Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
3965 MAIN STREET
--........--— mai/it 67igE7- o sc. . . , 1 --------------- . . , ,. . , • k.......\ m..••• , • ' • . 1— ., „. , a: , • • . „7 . '' .. . - • ,... . ,,,, • 7 ,. , .-.', • ..- , , . ' . .,, •."..„7 7 „..„ „ .. . . ,,`,_ ' :"' . r. .... . , . , • •• • • . , .• • • , , - , • , „ , . . „.. . ... ... ,, .-4* ,. ,...., ' .',".• „,, .1,,i' , . , •. . ' ,if , .. , , '- .' 'e. — , . .• 4, . ••,4 ... .•• , 4 4.• •. ' ' . , . , 4 • , ' r •,,,. ' • ' . , . . ' . '7,"-. . ,o'', 7 •7• - 7' , ''• --t.-' -- - '''' .''', A. ...,-i•-i."' - . , .• ' ' ' '''• . ' .. . 7 . .....1.,,4.i....' ,. ''''''''. , „ . -' . • - - •' -. , . . .. . . -, .- •-.• _ , . . .. , , . .-, , 4,..4'' .,: '''''''' '' . ' ' ,, , '' ••'"-' ' .f'''''.. .,, . ' . -• ,, , ,,,,..,„• , , ,,, , „,...., . . , ,, . .. ,, • . ,. , . 0. - '' . ' '•,1 . ' ,.. ..... ,, ,-' . .. , . • . , . ., . • . .,„ " • — . - ..., — . ,. , - , . . it . ''' `. • ' . — . ...., . ,.. . . ,. . • , .. ' . , . ,, .• , . . , • . . ,. ,, • , '... '' .. , • , 7,.. ,,_ .. ' „ ,. ., -- ' .„. ' , , , „ , , , . , ' „„ , — . , , , .. , ,. 7,, . ..• , , . ' . , , , . , . ... . . ' •„ . _ - — • of fHEts- Town of Barnstable *Permit O 15 �4,1 > ii3 ASS/ 'I'� Expires 6 months fro issue dat� Regulatory Services Fee 3� * BARNSTABLE, � A� Richard V.Scali,Director i6g9. �� Building Division 4 1'41 Tom Perry,CBO,Building Commissioner t, Mier 200 Main Street,Hyannis,MA 02601 �+Erp www.town.barnstable.ma.us S 0 1 2015 2-4038 TOW Fax: 5 Office: 508 8 EXPRESS PERMIT APPLICATION - RESIN 1 ipu, 0QE Bp * 08 790 6230 ELF 35 3,f Not Valid without Red X-Press Imprint Map/parcel Number Property Address _ Rk,5 so-v' (p A atstens/ B)6 54 Residential Value of Work$ (CCO. �`'p Minimum fee of$35.00 for work under$6000.00 Owner's Name&Address 0 u Z.Z.C t (.,AVJ IL P.O . &,-4. t 24 C 0 IAA vvta, u►b , nn A 0 2.6 73 Contractor's Name CA-YE-to! i>e eo-T (f' _P e_is es La-Telephone Number ,9}/S 477 Fc&7 Home Improvement Contractor License#(if applicable) I`l 3 3 58 Email: IgjcUc @'C?PCB t�E C—out Z PILL E S co Construction Supervisor's License#(if applicable) C.. 5 0 .a_1 2.1 3 ❑Workman's Compensation Insurance Check one: ❑ I am a sole proprietor jI am the Homeowner I have Worker's Compensation Insurance Insurance Company NameFl 1 Workman's Comp.Policy# q L28 5t0' I"t • 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 - BOCCIA-X— ! Re-roof(hurricane nailed)(not stripping. Going over existing layers of roof) Re-side ❑ Replacement Windows/doors/sliders.U-Value (maximum .32)#of windows #of doors: • • ❑ Smoke/Carbon Monoxide detectors 4 floor plans marked with red S and inspections required. Separate Electrical&Fire Permits required. *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 Improvement Contractors License&Construction Supervisors License is required. r SIGNATURE: ___ 17):).._ C:\Users\Decollik\AppData\Loc icrosoft\Window rary Internet Files\Content.Outlook\2P101 DHR\EXPRESS.doc Revised 040215 The Commonwealth o,f Massachusetts w; Department ofIndzistrial Accidents Office of nvestigatiairs 600 Washington Street Bosun MA 02111 t•`ix wwnunassrg'ovIdila Workers' Compensation Insurance Affidavit BuildersiContrzctors/ElecEriciansJPlumbers Applicant Information Pleaseg Print Legibly NRIT P,(Business/Organization/Individual): COI)e�C3G C •- LCi 6' ! (') ` g `'c_ Address: I. < 3 COM(YL &c!// 6 "Df-. City/State/Zip: t h PC 1" ( ' '`C Fiume CO 6 ci Are you an employer?Check the appropriate box: Type of project(regniret : �I. ..I am a employer with as 4 ❑I am a general contractor and I employees(full andlor part-time).* have hired the sub-contractors 6. ❑New consfiucction 2.❑ I.am a sole proprietor or partner- - listed on.the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have �PemP � $ [1 Demolition wory*iv forme in any capacity. employees and.have workers' [No workers'comp.insurance comp.insurance.1 9. ❑Building addition 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'camp. tight of exemption per MGL 12.❑Roof repairs insurance required..]I c.152, §1(4k and we have no employees.[No workers' 13.❑Other camp.insurance required] *Any appncautthat checks how f1 most also fill not the section below shavring their workers'compensation policy information_ Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors=c st submit a new affidavit indicating such.. CContraclom that check this box must attached au additioosl sheet showing the names of the sub-contractors and stale whether or not those entities have employees. If the sub-caatrectors have employees,they roust provide their'workexs'cornp.policy number. I am an employer that is providing workers'conrpertsatiolr insurance f for my employees. SeIow is the policy and job site information. Insurance Company Name: �- `' ✓ Policy 4 or Self-ins.Lie.#: a .sue 8 C 3 Expiration Date: �` ..5� / 'a Job Site Address: 3 cl.6 S (/?7 �� City/State/Zip: ///u Attach a copy of the workers'compensation policy declaration page(showing the policy member 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 imprisonments 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 maybe forwarded to the Office of Investigations of the for insurance coverage verification. I do hereby semi nder the pains and penalties o;f`perpary that the information provided abort is a and correct Simature: Date: 013 3co if Phone#: S- i 4. 9 Offici • .only. Do not write in this area,to be completed by city or town official City or Town.: PermitlLicense# Issuing Authority(circle one): 1.Board of Health 2.Budding Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: 6 Capewi4e ENTERPRISES, LLC • J.P. MACOMBER & SON •Since 1928 Construction Proposal 1 153 Commercial Street Mashpee, MA- 02649 June 12, 2015 PROPOSAL SUBMITTED TO: WORK TO BE PERFORMED AT: NAME: Lawrence Cuzzi ADDRESS: 3965 Route 6A ADDRESS: P.O. Box 124 1 Cummaquid, MA 02673 PHONE: 508-362-4427 E-MAIL: Capewide Enterprises, LLC propose to furnish the materials and perform the labor necessary for the completion of work at 3965 Route 6A, Cummaquid. Work to be Completed • Permit • Demo as need rot shingles (approximatelyq) Z. • Tyvek as need • . Install new white cedar clear shingles as need Total for all labor, material and disposal The material is guaranteed to be as specified, and the above work t„ ue performed ir,,accordance with the , drawings and specifications submitted for above work and completed,in a substantialiworkmanlike manner Payment Schedule: due upon completon o Iov ^; I 1/3 Sign Contract 1/3 Start of Work 1/3 Completion ur iG l ,,,yl y i_ S vy lld tills r Note—This proposal may be withdrawn by us ifir,not accepted within 30 days Ahy alteration or deviation from above specifications involving extra cost will be executed.only.upon written`or`def,%':and'will become an extra I, charge over and above the estimate; payment for"the extra is„due in,full before the:_change is made. All i' agreements contingent upon strikes, accidents or delays beyond our,control" e Enterp Capewrd rises, LLC ' hr ACCEPTANCE OF PROPOSAL i � J r t F l �'I ("1 I F r The above prices, specifications and conditions are satisfactory acid acre hereby accepted You are authorized to do the work as specified. Payments will be made as outimed above '' : ` ,,,,„,„,,, „, ,:, , ,... ,., ,._ Customer Signature A` . f f1 , r f p 4 i�i W p Date: (L/I._// Signature I •k ' A!thorized Cape ide Enterpri es,,Representative Phone: 508.477.8877 Fax: 508.477.4977 Rich@CapewideEnterprises.com Joao@CapewideEnterprises.com • ' www.CapewideEnterprises.com ,nco CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) L._----- 4/22/2015 1 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(les)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 NAME: Kelly Estano Rogers&Gray Ins.-Kingston Branch PHONE FAX 63 Smith Lane A/C,No.Exo:978-722-0205 (ac.No):877-816-2156 Kingston MA 02364 ADDRREsskestanO( rogersgray com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:ARBELLA PROTECTION 41360 INSURED CAPEENT-01 INSURER 8 Arbella Indemnity Insurance Capewide Enterprises LLC INSURERC: J.P.Macomber&Sons INSURER D: 153 Commercial Street . Mashpee MA 02649 . INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:452930371' 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP Lill TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY 8500050813 4/30/2015 4/30/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PRMMGE TO RENTED $250,000 PREMISES(Ea occurrence) CLAIMS-MADE X OCCUR MED EXP(Any one person) $5,000 1 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY X JEC n LOC $ B AUTOMOBILE LIABILITY COMBINED-SINGLE LIMI f 1020017539 4/20/2015 4/20/2016 (Ea accident) $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X HIRED AUTOSX NON-OWNED PROPERTY DAMAGE $ 1 AUTOS (Per accident) $ B X UMBRELLA LIAB X OCCUR 4600050814 4/30/2015 4/30/2016 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$10,000 $ B WORKERS COMPENSATION 9120510414 4/14/2015 4/14/2016 X WC STATU- OTH- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 A Leased Rented Equip 8500050813 4/30/2015 4/30/2016 LR Limit 130,000 Property Building Limit 860,000 1 Business Property 80,000 I DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space Is required) I . CERTIFICATE HOLDER i CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Evidence of Insurance i ACCORDANCE WITH THE POLICY PROVISIONS. I AU ED REPRESENTATIVE .., I ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD I r � O"'"1O4Cs&Bu ��Odlation License or registration valid for individul use only , Offce or Consumer Affairs&Busiaess Regulatloa OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: [ _w�_= Office of Consumer Affairs and Business Regulation � -`=e- egistratlon: �(.43358 Type: -_ 10 Park Plaza-Suite 5170 =_Jr xpiration:. 7/803'16. Ltd Liability Corpor t: .4' ,r, 3.1.1..41t .:::. Boston,MA 02116 CAPEWIDE ENTERP18a L; C °, ! RICHARD CAPEN __ 4507 R RTE 28 COTUIT,MA 02635 Undersecretary of valid witho Ignature Massachusetts -Department of Public Safety it Regulations and Standards which Board of Building g 1111 Unrestricted-Buildings of any `ate group hi Construction Supervisor License: C4-089273 ! contain!Os than 35;000 cubic Ns.- of .F r�1 s u�/ enclosed space. RICHARD M CAON lo. .. 122 WHIT MAR I#1 T Cotuit MA 02635 rV'`• .,,•to 1` Expiration ' Frllure to possess a current edition of the Massachusetts°J, a 11,2712015 state Building Code Is cause for revocation of this license. Commissioner For DPS licensing Information visit: wvvw.MMes.6or D PS TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map 37-7("- Parcel Application # Health Division Date Issued /o--Z7 "i q '4:- Conservation Division Application Fee Ca-! Planning Dept. Permit Fee 4 Date Definitive Plan Approved by Planning Board Historic - OKH Preservation/ Hyannis Project Street Address J/.;,� S Village Owner � C' Vz i Address Svr Telephone 3c'1.-`I"4.x Permit Request cal L1- Square feet: 1st 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 ciecurT tation. 412 Dwelling Type: Single Family u Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes Cl No On Old King's!Highway:-"a, Yes"*❑ No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other CI) Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing nevirts Number of Bedrooms: existing _new • Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: 0 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 CSL-58633 MC-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO .Yin". V.h. SIGNATURE DATE �s��1w1 FOR OFFICIAL USE ONLY • • APPLICATION# '} DATE ISSUED MAP/PARCEL NO. f . ADDRESS VILLAGE OWNER DATE OF INSPECTION: FOUNDATION FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH• FINAL FINAL BUILDING DATE CLOSED OUT ASSOCIATION PLAN NO. „ 'iy V The Ca ntnonweekx ofMass chusUs De t o,fIndustrial Accidents f� Office r,,fl stIgatians 600 Washington Street . Boston,MA ill sat + ww .rtzess.gotldia Workers' Compensation.Insurance Affidavit Builders/Contractors/Electricians/Plumbers Applicant Information. Mike McCarthy Constructiotlease Print Legibly Name mvation/Fnt yid l): • PO Box 52 West Dennis, MA 02670 Address: Cell (508) 280-6964 - CSL-5863363 CHIC-169393 CityfStatefZip: Are you an employer?Check the appropriate box: Typeproject L[ 4 am a employer with 4 ❑ I atxi a ge�etal confractor and I of lam (required): 6_ employees }(full andforpart-time * have hiredtbe sub-contractors New won ❑ I am a sole proprietor arparttier--- listed on the attached sheet 7- ❑Remodeling ship and have no employees These sob-contractors have S. El Demolition . working for me in any capacity. employees and have workers' Building addition [No workers' comp.insurance Coml-mtnrarw e I req5. ❑ We are a corporatiouand its 10_0 -1pttrical repairs or additions ��1 I ha ve aste exercisedtheir 1um repairs or adr3+tions 3_❑ I am a homeowner doing all work -❑Plbin1; , myself [No workers'comp_ riujrt of elemgtioir per MGI. 12_11 1Znof repairs c_152,§1(4),andwehaveno insurance reLlriiiEd_�F ' 13'_•I�'lJther employ �a workers comp-insurance required.] *Any applicant that checks boa#1 must also Ell ont the section below showing theirwoQireat rompensatiou policy information t homeowners who submit this gf5d iif indicsting they are doing`II t:n and t'h°"hit:ontsisle contractors most submit a new afadavit in ranee rnrt, !Contractors that rhxk this box mast attached an additional sheet showing the name of the sub-ors and state whether ocnot those entities have employees. If the soft-contractors have employees,they must provide their workers'comp.policy number. Iam an employer that is providing workers'compensation insurance for my,employees. Below is the policy and job sits information_ Insurance Company Name: Policy#or Self-ins_Lie.#: Expiration Date: Job Site Address: ?)LS )1746.c- 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 imam-Section 25A of NIGL c. 152 can lead to the ituposition of criminal penalties of a fine up to$1,500.0D and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDilt and a fine of up to S250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA insurance coverage verffication_ I do hereby certrfp ri s -r idpenalfies of perjury that the zrrfbrraatian provuTed above is hue and correct Signature: Date: tub/iv Phone i#: . Official use only. De riot write in this area,to be completed by city or town official City or Town: Perrn;t/License if Kcaring Authority(circle one): 1.Board of Health. 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone if: -- - - _ 6 • Information and Instructions . Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied, oral or written." 1 • An ernployl-is defined as"an individual,partnership,associaiio. corporation or other legal entity,or any two or more of the foregoir?g engaged in a joint enterprise,and iaclnrdfng th egal representatives of a deceased employer;or the receiver or • of an indivirhial,partnership,association o:other legal entity,employing employees. However the owner of a dwe 1...g house having not more than three ap.. •..eats and who resides therein,or the occupant of the dwelling house of •other who;employs persons to dorm:' •lice,construction or repair work on such dwelling house or on the grounds or mining appurtenantthe eto'shal n• because of such employment be deemed to bean employer." z...#.$ t. •7.t e Ra ix .�iilX MGL chapter 152, §25C also,states•that"eve sta or Ilocal licensing agency shall withhold the issuance or renewal of a license or pe �.'t to operatery a busines:or to,construct buildings in the commonwealth for any applicant who has not produ -d acceptable evide ce of compliance with the insurance.coverage required." . Additionally,MGL chapter 152, • C(7)states"N.-rther the-commonwealth nor any of its political Subdivisions shall - enter into any contract for the perfo ..ce of pub c work until acceptable evidence of compliance with the in ulance requirements of this chapter have bee. presented the contracting authority." J Applicants :_. _ _ Please fill out the workers' compensation affi..,vit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s), _:.. -ss(es)and phone number(s)along with their certifcate(s)of insurance. Limited Liability Companies(LL()or Liability Partnerships(LLP)with no employees other than the members or partners,are not required to - worke compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advise. .. this .::..vit may be submitted to the Department of Industrial Accidents for confirmation of insurance to^erage. Also - sure to sign and date the affidavit. The affidavit should be returned to the city or town that the app;cation for the p- or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarcfin• u e law or if you are required to obtain a workers' compensation policy,please call the Dep.,Lu.tent at the number - below. Self-insured companies should enter their self-insurance license number on the app opriate line. City or Town Officials _ Please be sure that the affidavit is co... ete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in th- event the Office of Investigations has to cantactyou regarding the applicant Please be sure to fill in the permitllice. e number which will be used as a referent ein nber. In addition,an applicant that must submit multiple perm it/lice..e applirations in any given year,need only submit one affidavit indicating current policy information(if necessary) and '.der"Job Site Address"the applir-.ant should write"all locations in (city or town)."A copy of the affidavit that h. been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affida t is on file for future permits or licenses. A new affidavit must be flied out each year.Where a home owner or citizen obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn IT yes etc.)said person is NOT required to complete this affidavit. The Office of Investigations would le 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 Ind fax number. f , The Commonwealth of Massachusetts Department of Industrial Aocid uts . 4Ktee of Investigations 600 Washington Street • Boffin,MA 02111 TeL g 617-727-4905ext 406 or 1-8T MAS AFE Revised 4-24-07 F # 617-727- 49 WWW rn .gov/dia • ACORO® CERTIFICATE OF LIABILITY INSURANCE OATE(MMIDD/YYYY) 07/10/2014 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 pollcy(les)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 atom. Bryden&Sullivan Ins Agcy of Dennis Inc ROL.ex): (508)3984060 r46.No.: (508)394-2267 PO Box 1497 iNtlitss: So Dennis,MA 02660 INSURER(S)AFFORDING COVERAGE NAIC N JN.SJIRERA: A.I.M.Mutual Insurance Company _ 26158 INSURED INSURER B Michael McCarthy Construction Inc JNSURF.R C P 0 Box 52 West Dennis,MA 02670 _IN$U$ER D _INgURER.E_; INQui(ER 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 POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INN TYPE OF INSURANCE POUCY NUMBER (MIST A) (U W) LIMITS GENERAL LIABIUTY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES(Ea occurrence) CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEM.AGGREGATE LIMIT APPLIES`PER: PRODUCTS-COMP/OP AGO $ PRO- POLICY Fl1ECT FOC AUTOMOBILE UABIUTY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED — SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS UAB CLAIMS MADE AGGREGATE $ DED RETENTION $ $ XIRIMEiBiS'RtPsM1151f4 X ARITA GI?t _ A NCPP III MEF ;(ECUTNE( j N/A VWC-100-6017656-2014A 7/17/2014 7/17/2015 E.L EACH ACCIDENT $ 500,000.00 (Mandatory In NH) I II EL DISEASE-EA EMPLOYEE $ 500,000.00 D �sCRIPTION OPERATIONS below I I E.L DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Workers Compensation Coverage applies to MA employees only. CERTIFICATE HOLDER CANCELLATION Thlelsch Engineering 195 Francis Avenue SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Cranston,RI 02910 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supers isor License: CS-058633 I i, , MICHAEL J MCCxR 11.1.- 11, PO `'1 W DENNISBOX52 MA 6267 • �'G � n "� Expiration Commissioner 04/10/2016 . 1, _ QV/ � �p ea i��� o Q tli 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 0 20M-05/11 ElAddress Ell Renewal [i`Employment 11 Lost Card Ica-titl ? • OWNER AUTHORIZATION FORM A W� G Iv G (.I I, G � C Z. (Owner's Name) owner of the property located at _ __ _ - (Property-A.Address) (110/4 14 Ui�il /11 dZC3 (Peoperty Address) herebyauthorize • C_�,�( 1rII cik C�S , (Subconf/fl actor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. dire' wner's Signature Date TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Parcel O 3 1 Permit# °r Health Division Date Issued 3 ( a , Conservation Division f'/ 55', Z j //O Z Fee 4 -36 • ee Tax Collector 3I7/t7.z Treasurer *171/61.2 Planning Dept. Date Definitive Plan Approved by Planning Board Historic-OKH Preservation/Hyannis 0 Project Street Address 3 q.65 ' A/At cg T' Village �, v vx-t oz-c 64-®,u r th Owner 6 4.0 (A 4�`�i).c11--e4(v " j Address 're 5" Al A-0U sr Telephone E©e 36 1 H.7 Permit Request f'o Our zv /0i X /4.' 5r-/L p . ' (zo sy.,fr (41s c$/7 ON f L S fe-.,D rG6 4 oeoa 11 OL/ fr/oW)' rllYw% Square feet: 1st floor: existing proposed 2nd floor: existing proposed Total new Valuation Zoning District Flood Plain Groundwater Overlay 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 0 new size Barn: 0 existing ❑new size Attached garage: 0 existing 0 new size Shed:O existing ❑new size Other: Zoning Board of Appeals Authorization O Appeal# Recorded❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use BUILDER INFORMATION Name 0 aJ/JL%Z. Telephone Number Address License# Home Improvement Contractor# Worker's Compensation# ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE &)LU4C R CLA_. I DATE 3 / /& >._ FOR OFFICIAL USE ONLY 1 .t _.., UED • - .. PARCEL NO. 1 . ADDRESS ''1 VILLAGE , '_'. - OWNER` - or r r DATE OF INSPECTION: . ; FOUNDATION (..48 It c ' FRAME r INSULATION FIREPLACE r ' ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL . i� GAS: ROUGH FINAL r �" FINAL BUILDING .i ?v Ci. R � • r r ! \ 1 1 q`. DATE CLOSED OUT . . f. f r ASSOCIATION PLAN NO. . ' / 1,. • t,, The Town of Barnstable Regulatory Services . , Thomas F. Geiler, Director Building Division • Peter F. DiMatteo, Building Commissioner • 200 Main Street,Hyannis MA 02601 • Office: 508-862-4038 Fax: 508-790-6230 Permit no. Date AFFIDAVIT • HOME IMPROVEMENT CONTRACTOR LAW SUPPLEMENT TO PERMIT APPLICATION MGL c. 142A requires that the"reconstruction,alterations,renovation,repair,modernization,conversion, improvement,removal,demolition,or construction of an addition to any pre-existing owner-occupied building containing.at least one but not more than four dwelling units or to structures which are adjacent to such residence or building be done by registered contractors,with certain exceptions,along with other requirements. ®<t 1.--..ra Type.of Work: '1 N ILa c T .. '1 4 5 Ne b Estimated Cost ' Address of Work: .3 q 6 5 4/L) 4 r C u/1 Ark 6 c.9 ,/' it.? Owner's Name:•' G-G O # 1-4 e - e '— oi4-1 c 4, L Z—6 Date of Application: .57 t 3/0 -2-- I hereby certify that: • Registration is not required for the following reason(s): Work excluded bylaw [�❑Jo�Under$1,000 ['Building not owner-occupied • ['Owner pulling own permit Notice is hereby given that: OWNERS PULLING THEIR OWN PERMIT OR DEALING WITH UNREGISTERED CONTRACTORS FOR APPLICABLE HOME IMPROVEMENT WORK DO NOT HAVE ACCESS TO THE ARBITRATION PROGRAM OR GUARANTY FUND UNDER MGL c. 142A. . SIGNED UNDER PENALTIES OF PERJURY I hereby apply for a permit as the agent of the owner: • Date Contractor Name Registration No. OR q:forms:Affidav :rev-122001 • RESIDENTIAL: SHEDS -POOLS-DECKS-OPEN PORCHES- GAZEBOS DETACHED GARAGES FEE VALUE WORKSHEET ACCESSORY STRUCTURES >120 sq.ft.(Sheds,detached garages,gazebos,etc.) >120 sf-500 sf $35.00 $ 4V %:' >500 sf-750 sf 50.00 $ >750 sf- 1000 sf 75.00 $ >1000 sf- 1500 sf 100.00 $ >1500 sf—USE NEW BUILDING PERMIT APPLICATION DECKS x$30.00= $ (Number) PORCHES x$30.00= $ (Number) IN GROUND SWIMMING POOL $60.00 $ ABOVE GROUND SWIMMING POOL $25.00 $ RELOCATION/MOVING $150.00 $ (Plus above fee if applicable) PERMIT FEE $ Q:forms:dkcost eff:082301 • �pSMEr v��0 " ' sf,' • The Town of Barnstable * BARNSTABLE, • 9 MAC' Regulatory Services pO i659_ ,�0 '''Fo MAC a• Thomas F. Geiler, Director Building Division . . Peter F. DiMatteo, Building Commissioner 200 Main Street,Hyannis MA 02601 . • ce: 508-862-4038 Pax: 508-790-6230 HOMEOWNER LICENSE EXEMPTION / Please Print • • DATE:<3 431° JOB LOCATION: 3 r6 S . M',4i0- 4 7 C vAr xe/f-6,,c i/ number street village „HOMEOWNER":t;4 4 /4 46-10 A // o -1 . S og-- 367 `lr4(2..7 . name home phone# work phone# CURRENT MAILING ADDRESS: Li) d L &( 'I'1 1 . • . C c-'/ya„P u 1 6 At 6 -a 6 3 2. 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. • 2 19.-"ei-G0‘. - ''' ( --(2--(4,rika-,?._,C,572 • Si lire of Hom eowner J . • 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:EXEMPTN Q�/�- .2,A� /Z/3//1/ / ssessor's map and lot number ,g3�;J — g"/ oz 0 THE TO Sewage Permit number C?›./.�.4.......ru... A; SEPTIC SYSTEM MUS`i'`O``k14► 1 , INSTALLED IN CO4lIPLI 14 sTeDLE. : House number 9 Mne6 WITH TITLE 5 °0 1639. $ ENVIR• L CODE Are w"a TOWN OF RARNS1t LAT'IONS BUILDING INSPECTOR APPLICATION FOR PERMIT TO ' ° rgletenthelieff4 Y(` G� e ��' — TYPE OF CONSTRUCTION eall"0144-41t1 ileil'in)1 00114_ i42�If 19...g! u. TO THE.,INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information:_ Location s 5 )1 �.wJ.-.. ....Ve Lea .... .. . . A Qf, S Qz6 3 7 GJ / 4 4 . Proposed Use .. .. 7. Qcittn^- i Zoning District VaaitAS Fire District ' �,,'.}. �,y� 5-. ]r ��yy Name of Owner�o fh!../..!lC Address ���" /`/��� cs �"Y'•zr a 4.. Name of Builder Qcth4�.6 thII 1p Address hey` / /Io a d So, rmwor.di) N/4 Name of Architect Address Number of Rooms / Foundation ei-h?. 1 Exterior Vitei ky Roofing Q - —O L -x 41- 1-4 Floors / InteriorStLe I . Heating .. .. . .. ... ' Plumbing ""^ "`, Fireplace A/61 Approximate Cost .622 S Definitive Plan Approved by Planning Board 19 Area / Q "/) -. Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH ,,be . ._______„ .1(7--1-7.,6(-0 . ,i7I-ous& ------L_____i . OCCUPANCY PERMITS REQUIRED FOR NEW DWELLINGS I hereby agree to conform to all the Rules and Regulations of the Town of arnstable regarding the above construction. Na eckei : R� fMCCUBREY, ROBERT6 s'i . j 23785 ADDITION # No Permit for � 0. Greenhouse /Single Family ;' ' 4 Location 3965 Main Street f! '"' Owner Robert McCubrey .� .. , ) 4 Y Type of Construction Frame ` > i .` ? , , "` . Plot Lot 'l lip ei. <1 . . '"' .►, 4 Permit 'Granted February 2 - 41'9 82 C fi"' 6 9 Date of Inspection 7 9 ? Date Corn Ie'ed - 19 ,571/ 4 ( ,1 .--i - iii:4: ) r'�. t C`, " ,� I4 �" i..., , �si .' : � i ;'. - - 4. 0-1 1) A el.es° ,e), A 1 , er-? i . . r, ef. 9 .k":5 4 , 4,-/, 19 e,.,1 x t_., , ‹,,, ,,, ei 2, i : . , I , . , r„,, ,,, , .840. , , .. .., . . . 4(4 ‘.. . .„...-0, • . i f 4 . y�r ;1 , . . .114-EsPTTAICLLSEYDSTEM MUST BE -,... Assesso?s map and lot)number M dO , -- j /V Z ( f ' I./- 6 * (7- /,- 7 7 . - .f, . ?, SeWage]Permit number 140(„efel . 4i $,S7r,4 , . IN COMPLIANCE :., ., ri, ,..1 WITH ARTICLE II STATE - . r TOWN OF EARRNISTABrE" , „. 47 ,,,,14..: , 4,1, F..! ,:.,, • . . .•.,. . t, . , t- t BARN STLIlit : .7, . . • BUILDING. INSPECTOR •.C.4 ,4, .' ." . . • 0 ;; , 0; ' • . . • el?- -Ci &/ 1'.- .-.Z.,&-57/&-Z 4C/O Lad/C APPLICATION FOR PERMIT TO / ---/e•ern6.• . .., TYPE OF CONSTRUCTION o , 71MY / f' 19 7,7 • !_. . . . . TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for cl permit according to the following information: - Location /1Qr 6/9 C/9HC °7_) Ce//77/77/f 9(// . . Proposed Use • / cern/ky-. Zoning District /e2i) 3 Fire District . . Name of Owner 4'52.672-7 ea CiC67"1 - ;gress /677 64 - 'Name of Builder Krilizz,//ve \f720/(4 7614edress '4:271 41/4-- /g(2e'e•----:- O 26 ?/ — ....--- . Name of Architect: — Address Number of Rooms Foundation Exterior t-li z 7 re-- d-61-- i 9 L 7 e Roofing Floors ,)/ 69614t/We Interior Heating Plumbing ,...zi, • Fireplace Approximate.Cost 75 v v - Definitive Plan Approved by Planning Board 19 Area M kiel- Cam• 4/ g'I'' .. • Diagram of Lot and Building with Dimensions. Fee . . SUBJECT TO APPROVAL OF BOARD OF HEALTH •., - . . . ' . . V, • , . ' . yq • . . • . : , . • • . .. . . . • . . . . , , . . 1 . . . . . I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above 1 • construction. . iit , , • Name .- ' 4-14.4Carc7 - • . . . McCubrey, Robert R. . , .t.. . . ' . ric:;', 19238 Permit for add find floor ... . • - .•• • z ...• . --. . i• . . . to dwelling - . - - , . 1 • . .. . . . ' . . . . , .• 4 . • • . . , . . , . . .Rkerlk:: 376/ NI . . . . - Location C>ci-IA ' •. . ,. . .. , . . . . . , ,•••Crismaarfrin3 c)...r.c-•YI.- . , .... . ., -, . . . . .., • . . . . , A - . . . .. . ,.. . . .• . . . Owner Robert K. McCubrey- ' , • . . .. -. . >..= 1 , . : • . . ••, _ . . . . 7 ' Z • , , '".. Type of Construction frame. .' - - • . ., . - . :._, .. . . .. . . .. . . . . ,..- , .. , - - . .- . • ... r • ..,• t . . . .. r_ ' Plot ) Lot ' . ' • . • - • . . , .: ... . .. . : - - .- May 23 ' , • : •• . . - • • • • ' : Permit Granted.' • • • • 19 i . . . . .." sate .09//6)777 .4°'419 . 1 of Inspection . • . ... • • ' • ' , : - . • ,i r . • . . . . , Date Completed /II - i 7/9 . 19 • ... . .• ••' ,.- .-r .._ .- • • . , . . •,.. , _.,_,, . . .. . . . . 1 ..` • .. . ! ••-, . , -.' . . . • . ••:. . . . .. . :•.:. . . <PERMIT REFUSED • ,, . : . . ,., . .. . . ,, ..._ . • . 19 $ -:. • . . - . . , •. .. ,-., . _-, I `,- • . . , ..., . . . .... . . . . ., I .. . . , - • . . ,. . . . .. •: I . . , . ., . . . -. ,. . . . ... ' ... . . . . . . . . . . . . . ,-. ..... , . .. . 1 . • . . , . . . . _ . . • . .. . .. . . . . ., . . . . .i -: • • Approved 19 . . • • . . . . .. . T.). .... . . . . . ,. . . . . . • . . . '.. ..... . : . .,. . .. . . .; . 1' , . . •. - . - . •. . . . . ' .. .