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Home My WebLink About1600 SANTUIT-NEWTOWN ROAD �� i��i'T-l��J��N /�...�_ 1 s__ U CJ ,. I � aoo OUA V Ov No.of Recessed Luminaries: 0 No.of Cell.-Susp(Paddle)Fans No.of Luminarie Outlets: 0 No.of Hot Tubs No.of Luminaries: 0 Swimming Pool No.of Receptacle Outlets 0 No.of Oil Burners No.of Switches 0 No.of Gas Burners: No.of Ranges: 0 No. of Air Conditioners: 0 --[ No.of Waste Disposers: 0 Heat Pump Number Totals: 0 No.of Dishwashers 0 Space/Area Heating KW No.of Dryers 0 Heating Appliances: 0 No.of Water Heaters 0 No.of Signs 0 N No.of Hydromassage Bathtubs: 0 No.of Motors 0 T Others: Tp vv► ��►�►2 f �� SAS _ �ZS -�I C� z Q �. �_ �� _ � �w� r� r � / ,MCGARTHY ' Tfa ri 51 e esid 'teal and Commercial Builder �" �,�EA TION SPECIALISTc` � --� AT u October 21, 2014 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Stret _G w Hyannis, MA 02601 RE: Insulation Permits Dear Mr. Perry, Q J 01% This affidavit is to certify that all work completed for permit application#0 at 1600 SANTUIT-NEW OWN RD 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 ' t TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map- .a Parcel Application # �i 1 �ttc'�' .3 �la .+* Health Division 2U34 z� F; t Date Issued Conservation Division Application Fee Planning Dept. Permit Fee s:p ,� 1 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation / Hyannis Project Street Address �� hr�-�,�- /V�c✓��•., �. Village Owner Lkc_ Address S.'en L ' Telephone �l a�►-3�� Permit Request •1-I 1a ,z„I s .1/, c D � 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 0 Other Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: p 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 A4eCar--thy Oe tenon Telephone Number PO Box 52 Address License# Dennis,West Cell (508) 280-6964 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO c doti v SIGNATURE DATE 1lr11Y FOR OFFICIAL USE ONLY APPLICATION# DATE.ISSUED MAP/PARCEL NO. P ADDRESS VILLAGE _ N; -S 4 OWNER • " DATE OF INSPECTION: FOUNDATION r. FRAME INSULATION z FIREPLACE F ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL r FINAL BUILDING DATE-,,CLOSED OUT AS_,S9Q,ilON_PLAN NO. f Department of IndustfialAccl ents Ofce of Investigations 600 Washington Street Boston,MA 02111 www massgov%dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ _ , uIrt r, --_jkase Print I.e�ibly Name(Business/Organization/LdMdual): PO Box 52 . West Dennis,MA 02670 Address: Cell (508) 280-6964 CSL-58633 HIC-169393 City/State/Zip: Phone#: Are you an employer?Check the appropriate box: A, Type of project(required): 1.01fam a employer with �j 4. ❑ I am a general contractor and I. T* have hired the sub-contractors 6. ❑New construction employees(full and/or part-time). 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 workingfor me in an capacity. employees and have workers' Y aP tY I 9. ❑Building addition [No workers'comp.insurance comp.insurance. 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:❑Plumbing repairs or additions myself [No workers'comp. right of exemption per MGL 12:ZRorepairs insurance required.]t c:I52, §1(4),and we have no employees,[No workers' 13. comp.insurance required.] *Any.applicantthat 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 him:outside contractors must submit a new affidavit indicating such. tContractors that check fhis box must attached an additional sheet showing the name of thcsub-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: Policy#or Self ins.Lic.M Expiration Date: Job Site Address:_ 1(,Do S, a- State/Zip: Attach a copy of the workers' compensation policy declaration.page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK-ORDER and a fine . of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA or insurance coverage verification I do hereby certify u d the and penalties o jury that the information provided above is true and correct Sigmature. Date`: S !� 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.EIectrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: M10�� 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 mdiyid ,'AQ�ar`tnersl ip asso on or other legal entity,employing employees. However the P c , owner of a dwelling,house haviiug not ofe than three apartments and who resides therein,or the occupant of the dwelling house of suib -er wlio employs persons 16 do maintenance,construction or repair work on such dwelling house or on the grouuads or Bung� urtenantt&riS shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or i 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." j 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 ino,rance requirements of this chapter have been presented to the contracting authority." Applicants . i 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 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 j 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 permittlicense number which will be used as a reference number. In addition,an applicant that must submif multiple pumitilicense 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. Anew 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 (Le.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. The Commonwealth of Massachusetts Department of Industrial Accidents a Office of lavestigations 600 washingfion Street. Boston,MA 02111 Tel,#617-727-4900 ext 406 or 1-877-MASSA.FE Fax#617-727-7749. Revised 4=24-07. wwwxa=.gov/din I DATE CERTIFICATE OF LIABILITY INSURANCE i 1 0/1 61201 3 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 i - I-NAME:Bryden . PO Box&Sul14971ivan Ins Agcy of Dennis Inc, jAHieNr�o.Exd;-(508)398-6060 - __-.. - I�AX (508)394-2267 - - EMAIL So Dennis,MA 02660 !ADDRESS:, - NAIC# INSURER A A LM Mutual Insurance Company 33758 INSURED INSURER 8 Michael McCarthy Construction Inc I -- - - -- --- ---- --- --- -------- --- West Dennis,MA 02670 I INSURER o: - -- ------- - - ---- - - - — INSURER E_------- - -- 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, EXCLUSIONS AND CONDITIONS OF SUCH POL!CIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLrUBR'---- -- -- -T POLICY F TOLICYEXP---- -- - ---- - - LTR - TYPE OF INSURANCE INSR WVD I__ POLICY NUMBER -) MM( /DD�1 MMIDD/YYYY)_.- LIMITS ----'--- --- t GENERAL LIABILITY I --— - - -- -- - EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY I I j I j DAMAGE TO RENTED--$ -- PREMISES Ea ccu rence --- I CLAIMS-MADE I OCCUR MED EXP(Any one person) $ 'PERSONAL&ADV INJURY I$ j GENERAL AGGREGATE $ L ---- - IGEN'L AGGREGATE LIMIT APPLIES PER. I PRODUCTS-COMP/OP AGG $ POLICY PRO- LOC - l_ AUTOMOBILE LIABILITY (Ea accident) I i - 1 COMBINED SINGLE LIMIT ANY AUTO I BODILY INJURY(Per person) �$ ALL OWNED - I SCHEDULED I j I AUTOS AUTOS BODILY INJURY(Per accident);$ . _ � F HIRED AUTOS NON-OWNED I '-------- -' — ----- �- AUTOS j LjPercde AGE a at)_PERTY AM - -$ --- - --- - I - I _1 -- -�--L --� ------ - --- I ---- - UMBRELLA LIAB j OCCUR I TEACH OCCURRENCE -1$ I EXCESS LIAR i CLAIMS MADE AGGREGATE I$ DED RETENTION $ i i 1$ WpRKERS COMPENSATION ! I ! WC STATU ' iOTHT AND EMPLOYERS'LIABILITY I I X TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEYIN I I I E L EACH ACCIDENT $ 500,000.00 A I OFFICER/MEMBBEER EXCLUDED? !•Y J N/A! VWC-100-6017656-2013A I 7/17/2013 :' 7/17/2014 i ---- '- -'-- - ---- ---- (Mandatory in NH) E.L.DISEASE-EA EMPLOYEEI $ 500,000.00 1,P If s desc ibe and r I F L ---- ------------ DSCRIPT�ON OF eOPERATIONS below - - .DISEASE-POLICY LIMIT $ 500,000.00 -.- --- ----. 1._.. I._ .-- I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) CERTIFICATE HOLDER CANCELLATION I 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. AUTHORIZED.REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. I 'r1Rr1 95 t,)nl ninrl - --r,., wrnon L Sb`5-�-1 -'37oG OWN L AUTHORIZATION F,;.rtM t_ (Owner's Name) owner of the property located at 66 2*-r\/lu (Property Address) (Property Address) 1 hereby authorize G v , - (Subcontractor) \Ij an authorized subcontractor for RISE Engineering, to act on my behalf to.obtain a building permit and to perform work on my property. Owner's Signature // J Date 4 d1111e oo�urnoi7cuea G/z o��p C �ss Regulation CYa License or re istration valid for individul use only Office of Consumer.Affairs&Business Regulation g Y OME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: egistration: 169393 Type: Office of Consumer Affairs and Business Regulation xpiration 6/16/201,5: Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 MICHAEL MCCARTHYa� - { - i MICHAEL MCCARTHY\ , Its 6 RANGLEY LN. SOUTH DENNIS, MA 02660 - Undersecretary 01'4o�tvalid without signature i u Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor a License:CS-058633 FS MICHAEL J MCC R . PO BOX 52 W DENNIS MA OM.70 e - Expiration Commissioner 04/10/2016 CAMLLi Carl_o zxi Tree &Landscape ft" Complete Estate Maintenance RO.BOX 1 OSTERVILLE,MA 02,655 _ (508)362-1441 CELL:•1508)737-3067 x FULLY INSURED LIC#1622 MA CERT ARBORIST B.S.URBAN FORESTRY Raymond D.Carlozzi ` s I �0-7