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HomeMy WebLinkAbout1017 PITCHER'S WAY TOWN OF BARNSTABLE BUILDING PERMIT APPLICATION Map, at Parcel Application # Health Division Date Issued Y 7 —I`t oi' Conservation Division Application Fee Planning Dept. Permit Fee Date Definitive Plan Approved by Planning Board Historic - OKH _ Preservation/ Hyannis Project Street Address �G 1 7 PI,c�sy Village --�T..r„S Owner l�,sQ��` Address Sr1 Telephone ����-a►��IfIS Permit Request f-13 :Square feet: 1 st floor: existing proposed 2nd floor: existing proposed Total new Zoning District Flood Plain Groundwater Overlay N Co Project Valuation Construction Type Lot Size Grandfathered: ❑Yes ❑ No If yes, attach supporting docume l%tion. v, Dwelling Type: Single Family � Two Family ❑ Multi-Family (# units) 7 Age of Existing Structure Historic House: ❑Yes ❑ No On Old King's Highway: E Yes !:q No Basement Type: ❑ Full ❑ Crawl ❑Walkout ❑ Other Y � tl"C7 Basement Finished Area (sq.ft.) Basement Unfinished Area (sq.ft) Number of Baths: Full: existing new Half: existing new Number of Bedrooms: existing —new Total Room Count (not including baths): existing new First Floor Room Count Heat Type and Fuel: ❑ Gas ❑ Oil ❑ Electric ❑ Other Central Air: ❑Yes ❑ No Fireplaces: Existing New Existing wood/coal stove: ❑Yes ❑ No Detached garage: ❑ existing ❑ new size_Pool: ❑ existing ❑ new size _ Barn: ❑ existing ❑ new size_ Attached garage: ❑ existing ❑ new size _Shed: ❑ existing ❑ new size _ Other: Zoning Board of Appeals Authorization ❑ Appeal # Recorded ❑ Commercial ❑Yes ❑ No If yes, site plan review# Current Use Proposed Use APPLICANT INFORMATION (BUILDER OR HOMEOWNER) Name Mike McCarthy Constructiu. i Telephone Number PO Box 52 Address West Dennis, MA 02670 License # Cell (508) 280-6964 CRI.-58633 14TC-169393 Home Improvement Contractor# Email Worker's Compensation # ALL CONSTRUCTION DEBRIS RESULTING FROM THIS PROJECT WILL BE TAKEN TO SIGNATURE DATE yI,I11-1 I FOR OFFICIAL USE ONLY ► APPLICATION# DATE ISSUED MAP/PARCEL NO. . _ � r 1 ' e .*a ADDRESS VILLAGE OWNER DATE OF INSPECTION: I FOUNDATION j FRAME INSULATION FIREPLACE ELECTRICAL: ROUGH FINAL PLUMBING: ROUGH FINAL GAS: ROUGH FINAL FINAL BUILDING r DATE CLOSED OUT 1 ASSOCIATION PLAN NO. The.Commonwealth of Massachuseffs _ Department of IndustrialAccidenis Office of Investigations ` 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Plumbers Applicant Information • .Xlease Print Legibly Mike McCarthyC-OnstrUVILYFURI Name(Business/O nization/Individual): PO Box 52 . West Dennis, MA 02670 Address: Cell(508) 2RO-6964 City/State/Zip: CSY- 863# HIC-169393 Aon re Tarn an employer?Check the appropriate box: Type of project(required): 1. a employer with_ 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. [—]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 workin for me in an capacity. employees and have workers' g Y aP tY• 9. ❑Building addition [No workers'comp.insurance comp.insurance t 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.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees.[No workers' 13.�ther comp.insurance required] *Any applicant that 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 hire outside contractors must submit a new affidavit indicating such. tContractors 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. lam 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.#: Expiration Date: Job Site Address: ��11 (���E;t+-, .; City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL 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 n th airs andpenalties ofperjury that the information provided above is true and correct Signature: Date: `1 I C Lt Phone#: Official use only. Do not write in this area,to be completed by city or town officiaC 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#: Information and Instructions a Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an emplyyee 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;m-mdividuA' partnership;associata6n4 or other legal entity,employing employees. However the owner of a dwelling house having-nof more than three apartments and who resides therein,or the occupant of the dwelling house of another;who employs persons ito'do-aaintenance,construction or repair work on such dwelling house or on the grounds or building:appurtenant tfiereto 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 renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C( )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 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-contractor(s)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 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. In addition,an applicant that must submit multiple permit/licease applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (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 Commonw' ealth of Massachusetts Department of Industrial Accidents Office of layestigations 600 Washington Street. Boston,MA 02111 Tel,#f 17-727-4900 ext 406 or 1-877-MASSAFE Revised 4-24-07 Fax#617-727-7749. WWW.M=.gov/dia CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) -' 10/16/2013 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND, OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s):- PRODUCER 01962-001 i NAME: - Bryden&Sullivan Ins Agcy of Dennis Inc �aLC.ON o.E)t_.(508)398-6060 - - (Fa_No._ (508)394-2267 — PO Box 1497 EMAIL So Dennis,MA•02660 I ADDRESS: _- --------- __ ! -- T-- - !.-_____-_-______,_INSURERL$)AFFORDING COVERAGE '- NAIC# __.-__-__ �I-JLSURER As_-A.LM.Mutual Insurance Company 33758 INSURED INSURER B: Michael McCarthy Construction Inc - - -- - - ------ -- ---- - I INSURER C -_ OsBDennis,MA 02670 i INSURER D We ILINWRER 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 CONDIT!CNS OF SUCH POL!CIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAMS. INSR i.. ... ....... ADDLrSUBR---. ------- ----T POLICY EFF POLICY EXP---- ----...- --- --- -- - LTR' TYPE OF INSURANCE I INSR I WVD I POLICY NUMBER )(MM/DD/Y`YYY MMIDD/=)l LIMITS GENERAL LIABILITY EACH OCCURRENCE L$ - I COMMERCIAL GENERAL LIABILITY ( j I j DAMAGE TO RENTED -I$ ..�.--; ----__� ' I ! .j •PF.REMISESRaoccurrence)---I .-...-- -------.... I CLAIMS-MADE I OCCUR I I' !MED FRCP(Any one person) $ • 'PERSONAL&ADV INJURY' j$ j GENERAL AGGREGATE $ ,GEN'L AGGREGATE LIMIT APPLIES PER: ; ? PRODUCTS-COMP/OP AGG .$ PRO- - j --- ------ -----=--- ----- - ...- POLICY CT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT - $ ANY AUTO I I BODILY INJURY(Per person) '$ - I ---------------- -L------ ---- ALL OWNED I SCHEDULED AUTOS AUTOS I I iBOD ILY INJURY(Per accident);$ j HIRED AUTOS i NON-OWNED j PROPERTY DAMAGE $ F_-- AUTOS j jeer accident) --__-----_ -------___--- UMBRELLA LIAB .j OCCUR I j I TEACH OCCURRENCE $ ' D RETENTION $ 1 EXCESS LIACLAIMS MADE $i i 1 i I AGGREGATE -----I D - W RKERS C MPENSATION � -'---I - -----T-----_- - -,---I j po o X ORY IM TS 1 OT AtJD EMPLOYERS'LIABILITY Y/N I �� -- - 1------- --- - I ANY PROPRIETOR/PARTNER/EXECUTIVEr--I' I E.L.EACH ACCIDENT $ 500,000.00 A j OFFICER/MEM ER EXCLUDED? j Y I N/A j VWC-100-6017656-2013A 7/17/2013 7/17/2014 r---___'-- - - --- ----.-- -- (Mandatory In NH) I - E.L.DISEASE_EA,EMPLOYEE$ 500,000.00 If s describe under j I I E.L.DISEASE-POLICY LIMIT $ 500,000.00 DESCRIPTION OF OPERATIONS below I T T i I I I � I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if 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 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 ht Home Improvement Contractor Registration �0 _ W Registration: 169393 y d� 7 , Tvpe: Individual t, 1 'x�� !� t` Expiration: 6/16/2015 Tr# 238121 `l�� kr� N " yco s c MICHAEL MCCARTHY in Q ° MICHAEL MCCARTHY j'clj �' P.O. BOX 52 , f '�,. N o WEST DENNIS, MA 02670 y ` r Update Address and return card.Mark reason for change. w o o _ Address Renewal Employment Lost Card SCA1 Co20M-OS/11 ��,. �,� .___..g., z Re ulat o _. a � ��e arninaarecuea Gl o�. u��czc accaelG,t e � License or registration valid for mdividul use only (p Q � Office of Consumer Affa►rs&Busy ess g m �.; � - before the expiration date. If found return to: x ":q ° 5 OME IMPROVEMENT CONTRACTOR .. Office of Consumer Affairs and Business Regulation 72. c a egistration: 169393 Type: °. �• a m xpiration:—6/16/2015, Individual 10 Park Plaza-Suite 5170 o Boston,MA 02116 MICHAEL MCCARTHY r MICHAEL MCCARTHYC i - 6 RANGLEY LN. SOUTH DENNIS, MA 02660 Undersecretary Not valid without signature r,V .1 OWNER. AUTHORIZATION HORIZATION FORM (Owner's Name) owner of the property located at (Property Address) (Property 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. r Owners Signa re 0 Mg Date kill � RUCTION CO. sid teal and Commercial Builder g TION SPECIACIS7 r �UAMM CCARTHYC October 21,2014 Town of Barnstable Thomas Perry CBO Building Commissioner 200 Main Stret Hyannis, MA 02601 ZZ Na RE: Insulation Permits s Dear Mr. Perry, 0% This affidavit is to certify that all work completed for permit application#0 at 1017 PITCHER'S WAY 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 TOWN OF BARNSTABLE Permit No. �______''__f ° r Building Inspector � S,urr.sc Cash Yll OCCUPANCY• PERMITBondNo building nor structure shall be erected, and no land, building or structure s used for a new, different, changed, or enlarged use%without a Building Permit therefor first having been obtained from the Building Inspector. No building shall be occupied until a certificate of occupancy has'been issued .by the Building Inspector." Issued to C F Buildem Address Wiring Inspector ✓ _ Inspection .date Plumbing Inspector " � op Inspection date Gas Inspector r Inspection date /Engineering Department Inspection date THIS PERMIT WILL NOT BE VALID, AND THE BUILDING SHALL NOT BE OCCUPIED UNTIL SIGNED BY THE BUILDING INSPECTOR UPON SATISFACTORY COMPLIANCE WITH TOWN REQUIREMENTS. � y -� ,,LL1 ...r 919.%� / , .rr .vz,."�„s�-. �`e;�'.�.'r� .�✓�A�`�J���« .._......... 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Z.+..i.+...` �......�.+.nt..� Assessor'`s"map and lot number ....�� ...T-................. • �OF?NE SeJwaga Permit number 8 ........Z1........,.............:..... �� SEPTIC SYSTEM MUST EIE Z EARESTADLE, i Hquse number � ? .. .. 'INSTALLED IN COMPLIANCE '°o M639 /Gr'................. �0 WITH TITLE 5 �a Mix a y. TOWN OF BARSMOWNIIE®E AND EGULATION a BUILDING ; INSPECTOR APPLICATION FOR PERMIT TO . .....�r...4' ...... ....................................... TYPE OF CONSTRUCTION ............... . { ............./-� TO THE INSPECTOR OF BUILDINGS: p The undersigned hereby applies for a permit according to the following information: Location ....................... ......`.......................s �/.. ......... ................................................ ProposedUse ................. . ........ . ...............................................0 .... ......................... Zoning District ...................../..1....6^.1.............................Fire District ................. .7..�. ..�1'�........................... Name of Owner ......... e ...............Address ........ , .....[9A4 / �// � Nameof Builder ...................� .........................Address ...................................:. ................................................ .Name of Architect ............... 47,t.e...•.........................Address .................................................................................... Number of Rooms ........................ .................... .....Foundation n Exterior ..... .... ....... . ... ..............Roofing .......... .......... - .................... Floors ....... .... .........................................Interior .................................................................................... ............. .. — - - - - - . /�G �� Fieatirg ........� .............:Plumbing ......................1............. ...................................... Fireplace ......................../1. 4: .e ............................Approximate Cost ....................511..����®....I..... Definitive Plan Approved by Planning Board _________/to_(__________19 Area .............. ................... ��� S Diagram of Lot and Building with Dimensions Fee. .......... .. ......... .. ........... SUBJECT TO APPROVAL OF BOARD OF HEALTH �l I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. t/ Name ........... ...C !. ..... .... ......................... .. ` C 6 F. BUILDERS No 2-3l 46"' Permit for ....................................ONE STORY � -----.. \ - / SingIe I7anzilv Dwelling �----^ `.. .. — � -------''~-------~—'' . . . � ocaticin J�qt—#3O—IO.l7—Pi hers Way Hyannis —~--^^-------------'-------' , C � I� Builders - ' Owner -----------------.----.. . ' . . ' . Type of Construction — —_—...----. '�,.--. .................................................................. ^ - ` ^ ' Plot ............................ Lot ................................ ' . May 28, ` 81 Permit Granted ---,--------.`..l9 Date of |nspechon -----.x������^~*lA���� ' . .��� | ' ~ � � - PERMIT REFUSED .----.�� .:`_----.------.. lV . -_. ---------- ...�—.--............... ��.—, .. ' --..��. � . . . .—.--- -----.., —.- _. �.;. .�..'.. . . — —. ...............................................................' .---.... � ' ' . -------.~—.—.-..,—..--,.....---.�. � Approved ^ �� ---------------- 19 ------------'`'—'—''^'---``r--'' . ' ---.---'----------...~—....—.. . Wa �� �«u� - u�v,'�� ^ Assessor's map and lot number ... ......... �FTIIEtO Q �ewage Permit number (.:��.......... ............................ ? • B/ ! f', AHB9TAIfLE, House number ... .............A........................ 1 !... ..:.:... yo 1639 � p i63q. 00 101 YAy a� T OF BARNSTABLE r' BUILDING INSPECTOR p / . APPLICATION FOR PERMIT TO ........ / .!li! ,�f �c,./,.,,....... ! ��/; ' ....................................:.. TYPE OF, CONSTRUCTION //1'/1101 .� ..... ........................................................... TO THE INSPECTOR OF BUILDINGS: The undersigned hereby applies for a permit according to the following information: Location ....................... .T� -... .................. ' �r. .:....... �............... Proposed Use .............................. ............... " X;/ ...................................................................................... m Zoning District ...................... ". .............................Fire District ................ • Name of Owner ...........................................Address Name of Builder .' ........Address .Name of Architect ...................:,.........,......................................Address .................................................................................... lf �Number of Rooms ........................:........................................Foundation Exierior � � A Roofing l-C ........ .... ........... .......................... Floors �.�`l�!� G Interior .......... .. .......7........ .................... ........ ............................ Heatirig g ........................... x . `'.. ...... ............... Fireplace ......................... ��..:.://�... .............................Approximate Cost ................... .................................. `Definitive Plan Approved by Planning Board _________� � _________19,/ Area > . .c' . ............ Diagram of Lot and Building with Dimensions Fee SUBJECT TO APPROVAL OF BOARD OF HEALTH b I hereby agree to conform to all the Rules and Regulations of the Town of Barnstable regarding the above construction. Name ......:T!!.!l�i' ,!.. . z........................... C & F BUILDERS A=272-148 No ..23146 Permit for , One Story .............. ............... Single Family Dwelling ............................................................................... Location „Lot #20 1.017. ...Pitchers. . . ...Way I .. .. .... ..... .... ....... .. .... Hyannis ............................................................................... Owner C & F Builders :: Type of Construction Frame. .................................................. .!.......................... Plot ............................ Lot ........................... I Permit Granted ......iY Y...2.$.r. ........ ....19 81 Lam/ Date of Inspection ........................... ........19 f Cate Completed ........................ .............19 PERMIT R�FIISED 19 ............................................................................... ................................................................................ t • ........................... ....................... .. ........................ . ................ Approved .......................�.... ..�.... ........... 19 ............................................................................... ...............................................................................