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HomeMy WebLinkAboutBld-20-000149 ce Use Only i? 'YAR;r a D �aoof. !-t O' O _ i. .H 'Amount i rl CS `. Ems,. Permit expires 180 days from := ,; ::''/ issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department ii 1146 Route 28 1 .i ' ' ``I i South Yarmouth, MA 02664 - 7, (508) 398-2231 Ext. 1261 CONSTRUCTION ADDRESS: e Lr--N S c r `/ L L-f )+- ASSESSOR'S INFORMATION: / Map: Parcel: OWNER: Lc.�.. S�I l,_._ 5N,.VL u_-1 -7 7 L— T.) I z NA1vlE Mike Ml > tleastructic�>;: TEL. # CONTRACTOR: PO Box 52 NAME West tigivanseDMAs 02670 TEL.# Cell (508) 280-6964 _ C,Jesidential ❑Commercial.- 111C-1090 of Construction$ jL" Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) ❑ I am the homeowner ❑ I am the sole proprietor LWl have 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 v Old Kings Highway/Historic Dist. ( )Replacing like for like Pool fencing 4-4 *The debris will be disposed of at: '4., l Location of Facility I declare under penalties of perjury that the statements herei cont ' ed 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 my lice a for secution under M.G.L.Ch.268,Section I. Applicant's Signature: Date: 7 Pi Owners Signature(or attachment) , -A-ki.-1 Date: Approved By: ✓ 1G✓_ 1� Date: '"'/. 1 C\ 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 • V• •••••• a •Nr••Y■ •rM UMW,•■ VU3 7)o 772,a mass save Form _ 0 r4%a a,, Site ID: 3816188 Customer: Laura Sullivan I, ,owner of the property located at: (Owner's Name,printed) 27 Merganser 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 building permit to perform insulation and/or weatherization work on my property. Owner's Signatur Date: i 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: Alik. PY2e (670470220tweClid 0 --C/i4ZailaCki-jelti _____ • w L' ....,..... Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston, -----r.--, - usetts 02116 ••• ,,,,,,, Home impro , -., _ :' •, , .r Registration ...... ,:t- ...--, Type: Individual MI ,-.-..—...z - L %wagon: 169393 --Z. • -CHAEL MCCARTHY -,,,.: 4 radon: 08,45/2019 .., P.O.SOX 52 , ., WEST DENNIS,MA 02870 .. ....... .. ,- ,,,,,. • g ....,,,.. 4 Update Address and return card. Mark moon frx change. 3CA 1 0 201A05/11 n Arldnitir ri Manowal n Fmoornant n Lest Card Ab.._ Office4174:fA""nweCensunier Ate11401r811,?EasthalsaCA4dadkragehltElsOulaIlan HOME IMPROVEMENT CONTRACTOR Registration valid for Individual use only TYPE:Individual before the expiration date. If found return to: • ., '.. . ... i " fumy °Moe of Consumer Affairs and Business Regulation , '-T"4 OS/15/2019 10 Path Plan-Suite 8170 Boston,MA 11 CHAEL MC ' -_, :-• : ;,:,-' , G*----e RANGLEY LN. •.i.,,_,___.:•:k-;:. .‘ ' Not valid without signature SOUTH DENNIS,MA wee° Undersecretary _ Commonwealth al ofs Massachusetts I Licensure Michael McCarthy Board of Building Regulations and standards Cons, tr4tOthtvi ti§tIPprVisor NIOCarthy Construction CS-058633 ... Has succesehdly Completed the National Fiber• ',...,,z, , 4,Pires:0411012020 , - ' Cellulose Training Coarse • dip of August 2011 INICHAEL J M'oc 231° .00'y ... • s , WEST DENNIS * •-# - ggif 4 ,e.,,• , .16111e.NMondlAber, . 114111- Mnoderotides NATIONAL FLAIR ernew...41r.......Oodueoprvoli Commissioner ' mg noltentissooddroased %,..ofinillairive ts. ','!:.'..-* '':;. - •••‘?'• • 7 ,,...:1,fr ..:4' ._400A OSHA 001558712 • . .., . 0„„,,,...,,...- Grp&alinalrlaranasset ' •- • , & Ammo. Csinilaftsibaktimssitigiata" .. --' _ ..... ..... .' . .. US.Department of Labor --..: ,. ., Occupational Safety and KWh Administration t: 31266td %604 . Michael McCarthy j„. ;.._. 4,'(' - 4114=epabaseysilidig theAllIting * h.„....... ,.... CATWebie4 iletinsbotiolt Safety ...'`- ,,; - 11 emus emu" TTainIn9-- --vCasw incmPlekid a 11)41aur OccuPalicmalSafetYlind Heenti ,-2 32 au* Thneand 8 bouts afield dine .t -• &ONO+X Health '' : , ,,4, -., ca'0110*4.8.1,kaws ••• 9/9/07 ' ^doL "•--,,---,r ":44.-t_p,,,,.%;...,-.4--,-•,..;..- • • • - The Commonwealth of Massachusetts • -,�k► Qi .Department of Industrial Accidents• • ::�t1= 1 Congress Street,Suite 100 ' ='A Boston,MA 02114-2017 www.mass.gov/dia • Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. • • TO BE FILED WITH THE PERMUTING AUTHORITY. Applicant Information Please PrintLegibly Name{Business/Organization/Individual): Michael McCarthy C Address: PO Box 52 > ni 1VIA — __ --- City/State/Zip: one : • Are you an employer?Check the appropriate box: Type of project(required): 1.1E I am a employer with ', employees(full and/or part-time).* 7. El New construction 2.0 I am a tole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.]• . • 3.01 am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition • • ensure that all contractors either have workers'compensation insurance or aro sole 11.0 Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.0Roof repairs These sub-contractors have employees and have workers'comp.insurance.t • 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.[ then .1.►'N>J 152,§1(4),and we have no employees.[No workers'comp.insurance required.] • *Any applicant that checks box g1 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 anew 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. Iam an employer that is providing workers'compensation insurance for my employees. Below is the policy andjob site Information. 11 Insurance Company Name Aic..'+-t'c„ c.i L.i cJ,�i� + Policy#or Self-ins.Lic.#: V q k/C3-4 3 57 N Expiration Date: I' .1►C)• • I�' Job Site Address: City/State/Zip: Attach a copy of the worlcers'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 punishableby•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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify and t e ins r' enalties of perjury that the information provided above is true and correct Signature: /' Date: 11-)'f t F • Phone#: Sat) -‘f C b Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): • 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Office of Consumer Affairs & Business Regulation - Mass.Gov Page 1 of 2 Mass gov Office of Consumer Affairand s Business Regulation (OCABR HIC Registration Complaints Registration # 169393 Registrant MICHAEL MCCARTHY Name MICHAEL McCARTHY Address 6 RANGLEY LN. City, State Zip SOUTH DENNIS, MA 02660 Expiration Date 06/15/2021 Complaints Details No complaints found for this registrant. You can also view arbitration and Guaranty Fund history. Back To Search Site Policies Contact Us https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=169393 7/10/2019 Office of Consumer Affairs & Business Regulation- Mass.Gov Page 2 of 2 ©2018 Commonwealth of Massachusetts. Mass.Gov® is a registered service mark of the Commonwealth of Massachusetts. https://services.oca.state.ma.us/hic/licdetails.aspx?txtSearchLN=169393 7/10/2019 C&Z''Ec7 UP 4..476.-2) C 7 /.vFp2ins¢-yio"'l) The Commonwealth of Massachusetts _ ._� City\Town of -�,—P-6— YARMOUTH New and Renewal Certificate of Inspection In accordance with 780 CMR, Chapter 1 (The Eighth Edition of the Massachusetts State Building Code)and Chapter 304 of the Acts of 2004(an Act to further enhance fire and life safety),this certificate of inspection is issued to the premise or structure or part thereof as herein identified. Identify Name of Establishment Certificate No. Issued to Business Name:AIDEN DY$E-T ,S' t,' )/fyflstov7bt t BLDCI-20-000049 Trade Name:AIDEN BY BEST WESTERN 1V� Identify property address including street number,name,city or town and county Certificate Expiration Located at 476 ROUTE 28 12/31/2019 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classifications(s) A-2 01st Floor 120 A-2 Nightclub/Restaurant/Bar/Banquet Hall 120 Restaurant/Lobby Allowable 02nd Floor 80 A-2 Nightclub/Restaurant/Bar/Banquet Hall 80 Banquet/Conference Occupant Load Room This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind glass and/or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to pose or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Philip Simonian Ill Name of Municipal Mark Grylls Date of Fire Chief Building Commissioner Inspection Signature of Municipal Signature of Municipal Date of Fire Chief Building Commissioner Issuance Fee:$150.00 B LD_Certofl nspection.rpt The Commonwealth of Massachusetts „ "': r. City\Town of --: .Ef_= p• YARMOUTH New and Renewal Certificate of Inspection Identify Name of Establishment Certificate No. Issued to Business Name: S&H Yarmouth Hotel 13Luc;i-zU-UUUU49 Trade Name:Aidan By Great Western @ Cape Point Identify property address including street number, name, city or town and county Certificate Expiration Located at 476 ROUTE 28 12/31/19 WEST YARMOUTH, MA 02673 Use Group Floor Occupancy Use Group Other Classification A-2 1st Floor 120 A-2 Restaurant/lobby Allowable Occupant Load 2' Floor 80 A-2 Banquet/conference room This certificate of inspection is hereby issued by the undersigned to certify that the premise,structure or portion thereof as herein specified has been inspected for general fire and life safety features. This certificate shall be framed behind glass and\or laminated and posted in a conspicuous place within the space as directed by the undersigned. Failure to post or tampering with the contents of the certificate is strictly prohibited. Name of Municipal Name of Municipal Mark Grylls Date of e1.23-6.- E• 54,„, r Building Commissioner nspection ?- 2•19 Signature of Municipal Signature of Municipal Date of / Building Commissioner Issuance -7_ 3 _ 19 Fee: $150.00 PI rl rarfnffncncrfinn rnt