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HomeMy WebLinkAbout0133 OLD TOWN ROAD i 33 Old `7-& --,--Rd, dFTM� 8�lCp> Town of Barnstable *Permit# -� pEp Expires 6 months frnn:issue date �q wilding Department Fee _ "B g N 312020 p Brian Florence,CBO i639 .� r (?� 0►NN Building Commissioner OFggR 200 Main Street,Hyannis,MA 02601 NSrA8t c www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 EXPRESS PERMIT APPLICATION- RESIDENTIAL ONLY SCANNED Not Valid Without Red X-Press Imprint FEB U 3 2020 Map/parcel Numbera r 0? Property Address 133 OLD TOWN ROAD HYANNIS MA 02601 0 Residential Value of Work$ `7 000. too Minimum fee of$35.00 for work under$6,000.00 Owner's Name&Address GILMAR BORSATTO—306 OLD JAIL LANE WEST BARNSTABLE MA� Contractor's Name PABLO C.MARTINEZ Telephone Number(508)274-3983 Home Improvement Contractor License#(if applicable) 142802 Email: climb512s(&yahoo.com Construction Supervisor's License#(if applicable)CS-103617 0 Workman's Compensation Insurance Check one: 0 I am a sole proprietor ❑ I am the Homeowner 0 I have Worker's Compensation Insurance Insurance Company Name A.I.M. Workman's Compensation Policy# VWC10060160852020 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 ❑ Re-roof(hurricane nailed)(not stripping old shin ,les. Going over existing layers of roof) 0 Replacement windows/doors/sliders.U-Value ✓. 2 5 (maximum 0.32) #of windows: I S� #of doors: *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. SIGNATURE. . The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation.Insurance Affidavit: Builders/Contractors/Electricians/Plumbers TO BE FILED WITH THE PERMITTING AUTHORITY Applicant Information Please Print Leg_iblx Name(Business/Organization/Individual): PABLO C.MARTINEZ Address: 49 SMITH STREET City/State/Zip: HYANNIS,MA 02601 Phone#: (508)274.3983 Are you an employer?Check the appropriate box: Type of Project(required): I. ❑ 1 am an employer with employees(full and/or part-time)* 7. ❑ New Construction 2. 211 am a sole proprietor or partnership and have no employees working for me in any capacity, g, ❑ Remodeling (No workers'comp.insurance required.) 9. ❑ Demolition 3. ❑ I am a homeowner doing all work myself.(No workers'comp.insurance required.)t 10. ❑ Building Addition 4. ❑ I am a homeowner and will be hiring contractors to conduct all work on my property.I will ensure that all contractors either have workers'compensation insurance or are sole proprietors 11. ❑ Electrical repairs or additions with no employees. 12. ❑ Plumbing repairs or additions 5. ❑ I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. ❑ Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14. © Other REPLACE WINDOWS 6. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c.152, §I(4),and we have no employees.(No workers'comp.insurance required.) 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners 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. 1 am an employer that is providing workers'compensation insurance for my employees.Below is the policy and job site information. Insurance Company Name:A.I.M. Policy#or Self-ins.Lic.#:VWC10060160852019 Expiration Date:08/3012020 Job Site Address:133 OLD TOWN ROAD City/State/Zip:HYANNIS,MA 02601 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to $1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do here y�un r enalt' of perjury that the information provided above is true and correct. Si Date: 2-c�0 Phone#:(508)274.3983 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#: Town of Barnstable Regulatory Services BMWSTA6 Thomas F.Geiler,Director ATE 9. Building Division Brian Florence,Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.maxs Office:.508-862-4038 Fax: 508-790-6230 BUILDING DEPARTMENT DEMOLITION DEBRIS DISPOSAL AFFIDAVIT Pursuant to M.G.L. Chapter 140, Section 54 and 780 CMR, Chapter 1, Section 111.5, I hereby certify that the debris resulting from the proposed work/demolition to be conducted at 133 OLD TOWN ROAD,HYANNIS,MA 02601. Work Address Is to be disposed of at the following location: TOWN OF YARMOUTH LANDFILL Sid disposal site shall be a licensed solid waste facility as defines by M.G.L. Chapter 111, Section 150A. 3D/2,0 Z.-�o Signature of Applicant Date Permit No. -office of Consumer Affairs S Business Regulation. HOME IMPROVEMENT CONTRACTOR TYPE:,.Individual I tlo Expiration 42802M 05/19/2020 PABLO DB/A CUERVOBt31 I;GiND REMODELING PABLO C.MARTINCLGw -- 49 SMITH ST HYANNIS,MA 02601 Undersecretary ®_ Commonwealth of Massachusetts Division of Professional Licensure Board of Building Regulations and Standards Cons ru-*A% rvisor :S-103617 ,` r+�` �c�pires: 11/17/2021 PABLO C MAkTINEZ r 49 SMITH ST?} { HYANNIS MA'�02 601 , 1S\.110 ' 4 Commissioner --- . _ �'�`� Town of Barnstable Building Department Brian Florence,CBO �. Building Commissioner 200 Main Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using a Builder I,_ (�r� ' ' , ►'-S ,as Owner of the subject property hereby authorize PABLO C.MARTINEZ to act on my behalf,in all matters relative to work authorized by this building permit. 133 OLD TOWN ROAD HYANNIS,MA 02601 (Address of Job) Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted. (2 , % C &A662 Si afore of Owner Signature of Applicant 1�VigrYSu — PABLO C.MARTINEZ Print Name Print Name _1 3e 20 Date r -Commonwealth of Massachusetts (� Sheet Metal Permit Map Parcel _ Q 1 a� (�[�RMly Permit V S "'� Date: �f �+ Estimated Job Cost: $ f i. Q g 2015 Pe—m tYee: O J Plans Submitted: YES 1- BARNSTABWa s Reviewed: YES NO Business License# Applicant License# DJ Business Information: Property Owner/.Job.,Location.Informalion: Name: il r I — Name: don"D !" l.L Mn�I tn� 0 Street: 1, � d Tow In Street: �3� ® �I D W �cL City/Town: �)(IIAIAIA City/Town: I`t`E O'VA A Cf Telephone: -� L) �� i _ Telephone: 7 �a 3 e Photo I.D.required/Copy of Photo.I.D. attached: YES NO 5� staff Initial /M�1-unrestricted.license I J-2/M-2-restricted to dwellings 3-stories or less and commercial up to 10)000 sq.. L /2-stories or less Residential: 1-2 family Multi-family Condo/Townhouses Other. Commercial:. Office Retail Industrial Educational j i. Fire Dept Approval Institutional_ Other Square Footage: under 10,000.sq. ft. over 10,000 sq. ft. Number of Stories: Sheet metal work to be completed: New Work:� Renovation: HVAC Metal Watershed Roofing. Kitchen Exhaust System i Metal Chimney/Vents Air Balancing Provide detailed descrip IItion of work to be done: a .INSURANCE COVERAGE: I have a current liabiiitv,insurance pa3icy or its equivalent which meets the requirements of M.G:L Ch.112 Yes No ❑ If you have checked YS,:indicate a type of coverage,by checking the appropriate box.below: i - i A liability Insurance policy Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:1 am:aware that the licensee does not have the insurance coverage required by Chapter 112 of the Massachusetts General Laws,and that my:signature on this permif applicatiorr.waives this..requirement iCheck One Only Owner ❑ Agent ❑ I Signature of Owner or'Owner-s Agent i . I By checking this.box❑,i hereby certify that all of the details and information d have submitted(or entered)regarding this application are true.and accurate to the best of'my knowledge and.that all sheet metal work and instaitations_performed under the permit issued for this.application will be In compliance with all pertinent provision of the Massachusetts Building Code and Chapter 112 of the General Laws. Duct inspection required prior to insulation installation:YES NO ProLress Inspections I Date Comments Final Inspection Date Comments i Type of License: 3y ❑ Master rifle ❑Master-Restricted 'itylTown RLJoumeyperso'n . Signature of Licensee �ecmit.# ❑Journeyperson-Restricted License:NurTiber:. =ee$ 0 Check at www.mass.g0V/dnl nspector Signature of Permit Approval Client#:21832 2AIRRI DATE(MM/DD/YYYY) ACORDTM CERTIFICATE OF LIABILITY INSURANCE 04/(MMIDD 5 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 CONTACT NAME: Dowling&O'Neil PHONE 508 775-1620 5087781218 A/C No Ext: A/C,No Insurance Agency -(A/C, E-MAIL ADDRESS: 973 6yannough Rd., PO Box 1990 INSURER(S)AFFORDING COVERAGE NAIC# Hyannis,MA 02601 INSURER A:National Grange Mutual Insuranc INSURED INSURER B: Air Rite HVAC Inc. 133,0Id:;T.own.Road - INSURER C "`Hyannis�'MAa0260� `INSURER'D: 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 CONTRACTOR 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INS WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY, MPT8454A 4/13/2015 04/13/201 -EACH p�OECCCUR��RENCE $1 000,000 TD X COMMERCIAL GENERAL LIABILITY PREMISES Ea ocju"..C. $500,000 CLAIMS-MADE I Fwl I OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000- GEN'L AGGREGATE LIMIT APPLIES PER: ti PRODUCTS-COMP/OP AGG $2,000,000 POLICY JECT LOC - $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $. _ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ i DED RETENTION$ $ A WORKERS COMPENSATION WCT8454A 4/13/2015 04/13/201 X WCSTATU- DTH- AND EMPLOYERS'LIABILITYEg ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $500 000 OFFICERIMEMBER EXCLUDED? � N/A (Mandatory in NH) r E.L.DISEASE-EA EMPLOYEE $500,000 If yes,describe under - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500-000 i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Operations performed by the named insured subject to policy conditions and exclusions. CERTIFICATE HOLDER CANCELLATION Town of Barnstable,BuildingSHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Main Street Hyannis,MA 02601 AUTHORIZED REPRESENTATIVE ,•A,f c ©1988-2010 ACORD CORPORATION.All rights reserved., ACORD 25(2010105). 1•of 1 The ACORD name and logo are registered marks of ACORD #S150177/M150176 MER /3 �. s� Ca���r�a�'?V1Fassrfehrrse �epwhneat ofI4 &i-&Accidents t` ce di `�itFiLVTSS 600 ffis Ifingtom Street Bosfariy,,MA 02HI wN.4rv.rr�uss.ga�ciu2 Work-�ers' CctmpensafionLism-anc tdavrE BudIde3rsfC�on#ra:ctars/]ZlectriciauMum'bers Applicant Please Print Tn y. Name✓ Addre-�� 3 06 roa ,t\ Ra City/Staire/Z-ip: 0,wws IM Pho=4-- -:3� q s a 9 3 �4 1 WAxe otr an employer? eck the ap1wupriate b o-m T of ect (r 4_ I arrta . contractor and I L I am a employer Witt 0 t ❑ 6_ New comsfroc6oa =3ployees{full andlorpart--tisne)-* have birerl.the . 2.❑ I am a sole proprietor or partner- listed on the attached shy 7- ❑Rrmndeling ship and bate no employees These sob-contractors have g- ❑Demolifioa woriing fvr me in arty rapacity employees and have workers- p- ❑Building addition PTO Workers.comp:Trasu=re C6T4p_inSLUWw r I -eq-ired-1 5-❑ We are a corporation and its 10.0 Electrical repairs or additions ❑ I am a homecimer doing all work officers Imam exercised f}iek 1IE Plc mbing repairs or additions . mysem [No worlo='comp- rig4t of eiwaiptionper'MGI. 12�0 Roof repairs an�xsirnrespired I C_152.§1(4? and we):rmmno employees-[NCY worlcrss' 1 -❑Other comp_mcrt mm required-j �t£�y mgfia�that checks box#1=ast also Ell ovt the section beRyw d owing ds'ro&ue co=pemssfi an ppa-i-Emn m �Hamettwnc-is tt�subrst this affdavif ir�rstirg they arx Cluing sIIvrr�c s�Bien mire oairide contactors most sob�a iteta s�d_�t in�g sn1CI1_ ICbnLscmrs thst check ties bmc n=t stiached an additinnil sheet shaming the name of tha mk--ma's zmd Ada vrhEler errant 1hage zmthies have aq&yees_ Ifthe svhcantactotsbsre empIagers,they mast provide tbt'warps'Comp-policy amnher .rani an arng7r�y�x fhatispmtriditrg tt�orkers'calsntinn artsttrruzce far m�T errzpinyaes lleiorr is t3iepalic}•artdob sill zrt;fornraii�� • Insurance CompauyNatne: Policy##or Self-ins Lic-;k Expit ationDate: Job Site Addreszs- CitgFSU 2l p- Witch a copy of the:workers'compensation policy declaration page(showing the policy number and expo Lion date). Failure to secure coverage as regttirednnder Section 25A o€MGL c M can lead to the imposition ofrsiminai penalties of a f me up to$1,500_QO andlor om-yearin3paivonment,as well as civil pemilfies m fhe f-otm of a STOP WORK OR:DEP and a fine ofup to S250_00 a day against the violator_ Be advised that a c-opy of this statement maybe fnxwarded to the Office of Investigations of the DIA for" erage Vedfication_ I&hereby certify R. hug n�&Correct Signature: - Bate: © P"I Phrme�#: 'I 4 J d'•� �� ©,ffucizd use anly. Da trot writes in this area,is be campfetesd by cifjp or tetra a�ciai i • i Y Gift'or Town- PacmitUceuse# Isstriaig r'1`atharity{circle oae}: L 13aard 6f Health 2.Riding Deprartxaent I Cit !Lawa Qerk 4.Electrical Inspector 6.P`-fambing Lector .6.Other ContactPerson: Phone#- 6 - e ]Information and Tnstfuctions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuantto this stag, 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 Iegal representatives of a deceased employer;or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees- However the owner of a dwelImg house having not more than three apartments and who resides therein,or the occupant of the - dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also staffs that"every state or Iocal 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 pray applicant who has not produced acceptable evidence of compliance with the insurance-coverage required." Additionally, MGL chapter 152, §25C(7)states`Nf-,ither 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 insurance requirements of this chapter have been presented to the contracting 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 numbers)along with their certificat4s)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 sbould 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 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 permit/license number which will be used as a reference number. La additioa,an applicant that must submit multiple permit/license applications is 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 aifida-\-it The Office of havesttigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a caIL The Department's address,telephone and fax number. Tho Commo Lwean of Massachusetts Depalt-ent of lndusttlal Accid=ts " office Ofluvestgatims 600 was m ou Street $agtoun MA 02111 Tel.A. 617-727-4900 W 4-06 or 1-3 MA.E�,SAFE Revised 4-24--07 Fax# 617-727-7749 w .mas,.gavMia Y Town of Barnstable .� Regulatory Services MASS' Thomas F.Gefler,Director �a sod Building Division Tom Perry,Bnilding:Commissioner 200 NWn Street,Hyannis,MA 02601. www.town.barnstable:ma.ns Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Section If Using A Builder I; Cal C 641b as Owner of thesubject ro—s ) P -PAY hereby authorize A i .f R f 6 ��y L to act.an my behalf; in.all matters relative.to w.o authorized by this builduzg permit 13 0 -10h �. � (Address of Job) **Pool fences and alarms are the responsibility of the applicant. Pools are not to be filled before fence is installed and pools are not to be utilized.until all fin inspections are performed and acce ted. S 0afore of Owner S' e of Applicant 1 f joNO /V'n otcelo Cnd�.�il��°a Print Name Print Name I o$ 1�15 Date t , Q:FORMS:OVn4WEM.SS10NPOOLS I s. r �CO'MMONWEALTHOFMSSACHI�SE}. `S { • • Tilt, 10 h4ET pL WORK RS } L�}W�qhlG`,�, �1MA I NIEMYP;ERSaQN` , '[R T l ��pq j1 CHUMB15,il I APT f aYOr2�63�2�``,� �r�`�"� 2 y "Mass. Corporations, external master page Page 1 of 2 �61 wnYY-.,gf� T.Y y h Corporations Division Business Entity Summary ID Number: 464243024 Request certificate [New search Summary for: AIR RITE HVAC INC The exact name of the Domestic Profit Corporation: AIR RITE HVAC INC Entity type: Domestic Profit Corporation Identification Number: 464243024 Date of Organization in Massachusetts: 12-06-2013 Last date certain: Current Fiscal Month/Day: 12/31 Previous Fiscal Month/Day: 12/31 The location of the Principal Office: Address: 133 OLD TOWN RD City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The name and address of the Registered Agent: Name: JOAO MARCELO CHUMBINHO Address: 133 OLD TOWN RD City or town, State, Zip code, HYANNIS, MA 02601 USA Country: The Officers and Directors of the Corporation: Title Individual Name Address PRESIDENT JOAO MARCELO CHUMBINHO 133 OLD TOWN RD HYANNIS, MA 02601 USA TREASURER JOAO MARCELO CHUMBINHO 133 OLD TOWN RD HYANNIS, MA 02601 USA SECRETARY GIULIANA R ALMEIDA 133 OLD TOWN RD HYANNIS, MA 02601 USA DIRECTOR JOAO MARCELO CHUMBINHO 133 OLD TOWN RD HYANNIS, MA 02601 USA Business entity stock is publicly traded: ❑ http://corp.sec.state.ma.us/CorpWeb/CorpSearch/CorpSummary.aspx?FEfN=464243024&... 10/8/2015 • TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map V Parcel l Application # C2,�) ISO a Health Division Date Issued 3- ' IT , Conservation Division Application Fee Z.� Planning Dept. Permit Fee J� Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation / Hyannis Project Street Address )33 014 Tows ica Village Owner S a6o , L Addressh1 Telephone '?7` 5a11 Permit Requester}1.�,�, a, 12 rclr' 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 4saporting docurr�ntation. az Dwelling Type: Single Family 6ir' Two Family ❑ Multi-Family (# units) Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's -lighway_�'❑Yrq ❑ No Basement Type: 0 Full ❑ Crawl 0 Walkout ❑ Other rn Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existingnew e w Half: existing new Number of Bedrooms: existing _new Total Roorp 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 14cCarthy Construction Telephone Number PO Box 52 Address West-—De u—n-6, AL 02670 License# Cell (508) 280-6964 C—cL 58633 HIC 169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE I FOR OFFICIAL USE ONLY APPLICATION# DATE ISSUED MAP/PARCELNO. �1 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. r Town of Barnstable ti Regulatory Services Richard V.Scati,Director tea,9. Building Division 'Tom Perry,Building Commissioner 200 Maiu Stieet,Hyarmis,A-k 02601 www.town.barnstable-ma.us Office: 508-862-4038 Fax: 508-790-6230 Property Owner Must Complete and Sign This Scction If use A Builder I, TOUL 0 OmI M 19► R K 0 as(?,rater of the subject prop-ay hcrrhy authorize-..--....► " CLWX4jLj;(j/J to act on my behalf, in all matters relative to work authonzj by this balding permit application for. 13S 014 t," fuALI Ajjft«jj t S . MA 621r&I (address of job) " "Pool fences and alarms are the responsibility of the Lapphcant. Pools are not to be filled or utilized before fence is installed and all final inspections are performed and accepted- -dO o M Chmbinh.(Fe6.1015). Signature of Chvner Signature of Applicant Print?Marne Print Name —� 6 Date Q:FORMS:OI'v?3FRPIrR,41SS10NPOOLS Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Superl isor License: CS-058633 MICHAEL J MCC,;d[R PO BOX 52 °� W DENNIS MA 0267p i C,. •�� Expiration Commissioner 04/10/2016 •.n Office of Consumer Affairs and Business Regulation r` 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 i 0 20M-05/11 'E to ment Lost Card ,/ n �Address Renewal I`� �mpy ❑ .7 r The Commonwealth of Maysachuselts Department oflndustrWAccidents Office of Investigations 600 Washington Street Boston,MA 02111 1VIVIV mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eleetriciammlumbers Applicant Information Please Print Le ' I Mike McCarthy Construction Name(Business/Organization/Individual):_ PO Box 52 Address: West Dennis, MA 02670 City/State/Zip: CSIi G#3 HIC-169393 Are�yxu an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 1 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole propridtor or partner- listed on the attached sheet t 7. ❑Remodeling ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity, workers'comp.insurance. 9. (]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c.i52,§1(4),'and we have no 12.(]R If repairs insurance required.]t employees.[No workers' comp.insurance required.] l 3. er *Any applicant that checks box#1 must also fill out the section below showing their workers'wmpmetion policy iaformadon. t Homeowners vdio submit this affidavit indicating thcy are doing all work and ffim hire outside contractors mast submit a new affidavit indicating such. lContractm that check this box must attached an additional shot showing the name of the sub•contractars and their waikere comp.policy Information. lam an employer that is providing workers'compensar<on insurance for my employees Below is the policy and job site Information. Insurance Company Name: - •77• HA-A Policy#or Selfins.Lic.M. V W1 C. �/csc9-(�d 1�1G Expiration Date: Job Site Address: I (�- '��'� -1 City/State/Zip; t Attach it copy of the workers'compensation polley declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a fire up to$1,500.00 and/or one-yearimprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine i of up to$250.00 it day against the violator. Be advised that a copy of this statement may be forwarded to the Office of i Investigations of the DIA for insurance coverage verification. I do hereby certify r! d e a enallies ofpe4ury that the information provided above is true and correct Si tore• Date: Phone #: Offletal use only. Do not sprite in this area,to be completed by city or town off klaL r City or Town: Permit/Lieense# Issuing Authority(circle one): t 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: -ACDO 07/1 /2014RL> CERTIFICATE OF LIABILITY INSURANCE °A�'M0/2014 `� 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 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 NQAj/►CT Bryden&Sullivan Ins Agcy of Dennis Inc )J8, 0,E,rt: (508)398-6060 ,No.: (508)394-2267 PO Box 1497 d��s{ ss: So Dennis,MA 02660 — IN RER AFFORDING COVERAGE _NAIC# INs RE : A.I.M.Mutual Insurance Company 26158 INSURED INSURER B: Michael McCarthy Construction Inc — — IN URE C: P 0 Box 52 INSURER D: West Dennis,MA 02670 INS RE E: I INSURER F I 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. NO-N ITHSTANDING ANY REOUIREENIENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 1MTH RESPECT TO 1A1diCH 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. ILTR TYPE OF INSURANCE I yP � POLICY NUMBER AM 9A9I1AM LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ PREMISES Ea o rrence _ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ EN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ ]OLICY IEC` I 0C AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea a i nt _ ANY AUTO BODILY INJURY(Per person) $ !ALL OWNED SCHEDULED _AUTOS ( AUTOS BODILY INJURY(Per accident) $ HIREDAUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS accident $ -- UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ p!DDEERDg ply! REEgTpENN�TpIONN $ �yC gT TU TH $ AND EMPLOCYERS€LIABILITY X TORY IIAMITS OER A 990U �/PPE7(y�1WECUTNE YIN E.L.EACH ACCIDENT $ 500,000.00 A o��IC r--uu �Y N/A VWC-100-6017656-2014A 7/17/2014 7/17/2015 (!�Ma�nsddattoorry(in NH) 4t E.L DISEASE-EA EMPLOYEE $ 500,000.00 D 5(:RIP i!ON OF 6PERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Workers Compensation Coverage applies to MA employees only. CERTIFICATE HOLDER CANCELLATION Thielsch 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 T YOU WISH TO OPEN A BUSINESS? ' For Your Information: Business certificates (cost$40.00 for 4 years). A business certificate ONLY REGISTERS YOUR NAME in town (which you must do by M.G.L.-it does not give you permission to operate.) You must first obtain the necessary signatures on this form at 200 Main St., Hyannis. Take the completed form to the Town Clerk's Office, 1 st FI.,367 Main St., Hyannis, MA 02601 (Town Hall) and get the Business Certificate that is required by law. DATE: I Q IDI ' I nn/n� I Fil in please: APPLICANT'S YOUR NAME/S: J /V6 Ul BUSINESS YOUR HOME ADDRESS: - 4 TELEPHONE # Home Telephone Number I NAME`OF CORPORATION:'' NAME OF NEW BUSINESS I TYPE OF BUSINESS IS-THIS A HOME OCCUPATION? t' (� tQG-fD 9r ADDRESS OF BUSINESS-...:-1 - MAP%PARCEL NUMBER b (Assessing) When starting a new business there are several things you must do in order to be in compliance with the rules and regulations of the Town of Barnstable. This form is intended to assist you in obtaining the information you may need. You MUST GO TO 200 Main St. - (corner of Yarmouth Rd. &Main Street) to make sure you have the appropriate permits and licenses required to left"fei6Muy Wp` "0Mt5 )PATION 1. BUILDING COM SSION R'S 0FFI RULES AND REGULATIONS. FAILURE TO This individua ha b n infer f a y - rmi a uirements that pertain tio this type of bu9QKFLY MAY RESULT IN FINES. Auth riz d Si nature COMMEN S: r (404 d a 2. BOARD OF HEA TH This individual has been informed of the permit requirements that pertain to this type of business. Authorized Signature* COMMENTS: I I 3. CONSUMER AFFAIRS (LICENSING AUTHORITY) u. This individual has been informed of the licensing requirements that pertain to this type of business. Authorized Signature* COMMENTS: Town of Barnstable ZFIE Regulatory Services l o Richard V.Scali,Director Building Division rsnxxsr,�sr.E. � - MASS. g Tom Perry,Building Commissioner i639. 10 200 Main.Street,Hyannis,MA 02601 www.town.barnstable.ma.us Office: 508-862-4038 Fax: 508-790-6230 Approved: Fee: Permit#: HOME OCCUPATION REGISTRATION Date: f Name: D10 1" ` . G u 'U_ V� Phone#: 4 Address: 1 0� 1C Village: Y V" I S / �/ I Name of Business: Type of Business: �0^Z t I ���� �2z 1�y\ A Coy Map/Lot: c),(00 INTENT: It is the intent of this section to allow the residents of the Town of Barnstable to operate a home occupation within single family dwellings,subject to the provisions of Section 4-1.4 of the Zoning ordinance,provided that the activity shall not be discernible from outside the dwelling. there shall be no increase in noise or odor;no visual alteration to the premises which would suggest anything other than a residential use;no increase in traffic above normal residential volumes; and no increase in air or groundwater pollution. After registration with the Building Inspector,a customary home occupation shall be permitted as of right subject to the following conditions: • The activity is carried on by the permanent resident of a single family residential dwelling unit,located within that dwelling unit.. • Such use occupies no more than 400 square feet of space. • There are no external alterations to the dwelling which are not customary in residential buildings,and there is no outside evidence of such use. • No traffic will be generated in excess of normal residential volumes. • The use does not involve the production of offensive noise,vibration,smoke,dust or other particular matter, odors,electrical disturbance,heat,glare,humidity or other objectionable effects. • There is no storage or use of toxic or hazardous materials,or flammable or explosive materials,in excess of normal household quantities. • Any need for parking generated by such use shall be met on the same lot containing the Customary Home Occupation,and not within the required front yard. There is no exterior storage or display of materials or equipment. _ - - • There are no commercial vehicles related to the Customary Home Occupation,other than one van or one pick-up truck not to exceed one ton capacity,and one trailer not to exceed 20 feet in length and not to exceed 4 tires;parked on the same lot containing the Customary Home Occupation.. m No sign shall be displayed indicating the Customary Home Occupation: is ® If the Customary Home Occupation is listed or advertised as a business,the street address shall not be included. o No person shall be employed in the Customary Home Occupation who is not apermanent resident of the dwelling unit. I,the undersigned, e with the above restrictions for my home occupation I am registe Applicant: Date: Hnmenr_A . 1' 10R11