIDENTWYWOF BARNSTABLE. (� Not Valid without Red X-Press Imprint Map/parcel Number v I Property Address \\ L Residential .Value of Work Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address CAA �� el %`3Q Contractor's Name Telephone-Number �} —�-[a Home Improvement Contractor License#(if applicable) i 3 L9C9 b a Construction Supervisor's License#(if applicable) / 4 (� ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor ❑ I am the Homeowner I have Worker's Compensation Insurance . Insurance Company Name h y 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 A., vj ❑Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) ❑ Re-side #of doors ❑ Replacement Windows/doors/sliders:U-Value (maximum.35)#ofwindows '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 t Contractors License&,Construction Supervisors License is quired. SIGNATURE: C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Internet Files\Conte t.0utlook\DDV87AAZ\EXPRESS.doc Revised 072110 v� Z The Commonwealth of Massachusetts Department.of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 ivmv.mast~gov/din Workers' Compensation Insurance Affidavit: Builders/Contractoix/Electricians/Plumbers Applicant Information Please Print Le 'bl j ' Name(Business/Organizzaaation/tndividuat): Address: City/State/Zip: tf�P'v NQQ ,� M^(\ Phone.#: L O AJ� you an employer?Check the appropriate box: T of project r 4. I am a general contractor and I Type P I (required): 1. I am a employer with I ❑ g 6. ❑New construction employees(full and/or part-time).* have hired the subcontractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees 'these sub-contractors have S. ❑Demolition w for me in an capacity. employees and have workers' working Y P tY• I 9_ ❑Building addition [No workers'comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10_0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions. self o workers' right of exemption per MGL myself � comp.- 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- 7 Homeowners who submit this affidatdt indicating they are doing all work and then hue 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-contactors have employees,they must provide their workers'comp.policy number. lain an employer that is providing workers'eo►rtpensation insurance for my entploy-em Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.o#: Expiration Date: Job Site Address: l SY C'J hL4 f City/State/Zip-an W t tle y . Attach a copy of the workers'compensation policy declara 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 Office of Investigations of the DIA for insurance coverage verification. I do)tere ce tinder thepain a enaltie ttry that the information provided abocv^e is bite and correct Si tune: Date: Phone#: Official use only. Do not write in this area,to be completed by city or town of ciaL 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#: 6 t snaxsTns Town of Barnstable Regulatory Services Thomas F.Geiler,Director Building Division Thomas Perry,CBO Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstalble.ma.us Office: 508-8624038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I, as Owner of the subject property hereby authorize --�� . � to act on my behalf, in all matters relative to work authorized by this building permit application for: qq 3s (Address of Job) Signature of Owner Date. DWAt-ts A U�Mr— Print Name If Property Owner is applying for permit,please complete the Homeowners License Exemption Form on the reverse side. C:\Users\decollik\AppData\Local\Microsoft\Windows\Temporary Intemet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 Office of CORSnmer Affairs&Bdsines iz> L ,ense or-registratinir valid for indtvidul use only HOME IMPROVEMENT CONTRACTOR.: Jiefiire the expiration date. If found return to: Registration - 132282 Type r Office of Consumer Affairs and Business Regulation Expiration. 42/21/2012 DBA 10 Park Plaza-Suite 5170 K.-P.. EMODELING _ Boston,MA 02116 Ef KENNETW PERRY' 19 GUILDFORD RD Centerville MA 02632 -ram r Undersecretary Not valid wr 1 ature �7 -'-�- Massachusetts- Department_of Public SafetN Board of Buildin.- Regulations and Standards Construction Supervisor License License: CS 76820 KENNETH O.PERRY 19 GUILDFORD ROAD :' CENTERVILLE, MA 02632 Expiration: 8/28/2043 Commissioner Tr#: 3806 a Town of Barnstable r r Regulatory Services LK Thomas F.Geiler,Director 9- p Building Division Tom Perry,Building Commissioner 200 Main Street, Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4.038 Fact: •508-790-6230 HOMEOWNER LICENSE EXEMPTION 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. 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 BamstableBuilding 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 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. m C:\Users\decollikWppData\Local\Microsoft\Windows\Temporary Internet Files\Content.Outlook\DDV87AAZ\EXPRESS.doc Revised 072110 03/26/2012 MON 8:12 FAX 508 778 1218 DOWLING & O'NEIL INS . 001/002 'Client#:9680 2KPRE ACORD.. CERTIFICATE OF LIABILITY INSURANCE DAYE(MMID1VYTM 03/26/2012 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 tho certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terns 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 CONTACT NAME: _ Dowling&O'Neil 0N u 508775-1620 ----+ acA ; 5087781218 Insurance Agency E-MAIL ADDRESS- 973 lyannough Rd., PO Box 1990 Hyannis,MA 02601 INSURERfS1AFFORDWGCOVERAGE NAICB INsuREaA:Western World . INSURED P FNSURER 5:Associated Employers Insurance Kenneth Perry D/B/A INSURER c K.P.Remodeling&Construction 19 Guildford Road INSURER°: INSURER IT: Centerville,NIA 02632 INSURER F: 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, D(CLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY IR PAIDCLAIMS. DO ICY EPP LTR 'TYPE OF INSURANCE INHR SW VD POLICY NUMBER MM/DD ME E P LIMITS A GENERAL LIA9wTY MPP8014991 3/04/2012 03/0,MO1 EACH OCCURRENCE S1,000,000 y` X COMMERCIAL OENEf7AL LIAOILITr �hMISt$ EaE ED occurmnm $50 000 CLAIMS-MADE 5XI OCCUR MED EXP(Any one Person) S S OOO X BI/PD Ded:500 PERSONAL A ADV INJURY $1 000 000 _ GENERAL AGGREGATE s2,000,000 OEN%AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $1 000 000 POLICY PRO- JECT LOC - _ $ AUTOMOBILE LIABILITY COMBIAED SInTGLE. Ea accident ANYAUTO r BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Plsarcidem) S HIRED AUTOS Ads/NED (�@OLFQT ItlDAMAGE $ $ UMBRFII A UAB OCCUR - EACH-OCCURRENCE HCLAIMS-MADF-EXCESS LIAR - - AGGREGATE $ DEC -[RETENTION,$ B WORKERS COMPENSATION WC5005450012011 D6111312011 06/13/201 X WCSTATu• OTH AND EMPLOYERS'LIABILITY L EIS ANNrr P{{��ppPRIETOR/PARTNER/EXECUTIVE Y N - - E.L.EACH ACCIDENT $1 OO OOO OFFIGEWMEM13ER EXCLUDED? . 7 N/A (Mandatory In NH) E,L,DISEASE-EA EMPLOYEE $100 000 I1 as,descnIie under DESCRIPTION OF OPERATIONS below - EL DISEASE•POLICY LIMB $500 O00 . DESCRIPTION OF OPERATIONS/LOCATIONS VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if mom spaco Is mqulmd) Job:993 Shootffying Hill Road,Centerville Kenneth Perry is excluded from the workers compensation policy. Insurance coverage is limited to the terms,conditions,exclusions,other limitations and endorsements. Nothing contained in the certificate of insurance shall be deemed to have altered,waived,or extended the (See Attached Descriptions) CERTIFICATE HOLDER CANCELLATION Town of Barnstable SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Bldg.Dept. ACCORDANCE WITH THE POLICY PROVISIONS_ 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE C. 01938-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) 1 of 2 The ACORD name and logo are registered marks of ACORD . #S03867IM93866 LS1