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Home My WebLink AboutBLD-20-003406 i oi.•Y.9R uuice use'nuy w • � �! `�O i Permit#� �a1ss�.., O�. `,t kii !Amount [s[c3 101, °""""°��e 1Permit expires 180 days from BU — b�D j issue date EXPRESS BUILDING PERMIT APPLICATION TOWN OF YARMOUTH Yarmouth Building Department 1146 Route 28 CV,41----31 % C South Yarmouth, MA 02664 5 (508) 398-2231 Ext. 1261 p CONSTRUCTION ADDRESS: ,,.�1 �� , F1- • iv^f.,Z ASSESSOR'S INFORMATION: Map: Parcel: OWNER: 14.cL..y (•)h�-C S,,n,4_ (;i'l_ C/ .7— 9 z NAME Mike McCarthy of f NIEss TEL. # CONTRACTOR: PO Box 52 NAMEWest Dennis, MA OZ DRESS TEL.# Cell (508) 280-6964 0 Residential Cs14-133)8403a1 HIC-169393 Est.Cost of Construction$ ' (j c`_ Home Improvement Contractor Lic.# Construction Supervisor Lic.# Workman's Compensation Insurance: (check one) 0 I am the homeowner ❑ I am the sole proprietorave 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: 54 J e-X,O Location of Facility I declare under penalties of perjury that the tat en herein 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 revocati of y I e and for prosecution under M.G.L.Ch.268,Section 1. Applicant's Signature: Date: ) Owners Signature(or attachment) ,A k Vt•.L- Date: Approved By: 4/ .�iv1Ai Date: /G "/7 Building 0 al esinee) L ADDRESS: Zoning District: Historical District: ❑ Yes ❑ No Flood Plain Zone: a Yes D No Water Resource Protection District: Within 100 ft.of Wetlands: 0 Yes 0 No 0 Yes = No 4' (-7 Li0'7 9SG3 RISE "Sc' ENGINEERING' �2- OWNER AUTHORIZATION FORM 1, Richard Bishop (Owner's Name) owner of the property located at: 17 Point of Rocks Road (Property Address) Yarmouthport, MA 02675 (Property Address) 1i hereby authorize ' F (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. 11WL'I.d4 Owner's Signature ) l a Date RISE Engineering, a Division of Thielsch Engineering, Inc. 5 Dupont Avenue I South Yarmouth, MA 02664 1508-568-1926 www.RlSEengineering.com g-4 FO-C1?"-12 -/M-GteCal 4 Office of Consumer Affairs and Business Regulation 1000 Washington Street - Suite 710 Boston, Massachusetts 021 18 Home Improvement Contractor Registration -- Type: Individual Registration: 169393 MICHAEL MCCARTHY Expiration: 06/15/2021 WEST DENNIS,MA 02670 .. _ Update Address and Return Card. SCA 1 0 20M-05/17 .:-.R; . .eit/dgezAiezuf,,Ase/h Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration valid for individual use only TYPE:Individual before the expiration date. If found return to: EiggikkAgit Expiration Office of Consumer Affairs and Business Regulation 41i9a9 ,..-,.., 06/15/2021 1000 Washington Street -Suite 710 Boston,MA.02118f ' /.....- --- MICHAEL MCCARTHYI::-..--.. .,,'' tavi s -- .• ( MICHAEL F.MCCAFWtVC----: • , . /,, ' y t.,' / , , / / 6 RANGLEY LN. ,-• ----. - • ditos4 •i ..; Not val out signature SOUTH DENNIS,MA02660 , Undersecretary 4 n of Professional Lk , • reilleittaid&tardy" Beard of swot:az:a ensure . , .....,7 ,, .one and Standards Consf, iiiipprvi 1 liligfiettly 011141.1110t1011 sor Kw guocillittinitttanaistiles National Fair• .-. i ! c8.058e33 :. 4...- :: ,ore , oftdontaigni Mem .. ! * ' 230 dayetAugast 2011 . ; maw J ,..:. PO acyx2 44....t.:...4- r• ,-- , INE3T omens slik dellr. , lift faillmotilbar. a . orwaroada, rwimarrakt.masa . Nag tillitrabstaiebeasid ' ................................ Cont . Lopmt,............ , ....• . . - . .. . ..,_ • ._ :. - --. . . '• _ . , .., :,.. . , _ ,: . _ . . •w::.---,- . -:,.,... ..- -.....,,:.. ..,::. _ . - .....,,. . ... OS 001558712 . • : - . -. -. - - , ....r_;.7-4 ..,.,--wr i, , _:,_ HA . ,. : - ligilahnitigite" U.S.Oessimeni of Labor :• ,,,± , ... - - toCc (Vet Cgt 1*Oka : ..; OccuPadoneRifety rind Hem Asticin . :---; e.. litattiffireAgregL. 4-' ' '" Michael McCarthy - . : : .- •• , ..1.--7-----7- ' : :' = Theienceeisou-, ,lOhour Ocipeirc . : .,-..;" Pihaeketakesuseeesehmionfaimm- e• • - .:. . _,.:-.:, ,._,,.- ___:...-.-'.7 : ..' .-, ' ..:• - .,.,ipiayir- ,.,... • .. ,..4‘,:.d.;., - ,., i....,............jay......_ ::. • • The Commonwealth of Massachusetts • u r-!! Department oflndustrialAccidents ' —1741�- 1 Congress Street,Suite 100 _1r:7= • 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 Legibly Name.(Business/Organization/Individual): Michael McCarthy. Address: PO Box 52 City/State/Zip: WeM D i0 l b�— —-- --- -- one • Are you an employer?Cheek the appropriate box: Type of project(required): 1.01 am a employer with ' . employees(full and/or part-time).* 7. ❑New construction 2.1:1 I am a sole proprietor of partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.]. . • 3.0I am a homeowner doing all work myself.[No worker'comp.insurance required]t 9. 0 Demolition 4.01 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition • • ensure that all contractors either have workers'compensation insurance or are sole 11.Q Electrical repairs or additions proprietors with no employees. 12.0 Plumbing repairs or additions 5.0 I am 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.t • 6.Q We are a corporation and its officers have exercised their right of exemption per MGL a14.126ther 152,11(4),and we have no employees.[No workers'comp.insurance required.] . 'Any applicant that checks box O1 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. :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-conracton have employees,they must provide their workers'comp.policy number. I am an employer that Is provldingworkers'compensation insurance for my employees. Below is the policy and fob site information: Insurance Company Name: Aic..'r t'on...1 Li cJi i 4/ + i"►Wit. -r S• Policy#or Self-ins.Lic.#: Expiration Date: 1'?-)1 S'I? Job Site Address: 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 MGL c.152,§25A is a criminal violation punishable bya 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certlfy and e j 'enalties of perjury that the information provided above is true and correct: Signature: Date: )Is4 s F Phone#: @.•0ao-C1C9 Official use only. Do not ivrite in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): • 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: d .11, , TOWN OF YARMOUTH Building Department BUILDING (508) 398-2231 ext.1261 0 ' ,`' 9 PERMIT NO :BLD-20 003406 PERMIT ., Ott. 9 ISSUE DATE 12/16/2019 JOB WEATHER CARD APPLICANT MICHAEL J McCARTHY PERMIT TO : New AT(LOCATION) 17 POINT OF ROCKS RD,YARMOUTH,MA 0267 ZONING DISTRICT FR 0-1j Bldg.Type: Residential SUBDIVISION MAP BLOCK LOT 125.121.1 § BUILDING IS TO BE: CONST TYPE 1V-E USE GROUP R-3 REMARKS Repair-Install Insulation(508-280-6964) CONTRACTOR I LICENSE [CS-058633 I 4 ` I [Construction Supervisor !I MICHAEL J MCCARTHY s IMMICHAELMcARTHY.. a s_ _ € West Dennis,MA 02670 AREA(SQ FT) 12631,844,7211 EST COST($) ~[1600.00 PERMIT FEE($) 135.00 3 -°-° OWNER [BISHOP RICHARD A I ___ BUILDING DEPT BY ADDRESS L17 POINT OF ROCKS RD _ _ .•_ _ YOUTH PORT MA 02675-2077FiONE THIS PERMIT CONVEYS NO RIGHT TO OCCUPY ANY STREET, ALLEY OR SIDEW OR NY PART THEREOF, EITHER TEMPORARILY OR PERMANENTLY. ENCROACHMENTS ON PUBLIC PROPERTY, NOT SPECIFICALL PERMITTED UNDER THE BUILDING CODE, MUST BE APPROVED BY THE JURISDICTION. STREET OR ALLEY GRADES AS WELL AS DEPTH AND LOCATION OF PUBLIC SEWERS MAY BE OBTAINED FROM THE DEPARTMENT OF PUBLIC WORKS. THE ISSUANCE OF THIS PERMIT DOES NOT RELEASE THE APPLICANT FROM THE CONDITIONS OF ANY APPLICABLE SUBDIVISION RESTRICTIONS. MINIMUM INSPECTIONS REQUIRED FOR ALL APPROVED PLANS MUST BE RETAINED ON WHERE APPLICABLE CONSTRUCTION WORK: 1)FOUNDATIONS OR JOB AND THIS CARD KEPT POSTED UNTIL SEPARATE PERMITS ARE FOOTINGS.2)PRIOR TO COVERING STRUCTURAL FINAL INSPECTION HAS BEEN MADE. REQUIRED FOR ELECTRICAL MEMBERS(READY FOR LATH OR FINISH WHERE A CERTIFICATE OF OCCUPANCY IS PLUMBING/GAS AND COVERING)3)FINAL INSPECTION BEFORE REQUIRED,SUCH BUILDING SHALL NOT BE MECHANICAL INSTALLATIONS. OCCUPIED UNTIL FINAL INSPECTION HAS OCCUPANCY 4)REFER TO DETAILED INSPECTION BEEN MADE. SCHEDULE POST THIS CARD SO IT IS VISIBLE FROM STREET BUILDING INSPECTIONS APPROVALS OTHER: I WORK SHALL NOT PROCEED PERMIT WILL BECOME NULL AND VOID IF INPSECTIONS INDICATED ON THIS CARD UNTIL THE INSPECTOR HAS CONSTRUCTION WORK IS NOT STARTED WITHIN CAN BE ARRANGED FOR BY TELEPHONE APPROVED THE VARIOUS SIX MONTHS OF DATE THE PERMIT IS ISSUED AS OR WRITTEN NOTIFICATION. STAGES OF CONSTRUCTION NOTED ABOVE.