Loading...
HomeMy WebLinkAbout0226 HARBOR HILLS ROAD t �IhF ;c � L'�1'11_ 1 �ri'�Y� ��5� , t7 ' ci r µ Eff V ',,, :r 1i'y.1V�'y� { �J. S a u r �.., a E. x + - .any .,.Kr..r- ,P p,i .. #i n:�. `�`�,- ,`:�t '�!' }� "f �i :� e' v "n• t _�� 'x,. ' a v �'�: r � R e, , �•�'� -wr �4 �} s A,} 's' �y e �j, e' a ^ x _ x ^:1 i .. 4 ti I - t v r 4 J r e F .w 1 o- , d5 � i 1 4". r, 3 ; .:r5 �:t yam.�,'i .1 �t F i y�::.r F, t d :-f E - ,', - o' , . - .1. ; - } t ,F, f ,y :: 1 r! v... 1 1,, l 1 i t.l : f: , . 1 _ 1 t r v,y C d ,.. �, _: , ,' : (, 1^ ... . :;r ,. ;' `Y: t' _;4 .. , i:., i ,l.i �, ,., ., .,: vs to - ,, .,. ..,,,... ,.,t-. F } .j, i� y. .r. 9 ':9 1 „ z- 5 v �.� 3 6 t. y ,.f. 4t` 1. M r' `t 'r a'' �;; d. e 1. , i,: 4 ''r. .+ .; { B r' i"i ., 1 j r ,r.5 a•. t i'' 1 1 1 fy A '�! �r } ! t ',( ,. ? } k d t 'I C ` o s - } `` s x a yy S h5 i '< y t., 1 P ': y' t 1f 'l iil Ff h, r t 4 t il A^ J 14 t�- y 0' tl 1 A, u. I �;: r i y i t 1 't 4' ! a 0 c t n ,:. ,. ;., ., , - .. Page 1 of 1 2015-02-04 20:53:14 (GMT) 17742839906 From: M.T. McMahon &Son f 2-1,-11.5 M.T:McMahon and S.on.,Jn.c.. ' . 19 Fieldstone:Way P lymo.uth,..M a:02360 mcmahoninsulation@gmail.com TM, 781.831>.1:234. _ R. February 4,2015 Town.of.Barnstable Building-Division �, 20.0.Main:5t Hyannis, Ma 026.02 RE: Insulation.P.erm.its , Dear.Mr, perry, This.`affiidav t is.to..eertify that all w..o.rk.c.ompletecl for in.sulat:ion:work:at22b Harbor Hills Rd has been by a certified.Building Performance Instit.ure{BPI) Inspector,. All work performed meets or.exceeds Federal&State requirements. . `l�rely, Michael T. McMahon p i r TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION 64� 66) 6( `�(� Map. Parcel �ppolicat4? Health Division—' Date Issued -13�IS Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address AtTJ flQLIZE WL W, Village _ Owner V( � Address Telephone ® �' 3 i Permit Request GJ� IU1� F� Square feet: 1 st floor: existing proposed 2nd floor: existing proposed T6TdI ne'- Zoning District Flood Plain Groundwater Overlay aJ 5" Project Valuation COD, 00 Construction Typelf7,a_-�*b-n tom;, �n 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# n Current Use Proposed Use APPLICANT INFORMATION - (BUILDER OR HOMEOWNER) Name Telephone Number Address 1 l IG ���5.�df2� GCJQ,1�( !lfl /IT License# Home Improvement Contractor# 7/G l6IS- 11 Email Q /q (U) uWw+ad— Worker's Compensation # C 166-6 1 q. �.rol ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE FOR OFFICIAL USE ONLY APPLICATION# i, t DATE ISSUED MAP/PARCEL NO. ADDRESS VILLAGE. :4 OWNER M DATE OF INSPECTION: FOUNDATION f t FRAME INSULATION r FIREPLACE ELECTRICAL: ROUGH FINAL ' PLUMBING: ROUGH FINAL t � GAS: ROUGH FINAL t` FINAL BUILDING f DATE CLOSED OUT ASSOCIATION PLAN NO. f The Commonwealth of Massachusetts Department of IndustrialAccidents x Office of Investigations 3 d 1 Congress Street, Suite 100 Y Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Hanle (Business/Organization/Individual): M.T. McMahon and Son, Inc Address: 19 Fieldstone Way City/State/Zip: Plymouth , Ma 02360 Phone#:781-831-1234 Are you an employer?Check the appropriate box: Type of project(required): 1.❑■ I am a employer with 9 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. El 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 workingfor me in an capacity. employees and have workers' Y P tY• 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 I I.❑ 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 Weatherization employees. [No workers' 13.❑■ Other comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :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:Aim Insurance Policy#or Self-ins. Lic. #:VCW-100-6014109-201 Expiration Date: 12/08/2015 Job Site Address: 226 Harbor Hills RD City/State/Zip:Centerville, Ma 02186 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 for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Sianatur Dat e: Phone#: 7818311234 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#: Zeexet i C el..." Business RegulaflOn Office or Consumer Affgirs,&Bus istr OR `-®' ENI-COWMCTOR ulconse or Fog r ",q registration: OMEIMPROWP R-Le Ann Type; apira 1F1816 lthe nd he ore A.&ITS a Onsual apiration, 4j2 Pdvate Corporation 6016 10 T! -S 51 2 to P t ZT1 DOW MICHAEL T.MCMA W MICKAP-L MCMAHOI.. 19 FIELDSTONE wRl,-.`. pLyMOLrrH,MA G2360 Undersecretary d vjjm • whi. d Buil of any use of fe et trin lesS&w 35,00 cubic iosed SPwe- AP lac-EaL 7 ig ri +�.iBBsi Rw- 0 ire to PDBWtdlng Code is caul, curre e r revocgdon ol s UcG , )pS Licansinginforrilalaon sit- ACORO® CERTIFICATE DATE(A1MIDIYYYYY) OF LIABILITY INSURANCE 11 12/9/14 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTFICATE 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 policyf es) 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 CONTACT Thompson Insurance NAME: PHONE 781 335-1890 r�x and Financial Services (781) 335-9782 - E nnA1L / No 389 Union Street " ADDRESS: JJTins@Comcast.net Weymouth, MA 02190-316 INSURE S AFFORDING COVERAGE NAIC# INSURED 1NSURERA:Travelers MT McMahon and Son Inc. ' INSURER B:AIM Mutual 19 Fieldstone Way INSURER C:Western World Insurance Co... Plymouth, MA 02360 ' INSURERo:Torus National .Insurance Co. INSURER E•' ` INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES OF INSURANCE.USTED 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 POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. "INSR A SUBR LTR TYPE OF INSURANCE WVD POLICY EFF POLICY E7(P POLICY NUMBER M/DD/Y MM/DLYYYYY LIMITS C GENERALLIAe1LnY NPP8202484 9/16/14 9/16/15 EACH Ef05-R OCCURRENCE $ 1 'OOO O00 COMMERCIAL GENE PAL LIABIU D LIABILITY DAMAGPREMISE TO RENTED $ 1OO OOO CLAIMS-MADE OCCUR ' ME E)(P(Arty one person) $ eJ OOO - PERSONAL&ADV INJURY $ 110001000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER POLICY PROECT ,LOC PRODUCTS-ODMP/OP AGG $ 1,000,000 A AUTOMOBILE LIABILITY 4 BA 2C882729 8/31/14 8/31/15 CO accident)ANYAUTO m $ 1,000,000 ALLOWNED BODILYINJURY(Perperson) $ SCHEDULED AUTOS X AUTOS BODILY INJURY(Per accident) $ ' X HIREDAUTOS X NON-OWNED AUTOS PROPERTY DAMAGE `. ..Peraccideni $ D UMBRELLA LIAR [::OCCUR 480313L140ALI 11/24/14 11/24/15 X IXCESSLIAB EACH OCCURRENCE $ .1` OOO OOO CLAIMS-MALE w 'AGGREGATE $ 1 000 000 DED RETENTION S ,.. w. B WORKERS COMPENSATION g AND EMPLOYERS'LIABILITY vWC=lOO-6014109-201 12/8/14 12/8/15 WCSTATU- X OTH- ANYCEPJMEMB R/PARTNER/EXEWTIVE YIN E.L.EACHA000ENT $ 500,000 OFFlCEtLMEMNMIIXCLUDED? N/A (Mandatory In NH) - _ ... -. - Ues,describe under r E.L.DISEASE-EA EMPLOYEE g 500 O0O DESCRIPTION OF OPERATIONS below r _ - . - E.L.DISEASE-POLICY LIMIT g 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Addldori at Rerrarks Scheduli,ifrn6re space is required) t CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE BLANK THE EXPIRATION DATE THEREOF,, NOTICE WILL BE DEUVERED IN, ACCORDANCE WITH THE POLICY PROVISIONS. i , AUTHOR EED REPRESENTATIVE John J. Thompson ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax.' E-Mail: RI S E ENCINLBtING OWNER AUTHORIZATION FORM 6 (Owner's Name) owner of the property located at: (Property Address) CAA , (Propertj Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. Owners Si "ature .0 /� Date E. RISE Engineering 5 Dupont Avenue South Yarmouth, MA 02664 t i