Loading...
HomeMy WebLinkAboutBLD-19-002756 c Office Ilse Only t1/.-4.'" 'gyp`. 'Permit* e' o g 3 S� - -Lea' H s � ; - Amount -----_h-Cs". 'Permit expires 180 days from --�. issue date 3U>—{c1-Dt r1S• 9 EXPRESS BUILDING PERMIT APPLICA• aC E 1 V E D TOWN OF YARMOUTH Yarmouth Building Department t:0V 06 2016 1146 Route 28 South Yarmouth,MA 02664 Bu ,;E � T I i g x{(508) 398-2231 Ext. 1261 ay:CONSTRUCTION i ' CONSTRUCTION ADDRESS: ) I ) I rot94rs EL\ l tc1) ASSESSOR'S INFORMATION: • 11 Map: Parcel: OWNER C kkikIk_ L.Z. ( 5,-- L 40--Cit -4ft//t NAME Mikellif eAilii gsConstruction TEL # • CONTRACTOR PO Box 52 NAME WS(Deii1IPgisIVIA 02670 TEL if Nfr esidential ❑Commercial Cell (508) 28( 66Construction$ Ie/ce CSL-58633 HI -16 3f9 Home Improvement Contractor Lie.# Construction Supervisor Lie.# Workman's Compensation Insurance: (check one) � ���� 0 I am the homeowner 0 I am the sole proprietor WAnave Worker's Compensation Insurance Insurance Company Name: Worker's Comp.Policy# • WORK TO BE PERFORMED Tent _ Duration (Fire Retardant Certificate attached?) Wood Stove Siding: #of Squares Replacement windows:# Replacement doors: # •Roofing: #of Squares ( )Remove existing*(max.2 layers) Insulation (/ Old Kings Highway/Historic Dist ( )Replacing like for like Pool fencing 'The debris will be disposed of at 91-- J t°<CC Location of Facility I declare under penalties of perjury that the . rents• in .ntained are true and correct to the best of my knowledge and belief. I understand that any false answer(s) will be just cause for denial or revocation of "li .fie:.:o . .secution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: )J!` /is Owners Signature(or attachment) Alle Date: Approved By: Date: I\-6 - 18 Building Official(or designee) EMAIL.ADDRESS: Zoning District Historical District 0 Yes 0 No Flood Plain Zone: 0 Yes 0 No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes 0 No loll � $ r( sly ' r Ys..►N144,��, Permit Authorization Y mass save Forms4. r '6c-d-41r cc — R.- 'o – S7 cell -ZSR- sc-- Site ID: 3420408 Customer: Charlotte Hazell t, ritu Vce l t ,owner of the property located at: (Owner's Name,printed) 119 Traders Lane West Yarmouth, MA 02673 (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a bui i permit to perform Insulation and/or weatherization work on my property. Owner's Signature: (' Date: 7 i .Z FOR OFFICE USE ONLY We have assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date Name: RISE Engineering Phone: 401-784-3700 Email: For Office Use Only Rev.102015 � • ., , _ Ci� aaJacireseh' eix = in ii Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 • Boston, ' assns 02116 • Home improve Tractor Registration TMICHAELMCCARTHY z_ Individual f ., j Registtalloonn: 189393 P.O.BOX 52 :t =4 ` Expiration: OW15f2079 T WEST DENNIS,MA 02670 ?1 , '.J,,r _, G — F,"' yrs=- /4,;.; Update Address;and return card. Mark reason forchange. SCA 1 Q 20M-05/11 -- --- .11 Arlan... r1 Ranewni r1 Emplovm.nt r]Lost Card ego%nenco:meai!/e clOgaaoaakmehS , _ Office of ConaumerARairs 8 Business Repulsion - ',w;v HOME IMPROVEMENT CONTRACTOR Registration va1W for IndMdual use only " s' TYPE:lndMduat before the expiration date. B found return to: �% �W '/0oD t:xnlrseon Office of Consumer Affairs and Business Regulation „ -42E093 , 06/16/2019 10 Park Plaza-Suits 5170 MICHAEL MCCA[{T ,trZ Boston,MA 118 t__ ,ti r 3dir yif11; MICHAEL P MC 4 ' y 4:' Y-CC P-- 0 REY LN. 'Yp, a},. (� Y Not valid without signature SOUTHUTH DENNIS,MA uwoc Undersecretary c. - ,®c Commonwealth of Massachusetts Division of Professional Lkrnsure Michael McCarthy Board of Building Regulations and Standards • MCCarMty ConetnzaHoh Constr{ittl<jrpitCparvisor Has successfully completed the National Fiber^ 1 CS-058633 Cellulose Training Course • .S• J" *Dims:04/10f2020 , 1 2Srd day or August 2011 MICHAEL J MOcAR } u - POBOX 62 , a - - WEST DENNISMAr 0267, +.,. + MMM ember• NF "}��'ti'e_1..`'�' 4 Noe tat rat SSe Nan embessed ATIONAL DOER `^- ^ Commissioner CZ it-- A iron INmeas,....... . . aa+..rar OSHA 001558712 • tisk.. „ crlwlrea.. ae� US.Department of tenor e Oxlpallonel Sagely and Health AdmmNatraaon " t! Wec'e4el t. Michael McCarthy �X`�` r ` b•; "CN°PI,tnslb.LbmNnd J . has suttesslusycomplel.d a to.hc,Ocgpafenal Selly end Hearth 'Ctrs otcL ins MleOkmLoWq,sere i H TaINnp Cousen '. _ Sa ea° oUeyly=1:aflwnofaeldante '- i conslnSafey 8 Heetul anaN awe**iv �' p i ' f . % The Commonwealth of Massae iaseai •i Dnrur<ofinlarsptahlcddalfa n= 1 CorgreasStrrefaSrfd00 — ' Bosom MA02114-2-2017s1 IVWNIaGINa . Workers'Compensation Insurance Midrib m/Plnmbe s. TORE SUED WITH THE PER)HTII NO AUTHORITY. Anna ant iafonuation Henn Print Leeibly Name n flt-l.,..l 11`C.-417 ... . �7 G . f,e Address: ' 9•Ct Gp er S City/$tate2ip: Wc>}- an-..y M 4- 0) 7'-Phone#: rot -)w Cee ti Are yr n miler?Meek/l��p�p�rep�aee ben TWO drilled(required): !thous:Omarwffi kyna(sdlmNaoattasel' 7. 0Nevi caostn 2❑Inest rapelnororpatomddpeodhanm employees within for mek L 0Remodeling • smy suped '.Nle work"`'co*kwm os required.] 9. 0 Daa:olitlm 7QIamaknow=doing drweekmyself[No work&eocd..imam remdred)t• IOOBuilding additiat AnIemabrowner end milt bebides wn_Eon'needed eUworkonmpprapenid y. Iw .acme 1 d mooiaon it have worm.'sempweedm kememe r are sok 110 Sechical repairs or additions ••owlet=wbbmao4loyees. I2.❑Pltnnbingrepairs oradditions 7.]IAmasclera matnomrandIhave Med the su eentremnlimedondmsttadndshat. 13.❑Roofrepairs Then a .am ktraomn bare employme and haw welters'comp.hymned • 6.0 we nexpand= smoked ekright ofexemption perlbae. l4.0Otber 172.II(0.and we have no employma[No wedeln'mom.Stemma e.tpthedl 'Any applomtoetabednhmrel nue elm oacut the motion below show*thelrwarbles'composition W6cykikmetion. t Nettpownan who admit this Oda*bdiattbs they vee doing as work and Nen hire omide eoneamn not aubmb a oar dmdavb indicating eek twist:ton Met cheek thh box mom ansobsd an'Morel miseet Swine the name of the sobmooniotors end we whether'snot6meseathave employes lithe sebomnenaehave employing.dry mist prattle Netr nit.ar mmp.policyrot lamMIemployer dtetkprovldbgworkers'eaegramadonSurma fir a 'n vein Below Is the polity andJob she kil6rotaaee. A ' Insurance Company Name: AAL.--1 L&b, e:.S rel .14-L. Policy#oeself&ina.Lic. t: J 1 W .7.1'75''7 y Exphatim Dec 14-I t ft Ji�ch a copy of the wotlrers' saffen policy declaration page( the pan eapin:don date). • Failure to secure coverage as required under MOL c.152,625A ie :criminal violatbn punishable by afine up to 21,500.0 . and/or one-year imprisonment,as well as civil penalties in the tin of STOP WORSORDERand afine of up to 2250.0a day against the violator.A copy of Ods.Ltement may be tbtttarded to the Office of Investigations of the DIA for ftntaance coverage verification. I do lierebycadyaade ` alPS*+i��I*►aatbnp .WJSdon itSeandcorrect Signature: Mt Date: /Jr/17 plipne# eibt)Ao-C.She( • ' Official we Dais Do not trite In this arm to be:worked bythy orawn offdal City er Town: Perm(t/Ucense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.Clty/fown Clerk 4.Electrical Inspector S.Plumbing Inspector •6.Other Contact Patios: Phone#: • t ' MCCART9 OP ID•TI{ ;`��� CERTIFICATE OF LIABILITY INSURANCE rr D03/01/218 o3rovzo16 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 have ADDITIONAL INSURED provisions or 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 5084984060 22aecT Dennis Office Bryden 8:Sullivan Ins Agency PHONE 5084984060 FAx 508-394-2267 of Dennis Inc. INC No,Ertl: (AIC,No): 485 Route 134,PO Box 1497 ADURhas• So.Dennis,MA 02660 Bryden&Sullivan Insurance INSURERS)AFFORDING COVERAGE MAIC. INSURER A:National Liability&Fire Ins INSURED Michael McCarthy Construction INSURER 6: PO Box 52 West Dennis,MA 02670 INSURER C: INSURER D: INSURER a: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ITR TYPE OF INSURANCE Mp it/815 POLICY NUMBER POLICY EFF MM/DDMOC IMOLICY FF IMM/DO/EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S _ CLAIMS-MADE OCCUR PREMISES(Ea occamaencel $ MED EXP(My one omen) $ PERSONAL ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 5 HPOLICY u Teefl LOC PRODUCTS.COMP/OP AGO S OTHER $ AUTOMOBILE LIABILITY (FO MBcINdenISINGLE LIMIT — ANY AUTO BODILY INJURY(Per Demon) 5 _ AUpTEO�S ONLY _ SCHEDULED AUTOS PBpODILY INJURY(Per ecddent) S AUTOSONLY — AUTOSONLY P(PteOeER14AMAGE S _ UMBRELLA LW _ OCCUR EACH OCCURRENCE S _ EXCESS WB CLAIMS-MADE AGGREGATE S DED RETENTIONS $ AUEPRNNX TTUTE FORµ WORKERS LIABILITY V9WC747574 12/15/2017 12/15/2018 ELEACH ACCIDENT s ANY PROPRIETOR/PARTNER/EXECUTIVE1,000,000 OFFICER/MEMBER EXCLUDED? Y N/A ""e,,atorydescribe M Nlij under E DISEASE•EA EMPLOYEE $ 1,000,000 If adescribe under 1,000,000 DESCRIPTION OF OPERATIONS below E L DISEASE•POLICY I IMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more span Is moulted) Michael McCarthy,President,has opted to exclude himself for Workers Compensation benefits CERTIFICATE HOLDER CANCELLATION CAPELIG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Cape Light Compact Box 427 AUTHORIZED REPRESENTATIVE Barnstable,MA 02630 1 n 0 ) lA ACORD 25(2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD