HomeMy WebLinkAboutBLD-19-003970 .OF YAR ice Se y
A',.- Permite
3 C Amount 3
- e ii.h Permit expires 180 days from
issue date
B' 3-i/1-//(1397
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EXPRESS BUILDING-PERMIT APPLICA 'ION C E V ( 1
TOWN OF YARMOUTH
Yarmouth Building Department AN 03 2111Q
1146 Route 28 E
South Yarmouth, MA 02664 n t 1Ii_WVi--7-1,
(508) 398-2231 Ext. 1261 ' —�rli ~ D
CONSTRUCTION ADDRESS: 2— Al Str (JL t,,,.1/4,)--
ASSESSOR'S INFORMATION: •
- _.. /'- Map: Parcel:
OWNER: f )ev-_/D.i h, __S.k A L SAC -50 _-37/3
ME
AMike Metaganhygstruttion TEL #
CONTRACTOR: PO Box 52
est 02670
NAME W Cell(5(18) 280aSa-69
TEL.#
CUCesidential
0 Commerci(h5L-58633 HTC-160393t of Construction$ J'gtC
Home Improvement Contractor Lic.# Construction Supervisor Lic.#
• I
Workman's Compensation Insurance: (check one) -
❑ I am the homeowner 0 I am the sole proprietor crilcave 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 Cier e7<5 o
Location of Facility
I declare under penalties of perjury that s - ements t-rein contained 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 revoca±./..✓ e. e and for prosecution under M.G.L.Ch.268,Section 1.
Applicant's Signature: -},� Date: 1 Bill
Owners Signature(or attachment) Atte Date:
Approved By: �Z, �� Date: /-3 /7
Building ci r designee) EN DRESS:
Zoning District:
Historical District: ❑ 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
g1r3vL 3 43
3 44 Permit Authorization F'e, _ 23-p —t-I5-bs c�
A Y` I`
mass save Form
Site ID: 3559057 Customer: Cynthia Lockwood
I �1f
I, CcpsJhi0 Lockwood 964 Gero.A,dtrw. (44rruT-i..ownerofthe property located at:
(Owner's Name,printed)
2 Alden Road West Yarmouth, MA 02673
(Property Street Address) - . ._ _ - (CM)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property. ����aaaa ,�p �,n
Owner's Signature: �.r n.`-i�.et- dcs 00
Date: / / a/if
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:
Page 1 of 1 For Office Use Only
Rev.102015
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Q2ie (pt ea i a/atassachetsell
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Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston, usetts 02116
Home improvetn tractor Registration
r".— .Type: . Individual
MICHAELMCCARTHY ..••• �,A • i Registration: 189393
P.O.BOX 52 • Expiration: 06/15/2019
WEST DENNIS.MA 02670 3
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Update Address and return card. Mark reason for change.' ...
e CAI 0 20M-05/II
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—'--'---- _..._.f1 Arieln m 11 Rrinnwel r'1 Fmelevment I/LastCard
Cine' .nmonweail/r ri6&araadEaeelt2
Office of CpnsumerAtldn&Business Regulation -
-' HOME IMPROVEMENT'CONTRACTOR Registration valid for Individual use only
al TYPE:lndMduel beton the expiration date. If found return to:
1 O EERImtl0.0 Office of Consumer Affairs and Business Regulation
a]89.993 06/16/2019 10 Park Plus-Butte 6170
MICHAEL MCCART- Y. '3: Boston,MA 110
t4 ib
a lit R. •
aRANGMICHAEL F M . 612-Cast---
SOUTH DENNIS,MA. 02880 Undersecretary Not valid without signature
� . Co; nonwaaith of Massachusetts
P.
Division of Professional Lk:ensure
if
Michael McCarthy Board f Building Regulations and Standards
McCarthy Construction ConstrylC}1dd"r$yrvisor
t CS-058833
Has sutxsssfully Completed the National FBter^ 4 fres:04/10/2020 .
Cellulose Training Course I -17 - y4. 71
23'dday ofAugust 2011 • • • MI HAEsi MCCAR
sox op
WEST DENNIS MA,02870f - ‘i".. i
eee.e>.ares.• WI r>!L =r ik-
• MISOrereals NATIONAL Plasm
Ned wed ml6ne beatM ..--`^ Commissioner Col-
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Lon ll ll,eew.o.. -.
OSHA 001558712 . ac..ac. eee..essars, ? ;.
U.S.Department of Labor
r C�list.emiewceem( erteranw : . F.
OxWetionaraaley and Health Administration - ' .. ,' .. , '?
aeC-XeesT -;
Michael McCarthy A. 1:..c.:?;�
ria 7i CtT �Naaa r
nes alw.sarwyoompel.deto+w,roxwaliow relay o.a rla.nq ^'�l4'a.saagA„y,laam�saoa safety
TnMng Caren' ae eaara otckel Caatae 7'
JSafetyd Health 7Lmaodeeoanofaefdllme .
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9/9/07 •; iw �.._ ;l . arm ._
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S The Commonwealth ofMassachasetis
I. ===pr Deptafaundofl»dxatrlablceldents
n_—JJ 1 CotgrrasSYtret�Suite 100
"'_!' Boston,MA0111 1017
•
Workers'Compensation Imannp�
TO BE FILED WITHTHE PERSSITI1NO AUTHORITY.
dpBaatInformation Please Print Ledidv
Name tilieLcI li`(..filr C• . 1,.. re,c
Address: ' 9•0- Ber C-2-
City/tate/Zip:
1.City/State/Zip: wc'?- an•.., /I/- 42)-c7`phone#: rot -)lo -Crccr
AreyweasapkyerOmsk:6yrepe see Type*fFbled( ):
Idiomamployrrkb S . yar(M1wdpa
orademl• _ _ 7. QNew comhuctlon
x❑Ieear*modestorpekimhbaodbewmemployeeswmkdptbrmtla S. ❑Remodeling .
Is
any eupadq.(Ho workers'leap.Mom curd..] eD
❑p, molitiDemolitionr.QtnesbooammrSakiallat dt[No mbar tom Sa remdrod]t
' I• U Building addition
{.❑1 enboomoaaredwin S laioj emtrrmn u amaema0 mak ea my property.Iwm
mom sorts0amkmmSaw kavaunites'caommraaimarso stamsots 11.0 ElectrIcal repairs or additions
provisos with co emptsyset 12.0 Plumbing repairs or additions
s.Itin areal omaammand Ihawkkedthe saSo notongoodanthesaarindohm. 13.❑Roofrepairs
This adtamkeoroa kava etployps and kae works'mop.Snood .
6.❑WemamperaQmrod its ofaabanerer eddetrdahtofamnpimprkdar. . 14.❑Othe
172,ft(p,ed vs boss m eploymm(No mime comp.Imam mpdfd l
Samoa .
Tendow the checks toot 6 � i
ut sbmtasauk bedk Sy an�OswhedSoemahmnaarmmost Sone meAMU k mak
bet.ter.StSok this burnout lashed a addlami shootahoaheaam come ofthe ebeammmawd stabs maim sot Then sash Nve
eophye .. Mhosobcatsrmtr have eployer.6ey mit psovWe their mime amm pmiay oomS
lemtut empigerthat IsprovMgworker?compensation hmooroefee a4 explopes. Bawls the poligsaga she
bdirnmaiote
Insurance Company Name: ti- .-i 1-4-6,Piy, c.- I7.
Policy#or Sdi=mu Lie.4: Ji vJ .7-1-75-7 v Expiration Dale: It Ifs-I t e
Job Site Address. :
Attach a copy of the worker's'cempoaWllei policy declaration page(showing the poSej amber and expiration date).
Failure to secure coverage as req*ed under MEN.c.IS2,623A la a criminal violation punishable by a fine up to 51,500.00
and/or one-year Imprisonment,es well as civil penalties in the lbrm of a STOP WORKORDERS a fine of up to$250.00 a
day against the violator.A copy of this stakematmay be forwarded to the Office of Investigations of the DIA ibr insurance
coverage veriflcatiasa
rtehereby c.s f ander rojperjorytheikeIgbranaonprofiled*boreIstrusaoteoned
Signature:
Dale: 11>h,
rani It:. est)*-C Mel •
Official ase only. Do not write bt tits tomb be completra(bydN otown of&!sL
City or Town: Permit/License# .
Issuing Authority(circle one):
1.Bodrd of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
.6.Other
Contact Person: Phone#:
r
%� MCCART9 OP ID:TN,
A COREY
CERTIFICATE OF LIABILITY INSURANCE DATE(MM/ODIYYYY)
•
03/01/2018
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 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 508-398-6060 gACT Dennis Office _
Bryden&Sullivan ins Agency PHONE 508-398-6060FAX 508.394-2267
of Dennis Inc. (AIC,N0,Exth I INC,No):
So.48Dennis,M134A 02660 1497 least
Bryden&Sullivan Insurance INSURER/SI AFFORDING COVERAGE NAICI
INSURER A:National Liability&Fire ins
INSURED Michael McCarthy Construction INSURER e:
PO Box 62
West Dennis,MA 02670 INSURER C:
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 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.
jNS TYPE OF INSURANCE ADOL SUBR POLICY EFF POLICY EXP
INSD yWVD POLICY NUMBER IMWDD/YYYYI IMWDD/YYYWI than
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLANS-MADE-MADEn OCCUR PREMISETSIOEsRENTED
ncel $
—
MED EXP(Any one venom $
—
PERSONAL d ADV INJURY $
''—GGEEEN'L AGGREGATE LIMIT.APPP S PER: GENERAL AGGREGATE $
RPOLICY u JES5 U LOC PRODUCTS-COMP/OP AGO $
OTHER $
AUTOMOBILE LABILITY /Es IaccN
egifl E LIMB $
— ANY AUTO BODILY INJURY/Per Person) $
_ AUgT�OS ONLY _ AUUTNOSSy�,�.�Dp pBODILY INJURY(Per ecddentl $
_ AUTOS ONLY _ AUTOS ONLY (Petit eCwR' t) GE
$ _
- $
— UMBRELLA UAB _ OCCUR EACH OCCURRENCE $
EXCESS LAB CLANS-MADE AGGREGATE $
DED RETENTIONS S
A ANDREMPLOL ERS'UABI�LITY N X STATUTE FRTM
ANYPROPRIETOR/PARTNER/EXECLfiVE V9WC747574 12115/2017 12/15/2018 Ey EACH ACCIDENT $ 1,000,000
OFFICER/MEMBER EXCLUDED? Y N/A
(Mandatory In NH) E,L.DISEASE-EA EMPLOYEES 1,000,000
rye.describe under
DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY I IMR S 1,000,000
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remade Schedule,may be attached Ifmore space Is required)
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
1 v
ACORD 25(2016/03) 01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
MMCCARTHY CONSTRUCTION CO.
MMC Date:t/r1 I/
mjmccarthyconst@gnail.
corn Building Commissioner
Building Department
PO Box 52 T �2,�
°`"�"� of •1v`J
West Dennis,Ma �'Lfl' 11 — O°3cj -4-6
02670
To whom it may concern,
This affidavit is to certify that all work completed for Permit
Location: Z Pr l 0 ex) Q.p U,s Y`i,om O LI
Has been inspected by a certified Building Performance Institute(BPI)inspector. All
work performed meets or exceed Federal and State requirements.
Sincerely yo rs;
i
//
Michael McCarthy
RECEIVED
SEP , 4 2019
BUILDING DEPARTMENT
BY —